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> Purely behavioral lifestyle interventions have the lowest long term success rates of all available treatments for obesity. What? Surely changing one's behavi

by tasuki 2mo ago

> Purely behavioral lifestyle interventions have the lowest long term success rates of all available treatments for obesity. What? Surely changing one's behaviour - particularly the parts of behaviour that caused the obesity in the first place - is a sure way to stop being obese.

aareet 2mo ago
The issue is not whether it works; it’s whether someone can stay compliant long enough for it to work
- tasuki 2mo ago
  Long enough in this case meaning forever. Behavioural changes work, the issue is that most people don't actually change their behaviour.
  - pibaker 2mo ago
    This is like saying gambling is a good way to get rich. The issue is that most people don't hit jackpot.
    - tasuki 2mo ago
      You have no control over whether you hit the jackpot. You do have control over what you put in your mouth.
- toasty228 2mo ago
  It's a lifestyle, the optimal basic lifestyle, the one were you don't shorten your life/healthspan by decades. It's how thing were intended to be really. It's funny how proposing an healthy diet is unrealistic and watching fatties eat themselves to death is the new normal, complete value inversion and looser mentality
  - matheusmoreira 2mo ago
    Lifestyle changes are essentially standard medical advice. There is nothing wrong with proposing diet and exercise. It's just that you should probably suggest other treatments in addition to the lifestyle changes that have relatively low long term efficacy. Of course, that assumes your goal is to actually help the fatties instead of judging them.
    - tasuki 2mo ago
      > Of course, that assumes your goal is to actually help the fatties I don't believe that's possible. They have to choose a healthier lifestyle by themselves. It's not that people are fat because no one told them to eat healthy and exercise sometimes. They're fat because they have ignored that advice for a long time. They aren't missing information about diet and exercise, they're missing diet and exercise.
      - amanaplanacanal 2mo ago
        You don't believe it's possible? Obviously it's possible! Look around, we have what are essentially miracle drugs available, and you are still pushing ideas that have mostly failed for the last 50 years!
        toasty228 2mo ago
        Failed for the past 50 years but worked for the last 300 000 years I wonder what changed in between? Maybe our food and our relation to it? Who knows right?
        amanaplanacanal 2mo ago
        Something in the environment changed for sure. There are many theories. Some of them include the rise of ultra-palatable foods, the rise of plasticisers in the environment fucking with our hormones, the greater exposure to lithium, the rise of the "low fat" has in the 70s, and probably others.
justacrow 2mo ago
By this reasoning, abstinence-only sex education is a sure way to stop teen pregnancies and spread of STDs.
- tasuki 2mo ago
  Your analogy is false. If you opt for it, then yes of course, abstinence-only sex education is a sure way to stop ten pregnancy. Similarly, if you opt to change your lifestyle and start living healthier, and follow through, it will work. If someone tries to force you, of course it will fail (in both of these cases). There is no way to stop someone else from being fat. We can only change ourselves.
  - rcxdude 2mo ago
    It's not even a case of internal/external motivation. Even internally motivated attempts often fail. You can always claim that they just didn't want it enough or lacked willpower, but it still reduces the effectiveness of the approach. You can claim any approach for solving a problem works if you reject all the cases where it doesn't.
  - matheusmoreira 2mo ago
    > We can only change ourselves. Being fit and maintaining the normal weight is not the same thing as reaching a BMI of 50 kg/m² then losing it. I've seen fitness influencers take up that challenge only to find that "changing oneself" is significantly harder than it used to be when they were fit.
matheusmoreira 2mo ago
Weight regain is common, especially after isolated lifestyle changes. Most people lose weight but do not keep it off over time.
- tasuki 2mo ago
  Weight regain... If you change your lifestyle temporarily, the effects are temporary. If you change your lifestyle permanently, the effects are permanent.
  - matheusmoreira 2mo ago
    > If you change your lifestyle temporarily, the effects are temporary. Not quite. If the lifestyle deteriorates, then weight regain is expected. However, people might regain only a fraction of the weight lost. It is possible for some of the weight loss to be permanent. Also, even temporary changes in lifestyle can produce benefits that outlast the intervention, like lower risk of disease such as diabetes. Exercise is notable for providing numerous benefits that persist even if weight is completely unmodified. > If you change your lifestyle permanently, the effects are permanent. No. It improves your odds of success, but does not guarantee it. Body adapts significantly over time when subjected to weight loss. There are compensatory physiological adaptations that favor weight regain, such as changes in energy expenditure and appetite. Even with sustained effort, maintaining the initial weight loss may become progressively more difficult because of those changes. This shows up in research as results like mean weight loss of ~9% at year 1 and ~5% at year 8.
  - kakacik 2mo ago
    Sad reality is, very few people have the resolve to do permanent changes to their behavior, the older the worse. Too deep in their comfort zone without even realizing this, even with looming heart attack or other massive health issues. Its much easier to end up seeing a grown man crying about how he has to eat that next snickers bar rather than sustaining resolve with some healthy trend. For the love of god or any other deity I can't grasp this, its trivial for me to muster a tiny fraction of discipline and simply change direction from now on. But people out there are vastly different than me, thats pretty obvious, ie many people detest sports or even sweating. Addictions, and over-eating is an addiction (or some form of stress-coping mechanism) have a way to grasp core of one's existence and not let go. My wife sees such overweight folks with not-so-much-time-remaining-on-earth as GP regularly. As she says - they basically over-ate themselves into mental disorder (or started with it and their body over time aligned with behavior). To actually fix this, that mental disorder needs to be tackled, no gastric operations or wegovy injections provide permanent solution. But they sure make pharma companies richer and give this warm fuzzy feeling of achieving actually something visible, even if temporary.
preg_match 2mo ago
Effectiveness is two parts: does it work in isolation, and are people able to do it. Running a marathon a month is a sure way to improve your health. However, less than 1% of people would be willing to do that. So it’s not an effective solution. It’s an effective solution if we just ignore life, sure. But solutions are rooted in pragmatism.

by tasuki 2mo ago

aareet 2mo ago

The issue is not whether it works; it’s whether someone can stay compliant long enough for it to work

tasuki 2mo ago
Long enough in this case meaning forever. Behavioural changes work, the issue is that most people don't actually change their behaviour.
- pibaker 2mo ago
  This is like saying gambling is a good way to get rich. The issue is that most people don't hit jackpot.
  - tasuki 2mo ago
    You have no control over whether you hit the jackpot. You do have control over what you put in your mouth.
toasty228 2mo ago
It's a lifestyle, the optimal basic lifestyle, the one were you don't shorten your life/healthspan by decades. It's how thing were intended to be really. It's funny how proposing an healthy diet is unrealistic and watching fatties eat themselves to death is the new normal, complete value inversion and looser mentality
- matheusmoreira 2mo ago
  Lifestyle changes are essentially standard medical advice. There is nothing wrong with proposing diet and exercise. It's just that you should probably suggest other treatments in addition to the lifestyle changes that have relatively low long term efficacy. Of course, that assumes your goal is to actually help the fatties instead of judging them.
  - tasuki 2mo ago
    > Of course, that assumes your goal is to actually help the fatties I don't believe that's possible. They have to choose a healthier lifestyle by themselves. It's not that people are fat because no one told them to eat healthy and exercise sometimes. They're fat because they have ignored that advice for a long time. They aren't missing information about diet and exercise, they're missing diet and exercise.
    - amanaplanacanal 2mo ago
      You don't believe it's possible? Obviously it's possible! Look around, we have what are essentially miracle drugs available, and you are still pushing ideas that have mostly failed for the last 50 years!
      - toasty228 2mo ago
        Failed for the past 50 years but worked for the last 300 000 years I wonder what changed in between? Maybe our food and our relation to it? Who knows right?
        amanaplanacanal 2mo ago
        Something in the environment changed for sure. There are many theories. Some of them include the rise of ultra-palatable foods, the rise of plasticisers in the environment fucking with our hormones, the greater exposure to lithium, the rise of the "low fat" has in the 70s, and probably others.

justacrow 2mo ago

By this reasoning, abstinence-only sex education is a sure way to stop teen pregnancies and spread of STDs.

tasuki 2mo ago
Your analogy is false. If you opt for it, then yes of course, abstinence-only sex education is a sure way to stop ten pregnancy. Similarly, if you opt to change your lifestyle and start living healthier, and follow through, it will work. If someone tries to force you, of course it will fail (in both of these cases). There is no way to stop someone else from being fat. We can only change ourselves.
- rcxdude 2mo ago
  It's not even a case of internal/external motivation. Even internally motivated attempts often fail. You can always claim that they just didn't want it enough or lacked willpower, but it still reduces the effectiveness of the approach. You can claim any approach for solving a problem works if you reject all the cases where it doesn't.
- matheusmoreira 2mo ago
  > We can only change ourselves. Being fit and maintaining the normal weight is not the same thing as reaching a BMI of 50 kg/m² then losing it. I've seen fitness influencers take up that challenge only to find that "changing oneself" is significantly harder than it used to be when they were fit.

matheusmoreira 2mo ago

Weight regain is common, especially after isolated lifestyle changes. Most people lose weight but do not keep it off over time.

tasuki 2mo ago
Weight regain... If you change your lifestyle temporarily, the effects are temporary. If you change your lifestyle permanently, the effects are permanent.
- matheusmoreira 2mo ago
  > If you change your lifestyle temporarily, the effects are temporary. Not quite. If the lifestyle deteriorates, then weight regain is expected. However, people might regain only a fraction of the weight lost. It is possible for some of the weight loss to be permanent. Also, even temporary changes in lifestyle can produce benefits that outlast the intervention, like lower risk of disease such as diabetes. Exercise is notable for providing numerous benefits that persist even if weight is completely unmodified. > If you change your lifestyle permanently, the effects are permanent. No. It improves your odds of success, but does not guarantee it. Body adapts significantly over time when subjected to weight loss. There are compensatory physiological adaptations that favor weight regain, such as changes in energy expenditure and appetite. Even with sustained effort, maintaining the initial weight loss may become progressively more difficult because of those changes. This shows up in research as results like mean weight loss of ~9% at year 1 and ~5% at year 8.
- kakacik 2mo ago
  Sad reality is, very few people have the resolve to do permanent changes to their behavior, the older the worse. Too deep in their comfort zone without even realizing this, even with looming heart attack or other massive health issues. Its much easier to end up seeing a grown man crying about how he has to eat that next snickers bar rather than sustaining resolve with some healthy trend. For the love of god or any other deity I can't grasp this, its trivial for me to muster a tiny fraction of discipline and simply change direction from now on. But people out there are vastly different than me, thats pretty obvious, ie many people detest sports or even sweating. Addictions, and over-eating is an addiction (or some form of stress-coping mechanism) have a way to grasp core of one's existence and not let go. My wife sees such overweight folks with not-so-much-time-remaining-on-earth as GP regularly. As she says - they basically over-ate themselves into mental disorder (or started with it and their body over time aligned with behavior). To actually fix this, that mental disorder needs to be tackled, no gastric operations or wegovy injections provide permanent solution. But they sure make pharma companies richer and give this warm fuzzy feeling of achieving actually something visible, even if temporary.

preg_match 2mo ago

Effectiveness is two parts: does it work in isolation, and are people able to do it. Running a marathon a month is a sure way to improve your health. However, less than 1% of people would be willing to do that. So it’s not an effective solution. It’s an effective solution if we just ignore life, sure. But solutions are rooted in pragmatism.