Over your extensive career, Dr. Eckel, what belief about obesity or metabolism have you changed your mind or evolved your thinking on the most?

Well, obesity is really a complex topic, and the whole etiology of obesity is really debated in terms of what the importance of genes in terms of genetic predisposition to excess body fat is, how to define obesity.

In fact, I'm involved in the Lancet Commission, which was released, released a year ago that's redefined obesity.

And then ultimately, the role of the individual subject and the environment that he or she lives in in terms of the impact that they have on the origin of excess body fat.

We're living in a world now where it's not only, you know, urban populations, but growing urban populations in underdeveloped areas of the world where obesity is a major problem.

And I've seen some recent data in China that I'm really part of reviewing and ready to publish that ultimately in China, the increasing prevalence of obesity has been dramatic over the last decade.

So we're looking at a real global problem.

So why, why the fuss and the research on looking at different types of obesity and who has obesity and is suffering metabolic or other consequences from that excessive fat versus not? If someone was to just sort of ask a very simple question here, you know, why not encourage every single person that has a BMI over a certain amount to lose weight, either through lifestyle plus or minus pharmaceuticals?

Tell us a little about how that interest evolved.

Well, Jim, good question.

I think it related to my being invited to be part of the nutrition committee at the American Heart Association.

This was in the mid-'90s.

And I was asked why am I being asked.

I mean, lipids and lipoproteins have always been the focus of my research, both at the basic science level and clinically.

And of course, the lipid metabolism very much relates to body weight regulation directly and in many ways indirectly.

So can you, can you tell us a little bit about the, the SELECT trial and, and how you think it's impacting, uh, the field now? And it, and I think it makes sense it's coming from what you've studied, and now we're here, and how is that gonna impact where we go almost?

Is, is understanding when the excessive adiposity sort of came on relevant and important to the treatment?

Yes, and I think one thing I, I really didn't mention is part of the history, which is an important answer to your question, is have you tried to lose weight, and how many times have you lost more than five percent or ten percent of your body weight? And were you able to maintain your weight loss? And often they can't, and why.

So this gets more directly to your question.

You know, the brain really probably has a fat stat.

That means there's a place in the brain that knows your body composition.

And you know, there's tremendous evidence of overfeeding studies over finite periods of time, months to six months, where people lose all their weight after they've been overfed.

And so we, we know we don't force-feed people to excess body weight.

But maybe we can just further explain the relationship between obesity and insulin resistance and why you care so much about insulin resistance.