The transcript below has been edited for readability, conciseness, and clarity.
How do I know what a healthy weight loss goal is for me? How many calories should I be eating?
Michelle Kennedy 2:05
We do get that a lot. What should I weigh? Is my goal reasonable? And honestly, from an obesity medicine specialist standpoint, 5-10% body weight loss is considered significant. So if you’re 200 pounds, that would be 10-20 pounds of weight loss.
That is not typically as much as folks want or believe they need to go off what we consider the BMI scale. The BMI scale is a population-wide measurement based on height and weight. And there are different categories.
So a BMI between 18.5 and 24.9 is considered a healthy weight. 25 to 29.9 is believed to have overweight or pre-obesity. And then 30 and above are deemed to have obesity.
That is not always what drives us to help people set or achieve goals. Although on the internet, you will find that as the most common thing. Get your BMI either under 30 or under 25. For many patients looking to lose weight, that is not a realistic or necessary goal. 5-10% is fantastic.
So wherever you’re at now, if you can lose just 5% of your body weight, many significant health improvements will be achieved. If you want to lose some more than that. That’s ok. But it’s not absolutely necessary. So at that point, we’re looking at comfort and maintainability.
Sometimes the weight that we want to get to is not as achievable as a weight that we can maintain long term because of the level of restriction that we’re going to have to live with to stay that lower weight that we had our mindset on.
Dr. Wickham Simonds 4:23
Michelle made some excellent points. However, I’m not a big fan of BMI. I think the BMI was initially intended to be a population assessment tool to be applied to populations rather than individuals. And at the time, there wasn’t an agreed-upon definition of what obesity and overweight were. So, organizations just picked up that ball despite the caution not to apply it to individuals and then started applying it to individuals.
Now, the way to explain it to patients is to never look at another species of animal and use this sort of reasoning. This sort of reasoning is like, you know, Star Wars. You know, Stormtroopers are all the same size; they’re robots.
But people and dogs, for example, come in different sizes. So you would never look at a St. Bernard to say, hey, you know, you’re way bigger than the Labradoodle. So you got to lose some weight. That St. Bernard is supposed to be a big dog. We don’t want him to be overweight for that kind of breed.
So people come in different shapes and sizes. You make an excellent point about talking about medically significant weight loss. Michelle made a comment about 5-10% of your weight. And you can always do more than that. Ok, you will know what’s right for you; in most cases, you will know.
I always say that the moment comes when you’re standing in your underwear in front of the mirror one morning, and you’re like, I’ve arrived. And really, it’s hard because of body types to know what that weight will be for many people.
But the medically significant stuff is, you know, we’ve had a couple organizations batting around the idea of 5-10% of body weight loss and what that does to cut your risk of developing diabetes or high blood pressure. And it’s significant. It’s over 50%.
So Michelle makes a good point, you don’t have to lose a lot of weight to be healthy, right? And there’s the second part, which I think is never said. If you gain 5-10%, this is what brings it on. And when you look at it like that, you’re like, Ok, this is what you know, previously in the medical community, what’s happened is we wait till people get really overweight, and they’re beset by these problems. And then we say, hey, let’s intervene.
That’s letting the horse out of the barn, then sending a bunch of people to round him up, right? You should have never let the horse get out of the barn in the first place. History is going to judge us harshly on this, ok?
We should be intercepting people when they are one pound overweight. When they start to gain weight, when they come in and say that, that’s when we should be intervening. And that’s how we get out of the current population problem regarding diabetes and these types of diseases. They start somewhere, and we have to be intercepting that stuff early on, and we currently don’t do that. So Michelle and I will do that. But there’s the medical community; we’ve not embraced that stuff.
Michelle Kennedy 7:41
That’s absolutely true. And Candice (viewer) has a wonderful point. A lot of patients do feel this way, that the BMI is like medical shaming. And unfortunately, it has turned into that; it really has.
Your chart has a stigma; your insurance company knows when your BMI is over 30. And it really is a mark that will work against you in many ways when it gets documented. So the fact that we still use that scale, we don’t look at individuals, we’re using this population-wide thing, it’s something that will need to change. But now, in our practice, we shoot for 5-10%.
We also use body composition scales, so we can look at not just your weight, which is more like your relationship to gravity, but your body composition, your body fat percentage where you carry that body fat, right? Because we know a lot of linebackers who have a BMI of over 30 are huge, but they’re solid muscle. So in their medical chart, they have documentation of obesity, but they do not have any associated health risks. Same with individuals. Come back in. We’re gonna help you.
We really want to go off to body fat because we even have thin, lean-looking individuals with a high body fat percentage and a very high risk for heart disease, diabetes, and other metabolic disorders.
So we really want to treat the individual, which is what we do well here at Dr. Simond’s office. We treat each individual as they need to be treated. So we will set a goal with you. So if you don’t know or are unsure, let us help. That’s what we’re here for.
Dr. Wickham Simonds 9:42
So the second part of her question, which I see him some other questions here, has to do with calories. How many calories should I be eating? I think you need to understand that starvation does, in fact, work. Ok, no one does obese when during a famine.
So calorie restriction will cause you to lose weight and eventually die. Ok? When you have starvation, just think of calorie restriction as a controlled form.
Now what you eat matters. Ok, so calories aren’t equal. So, you know, radical calorie restriction will produce weight loss. But you can’t say the calories from Twinkies are the same as the calories from the piece of meat or vegetables.
To me, it’s about calories and content. Right? And when you’re eating the correct type of food, you can have more calories.
Because there’s another question down here. The last question asks about tracking calories and still being hungry. The way out of that is to come and see us and get some medicine to help control your hunger. So we can help you with that. But the other way to deal with that is to eat the right content. And when you do that, you can have more calories and still lose weight just fine.
I always say animals, what comes from animals or what you’re growing gardens, there’s your way out of it. And if you’re eating that way, you generally don’t have to track calories.
Michelle Kennedy 12:03
Some of us carry our flaws on the outside. And unfortunately, that leaves society with an open invitation to judge, and that’s not ok. And we need to change that. But many of us have our own demons; we just don’t wear them on the outside.
But here, it doesn’t matter. It doesn’t matter what you’re wearing on the inside or outside. We are going to meet you where you’re at. We will make you feel safe, trusted, and listened to. And that’s really, really important. If you haven’t got that other places, you will never ever expect to get that from us. I assure you of that.
So how many calories should I be eating? I will just touch on that second question. That is also something that we can help you with, right? Part of what we do here with the body composition scan is we can see roughly your basal metabolic rate. And I will tell you, even though we have those machines and their fancy calculations, most of the time, you will find some on the internet, women are eating to lose weight between 1000, and 1200, maybe 1000, and 1400, with an average of about 1200 calories.
But the quality of those calories really matters, just like Dr. Simonds said. And men are usually between maybe 1500 and 2000. Right? Depending, right? A lot of them are eating 1500 to 1600 to lose weight. So that’s a general blanket; that’s just an idea. Protein calories are what to prioritize.
What is the best way to track my weight loss?
Michelle Kennedy 13:37
There are many things out there now that can help you track all kinds of things: steps, weight and calories, and the content of calories.
Dr. Wickham Simonds 13:53
All feedback is good. Because it creates mindfulness. And that’s the key. Whether it’s a scale, a measurement around your waist, the size of your britches, or the number of steps, it can be helpful.
The more stuff you put in there, the more mindful you are about what goes in your mouth. And that’s what we’re trying to create. Because once that happens, then you got it.
Michelle Kennedy 14:16
Yeah, yeah, absolutely. And it depends on the person. And we’ve had patients who don’t feel comfortable stepping on a scale regularly but have a particular dress, pair of pants, or skirt that they will try on every couple of weeks. And that could be their indicator. Other people will actually do measurements.
There’s really no wrong way to do it. It’s really finding the best way for you or the best practices if you’re tracking multiple things. The important thing is that you were doing something to track your progress, which we can help with as well.
Is there a danger of losing weight too fast?
Dr. Wickham Simonds 14:51
No.
I hear this a lot. And look, I understand the reason why people were concerned about it. Ok, so I think, you know, every person is different. These studies have actually been done. The people who lost weight the quickest, initially, but the people who kept it off the best.
Michelle Kennedy 15:12
That’s surprising for a lot of people.
Dr. Wickham Simonds 15:15
So it’s also true that I always have patients who intend to make a change. They change, lose weight slowly but consistently, and do a great job of keeping it off. So it depends on the person.
What I don’t, but I disagree with, is the concept of, hey, it’s a danger to lose weight too fast. That is true if you are too thin and trying to lose weight. You shouldn’t be trying to lose weight in that case.
But it is not valid if you are overweight because you have excess body fat. So yeah, we now have plenty of studies documenting the benefits of skipping meals, intermittent fasting, and this sort of content.
It is good for your health; your body needs a break from this stuff, right? All the food, the calories that we consume, in the form of food and drink in this country. So I wouldn’t be worried if you’re losing weight fast.
Michelle Kennedy 16:14
I do also have people say, well, I definitely need to do it low and slow so that I keep it off. And that’s, again, maybe true for them.
But studies show that the more you lose quickly, the more likely you will keep it off.
I bring this up with my patients to try to help them understand why it is so hard because we will never accidentally lose weight unless we are sick. And that’s something you really want to think through. Anybody that we know who is losing weight unintentionally, there is something wrong that they need to seek medical care for.
Weight loss is something we have to put effort into. We have to make it happen. It is a challenging task for some people. They spend a lot of energy, time, and money on it. Other people change a couple of things, but they are still putting effort in, and it may be coming off a little bit easier for them.
Either way, though, we have to make it happen. So when you intentionally make significant changes to your health and the weight is coming off rapidly, that is a good thing.
Another thing is the calories you’re consuming have some protein in them. And this is not a surprise for patients of ours to hear.
We talk all the time about the importance of protein because when you lose weight, whether it’s more slowly or rapidly, we want to preserve your muscle mass. And consuming amino acids in protein is an excellent way to do that. It keeps your metabolic rate up, your muscles strong, and your body going after the adipose tissue or the fat tissue and not the muscle tissue. So as long as you’re consuming reasonable amounts of protein when consuming any food, there is no danger.
I’ve heard that diet breaks can help you lose weight and reduce plateaus. Is there any truth to that? And if so, how should I approach a diet break?
Dr. Wickham Simonds 18:24
I would just be careful in this regard. I think that the idea, you know, primarily comes from the fact that your body gets adapted. It’s designed to do this, to adapt to what you’re doing. To be as efficient as it can be.
If you’re taking in a certain number of calories of a certain kind. The idea is you’ll adapt to that and learn to burn that exact number of calories, right? And indeed, in circles where there’s a lot of physical training, this is a concept that is encouraged.
And what I would say is that if people can be addicted to food, and so if taking a break means you’re going to delve into something that is an addictive substance that leads you to a pattern of bad behavior. If taking you’re taking a break is going to lead to undesirable things…
Michelle Kennedy 19:35
If it’s letting your horse out of the barn, right? And it’s hard to corral that guy…
Dr. Wickham Simonds 19:42
It depends on what kind of person you are; if you are a really disciplined person and you say ok, now I’m gonna take one cheat meal, and I’ve been stuck on the same plateau for, you know, three weeks or whatever. And before this, I had several months of really rock-solid dieting and weight loss.
Well, we’ll make it one cheat meal, and it’s over after the cheat meal. And then see what happens to your weight, and see if you come off the plateau a day or two later or not.
But it can’t be, “hey, I’m taking the cheat meal. I’m going to the spaghetti joint, I’m going to eat the spaghetti, it’s gonna be awesome.” And then, next thing you know, you’ve eaten pizza and lasagna for the next three nights, and you get into a disruptive pattern.
I’m not against the idea of taking, you know, cheat meals and short breaks and stuff like that, as long as they’re done in a really controlled manner. And you can do that.
Ok, food is fuel. And when you put bad fuel in your body, usually you’re not going to get a good result. So that’s the other thing. I’m not a big fan of just taking a break, eating junk, and expecting your body to feel good. I don’t think it’s gonna feel good.
Michelle Kennedy 21:14
For most of our patients, that is not a true statement. So the majority of people, this is not a requirement to get through their plateaus.
When a plateau happens, it does indicate something needs to change. However, it is not typically a default that the thing that needs to change is to come entirely off a plan at any time.
That may be something, but typically, what we’re going to do is we’re going to change a healthier variable within. So maybe we’ll do a little bit of fasting if we eat three meals daily. Or perhaps if we’re doing a lot of fasting, we’ll eat two or three meals in a day.
So it’s still within the plan that we had initially set. Keeping nutrient-dense, high-protein food a part of that plan and not saying, “Oh, you’re on a plateau? This is a good time to go to a spaghetti and pasta buffet. That’s not something you’ll hear us say a lot here.
But that doesn’t mean that it doesn’t work on occasion for certain individuals. So how you’re gonna approach it if you’re gonna do it. As Doc said, you’re gonna have a plan. You’ll indulge once with a plan, a set idea of what that looks like. And then you’re going to plan what it looks like at your next meal, whether that’s the next morning or the next, you know, the next meal on that day of how you’re going to get that right back on and not let it sort of roll down the hill. Ok?
I cut my calories to 1000 calories a day, and I’m still not losing weight. What am I doing wrong?
Michelle Kennedy 23:29
That’s frustrating.
Dr. Wickham Simonds 23:30
Well, first, make sure your calorie counts are correct, ok? Because I have a lot of people that think they’re eating a certain number of calories. But when they get more specific about it, they realize it’s more.
You know, so make sure it’s 1000. Because most people will lose weight on 1000 a day.
That then goes to the second concept. Look at the content. Because as I said, 1000 calories from Twinkies, it’s not the same as 1000 calories from meat. What your body responds to is entirely different. And so, you know, I would look at the content.
And then the third thing is some medical conditions make it hard to lose weight. You lose, but just not very quickly because of things like hypothyroidism. So maybe it’s more of a medical problem, and we can help you with that. That’s what we do. And it’s an excellent time to come see us.
That’s why we do the metabolic assessment. We go over what your health scenario is and try to identify the things that might slow you down.
Michelle Kennedy 24:47
Absolutely. We have some folks in our practice who have basically said they’ve dieted their entire lives, typically women. So their metabolic rate has been able to adjust. Their input has just been lower and lower and lower for so long, or there are periods where it drops way down that their output or metabolic rate has also matched. So it’s just like Doc was talking about adaptation.
The body is good at maintaining homeostasis, whether it’s our temperature or pH, right? So our body weight, our heart rate, there’s a goal that the brain has. And when we stray away from that, it will do everything it can to get us back to the goal it thinks. And for many of us, when we’ve been a higher weight, and then we drop weight, the body pushes right back up to try to get us back.
There are a lot of factors here that we would want to talk about with you, right? Like how you know your history of dieting and body weight. Have you already lost 150 pounds, right? Because that makes this question very different.
Have you had surgery, right? Your other medical conditions, and that’s what that individualized metabolic assessment is when you come to our practice. You will not get handed a sheet of paper that says eat this. And goodbye, right? We are going to hone in on what we think will work best for you. And you are going to help figure that out as well. Because you know yourself far better than we do. Right?
We may be experts in our field, but we are not experts in your body, history, determination, or goals. So that’s where we meet with a team effort for sure. Give us a call. I know that’s very, very frustrating to go through.
I track my calories. And often, after I hit my calorie goals, I’m still so hungry. What am I doing wrong? And how can I help reduce cravings?
Dr. Wickham Simonds 26:39
Number one, come to an office location of Dr. Simond’s Metabolics and Weight Loss and see us. You’re probably in need of some medication to help you.
We need to go over really, you know, your nutrition plan. What behavioral changes you’ve made. Whether you’re doing physical activities or need some medication… can we match you with stuff that’s gonna bring this under control? And we can kind of touch on all those things. And we just talked about the last question, the idea of a metabolic assessment, and all that.
I think this will get you moving in the right direction and bring both the hunger and the cravings under control. And as I’ve mentioned earlier, if you’re eating the right stuff, you will be surprised that you can lose weight fairly easily without having a drastic calorie restriction.
Getting the content of what you’re eating right will help you. And we do this every day. We steer you toward the right things.
Michelle Kennedy 28:15
And the medication is vital and helpful for the vast majority of people who are going through the same struggle. It is not a crutch. It is not cheating. It is a tool.
If your blood pressure was high, and you went to your primary care, they would say I want to put you on medication to lower your blood pressure. And they wouldn’t say after that, “as soon as your blood pressure is normal, I’m going to take your medication away.” And you get to figure it out from there.
It is a long-term treatment because it doesn’t get fixed like that, right? No chronic disease does. When we struggle with weight, it is a chronic thing, right? Hunger goes up as weight goes down. This is a phenomenon that, without the use of medication, people experience; it is not the medication causing that to happen.
Anybody who has attempted caloric restriction over time will find, at some point, the same things they were eating. They feel hungrier. And it’s confusing, but it’s because their body is trying to get that weight back up, get that body fat percentage back up.
Medications like Phentermine, an appetite suppressant that has been on the market since 1959 and has never left the market. It has been on the whole time. We use it a lot. It reduces appetite, reduces cravings, improves fullness, improves metabolic rate, and improves energy. It improves focus. It is a great medication for so many people.
Dr. Wickham Simonds 29:49
It is well tolerated and safe, so we use it a lot. We also use other things. We do a combination of drug therapy with things like Metformin. In addition to that Phentermine, there are newer medications like Contrave, Saxenda, or Wegovy. There is even some stuff we think will be approved, like Mounjaro.
We use all that stuff, and we often use it in combination. So we believe in the full-court press method. Bring it under control, right? And so I think that separates us from many other practices is that we don’t expect you just on willpower to do all of this.
Medically if you need medicine, then we need to put you on. And then get you to the point where it’s all under control, just like your blood pressure.
