Mini Mikkipedia - Appetite, weightloss and weight maintenance

Hey everyone, it's Mikki here. You're listening to Mini-Mikkipedia on a Monday. And today I just wanna chat to you about a study I saw released last week from Kevin Hall's lab that investigated the impact that different weight loss strategies had on overall appetite. And I think this is super interesting because obviously there are varying approaches that people can take to lose weight,

that weight loss is the hard part. Losing weight is for all intents and purposes pretty simple, but it's keeping it off that people really struggle with. So in light of that, scientists are super interested to determine which method of fat loss might be most effective for being able to maintain the weight that has lost and what actually impacts on that. And we do know that

a large proportion of people that lose weight are unable to keep it off. One of the major side effects, if you like, is hunger that is reported throughout that weight loss journey and of course post the weight loss when they've achieved whatever goal it is that they had. This study by Kevin Hall investigated the impact of different weight loss methods on what is referred to as the lipostat.

And this is the body fat regulatory system in the brain that opposes weight loss efforts. So regardless of what method you use and how you lose weight, we've got this sort of set point in our brain, this lipostat that will fight against our body's set point. And I'm pretty sure that I've talked about the body set point with regards to weight loss before in a mini-micropedia. It's a super interesting concept. And

I do know that I had an interview with Stephen Guernay whose large body of work really did investigate the impact that the brain has on weight loss and how important those messages are that the brain gets as to your ability to lose weight and keep it off. So Kevin Hall's study looked at different weight loss methods and by that I don't mean that they investigated exercise versus weight loss.

a vegan diet versus a paleo diet and all of that. What they did is they investigated the difference between bariatric surgery, between the GLP-1 agonist drugs, which I'll explain in a minute, and also diet and the overall impact this has on the lipostat and the brain opposing the weight loss effort. Now, I'm pretty sure that you'll be familiar with bariatric or weight loss surgery because it has been around for several years.

You may not be as familiar with these glucagon-like peptide drugs that are available on the market to assist in weight loss. Although I suspect if you're interested in this area, you probably would have heard of them and be sort of familiar with what these weight loss drugs do. But I do want to give just a little bit of background. So the GLP-1 drugs, which are also called GLP-1 agonists, are, as I said, shortened names for...

glucagon-like peptide 1 receptor agonists. These receptor agonists mimic a hormone called a GLP-1 in our body that is naturally released in the gastrointestinal tract in response to eating. When we eat a meal, GLP-1 is released. This increases and that theoretically should suppress our appetite and make us not want to eat. When we do eat, our digestive system breaks carbohydrates down into simple sugars that

The GLP-1 triggers the release of insulin from your pancreas. And insulin is a nutrient storage hormone that helps push glucose and fatty acids out of the bloodstream and into our cells, be it our fat cells or our muscle carbohydrate cells. So where they can be used, obviously, for energy or just to be stored for later use. And people with type 2 diabetes, I'm just giving you a little bit of background on these.

GLP-1 agonists, the body cells are resistant to the effects of insulin, so the body doesn't produce enough insulin to cover the demands of the meal and it requires more. GLP-1 agonists stimulate the pancreas to release insulin and suppresses the release of another hormone called glucagon, both of which help control blood sugar levels in people with type 2 diabetes. So the drugs then, the GLP-1 agonist drugs,

also act in the brain to reduce hunger and act on the stomach to delay emptying, so you feel full for a longer time. These effects can lead to weight loss, which can be an important part of managing diabetes, and therefore these GLP-1 agonists were developed and have been used to treat type 2 diabetes for about two decades. However, just more recently, the FDA in the States, and of course now this is available sort of worldwide,

has approved several GLP-1 agonists for weight loss in people with obesity who don't have diabetes, predominantly because of its ability to delay gastric emptying, keep you fuller for longer, you eat less, and you lose weight. And there are a variety of these out on the market. Some of them you would have heard of, such as Ozempic, which is a semi-glutide injection.

Ribelsis, Victoza, Zandia is another one which I have a few clients have been on. So there are a bunch of them and they typically do the same thing. Zandia has an approved use for weight loss as has Wegovi whereas Ozempic and Ribelsis have approved use for type 2 diabetes, but they used off label for weight loss. And essentially they are given either by injection.

There is one pill option, however, and for weight loss, we have seen some pretty dramatic results occur after 3, 6 and even 12 months. Of course, there are some side effects that come with any weight loss drug, and they are only intended for people with severe overweight or obesity. Of course, you probably are familiar that some of these have been termed sort of celebrity drugs and are used by people who may only have...

a little bit of weight to lose, rightly or wrongly. But the reason why I thought that I would tell you a little bit about these GLP-1 agonists is because the study, if I go back to the Kevin Hall study I was referring to, the study looked at using GLP-1 agonists alongside gastric bypass or gastric surgery, alongside diet as to the differences that these may have on appetite and on the lipostat.

Because of course, as I've said, we all know that weight loss is fairly simple, but weight loss maintenance is pretty challenging. And most people who attempt to lose weight using diet and exercise lose some weight. But if we look at the literature, there is quite a bit of regain over time. Not everyone though, and I think I have talked about some of the limitations of the published literature in and around the weight loss area. But a key reason for the inability to keep weight off.

is that the brain contains the lipostat that doesn't want you to lose weight. It's this ancient non-conscious survival circuit and it doesn't care about how well you're fitting into your genes. It is really just concerned with keeping you at this set point for weight. And

Kevin Hall in his study designed a mathematical model that estimated the strength of the feedback control and har hard the brain fights back against weight loss. And this is the point of the study. So the study applied, as I said, to diet-induced weight loss, the new GLP-1 drugs, and bariatric surgery. And the results found that in diet-induced weight loss, people bear the full brunt of the lipostat.

whether they're doing portion control, eating a low fat or a low carbohydrate diet. So the brain fights back hard. For every kilogram of weight lost, the brain cranks up its eating drive by about 83 to 101 calories per day. Whereas for people using the GLP-1 drugs to lose weight, the semi-glutide Wigovie and

reduced this brain response by about half, so to 48 to 49 calories for every kilogram lost. And bariatric surgery reduced it by the same ballpark as the drugs to about 58 calories per kilogram lost. So this suggests, in essence, that an important reason why the GLP-1 based drugs and bariatric surgery are so effective for weight loss is that they

and that appetite to eat is reduced by about half. And it's pretty consistent with the prevailing view among obesity researchers such as Stephen Guernay, who I have interviewed on this podcast, that body fat regulatory circuits in the brain are important in obesity, and they need to be addressed by effective weight loss therapies. So I find this super interesting because weight loss maintenance is such a critical part of...

being successful, right? Because you do not want to be in that yo-yo of losing weight and then having that rebound weight gain. And of course we do know that there are things which make weight loss much more successful and that can help preserve muscle mass, increase BMR, and you get away with eating more calories for the weight that you lose. However, if you have experienced that kind of hunger that occurs when you reach a certain body fat set point,

that might seem very difficult to overcome, then this explains a large part of why, is because your brain is fighting back a lot of the time and it fights back harder with the weight loss experience that you get through changes in diet and exercise alone. I do think there are things that you can do to offset this and Steven and I spoke of this in his podcast and I talk about this all of the time, including having an increased protein amount in your diet.

increasing the volume of food with which you eat. So you're not eating just small portions of energy dense food. You're really putting in like an abundance of vegetables, for example, in your plate, but you're also changing your food environment as well. This is another way to sort of fight back against that brain message that is driving you to eat. Making sure that hyper palatable foods are not in your food environment, that you're putting treat foods, if you like, up outside of eyeline so they're not

As soon as you dive into the pantry, you're not seeing four or five different things that you would love to eat, but you're trying to avoid. I think those things are super important as well. Then of course, when it comes to weight loss maintenance, exercise is key. You absolutely want to be doing strength training to help preserve that muscle mass. Even though it's a slight increase in your basal metabolic rate, you've still got that BMR increase through carrying more muscle.

comes with being active. That's a super critical part of that weight maintenance experience. It's interesting on those GLP-1 drugs, and I will just finish off with this, is there is a lot of chatter about the potential for muscle mass loss when you are on a drug like Zandia, for example. You might get rapid weight loss, but you could also lose a lot of muscle. I do think that that is correct. You can lose a lot of muscle.

However, you can do some things to help protect you against that. Of course, I'm referring to strength work because I do know that for some people who have been on these GLP-1 agonists, they really do lose their appetite and they lose their appetite for protein. You do really want to be quite careful if you're on one of these drugs to ensure that you're still getting adequate protein despite your lack of appetite. That can be really challenging.

And this is when I would definitely look to more liquid-based proteins, protein powder in water, but also being really serious about your strength training. Because again, weight loss is easy, but weight loss maintenance is a lot harder. What Kevin Hall's study or mathematical modeling has shown is that if you lose weight via the

your appetite for weight regain or appetite to eat more food is reduced by half that, then it is through diet alone. But hopefully those couple of strategies I even just mentioned in passing here regarding food volume, hyperbalatable foods in the environment, and of course protein, hopefully this is somewhat helpful. But absolutely go back and listen to the episode I did with Stephen Guenay because there are a lot of really good practical tips in that episode too.

I don't think all is lost when it comes to losing weight and keeping it off. Of course, with my client work and with Mondays Matter, I've seen people be extremely successful at maintaining weight loss for well over a year, which might not seem like a long time in the big scheme of things, but in terms of research and literature, that's actually an extremely long time. That is a long time sort of follow-up period. Anyway.

Hopefully you found that as interesting as I found reading it. It was a bit of a tough read to be honest, but there are some pretty smart people around who do a really great job of interpreting that data. And at the very least, I hope you learned something about GLP-1 agonists if you did not already know that. All right, team, just like to remind you, actually, this week, I'm doing my Anatomy of Fat Loss mini course.

So there is actually still time to sign up. This comes out on Monday. I've started it already, so I would have done my first session on Sunday. But if you signed up now, you would get a recording to that session. And we go into successful weight loss strategies and how to maintain that weight loss. And I talk about the barriers associated with it, but also give you some really practical strategies with how to overcome those barriers.

If you head to my Instagram, threads or Twitter @mikkiwilliden, Facebook @mikkiwillidennutrition or at my website,, you will find information about the course there. All right guys, you have the best week. See you later.