So give everyone GLP-1s to cast the shadow of personality responsibility (reduction in adverse reward center operations, broadly speaking) through better brain chemistry. Existence is hard, we can twiddle the wetware to make it less hard.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
> Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for type 2 diabetes and obesity treatment. Their effects on appetite and satiety are well established, but less is known about their associations with food purchases. Case reports and small observational studies suggest that GLP-1RA initiation is associated with altered preferences from highly processed, energy-dense products to minimally processed foods. We examined whether initiation of GLP-1RAs for treatment was associated with changes in nutritional quality and processing level of supermarket purchases.
> Changes in purchasing patterns after GLP-1RA initiation were seen across most nutrient categories. Opposed to comparisons, after the first prescription, participants purchased fewer calories, sugars, saturated fats, and carbohydrates, alongside modestly more protein. The share of ultraprocessed foods also decreased. Although modest at the individual level, these changes may accumulate at the population level, particularly given increasing GLP-1RA use.
This is incorrect, as demonstrated over and over again. For many people's bodies, consuming less will result in the body changing its metabolism to burn less, and not dipping into fat stores. Conversely, for many people's bodies, exercising more does not in fact change their metabolism and the amount of energy they burn. (There are studies that going from "zero" to "not zero" makes a meaningful difference, but "not zero" to "quite active" often doesn't.) "CICO" is not useful or actionable for many people.
The body has means to regulate it's energy expenditure to maintain homeostasis, and in some people it can be a hundreds of kcal difference. But if you're trying to lose body fat on a 10% estimated deficit and fail, the conclusion shouldn't be that a 20% deficit will also fail.
I'm not suggesting that it's impossible to lose weight through sufficiently large caloric restriction. I'm observing that it is not anywhere close to as simple as "CICO", because CO is heavily a function of CI, rather than the popular incorrect perception of CO being things like "exercise".
Calories in calories out is just the summation of expenditure and intake, just because the body is complex and there are many interdependent factors doesn't mean it cant be resolved to a vector which determines weight gain/loss. The problem is people google a tdee calculator, get some scalar which is likely wrong, perhaps substantially, make lifestyle changes, and then have an expectation of some result in a specific timeline that isn't realistic, and then eat a bunch of sodium, put on 2 lbs in their "deficit", and think the diet made them fatter! Or they read that -3500kcal == -1lb fat, calculate their calories burned from the machines at the gym, and get frustrated when it doesn't work (I'm guilty!).
Weight loss is actually really hard because it really just requires a sustained effort over a long period of time to achieve anything. You might not see any results for weeks as your body adjusts, you get your diet locked in, etc. And since your weight can vary so much day to day, it's hard to stay motivated. Ozempic kind of bypasses these problems. You know what else works? 20k steps a day and eating on a backpacker budget :P
The former is very well supported in the literature. The latter is only supported in low quality studies like where people self report their diet.
The CICO hypothesis accounts for metabolism. Your weight is a function of CICO and time. You can track calories in, weight, and time. From there you derive calories out.
The problem isn’t that CICO is wrong, the problem is that it turns out actual caloric restriction over time is really really hard.
The current best advice for weight loss is to avoid highly palatable and/or calorie dense foods, prefer foods that are highly satiating and low in calories, and strength training helps. Do whatever cardio you need for heart health; more cardio is at best unnecessary and at worst demotivating because extra effort will not net extra results. Slow and steady is easier to stick to.
One problem is that even though small deficits lead to more long term success, small deficits are very hard to track, and very hard to stick to.
When the size of your calorie deficit is two tablespoons of ranch dressing and a cookie per day, it’s easy to blow past it without even realizing.
CICO isn’t a diet strategy. By itself it won’t help you lose weight any more than kinematic equations help you to throw a ball.
But it’s not wrong.
That fallacy is "free will", which as we know doesn't exist at least in the way we think it does. Society's reckoning with the idea of free will as something fictional is on par with our upcoming intelligence reckoning, evolutionary reckoning and heliocentric reckoning.
"Science progresses one funeral at a time".
https://pmc.ncbi.nlm.nih.gov/articles/PMC12742762/
https://www.sciencedirect.com/science/article/pii/S003193842...
https://time.com/7340807/history-debate-insurance-glp-1s/
https://recursiveadaptation.com/p/the-growing-scientific-cas...
The consistency that I'm hearing from all across patient groups is gain of control, whereas previously, there was a loss of control… All of a sudden they're able to step back and say, 'oh, well I had this shopping phenomenon that was going on, gambling, addiction, or alcoholism, and all of a sudden, it just stopped,'
- Dr. Gitanjali Srivastava, Vanderbilt Medical Center