Why Are We Still So Fat? | Hacker News Reader

Why Are We Still So Fat?

nytimes.com

61 points_mhyx168 comments

This article is disturbingly enthusiastic about bariatric surgery, an extreme procedure with limited success and serious side-effects.

The long and short of it is that we understand far too little about the human body and what drives weight gain and difficulty losing.

For instance, there are complex health and immune issues (e.g., mast cell disorders) that can drive weight gain and difficulty losing in spite of healthy diets and high levels of activity (and researchers think mast cell disorders alone may affect 10% or more of the population, but was named only 5 years ago and is still poorly understood. What else could be similar that we just don't understand yet?)

Beyond this, what we put in our bodies (various medicines, antibiotics, ingredients in processed foods, various pesticides etc, even artificial light) may have effects on our physiology that we don't yet have a strong understanding of.

Our microbiomes are still a complete mystery to us, deeply impacting how and what we absorb from our food. The same food does not impact every body in the same way, period.

Bariatric surgery is a band-aid over a gaping wound. Until we understand the complexities of human physiology at a more sophisticated level than a high-schooler in physics class (calories in, calories out just doesn't cut it) -- we are going to continue seeing public health impacts in the form of fat and disease -- which may often have underlying causes that the fat is simply the most visible symptom of.

Edit: Seriously guys, is there any other area of science where people are so convinced that anecdotal and small-sample (both in terms of n and longitudinality) observations are valid? There's a huge market for delusion about fat, we're fighting that as much as we're fighting to learn more about the human body.

My sister in law had a lap band put in a decade ago and she recently had it taken out because of complications. It would be fair to say that it was a partial success and her doctor says that her case is not unusual and that lap bands haven't been as successful as had been hoped.

As for explanations of the obesity epidemic note the timing -- it really took off in the 1980s, together with the social and political changes that we call "globalization"

https://arxiv.org/abs/q-bio/0312011

one possibility is that it was a change in social stressors, another that it was some environmental chemical introduced around that time. (eg. neonictinoid pesticides or glyphosate)

Uh, it could also be the wealth increase that globalization brought? Food is more affordable now than ever before as well. I hope we don't throw around casually theories like that. These things usually are very complex and have multitudes of cause which may or may not center around a single event.

Agree. 100%.

bariatric surgery has around a 68%~ success rate (as in hits goal weight) and around a 2% total failure rate (all weight gained back) it is by far the most effective weight loss intervention that exists by miles and miles.

There are also a variety of surgeries with varying side effects and risk profiles from sleeve gastrectomy to something like a duodenal shift.

It's definitely the case that this is not root causing the issue. There are probably many root causes to increasing obesity with many probably centered around the creation, easy availability, and marketing of calorie dense foods that do not satiate, however, bariatric surgery is something an individual can do while changing most of the root causes requires vast institutional changes.

"We’re barely using the best tool we have to fight obesity"

https://www.vox.com/science-and-health/2017/12/7/16587316/ba...

Not all bariatric surgeries are the same. The lap band doesn't perform well long term. The Roux-en-Y procedure is one of the very few obesity treatments that carry long-term success, where the patients keep the lost weight off.

Waiting around for a better understanding is crazy, given the health complications are occurring now.

Quality of life increases. Medications are eliminated or reduced. Long-term mortality is reduced (https://www.nejm.org/doi/full/10.1056/NEJMoa066603 )

Pretty radical solutions for a cultural problem. I wonder, maybe long term mortality is reduced but as long as you don't change to eating good food you will be missing out on vital substances, will you really grow old healthily by just eating less of the same crappy food?. Wouldn't it be easier to just focus on eating high fiber food like muesli and yogurt? That stuff keeps me stuffed for hours and hours.

>that stuff keeps me stuffed for hours and hours

But.. you’re not 400 pounds with requirement to lose half your body weight, and keep it off for the rest of your life?

And this is a requirement that these patients have obviously never been successful at.

And they’ve probably done, and failed, long term, at most diets.

I recently read The Obesity Code by Dr. Jason Fung and in it he states that bariatric surgery is little more than surgically enforced fasting. Most people can fast without doing the surgery.

I highly recommend the book. It's more like a science book about dieting than a diet book. Now that I understand that when I eat is as important as what I eat, I've been able to lose 20 pounds (and still going). And, yes, sugar (especially fructose) and refined carbs are bad.

I read the book too and it was very good. More of a easy to read research paper than a fad diet. And makes a lot of sound conclusions. I adjusted my eating accordingly also and have lost weight. The only issue is I had to add a morning bite of something (i knwo this breaks the fast) but it kickstarts my metabolism. I follow everything else and only eat 2 meals and keep them close to maximize my fasting time. 15 lbs and counting.

It has also been helping with portion control as a side effect. I dont eat as much anymore

> Most people can fast without doing the surgery.

Very few fat people have that level of self control. That's why they're fat in the first place.

I think a lot of people can fast, but are never told to try this. Most people are recommended to eat 5 meals 300kcal each - and this is hard to do. Tell them to fast for 18h and eat in 6h window without calorie counting (but no shit food) and I would guess more people can do it.

All that does is attach a ritual to the fasting process. People start to think that it's the ritual doing the work, but really it's the calorie restriction. Again and again, study after study proves that restricting calories to 700 calories reverses diabetes in obese people and in fact cures their obesity, too.

It's no surprise that people who put on 100+ pounds of extra weight once would tend to put on 100+ pounds of extra weight a second time. But it's silly to claim that there is an underlying medical reason it's happening.

The body gets used to whatever conditions you face. Human beings have thrived in the Arctic Circle, the North African deserts, and everywhere in between. Obese people have accustomed themselves to an obese lifestyle. If they can make a permanent break and embrace the lifestyle of a person with normal weight then they can stay skinny forever. In the end, most people just don't want to exercise 2+ times per day and limit their portion sizes. So they don't.

Fasting has been hugely beneficial to me in terms of endurance sports and keeping even blood sugar. Interestingly it has never had much of an impact one way or another on my weight (I'm a fat person) but it's a lifelong lifestyle for sure.

Jason Fung sounds very interesting, I'm looking at: https://idmprogram.com/the-failure-of-the-calorie-theory-of-... where he provides some advice very relevant to this thread... "The [calories in calories out] model very useful because it efficiently flags <strike>idiots</strike> people who are not all that knowledgable about obesity, and I can safely ignore them. There are many of these people out there, and not everybody is worth listening to."

I love that book. I recommend Dr Fung's blog posts too. The success stories are really motivating, e.g:

https://idmprogram.com/idm-success-story-robert/

I've just found out they started a FB support group too thanks to the comments here (I haven't checked out his stuff in a while). The social support could be game changing for many struggling, hacking it out alone.

I know somebody who got bariatric surgery and ended up mega fat again a year later. Obesity is often not a deliberate choice, but it is a product of lifestyle decisions in almost all cases.

Even though I have never been overweight last year I lost 25 pounds in 3 months by eating more food, not working out, and vastly increasing my fat intake. The secret sauce was eliminating carbs 6 days a week and slightly increasing my water intake. Avoiding drugs also helps including caffeine and nicotine.

The lap band's long term performance is terrible - the sleeve and Roux-en-Y perform well long term with most patients keeping the weight off even 10 years later.

Weight loss isn't the fundamental issue at play - it's permanent weight loss.

Most individuals in their life are able to clean up their diets enough to lose weight, but maintaining that weight loss indefinitely for a lifetime, an overwhelming majority fail at it.

It's not that complicated in most cases.

Eat less garbage (sugar especially - cutting out soda and juice is a good start) and be more active. You'll almost certainly lose weight and be healthier.

The key is knowing what foods to eat and what to avoid. Then making it a lifestyle change, not bandaids or temporary diets.

Have you lost weight doing this method?

I've lost ~15 pound by cutting sugar, pasta and white bread. I also eat smaller portions overall, but i think this is a side effect.

Yeah, though I took it further, cutting out all the junk at once. No burgers, fries, chips, donuts, ice cream, soda, etc. Basically all my favorites gone, heh. At the same time I started going to the gym 5-6 days/wk (~30mins/day).

The result was losing 40 pounds in 3 months and feeling a lot better.

Going to that extreme isn't necessary, though it did have some helpful side effects:

- It reset my taste buds. Afterward sugary things tasted ridiculously sweet.

- No longer craved sugar.

- Portion sizes got a lot smaller.

I distinctly remember feeling light on my feet and having a lot more energy.

This was a decade ago. I kept off most of the weight, but ended up regaining 10 of the 40 as I reintroduced too much junk food.

"(calories in, calories out just doesn't cut it)"

Why not?

There is not some amazing mystery to why so many people are overweight. They eat more food (energy) than there body uses. Possibly over a long period of time. Just look at people's shopping carts at the grocery store.

Yes we understand so little of the body's biological processes but that doesn't mean CICO is not an extremely useful idea and something to put into action.

The mystery is in why some people eat more than they need and others don't. It's easy to say eat less calories, but until we solve the underlying biological reasons why certain people get full before overeating and don't gain weight and why certain people are always regaining lost weight your solution isn't going to help very many people.(Hint, see the satiety signals and hunger hormone comment I made lower down.)

There is a new trend of carnivore diets and I've noticed a lot of testimonials on youtube, where people swear they can eat as much meat as they want and still lose weight. Also some supposedly cured inflammations and other issues, probably because eating only meat is an extreme elimination diet.

It is however a very tasty elimination diet. I've tried it; ate all kinds of beef, lamb, pork, and fish: muscle meat, liver, roe, eggs, and somes dairy. Re: inflammation - I don't know what my hsCRP was beforehand, but during this experiment it was below the detectable range; all other inflammatory markers were low as well (insulin, IFG-1, fibrinogen, homocysteine, ferritin). I was only hungry about once a day, and leaned out quite a bit.

How many calories are you taking in? The answer is: It depends. There's a huge number of factors involved in simply identifying the number of calories present in the food we eat. Some studies show as much as a 20% difference in what was on the label and the actual caloric content. And that doesn't even account for how many calories are actually absorbed by the body - a value which has even more confounding factors.

How many calories are you expending? The answer is: It depends. How (warm|cold) is it? What's your average body temperature? How much clothing do you wear? What's your genetic makeup? Doing a lot of thinking? What's your current exercise regimen? Is your body in state X where it burns (more|less) calories than state Y? Are you sick?

Calories in and calories out sounds good on paper and seem obvious to an engineers mind, but if you can't tell how many calories are involved on each side of the equation, it's a meaningless measure.

How many calories are you taking in per day to 0.1 kcal? The answer is if you want to lose weight it doesn't matter. You just need to average a deficit over time.

We are not sending a rocket to the moon here. Just because something cannot be measured exactly doesn't mean it's worthless to measure.

> The answer is if you want to lose weight it doesn't matter. You just need to average a deficit over time.

If this were the case, Weight Watchers (which is at its core a calorie limiting system) should have a near 100% success rate. It doesn't. A casual perusal of Google shows closer to a 50% success rate for a 5% body weight change.

I can't think of many medical treatments where we go "yeah, a coin toss level of success is good enough for me."

As for the accuracy of the measurements - it does matter. Healthy weight loss rates are, mathematically, in the 10% calorie reduction range. That's less than the error rate for the caloric labeling of many foods.

I don't think you can draw meaningful conclusions from a self-enforced system like Weight Watchers either though. Self reporting particularly when it comes to anything diet related is going to be heavily skewed. There will always be social pressures within a group like that to over report exercise and under report intake.

If you can't trust the results of a self-selected group of individuals who are paying a good chunk of cash for the express purpose of loosing weight... who the hell can you trust?

Generally speaking you're absolutely right, but with diet the social pressures are significant enough to compromise analysis even if the group is paying for it. There have been quite a few studies on the topic, e.g.: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.103...

>If this were the case, Weight Watchers (which is at its core a calorie limiting system) should have a near 100% success rate. It doesn't. A casual perusal of Google shows closer to a 50% success rate for a 5% body weight change.

First off - that's an astonishing success rate against a backdrop of an article saying, literally, surgery is the only reliable option.

Second off - You're assuming 100% compliance. I know people with personal trainers who are gaining weight because they don't stick to the program. I halfheartedly went through a weightlifting routine for years and got nowhere because I never really stuck to the program. 100% compliance in the field of weight loss is just not going to happen.

>if you can't tell how many calories are involved on each side of the equation, it's a meaningless measure.

Incorrect. It's an imprecise measure. You said "Some studies show as much as a 20% difference in what was on the label and the actual caloric content". So then the labels are accurate within a 20% margin of error at worst.

Sounds like a pedantic little nag but then again

- "Star Spangled Blizzard - Mini" - 430 calories

- 1 serving of broccoli (1/2 cup, cooked) - 25 calories

A 50% margin of error would be fine given some of the choices out there. With that said, you usually don't pick between a dq blizzard or broccoli. More reasonable comparisons would be a blizzard vs water (0 cal) or broccoli vs french fries (regular size - 290 cal).

In a nutshell: if a thermostat's off by up to 10 degrees it can still ballpark whether the temperature's livable.

https://www.dairyqueen.com/us-en/Company/Nutrition/Treats/

https://www.livestrong.com/article/402398-what-is-a-serving-...

This is, almost literally, a comparison between apples and orange candy. The two are so incomparable that it's meaningless.

Now then, if you were comparing a Starbuck's chocolate muffin and a Blizzard as a treat to fit into your diet without blowing it - could you?

if you were comparing a Starbuck's chocolate muffin and a Blizzard as a treat to fit into your diet without blowing it - could you?

If I'm having a "treat" then I'm already blowing my diet; regardless of if the number fits within a calorie goal.

A calorie budget is a bit like a financial budget. Just because I have allocated a point up to which I can "spend" each day, the long-term goals are a force to minimize day-to-day spend even within that allocation.

Not every calorie is the same or cause the same metabolic effecs. Thats why calorie in calorie out fails. Its about the quality of the food. The real culprit is carbs and especially sugars and high fructose corn syrup which is as good as poison.

> Not every calorie is the same

This is nonsense. It's like saying that not every kilogram is the same.

> It's like saying that not every kilogram is the same.

Would you consider a kilogram of gold "the same as" a kilogram of air?

Caloric content refers to the amount of energy released when you literally burn the food in question. But our bodies do not literally burn food. They metabolize it in a sophisticated chemical process that converts said energy into a form that the body can use to do work. The rate and effectiveness of this metabolism is clearly influenced by the type and composition of food. For more information, enter "glycemic index" into your favorite source of knowledge to learn why this measure is important for how food is processed. Just as a small glimpse into the complexity of the metabolism.

  Would you consider a kilogram of gold "the same as" a kilogram of air?

More relevant would be, "is a kilogram of fat the same as a kilogram of muscle?"

This is the basic FUD that that sugar industry is spreading. Currently their strategy is to try to tarnish any study that would find negative health effects from too much sugar intake. It's the same strategy that was used by the tobacco industry many decades ago.

Still I'm hoping that some sense will prevail eventually and the sugar industry will be regulated. Before that happens though I'm afraid a lot more people will have to suffer from Type 2 diabetes.

When it is successful, much success can be attributed to the resulting decrease in ghrelin, which is mostly an accident of physiology (the part removed/constrained is chosen for surgical simplicity, and it happens to have higher ghrelin secretion).

The answer, in a word: "Sugar".

Obviously you can't take the word of one random commenter on HN. There's a lot of reporting around this in good news sources: https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-in...

When I say "the answer" I should, instead, state that that's a large part of the reason. It's not the SOLE reason. Of course it's more nuanced than that.

It's more Grains than any type of sugar

Humans have been eating grains for 10,000 years, and sugar for a hundred.

humans were extracting sugar from sugarcane 8,000 years ago. It was consumed heavily in india 2000 years ago. BUt of course we've been eating free sugars in foods for as long as we've been around.

Sugar was a rare luxury until recently. Even fruit was a luxury historically. Yes people ate sugar more than a hundred years ago, but it was a few pounds per year. Modern intake is more than fifty times as much.

Humans have been eating sugars in fruit form since day 1.

Grains were crucial when food was scarce and preparation tedious, not so much when abundant and effortless. Both may be an issue in the modern world.

Humans were working their asses from 4-5 in the morning, up to late nights, walking miles and miles, carrying heavy stuff (women with their infants strapped on their back, or in a pouch working in the field/farm).

I know, because i knew such strong person that was frickin healthy even in her 90 years - one of my grand grand grand mom. Rosy cheecks, wrinkled face of a worker. Still later in her years, was no problem for her waking up and working a lot.

Funnily enough, sugar is typically found alongside most grain based foods. It's in breads, cupcakes, etc etc. Ruling out grains consequently get's rid of a large source of sugar. The two are pretty intertwined.

Try removing all grains but keep eating as many raisans and dates as possible. You will loss weight. The type of sugar matters more than just all sugar.

Source? I treat all sugar the same, "to be consumed conservatively." My understanding is that the body processes pretty much all the same. Happy to read more from your sources

Depending on the type of sugar different processes are involved.

https://www.healthline.com/nutrition/sucrose-glucose-fructos...

It all ends up as glucose. If you eat glucose, it goes straight into your blood stream as glucose. If you eat fructose, it gets converted into glucose. If you eat starches, the polymers are chopped into simple sugars of glucose and fructose, and the fructose is converted to glucose. Whether you eat glucose directly, or eat other sugars and starches, it all ends up as glucose. The only difference is the workload that you create for your liver.

How it gets converted is the key not what it ends up as. One type will be easier to breakdown another more difficult. That's the key.

Sorry, that makes little sense to me. The extra calories burnt in conversion to glucose is not going to be enough to cause weight loss. Any glucose that your body does not immediately consume gets converted to lipids and stored.

Show me the chemistry. Show me how sugar in a raisin is somehow significantly fewer net calories of glucose than just eating the equivalent in refined cane sugar or wheat flour. Sure, it takes a small amount of energy to reduce other sugars to glucose, but I can't see how it can be enough to make a difference in a weight loss diet.

One aspect is speed.

Eat white sugar you will quickly get an energy boost but whatever cannot be used will be stored.

Eat a complex carb and it requires more steps to breakdown. That allows for a slower release of energy and less of a need to store.

The digestive system is a pipeline of processes.

Processed foods and high fructose corn syrup. This is the culprit here.

Both are carbohydrates. One might argue that grains make less fat than refined sugar. But it might also be more about the amount than about the source of things.

I'd add "cars" to the answer, but sugar definitely comes first.

I hate cars as much as the next tree hugging urbanist but they are almost certainly not a major culprit here. In the US cars were almost as dominant as they are today in the 1950s-70s (for adults, kid were much more likely to walk to school then). If anything the use of car has stayed close to constant. How we spend our time when not in transit has become far more sedentary though. Instead of going out and doing things for recreation we shitpost on the internet. Instead of manually washing dishes we load the dishwasher and go watch netflix. Our jobs have also become much less physically demanding. Many jobs that would have one engaging in a moderate amount of physical activity have been automated or altered to be far less demanding though this has greatly reduced workplace injuries from repetitive strain (manhandling stuff around all day might not be good for your back but you're not gonna get fat doing it). Even someone employed as a secretary is going to do far less physical work and walking around the office than in 1970 thanks to tech.

Oh yeah, cars will make you lazy in ways I'm still surprised. It changes your notion of time and space. You can go from A to Z in 1h, something that would take a day. And the speed increase is exhilarating. It's a bad drug.

To be more precise the answer, in a word: "Hormones".

Obesity is a endocrine disorder.

Sugar -- it so happens -- majorly screws up the endocrine system. Other things do too... but sugar is the biggie.

Yes! In Feb I've got diagnosed with diabetes - My estimated average glucose was 269 (mg/dL), A1C was 11.0!!! (1/31/2018)

Got started (myself) on diet, doctor prescribed me metmorphin and something stronger (had to stop it). Nearly 4 months ago, I'm without any medications again.

Not the best results - but on 5/15/2018 I was down to 126 mg/dL (6.0), and on 8/21/2018 + 12/4/2018 - same result of 114 (5.6) - ideally I should be lower - but this is without medications!

What did I changed - Went full carnivore... hah not really - but I am subscribed to various groups (still evaluating for myself)

I simply cut down not only sugar, but carbs too - though I decided to eat certain fruits in small quantities - like blackberries, strawberries, tangerines (they are small, so I can control it), occasionally watermelon (who knew!). No bananas, apples, etc + I can't give up tomatoes (technically fruits), cucumber, lettuce + nuts, cheese, etc.

When I got stomach flu (some mild food poisoning), went to "BRAT" diet for a day though - but just the RICE, apart from that avoiding rice, wheat, potatoes (very little, no fries at all).

Beer? Beer a month, and I used to jug 10 guinesses a night (heavy \m/etal style).

So it's a bit boorish, but had to do it.

Lost 40-50 lbs (320 -> 270, I'm 6'4"). Waist from 42-43 -> 38, still have belly fat though. Do exercises by walking the dog a lot + Iron Mind (can squeeze 3 with right hand, 2.5 with left). Started doing pull ups, and was very excited I can do 7 - but forgot one day to properly warm up - and had to stop for 2-3 months, as I tore something, would continue after new year.

Tried running, but not for me.

Other than that - no longer feeling sleepy through the day, had energy, but it's a bit different - I used to be able to grab two dudes on my side and lift them - I can't do this anymore (stupid thing really). Lol - another anecdotal thing - during mosh-pits used to be more stable - hahaha (too old for this shit anyway) - now can get put down easier (weight must count for something really).

So you go.

SUGAR... is the drug DEA should really look into :)

I strongly agree with this. I cut out sugar because I was getting sinus headaches. When I cut it out (multiple times) I would go through full withdrawal (massive sinus headache, cold sweat, shakes, vomiting). There are hundreds of articles that say you cannot develop a physical dependence on sugar, but I disagree from personal experience.

That said, avoiding it is tough. I understand why people would gain weight back when leaving a clinical setting. It's in everything and there is a reason it is in everything; it causes people to eat more of the things it is in. I'm lucky in a sense, I have a strong physical reaction when I eat the wrong thing and that helps me make the right choices (things that don't make me feel like hell). If other people don't have this physical dependence though, they would have no punishment for eating incorrectly. That's a much harder problem to address and I don't have the answers for it.

Random commenter #2, but I'm a genetics professor at a med school FWIW. Sugar is a major factor. The genetics of obesity point to a strong link to behavior. Sugar is addictive. Alcohol and nicotine are drugs, and so is sugar. There needs to be regulations on sugar content of foods. If you say it's not possible, I point to the low-fat craze years of the 1980s-1990s, where ironically we basically proved that swapping fat with sugar made our obesity problem worse.

With all due respect, professor, claiming that sugar is 'addictive' and that it is in fact a drug, is a bit of a stretch. I'm not nearly at the level of addiction research that you are privy too, so please excuse my ignorance of the most recent research results. However, in my lay understanding of the science of addiction, it seems that sugar is no where close to the same ball-park as nicotine or caffeine. Unless the definition of 'drug' and of 'addiction', has recently changed, of course. Still, if what you say is true, this would be a large overturn in the common, lay-person, understanding of drugs and addiction! It's implications on a dietary (and policy) level, would be fof a great boon to all of us. If you have the time, I would love to know more about this and how you formed your understanding. Thank you.

https://en.wikipedia.org/wiki/Addiction

It is a matter of definitions. Here is a review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234835/.

"The FA framework for understanding obesity is the notion that highly processed 'hyperpalatable' foods have hijacked the reward centers in the brain thus impairing the decision-making process, similar to drugs of abuse."

"Finally, there is strong evidence of the existence of sugar addiction, both at preclinical and clinical level. Our model has demonstrated that five out of eleven criteria for SUD are met, specifically: use of larger amounts and for longer than intended, craving, hazardous use, tolerance, and withdrawal. From an evolutionary perspective, we must consider addiction as a normal trait that permitted humans to survive primitive conditions when food was scarce. As we evolved culturally, the neural circuits involved in addictive behaviors became dysfunctional and instead of helping us survive they are in fact compromising our health."

Thank you, that was exactly what I was looking for.

I get physical dependence on sugar. My other comment in this thread details it a bit. If I eat sugar regularly I get small sinus headaches that are unpleasant, but bearable. When I cut it out I go into full withdrawal. I recognize that the literature doesn't support this and I would happily undergo studies to back it up. I have gone through this process multiple times and I get sick consistently (I no longer eat sugar because of this).

I might be an anomaly due to an autoimmune disorder, but we may need to start putting an asterisk that sugar is not addictive *for most people.

I cut out added sugars and dropped 80 lbs over 3 years.

YMMV.

Completely agree with this. I've struggled with my weight all my life. I was always hungry and dieting (simple calorie restriction) felt like torture and would never last. For my latest attempt, I cut out added sugar completely and switched to intermittent fasting. The first week was the hell I was used to, but after the sugar addiction waned so did my incessant appetite. I used to think about food all the time and always with an eye towards what my next meal would be. Now I feel like I can actually trust my hunger signals and as a result eating far fewer calories is easy and natural versus the constant struggle simple calorie restriction dieting was.

People are fat because they eat too much, and they have almost no incentive to stop it. Sure, they are mostly eating the wrong things too, in the wrong amounts, but the bottom line is the number of calories going in the front door.

I lost 40 pounds all while drinking gallons of beer in college. I did it by eating less and moving more. It was not an optimal way to lose weight, but it was effective.

These days I keep thin by eating high protein/fat, easy-to-digest carbs, and vegetables, and keeping sugar to a minimum.

There's a million ways to lose weight, and some are easier than others. But I promise you, if you eat less than your body needs to survive, you will start losing weight.

Today it's culturally acceptable to be fat, and there is ready access to so-so quality food in large cheap quantities. I love sugar. I have a massive sweet tooth. I have to be disciplined to stop from consuming all the candy in the world. Some people choose not to be disciplined. Their choice I guess.

> Some people choose not to be disciplined. Their choice I guess.

Empathy goes a long way. I think as a society we will get to the solution faster with the view that some people might have stronger urges to overeat then you. Congratulations you worked hard. Don't discount what others face.

I agree. Clearly it is easier for some people than it is for others. Not always simply a case of "you lack willpower" etc.

Please, why do you think I needed to lose 40 pounds in the first place? Not because I was the paragon of willpower I can tell you. I still go off the rails and eat an entire package of Oreos in a single sitting sometimes. It’s a constant struggle for me, but I don’t make excuses and I keep persevering. Other people can do that too.

I have a massive sweet tooth as well. If i buy a pack of cookies, i'l finish it one sitting. What has helped is to avoid buying them outright.

I get the impression people want to place blame on something, anything, except themselves. Everything from specific foods, diets and genetics, but it ultimately comes down to consuming too much energy over time, longer term. It's accepted as fact and they can't do anything about it because of genetics or because they can't or won't eat specific foods or can't get to the gym (go outside?).

We are surrounded by food. It's everywhere, but we really don't need that much of it (you can get a days worth of your energy in a single meal or drink with how processed and condensed our food has become). Yet, people act and suggest it as if it's the only thing to do. Go to almost any subreddit about a city or state. You'll see dozens upon dozens of posts asking what there is to do when moving or visiting.

Almost all the replies are go eat here, go eat there, try eating this while your here. Then way down at the bottom, lower voted replies, will be often actual activities that don't involve eating, it's no wonder we are all so fat with constant and consistent advice like this. Not to mention how much lazier we keep getting.

Hunger is very psychological too. People are just used to eating a certain amount at certain times every day. Change that pattern and you'll feel different, mentally and physically. Most people of health can go a day or few without eating and it won't have any negative affects. It will suck, yes, but no you won't starve or die. Missing lunch at work and waiting a few hours until you get home will not have detrimental affects. Skipping breakfast and waiting to eat until your noon/lunch/whatever break won't hurt. It might even help if it allows you to get extra sleep.

On another note, diet, health, and nutrition related posts to Hacker News seem to always be N=1 replies or bring out toxic debate. People, especially the Hacker News types, seem to have a very passionate opinion on the topic(s).

> I get the impression people want to place blame on something, anything, except themselves.

Human nature. Every way in which people compare well to others is the true measure of merit. Every way in which they compare poorly is a matter of circumstance. If something worked for me it's the One True Way, and if it doesn't work for someone else (even if something else would) it's evidence that they lack my discipline and fortitude. Once you learn to recognize this form of subjectivity, 90% of online discourse (95% on Hacker News) starts to make a lot more sense.

This is a very similar thing as saying people choose to be poor. Do you agree with that?

Some people definitely do choose to be poor. Others don't. But both kinds of people certainly exist.

I have been physically fit my whole life. The comments people make to me in casual conversation might raise your eyebrows. They don't say, "I wish I weren't overweight, and I feel powerless to do anything about my problem." Instead, they say things like, "HAW HAW HAW I don't run unless chased HAW HAW HAW!" They say, "I hate vegetables, I can't stand them. How can you eat steamed brussels sprouts? How do you go without sweets?"

They can't figure me out. They just don't understand how it's possible to work out twice a day, take two 15-minute walks, and restrict my daily calories to 2000. They can't figure out why I don't eat bacon all the time, like they do. They can't figure out why I don't eat patty melts and biscuits-and-gravy.

These folks are not fat for medical reasons.

People are obviously born with various IQ levels, right?

Doesn't it stand to reason that people are born with certain levels of willpower about food (or in general)?

Also, you can predict someone's future weight and bmi pretty well from the time they are children or teenagers. There is a ton of research on this. One of them: https://www.ncbi.nlm.nih.gov/m/pubmed/20927643/

I'm not making the strongest claim about obesity, I'm making the weakest. That is, my claim is merely that some people choose to be fat, not that all people do. It seems altogether unreasonable to suggest that there are no fat people on Earth who choose to be that way.

And, as I noted above, the people who talk to me don't generally discuss a lack of willpower. They discuss their willingness to eat things they know are bad and their unwillingness to be active. It's possible that this is all part of the hocus-pocus of cognitive science and that they're merely verbalizing a chemical predisposition, but I'm not quite so cynical about human consciousness to believe that.

There was a direct up-tick in obesity almost immediately after the government's Food Guide Pyramid was released.

https://www.bellybelly.com.au/health-lifestyle/did-the-food-...

The Food Pyramid And The Food Industry Contributed To A Massive Increase In Sugar, Carbohydrate And Calorie Intake.

Humans simply aren't supposed to eat so many carbs and so much sugar.

Whenever you eat carbs and sugar, it triggers insulin production. Insulin causes your body to store fat instead of burning it as fuel.

I've been doing a ton of research on this topic lately, and the /r/keto forum on reddit has proven to be a very useful resource.

Another one of my favorite resources has been the Youtube channel, "What I've Learned", which does some pretty amazing breakdowns on the topic, if you are interested: https://www.youtube.com/channel/UCqYPhGiB9tkShZorfgcL2lA/vid...

Here's some more evidence for the central conceit of this article:

Every legitimate long term study of major non surgical weight loss shows that it doesn't happen for the vast, vast majority of people. It's basically freakish when succesful in the long term.

1) ["In controlled settings, participants who remain in weight loss programs usually lose approximately 10% of their weight. However, one third to two thirds of the weight is regained within 1 year, and almost all is regained within 5 years. "](http://www.ncbi.nlm.nih.gov/pubmed/1580453)

2) Giant meta study of long term weight loss: ["Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3% of initial body weight."](http://ajcn.nutrition.org/content/74/5/579.full)

3) Less Scientific: [Weight Watcher's Failure - "about two out of a thousand Weight Watchers participants who reached goal weight stayed there for more than five years."](https://fatfu.wordpress.com/2008/01/24/weight-watchers/)

4) [The reason why it's impossible seems to be that although calories in < calories out works, the body of a fat person makes it extremely difficult psychologically to eat less.](http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-...) This is borne out by the above data.

5) [The only thing that does seem to work in the long term is gastric surgery.](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/)

Moreover, you won't find any reputable study on the web where the average person lost 10%+ of their body weight and kept it off for five years. Not even one.

> Moreover, you won't find any reputable study on the web where the average person lost 10%+ of their body weight and kept it off for five years. Not even one.

What about studies where someone moves from a high-obesity country to a low-obesity country? Is there such a study?

Oo, that's really interesting. I havn't seen one if there is, but I would love to.

It's only looking at moving inside of a country but this article: https://jamanetwork.com/journals/jamapediatrics/article-abst... finds a link. You've got me curious too so I'll look to see if I can find anything for international travel.

Entirely anecdotal, but all my friends that moved to France are now 15-20 pounds lighter than they used to.

so if calories in < calories out does not work, what about increasing exercise?

Calories in < calories out is specifically mentioned as working.

Exercise is also not the easy answer. Your best bet is still to change what you eat.

But it's not "calories in < calories out" that you should focus on. It's the quality of what you eat. For instance it's super easy to overeat calories wise if you eat candy since it doesn't do anything for your hunger, or if it does it makes you crave even more. While it's much harder to overeat on steak.

Calories works if you do it, but doing so requires an unrealistic amount of willpower.

> Moreover, you won't find any reputable study on the web where the average person lost 10%+ of their body weight and kept it off for five years. Not even one.

It is not a study but I know a person very well that lost 40% 10 years ago and kept it off. Key was changing habits and life style.

I'm not exactly a study test case, but I'm at least an average person who has drastically changed bodyweight (from ~230lbs to 180lbs) and has stayed there for over five years (about 7 years now).

This is obviously entirely anecdotal, but what seems to have worked for me is that I didn't do a diet "program", I genuinely changed what I eat. I grew up on fast food and microwave meals primarily, and did most of my gaining when I started working and was eating out much more.

I switched to making almost all my own food from basic ingredients (raw meat and vegetables). I occasionally eat out but try to keep it to once a week. I also changed my relationship with the gym, but that's primarily about muscle gain and not weight loss.

I suspect that the main problem is that diet programs are just that - a temporary fix that doesn't treat the underlying problem of diet. You are what you eat, ultimately.

About five to six years ago, I lost in excess of 40% of my body weight over the course of a year (I know, I know, too fast). After that, I've remained within ten pounds of my target weight.

It wasn't easy. I basically had to fight my body with my brian every step of the way. It worked through an amount of personal discipline I'm slowly coming to realize is very unusual.

Also, some of your links are broken. Looks like mostly malformed markdown.

I would say such a study is difficult to perform, somebody from the set of people requiring a structured system like weight watchers might be from a different set of people who lose weight through other approaches.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/#!po=5.... indicates there are definitely approaches people in the US can take and have taken to reliably maintain weight loss over extended periods of time.

I read the 2/1000 participants lost weight and kept it off on Weight watchers post you cited. It seems highly inaccurate. It considers within 5lbs of target weight as not successful as we cannot know if they were within 5lbs to begin with. But the studies cite 20% with most not being heavier than when they started. You can't join Weight Watchers unless you have 5lbs to lose or more.

Probably 90+% of people on diets fail but if 10% can be saved from surgery that really helps. If we've reached the point that we can't stop ourselves from eating outside of changing our digestive system we have a problem. The rise of sedentary jobs along with giant portion sizes is to blame. Not some fundamental condition with human beings.

I'm down 83 lbs from 2017 and I'm at a healthy BMI for the first time in 15 years. I know I will not gain the weight back. Why? Because I finally figured out how to manage a routine, how to exercise regularly, how to plan out what I eat, and I learned to get enough sleep.

Don't want to be fat anymore? Stop eating at restaurants, cook all your own food, bring in a lunch to work, count your calories. Also exercise, lots. And get 7+ hours a sleep a night.

That's it, that's all it takes.

oh wow massive life changes are all it takes to lose weight?

That seems fitting, doesn't it? Weight change requires weighty changes :)

> count your calories

That's all it really is. Everything else just makes it easier to eat few enough calories, including any crazy diets.

I'd be interested to hear from the couple people downvoting.

Find a lifestyle that lets you eat few enough calories. If that's low-carb, then go for it. If that's counting calories and just eating less, go for it.

When I was losing weight, I realized that certain foods made me feel more full per calorie (vegetables). Then I realized that drinking was using up a huge part of my calorie allotment. Then I realized that if I run then I can eat more. Everything was just to make it easier to eat few enough calories, and it happened to all make me healthier too.

I'm not claiming its easy, but it's true.

I can't see myself counting calories for the rest of my life

Don't fall victim to all-or-nothing thinking. I actually did it for almost 8 months straight, and then stopped when I went on vacation. The nice thing is, unlike some forms of data, if you skip a week or three, it won't hurt you. You just hop on the scale and you know where you're at, you can start again any day.

But even if you only do it for a few weeks, you'll learn valuable lessons about your good and bad habits. You might not ever have to do it again. Or you might prefer to keep doing it. YMMV.

That sounds wonderful and I really wish you the best with this. Please come back in 2022 (5 years after you started) and tell us more about this.

I'm fairly confident, I've had weight loss before that didn't last and it involved unsustainable dieting, no exercise, and unrealistic expectations. It's been over a year already, I actually started in September 2017. I don't see anything changing for me.

There was a lot of ignorance on my part. I had to learn how to exercise, learn how to have fun exercising, how to set and meet goals and how to cook, how do a lot. I have all these skills, I have a routine. I've already had setbacks from which I've recovered. I injured myself and couldn't exercise, I kept eating correctly and when I got better I got back to exercising. Over thanksgiving I ate a lot, I took a week break from managing a calorie deficit to enjoying myself and since then I've been back to cooking and counting my calories.

I dropped 40lbs in about 5 months and it was REALLY EASY. Put down your pitchforks, everyone, I know everyone has reasons and excuses, I'm just here to back up what you said about counting calories. It's the best thing I've ever done. Seriously.

I always viewed the idea as the last refuge of a miserable process. That I'd rather just be somewhat overweight than to track everything that closely. But actually it was INCREDIBLY freeing, because it helped me realize that 95% of my habits were REALLY GOOD, but the 5% that I thought was sorta bad was actually extremely terrible. By having the immediate data on what you're consuming or about to consume, it gives you the power of choice, rather than just hand-waving about "it's just one <whatever>" or "it's a friday, what the hell".

Anyone here should appreciate how having data, and seeing "I am on track to lose 2lbs this week" and then it shows up (not every week, but on average) creates a really positive feedback loop in a way that a vague concept of "cutting back on X" never does.

> Stop eating at restaurants, cook all your own food, bring in a lunch to work, count your calories. Also exercise, lots. And get 7+ hours a sleep a night.

> That's it, that's all it takes.

That's a simple recipe, but let's not pretend it's an easy one. It's a significant investment of your time and resources.

That's a fair point. It's definitely not a thing to do all at once, I took baby steps to get here.

Just the awareness is a great start. I'm reading the book Why We Sleep, which was recommended here recently. I've always loved sleep. I've always known you're SUPPOSED to get X hours of sleep and go to bed and wake up at roughly the same time. I've learned a lot of shocking things from the book already, but none of them scared me into sleeping more. Just the very fact that I'm a person reading a book about sleep has made me more aware of it. More likely to think "yes, i am a person who considers sleep valuable", which means I'm more likely to veto that extra TV episode before bed -- not because I necessarily learned more about the value of sleep, but just that the act of reading and thinking about it has made it more front-of-mind and hence more important.

It is pretty simple. Processed carbs that spike your glycemic index lead to a situation where your body has met its caloric needs for the day but your satiety mechanisms get wonked so you feel hungry when you should not be eating again. This is evidenced by things like white bread spiking your glycemic index higher than raw sugar.

This can be solved by not eating any foods that appreciably spike your glycemic index, which basically means no processed carbs. Vegetables for example are almost entirely carbohydrates but are encased in fiber so they do not get absorbed as fast into your system.

If you eat 'fast' carbs you have no choice but to starve yourself because listening to your natural instincts will automatically mean overeating.

People don't have glycemic indices. Foods have glycemic indices.

In a normal person with a functional pancreas, no amount of sugar or high-glycemic foods will cause hunger. It's just not possible. This is because the body naturally releases insulin and the hunger goes away (so does the blood sugar).

The reason people become insulin-resistant is because they eat too much, and put on weight. High-glycemic-index foods are implicated in weight gain because they are high-calorie foods. The added insulin means that the body is also absorbing them more readily. Insulin causes people to gain weight; in fact, one of the side-effects of insulin injections for diabetics is... weight gain! That's because insulin's sole purpose in the body is to make it absorb calories and deliver it to cells.

All that is to say that you're conflating effect for cause. Weight gain causes diabetes, which causes sugar cravings. Sugar doesn't cause diabetes, and it only causes weight gain if you eat too much of it. There are whole societies on earth that eat almost nothing but high glycemic index foods: the rice farmers of Bangladesh; the mango farmers of Central America; the rural people of Morocco who mostly eat dates; and so on.

Sugar doesn't cause diabetes or weight gain. Weight gain causes diabetes, which in turn causes sugar cravings.

I misspoke, replace glycemic index with insulin and I'm right.

For example if you eat 200 calories of ice cream vs broccoli. The ice cream will be absorbed so fast into your system that you will get hungry again before you actually need more calories. Every insulin spike is a notch towards metabolic syndrome. It is the crazy insulin spiking that leads to diabetes.

"Every insulin spike is a notch towards metabolic syndrome."

Completely disagree with this. The best available evidence suggests that it is visceral fat, not insulin itself, that causes insulin resistance. There is an underlying autoimmune malfunction at the heart of it. But because people with diabetes often crave sugar (because their bodies fail to absorb it), people have conflated cause and effect.

There is a growing body of research in this vein. You can find several recent studies like this if you are interested enough. This one in particular has 20% of the subjects no longer needing blood sugar medication after 10 weeks.

https://www.telegraph.co.uk/news/2016/05/31/low-carb-diet-he...

Totally anecdotal, and I wasn't obese but only marginally overweight; but when I was in the USA, I couldn't seem to get any lighter than 165-170 pounds even when trying to diet and exercise heavily (like 3-4 times a week of strenuous exercise for 1-2 hours minimum, and keeping track of all the food I was eating); but then when I lived in Japan for a few months (probably one of the skinniest countries in the world), I didn't even try to diet and I lost 15 pounds (now I'm at 150 lbs).

Lifestyle is clearly a big influence here. My understanding is that generally speaking foods are not sweetened as much there, portions are smaller, and people walk a hell of a lot more. I've also heard that the quality of ingredients in general tends to be higher across the board.

The cheap food, which I ate a whole lot of, aren't even something I could consider "healthy"—lots of fried food like tempura and kara-age, along with lots of noodles—but even without restraint eating those, I still ended up losing weight without trying. Interestingly I think my diet got a lot higher in carbohydrate intake and my protein intake shrank. Probably some amount of my weight loss involved muscle loss, but my belly shrank considerably as well, so I don't think it was exclusively that.

I think I just gradually got used to eating less, stimulating myself with sugar less frequently and intensely (omg, even diet soft drinks and gum are so powerfully sweet), and being more active, and now that I'm back I realize just how much of a premium I have to pay to not get huge portions of food completely saturated with fat and sugar.

As a 100% sedentary person (I sit for maybe 14-15 hours a day) I've had pretty good results with a combination of:

* 6 days of gym (4 lifting, 2 HIIT + cardio for 40 min)

* 2-3 days of water fasting every week, sometimes every other week

* reduced calories

* cutting out most foods that have added sugar, sweeteners or refined grains in them

* doing most of the cooking myself with non-processed ingredients (so vegetables and meats you could get at any market)

* 8-9 hours of sleep on a fixed schedule

It takes a significant amount of discipline and lifestyle changes, but it does lead to also significant results. You generally can't sit in front of a computer as much as I do and also expect to look a certain way without a fairly radical approach. 185lbs to about 160ish in ~6 months at 5'11".

I have a ridiculous amount of energy and for once I feel pretty good about how clothes look on me. Ultimately you have to experiment and see what works for you, most bodies are different and will react differently in subtle ways to diet and exercise.

Do you water fast the entire day?

I usually go for 48-72 hour water fasts, IF has never done anything for me for some reason. Haven't tried much beyond 80 hours or so, mostly because I get bored of it. https://www.amazon.com/Complete-Guide-Fasting-Intermittent-A... is a pretty decent resource on it.

You aren’t 100% sedentary if you’re in the gym six days a week!

A friend of mine puts it this way. If you don't want to die of a heart attack, figure out how only sit, sleep, stand or eat for 23 1/2 or fewer hours a day.

That's a great way to put it.

I guess I can't see how being in bed + on a chair for 23 hours a day can be considered anything but heavily sedentary. Yes, it's not 100%, if we want to nitpick.

you realize it's possible he/she is wheelchair bound?

Good thought, but that's not my case, fortunately. Most of my life revolves around a computer: 10-12 hours of work, photo editing, music production, Netflix, gaming etc.

Turn it into 2x PPL splits with 1 rest day in between for your weekly routine and you can look like a Men's Health cover model in ~6 months of hard work.

I hover between 172 - 176 with a 405 deadlift and 275 bench press.

> 2-3 days of water fasting every week, sometimes every other week

You only drink water for 2-3 days in a row, every week or "sometimes every other week"?? That seems a bit extreme to me, or at minimum, not something that we can expect most people to be able to accomplish.

I can't even fathom that because I'm still battling sleep issues (I have a tracker; last night was 4 hours), which of course doesn't make it any easier to eat less, in fact I become a total asshole when my blood sugar gets low :/

Fasting is not something most people are familiar with, so it comes off as scary and extreme to most people who are just starting out. Yours is definitely one of the most common reactions people doing it run into.

Assuming no pre-existing conditions, your body actually keeps your blood sugar in the right healthy range during fasting. We've evolved to expect to go without food for good chunks of time, which is why we even go into ketosis in the first place. It's not good or bad for you, it's just an alternate state for your body to be in that taps into the battery's reserves instead of the readily available energy coming from nutrition.

FWIW The few times I was in the US I noticed a couple of things different from my country: 1. We drink water/coffee/tea all day (mostly without sugar), in the US I see sodas constantly (ok, usually light). Also, US guests here always ask for the soda machine while we constantly offer black coffee and water. 2. Portions are huge! One cannot go home with even a trace of hunger. Whereas here, it's ok if it at least tasted nice. 3. Almost all food was sweet, have some Asian wok food? Extremely sweet chili sauce on top. 4. Unlimited refills of soda. It's nice but you drink a lot :) 5. 4 p.m. snack? Out come the pastries (sugar and flour glued together with butter)! Here we may have a cookie or some fruit among my colleagues at least. 6. Breakfast? We have yogurt with muesli or a sandwich (meaning we put a 2 micron thick slice of cheese on the bread) and perhaps a boiled egg. In the US: The smell of Fried potatoes fills the room! 7. Pizza: Have a good pizza here and the sauce is just tomatoes and some garlic. Have a US pizza (sure we also have them here) it's sugar and salt all the way. Better drink 5 glasses of water 1 hour after eating over 10 mg of salt or you will get a headache. 8. We usually cook ourselves, from fresh vegetables and meat or fish. In the US it's much more common to eat out. It's very unlikely to pile sugar and salt into a home cooked meal. 9. I haven't seen the situation in schools but one hears these "pizza is vegetable" stories from the US, here the kids only drink water in school (at least ours, it's not obligatory but parents provide the drinks and most of them get water) and a piece of fruit. During lunch they get about 2 slices of bread with meat or cheese or chocolate sprinkles (hagelslag).

At least that was my experience. Of course, I loved the burgers and after a few days of them you start to get that real craving for them. I love burgers and I love fries.

I've gone from 255 (BMI 33) down to 185 (BMI 24), back to 205, had an illness and got up to 225, now back to 210. I resent the article acting like this long-term weight loss is somehow a freak occurrence.

I just watch what I eat and exercise. Many people with obesity just don't like to exercise, but I love it. This is a natural advantage I have. But I also go on days when I don't feel like going, skip office snacks, and so on. It's neither magical nor impractical.

Ultimately, obesity has been normalized and people don't really care. This is going to be hard to change, either hard on society in funding education and support resources, or hard on the obese in cutting them off from health care and other Draconian measures.

Apparently even animals such as monkeys and rats kept in labs and fed the same calories under controlled conditions are fatter than the same animals fed the same decades ago. Xenoestrogens?

Do you have a source for that? Super interesting...

It might be climate change. https://www.theguardian.com/environment/2014/may/07/climate-... details how high CO2 levels lead to food crops with more sugar and less nutrients. As a result, animals fed the same diet aren't getting the same calories as they used to.

Soil depletion and optimizing for size has also caused a drop in vitamin and mineral content

https://www.scientificamerican.com/article/soil-depletion-an...

I'm also curious if there is any effect from trace amounts of insecticides, herbicides and fungicides in our water and food supply. Agriculture has experimented with many novel compounds in the past century, and I don't trust that each of these compounds was diligently studied by researchers without a conflict of interest.

Link to this data?

Thought there was an air conditioning hypothesis about that?

> “This idea that people should eat less and exercise more — if only it were so simple,” Dr. Hall said.

Of course pharma companies and the healthcare system don't want it to be that simple: better to sell drugs to people to fix the problem. Likewise, consumers would rather take a pill than do something difficult, like eat properly and exercise.

When you consider how prevalent this kind of attitude is the obesity levels stop being a mystery.

>> “This idea that people should eat less and exercise more — if only it were so simple,” Dr. Hall said.

Well, actually it is that simple.

The problem is: 1) sugar 2) long commutes 3) sitting all day

And the solution is pretty simple, too. 1) Turn sugar down to 0 2) Do 50 burpees per day

The big meta problem is that people talk about it and complain about it and hand wring about it rather than doing the simplest thing possible.

This applies to way more than just diet. As I've gotten older I've realized how many people are totally adverse to doing things that are even marginally difficult or inconvenient. Eating healthy and exercising definitely fall into that category.

People in the 70s didn't all have bariatric surgery, or access to miracle drugs to control hunger hormones. Nor did we all develop some mutation that caused the current obesity epidemic. Clearly something in our environment has changed. Seems to me that it would be simpler to figure out what's changed between now and then, rather than try and invent new drugs. I.e. we need to do root cause analysis rather than flounder for workarounds.

Some have suggested that the carb-heavy government food guide pyramids are to blame. That seems to be a good place to start.

It's the habits.

In the 1970s - people did not have a habit of eating 3 full blown high calorie meals. They were working physically intense jobs (agriculture, mines, metallurgy etc). Nowadays the hardest thing we do is think. They'd spent more time outdoors. They'd rather do sports and spend time in nature actively resting than binge watching tv-shows and movies on the weekends. People didn't have as much food available to them as today. They also had less commodity.

Why do people regain fat they lose? It's the habits.

They'll get the bariatric surgery done, but will never change the habits. They'll go through the 600 calorie liquid diet and will continue to eat the same things that made them fat initially.

They'll continue binge watching tv shows on the weekends, without lifting anything heavier than their spoon or the remote.

They'll continue undergoing the fad diets that don't do anything but make their metabolism slower and make their bodies over compensate due to starving. People are lazy and refuse to listen to their bodies, but will gladly listen to the brainbait titles of famous ads/instagram posts.

Why we're fat? We're fat because we look for immediate gratification that sugar produces rather than the gratification of being able to climb ten floors of stairs with ease. My dad recently told me that he wants to do bariatric surgery which will "jumpstart" his weight loss. He unfortunately can't walk 200 meters right now, without getting tired. Do you think something will change if he undergoes the surgery or will he continue eating the same :) ? I bet it's the latter, since he won't have an incentive to change something.

People regain weight because of the hunger hormone Grehlin, which gets high and stays high after losing weight.

I believe you can reduce Ghrelin by fasting - I'm not near a computer to fully support this claim, but can update later with proper links to studies.

Would like to see this data

If you go on a Very Low Calorie Diet(usually in the range of 400-700 calories or less a day), your body goes into starvation mode, thinks that there must not be enough food to go around so no need to feel hungry. That might be what you're referring to as fasting should have the same effect. I haven't heard of the effect continuing after starting to eat 1000+ calories a day again though, so I'd need to see some data on that.

Compare the serving sizes and caloric intakes at a USA restaurant with those in Japan, for example, and you'll see why. It's not hard to figure out, we put HFCS and sugar in everything now and people eat 2x as much as they used to.

I lost 30 pounds over 2 years by being hungry non-stop and walking about 3 miles per day to work, so losing weight isn't just a "pill disease" that we can solve with a pill, it requires a person to have the self-control to be hungry and exercise, and (from experience) over-eaters don't tend to have much self-control in that area.

I think obesity should be treated more as a mental health issue than physical (for most people, there are exceptions), because there is no better way to lose weight than diet and exercise and doing it at a slow rate.

Obesity is an example of a problem like climate change. We know how to solve it (less sugar, better food, less calories, more moving) but no one wants to take those steps. I feel like this will also fall back onto the food companies, who will probably be reviled in 50 years like the tobacco companies are today.

The body (ie the brain) is amazing at adapting to its environment. One thing to keep in mind is that as unhealthy food becomes the norm for a person, their brain sets a new baseline for how much of this food it thinks the body can handle (side effect: more sweets are needed to release pleasure in the brain).

Speaking from my own experience, I eat pretty healthily, and cook most of my own meals. The few times I've had anything sweet in the last decade, I could only handle a small amount of it before my brain and stomach were telling me I've had enough. If I push myself, I began to feel ill. (Example: 4-5 Sweetish Fish is enough for me)

My own defense mechanism is because of my parents. They never bought soda and sweet snacks (e.g. gushers, fruit roll ups) at the grocery store, although a handful times a year I got to go to a candy store and pick out a couple items.

I would guess (based on anecdotal experience though) that a child's diet is the number one cause/preventative of obesity. It sets the culinary stage that they will dance on for the rest of their life.

Congratulations, it sounds like you have the satiety signal that makes you feel nauseous if you eat a little too much!

> I would guess (based on anecdotal experience though) that a child's diet is the number one cause/preventative of obesity. It sets the culinary stage that they will dance on for the rest of their life.

While this is only anecdotal data, this is not true for me. I was a skinny kid because I never got soda, I never got ice cream truck, I never got pizza or pasta, and if I spent more than an hour on the computer (note: I'm a programmer now) my mom would yell at me to go outside and bike, or drag me to the local beach or town pool for the day.

Well, all that forcing me to eat "proper" instead of teaching me to eat "proper" built up quite a bit of resentment apparently, in my freshman year I gained 20 lbs and kept going (with swings up and down) and I have not seen 185 lbs since then.

I'm currently 6'3" and ~260lb @ 46 years old. Last week I worked out 4 times (all Orange Theory, which is no joke). I'm about to work out again in a few minutes. I'm trying to watch what I eat, considering going back to calorie tracking but IT IS SUCH A PAIN. The tracking is more of a pain than the eating less, lol. (I'm also ADHD, which might explain why.)

Let's not forget that obesity is also socially contagious, and there is tremendous social pressure to conform to obesity, which is why if you're less fat than fatter people, they will publicly shame you for your lack of comparable obesity with comments like "you need to eat a cheese burger" or 'get some meat on those bones' etc.

Because we can spend 1$ and get 400-1200 kcals out of a vending machine (that takes 10-30 seconds to consume), while we sit at a desk all day and evening, instead of having to plant/weed/harvest/process our food in a field.

he says as he eats candy

We have ridiculously kcal dense food immediately available while we also have, on average, extremely sedentary lives.

I mean, looking at:

- Starbucks menu you can get a beverage that comes in at 500 kcals without even getting fancy.

- Symphony milk chocolate bar: 149 kcals/ounce.

- White Castle chicken sandwich (about half the size of a deck of cards) 350 kcals

- Wendy's Baconator 950 kcals

- McDonald's double bacon smokehouse burger on artisan roll 1130 kcals (most of McDonald's value meals can actually easily get into the 1000+ kcal range without any special modifications)

- Burger King Whopper 660 kcals

- 32 ounce Coke 370 kcals

- Papa Johns sausage pizza 260-410 kcals a slice (depending on the pizza size)

We can get insane amounts of kcals, with relative ease, in dense little packages while being largely inactive.

Edit: since this was downvoted to -2, HN is throttling my ability to reply to the individual that replied to me, in regards to 'first world countries':

https://obesity.procon.org/view.resource.php?resourceID=0060...

Obesity percentages: US 36.2%, NZ 30.8%, CA 29.4%, AU 29%, UK 27.8% all 'first world countries' out of the top 10 and if you look at the complete list the bulk of the 'first world' countries, where convenience foods/fast foods are readily available, are above 20% obesity.

There aren't very many people in first-world countries who need to farm anymore, and all first-world countries have desk jobs and vending machines, yet the rate of obesity varies widely between first-world countries.

For the US: Cars and roads and vast distances to cover and the following unusefullness to walk? What i mean is, is a grocery store within walking distance for most of the population?

Edit: Not to forget all the drive-throughs born out of this misbalance.

Likewise, Belize and Qatar have higher obesity rates than the USA, so it's not necessarily correlated with the development of a nation

Because we eat like royalty. I have access to exceedingly tasty food all the time.

If you look at food we eat every day, they used to be celebration foods: Ice Cream, Tamales, Cake, etc.

Additionally, if you have a sedentary job, you won't be burning off the carbs.

There are so many things wrong with this article, here are some facts.

1. More insulin causes the body to store fat. Less insulin causes the body to burn fat.

2. A low-carb diet lowers insulin levels.

3. Over the last few decades they started adding sugar (carbs) into almost every food product while the US government published a food pyramid with a heavy emphasis on carbs.

4. As the article states, now we have an obesity problem which was not as severe in the last few decades.

> “This idea that people should eat less and exercise more — if only it were so simple,” Dr. Hall said.

For the majority of people, it is that simple. That doesn't mean it's easy. To give most folks a hall pass on their poor eating habits with bariatric surgery or a special pill (which are for extreme outliers) is dishonest at best and harmful or dangerous at worst.

Counter-acting the factors that made a person fat in the first place seems very difficult. Especially when compounded by an always-aging body.

Off the top of my head:

  - genetic pre-dispositions
  - Eating habits during childhood
  - Eating habits during early adulthood
  - the effects on metabolism and body chemistry of the above
  - Many more, I'm sure

Mostly it comes from our diet and what we eat.

We've become accustomed to eat for our senses (taste) instead of our survival (nutrition).

We're addicted to the taste of 'good' food.

Then you have food companies who are engineering that addictive taste for your senses.

A habit develops and it's hard to shake that off.

I've had success getting in shape by tracking what I eat and following a weight training routine (PPL). Counting macros gives you a flexible diet. Buy a food scale and eat enough food to hit your macro goals to be at a daily 250-500 calorie deficit.

That means you'll lose 0.5 - 1 pound per week. Once you're lean, eat at a slight surplus to gain some lean body mass.

Sorry everyone, there's no magic pill that burns all of your fat. There's steroids, but you'll still have to eat enough and go to the gym.

People want to get fit but don't put in the time nor effort.

It takes time, delayed gratification in this era of instant gratification is tough.

> No one really knows why bodies have changed so much

How can one claim this?

Eating garbage and sitting aroind all day.

Reading HN. Sigh.

Health shouldn't have to be hard. It's so simple yet we have a hard time reaching it in a normal life:

1. Eat real food (Cook it yourself) 2. Sleep! 3. Exercise 4. Socialise 5. Avoid stress

I'm currently losing weight with a weight loss specialist. They had an intro presentation and went over some of the reasons we have such an obesity epidemic and why it's so hard to keep weight off. Some of the key points they mentioned:(I'm paraphrasing here because I don't have my notes on me.)

There is a hunger hormone called Ghrelin. The amount that your body produces is based on the highest weight attained that you kept for at least a year. When you're at that weight, your Ghrelin levels are at about the same as someone who is 150 pounds lighter that you who is also at their max weight ever attained. However, once you've lost weight your body starts producing more Ghrelin which makes you hungrier. This takes decades to reset from whatever your bodies weight target from 'highest weight held for at least a year' to your new lower weight so basically your Ghrelin levels will be higher than average for decades after losing weight(unless you gain it back). There is also another hormone that was recently discovered to has an effect on appetite but I can't remember its name and we didn't know much about it yet.

Regarding gaining weight, there are three satiety signals that are used to help you not overeat. One is a feeling of fullness that only lasts for ~15 minutes but kicks in within a bite or two of calories needed to maintain weight so if you have this signal you may only gain 3 pounds max in a year as long as you don't wait 20 minutes and then go back for seconds. The second satiety signal was loss of savor(food just stops tasting good) and lasts for a couple(~4?) hours. The last was feeling nauseous(not the same as eating so much you couldn't fit another bite and can't move, we can all get that), and was triggered by eating a couple bites past the fullness signal level(if you only have this signal you may gain ~15-20 lbs in a year if I'm remembering correctly). The problem is that most people only have one or two of these signals and many don't have any of them. If you've never had to diet to lose weight and have always had a good weight level then congratulations, you probably have at least 1 or 2 of these and maybe all three. If you've had several diets and have lost hundreds of pounds in aggregate over several diets over a decade plus then chances are you probably don't have any of the 3 signals. Everyone else probably falls in the middle where they only have 1 or maybe 2 satiety signals.

If we were able to determine what gene/set of genes or other processes determined if you had these signals and were able to give others who don't have them the ability to receive these same signals we would be able to keep new people from gaining weight. If we found a way to reset Grehlin levels for people who have lost weight(hopefully a pill, maybe through gene modification via crispr) then we'd be able to help people who have lost weight to keep it off long term. Regarding sugars, etc. yes, it makes it infinitely harder to diet when there are so many high calorie options out there, but there are deeper underlying medical reasons out there than just that.

Basically, the only people who have been able to be successful at keeping weight off long term are those who either exercise 2+ hours PER DAY(less time can help with strength, etc but not with weight loss/maintenance because you'll just be hungrier and end up eating more calories to make up for the ones you burned) or those who are perpetually on a diet for the rest of their lives and work hard to re-lose any pounds gained after a trip, etc. The good news is we're making some progress in weight loss research(but still have a long ways to go) and there are decent appetite suppressants, etc. that can help you lose weight and keep it off if you go to a Dr. that specializes in this and that this isn't an impossible to solve willpower problem, but a medical one that can be fixed. The bad news is you'll probably be on a diet for the rest of your life or until we solve the above questions on satiety signals and hunger hormones.

tldr: it's a medical problem, not a willpower problem, and won't be fully solved until we treat it like such and invest the resources into finding a cure. Until then we're just treating the symptoms.

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