Giles Yeo: Moment 209: The Real Reason You’re Gaining Weight (Even If You’re Exercising!)
嘉宾：Giles Yeo
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With my genetic makeup, how might there be differences in my genetic makeup that make my relationship with food, eating, and weight loss different from yours?
Genetics does not have as good an answer about why different people eat differently aside from cultural differences at the moment. The reason behind that is because it's very difficult to accurately determine what someone has eaten in order to do genetics.
What we do know, because we can actually observe it, is how people of different ethnicities are susceptible to different diseases. Famously, East Asian people and South Asian people—Indians, Pakistanis, Bangladeshis—cannot get as large BMI-wise before becoming at risk of Type 2 diabetes compared to white people or Polynesians, who can get pretty large before they actually end up getting diseases.
That's a classic example where South Asian and East Asian people have a higher predisposition to diabetes even though obesity is not particularly a big thing in their cultures. But then you begin to look at body shape; that does matter as well. Where do you put your fat? Do you tend to put fat on your bum or your tummy? How tall are you? How short are you?
All of these things, which we can see visually, mean there are people who are then susceptible or not susceptible to specific diseases. Other things you can't see, like why African Americans are more likely to end up with cardiovascular heart disease and less likely with diabetes, whereas Indians are more likely—there, we have genetics.
What about in terms of this "obese gene"? I read in chapter two of your book that there is a gene for obesity.
There are more than a thousand genes for body weight. The obese gene in chapter two, which I talk about, is this Leptin gene. It is this gene which lets your brain know how much fat you have. Leptin is the gene that I talk about in chapter two with the "obese" label.
It's called the obese gene because the mouse was called "obese." There was a lack of imagination because the mouse was a naturally occurring mouse that had a mutation in this same gene. Scientists found out what that was and then found that it was conserved in humans. That's where my boss, Stephen O'Rahilly, then came in and found that that gene was also mutated in some humans. So, that's the obese gene. It's the fat gene—meaning the gene from fat—that lets your brain know how much fat you have.
And is that possible to be not just on or off, but slightly defective? So some people can just get a little bit more hungry than others, or is it a binary thing?
Leptin, for whatever odd reason, is pretty much binary. If you have a little bit of it, you're fine; if you have none of it, you're not. However, there is obviously a pathway. Leptin signals to the brain, which signals to something else.
There is another gene that I looked at called MC4R. It's part of the pathway; it's part of the same fat-sensing pathway. That is a rheostat, like a thermostat. We have found thousands of different mutations in this gene. You can imagine that depending on the severity of the dysfunction—some are completely dead, some are 70% functional—we can predict how much someone will eat in a test buffet meal scenario.
We now know that 0.3% in this country—so 200,000 people in the UK and a million people in the United States—will carry mutations in this MC4R gene, making them more likely to end up with obesity. At 18 years old, if you carry a mutation in this MC4R gene, you are on average 18 kilos (40 pounds) heavier than average.
It's not super common; it's still 99.7% of the people whose body weight is not determined by this. But there are a lot of people's body weights that are dependent on this specific gene. It is a tunable system. A little bit or a lot means that you're either slightly heavier or a lot heavier.
I'm thinking of how families often look quite similar in terms of body shape and size. I'm wondering how much control they have against fighting those genes to get, say, six-pack abs—not saying that's a sustainable or healthy place to get to—but is it significantly harder for certain people if their family is maybe a little bit more large to fight against that, get to a different state, and then stay in that state?
Undoubtedly so. There is certainly what we call—it used to be called the "set point hypothesis"—meaning that each of us has a weight we actually protect. It's probably more nuanced than that; it's a set range. There's a range that you can actually move within that we find easy to keep to.
For example, I'm not thinking about my body weight at the moment, and this is the weight that I am, but I wish I was half a stone or a stone lighter. If I lost that half a stone, I would then have to think about food all the time to keep that half a stone off. Whereas if I gain half a stone more, I don't raise my weight anymore. That's the idea that there's a weight range that is easy to protect, and each of us is different.
There are some people who are skinny, and some people who just find it more difficult to say no to food than others. That's pretty much it. Some people's thermostat for food is set a little higher than others, and you defend that thermostat—25 degrees versus 20 degrees. There's really next to nothing you can do. You can shift from 25 to 24.5, and maybe after Christmas, you're 25.5, but the likelihood of you getting down to 20 and staying there—you can get down to 20 if you do some stupid diet, but the moment you stop, you ping right back up again.
We do defend our weight. There is very little "choice," in inverted commas, in where we end up with body weight over a lifetime. In any given meal, we have a choice—pizza or no pizza—but over thousands of feeding events, there's very little choice.
What then—you reference age there. Do we get fatter with age? Generally, I look at younger people and they typically have a slightly leaner physique, and then something seems to happen along the way. Is that just a false observation I have, or is there some science that supports gaining weight as we age?
There is science. Weight is inexorably up, even though we've stopped growing when we're 18 years old. Actually, there's some latest science. If you had asked me the question five years ago, I would have said that by the time we hit 40 or 50, our metabolism starts to dip. As it turns out, that's not true. Our metabolism doesn't start to dip until we're 60.
But what happens as we get older are a number of different things. First of all, we tend to get richer; we have more money. We tend to sit on our arse more just in terms of the type of jobs we do. Because of both of those things, we tend to exercise less because we're busier, and so we lose muscle mass. Those are all three things.
Metabolically, the most active part of your body is the muscle. When you're younger and you're doing things and you have more time to go to the gym, your metabolic rate is linked to the amount of muscle you have. As you get older, you sit more, you eat a bit more, and we can buy richer food because we've got more money, and you begin to lose muscle mass. All of those things put together mean that you inexorably become larger. Then what happens at 60 years old is your metabolism then starts to drop as well, and then you get even larger middle-aged spread.
On that point about the more muscles you have, the higher your metabolism—does that mean if I've got big muscles, then I'm burning my food faster? Fantastic news. I'm going to work out later and lift some weights. I was really startled by that. After I read it in your book about us gaining more and more weight as we age, I Googled it, and the Agency for Healthcare Research and Quality said that we naturally tend to gain weight as we age to the tune of one to two pounds per year.
That's completely accurate. The numbers that we have—I think that's right—between 20 and 50 years old, those 30 years intervening, the average person will gain about 15 kilos in weight, which is 32 pounds. Yes, one to two pounds a year. Some gain very little; others gain a hell of a lot more.
I don't want to be that guy. What can I do to try and stay—for me, it's not really about the weight thing or how you look. It's more about being athletic and strong. I was in Indonesia a couple of months ago and there was this big set of stairs leading down to a lake. I remember thinking, "God, if I wasn't athletic and didn't have good knees, there's no way I'd be able to get down these stairs to go on this boat trip."
I got to the bottom and turned to the person I was with and said, "That's why I've got to stay in shape for as long as I can." I want to do these boat trips and rafting things, but I won't be able to access them unless I can go up and down those stairs. So that's what I care about. From what you've said about gravity and weight, being overweight is going to inhibit my chances of being able to do those stairs.
There are two elements there. First of all, there is doing the things that we want to do, like that. You're exactly right. These are the things which—I can still do that, I can still walk up or down a mountain because I'm still fit enough to do that and I want to stay as fit as long as I can. Weight will inhibit that, undoubtedly.
But then there's a second element to actually consider. We want to live longer, but healthier for longer. Undoubtedly, the thing that is closest related to health when you age is not your total weight—though there's a role to play there—it's the amount of muscle you have. It is your muscle mass as you age, independent of how much fat you have, that will determine how healthy you are as you age.
As you get older, the most crucial bit of information is to maintain resistance training. Not heavy powerlifting, but sitting on a wall, getting up and down a chair, because that—the amount of muscle mass you have—really marks the level of health that you're going to get. The science is startling; it is so related, independent of weight. So muscle mass is the most important for healthy aging the moment you get to 60 or 70 plus.
Interesting. Okay, so I'll keep doing resistance training and lifting weights as long as I can.
Correct. Always keep resistance training. At some point, you won't be able to lift weights just because—
Well, I don't know! Don't write me off. That's the hubris of youth and the naivety of youth. You just assume you'll always be able to do what you can do now.
I think a lot of people will watch this podcast because, especially this time of year in January, they'll probably be trying to find ways that they can cut fat. They want to be a bit skinner. You said you want to lose half a stone; I'm in the same place. What is the way that you would suggest to do that? The simple way. Not the complicated "go buy this guy's course and do three million sit-ups" way. What is the simple advice you'd give someone hoping to create sustainable weight loss?
This is like the last page of the *Why Calories Don't Count* book, but it is a set of numbers you can apply to whatever diet you like. The first is the amount of protein you eat. You need to try and focus on trying to keep to about 16% of the energy in your day from protein. 16% is a sweet spot. If you eat too much and you're not lifting, you're stressing your kidneys because they have to get rid of the nitrogen from the protein. It doesn't mean steaks only; it can be beans, tofu, any kind of protein. 16%.
Second is fiber. We need to eat as much fiber as physically possible. 30 grams is what we want to aim for, although on average in this country, we're probably only eating 15 grams. We need to double the amount of fiber we actually eat.
Third, we need to limit the amount of added sugars into our diet. Added sugars meaning sugars not tied up in fiber. Powdered stuff, maple syrup, agave nectar—all those are added sugars. Keep it to 5% or less of the energy content in your day. Those are the three numbers I want you to think about: 16% protein, 30 grams of fiber, and 5% or less of added sugars. Apply that to whatever you want to do—Keto, whatever—and I think that will be a sustainable, healthy way to eat.
Now there's been a lot said about exercise as a weight loss strategy. A lot of people think, "I will just run every day and I'll lose weight." In your books, you said the problem with using exercise as a weight loss strategy is that doing exercise makes you feel hungry; you can't outrun a bad diet. Is exercise a good strategy for weight loss?
It is a good strategy for weight loss if you're an Olympic athlete or a Tour de France rider.
What if you are a "muggle" like me?
A muggle like you or a muggle like me—then exercise... Look, you can never replace the goodness and health benefits of exercise. But is exercise a good weight loss strategy for a muggle like Steve? No. It's a good weight maintenance tool, though.
Once you've lost the weight—which means you need to eat less somehow—exercise helps you keep the weight off. Once you've actually lost the weight that you're aiming for, then do the exercise, and that will help keep the weight off. But it's not going to help me get the weight off in the first place.
That seems to sit in contradiction to what my old personal trainer said.
Only because we don't do it enough! Now, the way that it *would* work is if you had a personal trainer and a chef. Then your personal trainer would make you work hard, and your chef would make your meal. Therefore, it's controlled on both sides. That is not typically what happens in the real world.
I go on my run or my cycle, I come back ravenously hungry, I open the fridge, and I stuff my mouth full of carbs. That is my story. It is very difficult to control your diet after you've done long, hard exercise bouts because you get ravenously hungry. Professional sports teams exercise ridiculously—they train three times a day—but they still have chefs and dietitians, and they eat what the canteen puts out for them, which is healthy food.
Someone is looking after their diet for them, and they are burning so much that they don't have to worry too much about how much they eat, whereas we do. It's purely because we don't exercise enough.
And is that also ultimately because the brain is controlling our feeding behavior? The brain knows that we've just been for a run, so it's adding to our appetite a surplus to make us return to that weight it's trying to protect?
There's that, and there's also our own internal psychology on it. Now you feel a bit smug. You say, "I went for my run on Sunday morning, so I can eat what I want." There's that element too. Suddenly, when you normally would say, "I'd better not eat so much today," those internal controls are weakened once we've had our exercise because we feel that we have earned the food that's in front of us.
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