Why You Lose Weight Everywhere Except Where You Want To with Mike Jensen

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:
Today, we're diving into something almost everyone who's ever tried to lose weight has felt. Why am I losing weight everywhere except the place I really want to lose it? A close cousin to that question is, why do I always gain weight in the same spots?

James Hill:
Yeah, Holly, and people don't ask, does fat distribution matter? What they actually ask is, why is my stomach so stubborn? Why do my hips never budge? And why do I gain weight differently than my friends?

Holly Wyatt:
And here's the key. Those patterns aren't random, and they're not in your head. They're biological, they're hormonal, they shift and change as we age, and some of them can influence your metabolic health in ways that surprise you.

James Hill:
So, as usual, Holly, when we're not the top experts in an area, we bring in someone who is. So, to help us understand all of this, we brought in one of the world's top experts on body fat distribution. Someone who has shaped what modern medicine knows about where fat is stored and what that means for health. Dr. Mike Jensen is a renowned endocrinologist and obesity researcher at the Mayo Clinic. His decades of research have helped us understand the difference between visceral and subcutaneous fat and why certain depots are more dangerous than others and why bodies respond so differently to weight loss.

Holly Wyatt:
His work has fundamentally changed how clinicians and physicians think about fat. It's not just extra weight. It's a metabolically active tissue. And where it sits on your body is part of your health story.

James Hill:
Mike, we're so happy you're here to help us sort all this out.

Mike Jensen:
Well, thanks for the invitation, guys. Glad to be here.

James Hill:
Mike, when I started in this field, and I'm not going to tell you when. Longer than you. We've both been in it a while. I've been longer than you. Fat depots were sort of thought as not very interesting. Yeah, there's energy there. It goes in and out, but it's really muscle and liver where the action is. Most people think about BMI and pounds, but should we think differently about your fat?

Mike Jensen:
Yeah, I mean, certainly if you know where people store their body fat, you have a much better understanding of their risk for metabolic diseases than knowing just how much fat you've got. The worst possible phenotype is somebody with almost no lower body fat, and they store all their fat inside the abdomen. We're still working out why that's the case, but metabolically, that person is highly likely to be at risk for diabetes, high lipids, premature cardiovascular disease. They might even have a normal BMI. But because all of the body fat that we consider to be, and there's very, very healthy things about body fat, but when you lose the subcutaneous fat in the legs and arms and stuff like that, you're losing a potentially beneficial kind of fat. And that just leaves the kind of fat behind that's probably dysfunctional.

James Hill:
So two people can have the same amount of total body fat, but their risk of metabolic disease varies depending on where it is.

Mike Jensen:
Almost 180 degrees depending upon the distribution.

Holly Wyatt:
So what makes the visceral fat, this fat that you're saying is different than the fat that's on your arms and legs and that we're saying actually might be beneficial.

Mike Jensen:
I puzzled over this for decades. The question is, what's going on? Why is this visceral fat growing? And why is it such a good predictor? And I read a really cool commentary by Elliot Danforth. And he sort of said, like, well, maybe what we're seeing is that when the visceral fat is growing, it's growing because the subcutaneous fat is no longer doing its job properly.

Mike Jensen:
So, that job of a healthy subcutaneous fat is it needs to store the dietary fat that you've taken in so that it doesn't build up and cause health problems. But it also needs to be able to release the fatty acids that you need for energy exactly to match your energy needs. And his hypothesis was that when subcutaneous fat is not doing those two jobs properly, the visceral fat ends up being the fall guy. So, you've got too much fat in the bloodstream, visceral fat starts growing because it has to be, it's the only depot left that's going to do that job properly. And different people cross that line at different amounts. But his idea was, if you've got healthy subcutaneous fat, your visceral fat is not forced to take up extra fat. It's when you have rapid gain of fat, you're rapidly gaining fat above what subcutaneous fat can handle. Or when the subcutaneous fat actually starts to be dysfunctional, it's either not taking up your dietary fat properly, or it's releasing too much fat into the bloodstream at the wrong time. And then, just like, say, muscle and liver, visceral fat ends up having to take up that fat. So his idea is that people with more visceral fat, it's a marker of dysfunctional subcutaneous fat. And when I started looking at our results, I was going like, that's almost exactly what we're finding. That visceral fat is correlated strongly with dysfunctional subcutaneous fat. And when we try to make measurements of what is actually going wrong with visceral fat, about the only thing we see it's doing is it's sending some extra fatty acids to the liver. So clearly, visceral fat is doing something itself, but it's probably mostly affecting liver function and not affecting things that we would normally think of as blood vessels and muscles and pancreas and stuff like that.

James Hill:
So, Mike, you're changing the narrative a little bit because we think of fat as bad. You're actually saying, no, there's some fat that's good.

Mike Jensen:
I've got several different presentations that I put together about what's good about fat. And there's a lot of when you study it long enough, you go like, wow, this is really important that it does its job properly.

James Hill:
So are you born with a certain fat distribution? Does your lifestyle affect where the fat is? What do we know about that?

Mike Jensen:
Yeah. So, a lot of the genetic markers that relate to risk for diabetes are markers of genes in adipose tissue, and those genes don't tell us how much you've got. They more relate to where you store it. So there's clearly some heritable aspects to this. Now, the other thing is there's what we would call non-heritable but constitutional things. So, we know that kids who are born when there's malnutrition that occurs in the last trimester or in the first six months of infancy, that those people end up growing up with more central fat distribution. So, something is being programmed by malnutrition in early life. The biggest thing is like when kids go through puberty, there's this massive change in fat distribution. Both testosterone and estrogen have huge effects on our fat cells and which live and which die and what they do. And then there's some other lifestyle things, smoking, alcohol, things like that tend to make us store more fat centrally. We're not quite sure why. People who are regularly physically active have less visceral fat, specifically in regards to their whole body fat. So there's genetic, there's constitutional programming that's not heritable, and then there's hormones, and then there's lifestyle.

Holly Wyatt:
So if our listeners are sitting out there going, okay, how do I know if I've got this visceral fat that we're kind of calling bad fat versus the subcutaneous or the other fat that you're kind of calling good? I'm sure they're sitting out there going, okay, all right, what do I have? How do we know?

Mike Jensen:
Here's the easy test, right? So your belly's sticking out over your belt or your pants, right? But you can't pinch an inch in your abdominal fat. So you've got an abdomen sticking out. But when you go to pinch the fat, you go, well, I'm not fat. Look, there's hardly any fat that I'm pinching. But your belly's sticking out. Yeah, you've got visceral fat.

James Hill:
Oh, that's interesting. I haven't heard that one, Mike.

Holly Wyatt:
So you're saying if you pinch an inch, that's on the top of the skin versus if you just pinch…

James Hill:
That's subcutaneous.

Holly Wyatt:
Yeah.

James Hill:
You can't pinch visceral fat because it's inside your abdomen.

Holly Wyatt:
Huh. I've never heard that before.

James Hill:
I haven't ever heard that. But that is actually pretty cool. We're all pinching ourselves to see where we are.

Holly Wyatt:
Yeah, I've got some visceral fat. I've had visceral fat all my life. I've always been an apple. Even before menopause, before any hormonal changes, I've just kind of always been an apple and it's just gone up and down. But I've never thought of it that way. So that's a way that's kind of easier than measuring, I guess, waist circumference, which we talk about a lot.

Mike Jensen:
Well, yeah, I mean, waist circumference is quantitative. The nice thing about waist circumference is you can actually, you know, measure it and it changes from day to day or year to year. And you kind of know that. But if you're just at home and you're going, hmm, I've got a big belly. I wonder if I've got a lot of bad fat. You can just pinch it and get a good hint.

Holly Wyatt:
Here's a question, though. If your waist circumference is large, I mean, could it all be subcutaneous? Or probably if it's large, there's visceral in there, even if there's some on the out, you know, kind of the pinching. You can pinch or not pinch.

Mike Jensen:
We do the waist circumference as a screening for people to enter into our research studies. But then once they're in, we can do an abdominal CAT scan, and we do dexa and all that kind of stuff. And you'd be surprised at what proportion of the people who have, say, a big waist don't have much visceral fat.

Holly Wyatt:
Really?

Mike Jensen:
I mean, there's a huge heterogeneity in even an abdominal fat. Now, women are more likely to have the subcutaneous fat than men. But it's interesting that even people with a fair amount of subcutaneous fat, if they don't have a lot of visceral fat, when we measure the function of their subcutaneous fat in terms of its ability to store and release fatty acids and other stuff like that, the function is pretty normal. So that would be consistent with that idea that as long as your subcutaneous fat is doing its job properly, there's no need for you to put fat in the visceral compartment.

James Hill:
Wow. So, Mike, how does aging affect your fat distribution?

Mike Jensen:
Yeah. So, in general, as we age, we start running out of precursor cells. So one of the components of aging is, you know, our cells die and then we make new cells to replace them. And this happens all of our life. But in people, you know, eventually those precursor cells that turn into fat cells, when your old fat cells die, they stop working. And so now you have the normal loss of fat cells just because they only last roughly five years is what we think. And eventually you stop being able to replace them. And what's really interesting is that seems to occur distally first, so like arms, distal arms, distal legs, and works its way up. So there's a really interesting pattern. And if you've ever seen some elderly folks, if you see enough of them at the swimming pool or something like that, you go, man, that person didn't have any fat on their legs or arms. And yet, if you looked at them 30 years before, they would have plenty fat. And so what seems to happen is our fat distribution changes. And it's because we're losing fat from our arms and legs. And if you don't lose fat in general, that means the only fat that's left is up in your abdomen. Those visceral fat cells seem to last forever.

Holly Wyatt:
Oh, wow. So that's just an aging process or does hormones and menopause, does that come in and play a role too?

Mike Jensen:
Hormones play a big role. I mean, if you look at what happens to boys when they go through puberty, they lose a huge amount of that peripheral fat. And women don't. So when girls go through puberty and they may have some fat redistribution from upper body to lower body, And men just lose a lot of subcutaneous fat. And I think, I mean, personally, my suspicion is testosterone is doing something that is, you know, great for muscle, but it actually reduces your subcutaneous fat. Anecdotally, right, I have seen guys who clearly have been on anabolic steroids for muscle building, for things like that, and they do lose all their subcutaneous fat. Then they go off the steroids, they gain a bunch of weight, and all they gain is visceral fat. Really interesting phenomena. I think that testosterone, especially in high amounts, it actually does something bad to subcutaneous fat cells. Estrogen clearly has a very different property. It seems to be preserved or even allowed for liberation of subcutaneous fat, and this is almost surely at the stem cell level.

James Hill:
So there are hormones like estrogen and testosterone that affect fat cells. What about the opposite. What are fat cells doing and producing that may affect metabolism?

Mike Jensen:
There's a lot of stuff, right? So the biggest thing, the thing that I've been worried about in my career is like, how is fat regulating its storage and release of fat in a healthy versus unhealthy way? Normally, they coordinate. These billions and billions of fat cells somehow coordinate to get you exactly the right of fat fuel at exactly the right time to keep you healthy. When they start not working, now you start overloading tissues with too much fat at the wrong time. There's also hormonal properties. So we know that adipose tissue makes a lot of hormones, some that relate to appetite regulation, others that relate to metabolic health, others that relate to inflammatory state. So, the adipose tissue, we know, is a big endocrine organ. As an aside, when I went in to study obesity as an endocrinologist, everybody made fun of me because, it was like, well, if you're not very good at other stuff, you wouldn't.

James Hill:
So true, Mike.

Mike Jensen:
Yeah. And then it turns out adipose tissue is the biggest endocrine organ that we have.

Holly Wyatt:
I love it. I love that. So, I know what our listeners are thinking. I've got this. I've got this visceral fat. All right. How can I get rid of it? What can I do about it?

Mike Jensen:
Well, if you're at a younger age, when you lose body fat, it turns out proportionately people lose visceral fat first.

James Hill:
Oh, that's good.

Mike Jensen:
Yeah. So when we look at people going through nutritional diet interventions, behavioral interventions, the people with more visceral fat lose a lot of visceral fat. Now, there are exceptions, but for the most part, people who have gotten a lot of visceral fat, that's the first depot that proportionately goes down. But I mean, part of that's a little funny because you can only have a limited amount of visceral fat to begin with. So if you lose two kilograms of that, it looks like more than if you lose two kilograms of subcutaneous fat. But the health improvements do seem to relate to the shrinkage of that visceral fat depot. We're currently starting a study that relates to subcutaneous fat health. Our guess is that when you lose weight, what really is happening is your subcutaneous fat is readjusting to do its job better. And because it's doing that, it allows that visceral fat to unload the excess that it has stored. That's our best guess.

James Hill:
But is it true? You can't do anything to specifically target a fat depot, right? So there's nothing you can do to say, “If I lose weight this way, I lose more visceral fat.”

Mike Jensen:
So Bob Ross up in Queens in Canada did some really cool studies where he had had people lose weight with high-intensity exercise versus some other forms. And he had some, I thought it was pretty convincing data that losing weight in the context of high intensity exercise, you preferentially lose visceral fat.

James Hill:
Oh, Holly, he is singing my tune now.

Holly Wyatt:
Well, high intensity, though, he's saying, Jim. He's not just saying activity. He's saying high intensity.

Mike Jensen:
High intensity. But it’s not that you can do a bunch of sit-ups and lose visceral fat, right?

James Hill:
Yeah, that's what people think about. Exercise the stomach and you're going to lose visceral fat.

Holly Wyatt:
But this isn't walking. This is probably something a little bit more intensive than walking?

Mike Jensen:
This would be like high-intensity interval training on the bike, stuff like that. But, yeah, just doing leg exercise isn't going to get rid of leg fat. Doing sit-ups is not going to get rid of abdominal fat. Now, you may strengthen abdominal muscles so you can suck it in better.

James Hill:
Yeah. I love it. Okay, Mike, I have to ask you, with all the proliferation of these GLP-1-based medications, are they affecting fat distribution over and above just the change in weight? Do we know that?

Mike Jensen:
The people who have reported the results have not reported it in a way where you could draw that conclusion. I mean, they cause so much greater weight loss than the control interventions usually. It's impossible to say whether what they're reporting is just the result of the greater weight loss or it's a specific effect of the GLP-1s. Fat cells don't respond specifically to GLP-1s. They just don't have the receptor. So if it was doing it, it would have to be doing it through another mediator rather than the G1 itself. So the short answer is we don't know. Best guess is it's probably nothing specific.

James Hill:
You know, one of the things that I always worry about with the GLP-1 meds, they're fantastic and the results are just amazing, but a lot of people stop them and regain the weight. And I always worry if at the end of the day you're back where you started or if there might be a worse pattern for doing that.

Mike Jensen:
Yeah, and I know that there's several people who have expressed that same concern is that when people lose that weight, that much weight that quickly, they also lose some lean tissue.

James Hill:
Yep.

Mike Jensen:
The worry is that... You regain weight, but you don't regain that lean tissue. Now you just have more fat and you could be worse off. I suspect that's being studied, right?

Holly Wyatt:
Yeah.

James Hill:
I think the whole idea with the GLP-1s is we haven't totally figured out to separate the results that are due to weight loss versus maybe some independent effects of the medication.

Mike Jensen:
Yeah. And of course, if I was a pharmaceutical company, I'd want to make the argument that there's some independent effect. But as a doctor, literally, I don't care. I mean, the people who are responding are responding with good weight loss and really good health changes. As they say, that weight loss is the 800-pound gorilla in the room. Right? It's so powerful. It's going to be really tough to detect some additional effect of the meds on top of the effect of the weight loss.

Holly Wyatt:
Right. But I think where it could become a problem is if then people regain the weight and then they do, like you just said, when they regain the weight, they regain more fat and don't get some of the lean tissue back. And so that to me is, it's like, well, we've got to be thinking about that at the same time as, oh my gosh, this is such a great solution for weight loss.

Mike Jensen:
Yeah. And that's especially been a concern in the elderly, almost with any kind of weight loss intervention, or if you're aggressive enough to lose a lot of fat, do you lose muscle? And then can the elderly regain the muscle? And we're not so much worried about that 25-year-old chubby guy because we know that if he loses weight and gains it back. 25-year-olds can put on muscle at the drop of a hat. We're worried about the 75-year-old who loses a bunch of weight and loses muscle and then gains back the fat.

James Hill:
That muscle is so critical as you age. Mike, you and I now, our demographic is anything you can do to maintain muscle as you age is going to help you big time.

Holly Wyatt:
I'm going to switch just for a second because you got me thinking about something. So maybe the GLP-1s, we don't know that they're targeting a certain type of fat. It just seems like weight loss in general. Liposuction. People go in and in liposuction, they're really getting rid of the subcutaneous fat. It's not going in and getting rid of the visceral. So you're taking what you were saying might be good fat. We don't like how it looks necessarily. I think that's why people do liposuction. They want to get rid of the look of it, but you're sucking it out. Do we have any data on that, how that might impact overall weight gain in the future or metabolic health or...

Mike Jensen:
Our good friend Sam Klein had a fantastic study in New England Journal where they took people and they sucked out like 10 kilograms of subcutaneous abdominal fat and then measured how their metabolism changed after they'd recovered from surgery. If you lose 10 kilograms of fat by comprehensive lifestyle intervention, we know you're going to get better. I mean, everything gets better. When they sucked out 10 kilograms of fat, nothing got better.

Holly Wyatt:
So the subcu did not impact metabolic health.

Mike Jensen:
And then the problem is, right? So people just keep doing what they're doing, so they are typically going to gain that back. And some interesting observations, it's probably because of the damage that happens when you do liposuction and you distort some of the architecture for allowing fat to move back into that damaged tissue. Some people gain back fat in the weirdest places. Like they'll get huge fat pads above their knees. And so the plastic surgeons are just fountains of information when it comes to what happens after this stuff. And if you ask them, they'll talk your arm off.

James Hill:
So, Mike, we talked about exercise as potentially helping with visceral fat. What about diet? Is there anything our listeners can do if they're losing weight? Does what you eat during weight loss, any indication that affects fat distribution?

Mike Jensen:
Not that I've seen. I mean, because you know, there's been studies, five diet comparisons, all the different diets have been compared to each other. It looks like if you lose weight, doesn't matter what diet you're on, the amount of fat where you lose it seems to be about the same. If there are diet effects, they're probably hard to detect. I mean, obviously, you wouldn't want to lose diet if all you were drinking was soft drinks. I can't imagine that would be particularly a great diet to go on. You might not lose your visceral fat, but nobody in real life is going to go on a diet where they only drink Coca-Cola as their intervention. But yeah, I mean, it looks like weight loss is the most powerful driver of where you lose the fat.

James Hill:
If you have visceral fat, weight loss is good, no matter what. You should lose weight. Maybe consider intense exercise, but you're going to lose some visceral fat when you lose weight.

Mike Jensen:
Yeah.

Holly Wyatt:
And then if you regain the weight, does it return to the same place? Do we know that? Or could I lose it and then suddenly regain it in a different location?

Mike Jensen:
Yes, that's possible. But it would be under kind of a… Let's say the circumstances, you're a pre-menopausal woman and you lose a lot of weight and you lose some hip and thigh fat and you lose some upper body fat, but then you go through menopause and now you regain that weight. It seems as if you're less able to gain fat back in the hip and thigh area after menopause. So that would be sort of the exception to the rule is that you put it back on where you lost it.

James Hill:
You know, Mike, one of the things that's a little bit scary that I think you and others have pointed out is there can be people that have a normal BMI and they have excess visceral fat. And the problem is, how do we ever know that? Because at home, there's no reliable way to measure visceral fat. We need some sort of accurate measure of visceral fat at home because very few people actually go in and get the accurate measures of visceral fat.

Mike Jensen:
From the clinical perspective, it's really easy to recognize. If you've looked at enough people, you look at them and you go, oh, my gosh, this is somebody that has skinny arms, skinny legs, and a big tummy, even if they're big arms. But doing it at home, we're talking about population-based kind assessment. I think that even though people are not very good at it, my thought would be if you had somebody measure their thigh right up near the groin and then just do even a crude waist circumference, that's going to be a better indicator than just, say, weight or body mass index or something like that. And realizing that hopefully thigh is mostly muscle, but still, if you've got a big thigh, whether it's muscle or fat, that's better than having a little tiny thigh. The worst thing is a small thigh and a big abdomen.

Holly Wyatt:
So, we teach waist circumference alone, that you can measure your waist circumference because I get the patient who says, Holly, this is all muscle, you know, this is muscle. And now you're talking about pinching and I'm thinking, oh my goodness, they're going to show me that, you know, I don't know what they're going to do, but, and I always say, well, let's measure your waist and let's see. Because you don't put a lot of muscle on your waist. What's there is fat. But now I'm like saying maybe that waist circumference doesn't show us visceral from subcutaneous. But it still is it a pretty good predictor? I mean, if your waist is large, don't you think you probably have some visceral fat?

Mike Jensen:
Absolutely. It's a much better predictor than BMI. But again, if you want to refine it even more, people who have more peripheral fat probably have less visceral fat. So what I'm saying is I think the waist circumference is good. We could potentially make it better if we had the clue being if you can make a lot of peripheral fat cells, that's a better metabolic place to be in than people who can't.

Holly Wyatt:
Very interesting.

James Hill:
So, Mike, you're one of the docs that really knows a lot about obesity, but a lot of people go to primary care folks. What's happening in the primary care clinics? I mean, it took us a long time to get them to even ask about weight and BMI. Are they attuned to this idea of fat distribution being important?

Mike Jensen:
[28:43] Obviously, our practice might be a little bit different. But what I see is now that we have effective weight loss treatments, everybody thinks they're an obesity doctor.

James Hill:
Yeah.

Mike Jensen:
Either they're not happy with their way or their doctor's not or their provider's not happy. They go, oh, you need Ozempic, or you need this. I'm going to write your prescription for this. No conversation about what happens when you stop it, how costly it is, what the side effects are. It just drives me crazy that people are getting prescribed these medications by people who never showed an interest in this topic before, but now they think they're an expert because they can write a prescription for a GLP-1 in.

James Hill:
I worry a lot about that, Mike. They don't give accurate lifestyle advice. They don't really understand escalating doses and so forth. So, I do think it's a problem.

Holly Wyatt:
Yeah, I agree. And it's doctors are thinking that. I know I have doctors coming to me saying, can't you just write this script for this study? And I'm like, there's more to than just writing the script for putting people on these medications and doing it the right way. And there's side effects and there's adjustments. And so I agree with you. People are not really understanding that there's more than just writing a script involved for these GLP-1s.

Mike Jensen:
The thing that is most concerning to me is people love it. They lose weight, da-da-da-da. And then they start saying, well, you know, I really can't afford this copay. And so never told that when you stop taking this, you're going to regain all this weight. The three of us, we would really emphasize lifestyle changes; changing behavior, more activity, healthier eating habits, cognitive behavior stuff. But when you're skiing downhill on Ozempic, you think this is easy. You're going, I don't need to do this lifestyle stuff. Like, why learn lifestyle? I'm a success, right? I mean, you think you got a triple. No, you were just born on third base.

James Hill:
This is so cool, Holly. We talk about this a lot, Mike, is that you talk to people that are taking the meds and they say oh man I got it. I can manage my appetite. I don't need these meds and then you stop the meds and boom.

Mike Jensen:
Our health care system and the person has invested thousands if not tens of thousands of dollars for this and when they stop it, most people gain back all that weight. And now you've got no net benefit.

James Hill:
Yeah. And the data suggests that maybe the majority of the people aren't staying with it for even a year.

Mike Jensen:
Yeah. Yeah. I mean, it's way over 70% don't stay on it for a year.

Holly Wyatt:
Yeah.

James Hill:
All right. I'm going to ask you a softball question here, Mike. What excites you most about the future of fat distribution science?

Mike Jensen:
The problem we've been working on and have yet to solve is, you can have two people, same body mass index, same percent body fat, one of them is getting diabetes, hyperlipidemia, the whole thing, visceral fat, and the other normal everything. And so what we're trying to understand is what is different about the fat tissue, between those two groups of people, where in one case, it's functioning normally, and the other case, it's very dysfunctional. Because if I was really smart, I have invented a GLP-1 that would be easy, simple, safe, and cheap, right? Everybody would be at their ideal weight, they wouldn't need me. But if we're not that successful and people who aren't successful losing weight, if I could understand at the cellular level how to make those fat cells behave normally, at least if they couldn't lose weight, their risk for diabetes would go away, their risk for heart attacks would go way down, all that kind of stuff. So in my world of fat, understanding how fat works is what goes wrong when people have dysfunctional fat and how do I compare that to what's going right? And if I understand that at a cellular level, I can then maybe design therapies to help the dysfunctional fat cells become functional.

James Hill:
Wow. That would be exciting. All right, Holly, I think you should hit Mike with the rapid fire questions. We'd like to put our guests on the spot.

Holly Wyatt:
Yes, I like these. These are just quick. What comes to your head? All right. First one up. A piece of fat distribution advice that surprises people.

Mike Jensen:
Hip and thigh fat is good.

James Hill:
That surprises me in a way, but it's a good way to think about it.

Holly Wyatt:
Yeah. One thing people obsess about that doesn't matter.

Mike Jensen:
The thing that people obsess about is all or nothing thinking. They're obsessed that if they make one mistake, if everything's a failure, they have to give up.

James Hill:
Yeah, we see that.

Mike Jensen:
That's just not true, right? Whether it's weight or whether it's anything else in life, one mistake, you shouldn't give up.

Holly Wyatt:
Yeah, yeah. It's got to be perfect, all or nothing. Absolutely.

Mike Jensen:
Perfect on my diet or I'm a failure.

Holly Wyatt:
All right, I'll do one more. The one habit that reliably lowers visceral fat?

Mike Jensen:
Stop drinking sugar-sweet beverages.

James Hill:
Okay.

Holly Wyatt:
Okay.

James Hill:
All right. Good one.

Mike Jensen:
It would be easiest, simplest thing you can do if you're drinking a lot of sugar-sweetened beverages, stop those, and you're going to get better.

James Hill:
Cool. All right, Holly, let's do a couple of listener questions.

Holly Wyatt:
Okay, you start us off.

James Hill:
Okay, Mike. Can stress change where I store body fat?

Mike Jensen:
It certainly seems like it. I mean, certainly there's good animal models that suggest that not only stress, but how you respond to stress. The Swedes have had some really interesting observations that people who respond to stress with more of a cortisone-type response, what we would almost call a passive response, gain more central fat. And people who respond to stress with more of an adrenaline type response don't gain visceral fat. The animal models are pretty cool. The human data is more correlative rather than cause and effect. But when you're under stress, if you just sit there and perseverate about it, you don't do anything about it, the response that's been observed is more of a surge in cortisol. And cortisol is associated with a central fat distribution. On the other hand, you're in a stressful thing and your response is more of a fight kind of response to the stress. You get energized and you respond to the stress. Then that does not seem to be associated with a central fat gain problem. I get associations, but I think it's interesting as an endocrinologist. It makes sense.

James Hill:
So really, it's how you respond to stress.

Holly Wyatt:
Yeah, that is interesting. Hormonally, how you respond to stress.

James Hill:
Oh, you endocrinologists blame everything on hormones. I see where we're going.

Mike Jensen:
We've all seen people who are under stress, the first thing they do is reach for a donut.

James Hill:
Yeah, yeah.

Holly Wyatt:
Well, but Mike, I may reach for a donut and I take action at the same time. So, you know.

Mike Jensen:
I'm on the treadmill for an hour to burn off that donut. Yeah.

Holly Wyatt:
All right. Here's another listener question. I'm normal weight, but I had a DEXA and it did talk about having high visceral fat. What do I do?

Mike Jensen:
Well, let's assume it's true, right? If you do have high visceral fat or at normal weight, are you getting enough physical activity and do you have decent eating habits? If you're not, if you're a couch potato, that's kind of a warning sign. The second thing is just that the DEXA measurement of visceral fat is somewhat imperfect. And so if your health is actually good in terms of your blood sugar and blood fats and stuff like that, and you're already active and have decent eating habits, then maybe you just accept the fact that DEXA is not perfect and maybe it went wrong in your case.

Holly Wyatt:
So, look and see if you have other signs like insulin resistance or high blood glucose or high blood pressure, something that's saying, yeah, you also are seeing the effects of a lot of visceral fat.

Mike Jensen:
So, like if your triglycerides are going up, your good cholesterol is going down, your blood sugars at the top of the normal range are just above, those are signs that, yeah, you probably do have unhealthy fat and visceral fat would be a marker.

James Hill:
All right, Holly, now it's time for the vulnerability segment where we ask our guest vulnerability questions. You want to do the first one?

Holly Wyatt:
Yeah, I'll do the first one. So, even experts have something they find challenging. What part of managing your own health or habits surprises people who know your work? Where do you struggle?

Mike Jensen:
Eating in front of the TV at night.

Holly Wyatt:
Yeah, you know you shouldn't do it, but you do it anyway, right?

Mike Jensen:
It's bad in two ways. One is you probably eat too much, and the second thing is you're not talking to your spouse.

Holly Wyatt:
Oh!

James Hill:
Ah!

Holly Wyatt:
I was about to say you're not moving. I thought we were going to the activity, but now we're going to relationships. I like it.

James Hill:
Yeah. We could do a whole segment on that one. Mike, I'll ask you one. If you could go back and give your younger self one piece of advice about health or your body, what would it be?

Mike Jensen:
Well, you know how many orthopedic injuries I've had in sports participation, Jim. I would have told myself to give up on the soccer a lot sooner and to go to tennis so that I didn't have to have knees replacements. All sorts of other bad stuff that's happening.

James Hill:
Yeah, Mike is very bionic. He's got all kinds of artificial things. But he's still out there being active because we ski together every year. So I can vouch that he's very physically active and believes in the importance of physical activity.

Mike Jensen:
Yeah, I've crossed the line from cardiovascular health to orthopedic on health too many times.

James Hill:
All right, Holly, takeaways. Fat distribution is not a character flaw. It's biologically driven. We know that visceral fat, the fat within your abdomen, is associated with more negative health consequences than subcutaneous fat. And I think one of the things that really was enlightening for you and I both, it really changed the way I think of subcutaneous fat being positive. When subcutaneous fat may not work the way it was intended, that might actually be one of the things that leads to more visceral fat. We know that weight loss can reduce visceral fat. For most people, when you start weight loss, you're going to lose a lot from visceral fata early on. Diet probably doesn't make much of a difference, but there's some evidence that intensive physical activity can actually help target visceral fat. The bottom line is, in many ways, fat distribution is not within your control. What you can do is focus on the healthy habits. Try to maintain a healthy weight. Try to have a healthy diet, a healthy physical activity pattern. So those are my takeaways. Mike, did I get it fairly accurate?

Mike Jensen:
Yeah, no, that's great. I guess the only thing I might add is that if you are one who tends to put on a lot of central fat and you think it's visceral fat, cut back on the alcohol.

James Hill:
Oh, yes.

Holly Wyatt:
You spring that on us at the end, Mike.

James Hill:
Yeah, really.

Mike Jensen:
I didn't want to make it the main point.

Holly Wyatt:
Got it. Well, Mike, thank you for breaking down a topic that I think confuses so many people.

James Hill:
Yeah. And to our listeners, we like to help you understand focusing on the things you can change and not worrying so much on the things you can't change.

Holly Wyatt:
Yeah. And remember, everybody, send us your questions or stories to weightlossand.com. We'd love to hear from you.

James Hill:
And we'll be back next time with more science, stories, and strategies. Thanks, everybody.

Mike Jensen:
Thanks, guys.

Holly Wyatt:
Bye.

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.