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Diet and exercise methods don't[1] work for most people, for loss and especially for healthy weight maintenance. With extreme levels of direct, personal involv

Diet and exercise methods don't[1] work for most people, for loss and especially for healthy weight maintenance. With extreme levels of direct, personal involvement by multiple professionals (which is what rich people / celebrities have historically used, and variations of which have been studied by researchers) the efficacy level reaches "sort-of OK, but still not great". That's crazy-expensive, though, so not a realistic solution for the masses, plus the results are still pretty lackluster despite the cost. [1] Could, hypothetically, yes "CICO", technically anyone could lose weight, but they in fact do not work when applied in the real world, statistically speaking.

andoando 1y ago
I wonder how much of that is education. Most people also don't seem to know that weight loss is simply Calories in - calories out, what their BMR is, how to track calories. Most people, even educated people, still seem to believe things like they have slow metabolism, that herbal teas can help, doing situps will reduce belly fat, and number of dumb shit the market tries to sell. As a nation were just far too focused on $$$, and instead of focusing on fixing the root of the issue, were only incentivized to bandage the problem with producing more things that will make $$$. Sell shit food, people get fat, sell crap products for weigh loss, drugs, surgery, etc
- dekhn 1y ago
  Weight loss is not simply calories in - calories out. Fat is not burned and its metabolism does not change your weight. Oxygen/CO2 exchange in the lungs is also a major component of weight change. Further, your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption. And that's just addressing first order weight parameters.
  - dgfitz 1y ago
    It is calories in/out. Other mechanisms factor in, but I’ll bet anyone my bottom dollar they’ll lose weight if they eat 700 kcal/day. Yes, breathing is literally how weight is lost, I’m not sure what your point was there.
  - jtmarl1n 1y ago
    Weight loss is absolutely a result of CICO, please site a source that states otherwise. I have never heard another source citing Oxygen/CO2 exchange as a factor for weight change, again, please site a source. O2 levels are certainly a factor of cardio health which can be correlated to overall health and weight. Yes, macros also matter. But, nothing matters as much as the simple math of calories in/calories out. Its disingenuous, borderline irresponsible, to suggest otherwise.
    - SpicyLemonZest 1y ago
      https://www.bmj.com/content/349/bmj.g7257 https://www.bmj.com/content/349/bmj.g7257 is one analysis of oxygen/CO2 exchange being a major component of weight loss. As the authors say, it's really a question of chemistry; the CO2 you metabolize from your fat has to go somewhere. To be clear, I think your instinctive reaction is correct. It would be extremely silly for someone to read this analysis and conclude that they'll lose weight if they learn some special breathing technique to maximize CO2 output. The point is that "calories in - calories out" as a diet strategy is the same kind of error.
      - dekhn 1y ago
        By the way, if you ever want to start a scientific argument, bring up this paper among doctors and scientists. It never fails to start a big argument that is usually concluded with "human metabolism does not violate the conservation of mass/energy" (many doctors and scientists believe that "burning fat" with oxygen causes you to lose weight directly).
    - dekhn 1y ago
      "Burning" fat doesn't violate conservation of mass/energy. Instead, weight loss occurs primarily through co2/oxygen exchange that is connected to metabolism. https://www.bmj.com/content/349/bmj.g7257 https://www.bmj.com/content/349/bmj.g7257 (note I don't totally agree with this paper, and agree that if you eat almost no food, you will lose weight, and that exercise definitely seems to increase the metabolic rate and increased mass exchange in the lungs. Like I said, it's complicated). I'm not being disingenous or irresponsible- I'm describing mainstream science based on biophysical data.
  - meindnoch 1y ago
    >your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption Then exercise more. That's how you increase the "calories out" part of the equation. Yeah, it takes willpower.
    - dekhn 1y ago
      I don't disagree that increased exercise is associated with weight loss. I don't think I denied that. We're mainly disagreeing about mechanisms. Ultimately, fat metabolism does not violate the conservation of mass/energy.
    - wcfields 1y ago
      > willpower I mean, sure, but if it was just willpower for everyone then we'd all speak 10 languages, play piano, be buff as hell, be emotionally stable, and no one would be an alcoholic. But we're squishy apes that are regulated by hormones and live busy messy lives with cars that are probably needing a tire rotation 3000 miles ago and putting it off a few more miles won't really hurt.
    - const_cast 1y ago
      Or it doesn’t take any willpower at all. I certainly don’t have to do this, and I’m thin. I eat whatever I want, whenever I want. So why can I do that, but others can’t? It would be comforting to just say that I’m better. It would also be a lie.
      - reissbaker 1y ago
        There are generally a few answers to this. But they all boil down to: * You never used to be fat. Once you become fat, your body's homeostatic set point is permanently altered. Your body never destroys adipocytes — it only shrinks them. If you stay within some range of your current homeostatic set point, your body will either increase the size of your adipocytes, or decrease their size, depending on whether you're over- or under-consuming. But, after a certain amount of overconsumption, your body will actually create new adipocytes... And once you have them, you can never get rid of them, minus expensive and dangerous surgery. The best you can do is shrink them. But, keeping the adipocytes shrunken takes significant willpower. So basically, once you get fat, you're going to have a hard time. Pretty much the only alternative is somehow tricking your brain/gut into not getting hungry when it "should." Ozempic, etc seem to somehow allow you to not feel as hungry even when your adipocytes shrink, or at least alter your perceived set point to be more-shrunken. Bariatric surgery is similar although much more dangerous. (Liposuction actually removes adipocytes, but it's quite dangerous — and it doesn't remove visceral fat cells, which are the worst kind of fat from a health perspective.) Now, there's a separate question of "why do some people get fat initially?" And that can result from poor childhood nutrition, or genes (e.g. Samoans), or exposure to certain chemical compounds (e.g. certain psychiatric medications), or natural aging (recent research indicates middle-aged mice, and probably thus middle-aged humans, have their stem cells trigger more adipocyte production), or just lifestyle. But it's the initial weight gain that ends up trapping people into the higher homeostatic set point, which is very difficult to recover from, even with dieting and exercise, since you will need to keep yourself basically constantly hungry either by eating less or by exercising much more even after you "lost" the weight — because while you lost weight on the scale, you didn't lose adipocytes, and adipocytes do not want to be kept empty.
- SketchySeaBeast 1y ago
  I lost weight by measuring calories, shedding ~25% of my body weight. It's still a battle and will always be. I keep exercising the whole time - I'm training for my first marathon right now (I've run the distance before, just not in an official race), but my weight slides up, I adjust, it slides back down. I think some people are just built to like food, it's not a matter of education.
- deleted 1y ago
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- cjbgkagh 1y ago
  Rehashing my regular humans are not calorimeters post. Metabolism is driven by hormones, it’s very possible for signaling peptides to prevent weight gain no matter how much a person eats. While a person who eats nothing will clearly lose weight knowing that isn’t helpful as it’ll lead to a substantial loss in quality of life and most probably it is not long term stable. In my case I have ME/CFS at the same time that I have uncontrollable weight gain, I also did extended fasts to keep the weight off as best I could. It wasn’t a willpower thing, having to manage both while making enough money to survive is incredibly difficult and it was impossible to keep all the plates spinning at the same time. Post Exertional Malaise is very real for some people and triggers can cause me to be bed-bound for months on end. Thankfully not so much anymore since I’ve found a good combo of very strong medications.
  - andoando 1y ago
    When almost half the country is obese/overweight, these kind of medical conditions are not the cause. For 99% of people it is not a metabolic disorder. What I am talking about is people saying things like "Wow you have fast metabolism", without even understanding what metabolism is. Having twice as fast metabolism would mean my body requires twice the amount of calories for the same cellular activity. That'd be terrible! The truth is I am skinny because i barely eat and if I eat 500 calories above my calculated BMR, I gain 1 pound a week just like the science suggests. I think this is the fact for most people. >While a person who eats nothing will clearly lose weight That's a strawman. What I am saying is take your BMR+caloric expenditure from exercise - 500 calories, not starve yourself.
    - cjbgkagh 1y ago
      When giving a generalization it's important to constantly note that exceptions exist. On the percentage of exceptions I think it's higher than commonly thought for a few reasons, most autoimmune disorders are still undiagnosed and will remain undiagnosed for the duration of the persons life. Consider hEDS for example, a walking bag of symptoms yet still 20 years to get diagnosed from onset of symptoms for those who are eventually diagnosed - again most are never diagnosed. The other reason is that autoimmune conditions can be induced - it's not a genetic switch where you have it or you don't though there is a substantial genetic component especially with regards to susceptibility. People with my genetic background hEDS from multiple TNXB SNPs are extremely susceptible. The US population is also in new circumstances - we're several generations into the generally accepted medical advice that intermittent fasting will impair your metabolism. Prior generations would fast much more frequently than todays, they would just call it skipping meals. While what you are saying is technically correct the framing of it leads to poor conclusions and suboptimal strategy, it will meet the stated aim of weight loss but not meet the implied aim of a maintainable lifestyle. The source of the calories is incredibly important given the effect that has on the hormones, and the cadence of calories is also very important. Instead of counting calories a person would be better of eating one meal a day of heavy caloric foods with the occasional multi-day fast would be far more productive. Augmenting this with a GLP-1A would be even more productive.
- JumpCrisscross 1y ago
  > Most people also don't seem to know that weight loss is simply Calories in - calories out It is a problem of education. For example, in reading the common research that shows basal metabolism, which you can’t control, will rapidly undo most of your conscious gains from caloric balance manipulation. And that in those with severe metabolic syndrome, the body will reduce BM to starvation levels before giving up a single fat cell.
- alabastervlog 1y ago
  Are citizens of skinnier countries better-educated, then become less-so if they move to the US and (typically) pack on weight? If it's not education keeping other countries skinny, why would adding more education be the way we get out of it? (This works for other explanations, too, like "oh they have more willpower"—so do they lose willpower if they move to the US? No, more likely, a complex combination of factors mostly outside individual control are why they're skinnier in their home country and fatten up after moving to the US; more likely, it's harder to be skinny here)
  - andoando 1y ago
    >Are citizens of skinnier countries better-educated, then become less-so if they move to the US and (typically) pack on weight? "skinnier" countries have way different lifestyles, less driving, more walking, less fast food culture, etc. They don't need to be educated on weight loss because they naturally are not prone to it due to these socioeconomic conditions.
    - alabastervlog 1y ago
      Yes! One thing that would be pretty likely to work is radically changing our city layouts, patterns of settlement, methods of commute, density of living, food quality, food prices & price structuring, worker protection & time-off laws, and a bunch of other stuff. In the meantime (so... indefinitely, because moving the needle on one of those things would be the work of a lifetime) we now have drugs that can do it.
  - ahahahahah 1y ago
    > keeping other countries skinny Those countries basically don't exist, or rather they just haven't caught up yet. From 1985 to 2016, there are 117 countries where obesity has increased by more that 10.0% (in absolute terms). In no country was the increase less than 1.9% (which was vietnam, where 1.9% in absolute terms is a 10x increase in the percent of people who are obese).
lanfeust6 1y ago
This is normally because those diets are unsustainable, or not sustained at any rate. If you change your habits such that you start introducing more calories, it's not a question of "if" you'll gain back weight, but when. It's only fairly recently that we seem to have a better grip on what makes caloric restriction more sustainable, and accounting for effects like metabolic adaptation. Even then that information doesn't seem to reach most people. Also understated is the impact of one's environment, and social support systems. It's much harder if you break from what your family and friends are doing. Some habits, I've seen with my own two eyes, can be regarded as an obligation. I really believe the odds can turn around for a larger demographic, with a more optimal approach. Let's not forget that we've had far more invasive procedures than ozempic available to help facilitate weight-loss (like gastric bypass), and people still gain back weight on those, if they refuse to change their habits. Drinks, junk foods, and deep fried foods are not satiating compared to their caloric density, and that remains true regardless of surgery and pills. Nothing changes until it's internalized that binging has a price.
- SpicyLemonZest 1y ago
  > Drinks, junk foods, and deep fried foods are not satiating compared to their caloric density, and that remains true regardless of surgery and pills. But it doesn't remain true on GLP-1 medications, which is why they're so popular.
  - lanfeust6 1y ago
    It does remain true, that's the entire point. With GLP-1 you can be more full than without, but that doesn't mean that a baked potato and french fries grant equivalent satiety! Your body also adapts somewhat to the medication. If you factor in metabolic adaptation, then re-introduction of surplus calories will lead to regaining weight, even if they weren't as many calories as before. For the reports of mediated cravings, also: some people don't just overeat from physical cravings, but for emotional satisfaction. A binge session on comfort food has almost nothing to do with hunger. This is something addressed through therapy, not pills.
    - 1y ago
no_wizard 1y ago
Perhaps anecdotal but generally society doesn't seem to be setup to reward people making good choices. Before the GLP-1 drugs became mainstream for weight loss, I know friends who were overweight who had enough money[0] to go on programs where your entire meal days are planned for you[1]. They'd ship you enough food for 2 weeks at a time, but you never had to think about what you were going to eat, it was all pre portioned and decided by your meal plan as part of the program. They saw really meaningful results, lost weight, and as long as they were on the programs, they kept it off. As far as I could tell, the food wasn't anything special beyond being properly proportioned and nutrient dense - certainly achievable on ones own - but it seems the rigidity of it - that is, the fact they didn't have to make food choices every day - made it easy to stick to. The food prep itself was easy too - mostly throw it in a single skillet, microwaving it or putting it in the oven on a tray or in a baking dish was all it took. I watched as they got healthier they were more active, felt better, seemed generally overall much happier. Once the program was over or they for whatever reason had to stop, it didn't take long for the weight to come back, and they had discovered a big part of their problem was food anxiety - not knowing what they wanted to eat, having trouble with food cravings etc. This has lead to me to suspect there are some seriously chronic issues with food culture in the US - namely, we haven't made doing the objectively best thing the easiest thing. Its too often out of reach due to cost, availability or time - which also speaks to other interconnected issues in the US that are going unaddressed. For example, I know these programs worked exceedingly well for those I saw on them, why aren't they cheaper? Why don't we subsidize such things to nudge society in a better direction with food choices? We already subsidize the bad stuff - we should move those subsidies to better options. [0]: I'm talking breakfast, lunch, dinner, and a small allotment of daily mini meals - really snacks. [1]: This is the problem. To do this, you have to be of upper class means just to afford the food, and thats not even including the cost of the program associated with it, and in some cases its simply a meal delivery program and there's no additional anything, and its still expensive
- trollied 1y ago
  USA food is absolutely crazy. Lots of stuff that’s banned in the EU. Lots of high fructose corn syrup. If you eat out, portion sizes are off the scale. I ordered a starter salad at a restaurant once when I was over on business, and it would have fed me for the entire day! (Won’t even start on the sauces!) Everything involving food is screwed.
h2zizzle 1y ago
The realistic solution puts car manufacturers and certain food processors out of business (unless they learn to compete as export-focused/non-addiction-based businesses), so... Yeah, maybe not so realistic. But the obesity stats of countries with robust public transit, walkable neighborhoods, biking infrastructure, and restrictions on highly-processed food speak for themselves. In the end - as with so many issues - the question is if policymakers are going to throw capitalists or regular people under the bus.
- alabastervlog 1y ago
  Right, the non-drug solution that would actually work (we can observe it working in countries with different infrastructure, healthcare, culture, city design, food quality and costs and cost structures, and more—we can be fairly sure it's some combination of that stuff because the folks who live there put on weight if they move to the US) is "upend US society in a bunch of ways" so is, realistically, not workable, at least not on the scale of human lifetimes, though it still wouldn't be a bad thing to try to move somewhat closer to.
  - h2zizzle 1y ago
    Well, no. The countries that have done this have almost invariably done it within a 30-year timespan. Japan after WWII, China at the turn of the century, the Netherlands starting in the 70s. Even American cities like DC have made significant strides just since the Covid pandemic. Reminder that the US auto industry would have collapsed during the GFC without a bailout. Balancing food industry profits against the healthcare costs carried by the poor and middle class in this country becuse of the lack of access to high-quality food produces a net negative bottom line, one of many deleterious dynamics inflating both personal and public debt. But if you hide all of that, you get to go back to your constituents and say that you're supporting manufacturing jobs and shareholder value for their retirement funds. It's a choice between securing a few people's livelihoods and lifestyles, and securing the general well-being of a lot more people. We could change that choice, and we could do it very quickly, if we wanted to. But people would rather CICO tut-tut strangers on the internet.
meindnoch 1y ago
Diet and exercise don't work for most people, because they don't exercise enough and don't follow their diet. Simple as.
- SilasX 1y ago
  "Stop drinking" doesn't work for most alcoholics, because they go back to drinking. Simple as. "Don't commit violent crimes" doesn't work for most violent criminals, because they go back to committing violent crimes. Simple as. "Stop gambling" doesn't work for compulsive gamblers, because they go back to gambling. Simple as. "Have superhuman willpower in a domain where I don't feel temptation" isn't a cure, it's unempathetic judgment.
  - deleted 1y ago
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  - itsoktocry 1y ago
    5% of the US population self-report alcoholism. Why does food addiction encompass 40% of the US population?
    - doright 1y ago
      Possibly because you can completely avoid alcohol but you can't completely avoid food. Some large percentage of people who would have been addicted to other substances (due to less than optimal nature/nurture) but didn't, because they did not take those substances, instead became addicted to the substance of food. It might be more useful to see addicts to every type of substance as a large pool of anxious people who came across a substance to self-soothe, and figure out how to address the anxiety problem first.
    - alphager 1y ago
      Cheaper, much easier to get, socially acceptable everywhere, ... You won't get judged for eating alone at home, but start drinking alone at home...
    - 1y ago
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itsoktocry 1y ago
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- alabastervlog 1y ago
  > Diet and exercise works. We literally have the science, and, over a population and over time, no, they per se do not. The things that do mostly aren't accessible to normal people (three or four professional nutritionists and trainers and doctors helping out several hours per week; moving to a skinnier country) so "diet and exercise" has been the only available course to recommend, and it's better than nothing, but it's depressingly ineffective. This is precisely the difference between could and does I was trying to highlight to address this kind of thing in advance: diet and exercise could work, like, on paper they work every single time! Hell, technically, they're even essentially all of the mechanism by which methods that do work, achieve their effect, just indirectly. But just trying to improve diet and increase exercise directly does not work, not over a population. For outliers, yeah, but for most, no. Improving those is a an effect of approaches that do work.
  - greenchair 1y ago
    If someone refuses to eat much less food to get their weight under control, I don't see how a nutritionist or personal trainer would help. Maybe a psychiatrist could help them break their addiction.
  - LeafItAlone 1y ago
    >We literally have the science, and, over a population and over time, no, they per se do not. Can you share it?
  - jankyxenon 1y ago
    If it's not diet and exercise, what is it? Obesity is a relatively new problem. GLP-1 also seems to work - primarily through addressing diet. So again, curious what you mean when you say "diet and exercise" do not work.
- ben_w 1y ago
  Diet and exercise would work, if not for the fundamental problem: most people cannot apply those methods. Why they can't, I am unsure. Is it because hunger is a stronger drive than long-term planning? Is it because food is, like many other products and services sold in a capitalist economy, incentivised to develop in maximally addictive ways even without a deliberate choice by any supplier? Is it because advertising really does influence people? Overuse of antibiotics makes people hungry? Something else entirely? Whatever the cause, people can't apply those methods. Which means they don't work for most people — not that they can't work for most people, they just don't.

andoando 1y ago

I wonder how much of that is education. Most people also don't seem to know that weight loss is simply Calories in - calories out, what their BMR is, how to track calories. Most people, even educated people, still seem to believe things like they have slow metabolism, that herbal teas can help, doing situps will reduce belly fat, and number of dumb shit the market tries to sell. As a nation were just far too focused on $$$, and instead of focusing on fixing the root of the issue, were only incentivized to bandage the problem with producing more things that will make $$$. Sell shit food, people get fat, sell crap products for weigh loss, drugs, surgery, etc

dekhn 1y ago
Weight loss is not simply calories in - calories out. Fat is not burned and its metabolism does not change your weight. Oxygen/CO2 exchange in the lungs is also a major component of weight change. Further, your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption. And that's just addressing first order weight parameters.
- dgfitz 1y ago
  It is calories in/out. Other mechanisms factor in, but I’ll bet anyone my bottom dollar they’ll lose weight if they eat 700 kcal/day. Yes, breathing is literally how weight is lost, I’m not sure what your point was there.
- jtmarl1n 1y ago
  Weight loss is absolutely a result of CICO, please site a source that states otherwise. I have never heard another source citing Oxygen/CO2 exchange as a factor for weight change, again, please site a source. O2 levels are certainly a factor of cardio health which can be correlated to overall health and weight. Yes, macros also matter. But, nothing matters as much as the simple math of calories in/calories out. Its disingenuous, borderline irresponsible, to suggest otherwise.
  - SpicyLemonZest 1y ago
    https://www.bmj.com/content/349/bmj.g7257 https://www.bmj.com/content/349/bmj.g7257 is one analysis of oxygen/CO2 exchange being a major component of weight loss. As the authors say, it's really a question of chemistry; the CO2 you metabolize from your fat has to go somewhere. To be clear, I think your instinctive reaction is correct. It would be extremely silly for someone to read this analysis and conclude that they'll lose weight if they learn some special breathing technique to maximize CO2 output. The point is that "calories in - calories out" as a diet strategy is the same kind of error.
    - dekhn 1y ago
      By the way, if you ever want to start a scientific argument, bring up this paper among doctors and scientists. It never fails to start a big argument that is usually concluded with "human metabolism does not violate the conservation of mass/energy" (many doctors and scientists believe that "burning fat" with oxygen causes you to lose weight directly).
  - dekhn 1y ago
    "Burning" fat doesn't violate conservation of mass/energy. Instead, weight loss occurs primarily through co2/oxygen exchange that is connected to metabolism. https://www.bmj.com/content/349/bmj.g7257 https://www.bmj.com/content/349/bmj.g7257 (note I don't totally agree with this paper, and agree that if you eat almost no food, you will lose weight, and that exercise definitely seems to increase the metabolic rate and increased mass exchange in the lungs. Like I said, it's complicated). I'm not being disingenous or irresponsible- I'm describing mainstream science based on biophysical data.
- meindnoch 1y ago
  >your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption Then exercise more. That's how you increase the "calories out" part of the equation. Yeah, it takes willpower.
  - dekhn 1y ago
    I don't disagree that increased exercise is associated with weight loss. I don't think I denied that. We're mainly disagreeing about mechanisms. Ultimately, fat metabolism does not violate the conservation of mass/energy.
  - wcfields 1y ago
    > willpower I mean, sure, but if it was just willpower for everyone then we'd all speak 10 languages, play piano, be buff as hell, be emotionally stable, and no one would be an alcoholic. But we're squishy apes that are regulated by hormones and live busy messy lives with cars that are probably needing a tire rotation 3000 miles ago and putting it off a few more miles won't really hurt.
  - const_cast 1y ago
    Or it doesn’t take any willpower at all. I certainly don’t have to do this, and I’m thin. I eat whatever I want, whenever I want. So why can I do that, but others can’t? It would be comforting to just say that I’m better. It would also be a lie.
    - reissbaker 1y ago
      There are generally a few answers to this. But they all boil down to: * You never used to be fat. Once you become fat, your body's homeostatic set point is permanently altered. Your body never destroys adipocytes — it only shrinks them. If you stay within some range of your current homeostatic set point, your body will either increase the size of your adipocytes, or decrease their size, depending on whether you're over- or under-consuming. But, after a certain amount of overconsumption, your body will actually create new adipocytes... And once you have them, you can never get rid of them, minus expensive and dangerous surgery. The best you can do is shrink them. But, keeping the adipocytes shrunken takes significant willpower. So basically, once you get fat, you're going to have a hard time. Pretty much the only alternative is somehow tricking your brain/gut into not getting hungry when it "should." Ozempic, etc seem to somehow allow you to not feel as hungry even when your adipocytes shrink, or at least alter your perceived set point to be more-shrunken. Bariatric surgery is similar although much more dangerous. (Liposuction actually removes adipocytes, but it's quite dangerous — and it doesn't remove visceral fat cells, which are the worst kind of fat from a health perspective.) Now, there's a separate question of "why do some people get fat initially?" And that can result from poor childhood nutrition, or genes (e.g. Samoans), or exposure to certain chemical compounds (e.g. certain psychiatric medications), or natural aging (recent research indicates middle-aged mice, and probably thus middle-aged humans, have their stem cells trigger more adipocyte production), or just lifestyle. But it's the initial weight gain that ends up trapping people into the higher homeostatic set point, which is very difficult to recover from, even with dieting and exercise, since you will need to keep yourself basically constantly hungry either by eating less or by exercising much more even after you "lost" the weight — because while you lost weight on the scale, you didn't lose adipocytes, and adipocytes do not want to be kept empty.
SketchySeaBeast 1y ago
I lost weight by measuring calories, shedding ~25% of my body weight. It's still a battle and will always be. I keep exercising the whole time - I'm training for my first marathon right now (I've run the distance before, just not in an official race), but my weight slides up, I adjust, it slides back down. I think some people are just built to like food, it's not a matter of education.
deleted 1y ago
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cjbgkagh 1y ago
Rehashing my regular humans are not calorimeters post. Metabolism is driven by hormones, it’s very possible for signaling peptides to prevent weight gain no matter how much a person eats. While a person who eats nothing will clearly lose weight knowing that isn’t helpful as it’ll lead to a substantial loss in quality of life and most probably it is not long term stable. In my case I have ME/CFS at the same time that I have uncontrollable weight gain, I also did extended fasts to keep the weight off as best I could. It wasn’t a willpower thing, having to manage both while making enough money to survive is incredibly difficult and it was impossible to keep all the plates spinning at the same time. Post Exertional Malaise is very real for some people and triggers can cause me to be bed-bound for months on end. Thankfully not so much anymore since I’ve found a good combo of very strong medications.
- andoando 1y ago
  When almost half the country is obese/overweight, these kind of medical conditions are not the cause. For 99% of people it is not a metabolic disorder. What I am talking about is people saying things like "Wow you have fast metabolism", without even understanding what metabolism is. Having twice as fast metabolism would mean my body requires twice the amount of calories for the same cellular activity. That'd be terrible! The truth is I am skinny because i barely eat and if I eat 500 calories above my calculated BMR, I gain 1 pound a week just like the science suggests. I think this is the fact for most people. >While a person who eats nothing will clearly lose weight That's a strawman. What I am saying is take your BMR+caloric expenditure from exercise - 500 calories, not starve yourself.
  - cjbgkagh 1y ago
    When giving a generalization it's important to constantly note that exceptions exist. On the percentage of exceptions I think it's higher than commonly thought for a few reasons, most autoimmune disorders are still undiagnosed and will remain undiagnosed for the duration of the persons life. Consider hEDS for example, a walking bag of symptoms yet still 20 years to get diagnosed from onset of symptoms for those who are eventually diagnosed - again most are never diagnosed. The other reason is that autoimmune conditions can be induced - it's not a genetic switch where you have it or you don't though there is a substantial genetic component especially with regards to susceptibility. People with my genetic background hEDS from multiple TNXB SNPs are extremely susceptible. The US population is also in new circumstances - we're several generations into the generally accepted medical advice that intermittent fasting will impair your metabolism. Prior generations would fast much more frequently than todays, they would just call it skipping meals. While what you are saying is technically correct the framing of it leads to poor conclusions and suboptimal strategy, it will meet the stated aim of weight loss but not meet the implied aim of a maintainable lifestyle. The source of the calories is incredibly important given the effect that has on the hormones, and the cadence of calories is also very important. Instead of counting calories a person would be better of eating one meal a day of heavy caloric foods with the occasional multi-day fast would be far more productive. Augmenting this with a GLP-1A would be even more productive.
JumpCrisscross 1y ago
> Most people also don't seem to know that weight loss is simply Calories in - calories out It is a problem of education. For example, in reading the common research that shows basal metabolism, which you can’t control, will rapidly undo most of your conscious gains from caloric balance manipulation. And that in those with severe metabolic syndrome, the body will reduce BM to starvation levels before giving up a single fat cell.
alabastervlog 1y ago
Are citizens of skinnier countries better-educated, then become less-so if they move to the US and (typically) pack on weight? If it's not education keeping other countries skinny, why would adding more education be the way we get out of it? (This works for other explanations, too, like "oh they have more willpower"—so do they lose willpower if they move to the US? No, more likely, a complex combination of factors mostly outside individual control are why they're skinnier in their home country and fatten up after moving to the US; more likely, it's harder to be skinny here)
- andoando 1y ago
  >Are citizens of skinnier countries better-educated, then become less-so if they move to the US and (typically) pack on weight? "skinnier" countries have way different lifestyles, less driving, more walking, less fast food culture, etc. They don't need to be educated on weight loss because they naturally are not prone to it due to these socioeconomic conditions.
  - alabastervlog 1y ago
    Yes! One thing that would be pretty likely to work is radically changing our city layouts, patterns of settlement, methods of commute, density of living, food quality, food prices & price structuring, worker protection & time-off laws, and a bunch of other stuff. In the meantime (so... indefinitely, because moving the needle on one of those things would be the work of a lifetime) we now have drugs that can do it.
- ahahahahah 1y ago
  > keeping other countries skinny Those countries basically don't exist, or rather they just haven't caught up yet. From 1985 to 2016, there are 117 countries where obesity has increased by more that 10.0% (in absolute terms). In no country was the increase less than 1.9% (which was vietnam, where 1.9% in absolute terms is a 10x increase in the percent of people who are obese).

lanfeust6 1y ago

This is normally because those diets are unsustainable, or not sustained at any rate. If you change your habits such that you start introducing more calories, it's not a question of "if" you'll gain back weight, but when. It's only fairly recently that we seem to have a better grip on what makes caloric restriction more sustainable, and accounting for effects like metabolic adaptation. Even then that information doesn't seem to reach most people. Also understated is the impact of one's environment, and social support systems. It's much harder if you break from what your family and friends are doing. Some habits, I've seen with my own two eyes, can be regarded as an obligation. I really believe the odds can turn around for a larger demographic, with a more optimal approach. Let's not forget that we've had far more invasive procedures than ozempic available to help facilitate weight-loss (like gastric bypass), and people still gain back weight on those, if they refuse to change their habits. Drinks, junk foods, and deep fried foods are not satiating compared to their caloric density, and that remains true regardless of surgery and pills. Nothing changes until it's internalized that binging has a price.

SpicyLemonZest 1y ago
> Drinks, junk foods, and deep fried foods are not satiating compared to their caloric density, and that remains true regardless of surgery and pills. But it doesn't remain true on GLP-1 medications, which is why they're so popular.
- lanfeust6 1y ago
  It does remain true, that's the entire point. With GLP-1 you can be more full than without, but that doesn't mean that a baked potato and french fries grant equivalent satiety! Your body also adapts somewhat to the medication. If you factor in metabolic adaptation, then re-introduction of surplus calories will lead to regaining weight, even if they weren't as many calories as before. For the reports of mediated cravings, also: some people don't just overeat from physical cravings, but for emotional satisfaction. A binge session on comfort food has almost nothing to do with hunger. This is something addressed through therapy, not pills.
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no_wizard 1y ago

Perhaps anecdotal but generally society doesn't seem to be setup to reward people making good choices. Before the GLP-1 drugs became mainstream for weight loss, I know friends who were overweight who had enough money[0] to go on programs where your entire meal days are planned for you[1]. They'd ship you enough food for 2 weeks at a time, but you never had to think about what you were going to eat, it was all pre portioned and decided by your meal plan as part of the program. They saw really meaningful results, lost weight, and as long as they were on the programs, they kept it off. As far as I could tell, the food wasn't anything special beyond being properly proportioned and nutrient dense - certainly achievable on ones own - but it seems the rigidity of it - that is, the fact they didn't have to make food choices every day - made it easy to stick to. The food prep itself was easy too - mostly throw it in a single skillet, microwaving it or putting it in the oven on a tray or in a baking dish was all it took. I watched as they got healthier they were more active, felt better, seemed generally overall much happier. Once the program was over or they for whatever reason had to stop, it didn't take long for the weight to come back, and they had discovered a big part of their problem was food anxiety - not knowing what they wanted to eat, having trouble with food cravings etc. This has lead to me to suspect there are some seriously chronic issues with food culture in the US - namely, we haven't made doing the objectively best thing the easiest thing. Its too often out of reach due to cost, availability or time - which also speaks to other interconnected issues in the US that are going unaddressed. For example, I know these programs worked exceedingly well for those I saw on them, why aren't they cheaper? Why don't we subsidize such things to nudge society in a better direction with food choices? We already subsidize the bad stuff - we should move those subsidies to better options. [0]: I'm talking breakfast, lunch, dinner, and a small allotment of daily mini meals - really snacks. [1]: This is the problem. To do this, you have to be of upper class means just to afford the food, and thats not even including the cost of the program associated with it, and in some cases its simply a meal delivery program and there's no additional anything, and its still expensive

trollied 1y ago
USA food is absolutely crazy. Lots of stuff that’s banned in the EU. Lots of high fructose corn syrup. If you eat out, portion sizes are off the scale. I ordered a starter salad at a restaurant once when I was over on business, and it would have fed me for the entire day! (Won’t even start on the sauces!) Everything involving food is screwed.

h2zizzle 1y ago

The realistic solution puts car manufacturers and certain food processors out of business (unless they learn to compete as export-focused/non-addiction-based businesses), so... Yeah, maybe not so realistic. But the obesity stats of countries with robust public transit, walkable neighborhoods, biking infrastructure, and restrictions on highly-processed food speak for themselves. In the end - as with so many issues - the question is if policymakers are going to throw capitalists or regular people under the bus.

alabastervlog 1y ago
Right, the non-drug solution that would actually work (we can observe it working in countries with different infrastructure, healthcare, culture, city design, food quality and costs and cost structures, and more—we can be fairly sure it's some combination of that stuff because the folks who live there put on weight if they move to the US) is "upend US society in a bunch of ways" so is, realistically, not workable, at least not on the scale of human lifetimes, though it still wouldn't be a bad thing to try to move somewhat closer to.
- h2zizzle 1y ago
  Well, no. The countries that have done this have almost invariably done it within a 30-year timespan. Japan after WWII, China at the turn of the century, the Netherlands starting in the 70s. Even American cities like DC have made significant strides just since the Covid pandemic. Reminder that the US auto industry would have collapsed during the GFC without a bailout. Balancing food industry profits against the healthcare costs carried by the poor and middle class in this country becuse of the lack of access to high-quality food produces a net negative bottom line, one of many deleterious dynamics inflating both personal and public debt. But if you hide all of that, you get to go back to your constituents and say that you're supporting manufacturing jobs and shareholder value for their retirement funds. It's a choice between securing a few people's livelihoods and lifestyles, and securing the general well-being of a lot more people. We could change that choice, and we could do it very quickly, if we wanted to. But people would rather CICO tut-tut strangers on the internet.

meindnoch 1y ago

Diet and exercise don't work for most people, because they don't exercise enough and don't follow their diet. Simple as.

SilasX 1y ago
"Stop drinking" doesn't work for most alcoholics, because they go back to drinking. Simple as. "Don't commit violent crimes" doesn't work for most violent criminals, because they go back to committing violent crimes. Simple as. "Stop gambling" doesn't work for compulsive gamblers, because they go back to gambling. Simple as. "Have superhuman willpower in a domain where I don't feel temptation" isn't a cure, it's unempathetic judgment.
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- itsoktocry 1y ago
  5% of the US population self-report alcoholism. Why does food addiction encompass 40% of the US population?
  - doright 1y ago
    Possibly because you can completely avoid alcohol but you can't completely avoid food. Some large percentage of people who would have been addicted to other substances (due to less than optimal nature/nurture) but didn't, because they did not take those substances, instead became addicted to the substance of food. It might be more useful to see addicts to every type of substance as a large pool of anxious people who came across a substance to self-soothe, and figure out how to address the anxiety problem first.
  - alphager 1y ago
    Cheaper, much easier to get, socially acceptable everywhere, ... You won't get judged for eating alone at home, but start drinking alone at home...
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itsoktocry 1y ago

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alabastervlog 1y ago
> Diet and exercise works. We literally have the science, and, over a population and over time, no, they per se do not. The things that do mostly aren't accessible to normal people (three or four professional nutritionists and trainers and doctors helping out several hours per week; moving to a skinnier country) so "diet and exercise" has been the only available course to recommend, and it's better than nothing, but it's depressingly ineffective. This is precisely the difference between could and does I was trying to highlight to address this kind of thing in advance: diet and exercise could work, like, on paper they work every single time! Hell, technically, they're even essentially all of the mechanism by which methods that do work, achieve their effect, just indirectly. But just trying to improve diet and increase exercise directly does not work, not over a population. For outliers, yeah, but for most, no. Improving those is a an effect of approaches that do work.
- greenchair 1y ago
  If someone refuses to eat much less food to get their weight under control, I don't see how a nutritionist or personal trainer would help. Maybe a psychiatrist could help them break their addiction.
- LeafItAlone 1y ago
  >We literally have the science, and, over a population and over time, no, they per se do not. Can you share it?
- jankyxenon 1y ago
  If it's not diet and exercise, what is it? Obesity is a relatively new problem. GLP-1 also seems to work - primarily through addressing diet. So again, curious what you mean when you say "diet and exercise" do not work.
ben_w 1y ago
Diet and exercise would work, if not for the fundamental problem: most people cannot apply those methods. Why they can't, I am unsure. Is it because hunger is a stronger drive than long-term planning? Is it because food is, like many other products and services sold in a capitalist economy, incentivised to develop in maximally addictive ways even without a deliberate choice by any supplier? Is it because advertising really does influence people? Overuse of antibiotics makes people hungry? Something else entirely? Whatever the cause, people can't apply those methods. Which means they don't work for most people — not that they can't work for most people, they just don't.