DR JEN KERNS

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JAY: Welcome to another episode of Going Beyond The Scale.

Today's guest is very special because I don't believe there's ever been a contestant on The Biggest Loser, now after 18 seasons, who was a successful contestant, became a well-respected doctor, and worked with Dr. Huizenga, the show’s doctor, for two seasons post her Biggest Loser finale.

Read this with a filter of what a doctor is sharing with you, NOT a contestant on The Biggest Loser.

Whether you’re a lay person like me, or a medical professional, you’ll get a better view of what’s possible and valuable for you no matter what well-being journey you’re on.

Welcome to the show Dr. Jen!

DR. JEN: My pleasure. Thanks for having me.

JAY: Dr. Jen, to start things off it would be great if you’d share with everyone your back story, what I like to call “The Tale Of Your Scale.” As in… what were some of your earliest memories about what you were told about your shape, size, weight, and overall well-being. And then how those stories and beliefs evolved thru your teenage years right up to you became a contestant on The Biggest Loser. And if you’re game this can be the first of many more podcasts with you Dr. Jen because you truly are a wealth of well-being information and experience. So, let’s get right into it. Dr. Jen, give us an idea of your earliest challenges with your weight and how it all unfolded for you getting on The Biggest Loser as well.

DR. JEN: Wow. Ok… well I was one of those babies who was obese at birth. My poor mom had to have an emergency c-section because she couldn't get me out. I was over nine pounds at birth. And I was really chubby even as a toddler, and a child. Pediatricians put me on low fat diets, which was the fad back in the 70s. You know, so I would get skim milk instead of 2% or whole and, but lots of sugar. And I just learned from a very young age that sugar made me feel better. I mean I remember being at a babysitter's house before I was even in kindergarten and skinning my knee and being fed cake to make me stop crying and thinking… well, this is a good deal, if all I just have to do is skin my knee to get that kind of a reward, so be it. So, the habit of using food and especially sugar to make myself feel better was ingrained for me at a very young age. And my whole family has struggled with our weight, both my immediate family and my extended family. So, there's certainly a genetic component. But my parents didn't know any better about what to do like most parents who were raising chubby kids at that time. Like every night after dinner, we’d have dessert, and I started picking up snacks after school on the way home, that’s just that's how we ate. We ate all the deliciousness that we all now know American corporations can produce for us, and it became more of an issue for me than maybe for other kids.

I think in high school when I really was feeling my difference was at that really tender age in my teenage years with boys not noticing me or liking me, and me always having a crush on someone and them never liking me back, and all that sort of teen angst that comes with being a morbidly obese teenager.

Then in college I got to my heaviest. I probably gained the Freshman 50 instead of the Freshman 15 and I was at about 300 pounds which became my highest weight ever.

But one of the hardest emotional realities I ever experienced about my weight and how others may view me was in medical school.  We were in a lecture that became a turning point for me was in my medical school. In one of our classes, they actually taught us a course on sex and had us watch different pornographic movies with the intention of trying to facilitate comfort among all of us with various different sexual situations so that we would then at least feel comfortable being able to talk to patients about anything that they needed to talk to us about as doctorsSo, we watched, you know, clips of regular heterosexual sex. You know, vanilla sex. Kinky sex. Gay sex. Sex between different races. Someone who was disabled having sex. As you might imagine it was like a crazy class and very eye opening!

And then… there was a video of two people with obesity having sex.
And a fit young man sitting in front of me leans over to his buddy next to him
and makes a comment about how completely disgusting that is!

Wow! I'm sitting right behind him with my belly hanging over the little desk that doesn't fit me because I'm too big for it. It's one of those desks that don't move. I'm squeezed into it, and so feeling so uncomfortable already. And I thought like, he can watch Gay sex, and disabled sex, and any kind of probably animal sex, and that's all okay, but it's not okay for fat people to have sex. Like, really, that's how discriminated against I felt. I mean, I felt really shamed, fat-shamed without him realizing I was sitting behind him. Of course, I don't think he ever would have said it had he known I heard him. But my feelings were so hurt. At the same time I was thinking, I'm in medical school now, I'm going to be a doctor, and I don't think my patients are going to trust me if they think that I can't manage my own health. They're gonna think that the reason I'm fat is because I don't know what I'm doing. And of course, it wasn't a lack of knowledge by that point. It might have been when I was a child, as in having ingrained all those habits. But by the time I was halfway through med school, I knew the things that were likely to make me thinner or heavier and increase my body fat or not.

But doing the right thing is different from knowing what the right thing is.

It was sort of that last straw moment where I had to do something about this.

• Number one, I had never been in a relationship, I was in my early 20s. I really wanted to get a guy. So, I was driven by that. I wanted to look better, a lot of people call it superficial, but I think it's important for many of us to feel good in our skin. So that was a big part of it.

• Number two, the other big part of it was now I'm going to be a doctor. And I really want people to trust me. And I think that based on the way society acts, I felt like I would have a better shot at people trusting me if I were able to do it.

So that was it! My commitment level went right through the roof.

I joined Weight Watchers. I followed it to a tee even before they had the point system, which is now famous. I was checking off little boxes of how many bread servings I had that day and how many veggie servings, and stuff like that. I followed it so strictly, I started walking and I started running. I would walk to the Weight Watchers meeting which was 10 blocks away from my apartment in med school. And I would walk back, then I'm just going to jog half a block and then walk the rest of the way. I started very gradually adding another half a block and as I lost weight and was a little bit more mobile, it got easier for me and so I ended up running. I became a runner and lost all my excess weight, got down to 145 pounds by my third year of med school. I find maintenance to be harder than the weight-loss itself. I think many people with a significant weight-loss can probably commiserate with that. Then the stressors of life, which included going through internship and residency as a doctor, working 80 hours a week. Being up all night, it's an intense and stressful time for doctors. Then meeting my then fiancé and then going through an unsuccessful marriage and divorcing him within two years. Moving across the country starting a new job as a professor in San Diego. I had all kinds of every life stressor you could think of within a few years and so I regained all the weight I lost.

No surprise, I was emotionally eating,

ir.

It was at the point The Biggest Loser started to air.

I was living in San Diego working at UCSD (University of California, San Diego), and I was just separating from my husband, and I had regained all of my weight. I was feeling extremely dissatisfied and defeated. I was super unhappy with my physical state and my life in general. I wasn't happy in my job, not loving my position where I was. And so, I just thought, I'm going to show up for a casting call. They were having casting calls; I think Season 2 was running. And they had a live an open casting call in San Diego that I popped into and somehow convinced someone who didn't know what they were doing that I should be on the show.So, so that's how I came to be cast as a contestant. And I say now I'm grateful that I was not one of the actual contestants that season it was Season 3. It was this weird season where there were 50 of us. Each state was represented, and I was representing the state of Virginia which I found ironic because I was neither born in Virginia, nor did I live in Virginia at the time. I had lived in Virginia for a few years when I was a resident. So, I guess the production felt that that was good enough. I was one of the 36 people who basically got to be there for the premiere episode of Season 3 and then most of us had to go home and lose the weight by ourselves, and then come back for the Finale. I never was even mic’ed for my season, which I was grateful for because I'm not great at holding my tongue and being put in stressful situations on purpose on the show to create drama, I know I would have said something that would have ended my professional career as a physician. I'm like, everything worked out the way it was supposed to. So, I lost weight again as a contestant on The Biggest Loser. I followed a 1310 calorie a day diet as I recall, and exercised twice a day, most days before and after work, and ended up losing 108 pounds for my season.

During that time as a contestant, I emailed Dr. Huizenga because, of course, I'm a doctor. And I just wanted to network with him. I just asked him how he came to do obesity medicine, because I just wanted to know, because I wasn't happy in my job. I asked him if I could help him with research or anything else? And he's like, why don't you drive up to LA and we'll talk. And I was like, great. And so, I drove the two hours from San Diego. And he's like, you're gonna start working for me in January, this is how much I'm gonna pay you, and I was so excited! He offered to salary me for the year, and so I did. I left San Diego and moved to LA after our season was over. Our finale was in December, and I started working for him in January.

I got to work in his practice and help him out. And what I really wanted to do, was be a doctor for The Biggest Loser for a couple of seasons after I was a contestant. I did that for Seasons 4 and 5, which was super fun. And then at the end of that year Dr. H asked me to stay and to buy into his practice in LA. because at that point, he was just paying me a salary and, and he's like, you're gonna have too, actually buy into this practice and be here forever. I sort of had a panic attack. Because I was newly single, and still a little chubby. I sort of feel like smart, chubby girls’ stock is worth a little more on the East Coast than maybe in LA., and I just didn't feel like it was my city. I didn't have community there the way I had in other places. The only people I knew there were people in the industry, our Beverly Hills famous clientele, and his practice. I didn't really feel like I had any normal friends and family so it just didn't feel like I could see myself living there forever.

I got off the pot and ran home to DC where I where I grew up and I've been here ever since.

That was about 13 years ago since I left LA. Being back in DC, I've been working at the DC VA Medical Center as a federal employee taking care of veterans. I initially started as a hospitalist; you doing internal medicine for inpatients. But soon after I moved, I got my board certification in obesity medicine. Then when a new bariatric surgery program started at our hospital, I was helping with the medical aspects of that as I'm not a surgeon. We've expanded over the years for me to do regular non-surgical weight management as well with veterans. Most of my medical practice now is obesity medicine which is perfect because it aligns with my passion and obviously for personal reasons.

JAY: Dr. Jen, this brings up an issue, a concern, a frustration that I've had tons of people over the years that complain about, but me not being doctor I couldn’t answer. I can't tell you how many people that have issues with their weight are so put off whenever they visit their doctor because the first thing they must do is step on a scale. They feel fat-shamed and hear the same old suggestion that they need to lose weight without any real advice or support. And as you shared so well about you feeling fat-shamed, they too feel uncomfortable in their skin, and especially from their doctor. As you know you can hide it any way you want. You can hide it by being funny or suppress your feelings and act like it doesn’t matter, but we know in our heads and hearts it does! In your practice, in your private conversations with other doctors, does anyone talk about how doctors could establish a better rapport with people? Because almost everybody I know, doesn’t want to go to the doctor knowing they’re going to hear… you need to lose weight, eat more fruits and vegetables and exercise. In your medical world, besides your specialty of supporting gastric-bypass surgery patients, how much of a conversation are the doctors you know talking about all of this as in it’s both a mind and body exploration and conversation, and not just a number on a scale determination. Doctor visit weigh-ins and the same old conversation are probably the worst examples of very debilitating fat-shaming, but I’m sure that more often than not they send a patient into an even worse downward spiral than they walked into the appointment with.

DR. JEN: Yeah, it certainly is a big issue. It's been 20 years since I went through med school, so I when I say it's not taught in med school I don't know if that's true today. Certainly fat-shaming and how patients are approached are a big focus of the main obesity medicine organizations who are trying to help educate physicians and practitioners, healthcare practitioners, about how to approach patients and using people language first.

For example, saying this is a person with obesity, instead of this as an obese person.

Little subtle things like that can make a difference. It’s a big area of interest with the Obesity Society and with the Obesity Medicine Association. And I think that they're really trying to sort of get more education out there for people so that people with obesity or with overweight, can feel more comfortable seeking help. Certainly, anybody who's certified by the American Board of Obesity Medicine (ABOM) should be easily approachable by a patient and you can search on their website to find practitioners who do weight management who are certified by the ABOM. You can also search by state. So, if you want to see a doctor who specializes in weight management, will make someone feel more comfortable than a standard primary care doc who to be fair have 100,000 things they're supposed to worry about in 10 minutes. It's hard to sit down and have a heart to heart with a patient about how they're feeling when you've got 10 minutes to cover colon cancer screening, blood pressure…

JAY: Thanks for clearing that up, it makes total sense. One of the things I say to people is that no matter how much you like or don’t like the medical professionals you interact with, you must be your best advocate to make sure you’re getting access to what’s best for your well-being. Obviously, you won’t know what’s the best medical solution or treatment that may serve you. But you have to be the person that like you said, can do some research, can ask the questions, and if you're not getting the responses, you feel comfortable with, instead of getting pissed off at any medical professionals you need to stay in the inquiry, discovery, and conversation until you’re satisfied. I'm glad that after this chat you said you’ll share some ways to access the people, places, organizations, and links that can help anyone with their research. Ok, another topic I’d like you to weigh in on is metabolism, and how it was portrayed in the NIH (National Institute of Health) study that was done with contestants from Season 8 a few years after they were off the show.

https://www.nytimes.com/2017/10/31/health/biggest-losers-weight-loss.html

I never knew you were involved with the study until you shared that with our fellow alumni Marty Wolf on his “Chubby Talk” podcast. When the article came out, I got what they were saying, but many of the conclusions that they came to about why many of the contestants gained back most, or even more weight than when they started the show, wasn’t my experience post The Biggest Loser. The study came across to me as that they blamed The Biggest Loser for screwing up all the contestant’s metabolism because of rapid weight-loss. It felt like a they were giving contestants a reason, an excuse, that it wouldn’t make any difference what we did going forward because our rapid weight-loss permanently screwed up our metabolism, so most likely we were all destined to gain back all the weight we lost on the show. And you hear all the time that as we age our metabolism slows down, and it does. But for me, now 64, over the past 10+ years, I’ve found many ways to maintain my -181lb weight-loss from the show within about 20 – 30 pounds of wiggle room. And overall, I’ve continued to stay within in a very healthy range of the most important health-markers to track, and I’m still not on any medication. I also know that one of the reasons I’m very healthy and have maintained my weight is for the past 10+ years is that I’ve weighed myself every day which keeps me conscious and accountable. I visually journal every day what I’m thinking, what I weigh, what I’m eating, how I’m moving, when I’m exercising, how I’m sleeping, sharing it all on my @smartphonefitjay Instagram account living what I call a “smartphonefit” lifestyle, an idea I authored and shared in my first TEDx Talk of the same name. I guess you could say I became a “quantified-self” pioneer, and to this day I’m always looking for, researching, and adopting new tools and methods of living a “quantified-self” lifestyle. I’ve also become a veracious student of understanding all things body composition, and a navigator for others to know and understand how knowing what their body is made of is a real wellness game-changer! In addition to learning all I can about what affects our body composition; I’m also doing a deep dive into learning all I can about how our metabolism works as well.

Calories in, and calories out is major factor in weight gain and loss but our hormones, and our unique metabolisms are critical operating systems that run the show.

JAY: I’d love you to share what you’ve learned on your weight-loss journey, as a Dr., and now as someone who works daily with obese patients, what you believe to be true from the NIH study. Is it true that if someone loses a lot of weight rapidly that they permanently screw up their metabolism?  

DR. JEN: There's a lot of conflicting research on this topic. There's another group who's led by a researcher named Vicky Catenacci is doing further research in this area. When Vicky was a PhD student, Danielle Ostendorf published a paper after our paper came out a few years later, looking at people who had lost weight, retrospectively looking backwards in time, and seeing if it looked like they had metabolic adaptation or a slowing of their metabolism after weight-loss. And their conclusions for their paper was that there was no evidence of metabolic adaptation when they were looking at patients who were enrolled in the National Weight Control Registry, which is a huge database of patients who have lost at least 30 pounds. If I recall correctly, their conclusions came from a huge database of successful weight-losers and people who are maintaining weight-loss, and the interesting thing was that the headline of their paper said there was no metabolic adaptation. But if you read in the details of their paper, they said, except for in people with massive weight-loss. I think there may be something to the degree and the rapidity, as in how quickly you lose it, and how much you lose. When you lose a massive amount in a fast time, your body thinks something is going horribly wrong. And I don't know if you experienced this, but when I was the doctor on the show, I had many of the female contestants, you know, crying to me about how their hair was falling out. There is a condition where you lose your hair because your body is so stressed. Massive weight-loss is a huge stress on the body and your body thinks you're starving to death, which you are. I mean the balance of exercise and food when you lose weight like that is very extreme, so your body is gonna do whatever it can to conserve energy, so it makes sense that it would drop your metabolism. The thing is, is that the other thing though, is that if you look at our study that the NIH study on The Biggest Loser contestants and their metabolisms, if you look at the actual number of calories that they were eating every day, at the six year later mark, it was quite a high level it was like, I don't know, 3400 calories a day or something like that. I didn't look up the study right before we talk today so I don't remember the exact number. But it was a high number of calories. So, it's not like, it's not like The Biggest Loser contestants are screwed, and they can only eat 1500 calories a day, and they still regain all their weight. Ultimately what we found was that people who are exercising more did the best job at maintaining weight-loss and people who were less active in the long run, were the ones who tended to regain more of their weight, but that all people were eating calories way more than what was required to maintain a healthier weight.

JAY: Another thing you talked about on Marty Wolff’s “Chubby Talk” podcast was that exercise was an important part of the weight maintenance equation, but not the most important thing.

I couldn’t agree more personally which is what I share when people ask me about exercise.

I always suggest it should be something that they do for their overall health and vitality but not as a driving factor in losing and maintaining their weight unless they intend to keep up the same intensity in what they’re doing that helped them lose weight. Any exercise routine should be to create and add to their overall health, vitality and energy, as well as flexibility. Exercise shouldn’t be a hammer to beat down crazy eating habits. During COVID I saw first what happens to people who were excessive and obsessed with working out. I work part time for a few hours a week at our local YMCA doing body composition consultations and then helping people create an eating, movement, and exercise plan that they can fit into their mindset, lifestyle, and realistic time parameters that they can sustain 80% of the time.

As you might imagine being at the YMCA I get to see people there week after week who often working out 3 - 4 hours a day, often 5 - 6 to even 7 times a week.

When COVID shut down the YMCA for 18 months I'd be in town and I’d see the people who were always at the Y getting bigger and bigger, and often the change in their size was so shocking because you only always saw them as being very fit. I think if I remember right you told Marty was that what’s really important is what you eat way more than how much you exercise. I believe you said eating was 80 to 90% of the equation, is that true or not?

DR. JEN: What I always tell my patients is:

Diet is 90% of weight-loss, and exercise and sleep and
everything else is like the other 10%.

I might be exaggerating a little bit. It isn’t exercise, unless you’re working out like crazy that burns the most calories for you every day. Actually, the vast number of calories your body burns everyday are just keeping your body alive, running your brain, fueling your brain, fueling your heart, running digestion, like all of those things, the amount that physical activity contributes to the total is really quite small. When people exercise an hour a day, even if you're running for an hour, you don't really burn that many calories, maybe you burn 400 calories jogging for an hour. You can eat a king size bag of M&M’s which is about 460 calories which you can eat in 5 to 10 minutes.

It's very easy to overshoot the calories if you're eating processed foods that are sort of created to make us want them. You know, these aren't natural foods that would be in our environment, right? They're not what we evolved with. And so, our brains are really, our human brains evolved during the time for 1000s of years, when we didn't have food, I mean, we had to go and hunt it and find it and dig for it. And there would be a day or two where you might not eat. And so, where our bodies have been created to store energy to store fat for those periods of famine or fasting. Our brains have also been evolved to help us want to binge on high reward value high calorie foods when we do find them. Because that would keep us alive as a species.It's really only in the past, I don't know what 100 years, where there has been an industrialization of our food and you know, the creation of food products that are not natural, and would not have ever been found in nature.

The refining of grains and turning things into powders and then making them into other foods, like sugar beets or sugarcane into sugar powder. Flour didn't exist. Then when you could grind corn and wheat. But of these things in combination don't exist in nature.
There's nothing in nature that I can think of that combines sugar and and fat together.

• They're avocados and olives, which are fat, but not sugary.

• You can eat an animal or a fish and that's going to be protein and fat, but not sugar.

• You can find sugar like honey or fruit, but they don't typically have fat in them.

We humans have figured out a way to combine sugar and fat together in brownies and Oreos, which is sugar and fat.

The only thing that I can think of and that occurs naturally that combines things in that way is breast milk. And so, it sort of makes sense, right? We would want our babies and our infants to over eat and beef up because we want them to live and grow healthy. I think it's funny that we humans have tapped into that reward pathway in the brain and have created these Franken-foods that are intended to make us overeat them because that's how the companies make money. It’s not their job is not to make us healthy. Their job is to make money for their shareholders and they're doing a great job of creating foods that we want to eat a lot of. As long as we're around all of these foods like Oreos and Doritos and things like that, especially foods that are marketed as healthy, like breakfast cereals that say you know heart-healthy on it, when really it's a refined grain. Or sugar sweetened vanilla flavor Greek yogurt thinking you're eating something healthy because it's Greek yogurt, but it's really sugar. Those foods tend to put weight on people. There was a great study by Kevin Hall, who was the head researcher on the study that I helped participate with. He in 2019, his group published this awesome clinical trial from the NIH where they had people who were overweight or had obesity live in their metabolic ward for a month. And they fed them two different diets for two weeks each. One diet was ultra processed. It had foods like you know, tortillas, quesadillas made out of refined grains, or lemonade, or the flavored Greek yogurt, like I mentioned, and then the other diet was an unprocessed diet with but it was matched for the exact same amount of protein, same amount of fat, same amount of sugar, it's just that the sugar in the unprocessed diet was all in fruit. Whereas in the processed diet, it was often added to things like yogurt, or Fig Newtons or whatever. And so, they matched for fiber, fat, protein, sugar, salt, everything was matched. And they said, eat however much you want, until you're satisfied. And they measured their body composition and labs and all kinds of fancy things, you know, their metabolism in the metabolic chamber and exactly how much they were eating every day, and all of that. And they found that when people were presented with the highly processed foods, they ate more than 500 calories every day, just naturally, without thinking that they were necessarily overeating. And without rating that diet as being more delicious, they rated both diets as being equally pleasant and equally familiar. So, it wasn't like they hated the unprocessed food, and that's why they didn't eat it, you know. And they gained a pound a week when they were on the processed foods. And similarly, when they ate the unprocessed diet, which was things like whole eggs, cracked into an omelet with fresh veggies cooked in olive oil, they had potatoes, like they would just chop up potatoes and cook them in olive oil for breakfast potatoes or, you know, foods like that, that were like Mother Nature made them basically. And fresh fruit, you know, etc. They lost a pound a week and they ate more than 500 calories less every day just naturally and feeling justice satisfied. So, I think that's just good evidence that you know, those types of foods I think are the main problem. And so, what I like to tell my patients and my clients, my coaching clients is sugar and flour. If I have to simplify it, what should you avoid is added sugars. The only sugar I want people eating is in fresh fruit, dried fruits tricky because it's just concentrating all of that sugar into this little bit. You can eat a whole handful of dried apricots, but you're probably not going to eat 20 fresh apricots. Dried fruits are not the best but fresh fruit for your sugars and no flour because flour, is that refined grain that really seems to cause weight gain in people so that's like, tortillas, bread, and crackers. Another way to look at this is… let’s have a steak and potatoes, and maybe some bread, and you finish that meal, most likely you’re full. And the somebody's says, “Oh, do you want another steak?” Most people are not going to eat another steak when they're full. They're like, No, I'm full. Oh, do you have room for some ice cream?

Heck, yeah!

However, there's always room for dessert, the reward value is different in our brains for dessert and bread, and maybe you'll have one more piece of that warm crusty bread with the melted butter on it. There might be a little room for that, but probably not room for more broccoli or steak.

You can just tell what our brains are triggered to really want. Those foods are probably to be avoided.

JAY: One of the things I want to make sure I get you to weigh-in on is the reason why I call my podcasts “Going Beyond The Scale.”

On The Biggest Loser, we lived and died each week by “The Tale Of Our Scale.”

And to be clear, on The Biggest Loser we were clueless about how our body composition was changing week-to-week, because the only measure that mattered was hydrated “weight loss.” Meaning before each weigh-in they made sure we were all properly hydrated at the same percentage before we ever stepped on a scale to make sure that no one cheated by sweating out. How’d they do that, they always checked our urine before we got on scale. And for me post The Biggest Loser, over the past 10+ years, I’ve shifted my “weight loss” and “weight maintenance” navigation with people to be only about body composition, and certainly not just a number on the scale. In approaching all my consultations from that vantage point I've seen first-hand how powerful that distinction, education, and explanation is for people.

For example, one of my partners, Gloria, and I have been meeting monthly with an evolving group of 500 associates at Vaynermedia that range in age from their early 20’s to mid-40’s where we review their body composition stats, which always evolves into a broad conversation about what’s going in their life, and what they’re doing, or not doing about their mental health and physical well-being. When people look at their body composition stats, I always tell them that there are no good or bad numbers, it's only an internal view of their body at that date and time. And that their numbers show their current physical assets as it pertains to their lean muscle mass on reach of their body parts, their basal metabolic rate, overall body fat percentage, and how well their body is hydrated. From their body composition baseline we can look month-to-month to see how their actions and lifestyle changes they’re making or not making are changing their body composition, and most important, what they’re getting from those changes, and what they what to keep moving towards whatever their well-being goals are.

When people get to see what their body is made of for the first time, they start to have some freedom around whatever their present body size and shape is. And they start feeling empowered to think and act in ways that better serve their well-being. Also, whenever people start to understand their body composition and how it evolves, they also have a lot less stress around the things that in their past would throw them off course. For example, holiday’s, special events. Birthdays, business travel and even a vacation. In the past these types of lifestyle events would cause them to start stressing that they were going to blow all the progress they were making. Knowing this, I always ask them well in advance what are the events that in their past triggered them, and early on we start to talk through strategies so they can enjoy the event, and most important, mentally stay in the game. This is where having them understand and get related to their body composition well in advance of these triggering life events is such a powerful game-changer. And everyone I navigate knows I'm never not going to make them wrong with the outcome no matter what it is, it’s just an opportunity for us both to learn something. My most important “ask” from them is that they always come to our next appointment so that we don’t lose an opportunity to see how their, mind, body, and the things they did or didn’t do affected any change in their body composition. Now what I’m about to share isn’t a scientific study, and it’s coming from a layperson but it’s quite remarkable! Having done 1000’s of what would have been historically major triggering life events that people felt caused them to “blown it!”, people are shocked by the results! Before they step on the scale, they’re thinking… that they’ve gained 5 pounds, 10 pounds, and for some even more.

Why?

Because they meant to keep up their exercise routine but didn’t. If they like to drink, they tend to drink more which often leads to them loosening up from whatever eating plan they were doing by saying to themselves “I’ve been doing great, I deserve some treats.” But what we’ve discovered 99.9% of the time is that all that has happened is that maybe they gain a pound, but quite often the scale stays the same, their body composition stays the same, and some even actually lose a pound or two of body fat, true

Why?

Like I said it’s not a scientific study, and I’m not a doctor, but I have a feeling that when they relax, loosen up a little, maybe move a little more than sitting behind a desk all day even after going to the gym, maybe they got a little more rest, they could be sleeping better, and most likely their stress levels are lower, and their cortisol levels have settled down too. Results like these, which cause major shifts in peoples thinking are what has motivated me over the years to keep learning, sharing, and further pursuing having people create a new “Tale Of Their Scale” once they start to understand their body composition and what causes change in it. So, when I saw you sharing on social media that you wanted to lose more weight, I was kind of confused as I saw you were using a traditional bathroom scale. You weren’t talking about body composition, and as best as I could tell, it really didn’t seem like you needed to lose any more weight. From my perspective you look like you're fit, I know you're healthy, so how much more is your body going to give up? And then when we did a little pre-podcast chat and you shared that you had gotten a body composition analysis I was pleased. (Dr. Jen holds up a copy of the InBody body composition she got) Great! Now, you got that, what was that like for you? What have you learned out of doing it? Was it the first time you did it?

DR. JEN: It was the first time I ever did it. Yeah, I did a DEXA of course as a contestant on The Biggest Loser many years ago. And, and that was the last time I had body composition done. I had this done because now I'm particularly focused and interested in Alzheimer's prevention, which is a whole another story. My mother has Alzheimer's disease. And I have a very strong family history of it so I'm at quite high risk. And now today, I'm really driven by my desire to maximize my health, for preserving my mind, basically to try because about 1/3 of Alzheimer's cases are preventable with lifestyle change. And we never really knew that until the past decade or so. So, preventing it before it happens is possible for many people, not everyone, and maybe I will have it one day anyway. But even if I do get it at least maybe I can delay it 5 or 10 years. So as part of my own personal efforts in Alzheimer's prevention, I've had the great blessing to be accepted as a patient in the clinic of Dr. Richard Isaacson, who is the sort of leading Alzheimer's prevention expert in the world, probably certainly in the US. And he's at Cornell in Manhattan, and he is the one who asked me to go and get an Inbody 770 specifically to look at my body composition, because as you like to focus on as well.

As he agrees, it's not about what your scale weight says it's about how much body fat you have and how much lean tissue you have. And he wants my body fat to be a certain percentage, you know, or lower, ideally, to maximize my chances that you know, brain health. And so, what he had suggested to me was that my body fat be preferably 26 or lower, 27 maybe, above that is bad.

My body fat scan was 28.9.

So, I’m a little bit over fat compared to what would be the ideal for Alzheimer's prevention. I’m still trying to lose some body fat, not that I'm not happy in my skin now or I mean, I'm 150 pounds lighter than I was like, please I get how lucky I am and how, you know, I'm a whole different person, obviously. So, it's not that I'm unhappy with my current weight so much is really driven by this health goal. That's super important to me, especially now that I have a 4-year-old son.

So, for me focusing on the scale is just the easiest piece of data that I can collect. Checking my daily weight, which I do, and which I often suggest to people I think can be helpful to actually take some of the drama out of it. Because when you see that your weight is 2 or 3 pounds heavier the next day than it was the day prior, you know, it's not that you gained fat of that amount, it's the salt that was in the sushi you had or it's, you didn't poop or something, you know, something has changed, and obviously, that's why the scale weight has changed.

So, I've been taking a daily weight for probably 15 years. And, and it's just data, I mean, it's just neutral data, it's the pull of gravity on my body. And it helps give me a raw piece of information. Now, I'm curious because Dr. Isaacson had me change up my exercise routine. I write a blog, and I had posted a blog about what my exercise routine was probably a couple months ago now. And at that time, it was just elliptical, and he asked me to change my routine and said I need to do a couple of days a week of strength training, which I was not doing, and try to increase my lean tissue mass, and some high intensity interval training a couple days a week, but not every day. And then mostly just endurance aerobic exercise, otherwise, with the goal of eventually repeating one of these body compositions, and hopefully decreasing my body fat and increasing my lean tissue with all of that. So, I'm kind of excited to see my scale weight is a couple pounds lighter, maybe 3 pounds lighter than it was when I did this InBody. But I've been strength training twice a week. So, I'm curious, maybe I've maybe I've lost 5 pounds of fat and gained 2 pounds of muscle. It's exciting to get the body composition. I was happy to also see the type of scan I got has a visceral body fat, as well. It tells you what your belly fat is compared to the rest of your body. And that's really the fat that's most associated with metabolic problems like diabetes, and metabolic syndrome and stuff like that. I was pleased that even though my total body is a little bit over fat, my visceral fat was lower than the average woman of my age. So, it just gave me a lot more information than obviously a scale ever could.

JAY: Yes I've found that when you talk with people about visceral fat or body fat, I always start talking to them about their body composition with lean muscle mass first so they start listening, thinking and taking actions differently because when they start talking about making a change, I think the biggest freedom they get when talking about food, or their desires and cravings, is they start to think more about what’s possible than what they should or can’t do or have. Because when people don’t understand their body composition breakdown, and their only frame of reference they have about their weight is a number on a bathroom scale, or even a typical doctor’s office scale. If they think they’re overweight, even though most people know their bodies are made up of water, muscle, bone, and fat, they often just compress everything into one number.

I’m overweight, I’m fat, I weigh _______ I need to lose _______, fill in the blank.

I’ve found that people who use a bathroom scale to measure their success, even if they reach their desired weight-loss goal, that success is fleeting because they still think that number is them still being fat. They have no point of reference if whatever weight they’re at is better, the same, or maybe even worse than when what they weighed more. It’s a very shallow, misunderstood success. Which is why it often only lasts for a short while, and as soon as the scale starts moving up again, they feel resigned and give up for a period of time until the cycle repeats itself again and again, often their entire lives. For some people when they think they need to lose 5 or 10 pounds, or whatever the number is, even though that 5 or 10 pounds, or whatever could be lost, the number that sticks in their head is still THE BIG FAT NUMBER THAT’S LEFT ON THE SCALE. I’ve found that especially people that have major issues with binging or secret eating will try to explain away the challenges they’re facing or working through by calling themselves something, or saying they’re addicted…

DR. JEN: That's me! Oh, I've always said I'm a sugar addict. But it’s just a belief, it's just a made-up thought in my head.

JAY: I’m so glad you said that, because I really think people use their “I Am’s” as an excuse.

Personally, over time I saw that I was using various “I Am’s” as an excuse too, and I stopped doing that. Over the years I’ve met many other people who’ve let go of arguing for something they believed they were, something that they thought was set in stone, but it was just a story they kept telling themselves.

But when they became willing to let go of that label, and they did, it was like a muscle that needed training, needed repetition, they literally shifted from saying…
“I Am” ___________ (fill in the blank with a disempowering belief) to either nothing, or… they shifted to saying “I Am” ___________ (fill in the blank with an empowering belief) because they got really clear and honest with themselves.

Anyone can do it too if they’re willing. For instance, my wife Kim over the years has experienced every story, reason, excuse, and antic you can imagine with me and my eating. So last night for dinner we ordered out for Korean/Mexican. I got 4 bulgogi tacos, and Kim got a bulgogi bowl.  One of the things I’ve been doing for the past 10+ years is to visually journal everything I eat and post it to my @smartphonefitjay Instagram account. And whenever I take a picture of anything I eat I always like to make sure all my food is well presented. Not just to take a nice picture, but because I really think it’s important to take a little extra effort to make sure what you eat not only tastes good, but it also looks good too. So, as we’re sitting there eating in front of TV, we don't always eat in front of the TV, but we did last night, I notice Kim keeps looking over at what I’m eating, and I don’t know why, and eventually says, ‘”Why aren’t you eating the tortilla’s?” It surprised me that she asked that question because I'm like… you know me, why are you asking me that because you know I’m much more conscious and deliberate with how I eat now, and I’m “choosing” to eat everything else, and opting out of having the extra tortilla carbs. Overtime it’s become easier and easier to have so much more freedom in choosing and enjoying everything I eat, and at the same time without feeling as if I must, or I can’t, or I shouldn’t, have something when you take the power away from that kind of mindset you literally can have your cake and enjoy it too, guilt free! That's the place I do my best to help people navigate to. And I'm so glad to see that you're doing that too with how you think about what you’re eating. I think the more people understand their body composition and connect their thoughts with what they eat and how what they eat is metabolized in their body, the more sustainable weight maintenance and well-being they can create. You and I could talk for 10 more hours, but what I what I want to respect your time, so let’s start to wrap this up. But first of all, I would love to have you come back to do a deeper dive into a few more well-being topics that I know your insights and experiences could really support people with.

DR. JEN: Of course, I’d love to!

JAY: And…there’s one more thing now that I curious about… Something you started 3 years ago, and I too know what it's like to stop and start something, and to get busy with other things. So… Dr. Jen, what’s going on with your book?

DR. JEN: Oh my God, I completely abandoned that book for coach training. For anybody who doesn't know what we're talking about, I was planning to write a book about different diets. I still have all the draft writing I did. And all the lab results I did that I put my poor husband Kevin and myself through five or six different popular diets for 30 days each.

You know, the Whole 30, Keto, Vegan, and a few others. And what would make the book unique is that we monitored and recorded very detailed labs on each of us before and after each diet and how much weight we lost and what our measurements were. I was planning on writing a book about the whole experience and probably call it “Diet Science” at least that in my head for a title. Besides sharing the detailed labs for each different diets we’d share what our experience was with each one. But then I just ended up getting into a coaching program for myself to try to reach my goal weight, my final goal weight, and I had such a beautiful experience with coaching in many aspects of my life. Learning best practices, and how our thoughts and feelings really create all our results and how to harness our thinking that to achieve any goal you want. For me, it's a weight goal, but there are other goals too. I ended up going through coaching and then enrolling in a school for coach training. The book is still to be put out there one day for sure, but probably not this year.

JAY: I totally understand. And we'll share a link to your website so people can learn more about what you’re sharing and stay connected to you for when you’re ready to release your book. So, do you still have time to coach people?

DR. JEN: I'm still a full-time doctor. So, my time is limited on availability, but absolutely I'm coaching. I also write a blog, so that's obviously free information for anyone who would like to access it. Everyone can access what I’m up to on my website @ https://www.drjenkerns.com  Anyone is free to contact me there or they can email me at hello@drjenkerns.com com to ask about one-on-one coaching. If anyone's interested in in coaching, I wouldn't be their doctor with like a doctor/patient relationship, but it would be a coaching relationship where I could help them identify what their goals are and what what's keeping them back from achieving their goals. We would also talk about the connections between their food and their brain and how to get where they want to go. As I shared my passion right now better brain health, as I’m especially interested in helping people who are worried about their own brains and preserving their mind and being healthy for that reason. Anybody who needs help with their weight please reach out to me because that's my jam. But brain health is my newest passion so if someone has family members who are affected by dementia, please feel free to reach out to me as well.

JAY: Oh, one last thing I’d love you to weigh-in on, no pun intended, is kind of a dangerous, squirrely place, and that’s the often third rail conversation around “body positivity.” I'm an advocate people talking about body positivity, and I’m also really trying to listen to and better understand all the different voices around the topic. At this point, and I’m very open to shifting and expanding my thinking about this topic, but for me I think “body positivity” should also be inclusive of “well-being positivity.” I get the whole idea about feeling good about ourselves no matter what size you’re currently at, that’s a great thing to think and say.

But that’s not reality.

How can I say that, well, I’ve navigated people of every shape and size, and no matter if they were morbidly obese, or fit as a fiddle, most people, if they’re truly being open and vulnerable have a poor self-image of themselves. Yes, some people are narcistic and unrealistic about their size, shape, and well-being, and some are very repressive about their size, shape, and well-being, and everything in between. People can say all they want that people shouldn’t judge them by their appearance but it’s a primal trait we all have, it’s just the way we’re all wired. We see, we assess, we judge, we compare. I think having more people understand the world of body composition would not only start to shift and temper all of us… assessing, judging, and comparing ourselves to ourselves and others because once you know how your body is composed, and how other people’s bodies are composed they’d be more curiosity and true acceptance that we’re all very differently composed, and that’s ok! And if someone decides to stay whatever shape or size they are, or get bigger be if muscle, fat or both, and they understand that there are well-being +’s & -‘s with both then at least they’re better informed about what the thoughts they’re having and the choices their making is affecting their short-term and long-term well-being.” Let me share two ends of the spectrum to illustrate how appearances are deceiving.

Let’s say we see someone who’s chubby, overweight, fat, obese, morbidly obese, call it what you will in your mind as if you asked 100 people to label someone’s size, you’d hear one of those labels, and I’m sure others. And forget what you think they weigh or what their body composition is because any of us laypeople are clueless of what that would be without seeing their body composition scan.

Back to that person. You see them, well you think you see them… but the truth of the matter is that you’re clueless to any of the numbers that matter, their medical metrics… blood pressure, cholesterol, A1-C, and so on, and that persons percentage of lean muscle mass, bone density, their hydration, their body fat, and their visceral fat, all of which affects their well-being, and all of which are major factors in not only how all of those cumulative numbers is a “view” of their current well-being. And whatever those numbers are sets up how challenging or easy it will be if they decide they want to take an action, or actions to change their shape, size, and body composition which will affect their well-being. Having done over 5,000 one-on-one body composition consultations I will see someone step on a scale that is obviously challenged with excess weight, and then when I see their numbers and their lean muscle mass the very high, the first thing, I say is… “so were you an athlete in high school, college, both, or what are you doing now?” Because creating muscle is a lot harder and takes much more time that gaining fat if your metabolism is quite good at pointing on excess body fat (notice I didn’t say weight, which often is just inflammatory water-weight that gives all of us a false sense of gaining or losing).

Ok, that was one end of the spectrum, here’s the other end.

Have you ever heard of “skinny fat?” Let’s say you see someone from your definition/label that looks fit, trim, or maybe you say skinny. Just like my first example you have no clue to their numbers that matter, their medical metrics… blood pressure, cholesterol, A1-C, and so on, and that person’s percentage of lean muscle mass, bone density, their hydration, their body fat, and their visceral fat, all of which affects their well-being too. Skinny fat people look trim, but they have a low percentage of lean muscle mass and a much higher percentage of body fat in relation to their muscle for what would be considered a healthy balance for their well-being. What do each of these ends of the spectrum have in common? When we take away unfounded assessment, judgement, and comparison, truly appearances are medically deceiving. What’s the one thing everyone one of has that’s the same… everybody’s got a body… so the question you want to understand for yourself and those you love is… what’s you’re got? “Body positivity” should be about having a positive and healthy mindset about yourself where you are now, and also be open and willing to understand where your medical markers are, including a baseline body composition profile so you have a realistic view of your overall “well-being.” People who proclaim that their body size and weight doesn’t define them is obviously a personal choice to believe that, but for me I’m not so sure that’s being “body positive.”

It could be called body hide and don’t seek.

I agree that no one has the right to outwardly judge, disparage, bully, whatever anyone about their size or shape, that’s just wrong. And I said outwardly because as I said earlier if you think people aren’t going to have their own secret thoughts about whatever they have about you, you’re delusional, good luck thinking that’s going away.

So, Dr. Jen, with all that being said, I’d love your thinking on this. To me the part that’s disingenuous when a person talks about being body positive, as some call it, healthy at any size, and you’re a doctor, correct me if I’m wrong… if you have cancer, and you say my cancer doesn't define me, or you have diabetes, and my diabetes doesn't define me, or whatever medical challenge you may have, if it's something that is affecting your body and your health and well-being, it does possibly put you at risk for further challenges and complications, and even an early death. So, we’re making progress for people to start feeling better about themselves, and mental health challenges are finally open for help and support, but I think there’s room for a more empowering conversation around body positivity connecting to well-being positivity too. Also to make sure that you're not fooling yourself where you wake up and you have a stroke, or you have Alzheimer's, or you have some other co-morbidity factor that you hide your head in the sand about. One thing I will say that I think COVID did for a lot of us, and I know there are lots of people that don't believe in COVID, I think what it did for many of us is to realize how susceptible we are if our overall well-being is compromised.I know that was another mouthful from me, but does that make any sense from a Dr.’s point of view or am I completely off base. 

DR. JEN: Oh absolutely. I think you can have both. I mean, you can love yourself, and love how you look and who you are, and still want to have a healthier body. And just because you want to lose body fat. Or to put it simply lose weight.

When we say lose weight, we mean lose body fat,
nobody really wants to lose muscle.

So no, I'm, you can still want to lose weight to improve your health. And still love yourself and not blame yourself or allow others to shame you for the size that you are now. Right. You know, there are a lot of choices involved. But there's a lot of environment and manipulation by other people and companies and foods and things like that involved do. So, we are in control of what we do. It's it doesn't mean that there's something wrong with you. In fact, if you're overweight, and you're overeating foods that are high reward value that shows that you have a normal human brain. That's what our brain has evolved to do, as we talked about earlier on today. So, it's normal for us to want to overeat those foods. And it's normal to develop habits where you use food to make yourself feel better, because it does, it sets off dopamine in the brain, it's rewarding. And it can take away bad feelings and it can bolster positive feelings and make a good experience even better. And so just like any other habit that someone develops, you know, smoking, over drinking, shopping, whatever. It's just something that your brain has realized makes you feel better. And so, you do it more. And that doesn't make you a bad person. It doesn't make you someone who should tolerate shame from anyone else, or shame yourself. And so, I think like I just think that you can love yourself and love yourself into losing a little bit of fat to you don't have to beat yourself then you know? Yeah, definitely, but it is a delicate subject I agree with you it is I don't want to take away from the you know, body positivity movement and what their goal is because I think that that goal is super important is acceptance and self love and not tolerating shaming, I just don't think that that means that you can't also strive to improve your medical health. 

JAY: Dr. Jen I really want to thank you for being here today. And the other thing I'm going to say, as I said to you before, my background is branding, marketing, and social media so I would love you to have more of a voice out there because to me you're a breath of fresh air because you know what it's like to have all the wide world of feelings surrounding weight and well-being. I love the quote “what's most secrets is most common” and you have lived the secrets, and now you are helping others out the secrets they think are only theirs, and as you know, it’s so helpful when people realize they’re not alone. So, combining your personal experiences with your background in medical obesity medicine, you’ve become a real well-being game-changer. Always think of me as your cheerleader because I think more people need to hear what you're sharing.  And I get it, you’ve got a full-time job as a doctor, but I think you are very different from many of the people that are out there. As I said I would love to have you come back to explore more about some of the things we talked about today and other well-being topics as well. 

DR. JEN: Absolutely. I would love to, and I really appreciate those kind words, Jay, thank you so much. It means a lot to me to hear. Thank you.

JAY: Thank you. So, everybody, thank you for being here today. Remember you can access what Dr. Jen shares on her website @ https://www.drjenkerns.com  And please feel free to contact here there or at hello@drjenkerns.com to ask about her one-on-one coaching.

Also, if you like what you’ve heard please share her contact information, and this episode with people in your life that you think would benefit from hearing what she’s shared. She's somebody you can trust, and somebody who will listen and support you.

But you got to take the first step you got to reach out to her and give her a chance to hear what you got up your sleeve.

Thanks again for being here, and be well!