Why Losing Weight Might Not Make You Happier

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, the last few episodes, we've been testing some assumptions about what happens when people lose weight on the new GLP-1-based medications. First, we talked about if you're eating less on the medications, are you actually eating better?

James Hill:
Yeah, and then we talked about if you're losing weight and movement gets easier, are you actually moving more?

Holly Wyatt:
Yeah. And today, we want to ask a question that I think may matter more to, or may matter the most, maybe, to the person losing weight. Are you actually happier?

James Hill:
Well, as you know, this is right up my alley. I love this stuff. That's what people are hoping for, even if they don't always say it that way.

Holly Wyatt:
Exactly. They say, “I want to lose 40 pounds.” That's what they say. But underneath it, when you really peel down, it comes down to, “I want to feel good about myself. I want to enjoy going to places I haven't been going. I want to stop letting my weight hold me back.” Under that, “I want to lose 40 pounds” is so much stuff.

James Hill:
Yeah. And the weight loss gold often comes with an expectation about how life will feel afterwards.

Holly Wyatt:
Right. And now we can help people lose amounts of weight that were much harder to achieve before. So, do those expectations come true?

James Hill:
Well, you'd hope so, Holly, but how do we test that?

Holly Wyatt:
Well, there is a new study in the BMJ.

James Hill:
Aha, new study, love it.

Holly Wyatt:
We found one that starts to look at this.

James Hill:
British Medical Journal.

Holly Wyatt:
Yeah, you know, getting a little bit of a signal, like we were trying to do with the diet and the movement, you know. So the BMJ looked beyond how much the weight, beyond just the pounds lost. They looked at that, but they also examined in this study the quality of life and how that changed over time.

James Hill:
And that isn't exactly the same as happiness.

Holly Wyatt:
No, it's not. But I think it gets us closer to the question. Is your life getting better as your weight goes down?

James Hill:
Oh, what a great question. And what did they find?

Holly Wyatt:
Well, let's look at it. That's what this episode is going to be about. Because if we're getting better at helping people lose weight, we need to understand what that weight loss is actually doing for their lives.

James Hill:
We talk about this all the time. What is the real measure of success? Is it a number on the scale?

Holly Wyatt:
Yeah, and it's not. I know that people think it is, but it's not. So I think it's important that we measure the number on the scale. I think that's important, but we need to be measuring this: is your life getting better? Happiness, other things like that, because that's really what's driving a lot of the weight loss.

James Hill:
So tell us about this paper, this new paper in the British Medical Journal.

Holly Wyatt:
Yeah, so this was a paper published in BMJ. Okay. Let's see. The Nong and colleagues did it. The title of it was Comparative Effects of Drugs for Adults with Overweight or Obesity, a Systematic Review and Network Meta-Analysis. For those of you who like to look it up, like I said, published in 2026, it's a systematic review and meta-analysis of randomized trials. The entire review looked at 262 trials, had almost 100,000 participants in it, Jim.

James Hill:
That's quite a few. That's a good number.

Holly Wyatt:
Yeah, 19 different medications. One thing that's kind of important to think about or to realize with this review is there was both approved and investigational medications. So some of the medications we can't get yet, but they had data already published on them, so they included them.

James Hill:
And there may be some differences among the medications, but in terms of producing the weight loss, they're all pretty good at that.

Holly Wyatt:
Yeah. Well, we're getting different amounts, but we know that certain people may respond better to certain medications. We're trying to figure that out too. So within this study, specifically, we're going to focus on the quality of life analysis. There was a bunch of different, they looked at fatigue, they looked at side effects, they looked at weight loss. But for this episode, we want to focus on the quality of life analysis. And for that, there was 43 trials and about 45 or 46,000 participants, so a subset.

James Hill:
And there's a measure of quality of life, right? There's a survey, a questionnaire that assesses quality of life.

Holly Wyatt:
So they used several different kind of questionnaires, put them together, but they all tried to bring them back to the point system that's used or the points that's used in the SF-36, which is a very common, validated, patient-reported kind of outcome measure that assesses health-related quality of life. So they tried to bring it back there.

James Hill:
This is used a lot in our field to measure quality of life.

Holly Wyatt:
So there may have been different studies use some different techniques, but they tried to bring it all in and make it equivalent. So they expressed it in the SF-36 equivalent points because we're kind of used to that. And that's a way to look at all these different trials in one way, you know, together, in this analysis.

James Hill:
So I'm assuming, Holly, that the medications did produce weight loss.

Holly Wyatt:
They did. And you can pull that up and see the different medications and the different amounts of weight loss. And like I said, some of them are even investigational, so you can't get it yet. But there's enough data that's been published and peer-reviewed to be able to include in this systematic review and meta-analysis.

James Hill:
So the big drum roll is it produced weight loss, did it increase quality of life?

Holly Wyatt:
Well, it did change quality of life, but not by very much, I think is the drum roll. I mean, the researchers actually set a 10-point threshold. They wanted to see quality of life improved by 10 points.

James Hill:
Which isn't a huge amount, but it's enough to see an improvement. So they set the bar fairly low, and the medications didn't even achieved that bar.

Holly Wyatt:
Looks like if you look at all the different medications, they moved it three to four points. So nobody hit that 10 point threshold they were hoping for.

James Hill:
A third of what they thought would be a meaningful increase. Holly, are you surprised at this?

Holly Wyatt:
Well, once again, like our episodes, I'm not necessarily surprised, but I am disappointed because I feel like this, you know, people really believe, and I think they believe if I lose weight, I'm going to be happier. And quality of life and happiness aren't the same thing. We'll talk about that a little bit later.

James Hill:
But they're close. They're close.

Holly Wyatt:
Yeah. Yeah. I do think people really believe that. And I want that to be true so bad. But once again, here's a signal, Jim.

James Hill:
Well, we know it helps with weight loss. We know it helps improve metabolic health. Wouldn't it be great if it also made people happier? But it doesn't seem, the data aren't showing that.

Holly Wyatt:
Yeah. Once again, this may be without thinking about it. You know, like the quality of our diet didn't improve without thinking about it, without doing something. We are not moving more necessarily without thinking about it. Same thing here.

James Hill:
So maybe we need more than just the medications and all this.

Holly Wyatt:
I think that may be a theme that we're starting to see. I mean, I think the surprise...

James Hill:
We're seeing that. I mean, if you remember, we saw that just taking the medications, you aren't going to move more and you aren't going to eat better. Now we're saying you aren't going to necessarily increase your quality of life. But it doesn't mean that the medications are bad. It simply means they may not be the only treatment you need.

Holly Wyatt:
Yeah, and it is showing me maybe a small improvement, but I think there's a big gap. We're now producing big amounts of weight loss.

James Hill:
And small amounts of improvement in quality of life. Yeah, I'm disappointed in that too. But, you know, let's don't throw the baby out with the bathwater. Maybe there are some things we can do to have the increase in quality of life match the increase in weight loss and metabolic health.

Holly Wyatt:
Yeah. I want to just make sure our listeners, let's keep one thing straight. This does not mean that participants experienced no improvement.

James Hill:
Right. There was some improvement, a little improvement.

Holly Wyatt:
Yeah. It just means the average additional improvement didn't reach the author's chosen threshold. And there may be a gap. I'm kind of thinking a gap is developing, you know, large amount of weight loss. We're not seeing large amount of improvement.

James Hill:
But clearly things didn't get worse. They got a little better.

Holly Wyatt:
Yes. There we go, Jim. That's one way of thinking about it.

James Hill:
So you said before that quality of life is not the same as happiness. What's the difference?

Holly Wyatt:
I think they're related. So, quality of life can definitely, I think, help with happiness, but I don't think they're exactly the same thing. Well, what do you think is the difference between the two, Jim?

James Hill:
Yeah, I think they're very, very close. But quality of life, people tend to think about physical limitations. Am I in pain? Can I overcome some of these things? Where happiness gets at social interactions, how you interact with other people, how you feel about your life. So they're very similar, but I think happiness is a little bit of a broader sense of how am I doing with life? How am I feeling about being on this planet? And quality of life, people look at, can I move about? Can I lift the bag and the overhead and the plane? They focus on maybe more specific things.

Holly Wyatt:
More on how health affects someone's daily experience and functioning versus happiness, I agree, is more of a broader interpretation of your life.

James Hill:
And even though this didn't get at happiness, this does not give me confidence that happiness would have changed more than quality of life. Because I think if we aren't seeing it in quality of life. I wouldn't expect we would see it in happiness, but again, we need to have those studies to see.

Holly Wyatt:
So here's a question for you, Jim, that kind of gets at this. When a patient says, “I feel so much better.” What do they mean?

James Hill:
I think they're focusing on physical sense. I feel better. My knees don't hurt. You know, this and that. They aren't focusing on, oh my gosh, my life, I've got a better social network, I've got new friends and all that. I don't think they focus on that when they say, I feel so much better. I think they're more focusing on physical things.

Holly Wyatt:
Okay. What about, do you think they're maybe saying, what about food noise?

James Hill:
Well, food noise is an interesting one because my guess, Holly, I'm just speculating, is that when they say, “I feel so much better”, I think they're seeing food noise differently. And if you ask them, are you enjoying the food noise go away? They would say, “Oh, yeah.” But I don't know that they would associate those two.

Holly Wyatt:
Yeah. And that's what's hard to measure this.

James Hill:
It's hard. It's like food noise. We didn't even have this term a few years ago, and now we're figuring out how to measure it. This is the fun thing about science. We're figuring out how to measure this stuff.

Holly Wyatt:
And because there are so many things, for some people, it really might be about food noise. For some people, it might be more functional. For some people, it might be more about freedom or confidence. How do you have one questionnaire to capture all that.

James Hill:
But think about it. Let's say you're someone and you've just been in constant pain with knees and shoulder and that goes away. That's all you're focusing on. You're not focusing on, well, do I have new friends and have I gone out to do other things? So there are layers to this. And what's depressing to me is even if that first layer isn't improving very much. So I think we have a ways to go to get to an improvement in happiness.

Holly Wyatt:
Well, and I think you just brought up one thing that, once again, a treatment's effect on one person doesn't tell us what it means to someone else.

James Hill:
Someone with no pain and they're taken and they lose weight, that may be a whole different ballgame for them. They might say, “Oh, yeah, I move better. I'm getting out. I'm hiking. I'm enjoying things.” It's, you know, it is personalized.

Holly Wyatt:
And then therefore, what questionnaire you use to try to capture this so we can get some numbers to kind of understand it becomes complex because it means so many different things to different people. And it depends on where you're starting and what's important to you.

Holly Wyatt:
Very hard, I think, to really capture in studies.

James Hill:
But tell us, so what do we conclude from this paper? And again, this is one paper, but it's looking over a large number of people. What would you conclude from this?

Holly Wyatt:
Well, I think first is that we're seeing these large weight reductions, and they, I would say, coexist with maybe some small or modest additional quality of life improvements. That's what's happening out there. Not maybe for everybody, but that's kind of what we're starting to see. large amounts of weight loss, maybe small improvements, at least like you said, not going the other way in quality of life type measurements.

James Hill:
I'm going to speculate a little bit, but what I would say is losing weight doesn't automatically make you happier.

Holly Wyatt:
Yeah.

James Hill:
But I would also say losing weight can be a wonderful time maybe to do some other interventions that can make you happier.

Holly Wyatt:
Yeah, and we're going to talk about that. We have to put pie on the plate. So what do you do with this? If you get this data and you understand it now, how do you use it? I don't think that this study establishes that losing weight doesn't make people happier. I think there's some people that probably are getting happier. So I think that, like we said, is important too, and that there's a kind of a person-by-person relationship that we probably have to look at.

Holly Wyatt:
All right, Jim. So let's kind of, let's do a scenario.

James Hill:
Oh boy. I like this.

Holly Wyatt:
And go through it. I like when we do that. So kind of trying to put this now, what might this might mean for one of our listeners? And this is not, this is just a made up person, but let's say someone says, I want to lose 40 pounds.

James Hill:
Okay.

Holly Wyatt:
And you ask them, what would be different after? I always say this, once you reach that 40 pounds on the scale, what's going to be different in your life? I always ask that question.

James Hill:
And this is more relevant because, again, for most people on the medications, they are going to lose that weight. Before it's like, am I going to lose the weight? Am I going to do it? Now, there are some people that don't respond, but for most people, if they start the meds, they will lose the weight. So it's worth thinking about, then what?

Holly Wyatt:
So I think this is maybe a message for healthcare providers that are helping people lose weight on these medications. We used to just talk about goals in terms of weight loss.

James Hill:
Yeah.

Holly Wyatt:
Okay. Let's do that. Let's talk about that. But let's now automatically go to this next level. What would be different afterwards? So for instance, for this person who wants to lose 40 pounds, they might say, I'd feel comfortable going out. I always hear, I'd stop avoiding pictures. I'd really be in there and doing more and traveling more. I'd feel better about myself. I'd finally start really enjoying my life more. People are going to say it in different ways.

James Hill:
But that's getting at happiness. These are the kinds of things that I think when people separate quality of life from happiness, these are the happiness issues.

Holly Wyatt:
So I would challenge people, our listeners and healthcare providers who are helping people that, you know, you start out with the stated goal is weight loss, but what does that person think that weight loss will make possible? And start thinking about that from the very beginning. That goal that's right under that weight loss goal.

James Hill:
That's what we've always said. I feel like we've been saying this for decades is start with the end in mind. Start with having people right away, even before they lose weight, start thinking about life after weight loss. What's it's going to be? What are their goals? What are their dreams? And it's hard, you know, because people initially just want to focus on weight loss. But I think as professionals, we need to talk to these people even before they lose weight about the long term. How are they going to maintain it? What do they want to get out of it beyond weight loss? What else are they doing besides just taking the medications? These things are important.

Holly Wyatt:
Yeah, I don't think we asked this question early enough. And it's really the important question, right? What are you expecting to happen as a result of the weight loss? And yes, there's a lot of medical health-related improvements, but as we've talked about for my patients, it's really more about how they want to feel and live their life. It's all connected to that. So I think we need to ask these questions early enough that we can start focusing on them while they're losing weight.

James Hill:
I think, unfortunately, what we're seeing a lot of are people who reach their goal weight, but it's not the life they imagined.

Holly Wyatt:
For sure. And in their minds, I think they believed and really believed this is the you know, this this is going to solve my problem.

James Hill:
If I lose weight, life will be great.

Holly Wyatt:
Yes. And in these ways. And I think what we're seeing now with these tools that are producing this amount of weight loss. So before sometimes it was, well, I can't lose enough weight for it to happen. But now they're like, okay, we really have these tools that are getting us to those those numbers. We've talked about the happiness number and blah, blah, blah.

Holly Wyatt:
And it's not quite the same. It's not really delivering. So why might feeling better not keep pace with losing weight?

James Hill:
Yeah. So there are some possibilities to explore. Some people have a lot of energy when they're on the meds, but some people still suffer some side effects and some fatigue. So there may be some negative things associated with the medications that are affecting quality of life.

Holly Wyatt:
We've talked about this a little bit before, is that maybe one reason why people aren't moving more, Jim, is there fatigue or some side effects? So I think that's one possibility. The treatment itself is maybe doing something that's impacting their quality of life in some way.

James Hill:
I think what we're seeing with these medications, Holly, and we need to be clear right up front, there are so many positives of these medications. They are doing amazing things, but not everything is positive. We're seeing some positives. We're seeing some negatives. And that's okay. We need to weigh those and as much as we can, mitigate the negative effects.

Holly Wyatt:
Yeah. So I think that's when we're trying to understand why there's this gap. That's one thing we need to understand better. And then as like we've talked about is there's different medications, there may be shifts. You may try different medications, may have different impacts if some of them are making you tired or more nausea, etc., I think the other possibility to explore is that other difficulties remain. We've thought weight was it. And it may have been a big part of some of the difficulties. Weight loss may help with some of the problems. But there's still other difficulties that the weight loss doesn't solve, like stress or relationship difficulties that don't go away or loneliness, you know, things like that, that the weight doesn't solve.

James Hill:
And I think we know that people who struggle with weight issues also often struggle with some of those issues. And the weight loss itself, I mean, again, losing weight may not solve the loneliness problem. You may need some other kinds of things that go along with the weight loss to solve that problem.

Holly Wyatt:
Agree. So what else? What's another reason why we're seeing this kind of gap between?

James Hill:
One of the other things is oftentimes I think the expectations change. And this is why I think it's particularly important to talk to people ahead of time. So people start out, oh, I just want to lose weight. They go on the medications, they lose weight. It's like, oh, now what? Now I need to change my expectations. If you think about this up front, so you're anticipating you're going to reach your weight goal. So you're already thinking about expectations and what comes next.

Holly Wyatt:
This is the one that affects me because I've done this my whole life. Here's the problem. I target something, I achieve it, and then I'm on to the next thing, right? I'm already like, but now I've got to, I need to tackle this. And I think sometimes that mind state doing that gets in the way of happiness because it's always about achieving that next thing. So you reach one target, and that just becomes the starting point for the next target for you to achieve. And you kind of put happiness or enjoyment on hold until you reach whatever that is. So you're constantly achieving, you're kind of a hyper achiever. And that's, you know, maybe served you well, but maybe at the expense of, the quality of life or the happiness measures, because you solve one problem and then you focus on something else you need to change.

James Hill:
It's back to this recognizing the real benefits, also recognizing that there are maybe some other needs that the medication and the weight loss are not providing.

Holly Wyatt:
Yes. So I got another question for you, Jim. I like this one. Can someone be healthier and still feel disappointed?

James Hill:
Oh, absolutely. I think so. And that actually may be a little bit, Holly, where quality of life and happiness are separated. So I think you can. And again, this is not simple. It's not as if life is definitely good or bad. These things have improved. These things haven't. And we have to recognize that there are amazing benefits, but maybe some limitations. And we need to work on addressing those limitations.

Holly Wyatt:
And I think this is important for health care providers because a lot of times a doctor, for instance, may recognize a real benefit to health. and kind of dismiss this other part, and say, well, look at your cholesterol and look at your hemoglobin A1c.

James Hill:
I think we've done that. I think we have focused too much on metabolic health. And don't get me wrong. It's important. It's important. But if you're metabolically healthy and very unhappy in your life, there's still a problem. And it doesn't mean you shouldn't celebrate the improvement in metabolic health, but the problem isn't solved.

Holly Wyatt:
So if the scale's improving, health is improving, but the person's saying their life isn't, I think that deserves a conversation and it deserves recognition of that. And I think sometimes we don't do that in the healthcare world.

James Hill:
I'm curious, Holly, do you often see your patients putting happiness on hold? It's like, I'll do the weight and then I'll work on the happiness.

Holly Wyatt:
Oh, absolutely. And like I said, me too. I mean, I think a lot of times we say, once I get here and I solve this problem, I'm going to be happy and I'm going to celebrate. And then suddenly you're there and you realize, but, and I've got another problem. And it’s that cycle.

James Hill:
We address this in our book, Losing the Weight Loss Meds, saying that actually the two were interrelated. By putting happiness on hold, you're actually hurting your chances of long-term weight loss maintenance, that going out and going on that trip and starting dating and being in pictures, actually feeds back and helps you with weight loss maintenance. So putting happiness on hold is probably the wrong strategy.

Holly Wyatt:
I agree. I think we have to, I mean, I understand sometimes that there are true barriers and there are, you know, stigma and pain and things. But if you're always waiting. It's about, I do think, actually enjoying life, not waiting for the goal to start enjoying it, to be happy, quality of life. actually improves your outcome, not the other way around.

James Hill:
We talk in the book about living large, right? It's your opportunity. It's almost like losing weight is such a major thing. It's a chance to reinvent yourself and live large and go out and live life. And in fact, that helps you maintain your weight.

Holly Wyatt:
Yeah. So one thing that I think we talk about this in the book too, I ask people what's one thing you're waiting to do until you lose weight? And do you really have to wait to at least start doing it or doing part of it? So kind of starting to break that pattern of always waiting to do something that's going to bring quality of life or happiness to your life.

James Hill:
So we give people weight goals. Should we give them life goals as well?

Holly Wyatt:
Yes.

James Hill:
How would you do that? Let's get real specific now for our listeners.

Holly Wyatt:
Well, that's where you have to talk to them and it's going to be different for different people, But I think it's getting at this. I always start with if you lose weight, what do you think is going to change in your life because of it? And making some goals around that and starting now at the same time as you're losing weight, not waiting to the weights off to then do those things, making those goals and small steps. You might not can get to there overnight, just like any goal, but addressing them and at the same time as the weight loss goals.

James Hill:
We talk about, you know, people really recognize measuring weight. It's a goal. They track it. But we also talk about tracking how your life's going, right? Almost like a happiness score. How are you feeling about life?

Holly Wyatt:
Happiness score, I think, you know, a life score. That's what I call it, a life score, because I think it's more than happiness. I think it's a little broader.

James Hill:
And so we ask people, just like you get on the scale every morning, give yourself a checkup. Where are you in your life scale?

Holly Wyatt:
Yeah, your life scale and making a score. People like numbers because then they can kind of compare. So I think that's one thing.

James Hill:
So how do people start If you're talking to a patient and they're only focused on weight, how do you get them started thinking about life goals?

Holly Wyatt:
Yeah, I think we came up with some things I could actually do.

James Hill:
Yeah.

Holly Wyatt:
Okay. Let's start with that first one. What should I do about it? So let's say you're okay. All right. I'm on a GLP-1 meds. I'm losing weight. How do I also get at this broader life goal? So I think one thing you could do is finish this sentence. I want to lose weight so I can blank.

James Hill:
Go hiking. Have energy at night. Not feel tired. Participate in dancing classes. It doesn't matter but think about an answer to that that is associated with how you enjoy life.

Holly Wyatt:
[28:16] And don't say, the trap is, “Well, I'll see what happens when I lose the weight”, but so really think about that. And that's what we call a lot of times peeling the onion “I want to lose weight so I can…” and be concrete about it. So I can go dancing, so I can play with my kids, so I can hike the Grand Canyon, all those things, and write them down. And I think this gives you something to notice, besides the weight number. Now you're looking at the weight number and it's going to be changing and you're also looking at “here's what I want to be moving toward” also. And it has to be the things that are really important to you not just the things that sound good. That's what I always say too.

James Hill:
So it's sort of like are you doing more things that really matter to your life.

Holly Wyatt:
At this point I just want to get them to write them down and just recognize them right, just be honest and say…

James Hill:
You want to lose weight. What else do you want? I know there are many other things people want that aren't just weight loss. They're quality of life. They're happiness things.

Holly Wyatt:
So you finish that sentence, you write it down, and then here's something you do after that is you check both outcomes. So as you're losing weight, I want you to be looking at both outcomes, both the weight outcome and the life goals. I'm going to call them that, outcomes.

James Hill:
Track them. Track them both.

Holly Wyatt:
Yeah.

James Hill:
Write them down. Measure it every morning. Write your weight down. Write your life score down.

Holly Wyatt:
Yeah, what's happening in my daily life in addition to what's happening to the scale? Am I doing more of what matters to me? Am I starting to move toward them? At least be aware that you're tracking them and you're not going to wait or you're not going to assume. And this is the key because I think this is why we're getting these numbers maybe in the publications or in the study is people assume I'm going to lose the weight and these things are going to improve. I assume it's going to happen. Well, I think what we're going to say is it's not going to just happen without you taking some effort in there.

James Hill:
And just saying, well, maybe I need to lose more weight. That'll do it. That's not the answer either.

Holly Wyatt:
All right. So you finish that sentence. You check both outcomes. You're aware. You're following both outcomes, not just weight.

Holly Wyatt:
You're following your life goal outcomes. And then here's the key, Jim. And we do talk about this in the book. You take one step toward that life now as you're losing the weight.

James Hill:
Small steps.

Holly Wyatt:
Yes. So choose one small, realistic action that you can do right now that moves you closer. Maybe you can't go hike in the Grand Canyon. You can't. That's the goal.

James Hill:
You can hike down to the end of the driveway and back.

Holly Wyatt:
Right. I'm getting a few more steps. I'm moving toward it.

James Hill:
Or go to a park and walk with a friend.

Holly Wyatt:
Yeah. Or I'm just even looking into getting a trainer. I mean, small steps, but you're moving toward it. You're not waiting and you're not assuming that when you just get the weight off, all that's going to be, you know, you're going to have those goals are going to be there. You're not assuming that.

James Hill:
And Holly, we did a whole episode on, you know, are we looking at too much weight loss? And if you're on a medication and you're suffering side effects that may affect your quality of life, there's some adjustments you can do. So talk to your provider. You may want to cut back a little bit. So again, you're looking at this trade-off between medications that give you the weight loss, but also the improvement in happiness. And if persistent negative effects of the medication are interfering with your happiness, that's something that could be changed.

Holly Wyatt:
Yeah. I think that's the fourth step in what we're trying to tell people is speak up if the treatment's making your daily life harder, if you're having side effects or if you're having fatigue or if maybe your mood is worsening, that deserves attention. And don't just accept that. Speak up about it. So I love this is really pie in the plate for people, you know, to to finish that sentence, to check both outcomes, to be aware of both outcomes. They're equally important. And to take one step toward that life now to actually take some small action steps.

James Hill:
I love it. Four things you can do.

Holly Wyatt:
Yeah. And speak up if the treatment is making daily life harder, because if it's making your life harder, if you're having the nausea or you're having fatigue or whatever, that's not okay. That's not what you want. You want a better quality of life.

James Hill:
Yeah, I agree.

Holly Wyatt:
And you can have that. So I love this. And, you know, the parallel here, Jim, is we talked about what's happening to diet and that diet quality didn't seem to be improving. Just naturally, like…

James Hill:
Unfortunately.

Holly Wyatt:
Right? And movement didn't seem to be…

James Hill:
Didn't seem to improve.

Holly Wyatt:
And guess what? The quality of your life may not improve without you taking some specific actions.

James Hill:
So the medications are a powerful tool, but alone aren't going to make you eat healthier, aren't going to make you move more, and aren't going to make you happier. Wow.

Holly Wyatt:
Yeah. Maybe a little bit, but not, you know.

James Hill:
Not what you want.

Holly Wyatt:
Not what you really, really want. But this is okay. This is okay. Here's where, I've hyped myself up because I was depressed, but now I'm not, is if we recognize this, if we know that naturally this is what's happened to diet quality for the majority of people and they don't move more and they're not happier, quality of life doesn't improve, only improves a little bit compared to how much weight loss, we can do something about it.

James Hill:
See, that's the key. And I think we're saying over and over that drugs are wonderful tools, but they're just a tool and alone are not going to solve the problem.

Holly Wyatt:
Yeah, and just awareness and then saying, okay, I am gonna work on the quality of my diet specifically. I am gonna work on moving more and I am gonna work on quality of my life doing these steps and recognizing what's going on and not just assuming it's gonna happen with the weight loss.

James Hill:
All right, you wanna do some listener questions?

Holly Wyatt:
Yeah, let's do a few. You start out.

James Hill:
Okay, I've lost weight, but I'm not as happy as I thought I'd be. Did I fail? No.

Holly Wyatt:
Absolutely not.

James Hill:
Meeting a weight goal and meeting an emotional expectation are two different things. Ask what you hope would change and what actually changed. Recognize there are some benefits, but also recognizing what additional things need attention.

Holly Wyatt:
Yeah. So I think the two are connected, quality of life, happiness, and weight loss, but recognize you need to kind of think of them separately too and work on both of them, even though there is some overlapping connection.

James Hill:
But it's not, you didn't fail. No. You just, your journey's not complete yet.

Holly Wyatt:
Yes, yes, absolutely. Let's see, here's another one. If I still don't feel better, should I lose more weight? And I see this, I, unfortunately, I think we're starting to hear this. Never a question before, because I would have always said we weren't getting to the amounts of weight loss where this really played too much of a role. But I don't think that more weight loss is automatically the answer.

James Hill:
Yeah, I agree.

Holly Wyatt:
And that's interesting, Jim, isn't it? I mean, that's what these drugs are kind of producing for us, this difference.

James Hill:
Absolutely.

Holly Wyatt:
We talked about it, kind of maximal weight loss versus optimal weight loss. And max is maybe not always better, is not necessarily the best.

James Hill:
Okay, the last one. Is it wrong to want to lose weight because I think I'll feel better about myself? Totally understandable. This is the typical way that people are approaching it. And what we're saying is think ahead of time. Assume you're going to get the weight loss. Think about the other goals and use the pie on the plate that we talked about earlier to start thinking about life goals in addition to weight goals. You don't have to wait until you get a particular weight to begin to think about life goals.

Holly Wyatt:
That's the key. That's the key statement right there. Don't wait. You don't have to wait to be a particular weight to begin that work. We talk about this in the book. By just beginning that work, it actually makes it easier.

James Hill:
Right.

Holly Wyatt:
And so that to me is a really big pie in the plate. Recognize that and try to start working toward that in addition to the weight loss. All right, rapid fire?

James Hill:
Go for it.

Holly Wyatt:
All right, Jim. Goal weight or feeling good before you get there? Which do you choose?

James Hill:
Feeling good.

Holly Wyatt:
Absolutely.

James Hill:
All right, Holly, lose 10 more pounds or have more energy at this weight?

Holly Wyatt:
There was a time in my life where I would have said 10 pounds, Jim, but now more energy for sure.

James Hill:
Okay.

Holly Wyatt:
Better blood pressure, same happiness. Is that treatment success? So you've lowered the blood pressure, happiness, quality of life hasn't changed.

James Hill:
Partial success. It's success for health, but it's not full success. All right, Holly, less food noise, but less enjoyment of food. Is that a fair trade?

Holly Wyatt:
That's not a fair question.

James Hill:
It's a good one.

Holly Wyatt:
Oh my gosh. And I think this is what a lot of people are experiencing. Food noise is gone, but they also don't enjoy food as much. And I think it depends how much. I think if you don't enjoy food at all, I...

James Hill:
That's going to be one long term because for short term, people can live with a little less enjoyment. But if you're on these drugs for decades, is that going to become a factor?

Holly Wyatt:
And I think we may see a swing. Everybody's like, “Oh, it's so great to have no food noise.” And then over time, it may be like, but I don't enjoy my food anymore. Oh, it's going to be interesting.

James Hill:
It's going to be interesting.

Holly Wyatt:
Yeah. Let's see. Here's one. Ten points meaningful. So in the study, the ten points was what we were looking for. Is nine points meaningless or is four points meaningless?

James Hill:
No, there's no magic line here. But what I would take away is 10 was a conservative thing and they didn't meet that, which suggests it improved a little bit, but not nearly as much as we all hope for.

Holly Wyatt:
And not nearly as much as the weight that we're getting off, right? Big weight loss, small improvements in quality of life.

James Hill:
All right, Holly, you reach your goal weight and immediately set a lower one. Ambition or moving the goalposts?

Holly Wyatt:
Hmm. It could be either. It could be either. I can't say for sure. I think you need to watch and think about, is it moving the goalpost? But in some individuals, it could be they set small goals, they lost 10 pounds, 10 more pounds would be appropriate. So I would say could be either.

James Hill:
Okay.

Holly Wyatt:
Patient feels much better. The questionnaire barely changes. Which do you trust? So here's the answer in the questions. The questions didn't show improvement in quality of life. But the patient says, “I feel much better.”

James Hill:
Well, we've talked about the difficulty in getting a questionnaire that fits everybody. I would listen to the patient. Again, I would probe a little bit about what that means. But just because the questionnaire differs from the patient's experiences, don't say, well, the questionnaire must be right. Listen to the patient.

Holly Wyatt:
For sure.

James Hill:
All right, Holly, this is a good one. What's easier to measure, weight loss or happiness?

Holly Wyatt:
Weight loss.

James Hill:
That was a softball.

Holly Wyatt:
Golly. Yes. Well, here's another one. What's harder to achieve?

James Hill:
Oh, that one's a softball too. Happiness.

Holly Wyatt:
Yeah.

James Hill:
All right. One thing you wouldn't promise someone starting treatment.

Holly Wyatt:
I wouldn't promise them that they're going to be happier if they don't work on it.

James Hill:
Right. That's right. That's not going to come naturally.

Holly Wyatt:
Yes. That's what I think I would talk about. I wouldn't want to say...

James Hill:
Maybe a little bit. I think as the study shows, you might see a little bit just from the weight loss, but not a lot.

Holly Wyatt:
You might be disappointed with that.

James Hill:
If you're expecting a lot.

Holly Wyatt:
So, Jim, I was just thinking about this. We had all of the studies at the beginning that, you know, we couldn't get enough weight loss. So everybody was achieving a disappointed amount of weight loss. We almost need to do studies now. They're achieving a disappointed happiness or change in quality of life.

James Hill:
Yeah, yeah.

Holly Wyatt:
All right. Do we want to do a couple vulnerability questions?

James Hill:
Sure, I'll start. Have you ever caught yourself thinking, once I change this one thing about myself, then I'll feel the way I want to feel?

Holly Wyatt:
Oh, all the time. Like I said, that's probably one of the things I tend to do. I think this is going to help or I set this goal, I achieve it, and then I move on to the next goal. And so I never really celebrate it or recognize that. And so I'm constantly moving from one thing to the next. All right, Jim, here's yours. Looking back over your career, do you think we've sometimes expected the happiness part to take care of itself once people lost the weight? Did we contribute to this, basically?

James Hill:
Oh, yeah, I think we did because we were so focused on weight loss because we were terrible at producing it and maintaining it. And so it's the thing we wanted to focus on. So it's a natural progression. Where we are is to move forward. Now we can produce weight loss. Now we need to make sure we think about some of the other things. Could we have done a better job of that from the beginning? Probably. But, you know, we have made real progress in weight loss. And now we need to match that by giving these people who achieve amazing weight loss, giving them amazing improvements and happiness.

Holly Wyatt:
Yeah. And being aware of that.

James Hill:
And being aware. All right, put the pie on the plate for this episode, Holly.

Holly Wyatt:
Oh my goodness. I feel like we've been putting a lot of pie on the plate. I think we've been asking what follows when people lose weight on these medications. Eating less doesn't mean they're eating better. That's what we're starting to see. Losing weight doesn't mean they're necessarily moving more. And today I think we've added, it doesn't necessarily mean that your life will be better or be better by very much. And we need to start being aware. And once again, these are signals. We don't know for sure. It's not in everybody. But I think we're starting to see that.

James Hill:
Yeah. And I think the BMJ review really sort of makes us think simply losing weight is not necessarily going to improve your quality of life and your happiness. The two are separate. You need to work on both.

Holly Wyatt:
And I do think it challenges us to ask what we're hoping weight loss will accomplish, and putting that question in there right after the weight loss. And if you do want more freedom, more enjoyment, more participation, name those things. Write them down. Notice whether they're happening. Start moving toward them.

James Hill:
And figure out what's missing in your life and give it some attention.

Holly Wyatt:
Yeah. I think weight loss can help make those things possible. But you have to start working on that too. What do you want to do with those possibilities?

James Hill:
Well, this is a fun episode. I love talking about happiness, Holly. So I hope our listeners enjoyed it. Send us your questions, your comments, 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.