Speaker 2
So if you're waiting for a sign, if you're thinking you need to change something up and you need community, friends, we've got you covered. Dr. Jim Hill, welcome to the show. Thank
Speaker 1
you. I'm happy to be here.
Speaker 2
I feel like I'm sitting with a celebrity.
Speaker 1
No, I've just been around for a while.
Speaker 2
You are the co-founder of the National Weight Control Registry. Correct. For people who don't know what that is, that has really been a tool that has absolutely changed the game for our understanding and what it means to lose weight, but more importantly, keep it off. Yes. I would love to hear a little bit about your background for the listener or the viewer, because you are, I would say, an icon in the weight loss metabolism community. I
Speaker 1
started researching this area in the late 70s, early 80s. So literally, I've been around for a long, long time. And in the late 70s, obesity was not seen as a problem. Yeah, there was some obesity out there. It was maybe 10% in the population. Nobody really cared about it. That wasn't one of the big issues. It wouldn't have made anybody's top 10 list of things to study. I actually started out studying how the brain regulates energy balance. So I was struck by the fact at that time, most people kept the stable weight throughout their lifetime despite changes in intake and expenditure. Like, how does that work? So I was really interested in the role of the brain in maintaining energy balance. And I studied energy expenditure a lot. A lot of people look at food intake. I was looking at energy expenditure, the calories you burn. And I thought the calories you burn might be an important part of regulation. And then it was really in the mid-80s that the national surveys began to pick up a pretty dramatic increase in obesity. And suddenly people got interested, and I thought, this is perfect for what I'm looking at. And so I thought the reason people were getting obese is because they had a low energy expenditure. It wasn't what they were eating. It was their energy expenditure. And yeah,
Speaker 2
and we have to just point out that this is how new obesity research is. That's right. That there was a point in time where obesity wasn't thought of. People had no
Speaker 1
idea what was happening to them. No idea. No idea. And still, in some parts of the world, obesity and diabetes is so new that they're still trying to get a handle on it. But we've been dealing with it for a while. So my hypothesis that it was energy expenditure? No, first, first wrong, but not wrong. We learned a lot from it. And what I learned is that for most people, their energy expenditure was exactly what would be predicted from their body composition. Boy, and I thought, I'm going to find this defect in energy expenditure and be famous. Nope. So I began to look at other things. Is it food intake? Is it metabolism? And that led to a journey to try to both understand why obesity occurs, and in my recent years, really trying to do something about it. Can we prevent it? Can we treat it?
Speaker 2
When you were looking at energy expenditure for the audience, what does that mean?
Speaker 1
So let's look at the concept of energy balance, which has kind of driven my research. And it's the laws of thermodynamics. Energy that comes in the body has to go somewhere. Energy doesn't just disappear or appear. So energy balance is following that energy through the body. So you take in calories from food. Some of those calories you use just to maintain your body. call that basal or resting metabolic rate to make hormones and your heart beats and your kidneys function. All that requires some of the energy in. You require some energy to process food. So when you eat a meal, you've got to absorb that meal, etc. And then the third big one is physical activity. If you move your body, it takes more energy for that. So if you had good enough techniques, I could take every calorie that you consume and I could tell you where it goes. Can't always do that because it's tough to measure. But theoretically, energy intake and energy expenditure are related such that if intake is higher than expenditure, you're going to gain weight. And if it's lower than expenditure, you're going to lose weight. There is no way to lose weight without your energy intake being less than your energy expenditure.
Speaker 2
That's fascinating. You would think that that would solve it.
Speaker 1
Yeah. People say, well, it can't be that simple. The problem is it isn't simple. So if I look at all the things that affect your food intake, you know, your environment, the number of people you're with, the type of food, and the things that affect your expenditure, it is very, very complicated. And then more recently, one of the things I've been very interested on are differences in metabolism. So let's take two people that, let's take two women who weigh the same, exactly the same body composition. And I feed them the same amount of calories. You would expect the body weights would be the same. In fact, because metabolism is different, the body weights may change. Some people may have a little bit more efficient metabolism. Some people may have a microbiome, which is a little bit more leaning toward burning calories rather than storing calories. These are small differences, but it's why people say, how come my neighbor can eat what I eat, doesn't gain weight, I gain weight, because metabolism can differ. And I think we're beginning to learn a lot about the aspects of metabolism that relate to body weight.
Speaker 2
When you moved on from energy, this energy expenditure hypothesis, what was there a moment in time where you said, you know what, this, this just can't be, it can't be it? Yes,
Speaker 1
there was. And then the question is, what is it? Okay. And so you begin to look at energy intake. And I did a lot of work with different kinds of diets, macronutrients. What about fat? What about carbohydrate? What about protein? A lot of different studies looking at how those different nutrients are metabolized by the body. So fat comes in, it has more calories, has nine calories per gram. Carbohydrate has four calories per gram, but they're handled very differently by the body. And for example, you have virtually an unlimited ability to store fat. You're never going to run out of storage space for fat. You don't have an unlimited ability to store carbohydrate. You can store a little bit in the blood and a little bit in muscle and liver. So the body, I think, prioritizes regulating carbohydrate because it's important that you do something. And it's not so important you regulate fat. So I really did a lot of research looking at how diet composition affects metabolism and ultimately may affect body weight. You
Speaker 2
know, Don Lehman had mentioned that, I guess there was a period of time where you went to go, maybe you were a visiting professor at the University of Illinois. Is that what happened? I think
Speaker 2
you went, you visited the campus, and I think at that time, that must have been the early 2000s, perhaps. I'm curious as to what you were looking at. You are very unique in the way that you're also somewhat of a historian. There's the first generation, there's Ansel Keys and this kind of generation of nutritionists and biochemists, and then there's the generation after, which Don Lehman, which is you, which is Bob Wolf.
Speaker 2
have a historical perspective more so than any one of us. And at the time, what were you thinking? And I know that was some time ago. that was really probably towards whether it was maybe the food guide pyramid or is it carbohydrates? Is it protein? Is it fats? So at that point,
Speaker 1
and you're forcing me to think back, you know, you get old, your memory's not like it used to be. There were a couple things. I was continuing to look at diet composition. that point, one of my scientific heroes was a biochemist named JP Flatt. And this guy, brilliant. He couldn't write so that he could understand it at all. You almost had to go through and decode his papers. It was brilliant. And he was arguing why fat was a problem, more so than other nutrients. And I think it still is. I think it's gotten complicated, because the problem, and he actually outlined it, he said the most obesity producing diet is one that's high in fat and high in carbohydrate. And that's what we're eating today. We're eating that diet. And so what happens when you have a lot of carbohydrate is you burn the carbohydrate and store the fat. So is the problem carbohydrate or is it fat? And it's not, you know, it's not as simple as one versus the other. Where
Speaker 2
did the weight registry
Speaker 1
come in? How was that? And why was that developed? So this is I kid you not, this was a project developed over a beer. I hear that
Speaker 2
those are where great projects are developed.
Speaker 1
So I was at a conference with my co founder, Dr. Rena Wing, who's one of the most brilliant psychologists. She's now at Brown University. So we went to a break from the meeting. We went to the bar and we were talking about, gosh, the media just portrays that nobody succeeds at weight loss. You know, there've got to be people out there who succeed. And we kind of looked at each other and said, you know what, maybe we could find them. Okay. So then we put it together. Reena and I put it together. We came up with the criteria. We said we came up with all kinds of ways to recruit. Okay. And you'll love this being in the media. Then we had these plans to reach out to physicians, da, da, da. And just by chance, I remember I was asked to do an interview with the Orange County newspaper, just on something else. And I mentioned that we were starting the registry, and we got letters that just flooded in. And so being a brilliant scientist, I said, this is where the media may have some value. And so we largely recruited through the media. And they all wanted to do a story. And they wanted to talk to somebody in the registry. And so we said, if you talk to someone in the registry, you have to put our information in your article. And we populated the registry that way. And
Speaker 2
you know, I have here, this definitely is just a massive contribution. It was, you know, a study of long-term weight loss maintenance. And this was co-founded in 1994 and is the largest ongoing study tracking individuals who lost significant amount of weight. this was 13.6 kilograms right greater than or equal to 13.6 kilograms and maintained that for a year or longer to
Speaker 1
to as the entry criteria in fact we we ended up with over 10 000 people and i think the average uh the length of maintaining was five or six years so these weren't people that were a little bit successful. These were people that were very successful. And when we started out, we thought, wow, we're probably going to identify the right diet for weight loss, and that's going to make us famous. Well, what we realized is there was no similarity in how they lost weight. They lost weight with good diets. They lost weight with the beer diet. They lost weight with the red, green, you name it. They lost weight with that. No similarity. But when we were looking at how they were keeping it off, that's when we began to see the similarities. And that's what led me for the first time to understand that losing weight and keeping weight off are totally different processes regarding requiring totally different skills.
Speaker 2
I'm going to say that again because I don't think that it's nearly ever discussed that weight loss is a different skill than losing weight and keeping it off essentially weight loss maintenance. And
Speaker 1
I could talk for a long time about the differences, but I'll give you a few. The key to losing weight is food restriction. Let's face it, you can lose weight with exercise, but you got to do a lot of it. And for most people, it's not practical. And let me preface this with I'm going to tell you that exercise is critical. But for weight loss, you don't have to exercise to lose weight. So food, we always say food drives the bus on weight loss. And all you have to do is food restrict. And I think what we're seeing is it really doesn't matter what you eat, as long as you eat less. And that's why every diet works. Don't eat carb, don't eat fat, don't eat this. They all work. But what about protein? Protein's the same way. You can tell people not to eat a single macronutrient and the end result is they eat fewer calories and they lose weight. And so if you think about it, weight loss is generally, we'll get to the medications, but leaving the medications aside, weight loss has generally been like a three-month process. Most people with lifestyle changes who go on a weight loss, go on a diet, are going to lose all the weight they're going to lose in, say, three months. So for three months, think about what you can do. Number one, you restrict your food. Number two, you avoid any kind of situations. You avoid going out to dinner with friends for the three months. Maybe you don't drink any alcohol. You kind of put your life on hold. For weight loss maintenance, you have to live your life. You can't do this. And for weight loss maintenance, this is where physical activity now switches and becomes the driver. The reason that most people have failed, and most people have failed, we know that of most people who have lost weight, very few keep it off. People in the National Weight Control Registry are clearly in the minority. So for most people, what happens is you go on a food restricted plan, you lose weight, you try to restrict food forever. Well, guess what? You get hungry. And we have, I think we have decades of information showing that doesn't work. Back to the energy balance point, which is critical. When you lose weight, your body size is going down. Your energy expenditure is tied to your body size. So as you lose weight, you need fewer calories to maintain your reduced weight. Okay, so now you are in a situation where your energy expenditure is low. You're trying to food restrict to match that low energy expenditure, and people just can't eat enough to be satisfied. Alternatively, now, if you increase your physical activity, even though your energy expenditure went down with weight loss, you're sort of replacing that drop with physical activity. food, an amount of calories that may not be different than they were eating before, because they filled what we call this energy gap with physical activity, rather than food restriction. That's so fascinating.
Speaker 2
I want to circle back to this idea that exercise is not needed for weight loss. Can you parse that out for me? Yes. There
Speaker 1
is no time where I wouldn't recommend weight loss. Exercise. Weight loss too, but exercise. So yeah, so you don't need it. It helps a little bit. And the data are a little mixed. Some studies show that with exercise, you lose a little bit more weight. Maybe you lose a little bit more fat versus muscle. But there are tiny differences. You can totally lose weight with zero exercise. Now, we recommend that people do exercise with weight loss. But it shows the critical thing that's getting the weight off is food restriction. Totally different in weight loss maintenance. And this is where, and hopefully we can talk about this too, it goes just beyond diet and exercise because now the mind comes into play because now you have to live your life. You have to find a way of living your life. You are going to face challenges. With weight loss, you can sort of remove those challenges for a period of time while you lose weight. But with weight loss maintenance, it's forever. So you're going to have problems. And we tell people, it's not if you're going to have a problem, it's when and it's how you're going to handle the problem. So resiliency, positivity, I'm beginning to believe that these characteristics may be even as critical as diet and exercise in terms of long term success. I
