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I'm sure people can use diet and exercise to keep the weight off. At the end of the day, it's all "calories in calories out".

tjohns 3y ago
There's a hormonal component to weight loss. Some people literally do not get a reliable "I'm full, stop eating" signal from their bodies. For other people, eating is stress response. (Sometimes one becomes the other.) If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive - it's literally one of our most basic hardwired instincts. Even more so if you have a particularly stressful life or get poor sleep, which also feeds into the hormone issues. So yes, it is always "calories in - calories out"... but unless you're willing to lock people in a lab and have a third-party control the diet, you also have to consider the mental and biological factors that drive how many calories people's bodies are seeking out. Diet and exercise do work for some people, and is always the best option when it works. But we also know from decades of failed diets that they do not work for many people - lifestyle modification has a terrible success rate.
- rrrrrrrrrrrryan 3y ago
  > If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive Trying to ignore being hungry it is a poor strategy. The solution is to to make peace with the sensation of hunger. I do think most obesity should be treated as a mental health issue rather than a physical health issue. The issue isn't that the person is obese - that's the symptom. The issue is that they're overheating. "What's driving me to overeat?" is the question they need to be asking themselves, and that answer will be the first piece of the puzzle.
  - xvector 3y ago
    It is the literal feeling of incredible hunger. That is not a normal thing to expect people to live with. The average person does not feel constantly hungry and thus not the urge to overeat. Most obese people became obese in childhood. In obese people, especially those from childhood that were forced to always clean their plate, signaling pathways for satiation tend to stop working, so consuming a "normal" amount of food becomes difficult. Furthermore, mechanisms for hunger in obesity function very similarly to mechanisms for cocaine or alcohol addiction. Drugs like Ozempic finally allow their biological signals for "you've had enough food" to actually work, so obese people can lose weight because they feel satiated like normal people do. FWIW I have lost weight both ways - 80lbs through sheer will, and 25lbs through Mounjaro. I vastly prefer the second. The former is the hardest thing I have ever done (or will likely ever do) in my life. It was harder than getting into a top college, harder than anything relating to my career, harder than literally any other endeavor I've taken. It is definitely unreasonable to expect the average person to expend so much extreme mental effort when alternatives exist to become healthy.
    - deleted 3y ago
      [deleted]
    - burnerburnito 3y ago
      I've felt incredible hunger and pain. I've had a lifetime of voluntary fasting, sure, but I've also had an experience this year where I spent weeks starving while already underweight and sick as hell withdrawing from a couple drugs, unable to sleep for more than 20-30 minutes tops, and suffering from a (still mostly mystery) intestinal issue. I was SO hungry, it was indeed one of my dominant thoughts other than wanting to kill myself (or distract myself with hot hand warmers in between puking). It virtually never truly went away, other than when I was distracted by even worse senations. What I then struggle to understand is why my obese and well-off father with a LOT of free time can't make the decision to stop eating fast food, can't consistently stick with not buying presumably very immediately gratifying and pleasurable fast food that often makes him feel sick later. Why I could actually have made radical changes to my diet years before I ever had that level of extreme suffering, or consistently rejected taking any opioids or weed even when my tolerances were probably more reset 1 or 2 weeks in and they could've provided substantial short-term escape from that hell. I ask in this manner not to try to "brag", as if there's some achievement in meaningless and random suffering, but rather to ask about and understand how you might interpet it. I feel like I've experienced severe and truly engulfing hunger + pain. Coming out of that, I don't understand why some people can't escape the "addiction" of overeating unhealthy food, let alone too much of it, and others can escape the throes of drug dependency. What could be so alien about someone like me compared against my own father, as opposed to his being in an active refusal to try? Ultimately, it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure, and yet given the same opportunities of similar constant cheap pleasures I've mostly avoided them in seeing the longer term pain lying in wait behind their facade. I feel as though the only definitive observation I can make there is that most obese people can't seem to see their condition similarly. They can get hyped up selling themselved and those around them a meme "diet plan" while its easy in their mind, but once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
hackeraccount 3y ago
Sure but it's like trying to hide the keys to the liquor cabinet from yourself. Ultimately it's the root cause that interests people not the consequence of it.

tjohns 3y ago

There's a hormonal component to weight loss. Some people literally do not get a reliable "I'm full, stop eating" signal from their bodies. For other people, eating is stress response. (Sometimes one becomes the other.) If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive - it's literally one of our most basic hardwired instincts. Even more so if you have a particularly stressful life or get poor sleep, which also feeds into the hormone issues. So yes, it is always "calories in - calories out"... but unless you're willing to lock people in a lab and have a third-party control the diet, you also have to consider the mental and biological factors that drive how many calories people's bodies are seeking out. Diet and exercise do work for some people, and is always the best option when it works. But we also know from decades of failed diets that they do not work for many people - lifestyle modification has a terrible success rate.

rrrrrrrrrrrryan 3y ago
> If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive Trying to ignore being hungry it is a poor strategy. The solution is to to make peace with the sensation of hunger. I do think most obesity should be treated as a mental health issue rather than a physical health issue. The issue isn't that the person is obese - that's the symptom. The issue is that they're overheating. "What's driving me to overeat?" is the question they need to be asking themselves, and that answer will be the first piece of the puzzle.
- xvector 3y ago
  It is the literal feeling of incredible hunger. That is not a normal thing to expect people to live with. The average person does not feel constantly hungry and thus not the urge to overeat. Most obese people became obese in childhood. In obese people, especially those from childhood that were forced to always clean their plate, signaling pathways for satiation tend to stop working, so consuming a "normal" amount of food becomes difficult. Furthermore, mechanisms for hunger in obesity function very similarly to mechanisms for cocaine or alcohol addiction. Drugs like Ozempic finally allow their biological signals for "you've had enough food" to actually work, so obese people can lose weight because they feel satiated like normal people do. FWIW I have lost weight both ways - 80lbs through sheer will, and 25lbs through Mounjaro. I vastly prefer the second. The former is the hardest thing I have ever done (or will likely ever do) in my life. It was harder than getting into a top college, harder than anything relating to my career, harder than literally any other endeavor I've taken. It is definitely unreasonable to expect the average person to expend so much extreme mental effort when alternatives exist to become healthy.
  - deleted 3y ago
    [deleted]
  - burnerburnito 3y ago
    I've felt incredible hunger and pain. I've had a lifetime of voluntary fasting, sure, but I've also had an experience this year where I spent weeks starving while already underweight and sick as hell withdrawing from a couple drugs, unable to sleep for more than 20-30 minutes tops, and suffering from a (still mostly mystery) intestinal issue. I was SO hungry, it was indeed one of my dominant thoughts other than wanting to kill myself (or distract myself with hot hand warmers in between puking). It virtually never truly went away, other than when I was distracted by even worse senations. What I then struggle to understand is why my obese and well-off father with a LOT of free time can't make the decision to stop eating fast food, can't consistently stick with not buying presumably very immediately gratifying and pleasurable fast food that often makes him feel sick later. Why I could actually have made radical changes to my diet years before I ever had that level of extreme suffering, or consistently rejected taking any opioids or weed even when my tolerances were probably more reset 1 or 2 weeks in and they could've provided substantial short-term escape from that hell. I ask in this manner not to try to "brag", as if there's some achievement in meaningless and random suffering, but rather to ask about and understand how you might interpet it. I feel like I've experienced severe and truly engulfing hunger + pain. Coming out of that, I don't understand why some people can't escape the "addiction" of overeating unhealthy food, let alone too much of it, and others can escape the throes of drug dependency. What could be so alien about someone like me compared against my own father, as opposed to his being in an active refusal to try? Ultimately, it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure, and yet given the same opportunities of similar constant cheap pleasures I've mostly avoided them in seeing the longer term pain lying in wait behind their facade. I feel as though the only definitive observation I can make there is that most obese people can't seem to see their condition similarly. They can get hyped up selling themselved and those around them a meme "diet plan" while its easy in their mind, but once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.

hackeraccount 3y ago

Sure but it's like trying to hide the keys to the liquor cabinet from yourself. Ultimately it's the root cause that interests people not the consequence of it.