Barbell Medicine Podcast

How much resistance training do you actually need, and is there a point where more stops helping? We trace the "lift weights twice a week" recommendation back to the 1989 study it came from, which found that three days beat two, and to the citation loop that turned it into a guideline anyway. Then we go through the evidence on whether lifting is dangerous, including the heart, injury rates, and the J-shaped mortality curve, and work out where the dose-response actually saturates for strength, muscle mass, bone mineral density, and how your body handles fuel.
The short answer is that almost every number in this literature marks where a benefit starts, and very little of it goes far enough to show where a benefit stops. We finish by writing the resistance training guideline the way we think it should be written, with target outcomes, a training dose, and testable targets.

Timestamps 
00:00 Where the "lift weights twice a week" rule came from 
04:18 What actually counts as resistance training 
06:56 Does lifting make your heart wall thicker 
15:34 Anabolic steroids and the heart 
19:16 Injury rates and cardiac arrest at the gym 
22:03 How the lifting J-curve got made 
28:05 ACSM audits its own recommendation 
31:11 Strength: where the plateau actually sits 
35:49 Why grip strength can't answer this 
41:43 Muscle mass versus muscle function 
44:50 Bone, and the turkey wing that settled the dose 
49:50 Fuel handling, insulin sensitivity, and the clock 
1:00:46 The 2018 guidelines, and how I would write them

Resources
Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/
New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs
Barbell Medicine coaching and templates: https://www.barbellmedicine.com
Get early access, ad-free listening, and exclusive content here: https://barbellmedicine.supercast.com/
Braith RW, Graves JE, Pollock ML, Leggett SL, Carpenter DM, Colvin AB. Comparison of 2 vs 3 days/week of variable resistance training during 10- and 18-week programs. Int J Sports Med. 1989;10(6):450-454. doi:10.1055/s-2007-1024942. PMID 2628366.
American College of Sports Medicine. Position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc. 1990;22(2):265-274. PMID 2355825.
Sandercock GRH, Moran J, Cohen DD. Who is meeting the strengthening physical activity guidelines by definition: a cross-sectional study of 253,423 English adults? PLoS One. 2022;17(5):e0267277. doi:10.1371/journal.pone.0267277. PMID 35507575.
Shakespear-Druery J, De Cocker K, Biddle SJH, Gasevic D, Bennie JA. Assessment of muscle-strengthening exercise in public health surveillance for adults: a systematic review. Prev Med. 2021;148:106566. doi:10.1016/j.ypmed.2021.106566. PMID 33878352.
Zhang Y, Lee DH, Rezende LFM, et al. Long-term resistance training with all-cause and cause-specific mortality: assessing dose-response and joint associations with aerobic physical activity. Br J Sports Med. 2026;60(12):874-883. doi:10.1136/bjsports-2025-110503. PMID 42230125.
Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med. 1975;82(4):521-524. doi:10.7326/0003-4819-82-4-521. PMID 1119766.
Naylor LH, George K, O'Driscoll G, Green DJ. The athlete's heart: a contemporary appraisal of the Morganroth hypothesis. Sports Med. 2008;38(1):69-90. doi:10.2165/00007256-200838010-00006. PMID 18081368.
Myerson SG, Montgomery HE, World MJ, Pennell DJ. Left ventricular mass: reliability of M-mode and 2-dimensional echocardiographic formulas. Hypertension. 2002;40(5):673-678. doi:10.1161/01.hyp.0000036401.99908.db. PMID 12411461.
Pelliccia A, Maron BJ, Spataro A, Proschan MA, Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324(5):295-301. doi:10.1056/NEJM199101313240504. PMID 1824720.
Spirito P, Pelliccia A, Proschan MA, et al. Morphology of the "athlete's heart" assessed by echocardiography in 947 elite athletes representing 27 sports. Am J Cardiol. 1994;74(8):802-806. doi:10.1016/0002-9149(94)90439-1. PMID 7942554.
Pelliccia A, Spataro A, Caselli G, Maron BJ. Absence of left ventricular wall thickening in athletes engaged in intense power training. Am J Cardiol. 1993;72(14):1048-1054. doi:10.1016/0002-9149(93)90861-6. PMID 8213586.
Spence AL, Naylor LH, Carter HH, et al. A prospective randomised longitudinal MRI study of left ventricular adaptation to endurance and resistance exercise training in humans. J Physiol. 2011;589(Pt 22):5443-5452. doi:10.1113/jphysiol.2011.217125. PMID 21969450.
Utomi V, Oxborough D, Whyte GP, et al. Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete's heart. Heart. 2013;99(23):1727-1733. doi:10.1136/heartjnl-2012-303465. PMID 23474689.
Smit DL, Voogel AJ, den Heijer M, de Ronde W. Anabolic androgenic steroids induce reversible left ventricular hypertrophy and cardiac dysfunction: echocardiography results of the HAARLEM study. Front Reprod Health. 2021;3:732318. doi:10.3389/frph.2021.732318. PMID 36304014.
Abdullah R, Bjørnebekk A, Hauger LE, Hullstein IR, Edvardsen T, Haugaa KH, Almaas VM. Severe biventricular cardiomyopathy in both current and former long-term users of anabolic-androgenic steroids. Eur J Prev Cardiol. 2024;31(5):599-608. doi:10.1093/eurjpc/zwad362. PMID 37992194.
Keogh JWL, Winwood PW. The epidemiology of injuries across the weight-training sports. Sports Med. 2017;47(3):479-501. doi:10.1007/s40279-016-0575-0. PMID 27328853.
Aasa U, Svartholm I, Andersson F, Berglund L. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017;51(4):211-219. doi:10.1136/bjsports-2016-096037. PMID 27707741.
Page RL, Husain S, White LY, et al. Cardiac arrest at exercise facilities: implications for placement of automated external defibrillators. J Am Coll Cardiol. 2013;62(22):2102-2109. doi:10.1016/j.jacc.2013.06.048. PMID 23933539.
Hollings M, Mavros Y, Freeston J, Fiatarone Singh M. The effect of progressive resistance training on aerobic fitness and strength in adults with coronary heart disease: a systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol. 2017;24(12):1242-1259. doi:10.1177/2047487317713329.
Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022;56(13):755-763. doi:10.1136/bjsports-2021-105061. PMID 35228201.
O'Keefe JH, O'Keefe EL, Eckert R, Lavie CJ. Training strategies to optimize cardiovascular durability and life expectancy. Mo Med. 2023;120(2):155-162. PMID 37091937. PMCID PMC10121111.
Currier BS, McLeod JC, Banfield L, et al. American College of Sports Medicine position stand: resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: an overview of reviews. Med Sci Sports Exerc. 2026;58(4):851-872. PMID 41843416.
Ralston GW, Kilgore L, Wyatt FB, Buchan D, Baker JS. Weekly training frequency effects on strength gain: a meta-analysis. Sports Med Open. 2018;4(1):36. doi:10.1186/s40798-018-0149-9. PMID 30076500.
Pelland JC, Remmert JF, Robinson ZP, Hinson SR, Zourdos MC. The resistance training dose response: meta-regressions exploring the effects of weekly volume and frequency on muscle hypertrophy and strength gains. Sports Med. 2026;56(2):481-505. doi:10.1007/s40279-025-02344-w. PMID 41343037.
Ortega FB, Silventoinen K, Tynelius P, Rasmussen F. Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ. 2012;345:e7279. doi:10.1136/bmj.e7279. PMID 23144234.
Ruiz JR, Sui X, Lobelo F, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337:a439. doi:10.1136/bmj.a439. PMID 18595904.
Timpka S, Petersson IF, Zhou C, Englund M. Muscle strength in adolescent men and risk of cardiovascular disease events and mortality in middle age. BMC Med. 2014;12:62. doi:10.1186/1741-7015-12-62. PMID 24731728.
Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-273. doi:10.1016/S0140-6736(14)62000-6. PMID 25982160.
Tieland M, Verdijk LB, de Groot LCPGM, van Loon LJC. Handgrip strength does not represent an appropriate measure to evaluate changes in muscle strength during an exercise intervention program in frail older people. Int J Sport Nutr Exerc Metab. 2015;25(1):27-36. doi:10.1123/ijsnem.2013-0123. PMID 24903908.
Grgic J, Garofolini A, Orazem J, Sabol F, Schoenfeld BJ, Pedisic Z. Effects of resistance training on muscle size and strength in very elderly adults: a systematic review and meta-analysis of randomized controlled trials. Sports Med. 2020;50(11):1983-1999. doi:10.1007/s40279-020-01331-7. PMID 32740889.
Huebner M, Riemann B, Hatchett A. Grip strength and sports performance in competitive master weightlifters. Int J Environ Res Public Health. 2023;20(3):2033. doi:10.3390/ijerph20032033. PMID 36767396.
López-Bueno R, Andersen LL, Koyanagi A, et al. Thresholds of handgrip strength for all-cause, cancer, and cardiovascular mortality: a systematic review with dose-response meta-analysis. Ageing Res Rev. 2022;82:101778. doi:10.1016/j.arr.2022.101778.
MacDonald HV, Johnson BT, Huedo-Medina TB, et al. Dynamic resistance training as stand-alone antihypertensive lifestyle therapy: a meta-analysis. J Am Heart Assoc. 2016;5(10):e003231. doi:10.1161/JAHA.116.003231. PMID 27680663.
Bhasin S, Travison TG, Manini TM, et al. Sarcopenia definition: the position statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatr Soc. 2020;68(7):1410-1418. doi:10.1111/jgs.16372. PMID 32150289.
Cawthon PM, Manini T, Patel SM, et al. Putative cut-points in sarcopenia components and incident adverse health outcomes: an SDOC analysis. J Am Geriatr Soc. 2020;68(7):1429-1437. doi:10.1111/jgs.16517. PMID 32633824.
Rubin CT, Lanyon LE. Regulation of bone formation by applied dynamic loads. J Bone Joint Surg Am. 1984;66(3):397-402. PMID 6699056.
Rubin CT, Lanyon LE. Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int. 1985;37(4):411-417. doi:10.1007/BF02553711. PMID 3930039.
Zhao R, Zhang M, Zhang Q. The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis. Osteoporos Int. 2015;26(5):1605-1618. PMID 25603795.
Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211-220. doi:10.1002/jbmr.3284.
Reid IR, Horne AM, Mihov B, et al. Fracture prevention with zoledronate in older women with osteopenia. N Engl J Med. 2018;379(25):2407-2416. doi:10.1056/NEJMoa1808082. PMID 30575489.
Muniyappa R, Lee S, Chen H, Quon MJ. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab. 2008;294(1):E15-E26. PMID 17957034.
Koopman R, Manders RJF, Jonkers RAM, Hul GBJ, Kuipers H, van Loon LJC. Intramyocellular lipid and glycogen content are reduced following resistance exercise in untrained healthy males. Eur J Appl Physiol. 2006;96(5):525-534. doi:10.1007/s00421-006-0139-3. PMID 16369816.
Goodpaster BH, He J, Watkins S, Kelley DE. Skeletal muscle lipid content and insulin resistance: evidence for a paradox in endurance-trained athletes. J Clin Endocrinol Metab. 2001;86(12):5755-5761. doi:10.1210/jcem.86.12.8075. PMID 11739435.
van Loon LJC, Goodpaster BH. Increased intramuscular lipid storage in the insulin-resistant and endurance-trained state. Pflugers Arch. 2005;451(5):606-616. doi:10.1007/s00424-005-1509-0. PMID 16155759.
Richter EA, Mikines KJ, Galbo H, Kiens B. Effect of exercise on insulin action in human skeletal muscle. J Appl Physiol. 1989;66(2):876-885. PMID 2496078.
Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JFP, Dela F. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes. 2004;53(2):294-305. PMID 14747278.
Mikines KJ, Sonne B, Tronier B, Galbo H. Effects of acute exercise and detraining on insulin action in trained men. J Appl Physiol. 1989;66(2):704-711. PMID 2496077.
Kjøbsted R, Wojtaszewski JFP, Treebak JT. Role of AMP-activated protein kinase for regulating post-exercise insulin sensitivity. Experientia Suppl. 2016;107:81-126. doi:10.1007/978-3-319-43589-3_4. PMID 27812978.
Bird SR, Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport Exerc Med. 2017;2(1):e000143. doi:10.1136/bmjsem-2016-000143. PMID 28879026.
Iaccarino G, Franco D, Sorriento D, Strisciuglio T, Barbato E, Morisco C. Modulation of insulin sensitivity by exercise training: implications for cardiovascular prevention. J Cardiovasc Transl Res. 2021;14(2):256-270. doi:10.1007/s12265-020-10057-w. PMID 32737757.
Hingst, Janne R et al. “Insulin Sensitization Following a Single Exercise Bout Is Uncoupled to Glycogen in Human Skeletal Muscle: A Meta-analysis of 13 Single-Center Human Studies.” Diabetes vol. 71,11 (2022): 2237-2250. doi:10.2337/db22-0015
Gillen JB, Estafanos S, Williamson E, et al. Interrupting prolonged sitting with repeated chair stands or short walks reduces postprandial insulinemia in healthy adults. J Appl Physiol. 2020;130(1):104-113. doi:10.1152/japplphysiol.00796.2020. PMID 33180640.
Francois ME, Baldi JC, Manning PJ, et al. "Exercise snacks" before meals: a novel strategy to improve glycaemic control in individuals with insulin resistance. Diabetologia. 2014;57(7):1437-1445. doi:10.1007/s00125-014-3244-6. PMID 24817675.
US Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd ed. USDHHS; 2018.

Our Sponsors:
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code BBM for a great deal: https://www.quince.com
* Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc

Advertising Inquiries: https://redcircle.com/brands

Nearly every warning you've heard about lifting weights was written down before anybody checked it. We trace where those warnings came from, starting with a Harvard student in 1854 and ending with a curve on a graph that's being used today to argue you can lift too much.
Along the way: the men who built themselves with barbells and then sold the public five-pound dumbbells, because iron was expensive to mail and a booklet cost pennies. The muscle-bound myth, which nobody could define when a graduate student surveyed 45 physiologists about it. The 1961 report that took the deep squat out of every branch of the American military, measured with a device its author built himself and never validated. The claim that lifting stunts a child's growth, which no professional body ever actually made. And the argument women got, which was never about injury at all.

Timestamps:
0:00 Intro
2:33 2,500 years of people picking up heavy things
7:24 George Windship and the Health Lift
10:56 Blaikie's truck horse and the muscle-bound myth
14:59 Bernarr Macfadden
19:39 Charles Atlas and Dynamic Tension
27:01 Carl Klein, a homemade device, and the parallel squat
30:57 Thomas Delorme and three sets of ten
35:20 Kids, growth plates, and where the stunting idea came from
41:43 Women, "you'll get bulky," and Dudley Sargent in 1912
50:05 Pregnancy, from 1949 to a 2025 barbell study
53:40 The pattern, and the curve on next week's graph

Resources:
Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/

New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs

Barbell Medicine coaching and templates: https://www.barbellmedicine.com

1. Downs DS, Chasan-Taber L, Evenson KR, Leiferman J, Yeo S. Physical activity and pregnancy: past and present evidence and future recommendations. Res Q Exerc Sport. 2012;83(4):485-502. doi:10.1080/02701367.2012.10599138. PMID 23367811.

2. McMurray RG, Mottola MF, Wolfe LA, Artal R, Millar L, Pivarnik JM. Recent advances in understanding maternal and fetal responses to exercise. Med Sci Sports Exerc. 1993;25(12):1305-1321. PMID 8107536.

3. Smith KM, Campbell CG. Physical activity during pregnancy: impact of applying different physical activity guidelines. J Pregnancy. 2013;2013:165617. doi:10.1155/2013/165617. PMID 23476778.

4. American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 804. Obstet Gynecol. 2020;135(4):e178-e188. doi:10.1097/AOG.0000000000003772. PMID 32217980.

5. American Academy of Pediatrics Committee on Sports Medicine and Fitness. Strength training by children and adolescents. Pediatrics. 2001;107(6):1470-1472. doi:10.1542/peds.107.6.1470. PMID 11389279.

6. Stricker PR, Faigenbaum AD, McCambridge TM; Council on Sports Medicine and Fitness. Resistance training for children and adolescents. Pediatrics. 2020;145(6):e20201011. doi:10.1542/peds.2020-1011. PMID 32457216.

7. Gardiner EN. Athletics of the Ancient World. Clarendon Press; 1930:54. See also Gardiner EN. Olympia: Its History and Remains. Clarendon Press; 1925.

8. Heffernan C. The Bybon stone and ancient strength. Physical Culture Study. 2021. Accessed September 2026. https://physicalculturestudy.com.

9. Pausanias. Description of Greece. 6.14.5. Jones WHS, trans. Loeb Classical Library. Harvard University Press.

10. Quintilian. Institutio Oratoria. 1.9.5. Butler HE, trans. Loeb Classical Library. Harvard University Press.

11. Heffernan C. Milo of Croton and the invention of progressive overload. Physical Culture Study. 2026. Accessed September 2026. https://physicalculturestudy.com. See also H.J. Lutcher Stark Center for Physical Culture and Sports, University of Texas at Austin, Milo Bar-Bell Company holdings.

12. Liddell HG, Scott R. A Greek-English Lexicon. 9th ed. Clarendon Press; entry γυμνάσιον. Thucydides. History of the Peloponnesian War. 1.6. Crawley R, trans.

13. Tomlinson RA. Gymnasium. In: Oxford Classical Dictionary. Oxford University Press; 2015. doi:10.1093/acrefore/9780199381135.013.2963. See also Stavrou D. The Greek Gymnasium [thesis]. University of Leicester; 2016:38.

14. Xenophon. Constitution of the Lacedaimonians. 1.4. Marchant EC, trans. Loeb Classical Library. Harvard University Press.

15. Plutarch. Life of Lycurgus. 14. Perrin B, trans. Loeb Classical Library. Harvard University Press.

16. Ollier F. Le Mirage Spartiate. Vols 1-2. Boccard; 1933-1943. Discussed in Rahe PA. The Grand Strategy of Classical Sparta. Yale University Press; 2016. See also Christesen P. Utopia on the Eurotas: Economic Aspects of the Spartan Mirage. In: Powell A, Hodkinson S, eds. Sparta: The Body Politic. Classical Press of Wales; 2010.

17. Pausanias. Description of Greece. 5.16. Jones WHS, trans. Loeb Classical Library. Harvard University Press.

18. Scarborough J. Galen and the gladiators. Episteme. 1971;5:98-111.

19. Tipton CM. The history of "Exercise Is Medicine" in ancient civilizations. Adv Physiol Educ. 2014;38(2):109-117. doi:10.1152/advan.00136.2013. PMCID PMC4056176.

20. Vegetius FR. De Re Militari (The Military Institutions of the Romans). Book I. Clarke J, trans. 1767.

21. Surviving halteres: a catalogue. EXARC Journal. 2017;(3). Accessed September 2026. https://exarc.net.

22. Talaga M. Physical culture in the Middle Ages: revisiting the disappearance thesis. Cogent Arts Humanit. 2025. doi:10.1080/23311983.2025.2482388.

23. Rawcliffe C. Health and the environment in the medieval hospital. History. 2022. doi:10.1111/1468-229X.13238.

24. Elyot T. The Boke Named the Governour. 1531. Croft HHS, ed. Kegan Paul; 1883:171.

25. Campillo P, Caballero D. Girolamo Mercuriale and the art of gymnastics. Hektoen International. 2020. Accessed September 2026. https://hekint.org.

26. Todd T. The myth of the muscle-bound lifter. NSCA J. 1985;7(3):37-41. Citing Van Doren C. Benjamin Franklin. Viking Press; 1938.

27. Galen. Exhortation to the Study of the Arts (Protrepticus). Chapters 9-14. Walsh J, trans. Medical Life. 1930;37:507-529. See also Xenophontos S. Galen's Exhortation to the Study of Medicine. In: Bouras-Vallianatos P, Xenophontos S, eds. Greek Medical Literature and Its Readers. Routledge; 2018:67-93.

28. Todd J. "Strength is Health": George Barker Windship and the first American weight training boom. Iron Game History. 1993;3(1):3-14. https://starkcenter.org/igh/igh-v3/igh-v3-n1/igh0301c.pdf.

29. Windship GB. Autobiographical sketches of a strength-seeker. Atlantic Monthly. 1862;9(51):102-115.

30. US Patent 46,413. Improvement in graduated dumb-bells. GB Windship, Boston. Granted 14 February 1865.

31. Savage DF. US Patent 28,505. 1860.

32. The Health-Lift Reduced to a Science: Cumulative Exercise, A Thorough Gymnastic System in Ten Minutes Once a Day. New York: Health-Lift Company; 1875.

33. Blaikie W. How to Get Strong and How to Stay So. New York: Harper & Brothers; 1879:99-100.

34. Bryant D. William Blaikie and physical fitness in late nineteenth century America. Iron Game History. 1992;2(3):3.

35. Sandow E. Sandow on Physical Training. Adam GM, ed. 1894:12, 23, 207.

36. Sandow E. Strength and How to Obtain It. London: Gale & Polden; 1897:34, Table 7.

37. Sandow E. Strength and How to Obtain It. Revised ed. London: Gale & Polden; [c1899]. Project Gutenberg ebook 65987.

38. Todd J, Todd T. Requiem for a strongman: reassessing the career of Professor Louis Attila. Iron Game History. 2002;7(2-3):42-55.

39. Pall Mall Gazette. December 1889. Clipping in Attila's scrapbook, Todd-McLean Collection, H.J. Lutcher Stark Center, University of Texas at Austin.

40. Chapman D. Sandow's first triumph. Iron Game History. 1994;3(3):3-8.

41. Robert Hoffman Business Papers finding aid. H.J. Lutcher Stark Center for Physical Culture and Sports, University of Texas at Austin.

42. Hall DT, Fair JD. The pioneers of protein. Iron Game History. 2004;8(3):26-28.

43. Shurley J, Todd J. Joe Weider, All American Athlete, and the promotion of strength training for sport: 1940-1969. Iron Game History. 2012;12(1):9-12.

44. Todd J. Bernarr Macfadden: reformer of feminine form. Iron Game History. 1991;1(4-5):3-8.

45. Yagoda B. The true story of Bernarr Macfadden. American Heritage. 1981;33(1):22-28.

46. Murtha R, Heffernan C, Hunt T. Building American supermen? Bernarr MacFadden, Benito Mussolini and American fascism in the 1930s. Sport in Society. 2020. doi:10.1080/17430437.2020.1865313.

47. New York Times. 6 October 1905:10; 10 October 1905:9.

48. Macfadden B. Macfadden's Encyclopedia of Physical Culture. New York: Physical Culture Publishing; 1912:847. Quoted in Todd T, NSCA J. 1985;7(3):37-41.

49. Danna S. Charles Atlas: muscle man. Iron Game History. 1996;4(4):3-6, 12-14. https://starkcenter.org/igh/igh-v4/igh-v4-n4/igh0404c.pdf.

50. Guide to the Charles Atlas Records, NMAH.AC.0654. Archives Center, National Museum of American History, Smithsonian Institution.

51. Charles Atlas course text, undated later edition.

52. Charles P. Roman: a gloriously healthy life. Chief Marketer.

53. Kannenberg G Jr. The ad that made an icon out of Mac. Hogan's Alley. 1999;2(3).

54. Michigan State University Libraries comic art index, Charles Atlas advertisements. https://comics.lib.msu.edu/rri/arri/atlas.htm.

55. Charles Atlas. Encyclopedia.com.

56. Todd J, Todd T. The conversion of Dr. Peter Karpovich. Iron Game History. 2005;8(4):4-12. https://starkcenter.org/igh/igh-v8/igh-v8-n4/igh0804c.pdf.

57. Murray J, Karpovich P. Weight Training in Athletics. Englewood Cliffs, NJ: Prentice-Hall; 1956.

58. Murray J. John Carrol Grimek: the nonpareil. Iron Game History. 1994;3(3):10-12.

59. Zorbas WS, Karpovich PV. The effect of weight lifting upon the speed of muscular contractions. Res Q. 1951;22(2):145-148.

60. Klein KK. The deep squat exercise as utilized in weight training for athletes and its effect on the ligaments of the knee. J Assoc Phys Ment Rehabil. 1961;15(1):6-11, 23.

61. Sports Illustrated. Coverage of Klein's knee-ligament findings. 1962.

62. Todd T. Karl Klein and the squat. NSCA J. 1984;6(3):26-31.

63. Chandler TJ, Wilson GD, Stone MH. The effect of the squat exercise on knee stability. Med Sci Sports Exerc. 1989;21(3):299-303. PMID 2733579.

64. Panariello RA, Backus SI, Parker JW. The effect of the squat exercise on anterior-posterior knee translation in professional football players. Am J Sports Med. 1994;22(6):768-773. doi:10.1177/036354659402200607. PMID 7856800.

65. Berryman JW. Exercise is medicine: a historical perspective. Curr Sports Med Rep. 2010;9(4):195-201. doi:10.1249/JSR.0b013e3181e7d86d.

66. Todd JS, Shurley JP, Todd TC. Thomas L. DeLorme and the science of progressive resistance exercise. J Strength Cond Res. 2012;26(11):2913-2923. doi:10.1519/JSC.0b013e31825adcb4.

67. Kraus H, Hirschland RP. Minimum muscular fitness tests in school children. Res Q. 1954;25(2):178-188. doi:10.1080/10671188.1954.10624957.

68. The President's Council on Youth Fitness. Exhibit. H.J. Lutcher Stark Center for Physical Culture and Sports, University of Texas at Austin. Accessed September 2026.

69. Bonnie Prudden: biography. Bonnie Prudden Foundation. Accessed September 2026. https://bonnieprudden.com.

70. Executive Order 10673: Fitness of American Youth. 21 Fed Reg 5341. July 16, 1956.

71. Heady JA, Morris JN, Kagan A, Raffle PAB. Coronary heart disease in London busmen: a progress report with particular reference to physique. Br J Prev Soc Med. 1961;15(4):143-153.

72. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Chapter 2. Centers for Disease Control and Prevention; 1996.

73. American College of Sports Medicine. Position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc. 1990;22(2):265-274. PMID 2355825.

74. Brady TA, Cahill BR, Bodnar LM. Weight training-related injuries in the high school athlete. Am J Sports Med. 1982;10(1):1-5. doi:10.1177/036354658201000101. PMID 6459035.

75. Dahab KS, McCambridge TM. Strength training in children and adolescents: raising the bar for young athletes? Sports Health. 2009;1(3):223-226. doi:10.1177/1941738109334215. PMID 23015875.

76. American Academy of Pediatrics Committee on Sports Medicine. Weight training and weight lifting: information for the pediatrician. Physician Sportsmed. 1983;11(3):157-161.

77. American Academy of Pediatrics Committee on Sports Medicine. Strength training, weight and power lifting, and body building by children and adolescents. Pediatrics. 1990;86(5):801-803.

78. Smith NJ, Stanitski CL. Sports Medicine: A Practical Guide. Philadelphia, PA: WB Saunders; 1987:33.

79. Stricker PR, Faigenbaum AD, McCambridge TM; American Academy of Pediatrics Council on Sports Medicine and Fitness. Resistance training for children and adolescents. Pediatrics. 2020;145(6):e20201011. doi:10.1542/peds.2020-1011.

80. Faigenbaum AD. Youth resistance training. President's Council on Physical Fitness and Sports Research Digest. 2003;4(3):1-8.

81. Kato S, Ishiko T. Obstructed growth of children's bones due to excessive labor in remote corners. In: Kato K, ed. Proceedings of the International Congress of Sport Sciences. Tokyo, Japan: Japanese Union of Sport Sciences; 1964:476.

82. Rowe PH. Colles fracture due to weightlifting. Br J Sports Med. 1979;13(3):130-131. doi:10.1136/bjsm.13.3.130. PMID 486885.

83. Ryan JR, Salciccioli GG. Fractures of the distal radial epiphysis in adolescent weight lifters. Am J Sports Med. 1976;4(1):26-27. doi:10.1177/036354657600400105.

84. Benton JW. Epiphyseal fracture in sports. Physician Sportsmed. 1982;10(11):63-71.

85. Gumbs VL, Segal D, Halligan JB, Lower G. Bilateral distal radius and ulnar fractures in adolescent weight lifters. Am J Sports Med. 1982;10(6):375-379. doi:10.1177/036354658201000612.

86. Jenkins NH, Mintowt-Czyz WJ. Bilateral fracture separations of the distal radial epiphyses during weight-lifting. Br J Sports Med. 1986;20(2):72-73. doi:10.1136/bjsm.20.2.72.

87. Weiss AC, Sponseller PD. Salter-Harris type I fracture of the distal radius due to weightlifting. Orthop Rev. 1989;18(3):233-235.

88. Browne TD. Bilateral wrist fractures in an adolescent weightlifter. Orthopedics. 1990.

89. Faigenbaum AD, Myer GD. Resistance training among young athletes: safety, efficacy and injury prevention effects. Br J Sports Med. 2010;44(1):56-63. doi:10.1136/bjsm.2009.068098.

90. Sadres E, Eliakim A, Constantini N, Lidor R, Falk B. The effect of long-term resistance training on anthropometric measures, muscle strength, and self concept in pre-pubertal boys. Pediatr Exerc Sci. 2001;13(4):357-372. doi:10.1123/pes.13.4.357.

91. Malina RM. Weight training in youth: growth, maturation, and safety: an evidence-based review. Clin J Sport Med. 2006;16(6):478-487. doi:10.1097/01.jsm.0000248843.31874.be.

92. Lloyd RS, Faigenbaum AD, Stone MH, et al. Position statement on youth resistance training: the 2014 international consensus. Br J Sports Med. 2014;48(7):498-505. doi:10.1136/bjsports-2013-092952.

93. American Academy of Pediatrics Council on Sports Medicine and Fitness. Strength training by children and adolescents. Pediatrics. 2008;121(4):835-840. doi:10.1542/peds.2007-3790. PMID 18381549.

94. Faigenbaum AD, Kraemer WJ, Blimkie CJR, et al. Youth resistance training: updated position statement paper from the National Strength and Conditioning Association. J Strength Cond Res. 2009;23(5 Suppl):S60-S79. doi:10.1519/JSC.0b013e31819df407. PMID 19620931.

95. Milone MT, Bernstein J, Freedman KB, Tjoumakaris F. There is no need to avoid resistance training (weight lifting) until physeal closure. Phys Sportsmed. 2013;41(4):101-105. doi:10.3810/psm.2013.11.2040. PMID 24393806.

96. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians: effects on skeletal muscle. JAMA. 1990;263(22):3029-3034. PMID 2342214.

97. Fiatarone MA, O'Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330(25):1769-1775. doi:10.1056/NEJM199406233302501. PMID 8190152.

98. Sargent DA. Are athletics making girls masculine? A practical answer to a question every girl asks. 1912.

99. Jones A. Weight-training for women. In: Nautilus Bulletin No. 2. Ch. 15. DeLand, FL: Nautilus Sports/Medical Industries; [c1971]. http://www.arthurjonesexercise.com/Bulletin2/15.PDF.

100. Cureton KJ, Collins MA, Hill DW, McElhannon FM. Muscle hypertrophy in men and women. Med Sci Sports Exerc. 1988;20(4):338-344. PMID 3173042.

101. Hubal MJ, Gordish-Dressman H, Thompson PD, et al. Variability in muscle size and strength gain after unilateral resistance training. Med Sci Sports Exerc. 2005;37(6):964-972. PMID 15947721.

102. Roberts BM, Nuckols G, Krieger JW. Sex differences in resistance training: a systematic review and meta-analysis. J Strength Cond Res. 2020;34(5):1448-1460. doi:10.1519/JSC.0000000000003521. PMID 32218059.

103. Refalo MC, Nuckols G, Galpin AJ, Gallagher IJ, Hamilton DL, Fyfe JJ. Sex differences in absolute and relative changes in muscle size following resistance training in healthy adults: a systematic review with Bayesian meta-analysis. PeerJ. 2025;13:e19042. doi:10.7717/peerj.19042. PMID 40028215.

104. Handelsman DJ, Hirschberg AL, Bermon S. Circulating testosterone as the hormonal basis of sex differences in athletic performance. Endocr Rev. 2018;39(5):803-829. doi:10.1210/er.2018-00020. PMID 30010735.

105. Bhasin S, Storer TW, Berman N, et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med. 1996;335(1):1-7. doi:10.1056/NEJM199607043350101. PMID 8637535.

106. Huang G, Basaria S, Travison TG, et al. Testosterone dose-response relationships in hysterectomized women with or without oophorectomy. Menopause. 2014;21(6):612-623. doi:10.1097/GME.0000000000000093. PMID 24281237.

107. Franke WW, Berendonk B. Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government. Clin Chem. 1997;43(7):1262-1279. PMID 9216474.

108. OpenPowerlifting database analysis of tested versus untested totals.

109. Average player heights, National Basketball Association and Women's National Basketball Association, against US adult means from the National Health and Nutrition Examination Survey anthropometric reference data.

110. History of women's weightlifting. International Weightlifting Federation. Accessed September 2026. https://iwf.sport.

111. Adamfi A, IWF Director General, on the pre-1983 IWF constitution. Inside the Games. Accessed September 2026. https://www.insidethegames.biz.

112. History of women's powerlifting. International Powerlifting Federation. Accessed September 2026. https://www.powerlifting.sport.

113. Holloway JB, Gater D, Ritchie M, et al. Strength training for female athletes: a position paper. Part I. NSCA J. 1989;11(4):43-51. Part II. NSCA J. 1989;11(5):29-36.

114. Kehler AK, Heinrich KM. A selective review of prenatal exercise guidelines since the 1950s until present: written for women, health care professionals, and female athletes. Women Birth. 2015;28(4):e93-e98. doi:10.1016/j.wombi.2015.07.004. PMID 26210535.

115. Berghella V, Saccone G. Exercise in pregnancy! Am J Obstet Gynecol. 2017;216(4):335-337. doi:10.1016/j.ajog.2017.01.023.

116. Davenport MH, Ruchat SM, Poitras VJ, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018;52(21):1367-1375. doi:10.1136/bjsports-2018-099355. PMID 30337463.

117. Prevett C, Gingerich J, Sivak A, Davenport MH. Impact of resistance training on maternal and fetal outcomes: a systematic review and meta-analysis. Br J Sports Med. 2025;59(17):1173-1183. doi:10.1136/bjsports-2025-109626. PMID 40610191.

118. Moolyk AN, Wowdzia JB, Matenchuk BA, et al. Acute fetal response to high-intensity resistance training in pregnancy. Br J Sports Med. 2025;59(3):159-167. doi:10.1136/bjsports-2024-108569. PMID 39694629.

119. Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022;56(13):755-763. doi:10.1136/bjsports-2021-105061.

120. Bennie JA, Lee DC, Khan A, et al. Muscle-strengthening exercise among 397,423 U.S. adults: prevalence, correlates, and associations with health conditions. Am J Prev Med. 2018;55(6):864-874. doi:10.1016/j.amepre.2018.07.022. PMID 30458949.

Our Sponsors:
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code BBM for a great deal: https://www.quince.com
* Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc

Advertising Inquiries: https://redcircle.com/brands

Parts of the country now get a few weeks of wildfire smoke every year, and the obvious question is whether there is a point where the air is bad enough that the workout costs you more than it gives you. We went and looked. There is a real number, it comes from about 1.5 million people, and it is not the number that gets quoted.
This is a free preview of Direct Line, our monthly ask-us-anything for Barbell Medicine Plus subscribers. Two of this month's twelve questions are here in full.
First: training in wildfire smoke. What PM2.5 is, why the AQI on your phone and the number in the paper are not the same quantity, where the 90-minutes-at-100-micrograms figure comes from and why it is softer than it sounds, what happened when six cities modeled telling people to stay inside, and why your breathing rate during a set of squats matters more than you would think.
Second: the effective reps model. A subscriber noticed that if a set only counts when you are within five reps of failure, the triceps in a heavy bench press should not count, and if you are going to count that as a fractional set for the triceps, then a warm-up set counts for the chest. Both cannot be true. We go through the meta-regression on proximity to failure, the 67-study analysis that tested whether an indirect set should count as one, as half, or as zero, and where we actually put our sets.

Join Barbell Medicine Plus today: https://barbellmedicine.supercast.com/
Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/
New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs
Barbell Medicine coaching and templates: https://www.barbellmedicine.com

Timestamps
1:47 The question: is there a point where the air is too bad to train?
2:37 What PM2.5 actually is
3:05 AQI vs micrograms, and why your phone disagrees with the paper
3:50 Where the "90 minutes" number comes from
4:54 Austin: what breathing this air does to your lungs
9:14 1.5 million adults: does dirty air cancel the benefit of exercise?
10:44 Six cities modeled staying indoors. Mortality did not improve.
11:22 Lifting vs cycling: breathing rate is the whole mechanism
12:33 Indoor air during a wildfire, and what filtration does not fix
13:24 Is wildfire smoke worse than city pollution?
14:38 What we would actually tell a patient
18:35 The question: hard sets, fractional sets, and the five-rep rule
19:18 Reps in reserve, hard sets, and fractional sets defined
20:19 The meta-regression: no threshold, just a line
21:13 Do indirect sets count as half a set?
23:08 Would you rather: every set at 5 RIR, or every set to failure?
25:22 Why you get worse at judging RIR the further you are from failure
28:42 The numbers we use: RPE 7 to 9 for hypertrophy, 4 to 6 for strength
29:20 Austin: individual variation dwarfs all of this
33:28 Why nobody can measure training load in the weight room

Resources
Tainio M, de Nazelle AJ, Götschi T, et al. Can air pollution negate the health benefits of cycling and walking? Prev Med. 2016;87:233-236. doi:10.1016/j.ypmed.2016.02.002. PMID 27156248
Ku PW, Steptoe A, Hamer M, et al. Does ambient PM2.5 reduce the protective association of leisure-time physical activity with mortality? A systematic review, meta-analysis, and individual-level pooled analysis of cohort studies involving 1.5 million adults. BMC Med. 2025;23(1):647. doi:10.1186/s12916-025-04496-y. PMID 41310726
Giallouros G, Kouis P, Papatheodorou SI, Woodcock J, Tainio M. The long-term impact of restricting cycling and walking during high air pollution days on all-cause mortality: health impact assessment study. Environ Int. 2020;140:105679. doi:10.1016/j.envint.2020.105679. PMID 32353667
Sun S, Cao W, Qiu H, et al. Benefits of physical activity not affected by air pollution: a prospective cohort study. Int J Epidemiol. 2020;49(1):142-152. doi:10.1093/ije/dyz184. PMID 31504557
Robles P, Araujo T, Brooks D, et al. Cardiorespiratory responses to short bouts of resistance training exercises in individuals with chronic obstructive pulmonary disease: a comparison of exercise intensities. J Cardiopulm Rehabil Prev. 2017;37(5):356-362. doi:10.1097/HCR.0000000000000282. PMID 28858033
Liang Y, Sengupta D, Campmier MJ, Lunderberg DM, Apte JS, Goldstein AH. Wildfire smoke impacts on indoor air quality assessed using crowdsourced data in California. Proc Natl Acad Sci U S A. 2021;118(36):e2106478118. doi:10.1073/pnas.2106478118. PMID 34465624
Aguilera R, Corringham T, Gershunov A, Benmarhnia T. Wildfire smoke impacts respiratory health more than fine particles from other sources: observational evidence from Southern California. Nat Commun. 2021;12(1):1493. doi:10.1038/s41467-021-21708-0. PMID 33674571
US Environmental Protection Agency. Air Quality Index (AQI) breakpoints. Air Quality System code tables. Accessed August 10, 2026. https://aqs.epa.gov/aqsweb/documents/codetables/aqi_breakpoints.html
Robinson ZP, Pelland JC, Remmert JF, Refalo MC, Jukic I, Steele J, et al. Exploring the dose-response relationship between estimated resistance training proximity to failure, strength gain, and muscle hypertrophy: a series of meta-regressions. Sports Med. 2024;54(9):2209-2231. doi:10.1007/s40279-024-02069-2. PMID 38970765
Pelland JC, Remmert JF, Robinson ZP, Hinson SR, Zourdos MC. The resistance training dose response: meta-regressions exploring the effects of weekly volume and frequency on muscle hypertrophy and strength gains. Sports Med. 2026;56(2):481-505. doi:10.1007/s40279-025-02344-w

Our Sponsors:
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code BBM for a great deal: https://www.quince.com
* Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc

Advertising Inquiries: https://redcircle.com/brands

Most lifters have been told they need to eat in a Calorie surplus to build muscle. That rule has always come with a list of exceptions: unless you're new, unless you're carrying extra body fat, unless you're coming back from time off. Dr. Eric Helms joins Dr. Jordan Feigenbaum to work out what the rule is actually tracking, starting from a question with a real number attached: what does a pound of muscle cost to build? And then, do you need to be in a surplus to build muscle? 
Timestamps:
0:00 The rule, and its exceptions
2:08 Where "you need a surplus" came from
7:12 Heuristics versus theories
11:40 Hypertrophy, maintenance, deficit and surplus defined
14:58 Body fat as a savings account
18:24 How fast anyone can actually build muscle
23:39 What sets the ceiling: stimulus, not genetics
26:37 Microgravity, astronauts, and a 20 kg barbell
31:49 What constrains growth if steroids don't break the ceiling
36:44 If training sets the ceiling, what does energy do
38:45 What 1 kg of muscle costs to build
44:05 Why 3,500 Calories doesn't tell you what to eat
44:55 REDs and the dual intervention model
47:51 The 2000s bulking studies
51:34 Garthe 2013: elite athletes and a 500 Calorie surplus
58:30 Protein: 1.6 versus 2.5 g/kg
1:03:31 What starvation research shows the body protects
1:10:29 Vargas-Molina: maintenance versus deficit
1:19:17 What to do if you're lean
1:39:34 What would prove this wrong
1:57:57 Three buckets

Resources:
Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/
New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs
Barbell Medicine coaching and templates: https://www.barbellmedicine.com

Nikolaidis MG, Paschalis V, Margaritelis NV. The energetic cost of building human skeletal muscle. bioRxiv. Preprint posted online August 17, 2026. doi:10.64898/2026.08.17.745156
Rozenek R, Ward P, Long S, Garhammer J. Effects of high-calorie supplements on body composition and muscular strength following resistance training. J Sports Med Phys Fitness. 2002;42(3):340-347.
Garthe I, Raastad T, Refsnes PE, Koivisto A, Sundgot-Borgen J. Effect of two different weight-loss rates on body composition and strength and power-related performance in elite athletes. Int J Sport Nutr Exerc Metab. 2011;21(2):97-104.
Garthe I, Raastad T, Refsnes PE, Sundgot-Borgen J. Effect of nutritional intervention on body composition and performance in elite athletes. Eur J Sport Sci. 2013;13(3):295-303. doi:10.1080/17461391.2011.643923
Helms ER, Zinn C, Rowlands DS, Brown SR. A systematic review of dietary protein during caloric restriction in resistance trained lean athletes: a case for higher intakes. Int J Sport Nutr Exerc Metab. 2014;24(2):127-138. doi:10.1123/ijsnem.2013-0054
Slater GJ, Dieter BP, Marsh DJ, Helms ER, Shaw G, Iraki J. Is an energy surplus required to maximize skeletal muscle hypertrophy associated with resistance training. Front Nutr. 2019;6:131. doi:10.3389/fnut.2019.00131
Murphy C, Koehler K. Energy deficiency impairs resistance training gains in lean mass but not strength: a meta-analysis and meta-regression. Scand J Med Sci Sports. 2022;32(1):125-137. doi:10.1111/sms.14075
Helms ER, Spence A, Sousa C, et al. Effect of small and large energy surpluses on strength, muscle, and skinfold thickness in resistance-trained individuals: a parallel groups design. Sports Med Open. 2023;9(1):102. doi:10.1186/s40798-023-00651-y
Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097. doi:10.1136/bjsports-2023-106994
Speakman JR, Hall KD. Models of body weight and fatness regulation. Philos Trans R Soc Lond B Biol Sci. 2023;378(1888):20220231. doi:10.1098/rstb.2022.0231
Vargas-Molina S, García-Palumbo A, García-Sillero M, et al. Comparison of two nutritional protocols in body re-composition of resistance-trained participants. Eur J Appl Physiol. 2026;126(7):4019-4030. doi:10.1007/s00421-026-06209-6

Our Sponsors:
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code BBM for a great deal: https://www.quince.com
* Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc

Advertising Inquiries: https://redcircle.com/brands

Muscle is where most of the glucose goes, and muscle insulin resistance is the first thing that breaks on the road to type 2 diabetes. Both of those are true, and neither one means that building more muscle is the treatment for obesity. This episode works through what actually decides whether a tissue handles fuel well: not how much of it you have, but how fast it's moving fuel through. We go through the one-legged exercise studies, the 18,000-person analysis of what body composition actually predicts, the athlete's paradox, the energy cost of building a kilogram of muscle, the GLP-1 lean mass panic, and why sarcopenic obesity is named after the wrong organ.
This is part two of a two-part series on storage capacity. Part one covered where body fat goes and what happens when the storage runs out. 
Timestamps
0:00   The one-leg study, and the muscle-centric claim
02:06   What obesity is, and the garage analogy
05:06   How glucose gets into a muscle cell
11:21   Insulin sensitivity improves without building muscle
17:11   The best case for muscle-centric medicine
21:13   What predicts falls and death: strength, not lean mass
25:18   Separating muscle size from muscle function
31:33   Liver fat: amount, type, and flux
37:54   Should you build muscle first? The arithmetic
42:37   Building muscle in a calorie deficit
50:29   GLP-1s, DXA, and the lean mass panic
58:23   Sarcopenic obesity, and why the name is wrong
01:04:37 Why size still tells you something
01:11:46 So what is obesity?

Resources:
Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/
New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs
Barbell Medicine coaching and templates: https://www.barbellmedicine.com
1.   Richter EA, Mikines KJ, Galbo H, Kiens B. Effect of exercise on insulin action in human skeletal muscle. J Appl Physiol (1985). 1989;66(2):876-885. doi:10.1152/jappl.1989.66.2.876. PMID: 2496078. https://doi.org/10.1152/jappl.1989.66.2.876

2.   Cawthon PM, Travison TG, Manini TM, et al. Establishing the link between lean mass and grip strength cut points with mobility disability and other health outcomes. J Gerontol A Biol Sci Med Sci. 2020;75(7):1317-1323. doi:10.1093/gerona/glz081. PMID: 30869772. https://doi.org/10.1093/gerona/glz081

3.   Bhasin S, Travison TG, Manini TM, et al. Sarcopenia definition: the position statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatr Soc. 2020;68(7):1410-1418. doi:10.1111/jgs.16372. PMID: 32150289. https://doi.org/10.1111/jgs.16372

4.   Elgaddal N, Kramarow EA, Reuben C. Physical activity among adults aged 18 and over: United States, 2020. NCHS Data Brief No. 443. Hyattsville, MD: National Center for Health Statistics; 2022. PMID: 36043905. https://www.cdc.gov/nchs/products/databriefs/db443.htm

5.   Whitfield GP, Carlson SA, Ussery EN, Fulton JE, Galuska DA, Petersen R. Trends in meeting physical activity guidelines among urban and rural dwelling adults, United States, 2008-2017. MMWR Morb Mortal Wkly Rep. 2019;68(23):513-518. doi:10.15585/mmwr.mm6823a1. PMID: 31194722. https://doi.org/10.15585/mmwr.mm6823a1

6.   Wang T, Wang J, Hu X, Huang XJ, Chen GX. Current understanding of glucose transporter 4 expression and functional mechanisms. World J Biol Chem. 2020;11(3):76-98. doi:10.4331/wjbc.v11.i3.76. PMID: 33274014. https://doi.org/10.4331/wjbc.v11.i3.76

7.   DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care. 2009;32(Suppl 2):S157-S163. doi:10.2337/dc09-S302. PMID: 19875544. https://doi.org/10.2337/dc09-S302

8.   Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev. 2013;93(3):993-1017. doi:10.1152/physrev.00038.2012. PMID: 23899560. https://doi.org/10.1152/physrev.00038.2012

9.   Petersen KF, Dufour S, Savage DB, et al. The role of skeletal muscle insulin resistance in the pathogenesis of the metabolic syndrome. Proc Natl Acad Sci U S A. 2007;104(31):12587-12594. doi:10.1073/pnas.0705408104. PMID: 17640906. https://doi.org/10.1073/pnas.0705408104

10. Rabøl R, Petersen KF, Dufour S, Flannery C, Shulman GI. Reversal of muscle insulin resistance with exercise reduces postprandial hepatic de novo lipogenesis in insulin resistant individuals. Proc Natl Acad Sci U S A. 2011;108(33):13705-13709. doi:10.1073/pnas.1110105108. PMID: 21808028. https://doi.org/10.1073/pnas.1110105108

11. Perseghin G, Price TB, Petersen KF, et al. Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects. N Engl J Med. 1996;335(18):1357-1362. doi:10.1056/NEJM199610313351804. PMID: 8857019. https://doi.org/10.1056/NEJM199610313351804

12. Mikines KJ, Sonne B, Farrell PA, Tronier B, Galbo H. Effect of physical exercise on sensitivity and responsiveness to insulin in humans. Am J Physiol. 1988;254(3 Pt 1):E248-E259. doi:10.1152/ajpendo.1988.254.3.E248. PMID: 3126668. https://doi.org/10.1152/ajpendo.1988.254.3.E248

13. Mikines KJ, Sonne B, Tronier B, Galbo H. Effects of acute exercise and detraining on insulin action in trained men. J Appl Physiol (1985). 1989;66(2):704-711. doi:10.1152/jappl.1989.66.2.704. PMID: 2496077. https://doi.org/10.1152/jappl.1989.66.2.704

14. Yu R, Duncombe SL, Nemoto Y, et al. Physical activity trajectories and mortality. Br J Sports Med. 2025;59(17):1228-1241. doi:10.1136/bjsports-2024-109122. PMID: 40639966. https://doi.org/10.1136/bjsports-2024-109122

15. Saint-Maurice PF, Coughlan D, Kelly SP, et al. Association of leisure-time physical activity across the adult life course with all-cause and cause-specific mortality. JAMA Netw Open. 2019;2(3):e190355. doi:10.1001/jamanetworkopen.2019.0355. PMID: 30848809. https://doi.org/10.1001/jamanetworkopen.2019.0355

16. Wang Y, Luo D, Liu J, Song Y, Jiang B, Jiang H. Low skeletal muscle mass index and all-cause mortality. PLoS One. 2023;18(6):e0286745. doi:10.1371/journal.pone.0286745. PMID: 37288745. https://doi.org/10.1371/journal.pone.0286745

17. Umpierre D, Ribeiro PAB, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes. JAMA. 2011;305(17):1790-1799. doi:10.1001/jama.2011.576. PMID: 21540423. https://doi.org/10.1001/jama.2011.576

18. Goodpaster BH, Carlson CL, Visser M, et al. Attenuation of skeletal muscle and strength in the elderly: the Health ABC Study. J Appl Physiol (1985). 2001;90(6):2157-2165. doi:10.1152/jappl.2001.90.6.2157. PMID: 11356778. https://doi.org/10.1152/jappl.2001.90.6.2157

19. Paquin J, Lagacé JC, Brochu M, Dionne IJ. Exercising for insulin sensitivity, is there a mechanistic relationship with quantitative changes in skeletal muscle mass? Front Physiol. 2021;12:656909. doi:10.3389/fphys.2021.656909. PMID: 34054574. https://doi.org/10.3389/fphys.2021.656909

20. Eriksson J, Taimela S, Eriksson K, Parviainen S, Peltonen J, Kujala U. Resistance training in the treatment of non-insulin-dependent diabetes mellitus. Int J Sports Med. 1997;18(4):242-246. doi:10.1055/s-2007-972627. PMID: 9231838. https://doi.org/10.1055/s-2007-972627

21. Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-2982. doi:10.2337/diacare.26.11.2977. PMID: 14578226. https://doi.org/10.2337/diacare.26.11.2977

22. Bucci M, Huovinen V, Guzzardi MA, et al. Resistance training improves skeletal muscle insulin sensitivity in elderly offspring of overweight and obese mothers. Diabetologia. 2016;59(1):77-86. doi:10.1007/s00125-015-3780-8. PMID: 26486356. https://doi.org/10.1007/s00125-015-3780-8

23. Mavros Y, Kay S, Anderberg KA, et al. Changes in insulin resistance and HbA1c are related to exercise-mediated changes in body composition in older adults with type 2 diabetes: interim outcomes from the GREAT2DO trial. Diabetes Care. 2013;36(8):2372-2379. doi:10.2337/dc12-2196. PMID: 23474589. https://doi.org/10.2337/dc12-2196

24. Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol (1985). 2000;89(1):81-88. doi:10.1152/jappl.2000.89.1.81. PMID: 10904038. https://doi.org/10.1152/jappl.2000.89.1.81

25. Orwoll ES, Peters KE, Hellerstein M, Cummings SR, Evans WJ, Cawthon PM. The importance of muscle versus fat mass in sarcopenic obesity: a re-evaluation using D3-creatine muscle mass versus DXA lean mass measurements. J Gerontol A Biol Sci Med Sci. 2020;75(7):1362-1368. doi:10.1093/gerona/glaa064. PMID: 32232396. https://doi.org/10.1093/gerona/glaa064

26. Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JFP, Dela F. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes. 2004;53(2):294-305. doi:10.2337/diabetes.53.2.294. PMID: 14747278. https://doi.org/10.2337/diabetes.53.2.294

27. Manca A, Dragone D, Dvir Z, Deriu F. Cross-education of muscular strength following unilateral resistance training: a meta-analysis. Eur J Appl Physiol. 2017;117(11):2335-2354. doi:10.1007/s00421-017-3720-z. PMID: 28936703. https://doi.org/10.1007/s00421-017-3720-z

28. Bilet L, Phielix E, van de Weijer T, et al. One-leg inactivity induces a reduction in mitochondrial oxidative capacity, intramyocellular lipid accumulation and reduced insulin signalling upon lipid infusion. Diabetologia. 2020;63(6):1211-1222. doi:10.1007/s00125-020-05128-1. PMID: 32185462. https://doi.org/10.1007/s00125-020-05128-1

29. Lee J, Kim D, Kim C. Resistance training for glycemic control, muscular strength, and lean body mass in old type 2 diabetic patients: a meta-analysis. Diabetes Ther. 2017;8(3):459-473. doi:10.1007/s13300-017-0258-3. PMID: 28382531. https://doi.org/10.1007/s13300-017-0258-3

30. Goodpaster BH, He J, Watkins S, Kelley DE. Skeletal muscle lipid content and insulin resistance: evidence for a paradox in endurance-trained athletes. J Clin Endocrinol Metab. 2001;86(12):5755-5761. doi:10.1210/jcem.86.12.8075. PMID: 11739435. https://doi.org/10.1210/jcem.86.12.8075

31. Amati F, Dubé JJ, Alvarez-Carnero E, et al. Skeletal muscle triglycerides, diacylglycerols, and ceramides in insulin resistance: another paradox in endurance-trained athletes? Diabetes. 2011;60(10):2588-2597. doi:10.2337/db10-1221. PMID: 21873552. https://doi.org/10.2337/db10-1221

32. Bergman BC, Perreault L, Hunerdosse DM, Koehler MC, Samek AM, Eckel RH. Increased intramuscular lipid synthesis and low saturation relate to insulin sensitivity in endurance-trained athletes. J Appl Physiol (1985). 2010;108(5):1134-1141. doi:10.1152/japplphysiol.00684.2009. PMID: 20299618. https://doi.org/10.1152/japplphysiol.00684.2009

33. Dubé JJ, Amati F, Stefanovic-Racic M, Toledo FGS, Sauers SE, Goodpaster BH. Exercise-induced alterations in intramyocellular lipids and insulin resistance: the athlete's paradox revisited. Am J Physiol Endocrinol Metab. 2008;294(5):E882-E888. doi:10.1152/ajpendo.00769.2007. PMID: 18319352. https://doi.org/10.1152/ajpendo.00769.2007

34. Dubé JJ, Amati F, Toledo FGS, et al. Effects of weight loss and exercise on insulin resistance, and intramyocellular triacylglycerol, diacylglycerol and ceramide. Diabetologia. 2011;54(5):1147-1156. doi:10.1007/s00125-011-2065-0. PMID: 21327867. https://doi.org/10.1007/s00125-011-2065-0

35. Ter Horst KW, Vatner DF, Zhang D, et al. Hepatic insulin resistance is not pathway selective in humans with nonalcoholic fatty liver disease. Cell Rep. 2017;19(10):1997-2004. doi:10.1016/j.celrep.2017.05.035. PMID: 28591572. PMCID: PMC5469939. https://doi.org/10.1016/j.celrep.2017.05.035

36. Lyu K, Zhang Y, Zhang D, et al. A membrane-bound diacylglycerol species induces PKCepsilon-mediated hepatic insulin resistance. Cell Metab. 2020;32(4):654-664.e5. doi:10.1016/j.cmet.2020.08.001. PMID: 32882164. PMCID: PMC7544641. https://doi.org/10.1016/j.cmet.2020.08.001

37. Sargeant JA, Gray LJ, Bodicoat DH, et al. The effect of exercise training on intrahepatic triglyceride and hepatic insulin sensitivity: a systematic review and meta-analysis. Obes Rev. 2018;19(10):1446-1459. doi:10.1111/obr.12719. PMID: 30092609. https://doi.org/10.1111/obr.12719

38. Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966-1986. doi:10.1097/HEP.0000000000000520. PMID: 37363821. https://doi.org/10.1097/HEP.0000000000000520

39. Stine JG, DiJoseph K, Pattison Z, et al. Exercise training is associated with treatment response in liver fat content by magnetic resonance imaging independent of clinically significant body weight loss in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Am J Gastroenterol. 2023;118(7):1204-1213. doi:10.14309/ajg.0000000000002098. PMID: 36705333. https://doi.org/10.14309/ajg.0000000000002098

40. Mucinski JM, Salvador AF, Moore MP, et al. Histological improvements following energy restriction and exercise: the role of insulin resistance in resolution of MASH. J Hepatol. 2024;81(5):781-793. doi:10.1016/j.jhep.2024.06.017. PMID: 38914313. PMCID: PMC12007730. ClinicalTrials.gov NCT03151798. https://doi.org/10.1016/j.jhep.2024.06.017

41. Nikolaidis MG, Paschalis V, Margaritelis NV. The energetic cost of building human skeletal muscle. bioRxiv. Preprint posted August 20, 2026. doi:10.64898/2026.08.17.745156. Preprint, not peer reviewed. https://doi.org/10.64898/2026.08.17.745156

42. Helms ER, Spence AJ, Sousa C, et al. Effect of small and large energy surpluses on strength, muscle, and skinfold thickness in resistance-trained individuals: a parallel groups design. Sports Med Open. 2023;9(1):102. doi:10.1186/s40798-023-00651-y. PMID: 37914977. https://doi.org/10.1186/s40798-023-00651-y

43. Murphy C, Koehler K. Energy deficiency impairs resistance training gains in lean mass but not strength: a meta-analysis and meta-regression. Scand J Med Sci Sports. 2022;32(1):125-137. doi:10.1111/sms.14075. PMID: 34623696. https://doi.org/10.1111/sms.14075

44. Elia M, Stubbs RJ, Henry CJ. Differences in fat, carbohydrate, and protein metabolism between lean and obese subjects undergoing total starvation. Obes Res. 1999;7(6):597-604. doi:10.1002/j.1550-8528.1999.tb00720.x. PMID: 10574520. https://doi.org/10.1002/j.1550-8528.1999.tb00720.x

45. Colles SL, Dixon JB, Marks P, Strauss BJ, O'Brien PE. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304-311. doi:10.1093/ajcn/84.1.304. PMID: 16895876. https://doi.org/10.1093/ajcn/84.1.304

46. Vargas-Molina S, García-Palumbo A, García-Sillero M, et al. Effects of a moderate caloric deficit on body composition in resistance-trained individuals. Eur J Appl Physiol. 2026;126(7):4019-4030. doi:10.1007/s00421-026-06209-6. PMID: 41940947. https://doi.org/10.1007/s00421-026-06209-6

47. Longland TM, Oikawa SY, Mitchell CJ, Devries MC, Phillips SM. Higher compared with lower dietary protein during an energy deficit combined with intense exercise promotes greater lean mass gain and fat mass loss: a randomized trial. Am J Clin Nutr. 2016;103(3):738-746. doi:10.3945/ajcn.115.119339. PMID: 26817506. https://doi.org/10.3945/ajcn.115.119339

48. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183. PMID: 33567185. https://doi.org/10.1056/NEJMoa2032183

49. Wilding JPH, Batterham RL, Davies M, et al. Impact of semaglutide on body composition in adults with overweight or obesity: exploratory analysis of the STEP 1 study. J Endocr Soc. 2021;5(Suppl 1):A16-A17. doi:10.1210/jendso/bvab048.030. https://doi.org/10.1210/jendso/bvab048.030

50. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038. PMID: 35658024. https://doi.org/10.1056/NEJMoa2206038

51. Look M, Dunn JP, Kushner RF, et al. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. Diabetes Obes Metab. 2025;27(5):2720-2729. doi:10.1111/dom.16275. PMID: 39996356. https://doi.org/10.1111/dom.16275

52. Wang Z, Deurenberg P, Wang W, Pietrobelli A, Baumgartner RN, Heymsfield SB. Hydration of fat-free body mass: review and critique of a classic body-composition constant. Am J Clin Nutr. 1999;69(5):833-841. doi:10.1093/ajcn/69.5.833. PMID: 10232621. https://doi.org/10.1093/ajcn/69.5.833

53. Wang ZM, Pierson RN Jr, Heymsfield SB. The five-level model: a new approach to organizing body-composition research. Am J Clin Nutr. 1992;56(1):19-28. doi:10.1093/ajcn/56.1.19. PMID: 1609756. https://doi.org/10.1093/ajcn/56.1.19

54. Wadden TA, Neiberg RH, Wing RR, et al. Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity (Silver Spring). 2011;19(10):1987-1998. doi:10.1038/oby.2011.230. PMID: 21779086. https://doi.org/10.1038/oby.2011.230

55. Fildes A, Charlton J, Rudisill C, Littlejohns P, Prevost AT, Gulliford MC. Probability of an obese person attaining normal body weight: cohort study using electronic health records. Am J Public Health. 2015;105(9):e54-e59. doi:10.2105/AJPH.2015.302773. PMID: 26180980. https://doi.org/10.2105/AJPH.2015.302773

56. Alissou M, Demangeat T, Folope V, et al. Effect of semaglutide on sarcopenic obesity. Diabetes Obes Metab. 2026;28(1):112-121. doi:10.1111/dom.70141. PMID: 41068996. https://doi.org/10.1111/dom.70141

57. Bansal MB, Patton H, Morgan TR, Carr RM, Dranoff JA, Allen AM. Semaglutide therapy for metabolic dysfunction-associated steatohepatitis: November 2025 updates to AASLD Practice Guidance. Hepatology. 2025;83(5):1326-1340. doi:10.1097/HEP.0000000000001608. PMID: 41201884. https://doi.org/10.1097/HEP.0000000000001608

58. Sardeli AV, Komatsu TR, Mori MA, Gáspari AF, Chacon-Mikahil MPT. Resistance training prevents muscle loss induced by caloric restriction in obese elderly individuals: a systematic review and meta-analysis. Nutrients. 2018;10(4):423. doi:10.3390/nu10040423. PMID: 29596307. https://doi.org/10.3390/nu10040423

59. Rosenberg IH. Summary comments. Am J Clin Nutr. 1989;50(5):1231-1233. doi:10.1093/ajcn/50.5.1231. Not indexed in PubMed. https://doi.org/10.1093/ajcn/50.5.1231

60. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127(5 Suppl):990S-991S. doi:10.1093/jn/127.5.990S. PMID: 9164280. https://doi.org/10.1093/jn/127.5.990S

61. Kirk B, Cawthon PM, Arai H, et al. The conceptual definition of sarcopenia: Delphi consensus from the Global Leadership Initiative in Sarcopenia. Age Ageing. 2024;53(3):afae052. doi:10.1093/ageing/afae052. PMID: 38520141. https://doi.org/10.1093/ageing/afae052

62. Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the Health, Aging and Body Composition Study. J Gerontol A Biol Sci Med Sci. 2006;61(10):1059-1064. doi:10.1093/gerona/61.10.1059. PMID: 17077199. https://doi.org/10.1093/gerona/61.10.1059

63. Pascual-Fernández J, Fernández-Montero A, Córdova-Martínez A, Pastor D, Martínez-Rodríguez A, Roche E. Sarcopenia: molecular pathways and potential targets for intervention. Int J Mol Sci. 2020;21(22):8844. doi:10.3390/ijms21228844. PMID: 33266508. https://doi.org/10.3390/ijms21228844

64. Kwon YN, Yoon SS. Sarcopenia: neurological point of view. J Bone Metab. 2017;24(2):83-89. doi:10.11005/jbm.2017.24.2.83. PMID: 28642851. https://doi.org/10.11005/jbm.2017.24.2.83

65. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018;14(9):513-537. doi:10.1038/s41574-018-0062-9. PMID: 30065268. https://doi.org/10.1038/s41574-018-0062-9

66. Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563. PMID: 37952131. https://doi.org/10.1056/NEJMoa2307563

67. Deanfield J, Lincoff AM, Kahn SE, et al. Impact of semaglutide on cardiovascular outcomes by adiposity measures in SELECT. Lancet. 2025;406(10516):2257-2268. doi:10.1016/S0140-6736(25)01375-3. PMID: 41138739. https://doi.org/10.1016/S0140-6736(25)01375-3

68. Perkovic V, Tuttle KR, Rossing P, et al. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. N Engl J Med. 2024;391(2):109-121. doi:10.1056/NEJMoa2403347. PMID: 38785209. https://doi.org/10.1056/NEJMoa2403347

69. Obesity Medicine Association. Definition of obesity. https://obesitymedicine.org/blog/why-is-obesity-a-disease/

70. Tomiyama AJ, Hunger JM, Nguyen-Cuu J, Wells C. Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012. Int J Obes (Lond). 2016;40(5):883-886. doi:10.1038/ijo.2016.17. PMID: 26841729. https://doi.org/10.1038/ijo.2016.17

Our Sponsors:
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code BBM for a great deal: https://www.quince.com
* Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc

Advertising Inquiries: https://redcircle.com/brands