 Traffic! Hey everybody, Dr. O here. Welcome to chapter nine on weight management. So overweight, obesity, and underweight. So we've talked about some of this in the last chapter, like how we classify overweight versus obese. And we'll definitely look at underweight as well. So, you know, less than 2% of Americans are underweight and 2 thirds or more are overweight or obese. So we'll probably focus more on that half of the equation. Okay, so let's start with the icebreaker. Does a normal body weight mean good health? What are the factors that influence our overall health? How can we improve our overall health and support a reasonable body weight? So back to the beginning, does a normal body weight mean good health? I mean, no, right there. We talked about this in the last chapter, but there you could look at, you know, six, they've done this in studies, you know, look at six different people that are the same height and same weight, meaning they have the same BMI. But their body weight percentages are wickedly different. Or you could look at two people that have the same weight and the same body fat, but one of them is carrying that weight in that pear shape right below the waist and the other is carrying that more dangerous central adiposity, that central obesity that's full of visceral fat. So one of them has disease risk that the other one doesn't. And then there are people that are metabolically healthy obese that are quite overweight, but most of the fat in their body is subcutaneous fat or fat in these safer, lower risk places and they don't have any disease risk. They don't have hypertension, they don't have high cholesterol, et cetera, et cetera. So someone that has a normal body weight can certainly be very unhealthy and someone that's overweight can be metabolically healthy. What are the factors that influence our overall health? I mean, those are countless, but obviously diet and lifestyle are the big ones. So we obviously talk a lot about diet in nutrition class, but stress management and stress reduction and mindfulness and gratitude and sleep, these are all things that impact health as well. That's, and one of the cool things about physical activity is if you become more physically active, even without exercise, you can see improvements in health even without changes in body weight. So if someone is overweight and wants to lose weight, of course that's the goal, but if you make some healthy changes like getting more physically active and adding exercise, you will see health benefits before you see any weight loss. It's pretty amazing. All right, how can we improve our overall health and support a reasonable body weight? So we've looked at a lot of those factors, but it's usually a combination of diet and lifestyle being exercise, physical activity, stress reduction, sleep, all of those being important hydration. So we'll look at a lot of those factors and we've talked about quite a few of them throughout the weeks already. All right, lots and lots of good stuff here. So let's look at our learning objectives. So the first one, describe how body fat develops and why it can be difficult to maintain weight gains and losses. So we'll look at how your body has a set point or a settling point and it likes to fight changes, right? Your body likes to maintain homeostasis, changes rarely good to the human body. So your body sees weight loss or weight gain as a problem potentially and we'll see how it fights those two changes. Now, sadly, the human body is much better at fighting weight loss than it is weight gain and we can talk about why that is. We'll also talk about when new body fat develops, there's a huge difference between fat cells getting bigger and getting more fat cells. So we'll come back to that. Review some of the causes of obesity. Obviously you've got the energy in, is greater than energy out, calories in, greater in calories out, but we can look at why those, the two sides of that scale can be unbalanced. Discuss the physical, social and psychological consequences of overweight and obesity. Lot to impact there. Explain the risks and benefits, if any, of aggressive ways to treat obesity. So we'll look at really aggressive ways like medication and surgery and those kinds of things and when they make sense and when they don't. Outline reasonable strategies for achieving and maintaining a healthy body weight, which, you know, about 70% of Americans need that information so that'll be good. And summarize strategies for gaining weight for the less than 2% or so of Americans or people that are listening to this that are underweight. So, you know, personally I've lost a ton of weight. So I've got a lot of experience here. I know what it's like to be obese and I know what it's like to lose weight. I know what it's like to maintain weight loss. I'm still, like this summer, I'm focusing on actually adding a few pounds of muscle. So for the first time in my life, I'm trying to gain weight. But then at the end of the summer, you know, when I'm recording this anyways, at the end of the summer, I will go and aggressively try to lose some more weight. So I've used all the advice that I'm going to offer here in this chapter. And I know a lot about the behavioral change that's really needed to lose weight because that's the main reason that temporary things like diet and exercise changes don't succeed over the long term is there's no true behavioral change that comes along with it. All right, let's dive in. So overweight and obesity. So here you see the map of the United States and the comparison of 2011 to 2018 as far as the percent of people in the United States that are overweight or obese. It is now estimated to be 70% of US adults are overweight and obese. And you can see by the map there that Midwest and the Southeast is where you see a higher percentage of it. But notice there are zero states where there are less than 20% of people that are overweight or that are not overweight or obese. It is also a growing concern worldwide. You see here 1.9 billion adults and 41 million children worldwide are overweight or obese. We've now reached a point where basically there are more people overweight and obese than there are that are malnourished and underweight. So you're seeing this as a much more global issue. It isn't just an issue in developed nations like the United States. It's becoming an issue everywhere. And that's kind of seems like a paradox. They actually call it the obesity paradox. How could people be overweight and obese in places where it's hard to find food? Well, the reality is that obesity and malnutrition and obesity and poverty are linked because if you don't have a lot of money to spend on food then you buy food based on cost. And cheap food is generally full of calories and sugar and highly processed and refined carbohydrates and fats but not full of vitamins and minerals and fiber and protein and nutrition. So people are, when cost is the number one concern when you buy food, you're generally gonna buy very fattening food. So you can be struggling to find enough nutrition. You can be malnourished and overfed at the same time because of the fact that most cheap food is more fattening than a lot of your healthy foods. So, all right, and we can talk about that more, I guess, but I think that makes sense, right? You can go buy something off the dollar menu at a fast food place that's not gonna be very good for you but how much broccoli are you gonna get for a dollar, right? Or how much wild caught salmon are you gonna get for a dollar? Prevalence continues to increase across all ages, ages, races and education levels. I mean, this is truly a problem for everyone now. All right, fat cells, this is a very important point. So fat cells are capable of increasing their size by 20 fold and their number by several thousand fold. So I'll read what it says here and then kind of talk about a little more. So during growth, fat cells increase in numbers, like as you're growing, as you're going through growth spurts, then you're gonna get more fat cells. When energy intake exceeds expenditure, your fat cells increase in size, that's caused called fat cell hypertrophy. So your fat cells can swell up, like it says there, they can get 20 times bigger. A fat cell or a dipocyte is basically like a ring, looks kind of like a wedding ring with the nucleus off to one side, maybe like the diamond and they just, fat just gets dumped into these cells and it swells and swells and swells. But the higher your energy intake or the higher the excess energy that you're consuming, if your fat cells can't fill fast enough, then the next thing happens. So when fat cells have enlarged and energy intake continues to exceed energy expenditure, fat cells may increase in number again. That's called fat cell hyperplasia. So hypertrophy or hypertrophy is when fat cells get bigger. Hyperplasia is when you see an increase in number and this is way worse, right? It's one thing for a fat cell to swell up and then to shrink as you gain and lose fat. But fat cell hyperplasia is a pretty big problem for long-term weight loss success because this last point, with fat loss, the fat cells shrink in size but not in number. So you probably will never lose those fat cells. If you do, we're talking about a decade or longer for them to be broken down and not replaced. So once you have a fat cell, let's just assume you have it forever. The problem is one of the signals, so leptin is this critically important hormone we'll talk about later, that tells your brain, it's like a fuel gauge. If your leptin levels are low, your brain thinks that you don't have enough body fat and you need to be eating and you need to stop moving. If your leptin levels are high, your brain knows you have more than enough stored energy, your fuel tank is full, so you don't need to be eating as much and you can keep moving. So leptin is a very important signaling molecule. The problem is, so fat cells do secrete leptin. So fat cells are endocrine organs and they do tell your brain how much fat you have. This can be dysregulated, but one of the big issues, let's say you gained 50 pounds and during that process, you increase the number of fat cells you have. Then you lost 50 pounds. Well, so your fat cells are smaller and a fat cell that is full will release more leptin than a fat cell that's not. So now you have more fat cells and they're not as full as they could be. So they're not gonna send as strong of a signal to the brain that you should stop eating because there's room. They're like, hey, our gas tank is only half full, we're fine, we still have half a tank of gas, but hey, let's fill this back up. So you will actually, for the rest of your life, you will have less leptin signaling to the brain because you have more fat cells that are partially full. Instead of a lower number of fat cells that are full, you now have more fat cells. So a fat cell growing and shrinking, that can, that certainly, I mean, it's hard to keep weight off after you've lost it, but it is harder if you've increased the number of fat cells that you have. So that's why I wanted to talk about fat cell hypertrophy versus hyperplasia. So it's too late to go back, right? You know, they say the best time to start was 20 years ago, the second best time is now. You have the number of fat cells that you have, but moving forward, if you keep yourself from increasing the number of fat cells you have on your body, the easier it will be to maintain your weight or to maintain weight loss in the future. So how do you do that? Just again, the more rapidly you're gaining weight, the more rapidly your body would start to add fat cells. And everyone has a different like genetic limit. This is why some people can be way overweight and still metabolically healthy because their fat cells can handle the amount of fat that they have. It's mainly subcutaneous fat, but they're doing pretty good, right? Once your fat cells are full and the excess nutrition is spilling into your bloodstream, that's when you see things like high cholesterol, high triglycerides in your blood, fatty liver disease, these kind of things. So there are, so if your body can handle storing more fat, then you're probably more metabolically healthy. This is why some people, and especially people from certain, genetically people from certain parts of the world, even at much lower weights, they start to see things like high triglycerides and fatty liver disease because they just don't have the genetic limit to store fat that other people do. All right, so that's kind of fat cell hypertrophy versus hyperplasia and it is important. But back to that, just to remind you that one key point, this is one of the main reasons that it's hard to maintain weight loss. And that's why if you weigh 250 pounds and you lose 100 pounds and now weigh 150 pounds, you're not the same as a person that's always weighed 150 pounds, right? You will be hungrier than them because you'll have more fat cells that aren't as full as theirs. Your leptin levels will be lower than theirs, et cetera, et cetera, right? It is hard work to maintain weight loss and it's much harder to be a formerly 250 pound person that now weighs 150 pounds than it is someone that's always weighed 150 pounds. So sad but true. All right, I mean, I've lost tons of weight. I will have to work harder to maintain the body weight that I have than someone else that's been my body weight forever. That's, it's the reality, but it's the battle that I'm willing to fight. All right, reflection number one, fill in the correct answer so you can pause this if you want to before I go on. But fat is stored in adipose tissue. So we'll talk about the different types of adipose tissue in just a little bit. But adipose tissue is fat tissue and the cells that make up your fat tissue are called adipocytes. The number and size of fat cells increases when energy balance is positive. And that increase in size is a problem because you're gaining fat, but the increase in number is the real problem. As fat cells enlarge, they stimulate cell proliferation, meaning the number of cells increases that's that fat cell hyperplasia I mentioned. If energy balance becomes negative, the number of fat cells remains the same. So like I mentioned, you probably don't lose them at all. If you do, it appears to take at least 10 years to lose these extra fat cells that you would have gained. So fat is stored when, excuse me, fat is stored when energy in is greater than energy out. Even with weight loss, the size of fat cells shrink, but the number doesn't change. And I just assumed that they'll never change, but there's a little bit of evidence that you might start to lose them after years and years. Okay, fat cell metabolism. We've covered this hormone before, but lipoprotein lipase, or sorry, the enzyme is an enzyme that breaks down. So you have triglycerides floating through your bloodstream. Lipoprotein lipase will grab them, break them down into their constituent parts, absorb them into your cells. So lipoprotein lipase is how your cells get fat into them. So the parts of your body that have more of these enzymes are gonna be where you store more of your body fat. So that's what it says there. It's influenced by gender. Women have higher lipoprotein lipase levels in breasts, hips, and thighs, which is why a typical woman would have more of a pear shape. So you're gonna have more fat tissue in the mammary area and then below the waist, hips, and thighs, whereas men have higher lipoprotein lipase levels in the abdomen. So a typical male will be more likely to be the apple shape. So this is good news for women because the central obesity or central adiposity, that visceral fat in the abdomen is the one that greatly increases disease risk. So any fat you're carrying in your breasts or below your waist and your hips and thighs doesn't really increase disease risk. I guess unless you're talking about maybe arthritis at the knees or something. So where your body has more of this enzyme is where you'll start to gain fat first. So that's why we put fat in different places. And you look at puberty as a typical boy becomes a man. You see body fat levels go down and then body fat distribution change. As a typical girl becomes a woman, you'll see body fat levels go up and this is the places that it is going up. So the gender plays a big role here. All right, enzyme activity may explain why some who lose weight regain it so easily because adipose tissue LPL or lipoprotein lipase activity increases. Once you've lost weight, when we're talking about these things are gonna change forever, at least for years and years. If you've lost weight, then your hunger hormone, grayland is gonna be higher than it ever was and it'll stay high. These lipoprotein lipase levels will stay elevated. These fat cells, your body has lost fat that it wants. So it's gonna increase enzyme activity and it's gonna do its best to regain that fat if you allow it. It takes diligence to maintain weight loss. All right, then that imparted that's because of the set point theory. So the set point theory says your body strives to achieve homeostasis. So that means that you have a body weight that your body is willing to defend. Let's say it's 250 pounds. If you try to lose weight below 250 pounds, your body will adapt to try to stop that. If you try to gain weight above 250 pounds, your body will make changes to try to stop that. Now, sadly for us in the modern world, your body is way better at fighting weight loss than weight gain. And that's just because the risks of being overweight in our ancestral history were small. There wasn't a lot of food around and if you were overweight, you'd be a little slower and maybe easier to get caught by a predator. But then we became the apex predator. We didn't have predators really. I mean, we did, but we became the dominant predator in whatever region we lived in. So being a little bit overweight wasn't dangerous. Being underweight certainly was. So that's why from an evolutionary standpoint, your body will fight this set point as it drops much more aggressively than as it climbs, which is why you see people continue to gain weight. All right, so the set point is so it says here that after weight loss, your body will adjust your metabolism. Your metabolic rate after weight loss, this should say lower, this is definitely not greater. Metabolic rate after weight loss is lower than it would be expected based on body composition. I mentioned that. If you were 250 pounds and you lost weight and you're now 200 pounds, you do not have the metabolic rate of a person that was always 200 pounds. Your metabolic rate will be lower. Some of the drop in metabolism can be explained by the fact that you lost 50 pounds and you're carrying less, a lean tissue and you're carrying less weight around, but it can't all be explained by that. The other amount that can't be explained is your body has adjusted your metabolism. It is trying to keep you from losing more weight because it thinks you're starving. So the set point is this number. I'm a believer in more of the settling point theory which says there's a range of weight that your body will defend. So if you lose five pounds or gain five pounds, your body doesn't really care, but the farther you get from this range, the harder it becomes. And anyone that's lost weight knows that. When you first start to lose, or gain weight, or tried to gain weight, when you first start to lose weight, the weight comes off pretty easily, but then your body fights it harder and harder and harder and you either have to die at harder or you have to move more because your body will continue to adapt and that's this metabolic adaptation. People have called this like starvation mode or whatever, but metabolic adaptation is a much better term. It's not a starvation mode, but it's the same thing if maybe you are or know someone that's trying their hardest to gain weight and has a trouble doing it, right? I know people that have to eat four or 5,000 calories a day because they're trying to gain weight and their body fights their weight gain attempts. And so how does your body do these kinds of things? We talked about this in the last chapter, but it increases or decreases non-exercise activity thermogenesis. That's the key thing. So some people, if they're trying to gain weight, they eat more calories and their body just burns more calories or they're trying to lose weight and their body just burns less calories. So if you go on a 500 calorie a day, decrease your calories by 500 calories a day, then for a while you lose a pound a week, but then all of a sudden you're only losing half a pound a week and then a quarter of a pound a week and then you're not losing weight. Well, the most common culprit is that you actually aren't on a diet anymore and you're not tracking your food well enough, but if you are and you truly are eating 500 or less calories than you used to, well, your body has adapted, your metabolism has adapted and you're probably moving less. So yes, you are eating 500 less calories, but you're now burning less calories as well. Okay, so that's this idea of the set point and all of this is well studied, but the good news is that most of the changes in energy expenditure come from activity. So if you keep moving, you won't see this huge decline. That's why I recommend, if you're trying to lose weight, I recommend keeping a step count just to make sure, if you were walking 10,000 steps a day and now you notice you're only getting 8,000 and then 7,000, well, that's because your body's responding to your diet by asking you to move less, but you can force yourself to get to that step count. So it's not the same thing as true subconscious non-exercise activity, thermogenesis, but it's a good proxy, I think. All right, so yes, the set point and settling point just says that your body will fight to defend these numbers and it may not be a number that you want right there. I mean, you may want to weigh 200 pounds, your body may want you to weigh 230 pounds. You can get to 200 pounds, but it's gonna be a struggle, right? Whereas if someone has a set point of 200 pounds, it will be easy for them to stay there. Okay, this just so, so physiological variables remain fairly stable under a variety of conditions. That's just the idea of homeostasis covered more in anatomy. You see things like blood glucose, blood pH, body temperature, but your body weight is one of those things that your body tries to maintain. And that's the main thing you have to remember is from an evolutionary standpoint, weight loss is not good, right? It used to be that food was hard to come by. So if you could get it, you should eat it and you should store it because you might not get it tomorrow. You might not get it for the next several days. So your body does defend itself against starvation whenever it senses that threat and weight loss is that. Now you're doing, you can't convince your subconscious brain that you're doing it on purpose, but so it is what it is. All right, that's the set point or the settling point. Causes of overweight and obesity. The simple answer is consuming more food then you get more calories than you're burning, but there are lots of factors. So here we see a genetic factor impacting a hormone called leptin. So the gene is called the OB gene and you see here on the right, you have a mouse that does not produce enough leptin and it weighs three times as much. When you treat them with leptin, then they lose a bunch of weight. They're still overweight, but they lose a bunch of weight. So when they first figured out what leptin was doing and they found even some people that had this genetic condition where they don't produce enough leptin or the leptin signaling is broken. Giving them leptin was phenomenal and it works really, really well. They actually thought this might be the solution to obesity to give people leptin, but what they found was if you truly have a leptin deficiency because of genetics, then giving you leptin is a game changer. But they studied this, they were giving people $500 a day worth of leptin and they were expecting their weight to melt off and it didn't work. Well, that's because they realized that the typical obese person isn't leptin deficient. They actually have way too much of it. They have maybe two or three times more leptin than you might expect, which means they are leptin resistant. So just like a type two diabetic is insulin resistant. Giving them more insulin won't help them. They already have too much of it. They need to increase their leptin sensitivity. Well, the same thing with the typical obese person. They are leptin resistant. Giving them more leptin won't help. You have to make them more sensitive to leptin. So let's talk about what leptin does and then I'll talk about maybe how you can sensitize someone to leptin. So the gene is the OB gene. It codes for this protein hormone leptin. The leptin comes from body fat. Your body fat is endocrine tissue and it tells your hypothalamus like if your fuel gauge is full or not. Insulin is kind of like the short term telling your brain about your energy status. Leptin is long term. Do we have enough body fat or not? All right, acts as a hormone in the hypothalamus, promotes negative energy balance. So if you have a bunch of leptin, then your body will, your subconscious mind should, if it's working properly, should tell you to eat less and move more. So it suppresses your appetite and increases energy expenditure. If you've ever just had the urge like I have to get up, I have to take a walk, I have to do something, that's your brain trying to get you to increase your energy expenditure. So maybe you ate more than you should yesterday and your body's trying to balance that. And then leptin should also make you feel full. Leptin's the opposite of the hunger hormone grayling which we'll cover in a bit. So leptin injections are effective in reducing body weight in animals and humans if they have, like it says there, with genetic deficiency of leptin or receptor mutation. So it's just like a type one diabetic doesn't have enough insulin. So giving them insulin is a lifesaver. A type two diabetic is insulin resistant. They don't need insulin. They need to sensitize their body to insulin. Same thing here. If you're deficient in leptin, then leptin's the answer. If you're a typical obese person, though you're leptin resistant and you need to sensitize your body to this. How do you do that? I mean, getting good sleep and exercise are two ways to kind of sensitize your body to all hormones. So there's no magic, but getting your diet under control, getting more physically active, exercising, getting good sleep, those are the ways that you can sensitize your body to leptin. So hopefully finally, your body will start to understand that it has plenty of excess energy and it can get rid of it. Which is the goal of fat loss, right? To get rid of excess energy. All right. Grayland's the opposite. So grayland is a hunger hormone produced by your stomach. It increases your appetite and promotes a positive energy balance. So the more grayland you have, the hungrier you are and then the more you will eat. And that's why you see an inverse correlation with body weight. So if you have a lot of grayland, then your body weight's going to go up. What are some things that impact grayland? Psychological mindset influences grayland's response to a meal. So a mindset of indulgence promotes satiety. It does promote sleep, but the opposite is true too. So grayland, if you sleep poorly, grayland levels are going to be elevated. So this is why if you have a bad night's sleep, you're generally going to be hungrier. Let's say you slept four hours last night. Well, your grayland levels are going to be higher than normal and your leptin levels are going to be lower than normal. So you really have to be careful or your body's going to want to put you in a state of positive energy balance or you'll gain weight. Uncoupling proteins, we'll cover this in just a little bit, but this has more to do with the types of adipose tissue we have. So we have, most of your fat is called white adipose tissue, which is stored energy. A pound of fat stores around 3,500 calories, but brown adipose tissue is different. It has uncoupling proteins. So the mitochondria just burn, they burn fat off as heat instead of using it as energy. It's kind of like lights, right? If you look at a light, 99% of the energy that's coming off of a light bulb is lost in the form of heat. Only 1% is needed to make that light. So brown adipose tissue is wasteful in a sense, but it burns calories for heat. So that's what it was needed for. You have it when you're younger, especially to help maintain your body temperature. Bright adipocytes, those are a combination. I like to call them beige adipocytes, but so beige adipose tissue is a combination of brown and white. So we'll come back to that. All right, got some matching to do here. Oxidation releases energy as heat and ATP. That's your white adipose tissue, normal body fat. That's one pound is 3,500 calories worth of fuel. Formation triggered by exercise is bright adipocyte. So this beiging they talk about are browning. So exercise does, it does turn more of your white adipose tissue into this beige tissue. That's kind of a combination of the two. Another benefit of exercise. Releases energy as heat only. That's your brown adipose tissue. We don't have a lot of it as adults, but some people have more or less than others and it does matter. Stores fat for use by other cells. That'd be your white adipose tissue again. We store the food we ate last week or last year. Oxidation is uncoupled from ATP formation. That's going to be the, well the uncoupling proteins are the brown adipose tissue, but because you want energy production to occur from your fat in your white adipose tissue. Human adults have little brown fat, overweight and obese people have less and that's part of the reason for overweight or obese potentially. Browning can occur in some white fat cells where they take on characteristics of brown fat, most notably the activity of uncoupled proteins and that would be exercise is one of the main ways you would do this. Cold exposure can also increase the browning of your fat. All right, so how does the environment, how does an obesogenic environment play a role? So obesity reflects interactions between genes and the environment. We've talked about how your genes load the gun, the environment pulls the trigger, right? So genetics play a huge role in your body weight, no doubt about it. But let's say you have genes that make you prone to obesity. Well, you still can't be obese unless you consume more calories than you expend. So your genes will predispose you to obesity or leanness, the opposite is true too. You could have a bunch of genes that make you lean but you can force yourself to gain weight. So your genes play a big role but it truly is the environment that has been the biggest change. Like why is the average American so much heavier than they used to be? Our genes haven't changed. It's the environment that these genes are in. All right, so many of us have very thrifty genotypes meaning that our ancestors survived because they were really good at finding and eating and storing food. Well, now we're really good at finding and eating and storing food but the problem is food's everywhere and we don't have to work very hard to get it, right? It's one thing our ancestors would only move if they needed to, right? They wouldn't waste energy. They would think it's laughable to exercise. Like why calories are so hard to come by? Why would I purposely waste them? So our ancestors would only move when they needed to but they needed to move a lot. We only move when we need to but we don't need to move a lot. That's a problem. Our ancestors would eat whenever they had the opportunity but they didn't have a lot of opportunities. We eat whenever we have the opportunity and we have lots of opportunities. So it's not our genes that have changed. It's the environment that our genes are in that have changed. So, all right, so overeating, present and past eating and activity patterns influence your current body weight. So again, you can have genes that make you prone to obesity but if you control how much you eat, you control your portions and you are physically active then you will not be obese. It's just, it's harder for you to not be obese but not impossible. Again, like I've said, I've lost over 100 pounds which statistically it's very hard to do and it's also very hard to keep the weight off but you can be the exception, right? The rule is that most diets fail and most people that lose weight don't reach their target goal and the gain weight back and some gain even more but you can be the exception, not the rule. It's just that you have to alter the environment because you can't change your genes. So food availability is a big one for a lot of people, right? Like I've talked about this before and I'll talk about it again but I'm an abstainer, like I think everyone's either an abstainer or a moderator and I guess it probably depends on the type of foods too. Maybe you're some of both but I'm okay with having food around that I shouldn't eat because I just, I don't eat it. It's not part of my diet whereas a lot of people, they need to completely get rid of foods that are a problem because they will eat them, right? My wife's more of a moderator. I've mentioned this in the last chapter. She's more, she can control what she eats. She likes treats and she can eat little treats here and there and no problem. I just need to avoid them. So food availability is definitely a big problem but it's a bigger problem for some people than for others and so serving sizes. Another thing is if you eat what you're served our serving sizes have gotten bigger, right? The typical serving in a restaurant or at a fast food place is really probably two or three servings and that's certainly gonna be so portion size and serving sizes. These are all things that impact our ability, our capability to overeat. Okay, so I'll just back to that. We're prone to overeating. If you put yourself in an environment where you're going to overeat then the net result is consuming more than you should. All right, physical inactivity on the flip side. So I mentioned earlier that we, our ancestors moved when they needed to, right? They moved when it made sense to either find food or not become food or for reproduction, whatever. But now we don't need to move, right? So we have the same urge to only move when needed and we just don't need to. You sit at a desk job, you drive in your car, someone delivers your food to your house, right? I mean, we have tractors and lawnmowers and washing machines and all these modern conveniences that save all our energy. Think about how many calories you don't have to burn in a day now because machines do the work for you. Inactivity contributes to weight gain and poor health, sedentary activities and weight gain, absolutely. One of the, I love looking at the research between physical activity and life expectancy. If you, besides like not smoking and maintaining a normal weight and sleeping well and all that, if you want a general idea of how long you're going to live, look at how many steps you walk in a day, right? So, you know, so people that move more, people that have higher step counts have less risk of dying every year and are more likely to live longer. So if you walk 16,000 steps a day, your risk of death is way lower than someone that walks 2,500 steps a day. We're talking about way lower. Now I don't know if it's correlation or causation because people that walk only 2,500 steps a day probably have underlying health problems that make them not want to move a lot. So I'm not saying it's magic, but if you're the more physically active you are, generally speaking, the healthier you are, whether that's cause or effect, I can't say. All right, so what is the DRI for the prevention of weight gain? That's a dietary reference intake. They recommend 60 minutes of moderately intense physical activity every day. And we'll have a whole chapter covering activity later. All right, there are a variety, hold on just a sec. Okay, I am sorry about that. I need to take a call from my son. He's at the orthodontist. All right, so activity one, there are a variety of ways to increase daily physical activity. Think of five creative ways people can increase their daily physical activity. So you can think of any you want. But I like maintaining a step count so wearing something like an Apple Watch and making sure you reach a certain step count, that's not ways to increase physical activity but kind of monitor it. I'll tell you some of the things that I do. So I do most of shopping, like I talked about how you can have your food delivered to your door, but I go out and go shopping, right? I go to Walmart, I go to Costco. These are 1,000, 2,000 steps every time you do that. So I think that's one way that I increase my physical activity. I keep my food in a refrigerator in the garage. So every time I'm preparing food I have to go into and out of the garage a couple of times rather than just being in the kitchen. I keep my vitamins and stuff like that down here, downstairs. So I have to go downstairs to grab my morning vitamins and then go back up the stairs. I work in the basement, so I always wanna use the restroom or get water or something. I always go upstairs. We have a kitchenette right here in a restroom but I always go upstairs. So I walk a flight of steps every time I need water or to use the restroom. So those are some examples of ways that I just play with my kid and things like that. So those are ways that I increase my physical activity. So I don't know what you do but there are things you can do. The problems of overweight and obesity. Overweight and good health. We've talked about this. Metaboxy healthy overweight people. So if you're overweight but you don't have any of these obesity related risk factors at the bottom of the screen. Hypertension, failure of disease, abnormal blood lipids, diabetes, prediabetes, sleep apnea. If you look at your blood work and you look at all your other variables and you don't see any health problems then carrying excess weight is not impacting you. At least not yet. So sometimes health is not the motivation for weight loss. So someone might quote unquote need to lose weight but not because it's impacting their health. And we've talked about why, where the fat is, they haven't reached their storage capacity, et cetera, et cetera. So some people are metabolically healthy even if they're obese. Or obese are overweight with risk factors. So weight loss is recommended with two or more of these risk factors but again, even one would be something to consider. Obese are overweight with life-threatening conditions. So that means that the reason you care about these things is how aggressive will we be with weight loss? Because there are risks to surgeries and medications and weight loss treatments. The risks need to be outweighed by the benefit. So if someone is obese with life-threatening conditions then you can be way more aggressive with treatment because the risk of staying obese is higher than the risk of the treatment. So weight loss is recommended with if you have any of these risk factors for sure. And if someone is overweight and in good health, I mean still increasing physical activity is good for everyone, right? Obesity-related risk factors, so I mentioned them, hypertension, that's high blood pressure. So really anything above 120 over 80, you should be considering that. Thyal liver disease, very common in the developed world and very common in people that are overweight and obese. So you basically have fat accumulating in the liver. Thyal liver disease is kind of a precursor to inflammatory conditions of the liver that can lead to things like cirrhosis. Used to be always assumed that fatty liver disease was caused by alcohol. So alcoholic fatty liver disease. But we now know that the majority of people in America anyways that have it have non-alcoholic fatty liver disease. So it's being caused by excess calories, excess sugar, et cetera. Abnormal blood limits, that would be high LDL cholesterol, high triglycerides, low HDL cholesterol, those kind of things. Diabetes or prediabetes, that would be if your fasting blood glucose is 125 or above, you have diabetes. If your fasting blood glucose is above 100, you have prediabetes. And then sleep apnea, which is very, very common where you have a lot of issues sleeping and your quality of sleep is definitely impacted. People that aren't overweight or obese can have sleep apnea, but you're way more likely to have it if you are overweight or obese. Knowledge check one, which of the following are health risk indicators used by healthcare professionals? And the answer is all these. So the BMI, the body mass index, waist circumference, that tells you how much central obesity you have or how much visceral fat potentially. Disease risk profile, so looking at those risks, family history, so is there a history of heart disease, et cetera? And the answer is all the above. Disease risk profile takes family history, life-threatening diseases and common chronic diseases, risk factors into account. This can include body mass index, waist circumference, disease risk profiles, and other methods. All right, perceptions and prejudices about being overweight or obese. So I'll read the image first. So I am fat and I'm unhappy. I want to be happy. If I lose weight, I will be happy. I try too hard to reach an unrealistic goal. I lose a little weight, but then regain it and sometimes more. This is not the case for everyone, but this is the case for lots and lots of people, right? We decide that it's time to lose weight and we get super, super aggressive and our methods are unsustainable and this is why most diets fail. Now, again, that number that like, what, 95 or whatever percent of diets fail, that's assuming that that means you never reached your goal weight and maybe your goal weight wasn't realistic. The best news about the health benefits of losing weight is a huge chunk of the health benefits come after you lose that first five or 6% of your body weight. So if you're 250 pounds and you want to be 200 pounds and you do healthy, sustainable things that gets you to 230 pounds, you've gotten a lot of the health benefits. Now, you may not be happy at 230 pounds. You may want to be 200 pounds, but you've made yourself much healthier with that first 20 pound weight loss for sure. So this cycle, many of you, if you're like me, will understand this cycle completely. Most obese people do not successfully lose weight and maintain it and we'll look at the ones that do maintain it and what sets them apart. Social consequences, jobs, school and social situations. I remember I was the fat kid growing up and I knew how hard that was. Certainly traveling, I hated going on airplanes and things like that. So I completely understand that. There are things that I just wouldn't do when I was heavier that I will do now. Some I shouldn't do. I got them trampoline a couple months ago and I was super proud of myself that I'd gotten healthy enough that I could jump on the trampoline with Oliver. And then I sprained my big toe and two months out and I'm still, I had to get a steroid injection and I'm wearing like a fiberglass thing in my shoes. But I'm still proud of the fact that I was able to do it. All right, psychological problems, the embarrassments and other feelings, yeah. So like, it just stinks. And so I trust me, I've been there and I completely understand the concerns that people have psychologically and socially when it comes to being overweight or obese. All right, so some people, when they get fed up, again we try to do things that are unsustainable and we try things that are aggressive and we try things that are potentially dangerous. So diet books and weight loss programs, there's little success in maintaining weight loss, right? The things that work, you know, people are always interested in, will this pill help me? Will this special, will the peanut butter diet help me this and that? But the, you know, the basics are what works. You sleep, you exercise, you consume less calories than your body needs in a given day and you do things that are sustainable for long periods of time and hopefully you see great progress. So people try really aggressive fad diets, you know, you got your, you got water fasts and just all sorts of things from weight loss products, you see some, all the weird exercise tools and the pills and things like that. Herbal products, some of these have been dangerous, some are taken off the market, right? You've got a lot of your fat burners and those kind of things. So you got to be careful with those things. The thing about gimmicks is they just don't work, right? I mean, even if they do help, they help a little tiny bit, right? Are there pills that will help you lose weight? I mean, they all say in the fine print with diet and exercise, right? And the diet and exercise does most of the work. So there are some pills that are, you know, quite expensive and they might help you lose another percent or two of your body weight. But the huge majority, if you're going to lose weight, the huge majority are going to come from diet, physical activity, exercise, stress reduction, sleep. I mean, that's how you lose weight. These things might help a little bit, but they're never the solution that people hope. They're just no easy, there's no easy way out. All right, aggressive treatments for obesity. So when will we do this? So all treatments come with risks. When the risk of staying overweight is higher than the risk of whatever treatment we're talking about, that's when you do it, right? So if the risk of staying overweight is higher than the risk of a gastric bypass surgery, then you can get approved to do a gastric bypass surgery. If the risk of staying overweight is higher than the risk of a drug treatment, then you can get approved for the drug treatment, but that's the key. All right, so you're talking about drugs first. Strategies for weight reduction depend on the degree of obesity and the risk of disease. So again, if you have all those risk factors, if you have fat liver disease, high blood pressure, high cholesterol, all those things, then you're at really high risk, so they're gonna treat you really aggressively. If you're overweight and don't have those risk factors, they may not use drugs to treat you at all. And you need to at least be obese, right, of a BMI of 40. Use drugs is part of a long-term comprehensive weight loss program, so the drugs still only work with, you know, by creating a caloric deficit, so you still need to consume less calories when you're burning. These drugs might help you with appetite, they might help you burn a few more calories, those kind of things. So the drugs are for people with medical risks, so again, I think you have to at least have a BMI of 40 before they can even use these drugs, and they will help, right? They can help you lose that five to 6% of your body weight that will give you the biggest bang for your buck. So we talked about the mandate there, the benefits of the treatment have to outweigh the risks. Surgery, so we have different types of surgeries here. I'll show you the picture. I'll skip to the next slide and show you these on there. So we have the first is the gastric bypass, so let's read it. The surgeon constructs a small gastric pouch and connects it directly to the jejunum of the small intestine, so that the flow of food bypasses a substantial portion of the small intestine, so you bypass the stomach and the duodenum and then part of the jejunum, and you have that, that's why it's called a gastric bypass. The next one here, the gastric banding, so I think they call these a lap band, right? The surgeon creates a small gastric pouch using an inflatable band placed near the top of the stomach. The band is tightened or loosened by adding or removing fluid via an excess port placed under the skin. So this one's clearly less permanent, but maybe not as effective. Then you have the sleeve gastrectomy or the gastric sleeve. The surgeon removes 70 to 85% of the stomach and staples the remaining portion together to create a vertical tube-shaped stomach with limited capacity, so these would be examples of some of the surgeries you could do. All right, so surgery for obesity could be an option if the person's BMI is above 40. Gastric surgeries decrease stomach size, it therefore limits food intake, so it might not change at the brain level how much you want to eat, but it'll change the signaling from the stomach for sure. And gastric bypass surgery changes hormone production. So it changes hormone production because you're not using some of these tissues that stimulate hormone production. It also changes the microbiome. Your gut microbes do change, and that is part of where the weight loss comes from after these kind of procedures. Long-term safety and effectiveness depend largely on compliance with dietary instructions. Deficiencies in vitamins and minerals are common. So yeah, you can restretch these gastric pouches really easily, so plenty of people that have these surgeries gain the weight back, and they just, I mean, I know of a case where someone was losing weight and doing it well, then all of a sudden they started gaining weight, so they had them analyze what they were eating. They were eating like boxes of pop tarts, they were eating multiple Big Macs. They had just stretched this new, this gastric pouch back out. And so that's why long-term, they're not always successful because it hopefully forces you to change how you eat, but you have to change how you eat forever. And then yes, because you're getting rid of this absorptive area of your GI tract, deficiencies in vitamins and minerals are common and need to be accommodated for. All right, other medical procedures. So you have endoscopic procedures using scopes. Recently approved for weight loss, actually my wife works with someone that was very actively involved in the early testing of these intragastric balloons. So they actually will put a balloon in your stomach to make the stomach feel full earlier. Gastric aspiration, you empty the contents of the stomach 20 to 30 minutes after each meal, so sadly it's kind of like bulimia, but without the damage from the vomiting, I guess. And then liposuction, just removes the fat, alters body shape in specific areas, but if you remember your body as a set point and your body likes to maintain homeostasis. So if you remove fat through a gastric bypass, your body will replace those fat cells. All right, so other weight loss, not less aggressive weight loss strategies. Changes, losses, and goals. So the characteristics of successful strategies. And this is gonna be different for everyone. A lot of trial and error, but to me, like in a word, like your new life has to become the new you. I mean, you gotta kind of bury the old you and create this new you, I think, and they have to become habits, right? So I knew that I was gonna be successful of maintaining my weight loss and hopefully continue to lose more when I used to have to talk myself into exercise, now I have to talk myself out of exercising, right? If I was like my hips a little sore today, I have to like convince myself that I shouldn't exercise. Well, I used to have, so I have to convince myself to take a day off. I used to have to convince myself to exercise. Same thing with food. I used to have to convince myself to eat healthy. Now I have to convince myself it's okay to occasionally not eat healthy. So I feel like my diet is just my new diet. Diet just means a way of living or a way of life. That's where the word actually comes from. It doesn't have to be this temporary thing. So my diet is just the diet that I eat. I went off of my diet. I had a lemon bar for my birthday and I had like a fully loaded baked potato, things I don't eat. So I had to like convince myself that it was okay to do that, rather than convince myself that I need to eat healthy. So that's why I mean, I feel like I've just reached this tipping point where this is just the new me. But trust me, I've tried and failed for decades. I've lost lots of weight that I've gained back, but that's because I didn't have these successful strategies, right? I've done starvation diets and all sorts of different things, but none of them were sustainable and that's the key. You have to figure out how you can sustainably lose weight and basically, if you're doing something to lose weight that you can't sustain, then how are you going to maintain the weight loss? And what's the point of losing weight if you're going to gain it back, right? If you lose weight and gain it back, you don't see the health benefits and all you've done is kind of torture yourself. So you have to find sustainable ways to change your behavior, change your environment and change forever. All right, so the characteristics of successful strategies, embrace the changes, right? Just like you are trying to create a new you. That's why I like framing it that way. Celebrate losses. So again, you might want to lose 50 pounds, but once you lose 5% of your body weight, celebrate the fact that you've gotten a lot of the health benefits you're going to get from weight loss have already happened. Some of the health benefits have occurred before you've lost any weight. So set goals. We'll talk about goal setting later and then having support, whatever support you need, right? Whether I have like an online community that I kind of lean on to for support, obviously my family and stuff too, but it is kind of a team effort. All right, so the benefits of modest weight loss, again, the slower or more modest the weight loss, the more likely you are to sustain it. That's the key thing there. So a reasonable weight loss rate here, it says a half a pound to two pounds per week. Those numbers are fine, but to me it's a percentage. So it's half a percent to 1% of your body weight per week. Because if you're 400 pounds, then you don't need to lose half a pound a week. You can lose more than that. So half a percent to 1% of your body weight a week is safe weight loss. Incorporation of healthy eating and physical activity. So again, if you start eating healthily and you make changes to your diet, even before you lost weight, you'll see health benefits. Same thing with physical activity. Your weight loss, you might not lose any weight, but you'll lose visceral fat and you'll get healthier, you'll feel better, et cetera, et cetera. So you need to do these kind of things. All right, so you're eating patterns. So if you're trying to healthily lose weight, be realistic about energy intake. So you cut 500 to 750 calories per day. I think that's a fine number. So the more aggressive the cut, the faster you lose weight, but the higher percentage of that weight will be muscle or lean tissue and you'll be more likely to gain the weight back. So emphasize nutritional adequacy and making sure that you're getting all your nutritional needs met, because it's harder to do since you're eating less calories. Nutrition is likely to be compromised if you're on a crash diet. If you're only eating 1,000 calories a day, how are you getting enough of all your nutrients? How are you getting your essential fats, et cetera, et cetera. Rapid weight loss often results in loss of lean tissue, which leads to, that should say, which leads to lower BMR and rapid weight regain. I've talked about this before. So if you want to lose mainly fat, then lose weight slowly, strength, train and sleep, right? If you aren't sleeping well and you're not doing strength training and you're on a severe caloric deficit, then 50 or 60% of the weight you lose could be lean tissue. If you lose weight slowly, you're physically active, you're sleeping, you're strength training to preserve muscle, then 90% or more of the weight that you lose can be fat. You're going to lose some lean tissue, because if you lose 50 pounds, I mean your bones are going to be a little less dense because you're carrying less weight around, et cetera. So eat small portions. Again, not, you know, is that what you can, you want to try to eat, just however you manage hunger, whatever works best for you. Some people do time-resected feeding where, or like OMAD, which means one meal a day. Some people like to have one really big meal a day and get all their calories at once. I don't recommend that, but I do like fasting and time-resected feeding strategies. I've lost most of my weight using an alternate day kind of fasting approach where I'll eat more calorie cycling would be a term for it. I eat more calories, like on the days that I train hard, the days I exercise, and then less calories when I don't. Reason I like that is, again, this is just personally, this is not medical advice, this is just what I did. But I like being able to eat till I'm full on one day and then be pretty hungry the next day, this alternate day fasting approach or calorie cycling. To me, it's easier to be kind of really hungry every other day than to be sort of hungry every day, right? So I would say that in a seven day week, I have two or three days where I'm not on a diet at all. I'm eating to maintenance on those days, and then I'm eating, I have a more serious caloric deficit on the other days. But that works for me. So I can't tell you that you should eat five small meals a day. Even you gotta figure out what works for you. Does eating one meal, two meal, three meal, four meal, five meals, whatever is sustainable for you is what you should try. Slow down when you eat, that absolutely, you should chew your food more, you should put your fork down, you should slow down because you want the hormones, you want your brain to tell you you're full when you're trying to lose weight. You don't wanna wait until your stomach tells you that you're full. Lower energy density foods. So this would be, you wanna try to have a lot of volume of your food without a lot of calories. So often choose foods based on portion sizes. That's the idea of volume metrics. You want foods that are watery, have a lot of fiber, these kind of things. So a big old salad is gonna have a low energy density, so it's gonna fill you up like a chicken salad, whereas something like soda or things that have tons of calories that don't fill you up would be a no-no if you're trying to lose weight. Plant-based foods, mainly because of the fiber. So fiber is low in energy and then it takes a long time to eat. You gotta really chew it. Like if I'm eating a big old plate of raw broccoli with my meat or whatever, well it's gonna take me a long time to chew on that, to eat that broccoli, it's gonna force me to slow down. Choose your fats sensibly. You just remember that fats are satiating, but they come with a lot of calories. So are they worth the calories to get that feeling of fullness when you can get a better feeling of fullness with protein and fiber? Select carbs carefully. You have artificial sweeteners. So you decide where you stand on artificial sweeteners, but studies actually show that using artificial sweeteners can help with weight loss. So if someone switches from soda to diet soda and without accommodating those calories somewhere else, they're almost guaranteed to lose weight. So artificial sweeteners can be very helpful for most people when they're trying to lose weight. Some studies have shown that getting people to switch from regular soda to diet soda helps them lose weight better than getting them to switch from regular soda to water. I think it's the sweeteness thing. I know if I'm craving something sweet, I will have a diet soda. I will have a sugar-free gum, right? So I can manage my cravings rather than having dessert. I have a piece of gum for five calories. So that works for me. Watch for empty kilo calories or calories. So things with a lot of fat and sugar and alcohol. And then staying hydrated. Water keeps your stomach full. I definitely drink more water when I'm trying to lose weight than when I don't. All right, so there's this activity. You can do this, but partner or group activity description, review and think up five creative weight loss strategies. So, I mean, just, these aren't really super creative ones but I just wanna see. Yeah, every meal needs to have protein. Every meal should have fiber. You should be drinking lots of water, right? So those are kind of some of the real big things. Like I told you, I like to do calorie cycling. Not everyone likes to do that and that's perfectly fine. But I found that eating, and this is why some people like that one meal a day approach as well or time-restricted feeding, which means that they eat all their calories in a four or six or eight hour window. So maybe you can, you know, you're hungry in the morning, but you know you got these two big meals coming up later and then you can feel full when you eat your larger meals. So maybe that works for you. I found that, like I said, I feel better knowing that, you know, when I'm calorie cycling, the yeah, I'm hungry today, but I get to eat more tomorrow, right? So I have a larger caloric deficit on one day and then don't have a deficit or have a much smaller deficit on the next day. That works for me. But again, these are all things, you have to find what works best for you. For some people, waiting and eating one meal a day would lead to over-consuming. We're eating too much at that meal. So time-restricted feeding is not the answer for everyone either. It's just you've got to figure out the approach that you can actually do that's sustainable for you. All right, physical activity. The best approach, so notice it says the best approach to weight management. Right, so exercise and physical activity have not always been shown to be super effective at helping you lose weight, lose pounds on the scale, but it's a great way to keep weight off, absolutely. And the other benefit of physical activity is it may not help you lose weight, it may slow your weight loss, but the percent of the weight you're losing that's actually fat, which fat loss is what we really care about, the percent that you're losing that's actually fat is gonna be higher. So definitely it may even slow your weight loss, but it'll still be worth it. So best approach to weight management, moderate physical activity, plus activities of daily living. So it's not just exercise, right? If you go and exercise 30 minutes a day, then lay on the couch the rest of the day, you're not gonna get most of the benefit. To me, maintaining that step count, keeping yourself physically active throughout the day, much better approach. If you were to, you should do both, but if you were to ask me, should I go to the gym and do 30 minutes or 45 minutes a day of exercise, or should I be physically active throughout the day? I'd tell you to be physically active throughout the day. Now, when you go to the gym, you should be, I would recommend strength training to build muscle, but still, I think that you'll burn more calories just throughout the day than you will in the short exercise sessions. All right, so a combination of diet and physical activity, you'll lose more of the weight you lose will be fat and more of it will be abdominal fat, that visceral fat that's dangerous. You'll retain more muscle or maybe even build muscle. When you first start, if you have a lot of weight to lose and you first start exercising, you may have what's called body recomposition. You will lose fat and gain muscle at the same time. So that's pretty awesome. And then you will regain less weight, right? One of the key things that people do to keep weight off is exercise and stay physically active. And then I mentioned the reduction of abdominal fat. Even if you haven't lost weight and you start exercising and being physically active, you will lose some of that visceral fat around your abdominal organs, which is great. All right, so activity and metabolism. I like to talk about this term of like fat flux or calorie flux here. So calorie expenditure influenced by body weight, intensity and duration. So the heavier you are, if we both go on a walk, if I weigh more than you, then I'm gonna burn more energy on that walk than you will. So that makes sense. And then of course, if I'm running, I'll burn more calories per minute than if I'm walking. And if I run for 20 minutes, I'll burn more calories than if I run for 10. The greater the energy deficit, the greater the fat loss. So you see here this idea of this active person is burning more calories. So the energy deficit's gonna be bigger. And then so that's a good thing. And then this idea of discretionary calories. This is the idea of like fat flux or calorie flux. So there's two options. You can go on a diet and you can eat less and move less and let's say you still maintain that 500 calorie day deficit. Or you can be more physically active and you can still maintain a 500 calorie day deficit but you get to eat more. So when people are losing weight, like body builders, when they're trying to get super lean, they have to decide are they going to eat less and move less or are they going to try to lose weight by eating the same amount and moving more. So you can kind of decide. It's just whatever's best for you. So I found that staying active throughout the day allows me to eat more and still lose weight and that works better for me. But for some people, that wouldn't work as well for them. All right, so your metabolism speeds up with activity because you're repairing tissue and building lean mass. So there are immediate and long-term benefits. So while you're exercising, you're burning calories now, plus you're gonna burn calories for two or three days while you're repairing tissue, et cetera, especially with strength training. And those just help benefits to being physically active that have nothing to do with weight loss. All right, so there's one more thing about that flux thing. So you have to decide for yourself and I think that there are two, if you're at a plateau and you're not losing weight, you have to decide what works better for you. Should I try to increase my physical activity to continue to lose weight or should I cut my calories again? That's a personal decision. All right, what changes can one expect to see in their body when they exercise? What is the effect of exercise on appetite? So great question, but what changes can someone expect to see? Changes in body composition result from exercise, body fat decreases, lean mass increases, even without weight loss. So if you start exercising, you will look better even if the weight on the scale doesn't change. I talked about that body recomposition. You can lose fat and gain muscle at the same time. And so, yeah, you're upset that the scale's not moving but what your belt is, your pants are getting loose. That's a change in body composition. People talk about wanting to be toned and things like that. You always will look better. If you have more muscle and you have more muscle on your frame, I think. So what about the effect of exercise on appetite? When exercising, appetite is suppressed after an aerobic workout. Exercise doesn't cause overeating. Exercise can help curb inappropriate appetite caused by boredom or anxiety. I believe in those things. I think at some point, exercising more will cause you to be hungrier. Your body will try to get those calories back somewhere. But the cool thing is physical activity has been shown to regulate satiety signals. So the most famous things I've ever done, I'm sure I'll do a video on it at some point, but people that are sedentary workers basically eat more calories than they should. People that have physically active jobs eat the appropriate number of calories. So you have, and then people that have really physically active jobs will eat more but it's still in line with their needs because they're burning more calories. So if you're not physically active at all, getting physically active will cause you to eat less. And then when you become moderate to more intensely active, if you want to use that term, then your satiety signals will be linked to your needs. So it will help. If you're doing nothing right now, doing some physical activity will probably regulate your appetite and help you eat less, not more. Physical activity decreases abdominal fat even without weight loss, that's what I mentioned before. Even before you lose weight, you get healthier when you start to exercise because that visceral fat starts to go away. All right, environmental influences on weight loss. Atmosphere, things like colors of walls and paint and lighting and decor, they do matter. I mean, I wouldn't paint your kitchen to help you lose weight but trust me, McDonald's and these kind of places, they know all these tricks. Accessibility, so the ease and convenience of obtaining food. If you really like Oreos, then they shouldn't be in your house because if they're in your house, they're too easy to eat. If you really are craving an Oreo and you decide, okay, I'm gonna go get an Oreo and first of all you decide, instead of buying the whole packet, you go to the gas station or whatever and you buy those individual things which you gotta like, I gotta put my shoes on, I gotta drive to the gas station to go get it. It's like, I don't really want to. But if you really wanted that Oreo, then do that occasionally. But don't buy the whole packet and definitely don't bring it in the house. Go buy the little two pack, I don't know what they are, but buy a two pack or whatever it is and then so don't make the rest of that, the rest of those 40 Oreos or whatever's in a pack accessible. Socializing, you tend to eat more one with others. So again, if you're at a party where there's snacks sitting out, you're just gonna mindlessly be eating. Distraction, same thing. If you're distracted, when you eat supper, you should be sitting at the table focusing on the supper. If you're eating while you're watching TV, you'll eat more calories. If you're eating while you're talking to friends, you'll eat more calories, these are just realities. Package in portion sizes, you generally like you'll eat whatever you have. So if you bring a bag of chips, the big bag of chips to the couch, you will eat way more than if you portion it out and bring that portion. All right, and same thing with serving containers. Like if they've done studies where they do this, where they give you like larger containers, you eat more, et cetera. So just be smart about the environment that you're creating, the food environment. Okay, behavior and attitude. This is talking about making smart goals. So behavior modification, positive matter of fact attitude. So again, willpower, you need willpower, but you really need discipline and motivation more. Like the reasons you have for losing weight have to be stronger than your reasons to not lose weight, right? Your reasons, your motivation has to be stronger than your excuses, basically. So you just, you have to have a big enough why to make the hard work worth it. Become aware of your behaviors. I believe that, keep a record. I mean, what are you eating? What do you feel like when you're eating? What do you feel when you fall off? What do you feel like when you fall off your diet? Like what are the things that make you more likely to be successful? Do more of those. What are the things that make you less likely to succeed? Do less of those if possible. So change your behaviors, set small, time-specific goals. That's this, you can read the smart goals, but smart means specific, measurable, attainable, relevant or realistic and time-based. Practice and then reward. So your reward shouldn't be food, right? So that's why the rewards that I've used have been new exercise equipment, new clothing, just special days, taking time off, et cetera. But I don't think you should celebrate your weight loss with food because it kind of defeats the purpose. All right, and then practice. What's the idea of this? So start small, right? Set small goals. Like if you want to lose 100 pounds, focus on losing the first one. Focus on doing things that make you healthier before you lose any weight. And because if you focus on, if your goal is to lose 100 pounds and you never get there, then you failed. But if you set small goals along the way, then you have all these successes and all these milestones and you have all these opportunities to be proud of yourself. All right, so the cognitive skills around weight loss. So problem solving, just again, what are the obstacles between you and your success? Get rid of them and put the obstacles between you and failure, right? Make it easy to exercise, hard to not exercise. Whether that means paying for a gym membership or whatever, having your workout clothes sitting out, whatever, make it as easy as possible to exercise. Make it as easy as possible to eat well and then make it harder to not. So only have healthy food in the house. Now it's easy to eat healthy, hard to eat unhealthy because you have to get dressed and go out and do this and that. What are some other ones you can do? Again, creating an environment. Like if I forced myself to move more, I have to come down here to get my vitamins. I have to do this, I have to do that. So just create an environment where you need to move more. Create an environment where it's easier to eat well than it is to eat poorly. Create an environment where it's easier to stay physically active than not. Like I have this here is my standing desk. I don't use it when I'm recording. So I can stay in front of the camera and not wiggle too much, but when I'm working I generally have my desk up, so I have to stand if I want to work and then I usually listen to music so that kind of keeps me moving. So I'm burning more calories, just kind of out of habit. All right, cognitive restructuring. Replace negative thoughts, like focus on the positives. Focus on the positives, not the negatives, right? And when you fail, it's an opportunity to, when you fail today, don't let it impact tomorrow. It's an opportunity to do better. Look at it that way instead of like, I'm a failure. I can't do this and giving up. If you're listening to this and you've tried losing weight before, you know exactly what happens, right? The worst part about this roller coaster is, okay, I'm gonna start my diet on Monday. So that you eat like crap all weekend, like you're eating up all the food in your house that you don't want to be there and this and that. So you actually ate worse because you were gonna get on a diet. Then you get on the diet and you fail because it's too aggressive and not sustainable. You fail, you give up, you go off the diet. I mean, you'd have been better off never trying to diet than to doing this. So yeah, you gotta replace these negative attitudes that put you in this cycle. Personal attitude. Understand your personal relationship with food. I've talked about this several times. I know I'm an abstainer. I do well with a pretty restrictive diet where I basically have like six or seven meals that I rotate and eat on a regular basis and then I occasionally, very occasionally stray from it. That works for me because I know my relationship with food. I am an abstainer. It's easier for me to not eat ice cream than to decide how much to eat and how often to eat it. Maybe you're a moderator and you can have a snack every night or a snack twice a week or this or that. You have to understand your relationship with food. I know there are certain foods I just can't eat because I just can't control it. I just, I like them too much. So it's easier for me not to eat them than to try to eat a reasonable amount. Sound emotional health and that can count. Again, sleep, stress management, those things would help. And then support. We've talked about that. Whatever works for you, whether you have a workout buddy or a diet buddy or I have an online community that I kind of work with and I would say I get great support from my family and those kind of things too. Okay, so weight maintenance. What do you do once you've lost the weight and you should have a plan? If you're trying to lose weight, first of all, you shouldn't be. You're trying to lose fat. If you're trying to lose fat, you should have a goal for how you're gonna maintain that loss because we know how easy it is to put it back on. So weight maintenance would be weight loss. You've maintained it for at least a year. That's like that's success. The prevalence of successful weight loss is difficult to determine. Obviously, I told you that most diets fail but it really depends on how you look at it. Did you lose all the weight you wanted to? Then yeah, most diets are gonna fail. Did you gain your weight back? That does happen in the majority of the time, no doubt. But here's the three key things and there is a weight loss or weight maintenance registry where they keep track of people that have successfully lost I think at least 30 or 40 pounds and they've lost it for at least a year and they monitor them and to look for what are things that people do that keep their weight off? And these are by far the three big ones. Number one, vigorous exercise regimens. They're physically active. It doesn't have to be like intense training every day but they're very physically active. A typical person that's lost weight and kept it off is more physically active than a person that doesn't keep the weight off. Careful eating patterns, they track what they're eating. Not all the time but they weigh and measure food, they use diet records, they use my fitness pal. So people that lose weight and keep it off they're physically more physically active, they exercise, they track what they're eating and they frequently self-monitoring. That means like using a scale, right? That way if all of a sudden you've gained a pound a week for the last three weeks, well you can get on top of that and you can solve that before you gain 20 pounds or 30 pounds, right? If you wait until your clothes don't fit, you weren't successfully monitoring yourself. So scales are important. They're a necessary evil but they are important for weight maintenance. All right, prevention. So the best way to lose weight is to never have to lose it, I guess, right? And that's why as someone that struggled with his weight his whole life, that's a really big focus with my kids, especially my youngest, Oliver. Like, I had a conversation with him the other week, a week or so ago, talking about how, I've had to work really hard to get healthy because I was unhealthy and his brother has had to work really hard to get healthy because he was unhealthy. Well, he's only seven and he's, and we're trying to keep him healthy. So I'm like, you're lucky. You can just be healthy forever, right? You don't never have to reach an unhealthy point that you have to dig yourself out of that hole. So that's kind of the attitude that I'm using with him is trying to keep him from ever needing to worry about losing a bunch of weight. So it does begin early. Hormonal and metabolic changes persist over time. So again, keeping my young boy from getting insulin resistant and these kinds of things will help. It takes more effort to prevent weight regain than to prevent weight gain, no doubt about it because of that fat cell hyperplasia, right? So if it's easier to not gain 50 pounds than it is to gain it and lose it and then keep it off. Community programs, again, there's lots of things here but thankfully that there are programs out there that are trying to put in dent in these things but in the end, you decide, right? I mean, you decide what your environment's gonna look like to the best of your ability but even whatever environment you're in, it may not be your fault that you're gaining weight but it's your responsibility to do something about it. So we get to decide how much we eat. I know it's not a level playing field because cheap food is fattening, et cetera and we decide that we're gonna be physically active and we take the genetic and environmental hands that were dealt and we decide what to do with it. Okay, so community programs, social networks, community institutions, government policies, all these things, they don't work as well as we would hope because personal accountability is still a big part of it. They can put food labels, they can put nutrition facts panels on Big Macs. You get to decide if you're gonna eat it or not, right? That's the reality. Okay, opposite. So we talked a lot about being overweight and what about underweight? So the problems of being underweight, diverse causes, a high demand for energy may contribute. So again, there are some people that try their hardest to gain weight and can't. I know people that do something called GOMAD so I mentioned earlier, OMAD is one meal a day. People that are strength training, they're athletes, they're in sports, they're trying to gain weight. GOMAD is gallon of milk a day so they eat as much as they can and drink a gallon of milk a day and they finally can gain weight. This is not medical advice, I'm just saying. Some people have to go to extremes to gain weight just like some people have to go to extremes to lose it. Being physical activity is definitely part of it. It's harder, like for high school kids, maybe some of them will have trouble gaining weight because they're already growing and they have a huge caloric need anyways. Difficult to gain weight, this idea of adaptive thermogenesis, just like if you lose weight, your body fights you. For some people, if they gain weight, their body fights them. They increase activity, decrease hunger. There are people at the gym that are trying to gain weight. They're just so sick of eating. Could you imagine that? I spend most of my life on a diet. They're force feeding themselves and sick of eating. They're like, if I take another bite, I'm gonna throw up. That's their brain telling them, hey, you're gaining weight and we don't want you to because you're trying to carry all this extra tissue around that's metabolically expensive. All right, learn new habits and like new foods. So this would be, again, this kind of person would need to eat energy dense foods, the opposite of everything we said for losing weight. Difference between underweight and anorexia nervosa, there are people that are underweight that are trying to gain weight. If you have anorexia, you're underweight on purpose because you're starving yourself. You're not eating. All right, in the United States, how many adults are affected by being underweight? That would be around 2%. So underweight is a far less prevalent problem than overweight in the United States, affecting no more than 2% of adults. Whether an underweight person needs to gain weight is a question of health and, like weight loss, a highly individual matter. Some people are just, are underweight, but all their health markers are good. They're eating plenty. They're not malnourished, et cetera, et cetera. There are no compelling reasons for people who are healthy at their present weight to try to gain weight. This would only be someone that's, again, they're trying to put on muscle for sports or something like that. All right, what are weight gain strategies? All the opposite of weight loss strategies. I mentioned earlier, maybe eating less meals a day is a good idea. Well, if you're trying to gain weight, it'd be more. So eating energy dense foods, pick the highest calorie items from each food group. So this person would want to eat things that are high in calories. And sometimes some people try to gain weight and they just can't do it only on whole foods. Like, this is not a health strategy, I'm not recommending this, but if you're trying to gain weight, sometimes you have to eat the Pop Tarts and you have to eat the ice cream because you need foods that are energy dense, you have to get more calories. They're like weight gainers, shakes, people can use, these kind of things. But yeah, so if you're trying to gain weight, then you want to eat more energy dense foods, which means more calories per gram, more calories per bite. This is so again, opposite of weight loss strategies. Eat at least three meals a day and eat more food at each meal. So you want to eat more food more often, but the point is to gain weight. Include extra snacks. You want to keep eating. Juice and milk, which again, those are considered kind of more like empty calories, especially juice and soda, these kind of things. But if you're trying to get more calories without feeling stuffed all the time, then drinking them is a good way to do it. I mentioned the gallon of milk a day thing earlier. And then exercise if you're trying to build muscle. Exercise will, you'll have to eat more if you exercise because you're going to burn more calories, but you will build the right kind of body, right? If you're trying to gain weight, you shouldn't really be trying to gain fat unless you're so lean that it's impacting your health. Okay, so we did it. Good chapter, a lot of good stuff here. You know, personally means a lot to me. Now that this lesson is over, you should have learned to describe how body fat develops and why it can be difficult to maintain weight gains and losses, the idea of that set point or settling point and how your body just doesn't like to stray from balance, I guess. Review some of the causes of obesity. We've talked about genetics and environment and everything else. Discuss the physical, social and psychological consequences of overweight and obesity and cover those. Explain the risks and benefits of any of aggressive ways to treat obesity. Again, the more risks someone has of staying obese, the more aggressively you treat it. Outline reasonable strategies for achieving and maintaining a healthy body weight. We did that, and then summarize strategies for gaining weight, we just did that. So good chapter, very important. Again, we have the majority of Americans are overweight or obese, so we have to do something about that. And COVID certainly didn't help, right? The average American gained, I don't know, almost 30 pounds, 29 pounds I saw in one study during the peak two years of COVID there. So this problem is gonna be worse than ever now. All right, I hope you learned a lot. I hope this helps you or someone you love and I hope you have a wonderful day. Be blessed.