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Comment by paulpauper | Hacker News Reader

But most contestants regained a lot of weight and metabolisms slowed relative to bodyweight and stayed slow long after regaining weight. The adaptation explains why they regained weight so fast. It's incontrovertible that the show was a failure for the majority of the contestants. this also agrees with the high failure rates of diets overall and why formerly fat people regain so fast . Biology screws you over and has the final say. This is why it took so long to develop GLP-1 weight loss drugs and why they are such a big deal, by at last giving people a leg-up in this often losing battle against the body.

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FYI the show was not an incontrovertible failure for most contestants

> Six years after the competition, median weight loss in 14 of "The Biggest Loser" participants was 13%...

That means at least 7 of them lost 13%. That's pretty significant. On Ozempic, average weight loss is 11% after six months.

The show worked for the majority, and the difference between the people who it worked for and the people for whom it did not work is Physical Activity not Energy Intake. This is covered in the OP link and also in https://pubmed.ncbi.nlm.nih.gov/29086499/

Based on a Mayo Clinic article [1], it's possible that Ozempic affects ghrelin uptake [2].

[1] https://diet.mayoclinic.org/us/blog/2024/how-does-ozempic-af...

[2] https://en.wikipedia.org/wiki/Ghrelin

Tbf they were massively obsese so they "should" have lost like 30% of their body weight.

But yes, 13% is significant.

I don’t understand how this needs anything beyond surface level complexity… you have fat people who for show reasons were tightly controlled on exercise and food intake - which works for well understood reasons - then they took that away and left the people to their lifelong established habits.

Of course they regain the weight.

These people didn’t magically create mass from nothing. They ate too much for their activity. Done. Stop doing that if you don’t want to gain weight. Obviously easier said than done. But I’m sick of the idea that these poor souls are visited at night by globs of mass that force their way inside.

All these magic drugs are going to do is incentive bad food and bad habits. This isn’t good news.

Do you have first-hand experience with being overweight and/or losing a significant amount of weight?

I think you're vastly overestimating how much of this (particularly "calories out") is under voluntary control. We're discussing an article that showed that extra active calories burned tend to lead to a compensatory reduction in resting metabolism.

And there are some very strong psychological/physiological drives that influence "calories in" (read up on the Minnesota Starvation Experiment for examples).

yup. many of these people who are on weight loss drugs already tried dieting and it did not work.

“It did not work”… interesting choice of words.

It requires that complexity because a metric shit ton of scientific research shows that it is more complicated than that.

Permanent weight loss of more than ten pounds is nearly impossible from a scientific standpoint. The success rate after 5 years of weight loss is somewhere around 0.1%. You'd think that if it was as easy as everyone claims, more people would succeed. Heck, many people who have had gastric bypass surgery regain a significant amount of weight, even if their stomachs have been reduced to the size of a ping pong ball.

And yet I personally know several people who have dropped more than 10 pounds, and have kept it off (or even lost more) for more than 5 years. The statistical odds are meaningless on an individual basis. In most cases what it took was hitting some sort of low point and then making a major, permanent lifestyle change such as committing to a daily exercise program or quitting drinking (alcoholic drinks contain a lot of empty calories).

https://www.hubermanlab.com/episode/david-goggins-how-to-bui...

My weight floats in a range that's 40-50 pounds lighter today than I was a decade ago. It's because I eat less and move more.

Physically, weight-loss is utterly trivial. Literally everything that people say works, does. Eat less calories, eat less sugar, cut out snacking, cut out liquid calories, cut out processed food, reduce carbs, literally any and all of those work, choose whichever is most appealing to the individual.

The challenge to weight and diet in America is mental and cultural. Obese people remain obese because they have unhealthy relationships with food and eat addictively or emotionally, using food to soothe anxiety, depression, loneliness, disappointment, etc and because cultural norms and advertising have normalized obesity-causing diets.

Eat food. Not too much. Mostly plants.

Fully agree.

The science of body metabolism is hard. But the rules for weight loss are simple: move more, eat less. For some people it's just "Move more, eat the same".

"Eat less" means "less calories", volume can be the same - really helps.

PS chips are a crime against humanity

Not even that, if you change what you eat, you can have a dramatic effect as well. Try cutting out carbs and sugar as much as possible, results in two weeks.

Changing when you eat is a factor too.

I would suggest to be careful with cutting out things, this leads to bouncing back, like all dramatic changes.

I noticed that carbs such as bread or pasta really help with food satisfaction, unlike fat-intence or protein foods.

Remove sugar in secondary things: tea, coffee, soda. Understand the calorie count in carbs such as chips. East to the mild calorie deficit. Compensate with moderate excercise. And so on, setup new dietary habits one by one.

It doesn't have to be painful!

> It doesn't have to be painful!

Agreed; but it is work. And for a great many people, that is an issue.

As many other things in life it cab be seen as work.

My journey to effective body weight control was 10 years long. Misinformation is everywhere these days...

But... it doesn't have to be hard. For me gamification of the calorie couting game and step counting worked surprisingly well.

> Physically, weight-loss is utterly trivial. Literally everything that people say works, does.

You can't say this on HN, where weight loss is a myth and the only way out is to take a crazy life-altering medicine. Exercise? PFFT. I walked a flight of stairs once, and did not lose a single gram.

Do you have a citation on that 0.1%? I'd love to learn more.

The number one in a thousand is simply a ballpark figure that is frequently used in nutritional science. There are literally hundreds of papers, and not all of them are good (you should look at the parameters because many of them are quite lax), but here are a few examples easily found online.

https://www.sciencedirect.com/science/article/abs/pii/030646...

https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1098-1...

https://www.tandfonline.com/doi/abs/10.1080/07315724.1999.10...

https://europepmc.org/article/med/2663745

Perhaps you should read your own sources. From the abstract of the second study: "At the 3-year follow-up, 53% of the original sample (of 621 persons) maintained losses of 5% or more and 35% losses of 10% or more.". From the third study: "When successful weight maintenance was defined as maintaining a weight loss of 5% or 10% of initial (pre-treatment) body weight, 40% were maintaining a 5% weight loss at five years and 25% were maintaining a weight loss of 10% at 7 years." The other studies also don't back up your 0.1% estimate.

Your initial statement is completely misleading and shockingly you have provided hard evidence against it.

Perhaps you didn't read what I wrote. You really need to look at the parameters (as well as the data).

A 5% weight loss for a 200-pound person equals 10 pounds. Anyone can achieve this by following a fad diet for a week or two.

Here is what you wrote:

> Permanent weight loss of more than ten pounds is nearly impossible from a scientific standpoint. The success rate after 5 years of weight loss is somewhere around 0.1%.

Your sources indicate that your initial statement was wrong by a factor of ~100 at least.

If you deliberately misinterpret what I'm saying, I suppose I'm mistaken.

The majority of these studies consider a weight loss of 10 pounds over two years to be successful. If you start with 100 pounds or more, that is almost nothing.

Many of them consider anyone who starts at 300, loses 100, and gains 80 back in five years to be a huge success. Is it really?

In healthcare, an obese person is typically considered successful if they lose more than 30% of their body weight permanently. This is extremely unlikely to happen without surgery or medication.

Mate these studies are very clearly talking about percentages here, so they are directly comparable. You said 0.1% could lose 10 pounds over five years, the studies you cited mention 25-35% are able to do at least that after five years - the average man in the US is 200 pounds, and these are obese people, so the loss was actually higher than 10 pounds. Now you are changing the goal posts to 30%!

A good diet and exercise routine can have wonderful results, even in the long-term. The percentage of success in losing significant weight with those methods is far, far above 0.1%, and I think people should be aware of that.

I understand that you don't mean 10 pounds in a strict sense but even 20 pounds is an easily achievable and sustainable goal for fellow overweight 40-something HN readers.

It doesn't take more than restricted calorie intake and moderate excercise (walking, gym, etc). After a few cycles of gain/loss it becomes easier food consumption habits change

yup, the stomach gradually expands and the weight returns. Really hard to beat the body.

> They ate too much for their activity. Done. Stop doing that if you don’t want to gain weight.

So much science out here to disprove this kind of statement, yet you still make it.

Sure, blame the people. Fat shame all you want. Problem solved. Done.

It's so easy, just stop eating so much. As if fat people haven't heard that one a bilion times over. As if fat people havent tried time and time again.

Personal responsibility! you put that stuff in your mouth, rah! rah!

Personally I'm actually sick of people having no eye for the bigger picture, for many systemic reasons and larger society, and just blame stuff like this on individuals.

Too bad bootstrappers can't be barred from welfare. They can never dogfood their own philosophy when on the wrong side of it!

Thank you

But... Not eating works, though?

How are statements about reality fat shaming?

Why don’t poor people just work hard and become rich?

Alas, the laws of thermodynamics remain despite irrelevant comments.

Well, it is easy to hold people accountable for what they themselves put in their mouths no?

That being said, there is some issues with the prevelance of hyperprocessed unhealthy foods.

The fact that the most unhealthy options also tend to be the cheapest and easies, really do not help.

Easy, yes, but not exactly correct and certainly not helpful in the slightest.

For those contestants, weight loss was a full time job, and they had trainers and dieticians. How is that supposed to work for average people who have jobs and families or do not have a lot of willpower? Weight loss drugs can make it easier, which I am all for. Availing oneself of medical technology is not cheating; it's why the technology exists in the first place.

I agree that people should accept help if they need it, and should not feel ashamed for doing it, but having a strong willpower is a superpower that will help people in all aspects of their lives. I wonder if there are ways you can improve your willpower.

I wonder if there are ways you can improve your willpower.

stimulants

Welcome to weight loss discussion on HN, where any rational point like "eat less" or "calories in, calories out" gets downvoted and discussed to death.

Apparently for this crowd taking medicines is better than stopping stuffing yourself, because you know, if you take a medicine you can keep stuffing yourself.

Oh, and also "it's more complicated than that" is always a nice escape from the harsh reality of thermodynamics.

It gets downvoted because it's stupid and unhelpful.

If your body has the wrong idea of how much fat it should store, it'll do its best to force you to eat more to get that fat, even if it makes you unhealthily overweight. Medication can fix the body's idea of how much fat it should have.

Taking that medication doesn't mean you can keep stuffing yourself, it means you can finally _stop_ stuffing yourself, without your body incorrectly reporting that it's starving. The point of the medication is to make it possible to do the right thing.

> if you take a medicine you can keep stuffing yourself

That’s not at all how these new medicines work. You can’t (well, don’t) keep stuffing yourself on Wegovy (Ozempic) and Zepbound (Mounjaro), because you no longer spend all your time wanting to. These drugs work by switching off your desire to stuff yourself, not by allowing you to stuff yourself without weight gain. When you eat a big meal on these medicines, you feel satisfied and over-full, rather than like an addict who just got a partial hit and wants to ride it.

I take an immensely helpful SSRI for GAD, that no amount of mindfulness, therapy, or healthy living seemed to touch. I take a GLP-1 agonist for a food compulsion I’ve had for 25 years and couldn’t shake. I never got properly fat, but fighting a desire to EAT ALL THE FOOD no longer occupies 50% of my mental energy.

Have you ever come off nicotine? If so, you’ll know the little voice in your head that is continually telling you that you should have a cigarette for the first few days. You can’t shut it up. Hey, have a cigarette. You know what’s be good right now? A cigarette. Oh you just woke up? Have a cigarette. It fades eventually for nicotine. In my experience, and, in that of many/most fat people, you have that constantly for food, that food noise. GLP-1 agonists turn the food noise off.

> I take an immensely helpful SSRI

You and almost the rest of HN. I’m uninterested in users of a drug that alters your thinking telling me about other new drugs.

No offense of of course. My point is you are already conditioned that “pills solve problems”.

it gets downvoted because there are tons of research telling it's more complicated than that.

it's also a very poor point because it's presented as a solution without addressing the fact that it's really, really, really hard for people to eat less.

Lots of things are really hard.

We all know it’s easier to eat garbage than to exercise and eat healthy. We all know it’s more expensive. We all know it takes some degree of knowledge of what and when to eat.

That isn’t the point. It’s that HARD and UNKNOWN is not faultless.

The bad food habits are only going to get worse as meat+dairy is forcibly taken away from us by the powers that be.

Fewer options for an appealing 'proper meal', more temptation to eat sugar-laden junk.

I agree 100%. (though I don't think there are any particular "powers" at play)

The sentiment still stands though, all the cogs in play seem to spin to make real food inaccessible and expensive.

(by real I mean animal products and good produce) (raw milk is straight up illegal in Australia, most of the world would laugh at that)

====

Side note: Judging health questions off a game show is ridiculous

Ah, moralism.

As opposed to the immoralism that has been making us fatter and fatter?

> These people didn’t magically create mass from nothing. They ate too much for their activity. Done. Stop doing that if you don’t want to gain weight

Not true.

https://www.scientificamerican.com/article/science-reveals-w...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082693/

> discovered that certain Russian populations had large intestines that were about 57 centimeters longer on average than those of certain Polish populations. Because the final stages of nutrient absorption occur in the large intestine, a Russian eating the same amount of food as a Pole is likely to get more calories from it. People also vary in the particular enzymes they produce. By some measures, most adults do not produce the enzyme lactase, which is necessary to break down lactose sugars in milk. As a result, one man's high-calorie latte is another's low-calorie case of the runs.

> Call out: Germ-free mice can eat more and gain less weight than conventional mice

> "certain Russian populations"

Yes, of course. There are always outliers. But 50+% of the American population doesn't fall into this bucket, do they? Nor did they suddenly become that after they were born (i.e., obesity is a relatively new problem and not so much driven by DNA else why didn't it exist so much even just 50 yrs ago?).

We keep looking for all kinds of "answers" to obesity but we already have the one that works for most people most of the time:

Take in more calories than you burn, and those extra calories will become added weight.

That's it. It is *that* simple.

But people refuse to change their diet and/or lifestyle. In fact they're being told it's not their fault, as if someone else is responsible for what goes in their mouth and their sedentary lifestyles.

It might be that simple from a high level conceptual standpoint, but when the amount of calories you burn passively adjusts up or down as your body fights to maintain its weight, it is much more complex.

Agreed. But that's a weight *loss* issue.

The more basic "Why has there been a rise in obesity?" keeps being asked, and that's already answered.

The idea that people are falling asleep next to a pod and waking up with too much weight for some mysterious reason is a false narrative. It's not making anyone any more aware or any healthier.

I agree that would be a false narrative to some extent, but in this thread I don't see a better explanation. Just the idea that in e.g. parts of the USA they have been told it's impossible to control their weight, so they then go on to eat too much and exercise less than in other places and other times in history, doesn't make any sense to me as an explanation. Apologies if that's not what you're saying.

> The more basic "Why has there been a rise in obesity?" keeps being asked, and that's already answered.

to my knowledge, it has not. Researchers are still trying to understand why.

That's a different why. That a:

Why are people eating so many calories?

Why aren't people getting off the sofa and moving?

The actual "mechanic" of weight gain are well known. That's not up for debate. But for some reason, it is. And the gains keep on coming.

But what if consuming as low amount of calories as needed to be equal to or less than energy expended leaves you constantly feeling tired and with headaches and such from eating so little?

Is this not something that actually happens?

It seems like a spiral of doom. Eat less, so now I have even less energy for activity and thus now I am burning less energy, so I need to eat even less...

Sure. That sucks. But so does diabetes, strokes, heart attacks, and premature death.

The ultimate solution is prevention. But bring that up and you're accessed of being insensitive, fat shaming, etc. We've normalized the abnormal, and too few what to see that reversed.

Sigh. Exhibit A of lazy internet arguing.

The things you linked are completely irrelevant. First link: The calorie counts of food are wrong? Sure. Absolutely. No shock there. Treat them as rough estimates.

Second link: different people are different? Whoa. Wow. Oh man, mind blown.

What you naively describe as "not true", the universe itself would describe as bedrock reality.

Despite the bad scientism (i.e. coping) everyone hides behind, nothing changes the fact that if you burn more calories than you consume, you'll loose weight.

If you aren't loosing weight AND counting all of your calories, guess what: you've counted wrong. Dial them back more. Keep dialing back until results are achieved. The gym bros have truly found This One Weird Trick that works 100% of the time.

You just proved the point you want to disprove. Those that absorb more calories gain more weight, thus CICO.

The problem is, it still boils down to CICO due to thermodynamics. That means they're still eating too much given a certain amount of physical activity.

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