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Yes, the problem is (i am someone who was put on a VLCD of 800 calories a day- and didn't lose that much weight from it) that your body has a set metabolism that keeps slowing down as you lower calories over the years. I had no problem going on the vlcd besides fatigue. The reason is I was already only consuming 1200 calories a day. These diets don't work over the long haul. I realize my case isn't the most common, but they are now looking into microbiome therapy as a possible solution. This resetting of metabolism plagued the biggest losers from "the biggest loser" as well. I do hope more research is done, because in my case, following diets (and perhaps other medical factors like igg)slowed my metabolism to a ridiculous level. And I don't have diabetes or high blood pressure, luckily.

The notion of a metabolic set point is mostly a myth. The actual changes in resting metabolic rate from mild caloric restriction are very small. Most people underestimate how many calories they consume unless they carefully weigh and log everything.

My reading of the last 3 years of findings regarding changes in resting metabolic rate due to caloric restriction is that they could become big enough to explain the pattern of weight regain. Now, the specific quantification of the relationship between amount, lenght of caloric restriction and resting metabolic rate is, in my opinion, waiting for a trove of data we do not have yet.

well, my doc is head of bariatric surgery at nyu, so I'll pass on what you said. Btw, I do weigh and log everything.

"It is difficult to get a man to understand something when his salary depends upon his not understanding it" -Upton Sinclair

Your surgeon's income depends on people getting bariatric surgery. You can add in exercise to increase total calories burned to support a larger food intake and still lose weight.

> Your surgeon's income depends on people getting bariatric surgery.

Surgeons are usually good at doing other surgeries as well...

(1) that’s not a meaningful support of any kind of argument. It’s borderline vacuous.

(2) I’ve never heard a bari surgeon Not recommend lifestyle change. Most will ask you to do your best pre-op, to make the surgery as safe as possible. They will counsel you on the same post-op. Many have in-house dietitians to assist.

(3) Your argument implies the following: Bari surgeons pretend and contend diet doesn’t work, to keep the supply of customers coming. Fact check: diet was failing for decades, and only the resultant epidemic made something as extreme as cutting out pieces of a non-diseased GI tract not entirely insane. Go read another hundred diet books of the week; proclaim their findings from the rooftops. I’m pretty sure the bari surgeons aren’t going to run out of willing customers.

I think the problem is that most people, and that includes doctors and bariatric surgeons alike, don't really know how to diet.

Using only diet, I have successfully lost 90lbs and continue to lose.

Good for you! I mean that. But your experience isn't everyone's experience. Mine isn't either. I said so. For one, men have much easier time losing weight. I'm not a man. I offered my singular experience to give support for those who might also be mystified after trying everything with a doctor. To those who think my surgeon is trying to get me to buy surgery by saying a diet won't work-- actually, my surgeon (also head of a weight loss clinic) recommended against surgery and against my eating less that I already do. There are a number of drugs that can help people trying to lose weight that aren't phentermine. Some people like me can't take them because of a family history of thyroid cancer or other diseases. But for those who can take these, they are helpful tools. Often, those who struggle with weight loss have struggled with it throughout their life for a host of reasons, only one of which may be eating and exercising habits. To the person who told me I could "add in exercise", what are you trying to accomplish with comments like this? Of course I exercise. People who struggle with this health issue need support and to know that there are other difficult cases sometimes and to keep at it anyway. I keep at it anyway, because being in shape and healthy matters to me and always has. I do an hour of cardio 5x a week and I weight train every other day. I was a serious athlete as a young person (high school/college) and never had trouble with weight gain/eating disorders. I definitely know how to add in exercise. In fact, I never didn't exercise in my life. When I hear simplistic comments like some of these that seem to be meant to shame someone for not exercising, or for having no willpower, or for just generally not being disciplined at losing weight, I have to ask myself where is this kind of thing coming from? I can't say for sure, but perhaps it is because they feel that way about themselves and it feels harsh to them so they throw it at other people so they don't have to deal with the discouragement. To these people I say: don't be too harsh with yourselves! You will do much better at all of these things if you support your own small successes every day. Ultimately, don't you want to succeed at being as healthy as you can? Well, you get there through encouragement and support of yourself. You get there hopefully with the help of better data, drugs, approaches, exercise, and emotional support as better and better research is done into weight loss. And this is what the OP was all about anyhow. One of the best things a person can learn from being an athlete is that if you have team support-- if you root each other on-- you raise the level of the team. People who are trying to lose weight, including yourselves, need this. Because the other raises cortisol levels, and we know what happens then.

I only have my own anecdotal experience to work from, but I genuinely believe that most Americans are so lost when it comes to diet that these last-resorts are all they have left.

I am very fortunate to have fallen in love with a Greek woman who has shared her family's diet with me. It's likely saved me from needing an extreme solution myself.

I think that in North America, we don't know the first thing about eating healthy. A big part of the Mediterranean diet is using high quality, expensive, olive oil with everything. My parents would blow a gasket if they knew that we paid for the fancy stuff. At $10/L it's more than my parents would ever spend, but it's honestly not noticeable as far as my budget is concerned. It's seriously a game changer.

By putting high quality olive oil in all you're food, everything becomes much tastier and satisfying than before. It allows you to eat and be satisfied with much less. The other key is to splurge on expensive, good looking vegetables.

Having delicious vegan recipes allows you to get your kicks without eating tons of saturated fats.

This allows you to be satisfied with less volume. It's made up through quality and taste. This is the foundation of a healthy diet, eating high quality tasty food.

The problem with the North American diet is that we don't have the same traditions of passing down recipes as they do in other parts of the world and so none of us know how tasty a simple dish can be. We then eat this processed crap that gets passed off as identical to the original when it's a fraction as tasty and nutritious. As a result, we compensate by eating far too much of it.

I think that this continent is in dire need of better recipes and respect for their ingredients. Until that gets integrated into the culture, we are doomed to depend on these extreme measures to stay at a healthy weight.

Don't get me started on drive-through culture or eating at your desk. Eating is something to be enjoyed, not rushed. When you rush your meal, you eat more and you aren't taking the time to enjoy any subtlety in the taste. This results, again, in overeating.

Do you have a source for this? It's a fairly trivial Google search to find papers making the counter-claim, but I'm aware that nutritional science is kind of a dumpster fire, and much of the research is at least a couple decades old.

>The actual changes in resting metabolic rate from mild caloric restriction are very small.

But only a small change in metabolic rate can easily produce ten or more pounds of additional weight a year.

There are obviously some exceptions. I've met people who have maintained long term weight loss purely through lifestyle changes. There may not be many but they certainly exist.

> Thing is, we have about half a century of consistent clinical findings saying, without exception, no diet-based approach shows long term weight reduction.

This baffles me, because these results are trivially disproved. It's not particularly rare for people to lose weight and keep it off long term by changing their diets. Are the studies poorly constructed or are they just being misinterpreted?

But long-term, 10, 20 30 years out?

I can't name a single friend who has successfully dieted short term that has kept it off long term.

Is 30 years a reasonable expectation? Does someone who loses weight in their 50s have to literally die of old age before you'd grant that they'd 'kept it off'?

Actually... Yes.

Obesity related complication occurr with excess weight. So, if they were at their ideal weight at 50 yrs old and gained it back at 80 when they also incurred high blood pressure and diabetes, then they weren't successful.

That's why it's difficult. Most can lose weight at some point in their lives. But the weight eventually comes back, along with the other complications.

This seems like an odd way to split the data. Is it not the case that healthy-weight people sometimes gain weight in their old age? Your claim seems unfalsifiable: Whatever mechanism is at play that makes healthy-weight people gain weight later in life could also be at play for people who lost weight, and 30 years later regained it in their old age.

To put it another way, it's a silly bar to use to say that weight-loss programs must move their adherents level of health wrt weight past those of normal slim people, and that any weight gain from a former dieter is proof of a diet's failure of efficacy (while any weight gain from a formerly-healthy-weight, non-dieter is just happenstance).

It's tough to look at just the existing data to tease this out, but if you need to resort to a bar as absurdly stringent as that to make your point, I'm afraid it's not a very convincing one.

You’re begging the question. You assert it’s not particularly rare for people to lose weight and keep it off long term, and therefore it’s trivially obvious to prove that it’s not particularly rare. Except that all studies to date show that it -is- rare, especially for the group of people that are candidates for an intensive intervention like medically managed weight reduction or bari surgery.

The data show that over ten years average sustained weight loss in diet-and-lifestyle interventions is zero (actually, there’s usually weight gain). That doesn’t rule out particular rare exceptions, but they’re just that, and not useful for evaluating the intervention as a whole.

That's not what 'begging the question' means. If you say "iron doesn't rust" and I show you a rusty piece of iron, that's not 'begging the question' regardless of how many studies you can cite that show iron not rusting under various conditions.

And 'average sustained weight loss over a cohort' is the wrong measure, especially if your cohort are candidates for bariatric surgery (ie. pre-selected for being medically recognized as incapable of losing weight voluntarily) rather than just overweight people in general (a fair few of whom do choose do get back in shape.)

So, I dove into this a bit (as a professor in a related discipline but who doesn't study weight) and had some heated conversations with researchers in this and related areas. My impression is that those studies are controversial because they "define away" diet effects.

They often engage in a bit of semantic game-playing about the meaning of the term "diet."

The problem is a lot of the "diets don't work" conclusions are based on very strict assumptions about "diet" meaning "telling people to just lower their calorie intake" or "telling people not to eat certain foods." They don't necessarily mean giving strategies for lifestyle changes, or ways to avoid increased calorie intake, or replacements.

As a concrete example, one researcher I spoke to is a very publicly prominent advocate that "diets don't work," and gave a talk I attended. She was discussing studies of weight loss and was explaining how studies that instructed participants to do things like use smaller plates (to change perspective on how much food is being consumed) or strategies for coping with parties, etc. were not "diet" studies because they did more than just tell participants to diet out of sheer willpower.

So, in effect, diets, if they are defined as just telling people to lower intake, and nothing else, don't work. However, if you support them, and give them alternative behaviors or foods, or strategies for lowering intake, they do work.

What also became clear to me, and which people on this forum are maybe pointing out, is that there's also a lot of gamesmanship in these papers about individual trends and what counts as a control group. There are in fact people who do reliably lose weight on diets (you can see it in their individual-level-data graphs), but their trends are often explained away by switching controls ad hoc.

I was left very frustrated by these studies, because it wasn't clear to me why these researchers wouldn't be promoting the strategies, etc. more, or advocating more for understanding why people who lose weight on diets do lose that weight, to gain strategies. I got the impression they were trying to be sensationalistic or something, to gain attention, by trying to sound counter-intuitive.

As a side note, I've worked in bariatric clinics, and I can say from my experiences there they have their own brand of burying side effects and defining outcomes in such a way as to achieve success (for example, by only selecting "appropriate" individuals for surgery).

Studies will also show that inducing and keeping them in coma is one of the foolproof ways to ensure a person never tells another lie over a period of 10 or 20 or 30 years.

Controlling or having a low calorie diet isn't a medical treatment [1], it's simply a choice an individual (in most cases) makes. They choose to not continue with the original choice after some time, so to club diet-control under 'medical treatment', and say that it doesn't work, is incorrect.

[1] https://www.wisconsin.edu/workers-compensation/coordinators/...

Edit, grammar.

>Thing is, we have about half a century of consistent clinical findings saying, without exception, no diet-based approach shows long term weight reduction. The most successful have zero effects by 5-10 years out.

Does "diet" mean counting calories and eating less than you want to eat?

I ask because another approach, as in Susan Robinson's book The I Diet, is to eat as much as you want but just make sure it is foods that are moderately low in calories. In particular, avoid refined carbohydrates, potatoes, and fatty foods.

I have been following this approach for 5 years. I lost 50 pounds, I have no will power when it comes to food, but the pounds have stayed off.

I forgot, another principle is lots of fiber.

I have also lost a large amount of weight and kept it off for over a decade by changing what I eat.

In my case, I cut out refined carbohydrates (white rice, white bread, pasta, potatoes, etc.) and sugar (sweetened beverages, desserts). I still eat plenty of carbs that come with a large dose of fiber, such as oatmeal, peas, and beans.

At the same time, I increased my intake of animal fats and dairy.

There are also some interesting ideas in the interventional field regarding minimally invasive embolization of the left gastric artery to reduce hunger via inhibition of ghrelin production.

I hadn’t heard about that. But jfc, even with collateral circulation, I can only imagine the number of perfs you’d see! I mean, h. Pylori already destroys local microvasc - embolism the LGA and you’re begging for some tragic endings.

Or such is my arm chair hypothesis, at least.

I wouldn’t conflate “only diet” with “only treatment.” Stimulant drugs are a treatment that works over the long term—just not one that’s particularly free of side-effects.

—just not one that’s particularly free of side-effects.

Especially for the target audience of chronically morbidly obese people with diabetes!

Thank you!

Its a protestantic thing. If you have sinned, as in you couldnt keep your behaviour under controll- you must suffer and punish for your sin and repent.

Its the same thing that creeps into every drug discussion. Its one of those caddisfly larva conglomerates, where people glue lots of pseudo science onto theire "feel-good" opinions instead of really trying to solve the issue with realistic solutions.

You could sell the realistic solution to these individuals by telling how much the "sinners" suffer after the operation and how heartily they regret taking the left hand path.