The New Goal Isn’t Weight Loss—It’s Metabolic Health! Do These 5 Things Now!

Let me start with something that sounds like a paradox. You could lose 20 pounds and become less healthy. Now, I know that goes against everything we've been told, but stay with me because by the end of this, it's going to make complete sense. For decades, we've been handed one tool to measure our health, a bathroom scale, a single number, and we treat that number like a report card. Weight goes down, you're winning. Weight goes up, you're failing. We step on that thing in the morning and we let it decide whether it's a good day or a bad day. But Here's the problem. The scale is measuring the wrong thing. It only knows one thing: how hard gravity is pulling on your body. It has no idea what you're actually made of. Take two people, same height, same weight, same body mass index, or BMI. On paper, identical. Now look inside. One is strong, has plenty of muscle, very little fat around the organs, and beautiful blood sugar. The other has almost no muscle, a belly full of fat wrapped around the liver, and cells that have stopped listening to insulin. One is healthy, the other is quietly walking towards heart disease, type 2 diabetes, fatty liver, even dementia. Same weight, completely different bodies, completely different futures. The scale can't tell them apart. To the scale, a pound is a pound, but to your body, a pound of muscle and a pound of belly fat are as different as medicine and poison. So the real question isn't how much do I weigh? It's what am I made of and how well is my metabolism actually working? So that's what we're going to get into today. That's where I unpack in plain English. Why is muscle one of the best predictors of how well you'll age? Why is the fat that you can't see more dangerous than the fat that you can pinch? Why does your waist tell you more than your weight? What exactly is insulin resistance and why do so many people have it and not know? I'm going to give you 5 things that are worth measuring far more than any number on your scale. This episode was brought to you by Function. Get access to over 160 lab tests annually at functionhealth.com/mark. The scale doesn't know what it's measuring. When you drop 5 pounds on a crash diet, the scale applauds, but it has no idea what you lost. Water, fat, muscle, bone. Those are radically different outcomes, and the scale treats them all the same. And here's the dirty little secret of rapid weight loss. A big chunk of it comes from what isn't fat. It's water and muscle. When you starve your body, it happily burns muscle for fuel. The number drops, you're thrilled, but you just torched the very tissue that keeps your metabolism running. And when the weight comes back, and it usually does, it comes back as fat. Now you're the same weight with less muscle and more fat than when you started. You suffered your way to worse. That's the trap. We're celebrating the wrong victory. The scale can't tell you if you got healthier or just lighter. And those are completely different things. Now we think of muscle as something for athletes or for the beach. That's a massive underappreciation of what muscle actually is. Muscle is an organ, one of the most health-protecting organs in your body. And most of us are letting it waste away. And here's what it does. Muscle is the single biggest place your body stores sugar. When you eat carbs, your blood sugar rises, and most of that glucose gets pulled out of your blood and parked in your muscle. Think of muscle as a giant sponge for sugar. The more you have of it, the more you use it, the easier it is to handle a meal without your blood sugar and insulin spiking. And here's the beautiful part. Inside your muscle cells are little glucose doorways. Scientists call them GLUT4 receptors. When you do strength training, you build more of them and move them to the surface so sugar can get outta your blood and into the muscle without needing as much insulin at all. That's a good thing. That's why a single workout lowers your blood sugar for the next day or two. You're not just burning calories, you're upgrading the machinery. So starting in your thirties and forties, you naturally start losing muscle. We call it sarcopenia, which means less muscle. Less muscle means a smaller sugar sponge, which means more insulin resistance, more fat storage, more weight gain. And on the far end of that spiral is frailty, falls, losing your independence. And that's why I tell every patient strength training is not optional and it isn't vanity. It's preventive medicine. Maybe the most important prescription I write. Not all fat is created equal. This is one of the most important things I want you to take away. The fat you can see and you can pinch right under the skin honestly isn't the villain. That dangerous fat is the fat that you can't see. It's called visceral fat or belly fat. It lives deep in your belly, wrapped around your liver, your pancreas, your intestines. This fat behaves so completely differently. It acts like an organ gone rogue, pumping out inflammatory chemicals, messengers with names like IL-6 and TNF-alpha that drive inflammation through your whole body. These are cytokines. Basically, your belly fat is like an immune organ pumping out inflammatory cytokines. And when fat packs into your liver, your liver starts turning that excess sugar into more fat. Sugar turns to fat. That's how you get foie gras. Like, and that's what happens when you feed a duck or a goose corn, it gets a fatty liver. That's how they do it. And if you do that to your human body, it'll do the same thing. It'll create a fatty liver. And there's a name for that. It's called de novo lipogenesis, making new fat from scratch. Your liver becomes a little fat factory. And that's a fatty liver. It's the most common liver condition in the world now. Most people who have it have no idea. And here's why this matters. You can be thin on the outside and sick on the inside. Someone walks into my office looking great, normal weight, normal BMI. Their labs show a liver full of fat and cells that have stopped responding to insulin very well. We even have a term for it, thin on the outside, fat on the inside, or TOFI, not tofu. And the flip side is true. A bigger A person can carry more weight and still have plenty of muscle, low visceral fat, and healthy markers. Looking in the mirror tells you almost nothing about what's happening inside. The goal was never a clothing size. It's to melt away the dangerous fat around your organs while you build muscle that keeps you strong. If I could get every patient to watch one number, it would not be their weight. It might be their waist, because your waist is a pretty good window into how much of that dangerous visceral belly fat you're carrying. As it shrinks, you're very often losing exactly the fat that drives inflammation and insulin resistance. It's a simple test, it's free, and it tells you something really important. You just need a tape measure. The general guidelines for men: under 40 inches is ideal, about 102 centimeters. For women, under 35 inches, about 88 centimeters. But I think that's actually way too generous. A nice rule of thumb is to keep your waist under half your height. Measure it right, right? Stand up, relax your belly, don't suck it in. We want the truth. Breathe out, wrap a tape measure around the middle at the level of your belly button. Do it snug, not squeezing it. Write it down. And here's the magic. Your waist can shrink even when the scale barely moves. When that happens, it's often fantastic news. It usually means you're trading dangerous visceral fat for healthy muscle. You're getting profoundly healthier, but the scale is completely blind to it. All right. A couple of tips. Measure under the same conditions each time. I like the first thing in the morning after going to the bathroom before eating. For women listening, your cycle matters. In the week before your period, it's normal to hold fluid and bloat, so your waist can jump an inch. That's not visceral fat, that's hormones. So compare at the same point in your cycle, apples, apples. And don't obsess over one day. We're after the trend over months. And those trends shift long before you feel sick, long before the scale moves, long before anyone hands you a diagnosis. I'm pretty sure inflammation gets blamed for just about everything these days, but here's what most people don't realize. Inflammation is one of the reasons you're alive. It's what helps heal a cut, fight off an infection, and repair damage when something goes wrong. The problem isn't inflammation. The problem is when it never gets the message to stop. That's when something designed to protect you can begin working against you. And here's the challenge. You usually can't feel the chronic inflammation. It's happening quietly beneath the surface. Which is why measuring it matters. And that's why I pay attention to markers like hs-CRP that can detect low-grade systemic inflammation. That's exactly why we built Function. Function gives you access to 160+ lab tests annually that measure signals in your blood, including nutrients, liver health, inflammation, and hormones. You can also complete your health baseline with an annual MRI that helps you see organs, tissues, and other changes. Check your health at functionhealth.com/mark. And if you're one of the first 1,000 people this week. Use the code MARK2026 for a $50 credit for your $365 a year membership. You've heard insulin resistance, that whole term. You've probably heard of it thrown around a lot. Let me, let me actually explain it because once you get it, so much clicks into place. Every time you eat, your body breaks carbs down into glucose, sugar in your blood, but glucose can't get in your cells on its own. It needs a key and that key is insulin. It's made by your pancreas. You eat, your blood sugar rises, your pancreas releases insulin, insulin unlocks the doors on your muscle, liver, and fat cells. Sugar moves in, blood sugar comes back to normal. Beautiful. But do what our culture does— ultra-processed food all day long, sitting, losing muscle, carrying belly fat, being stressed, sleeping badly— and your cells stop responding to insulin's knock. It's like the key still fits, but the lock's rusted. So your pancreas shouts louder, pumping more and more insulin out into the blood to force the sugar in. And for a while it works. Your blood sugar looks totally normal on your annual physical, but even though your doctor says you're fine, you're not. Your sugar is only normal because your pancreas is flooding the body with insulin to keep it there. Now, high insulin is the storm before the storm, and it drives even more belly fat. And this goes on for years, sometimes 10, 15, 20 years silently. And then the pancreas finally can't keep up and your blood sugar starts to climb. First, it's prediabetes, then if nothing changes, it's type 2 diabetes. And here's the crucial insight: diabetes doesn't happen overnight. By the time it's diagnosed, it's been building quietly for a decade. And those silent years, well, they're the greatest opportunity we have because in that window, this is almost entirely reversible. This is the heart of functional medicine. We go upstream. We find the problem while it's still a whisper. What are the whispers? Well, an expanding waist, triglycerides creeping up. HDL or that good cholesterol dropping. A fasting insulin that's too high. Nobody checks that. We do at Function Health. We check all these numbers. An A1C, which is your 3-month sugar average, slowly going up. Even if it's not abnormal, if it's going up, you're in trouble. A liver that's showing fat on lab tests. One of my favorites is, is dead simple. Your triglycerides divided by your HDL. This is such an important number that most people don't pay attention to. If that ratio is high, if it's over 1.5, triglycerides divided by HDL, you probably have insulin resistance and it's already brewing. Even if you're fasting, blood sugar looks perfect. Now here's 5 things worth measuring more than your weight. Number 1, your waist. That's the one we talked about. The simplest read you have on visceral fat. As it comes down, you're improving insulin sensitivity, you're lowering inflammation, you're cutting your risk. And remember, sometimes your waist shrinks even when your weight doesn't. That's a win. That's a good thing. Number 2 is your strength. Muscle is your sugar sponge, your engine, your insurance for aging well. You don't need a lab. Can you carry the groceries in one trip? Can you get up off the floor without using your hands? Can you lift your suitcase overhead? How many pushups can you do? When I was 50, I couldn't do 10 pushups. Now I can do 50 pushups. That's good. And here's the stat that stopped people cold. Grip strength. Literally, how hard can you squeeze is one of the strongest predictors we have of how long you'll live. The goal isn't to look stronger, is to be stronger. Third thing I want you to pay attention to is your blood pressure. Your blood vessels are the highways delivering oxygen to every cell. When your blood pressure creeps up, well, it's often an early signal of something metabolic. Inflammation, insulin resistance, stiff blood vessels. And most people think high blood pressure is a heart problem. It's not. It's mostly a metabolic problem. A cheap home blood pressure cuff, 30 seconds, it gives you a real window into what's going on. Okay. Number 4, a thing I want you to check. Number 4 is your blood work. And this is really why I co-founded Functional Health to give you easy access for $365 a day. You can access a full panel of deep lab tests, all the ones I just mentioned and lots more. This is where we see under the surface, you know, under the hood. We, we go past just your cholesterol numbers. We look at your metabolic markers, your glucose, Your A1C, your fat triglycerides, your HDL, your particle size, all these things are super important. And, and there's a big one that most doctors skip. Your fasting insulin. Your glucose can look perfectly normal for a decade while your insulin resistance quietly builds. And fasting insulin catches it way earlier, years earlier. It's seeing the smoke before the flames. And for heart risk, also you should ask about ApoB. Really important. It's the most important predictor and nobody's checking it. It counts. The actual artery clogging particles. And it's a far better predictor of your heart disease risk than standard LDL cholesterol. And that's a big part of why I co-founded Function Health. For a yearly membership, it runs 160 biomarkers or more, including these exact metabolic markers that you and your doctor can use to catch trends early. And because the earlier you know, the more you can do about it. Okay. Number 5, the last thing I want you to track is your energy. Sometimes the earliest signal isn't a number. Is how you feel. Do you wake up rested? Do you get through the afternoon without crashing? Do you need coffee or something sweet in the afternoon? Do you feel satisfied after a meal instead of feeling hungry an hour later? Is your thinking sharp? These aren't just quality of life questions, they're metabolic signals. When your cells make energy efficiently, you feel it. And here's why I love these 5. The scale can take weeks or months to move, but your energy, your waist, your strength, your labs often ship sooner. So let's stop letting the scale be your only scorecard. The real goal is important here. Weight loss is not the goal. Health is the goal. When you get healthy, you lose weight as a side effect, right? I've watched this for over 30 years of practice. It happens over and over. When you build a generally healthy metabolism, your body very often takes care of the weight on its own. I never tell my patients to lose weight. I never tell them to cut calories. I teach them how to be healthy, and the weight loss happens as a side effect. But even more valuable than the weight, you're building a body that's stronger, more energetic, more resilient, a body that's built to prevent disease instead of just treating it. So this week, instead of how much the weight that I lose, ask a different set of questions. Did I feed my body real food? Did I move my muscles? Did I challenge my heart? Did I sleep well? Did I bring my stress down? Am I stronger than last week? Is my waist trending down? Is my energy steadier? Those are the questions that tell you your metabolism is healing. Health isn't built by chasing a number on a scale. It's built in the small choices that you make every day. You're the CEO of your own health. Every meal, every walk, every workout, every good night's sleep is an investment. And those small decisions, they compound quietly until one day you don't just weigh a little less, you have more energy, you have more strength, you have a clearer mind, you have a stronger heart and a body that can carry you through decades ahead. That's the real goal. Not just adding years to your life, but adding life to your years. And if you want to go deeper on why muscle is so central to all of this, check out this clip from my conversation with my friend, Dr. Gabrielle Lyon, on why muscle is the true organ of longevity. Let's get into kind of the details a little bit, because clearly muscle is, as you laid out, is, is such a neglected and important part of our long-term health. You call it the organ of longevity. I agree. I think, you know, if you look at all the things you could do, I mean, then when you're younger, you have a lot of trophic factors and hormones that keep you kind of going. When you get older, those change and you end up, you know, having the, the, the dwindles, we call it in medicine.

I never heard, I, well, wait a second. I never heard of the dwindles.

You never heard of that?

No.

Well, you're a geriatrician.

I know we didn't, we never called it the dwindles. That is definitely not a geriatric word. That is a Mark Hyman word.

It's like, you know, you see a slow gradual decline, you dwindle in your ability to function.

David never heard of that either, the producer.

Well, anyway, maybe I made it up, but it's something that you kind of notice. And like you said, what we see in our aging population, we think is inevitable part of getting older, which is this decline in ability and function and doing things. And, and the, the truth is that that's not inevitable. Now it takes a lot of more input and work and dedication and diligence. And I want to really get into what does it actually take? Because, you know, people can hear this and go, well, I'm not gonna go to the gym every day and I'm looking— no, they're not.

They're gonna hear this and they're gonna go, you know what? This is the new standard because this is more impactful than any medication I could ever take.

It really is. I mean, you know, losing body fat's important, but I, I would argue with, along with you, that I think building muscle is, is probably one of the best ways to lose body fat, but also to wreck your metabolism, to lower inflammation, improve your cognitive function, to improve your— improve, improve your immunity, help your sexual function. I mean, pretty much everything. Your immune, everything.

And also we have a direct mechanism. So one of the things that we have to understand is that, you know, in medicine we have to ask, okay, so what is the mechanism of action? So for example, muscle mass and sexual function, which we published with my colleagues at Baylor, we have a direct action, and that is what does muscle do? Muscle, strong muscle improves endothelial function. Okay. Improves all vascular health. Strong, healthy muscle mass improves NO2, which is vasodilation, strong, healthy muscle helps improve metabolic risk factors, helps control blood glucose, helps control fats, and it's under voluntary control. And you had said something that sounds like a good ROI. There's also twofold. We just have to become more strategic at the inputs that we put in. Meaning, what does that mean in terms of inputs that are valuable? You know, as we age, you had pointed out when we're younger, our system, you know, it's this, this idea of mTOR. We've all, people have heard about this, but anyway, it's this protein kinase. Mm-hmm. It's this growth factor. It's this growth perpetuator. Yeah. And when we think about it, it's in all tissues. So mTOR, and I'll get to why this is even important, not to get too caught up in the weeds, but mTOR, which is responsible for muscle protein synthesis, is in all tissues. The signaling of our muscle decreases. The efficiency becomes decreased to inputs like protein. And so when we're young, we're highly anabolic. You know, uh, you've met my son, my little one, he's training for the SEAL Teams. He's 4. He's highly anabolic. He could have 5 grams of protein and it would still stimulate his muscle because he's growing. He's driven by growth factors and insulin. Yeah. But when we're done growing, then this input has to change. And this input would then be resistance training, calories, hormones, carbohydrates, and the balance between all of them changes. So we have to get the—

and protein.

Well, protein is right. The amino acids. So, and that's probably the most important. The most important is the resistance training input, the mechanical input, and then the protein input.

Yeah.

Primarily. Lucy.

I'll see you next time on Office Hours. If you love that last video, you're going to love the next one. Check it out here.