Overweight Doesn't Mean Unhealthy: Beyond the Scale! ft. Dr. Jennifer L. Temple, PhD

I have gotten to a place where I am no longer comfortable telling people to try and fight what their bodies are telling them, right? Body is telling you that it's hungry. You need to eat something. I think 15 years ago, I might have said something like, you need to have more willpower. You need to fight the urge to eat. And now I'm like, absolutely not. You need to listen to your body. Now that doesn't mean that if your body is telling you to eat that you should eat Oreos, you should, your body's telling you that it's hungry. You should do some reflection on what kind of food is gonna make your body feel good. - I like that approach so much better. - Yeah, what kind of food is gonna make your body feel satisfied? What kind of food is going to, to taste good, to feel good? What kind of food is gonna make your body feel good an hour after you eat it? 'Cause I'll tell you what, like a five guys cheeseburger is gonna taste amazing. - Every time I eat it. - And then an hour later, my body is gonna feel terrible. And so keeping that in mind, like not just thinking about what's gonna be pleasurable in the moment, but what is gonna fuel my body in a way that's gonna continue to make my body feel good? Help support what I want my body to do later. Like if I wanna go for a run or if I wanna make sure that I get a good night's sleep, like what food can I eat now that's gonna help me be able to do those things later? - All right, three, two, one. Welcome back to Bull's Rise. My name is Dr. Perry, now the absolute blessing to have an absolute legend on the podcast today when it comes to nutrition. And she's actually the first one who's representing the nutrition department and there's no one better in this case. So let's start with the hooks, we can introduce her, huh? For 10 years, a researcher studied the effects of caffeine on children and adolescents. She went into the research fully expecting to find harmful effects. After all, that's what everyone assumes. placebo control, double blind dose response studies, rigorous science and the conclusion, the effects are relatively mild, not harmful, not what she expected. This is what happens when you let evidence challenge your assumptions. Today's guest has built a career on discovering that things are rarely as simple as pop culture wants them to be and she's about to challenge some deeply held beliefs about food, weight and health. Welcome Dr. Jen Temple. - What an amazing introduction. - Do you like that? (laughing) - I love it. - How you doing? - I'm doing great, how are you? - You've been hiding in your office or like the Dean's office this year. I could barely find you. - Fine. - What are you working on right now? Now I know that you've been writing some things, getting some things ready for research. What are some big things you're working on right now? - So right now I'm working on, so in August I started as the Associate Dean for Academic and Student Affairs in the school. So a lot of my time has been spent on that position, learning about all the different programs, learning about undergraduate programs, working on trying to improve enrollment. So really doing a lot of listening and I guess trying to come up with some innovative ideas to connect with students and to grow our enrollment. For a research perspective, I am trying like a lot of people to understand the impact of the new GLP-1 receptor agonists. Not as much on weight, we know they're really useful for weight loss, but more about what it's doing to people's motivation to eat, which is what my area of research has been. So trying to understand some of those relationships, the mechanisms by which it's having its effect. And then what can we do to help people sustain the weight loss that those drugs are leading to? Which again, I think these drugs have been life changing for members of my family included, but how can we help people have life long, sustain the weight loss? - That's some of the stuff we're doing. - That's such a hot topic that we're gonna have to have you back for because I think that's something that not only our students are interested in, but I know our staff, fellow faculty, in our community as well who deal with a lot of these issues that are so prominent nowadays. And so, but before we get there, we gotta talk about how you got to be your start. And so for those of you who don't know, she did say, she's the associate dean of academic and student affairs, but she's also an awesome professor in our department, her research focuses like she said on understanding why people eat the things that they do and how experience is like food insecurity and stress, impact eating decisions. So spending 15 years studying a phenomenon called sentatization, let's get back to where it all started. So your graduate and postdoctoral work was highly mechanistic, animal models, cellular models, but you were moving too far away from something. What was that? - Yeah, so my bachelor's degree is actually in psychology. So I started college pre-med like a lot of people and then became really interested in understanding the human brain and behavior and what motivates people to do different things. And so as an undergraduate, I changed my major to psychology. And then when I went to graduate school, I studied neuroscience. And so I worked in animal models, studying animal behavior. And then I went even smaller in my first postdoc where I was studying cellular aspects of the brain. And the further I moved away from people, the harder time, I had a harder time connecting with the work I was doing. Like I really value basic science and I don't think that all scientific research has to be about a human disease or even has to be directly tied to something human. I think there's a lot of value in understanding how the body works, how the brain works, how the cells work. But for me personally, for my interests, for what I like to think about, what I like to read about, I felt really disconnected from the things that got me excited about studying the brain to begin with. And so I decided to look for an opportunity to do more postdoctoral training in humans. And so I came here to UB to do a postdoc in behavioral medicine with Dr. O'Rilland Epstein. And I reached out to him and I was like, I think I might want to study humans. And he was like, I just got a grant to study the genetics of the dopamine system. And I don't know much about genetics or dopamine. And I'm like, well, I don't know much about studying people. And so we came together and that was the beginning of an ongoing relationship that we had for over 20 years of collaborating together. But it was the right time for both of us to collaborate. And that really started this journey where I started, not only did I learn about experimental design and statistics, some of the stuff that was weak, but I started engaging with people and talking to my first research was on eight to 12 year olds. And I started asking kids about their, what they had to eat and drink the day before. And so many kids were like talking about soda or frappuccino's or coffee and I was like, this can't be good. And so I went to the literature to say, what do we know about the effect of caffeine in kids? And there was not a ton of rigorous science out there. And so I asked Lynn if I could have a little pot of money to do some pilot studies. And that was the beginning of my program of research for a long time was I want to see what the impact is. And so I did some pilot work in 12 to 17 year olds. And that was the foundation for a grant that I got for a five year grant to study. Again, you mentioned in your introduction about these double blind placebo control dose response studies where we were really trying to understand the broad effects of caffeine. So caffeine on physiology, caffeine on mood, caffeine on the reinforcing properties of foods and drinks that it's paired with. And so we did that work for a long time. Then we got another five year grant to continue that work. And so that's how I got started. And broadly thinking about what influences people's decisions around what they eat and drink. And that was actually, I think the big takeaway from that 10 year research program was that caffeine at the amounts that kids are drinking, a canter to a soda day, even a cup of coffee, it doesn't have these huge harms if the kids have our healthy to begin with. But what we did find was that it had a strong impact on their desire to drink beverages that it was paired with. So when we compare their motivation for non-caffeinated versus caffeinated drinks, they shifted their preference toward the caffeinated drinks without even being able to articulate. They didn't know how caffeine in it. But there was something about it when they had experience with those drinks that made them more enticing to them, especially the boys that we found these sex differences. And so even though from a cardiovascular perspective or a subjective perspective, there weren't these huge effects of the caffeine, it really did shift their motivation toward caffeinated beverages. And so we started thinking about why the beverage companies add caffeine to beverages. And-- Interesting. The food companies have a ton of internal research on this stuff. And so we began to suspect that they added to these beverages because it makes people want to drink the beverages more. And then they can sell more beverages. And buy them more. Right? And so that was the beginning of that work. But that work fizzled out as the opioid epidemic became more serious. The shifting from the federal government, caffeine was deprioritized. And opioid research was shifted up in priority. And so we weren't able to continue finding that line of work. But in parallel, I maintain this interest in what drives people to drink. And so we shifted toward looking more at food and eating behavior and then how that is related to weight change, health, overall. And that's where we got into this sensation research that you hinted at. Which is a perfect segue. So well, I want to come back eventually to talk about the different types of sources of caffeine. And why people are-- I can pretty much gather why someone wants a frappuccino over a glass of water. When it's delicious and it gives an enticing effect and just that little kick of "Ooh, I give you that sense of dopamine feeling and that serotonin happiness to be like, I need my frappuccino." Right, and you're so like focused and you have a little more energy. So going into sensitization now, and this is something that I'm sure a lot of our body building grows and be like, "So how much caffeine can I have per day before I have to take a break off? We'll get there. Let's focus on the research first." And so with your research focusing on sensitization, walk us through what that is and why it matters. Yeah, so sensitization is a term that is used. It's a very broad term. And basically what it means is it's an increase in wanting something. It's an increase in a response after a repeated exposure to a stimulus. That's really broadly. So, a lot of times we think about, when we think about sensory systems in the brain, a lot of times what is the opposite effect? So the best way to talk about the opposite of sensitization is habituation. And the best thing that most people can relate to is if you walk into a room and there's something that smells really bad. Let's say the garbage really needs to be taken out and you walk into the room and it smells, when you first walk in, it smells really bad. But if you can stand it to hang out in the room for a minute or two, you habituate to the smell. It doesn't smell that bad anymore. This is an important property of the nervous system because you don't want your brain to be like, this smells bad. Like it's, you want it to be like, this smells bad. I've alerted you to it. But now I'm going to stop responding at that high level so that you can be primed to respond to a different stimulus that comes in right. We're typically primed for change, to respond to change. So that's really tangential to the answer about sensitization. So sensitization is the opposite. It is, you're going to be exposed to the same stimulus over and over again, but instead of decreasing your response, you actually increase your response. And there is a theory that has mostly been applied to the substance use literature called incentive sensitization theory, which basically says that for a subset of people, so if we think about substance use, a lot of people dabble in substance use, right? You try, you try caffeine, you try cigarettes, you try vaping, you try, maybe some people try cocaine or whatever. A lot of people try drugs, but don't escalate their substance use. And then there's a subset of those people that like do it more frequently, they'll escalate substance use, but they don't ever develop substance use disorder. And then of those people, there's a smaller subset that actually develop into substance use disorder and they become addicted. And there's a theory that those people actually have an increase. So every time they are exposed to, let's say cocaine or opioids, they actually have a heightened response to it. Fascinating. And that those people that have that sensitization to the drug stimulus are actually the ones that are at very high risk for substance use disorder because they need more and more, and they have a heightened response. So when I first, so actually that isn't how I got into this and so I should probably back up. And I first shifted to thinking about food as opposed to caffeine. One of the ideas I had, and there's a large literature on this, when you restrict people, you tell them they can't have food, especially if they really like, they end up wanting it a lot more. And then after a period of restriction, they end up having disinhibited eating where they can't help themselves, they eat it and then they tend to oory, they tend to fall off the wagon, they tend to go off their diet and revert back to their former eating habits. And so my idea was, well, what if instead of restricting people, we tell people they have to eat the food that they like. So let's have a conversation with people about a food that they just can't resist and try to make eating that food every day fit within a calorie or certain diet. So people could stick with their weight loss goals, but not feel deprived from their M&M's. And so we wanted to do a proof of concept study. So to see if this would even shift motivation. So we did a study in healthy adult women. And we randomized them to two different periods, two different interventions. It was a crossover study where they were randomized to a period of time where they were not allowed to have the food that they liked. And then they had another two week period where they had to eat it every day. And we did it in a randomized order. So half the people got the eat it every day, think, condition first and half the people got the restriction period first. And we just measured how motivated they were to get the food. This is a technique that we use in my lab, in Lenevcene's lab, in Kiting Londtikin's lab. And it's adapted from animal research where in animals, you want to know how motivated an animal is to get a food or a drug or a stimulus. You have them press a lever for it. So you have to press a lever, let's say five times and you get a little sugar pellet. And if you want another sugar pellet, you have to press a lever again. We do the same thing in people. We have to press a mouse button. The first reward takes 20 mouse button presses, then you get a little pile of MNAMs. And if you want another pile of MNAMs, you got to press the mouse button 40 times. And if you want another pile, you get to press that 80 times. And it's really easy in the beginning. People get several piles of MNAMs. And then after a while, they're clicking and they're like, it's really taken a while. Is it really worth it? Right? That's what we're trying to see. And some people are like, no, it's not worth it. I've got my three piles of MNAMs. I want, and then other people will work for four, five, six, seven, eight. Never had anyone work for nine. Takes about 30 minutes of continuous mouse button clicking to get to that ninth one. Never had anyone that motivated, but people will push the mouse button a lot. And so that is how we assess motivation to get the food. And so we assess this motivation. I always use MNAMs because of all the foods we use. It's the one I like the most. But so we assess baseline motivation. And then we see if we can push it around. So, okay, how does your motivation change if I tell you you can't? Not only can you not have MNAMs, but you can't have other kinds of chocolate, right? We want people to feel really deprived from the chocolate. And then they come back in and usually that restriction leads to an increase in motivation to get them in MNAMs. So then we were like, okay, well, what happens if we make you eat it every day? And then that first study with healthy, with women who were healthy way after they ate it every day, they didn't, they came back in and they were like, I don't want a single MNAM. I don't ever want to see a MNAM again. I don't want to push any buttons for MNAM. And their motivation really tanked. And that was what our hypothesis was. And this is amazing. So let's do this study again, but let's do it in people within without obesity. And then let's also add a dose response element to it. So let's have a group that doesn't get any food. So a zero calorie group. And then let's have another one that's 100 calorie calories. So something that would be more in line with what you could feasibly do with an energy restricted diet. So you could eat a hundred calories a moment M's every day and not disrupt your energy restriction. And the original amount we used was 300 calories. So let's also have a 300 calorie group. When we did that, we found that there was no difference in the zero or a hundred calorie group. The hundred calorie group did not suppress motivation at all. People still worked about as hard for the hundred calorie. But when we got to the 300 calorie group, we saw that the people with healthy way decreased their motivation after eating the 300 calories of whatever their food, it would be MNAM's for me every day for two weeks. But the people with overweight and obesity actually increased their responding. So they respond for MNAM's, then they eat MNAM's every day for two weeks and then they come back and they wanted the MNAM's more. They worked harder for the MNAM's. So obviously, as a scientist, I'm like, well, this can't be real. Obviously, we just did the wrong. And so we're like, let's do that again. Let's do that same study design. And of course, you don't want to do the same exact study. Replication is really important. But we're like, okay, we're going to take this condition where it was not this. And now we're going to randomize some people to MNAM's or another unhealthy food that they enjoy eating, or we're going to randomize them to a healthy food. Because maybe if we can do this with MNAM's, we can also do it with carrots. And we replicated the study and we found carrots don't work as well. People don't increase their motivation for carrots as easily as some people do. But it's pretty rare. But we found the same thing again where the people with healthy weight decreased their responding after they ate the food every day for two weeks, but the people with overweight or obesity increased their responding. So this was the second replication of this. So we did it one more time and we found the same thing a third time. And so I was like, okay, this is a thing that is happening. And so we started to, when we were writing up the results of these papers, we started to look at the literature, which is where we found this incentive sensitization theory, right? So that wasn't, that was an unanticipated response because I, my hypothesis was that after you eat this food every day for two weeks, you're not going to want it as much. So when we saw the motivation increase, we went to the literature and we found this literature that supported this idea that I subset. And it wasn't like it was everybody with overweight or obesity. It was about 30 to 40 percent of the people with overweight or obesity. So we started to really study this phenomenon and we wrote a grant to study this in kids actually because we wanted to capture kids before they were overweight or obese. So we wanted to look and see if it could actually, if kids with this behavioral phenotype gain more weight over time. And so we got a grant to study that. And so we did that for five years. It was called the UBSNAC study, the study of nutrition and activity in kids. A lot of my time is spent coming up with acronyms for our studies. And so, the snack was, UBS great. Actually, it's really great for acronyms because you can put UBE in front of anything and it's Y-O-U-B-E and not just UBE. And so it's like, UBSNAC and UBE and UBE. So whenever we're doing a study, we try to have it be something like that. we do. We did that study, that snack study, we snacked study for five years, and at the end of that study, we found that we found the same effect, we found the kids with this sensitization phenotype, gained more weight over two years than kids without it. But we also found that the kids at the highest risk for excess weight gain were kids from food and secure households. And we didn't have a lot of power in that study. We had 240 kids that we recruited for that study, but only 38 of them came from food and secure households. So we wrote another grant to study lower income families and to study kids with them without food and security, which is the grant we're currently finishing right now. It's called UBE, Eats, UBE Eating in Act, and Activity and Teens Study. And so we're in the final stages. We actually are finishing up our final two year follow-up visits next month, and then we'll have all those data to analyze. But that study will allow us to see what the impact of food and security, home food environment, and also we've looked at things like perceived stress that we know could have a larger impact on people from lower income households. - So this stellar, this really fascinating. And so what my brain's going to as far as from a practical standpoint, so this has been building for 15 years. You've been looking at this research and I've been finding more and more practical takeaways from this. Let's say someone's listening to this and they start to say, "Wow, that's fascinating. Could that be why I can't stop eating Doritos or can't stop going for?" Even when I try my best, especially with dietary practices, what are some kind of practical applications here as far as, if someone, how does someone figure out if they're sensitive to food in this way? Or what should they do? Is this monofilable? Can someone change their sensitization response in this way? - Yeah, that's such a great question. And the unfortunate answer is we don't know, but there does seem to be something about, again, if we look back at that dose response study, there does seem to be something where that sensitization relies on a certain threshold amount that people are eating every day. So when we asked people to eat 100 calories a day, they didn't show this sensitization response. And this is also consistent with the substance use literature that there are subthreshold doses. They don't elicit this sensitization response. So if people seem like they're particularly drawn to certain foods that they can't resist those foods, I think an approach would be to maybe not feel like you need to resist those foods, but maybe try to eat less of them. Or to try to come up with options that are equally pleasurable that you could maybe act as a substitute. Like my brain is telling me I really want Doritos right now, but I'm gonna have, I don't know, like, maybe carrots are not a substitute for Doritos if I need a stretch, but try to think about something healthier that could substitute. And this is gonna sound crazy, but I really love those sweetest batch blackberries. - Yeah. - And I would not normally tell you that blackberries are a good substitute for girls' cow cookies. But for me, for me they are. Like that, like finding a food that is healthy, but that feels like a treat, like they're a little bit pricey, they're not available all the time. But when I have those around, I find that I am able to be like, I'm feeling like I want something sweet right now. I want a little treat right now. I'm gonna have these blackberries and said, or I'm gonna have two thinments and some blackberries instead of having a half a sleeve of the men's. - Right. - So I don't, I'm very, and I feel like I'm jumping all over the place and maybe you'll get to this. - Oh no, you're fine. But I really have come to in my time of thinking about reading, about studying, about weight and obesity. Your body is telling you that it's hungry, you need to eat something. Now that doesn't mean that if your body is telling you to eat that you should eat Oreos, you should, your body's telling you that it's hungry, you should do some reflection on what kind of food is gonna make your body feel good. What kind of food is going to taste good to feel good? - Every time. - And an hour later, my body is gonna feel terrible. If I wanna go for a run or if I wanna make sure that I get a good night's sleep, like what food can I eat now that's gonna help me be able to do those things later? - I love that approach that you just said, particularly around willpower. And so I love reading environmental psychology and how willpower doesn't work. And so Benjamin Hardy did research in this area. And so related to obesity, how is it like, if you put your foot even 10% out the door then changing 100% of who you are, you're leaving that amount of time to where you'll be able to potentially come back and resort to those poor habits that used to engage in. And so what is it that you do in this case? And I love the non-restricted approach when it comes to have the thin mint, just don't have the whole sleeve. And so I have this fear all the time because Kelly and I just went to a one of our UB basketball games came outside and there's telling girls cow cookies out there and she having cravings was going over there and she's, I gotta get some. And just know because I don't trust myself for raw adventure fools or peanut butter. And so in this way it's saying, "Okay, I can have two adventure fools as long as I pair it with a couple blueberries or some celery to go along with, that's gonna give me the fiber to potentially stay more satiated." And so how much nuance is there in that though when it comes to the, 'cause I did like your take though as far as fueling your body. And so that's something that a body builder would say all the time, is, "Are you fueling your body in the right way?" And how it's gonna help you perform and work out the next day. And that's how I tell my clients, is look for future prognostication here on your performance. If you know it's not gonna serve you, then. - I think it's a really great approach to conserve everybody, but I will say that as somebody that has been trying to live and eat this way, it is an active process. And it involves some, I don't even wanna say backsliding because I think it's all part of the journey. But it involves making some choices that an hour or two later, feel like the wrong choice. Because that's part of the learning experience. And so I have been on this journey personally for a few years where I am no longer willing to endure being hungry. That feels foolish to me. I try to always make sure I have, if you look at my lunches like whatever the leftovers from last night were. And baby carrots, some kind of fruit, like right now I have strawberries and then I'll have some clementines. - And. - Who's always bringing the clementines in their fridge? - I always have clementines. And so that when I feel hungry, I have a lot of options to eat that are gonna be healthy options. And so I am unwilling to endure being hungry, but I certainly, people are always, when people are like, "What do you do?" I'm like, "I'm a professor." And then they're like, "What do you teach?" And I'm like, "Natrition." And then they're like, "They wanna tell me some, usually some crazy diet that they're doing." But they want, "Oh, you must eat really healthy." And I'm like, "I try to eat a lot of fruits and vegetables. I will also tell you that I have some kind of food with a lot of added sugar every single day." It might not be a lot, but I will have, usually at the end of the day, I will have a scoop of ice cream. I will have a couple of calscacoes. I will have a brownie. I love sweet food. And I have found that I can feel perfectly fine and healthy with eating like some small amount of sweet food every day as long as the rest of my day has been really healthy. So I strive to eat a large amount of fruits and vegetables every day. If I'm getting enough fruits and vegetables, if I'm getting enough lean protein, and I wanna have a scoop of ice cream at the end of the day, my body feels good. And I feel satisfied eating that way, but it's different for every single person. And you have to, I have to endure, don't have to. I choose to endure. There are times when I overeat. And I'm in the middle of, especially when I go, I hardly ever go out to eat, right? So we're interviewing all these faculty candidates. We're going out, the food is delicious. And I get to a point where I'm like, I'm full. My body is full, but this food tastes so good, and I'm gonna eat, I'm gonna finish it. I'm gonna eat more of it. And then I get home and I'm like, that was a huge mistake. I have trouble falling asleep. My body doesn't feel good. And I have to remember that next time you go out, it was at worth it. And sometimes it's 100%. That was absolutely worth it. But that, it's all part of this learning process about really going inward and listening to your body and giving your body what it wants and what feels good. And I think that any person listening to this, I don't care how old you are, I don't care how much you weigh, I don't care how much you lift. If every single person tried to give their body what their body needed, I think we would all be healthier. We might not all be skinny, but I think we would all be healthier. - This is such a radical from a good perspective approach and insight to this. And so what you basically described is the journey that it takes to build a good relationship with food. Because the fact that you had those thoughts, when you came home saying, oh man, this is gonna be terrible. for sleep don't tell Coach P. - Yeah, exactly. - And then how I'm gonna perform the next day, someone who hasn't built that relationship would not have reflected in that way, and potentially would have woken up the next morning, well that sucks, okay, what time are doing it tomorrow? - Right. - And so, and that's what starts that cascade. So, you know, it's really enlightening to hear, and awesome to hear someone from your stature of professional and where you are in nutrition to be able to say that it's really about the journey and the relationship, and I'm not perfect, but that's okay. Because if I tried to be, then maybe there's a less likelihood that I would succeed. - Right, but I think that this whole experience for me has also grown out of, let's interrogate why, and I think this can be true for men, but I think it's especially true for women. Why do we have such a terrible relationship with food? Why have, and I am somebody who grew up in the '90s, right? So, I grew up in the '90s where the thin ideal was like a moss, right? That like women were told that in order to be valuable in order to be beautiful, our bodies need to be small. We need to be small and quiet and make ourselves like disappear. And it is a radical idea that you should want to take up space. And so I've really wrestled with the origin of women's desire to be smaller. And so that has led to a persistent and pervasive very poor relationship with food. Food is something that we're fighting against. We're fighting against food that tastes good, or food that we desire. And my research would suggest that when you are fighting against it, when you're restricting it, all that does is make you want it more. Right. So we have to not necessarily eat it all the time, but we need to get to a place where we don't have to fight that. If you want to eat something sweet, just but then think about was that the best choice without? Does that again, what do you want to do later? How are you going to feel good doing that thing and then eat the foods that make you feel good? And I am not, I'm not a dietician. And I'm not somebody who has done a lot of work in the intuitive eating space. But when you hear people, and I love listening to people talk about intuitive eating, which is this idea, listen to your body. And they will say when people are like, I couldn't possibly do that because I would just eat the whole bag of Doritos. I would eat the whole sleeve of girls' alcoquies. And people just don't do that, actually. If you really just let yourself, you might do it in the beginning, especially if you've been really restricted, you might feel this freedom to come from, I can eat whatever I want. But over time, you really migrate back to like, when you eat that way, it doesn't feel good. And that would connect right back to you saying the beginning was sensitization, right? It would just get to the point where they just don't want these anymore. Yeah. And so most people, even if they do that, most people get to the point where they're like, but it's all a journey of if you have a really, if you've had a really restrictive, really negative relationship with food, and you decide to go down this journey where you're going to listen to your body, you may have a period of time where you are eating a lot of Doritos or eating a lot of Oreos or whatever. But if you continue to listen to your body, and your goal is to feed your body what it needs to be healthy, then you will eventually get back to a place where you, you fill your diet with the foods that are fueling you appropriately. So I just, I think the way that I approach it is, again, people are always asking me like, what should I eat? And again, not a diet, I always say I'm not a dietitian, but you know, what has served me, and I think what most dietitians would recommend is eat real food, eat a lot of plants, lean protein, drink a lot of water, get enough sleep. This is how to be healthy. It's so born. The basics. It's basics. It's boring. This message has not changed. It has not changed. And yet everyone on social media is looking for something that will get them something in 24 hours. Yes. I don't want to risk, I don't want to have to think about what I eat. I don't want to have people who don't want to exercise. Don't get me started on that. That's not even my area of research by people. They want to keep doing what they're doing, but also lose weight. Right. And maybe weight less than be the goal. Now, not to segue from this conversation, because I could talk to you for hours about the relationship with food and to it of eating. So I've already decided, what have you back to talk about that? But to segue back now into your changed mind how caffeine isn't the villain. And I'm pumped for this because I am a Tim Horton snob myself. I never used to be though. I'm totally getting a bop. I was about to say, you didn't even know about Tim Horton's eating. You knew it existed until I met someone with the initials KC now P. Well, I'll have to excuse my favorite person. But a lot of your researchers don't know caffeine. And so you studied the effects on children for many years expecting to find harm, but didn't find that. What did you actually find? Well, again, we found that there were-- there's physiological effects to caffeine, right? You give caffeine and it affects your heart rate, it affects your blood pressure. And we found all those effects in kids. And we found dose response effects, but we're talking about an increase in blood pressure of five to seven millimeters of mercury, right? You're not taking kids from a normal, intensive to a hypertensive state. Like it's not that radical, the change in heart rate, not that much, five beats per minute. So-- and that's it, 200 milligrams doses that we were giving these kids. That's two cups of coffee. Like we weren't able-- again, these studies were done in a well-controlled environment, but they're also approved by the IRB. We couldn't give kids four, five, 600 milligrams of caffeine. So there are doses of caffeine that are very harmful to anybody. So the FDA says that 400 milligrams of caffeine is considered safe for healthy adults. The FDA doesn't discuss recommendations for kids, but the American Academy of Pediatric says that kids under the age of 12 should have no caffeine. And kids above the age of 12 can have about 200 milligrams a day, and that's considered safe. And our research would suggest that. I don't recommend giving caffeine to kids. When I do interviews about caffeine, people are like, what do you recommend? And I'm like, well, there's no reason for kids to be caffeinated. All I'm saying is that if your kid wants to have a soda, it's like none of our research suggests that's going to be particularly harmful to them. I always put a caveat around this discussion and that one of the outcomes that we did not study was sleep. Because I-- Uh-huh. So I-- And I will tell you that nobody is going to fund research on caffeine and sleep because there's a ton of research on caffeine and sleep, right? It's one of the things-- just the way the caffeine works at disrupt sleep. That is the whole point of caffeine. It antagonizes the system in your brain that makes you fall asleep. That is its job. And so we know that caffeine disrupts sleep. And so what I always say and what I tell parents is none of our research suggests that caffeine is particularly harmful in kids, but I still wouldn't give a kid caffeine after-- I always put a hard cut off at 3 p.m. Because we know it's going to disrupt sleep. And you-- and that can have a lot of harmful effects. So if a kid wants to have a soda, even a Starbucks for a patina or whatever, if it's before 3 p.m. and they're-- and they're otherwise healthy, that's fine, but not late in the day. And it actually has become, as my children have gotten older, the thing has not been the drinks as much, although both of my older kids drink coffee in the morning has been the pre-workout. So my 17-year-old is very interested in making his body larger and he goes to the gym every day. Now he goes at 5.30 in the morning, but he used to go. When he first started going to gym, he was going in the evening. And I'm like, so I was-- Oh, terrible. --starting for pre-workout that didn't have caffeine in it. It was just hard to find. And then is it the same? I don't know. You talk. But-- yeah. That's a whole other-- we haven't used so many podcasts. I thought that was a whole gen temple series. But that was, in part, why he shifted to morning workouts. And now it's not an issue. But he was really having trouble sleeping. And of course, he's not listening to me because he knows 15, 16, 17-year-olds no better than anybody about what's best for their bodies. But it became a real problem. And it was affecting him in so many other ways. And the way that I really convinced him to shift off of it was that he wasn't seeing the gains he wanted at the gym. And I was like, sleep is so foundational to everything that you're trying to do with your body. And you're robbing yourself of that opportunity by having this pre-workout late in the day. And I was like, just try shifting your morning's workouts in the morning. And he's been doing it ever since. It's just it just helps him feel better all around. And he's not disrupting his sleep. And he's gotten a much better pattern. But that is the main-- so I don't want to imply that caffeine isn't potentially harmful. And I want to be very careful to say that my personal research wasn't on sleep. But we know that caffeine is very disruptive to sleep. So I do not recommend-- none of our studies were done later in the day because we didn't want to disrupt sleep in kids or anything like that. But that was the biggest surprise to me was that in general, with healthy kids, they're fine. There's not a lot of really harmful side effect. The other flip side of it is when we think about caffeine in adults, many adults-- most adults, at least of my generation, this may be shifting with the younger kids, but drink caffeine in a habitual way. I wake up every morning and shuffle down to the kitchen. And the first thing I do is I start my pot of coffee. Kids don't drink caffeine that way. Even kids that may on occasion drink one or two energy drinks, they are not doing it in a habitual way. So they don't have the same tolerance that we do, where over time, we can have more and more caffeine than it doesn't have an effect. But they also don't experience withdrawal the way that we do. So if I woke up in the morning and I decided to skip my pot of coffee, I will tell you that for-- You're gonna hold Prachand for three to five days. I will. super bad headache and then it will go away, but I will have those withdrawal effects. The kids don't have that and so some of the things that we look for when we're studying caffeine intake in adults, kids don't have, they don't show signs of withdrawal in general because they're not using it in the same way and so it was really interesting to study this in kids to try and figure out like whether or not it's even harmful. So I think that was a little bit surprising that we didn't. Is children the only population that you studied caffeine in? We studied so my initial work was in 12 to 17 year olds and in that first set of studies we found sex differences and one of my questions was are these sex differences driven by biological factors? So things like pubertal development, steroid hormones, or are they more psychosocial? It's appropriate that energy during start marketed to young men and boys, so are boys and young men more likely to drink caffeine. So the next set of studies we did, we needed to look at pre, I wanted to look at pre and post pubertal kits. So we did eight and nine year olds and then 15 to 17 year olds and we studied in the older kids, we studied girls across the menstrual cycle, the luteal and the follicular phase of the menstrual cycle. And so this work spanned kids as young as a and kids as older 17, but I have not done any of the caffeine research in adult populations. Interesting. So I find caffeine fascinating, especially from the sleep perspective and knowing how sensitive I am to caffeine and I even have to three ppm for me is even pushing it sometimes. I got to back it up to 11 a.m. when it comes to utilizing caffeine. But I think as you said as well, the dose differences, you were not having kids that are drinking a whole pot of coffee or anything like this at any time. I hope. It comes to this. But to get into now on that topic of caffeine that drives us into more controversial related talks and I know in your in our questionnaire, you had some really awesome things that I know that the audience, especially our students are going to want to hear, particularly on weight, health and food addiction. Let's start with the first unpopular opinion of overweight doesn't necessarily mean unhealthy. Can you dive into this for me? I certainly can. It's one of the things that I have tried to focus on. So I think that as overweight and obesity have increased that we hyper focus on weight as a proxy for health where if you see somebody that has obesity, you're like that person as unhealthy, we make assumptions, right? That person's probably doesn't exercise. That person probably has an unhealthy diet, right? And the flip side of that is true. You see somebody that's relatively lean and we're like, oh, that person is healthy. That lean means healthy and obese means unhealthy. And it's simply not true. There are people with overweight and obesity that are very active, that have really healthy diets. There are people who are thin that eat nothing but garbage and that never exercise. And so I think that we need to disaggregate these ideas from one another and we need to think about what we mean by health. And we say that somebody is healthy. What does that mean? There's lots of other ways that we can look at health that are a more direct index of what we need my health. So when we were talking about health, we could mean metabolic health. So instead of looking at somebody's BMI, let's look at their hemoglobin A1C, let's look at their triglycerides, let's look at their blood pressure. These are more direct indices of health than purely somebody's weight. And if you were to look at these biomarkers and people across a range of weights, you would see that there are people who are thin, who have high blood pressure or high blood glucose. And there's people that are obese that have perfectly healthy blood glucose and perfectly healthy blood pressure. So I think that what happens when we conflate the idea of weight and health is we don't talk to people about how to know if they're healthy. If we take somebody with obesity and we say, you need to lose weight in order to be healthy, we miss an opportunity to say, you tell me about your diet, tell me about your physical activity, tell me about your sleep, tell me about your stress, tell me about your hydration, and to have a really holistic conversation about all of these things. Because if we do that, we might find that the person with obesity is doing all the right thing. They're eating the fruits and vegetables, they're drinking the water, they're moving their bodies every day, and they are healthy. And then we don't have to have a conversation about weight. You could have a conversation. Everything I'm looking at says that you are healthy. Good job. If they have overweight or obesity and you do find that they have high blood pressure, high triglycerides, then you have a conversation about them. I'm seeing these numbers that are concerning. This high triglyceride means that you might be at high risk for cardiovascular disease. This high hemoglobin A1C might mean that you're pre-diabetic. Let's talk about what that means. Let's talk about your diet. Let's talk about your physical activity. What are some things you could be doing with your behavior that's going to help bring these numbers back down to a healthy range? And that is a much better conversation because it is framed within the actual data that's related to disease. It's not framed around a person's weight, which gets conflated with what they look like, which it's conflated with their self-worth. Now I am not saying, I teach an entire graduate level class called obesity. I am not saying that the data don't suggest that in the aggregate, people with obesity are at higher risk for metabolic disease. That doesn't mean that an individual sitting in front of you with obesity has metabolic disease. You have to actually measure those markers to know whether they had it. The flip side of this, I will say, is I think that assuming that somebody with obesity needs to lose weight in order to be healthy is harmful to that person. It doesn't even afford them a conversation about their health or looking at some of these biomarkers as well. You have obesity, so obviously you should lose weight. I think that there are problems there and I think that can lead to a lot of psychological trauma in people with obesity and it leads to healthcare avoidance. I love your take on this, Jen, because oftentimes especially working in the industry, we see this all the time. Another perspective to look at this is psychologically. I could have someone that would see a picture of health, a bodybuilder, or an all-themed time triathlete with ripped abs, looks great. On social media, it has millions of followers and everyone going, "You must be so healthy, you must be so in shape, but do a psychological profile and come to find out that when it comes to the amount of, let's say, lack of harmonious obsession with their sport, it's actually more actually harmful obsession with their sport." If you were to take a look at their biomarkers, you would actually find that some of these athletes oftentimes are pre-diabetic. They are high lipid profiles that put them at risk of out the sclerosis and all these things. I've seen it, which is so opposite of what you would expect, especially in a day and age where everyone is looking at the aesthetics and the visuals upfront as health rather than what's actually underneath. Exactly. I think you miss things on the flip side of it is, I think you miss things in people that appear outwardly healthy. Those people might, they might not avoid treatment seeking the way that some people with obesity that feel like they've been burned by healthcare providers do, but they might not even look at, they might be like, "You're obviously you're healthy, you're a bodybuilder or you're a runner, we don't even need to do a panel on you because you're clearly healthy." Things might get missed, so when we can flate, wait and health, we miss an opportunity to provide high quality healthcare to people with and without obesity. That is my perhaps unpopular opinion about, but I do not think that we should be conflating health at food. I would love to dive into food specifically now and how your unpopular opinion is food is not addictive and I actually come from a graduate program that agrees the exact same thing in how they teach at Arizona State. Can you dive into your unpopular opinion in this way? Okay, so my unpopular opinion may not be as unpopular as I led you to believe. I take offense with the use of the term addiction. I think that has a very particular definition that is challenging to apply food to for the primary reason that we need to eat and that we don't need to do cocaine, we just don't. So it is challenging once we try to say that food is addictive, then it becomes really hard to be like, well, what food? What food is addictive? Because baby carrots are probably not addictive, not addictive, but there might be somebody out there that can't stop eating baby carrots and might feel like they are addicted to baby carrots, right? So saying food is addictive is too broad, which foods for whom, how do you know that something is addictive, right? So when we think about addiction, we think about, I think if we think about it in sort of colloquial terms, we think about you consume this thing and you can't stop doing it and you do it despite the fact that it is harmful, despite the fact that it ruins your life. When you look at the definition of substance use disorder, part of that definition is the impact that it's having on your life. And so it like impacts your life. pairs your ability to work and to maintain social attachments and things like that. So just by the very definition, like food doesn't really have those properties, right? So we all eat food. I am not saying that there aren't some people that are very driven to eat certain foods. In particular, foods that are high in sugar and high in fat seem to have this pull on people. I am just hesitant to call it addiction. I will say that to dive back into the GLP1 receptor agonist conversation, we, these medications, again, these medications have been lifesaving. My sister has lost over 100 pounds on these medications, like life altering medications. But it has also given us a glimpse into this idea of food noise, which some people might think is the same thing as addiction. And we could have that debate. I think my issue with it is more with the terminology, but this food noise is actually what I've been studying for decades, right? It's this drive to eat these foods. But we didn't really have the language for it. And when people started taking these medications, you started hearing this more and more. People were describing like, the food noise is gone. And I don't, I used to think about food all the time and now I just don't think about food anymore. And I don't think people realized how much they thought about food until it was gone. And then they were like, oh my, my mind is quiet. Like, I don't have that food noise. And what we're seeing now as the, as people become tolerant to the medications, they will say stuff like the food noise is coming back. Like they feel it coming back. And so I do think that they're, I don't want to say that there aren't people who have a strong motivation to eat food. And that drive is overwhelming. I don't want to imply that. I think that there aren't those people out there. I think there are. I think it just becomes really complicated when we use terms like addiction. And as somebody who studies these behaviors for a living, I get really particular about using the correct terminology for thing. Having an operational definition for what we're studying. And so I'm hesitant to say that food is addictive. But I do think that there are some people that have a very strong drive that is very hard to overcome that some might feel like is akin to addiction. And the thing about these DLP ones that's really helping us understand this as well is people not only have less food noise, but they're also less feel less of a desire to drink alcohol, to do drugs, to smoke cigarettes, like that kind of thing. So it does seem like there's a general dampening of these behaviors that may extend into more addictive behaviors like substance use disorder. So we know they're all regulated by the same part of the brain that is being impacted by these drugs. So yeah, so I would say food is not addictive with a little asterisk, the same food might be very motivating and difficult to resist. I just don't want to put the name addiction on. I love that take on it. And ever since I heard you and Katie talking about food noise in that whips meeting we had all those weeks ago in talking about that, especially around GLP ones. And hopefully more research will be able to elucidate for findings behind working with this. But you've talked a lot today about the psychology of nutrition and what goes behind this. And one of the things that I really stuck out to me before we get into your actionable takeaways. And coming in from unpopular myths as well goes this next thing is why is it that so many people crave complexity when it comes to how to solve my issue with weight loss or how what can I do to get in better shape? Why is it that the simple thing? Simply just aren't of feeling. Walk every day, eat healthy, get better sleep. Why is it that we crave this massive elucidating, this magic pill? What's going on here? I love to talk about fat diets. So I want to set aside the GLP ones for a second because I think that now a lot of people want the GLP ones because it is very simple. It's not complex. It is simple. I'm going to take this thing and I am not going to think about food anymore and it's going to help me achieve all my weight loss goals. I think that I think that fat diets are an example of people actually craving simplicity. So to me and to you, the idea of eating five to seven servings of fruits and vegetables a day, drinking eight glasses of water a day, making sure that I exercise for 30 to 45 minutes, 60 to 80 percent of my hurrying max, getting eight hours of sleep every night, meditating to reduce stress all that stuff. Like that seems simple, but because we're relatively healthy people, but to most people, that's a lot of things. The fat diets have appealed to people's desire to have something very simple. And I say this as a person, my mother has done every fat diet you can think of, right? So I'm very familiar with these fat diets and I'm fascinated by them because they all have these similar characteristics. Where first of all, they try to sell you on some sort of physiological complexity that it's not real. Nope. But if you combine, I can't even remember, I remember my mom doing one where it was like, I, this is not the actual one, but it was something like you had to eat foods in different combinations. Like you could only eat bananas and tomatoes at the same time. So just, and it's because of the potassium and the acid can't slit each other out and burn the fat or there's always some kind of thing that sounds really complex, but that that like on the edges seems like, yeah, that makes perfect sense. I'm going to drink hot soup and that's going to melt my fat. That makes sense to me. Even though if you know anything about physiology, it doesn't make any sense. But the other thing that is appealing about these bad diets is there are these rules that are like, here's a list of foods that you can eat. And so, okay, every time I'm hungry, I just go to this list and I eat these foods and or like thinking about about the very low carbohydrate diets. Like it's similar. It's can eat this food, but I can eat this food. And so that is very appealing to be my mom used to always say, just tell me, give me a list of foods I can eat. And that's it. I just want to know what I can eat. And I'll only eat those foods. And I don't have to think about exercise. I don't have to think about sleep. I don't have to think about water. I just eat the foods on this list. And I lose weight. And the problem with them is that a lot of them work in the short term, but they're not sustainable. You're not getting, oh, oftentimes you're not getting the nutrition you need. And when you're not giving your body what it needs, you crave the things that it's missing. Like your body is very well designed to try to get the nutrients that it needs. And so, and that craving becomes stronger. It's stronger and eventually eat a piece of bread. And then you're like, "Oh, then you're going back to carbs." Right. And so, the things that we see are simple, that those eating fruits and vegetables and leemy and walking and drinking hot. Car no hell has. Right. Right. So, those, while it might seem like a lot of things to do, it is the thing that is the healthiest for everybody. And, and that is never going to change. There's no fat diet. There's no pharmaceutical strategy. There's nothing that we are going to discover in 10, 20, 30 years. It is going to change the fact that eating real food, eating mostly plants, eating lean protein, drinking water, getting good sleep, de-stressing, there's nothing that's going to upend that. Now, I will say there are things that push that around. Right. So, one of the things that has been fascinating to me is the recognition that our recommendations for protein and take were probably too low, especially as people age. Oh, I heard of some of that. That is actively aging. We're all actively aging, right? You're older than you've ever been and now you've been older. And now you've been older. But as somebody who, you know, as a woman who is firmly in menopause, I have appreciated that I am going through menopause at a time that we are like, we can make women healthier during menopause. And one of the ways to do that is to focus on eating more protein and doing more resistance training, right? Lifting more weight. And I feel like my body is healthier when I do that. But for a long time, what we were taught, and this was based on research, but it was just incomplete research. It's something that people outside of science, who are not scientists, struggle with. They want the answer and they want things to be settled. But there's a lot of complexities. And the bottom line is people weren't doing, people weren't studying the impact of more protein. We weren't looking at what these higher levels of protein could potentially do. And nutrition research, I keep feeling like I'm going off on Tandons, right? Nutrition research for a very long time has focused on avoiding deficiency. So we have a level of vitamin C or a level of vitamin D or a level of protein that if you eat this much, you will not be considered deficient. But it has really lagged behind in studying optimization. I don't want to know. I love this conversation. I don't want to know how much vitamin D I need to take to avoid deficiency. I want to know how much vitamin D I need to perform. And we are just beginning to do that work in regular people. Some of that work has lived in the athlete space and the performance space. We are just starting to take regular old men, a puzzle women off the street and be like, how can we optimize your health not so that you You can go out and be a bodybuilder or write a marathon, but so you can perform activity activities of daily living into your 70s and 80s. What do you need to be doing now in terms of lifting, protein, mobility, work, whatever? And so I think that our dietary recommendations often change, but it's not because we were wrong. It's because we didn't, we just hadn't done that research yet. So nutrition hasn't changed. Like the foods that are good for you don't change. Fruits, vegetables, lemme, I don't know how many times I can say it, like right. - It's your high leverage habit for sure. - But now, as opposed to the type of dietary approach I had 10 years ago, I will say that now, in addition to focusing on getting five to seven servings of fruits and vegetables a day, I focus on getting 100 grams of protein a day. And I never used to think about protein. I used to literally think like I'm a meat eater, I'm probably getting enough protein, and I probably wasn't. But, you know, so I do think that we can shift over time as we learn new information. But I think the fundamentals of healthy lifestyle don't change all that much. - I couldn't agree more. And as someone who's been working in the industry for 20 years, working with clients, that is exactly what we need the most of now. And I love that you brought up optimization because that's exactly what we do and what we work on in the settings that I'm with as far as looking at athletes and looking at general population. 'Cause you're right, a lot of people just are unsure as well, what do I need to actually feel better and be able to push more? And so I'm really fascinated about these talks. And we could go on for hours here, which is why you're definitely coming back. This is the point in the episode where we do a lightning round. And so I'm gonna give you a couple quick hits. I want the first thoughts that come to your mind. Starting with first, most people underestimate this. - The importance of sleep. Because I think people feel like they can get by with. I seem fine. It's this optimization question, right? I seem fine. I get six hours and I'm fine. Think, could you be better with eight? Maybe try it. Most often in my experience, yes. Most often, but then on the opposite side, some people actually know. Some people do this exercise. - Oh, what was the first part of the question? - Most people underestimate. Oh, the importance of exercise. I think that's also true. But actually, I'm revising my answer because I think sleep is probably more. I think most people will tell you exercise is important even if they don't choose to do it. - It's a big debate that goes back and forth with sleep researchers, actually. What would you do if you had an hour in the day? Would you sleep long or would you exercise? - Yeah, you probably exercise. Like, maybe you're right. Because I wouldn't want to give up exercise at the expense of sleep, but I would try to do both. Like, how can I build enough sleep and also exercise? But I will say to go back and revise my revision. - Sure. - I was initially brilliant. And then when you were lightning rounding me, I didn't remember how brilliant I was. I think the exercise piece, and this, I can't keep going back to the GOP ones. Because people are so successful with weight loss with the GOP ones, there's no evidence that most people that are losing weight this way are increasing their exercise. They're like, look, I have lost weight and I haven't even, I haven't had to start exercising at all. - Right. - But the literature would suggest that exercise is absolutely critical for weight loss maintenance. So if you want to keep that weight off, now again, these drugs are revolutionary, but we do not have 5, 10, 15 year data on them. The little bit of evidence we have now suggests that people will have to stay on them forever or they will regain the weight. And I believe that if people built in healthier habits in particular exercise that they wouldn't regain the weight or wouldn't regain the weight as much. So literature suggests that. We can get people to lose weight, all kinds of ways. - All kinds of ways. - But to get people to maintain it, they have to exercise. We don't understand fully the physiology behind it, but they absolutely have to exercise. And so I think people understand the importance of exercise for weight loss maintenance. But I think people also underestimate the importance of exercise for health in general. People focus so much on weight. - I know. - But exercise is critical for so many other aspects of health that have nothing to do with weight. And so I would urge people to prioritize exercise, even if you don't want to lose weight. And exercise, PS is not going to help you lose weight. - It's terrible for weight loss. - Exercise alone, there's really no evidence that exercise alone helps you lose weight. And I know that flies in the face of the energy balance equation, but what happens is, unless you're doing, unless you're burning, a thousand pounds. - Assured amount of calories, you're going to eat a little bit more. You're going to go for a walk for 30 minutes. - Like you said, the body's very smart, and I'm accommodating. - Yeah, and so, and unless you're really tracking, you can do it, right? Don't affect your food, but you have to really be precisely tracking and weighing and measuring. Otherwise, it's so easy to take an extra handful of nuts, an extra cracker, an extra bite of this, an extra zip of this, and then all of a sudden, you've made up all of your calories that you've been exercising. So, but exercise is so important for well-being, for stress, for sleep, for mood, for cognitive health, for mental health. There's data out there that shows the benefits. And there's old studies now that show that exercise can be as beneficial as any press of medication. - Yeah. - For some people with depression. And so, I don't think we do enough talking about the benefits for exercise beyond weight loss. - If you could change one thing about nutrition science communication, who would be this? - It said, this falls into media literacy in general. I think that I would, if I could change one thing, it would be for people to know where to seek out truthful information about nutrition that is based on science and based on evidence. There's so much, but I could say this about anything, not just in truth, I could say this about politics, I could say this about physical activity. Like, there's so much out there on social media in particular that is a 30-second sound bite or real or an influencer or somebody being like, do this thing, it's amazing. And if it falls in line with people's beliefs or people's desires, oh, I can do this one thing and it's quick and easy and it's gonna make me lose weight. People are really drawn to that. But if you really wanna know the truth about nutrition, you're gonna have to read some journal articles or go to a trusted source that is like the Academy of Nutrition and Dietetics that is a trusted source for understanding nutrition and or talk to a dietitian, somebody with the proper training to understand that. Again, it's more time consuming, it's more difficult than watching something on Instagram. But I think that would go a long way to help people not fall into this trap of, I don't know, believing this stuff that isn't true. And it's especially prominent in the sort of wellness space. But there's a lot of misinformation out there. Anyone can be an influencer. - Anyone can be an influencer. - And this transfers perfectly now into the big benefits for our audience, particularly here at UB and your teaching philosophy. Straight in with the evidence-based practice with you really focusing on getting students to understand the facts and teach it from a place of evidence. How is it that you teach this to the students to develop that critical thinking and communication being such essential skills that they need to be when it comes out to be in their professional careers? - Yeah, so it's one of the things that I think is really important and I have the luxury for the last several years. All of my teaching is better at the graduate level. So if I were teaching at the undergraduate level, I might have a different approach. But at the graduate level, they really need to be trained in critical evaluation of the literature. So I do a lot of work in my obesity class to talk about what are some things that you believe about obesity. And then let's take a look at what the literature actually says and let's read some papers on that and let's challenge some of those assumptions. So one example of this that I like to do in my class is there's this idea out there that high-frequency just corn syrup is related to obesity somehow. - I've seen that in papers. - And I am not out here trying to say that high-frequency just corn syrup is good. It is delicious, but it is not necessarily something that people should seek out in their diets. But when you look at the literature, there is not a literature that shows that high-frequency just corn syrup in any way is a physiological cost of obesity. So we really dive into that literature. So there's really well-controlled studies that give people drinks with high-frequency corn syrup compared to sucrose and look at the blood glucose response and the insulin response. And there's no difference. The lines actually literally line up with one another. Then other studies that have done the same thing where they've asked people to rate their hunger and their thirst and their fullness and all this stuff, none of those appetite parameters change. And then you give people drinks with high-frequency corn syrup and not and you look at how it affects their eating and people aren't eating more. People aren't changing their blood. Like there's just no evidence that high-frequency corn syrup is driving obesity at least not from a physiological perspective. And so I like to do things like that. Like what have you heard? And then let's read some literature on that and see what the evidence actually says. It's challenging, again, people, it goes back to media literacy, but it also goes back to this idea that people don't like ambiguity. And oftentimes when you're in the literature, there's still some ambiguity. They're, and not necessarily with the high-frequency corn syrup causing obesity, but I think that's something else that students have to do. to learn that on a wide range of topics, you're going to find some papers that support your hypothesis and some papers that don't support your hypothesis. One other area we talk about is the relationship between the SNAP program and obesity. So there are some papers out there that show that people on SNAP are more likely to have obesity, but there's other papers that show that there's no relationship. And so what's true, right? So then you have to dive into what was different about this group of studies than this group of studies, were they studying a different population, how are they collecting their data. So it takes its time consuming, but graduate students need to have these skills. They need to, if they are going to be out there, especially a lot of the students that take my class, I get a mixture of masters and exercise science, masters of public health and masters in nutrition science. But they might be out there working with clients who are going to ask them questions. And if you're going to be giving advice about, about really related to health, you need to understand where that comes from. And you also need to be answered questions and be able to answer questions like for our future dieticians, patients might come to me like, oh, I heard that if I drink celery juice, it's going to reduce inflammation. Well, not only do not the best response is not just, well, that's just simply not true, but actually that's not true. And here's the study that shows that like when people actually have done studies, they've shown that's not true. So I know you heard that on TikTok, but that the science would suggest that's not accurate. And so teaching people, especially people that are going to be practitioners, the value of understanding the evidence that is behind the recommendations that you're making. You need to talk to your patients about the Mediterranean diet. Well, let me tell you about the Predimid study, which is a beautiful study that is so well done that is the scientific evidence for the benefits of the Mediterranean diet on heart health, but they need to read that study. And they need to understand that because they need to be able to recognize when recommendations are evidence-based and when they're not. And they need to be applying the evidence-based recommendations. And so as somebody teaching graduate students, I think it's not that undergraduates don't need to know that, but they're still building some of that foundational knowledge. But when you're putting that foundational knowledge into practice, that practice needs to be informed by evidence. To bring this full circle, Jen, because we've talked about so many wonderful things of value. You're a wealth of knowledge in this space, almost. To cap this off and really bring this home as far as hitting a home run, just like at the end of the natural and that baseball game, for your values reflection, let's focus on why weight de-emphasis matters. So you mentioned that working in obesity research, which intersects with social pressure and body image ideals made you reflect on your own values. And we've talked about this a little bit too. That led you to de-emphasize weight. Like we just discussed when it comes to how, just because someone's obese doesn't necessarily mean they're not healthy. And that this feels important. Talk to me about this reflection process and how this can get our students and anyone in our community to start to think about things differently about weight. Yeah. So I think this process really originated. With this graduate class of atage on obesity, I will be the first to admit. I started teaching this class in 2009. And I used to teach this class from an approach of, it sounds so awful to say it loud. All you have to do is eat less and exercise more and you will be able to lose weight. And I didn't even think about what hearing something like that would mean for somebody that had obesity. And over time, teaching that class, and I also used to teach the medical students. I used to do a lecture with them on obesity. And my lecture was very similar. It was very dry, very, these are the lifestyle approaches. These are the bariatric surgery options. These are the outcome measures. This is and over time I started listening to more people in larger bodies talk about their experiences. Just what it's like to move through the world in a larger body, what it's like to feel undervalued because you're somebody that's taking up more space. And what it's like to engage with healthcare professionals when you have obesity. And I started shifting my class toward understanding not only these experiences, listening to these voices, but having people interrogate their own implicit bias. So now the first class of my semester, my students and I do it every semester, take the Harvard Implicit Association test for weight bias. So that they can start out the semester understanding their weight bias. And they retake it again at the end. And they reflect on whether or not their bias is shifted. There's no expectation that their bias will shift. It takes time. It's not something they can necessarily happen over a semester. But often students do see a little bit of a shift toward being more accepting of people in larger bodies. And my medical school lecture has shifted entirely toward what is the impact of your bias on your patients and how can you develop a more inclusive practice. And I have this whole approach feels better to me. It feels lestihumanizing. Like I just really, I don't know, I feel really ashamed of how I used to think about, I feel ashamed of my own prior biases. And I'm, I've done a lot of work to shift my biases away. But I have really come to truly believe that that if we care about being healthy, we cannot ignore the mental health impact that stigmatizing people with overweight inability has on them. And I think we in general overemphasized physical health and deemphasized mental health. And I think that for all of us to be healthier, regardless of what our weight is, we need to shift our priorities toward a more holistic approach, not just physical health. Dr. Temple, this has been one of the most thought-provoking, valuable conversations we've had on Bull's Rise, particularly around nutrition. And real things that people need to hear about when it comes to nutrition, when it comes to weight loss, when it comes to all your hard work that you've done in sensitization. And now teaching others how to have better evidence-based approaches and how to think when it comes to all these things. To leave us with one last thing, what would you say your biggest mission is here at UP? What your goals are for as you progress and your final takeaway that you want our students and our community to take away from our conversation today. Biggest mission. I think all of, I'm going to try to summarize all of these. One, I think that and this might sound repetitious from what I have what I've said and what I've just said recently, but I really think if at the end of my career, or at the end of the day, at the end of the semester, would we walk away for the summer if students that I have interacted with have a more, have a better relationship with eating and with their bodies, I will feel good about that. If people can get away from the idea of restricting and thinking more about fueling and then also thinking more about just being healthy in general, again. Fruit and vegetables, lean protein, plenty of water, exercise, sleep, less stress. If we can get students, faculty, medical students, physicians to take a more holistic approach to what it means to be healthy and not what it means to be skinny, I think that I will feel like I've done something good in the world. Jen, thank you so much for being here. We can't wait to have you back. There's going to be, we win for 90 minutes. So we've got plenty more to talk about in the future. I really appreciate you being here and I know that our audience really appreciates it as well. Thanks Chris. Thanks, Ryan. (upbeat music)