All You Need to Know about Bodyfat

If you want to understand body fat and what it means for your health, then this is the podcast for you. In this episode I chat with Rob Webster from BodyScan UK  which is a company that provides my patients with gold standard measurements of body fat and muscle mass that can be used to monitor body composition and overall health. 

Of particular interest is the measurement of VAT or visceral adipose fat - this is the 'bad' fat around your organs which increases your risk of diabetes and other diseases. If you want to find out more, listen in and enjoy this latest episode. 

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Transcript

Pete Williams  0:03  
So welcome everyone. Welcome to functional medicine, bite sized as we are now in 2025 geez, where does the time go? And as you probably listen to my voice, I am a bit creaky. That Christmas flu is, well, not quite that sick. I'm still in work, but feeling a little bit grotty. So I apologize if I if I'm going to feel a bit rough and ready, but with, with the new year becomes most people's sort of, sort of processes that we want to start maybe looking after ourselves a little bit better. And today, I think, is just a really good introduction, because we're going to be talking to Rob Webster. Rob's an exercise scientist, and he's part of the body scan group and part of one of the, I think one of the most important tests that I do with my patients, and that is the DEXA body scan that looks at both body fat looks at um, muscle mass. It does give a very good, but not diagnostic picture of bone mineral density, and it does it really cheaply as well. So for me, this is increasingly a test that I think everyone should do once a year and maybe two or three times a year, depending on how definitive their strategy is, and we do have our patients. Some of them are on are being scanned two or three times a year, simply because it's so informative, but it's pretty cheap. Well, it's damn cheap to do as well. So Rob, welcome mate. Thanks

Rob Webster  1:33  
Thanks for having me. Pete, yeah, so I'll just introduced myself.

Pete Williams  1:36  
Go for it pal we always like to listen to who we're speaking to good.

Rob Webster  1:40  
So I've been a DEXA scan consultant for the last five years. I've scanned over 8000 individuals, and we're just doing body scans. So we're looking at body composition. We're looking at the fat mass, the muscle mass, the bone density. I've scanned clients ranging in the age from 18 to 81 so you can imagine people at all stages of life all trying to do the same thing, just optimize their body composition. I think people are realizing that body composition is so highly correlated with risk of diseases of slow death. So we're thinking stroke, we're thinking type two diabetes, atherosclerosis, and just making sure that your fat parameters, especially visceral fat, which is that kind of hidden, dangerous fat deep within the abdomen that is very important for reducing the risk of these diseases. We want to make sure that muscle mass is optimized. We want to make sure we're avoiding things like osteopenia, osteoporosis, those bone conditions. But in order to know this, we have to track it accurately, and a DEXA scan is just a very available way to do that for normal people, it's no longer just for hyper athletes. It's, it's very readily available now.

Pete Williams  2:44  
Yeah, look, totally agree, because we've been using your DEXA scans for pretty much ever since you've been working as a business. I mean, because I recently popped in just before Christmas for my 10 year re scan, which was quite informative. And I suppose, do you want it? Well, look, I'm, I'm a bit bit chuffed with quite a few bits, maybe not so chuffed with, uh, with a couple of the results. But could you just give us a summary of all the hard work from that I've done for 10 years? What it showed? Yeah,

Rob Webster  3:16  
absolutely. So Pete's done very well. Managed to maintain an extremely low body fat level, kind of top two percentile for his age. So that, in and of itself, is very difficult to do. As we age, we generally tend to accumulate more fat. Generally tend to accumulate more of that visceral fat, that fat around our organs. But Pete's managed to keep that incredibly low muscle mass has declined slightly, and that's generally can be a function of age, but it also can just be maybe not keeping up enough with the with the lifting. So we want plenty of lifting, plenty of resistance training, and we want to make sure we're not doing anything that's going to corrupt muscle mass. And that's where you know, if we're doing extended fasts, for example, to try and keep body fat down, we gotta make sure that that's not interfering with with muscle mass. And we've definitely saw that yours drop a tiny bit.

Peter Williams  4:06  
Yeah, and look, I think we should jump straight into that, because I think this is an important thing that I see, and I think it's a sort of, it's sometimes a lack of understanding that if you do what, if you're doing one process, it may ultimately affect another, and I will, as I said to you, I clearly stated to you that several years ago I went through a fasting stage and actually felt like I did pretty well on that fasting stage as far as how I felt, but it was clear to Me, you know, several months in that I knew I was losing muscle mass and and I was, I was getting my protein as high as I could well, within reason, I was around about 1.6 grams per kilo. I probably should have taken more given on the fact that I simply did the the fasting protocols. From a point of view, just went essentially down to two meals a day. But, and it worked, as I say, felt good on it, but I knew I was losing muscle mass, Rob, and I'm pretty sure I've never been able to put it all back on since then. So, and I think you know, this is the sort of pros and cons of you know, maybe trying to do something from a health and longevity perspective that actually probably, I probably needed to fine tune that better. So it's not that I don't believe fasting is something that many individuals shouldn't do, and I think there's a good argument for many of the people that we will see who are overweight, type two diabetic, or certainly pre diabetic were, you know, you're going to have to take them through some calorie restriction over time. Makes sense there. But I think if you've got a metabolically optimized individual for a certain age of mine, then it may actually be the wrong thing to do. I mean, what's your thoughts on that

Rob Webster  6:01  
completely agree, it depends on the individual. If you're already very low in body fat, then really want to be making sure that your total energy intake is high enough to maintain muscle but also to maintain the training that it takes to stimulate muscle mass if you're incredibly overweight. So there's a there might be a place for fasting, but the goal really is not just to lose weight, it's to optimize the fat mass that you're losing, and that's why resistance training is so crucial. But then if you're fasting, that kind of interferes with your ability to recover from that training. So I really want to take a muscle first approach, and then it's not just about weight loss, it's specifically fat loss, good.

Peter Williams  6:39  
So so let's jump into that. Because, again, totally agree with you. And I suppose the only difficulty with that isn't it is that you know, the fact that it is, it's a bit of a leap of faith for people, because you're a lot of the time taking people who are probably undernourished, and I mean under calorieed as well, and then you're asking maybe to eat a little bit more calories. But that has to run along with very specific training regimes that are going to make sure that they are breaking down their muscle tissue progressively over time. And that takes quite a bit of time and quite a leap of faith, that needs a good structure around it to make sure that you're on the right track. So again, what's your opinion on that?

Rob Webster  7:24  
Yeah, I completely agree. We want to, we want to up regulate the processes which will preserve muscle mass, and so we're talking about muscle protein synthesis, but in order to do that, we need to be training, but also eating a sufficient amount of protein. And it might seem strange to tell people to eat more to help them lose fat, but really it's to drive the training aspect the exercise, because exercise is absolutely the way to preserve muscle mass. Weight training is the only form of exercise that's meaningfully going to preserve muscle mass in in a slight, yeah, calorie deficit. So we're trying to get people to eat more, to do more, to change their composition, rather than just lose weight. And

Peter Williams  8:09  
let's, let's, let's dig into that. Because the reality is, is that we're talking about the, you know, the process of what we call progressive overload, ie, we've got to consistently and progressively just damage a muscle just a little bit, so that progressively, over time, gets stronger and stronger. And usually there's a relationship with strength, and it's cross sectional area, so it gets bigger. My thoughts on that, and again, your thoughts with regards to if you're taking a sedentary individual, then progressive overload means that, you know, maybe they can do sort of lighter, maybe types of exercise, and I'm just going to throw out here, simply because of the science backs it up, like Pilates and yoga, would probably give that individual, would you? Would you say, enough of a progressive overload for a period of time.

Rob Webster  9:02  
Better than nothing, definitely. But the amount of mechanical tension that you can create with something like Yoga is not the same as it would be for lifting some weights or even using resistance bands, for example. So we do want something more we want clients to be pushing to failure, to try to stimulate that muscle hypertrophy.

Speaker 1  9:25  
So Rob, let's, let's define this. Because, again, I think you're, you're hitting a very important point here. Because I would, in my experience, I would say almost 90% if not more, of our patient populations coming towards saying, Well, I'm doing X, Y and Z, and it's almost like a difficult conversation with them, because you don't, you want to, you want to, you know, praise them because they're working out, but also tell them that we know in the scientific literature that there's just not enough application of muscular tension to drive those changes. So how do you get around that conversation with them? Because you must have had that. I mean, you've seen so many people. You must have that conversation all the time.

Rob Webster  10:10  
Yeah, I just, I take the approach of radical candor. My goal there is to provide the client with the most useful information. And I have to be quite direct with them and say Yoga is not going to cut it. You're going to have to lift weights. You may not enjoy it, but sadly, you don't have to enjoy it for the period of time that you're doing it to preserve your muscle mass, especially if you're in this kind of energy restriction phase, it's crucial that the exercise selection is appropriate for muscle mass retention. So you've really got to look at it as a I'm doing this for my muscle mass. I'm doing this for my future health, rather than I'm doing this just to enjoy the exercise. You can do the yoga on the side as a bonus. But really the mainstay of your training should be the progressive resistance training.

Speaker 1  10:54  
And what would be so and again, no doubt, with lifting, lifting weights, I think, is where we're at. And again, for you, do you recommend any specifics, so any specific movements, or any specific ranges, or any specific sort of weekly workout sessions, what would be ultimately, and of course, look, this depends on fitness of patient. This also depends on age of patient. But what would be your sort of specific recommendations on that? Yeah, so

Rob Webster  11:26  
in my experience, it takes about three sessions per week to meaningfully retain muscle mass or to stimulate muscle growth, depending on your energy balance. So we're looking at three weight training sessions per week, you know, hopefully spaced out with maybe a day in between. And we're looking for a full body routine. We're not looking for any particular minutia. No movement is necessarily better than another. As long as you are getting full body stimulation and you are not getting injured, right? That you want to design a program that is sustainable across time, because this really is something we have to do for our whole life. We're trying to preserve muscle mass for our whole life, preserve bone density for our whole life. So you want to design a program that you can do, hopefully indefinitely. So that's a simple program that you enjoy as much as possible within the scope of weight training, and that one that you're not going to get injured. So full body movements, and three times a week for maybe an hour. Yeah.

Peter Williams  12:28  
And that would, really, I think, would be minimum requirements. And unfortunately, most people, as I said to you, it's a bit of a wake up call, and it's sometimes it's difficult, isn't it? Saying to patients, well, it's just not enough what you're doing. And it's not that that's not It's not like it's a waste of time, but it's not the most effective way to get the results that we're trying to get for you. And it is what it is, 

Rob Webster  12:51  
indeed, and this is why it's so important to measure it, because it's all well and good us telling people that they need to do more, but when they see in their body that their current process is not leading to the outcomes that they want. That is the impetus to make a change or ratchet up what they're doing. So tracking it, you know, it's if you don't measure it, you're not going to manage it, you're not going to change it or do anything about it. But as soon as you see, oh dear, my muscle mass is going down. Oh dear, I'm not really losing that much fat. I'm just losing lots of weight that isn't from fat. Yeah, I need to make a change.

Peter Williams  13:19  
And of course, the problem with that is that it becomes more and more difficult for you going forward, because obviously you've got to try and get that muscle mass back, indeed. And so again, I always look at this and say, the reason why we test is because do you really want to wait six months and then realize actually all that work that you did have to put in, all that commitment, actually hasn't worked at all, because we've exactly didn't get it right, didn't get it right. So look, I think, Well, I think we're defining and a lot, let's, can we have a review first regards, because, as I said to you, I think we have a, certainly, our practice has a very muscle centric approach. IE, you know, we're very clear that the trying to obtain optimal muscle mass as you age has some very good science with regards to risk reduction, or certainly on the cardio metabolic side, but certainly on most chronic diseases, but also just from a point of view of longevity and risk reduction on falls. And then, of course, we've got the other side, haven't we? We've got the body fat side, which, I mean, you've done over 8000 scans on people. Can we talk about I suppose the good thing is, is that it's clear from from the science, that as a population group, we are quite significantly overweight. And I can't remember the numbers, Rob, maybe you can put on here, but we're getting close to maybe 40% is actually defined as obese. That's right. So what are the what are the numbers? Did you know? 

Rob Webster  14:54  
Well, certainly inthe States, two thirds would be overweight. So I mean, it's, you know, over half the population will be categorized as overweight, at least according to BMI, body mass index scale, which is just weight for height, which is has its limitations, but on a population level, somewhat useful to,

Speaker 1  15:12  
yeah, I think population level, sedentary population, it's sort of, it's, it's, it's, it's a good population marker. It's not perfect, but, and let's talk about it. So what, what is I mean? I think there are a couple of things, haven't we, and I think this is where your scan comes into it really well, because there's body fat from a point of view of total which are we should we should talk about its implications of, you know, the fatter you get, the bigger the risk of x, y and z, but then we have where it's distributed, which I think is it's not, you know, as far as I read the research, it's not so how much body fat you have, per se, but where it tends to be located. And I think we've got two sort of aspects of those. So, and this is one of the key things that I think your scan does brilliantly. So can we sort of explore that? Because we've got stuff like, I mean, your scan is doing overall body fat percentage, and it's looking at everything. It's not just looking at subcutaneous it's looking at all body fat. But then we've got stuff like, lean to high indices. We've got Android to gynoid ratios. We've got, you know, and we've also got the thing we  probably spend most of the time and isn't one of the main reasons why I send most of our patients to your clinic is the visceral adipose tissue aspect. So can you sort of give us the sort of next 10 minutes of what we understand with body fat? 

Rob Webster  16:36  
Absolutelyolutley sure. So the scan, just to give some kind of context to people, you lie on a table and a machine arm is going to pass over your body at a distance of about a foot, or 30 centimeters, and three minutes later, you get a comprehensive report that's looking at just so many different metrics about your body. So we're looking at body fat percentage, but beyond that, we're looking at how much fat you have for your height, the fat, the fat distribution, as you mentioned, we're looking at two key areas. One is called your Android region, which is around the abdomen, and one is your gynoid, which is the hips and the thighs. So we're looking not just at how much fat there is, but where that fat is distributed, which is so crucial, because having too much subcutaneous fat is definitely deleterious to health in terms of insulin sensitivity and your risk of these diseases, but more so the visceral fat, the fact that's kind of within the abdomen that is highly correlated with your risk of stroke, cancer, type two diabetes and even things like Alzheimer's. This new research studies that look at these neurodegenerative diseases and how high visceral fat correlates with the with the proteins that are linked to disruption of the synaptic communication in your brain. So it's, it's not just about your body, it's not just about your heart. It's really it's about the your your cognitive faculties as well, that your body composition is going to influence. So we want to make sure that what

Speaker 1  17:59  
so what is it, if we understood? Because there's, as I understand it, someone really had a brilliant description of it once is that there are parts of our body which is happy fat, and then there's parts of our body which is really angry fat, which is where the adipose tissue sort of story comes in.

Rob Webster  18:16  
Yeah. So the happy fat is the is the fat that you can pinch it's the wobbly stuff that we can see on the outside of the skin called the subcutaneous Yeah, yeah, that's right. But the benefit of the DEXA scan is it's able to distinguish between the fact that's in the subcutaneous ring and the fact that it is below the abdominal wall. There's a sheet of muscle in your abdomen, and below that, we find all your organs. And in and around this cavity, your body has the the ability to store fat, and we don't want much visceral fat, because it is extremely damaging to the body, both in terms of the inflammation that it causes, but also it's just disruptive to your endocrine system. All your hormones get thrown off. Your blood pressure will increase just as a function of having this fat and the the atherosclerosis risk from visceral fat is, is big. I mean, it's, it's the it's the leading is one of the biggest correlations with with risk of disease is how much visceral fat you carry. Yeah,

Speaker 1  19:13  
isn't that really interesting, you know? And that, I suppose, as I said to you, that there's the fact that you can pinch and you may have lots of that, but it seems to be quite a it's a sort of, I'm not going to say it's a neutral cell, but it it's quite happy, isn't it? You know, ikes to be nice and full, but, you know, usually that's where I'll talk to that in a minute, but, but the visceral adipose tissue is really angry, and it very pro inflammatory, and it sends out all of these pro inflammatory molecules that, as I said to you, are part and parcel of the degeneration and the sort of the mitigation of increasing pretty much every chronic disease, certainly the cardiometabolic, for sure, absolutely, and so, so what so for you? I mean, what's the most important thing for you when you're looking at body fat? Is it that fat parameter? Is that the key thing? Well, I think we've got two things, haven't we? We've got people sort of, everyone wants to look, you know, six pack for holiday, you know? So there's an, there's always an aesthetic feel to, you know, body fat, but that's generally the subcutaneous and again, it's not that, hey, listen, I want to look good on the beach, but, you know, for me, the key thing is, what is happening inside that, you know, that abdominal cavity that is a big risk factor for chronic disease. How many of your people that you come in? We've seen 8000 how as how many is a percentage of them understand that of what we've just talked about? 

Rob Webster  20:52  
Maybe half. 

Right? Okay, wow. Okay, that's pretty good. Is that because? Is that because? Because we talked about your population group, didn't you? Do you think your population group is is slightly more health aware, and that's why it's coming for the scan. Okay, so it's a slightly skewed population, isn't it? From that perspective?

That's absolutely correct. People have already done their research. They've already been willing to pay for the scan so they understand the value add for them, but most normal people don't understand the impact of visceral fat. They don't really understand the distinction between subcutaneous and visceral. But visceral is absolutely the crucial metric for us, and it should be for everybody, because everybody distributes their fat differently. Two people could have the same number of kilos of fat. I could have 20 kilos, and another person could have 20 kilos, but if that person has a very big Android distribution of that fat, then their risk of cardio metabolic diseases could be very greatly enhanced. So that individual needs to know what their body makeup is, so that they can tune their exercise and their nutrition accordingly. And two people need, you know, we need different approaches. So that's why we've got to we've got to, we've got to measure it, to understand, well, what's my makeup?

Speaker 1  22:04  
So what we're looking at here again is that I'm going to, I'm going to dumb the terminology down, because obviously some people might not understand Android gynoid, but we're looking at apples and pears, aren't we? I, you know, are you an do you? Do you distribute your fat, fat like an apple, or you're more like a pear meaning that below the waist, you know, you might have quite big hips. And I think about those women who store a little bit more on the outside, but you know, the gift to them, of course, and maybe you can expand on this, is that actually there is a, there is a much more of a health providing, or health reduction aspect to where your body fat is, districributed, both from a hormone perspective, etc. Can you expand a little bit more on that? 

Rob Webster  22:48  
Yeah. So how much fat two individuals would need to lose is really influenced by where that fat is located. If somebody has more fat in their their hips and their thighs, then they really don't need to reduce their global fat by the same degree as someone might. If all their fat is just distributed within the abdomen and the individual with the kind of pear shape, perhaps they can focus more on their muscle mass and focus more on their bone density, but if you're shaped like an apple, the single high leverage change that you're going to make to improve your health and risk of all these diseases is simply fat loss, and that should be taken as the priority. Even if that individual may not have the best muscle mass, they should still do their weight training to keep up their muscular strength. But fat reduction should be the should be the absolute priority for them.

Peter Williams  23:38  
And just to confirm because a lot of people will, what they don't want is someone going off this, this podcast, and thinking, well, all I'm going to do is do sit ups, because that I will lose the the fat from my waist by doing that. But can you just sort of just give everyone the overview with regards to spot fat reduction

Rob Webster  24:01  
yeah. Sadly, there's no local spot fat reduction. So we're looking at global fat loss, and that's the that's facilitated by an energy deficit across time. So it's, it's really about your to put in financial terms, your P and L. You want to make sure that at the end of the day you got more coming out the system than you got going in. And you want to make sure you've got a muscle preservation stimulus in place. So nutrition is really going to govern your energy balance, whether at the end of the day, you're going to be either gaining weight or losing weight. But then your exercise specificity, so particularly what, specifically what exercise you're doing, is going to govern where your body chooses to to find that that deficit of energy. And if you have enough weight training and you eat enough protein where your body is going to get that message that, hey, we need to maintain this muscle mass, let's pull from our fat reserves to make up that deficit.

Peter Williams  24:51  
Yeah, and the reality is, is that I think this is, again, where I think a lot of what is happening in healthcare is that I think that over. Simplify. Well, they are overly complicating, some fundamental, simple messages. And that I would say on that for, I would say for, I mean, I would say 99% of every population, or every patient I've ever seen, they could do with losing some body fat, and that, unfortunately, can only come from expending more energy than the bringing back in. So, you know, we are talking in some degree with regard whether you want to say energy in, energy out, or some degree of calorie deficit over time. Any problems Rob with that? And look, I totally agree with you. Many people wouldn't say, you know, there's a big argument a calories, a calorie etc, yeah. And we can. We can argue about, well, what's contained in different things, but ultimately, you've got to be expending more energy than you're putting in. However, what would you say? Because you're obviously asking people to eat maybe a little bit more, to put on more muscle mass. So can we talk about that, because that's generally a cat you need to be have a slightly calorie positive for that side.

Rob Webster  26:06  
Yeah. So if your goal is exclusively building muscle mass, then you do need more more energy to come in than you're burning. I mean, that muscle can't really be built out of nothing. So for those individuals, they need to be increasing their food consumption and increasing their protein level to facilitate that growth. For those that are do

Peter Williams  26:28  
you have, I mean, do you have a number that you like to work to?

Rob Webster  26:32  
There's a range in the literature, but a good rule of thumb would be around two grams per kilo of body weight is generally what we go by. It's on the upper end, but that's just because better to be safe than sorry, and that's not not a dangerous level to be at. Well,

Speaker 1  26:46  
I totally agree with you, and I think there's a couple of things I would add to that. I think number one, again, I think over the last 25 years, I've never been so surprised with regards to what you put in your mouth doesn't necessarily need to get to the place that it does. And so a slight over compensation on that sort of makes sense. And wouldn't it be a waste if you put all that training in and you didn't quite compensate enough from that side yet? So again, so we're looking at two grams per kilogram. So if you've got a 70 kilo man, that's 140 grams a day to sort of to give you the insurance policy that probably you've had enough. And then, of course, with that, you've got to be able to do the training that is, that is robust enough to make sure that you're actually creating that slight damage to that muscle when you or all those muscle groups when you're in the training. That's right. I'm assuming you see quite a few who are on routines who don't get it right, because it's not an easy thing to do. This is not, I mean, we're talking about this, and this is the key thing, isn't it? Is that it's a little bit like what we were saying with a lot of the patients we see. I've got two coming in this afternoon. They're both type two diabetics. They're both overweight. And the answer is really simple. The answer to pretty much solving most of that is that over time, we need to get your weight, and I like to work for long term. Let's go for 10% of your body weight. Let's get that lost, because, again, the literature supports that that can have very favorable changes, but then you've got the complication of their lifestyle. So how many do you see that come in are successes and failures? Because you've seen a lot of people. I mean, this is your day in, day in, day out job.

Rob Webster  28:23  
Yeah, good question. So of the cohort of people who are trying their very best to get this right, perhaps up to half may get it wrong the first time, you know, the first time they're trying their new system of training and lifestyle modification, they may not hit the nail on the head, and it may take three iterations for them to really dial things in.

Speaker 1  28:46  
And is that because? Is that just because? It because? So this is the other, you know, things that I see is that you can't have everything. And we get these people in. For me, I get a lot of these, well, people who are trying to optimize their health, and they've got a low, say, not a low calorie intake, but they, they have a calorific intake that maybe doesn't support the ongoing development of muscle. And they, they end up being just in this they do all that work, and nothing really changes

Rob Webster  29:20  
exactly, or they might be diluted in terms of their training outcomes. They may be looking to improve their vo two Max, whilst also trying to increase their muscle mass and also trying to decrease their body fat. And they've got all these different goals, but the sadly, the process to achieve these goals is they ultimately interfere with each other. Yeah. I mean, with what a DEXA scan measures is your muscle mass and your fat mass. So if you're training for for a vo two max or a half marathon, we can't be benchmarking your success on that, and you shouldn't expect your muscle mass to be going up if all you're doing is really long distance running all

Speaker 1  29:53  
the time. Totally agree. And again, I think this is the point, isn't it? There's always a cost, risk benefit to do. Doing something because it may have a negative effect on something else, because we discussed mine, didn't we, because I'm very clear. And you know, if we look at, if we look at I suppose you know me, and you, as you say, are certainly my original background, academically, is I'm an Exercise Scientist. I would still absolutely say that that's me. And what's really nice about our field of expertise, all the health research has literally come full circle, where if you want to be healthy and you want to optimize your life, then the exercise side predominantly is where all the action is at, as far as I read it. And we can look at that in two ways. We can look at that about how much muscle mass you carry and how well it functions as you age. But then again, you know, your capacity to metabolize oxygen is one of the key fundamental markers of aging. So can you just explain that a little bit more, because you talked about, you know, fitness, cardiovascular fitness, and a vo two max. So can you just expand into that a little bit more?

Rob Webster  31:07  
So you're absolutely right. The Science clearly indicates that a high vo two Max and high muscular strength is associated with the biggest reduction in all cause mortality, and the kind of hazard ratios are used to quantify that. Essentially, the more functional your muscle is, and the more oxygen, like you say, you can metabolize. Essentially, you're probably doing a lot of exercise to get those benchmarks, and as a result of that, we see the longevity improvements. It's hard to do that at the same time as, let's say, doing a body recomposition or doing fat loss, because you may be diluting your resistance training with a lot of cardiovascular work, but then coming back and expecting to have maintained muscle. But in fact, it's it may have wasted away. So that's, that's probably the most common, I shouldn't say mistake, because it's just a function of training specificity. It's just, it's just, the most common surprise is people don't expect to have lost muscle mass, but the balance of training there isn't quite right for the for the goal.

Speaker 1  32:10  
But again, what you're talking about there is that, you know, your body is the specificity is, you know, again, is that it's a little bit, I like to say to people, it really doesn't matter how strong you are, from a point of view of your legs and your hips. If you're suddenly going to go and go skiing and you haven't skied for the year, your legs are really going to suffer. That's not because they're strong. It's not because they're weak. It's because you're introducing a completely different aspect of how muscle strange, how exercise s strains muscles, and it's completely different movement patterns. So again, your body has to be very specific. And you know, if you're going to get a higher vo two Max, you're probably are going to lose a little bit of muscle mass, most

Rob Webster  32:57  
likely. And it could actually be advantageous to do so if you're a heavily muscular person, VO two Max is obviously a kilogram adjusted metric. So if you're very heavy, it's going to be quite difficult for you to perform really well from a cardiovascular standpoint. But then if you're too much on the cardio side, if you're just an elite cyclist, I mean, that's obviously going to bring you amazing cardio and respiratory fitness. But if you then don't have enough resistance training and muscle mass, or perhaps loading of your skeleton, so bone density, then we're kind of, we're not hitting all the the marks, really.

Speaker 1  33:30  
And isn't it interesting that, again, what we're seeing in the literature, both with jockeys and with elite scientists, elite scientists, elite cyclists, that they are suffering from early stage osteopenia and osteoporosis, which, again, because it we're not loading those bones in a way that we would like. Can I, again, I think what we're trying to do here is we're trying to get this really good indication of why muscle mass is so important and why we need to measure it, why body fat is so important and why we need to measure it, and obviously you know the differences between where you carry those muscle mass. So here's a question for you. Is it more important to have? Let's assume we've got two individuals. We've got one individual who has lower total body fat, but higher VAT mass, as opposed to someone as higher total body fat or or and lower VAT mass from a health perspective, is it? Is it the person with the higher VAT mass which is at the bigger risk, even though their total body fat is lower, yes, and that's definitive, isn't it?

Rob Webster  34:38  
In my experience and expertise, yes, yeah.

Speaker 1  34:43  
And I think, I think it bears out in the literature. Doesn't it like again, it's it comes down to happy fat and unhappy fat. That's right,

Rob Webster  34:52  
yes, indeed. And so the person with the low total global fat, but higher visceral definitely should try to bring down their fat as. Much as they can, but they're going to have to address other things that might be causing high visceral fat. And one of the most common ones that we see is just, comes consumption of alcohol. Yeah, that one's so highly correlated with visceral fat, in my experience, that it's just, it's just so clear. And I think the mechanism is probably just the disruption of hormones, increasing cortisol, corruption of sleep, reduction in muscle protein synthesis, uh, essentially, it's just not good, right? It's just not good for your body. And but if it leads to more visceral fat independent of global fat, then that's a problem, because how then do we reduce visceral fat with with fat loss? If this person is already incredibly lean, it's like the kind of skinny fat individual,

Peter Williams  35:38  
yeah, yeah. And you do find those. You do find those phenotypes, then the reasonably rare. But again, I think this is one of the key things, isn't it where, I think both, I've had definitely a few, a few female patients were, you know, if you see them in clothes, they are slim, they've got a nice figure, and that you put them on the DEXA, and actually, it's a real eye opener from a point of view of the percentage of muscle mass, that's just not there. I mean, these are skinny fat, and that's indeed shocker for them. And again, through none of their fault, because they've always looked good, they probably still  jean wearing the sa size that they did when they were in their 20s. I mean, that's always the conversation that we have with them, like, you know, but nothing's changed. I'm like, Well, you know, things have changed. And this is the key thing why we're doing the test, because we want to see the proportion of body fat where it is to your muscle mass. And again, you are a skinny fat, which is sometimes even more dangerous, because you don't even realize, again, I'm assuming that you see quite a few of those. We do, we do.

Rob Webster  36:44  
And that's why waist circumference over time is probably the more useful metric, rather than just, well, my hips haven't changed. But actually that body fat over time is starting to accumulate around the kind of upper abdomen region, and for women in particular, especially post menopause, the kind of hormone changes tends to really scale that visceral fat in a way that is quite worrying, and that's why you need to do all you can to keep things like cortisol low. You need to be getting good sleep. You need to mitigate stress as much as possible. You need to avoid alcohol, if you can. And stress is is playing a big role in that visceral fat accumulation.

Speaker 1  37:24  
So what you're what you're doing there, is you're sending out a message to every perimenopausal and menopausal woman, because they do get hit really hard. Because particularly, again, estrogen is quite a wonderful molecule from a point of view of its particularly its cardio protective aspects, but also its protection cardio metabolic, visceral fat aspect as well. And that changes dramatically once they get perimenopausal and menopausal, and you're dead right, that causes a massive shift. So what you see is that sort of the body fat, sort of, particularly with the the the pear shaped, I'd say more below the waist, it shifts, doesn't it? And then you start that, you start to get the the classic muffin top as well. And you know, they never had that before. But, you know, that's a real big parameter, and it's for me, if I'm giving any information, as if, if you, if you are one, one of these women in this situation, this is why I think it's really important. And we try to stratify some key testing tests for our patients, and particularly the the post meno, perimenopausal and menopausal women, there are key things that we stratify. Number one, let's just do a basic blood test, because your lipids are going to change, and we want to make sure that we're following the risk that your lipids change very quickly and adversely, because your perimenopausal or menopausal and the other thing is the change in body fat accumulation. So we're trying to get those that group into your into your place, and just into the lab to have the blood test and the muscle mass and body fat percentages done. So really key time in life were, as I said to you, compartments change, hormones change, and as a consequence, their fat deposition changes. Do you see anything in males? Because we know there is an argument that men have in andropause. I mean, listen, mate, I'm 55 and I sort of feel as though maybe there is, I mean, again, and I'm working out probably somewhere between six and eight hours a week. You know, I do have to look after my foods yet. I'll let it go occasionally. Um, certainly let it go over Christmas. But, you know, as I said to you, my body fat hasn't changed, but boy, do I work for it, and I'm probably quite lucky genetically. Do you see that?

Rob Webster  39:57  
I'd say the the drop off is much. Steeper and acute for women than it is for men. For men, I think it's a gradual decline, perhaps in testosterone, whatever the stat is, 1% a year. But for women, post menopause, it's much more marked, and it's very noticeable, especially in bone density, right? You look at the graphs, and it's just post menopause, the estrogen, the protective effects it has on bones as well, just is gone. And we also see visceral fat scale faster in older women than we do in older men. Men, it tends to just kind of linearly go up with age. And for women, it really exponentially goes up.

Speaker 1  40:34  
Do you think that is, again, just simply because of the loss of estrogen? And my question on that would be, have you have any patients where they've made a decision to go on HRT, and that's actually really helped, because if I can just go back, because your your DEXA body scan, I think again, I just want to, don't want to get people confused here, your Dexter body scan is specifically designed to look at muscle mass and fat mass, but within that, of course, it does a really good analysis of bone mineral density as well. So that's right, which isn't a diagnostic test, but it's accurate enough, in my opinion, and you can just quantify this, that it is giving us almost a diagnostic guide, that if these numbers look poor, or you're way below what we think, or you may be in the designated osteopenic osteoporotic range based off your scan, then you would need to go and quantify that with a DEXA scan solely associated with bone mineral density, is that, is that? Is that correct?

Rob Webster  41:42  
That's right. I mean, it ultimately is just an indication, like you say, we're not, we're not going to diagnose osteoporosis with a with a body scan, because it simply doesn't have the granularity that you would get from a 30 minute dedicated DEXA for bone density, where you'd look at the hip or you look at the lumbar spine. But we do get an indication, and over time, we can see trends in that, in that, in that number. So if women are noticing their bone density go down, let's say across a five year span, that's a good indication that, well, they may need to do more weight training, or they may need to look at things like vitamin D or or whatever

Speaker 1  42:17  
it is. Can we use my example? Because obviously we've got, we've got two scans 10 years apart, so 45/55 and so could you just explain what we saw on my scan? And then I could sort of put why I think, you know, things changed,

Rob Webster  42:36  
sure. So Well, the the fat mass was, was stable,

yeah. Fat mass was good. Muscle mass 1.3 kilos down,

Peter Williams  42:45  
yeah. And I think, again, as I said to you, I think that was simply because I was pretty sure that I lost quite a lot of muscle mass when I was fasting, and that's why I stopped the fasting. And again, it's been and I probably reckon I lost quite a bit more, because I could feel it. And, you know, I've probably regained quite a bit back, but not quite there. So for me, my key is next year is, as you said on our conversation, is probably, you know, knock my good calories again, making sure that it's Whole Foods. There's no There's no crap in my food. And just get that up a little bit and then continue to strength train and put that on. But my bone mineral density, I thought was really interesting as far as its result, yeah, remind me, it went up 3% over 10 years.

Rob Webster  43:30  
Okay, good men's bone density generally declines a tiny bit over that time frame, but yours obviously increased 3% is statistically significant as a change. So I guess that speaks to the amount of resistance, progressive resistance training that you've been doing,

Peter Williams  43:47  
yeah, I think so. But I also, as I said to you, I think what I discovered in early lockdown, which was obviously way before, way, I mean, I think, did I add my scan, 2014 didn't I know? Well, yeah, 2014 Yeah. And what we found is that I actually having done my vitamin D genetics and actually having done a vitamin D test after just the most amazing summer, again, I think it was the first or second lockdown in the summer when we had COVID. I mean, as I say, my business was all but sort of broken. And no, we weren't anyone. I just basically trained in the garden, basically. So I was brown as a button by the end. I remember, did it? Did a well man blood test, and my vitamin D was, was actually poor. And it just didn't make any sense. I think it was coming round about I was around about 60 nanomoles. And I'm like, That just doesn't make any sense. And then that pushed me into doing the vitamin D genetics. And when we found the results, my results for vitamin D metabolism and physiology was just pretty rubbish. So I think what we're looking at is an individual whose vitamin D genetics are poor. Meaning that for the majority of the year I probably need to be supplemented. And I think that was one of the key additional metrics that I think has helped, because I've always kept fit through my life. I've always strength trained, and so that was the mechanism, I think that has helped. Here's a question for you, if you're if you're on a calorie deficit consistently, are you going to lose bone within that as well? Are you more likely to lose bones

Rob Webster  45:28  
on the training? Well, again, you're the bigger lever. So

Speaker 1  45:32  
and what sort of training? Because this is the other thing, isn't it, to really stimulate that bone density. What sort of training do you need to be doing?

Rob Webster  45:43  
I'd say the the work you're doing for your muscle is sufficient for bone density as well. So that we're talking we're talking muscular hypertrophy training, three, one hour sessions per week across the full body. It really comes down to making sure that you're creating axial load. Axial load is load through your spine in a safe way. Your axis is ultimately just your spine. And any big multi jointed movements that do that, let's say the leg press, or perhaps a squat, that's going to put a lot of tension through your entire structure. And that that mechanical tension, as long as it's progressive over time, is just going to continue to send a signal to the body that, hey, we have preserved these bones. These bones need to get stronger to adapt to this environmental stressor that we're under. So even in a deficit, we do see bone density increase assuming sufficient protein intake and adequate recovery. Yeah. Okay, really

Speaker 1  46:40  
important point on that one, can we talk about again, some of these, I think some of these indices that your test is coming up with, particularly on your on your reports, because I find them incredibly informative for giving us the bigger picture, which also I think fits beautifully in a lot of the blood tests that we get. And so we can sort of mix and match and see how sort of metabolically Healthy People are, or how metabolically derained They are, deranged. Is that right wing to say? Maybe, so we can we talk about fat mass index and what that means, because that you guys do, yeah, so

Rob Webster  47:17  
fat mass index is How many kilos of fat mass you have for your height, and that one's going to be closely correlated with, let's say, blood pressure. So if you are overweight, especially from too much fat, you're going to have a higher a higher blood pressure. And we know that higher blood pressure is obviously correlated with actually risk of a lot of diseases, but particularly just damage to your endothelium. Right? You know you've got high blood pressure, you're going to be putting a lot of stress through your blood vessels, and you and that damage can just contribute to your risk of atherosclerosis

Speaker 1  47:46  
totally. I just want, I just want to reinforce this. Because, again, I think it's such a it's, it's such an easy thing. You've probably been told, but if you have high blood pressure, it's one of your biggest risk factors for for a cardiovascular event, and because the higher the pressure, the more stress that arterial lining, the endothelium is under, and it gets damaged. So and a lot of that. Again, we can talk about what causes blood pressure, but being overweight is one of the key metrics that increases your your blood pressure. So again, this simple fact does, do you know, what if we can lose a bit of body fat, then it's going to be really helpful for us cardio, metabolically, so we've got fat mass index. Is there any other ones that you think are really important as far as, I mean, the Android gynoid ratio? Can we just talk about what you're looking to try and achieve, as far as a percentage,

Rob Webster  48:36  
sure? So it's, it's the men generally, an Android gynoid ratio of one or below is very healthy. So what that just means is there's a kind of equivalent distribution between these two areas. As soon as we start to see an overweight or over indexing of fat towards the Android region, that kind of abdominal belt, then we're starting to expect to see high levels of visceral fat for women, generally point eight or below because of the hormones. Women generally just carry more fat around the hips anyway. But if women have a score of one or even higher, then that's that's starting to get outside of the normal range, and definitely is going to be an issue. We also look at the kind of the torso, the trunk, and that's capturing your entire upper body, and looking at that in relation to your limbs. Now we see a lot of men and women who have very lean arms and legs. Visually, they can see vascular you can see their veins in their arms, and yet they've got big, big bellies, and across the whole entire trunk, they're just carrying more fat, and that that is going to obviously be a problem as well, because the fat is just centrally located, central adiposity. That's just basically fat around your middle. That's that's the problem, and

Speaker 1  49:53  
that's fundamentally the problem in in most, as I say, is this cardio metabolic so, you know, cardio. Disease and sort of sort of diabetic, you know, and we can dress this or call it metabolic syndrome or cardio metabolic disease, but this is where I think, as I said to you, your your test, has moved for me from this, this used to only be fitness people, athletes using your test. And I think, as I said to you, as I think as as the science has evolved us from a point of view of these standardized things that we, you know, we were doing. I mean, God, you know, whether it was caliper tests, you know, nearly 40 years ago at uni, that sort of stuff, they are really coming back in now. We have the science to show that understanding where you are with body fat and muscle mass are just key markers of how well you're going to age from that perspective. And they're almost giving you the picture. This is what I like about it, from a point of view of certainly on muscle mass, you know what you can do now in your 50s is giving you an indication of what will I be able to do in my 80s? Because if I'm not very strong now, you know, I'm probably not going to be able to get up on this up the stairs when I'm 80. So I think again, this is this key metric, from a point of view of you cannot go quietly as you age, in my opinion. And we're super hot on our people to say you're gonna have to find the time. We can't dress this up. We can't give you a magic bullet. Being in the gym is about, have you got the time to do it? And if you happen, it's going to be one of the key metrics of your success or your lack of success, because it's because sometimes the messaging is very simple. You know, what we need to do is we need to lose somebody fat but you know, do you have the time and the energy and, you know, the the weekly opportunity to be able to do what we need to do, yeah,

Rob Webster  51:45  
indeed. I mean, a three hour investment each week is quite a lot. People have busy lives. You know, you're trying to take care of kids, trying to go to work, trying to get enough sleep, trying not to be stressed, and now suddenly, gotta find time for the exercise. But your body, your body is the most important piece of real estate you're ever going to own. You know, there's no there's no exchanges, there's no refunds. It's just this is the one body you've got. You got to take care of it and doing the work up front. Building that reserve of muscle mass for the future, building that reserve of bone density for the future, given that all these things are going to decline, we're going to get ahead of the curve, and we're going to do that as early as possible. The early start, the better. But you need not, you need to know. You need to have these insights, and having that knowledge is power, because you can tune your exercise according to your own physiology. Yeah. So,

Speaker 1  52:27  
so Rob, what do we I mean, obviously, we're in a population now where, I think it's always caution to know what the average is, because if we're talking about I think we've got two things is that the average population, the body fat, the average body fat, is going to be probably much higher than is appropriate for health. So where do you think we're at with that? Because obviously we've got a population where the body fat is way too high, the average is way too high. But that is indicative of where we are as a population, as a species, for you, is, is there any, I mean, is there, is there any specific targets that you would look look for? So let's assume that, you know, I mean, you're probably going to say, the lower the better, but more maybe the lower the visceral adipose tissue, the better. Is there any markers that you think this is what we would consider optimal?

Rob Webster  53:20  
Yeah, we would definitely try and target the top 25% top quartile. So that means you're lower than three quarters of of the population. We don't need to be top 1% I mean ultimately, being down there might just be marginal gains at some point, but if you go from the worst quartile to the best quartile, you're going to get some serious health improvements. You make a good point about comparing yourself to averages, because if two thirds of the population are overweight, then really well, why change? Right? You're probably already Okay as you are. But if we're looking for longevity, if we're looking to kind of outlive the average life expectancy, then we've really got to have habits that are that are different to average people

Speaker 1  53:59  
totally agree. Mate Can I summarize up? Because as I said to you, I think the importance of this, this is what I think you're just just on body scan where, obviously we're getting the scans done. They only have two. They're only in London at the moment, aren't they, that's right. Okay. So if you're listening to this and you live in London, I'll put the body scans address at the bottom of the podcast. Do you know any Anyone, anyone else around the country that is doing this sort of scan? It's

Rob Webster  54:29  
very hard to do it in the UK, and most people who have access to a DEXA scanner probably operate within a university, and they're only able to do it for a study. So if you want to do this as a layman, then you really got to find a company that's been that does this privately and like, like, you know, body scans been around for 10 years. And in total, the company has done about 22,000 scans, body scans. And we think that's not just the highest in the UK, but probably maybe even Europe as well. Yeah.

Peter Williams  54:58  
And again, the whole point about that is that. You're starting to build a very significant population group where you can be more of an reason why we're interviewing you is that there's not going to be many people who have your expertise based on the amount that you see. So so I'll put body scan into the address I would strongly recommend. So there's two ways we could do this, but again, I think what's so important is that you get baselines, and you can have this scan with a one hour consultation, and it's 250 quid. It's a no brainer for me. We get all our patients on there because that first one is our baseline, and then from there, we can work out what we need to do based off your information as well. Because I say, I think the look, here's the hard and shorts. I think everyone who's ever been to body scan comes back with, Okay, well, you know, they were pretty straight to the point about what needs to be done. And then we can work out how we're going to do it. And then, of course, the key thing is that once you've got that first line in the sand is that you can work from that. And as I said to you, I did my first one over 10, years ago, and I can come back to that, and I can look at that and go, Wow, do you know what all that work I've put into over the last 10 years has actually served me pretty well. And it's really sort of, it's really empowering to know that, you know, I would love to drink too much. I like drinking, but I know it's not good for me, and so I hardly ever do it. I know sort of crappy, refined foods from a point of view of taste amazing, and yeah, occasionally I'm gonna have a cake, but I realized that, you know, this is, this is probably going to give me calories that really aren't going to help me, and the choices you have to make from that perspective. So it's really, really nice to know if I'm going to put time and energy into something, then I want to be able to have a really well validated scientific measure of whether I'm doing things right. And I think the other thing about this, there's nothing worse than you putting all that work and energy into a program, and then three to six months later coming back and going, Well, I didn't actually it got worse. Or what I would say on that, going two years doing the same thing and realizing you're not getting you're not getting anywhere. The crucial thing is, at some stage, you've got to come back to the garage to get it looked at, because you want to know, is this working? And I think what's way we've used your your scan, and it's been just incredibly invaluable from a point of view of and it's graphically nice. I like the graphics of it because you essentially see yourself in a really weird way, but it's kind of very cool. So Rob, what would be what like you to end with what would be the most important sort of three or four nuggets of information that you would give people around body fat, muscle mass. Obviously, we'd love them to all get scanned from you. But for the ones who maybe want to think about it, or, you know that's not possible for them, because maybe don't live in London, etc, what would be your from your expertise, the sort of the key aspects from a point of your body, fat and muscle mass, and maybe even bone,

Rob Webster  58:09  
sure, so I completely agree what you said. Firstly, what get what gets measured, gets managed, so you have to measure it. And of course, you know you can do a DEXA scan, but if you don't have access to a DEXA, just track your waist circumference and use that as a good proxy for your fat mass. It's much better than just body weight. So instead of tracking your weight over time, track your waist and try to trim 2/3/4, inches off your waist if it's too high, that's that's the best proxy for your risk of all these diseases is just how much, how big your abdomen is, to how big is in relation to what perhaps it should be, relative to your height, you can bring your body weight down, but we want to make sure that you're doing that in concert with sufficient resistance training to preserve your muscle mass.

Peter Williams  59:00  
So just to confine, or just to define that, and what you're really saying there is that if you are going to lose weight, make sure your strength training as you're doing it, correct? Yeah, okay, cool. And

Rob Webster  59:12  
if you don't, half of the weight that you'll lose is likely to be muscle, okay? And therefore you'd have to lose probably twice the amount of total weight, and at that point you're going to look gaunt and too skinny and probably give up. So make sure you're efficient with the process, and make sure every kilo that you lose on the scale is fat mass by having a muscle preservation stimulus in place, which is the resistance training, and it's the two grams of protein per kilo body weight. Okay?

Speaker 1  59:39  
And I think that would be it, wouldn't it really, yeah, metrics, and is there anything, again, from a point of view of percentage weight loss that you would ask people to aim for, or do you not? Do you not recommend anything on that side?

Rob Webster  59:52  
It's, I mean, you're probably better on this than I am. Did you say 10%

Peter Williams  59:58  
I think, I think there's a lot of. Arguments regards to 5% 10% but again, the key thing is, is that, you know, I look at that and go, Well, what does that 10% come from? Because if it's, if it's a larger percentage of that is muscle mass, then we get, we're going to pay for that somewhere down the down, down the road. So, so I'm sort of keen on, again, it's more a question of, let's not get carried away with weight loss, per se, because if it's all coming from the wrong places or the majority of it, then it's it. We're going to run into problems. I suppose the only risk for that is that, you know, people want to do things quickly, and this is never a quick process,

Rob Webster  1:00:37  
indeed, and actually doing it quickly could confound what you're trying to achieve. A lot of clients come back and they've lost weight quickly, but in doing that, you've actually lost a lot of muscle mass, and then you've got to put that muscle back on, but you still got more fat to lose. So ultimately, you've, you've kind of endured the deficit. But half of what you've half of the pain has, has been from muscle, yeah, yeah.

Peter Williams  1:00:59  
And isn't that, I mean, and that's the sort of, this is why, I think, fundamentally that, years ago, we started scanning people, because that's the conversation that we needed to have with them. And many people don't get that. They think, weight lost, it's really, where's it come from? What is it continued off? Because, as I said to you again, comes into the yo yo dieting aspect. You know, it's that, you know, the more we lose, if the more comes off muscle mass, the more we're probably going to be in problems further down the line. So, so, I think, very slow and steady, making sure that we're, we're have to, we have to be preserving that muscle mass if we're going to put anyone into some kind of longer term. A calorie deficit mate super, super podcast. Thank you so much for bringing your expertise to it. And you know, as I said to you, there isn't going to be many people at all in the UK with your experience with regards to the scans and what they've shown. Really appreciate it, mate. So thanks so much. And I'll be in. I'll be in in the summer to be scanned again, because obviously you've told me that I probably just need to concentrate on the training a bit more. So which I will so mate really appreciate it. Thanks so much.

Rob Webster  1:02:11  
You're welcome. You're welcome. You.

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