483: Obesity Epidemic: Changing The Conversation About Obesity & How To Get Your Weight Under Control with Dr. Spencer Nadolsky

Podcast Transcription: Obesity Epidemic: Changing The Conversation About Obesity & How To Get Your Weight Under Control with Dr. Spencer Nadolsky  

Ted Ryce: Spencer Nadolsky, thank you so much for coming back on the show, man. It’s been about a year, I think. And the battle rages on online, doesn’t it? The battle against misinformation, so thanks for coming back on and helping to fight it.

Spencer Nadolsky: Of course, anytime. I’m always here to fight the misinformation epidemic here.

Ted Ryce: The epidemic of misinformation about nutrition. I just want to start off and ask you like, what’s been going on? What types of changes have you seen, say, after or during, rather, the pandemic? What are people struggling with? And I don’t mean vaccination and that type of thing, that could be for another day or another podcast, but with health, with nutrition, what do you see people struggling with out there right now?

Spencer Nadolsky: Yeah, I mean, in the beginning of the pandemic, it was a lot of stress eating and people having to stay back and isolate, they weren’t sure what was going on. So as predicted, many people gained, you know, 10/20 pounds to where…I mean, it was obvious, if you stress eating because you’re stressed out, you’re anxious and then you’re not getting out and going places and getting your steps in, you’re getting your non-exercise activity, people gain weight.

Now it seems like people are—whether or not they’re vaccine or not—they’re getting out there and realizing that they need to go back to their habits that they were pre-pandemic. So that means walking a lot, getting out there and cutting back on the snacking, although that can be tough after getting used to that for a little bit. So, the most thing I see is this kind of stress eating that’s been going on.

Ted Ryce: Yeah, I think the way to kick this off, right? I just did a presentation the other night for an Instagram influencer, Coach Sonia—really love her. By the way, if you’re on the IG, Coach Sonia, I can’t say her last name. But if you search up, Coach Sonia, you’ll find her. And a lot of people—they were mostly women, and a lot of them had a lot of guilt about their weight.

And not just their weight, but their struggle to get this right. And a lot of them are successful. I see this in my clientele as well. There are people who are successful in this crazy modern world of: “Hey, let’s get an education. Let’s get a job. Let’s perform well at that job. Let’s either make our company money or make the company that we’re working with some money,” but health falls by the wayside.

And a lot of them even doubt how good they are, how much of a high-performer they are when they struggle with this. And I think a conversation about how we’re living in this obesogenic environment, might help people put it in perspective. It’s our responsibility to change our behavior and to recognize the situation, but I think also saying, “Hey, this is not all my fault,” might be helpful.

How do you explain the obesogenic environment and the challenges that people face when living in the world that we live in, in the west and in America and Canada, UK? How do you explain it to people?

Spencer Nadolsky: Yeah, I usually say that obesity is not a choice. And people are like, “Whoa, whoa, wait a second, but you choose what you eat. You choose how you live and all that type of thing.” Yeah, true. We do make choices during the day, but we have this kind of passive of—there’s this passiveness, we just kind of go through life in whatever environment we’re in and follow the path of what’s in front of us.

So, when we’re young, we don’t necessarily choose the foods we eat, our parents get it for us. And then yeah, we do become adults, but at some point, it’s like you don’t really think about this slow, insidious weight gain that occurs over life and then obesity occurs and then maybe you make a decision.

Now you do make choices to then fight against it. The problem is that…I’m not going to say it’s futile or futile fighting against it because obviously people can be successful but it’s actually difficult, their bodies and environments fight against us.

So once you’ve gained the weight, and then try to fight back, you know, people talk about the metabolic adaptations or metabolic rate goes down, that’s not as big of a deal as the appetite differences and also being surrounded by foods that are just hard to say no to.

So, like, okay, so you’re 300 pounds, let’s say or 250 pounds and you lose 25 to 50 pounds, which is actually really good. If you’re 250 pounds, you lose 25 pounds, that’s 10% of your weight, we’d call that a medical success as long as you keep it off for at least a year. Let’s say you get 50 pounds off, then you’re looking at 20% of your weight. That’s where you start seeing really big changes in your appetite compared to before, your appetite is trying to drive you to eat a little bit more.

So yes, to combat that, you’re supposed to be eating mostly whole non-processed, or minimally processed foods, I should say, lots of vegetables, lean meat, whole grains, like lentils and/or oats, lentils, tubers, and that type of thing, satiating whole foods.

The problem is you’re going to work and it’s donut day at work, you come home to a family, your kids want their Goldfish and the crackers, and the wife or spouse or whoever it is, if you’re a woman listening, partner, husband, whatever, whoever you’re living with, your friends, family, all these things start— they may not be on the same plan as you or that same wavelength.

So, all these people start offering you certain foods, it’s tough. You can do it, you can make the choice to fight back, but there are many drivers against you.

So, our genetics didn’t all of a sudden change; our environment’s the thing that changed. So, the famous saying—it’s one of these obesity researchers, very famous guy in academia, not in the social media world, but George Bray, “Genetics loads the gun, environment pulls the trigger.”

So, there are people that have had these genetics that have had a propensity to gain weight. But in the past, it was just small, you didn’t even really see it much. You have a couple of kids in class that maybe had obesity, but now we’re seeing much more of it. And it’s simply because that threshold or that level has just been pushed up a little bit everywhere by the environment.

So, again, I say obesity is not a choice, in the context that we all kind of go through life passively not really thinking about it, just kind of doing our normal daily routines how we normally would. We have to actually make the conscious decision to kind of fight back because we’re all on this path to have a few extra pounds, then we probably should.

Ted Ryce: Right. So, people have this guilt around their weight and their struggles with weight, but they don’t realize that…You know, it’s kind of interesting, because I’ve made the connection, or the metaphor rather of brushing your teeth every morning, right? It’s something we all do. It’s something we do along with taking a shower, we learned that from our parents.

And it’s a habit, we don’t think about it, we need to do it. And there’s social consequences to bad breath or smelly underarms that are immediate. But our parents, in most cases, I know you probably have your kids training and lifting weights and doing all types of cool stuff and you’re feeding them in a certain way. I know your wife’s a doctor and she’s into health as well.

Spencer Nadolsky: Trying.

Ted Ryce: Trying.

Spencer Nadolsky: Although they like their Goldfish—they like their Goldfish, cookies and stuff. Trying, just trying to give them the best shot possible. Trying.

Ted Ryce: Right. And even then, it’s a struggle with both of you being doctors, both of you being in health and fitness, taking care of yourselves. And even then, it’s a struggle because of the environment. So, I think you also point out something really important, the narrative, if you go online—and you do a lot of this…

By the way, if you’re listening right now and you’re not following Dr. Spencer Nadolsky on Instagram, and/or Twitter, you’ve got to follow him, I’ll have the link to that. But he’s one of the best people to follow online.

You add a nice dose of humour, which I think is refreshing; something I try to do more of because it can get really serious this talk about health and getting in better shape. You do a nice job of adding a dose of humour, which takes the stress off. So, you’ve got to follow him, he’s one of the people to follow, follow online to push out some of the other more extreme people.

So back to the point here, the narrative online with a lot of influencers, let’s say, it’s your hormones. So, you’ve got to do the hormone reset diet. It’s your metabolism is slow. You’ve got to reboot your metabolism. There’s all this talk. It’s all focused on physiology, and it sells too. I’ve studied Marketing. I know how it works. I’m sure you have to.

People don’t want to hear about, “Oh, man, you mean I have to have a tough conversation with my husband or wife who brings home these foods that they can moderate with, but me, I just end up with the…” Nobody wants to hear, that they want to hear it’s their slow metabolism.

They don’t want to hear the conversation that: “Hey, listen, maybe if you’re in a soul-sucking job and you’re medicating with food to make you feel better, maybe you need to work on getting out of that job, finding another place where there isn’t a toxic boss, or getting out of your business and into a business that you’re really passionate about. That’s a much harder sell, than just reboot your metabolism, rebalance your hormones. What do you have to say about some of the influencers because I know you talk about it a lot?

Spencer Nadolsky: I post about it probably once every week or every other week. My messages are like same thing pretty much non-stop. But yeah, those types of things drive me nuts. I took many marketing courses and classes, whatever. And I understand that you have to have some sort of special pitch, otherwise you don’t get people’s attention. What I’m finding now is that my niche is the people that are sick of getting duped over and over again. I’ll never be as viral as—until I make some funny memes.

Some of my funny memes go viral, but these people that explode in terms of making money, they have a very, very poor long term business plan for it, and also garnering respect from good professionals out there.

But these people drive me nuts because they’re essentially lying to their customers in order to make a quick buck. You see it, you see they’ll write the same kind of book over and over again, with a slightly different pitch. That is something that no obesity researcher will ever say, no obesity physician—well, some maybe, some of the quacks.

But basically, they make some sort of pitch that just goes against what we know about normal physiology. And they’ll try to say they discovered something that no other doctors or no other researchers have found. Yet, they’re never the ones doing the study, so how did they discover this? They didn’t discover it. They’re just making something up.

So, like resetting your hormones. So, what does that even mean? Or balancing your hormones, that’s the one I always laugh about, “we’re going to balance your hormones.”

What does that mean? What hormones? How are we going to balance them? What was the underlying pathology in the first place?

So, when it comes to dieting, people go, “What about insulin resistance?” So yeah, we can improve that with diet. Yeah, any type of weight loss will improve insulin resistance. So, the underlying pathology was an excess of energy, and excess energy stored around our organs topically and viscerally.

And so, any type of calorie deficit and eating fewer calories, whether it’s low carb, high carb, it doesn’t matter, will improve that insulin resistance. So someone didn’t come up with anything new, they’re just trying to hook somebody with some special marketing.

Now, what they’ll say is, marketers will say this, they’ll say, “If you have a good program, you’ve got to do everything in your power to get that program into people’s hands.”

Now I agree if you have a good program, but ethically, you still shouldn’t lie about it. Because what happens is that you end up lying and you create a false narrative and potentially false hope. And when somebody then maybe is successful on the program, they’ll tell somebody else, and they’ll fail, and they’ll think, “Well, maybe I’m broken, because clearly my hormones are messed up, and this didn’t reset them,” or whatever. It doesn’t matter.

When you say you have the secret, and then it doesn’t work, it just adds one more time to where that person goes: “Why even try because this doesn’t work.” So, I honestly hate these marketers. Maybe I’m not the best at marketing, but I think that being more truthful will do a lot less harm and a lot more benefit in the long run.

And you may not make millions of dollars right off the bat, but you’ll do fine in the long run and, you know, whatever. Maybe people want their private jets and maybe they just want to fly without anybody else and so they have to lie to get to that point, but I don’t think it’s ethical.

Ted Ryce: I don’t think it’s ethical either. I think that you can do it without lying. I think it’s lazy. And if you’re listening right now, you understand, people just lie and they don’t know how to “market” in a better way.

Spencer Nadolsky: Right.

Ted Ryce: And this is not just people who are without education—by the way, I’m a college dropout but I base…Let’s talk about this, because we’re in this weird world where like I, you know, I say I’m a college dropout, I was doing my pre-med requisites, I got straight A’s, a parent died, I dropped out to take care of my dad, when my step mom died.

But it doesn’t matter what my qualifications are if I’m basing what I do on the physiology on the best evidence that we have with say, you know, the studies that Kevin Hall has done with the mechanism that causes weight loss, for example, its calories, not the carbohydrate insulin model, and as far as psychology is concerned, cognitive behavioural therapy, versus—I believe it was an ER doctor that I saw that you shared… she’s a medical doctor went did all her pre-med requisites, went to medical school for four years, did her ER training, and there she is on Tik-Tok promoting a hormone balancing cocktail. I don’t know if you remember that one.

Spencer Nadolsky: There’s a bunch of them. They’re ER doctors, an anaesthesiologist, for some reason, I don’t know what it is. It’s like they’re sick of it. One was an anaesthesiologist who decided to do an adrenal cocktail. I remember… yeah. I mean, it’s… yeah, just horrible. It’s like just making up stuff. You’re just being a huckster for the heck of it. I don’t know. Weird.

Ted Ryce: Well, can you talk about that, because you… I mean, I feel like just a few decades ago, if someone had an MD behind their name, they really had a lot of authority, a lot of trust that you can put in them, and now we’re in a weird world where that isn’t necessarily… And granted, let me say this to qualify what I’m saying here, I’m talking about, not the doctors that are just in their offices, in their clinics everyday working with people, but the ones that are posting on social media.

It’s this weird world where their qualifications don’t necessarily mean anything. I’ll say one more thing and then I want to hear your thoughts on this. I’ve had people say to me, “Ted, you say that carbs aren't inherently fattening, but I just listened to a podcast. And a doctor said it was all about—like, Jason Fung, for example—it was all about insulin. You’re not even a doctor, how am I supposed to listen to you and I believe what you’re saying, when a doctor’s here in a podcast, and he’s talking about the hormones as being the key to weight loss.” What do you have to say about that for the person listening who is trying to figure this out?

Spencer Nadolsky: It’s really tough. How do you know who to trust? And honestly, I don’t think the general population is trained well enough to know in the beginning. I can give you some red flags, if somebody says, “This is the absolute truth,” that’s a red flag, like, “Hey, we have studies on certainness, it seems to be this is likely the case, there may be something that has to do with this, but most of the data supports x.”

If somebody comes in and goes against the current consensus, big red flag, it doesn’t mean that they’re wrong, you know, there’s certain things that the consensus gets wrong. But more than likely if everything they’re saying is going against and they’re just being a contrarian, they’re probably making something up. But again, there are certain instances where some things happen to be true.

A lot of these people that make up claims, they’re not doing the original research, that doesn’t mean they’re wrong, it just means they may be distorting the truth. So, someone like Jason Fung, for example, he comes up with this great story, but it’s the same story that Gary Taubes, and all these people, they come up with the same thing that like, “No, carbohydrates increase insulin; insulin is an adapogenic hormone, storage hormone. We learned that in medical school, and therefore, eating carbohydrates is fattening.”

Well, okay, let’s actually do the experiments. Well, yeah, like you said, Kevin Hall and there have been a bunch of other studies, they’ve done this, and also normal doctors that see people in the clinic, “Oh, I followed a high carb, low fat diet and I lost weight, and I’ve kept it off for a few years.” So that by itself would go against anything that these people are saying. So, it’s hard to know.

So, for example, why would you listen to me. Some people, you know, I get on these podcasts, people will say, “He’s a doctor, you’ve got to listen to him.” And I’m always like, “All right, yes, that’s true, but there’s…” and that’s great that people see the authority in my degrees and specialties and whatever but like, there a lot other people like me in the same academic, and maybe they’re at Harvard that...

Here’s the ones that kill me, the ones that go to Stanford, Harvard, any Ivy Leagues and they’re quacks. And so, then because they went to Harvard, and I didn’t, people are like, “No, that person went to Harvard, I’m going to listen to them.” And I’m like, okay, so this is the same spectrum. So, like, for you, you didn’t go to medical school, so why should we listen to you?

Well, you still follow the lines of evidence that we know are true. And I think as long as people are backing up their claims with evidence—now, the problem is the general population may not understand how to assess usual evidence, and it’s okay. So sometimes it just takes some trial and error and kind of figuring out your way through it, but there are a lot of people out there trying to push back against this misinformation.

There are a lot of registered dieticians who are PhDs, and physicians who are PhDs, they make up stuff, they go to Harvard, and they’re like, “I’m going to use this Harvard, namesake and I’m going to say whatever I want and make big claims without great evidence,” or the evidence that they use is like, in mice that they distort to fit their narrative. And it’s hard, I can’t give you a perfect template to say, here’s how to know if somebody’s full of it.

Red flag should go off, certain things like, “Hmm, that goes against conventional wisdom.” Again, conventional wisdom isn’t always correct, but it should throw some signs up there and maybe look it up. And there are lots of people out there myth-busting. Brandolini’s Law takes a lot more effort to dispel the BS that’s out there than to give the right information. So, like when somebody says, “No, artificial sweeteners are fattening, and it’s because of the insulin and hormones,” or whatever they’ll say, “because of the microbiome.”

Yeah, the microbiome, or something like that, so then you’ve got to go, “Ugh,” okay, so then you have to explain it. Okay, we have XYZ studies that have done this and this, therefore, it takes a lot of effort to dispel these myths. But it sounds so much better to go, “Oh, chemicals and stuff that we don’t really understand, it’s bad for you.”

Anyway, so that was a long, long rant on the situation, but it’s very frustrating. So, like a Jason Fung, you know, okay, he comes up with a pretty good story, except we have a plethora –how about that word—a plethora of data showing that whatever he’s claiming isn’t actually true. You don’t have to fast lose weight, you don’t have to go low carb to lose weight. You can, though, you can, but anyway…

Ted Ryce: When you say that, it brings up two things for me. So, number one, it brings up a recent statistic that I read somewhere else—I forget, unfortunately, I can’t remember exactly. But it was talking about how there’s a correlation between high IQ and confirmation bias—a positive correlation. So what that means is, someone who is really smart, has a high IQ, and probably very educated as well, isn’t immune from using their intelligence and high IQ and education to just look for ways to prove that they’re right.

And we’re getting into this weird realm of like, well, who’s emotionally healthy enough to kind of not be extreme in their approaches and what they say and, you know, that’s kind of a hard one to figure out. And I would say, if you’re listening… I don’t know about you, Spencer, I would assume that you kind of take the same approach as me, there’s just some people who, whether it’s their wiring…

I’ve had a performance psychologist on Chris Friesen and he was talking about how we all have this, you know, 40 to 60% of our personality comes from a genetic predisposition, something that we’re born with. So, if you’re high on the trait of openness, and low on agreeableness, you’re going to be very open to what a lot of people refer to as conspiracy theories or maybe anti-establishment narratives, for whatever reason, you’re wired and you hear something about how big food or Big Pharma is trying to screw you over and that’s the reason you’re going to be more likely to believe it.

So you’re going to have to work even harder to check your confirmation bias. I just put stuff out there. And I think asking people to do experiments too, if you’re familiar with the Masters Cleanse, you of course know what that is, right? The Masters Cleanse? The Lemonade Diet, the one where people drink maple syrup and lemon and cayenne pepper.

Yep, but here’s the thing: do it for three days, and you’re drinking nothing but syrup. It’s not something that’s good for long term. But you can prove to yourself very quickly that you can lose weight by drinking nothing but sugar water, which is arguably one of the worst things you can have. But it works to lose fat. Or do the potato hack potato, boiled potatoes for three days and prove it to yourself. It’s not going to be a long-term strategy, but you can at least start to test these things and make up your own mind. What do you think about that?

Spencer Nadolsky: Yeah, I mean, I do. Similarly, I’ll do like a meal replacement type of diet with people, because people just don’t—we’re not good at estimating how much we eat. We don’t live in a metabolic lab or kitchen where they know every calorie in every morsel of food that you’re eating. Even if people are weighing their food and eating it, it’s going to be off by X percent.

So yeah, same thing like, “Oh, you, you think you’re eating 1000 calories, and you’re not losing weight despite being 300 pounds, okay, well, drink three protein shakes a day and take, you know, this multivitamin or whatever. It’s like an 800-calorie diet and do it for a week. Like, it’s never happened where these people have gone into a metabolic ward and not lost weight by doing something like that. So clearly, it’s just their estimate, the same kind of thing. Or they could drink Diet Coke, but obviously, I wouldn’t recommend that, but it’d probably be similar to the Master Cleanse.

Ted Ryce: Right. So just to explain, because I don’t think a lot of people, even who listen to this podcast understand what a metabolic ward is. Can you talk a little bit about the studies that have been conducted in metabolic wards what they show? And then why people struggle so much when they’re not in a metabolic ward and maybe tracking their calories? Can you talk a little bit about that?

Spencer Nadolsky: Yeah, these things… I got to visit Kevin Hall’s metabolic ward, a few years back, pretty cool. I’ve never been in one. You just kind of learn about it through medical school and, highly, highly controlled environment where they measure everything, the ins and outs, the how much carbon dioxide you’re breathing out, and how much energy expenditure and how exactly much you’re eating and moving and all this different stuff, so very controlled.

So not  what we call a free living situation where you do these studies where you tell people to go, “Hey, eat low carb,” and you give them parameters to follow on the other group, you tell them to eat low fat, and maybe you have a control group where you just tell them the usual stuff that a doctor says, “Hey, go kind of eat better," usual doctor.

So, free living situation, people do whatever they usually do. And it doesn’t matter if you told them to do something, and even if you give them the best advice, you don’t know if they’re following it, whereas in a metabolic ward, they have no choice, they’re eating what they’re given. And every little bit is measured in terms of their intake and their output, and it’s really cool. I wish I had one to….

Honestly, here’s what I wish: I wish I could win one of those big lotteries, you know, one of those big like, close to billion dollar lotteries, I’d build a metabolic ward. And this would be the coolest thing ever. Now some people would call it shaming, and maybe I wouldn’t publicize it, but I would, you know, the people I get on Instagram that it says they have PCOS or whatever, and they’re eating 1,000 calories, and they’re not losing weight, despite eating 1,000 calories.

I’d go, “Okay, all expenses paid trip to my metabolic ward and let’s see.” Now, they’ve done some of these in the past, I’ve seen people that sign up, “I’m diet resistant and I can’t lose weight”. They’ve done this in the past. And then they see they give them something called doubly labeled water where they drink this stuff and then they can measure how much energy they expand over time by measuring the metabolites.

And people say they’re eating 1,200 calories and not losing weight, but then they see they’re burning, like 2500 calories in a day or something like that. So I would love to get one of these metabolic wards, and, I don’t know, maybe in the future, I’ll be able to…If stuff with my business goes well, I’ll be able to do this. But that’s what I would love to do. Because I think some of its intro, maybe there’s some truth to what these people are saying. But if I had to guess I’d say probably it’s just normal human behavior. We eat a lot more than we think in a normal free-living situation.

Some ways to get around that; some big researchers they have to get a lot of money and then what they do is they get one of these food delivery services where they know how much at least they’re delivering and they know they’re getting the food, but you still don’t know if people are eating and snacking in between and doing whatever. But at least that improves the adherence to whatever was prescribed in the study. So that’s the gist.

Ted Ryce: Yeah, very important, and that would be cool to see. Have you ever had a patient who, for whatever reason, there was a medical reason why lowering calories didn’t work. And we’re talking physiology here, not, we lowered calories and they were stress eating and/or super hungry and had to eat, but really, they were sticking to what you gave them, and then there was some sort of problem with fat loss.

Spencer Nadolsky: Yeah, no matter what, in a calorie deficit, like it doesn’t even matter which type of medical issue, you get things like lipodystrophy where you actually can’t control where certain fat is being stored, something called Cushing’s disease. It’s still a calorie deficit. But the Cushing’s disease is something where you either have a tumor in your brain or tumor in your adrenal glands, that’s making your body produce a lot more cortisol than it needs, pathologic level, super high cortisol.

And then you see storage of fat around your abdomen, you get skinny arms and legs, and hunger goes high. But even still, in those people, if they’re eating nothing, you can’t store fat out of ions in the air, you still need energy. So, I’ve had a few cases where significant hypothyroidism where they’re feeling so tired, and hypothyroidism, thyroid controls or metabolism…

And actually, a lot of the weight gain that occurs in hypothyroidism is actually fluid. It’s water weight. I’ve had a few of those cases. But I’ve had a lot a lot more cases where people say, you know, the 200, 300 pounds, say they’re eating 1200 calories. And I give them a powerful appetite suppressant and boom, 50 pounds comes off. So, it’s not that they were eating 1200 calories, now they’re eating 500 calories, they were never even getting close to 1200 calories in the first place.

So, in the majority of cases, it’s just that they’re eating a lot more than they think they’re. And then in some of these medical cases, so like PCOS, there may be some changes in appetite, there may be changes in where we store the fat. So it can start blurring the lines to where like, hey, if they think they’re eating this much and they’re eating more, it’s not necessarily…It’s never their fault if they’re eating more than they think they are. But it makes it that it’s another barrier they have to overcome.

So, we see it a lot in PCOS, and I think the studies need to be done a little bit more in that. PCOS is polycystic ovarian syndrome, for people listening. For some reason with PCOS women who struggle with their weight that have PCOS, the research shows that it might be an appetite difference. Some people think it’s the differences in hormones, but a lot of it’s probably appetite related, so it’s mostly appetite.

Ted Ryce: You said something interesting, I forget when or where exactly, but you were talking about…so let’s talk about this. The most successful weight loss approach that’s been studied is obesity surgery, something that’s coming up that seems to be very effective, as well as some of the drugs like semaglutide, if I remember the name correctly, and what these approaches do…

And there’s a way to do this, I feel, for most people without those extreme things, but just so they understand the big needle movers, the big successes, what they do is they focus on managing your appetite. So many people are focused on, “Oh, the carbs are making me fat” or “it’s the sugar or the chemicals in my food,” but really, it’s our appetite and that’s the thing to focus on.

In my coaching program, what we focus on is we focus on satiating foods, we look at the satiety index, we relate it to what people are eating in their My Fitness Pal, when they track their food, like, how many are you struggling with? When someone struggling with hunger, it’s like, well, how many of these satiating foods are you eating? And are you taking advantage of the gastric distension, the stretch receptors in our stomach that sends signals to your brain saying, “Hey, you’re full.”

When a lot of people they think like there’s something really wrong with…I’ve even had people tell me there’s… I’m kind of going off a little bit on a tangent, but I still think it’s related. They think they have an eating disorder when they have a potato chip, and they try to moderate and they end up eating the entire bag.

Or me, I’ve got my thing with ice cream, I eat the entire—it doesn’t matter if it’s a pint or half a gallon, it’s going to disappear very quickly. That’s not an eating disorder, that’s a normal reaction to a hyper palatable food or ultra-processed food. Can you talk a bit more about it? The future of obesity, handling obesity is really about regulating appetite in some way whether that’s drugs, surgery, lifestyle change, food choice.

Spencer Nadolsky: Yeah, obviously, if we could, we’d prevent it from occurring in the first place, because once it occurs, it’s harder to treat. So, if we could, we could just take out the environment, how are we going to do that? I have no idea. And I’m sure some of the things that I would mention would not go over well.

Ted Ryce: Like what? Sugar tax?

Spencer Nadolsky: Yeah, but even that, it’s…Sure, on a population level, that might have some… I mean, they do it with soda taxes and stuff like that. Honestly, like, you’ve just got to get rid of it.

Ted Ryce: What do you mean, get rid of Oreo cookies?

Spencer Nadolsky: Yeah, you get? How are you going to do that? How are you going to have big brother, you’re going to have a government go, all right, in every grocery store, you can’t even buy this stuff anymore. That’s not going to happen. We’re not even close to that. It will never happen. You look at some of these places that haven’t been westernized, and there’s very few of these places left.

And how are you going to ever gain a ton of weight when all you can eat is mostly vegetables, and eat some tubers and some lentils and some fruit, and maybe once in a while get some meat in there? How are you ever going to gain weight? That’s not going to happen. So, to prevent it, that’s really… I don’t know, I mean, you could look back in the 19, whatever, 1940s, 50s and see what was available.

But the portion sizes were so much smaller, the fast-food restaurants were much fewer, and you didn’t have all these different things. And people ate home cooked meals a lot more often, we didn’t have the variety of these chips. I mean, these chips are amazing. I like ice cream, but like salty, crunchy, starchy, fatty chips. Kettle cooked potato chips, I mean, they’re just like—it’s just like, “This is ridiculous.” This is how good it is, you know? So what are you going to do?

Okay, so, yes, to prevent it, I think we would need to somehow remove the environment. That, to me, seems impossible, that will never happen. So maybe some sort of taxes to even that. I mean, it’s ridiculous. I don’t know, I don’t have a great answer to it. All I know is that somehow, we need to get more towards that. However that is, I’m not sure. I don’t know the best way.

So then treating it, that was a long aside to just go into treating it. So, treating it is not tackling the metabolism, although they’re still trying to figure that component out, because that probably does play a little role. As we lose weight, metabolism goes down; sometimes a little bit further than expected. Although I think that plays a minimal role compared to the appetite changes.

You give somebody these drugs, and just from a clinical aspect, I mean, you see from the studies, yes, the new one, semaglutide, it’s a glucagon like peptide one. Our intestines naturally secrete a little bit of this when we eat, but we can give this now compound that our body can’t break down, and it has massive, massive appetite regulation, it just shuts down your appetite. So, when I give this to patients, massive amounts of weight loss, and they tell me all the time, they finally feel normal.

So, when you describe “I have a tough time stopping eating ice cream,” I love to eat these potato chips. These patients, they struggle with it all day, they want to go get the extra help, and they’re trying to eat mostly vegetables and lean protein or whatever. But they’re just struggling, it’s hard to do that when your brains kind of nudging you one way, like, “come on, come on, go eat a little bit more, go eat a little bit more, have those chips, they’re right in the pantry, go out and get some french fries,” whatever.

And so these medicines can shut down that portion of the brain to where they go, “Oh gosh, I actually don’t feel like I need to go get that.” And then they do fine, they lose a ton of weight. The thing is you’ve got to stay on the drug in general. People are like, “Well, can I come off of it?” Sure. Indefinitely. You take them off, some people can do it. Other people…most people…

I used to say like, there’s a significant portion that come off of it, but as I’ve gotten more and more patients, and it’s a very small percentage, and the studies support that as well. They can keep a decent amount of weight off.

But if they want to keep most of the weight off, they’re going to have to stay on the drug. It’s expensive, the drugs are expensive, they seem to have a cardiovascular benefit, we’re going to see soon specifically for the dose of semaglutide that we’re giving for weight loss instead of type two diabetes, but they’re expensive, probably a benefit as opposed to neutral or even harm, I would bet a lot of money there’s no harm in this medicine.

Ted Ryce: From the side effects.

Spencer Nadolsky: No.

Ted Ryce: Except to your bank account. Spencer, I want to be really clear here because there’s someone who might need to lose 10 pounds, or might wanting to go from just normal body fat to really lean and hearing this and thinking maybe this is something they should try. When you’re talking about an intervention like semaglutide, who is that right for?

Spencer Nadolsky: Yeah, the indications are this: if you have a BMI of 30 and above, and now…

Ted Ryce: So, you’re obese?

Spencer Nadolsky: Yeah, you have obesity. The thing is like, BMI, some people call, “Oh, I’ve got a lot of muscle, I have a 30 BMI.” If you have abs and you have a 30 BMI, this is not for you. It’s for people that have body fat, they qualify…Also 27 BMI, but also an obesity related conditions such as pre-diabetes, diabetes, Type II diabetes, elevated blood pressure, hypertension, sleep apnea, those types of things. So, you can also qualify.

Now, one other reason that I would give it is someone who’s lost a significant amount of weight and they’re just struggling to keep it off because of their appetite, you know, insurance companies and whatever, they’d be like, “No, they don’t qualify, their BMI is too low to start this,” but I would be like, “Hey, they were a BMI of 30, whatever and they’re just really struggling right now, so I would give it to them.”

But that’s technically off label. But yeah, so this isn’t for vanity weight, losing just like 10 or so pounds; it’s usually those who can gain some health benefit from 5 to 10%, or even more of weight loss. So…

Ted Ryce: I’ve gotten back and forth with actually, your brother on this a little bit on Twitter, I’ve got to get him on and talk about TRT, but we went back and forth. I’m curious about your opinion. Obviously, there’s powerful biological factors at play here with our brains, the hormone signaling, leptin, hypothalamus, all the stuff that Stephen Guyenet about in his Hungry Brain book, which if you haven’t read that and you want to try to understand this a bit better, that’s a great book.

Herman Pantser’s, Burn, is another one where he kind of talks about this. How much of this, in your opinion, because I know there’s probably not a lot of research on it, is driven by psychological factors? Obviously, can’t reduction…Or what do you call it? You can’t separate the two, they’re intertwined, interrelated, interdependent, but if we had to—and it’s individual—but how do you look at the psychological factors: stress, poor sleep, and its effect on this, toxic relationships?

Spencer Nadolsky: There’s clearly an effect. I would say most people have a combination of the two. Now the thing is, though… I just made a meme. I can’t share the meme, because it’s a… I might be…I’m trying to be a little bit more professional.

I’m working with a few companies in that I need to be a little bit more professional just in the meantime until I sign with them, then I can start being a little bit edgier. So actually, some of my memes, they’re not getting as many likes recently because I’m not being as edgy and it’s like, “Ah, come on.”

Anyway, here’s the deal: if you give this drug—so, somebody does all the behavioral change stuff, they go through intensive behavioral change. In general, you start seeing that a population over the course of a year, you see around a 6% average weight loss, which is pretty good. For some people, that’s not enough. But in terms of population weight loss, 6% is pretty good. And I’m talking about total body weight.

So, let’s just say if you’re 200 pounds, 10% is 20 pounds, 5% is 10 pounds, so somewhere above 10 pounds. So, that might not seem like a lot if you’re 200 pounds but significant health outcomes. I post about that all like, once or twice a week, which is 5 to 10%. So, 6% is pretty good, but over the course of time that starts getting lower and lower over the years, but it’s just hard.

Now compared to that to semaglutide, you’re looking at 10, 15%. And really, like, you probably don’t even need to give as much of that intensive behavioral therapy, you want to because you still want people maximizing their health benefit from eating a better dietary pattern and getting to exercise and whatever. But that’s how powerful these drugs are.

And so like, what part of its psychological, what’s physiological? we didn’t need those psychological…

Are we all suffering from psychological issues now in this future? Maybe. Maybe social media and lots of these different things are having an effect and maybe that’s part of the that environmental effect.

But I personally think it’s mostly environmental, physiological, as opposed to psychological. I think the psychological stuff has? I lost 100 pounds or 50 pounds and I’ve kept it off. And if I can do it, anybody can.”

Unfortunately, maybe anybody can, but not everybody will. And so, it’s just hard, the physiology drives us so hard that the physiology may drive our psychology as well. So, if you’re always feeling kind of hungry, it may make you feel like you want to give up, type of thing.

Ted Ryce: Yeah, interesting perspective. It almost—I don’t know if it’s the proper analogy to make, but it’s almost like depression, antidepressants where, do you really need them, you could probably go to therapy, quit your job that you hate, leave your relationship that’s not satisfying you anymore.

Spencer Nadolsky: So, okay, in that analogy, if you want to go with that analogy, again, they’re not the same diseases, but they have a lot of crossover, specifically because you got to do behavioral therapy, and maybe do take medicines, depressions… but there’s situational depression, but there’s also situational obesity.

Someone dies in your family, as you discussed, you quit pre-med, right? So, I have patients that they’re fine, I see them, talk to them in a year or two, because they were fine and they gained 50 pounds because their family member died or they got where they got married, or they change a job and they’re in a job that they hate.

So yeah, technically, you could be like a situation obesity or weight gain and you remove them. Or COVID, whatever COVID pandemic, you remove them, we put them on an island where they have to hunt and fish and gather their own food and whatever, or we put them in a metabolic ward.

Yeah, so certainly, the psychology plays a role. But if we had an environment that was conducive to not gaining weight by just, like I said, being on an island. If we’re all on an island and we all had to get our own food, it just wouldn’t happen. There, of course, would be these genetic outliers that have, like what we call one major mutation in their genes to where they’re just so hungry and they’re eating a lot more than everybody else. But they would be the outliers, it wouldn’t be prevalent. So anyway, just an interesting thought experiment.

Ted Ryce: After thinking, I agree with you, by the way, because if we were all on that island, or if you know, you hear about how the Hodza live in Tanzania, in Africa, or the Chimani in Bolivia, these hunter-gatherer tribes who wouldn’t have this situation, so it’s almost like, we have the environment that’s working against us. That’s really the cause here, the environment and say, the mismatch between how our brains are wired.

It’s almost like you need the behavior change, you need the psychology, let’s say the psychology…You need something to combat the environment. And if the psychology isn’t working for you, maybe try another psychologist or coach, or you’re going to need some weight loss surgery or perhaps these new drugs, but the environment really is the cause.

Spencer Nadolsky: I’m not saying everybody just needs to get drugs, I’m saying try the intensive behavioral therapy first. But if you’ve been trying forever and you’ve tried multiple times, probably the 10^th time trying, it’s probably not going to go well, you’re probably going to need some help. So that’s what I would say.

And it’s really hard, sometimes you’re like, emotional eating… I get these patients like, “I emotionally, I stressed eat,” and they’ve done all the emotional eating exercises and everything, I give them a drug that works in certain areas of the reward center. You talk about now naltrexone and bupropion, things that help with smoking and drinking cessation. Boom. They’re like, “Holy cow, I don’t feel like grabbing those potato chips anymore.”

Semaglutide also work. I’m on shield for semaglutide, but that also has to have probably some work in that area of the brain, too. And also just purely turning off your appetite, but like…So yeah, it’s hard to tease out which part’s which—likely a mix, I think mostly physiological and environmental.

But not everybody, you’ll see people that do fine working on their mindset and everything. It’s just not the majority,

Ted Ryce: Just not the majority. Spencer, I feel like we could talk for another bunch of hours and still not get any closer to solving this situation. It’s not going to happen.

Spencer Nadolsky:  I wish I could solve it. I mean, honestly, like, if I could stay in house. And obviously, if you could just stay in house, you would just switch everybody and just melt off their fat and who cares? We could all eat pizza and potato chips all day, and it wouldn’t matter. But if I had to do it, environmentally, I would stay in house and snap all these other foods away and we wouldn’t have any choice but…

How are you going to overeat on freaking carrots and broccoli? Like, it’s impossible. I’ve tried like… I’m like full. I was just eating boiled shrimp yesterday, steamed shrimp yesterday and thinking to myself, like, I couldn’t overeat this.

It’s pretty good, but it’s not overly delicious. It’s good, and it’s filling and it’s really lean. I live in an area where you go out and net a bunch of shrimps if you want to. It’s pretty cool.

But most people can, you know, shrimp’s kind of expensive. But yeah, if we were surrounded by—you’ve got to hunt your own fish, go fishing, and you grill some mahi mahi or whatever and catch some shrimp and then mostly eat some vegetables and fruit from the tree and some nuts, there’s no way you can overeat unless you have a true genetic model, a major genetic issue.

Ted Ryce: Which is very rare.

Spencer Nadolsky: It’s relatively rare, yeah.

Ted Ryce: Well, Spencer, thanks so much for coming today. We’ve got to get you back on the podcast again. I didn’t get to ask you about the cholesterol, some of the things that people are talking about out there. And I don’t want to go another hour because we want to be respectful your time to my time, but we’ve got to get you back on. Where would you like people to go? Do you want them to follow you on social media? Instagram?

Spencer Nadolsky: Instagram’s fine. If you’re interested, I have a Start Here guide in my bio I get asked the same questions over and over again, so I just made a quick little white paper download for free. You join my newsletter and then I send out an email every couple of weeks, basically talking about what’s going on in the media with nutrition or something like that. But yeah, go check me out on Instagram @Dr.Nadolski, D-R-N-A-D-O-L-S-K-Y. I’m sure Ted will put a link in.

Ted Ryce: We’ll pimp you out on the show notes, of course. We definitely need more people following you and getting better information to counteract all the things that we’ve talked about earlier in the interview. But Spencer, thanks so much for coming on the show. Well, I would ask you one more thing, what is the big takeaway you’d want someone to leave with after hearing this entire conversation we had?

Spencer Nadolsky: Yeah, well, I would say obesity is not necessarily your fault. It’s losing the weight, if you want to do it, it’s going to have to be your responsibility. Nobody else can do it. It’s not your hormones necessarily. There could be some hormonal involvement. It’s still energy balance, but regulating appetite is your key. You want to eat mostly satiating foods, as Ted promotes, and if you need some extra help, you can see a doctor that can give you some medicine if you qualify, but try your best.

Ted Ryce: Thanks so much, Spencer, really appreciate it and we’ve got to get you back on again to talk about some cholesterol.

Spencer Nadolsky: Perfect. Sounds good.