my favorite part of ozempic is that it settled the debate on calorie reduction.
The latter was settled in a 2023 cohort study that showed doing is completely ineffective. [1]
There's been tons of data on this. The scientific consensus has been pretty clear for a hundred years, but nobody wanted to listen. Probably in part because there was no good solution before.
Maybe the debate amongst actual doctors and researchers. But, the debate amongst dummies on the internet (social media) CERTAINLY had people arguing that it was somehow about more than the number of calories in and out.
Edit: to be clear, this also applies to comment sections on HN :-)
So, I don't know. I guess I just wanted to chime in to note that I have seen people repeat this crap about calories.
If you missed the whole "calories in, calories out" debate, consider yourself lucky. The comment above isn't helpful, but there really was a period of time where the topic du jour among health influencers was debating that calories didn't explain weight gain or loss. It played into the popular idea that blame for the obesity epidemic rested squarely on the food industry and "chemicals" in our food.
At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.
The CICO debate was especially popular among influencers pushing their own diet. Debating CICO was a convenient gateway to selling people your special diet that supposedly avoids the "bad" calories and replaces them with "good" calories, making you lose weight.
For what it's worth CICO sucks because (1) nobody can stick to it, ever (2) humans are awful at estimating their calories in, studies show only 1/5 of people can properly estimate the calorie content of their food [1] and (3) your metabolism slows down in response to, specifically, caloric restriction diets and your hunger rises which makes it difficult to estimate your calories out without indirect calorimetry.
Yes, CICO works in a lab, and for some weird people. It's a matter of thermodynamics. However you are a far more complex system than a coal powered furnace. And yes certain types of food will be more or less satiating and may influence the amount of total calories you consume. It's really really hard to overeat if you just eat lean protein, for instance.
CICO is, in practice, a tool that is roughly impossible for most people to leverage to lose a meaningful amount of weight and keep it off.
Which brings us back to the difference between maintaining a persistent caloric deficit -- and instructing people to do so.
This is the critical one that leads people to correctly argue CICO is largely useless for attempting to lose weight: the "CO" part of that is highly variable and is not merely a matter of being active. The body has all sorts of mechanisms that it can adjust to achieve the amount of storage vs burning that it wants to do, regardless of the amount of food consumed or the activity level.
Put simply: starvation mode is a myth for everything but outliers that are uninteresting to discuss.
Full stop.
Even if your metabolism slows down in response to caloric restriction, it does not move the needle to any appreciable degree.
Because it takes energy to do. It just does, you cannot fool physics.
However, measuring calories is incredibly difficult. Both in and out. Also, if you put 5000 calories worth of food inside of you, but then immediately vomit out 4500 of those calories, you've only really consumed 500 calories. You can overwhelm the system.
If you can restrict yourself to consuming at a caloric deficit, you will lose weight.
That's difficult however. Because if you pick a target calorie amount, you will see less progress as you lose weight. Because of math. 1500 is half of 3000, but only a quarter of 2000. People get fixated on 2000, as if we operate based on 2000 calories a day. But if you were previously consuming 3000 calories a day, your weight requires 3000 calories a day. So when you drop to 1500, you are going to lose about a pound every two days for a while. When you get to about 2500 maintenance calories/day, you're going to slow down to a about pound every three days. This is not your metabolism "adjusting". You weigh less, it takes fewer calories to maintain that weight.
And you will be hungry. It will suck. And you have to be meticulous in your record keeping. There are no "free" calories.
And we're not even getting into the mental component of all of this. What's been termed as "food noise". And it's one of the things that people on Ozempic and the like notice the most, they stop thinking about food. And food addiction is one of the absolute worst addictions to have. Hands down. With just about every other addiction, abstinence is an option. Alcohol, gambling, heroin, cocaine, meth, etc, none of that is necessary to live. We need food. We need to eat. You cannot avoid food. You have to actually develop discipline. Teetotalers do not have discipline. They avoid the issue altogether.
So CICO works, but it's incredibly difficult to do for lots of reasons that are not related to the biology or physics of it.
It CICO is physics, not a complete instruction set for life. I dont understand why it makes people so angry.
This is like saying most people barely use 5lb dumbbells when told to work out, so working out must not work. Like, of course major lifestyle changes take willpower!
https://www.thecanadianencyclopedia.ca/en/article/rabbit-sta....
>At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.
The week after Thanksgiving, I had a heart attack (age 50). I was in the CICU for nearly a week before they let me go home. On the day I was released, they sent a nutritionist in to tell me that I shouldn't try to eat one meal a day, that I really needed to be eating 3 meals a day, and to eat bread at least for two of those (or other carbs). Don't eat butter, eat margarine though. Yadda yadda. This was what, 8 weeks ago? Not 1962 in any event.
Do you know what 1000 calories looks like spread across 3 meals? Or how long you have to run on a treadmill to make up 300 calories if you bump that up to 1300? Or that, even sitting in an office chair every day, I can't lose weight (of any significance) at caloric intake much above that? I'm willing to concede that any problems I'm having here are in my own head, that I can't change my behavior or habits or whatever (to literally save my own life), but this isn't the sort of problem that can be handled by any but the most godlike of willpowers (which I do not have, if that doesn't go without saying). Right now, I probably need to be eating just one meal every other day, as I'm not really gaining any weight back but I'm not losing much either. My meal, such as it is, is a salad that fits in a small bowl (less than 2 cups of lettuce and uncooked vegetables). None of this is helped by knowing that people who are so-called medical professionals are giving me is absolute horseshit.
The truth of the matter is that we are adapted to eat only once every few days, and for even that meal to be meager and less than appetizing. But we live in a world that has mastered abundance and flavor, and uses marketing science to constantly try to get us to to buy all that. When you tell people "just eat less", really you're just doing the r/fatpeoplehate but in a covert way where you don't have to feel like an asshole. We (all of us, sympathizers, haters, acceptance activists) turn this into a morality tale, and can't think about this rationally. For anyone that cares, I wear 33" jeans, but I probably need to drop another 20-25lbs realistically.
PS Just giggled thinking about what it would mean to the US economy if suddenly every adult over the age of 28 started eating one small meal every 2-3 days... even our stock market is arrayed against us.
Yup welcome to the bad genetics club. Those calculators of TDEE vs weight/height are only an approximation. Many such cases of people who fall well-below those estimates. Many people need far less food than commonly assumed.
PS Just giggled thinking about what it would mean to the US economy if suddenly every adult over the age of 28 started eating one small meal every 2-3 days... even our stock market is arrayed against us.
Not just from less consumption, but also reduced productivity--people being tired all the time, irritable, unable to work as effectively or unable to concentrate. This is why tech companies put so much emphasis on food and having cafeterias stocked with snacks or catering.
The whole debate seems like people violently agreeing with each other aside from some fringe idiots that dont believe in thermodynamics.
They're not.
If you account for that, a lot of the calculators make more sense, and a lot of people would be shocked at how little they should be eating.
"Reduce calories" is about as useful as "exercise more", "sit less", "drink less", etc, etc. All are obviously good, but for various reasons it can be hard for people to achieve them.
GLP-1's basically take the "how" out of the equation. Take this drug, eat less without fighting your own desires.
this is a case where more personal / colloquial / folk evidence was needed to convince people.
The amount of woo-woo “science” in laymen communities on the subject is utterly astounding considering the evidence directly in front of them. Check out the various subreddits for a casual glimpse - anyone saying stuff like “the primary method of action is eating less” is downvoted and the woo woo “metabolism” or “hormones” stuff is upvoted and celebrated.
In the end I think there is a lot of weird guilt around overeating I never really understood existed before. I lost 100lbs using Mounjaro but never once thought it was anything other than me eating too much and moving too little while I was obese. It’s just a lot of damn work and willpower for me to change that. Tirzepatide was simply a performance enhancing drug for my diet that finally put me over escape velocity to make lifestyle changes that so far have stuck for a couple years now.
Calories in / calories used is NOT a complete model because different foods can have different caloric retention. The most extreme example being corn that comes out entirely undigested. Further, shittier foods that the body craves most are also the least satiating over the longer term.
Reducing calories is three or four steps removed from the actual problem. Like arguing the problem is organ failure when in the first order problem is that you got shot. You have to deal with the wound; and you have to deal with the blood loss. That will, in turn, address the organ failure.
Really? Because GLP1s reduce hunger and food cravings, less of those means less eating, less eating means less calories. The drug just makes people involuntarily fast, it has no thermogenic of lipolysis abilities.