3 ms·

Having seen friends and relatives succumb to cardiovascular disease, it's really heartbreaking. I've watched people starve themselves on brown rice and broccoli

Having seen friends and relatives succumb to cardiovascular disease, it's really heartbreaking. I've watched people starve themselves on brown rice and broccoli for years (with only modest results, followed by total failure) because diet-only interventions are completely unrealistic and don't work long term.

nradov 4y ago
Those friends and relatives weren't really starving themselves brown rice and broccoli. They were eating a bunch of other stuff when you weren't looking. We have existence proofs that diet-only interventions work for some people. I literally know people who have lost large amounts of weight and kept it off for years that way. Medications have risks and side effects, so should only be prescribed if behavior modification has failed.
- matthewdgreen 4y ago
  We have many unsuccessful treatments that work for a small percentage of patients. That's why we measure treatments by effectiveness rather than identifying existence proofs that it worked for someone.
  - nradov 4y ago
    You're really missing the point. Every patient is unique. That's why competent healthcare providers take a step therapy approach and try cheaper, lower-risk treatments first before moving on to more expensive and riskier medication or bariatric surgery.
    - matthewdgreen 4y ago
      You seem to have misread my posts as saying that healthcare providers should immediately move to medication rather than try dietary intervention. I didn't say that, I didn't imply that, I didn't even think it. What I did say is that we are increasingly learning that overeating is a very complex and life-threatening medical concern that often cannot be solved through dietary intervention. Even people who may die if they don't adhere to a diet frequently have difficulty adhering to one. Saying that there are "existence proofs" that diets sometimes they work is a terrible response. My view is that we should treat diet as one possible medical treatment, and evaluate it apples-to-apples (in terms of efficacy and side effects) against more recent FDA-approved treatments. And now that we've seen how much impact those treatments can have -- and particularly how critical the GLP-1 mechanism is to the sustainability of weight-loss interventions -- we should work our asses off to find more and better treatments that treat overeating as a health condition rather than a question of mind-over-matter. You seem extremely attached to your position, to the point where defending your position required you to declare that my relatives "were eating a bunch of other stuff when you weren't looking."

nradov 4y ago

Those friends and relatives weren't really starving themselves brown rice and broccoli. They were eating a bunch of other stuff when you weren't looking. We have existence proofs that diet-only interventions work for some people. I literally know people who have lost large amounts of weight and kept it off for years that way. Medications have risks and side effects, so should only be prescribed if behavior modification has failed.

matthewdgreen 4y ago
We have many unsuccessful treatments that work for a small percentage of patients. That's why we measure treatments by effectiveness rather than identifying existence proofs that it worked for someone.
- nradov 4y ago
  You're really missing the point. Every patient is unique. That's why competent healthcare providers take a step therapy approach and try cheaper, lower-risk treatments first before moving on to more expensive and riskier medication or bariatric surgery.
  - matthewdgreen 4y ago
    You seem to have misread my posts as saying that healthcare providers should immediately move to medication rather than try dietary intervention. I didn't say that, I didn't imply that, I didn't even think it. What I did say is that we are increasingly learning that overeating is a very complex and life-threatening medical concern that often cannot be solved through dietary intervention. Even people who may die if they don't adhere to a diet frequently have difficulty adhering to one. Saying that there are "existence proofs" that diets sometimes they work is a terrible response. My view is that we should treat diet as one possible medical treatment, and evaluate it apples-to-apples (in terms of efficacy and side effects) against more recent FDA-approved treatments. And now that we've seen how much impact those treatments can have -- and particularly how critical the GLP-1 mechanism is to the sustainability of weight-loss interventions -- we should work our asses off to find more and better treatments that treat overeating as a health condition rather than a question of mind-over-matter. You seem extremely attached to your position, to the point where defending your position required you to declare that my relatives "were eating a bunch of other stuff when you weren't looking."