Pop Quiz: What Do You Really Know About Keeping Weight Off?

James Hill:
Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:
And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:
Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:
Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:
Ready for the “And” factor?

Holly Wyatt:
Let's dive in.

James Hill:
Here we go.

Holly Wyatt:
Jim, we talk a lot about weight loss maintenance on this show, maybe every episode.

James Hill:
We do because that's the key.

Holly Wyatt:
We bring it up. We figure out a way to get it in there. But today we're going to find out how much our listeners actually know about it. Are they listening to us? What do they know about weight loss maintenance?

James Hill:
We're going to do a quiz, a pop quiz?

Holly Wyatt:
Yeah.

James Hill:
And they didn't study? Oh my gosh. Well, there's a lot to know, Holly. What happens to your body after you lose weight? That has fascinated me for a long time. What have we learned from people who've successfully kept weight off? You and I have worked with tens of thousands of these successful people. And the key, what really predicts long-term success?

Holly Wyatt:
Yeah, and Jim, there's a whole new piece to the puzzle that we talk a lot about. Do the things that we've learned about maintenance over decades, do they still apply in this new GLP-1 era?

James Hill:
Oh my gosh, what a great question, Holly. Well, guess what? We've got 20 questions for you, our listeners, covering the science of keeping weight off from biology and behavior, to the National Weight Control Registry to the newest obesity medications.

Holly Wyatt:
Yeah, so some of these questions we made multiple choice. Some are true-false. And as always, some of these answers may not be exactly what you expect.

James Hill:
So play along and keep score.

Holly Wyatt:
And Jim, also for the questions that really matter, we're not just going to give you the right answer. We will give you the right answer. But we're going to then apply it and say, what should you do with this information? That pie in the plate. I now understand maybe the science or I understand what's going on. How do I use it in real life?

James Hill:
Yeah, knowing what happens after weight loss is one thing. Knowing how to use that information to help maintain weight is what really matters.

Holly Wyatt:
All right, Jim. So let's see if our listeners can pass The Weight Loss Maintenance Test.

James Hill:
Oh, okay.

Holly Wyatt:
A test. It's not even a quiz. It's a test.

James Hill:
A test. Okay.

Holly Wyatt:
[2:48] So, Jim, the way we organized it is into four themes or segments. I think there's about five questions in each kind of theme. And this first segment or theme is a good one. It's your favorite. I think you're going to have a lot to say during this segment. What happens to your body after weight loss? All the questions are going to be along that line. What happens to your body after you lose the weight?

James Hill:
Okay.

Holly Wyatt:
Okay. Are you ready? First question. I think you're going to do some heavy lifting.

James Hill:
I'm ready.

Holly Wyatt:
All right. This is a true or false. The biology of losing weight is the same as the biology of keeping it off.

James Hill:
Ah, the biology is the same.

Holly Wyatt:
Yeah. I think that means like the physiology.

James Hill:
Yeah.

Holly Wyatt:
Yeah. What do you think?

James Hill:
Holly, I know the answer to this one. That is false because anyone who listens to our podcast understands weight loss maintenance. Keeping weight off is very different than losing weight. There are two different processes and people have worked for decades on weight loss, but not so much on weight loss maintenance. During weight loss, you're trying to lose weight. You're eating less. You can do a lot of things temporarily. You cannot go to parties and you can avoid going out to eat. Weight loss maintenance is forever. It's your life and it's just hitting that exact equilibrium where what energy you take in equals energy you take out and doing it permanently.

Holly Wyatt:
Yeah, so it's energy balance. How do you achieve energy balance versus negative energy balance for weight loss.

James Hill:
You're starting at a different place. Before you lose weight, you're eating a lot, you're probably inactive. Once you lose weight, now your biology has changed as a result of that weight loss making it a whole different process for keeping weight off. So that one is false.

Holly Wyatt:
And I think this is such an important question because I would say one of the biggest reasons why I believe a lot of people regain weight, there's multiple reasons, but one of the biggest reasons is they don't understand this. And what they do to lose the weight works for weight loss for them, and they don't switch. They don't understand that there's two different biologies going on, two different physiologies going on, and the strategies; what they did to lose the weight, don't work as well. You need new strategies for weight loss maintenance. So they just keep doing what they did for weight loss. And that to me is a big reason why people yo-yo, which means regain the weight and then need to or try to lose it again. So this is an important thing to understand so that you can then realize I need to switch. I need to use strategies for weight loss and then different strategies for weight loss maintenance.

James Hill:
This may be the most important concept we cover. If I could get people to understand one thing that they don't currently understand, it's that you're going to need a whole different strategy to keep weight off than the strategy you use to lose weight.

Holly Wyatt:
And it makes sense from a physiology or biology standpoint, it fits the science.

James Hill:
Yes.

Holly Wyatt:
Yeah. All right, Jim, what's question number two?

James Hill:
Question two. Here is a multiple choice. After significant weight loss, your resting energy expenditure is… Now, your resting energy expenditure is your energy expenditure at rest. How many calories your body burns at rest? So, after weight loss, your energy expenditure is A, higher than you would predict for your new body size, B, exactly what you would predict from your new body size, or C, lower than predicted for your new body size?

Holly Wyatt:
So let's give them a second there to think about higher, the same, or lower. And I think the key word in there, guys, I'll give you a little hint, is this predicted for new body size.

Holly Wyatt:
Predicted for new body size. So, all right, the answer is C, lower than predicted. And we'll talk a little bit more about that. We've talked many times on this show, when you lose weight, your energy expenditure decreases because you're smaller. Your resting metabolic rate goes down because when you lose weight, you lose fat and you lose some lean tissue. Both of those, those decreases cause your resting metabolic rate to decrease, your total energy expenditure decreased. So we know that it goes down. But the key in this question is predicted. So meaning there's a certain amount you would expect it to go down from the amount of weight you lost and the body composition changes that have happened. And then does it go down even a little bit more than you might predict if you were looking at someone who hadn't lost the weight, but was your exact body size and body composition, would your resting metabolic rate be a little bit lower than that person? And while there's been some controversies in the field, I think in general, it probably does go down a little bit. How much I think we argue about how important, that decrease is, sometimes we argue about. But I think in general, probably there is a little bit of metabolic adaptation, we call that, where your resting energy expenditure probably is a little bit lower, although there's been some studies that haven't shown that. What are your thoughts, Jim?

James Hill:
Yeah, I think this one is a little bit controversial. And in fact, I think this may not even be the important issue at all. The fact of the matter is when you lose weight, your energy expenditure goes down significantly. We can debate whether it's exactly expected, probably a little lower than expected but what it means is after you've lost that weight, your body burns fewer calories and to keep your weight off you have to either eat a lower amount of calories to match that lower energy expenditure, or to increase your activity to increase it or what we say is a combination. So the fact of the matter is after weight loss, if you go back to eating the same number of calories you ate before, you're going to gain that weight very quickly because your body has adapted and your energy expenditure has gone down significantly.

Holly Wyatt:
Yeah, but I'm going to push you because this question was about metabolic adaptation. And people hear this all the time, right? My body does something and adapts, and this is what's pushing me back. And yes, physiology, total energy expenditure is going down and it has nothing to do with adaptation as expected. But do you think it goes down more than we can explain by the reduction in body weight or composition?

James Hill:
I think maybe a little. I think most of the reduction is due to loss of lean body mass. I think in the short term, there's some extra decrease probably due to eating less. So in the short term, I think it does go down more than expected. But over the long run, I'm not sure that that degree of adaptation is very important.

Holly Wyatt:
I agree. Because when you look at predictions, when you try to look at does it predict who regains, I've never seen a study that really showed that to be a factor that was having a big impact on weight regain.

James Hill:
Exactly. Which is why I say arguing about whether it's a little more than expected or not may not be as important as realizing it's a significant drop. And it means you're going to have to modify your intake or your expenditure in order to reachieve energy balance.

Holly Wyatt:
But this has been this metabolic adaptation, which is different than metabolic flexibility. And I think sometimes people think those are the same terms, but it's been something people have studied their whole careers on.

James Hill:
That's right, that's right. And my sense, Holly, is it's, of all the things to worry about, it wouldn't be at the top of my list.

Holly Wyatt:
But you can also think about it in terms of hormones and other things that may adapt. So there's other ways to look at it.

James Hill:
And individual variability. I mean, some people go down a lot, some people go down a little.

Holly Wyatt:
All right.

James Hill:
So that one's a little murky, but we'll go with your answer of lower.

Holly Wyatt:
Oh, so I got it right?

James Hill:
Yeah.

Holly Wyatt:
All right.

James Hill:
Here's question three, true or false? The hunger and fullness hormone changes that follow weight loss go away after a few weeks once your body adjusts. So there are hormonal changes that go along with weight loss. Those go back to normal basically once your body adjusts. Is that true or false?

Holly Wyatt:
Yeah. So that is, I think, false. There have been some studies. So we used to think, well, maybe it was just temporary. We did see that your hunger hormones tend to increase, right? They tend to send you out there to want to eat food when you've lost weight. So those are some adaptations that happen. Those hunger hormones can change and go up. I think the research has shown that even a year out that may persist, they are still elevated even a year out or so. And so that it's not just a temporary thing. It probably is more of a longer term signal.

James Hill:
Yeah, I agree totally. And just like your change in energy expenditure doesn't go back to normal, it stays. The increase in hunger and other, the hunger hormones also is permanent, which simply means that you're at a disadvantage and you're going to be fighting biology as you try to keep the weight off. It's the bad news. The good news is people can do it. We've seen people in the National Weight Control Registry, the International Weight Control Registry, people do it and they enjoy it. They experience a higher quality of life doing it, but you're still sort of battling the strive to regain.

Holly Wyatt:
And that's what we talk about in the book. If you stay on the weight loss medications, for instance, the medications are going to help keep those hormones, the hunger hormones lower. But if you go off the medications or you're not on the medications, you may have these signals that are going to persist. But I do think there's things you can do to make them better. And that's what we talk about in the book, right? So it's not like, oh my gosh, I'm going to fight these forever and it's going to be terrible. You can do things to if you know that, if you know that's what's going to happen, you can use food and physical activity and even mind state to help with that fact that that's what's going on.

Holly Wyatt:
All right, Jim, question four, and I had this one laying for you because I knew you were going to love it. And this is, if you're a listener and you can describe this, you are one of our stars. Question number four is, what is the energy gap? What is the energy gap? This is something Jim and I...

James Hill:
We coined this term. We developed this term.

Holly Wyatt:
Yeah. So you may not know it. I mean, our listeners may not know, but I think we've talked about it enough that some of them will.

James Hill:
So we coined the term energy gap to talk about the mismatch between energy in and energy out after you reach a new lower body weight, okay? So you reach a new lower body weight. What's that gap that you have to fill to keep it off? And you can fill that gap by reducing intake so you can calorie restrict. We have pretty good evidence that doesn't work in the long term. You can increase that gap by increasing physical activity, which works. And probably the best way is to rely a lot on physical activity and a little bit on calorie restriction. But you have to close that gap. And we can actually estimate number of calories for that gap, which gives people a goal, a behavioral goal to keep the weight off. So you might have reduced your energy expenditure by 300 calories a day, which means you've got to either continuously eat 300 less, exercise 300 more, or some combination that reaches 300. So that 300 would be your energy gap.

Holly Wyatt:
So it kind of gives you an idea of how much behavioral change I need. And Jim, as you lose more weight, what happens to the energy gap?

James Hill:
The energy gap is bigger, which is why people who lose more weight have to do a little bit more behavioral compensation to keep the weight off. And that makes total sense.

Holly Wyatt:
Right. So it's a kind of a scientific way to look at what's going on and try to kind of quantify it and give you an idea of how much behavioral change I need for weight loss maintenance. Not for weight loss, but for weight loss maintenance.

James Hill:
And the one thing we've seen over and over. You cannot do it all with food restriction. That's what people have tried. They try to just eat less forever. And you can't. You just get hungry. Those hormones, you know, physical activity is the real key. So close it as much as possible by physical activity. We can do a little. You can eat smarter. And we talk about that in the book. Ways to eat smarter so you eat less without being hungry.

Holly Wyatt:
Yeah, I think you can do some with food, but not all with food. Now, here's where the GLP-1 era is changing things a little bit. We used to say this all the time. For the first time in a long time, if people stay on the medications, in theory, the meds themselves could keep that energy intake low. Now, there may be some downside to that, but in theory, that's what could be going on with the medications if you stay on them for a long time.

James Hill:
That's a fascinating question. So theoretically, what we've said is you can't maintain weight by eating less forever. With the medications, maybe you can, because they are allowing you to eat less without becoming hungry. Without the meds, it's almost impossible. So, what it means, we talk about with the meds, you're maintaining weight at a low energy flux, which means a low amount of energy coming in and a low amount going out.

Holly Wyatt:
Most people, there's some people that may be doing it differently.

James Hill:
But we've seen without the meds, when we've studied this for years, that's a recipe for failure. The people that succeed increase their physical activity so they have a high energy in and a high energy out. So it's a fascinating experiment to see how successful we're going to be over the long term at maintaining weight loss at low energy flux with the meds.

Holly Wyatt:
And what else might that mean? Because we talk about high energy flux creating that metabolic flexibility. which is important for weight maintenance, but may be important for other things in our body too, not just body weight regulation. Being flexible metabolically is probably a good thing for many different pathways in our body and many different things that we're doing. So by forcing our body to be able to maintain a weight, a low body weight, but at low flux, what other things might, how is that going to play out?

James Hill:
It's fascinating to see long-term if people are going to be successful. The other thing it does is low flux. Anything that goes wrong that causes your intake to go back up, boy, you're primed to regain weight quickly. All right, Holly, we're going to have to speed up here to get through this.

Holly Wyatt:
These first ones are a little bit longer, then they get quick.

James Hill:
All right, question five. Which generally requires more physical activity, losing the weight or keeping it off? If you listen to our podcast, you know this when we talk about it a lot.

Holly Wyatt:
It can be a little tricky, but in general, yes, keeping it off requires more physical activity. Now, if you were saying how much physical activity would I have to do to lose weight, it would be you need a lot of physical activity. But most people, in the way that we look in the literature, you do that with diet restriction, with caloric restriction, and you don't have to do very much physical activity to be successful at losing weight, but when it comes to keeping it off, then you need to do quite a bit of physical activity.

James Hill:
And it really relates to closing that energy gap. When you're losing weight, most people for a short period of time can do the calorie restriction. Boy, they get excited about a diet and they eat less and it's fine. The problem is you just can't do that forever. So in weight loss maintenance, it becomes critical to increase physical activity to close that energy gap because it's difficult to fill that gap with food restriction over the long term.

Holly Wyatt:
So what does this mean for people? What do you do with that information? This is what I say. While you're losing the weight, you don't have to do the physical activity to be successful at weight loss. There are other reasons why you should and then body composition. I'm not saying you shouldn't, but start preparing. I would say, even if you don't need it for weight loss, you are gonna need it for weight loss maintenance. So start slowly, gradually figuring out what you like, how you can put it in there, knowing that you really do need to be at a higher level of energy flux and therefore have some more movement or physical activity in your life to be able to do that by the time you get to weight loss maintenance.

James Hill:
Okay, Holly, we're gonna switch to segment two.

Holly Wyatt:
Yeah.

James Hill:
What does successful maintainers actually do? Now, these questions come from the National Weight Control Registry. This is a study of successful weight loss maintainers that Dr. Rena Wing and I started in 1994. Rena is a very famous behavioral psychologist at Brown University. So she and I really put this registry together to say, what can we learn by studying people who actually succeed? Now, a couple of caveats. The people in the registry volunteered for this. They self-reported that they had achieved weight loss for some period of time. They aren't a random sample. And we've studied over the years more than 10,000 people who have joined this registry. And on average, oh, I'm getting ahead of our question.

Holly Wyatt:
Oh, you almost gave it away.

James Hill:
Yeah, I almost gave it away. So these are people who succeeded not just at losing weight, but keeping it off. Okay, Holly. So, what are the criteria for entering? What criteria did Rena and I establish to say, here's who can get into the weight loss registry?

Holly Wyatt:
Yeah, so that's the question. Does anybody know, if you've listened to us a lot, you probably do know this, the criteria was you have to have lost 30 pounds and have kept it off for at least one year. Now, Jim, I'm going to push you on this. Why did you hit, why did you say 30 pounds in one year?

James Hill:
Well, we had so much discussion over this, Holly. We debated what's the best way to do it because at that time, well, really now there's no great definition of maintenance. We thought about, well, people who lost 10%, what about regain? And we went through all these very elaborate ways to do it. And then we finally said, wait a minute, we're overthinking it. How much weight loss would be significant? Well, 10 pounds, maybe not 20 pounds, you don't need 50. So we came up with 30 because we said, you know what, that to us would be a measure of success for most people. So that's what we came up with. And it's worked really well. I think it gets the people who are really successful and keeps out the people that have just lost five or 10 pounds. So, you know, it worked.

Holly Wyatt:
Yeah. 30 pounds, you can regain some of it and still be reduced. I think there was a lot of good things about that number, but it wasn't really based in science. It was kind of just said, this is what sounds good at the moment. All right, Jim, question seven. What percentage of National Weight Control Registry members weigh themselves at least once a week?

James Hill:
Yeah, we promote regular weighing yourself as a strategy. And part of the reason is it comes from the National Weight Control Registry, where about 75% of people weigh themselves every week. A lot of people, Holly, weigh themselves every day. And again, what we've said is weighing yourself is just an early warning system. If you want to keep your weight off, how are you going to know unless you measure your weight? And we've talked about this a lot. The scale has no emotional influence on you. It's simply a tool. And one of the things the National Weight Control Registry people say is “One of the reasons I weigh myself is if I start going up, I want to know early so I can do something to catch it rather than get on the scale and say, oh, my God, 20 pounds. Where did that come from?”

Holly Wyatt:
So it's a feedback mechanism. And what I think is interesting, when we talk to the National Weight Control Register, we've done focus groups with them and asked these. They see this as an empowering tool, not something they feel bad about. It's something they use that they're like, OK, I know what to do when it starts going up. Therefore, I want to know when that happens because I'm empowered to be able to do something about it, which is a very different place than a lot of people when they get on the scale, what they think. And I point that out because I do think there's a mind state shift and people in National Weight Control Registry are like, “Yeah, I want to get on. I want to know what's going on. I can do something about it.”

James Hill:
Question eight, Holly. What's the single most common form of physical activity reported in the registry? This is multiple choice. A, running. B, high intensity interval training. C, walking. D, strength training. What's the most common?

Holly Wyatt:
Yeah. So the answer to this is walking or C. A lot of people in the registry do walk as one form. Sometimes they do something else, but walking is the most common. So it isn't running marathons or it isn't doing extraordinary, you know, extremely high intensity. Walking makes up a big significant piece of what people report in terms of their physical activity. And I think this is an important question. Some people don't realize that. They think, oh, I've got to become a person that goes to the gym every day, or I have to be a person who runs marathons, or I have to be a person that goes to CrossFit. You can, but you don't have to. And people in the registry are successful with walking as their primary.

James Hill:
And a couple of caveats though, Holly. So they do a lot of activity. They report on average about an hour a day of accumulated activity. Doesn't have to be all at once. And a lot of people, while they use walking, they add some other things along with it. And one of the things that we reported years ago, people in the National Weight Control Registry do more strength training than ordinary Americans. So walking is, it's almost like that's their foundation. Walking is the way to get around. Then they add other things on there to accumulate this hour a day of activity.

Holly Wyatt:
All right, Jim, let's move to question number nine. Do successful maintainers tend to eat differently on the weekends and holidays, or are they relatively consistent? So do they hit it hard during the week and let up on the weekends, or are they consistent throughout?

James Hill:
So this was a question Rena and I were chatting one day, and it came up, and it's like, well, are these people, like, they're regimented, and weekends they take a break, or holidays is time off? And we said, well, let's go in and ask. Guess what we found? They're consistent. They don't take days off. They don't take weekends off. They don't take holidays off. They are consistent. And people who do this in the registry, it's associated with rate regain. So this consistency, and you and I talk about it, habits, routines, rituals. They do it and they do it every day.

Holly Wyatt:
It doesn't mean that they never have a celebration or a vacation, but it's a routine thing. And this kind of gets to something that I've been talking about more recently. When people tell me I need a vacation from my lifestyle, I'm always like, wait a minute, we don't have the right lifestyle going on if you need a vacation from your lifestyle. And so I think that's what the registry is showing. I don't need to change it on the weekends, right? The weekdays aren't bad, right? I'm not, you know. I don't have to-

James Hill:
This is the lifestyle I enjoy and I love it and I do it.

Holly Wyatt:
Right, and that's why I think you see that consistency. It's like “Well I don't need to change it. I may occasionally change it but it's not something I gotta change every weekend.” That's important. That's something people need to think about if you're saying “What i'm doing, I need a vacation from it.”

James Hill:
They establish a lifestyle they're happy so they don't need to take off the day from.

James Hill:
All right. Here's one holly.

Holly Wyatt:
Okay.

James Hill:
Most registry members lose their weight using the same diet. Were we able to identify the best diet for weight loss in the registry?

Holly Wyatt:
And that's what you really set out to do.

James Hill:
I thought we were just going to be famous and identify this diet that everybody should be on.

Holly Wyatt:
The key diet, the most important diet.

James Hill:
What did we find?

Holly Wyatt:
No, there was not one diet for weight loss. There were multiple diets. There is no single diet that was identified by the Weight Control Registry. In fact, that's one of the key findings, that there wasn't one diet. And so to kind of start to move away from this idea that there's only one way to lose weight when it comes to a diet, I think part of the registry really, the science behind the registry helped push that forward.

James Hill:
Well, it's really where I began to learn that weight loss and weight loss maintenance were different because there was no consistency in how they lost weight, but a lot of consistency in how they kept it off. So the strategies for losing weight weren't linked to successful strategies for keeping weight off. So that's the first time that I began to say, “Wait a minute, there's different processes here.” Losing weight and keeping it off are very different. And the registry has reinforced that. And Holly, before we leave the registry, one of the things I want people to understand is something like 95% of people in the registry tell us their quality of life is so much better now than before they lost the weight. So back to your idea. These aren't people that are just hanging on and they've achieved a lifestyle they have to take breaks from and vacations from. They've achieved a lifestyle that lets them maintain their weight, but also has improved their quality of life.

Holly Wyatt:
Yes, yes. All right, are we ready for segment three?

James Hill:
Let's do it.

Holly Wyatt:
Maintenance myths. What do we really know? All right, question 11, Jim. What fraction of people who lose a meaningful amount of weight actually keep it off long-term? I'm going to give you that one. That's a hard one.

James Hill:
Well, we've actually done some work on that. One of the things you hear is 95% of people who diet fail. It's all in how you define it. We don't have a good measure of weight loss maintenance. And as you and I have said over and over, it's not as simple as, oh, you go down, you reach a weight, you keep that weight forever. It's much more messy. You gain weight, you lose weight, you lose some, you gain some back. Rena and I actually went out and did a national survey. And we asked how many people in this just random telephone survey had achieved and maintained a 10% weight loss. And it was about 20% of people. So 95% is too harsh. People are succeeding. But the sad part is more people still fail than succeed. And that's why weight loss maintenance is still a major challenge for us, especially in the GLP-1 era. We now can produce weight loss. The question is, can we keep it off? And right now, there's no indication that most people losing weight are successful keeping it off in the long term. Hopefully, that will change.

Holly Wyatt:
Right. I think it's going to allow us to look at this a little bit differently and see if those numbers change. But the numbers that we're looking at now, people are regaining the weight because a lot of them are coming off the drugs for different reasons.

James Hill:
Absolutely. And we'll see if people end up staying on the drugs longer and maybe that will help them maintain it. So, lots of interesting research coming up. All right, Holly, 12. True or false, losing weight slowly makes you more likely to keep it off.

Holly Wyatt:
Oh, this is a big one. So what do y'all think, guys? Do you think if you lose it slowly, you're more likely to be successful in weight loss maintenance or not? And I think that there isn't a lot of data to say slow is better. Slow is better in terms of keeping the weight off. Although I think there's a myth out there that people believe that, oh, lose it slowly and you're going to be able to keep it off. I don't think there's a lot of data to support that. I mean, it's kind of intuitive, you might think, but not when it comes to data. There's even been several trials that have actually found that larger early weight losses predict better long-term outcomes. And there's been a little data actually to go the other way. So I would say this is false, that we don't have data to say that slowly makes you more likely to keep it off.

James Hill:
I agree, Holly. I think it's a myth, really. I think there are so many different ways to lose weight. And again, it comes back to, yeah, you can lose it, but are you going to keep it off? I remember when this was just widely believed that slow weight loss was better. I don't think that's well supported with the science.

Holly Wyatt:
And if anything now, I like for people to get a significant amount of weight off early because I think it helps with motivation sometimes to keep going in the weight loss space. So I actually encourage a little bit quicker weight loss up front. So people say, oh, this is working and they feel empowered and they keep going.

James Hill:
All right. We're going to have to speed it up.

Holly Wyatt:
All right. All right.

James Hill:
13. True or false, after two or three years, maintenance becomes automatic and you no longer have to think about it. So does it get easier over time to maintain?

Holly Wyatt:
Well, I think it gets easier, but I think this question is false. It's the idea that you no longer have to think about it. And people come to me all the time and say, “When will I no longer have to think about getting my exercise minutes in or thinking a little bit about what I have to eat?” I'm like, you know, you're probably going to have to think about it somewhat for the rest of your life, for forever. I don't think it goes away.

James Hill:
Well, it's back to the registry. These people get a new lifestyle that becomes automatic. So, you know.

Holly Wyatt:
But it's not automatic. They still think a little, Jim. That's the key.

James Hill:
They think about it. But it's a lifestyle where they have routines and rituals that they do. Yes, it becomes easier. It's interesting. Registry people don't say it gets easier, but they say, “I know I've got it now.” So there's something about this routines and rituals and lifestyle that allow people to be more successful over time and enjoy it, I think.

Holly Wyatt:
Yeah, I don't think they say, oh, I don't have to think about it, though. And that's the point I want to get to people.

James Hill:
They're always thinking about it. Believe me, they're always thinking about it. But it's not that I get up every day and it's just so hard. Yes, I think about it, but I have all these automatic things going on that make it easier for me to stick with my lifestyle.

Holly Wyatt:
Right. I would say that effort may decrease over time. And it's around two years when they say that a little bit of the effort may go away, but it doesn't completely disappear. Maybe that's the best way.

James Hill:
You're not going to not think about it. You're going to think about it.

Holly Wyatt:
All right. Question 14. True or false, regaining weight means the person did something wrong.

James Hill:
Oh my gosh, Holly, this one's easy. No, and we've got to stop thinking that. You're not a bad person if you fail. It's biology. It's environment. There are so many reasons that some people, it's harder for them to lose weight and maintain it than others. Some people have no problem with obesity. There's so much variation, genetics, biology, behavior. It's not a personal failure.

Holly Wyatt:
Yeah. Hopefully people know that now.

James Hill:
All right. 15. Which is a stronger prediction of long-term weight loss maintenance, willpower, or how someone's environment is set up?

Holly Wyatt:
Absolutely, environment.

James Hill:
Right. It's not willpower.

Holly Wyatt:
No, it is absolutely not willpower. It's environment. I think environment is critically important, and people don't do enough with their environment to set them up for success. I think that will predict long-term weight maintenance over willpower any day. Once again, it's about making it as easy as possible. So setting up your environment to help you, not for you to have to use willpower to push back against your environment.

James Hill:
All right. So let's do segment four.

Holly Wyatt:
Okay.

James Hill:
GLP-1 era. Does everything change? Do the old lessons apply?

Holly Wyatt:
Yeah.

James Hill:
So Holly, what happens to body weight on average when people stop a GLP-1 medication?

Holly Wyatt:
Well, I hope our listeners know this for sure. if you stop a GLP-1 medication, and I'll put a caveat, and you don't have a plan, most people gain a substantial amount of the lost weight back. We don't necessarily have numbers. We have different numbers in different situations. But I think in general, I think there's good data to show that people are gaining anywhere from all of it back to two-thirds of it back. But the majority of it comes back when you stop the medication if you don't do anything else to prevent that.

James Hill:
And that's why we wrote the book to say, look, you've got to have a plan. If you stop the medication without a plan, you're going to regain the weight. The plan gives you a chance. So you still have some challenges and we talk about that in the book, but it gives you a chance of not regaining the weight. All right, a follow-up. Does weight regain after stopping the medication mean the medication failed?

Holly Wyatt:
No, we've talked about this so many times that the medication only works while you're taking it. You stop the medication. You would not expect the medication to be having the effect. The medication didn't fail. That's just how the medication works. I think people are starting to understand that just like a high blood pressure pill or a pill for blood sugar. If you stop taking it, the impact goes away. The impact on your weight goes away if you stop taking the medication.

James Hill:
The appetite comes back. The food noise comes back. It's funny. We talk to people on the meds. They're saying, oh, this is great. I don't need the meds anymore. Well, because the meds are working. Then you stop them. All this comes back.

Holly Wyatt:
Now, it is a little different than other medications that it takes a while. It's not as immediate of an impact. And to gain weight will take longer than your blood pressure can go up in a few days. Your weight isn't going to return in a few days. So it's a little bit different time course, but in general, I think you can think of it the same way. So question 18, Jim, we just got a couple more.

James Hill:
We're getting there.

Holly Wyatt:
True or false, weight loss on a GLP-1 medication is mostly fat with only small amounts of lean tissue loss?

James Hill:
This one is false, but it's really some interesting stuff going on. So anytime you lose weight, even without the meds, some of your weight's going to be fat. Most of it's going to come from fat, some from lean mass. But lean mass is a combination of muscle, connective tissue, and other kinds of things. So we've always divided weight loss into fat and lean mass. Now we're much more interested in muscle. So the newer studies are like actually looking at muscle loss. With GLP-1 meds, you lose a lot of weight, you lose a lot of fat, but you also lose a lot of muscle. Now back to the question we did before, are you losing what we do expect or more than what you would expect? And this is the question that we haven't totally answered. But because people are losing 20, 25, 30% of their body weight, they're going to lose a lot of muscle. Now, is that appropriate or inappropriate? We don't know for sure. But the more muscle you have, the easier it is to keep weight off because muscle burns calories that allows you to do physical activity. So this is genuinely a really important area of interest. But we know for sure it's not all fat. You're going to lose a lot of muscle. And we talk about the things you probably can do to minimize that is a little bit higher protein and resistance exercise.

Holly Wyatt:
And I think the key was what is a lot? And that's what we're trying to kind of say. And it's really probably a percentage. You lose a certain amount of weight, a certain percent of it. You want more than 50% of it to be fat. And then what percent of it might be muscle or lean tissue, depending on how you're evaluating it.

James Hill:
When you gain weight, Holly, you gain extra muscle. So when you lose it, it's not surprising you lose some, but do you lose more than you would expect? And that's what we don't know.

Holly Wyatt:
Yep.

James Hill:
All right. When should someone taking a GLP-1 medication build their maintenance behavior?

Holly Wyatt:
Oh, we got multiple choice for this one. Multiple choice.

James Hill:
A, once you reach your goal weight. B, when you start reducing your dose. C, after stopping the medication. Or D, while you're actually taking the medication.

Holly Wyatt:
So I feel very strongly about this answer. You need to build your maintenance behaviors while you're taking it. That's when you can put some of the maintenance pieces in place. People always say I'll wait until I'm going off the meds or I'll wait until I've lost all the weight or wait until I start coming down on my dose. And I'm like, no, no, no. Let's start planning. Let's begin with the end in mind. Let's start putting these maintenance behaviors in place while you're on the medication.

James Hill:
Yes.

Holly Wyatt:
Not to help you with the weight loss. And that's what they sometimes get confused. Not because I'm putting these in so that you lose more weight. I'm putting these in specifically for you to maintain, but I'm doing it while you're losing the weight.

James Hill:
Very important. Okay, here's the last one. When is someone most vulnerable to weight regain during medication-assisted weight loss? A, during the first few weeks of treatment. B, when weight loss begins to plateau. C, during the transition, when medication is reduced, interrupted, or stopped. And D, after they've maintained their new weight for a year. When are they most vulnerable to regain?

Holly Wyatt:
[42:34] All right, Jim, I know you know this.

James Hill:
During the transition.

Holly Wyatt:
Absolutely.

James Hill:
While you're taking the meds, seems to be great. Even if weight plateaus on the meds, the meds are still working. But it's when you reduce them or stop them or interrupt them, boy, the effect of the meds go away and you're fighting this biological drive to regain weight.

Holly Wyatt:
Yeah, I think that's when you are the most vulnerable. So recognizing that, I think, is important. And I think a lot of times people get it backwards. They put a lot of support around when they're starting the meds, when they're losing the weight, and then they feel like they've done it. And then, ooh, the critical period is coming, the transition, and they're not really putting their support into that time or not thinking about, you know, having a plan during that time.

James Hill:
We talk about the complete weight journey, and this transition phase is a part of that. People think of weight loss and weight loss maintenance, but however you lose the weight, there's this transition from weight loss to weight loss maintenance, an important phase to not forget. Oh, Holly, we did it.

Holly Wyatt:
We did it.

James Hill:
Do we have time for one or two questions.

Holly Wyatt:
I don't know that we have time for any listener questions and we've been asking a ton of questions anyway. Let's do rapid fire. All right. So, Jim, most underrated maintenance behavior?

James Hill:
Physical activity.

Holly Wyatt:
I knew that.

James Hill:
Most overrated maintenance strategy.

Holly Wyatt:
So you were underrated. I'm overrated.

James Hill:
Okay.

Holly Wyatt:
So I'm going to say finding the perfect diet.

James Hill:
Okay, fair enough.

Holly Wyatt:
All right, Jim, daily weighing, weekly weighing, or never weighing? Which would you choose?

James Hill:
Daily weighing.

Holly Wyatt:
Yay.

James Hill:
All right, Holly, better for maintenance, running or walking?

Holly Wyatt:
Ooh, I will say whichever one you enjoy doing and still will be doing three years from now.

James Hill:
Okay.

Holly Wyatt:
All right, what's worse, regaining three pounds or refusing to get on the scale because you're afraid you've regained three pounds?

James Hill:
The worst thing is not knowing. If you don't get on the scale, you don't know.

Holly Wyatt:
You can't make a choice. That's the worst thing, right?

James Hill:
All right. One thing everyone should build before active weight loss ends.

Holly Wyatt:
Easy. Their maintenance plan.

James Hill:
Yes. You can't forget that one.

Holly Wyatt:
One thing you've changed your mind about after 40 years studying weight management.

James Hill:
How powerful the biology of weight is. The meds have shown us that.

Holly Wyatt:
Yeah.

James Hill:
Yeah. All right, Holly. One thing you haven't changed your mind about.

Holly Wyatt:
Behavior still matters. If anything, I think it matters more, not less.

James Hill:
Nutrition, physical activity, behavior. The meds can't do it all.

Holly Wyatt:
Yep. All right, Jim. Finish this sentence. Successful maintenance isn't about perfection. It's about?

James Hill:
Responding.

Holly Wyatt:
Ooh, good one.

James Hill:
All right, we did it.

Holly Wyatt:
Yes.

James Hill:
Okay, I think we're about at the end here. I hope people enjoyed this. One of the things that we stress over and over and over is weight loss maintenance is different from weight loss. And with the medication era where people are really, really succeeding at weight loss, we have to get better at helping people keep weight off.

Holly Wyatt:
Agree. I always say if you could be an expert at only weight loss or weight loss maintenance, which one should you be an expert on? When should you be able to answer all these questions?

James Hill:
Yes.

Holly Wyatt:
Weight loss maintenance, for sure.

James Hill:
Weight loss maintenance. It's the challenge. It's going to be what really defines your success. So thanks, everybody. And we'll see you next time on Weight Loss And.

Holly Wyatt:
Bye, everybody.

James Hill:
And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:
If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

James Hill:
We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at weightlossand.com. Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:
And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.