12 ms·

Why aren’t medical breakthroughs in obesity a bigger deal?

31 points by andrewla 4y ago

Quixotica1 4y ago
Pun intended?
RobotToaster 4y ago
The primary problem is the insane cost pharma companies are allowed to charge for these drugs. Imagine the benefits to society if they could be rolled out cheaply and widely.
- cassianoleal 4y ago
  Imagine if medicines and medical procedures would contribute negatively to the GDP rather than positively. I mean, they are there because something went wrong before, leading to the need for them. By having them as a cost, the incentives to avoid them are put in place, so suddenly healthier foods and habits become more profitable. The problem is that medicine should not be an industry, it should be a cost centre, and the more unhealthy something is the heavier it should be taxed in order to pay for that cost.
oifjsidjf 4y ago
Imagine cutting up your own stomach instead of admiting to yourself that you have changed your diet incorrectly...sad state of humanity. Or using drugs... Weight loss can be done with food only. "Reducing calories" is NOT a good way to loose weight and KEEP IT off as it's unsustainable due to hunger. The general dietary patterns that one finds across tribal people/historyical are two: 1) high carb, low fat 2) high fat, low carb. Pick one and stick to it. As long as you mix carbs and fats the body goes crazy since due to the Randle cycle the body cannot effectively process both at the same time + it causes blood sugar buildup. Guess what kind of a diet is the Western diet? The one that MIXES fats and carbs in HIGH AMOUNTS (eg 40% carbs, 40% fat, 20% protein as calories). Such a diet is cancer. Also do note that some obese people will NOT see weight loss for the 1st few months at all if they have a chronicaly elevated insulin, which can take months to normalize. And until insulin falls down to a normal level it's IMPOSSIBLE to lose fat since insulin is KEEPING the fat in the fat cells.
- kodyo 4y ago
  Surgery and drugs definitely feel like a Plan C or D. There are subconscious and cultural aspects to food that those don't address. For one thing, in a lot of cases, the worst food to eat is also the cheapest to buy and the easiest to prepare and the most profitable to market. I think most people who are overweight or out of shape know it and also know how to start to fix it. But habits and carbs and sugars are a hell of a combo, and it almost requires an "event" (something beyond a simple "diagnosis") to get people motivated. And that doesn't even work universally.
- episteme 4y ago
  Those patterns will only work if they also reduce calories though. The vast majority of people who are normal weight in the western world will have a mixed diet and their body is not 'going crazy'.
- post_break 4y ago
  Blaming it on the person if you're in America is mostly wrong. HFCS and sugar is in literally everything. It's super expensive to buy healthy food. You have to drive everywhere so you don't get the exercise. Can weight loss be done with food only? Sure. Is it affordable or attainable for the average american? Not really.
  - xbar 4y ago
    It's ok to be accountable for what you eat when you do have choices. America has a food regulation problems that drive a variety of obesity-related problems. America also has a laziness problem that is almost mandated by suburban sprawl and automobile-oriented urban centers. Most Americans have severely limited food choices. But even those who don't are subject to marketing and sugar-addiction that leads to bad food choices even when better choices are at hand. Still, it's ok to hold accountable a person for buying and drinking two 20-ounce sugar-coffees for breakfast and then heading to the local strip mall to eat dinner at the restaurant that only serves 2000mg sodium meals--the affordability of vegetables was not the problem.
  - skorpeon87 4y ago
deleted 4y ago
[deleted]
hirundo 4y ago
I was obese for fifty-one years before discovering a simple dietary fix. For most of that time I was morbidly obese. Among yo-yo dieters I may be world class, being on a diet for most of that time, losing and gaining over 100 pound four times. Two years and a few months ago I tried yet another diet. (I haven't tried _all_ of the others, just almost all.) This time it worked. I've lost 80 pounds and my diabetes is in remission, but that has happened so many times before that it isn't what has me smiling. The difference is that it has controlled my appetite. I don't crave the carbs anymore that used to be my life's breath. I'm not obsessed with food anymore, I just eat two moderate meals a day and move on with my life in between. I feel like my relationship with food has become like the normal, healthy people that I've misunderstood as masters of self control. Here's the secret: I went on a lately popular but politically incorrect diet, that when mentioned on this site gathers instant opprobrium. But the effect is that I'm consuming a much greater proportion of protein than before, in a more bioavailable and complete form. I attribute my progress to this change to my macros. I'd just never tried it before. But it turns out that it makes a huge change to my satiety, and the rest follows. I don't assert that other obese people are/were obese because of protein deficiency, just me. I do assert that it's mostly an issue of not getting the right nutrients from their food. No drugs, no surgery, and exercise only now, after great weight loss, for the joy of it.
- jononomo 4y ago
  I eat mainly beef and I don't understand why everyone in the world doesn't eat mainly beef -- it just fixes everything. I'm thinking about doing an only-beef 2023.
  - nimbius 4y ago
    youve got it all wrong now. Ever since I read an article about farmhands and astute svelt businessmen who stand at 18th century lecterns conducting traditional old fashioned business I learned our modern diet is causing everything from climate change to the inevitable heat death of the universe itself. Cornkids and Soyboys beware, for what I propose is a radical change in everything youve ever known about putting a thing into your mouth. For the past 1500 years ive made it a point to eat nothing but the rancid dew-pocked suet in unattended suburban bird feeders for breakfast. My lunch is a simple trip back to those very same bird feeders, and --you guessed it buddy-- dinner is a quick helping of that sweet greasy nectar of the caged brick full of seeds and lawn detritus. Most people say they cannot believe their eyes when they see what i look like, or how I managed to stay so physically fit, or where all their suet keeps going to. I hope to start a blog soon where i will expound upon the brilliance of giving up old fashioned coffee as well in favour of a modern advancement in nutrition i call, contact cement and model epoxy.
plgonzalezrx8 4y ago
If dieting doesn't work, how come the procedure he's talking about is basically reducing the volume of his stomach? Sort of a "Forced" dieting if you will? Dieting and exercise ABSOLUTELY work. Calorie deficit will make you lose weight. You can't create/add matter to your body from nothing. Every atom that your body gained in order to gain weight, came from somewhere, namely, food. 99% of the time when people say the diet didn't work, they were doing a half assed diet with "cheat" days every couple days where they down a 2,000 calorie milkshake. Source: I used to be that guy making excuses and blaming genetics for being overweight.
- Enginerrrd 4y ago
  It's not that dieting doesn't work. It's that telling people to diet, as a medical intervention, doesn't work. The science of dieting is refined. The science of getting people to diet however has not been very fruitful. It's probably one of the least successful interventions in all of modern medicine, so we obviously need to do better.
  - sasaf5 4y ago
    The problem is the food supply. Sugary, fatty food, constantly available.
  - Sparkle-san 4y ago
    And even when dieting is done successfully, most people regain the majority of weight lost within 5 years. It takes permanent lifestyle changes to make weight loss persist over time which is not a simple thing to do.
    - plgonzalezrx8 4y ago
      Same with alcoholics, drug addicts, or anyone with any other addiction (In this case food). They can go sober for years, then BAM, back to square one. With food is harder because your addiction is right in your face every day.
  - TheNewsIsHere 4y ago
pjc50 4y ago
This reads like an advert. But the sad truth is that obesity is a disaster area full of people promoting quack cures, nutritional pseudoscience sponsored by food companies, and people who are far more interested in shaming others than actually helping them.
- Loughla 4y ago
  I think the largest problem with obesity, honestly, is food labeling. Every sentence on every piece of packaging for food is a targeted advertisement, and I don't think most people know that. Whole grain, stone ground, low-fat, etc. They all specifically, legally mean something, and have across the board been perverted to the point that an average consumer absolutely cannot understand what is sold that is actually okay to eat and what is not. Hell, even when just tracking calories - look at the caloric content. Sitting on my desk is a package of pretzels. It says one serving is 28g, or about 17 pretzels. It's 12 pretzels when actually weighed. That's 70% of what they list. Read that again; the actual weight of 28 grams is 12 pretzels, not 17. How can we even hope to be able to understand what we're eating, when even basic facts are fucked beyond comprehension?
  - andrewla 4y ago
    There may be some very small subset of obese people who religiously count calories and check nutrition labels whose lives would be improved by this advice, but I don't feel like I'm going out on a limb when I say that the overwhelming majority of obese people are well aware that they are eating poorly.
CrypticShift 4y ago
> We’re stuck in a dead-end debate over body positivity and dieting when real solutions to the problem exist. Really ? IMO Here is the real fundamental dead-end debate we are stuck in -> https://news.ycombinator.com/item?id=33765129 https://news.ycombinator.com/item?id=33765129 It is always the same debate those days : you cure the symptoms, not the disease because it is easier and makes more sense economically.
- csours 4y ago
  "Value Add" for food is insidious.
  - algoatecorn 4y ago
    That's an interesting statement. Can you expand? I'm genuinely curious.
    - csours 4y ago
      Value Add for food means changing something cheap into something you can sell for a profit. Corn -> Corn Chips; Corn -> Corn Syrup -> (Candy Bar | Sugar Soda). Value Add for food means making food more tasty (how could that be a bad thing?) and more tempting. It means advertising your food as a solution to a problem. Value Add for food means making people eat more food. It means advertising low-nutrition, high calorie food. Value Add means that high calorie snacks are cheaper than "real food" ---- I know that you can still get good food, but Value Add makes it harder to get good food, and easier to get bad food.
      - algoatecorn 4y ago
        Ah I see. I agree too much of our food is processed into things that are not necessary or good for us. Could you also argue that value add can preserve food in ways that reduce cost? Thus freeing up income and human capital for other sectors. How can we find a balance of reducing the insidious forms of value add while also keeping food costs down and allowing people to work in non-agriculture?
mellosouls 4y ago
Maybe because "medical breakthroughs" are not needed. Moderation and self-discipline in diet and exercise are needed. Psychological issues (or parenting failures for the young) may undermine those - as indicated in the article - but its difficult to see where "medical breakthroughs" add value to more common-sense solutions.
- PhasmaFelis 4y ago
  This is the same vibe as people telling me I don't need ADD/anxiety meds, I just need to toughen up and try harder. If moderation and self-discipline work for you, that's great. They demonstrably aren't working for millions of people. If medicine can help fix this, there's no reason it shouldn't.
  - mellosouls 4y ago
    Psychological issues [...] may undermine those I explicitly mentioned that and am very aware of it as an issue; I am criticising the idea of surgical approaches being "medical breakthroughs", not psychiatric/psychological treatments, including medicine. I should have distinguished that in my comment for clarity.
    - rsr 4y ago
      If a surgery were developed that reversed the effects of alcoholism and dramatically reduced a person's desire to consume alcohol, wouldn't we still consider that a medical breakthrough?
      - mellosouls 4y ago
        I think so, but I suspect it would be neuro or related surgery and, regardless, we need to distinguish between severe "last resort" cases in extreme contexts (which obviously exist in alcohol, eating and other disorders), and more generally aimed surgical "quick fixes" as in the article that are a) not needed and b) detrimental to the individual and society as they undermine those long term solutions, disciple and moderation as discussed.
csours 4y ago
Before making a reply, please consider that I know that not all of these points apply to every person. I think most of them apply to most people with chronic obesity. When I was a teenager, I wondered why smart people could ever be fat. It's so easy to see how to lose weight. The answer is: Your body is very very good at maintaining energy balance. You are not bad at losing weight, your body is very good at holding on to energy stores. Diet and exercise do not fix hunger. When you lose weight, your body tries really hard to get it back. Many interventions can show a short term improvement, long term improvement is very very hard. Book suggestions: Pontzer "Burn" Guyenet "Hungry Brain" Intervention suggestions: Control your food environment - if it's within reach you'll eat it soon. If it's in your house, you'll eat it eventually. Learn to enjoy the food you eat - savor the first few bites, eat slowly. You don't need to eat a lot to enjoy what you eat. You don't have to empty your plate, or you can get a to-go box. Protein and Fiber are good. Sugar and salt taste very good and will make you eat more. Do not buy sugary or salty snacks, or limit the amount that you buy. Sugar is a triple threat (at least): The calories are empty; Blood sugar crash drives hunger; sugar causes both medium and long term metabolic changes. Hunger can be put into two big buckets: Energy Balance and Food Pleasure. Energy balance is the hunger you get when you haven't eaten for a while, or after exercise. Food Pleasure is the temptation of snacks, and the drive to continue eating tasty food after you are full. You will need to learn to address all of these. If medically feasible, try fasting for a couple of days, to prove to yourself that you can survive hunger. Exercise is very good for your body, but it won't do much for losing weight. It is technically possible to outrun your diet (for a week or two, for extremely healthy people), it is impossible to outrun your body's response to calorie deficit. "Losing weight" is a terrible goal for most obese people. "Reducing body fat mass" is a much better goal. Those sound like exactly the same thing, but consider that a daily fluctuation of even 1% (up to 3% is realistic) will hide the realistic fat loss of 5 ounces. Adding muscle as you begin to exercise will also make the number on the scale bigger. GLP-1 works, but it can be very unpleasant. It will not fix your food behaviors when you go off the meds, you need to learn to manage hunger and your food environment. I'm down 40 pounds from my max, and I've maintained for about a year now. I wish you all success.
- algoatecorn 4y ago
  >You don't have to empty your plate, or you can get a to-go box. >Protein and Fiber are good. These are big. I'm from the American South, and you are taught to eat until you are full. We should be taught to eat until we are not hungry. Two different things. Protein is highly satiating and every gram of protein in lieu of fat is a good thing. 4cal/gram vs 9cal/gram Fiber is highly underdosed in American diet, leading to all sorts of issues over the long run

31 points by andrewla 4y ago

Pun intended?

The primary problem is the insane cost pharma companies are allowed to charge for these drugs. Imagine the benefits to society if they could be rolled out cheaply and widely.

cassianoleal 4y ago
Imagine if medicines and medical procedures would contribute negatively to the GDP rather than positively. I mean, they are there because something went wrong before, leading to the need for them. By having them as a cost, the incentives to avoid them are put in place, so suddenly healthier foods and habits become more profitable. The problem is that medicine should not be an industry, it should be a cost centre, and the more unhealthy something is the heavier it should be taxed in order to pay for that cost.

oifjsidjf 4y ago

Imagine cutting up your own stomach instead of admiting to yourself that you have changed your diet incorrectly...sad state of humanity. Or using drugs... Weight loss can be done with food only. "Reducing calories" is NOT a good way to loose weight and KEEP IT off as it's unsustainable due to hunger. The general dietary patterns that one finds across tribal people/historyical are two: 1) high carb, low fat 2) high fat, low carb. Pick one and stick to it. As long as you mix carbs and fats the body goes crazy since due to the Randle cycle the body cannot effectively process both at the same time + it causes blood sugar buildup. Guess what kind of a diet is the Western diet? The one that MIXES fats and carbs in HIGH AMOUNTS (eg 40% carbs, 40% fat, 20% protein as calories). Such a diet is cancer. Also do note that some obese people will NOT see weight loss for the 1st few months at all if they have a chronicaly elevated insulin, which can take months to normalize. And until insulin falls down to a normal level it's IMPOSSIBLE to lose fat since insulin is KEEPING the fat in the fat cells.

kodyo 4y ago
Surgery and drugs definitely feel like a Plan C or D. There are subconscious and cultural aspects to food that those don't address. For one thing, in a lot of cases, the worst food to eat is also the cheapest to buy and the easiest to prepare and the most profitable to market. I think most people who are overweight or out of shape know it and also know how to start to fix it. But habits and carbs and sugars are a hell of a combo, and it almost requires an "event" (something beyond a simple "diagnosis") to get people motivated. And that doesn't even work universally.
episteme 4y ago
Those patterns will only work if they also reduce calories though. The vast majority of people who are normal weight in the western world will have a mixed diet and their body is not 'going crazy'.
post_break 4y ago
Blaming it on the person if you're in America is mostly wrong. HFCS and sugar is in literally everything. It's super expensive to buy healthy food. You have to drive everywhere so you don't get the exercise. Can weight loss be done with food only? Sure. Is it affordable or attainable for the average american? Not really.
- xbar 4y ago
  It's ok to be accountable for what you eat when you do have choices. America has a food regulation problems that drive a variety of obesity-related problems. America also has a laziness problem that is almost mandated by suburban sprawl and automobile-oriented urban centers. Most Americans have severely limited food choices. But even those who don't are subject to marketing and sugar-addiction that leads to bad food choices even when better choices are at hand. Still, it's ok to hold accountable a person for buying and drinking two 20-ounce sugar-coffees for breakfast and then heading to the local strip mall to eat dinner at the restaurant that only serves 2000mg sodium meals--the affordability of vegetables was not the problem.
- skorpeon87 4y ago

deleted 4y ago

[deleted]

hirundo 4y ago

I was obese for fifty-one years before discovering a simple dietary fix. For most of that time I was morbidly obese. Among yo-yo dieters I may be world class, being on a diet for most of that time, losing and gaining over 100 pound four times. Two years and a few months ago I tried yet another diet. (I haven't tried _all_ of the others, just almost all.) This time it worked. I've lost 80 pounds and my diabetes is in remission, but that has happened so many times before that it isn't what has me smiling. The difference is that it has controlled my appetite. I don't crave the carbs anymore that used to be my life's breath. I'm not obsessed with food anymore, I just eat two moderate meals a day and move on with my life in between. I feel like my relationship with food has become like the normal, healthy people that I've misunderstood as masters of self control. Here's the secret: I went on a lately popular but politically incorrect diet, that when mentioned on this site gathers instant opprobrium. But the effect is that I'm consuming a much greater proportion of protein than before, in a more bioavailable and complete form. I attribute my progress to this change to my macros. I'd just never tried it before. But it turns out that it makes a huge change to my satiety, and the rest follows. I don't assert that other obese people are/were obese because of protein deficiency, just me. I do assert that it's mostly an issue of not getting the right nutrients from their food. No drugs, no surgery, and exercise only now, after great weight loss, for the joy of it.

jononomo 4y ago
I eat mainly beef and I don't understand why everyone in the world doesn't eat mainly beef -- it just fixes everything. I'm thinking about doing an only-beef 2023.
- nimbius 4y ago
  youve got it all wrong now. Ever since I read an article about farmhands and astute svelt businessmen who stand at 18th century lecterns conducting traditional old fashioned business I learned our modern diet is causing everything from climate change to the inevitable heat death of the universe itself. Cornkids and Soyboys beware, for what I propose is a radical change in everything youve ever known about putting a thing into your mouth. For the past 1500 years ive made it a point to eat nothing but the rancid dew-pocked suet in unattended suburban bird feeders for breakfast. My lunch is a simple trip back to those very same bird feeders, and --you guessed it buddy-- dinner is a quick helping of that sweet greasy nectar of the caged brick full of seeds and lawn detritus. Most people say they cannot believe their eyes when they see what i look like, or how I managed to stay so physically fit, or where all their suet keeps going to. I hope to start a blog soon where i will expound upon the brilliance of giving up old fashioned coffee as well in favour of a modern advancement in nutrition i call, contact cement and model epoxy.

plgonzalezrx8 4y ago

If dieting doesn't work, how come the procedure he's talking about is basically reducing the volume of his stomach? Sort of a "Forced" dieting if you will? Dieting and exercise ABSOLUTELY work. Calorie deficit will make you lose weight. You can't create/add matter to your body from nothing. Every atom that your body gained in order to gain weight, came from somewhere, namely, food. 99% of the time when people say the diet didn't work, they were doing a half assed diet with "cheat" days every couple days where they down a 2,000 calorie milkshake. Source: I used to be that guy making excuses and blaming genetics for being overweight.

Enginerrrd 4y ago
It's not that dieting doesn't work. It's that telling people to diet, as a medical intervention, doesn't work. The science of dieting is refined. The science of getting people to diet however has not been very fruitful. It's probably one of the least successful interventions in all of modern medicine, so we obviously need to do better.
- sasaf5 4y ago
  The problem is the food supply. Sugary, fatty food, constantly available.
- Sparkle-san 4y ago
  And even when dieting is done successfully, most people regain the majority of weight lost within 5 years. It takes permanent lifestyle changes to make weight loss persist over time which is not a simple thing to do.
  - plgonzalezrx8 4y ago
    Same with alcoholics, drug addicts, or anyone with any other addiction (In this case food). They can go sober for years, then BAM, back to square one. With food is harder because your addiction is right in your face every day.
- TheNewsIsHere 4y ago

pjc50 4y ago

This reads like an advert. But the sad truth is that obesity is a disaster area full of people promoting quack cures, nutritional pseudoscience sponsored by food companies, and people who are far more interested in shaming others than actually helping them.

Loughla 4y ago
I think the largest problem with obesity, honestly, is food labeling. Every sentence on every piece of packaging for food is a targeted advertisement, and I don't think most people know that. Whole grain, stone ground, low-fat, etc. They all specifically, legally mean something, and have across the board been perverted to the point that an average consumer absolutely cannot understand what is sold that is actually okay to eat and what is not. Hell, even when just tracking calories - look at the caloric content. Sitting on my desk is a package of pretzels. It says one serving is 28g, or about 17 pretzels. It's 12 pretzels when actually weighed. That's 70% of what they list. Read that again; the actual weight of 28 grams is 12 pretzels, not 17. How can we even hope to be able to understand what we're eating, when even basic facts are fucked beyond comprehension?
- andrewla 4y ago
  There may be some very small subset of obese people who religiously count calories and check nutrition labels whose lives would be improved by this advice, but I don't feel like I'm going out on a limb when I say that the overwhelming majority of obese people are well aware that they are eating poorly.

CrypticShift 4y ago

> We’re stuck in a dead-end debate over body positivity and dieting when real solutions to the problem exist. Really ? IMO Here is the real fundamental dead-end debate we are stuck in -> https://news.ycombinator.com/item?id=33765129 https://news.ycombinator.com/item?id=33765129 It is always the same debate those days : you cure the symptoms, not the disease because it is easier and makes more sense economically.

csours 4y ago
"Value Add" for food is insidious.
- algoatecorn 4y ago
  That's an interesting statement. Can you expand? I'm genuinely curious.
  - csours 4y ago
    Value Add for food means changing something cheap into something you can sell for a profit. Corn -> Corn Chips; Corn -> Corn Syrup -> (Candy Bar | Sugar Soda). Value Add for food means making food more tasty (how could that be a bad thing?) and more tempting. It means advertising your food as a solution to a problem. Value Add for food means making people eat more food. It means advertising low-nutrition, high calorie food. Value Add means that high calorie snacks are cheaper than "real food" ---- I know that you can still get good food, but Value Add makes it harder to get good food, and easier to get bad food.
    - algoatecorn 4y ago
      Ah I see. I agree too much of our food is processed into things that are not necessary or good for us. Could you also argue that value add can preserve food in ways that reduce cost? Thus freeing up income and human capital for other sectors. How can we find a balance of reducing the insidious forms of value add while also keeping food costs down and allowing people to work in non-agriculture?

mellosouls 4y ago

Maybe because "medical breakthroughs" are not needed. Moderation and self-discipline in diet and exercise are needed. Psychological issues (or parenting failures for the young) may undermine those - as indicated in the article - but its difficult to see where "medical breakthroughs" add value to more common-sense solutions.

PhasmaFelis 4y ago
This is the same vibe as people telling me I don't need ADD/anxiety meds, I just need to toughen up and try harder. If moderation and self-discipline work for you, that's great. They demonstrably aren't working for millions of people. If medicine can help fix this, there's no reason it shouldn't.
- mellosouls 4y ago
  Psychological issues [...] may undermine those I explicitly mentioned that and am very aware of it as an issue; I am criticising the idea of surgical approaches being "medical breakthroughs", not psychiatric/psychological treatments, including medicine. I should have distinguished that in my comment for clarity.
  - rsr 4y ago
    If a surgery were developed that reversed the effects of alcoholism and dramatically reduced a person's desire to consume alcohol, wouldn't we still consider that a medical breakthrough?
    - mellosouls 4y ago
      I think so, but I suspect it would be neuro or related surgery and, regardless, we need to distinguish between severe "last resort" cases in extreme contexts (which obviously exist in alcohol, eating and other disorders), and more generally aimed surgical "quick fixes" as in the article that are a) not needed and b) detrimental to the individual and society as they undermine those long term solutions, disciple and moderation as discussed.

csours 4y ago

Before making a reply, please consider that I know that not all of these points apply to every person. I think most of them apply to most people with chronic obesity. When I was a teenager, I wondered why smart people could ever be fat. It's so easy to see how to lose weight. The answer is: Your body is very very good at maintaining energy balance. You are not bad at losing weight, your body is very good at holding on to energy stores. Diet and exercise do not fix hunger. When you lose weight, your body tries really hard to get it back. Many interventions can show a short term improvement, long term improvement is very very hard. Book suggestions: Pontzer "Burn" Guyenet "Hungry Brain" Intervention suggestions: Control your food environment - if it's within reach you'll eat it soon. If it's in your house, you'll eat it eventually. Learn to enjoy the food you eat - savor the first few bites, eat slowly. You don't need to eat a lot to enjoy what you eat. You don't have to empty your plate, or you can get a to-go box. Protein and Fiber are good. Sugar and salt taste very good and will make you eat more. Do not buy sugary or salty snacks, or limit the amount that you buy. Sugar is a triple threat (at least): The calories are empty; Blood sugar crash drives hunger; sugar causes both medium and long term metabolic changes. Hunger can be put into two big buckets: Energy Balance and Food Pleasure. Energy balance is the hunger you get when you haven't eaten for a while, or after exercise. Food Pleasure is the temptation of snacks, and the drive to continue eating tasty food after you are full. You will need to learn to address all of these. If medically feasible, try fasting for a couple of days, to prove to yourself that you can survive hunger. Exercise is very good for your body, but it won't do much for losing weight. It is technically possible to outrun your diet (for a week or two, for extremely healthy people), it is impossible to outrun your body's response to calorie deficit. "Losing weight" is a terrible goal for most obese people. "Reducing body fat mass" is a much better goal. Those sound like exactly the same thing, but consider that a daily fluctuation of even 1% (up to 3% is realistic) will hide the realistic fat loss of 5 ounces. Adding muscle as you begin to exercise will also make the number on the scale bigger. GLP-1 works, but it can be very unpleasant. It will not fix your food behaviors when you go off the meds, you need to learn to manage hunger and your food environment. I'm down 40 pounds from my max, and I've maintained for about a year now. I wish you all success.

algoatecorn 4y ago
>You don't have to empty your plate, or you can get a to-go box. >Protein and Fiber are good. These are big. I'm from the American South, and you are taught to eat until you are full. We should be taught to eat until we are not hungry. Two different things. Protein is highly satiating and every gram of protein in lieu of fat is a good thing. 4cal/gram vs 9cal/gram Fiber is highly underdosed in American diet, leading to all sorts of issues over the long run