Jim 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.

Jim 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.

Jim Hill:

Ready for the “And” factor?

Holly Wyatt:

Let's dive in.

Jim Hill:

Here we go.

Holly Wyatt:

Today, we're going to tackle another big question. Why is it so hard to reduce obesity, not just in individuals? We talk about that a lot, right? How to lose weight at an individual level, but why is it so hard for the entire population? And are those different?

Jim Hill:

I think we recognize that obesity is one of the biggest problems facing society. And it's kind of ironic. We have more knowledge than ever. We have more tools. We even have new, fantastic medications. And yet obesity rates are still climbing or maybe staying the same at very high with three quarters of the population overweight. Why? Because there are barriers, big ones, that keep getting in the way. Some are personal, some are societal, and some come from the way we've been approaching obesity all along.

Holly Wyatt:

Yeah, and today we're going to break down the 10 biggest barriers that make lasting weight loss so difficult, thinking about it from a population standpoint. Some of these might challenge the way you think about weight loss. Others might explain why you or someone you know has struggled despite doing all the right things.

Jim Hill:

Yeah, you know, Holly, most of the podcasts we do are focused on translating the science to help our individual listeners. But I think occasionally we step back a little bit and say, yes, we want to work on individuals, but we also want to work on the problem as a societal problem. And I know we did a podcast not too long ago on how to make America healthy again. And this is kind of a follow-up of that. And the things we're going to talk about, they fit for individuals. I think you're going to find them useful, but they also fit at a societal level. So let's dig in. Now, we've come up with 10 barriers. We do all these numbers and we never get through them. So who knows if we'll make it through 10, but we've listed 10 barriers that we want to...

Holly Wyatt:

We like numbers, don't we, Jim?

Jim Hill:

We like numbers.

Holly Wyatt:

We like numbers. There's something we always like that.

Jim Hill:

We never make our goal, but we like numbers and we're going to have fun talking about these. So this episode, the 10 biggest barriers to reducing obesity in our society.

Holly Wyatt:

All right. We're taking on a big issue here. We're taking on a big one.

Jim Hill:

It's fun to do this. I mean, at some point in our field, everybody focuses on one little thing, but we need to step back at some point and put it together and say, maybe what should we try to do differently?

Holly Wyatt:

Yeah. And some of these may not be an issue for you or a barrier for you, but they are for society. And that's where you kind of shift your thinking a little bit. All right, Let's get going. What's the first one on your list?

Jim Hill:

I'll take the first one because it's right up my alley, as you know.

Holly Wyatt:

All right.

Jim Hill:

And that's the failure to appreciate the importance of physical activity. Now, we are not saying diet isn't important. You know we think diet's important. But physical activity is not just important, it's essential.

Jim Hill:

We're a sedentary society, and given our biology, and our biology is really set up so that we don't starve to death, we eat and we're driven to eat. And in an environment where your physical activity is low, you just can't eat enough to satisfy your hunger. If you do, you're going to be over your energy expenditure. So again, we've said over and over, it's both intake and expenditure. But if I had to make one big change in society, Holly, I would start with getting people more active. Lots of things we can do on the food side. If a society is going to be as inactive as our society, I actually think obesity is a necessary consequence. In other words, if we're going to be sedentary, we're going to be obese. So we have to figure out a way to increase physical activity. And you know, I talk about all the time, the nutrition and the physical activity people debate about which is more important. And it's just a silly, silly debate. They're both critically important. You can't do it with physical activity alone and you can't do it with diet alone. But we spend a lot of time trying to get people to restrict their food intake so low to maintain their weight. And I think it's impossible with our biology.

Holly Wyatt:

Well, I like what you said a little bit earlier. You said, we have to eat. We're wired to eat. We would die if we didn't eat. So we're wired to eat and so we will go out and seek out food. You can't turn that off. But interestingly, you can turn off physical activity. So, I mean, there are a little different in that. And so I think what you're saying is, and people will, I think, quote you wrong a lot and say, well, you're not interested in the diet. No, you're just saying we have to have this physical activity to be able to make successful changes in the diet, right? Not an or, but an and in a situation.

Jim Hill:

Absolutely. And the food environment's important. If we had an environment where it was very hard to get food, first of all, you have to be more physically active to do it. We probably wouldn't overeat. We have an environment where you go in the grocery store, there's good stuff in there, but there's lots of unhealthy stuff that tastes good. So our food environment coupled with our desire to eat, there's no way we can food restrict.

Holly Wyatt:

Yeah. But I'm going to push back just for a minute. So the barrier we're saying at a society level is failure to appreciate the importance of physical activity. Is that true? I mean, I think the message is out there, Jim, that we need to move.

Jim Hill:

No, Holly, I see where you're coming from. But let's take the nutrition field. They're saying, yeah, eat healthy, don't eat ultra processed. And oh, by the way, it's good to exercise. It's sort of, it's out there, but it's not prioritized. Let's look at just from a policy point of view. People have all kinds of policy ideas around food. You tax this, you restrict this, you do this, you reform. So lots of policy on the physical activity side. It's, oh, just encourage people to go out and be physically active. So even though if you ask the person on the street, they're going to say, yeah, physical activity is good for you, I don't think as a society we've taken on it as critically as we've taken on food.

Holly Wyatt:

All right. That's fair.

Jim Hill:

And not to stop taking on food. Don't get me wrong. People all the time say, oh, you're just saying it's all physical activity. It's not. But physical activity is necessary. If we're going to be sedentary, we're going to be obese in today's environment.

Holly Wyatt:

I agree. We've got to appreciate the importance of physical activity. And then we're going to have to figure out how to get the population able to move more. So appreciating it and doing it, not necessarily the same.

Jim Hill:

Same thing on the food side. It's easy for us to say, here's the problem, we've got to change it. But look at how society's changed in the past few years. It makes it easier to be sedentary. We all now sit in front of a computer when we work, we go home, we've got all kinds of sedentary entertainment. So it's one thing to say, let's appreciate it. And that's a big step. Then we have to do something about it. And boy, here is where we need innovation. We need ideas that don't exist today on how we increase physical activity in the population.

Holly Wyatt:

So I've got one, Jim. You know what has made a huge difference in my activity and I didn't even realize it, and there's actually some research on this? Get a puppy. Get a puppy that has to go out. You don't want this puppy to go on your floor. You got to get out multiple times. The amount of steps that have gone up since I got my new dog, huge. Huge.

Jim Hill:

That's great. And that's a good strategy.

Holly Wyatt:

I know. So we can mandate that everybody takes a dog. No, I'm joking.

Jim Hill:

They'll solve a couple of problems.

Jim Hill:

All right. So Holly, what's next?

Holly Wyatt:

Number two on our list of the biggest barriers to reduce obesity, things that get in the way. The reason why the obesity is not decreasing, trying to oversimplify a healthy diet. This is a big one for me. You know, the idea all the time. And there's really smart people that do this. Drives me crazy.

Jim Hill:

So what's a healthy diet, Holly?

Holly Wyatt:

That's the problem, right? What is a healthy diet? And it's very individual. And what is it going to focus on? And then if it focuses on everything, I would say you don't have anything left. If you can't eat sugar and you can't eat fat and you need to reduce carbohydrates and you need to get rid of the processed foods. And oh, yeah, watch the salt level, right? Because that's not good. And you go off to I have nothing to eat.

Jim Hill:

So I get all my information from YouTube and TikTok, and it seems pretty easy out there. Just don't eat ultra-processed foods, Holly.

Holly Wyatt:

Oh my goodness. Yeah. And well, we've had a whole show on that. You know that processing foods actually is a good thing. Keeps us from getting sick so much. If we didn't do some of the processes we do, our food supply actually wouldn't even be safe to eat.

Jim Hill:

So how do we figure out what to tell people to eat?

Holly Wyatt:

Yeah, well, that is the question. But I think it's not going to be simple. And that's the barrier, right? They want it to be a simple message. And they partly sometimes think people can't handle a complex message. And I don't think that's true. I just think it needs to be clear, right? We need clarity. But simple isn't going to solve it. What do you think? I mean, what would you do?

Jim Hill:

So I see where we're going here. Our job is to call out the problems. Not necessarily to come up with solutions.

Holly Wyatt:

We could do a whole show, but I'm not sure. If we could solve one of these problems, Jim, we'd be...

Jim Hill:

I'm kidding. I think it really is a big one because... We hear from a lot of our listeners, Holly, is they're confused. On one hand, you say eat more protein. On the other hand, you say don't eat carb, don't eat fat, don't eat this, don't eat that. And I think the problem is we want to oversimplify it. First of all, let's back to the first one. If your physical activity is low, you have to restrict yourself so much it's hard. You have to eat an amount of calories that match your energy expenditure. Now, within that, the idea is you've got protein, fat, and carbs. And we go round and round on telling people not to eat this one, not to eat that one, not to eat that one.

Holly Wyatt:

And then there's nothing to eat, Jim.

Jim Hill:

That's right. And the other thing is we concentrate a lot on foods not to eat, when in fact it's the diet. It's the holistic approach. So Holly, you can have chips every now and then. You can't have them very often. Dietitians often say there are no bad foods. Well, there are bad diets and good diets, but most foods can fit within a healthy lifestyle. I think we haven't done a good job of trying to get the message out. And as you said, it's not a simple message saying, don't eat carbs. I'm sorry. That message has gone nowhere. Just like don't eat fat went nowhere. We've got to do a better job of taking the complexities and helping people understand it. I think the public's smarter than we give them credit for here.

Holly Wyatt:

Right. And then once again, what you've been saying is when you put in activity, it gives you more room for your diet to put in those things. And then it allows you to have a healthy diet. To have a healthy diet at a very low amount of calories, there's certain things you can't put in there because the calories are too much, are too dense. So I think they kind of go hand in hand. That's a big one. I hope we stop trying to oversimplify it and start trying to think how we clarify what the options are. And I think options is the word, right? More than one, which makes it not as simple, but I think that's where we need to go.

Jim Hill:

Well, that fits in with the whole precision nutrition thing of what fits for one person isn't going to fit for the other person. And maybe this will help us as we understand more and more why people are different in how food affects them, maybe that will help us in coming up with solutions.

Holly Wyatt:

All right. Number three.

Jim Hill:

Number three sort of relates to the other two. But right now, we are promoting as a major strategy to reduce obesity, food restriction. If you look out there, you ask the person on the street, how do you reduce obesity? They say I have to eat less. And what we know, you and I talk about this all the time. Yes, you don't have to lose weight to get your weight off, but that is a temporary process. Food restriction is not a long-term strategy. Our biology developed to promote eating, not promoting food restriction. So when you're eating less than you want to eat, you're constantly fighting your biology. And surprisingly, a few people can win in the long term, but not very many. At the end of the day, your biology will win and you won't be able to maintain that food restriction long-term.

Holly Wyatt:

And who wants to not be able to eat food? I mean, I enjoy eating food. If I can only eat a very small amount of food for the rest of my life, that's not the life I really want. I want to be able to have some food.

Jim Hill:

And I think we hear from lots of people that have tried to do that about how frustrating it is to constantly feel like you're hungry, you're not eating enough food. The only long-term solution is, A, to increase energy expenditure so you can eat more, but then find a diet that's satisfying, that you can do forever, and you don't have to constantly fight your biology.

Holly Wyatt:

Well, I'll push back a little bit because here's what the new weight loss drugs are doing, right? They're allowing, if you stay on the drug, to food restrict forever, to not eat very much food forever. So maybe that, is that the solution? I mean, maybe this isn't a barrier if you're on the drugs.

Jim Hill:

Well, you're exactly right. The drugs are game changers in that they help people maintain food restriction without this feeling of hunger because they actually don't change the behavior, they change the biology. And I think in the short term, absolutely, these medications are fantastic. I think we'll see in the long term if that really is the solution to maintain your weight by eating less and having a low energy expenditure at a low flux. We talk about a high flux, eating a lot, exercising a lot, and a low flux is exercising not very much, eating not very much. So I think we'll see in the long term how effective these medications are. They're clearly effective in the short term.

Holly Wyatt:

Yeah. All right. Number four, a barrier, I think, is treating obesity as a personal failure. And I hope we're moving away from this. People are understanding more and more that it's not a personal failure, that genetics, physiology play a role, that different people struggle with this more than others, and that there's no reason to blame yourself. And that just doesn't help. And I think that's a failure and a barrier, people blaming themselves that's gotten in the way. I also, though, say we don't want to go too far because I can also then see kind of the field going too far saying, okay, it's not a personal failure, which it's not. I don't even need to deal with it. There's no responsibility. I don't have to think about it. I don't need to have a physician discuss my diet with me. And I think that's too far. But I definitely agree with a barrier being seeing it, treating it, doctors talking about it, thinking of it as a personal failure.

Jim Hill:

I think we're starting to turn the corner on that because, Holly, when we started our careers, it was totally seen as a lack of willpower. If you couldn't maintain your weight, something's wrong with you. You weren't a strong enough person. You didn't have enough willpower. I think we're understanding now, and the new medications have helped do this because people that couldn't do it before with the medications, they can do it because the biology was working so strongly against them. But I think you're also right that you can't give up all responsibility because at the end of the day, we know genetics plays a role. It may be genetically easy for you to maintain your weight or hard for you to maintain your weight, but you still have to put some skin in the game with doing the behavior change. So I think it's trying to get mix right. You don't blame the individual, but there is some responsibility to make some behavior changes.

Holly Wyatt:

Right. No shame, no blame. But I always kind of think about it as cards you've been dealt, you know, the genetic cards you've been dealt, and that's not your fault, that's not your failure. But what do you do with what you have?

Jim Hill:

Right. You got to play the cards you're dealt.

Holly Wyatt:

Yeah, play those cards. And I say responsibility. That's what you have, the power you have, right? There's things I can do. Yes, I have this genetic predisposition, but I don't have to throw up my hands and do nothing. There are things I can still do to modify and affect my body weight, even though we know and understand the physiology and the genetic predisposition to obesity.

Jim Hill:

So it's not your total fault, but you have some responsibility in treatment.

Holly Wyatt:

Yeah, it's not your fault at all. I think that word fault and blame and shame, get rid of those.

Jim Hill:

There's no fault. Get rid of that. And I think we're doing that. So I think we're making some progress there.

Holly Wyatt:

I agree.

Jim Hill:

All right, Holly, the next one, I love this one. Focusing only on weight in treating obesity. So is the scale the ultimate goal here? Is the goal to get that number on the scale where you want it to be? And I don't think it is. I think the goal is bigger than that. So you might say, well, the goal is to get the number there so my health is better. And that's part of it. I think that's the driver. But you know what I think the real goal is? The real goal is to be happier. The reason we want to lose weight is because we will be happier. Part of that is health. Health is a part of happiness. But the other thing, we will feel good. We will feel like we look better. We will have more confidence. So I think, again, now that we're helping lots of people reach their goal through medication and other ways, it's time to start thinking about there are some other measures of success rather than just the scale. Is your life better? Part of that is how you lose the weight. So oftentimes just getting the weight off isn't going to impact your happiness as the way you get it off with improving your fitness, eating a healthy diet, working on your mindset, working on your relationships. These are not things the scale can measure.

Holly Wyatt:

Yeah. The journey to get there, the changes you choose to make can have a huge impact. But I was, undergraduate classes have started here at UAB. So I was teaching a class yesterday. We kind of started talking about this. I'm going to be devil's advocate a little bit. There was definitely a group of students that said, you know what, we shouldn't focus on weight at all. Now we just said you shouldn't, you know, focusing only on weight and treating obesity as a problem. And I agree. Just the scale is not the only thing, just what you said. But there's some to be like, weight doesn't matter at all. We should only be focusing on health, or we should only be focusing on happiness, or we should, you know, they even brought up, and this is kind of to me, that physicians shouldn't even bring up weight, that that's not the issue. What do you think about that?

Jim Hill:

Well, again, I think it's complex, and I think that's going too far overboard. Again, I don't think we should focus totally on weight, but let's be realistic. Weight is something easily measured. It does impact health. So if you're overweight or obese, losing weight is going to impact your health. I think it's not the only factor. It's not the factor we should key on. If you focused on health rather than weight, losing weight is one of the ways you're going to improve your health. So I think we keep it in the equation, but we don't focus everything on weight. And you know what? Not everybody can be the weight they want, but at any weight, you can be healthier. If you're overweight, it's better to lose weight, but you can also increase your fitness and other things. So we've got to get away from weight as the only measure of success, but I don't think we get away from it totally.

Holly Wyatt:

To say that you shouldn't bring up weight as a physician, I don't agree with that. I think you need to be sensitive about how you bring it up, but I wouldn't not talk about someone's elevated blood pressure if they were in my office. And so I do think bringing up weight is important. I think the students were pretty much saying, we shouldn't talk about weight, we should talk about diet and physical activity. And if you're working on a healthy diet, you're working on physical activity, then you don't really need to talk about weight.

Jim Hill:

But if you do that, your weight's going to change, and it's one measure of success, of monitoring your success.

Holly Wyatt:

Well, no, Jim, because if you don't restrict your diet, you may prevent weight gain, but you may not lose weight.

Jim Hill:

I think most of the time, if you change your exercise and diet and you're overweight, you're going to lose some weight.

Holly Wyatt:

Oh, we're going to disagree on that one.

Jim Hill:

All right. So what we can agree on is that weight, it's okay for it to be in the equation. And it's one thing to monitor as a measure of success, but it's not the only thing. There are lots of other things we should look at in terms of success in lowering obesity.

Holly Wyatt:

All right. So here's the next one.

Jim Hill:

Let me take this one and you take the next one because the next one is up your alley.

Holly Wyatt:

All right. But this one, is it written as a barrier? I have it written down here. So change it, make it a barrier. I think this is a solution.

Jim Hill:

Well, the barrier, and again, some of this comes back to what we said before. So I hear all the time people say, eat less and exercise more. And that doesn't work. Thinking of that as a goal is a barrier. Here's what we should change, Holly. We should change exercise more and eat more. What we see is the people that are successful long-term aren't restricting their calories. They're actually increasing their exercise so they can actually eat enough to be satisfied. So get rid of eat less, exercise more. That's silly. It doesn't work. And if we need a slogan, it's exercise more and eat more. People that are successfully maintaining their weight long-term, their weight loss long-term, aren't eating less, they're actually eating more. But the reason they can eat more, they're exercising more.

Holly Wyatt:

Yeah. I often tell my patients when we're losing weight, I want you losing weight on as many calories as you can eat and lose. And when you're in maintenance, I want you eating as many calories as possible and maintain, right? And they're like looking at me like I'm crazy. I'm like, no, that is how we're going to do this long-term. That's what's really going to work.

Jim Hill:

That's why the mindset right now is food restriction. People are saying, you're telling me to eat more, that's not going to work. All my life, I've been told to eat less. We've got to change that. That's a barrier.

Holly Wyatt:

But with that comes you got to move more.

Jim Hill:

Absolutely.

Holly Wyatt:

It's that and, that's that important part, putting them together.

Jim Hill:

All right, Holly, this next one is made for you.

Holly Wyatt:

Oh, it's made for you too. This one is the barrier, failure to appreciate the importance of mindset and weight management. And we've been talking about this for years, Jim. Everybody wants to talk about what to eat, how much to move, but nobody really does any real work on what you think, that mindset, how you perceive the world, how you perceive what you're doing, what you focus your mental energy on. I say there's physical fitness. There's mental fitness. And I hope in the future, and in the future, I think in one of the books we're writing, we're putting this in, Jim, mind minutes, just like you do activity minutes.

Jim Hill:

I love it. But if you look at most programs out there, they don't include this. They're big on eat this, eat this, maybe some exercise, but they don't ever deal with the mindset.

Holly Wyatt:

They say they do that. They're starting to say it, but when you really look at it, they don't do very much or they just mention it, right? I always say it's lip service. You got to get in there just like you got to do activity. You got to move. You got to look at the minutes. You got to look at the volume. You got to look at the amount. Same thing with mindset. It's not just saying it. You got to do some stuff.

Jim Hill:

Yeah. I think as we've gotten into this, Holly, you and I probably believe mindset is as important, if not more important than anything else in the weight loss journey. If you don't have the right mindset or as we call it mind state, there's no way you're going to sustain the lifestyle you need to keep your weight off.

Holly Wyatt:

Yeah. I just started a group last night that's losing weight. And immediately everybody wants to know what they should be eating and how many minutes they should be moving. I'm like, you know what? No, tonight, is about getting our minds right. We're going to work on mind state first before we do the other.

Holly Wyatt:

That's how important I think it is.

Jim Hill:

Okay. Next, a big barrier is thinking that the new weight loss medications totally solve the problem.

Holly Wyatt:

Oh, well, some people say they do. This is it.

Jim Hill:

They're saying, Holly, what are you going to do now that obesity is solved? What are you going to work on next?

Holly Wyatt:

Right.

Jim Hill:

We've seen this over and over in our career. Something comes along and it's the answer. Don't get me wrong. These medications are wonderful game changers. They're fabulous new tools. But you know what, Holly? We don't yet know the best way to use these tools. What we know is they're very effective for weight loss in most people. There's still some people that don't do well with them. The side effects, at least so far, seem reasonably tolerable for most people. The question is over the long term. We've always had this issue. We've been better at getting weight off than keeping it off. And so the idea with the medications is how are we going to keep that weight off?

Holly Wyatt:

Well, wait, let's back up though, because we've been better at getting small amounts of weight off.

Jim Hill:

But we hadn't even been able to keep small amounts off.

Holly Wyatt:

Exactly.

Jim Hill:

So now we're getting large amounts of weight loss. And the question is, can we keep it off? Well, one model, and a lot of our colleagues think this is the best model. You go on the meds and you stay on them for a lifetime, just like you stay on blood pressure meds and diabetes meds. So that's one model. We don't have that long-term data, but from everything we know, That could be a reasonable choice for some people. That could be the answer. But you and I have learned in talking to a lot of people, there are a lot of reasons why some people can't or don't want to continue long-term on the medications. And right now, what we know is when you go off the medications, most people regain their weight. So we've said this is an opportunity for the lifestyle people to say, look, we've had trouble helping people reach their goal of weight. We don't need to do that anymore. Let's concentrate on helping them keep it off because, Holly, weight loss and weight loss maintenance are different, and that's going to be another one of our 10 that we're going to talk about.

Holly Wyatt:

Yeah, but back up to this one because one thing I think it actually hooks to a barrier we talked about before. If you do think that these drugs are going to solve the problem, then you're basically saying the problem is just weight.

Jim Hill:

Yes, that's right.

Holly Wyatt:

And I think we're saying, no, it's not just weight, right? There's what you eat, how much you move. It's your happiness.

Jim Hill:

Your cardiometabolic fitness. We talked about on our last podcast, best predictor of longevity is your cardiometabolic fitness. The drugs don't increase that.

Holly Wyatt:

Right. So if you think weight is the only problem, then maybe this would solve it. But I think the problem is bigger than that. It's not just the weight. It's weight and. Medications don't take care of the and part.

Jim Hill:

So wonderful tools. We still have to figure out the best way to use them, but they're welcome additions for those of us who want to help reduce obesity.

Holly Wyatt:

Yeah. So the next barrier you already kind of talked about, failure to see weight loss and weight maintenance as different processes requiring different behaviors and different skills. We've talked about this.

Jim Hill:

Why is that important, Holly?

Holly Wyatt:

Oh my gosh, because they're totally different, right? Weight loss is about being in a negative energy balance. It's about burning fat. It's a total physiology difference, right? It's physiologically what's going on in your body is very different. Your body doesn't want you to be in a negative energy balance forever because you would die. The strategies that put you in that negative energy balance are different than the strategies for weight loss maintenance where what you're eating and how much you're moving need to balance. Physiologically, very different. The strategies that help you balance between the two, make those two things equal, very different than the strategies that put you in that negative energy balance. So to me, this is just foundational. You know, you gotta understand this. And I do think it's a barrier because people, whatever they do to lose the weight. They just keep doing it forever. They think that's what's required.

Jim Hill:

So if you want to help somebody lose weight, you're going to have them engage in behaviors that are very different behaviors than if you're helping them maintain the weight.

Holly Wyatt:

Yes. And what I typically do is I know the behaviors that are required for weight loss, but while they're losing weight, I'm also teaching the behaviors for weight loss maintenance. So when it's time to switch, you can switch over and do the behaviors for weight loss maintenance. We say we begin with the end in mind. Where do you need to be behaviorally to keep it off?

Jim Hill:

But people a lot of times don't want to do that. They want to focus so much on the behaviors for weight loss, that they never switch. They never understand that those behaviors aren't going to continue to work during weight loss maintenance. And you and I have talked about this. We think this is the wonderful opportunity for lifestyle. We don't have to get the weight off. We don't have to focus on those behaviors. We can go and help people focus on the behaviors to keep them off.

Holly Wyatt:

You mean if they get the weight off in another way, like with the medications? Yeah. I think this is one of the reasons why, Jim, people will do lip service to physical activity but not really increase their physical activity because the physical activity is what's really going to help with the weight loss maintenance, but they're always in weight loss. In the past, I've been in weight loss and haven't really ever switched over to weight loss maintenance and, I guess, see the importance of physical activity.

Jim Hill:

But see, most of our programs in the past, Holly, have tried to do both. You try to get the weight off and keep it off. If we actually develop some programs that are focused on weight loss maintenance to apply to people that have lost the weight, we've never tried that before.

Holly Wyatt:

Well, we have tried that before, Jim, and no one showed up because no one lost enough weight. I always said that was the death of a program. If I said weight loss maintenance, no one would show up.

Jim Hill:

That's the problem. You have to get the weight off before people are ready to do this.

Holly Wyatt:

Yeah. So we tried it, but under different circumstances. But now, now you're right. Now we can do it, I think.

Jim Hill:

All right, Holly, we're going to get through these. We're at number 10. We're going to make it in one episode.

Jim Hill:

And number 10 is one you and I talk about all the time. One barrier is seeing obesity just as a metabolic problem. Now, we know obesity is a metabolic problem. It leads to diabetes and heart disease and cancer. Yes. But you know what? There are other reasons that people want to lose weight. They want to lose weight to look good. You think that's an okay reason?

Holly Wyatt:

Absolutely. I totally do. We got to stop judging people too. Everybody thinks, oh, my health. And if I want to be it because I'd want to prevent type 2 diabetes or treat my type 2 diabetes, that's good. I can say that. But I can't say that I want to wear a little black dress or I want to feel good in my own skin or I like how I look. Why this judgment. Why would we judge anybody? You get to pick what motivates you, in my opinion.

Jim Hill:

I love it. And that's why people often say, oh, yeah, the reason I want to lose weight is my health because they know that's the answer they think people are looking for because they think they will be judged as, oh, Holly, you just want to lose weight to look good. That's not a real reason to lose weight. That's a judgment.

Holly Wyatt:

Yeah. And what I say is I want to find the thing that motivates you the most, and in my opinion, sometimes metabolic health motivates people.

Jim Hill:

Right.

Holly Wyatt:

But for a lot of people, that's not the most powerful motivator.

Holly Wyatt:

And I want to find the most powerful motivator. That's what's going to help somebody.

Jim Hill:

I love it. Wow. Holly, we got through 10 barriers. Can you believe it?

Holly Wyatt:

I can, Jim, because we're just like that.

Jim Hill:

So again, these are issues we see as potentially holding us back as a society from addressing obesity. But I think almost all of fit for individuals. So if you're listening and you're managing your own weight, I think these are all very applicable to you as well as to society.

Holly Wyatt:

Yeah, I would say pick one or two that you think really kind of fit you. You don't probably have all of these barriers. Some of these may not be barriers for you. So pick the ones that you recognize in yourself. That would be kind of what I would go for.

Jim Hill:

Okay, you want to do some listener questions?

Holly Wyatt:

Yeah, we have a couple that I think kind of worked into the show. We could work them into the show and it makes sense. So you want to go first?

Jim Hill:

All right. So here's one question we got. I feel like every diet plan contradicts the last one. How do I know what actually works for long-term health? That's a great question. I wish I knew the answer to that.

Holly Wyatt:

It kind of fits with that barrier trying to oversimplify a healthy diet, right? We talked about that.

Jim Hill:

It totally does. So again, what I'd say sometimes is you can decide what you want to eat and you can go in a bookstore and find somebody that's written a book to tell you to eat that exact thing. There is every kind of advice out there. It contradicts itself. Eat carb. Don't eat carb. Eat fat. Don't eat fat. More protein. Less protein. I understand why people are frustrated. I think part of it is separating out weight loss from weight loss maintenance. And weight loss, if you take one thing out, eliminate something from your diet, protein, fat, carb, whatever, you're going to lose weight because you're going to eat less. Weight loss maintenance is a whole different ballgame. If you've increased your physical activity, now you have some choices. Now you can put together a satisfying diet. But still, Holly, we don't have that long-term information about the best diets to keep weight off and that's information that we need.

Holly Wyatt:

Yeah. So what I would tell this listener or what I kind of tell people now is I like what you said, you know, the diet, think about what you're going to eat for weight loss may be different than what you're going to eat, the diet for weight loss maintenance. But if we're talking about weight loss maintenance, you want a diet that is satisfying, that you enjoy. And first off, get the physical activity up.

Jim Hill:

Yes.

Holly Wyatt:

Make sure the physical activity is up and then you have a lot more choices and that's really only how you're going to win, but get a lot more choice in your diet. So physical activity has to be up. Then you can pick your diet and you know what? You can do a little bit of experimentation. This is where trying something, seeing what's working, we don't have the data yet to be able to say this individual does best on this diet, which I think is where we want to go, but you can do your own little bit of experiment and figure it out.

Jim Hill:

There's some science-based tips people can use, like eating foods that have a lot of volume and not a lot of calories, energy density, doing more volume, looking at foods like fiber that increase satiety. So there are a number of things you can do in weight loss maintenance that might not work for weight loss.

Holly Wyatt:

Right. And that's exactly what I mean. There's big tips like some of us are volume eaters. That's me. And so if you know that, then you can try out making the volume and making the energy density of the meal less by adding the vegetables, adding things that make the volume big without making the calories big. Try that out and see how that's working for you. That's not 100% though, Jim. I think a lot of people are volume eaters, but there are a few people. I definitely run into them where just a small amount of really satisfying food, they do well with that. You know, Jim, you do a little bit well that you're always like a handful of nuts. And I'm like, a handful of nuts. No, that is not something that is going to work for me. But it works for you, I think, sometimes. So that's where I think trying some strategies out.

Jim Hill:

And if you're in maintenance and your physical activity is high, you can try out some things without negative consequences.

Holly Wyatt:

Yeah.

Jim Hill:

If you're sedentary, you know, and you try out things and it doesn't work, you're going to gain weight back. But if your physical activity is up, you've got a buffer on being able to try out new things.

Holly Wyatt:

Yep, I agree. All right. Do you want to do one more listener question?

Jim Hill:

All right. My doctor keeps telling me to lose weight, but I want to focus on being healthy, not just hitting a number on the scale. What should I do? So we've talked about that a little bit more is weight isn't the only thing. If you focus on being healthy and you do it in a right way, you're probably also going to produce some weight loss. So again, what I would say is make sure you're getting physical activity, look at weight loss, and then be ready to switch to weight loss maintenance. And weight loss maintenance is where it's really important to have this healthy lifestyle in order to keep your weight off.

Holly Wyatt:

Yeah. So this question where they say, my doctor keeps telling me to lose weight. I think as a physician, I do feel like I have to bring up weight with my patients. I need to, just like I wouldn't let a patient walk out of an office with a high blood pressure or a high blood glucose without explaining to them, without talking about it. But at some point, bring it up. And if the patient and you don't want to do anything about your weight, That's your choice.

Jim Hill:

So it does come back to your why, right? And maybe the thing to do for this person is to say, well, the doctor wants you to lose weight. Do you want to lose weight? And if you do, why? And if you want to eat healthy, why? So come up with your own goal. I am fine if somebody says, hey, I want to improve my diet. I want to exercise. I don't care if I lose weight or not. Great. That's going to work for you.

Holly Wyatt:

Yeah. So I would say for this person, talk to your doctor about that. Say, I hear you. I understand that my weight may put me in a category that increases my risk and that it would be helpful for me to lose a few pounds. But right now, that's not important to me. But I am interested in increasing my physical activity or I am interestedin working on my mental health and decreasing my stress or increasing my emotional resiliency. So I think it's just having a conversation with your doctor and saying, here's what I'm willing to work on. My guess is your doctor's going to be willing to do that.

Jim Hill:

Right. They will work with you.

Holly Wyatt:

Yeah. That's what I would do. All right. So let's do a couple of vulnerability questions. Let's see. All right. This one's good for you, Jim. It's about failure to appreciate the importance of physical activity. So the question is, have you ever struggled to stay consistent with your physical activity? You know, Jim, it's important, right? You've done all the research. You talk about it all the time, but do you, have you ever struggled and what changed your perspective in that case.

Jim Hill:

Yeah. So early in my career, I traveled a lot. I travel a fair amount now, but I traveled a lot. And most of the time, I was much younger. My exercise was tennis and some running. And the travel really took its toll. I couldn't find time to do that. And what switched is I actually discovered working out in gyms. I didn't do that before. And most hotels have a gym. So I started now, when I travel, I always take my gym clothes. And I go to the hotel gyms. But I did struggle for a while because the travel such that I felt like I didn't have time to do the kind of physical activity I wanted. And so I kind of changed the kind of physical activity I did.

Holly Wyatt:

Yeah. Different stages in your life, different times in your life. You have kids. Things may need to change. You get a new job. That's why you always got to be kind of constantly thinking about it and trying new things. And yeah, that's important. So I think it's important for the listeners to say you knew it was important, but even you struggled.

Jim Hill:

I did. I struggled. And there were times when I didn't keep my physical activity up.

Holly Wyatt:

Yeah, it happens.

Jim Hill:

All right, Holly, if you take one thing away from today, let it be this. Obesity isn't just about willpower. It isn't just about metabolism. It's about the systems we live in, the way we think about weight, and the strategies we use to lose it. If we keep approaching obesity the same way we always have, nothing is going to change.

Holly Wyatt:

I totally agree. But the good news, I think there's some good news. Once we start, I think, identifying these barriers, we can work around them. I always say awareness and being aware of what's getting in our way is the first step. So if you've been struggling, it's not because you're failing. It's because you maybe have some obstacles that society, our population has really put in place or has developed. And maybe you didn't even know they were there. And if you now recognize those barriers, you can navigate them in a way that works for you.

Jim Hill:

Yeah. So let's keep this conversation going. If this episode resonated with you, share it with a friend, subscribe, and send us your questions for a future episode. Do you want us to do more of this kind of thing? Let us know. We want to hear from you. What barriers have you faced in your weight loss journey?

Holly Wyatt:

Absolutely. And progress is possible. You're never stuck. You're just one change, one breakthrough away from moving forward. All right. Until next time, guys.

Jim Hill:

See ya. Bye. 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.

Jim Hill:

We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://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.