Search for tag: "weight management"

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: We had a whole episode about Scot's fatness, and this is an update to the fatness because I decided to take a different route to losing the weight than I had in the past.

So we had Thunder Jalili on, and in order to lose the 15 pounds, I normally would put myself in a calorie deficit. I would figure out what my base metabolic rate is. And this gets a little complicated, but your base metabolic rate is basically the amount of calories your body would burn just to survive. And you eat less than that, and you do some exercising, and that puts you in a deficit, which then would encourage your body theoretically to burn fat.

Thunder told me not to do that, which was totally different. So this is a little update on what's going on.

You're listening to "Who Cares About Men's Health," providing inspiration, information, and a different interpretation on men and men's health. We've got a good crew here today. It's the core crew, as I like to call it. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I'm part of the core, and I'm proud of it.

Scot: All right. My name is Scot Singpiel, and we've got producer Mitch over here. He brings the microphones and so much more.

Mitch: So much more. Hoo-gah.

Scot: Mitch just got promoted.

Mitch: I know.

Scot: Mitch got a promotion.

Mitch: Love it. Yeah. Core, I'm in the core.

Troy: You're in the core.

Scot: Thunder encouraged me to just stop eating the stuff that got me there, which was Reese's peanut butter cups and probably drinking too much beer, to go back to time-restricted eating, which is this concept that you stop eating for a prolonged period of time. It could be 10, 12 hours, whatever. So you might stop eating at 6:00 at night, not eat until 6:00 the next morning. And get some activity. And remember that I had a fun time and it took me a while to get to where I was, and it might take me a little while to get back.

So I've got a little update. I'm down five pounds. Yeah, I've gotten rid of 5 of the 15.

Troy: That's pretty good.

Scot: Yeah. I mean, I don't know. We'll see if this continues. The win for me was I went on a weeklong vacation and I just didn't eat sweets.

Troy: Wow.

Scot: But you can't necessarily control what you eat as well when you're on vacation. And when I came back, I was at the same spot. So that makes me happy.

Troy: Oh, so that was the win. Okay. I was going to say, "You lost weight on vacation?" But you're just saying you were able to maintain.

Scot: I was able to maintain. I didn't think about it too much and I didn't probably have as much activity as I would.

Mitch: Did you road trip?

Scot: Yeah.

Mitch: Do you not get fun snacks every time you fill up the gas?

Scot: Normally, yes. This trip, no.

Mitch: Okay. Not this time? No?

Scot: No.

Mitch: All right.

Troy: It doesn't sound like a fun road trip.

Scot: No. The snacks . . .

Mitch: That's what I was about to say. That's a part of it.

Scot: Yeah. Well, we did have snacks. I mean, it was Triscuits and cheese, and it was trail mix, but not with chocolate in it. So it was a lot of nuts and some dried fruit. So kind of healthier stuff, I guess.

Mitch: Sure.

Scot: Yeah, Mitch does not look enthusiastic.

Mitch: No. I'm about to go on a road trip myself and highlight, day one, going and filling the tires, topping off at the gas station, and getting a big old sack . . .

Scot: That's right.

Mitch: . . . of every bit of junk food.

Scot: I mean, I guess . . .

Mitch: Maybe I won't do it this time.

Scot: No. I think every once in a while, you might be able to do that, right? I mean, if you're in a position. It just kind of worked out for me that way.

Mitch: Okay. That's good.

Scot: So anyway, down five pounds. I've been doing some reading and I'm a little scared, because I'm afraid that five pounds is just kind of those five easy pounds, right? Like, just maybe some water weight, some salt weight. I don't know.

So I started doing some reading because I was interested in this base metabolic rate and the different exercise levels. So you've got your base metabolic, which is your body. If you just sat around, did nothing, this is how many calories your body needs to function.

And then you've got some of these other levels, right? You've got sedentary. Sedentary, that's how you pronounce it. What is sedentary, do you think? And that bumps you up a couple. You get to eat a couple hundred more calories if you're sedentary. What do you think that is?

Troy: I mean, you're a couch potato. Those are couch potato calories. Those are like just lifting your arm to use the remote and turn on the TV and reach for your soda. Those are your sedentary.

Scot: This is, I think, where some people might run into problems. That's not the case.

Troy: Sedentary?

Scot: Sedentary, according to a couple places I looked, includes activities of daily living. So doing the kinds of things like going out and raking, vacuuming, and even they included walking the dog.

Troy: No. I think of sedentary as . . . Someone who's sedentary in my opinion, in medical terms, in my practice, if I describe someone as sedentary, they're not walking a dog. They're able to take care of themselves, so they're getting up, walking to the kitchen, and walking to the restroom, but they're not doing a whole lot beyond that. I don't see them as out raking leaves and walking dogs. I don't know.

Scot: Yeah. I think that's where this problem is. I think the problem could be as an individual that you're trying to figure out what your activity level is so you can go, "This is how much I should be eating." Well, I'm not sedentary because I go out and I do stuff. I clean the house. I rake leaves. I mow the lawn. In the definitions I've seen, all those things are included in sedentary. The difference is that you do not do 30 minutes of intentional exercise a day.

Troy: So that's the next step up? So to not be sedentary, you have to do 30 minutes of intentional exercise a day?

Scot: Yep, and that's called low active. And low active is daily . . .

Troy: No. Low active is 30 minutes?

Scot: Yeah. Low active is exercise equal to walking 30 minutes at four miles an hour, which burns anywhere from 135 to 165 calories for the average-weight person.

Troy: Four miles an hour is a pretty brisk walk.

Scot: That is an incredibly brisk walk. I have long legs and I can walk fast. I'm probably doing 3.7, 3.8 max. So that seemed a little weird.

Troy: That's fast. I don't know who made the scale up.

Mitch: Let me tell you. It is the FDA and the NCBI. [Crosstalk 00:06:08] this group is the front for public health. It was published back in 2018 when they decided that this is what sedentary meant.

Scot: So this is all going someplace that hopefully will be helpful to listeners and also is going to inform my thinking, and I wanted to throw this out to you guys.

So then the difference between low active to active is it's kind of the same. Your daily activities of living, except for you're doing an hour and 45 minutes of intentional exercise. So that's walking at four miles an hour.

Troy: A day?

Scot: Yeah, a day.

Mitch: A day.

Scot: And then very active is daily exercise walking four hours and 15 minutes at four miles an hour, or you could jog for two hours a day. And that burns anywhere from 1,100 to 1,400 calories.

Troy: This is an interesting scale.

Scot: It is. I mean, think about the individuals we've had on the show in the past who have struggled with losing weight, right? We're saying, "Well, if you get out and get those 30 minutes of activity, that should be pretty good." But I'm starting to kind of wonder if those 30 minutes is good for your cardiovascular health, it's good for your health in general, but if you're trying to lose some weight, you're going to have to go beyond that.

Troy: See, the problem with this scale, though, is there are just so many studies that show if you can just do 30 minutes of activity three times a week, there are very clear health benefits from it, where this scale is implying that those people are just low active, and even they're less than low active.

Scot: I'm going to say there's a differentiation. There's a fine differentiation here.

Troy: Thirty minutes?

Scot: Thirty minutes a day has health benefits for cardiovascular and those other things, but if you're trying to lose body mass, fat, you need to do more.

Troy: But do you think that's sustainable? We're talking 30 minutes of brisk walking at four miles an hour every day. For the average person, it's . . . I feel like you have to have a routine that's sustainable for you. And on the activity side, it sounds like they're recommending high activity, where I'm sure you could balance that with just some decreased caloric intake or adjustment in whatever your dietary intake is, and you're going to accomplish the same thing,

I don't know. I guess I'm trying to figure out where they're going with this, just because that activity level they're putting for active and very active is really active. And maybe I'm kind of taking it a little bit personally here, because I feel like I'm pretty active. I'm pretty active, but I'm not meeting their definition of very active.

I mean, maybe over the course of a week, if you added it all up, I would meet that definition. But over the course of a week, I get about 11 hours, 10 to 11 hours of . . . I don't want to call it jogging because I don't want to be called a jogger.

Scot: I mean, you're running.

Troy: It's running, but still it's . . . Yeah, that's really active what they're getting at there. Two hours a day of what they're describing as jogging.

Mitch: Well, again, this is just how you do your calculations. So when you look up base metabolic rates and things like that and try to get your diet clued in . . .

Scot: Yeah, and you're trying to figure out how many calories you need to sustain. But it could also be used for, "How many calories can I eat, and then what do I have to do to put myself in a bit of a calorie deficit so I can lose that weight?"

Troy: So maybe that's the flip side, just saying, "If you really want to eat this many calories, you're going to have to exercise a ton." Maybe that's what they're trying to say.

Scot: Yeah, I think so.

There was a "Time" magazine article, and I need to send this to you because they quote a lot of research. This is the next part of my thinking, because this was the next thing that I read.

So they cited many studies that exercising at a moderate level for 30 minutes, which is good for health, results according to these studies in little weight loss. So it's good for maintaining, but for losing it's not.

And then they cited some other studies. A combination of diet and exercise generated no greater weight loss than diet alone after six months. At 12 months, the diet and exercise combo showed an advantage, but it was slight, about four pounds on average.

So, in this, the conclusion that they came to based on the research . . . And there was another study. It said exercise results in weight loss when 400 to 500 calories are burned per session at least five times a week.

Troy: So I see what you're getting at here, Scot. What you're saying is if you want to lose weight, don't focus on exercise. Focus on diet. There are clear health benefits from exercise, but it's not going to accomplish the weight loss you need.

Scot: Yeah. Exercise is not going to accomplish the weight loss you need, diet and exercise. But then beyond that, you have to put in a certain amount of exercise, which they're saying is something that can burn 400 to 500 calories per session, 5 times a week, which they equated to 90 minutes of brisk walking or 30 minutes of running 8-minute miles.

Troy: Yeah.

Mitch: Geez.

Scot: I mean, 400 to 500 calories, that's a lot, right? Ninety minutes of brisk walking? Or if you get on a cardio machine and you're not pushing yourself super hard, 90 minutes, that's a lot.

Troy: It is a lot. And how many calories are in just a large soda?

Scot: Right?

Mitch: Too many.

Scot: Too many.

Troy: Yeah, you get a large soda for your road trip and right there you're at 400 calories.

Mitch: This is something that I'm really excited . . . We have a guest coming on in a couple weeks who is part of the weight management program here at The U. And she was talking a lot about in our little pre-interview . . . She was like, "Yeah, losing weight is a lot more than just diet and exercise," and I'm excited to kind of talk to her about all this.

Scot: Yeah. So, for some people, diet and exercise might work, but there are some people that it does not work. And she's going to hopefully tell us some of the things that could happen or some of the things that could be going on that could be preventing somebody from losing.

But I just feel like there's a huge disconnect in the information that I've received. And again, you know what? There are a lot of studies out there. Who knows? But if in order to get some weight loss I have to be doing 400 to 500 calories burned per session, that's a lot more than what I'm currently doing. So maybe that's where my frustration is that in the past I haven't lost weight, or where other people have frustration. So I feel like that needs to get figured out.

Troy: Yeah. I mean, again, it just seems like . . . Like you said, Mitch, maybe we'll have someone on here who talks about all the other factors besides diet and exercise. But my takeaway from this is that you can't just sweat off the calories. You've got to focus on the caloric intake if you really want to lose weight.

Scot: Yeah. You've got to focus on both.

Troy: Yeah. I mean, you've got to do both, but it's going to come down a lot to caloric intake. You can't just say, "I'm going to burn it off by going out and walking the dog," or something. It's a lot of exercise to burn off 400 to 500 calories.

Scot: Yeah. Like you said, what's an average soda have? And if you are doing 30 minutes, according to the scale, which is low active, that burns 135 to 165 calories. So a soda is probably what, 220? I'm guessing.

Mitch: It's 180 per 12 ounces.

Troy: A 12-ounce can.

Mitch: If you get a Big Gulp . . .

Scot: Yeah. So you can either walk for 30 minutes at four miles an hour to burn that or just not drink that, right? So that really kind of shows the importance of watching some of that stuff.

Anyway, here's what I'm thinking. And again, it comes back to sustainability on a couple of levels. One, time. I don't have 90 minutes a day. Two, I'm not in that great of shape anymore.

Troy: Oh, no.

Scot: And I don't know if I could sustain five sessions of 400 to 500 calorie burning and not be completely drained. So I don't know. Part of me wants to try to start to burn some more calories so I can get . . .

Here's the deal on the road trip. This time, instead of the punishment pants, I just sat and played with my fat to remind myself how miserable it is.

Troy: So you were just . . . Is this as you're driving? You're just holding your fat rolls and kind of bouncing them and jiggling them?

Scot: Yeah, exactly.

Troy: What are you doing?

Scot: You drive with one hand and you kind of bounce it and you kind of grab it.

Mitch: For the listeners, he's cupping underneath his lower abdomen and kind of making a flipping, squishing motion. I'm so glad I'm back in studio.

Troy: Yeah, that's wonderful.

Scot: I want not to have to do that anymore.

Troy: So was this what you did just to keep yourself from going in every gas station and getting a large soda and a big thing of candy or something?

Scot: Top of mind, man. Top of mind.

So I don't know what to do with this information other than to say it was kind of eye-opening to me the amount of activity that it kind of takes to burn fat. There are two things. There's the amount of activity that takes to be healthy and reduce the risk of disease. But if you're trying to get rid of body fat, that number has got to go up quite a bit. And then once you get rid of it, maybe your daily exercise goes down again because maintaining is easy. I don't know. But anyway . . .

Troy: I totally get it now. At first, I just thought, "Wow, where is this going?" But I get the point of it, that you have to exercise a lot to burn calories. I mean, that's the simple reality. You've got your basal metabolic rate and that burns quite a few calories, just the thing that keeps you alive. But then beyond that, it's not like you can tell yourself, "Hey, I just went and did a brisk walk with the dog for 30 minutes, and I'm going to reward myself now for that exercise by having a soda or taking in some extra calories." Yeah, you did not burn that many calories.

Scot: Yeah. Even if you don't take in those extra calories, you're probably not going to be losing much fat from just walking the dog.

Troy: Yeah. It takes a lot to burn. Yeah, it really does.

Scot: So that's my update. Those are the things I'm kind of struggling with and I'm trying to figure out. So I'll keep you up to date. Mitch, you have an update too.

Troy: Well, I was going to say, though, Scot, you made progress. I thought that was the best point. I mean, Thunder made a lot of great points, but the one that I think really made sense is it takes you a long time to put that weight on. Think how long it took. It's not going to come off in a month. It's a process. So you're a month out from that discussion with Thunder and you've already lost a third of the weight. That's great.

Scot: Yeah. We'll see if that keeps going down.

Mitch brought up that he felt like he had a different situation, that he has struggled his whole life to try to lose those extra pounds. What's your update?

Mitch: So I was weighing around 230 a little over a month ago, and I am just under 210 pounds as of this morning. So in a month I've lost over 20 pounds.

Troy: Wow. That's crazy. You've lost almost 10% of your body weight in a month.

Scot: Yeah. You want to ask him what he's done, Troy? Do you have any guesses what the difference is? For you, Mitch, this is crazy.

Troy: Let me guess. Did you just stop eating or what?

Mitch: No. I'm eating red meat and sunlight.

Troy: Eating red meat and sunlight. You just go outside and open your mouth.

Scot: Yeah. Any other guesses as to why? Like Mitch said, this is just kind of unheard of that it would be this easy.

Troy: Wow, I'm trying to think what you could have done. I'm guessing you went back to time-restricted eating. I'm sure that was part of it.

Mitch: I was doing that before. I'm still doing it.

Troy: Oh, you were doing it before. That's right. You were doing it before, and you had already really focused on cutting down on sodas and sweets and all that kind of stuff.

Scot: Yeah. He was doing all the right things, remember, and then he was just getting frustrated because it wasn't happening.

Troy: Yeah. I know you were talking more about the carbs. Have you focused more on carbs?

Mitch: I'm eating the same I've always eaten.

Troy: Did you get a different scale? I'm kidding. "This scale makes me look great."

Scot: The best way to lose weight is get that little dial underneath the scale and calibrate it differently.

Troy: Just change the dial. Wow. I really want to figure out how you've done this. Are you exercising more? I know you were trying to . . . You were already doing some exercising.

Scot: I mean, I'm doing it maybe once more a week, once more than I used to, but no, not really.

Troy: Okay. This is huge. You've lost almost 10% of your body weight in a month, and you were struggling before and you were doing everything right. So I don't know the answer. What have you done?

Mitch: So I got my hormones figured out.

Troy: That's right.

Mitch: So I've been working with Dr. John Smith, and he identified that I had really low testosterone. And now that the hormones are . . . I've been three, four weeks on this medication that we'll probably talk about in a future episode that just helps up my testosterone a little bit, and suddenly, I have tons more energy, and I'm losing weight like crazy, and I haven't changed anything.

I've been working out the same I've always been and struggled. I'm eating the same 1,800 to 2,000 calories every day that I've been doing forever and watching the macros and blah, blah, blah, sleeping all the time, etc. But all it took was getting my hormones in check and suddenly I'm starting to get to a healthy weight.

Troy: Wow. That's impressive. Are you putting on muscle mass too?

Mitch: We'll find out when I get in the BOD POD. I don't know if I trust my scale, but maybe. Hopefully. I don't know.

Scot: He just pulled out the guns.

Mitch: Scot, how are my guns?

Troy: He's flexing.

Scot: Does your scale give you a body fat percentage?

Mitch: It does.

Scot: And has that been dropping too?

Mitch: Yes.

Scot: My scale did not match up at all with the BOD POD, so it'll be interesting to see how accurate yours is.

Mitch: That's what I'm curious about too, yeah.

Troy: But it seems like on the scale it was all about relative change. Like, the number itself isn't as meaningful. How much has your body fat percent changed on your scale?

Scot: He's looking that up.

Mitch: It says 4%.

Troy: So you're a 4% body fat change. Like we've talked about before, the actual number maybe isn't super accurate on those home scales, but the relative change is . . . Again, that's significant.

Scot: It is significant. So it was all hormones. How does that make you feel?

Mitch: Well, it's a little strange because I do not want to be the guy that is like, "Testosterone solves everything. It's the magic bullet. You'll lose weight. You'll get your libido back," all the stuff you see on those irritating ads on the internet.

But if you legitimately have a hormonal imbalance, you should go talk to your doctor and you should probably get it fixed, right? It's not the magic bullet for people who are just a little low or something like that. But for me, I was well below the acceptable range when I did my follow-up test with John Smith, and it's night and day for me.

Troy: What was your level?

Mitch: I was in the lower 200s when I got it tested.

Scot: Because the low range is like 180, right?

Mitch: Three hundred.

Troy: He said if you're less than 300, you're low and you were . . . what did you say again? Low 200s?

Mitch: Yeah, 226 I think was the average between the two tests.

Troy: Yeah. So it wasn't like you were going in there and just being like, "Oh, I'm 330 and I need to get on testosterone." You were definitely below the level that he said he really kind of uses as a cutoff. And you'll get your levels rechecked here, it sounds like, in the next couple of weeks.

Mitch: Yeah. And we'll have him back on, and we'll kind of talk about what's going on. Yeah, there was something about, "No, this isn't 'optimizing T levels.'" I had a hormonal deficiency, and it was impacting metabolism, energy levels, etc. And it took some meds to get back to where I needed to be.

Scot: Wow. I think that's awesome.

Troy: It is.

Mitch: I think it's awesome too.

Scot: I keep looking for the thing that's wrong with me, Troy. I keep hoping . . .

Troy: What's yours, Scot?

Scot: I keep looking. Is it testosterone? No. I keep looking for that test that's going to just shine a light on why I have struggled in the past to put on muscle or to lose . . . Even when I was at my lower weight, I still had a good percentage of body fat because I just don't have a lot of lean mass. So I'm still looking for my thing.

Troy: The magic bullet.

Scot: Yeah. It's a magic bullet, right? What's the difference between a magic bullet and what Mitch experienced?

Troy: There's not. That is a magic bullet. That's a dramatic change. You want to talk about a magic bullet? Yeah. I mean, 4% body fat reduction, almost 10% weight loss in a month, that's impressive. And I've known very few people who could ever say they had that sort of experience while really not making any other changes. It sounds like you said you're exercising maybe one more day a week, but . . .

Mitch: Yeah. It's not huge changes. It's tracking a little closer on my calories. I'm working out a little bit more. It's not anything huge. It really is this medical thing that needed to get fixed before anything else could work.

Scot: And I think it's worth, if you are curious about testosterone, going back to our episode on testosterone. I think the thing to really keep in mind for everybody is it is not a magic bullet.

I can't remember what Dr. Smith said that range was. Like much beyond 600? You're not getting much return on that. So if you're around 500 or 600, you're probably fine, right? That's probably not what the problem is. Does that sound familiar to you, Troy?

Troy: I can't remember the exact numbers. I wish I did. Yeah, again, we should probably look at that just to give the exact numbers, but I do remember him saying the 300 number and if you're under that, you definitely need to be on some sort of hormonal therapy.

That episode, I was kind of skeptical throughout it, like, "Really? Do we really need testosterone? Does it really make that big of a difference?" But, Mitch, your experience, and clearly you met the criteria he talked about, and it's made a difference, no doubt.

Mitch: So I was having a conversation with one family member who had been experiencing some hormonal issues themselves. And it was really interesting because from the female perspective, hormones are a huge part of everything from energy levels to how your skin looks, to how much energy you have, how well you sleep, etc. And I think a lot of times as guys we just assume it's a yes or no, like an "Am I low on oil?" kind of approach to your car. Am I low on testosterone? Better put some more in me if it's going to work.

But talking with the doctor and stuff like that, testosterone has everything to do with estradiol levels, with all these other pieces and parts floating in your soup of juices all through your body. And it has a holistic impact on everything.

Troy: Yeah. That's cool.

Scot: Troy, do you have an update for us? Now, you don't have a weight problem. Actually, you'll be gaining about 8 to 10 pounds here in a few months in the form of a new life, a new Madsen.

Troy: I know. I've got a baby carrier that I'm going to be carrying on my . . . I looked at it. So, for the first several months, I carry the baby on my front side and then I can transfer the baby to my backside. I guess my back, not my backside. It's going to be another 8 to 10 pounds I'll be carrying around.

Scot: Are you going to go running with the newborn?

Troy: Oh, you know it. This is so funny. So Laura shared the news with me as I got home from work from a late shift. That next morning, I was reading all about running strollers, reviews, what's the best thing, all that stuff.

Scot: Good for you.

Troy: I know. This is embarrassing. I spent more money on a running stroller than I would ever care to admit. But I asked around. I talked to people. Yeah, I will be taking her running, and this is what some good runners I know recommended and said, "If you really are serious about going on long runs with a child, get this." So yeah, I'll be taking her running.

Scot: That's good. We learned that exercise is super important even for the dads when the child first comes along to counteract any potential . . . I mean, it's a massive lifestyle change, and you're trying to mitigate that as much as possible. Anything else going on? Any other new updates?

Troy: No, things are good. And it's a good point you made too, Scot, because I think it can be a massive lifestyle change. But I was talking to my brother about it. He was just visiting here a week or two ago, and he has three kids and he said that's what people always said to him too. It's a massive lifestyle change, but he said, "Hey, we're just going to do the same things we've always done. We're going to bring our kids." And his kids now are early teens down to about 9 years old. And the kids are crazy active. They love running.

My little 9-year-old niece, we just did a run. She ran a half marathon with me, just went out and busted out a half marathon trail run with me. They're just super active. And so I'm hoping that's how this can be. I'm hoping running can be something that we share as a family and that we're all out doing things together.

So I don't want it to be a massive lifestyle change, because I kind of have had that thought as I'm continuing to run. Not necessarily, "Why am I doing this?" but kind of the back of my mind thinking, "Wow, I'm not going to be able to do this as much in about two months." But then I tell myself, "Well, it doesn't have to change. We can keep doing this, we can stay active, we can keep running and doing all these things." So that's what I'm hoping for, and that's our plan.

Scot: Have to come up with some creative solutions and just have to be dedicated to it, I guess.

Troy: Yeah, I think so. Yeah, you come up with some creative solutions. You have to spend some money on some gear. Like I said, it's a whole lot more money than I ever expected to spend on a stroller, but it should be a stroller that lasts us for many, many years and hopefully running marathons together and doing lots of long runs with her. That's the hope, so we'll see how it all works out. I'll report back in about three months, Scot, and tell you where things are.

Scot: All right. Well, I guess that's that. This is going to be kind of an ongoing thing. We're really excited about some of the upcoming episodes talking about body weight control, losing some body weight, some fat if you have to.

Mitch: And having some people on to talk about testosterone again, and a little bit more about how all that connects and . . .

Scot: Yeah. And I'm just going to keep on keeping on and we'll see if I can catch up to Mitch. He's a Troy Madsen distance ahead of me in the marathon.

Mitch: Oh, no.

Troy: Mitch is smoking you, Scot.

Scot: He really is.

Troy: He's far beyond where I would be right now if this were a marathon. That's impressive.

Scot: I'm going to keep investigating just the amount of activity that you need and keep reading on that. I'll send you some of that information, Troy. You can see what your take is.

Troy: But give yourself credit though, Scot. You didn't lose 10% of your body weight, but you're down 33% of your weight gain. That's great.

Scot: No, I'm cool with it.

Troy: Yeah, you're making progress.

Scot: I just want to get to a point where I'm not playing with it anymore.

Mitch: You've got to quit doing that. I will leave the studio if you keep doing that.

Troy: Well, you can't play with it on a road trip, because you're sitting down. You're kind of hunched down. It's naturally just going to kind of bunch up there. So it's like, "Oh, feel all this fat here." I'm sure it's not as bad as you're saying it is.

Scot: All right. Well, gentlemen, as always, great conversation. Thanks for listening. And if you have any questions, you can reach out to us. It's super easy to do. You can just email us at hello@thescoperadio.com if you have any questions or stories you want to share. Thanks for listening, and thanks for caring about men's health.

Contact: hello@thescoperadio.com
Listener Line: 601-55-SCOPE
The Scope Radio: https://thescoperadio.com
Who Cares About Men’s Health?: https://whocaresmenshealth.com
Facebook: https://www.facebook.com/whocaresmenshealth

Interviewer: In spring of 2022, there were some headlines going around almost every news outlet saying that the FDA had finally approved a new weight loss drug, one that would promised 10% to 25% weight loss with little more than just a weekly injection. The drug is called tirzepatide, or a brand name Mounjaro.

Now, it seems a little too good to be true. So, today, we're going to be looking at what exactly is the drug and what can it actually do for weight management.

Joining us today is Juliana Simonetti. She is the medical co-director of the Comprehensive Weight Management Program at U of U Health. So she knows a thing or two about weight management.

Dr. Simonetti, thank you so much for joining us.

Dr. Simonetti: Yes. Thank you so much for having me here today. I'm very excited to be talking about this new drug.

Interviewer: So why don't we start there? What is tirzepatide and what does it do to the body?

Dr. Simonetti: I'll start by just telling a short story. I was at an endocrine meeting in California two weeks ago when this drug got approved by the FDA for the treatment of diabetes. And we were doing a lecture, and all of a sudden, everyone started clapping and announced that this drug had been approved by the FDA for the treatment of the diabetes. So that's the kind of excitement we're getting with this drug.

It is a new class of medication for the treatment . . . Currently, it's only approved for the treatment of diabetes. However, we have seen really significant amounts of weight loss with the medication, and they are doing clinical trials at this point, and they have the results of the clinical trial for the treatment of obesity with this drug as well.

Tirzepatide is unique in the sense that is a dual incretin medication. It attaches to two different receptors. So we have a class of medication that has been in the market now for about 15 years called GLP-1 receptor agonist. And some of the drugs I think are well known at this point, both for diabetes and for weight loss. All those drugs were initially developed for the treatment of diabetes, and then they found that they led to significant amounts of weight loss.

So some of the drugs currently on the market that are GLP-1 receptor agonists are Victoza, Ozempic, Trulicity, and those drugs really have revolutionized the treatment of diabetes in the sense that they bind to receptors in our body that stimulates our own pancreas to produce insulin. And at the same time, they cross the receptors in our brain and tell us that we're full.

Therefore, when you start eating, you feel fuller sooner. It leads to induced satiety, so therefore people eat less, and it promotes the release of our own insulin so you have better glucose control, better sugar control for the treatment of diabetes. And we have this induced satiety that leads to people eating less, feeling fuller, and therefore losing significant amounts of weight.

Interviewer: So tirzepatide has been approved by the FDA to help manage and treat types of diabetes. But there's a lot of evidence in their, I guess, Phase 3 trials that are showing real potential to help with weight loss. What are they finding?

Dr. Simonetti: That's right. So their clinical trials for diabetes show . . . for those participants that had diabetes, it led to a significant amount of weight loss. And so they also then did clinical trials for this medication for those without diabetes for the treatment of obesity.

And what they found is that they highest dose of the medication, which is 15 milligrams, can reduce body weight on average by 28.4 pounds, which is nearly about 14% of the total body weight. So, for someone that weighs about 200 pounds, they will lose on average of about 28 pounds on this medication, which is really, really significant.

Interviewer: Wow. That sounds like a lot of weight loss for people without diabetes, but what does it do for people who do have type 2 diabetes? What kind of results have they been seeing with them?

Dr. Simonetti: Yeah, the results, it's really interesting because the results for those with type 2 diabetes, on the highest dose, show that those participants lost almost 21% of their total amount of weight, which is really, really impressive. This is more than anything else, any other medication we currently have in the market.

Interviewer: So if I get this correct, there are other . . . I've seen other drugs out there that fill your stomach up, the Plenity or whatever it's called, or they claim to impact your metabolic system, etc., but this drug actually impacts your pancreas in a way to help with glucose levels and help suppress hunger.

Dr. Simonetti: Yes. So the class of medication I was talking about is the GLP-1 receptor agonists that already exist that have been in the market now for about 15 years. The newer ones, one of them being semaglutide, or the other name is Ozempic, has been the latest.

They also got approved for the treatment of obesity and leads to very significant amounts of weight loss and improvement in the sugars in our blood because it stimulates the pancreas to release insulin and tells our brain . . . So it works on the appetite centers of the brain.

The difference between some of these drugs and what you're talking about, Plenity . . . So Plenity is considered a device because it's three capsules that kind of inflate in your stomach and therefore makes you feel fuller, so you have the physical sensation of fullness. However, the GLP-1 receptor agonists work in your brain and in the appetite centers of the brain. It works in the brain to tell you that you're full, so you don't have those cravings and then sensation that you wanted to keep on eating. It really leads to the feeling of feeling fuller.

With tirzepatide, why this is so exciting and different is that this not only works with the GLP-1 receptors, but also works in another receptor called GIP, which is a glucose-dependent insulinotropic peptide. It's a mouthful, but it's really another hormone in our body that is usually . . .

Both of those hormones are released in response to us eating food. So when I eat carbs or sugar, it goes in my stomach and then reaches my stomach and my intestines, my gut. My body says, "Whoa, we got nutrients here." We release the GLP-1 and this other one called GIP hormones that then say, "We got food, we got carbs, we got sugar. Let's tell our pancreas to release insulin," because we just got some food in our body. We got some sugar in our body. And then it crosses the brain and tells the appetite centers in my brain that, "I just got nutrients. We should stop eating." It should make me feel a little fuller.

The issue with our natural hormones in our body is that they get taken down, they get broken down very quickly. They only last a few seconds. And these new drugs bind now to those two different kinds of hormones and lead to this really much heightened sensation of fullness and to a much more significant response lasting much longer than what our own body would produce.

Therefore, that's why they're so effective. And therefore, that's why they are also given once a week, which is really kind of neat for a lot of those medications. So you don't have to take a medication every day. It's a small injection once a week.

Interviewer: Wow. So I guess when I first came into this interview, I'm used to doing stories about how some new drug that came out is not actually going to help you with weight loss when you really look at the research. But with your professional opinion, as a doctor who works with patients suffering from obesity or helping them live healthier with their weight management, why is this drug so exciting like you keep saying?

Dr. Simonetti: It is so exciting because the amount of weight loss we are seeing with the clinical trials from this drug is much more significant than what we had seen previously.

So as a measure for FDA approval for a drug for weight loss is usually about 5%. And with the latest drug, which is semaglutide with the other name of Wegovy, we saw a significant more amount of weight loss, around 14%, 15% with the higher doses. And with tirzepatide, we are seeing weight loss of around 20% with the higher dose of the medication, which 20% is a lot of weight, right? So it's a really significant amount of weight loss that we are seeing with these new classes of medication.

And as we know, weight loss is extremely difficult, right? This idea that if we just diet and exercise, we should just be able to lose weight. And it's not true. Eighty-five percent of those that diet and exercise actually, unfortunately, end up gaining the weight back and this weight loss is not sustainable.

And there are a lot of reasons for that, right? There is genetics. So 60% to 70% of the way we are, we know that it's related to genetics or the way we accumulate fat.

There's also our environment, and then there is this regulation in a lot of the hormones. There are these regulation appetite hormones. There is this regulation with insulin. The more weight that we gain, the more insulin-resistant we become. Therefore, there is this combination of insulin resistance.

So 90% of those that have diabetes also have excess weight. And some of the older medications that we had for diabetes, like the glipizide, glimepiride, and even insulin would lead to more weight gain, which then meant more insulin resistance and then making the condition just worse.

And with these new drugs, we see significant improvement in weight. Therefore, you also see significant improvement in decreasing in insulin resistance and also improvement in the glucose control and the sugar control in the blood because it works in conjunction. You have the stimulation of the pancreas and decrease in appetite.

Reading through the clinical trials again, and I just had done a quick review before we sat down for this interview, really it's quite impressive. One of their trials, they compare this drug for participants that have diabetes that were taking insulin and they gave them the tirzepatide. And those that took the tirzepatide lost weight versus those that were taking insulin actually by itself gained weight. So this is, again, quite significant in the amount of weight loss as well as in the amount of glucose control that we get with this medication.

Interviewer: So for all of the people who are thinking, "Oh, hey, this is the drug that's going to make me lose all my weight, finally," it's not ready for them, right? Is that what I'm understanding correctly?

Dr. Simonetti: That's right. So this medication is not yet approved for weight loss. I believe it will be, hopefully, within the next year or two. They are just finishing the Phase 3 clinical trials for weight loss.

Currently, this medication is approved for those with diabetes, and I think it'll be a wonderful tool for those that have diabetes and excess weight, overweight or obesity. This would be just a wonderful medication because it leads to a significant amount of weight loss and improvement of their diabetes.

This is great, and I think this is going to really improve the care that we can provide. However, we need to remember that obesity is such a complex disease, right? There's a multitude of issues that go with it. So this is addressing maybe some of our physiology, but we still need to do lifestyle modifications with modifications in our diet, increasing physical activity.

Behavioral health is a really important piece. Oftentimes, we eat in response to feeling sad, depressed, because when we eat in particular foods that are sweet or high caloric foods, it releases dopamine and serotonin in our brain. So it actually makes us physically feel better at the moment. And therefore, we go back and eat more because then I need another hit and then I feel better. And it becomes that very vicious cycle that once you start eating certain things . . . know for me, it's a piece of chocolate, right? I'm having a bad day at work, I eat a little piece of chocolate and my life is better at that moment. However, that doesn't help me because then my sugars crash and it makes me want to crave it more.

So really trying to address as many things as possible, and that's why in our program, we have this multidisciplinary team approach. We have the registered dieticians. We have an exercise physiologist. We have two Ph.D. psychologists. We also have other options such as surgery. So we work with the bariatric surgeons.

So again, it's wonderful to have one more tool, a very effective tool in our toolbox, but this is a tool. We are able to use it, and the more tools that we have, I think the better offer we're going to be, but we have to address all these other pieces as well.

Interviewer: So, obesity, it is not as simple to treat as just getting a new injection, even with some of these great new drugs. So I guess we'll just keep a look on the headlines, see if this is approved for obesity treatment in the next couple years, and maybe we'll have you back on and we can talk about how you guys can utilize it in your toolbox to battle obesity.

Thank you so much for joining us, Dr. Simonetti. I really appreciate you taking some time to talk to us about this new drug.

Interviewer: What you eat, what you don't eat, and other lifestyle factors, they play a role in the severity and frequency of migraine headaches. Dr. Karly Pippitt is a headache expert at University of Utah Health. And let's just get into how important are lifestyle and nutrition factors when it comes to migraines.

Dr. Pippitt: I'll often tell patients that medications can only do so much, and so they have to be doing the things that are under their control to help us best control their migraines. And typically, people will have some awareness of some of these because they will have realized these are their triggers.

So sleep is a really big one for people. You want to make sure that you're consistent in your sleep hours, so trying to go to bed around the same time, getting up around the same time, and just getting good sleep quality, if you have something like sleep apnea or another medical condition, that you're getting those treated. A lot of people will have already known that if they didn't sleep very well or if they slept too much, that they happened to get a migraine. So people usually know that that's a big trigger. Some of us don't have good control of our sleep because we're shift workers or something else has happened. And that makes your migraines a little bit worse. So to the best of your ability, if you can control your sleep, that really helps.

Staying hydrated is really huge. We live in a really dry climate, and so making sure that you're drinking water, drinking things that are going to keep you hydrated throughout the day is really important. Again, sometimes people will be like, "Oh, it was a hot day and I was out hiking and then I came home and I had a bad headache." There you go. So making sure that you're staying hydrated.

Being active, right, getting out, doing something. I'm not saying you need to be these crazy Utah individuals who are running ultra marathons and hiking Mount Olympus every weekend. But just go out and walk 20 minutes a couple of times a day, making sure you're doing that and not just being sort of still and sedentary. That's a really important thing with your migraines.

And then you brought up nutrition. So not only what you eat, but I would also say how frequently you eat. We'll typically recommend that patients with migraines or with headaches that you're eating something probably somewhere between every two to four hours. That's something to sort of fiddle with, that works with your body best, but not going for long periods of fasting. That tends to be a trigger for a lot of people. And when you do eat a snack, making sure that you're eating something with a little bit of protein, a little bit of complex carbohydrates, something that's going to kind of sustain you and keep you going, so peanut butter, nuts, dried fruit, yogurt, cheese, something like that.

And then what you eat, it does matter to a certain extent. A lot of people will say that there are certain foods that are a trigger. And you've heard me say that a couple of times now, "What is your trigger for migraines?" It's helpful to look at what you're eating and know what some common triggers are, but don't torture yourself in trying to find what you think is the cause. So some really common triggers, I would say for people, red wines or wines with sulfate. Sometimes alcohol in general, but typically red wines and beer are probably big ones. Chocolate can do it. Processed meat, so things like hot dogs, sausages, that can be a trigger for people. MSG for some people, though I would say the data is a little bit less supportive of that. And then sometimes things like fermented foods can also be a trigger. But everyone is very different. So you may have those and not bother you at all, and other people may be more sensitive.

And also, maybe it's just you had a night that you didn't sleep very well, you were really busy at work and maybe you skipped breakfast. And then when you had lunch, you had a hot dog and a Coke and then later you had a headache. Was it the hot dog? Was it the skipped breakfast? Was it the poor sleep? Yes. It was really probably all of those things that did it.

Interviewer: I was waiting for the answer.

Dr. Pippitt: So I think that's an important thing to think about is that I've heard it described at one of our migraine conferences as the inferno of migraine. And so each of those are a little match, right? So a match that you didn't sleep very well, another little match to some dry kindling that you didn't eat breakfast, and then whatever you ate for lunch and maybe didn't stay hydrated. And all of those are really leading to that inferno that then becomes the migraine.

Interviewer: I like to think of things like that in terms of the cup. So you didn't have your breakfast, you put a little water in that cup, and eventually it just gets so full it runs over. Boom, that's when you have the migraine headache.

Dr. Pippitt: Absolutely.

Interviewer: That's kind of my analogy. It worked for me. But I like the inferno. You had fire. I had water. So you went through a lot of kind of lifestyle things that really all of us should be trying to do to the best of our ability anyway -- staying active, eating healthy, trying to get enough sleep, controlling our alcohol consumption.

Interviewer:When somebody comes in, out of all of those, do you kind of have them start with one above the other? Like what's the biggest bang for my trigger buck?

Dr. Pippitt: Oh, great question. I would say probably sleep. Sleep is a really big trigger for people. And not just not enough sleep, but too much sleep can also be a trigger for you. Most people, when you come in, we talk about those four. And I'll tease people that there's usually one I can pick on them about, right? Like very few of us are like good at all four of those things, so there's usually one. So if there's just one, then that's the one that I'll typically pick on. But sleep and then a close second would probably be either hydration. I don't even know that I'd give you a close second, because I feel like all of those are really common, that we get busy, we don't eat, we get busy, we don't stay hydrated, and we don't exercise.

Interviewer: Yeah. We get stressed, we drink alcohol.

Dr. Pippitt: Yeah. So just trying to find time to do the right thing.

Interviewer: I'd like to add in too, for any of those things, it's really I think important to keep a diary, because before I got my Fitbit a couple of years ago, I thought, "Oh, I get eight hours of sleep. I go to bed at 10:00 and get up at 6:00." Well, actually, it told a little bit of a different story. I guess I didn't realize I was going to bed at 10:45 or 11:00. I thought I was going to bed at 10:00. So writing that stuff down and like what you eat is the same thing. So I think really be critical.

Dr. Pippitt: Absolutely. And I love all the activity trackers, because I think a lot of us think that we're active. I have on my busiest day of clinic, I remember when I first got my Fitbit, I was like, "You got to be kidding me. I'm only doing 3,000 or 4,000 steps. Like I'm exhausted when I come home." And it's interesting how different trackers will then talk about how much you stand, how much you moved. Like maybe you didn't take that many steps, but you were up and moving around. And I was like, "Okay. Either that just made me feel better because I was actually a little more active even if it wasn't just from like a step standpoint." But I think that is useful feedback and information for you to act on.

Interviewer: What about posture? Does posture trigger migraines? I know for me, if I sit all day at work, which sometimes, again, I try to get up every 10 minutes every hour. But if I sit all day, I'll start to notice headaches creeping in around 4:00 or 5:00 in the afternoon.

Dr. Pippitt: Yeah. Posture can definitely lead to more headaches, maybe a little bit more tension headaches and tension headaches can then lead to migraine headaches. So you're doing the right thing by standing up every 10 minutes or so. Making sure your setup is good so that you're not hunched over. I definitely have a tendency, even though I have a pretty good setup, to hunch a little bit more, especially as I keep looking into a camera screen, that tends to curl my shoulders a little bit. So standing up, stretching, like bringing your arms above your head, sort of stretching out your pecs is really what you're looking for. So if you've got one of those exercise balls, rolling that onto your shoulders and just letting your arms fall open. We often think about, "Okay. What can I do for my neck?" But we don't realize that as we're hunching forward, you're actually shortening your pec muscles. So opening those up or going to a corner of a room and putting your hand on each of the wall and almost doing a little push-up against the wall to stretch out those areas is huge.

Interviewer: Some great advice to look to try to reduce the severity. Now, do these things reduce both the severity and frequency of headaches, or do they tend to impact one or the other?

Dr. Pippitt: They could do both, to be quite honest. Maybe not as much the like intensity of one that you have, but I suppose if you really filled your cup up and just like kept the hose running, that might actually make a difference with the intensity. The goal is really probably more with frequency, I would say.

Interviewer: All right. And is this an alternative to taking medication, or would you recommend, if somebody has migraines, that this is in addition to?

Dr. Pippitt: I would say definitely in addition to. Like I said, medications can only do so much. So even if we had a perfect medication regimen for you and you weren't sleeping, weren't eating, weren't exercising, and didn't stay hydrated, I don't know that those medicines would really do any good for you.

Dr. Pippitt: I'll often tell patients that medications can only do so much, and so they have to be doing the things that are under their control to help us best control their migraines. And typically, people will have some awareness of some of these because they will have realized these are their triggers.

So sleep is a really big one for people. You want to make sure that you're consistent in your sleep hours, so trying to go to bed around the same time, getting up around the same time, and just getting good sleep quality, if you have something like sleep apnea or another medical condition, that you're getting those treated. A lot of people will have already known that if they didn't sleep very well or if they slept too much, that they happened to get a migraine. So people usually know that that's a big trigger. Some of us don't have good control of our sleep because we're shift workers or something else has happened. And that makes your migraines a little bit worse. So to the best of your ability, if you can control your sleep, that really helps.

Staying hydrated is really huge. We live in a really dry climate, and so making sure that you're drinking water, drinking things that are going to keep you hydrated throughout the day is really important. Again, sometimes people will be like, "Oh, it was a hot day and I was out hiking and then I came home and I had a bad headache." There you go. So making sure that you're staying hydrated.

Being active, right, getting out, doing something. I'm not saying you need to be these crazy Utah individuals who are running ultra marathons and hiking Mount Olympus every weekend. But just go out and walk 20 minutes a couple of times a day, making sure you're doing that and not just being sort of still and sedentary. That's a really important thing with your migraines.

And then you brought up nutrition. So not only what you eat, but I would also say how frequently you eat. We'll typically recommend that patients with migraines or with headaches that you're eating something probably somewhere between every two to four hours. That's something to sort of fiddle with, that works with your body best, but not going for long periods of fasting. That tends to be a trigger for a lot of people. And when you do eat a snack, making sure that you're eating something with a little bit of protein, a little bit of complex carbohydrates, something that's going to kind of sustain you and keep you going, so peanut butter, nuts, dried fruit, yogurt, cheese, something like that.

And then what you eat, it does matter to a certain extent. A lot of people will say that there are certain foods that are a trigger. And you've heard me say that a couple of times now, "What is your trigger for migraines?" It's helpful to look at what you're eating and know what some common triggers are, but don't torture yourself in trying to find what you think is the cause. So some really common triggers, I would say for people, red wines or wines with sulfate. Sometimes alcohol in general, but typically red wines and beer are probably big ones. Chocolate can do it. Processed meat, so things like hot dogs, sausages, that can be a trigger for people. MSG for some people, though I would say the data is a little bit less supportive of that. And then sometimes things like fermented foods can also be a trigger. But everyone is very different. So you may have those and not bother you at all, and other people may be more sensitive.

And also, maybe it's just you had a night that you didn't sleep very well, you were really busy at work and maybe you skipped breakfast. And then when you had lunch, you had a hot dog and a Coke and then later you had a headache. Was it the hot dog? Was it the skipped breakfast? Was it the poor sleep? Yes. It was really probably all of those things that did it.

Interviewer: I was waiting for the answer.

Dr. Pippitt: So I think that's an important thing to think about is that I've heard it described at one of our migraine conferences as the inferno of migraine. And so each of those are a little match, right? So a match that you didn't sleep very well, another little match to some dry kindling that you didn't eat breakfast, and then whatever you ate for lunch and maybe didn't stay hydrated. And all of those are really leading to that inferno that then becomes the migraine.

Interviewer: I like to think of things like that in terms of the cup. So you didn't have your breakfast, you put a little water in that cup, and eventually it just gets so full it runs over. Boom, that's when you have the migraine headache.

Dr. Pippitt: Absolutely.

Interviewer: That's kind of my analogy. It worked for me. But I like the inferno. You had fire. I had water. So you went through a lot of kind of lifestyle things that really all of us should be trying to do to the best of our ability anyway -- staying active, eating healthy, trying to get enough sleep, controlling our alcohol consumption. When somebody comes in, out of all of those, do you kind of have them start with one above the other? Like what's the biggest bang for my trigger buck?

Dr. Pippitt: Oh, great question. I would say probably sleep. Sleep is a really big trigger for people. And not just not enough sleep, but too much sleep can also be a trigger for you. Most people, when you come in, we talk about those four. And I'll tease people that there's usually one I can pick on them about, right? Like very few of us are like good at all four of those things, so there's usually one. So if there's just one, then that's the one that I'll typically pick on. But sleep and then a close second would probably be either hydration. I don't even know that I'd give you a close second, because I feel like all of those are really common, that we get busy, we don't eat, we get busy, we don't stay hydrated, and we don't exercise.

Interviewer: Yeah. We get stressed, we drink alcohol.

Dr. Pippitt: Yeah. So just trying to find time to do the right thing.

Interviewer: I'd like to add in too, for any of those things, it's really I think important to keep a diary, because before I got my Fitbit a couple of years ago, I thought, "Oh, I get eight hours of sleep. I go to bed at 10:00 and get up at 6:00." Well, actually, it told a little bit of a different story. I guess I didn't realize I was going to bed at 10:45 or 11:00. I thought I was going to bed at 10:00. So writing that stuff down and like what you eat is the same thing. So I think really be critical.

Dr. Pippitt: Absolutely. And I love all the activity trackers, because I think a lot of us think that we're active. I have on my busiest day of clinic, I remember when I first got my Fitbit, I was like, "You got to be kidding me. I'm only doing 3,000 or 4,000 steps. Like I'm exhausted when I come home." And it's interesting how different trackers will then talk about how much you stand, how much you moved. Like maybe you didn't take that many steps, but you were up and moving around. And I was like, "Okay. Either that just made me feel better because I was actually a little more active even if it wasn't just from like a step standpoint." But I think that is useful feedback and information for you to act on.

Interviewer: What about posture? Does posture trigger migraines? I know for me, if I sit all day at work, which sometimes, again, I try to get up every 10 minutes every hour. But if I sit all day, I'll start to notice headaches creeping in around 4:00 or 5:00 in the afternoon.

Dr. Pippitt: Yeah. Posture can definitely lead to more headaches, maybe a little bit more tension headaches and tension headaches can then lead to migraine headaches. So you're doing the right thing by standing up every 10 minutes or so. Making sure your setup is good so that you're not hunched over. I definitely have a tendency, even though I have a pretty good setup, to hunch a little bit more, especially as I keep looking into a camera screen, that tends to curl my shoulders a little bit. So standing up, stretching, like bringing your arms above your head, sort of stretching out your pecs is really what you're looking for. So if you've got one of those exercise balls, rolling that onto your shoulders and just letting your arms fall open. We often think about, "Okay. What can I do for my neck?" But we don't realize that as we're hunching forward, you're actually shortening your pec muscles. So opening those up or going to a corner of a room and putting your hand on each of the wall and almost doing a little push-up against the wall to stretch out those areas is huge.

Interviewer: Some great advice to look to try to reduce the severity. Now, do these things reduce both the severity and frequency of headaches, or do they tend to impact one or the other?

Dr. Pippitt: They could do both, to be quite honest. Maybe not as much the like intensity of one that you have, but I suppose if you really filled your cup up and just like kept the hose running, that might actually make a difference with the intensity. The goal is really probably more with frequency, I would say.

Interviewer: All right. And is this an alternative to taking medication, or would you recommend, if somebody has migraines, that this is in addition to?

Dr. Pippitt: I would say definitely in addition to. Like I said, medications can only do so much. So even if we had a perfect medication regimen for you and you weren't sleeping, weren't eating, weren't exercising, and didn't stay hydrated, I don't know that those medicines would really do any good for you.

Dr. Jones: So you've been very successful at achieving your weight loss goal. Congratulations. But you don't fill out your bra anymore. What is that about?

Most women who undertake a significant weight loss through diet or through weight loss surgery are hoping to lose fat. That's the part of the body that we don't need so much. We don't want to lose a lot of muscle when we do a weight loss thing. But some parts of our body are mostly fat, and that would be our breasts, and weight loss may lead to a body change that isn't welcome. So what can we do about that?

Today, in the virtual Scope Studio, I'm talking with Dr. Cori Agarwal. She is a plastic surgeon who specializes in aesthetic and reconstructive surgery at the University of Utah, and she has an interest in helping women find the body that they're looking for.

So I have some questions about this, because this is a really interesting topic for people who have really undergone a basic transformation of their body, whether it was 30 or 50 pounds, or they lost baby weight and the baby and then they nursed and so their body isn't the same. After substantial weight loss, women may find their bodies change in ways that they hadn't anticipated. Can you talk about weight loss and how it affects breast structure?

Dr. Agarwal: I think that's a really overlooked conversation when people set out to lose weight. They're really focused on health and kind of the getting back to feeling more active. And sometimes it's a surprise when there's this negative effect on specifically the breasts.

The breasts, as you mentioned earlier, are made up of quite a bit of fatty tissue, and that really varies person to person. But I'd say most women, especially as we age, the breasts become more and more percentage of fat. So when you lose weight all over your body and you lose fatty weight, naturally some amount of that is going to come off of the breasts. And you don't always know until you're there. So, for some women, it's just a minor effect. And for some, it's completely deflated after the weight loss.

Dr. Jones: Oh, deflated. I mean, it's hard enough getting older and if you've had babies, but to have . . . even that word deflated, that would have me rushing to you to get some help.

Dr. Agarwal: Well, I was going to say the deflation, it's really important to think of it in two areas. There is the loss of volume, so the loss of this fat where you really just lose the size of your breast. And then there's the deflation, the sagging of the skin where the nipples kind of point down and everything stretches down.

And those two we really think of separately and independently. When we talk what options there are for rejuvenating and filling the breasts, we really think of the sagging and the loss of volume separately, because not every individual has as much sagging or as much loss of volume.

Dr. Jones: When you said there are really two parts to two different kinds of changes that happen with weight loss, there's sagging and then volume, what are you going to do? What are the procedures here that you're going to undertake with this woman?

Dr. Agarwal: There are really two main objectives. And one is to fill the volume to the size that was lost. And for some women, they want to be a little bit smaller than they were to start. Some want to be a little bit bigger. And to fill that volume back, to restore that deflated volume, the mainstay operation is a breast augmentation, and that's placing an implant in the breast usually behind the muscle to regain the volume.

However, if the skin has at the same time sagged, which it usually does, in the process, there needs to be a skin tightening procedure done at the same time. And that's called a mastopexy or breast lift.

Now, these can be done independently. Someone may just want the lift. They might like the size that they've ended up, but everything's just droopy. So we'll just do the breast lift. And then more commonly, we will offer and recommend a lift with an implant, because in most people, I think both of those processes are happening. That's something that's very individualized, but I think it's important to think of those two separately, the lift and the augmentation.

Dr. Jones: And so, rather than some people thinking they're just going to have a little incision somewhere and something is going to be slipped in and pumped up or something, you're really going to have to remove some skin and maybe lift the nipple.

Dr. Agarwal: Right. I think that's often a surprise for women because they think, "Well, this is just like a deflated balloon. I'm just going to fill up the balloon," but they haven't really noticed how far things have stretched. And we really have to have an honest conversation about what it will look like with just the implant, or if you really want or would recommend a lift along with that implant.

Dr. Jones: So what are the options for women who would choose breast surgery? Do you call it aesthetic or cosmetic, or in this case, is it really reconstructive and is it paid for by insurance?

Dr. Agarwal: That's a really important thing, and so many things are blurred in the world of plastic and reconstructive surgery. A lot of things that we do that are reconstructive really are also cosmetic, and there is a blurred line, especially when it comes to the breast.

So when we talk about the words cosmetic and reconstructive, what we're usually getting to is "Will insurance pay for it?" Because if insurance sees it as cosmetic, then even if we think it's really truly a reconstructive thing, building your body back, we have to call it cosmetic. And the sad truth is that for most breasts that have sagged or lost volume almost all the time will be considered cosmetic by insurance companies and is not covered.

Dr. Jones: Well, for women who part of their weight loss journey has been becoming really active, and now they have breasts that don't want to stay where they want to put them, that ends up getting in the way of their being the physically active person that they have to be if they're going to maintain their weight loss.

Dr. Agarwal: Right. And we do try to make those arguments to insurance, but I think that it's just outside the scope of what we can declare medically necessary for the breast. Breasts sag for so many reasons. Pretty much anyone who has gone through a pregnancy and nursed a baby, even just age, breasts just sag almost 100% of the time. And so I think that's just beyond what we can argue for insurance to cover.

Dr. Jones: Knowing that many people who lose weight gain it back again, is there any recommendation about waiting for weight to stabilize for a while before considering breast augmentation? I mean, we've all watched the successes and failures on "The Biggest Loser," and some people are back right where they started from within a year or two. So how do you counsel people in terms of when they should consider this reconstruction?

Dr. Agarwal: I think as a general rule of thumb after a lot of weight loss, we'd like people to maintain their weight for about six months. If it's just a quick diet that's severe and maybe they're going to bounce right back in a couple of months . . . but by six months of sustained weight loss, most people are pretty steady in their weight. So that's the general recommendation, but of course, it's very individualized.

Dr. Jones: Right. And can this surgery be part of a larger surgery? So you certainly know people who have maybe had bariatric surgery and they lost 150 pounds, and now they have sagging not just in their breasts, but throughout skin, all over their body, which becomes a significant issue in just terms of staying healthy. Can you do redundant skin reduction at the same time that you do a breast surgery, or are these staged at different times?

Dr. Agarwal: I think both are true for each individual. When we're thinking about doing reduction of skin, tightening of skin after a lot of weight loss, safety is the main priority. We want to limit the amount of time under anesthesia for any individuals. So if they came in and said, "I want my breasts and my belly and my thighs and my back," we really have to slow it down and say, "Okay, what's the most important thing here? Can we combine it with something else?"

We try to limit the surgery time somewhere between three and six hours. And so we can do sometimes breast work with something else, but depending on what other areas are the priorities, it's very common to stage this.

But that's the conversation we have after we get to know the patient and see how healthy they are, how prepared they are for a long recovery. So it can go both ways.

Dr. Jones: So when you say how healthy they are and how emotionally prepared, it's hard when you have just a few minutes to get to know someone. And I know that sometimes before people undergo bariatric surgery, they might actually see a behavioral psychologist. But how do you get to know people to know that this is the right thing for them to do and they're not just seeking something that's really unobtainable? How do you set realistic expectations about what they're hoping for?

Dr. Agarwal: This is really important. We spend a lot of time . . . I'd say the first visit is usually about an hour. And during that time, a portion of it is talking about the surgery and evaluating them. But a big part of it is talking about how they've gotten to that point, how they feel, what their expectations are, and then their social support. I think social support is critical when you talk about getting through a big surgery like that. And so we'll make sure that they've really thought through who needs to help them, someone to help with the children, someone to help with themselves and their work. So that first visit, we do a fair amount of that really trying to get to know someone.

And you're right, it's only one visit, but usually we have another one or two visits after that before surgery and really get to these critical questions of whether they've thought this through and have the support on the other side. Some will have to really set realistic expectations, that you will not have a 20-year-old body after this, but you will have this and you won't have that. So we try to be really realistic and not try to sugarcoat it or make it seem better or easier than it will be.

Dr. Jones: Right. Well, I would think that most people having gone through . . . particularly if it was significant weight loss, they've been with this body for a while and they know what they're looking for, and I bet you they're mostly pretty realistic. They're not coming in with perfect breasts hoping for more perfect breasts.

Dr. Agarwal: I wish that was the case in everyone. I think there are certainly a lot of women who are exactly in that category, but there are a lot of people who still . . . maybe it's a lot of the TV shows out there, but there is an idea that there's some magic that happens and some Photoshopping. I do think we have to ground them sometimes if maybe what they've been seeing isn't realistic, because . . .

Dr. Jones: I've seen some of those YouTube videos, the befores and the afters, and I look at the afters and say, "How can she have lost 150 pounds and have breasts and legs that look like that? Is that real?"

Dr. Agarwal: Exactly. So you have to take a lot of it with a grain of salt, and so that's the job. I think that that's the consultation. You're not going to know that before really meeting with your surgeon and understanding what can be achieved.

Dr. Jones: I want to thank you because I hadn't really thought about this one. Certainly I've had patients over the years who were thinking about bariatric surgery, and I didn't really take them through all the steps that this will happen when you get there. You will get there, but then this may happen. It may not. So I want to thank you for giving us some insight.

And for women who've taken the big steps to make a big positive change in their body through weight loss, there are sometimes still steps to take to feel like yourself again. You're not alone and there are options and procedures that can help.

I want to thank you, Dr. Agarwal, for joining us. And thanks for everyone who's listening on The Scope.

Scot: All right. We're back with Thunder Jalili. He's our resident nutrition expert. And we're going to throw out another one of these things you might see on the internet, or some of this common sense, or, you know, something that you've believed for a long time. And we're going to find out if it's truth or if Thunder is going to debunk it on "Truth or Thunder-Debunked." Thunder, are you ready for your challenge today?

Thunder: I hope so.

Scot:: All right. Does eating at night really cause weight gains? Because there's this kind of, I think, this wisdom that you eat late at night and that's what's going to cause weight gains if you're eating like right before bed or something like that. So is that truth, or are you going to Thunder-debunk it today?

Thunder: No, I actually think there's truth to that.

Scot: What?

Thunder: Yeah.

Troy: Good, I was going to say don't tell me this is not true, because my whole takeaway from all our discussions is that this is true.

Scot: All right. Well, go ahead and explain.

Thunder: We talked in earlier podcasts about kind of the length of time that you eat, in terms of like what time do you eat in the morning when you wake up and then kind of when in the day you stop eating. And as we eat, our insulin levels go up, and that's kind of the hormone to store nutrients like fat.

So people that do that late-night snacking, you know, they've got to have something at, you know, 10:00, 11:00, 12:00 at night, maybe even later, they're kind of extending that whole time that they're putting calories into their system, and their insulin levels are high. So that's a recipe for, you know, storing fat.

So one of the ways that we would, like, advise somebody if they want to try to lose weight, you know, what are some easy steps I can think about, well, one of the easy steps is try not to eat after dinner, you know. Then you kind of have a longer time period where your body can go into that natural fasting state overnight and that helps us control our weight.

Troy: See, I'm so glad you said that, Thunder, because I have now, after all of these discussions we've had about this, I now watch the clock. I don't eat after 8:00, and sometimes it is a rush to get calories in before 8:00 p.m. I admit it's a little weird, but sometimes I am just like, okay, gotta eat, gotta eat, gotta eat. Okay, it's 8:00, I'm done.

Scot: So if you do work later, though, let's say you don't start eating until 6:00 p.m. and you shut it down at midnight. You're eating at night. Is that going to cause weight gains? Is there something about the night, or is it really just about that time of eating and not eating?

Thunder: It's not . . . there's nothing special about night. It's about the time period.

Troy: So maybe it was Thunder-debunked then. So it's nothing about the night in general. It's more just that period between when you last ate and when you eat again.

Thunder: Yeah. Oh, that's true. I guess in that sense it could be debunked. I guess I was assuming most people, you know, do have kind of a more regular schedule of having, you know, three meals, more or less, a day and then throwing snacks in there. So the night snacking, when I hear that, I assume that the person is, you know, kind of doing that normal, three-meals-a-day thing. But, yeah, to your point, if that's not you, if your first meal doesn't come until 4:00 in the afternoon, then, by all means, eat at 10:00.

Interviewer: Today, you're going to learn about four research-supported steps to begin your weight loss journey.

Dr. Jennwood Chen is a member of the University of Utah Health Weight Management Program, and he helps patients that want to lose excess weight, not only for appearance but more importantly for better health. So let's talk about those four steps. What are those four steps to help somebody create some new eating habits to help them lose weight?

Dr. Chen: Yeah, yeah, absolutely. So, you know, changing what you eat or starting any new habit is notoriously difficult, right? I mean, we all are familiar with the New Year's resolutions that are broken and abandoned by, you know, January 5th. And so really in looking at how people actually implement, start and retain healthy habits, I think science has really identified four steps, and those four steps are inspiration, intention, action, and repetition.

So really, so, for instance, if someone is wanting to make a healthy change in their diet, really you need an inspiration. So many of my patients, when I talk to them, "Why do you want to lose this? Why do you want to lose this weight?" And they'll tell me that, you know, "I have young children and I know that my excess weight is affecting my health and I want to be around for them and I want to be able to play with them and be active with them." And that's inspiration, and that inspiration is it's what you draw on in those times where you know it's going to get hard just to stay with it.

However, we know research tells us that that inspiration is fleeting. So you may be inspired today to make a change, and tomorrow you can't rely on that inspiration because you just can't feel inspired all the time. And so that's where the next step intention. Once you're inspired, you need to set an intention. Okay, tomorrow, I'm going to cut this out of my diet.

Interviewer: And when you talk about intention and you have a patient, what are some of the first suggestions you have? I've heard like eliminate sugary drinks. If that's something you do, maybe start to eliminate those. That's like a really low-hanging fruit, high-impact sort of a thing. Are there some other things?

Dr. Chen: Well, that is absolutely. If someone tells me that they, you know, drink a couple of cans of soda a day, I immediately jump on that one. And, you know, people will get pretty addicted to soda. I have patients that tell me, you know, they drink up to a liter of pop a day. And so that intention to make a change needs to be a realistic. For some people, you know, cutting a whole liter of soda out of their daily routine is not that realistic. So cutting it down to a half liter a day for a while and then weaning yourself off it is a more realistic thing.

Interviewer: All right. What is the next step? We've had inspiration and intention.

Dr. Chen: Action. So really, you know, once you've set an intention, the action, and by action I mean immediate action. If you have inspiration, your intention is to start cutting out the soda, don't start next week. Start with the next time you are going to have a soda, that next time and just take action right then. It could be a small thing. Yeah, I'm not going to drink the whole liter. I'm just going to, you know, cut out half a liter, but, you know, take action now.

Interviewer: All right. When the inspiration is there and you're ready to go . . .

Dr. Chen: That's right.

Interviewer: You got to cash in on those deals, right.

Dr. Chen: That's absolutely right.

Interviewer: So inspiration, intention, action, and now rinse and repeat with repetition.

Dr. Chen: Rinse and repeat. Absolutely, yeah. And so we know, on average, it takes about three weeks to really develop a "habit," you know, and it just doesn't happen unless you could repeat these steps.

Interviewer: After three or four weeks of somebody doing this, you know, they come back to your office. What do you find that are some of the other things they can do to succeed on these four steps or some of the things that maybe, you know, cause people not to succeed?

Dr. Chen: I really think that, through all of this, you have to have self-compassion. And that really means that when you slip and it's inevitable, we all do. We all miss going to the gym. Even though I say, hey, I'm going to go, you know, five days a week at 7: 30, there's just, you know, life happens and you just miss a day. You can't beat yourself up about it. You can't torpedo the whole idea just because you slipped up once.

And on the flip side, at the end of the week, when you have, you know, cut out a liter of soda a day for five days, you got to pat yourself on the back, and you should tell your family, you should tell your friends, and you should be proud of yourself really. And that's how we stay on the path.

updated: December 30, 2022
originally published: March 26, 2021