How about starting with an explanation about who you are, where you’ve been, and what you’re up to?
JAMES:
Thanks for the opportunity, Steve!
Well currently I’m wearing quite a few hats and doing a lot of different things. I have a full-time day job as a healthcare analyst where I crunch numbers and look at how modifiable health risk factors such as obesity affect healthcare costs. Before that, my full-time gig was as the head researcher for a corporate weight management program. We treated mainly Microsoft employees (in fact, we were right across the street from the Microsoft campus), and our average weight loss was 40 pounds in 3 months. It was a highly successful program (and still is). I had a number of responsibilities there, including constantly reading research and investigating ways to make the program better. I also provided monthly scientific literature reviews to the doctors and dietitians. They did some downsizing because of the economic downturn which is why I’m not there anymore, but it was a great gig for 5 years.
My night/weekend job is running my business and website, Weightology. There is a subscription-only section called Weightology Weekly where I critically review research in the field of obesity and weight management. It is similar to what Alan Aragon does with his research review, although my topics are focused almost solely on weight and fat loss, while he covers a broader range of fitness topics. I also have a free blog on Weightology but haven’t updated it in a while simply because I’m spread pretty thin, but I do have some blog post ideas that I want to eventually write. I also work with clients, giving them online nutritional and exercise counseling.
Another side gig is that I teach people how to be weight loss coaches. Berry Fowler, the founder of Sylvan Learning Centers, is a former client of mine and he started a business to teach people how to be life coaches. He wanted a supplementary weight loss coaching course, which he asked me to design and teach, so I do that now. I used to do it 1-2 times per month, but now am doing it quarterly and am developing a self-directed version of the course.
I also day-trade part-time, and even have a trading blog at welcometothegutter.com. I got married a couple years ago and we’re currently house hunting. And of course I need to try to spend some time with our families when I can, and sneak some kiteboarding in here and there. So I’m pretty busy.
I was the editor for Journal of Pure Power (formerly Pure Power Magazine), and did that for 10 years. I had to step down though because I was getting burnt out and spread too thin. Dan Wagman, the former science editor for Muscle and Fitness and a champion and record-holding powerlifter, is the publisher and he’s a very science-oriented guy like me. The main focus of JOPP is, like my research review or Alan’s research review, to take a critical look at research and how you can apply it. JOPP mainly revolves around research related to strength and power sports. It's a great publication and I am proud to have been a part of it for 10 years.
As far as my background, I have a master’s degree in exercise science from Washington State University and a second master’s degree in nutrition from University of Florida. I also have some research publications in journals, including the Journal of Applied Physiology and American Journal of Clinical Nutrition.
STEVE:
That’s quite the resume. It’s always a pleasure to speak with driven people who are passionate about improving and progressing their respective areas of expertise. I’d also like to say that I do subscribe to your research review and it’s excellent. For those looking for the most up-to-date research pertaining to obesity and weight management written in plain English, it’s a must have.
On that note, let’s dive right into the meat of things…
I have a feeling you’re going to hate this question. I do have questions for you that deal with very specific nuances, but I’d like to start with a pretty general one. Obviously the issue of overweight and obesity is extremely complex. Once you factor in the physiological, psychological, and cultural aspects of the problem, fixing it can seem like a daunting task. This is compounded by the fact that no one case is the same.
What’s your general approach to guiding an overweight or obese individual to successful and permanent weight loss?
JAMES:
I always start with getting as complete of a history and background on a client as I can. That helps me learn about what the client has tried in the past, and what they have succeeded with or what has not been very successful with them.
From there I’ll then determine what is the most appropriate course of action for the client. For many clients, I like to use a system similar to what we used when I was a researcher for the corporate weight management program. In general I start with a high protein, moderate carb, low to moderate fat approach. I mainly start with lean meats and vegetables, and then gradually reintroduce foods back in. As foods are added back in, I monitor the client, how he/she is feeling, and how different foods affect them in terms of satiety and mood. Eventually I end up with a highly customized approach that is unique for that client.
STEVE:
Essentially you strip the diet down to nothing but the basics or the essentials. From there, it’s a matter of figuring out what else the client can add on top of the foundation while still managing weight. Is that correct? Do you simply give them a list of foods and a meal plan or do you have them monitor calorie intake as well?
JAMES:
Yeah, that’s pretty much it. I do both with them…develop a meal plan but also have them monitor calorie intake. It’s important to develop awareness of what you are eating.
STEVE:
Do you use the traditional means of calculating maintenance or total daily energy expenditure by estimating basal metabolic rate using an equation (Harris-Benedict, Katch-McArdle, Mifflin-St. Jeor, or whatever) and then multiply that by an activity factor? Or do you use another method and if so which?
Secondly, the stock standard recommendation you’ll commonly see pertaining to how large a calorie deficit should be is 20-35% off of maintenance. It seems that obese folks can get away with larger deficits though. Generally speaking, they won’t experience significant muscle loss and metabolic slowdown like their leaner counterparts might. I believe that I’ve also seen research indicating that obese folks might have better long term success when they initiate the weight loss process with a significant calorie deficit and thus a high rate of weekly weight loss… a means of “jump starting” the process and empowering them.
What are your thoughts when it comes to initial calorie targets for obese folks?
JAMES:
I usually don’t use any equations as they can be way off sometimes for an individual. I usually like to take a person’s regular baseline diet, get an idea of whether they’ve been weight stable or not on that calorie intake, and then make changes from there. If I were to use an equation, Mifflin-St Jeor is probably the best for estimating RMR, and multiplying by an activity factor. Or you can use the National Academy of Sciences equations for estimating total daily energy expenditure.
I tend to favor the lower targets for obese individuals, as long as its sustainable and the individual can adhere to the plan. You are correct that obese individuals tend to have better long-term success when they have larger initial calorie deficits and weight loss. In the clinic I used to work, some of our individuals lost 8-10 pounds in the first few weeks. Of course much of that is water weight, but it can be psychologically motivating to the person with the caveat that they understand that some of it is water weight.
STEVE:
Speaking of large deficits and rates of weight loss, what’s your personal opinion of the Biggest Loser show and its impact on our culture?
JAMES:
There are good things and bad things about the Biggest Loser. The good thing is that it shows you can lose large amounts of weight with discipline, determiation, and hard work, no matter how heavy you are. Unfortunately there are too many bad things that come along with it, including the unrealistic weight loss achieved by the contestants. Many people begin to think that if they aren’t losing 8-10 pounds every week, they are somehow not succeeding. They fail to realize that these people are subject to extreme conditions and are confined to essentially a boot camp for many, many days. That’s also not to mention some of the stories of contestants engaging in extreme practices to get their weight down, such as dehydration. The show also puts out misinformation. In fact, I used to write a blog for the obesity treatment program I used to work for, and I “fact-checked” some of the information that was being delivered on the Biggest Loser.
Weight loss is about lifestyle change, and unfortunately the methods used by the Biggest Loser contestants cannot be classified as sustainable lifestyle changes.
STEVE:
Extremism sells about as well as sex in our culture, that’s for sure. I’m torn about the show’s impact being more helpful or harmful for the public. Motivation and the instillation of belief are huge. But setting false expectations and pushing questionable “facts” while having such a large and attentive audience is dubious at best. Plus, I follow Bob (the trainer on BL) on facebook and that guy puts out some of the most ridiculous information I’ve seen.
Not to mention that very few of the contestants actually maintain their weight loss. Speaking of which, let’s discuss set point. What exactly is the set point theory and what does it mean for long term weight control?
I recently read the following passage in the blog of a well known obesity researcher and I was hoping you could share your opinion about this line of reasoning:
As regular readers are well aware, one of the major dilemmas in obesity management is the fact that virtually any attempt at weight loss is counteracted by complex mechanisms that aim to restore the body back to initial weight. So far, no one has discovered a way to reverse or ‘reset’ this mechanism so that, once weight is lost, the body ‘relaxes’ and ‘accepts’ that new, lower body weight again. This is why, no matter what program, diet, exercise, medication or surgery you chose for weight loss, when you stop the program, diet, exercise, medication, or reverse the surgery, your weight comes back – there are almost no exceptions to this rule.
JAMES:
Set point theory, in laymen’s terms, refers to the idea that your weight has a “set point” that it likes to be at, and when you try to change your weight from that point, your body produces signals to get you back to that point. There’s debate about the existence of the set point and exactly how it works in the body. I am of the opinion that, while there is scientific support for the set point, the “rigidity” of that set point will vary from one person to the next. Also, there is data that suggests that humans have much more efficient signals for returning to a set point when they lose weight as compared to gain weight. This is why weight gain tends to be favored over time.
The set point has implications for long term weight control because, when someone loses weight, their body will produce signals to try to gain that weight back, even if they’ve kept the weight off for a year or more. This is why long term weight loss requires work, diligence, and long term lifestyle change. Someone who used to be obese will never be like someone who’s never had a weight problem; they will always have to work harder to keep the weight off than someone who has never had a weight issue. This is a reality that some people don’t like to hear, but unfortunately it is true.
That passage that you quoted is true for the most part. I always like to use the phrase, “If you do what you’ve always done, you’ll get what you’ve always gotten.” Long-term weight loss requires permanent lifestyle change. You cannot expect to revert to old habits and keep your weight off. In the weight clinic I used to work in, our CEO used to tell people that losing weight and keeping it off would be a part-time job for the rest of their lives. We didn’t sugar coat anything. People don’t like that message that it’s going to take hard work not only to lose the weight but to keep it off, but it’s the reality of the situation. That’s not to say that people can’t be successful. People certainly can and have been successful, but you have to be willing to be in it for the long haul.
STEVE:
So set point is sort of like a gravitational pull towards your initial weight. From the sounds of it, it’s quick to rise as you gain weight but, in most cases, it’s slow to adjust back down when you lose. I’ve always thought of set point as a garbage term that helps explain the myriad adaptations that happen across numerous levels of our biology in response to an energy shortage (changes in leptin, insulin, ghrelin, thyroid, various neurochemicals, etc.)
One of the interesting adaptations is the reduction in what’s referred to as NEAT, which stands for non-exercise activity thermogenesis. You’ve written great articles that explain what NEAT is and the role that it plays in the maintenance of weight loss.
Can you give our readers a quick overview of what it is and the role it can play in making permanent weight loss more difficult than it already is? Also, can you share any “tricks of the trade” that you like to use with your clients for offsetting the adaptations associated with the reduction in NEAT?
JAMES:
NEAT refers to all of your daily movement and activity, other than formal exercise. Everything from fidgeting to moving your mouth while you talk to walking down the hall can be classifed as NEAT. NEAT plays a powerful and underappreciated role in weight management. Research shows that as people lose weight, their NEAT levels go down without them even being aware of it. This reduces energy expenditure, which makes it easier to regain weight.
I really work hard to promote awareness of NEAT among my clients. I’m a big fan of devices such as pedometers or accelerometers, as they can give you an objective look at how much you’re really moving around over a 24 hour period.
There are so many simple ways to increase NEAT. For example, my day job involves sitting in a cubicle all day. I make sure I get up just for 5 minutes every hour and walk around the perimeter of my building. After an 8 hour day, I’ve accumulated about 30 minutes of NEAT that I wouldn’t have otherwise.
STEVE:
I’ve seen you recommend the use of pedometers previously… I think it’s a great idea.
You hear things like “genetics load the gun of obesity, but lifestyle pulls the trigger.” This implies that some people’s genetic profiles are such that it’ll be much simpler for them pack on the pounds. To what extent, in your opinion, does this account for the obesity epidemic? Is our world getting fatter because of crappy genetics? Or does it have more to do with cultural evolution – where meals containing a day’s allotment of calories can be found at most every major crossroad, computers and electronics rule, and people lack ownership for their choices?
JAMES:
The human gene pool has changed very little over time, and it is impossible to argue that genetics are playing a role in the rapid spread of obesity. Certainly, some people are more susceptible to obesity than others due to genetics, but there is no evidence that this gene pool is spreading. The overall driving force is the culture and environment, which has changed dramatically over the past 100 years.
There is, however, evidence of fetal programming that can occur that will increase a child’s risk of obesity before it is even born. The environment in the uterus can actually impact a fetus’s risk of obesity into childhood and adulthood. This is not due to genes passed on from the mother; instead it is due to the environment in the uterus affecting gene expression. Thus, the diet and behavior of an expectant mother can play a role in her child’s risk of becoming obese. Thus, what can look like a genetic problem is really still an environmental/behavioral problem in disguise.
STEVE:
Interesting. Can you point our readers to any literature or publications pertaining the fetal programming that you speak of?
Let’s switch gears with one last question before wrapping things up. I want to venture to the opposite end of the spectrum. We’ve been talking about obesity throughout this discussion – now I want to now zero in on relatively lean people who are trying to get leaner.
Without fail folks tend to struggle with the last 5-10 lbs it seems. Obviously the leaner we get the harder it’s going to be. Evolutionarily speaking, it wasn’t beneficial to be ridiculously lean back in caveman times. Lean people died from starvation. It’s only natural that the body is going to resist the last 5 lbs more than it does the first.
In an attempt to “trick” the body, you’ll see many dieters cycling carbohydrates and/or calories. They believe that they can fool the body into thinking it’s fed. Is there merit to this approach or is gaining the fat back the only way to reverse the adaptations?
JAMES:
Here’s a couple relevant papers on fetal programming:
http://www.ncbi.nlm.nih.gov/pubmed/18525008
http://www.ncbi.nlm.nih.gov/pubmed/18032473
I’ve never seen any scientific evidence that those “tricks” actually work. Of course, I don’t think anyone has ever adequately tested it scientifically, either. However, there is one study out there (can’t remember the reference off hand) where they had two groups. One group had a consistent, daily calorie deficit, and the other group alternated between deficit days and non-deficit days to try to “trick” the metabolism from not slowing down. The trick didn’t work. This is the only study I know of that’s directly looked at the efficacy of some of these oft-used tricks. Personally I think it’s pretty tough to trick your body through purely dietary means.
STEVE:
I lied. I do have one more question.
It’s easy to scoff at an obese person… to judge them based on their weight. I’ve even seen fitness authorities imply that obese folks are slowly committing suicide by choice. In a sense, I can see their point. At the end of the day, people choose how much they move and eat and obesity doesn’t exist without a significant imbalance between calories spent and calories consumed.
It’s not so simple in my mind though. You have genetics that make it much harder for some people. You have things like fetal programming, as you noted above. You have parents who simply don’t care… who pretty much program their children to become obese. It doesn’t help that our culture is such that there’s very little incentive to invest in being active and eating healthily.
As it stands, if we’re relying simply on education, behavior modification and willpower, the success of permanent weight loss across large portions of our population doesn’t seem probable to me.
With an ever-growing rate of obesity among younger populations, do you believe the tide will ever change? If so, how? Do we have to wait for pharmacology to provide a solution for broad based success?
JAMES:
What you said is right on. The solution is not simple because the problem is so complicated, and there are so many factors working against you. I completely agree with you that achieving success across large portions of the population is likely impossible. I know this sounds grim, but I don’t think the tide will ever change, because there are so many things that are engrained in our culture that contribute to the problem. And unfortunately it is unlikely that our culture will change. I don’t think pharmacology will ever find a solution, either, because there are so many different things controlling appetite and energy expenditure. If you develop a drug that targets one thing, a bunch of other things end up taking up the slack and negate any effect the drug might have. That’s also not to mention that drugs are not free of side effects, and adherence to drug therapy tends to be poor. Even bariatric surgery is not always an answer, because there are many people who have had the surgery and still gain their weight back. For example, the Roux-en-Y bypass surgery makes your stomach about the size of your thumb, but there are people who will eat enough to restretch the stomach out, or they will drink their calories (like in sodas or milkshakes) and completely defeat the purpose of the surgery in the first place.
The bottom line is that success is up to the individual and if that person can sustain a permanent lifestyle change. Long term weight maintenance requires constant diligence, which can be challenging. However, it is not impossible, because we know there are people who are successful.
The truth comes in pills that are too large for some people to swallow.
STEVE:
James, I can’t thank you enough for taking this time out of your busy schedule. Maybe in a year or so we can circle back around and take a more focused approach to an interview… that way we can dive into one particular nuance of weight loss or nutrition in extensive detail.
Until then though, good luck with your future endeavors and keep up the good work. To my readers, if you’ve not checked out Weightology Weekly, it’s definitely something to consider.
Any final thoughts?
JAMES:
I want to thank you for the opportunity to share my thoughts with your readers. I really appreciate it. For anyone out there struggling with their weight, remember that you can do it, but it will take hard work and diligence to achieve success over the long run. There are no shortcuts.
