Ten Key Decisions That Shape Your Weight Loss Success

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, today we're bringing back one of our favorite kinds of episodes, or at least one of my favorite kinds. And I think it's one of the kinds of episodes that our listeners seem to love, too.

James Hill:
Yes, it's a top 10 countdown. We haven't done this one in a while, Holly, so this will be fun.

Holly Wyatt:
I don't think we've done it in 2026, Jim. We did a bunch of them in 2025.

James Hill:
Yeah, I love top 10 things.

Holly Wyatt:
We have a lot of fun ones out there. We have, I was looking back, we did Top 10 Barriers to Reducing Obesity in our Society. We did Top 10 Common Mistakes People Make When They Start the Weight Loss Meds. We did Top 10 of your Burning Weight Loss Questions Answered. So I think this is a fun way to do these podcasts and y'all seem to like them. So if you like today's episode, there are more top 10s waiting for you in Weight Loss And archives.

James Hill:
But today may be one of our most important ones, because what we're talking about are 10 decisions that can determine whether your weight loss journey actually works.

Holly Wyatt:
Yes, decisions. That's the key word there. People spend, I think, a lot of time, a tremendous amount of time. What should I do to lose weight? What's the best approach? Should I exercise more? Should I take a medication? What should I change about the way I eat? And those are important questions, but there are some bigger decisions underneath them.

James Hill:
There really are. Questions such as, what are you really trying to accomplish?

Holly Wyatt:
Yeah.

James Hill:
How are you going to define success? We talk a lot about that. And you know, this is something I feel very strongly about. Success is not a number on the scale.

Holly Wyatt:
And it's a decision.

James Hill:
It's a decision. What treatment approach makes sense for you? And now the fun thing is we have many options to choose from. And here's the big one, Holly. What are you willing to change long-term?

Holly Wyatt:
Yes, definitely. Because you can have the best treatment plan. You can have the newest medications. You can have all the information in the world. But if you haven't made some of these bigger decisions, you can still end up right back where you started.

James Hill:
And you're going to make these decisions whether you realize it or not.

Holly Wyatt:
That's key. That is key. You can make them intentionally, which is what we're proposing you do. You can make them based on science and what matters to you. Or you can let the scale, you can let social media, you can let your friends, your past experience or whatever happens that day, make them for you.

James Hill:
Ooh, that's not good. And you know, these aren't just decisions for someone who's starting to lose weight. If you're already losing weight now, if you're taking a GLP-1 medication, if you're working to maintain your weight loss, if you're struggling to avoid weight regain or wondering whether your current plan is still the right one for you? Hey, you're in luck. Today's countdown is for you.

Holly Wyatt:
Because I think somewhere in these 10, you're going to hear one and think, “Wait, I never actually decided that.” And that decision might change what you decide to do next.

James Hill:
So we're asking people to make 10 decisions today, Holly. Is that it?

Holly Wyatt:
Yeah, 10 decisions that they probably haven't thought about, but we think are critical. And you want to make them intentionally, not by default.

James Hill:
So we've ranked all 10. And let's just see if Holly and I agree by the time we get to number one.

Holly Wyatt:
Well, Jim, we kind of put these together. We do kind of agree, although I think we...

James Hill:
You mean we actually put some thought into these episodes before we do them?

Holly Wyatt:
And I think we came to consensus, which is amazing. What I want the listeners to realize is what is number one? If they had to predict what we would say was number one right now, I think they would get it wrong.

James Hill:
Oh, interesting. Well, you can think about that, listener. Or what do you think our number one's going to be and see if you get it right?

Holly Wyatt:
And how well do you know us? Because if you know us well, I think you're going to go in one direction. And we actually went in a little bit different one.

James Hill:
Oh, interesting. They all bait and switch.

Holly Wyatt:
Yes.

James Hill:
All right, Holly, number 10. What's the first decision?

Holly Wyatt:
All right. This one may sound a little strange coming from two people who host a podcast called Weight Loss And, but the first decision that I think you need to think about is, do I actually need to lose weight?

James Hill:
That's a pretty important question to answer before you start trying to lose weight.

Holly Wyatt:
And I think people don't always really stop to think about that, really think about, is this something they need to do? A lot of times they think, yes, of course. But really stopped and really thinking about, do I need to do this?

James Hill:
So maybe you start with, what's my reason for wanting to lose weight?

Holly Wyatt:
Yeah, that kind of gets you there.

James Hill:
Do you think a lot of people stop and think that before they jump into a program?

Holly Wyatt:
I don't. I think there's underlying, there is a reason there, but they don't spend enough time on that to really make sure that that reason makes sense.

James Hill:
They don't dive deep.

Holly Wyatt:
Yeah, yeah.

James Hill:
Okay.

Holly Wyatt:
And I think that, you know, we've become really accustomed to assuming that everyone with a BMI above a certain number should lose weight. We've taught that, right? BMI of 30, you need to lose weight. Is that always true, Jim?

James Hill:
Well, there are plenty of reasons to lose weight, Holly. One of the ones you see in our world a lot of time are health reasons. Everybody focuses on health reasons. But desire to lose weight can be driven by parents, by comparison, by social pressure. It can be even people think there's an arbitrary number they need to get to. So there are many, many facets to this whole decision of why you want to lose weight.

Holly Wyatt:
And if you've listened to at least me long enough, you know that I'm not just about the medical reasons, the health reasons why you want to lose weight. I think those are very important and a lot of we need to think about those. But I also think that personal, I want to lose weight for some of these personal reasons that you were talking about are important too.

James Hill:
Perfectly fine. It's a perfectly fine reason to lose weight. You want to look better. You want to feel better. We're not judging, but what we are saying, it's worth making a decision about the reasons. And you don't have to share that with anybody, just internally understand why you're doing this.

Holly Wyatt:
And I guess for me, it's more like, don't just make a knee jerk, I need to lose weight. Really think about, do I need to lose weight? Why do I need to lose weight? Understanding the reasons behind it instead of just assuming it because of a number or even because someone told you to or because you think society expects it of you. I think really diving deep into doing that. And here's a question for you, Jim. When might weight maintenance rather than weight loss be the better goal?

James Hill:
Oh, Holly, I spent a good part of my career saying if we could just help people avoid gaining weight, the benefits of the population would be tremendous. So for some people, just avoiding weight gain, keeping the weight you have is a very reasonable goal and very worthwhile goal for all the reasons we talked about.

Holly Wyatt:
Yeah. So I think we start off with, do I actually need to lose weight? Make that decision. All right, Jim, are we ready for number nine?

James Hill:
But maybe, maybe what you do is rather than start out saying how much weight should I lose? Start by saying, what am I hoping weight loss will improve? What am I looking for from weight loss?

Holly Wyatt:
Yeah.

James Hill:
Okay.

Holly Wyatt:
Yeah.

James Hill:
All right. We got to roll here. We're going to get through 10. What's number nine, Holly?

Holly Wyatt:
All right. Coming in at number nine. This is a good one. What does success mean to me? Here we are talking about decisions that determine if you will be successful, right? Your weight loss success. Well, you've got to determine what success is, you need to think about what is success to be successful.

James Hill:
So oftentimes people will start by saying, “I want to lose 30 pounds. I want to weigh 150. I want to get back to what I weighed in my 30s. Is that really what success means to you? Or is it what comes with achieving those goals?

Holly Wyatt:
Yeah, you can have a goal weight, but a goal weight and a successful outcome aren't necessarily the same thing.

James Hill:
Yeah, that's right. There are a lot of ways to define success. Again, a lot of people look at it as a health thing. Are you improving your glucose control, your A1C, or your blood pressure? Are you getting off diabetes medication? Are you improving sleep apnea? Are you reducing pain? Do you want to be stronger and fitter? Plenty, plenty of health reasons, but there are other reasons too, Holly, that relate to quality of life.

Holly Wyatt:
Yeah. So what are some other things that people could consider? So it's really making it broader than just about the weight and what the weight's tied to and really spending some time with this question, what does success mean to me, I think is important to whether you will have success at the end of this journey.

James Hill:
And you can have some success with fairly modest weight loss. We talked about all these medications that produce 20, 25, 30% weight loss, but you can improve a lot with 5 or 10% weight loss.

Holly Wyatt:
You can. And so recognizing that and putting some other things on the table. So other things people talk to me a lot about, they want to be able to do something they can't comfortably do today. Something that's important to them. And so it's an individual goal. I want to be able to do this. I can't do it or I can't do it very comfortably. And I would love to be able to do it and feel good while I'm doing it or do it better. And it's something that really has meaning to them. Well, that's huge success.

James Hill:
So those are quality of life issues that may not be directly tied to how much weight you lose, right? And I think those are the real motivations that keep people going rather than just looking at the number on the scale. Being able to get out, and walk around your neighborhood, be able to play with your kids or your grandkids, be able to hike up a mountain. Those are things that people really value.

Holly Wyatt:
And so making that decision early, I think, is important. And I've said this many times on this show. If you got on the scale and that perfect number popped up, but nothing else in your life changed, would that be success?

James Hill:
Yeah.

Holly Wyatt:
And everybody, most people say no. No, because that number is tied to something bigger. And spending some time making that decision about what that is, I think, is associated with being successful in your journey.

James Hill:
So don't let the number on the scale be your definition of success. Decide what you want weight loss to do for your health, your life, and measure your success not by the scale, but by whether you're achieving those goals.

Holly Wyatt:
All right, Jim.

Holly Wyatt:
Take us to number eight.

James Hill:
Coming in at number eight, and this is a good one, Holly. What treatment approach is right for me? Okay, you've gone through the decisions, you understand why you want to lose weight, you understand what your goals are. So what do you do? What's the treatment you choose? And now more than ever, there are so many opportunities. There are behavioral opportunities, there are medication opportunities, there are surgery opportunities. I think one of the ways that our field has come together is to agree there's no single best way to lose weight for everybody. You have options on lifestyle, on medications, on surgery, or any combination of those approaches. So, Holly, given all this, how the heck do you figure out a treatment program?

Holly Wyatt:
You got to spend some time. That's why it's one of these questions that helps determine success are decisions you got to make. I think you have to think about the severity of the obesity, how much weight you may need to lose, your health risks, complications, your previous treatment experience, preferences, cost, all kinds of things kind of come into this. This is why this is a big decision that I think determines your success. There's now, like you said earlier, the availability. We have so many more options that now this becomes even a bigger question and figuring out which one's going to be right for you.

James Hill:
You know, Holly, in our book, we have a whole chapter on preparing for weight loss. The idea is people go into it. Okay, I've decided I'm going to start losing weight. Here's a diet I'm going to go. We go through a whole bunch of things for people to think about. And one of the big, big mistakes that I think a lot of people make is they think short term and not long term. This is not a short process. You are committing to really a lifelong kind of change. And it's worth taking some time right at the beginning to think through those kinds of things. What's your life circumstances now? As you always say, if you're an accountant and it's tax season, it's not a good time to start. What's your next few months look like? What are you willing to do? What's your life situation? What are the unexpected things that could come up? All these things, it's worth just taking a little while before you start and making these decisions on what can you do, what are you willing to do, what's feasible given your life.

Holly Wyatt:
Right. Making them strategically, purposefully, because you're going to make them anyway. So these decisions are going to happen. It's whether you play a role in it or not, which I think is that critical piece. The other thing I was going to bring up is, we have the new medications and they've, I think, expanded the possibilities of the treatment approaches. But I'm telling people, you know, the newest or the most powerful treatment isn't automatically the right treatment. And that's kind of the, sometimes the default people say, “I'm not even going to think about the treatment. I'm just going to do the most powerful or the newest.” And I'm like, no, no, no. This is where this decision becomes important.

James Hill:
If your goal is to lose 10 pounds, you might not want to go out and get one of these hot new medications that have some potential to produce 30% weight loss. So again, there are plenty of people that would like 30% weight loss, but it's not a one size fits all. We have lots of tools that can help you with 5% to 10% weight loss without meds. Combining some meds and lifestyle can do higher. Wonderful time to begin to mix and match tools.

Holly Wyatt:
Right. And it doesn't have to be default. Like, “Oh, I have to do this because this is what everybody's doing.” No, you get a choice in the matter if you decide I'm going to make this decision. And the other point to make is you can start with one approach and adjust or change treatment. Some people are like, what if I make the wrong decision? We can adjust. It doesn't have to be what you decide with the best evidence that you have at the beginning, the decision you make at the beginning. It can change over time.

James Hill:
Right. So don't just ask what's the best weight loss treatment. Ask what's the best treatment for me for the outcome I'm trying to achieve at this point in my journey. So that's the decision. Given where you are with your life, your goals, your situation, what you're trying to achieve, what's the best place to start right now?

Holly Wyatt:
Right. And number nine, we talked about success. So it's really what treatment is going to give you the success you've identified in the prior question.

James Hill:
All right. Number seven, Holly.

Holly Wyatt:
All right. Number seven. This is a good one, Jim. I think this isn't going to shock people.

Holly Wyatt:
But number seven decision, what am I willing to change long term?

James Hill:
Yeah.

Holly Wyatt:
You talked a little bit about this already. We couldn't help ourselves.

James Hill:
You and I talk more and more, we use the term weight loss journey because what we've realized is people have always focused on, I want to lose weight, I want to keep weight off. What we are looking at is the complete weight loss journey. That's gaining weight, losing weight, successful, unsuccessful, keeping it off, etc. And what we need to think about is support for that entire journey. Losing weight is only one part of that journey. And you have not succeeded when you've lost weight because even in this day and age of the medications, Holly, most people who lose weight regain it. So you have only achieved step one. If you lose weight, there's more to go. And actually, the fun part is keeping it off and enriching your life and so forth.

Holly Wyatt:
So I love that. The fun part is keeping it off.

James Hill:
I used to say it's hard, but you convinced me that it's the fun part.

Holly Wyatt:
I know.

James Hill:
But it really is. it's the fun part because you get to change your life. You get to almost reinvent yourself. So weight loss is important, but one of the great things that I love about what's happening right now, Holly, we have wonderful tools for weight loss. Now our challenge is long-term and the decision is, yes, you can lose the weight without having to think about long-term change, but you're going to regain it unless you think about what you're willing to do over the long term.

Holly Wyatt:
Yeah. This kind of fits with what we say, begin with the end in mind.

James Hill:
Right.

Holly Wyatt:
And I don't want people to be confused. We're not saying what you do to lose the weight, you've got to be willing to do long term.

James Hill:
Right.

Holly Wyatt:
Because some of the things that produce the weight loss are not necessary or the best strategy when you get into weight loss maintenance. But we are saying you need to think about that and realize what you're doing before you lose the weight. The patterns, the strategies, the behaviors, whatever you're doing, you can't go back to that. You are going to have to make some long term changes specifically and to make that decision. What am I willing to change long term that is associated with success? Because if you're not willing to change some things long term, you're not going to probably be very successful if you're not willing to change anything. So what are you willing to change to start making that decision early so you don't just lose the weight and regain it? Because that's not success.

James Hill:
Yeah, and it's a little depressing, Holly. Oftentimes when we talk to people that are starting a weight loss program and say, what's your long-term plan? My plan is just to lose weight. They aren't thinking about a long-term. And again, with these new medications and new tools, you are going to succeed. So if you're starting weight loss, assume you're going to reach your goal or reach a good weight. Now what? What are you going to do to keep it up?

Holly Wyatt:
So people who I talk with know this. I'll ask them this question and they'll say, I'll deal with it when it's time or I'll deal with it once I get the weight off. And I'm like, no, no, this is one of those decisions we need to talk about now. I think it's associated with your long-term success. So let's not put this off because this is important now. Because one thing we want to start making sure, what are you willing to change and putting that into place so it's ready when you need to maintain the weight that you've successfully lost.

James Hill:
So you don't have to do forever what you did to lose weight, but you do need to keep the end in mind and be ready to build a different strategy for keeping it off.

Holly Wyatt:
And to think about it now.

James Hill:
Think about it now.

Holly Wyatt:
Don't have that tendency to push it away.

James Hill:
Don't say I'll deal with it when it comes up because you will fail unless you have planned for it.

Holly Wyatt:
I've seen that too many times. Let's plan now. All right, Jim, I'm going to do number, what are we on, six?

James Hill:
Six.

Holly Wyatt:
We're on six already.

James Hill:
We got to hustle up.

Holly Wyatt:
This is a new one. This is recent for me.

Holly Wyatt:
This is a decision that I usually, I could say two or three years ago, we didn't discuss. Number six is, how will I protect my muscle?

James Hill:
Muscle is important, Holly. And again, the reason I think this becomes important, we've always known that you lose some weight, you lose some muscle. But with the magnitude of weight loss that we're seeing, massive losses of muscle. Still, most of it's going to be fat. Don't get me wrong. You're going to lose most of it from fat.

Holly Wyatt:
Well, we hope.

James Hill:
But if you're losing 30% of your body weight, you're going to lose some muscle. And so we have rethought strategies that we can do to minimize loss of muscle.

Holly Wyatt:
And I think why this wasn't in my top 10 five years ago is because we weren't producing as much weight loss. We were striving for 5, 10, maybe 15%. And so it just wasn't as high on my radar screen because there weren't that many people where we really had to think about this. But now the game has changed. We have these medications that are going to, you know, producing 20% and some that are coming that will produce 30% in a lot of people. So now this becomes something that you need to think about that we think this decision up front helps determine whether you're going to be successful.

James Hill:
Yeah, we've talked to a lot of experts in this area. We've done some podcasts on this. And the big thing right now is protein, protein. You get protein everywhere. All the food companies are putting protein in everything. And that's probably pretty good. But again, when we talk to some of the experts, it's like the protein alone may not be enough. Protein gives you the fuel, but you've got to have the impetus to use that for muscles, and that's resistance exercise. And so I think still the best advice to minimize muscle is a little higher protein intake combined with resistance exercise.

Holly Wyatt:
Right. So determine this up front. Say, I am going to pay attention to what I'm eating while I'm losing weight. And I'm going to stress my muscles, which is resistance training, right? Do some specific exercises to try to minimize. You're not going to probably completely get rid of the muscle loss, but minimize the amount of muscle I lose. And this sets you up for success. So here's a decision. Okay, here's what I'm going to do. I'm not going to wait till after I've lost the weight to try to deal with this. I'm going to think about it now.

James Hill:
And bottom line is after you've lost the weight, the more muscle you have, the higher your energy expenditure and the greater your chances of long-term success. Keeping muscle is a huge, huge advantage in long-term weight loss maintenance.

Holly Wyatt:
And so this is a perfect decision that you want to be strategic and think about and not let it happen by default meaning whatever I eat and however much I move will produce however much weight I get off and how much muscle I lose. This is where you can be proactive and why I think this is a good one for our top 10.

James Hill:
You know, I've always just been so adamant that exercise is essential for all this. And I think now, even in the era of the medications, exercise becomes important. You don't have to exercise to lose weight on the medications, but exercise can help giving you more muscle after you've achieved weight loss.

Holly Wyatt:
Well, this is a little bit of an aside, but I was just thinking of this the other day. Here we have these medications now that produce weight loss and it becomes to me more nutrition is becoming more important.

James Hill:
Yes.

Holly Wyatt:
And physical activity and exercise is becoming more important. Not less, more.

James Hill:
It's why the medications alone are not the only answer. Wonderful, powerful tools, but you combine the medication with good nutrition and physical activity. Now you've got a plan. You've got a comprehensive plan that's going to help you succeed long-term.

Holly Wyatt:
And what I don't want people to do, Jim, and this is what I'm scared a lot of people are doing, is “I have this drug that produces the weight loss. I don't need to think about my nutrition. I don't have to think about my nutrition to lose weight. I don't have to think about my exercise to lose weight.” But wow, you really do if you want to be successful. I'm worried about that a little bit.

James Hill:
I know, me too. You can't just rely on the meds, which is why prescribing medications is not a comprehensive obesity plan. Part of a plan, but not the plan. So Holly, the decision here, don't just ask how much weight I'm losing. Ask, what am I doing to make sure I stay strong and maintain my muscle while I'm losing weight? And exercise is unavoidable if you want to achieve that.

Holly Wyatt:
Really important decision.

James Hill:
All right, Holly, five. I love this one. I talk about this one all the time. What am I going to measure beside my weight? And again, the number on the scale is not your measure of success. The number on the scale isn't why you're doing this. Body weight matters, losing weight matters, but success is more than a number on the scale. It might be health success, A1C, blood pressure, lipids, all that. It might be how you function, your strengths, your mobility, your endurance, but it also, Holly, quality of life. Are you happier? Just because you reach that number on the scale doesn't mean you're going to be happier. And what we talk about all the time is while you're losing weight, work on some of these other things that are going to help you succeed beyond just the number on the scale.

Holly Wyatt:
And specifically with this decision, decide you're gonna measure some of them upfront. You'll step on the scale, you get that number. And I believe in getting that number. I do think that number is a helpful metric, but I don't think it's the only metric. I think it's one piece of information. So we talked about in number nine, what did success look like for you? Now it's saying, okay, if this is what success looks like for me. If I've dug down and I know what it is in addition to the weight, what can I measure now? Because we like to measure things. We like that we see things change. It's motivational. And so expanding it beyond just the weight and making it very personal to you, what other measures mean something to you. So I talked about being able to do some activity more comfortably. Well, is there a way to measure that? Is there a way to go out and see kind of how it feels or how far you can go if it's to, you know, walk or hike or whatever it may be? Measure it so you can see some change. That, I think, is a decision that will help you be successful if you do it, especially when you first start. Or even if you're in the middle of it, measure it now and follow that over time because that's what's really driving you to want to lose the weight.

James Hill:
So we've always been very out front of we recommend weighing every day to monitor your weight. Is there something else you can measure about life happiness, Holly, that you can just make it routine along when you do your weight every morning, what else you measure?

Holly Wyatt:
Well, we talk about, Jim, in our book and in our programs, I've had a life state measurement where you kind of start in the middle. How is my life going?

James Hill:
Here's your weight today. How's your life doing?

Holly Wyatt:
How's my life going?

James Hill:
Two simple things to just evaluate every morning.

Holly Wyatt:
Yes, a scale to zero to 10.

James Hill:
Write it down. That's the other thing we like is don't just put it in your head. Write it down.

Holly Wyatt:
Which is really what this one's all about is measuring something. Don't just, you know, really measure it because we love to see things change. And even if the scale maybe doesn't change as much as you would like, or maybe the scale slows down or when you plateau, you have some other measurements. In our programs, I create what I call a point A document and a point B document and a point C document, and you measure things all along. And you get to decide, what does my point A look like? What do I want to measure right now? What do I want to change? And then I go back in a few months and measure point B. And guess what? There's a point C. I get to measure again. And I think that is associated with success. People like to see these things that are important to them change in addition to seeing the weight change.

James Hill:
I love this decision. So decide what success looks like for you. Then measure things that can actually tell you if you're succeeding. The scale can be one of them, but it shouldn't be the only one.

Holly Wyatt:
Yeah. Are you getting there? Are you getting there? Yeah. Love this. All right, Jim. Number four, when will I change my plan. And you could say, “Oh, I'll just wait.” No, once again, this is preparing. I want you to be ahead of things. This is associated with success, a decision you can make and think about ahead of time. When will I change my plan? One of the hardest decisions in weight loss is knowing the difference between when I need to just stay on my plan or when I need to change and being willing to do it.

James Hill:
Yeah, this is a good one because again, it comes back to monitoring too and knowing when things are working, when things are not working. So you actually can sort of modify early on if you need to modify. So what should people track in order to do this?

Holly Wyatt:
Weight is one, but I think you can track and just kind of see what's happening over time. You don't want to adjust too soon, but I want you basically to have in your head, what does success look like? How will I make a change at a certain point? I'm not going to just continue this forever. What would make me change course? Actually, thinking about that. If my weight was changing, but my life score wasn't changing, Jim.

James Hill:
Yeah.

Holly Wyatt:
Right?

James Hill:
Interesting, yes.

Holly Wyatt:
Would I change course? My answer would be yes.

James Hill:
It comes back to what your goals are. It's not the number on the scale. The number on the scale might be there, but if your real measures of success aren't, it isn't working.

Holly Wyatt:
So all these numbers kind of work together. All these decisions work together. But if my scale was going down, but my life score was going in the opposite direction, I would say, “Wait a minute. I may need to change course, do something a little different because I'm not really headed to what's important to me.”

James Hill:
So the decision here is to think about don't confuse persistence with staying on a plan that isn't working. You don't have to do that. And again, with so many options, if your option isn't working, there are other ones around. So the decision is decide what success looks like, monitor how it's going, and be willing to adjust if necessary.

Holly Wyatt:
Yeah, exactly. This really works with some of the other decisions that people that we're...

James Hill:
Number three, I love this one, Holly. What do I do when the weight loss stops? There are two decisions. They're related, but they're not the same. Is this treatment producing enough benefit or do I need to change my approach? That's one. The second is my plan has been working, but now my weight loss has slowed or stopped. What am I going to do? And again, people have to keep in mind, weight loss is not a forever process. If you are successful, you're going to lose weight and your weight is going to plateau. That is not failure. That is success. And you really need to be ready then to keep the weight off. And again, you've got some challenges because your body weight goes down. Your energy expenditure goes down because you have a smaller body. You're probably getting hungrier, and you've got to have a plan. So the first thing is, it's not a failure. Your plan's working. Now you have to switch over into a different mode from weight loss to weight loss maintenance. You have to achieve a new energy balance. So a plateau is not necessarily a bad thing if you are at a weight that's at or near your goal, a weight that you want to maintain forever.

Holly Wyatt:
Yeah, I think this is important because this is happening on the new medications a lot, reaching this plateau. And people need to be thinking about ahead, making the decision, this is going to happen because it is, it's normal, right? That doesn't mean the medications aren't working.

James Hill:
And it doesn't mean the drugs aren't working, right?

Holly Wyatt:
Exactly. So what am I going to do? What am I going to do when that happens? Or at least be being aware that this is going to happen and it doesn't mean the drug is failing or you're failing. And what's the real decision going to be? Do I still want or need to lose additional weight? Is it time to maintain? But just being aware of the plateau is I think an important decision to make for your success because so many people don't understand that.

James Hill:
I think a big mistake people make is not being willing to move into weight loss maintenance. They may have lost weight. You may be a little short of your goal, but you just aren't ready to stop losing weight when in fact your body is probably telling you that you've reached a point of a new weight that now you can maintain that weight.

Holly Wyatt:
And so maybe the idea is that recognize that a plateau doesn't automatically mean that you failed. To recognize when your weight loss stops. Don't immediately say, how do I make the scale move again? But before, maybe say, do I need it to?

James Hill:
Yeah. That's exactly right. And again, what we've said in the past is, when you have reached a plateau, hopefully with some success, even though you may want to do more weight loss, try maintaining for a while. If you can't maintain that weight, you aren't likely going to be successful in losing more. You can always come back. Once you're good at achieving energy balance at this new weight, you can come back and decide maybe if it's better to try to lose a little bit more or if you're happy where you are.

Holly Wyatt:
Yeah. So the idea would be thinking, does reaching a plateau, can we think of this as a successful outcome?

James Hill:
Yes.

Holly Wyatt:
Rather than a problem to solve. And I think thinking of it that way is associated with success versus, oh my gosh, I plateaued. It's a problem.

James Hill:
So a plateau isn't automatically a failure. When weight loss stops, there are a number of reasons why weight loss can stop. But don't immediately think how I can make the scale move again. Think, first of all, do I need to? Am I happy where I'm at? Can I maintain this? So that's the decision to be prepared for. If you're successful, you will reach a plateau.

Holly Wyatt:
Yes.

James Hill:
And think about how you're going to deal with that.

Holly Wyatt:
A plateau is success.

James Hill:
It is.

Holly Wyatt:
It can be success.

James Hill:
Number two, Holly.

Holly Wyatt:
All right. This is one that I think everybody probably thought would be our number one.

James Hill:
You mean there's one more to go?

Holly Wyatt:
There's one more. But our number two is what is my maintenance strategy?

James Hill:
Yeah, that's a big one. That's a big one.

Holly Wyatt:
And this is a little different than number seven where we were talking about beginning with the end in mind. This is where I want you to think exactly, start to really put some details around what will maintenance look like when you start losing weight. Not waiting till you get to that part. Being able to recognize that weight management is long term and it's time to start building a maintenance strategy even while you're losing weight.

James Hill:
And again, one of the things that we've been working so hard to help people understand, even our colleagues, is that weight loss maintenance is a very different process than weight loss. It involves different skills. It involves different approaches. Think about weight loss as sort of a short-term thing. You can do all these things with weight loss that aren't feasible long-term when you're trying to live your life. So you've got to have a strategy for weight loss, but your strategy for weight loss maintenance may be different. And in this era, with the new medications, you have some choices. It is perfectly acceptable if you decide to stay on the medications long term. And the data suggests that people that do that are successful. People who go off without a plan regain it. We wrote a whole book on it's possible to lose weight on the meds, keep it off with lifestyle. And then there's the mix and match. I think in the future, we're going to see people maintaining with the combination of lifestyle and medications. But your plan for weight loss maintenance cannot be the same as your plan for weight loss. Even with the medications, you're going to need the diet and the exercise long term.

Holly Wyatt:
I'll take that even a step further. If your plan for weight loss is the same for weight loss maintenance, I would say you're setting yourself up for failure, not setting yourself up for success.

James Hill:
I think we have decades of information to say that people that try that do not succeed.

Holly Wyatt:
Right. Number seven, we talked about what changes are you willing to make long term? Now it's about actually having a plan for those changes. Our book, I think, is a great place to start because it isn't one plan for everybody. You need to really think about what you need. But what we know is you need a plan.

James Hill:
Yeah, and the other thing is, you know, I've always been frustrated because there are plans, as Ross Perot would say, under every rock for weight loss. You can go on the Internet. There's tons of stuff for weight loss. We don't have enough help and information for weight loss maintenance. But, Holly, I think that's going to change because with the success of these medications, we're going to see a whole bunch of people achieving their weight loss goals. But they are going to regain it unless we help them, give them support. And this needs to be long-term support because weight loss maintenance is lifelong. So we need to give people support for that part of their journey. And weight loss maintenance is not one plan. There are different kinds of support you need early on versus later on after you've developed new habits and routines. This is where I think our field needs to go. We need to develop more support for helping people keep weight off.

Holly Wyatt:
Well, I think you make a good point. Weight loss maintenance evolves. It's a longer period of time than weight loss. Weight loss maintenance is years.

Holly Wyatt:
It's forever. So it would make sense that it evolves. Your first year might look different than your second year, your third year. You might have a period where you regain, you go back into weight loss and come back into weight loss maintenance. And that's normal. The other thing I tell people is expect maintenance to require some experimentation. It's not just here.

James Hill:
One size doesn't fit all. In our book, we give people a lot of things to try, but we say right away, this one may not work for everybody. Try them. Find out what works for you. Keep the ones that work. Get rid of the ones that don't.

Holly Wyatt:
Maintenance is something you learn.

James Hill:
You learn, and it's an ongoing process. So don't wait for regain to decide how you're going to maintain. Build your maintenance strategy while things are going well. That's a big one. Don't build it after you've stopped and you regain it. Build it while things are going well. Know your range, know your triggers, and know what you're going to do if the scale starts to move in the wrong direction.

Holly Wyatt:
Absolutely.

James Hill:
All right, we're ready for number one. I'm going to let you do it.

Holly Wyatt:
No, Jim, it's your turn. Your turn. You get to do it. Number one, drum roll. Not what I think what people would expect us to say.

James Hill:
Number one, the decision to make is who am I becoming? Wow, Holly.

James Hill:
This one, we have learned so much about this one that it is absolutely, I think this is the most powerful, positive impact of weight management. You can become someone that you've always wanted to come, that makes you happier, that makes your quality of life higher, you have the potential in a way to reinvent yourself.

Holly Wyatt:
Yeah. The question to ask here, the decision to make or the question to think about is, who do I want to become?

James Hill:
Yeah.

Holly Wyatt:
And how does managing my weight fit into that life?

James Hill:
Yeah, I remember, you and I worked for a couple of seasons on that reality show, Extreme Weight Loss. And in the two years we worked with these people, over a year, they lost half their body weight, 50%. And we always asked them what their biggest success was. And we were kind of amazed. Weight loss was never number one. It was up there. But it were things like, I got my life back. I work better with my family and friends. I'm who I am on the outside now that matches who I've been on the inside. These are things that have nothing necessarily to do with the number on the scale. Yeah, the number on scale is part of it. But the success is not the number on the scale. It's who they became. And they essentially, every one of them became a happier person.

Holly Wyatt:
Yeah, I agree. It isn't about becoming a different person because you lost the weight.

James Hill:
Right.

Holly Wyatt:
That's not it. It's about deciding what kind of life you want and creating that as you're losing the weight as part of it.

James Hill:
That's the one thing you've always said is don't wait. People say, once I lose the weight, I'm going to da-da-da. What you've always said is no, start doing that right away because that actually helps you lose the weight. It works both ways. As you're improving your life and becoming a different person, that feeds back and helps you be more successful at weight loss.

Holly Wyatt:
Exactly, they fit together. But so many times it's like, “I'm gonna get the weight off and then see what type of person I create.” No, you get to create. This is who you wanna be, who aligns with you, what's important to you. Maybe you wanna be someone who's physically active. You like that identity. Maybe you want to be someone that has energy to travel, to play with your grandkids, to feel strong, there's so many things that you can become that you that have meaning to you.

James Hill:
And that's driving over time. You can even get better and better and better. And we see that in people in the National Weight Control Registry. I think almost to a person, they tell us they're way happier now than they were before they lost weight. And this changes positively over time.

Holly Wyatt:
So the question I ask people, how does the person I want to be live?

James Hill:
Wow, that's a powerful one.

Holly Wyatt:
Yeah, but it tells you a lot.

James Hill:
It does. So number one decision is think about who you want to become.

Holly Wyatt:
All right, Jim.

James Hill:
Wow. Okay, Holly, we got through all 10.

Holly Wyatt:
We did. Why don't you count it down a little bit? Bring the entire countdown together, Jim.

James Hill:
All right. So coming in at number 10, do I actually need to lose weight? Coming in at number nine, what does success mean to me? Coming in at number eight, what treatment approach is right for me? Number seven, what am I willing to change long term? Number six, how will I protect my muscle? Number five, what am I going to measure besides weight? Number four, when will I need to change my plan? Number three, what will I do when weight loss stops? Number two, what is my maintenance strategy? And number one, who am I becoming? Wow. Ten good ones. I hope this helps because this is a way of thinking about your journey in a way that helps you prepare for what's coming down the line.

Holly Wyatt:
I think these are not the questions people think they could ask themselves or decisions they think they could make, but I think these are the ones that are associated with your long-term success.

James Hill:
So let us hear from you. This is an episode we'd love to get your feedback on this. What do you think about this? And do you agree with Holly and I's number one? But we'd love to hear feedback. Have you gone through this? Have you faced these decisions? Let us hear from you 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.