Why aren’t medical breakthroughs in obesity a bigger deal?

I eat mainly beef and I don't understand why everyone in the world doesn't eat mainly beef -- it just fixes everything. I'm thinking about doing an only-beef 2023.

> I went on a lately popular but politically incorrect diet

How can a diet be "politically incorrect"? Did you go on a Nazi diet or something?

> I went on a lately popular but politically incorrect diet

Well, what was it?

Sounds kind you went went Carnivore. I've been doing the Carnivore diet for the past eight weeks tomorrow and I'm down 14 pounds despite not exercising and increasing my daily caloric intake to about 3500 calories. The change is remarkable. It makes so much sense to me now that obesity rates were about 2% a hundred years ago when nobody knew what a calorie was and ate all the butter and meat they liked but as soon as people been limiting fat in the 80s the obesity rate exploded culminating in today's over 40%: eating fat was never what made people fat.

The sad reality is that diets aren't a one size fits all solution. Different diets work for different folks. And before someone tries to be a smartass, I understand the calorie out > calorie in requirement; the whole point of finding the right diet is finding one that best helps you control your appetite.

I can attest to both the efficacy of a low-carbohydrate diet and the odd skepticism and judgement that follows it. It's as if some people have so strongly internalized "conventional wisdom" that when their own eyes undermine it, they react to the resulting cognitive dissonance with hostility. The evidence against the past 40 years of official nutrition advice now appears to be overwhelming, but there's still an ugly part of our psychology that wants to punish people socially for dissenting from the opinions of credentialed experts. We're in a strange moment in history when it pays to basically do the opposite of what conventionally credentialed people say --- in a variety of areas.

"Value Add" for food is insidious.

Imagine if medicines and medical procedures would contribute negatively to the GDP rather than positively.

I mean, they are there because something went wrong before, leading to the need for them.

By having them as a cost, the incentives to avoid them are put in place, so suddenly healthier foods and habits become more profitable.

The problem is that medicine should not be an industry, it should be a cost centre, and the more unhealthy something is the heavier it should be taxed in order to pay for that cost.

This is the same vibe as people telling me I don't need ADD/anxiety meds, I just need to toughen up and try harder.

If moderation and self-discipline work for you, that's great. They demonstrably aren't working for millions of people. If medicine can help fix this, there's no reason it shouldn't.

Okay -- what is your idea for how to get people to practice moderation and self-discipline?

I don't think anyone would disagree that these would be effective if they were accessible, but practically speaking, telling people that they need to do this doesn't work as a medical intervention.

And I would be surprised if there were obese people that were not aware of this already. The solution is "simple but not easy" and so is ineffective for the vast majority of obese individuals.

In the meantime, the article talks about concrete progress being made to reduce obesity along with it's associated health problems. It's all well and good to say that "it's your fault for being weak and undisciplined" but saying "and therefore you deserve to die" seems a bit extreme.

>You don't have to empty your plate, or you can get a to-go box.

>Protein and Fiber are good.

These are big. I'm from the American South, and you are taught to eat until you are full. We should be taught to eat until we are not hungry. Two different things.

Protein is highly satiating and every gram of protein in lieu of fat is a good thing. 4cal/gram vs 9cal/gram

Fiber is highly underdosed in American diet, leading to all sorts of issues over the long run

Don't forget habits. Breakfast before leaving for work (even if you aren't hungry), lunch at noon, and dinner when you get home. And the 2:30 pm snacks. And the morning coffee loaded up with cream and sugar.

One thing that I found works for me is to adjust some of these habits. So even though breakfast is still done at the same time, I adjusted it to be only unsweetened steel-cut oatmeal (7 minutes in the electric pressure cooker). That gives me 180 calories, or I can add a cup of frozen fruit which brings it to 230 calories. If I find that it doesn't hold me over till lunch, I'll add a pat of butter (about 70 calories I believe).

For lunch, when at home I switched to having very specific items rotate through, each one chosen for the calorie count and how much it fills me up. If at the office, and if part of a group lunch where I'm not as selective, I may choose those days to skip dinner (or have a very light dinner).

My biggest habit to break was to cut out a snack before going to bed (don't eat anything after 7:00 pm). But instead switch to herbal tea, or if I wanted to munch on something grab some hot peppers (gives my mouth some entertainment without calories) or a carrot or two.

I think the largest problem with obesity, honestly, is food labeling.

Every sentence on every piece of packaging for food is a targeted advertisement, and I don't think most people know that. Whole grain, stone ground, low-fat, etc. They all specifically, legally mean something, and have across the board been perverted to the point that an average consumer absolutely cannot understand what is sold that is actually okay to eat and what is not.

Hell, even when just tracking calories - look at the caloric content. Sitting on my desk is a package of pretzels. It says one serving is 28g, or about 17 pretzels.

It's 12 pretzels when actually weighed. That's 70% of what they list. Read that again; the actual weight of 28 grams is 12 pretzels, not 17.

How can we even hope to be able to understand what we're eating, when even basic facts are fucked beyond comprehension?

It's not that dieting doesn't work. It's that telling people to diet, as a medical intervention, doesn't work. The science of dieting is refined. The science of getting people to diet however has not been very fruitful. It's probably one of the least successful interventions in all of modern medicine, so we obviously need to do better.

The procedures and drugs the author discusses affect the regulatory mechanisms at the heart of the drive to eat. People on GLP-1 agonists eat less because they don't want to eat. People with bariatric surgery eat less because they don't want to eat. These procedures are effectively diets.

This simplistic model sounds nice but (and he notes this in the article) doesn't pass the test of explaining the dynamics of weight/gain loss in live humans. Lots of people have pet theories ("just eat meat" or whatever) but researchers who work on this stuff don't seem to think it's such a simple or settled question. I'm an unexceptional counterexample: Despite substantial variation in how I eat and exercise over the last 20 years or so, not disciplined at all, my weight has varied by less than 10%. Is there some secret thing I'm doing that protects me? I doubt it, I think there's just a lot of variation in how different people's bodies run that means some people's lives are a lot harder and there's no silver bullet.

>You can't create/add matter to your body from nothing

Sure you can, imagine two scenarios:

1. You eat 100 calories, and you have a 70 calorie deficit in your cells. 70 calories go to your cells to make ADP (this makes you feel full) and the extra 30 goes to fat.

2. You eat 100 calories of HFCS, it spikes your insulin and your body take 90 calories into fat FIRST and 10 calories into your cells to make ADP. You are still hungry because you have a 60 calorie deficit because your cells still lack ADP, you still feel tired and you got fatter.

It is fully possible to eat nothing but trash food that freaks your body out. The problem is for a lot of people we were though the wrong facts about nutrition, like "Fat is bad and (highly processed) carbs are good".

100% agree, however I do think we have to apply way more empathy cause losing weight is extremely hard and there are bigger factors that make it harder even if your fully educated and have good will power. Like time and money

I went from 250 to 200 then 200 to 170 pounds, first run I could afford the healthy alternative foods the second time I couldn't. It was 10x harder to lose the 30 pounds than the 50, not just cause higher body fat caused it to be easier to lose but cause the food filled me up. I couldn't afford to get the ideal ratio of protien or even really get about 90g of protein a day on my budget. I then had to be making all this food myself in order to have any filling meals, which took up the last bits of my free time as I was struggling to find contract work.

Of course you can make it yourself, but now you have to learn a bunch about nutrition and cooking, then also have the time to cook it. The super high calorie foods are exponentially cheaper, when you factor your time into it. Mcdoubles have a similar macro density if not better than a protein bar and are more filling. Before a price raise I could eat for 5 bucks in 10 minutes or eat for 1.5-2.5 be filled but lose 1-2hours research, gorceries, prep, and cooking. all of which is cheaper than giving up time you could be working or resting to work better.

I think the time and money to put to dieting is a luxury. I do agree we need to cut the BS excuses, but I do think that someone has a choice to be over weight if they only have a few hours to themselves opt to not spend those hours working but for their health and accept the consiquences. I think we need to focus on finding solutions for that person not the person with no drive to figure it out

> If dieting doesn't work, how come the procedure he's talking about is basically reducing the volume of his stomach? Sort of a "Forced" dieting if you will?

It's pretty simple actually. The forced reduction of stomach volume results in a different physiological response to eating moderate amounts.

You are mixing diet effectiveness (physics) and adherence. Let me give you an example.

I just had a giant mound of quinoa with a mix of sauteed vegetables and a little more raw olive oil. It met my calorie requirements, but was slightly low in ideal protein. (I've had the same meal with a chicken breast, with the same effect.) I've hit my calorie limit and I'm still hungry.

Sure, it's as simple of CICO, but if CICO with a high vegetable diet leaves me hungry for 14 hours a day to maintain my current weight, it's going to be incredibly hard to maintain adherence. (Let me tell you, it's awesome to wake up at 3AM and so hungry you can't get back to sleep. I will choose sleep over my calorie deficit every time.)

Diets don't work because they are hard to adhere to, even if you are not eating junk food.

Surgery and drugs definitely feel like a Plan C or D. There are subconscious and cultural aspects to food that those don't address.

For one thing, in a lot of cases, the worst food to eat is also the cheapest to buy and the easiest to prepare and the most profitable to market.

I think most people who are overweight or out of shape know it and also know how to start to fix it. But habits and carbs and sugars are a hell of a combo, and it almost requires an "event" (something beyond a simple "diagnosis") to get people motivated. And that doesn't even work universally.

Those patterns will only work if they also reduce calories though. The vast majority of people who are normal weight in the western world will have a mixed diet and their body is not 'going crazy'.

Blaming it on the person if you're in America is mostly wrong. HFCS and sugar is in literally everything. It's super expensive to buy healthy food. You have to drive everywhere so you don't get the exercise.

Can weight loss be done with food only? Sure. Is it affordable or attainable for the average american? Not really.

Anecdotal evidence, but no obese person I’ve ever talked to about this (including me) is unaware that changing their diet would lead to a reduction in their bodyweight. Smokers also know that not smoking would improve their health significantly. Drug addicts know that drugs are extremely dangerous. Nobody is questioning that obesity can be undone through dietary approaches, just as it’s possible to quit harmful relationships with tobacco and drugs cold-turkey. The problem with these approaches is that they just don’t work at the population level. Obesity is massively costly to society and a burden on individuals. Rejecting effective treatments because they’re not natural, or involve invasive surgery, doesn’t make any sense to me if it means adults who would otherwise live their entire adult lives in ill health would have longer, happier lives with much lower medical costs.

You are making unorthodox claims and are going to need a bit more citation here. I can also point to the Mediterranean diet that is moderately high in fats (olive oil) and carbs, yet was not considered a disaster.

Further, it's making unwarranted value judgements about surgery - it's essentially an appeal to nature.

Easiest thing to do is just make a rule for yourself that you will never eat anything that isn't beef.