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> "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape. Studies show it just doesn't work. There was a massive (18

> "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape. Studies show it just doesn't work. There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 and the likelihood of going from severely obese to normal weight is 1 in 1667. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407685/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407685/ [edit] not to mention for those 1 in 11, the average weight regain over 5 years is 80%. https://www.sciencedirect.com/science/article/pii/S0002916523063748 https://www.sciencedirect.com/science/article/pii/S000291652...

oldpersonintx 2y ago
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pfdietz 2y ago
I've lost 27 pounds since May (12%). Eliminating most carbs and doing lots of walking. I think being on metformin helped.
- jeffbee 2y ago
  > and doing lots of walking If you just teleport a fat guy from Bentonville to Manhattan and give him a Metrocard he will lose a pound a week. The people who say nobody can lose weight, it's too hard, cannot explain why there are macroscale populations with lower obesity.
  - arcticbull 2y ago
    Surely you have a study to support this? Or are we just speculating. The problem with this particular area is that it's not intuitive, and relying on "common sense" guidance is why everyone got fat in the first place.
    - randomdata 2y ago
      Does it matter? This is a discussion forum, not a scientific journal. If you have something more informative to add, just do it.
      - arcticbull 2y ago
        Generally here if you make a claim it's totally fair to be asked to substantiate it. I already provided the evidence that this individual was wrong, so I'm looking to see why they think otherwise. Maybe they'll teach me something new.
        randomdata 2y ago
        > Generally here if you make a claim it's totally fair to be asked to substantiate it. Anything is fair. It is a discussion forum. You can say whatever the hell you want. But it is equally nonsensical. > so I'm looking to see why they think otherwise. You looked for someone else – someone who prepared a study – to tell you why it might be otherwise. But if you want to talk to someone else, go talk to that someone else. If you want to come here, be happy with the people who are here. They might actually teach you something without having to defer to random other people.
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      - tikhonj 2y ago
        Questioning questionable claims is as much discussion as anything else.
        2y ago
  - connicpu 2y ago
    "It's too hard" includes "It's too hard to just magically change the environmental factors making it difficult for this specific person". We can't just magically move every obese person to NYC, and unwalkable car-dependent infrastructure cannot be fixed overnight either, even if the people living there all decided to vote for politicians who would legitimately work towards making that happen (still seems unlikely). Unless and until we work towards fixing the societal problems that created the obesity crisis in the first place, we still need short term solutions for the next couple decades at least.
  - rootusrootus 2y ago
    Those same populations are gaining weight at a trajectory that is behind the US but still headed the same direction. AFAIK most western European nations have a majority of people overweight, with 20-25% obese. This is less than the US (though it's very regional within the US), but you don't get to brag about a 1-in-4 obesity rate.
    - mmsc 2y ago
      >This is less than the US (though it's very regional within the US), but you don't get to brag about a 1-in-4 obesity rate. Are you sure? >In 2023, over 35 percent of adults in the Netherlands were classed as overweight, meaning they had a body mass index (BMI)of between 25 and 30. Furthermore, just under 16 percent of adults were obese >47 percent of French adults were overweight, of which 17 percent suffered from obesity >49% of the Belgian population has overweight, of which 18% have obesity. >Spain: 43% of adults aged 18 years and over were overweight and 16% were living with obesity >46.6% of women and 60.5% of men in Germany are affected by overweight (including obesity). Nearly one-fifth of adults (19%) have obesity. Looks like it's actually 1-in-5.
      - rootusrootus 2y ago
        For the purposes of this discussion, I will take your numbers as truth and run with it. Are you arguing that 1:5 is good, but 1:4 is bad? The only large populations of people in the world that aren't quite fat are southeast Asians. And this is fairly accurate whether they leave in southeast Asia or in the US or western Europe. Not 1:5, closer to 1:20 or in one case 1:50. Even then, southeast Asian obesity rates are climbing. The US may have led the pack because of a consistently high standard of living, but I don't see any indication that there are macroscale populations anywhere in the world keeping the disease at bay.
        mmsc 2y ago
        >Are you arguing that 1:5 is good, but 1:4 is bad? No, I'm saying that 1:4 is something to brag about, and 1:5 is even better.
  - dmonitor 2y ago
    Giving fat guys ozempic is significantly easier than teleporting them all to Manhattan
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  - CydeWeys 2y ago
    Realistically this treatment is just not available to most people (for the simple reason that there are way too few non-car-dependent cities in the US, and the ones that there are are super expensive). But GLP1 agonists are available to most people.
- rootusrootus 2y ago
  I did that in 2020. May through November. 40 pounds off. Then I sprained my ankle. I apologize for being negative, but come back in a year and let us know how it's going. Many, many people can lose 10%, 20%, even 30% of their body weight with concerted effort. Works for a year or maybe two. It's actually pretty easy, to be honest, most people who've done it will agree with me.
  - crooked-v 2y ago
    I had the same kind of experience. Not as dramatic as that, but six months of careful dieting lost weight, but then within a month after I stopped calorie-counting I was back at the same original slightly-overweight weight I had previously plateaued at.
  - pfdietz 2y ago
    Not going to claim that won't happen.
patmcc 2y ago
>>>Studies show it just doesn't work. It's not that "eat less and exercise more" doesn't work, it's that nobody does it, because it's really, really hard. Calories in/Calories out is both completely true and completely useless for actual humans. edit: that's unfair, mostly useless
- petesergeant 2y ago
  The best way to stop smoking is to never have another cigarette!
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- logicchains 2y ago
  >It's not that "eat less and exercise more" doesn't work, it's that nobody does it There are plenty of examples of people who've managed to lose weight through diet and exercise, it's not "nobody". Sure it's a small % success rate, but that's because it's not easy. Just like squatting or deadlifting 300 lbs, it's not easy to get there, but the vast majority of humans could if they decided to put the time and effort into it.
  - arcticbull 2y ago
    Would you apply the same analysis to people with depression who cured their depression by smiling more? It's not zero, it's just very hard. Ultimately both are chronic issues of the central nervous system. We know GLP-1s act on the GABAergic central nervous system.
    - spicyusername 2y ago
      I think that as convenient as it would be, depression and the inability to not eat too much are not the same. The fact is that you have much more control over one than the other. I don't disagree that maintaining a healthy weight is a challenge in today's environment, but it's not impossible or inevitable, like so many in this thread are pretending.
CooCooCaCha 2y ago
Eating less and exercising more does work, in fact that is how you lose weight. The problem is doing it consistently which is what these drugs help with.
- thfuran 2y ago
  Yes, they clearly mean that it doesn't work at a societal level. If you take a human and force them to exercise more and eat less, they're going to lose weight. And everyone knows that, but pretty much every modern society is increasingly overweight. Ergo, "it doesn't work".
  - CooCooCaCha 2y ago
    No, everyone does not know that. That’s why the phrasing is harmful.
lukasb 2y ago
Are there any studies that look at body fat % instead of weight? I don't care how much I weigh.
- adrian_b 2y ago
  A good proxy for body fat %, especially for males, is the waist circumference / hip circumference ratio. See e.g. https://en.wikipedia.org/wiki/Waist%E2%80%93hip_ratio https://en.wikipedia.org/wiki/Waist%E2%80%93hip_ratio for recommended values.
potta_coffee 2y ago
It would work if people would actually do it. It 100% works. Human nature is such that people would rather take a drug than change their lifestyle. I've done it myself but it requires a complete realignment of lifestyle to make lasting change.
- icedchai 2y ago
  Another problem is not doing it enough. Walking a couple miles once a week isn't going to do much. You have to make it a habit, part of your routine, and do it every day.
  - arcticbull 2y ago
    Also not only is your body very efficient at walking/running (losing 10lbs of fat requires an average person to run from SF to LA) there's evidence of a constrained total energy expenditure model. If you try and create a large caloric deficit through exercise you become more efficient at the exercise (so each incremental step costs less calories) and your metabolism slows down (and your NEAT - non exercise activity thermogenesis - levels drop) to conserve energy for you to expend on exercise. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803033/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803033/
- asib 2y ago
  In 2018 I did an Ironman triathlon. Across 2020 and 2021 I cycled over 20,000 miles. I cycled 200 miles on the hottest day of 2022 in the UK. In 2021 I cycled 200 miles in under 12 hours. In 2023 I ran over 10 half marathons. You simply cannot tell me I didn't completely realign my lifestyle or that I'm not determined. At my lightest in 2023, I weighed 60kg. Currently I weigh over 95kg. I don't know what else people who hold your view can be told to convince them this problem is not one of willpower. I have the capacity to suffer. I've given up smoking. There is no escape from food.
  - manfre 2y ago
    You described a lot of physical activities, but diet controls your weight. It's natural to have more of an appetite with increased activity. It's also normal to increase your weight a bit due to increased muscle mass.
icedchai 2y ago
Of course, it "doesn't work" because people don't keep it up. I started exercising regularly during covid and didn't stop. I cut out all the soda. It works.
- aantix 2y ago
  Report back in 10, 15 and 20 years. Likely, you will at some point revert to unhealthy habits and become fat again. Long-term weight loss success numbers are abysmal.
  - doublepg23 2y ago
    So we should be on drugs the rest of our lives?
    - soulbadguy 2y ago
      Aren't we already ?
    - aantix 2y ago
      Many embrace it. Testosterone replacement therapy, highly refined protein powders, nootropics, etc. We’re all trying to make the best of what’s given, revert mistakes, live longer. All options are on the table.
    - arcticbull 2y ago
      We’re on fluoride from the water our entries lives, iodine in the salt and various B vitamins, iron and calcium in the flour. Why stop there? This has been an overwhelming coup for public health.
  - WorkerBee28474 2y ago
    I dropped from the mid 300s 10-15 years ago to 260-ish these days. It fluctuates from 250 to 280 over time, but keeping off weight long-term by changing diet is very much doable.
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oremolten 2y ago
it's interesting you state "Studies show it just doesn't work." While we are commenting on an article about a drug which makes you feel less hungry, there by "eating less". The drug doesn't make you use more calories, it simply "makes" you EAT LESS. Eating less(calories) than your body uses consistently for duration is literally the only way you can lose weight. (outside of literally losing limbs, or surgery to remove mass) Exercise only augments the process, it all comes back down to EATING LESS(calories).
- soulbadguy 2y ago
  "Telling people to eat less" doesn't work the same way telling people to relax doesn't work. It assumes that relaxing is under voluntary control. To bring it back food, the issue is not the eating, the core issue is the hunger causing the eating and that's what the medication is addressing. The people you think are eating ea
- vessenes 2y ago
  There are a number of pathways these drugs hit - dopamine receptors, they slow processing of food, and in tirzepatide's case at least increase insulin response. They're not just small portions in a shot. I take "Studies show it just doesn't work" to mean "Studies show telling people to eat less and exercise more definitely doesn't work," as opposed to "caloric deficits don't work".
AtlasBarfed 2y ago
People need to understand what activity / exercise really is. The desperation of the medical establishment to get people to do ANY exercise meant the general advice is watered down. It's the doom of the statistical distribution. Good outcomes are defined in relative terms on the bell curve, not on absolute performance which exercise is actually suited for. In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. I can imagine farmers back in the days of 12-hour days of physical labor may burn 5000 or 6,000 calories. A pound of fat is 3500 calories. Meanwhile, people that are generally following some 20 minutes of exercise five times a week, regimen of the medical establishment are likely really only burning about 300 to 400 calories tops in those 20 minutes sessions, if they even do that. For the sake of argument, we're going to ignore the basal metabolic advantages of people that are burning an extra 1,500 to 3000 calories per day and the stimulated muscle growth that comes with it. People back in olden days just on activity were burning a third to a half a pound extra of fat per day in terms of energy. Meanwhile, modern people who "exercise" are burning maybe a tenth of a pound. Only when you get to "athletes" that are "training" do you get to the calorie burns that people's lives used to entail. So it's important to keep in mind when people say exercise is ineffective in weight loss that they really are talking about very minor amounts of added activity by by modern medical standards. Exercise is extremely effective at limiting weight if you get to what I call the 1000 calorie Hammer, where your exercise is adding an extra thousand calories or more per day to your activity. And you're simultaneously not going nuts on your diet. A 1000 calories is a considerable amount of activity. For a 180 lb man, that's 4000 yards of swimming, 7 miles of running, or 25-30 miles of biking. If you are a 120 lb woman, increase those distances by 50%. Most people consider those loads to be exercise obsessives, but practically that's what's necessary in order to employ exercise as a usable means for weight control and surviving the corn syrup world we're in
- rootusrootus 2y ago
  > In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. Hasn't this idea been studied using modern-but-primitive groups of people who still live much as they have for thousands of years? Their bodies are quite efficient and they do not burn substantially more calories than "civilized" humans in regular society do.
rybosworld 2y ago
> Studies show it just doesn't work. Eating less and exercising most certainly does work, if the individual sticks to the routine. I do agree it's difficult to stick to a routine because our modern lives are demanding and so we compromise by eating fast food and avoid going to the gym. I think the exercise paradox video recently put out by Kurzgesagt has been a net negative for how people think about diet and exercise. The paper the video is based on is highly flawed. That paper has a few major problems but these are the biggest: 1) The authors didn't control for body mass. The Hadza and Bolivians burned 52kcal per kg of body weight. Americans burned only 38kcal per kg of body weight. That is: the active groups burned significantly more calories than the inactive groups, on a pound-for-pound basis. 2) The active groups were defined as such because they walked ~12km per day. This is significant because the human body is exceptionally efficient at walking. It is certainly true that over a comparable span of time, you will burn less calories walking than you would running, or lifting weights. GLP-1's are miracle drugs and people should take them if they at are high risk for obesity-related diseases. But diet and exercise certainly do aid weight loss, and will have fewer negative side effects than a GLP-1 drug. https://www.germanjournalsportsmedicine.com/archive/archive-2018/heft-1/editorial-fat-in-spite-of-exercise-an-alleged-paradigm-change-results-from-calculation-mistakes/ https://www.germanjournalsportsmedicine.com/archive/archive-...
bdndndndbve 2y ago
Homeostasis is a powerful force. Once you gain weight your body has a tendency to keep it, and overcoming that to establish a new equilibrium is difficult and uncomfortable.
bozhark 2y ago
This is absurd. Caloric intake and outtake is just that.
- rootusrootus 2y ago
  That is a simplistic description which is superficially true. The body, however, is quite a bit more complicated than that. Especially when you get to that wrinkly pink lump in your skull.
- crooked-v 2y ago
  The point you're missing is that telling people "just eat less" doesn't work, because it's extremely difficult for many people to "just eat less". That's literally the whole reason that ozempic etc are popular, because they make it easier for most people to just eat less, in the same kind of way that caffeine makes it subjectively easier for someone who's tired to be productive.
  - rootusrootus 2y ago
    > it's extremely difficult for many people to "just eat less" Right. To be explicit, "just eat less" means "live your life always hungry." There's a reason this more-or-less never works in practice.
pugets 2y ago
It does work. It couldn't not work. Each day of your life, you choose to do one of three things: 1. Consume more calories than your body will need to function 2. Consume as many calories as your body will need to function 3. Consume fewer calories than your body will need to function When you consume more energy than you require, your body stores the remainder as fat. When you consume less energy than is required, your body converts your fat into usable energy. Now obviously, this is an over-simplified explanation of nutrition. What you eat, when you eat it, how efficiently your body converts food to energy, and other factors will determine the little details. But the explanation I've provided is not nearly as over-simplified as "it just doesn't work." To make a comparison, it would be like suggesting that the financial advice "earn more money than you spend" just doesn't work as a method of saving money, on the grounds that some % of Americans who try to save money end up in credit card debt.
- grayhatter 2y ago
  So if understanding the equation about how humans can obtain and maintain a healthy diet/weight is as simple as you present here. Why doesn't everybody just do that? You say yourself, it couldn't not work. And yet there's hundreds of thousands of people that say it didn't work. Explain them, are they lying? I'd assert, the oversimplified explanation is misleading. It's only true in the same way that drinking cold water will help you lose more weight than warm water. True or not, reality seems to strongly suggest it's irrelevant
  - rybosworld 2y ago
    > Explain them, are they lying? Yes.
    - grayhatter 2y ago
      It's more likely that hundreds of thousands of people are collectively lying, than it is that trying to find a solution that works for hundreds of thousands of different humans all with different needs, lifestyles, desires, capabilities, and understanding, might be a tad more complicated than just counting intake calories?
confidantlake 2y ago
It works in the same way as crossing the finish line first works to win a race. Of course it works, do that and you win 100% of the time. It is not that it doesn't work, it is that it is extremely difficult to do.
adrian_b 2y ago
I hear very often this theory that "it just doesn't work". To be fair, I had also believed this for many years. However, all the people who claim that "it just doesn't work", have never made any serious attempt to do "it", so they cannot know whether it does work or not. I have been obese for more than a decade, during which I have made several attempts to lose weight, which have all failed, because they were not done in the right manner. Then I have made a final attempt using the correct method, and I have lost about 35% of my initial body weight during about ten months, at a steady rate between 100 g and 150 g per day, i.e. about 1 kg per week. This was more than 10 years ago and since then I have kept a constant weight. Because I have done this once, now I can control my weight and have any weight I want, even if I gain weight extremely easily. It is enough to eat one day like I was eating when I was obese to gain enough weight to require a week of weight losing diet to go back to the desired weight. The rules for losing weight and maintaining the weight are very simple, but they must be observed and those who claim that "it doesn't work" never try to observe the rules, so it is entirely predictable that it cannot work for them. First, it should be obvious that after losing weight one must eat differently as before, otherwise weight will be gained until reaching again the original weight. To be able to control the weight, anyone who is or has been obese must stop eating until they feel satiated. At each meal, one must plan before beginning to eat how much to eat and then eat only the amount planned, never more than that. One must eat a fixed number of meals per day (preferably few, e.g. only two meals per day should be enough for an adult who has a sedentary lifestyle) and never eat between meals any kind of snacks or drink any sweet of fatty beverages. Between meals, only water or beverages without any calories (e.g. unsweetened herbal teas or tea or coffee) are acceptable intakes. While losing weight, the most important thing is to weigh oneself every day with precise digital scales (with a resolution of 100 grams or less), at the same hour and in the same physiological conditions, i.e. in the same order with respect to meals and relieving oneself. Whenever the weight is not less than the previous day, then the quantity of food planned for the current day must be diminished in comparison with the previous day. At the very beginning of losing weight there may be a delay, e.g. of a week or so between starting to eat less every day until the weight begins to decrease, but eventually it is possible to reach a steady state of a constant rate of losing weight per day. When diminishing the amount of eaten food, only the carbohydrates and the non-essential fats must be reduced. The amount of proteins, essential fatty acids, vitamins and minerals must remain normal. To achieve this, one must eat a source of pure proteins, for example turkey breast or chicken breast or some kind of protein powders, so that eating enough proteins contributes only a minimum amount of calories. The rest of the nutrients can be provided mostly by non-starchy vegetables and perhaps by some supplements like fish oil. One could also eat almost anything that is not recommended, for instance chocolate, with the condition that the quantity is negligible, which can normally be achieved only when such treats are not eaten every day, but e.g. only once or twice per week. These rules are simple and anyone who follows them will lose as much weight as desired. Obviously, this is easier said than done, because for the entire duration of the weight-losing diet one will be permanently hungry and one would tend to think about food and it will be difficult to resist temptations, so it is better to not keep in the house any kind of food that can be eaten immediately, without requiring some kind of preparation. Unfortunately, this is unavoidable and it is the price that must be paid. After the first few weeks, the hunger sensation diminishes in intensity and it always disappears for a few hours whenever you find some work to do that captures your attention. As long as you do not want to follow such rules, you will not lose weight, but that is because you do not want to do it, not because it does not work. Not wanting to do it is a valid reason, because one may abhor more the feeling of hunger during many months than being obese, but this decision must be described correctly and not be justified by the false claim that "it doesn't work". At least in my case, the improvement in my health and in what I was able to do (e.g. before losing weight climbing a few stairs would make me tired and sweaty) has made worthwhile any displeasure felt during losing weight and I have been very happy to have achieved that.
_heimdall 2y ago
All this study really shows is an analysis of medical records with no background of the peoples' diet or lifestyle. The outcome should be obvious and expected, those who are overweight and obese were found to stay that way. The fact that the rate of obesity in the US has pretty consistently risen for decades makes that clear, you don't need statistical models of medical records to know that the rate of obesity could only really keep going up if those already obese stay that way.
zahlman 2y ago
>There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 Unsurprising. They ran statistics on arbitrary overweight and obese people, with no idea of who was actively seeking to lose weight or who was just coming away from such an effort. If a significant fraction of the overweight/obese population did lose 5% of body weight/year, we wouldn't be seeing a bunch of overweight/obese people.

oldpersonintx 2y ago

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pfdietz 2y ago

I've lost 27 pounds since May (12%). Eliminating most carbs and doing lots of walking. I think being on metformin helped.

jeffbee 2y ago
> and doing lots of walking If you just teleport a fat guy from Bentonville to Manhattan and give him a Metrocard he will lose a pound a week. The people who say nobody can lose weight, it's too hard, cannot explain why there are macroscale populations with lower obesity.
- arcticbull 2y ago
  Surely you have a study to support this? Or are we just speculating. The problem with this particular area is that it's not intuitive, and relying on "common sense" guidance is why everyone got fat in the first place.
  - randomdata 2y ago
    Does it matter? This is a discussion forum, not a scientific journal. If you have something more informative to add, just do it.
    - arcticbull 2y ago
      Generally here if you make a claim it's totally fair to be asked to substantiate it. I already provided the evidence that this individual was wrong, so I'm looking to see why they think otherwise. Maybe they'll teach me something new.
      - randomdata 2y ago
        > Generally here if you make a claim it's totally fair to be asked to substantiate it. Anything is fair. It is a discussion forum. You can say whatever the hell you want. But it is equally nonsensical. > so I'm looking to see why they think otherwise. You looked for someone else – someone who prepared a study – to tell you why it might be otherwise. But if you want to talk to someone else, go talk to that someone else. If you want to come here, be happy with the people who are here. They might actually teach you something without having to defer to random other people.
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    - tikhonj 2y ago
      Questioning questionable claims is as much discussion as anything else.
      - 2y ago
- connicpu 2y ago
  "It's too hard" includes "It's too hard to just magically change the environmental factors making it difficult for this specific person". We can't just magically move every obese person to NYC, and unwalkable car-dependent infrastructure cannot be fixed overnight either, even if the people living there all decided to vote for politicians who would legitimately work towards making that happen (still seems unlikely). Unless and until we work towards fixing the societal problems that created the obesity crisis in the first place, we still need short term solutions for the next couple decades at least.
- rootusrootus 2y ago
  Those same populations are gaining weight at a trajectory that is behind the US but still headed the same direction. AFAIK most western European nations have a majority of people overweight, with 20-25% obese. This is less than the US (though it's very regional within the US), but you don't get to brag about a 1-in-4 obesity rate.
  - mmsc 2y ago
    >This is less than the US (though it's very regional within the US), but you don't get to brag about a 1-in-4 obesity rate. Are you sure? >In 2023, over 35 percent of adults in the Netherlands were classed as overweight, meaning they had a body mass index (BMI)of between 25 and 30. Furthermore, just under 16 percent of adults were obese >47 percent of French adults were overweight, of which 17 percent suffered from obesity >49% of the Belgian population has overweight, of which 18% have obesity. >Spain: 43% of adults aged 18 years and over were overweight and 16% were living with obesity >46.6% of women and 60.5% of men in Germany are affected by overweight (including obesity). Nearly one-fifth of adults (19%) have obesity. Looks like it's actually 1-in-5.
    - rootusrootus 2y ago
      For the purposes of this discussion, I will take your numbers as truth and run with it. Are you arguing that 1:5 is good, but 1:4 is bad? The only large populations of people in the world that aren't quite fat are southeast Asians. And this is fairly accurate whether they leave in southeast Asia or in the US or western Europe. Not 1:5, closer to 1:20 or in one case 1:50. Even then, southeast Asian obesity rates are climbing. The US may have led the pack because of a consistently high standard of living, but I don't see any indication that there are macroscale populations anywhere in the world keeping the disease at bay.
      - mmsc 2y ago
        >Are you arguing that 1:5 is good, but 1:4 is bad? No, I'm saying that 1:4 is something to brag about, and 1:5 is even better.
- dmonitor 2y ago
  Giving fat guys ozempic is significantly easier than teleporting them all to Manhattan
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- CydeWeys 2y ago
  Realistically this treatment is just not available to most people (for the simple reason that there are way too few non-car-dependent cities in the US, and the ones that there are are super expensive). But GLP1 agonists are available to most people.
rootusrootus 2y ago
I did that in 2020. May through November. 40 pounds off. Then I sprained my ankle. I apologize for being negative, but come back in a year and let us know how it's going. Many, many people can lose 10%, 20%, even 30% of their body weight with concerted effort. Works for a year or maybe two. It's actually pretty easy, to be honest, most people who've done it will agree with me.
- crooked-v 2y ago
  I had the same kind of experience. Not as dramatic as that, but six months of careful dieting lost weight, but then within a month after I stopped calorie-counting I was back at the same original slightly-overweight weight I had previously plateaued at.
- pfdietz 2y ago
  Not going to claim that won't happen.

patmcc 2y ago

>>>Studies show it just doesn't work. It's not that "eat less and exercise more" doesn't work, it's that nobody does it, because it's really, really hard. Calories in/Calories out is both completely true and completely useless for actual humans. edit: that's unfair, mostly useless

petesergeant 2y ago
The best way to stop smoking is to never have another cigarette!
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logicchains 2y ago
>It's not that "eat less and exercise more" doesn't work, it's that nobody does it There are plenty of examples of people who've managed to lose weight through diet and exercise, it's not "nobody". Sure it's a small % success rate, but that's because it's not easy. Just like squatting or deadlifting 300 lbs, it's not easy to get there, but the vast majority of humans could if they decided to put the time and effort into it.
- arcticbull 2y ago
  Would you apply the same analysis to people with depression who cured their depression by smiling more? It's not zero, it's just very hard. Ultimately both are chronic issues of the central nervous system. We know GLP-1s act on the GABAergic central nervous system.
  - spicyusername 2y ago
    I think that as convenient as it would be, depression and the inability to not eat too much are not the same. The fact is that you have much more control over one than the other. I don't disagree that maintaining a healthy weight is a challenge in today's environment, but it's not impossible or inevitable, like so many in this thread are pretending.

CooCooCaCha 2y ago

Eating less and exercising more does work, in fact that is how you lose weight. The problem is doing it consistently which is what these drugs help with.

thfuran 2y ago
Yes, they clearly mean that it doesn't work at a societal level. If you take a human and force them to exercise more and eat less, they're going to lose weight. And everyone knows that, but pretty much every modern society is increasingly overweight. Ergo, "it doesn't work".
- CooCooCaCha 2y ago
  No, everyone does not know that. That’s why the phrasing is harmful.

lukasb 2y ago

Are there any studies that look at body fat % instead of weight? I don't care how much I weigh.

adrian_b 2y ago
A good proxy for body fat %, especially for males, is the waist circumference / hip circumference ratio. See e.g. https://en.wikipedia.org/wiki/Waist%E2%80%93hip_ratio https://en.wikipedia.org/wiki/Waist%E2%80%93hip_ratio for recommended values.

potta_coffee 2y ago

It would work if people would actually do it. It 100% works. Human nature is such that people would rather take a drug than change their lifestyle. I've done it myself but it requires a complete realignment of lifestyle to make lasting change.

icedchai 2y ago
Another problem is not doing it enough. Walking a couple miles once a week isn't going to do much. You have to make it a habit, part of your routine, and do it every day.
- arcticbull 2y ago
  Also not only is your body very efficient at walking/running (losing 10lbs of fat requires an average person to run from SF to LA) there's evidence of a constrained total energy expenditure model. If you try and create a large caloric deficit through exercise you become more efficient at the exercise (so each incremental step costs less calories) and your metabolism slows down (and your NEAT - non exercise activity thermogenesis - levels drop) to conserve energy for you to expend on exercise. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803033/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803033/
asib 2y ago
In 2018 I did an Ironman triathlon. Across 2020 and 2021 I cycled over 20,000 miles. I cycled 200 miles on the hottest day of 2022 in the UK. In 2021 I cycled 200 miles in under 12 hours. In 2023 I ran over 10 half marathons. You simply cannot tell me I didn't completely realign my lifestyle or that I'm not determined. At my lightest in 2023, I weighed 60kg. Currently I weigh over 95kg. I don't know what else people who hold your view can be told to convince them this problem is not one of willpower. I have the capacity to suffer. I've given up smoking. There is no escape from food.
- manfre 2y ago
  You described a lot of physical activities, but diet controls your weight. It's natural to have more of an appetite with increased activity. It's also normal to increase your weight a bit due to increased muscle mass.

icedchai 2y ago

Of course, it "doesn't work" because people don't keep it up. I started exercising regularly during covid and didn't stop. I cut out all the soda. It works.

aantix 2y ago
Report back in 10, 15 and 20 years. Likely, you will at some point revert to unhealthy habits and become fat again. Long-term weight loss success numbers are abysmal.
- doublepg23 2y ago
  So we should be on drugs the rest of our lives?
  - soulbadguy 2y ago
    Aren't we already ?
  - aantix 2y ago
    Many embrace it. Testosterone replacement therapy, highly refined protein powders, nootropics, etc. We’re all trying to make the best of what’s given, revert mistakes, live longer. All options are on the table.
  - arcticbull 2y ago
    We’re on fluoride from the water our entries lives, iodine in the salt and various B vitamins, iron and calcium in the flour. Why stop there? This has been an overwhelming coup for public health.
- WorkerBee28474 2y ago
  I dropped from the mid 300s 10-15 years ago to 260-ish these days. It fluctuates from 250 to 280 over time, but keeping off weight long-term by changing diet is very much doable.
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oremolten 2y ago

it's interesting you state "Studies show it just doesn't work." While we are commenting on an article about a drug which makes you feel less hungry, there by "eating less". The drug doesn't make you use more calories, it simply "makes" you EAT LESS. Eating less(calories) than your body uses consistently for duration is literally the only way you can lose weight. (outside of literally losing limbs, or surgery to remove mass) Exercise only augments the process, it all comes back down to EATING LESS(calories).

soulbadguy 2y ago
"Telling people to eat less" doesn't work the same way telling people to relax doesn't work. It assumes that relaxing is under voluntary control. To bring it back food, the issue is not the eating, the core issue is the hunger causing the eating and that's what the medication is addressing. The people you think are eating ea
vessenes 2y ago
There are a number of pathways these drugs hit - dopamine receptors, they slow processing of food, and in tirzepatide's case at least increase insulin response. They're not just small portions in a shot. I take "Studies show it just doesn't work" to mean "Studies show telling people to eat less and exercise more definitely doesn't work," as opposed to "caloric deficits don't work".

AtlasBarfed 2y ago

People need to understand what activity / exercise really is. The desperation of the medical establishment to get people to do ANY exercise meant the general advice is watered down. It's the doom of the statistical distribution. Good outcomes are defined in relative terms on the bell curve, not on absolute performance which exercise is actually suited for. In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. I can imagine farmers back in the days of 12-hour days of physical labor may burn 5000 or 6,000 calories. A pound of fat is 3500 calories. Meanwhile, people that are generally following some 20 minutes of exercise five times a week, regimen of the medical establishment are likely really only burning about 300 to 400 calories tops in those 20 minutes sessions, if they even do that. For the sake of argument, we're going to ignore the basal metabolic advantages of people that are burning an extra 1,500 to 3000 calories per day and the stimulated muscle growth that comes with it. People back in olden days just on activity were burning a third to a half a pound extra of fat per day in terms of energy. Meanwhile, modern people who "exercise" are burning maybe a tenth of a pound. Only when you get to "athletes" that are "training" do you get to the calorie burns that people's lives used to entail. So it's important to keep in mind when people say exercise is ineffective in weight loss that they really are talking about very minor amounts of added activity by by modern medical standards. Exercise is extremely effective at limiting weight if you get to what I call the 1000 calorie Hammer, where your exercise is adding an extra thousand calories or more per day to your activity. And you're simultaneously not going nuts on your diet. A 1000 calories is a considerable amount of activity. For a 180 lb man, that's 4000 yards of swimming, 7 miles of running, or 25-30 miles of biking. If you are a 120 lb woman, increase those distances by 50%. Most people consider those loads to be exercise obsessives, but practically that's what's necessary in order to employ exercise as a usable means for weight control and surviving the corn syrup world we're in

rootusrootus 2y ago
> In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. Hasn't this idea been studied using modern-but-primitive groups of people who still live much as they have for thousands of years? Their bodies are quite efficient and they do not burn substantially more calories than "civilized" humans in regular society do.

rybosworld 2y ago

> Studies show it just doesn't work. Eating less and exercising most certainly does work, if the individual sticks to the routine. I do agree it's difficult to stick to a routine because our modern lives are demanding and so we compromise by eating fast food and avoid going to the gym. I think the exercise paradox video recently put out by Kurzgesagt has been a net negative for how people think about diet and exercise. The paper the video is based on is highly flawed. That paper has a few major problems but these are the biggest: 1) The authors didn't control for body mass. The Hadza and Bolivians burned 52kcal per kg of body weight. Americans burned only 38kcal per kg of body weight. That is: the active groups burned significantly more calories than the inactive groups, on a pound-for-pound basis. 2) The active groups were defined as such because they walked ~12km per day. This is significant because the human body is exceptionally efficient at walking. It is certainly true that over a comparable span of time, you will burn less calories walking than you would running, or lifting weights. GLP-1's are miracle drugs and people should take them if they at are high risk for obesity-related diseases. But diet and exercise certainly do aid weight loss, and will have fewer negative side effects than a GLP-1 drug. https://www.germanjournalsportsmedicine.com/archive/archive-2018/heft-1/editorial-fat-in-spite-of-exercise-an-alleged-paradigm-change-results-from-calculation-mistakes/ https://www.germanjournalsportsmedicine.com/archive/archive-...

bdndndndbve 2y ago

Homeostasis is a powerful force. Once you gain weight your body has a tendency to keep it, and overcoming that to establish a new equilibrium is difficult and uncomfortable.

bozhark 2y ago

This is absurd. Caloric intake and outtake is just that.

rootusrootus 2y ago
That is a simplistic description which is superficially true. The body, however, is quite a bit more complicated than that. Especially when you get to that wrinkly pink lump in your skull.
crooked-v 2y ago
The point you're missing is that telling people "just eat less" doesn't work, because it's extremely difficult for many people to "just eat less". That's literally the whole reason that ozempic etc are popular, because they make it easier for most people to just eat less, in the same kind of way that caffeine makes it subjectively easier for someone who's tired to be productive.
- rootusrootus 2y ago
  > it's extremely difficult for many people to "just eat less" Right. To be explicit, "just eat less" means "live your life always hungry." There's a reason this more-or-less never works in practice.

pugets 2y ago

It does work. It couldn't not work. Each day of your life, you choose to do one of three things: 1. Consume more calories than your body will need to function 2. Consume as many calories as your body will need to function 3. Consume fewer calories than your body will need to function When you consume more energy than you require, your body stores the remainder as fat. When you consume less energy than is required, your body converts your fat into usable energy. Now obviously, this is an over-simplified explanation of nutrition. What you eat, when you eat it, how efficiently your body converts food to energy, and other factors will determine the little details. But the explanation I've provided is not nearly as over-simplified as "it just doesn't work." To make a comparison, it would be like suggesting that the financial advice "earn more money than you spend" just doesn't work as a method of saving money, on the grounds that some % of Americans who try to save money end up in credit card debt.

grayhatter 2y ago
So if understanding the equation about how humans can obtain and maintain a healthy diet/weight is as simple as you present here. Why doesn't everybody just do that? You say yourself, it couldn't not work. And yet there's hundreds of thousands of people that say it didn't work. Explain them, are they lying? I'd assert, the oversimplified explanation is misleading. It's only true in the same way that drinking cold water will help you lose more weight than warm water. True or not, reality seems to strongly suggest it's irrelevant
- rybosworld 2y ago
  > Explain them, are they lying? Yes.
  - grayhatter 2y ago
    It's more likely that hundreds of thousands of people are collectively lying, than it is that trying to find a solution that works for hundreds of thousands of different humans all with different needs, lifestyles, desires, capabilities, and understanding, might be a tad more complicated than just counting intake calories?

confidantlake 2y ago

It works in the same way as crossing the finish line first works to win a race. Of course it works, do that and you win 100% of the time. It is not that it doesn't work, it is that it is extremely difficult to do.

adrian_b 2y ago

I hear very often this theory that "it just doesn't work". To be fair, I had also believed this for many years. However, all the people who claim that "it just doesn't work", have never made any serious attempt to do "it", so they cannot know whether it does work or not. I have been obese for more than a decade, during which I have made several attempts to lose weight, which have all failed, because they were not done in the right manner. Then I have made a final attempt using the correct method, and I have lost about 35% of my initial body weight during about ten months, at a steady rate between 100 g and 150 g per day, i.e. about 1 kg per week. This was more than 10 years ago and since then I have kept a constant weight. Because I have done this once, now I can control my weight and have any weight I want, even if I gain weight extremely easily. It is enough to eat one day like I was eating when I was obese to gain enough weight to require a week of weight losing diet to go back to the desired weight. The rules for losing weight and maintaining the weight are very simple, but they must be observed and those who claim that "it doesn't work" never try to observe the rules, so it is entirely predictable that it cannot work for them. First, it should be obvious that after losing weight one must eat differently as before, otherwise weight will be gained until reaching again the original weight. To be able to control the weight, anyone who is or has been obese must stop eating until they feel satiated. At each meal, one must plan before beginning to eat how much to eat and then eat only the amount planned, never more than that. One must eat a fixed number of meals per day (preferably few, e.g. only two meals per day should be enough for an adult who has a sedentary lifestyle) and never eat between meals any kind of snacks or drink any sweet of fatty beverages. Between meals, only water or beverages without any calories (e.g. unsweetened herbal teas or tea or coffee) are acceptable intakes. While losing weight, the most important thing is to weigh oneself every day with precise digital scales (with a resolution of 100 grams or less), at the same hour and in the same physiological conditions, i.e. in the same order with respect to meals and relieving oneself. Whenever the weight is not less than the previous day, then the quantity of food planned for the current day must be diminished in comparison with the previous day. At the very beginning of losing weight there may be a delay, e.g. of a week or so between starting to eat less every day until the weight begins to decrease, but eventually it is possible to reach a steady state of a constant rate of losing weight per day. When diminishing the amount of eaten food, only the carbohydrates and the non-essential fats must be reduced. The amount of proteins, essential fatty acids, vitamins and minerals must remain normal. To achieve this, one must eat a source of pure proteins, for example turkey breast or chicken breast or some kind of protein powders, so that eating enough proteins contributes only a minimum amount of calories. The rest of the nutrients can be provided mostly by non-starchy vegetables and perhaps by some supplements like fish oil. One could also eat almost anything that is not recommended, for instance chocolate, with the condition that the quantity is negligible, which can normally be achieved only when such treats are not eaten every day, but e.g. only once or twice per week. These rules are simple and anyone who follows them will lose as much weight as desired. Obviously, this is easier said than done, because for the entire duration of the weight-losing diet one will be permanently hungry and one would tend to think about food and it will be difficult to resist temptations, so it is better to not keep in the house any kind of food that can be eaten immediately, without requiring some kind of preparation. Unfortunately, this is unavoidable and it is the price that must be paid. After the first few weeks, the hunger sensation diminishes in intensity and it always disappears for a few hours whenever you find some work to do that captures your attention. As long as you do not want to follow such rules, you will not lose weight, but that is because you do not want to do it, not because it does not work. Not wanting to do it is a valid reason, because one may abhor more the feeling of hunger during many months than being obese, but this decision must be described correctly and not be justified by the false claim that "it doesn't work". At least in my case, the improvement in my health and in what I was able to do (e.g. before losing weight climbing a few stairs would make me tired and sweaty) has made worthwhile any displeasure felt during losing weight and I have been very happy to have achieved that.

_heimdall 2y ago

All this study really shows is an analysis of medical records with no background of the peoples' diet or lifestyle. The outcome should be obvious and expected, those who are overweight and obese were found to stay that way. The fact that the rate of obesity in the US has pretty consistently risen for decades makes that clear, you don't need statistical models of medical records to know that the rate of obesity could only really keep going up if those already obese stay that way.

zahlman 2y ago

>There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 Unsurprising. They ran statistics on arbitrary overweight and obese people, with no idea of who was actively seeking to lose weight or who was just coming away from such an effort. If a significant fraction of the overweight/obese population did lose 5% of body weight/year, we wouldn't be seeing a bunch of overweight/obese people.