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Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the firs

Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the first place. It's way easier to take a pill than cut to 1500 calories a day for 2 years.

bsder 5y ago
> Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the first place. Research continues its trend against this statement. 1) One problem is the fact that the number of fat cells in the body is conserved after some point. So, if you grew lots of fat cells as a child, sucks to be you, you're now stuck with them as an adult. 2) Caloric consumption has been tracked and cross referenced between countries, and obesity doesn't always correlate with it. Apparently, there are other things going on. Some of these seem to be environmental. 3) Fat cells "remember" your weight when they were formed. Once you become obese, your body fights your attempts to lose weight all the way down until those cells die off and are replaced (about 10% per year or so). It takes MASSIVE amounts of willpower to fight your own body over years. 4) Exercise is practically useless for weight loss. The body demands a fixed number of calories (up until you're doing something at the level of extreme training) and shunts the available calories between systems. Exercise has lots of benefits. Weight loss just isn't one of them. 5) I do agree that nothing in the US helps you avoid gaining weight. Portion sizes are gigantic (a "personal" pizza in the US is a full pizza in Naples). Walking or bicycling is rarely useful for most people. Sugar gets added to everything (For example: Austin, TX has been a particular victim of this--gigantic glasses of unsweetened iced tea used to be the default a decade or so ago but has been replaced by sweetened or double-sweetened iced tea (which used to be limited to the Southeastern states)).
- adrian_b 5y ago
  I agree with a part of what you say, e.g. that exercise is almost useless for weight loss. I know these theories about the number of fat cells and about their slow replacement, etc. Nevertheless, they do not match my experience. I have been obese during about 15 years. Then I began to measure precisely the quantities of food that I eat and after almost a year I reduced my weight to only two thirds from that of the previous year. Since then, another 15 years have passed, during which I controlled easily my weight, also by eating most of the time only carefully measured quantities of food. During my weight loss, I was concerned about possible problems, precisely because I had also heard these theories about the fat cells that you have mentioned. However, I have not seen any evidence for them. Before losing weight, climbing stairs was difficult, it felt like carrying a huge backpack, and I could not even see my lower body due to my belly. After losing weight, not only all physical activities became easy, but even if there was a very large reduction in waist circumference, so initially the skin remained rather loose, after not a long time it adjusted, so no signs of the former size remained. There were no problems whatsoever caused by the weight loss, but I had to retain forever the habit of eating according to a plan, because any day when I eat outside the plan, I immediately gain weight. If you do not eat enough food to keep alive all your cells, some cells must die (after you have already consumed most of the internal energy supplies stored in fat). It is very unlikely that your internal regulation mechanisms will not ensure that the unused fat cells will die before cells that are in active use, e.g. muscle cells. So that theory about the constancy of the fat cell number can be true only while you are still eating some excess food or while you have not lost most of the fat reserves yet.
- nerdawson 5y ago
  #4 is surprisingly difficult for people to understand. It seems to fly in the face of what weight loss is expected to entail. Strength training, on the other hand, is (at least I hear) helpful in losing weight.
  - anonfornoreason 5y ago
    #4 is t correct, or rather it’s helpful but in a counter intuitive way. On its face, it’s very hard to exercise away a donut, but daily exercise causes your metabolism to pickup and you burn more calories for the rest of the day. Additionally, the more muscle you have the more your body will burn calories, so for weight loss it’s best to start with strength training (and not bullshit “toning” exercises) and then move into cardio.
- mecha_ghidorah 5y ago
  > Exercise is practically useless for weight loss. The body demands a fixed number of calories (up until you're doing something at the level of extreme training) and shunts the available calories between systems. Exercise has lots of benefits. Weight loss just isn't one of them. This is sort of true but also sort of not. The body doesn't require a fixed amount of calories exactly, a specific body composition does. If you put on muscle the amount of calories the body demands goes up.
sph 5y ago
Bullshit, and my response is a bit tangential, sorry. Obesity isn't a defect of self-control, it's a systematic metabolic disease that makes these people ravenous yet ingest enormous amount of calories. Low carb eating has been successful outside of the mainstream lie of "eat more whole grains" because it simply avoids the foods that worsen runaway metabolic syndrome; the common advice is just to "eat less", while these poor people are ravenous and gain fat on whole foods 2,000 kcal diets. CICO doesn't mean anything in a vacuum if one way of eating causes you to be constantly hungry, and the other teaches your body to make use of its great amount of stored energy. Obesity is eating the same food that previously kept you healthy, but now makes you sick and hungry. Here's abundance of doctors and researchers talking about it: https://www.youtube.com/c/lowcarbdownunder/search?query=diabetes https://www.youtube.com/c/lowcarbdownunder/search?query=diab... Here's one I've watched and can recommend: Prof. Robert Lustig - 'Sugar, metabolic syndrome, and cancer': https://www.youtube.com/watch?v=jpNU72dny2s https://www.youtube.com/watch?v=jpNU72dny2s
imtringued 5y ago
That's why you give them a continuous glucose monitor.
- paulcole 5y ago
  As I said in another comment, a CGM for Type 2 is not shown to improve outcomes.
giantg2 5y ago
Some people do change. Point in case would be grandparent(?) stating that they changed to a low carb diet that fixed their issue.
idorosen 5y ago
It is a harmful stereotype to label obese people as lacking willpower as you have done. Many obese people don’t have the resources (time, money) or tools (nutrition understanding) to improve their situation. Many have metabolic or familial history of obesity which has both physical and psychological (normalization) impact on their ability to control their weight. The former can be helped with diet and/or medication, the latter often causes them not to seek help. Most people in the US live in poverty and make marginal spending food decisions based on money per dopamine reward unit rather than optimizing nutrition. McDonalds is cheap and unhealthy; fresh fruits and vegetables and the free time to educate oneself on proper nutrition, then cook healthy meals and do meal prep often cost more money and time than most can afford. As does proper exercise when you’re working 12 hours per day trying to make ends meet. A less harmful way to phrase your point is that medication can help people who self-medicate with food overcome metabolic efficiency. I lost 40 pounds on semaglutide (Wegovy) so far this past year and dropping; exercise and diet alone didn’t work for me. I hope to eventually not rely on medication to maintain a healthy weight.
- akomtu 5y ago
  No, it's the lack of will power, with few exceptions. Most of the food these days, even expensive food, has atrocious amount of calories, so to burn one cookie-worth of energy one would have to do a stupid amount of weight lifting. For example, lifting a 50 lbs dumbbell 3 feet high burns just 5 calories, while a small cookie I have on my plate has 200 calories. That's 40 times to lift that dumbbell just to burn 1 cookie. Edit: or let's take a look at cheese. I've found some pretty expensive cheese in my fridge, packed into small cube boxes, because otherwise its price per pound would be offensive. So we might expect that cheese would do better than cookies. The nutrinion facts label on its reverse begins with "serving size: 2 table spoons, 120 calories" - a borderline fradulent label that's trying to hide the fact that the small chunk of cheese has 600 calories in it.
- AmericanChopper 5y ago
  I would say it’s much more harmful to rationalize obesity as something that afflicts people according to their circumstances, rather than what it actually is, a direct outcome of a person’s intentional choices. It’s also quite harmful to dramatize the solutions out to be something unattainable to many people. They are attainable to all people. The healthiest diet I’ve ever eaten was also the cheapest diet I’ve ever eaten, and almost everybody can get 30 minutes of low intensity exercise a day.

bsder 5y ago

> Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the first place. Research continues its trend against this statement. 1) One problem is the fact that the number of fat cells in the body is conserved after some point. So, if you grew lots of fat cells as a child, sucks to be you, you're now stuck with them as an adult. 2) Caloric consumption has been tracked and cross referenced between countries, and obesity doesn't always correlate with it. Apparently, there are other things going on. Some of these seem to be environmental. 3) Fat cells "remember" your weight when they were formed. Once you become obese, your body fights your attempts to lose weight all the way down until those cells die off and are replaced (about 10% per year or so). It takes MASSIVE amounts of willpower to fight your own body over years. 4) Exercise is practically useless for weight loss. The body demands a fixed number of calories (up until you're doing something at the level of extreme training) and shunts the available calories between systems. Exercise has lots of benefits. Weight loss just isn't one of them. 5) I do agree that nothing in the US helps you avoid gaining weight. Portion sizes are gigantic (a "personal" pizza in the US is a full pizza in Naples). Walking or bicycling is rarely useful for most people. Sugar gets added to everything (For example: Austin, TX has been a particular victim of this--gigantic glasses of unsweetened iced tea used to be the default a decade or so ago but has been replaced by sweetened or double-sweetened iced tea (which used to be limited to the Southeastern states)).

adrian_b 5y ago
I agree with a part of what you say, e.g. that exercise is almost useless for weight loss. I know these theories about the number of fat cells and about their slow replacement, etc. Nevertheless, they do not match my experience. I have been obese during about 15 years. Then I began to measure precisely the quantities of food that I eat and after almost a year I reduced my weight to only two thirds from that of the previous year. Since then, another 15 years have passed, during which I controlled easily my weight, also by eating most of the time only carefully measured quantities of food. During my weight loss, I was concerned about possible problems, precisely because I had also heard these theories about the fat cells that you have mentioned. However, I have not seen any evidence for them. Before losing weight, climbing stairs was difficult, it felt like carrying a huge backpack, and I could not even see my lower body due to my belly. After losing weight, not only all physical activities became easy, but even if there was a very large reduction in waist circumference, so initially the skin remained rather loose, after not a long time it adjusted, so no signs of the former size remained. There were no problems whatsoever caused by the weight loss, but I had to retain forever the habit of eating according to a plan, because any day when I eat outside the plan, I immediately gain weight. If you do not eat enough food to keep alive all your cells, some cells must die (after you have already consumed most of the internal energy supplies stored in fat). It is very unlikely that your internal regulation mechanisms will not ensure that the unused fat cells will die before cells that are in active use, e.g. muscle cells. So that theory about the constancy of the fat cell number can be true only while you are still eating some excess food or while you have not lost most of the fat reserves yet.
nerdawson 5y ago
#4 is surprisingly difficult for people to understand. It seems to fly in the face of what weight loss is expected to entail. Strength training, on the other hand, is (at least I hear) helpful in losing weight.
- anonfornoreason 5y ago
  #4 is t correct, or rather it’s helpful but in a counter intuitive way. On its face, it’s very hard to exercise away a donut, but daily exercise causes your metabolism to pickup and you burn more calories for the rest of the day. Additionally, the more muscle you have the more your body will burn calories, so for weight loss it’s best to start with strength training (and not bullshit “toning” exercises) and then move into cardio.
mecha_ghidorah 5y ago
> Exercise is practically useless for weight loss. The body demands a fixed number of calories (up until you're doing something at the level of extreme training) and shunts the available calories between systems. Exercise has lots of benefits. Weight loss just isn't one of them. This is sort of true but also sort of not. The body doesn't require a fixed amount of calories exactly, a specific body composition does. If you put on muscle the amount of calories the body demands goes up.

sph 5y ago

Bullshit, and my response is a bit tangential, sorry. Obesity isn't a defect of self-control, it's a systematic metabolic disease that makes these people ravenous yet ingest enormous amount of calories. Low carb eating has been successful outside of the mainstream lie of "eat more whole grains" because it simply avoids the foods that worsen runaway metabolic syndrome; the common advice is just to "eat less", while these poor people are ravenous and gain fat on whole foods 2,000 kcal diets. CICO doesn't mean anything in a vacuum if one way of eating causes you to be constantly hungry, and the other teaches your body to make use of its great amount of stored energy. Obesity is eating the same food that previously kept you healthy, but now makes you sick and hungry. Here's abundance of doctors and researchers talking about it: https://www.youtube.com/c/lowcarbdownunder/search?query=diabetes https://www.youtube.com/c/lowcarbdownunder/search?query=diab... Here's one I've watched and can recommend: Prof. Robert Lustig - 'Sugar, metabolic syndrome, and cancer': https://www.youtube.com/watch?v=jpNU72dny2s https://www.youtube.com/watch?v=jpNU72dny2s

imtringued 5y ago

That's why you give them a continuous glucose monitor.

paulcole 5y ago
As I said in another comment, a CGM for Type 2 is not shown to improve outcomes.

giantg2 5y ago

Some people do change. Point in case would be grandparent(?) stating that they changed to a low carb diet that fixed their issue.

idorosen 5y ago

It is a harmful stereotype to label obese people as lacking willpower as you have done. Many obese people don’t have the resources (time, money) or tools (nutrition understanding) to improve their situation. Many have metabolic or familial history of obesity which has both physical and psychological (normalization) impact on their ability to control their weight. The former can be helped with diet and/or medication, the latter often causes them not to seek help. Most people in the US live in poverty and make marginal spending food decisions based on money per dopamine reward unit rather than optimizing nutrition. McDonalds is cheap and unhealthy; fresh fruits and vegetables and the free time to educate oneself on proper nutrition, then cook healthy meals and do meal prep often cost more money and time than most can afford. As does proper exercise when you’re working 12 hours per day trying to make ends meet. A less harmful way to phrase your point is that medication can help people who self-medicate with food overcome metabolic efficiency. I lost 40 pounds on semaglutide (Wegovy) so far this past year and dropping; exercise and diet alone didn’t work for me. I hope to eventually not rely on medication to maintain a healthy weight.

akomtu 5y ago
No, it's the lack of will power, with few exceptions. Most of the food these days, even expensive food, has atrocious amount of calories, so to burn one cookie-worth of energy one would have to do a stupid amount of weight lifting. For example, lifting a 50 lbs dumbbell 3 feet high burns just 5 calories, while a small cookie I have on my plate has 200 calories. That's 40 times to lift that dumbbell just to burn 1 cookie. Edit: or let's take a look at cheese. I've found some pretty expensive cheese in my fridge, packed into small cube boxes, because otherwise its price per pound would be offensive. So we might expect that cheese would do better than cookies. The nutrinion facts label on its reverse begins with "serving size: 2 table spoons, 120 calories" - a borderline fradulent label that's trying to hide the fact that the small chunk of cheese has 600 calories in it.
AmericanChopper 5y ago
I would say it’s much more harmful to rationalize obesity as something that afflicts people according to their circumstances, rather than what it actually is, a direct outcome of a person’s intentional choices. It’s also quite harmful to dramatize the solutions out to be something unattainable to many people. They are attainable to all people. The healthiest diet I’ve ever eaten was also the cheapest diet I’ve ever eaten, and almost everybody can get 30 minutes of low intensity exercise a day.