Comment by starchild_3001 | Hacker News Reader

Comment by starchild_3001 | Hacker News Reader

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Diet and exercise are universally failed interventions to stop major diseases (CVD, cancer...). People who have a vested interest in them promote them (e.g. exercise specialists, keto experts, vegan gurus, your favorite TV Dr, harvard nutrition dept whose livelihood depends on the effectiveness of "optimal diet" etc), but the results in intervention trials have been extremely disappointing.

1) The best diet studies where people were asked to follow Mediterranean diet only managed to lower CVD and/or mortality by 10s of % points. This is a very poor outcome. At best adds a few years to someone's lifespan. At best. The average Mediterranean dieter fares a lot worse. https://pubmed.ncbi.nlm.nih.gov/26528631/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368053 Don't get me started about Keto, Vegan etc. Those have even less convincing evidence regarding hard outcomes (e.g. MACE, Cancer etc) though our opinion might change if they ever get tested in large scale.

2) Exercise is even worse. It has virtually zero effect on CVD outcomes, mortality outcomes in trials where participants were asked to change their behaviors. "Exercise did not reduce all-cause mortality and incident CVD in older adults or in people with chronic conditions, based on RCTs comprising ∼50,000 participants" https://scholar.google.com/scholar?cluster=10512580439138189...

It's a myth that diet and exercise will save you from Cancer or CVD. There's virtually zero evidence for that, when you look at things from intervention point of view -- intervention evidence is the only evidence acceptable in science. The rest is pseudo-science or proto-science.

Btw, I believe weight loss is the best thing you can do to live longer (that is if you're overweight or obese). But diets still universally fail. E.g. bariatric surgery probably works, maybe drugs will be shown to work (Tirzepatide/Semaglutide I'm looking at you). A publication on how 90% of obese dieters fail after 1-2 yrs on the same diet: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/

> Exercise is even worse. It has virtually zero effect on CVD outcomes, mortality outcomes in trials where participants were asked to change their behaviors.

This is simply not true and you jump through some curious hoops to make it look credible. The paragraph you cite basically says "if you start after 60 it's too late". Is then proceeds to add that a few weeks of exercise are not enough, and a few months of follow-up don't catch measurable differences.

But if you actually read the full study that you cite and check the papers it reviews, you'll see that multi-year interventions at middle age with multi-year follow-ups are extremely effective.

Here's one of the reviewed papers, with 6-year intervention and 30-year follow-up: https://www.thelancet.com/journals/landia/article/PIIS2213-8...

> During the 30-year follow-up, compared with control, the combined intervention group had a median delay in diabetes onset of 3·96 years (95% CI 1·25 to 6·67; p=0·0042), fewer cardiovascular disease events (hazard ratio 0·74, 95% CI 0·59–0·92; p=0·0060), a lower incidence of microvascular complications (0·65, 0·45–0·95; p=0·025), fewer cardiovascular disease deaths (0·67, 0·48–0·94; p=0·022), fewer all-cause deaths (0·74, 0·61–0·89; p=0·0015), and an average increase in life expectancy of 1·44 years (95% CI 0·20–2·68; p=0·023).

Healthcare Triage: "To the research!"

https://www.youtube.com/watch?v=hkO44tzkXyQ

https://www.youtube.com/watch?v=SFBBjynBpSw

tl;dw -- the relative risk reduction can be as high as 50%, and depending on risk factors, the absolute risk reduction can be 5%.

This is biased reading at its worst. I was simply stating what the authors concluded based on their analysis of 10-20 studies (not just one). This is what they say in the abstract: "The results show that exercise does not reduce all-cause mortality and incident CVD in older adults or in people with chronic conditions, based on RCTs comprising ∼50,000 participants."

One study with 500 people doesn't prove a point.

Of the top of my head I know at least one other study where mid-life lifestyle intervention didn't reduce mortality (it slightly increased it in a statistically non-significant manner). 21 yrs follow up. ~3000 people. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.0...

Diets don’t fail, people fail to follow diets. Which is probably fine in the long run, because they’re always there for people who want them. There’s probably never going to be a wonder drug for obesity though. But Anavar or Trenbolone would work better than Semaglutide, and the side effects likely aren’t that much worse (all of those options are still bad ideas).

> Diets don’t fail, people fail to follow diets.

That's like saying, "Exhortations to developers not to write bugs don't fail, programmers fail to follow exhortations." Guess what? Even the most skilled and well-intentioned programmers will write bugs, despite their best efforts; and lots of programmers simply won't put out their best efforts. If your goal is simply to find someone to blame, then sure, blame the developers. But if your goal is better software, exhortations not to write bugs are simply an ineffective intervention. You need to introduce other measures, like type systems, linters, static checkers, code reviews, and testing.

Similarly, if people consistently fail to follow diets, then the current crop of diets are an ineffective intervention. If your goal is to assign blame, then sure, you can stop there and feel good that you've found someone to blame. But if your goal is to actually make the situation better, then you need to find something else.

> That's like saying, "Exhortations to developers not to write bugs don't fail, programmers fail to follow exhortations."

It’s not even the littlest bit like that. Nobody knows how to write software without bugs. Everybody knows how to lose weight. Just do some exercise and eat less calories than you burn. You don’t even have to do the exercise part, but you should do at least a little bit if you’re trying to be healthy. The only problem is that most people don’t want to commit the effort or make the sacrifices required to do that. If anybody’s trying to find something to blame, it’s the legions of obese people desperately in search of any reason for their obesity other than their own lifestyle choices. It’s a lifestyle problem, and it’s unlikely that there will ever be a pharmaceutical intervention for it that doesn’t have pretty bad side effects. But if bad side effects are acceptable for you, then magic drugs already exist for obesity. Anabolic steroids. They’ll do exactly what you’re looking for.

> But diets still universally fail. E.g. bariatric surgery probably works, maybe drugs will be shown to work (Tirzepatide/Semaglutide I'm looking at you). A publication on how 90% of obese dieters fail after 1-2 yrs on the same diet:

This is not evidence that diets universally fail.

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