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Weight loss surgeries are an incredible tool with great research to back them up. Until the recent invention of semaglutides, they were the only tool that works

by cm2012 3y ago

Weight loss surgeries are an incredible tool with great research to back them up. Until the recent invention of semaglutides, they were the only tool that works for doctor prescribed weight loss (telling people to eat right and diet doesn't help outcomes at all, its more or less a waste of time).

josephcsible 3y ago
> telling people to eat right and diet doesn't help outcomes at all That's only because they don't listen to what you tell them. When people actually do eat right and diet, that works to lose weight 100% of the time.
- cm2012 3y ago
  Yes, but that's pointless as a policy for doctors and healthcare in general.
- simiones 3y ago
  No, it's because people can't just fight what their body tells them they need for any significant amount of time. It is incredibly difficult to lose weight for anything more than a year or two, and in fact very rarely happens - at least without surgery.
  - chiefalchemist 3y ago
    > it's because people can't just fight what their body tells them they need for any significant amount of time. Yes, the body is saying "nourish me" and they're feeding it food that is high-calorie and low-nutrient. So the body keeps asking "nourish me". And they feed it the same thing. We shouldn't be so quick to blame the body for the mind making poor decisions. > It is incredibly difficult to lose weight for anything more than a year or two, and in fact very rarely happens But why is that? Have they developed new better habits, or simply put the proven bad ones on hold? Is the whole family / household in on the effort, or is it usually one very obese person trying to change, while the obese and overweight under the same roof aren't making any effort (to change diet, exercise, and TV watching* routines). The point is, we are known creatures of habit. We are also creatures known to conform to the surrounding norms. If the norms of the house are counter-productive then yes you're going to lose. If the norms once you leave the house (or turn on the TV) are against you, that doesn't help either (but it's a bit less impactful). I understand it's a complicated social issue. But the biology and psychology / behavior aspects are fairly well known and documented. People don't want to believe that all that good tasting food is bad for them. They don't want to give up the idea that ice cream is for daily consumption (not limited to special occasions). Etc. I agree. It's not easy. But the denial doesn't make it any easier. * My parents loved to watching cooking shows, and their diet reflected it. I wish I had $20 for every time I said, "Food is for nutrition, not a pleasure center...Rachael Ray is not your friend." I'd like to add that Oprah spent years pushing the idea of "love yourself" (regardless of how unhealthy that might be) now has a diet-friendly food line (a la Weight Watchers). And yet no one stops to say, wait didn't she help normalize this problem?
    - simiones 3y ago
      Lots of people become obese on excellent food. It's far more common than obese people who become normal weight for a long period of time. The food doesn't really seem to be the main issue (though it probably adds its own set of health complications). Newer research tends to suggest that the body is not saying "nourish me", it's saying "I need to be 120kg" (the lipostat model), and it doesn't seem food is what's affecting that. Various other substances are known to cause similar effects (hormones, lithium, possibly PFAS and other plastics), but it remains to be seen if any of them is present in high enough quantities to be the root cause.
      - chiefalchemist 3y ago
        That happens. But it's not the majority. I agree. There are also too many unknown environmental factors. Nonetheless, too many calories ingested, and not enough calories burned is only going to go in one direction. btw, I recently read "The Comfort Crisis" by Michael Easter. I wouldn't say there was a whole not a new info (for me) in it. But he does a very good job of bring a wide range of info together and presents it in a way that's easy to consume (but not in a junk food sort of way). I think it's worth a read for anyone who looking to improve their health via diet + movement.
- EatingWithForks 3y ago
  I mean, based on the fact the new drugs are hormone related (they help lose weight by suppressing the hunger mechanics in the body) of course people "don't listen to what you tell them". You're telling them to, with will alone, totally ignore their own body's hormone disorder. I'm sure narcoleptics can also just stay awake when you tell them, or I'm sure people with thyroid disorders can also just overcome it with sheer will. I think no one willingly eats themselves obese. Something else must be going wrong-- an eating disorder caused by trauma, or a hormone disorder, or something. Normal-sized people just don't feel the need to eat that much and genuinely find overeating to be deeply unpleasant, because their bodies are responding healthily to too many calories ["I shouldn't have had that extra slice of pizza, I feel like shit"].
  - stanmancan 3y ago
    I think the real problem is that the vast majority of people know nothing about nutrition and thus are unable to make healthy decisions. Nutrition, diet, and cooking should be required courses in high school.
    - EatingWithForks 3y ago
      The thing is that nutrition education hasn't been proven to work for obese people. They do not educate themselves thin, no matter how much education they get. It's very clear to me something is going wrong at a greater population level. There's no education needed to think "nah I don't need dessert" or "yeah I'm done, I'll take these leftovers home". That's just listening to your body. Something has gone wrong where obese people's bodies aren't responding properly to food.
      - stanmancan 3y ago
        My theory, based on nothing, is that up until recently food was scarce so when it was available we had to eat for survival. The more calorie dense something was the more likely we were to survive. After millions of years of evolution we've only recently had an abundance of food in many places and our instincts to eat it all haven't evolved quite yet. (To confirm again, this is just my personal theory and I know nothing about the space) Anyways; personally I've found education to be very helpful. It does take some will power but that's the same for anything. Lots of people find drinking fun; why don't you wake up and drink in the morning? Relaxing, hanging with friends, and doing hobbies is more fun than work so why don't we all quit our jobs to pursue those things? We know drinking can be destructive and is bad for us so, addicts aside, we know to drink with moderation. We know we have bills to pay to survive so we know we can't quit our job. With proper education people might realize their food choices are killing them and make healthier choices. Most people just simply don't know. It won't work for everyone, but some people are alcoholics and some are unemployed, but having the proper education and tools would absolutely empower a lot of people to make better choices and live healthier lives. People's diets are literally killing them and they don't know any better.
- JamesBarney 3y ago
  1. Start business 2. Grow revenue to 500k/year 3. Pay yourself 100k per year. When people actually do this, it cures poverty 100% of the time. Or put another way, imagine a drug that cures schizophrenia but that causes the patient to be in such excruciating pain that only 1% continue to take the drug after a year. On an intent to treat basis the drug is useless, but if you look at study completers it's 100% effective. Should we still look for other treatments for the condition?
- saithound 3y ago
  And telling cats not to murder random birds doesn't help outcomes at all, but only because the cats don't listen to what you tell them.
blueberrychpstx 3y ago
Is this satire?
- JimtheCoder 3y ago
  Sadly, this is the attitude of some obese people...
  - cm2012 3y ago
    First of all, I'm not obese. Second, you lack reading comprehension. Third, you come across as a judgmental and unpleasant person. It's obviously possible to lose weight with diet and exercise. It is completely useless (scientifically) for a doctor to say, "Go exercise and lose weight." Same for other similar things, like weight loss and nutrition education. It's been proven over and over again in scientific literature that it doesn't affect outcomes at scale, every trial shows the same thing. People know that they should eat less and exercise, saying it is not the issue.
    - JimtheCoder 3y ago
      "First of all, I'm not obese. Second, you lack reading comprehension. Third, you come across as a judgmental and unpleasant person." I never said you were obese, I said this is the attitude of some obese people. Not the same thing, so maybe reading comprehension is something you need a little bit of help with. Judgmental? Probably a little...As someone who lost over 100lbs and has kept it off for over a decade the old fashioned way...exercise and portion control...hearing people make excuses for why they cannot do the same gets kind of lame after a while.
    - neffy 3y ago
      Pot - Kettle on that. For a non-scientific case study of 2 - I know one obese person who has had gastric surgery, and complication from it - it hasn't helped them, and one formally obese person who successfully lost 20kg and has kept it off. Consider perhaps that trial participants may in some sense be self-selected from the sector of the population for whom normal diets don't work. fwiw... the latter person strongly recommended deleting all sugar from the diet.
cm2012 3y ago
Here's a follow up to this: PSA: Every legitimate long term study of major non surgical weight loss shows that it doesn't happen for the vast, vast majority of people. It's basically freakish when succesful in the long term. 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 in the study lost 10%+ of their body weight and kept it off for five years. Not even one.
- Maxburn 3y ago
  I guess I'm a freak, I dropped 30~40 lbs and all it took was a permanent overhaul of my diet (keto/paleo) and committing to some exercise (close rings on apple watch most days). You know, discipline. About 4 years now... People hate when I tell them the secret is proper diet and exercise, they just don't have the discipline.
  - deleted 3y ago
    [deleted]
  - chiefalchemist 3y ago
0zemp2c 3y ago
[dead]

by cm2012 3y ago

josephcsible 3y ago

> telling people to eat right and diet doesn't help outcomes at all That's only because they don't listen to what you tell them. When people actually do eat right and diet, that works to lose weight 100% of the time.

cm2012 3y ago
Yes, but that's pointless as a policy for doctors and healthcare in general.
simiones 3y ago
No, it's because people can't just fight what their body tells them they need for any significant amount of time. It is incredibly difficult to lose weight for anything more than a year or two, and in fact very rarely happens - at least without surgery.
- chiefalchemist 3y ago
  > it's because people can't just fight what their body tells them they need for any significant amount of time. Yes, the body is saying "nourish me" and they're feeding it food that is high-calorie and low-nutrient. So the body keeps asking "nourish me". And they feed it the same thing. We shouldn't be so quick to blame the body for the mind making poor decisions. > It is incredibly difficult to lose weight for anything more than a year or two, and in fact very rarely happens But why is that? Have they developed new better habits, or simply put the proven bad ones on hold? Is the whole family / household in on the effort, or is it usually one very obese person trying to change, while the obese and overweight under the same roof aren't making any effort (to change diet, exercise, and TV watching* routines). The point is, we are known creatures of habit. We are also creatures known to conform to the surrounding norms. If the norms of the house are counter-productive then yes you're going to lose. If the norms once you leave the house (or turn on the TV) are against you, that doesn't help either (but it's a bit less impactful). I understand it's a complicated social issue. But the biology and psychology / behavior aspects are fairly well known and documented. People don't want to believe that all that good tasting food is bad for them. They don't want to give up the idea that ice cream is for daily consumption (not limited to special occasions). Etc. I agree. It's not easy. But the denial doesn't make it any easier. * My parents loved to watching cooking shows, and their diet reflected it. I wish I had $20 for every time I said, "Food is for nutrition, not a pleasure center...Rachael Ray is not your friend." I'd like to add that Oprah spent years pushing the idea of "love yourself" (regardless of how unhealthy that might be) now has a diet-friendly food line (a la Weight Watchers). And yet no one stops to say, wait didn't she help normalize this problem?
  - simiones 3y ago
    Lots of people become obese on excellent food. It's far more common than obese people who become normal weight for a long period of time. The food doesn't really seem to be the main issue (though it probably adds its own set of health complications). Newer research tends to suggest that the body is not saying "nourish me", it's saying "I need to be 120kg" (the lipostat model), and it doesn't seem food is what's affecting that. Various other substances are known to cause similar effects (hormones, lithium, possibly PFAS and other plastics), but it remains to be seen if any of them is present in high enough quantities to be the root cause.
    - chiefalchemist 3y ago
      That happens. But it's not the majority. I agree. There are also too many unknown environmental factors. Nonetheless, too many calories ingested, and not enough calories burned is only going to go in one direction. btw, I recently read "The Comfort Crisis" by Michael Easter. I wouldn't say there was a whole not a new info (for me) in it. But he does a very good job of bring a wide range of info together and presents it in a way that's easy to consume (but not in a junk food sort of way). I think it's worth a read for anyone who looking to improve their health via diet + movement.
EatingWithForks 3y ago
I mean, based on the fact the new drugs are hormone related (they help lose weight by suppressing the hunger mechanics in the body) of course people "don't listen to what you tell them". You're telling them to, with will alone, totally ignore their own body's hormone disorder. I'm sure narcoleptics can also just stay awake when you tell them, or I'm sure people with thyroid disorders can also just overcome it with sheer will. I think no one willingly eats themselves obese. Something else must be going wrong-- an eating disorder caused by trauma, or a hormone disorder, or something. Normal-sized people just don't feel the need to eat that much and genuinely find overeating to be deeply unpleasant, because their bodies are responding healthily to too many calories ["I shouldn't have had that extra slice of pizza, I feel like shit"].
- stanmancan 3y ago
  I think the real problem is that the vast majority of people know nothing about nutrition and thus are unable to make healthy decisions. Nutrition, diet, and cooking should be required courses in high school.
  - EatingWithForks 3y ago
    The thing is that nutrition education hasn't been proven to work for obese people. They do not educate themselves thin, no matter how much education they get. It's very clear to me something is going wrong at a greater population level. There's no education needed to think "nah I don't need dessert" or "yeah I'm done, I'll take these leftovers home". That's just listening to your body. Something has gone wrong where obese people's bodies aren't responding properly to food.
    - stanmancan 3y ago
      My theory, based on nothing, is that up until recently food was scarce so when it was available we had to eat for survival. The more calorie dense something was the more likely we were to survive. After millions of years of evolution we've only recently had an abundance of food in many places and our instincts to eat it all haven't evolved quite yet. (To confirm again, this is just my personal theory and I know nothing about the space) Anyways; personally I've found education to be very helpful. It does take some will power but that's the same for anything. Lots of people find drinking fun; why don't you wake up and drink in the morning? Relaxing, hanging with friends, and doing hobbies is more fun than work so why don't we all quit our jobs to pursue those things? We know drinking can be destructive and is bad for us so, addicts aside, we know to drink with moderation. We know we have bills to pay to survive so we know we can't quit our job. With proper education people might realize their food choices are killing them and make healthier choices. Most people just simply don't know. It won't work for everyone, but some people are alcoholics and some are unemployed, but having the proper education and tools would absolutely empower a lot of people to make better choices and live healthier lives. People's diets are literally killing them and they don't know any better.
JamesBarney 3y ago
1. Start business 2. Grow revenue to 500k/year 3. Pay yourself 100k per year. When people actually do this, it cures poverty 100% of the time. Or put another way, imagine a drug that cures schizophrenia but that causes the patient to be in such excruciating pain that only 1% continue to take the drug after a year. On an intent to treat basis the drug is useless, but if you look at study completers it's 100% effective. Should we still look for other treatments for the condition?
saithound 3y ago
And telling cats not to murder random birds doesn't help outcomes at all, but only because the cats don't listen to what you tell them.

blueberrychpstx 3y ago

Is this satire?

JimtheCoder 3y ago
Sadly, this is the attitude of some obese people...
- cm2012 3y ago
  First of all, I'm not obese. Second, you lack reading comprehension. Third, you come across as a judgmental and unpleasant person. It's obviously possible to lose weight with diet and exercise. It is completely useless (scientifically) for a doctor to say, "Go exercise and lose weight." Same for other similar things, like weight loss and nutrition education. It's been proven over and over again in scientific literature that it doesn't affect outcomes at scale, every trial shows the same thing. People know that they should eat less and exercise, saying it is not the issue.
  - JimtheCoder 3y ago
    "First of all, I'm not obese. Second, you lack reading comprehension. Third, you come across as a judgmental and unpleasant person." I never said you were obese, I said this is the attitude of some obese people. Not the same thing, so maybe reading comprehension is something you need a little bit of help with. Judgmental? Probably a little...As someone who lost over 100lbs and has kept it off for over a decade the old fashioned way...exercise and portion control...hearing people make excuses for why they cannot do the same gets kind of lame after a while.
  - neffy 3y ago
    Pot - Kettle on that. For a non-scientific case study of 2 - I know one obese person who has had gastric surgery, and complication from it - it hasn't helped them, and one formally obese person who successfully lost 20kg and has kept it off. Consider perhaps that trial participants may in some sense be self-selected from the sector of the population for whom normal diets don't work. fwiw... the latter person strongly recommended deleting all sugar from the diet.

cm2012 3y ago

Here's a follow up to this: PSA: Every legitimate long term study of major non surgical weight loss shows that it doesn't happen for the vast, vast majority of people. It's basically freakish when succesful in the long term. 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 in the study lost 10%+ of their body weight and kept it off for five years. Not even one.

Maxburn 3y ago
I guess I'm a freak, I dropped 30~40 lbs and all it took was a permanent overhaul of my diet (keto/paleo) and committing to some exercise (close rings on apple watch most days). You know, discipline. About 4 years now... People hate when I tell them the secret is proper diet and exercise, they just don't have the discipline.
- deleted 3y ago
  [deleted]
- chiefalchemist 3y ago

0zemp2c 3y ago

[dead]