In this episode, Vanessa, our fitness coach and your guide on this exhilarating journey, will dive deep into the fascinating world of body composition and weight loss with the brilliant Dr. Bastian. Are you ready to unlock the secrets to a healthier, more vibrant you?
We’ve fixated on that pesky scale, the ultimate judge of our health, right? Wrong! Dr. Bastian sets the record straight. Weight alone doesn’t reveal the full story. Imagine being short, strong, and technically heavy? Or tall, skinny, yet harboring risky body composition changes. The game-changer? Shifting our focus from weight to body composition.
Curious about Ozempic’s impact on appetite and weight loss? Wondering if it’s the magic pill you’ve been searching for? Tune in to get expert insights and answers to your burning questions.
Don’t miss out. Hit play now!
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Vanessa: Welcome to the Aeon Future Health Podcast. I’m Vanessa, your host, lead fitness coach at Aeon. Today we will be talking about body composition and weight loss with Dr. Bastian. What do you have to say about this major topic?
Dr. Bastian: I think one of the first things that we really need to understand is the difference between weight loss and body composition changes, and why we value body composition generally over weight loss as an initial metric.
So, really, for as long as we’ve been trying to maintain our weight, the only thing we’ve had access to is the scale. Everybody has used that as a metric for health. But the truth is, it’s a bad metric. you can be short, strong and, and technically be heavy.
You can be tall and skinny and still have different body composition changes that put you at risk for morbidity and mortality. So I think the key thing that has changed perhaps in the last five or 10 years is the shifting paradigm from using weight as the ultimate driver, towards body composition.
And now that we have things, like, Our 3d body scanner, which can address things more readily around estimations of, percent body fat, visceral fat and muscle mass. You can get way more granular, way more detailed, about your tracking, which ultimately I think just helps people, create a better roadmap for what they need for their health.
Vanessa: I actually love the STYKO scanner that we use here, because as you mentioned, there are different metrics on there and not just the weight. So when people see that their muscle mass is going up and the inches are coming off and maybe that number on the scale hasn’t changed, people are really happy that their muscle is increasing and body fat percentage is going down.
So those are great metrics, as you mentioned, to look for instead of just that one on the scale.
Dr. Bastian: Yeah, for sure. when it comes to health optimization and longevity. So, you know when people are thinking about Wanting to look better, right?
Usually they’re talking about subcutaneous fat. That’s the fat sort of overlying your skin. You carry it in your belly, around your belly. You carry it, you know, around your, your glutes and things like that. So that’s a, that’s an easier fat to access generally. but it doesn’t carry the same, Serious risks and consequences as other fats.
So when we think about other fats specifically visceral fat Which kind of surrounds your internal organs and especially fat sort of within your liver That fat is different in the sense that It has a way higher rate of increasing markers of inflammation, like interleukin 6 and, TNF alpha, that put you at increased risk of, some pretty serious diseases.
Increased risk of heart attack, increased risk of stroke, increased risk of different types of cancers. And so our focus is really on not just Helping people to trim that subcutaneous fat, which is important. But also, let’s keep an eye on some of these other numbers that, for your overall health and longevity, actually have some pretty significant impact.
Vanessa: I completely agree with that. And a question someone may want to know, is there a way to target your visceral fat or your subcutaneous fat? Or does it just come off where it does.
Dr. Bastian: Yeah, I mean, it’s a really great question. I think the idea of targeting fat is generally a misnomer. It’s hard to target any specific focal area of fat. However, what we do know is insulin is a massive driver of some of those deeper tissues of fat, a massive driver of your visceral fat, which is just around your organs, and a massive driver of fat that gets stored around your liver. Which is especially important because that fat sort of in and around your liver, often called non alcoholic fatty liver disease, can actually lead to liver hardening, and then eventually liver scarring, liver cirrhosis. And so by focusing on things that we know can help bring your insulin levels down over time, we might not be able to target that fat.
Specifically, but certainly we can take away some of the drivers that are required to get that fat storage in the first place. A common myth, and I think we’ve heard this through the years, is eating fatty foods doesn’t lead to weight gain.
Vanessa: Does it make us fatter? Does eating fat make us, you know, or eliminate that from our diet? Does that help? Like nutrition plays a huge role on this,
Dr. Bastian: Oh man, totally. So there’s a couple of myths to bust here. So the first one is that, having a diet high in fat is going to increase your cholesterol. Only about 4-5 percent of your entire body’s cholesterol is based on your dietary intake.
Vanessa: How much percent, sorry?
Dr. Bastian: 4,5. 4 5. Yeah, so 90-95 percent of your body’s cholesterol Is genetics. It’s based on how you create it in the first place. Secondly, eating fatty foods doesn’t make you fat in isolation. But the trouble is that fatty foods contain a high density of calories And you know calories in versus calories out.
I mean we should chat about that in a second, but it’s not the fatty foods themselves. It’s what large quantities of those fatty foods drive Which is things like metabolic syndrome, you know increased insulin which then acts as the signal The signaling property for these other other pieces
Vanessa: Exactly and you kind of led us to our Next topic here of calories in What’s important there, what you put into your body is really important for many of the things that you just mentioned. But also getting that energy in order to exercise and then in order to change that body composition rather than just the weight loss increasing that muscle mass, right? So it really depends on what type of calories you’re putting into your body in order to fuel the tank
Would you put water in your gas tank to make your car run, right? I don’t want to continue to put fatty foods into my system or chips all the time in order to fuel my body. It is just super important because your insulin levels will go up. different hormones are going to be changed depending on what you put in your body too, right?
Dr. Bastian: Yeah for sure and I think the other important thing that is only now shifting, is this idea that it’s, I mean, ultimately calories in, calories out, the calories that you put in your body, those are critical pieces to weight management. critical pieces to body composition management, and crucial for fat loss, right? But I also feel like the medical community’s done a massive disservice to people by saying that those are the only things that are involved. So the classic example is, somebody will start on a diet. They’ll have tons of success. They’ll lose weight quickly.
And then what happens? Well, you know, they fall off the wagon, their weight climbs up and they feel like that’s on them. Of course, habits are crucial to that, but there’s a huge component of that, which is actually far more based on genetics than your hormones. So, we know that you have hormones in your body that try to maintain your weight at a certain level.
And these are really driven by, lots of things from, the environment lots of things from us, you know, and in in previous times where resources were scarce So you didn’t want to lose weight because then you’d be at risk of starving And so, you know, one of these hormones is called leptin leptin actually signals When your fat cells are at a healthy stage for themselves And when your weight goes down Your leptin goes down as well, and when your weight comes up to a space where it’s healthy, or where it’s most comfortable, your leptin then signals to your brain, yep, we’ve got enough, we can take it a little bit easier.
And what happens when you diet and you’re in that caloric restriction phase? You have not only leptin, but other hormones called ghrelin, which makes you feel hungry and insulin. All of those work together to actually make you feel more hungry.
And they actually tell your brain to conserve calories more tightly, which is why people often hit this plateau, and then, it gets incrementally harder to lose weight beyond that piece. We now know that, one of the challenges behind weight loss that people used to think was just, weakness of will or inability to maintain, a program is actually heavily based in genetics.
Vanessa: What are your views on ozempic and how it suppresses appetite? So, I think The first thing that people need to understand is that Ozempic is by no means a miracle drug.
Dr. Bastian: People have this idea that they’ll start this medication, they’ll lose tons of weight, and everything will be perfect. Weight loss and body composition is an intricate play of multiple different hormones, coinciding with your lifestyle choices. Now, Ozempic does help.
If you’ve already implemented some of those lifestyle features, it does help to secrete a hormone called GLP 1, which acts really in two places. It acts centrally on the brain to make you feel more full, and it also acts on your gut to slow down transit through your gut. And the combination of those two pieces mean that it can help to promote weight loss after you’ve reached one of those plateaus.
I really think it’s used in two ways. I think there’s value in the hormonal piece for people to be on it long term who have Long term struggles with weight, but I also think it can be really helpful to get some of those behaviors in check So when you have people who are struggling to make healthy changes struggling to get their protein intake Struggling to intermittent fast, you know, it takes time and mental energy to get those things started and get consistent with And so I think it can be an effective tool once we’ve looked at some of these other treatments to help extend weight loss
Vanessa: So I was just wondering What is your approach to ozempic?
Dr. Bastian: That’s a great question and one I get asked quite a bit. When we are talking about weight loss, we know that there’s hormones at play that essentially allow you to achieve somewhere between 4 and 7 percent body weight loss before these hormonal signals kick in. you can do a lot for your body composition, can’t do much to change the scale beyond that.
Ozempic essentially helps patients to push past that number, and it does so really functioning in two ways. It acts centrally on your brain, to make you feel less hungry and it acts on your stomach and your intestine to slow down the transit of food to make you feel more full. weight, like a really good add on for patients once they have some of these other things in place, once they’re already focused on nutrition or already focused on strength training and exercise, and they’ve reached some of those goals, it can be a great way to see improved results.
And it’s not just the scale. We know that Ozempic also helps to decrease the amount of fat you have around your liver. and that fat in particular called your visceral fat can be extremely inflammatory, increasing your risk of heart disease, heart attack, stroke, certain kinds of cancers. so trying to drive that down is really important for longevity.
In the same tone, like any medication, Ozempic isn’t without its risks. Right? It’s got side effects like, bloating and constipation initially, it’s a medication. It can be expensive. So I think for each patient it’s a real case by case assessment, but when you’re using it in conjunction with some of these other integrative pieces, for many patients it can be a really effective tool in the toolbox, to improve your overall body composition.
Vanessa: Is eating a little bit less and they have less energy. and they still want to train, but they don’t have the energy to train. What would you recommend?
Dr. Bastian: Well, there’s two pieces to that question. So number one is, when patients are eating far too little and have severe caloric restriction, definitely that’s going to impact their, you know, glycogen stores and, and how they work through some of those pieces, which is going to have a direct impact on how well they can train.
Finding a balance where you actually have the energy and you’re fueled your body properly, to hit the gym hard is important. The flip side is that, many times with a gentle caloric restriction, you need some of that caloric restriction, to see changes in your fat loss and your weight loss as well. Trying to strike a balance between the two where you have enough energy to. Do the activities that you want to do and in the same tone You’re still running a gentle caloric restriction to increase your fat utilization is a fine balance that’s really required if you’re trying to take an integrative approach to weight loss
Vanessa: But I think it can be used as a tool for a positive mindset in terms of that little extra push for weight loss. Some people have tried everything and it’s just not working and they get discouraged, right? So going on those Epic and then kicking the nose, healthy, healthy habits.
Again, even if it’s at five pounds, 10 pounds, they need it in order to stick to those habits. I think it’s a positive thing that way. I want people to continue with exercising, getting enough protein in, just forming those great habits that they are going to need for life. Hormones are a different story, obviously.
Like a lot of people struggle with that as we’ve said, so they’ll probably always need to be on it.
Dr. Bastian: Yeah. And I think the other thing that is so crucial to understand is one of the big myths that people have about Ozempic is that Ozempic is going to lead to muscle loss, right? So if you look at Ozempic in the step two trial that they looked at, you do end up with some muscle loss. But you, as a proportion of the total weight, you end up with a greater fat to muscle loss ratio. A lot of that muscle mass can be conserved by doing resistance training while you’re taking that medication. and similarly, the newer version of Ozempic called Monjaro, has another trial called a Mount One trial, and that trial actually showed like a ratio of three to one, loss of fat loss to muscle.
So when we’re talking about all these drugs, looking at the scale as one piece of it, and maximizing that relationship between fat loss and muscle loss, is a crucial component if you’re trying to maintain for, for health and longevity.
Vanessa: And once again, what we promote here is building up that strength for longevity, not only aesthetics and fitness.
Dr. Bastian: Yeah, there’s no, Real way to do spot reduction for fat loss when we’re talking about exercise and training
Vanessa: It’s a combination of exercise, nutrition, sleep, stress management. People say get at least seven to eight hours of sleep. It’s kind of managing it all, right? there’s not one specific thing. I am a big promoter of resistance training. Especially as we get a little older, because our bone mass is going to decrease. We get that through a lot of strength training, but just as, Good is cardiovascular exercise.
So a combination of things, and I’m not talking about HIIT training and doing tons of sprints, but like moderation of things. And it really depends, I think, also where your hormones are at, if you’re going to be doing some HIIT training as well, cause that could change your cortisol levels, which is a stress hormone, which leads to, just hugging and all that fat and not being able to lose it.
So it’s a combination of it all. There’s not one special thing that’s going to do it or if someone says I want to lose, you know, this fat around my belly, it’s driving me crazy. We’re not going to be doing a lot of sit ups. It’s a combination of it all.
Dr. Bastian: Yeah. And I think like, to your point, it’s so person dependent.
Vanessa: Very much
Dr. Bastian: So, you know, for patients who have high insulin resistance, right? We know that insulin is a signaling hormone to your fat cells to hold on to those fat cells more tightly and use glucose as your energy source. And so. You know, for some people who are starting with high levels of insulin and have a long way to go, sometimes that gradual zone two training is a great place to start because they need to build up their mitochondria.
They need to build up their energy and they need to gradually take down those insulin resistance levels. In the same tone, for someone who’s already active, HIT training can be, You know, in my opinion, really effective, cause it’s a very effective way to increase fat metabolism. and then, you know, I think it also helps to increase your fat metabolism burn. Even when you’re done working out.
Vanessa: It’s like strength training too. If you strength train, you’re burning 24 to 48 hours after a lot of just steady base cardio, though, I’m going to argue on that one is just in that moment.
Dr. Bastian:That’s fascinating. I didn’t know that.
Vanessa: Yeah, but then as you were mentioning, just at the beginning, it’s different for everybody, right?
HIIT training might not be the best for women who are perimenopausal. their hormones are all over the place, so that’s just going to stress their bodies out more and make them latch on to everything. So you have to do what works for you.
It might take a little bit of time to. realize what’s working for you. That’s where people get frustrated and they don’t give themselves enough time to realize their body composition is not going to change in six weeks. It could take 12 weeks. It could take five to six months to change.
So you have to continue at something instead of just dropping it right off the bat and saying, Oh, this isn’t working for me. And you only gave it three weeks. Right. It takes time, but you have to realize it does. Yeah.
Dr. Bastian: And, you know, the other thing that I think is really interesting and just from my own learning is the recovery tech that we do here that I generally think helps to take down your cortisol levels.
I actually am a really strong proponent. I think that’s a really big piece to help balance some of these fat loss pieces because When your cortisol is high that signals your insulin to remain high, to avoid that fat loss and fat metabolism So that integrative approach that you’re talking about It just seems like it has to be Implemented in some form or another because it just seems like it’s Really the only way to create some really lasting results. Is that fair?
Vanessa: I agree completely, yes.
Dr. Bastian: I mean medically, I think it’s easy to say things and then you know have some follow up but really, I think a lot of the Change comes from the health coaches and the nutrition team working together. So when you have a patient come in, what do you prefer to do?
Do you prefer to start them on like a more aggressive caloric restriction with intense activity versus a more stepwise change? Like what makes the most sense for most clients?
Vanessa: If we want to set someone up for good results and positive outcomes, a gradual approach is best. we’re not a clinic who’s going to promote, Hey, let’s get ripped for summer and get that bikini body on or competition body on.
Because that is an extreme goal. So we’d like to talk about realistic goals and what to do. those healthy habits look like getting to those different goals. so not an extreme calorie deficit or exercising six days a week. It doesn’t have to be like that because I think people will eventually burn out and it happens time after time.
There’s all these results in the beginning and you’re hitting, you know, these milestones and then people just plateau. Realistic goals, talking about calories, talking about macros, what’s in something, what they’re going to be eating, exercise regime that’s going to work for them, lifestyle, stress management, when they’re going to get in is really, really important. So we take more of that approach. It still happens though that people do end up plateauing and not end up losing after several months. And then we look back and see what they were doing. if they were listening to the plan, if they eliminated too many calories too quickly, if they were exercising, too much, so it’s all about balancing that out and seeing what we can work on.
Cause if they hit it too hard in the beginning, obviously they’re not going to be able to maintain that six months down the line.
Dr. Bastian: The two things that I think generally work very well for our patients is number one, having a really integrative approach, right? So instead of just focusing on severe caloric restriction or just focusing on, intensive exercise, being able to look at some of these other pieces, I think, are really valuable.And then, the other thing that, you know, we keep coming back to is if you’re only, you know, using the scale, you’re kind of missing the point because the aesthetics piece is so crucial, right? I get it. Everybody wants to look good and feel good in their own skin. I think that’s something that we help with, help people with all the time.
The other component is focusing on what that body composition does, to help promote, Your overall health and longevity and so, you know, by focusing more on resistance training, increasing your protein intake, trying to get your insulin levels down. I mean, those all have a massive impact on your overall health, that go way beyond the scale.
Vanessa: In doing so, looking at your lifespan ahead of you, that energy you’re getting from adding in that exercise, changing up your diet. You look at your young, you know, we have some people who are a bit older and have grandkids and they want to keep up with their grandkids and they finally are right.
Because they want to see them grow up. So those are really big wins for people. just to get that energy and go on that hike with their whole family, you know, and they’re the oldest ones there. So a mindset like that is really huge.
Dr. Bastian: Which I think sort of parlays into another really good question, which is like body composition changes, health optimization, longevity, it’s a long term game.
How do you keep people motivated, to sort of maintain that success once they’ve got it?
Vanessa: I think it’s, as we saw, I said before, mindset, you know, and what really in the end does matter. And we’re trying to promote the long term and where you want to be, not just, Hey, I lost that 50 pounds and I look great in these tights.
I put them on when I was in my twenties, you know? So it’s a long term. What is important? Really realizing why I think is a huge, huge thing. And when people know their why, that’s going to be that mental change. And realize it’s not just that weight on the scale.
Dr. Bastian: And you know, like the other thing is when you’re carrying less fat and you have more energy you feel better and that that’s like a noble goal once you start putting in these habits and you really start to feel like yourself again with better energy, some of your hormone balances change, everything just is a little bit more easier to maintain.
Vanessa: And with that comes typically better sleep. Yeah. And we all know how important sleep is and we sleep more. We’re in a better state of mind and just happier and look at things a bit differently, right? Well, thank you so much for talking about body composition and weight loss today. I think it’s a huge topic that we have a lot of questions about, and hopefully we’ve answered a lot of the viewers’ questions.
Dr. Bastian: Yeah, of course. And thanks for hosting, Vanessa. That was wonderful.
Vanessa:Thanks for having me.
