But obviously, most people are a lot more interested in finding a magic food which does this rather than a proven calorie deficit, which is highly effective.
Purely behavioral lifestyle interventions have the lowest long term success rates of all available treatments for obesity. It's especially unreliable if you have weight loss targets higher than 15%.
They are of course still widely recommended due to numerous benefits other than weight loss, but "highly effective" is just wrong in the context of obesity treatments.
I seem to remember a meta analysis a decade ago or so finding that the particulars (high protein, atkins, paleo, whatever) didn't really matter so much as the the willingness and commitment to the change.
What? Surely changing one's behaviour - particularly the parts of behaviour that caused the obesity in the first place - is a sure way to stop being obese.
Behavioural changes work, the issue is that most people don't actually change their behaviour.
It's funny how proposing an healthy diet is unrealistic and watching fatties eat themselves to death is the new normal, complete value inversion and looser mentality
It's just that you should probably suggest other treatments in addition to the lifestyle changes that have relatively low long term efficacy.
Of course, that assumes your goal is to actually help the fatties instead of judging them.
I don't believe that's possible. They have to choose a healthier lifestyle by themselves.
It's not that people are fat because no one told them to eat healthy and exercise sometimes. They're fat because they have ignored that advice for a long time.
They aren't missing information about diet and exercise, they're missing diet and exercise.
I wonder what changed in between? Maybe our food and our relation to it? Who knows right?
You believe incorrectly.
> They're fat because they have ignored that advice for a long time.
Ah yes, the medical equivalent of "works on my machine".
You've now shifted from "how effective is this treatment" to "whose fault is it when the treatment doesn't work".
You will be able to help the fatties when you shift back into asking the question that matters.
But you are right with the fact that at the end, it mostly doesn't work. But those who stick with regime, it works 100% and positive changes in life, quality, happiness etc are massive.
The real solution - treat underlying mental issues. They are always there with obese people, they are massive (no pun intended), and they manifest as obesity, among plethora of other mental issues.
No. Even nearly a decade of intensive behavioral treatment has highly variable results.
Here's what the numbers tend to look like in practice:
~26% weighed more than at baseline
~23% lost >0% to <5%
~23% lost 5% to <10%
~16% lost 10% to <15%
~11% lost ≥15%
> positive changes in life, quality, happiness etc are massive
This is generally true. Eating better and exercising will improve your life.
But will you lose weight? How much weight? Those are far more difficult questions.
Again, we can not change other people. People can only change themselves.
We have.
https://news.ycombinator.com/item?id=49319339
> Body adapts significantly over time when subjected to weight loss.
> There are compensatory physiological adaptations that favor weight regain, such as changes in energy expenditure and appetite.
> Even with sustained effort, maintaining the initial weight loss may become progressively more difficult because of those changes.
> This shows up in research as results like mean weight loss of ~9% at year 1 and ~5% at year 8.
Mental issues is a broad category as well. Are food cravings a "mental issue", or a "physiological/hormonal issue"? No clear difference between those two, and given how GLP-1s quench cravings in general - not just food cravings, plenty of people on those report losing their compulsive behaviors, even such as gambling or shopping - the hormonal variant sounds quite plausible.
Which may be actually good. We are a lot better in treating hormonal issues than mental issues.
perhaps you can elaborate on how systemic death spirals are funny?
Running a marathon a month is a sure way to improve your health. However, less than 1% of people would be willing to do that. So it’s not an effective solution.
It’s an effective solution if we just ignore life, sure. But solutions are rooted in pragmatism.
If you opt for it, then yes of course, abstinence-only sex education is a sure way to stop ten pregnancy.
Similarly, if you opt to change your lifestyle and start living healthier, and follow through, it will work.
If someone tries to force you, of course it will fail (in both of these cases). There is no way to stop someone else from being fat. We can only change ourselves.
Being fit and maintaining the normal weight is not the same thing as reaching a BMI of 50 kg/m² then losing it. I've seen fitness influencers take up that challenge only to find that "changing oneself" is significantly harder than it used to be when they were fit.
If you change your lifestyle temporarily, the effects are temporary.
If you change your lifestyle permanently, the effects are permanent.
For the love of god or any other deity I can't grasp this, its trivial for me to muster a tiny fraction of discipline and simply change direction from now on. But people out there are vastly different than me, thats pretty obvious, ie many people detest sports or even sweating. Addictions, and over-eating is an addiction (or some form of stress-coping mechanism) have a way to grasp core of one's existence and not let go.
My wife sees such overweight folks with not-so-much-time-remaining-on-earth as GP regularly. As she says - they basically over-ate themselves into mental disorder (or started with it and their body over time aligned with behavior). To actually fix this, that mental disorder needs to be tackled, no gastric operations or wegovy injections provide permanent solution. But they sure make pharma companies richer and give this warm fuzzy feeling of achieving actually something visible, even if temporary.
Not quite.
If the lifestyle deteriorates, then weight regain is expected. However, people might regain only a fraction of the weight lost. It is possible for some of the weight loss to be permanent.
Also, even temporary changes in lifestyle can produce benefits that outlast the intervention, like lower risk of disease such as diabetes. Exercise is notable for providing numerous benefits that persist even if weight is completely unmodified.
> If you change your lifestyle permanently, the effects are permanent.
No. It improves your odds of success, but does not guarantee it.
Body adapts significantly over time when subjected to weight loss. There are compensatory physiological adaptations that favor weight regain, such as changes in energy expenditure and appetite. Even with sustained effort, maintaining the initial weight loss may become progressively more difficult because of those changes. This shows up in research as results like mean weight loss of ~9% at year 1 and ~5% at year 8.
It's the same thing for the mental issues epidemic... you can't build a completely hostile environment to human life and well being and then say "welp, I guess we need drugs to make you feel normal now", now they'll sell us the drug and the cure, and you'll be clapping and thanking them for saving you, truly amazing.
Henry VIII might have a word for you on that one, as would many other of history’s aristocrats. The only thing that’s really changed is the cost of food that used to be reserved for kings.
When I lived, in my childhood, in communistic Bulgaria/Czechoslovakia, nobody was starving. Yes, we did not have bananas and Argentinian steaks, but there was enough basic food, including the protein-rich one (eggs, cheese, even meat, although the best cuts were 'under the counter'). Still, few people were really obese; those were obviously sick.
Nowadays, there is plenty of junk food. The food is not really cheap (especially with the recent inflation), even the junk one. Still, being obese is (almost) the new normal. You can see that everywhere.
Yes, people spend more time indoors - but even in the old times people tended to spend a lot of time behind TV.
My hypothesis is that the junk food just does not have enough real nutrients, just mostly empty calories. So the body signals 'I need more nutrients', to which the typical response is 'here you have more empty calories'.
The quality and type of food also completely changed, you can't ignore that.
5% of supermarket aisles are food, the rest are treats and comfort food you should have less than once a week at best
The markets responding by promoting extremely cheap calories from industrial sugar sources rather than cane cut by hand by (relative to a machine or petrochemical processes extremely costly) slave labour is really just a natural consequence of capitalism feeding capitalists.
It’s not the food killing people, it’s the people selling the food that are killing people.
You’re right we didn’t evolve since the 80s. But our food has certainly changed. It’s not like some God from above put laziness in peoples brains just now. No… people were always lazy.
It’s just that you could be accidentally skinny before. You can’t be accidentally skinny now, it has to be intentional.
Many jobs used to involve physical labour, huge number of us now are desk jockeys. Decades of prioritising motorists and increasingly large vehicles over active transport mean walking, cycling are a fraction of what they used to be [0].
[0] e.g. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2010.... , https://la.streetsblog.org/2023/04/17/exactly-how-much-less-...
What really changed is the foodscape. And quite thoroughly so. Even basic agricultural products like wheat, corn or fruit are different from the variants 50+ years ago, there was a concerted effort to make them bigger, pesticide-resistant, more sweet, more energy-dense...
I remember the apples of the 1980s. Nowhere near as sweet as today, some were thoroughly sour. And these are considered the healthy choice now.
"The only solution is behavioural, everything else is cope."
This is like, your opinion, man. An opinion that can make you feel smug, but that is no victory. In practice, GLP-1s are doing what a generation of preachers like you could not - making people more thin and healthier.
In a sense, it is you who is coping hard and defending a "solution" which provably never worked on a population scale.
Alright, then let's continue making food worse and worse over the years, let's keep building a system that is less and less viable for humans. When we'll all be on GLP-1, + depression + ADHD drugs to just cope with days to day life maybe we'll finally wake up and ask ourselves how we ended in such a shit show.
If you really did something material to improve our food choice and food quality, I salute you. But this is rare enough for me to doubt it. Most people are content with wagging their fingers on strangers.
I've lost weight through forcing myself into a calorie deficit, and it works really well, but it's not particularly fun.
Sure but food doesn't have to equate to consume large quantities of junk food for it to be pleasurable.
We can learn to have a healthy meal with a reasonable portion that is as satisfying.
For the "eat to get slimmer" claim, I think we're at the point where "extraordinary claims require extraordinary proof."
What do you mean by "these foods"? Just buy unprocessed food and 99% of the problems disappear. There is no fake, no people trying to sell you these out of malicious intent. Just buy local food people had access to in 1900 and you'll cure all your problems.
It definitely is not "you can just go on a calorie deficit", that is how jo-jo effect works.
For average person that has children, full time job, and whole range of adult responsibilities it is hard. Not impossible but hard, this is why people are looking fo easier solutions.
I've lost weight and kept it off by making sure I don't have sweets and other types of food that I know I'll down in ten minutes. But if I don't have any on hand, I won't eat any.
Ditto for normal food: if I increase the portion of filling, low-calorie foods (think salads and other greens), with a lot of protein, I know I won't have cravings later in the day and feel full longer. But if I buy fatty sausage, with a hefty helping of salty cheese, I'll eat until I explode.
If when I'm hungry I have a choice between "a quick bite" of something very palatable, calorie-rich but nutritionally poor, and a "good" meal, I know I'll make the wrong choice. But if my only choice is the good meal, I'll eat that and stay on track.
This also has a positive feedback effect: after a while, not only did I stop craving various junk foods, but they actually don't register as food anymore when I see them in ads or similar. Which, of course, makes it easier to stick to the "diet". Now, when I'm hungry, I crave "actual" food. The other day I couldn't have lunch on time, and all I could think of was a fat bowl of lettuce with some roasted chicken breast and yogurt. Walking in front of the local McDonald's peddling their latest mystery burger didn't do anything to me.
Short term "diets" are nonsense. The solution is permanent lifestyle changes.
A good dietician is worth a few consults if you don’t have the will power to just fast. And as a bonus you don’t lose muscle mass as well because they’ll focus on keeping protein up.
Fasting is like using a nuke where a bullet would do.
How will a dietician measure your maintenance calories? How will they continuously update your macros and calories when your maintenance calorie change week to week?
I am making a claim here: most dietician will not be able to track your maintenance calories better than MacroCodex's algorithm.
Many dieticians simply rely on BMR/TDEE static formulas, and the limitation of this approach is that it cannot reliably track a user's actual maintenance calories well through the span of their dieting journey.
But changing lifestyle is virtually impossible for parents who also work, and have a bunch of issues here and there. Remaining the current lifestyle without dropping to a worse one is difficult enough.
Also this pic says it all, if everyone is so loved and beautiful why is everyone hopping on the ozempic train...?
How are you defining highly effective? In the sense that a body will definitely lose weight when starved? Or in the sense that counting calories is broadly effective as a weight loss strategy?
The former is painfully obvious and entirely unhelpful, and the latter is provably false.
Anyway what's cute about this is that this isn't novel phenomenon. There are lots of parallels to this in other fields where often effective solutions do exist, but at a system level don't seem to work.
Telling people to diet doesn't fix population level obesity. Telling people about personal financial management doesn't stop people from accruing too much high interest debt. Telling teenagers to stop idolizing instagram influences doesn't fix body anxiety issues. Telling people to stop smoking/drinking doesn't fix addictions. 3-2-1 data backups absolutely work but people lose files all the time.
"general population doesn't have the discipline for it" — only that this feels somewhat condescending.
Let's agree that counting macros or going for calorie deficit is hard if it is not someones job. General population has other jobs, family, social life, other hobbies they enjoy more than fitness. It is not "just eat less" it is "spend considerable amount of time thinking about and planning your eating".
If you turn things into individual discipline problems then surprise you get population level issues. As you pointed out people have other things to focus willpower on thats not this.
The fault, as it often does, lies in marketing. Turns out heavily marketed, hyper palatable food, designed to be minimally satiating so you maximally over eat is great for profits and terrible for obesity.
Nonsense. It doesn't take any more time. Just buy unprocessed, basic food, fruit and veg. When you open your cupboard, cook something tasty from what you have.
When you go to the supermarket, just don't walk into the aisles with snacks. Don't buy anything laden with sugar and fat.
Get into the habit of drinking black coffee instead of Starbucks' calorific drinks; it takes less than a week for your taste buds to adjust.
It's not rocket science. Just most people don't want to admit that every excess 100 calories they eat adds 11 grams of fat to their middle. Which adds up week by week, year by year.
Because for me it sounds like you might have awful lot of time to figure out your life.
In my previous and current post I am writing about an average person. I am pretty well off myself — what I was writing about I am far from dropping advice "just do X" on less fortunate. Because what is easy: "writing someone should do XYZ".
I have the problem that I absolutely abhor most fruit and veg and would rather not eat anything (which you can do for a couple of days at most). It's hard to get full on onions and sundried tomatoes.
But even with this kind of food, if I figure "sure, lemme have a sugary ice-cream", two hours later I'll be looking around the fridge and cupboards for some "quick bite".
Just don't buy this crap. I find it's much, much easier to have none at all than to hope to be "reasonable" and only eat a bit.
If your maintenance calories are 2700kcal and you eat 300kcal less than that, is eating 2400kcal starving for you?
Most people cannot tell a difference if they eat 100-150kcal less in a day.
>Or in the sense that counting calories is broadly effective as a weight loss strategy?
Yes, it is, and the reason people fail with it is not because calorie counting doesn't work, but because people's maintenance calorie estimates are often poor.
Deficit = maintenance calories (TDEE) - calorie intake
In this, even if your calorie tracking is on point, a deficit requires you to have a decent estimate of maintenance calories.
To throw a monkey wrench into all this, your maintenance calories often shift downward as you progress in your "diet" journey.
It's already factored in our algorihtm: https://macrocodex.app/knowledge/macrocodex/smart-calorie-bu...
I would have thought that it would mostly be because they can't resist that extra snack.
Or 'optimistically' underestimate the calories in the not pre-packaged food.
Serious question: Is there a significant variability in how the food calories are absorbed? Maybe different combinations are not absorbed equally efficiently (like with water/oil-based vitamins)
This is a pretty good inadvertent explanation for why a lot of people come into this discussion waving around morality arguments, lack of discipline, etc.
The average person gains a couple pounds a year. Adds up. How many calories do you think that is, amortized throughout the year? I'll help you with the math. It's 19. The average person eats 19 calories per day beyond maintenance.
It's not "weak willed slob cannot resist that extra snack."
I feel like discussions like this attract a number of people who've never actually been overweight and then lost the weight and tried to keep it off longer than a year. So much bro science, so much condescension, so much smug analysis that anybody who cannot resist their own body's hunger indefinitely are just weak.
A bit more complicated than that, CICO is not the answer. It's an observation, not a strategy.