Effect of Weight Loss on Obstructive Sleep Apnea: The Importance of Tongue Fat

Nobody who fat shames has shown me research about the efficacy of fat shaming on weight reduction. That's not necessarily because the research doesn't exist, it's because they just don't care.

I understand what you are saying but, economically, treating the symptom rather than the cause is expensive; somehow there needs to be some way to create a cost high enough to encourage people to attack the cause of the problem; and shame can be a useful way to increase the cost. So "fat shaming", although politically incorrect these days, should not be thrown out as a way to encourage behavior that benefits society as a whole and the person as whole. If there was a high enough cost to being fat then you would see it would become practical and maintainable.

>In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable and for that reason it is critical that we continue to advance our treatment of things like sleep apnea.

Sorry, but I have to call BS on that. Having lost ~50 lbs last year (after my blood pressure started getting scary), I can tell you it's all about planning and self-discipline. You plan a diet that fills your stomach and provides the major types of nutrients, yet gives less calories that your body burns every day, and you stick to it for a couple of months. No bullshit, no cheat days, no "let me just have that 500cal chocolate bar as an exception". And it works like clockwork, solving a bunch of health problems on the way.

As a matter of fact, I would call it very unethical to comfort people into an unhealthy lifestyle associated with major health risks and shorter life expectancy just to get an extra buck from treating numerous symptoms, instead of giving them a strong motivation to resolve the underlying cause.

> In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable and for that reason it is critical that we continue to advance our treatment of things like sleep apnea.

Thank you for this comment! I'd like to emphasize this point in particular. It took me a long time to come to this realization on my own, and I regret putting my brother under so much pressure to lose weight out of my own concern for his health. I likely did more harm than good with my efforts, only worsening his mental and physical health.

While losing weight solves a lot of problems, the decision to do so is one's own, and for some, it's an unreasonably difficult task. Not everyone is like you, and not every body is like yours. The best you can do to help someone suffering the consequences of excess weight is to be compassionate and supportive. Feel free to offer solutions and perspectives, but leave your emotions out of it. Respect the dignity and autonomy of others.

I'd just like to chime in as someone who has lost and kept off about half his bodyweight, that yeah, losing significant amounts of weight is a very demanding undertaking. It requires a significant lifestyle change, large investments of time, is emotionally and cognitively draining, and to top it all off does not positively impact your quality of life nearly as much as is touted. To be successful at it requires a level of obsession that qualifies as an eating disorder in its own. I track every calorie I eat, and weigh myself everyday. I have to hate seeing those numbers go up. I have to feel shame at overeating and not allow myself to make excuses for it, lest I become complacent. I can't keep food in my house. I avoid social gatherings because there's almost always food involved. You might think you can just not partake but it doesn't work like that, your brain thinks you're starving and has all sorts of ways to wear down your will and convince you it is ok to eat. It's kind of a living hell.

Based on personal experience, I am quite confident that physicians have absolutely no idea how to give actionable advice in this area, and nutritional specialists are only slightly better. None of them care about your suffering, because that isn't something they measure.

I guess what I'm saying is that yeah, it is possible for anyone to lose and keep off significant amounts of weight, but basically none of you have any idea what it really takes.

CPAP is 800CAD here (though only about 200 after insurance) and dental appliances are even more expensive and not covered by insurance. Anecdata: I know that going over a certain weight triggers apnea and snoring for me so I try to stay under it - less expensive, less intrusive, better for the health overall. Research like this is both interesting and important to me. It is not about fat-shaming, it is about knowing the options. I understand that there are people for whom weight loss mai not be attainable or maintainable but it certainly will help to a great number of people.

> for many people weight loss is neither practical nor maintainable

Hard disagree.

As for practicality, weight loss is a function of thermodynamics. Caloric deficit == weight reduction. Doesn't matter your physiology.

As for maintainability, well that certainly depends on how a person is taught to diet. If you tell someone they need to eat less to lose weight (which is what almost every diet does) then, yes, it will be hard to maintain. If you tell someone to eat more (low calorie) food then weight loss is easy.

Most obese, untrained people will very readily drop tons of fat weight with little stimulus.

When I diet (whether the intention is gaining or losing weight) I'm probably eating 2x as much food as an obese person who is wondering to themselves "why is my metabolism so slow?". It's not. The foods I eat just contain less energy than the foods they're eating.

Got a CPAP about a year ago, changed my life. Weight issues aside I also have a big neck which means I'll probably have OSA even if I achieve a normal BMI.

Anyway, highly recommend a sleep study for anyone here who has symptoms like waking up feeling tired, dozing off in the afternoon, etc.

>it is important to understand that for many people weight loss is neither practical nor maintainable

People need to stop eating processed sugar. Losing and keeping off weight is easy. As soon as I stopped eating, candy, baked shit from coffee shops and crap, fast food, and stopped drinking pop, it became hard to gain weight. That shit's poison. It gives your body nothing. Cutting out nearly all processed sugary food is the easiest way to lose weight with basically no effort. I didn't change my lifestyle, I don't count calories or exercise to any regime. I sat for hours a day at my last job. I just stopped eating garbage and eating food that's actually food. I'm 5'8", I'd been over 200lbs for years and years. I can't get above 150lbs now and all I do is not eat sugar or processed crap. I eat tons of cheese and meat, I have at least one kind of grain and vegetable with each meal.

If the main ingredients of something are chemicals and sugar. It's not food. Don't eat it. Your body will be healthy, you'll lose weight. It's a pretty simple concept. These things give your body nothing. Your body needs certain things to make new cells and perform biological functions, eat those things and you'll be healthy. Eat garbage and poison and you won't be.

Eta: Sorry for the tone of my post. I've sat and watched a good friend of mine slipping in and out of a diabetic coma in a hospital brought on directly by the food he eats and to this day he still refuses to change his diet in anyway and I'm honestly worried it's going to kill him. This topic makes me a little more unreasonable than usual.

> In reaction to that, it is important to understand that for many people weight loss is neither practical nor maintainable

So you're saying that even though the obesity epidemic is an entirely new thing, that there's no way that these people can lose weight and keep it off?

It might require a lifestyle change, but saying it's not possible because change is hard is bullshit.

As someone with OSA - and a busted TMJ, so no mandibular advancement for me -, let me tell you: CPAP sucks.

Sure, you die slower, you snore a hell of a lot less, and you feel more rested and energized. That's all (truly, no snark) great.

But it sucks. Spontaneous sleepovers become impossible. Travel becomes a chore. Sleeping with bedfellows now comes with a noisy attachment. You have to rent or buy a relatively expensive machine. You have to get annual checkups, and you have to give up a fair amount of privacy to prove you are complying with the therapy... Not that much fun.

Weight affects so much more though. It's not just sleep apnea, but heart disease and diabetes as well. Any type of surgery risk is greatly increased by obesity.

Look at history. Even for people working desk jobs, Americans were much less obese than they are today. It's a systemic problem. Go into any gas station and try to grab a snack without sugar. It's difficult to impossible. We have more sugar and starch in our food today. I agree it's not necessarily a personal problem. It's a problem with the entire food industry and access to cheap sugar.

It's starting to affect people in other western countries too and we are missing a lot of education about the dangers of starch and sugar.

Forgive my ignorance in this area -- these dental appliances, do they permanently reshape the jaw over time?

Just adding another datapoint: With no particular dieting, I tend to hover around 95kg. I was able to get down to 80kg with smart dieting. But I was miserable at that weight.. I couldn't concentrate when programming, my brain kept interrupting me with hunger signals. I put the weight back on; I'd rather not live the rest of my life in hunger-misery. 20 years later and I'm still fine with that decision. I get plenty of exercise and eat lots of vegetables and take other steps to be healthy, but significant sustained weight loss with it's side effects is no longer desirable... until medicine comes up with a pill that removes the hunger itself w/o nasty side effects.

Wow great to see a dentist here! I've had a lot of experience with sleep apnea in the last couple years, and it seems to be under control now after about 5 remedies, the most of important of which is a dental appliance. The other ones were sleep position, weight loss, and breathing habits, as you might imagine.

What do you mean by "gold standard"? Is it because it's more effective for severe sleep apnea?

From my perspective, the dental appliance is easier to use, and is better for traveling. I also tried a CPAP but couldn't get the hang of it.

It's also super creepy that CPAPs all seem to have a cell modem that spies on you. (OK, that info also helps the doctor, but still.)

I know a couple other people who are having problems with CPAP, and the doctor has not even made them aware of the dental appliance. They're surprised when I tell them there's an alternative.

And one of these people is a doctor himself! I feel like sleep apnea is being treated very poorly given how common it is, probably for economic reasons.

I know everyone wants to say this about their pet cause -- but it does seem like an "epidemic". The "epidemic" of weight gain seems to be an obvious reason for this. FWIW my BMI is now normal (less than 25, 166-169 at 5'9"), and I still need the dental appliance and to sleep on my side. Either one alone doesn't cut it.

I've also been meaning to write a article about "Why AHI is wrong", which is basically because outliers determine outcomes and AHI doesn't measure outliers. It's a "count". It has a lot of the fallacies that Nassim Taleb talks about in his books.

The AVERAGE minute of sleep doesn't matter; the WORST minute of sleep matters. The worst minute can ruin your whole night's sleep (or at least a REM's cycle worth of sleep), or it can cause you to have a heart attack and die.

My AHI is 6 or 7, and most doctors have dismissed that as not important. However my sleep quality has improved greatly with all these remedies. Several minor health problems have cleared up all at once.

The thing that motivated me to get treated was that I crushed a tooth in my sleep, which many doctors don't realize is related to sleep apnea (but my dentist did thankfully). But I think of all the people who did NOT happen to crush a tooth and are undiagnosed. I guess it's one of those things that kills you over 20 years and used to be called "getting old". But really it was amazing to me how many problems can have the same fundamental cause.

FWIW I highly recommend this book about the "sleep breathing paradigm". It's written by an ENT who has observed a lot of these things in his practice. A key point is that he actually looks at your airway and sees if your tongue obstructs your airway when lying down. I went to 2 ENTs and neither of them did that. They don't understand the mechanism behind sleep apnea! It's geometry and gravity.

This book is not popular, which is a shame. Don't judge a book by its cover :) It's a bit dense but that will be fine for HN readers.

https://www.amazon.com/Sleep-Interrupted-physician-reveals-r...

Hey, are you referring to the SUAD Device? I am thinking about getting one and curious if there is an alternative. I have heard mixed things about their quality. Thank you for sharing your knowledge with us.

Proper and adequate sleep is also an important part of weight loss, so I find it naive to only attempt to fix the weight issue.

It's a vicious catch-22 to not be able to breathe enough to sleep well enough to lose weight so that one can breathe in the first place.

On topic: losing weight has a positive effect for sleep apnea. This is interesting, but something I had intuited from the small sampling of those I know with sleep apnea and weight problems. There are other factors that seem causal, like smoking, that would be interesting to hear about. Off topic: losing weight is hard to do for many people.