An Interview with Jeff Hyman (Continued)
Retrofit and Diabetes
Adam: What about people with diabetes? Can you talk about that aspect?
Mr. Hyman: We have a number of people with diabetes on the program, and quite a few people with prediabetes, where their physician has told them they're on the wrong path. And we paired them up with dietitians who have expertise in diabetes, and with behavior coaches that have expertise in diabetes. So while it's not a diabetes-focused program, we leverage that expertise. We're always evaluating if we should have a diabetes-specific program, and maybe we will one day.
Adam: From an insurer perspective, it would be very compelling to show that Retrofit slows or halts the progression from prediabetes to diabetes.
Mr. Hyman: So many of our clients track their blood glucose numbers before the program, and then during the program they send us a copy of the report. We'll actually liaise with their physician if they want with no additional fee. Their blood glucose numbers are transformed in six months. And they didn't lose a ton of weight, but they lose enough to make a difference.
So what I've learned from the experts on our team is that an overweight person losing 10% of their weight reduces their risk of many diseases by 50% to 80%. That's where you get the biggest bang for your buck. We get customers who lose 25 pounds or 30 pounds, but they're not going to become a cover model anytime soon. However, it's enough to make the difference such that their blood glucose numbers are transformed. They go off medications or they reduce them. That's why we focus on losing at least 10% of body weight.
The Role of Exercise
Adam: We spoke with Dr. Arya Sharma, who's a weight loss guru. It is his opinion that if you go on a calorie restriction diet, you will lose a certain amount of weight. But in order to maintain that weight loss over a long period of time, you have to maintain the diet. Is that realistic for anybody?
Mr. Hyman: Just so I'm very clear, to lose one pound per week, you need to create a net calorie deficit of 500 calories per day (i.e., 3500 calories a week is about one pound of fat). That is roughly what we work with our clients to do. Some of them lose two pounds, depending on their story.
Over time, you start seeing the curves plateau as it becomes harder and harder to lose weight. To continue to lose weight, you have then to begin to increase the exercise. There's no question about it. Dr. Holly Wyatt, in her research, has found that there's a trade off. Initially, you do it with food. But to keep the weight off over time, it's got to be through increasing activity, and more importantly, strength training. That's really the engine that burns calories throughout the day. Most Americans have no idea — they think you just go onto the treadmill. While that's great, you've got to do strength training twice a week. We teach clients how to do all that.
Once our customer gets to the goal weight, we're just working with them to maintain. That is in and of itself another process. So of the one-year product, roughly half of it is weight loss, and half is weight maintenance. And we actually think weight maintenance is the harder part, because now we created that deficit.
Now, we need to teach you how to live within a band. You're not going to be perfect, but it's almost like a stock price chart that's kind of going sideways. You know you've got some fluctuations. And what the National Weight Loss Control Registry — which Dr. Hill developed — shows is that people that keep the weight off over time learn how to live within this span. They weigh themselves regularly, a couple of times a week at least. And they notice that they've gained a little bit, and then the alarm bells go off. And they start to lose weight, and then they gain weight, and they live within this very tight range.
And that's what we teach our clients how to do. It's an energy balance and all about balancing your calories in and out. You can't give an exact range, and it's a little bit different for everybody based on your metabolism, your starting weight, your gender, your age, and your percent muscle versus fat. So we can't just give people a number. We have to iterate to get there. But that's what the second phase of the program is all about.
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Because I wear my Dexcom on my arm, I’ve slowly adjusted to the fact that people will ask me about it. Sometimes it’s the rude and inquisitive “What’s that?” and sometimes it’s somewhat sincere curiosity “Is that a (insert random type of medical device that they assume)?” Sometimes it bothers me more than others depending on how they ask and how they respond once I’ve told them what it is. I have limits to how much myth-busting I want to do in everyday conversation and how much rudeness I can...