We are an endocrinologist, a woman who lost 140 pounds and became a personal trainer, and a primary care internist. Ask Us Anything.

I've often heard that if you try to lose weight by skipping meals your body will think it's starving and somehow hold onto the weight you're trying to lose. How true is that if a normal, well fed person like me starts skipping lunch? In the end, isn't it a matter of calories in vs calories used? Is it possible to skip enough lunches that your body just accepts that as normal and doesn't think it's starving? If I increase the amount of calories I eat at breakfast or dinner by the amount I would have eaten at lunch, will I gain weight since my body will think I'm starving at lunch time? If my body thinks it's starving because I skip lunch, what's the smallest thing I can eat to get it out of that mode so it doesn't try holding onto weight, like can I trick it with a LifeSaver or a blueberry or do I have to eat a sandwich? Thanks.

A reduction in calories will cause your metabolism to slow -- NOT skipped meals.

It’s a compensatory mechanism your body kicks into when it senses that you have a caloric deficit. Unfortunately, it’s also the reason that many folks -- trying to lose weight -- plateau.

This often leads to folks giving up weight loss efforts. However, in order to overcome this it’s key that you increase your level of physical activity. - Dr. Bruni Nazario

There are different perspectives on this. Today, intermittent fasting is popular, which often involves going 8 hours during the day without eating (there are variations on this theme). It’s not necessarily a weight loss regimen (of course everyone is different) but early studies do show some beneficial metabolic effects, such as on blood sugar. My personal perspective is that you’re better off eating every 2-3 hours and that’s the approach I use personally and with those that I coach through their weight loss journey. You are right that ultimately, calories in, calories out is important. But of course 100 calories from a candy bar would not be nutritionally equivalent to 100 calories from a lean protein/healthy carb snack. One thing with skipping meals is that you can tend to get extra hungry and overeat at your next meal -- or get so hungry that you end up reaching for something that’s less than ideal. Ultimately, find what works for you and that helps you make good choices along with seeing progress in your journey. - Dr. Michael Smith

What affect does out gut and intestinal biome have on our health, nutrition, and metabolism? I know this is a relatively new area of research, but is there anything we know for sure?

Or maybe this is a better question: how does our digestive system come into play in regards to nutrition and weight loss?

Great question. There’s so much interest in the are of the gut microbiome and health in general. The most current thoughts are that a normal healthy gut is key to reduction in overall inflammation. In folks that have weight issues , we know that their fat cells have an excess number of inflammatory cells that contribute to the comorbidities associated with weight. Improving gut health with things such as probiotics has been shown to reduce conditions such as IBD, eczema and improve efforts to lose weight. Dr Bruni Nazario

1. How does PCOS play into long term weight loss efforts?
   
2. What are other common maladies that one should take into account when forming a strategy for long term exercise and weight goals?

This is something that Dr. Nazario and I have spoken about often. Weight gain, even obesity, is a common occurrence in women with PCOS (polycystic ovary syndrome). Insulin resistance, where our bodies have trouble metabolizing sugar, is also a significant factor, predisposing you to diabetes. Studies have shown how effective weight loss can be in both turning around the insulin resistance but also the other hormonal changes that occur in women with PCOS. Your metabolic makeup will tend to cause weight gain. However, the right dietary approach can turn this around as well as help correct some of the metabolic and hormonal imbalances associated with PCOS. A low-carb approach (not necessarily keto) is an effective approach to help with weight loss and address the insulin resistance. One study in recent years also showed that eating more soy is an effective strategy in women with PCOS as well. - Dr. Michael Smith

Answer to part 2: It depends on certain variables. When planning a weight loss program, it’s important to take into account any medications that may be affected by weight loss. These include drugs such as those used to treat diabetes, high blood pressure or even water pills. A reduction in your weight would require some adjustments. It’s also not uncommon to feel fatigued during the initial weight loss phase. This can be the result of medications [now taken in excess] or mineral deficiencies associated with the early weight loss. - Dr. Bruni Nazario

The first time I successfully lost weight, I did so with a personal trainer. I struck a deal to be the “test subject” of a local sports science gym. $5 a session, 5 days a week, for 9 months. I had powerlifted in college, but began the journey at 374. I lost 100 lbs, and started CrossFit. Then after 3 months, I became very tired, a little burnt out. I hovered around 290, but hard a time with diet. In the nine months losing weight, I basically ate the same thing (chicken and veggies) and juiced. Fast forward three years, to 2015, I was still at 290. And I couldn’t motivate myself to HIIT train or even ride my bike after I failed an attempt at hiking the Appalachian Trail. Then, I moved out of my parents place, and lived with my grandmother. There, I started learning how to be healthy. I juiced regularly, cut meat in half, and started growing vegetables. Over the next year, I installed a basketball goal, found a great yoga teacher and restructured my life. The lowest weight I ever got to was 234 lbs at 6’2. I was strong, turning compost, and really happy. Then, I started college again, my yoga teacher moved away, and I became busy. I still kept gardening, but I stopped going to yoga (would take another year to completely stop all yoga), I had a falling out with my grandmothers family, and moved back in with my parents. I’m still growing vegetables, and eating locally. However, since I stopped exercising with a group, or by myself, I’ve packed on the lbs. I’m somewhere over 300 lbs, I’m too afraid to weigh. Since gaining weight, I’ve been struggling with sciatica and it’s been so hard to motivate myself to exercise. I live in a rural area, 30 miles from a gym. I have a 1/3 mile driveway, lots of yoga training, I like to bicycle, and I have a big garden. What can I do in y’alls opinion to get back on the right path?

tl:dr 374->274->314->234 to currently at 320+lbs. I am depressed from not getting motivated to lose weight and exercise after struggling with the physical and mental side effects regaining weight.

First, let me just say how incredibly awesome it is with the success you’ve had. It’s not easy, especially when you do it alone! And that would be my recommendation to you. Don’t do it alone. Figure out a way you can become part of a community. Given that you live in a remote area, perhaps that’s not easily attainable locally. So look online. There are also programs where you can work with a health coach virtually. And with today’s technology, we can often feel like we are right there with people even from across the country. You need others. Research shows that support is one of the most important components of a weight loss program. A health coach can help supply that. An online weight loss community -- but one that’s focused on positivity and support. Surrounding yourself with others working on similar goals together will help motivate you and inspire you. And they can also help lift you up when needed. I know you can do this. You’ve done it already. This is just a continuation of your journey. Keep pushing forward. You will make this happen. - Dr. Michael Smith

Hi, I have a question regarding Hashimoto's Disease.

For those of you unfamiliar with it - read here..

I have read articles that state any type of hypothyroidism really only related to 10-15 lbs of weight.

1) Is the above statement true?

2) Once you get on a treatment plan with your doc, can you expect the weight to go away with the assistance of medication (once labs come back with normal levels) or will that require the same amount of work and effort required by anyone?

3) Does this disease make weight loss harder? I have established healthy eating habits and run several miles a week as well as just walking and I find it insanely frustrating that my weight loss is so slow.

4) I am struggling with slow weight loss... Ms. LeVine, what did you do to help combat frustrations with the scale?

I was frustrated many, many times and that’s absolutely normal. Sometimes you can lose 5 lbs in one week and then nothing for two weeks and next week lose 8 lbs. Your friends and family start noticing subtle changes with your looks but nothing on the scale happens. It happens like that sometimes. PLUS DON'T BE A SLAVE TO THE SCALE! Use a pair of jeans or a belt as a guide too. If you’ve been doing the same routine for while- same meal plan and macros and exercise, change it up one week alter calories and cardio. Your body may need a change. I would do a week of a new intense HIIT cardio and switch out chicken to fish or any lean meat. Doing those things helped me mentally. For me knowing that I was doing everything I could to keep that scale going down help me from eating a bag of chips and cake icing.

Basically don’t give up no matter what you do, you didn’t gain it overnight and you won't lose it overnight. -Indira LeVine

Thyroid hormone is the primary driver to your metabolism; With an underactive thyroid, it’s expected that maintaining your normal weight will be challenging. In other words, ‘yes, weight loss will be harder.’ Yet, many people with treated thyroid conditions can maintain a normal weight... having said that, it’s important that you also have a well-rounded weight and strength training exercise program. The weight loss that you might have experienced during your initial hyperthyroid stages of Hashimoto's means you've also had some muscle loss. AND especially in women, muscle strengthening is required for weight management. - Dr. Bruni Nazario

Can you speak to the fact that most people who lose a significant amount of weight gain it back due to biological changes such as lower resting metabolism and changes in leptin and grehlin? This can be really discouraging -- given that information, what do you think is a reasonable expectation for balanced weight loss, weight loss maintenance, and overall quality of life?

This boils down to your approach to weight loss and what you do after you hit your weight loss goal. This is one reason I cringe when people say they’re going on a “diet.” Diets are something you do temporarily. So what happens? You have temporary results. There was a study looking at participants on the Biggest Loser a few years back and about how most had gained their weight back and their metabolism had taken a hit. This doesn’t apply to us mortals as most of us are not losing weight by exercising for hours on end in the gym and losing sometimes 20-30 pounds in a week. We have lives to lead. If you lose weight through healthy changes, cutting calories while keeping a well-balanced approach to your diet, and ramping up exercise once you lose the weight, your chances of long-term maintenance are great. And address whatever issues led to the weight gain in the first place. Stress eating? Boredom eating? What’s your challenge? Work with someone, such as a health coach, if needed to not only identify challenges that led to the weight gain but also to develop strategies so that you know how to manage that for the long-term. That’s not something you do when you’re on a diet -- that’s a true lifestyle change. - Dr. Michael Smith

Would you recommend a rowing machine for a beginner who wants to gain endurance and muscle tone?

A rowing machine is great for beginners because you can easily adapt it to your level of fitness. It’s a great aerobic workout, obviously tying in muscle endurance as well -- both upper and lower body. But your best approach is to do a variety of types of activity, with rowing being one of those. And don’t forget to throw in a couple of days at least of muscle resistance exercises and round out your program with flexibility exercises, best left to after your workout. - Dr. Michael Smith

What's the best way or diet to get rid of love handles?

Any approach that burns fat is going to help with love handles. First off, we need to understand that you can’t target any particular area of your body, including love handles. When you burn fat, your body is going to burn it from where it wants. That said, if you’re prone to love handles, then your body will likely help you out here and target the love handles when you burn fat. So how do you do that? Your best approach is through nutrition. But exactly how you do that is personalized to you. I do favor a lower carb approach (not necessarily keto or extreme carb cutting) so that your body turns to your fat stores. Shoot for cutting carbs to below 80-100 a day. That should put your body in fat burn and get you on your way to shedding those love handles. - Dr. Michael Smith

Clarification - 80-100 grams or Calories of carbs?

Grams. - Dr. Michael Smith

I've hit a barrier to losing weight. My current battle, after losing 260lbs, is in the skin I'm carrying around. It's not just skin, but because of it, I'm always having trouble getting lean. It's like that last 40lbs just won't go away and that's absolutely defeating. It keeps me from activities because when I'm in motion, I'm absolutely off balance with my skin often changing my center of gravity and just making everything sluggish. I can feel muscles, but they're hidden under all this skin fat that never goes away. I've been on maintenance for five years and I can't get past it.

Can you suggest a way of working down that skin fat? I am at a loss both in diet and in activity. I recently took up rowing, buying a machine for home because it helps me work out without my body getting in the way.

Can I just start by jumping up and down for you losing 260lbs!!!! Wow! That’s major! Losing all that, getting leaner, building confidence and now you’re left with the skin… when I lost my 140lbs I also had some skin left over, I went back and forth with what to do about it go to a surgeon, deal with it or lift weights and try to fill it up with muscles. I decided right now to lift heavy weights and get stronger and then decide later. Honestly for me there are certain parts that are sagging and dragging and are NEVER gonna get back right, so with that I know what I need to do. It’s just a personal choice you have to make to increase your quality of life and continue on your weight loss journey. BUT great job on losing the 260lbs!!! - Indira LeVine

I had a semi complicated question for you.

Just recently diagnosed with GERD, which has been inconvenient.

In a few weeks I plan on hiking the Appalachian trail (~2100 miles). Weight requirements require only consuming calorie dense food. Optimally >100 calories/oz.

Any recommendations for stuff to eat that won’t aggrivate my GERD while still being calorically dense?

Thanks

I've done a few endurance events [century rides] that require similar type fueling. I'm not a huge advocate of carb loading before events... especially for those of us that normally do not use carbs as our main macronutrients. But for endurance events and fuel I carry along the old fashioned fruit cake as a dense source of energy! With GERD, I caution the use of energy gels only; while they are convenient they’ll aggravate acid release. - Dr. Bruni Nazario

As doctors or medical professionals, do you feel excess skin removal should be covered by medical insurance?

often times people who go through extreme weight loss experience a host of psychological or lifestyle challenges due to loose skin. And very few health insurance cover its removal... deeming it cosmetic.

For the woman who lost 140lbs over 9 yrs, did she find herself dealing with loose skin? or did the long period of weight loss help mitigate that?

​

If you are asking my personal opinion, here it is… surgery to remove excess skin is deemed a cosmetic procedure. Obesity, the medical condition, was treated with weight loss; however, the excess skin that results can lead to abrasions, ulcerations and infections. And as you mentioned, it also has a host of negative psychological effects on the individual. My opinion is this should be covered by insurance to prevent these complications. - Dr. Bruni Nazario

Oh definitely yes!! I was blessed that I didn’t have too much but I have some in the lower stomach and inner thigh area. I honestly believe that losing it slowly over a long period of time and keeping myself moisturized and drinking tons of water helped GREATLY. I was so worried about skin I made butters and oils and constantly rubbed myself down, I know it sounds insane but I don’t have a ton of stretch marks so I believe all that helped or at least I tell myself that. The thing is you’re probably gonna have some extra skin, parts may start to fall or not be as perky but you can’t let that discourage you from continuing on with this journey. I just had to deal with it. Building muscles and lifting heavy creating a more athletic look along with eating right helped fill me out too. -Indira LeVine

I am on the opposite side of the spectrum. I want to gain weight . What should should i do?

I would assume you would prefer to gain muscle rather than fat, correct? So muscle resistance exercises will be very important for you. And of course eating more calories in the form of healthy calories -- vegetables, fruits, lean protein, whole grains. No need to load up on a bunch of empty calories, such as high-sugar foods. That won’t serve you in the long run. As long as you’re sticking with healthy foods, you don’t have to be too concerned about eating too much as long as your weight is within the healthy range. You’ll want to include weight resistance exercises to help build muscle from the calories you’re eating. I don’t know your age but over time, metabolism tends to slow (exercise offsets that) so eventually you may not have the issue of wanting to gain weight, so just keep an eye on that. - Dr. Michael Smith

I have a question for the endocrinologist! My doctor has had me take 3 blood tests because my cortisol levels keep coming back slightly elevated. How high is too high? Last test was 3 hours after waking up, and my reading was 27.1

I do have a lot of the classic symptoms of high cortisol, but since the readings are only slightly high, my doctor just keeps ordering the same test over and over....

An elevated cortisol in and of itself could be caused by anything from stress to depression to an actual endocrine disorder like Cushing's disease. Normal hormones work very precisely, so overproduction means something is going on; The next step would be to see if this is a pathology process and do a dexamethasone suppression test. The value of 27.1 needs to be confirmed after an overnight dex suppression before any interpretation can be made. - Dr. Bruni Nazario

I lost 50 pounds (240-->190) by restricting calories, over a 4 month period. I kept it off for over 3 years. I exercised daily and felt great but my face lost too much fat and I looked sick and old.

I've since had a a big problem with eczema. Between several rounds of prednisone and other cortico-steroids and depression from suffering with this shitty skin problem, I'm back to 230.

My face has filled back out. But I want to start restricting calories again and drop weight. Is there any way to keep the fat in my face?

Ok great job losing the weight and I’m sure you look amazing, you may just not be used to the new you because you’ve been looking at yourself your entire life. And no, you can’t just keep your face plump and lose the rest everywhere else. If that was the case I would still have breasts, cause I lost most of mine losing my weight. - Indira LeVine

Hi there, folks! Thanks for doing an AMA.

I have a coworker who says he is trying to lose weight by skipping breakfast and having light lunches and dinners (paired with exercise). I had to stop myself from blurting out that breakfast is even more important if you're trying to lose weight than normal because I realized I wasn't sure this was the case. Is this generally the case? What is a good, generic weight loss strategy, assuming an elevated level of aerobic exercise?

Also, what was something you thought you knew but later found out you were wrong about?

Thanks!

A morning meal [breakfast] is key if that’s your usual routine. Studies have shown that folks trying to lose weight and that typically skip the first morning meal aren’t any less successful at weight loss. As far as a strategy, for weight loss… reduction in calories is key. While exercise is important for weight maintenance, it's not going to drive a drop in the pounds. Focus on what you eat. I generally recommend higher lean protein and reductions in carb intakes. - Dr. Bruni Nazario

As far as what I thought I knew, my perspective about the role of exercise for weight loss has changed significantly in recent years. Research shows that when it comes to weight loss, the best strategy is nutrition. Exercise is a relatively inefficient way to burn body fat (i.e. lose weight). That’s why so many people hit the gym to lose weight and get frustrated, especially if they don’t change what they eat. So today, for weight loss we recommend nutritional changes primarily. We estimate 80-90% of weight loss comes from nutrition. Exercise is important for maintaining weight loss and of course for optimal health. Ultimately, it’s the balance between nutrition and exercise but nutritional changes are far more effective for weight loss. - Dr. Michael Smith

Well I’m a believer in trying what works for your lifestyle. I do intermittent fasting. And with that I go about 16 hrs without a meal and the remaining hours I ate ALL my food. The key is ALL your food. I also meal prep and follow macros. I eat 2100 calories a day and I make sure that I eat all!!! And chewing is fun, eating good healthy food is fun! Your coworker isn’t gonna be able to maintain that lifestyle for long, I believe. The one thing you don’t wanna do is starve yourself, you gotta keep your metabolism burning and if you DON’T eat your body will eventually go into starvation mode and start holding onto everything. Plus if he wants to workout, he needs to eat to give himself the energy to get through the workout.

Good food, HEALTHY food isn’t the enemy.

I did exactly what your coworker did when I was 336lbs, didn’t eat well balanced meals, skipped them, NO carbs and then I was freaking out when I wasn’t losing weight. I had to learn how and what to properly eat and the portions for keeping the weight off for life. - Indira LeVine

Actually I started skipping breakfast last year and lost 10 pounds with that alone. This year I went back to that and no drinking soda and only having alcohol once a month and lost almost 20 pounds. It honestly just comes down to what you eat. Don’t eat more than what you should be and if you’re not feeling hungry don’t force you’re self to eat. Not hungry? Just skip meal and eat the next one. Also find myself feeling a lot better when I only eat when I feel hungry and not at set times. Also the 20 pounds this year has pretty much been diet and not much exercise since I’ve been working loads of overtime. Hoping to get back to the gym tonight.

I’m a firm believer in doing what works best for you and your lifestyle and what you can keep up for the rest of your life. If you skip that meal make sure you’re making up for it later in the day- maybe adding it into the other meals. Those “missed meals” calories can add up quickly.

Way to go!! Round of applause for cutting the sodas and alcohol, that’s challenge for many people and they both contain HUGE amounts of sugar. - Indira LeVine

Hi, and thanks for the AMA! A few questions:

• A belief I encounter a lot is that medications are just band aid approaches to when it comes to obesity and heart disease, how do you feel about the idea that money would be better spent in nutrition and physical fitness programs to create long term health benefits as opposed to being reliant on medication?

• There is a lot of interest in the pharmaceutical industry in trying to target fatty liver diseases. Is there one (or more) approach that looks especially promising to you?

• Indira: what is your favorite body weight workout that you can do just about anywhere? For me, I love burpees as a way to get a bit of exercise in when I’m traveling or unable to make it to the gym.

Thanks!

OMG I’m so glad you asked me this!! There are so many body weight exercises… you’ve got mountain climbers, push-ups, squats, dips off a chairs, high knees, jumping jacks, wall squat, flutter kicks and to end it all the MIGHTY BURPEE!!! 20 secs each, 5-6 rounds and you will have a glorious sweat and burning some fat!! Even during commercial breaks while you’re watching TV -- do squats on whatever you’re sitting on. But continue to LOVE burpees, I believe you and like 5 other ppl love them lol, awesome! - Indira LeVine

The best approach for fatty liver is not through medications. We know that weight loss, and in particular, decreasing carbs (especially starchy carbs) is the most effective way to turn fatty liver around. I recently worked with someone who had very high liver enzymes from fatty liver. He did not take any medication but we put him on a low carb (low starchy carb) weight loss regimen and within a few weeks, his liver enzymes decreased significantly, nearing normal levels. Of course, everyone is different but the predictable response to losing weight is that it will lead to significant improvements in fatty liver. This is very important to tackle because fatty liver can ultimately damage the function of the liver. So focus on weight loss if you have extra pounds to lose and if not, focus on eating a healthy diet that includes cutting starchy carbs and fatty meats. Work with a nutritionist or your doctor on that if you’re not sure how to approach that. - Dr. Michael Smith

Agree completely in regards to nutrition and physical fitness as effective treatment for obesity and heart disease.

Despite what many people have heard, our diets are the number one killer. Poor nutrition contributes to the top leading preventable medical conditions in this country. Weight-related conditions such as diabetes, high blood pressure, excess cholesterol, and many others can all be treated with medications. However, changes in diet and exercise are both safe and effective means of treatments. Many times these are forgotten.

All of the listed conditions are progressive and require lifelong medications [occasionally more than one pill per condition] yet, good nutrition and addressing your lifestyle may reverse, prevent, treat and even reduce the number of prescription medications one takes. - Dr Bruni Nazario

Best way you know to lose belly fat and/or tone that area? I’m attempting 82 pound loss total and have lost 10 so far. 232-> 222. Doing well with cardio and strength training with weight lifting at home.

So it sounds like you have your exercise in check, but to lose belly fat, you need to focus on nutrition -- cutting calories and unhealthy foods to shed the fat. I like a low carb approach, cutting carbs to around 80 grams a day, to put your body in a mild fat burn state but still allow you to fill yourself up with healthy nutrients. You’re going to burn belly fat from changing up your nutrition -- not so much from exercise. This will speed up your weight loss and allow your body to focus on burning fat for the weight loss vs. losing muscle. And keep up with moderate exercise. - Dr. Michael Smith

What’s your opinion on the widely popular and controversial Keto diet?

See answer to user/jj117's question - Dr. Michael Smith

To lose weight in general, what is the hardest obstacle that people fall over? Ive always believed that people who cant lose weight just suck at impulse control and dont have a good coping mechanism

I’d have to strongly disagree. If only the answer were that simple! The obstacles are many and different for everyone. There is no one obstacle that stands out among the many. But I’d say the lack of support is something that often stands in the way of people’s success. So the best thing you can do for someone who is struggling is ask them empathetic questions to understand what their struggles are. Then you can actually try to help them and support them. - Dr. Michael Smith

I'm currently taking a medication with a side effect of fat accumulating in the torso. Will it be more difficult losing the weight because of the medication?

Is there anything special with diet and exercise to address the issue? Will I have a tougher time overall losing torso fat because of it ?

When you lose weight, it will also decrease the fat in your torso. There’s nothing you can do to target that fat but losing weight by burning body fat will help decrease it there and elsewhere. No special diets in particular for that. - Dr. Michael Smith

What're your thoughts on intermittent fasting? Any issues that you've come across? I have been doing it for about 3 months now and personally I love it. Helps with calorie restriction and I don't get that post meal fog that I tend to get. And after not eating all day, food tastes waaaay better too haha

There isn’t a lot of research on intermittent fasting yet but we’re starting to see more. There’s no doubt that it can have some positive metabolic effects, such as improving insulin resistance and blood sugar. Some people see weight loss and others don’t. One question is what are the long-term implications of it. At this point, we don’t know. But as long as you’re keeping a healthy weight and you feel good with good levels of energy, which it sounds like you are, I would say you’re on the right track. As of now, there’s no significant cause for concern, so if it’s working for you, keep with it. - Dr. Michael Smith

When's your next Spartan? (Asking the real questions here)

You are probably the 4th person to ask me that this month, I honestly don’t know. But what I do know is I haven’t done much running or cardio since I became a powerlifter. Lifting heavy weight and making muscle gains has been my focus lately but I actually started running again last week. I realized that it’s HARD getting back into it!! Lol The Spartan race has a ton of running and I wanna make sure I can beat my time from before, I’m super competitive!! Doing that race was hard. VERY mental. Now that I’m thinking about it, I’m going to look at one for the end of the year. - Indira LeVine

I am absolutely unable lose weight. I exercise 4-5 times a week, doing HIIT, eat about 1400-1800 calories. About 61 inches. Weight 147 pounds.

What can I do different?

This is going to sound crazy, especially coming from a doctor who is also a certified personal trainer -- but cut back on your exercise. Scale it back. HIIT isn’t really your friend for weight loss. Keep your exercise on the light to moderate level and scale back your calories. Decrease starchy carbs (even better, eliminate them), focus on lean protein and vegetables (not starchy ones), even consider cutting out fruit for now and see what happens with your weight (and bring back in a little bit of fruit once you hit your weight loss goal). Focus on nutrition for weight loss and exercise to maintain your weight and continue on your journey to optimal health. - Dr. Michael Smith

Breaking Bad or Game Of Thrones ?

Breaking Bad, of course! - Dr. Bruni Nazario

What’s Game of Thrones? OK, before everyone blows up, I’m kidding. But I’m not kidding about never having seen an episode -- only glimpses of it since it’s pretty much all anyone can talk about. But I’m Breaking Bad all the way. Never heard about it while it was on but as soon as it ended and there was so much attention to it, I started watching it, got hooked, and binged it. - Dr. Michael Smith

I’m gonna say Game of Thrones because if I don’t, I’m afraid GOT fans will come after me. GOT fans are like a mafia. LOL - Indira LeVine

what are your thoughts on HIIT workouts? do you think you can have the same health benefits from lower impact workouts (more toning/yoga/barre focused)? thanks!

HIIT is a great way to increase the intensity of your workout with little time. It increases your maxed out efforts and improves your cardio fitness quickly. However, I also caution that it’s an easy way to get injured if you’re not trained. - Dr. Bruni Nazario

I’m 100% for HIIT! One huge thing I’m for is maximizing my time in the gym. If you have the ability to run a great simple way to build endurance and burn fat is walk for 30 sec and run for 15 seconds, get that heart rate up. I do that for 10 minutes before I start lifting weights, just to get into fat burning mode. Lower impact… just a quick walk can replace a run, that will be easier on the knees and joints. - Indira LeVine

When you walked into a bar, what did you say to the bartender?

Vodka soda, please. I pride myself on healthy drinking (well, as healthy as that can be) along with healthy eating. No reason to load up on empty calories while enjoying a drink. So minimize it. Used to be a vodka/tonic guy until I actually looked at the label. As bitter as that stuff tastes, it’s loaded with sugar. If the bartender is at a Mexican restaurant, I’m all about the tequila/soda. Margaritas, as tasty as those suckers are, are about the worst drink when it comes to sugar and calories. So while this probably has nothing to do with why you asked what we say to a bartender, there ya go. - Dr. Michael Smith

I co-sign everything Dr. Michael Smith said. And if you’re trying to lose weight, lean out, don’t have a “cheat meal or drink” until you’ve earned it. I would always think “I made it to Friday and I ate good all week, time for a drink!!” But then I look at the scale and it hasn’t moved. So that means Indira isn’t cheating.

So tell the bartender “water with lime please.” - Indira LeVine

Bodybuilder here! The speedo on stage hitting poses kind of bodybuilder.

Cutting fat is obviously a huge part of this and there's a major split in how folks go about it.

• Method A: Crash diet - reduce your intake to a point where you're dropping fat. When you get to the point that fat stops coming off, reduce intake further. I see people at 1200 or less Calories a day using this method. Often also referred to as a suicide cut.

• Method B: Modest caloric deficit in the diet and use basic cardio to create a larger caloric deficit by increasing the daily energy expenditure. Of course you can't out-workout a bad diet but the idea here is that a modest nutritional deficit will be more supportive of body processes and that increasing cardio increases the caloric demand without increasing healing/recovery demand of the body.

I tried to be objective in describing those methods but it's pretty clear I'm on team B. Lots of folks see method B as a less effective method and not worth consideration. Also people hate cardio lol. I view it under the idea that we're bodybuilding and should be supporting our bodies as much as makes sense.

What are your thoughts on this? Any idea if any studies have compared methods like these? If you agree that method B is preferred do you have any suggestions on how I can better 'sell' it to fellow athletes? If not - I'm open to being proven wrong of course! :D thanks!

I feel like I’m about to dive deep into a heated bodybuilder tiff. But here goes … why do you feel the need to “sell” your approach to others? There’s not one right way. So my answer would be all of the above. It’s clear that what you’re asking would not apply to the majority of us who aren’t on-stage bikini ready. If you’ve found an approach that works for you, stick with that. And I would say the same to someone who’s a proponent of the other approach. There’s no research to suggest one approach over the other. At this point, we’re not talking about health per se. We’re talking about a short-term approach to get cut. None of it is sustainable, but competitors of many different sports will do something short-term in order to get ready for an event. So do what works for you -- but let others do the same. - Dr. Michael Smith