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> The phrase that being overweight is "simply calories in vs calories out" is both trivially true and completely unhelpful.

Why is it completely unhelpful? The corollary is that if you adjust your intake to X (where X might have to be determined empirically for the individual), and use planning and your conscious brain to know when and what to eat, you _will_ lose weight.

This is a revelation to some people, who, once they realize the simplicity of it and plan around it, are able to completely change their bodies. Many of these same people try various intuitive plans that don't work for them (because they don't have the intuition) or try to manipulate exercise first (which makes some people increase appetite).

If you don't believe me that it works, is useful, and is a revelation, go lurk on the myfitnesspal forums for a while or /progresspics on reddit and read how people succeed.

The reason that it isn't helpful, despite you're peer reviewed, laboratory evidence cited on MyFitnessPal postings, is that the causal mechanism that common sense derives from this is completely incorrect.

People aren't fat because they eat too much. People (and mammals) eat too much because their fat cells are being metabolically triggered by environmental and/or genetic factors to store fat at a higher than normal rate, diverting calories from operational needs, thus stimulating hunger.

Bears don't go into hibernation because they've gotten fat. They get fat because their endocrine system begins gearing up for hibernation, and telling their fat cells to kick into overdrive growing. They will literally burn muscle while simultaneously gaining fat in this stage, like all hibernating mammals. The other side effect of growing fat cells is massive hunger, obviously.

In humans, simple things like not eating sugar can help correct the endocrine factors which, for a lot of people, cause the fat cells to do this. However, genetic factors are going to be a different story.

I say this as somebody who is fit and active, but have had running buddies who are fat. Pitting will-power against metabotically driven hunger ends, in the long-term, with biology winning every time.

Without endocrine/genetic factors taken into account, reduction in calories in simply causes a mammalian body's system to reduce calories out by making the subject less energetic.

If we reduce to core principles, if you know your stuff, there's probably not much to disagree on. There are many factors affecting variables like appetite, subjective energy level, energy used through spontaneous movement, many hormones and so on.

But, if you're an individual trying to decide what works and what doesn't in a field where the popular media is full of misinformation, I have a really hard time seeing the position that counting calories is _completely_ unhelpful.

> "Pitting will-power against metabotically driven hunger ends, in the long-term, with biology winning every time."

Yet, awareness of calories in vs calories out can be a way to plan your strategies, to know from the start whether a given strategy can even work or not, from the point of view of physics. Many people try things that this simple knowledge would rule out. A lifestyle change that does not result in a negative energy balance will not cause someone to lose weight, period.

It's also a framework where you can discover what works for yourself. Does lowering carbs vs lowering fat affect your appetite at the same calorie level? How does burning an extra 500 calories through exercise make you feel vs lowering food intake by that amount? These are valuable things to know, again for an individual on a personal quest, not talking about making public policy or population science.

Some people find an intuitive lifestyle change that successfully allows them to lower their body fat and keep it down. Bravo. Some people also succeed more mechanically with conscious calorie control. I have a hard time seeing the argument that both of these can't be useful and successful.

I don't know the research on this area very well. Does that mean for some people, their bodies will actually store the intake as fat preferentially even if the intake is a minimal amount for survival? You can actually die by eating a minimal amount of food because your body doesn't know to use it for energy and, instead, stores it as fat? Are there any studies on this phenomena?

One thing that would mimic the symptoms you describe would be induced hypoglycemia.

Diabetes medication can cause that. But that's basically a knock-on effect of an already present metabolic issue.

For a healthy adult there shouldn't be any such issue.

I am not sure that genetics & weight have that a big effect on weight but a lot of people use it to justify their weight.

I say this based on my observation and because today I find out I am at risk of obesity (based on this study), yet I slightly overweight.

In my personal circle, I have a lot of overweight friends and like hanging out with them. Some of them are always talking about losing weight, 10K steps, and other diet fads. And some have given up, I guess.

But sometimes it is difficult to eat/hangout with them. Overweight friends who want to lose weight will want to go to healthy restaurant. Then they will get footlong sub with every possible thing at counter. Oh and of course, diet soda and chips. How does it make any sense? I have to bite my lips to stay quiet.

And then other overweight friends/arrogant normal-weight friends, who will only want to eat buffets. And make fun of you if you don't get second refill. Apparently, you have to eat a lot to proof you are a man.

My biggest problem with food is people's obsession with talking about it. I can't help but feel that people make it such a huge deal about how much/little/what people eat that we're creating food issues in children that might otherwise not have it.

> thus stimulating hunger.

Then go hungry every now and then once you know the causal link. It's not like it's an irresistible force to which you have no choice but to succumb.

> Pitting will-power against metabotically driven hunger ends, in the long-term, with biology winning every time.

In my experience [sample size: 1] it's entirely possible to ignore hunger for quite some time.

Additionally there are options such as adding filler ingredients that help with reaching satiety with fewer calories. Carbohydrates with a low glycemic index which get absorbed more slowly, thus avoiding a boom-bust cycle as far as your blood sugar levels are concerned are also something you can adjust. This also helps staving off the next hunger for more hours.

It's certainly not an inevitable "I'm hungry, therefore I must eat and grow fat" link that can't be broken.

There are also plenty of factors which can lead to overeating which are not caused by the hunger response (i.e. craving food based on learned behaviors, peer pressure, desire for a particular taste, boredom, depression, etc).

The grandparent's post seems highly suspect to me. Hunger no doubt plays a role in obesity among some individuals, but the ultimate determinant is how many calories are available to be processed versus how many are expended, regardless of why they have been ingested.

When you take a hypothetical individual and lock them in a room and control their food you can give them a restricted calorie diet and they will lose weight.

No-one credible denies that.

What the people arguing against CICO are saying is that it's fucking stupid pointless advice to give to a population because while true it's not helpful. We know it's not helpful because we've been saying loud and clear it for many years and obesity rates have risen in almost every country every year.

"We could cure cancer if we just kill all the cancer cells" is true but not helpful.

"We could fix world hunger if hungry people just grew food" is true but not helpful.

I'm going to quote the grandparent here:

> People aren't fat because they eat too much. People (and mammals) eat too much because their fat cells are being metabolically triggered by environmental and/or genetic factors to store fat at a higher than normal rate, diverting calories from operational needs, thus stimulating hunger.

Is hunger really the primary cause of overeating for those who suffer from obesity? This seems unlikely to me.

It's true that calin/calout is a simplification, but there are many who outright deny it. They may not be credible to you, but they are still powerful voices across all media and their gospel is happily accepted by many.

> What the people arguing against CICO are saying is that it's fucking stupid pointless advice to give to a population because while true it's not helpful. We know it's not helpful because we've been saying loud and clear it for many years and obesity rates have risen in almost every country every year.

Posts like yours that deride calin/calout as a useless oversimplification miss the mark; of course it's a very basic fact, not a treatment plan. It's crucial that people understand that this is the mechanism at play if they want to succeed at regulating their weight, and despite your assertion that "nobody credible denies it" there are a lot of big names who will sell you all kinds of solutions that ignore it, and focus on specific distractions rather than looking at obesity as a complex disease with many causes that lead to calorie surplus.

Calories in vs calories out is simple thermodynamics, human nutrition is complex biochemistry. The real question is, why should anybody have to count calories? Is there a way of eating that leads to the same level of satiety with fewer calories?

It's not "the" question, but it's "a" question. What I don't understand is why people balk at counting calories as part of a successful plan to change body composition, but plan everything else. Should you only go to the gym intuitively, or is it useful to count sets, weights, plan a certain time of day, maybe measure heart rates, plan rest periods and so on?

Why is food different? We know the human body is adaptable to an incredible variance of conditions, including the fact that we know that if anything, prolonged caloric restriction seems to cause adaptations that _increase_ lifespan. So what's the objection to counting and measuring?

I think that counting calories, while certainly helpful, is not a long term solution. I prefer to eat in a way that triggers certain hormonal responses that lead to me eating fewer calories naturally. (Yeah, that means no carbs)

> Why is it completely unhelpful? The corollary is that if you adjust your intake to X (where X might have to be determined empirically for the individual), and use planning and your conscious brain to know when and what to eat, you _will_ lose weight.

People talk about how hard it is to lose this way, but although I've tried diet after diet, I only recently understood intuitively the reverse: why some people can't understand how difficult it is for some. When I moved to a new area this year and went to a new GP, he wanted to talk about my weight, of course (I'm 42, but everything else about my health was quite good). I explained that I had managed to lose about 50 pounds since my peak in 2012, through various diets like intermittent fasting, keto, and sometimes just counting calories for a bit. He suggested I try an appetite suppressant. I scoffed a bit, saying that my problem wasn't that I was too hungry, since I rarely ate so infrequently as to experience hunger. Instead, I said, my problem was that I ate when I was bored, or when friends were, or ate to improve other experiences like TV or movies, or just because it had been a while and I felt increasingly that I "ought" to eat. He didn't argue with me, but just mildly pointed out that it might well not work, but why not give it a shot for a few weeks and see? So I agreed. That was three months ago, and on the appetite suppressant I've lost another 50 pounds. But that's not my point, exactly.

My worldview around food has changed. Before, I assumed that people who were thin were either heroically couting every calorie they ate, or had some weird biology that meant that they couldn't gain even when they tried. I think both of those sets do exist (since I know people in each), but now I realize that there is a large group of people out there who simply don't care about food that much. I didn't even understand that I had this constant drive to eat until it vanished; I'd never not experienced it, as far back as I can remember. I didn't know what people were talking about when they talked about appetite, because the only thing that ever changed was hunger, until I started taking the suppressant.

"but now I realize that there is a large group of people out there who simply don't care about food that much."

This. I used to be a member of this group. In college and early twenties, I had friends who didn't care about food.

Now most of my friends only focus seems to be food, how to eat it properly, how much to eat, where to eat, what is healthy. It is frustrating sometimes but it is hard to find friends in mid 30s who are into playing sports, bars, pool, and video games as much as me.

Which "appetite suppressant" did you use? I wasn't even aware there's a class of drugs / pills / additives with that title.

Can you also say where you started before losing those 100 pounds?

The drug is phentermine. It has at least three positive effects: appetite suppressant, stimulant, and a separate "weight loss" factor. The "drug facts" include a statement that after accounting for the first two, it is not understood how phentermine causes weight loss. It also has a list of side effects, one of which is that it raises blood pressure, so if someone has blood pressure issues already, this isn't something your doctor is likely to want you to take. Fortunately, I don't have that problem.

A fourth effect that it seems to have is to make exercise stop being terrible, which was a whole other revelation for me separately from the one I talked about, above. I've taken stimulants before, and none of them ever made me eager to go run around and do physical activity; phentermine has. I'm not sure if they classify this under the stimulant effect, though.

In January 2012, I was about 380 pounds. I'd hovered around 335 for years, and the higher figure was shocking enough to me that I immediately went to a ketogenic diet intermittent fasting, and shed about 65 pounds in six months. It then became quite difficult to continue the loss, and I stopped trying so hard. On February 9, 2015, I was 336. I started keto again and lost about 10 pounds through mid-May, which was when I finally had that meeting with my new GP, where I talked about being discouraged because keto wasn't working the way it had three years before. :)

As of this morning, I'm 286.

> being overweight is "simply calories in vs calories out" is both trivially true and completely unhelpful

I appreciate your overall point, but would argue that the phrase in not necessarily "trivially true" in some cases. Unlike thermodynamics, biology is not simple. A person could potentially die of hunger while also being grossly overweight if they have a problem with certain metabolic genes. If your catabolic enzymes for lipids do not function, you cannot utilize fat or break it down regardless of your overall energy budget.

That being said, I doubt that very many people have mutations in the genes for those enzymes, since those variants will tend to be selected out of the population.

die of hunger while also being grossly overweight

Another fun diets-aren't-thermodynamics argument: rabbit starvation.

Seiji, thanks for the reference.

Wikipedia (https://en.wikipedia.org/wiki/Rabbit_starvation) has details. In summary, rabbit starvation occurs on a high protein, no/very low fat diet.

The long term efficacy of dieting is low, and that should be totally unsurprising: the very name implies temporariness. If the overweight wish to lose fat, a diet will work. If they wish to keep it off, they must make permanent diet and behavioral modifications, which is not what a diet is. Fewer calories and less sugar/carbs/highly processed foods does work, but it must be permanent.

People want a pill that you just pop once a day without any changes in behavior. And the vast majority of people complaining they can't lose weight don't prioritize losing weight over their current behaviors: diet composition, sedentary lifestyles, etc.

> Why do some people's bodies burn off excess calories through things like non-exercise activity thermogenesis and other store it as fat?

There is a very limited degree to which this can happen. The way some people eat, if it all burned by thermogenesis, they would die of overheating (hyperthermia).

Fat storage is saving them from cooking in their own juices.

[Citation needed]

You could sweat off the heat from 1000 kcal/day of thermogenesis (or any other bodily exothermic reactions) in just 75 mL/hr of extra sweat. You're sweating about 25 mL/hr even when you don't notice you're sweating at all, and people in tropical climates can sweat as much as 3.5 L/hr. [1] I think that's plenty of budget, not to mention the additional budget available via regular convective and radiative heat transfer.

If a person's metabolism is prone to converting energy to fat, just 120 kcal a day could add 10lbs of fat in a year. [2]

[1] http://hyperphysics.phy-astr.gsu.edu/hbase/thermo/sweat.html

[2] http://www.google.com/search?q=(80%+*+120+kcal/1+day)+*+1+ye...

Edited: 1000 kcal -> 1000 kcal/day

I think modern "foods," of the extracted and refined sugars sort, and artificial colors and flavors sort, definitely play a large role in this.

I find all this searching for bio-chemical processes to blame obesity on pretty silly. A non-trivial portion of society has shown it is possible to not be obese. People have also shown it is possible to go from being obese to not being obese.

There are several inter-playing factors that shoulder most the blame I would say.

One major factor that seems to be missing from most conversations is that there is a huge mental factor in obesity I would surmise. And I think you're overlooking that when you ask why do some people feel satiety when others don't.

I think obesity can rightly be considered a mental illness. Why do some people continue to eat when it does their body no good? Everyone probably does this on occasion, but why do obese people do it routinely?

Most obese people I'm guessing would tell you that a lot of their eating has an emotional component, beyond a feeling of hunger.

When you think about it, present day "food" companies, are just as bad as tobacco companies, arguably worse when you calculate the costs. How many people are suffering from diabetes, or potentially will in coming years, how many from other 'diseases of civilization,' what amount of health and monetary resources are expended on these preventable conditions each year?

These are diseases of a civilization that is structured poorly. Just think about it, a civilization of overworked, overstressed, underslept, mindless-media over-exposed people who emotionally stuff their faces with garbage 'foods.'

The "food" industry and regulation there of no doubt shoulders a lot of blame, just consider for some people, the majority of their food energy intake comes basically from candy.

It appears that 'food' companies are exploitative of the low iq, low income segments of our society, but in the US I think that has a lot to do with agricultural policies that subsidize sugar and corn production and the like. And the people running these "food" companies navigate current market dynamics and govt incentives/subsidies to maximize shareholder returns, and that is producing negative health results for many people.

So with these factors considered, I would say that there are better ways of addressing this issue than the search for obesity immunity conferring pills and the like.

"Calories in vs calories out" is really just Occam's razor in action an hence helpful. At least it was helpful to me to re-engineer my lifestyle from 10h TV per day and fastfood as a teenager to regular workouts and healthy food.

>The problem is the long term efficacy rate of dieting is around 5%. If dieting were a drug it would never pass FDA approval for effectiveness.

If your diet has an "end" you have already failed. There's a huge difference between a fad diet and a lifestyle change.

If we are going to compare it to medicine, let's use this as an example:

You suffer terrible headaches. Your doctor prescribes you a once-daily pill to treat it. After 30 days, you suffer no more headaches. After 60 days, you stop taking the pill. After 70 days, your headaches are back.

The pill didn't fail to fix your headaches, you failed to keep up with your medication.

If you diet for 6 months and lose 40Lbs, congrats! If you "stop dieting" and gain all 40Lbs back in a year, the diet didn't fail, you failed to maintain a healthy diet/lifestyle.

>The phrase that being overweight is "simply calories in vs calories out" is both trivially true and completely unhelpful.

For the issues most obese Americans face, which is a poor diet high in sugar, it is absolutely helpful. As I understand it, the bulk of the problem of our obesity epidemic is that people eat calorically dense foods with little nutrition, not that 40% of the population suddenly stopped being able to be sated by their food.

Of course people don't respond the same way to food and exercise. But your post is about fixing edge cases before the actual problem is solved. The low hanging fruit is in fact, calories in vs calories out. Once people's diets get back in line, then we can worry about why some people have a harder time losing weight than others.

See my previous comment regarding sugar. It's not the calorie density, but the metabolic effects of sugar that are the issue.

It's not binary. Both of those things can be issues with it.

Absolutely. However, it is important to note that there are a very large number of obese people who don't eat sugar.

So sugar, while deservedly notorious, is far from the only highly significant factor, yet it sometimes receives 100% of the blame.

One of the several problems with that is that, due to popular perception, many will swear off sugar and yet still be unable to drop to a healthy weight.

Although a good percentage of those eat white carbs like bread and potatoes that easily convert to sugar in the body. Those on the salads without bread/chips tend to do quite well weight wise.

Yes, and that's part of my point: too many emphasize the evils of sugar, where it is far more to the point to warn against all high glycemic index foods.

The rest of my point is something like: people too often oversimplify complex subjects, which can be actively harmful.

Changing my habits is hard, can you please prescribe me some medication instead?