Dr Rupy: Nick, great to see you again.
Dr Nick Fuller: Likewise.
Dr Rupy: What what are the what what is the number one reason why people can't lose weight?
Dr Nick Fuller: Well, most of us think it's because of that lack of willpower, that we just don't stick to the diet for long enough. We go back to our old habits and consequently we put the weight back on. And that's largely due to the way, I guess, the dieting industry bundle up their programs. They sell these cute, neatly packaged four, eight, 12 week programs. They get you to, I guess, restrict your calorie consumption, and often quite extreme. And they get you to follow a strict militant exercise program. And we stick to it for anywhere between that four to 12 weeks. And yes, we do go back to some of our old ways, but it's not the reason why we're putting the weight back on. The reason is because of our physiology, all these biological protections that come into play the minute you lose a small but clinically significant amount of weight. And I'm just talking about three to five kilos or 5% of your body weight. Your body starts to go, hang on, what's happening here? It goes into survival mode, it shuts down and a whole cascade of reactions take place within your body to take you back to your start point. And this is the real reason why, and the very reason why we're failing on our long-term weight loss journey or our dieting attempts. And it's the thing we're not talking about. We all talk about the short-term wins. We go out and we celebrate the five, 10, 20 kilo weight loss that we've had with our friends, family and colleagues, but then we're not talking about that long-term pain when we stack that weight back on. And that's the long-term repercussions of dieting that we're seeing in our clinics at the University of Sydney and Royal Prince Alfred Hospital. Everyone has been on the latest and greatest diet. Often they're trying up to five diets every year, and they're just in this vicious cycle of up, down, up, down, and often driving up their weight. And I guess just to summarise that, there's some fascinating research within twins that shows that intentional weight loss actually accelerates your weight gain.
Dr Rupy: What?
Dr Nick Fuller: So over a 25-year study, they followed up more than 4,000 sets of twins and they found that the twin that had been dieting was always heavier than the one that hadn't been dieting throughout their life.
Dr Rupy: Really? Wow.
Dr Nick Fuller: So it's obviously independent of genetic factors, that intentional weight loss or cyclic weight loss over and over and over again is actually driving up your set point over time. And it's something that we need to stop. We need to be equipping people with the right education so they stop that dieting or yo-yo dieting journey that they're on and follow evidence-based care from healthcare professionals that actually know what they're talking about.
Dr Rupy: Yeah. So I just want to reiterate that because I think what you said there deserves to be hammered home. A clinically significant amount of weight loss is just 5% of your weight. So if I'm 100 kilos, let's say, and I lose 5 kilos, that is enough to start the process of those mechanisms that are designed to protect us from too quick a weight loss. In the wild, this is part of our evolutionary makeup, that can trigger actually weight gain over the long term if I don't stick to my sort of militant weight loss protocol of exercise and low calorie diets.
Dr Nick Fuller: Yeah, absolutely. And it can happen at even a lower weight loss. So just three kilograms of weight loss is when you start to see these changes within a body, but yeah, I mean, a sort of a good way of thinking of it is because typically we do lose the five kilos quite easy or 5% of our body weight. That is when this cascade of physiological changes start to take place within your body to take you back to your start point. So even if you're sticking to your diet and you're doing all you can to follow those new habits, keep the calories down, keep the exercise going, this is taking place within your body, which we can get into in a little bit more depth, to take you back to where you began. And this is your body going, I need to survive and in order to procreate and survive, I need to go back to where I once was because tens of thousands of years ago, food wasn't available on every corner of every block. And when food was available, we would gorge. We'd gorge on those foods naturally high in sugar, naturally high in fat. And then our bodies learned to shut down during times of deprivation to hold on to those calories, to hold on to our fat stores until food was then available again. You fast forward to the modern day environment, food is available on every corner of every block. We have a hard time saying no. Consequently, our weight's going up by about 0.5 to 1 kilo every year. So that's up to around two pounds. And then what do we do? We look in the mirror and we react. We react by following the latest and greatest diet. And this is where these cascade of physiological responses take place taking you back to your start point.
Dr Rupy: Yeah. I'm going to put a bookmark on that because you mentioned set point or weight set point, so I definitely want to go into that in a bit more depth. Another thing that people ask us a lot about is visceral fat in particular. And I guess what are the three most important things that people should be aware when it comes to losing visceral fat? Because DEXA scans are getting more popular these days. I think they're giving us vital information about the hidden fat around our organs and why that is more of an issue somewhat than subcutaneous fat that doesn't look as aesthetically pleasing. But perhaps you could tell us a bit more about visceral fat and what are the three most important things in your opinion that are necessary for people to know about how to lose that visceral fat?
Dr Nick Fuller: Absolutely. So like you said, subcutaneous fat is the fat that you typically see as the folds on the stomach. The visceral fat is the one that lies deep within that surrounds the organs and prevents your organs from working efficiently. So that fat surrounding, for example, your pancreas, not allowing it to do its job and bring blood sugar levels down. Consequently, your body's not working properly and you can then move into a state of pre-diabetes and then eventually type two diabetes and the complications that come with that. And the most powerful way of reducing our visceral fat and the number one thing that we should all be focusing on, not even three things, is exercise. All you need to be doing every day is moving. And I'm not talking about the strict militant exercise programs that are often prescribed in the diet programs where we go all or nothing, we get injured, and then have the setbacks and go back to where we once were in terms of our baseline activity level. I'm talking about incorporating incidental activity, focusing on the everyday movement. We evolved to move, but now in the modern day environment, we drive everywhere from A to B. The absurdity is if we even include structured activity, often we drive to say a structured environment like a gym, do our 30-minute workout, drive back home again. So if there's one thing that you want to do to improve your health and improve your visceral fat is get moving, particularly as we come into the new year, these new new year's resolutions are being set. If you're going to reduce visceral fat and reduce your risk of developing heart disease, type two diabetes and other metabolic disease, it's just incorporating at least 30 minutes of exercise every day, but more importantly focusing on incidental activity. And the other thing, I guess, is a good way of highlighting that difference between subcutaneous and visceral fat is a population group known as the sumo wrestlers. Now, some of them have body weights up to 200 kilograms, but yet they are metabolically healthy. Most of that fat that they have is subcutaneous fat that lies just beneath the skin. And when we do metabolic tests on them, we take bloods and and check their diabetes and heart disease risk, most of the time they actually come back in the normal range despite their presence or or profile putting them in what would be an overweight or obesity range according to body mass index. And why? Because they are moving and they are doing strenuous activity a large part of the day and they're doing it every day. So you can be walking around and still be in a healthy body weight range but have a high visceral fat percentage, particularly if you're not doing any activity. So it really comes down to one thing, not even three, it's just exercise. And it's it's not necessarily the structured exercise, it's firstly focusing on incidental exercise, particularly if you haven't been moving for a period of time because you're putting yourself at high risk of heart attack if you all of a sudden start a strenuous program. And once you get a good baseline incidental activity, I'm talking about using stairs instead of lifts, walking to and from the bus stop if you can, walking around, having walking meetings, little simple things like that. Once you've incorporated that baseline level, then you can start to focus on including some structured activity and a mixture. So some of it might be huffing and puffing where you're running or run walk at an oval. The next day you might be in the pool swimming some easy laps. The next day you might be walking with a friend and then next day cycling. Mixing up what you do, but making sure it becomes part of your every day. It should be in the calendar. It's not something that you do as a nice to have, it's a must have.
Dr Rupy: Yeah, it's almost like you should be focusing on the incidental exercise before you even think about going to the gym or getting a gym membership. So before actually investing in structured exercise, it's actually just a case of, okay, what are the opportunities I have to start moving a lot more in my day? And I always feel a bit of a fraud saying this on a podcast because generally we're sat down, we're not moving, we're inside. It would be wonderful to have this as a walking sort of podcast, but the the audio is terrible and I've tried it before and it just doesn't work. But when I think about my sort of incidental exercise, it's walking to work, taking the bus sort of like one stop earlier than I would do, making sure that whenever I'm doing a meeting that's virtual, I'm usually on on like in a park environment or just taking a walking meeting if it's in person. And my friend does a really interesting thing where he keeps a kettlebell by his desk and he has like an hour timer and he'll literally just pick up the kettlebell and do a few swings, obviously taking care that he's not going to be hitting anyone. But just to get that sort of like movement in every hour because, I mean, you're an academic, you know what it's like, you're going to be sat behind your desk quite often indoors without the opportunity to get that incidental exercise. What are the things that you tend to do?
Dr Nick Fuller: Well, I definitely focus on those small things that you mentioned. So, you know, parking further away, if you're on a public transport, getting off a stop earlier. And yes, I know, I understand that some of these things do take more time out of your day, but it's so important to focus on those small things and our health. Because without our health, we don't have anything else. So, you know, make those little small changes. You don't need to be signing, like you said, signing up to the gym membership and doing the all or nothing because often we're not getting that baseline activity level in. And it could even be housework, you know, and and focusing on doing that house chore a little bit more vigorously than you normally would. It might be sweeping the stairs or, you know, mowing the lawns. All of that adds up and if you can get your heart rate up and down for short bouts of of time, that is just as potent. So, think about the cumulative effect of of your exercise throughout the day through incidental activity. And once you've got to that level, then you can start thinking about ways of maybe incorporating structured activity with friends. So instead of going to catch up over coffee and sitting down, again, you could just go for a walk together. Something that I like to do with my friends, go to the park, kick a ball, whatever it might be. It's it's it's, you know, simple but very effective way of, uh, you know, focusing on that number one thing being activity and keeping our visceral fat levels low.
Dr Rupy: Yeah, definitely. It reminds me of a a study actually that was conducted by some Stanford researchers and they had two cohorts of house workers, and I think they were cleaners within a hotel or some sort of environment like that. And they told one group that the amount of activity that they were doing equated to like a full workout in the gym. And the others they didn't inform them, something to that effect. And the ones that had that mindset of, I'm doing this work every day and this is actually exercise and really good for me, lost weight. So there is something to be said about the psychology of that incidental exercise that you do every single day and just the mindset and engaging in that mindset of, you know what, like me walking to work doesn't feel like much, but actually is that cumulative effect that's going to be supporting my metabolic health. And I guess the question that comes to mind and I'm sure people are going to be thinking about this is, okay, I do all these small things, I try and exercise every day and get the opportunities when I do walking meetings, all the rest of it. If there were certain types of exercise that I should be focusing a little bit more on that could help with visceral fat. Are there ones that you can point to or is it any sort of cardiovascular exercise?
Dr Nick Fuller: Yes, so this is a good question. I think the other point to raise is if you are moving every day and but still, uh, you know, classified as as overweight or in the obesity range according to the crude measure of BMI, your visceral fat will be will be low. You know, you won't have a high visceral fat. Uh, you'll probably be metabolically healthy. And so that's an important take-home message. You can be, you know, overweight but still healthy. Um, in terms of what types of exercise, it's important to focus on a mixture. Now, that's important for two reasons. Um, the first one is because you have to think of your body, um, I guess, or or what you're trying to do, um, as a similar sort of thing as as what an athlete's trying to do. You know, if you keep giving them the same program day in, day out, their performance plateaus. Now, the same thing unfortunately happens with weight management and specifically weight loss. If you keep doing the same thing day in, day out, if you've got to a level where, um, it's an adequate baseline level for weight loss, which is usually around 60 minutes of exercise a day, 60 minutes of structured activity, not 30 minutes, then, um, you've got to mix up what you're doing. So, I gave a brief example before, but that might look like something where one day you do some general aerobic activity, a slow 30, 40 minute walk or a moderate intensity where you're slightly huffing and puffing, struggling to maintain a conversation with the person you might be walking with. Um, but the next day, you focus on, you might be time poor, you focus on a higher intensity workout. So it might be just 15 or 20 minutes where you go down to the oval and you do a a shuttle run and then you walk back. Shuttle run, walk back. And if you can't run because of pain with joints, etc, you do it in the pool. And that might be a quick lap of swimming followed by a little bit of recovery. Quick lap or some running, pool running, get your breath back, etc, etc. Then you would go back to another day where maybe it's the aerobic continuous activity again, where you go and have a game of tennis with your friends. So I think the most important thing there is that you're not focusing on the same thing every day. You need to shake up what you're doing. That's the best, um, way of achieving your your weight loss goals because otherwise you're going to hit that plateau. Um, and the second point is all activity is actually good for reducing our visceral fat. So it's continuous aerobic, um, where you do the long 45, one hour walk, whatever it might be, but it's also the short higher intensity workouts. All exercise is good and the most important thing is that you do it.
Dr Rupy: Yeah. I I'm glad to hear that because that's basically the mix of exercise that I'm doing right now. Like, if I just think about the last few days since arriving in Australia, I did a strength workout at the outdoor gym. So that was a mixture of sort of body weight exercises, dips, chin-ups, that sort of thing. And I then I did, um, a hit workout, um, which was basically walking down the hill and running up, and then walking down at a leisurely place and then running up as fast as I can. That, I mean, those kill me to be honest. And the reason why I've started doing a little bit more of the hit stuff, um, as well as the the long steady, uh, cardio is I want to try and push up my VO2 max. And my VO2 max is in the good level, but I want it to be in the great level as that not only has obviously visceral fat benefits and weight maintenance benefits, um, but it also has longevity benefits as well that I'm, I'm thinking a bit more about. Are you, are you doing some, do you, do you sort of measure your VO2 max yourself or?
Dr Nick Fuller: Yeah, I do occasionally. Um, you know, training for track and field. Uh, but you're right, there is, you know, a lot of indicators there that high VO2 max are good outcomes for things like, um, longevity. So, but again, I think that comes down to, you know, mixing up what you do. Because to get those improvements in in your aerobic capacity, um, you can't be doing the same thing all the time. You need to stress your body. You need to shake up what you're doing. Think of yourself as an athlete, even if you're really struggling with your weight, but do it in the comfort of your own environment. So that might have been a pool where you feel, you know, happy working out or comfortable working out, or it might be in your lounge room, doing, um, you mentioned body weight circuits, YouTube videos, anything like that, where, um, most importantly, you're actually going to do it. Because if you're taking yourself to an environment where you don't feel comfortable, um, one, you won't enjoy it, but two, you won't stick to it. So, I think that's, that's a key message as well.
Dr Rupy: Yeah, yeah. I think consistency is a big, big area that a lot of people struggle with. And I think, you know, just making sure that you're getting back on it as soon as you can and not spiraling to that shame and beating yourself up that you haven't done it, uh, uh, as regularly as you wanted to. You know, I've had many patients and colleagues that fall into that trap and then just sort of throw everything out the window and be like, well, I'm, you know, I'll do it next month or you you put it off. So just getting those sort of like small consistent habits as your foundation and then you can build on top of that.
Dr Nick Fuller: Absolutely. And just start small, 5 minutes, 10 minutes. Um, before you know it, you'll find that 20 minutes is quite easy and you'll find 30 minutes is quite easy and then before you know it, you'll probably find that over the course of the day, you're actually doing an hour of activity. So start gradual. It's you're not going to get there straight away, but that's also important for preventing injury and setbacks, particularly if you are carrying excess weight. So a lot of stress we're putting through the joints. And that's why it's also important to mix up your body weight bearing exercise with non-body weight bearing exercise. What I mean by that is, um, body weight would be where you're walking or running, and then the non-body weight is where you take all the stress off the joints and you might be on the bike, um, or in the pool.
Dr Rupy: Yeah, yeah. Uh, let's talk about these three bug ideas, big ideas about what people should know about weight loss. So I'm, I'm sort of trying to introduce a new concept to the podcast where a guest with expertise such as yourself can give away three tangible big ideas that people can take home. You've already given us a big one already, I think, a few. Um, but I thought, you know, if, if people are going to think of three things, what would be the first thing that you'd want people to know about when it comes to weight loss?
Dr Nick Fuller: Number one would be that fad dieting, um, and and these unrealistic, unsustainable programs in particular, uh, is is going to accelerate your your weight problem, accelerate weight gain. So, you know, you might start at 90 kilos and go down to the 80, but I promise you and research has also proven this, that you will go back not just to 90, you'll put on a little bit of extra. In Australia, we refer to that as the plus GST, the plus 10%. Unfortunately, your body's going into protection mode. It's it's learning to prepare for that next bout of starvation and it will it will put on a little bit of extra fat to prepare for it so that it's better able to survive that next bout of starvation that you're going to put it through. So the biggest, I guess, um, message around what do you do when it comes to weight loss is, yeah, definitely stop, um, that dieting cycle because, you know, we talked about the the research in twins, it will accelerate your weight gain and it will drive up your set point over time. And we've had many, you know, cases and patients in our clinics where they started off in a normal weight range. And unfortunately, they began dieting very early. They then dieted themselves into an overweight range. Um, by the time we start seeing them in our clinics, they're then classified as as obesity, um, as per BMI. So you need to stop that, you need to break that cycle because it's doing more harm than good.
Dr Rupy: Yeah. You mentioned weight set point there. Um, I wonder if we can go into a little bit more detail about what that means.
Dr Nick Fuller: Yeah, so set point is is is basically the weight you remember being at for a long period of time in your adult years. Now, what I mean by adult years is probably typically 20 years plus, um, when all the growth and development has stopped and and we're sort of at that weight, programmed weight, um, in our adulthood. Now, for one person it might be 60 kilos, for the next person it might be 110, the next person it might be 75. Everyone has a unique set point and that weight that they remember being at for a long period of time. Now, this is the weight that our body is now protecting. This is the weight that it says, okay, in order to survive and procreate, I need to stay at this weight. So if it goes down low, I need to shut down and go back to that start point. Now, unfortunately, our body is very good at protecting against weight loss, but not so good at protecting against weight gain. Right. Um, so that's the best way of thinking about your set point. And the second way of of sort of visualizing that is you might start a diet and you're at 100 kilos and you lose the 10, 20, whatever it is, and you go down to 80, but then you start clawing back to the 100. Well, you're going back to your set point. And when you're going back to your set point, remember this is not just going back to some of those old habits. Sure, some of those programs we follow are unrealistic, unsustainable because they tell us to cut out our favorite foods or entire food groups or get us to follow exercise programs that are not sustainable. But more importantly, even if you're following some of those, um, new habits and new lifestyle changes, the physiology is changing. So as you're climbing back, back to your 100 kilos in this case, um, back to your set point, your metabolism's slowing, you're burning less calories at rest. Your appetite hormones are changing, ghrelin levels are surging, telling you to go and reach for more food, and the the appetite hormones that typically tell you to terminate food consumption, like your GLP-1, your CCK, your leptin, well, they're being suppressed. So you continue to feel hungry even though you've just had a meal. Um, but other things are happening too. Your thyroid function's not working, um, as as good as it once was. And that's important because your thyroid gland is the gatekeeper to your metabolism. It produces a range of different hormones, T3 and T4, um, in particular. Those hormones are suppressed, which means your metabolic rate goes down, you burn less calories at rest. Again, meaning you regain more of that weight that you've lost. But your adrenal glands start pumping out more cortisol. Cortisol is not good because that promotes weight gain. Your brain starts changing its function. Now, those foods that you cut out, your favorite foods or entire food groups, well, your brain starts going, hang on, um, something's not right here. It starts to change, um, its function so that you go to seek those foods that are missing from your diet. So the emotional control, um, and and that sort of regulation of of appetite in terms of energy stores, well, it all goes out of whack. It's it's not working as as well as it once would. And all of those physiological responses, um, are sending you back to your start point or your set point. So when we're referring to our set point, it's the weight you're protecting, it's the weight you're going to bounce back to with dieting, but remember, you don't just go back to the start, you put on the plus GST, the plus 10%, the one kilo. And instead of putting on the 0.5 to 1 kilo every year, which is sort of a baseline or population weight gain, you might end up putting on the one to two kilos because of the intentional weight loss through dieting. Remember, intentional weight loss is actually driving up your set point over time.
Dr Rupy: Wow. And so the next obvious question would be, can I change my set point at all? Can I reduce it or can I, I mean, we've already talked about how it's, uh, essentially increasing, but can I reduce it if there's some other way in which I can manipulate my diet?
Dr Nick Fuller: Yes, so you can. Um, but it's not going to come from, um, these, I guess, drastic attempts at weight loss because we talked about how they're often very unsustainable, but often very unhealthy as well because many of those diets are getting us to cut out foods or entire food groups that are important for our health. So, whole grain carbs are often a common scapegoat for weight gain. Um, the next minute it's nuts and then it's it's dairy. Uh, and then we're talking about sugar and the whole I quit sugar. Anything or any time you're going to follow a weight loss program or diet program, lifestyle weight loss change, weight management program, it shouldn't be telling you to cut out foods. All foods play a role, but what we need to be doing is retraining our brain back to nature's treats. Now, remember, we always sought out foods that were naturally high in sugar, naturally high in fat. They gave us best bang for our buck. They were the ones that were going to fill us up, allow us to store the calories, um, until food was then available again. So in the modern day environment, we still seek out those foods, but unfortunately that, I guess, pleasure seeking is coming from the processed and packaged foods. Right. Now, those foods also are no good for things like our visceral fat. Okay? So not just our total body fat, but also our visceral fat. So they're, I guess, a a food group that we need to be able to include in our modern day diet, but not as an everyday occurrence, which is what they've become. Instead, they need to be a one to two times a week occurrence. So, I guess that important message there is a diet shouldn't be telling you to cut out foods or food groups. Now, we've been talking about low carb diets and and, you know, keto and and, you know, intermittent fasting is very popular at the moment. And these diets have sort of evolved since the 1970s. It sort of took really took hold with the Atkins revolution back at that time. And since then, what we've seen is pretty much the same diets coming out, but they're just a deviation of their predecessor. And one, when you look at the research and you conduct randomized control trials, unfortunately, they're not achieving any better results. Modern day diets compared to their predecessors. And that's the same with intermittent fasting and various forms of intermittent fasting that we're talking about. You do get weight loss followed by weight regain. And that's because of these physiological changes that we discussed taking place. Diets are not addressing the very reason why we put the weight back on. Because when you continue to lose weight, your body goes into shutdown, it climbs back to its start point. But the other worrying thing is, remember, a lot of those diets are getting you to cut out foods. Those foods are good for your health, so you're going to put your health at long-term risk and potentially increase your risk of things like cancer, type two diabetes and heart disease, um, because those foods are an important part of everyday health. Yeah, yeah. Um, so, I guess that's one part of the puzzle when it comes to diets. Um, unfortunately, the news is not good when you're talking about all these popular celebrity diets. It is weight loss followed by weight regain. You will always have someone tell you about their anecdotal story about how much weight they lost on the latest diet. But again, this is what the research shows. This is what, um, randomized control trials show, particularly over a 12-month period, um, where you put a person on a traditional diet, continuous calorie restriction versus say a keto diet or an intermittent fasting, they're all at the same point, same weight loss when you follow them up at 12 months. So, what's the answer, I guess, when it comes to lifestyle, um, intervention? Because this is important. It's first line therapy. Anyone needing to lose weight should be doing something about their lifestyle, but following evidence-based care. Uh, and we have also been working on how to shut off these physiological responses. Yeah. How to stop our biology coming into play. Um, and we've found that when you get a person to lose weight in small incremental doses every second month, you can get long-term weight loss and you can prevent that U or V-shaped response that we typically get. So visually, um, a diet will look like, you know, weight loss, very good weight loss, three to six months, you hit a plateau and then it starts to regain from three to six months. Yeah, typical U-shaped curve. And usually with a a longer end of the U. Exactly, exactly. Um, but with the, uh, intermittent weight loss, interval weight loss, you're losing weight, um, every second month. So it looks like a step down approach. So if you think about it visually, it's like a little, um, set of stairs where you go down for a couple of kilos, you maintain the weight loss the next month, down for a couple of kilos, maintain. And then, um, what you're doing with that approach is stopping the metabolism slowing down, stopping the appetite hormones getting out of control, the thyroid function being suppressed, etc. Gotcha. So over the course of 12 months, instead of seeing say 10 or 12 kilos of weight loss and then 10 or 12 kilos of weight gain, we're getting around 11 kilos of weight loss with continuous incremental weight loss over the course of a year.
Dr Rupy: So just to summarize that, so the evolutionary mechanisms that are designed to protect us during times of famine include this milieu of, um, uh, occurrences. So you've got, if I lose 5 kg, let's say, over the next 30 days, and I do it via intermittent fasting or go keto or very low calorie diet, whatever it is, um, my appetite hormones are messed up, so I become hungrier. Um, I, uh, my thyroid function will most notably go down, which will affect my basal metabolic rate. Um, my cortisol levels will probably go up, so, uh, compounding my stress as well, dumping sugar into my bloodstream, not great for weight, uh, uh, loss for sure. Um, and all these things sort of coalesce to change my weight set point, um, whereby if I have the same amount of food or I go back to how I was eating before, not only will I go back to the same weight, I'll go beyond that. And what you're suggesting is, if we do it in a calculated manner that switches off that fire alarm that goes off that's designed to protect us against excessive weight loss, we can avoid that collection of, uh, signals that occur to that are designed to protect us, uh, from from excessive weight loss. So we can, we can avoid the cortisol spikes, the appetite hormones being messed up and the thyroid function, um, uh, dysfunction.
Dr Nick Fuller: Yes, absolutely. And the other important part of the, I guess, puzzle when it comes to dieting and and lifestyle intervention is habits. It's one thing to prescribe a weight loss methodology, but then how do you actually go about losing that weight? Um, typically most people can lose the 0.5 or one, 0.5 kilo, one pound over the course of a week. So you can lose two kilos over the course of a month. That's pretty achievable for most people. The hardest thing is then having the breaks, saying take the foot off the accelerator, you're not allowed to lose. Everyone gets excited by the number on the scales going down, they want to continue. So for our patients, it's saying, hey, you've got to stop, otherwise you will get the same results you've always got. Weight loss followed by weight regain. But then what are we focusing on? Well, the key pillars of any lifestyle program should not just focus on diet. We talked about the importance of exercise. Exercise alone is not going to achieve much in terms of weight loss. We know that, the research has proven that, but it helps in terms of all of the other metabolic parameters, the visceral fat, the long-term weight maintenance and most importantly holding on to our muscle stores. Because when you lose weight, you want to be losing it predominantly from fat mass, fat stores and not muscle because muscle is the determining factor of how efficiently your engine or your metabolic rate is going to be revving along. So you can have two people sitting here, both 80 kilos, but if one has a higher muscle mass, they're going to be burning more calories at rest than the other person, they're going to have much better success rate in terms of keeping the weight off. But then the other key part of the lifestyle program or or pillar is sleep health. So any, I guess, lifestyle program or diet program should be focusing on all of the three pillars, diet, exercise and sleep. Um, and we talked about, you know, what sort of red flags there are when it comes to diet when they're telling you to cut out certain foods or food groups. Um, but we've also got it the wrong way around in terms of food orientation throughout the day. Now, unfortunately, with with diets like intermittent fasting, often they do say, well, we've got to shorten the window of when we eat. And sometimes or often breakfast is the first meal to be cut. But again, research has shown that that is the time when our body best uses the calories. Um, and it's more metabolically active at that time. So when you sit down to a meal, it's going to burn the calories from that meal two and a half times more efficiently than what it would in the evening time.
Dr Rupy: Oh, interesting.
Dr Nick Fuller: So you should actually be including breakfast, but not just having a small breakfast, making that as the biggest meal of the day, tapering off throughout the end of the day, so that the dinner is the smallest meal from a portion size perspective, but the most important from a social and cultural perspective.
Dr Rupy: That's so interesting because a lot of people will have been, uh, told relatively recently from people who are, uh, proponents of intermittent fasting that it's perfectly healthy to skip breakfast every day and just have two or one big meal throughout the rest of the day, as long as it's not like a massive three or 4,000 calorie binge, let's say. Um, but what you're saying is because we are more metabolically active at the start of the day, that's where we should be concentrating the bulk of our energy consumption.
Dr Nick Fuller: That's right. And the research has also shown that we're better able to appetite our appetite, um, feelings of of hunger throughout the rest of the day if we've included breakfast. And we're more likely to resist the urge for the the, um, the the high calorie sweet treats. So it should be a part of your your lifestyle program, diet program. Um, and remember you're not cutting out any foods. And I guess that sort of ties into what the macronutrient profile should look like. Yeah. Now, it needs to be balanced. Um, again, if you look at different macronutrient compositions, there's a fascinating publication that came out in New England Journal of Medicine, um, you know, not that long ago, a few years ago. And they basically put people on six different diets. The six different diets were just varying in macronutrient content. And sure, the low carb, high protein, um, diets achieved more weight loss at the start. Uh, but when you follow these participants up at 12 and 24 months, everyone was at the same weight loss. Everyone had had the same sort of weight loss followed by weight regain. And the long-term results show that no diet is more superior than the other in terms of macronutrient composition. But importantly, um, a lot of those foods we talked about that we are cutting out, like the whole grain carbs are high in fiber and they're important for long-term health. So your diet should actually consist of whole grain carbs, protein and good fats. And each meal should be nutritionally balanced. You don't need to overthink that macronutrient composition. I'm just talking about instead of sitting down to a plate of eggs alone at breakfast, you'd have eggs on whole grain toast with some avocado. So making sure that meal is balanced because, um, we don't need to fixate on a particular macronutrient as long as you're balancing it out over the course of the day. And the simplest way of doing that is just making sure that you have one of those macronutrients at each of those meals.
Dr Rupy: Yeah, yeah. I was, uh, I was researching recently for a podcast that we did, um, internally, um, about carbohydrates because they they get a bit of a bad rep. Um, you know, 50 to 60% of total energy intake appears to be from carbohydrates and we have an obesity issue. And the recommendation is to have around 50 to 60% of energy intake from carbohydrates, but from whole quality carbohydrates. Um, and when you dig a little bit deeper, you actually uncover that the majority of the carbohydrates that populations are consuming today are refined, ultra-processed carbohydrates. And only around 9% of that total 50% of total, uh, energy intake is from unrefined, unprocessed carbohydrates. So things like, you know, whole butternut squash or sweet potato or, you know, broccoli, whole grains, etc. So therein lies sort of the branding issue that I think carbohydrates have got. Um, and the benefits of carbohydrates or the, uh, disadvantages of excluding carbohydrates are pretty stark because they're feeding our microbes, they're protecting us through the phytonutrients that they contain, uh, they taste great, and they also, um, will allow us to enjoy a plethora of other things other than just, you know, pure, uh, protein and and fats from from animal sources. Um, one question I get asked quite commonly though is, okay, I get getting a mixture of all these different things. I get having a balanced plate. Are there particular protein targets that I should be aiming for? Um, and does that differ according to sexes and stage of life at all?
Dr Nick Fuller: I think, um, one key part of the messaging is often we're getting enough protein. Okay. We don't think we are, so what do we do? We go and buy the high protein version of the yogurt. We know yogurt's already high in protein. Yeah, yeah. Um, now, in terms of protein sources, um, again, I guess what the most important message there is it needs to be a mix. You don't need to sit down to a plate of meat every day. Think about how you can include other sources of protein, potentially plant-based sources of protein to mix up what you're having because they will also have very good outcomes in terms of your health. So beans and legumes, um, eggs, another great protein source. And then maybe meat, if you're including meat on one to two days a week rather than the everyday occurrence. So try a range of protein sources and try potentially different sources to what you've typically had. And the same goes with the whole grain carbs. Um, it's it's it's about mixing up what you have. These foods are packed full of nutrition and they will fill you up for a long period of time and as you alluded to as well, they're so good for our health. Um, but often they're the first thing to get cut from a diet, um, because why? When we cut carbs, we're dropping body water content. What happens when we drop body water content? Well, the number on the scales go down down. So everyone uses carbs as that scapegoat for our weight gain when all you're really doing at the start of a diet when you restrict carbs is reducing total body water content because glycogen, um, which is the storage form of carbs, binds a lot of water. It's very heavy. So the minute you take it out, the instant, I guess, success or gratification you get with the number on the scales going down. Um, so I guess the messaging with the the macros is mix up what you're doing, try different sources of protein and whole grain carb and try not to have the same thing all the time. Um, and then in terms of the aging population, well then, yes, our protein requirements do change. We don't absorb nutrients as good as we we start to age. So, um, there are considerations as you, I guess, go into that next stage of life, particularly over the age of 70, where you do need to focus on a little bit of extra protein. But again, it's not sitting down to just a plate of eggs. You've still got to make sure that each meal is balanced. But instead of having just your toast with with a spread on it, including a source of protein with that meal. That would be sufficient then to boost your protein requirements, um, which is particularly relevant as we become a little bit more frail, more prone to fractures, um, and and other, you know, I guess, diseases later in life.
Dr Rupy: Yeah, yeah. So overall, are you bullish on the the new class of drugs or?
Dr Nick Fuller: Well, they're a tool in the workshop. Okay. So, the most important thing is that people need to be following lifestyle intervention as first line therapy. Everyone will put up their hand and say, I've done that, I've tried that, but they haven't. They've been following fad diets for the better part of, you know, either the last few years or decades of their lifetime. They haven't seen healthcare professionals, they haven't been following evidence-based lifestyle interventions and consequently they've been failing. They also haven't understood why they've been failing because the dieting industry want us to make us think that we're failing due to a lack of willpower. Why? So we go back and sign up to their program again. Often we sign up to the same program over the course of the year. So people are signing up to five diets, but not always five different diets, often five of the same diet over and over and over again. They do the 12 week cycle, regain, 12 week cycle, regain. So, you know, I guess that's the most important thing. If a person's failed with evidence-based lifestyle intervention, then some of these other tools, um, are effective and and part of that that long-term weight loss or weight management.
Dr Rupy: Yeah, yeah, yeah. I think the the jury is out on these kind of medications long term to see whether they can be paired with lifestyle interventions as well in a more holistic sort of education. And I and I guess, um, I'd love your hot take on personalized nutrition as well because obviously personalized medicine is becoming a bigger thing with more targeted pharmaceuticals based on things like genomics, etc. Um, but personalized nutrition is becoming a big thing where people are measuring their unique responses to certain foods, whether that be through, uh, a continuous glucose monitor, uh, a gut microbiota test, um, what what are your thoughts on it? Do you think this could be a good thing?
Dr Nick Fuller: Yeah, look, there's definitely, um, a lot of research in this field. It's an evolving field, um, and I guess what what's the take-home message there? We definitely do respond, we all respond differently to to different diets and different diet approaches. Um, so, uh, I guess it's a very interesting and fascinating field and it definitely has application in the real world. But I guess when you're you're sort of mirroring it up with what we've been talking about and that physiology of weight loss and and why we're regaining weight, it's still got to tie in with that. Yeah. Remember, this is what we're up against. We're up against our body. It's going to shut down. It doesn't matter what approach and how you you personalize that approach, um, based on the data you're collecting, you're still going to be unfortunately in that situation where your body goes into shutdown mode. Everybody's, everyone's body does this. There's no one that's exempt from this rule. Unfortunately, we all evolved in the same way to sort of fight this starvation mode and you will see your body changing its response when you start to lose weight. Yeah. So that's a real key part of the education because if you can like empower a person with that education so that they understand why they've been failing, um, often you can sort of divert them away from, you know, the the nitty-gritty details because it is far simpler than that. Um, and it's about, you know, finding a way and finding things that you can stick to so that again you form those habits.
Dr Rupy: Yeah. These are great takeaways. Uh, you know, for the listener, if they don't know already, you shouldn't be losing weight too fast and stick to a holistic way of eating and you'll be all right. Is that a fair summary?
Dr Nick Fuller: It is. I mean, look, there's another interesting part there around fast weight loss versus slow weight loss. Yeah, yeah. Because again, you know, being across all of the literature and studying this day in, day out for the better part of now the last two decades at the one place, RPA, Sydney Uni, even if you lose the weight slow and continuous, you're going to regain it, right? But if you lose it fast, yes, you are going to regain it. Not necessarily faster than the slower approach. What we're saying is that the physiology is still coming into play. So regardless of whether you lose it slow versus fast, you're getting the U or V-shaped response. The biological protections are coming into play. But what we're saying is rethink what you're doing and instead of that continuous weight loss approach, lose it with an interval approach in small increments every second month. So you visualize that step down approach. So you switch off the physiology and you keep your body out of the whole race. Because you've got to, you've got to turn it off. You've got to get it working with you. You've got to redefine your set point at intervals along the way and you've got to think about the long term. And that long term is, you know, maybe not just a year, it could be two, five years, 10 years down the track. What is it you're working towards? Are you a father, a mother? Do you want to be a healthy role model for them? Well, focus on things like that. Don't focus on the number on the scales. You have to take the focus away from that and focus on a much more, um, I guess, holistic, bigger goal, particularly focused around health. If you do that, you're more likely to stick to your goals, you're more likely to form the habits and you're more likely to reach out in years down the track and say, hey, guess what? It worked and I'm still kept the weight off and I'm metabolically healthy.
Dr Rupy: Brilliant. I love it. Thank you so much. I think that's going to be super useful for people, honestly. And uh, you know, that emotional piece, that emotional connection to the why, I think is um something that a lot of fad diets completely gloss over and it's so, so important. So I really appreciate you uh taking the time whilst I'm in Oz to to tell us all about it.
Dr Nick Fuller: Oh, it's always a pleasure. Always, man. Great to be back on and great to see you again. So thank you very much.
Dr Rupy: Yeah, well, I'm enjoying the sunshine, so. Yeah, I know, it's gorgeous.
