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Comment by evol262 | Hacker News Reader

Diets don't fail because they're inherently flawed and the system is more complex than we think it is. Diets fail because people fail. "I tried and I failed, but I still do all this physical stuff or could if I wanted to" is dishonesty, whether intended or not.

Asserting that, for some unspecified (but large) fraction of the population, tracking your caloric intake and energy expenditure versus the number on the scale is inherently flawed is dangerous, misleading, and probably false. At least partly because overweight people may lie to themselves.

In this sense, and in the context of Fella, throwing more drugs at the problem isn't a solution any more than throwing additional hardware at an application because the developer insists that database indexes don't work everywhere. It's true, but requires extraordinary evidence, and should not be the baseline assumption.

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It does look like Fella is addressing psychological issues which I think are huge. The issue if you deny that calories in v calories burnt is the essential metric is you end up with the problem with bariatric surgery where people literally eat to the point of severe pain and don't lose weight. It's why responsible surgeon always require significant calorie restriction weight loss before surgery.

I'm sorry this isn't clearer. The core part of the coaching program is focused on psychology: we even call it "psychological coaching" internally! That's the stress eating side, then also diving deeper into why we make the food choices & portion size choices we do.

My take: a approach focused only on changing behavior has good parts, but traditionally been way too much reliance on this and not enough on the psychological/cognitive side.

The thing is, if you speak to obesity specialist MDs, they really do come at this in a different way. They have a much more nuanced view of how underlying metabolism / biology interact with CICO.

I know personally because I used to believe a puritan CICO, but had a "viewquake" moment speaking with them and had to change a lot about what I believe!

Importantly they try to focus exclusively on practical solutions for the population: what will actually work in the world. They detach themselves from a lot of the moralizing we see.

Your attitude toward the topic is fairly typical, and pretty harmful. "Diets fail because people fail" is true, of course - my point is that people "failing" is not always (or even usually) a result of intrinsic weakness of willpower, but a result of substantial variation in the real world experience of maintaining a calorie-restricted diet.

As a thought experiment, imagine if, for every 100 calories of deficit in their daily consumption, a random tenth of the population felt substantial and increasing physical pain. Would you describe their inability to consistently lose weight as a 'failure' on their part? As essentially due to a lack of sufficient discipline? What if it were nausea? Exhaustion?

Now picture a world in which that is the actual norm, and those people are subjected to frequent ridicule for their lack of willpower and bombarded with the message that they are inferior because of it. If they'd just man up and stomach the pain for the rest of their lives, they'd have no trouble losing weight, it's simple physics.

This isn't an accurate representation of reality of course. I don't feel physical pain when I run a hundred calorie deficit, I just feel tired most of the time, and I lose the energy to enjoy physical pursuits. I'm confident that if I applied enough effort (again), I'd lose some weight (again), and keep it off for as long as I continued spending that effort. Again.

> Asserting that .. tracking your caloric intake and energy expenditure versus the number on the scale is inherently flawed is dangerous, misleading, and probably false.

That's not what I'm asserting. And I think that's been pretty clear, really! There are millions of fat people who are actively trying to be thinner in various ways and repeatedly "failing". Do you really think that telling all of those people to "just try harder" is a useful thing to do?

I don't personally expect drugs to be the answer to the problem, and I don't have any opinion on the "Fella" business model or likely effectiveness. My position this whole time has just been that fat people are mostly not fat because they don't understand that restricting calories will make them thinner. Understanding the actual reasons is important, and it's far more difficult to do when any real conversation on the topic is inundated with comments to the effect of "have you tried not eating as much? It's really easy, just eat less."

On re-read, this jumped out at me:

> Diets don't fail because they're inherently flawed and the system is more complex than we think it is. Diets fail because people fail.

The system includes the people. If the people "fail", that is relevant information, and should be used to evaluate the 'effectiveness' of the approach. The system is extremely complex, including as it does all of human psychology and physicality, and yet every one of these discussions is dogged by people like you, that think that the problem is just that people don't try hard enough.

Well sure they don't, that's also the reason they can't all bench 400 pounds - "hard enough" is the critical phrase here, and your language and attitude place all of the blame on the individual. It's a lot like explaining that depressed people are responsible for their own emotional state, and should just start exercising and cheer up - it's factually true, and yet also unhelpful, counterproductive, and insulting.

Well written.

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