Why our waistlines expand in middle age: aging stem cells shift into overdrive
medicalxpress.com
medicalxpress.com
Single-cell RNA sequencing of APCs then identified a new committed preadipocyte population that is age enriched (CP-A), both in mice and humans. CP-As displayed high proliferation and differentiation capacities, both in vitro and in vivo.
It should read more like "aging triggers emergence of a specific stem cell type (APCs) which drives visceral fat expansion"
Let's say they "hit the nitro" (not turbo!) or "floor it" or "give it the beans"
I gained a good amount of weight since I had kids, went from a healthy weight of 210lbs at 6'1 to 240lbs at 45 years old.
I always worked out so I had good muscle mass but my diet was terrible, often consuming a pint of ice cream at night once the kids went to sleep.
I got on TRT and compound semaglutide and now I am 215lbs with abs and in the best shape of my life. I recently benched 405lbs at 46 years old. Prior to this I could do 2 pull ups if I was lucky I can rep 10 - 15 now. My stress levels are down, my blood pressure is in a healthy range for the first time in decades. I go to the gym 5 days a week, sometimes 6 and I love it. There are always solutions, we don't have to accept a slow decay.
for many people, it is not. you have enough free time, energy, and money to fix your weight issue - many people are missing at least one of these factors, oftentimes more.
there are more complicating factors here too - try telling someone taking lithium that gaining weight is a choice. or birth control, or SSRIs... the list goes on.
yeah, it's pretty easy for you - a middle aged wealthy guy - with enough free time to go to the gym 5-6 days a week - to maintain your weight. most people aren't in that situation.
There are exceptions but the vast majority of us can accomplish this, we just don't prioritize it. You get what you prioritize.
Survivorship bias is irrelevant
What other factors influence that outside of you making the choice to eat something?
I'm very lucky that the stars aligned, so I don't have to try at all. Really, zero effort.
Others have to try very, very hard every day of their life. They need to think about what they're eating constantly. Do you know when I think about what I'm eating? Never. I just eat whatever I want, whenever I want.
it's a lot easier to prioritize it when you have time, money, and energy. that's my whole point. you are in a position that enables you to manage your weight effectively. many people are not.
i personally know many people who struggle immensely, despite eating far less than me.
for me, it takes exactly 0 effort to remain thin. zero. i literally don't even think about it. other people count every single calorie they eat, exercise religiously, take weight loss medication, and still have trouble managing their weight.
but hunger is a primal thing - some people are far hungrier far more often than other people, for many reasons - and yes, it takes energy to resist hunger.
money and free time aren't required, no, but it definitely helps your odds.
I'm the same, but not because my bodies special. I can very easily gain weight and actually have really bad self control around food.. especially snacks
I pretty recently moved to the US and it infuriates me that so many stores only have 200g+ family-size packs of chips/crisps/whatever you call them.. I want them, but not a huge pack, so I just don't buy them. I know if I keep them at home I'll eat the whole bag in a day
I eat mostly nutritionally dense, unprocessed food because even though I hate cooking I found ways to bulk cook tasty meals and keep them in the fridge/freezer for when I'm lazy and would otherwise order shit
I have breakfast at 1-2pm.. which makes it really hard to overeat in such a short time window before bed. Not for any specific reason I just have coffee before then and it blunts my hunger
I don't think about it either.. but so many of my habits I've built up, if I look at it, make it really hard for me to get fat. I'm guessing you have similar things
"choices" are as much lifestyle design (whether you meant to do it or not) as they are pure willpower. They're all things in your control that can make it so you don't rely on just resisting hunger
>There are always solutions, we don't have to accept a slow decay.
I find it funny that you say there are always solutions when two of the solutions (or if you bristle at referring to them as solutions in themselves, certainly pieces of a solution) you mention have only really existed for the last twenty years. Semaglutide obviously was only approved by the FDA recently, but the first transdermal/non-injectable Testosterone (which I'm guessing is the form you're taking) replacement therapy was only approved in the late 90's. Most people today, even in developed countries, still can't afford Semaglutide.
I agree with your broader message that people shouldn't give up and should seek to leverage every resource available to them, but there's a faint whiff of moralizing in your comment that seems unearned when it's based upon the happy fortune of living in an era of medical marvels.
I'm on injectable testosterone, give myself a shot every week. Semaglutide (compounded not name brand) is relatively affordable. I spend $120 a month on it. If I did the work I could probably get it for cheaper.
Edit: I took a look, appears I can get it for ~$40 a month if I want.
Right now at age 32, I haven't been able to go to gym consistently mainly because work takes so much out of my life/time.
It takes about two weeks to adjust to the decrease in sleep, but the well-being that exercise provides in my experience more than offsets it.
You are taking an anabolic androgenic steroid. Of course it will help you have muscles and be in "better" shape that when you weren't taking it. Same with the GLP1 drug and weight. You are literally taking drugs to lower your weight and drugs improve your muscle mass. I'm glad you are happy with the way you look now, but setting the bar to "must take drugs to make your body look a specific way that most bodies do not / have not at 45+" is literally part of the problem (or transhumanist). But calling it a choice everyone can make (hundreds of dollars per month plus all the doctors / etc plus all the gym time) is a bit far fetched.
Humans do homeostasis very well. If you stop exercising at all ("rest days"), your brain normalizes that and creates inertia against resuming exercise. Like all good habits, the point is to make it automatic and the default rather than a choice.
Once you start exercising and make it a non-negotiable daily habit, it becomes progressively harder to stop exercising than to start. Most people that fall out of exercise habits do so primarily because of injuries rather than the failure of the habit itself. You just have to prioritize it ahead of or even alongside other habits (e.g. exercise while watching TV, take the stairs) until it becomes automatic.
We all have to make our own choices but obesity is a choice and the repercussions and treatments are often far worse than the treatments I have selected to avoid it.
Note: You can get glp1 medication for $40 a month if you look for it
I went from 220lbs to 160lbs with the help of a GLP-1, but then had to stop due to gallstones and pancreatitis. Now I'm on TRT (under the guidance of a physician) and trying hard to do low carb and high protein. So far so good. And energy level is much higher.
Obviously obesity and low T are both pretty bad from a quality of life perspective (if not life expectancy)
I inject myself once a week.
It’s positively affected every aspect of my life from work to family to personal satisfaction. At 45 i looked 50. At 46 I look 40.
What was it before TRT and what is it after?
I turned 50 about 6 months ago, I'm 6"2 and dont drink alcohol, dont drink soda, dont eat breakfast and do 45-60 mins of gym weights and cardio 4-5 days a week. I have never been an over eater or a non stop snacker, I do fast food maybe once or twice a week. I drink mostly water.
I just cannot seem to get my gut fat down. I swing from 93-96 kg for no real discernible reasons.
There is something else going on, in my teens till about 35/40 i have always been whip thin.
I dont think we have the answers yet.. so statements like "Gaining weight and keeping it is a choice." is just absurd.
Get on testosterone and the weight will fall off.
Your choice. Best of luck.
The point is that it's very easy to go too far in the opposite direction, from being overweight to being a gym addict.
No need to over complicate things
This is akin to me saying women on average are shorter than men and you retorting with "I know a tall woman"
Unibrow: Tajikistan Crossed eyes: ancient Mayan culture Teeth blackening: Ohaguro etc
Our modern globalized culture only gives us a tiny taste of what cultural diversity really is. That is because cultural diversity is actually erased by globalization - a process really begun by colonization, really the earliest form of globalization.
I'm going to confidently continue to find attractive what I find attractive and 95% of the world agrees with me. I celebrate the rise of the current global culture.
I’ll leave it to you to lament the end of foot binding and blackened teeth.
Please remember that your culture affects your idea of normal immensley. There are large periods of history where europeans considered being overweight attractive, where being extremely pale was attractive rather than tan etc. Some cultures have even more extreme versions of this (foot binding, neck lengthening rings etc). Those people probably thought that their idea of beuaty was "just a fact of life" too.
The fact is calories in and calories out.
Despite that, losing weight is not easy. It is not trivial or simple. It takes consistent hard work over many months.
Making wishy-washy excuses for some people does not solve the problem.
I wish I never read IIFYM when I was younger
Study after study has shown that people who claim to not be able to lose weight via diet simply do not have any idea how many calories they are actually eating.
What do you propose to do about that?
But the fact people over eat so readily is most likely down to the heavily refined food we eat that our hormones aren’t tuned to handle in my opinion.
I know I was miserable on CICO as Iw as constantly going through cycles of gaining then losing lbs. Whereas once I switched to a whole food diet I no longer even need to think about the calories I eat, I just eat when I’m hungry. And I don’t even crave the cookies and marshmallows at all
People overeat for a variety of extremely complex reasons. Mental health, stress, hormonal interactions. gut microbiome, dopamine deficiency, and on.
The assumption that forcing yourself to eat less is solving the root cause is not sound, in my opinion. If you look at GLP-1 inhibitors, those appear to be a much more root cause solution. Rather than solving over-consumption, they solve the propensity to over-consume, which then solves over-consumption.
What we really need to be looking at is why some people have a propensity to over-consume and why some don't. Why are some people destined to a life of constantly fighting food when others don't have to try at all and they stay thin?
Just intuitive, I know this is also the case for other substances like alcohol. I've never had to struggle with alcohol and I never will. I just drink whenever and never think about it. But for some people, it's a lifelong struggle. They have to constantly be thinking about alcohol, and every time it touches there lips it's a problem. Why? Is it genes? Our environment? Psychological support in childhood?
People get burned when measuring the “out” part because our bodies want to hold on to as much energy as possible.
But yes. CICO is and always has been absolutely true. People are just overly reductive in how they measure both sides, and then claim that CICO is garbage.
It’s ok to assume that you absorb 100% of what you eat, unless you see evidence to the contrary, and no corn kernel poop doesn’t count. Frequent diarrhea, weight loss, skin rash, and basically any symptom of vitamin or mineral deficiency.
That's not really true. If you've ever done the keto diet, you know that your body expels unburned ketones through your breath, sweat, and urine. Protein can be used to repair structures rather than burned or stored for energy.
There's also something called the "thermic effect of feeding". Your body requires more energy to process protein (20-30% of calories consumed) than it does carbs (5-10%) than it does fats (0-3%).
In other words, "calories out".
> It’s ok to assume that you absorb 100% of what you eat
Your gut absorbed it. That is literally what digestive absorption is about. Expelling ketones is not digestive malabsorption.
I don't think it's unreasonable to think that different bodies absorb food in different ways (or proportions), particularly given what we've seen about the gut microbiome
Apparently even just changing the time of food intake can affect obesity (in rats) if this study is to be believed: https://pubmed.ncbi.nlm.nih.gov/22608008/
In response to, "but those are rats", I think it's a lot easier to cast doubt on "100% of food is always absorbed" vs "I don't think that always holds true"
I mean, heck: if there are no residual calories in human waste, how can it burn?
About the rat thing: the cico hypothesis point of view might look at whether meal timing affecting energy expenditure first, rather than assuming meal timing change digestive absorption.
There is not much point in getting in the weeds about how much you absorb, unless you're running trials on yourself like changing when you eat, or what you eat, and leaving all other things equal like calorie intake and expenditure.
The best dieting strategies I've seen track calories in and weight change. From their you derive calorie expenditure, and it really doesn't matter if you burned it or pooped it out, does it?
https://www.latimes.com/science/story/2020-02-04/calorie-cou...
Being wrong about the number of calories in almonds doesn’t count as evidence that skinny people are skinny because they poop out undigested calories.
Also, I’m not saying digestive malabsorption is impossible, just that you shouldn’t assume it unless you have strong evidence to the contrary that doesn’t have another simpler explanation.
1. Log everything you eat each day.
2. Weigh yourself first thing the next morning, before eating.
3. Track the trend (did you gain, lose, or maintain?)
Over time, clear patterns emerge. You start to see exactly how your intake maps to weight changes, and you can fine-tune accordingly. It’s not guesswork, it’s feedback.
What surprised me most was how little food I actually needed. Even with regular strength training, a modest surplus was enough to support muscle growth.
(Hell, CICO isn't even valid for something as "simple" as an electric vehicle. My EV's end-to-end efficiency is quite a bit different depending on whether I'm charging from 120V or 240V, the outside temperature at charging time, the outside temperature at driving time, and a handful other factors like state-of-charge. The human body is even more complicated.)
The mechanism from article really does suck, but what does that have to do with CICO? While white adipose cells are created, it's still excess calories that fills those cells.
No, CICO IS the practical diet. Satiety, microbiome, none of that shit matters. All excuses to not properly stick to the diet. You weigh your food, calculate the macros, and that's it. Zero thought required past that.
It is literally impossible to not lose weight even if you are eating nothing but 500 calories of pure corn syrup every day (Though you may feel pretty sick)
So, I maintain that, yes, CICO works and calories + macros is the most important. But unless you control intake 100%, then the types of food you consume affect how much you eat, energy levels and compliance. This is especially true long term (over 5 years).
I like to compare it to programming. If you tell a C++ developer that their software should have good uptime, your advice here is the equivalent of saying "don't have memory leaks, null pointer dereferces or use-after-free". Yes, all true, but everyone know that. What we need are behaviour patterns like RAII, an extensive test suite, running those tests in valgrind/ASAN, etc. that actually help in a forward looking perspective achieve this goal of not making those mistakes which lead to poor performance.
If they can't have the discipline for CICO, why would you give them benefit of the doubt they have the discipline to "follow" the other methods? It makes no sense.
Adherence is way more important than getting pedantic about thermodynamics.
People can do intermittent fasting all they want, but if they're eating a stick of butter during feeding times, its worthless. Eating to satiety is useless as a marker because satiety is subjective.
Measuring your food does not give you an excuse to cheat, except the person simply choosing not to do it properly. There are no weird ways of getting around the fact that you have a maximum calorie limit, and thats it.
Of course satiety and gut microbiome matters.
I'm thin. Do you know what I do to maintain that? Fuck all. I eat what I want, when I want. Do I exercise? No.
Why is it that I don't have to try at all, but you do? Shouldn't you be a little curious, a little jealous? How cool would it be if you could maintain what you have now, but without any of the effort?
There's a lot of stuff I don't care about. I don't care about alcohol consumption either. I drink what I want, when I want. And it works out great for me. For others, that plunges them into a life of alcoholism and they die young of cirrhosis. Why? Why does it work that way? Why is it that I can do whatever but other people can't?
These are the questions we should be asking. You're solving the symptom, not the cause here. Eating too much is a symptom. The root cause is the propensity to overeat. I don't have that propensity, so guess what - I never have to try. But why don't I have it? Will I one day get it?
Related discussion: https://news.ycombinator.com/item?id=42376760
I lost 150 pounds in 2 years and all I did was eat less, and I kept it off easily. I'm not curious because I saw pictures of myself before I lost weight and I saw the plates of food in front of me and it was absolutely disgusting amounts of food.
I feel sick when I eat large amounts of food and I like to keep it that way, and all it needed was getting used to eating less.
Some people…
I don't have to try at all, you had to try a little, and some people have to try a lot. And that's why we're seeing a variety of experiences with obesity.
The difference is, I recognize there must be something about my genetics, or my way of life, or my upbringing, or whatever, that gives me such privilege. You, however, have zero humility, and simply believe yourself superior. I doubt it works that way.
I mean, I have plenty of other problems. I have no discipline, no self control. And I'm thin. So... it's more complicated then you give it credit.
I personally don't think that anyone without enough will power and discomfort tolerance to feel hungry for long periods of time when surrounded by limitless food should be forced to live a shorter more painful life.
The key to getting people to quit smoking is for them to stop smoking. Very simple. Why on earth do we have nicotine gum and patches?
Not the GP, but based on their abstinence-only sex comment I imagine the point being raised is that it's something that is technically true but not a practical guideline.
CICO is a true statement. But you're not going to be able to accurately measure CI and especially not CO. So why bother using that as your guideline on how to proceed? Instead it is known and understood that there are mechanisms for things such as improving CO efficiency, and it's much more practical to focus on that.
It doesn't though, at the end of the day there's an objective amount of CI and an objective amount of CO. Further, CO isn't just "activities", for instance you burn calories merely by existing. Things you're describing will impact CI and CO, but at the end of the day if one had the ability to fully and 100% accurately measure CI & CO it'd be apparent that the math works.
But this is why "it's just CICO" is at best a tricky phrase. Because the hard part is in the nuance you describe.
Math truth is not always good policy guidance.
It is true that CI==CO. It must. It is not true that telling someone that CI==CO is a good way to get them to manage their weight, because (as mentioned) it's hard to measure and (as I added) even if you measure correctly, you _reduce likelihood of compliance_ by ignoring appetite effects when you call all calories equal.
I think we agree, just trying to find the right words anyway.
A 5K run for 30m burns ~300-600 calories. A single serving of a candy bar is ~250 calories. You NEED to restrict the CI portion since its the easiest part of the equation to control.
The typical person who is maligning CICO because it doesn't explain why they're still fat, that person would do much better by better focusing on CICO and performing the all time best exercise for weight loss - the "table push away"
Meanwhile the typical strict advocate of CICO as the end all be all also needs to understand that there's a lot of nuance in both the CI and CO variables.
People who staunchly support CICO as the end all be all talking point miss what you describe. At the same time people who decry CICO as being bogus are missing what I describe. Both are true and both are wrong. It's really just a semantic argument.
Of course, greatly over-simplified models are still useful. CICO as a useful first approximation of a diet still has its uses and its places where it is more useful than some alternative models.
I think food calories and the way we talk about them (like food "contains" them, always burning them) feel a lot to me like the last bastion of Phlogiston Theory in any of the sciences. Chemistry has moved away from the "Calorie" as an approved unit of measure for the more accurate/more reliable "Joule", but also to remove some ties to old Phlogiston baggage.
I think most people would laugh at this idea pushed to its current Physics extreme that food should be measured in Joules by Relativity's infamous E = mc^2 mass-to-energy conversion ratio and that we should assume that the human body is some efficiency percentage of an ideal spherical fusion reactor. Joules In/Joules Out, right?. Why does it sound more accurate to so many as a model when it is "heat particles"/Calories?
(Which again, isn't a call to entirely toss the model, it serves many as a first approximation well enough. But it seems past time to develop better, more targeted models.)
* Or its proponents say it says
> As Clotaire Rapaille wrote in his terrific book, The Culture Code,
“Years ago, Tufts University invited me to lecture during a symposium on obesity.
Lecturer after lecturer offered solutions for America’s obesity problem, all of which revolved around education. Americans would be thinner if only they knew about good nutrition and the benefits of exercise, they told us. Slimming down the entire country was possible through an aggressive public awareness campaign.
When it was my turn to speak, I couldn’t help beginning with an observation.
“I think it is fascinating that the other speakers today have suggested that education is the answer to our country’s obesity problem,” I said. I slowly gestured around the room.
“If education is the answer, then why hasn’t it helped more of you?”
There were audible gasps in the auditorium when I said this, quite a few snickers, and five times as many sneers. Unsurprisingly, Tufts never invited me to lecture again.”