If you  believe that weight loss is an essential step in improving your health, this episode will explain why that assumption just doesn't hold up. I'm joined by registered dietitian and menopause expert Dr. Val Schonberg who draws on her background in sports nutrition and eating disorders to explain why behavior-based goals—rather than the scale—are key to sustainable well-being.

We dive into the myths surrounding weight, BMI, and body composition, especially for women in midlife and beyond. We explore how diet culture, weight cycling, and flawed metrics have distorted our understanding of health, and why focusing on intuitive eating, and balanced nutrition is a more sustainable and realistic approach.

Links Mentioned:

• Episode 54: Raising the Red Flag About Eating Disorders in Midlife with Val Schonberg RD 
• Episode 78: Filtering the Fear of Insulin Resistance in Menopause with Val Schonberg, RD
• Episode 107: Why Diets Don’t Work with Dr. Amy Porto, PhD, RD

Connect with Val:
The Website: https://valschonberg.com
Instagram @v.schonbergRD 

✏️Take the Midlife Body Assessment

TRANSCRIPT

Jenn Salib Huber: 0:00

Hi and welcome to the Midlife Feast, the podcast for women who are hungry for more in this season of life. I'm your host, Dr Jenn Salib-Huber. I'm an intuitive eating dietitian and naturopathic doctor, and I help women manage menopause without dieting and food rules. Come to my table, listen and learn from me trusted guest experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. 

And if you're looking for more information about menopause, nutrition and intuitive eating, check out the midlife feast community, my monthly membership that combines my no nonsense approach that you all love to nutrition with community, so that you can learn from me and others who can relate to the cheers and challenges of midlife.

Debunking the Myth: Why Weight is Not a Proxy for Health

Jenn Salib Huber: 0:50

Have you ever said or thought I have to lose weight for my health? If you're like most people, you probably believe that weight loss is required in order to achieve health or improve your health. But what if I told you that that's not true, that weight and health aren't the same thing and that you can actually improve your health without ever stepping on the scale? That's exactly why I invited my friend and colleague, val Schoenberg, to talk about what is the difference between weight care, health care and how do we set behavior-based goals that have nothing to do with the number on the scale? 

Jenn Salib Huber: 1:26

Val's episode is kicking off this month's non-diet resolution challenge. Next week I'll be joined by Dr Emma Beckett talking about how to spot misinformation in the media, and in two weeks I'll be back with a solo episode just before we start the live challenge. So if you haven't saved your spot in this year's non-diet resolution challenge, go to the show notes or the comment section on YouTube and make sure that you save your spot. This is my most popular free training that I offer every year and it will help you get out and stay out of the diet mentality this year so that you can focus on the things that really matter. Hi Val, welcome back to the Midlife Feast.

Val Schonberg: 2:03

Hi Jen, it's exciting to be here.

Jenn Salib Huber: 2:06

Yeah, this is the third time, so I think anybody who is a regular listener will certainly recognize your voice, your name, because we've done two other episodes talking about insulin resistance and eating disorders, which are two very important topics, but today's episode is actually one that I asked my Instagram community a couple of months ago what would you like Val and I to talk about next and we put up a few topics, and this one, I think, won by like 46% that people wanted to hear us talk out why isn't weight a proxy for health? 

Or just trying to add more to this conversation about weight and health, which seems or sometimes feels like it's a slam dunk in the medical world that losing weight is always going to be health promoting or is always a good idea. So, before we dig into all that, though, can you just tell us a little bit about you and who you are, and just kind of a little bit of your background, for maybe someone who hasn't listened to you before- Sure, well, I am a registered dietitian.

Val Schonberg: 3:14

I'm also a board certified specialist in sports dietetics, so I do a lot in sports nutrition as well, as I'm a certified menopause practitioner as well as I'm a certified menopause practitioner. So midlife health, especially women's health, is really near and dear to my heart and where I spend a lot of my time immersed in the research and the literature.

But I have this extensive background working in eating disorders, so it's a little bit of a Venn diagram of those three environments and addressing the health and nutrition needs of a lot of different people. As it comes to that, my background is that I'm originally from Minnesota, so my private practice is in Atlanta. I live in Atlanta, georgia now, but I'm originally from Minnesota Well, even before that, nebraska so I'm a Midwestern girl when it comes to the United States. But it's interesting as it relates to this topic, I think about my own.

Val Schonberg: 4:05

I think all of us who work in a weight neutral space which we'll probably get into that have our own personal background with potentially dieting and trying to lose weight, and oftentimes in the spirit of health right, even if it wasn't necessarily totally driven by that, we told ourselves that was what it was. So I started my nutrition degree back in 1992. I'm coming out of really that low fat, nonfat space and I was very focused on helping people lose weight by taking fat out of their diet and fast forward. Long story short is that didn't work, as we know, historically, but it didn't really work for me either. And they did. Long story short is that didn't work, as we know, historically, but it didn't really work for me either. And they did at first right, there was a huge sense of control.

Val Schonberg: 4:52

I'm I'm brilliant at calorie counting and tracking all of that and all I found over I don't know a decade or two of doing that kind of stuff was learning that that what you do is you don't really achieve much in terms of weight loss.

Understanding the Impact of Weight Cycling on Long-Term Health

Val Schonberg: 5:09

But even if you do, and you do kind of temporarily feel better in your body, the weight regain and the overshoot when you release those diet rules is horrendous. And so I definitely have this lived experience and I have a passion for helping women just be at peace in their relationship with food and their relationship with their body. So that drives a lot of the work that I do. And then, secondary to this, is being immersed in the research since the 80s and knowing like we are saying the same thing over and over and over that diets don't work and that weight cycling is problematic, and and here we are in 2024 and we're doing the same thing over and over. 

So I just am really passionate about even as clinicians, you know and kind of bringing this weight neutral perspective into helping people realize that there is a better way to finding peace in your relationship with food and body and then overall you can be healthy.

Jenn Salib Huber: 6:12

Thanks so much for that, val.

Jenn Salib Huber: 6:13

I think that one of the things that we connected over way back when I think when you were at a menopause conference, a menopause society conference, and I was following your stories was the lack of weight neutral research, especially in the midlife space.

Jenn Salib Huber: 6:27

And even a few years ago because I think it was a few years ago now there was a lot of noise coming into the menopause nutrition, menopause health conversations and really fear mongering, if we're going to be honest about if your weight is changing. You better get on top of it, you better do something about it. You know this, you know this big bad thing is coming for you. It's like the weight gain train of menopause. So so many of the conversations started to become even more weight centric than they had been, which is saying a lot because they were already pretty weight centric to start with. 

So let's kind of dive in a little bit to why we think, or why diet culture has led us to believe, that it is such a strong connection between weight and health. Maybe another way of putting it is what are some of the misconceptions or the common myths that you hear about weight and health? Or that maybe we think that society as a whole has about them.

Val Schonberg: 7:21

Yeah Well, I think one way to neutralize it for everyone who might be listening is that it's two different paradigms really. So there are individuals who really look at this through the weight equals health research, and it's just kind of the way they perceive that. And then there's those of us who look at it through the well, no, there's so many confounding factors to the weight element and so it can't be just weight equals health. There's flaws in that particular perspective, and I think those on the weight centric side would say the same about people who are weight neutral. 

They're like their flaws in that research. So I think it's helpful to say look, there's two different ways that we are looking at health as it relates to weight, and if we can take the emotion out of it and say that, okay, there is some literature that suggests maybe there's some causal factors I haven't really seen a lot of that but there's all of this other research that's from the weight neutral space but that often gets clouded by the weight equals health narrative. So that's one thing is recognize. 

Okay, there's just two different viewpoints. It's how we're looking at this science, it's how we're studying and our experience and all of that. But then there's also this has been a driver for a long time like really taking us back to the 19 fees, where you're really looking at the idea that weight is something that does translate into health outcomes.

Val Schonberg: 9:03

And then you fast forward over a few decades and those proponents of that weight is so important and tied up in health really kind of drove a lot of the definitions related to BMI and those BMI classifications and how we determine things that are, quote unquote overweight or, quote unquote obese, and obesity is really tangled up in all of that. And then fast forward to 2013, where the American Medical Association wanted to classify obesity as a disease for a whole bunch of reasons. But largely it contributes to research dollars. It contributes to pharmaceutical research and interventions, and they said that that would help decrease stigma around weight, which even back then we knew that would not happen.

Val Schonberg: 9:58

But there was an opposing viewpoint to that that said at that position no, there's too much research that says weight isn't necessarily a predictor of health or mortality outcomes, so we can't really say, based on the definitions of disease, that obesity in and of itself is a disease. Well, nevertheless, that got pushed through right. So then we have quote unquote obesity and I say quote unquote, because obesity is such a stigmatizing word and all we're doing to define it is BMI, which everyone would agree is very problematic, but you know, we just keep going back to it. 

So it's helpful for the listeners to understand that some of why there's such a domineering or dominant message around weight and health is because of some of this political history really tied up in. Look, we got to get this definition out there, we got to get this diagnosis so that we can do research and get some pharmaceuticals to eventually to do the interventions and treatment, and I think that's why that narrative has also been really promoted quite strongly.

Jenn Salib Huber: 11:10

Absolutely and I really appreciate the kind of historical context on that and I don't think we have enough time to get into all the problems with BMI. I will try and link some resources in the show notes of maybe some other podcasts that do kind of dive into that, of maybe some other podcasts that do kind of dive into that.

But really whenever you see a study and they you know the headline or how it's reported says weight increases, risk of XYZ, they're, they're using BMI, right, that is how they are categorizing you know what category of weight a person is in. They're not typically looking at behaviors, they're not typically looking at other things. They're using this really simplified formula that uses data that you can collect quickly and easily in an office setting or a research setting to categorize people as easily as possible.

The Truth About BMI: Why It’s an Oversimplified Health Metric

Jenn Salib Huber: 12:02

And it's an oversimplification. I mean, I think that's kind of one of the biggest things about BMI which, thankfully, we saw some wonderful media or social media around that during the Olympics, with you know, athletes kind of saying like hey, look at, look at my BMI, I'm in the overweight or the obese category. So that was kind of a really relevant reminder.

But I think that that's one of the hardest things is that people will see these media headlines, or even healthcare practitioners in a clinical setting will be getting continuing education or doing research, and that is kind of always. The conclusion is like well, look, weight has the strongest association. That is, assuming that weight is a proxy for health, and that is where the weight neutral space tries to say wait, hold on a second. We can't say that weight is a proxy for health. Therefore, we cannot say that modifying weight is going to result in an XYZ change in health.

Val Schonberg: 13:00

Well, and then let's add to that because I think this is where the midlife woman comes into having even more confusing messaging, is that now we have this normal weight obesity narrative too, which is that, oh, it's about body composition and where their body fat is stored in the abdomen. Then even if they tell us that you know, I'm not that worried about the scale, but my shape has changed and my doctor's telling me that, because my cholesterol has increased or this is happening that now I need to get rid of the belly fat, so now we're focusing on spot reducing, which we know any of us who've been around enough know that that's not really something we can do. 

But that becomes even when someone says, yeah, but I'm still gaining weight and I shouldn't be gaining weight because that's going to increase my risk of health problems. And that's where I see a lot of the midlife and older women. I'm feeling really scared, you know, because it's like man, like my body's out of control. This is happening.

Val Schonberg: 14:09

And then they see some health markers, maybe even shifts in their previous conversation about A1C, and, lo and behold, we're still back to the dieting and the weight centric narrative. So just to be clear that I think that even the medical establishment is saying, yeah, we recognize that BMI isn't super helpful. So now to be clear that I think that even the medical establishment is saying, yeah, we recognize that BMI isn't super helpful.

So now we're going to measure waist circumference and we're going to put more emphasis on, you know, body composition, and I think that's a really risky proposition when it comes to our older individuals, where we know that increasing body fat is is not necessarily catastrophic and it actually seems to be a protective, if not just normal, natural part of the process, and I do see that as becoming an emerging problem as well.

Jenn Salib Huber: 14:57

So, even if we can wrap our heads around, weight is not a proxy for health. And okay, maybe if my BMI has changed not that anyone should be worried about BMI, but like if the number on the scale is going up maybe I can kind of sort of buy into it it's still a really hard thing to separate out in our day-to-day lives and a lot of that, I think, is based on what we see in the media. We're constantly bombarded with it. What are some of the other reasons why it's hard for an individual, let alone a healthcare practitioner, to maintain that separation between weight and health?

How Diet Culture Shapes Our Perception of Health and Body Image

Val Schonberg: 15:36

Yeah, I think there's a few reasons. One is that we are immersed, like we are raised up in a culture that has put so much stigma on weight that people who are in larger bodies have they're lazy, they're not addressing their health, they don't eat well enough, they don't exercise enough, and there's just this stigmatizing language that is associated with body size, and so we get immersed in that. I mean, I've seen individuals, high schoolers, that I'm treating for an eating disorder that we trace back to a health class. I mean, eating disorders are biopsychosocial illnesses. 

There's many precipitating factors. Disorders or biopsychosocial illnesses, there's many un-precipitating factors. But you know, they hear that obesity is this horrible thing, that you're going to get judged, and so it's this shame-based messaging, even in health classes as a young person, and so it's like, well, I don't want that. And so then we kind of fall into this well, you know, I'm going to do everything to be healthy, and maybe someone in their adult years never kind of quote unquote worried about their weight, and then they go through this transition and they're like, wait a second now, now I'm getting fat, and then all of the thoughts and ideas about what that means is a bad thing, instead of nope, your body's changing and it's okay, like, let's bring it back to lifestyle. 

So I think there's that. It's this immersion that we've had in terms of how we look at body size or body fatness, okay. So then the other part of this is how it feels in your body. So when your body changes and there's this discomfort like I got to go buy new clothes, my clothes don't fit the same anymore.

Val Schonberg: 17:24

I you know that might increase body dissatisfaction, maybe your views of body image, even if they're shifting, or they've always been tied up in your self-worth.

Val Schonberg: 17:33

I think that can contribute to the buying into weight equals health, like okay, but I still need to lose weight for all these reasons.

Val Schonberg: 17:41

So when I know you and I do similar work in terms of trying to help women come into a space of tuning into their body, nourishing their body from a place of respect and care, and you know we're going to trust our body, that our body knows what it needs at this stage of life, when we are nourishing it and doing a joyful movement and managing all these other stressors in life, but then women will still come back to but I still want to lose weight and oftentimes it's tied into body dissatisfaction and then second to that would be the weight equals health narratives.

Intuitive Eating: A Sustainable Approach to Midlife Nutrition

Val Schonberg: 18:18

So we can do all kinds of debunking, like you and I could go on for another hour talking about all the research that says, nope, there are plenty of things that we can show that when you do this or eat this way, even if weight doesn't change, your health outcomes improve. We have research to document that, and so we can rationally wrap our head around it.

But then there's still this embodiment, there's this experience of but I don't want my body to change, like that's super uncomfortable, and I get reminders on these messages and social media or you know, diet culture, that I don't have to let my body change, that I should fight back and fight my biology. So I think that's why we end up in this vicious cycle too, especially at this stage of life.

Jenn Salib Huber: 19:06

I think that's a great summary and the only thing I would add to it is that we, even if it has not been true in our own lived experience, so even if losing weight has not improved our health and losing weight has not led us to feeling more comfortable in a more sustainable way in our bodies, our default is to think that we did something wrong and that we just have to try a different way. Or we have to try again, or we have to try harder. And it is because of this indoctrination into believing that, well, if I lose weight, I will, by default, almost by you know, it's like the de facto way of feeling better, improving my body image, when really that's not the case. 

Because we know that people in all body sizes and shapes experience struggles with their body image body image dissatisfaction, changes in health status, changes in health status, changes in health markers. There is not a single thing that we can pin on body size. But that is so pervasive as the message that, yeah, it keeps coming up Like I always refer to it as default programming that you know, until you're changing your default programming, it doesn't matter what script you're running.

Jenn Salib Huber: 20:16

You can be running a non diet, intuitive eating script, but you'll run up with like a what I call a syntax error, which I think is like a reference to anybody who grew up in the 80s and 90s, and then you have to, like, start the script all over again and you know. So what we want to do is spend less time looking at the script and more time looking at the assumptions. 

What is running your script, what is, what are the beliefs and what are the things in your life that are holding up those beliefs? Because if you can't change those, you have to have a way to kind of counter them, to at least kind of balance that influence, because it's everywhere. You don't have to look hard to find diet culture hiding in every not even hiding just in every corner. Right, but let's take a minute to oh sorry, go ahead.

Val Schonberg: 20:58

Well, I was just going to say, I mean, I think what's what's kind of within that? It was just so funny because I used to work for IBM, that's, I get all that computer stuff. But you know, the thought is that we can control our body weight and that is, and maybe at some point in our lifespan we might've been able to control it within some particular range, and people learn that. But really what we know in terms of physiology and research and all of this, is that we really can't control our body weight as much as it's suggested. So then that's a source of some of that misinformation.

Menopause and Weight Gain: Separating Fact from Fiction

Val Schonberg: 21:37

And then I think, second to that which I get asked about quite a bit, is, you know, are women, you know, misled in terms of menopause? Right, like they're shocked that they? You know that the average weight gain is five pounds over the menopause transition and women weren't warned about this. And I'm like, look, if it were only five pounds, you know we would not be having this conversation. 

So that is another source of misinformation is that you look at certain studies and they will say, yeah, on average, women gain one and a half pounds per year during the menopause transition, or they gain on average five pounds, and then when women are gaining 10 or 20 pounds in a year, they're like what in the world? Like what is happening to me? What am I doing wrong, when that's just because the headlines haven't really shown you all of what the research is saying? 

So I think that is kind of where, luckily, in the menopause space which you know, as we know, used to be a taboo topic, and now we're spending more time educating women, helping them understand what to expect but what we're missing is the weight messaging that you know what. It's not too abnormal to gain weight, and the amount that you might gain is really highly variable, and there's a lot of individuality to that, a lot of social determinants of health that contribute to that, and I think that is another important piece of why it can feel so confusing to women that they're like but I still need to lose weight.

Val Schonberg: 23:10

And the other thing that you said that I kind of wanted to tap into too, just to justify this, because I work again with a lot of athletes.

Val Schonberg: 23:18

So these are women who are doing quite a bit of activity and then their bodies are changing and so it is this like yeah, I'm not so worried about the scale, but my body composition is changing and so there's this kind of thin narrative as well that I want to maintain my younger body.

Val Schonberg: 23:37

And so one of the things that I kind of talk about when it comes to body image is okay, maybe, in terms of body image, in your younger years you were dealing with fat talk right, like oh, they've lost so much weight, or you know some of that, that kind of narrative.

Val Schonberg: 23:56

Well, now we're we're butting up against the old talk Like, oh, you look so young for your age. Or oh my gosh, did you see, like that person, like that 85 year old, you look so young for your age. Or oh my gosh, did you see like that person, like that 85 year old, they look so young or they look old. And now I think we have a couple things kind of coming at women in the anti-aging space which says, not only should you look a certain way and your body not change, but also, if you stay thin, well then that aligns with the healthy, successful portrayal of women today that you know, older, unhealthy women are certainly not what anyone wants to do or become, and I think that's another of the fear that gets into the weight narrative as well.

Jenn Salib Huber: 24:39

Oh, there's definitely a feminist thread that runs deep in all of this. That needs to run deep right, that we need to, I think, just be changing that narrative. We need to be involved and I think our generation is actually doing a decent job, as much as we can, given lots of things that we can't control. But I want to spend a minute not a super long time, but I do want to spend a minute talking about how do we know that diets don't work, and I'm going to put a link to an episode with Dr Amy Porto a few months ago where we talked about the Minnesota starvation experiment, which is probably near and dear to your heart and being from Minnesota. 

But you know, this is also an area when I think, when people are separating out weight from health, that it's hard, even if their lived experience tells them this is true, you know deep in their bones that it's really hard to understand. But maybe I should just try again. Maybe if I tried harder, I'd love to hear how you kind of explain why diets don't work.

Val Schonberg: 25:37

Yeah, well, the biggest reason is that it's a futile process. So, you know, most women by this age at least potentially had that lived experience that they did a diet, they lost weight and then the weight came back on and potentially more. And then they do another diet and they lose the weight and the weight comes back on and potentially more. And so by the time I see women in their forties and beyond, they've potentially been dieting for 20 to even 40 years. And so it's kind of like, well, you have this data, you have this evidence for you, just yourself. 

But we can see this in large studies that dieting or weight loss interventions first and foremost cause anxiety and stress. I mean, just the idea of, okay, I need to lose 20 pounds is going to set you up for an element of some anxiety and stress at a time in our life where we have enough stress to deal with. So I think that's really an important part.

But really this is well documented again in research to say that if we go down this diet intervention road which that you know as we go through the years, there's more, whether it's intermittent fasting or the keto diet, or you know, it used to be paleo and then it used to be whole 30. Maybe those are still kind of around, but there's always something. There's always something and it's like nope, this isn't about you know, dieting, this is about wellness. 

Okay, so you do this restrictive diet, you lose some weight, you gain the weight back and, guess what, you don't realize any health benefits when you stay in that cycle. That's the problem is that we can talk about specifically endometrial cancer, where you can look at a study and if someone loses weight or is at a certain body weight, that maybe their risk of endometrial cancer is lower. 

But when they have weight cycled and there's studies that show this, five to six times of doing this lose weight, gain weight, lose weight, gain weight this five to six times of doing this lose weight, gain weight, lose weight, gain weight their risk of endometrial cancer is almost 40% higher than if someone would have never lost weight. So when a physician tells someone their risk of endometrial cancer is high if they don't try weight loss, and then they've never really done an assessment of have they ever tried to lose weight Like what is going on here Most women have tried to lose weight. Well then, that's a contraindicated recommendation really. So that's something important to know is that diets don't work, because we've experienced it.

Val Schonberg: 28:14

But you stay in this vicious diet cycle or weight cycle and then you're not getting any health benefits versus if we focus on, how can we support you in terms of physical activity?

Key Health Behaviors That Matter More Than Weight Loss

Val Schonberg: 28:26

So if you even just look at cardiorespiratory fitness and the benefits on terms of cardiovascular health, cancer and all-cause mortality there's pretty clear data on that irrespective of weight loss, that helping someone stay committed or connected or consistent with physical activity that they enjoy, that in and of itself can have benefits. Then, if you even just look at fruit and vegetable intake I mean we have research that shows just fruit and vegetable intake or things like you know dietary approaches to stop hypertension. 

When you look at the literature which is focused on the benefits of fruits and vegetables or potassium intake or dairy and the calcium delivery to the body and so food itself, and you know having that type of a, you know eating and nourishing your body, that then you get health benefits. So you may or may not lose weight, but the health benefits are definitely going to be more associated with those behaviors than this futile cycle of losing and gaining and losing and gaining, and that is pretty well established in the literature. It's just, it doesn't make headlines.

Jenn Salib Huber: 29:34

And also and thank you for summarizing that and also we are hardwired to resist biologically. And also we are hardwired to resist biologically, psychologically, under eating and we're not talking about under eating 500 calories a day, we're talking about any kind of pattern of continued caloric restriction will be perceived as a potential lack of access to reliable food, and so you become more interested in food. All food starts to look good I always joke that, you know, I knew I was at the breaking point of my diet when a sleeve of rice cakes started to look like a delectable treat, even though I would never touch them any other time, you know. 

So we become interested in eating and that is kind of by that's biologically hardwired that you know our body resists weight loss, and that's just a fact. And so the more times we force it or try to force it to pursue intentional weight loss, the harder and harder it becomes to achieve and maintain, which is where the weight cycling information is, you know, and especially the research around weight cycling is saying like, hey, wait a minute, this isn't benign. 

You know, to tell people to keep trying when there are potential consequences to that that are impacting the exact thing they're trying to manage is like that they're not receiving informed consent with that. They're not being told like, hey, there's a really potential big side effect to keep pursuing intentional weight loss, and that is you're probably going to end up at a higher weight and there are independent risk factors associated with weight cycling. I think if people were told that in their medical conversations, they would maybe take a minute before saying like maybe I'm not going to start counting all my calories again, saying like maybe I'm not going to start counting all my calories again.

Jenn Salib Huber: 31:24

But I'd love to talk about some of the weight research, especially around behaviors, because one of the weight neutral messages that sometimes gets lost in the anti-diet messages is that we are still promoting healthy behaviors. Like at no point is this not about health. At no point are we not talking about fruits and vegetables and the value of adding in foods for health reasons. Even we're just saying don't choose foods and don't count, measure and track them for the purposes of pursuing intentional weight loss, which is where some of this research on behaviors can be so interesting.

Jenn Salib Huber: 31:57

And one particular study that we were talking about before we started to record is one from, I think, a decade ago now, maybe 2012, I want to say, or 2014. And admittedly, it's looking at, you know, a younger population I think it was about 11,000 people but all adults and when they compared four behaviors smoking, alcohol intake, regular activity and consuming five servings of fruits and vegetables, which is not as much as people think. It is not like five, 10 cup servings Like these are usually half to one cup servings, depending on the fruit or vegetable that the risk of all cause mortality, so dying of any reason, was essentially equal between all the BMI groups, and I think that that's such an important reminder of what actually matters. 

You know we get so lost in the granularity of like kale being better than romaine lettuce and you know that kind of stuff, but I'd love to hear your thoughts on that research and just other research that talks about the behaviors that matter.

Val Schonberg: 33:00

Yeah, yeah, I mean that research is there and then again, like we were talking about, it kind of gets buried and we don't pay attention to it. And so I think, recognizing that in that particular study that you're mentioning, um, because I mean I think it goes we're saying, like smoking, um, alcohol intake were two of the behaviors that they were looking at with that, and then activity, and specifically fruit and vegetable intake, and so it didn't matter what your body size was. If you had more of those behaviors, like three or four, your risk of different diseases was similar.

So weight wasn't an element. I think other interesting research is, even if you look at bariatric surgery, well, someone will say, okay, but if you have bariatric surgery, your health outcomes improve, so then weight is a part of it. Well, a lot of those health outcomes are improved within a week after the surgery, before weight loss has really happened. And if you look at the hypothesis of why that might be, is because they've been doing restrictive eating going into the surgery and short term after. So, whether it's bariatric surgery or the new weight loss drugs, you're still changing your behavior. You're changing your eating.

The Role of Exercise in Health Beyond Weight Loss Goals

Val Schonberg: 34:21

The look ahead trial is another really good example of some of this and this is a study where it's a huge study. Individuals had type two diabetes and they were in our age range, like they are the older individuals I think there were I don't know how many sites around the United States, kind of forgetting specifically but like almost 4,000 participants and it went on for eight years and what they were looking at is what is the impact of an intensive lifestyle intervention on decreasing cardiovascular health outcomes? And they had to stop the study early because there was no benefit. 

So they're like, okay, this is futile. But at the same time, when you look at the weight loss data on that particular study in the first year, these individuals now, intensive lifestyle intervention for your listeners is really something that I come back to too, because whether we're measuring blood pressure outcomes or cardiovascular health outcomes or type 2 diabetes, when they do these intensive lifestyle interventions, we are talking about weekly appointments in groups, small groups. 

They have tailored dietary goals. They meet with an exercise physiologist to do their exercise three to four times a week and they're doing this for like six months. So when you get all of that support, you're changing your behaviors, like they're getting problem solving, they're managing cravings, meal planning.

Val Schonberg: 35:50

So when you look at these types of interventions and then you see like, oh man, these people are losing weight. Okay, well, so they lose weight, their A1C improves. But now we have eight year data to say well, most of the people gain the weight back and in fact, for the people who completed the study, the average weight loss was 4.7% and A1C came all the way back up to baseline. 

So when you look at like well, dieting in and of itself restrictive eating, but like even the defense of the body, because a lot of these people were still eating well dieting in itself restrictive eating, but like even the defense of the body, because a lot of these people were still eating well the biggest loser study is another great example.

Val Schonberg: 36:25

This isn't that people, you know, just going back to binge eating or anything, they're still maintaining. You know, healthy eating patterns, exercise, but the biology is defending itself. But the look ahead study is a good example of where they said, okay, don't dismiss this study. There were important health outcomes beyond, even just looking at the cardiovascular risk. 

So it was really because of these behaviors that people had learned problem solving skills for, you know, stabilizing their eating pattern and doing regular activity. So that's, I think, what happens is we focus on the research so often at just looking at that outcome of the scale and the weight and we miss there's so many other biological benefits to just doing the behaviors. So yes, that there's a lot of different studies that will show that.

Jenn Salib Huber: 37:18

So hopefully people can hear from what we're saying that the research is out there and this isn't something that we're making up not just we, but the bigger kind of weight neutral community and because behaviors are something that we can control more than our weight, weight is not a behavior. It is a complex outcome of many different factors, many of which we can't control we do like to talk about the behaviors that we can add in. So what does a weight neutral approach look like? What are some of the things that you know other? You know we've talked about fruits and vegetables. We've talked about movement. What are some of the other ways that we can pursue health without weight loss?

Val Schonberg: 38:01

Yeah, I mean, I think intuitive eating is kind of a way that we, you know, kind of shorten that answer. But what does that really mean? Is really first starting with tuning into your body, like, are you even aware of your internal cues? Because, with a history of dieting or external messages telling you what and when to eat, you probably don't really know what you need to do. 

So it's getting some guidance on stabilizing your eating. So then, if you have this like skewed eating pattern where you skip breakfast, skimp on lunch and catch up later in the day, well, just simply stabilizing your eating, of giving you know, having confidence that you can eat three or four times a day, and then that might be a start. And then the next element might be OK, well, when we are eating, what do we want to be including? Like you know, are we overdoing fruits and vegetables, or is that something that you're not included? Maybe you don't like vegetables? 

Ok, well, let's work with your food preferences, build meals and snacks that make sense but include a variety of these important foods. Right, starches, grains a lot of those have been demonized, so how do we reclaim those? So that's. The other thing is, I think, like the Mediterranean diet gets a lot of attention, and and once again, we kind of get fixated on that okay, only be these foods instead of no, it's the dietary pattern as a whole, and what that looks like is certainly plant foods, fruits, vegetables, grains, nuts, seeds, different kinds of protein based on your food preferences. So I think that's one of the most important elements is it really depends, because it depends on where that individual's at.

Val Schonberg: 39:48

I think secondary to that and this is where both you and I talk, and many in our professional group we talk about this quite a bit is this fixation on protein, though. So people will say, yeah, yeah, yeah, yeah, I'm weight neutral. And then how many grams of protein do I need to eat? And it's like, okay, but so let's rewind and, like we're not paying attention to grams of protein, we're saying, when you have breakfast, what kind of foods do you enjoy? Are we just having a granola bar, or can we add a yogurt to that? Could we add some nuts? Okay, voila, you've got some protein. And that's another thing where I think we will say yeah, yeah, yeah, yeah.

Val Schonberg: 40:23

And then there's still this health halo on something that we need to be doing perfect, correct and right, and I'm not saying that we shouldn't be respectful of all of the different foods, including protein, but sometimes we still kind of attach onto something that really is a part of diet culture. And because we don't know for sure exactly how many grams per kilogram per day is the sweet spot for ensuring that we're protecting our musculoskeletal health, because that's a whole nother part of the conversation that we haven't talked about, like the downsides of dieting. 

You know, in addition to the one thing I had said, like weight cycling increases your risk of certain cancers and other problems, but there is a downside to dieting and restrictive eating, which is loss of lean tissue, potential loss of bone mass at a time in our life when we can't really just get that back. And so, yes, stabilizing your eating, looking at you know what kind of foods do we need to reclaim?

Val Schonberg: 41:18

And then the other part of that that I feel is super important is do you enjoy your meals? Like, do you enjoy what you're eating? Because if you don't, and you have this chicken, broccoli, you know rice kind of thing, and you're like see, I got my protein, I got my carbs, and yeah, but like I mean, I love a meal like that too, but I also like a really good fried chicken and collard greens and, you know, grits kind of meal too. 

So it's. Are you ever getting reward from your meals and your snacks? Or are they so perfect, correct and right in terms of all of these nutritional profiles that are out there that you're missing out on things that really have good food memories, are things you really enjoy? You've got that satisfaction principle right, so are you really satisfied and enjoying your meals?

Val Schonberg: 42:09

And that's why, certainly, you know, the chicken, rice, broccoli kind of meal can be just as healthy as a cream of blah blah blah soup that we're not labeling as a keto soup. It just happens to, you know, like it just cracks me up when they'll have like keto potato soup and it's like it's cream of potato soup or it can't be. That wouldn't be keto. I don't know which one it is. I saw it and I'm like can we just take off the labeling?

Jenn Salib Huber: 42:39

I know I mean, and the labels are a big part of the problem right. You know there's so much labeling of like low carb, high protein, plant forward grain free. You know all of these things confuse things because it gives people the impression that those are important definitions and they're usually not.

Jenn Salib Huber: 42:58

Unless you're a diabetic, you don't need to know if something is low carb or high carb. You know what I mean. Like there are very few circumstances where that's actually helpful information. More often than not, those labels just are marketing and they just make things more complicated. But to just, you know, emphasize the pleasure of eating. Food is meant to be pleasurable. I say that all the time. It is meant to be pleasurable and in fact you should try to include it in however you choose to plan to eat, because if you are only planning for the nutrition and not the pleasure and not all of the other functions that food serves, it's not going to be sustainable and you're not going to want to do it.

Jenn Salib Huber: 43:36

And just to like dot the I on the point that you made about muscle, I have taken to saying this fairly bluntly that I would rather gain fat than lose muscle in post-menopause, and I will say that unapologetically. And when I say it that way because it is hard, it's not impossible, but it is harder to build and maintain muscle. I see that now, three years post menopause, if we go away for a two week vacation, I absolutely feel the loss of strength, even just when I get back to my regular movement. 

Like two weeks it comes back but it's not as flexible as it was. And so pursuing intentional weight loss, especially when it is aggressive you know really big caloric deficits or you know any of the other means by which people pursue aggressive weight loss always comes with muscle loss. It is a very difficult side effect to control for.

Val Schonberg: 44:30

So just to kind of dot that I on that so I would say that, like for the individual who might be listening and saying I think that, like when I'm meeting with individuals and they really started from a place of I feel like I need to lose weight or I want to lose weight and we talk through all of this stuff, right, try to help people come back to is look, you can, you're trying to get control. Like some of this is life feels out of control, my body's out of control, my weight's out of control. How do to get control? Like some of this is life feels out of control, my body's out of control, my weight's out of control. How do I get control back?

Val Schonberg: 45:03

And so it's these kinds of things where you can look through, like you know, assess your nutrition, like are you overeating, could you eat any less? Like, if you can like, say no, you know I have these pretty balanced meals most of the time. You know I have some fun foods in there but I'm not overeating. And then my exercise I do, you know, sustainable, consistent, enjoyable movement. 

You know, maybe sleep might be a problem, that might be something that you can address, but, assuming all of those other factors, that's when, okay, kind of check the boxes and then say, all right, like I'm not, there's nothing I can do to change my body weight. That's not going to come with a potential unintentional harm like muscle loss or bone loss, and so I think that becomes a way to dialogue with yourself when it starts to feel really like a lot of pressure, like I need to lose weight at all costs, like really let's get rid of the at all costs part of it.

Val Schonberg: 46:06

And let's look back to what are the healthy habits that maybe we need to address and do that in a meaningful way that fits in with your lifestyle and your food preferences. And the other, I think, element that can be helpful is when we're shifting from weight to well-being. Well, the well-being part of it is also maybe you need to reassess your values and your health goals and what's really important to you at this stage of life. Maybe weight has felt really important, Maybe it's a part of your identity. You looked a certain way and that was just something you took for granted, and now your body's changing.

Val Schonberg: 46:40

Okay, but you know there's other things that we care about and that might just be. You know, I want to be mobile. I want to maintain independent living. I want to be able to travel when I'm 80. I want to run around and chase after grandkids, whatever that might be. Then just keep shifting back to that. What will your lifestyle look like for you to be able to travel and chase around your grandkids? Do the things that you're passionate about, and because most likely you'll be able to notice like I need to eat. Human bodies actually need nourishment.

Val Schonberg: 47:17

We cannot survive without food, surprise surprise and movement like if you want to be able to hike, you got to hike. You know it's gonna happen. So it's irrespective of what your weight is, you can do all those things and I know that sometimes really hard that process to get to that place of body peace and body trust. But it is possible and a lot, a lot of people can do it.

Jenn Salib Huber: 47:44

Thank you so much, val and I just to kind of round out this conversation. You know we I hope that we've given everyone a summary, an overview, some reassurance that this weight neutral approach is is actually very evidence-based and that weight as a proxy for health is not the slam dunk case that maybe you've been led to believe. But even when we know all that, I think the part that requires maybe more support is uncoupling the belief that your weight is tied to your worth and your value.

Jenn Salib Huber: 48:18

And so even when we can get ourselves into a place of like okay, I know diets don't work and I know behaviors are more important there can still be a lot of support and work that's needed around. You know, moving past that, my weight is my worth right, and so it's a process, and we're not trying to oversimplify it. I think both of us have enough experience to know that it is not ever a straightforward process, and so expect bumps in the road, but anybody who's listening just know that it's not something that you should be expected to do alone either. You should be able to find healthcare providers who can support you if you're on this journey.

Jenn Salib Huber: 48:58

So, thank you so, so much, Val. This has been another amazing conversation. Are you ready to answer the question for the third time? What do you think is the missing ingredient in midlife?

The Missing Ingredient in Midlife According to Val

Val Schonberg: 49:11

The missing ingredient in midlife. I forgot about that question.

Val Schonberg: 49:18

That's a really good question. I think the missing ingredient might be just this right Like what, what are your values? What are what are really the priorities and and when? You can wrap your head around. Like you know, I have these priorities that have shifted and changed. My values have changed, then changed. Then we don't need to be so attached to the weight-centric narrative. I think one other part to that that I feel really passionate about is being authentic. 

So authenticity, I feel, is something that's a value of mine, and so when I measure my value against like yes, this is X, y, z, bothering me about my body changing or these things, being authentic means when you're doing that, we're vibrant and fun people to be around and engaging and they're smart, like all of those characteristics are things that we can do, like when we work on body acceptance. So body acceptance might maybe that's my answer Really body acceptance in mid life and older probably is the missing ingredient that we need to do a better job on.

Jenn Salib Huber: 50:38

I love it. Thank you so much, val. We'll have all the links to where people can find you in the show notes, but I, as always, appreciate your time.

Val Schonberg: 50:47

Thanks for having me. It's always the treat.

Jenn Salib Huber: 50:51

Thanks for tuning in to this week's episode of the Midlife Feast. For more non-diet health, hormone and general midlife support support. Click the link in the show notes to learn how you can work and learn from me. And if you enjoyed this episode and found it helpful, please consider leaving a review or subscribing, because it helps other women just like you find us and feel supported in midlife.