Speaker 1: One of the first things I noticed when I walk
Speaker 1: into Pennington Biomedical Research Center is a giant stained glass window.
Speaker 1: It's filled with images of healthy living cast in rainbow colors.
Speaker 1: You see there are two wheels here, and there is
Speaker 1: a cyclist on on the top, and then there is
Speaker 1: all kinds of fruits and vegetable. I mean, it's it's
Speaker 1: quite a nice piece of art. The stained glass window
Speaker 1: towers above a Pennington entryway. Brightly colored shards of glass
Speaker 1: depict asparagus, bananas, peace, and a pineapple. The outline of
Speaker 1: a runner cuts through the background, painted in shades of
Speaker 1: orange and purple. And then there's a DNA DNA on
Speaker 1: the right. There are blue and pink fish at the bottom,
Speaker 1: canteloupe on the side. The longer I stare, the more
Speaker 1: bowls of healthy living reveal themselves. But it's all about
Speaker 1: what we do. I mean, you know health, genetics and biology,
Speaker 1: and you have you have all the elements of nutrition,
Speaker 1: you have the exercise, you have the d n A.
Speaker 1: The whole thing makes the place feel like a temple
Speaker 1: to nutrition, because it kind of is. Pennington is a
Speaker 1: sprawling research center working to study obesity. Our tour guide
Speaker 1: today is Eric Ravasan, a prominent scientist in the space
Speaker 1: who is Associate executive director for Clinical Science at Pennington.
Speaker 1: He's the one talking me through all of the stuff
Speaker 1: in this very large stained glass window. Stained glass is
Speaker 1: obviously more a feature of churches, but the religious symbolism
Speaker 1: is sort of fitting. Really, this is a place that
Speaker 1: treats weight loss as a sort of gospel. Pennington has
Speaker 1: two acres of campus, including labs and research facilities, around
Speaker 1: two hundred scientists and state of the art equipment, much
Speaker 1: of it dedicated to unlocking the secrets to shedding pounds.
Speaker 1: It's in Baton Rouge, Louisiana, and it feels like a
Speaker 1: college campus minus the students. I've been on a journey
Speaker 1: to get to the bottom of the science of weight loss,
Speaker 1: and as our stained glass windows shows, weight loss is
Speaker 1: something we all have lots of ideas about. Some of
Speaker 1: those ideas are actually true, but they're all too often
Speaker 1: not the whole truth. If anyone could help us sort
Speaker 1: one from the other, I figured it would be the
Speaker 1: people here. First, though, We're going to take a look around.
Speaker 1: That's part of the way you test. Participants are like,
Speaker 1: we're walking up to the fourth floor. Yeah, we got.
Speaker 1: Our first stop is to check out some fairly innoxious
Speaker 1: looking medical machinery. It's big and gray and looks almost
Speaker 1: like a bed. And is this the machine beginning now?
Speaker 1: It started already. Radiation is on right now because you
Speaker 1: can see the lagser on saying in a radiation is
Speaker 1: that this equipment can actually tell you how much of
Speaker 1: your body is fat, and how much of it is muscle,
Speaker 1: and how much is bone. I want to call it
Speaker 1: a nightmare machine. It's the scan no one wants to
Speaker 1: see of themselves. But what this equipment really measures is
Speaker 1: body composition. And the total of this person here is
Speaker 1: thirty points six of the body is fat. We often
Speaker 1: talk about the number on the scale like it's the
Speaker 1: only thing that matters, but this is a good reminder
Speaker 1: that wheat isn't every thing. That's why weight loss researchers
Speaker 1: use tools like these body composition machines. And a big
Speaker 1: finding they've had is that people vary a lot. People's
Speaker 1: bodies are different, really really different, and that's actually at
Speaker 1: the root of a lot of the findings they've made
Speaker 1: here at Pennington. But first, back to the tour, We
Speaker 1: check out a big area known as a metabolic kitchen,
Speaker 1: where calorically precise foods are prepared for studies, and we
Speaker 1: walk by spaces that look like hospital rooms. They're also
Speaker 1: used for research. Eventually we get to the craziest stop
Speaker 1: on the tour. We step into a hall that looks
Speaker 1: into small furnished rooms to seek a curtain and the
Speaker 1: bed and you have everything could be happy, and there's Stevie.
Speaker 1: They look like really sad studio apartments. Even though there's furniture,
Speaker 1: the rooms are sterile looking. There aren't exactly many homey touches.
Speaker 1: That's because they're actually rooms where scientific research happens. They're
Speaker 1: called metabolic chambers, and they measure metabolism. Like the name suggests,
Speaker 1: these sad little rooms are designed to measure how many
Speaker 1: calories the person inside is burning. People stay in them
Speaker 1: for a good chunk of time, thus all the furniture.
Speaker 1: Eric also points out that they have windows. We fast
Speaker 1: the food and uh and you know through here outside
Speaker 1: of the metabolic chambers, in the hallway where we're standing,
Speaker 1: a bunch of pipes and scientific instruments line the walls.
Speaker 1: It kind of looks like a boiler room or something.
Speaker 1: This equipment track everything going on in the little rooms.
Speaker 1: Cool right, Maybe a little creepy too. Eric tells me
Speaker 1: that there are only about thirty metabolic chambers in the
Speaker 1: world thirty, and Pennington is home to four of them.
Speaker 1: When we arrive, there's actually a woman in one of
Speaker 1: the rooms already. She's sitting on the bed. It looks
Speaker 1: like she's scrolling on her phone. Maybe in a little
Speaker 1: while she'll go use the adjoining toilet. Watching the stranger
Speaker 1: live her life in a little box while equipment measures
Speaker 1: what's going on inside her body is pretty weird, Even
Speaker 1: if it is for science. The whole thing feels a
Speaker 1: bit dystopian. It makes me think of like a lab
Speaker 1: rate in a maze or something. Now she probably can't
Speaker 1: see this, but a computer screen right behind Eric and
Speaker 1: I actually shows how many calories she's burning on a
Speaker 1: minute by minute basis. A chart shows us how that
Speaker 1: rate is changing over time. Eric tells me that while
Speaker 1: the woman slept, she burned just under a calorie a minute.
Speaker 1: Then I would say she got up here. He's saying
Speaker 1: that because we can see on the screen that at
Speaker 1: this point her metabolism jumps. People tend to burn more
Speaker 1: calories as they become more active. She went to brush
Speaker 1: your teeth, you know, metabolious me here goes to three
Speaker 1: calories a minute. Then you can see and at the
Speaker 1: end of the day we summarize how many calories she
Speaker 1: has doing. The real work of the metabolic chamber is
Speaker 1: happening silently in the air, because the chamber is actually
Speaker 1: tracking how much oxygen the woman in the room is
Speaker 1: taking in and how much carbon dioxide she's breathing out.
Speaker 1: I Well, both oxygen and carbon dioxide are involved in
Speaker 1: the process of converting food into usable energy. A little
Speaker 1: math and toda, you have calories burned. This is all
Speaker 1: part of metabolism, something we usually think about only in
Speaker 1: terms of how fast we gain or lose weight, and
Speaker 1: that's definitely part of it, but metabolism is also what
Speaker 1: keeps us alive and kicking, something that we should celebrate
Speaker 1: not blame. You know how people are always talking about
Speaker 1: calories in calories out. A metabolic chamber is a very
Speaker 1: precise way of calculating the calories out. Part. Technology like
Speaker 1: this is really important at places like Pennington where researchers
Speaker 1: are digging into the secrets of weight loss. And by
Speaker 1: the way, some of what they've learned, is that calories in,
Speaker 1: calories out is not the whole story, not by a
Speaker 1: long shot. I asked Eric what to make of the
Speaker 1: numbers the metabolic chamber is spitting out? Would another person
Speaker 1: burn three calories a minute doing the same things as
Speaker 1: the woman in the room just now? Like? Did I
Speaker 1: burn that much getting ready this morning? That seems like
Speaker 1: really interesting and even important data to have about yourself.
Speaker 1: If any given way, sex page, and body composition, you
Speaker 1: have large variability in between people. Metabolism differs a lot
Speaker 1: by person. In other words, Eric couldn't really say if
Speaker 1: I or another person would burn as many calories a
Speaker 1: minute as the woman in the room. But he tells
Speaker 1: me about some research he did way back in the eighties.
Speaker 1: We measured people like in the chambers, re measured them
Speaker 1: five years later and looked at the relationship between the
Speaker 1: metabolism and the weight gain. They gain a lot of weight,
Speaker 1: and we found that a low metabolity create is a
Speaker 1: risk factor for weight game, otherwise known as I have
Speaker 1: a slow metabolism. People love to say I'm gaining weight
Speaker 1: just because I have a slow metabolism. But when we
Speaker 1: say that, do we really know it for sure. No, no,
Speaker 1: that you have to measure it. You have to get
Speaker 1: into one of the sad little rooms. Metabolism isn't a
Speaker 1: straight line. It can change over your lifetime, including as
Speaker 1: you age and when you lose weight. Researchers have learned
Speaker 1: more about that in recent years, and it may help
Speaker 1: explain why dieters overwhelmingly regain weight over time. We'll get
Speaker 1: more into this later. We walk by another suite of
Speaker 1: rooms with a tread mill and stationary bike. Researchers use
Speaker 1: these to push people to their exercise limits. It's kind
Speaker 1: of like a stress test done by a cardiologist, except
Speaker 1: even more intense. Nearby, a person is actually getting biopsies
Speaker 1: taken of her fat and muscle. I watched the lab
Speaker 1: tech sitting at her microscope work on a sample. There
Speaker 1: are actual fat and muscle cells in front of her.
Speaker 1: Is there anything you can't measure here? When it comes
Speaker 1: to UM two, obesti, diabetes and cardiovascular disease. I think
Speaker 1: we have it all. One of my co league used
Speaker 1: to say, it's like toys are us for a kid? Uh,
Speaker 1: you know, it's toys are us for a scientist? So yeah,
Speaker 1: you're probably realizing by now that this is a place
Speaker 1: with incredible resources fort etting weight loss. And the thing
Speaker 1: about weight loss is that we all kind of think
Speaker 1: we know the basics. Losing weight is about eating fewer
Speaker 1: calories than you burn calories in calories out right. In
Speaker 1: this episode, I'm going to get to the bottom of
Speaker 1: what we actually know the science of weight loss. How
Speaker 1: it's actually a lot more complicated than that simple formula.
Speaker 1: And we're going to try to figure out why, why
Speaker 1: it's so complicated, and why despite that the simple formula
Speaker 1: of calories in calories out keeps getting repeated anyway, not
Speaker 1: just by your neighbor or uncle, but by doctors and scientists.
Speaker 1: To do that, we'll start this mecca of weight loss,
Speaker 1: but we'll go beyond its walls too. I'm Bloomberg News
Speaker 1: health reporter Emma Court and from the Prognosis podcast. This
Speaker 1: is Losing It. Imagine that you're at the doctor's office
Speaker 1: and they tell you to step onto the scale, which
Speaker 1: they invariably do visit after visit. That number is measuring
Speaker 1: not just your bone, muscle, and fat, but also possibly
Speaker 1: your lunch from earlier, your shirt and pants, maybe some
Speaker 1: p You can't talk about weight loss without first, making
Speaker 1: sense of weight itself. And what doctors and scientists are
Speaker 1: concerned about is not your clothing or undigested chopped salad,
Speaker 1: or even your bone and muscle. They're worried about fat,
Speaker 1: and specifically a person having too much. So how does
Speaker 1: a person get more body fat? That comes back to calories,
Speaker 1: which we went deep on in our first episode. Remember,
Speaker 1: calories aren't just align on a nutrition label. They are
Speaker 1: source of energy for your body. Calories are the gas
Speaker 1: in your cars fuel tank. Every day we're taking from
Speaker 1: that tank because we gotta um, we gotta move. This
Speaker 1: is Leanne Redman. She's an expert in physiology or how
Speaker 1: human bodies function, and she works for Pennington. We've got
Speaker 1: a digest food we think we just function to every day,
Speaker 1: we've got energy going out of the tank. So every
Speaker 1: day we have to replenish the energy going into the
Speaker 1: tank to keep your weight the same. Ideally, you'd be
Speaker 1: eating around the same number of calories that you burn.
Speaker 1: Lean says, there's a little wiggle room here of about
Speaker 1: a few hundred calories a day. But eat too many
Speaker 1: calories for too long and that energy has to go somewhere.
Speaker 1: It gets stored in the adipose tissue in the body fat,
Speaker 1: and then we gain weight gain atiposity of a time,
Speaker 1: and that eventually leads to obesity. In other words, fat
Speaker 1: is another store of energy. We've demonized it the same
Speaker 1: way we've demonized metabolism, but it actually serves this and
Speaker 1: other really important functions. Still, extra fat can put a
Speaker 1: lot of stress on your body. That's why doctors and
Speaker 1: scientists worry about people having too much fat. A quick
Speaker 1: note about language here. We will be talking a lot
Speaker 1: about weight in this episode, in particular because of the
Speaker 1: stigma and bias about this subject. There are different schools
Speaker 1: of thought about how to talk about it. The fat
Speaker 1: Acceptance movement embraces the term fat. Some doctors and scientists
Speaker 1: favor saying person with obesity. I will talk about it
Speaker 1: as much as possible the way people do themselves. I
Speaker 1: have tried to avoid the terms overweight and obese, though
Speaker 1: I have had to use them at times for clarity's sake,
Speaker 1: times like now. Obesity is usually defined as when a
Speaker 1: person's body mass index is over thirty. As a refresher
Speaker 1: b M I equals weight divided by height squared. The
Speaker 1: number is supposed to be a proxy for body fat.
Speaker 1: But as the formula I just rattled off makes clear,
Speaker 1: b M I doesn't actually rely on your body's measured
Speaker 1: fat composition, just weight and height, and b M I
Speaker 1: is what's overwhelmingly used to talk about weight, like when
Speaker 1: rates of obesity in the US began increasing in the eighties.
Speaker 1: Around this time, government stats show that nearly six of
Speaker 1: American adults were considered too heavy increase from an earlier period.
Speaker 1: That judgment was made using b M I, and it
Speaker 1: keeps being made using b M I, and it tells
Speaker 1: us that Americans keep getting heavier. Today, nearly three quarters
Speaker 1: of adults are considered by the government to have higher
Speaker 1: than normal weights. So again, calories matter because extra calories
Speaker 1: can turn into fat. It's that saying that you've heard
Speaker 1: so many times before, calories in calories out. This is
Speaker 1: also something we've known for a long time. When you
Speaker 1: eat just enough food to supply the energy you need,
Speaker 1: your white stays the same. But when you eat more
Speaker 1: than you burn up an energy, the rest is starred
Speaker 1: as fact. So is it really just that simple calories
Speaker 1: in calories out. The answer is yes, sort of ish,
Speaker 1: not exactly. Calories in calories out is true, but it's
Speaker 1: also not true. If you're lost right now, that's okay.
Speaker 1: I promise it will all make sense by the end
Speaker 1: of the episode. Remember, we came here to Pennington for
Speaker 1: a reason. We wanted to sort out when it comes
Speaker 1: to wait, what's fact, what's fiction, and what's still a mystery?
Speaker 1: So how do we know that calories in calories out works?
Speaker 1: When you walked through this thing that looked like a
Speaker 1: medical ward to get to the metabolic chambers. This is
Speaker 1: Owen Carmichael. He runs the Biomedical Imaging Center at Pennington.
Speaker 1: So basically some of the fancy machines we've been looking at,
Speaker 1: we've actually had studies where people live there and they
Speaker 1: sleep in the hospital like beds. They're living in a
Speaker 1: what looks like a hospital where they're interacting with a
Speaker 1: lot of nurses and um that they do not have
Speaker 1: a refrigerator that they have free access to. They cannot
Speaker 1: order up snacks. They're in a controlled environment. They're being
Speaker 1: given calorically precise meals. The sprawling Pennington Gym is nearby.
Speaker 1: For some people, this might sound like the ideal conditions
Speaker 1: to diet, the v I P diet life, and that's
Speaker 1: exactly what the scientists intended for other people. Of course,
Speaker 1: this might sound more like torture, but anyway, Pennington researchers
Speaker 1: have found that they really, honest to goodness, lose weight,
Speaker 1: and they lose fat, not muscle, So it's good weight loss.
Speaker 1: People lose weight, at least they do when they spend
Speaker 1: that whole time at Pennington. But you can't do that
Speaker 1: for a really long time. Study participants have lives to
Speaker 1: get back to, and it's exactly when they do that
Speaker 1: step outside the boundaries of Pennington out into the real world,
Speaker 1: that the trouble begins. I think it's very difficult to
Speaker 1: really wrap your head around how seven this thing we
Speaker 1: call the obesogenic environment is that scientists speak for the
Speaker 1: kinds of unhealthy environments that surround us every day. The
Speaker 1: Danish cart on the corner by your office, not having
Speaker 1: a grocery store in your neighborhood, living somewhere with lots
Speaker 1: of cars but no sidewalks. If you're lucky enough to
Speaker 1: have enough to eat, the world can sometimes seem like
Speaker 1: it's shoving a plate of fries down your throat. Seven.
Speaker 1: And while you have some limited ability to decline, that
Speaker 1: metaphorical plate of fries. Not everything is under your control.
Speaker 1: We've all experienced this. I even saw it when I
Speaker 1: was visiting Pennington for this episode. Here I was speaking
Speaker 1: with scientists all day long, talking about the importance of
Speaker 1: healthy eating and portion control and cooking food at home.
Speaker 1: And meanwhile, I'm staying in a hotel and eating literally
Speaker 1: all of my meals out. And did I mention that
Speaker 1: Pennington is based in Louisiana A fantastic lace into like
Speaker 1: a little peopood. This is a place essentially a full boy.
Speaker 1: I like my overflowing with brad shrimp. That thing is
Speaker 1: as big as you. Everywhere I went, I kept ordering
Speaker 1: food without realizing that it was all deep fried. I
Speaker 1: was at lunch one day with a bariatric surgeon who
Speaker 1: works at Pennington, and the waiter rattled off a long
Speaker 1: list of very fried recommendations. Again, my dining companion here
Speaker 1: does weight loss surgery for a living. It was kind
Speaker 1: of surreal. When we finished up, they actually brought us
Speaker 1: a plate of cotton candy, which we had not ordered
Speaker 1: for free. And it's not just the environment around us
Speaker 1: that's making things difficult. It can be us too. Here's
Speaker 1: leanne again, So it is definitely ultimately about this imbalancing calories.
Speaker 1: But it's very, very complicated, right because there are so
Speaker 1: many factors that determine what we eat when we you know,
Speaker 1: where we're craving something, whether we're full, whether we're hungry
Speaker 1: or not. And then on the other side, when you
Speaker 1: reduce people's calories, they're like, oh, I'm eating less, so
Speaker 1: I'm gonna like, I can, you know, move less? Right,
Speaker 1: So they start conserving calories and maybe not as physically active.
Speaker 1: The same is true when people are exercising more, they
Speaker 1: need more calories, and when people start eating less, our
Speaker 1: bodies respond to that. Remember that calories aren't some inconvenient
Speaker 1: aspect of oreos their energy. When you have less energy
Speaker 1: coming in, your metabolism slows down. That actually makes sense
Speaker 1: if you think about it. Your body is now smaller,
Speaker 1: so running it moving it around that takes less energy,
Speaker 1: kind of like how smaller cars can be more fuel efficient.
Speaker 1: But studies of contestants on the TV show The Biggest
Speaker 1: Loser have found that metabolism can drop even more than
Speaker 1: you would expect. Pennington researchers were actually involved in those studies,
Speaker 1: including Eric Ravesson, who took us on the tour earlier,
Speaker 1: but we we measured all the people from this season eleven.
Speaker 1: He was quite a riot to go to the ranch
Speaker 1: outside in California. There's a name for this phenomenon of
Speaker 1: metabolism slowing more than expected after weight loss. It's called
Speaker 1: metabolic adaptation. Scientists have also found that after weight loss,
Speaker 1: hormones that regulate hunger and weight can get disrupted for
Speaker 1: long periods of time. These hormonal disruptions and metabolic adaptation
Speaker 1: could help explain why so many people regain weight after dieting.
Speaker 1: In other words, a person goes on a diet, they
Speaker 1: regain the weight later, and people assume it's the dieter's fault. Right,
Speaker 1: It seems pretty logical. After all, they say, oh, she
Speaker 1: stopped eating as many salads, or that he stopped going
Speaker 1: to the gym as much, and maybe they say even
Speaker 1: more unkind things than that. But here's the thing. Scientific
Speaker 1: research tells us that there may actually be a biological
Speaker 1: reason for those things happening. That a dieter could be
Speaker 1: getting really hungry because of hormonal disruptions, that their body
Speaker 1: might actually be burning way fewer calories after weight loss.
Speaker 1: When I first learned about this, It kind of blew
Speaker 1: my mind because there seems to be a scientific explanation
Speaker 1: for why so many dieters regain weight over time. Your
Speaker 1: body is actively fighting back, and that actually makes sense
Speaker 1: if you think about evolution, because bodies need energy to live.
Speaker 1: An energy used to be a lot harder to come by,
Speaker 1: so at the end of the day, it does come
Speaker 1: down to the energy imbalance, the intake, and the expenditure.
Speaker 1: You have to be out of balance in order to
Speaker 1: change weight. But it's all of these other physiological signals
Speaker 1: that are driving the intake and the expenditure that we
Speaker 1: need to understand better in order to be able to
Speaker 1: achieve weight loss for everyone. We're simplifying the science here,
Speaker 1: but needless to say, these are complicated things to study,
Speaker 1: and it helps to have a dedicated research facility like
Speaker 1: Pennington with all its bells and whistles focused on it.
Speaker 1: Remember how earlier I said that Pennington feels like a
Speaker 1: college campus. It's actually officially part of Louisiana State University,
Speaker 1: which is also in Baton Rouge a few miles away.
Speaker 1: Back in the nineteen eighties, the head of l s
Speaker 1: U got the billionaire oilman Claude Bernard Pennington to commit
Speaker 1: hundred and twenty five million dollars to start a nutrition
Speaker 1: research center. Over the decades since, the center has been
Speaker 1: involved in some of the most cordant research done about
Speaker 1: weight and weight related conditions at the Pennington Biomedical Research
Speaker 1: Center Biomedical Research Center. Researchers from the Pennington Biomedical Research
Speaker 1: Center in Louisiana found Pennington Biomedical Pennington Biomedical Research Center
Speaker 1: Pennington Biomedical Research Center in Baton Rouge, So to summarize, studies,
Speaker 1: including ones done at Pennington, have shown that when people
Speaker 1: eat less, they lose weight. Calories matter pretty self explanatory,
Speaker 1: but as we just talked about, calories also aren't the
Speaker 1: full story. There's this big gulf between what happens in
Speaker 1: research studies at places like Pennington with its gadgets and gizmos,
Speaker 1: and the real world. And scientists are also still learning
Speaker 1: more about how your body seems to fend off long
Speaker 1: term weight loss. So what is all this add up to.
Speaker 1: It means that weight loss is more complicated than advertised,
Speaker 1: a lot more complicated. It also means that losing weight
Speaker 1: isn't fully in a person's control, even though that's how
Speaker 1: we tend to talk about it. Reasons like this are
Speaker 1: why scientists and doctors have started to call obesity a
Speaker 1: disease the same way that diabetes and cancer are diseases.
Speaker 1: And if obesity is a disease, dieting takes on even
Speaker 1: more importance. It's not just a way to lose weight,
Speaker 1: but also a form of medical treatment. And if diets
Speaker 1: are medicine, surely we know what the best diet is
Speaker 1: for a person. Right the Great diet debate, low carb
Speaker 1: or low fat, high fat diets actually may be superior
Speaker 1: to low fat diet. In the low carbohydrate groups, they
Speaker 1: lost about two and a half to five pounds more
Speaker 1: than those in the low fat diet crew. Carbohydrates are
Speaker 1: the single most important thing you can eat for health
Speaker 1: and weight loss. And you're thinking, right now, Dr Hyman,
Speaker 1: have you gotten nuts? Practically each decade has had a
Speaker 1: new dietary villain. First fat was bad, and then carbs
Speaker 1: were bad. Now I think maybe they're both still bad,
Speaker 1: but so is sugar too. Right where did we land
Speaker 1: on all that? I'll answer that in a minute. First though,
Speaker 1: back to Pennington. As I spoke with scientists at the Center,
Speaker 1: I kept feeling like I was going in circles. They
Speaker 1: would tell me how complicated weight loss turns out to be.
Speaker 1: Now there's so much variability between people, and not just
Speaker 1: with burning calories, but in terms of how easily people
Speaker 1: lose or gain weight. Now there's still so much scientists
Speaker 1: are learning. And then I would ask them, well, what
Speaker 1: should people do if they want lose weight? And they
Speaker 1: would say, diet, eat fewer calories. And so I'm going
Speaker 1: to get the person to write down everything that they
Speaker 1: eat and drink for the next five days, and we're
Speaker 1: going to look at where the excess calories are coming from,
Speaker 1: and we're going to start there. I told Leanne how
Speaker 1: confused I was by this. How can it be more
Speaker 1: complicated than calories in calories out? But also that calories
Speaker 1: in calories out is the answer. And then leon tells
Speaker 1: me something that just might haunt me forever. Remember our
Speaker 1: metabolic chamber from earlier, the sad little rooms. She and
Speaker 1: her colleagues at Pennington did a study where they put
Speaker 1: people in there, and the scientists actually over fed these
Speaker 1: people on purpose. They gave them more calories than needed.
Speaker 1: They were trying to make them gain weight, and this
Speaker 1: is what they learned. Some people will burn majority of
Speaker 1: the excess calories that they've eaten, and they're the people
Speaker 1: that will retaine their weight. Some people will burn, will
Speaker 1: burn those extras, some people will burn none. And Leanne
Speaker 1: says they've also found that the opposite is true. When
Speaker 1: you give people less to eat, some people lose weight
Speaker 1: immediately and others just don't. In other words, it's calories in,
Speaker 1: calories out, but only for some people. So what I'm
Speaker 1: taking away from all this is, if you are a
Speaker 1: person who wants to lose weight, we don't have great
Speaker 1: information for you dieting calories in, calories out best. We
Speaker 1: have another way of putting all this is other people
Speaker 1: get to eat as many honey buns from the vending
Speaker 1: machine as they want and just burn it all off.
Speaker 1: But you don't. By the way, there are other options
Speaker 1: for weight loss besides diet, like medication and surgery, but
Speaker 1: they're used a lot less. I was struck by what
Speaker 1: Leanne said. Though, for all the new fingled machinery and
Speaker 1: fancy gadgets we toured earlier, the answer is that we
Speaker 1: still don't have an answer. Even though dieting doesn't work
Speaker 1: in a long term way for many people, dieting is
Speaker 1: still the best we've got, and yet the dogma is
Speaker 1: still why don't you just diet? No uncertainty, no caveats,
Speaker 1: none of the nuance we uncovered here at Pennington. I
Speaker 1: asked Leanne about the uncertainty about the lack of sufficient
Speaker 1: answers a couple of times, until finally she said this.
Speaker 1: You know, we've spent billions of dollars trying to understand
Speaker 1: obesity and white management and how it a fixed people
Speaker 1: and how we can help people, and it just seems
Speaker 1: like it's all going to a black hole because you know,
Speaker 1: even with that huge investment, we have no answers. You
Speaker 1: just heard Leanne Redman, an expert in physiology at Pennington,
Speaker 1: saying that despite all the money that's been invested in
Speaker 1: weight loss, not to mention all the fancy equipment and
Speaker 1: scientists who have spent their careers working on the subject,
Speaker 1: we have no answers. We have no answers. In fact,
Speaker 1: that's exactly why we keep coming back to diets. They're
Speaker 1: not the answer, but they are the closest we've gotten
Speaker 1: to an answer. Then again, there are a lot of
Speaker 1: diets out there. The South Beach diet low fat whole thirty,
Speaker 1: So so many diets, which ones actually work the best?
Speaker 1: I put the question to Christopher Gardner, a nutrition scientist
Speaker 1: at Stanford. This is a super depressing answer that nothing
Speaker 1: works because we haven't resolved the obesity epidemic. I know,
Speaker 1: this is getting really frustrating, right. One of the things
Speaker 1: that we do know is that there isn't one diet
Speaker 1: for everyone. So people who claim that it's my diet
Speaker 1: or it's the Paleo or the Kido or the something else,
Speaker 1: I just it's not true. Let's say I invented a diet,
Speaker 1: it's named after me, obviously, and I go around telling everyone, look,
Speaker 1: this is the diet that's going to finally make you
Speaker 1: lose weight. Basically, what I'm saying is I tried Emma's
Speaker 1: diet and it was awesome, and everybody should try Emma's diet.
Speaker 1: And what I do as a scientist is I get
Speaker 1: a hundred people and I signed fifty two Emma's diet
Speaker 1: and fifty to the other diet. And I have to
Speaker 1: see that, yeah, way more people on diet A work
Speaker 1: than DIETETE and you really doesn't happen. And so what
Speaker 1: we found is that there isn't one diet for everyone.
Speaker 1: The big problem is keeping it up. I don't eat
Speaker 1: carbs until I'm craving them so much that I give in.
Speaker 1: I don't eat out until it starts crushing my social life.
Speaker 1: All diets have at least this in common. What's the
Speaker 1: best diet to be on? It's the one you can maintain.
Speaker 1: In other words, if you can keep up a low
Speaker 1: carb diet, power to you, same for a low fat diet.
Speaker 1: But how do you know at the outset which one
Speaker 1: is going to work for you. That's where lots of
Speaker 1: scientists across this field are now channeling their efforts. The
Speaker 1: consensus now is that diets should be individually matched a
Speaker 1: person based on different factors about them, kind of like dating.
Speaker 1: My diet biography might say I'm a court journalist, sits
Speaker 1: at a desk all day, works out a few days
Speaker 1: a week, loves her kale salads, sweet tooth. But there's
Speaker 1: still a lot missing from that description, things that I
Speaker 1: couldn't tell you, and even Pennington scientists can't use right
Speaker 1: now to match me to a diet, Like what's going
Speaker 1: on in my gut microbiome that's the collection of bacteria
Speaker 1: involved in digestion and metabolism. What about my genetics? Those
Speaker 1: are factors that could help you match a person better
Speaker 1: to specific diet or what's known as precision health. But
Speaker 1: it's very hard to find the genetics or the metabolism
Speaker 1: so far that would point you to one diet or another.
Speaker 1: We're not there yet, not by a long shot. Scientists
Speaker 1: are trying to figure it out though. In fact, the
Speaker 1: National Institutes of Health is just starting to fund a
Speaker 1: study about this. So again, low fat diets aren't the
Speaker 1: best diet it for everyone. Neither is low carb diets
Speaker 1: may have to be tailored to the individual. All the
Speaker 1: research on dieting and weight loss over the years has
Speaker 1: brought scientists to this conclusion. I know, I know. But
Speaker 1: the thing is, for all we don't know about weight loss,
Speaker 1: there are some things we do know. We actually know
Speaker 1: a fair amount about the people who lose weight and
Speaker 1: keep it off, what they do, and what it takes.
Speaker 1: There was a sense of it's pretty hopeless, uh and nobody,
Speaker 1: nobody really succeeds in weight management. If you're a based
Speaker 1: you're just out of luck because you know there's not
Speaker 1: much you can do about it. People try to diet
Speaker 1: but it doesn't work. That was James Hill, who is
Speaker 1: Chair of Nutrition Sciences at the University of Alabama at Birmingham.
Speaker 1: He's talking about how in the late nineteen eighties rates
Speaker 1: of obesity began rising very suddenly. Remember we talked about
Speaker 1: this earlier, how those rates had been stable beforehand, but
Speaker 1: they've risen and risen until today. And again, as all
Speaker 1: this is happening, people are feeling pretty hopeless about losing weight.
Speaker 1: So James and his colleague Rena Wayne, who is a
Speaker 1: professor at Brown University's Medical School, decided to start tracking
Speaker 1: successful dieters. They created the National Weight Control Registry, which
Speaker 1: people can join if they have lost at least thirty
Speaker 1: pounds and kept it off for at least a year.
Speaker 1: There are more than ten thousand members today. James says
Speaker 1: that the Registry was supposed to answer a key question,
Speaker 1: what does it take to lose weight long term? And
Speaker 1: the Registry has actually provided some answers, as evidenced by
Speaker 1: thirty scientific papers James and his colleague have written about it.
Speaker 1: That's right, we know what it takes to lose weight
Speaker 1: long term. You just have to diet and exercise and
Speaker 1: prioritize it every single day and worked really hard forever.
Speaker 1: So one of the things I always tell people that
Speaker 1: we've learned from the National Wake Control registreet it takes
Speaker 1: a lot of conscious effort for these people to stay successful.
Speaker 1: So it's not the case that they lost weight and
Speaker 1: then they went back to living your lives and didn't
Speaker 1: think about it. You might remember from our last episode
Speaker 1: that this is a diet myth the South Beach Diet
Speaker 1: helped spread in the two thousands. They prioritize their weight
Speaker 1: very very highly. Of all the people who diet, and
Speaker 1: there are many, very few of them actually end up
Speaker 1: joining the Red Distry. We'll talk about that more in
Speaker 1: a bit. First, though, here's what we know about people
Speaker 1: in the National Weight Control Registry. Most of them eat
Speaker 1: a relatively low fat diet, but some people do the
Speaker 1: low carb thing too. Again, the specific diet doesn't seem
Speaker 1: to matter that these folks. Diet seems to matter more
Speaker 1: than what kind of diet. Most of them spend probably
Speaker 1: more time than the average person thinking about their diet
Speaker 1: during the dash, thinking about what they eat, keeping track.
Speaker 1: A lot of them keep diet diaries, so they pay
Speaker 1: attention to the food they eat. National Weight Control Registry
Speaker 1: members weigh themselves every day. They track what they eat
Speaker 1: and how much physical activity they get. They're also all
Speaker 1: exercising about an hour a day. Jane Fonda and eighties
Speaker 1: exercise icon wanted everyone to feel the burdens, not just
Speaker 1: National Weight Control Registry participants. If you're thinking that an
Speaker 1: hour a day is a lot of exercise, you're right.
Speaker 1: The US government recommends a few hours of exercise a week,
Speaker 1: and most adults aren't even doing that. I spoke with
Speaker 1: five members of the National Weight Control Registry for this
Speaker 1: episode and heard similar things for starters. Nearly all of
Speaker 1: them exercise intensely most days, and a lot have adopted
Speaker 1: some pretty extreme habits to keep their weight off over time.
Speaker 1: One guy I spoke with, his name is Marcos Goodman,
Speaker 1: told me that he had lost sixty five pounds eight
Speaker 1: years ago. To keep it off, he eats the same
Speaker 1: five or six meals every day so he doesn't have
Speaker 1: attract different foods, like for breakfast, oatmeal with flax seed
Speaker 1: and sesame seeds, a banana and some non fat milk,
Speaker 1: a stew for lunch made of either sardines or chicken,
Speaker 1: and then an evening meal of soybeans. Another woman I
Speaker 1: spoke to, Susan Pierced Thompson, lost sixty pounds eighteen years
Speaker 1: ago and then since then maintained her weight by cutting
Speaker 1: out flour and sugar completely. Susan ended up starting her
Speaker 1: own weight loss program based on those ideas. But the
Speaker 1: thing that struck me the most was the mental and
Speaker 1: emotional energy all these people spent on simply maintaining the
Speaker 1: weight that they had lost. It just became this big
Speaker 1: part of their lives. For some of them, their lives
Speaker 1: even sort of seemed to revolve around this one thing.
Speaker 1: No one ever says, this is going to be really painful.
Speaker 1: You better get ready because you are going to suffer.
Speaker 1: No one ever says that, and I did suffer tremendously.
Speaker 1: This is Desha Gill, a fifty six year old stay
Speaker 1: at home mom who lives in Dallas, Texas. She's talking
Speaker 1: about the process of losing weight what it was like
Speaker 1: for her. I don't know if you've ever tried to
Speaker 1: sleep when you're really really hungry, not just wanting to eat,
Speaker 1: but truly feeling like you're starved. That's how I had
Speaker 1: to feel every night. Disia says she has struggled her
Speaker 1: weight since she was eleven years old. She told me
Speaker 1: that she started off binging on candy bars at summer camp.
Speaker 1: I was always very interested in health and longevity, and
Speaker 1: I wanted to be active and athletic, and but who
Speaker 1: I felt like and what I looked like could not
Speaker 1: have been anymore opposite. And I found it humiliating and
Speaker 1: embarrassing to look at myself and for people to see
Speaker 1: how I would. I was repulsed and so ashamed all
Speaker 1: the time, all the time. Desha says she has probably
Speaker 1: read hundreds of weight lost books. She has tried weight watchers,
Speaker 1: Jenny Craig over eaters anonymous, she got a lap band,
Speaker 1: a surgical procedure that constricts the stomach. She even tried hypnosis,
Speaker 1: none of it worked. She also says she experienced health
Speaker 1: issues that seemed related to her weight, like fatty liver disease,
Speaker 1: and asthma. Desha knew she needed to make a major change.
Speaker 1: She begins shifting how she eats and ends up losing
Speaker 1: a hundred and ten pounds, But she's also raising suns,
Speaker 1: which means lots of tempting foods in the house. I
Speaker 1: did research and found these food safe that have timers
Speaker 1: on them, and so I bought some food safe so
Speaker 1: that I could put the food that I had trouble
Speaker 1: controlling myself with those food staves, so that my son
Speaker 1: and this could get them, or if I wanted to
Speaker 1: treat at some point, I could time it so that
Speaker 1: I couldn't get into the food safe until I said
Speaker 1: that I could. Disha still uses those food saves. They're
Speaker 1: made of plastic and have a dial at the top.
Speaker 1: She sets them to unlock over periods of hours or days,
Speaker 1: so she can't eat, say, candy or chocolate whenever she wants.
Speaker 1: She also keeps a fridge near her bedroom in case
Speaker 1: she gets the urge to eat late at night. There
Speaker 1: are protein bars in there, as well as apples and
Speaker 1: bottles of water. It keeps me from going downstairs and
Speaker 1: eating four thousand calories because I can't sleep and I'm
Speaker 1: upset about something that happened that day. Disha also spends
Speaker 1: about five days a week exercising for ninety minutes. She
Speaker 1: has a special playlist of upbeat music that she listens
Speaker 1: to when she exercises, and only when she exercises, like
Speaker 1: Let's say she gets a craving to listen to those
Speaker 1: songs at another time. It happens a lot, in fact,
Speaker 1: but Disha doesn't do it. She won't let herself. So
Speaker 1: anything I can do to spice it up and make
Speaker 1: it different. And because it is easy to stop feeling motivated,
Speaker 1: especially when you're basically at your goal, but I do
Speaker 1: find new ways to constantly motivate myself and make it fun.
Speaker 1: It has to be fun. The measures that successful dieters take,
Speaker 1: other words, can take over their lives. This is the
Speaker 1: part that's usually missed about the National Weight Control Registry. Sure,
Speaker 1: these people have all lost large amounts of weight and
Speaker 1: kept it off for many years, but what it has
Speaker 1: taken to get them there is totally unreasonable. It just
Speaker 1: doesn't seem possible for most people or even worth it.
Speaker 1: And you always find a few people who are able
Speaker 1: to lose a lot of weight. This is Glenn Geeser,
Speaker 1: a professor at Arizona State University who's criticized the National
Speaker 1: Weight Control Registry. Most people are unwilling to do what
Speaker 1: it takes to get the weight loss that they would like,
Speaker 1: things like lock your favorite snacks in a safe so
Speaker 1: there's a huge gap between what people would like to
Speaker 1: weigh and what is feasible. Glenn has actually done some
Speaker 1: math to figure out how many dieters make it to
Speaker 1: the National Weight Control Registry. In other words, lots of
Speaker 1: people diet, how many lose at least thirty pounds and
Speaker 1: keep it off for a year or more. About a
Speaker 1: hundred and twenty five million Americans try to lose weight
Speaker 1: each year, So the ten thousand people that are in
Speaker 1: the National Weight Control Registry represent about one out of
Speaker 1: every twelve thousand five US adults trying to lose weight.
Speaker 1: As in, for every person in it, there are probably
Speaker 1: twelve thousand, four hundred and people who didn't lose that
Speaker 1: kind of weight or didn't keep the weight loss off.
Speaker 1: That means registry participants aren't even the one percent, they
Speaker 1: are the point zero zero eight. But the point is
Speaker 1: is that the people who are in the National Weight
Speaker 1: Control Registry are just a very very small drop in
Speaker 1: in a big, big bucket of people. James Hill, the
Speaker 1: registry is co founder who we talked to earlier, actually
Speaker 1: sort of agrees with some of the criticism. This is
Speaker 1: not for the faint of heart. If you're going to succeed,
Speaker 1: You're going to have to put time and effort into
Speaker 1: it for the foreseeable future. This idea, you know, it's
Speaker 1: short of the American ideas go out and go on
Speaker 1: a diet and then everything will be fine. Right, It
Speaker 1: doesn't happen. Most people who lose weight regain it. The
Speaker 1: hardest part, James says, is keeping it off. He has
Speaker 1: responded to some of these critiques by starting a whole
Speaker 1: new project. It's called the International Weight Control Registry, and
Speaker 1: it launched last year. This new registry is tracking a
Speaker 1: much wider group of people, including those who have not
Speaker 1: been able to lose weight. The team is also trying
Speaker 1: to reach a more diverse group of members. The National
Speaker 1: Week Control Registry's typical member is four. You're fifty years
Speaker 1: old and generally a white woman. I kept thinking about
Speaker 1: how much people in the registry who have kept weight
Speaker 1: loss off have had to diet and exercise. For some
Speaker 1: of them, it became so all encompassing that they turned
Speaker 1: it into a profession. They became dietitians or personal trainers,
Speaker 1: and it seemed like it was worth it for them.
Speaker 1: Many of the things they did probably did help make
Speaker 1: them healthier, and they probably started thinking of themselves differently too,
Speaker 1: as someone really fit with a lot of willpower and determination.
Speaker 1: Like Dasha, I basically did something that I have been
Speaker 1: able to do according to science, according to everything that
Speaker 1: I've ever read, And in a way, Desha and the
Speaker 1: others have new lives now, but that number on the
Speaker 1: scale still rules their time, their energy, their interests, and
Speaker 1: their identities. They're afraid of what will happen if they
Speaker 1: stop dieting and exercising, because they might gain the weight back.
Speaker 1: Even though they've gotten what they wanted, they still live
Speaker 1: with a lot of fear. So maybe you're wondering why
Speaker 1: diet anyway, The backlash against dieting is very much at
Speaker 1: our doorstep. So I really don't like the word diet.
Speaker 1: That word, to me is just so negative and it's just,
Speaker 1: you know, the thoughts that come with that word are
Speaker 1: like deprivations, starving and just not getting to have anything good.
Speaker 1: And in our next episode will look at how diet
Speaker 1: has become sort of a four letter word but hasn't
Speaker 1: really gone away a some of the people in the
Speaker 1: biggest rush away from dieting, they actually run weight loss companies.
Speaker 1: It's different it's something that I can actually live with.
Speaker 1: It's I wouldn't even call it a diet losing. It
Speaker 1: is written and reported by me Ema Court and edited
Speaker 1: by Kristin B. Brown. Magnus Hendrickson is our senior producer,
Speaker 1: Stacy Wong our associate producer, and Blake Maples is our
Speaker 1: audio engineer. Our theme was composed and performed by Hannis Brown.
Speaker 1: Thanks to Francesco Leavie and Tim Annette. Be sure to
Speaker 1: subscribe to Prognosis if you haven't already, and if you
Speaker 1: like our show, please leave us a review that helps
Speaker 1: others find out about it. Thanks for listening, See you
Speaker 1: next time. Two