"Movement offers us pleasure, identity, belonging, and hope."
Identity? What identity? "I can move my legs, that means I am A Leg-Moving Person"?
Sorry, but this is where the exercise evangelists get ridiculous. If I were to be confined to a wheelchair tomorrow, I *might* construct a new identity around being disabled or a wheelchair user (I don't think I would, but I might). However, I am positive I would never construct an identity around being a runner, and if someone feels that the most important thing in their life is that they are a runner - well, you do you, but heck.
Honestly, your McGonigal person sounds like all the dopeheads on here urging "LSD, man, psychedelics, will give you a cosmic experience and fix all your mental problems with a reset!" Maybe the exercise high people and the psychedelic high people should get together and get mutually baked before running a marathon, then they could both disappear up their own crown chakras about the cosmic best and highest human spirit coming out, maaaaaan.
What makes you think we don't exercise? I've exercised for a minimum of an hour a day, seven days a week, since elementary school. Usually I get more exercise than that. I'm past middle age now. It never made a dent in my weight. This is the kind of mean-spirited assumption that fat people have to fight all the time.
Exercise doesn't shift weight, unless (as has been mentioned) you are preparing for an expedition to the Antarctic or triathlons or the Tour de France.
What exercise will do is tone up muscles (I did find that the flabby underarms tightened up) and help with endurance (being able to walk distances without getting winded). But you can be fairly fit (able to do everyday tasks as normal) and still fat, even very fat.
I think the "diet and exercise" mantra comes from treating people who only have a few pounds excess to shift; the exercise will tone muscles and burn off some extra calories, and that in combination with restricting calories to below normal metabolism maintenance will shift enough weight/fat so that you do 'go down a dress size' or whatever.
But for seriously overweight people, it won't work like that. And exercise *alone* definitely won't work, because it makes you hungry so you eat to compensate.
No, this isn’t related to phentermine. It’s not any kind of stimulant. It works by making you think you are full and not hungry any more. Source: my better half takes one of the versions for diabetics.
Sorry, I thought I read somewhere that Wegovy is actually phentermine, but on further reading it seems you are correct. It is just a different weight loss medication. And has less long term results and perhaps more side effects.
There are shady weight loss clinics that prescribe and dispense "all natural weight loss supplements" that are actually phentermine. (Getting customers hooked on stimulants is a great way to ensure repeat business!) I wouldn’t be surprised if some of them latched on to the semaglutide hype and started pretending to offer that.
I dunno, I don't find that toooo shady — I'd be pleased to get something that actually works, if anything!
And stimulants mostly aren't physically addictive, so "getting hooked" on them because you took some for weight loss and really liked them sounds like complaining that Krispy Kreme got you hooked on food because you really like eating donuts, it seems to me...
Edit: Well, marketing it as "all-natural" *would* be shady — forgot about that part, sorry!
("All-natural" is a stupid term to base purchasing decisions on, though, for many different reasons... so I can't get too worked up about it, heh.)
Phentermine is fantastic for weight loss. There have been 3 studies to determine whether it's addictive, and all 3 concluded it is not. I took it myself for 2 years before the new, stricter, more-fascist rules saying you have to have a BMI of 30 to get it went into place.
Standard dose is 15-30mg / day. I was using 38mg tabs, and found it effective at 19mg/week, as taking 19mg on a single day enabled me to fast for that entire day.
I believe the medical community is so down on phentermine now for religious, not scientific reasons. Doctors really don't like it when a person can just take a pill instead of exercising. It feels like sin to them.
Phentermine is actually a controlled prescription medication under the same rules and regulations as ADD medications and pain medication. Phentermine is only available by prescription. There are supplements that weight loss specialists use but there is no reason to try to "hook patients" on a medication. Patients actually seek out Phentermine and try to rely on it versus actually changing their diets. Phentermine is highly controlled and should be in a prescription bottle from a pharmacy or a dispensing medical office.
All of the studies on the addictivity of phentermine that I have seen, concluded it is not addictive. I challenge you to find any experimental evidence that it's habit-forming. I took it myself for 2 years, and had no problem on being forced by new regulations to discontinue it suddenly, other than getting fatter as a result.
You said, “I have a pretty minimal insurance and it looks like if I got semaglutide my copay would be about $500/month until I reach my deductible.” I think you mean out of pocket limit, not deductible, though maybe your plan is odd. Usually, you get zero benefit until you hit the deductible.
I tried semaglutide and it did nothing to slow rate of weight gain, just produced stomach upset, going up to 2.4mg injectable. I know one other person trying semaglutide and they reported something similar. I wonder if they played some clever games with their choice of patients. My expectation of how the news goes here is a whole lot of people who try semaglutide, maybe after fighting really hard to get on it, and find that it does nothing. That said, I know at least one friend of a friend, if not a friend per se, who claims that semaglutide was their miracle drug. So maybe still worth that hard fight, even if I'm guessing that the real proportion who get nothing out of it will prove to be over 50% in real populations.
Further fun fact: Semaglutide comes heavily recommended with diet and exercise and many stern injunctions about that! The actual insert sheet includes a graph for how much weight people lose with and without "lifestyle interventions" added. The two graphs are roughly the same.
I hate to be that guy, but I do find all these debates about extremely expensive weight loss cures (Matt Yglesias has a recent article about getting [I forget which] surgery) kind of annoying, where there are literally money-saving ways to lose weight - and more importantly than that, improve your metabolic health (where obesity is a potential symptom).
"semaglutide comes heavily recommended with diet and exercise and many stern injunctions about that!"
I wonder what effect that heavily recommending things that cause weight loss alongside your weight loss drug does.... I also wonder "what" diet and exercise is being recommended, when there is so much (conventional wisdom) diet and exercise advice that will definitely not make you lose weight, or worse, make losing weight so unenjoyable that you don't want to do it.
Yes, and that's why just waving the magic totem labeled "do diet and exercise" doesn't work. Exercise done right doesn't make you lose weight, but you should still do it. Diet can, but most diet advice doesn't work, or works, but is too difficult to stick to - giving an out to the Puritans who lecture people for being insufficiently pious. And remember "work" isn't defined as "lose weight" it is "be healthier and less likely to have the bad health outcomes that are currently correlated with being overweight"
Yeah, my first year Behavioural Psych teacher had a great point when he said imagine a problem in the world (I picked AIDS). Then imagine a behavioural change that would 'cure' it. This idea was revitalised with Scot's post along the lines of technology is possible biology (behaviour change) is not (immutable).
>The same can be said about pregnancy and STDs ("Just don't have sex")
Terrible analogy. Not having sex works 100% (alright let's say 99.999% to account for urban legend-tier accidents) for STDs and pregnancy. It's not a problem of effectiveness, it's a problem of "people don't use it". If a medicine cures a disease, it's not a failure when people who decided to not take the medicine suffer from the disease.
"People don't use it" is very close to "the cure is more unpleasant than the disease", which is a failure of the cure.
Amputating one's hands is 100% effective against carpal tunnel syndrome, both as a cure and for prevention, but I wouldn't say it's not a failure of that treatment that people choose not to do it.
"eat less stuff" is a gold star way to lose weight except that people suck ass at it. I have succeeded in the past, but put back on 20 pounds from my ideal body and am failing currently; it's pretty damn hard. I don't know if that's what you mean by money-saving way to lose weight, but if it is then I think it's an incomplete solution--eat less stuff needs a very firm "how," and that seems to vary person-to-person
Why eating less is so difficult and why losing weight at all by any method is so difficult are questions at the very edges of current neuro- and metabolic research. Most of what we tell the obese is unhelpful.
The real reason it's so difficult is that eating too much has simply become too convenient, whereas not doing so apparently doesn't come natural for many people.
I can see it in my wife: when she had the mental strength to account for everything she ate, counting calories and adjusting her diet to get enough protein, she easily lost weight at exactly the expected rate. As soon as she stopped doing that she started to eat too much calories with too little nutritional value again, as those meals are way more convenient to make, more tastier for her and immediately rewarding for the brain (but don't actually make the hunger go away for long). Despite her noticing how a protein rich diet made her feel full for far longer, allowing her to eat only two meals a day easily, she can't maintain such a diet without dedicating substantial mental strength to it; and she can't properly limit her calories with a more convenient diet either.
The difference between her and me is that she absolutely can't tolerate hunger, like at all. Not eating breakfast when starting early into the day to achieve something is simply not an option for her. Neither is skipping meals when eating her usual diet.
I on the other hand would rather sleep in another 15 minutes than to get up early to find the time to eat something. I can easily skip two meals out of three without any issues for days. I feel hunger sometimes, but I can just ignore it for an hour or two, and then it goes away. For me its absolutely no issue to maintain a BMI of 22-23 without ever stepping on a scale, counting calories or diet adjustment. I just stop eating when it's too much. I also don't stuff in left-overs for the sake of finishing them, which makes my wife mad regularly. She just can't get off the idea that this means wasting food.
A drug that would make the feeling of hunger go away would certainly help. But the real message is: convenient diets are unhealthy. We should have more healthy food options which are convenient to consume. If eating healthy requires extra effort, a lot of people will fail to do so ...
And all of that is without even considering people who simply have to eat whatever is the cheapest option available ...
Sorry, but I'm a little miffed here. "Convenient diets are too easy" is certainly a contributing factor, but the rest of your comment reads like someone lecturing a person suffering from chronic pain.
"Well, *I* don't get sensations like my bones are splintering and turning into knives cutting my flesh, so an occasional aspirin handles things for me just fine! Why do *you* need strong pain-killers? Modern pharmaceuticals have made things way too convenient!"
You say you don't get hungry and can easily skip meals without noticing, or ignore any hunger you do feel. Yes, that means it's easier for you not to eat and to stay at a 'normal' weight.
Try imagining you *do* feel hungry. Not even that - do you get thirsty? Do you drink plenty of fluids during the day? Can you easily ignore being thirsty? The next time you are thirsty, try "no you can't have something to drink right now, you had a glass of water this morning, you have to wait a minimum of four hours before you can have your next glass - and only one!" and see how you hold out.
This is probably not how you intended it to sound, but your comment comes off as "my wife is so over-sensitive and has no grit, she can't handle a little bit of pain/hunger, she just needs to toughen up - me, I could have my hand chopped off and not even notice, *that's* normal!" - see what I mean about the comparison to chronic pain?
You took my post in exactly the opposite way it was meant. I'm not saying that anyone would be at fault in the way you construed it. Quite the opposite. I was saying that the individual experience of hunger was very different; as is btw. the individual experience of pain.
This makes it extremely difficult for my wife to maintain her weight while consuming exactly the same kind of diet which I eat. Where she needs willpower not to eat something, I just need lazyness to prepare food. While she had to adjust her diet to lose weight to a high protein one, I can live as a skinny fat on a low protein diet just fine without any effort (and then still suffer from much of the issues such a bad diet entails). None of this is my achievement or her failure. It's just a simple fact.
I'm sorry if it came off differently. But I feel as if you were reading my comment almost in bad faith here. How would it even be my wife's fault that she experiences hunger far more severely than I do? And how would it be an achievement of mine that my body reacts far more charitably to not getting any food for an extended period of time? Neither of us chose our bodies or our body experiences. And nowhere did I blame her for her way of experiencing it.
I then proceeded to say that the reason this difference leads to that much obesity is that high calorie diets with low nutritional value are much easier to purchase and consume nowadays than diets which are well balanced. My wife, when trying to lose weight, had to go to great lengths to get all the nutrients she needed, while going cal negative for an extended period of time. IMO this is something we as a society could and should address.
Here again I'm under the impression that you are reading my comment in bad faith, as your example with pain killers works exactly the opposite to what I said. So your comparison doesn't even make sense and IMO only serves to discredit my thought.
And to answer your similar bad faith attempt at thirst: yes, I also experience thirst way less severely than my wife. Again: this isn't her fault or my achievement, it's just a plain fact.
Btw.: I am a chronic pain patient, having shattered my left hip a few years ago. I don't have a single day in my life without pain. And I don't use any medication for it (though I had doctors call me out for it, claiming stupidly that no one should ever need to experience any pain at all). Yet I never told anyone that therefor they shouldn't need any either. That would be simply plain stupid. I did need quite a lot of those the day I shattered my hip ...
I sort of get the convenience complaint, but sort of don’t. I think it is mostly just about the raw hedons. A cucumber is pretty good and super convenient, and you can just eat it like an apple.
But people will make a sandwich or cook something in the microwave instead because that food simply tastes better.
I just don’t think convenience is as much of an issue compared to accessibility and the overlap between caloric density and tastiness. Sugar tastes great.
Maybe I phrased it wrong, but I was trying to convey the convenience of foods actually filling you such that you no longer have any cravings.
My wife eats lots of cucumber btw. ;-), but I wouldn't call them a meal. I could eat ten of them and still be hungry. They might help with alleviating thirst though ;-)
I'd consider accessibility the main part of the convenience btw. A major issue, while trying to lose some weight, for my wife was finding something suitable to eat when not eating at home and not having brought our own food along.
Your wife's (and yours!) experience is totally normal. Most people cannot (and shouldn't) abide hunger, and that is a huge part of why normal "eat 20% less calories" diets don't work, even for people (like her) who have the capacity to measure it. Eating 20% less at 3 meals is also far more difficult (and will result in those leftovers) than eating less in discrete chunks by eliminating meals. Obesity (or lack of it) does not come from
But yeah, if you feel HUNGRY, a "diet" isn't gonna work, period. No one can manage long term hunger in a world that has so many easy things to eat.
Not to be internet nutritionist, but the the thing that everyone I've spoken to has worked (for varying quantities of "worked") for is adding replacing carbs with fat/protein (eat as much as you want for dinner, earlier is better) and then just extending the time period until you eat next (breakfast, or lunch, or later lunch, etc...) til whenever you feel hungry. If you feel "kinda" hungry, drink a zero-cal electrolyte drink first and then check if you still wanna eat a meal. Measuring whether you ate 1741 calories or 1787 calories is impossible.
And also, I just want to reiterate: obesity is a symptom of underlying nutritional condition, not a disease. Some people who have it are fat, some are not. It has bad effects even if you aren't fat. Semiglutides (being diabetes treatments) may somewhat treat the underlying thing (I don't know for sure) but if you adopt a diet that you enjoy, and your A1c and other metabolic indicators get better, you are HEALTHIER, and much lower risk for a long laundry list of bad outcomes even if you don't lose any weight, or never had much fat in the first place. Depending on *what/when* you eat, you (with your low BMI) might have less healthy A1c/etc... than your wife, with the potential bad outcomes. This entire thread is far too focused on treating the symptom of obesity and pretending that if we removed that, we'd fix the problem. (it is possible that semiglutides DO partially treat the underlying problem) There are too many skinny 60 year olds who die of things and we go "so sad, what bad luck, they were so healthy!" but if they were fat we'd go "oh man, if only he'd kept in shape" but they died of the same thing for the same reasons.
Well, those diets actually do work. Physics can't be cheated. That's a big part of the problem. Because it puts so much guilt onto people to whom it doesn't come naturally. The problem is that hardly anyone can put up with them for long enough to get into another mindset, where those changes suddenly come naturally.
Btw.: my wife never felt hungry during her time of losing weight, simply because she did ensure to always consume enough protein. The problem is that most foods which are easily available don't come with enough protein to do that. Just eating less doesn't cut it most of the time, as your diet then quickly become protein deficient. You have to adjust your food items a lot to do it. And then convenience goes out the window. That's what made my wife fail eventually as well after nearly making it into perfect BMI territory.
As for "Some people who have it are fat, some are not.": that's exactly what the term skinny fat refers to.
Just for the record: I never pressured my wife into doing any of this and love her just the way she is. I'm merely trying to recount her experience when she tried a few yours ago.
This seems an extremely weakminded and degenerate statement to make. Hunger is a natural and healthy state we evolved to cope with. Certainly you SHOULD abide hunger if you are an unhealthy weight
What about, like, peanuts, though? Peanuts are convenient, nutritious, and filling, but eating lots and lots of peanuts isn't very palatable. I don't think we can blame this on convenience, except insofar as convenience is one of several competing, difficult things we're trying to simultaneously optimize for.
Well, good point. What about peanuts? Answer: they are one nutrient, not a meal, and thus lack lots of crucial trace elements. To add insult to injury, opposed to what you said, they aren't convenient at all. Not only don't they solve the issue at hand, but additionally where I live they aren't really readily available. I can easily get french fries, burgers and various other fast food meals on the go. I've never seen peanuts on offer (for obvious reasons). I could go into a super market and buy some; but then again I still wouldn't have a meal, and rather just one ingredient for a meal.
That's the exact opposite of convenient. Rather hard to come by and still lacking all but one ingredients for a meal I still would have to prepare. As opposed to just ordering the Pizza, wait 5 minutes, eat ...
Nuts are kind of weird. I don't know if other people experience this, but when I get a sudden pang of hunger my body completely rejects my suggestions that we eat some nuts. I'll be super hungry, staring into my cupboard, and that bag of peanuts will be completely unpalatable to me. This is in spite of the fact that I love nuts as a snack.
It think it's something where my body doesn't want to deal with a hard and dense fatty food on an empty stomach. Combined with the fact that nuts are quite slow to affect my blood sugar.
In general I think something with starch and fiber is the best remedy when I get that kind of sudden hunger.
I've had a lot more luck with "eat normal portion sizes with fewer calories, and track what you eat." It took me from BMI obese to BMI normal and has kept me there.
Portion control went so disastrously wrong that I'm skeptical of it as dietary advice. It doesn't seem supported by a lot of evidence, either (e.g. https://www.nature.com/articles/ijo201482#Sec11).
Can you elaborate on the distinction you're drawing here? You said you succeeded with a strategy that sounds to me a lot like "portion control", but then say portion control went disastrously wrong?
If the food you eat is smaller in mass, it will make you psychologically feel starved and physiologically feel unfull. Your brain will interpret this as 'you are going through a famine' and flip switches that make you value finding food more, because that was the appropriate response to a famine in the environment our ancestors lived in for millions of years.
If the food is bulky but has few calories, like potatoes, this makes the body and mind feel like you have plenty to eat, even when you are burning fat to sustain yourself.
> To go with the biscuit, sailors in the RN were issued other food on a standard weekly rotation. On Sunday and Thursday, this was a pound of salt pork and a half-pint of dried peas. Monday was a pint of oatmeal, two ounces of butter, and four of cheese. This was also served on Wednesday and Friday, along with a half-pint of peas. Finally, Tuesday and Saturday usually meant 2 pounds of salt beef. Conventionally, this was washed down with a daily gallon of beer. The total came to approximately 5,000 calories a day, an incredible amount to modern eyes but quite appropriate for sailors at the time.
For comparison, 3000kcal/day is about my current maintenance (180cm 72kg male). And I am _definitely_ way less active (and less muscular) than a sailor or soldier in history (1-2 hours of mostly anaerobic exercise every day).
I think you're right, and the "diet" suggestions tend to be "just eat 10/20% less calories during the day" which isn't gonna work: people don't suck ass at it because they have low discipline, but because it's enormously difficult to measure calories in this scenario, and your behavior/brain/metabolism compensate it. It's not a single-input mechanism black box. Your 20 off, 20 on experience is the absolutely normal failure mode for calorie restriction diets.
Not to be the Weirdo Diet person , but what I mean is: intermittent fasting, cutting out breakfast (and/or lunch) and replacing enough of your daily quick-burn carbs with long-burn fat so you don't feel very hungry while you're doing it. This works because unlike calorie restriction, it doesn't cut against daily Regular American Life behavior (you "fast" every night from after dinner until break-fast, this is just a few more hours) and all the countervailing mechanisms your body has evolved over a billion years to counter generalized calorie restriction.
I don't eat breakfast. I've never felt hungry in the mornings, and when I do eat then, it (ironically) makes me *hungrier*, e.g. at around 11 o'clock I feel like I need a quick snack, whereas without eating breakfast I don't feel that and can even go without lunch.
So all the well-intentioned advice about "skip meals" or "don't skip meals" or "eat more protein" or "eat saturated - I mean unsaturated - I mean polyunsaturated, not monounsaturated - I mean saturated fats" or "just cut out the junk and move more, what's so hard about that?" becomes frustrating.
Human biology is not like a tidy physics experiment. It *should* be "calories in, calories out". It *is* "calories in, calories out* but that is *not* the whole of it, and that is what gets forgotten.
Some people will react beautifully to "I fast X hours a day from this time at night to that time the next morning between meals" but some people will not. Some people will control hunger cravings by eating breakfast, other people will have their appetite stimulated. Some people will tolerate more fat in the diet than others. Potato diet works for one person, packs the pounds on for another.
I think you are right within the realm of the recommendations you are describing, because they're so vague/contradictory. I'm not advocating any of the advice you're mentioning, which you are rightly skeptical about them applying to everyone. Calories in, calories out doesn't "work", as a METHOD of dieting, not as a thermodynamic fact.
But is there any debate at all that replacing carbs with fat/protein in a meal will not result in greater satiety/less hunger later on, and therefore enable one to go longer before their next meal? I think everyone agrees on that, and that it applies to everyone - sure, perhaps in different ways/amounts!
Does it seem acceptable that if you go longer between meals, that your body will spend more time burning energy than storing it? Sort of by definition?
Does it seem acceptable that this would then (regardless of totally weekly calorie consumption) result in storing less energy (fat)?
And again, the goal should not be "weight loss" it should be "reducing the unhealthy outcomes", the likelihood of which can be more accurately measured by metabolic lab values like A1c than at the scale.
If you're someone who's had a good BMI forever and doesn't get their labs done, then you're never gonna notice anything because you aren't measuring anything.
"But is there any debate at all that replacing carbs with fat/protein in a meal will not result in greater satiety/less hunger later on, and therefore enable one to go longer before their next meal?I think everyone agrees on that, and that it applies to everyone - sure, perhaps in different ways/amounts!"
No, not everyone agrees, and it does not apply to everyone. It absolutely does not work for me; restricting carbs triggers middle-of-the-night half-asleep binge eating.
(I'm not normally a binge eater at all; I've only ever had this problem when I've restricted either carbs or eating in the evening.)
"counting calories of every thing one eats, to the gram" is not extremely hard. i know so because I'm doing it, and i do not ever do anything remotely hard.
To do so accurately is hard, because even if you're measuring the weight, you're relying on estimates of calorie density that are potentially many years out of date, wrong in the first place, or that the producer of the food is wrong is assessing.
And ok, that it is easy for you is fine - for millions of other people, it would be A) hard B) sufficiently time-consuming they wouldn't want to do it or C) would result in no measurable effect on their health/weight, so they would stop doing it. Maybe "hard" was the wrong term to use.
The approach you are describing sounds reasonable, but, as with most weight loss approaches, there are a lot of things that will make it hard for people to stick with over the long run:
(1)It is hard to change ones habits, including one's eating habits -- not impossible, of course, but HARD. The effort and attention devoted to that have to come out of the same pot of energy people are using to do all the other hard things in their lives -- do a good job parenting their difficult kid, produce good work in their field, keep their marriage in good shape, budget, ruminate about all the bad stuff in the news. On days when the energy pot's almost empty, most reasonable people are going to choose to reduce their effort to eat in a different way, rather than their effort in other areas which are more clearly crucial
(2) It is a heavy burden to stay continuously aware of something. Take blinking -- if I ask you now to notice your blinks, it's easy as pie, right? But how about if I ask you to stay aware of them continuously for the rest of the day? Very very few could succeed at that, especially while doing all the stuff they need to get done today, and responding to whatever comes at them this evening. Continuously monitoring eating to keep it in compliance with a certain pattern is the same -- easy in the short term, very hard in the longer term.
(3) We are surrounded by highly palatable foods, and our brains are not wired for an environment with that feature. We evolved in settings where it was hard to get enough calories. If you found a honeycomb or were presented with a bunch of roasted animal fat it was desirable to eat as much of that stuff as possible. The parts of our brain that push us to eat the sweet, fatty, salty stuff that is all around us is quite powerful, and the part that understands that it's undesirable to gorge on those things on 2022 cannot reason with the parts that want to gorge. It is possible to simply override them, but it is difficult, and it's probably not possible to override them most of the time if you have other heavy demands on you as well.
1) the goal is not weight loss. That is a side effect. The goal is a healthy diet, and reduction of serious bad outcomes in the future.
2) Yes it is hard to change habits. That's why the method is designed to affect the underlying drives that cause the habits to be hard to change. It IS hard to not eat when you are hungry. It is EASIER to not eat when you have made decisions in the past that mean you are less hungry now. Eating more fat and protein in your past makes you less hungry now.
3) There are immensely palatable foods that are not bad for you, and will provide more satiety so you are not driven to consume more so soon. Animal fat is not (particularly) bad for you. Salt is not bad for you. Replace carbs with them in your meal, eat them, and enjoy not feeling hungry so soon. The goal isn't to override your desire to eat awesome tasty food, it's to hack the system so you eat awesome tasty food that reduces your desire to need to eat ANY food for longer.
This is not a moral system. There are not desires to be overcome. There is not decadence to resist. This is not ascetism. There is no willpower. This is a physical system of chemical reactions that we can affect in different ways. We impute no moral significance to a molecule binding to one molecule instead of another, nor should we.
I do think content is certainly as important as portions, if one wants to control obesity. The national health system is pretty good about listing contents on food products. We respond to heat, salt, and sugar, and food manufacturers exploit that. I think if one adheres to a healthy, lean diet, obesity is easier to control. Another important aspect is the consumption of alcohol. Alcohol can provide energy and calories, but can maintain too much weight in an unhealthy body.
I used to be borderline obese when I drank beer or wine, but I lost 75 lbs. when I came down with pancreatitis. Today, after the most recent flare-up, I'm down to 114 lbs. -- but still 6 feet tall. For a time I thought marijuana might help ease the pain, but now my body objects when I try and ingest it, so I've given that up, too. There are certainly no easy answers, but I think the content of one's diet and the consumption of alcohol are important factors. My stomach emptied with this most recent flare-up, which is unusual, so I'm taking the opportunity to curate what I ingest carefully. I'm drinking kefir and Gatorade.
In this case, the problem with “that guy” is not that he’s stating an uncomfortable truth; the problem is that he’s missing the point.
If you think that we should downplay pharma/surgical interventions because dieting and exercise “work,” it is incumbent upon you to show how we will overcome the fact that people don’t seem to have the willpower required to use these tools longterm. What’s your plan?
Willpower is a choice. In this study alone https://www.cuimc.columbia.edu/news/new-weight-loss-drug-approved-fda-it-right-you, 5% of participants on placebo lost 15% or more of their body weight. The average placebo loss was 2.4%. Granted both of these are hugely less than the treatment group, but they're also hugely less expensive. This is the case in every weight-loss placebo study I'm aware of, just the simple act of taking a pill (sub vitamin or other "healthy" pill they believe could affect weight for placebo in non-lab use) or putting an ab roller in the living room, or anything else that moves diet and exercise slightly closer to the forefront of mind than it was previously can have a significant effect. According to the paper, the lower end fda approved weight loss drugs cause a 4% weight loss, so assuming equal treatment time periods, placebo is 60% as effective on average as some drugs, at 0% of the cost. People are all different, they just need to figure out what best triggers that effect for them, whether it's my examples above (variations of which work for me) or something else.
"just the simple act of taking a pill (sub vitamin or other "healthy" pill they believe could affect weight for placebo in non-lab use) or putting an ab roller in the living room, or anything else that moves diet and exercise slightly closer to the forefront of mind than it was previously can have a significant effect"
Whether you're talking to me or not, the solution is to reduce the thing that is calling on their willpower. It does not take much willpower to not eat if you are not hungry. You achieve being not hungry by increasing the satiety of the food you ate most recently. Food that does that is that which has more fat and protein, and less carbs.
> Granted both of these are hugely less than the treatment group, but they're also hugely less expensive.
Breaking: doing nothing has no effect; is free
> According to the paper, the lower end fda approved weight loss drugs cause a 4% weight loss
Yeah, if you move the goalposts to “the worst drug on the market” the relative effect of the placebo goes up. This doesn’t bear on the article, which is about the best drug on the market.
Breaking: 16% of the improvement of the best drug on the market from taking a sugar pill is not "doing nothing" and is in fact statistically significant. That's why it's included in this paper, and every paper on weight loss drugs.
> This doesn’t bear on the article, which is about the best drug on the market.
No, if you missed it the article is about the best drug on the market and how unattainable it is to most people (and statistically those who would most benefit from it) due to cost. So if we can get 16% of the benefits for almost zero cost that actually a huge deal on its own, and this could likely be improved significantly with other tweaks, as I've now mentioned twice. Less snark, more reading comp next time👍
What does that even mean? You state that conclusion as if it implies something significant but, I'd argue, it's really just a way to summarize the relation between incentives and behavior. Some things we call choices because they result in different outcomes when you change the incentives (prison for murder decreases murder rater but prison for being short doesn't increase height much). I mean, if you really get down into the details the difference between 'choices' and 'non-choices' isn't that the laws of physics plus initial conditions are any less binding in one than the other or that the biology that happens in the brain obeys some other kind of principle than that in the rest of the body.
But, given that background, saying something is a choice is just a shorthand for describing how responsive it is to incentives. Certainly, choosing not to eat as much is more responsive to incentives than height is but it's a lot less responsive to incentives than many other things.
And once we are made aware of how responsive it is talk of whether it is a choice or not becomes irrelevant. It's like saying something is heavy once you know it weighs 100lbs. It's not adding any information about the thing or helping you figure out what to do with it. Same with weight loss it seems. Absent interventions we aren't willing to make (for good reason) many people don't lose weight but they do on the drug and that's all that's really relevant to deciding policy.
You're exactly right, except that I'm biting the willpower point bullet. Maybe I'm bad at metaphors, sorry.
The plan is this:
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family.
2. Replace carbs in your dinner with fat/protein. Eat as early as possible, eat as much as you want. Don't eat bedtime snacks.
3. Over time, extend the time from ending dinner (your "fast" length) til the next time you eat (breakfast? 12:30 lunch? 2:30 lunch?) as much as possible. Eat the next day when you're hungry, but if you're only feeling kinda hungry try drinking a zero-cal electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories a day is impossible. Measuring that you ate 10 minutes later is easy. Don't put any sugar or carbs in your morning drinks.
4. Eventually cut out breakfast or lunch, or eat later lunch. Just like dinner, replace carbs with fat/protein as much as possible. Whatever feels okay.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale.
These are’t terrible recommendations. I do some of the things you list, and it helps me maintain my bodyweight.
But do you seriously think that an epidemic of 70M obese Americans would be fixed if only people would read your five bullet points about intermittent fasting? As per Scott’s math, you are claiming that your tweet-length comment on ACX is worth 500bil. The market disagrees.
"But do you seriously think that an epidemic of 70M obese Americans would be fixed if only people would read your five bullet points about intermittent fasting? As per Scott’s math, you are claiming that your tweet-length comment on ACX is worth 500bil. "
Yes.
But humbly, my comment is worthless. It's the advertising and execution that matters. Any idiot like me can say "gee, maybe we should build cars in assembly lines with replaceable parts" but it takes Henry Ford to execute. Even tougher, the actual problem here isn't knowing what to do, it's teleporting what to do into the minds and 70M people and then they all have to execute. Which is why I'm babbling my insane, otherwise-worthless ideas in a place run by a person who seems to do a decent job of teleporting ideas into other people's heads.
To elaborate, yes, I really do think it's worth half a trillion, obviously conditional on people actually doing it (though the lack of difficult in doing so is the key feature) and the cost of the advertisement/propaganda to publicize it, and coach people through it. There are companies (look up Virtahealth) that provide physician-led diabetes reversal for a few hundred a year using similar techniques and coaching on it. My only disagreement is you're understating the worth at 500B, because that's only the (estimated) consumer value of "weight loss", because if all 70M people did those 5 things, it would also reduce the downstream occurrence of diabetes, heart disease and cancer as well. (claiming that reducing weight/improving metabolic health reduces those things is a boring conventional medical claim).
Also, re: "the market disagrees", as I pointed out, there are lots of (small) companies providing these services successfully and getting paid for them. Markets can agree in differing amounts, and markets also need information/advertising to match sellers and buyers. If "make cars with assembly lines" was an idea that didn't actually get Ford any money, but rather only gave distributed consumer surplus, he probably wouldn't have executed it.
And while I am a committed free marketeer, markets for services that provide little financial benefits to those who provide them often don't work! I'm not making any money from this. Doctors won't make any money from this - in fact, they will lose money because their gov-mandated quality metrics don't support this type of treatment for obesity or diabetes. Novo Nordisk doesn't make any money recommending this. No supplement or food manufacturer can make money from this. It's not really a product or service to be sold, though some (like Virtahealth) are.
Looked up Virtahealth. Digging in a little it appears to be "we will teach you to eat a keto diet, which will have so few carbs in it that your blood sugar will remain low enough without drugs to call it reversal, except we don't count metformin as a drug because some people like to stay on it".
As someone who took metformin for 3 months and *absolutely could not* tolerate the severe GI side effects, which I never built any tolerance to: lol. lmao, even.
I don't care how much fat you have, if you get a good diet your body will figure that out on its own. But also, yes, going from obese to just chubby IS correlated (but not causative!) with better health outcomes.
I want you to be healthier, which isn't measured on the scale, but in your blood work and in long term lack of massive health disasters like diabetes, heart disease and cancer. If you're still "chubby" but you don't get those things, well, great!
You basically call "healthy" being fat but not sick. Better than being morbidly obese and sick, I guess, but that's not saying much.
That's not good enough, people want to be "fit". You are right by accident with "health isn't measured on the scale" because yes, body fat percentage is what actually matters but it's very hard to measure without (other than doing an autopsy). Unless you are extremely muscular or have great bone density, the scale is a good measure of fitness.
If you want to be fit you can't eat ass much you want for a meal. The usual guides of 2000 kcal a day for the average adult male is probably too much already an puts you on a slight calorie surplus.
This comment is not worth $500bil because, like all comments in this vein, it fails to take into account the complexity of human nutrition. There is no list of 5 points that will work for those 70M obese people. For some, the drug will be the only way. For some it will be a completely different diet. For some, your comment will work, but I expect it to be a decisive minority.
Comments like this are more common than you think, and for me they are just too naive.
2. Literally more than half of my meals are just pasta/rice/bread. Seriously, it's a carb fest down here*.
3. My breakfast is literally chocolate chip cookies. It's one step removed to just shove down my throat spoonfuls of sugar. And it's not even that big of a step.
4. I never skipped a meal. The idea alone of skipping breakfast or lunch is abhorrent to my Italian brain.
And yet, I'm chronically underweight. The only point of yours that I feel to thoroughly endorse without a second thought is the first one.
My set of oversimplified comments will be: never eat sodas, almost never drink alcohol (less than one beer / glass of wine per month), keep a super regular schedule (breakfast lunch, snack, dinner) and never eat out of it (forget chips at parties etc), cook your own meals and eat fast food only occasionally in special circumstances (e.g. you're late for your plane).
Will it work for a "random you" reading? Hell no.
* The hate carbs are getting lately is really puzzling to me. Sure, fat isn't as bad as once thought. But this notion that its ills are solely the product of an evil carb industry that captured the government is ridiculous. I'm sure there is no fat industry that has ever tried to manipulate the public, and, if they do, they only have the public's health interest in mind.
Do not adopt diets to lose weight. Adopt a diet to be healthier.
This is the hidden problem* with the semiglutide process: if you take it, lose 20 lbs, fit into your old clothes and declare success, but you're still eating a constant stream of crap 3 times a day, you are still gonna have a higher chance of bad outcomes.
* it's possible that semiglutide is actually affecting your metabolism, in which case it might directly affect your metabolic health, in which case, good for it - it overcomes my "hidden problem" above.
"it fails to take into account the complexity of human nutrition. There is no list of 5 points that will work for those 70M obese people. For some, the drug will be the only way. For some it will be a completely different diet. "
Why do you think human nutrition is only complex on the downside (i.e. losing weight) - in reality, human nutrition is so non-complex that hundreds of millions of people - through diet/lifestyle changes alone - became overweight when before they were not. Nutrition is so non-complex that millions of people were able to gain weight literally without even thinking about it, like breathing.
"And yet, I'm chronically underweight. "
This gets back to my main point: don't focus on weight. Don't think I'm focusing on weight. It's a symptom that does not always present when someone has an underlying issue caused by terrible diet. The key is to increase healthiness (the highly costly downstream effects that we associate with obesity), NOT to lose weight - except that it is often an indicator. I'm not going to judge you, but what you describe yourself consuming does seem to be an unhealthy diet. The key is that unhealthy diets do not always result in obesity for, as you point out, a wide array of reasons, especially age. Would I be wrong in guessing that you're probably under 30?
There is no point whatsoever for you to lose weight, in fact, if you are truly the clinical definition of "chronically underweight" *that itself* is an indicator of even worse health outcomes than being mildly overweight! I am telling you that, in this thread about obsessing over spending 15k a year on weight loss, you could probably stand to gain some pounds. You are not the average American, and to the goal of this post (from Alexander's perspective) you are already cured. But not to my goal, because my goal is "be healthy, avoid really bad health outcomes" and there are people (yourself included) that can (again, going only on your self-report) have unhealthy diets, experience the higher likelihood of bad health outcomes, while not displaying obesity.
I recommend getting some blood work and checking your metabolic indicators. It is possible that you have an unhealthy metabolism without displaying obesity. There are all kinds of people who die of a heart attack at 55 and people go "but he was so skinny!". I
"The idea alone of skipping lunch is abhorrent to my Italian brain."
It's not your Italian brain. It's that for breakfast you consumed a great deal of sugar/carbs, which (short version) burn in your body very fast, (or are stored as fat, which obviously your body is not doing) and your body concludes it needs more quickly, so it tells you are hungry for lunch. The chocolate chip cookies are not unusual. Most cold cereal that anyone actually likes has a similar sugar profile. You are absolutely correct about one thing: people have radically different "energy intake -> how much fat they get" curves, and you have (whatever your age) the "18 year old boy" curve. But the underlying metabolism can be healthy or unhealthy, and one that takes in cookies for breakfast probably isn't.
"The hate carbs are getting lately is really puzzling to me."
From me, it's not hate. It's the simple fact (conventional scientific wisdom) that carbs (especially sugar) are (again, short version) burned faster (some types more than others) in your body that fat or protein, remaining available to be consumed for activity for a shorter period of time, and therefore when they're gone (or converted to storage) your body tells your brain it needs more. It is conventional wisdom that fat and protein create more satiety, which is longer time before hunger. Therefore if you wish to spend more time burning energy (in your case, you want this for good metabolism reasons, rather than weight loss) than consuming energy, and to reduce hunger, carbs are just objectively inferior to fat/protein. It's not some theory that carbs infect your body like poison. Well, except for sugary high fructose corn syrup sodas, those are definitely poison.
About the complexity, I'm unconvinced that people having tried a million things and still being unhealthy is a proof that nutrition is simple. The two doesn't seem to follow.
Anyway, just because you asked, if you were to see a picture of me, you'd think I'm under 30 -- I've got such a baby face, no wrinkles, no grey hair. But I'm 38. And actually I checked, my BMI is 19 (roughly, I don't own a scale) so I was actually wrong about the underweight thing. I'd love to gain a few pounds, but I'd rather them being muscles rather than just fat, this clashes with my couch potato nature unfortunately.
The bit about being Italian is a poor attempt at conveying the memetic nature of eating. Really, the horror of skipping meals has nothing to do with how fast carbs burn (and, again, in the tangent of the carbs, Deiseach writes better than I can the fact that a model that lumps in the same class coca cola and polenta isn't... great?). It's just that meals are a sacred tradition. So my "one neat trick, nutritionists hate him" is: let's just get better memes about food. Italian memes seem to be working well.
This religious aspect colors my opinion, and then I asked myself: if I were to follow your advice, I'd only have one meal at day (dinner) and it should be mostly fat/protein to cover my entire daily calorie intake. Is that even physically possible?
Other than that, in many things we agree, I don't think the pill treatment is the best, since it's unclear whether a taker will then have to be on it for the rest of their life (15k/year, yikes). But if someone there's no other choice, why deny it?
"The hate carbs are getting lately is really puzzling to me."
Oh, diet recommendations have swung around all over the place. Fats of all kinds are bad for you, replace those fatty foods with (carbs) and (protein). Take the skin off chicken, trim the fat off red meat.
Then it was "not all fats", it was saturated fats, so consume unsaturated fats. Then it was well monounsaturated fats are bad for you, only consume polyunsaturated fats. Omega fats such as found in fish good for you! Well, no, hang on, too much omega-6 is bad for you, you need to up the omega-3 (jury still out on omega-9 for the moment, I suppose).
Dairy bad for you! Dairy good for you! Confused yet?
Then it was red meat is bad for you in excess, so that was (protein) the bad guy. Then smoked meats, because carcinogens.
(Carbs) were still okayish, but then SUGAR - THE PRIME EVILLEST EVIL THAT EVER EVILED. So cut out all the sugary junk (good enough advice). Then that expanded out into other carbs. Simple carbs like potatoes and rice and bread and pasta - bad. Need complex carbs. GI index, so forth and so on.
I think the swinging pendulum of "X is bad, Y is good - now X is good and Y is bad" is down to the complexity of nutrition and metabolism. People are getting fatter and unhealthier, how is this? The simple story of "consuming more calories, and being more sedentary, than past generations" seems not to be the whole picture. So there must be a 'bad' food or class of foods.
Fat makes you fat, right? So fats bad! Cut out fats!
Okay, people still getting fatter - why? how come?
Carbs bad?
Protein bad?
There will be people who eat lots of carbs or fat or protein or whatever, and don't get fat/are chubby but healthy. There will be people who cut out carbs or fat or protein and are fat/unhealthy. There is no simple "one easy fix, just change your portion/plate size and eat six tons of lettuce" cure.
I joke, but it's only half a joke, that the next recommended diet will be "you can only safely consume moss and water".
You know, I gained most of my body weight and reached my fattest point doing exactly that: keto, skipping meals, tons of water and zero calorie drinks. So I'm extremely skeptical of this being useful advice.
My numbers just got worse and worse until I bit the bullet and had them cut out half my stomach and part of my intestines.
"Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale."
Yes, Brian, but you are forgetting one thing - people in the street can't see your bloodwork numbers, they can see your double chin.
*That's* the metric by which people, including doctors, judge are you 'healthy' or not. I take your point that people confuse "healthy" and "thin", but given all the messaging about "fat is unhealthy", can you expect any different?
About ten to fifteen years back, I had *great* bloodwork numbers. I was still visibly porky. I still had kids yelling at me in the street about being an elephant. I still had at least one doctor visibly and openly furious with anger that he could not punish me for being fat because my blood work didn't back him up.
If you're pudgy, that is the metric society, and you yourself, judge you on. Have you dropped two dress sizes? No? Then it doesn't matter if you can run a mile or have perfect cholesterol levels, you are part of the obesity epidemic that is blighting our healthcare system.
(There's particular irony at work here; I have a sibling who has a thyroid condition and they have to be ultra-careful about their cholesterol levels and fat intake. They are also 'normal weight'. So anyone looking at the two of us together and being asked "who has the high cholesterol?" is going to pick me, the fat hippo. They'll be wrong, but they still won't change their mind - oh that number doesn't matter, we all know being fat is bad for you).
Improving or maintaining your health is worth doing if feasible.
The simplest thing I can think of to solve the prejudice against fat people is a famine, and it isn't worth it. It might not even work.
An expensive preventative for heart disease might work, but that's another version of turning being fat into a status symbol (perhaps an expensive watch is also required). This is better than a famine (do I need to say that?) but way short of excellent.
Yes, I don't know what to do about that, except advertise the fact that bloodwork is a better indicator than weight. The only thing I do know is that, in the case of "good bloodwork, overweight" the answer is NOT "$15k a year semiglutide" or "high mortality-rate surgery."
Speaking as a Person Of Amplitude, I think obesity isn't one disease (since we are now calling it that) but a range of factors that have been lumped under the one umbrella of "you're a fat pig".
(1) People who are naturally chunky versus those who are naturally skinny. I think we all know or have seen people who are like twigs, who don't put on weight, who have thin little limbs like sticks. That's not because they're dieting themselves down to that weight, it's natural for them. On the opposite end, I submit that there are people who are naturally going to be chunkier than the median, because that's how their metabolism is set up. They will go a few pounds over what is considered optimum weight, and if they go too far over, their doctor harrumphs at them about "diet and exercise" and they do that and lose the weight. It'll be tougher for them to keep off the weight and they will have to make lifestyle changes like "I can't eat birthday cake ever again", but in the main it will work for them. At the worst, they'll be 'pleasantly plump' or a bit chubby, but not grossly overweight.
An example of someone naturally skinny who is not doing cooking episodes about salads:
This is the good old "willpower" argument: if Joe can lose ten pounds simply by not stuffing his face with rubbish, why can't you?
That brings me on to:
(2) Slowing-down of metabolism. Middle-aged spread. "When I was younger, I could eat what I liked but now I eat the same and put on weight". People get more sedentary, they eat more convenience food, lifestyle changes.
Again, "diet and exercise" will help here. It'll be tougher, but if you were one of the 'naturally' slim types, it helps. Again, you'll probably have to make some lifestyle changes, but you will be able to get off the weight.
(3) Weight gain due to medication. I think we all know about steroids (my late father was put on a course of them and ballooned up, even though he wasn't eating more) and there are other medications with the same side-effects. It's difficult for people who gain weight like this, because they treated like the rest of us greedy lazy porkers, and get the "oh that's only an excuse" response unless they pull out the prescription to prove what they are saying is true, and who wants to have to reveal that *ackshully*, I'm on anti-psychotics which is why I'm stuffing my face with carbs?
Hard case here, since once you don't need to take the meds anymore, you will go back to your natural weight - unless of course you need to constantly be on psych meds, which means increased appetite/weight gain, which gets you the "just have some WILLPOWER" argument from everyone.
(4) And last, the rest of us fat, lazy, greedy slobs with no willpower who just stuff our faces with junk food and never get up off our idle behinds and just go for a walk or something.
The gluttons. The "why don't you just have some WILLPOWER?" people. The "diet and exercise, you moron, never heard of that?" folks.
And you know, there is something to that. Yes, we eat too much. Yes, we don't exercise enough. But, like the anecdote related in Dante, when the bishop asked his servant "What do the people say of me?" "Your Grace, that you are always drinking" "Ah yes, but I am always thirsty" - we're always hungry.
Scott mentioned a few years back examples of patients who suffered from unrelenting thirst, who had to be monitored with their fluid intake or else they would literally drink themselves to death, and even when they got enough to drink would still feel thirsty.
Nobody is going to condemn someone who is guzzling pints of water "Just have some WILLPOWER!", because they realise that's not normal and is indicative of a problem.
Now, for the likes of us that are always hungry and never feel full, even when "but I just ate a full meal a couple of hours ago, I shouldn't be feeling hungry", it's hard. Because yeah, you can visibly see we are gross landwhales. And yes, we are leeching the health services normal people should be using with our horrible diseases of obesity that are all our own fault. And yes, calorie-laden tasty modern processed foods, and yes sedentary lifestyles, and yes over-eating and being greedy, and yes diet and exercise work to a degree, and yes "why don't you just have some WILLPOWER?" and get used to feeling pangs all the time. And yes, "I'm big-boned/it's my glands/it's PCOS/it's a response to trauma" do get used as excuses. Yes to all of that, yes I admit we do contribute to our own problems. Having said that:
Do you really think it's a simple problem of NOT ENOUGH MORAL FIBRE once people are desperate enough to have the likes of this done in order to lose weight?
"Roux-en-Y (roo-en-wy) gastric bypass. This procedure is the most common method of gastric bypass. This surgery is typically not reversible. It works by decreasing the amount of food you can eat at one sitting and reducing absorption of nutrients.
The surgeon cuts across the top of the stomach, sealing it off from the rest of the stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Typically, the stomach can hold about 3 pints of food.
Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. Food then goes into this small pouch of stomach and then directly into the small intestine sewn to it. Food bypasses most of the stomach and the first section of the small intestine, and instead enters directly into the middle part of the small intestine.
Sleeve gastrectomy. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can't hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen the desire to eat.
Advantages to this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than do most other procedures.
Biliopancreatic diversion with duodenal switch. This is a two-part surgery in which the first step involves performing a procedure similar to a sleeve gastrectomy. The second surgery involves connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing the majority of the intestine.
This surgery both limits how much you can eat and reduces the absorption of nutrients. While it is extremely effective, it has greater risk, including malnutrition and vitamin deficiencies."
Reading those comments, they resonate with me. Constantly eating, never feeling 'full', eating until so stuffed I might throw up, And I've tried diets and they've worked - for a time. Then I plateau at a certain weight, and something happens (the last, most successful diet, I got swine flu then the weather was so unseasonably bad I couldn't go out for exercise) and I fall off the wagon and put all the weight back on.
So yeah, maybe all I need is some WILLPOWER, can you tell me where I can obtain a shot of that, because I don't manufacture enough myself? And that's where the "moral failing" angle of the condemnation of the overweight comes in - if we just gritted our teeth and scrunched up our eyes and *willed* hard enough, we could do it!
I don't know if this new drug *is* a miracle cure for weight loss, I think like all new treatments it is being hyped out of enthusiasm. Once it settles down, I think it's more likely to be at the 60% end of the successful treatments scale. And this is something you have to take forever, or else you will put the weight back on. And there probably will be some people for whom it doesn't work - I've had at least two medications prescribed where I was told that a side-effect was weight loss so that would help me, and no, it didn't happen at all.
So yeah, "CICO" - but that's simple. Why people consume a heck of a lot more CI than expend CO is the hard part to solve.
This doesn't respond to most of your very valid points, and it's definitely not meant as a "just exercise more" response, nor to suggest it will solve all your weight problems, but I think it is likely to be more effective and metabolically helpful than most forms of workouts: have you looked into Zone 2 exercise? Peter Attia has a number of podcasts and videos on it, and it's the central plank in his treatment of patients with metabolic disorders.
Briefly, zone 2 exercise is low intensity exertion which stays just within the energy regime at which the mitochondria in muscle cells can burn fat to supply the fuel they need. By training within that zone, not only are you specifically burning fat, but you are also training your mitochondria to be more effective at utilizing fat and less dependent on glucose, thus improving your overall metabolic health.
A simple way to try it is to get a cheap used rowing machine or exercise bike, set it up in front of the TV or computer, and ride them for 45 minutes to an hour at the intensity level that lets you still just barely breathe through your nose or maintain a conversation. Aim for at least 3 hours a week; more is better.
I'm surprised that you, usually a defender of religion and traditionalism, would have such a view on willpower. This isn't a criticism--when people are too predictable in their views, I tend to wonder if they ever think for themselves.
Isn't gluttony one of the seven deadly sins? Sin is part of the human condition, and the seven deadly sins are remarkable for their mundaneness: probably every person who ever lived has been guilty of all of them on a regular basis. But that doesn't mean societies (and not just Christian ones!) don't or shouldn't blame people for being lazy, angry, greedy, arrogant, or gluttonous. The purpose of the blaming and shaming is to discourage the sin by imposing a social cost. Just willpower alone may not be enough for someone to not have bursts of rage or to not eat to excess, but the combined effect of willpower and social disincentives might be enough to make people relatively healthy and well behaved. And so, in moderation, fat shaming is good in the same way that small amounts of sloth-shaming and wrath-shaming are good.
"I'm surprised that you, usually a defender of religion and traditionalism, would have such a view on willpower."
Oh ho, friend! What do you think I am, a Pelagian heretic?
We can do nothing of our own will to be freed from sin, we need the help of grace. Gluttony is a sin, but willpower alone won't free you from that sin.
I haven't enough willpower natively, I need the injection of it from outside to help me . Shaming people and blaming people is not that help.
God alone knows. If I were a totally different person with a totally different personality, maybe I would love exercise, or be able to muster willpower to only eat three slices of carrot and six heads of steamed unbuttered unoiled unsauced* broccoli for every meal.
*I mean white sauces like bread sauce, parsley sauce, cheese sauce, onion sauce, etc . The ones made with flour and butter and hence Bad For You.
"We can do nothing of our own will to be freed from sin, we need the help of grace. Gluttony is a sin, but willpower alone won't free you from that sin."
My theology is rusty, so forgive me if I'm wrong, but aren't we supposed to at least try? No Christian I've met has ever said "don't worry about it and sin as much as you want, because God will forgive you". At the very least they stress repentance, which doesn't sound very different from accepting blame--and when done publicly, it's not very different from shame.
"Eat less, cook instead of ordering takeout, walk instead of bus, bike instead of car, etc."
Excuse me while I rock in my chair, laughing.
In my 30s-40s I was one of the fittest fat people you'd ever meet. I can't drive, and there isn't a bus service in my town, so I walked everywhere I needed to go. Sometimes I'd cycle. That was my entire life, pretty much (if I needed to go somewhere further than my local town, I'd get the intercity bus or a lift from a family member with a car).
I had tree-trunk calves from about the age of twelve from all that cycling and walking and carrying things while I walked. Did it make me lose weight? No, I was still podgy of body and pudgy of face. But I was *fit*.
So yeah, "just exercise more and it'll drop off" was always a source of amusement to me. I once, due to a screw-up in getting paid, while living away from home spent an entire week living on soup once a day and (of course) walking everywhere. I was at the point of fainting into bed at night, but the one bright spot was that surely I'd lose *some* weight.
Guess what? No. Maybe a pound or two, but nothing significant. My body was grimly hanging on to the fat reserves come hell or high water. The biggest disappointment of my life, but the reality of what the hell my metabolism is and I don't know why. I keep being told my thyroid levels are fine, but I don't know.
[speculation] In men it's mostly testosterone levels. It signals the body to both repair+increase the muscle mass AND not to burn muscle for energy when on a calorie deficit. Some people will never be lean as their bodies prefer shedding muscle before burning fat.
There's also probably some other factor regulating this behavior. IIRC there's a yet unexplained effect of anabolic steroids that makes fat burning more predominant even beyond what would be accounted by the muscle gain. It could be that steroids activate what naturally lean people have going.
Did you grow up food-insecure? Because this sounds pretty in line with the 'thrifty phenotype/epigenotype' hypothesis: your body is hanging on to those fat reserves because experience has told it that reliable access to food is not something it can take for granted. Maybe the hunter gatherer lifestyle that it's adapted for needed all that fat when it was living on raw tubers and bugs for months on end, and it doesn't think a week on soup is an emergency worth burning more than two pounds of fat for.
I wouldn't say that, but there is obesity on one side of the family, so you tell me if it's genetics or what at work.
Also Irish, so... descendant of the people who *didn't* die in the Famine? 😁
Some of it is environmental/genetics, but some of it must be bad habits and no willpower, since I have a sibling who has the opposite problem (they get stressed and stop eating and over-exercise and are always skinny; I get stressed and comfort-eat).
Tangential to your main point (that one can't really lose weight by pure exercise), which so far as I know is quite accurate, I thought it might be worth mentioning that a pound or two is a pretty significant weight loss for a week.
1 lb = 3500 kcal, so if you actually lost 2 lb = 7000 kcal that implies a deficit of 1000 kcal/day, which would be very noticeable indeed. The basal metabolism demands for a 5'4" female age 35 at 135 lb is ~1400 kcal, and walking tends to burn ~200-350 kcal/hour, so to run a 1000 kcal deficit daily one would have to cut the usual ration by two thirds, walk 3-5 hours a day, or some combination of both -- pretty harsh.
I think Gary Taubes in one of his many diatribes against calories in/calories out points to some empirical evidence that if people exercise they almost always boost their intake more than enough to compensate for the calories burned, because exercise makes you hungrier of course.
No, the first weight you lose is water weight. It's easy to 'lose' weight like that, but it's not shifting fat. I was disabused of that the first time I had stuck to a diet (as advised by my doctor to go on a diet), lost a stone, and went back to report all pleased with myself.
Doctor told me that was just water weight, I hadn't really lost fat, and I would have to continue on a lot longer to really start losing weight.
So living on a bowl of soup and lots of water per day for a week got rid of some of that water weight, but didn't kick off the fat-burning. And of course once I got my money sorted out and could buy food, I went back to eating normally so naturally no weight loss. If I stuck to "one bowl of soup a day" for a month, then maybe real fat-burning weight loss would have happened.
The amount of water (and of (literal) shit) in your body can fluctuate by more than a pound or two -- you're better off treating the last digit of your weight as a random number generator. See _The Hacker's Diet_.
I don't even have a car or a bike, and since covid I also started avoiding buses. I walk to my work for 40 minutes.
I admit I could work harder about the eating less part.
The meta-point about the traditional advice is that either you need to do it 100% right and mere 90% gets you nowhere (possible, but then it would be nice to admit that following the advice is harder than it seems), or just one part of it is the real advice and the rest is bullshit (also possible, but then please stop telling the bullshit parts).
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family.
2. Replace carbs in your dinner with fat/protein. Eat as early as possible, eat as much as you want. Don't eat bedtime snacks.
3. Over time, extend the time from ending dinner (your "fast" length) til the next time you eat (breakfast? 12:30 lunch? 2:30 lunch?) as much as possible. Eat the next day when you're hungry, but if you're only feeling kinda hungry try drinking a zero-cal electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories a day is impossible. Measuring that you ate 10 minutes later is easy. Don't put any sugar or carbs in your morning drinks.
4. Eventually cut out breakfast or lunch, or eat later lunch. Just like dinner, replace carbs with fat/protein as much as possible. Whatever feels okay.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale.
Hey you have described your weight loss system multiple times here. I think readers get it. You sound like you think the reason we're not all converts is that we do not understand your system, and need to hear it explained again. In fact, people are telling you multiple reasons why things along these lines have not worked for them, and/or multiple reasons why they believe such things generally do not work for many people over the long run. Are you giving any thought to all this testimony and all these ideas?
"Are you giving any thought to all this testimony and all these ideas?"
Absolutely, previous people's testimony and experience (of which all of the versions given in this thread are a subset - not as a critical judgment of them, just that diet advice almost always fails in relatively predictable ways) is the reason this is my plan, instead of being traditional stuff like weight watchers calorie restriction.
"Hey you have described your weight loss system multiple times here. "
Well, not to be rude, but if you're describing it as a weight loss system, then I haven't explained it well, because it's not a weight loss system, it's a "increase healthiness system" and I posted it here because I think focus on specifically weight loss via semiglutides or surgery is part of the problem.
"In fact, people are telling you multiple reasons why things along these lines have not worked for them, and/or multiple reasons why they believe such things generally do not work for many people over the long run."
To be very specific, no one I've seen so far (maybe I missed it) is saying they have tried something like this and failed, (whereas I personally have succeeded, and know dozens of other real live people whose testimony is that it works) and the "such things" they present are often critically different in major ways that are also exactly the reason I present this strategy as an antidote to them. You're essentially saying "well, all these other people have tried such things like, leeches and balancing bodily humors, why do we expect your plan to take antibiotics to work?" Maybe I'm arrogantly assuming my method is superior, but it was created (not by me!) precisely to incorporate what you're saying - the testimony of millions of people saying that previously recommended "diet" advice didn't work. The key is in the "what" is being recommended, and whether it goes against the grain of how we understand humans and their metabolisms to function.
Additionally, when people are saying "diet advice X didn't work for me" in this thread, in every case they have cited weight. This is the part I want to repeat more than my strategy: don't measure success on the scale. You can't timetravel to see if you get diabetes 25 years from now, you have to get bloodwork done, or you have to read all the papers describing the other markers you can see to detect a healthier metabolism, or get a continuous glucose monitor, or you have to take my word for it. (This cost of this measuring indeed a major failure point of my plan, which you should critique)
OK, Brian, I have tried it and failed, and by failed I mean not simply that I did not lose weight, but that I did not stick with the plan. I had been reading about carbs, and how processed carbs and sugar do not really satisfy and you make you crave more of them. So I planned to follow a regimen of eating nothing sweet except fruit, not much refined flour & the like, and lots of protein, fruits and veggies. I did not avoid animal fat. I am a vegetarian, but ate lots of sharp cheddar, an animal fat favorite of mine. I did not count calories. I was not solely focused on losing the 20 pounds I wish I were not carrying, but of course that was on my mind. It is simply impossible not to care about that. And I did deviate from the approach you describe in that I did not make insanely delicious meals that gave me deep satisfaction. I absolutely hate cooking, and am simply not willing to take much time away from activities I value in order to do awesome cooking.
I have stuck with the no-sugar part for several years now, and find that cookies etc. are no longer calling my name when I'm in a bakery. However, I have not stayed with lots of fruits and veggies, I have slid back into eating simple carbs, things like slices of white bread, because I like them and they're easy to grab . And I never did do the part of preparing wonderfully palatable meals. The things that have kept me from sticking to my plan are things like this:
-Most vegetables are not pleasant to eat unless you chop them up and put a nice dressing on them, or cook them. I hate doing food prep. If I'm busy, tired, or preoccupied with something else important to me cooking is the first thing to go.
-I default to eating lots of cheddar cheese and little else -- because I'm out of fruit, and the veggies I have need prep to be bearable. I got busy and did not shop.
-I get busy doing something important to me, miss a meal, then am so hungry I grab whatever's handy that I can stand -- cans of cashews, lumps of cheese, fried stuff from Uber eats.
Obviously I *could* have done other things at those times. I could have made a salad or cooked the veggies or made an awesome delicious meal. I could have shopped more often so there was more healthy stuff in the house. I could have not let myself get so hungry. But it is an illusion that knowing that makes it likely that in the future one will act differently. The same factors that led to suboptimal eating in the recent past are all going to be there in the near future. Habits are hard to break, and the breaking of them draws on the same limited pool of energy and self-monitoring capacity as all the other things we need to accomplish. Eating is a simple pleasure and doing it provides a break from life's demands. Turning it into something that must be done a certain way both reduces the amount of simple pleasure in the day and also adds a new demand. That's a hard sell. There may exist some heaven of healthy eating, zero minutes per day of craving things that are unhealthy, and amazingly delicious meals that satisfy the living daylights out of a person, but then again there may not, for all of us. And even if it does exist, getting there is no easier than accomplishing lots of other goals we have for our careers and relationships, and far more dispensable.
isn't the way that semaglutide works is by making you feel full and satiated after eating? of course you need to be changing your diet -- if you continued eating the same way, you wouldn't be able to lose any weight. the hard thing about losing weight is that your body will do anything it can to make you eat the calories you're trying to avoid (and will hold on to the fat it already has, although that can usually be overcome with enough time). the brilliance of this drug is that it basically helps you stick to a diet.
IMO exercise doesn't actually help you lose weight anyway except insofar as it helps you build muscle, which makes your metabolism higher, but it's a good thing that people should do regardless.
re: diet, I think semiglutide might being affecting your metablism too - hence its use as diabetes drug, but I'm not educated enough to know for sure.
re: exercise, yes, it may not make you lose weight (in fact I think you should gain weight, if you're doing strength training) but it makes you healthier.
And to dovetail both: we want to be healthier metabolically, that is the goal. Weight is just a symptom that we only care about as potential signal.
This jives with my experience on the drug earlier this year. I was on living primarily on pre-made keto meals and after starting on semaglutide I felt like it was too much food for a setting, switched to a lower cal option. When shortages of the drug caused me to miss a few weeks, the lighter meals were quickly noticed as not-satiating.
While this is technically true, there are a *lot* of things that would be unnecessary if everyone in the world always made good decisions and showed perfect discipline at all times and experienced no akrasia at all. That world would look extremely alien to the one we actually live in.
Given that we live in a world of imperfect willpower and decision making, finding ways to mitigate the consequences of those failures is both important and valuable.
I will say, though, this is one of the areas where I feel like government intervention may be warranted, or at least could have good outcomes. I don't think people would suffer if there was a tax on fat and sugar above a certain point on all foods such that all their food choices were healthier.
Wait, I've got an idea. Let's put everyone on the diet-that-can't-fail. Then, we can piggyback all the other things people have trouble sticking to onto it, like ornaments onto a Christmas tree: Every time you have a proteiny meal, write down a work goal for the next few hours -- productivity solved! Every time you lose a pound, pay any unpaid bills -- budgeting solved! Every time you lose 5 pounds, spend an afternoon working on that great idea you had that you've been procrastinating on fleshing out -- getting rich and famous solved!
Nope. It is the semaglutide. See my comment below for details. I lost 20% of my weight (55 lbs) in 14 months. I did not change what I ate (good fresh home prepared food) or how much I exercise (mostly an hour a day of walking). I just ate less of the same stuff.
"Movement offers us pleasure, identity, belonging, and hope."
Identity? What identity? "I can move my legs, that means I am A Leg-Moving Person"?
Sorry, but this is where the exercise evangelists get ridiculous. If I were to be confined to a wheelchair tomorrow, I *might* construct a new identity around being disabled or a wheelchair user (I don't think I would, but I might). However, I am positive I would never construct an identity around being a runner, and if someone feels that the most important thing in their life is that they are a runner - well, you do you, but heck.
Honestly, your McGonigal person sounds like all the dopeheads on here urging "LSD, man, psychedelics, will give you a cosmic experience and fix all your mental problems with a reset!" Maybe the exercise high people and the psychedelic high people should get together and get mutually baked before running a marathon, then they could both disappear up their own crown chakras about the cosmic best and highest human spirit coming out, maaaaaan.
What makes you think we don't exercise? I've exercised for a minimum of an hour a day, seven days a week, since elementary school. Usually I get more exercise than that. I'm past middle age now. It never made a dent in my weight. This is the kind of mean-spirited assumption that fat people have to fight all the time.
Exercise doesn't shift weight, unless (as has been mentioned) you are preparing for an expedition to the Antarctic or triathlons or the Tour de France.
What exercise will do is tone up muscles (I did find that the flabby underarms tightened up) and help with endurance (being able to walk distances without getting winded). But you can be fairly fit (able to do everyday tasks as normal) and still fat, even very fat.
I think the "diet and exercise" mantra comes from treating people who only have a few pounds excess to shift; the exercise will tone muscles and burn off some extra calories, and that in combination with restricting calories to below normal metabolism maintenance will shift enough weight/fat so that you do 'go down a dress size' or whatever.
But for seriously overweight people, it won't work like that. And exercise *alone* definitely won't work, because it makes you hungry so you eat to compensate.
Isn’t this phentermine? Wasn’t it part of the old phen-phen diet? One “phen” was found to cause heart problems.
No, this isn’t related to phentermine. It’s not any kind of stimulant. It works by making you think you are full and not hungry any more. Source: my better half takes one of the versions for diabetics.
Sorry, I thought I read somewhere that Wegovy is actually phentermine, but on further reading it seems you are correct. It is just a different weight loss medication. And has less long term results and perhaps more side effects.
There are shady weight loss clinics that prescribe and dispense "all natural weight loss supplements" that are actually phentermine. (Getting customers hooked on stimulants is a great way to ensure repeat business!) I wouldn’t be surprised if some of them latched on to the semaglutide hype and started pretending to offer that.
I dunno, I don't find that toooo shady — I'd be pleased to get something that actually works, if anything!
And stimulants mostly aren't physically addictive, so "getting hooked" on them because you took some for weight loss and really liked them sounds like complaining that Krispy Kreme got you hooked on food because you really like eating donuts, it seems to me...
Edit: Well, marketing it as "all-natural" *would* be shady — forgot about that part, sorry!
("All-natural" is a stupid term to base purchasing decisions on, though, for many different reasons... so I can't get too worked up about it, heh.)
Phentermine is fantastic for weight loss. There have been 3 studies to determine whether it's addictive, and all 3 concluded it is not. I took it myself for 2 years before the new, stricter, more-fascist rules saying you have to have a BMI of 30 to get it went into place.
Standard dose is 15-30mg / day. I was using 38mg tabs, and found it effective at 19mg/week, as taking 19mg on a single day enabled me to fast for that entire day.
I believe the medical community is so down on phentermine now for religious, not scientific reasons. Doctors really don't like it when a person can just take a pill instead of exercising. It feels like sin to them.
Phentermine is actually a controlled prescription medication under the same rules and regulations as ADD medications and pain medication. Phentermine is only available by prescription. There are supplements that weight loss specialists use but there is no reason to try to "hook patients" on a medication. Patients actually seek out Phentermine and try to rely on it versus actually changing their diets. Phentermine is highly controlled and should be in a prescription bottle from a pharmacy or a dispensing medical office.
All of the studies on the addictivity of phentermine that I have seen, concluded it is not addictive. I challenge you to find any experimental evidence that it's habit-forming. I took it myself for 2 years, and had no problem on being forced by new regulations to discontinue it suddenly, other than getting fatter as a result.
They're both drugs used to treat obesity, no other connection. Are you asking about something more complicated than that?
Can you extend the cost benefit analysis to include stimulants and other harmful weight loss drugs?
No, GLP-1 drugs work completely differently. Here’s a useful summary by Stephan Guyenet, whom SA has written about approvingly before: https://www.worksinprogress.co/issue/the-future-of-weight-loss/
Wegovy is unrelated, but Qysymia, the less-functional diet drug mentioned in passing from the chart, is phentermine + topiramate.
You said, “I have a pretty minimal insurance and it looks like if I got semaglutide my copay would be about $500/month until I reach my deductible.” I think you mean out of pocket limit, not deductible, though maybe your plan is odd. Usually, you get zero benefit until you hit the deductible.
Thanks, corrected.
I tried semaglutide and it did nothing to slow rate of weight gain, just produced stomach upset, going up to 2.4mg injectable. I know one other person trying semaglutide and they reported something similar. I wonder if they played some clever games with their choice of patients. My expectation of how the news goes here is a whole lot of people who try semaglutide, maybe after fighting really hard to get on it, and find that it does nothing. That said, I know at least one friend of a friend, if not a friend per se, who claims that semaglutide was their miracle drug. So maybe still worth that hard fight, even if I'm guessing that the real proportion who get nothing out of it will prove to be over 50% in real populations.
Further fun fact: Semaglutide comes heavily recommended with diet and exercise and many stern injunctions about that! The actual insert sheet includes a graph for how much weight people lose with and without "lifestyle interventions" added. The two graphs are roughly the same.
I thought the comments at https://www.reddit.com/r/slatestarcodex/comments/y40owh/semaglutide_has_changed_the_world/ were impressive, although of course that's a different kind of selection bias.
I hate to be that guy, but I do find all these debates about extremely expensive weight loss cures (Matt Yglesias has a recent article about getting [I forget which] surgery) kind of annoying, where there are literally money-saving ways to lose weight - and more importantly than that, improve your metabolic health (where obesity is a potential symptom).
"semaglutide comes heavily recommended with diet and exercise and many stern injunctions about that!"
I wonder what effect that heavily recommending things that cause weight loss alongside your weight loss drug does.... I also wonder "what" diet and exercise is being recommended, when there is so much (conventional wisdom) diet and exercise advice that will definitely not make you lose weight, or worse, make losing weight so unenjoyable that you don't want to do it.
Yes, and that's why just waving the magic totem labeled "do diet and exercise" doesn't work. Exercise done right doesn't make you lose weight, but you should still do it. Diet can, but most diet advice doesn't work, or works, but is too difficult to stick to - giving an out to the Puritans who lecture people for being insufficiently pious. And remember "work" isn't defined as "lose weight" it is "be healthier and less likely to have the bad health outcomes that are currently correlated with being overweight"
This works: https://moore2024.substack.com/p/no?sd=pf
Yeah, my first year Behavioural Psych teacher had a great point when he said imagine a problem in the world (I picked AIDS). Then imagine a behavioural change that would 'cure' it. This idea was revitalised with Scot's post along the lines of technology is possible biology (behaviour change) is not (immutable).
Behavior does change, but that doesn't mean anyone can reliably choose to make it change, for themselves, or large groups, or for everyone.
yes. Human behavior is immutable. That's why we still live in tribal societies of no more than a couple hundred people led by hereditary nobles.
>The same can be said about pregnancy and STDs ("Just don't have sex")
Terrible analogy. Not having sex works 100% (alright let's say 99.999% to account for urban legend-tier accidents) for STDs and pregnancy. It's not a problem of effectiveness, it's a problem of "people don't use it". If a medicine cures a disease, it's not a failure when people who decided to not take the medicine suffer from the disease.
"People don't use it" is very close to "the cure is more unpleasant than the disease", which is a failure of the cure.
Amputating one's hands is 100% effective against carpal tunnel syndrome, both as a cure and for prevention, but I wouldn't say it's not a failure of that treatment that people choose not to do it.
"eat less stuff" is a gold star way to lose weight except that people suck ass at it. I have succeeded in the past, but put back on 20 pounds from my ideal body and am failing currently; it's pretty damn hard. I don't know if that's what you mean by money-saving way to lose weight, but if it is then I think it's an incomplete solution--eat less stuff needs a very firm "how," and that seems to vary person-to-person
Why eating less is so difficult and why losing weight at all by any method is so difficult are questions at the very edges of current neuro- and metabolic research. Most of what we tell the obese is unhelpful.
The real reason it's so difficult is that eating too much has simply become too convenient, whereas not doing so apparently doesn't come natural for many people.
I can see it in my wife: when she had the mental strength to account for everything she ate, counting calories and adjusting her diet to get enough protein, she easily lost weight at exactly the expected rate. As soon as she stopped doing that she started to eat too much calories with too little nutritional value again, as those meals are way more convenient to make, more tastier for her and immediately rewarding for the brain (but don't actually make the hunger go away for long). Despite her noticing how a protein rich diet made her feel full for far longer, allowing her to eat only two meals a day easily, she can't maintain such a diet without dedicating substantial mental strength to it; and she can't properly limit her calories with a more convenient diet either.
The difference between her and me is that she absolutely can't tolerate hunger, like at all. Not eating breakfast when starting early into the day to achieve something is simply not an option for her. Neither is skipping meals when eating her usual diet.
I on the other hand would rather sleep in another 15 minutes than to get up early to find the time to eat something. I can easily skip two meals out of three without any issues for days. I feel hunger sometimes, but I can just ignore it for an hour or two, and then it goes away. For me its absolutely no issue to maintain a BMI of 22-23 without ever stepping on a scale, counting calories or diet adjustment. I just stop eating when it's too much. I also don't stuff in left-overs for the sake of finishing them, which makes my wife mad regularly. She just can't get off the idea that this means wasting food.
A drug that would make the feeling of hunger go away would certainly help. But the real message is: convenient diets are unhealthy. We should have more healthy food options which are convenient to consume. If eating healthy requires extra effort, a lot of people will fail to do so ...
And all of that is without even considering people who simply have to eat whatever is the cheapest option available ...
Sorry, but I'm a little miffed here. "Convenient diets are too easy" is certainly a contributing factor, but the rest of your comment reads like someone lecturing a person suffering from chronic pain.
"Well, *I* don't get sensations like my bones are splintering and turning into knives cutting my flesh, so an occasional aspirin handles things for me just fine! Why do *you* need strong pain-killers? Modern pharmaceuticals have made things way too convenient!"
You say you don't get hungry and can easily skip meals without noticing, or ignore any hunger you do feel. Yes, that means it's easier for you not to eat and to stay at a 'normal' weight.
Try imagining you *do* feel hungry. Not even that - do you get thirsty? Do you drink plenty of fluids during the day? Can you easily ignore being thirsty? The next time you are thirsty, try "no you can't have something to drink right now, you had a glass of water this morning, you have to wait a minimum of four hours before you can have your next glass - and only one!" and see how you hold out.
This is probably not how you intended it to sound, but your comment comes off as "my wife is so over-sensitive and has no grit, she can't handle a little bit of pain/hunger, she just needs to toughen up - me, I could have my hand chopped off and not even notice, *that's* normal!" - see what I mean about the comparison to chronic pain?
You took my post in exactly the opposite way it was meant. I'm not saying that anyone would be at fault in the way you construed it. Quite the opposite. I was saying that the individual experience of hunger was very different; as is btw. the individual experience of pain.
This makes it extremely difficult for my wife to maintain her weight while consuming exactly the same kind of diet which I eat. Where she needs willpower not to eat something, I just need lazyness to prepare food. While she had to adjust her diet to lose weight to a high protein one, I can live as a skinny fat on a low protein diet just fine without any effort (and then still suffer from much of the issues such a bad diet entails). None of this is my achievement or her failure. It's just a simple fact.
I'm sorry if it came off differently. But I feel as if you were reading my comment almost in bad faith here. How would it even be my wife's fault that she experiences hunger far more severely than I do? And how would it be an achievement of mine that my body reacts far more charitably to not getting any food for an extended period of time? Neither of us chose our bodies or our body experiences. And nowhere did I blame her for her way of experiencing it.
I then proceeded to say that the reason this difference leads to that much obesity is that high calorie diets with low nutritional value are much easier to purchase and consume nowadays than diets which are well balanced. My wife, when trying to lose weight, had to go to great lengths to get all the nutrients she needed, while going cal negative for an extended period of time. IMO this is something we as a society could and should address.
Here again I'm under the impression that you are reading my comment in bad faith, as your example with pain killers works exactly the opposite to what I said. So your comparison doesn't even make sense and IMO only serves to discredit my thought.
And to answer your similar bad faith attempt at thirst: yes, I also experience thirst way less severely than my wife. Again: this isn't her fault or my achievement, it's just a plain fact.
Btw.: I am a chronic pain patient, having shattered my left hip a few years ago. I don't have a single day in my life without pain. And I don't use any medication for it (though I had doctors call me out for it, claiming stupidly that no one should ever need to experience any pain at all). Yet I never told anyone that therefor they shouldn't need any either. That would be simply plain stupid. I did need quite a lot of those the day I shattered my hip ...
I sort of get the convenience complaint, but sort of don’t. I think it is mostly just about the raw hedons. A cucumber is pretty good and super convenient, and you can just eat it like an apple.
But people will make a sandwich or cook something in the microwave instead because that food simply tastes better.
I just don’t think convenience is as much of an issue compared to accessibility and the overlap between caloric density and tastiness. Sugar tastes great.
Maybe I phrased it wrong, but I was trying to convey the convenience of foods actually filling you such that you no longer have any cravings.
My wife eats lots of cucumber btw. ;-), but I wouldn't call them a meal. I could eat ten of them and still be hungry. They might help with alleviating thirst though ;-)
I'd consider accessibility the main part of the convenience btw. A major issue, while trying to lose some weight, for my wife was finding something suitable to eat when not eating at home and not having brought our own food along.
Your wife's (and yours!) experience is totally normal. Most people cannot (and shouldn't) abide hunger, and that is a huge part of why normal "eat 20% less calories" diets don't work, even for people (like her) who have the capacity to measure it. Eating 20% less at 3 meals is also far more difficult (and will result in those leftovers) than eating less in discrete chunks by eliminating meals. Obesity (or lack of it) does not come from
But yeah, if you feel HUNGRY, a "diet" isn't gonna work, period. No one can manage long term hunger in a world that has so many easy things to eat.
Not to be internet nutritionist, but the the thing that everyone I've spoken to has worked (for varying quantities of "worked") for is adding replacing carbs with fat/protein (eat as much as you want for dinner, earlier is better) and then just extending the time period until you eat next (breakfast, or lunch, or later lunch, etc...) til whenever you feel hungry. If you feel "kinda" hungry, drink a zero-cal electrolyte drink first and then check if you still wanna eat a meal. Measuring whether you ate 1741 calories or 1787 calories is impossible.
And also, I just want to reiterate: obesity is a symptom of underlying nutritional condition, not a disease. Some people who have it are fat, some are not. It has bad effects even if you aren't fat. Semiglutides (being diabetes treatments) may somewhat treat the underlying thing (I don't know for sure) but if you adopt a diet that you enjoy, and your A1c and other metabolic indicators get better, you are HEALTHIER, and much lower risk for a long laundry list of bad outcomes even if you don't lose any weight, or never had much fat in the first place. Depending on *what/when* you eat, you (with your low BMI) might have less healthy A1c/etc... than your wife, with the potential bad outcomes. This entire thread is far too focused on treating the symptom of obesity and pretending that if we removed that, we'd fix the problem. (it is possible that semiglutides DO partially treat the underlying problem) There are too many skinny 60 year olds who die of things and we go "so sad, what bad luck, they were so healthy!" but if they were fat we'd go "oh man, if only he'd kept in shape" but they died of the same thing for the same reasons.
Well, those diets actually do work. Physics can't be cheated. That's a big part of the problem. Because it puts so much guilt onto people to whom it doesn't come naturally. The problem is that hardly anyone can put up with them for long enough to get into another mindset, where those changes suddenly come naturally.
Btw.: my wife never felt hungry during her time of losing weight, simply because she did ensure to always consume enough protein. The problem is that most foods which are easily available don't come with enough protein to do that. Just eating less doesn't cut it most of the time, as your diet then quickly become protein deficient. You have to adjust your food items a lot to do it. And then convenience goes out the window. That's what made my wife fail eventually as well after nearly making it into perfect BMI territory.
As for "Some people who have it are fat, some are not.": that's exactly what the term skinny fat refers to.
Just for the record: I never pressured my wife into doing any of this and love her just the way she is. I'm merely trying to recount her experience when she tried a few yours ago.
> Most people cannot (and shouldn't) abide hunger
This seems an extremely weakminded and degenerate statement to make. Hunger is a natural and healthy state we evolved to cope with. Certainly you SHOULD abide hunger if you are an unhealthy weight
What about, like, peanuts, though? Peanuts are convenient, nutritious, and filling, but eating lots and lots of peanuts isn't very palatable. I don't think we can blame this on convenience, except insofar as convenience is one of several competing, difficult things we're trying to simultaneously optimize for.
Well, good point. What about peanuts? Answer: they are one nutrient, not a meal, and thus lack lots of crucial trace elements. To add insult to injury, opposed to what you said, they aren't convenient at all. Not only don't they solve the issue at hand, but additionally where I live they aren't really readily available. I can easily get french fries, burgers and various other fast food meals on the go. I've never seen peanuts on offer (for obvious reasons). I could go into a super market and buy some; but then again I still wouldn't have a meal, and rather just one ingredient for a meal.
That's the exact opposite of convenient. Rather hard to come by and still lacking all but one ingredients for a meal I still would have to prepare. As opposed to just ordering the Pizza, wait 5 minutes, eat ...
Nuts are kind of weird. I don't know if other people experience this, but when I get a sudden pang of hunger my body completely rejects my suggestions that we eat some nuts. I'll be super hungry, staring into my cupboard, and that bag of peanuts will be completely unpalatable to me. This is in spite of the fact that I love nuts as a snack.
It think it's something where my body doesn't want to deal with a hard and dense fatty food on an empty stomach. Combined with the fact that nuts are quite slow to affect my blood sugar.
In general I think something with starch and fiber is the best remedy when I get that kind of sudden hunger.
I've had a lot more luck with "eat normal portion sizes with fewer calories, and track what you eat." It took me from BMI obese to BMI normal and has kept me there.
Portion control went so disastrously wrong that I'm skeptical of it as dietary advice. It doesn't seem supported by a lot of evidence, either (e.g. https://www.nature.com/articles/ijo201482#Sec11).
Can you elaborate on the distinction you're drawing here? You said you succeeded with a strategy that sounds to me a lot like "portion control", but then say portion control went disastrously wrong?
If the food you eat is smaller in mass, it will make you psychologically feel starved and physiologically feel unfull. Your brain will interpret this as 'you are going through a famine' and flip switches that make you value finding food more, because that was the appropriate response to a famine in the environment our ancestors lived in for millions of years.
If the food is bulky but has few calories, like potatoes, this makes the body and mind feel like you have plenty to eat, even when you are burning fat to sustain yourself.
Evolutionary mismatch, IMHO. No way to get a 3000 calorie diet 200 years ago unless you were a king.
There's also a lot of calorically dense processed food out there.
> To go with the biscuit, sailors in the RN were issued other food on a standard weekly rotation. On Sunday and Thursday, this was a pound of salt pork and a half-pint of dried peas. Monday was a pint of oatmeal, two ounces of butter, and four of cheese. This was also served on Wednesday and Friday, along with a half-pint of peas. Finally, Tuesday and Saturday usually meant 2 pounds of salt beef. Conventionally, this was washed down with a daily gallon of beer. The total came to approximately 5,000 calories a day, an incredible amount to modern eyes but quite appropriate for sailors at the time.
https://www.navalgazing.net/Naval-Rations-Part-1
For comparison, 3000kcal/day is about my current maintenance (180cm 72kg male). And I am _definitely_ way less active (and less muscular) than a sailor or soldier in history (1-2 hours of mostly anaerobic exercise every day).
Absolutely untrue. Bread and lard weren't that expensive, and it's easy to get up there in calories on them.
I think you're right, and the "diet" suggestions tend to be "just eat 10/20% less calories during the day" which isn't gonna work: people don't suck ass at it because they have low discipline, but because it's enormously difficult to measure calories in this scenario, and your behavior/brain/metabolism compensate it. It's not a single-input mechanism black box. Your 20 off, 20 on experience is the absolutely normal failure mode for calorie restriction diets.
Not to be the Weirdo Diet person , but what I mean is: intermittent fasting, cutting out breakfast (and/or lunch) and replacing enough of your daily quick-burn carbs with long-burn fat so you don't feel very hungry while you're doing it. This works because unlike calorie restriction, it doesn't cut against daily Regular American Life behavior (you "fast" every night from after dinner until break-fast, this is just a few more hours) and all the countervailing mechanisms your body has evolved over a billion years to counter generalized calorie restriction.
I don't eat breakfast. I've never felt hungry in the mornings, and when I do eat then, it (ironically) makes me *hungrier*, e.g. at around 11 o'clock I feel like I need a quick snack, whereas without eating breakfast I don't feel that and can even go without lunch.
So all the well-intentioned advice about "skip meals" or "don't skip meals" or "eat more protein" or "eat saturated - I mean unsaturated - I mean polyunsaturated, not monounsaturated - I mean saturated fats" or "just cut out the junk and move more, what's so hard about that?" becomes frustrating.
Human biology is not like a tidy physics experiment. It *should* be "calories in, calories out". It *is* "calories in, calories out* but that is *not* the whole of it, and that is what gets forgotten.
Some people will react beautifully to "I fast X hours a day from this time at night to that time the next morning between meals" but some people will not. Some people will control hunger cravings by eating breakfast, other people will have their appetite stimulated. Some people will tolerate more fat in the diet than others. Potato diet works for one person, packs the pounds on for another.
I think you are right within the realm of the recommendations you are describing, because they're so vague/contradictory. I'm not advocating any of the advice you're mentioning, which you are rightly skeptical about them applying to everyone. Calories in, calories out doesn't "work", as a METHOD of dieting, not as a thermodynamic fact.
But is there any debate at all that replacing carbs with fat/protein in a meal will not result in greater satiety/less hunger later on, and therefore enable one to go longer before their next meal? I think everyone agrees on that, and that it applies to everyone - sure, perhaps in different ways/amounts!
Does it seem acceptable that if you go longer between meals, that your body will spend more time burning energy than storing it? Sort of by definition?
Does it seem acceptable that this would then (regardless of totally weekly calorie consumption) result in storing less energy (fat)?
And again, the goal should not be "weight loss" it should be "reducing the unhealthy outcomes", the likelihood of which can be more accurately measured by metabolic lab values like A1c than at the scale.
If you're someone who's had a good BMI forever and doesn't get their labs done, then you're never gonna notice anything because you aren't measuring anything.
"But is there any debate at all that replacing carbs with fat/protein in a meal will not result in greater satiety/less hunger later on, and therefore enable one to go longer before their next meal?I think everyone agrees on that, and that it applies to everyone - sure, perhaps in different ways/amounts!"
No, not everyone agrees, and it does not apply to everyone. It absolutely does not work for me; restricting carbs triggers middle-of-the-night half-asleep binge eating.
(I'm not normally a binge eater at all; I've only ever had this problem when I've restricted either carbs or eating in the evening.)
"counting calories of every thing one eats, to the gram" is not extremely hard. i know so because I'm doing it, and i do not ever do anything remotely hard.
To do so accurately is hard, because even if you're measuring the weight, you're relying on estimates of calorie density that are potentially many years out of date, wrong in the first place, or that the producer of the food is wrong is assessing.
And ok, that it is easy for you is fine - for millions of other people, it would be A) hard B) sufficiently time-consuming they wouldn't want to do it or C) would result in no measurable effect on their health/weight, so they would stop doing it. Maybe "hard" was the wrong term to use.
The approach you are describing sounds reasonable, but, as with most weight loss approaches, there are a lot of things that will make it hard for people to stick with over the long run:
(1)It is hard to change ones habits, including one's eating habits -- not impossible, of course, but HARD. The effort and attention devoted to that have to come out of the same pot of energy people are using to do all the other hard things in their lives -- do a good job parenting their difficult kid, produce good work in their field, keep their marriage in good shape, budget, ruminate about all the bad stuff in the news. On days when the energy pot's almost empty, most reasonable people are going to choose to reduce their effort to eat in a different way, rather than their effort in other areas which are more clearly crucial
(2) It is a heavy burden to stay continuously aware of something. Take blinking -- if I ask you now to notice your blinks, it's easy as pie, right? But how about if I ask you to stay aware of them continuously for the rest of the day? Very very few could succeed at that, especially while doing all the stuff they need to get done today, and responding to whatever comes at them this evening. Continuously monitoring eating to keep it in compliance with a certain pattern is the same -- easy in the short term, very hard in the longer term.
(3) We are surrounded by highly palatable foods, and our brains are not wired for an environment with that feature. We evolved in settings where it was hard to get enough calories. If you found a honeycomb or were presented with a bunch of roasted animal fat it was desirable to eat as much of that stuff as possible. The parts of our brain that push us to eat the sweet, fatty, salty stuff that is all around us is quite powerful, and the part that understands that it's undesirable to gorge on those things on 2022 cannot reason with the parts that want to gorge. It is possible to simply override them, but it is difficult, and it's probably not possible to override them most of the time if you have other heavy demands on you as well.
1) the goal is not weight loss. That is a side effect. The goal is a healthy diet, and reduction of serious bad outcomes in the future.
2) Yes it is hard to change habits. That's why the method is designed to affect the underlying drives that cause the habits to be hard to change. It IS hard to not eat when you are hungry. It is EASIER to not eat when you have made decisions in the past that mean you are less hungry now. Eating more fat and protein in your past makes you less hungry now.
3) There are immensely palatable foods that are not bad for you, and will provide more satiety so you are not driven to consume more so soon. Animal fat is not (particularly) bad for you. Salt is not bad for you. Replace carbs with them in your meal, eat them, and enjoy not feeling hungry so soon. The goal isn't to override your desire to eat awesome tasty food, it's to hack the system so you eat awesome tasty food that reduces your desire to need to eat ANY food for longer.
This is not a moral system. There are not desires to be overcome. There is not decadence to resist. This is not ascetism. There is no willpower. This is a physical system of chemical reactions that we can affect in different ways. We impute no moral significance to a molecule binding to one molecule instead of another, nor should we.
I do think content is certainly as important as portions, if one wants to control obesity. The national health system is pretty good about listing contents on food products. We respond to heat, salt, and sugar, and food manufacturers exploit that. I think if one adheres to a healthy, lean diet, obesity is easier to control. Another important aspect is the consumption of alcohol. Alcohol can provide energy and calories, but can maintain too much weight in an unhealthy body.
I used to be borderline obese when I drank beer or wine, but I lost 75 lbs. when I came down with pancreatitis. Today, after the most recent flare-up, I'm down to 114 lbs. -- but still 6 feet tall. For a time I thought marijuana might help ease the pain, but now my body objects when I try and ingest it, so I've given that up, too. There are certainly no easy answers, but I think the content of one's diet and the consumption of alcohol are important factors. My stomach emptied with this most recent flare-up, which is unusual, so I'm taking the opportunity to curate what I ingest carefully. I'm drinking kefir and Gatorade.
In this case, the problem with “that guy” is not that he’s stating an uncomfortable truth; the problem is that he’s missing the point.
If you think that we should downplay pharma/surgical interventions because dieting and exercise “work,” it is incumbent upon you to show how we will overcome the fact that people don’t seem to have the willpower required to use these tools longterm. What’s your plan?
Willpower is a choice. In this study alone https://www.cuimc.columbia.edu/news/new-weight-loss-drug-approved-fda-it-right-you, 5% of participants on placebo lost 15% or more of their body weight. The average placebo loss was 2.4%. Granted both of these are hugely less than the treatment group, but they're also hugely less expensive. This is the case in every weight-loss placebo study I'm aware of, just the simple act of taking a pill (sub vitamin or other "healthy" pill they believe could affect weight for placebo in non-lab use) or putting an ab roller in the living room, or anything else that moves diet and exercise slightly closer to the forefront of mind than it was previously can have a significant effect. According to the paper, the lower end fda approved weight loss drugs cause a 4% weight loss, so assuming equal treatment time periods, placebo is 60% as effective on average as some drugs, at 0% of the cost. People are all different, they just need to figure out what best triggers that effect for them, whether it's my examples above (variations of which work for me) or something else.
Again. What’s your plan to get people to actually succeed in exercising willpower?
"just the simple act of taking a pill (sub vitamin or other "healthy" pill they believe could affect weight for placebo in non-lab use) or putting an ab roller in the living room, or anything else that moves diet and exercise slightly closer to the forefront of mind than it was previously can have a significant effect"
Whether you're talking to me or not, the solution is to reduce the thing that is calling on their willpower. It does not take much willpower to not eat if you are not hungry. You achieve being not hungry by increasing the satiety of the food you ate most recently. Food that does that is that which has more fat and protein, and less carbs.
And yet, I was easily overeating and hungry as usual after the first year on a keto diet.
Well, Kenny, just try very hard to try very hard. And if that doesn't work, just try very hard to try very hard to try very hard.
> Granted both of these are hugely less than the treatment group, but they're also hugely less expensive.
Breaking: doing nothing has no effect; is free
> According to the paper, the lower end fda approved weight loss drugs cause a 4% weight loss
Yeah, if you move the goalposts to “the worst drug on the market” the relative effect of the placebo goes up. This doesn’t bear on the article, which is about the best drug on the market.
>Breaking: doing nothing has no effect; is free
Breaking: 16% of the improvement of the best drug on the market from taking a sugar pill is not "doing nothing" and is in fact statistically significant. That's why it's included in this paper, and every paper on weight loss drugs.
> This doesn’t bear on the article, which is about the best drug on the market.
No, if you missed it the article is about the best drug on the market and how unattainable it is to most people (and statistically those who would most benefit from it) due to cost. So if we can get 16% of the benefits for almost zero cost that actually a huge deal on its own, and this could likely be improved significantly with other tweaks, as I've now mentioned twice. Less snark, more reading comp next time👍
What does that even mean? You state that conclusion as if it implies something significant but, I'd argue, it's really just a way to summarize the relation between incentives and behavior. Some things we call choices because they result in different outcomes when you change the incentives (prison for murder decreases murder rater but prison for being short doesn't increase height much). I mean, if you really get down into the details the difference between 'choices' and 'non-choices' isn't that the laws of physics plus initial conditions are any less binding in one than the other or that the biology that happens in the brain obeys some other kind of principle than that in the rest of the body.
But, given that background, saying something is a choice is just a shorthand for describing how responsive it is to incentives. Certainly, choosing not to eat as much is more responsive to incentives than height is but it's a lot less responsive to incentives than many other things.
And once we are made aware of how responsive it is talk of whether it is a choice or not becomes irrelevant. It's like saying something is heavy once you know it weighs 100lbs. It's not adding any information about the thing or helping you figure out what to do with it. Same with weight loss it seems. Absent interventions we aren't willing to make (for good reason) many people don't lose weight but they do on the drug and that's all that's really relevant to deciding policy.
You're exactly right, except that I'm biting the willpower point bullet. Maybe I'm bad at metaphors, sorry.
The plan is this:
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family.
2. Replace carbs in your dinner with fat/protein. Eat as early as possible, eat as much as you want. Don't eat bedtime snacks.
3. Over time, extend the time from ending dinner (your "fast" length) til the next time you eat (breakfast? 12:30 lunch? 2:30 lunch?) as much as possible. Eat the next day when you're hungry, but if you're only feeling kinda hungry try drinking a zero-cal electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories a day is impossible. Measuring that you ate 10 minutes later is easy. Don't put any sugar or carbs in your morning drinks.
4. Eventually cut out breakfast or lunch, or eat later lunch. Just like dinner, replace carbs with fat/protein as much as possible. Whatever feels okay.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale.
These are’t terrible recommendations. I do some of the things you list, and it helps me maintain my bodyweight.
But do you seriously think that an epidemic of 70M obese Americans would be fixed if only people would read your five bullet points about intermittent fasting? As per Scott’s math, you are claiming that your tweet-length comment on ACX is worth 500bil. The market disagrees.
"But do you seriously think that an epidemic of 70M obese Americans would be fixed if only people would read your five bullet points about intermittent fasting? As per Scott’s math, you are claiming that your tweet-length comment on ACX is worth 500bil. "
Yes.
But humbly, my comment is worthless. It's the advertising and execution that matters. Any idiot like me can say "gee, maybe we should build cars in assembly lines with replaceable parts" but it takes Henry Ford to execute. Even tougher, the actual problem here isn't knowing what to do, it's teleporting what to do into the minds and 70M people and then they all have to execute. Which is why I'm babbling my insane, otherwise-worthless ideas in a place run by a person who seems to do a decent job of teleporting ideas into other people's heads.
To elaborate, yes, I really do think it's worth half a trillion, obviously conditional on people actually doing it (though the lack of difficult in doing so is the key feature) and the cost of the advertisement/propaganda to publicize it, and coach people through it. There are companies (look up Virtahealth) that provide physician-led diabetes reversal for a few hundred a year using similar techniques and coaching on it. My only disagreement is you're understating the worth at 500B, because that's only the (estimated) consumer value of "weight loss", because if all 70M people did those 5 things, it would also reduce the downstream occurrence of diabetes, heart disease and cancer as well. (claiming that reducing weight/improving metabolic health reduces those things is a boring conventional medical claim).
Also, re: "the market disagrees", as I pointed out, there are lots of (small) companies providing these services successfully and getting paid for them. Markets can agree in differing amounts, and markets also need information/advertising to match sellers and buyers. If "make cars with assembly lines" was an idea that didn't actually get Ford any money, but rather only gave distributed consumer surplus, he probably wouldn't have executed it.
And while I am a committed free marketeer, markets for services that provide little financial benefits to those who provide them often don't work! I'm not making any money from this. Doctors won't make any money from this - in fact, they will lose money because their gov-mandated quality metrics don't support this type of treatment for obesity or diabetes. Novo Nordisk doesn't make any money recommending this. No supplement or food manufacturer can make money from this. It's not really a product or service to be sold, though some (like Virtahealth) are.
Looked up Virtahealth. Digging in a little it appears to be "we will teach you to eat a keto diet, which will have so few carbs in it that your blood sugar will remain low enough without drugs to call it reversal, except we don't count metformin as a drug because some people like to stay on it".
As someone who took metformin for 3 months and *absolutely could not* tolerate the severe GI side effects, which I never built any tolerance to: lol. lmao, even.
This sounds okey if your goal is to go from obese to just chubby.
I don't care how much fat you have, if you get a good diet your body will figure that out on its own. But also, yes, going from obese to just chubby IS correlated (but not causative!) with better health outcomes.
I want you to be healthier, which isn't measured on the scale, but in your blood work and in long term lack of massive health disasters like diabetes, heart disease and cancer. If you're still "chubby" but you don't get those things, well, great!
You basically call "healthy" being fat but not sick. Better than being morbidly obese and sick, I guess, but that's not saying much.
That's not good enough, people want to be "fit". You are right by accident with "health isn't measured on the scale" because yes, body fat percentage is what actually matters but it's very hard to measure without (other than doing an autopsy). Unless you are extremely muscular or have great bone density, the scale is a good measure of fitness.
If you want to be fit you can't eat ass much you want for a meal. The usual guides of 2000 kcal a day for the average adult male is probably too much already an puts you on a slight calorie surplus.
This comment is not worth $500bil because, like all comments in this vein, it fails to take into account the complexity of human nutrition. There is no list of 5 points that will work for those 70M obese people. For some, the drug will be the only way. For some it will be a completely different diet. For some, your comment will work, but I expect it to be a decisive minority.
Comments like this are more common than you think, and for me they are just too naive.
2. Literally more than half of my meals are just pasta/rice/bread. Seriously, it's a carb fest down here*.
3. My breakfast is literally chocolate chip cookies. It's one step removed to just shove down my throat spoonfuls of sugar. And it's not even that big of a step.
4. I never skipped a meal. The idea alone of skipping breakfast or lunch is abhorrent to my Italian brain.
And yet, I'm chronically underweight. The only point of yours that I feel to thoroughly endorse without a second thought is the first one.
My set of oversimplified comments will be: never eat sodas, almost never drink alcohol (less than one beer / glass of wine per month), keep a super regular schedule (breakfast lunch, snack, dinner) and never eat out of it (forget chips at parties etc), cook your own meals and eat fast food only occasionally in special circumstances (e.g. you're late for your plane).
Will it work for a "random you" reading? Hell no.
* The hate carbs are getting lately is really puzzling to me. Sure, fat isn't as bad as once thought. But this notion that its ills are solely the product of an evil carb industry that captured the government is ridiculous. I'm sure there is no fat industry that has ever tried to manipulate the public, and, if they do, they only have the public's health interest in mind.
Thank you.
A lot of diets will work for a few people, assuming the only purpose is to lose weight.
Normal people believe that quality of life as reposted by fat people is irrelevant.
Do not adopt diets to lose weight. Adopt a diet to be healthier.
This is the hidden problem* with the semiglutide process: if you take it, lose 20 lbs, fit into your old clothes and declare success, but you're still eating a constant stream of crap 3 times a day, you are still gonna have a higher chance of bad outcomes.
* it's possible that semiglutide is actually affecting your metabolism, in which case it might directly affect your metabolic health, in which case, good for it - it overcomes my "hidden problem" above.
"it fails to take into account the complexity of human nutrition. There is no list of 5 points that will work for those 70M obese people. For some, the drug will be the only way. For some it will be a completely different diet. "
Why do you think human nutrition is only complex on the downside (i.e. losing weight) - in reality, human nutrition is so non-complex that hundreds of millions of people - through diet/lifestyle changes alone - became overweight when before they were not. Nutrition is so non-complex that millions of people were able to gain weight literally without even thinking about it, like breathing.
"And yet, I'm chronically underweight. "
This gets back to my main point: don't focus on weight. Don't think I'm focusing on weight. It's a symptom that does not always present when someone has an underlying issue caused by terrible diet. The key is to increase healthiness (the highly costly downstream effects that we associate with obesity), NOT to lose weight - except that it is often an indicator. I'm not going to judge you, but what you describe yourself consuming does seem to be an unhealthy diet. The key is that unhealthy diets do not always result in obesity for, as you point out, a wide array of reasons, especially age. Would I be wrong in guessing that you're probably under 30?
There is no point whatsoever for you to lose weight, in fact, if you are truly the clinical definition of "chronically underweight" *that itself* is an indicator of even worse health outcomes than being mildly overweight! I am telling you that, in this thread about obsessing over spending 15k a year on weight loss, you could probably stand to gain some pounds. You are not the average American, and to the goal of this post (from Alexander's perspective) you are already cured. But not to my goal, because my goal is "be healthy, avoid really bad health outcomes" and there are people (yourself included) that can (again, going only on your self-report) have unhealthy diets, experience the higher likelihood of bad health outcomes, while not displaying obesity.
I recommend getting some blood work and checking your metabolic indicators. It is possible that you have an unhealthy metabolism without displaying obesity. There are all kinds of people who die of a heart attack at 55 and people go "but he was so skinny!". I
"The idea alone of skipping lunch is abhorrent to my Italian brain."
It's not your Italian brain. It's that for breakfast you consumed a great deal of sugar/carbs, which (short version) burn in your body very fast, (or are stored as fat, which obviously your body is not doing) and your body concludes it needs more quickly, so it tells you are hungry for lunch. The chocolate chip cookies are not unusual. Most cold cereal that anyone actually likes has a similar sugar profile. You are absolutely correct about one thing: people have radically different "energy intake -> how much fat they get" curves, and you have (whatever your age) the "18 year old boy" curve. But the underlying metabolism can be healthy or unhealthy, and one that takes in cookies for breakfast probably isn't.
"The hate carbs are getting lately is really puzzling to me."
From me, it's not hate. It's the simple fact (conventional scientific wisdom) that carbs (especially sugar) are (again, short version) burned faster (some types more than others) in your body that fat or protein, remaining available to be consumed for activity for a shorter period of time, and therefore when they're gone (or converted to storage) your body tells your brain it needs more. It is conventional wisdom that fat and protein create more satiety, which is longer time before hunger. Therefore if you wish to spend more time burning energy (in your case, you want this for good metabolism reasons, rather than weight loss) than consuming energy, and to reduce hunger, carbs are just objectively inferior to fat/protein. It's not some theory that carbs infect your body like poison. Well, except for sugary high fructose corn syrup sodas, those are definitely poison.
"I recommend getting some blood work and checking your metabolic indicators."
And if his bloodwork comes back with "he's fine, he's healthy", then what, Brian? Your tidy clockwork explanation has failed.
About the complexity, I'm unconvinced that people having tried a million things and still being unhealthy is a proof that nutrition is simple. The two doesn't seem to follow.
Anyway, just because you asked, if you were to see a picture of me, you'd think I'm under 30 -- I've got such a baby face, no wrinkles, no grey hair. But I'm 38. And actually I checked, my BMI is 19 (roughly, I don't own a scale) so I was actually wrong about the underweight thing. I'd love to gain a few pounds, but I'd rather them being muscles rather than just fat, this clashes with my couch potato nature unfortunately.
The bit about being Italian is a poor attempt at conveying the memetic nature of eating. Really, the horror of skipping meals has nothing to do with how fast carbs burn (and, again, in the tangent of the carbs, Deiseach writes better than I can the fact that a model that lumps in the same class coca cola and polenta isn't... great?). It's just that meals are a sacred tradition. So my "one neat trick, nutritionists hate him" is: let's just get better memes about food. Italian memes seem to be working well.
This religious aspect colors my opinion, and then I asked myself: if I were to follow your advice, I'd only have one meal at day (dinner) and it should be mostly fat/protein to cover my entire daily calorie intake. Is that even physically possible?
Other than that, in many things we agree, I don't think the pill treatment is the best, since it's unclear whether a taker will then have to be on it for the rest of their life (15k/year, yikes). But if someone there's no other choice, why deny it?
"The hate carbs are getting lately is really puzzling to me."
Oh, diet recommendations have swung around all over the place. Fats of all kinds are bad for you, replace those fatty foods with (carbs) and (protein). Take the skin off chicken, trim the fat off red meat.
Then it was "not all fats", it was saturated fats, so consume unsaturated fats. Then it was well monounsaturated fats are bad for you, only consume polyunsaturated fats. Omega fats such as found in fish good for you! Well, no, hang on, too much omega-6 is bad for you, you need to up the omega-3 (jury still out on omega-9 for the moment, I suppose).
Dairy bad for you! Dairy good for you! Confused yet?
Then it was red meat is bad for you in excess, so that was (protein) the bad guy. Then smoked meats, because carcinogens.
(Carbs) were still okayish, but then SUGAR - THE PRIME EVILLEST EVIL THAT EVER EVILED. So cut out all the sugary junk (good enough advice). Then that expanded out into other carbs. Simple carbs like potatoes and rice and bread and pasta - bad. Need complex carbs. GI index, so forth and so on.
I think the swinging pendulum of "X is bad, Y is good - now X is good and Y is bad" is down to the complexity of nutrition and metabolism. People are getting fatter and unhealthier, how is this? The simple story of "consuming more calories, and being more sedentary, than past generations" seems not to be the whole picture. So there must be a 'bad' food or class of foods.
Fat makes you fat, right? So fats bad! Cut out fats!
Okay, people still getting fatter - why? how come?
Carbs bad?
Protein bad?
There will be people who eat lots of carbs or fat or protein or whatever, and don't get fat/are chubby but healthy. There will be people who cut out carbs or fat or protein and are fat/unhealthy. There is no simple "one easy fix, just change your portion/plate size and eat six tons of lettuce" cure.
I joke, but it's only half a joke, that the next recommended diet will be "you can only safely consume moss and water".
There's a similar dance around eggs.
I reserve a special rage for the people who said, "Actually, eggs aren't bad for you. You can have one or two per week."
You know, I gained most of my body weight and reached my fattest point doing exactly that: keto, skipping meals, tons of water and zero calorie drinks. So I'm extremely skeptical of this being useful advice.
My numbers just got worse and worse until I bit the bullet and had them cut out half my stomach and part of my intestines.
Which numbers are we talking about? Weight/BMI? Or ones like A1c?
Weight/BMI, but A1c also got worse. My diabetes had progressed to a point where I couldn't control it with diet and metformin.
Everyone is different. If I could send a letter back to my younger self, the advice I'd put there is to sleep at night and never, ever skip meals.
"Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale."
Yes, Brian, but you are forgetting one thing - people in the street can't see your bloodwork numbers, they can see your double chin.
*That's* the metric by which people, including doctors, judge are you 'healthy' or not. I take your point that people confuse "healthy" and "thin", but given all the messaging about "fat is unhealthy", can you expect any different?
About ten to fifteen years back, I had *great* bloodwork numbers. I was still visibly porky. I still had kids yelling at me in the street about being an elephant. I still had at least one doctor visibly and openly furious with anger that he could not punish me for being fat because my blood work didn't back him up.
If you're pudgy, that is the metric society, and you yourself, judge you on. Have you dropped two dress sizes? No? Then it doesn't matter if you can run a mile or have perfect cholesterol levels, you are part of the obesity epidemic that is blighting our healthcare system.
(There's particular irony at work here; I have a sibling who has a thyroid condition and they have to be ultra-careful about their cholesterol levels and fat intake. They are also 'normal weight'. So anyone looking at the two of us together and being asked "who has the high cholesterol?" is going to pick me, the fat hippo. They'll be wrong, but they still won't change their mind - oh that number doesn't matter, we all know being fat is bad for you).
Improving or maintaining your health is worth doing if feasible.
The simplest thing I can think of to solve the prejudice against fat people is a famine, and it isn't worth it. It might not even work.
An expensive preventative for heart disease might work, but that's another version of turning being fat into a status symbol (perhaps an expensive watch is also required). This is better than a famine (do I need to say that?) but way short of excellent.
Continuous blood glucose monitors that displays the numbers on a big LED across your shirt? :)
Yes, I don't know what to do about that, except advertise the fact that bloodwork is a better indicator than weight. The only thing I do know is that, in the case of "good bloodwork, overweight" the answer is NOT "$15k a year semiglutide" or "high mortality-rate surgery."
Speaking as a Person Of Amplitude, I think obesity isn't one disease (since we are now calling it that) but a range of factors that have been lumped under the one umbrella of "you're a fat pig".
(1) People who are naturally chunky versus those who are naturally skinny. I think we all know or have seen people who are like twigs, who don't put on weight, who have thin little limbs like sticks. That's not because they're dieting themselves down to that weight, it's natural for them. On the opposite end, I submit that there are people who are naturally going to be chunkier than the median, because that's how their metabolism is set up. They will go a few pounds over what is considered optimum weight, and if they go too far over, their doctor harrumphs at them about "diet and exercise" and they do that and lose the weight. It'll be tougher for them to keep off the weight and they will have to make lifestyle changes like "I can't eat birthday cake ever again", but in the main it will work for them. At the worst, they'll be 'pleasantly plump' or a bit chubby, but not grossly overweight.
An example of someone naturally skinny who is not doing cooking episodes about salads:
https://www.youtube.com/shorts/513TiHieN9c
This is the good old "willpower" argument: if Joe can lose ten pounds simply by not stuffing his face with rubbish, why can't you?
That brings me on to:
(2) Slowing-down of metabolism. Middle-aged spread. "When I was younger, I could eat what I liked but now I eat the same and put on weight". People get more sedentary, they eat more convenience food, lifestyle changes.
Again, "diet and exercise" will help here. It'll be tougher, but if you were one of the 'naturally' slim types, it helps. Again, you'll probably have to make some lifestyle changes, but you will be able to get off the weight.
(3) Weight gain due to medication. I think we all know about steroids (my late father was put on a course of them and ballooned up, even though he wasn't eating more) and there are other medications with the same side-effects. It's difficult for people who gain weight like this, because they treated like the rest of us greedy lazy porkers, and get the "oh that's only an excuse" response unless they pull out the prescription to prove what they are saying is true, and who wants to have to reveal that *ackshully*, I'm on anti-psychotics which is why I'm stuffing my face with carbs?
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00500-9/fulltext
Hard case here, since once you don't need to take the meds anymore, you will go back to your natural weight - unless of course you need to constantly be on psych meds, which means increased appetite/weight gain, which gets you the "just have some WILLPOWER" argument from everyone.
(4) And last, the rest of us fat, lazy, greedy slobs with no willpower who just stuff our faces with junk food and never get up off our idle behinds and just go for a walk or something.
The gluttons. The "why don't you just have some WILLPOWER?" people. The "diet and exercise, you moron, never heard of that?" folks.
And you know, there is something to that. Yes, we eat too much. Yes, we don't exercise enough. But, like the anecdote related in Dante, when the bishop asked his servant "What do the people say of me?" "Your Grace, that you are always drinking" "Ah yes, but I am always thirsty" - we're always hungry.
Scott mentioned a few years back examples of patients who suffered from unrelenting thirst, who had to be monitored with their fluid intake or else they would literally drink themselves to death, and even when they got enough to drink would still feel thirsty.
Nobody is going to condemn someone who is guzzling pints of water "Just have some WILLPOWER!", because they realise that's not normal and is indicative of a problem.
Now, for the likes of us that are always hungry and never feel full, even when "but I just ate a full meal a couple of hours ago, I shouldn't be feeling hungry", it's hard. Because yeah, you can visibly see we are gross landwhales. And yes, we are leeching the health services normal people should be using with our horrible diseases of obesity that are all our own fault. And yes, calorie-laden tasty modern processed foods, and yes sedentary lifestyles, and yes over-eating and being greedy, and yes diet and exercise work to a degree, and yes "why don't you just have some WILLPOWER?" and get used to feeling pangs all the time. And yes, "I'm big-boned/it's my glands/it's PCOS/it's a response to trauma" do get used as excuses. Yes to all of that, yes I admit we do contribute to our own problems. Having said that:
Do you really think it's a simple problem of NOT ENOUGH MORAL FIBRE once people are desperate enough to have the likes of this done in order to lose weight?
https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
"Roux-en-Y (roo-en-wy) gastric bypass. This procedure is the most common method of gastric bypass. This surgery is typically not reversible. It works by decreasing the amount of food you can eat at one sitting and reducing absorption of nutrients.
The surgeon cuts across the top of the stomach, sealing it off from the rest of the stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Typically, the stomach can hold about 3 pints of food.
Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. Food then goes into this small pouch of stomach and then directly into the small intestine sewn to it. Food bypasses most of the stomach and the first section of the small intestine, and instead enters directly into the middle part of the small intestine.
Sleeve gastrectomy. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can't hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen the desire to eat.
Advantages to this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than do most other procedures.
Biliopancreatic diversion with duodenal switch. This is a two-part surgery in which the first step involves performing a procedure similar to a sleeve gastrectomy. The second surgery involves connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing the majority of the intestine.
This surgery both limits how much you can eat and reduces the absorption of nutrients. While it is extremely effective, it has greater risk, including malnutrition and vitamin deficiencies."
Reading those comments, they resonate with me. Constantly eating, never feeling 'full', eating until so stuffed I might throw up, And I've tried diets and they've worked - for a time. Then I plateau at a certain weight, and something happens (the last, most successful diet, I got swine flu then the weather was so unseasonably bad I couldn't go out for exercise) and I fall off the wagon and put all the weight back on.
So yeah, maybe all I need is some WILLPOWER, can you tell me where I can obtain a shot of that, because I don't manufacture enough myself? And that's where the "moral failing" angle of the condemnation of the overweight comes in - if we just gritted our teeth and scrunched up our eyes and *willed* hard enough, we could do it!
I don't know if this new drug *is* a miracle cure for weight loss, I think like all new treatments it is being hyped out of enthusiasm. Once it settles down, I think it's more likely to be at the 60% end of the successful treatments scale. And this is something you have to take forever, or else you will put the weight back on. And there probably will be some people for whom it doesn't work - I've had at least two medications prescribed where I was told that a side-effect was weight loss so that would help me, and no, it didn't happen at all.
So yeah, "CICO" - but that's simple. Why people consume a heck of a lot more CI than expend CO is the hard part to solve.
This doesn't respond to most of your very valid points, and it's definitely not meant as a "just exercise more" response, nor to suggest it will solve all your weight problems, but I think it is likely to be more effective and metabolically helpful than most forms of workouts: have you looked into Zone 2 exercise? Peter Attia has a number of podcasts and videos on it, and it's the central plank in his treatment of patients with metabolic disorders.
Briefly, zone 2 exercise is low intensity exertion which stays just within the energy regime at which the mitochondria in muscle cells can burn fat to supply the fuel they need. By training within that zone, not only are you specifically burning fat, but you are also training your mitochondria to be more effective at utilizing fat and less dependent on glucose, thus improving your overall metabolic health.
A simple way to try it is to get a cheap used rowing machine or exercise bike, set it up in front of the TV or computer, and ride them for 45 minutes to an hour at the intensity level that lets you still just barely breathe through your nose or maintain a conversation. Aim for at least 3 hours a week; more is better.
I'm surprised that you, usually a defender of religion and traditionalism, would have such a view on willpower. This isn't a criticism--when people are too predictable in their views, I tend to wonder if they ever think for themselves.
Isn't gluttony one of the seven deadly sins? Sin is part of the human condition, and the seven deadly sins are remarkable for their mundaneness: probably every person who ever lived has been guilty of all of them on a regular basis. But that doesn't mean societies (and not just Christian ones!) don't or shouldn't blame people for being lazy, angry, greedy, arrogant, or gluttonous. The purpose of the blaming and shaming is to discourage the sin by imposing a social cost. Just willpower alone may not be enough for someone to not have bursts of rage or to not eat to excess, but the combined effect of willpower and social disincentives might be enough to make people relatively healthy and well behaved. And so, in moderation, fat shaming is good in the same way that small amounts of sloth-shaming and wrath-shaming are good.
"I'm surprised that you, usually a defender of religion and traditionalism, would have such a view on willpower."
Oh ho, friend! What do you think I am, a Pelagian heretic?
We can do nothing of our own will to be freed from sin, we need the help of grace. Gluttony is a sin, but willpower alone won't free you from that sin.
I haven't enough willpower natively, I need the injection of it from outside to help me . Shaming people and blaming people is not that help.
What works?
Semaglutide, apparently
God alone knows. If I were a totally different person with a totally different personality, maybe I would love exercise, or be able to muster willpower to only eat three slices of carrot and six heads of steamed unbuttered unoiled unsauced* broccoli for every meal.
*I mean white sauces like bread sauce, parsley sauce, cheese sauce, onion sauce, etc . The ones made with flour and butter and hence Bad For You.
"We can do nothing of our own will to be freed from sin, we need the help of grace. Gluttony is a sin, but willpower alone won't free you from that sin."
My theology is rusty, so forgive me if I'm wrong, but aren't we supposed to at least try? No Christian I've met has ever said "don't worry about it and sin as much as you want, because God will forgive you". At the very least they stress repentance, which doesn't sound very different from accepting blame--and when done publicly, it's not very different from shame.
> there are literally money-saving ways to lose weight
Too bad you didn't mention them.
Eat less, cook instead of ordering takeout, walk instead of bus, bike instead of car, etc.
"Eat less, cook instead of ordering takeout, walk instead of bus, bike instead of car, etc."
Excuse me while I rock in my chair, laughing.
In my 30s-40s I was one of the fittest fat people you'd ever meet. I can't drive, and there isn't a bus service in my town, so I walked everywhere I needed to go. Sometimes I'd cycle. That was my entire life, pretty much (if I needed to go somewhere further than my local town, I'd get the intercity bus or a lift from a family member with a car).
I had tree-trunk calves from about the age of twelve from all that cycling and walking and carrying things while I walked. Did it make me lose weight? No, I was still podgy of body and pudgy of face. But I was *fit*.
So yeah, "just exercise more and it'll drop off" was always a source of amusement to me. I once, due to a screw-up in getting paid, while living away from home spent an entire week living on soup once a day and (of course) walking everywhere. I was at the point of fainting into bed at night, but the one bright spot was that surely I'd lose *some* weight.
Guess what? No. Maybe a pound or two, but nothing significant. My body was grimly hanging on to the fat reserves come hell or high water. The biggest disappointment of my life, but the reality of what the hell my metabolism is and I don't know why. I keep being told my thyroid levels are fine, but I don't know.
I have a theory people vary in their ability to take fat out of storage and use it for energy.
Yeah, I think the actual pill we need is: "convince the fat cells to release their energy into the bloodstream".
[speculation] In men it's mostly testosterone levels. It signals the body to both repair+increase the muscle mass AND not to burn muscle for energy when on a calorie deficit. Some people will never be lean as their bodies prefer shedding muscle before burning fat.
There's also probably some other factor regulating this behavior. IIRC there's a yet unexplained effect of anabolic steroids that makes fat burning more predominant even beyond what would be accounted by the muscle gain. It could be that steroids activate what naturally lean people have going.
Did you grow up food-insecure? Because this sounds pretty in line with the 'thrifty phenotype/epigenotype' hypothesis: your body is hanging on to those fat reserves because experience has told it that reliable access to food is not something it can take for granted. Maybe the hunter gatherer lifestyle that it's adapted for needed all that fat when it was living on raw tubers and bugs for months on end, and it doesn't think a week on soup is an emergency worth burning more than two pounds of fat for.
I wouldn't say that, but there is obesity on one side of the family, so you tell me if it's genetics or what at work.
Also Irish, so... descendant of the people who *didn't* die in the Famine? 😁
Some of it is environmental/genetics, but some of it must be bad habits and no willpower, since I have a sibling who has the opposite problem (they get stressed and stop eating and over-exercise and are always skinny; I get stressed and comfort-eat).
Tangential to your main point (that one can't really lose weight by pure exercise), which so far as I know is quite accurate, I thought it might be worth mentioning that a pound or two is a pretty significant weight loss for a week.
1 lb = 3500 kcal, so if you actually lost 2 lb = 7000 kcal that implies a deficit of 1000 kcal/day, which would be very noticeable indeed. The basal metabolism demands for a 5'4" female age 35 at 135 lb is ~1400 kcal, and walking tends to burn ~200-350 kcal/hour, so to run a 1000 kcal deficit daily one would have to cut the usual ration by two thirds, walk 3-5 hours a day, or some combination of both -- pretty harsh.
I think Gary Taubes in one of his many diatribes against calories in/calories out points to some empirical evidence that if people exercise they almost always boost their intake more than enough to compensate for the calories burned, because exercise makes you hungrier of course.
No, the first weight you lose is water weight. It's easy to 'lose' weight like that, but it's not shifting fat. I was disabused of that the first time I had stuck to a diet (as advised by my doctor to go on a diet), lost a stone, and went back to report all pleased with myself.
Doctor told me that was just water weight, I hadn't really lost fat, and I would have to continue on a lot longer to really start losing weight.
So living on a bowl of soup and lots of water per day for a week got rid of some of that water weight, but didn't kick off the fat-burning. And of course once I got my money sorted out and could buy food, I went back to eating normally so naturally no weight loss. If I stuck to "one bowl of soup a day" for a month, then maybe real fat-burning weight loss would have happened.
The amount of water (and of (literal) shit) in your body can fluctuate by more than a pound or two -- you're better off treating the last digit of your weight as a random number generator. See _The Hacker's Diet_.
I don't even have a car or a bike, and since covid I also started avoiding buses. I walk to my work for 40 minutes.
I admit I could work harder about the eating less part.
The meta-point about the traditional advice is that either you need to do it 100% right and mere 90% gets you nowhere (possible, but then it would be nice to admit that following the advice is harder than it seems), or just one part of it is the real advice and the rest is bullshit (also possible, but then please stop telling the bullshit parts).
Let me fix that failure here:
<< reposted from other comment >>
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family.
2. Replace carbs in your dinner with fat/protein. Eat as early as possible, eat as much as you want. Don't eat bedtime snacks.
3. Over time, extend the time from ending dinner (your "fast" length) til the next time you eat (breakfast? 12:30 lunch? 2:30 lunch?) as much as possible. Eat the next day when you're hungry, but if you're only feeling kinda hungry try drinking a zero-cal electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories a day is impossible. Measuring that you ate 10 minutes later is easy. Don't put any sugar or carbs in your morning drinks.
4. Eventually cut out breakfast or lunch, or eat later lunch. Just like dinner, replace carbs with fat/protein as much as possible. Whatever feels okay.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale.
Hey you have described your weight loss system multiple times here. I think readers get it. You sound like you think the reason we're not all converts is that we do not understand your system, and need to hear it explained again. In fact, people are telling you multiple reasons why things along these lines have not worked for them, and/or multiple reasons why they believe such things generally do not work for many people over the long run. Are you giving any thought to all this testimony and all these ideas?
"Are you giving any thought to all this testimony and all these ideas?"
Absolutely, previous people's testimony and experience (of which all of the versions given in this thread are a subset - not as a critical judgment of them, just that diet advice almost always fails in relatively predictable ways) is the reason this is my plan, instead of being traditional stuff like weight watchers calorie restriction.
"Hey you have described your weight loss system multiple times here. "
Well, not to be rude, but if you're describing it as a weight loss system, then I haven't explained it well, because it's not a weight loss system, it's a "increase healthiness system" and I posted it here because I think focus on specifically weight loss via semiglutides or surgery is part of the problem.
"In fact, people are telling you multiple reasons why things along these lines have not worked for them, and/or multiple reasons why they believe such things generally do not work for many people over the long run."
To be very specific, no one I've seen so far (maybe I missed it) is saying they have tried something like this and failed, (whereas I personally have succeeded, and know dozens of other real live people whose testimony is that it works) and the "such things" they present are often critically different in major ways that are also exactly the reason I present this strategy as an antidote to them. You're essentially saying "well, all these other people have tried such things like, leeches and balancing bodily humors, why do we expect your plan to take antibiotics to work?" Maybe I'm arrogantly assuming my method is superior, but it was created (not by me!) precisely to incorporate what you're saying - the testimony of millions of people saying that previously recommended "diet" advice didn't work. The key is in the "what" is being recommended, and whether it goes against the grain of how we understand humans and their metabolisms to function.
Additionally, when people are saying "diet advice X didn't work for me" in this thread, in every case they have cited weight. This is the part I want to repeat more than my strategy: don't measure success on the scale. You can't timetravel to see if you get diabetes 25 years from now, you have to get bloodwork done, or you have to read all the papers describing the other markers you can see to detect a healthier metabolism, or get a continuous glucose monitor, or you have to take my word for it. (This cost of this measuring indeed a major failure point of my plan, which you should critique)
OK, Brian, I have tried it and failed, and by failed I mean not simply that I did not lose weight, but that I did not stick with the plan. I had been reading about carbs, and how processed carbs and sugar do not really satisfy and you make you crave more of them. So I planned to follow a regimen of eating nothing sweet except fruit, not much refined flour & the like, and lots of protein, fruits and veggies. I did not avoid animal fat. I am a vegetarian, but ate lots of sharp cheddar, an animal fat favorite of mine. I did not count calories. I was not solely focused on losing the 20 pounds I wish I were not carrying, but of course that was on my mind. It is simply impossible not to care about that. And I did deviate from the approach you describe in that I did not make insanely delicious meals that gave me deep satisfaction. I absolutely hate cooking, and am simply not willing to take much time away from activities I value in order to do awesome cooking.
I have stuck with the no-sugar part for several years now, and find that cookies etc. are no longer calling my name when I'm in a bakery. However, I have not stayed with lots of fruits and veggies, I have slid back into eating simple carbs, things like slices of white bread, because I like them and they're easy to grab . And I never did do the part of preparing wonderfully palatable meals. The things that have kept me from sticking to my plan are things like this:
-Most vegetables are not pleasant to eat unless you chop them up and put a nice dressing on them, or cook them. I hate doing food prep. If I'm busy, tired, or preoccupied with something else important to me cooking is the first thing to go.
-I default to eating lots of cheddar cheese and little else -- because I'm out of fruit, and the veggies I have need prep to be bearable. I got busy and did not shop.
-I get busy doing something important to me, miss a meal, then am so hungry I grab whatever's handy that I can stand -- cans of cashews, lumps of cheese, fried stuff from Uber eats.
Obviously I *could* have done other things at those times. I could have made a salad or cooked the veggies or made an awesome delicious meal. I could have shopped more often so there was more healthy stuff in the house. I could have not let myself get so hungry. But it is an illusion that knowing that makes it likely that in the future one will act differently. The same factors that led to suboptimal eating in the recent past are all going to be there in the near future. Habits are hard to break, and the breaking of them draws on the same limited pool of energy and self-monitoring capacity as all the other things we need to accomplish. Eating is a simple pleasure and doing it provides a break from life's demands. Turning it into something that must be done a certain way both reduces the amount of simple pleasure in the day and also adds a new demand. That's a hard sell. There may exist some heaven of healthy eating, zero minutes per day of craving things that are unhealthy, and amazingly delicious meals that satisfy the living daylights out of a person, but then again there may not, for all of us. And even if it does exist, getting there is no easier than accomplishing lots of other goals we have for our careers and relationships, and far more dispensable.
isn't the way that semaglutide works is by making you feel full and satiated after eating? of course you need to be changing your diet -- if you continued eating the same way, you wouldn't be able to lose any weight. the hard thing about losing weight is that your body will do anything it can to make you eat the calories you're trying to avoid (and will hold on to the fat it already has, although that can usually be overcome with enough time). the brilliance of this drug is that it basically helps you stick to a diet.
IMO exercise doesn't actually help you lose weight anyway except insofar as it helps you build muscle, which makes your metabolism higher, but it's a good thing that people should do regardless.
You're spot on, on both diet and exercise.
re: diet, I think semiglutide might being affecting your metablism too - hence its use as diabetes drug, but I'm not educated enough to know for sure.
re: exercise, yes, it may not make you lose weight (in fact I think you should gain weight, if you're doing strength training) but it makes you healthier.
And to dovetail both: we want to be healthier metabolically, that is the goal. Weight is just a symptom that we only care about as potential signal.
This jives with my experience on the drug earlier this year. I was on living primarily on pre-made keto meals and after starting on semaglutide I felt like it was too much food for a setting, switched to a lower cal option. When shortages of the drug caused me to miss a few weeks, the lighter meals were quickly noticed as not-satiating.
While this is technically true, there are a *lot* of things that would be unnecessary if everyone in the world always made good decisions and showed perfect discipline at all times and experienced no akrasia at all. That world would look extremely alien to the one we actually live in.
Given that we live in a world of imperfect willpower and decision making, finding ways to mitigate the consequences of those failures is both important and valuable.
I will say, though, this is one of the areas where I feel like government intervention may be warranted, or at least could have good outcomes. I don't think people would suffer if there was a tax on fat and sugar above a certain point on all foods such that all their food choices were healthier.
My quality of life drops sharply if I don't eat a fair amount of fat, possibly more than some theory of health would permit.
Wait, I've got an idea. Let's put everyone on the diet-that-can't-fail. Then, we can piggyback all the other things people have trouble sticking to onto it, like ornaments onto a Christmas tree: Every time you have a proteiny meal, write down a work goal for the next few hours -- productivity solved! Every time you lose a pound, pay any unpaid bills -- budgeting solved! Every time you lose 5 pounds, spend an afternoon working on that great idea you had that you've been procrastinating on fleshing out -- getting rich and famous solved!
Nope. It is the semaglutide. See my comment below for details. I lost 20% of my weight (55 lbs) in 14 months. I did not change what I ate (good fresh home prepared food) or how much I exercise (mostly an hour a day of walking). I just ate less of the same stuff.