8 ms·

Research shows that nothing doctors recommend has any effect on weight loss except bariatric surgery. This has been shown over and over again in every study. Do

by cm2012 5y ago

Research shows that nothing doctors recommend has any effect on weight loss except bariatric surgery. This has been shown over and over again in every study. Doctor moralizing is pointless, people know they are supposed to be eating right. Every legitimate long term study of non surgical weight loss shows that it doesn't happen for the vast, vast majority of people. 1) ["In controlled settings, participants who remain in weight loss programs usually lose approximately 10% of their weight. However, one third to two thirds of the weight is regained within 1 year, and almost all is regained within 5 years. "](http://www.ncbi.nlm.nih.gov/pubmed/1580453 http://www.ncbi.nlm.nih.gov/pubmed/1580453) 2) Giant meta study of long term weight loss: ["Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3% of initial body weight."](http://ajcn.nutrition.org/content/74/5/579.full http://ajcn.nutrition.org/content/74/5/579.full) 3) Less Scientific: [Weight Watcher's Failure - "about two out of a thousand Weight Watchers participants who reached goal weight stayed there for more than five years."](https://fatfu.wordpress.com/2008/01/24/weight-watchers/ https://fatfu.wordpress.com/2008/01/24/weight-watchers/) 4) [The reason why it's impossible seems to be that although calories in < calories out works, the body of a fat person makes it extremely difficult psychologically to eat less.](http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope- http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-...) This is borne out by the above data. 5) [The only thing that does seem to work in the long term is gastric surgery.](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/) Moreover, you won't find any reputable study on the web where the average person lost 10%+ of their body weight and kept it off for five years. Not even one.

ellyagg 5y ago
The problem with studies like these is you only need to know one person who contradicts the claim to know that it's false as an absolute. And I know several. It more points to the limitations of studies like these than it does an incontrovertible fact. Some people who are highly internally motivated can lose weight and keep it off.
- NineStarPoint 5y ago
  Ignoring the possibility that people have different physiologies that react to these things differently: We’re not dealing with machines, we’re dealing with humans. If only 5% of people are capable of following the advice then we need to find a better method. It could be any number of things that need to be changed, but just telling people to do x and y the way we currently are clearly isn’t working.
rdmirza 5y ago
This is no longer true. The GLP1s have proven to have excellent efficacy for weight loss (and cardiovascular mortality in diabetics). Their numbers approach bariatric surgery (>10% body weight in the obese). People keep the weight off too. Here's one study showing 5kg on average weight loss at 5 years according to this study: https://www.mdpi.com/1660-4601/17/1/207/pdf https://www.mdpi.com/1660-4601/17/1/207/pdf
boublepop 5y ago
There are products and studies now with Liraglutide and semaglutide, which show consistent and maintainable weight loss, but neither has been on the market for 5 years yet afaik, and the longest study only ran for 2 yearsit seems. Though it seems likely sustainable results from a 2 year study will hold for 5 years. https://www.europeanpharmaceuticalreview.com/news/165203/wegovy-demonstrates-sustained-weight-loss-in-two-year-obesity-study/ https://www.europeanpharmaceuticalreview.com/news/165203/weg...
eyeball 5y ago
It would be nice if there were a drug to counteract the changes that make it so hard to keep weight off. Losing it is easy. I’ve lost 100lbs five times in my life. It’s fucked.
- nradov 5y ago
  No drug can ever substitute for a permanent lifestyle change.
  - jfengel 5y ago
    Permanent lifestyle change is never easy. It would be great if it were a one-time thing that you could be done with, but for most people, it's a constant mental strain for the rest of their lives. It's not impossible; some people do it. But it's not easy to change how you think about food and your body, especially when you're surrounded by your old habits every day.
    - nradov 5y ago
      Nothing worth having comes easy. https://davidgoggins.com/book/ https://davidgoggins.com/book/ https://suereynolds.net/journey-history/ https://suereynolds.net/journey-history/
  - eyeball 5y ago
    I’m talking about irreversible physiological changes caused by getting fat that don’t reverse after you lose weight. This is what makes keeping weight off after losing a bunch harder than maintaining the same weight if you’ve never been fat to start with. Things like damage in the hippocampus preventing normal leptin signaling. Once you’ve gotten fat, you’re pretty much fucked for life, even if you reverse the behaviors that got you there. https://www.stephanguyenet.com/thehungrybrain/ https://www.stephanguyenet.com/thehungrybrain/
    - nradov 5y ago
      That's mostly pseudoscience.
WalterBright 5y ago
My dad developed a spare tire in middle age. His doctor sent him to a nutritionist, who listlessly gave him a nutrition plan and explained it to him, and scheduled a followup in 3 months. He returned in 3 months, and shocked the nutritionist is he was exactly on the target weight and had followed the plan. She remarked that nobody had ever followed her plans before. He never regained the weight. I've seen statistics that only 5% of dieters keep the weight off more than 5 years. It's not impossible, but it is unusual. I've known a couple others who've done it, too.
- giardini 5y ago
  I developed a spare tire at 20 and it persists stubbornly despite quite strenuous exercise. Could you share your dad's diet?
  - joeman1000 5y ago
    I’ve been struggling for years too in my 20s. I suggest reading ‘The Hackers Diet’ by John Walker. It gives you a systems view of diets. The most useful insight for me: setting a weight loss goal based on the fact that a kg of fat is 37 MJ of energy. Want to lose a kilogram a week? You have to make up that 37 MJ deficit then. Ie. I need ~13 MJ of energy per day to subsist (calculated using an online tool). I subtract (37/7 = 5.3) from that daily energy requirement and arrive at 7.7 MJ per day that I can eat. I stick to that intake goal EVERY SINGLE DAY and I lose weight. It helps to keep punching your small energy intake amounts into a calculator (phone or watch) and keeping a running total that way. I’ve gone from 92 to 84 kg in a couple of months and it’s not that hard. Strenuous exercise doesn’t really do much when your energy intake is way too much to begin with. It all starts with the intake. Exercise actually doesn’t burn much energy at all.
  - prirun 5y ago
    Stop eating carbs: bread, crackers, pasta, cereal, fruit, juice, potatoes, sugar, starchy vegetables like beans, peas, corn, no sodas, no alcohol. Once you are at your target weight, you can go back to eating the things that are nutritious, but no junk. If combined with a confined window of eating, like 11am to 5pm, you'll lose weight faster.
throwawaycities 5y ago
One interesting thing about obesity and bariatric surgery is the changes in the microbiome. The following comes from a study on T2D reversal where bariatric surgery was one aspect of the study: “Furthermore, microbial changes in the human gut have been linked to obesity, and surgical alterations to gastrointestinal anatomy have been associated with dramatic changes in gut microbiota populations with reversion from an “obesogenic” to a lean bacterial population [13,14,16,19,23,24].” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/ It’s a relatively new science and area of study but some of it is fascinating if not hopeful. One in particular looked at identical twins where only 1 suffered from malnutrition finding in all such cases the microbiomes were different between the twins and the malnutrition was successfully treated via the microbiome.
Turing_Machine 5y ago
Well, you're going against billions of years of evolution that say "Eat everything you can and put on some extra weight. There might not be any food tomorrow." Unfortunately, in modern times the days of short rations never come, at least in First World countries. That drive functions at a neural level way below the level of the rational mind. People often make poor choices vis-a-vis sexual activity, too, and for much the same reason.
- adrianN 5y ago
  The old drive to eat anything meets an industry of chemists who spend their lives making the food on the shelves as addictive as possible. It's relatively hard to become morbidly obese without snacking on highly processed food all the time.
  - Turing_Machine 5y ago
    By making it "as addictive as possible" you mean "tastes good"?
    - adrianN 5y ago
      Yes, but not exclusively so. A key ingredient to really addictive food is also that it's not very filling and easy to eat.
- deanCommie 5y ago
  Most of us under 40 were still raised in cultures where our parents grew up immediately after the war. The concept of "finishing your plate, whether you were full or not" was universal - precisely because their parents remembered shortages. They passed it on to us before there was a chance to introspect the nutritional and psychological realities of food. My partner and I are both overweight and we are trying to do a better job with our child - giving them healthy but delicious options, while also not turning any junky food into a reward or a mystery that must be guarded or doled out in careful portions. So far, we're okay. Not sure how this is going to last once the kid gets into school age...
pizza234 5y ago
I'm more or less in the ballpark of 10% of weight lost and maintained in a timeline of 5+ years (although weight is always in flux). I have no genetic gifts - I must keep an eye on the nutrition and training; otherwise, my weight slowly goes up. If I saw people permanently ban junk/fat/sugary food from their homes, do at least 3 hours/week of complete training (weights and cardio), and not being able to stay fit, I would believe that weight loss/being fit is a serious physiological and psychological challenge. What I observe though, starting from mid-30s, is that the vast majority of people keeps junk food at home (which is, no wonder, "extremely difficult psychologically" not to eat) and/or doesn't do traning (let alone complete training). And invariably blames it on genetics and aging. (I don't doubt that there is a minority of the people that has serious metabolic disorders, but that's not the general case)
- cm2012 5y ago
  You should carefully read what I wrote in the context of the parent comment, and see why your comment is not adding anything to the conversation. In other words, if you're a doctor, go ahead and tell all your patients the above. You will see negligible impact on their weight, so your advice was useless (worse than useless, since you come across as an asshole). As an aside, conscientiousness/willpower is highly heritable (as much as height and IQ), so if you're especially good at sticking to a diet, that's also genetics.
  - oaktrout 5y ago
    If it works for 5% of people it is by definition not useless. Bariatric surgery is not without its risks, and I would rather weed out the 5% who respond to the low risk approach before exposing them to the risks and long term side effects of bariatric surgery.
    - cm2012 5y ago
      5% is really generous in the data I've seen and posted above, and I've never seen any positive data on just advice. Maybe the data on what happens if you call your patients weak willed losers would surprise us all, but I doubt it.
scythe 5y ago
[1] is from 1992, [2] is from 2001. [3] evaluates a bad program[fuller2014] based on a worse metric. You find different things in more recent research, e.g.: https://www.nature.com/articles/ijo201094 https://www.nature.com/articles/ijo201094 >More than one out of every six US adults who has ever been overweight or obese has accomplished LTWLM [1y] of at least 10%. review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/ As far as the doctor's advice is concerned, focusing on weight loss as the sole outcome is misguided. The typical trajectory of an obese individual is to keep gaining weight; if doctors could even make their patients stop gaining weight, that would already be a major development in standards of care. It's also important to consider the limitations of the metric. Studies don't evaluate sustained cultural shifts like "do doctors regularly talk to the patients about nutrition", because it's hard enough to track a patient for five years, let alone get a doctor to do blinded controlled interventions for five years. So what the study tests is a controlled diet for a short period followed by a period of unsupervised maintenance (with a recipe book), not the consistent availability of nutrition guidance over a period of years. It's perhaps more important to note that while the results in adults are quite bad, it has been shown possible for adolescents to drop by more than a standard deviation in BMI after an intervention and maintain this for two years: https://www.sciencedirect.com/science/article/pii/S0022347607009560 https://www.sciencedirect.com/science/article/pii/S002234760... https://www.sciencedirect.com/science/article/pii/S1054139X13002383 https://www.sciencedirect.com/science/article/pii/S1054139X1... Professional interventions for weight loss and/or maintenance aren't infeasible, they're just hard, and it pays to start early. It's not too surprising that older people are more reluctant to change their habits. [fuller2014]: Finds that Weight Watchers underperforms standard national guidelines: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282338/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282338/
- cm2012 5y ago
  1 year data is a lot more variable, 5 year data is still grim. Not to mention this hasn't changed in modern times - even with all the focus on health in modern culture, obesity keeps rising and rising: https://www.cdc.gov/nchs/images/databriefs/351-400/db360-fig4.png https://www.cdc.gov/nchs/images/databriefs/351-400/db360-fig... Those studies on adolescents is heartening though.
oaktrout 5y ago
"Research shows that nothing doctors recommend has any effect on weight loss except bariatric surgery." Source 2 that you posted contradicts that statement, and notes that the average person was successful in maintaining some weight loss (about 3%, or 7lbs). That means that about 50% of people are able to maintain a weight loss of greater than 7lbs 5 years after a structured weight-loss program. Source 1 seems to be from a conference, and they don't list specific numbers or cite sources, so I have no idea what "almost all" means. "5) [The only thing that does seem to work in the long term is gastric surgery." That study says that gastric surgery works, it says nothing about the other methods for weight loss.
deanCommie 5y ago
The moralizing about food and diet is similar to the moralizing about drugs and addiction: "Just lock up all the homeless drug addicts in rehab for 3 months, and they'll get clean. Problem solved!" Right, except they'll still be homeless, poor, mentally unstable, or all of the above. Drug use is often the symptom, not the root cause. It's similar with food. For many people, food becomes the primary source of joy in life. And just like with drugs, the joy shrinks, the high gets shorter, and the health side effects soon start outweighing the benefits. But it's still quite hard to go cold turkey, and just like a recovering addict, even years after establishing a healthy diet it becomes really easy to fall off the wagon. We can moralize about how starving children in africa have things much worse, but human happiness is contextual to the reality we know. And life in modern western society has a lot of pitfalls, anxiety, and depression. Obesity is in many ways a side effect of people's lived experience.
krzat 5y ago
I am someone who lost 10% and kept it. If there are no studies on people like me, then no wonder why doctors are so bad at treating obesity.
- cm2012 5y ago
  Probably 5000 people read this comment chain. It's bound to happen for some people.
  - krzat 5y ago
    My point is that nobody is doing research on effective weight loss, so it's not surprising that doctors can't deal with it. Giving a diet plan for weight loss is basically an equivalent of giving an exercise plan for depression.
masonic 5y ago
>Research shows that nothing doctors recommend has any effect on weight loss except bariatric surgery. This mostly reflects on what doctors recommend rather than blanket discipline failure across a broad population. I can tell you what my local Kaiser recommended for T2D and obesity: 1) they send you to a Registered Dietician who shows you a modernized food pyramid based heavily on grains. Minimize animal fats, replacing with seed oils. 70% calories as carbohydrate. 2) MD flat tells you "you MUST eat 6 small meals a day so you never get hungry." What was done instead: Time Restricted Feeding, 4-6 hour window, low carb, limiting to mostly keto first half of window. A1C dropped over 3 points (10.3 to 7) by next labs.
- imtringued 5y ago
  >1) they send you to a Registered Dietician who shows you a modernized food pyramid based heavily on grains. Minimize animal fats, replacing with seed oils. 70% calories as carbohydrate. Crazy, that's what I would recommend if you want to become obese. >2) MD flat tells you "you MUST eat 6 small meals a day so you never get hungry." I guess that MD really wants his patients to become insulin resistant and eventually develop diabetes.
imtringued 5y ago
You can't loose weight with the current food system unless you completely abandon it. It's literally impossible based on how the body works. Fad diets and weightloss programs don't work. You must address the problem at its root: How to deal with hunger. This is a hormonal problem. Everything (hyperbole) you can buy in a supermarket is meant to make you feel full for an hour and then hungry again. An alternative to surgery would be to just to continuously monitor blood glucose. The patient would immediately know when the food they are eating is messing up their body and the doctor can control the diet of the patient.

by cm2012 5y ago

ellyagg 5y ago

The problem with studies like these is you only need to know one person who contradicts the claim to know that it's false as an absolute. And I know several. It more points to the limitations of studies like these than it does an incontrovertible fact. Some people who are highly internally motivated can lose weight and keep it off.

NineStarPoint 5y ago
Ignoring the possibility that people have different physiologies that react to these things differently: We’re not dealing with machines, we’re dealing with humans. If only 5% of people are capable of following the advice then we need to find a better method. It could be any number of things that need to be changed, but just telling people to do x and y the way we currently are clearly isn’t working.

rdmirza 5y ago

This is no longer true. The GLP1s have proven to have excellent efficacy for weight loss (and cardiovascular mortality in diabetics). Their numbers approach bariatric surgery (>10% body weight in the obese). People keep the weight off too. Here's one study showing 5kg on average weight loss at 5 years according to this study: https://www.mdpi.com/1660-4601/17/1/207/pdf https://www.mdpi.com/1660-4601/17/1/207/pdf

boublepop 5y ago

There are products and studies now with Liraglutide and semaglutide, which show consistent and maintainable weight loss, but neither has been on the market for 5 years yet afaik, and the longest study only ran for 2 yearsit seems. Though it seems likely sustainable results from a 2 year study will hold for 5 years. https://www.europeanpharmaceuticalreview.com/news/165203/wegovy-demonstrates-sustained-weight-loss-in-two-year-obesity-study/ https://www.europeanpharmaceuticalreview.com/news/165203/weg...

eyeball 5y ago

It would be nice if there were a drug to counteract the changes that make it so hard to keep weight off. Losing it is easy. I’ve lost 100lbs five times in my life. It’s fucked.

nradov 5y ago
No drug can ever substitute for a permanent lifestyle change.
- jfengel 5y ago
  Permanent lifestyle change is never easy. It would be great if it were a one-time thing that you could be done with, but for most people, it's a constant mental strain for the rest of their lives. It's not impossible; some people do it. But it's not easy to change how you think about food and your body, especially when you're surrounded by your old habits every day.
  - nradov 5y ago
    Nothing worth having comes easy. https://davidgoggins.com/book/ https://davidgoggins.com/book/ https://suereynolds.net/journey-history/ https://suereynolds.net/journey-history/
- eyeball 5y ago
  I’m talking about irreversible physiological changes caused by getting fat that don’t reverse after you lose weight. This is what makes keeping weight off after losing a bunch harder than maintaining the same weight if you’ve never been fat to start with. Things like damage in the hippocampus preventing normal leptin signaling. Once you’ve gotten fat, you’re pretty much fucked for life, even if you reverse the behaviors that got you there. https://www.stephanguyenet.com/thehungrybrain/ https://www.stephanguyenet.com/thehungrybrain/
  - nradov 5y ago
    That's mostly pseudoscience.

WalterBright 5y ago

My dad developed a spare tire in middle age. His doctor sent him to a nutritionist, who listlessly gave him a nutrition plan and explained it to him, and scheduled a followup in 3 months. He returned in 3 months, and shocked the nutritionist is he was exactly on the target weight and had followed the plan. She remarked that nobody had ever followed her plans before. He never regained the weight. I've seen statistics that only 5% of dieters keep the weight off more than 5 years. It's not impossible, but it is unusual. I've known a couple others who've done it, too.

giardini 5y ago
I developed a spare tire at 20 and it persists stubbornly despite quite strenuous exercise. Could you share your dad's diet?
- joeman1000 5y ago
  I’ve been struggling for years too in my 20s. I suggest reading ‘The Hackers Diet’ by John Walker. It gives you a systems view of diets. The most useful insight for me: setting a weight loss goal based on the fact that a kg of fat is 37 MJ of energy. Want to lose a kilogram a week? You have to make up that 37 MJ deficit then. Ie. I need ~13 MJ of energy per day to subsist (calculated using an online tool). I subtract (37/7 = 5.3) from that daily energy requirement and arrive at 7.7 MJ per day that I can eat. I stick to that intake goal EVERY SINGLE DAY and I lose weight. It helps to keep punching your small energy intake amounts into a calculator (phone or watch) and keeping a running total that way. I’ve gone from 92 to 84 kg in a couple of months and it’s not that hard. Strenuous exercise doesn’t really do much when your energy intake is way too much to begin with. It all starts with the intake. Exercise actually doesn’t burn much energy at all.
- prirun 5y ago
  Stop eating carbs: bread, crackers, pasta, cereal, fruit, juice, potatoes, sugar, starchy vegetables like beans, peas, corn, no sodas, no alcohol. Once you are at your target weight, you can go back to eating the things that are nutritious, but no junk. If combined with a confined window of eating, like 11am to 5pm, you'll lose weight faster.

throwawaycities 5y ago

One interesting thing about obesity and bariatric surgery is the changes in the microbiome. The following comes from a study on T2D reversal where bariatric surgery was one aspect of the study: “Furthermore, microbial changes in the human gut have been linked to obesity, and surgical alterations to gastrointestinal anatomy have been associated with dramatic changes in gut microbiota populations with reversion from an “obesogenic” to a lean bacterial population [13,14,16,19,23,24].” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/ It’s a relatively new science and area of study but some of it is fascinating if not hopeful. One in particular looked at identical twins where only 1 suffered from malnutrition finding in all such cases the microbiomes were different between the twins and the malnutrition was successfully treated via the microbiome.

Turing_Machine 5y ago

Well, you're going against billions of years of evolution that say "Eat everything you can and put on some extra weight. There might not be any food tomorrow." Unfortunately, in modern times the days of short rations never come, at least in First World countries. That drive functions at a neural level way below the level of the rational mind. People often make poor choices vis-a-vis sexual activity, too, and for much the same reason.

adrianN 5y ago
The old drive to eat anything meets an industry of chemists who spend their lives making the food on the shelves as addictive as possible. It's relatively hard to become morbidly obese without snacking on highly processed food all the time.
- Turing_Machine 5y ago
  By making it "as addictive as possible" you mean "tastes good"?
  - adrianN 5y ago
    Yes, but not exclusively so. A key ingredient to really addictive food is also that it's not very filling and easy to eat.
deanCommie 5y ago
Most of us under 40 were still raised in cultures where our parents grew up immediately after the war. The concept of "finishing your plate, whether you were full or not" was universal - precisely because their parents remembered shortages. They passed it on to us before there was a chance to introspect the nutritional and psychological realities of food. My partner and I are both overweight and we are trying to do a better job with our child - giving them healthy but delicious options, while also not turning any junky food into a reward or a mystery that must be guarded or doled out in careful portions. So far, we're okay. Not sure how this is going to last once the kid gets into school age...

pizza234 5y ago

I'm more or less in the ballpark of 10% of weight lost and maintained in a timeline of 5+ years (although weight is always in flux). I have no genetic gifts - I must keep an eye on the nutrition and training; otherwise, my weight slowly goes up. If I saw people permanently ban junk/fat/sugary food from their homes, do at least 3 hours/week of complete training (weights and cardio), and not being able to stay fit, I would believe that weight loss/being fit is a serious physiological and psychological challenge. What I observe though, starting from mid-30s, is that the vast majority of people keeps junk food at home (which is, no wonder, "extremely difficult psychologically" not to eat) and/or doesn't do traning (let alone complete training). And invariably blames it on genetics and aging. (I don't doubt that there is a minority of the people that has serious metabolic disorders, but that's not the general case)

cm2012 5y ago
You should carefully read what I wrote in the context of the parent comment, and see why your comment is not adding anything to the conversation. In other words, if you're a doctor, go ahead and tell all your patients the above. You will see negligible impact on their weight, so your advice was useless (worse than useless, since you come across as an asshole). As an aside, conscientiousness/willpower is highly heritable (as much as height and IQ), so if you're especially good at sticking to a diet, that's also genetics.
- oaktrout 5y ago
  If it works for 5% of people it is by definition not useless. Bariatric surgery is not without its risks, and I would rather weed out the 5% who respond to the low risk approach before exposing them to the risks and long term side effects of bariatric surgery.
  - cm2012 5y ago
    5% is really generous in the data I've seen and posted above, and I've never seen any positive data on just advice. Maybe the data on what happens if you call your patients weak willed losers would surprise us all, but I doubt it.

scythe 5y ago

[1] is from 1992, [2] is from 2001. [3] evaluates a bad program[fuller2014] based on a worse metric. You find different things in more recent research, e.g.: https://www.nature.com/articles/ijo201094 https://www.nature.com/articles/ijo201094 >More than one out of every six US adults who has ever been overweight or obese has accomplished LTWLM [1y] of at least 10%. review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/ As far as the doctor's advice is concerned, focusing on weight loss as the sole outcome is misguided. The typical trajectory of an obese individual is to keep gaining weight; if doctors could even make their patients stop gaining weight, that would already be a major development in standards of care. It's also important to consider the limitations of the metric. Studies don't evaluate sustained cultural shifts like "do doctors regularly talk to the patients about nutrition", because it's hard enough to track a patient for five years, let alone get a doctor to do blinded controlled interventions for five years. So what the study tests is a controlled diet for a short period followed by a period of unsupervised maintenance (with a recipe book), not the consistent availability of nutrition guidance over a period of years. It's perhaps more important to note that while the results in adults are quite bad, it has been shown possible for adolescents to drop by more than a standard deviation in BMI after an intervention and maintain this for two years: https://www.sciencedirect.com/science/article/pii/S0022347607009560 https://www.sciencedirect.com/science/article/pii/S002234760... https://www.sciencedirect.com/science/article/pii/S1054139X13002383 https://www.sciencedirect.com/science/article/pii/S1054139X1... Professional interventions for weight loss and/or maintenance aren't infeasible, they're just hard, and it pays to start early. It's not too surprising that older people are more reluctant to change their habits. [fuller2014]: Finds that Weight Watchers underperforms standard national guidelines: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282338/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282338/

cm2012 5y ago
1 year data is a lot more variable, 5 year data is still grim. Not to mention this hasn't changed in modern times - even with all the focus on health in modern culture, obesity keeps rising and rising: https://www.cdc.gov/nchs/images/databriefs/351-400/db360-fig4.png https://www.cdc.gov/nchs/images/databriefs/351-400/db360-fig... Those studies on adolescents is heartening though.

oaktrout 5y ago

"Research shows that nothing doctors recommend has any effect on weight loss except bariatric surgery." Source 2 that you posted contradicts that statement, and notes that the average person was successful in maintaining some weight loss (about 3%, or 7lbs). That means that about 50% of people are able to maintain a weight loss of greater than 7lbs 5 years after a structured weight-loss program. Source 1 seems to be from a conference, and they don't list specific numbers or cite sources, so I have no idea what "almost all" means. "5) [The only thing that does seem to work in the long term is gastric surgery." That study says that gastric surgery works, it says nothing about the other methods for weight loss.

deanCommie 5y ago

The moralizing about food and diet is similar to the moralizing about drugs and addiction: "Just lock up all the homeless drug addicts in rehab for 3 months, and they'll get clean. Problem solved!" Right, except they'll still be homeless, poor, mentally unstable, or all of the above. Drug use is often the symptom, not the root cause. It's similar with food. For many people, food becomes the primary source of joy in life. And just like with drugs, the joy shrinks, the high gets shorter, and the health side effects soon start outweighing the benefits. But it's still quite hard to go cold turkey, and just like a recovering addict, even years after establishing a healthy diet it becomes really easy to fall off the wagon. We can moralize about how starving children in africa have things much worse, but human happiness is contextual to the reality we know. And life in modern western society has a lot of pitfalls, anxiety, and depression. Obesity is in many ways a side effect of people's lived experience.

krzat 5y ago

I am someone who lost 10% and kept it. If there are no studies on people like me, then no wonder why doctors are so bad at treating obesity.

cm2012 5y ago
Probably 5000 people read this comment chain. It's bound to happen for some people.
- krzat 5y ago
  My point is that nobody is doing research on effective weight loss, so it's not surprising that doctors can't deal with it. Giving a diet plan for weight loss is basically an equivalent of giving an exercise plan for depression.

masonic 5y ago

>Research shows that nothing doctors recommend has any effect on weight loss except bariatric surgery. This mostly reflects on what doctors recommend rather than blanket discipline failure across a broad population. I can tell you what my local Kaiser recommended for T2D and obesity: 1) they send you to a Registered Dietician who shows you a modernized food pyramid based heavily on grains. Minimize animal fats, replacing with seed oils. 70% calories as carbohydrate. 2) MD flat tells you "you MUST eat 6 small meals a day so you never get hungry." What was done instead: Time Restricted Feeding, 4-6 hour window, low carb, limiting to mostly keto first half of window. A1C dropped over 3 points (10.3 to 7) by next labs.

imtringued 5y ago
>1) they send you to a Registered Dietician who shows you a modernized food pyramid based heavily on grains. Minimize animal fats, replacing with seed oils. 70% calories as carbohydrate. Crazy, that's what I would recommend if you want to become obese. >2) MD flat tells you "you MUST eat 6 small meals a day so you never get hungry." I guess that MD really wants his patients to become insulin resistant and eventually develop diabetes.

imtringued 5y ago

You can't loose weight with the current food system unless you completely abandon it. It's literally impossible based on how the body works. Fad diets and weightloss programs don't work. You must address the problem at its root: How to deal with hunger. This is a hormonal problem. Everything (hyperbole) you can buy in a supermarket is meant to make you feel full for an hour and then hungry again. An alternative to surgery would be to just to continuously monitor blood glucose. The patient would immediately know when the food they are eating is messing up their body and the doctor can control the diet of the patient.