**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, today we're tackling a topic that could totally change how people approach their weight loss journey, body composition. Now if you're not familiar with that term, it's basically what your body is made of. Fat, muscle, bone, water, organs, all this you're carrying around. The scale gives you a number, but it doesn't tell you about the different components inside. Once you understand what's really happening inside your body, it could make a big difference in how you lose weight and keep it off.

**Holly Wyatt:** Absolutely. We get so many questions about body composition. People want to lose fat, people want to gain muscle, they want to know can they do it at the same time. I think that understanding this topic, body composition, can be a game changer for some people. I think it's why today's conversation is going to be so eye-opening.

**Jim Hill:** To dive into this topic, we're thrilled to have one of the world's top experts in body composition with us, Dr. Steve Heymsfield. Steve is an internationally renowned for his groundbreaking work in the fields of obesity and nutrition, particularly in understanding body composition and how it influences weight management. He is a professor at the Pennington Biomedical Research Center, and he's published hundreds of peer-reviewed articles that have shaped the way we think about and treat obesity. His research has truly changed the game when it comes to managing weight beyond just what the scale said. Steve is also a member of the Pennington Nutrition Obesity Research Center, the NORC. Again, this whole podcast is part of the UAB NORC, so we really love to have other people from other NORCs on. The other thing, Holly, you may or may not know, is Steve was one of my mentors when I was a postdoc. He's older than I am.

I'll just put that out there. Steve and I worked together at Emory. He was a faculty member at Emory, and I was a postdoc. I was primarily working in a basic science lab, but I became so interested in what Steve was doing that I began to work with him. Steve, we published several papers together over the years.

**Steve Heymsfield:** We did. We certainly did.

**Jim Hill:** Well, welcome to Weight Loss And, Steve.

**Steve Heymsfield:** Thanks very much, Jim and Holly.

**Holly Wyatt:** Yeah. So, do you want to just jump in with questions? Are you ready?

**Jim Hill:** Let's do it. Let's pepper him with questions. He has lots of good answers.

**Holly Wyatt:** All right. I'll kick us off. So, we often hear people talk about the number on the scale, right? They're always saying, how much do they weigh? But I know that it's only one part of the story. What does body composition reveal that the scale can't?

**Steven Heymsfield:** Well, a scale simply gives you your body weight, but it doesn't tell you what you're made out of. And what you're made out of has a big influence on your health, particularly how much fat you have and how much muscle and bone and other components like that. So you learn a lot more beyond body weight.

**Jim Hill:** So, the different components, Steve, are linked to different metabolic health. For example, you really don't want to lose weight. You want to lose fat, would be ideally. How does the different components, and I know you've spent your career looking at how the different components of the body influence energy expenditure and metabolic health, etc.?

**Steven Heymsfield:** Well, the largest factor that influences energy expenditure are the nonfat parts of your body, like your heart, your kidneys, your brain determines your energy expenditure to a large extent, and that in turn determines how much you can eat every day to keep yourself in energy balance or weight balance.

So that's a major factor. Fat or adipose tissue doesn't really burn many calories. It stores calories, and so having more body fat doesn't really increase your energy expenditure very much.

**Holly Wyatt:** So, when people lose weight, where is that weight actually coming from? Is it coming from fat or are they also losing it in their muscle? Are you talked about the heart?

**Jim Hill:** and organs?

**Steven Heymsfield:** When you lose weight, presumably, if you just go on a low-calorie diet, for example, and you don't do excessive amounts of physical activity, the largest proportion of the weight loss comes from your body fat, because fat is a source of energy and you need it when you're losing weight. But also, some of it comes from the other parts of your body, the muscle, the bone, the heart, the liver, and other visceral organs like that. And so, we do know that weight loss is not pure fat. If it only was, life would be pretty simple, but it's not.

**Jim Hill:** Is there anything people can do, Steve, to maximize loss of fat and minimize loss of the other body components?

**Steve Heymsfield:** Yes, there are a few things people can do to minimize the loss of these other vital components, which all have functions like strength, endurance, and other functions like that. And the best way to do that is, number one, keeping physically active.

**Jim Hill:** Yeah, I love that.

**Steven Heymsfield:** Right? If you're sedentary, that will promote the loss of muscle and bone. Also, you have to eat adequately. Even though you're on a low-calorie diet and losing weight, you want to make sure you get all those other essential things, including adequate amounts of protein, minerals, vitamins, and factors like that. We have great historical knowledge about what happened when people ate inadequate diets and lost a lot of weight, and it was very damaging to those other tissues in the body.

**Holly Wyatt:** So let's get some details. I know what the listeners are thinking. Is there one diet that's better than another diet when it comes to really targeting fat loss and preventing these other types of weight loss that may not be as good?

**Steven Heymsfield:** Well, first of all, let's start out by saying that we should avoid fat diets that have strange composition of nutrients. Say, for example, all protein or all carbohydrate or all fat or things like that, we should avoid those. So eating a balanced diet and reduced number of calories is probably the best thing you can do. I think one thing we've learned today is that individuals vary a lot in how they respond to different diets. It's called personalized nutritional health and responsiveness. So it's important that each of us finds our optimum diet to lose weight and keep it off. It's not just the composition of the diet, but we now know that how you eat it, what times of day, days in the week and other factors like that can also play a role.

**Jim Hill:** So two people could lose exactly the same amount of weight, but they might lose different amounts of muscle and fat, and they might end up with a different total energy expenditure after weight loss.

**Steven Heymsfield:** Yes, that's absolutely right. And one thing we know fairly clearly is that when men lose weight, they tend to lose more lean mass, muscle and other things like that than women do. And a smaller proportion of the weight loss is fat. But that's just basically because men tend to have more muscle and other components like that to begin with.

**Holly Wyatt:** I always tell people it's normal to lose a little bit of lean tissue when you lose weight. When we gain weight, we tend to gain a little bit of lean too. We gain mostly fat, but a little bit of lean.

If you lose, it would make sense to do the other. But how much is too much? Like what's normal there versus when are you really starting to get into where you really are losing too much of the good stuff?

**Steven Heymsfield:** We have sort of rough estimates of what people should lose when they go on a diet. And again, men and women are different in this context, but roughly a fourth or a third of the weight loss typically will be lean tissues.

That includes muscle and bone and other components like that. Roughly about a third. If you're extremely sedentary, you're not active at all. Maybe that proportion could go up a little higher. And if you're very active, you could reduce that proportion considerably. So you might be able, if if say, do strength training or endurance exercise, you might be able to reduce the amount of muscle and liver and kidney and other organs like that you lose.

**Jim Hill:** Steve, one of the things that we talk a lot about and people are very interested in are these new JLP-1-based weight loss medications. And some people have raised some concerns. I don't know that there's a lot of data available about whether you might be losing more muscle than maybe optimum on these meds. Any thoughts on that one?

**Steven Heymsfield:** Well, I'm very interested in that question in particular. And it's been reported that a fourth to one half of the weight loss can be lean tissues like muscle on these new JLP-1 drugs. What we don't really know clearly yet if it's the drug that causes that or if it's just the large amount of weight loss. If we go back in history, most of the drugs and diets we have can lead to five or maybe maximum 10% weight loss. Now we're in a range of 10% to 20% weight loss with some of these drugs. And we're beginning to recognize that loss of lean tissue can be quite large with that larger amount of weight loss. So people have really gotten interested in this.

**Jim Hill:** It's kind of new territory when you get this amount of weight loss. I I Holly and I have experienced this over the years. We struggle to get people to be happy with the 10% weight loss. And as you know, they rarely are. But you give them a 20% or or weight loss and things are very, very different.

**Steven Heymsfield:** You're right. And we spent years and years convincing ourselves that a 5% weight loss was healthy and wonderful. But now we're getting 15% or 20% weight loss. You know, that's the higher amounts. But what we're beginning to see is that conditions like heart failure improved, diabetes improves much more than we had really anticipated.

**Holly Wyatt:** I think it's interesting with these drugs. You You is it the drug that may be shifting some of the weight loss into the lean tissue? Or is it the amount of weight? Or is it the fact that people are really cutting their calories, you know, really going below maybe a threshold of calories that is required because people are losing weight fast too on these drugs? Any idea or is there a certain number of calories people shouldn't go below? I get that question a lot to, you know, prevent the loss of lean muscle or lean tissue.

**Steven Heymsfield:** First of all, rapid weight loss is risky. You don't want to lose weight quickly because number one, you can have electrolyte problems. But also people get gallstones that they lose weight too fast.

So it's risky. You don't want to lose weight too quickly. And with these new drugs, the titration, the slow increase over several months is a good idea.

Not only because your tolerance to the drug will improve, but you reduce those risks. The other thing you mentioned, which is a really interesting one about maybe people are taking in too few calories or too few nutrients during that phase of weight loss, that is risky. And there is data that people have developed nutrient deficiencies.

The most common is vitamin D deficiencies, which is not unusual, but other things have shown up that people aren't eating adequately. So you want to eat a balanced diet. And we know that if people eat under a thousand calories a day, for example, then that poses a certain risk, especially we went through an era at Jim's part of this. Perhaps you were also about 500 calorie diets, and that posed enormous risks for people. And And the kind of current paradigm says somewhere between 1,000, 1,200 calories a day is probably a safe level. As long as it's a balanced diet, you're getting all the other nutrients you need.

**Jim Hill:** Steve, I'm fascinated by the power of these new drugs because people will say, I forget to eat. I have to set my alarm clock to eat. I'm not hungry. On one hand, that's great. But there is a little bit of concern about that too, right?

**Steven Heymsfield:** Absolutely. The last thing you want to do is lose weight too quickly and lose all those other things we talked about. There is some data that if you lose it slower, that perhaps you'll lose less lean mass.

It's not yet totally convincing, but it's certainly been hypothesized and people are doing studies looking at that. But if you just stop eating, then of course you're putting yourself at risk for other problems.

**Holly Wyatt:** So talked about physical activity being helpful in preventing the loss of lean tissue. Any types of physical activity or amounts, can you help us out there? Are there there things that would be more helpful than others?

**Steven Heymsfield:** I know Jim's an expert in that area, but in particular, strength training has been recommended as the best way to prevent loss of muscle. You obviously want to do that. Aerobic training also has benefits because you burn more calories and you improve your fitness. Fitness per se is an important aspect of our biology that prevents other diseases and so on. So somewhere, some kind of balance between an aerobic endurance kind of exercise and a strength training really is probably the ideal.

**Jim Hill:** Holly, he's singing my song. That's exactly right. I think you want to mix. What we recommend, Steve, is that most of it should be aerobic because you get so many benefits on fitness and so forth. But you need to do some resistance, especially as you age.

And I want to talk about that in a minute to keep yourself functional. But a real reason, you want to lose more body fat because you want the fat gone. But by preserving muscle, you also preserve energy expenditure. The less muscle you lose, the less food restriction you have to do to keep the weight off.

**Steven Heymsfield:** There's no doubt about it. You're absolutely right for all of those reasons. And coming back to the issue about aging, as you know, as we age, we we muscle and bone, osteoporosis and conditions like sarcopenia are very common later in life, frailty, people fracture hips. So you want to keep your activity level healthy, do both types of activity. One thing we should say, though, sometimes people who are obese or overweight even have a lot of joint and musculoskeletal problems. And so those need to be watched out for getting consultations with physical therapy.

It's very common. Trying to avoid joint replacements to the extent you can. And I see it, I'm a little older. So I see it a lot in my peer age group of people who have had joint replacements who have been overweight their whole lives. So that's something you really have to guard against.

**Jim Hill:** So big question. If you are a little older and overweight, is it okay to lose weight or should you be more careful if you're older?

**Steven Heymsfield:** That is a question a lot of people are asking now. It used to be asked a lot before the GLP1 drugs because sarcopenia frailty is a common thing in older age groups, but even more so with these drugs. You have a 70-year-old who comes in who's obese and says they'd like to take one of these drugs and lose 20% of their weight. We don't have a clear answer yet to that person, but if you go ahead and do it here again, you want to make sure you eat enough protein that you get enough activity to prevent that loss of muscle, which you're going to have a much lower amount to begin with about as age 70 than at age 20.

**Holly Wyatt:** I think that kind of goes into that obesity paradox that we see a little bit when, as people get older, it seems to be beneficial to have a little bit more body weight on you. And we don't completely understand why, but we do see that it changing a little bit as you get older. So I think we do have to look at that a little bit differently and be careful.

**Steven Heymsfield:** Yeah, that's absolutely right. And one thing is very clear. The population is aging. You You a lot more older adults. We're healthier. We grow up with better nutrition and medical advances of so prolonged lives of many people, including people who are obese who can take high blood pressure medicine, statin, get joint replacements, and they're arriving into this older age group. I'm not sure where we consider old, but older age group. And therefore, these kinds of questions are coming up a lot now.

**Jim Hill:** My definition of aging is moving back and back over time, Steve.

**Steven Heymsfield:** Yeah, you're right. You're right.

**Jim Hill:** So back for a minute to these GLP-1 medications. The data, at least as I've seen, suggests that if you take them and stay on them, they're very powerful for helping you lose weight and keep it off. But some of the early data, and I know we need lots more data, suggests that a lot of people don't stay on them. Even if they lose weight, they go off them. And at least in the clinical studies, it suggests that if you go off them, you gain the weight back. Is there any danger there of being worse off after you've lost weight and regained it than if you hadn't done it at all?

**Steven Heymsfield:** I can tell you what people say. First of all, the statistics are quite stunning and I think we need more data, but I've been told that maybe only a third of people are still on these drugs after a year.

**Jim Hill:** Yes, which amazes me quite frankly.

**Steven Heymsfield:** That's right. You would never do that with a high blood pressure drug, statin drug, because they're lifetime drugs as are the GLP1 agonists, but the recidivism rate seems very high. The question then is, of course, you don't take the drug, your weight will return. Your excess weight will return sometimes with a vengeance, very fast.

There's been a lot of discussion. Is more that weight gain fat and less of it muscle? Some people say it is more fat, but I'm not convinced. I'd like to see the data, but it is something that you it's not good to rebound again in weight. It's depressing for one thing. One has to be cautious about that.

**Holly Wyatt:** That brings me to another question that a lot of people ask, is when you're losing weight, can you also be gaining muscle? Can you do the two things simultaneously? We think about losing, and you can lose both or gain. You can gain both, but can they go in the opposite directions? Could you be losing fat and at the same time gaining muscle?

**Steven Heymsfield:** First, the short answer is yes. There have been a number of studies, a few of which I've participated in, where people have lost weight through low-calorie diets and also exercised very vigorously. You don't gain as much. In fact, maybe gaining is not the right word, preventing the loss.

It might be a better way of thinking about it. It's very hard to put on muscle mass in the face of negative energy balance or negative weight balance. You can, particularly if you're doing strength training, and maybe as Jim mentioned, some aerobic training, but it's hard to build muscle, but it's easier to prevent its loss.

**Holly Wyatt:** People always say, I've gained 10 pounds of muscle, and I'm like, whoa. When you talk about that, how much do you think they're gaining?

**Steven Heymsfield:** Yeah, I don't think anything.

**Jim Hill:** I think it's hard to gain muscle anyway, even if you're not losing weight. Look at these bodybuilders. They basically, they have a full-time job of building muscle. I think you're exactly right. I think that's a hugely important thing for people to understand. Your goal for most of our listeners, they're not going to gain muscle, but there are things you can do to prevent the loss of muscle, and that's important.

**Steven Heymsfield:** That's absolutely right. The other thing about muscle is you don't always have to change muscle mass to get an improvement in muscle function. We haven't talked about that too much, but function is a broad category, not only of strength and endurance but of metabolic functions. And so there's a lot of interest now in, okay, so maybe the mass of muscle doesn't change much with weight loss, but functional things can change, either improving or worsening. So that's a topic of great interest.

**Holly Wyatt:** That means that's another thing then that people should be looking at, not just looking at the scale or looking at specifically even about how changes in muscle might be happening, but they need to be maybe measuring some functional or strength or doing something else that could show some changes that the scale wouldn't show at all.

**Steven Heymsfield:** That's absolutely right. For example, if you lose a lot of weight, the most common example of this is with bariatric surgery, where people lose 25%, have 25% weight loss, they clearly are less strong, but they're more mobile, they can walk further, they have better endurance. And so we have to think about these things more physiologically.

This comes up a lot with the GLP1 agonist. Okay, so you lose a kilogram of muscle, that's two pounds. Does it really make a difference to your strength? And people say, oh, there's not much change in strength, but maybe there's other factors that are going on we should think about.

**Jim Hill:** Interesting. Okay, Steve, I want to spend a couple of minutes on a topic for which, in my opinion, you're the world's leading expert. How do you measure body composition?

**Steven Heymsfield:** Well, let's start with this extremely simple thing to do is calculate your body mass index. And if those non-mathematically inclined people, there are equations you can-

**Jim Hill:** Google it, they're easy to do it online. Google body mass index.

**Steven Heymsfield:** Okay, so that's stage one. Then the next question is people vary a lot at the same BMI in body fat. So how would you do that? A very simple thing. As you probably know, there are biomedicine scales, biomedicine analysis, they're commonly available, they vary in quality a lot. We have skin-full calipers and tape measures that we can use to do this.

Those are all things that can be done by anybody almost any time. Go to the next level, then we have laboratory and clinical kinds of equipment like dual energy x-ray absorptiometry or DEXA scans, which involve use of x-rays to divide the body up into the different components. We have computerized tomography and magnetic resonance imaging. Those are really research tools, mainly research tools. And we have other kinds of tests that we can use in laboratory settings.

**Jim Hill:** So Steve, I know you think about this. Predict the future. What are the innovative ways that could revolutionize body composition?

**Steven Heymsfield:** Well, that's a great question. I wish I had a crystal ball, but I'm going to start with probably the most distal, if that's the right word, one first, which is there are a number of factors circulating in blood that reflect body composition. Hundreds of different metabolites. And there are companies, at least two companies I know of, have a blood test that predicts body fat and fat distribution. Not widely validated. In fact, the NIH has put out some ideas about validating them. But that would be something we could think of in the five to 10-year range or something like that.

And clearly, there must be an association like that. Then maybe a little more proximally, we have these imaging techniques like in a smartphone, as you probably know, you can have a smartphone app that takes a 3D image of you, and particularly if you dress appropriately like in tight-fitting clothing. And then from that, you can get all your body circumferences and dimensions.

And that, in turn, will give you your muscle mass and fat mass and other factors like that. Those technologies are already on the immediate horizon. So those are the kinds of things people are thinking about.

**Jim Hill:** I love it, Steve. I love it.

**Holly Wyatt:** I think that last one is exciting because it's not invasive. You can do it from your own home. You could do it multiple times. You don't have to go somewhere. It could be inexpensive or cost-effective in that sense. So that one to me is really exciting. If we could start being able to do that really accurately with our phone, I think that changes things.

**Steven Heymsfield:** Yes, absolutely. In fact, the idea came from early studies at UAB. I'm not sure how much you're aware of that, but there was some people at UAB who started working with very simple smartphone pictures, photographs, and used those. And now, of course, that's transformed to 3D, 3D images of yourself.

**Jim Hill:** So, Holly, you want to play a speed round of myth or fact?

**Holly Wyatt:** Yes. Myth or fact. This is like truth or dare for an academic, right? Think of it this way. I'm going to give you a sentence, basically. And you say myth or fact to it.

If it's a myth or if it's a fact. And you can give us a little bit of an answer after, but the idea is we keep it short and we keep it sweet and we keep it hopefully fun.

**Steven Heymsfield:** Okay.

**Holly Wyatt:** You ready? All right. Number one, muscle weighs more than fat. Myth or fact?

**Steven Heymsfield:** Myth because a pound of fat and a pound of muscle still a pound.

**Holly Wyatt:** Yes. That was a trick one. You passed. Yes. Okay. All right. Number two, you can build muscle while losing fat at the same time.

**Steven Heymsfield:** As we said, that submit, at best, you can preserve muscle.

**Holly Wyatt:** Yeah. And if you gain it, it's such a tiny, tiny mouth. So, yeah. Yeah. I agree with you there. All right. The third one, you need to drink protein shakes immediately after a workout to build muscle.

**Steven Heymsfield:** That's a myth.

**Holly Wyatt:** Why is that a myth?

**Steven Heymsfield:** It's a myth because as long as you eat an adequate amount of protein, then you shouldn't need to drink a protein shake, particularly right after a meal. But you revise always have to eat adequate amount of protein.

**Holly Wyatt:** Right. It could be helpful, but I think people think that has to happen. And bulk up from lifting heavy weights. It's true. I think so many women think they're going to lift some heavy weights. I think it's very hard and very rare for women to bulk up with resistance training.

**Jim Hill:** It's not something they should worry about.

**Steven Heymsfield:** No. In fact, that's a good point, Jim. You don't want to look like a bodybuilder if you can help it, unless you really want to do that.

**Holly Wyatt:** All right. We're on number five. You can target fat loss by doing exercises for specific areas like crunches for your belly fat.

**Steven Heymsfield:** That's a myth because your body just doesn't know where to take off specific fat. It's going to come off wherever it wants to take it from.

**Holly Wyatt:** Unfortunately, for me, I always wish I could sculpt my body by moving it, but I agree. Yeah, it's hard. Then number six, the more you sweat, the more fat you're burning.

**Steven Heymsfield:** The more you sweat, no, that's a myth. Yeah, I wish that was true.

**Holly Wyatt:** But some of my listeners are going to say something to me about this because I always say sweat is your fat crying. Just kind of as a joke in other words, get out there and move, but you're correct. Sweat is a result of the body temperature regulation and it's not necessarily fat-burning. All right. Number seven, strength training boosts your metabolism even after you stop exercising.

**Steven Heymsfield:** There is some truth to that. There are effects that last for many hours, sometimes a day or so after you do a vigorous exercise program.

**Jim Hill:** It's probably relatively small, but a lot of studies show that there is something there, which is another reason to exercise.

**Steven Heymsfield:** Yes, absolutely. It's not been well publicized in a sense. I know a lot of investigators are very interested in that effect even 24 hours later.

**Holly Wyatt:** I think the amount is small, but it's there. I think some people tend to say, oh, you burn a lot for a long time and that's not true. But I do think, yeah, it does give you a little bit of an extra burn. All right. Number eight, eating fewer carbs is the best way to lose fat.

**Steven Heymsfield:** Well, eating fewer calories is the best way to lose fat. So carbs are not specific for that effect.

**Holly Wyatt:** I agree. So that's a myth. Yep. All right. Number nine, we're almost there. Visceral fat is more dangerous than subcutaneous fat.

**Steven Heymsfield:** Well, that's certainly true. There's a mountain of evidence to support that. I won't say myth, they're claim.

**Holly Wyatt:** Yeah. So that's a fact. It's more dangerous. That's the fact that's around kind of describe that for our audience. What's that fat?

**Steven Heymsfield:** Well, visceral fat's the fat around your organs as compared to the fat under your skin, which is the subcutaneous fat. So visceral fat, there's this quite a bit of it in the body.

**Holly Wyatt:** Yeah. All right. Last one, you need to do hours of cardio to lose fat effectively.

**Steven Heymsfield:** I'm going to say that's a myth.

**Jim Hill:** Good answer.

**Steven Heymsfield:** Okay.

**Holly Wyatt:** Yes. You don't have to do cardio.

**Jim Hill:** You can lose fat without doing any exercise. That's right. She's tricky though. That was worded in a tricky way.

**Steven Heymsfield:** You know, I guess what popped to my mind was that the more exercise you do, the more you're going to eat, whether you know it or not. There's sort of a little compensation there, right, Jim?

**Jim Hill:** There is some compensation, but for most people, it didn't total. You're going to compensate, but you still get the good effect from exercise.

**Steven Heymsfield:** Exactly. Yeah.

**Jim Hill:** I think he did pretty good, Holly.

**Steven Heymsfield:** Oh, he did great. He did great. On the spot, you know, just rapid fire.

**Jim Hill:** Let's do a couple of quick listeners questions and then we'll sum up. Here's a question from Bob. I'm 74 years old with a BMI of 30. At my age, should I still be focused on losing weight or is there something more important I should be paying attention to when it comes to my health?

**Steven Heymsfield:** We'll go back to the first start with eating a healthy diet. Keep your saturated fat low, your sodium intake low, and avoid added sugars. You know, go along those lines. Don't smoke and make sure to have a healthy exercise activity program. Let's call it activity program.

Start there. Then if you want to lose weight, I would definitely consider doing it slowly with a healthy diet again and maybe even speaking to register dietitian nutrition along the way because in older people, maybe there's a few other considerations.

**Holly Wyatt:** Would you recommend that he get his body composition measured other than not with the regular scale, but in some way that you can actually see the difference in muscle and fat?

**Steven Heymsfield:** I think that's not a bad idea at all, particularly in that age group because he could have sarcopenia, which is a low muscle mass relative to your body fat. I think that might be very useful for him to know.

**Holly Wyatt:** All right. One more. This is something I hear all the time. This comes from Trish. Most of my excess weight seems to be in my hips, not in my belly. Not that visceral fat, more in their hips. Is there a way to specifically target fat in this area?

**Steven Heymsfield:** Not specifically. We talked about that earlier. It's difficult to do that. The best thing is, again, having a good exercise program so your muscles are toned and your fat doesn't wobble around and watch how much you eat and perhaps lose a little bit of weight. That's the best thing you could do.

**Holly Wyatt:** Should she worry about fat in her hips? Since we talked about the visceral fat, since it doesn't seem to be around her organs, if that's all the fat she has on her hips, should she worry about that fat at all?

**Steven Heymsfield:** There's quite a bit of evidence that fat in the lower body, particularly that part of the body, is actually somewhat beneficial if that's the right word. In other words, it's not a high-risk fat like visceral fat.

**Holly Wyatt:** Beneficial, though. I don't know if I've ever heard that, so it's a good thing.

**Steven Heymsfield:** It's a positive. When you look in epidemiological studies, people who have fat in the thighs and lower hips region, they actually have somewhat lower risk.

**Holly Wyatt:** Interesting.

**Jim Hill:** Okay, Steve, now we're going to hit you with a couple of personal vulnerability questions to put you on the spot. You've had an incredible career in obesity research. I know this, and I think you're one of the top obesity researchers in the world and have been for years. But science has involved so much over the years. Was there ever a time when you were confident in your approach or in a specific theory only to later realize that you were off the mark or wrong?

**Steven Heymsfield:** I think, Jim, one of the amazing things about getting old, I'd say, is that you realize you're not always right. Have you ever thought about that? You're not-

**Jim Hill:** All the time.

**Steven Heymsfield:** When I was younger, I was convinced I was right about so many things that have turned out to be wrong. I'll just give you a very obvious example. 15 or 20 years ago, I had very intense discussions about GLP-1 agonists. We had advisors talk to us about what they thought would those ever mount any effective drugs. They all said no.

**Holly Wyatt:** Oh my goodness.

**Steven Heymsfield:** Well, the reason was because GLP-1, natural GLP-1 is a peripheral. It works in the periphery. It doesn't work in the central nervous system. It has a very short half-life seconds. People said, you will never get an effective obesity drug that doesn't work in the brain. These are really high-quality people. I believe them and so did my colleagues and decided therefore not to further look at GLP-1 drugs. I was skeptical about hearing these reports of these new drugs from Lily and Novo Nordisk. I kept thinking, no way. I'm not interested. Wow. That was a big mistake.

**Jim Hill:** Wow. Missed opportunity there.

**Steven Heymsfield:** I was convinced. I just didn't understand that they made these drugs. They have very long lives and you can get very long high concentrations in blood. They do act in the brain, which was a big surprise to me. I want to say extremely well-known people who had ideas for developing GLP-1 agonists and were told 20 years ago, don't waste your time. They're just sitting around crying now.

**Holly Wyatt:** That just shows how the field evolves. It's constantly changing. I think it's great as you get older, you become aware of that. You understand that better. That's just part of life, I think.

**Steven Heymsfield:** It is. You need a long timeline on a lot of things. Then the opposite was we all thought leptin was going to be a miracle. We thought drug companies bought it, spent millions of dollars, Amgen. This is the next great thing. Nobel Prizes all over the place. Nope.

**Holly Wyatt:** I love it. All right. One more vulnerability question. You've dedicated your life to helping others improve their health, but we all have our own personal challenges. What's one area of your own health or lifestyle that you still find tough to manage, even with all your knowledge?

**Steven Heymsfield:** That's a great question. Well, I do a lot of activity even in my age. I try and maintain it as much as I can. I think if I had more time, I would do even more. I'm still pretty much sitting in front of a computer all day long. I try to standing desk. I try all these other measures, but there I am. It's a liability as you get older as you know sitting. It's a risk factor.

**Holly Wyatt:** You recognize it and you're still sitting?

**Steven Heymsfield:** Still sitting. I think we're all a victim of our habits. It's such an easy habit just to sit. I tried all the other measures, the standing desk, things like that. I'm back in my chair. I find myself as I'm getting older, I'm bending over a little bit when you see a lot of older men in their 70s and 80s. They're all bent over. I know how that happens and it's very hard to avoid it.

**Holly Wyatt:** Love it.

**Steven Heymsfield:** You're sitting in front of that computer. You're bent over. Watch out for it.

**Jim Hill:** All right, Holly. Is it time to sum up?

**Holly Wyatt:** It is. Go for it, Jim.

**Jim Hill:** I think what we've heard today is the scale can tell you something, but there's more to it than that. There's body composition. Again, ideally what you want to do, particularly people who lose weight, you want to lose as much as possible from fat. You're not going to lose all from fat. You're going to lose some from muscle in other areas, but there are things you can do, particularly exercising. Don't go too low on the calories. Eat a healthy diet that will allow you to lose weight in a way that you're most likely going to preserve your muscle, not gain muscle, but prevent the loss of muscle mass. The more muscle you have, the easier it is to maintain your weight. Is that okay?

**Holly Wyatt:** Sounds good to me. Yes.

**Jim Hill:** Steve, this has been fun. Thank you for all you do. I've worked closely with you over the years. You just have done amazing things in this field. Thanks for giving us time to be on this podcast.

**Steven Heymsfield:** Terrific, Jim. I really enjoyed it, Holly. Good singing. I'm sure I'll see you up in Birmingham in the near future.

**Jim Hill:** Great. Well, that's it for another episode of Weight Loss And...

**Holly Wyatt:** Bye, everybody.

**Jim 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.

**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.