Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients. 2019 Apr 1;11(4):766. doi: 10.3390/nu11040766. PMID: 30939855; PMCID: PMC6520897.
The basic problem, which has been unchanged for decades, is that hardly anyone actually follows the "proper" diet on a long-term basis without some kind of surgical or drug treatment. Despite weight loss being a massive industry and a very common goal, researchers routinely struggle to find study subjects who have maintained significant long-term weight loss without medical interventions, to the point that there's a special registry to keep track of such people for scientific purposes [1].
Nevertheless, I agree that such people might be a very small part of those who lose weight.
About 15 years ago, I have lost about one third of my initial body weight during almost a year, and then I have kept my desired weight until today, without any kind of medical treatment, either surgical or drug-based.
Nevertheless it was not easy and it required a lot of thought and experiments with the diet, until I have learned how to control my weight, after many years during which I had believed that this is impossible. It also required completely dropping many bad habits, for example drinking commercial juices or eating commercial mixes of yogurt with fruits or eating various kinds of "breakfast cereals" or any other such commercial products containing an excessive amount of sugar. I have never eaten or drunk again any of the products that I have blacklisted, even if they were among those that I had eaten or drunk daily, for many years.
I believe that most people are not introspective enough to succeed in changing so much their habits by themselves so they need some kind of external help. The main obstacles for weight control are psychological, not physiological, i.e. those who need to control their weight must learn somehow to love to eat food that is different from what they had been eating, because if they will ever revert to their old eating style, then they will certainly also revert to their previous weight.
The census.gov says there are a little under 260 million adults in the united states, and we know obesity is something like approaching 40% of these adults, so 104 million.
10,000 is not even one thousandth of a percentage point of the obese people of the untied states.
For contrast, a disease is considered rare if it occurs 1 in every 1500 people in the united states. A person who un-obesity's themselves into healthy weight is literally a magnitude rarer than this.
Consider that the rate of obesity continues to increase in the US. This shows that people are simply eating more and doing less exercise. And of course those that are already obese are the least likley to consume healthy ammounts of food and exercise as needed.
In other words, yes, the issue with overeating is in fact overeating. The only way to solve this problem for the whole population (as in, not for a single individual) is to change society and how it views unhealthy food. Off the top of my head, fast food advertisments should be made illegal. The entire point of those ads to get people to eat fast food. This single step could reduce obesity in the US by a noticable amount and requires no loss of freedom to any individual. A sugar tax or the like is a more extreme solution. But this idea is not unfounded:
>Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.
-Adam Smith
Book V: On the Revenue of the Sovereign or Commonwealth Chapter III: On Public Debts
https://www.adamsmithworks.org/documents/chapter-iii-of-publ...
This is ridiculous. Nearly everyone I know who is overweight eats hardly any fast food.
What I do see is lots of snacking throughout the day on high carb things (chips, breads, etc) and just way too many calories due to large serving sizes in both regular “slow food” restaurants and meals made at home.
Fast food meals if you skip the sugared soda tend to be closer to proper per meal calorie targets than sit down restaurants because of how cheap they are.
At sit down restaurants the price is higher to support a wait staff and lower throughput so they compensate with ridiculously huge portions.
For example, when I visited my family in the states, I ate two double cheeseburgers at a fast food joint at 1000+ calories per burger, and I figured I could probably eat two more in that sitting without issue.
In other words I ate 2000+ calories in a few minutes and could have kept going. Even one burger has more calories than I eat in a single meal.
Meanwhile, I couldn’t eat 15 medium sweet potatoes (1000 calories) in one sitting.
Though I do think the public would be better off if they replaced the bread with lettuce or something. It seems like they're willing to do that anywhere I've gone.
Where was this? A double quarter pounder BLT at McD with standard toppings is 830 calories. A McDouble is half that.
One, along with fries, is enough to fill me up for practically the whole day. I think fast food gets a bad rap. It’s calorie dense but with all of the fat it keeps you pretty darn full.
Compare that burger with a few candy bars or not all that much soda…
Another point, while I did say that "The entire point of those ads to get people to eat fast food" what I really meant is that they make people want to eat in general[note 1]. What this means is that fast food ads can be harmful even if they do not cause the viewer to buy fast food. What this does is contribute to a culture of consumption which is part of what I meant when I said "The only way to solve this problem for the whole population [...] is to change society and how it views unhealthy food." I did not mention sit down restaurants because they generaly do not advertise. My suggestion was "off the top of my head" and not fully thought out. I'm glad you made your comment because I did not express my reasoning clearly.
[0]https://epi.grants.cancer.gov/diet/foodsources/top-food-sour... page 77
[note 1] That is, the "point" of the fast food ads collectivly are to generate a demand for fast food from the point of view of the advertisers, but the effect, while more pronounced for fast food, generates a general demand for caloric intake.
They do in the US. TV adverts are littered with ads for national chains (Olive Garden, Buffalo Wild Wings, Red Robin, etc).
Media that allows more targeted local stuff (Facebook, billboards, newspaper, Google maps, etc) is plastered with ads for local sit down restaurants. If anything these ones advertise even more because they don’t have an established mindshare.
To me, it seems obvious that sustaining a low calorie diet (LCD) long-term is basically impossible (from a maximal fat oxidation and, even a thermodynamics perspective). On the bio-mechanistic side, it's also important to note that hyperinsulemia inhibits lipolysis [2], which is one factor that is also usually not taken into consideration. Anyway, while a LCD may be effective for a while (maybe even years), it's probably quite miserable and almost by definition, can't be a sustainable lifestyle change. Even as a short term fix, it may not a very healthy and might be counter-productive long term... [3]
To me, the biggest problem is that T2D is in many (but, to be clear, not all) cases, the end stage of a metabolic patho-physiology that can be identified by other markers (as simple as WtHR, or cheap labs like fasting insulin, or NAFLD indices) that are cheap and easy to measure, but from my experience, most clinicians are completely unaware of this. Which is too bad, since the overwhelming majority of their patients in the US these days (over 80%) are suffering from metabolic diseases. [4]
Over the years (I moved a lot) I've had close to a dozen different primary care providers, and diligently did my annual health checks, all while slowly putting a couple pounds each year and none of them were able to give any useful treatment or even medical advice as my MetS markers crept up. I had to figure it out myself - in fact most gave bad advice and weren't even measuring or diagnosing the right markers. The real kicker to me is how cheap some of these tests are (fasting insulin is <$10 more to test even if you're paying out of pocket and is required for useful indices like HOMA/2-IR and NAFLD LFS, but most GP's won't request this test even if you ask them too)...
I'll also mention that both from the literature [5] and my personal experience [1], some of the worst damage can be reversed in a matter of weeks. I did labs right before I started my diet changes and 1-month in, and even in a single month my TGs and my liver numbers moved from unhealthy to healthy ranges.
As for sustainability, there are some lifestyle treatments like Virta's that have shown better than medication retention rates and efficacy, so it's possible to do... https://www.virtahealth.com/outcomes
How do they do it? A combination of responsive/actionable biomarker monitoring/feedback coupled long-term coaching and peer-support groups. Not impossible and way cheaper (and better quality of life!) than any pharmaceutical alternatives.
[1] https://randomfoo.net/2019/09/17/1-year-personal-health-inte...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753874/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/