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> "what if the obesity epidemic has nothing to do with calories in vs calories out, and actually there is some toxin which the body has to sequester in subcutaneous fat and that's why everyone's getting obese"

Everyone loses weight on a caloric deficit. And "doubly labeled water" experiments show that people vastly underestimate how many calories they actually eat each day.

See this often cited paper: https://www.nejm.org/doi/full/10.1056/NEJM199212313272701

In a test of people who believed themselves to be diet resistant, every single subject lied about how much they ate when asked to self report.

> The failure of some obese subjects to lose weight while eating a diet they report as low in calories is due to an energy intake substantially higher than reported and an overestimation of physical activity, not to an abnormality in thermogenesis.

The actual Slime Mold Time Mold analysis is more nuanced than the previous characterization. Yes, you'll lose weight if you run a caloric deficit; the SMTM argument is that something is messing with what they call the "lipostat", which regulates how much your body thinks you should be eating. So when your body is yelling at you that you're starving (even though you aren't), it's very hard not to overeat, because hunger is right there at the bottom of the Maslow pyramid and it takes inordinate willpower to consistently ignore it.

http://achemicalhunger.com/

For some real life examples see the "Secret Eaters" TV series. When people claim that they gain weight despite not eating much they are lying or delusional.

https://en.wikipedia.org/wiki/Secret_Eaters?wprov=sfla1

I do understand that it can be challenging for many people to reduce their energy intake.

I've seen the show. There's so much denial. Even here at Hacker News, suggesting that fat people eat too much food gets you downvoted and flagged.

Thanks for the recommendation, I'm watching the first episode on YouTube: https://m.youtube.com/watch?v=bYJrC3RTtgQ

I think this means that obese people have something wrong where they are prevented from accurately gauging portion sizes. I’m not talking like they’re stupid. I’m talking like something is wrong with their bodies and the inner satiety mechanism is broken. Counting calories sounds insane to me as a thin person. I’m not counting the calories of a fucking croissant I had for breakfast today, I just know I really preferred a lighter lunch! And I don’t gain noticeable weight without giving a crap about it, just eating what my body says fulfills me keeps me at healthy weight.

In my opinion the fact ozempic, which has nothing to do with calorie consumption or calorie counting but instead is a hormone working on satiety, tells me somethings wrong with the hormones of fat people. And I wouldn’t begrudge a fat person they’re overeating any more than I would begrudge a hyperthyroidic person their thinness!

When asked to objectively measure their food and keep a log, fat people will lie about it, as revealed in "doubly labeled water" studies. Read the study I linked.

Yes, something is sick with fat people that’s causing them to do that. Anorexic people exaggerate how fat they are and how much (how little) they eat, and that’s clearly some kind of illness that needs medical intervention and medication as needed to get them proper. Same for fat people, I think fat people have something wrong with them where the whole process of eat food -> feel sated is off. If everything I ate felt like half the portion is actually was I’d also be totally fucked up in how I understood my portion sizes too and would probably inadvertently lie on “objective” measures too!

Like I don’t know how much a portion of chicken is. But damn if I ate a chicken leg, and I feel like I ate nothing, I’d be sorely tempted to argue I didn’t have a full portion of protein… because it doesn’t feel like I did, in my body. I think that’s what’s happening to fat people. Otherwise drugs like ozempic wouldn’t be working like they do— the fat person doesn’t become suddenly honest on some dumb journal and suddenly the pounds come off! They just actually feel full when they should like normal people for once so their bodies are getting to normal people sizes.

> I think fat people have something wrong with them where the whole process of eat food -> feel sated is off.

This isn't something that's wrong with fat people, it's something wrong with the food environment they're in. 75 years ago your idea would have some intrinsic plausibility, as only a very small number of people had obesity. Now, in the United States, we're at a point where ~40% of adults have obesity. The explanation almost certainly lies with changes in the food environment, instead of with a huge portion of people catching an unknown disease that causes them to not know how much they're eating.

That's because in fact we do know about changes to food environment that could cause this. Since roughly the 1970s we've switched to foods that are more calorie-dense and less nutritious because they have become cheaper to produce. The relative cost of soft drinks and other sugary goods has increased much less than the cost of fresh vegetables, and in fact the industry has higher profits on these foods. I bought two liters of sugary soda for $1 the other day, that's a common offer at a grocery store near me.

If you drill down to how this is being accomplished, you'll notice that the rates of corn and soy production per person have vastly increased over the last 50 years. That's not because people are eating more tofu (which would be healthy), it's because (a) they're both used as additives or sweeteners (corn syrup), and (b) they're used as feed for animals who get turned into cheap meat at fast food restaurants. The US heavily subsidizes these crops - in fact they make up close to half of US farm land. As a result, the same (genetic) individual would almost certainly experience a much worse food environment today than in 1960.

People who aren't affected by this are those who are either (a) genetically blessed, and would hardly gain weight in any environment, or (b) are socially blessed, in that they are wealthier, live in places with a strong culture of exercise, and/or have easy access to nutritious fresh vegetables.

> People who aren't affected by this are those who are either (a) genetically blessed, and would hardly gain weight in any environment, or (b) are socially blessed, in that they are wealthier, live in places with a strong culture of exercise, and/or have easy access to nutritious fresh vegetables.

or c) are disciplined enough to count their calories and stopping when they hit 2,000 kCal/day or so.

Yeah, that obviously works for a small number of people. I'm talking about the large scale demographic changes though - they're clearly the result of changes in food availability in one's environment. In an environment like that seen in most of America, the majority of people are going to be fat. You don't solve that problem by emphasizing personal responsibility, even if it can in theory work for some individuals.

> I’m not counting the calories of a fucking croissant I had for breakfast today

A croissant is very calorific

Hence the lighter lunch

True but also I don’t agree that he automatically chose a lighter lunch intuitively based on the croissant. A croissant is calorific but not filling

Just to be clear, I am trained as a physicist and I am not criticizing the thermodynamics as incorrect but rather insufficient.

It is also incorrect, which is to say that there is only a vague relationship between the kilocalories reported on the side of the box and the actual marginal energy absorbed into your body. This is due to multiple factors. The most basic is measurement methodology: “count up the carbs in grams and multiply by 4 because this one ancient paper claimed that was the right fudge factor to average all carbohydrates with”; then there is the reality that the carbs described as “dietary fiber” on the label should never have been counted in the first place; add to this that the fudge factor for protein is also 4 kcal/gr even though it is known that proteins require twice the energy input from your body to be metabolized. If you're a physicist you're hoping for very clean simple measurements, “we put this into a calorimeter and burned it, or maybe we let some bacteria rot the thing in a sealed jar and monitored the oxygen in there” or something. The nutrition facts are nothing of the sort! (Related: the scale llliiieeesss, it lies, liar liar pants on fire how it lies.)

However the bigger problem is that it is insufficient. For instance if you are worried about health outcomes, like diabetes risks, it turns out that calories in minus calories out doesn't predict those well. Both Omega-3 fats and trans fats are given the same fudge factor of 9 kcal/gr, but one is significantly less healthy than the other.

It's not even terribly helpful to understand the full context of weight gain. Did you know that before our species grew up in Africa, our ape ancestors actually grew up in Europe? During this process they lost the ability to make an enzyme called uricase, which helps most other mammals eliminate a waste product called uric acid from the body. The loss of this enzyme is usually chalked up to, “those apes needed to put on a lot of weight really fast at harvest time before the winter came up”—google «uricase evolution» to learn more. So we actually have a hardwired tendency which most mammals do not have, to consume fructose and not consciously register those kilocalories as satiety signal, and instead we pack on those kilocalories as fat because of our artificially high uric acid levels. Wild stuff.

The physics curriculum does touch on this but in a strange place: it's the courses where we teach kids to analyze circuits made with nonlinear components like op-amps and transistors. So there's the thermodynamic fact of calories in, calories out... but it also comes with a sales pitch which is trying to provide a simple answer that would work for a linear system, “just perturb this input a little bit and you will get the corresponding output.” But nonlinear systems don't work that way!

The thing about CICO is that it's not a very good scientific model for obesity because it says nothing about hunger or satiety, but tracking calories is useful for ordinary people looking to control their food intake, so it sticks around.

CICO doesn't have any opinion on the relative satiation offered by sugars vs proteins, or bread vs potatoes, but it turns one's diet into a marketplace for satiation, which does teach which foods are the best "value" per kcal (even if a kcal is itself very inaccurate).

Maybe we'll see it as a dated but situationally valid tool, like leeches or "Red sky at night, shepard's delight".

Yeah I am inclined to agree. The “calorie counting fad diet,” such as it is, is like other fad diets where it does have good short-term results, and it can have good long-term results for the people who really stick with it: as you say, you can get a sense for a healthier rhythm.

But remember this was a thread about a game where you think about these “K factors” that make us laugh at history, and imagining ourselves being laughed at and what sort of K-factor could that be. When I play this game, it's not really truthfinding, it's fun because it's kind of a constructive way to direct a conspiracy-theory impulse that wants to deny a mainstream view by latching on to all of these little details. By declaring myself as the sheeple up-front, the end place is always Socrates’ “well, at least I know that I don't know!”

In that vein, it is fun to think about SMTM’s thesis or, say, K=“obese people literally have a hormonal imbalance H which makes them feel like shit, and them feeling like shit is why they eat and don't exercise, and these people in the past just thought they would cure the problem by making obese people feel EVEN MORE like shit and the less it worked the more goofy shit they tried!”

It's not that this is something I know to be correct, it's not. But if this became the mainstream scientific view 100 years down the line, they would laugh at me trying to do a smoothie cleanse and drinking kale-ginger-cinnamon grossness, “they didn't know that they just needed more lycopene hahaha that green glass is the wrong color!!” and it's fun to imagine yourself as ridiculous. “Well shit, my conspiratorial instincts have generated an alternative explanation to my preferred one and I don't know what is true, haha, see me walking around like some smarty pants knowing nothing.”

"You know, if we starve people, they lose weight. Obviously it's just self control."

"Yeah. Weird. Well, guess I'll go have a donut or whatever and think it over. It's a mystery why they aren't just thin like us, must be a personal failing."

"Starving?" Hardly.

Point went right by you.

Most people do not count calories and calorie counts aren’t accurate anyway. The people sitting around counting calories because they have to are afflicted with the same thing that obese people are, they’re just putting in. A bunch of effort to manage it (or more likely actually aren’t).

The issue you are missing is that the real question is not “can we create a totally artificial situation where one of the outcomes is managed” but instead “why isn’t the system that manages this in healthy people working?”

In the counting calories example, it’s like saying the answer to diabetes is an insulin pump. People who d think this way are missing the point and basically are engaging in the shallowest of thought.

Mental health care is still in the dark ages and the medicine we have are mostly crappy. I just got off SSRIs - the most prescribed mental health medication. It messes with your whole body since serotonin has hundreds of different uses in the body. And we don’t know why it works! It’s basically bloodletting or eating the village healers herbs

Indeed, I've seen multiple people end up with their lives completely and utterly detailed, as well as wrecking their family and fiends (yours truly included) and a result of such prescriptions. I don't understand how this goes totally ignored by the public at large.

SSRIs and other anti-depression medication are a lottery. There often isn't a good rationale for picking one over another. Many people get great benefits; some people have to go through trying several drugs to get benefits; a few get dramatically bad side effects.

There’s genetic testing now that can help us avoid some of these problems.

Same here. SSRI -> different SSRI -> benzos -> antipsychotics. With some overlap.

Finally off of everything and it was fucking brutal. My life is a pale shadow of what it used to be. Relationships and finances burned to the ground.

Engaging with the mental healthcare system was one of the worst decisions of my life.

> A major theoretical discovery of K="computers can't do XYZ" would be another such thing for all of us who in the modern world chase these fads about computers reinventing finance or art or the modern economy. You'd have people in the year 2100 saying "can you believe only 75 years ago, everyone would just believe that computers were magically going to fix X and then they wouldn't and everyone would suddenly believe they would now fix Y and then they wouldn't and then Z and they wouldn't and and and... straight faced rationalist businesspeople acting like 'Tech-Jesus is coming' on August 1st, oh sorry it's September 1st, sorry -- October 1st? November? Maybe in the coming year? well SURELY this decade."

This might be a higher-level thing that you mean given that I'm not sure it's something "provable" or "disprovable", but I'm constantly amazed how incredulous people are that I don't expect any car to be fully self-driving (like in the sense that there wouldn't even need to be a steering wheel and someone without a license could ride in it alone) any time in the next few decades. To be clear, I'm not claiming that it's something that _definitely_ won't happen, but I don't think it's super likely, whereas the vast majority of people I share this opinion with (even people with similarly high levels of technical expertise) seem to think that it's almost a foregone conclusion that this will be solved within maybe 30 years.

Have you experienced any of the current driverless taxi services?

Personally i see the current limits to rollout as ones of hardware cost, but this is steadily declining.

There are only 3 cities in the entire US with generally available driverless taxis. All three of which are in sunny areas with generally no real inclement weather.

At this point, driverless taxis are more science fiction than reality for a supermajority of Americans, let alone the rest of the world.

Meanwhile up in Canada, I'm still struggling with the fact that google has completely mislabeled two of the streets that touch my corner lot, and invented a through street that has never existed on my neighbors property. All of this is information that I have submitted a correction to, as well as being available through our excellent public GIS system.

The existence of these sorts of ambiguities in the map, and in the real world means that driverless taxis will be doing exactly what the poor pizza guy does periodically and wandering down my dead end road thinking they are on a completely different street. Luckily the pizza guy has the ability to knock on my door and get directions, while a driverless car will just... turn on its flashers and block the road as far as I can tell.

When driverless cars can operate in Salt Lake City, a city that is incredibly tech friendly, low regulation, car centric, but with genuinely bad weather I will be impressed. In the meantime I would settle for more frequent bus service.

from people who work in those companies:

those cars could be in every city and they’d run great (except snow. snow is tough, rain not so much)

but why aren’t driverless cars there?

It’s been decided you want a perfect track record, as close to flawless - to appease regulation bodies.

regulation is what kills and regulation is the biggest fear. The cars and tech are always getting better, the ‘slowness’ is deliberate, the bet is on the future.

> It’s been decided you want a perfect track record, as close to flawless - to appease regulation bodies.

This is why I feel China will be the first to have unlimited self-driving. They would be able to treat self-driving cars the way that we treat trains: liability on the person hit by the train, so long as the train was functioning properly.

Maybe the Chinese self-driving cars will be programmed to kill any pedestrians they accidentally hit. Apparently it's cheaper that way.

https://slate.com/news-and-politics/2015/09/why-drivers-in-c...

According to the DOT over 70% of US roads are in areas that receive snowfall. (https://ops.fhwa.dot.gov/weather/weather_events/snow_ice.htm)

The inability to operate in conditions where people are most likely to not be able to use active transportation seems like a pretty major flaw.

People who work there will of course claim that. Maybe they should demonstrate it.

> All three of which are in sunny areas with generally no real inclement weather.

This isn't an accurate description of SF, but more importantly, the sun doesn't come out at night.

In terms of inclement weather for driving purposes, SF is more similar to Austin than say, Seattle.

My point wasn't that sunshine specifically helps, but that the complete lack of snow, ice and other roadway altering weather conditions is a serious asterisk that needs to be solved before this technology can be moved out of Beta for most of the US.

Self_driving cars seemingly can't handle snowy conditions. 70% of the roads in the US receive at least five inches of snow per year. (https://ops.fhwa.dot.gov/weather/weather_events/snow_ice.htm)

Yes they may not be ready for this decade, but the arguments against remind me of those that said nobody would ever have a computer in their home. Even some stupid connected lightbulb have more computing power than some of the machines at that time...

Don't trust anybody that believe they can predict the future.

>more or less based on the idea that bloodletting and rectal feeding and wound probing were medical "best practices" of the past and now seem so obviously ludicrous to us now

I often remind myself that the Australian aboriginal people, the previous members of what was once a fantastic civilisation, had a sense of anti-bacterial properties of plants and things, and often treated their frail and ill in interesting ways which we, 'modern' Europeans, misinterpreted as "primitive hysteria", because everyone know: 'miasma theory was real, whereas the primitives are just cooking themselves'.

So much life lost to those who always, always know best and never question themselves, really...

To go off on tangent, if slime mold theory were true it would be possible to cure obesity by just switching to healthy, non-processed foods. i tried this in my own weight loss journey, and way easier said than done. CICO means you can get fat with anything. Thank god for new weight loss drugs . It took a century to get to this point and a century to develop these drugs...go figure.

slime mold made most of his fat theory up and got shot down doing poor analysis. He’s a well meaning charlatan but a charlatan nonetheless.

skip his diet ideas. He’d tell you your baseball team lost because the humidity was too high when in actuality half the team is out sick with the flu. He ignores basic obvious reasons. Always a zebra when he thinks it’s never a horse…

Cancer treatment is progressing quite rapidly.

I like to think in 40 years or so that people will look back on radiation and chemo like bloodletting.

Chemo and radiation - at least 10-ish years ago - were pretty close to straight up killing yourself...

Nah, I do get thy people want to shift blame away from their failings to control food intake and mental weaknesses thats literally in front of them - I see it often in peers struggling and failing with some aspect of life, but obesity is fully self-inflicted.

As somebody currently used to mediterranean/french cuisine, and seeing what typical american eats and drinks, and how much, its definitely this. Plus idiotic car-first culture, compare it to how say Amsterdam looks like. And compare how local people on streets look like.

HFCS, hectoliters of sugary drinks, pizzas and other fast food in quantities beyond ridiculous. Obviously bad diet messes up your gut biome, which adds to bad stuff happening but is not the primary source. More stressful lives don't help but same applies.