Why Your Weight Loss Maintenance Plan Doesn’t Fit

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 answering one of the most common questions we get, or at least frequently, what we've been getting now. What does a successful weight loss maintenance plan actually look like? We talk about needing a plan, that that's a non-negotiable, but describe what does it really look like? Is there one formula? Is there one right way? Is our book the only way to do it?

James Hill:
Short answer, no.

Holly Wyatt:
Love it, love it. There are multiple ways to win the weight loss maintenance game, but what doesn't work is guessing blindly or copying someone else's plan.

Holly Wyatt:
Today, we're going to talk about personalization because maintenance isn't one size fits all.

James Hill:
I don't think a lot of people realize that, Holly. They go into it thinking there's a way to do it, a right way and a wrong way. Man, if there's anything we've learned with working with people that are successful is if you study one person, you've learned about one person and everybody does it a little different. I actually think that's positive. You don't have to have one formula. You have some options and you can individualize it.

Holly Wyatt:
I think people are surprised when we say our book is one way. We've put everything we've learned about weight loss maintenance into a book to help, but it's not the only way.

James Hill:
It's not? You mean our book isn't the only way to do it? Oh my God.

Holly Wyatt:
And I think people want, this is the way to do it. And we've got to move away from that.

James Hill:
We did struggle with that in writing the book because we wanted to make sure that people understood that we aren't giving you the formula because there is no formula. What we're giving you is a template to use to sort of structure your own personalized approach.

Holly Wyatt:
And there is science-backed data and things we know are required. We have a lot of the National Weight Control Registry. We know a lot of stuff. But how you put it together and exactly what each individual needs, that's very different from person to person.

James Hill:
The way I think we looked at it is we first of all went to science and said, what do we know from research? And we came up with some principles. I think we did a good job. These are important principles. And then what we tried to do, and the principles are what, Holly, you would call pie in the sky, right? And so we looked at the principles, tried to help the reader understand the principles. But then we went to what you call pie on the plate to say, okay, how do you actually actualize on these principles? What does it look like? What do you eat? What do you do in terms of moving? How do you improve your mind state?

Holly Wyatt:
And so then we created multiple plays from the principles. The principles are what has science. So each of our principle, we could produce a lot of science to back up that principle. The plays then translate the principles. And sometimes one play, I would love it when we came up with one play that would hit two, three, four of the principles, because that's golden, right? Do one thing, and you're doing these four key principles that have science behind them in terms of managing or maintaining your weight. So in this first kind of segment, I divided this podcast into segments, Jim. I want to talk about, is the book the only way? And we're saying, no, it's not the only way. And you don't need all the principles. So what would you say about that? We have these principles. Do you think every person needs all the principles in the book?

James Hill:
Well, no, the short answer is no, because people start at different places. And again, becoming overweight isn't due to one problem. There are different reasons people become overweight, and we've tried to sort of point that in the book in terms of different profiles. There are some people who struggle with food. There are other people “ah, food's no problem. I can take it or leave it.” So I think we started out recognizing that not everybody starts from the same point. You know, Holly, there are plenty of people that are very overweight and they do physical activity like crazy. That isn’t their problem.

Holly Wyatt:
Right.

James Hill:
So they need to understand the principle, but they probably don't need as much or maybe no behavior change in that area where they need it in the other areas.

Holly Wyatt:
I think we're seeing that the physiology and behavior goes hand in hand. And for some people, they may have a physiology that doesn't require one of the principles. They naturally do one of the principles. I'll call you out, Jim. You don't need the mind state as much. You naturally do a lot of what we put into the mind is medicine piece. I've said that all my life. I had to work more on it. You naturally were born that direction. So that piece is important, but you don't have to work on it as much as maybe somebody else.

James Hill:
Well, I think where this can help people is you, first of all, look at where you're starting from, understand what your problems are. If you could look at our books, oh my God, we got to do all this.

James Hill:
Well, maybe, but you got to start somewhere, start where your biggest problem is. And that's where I think coming up with the profiles, I think we were brilliant in terms of coming up with the profiles, Holly. And they actually reflect people we've worked with over the years, real people.

Holly Wyatt:
And I want to do a deep dive in the profiles in a minute, but one more question. So people like, or I don't know if it's they like to, but they assume there's one correct formula. They are searching for the one correct formula. So they even want me to say, yes, the book with everything in it is the way to go.

James Hill:
I'd love to say that's the only answer, but we know it isn't. We put out a good plan, but it's not the only plan.

Holly Wyatt:
But why do you think people are like that? Why are we constantly looking for the solution, the right way, the secret?

James Hill:
Well, I think it takes some individual responsibility off of you. I mean, we're actually telling people you have to work a little bit to figure out where you are. And some people just tell me where I am, where I start, and we can't do that.

Holly Wyatt:
They don't want it to be complex.

James Hill:
Yeah, but it is complex.

Holly Wyatt:
And complex is different than hard. That's the other point I want to do.

James Hill:
You've told me that, Holly. I finally get it.

Holly Wyatt:
It is not just one thing. Maintenance isn't simple. It's complex. But that doesn't mean it's super hard. And that's the mindset shift I really want to get out there.

James Hill:
I think you're exactly right. And I think that's an important part that is not appreciated. I bet you if you stopped people on the street and asked them, is keeping weight off hard? They would all say it's hard. And yet...

Holly Wyatt:
Oh, they do. They get mad at me sometimes. It's hard. Don't you tell me it's not hard. They'll say that.

James Hill:
Well, we sort of learned a lot about that from the National Weight Control registry where first of all, we had to figure out how to ask the right questions. They didn't say, oh, this is easy, easy. But they said, you get routines and you work at it and it enriches your life and it becomes something you just naturally do. And I think that's what we're after. And they all, almost to a person, say life is better doing these kinds of things. So yeah, it isn't easy, but it isn't hard. It's somehow getting the routines and rituals and daily ways of doing things that are just natural, where you don't have to spend a lot of energy.

Holly Wyatt:
I think if you get past this, it needs to be simple or it has to be simple. If you say, okay, it is complex, it doesn't have to be hard, but the solution has to match the complexity.

James Hill:
Well, I think there's part of understanding that the problem is complex, but the solution may be more simple. I think people go into it saying, oh, it's just a matter of I eat too much, and it's more than that. But changing your diet may be a strategy you use to solve the problem.

Holly Wyatt:
Okay. Okay. So this brings us to this hot topic out there of personalization, precision.

James Hill:
Oh, yeah. Everything is personalization or precision. Precision medicine, precision nutrition, precision physical activity.

Holly Wyatt:
So where do you think the field is headed in terms of this precision medicine? Are we going to get there? What is that going to look like?

James Hill:
Well, on one hand, it seems intuitive, the fact that everybody's realized this. They look at their best friend or their husband or this and that saying, I'm eating exactly the same thing they are, and they're maintaining weight and I'm overweight. So this idea that nutrition doesn't affect everybody the same way, physical activity doesn't affect everybody the same way. I think it's intuitive. The question is, what do you do with that? Do you have an individual strategy for every single person? Do you look at general strategies that may apply to certain kind of people? So I think personalization, the concept is here to stay. Putting into practice, we hadn't quite figured out how to do that.

Holly Wyatt:
Right. We don't know. Do we look at blood tests? Do we look at genes? Do we look at how you react to a meal? I mean, we're studying that. There's NIH studies looking at how can we start to look at patterns and predictions and you have something that maybe we could test that then puts people in groups that we could then personalize a plan for either the best diet or for weight loss or for weight loss maintenance or to prevent cancer. And that's the other problem. What's your outcome? What are you trying to personalize?

James Hill:
And again, the problem is that, okay, people say, well, let's look at genetic information, Maybe based on your genes, I can figure out the right diet. But what about your behavior? What about your environment? There are so many things that can complicate this. So I love the concept. I think how we put it in practice, we hadn't totally figured that out yet.

Holly Wyatt:
So I don't think we're there yet, meaning we don't know how to do a test. We don't have a genetic test or a blood test or something like that. Or now people are sending in their poop, Jim, for the microbiome.

James Hill:
Right, right.

Holly Wyatt:
You know, and saying based on the bacteria in your sample, then you should do A, B, C, or D. There's companies and people selling that right now. Do you think the science is there to really support that?

James Hill:
No, it's not. I mean, basically, in the last 10 years, we've gone from sort of ignoring the microbiome to, oh, my gosh, it's the most important thing out there. And the microbiome is complex. And I think there are a whole bunch of people studying it, trying to figure out like one thing I look at is, you got all these bacteria in the microbiome. What are you looking for? What's the optimum value there? So I think it's a work in progress, and I think the science that's going on will eventually help us to understand what we can do behaviorally that maximizes our microbiome.

Holly Wyatt:
But it's not just the microbiome. People sometimes will say, send this blood sample in or a cheek swab. And based on whether they're looking at genes or whether they're looking at some kind of blood markers, they then give you a plan based on that. And I don't know any data that really supports that yet. And so people are giving a lot of money and people sometimes send it to multiple companies and get totally different results.

James Hill:
Yeah. And there again is the complexity. Certainly looking at blood type, looking at microbiome, looking at genetics, all those things play a role. But the problem is so many other things play a role.

James Hill:
So you may look at your genetics, but your environment and your behavior may modify things just as importantly as the genetics. We talk about your biology is important, but so is your environment influencing behavior. The beauty, though, Holly, is artificial intelligence is actually changing the way that we can look at complex things. I mean, until some of the recent AI tools, there's no way you could say, let's look at a person's environment and their behavior and their genetics. And from all that, let's predict something. With AI, you can do that. And the study you and I are doing with NIH, where we're trying to predict response to diet. We're using AI to look at patterns that there is no way we could have figured out those patterns without these sophisticated tools.

Holly Wyatt:
I agree. I think in the future we will get there. And I think AI and new ways of looking at data is going to be key that we haven't had before. And now we're opening that door. The message I want to get out though is don't think we're there yet. So people are spending money and putting a lot of effort into these products that are promising to individualize things. And I just don't see the data behind them yet.

James Hill:
You're exactly right. But we will get there. I mean, that's the point of science is that we didn't even know that we needed to do this a few years ago. Now that we need to do it, we have a lot of people using a lot of sophisticated tools to move it forward. So I do think we will get there. And whether we will ultimately be able to individualize at the level of the person or different groups of people, I think it will help us go beyond what we're doing now, which is one size fits all. I mean, we go out as a country, we do dietary guidelines as if that's the right thing for everybody.

Holly Wyatt:
That's a great example because those just came out again and I look at them and I'm like, wow, how can this one guideline?

James Hill:
Well, I always use the example, I think of elite athletes. You think the same diet is optimum for an elite athlete versus an overweight person with diabetes? I mean, come on. Those have got to be different. We just don't have the ability yet to individualize at that level, but it's coming. And I think in the future, we won't have one set of dietary guidelines. We'll have a way to personalize those guidelines.

Holly Wyatt:
Well, I think genetics probably play a big role in what diet is optimal for you. You don't even really know what to do with when you look at the guideline. I mean, if you're an athlete, you can say, okay, I'm an athlete, maybe, but if you don't even know that we don't even understand the interactions between certain genes and diet composition, that makes it even harder.

Holly Wyatt:
So this leads to what I wanna talk about next are the three profiles. This is kind of a simple way to try to start to personalize. Once again, it's not the end all, be all. It just is a framework that we came up with from talking to a lot of people. And really what I would do in my head when someone would come to me and start talking, I noticed that I would start putting them into a couple different or three or four even different buckets about where we should start. Because if you don't, it can be overwhelming to say, where do I even start? If something that I need to do multiple plays or it is complex. So the profiles that we put in the book, the three profiles are just a way to start, to start to think about it, for you to be aware, to reflect on what's going on with you and maybe say, okay, here is something to begin with.

James Hill:
Yeah, I agree. And I think it's very, very valuable. Maybe we'll modify these as we go forward. But for right now, I think they're very useful. So if you're saying, where should I start? I think the first way to start is to say, which of these profiles best fits me? It may fit parts of you in different profiles, but which one is closer to where you are?

Holly Wyatt:
And that's what happens. People say, “Oh, I see a little bit of this and a little bit of that.” But I still think it gives us something to think about. And so the first profile is the nonstop food seeker. This is common. I see this a lot. This is someone who has a high drive to eat. They think about food. I would say I don't have data to say what their food noise level is. We could get that now since we have tools now to look at that, but we didn't have them before. But I feel like they have constant mental food noise. They think about food a lot. Appetite regulation is a big struggle for them. So I fit in this category. I think about food a lot. I have to have a large volume of food to feel satisfied. And so that is one group that the food is a big, big player. And in the past, before the weight loss medications, this group would struggle with weight loss. We would really have to clamp, what I say, kind of clamp that intake, restrict that intake for them to lose weight. And they would, in my opinion, fight for every pound. They would struggle. They would fight for every pound. We would have to use multiple strategies, really get in there and work on that. They could lose weight, but they had to put a lot of effort into that weight loss phase.

James Hill:
These people really do well on the medications, the GLP-1 medications, don't they? Because it gets directly at their problem.

Holly Wyatt:
They're the ones that say, “Oh my gosh, I did not understand what this could possibly feel like.” They feel very, very different on the GLP-1s in my experience because they thought that this food noise and this constant thinking about what I'm going to eat, how much I'm going to eat, how can I restrict what I'm going to eat, has been there forever and been so strong that when it's decreased or goes away, they notice the big, big difference.

James Hill:
Yeah, we've had people tell us that they never ever before knew what it's like to not be hungry. And that's amazing to me. That's probably where most people fit, don't you think that would be the most frequent category?

Holly Wyatt:
I don't know if it's the most frequent category or they're getting help. So they come to me.

James Hill:
They're the ones that are loving these medications, at least in the short run.

Holly Wyatt:
Right. And they've struggled with the weight loss. It felt really hard. So they've come and asked for a lot of help. I don't know if they're the most in the population or not. And they do feel the most different on the medication. The idea with this group is when you, or if you need to transition off the medication, and maybe this group doesn't. Maybe this is a group that really should stay on.

James Hill:
Benefit from staying on them chronically.

Holly Wyatt:
Or a lower dose of it or some type of transition. But if you are and you need to transition off or you want to try to transition off, the food as medicine plays are critical. I would start with those.

James Hill:
So what we're trying to do there, Holly, is you can't totally replace the impact of the medications because they're powerful in their effect on the brain and biology. But behaviorally, there are things you can do that sort of pick up some of that lifting that the meds were doing to help you better regulate your appetite. You're not going to feel full easily like you do on the meds, but you may also not go back to where you were before about just being almost a slave to food.

Holly Wyatt:
Definitely there's some things you can do to help regulate the appetite, to make it not as low. The appetite as low as it was on the medication, but not as high as it was without the medication. And we do that in the book by taking the principles around food as medicine and translating them into play. So that's where I would start. Doesn't mean that's the only plays you need, but if you're saying, where do I start? If you kind of recognize yourself as a nonstop food seeker, I would definitely start with the food plays.

James Hill:
The second profile is one I really like. It's the sedentary sitter. These are pretty interesting. Again, for most of those people, they can handle the weight stuff. So they go on a diet and they restrict food and it's not that hard for them. It's a little bit hard, but not like the nonstop food seeker. It's like, “Okay, here's the diet. It tells me not to eat this. I'm not going to eat this.” And oftentimes they'll do really well. Weight loss. And in fact, we see many of these, Holly, they've lost weight successfully many, many times.

Holly Wyatt:
Yes.

James Hill:
The problem comes in and they struggle to keep it off. And because they're sedentary and not being physically active, they have two major problems they have to deal with. One is because they're not very active, their total energy expenditure is lower. So it's much easier for them to overeat. They have to almost constantly food restrict to match their low level of energy expenditure. It's what we call a low energy flux. They have a low amount of energy coming in, a low amount of energy going out. And that seems to be hard for people to maintain. It's much easier when they have a high energy expenditure and they get to eat a lot of food coming in. The second thing, and we talk about this a lot in the book, is they have a sluggish metabolism. Oftentimes that's talked about being metabolically inflexible. If you think about your metabolism, it's how your body operates. It's your insulin-glucose cycle. It's your mitochondria and muscles. It's how you put fat in and out of fat cells. It's your mitochondria. All this working together. And what we found is that physical activity optimizes that. Another way to put it is physical inactivity makes it more sluggish. It's almost like your muscles.

James Hill:
For your muscles to work well, you have to use them. For your metabolism to work well, you have to use it. And so the sedentary sitters are at a disadvantage when they lose the weight. Now they have a low energy expenditure, so they have to keep food intake low. And they have a sluggish metabolism, which works day in and day out just a little bit to store fat over burning fat. And that's why they're oftentimes really good at weight loss, but not very good at weight loss maintenance.

Holly Wyatt:
Yes. Clues that you might be a sedentary sitter or lean into that profile is you've lost weight successfully a lot. If someone gives you a diet, you can follow it. It's not that big a deal. And remember a diet, a restricted energy diet, you can, we only do that for a short period of time, but you can do it for a short period of and you can get the weight off. But when it comes to maintaining it and you stop eating that restricted diet, you go off plan, that's when the wheels fall off. That's where the yo-yo happens. So you repeat the process over and over again. The other clue would be you have a sedentary life. You sit a lot, that seems obvious, but how much do you move? If you're in a job that eight hours a day, you're sitting at your desk, you might fall into that profile.

James Hill:
And this really emphasizes what we say over and over. Weight loss and weight loss maintenance are different processes. And again, the sedentary sitters do fine on weight loss. Being sedentary doesn't prevent them from losing weight because food restriction drives the weight loss. It's during weight loss maintenance where now physical activity becomes primary other than secondary. And they're very good at weight loss. They're not very good at weight loss maintenance.

Holly Wyatt:
So Jim, think about this in terms of the GLP-1. So you have a sedentary sitter on a GLP-1 losing weight, what happens when they go off the med versus what if they stay on the med?

James Hill:
Yeah, just like we said, the nonstop food seekers may be the ones that benefit longer term from staying on the meds. I actually think these sedentary sitters might do well if they could increase physical activity. They may be the ones that are most able to go off the meds because, again, the meds help them on the food intake, but that wasn't their real problem. They're okay on managing food intake. Now they increase their energy expenditure, increase their metabolic flexibility. You know what? They may be well-equipped to keep it off, much better than the nonstop food seekers.

Holly Wyatt:
Yeah, they may not have that as much of that appetite drive. They just need to get that flexibility, and then their body is working optimally with that one change.

James Hill:
I think this is interesting. These people might be the ones who could most effectively and successfully transition from meds to lifestyle.

Holly Wyatt:
And so if you see yourself in that profile, the physical activity as medicine plays would be where to focus.

Holly Wyatt:
It doesn't mean you can't do the other ones, but if you want to know where to start or what are some of the foundational plays you need, I would look at the physical activity as medicine section.

James Hill:
And one of the things I want to emphasize it's important when you increase physical activity to find something you like. If you don't like it, you won't do it. And so in the book, we give you a lot of ideas for how to go out and find something you enjoy.

Holly Wyatt:
And that's not something you have to do. That's something you get to do. We get to move our bodies. I don't know why it's become this “Oh my gosh, I have to exercise. It's terrible.” We're meant to exercise. And so figuring out how can I move 60 minutes? I mean, let's change our mind state about that too.

James Hill:
And every bit of data suggests that you feel better and you have better mood and your mental health is better without exercise. So don't see it as a chore. See it as, oh my God, I get all this with exercise?

Holly Wyatt:
Yeah. Which leads us a little bit into our third profile. We call this profile the setback cycler.

James Hill:
Yeah.

Holly Wyatt:
And I see this one a lot too. These are individuals that they may struggle with weight loss. They may not struggle with weight loss. It kind of depends on where they are, what's happening in their life, what's kind of going on in their life. So they may sometimes have difficulty losing weight. Sometimes it may have been easier to lose weight. But what holds this profile together is things tend to fall apart when life throws them a curveball. A life event. They notice there's a lot of times there's a lot of drama around things and things are constantly happening to them. And when something happens to them, as they like to put it, I'm kind of using their language, as they get a curveball in life, they like to kind of justify it, talk about it, and then they throw up their hands and they believe they can't do anything. Everything goes out the window, what they're eating, how much they're moving, taking care of themselves, sleep. They just lose their structure. They don't know how to kind of deal with the emotions that may go with the curveballs or triggers that may be going on. They use food sometimes to deal with those triggers, or they just can't continue in the strategies they put into place. They kind of throw up their pants.

James Hill:
So I got a new boss and I hate this boss. And gosh, there's no way I can stick with my program with all this stress going on. It's not my fault. I could do it. But if I hadn't gotten a new boss, I would be fine. But I just can't deal with this. I'm going to start over.

Holly Wyatt:
And there's a pattern. And what they're talking about may be true. Their boss may be a... I mean, it's not that it's not true.

James Hill:
You're going to have these challenges in life, right?

Holly Wyatt:
Think about it, though, how they then believe it impacts them and how they deal with emotions and triggers. And so a lot of times the one thing when they're talking to me is real and it's powerful. The key here is to look for patterns. Is this happening over and over again? First it may be a move. Then it may be a job change. Then it may be a family crisis. And then it may be a health crisis. And then it may be a time crisis. And then we may be moving across the country, but there's something. And when that something happens, everything goes away. Everything stops. And they wait until whatever has happened to them, the event, the curveball goes away to get back on track. And they do. They come back. They come back. That's why they're a setback cycler, because they will cycle back through. But they do this over and over and over again.

James Hill:
And so the key is understanding that you're going to have these challenges and feeling like you have the skills, the resiliency, the approach to get through them.

Holly Wyatt:
And this can be a hard one because you can be a little blind to this because when you're going through it, it feels so real and it is real. And I don't want people to think you're making more of it than it is. Life events are big. It’s how you react to it. And so sometimes you have blinders on. So sometimes another person will see this pattern before you will.

James Hill:
Yeah, that's true.

Holly Wyatt:
So what I call super friends can be good. It's like, you know the people. So think about someone that maybe is a friend that this happens to. They call you. They always have these big events and then everything in their life stops, not just wait. It can be other things stop until whatever it is passes and they get back on. And then guess what? Something else happens again. And they call you up. And you can see the pattern sometimes before they can. So this is sometimes you can help other people out with this one. If you're struggling. Am I a setback cycler? You might ask your best friend, someone you trust, to say if they've noticed this pattern.

James Hill:
Ooh, who can tell you the truth.

Holly Wyatt:
Yeah, yeah.

James Hill:
A super friend.

Holly Wyatt:
So people then ask me, what if you see yourself in all three? I'm all three of these, Jim. What do you do then? How do you deal with that? Because I didn't say this the setback cycler they would start with mind as medicine. Those are the plays that they could start with.

James Hill:
And there's some good ones to help you get your mind state where it should be.

Holly Wyatt:
I would say most people are a blend to some degree.

James Hill:
Oh yeah. Most people are a blend for sure.

Holly Wyatt:
Yeah. So I would just say which one just feels the strongest might be the place to start. And you can add in plays from the other profiles, but just give you a place to start. Don't get worried about it, but just go with your gut almost. This one feels like the one I struggle with the most.

James Hill:
Yeah, yeah, I agree.

Holly Wyatt:
So then, Jim, you have now thought about the plays, right? This is where I want to start. Now you've got to put the plays into a plan.

James Hill:
Yeah. How do you do a plan, Holly? God, there's so many options. If I'm a blend, I see a little of everything. What do I do?

Holly Wyatt:
So in the book, we came up with three options. And I know our publishers were like, “Do you really have to make everything so complex?” And I'm like, yes. We try to simplify it, but we can't just have one plan. So three options. You get to pick one. One of the plans is called the focused plan. One is intensive. And then the a la carte is the third. And the focused plan is where you do a deep dive in five of the foundational plays in one area. So you pick food as medicine and you're going to do a deep dive. I call it five in five weeks. You're going to put five of the foundational plays into action over a five week period of time. And then after that, you can go into a second area, but you focus on one area, like food is medicine first.

James Hill:
So a deep dive into one area.

Holly Wyatt:
Yes. And then the intensive we call 15 plays in 10 weeks. And this is for the person that really wants to go in and do it all. They want it all. They really feel like they're all three profiles. They're ready to put multiple plays and put them into action. And so in 10 weeks, you can get all 15 of the foundational plays put into place. And there's a plan how you do that each week in the book. So that's for a little bit of my overachievers, the ones who's like, I want it all. And that's the plan for that.

James Hill:
But if that's what you want to do, that's an option. And there's a way to do that.

Holly Wyatt:
And then a la carte is where you get to piece the plays together, where you really get to say, “Okay, I want a little of this. I want a little of that. I don't need that. That fits me. Let me try to create something that fits me perfectly.” And the thing we have in the book that I love that helps you a little bit with this, we have a table that says, it gives a challenge. So if you're always hungry, here are the plays that would help you. If you love eating large portions, here are the specific plays that would help you. If you're waiting for the other shoe to drop, if you kind of feel like you're always waiting for the other shoe to drop, here's the mind foundational play that would help you. If you doubt your ability to succeed, here is a play that would help you. So you can look at the challenges that you're feeling or experiencing and then look for a play either in the food, the physical activity or the mind areas that match that up and kind of understand what it was designed to help with.

James Hill:
I love that.

Holly Wyatt:
So that gives you a little bit more structure, but you can use that a la carte and really make it your own.

James Hill:
You personalize it yourself.

Holly Wyatt:
Yes. So Jim, the next section I know is a little bit different, but people always are now talking about, do you want to be on the meds chronically? Should we cycle the meds? No meds? How are you starting to think about that?

James Hill:
Yeah. Number one, the meds provide a wonderful, effective tool. These meds work. And I think the companies and the scientists who developed them developed them with the idea of here's a medication, you take it, you lose weight, you continue taking it the rest of your life, and you maintain your weight loss. And Holly, the data that we have from clinical trials suggest at least up to maybe four years. That's the case. As long as you stay on the meds, you're going to manage your weight. Now, it's important to realize you're not going to continue to lose weight forever. And that's a good thing. You'd waste weight in nothing. Even on the medications, you're going to lose weight. You're going to reach a new equilibrium. But the medications seem to allow you to stay there. You're not going to lose more weight. And I think people get frustrated. Well, I've stopped losing weight, so the meds aren't working. No, they're working. Take them away and see what happens. But the other thing, even though the pharmaceutical companies said people are going to take these and take them forever, in the real world, we see that probably the majority of people don't do that.

James Hill:
They take them for a period of time, and then they stop taking them. And part of it is I think they go into it thinking, I'm going to get weight loss, and I won't need the drugs anymore. And the problem is if you lose weight on the medications and you stop them without a plan like one we've been talking about, the data suggests you regain the weight very quickly. The meds only work if you take them. So I think the future here is going to be how do we combine medications and lifestyle? These medications are fantastic, but I just do not believe that you're going to optimize your health and happiness without doing some of the other lifestyle behaviors, whether you stay on the meds or off the meds. So I think in the future, people are going to have options. We just talked about maybe the nonstop food seekers are the ones that should think of more chronic use. Maybe the sedentary sitters are ones that can wean off the drugs very actively. So I think we're going to see combinations. People are trying out low-dose medications. They're losing weight on the GLP meds and going to some older form medications. I think we're going to see a lot of mix and match in the future. But Holly, I'm convinced you've got to do the lifestyle changes to succeed whether or not you use medications or not.

Holly Wyatt:
So what you're really saying is mix and match. What is that? That's personalization.

James Hill:
Personalization.

Holly Wyatt:
That's what that is, figuring out what's going to work for you. And so while we don't have data exactly on how to cycle the meds or the lower dose, that's the art of medicine. And as more and more doctors get experience helping the patients on these meds, we're going to start to see that, I believe, more and more. That's the art of medicine. We have the science and then we have the art.

James Hill:
I totally believe, Holly, that for some people, low dose is going to work fine. I think, for other people, it's not going to work. And there's some trial and error in figuring out who it works for.

Holly Wyatt:
And I think it may be for this. Let's do the setback cyclers. It may be they lose weight for a while they're off the med. And then something happens in their life or something happens in anybody's life. You regain.

James Hill:
So go back on the meds.

Holly Wyatt:
Go back on. That's success. To me, that is success. That's not failure. That's success.

James Hill:
I think it's an exciting time to think about the mix and match because for the first time ever, we have effective tools.

Holly Wyatt:
Yes. It could be seasonal. It may be that you need to be on a little dose of the med or some dose of the med during a season. It might be different life phases may require you to be on the med or not be on the med.

James Hill:
Might be acute stresses. So when you get that new boss, you go back on the medications to get through it.

Holly Wyatt:
Maybe so. I mean, that's where I think we're going. And I want us to not get into there's only one path to success. This is that personalization piece, that art piece that I think is going to be important for a lot of people.

James Hill:
Let's do listener questions.

Holly Wyatt:
All right. So the first question I have down, someone said, how do I know which profile I am? Well, Jim, we've talked about creating some questions and we still may do that. Some questions that we can ask you and kind of give you a score because that's really what people like. But I would just read through in the book, we put the profiles, we describe a person that has this typical profile and see if you see yourself in that person, if that makes sense. We talked a little bit about some of the characteristics of the profile. So read the book. Just go with your gut if you read through and think which one maybe is the predominant one. I don't think there's a right or wrong here. You probably have a pretty good feeling which fits you best.

James Hill:
Yeah.

Holly Wyatt:
All right. Next question, Jim. What about this one? Can I shift from one profile to another?

James Hill:
That's a great question. I have no idea. My sense is that probably you won't. Probably you're going to be, you know, who you are, that these profiles are more of a characteristic of people. But I am not 100% sure of that, Holly. What do you think?

Holly Wyatt:
I think you have probably a characteristic pattern. But let's say you were a sedentary sitter, and you then started exercising. And maybe then that went away, you had that going on. And then, I don't know, maybe you started seeing more the setback cycler. You know, something like that comes up. But I kind of agree with you. There's probably a predominance. You're probably one that's really the base.

James Hill:
I think if you're a sedentary sitter, you can get to the point where physical activity is an important part of your life. But it's probably still something that would be harder for you than someone who wasn't a sedentary sitter. I don't know. I'm open to changing my mind.

Holly Wyatt:
So what you're saying with that, there's more physiology or genetics involved than environment in a sedentary sitter?

James Hill:
No, I'm saying both are important. But in determining these profiles, I actually think, yes, it may be more genetics than environment.

Holly Wyatt:
Okay. All right. We can have another discussion on that. All right. Well, here's a good question for you, Jim. I know my answer. Let's see what your answer is. What if I hate exercise? I'm a sedentary sitter, but Jim, I do not like it.

James Hill:
So we go through this in the book. First of all, use physical activity rather than exercise. Exercise just has a connotation on, God, I have to go and get on that equipment and sweat and I hate it and it's boring. If you think of physical activity and moving your body, I truly, truly believe that anybody can find a type of physical activity that they don't hate. I'm not going to say that they love, but they can find one that they don't hate and that they can make a routine part of their life. And I think part of the battle is figuring it out. You got to find something you enjoy. If you hate the physical activity you're doing, you won't do it. Try a dance class. Try pickleball. Try starting a walking group. Try swimming. There's so many things you can try i truly believe you can find something you don't hate.

Holly Wyatt:
So I agree with that. If I get someone who tells me that and they're sitting there with their arms crossed and they're like, I hate exercise, what am I going to do? We're going to go to mind as medicine. We're not even going to start in physical activity as medicine. We're going to go work on the mind first and then transition into that physical activity as medicine. But you're absolutely right about finding something you love. But part of that is shifting your mind state about it.

James Hill:
Well, it's the idea of, you know, we tell people they should do an hour a day of exercise. “An hour a day? Oh, my God, that's a lot.” “An hour a day? Only an hour out of 24 hours? That's all it takes?” You see the difference in how you approach it.

Holly Wyatt:
Next, what if I'm overwhelmed by complexity? If you're overwhelmed by complexity, go do the a la carte plan and just pick one or two. Try them out. If they're not working, you can add a few more. You don't have to go into the intensive plan. You don't have to do it all. I usually recommend the a la carte plan for people who are just said that your book is too complex. I'm overwhelmed by it.

James Hill:
Yeah, that's last question.

Holly Wyatt:
Can I build this plan while still losing weight?

James Hill:
Absolutely. In fact, that's the best way to do it is you start out while you're losing weight. So if you're on the GLP-1s, you're losing weight, great. Concentrate on the physical activity and the mind state, but be prepared that when the meds stop, you're going to have to put the food plays into action. You don't need them while you're on the meds so you can work on the other things, but be prepared because when you stop the meds, the appetite is going to come back. So have in mind the place you're going to use. Be prepared. Maybe practice them. Put them into play when you stop.

Holly Wyatt:
Yes, practice them. That's what I love. It's bonus. I think it's bonus if you can build this plan while you're still losing weight. Maybe it's starting to slow down. You can see that it's tapering.

James Hill:
I would love it if everybody who's even considering going on a GLP-1 meds would read our book, because it helps you think about the whole program, not just the first half of losing weight.

Holly Wyatt:
Agree, agree.

James Hill:
So, Holly, when you think about personalization, what excites you most on where the field is headed?

Holly Wyatt:
I love to think about this combination of physiology and behavior. And what I want to get to, and I don't know if we will. I think we will. I don't know if it's gonna be next year though. I think it's gonna be in the future is being able to find some pathway, a blood test, a pattern, a challenge that you could do that would highlight something about your physiology that then would show you the best plan for you or the best strategy for you. That's what excites me the most. We're not there yet, but I would love to be there. And so, Jim, have you ever changed your own thinking about maintenance over time? Has this, like maybe the high flux, low flux, has that changed or has it always been the same?

James Hill:
Yeah, it's changed a little bit. I think, if anything, I've become more aware of the flexibility and maintenance. I probably started out a little bit more. You have to do this and you have to do that. And here are the diets that are going to work best. And here's the amount of physical activity that's going to work best. I think we've seen enough people that mix and match that I'm a little bit more open to flexibility. Now, saying that, I still think high energy flux is a big deal. You know, Holly, people talk about, you used to say, well, eat less and exercise more. And you and I have changed it to exercise more and eat more. So the idea that you want to eat as much as possible without gaining weight, and the only way you can do that is to be engaged in a lot of energy expenditure and have a high flux. So I still think the higher the flux, the better, but there is an interplay between how people manage food and manage physical activity. I don't think many people can do it at low flux, but there may be some in-between where people can be successful without being incredibly fiscally active.

Holly Wyatt:
Right. There's not just one number.

James Hill:
Not just one number.

Holly Wyatt:
There is that flexibility. Yeah, I agree with that. All right. It's pie on the plate time. Can we sum it up? We've talked about a lot.

James Hill:
Go for it.

Holly Wyatt:
Let me give it a try. Here's some pie on the plate. Number one, there isn't one plan.

James Hill:
I agree.

Holly Wyatt:
You don't need to do everything that's out there. You don't need to cover every principle. You don't have to follow every play that's in the book or everything that other people do even. You need the right combination for you. That's the key. I think the profiles in the book can give you a starting place if you want some place to start. And the three plans, they give you some structure. But you have to adjust, and you may need to continue to adjust over time.

James Hill:
Yeah, and so it isn't simple. Maintenance isn't simple. But, Holly, you can navigate it with a good plan and being flexible and figuring out what works for you. When you personalize it, it can be sustainable.

Holly Wyatt:
Absolutely. Love it.

James Hill:
All right. See you next time on Weight Loss And.

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.