Peter Attia MD228‒Improving body composition, female-specific training principles, & overcoming an eating disorder
CHAPTERS
- 0:02 – 4:50
Growing Up in Tasmania: Track, Lifting, and Choosing Nutrition
Holly Baxter describes growing up in Tasmania, sprinting from age eight, and moving to Melbourne to study nutrition and dietetics. She says her choice of nutrition was driven by a desire for control over food rather than pure passion for sport.
- •Grew up in Launceston, Tasmania, and moved to Melbourne for a nutrition science degree and a master's in dietetics
- •Ran sprints, long jump and triple jump from age eight to about 18
- •Began lifting weights in year 11 at the Tasmanian Institute of Sport
- •Chose academics over sport because opportunities for women in Australian sport were limited
- •Reveals she only recently overcame a 15-year eating disorder
- 4:50 – 14:57
Roots of Depression and the Eating Disorder
Holly explains how a childhood where praise came only from achievement, a strained and controlling home, and sexual trauma fed her depression and eating disorder. Peter asks about prevalence, and she describes how restriction gave way to binging and purging.
- •Praise at home came only when she excelled, so she felt worthless unless she was the best
- •She experienced sexual trauma around age 15 and received blaming responses at home
- •Early therapy and medication were ineffective, and the medication made things worse
- •Restriction was unsustainable given her heavy training and became daily binge-purge behavior for about five years
- •She hid the disorder out of shame for roughly 10 years
- 14:57 – 24:25
Body Image, Control, and Her Family's Response
Holly describes appearing a normal, healthy weight despite the disorder. She recounts the aftermath of her suicide attempt and explains that the disorder began as a need for control and only later became about physique and self-worth.
- •She sat in the middle of the weight spectrum, so no one suspected a problem
- •Her father's reaction to her suicide attempt was harsh, while her mother was overbearing
- •Moving away from Tasmania gave her independence and life skills
- •The disorder began as control, and external praise for her physique later turned it into an obsession with appearance
- 24:25 – 34:38
Breaking Point: Burnout, Rehab, and Starting Therapy
Holly describes how her disorder cycled through waves of control and collapse. At about 25 she hit burnout and anxiety, which led her to therapy and a seven-day rehab. The rehab was short but showed her the value of openness, and she has been in weekly therapy since 2016.
- •Binge eating after strict restriction, fast eating and secret eating persisted into adulthood
- •At about 25, running a new business, anxiety left her unable to open her laptop
- •She admitted herself to a seven-day rehab and felt suicidal thoughts again
- •The rehab did not cure her but introduced relaxation, meditation and open communication
- •Weekly therapy since 2016 helped her reflect on her past and deconstruct dysfunctional beliefs
- 34:38 – 43:58
Recovery Is Non-Linear: Faith, Commitment, and Accepting Weight Gain
Peter reflects that Holly's improvement was gradual and that recovery is ongoing, and Holly agrees that no one fully recovers. She describes deciding to stop purging, finding purpose through church, and sitting with weight gain to about 75 kilos.
- •Peter notes progress was slow and non-linear, and compares it to managing addiction
- •A bathroom-floor moment during contest prep led her to commit to stopping purging
- •Without purging or compensatory exercise, she had to eat mindfully and listen to her body
- •Self-compassion helped, including treating herself as she would a client
- •Going to church gave her a sense of purpose and she says she has never been happier
- 43:58 – 52:56
Bodybuilding After an Eating Disorder and Its Toll on Women
Peter raises the apparent contradiction of pursuing drug-free bodybuilding after an eating disorder. Holly discusses her earlier belief that she had to be lean, the body fat levels of competitors, the loss of her period, and what she would tell her younger self.
- •She says she believed for 10 years that she needed to be lean to be taken seriously as a coach
- •Figure competitors reach about 10% body fat, and she reaches 10 to 11% in fitness
- •She went about five years without a period, and about half her competitors lose theirs
- •Both speakers note this is an evolutionary signal of low energy availability
- •She says working on mental health and one's 'why' matters for anyone entering the sport
- 52:56 – 1:05:05
Setting Physique Goals and Realistic Muscle Gain for Women
Peter sets up a walkthrough of a build, cut and recovery, and Holly explains how she clarifies client goals. They discuss the myth of getting bulky by accident, expected rates of lean mass gain, and Holly's own six-kilogram gain with its volume and time demands.
- •Most clients are general population and the process is the same as for pros, differing only in degree
- •Women fear getting bulky, but a physique like hers takes years of consistency and is not accidental
- •Holly maps goals using scale weight, DEXA and photos
- •Natural athletes gain just under a kilogram of fat-free mass per eight weeks
- •She gained about 6 kg of lean tissue with body fat rising from 12% to 19%, training up to 2.5 hours, five days a week
- 1:05:05 – 1:17:31
Training Intensity (RPE/RIR) and Programming Principles
Holly explains RPE and RIR and how powerlifting taught her training intensity. She describes her build-phase split of four lower-body days and one upper-body day, then how she would start a newer client with very low volume and short sessions.
- •RPE measures perceived exertion and RIR counts repetitions left in reserve
- •Powerlifting taught her true strength and how to select weights
- •Her build prioritized glute and shoulder hypertrophy with lower-body-heavy sessions
- •A newer client would start with about one working set per exercise and sessions of 30 to 40 minutes at RPE 6 to 7
- •Mesocycles run four to six weeks, with variety and adherence as priorities
- 1:17:31 – 1:36:32
Lower Body Training: Squats, Deadlifts, and Muscle-Specific Exercises
Holly walks through her lower-body approach: squat and deadlift variations tailored to anatomy, set counts per muscle group, and favorite glute, quad, hamstring and calf exercises. She also covers the Anderson squat for building confidence and why she rarely programs arms for women.
- •Squat and deadlift variations such as low bar and sumo are chosen based on limb and spine proportions
- •The Anderson squat from the catch bars helps build confidence
- •Compound lifts come first and the target is 10 to 15 sets per muscle group, rising to 30 per week for advanced lifters
- •Glute exercises include hip thrusts, step-ups and abduction work, with step-ups showing comparable glute activation in a review she cited
- •Seated hamstring curls, RDLs, and forward knee travel in the leg press or Smith squat are favorites
- 1:36:32 – 1:47:21
Upper Body Training: Back, Shoulders, and Pull-Ups
Holly explains that women's programs usually emphasize back and shoulders over chest and arms, tailored to posture and aesthetic goals. She describes progressing to pull-ups, rest between sets, and her shoulder exercises.
- •Chest and arm volume is lower for women, and posture can call for more back and less chest
- •Lat work such as wide-grip pulldowns and pull-ups creates the illusion of a smaller waist
- •Holly built from banded pull-ups to 20 bodyweight reps over about five years
- •She rests until her heart rate drops below 100 bpm, sometimes five minutes between sets
- •Shoulder favorites include scrape-the-rack presses, lateral raises and rear delt work, and she hasn't done direct arm work in 12 months
- 1:47:21 – 1:54:37
Nutrition in the Build: Protein and Calorie Surplus
Holly says diet accounts for about half of the outcome of a build. She gives protein targets and explains why a modest surplus is best, noting that women are the hardest group to encourage to gain body fat.
- •Protein targets of 1.8 to 3 g per kg of lean body mass are the same for men and women
- •Consistency in protein matters because of its thermic effect and its effect on energy balance
- •Overfeeding studies show the best muscle gain at about a 20% surplus, with more just adding fat
- •Holly often prescribes about 10% above maintenance because most women won't adhere to 20%
- •Clients with higher body fat may need little or no surplus
- 1:54:37 – 2:02:36
Fat Loss Phase: Rate of Loss, Tracking, and Expectations
Holly explains that training stays largely the same during a cut and that the weekly rate of loss should not exceed about 1.5% of body weight to limit metabolic adaptation and muscle loss. They discuss calculating deficits, weighing food as a skill, and how visible a five-and-five change really is.
- •Training changes little when dieting begins
- •Weekly weight loss should be capped at about 1.5% of body weight to protect muscle and metabolic rate
- •A calculation from her books estimates the deficit needed for a target rate of loss
- •Weighing food for a period builds a lifelong estimation skill
- •A five-pound recomposition is realistic but may not look dramatic, and multiple diet cycles may be needed
- 2:02:36 – 2:08:53
Reverse Dieting After a Cut
Peter asks how to recover from a diet without undoing progress. Holly explains why people regain weight, including lost muscle, a lower metabolic rate and hyperphagia, and describes finding new maintenance calories and adding calories slowly.
- •People usually lose weight easily but struggle to keep it off, often after extreme diets
- •Post-diet hormonal changes cause hyperphagia, an excessive urge to eat
- •Reverse dieting starts by finding new maintenance calories from the final weeks' weight loss
- •Maintenance may be lower than before the build because some muscle is lost in a cut
- •Calories rise in small weekly increments while weight is monitored, which can feel like dieting without visible reward
- 2:08:53 – 2:23:34
Female-Specific Training: Muscle Fibers, Menstrual Cycle, Menopause, and Motherhood
Holly covers sex differences such as more type one fibers and rep range tendencies, mixed findings on the menstrual cycle, and her default of scheduling deloads around it. They also discuss menopause and hormone replacement, and how having children changes time and expectations.
- •Women have a greater proportion of type one fibers, fatigue less and use fatty acids well, so they often tolerate moderate-to-higher rep ranges
- •Fasted versus fed training preference is subjective, and Holly trains fasted because of IBS
- •Menstrual cycle studies are about 50/50, so she defaults to setting deloads around the cycle
- •Menopausal women not on hormone therapy often show low intake, high exercise and frustration, while those treated feel better with more energy
- •Mothers of several kids have less time, so goals take longer and expectations must be managed
- 2:23:34 – 2:32:06
Holly's Future: Advocacy, Longevity, and Bone Health
Holly says she feels pulled to stay in the industry as an advocate but no longer desires extreme leanness, and she is considering a PhD in mental health and eating disorders. She and Peter close on longevity, muscle and bone density over scale weight, and unfollowing aesthetic-focused social media.
- •She wants to advocate for people suffering in silence and shows that competing without an eating disorder is possible
- •She is considering a PhD in neuropsychology or eating disorders
- •Her focus is longevity, functional fitness and lifelong lifting
- •Peter says muscle mass and bone density matter more than scale weight, especially for women
- •She unfollowed aesthetic-focused social media and spends her time on personal growth
