I hate to be that guy, but I do find all these debates about extremely expensive weight loss cures (Matt Yglesias has a recent article about getting [I forget which] surgery) kind of annoying, where there are literally money-saving ways to lose weight - and more importantly than that, improve your metabolic health (where obesity is a pot…
I hate to be that guy, but I do find all these debates about extremely expensive weight loss cures (Matt Yglesias has a recent article about getting [I forget which] surgery) kind of annoying, where there are literally money-saving ways to lose weight - and more importantly than that, improve your metabolic health (where obesity is a potential symptom).
"semaglutide comes heavily recommended with diet and exercise and many stern injunctions about that!"
I wonder what effect that heavily recommending things that cause weight loss alongside your weight loss drug does.... I also wonder "what" diet and exercise is being recommended, when there is so much (conventional wisdom) diet and exercise advice that will definitely not make you lose weight, or worse, make losing weight so unenjoyable that you don't want to do it.
Yes, and that's why just waving the magic totem labeled "do diet and exercise" doesn't work. Exercise done right doesn't make you lose weight, but you should still do it. Diet can, but most diet advice doesn't work, or works, but is too difficult to stick to - giving an out to the Puritans who lecture people for being insufficiently pious. And remember "work" isn't defined as "lose weight" it is "be healthier and less likely to have the bad health outcomes that are currently correlated with being overweight"
Yeah, my first year Behavioural Psych teacher had a great point when he said imagine a problem in the world (I picked AIDS). Then imagine a behavioural change that would 'cure' it. This idea was revitalised with Scot's post along the lines of technology is possible biology (behaviour change) is not (immutable).
>The same can be said about pregnancy and STDs ("Just don't have sex")
Terrible analogy. Not having sex works 100% (alright let's say 99.999% to account for urban legend-tier accidents) for STDs and pregnancy. It's not a problem of effectiveness, it's a problem of "people don't use it". If a medicine cures a disease, it's not a failure when people who decided to not take the medicine suffer from the disease.
"People don't use it" is very close to "the cure is more unpleasant than the disease", which is a failure of the cure.
Amputating one's hands is 100% effective against carpal tunnel syndrome, both as a cure and for prevention, but I wouldn't say it's not a failure of that treatment that people choose not to do it.
"eat less stuff" is a gold star way to lose weight except that people suck ass at it. I have succeeded in the past, but put back on 20 pounds from my ideal body and am failing currently; it's pretty damn hard. I don't know if that's what you mean by money-saving way to lose weight, but if it is then I think it's an incomplete solution--eat less stuff needs a very firm "how," and that seems to vary person-to-person
Why eating less is so difficult and why losing weight at all by any method is so difficult are questions at the very edges of current neuro- and metabolic research. Most of what we tell the obese is unhelpful.
The real reason it's so difficult is that eating too much has simply become too convenient, whereas not doing so apparently doesn't come natural for many people.
I can see it in my wife: when she had the mental strength to account for everything she ate, counting calories and adjusting her diet to get enough protein, she easily lost weight at exactly the expected rate. As soon as she stopped doing that she started to eat too much calories with too little nutritional value again, as those meals are way more convenient to make, more tastier for her and immediately rewarding for the brain (but don't actually make the hunger go away for long). Despite her noticing how a protein rich diet made her feel full for far longer, allowing her to eat only two meals a day easily, she can't maintain such a diet without dedicating substantial mental strength to it; and she can't properly limit her calories with a more convenient diet either.
The difference between her and me is that she absolutely can't tolerate hunger, like at all. Not eating breakfast when starting early into the day to achieve something is simply not an option for her. Neither is skipping meals when eating her usual diet.
I on the other hand would rather sleep in another 15 minutes than to get up early to find the time to eat something. I can easily skip two meals out of three without any issues for days. I feel hunger sometimes, but I can just ignore it for an hour or two, and then it goes away. For me its absolutely no issue to maintain a BMI of 22-23 without ever stepping on a scale, counting calories or diet adjustment. I just stop eating when it's too much. I also don't stuff in left-overs for the sake of finishing them, which makes my wife mad regularly. She just can't get off the idea that this means wasting food.
A drug that would make the feeling of hunger go away would certainly help. But the real message is: convenient diets are unhealthy. We should have more healthy food options which are convenient to consume. If eating healthy requires extra effort, a lot of people will fail to do so ...
And all of that is without even considering people who simply have to eat whatever is the cheapest option available ...
Sorry, but I'm a little miffed here. "Convenient diets are too easy" is certainly a contributing factor, but the rest of your comment reads like someone lecturing a person suffering from chronic pain.
"Well, *I* don't get sensations like my bones are splintering and turning into knives cutting my flesh, so an occasional aspirin handles things for me just fine! Why do *you* need strong pain-killers? Modern pharmaceuticals have made things way too convenient!"
You say you don't get hungry and can easily skip meals without noticing, or ignore any hunger you do feel. Yes, that means it's easier for you not to eat and to stay at a 'normal' weight.
Try imagining you *do* feel hungry. Not even that - do you get thirsty? Do you drink plenty of fluids during the day? Can you easily ignore being thirsty? The next time you are thirsty, try "no you can't have something to drink right now, you had a glass of water this morning, you have to wait a minimum of four hours before you can have your next glass - and only one!" and see how you hold out.
This is probably not how you intended it to sound, but your comment comes off as "my wife is so over-sensitive and has no grit, she can't handle a little bit of pain/hunger, she just needs to toughen up - me, I could have my hand chopped off and not even notice, *that's* normal!" - see what I mean about the comparison to chronic pain?
You took my post in exactly the opposite way it was meant. I'm not saying that anyone would be at fault in the way you construed it. Quite the opposite. I was saying that the individual experience of hunger was very different; as is btw. the individual experience of pain.
This makes it extremely difficult for my wife to maintain her weight while consuming exactly the same kind of diet which I eat. Where she needs willpower not to eat something, I just need lazyness to prepare food. While she had to adjust her diet to lose weight to a high protein one, I can live as a skinny fat on a low protein diet just fine without any effort (and then still suffer from much of the issues such a bad diet entails). None of this is my achievement or her failure. It's just a simple fact.
I'm sorry if it came off differently. But I feel as if you were reading my comment almost in bad faith here. How would it even be my wife's fault that she experiences hunger far more severely than I do? And how would it be an achievement of mine that my body reacts far more charitably to not getting any food for an extended period of time? Neither of us chose our bodies or our body experiences. And nowhere did I blame her for her way of experiencing it.
I then proceeded to say that the reason this difference leads to that much obesity is that high calorie diets with low nutritional value are much easier to purchase and consume nowadays than diets which are well balanced. My wife, when trying to lose weight, had to go to great lengths to get all the nutrients she needed, while going cal negative for an extended period of time. IMO this is something we as a society could and should address.
Here again I'm under the impression that you are reading my comment in bad faith, as your example with pain killers works exactly the opposite to what I said. So your comparison doesn't even make sense and IMO only serves to discredit my thought.
And to answer your similar bad faith attempt at thirst: yes, I also experience thirst way less severely than my wife. Again: this isn't her fault or my achievement, it's just a plain fact.
Btw.: I am a chronic pain patient, having shattered my left hip a few years ago. I don't have a single day in my life without pain. And I don't use any medication for it (though I had doctors call me out for it, claiming stupidly that no one should ever need to experience any pain at all). Yet I never told anyone that therefor they shouldn't need any either. That would be simply plain stupid. I did need quite a lot of those the day I shattered my hip ...
No worries. It's phrases like "a little too convenient" which, if you've had a lifetime's worth of advice about "don't be fat", sound like the same old "just have some WILLPOWER" scolding.
"Eating too much has simply become too convenient" may indeed be true, but there is the whiff of moral judgement about it. If only you, fat tub of lard, would bother to go out and shop for HEALTHY FOODS LIKE VEGETABLES and then put some effort into COOKING A PROPER MEAL, then you wouldn't over-eat and what you ate would be PROPER FOOD. But instead you are too lazy and greedy and want FAST, CONVENIENT, NO-EFFORT CALORIES.
You know, the popular imagery when you search for "overweight" or "obesity":
You know your own home situation better. Is your wife sitting on the couch in front of the TV, cigarette in one hand, bowl of candy on her lap, and sugary soda in the other hand? Does she never cook and eat vegetables?
Or maybe she does that, but still has trouble controlling cravings and habits.
Most of my life, I had no easy access to those sugary snacks or fast food. I grew up eating those healthy veggies and home-cooked meals. And I was a fat kid, a fat teenager, a fat young adult.
"Convenience" is a label that covers a multitude, including accusations, which is why I react badly to it ('you're too LAZY to cook healthy meals!')
I was specifically talking about the convenience of accessing foods with lots of calories but a lack of protein, not about the easy of access to foods in general.
We noticed this when my wife was actively losing weight. Whenever we were searching food on the go, it was essentially impossible for her to get something which would provide her with enough protein, but not add too many calories. She always had to prepare special meals for herself instead of being able to just eat whatever was available. You can do this for some time, but you can't do this all the time. Which is why she did gain everything back pretty quickly once she lacked the time to painfully account for everything she consumed and to plan ahead everything she consumed for several days.
I'm fully aware that I'm not living healthier than her, as we both eat the same things most of the time. I just have it easier than her to stop at the right amount of calories to maintain my weight. That's all ...
I didn't find that your comment at all had that tone, FWIW. Like, it didn't even occur to me to interpret it as dismissive, and I was surprised to see Deiseach reply like that.
A little surprised. It's Deiseach, after all... (Kidding, kidding!)
I too get a bit pissed, sometimes, when people say something is too easy or too convenient or too pleasurable(†) — that's the point of life, as far as I'm concerned: ease and pleasure, mmm! — but in context I thought you clearly meant "too convenient [to easily resist / go with an alternative]", and not any sort of value judgment.
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(†) all that said, I totally disagree with your characterization of the doctor's remark! IMO no one *should* ever need experience pain — both in the sense that there's no moral reason, and in the sense that painkillers are great, heh.
Pain has a very useful function though. It's essentially a stop sign issued by your body meant for you to make adjustments to whatever it is you are doing.
Would I like the pain to go away? Of course I'd like that. But would I want to sacrifice the utility it has? Hell no ...
My pain levels are a clear indicator on how well I've done in the past days to regenerate on (replacement) cartilage. They are a clear reminder to train my joints properly and regularly; and to go slowly when my hip joint is fragile ...
I sort of get the convenience complaint, but sort of don’t. I think it is mostly just about the raw hedons. A cucumber is pretty good and super convenient, and you can just eat it like an apple.
But people will make a sandwich or cook something in the microwave instead because that food simply tastes better.
I just don’t think convenience is as much of an issue compared to accessibility and the overlap between caloric density and tastiness. Sugar tastes great.
Maybe I phrased it wrong, but I was trying to convey the convenience of foods actually filling you such that you no longer have any cravings.
My wife eats lots of cucumber btw. ;-), but I wouldn't call them a meal. I could eat ten of them and still be hungry. They might help with alleviating thirst though ;-)
I'd consider accessibility the main part of the convenience btw. A major issue, while trying to lose some weight, for my wife was finding something suitable to eat when not eating at home and not having brought our own food along.
No, I totally agree with you and not with Martin Blank. Convenience is the #1 issue for me; if there was anywhere around me that offered quick healthy meals, I'd go there. I don't care too much about how food tastes; I just hate fucking around with it. I end up with fast food mostly because I don't want to take >15min on a meal.
Of course, I'm not obese, so maybe my anecdata doesn't apply to the point Martin was trying to make; but still, I'd certainly be eating *healthier* if it was more convenient, and the same goes for people I know who *are* overweight, I think.
Ah, somebody else who hates fucking around with food! Me too. I hate shopping for it, I hate unloading it and storing it, I hate cooking it and I hate cleaning up the mess that cooking makes. I cannot believe how much time per day other people spend on food prep and related labor. I don't look down on them, just have a hard time understanding why it's worth it to them. Like you, I don't care that much how food tastes. So long as it tastes decent I'm fine with it. I just try to find reasonably healthy things that require little prep, like 5 mins. in the microwave, or can be eaten as is. Fruit, bags of nuts, bags of peeled carrots, Trader Joe's frozen pot stickers . . .
I can buy dried fruit without added sugar at shop. That sounds like a combination of "healthy" and "fast food". But it would be better if I could also buy *vegetables* like that. (And preferably, not too expensive.)
Dried fruit can be hard on my blood sugar. My tolerance for it varies, but it would be a bad idea for me to use it as a staple. It's not health food for me.
Your wife's (and yours!) experience is totally normal. Most people cannot (and shouldn't) abide hunger, and that is a huge part of why normal "eat 20% less calories" diets don't work, even for people (like her) who have the capacity to measure it. Eating 20% less at 3 meals is also far more difficult (and will result in those leftovers) than eating less in discrete chunks by eliminating meals. Obesity (or lack of it) does not come from
But yeah, if you feel HUNGRY, a "diet" isn't gonna work, period. No one can manage long term hunger in a world that has so many easy things to eat.
Not to be internet nutritionist, but the the thing that everyone I've spoken to has worked (for varying quantities of "worked") for is adding replacing carbs with fat/protein (eat as much as you want for dinner, earlier is better) and then just extending the time period until you eat next (breakfast, or lunch, or later lunch, etc...) til whenever you feel hungry. If you feel "kinda" hungry, drink a zero-cal electrolyte drink first and then check if you still wanna eat a meal. Measuring whether you ate 1741 calories or 1787 calories is impossible.
And also, I just want to reiterate: obesity is a symptom of underlying nutritional condition, not a disease. Some people who have it are fat, some are not. It has bad effects even if you aren't fat. Semiglutides (being diabetes treatments) may somewhat treat the underlying thing (I don't know for sure) but if you adopt a diet that you enjoy, and your A1c and other metabolic indicators get better, you are HEALTHIER, and much lower risk for a long laundry list of bad outcomes even if you don't lose any weight, or never had much fat in the first place. Depending on *what/when* you eat, you (with your low BMI) might have less healthy A1c/etc... than your wife, with the potential bad outcomes. This entire thread is far too focused on treating the symptom of obesity and pretending that if we removed that, we'd fix the problem. (it is possible that semiglutides DO partially treat the underlying problem) There are too many skinny 60 year olds who die of things and we go "so sad, what bad luck, they were so healthy!" but if they were fat we'd go "oh man, if only he'd kept in shape" but they died of the same thing for the same reasons.
Well, those diets actually do work. Physics can't be cheated. That's a big part of the problem. Because it puts so much guilt onto people to whom it doesn't come naturally. The problem is that hardly anyone can put up with them for long enough to get into another mindset, where those changes suddenly come naturally.
Btw.: my wife never felt hungry during her time of losing weight, simply because she did ensure to always consume enough protein. The problem is that most foods which are easily available don't come with enough protein to do that. Just eating less doesn't cut it most of the time, as your diet then quickly become protein deficient. You have to adjust your food items a lot to do it. And then convenience goes out the window. That's what made my wife fail eventually as well after nearly making it into perfect BMI territory.
As for "Some people who have it are fat, some are not.": that's exactly what the term skinny fat refers to.
Just for the record: I never pressured my wife into doing any of this and love her just the way she is. I'm merely trying to recount her experience when she tried a few yours ago.
Well, depends what we define as "work." I am defining "work" as "reduce unhealthy outcomes," not necessarily as "lose weight."
"Btw.: my wife never felt hungry during her time of losing weight, simply because she did ensure to always consume enough protein. The problem is that most foods which are easily available don't come with enough protein to do that. Just eating less doesn't cut it most of the time, as your diet then quickly become protein deficient. You have to adjust your food items a lot to do it. And then convenience goes out the window. "
Your wife (and you) are doing great, and what you're saying makes great sense: my only suggestion to you specifically is that while protein is great, the only way to really beat back hunger long term is fat. I guess my other recommendation is to get yearly blood work, and look at those numbers instead of the scale. If your wife is eating healthy and exercising and her numbers look good, extra pounds (which absolutely are going to get harder to keep off as we all get older) can be ignored. I don't want to read into people's thoughts but you are absolutely right about the guilt, and for me at least, having good lab numbers (which are more important than BMI) trumps (and should) what the scale says.
"As for "Some people who have it are fat, some are not.": that's exactly what the term skinny fat refers to."
Yes! It's a great term, especially since it emphasizes that we've mentally replaced the word "unhealthy" with "fat".
I agree about the "lab numbers" > "BMI". My wife was only trying because her parents and her sister really struggle hard with obesity, and their lab numbers have become alarming because of it. Prevention is better than trying to deal with the issues later. We both want to grow old ;-)
That is the same motivation my wife and I have. :) I only mention it because there are times, especially for people like us who are.... on that process of growing older already... when you can do all the Right things with regard to health, diet and exercise, and see good lab numbers but still have "bad" weight/BMI numbers or visible fat, and to not worry as much about that.
This seems an extremely weakminded and degenerate statement to make. Hunger is a natural and healthy state we evolved to cope with. Certainly you SHOULD abide hunger if you are an unhealthy weight
That's fine, and I heartily endorse confronting yourself with things like hunger and overcoming them for all kinds of personal reasons, but within the context of "having a goal of reducing bad health outcomes for hundreds of millions of people with a policy to do every day" then adding a cost (suffering hunger) is something that will detract from that goal.
If hunger (there is also some definition difference here, most Americans have no idea what "hunger" actually is, and use the term to describe the blood sugar low of "it is 4:30 and my tummy says it is time to eat dinner" that is fundamentally not "my body is suffering from lack of vital nutrients and is sending a signal to my brain to acquire sustenance" that comes from different, more extreme situations) were necessary (or the most effective) to become healthier, then I'd agree with you. But it's not. If you eat satiating things for dinner, you won't be "hungry" as soon, making it easier to extend that period. Also, the "hunger" is a real sensation, and if you are feeling hunger, your body is too, and will be doing things (reducing metabolic activity and temperature output) in response to it. For our goals in this case, you want your body to not feel hunger too.
It's not a moral judgement, it's a changing the gear ratio on a machine to reduce friction.
Ok, I agree there. I thought you meant we couldn't abide it for moral reasons, which struck me as decadent/degenerate path to take.
Ultimately this doesn't seem all that dissimilar from antidepressants - one one level it probably is possible for many otherwise medicalized people to bootstrap themselves out of depression as well as obesity by personal fortitude, but pharmacological assistance might just lead to the best public health outcome in aggregate.
Pharmaceutical interventions can really help start the bootstrapping, too - A lot of the ruts one can get stuck in are very stable without chemical intervention, but comparatively easy to stay out of once you get out, so taking drugs to get out of the rut doesn't necessarily mean you'll need to keep taking drugs to stay out of it. (though doctors may just keep re-issuing scripts regardless....)
What about, like, peanuts, though? Peanuts are convenient, nutritious, and filling, but eating lots and lots of peanuts isn't very palatable. I don't think we can blame this on convenience, except insofar as convenience is one of several competing, difficult things we're trying to simultaneously optimize for.
Well, good point. What about peanuts? Answer: they are one nutrient, not a meal, and thus lack lots of crucial trace elements. To add insult to injury, opposed to what you said, they aren't convenient at all. Not only don't they solve the issue at hand, but additionally where I live they aren't really readily available. I can easily get french fries, burgers and various other fast food meals on the go. I've never seen peanuts on offer (for obvious reasons). I could go into a super market and buy some; but then again I still wouldn't have a meal, and rather just one ingredient for a meal.
That's the exact opposite of convenient. Rather hard to come by and still lacking all but one ingredients for a meal I still would have to prepare. As opposed to just ordering the Pizza, wait 5 minutes, eat ...
Nuts are kind of weird. I don't know if other people experience this, but when I get a sudden pang of hunger my body completely rejects my suggestions that we eat some nuts. I'll be super hungry, staring into my cupboard, and that bag of peanuts will be completely unpalatable to me. This is in spite of the fact that I love nuts as a snack.
It think it's something where my body doesn't want to deal with a hard and dense fatty food on an empty stomach. Combined with the fact that nuts are quite slow to affect my blood sugar.
In general I think something with starch and fiber is the best remedy when I get that kind of sudden hunger.
I've had a lot more luck with "eat normal portion sizes with fewer calories, and track what you eat." It took me from BMI obese to BMI normal and has kept me there.
Portion control went so disastrously wrong that I'm skeptical of it as dietary advice. It doesn't seem supported by a lot of evidence, either (e.g. https://www.nature.com/articles/ijo201482#Sec11).
Can you elaborate on the distinction you're drawing here? You said you succeeded with a strategy that sounds to me a lot like "portion control", but then say portion control went disastrously wrong?
If the food you eat is smaller in mass, it will make you psychologically feel starved and physiologically feel unfull. Your brain will interpret this as 'you are going through a famine' and flip switches that make you value finding food more, because that was the appropriate response to a famine in the environment our ancestors lived in for millions of years.
If the food is bulky but has few calories, like potatoes, this makes the body and mind feel like you have plenty to eat, even when you are burning fat to sustain yourself.
> To go with the biscuit, sailors in the RN were issued other food on a standard weekly rotation. On Sunday and Thursday, this was a pound of salt pork and a half-pint of dried peas. Monday was a pint of oatmeal, two ounces of butter, and four of cheese. This was also served on Wednesday and Friday, along with a half-pint of peas. Finally, Tuesday and Saturday usually meant 2 pounds of salt beef. Conventionally, this was washed down with a daily gallon of beer. The total came to approximately 5,000 calories a day, an incredible amount to modern eyes but quite appropriate for sailors at the time.
For comparison, 3000kcal/day is about my current maintenance (180cm 72kg male). And I am _definitely_ way less active (and less muscular) than a sailor or soldier in history (1-2 hours of mostly anaerobic exercise every day).
I think you're right, and the "diet" suggestions tend to be "just eat 10/20% less calories during the day" which isn't gonna work: people don't suck ass at it because they have low discipline, but because it's enormously difficult to measure calories in this scenario, and your behavior/brain/metabolism compensate it. It's not a single-input mechanism black box. Your 20 off, 20 on experience is the absolutely normal failure mode for calorie restriction diets.
Not to be the Weirdo Diet person , but what I mean is: intermittent fasting, cutting out breakfast (and/or lunch) and replacing enough of your daily quick-burn carbs with long-burn fat so you don't feel very hungry while you're doing it. This works because unlike calorie restriction, it doesn't cut against daily Regular American Life behavior (you "fast" every night from after dinner until break-fast, this is just a few more hours) and all the countervailing mechanisms your body has evolved over a billion years to counter generalized calorie restriction.
I don't eat breakfast. I've never felt hungry in the mornings, and when I do eat then, it (ironically) makes me *hungrier*, e.g. at around 11 o'clock I feel like I need a quick snack, whereas without eating breakfast I don't feel that and can even go without lunch.
So all the well-intentioned advice about "skip meals" or "don't skip meals" or "eat more protein" or "eat saturated - I mean unsaturated - I mean polyunsaturated, not monounsaturated - I mean saturated fats" or "just cut out the junk and move more, what's so hard about that?" becomes frustrating.
Human biology is not like a tidy physics experiment. It *should* be "calories in, calories out". It *is* "calories in, calories out* but that is *not* the whole of it, and that is what gets forgotten.
Some people will react beautifully to "I fast X hours a day from this time at night to that time the next morning between meals" but some people will not. Some people will control hunger cravings by eating breakfast, other people will have their appetite stimulated. Some people will tolerate more fat in the diet than others. Potato diet works for one person, packs the pounds on for another.
I think you are right within the realm of the recommendations you are describing, because they're so vague/contradictory. I'm not advocating any of the advice you're mentioning, which you are rightly skeptical about them applying to everyone. Calories in, calories out doesn't "work", as a METHOD of dieting, not as a thermodynamic fact.
But is there any debate at all that replacing carbs with fat/protein in a meal will not result in greater satiety/less hunger later on, and therefore enable one to go longer before their next meal? I think everyone agrees on that, and that it applies to everyone - sure, perhaps in different ways/amounts!
Does it seem acceptable that if you go longer between meals, that your body will spend more time burning energy than storing it? Sort of by definition?
Does it seem acceptable that this would then (regardless of totally weekly calorie consumption) result in storing less energy (fat)?
And again, the goal should not be "weight loss" it should be "reducing the unhealthy outcomes", the likelihood of which can be more accurately measured by metabolic lab values like A1c than at the scale.
If you're someone who's had a good BMI forever and doesn't get their labs done, then you're never gonna notice anything because you aren't measuring anything.
"But is there any debate at all that replacing carbs with fat/protein in a meal will not result in greater satiety/less hunger later on, and therefore enable one to go longer before their next meal?I think everyone agrees on that, and that it applies to everyone - sure, perhaps in different ways/amounts!"
No, not everyone agrees, and it does not apply to everyone. It absolutely does not work for me; restricting carbs triggers middle-of-the-night half-asleep binge eating.
(I'm not normally a binge eater at all; I've only ever had this problem when I've restricted either carbs or eating in the evening.)
"counting calories of every thing one eats, to the gram" is not extremely hard. i know so because I'm doing it, and i do not ever do anything remotely hard.
To do so accurately is hard, because even if you're measuring the weight, you're relying on estimates of calorie density that are potentially many years out of date, wrong in the first place, or that the producer of the food is wrong is assessing.
And ok, that it is easy for you is fine - for millions of other people, it would be A) hard B) sufficiently time-consuming they wouldn't want to do it or C) would result in no measurable effect on their health/weight, so they would stop doing it. Maybe "hard" was the wrong term to use.
The approach you are describing sounds reasonable, but, as with most weight loss approaches, there are a lot of things that will make it hard for people to stick with over the long run:
(1)It is hard to change ones habits, including one's eating habits -- not impossible, of course, but HARD. The effort and attention devoted to that have to come out of the same pot of energy people are using to do all the other hard things in their lives -- do a good job parenting their difficult kid, produce good work in their field, keep their marriage in good shape, budget, ruminate about all the bad stuff in the news. On days when the energy pot's almost empty, most reasonable people are going to choose to reduce their effort to eat in a different way, rather than their effort in other areas which are more clearly crucial
(2) It is a heavy burden to stay continuously aware of something. Take blinking -- if I ask you now to notice your blinks, it's easy as pie, right? But how about if I ask you to stay aware of them continuously for the rest of the day? Very very few could succeed at that, especially while doing all the stuff they need to get done today, and responding to whatever comes at them this evening. Continuously monitoring eating to keep it in compliance with a certain pattern is the same -- easy in the short term, very hard in the longer term.
(3) We are surrounded by highly palatable foods, and our brains are not wired for an environment with that feature. We evolved in settings where it was hard to get enough calories. If you found a honeycomb or were presented with a bunch of roasted animal fat it was desirable to eat as much of that stuff as possible. The parts of our brain that push us to eat the sweet, fatty, salty stuff that is all around us is quite powerful, and the part that understands that it's undesirable to gorge on those things on 2022 cannot reason with the parts that want to gorge. It is possible to simply override them, but it is difficult, and it's probably not possible to override them most of the time if you have other heavy demands on you as well.
1) the goal is not weight loss. That is a side effect. The goal is a healthy diet, and reduction of serious bad outcomes in the future.
2) Yes it is hard to change habits. That's why the method is designed to affect the underlying drives that cause the habits to be hard to change. It IS hard to not eat when you are hungry. It is EASIER to not eat when you have made decisions in the past that mean you are less hungry now. Eating more fat and protein in your past makes you less hungry now.
3) There are immensely palatable foods that are not bad for you, and will provide more satiety so you are not driven to consume more so soon. Animal fat is not (particularly) bad for you. Salt is not bad for you. Replace carbs with them in your meal, eat them, and enjoy not feeling hungry so soon. The goal isn't to override your desire to eat awesome tasty food, it's to hack the system so you eat awesome tasty food that reduces your desire to need to eat ANY food for longer.
This is not a moral system. There are not desires to be overcome. There is not decadence to resist. This is not ascetism. There is no willpower. This is a physical system of chemical reactions that we can affect in different ways. We impute no moral significance to a molecule binding to one molecule instead of another, nor should we.
I do think content is certainly as important as portions, if one wants to control obesity. The national health system is pretty good about listing contents on food products. We respond to heat, salt, and sugar, and food manufacturers exploit that. I think if one adheres to a healthy, lean diet, obesity is easier to control. Another important aspect is the consumption of alcohol. Alcohol can provide energy and calories, but can maintain too much weight in an unhealthy body.
I used to be borderline obese when I drank beer or wine, but I lost 75 lbs. when I came down with pancreatitis. Today, after the most recent flare-up, I'm down to 114 lbs. -- but still 6 feet tall. For a time I thought marijuana might help ease the pain, but now my body objects when I try and ingest it, so I've given that up, too. There are certainly no easy answers, but I think the content of one's diet and the consumption of alcohol are important factors. My stomach emptied with this most recent flare-up, which is unusual, so I'm taking the opportunity to curate what I ingest carefully. I'm drinking kefir and Gatorade.
In this case, the problem with “that guy” is not that he’s stating an uncomfortable truth; the problem is that he’s missing the point.
If you think that we should downplay pharma/surgical interventions because dieting and exercise “work,” it is incumbent upon you to show how we will overcome the fact that people don’t seem to have the willpower required to use these tools longterm. What’s your plan?
Willpower is a choice. In this study alone https://www.cuimc.columbia.edu/news/new-weight-loss-drug-approved-fda-it-right-you, 5% of participants on placebo lost 15% or more of their body weight. The average placebo loss was 2.4%. Granted both of these are hugely less than the treatment group, but they're also hugely less expensive. This is the case in every weight-loss placebo study I'm aware of, just the simple act of taking a pill (sub vitamin or other "healthy" pill they believe could affect weight for placebo in non-lab use) or putting an ab roller in the living room, or anything else that moves diet and exercise slightly closer to the forefront of mind than it was previously can have a significant effect. According to the paper, the lower end fda approved weight loss drugs cause a 4% weight loss, so assuming equal treatment time periods, placebo is 60% as effective on average as some drugs, at 0% of the cost. People are all different, they just need to figure out what best triggers that effect for them, whether it's my examples above (variations of which work for me) or something else.
"just the simple act of taking a pill (sub vitamin or other "healthy" pill they believe could affect weight for placebo in non-lab use) or putting an ab roller in the living room, or anything else that moves diet and exercise slightly closer to the forefront of mind than it was previously can have a significant effect"
Whether you're talking to me or not, the solution is to reduce the thing that is calling on their willpower. It does not take much willpower to not eat if you are not hungry. You achieve being not hungry by increasing the satiety of the food you ate most recently. Food that does that is that which has more fat and protein, and less carbs.
> Granted both of these are hugely less than the treatment group, but they're also hugely less expensive.
Breaking: doing nothing has no effect; is free
> According to the paper, the lower end fda approved weight loss drugs cause a 4% weight loss
Yeah, if you move the goalposts to “the worst drug on the market” the relative effect of the placebo goes up. This doesn’t bear on the article, which is about the best drug on the market.
Breaking: 16% of the improvement of the best drug on the market from taking a sugar pill is not "doing nothing" and is in fact statistically significant. That's why it's included in this paper, and every paper on weight loss drugs.
> This doesn’t bear on the article, which is about the best drug on the market.
No, if you missed it the article is about the best drug on the market and how unattainable it is to most people (and statistically those who would most benefit from it) due to cost. So if we can get 16% of the benefits for almost zero cost that actually a huge deal on its own, and this could likely be improved significantly with other tweaks, as I've now mentioned twice. Less snark, more reading comp next time👍
What does that even mean? You state that conclusion as if it implies something significant but, I'd argue, it's really just a way to summarize the relation between incentives and behavior. Some things we call choices because they result in different outcomes when you change the incentives (prison for murder decreases murder rater but prison for being short doesn't increase height much). I mean, if you really get down into the details the difference between 'choices' and 'non-choices' isn't that the laws of physics plus initial conditions are any less binding in one than the other or that the biology that happens in the brain obeys some other kind of principle than that in the rest of the body.
But, given that background, saying something is a choice is just a shorthand for describing how responsive it is to incentives. Certainly, choosing not to eat as much is more responsive to incentives than height is but it's a lot less responsive to incentives than many other things.
And once we are made aware of how responsive it is talk of whether it is a choice or not becomes irrelevant. It's like saying something is heavy once you know it weighs 100lbs. It's not adding any information about the thing or helping you figure out what to do with it. Same with weight loss it seems. Absent interventions we aren't willing to make (for good reason) many people don't lose weight but they do on the drug and that's all that's really relevant to deciding policy.
You're exactly right, except that I'm biting the willpower point bullet. Maybe I'm bad at metaphors, sorry.
The plan is this:
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family.
2. Replace carbs in your dinner with fat/protein. Eat as early as possible, eat as much as you want. Don't eat bedtime snacks.
3. Over time, extend the time from ending dinner (your "fast" length) til the next time you eat (breakfast? 12:30 lunch? 2:30 lunch?) as much as possible. Eat the next day when you're hungry, but if you're only feeling kinda hungry try drinking a zero-cal electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories a day is impossible. Measuring that you ate 10 minutes later is easy. Don't put any sugar or carbs in your morning drinks.
4. Eventually cut out breakfast or lunch, or eat later lunch. Just like dinner, replace carbs with fat/protein as much as possible. Whatever feels okay.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale.
These are’t terrible recommendations. I do some of the things you list, and it helps me maintain my bodyweight.
But do you seriously think that an epidemic of 70M obese Americans would be fixed if only people would read your five bullet points about intermittent fasting? As per Scott’s math, you are claiming that your tweet-length comment on ACX is worth 500bil. The market disagrees.
"But do you seriously think that an epidemic of 70M obese Americans would be fixed if only people would read your five bullet points about intermittent fasting? As per Scott’s math, you are claiming that your tweet-length comment on ACX is worth 500bil. "
Yes.
But humbly, my comment is worthless. It's the advertising and execution that matters. Any idiot like me can say "gee, maybe we should build cars in assembly lines with replaceable parts" but it takes Henry Ford to execute. Even tougher, the actual problem here isn't knowing what to do, it's teleporting what to do into the minds and 70M people and then they all have to execute. Which is why I'm babbling my insane, otherwise-worthless ideas in a place run by a person who seems to do a decent job of teleporting ideas into other people's heads.
To elaborate, yes, I really do think it's worth half a trillion, obviously conditional on people actually doing it (though the lack of difficult in doing so is the key feature) and the cost of the advertisement/propaganda to publicize it, and coach people through it. There are companies (look up Virtahealth) that provide physician-led diabetes reversal for a few hundred a year using similar techniques and coaching on it. My only disagreement is you're understating the worth at 500B, because that's only the (estimated) consumer value of "weight loss", because if all 70M people did those 5 things, it would also reduce the downstream occurrence of diabetes, heart disease and cancer as well. (claiming that reducing weight/improving metabolic health reduces those things is a boring conventional medical claim).
Also, re: "the market disagrees", as I pointed out, there are lots of (small) companies providing these services successfully and getting paid for them. Markets can agree in differing amounts, and markets also need information/advertising to match sellers and buyers. If "make cars with assembly lines" was an idea that didn't actually get Ford any money, but rather only gave distributed consumer surplus, he probably wouldn't have executed it.
And while I am a committed free marketeer, markets for services that provide little financial benefits to those who provide them often don't work! I'm not making any money from this. Doctors won't make any money from this - in fact, they will lose money because their gov-mandated quality metrics don't support this type of treatment for obesity or diabetes. Novo Nordisk doesn't make any money recommending this. No supplement or food manufacturer can make money from this. It's not really a product or service to be sold, though some (like Virtahealth) are.
Looked up Virtahealth. Digging in a little it appears to be "we will teach you to eat a keto diet, which will have so few carbs in it that your blood sugar will remain low enough without drugs to call it reversal, except we don't count metformin as a drug because some people like to stay on it".
As someone who took metformin for 3 months and *absolutely could not* tolerate the severe GI side effects, which I never built any tolerance to: lol. lmao, even.
For what it's worth, CoQ`10 settled my stomach (GI tract) when I was starting out with metaformin, but my side effects were never worse than vague queasiness.
They will happily do non-metformin regimes for those who don't want to take metformin, and they will still work.
If your reaction to "this company will, without medication, coach you through reversing your diabetes, which costs millions of Americans billions of dollars a year in insulin, suffering and death" is "lol" then.... what do you want?
I mean, I've been aware of ketogenic diets, and considered trying them, for over half a decade at this point. I know I would not succeed, because like 75% of my favorite foods are incredibly carby and it would be too much of a sacrifice to be sustainable. And I don't have any of the medical conditions that make keto inadvisable for a lot of people.
I also know metformin isn't worth it for me.
I therefore wonder how many of those millions of Americans are in the same spot, and therefore how useful in solving the problem a company whose whole pitch is "keto coaching and maybe keep on metformin" is.
re: Virtahealth, because that's not their "whole pitch." Their method isn't "shove strict keto and metformin down your throat", it's coaching with those as options. If you sign up and say "I don't wanna do those things" they'll work with you. They list those things because they A) do work for many people and B) demonstrate that their goal is metabolic health, rather than counting calories or just losing weight.
"because like 75% of my favorite foods are incredibly carby and it would be too much of a sacrifice to be sustainable."
Which is why I prefer this method to strict, uncoached keto:
1. replace dinner carbs with tasty fat/protein, which are more satiating, therefore you can go longer before being hungry.
2. gradually move back the time you eat your first meal the next day, eventually eliminate breakfast, especially if it's boring crappy cereal. Then push back lunch
3. get your blood work done, if your metabolic indicators (A1c) look good, then you're fine!
Because do you eat those favorite foods at every meal? Maybe you do, congratulations - but most people eat pretty boring and crappy (from a food enjoyment perspective) breakfasts and lunches most of the time. I agree, no diet that says "you can't have your favorite foods at your major dinner time meal with your family" is gonna work. But one that says "maybe you can cut that bland cold cereal in the morning" or "instead of a sugar bomb starbucks latte, get one that just has still-really-awesome-tasting-heavy-cream" or "maybe just push lunch later in the day a bit" can. I'm sure you have favorite foods that have fat and protein instead!
The reason I brought up virtahealth is not "because they force you to do keto/metformin and that is the ONLY WAY" but because they do interactive, working-with-you coaching (that can involve keto or metformin, or intermittent fasting) that provably shows that you can just Talk To People Over Zoom And Get Them To Improve Their Metabolic Health, as a counterpoint to "spend 15k on semiglutide". And I consider the plan above to be an improvement to THAT, because it's something that almost anyone with a messed up metabolism can do even without coaching, in a montessori-sort of "the things that need to be done are simple and intelligible, and you can see for yourself if they are working" way.
I feel like nutrition/metabolism has become very politicized and moralizing. It's just a machine that we can optimize, and I am recommending that we put some oil in the engine to make it run a bit more efficiently. There should be no moral judgements of anyone, except that there is a future where 40% of the nation's GDP goes to insulin and semiglutide and bariatric surgery and.... I judge that as morally inferior to one where we don't?
"1. replace dinner carbs with tasty fat/protein, which are more satiating, therefore you can go longer before being hungry."
Brian, THAT DON'T WORK. Do you think I and other fat people haven't tried that? Now, maybe it's habit, maybe it's a combination of things, but when I do try the "eat meat and veg but no carbs for your meal", then the carb cravings kick in later and I have to eat something carby.
Meat doesn't 'satiate' me the same way potatoes or bread does. I can eat a chicken salad with tasty roast chicken with the skin on (that's your tasty fat and protein combo) and plenty of salad veggies and even a bit of dressing. Lovely. That does me - for a couple of hours. Then I start craving "oh I wish I had eaten some bread with that" and here we go again.
You are pushing the same points over and over in blind fervour that "well it worked for me and a lot of people so it should work for everyone". It doesn't.
"Tasty fat/protein will fill you up so you don't want carbs" does not work for me. I bet it doesn't work for others. It worked for you, great. I hope it continues. But right now even typing this much out and talking about carbs has evoked a sudden craving in me for a heap of mashed carrot and parsnip (bad for all the carbs):
"3. get your blood work done, if your metabolic indicators (A1c) look good, then you're fine!"
No, you/we are NOT. Early on, in the 'honeymoon' phase of being diagnosed Type II diabetic, I had it under control and good HbA1c numbers regularly. Still overweight. Still not good enough for my doctor who was recommending "now lose weight".
Nobody will ever stop at "well you have metabolic indicators of health despite being so fat, so we will take it you are fine as you are". They *will* keep on at you to lose the visible weight so you reach a 'normal' weight, they will keep telling you the bad sides of being overweight, they will keep nagging and shaming and telling you that you *need* to drop all that excess. Holding up "but my bloodwork came back okay!" does *nothing* to change that.
Yeah, I mean, Deiseach said basically everything I was going to, but I'll add:
Do you think I have not considered this stuff? Do you think that by the time I'm posting on ACX about digging into a program like Vitahealth when it's linked because at this point I'm open to trying anything *actually new* that I am the kind of person still chugging sugar bomb lattes? I sure as hell hope nobody who gets to the point of trying and rejecting metformin is still at that point.
I'm 5'10, 245, and run an A1C somewhere between 7 and 8, despite not eating any crappy sugar bomb garbage anymore (telling me to cut off cereal as if I haven't already picked that extremely low hanging fruit...) because at this point the damage is done and because yes, despite my frequent consumption of steak and other meaty, fatty meals in the dinner rotation, despite lunch being a very protein loaded sandwich at 1 or 2 pm, and despite actively switching ingredients in things (e.g. did you know croissants as a sandwich enclosure have fewer carbs, and calories, than sandwich buns?) I still eat enough pasta and rice for that to be problem given the state of my metabolism. I'm down 30 pounds since adderall, I did some serious free weight work last year and gained a bunch of muscle (squat topped out at 1.5x bodyweight before I screwed up a joint, so it's not like I "didn't try hard enough" or anything), I'm on supplemental testosterone due to low T levels, all of which are supposed to improve blood sugar and lower A1C, and it doesn't seem to have been enough.
At this point, yeah, if the cinnamon and berberine supplements I'm now trying don't keep me under 7, I'll try semaglutide, because that has a lot more chance of working than *even more aggressive dietary and behavioral modification than I already do and have done for years*. I work a stressful, sedentary, time-consuming job and have a lot of shit that needs to get done around that as it is, I do not have the time or energy budget to micromanage every meal and do 1+ hour of hard 160bpm cardio a day (the way I did when I made a quarter of my current income and had loads of free time and dropped 80 pounds in a year). I know how to do it, I just cannot spare the overhead and still function at this point in my life.
Do not assume everyone with a problem is some uninformed child who can "learn to do the right things" with a little bit of handholding. We don't need Fat Adult Montessori, thank you very much for the patronization.
I don't care how much fat you have, if you get a good diet your body will figure that out on its own. But also, yes, going from obese to just chubby IS correlated (but not causative!) with better health outcomes.
I want you to be healthier, which isn't measured on the scale, but in your blood work and in long term lack of massive health disasters like diabetes, heart disease and cancer. If you're still "chubby" but you don't get those things, well, great!
You basically call "healthy" being fat but not sick. Better than being morbidly obese and sick, I guess, but that's not saying much.
That's not good enough, people want to be "fit". You are right by accident with "health isn't measured on the scale" because yes, body fat percentage is what actually matters but it's very hard to measure without (other than doing an autopsy). Unless you are extremely muscular or have great bone density, the scale is a good measure of fitness.
If you want to be fit you can't eat ass much you want for a meal. The usual guides of 2000 kcal a day for the average adult male is probably too much already an puts you on a slight calorie surplus.
Healthy in this case is avoiding bad health outcomes, like diabetes, heart disease or cancer or just death. Good metabolic indicators (A1c) predict that better than weight, (or even body fat, which yes, is better than just weight) which is what I'm talking about.
Yes, sure, some people want to be "fit" by whatever they define that. But "just don't eat as much as you want" isn't helpful advice, and calculating what exactly a "slight" calorie surplus is is really difficult. But if you're trying to improve the health outcomes of 300m different people, you need to measure (at least in a sample population) something more concrete, and you have to have a plan to achieve it that's simple and doable for nearly everyone.
2000 kcal a day is a guide for an average human, male or female. Unless you lay in bed all day or have no muscle mass, as a male you'll be at a deficit at 2000.
As advice, that doesn't work for many people because
- it is very hard to measure calorie intake
- very difficult to measure calorie expenditure
- depending on person, your body will decrease your metabolism in response to getting less calories on average over the day
- also depending on person, your body will send you increasing "hunger" signals if it is getting less average steady stream calories than it did before
- human metabolism is not a calories in, calories out mechanism. It is a goal-seeking mechanism, where one of its goals is to be able to see you through a famine. Even if you think "it would be healthier if you react to this calorie deficit by burning fat/producing less fat" it may think that acquiring excess body fat is healthier so you can avoid a famine, and tweak your hunger/metabolic to achieve that instead.
"Just eat 2000 calories" is the diet advice that most people get, and it doesn't often work, which colors their opinion of simple diet advice in general because it has such scientific consensus and wisdom attached to it. Additionally, it does seem to "work" for lots of people who are already at a "good" weight", but they probably would be so even without the advice, and this also colors their views about what advice "works."
I'm a 71 kg, 181cm, 30 years old man. I can do 13 pull ups, 25ish push ups, toes to the bar abs workout, etc. I'm trying to get some more definition (lower back and abs fat are the most stubborn). I think I hit maintenance at something like 1800 kcal, but need to go south of 1500 to lose any weight for sure.
I think 2000 kcal puts me in that sort of slight surplus that makes people skinny fat over time. I don't know if calorie labels are wrong or consumption guidelines are too high though.
If you are that weight/height/age, doing regular muscle-building work outs, and your metabolic indicators are good, I really don't think you need to worry about counting calories or watching your weight. I wouldn't think you'd get "skinny fat" from 2000 cals and doing that, I'd think you'll probably be gaining muscle weight? I mean, I Am Not A Doctor and skinny fat is Not A Medical Condition, but I think you're good?
well I don't need it, I just want to. I'm trying for something like sub 15% body fat to see what it looks like.
> I'd think you'll probably be gaining muscle weight?
You gain muscle extremely slowly. A kilo lean muscle mass a month would be a LOT. You can put on half a kilo of fat a day if you eat enough. So being on even a slight surplus consistely for some time will get you pudgy.
All I'm saying is calorie guidelines are overshot. The usual guidelines would prescribe above averge consumption for someone like me (even if sedentary), yet 2000 kcal is a slight surplus. There's no way the average 165cm office worker adult woman doesn't gain weight above 1500kcal.
> All I'm saying is calorie guidelines are overshot.
I don't think calorie guidelines work at all. They can appear to work for people with a certain subset of metabolic conditions, but your body absolutely can regulate calorie burn, fat buildup and hunger signals in a way that (for at least hundreds of millions of people who ARE attempting to lose weight) swamps "just eat X calories" recommendations.
This comment is not worth $500bil because, like all comments in this vein, it fails to take into account the complexity of human nutrition. There is no list of 5 points that will work for those 70M obese people. For some, the drug will be the only way. For some it will be a completely different diet. For some, your comment will work, but I expect it to be a decisive minority.
Comments like this are more common than you think, and for me they are just too naive.
2. Literally more than half of my meals are just pasta/rice/bread. Seriously, it's a carb fest down here*.
3. My breakfast is literally chocolate chip cookies. It's one step removed to just shove down my throat spoonfuls of sugar. And it's not even that big of a step.
4. I never skipped a meal. The idea alone of skipping breakfast or lunch is abhorrent to my Italian brain.
And yet, I'm chronically underweight. The only point of yours that I feel to thoroughly endorse without a second thought is the first one.
My set of oversimplified comments will be: never eat sodas, almost never drink alcohol (less than one beer / glass of wine per month), keep a super regular schedule (breakfast lunch, snack, dinner) and never eat out of it (forget chips at parties etc), cook your own meals and eat fast food only occasionally in special circumstances (e.g. you're late for your plane).
Will it work for a "random you" reading? Hell no.
* The hate carbs are getting lately is really puzzling to me. Sure, fat isn't as bad as once thought. But this notion that its ills are solely the product of an evil carb industry that captured the government is ridiculous. I'm sure there is no fat industry that has ever tried to manipulate the public, and, if they do, they only have the public's health interest in mind.
Do not adopt diets to lose weight. Adopt a diet to be healthier.
This is the hidden problem* with the semiglutide process: if you take it, lose 20 lbs, fit into your old clothes and declare success, but you're still eating a constant stream of crap 3 times a day, you are still gonna have a higher chance of bad outcomes.
* it's possible that semiglutide is actually affecting your metabolism, in which case it might directly affect your metabolic health, in which case, good for it - it overcomes my "hidden problem" above.
"it fails to take into account the complexity of human nutrition. There is no list of 5 points that will work for those 70M obese people. For some, the drug will be the only way. For some it will be a completely different diet. "
Why do you think human nutrition is only complex on the downside (i.e. losing weight) - in reality, human nutrition is so non-complex that hundreds of millions of people - through diet/lifestyle changes alone - became overweight when before they were not. Nutrition is so non-complex that millions of people were able to gain weight literally without even thinking about it, like breathing.
"And yet, I'm chronically underweight. "
This gets back to my main point: don't focus on weight. Don't think I'm focusing on weight. It's a symptom that does not always present when someone has an underlying issue caused by terrible diet. The key is to increase healthiness (the highly costly downstream effects that we associate with obesity), NOT to lose weight - except that it is often an indicator. I'm not going to judge you, but what you describe yourself consuming does seem to be an unhealthy diet. The key is that unhealthy diets do not always result in obesity for, as you point out, a wide array of reasons, especially age. Would I be wrong in guessing that you're probably under 30?
There is no point whatsoever for you to lose weight, in fact, if you are truly the clinical definition of "chronically underweight" *that itself* is an indicator of even worse health outcomes than being mildly overweight! I am telling you that, in this thread about obsessing over spending 15k a year on weight loss, you could probably stand to gain some pounds. You are not the average American, and to the goal of this post (from Alexander's perspective) you are already cured. But not to my goal, because my goal is "be healthy, avoid really bad health outcomes" and there are people (yourself included) that can (again, going only on your self-report) have unhealthy diets, experience the higher likelihood of bad health outcomes, while not displaying obesity.
I recommend getting some blood work and checking your metabolic indicators. It is possible that you have an unhealthy metabolism without displaying obesity. There are all kinds of people who die of a heart attack at 55 and people go "but he was so skinny!". I
"The idea alone of skipping lunch is abhorrent to my Italian brain."
It's not your Italian brain. It's that for breakfast you consumed a great deal of sugar/carbs, which (short version) burn in your body very fast, (or are stored as fat, which obviously your body is not doing) and your body concludes it needs more quickly, so it tells you are hungry for lunch. The chocolate chip cookies are not unusual. Most cold cereal that anyone actually likes has a similar sugar profile. You are absolutely correct about one thing: people have radically different "energy intake -> how much fat they get" curves, and you have (whatever your age) the "18 year old boy" curve. But the underlying metabolism can be healthy or unhealthy, and one that takes in cookies for breakfast probably isn't.
"The hate carbs are getting lately is really puzzling to me."
From me, it's not hate. It's the simple fact (conventional scientific wisdom) that carbs (especially sugar) are (again, short version) burned faster (some types more than others) in your body that fat or protein, remaining available to be consumed for activity for a shorter period of time, and therefore when they're gone (or converted to storage) your body tells your brain it needs more. It is conventional wisdom that fat and protein create more satiety, which is longer time before hunger. Therefore if you wish to spend more time burning energy (in your case, you want this for good metabolism reasons, rather than weight loss) than consuming energy, and to reduce hunger, carbs are just objectively inferior to fat/protein. It's not some theory that carbs infect your body like poison. Well, except for sugary high fructose corn syrup sodas, those are definitely poison.
No, I'm not asserting that "if you aren't doing my plan, you can't have good numbers", human variance in history, age, genes, circumstances, mental states, environment and many others mean that there are tons of people who, by my standards, don't eat well but won't have bad indicators. What I am saying is "IF you have bad numbers and you want to improve them, because they are better correlated with bad outcomes than weight, THEN this is a non-15k a year, non-surgical way to do it that I think is easier to follow than most other diet advice."
The fact that there are tons of highly complex factors that could influence where a specific apple is in the universe: the structure of its tree, terrain, climate, soil, growth patterns, it remains that a simple model: if you pluck it from the tree and throw it up in the air, it will go up, and if you throw down to the ground, it will go down - will work to determine its future position.
What you're saying, effectively, is: "you say you have a plan for someone to do X, but what if they don't NEED to do X? Then you have nothing!" to which I say, yep, ok?
About the complexity, I'm unconvinced that people having tried a million things and still being unhealthy is a proof that nutrition is simple. The two doesn't seem to follow.
Anyway, just because you asked, if you were to see a picture of me, you'd think I'm under 30 -- I've got such a baby face, no wrinkles, no grey hair. But I'm 38. And actually I checked, my BMI is 19 (roughly, I don't own a scale) so I was actually wrong about the underweight thing. I'd love to gain a few pounds, but I'd rather them being muscles rather than just fat, this clashes with my couch potato nature unfortunately.
The bit about being Italian is a poor attempt at conveying the memetic nature of eating. Really, the horror of skipping meals has nothing to do with how fast carbs burn (and, again, in the tangent of the carbs, Deiseach writes better than I can the fact that a model that lumps in the same class coca cola and polenta isn't... great?). It's just that meals are a sacred tradition. So my "one neat trick, nutritionists hate him" is: let's just get better memes about food. Italian memes seem to be working well.
This religious aspect colors my opinion, and then I asked myself: if I were to follow your advice, I'd only have one meal at day (dinner) and it should be mostly fat/protein to cover my entire daily calorie intake. Is that even physically possible?
Other than that, in many things we agree, I don't think the pill treatment is the best, since it's unclear whether a taker will then have to be on it for the rest of their life (15k/year, yikes). But if someone there's no other choice, why deny it?
That is kind of on the border of where lower BMI starts to be associated with bad outcomes, but with an imprecise calc, and me not being a doctor, I can't really say.
"a model that lumps in the same class coca cola and polenta isn't... great?)"
They are both "carbs" the way they are both "food" or "made of atoms" but no low carb/keto person would consider them in the same quality from a "should I eat this" diet perspective. Full sugar coke is basically the worst. Polenta has (and is often served with) other stuff than carbs in it!
"It's just that meals are a sacred tradition."
Absolutely, that's the primary motivator of my plan: because family dinner meals are a sacred tradition and you shouldn't ever touch them, except to add more tasty fat/protein. I'm talking about cutting out extremely non-sacred meals like your cold sugary cereal in the morning, or the limp sandwich at lunch, or the junk food candy snack at 330.
"if I were to follow your advice, I'd only have one meal at day (dinner) and it should be mostly fat/protein to cover my entire daily calorie intake. Is that even physically possible?"
It is 100% possible, tons of people follow "One Meal A Day", I've done it hundreds of times - and remember, for a long span of humanity's life, we didn't have time for breakfasts or lunches, everyone worked in the fields all day and gathered at the end for that together, family, sacred meal.
But you don't have to go right to that, and probably shouldn't, because if you currently do eat lots of carbs, you will feel super blood-sugar-low-hungry long before you get to dinner! That's another primary motivator of the advice: that it lets you gradually, slowly, measurably ease yourself into it, as far as you want, and only so long as it feels good. If you get migraines from delaying your meal like another commenter then.... don't do it.
Finally, to your specific situation, which is not the "American average person who is considering semiglutide", have you gotten bloodwork done? If all the metabolic stuff looks good, then you're fine!
"But if someone there's no other choice, why deny it?"
On a diff comment, I totally agree that semiglutide has its place for people who want specifically weight loss, and it may just have straight affect-your-metabolism positive effects, which would be great! But the topic at hand is "70 million other people need something like this and they can't all pay 15k" so that's why I'm offering my solution. Also, as Mr. Yudkowsky points out above, semiglutide comes with an emphatic demand to improve your diet and exercise - people should do that (with GOOD diet advice) regardless of being on it or not!
"The hate carbs are getting lately is really puzzling to me."
Oh, diet recommendations have swung around all over the place. Fats of all kinds are bad for you, replace those fatty foods with (carbs) and (protein). Take the skin off chicken, trim the fat off red meat.
Then it was "not all fats", it was saturated fats, so consume unsaturated fats. Then it was well monounsaturated fats are bad for you, only consume polyunsaturated fats. Omega fats such as found in fish good for you! Well, no, hang on, too much omega-6 is bad for you, you need to up the omega-3 (jury still out on omega-9 for the moment, I suppose).
Dairy bad for you! Dairy good for you! Confused yet?
Then it was red meat is bad for you in excess, so that was (protein) the bad guy. Then smoked meats, because carcinogens.
(Carbs) were still okayish, but then SUGAR - THE PRIME EVILLEST EVIL THAT EVER EVILED. So cut out all the sugary junk (good enough advice). Then that expanded out into other carbs. Simple carbs like potatoes and rice and bread and pasta - bad. Need complex carbs. GI index, so forth and so on.
I think the swinging pendulum of "X is bad, Y is good - now X is good and Y is bad" is down to the complexity of nutrition and metabolism. People are getting fatter and unhealthier, how is this? The simple story of "consuming more calories, and being more sedentary, than past generations" seems not to be the whole picture. So there must be a 'bad' food or class of foods.
Fat makes you fat, right? So fats bad! Cut out fats!
Okay, people still getting fatter - why? how come?
Carbs bad?
Protein bad?
There will be people who eat lots of carbs or fat or protein or whatever, and don't get fat/are chubby but healthy. There will be people who cut out carbs or fat or protein and are fat/unhealthy. There is no simple "one easy fix, just change your portion/plate size and eat six tons of lettuce" cure.
I joke, but it's only half a joke, that the next recommended diet will be "you can only safely consume moss and water".
But then it was discovered eggs were full of cholesterol and cholesterol is bad for you, so this was dangerous and terrible to eat eggs and you should never eat them.
*Then* it was revised to "well, there is some *good* cholesterol and eggs have that, so you can eat a couple a week".
I don't think eating nothing but eggs would be healthy, but neither do I think eating one egg per day is going to do you in. Again, it's the swinging pendulum around dietary advice that causes more confusion than it solves problems.
"Recent observational studies and meta-analyses have found that eating eggs may not increase your risk of heart disease or its risk factors, like inflammation, stiffening of the arteries, and high cholesterol levels "
You know, I gained most of my body weight and reached my fattest point doing exactly that: keto, skipping meals, tons of water and zero calorie drinks. So I'm extremely skeptical of this being useful advice.
My numbers just got worse and worse until I bit the bullet and had them cut out half my stomach and part of my intestines.
"Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale."
Yes, Brian, but you are forgetting one thing - people in the street can't see your bloodwork numbers, they can see your double chin.
*That's* the metric by which people, including doctors, judge are you 'healthy' or not. I take your point that people confuse "healthy" and "thin", but given all the messaging about "fat is unhealthy", can you expect any different?
About ten to fifteen years back, I had *great* bloodwork numbers. I was still visibly porky. I still had kids yelling at me in the street about being an elephant. I still had at least one doctor visibly and openly furious with anger that he could not punish me for being fat because my blood work didn't back him up.
If you're pudgy, that is the metric society, and you yourself, judge you on. Have you dropped two dress sizes? No? Then it doesn't matter if you can run a mile or have perfect cholesterol levels, you are part of the obesity epidemic that is blighting our healthcare system.
(There's particular irony at work here; I have a sibling who has a thyroid condition and they have to be ultra-careful about their cholesterol levels and fat intake. They are also 'normal weight'. So anyone looking at the two of us together and being asked "who has the high cholesterol?" is going to pick me, the fat hippo. They'll be wrong, but they still won't change their mind - oh that number doesn't matter, we all know being fat is bad for you).
Improving or maintaining your health is worth doing if feasible.
The simplest thing I can think of to solve the prejudice against fat people is a famine, and it isn't worth it. It might not even work.
An expensive preventative for heart disease might work, but that's another version of turning being fat into a status symbol (perhaps an expensive watch is also required). This is better than a famine (do I need to say that?) but way short of excellent.
Yes, I don't know what to do about that, except advertise the fact that bloodwork is a better indicator than weight. The only thing I do know is that, in the case of "good bloodwork, overweight" the answer is NOT "$15k a year semiglutide" or "high mortality-rate surgery."
Speaking as a Person Of Amplitude, I think obesity isn't one disease (since we are now calling it that) but a range of factors that have been lumped under the one umbrella of "you're a fat pig".
(1) People who are naturally chunky versus those who are naturally skinny. I think we all know or have seen people who are like twigs, who don't put on weight, who have thin little limbs like sticks. That's not because they're dieting themselves down to that weight, it's natural for them. On the opposite end, I submit that there are people who are naturally going to be chunkier than the median, because that's how their metabolism is set up. They will go a few pounds over what is considered optimum weight, and if they go too far over, their doctor harrumphs at them about "diet and exercise" and they do that and lose the weight. It'll be tougher for them to keep off the weight and they will have to make lifestyle changes like "I can't eat birthday cake ever again", but in the main it will work for them. At the worst, they'll be 'pleasantly plump' or a bit chubby, but not grossly overweight.
An example of someone naturally skinny who is not doing cooking episodes about salads:
This is the good old "willpower" argument: if Joe can lose ten pounds simply by not stuffing his face with rubbish, why can't you?
That brings me on to:
(2) Slowing-down of metabolism. Middle-aged spread. "When I was younger, I could eat what I liked but now I eat the same and put on weight". People get more sedentary, they eat more convenience food, lifestyle changes.
Again, "diet and exercise" will help here. It'll be tougher, but if you were one of the 'naturally' slim types, it helps. Again, you'll probably have to make some lifestyle changes, but you will be able to get off the weight.
(3) Weight gain due to medication. I think we all know about steroids (my late father was put on a course of them and ballooned up, even though he wasn't eating more) and there are other medications with the same side-effects. It's difficult for people who gain weight like this, because they treated like the rest of us greedy lazy porkers, and get the "oh that's only an excuse" response unless they pull out the prescription to prove what they are saying is true, and who wants to have to reveal that *ackshully*, I'm on anti-psychotics which is why I'm stuffing my face with carbs?
Hard case here, since once you don't need to take the meds anymore, you will go back to your natural weight - unless of course you need to constantly be on psych meds, which means increased appetite/weight gain, which gets you the "just have some WILLPOWER" argument from everyone.
(4) And last, the rest of us fat, lazy, greedy slobs with no willpower who just stuff our faces with junk food and never get up off our idle behinds and just go for a walk or something.
The gluttons. The "why don't you just have some WILLPOWER?" people. The "diet and exercise, you moron, never heard of that?" folks.
And you know, there is something to that. Yes, we eat too much. Yes, we don't exercise enough. But, like the anecdote related in Dante, when the bishop asked his servant "What do the people say of me?" "Your Grace, that you are always drinking" "Ah yes, but I am always thirsty" - we're always hungry.
Scott mentioned a few years back examples of patients who suffered from unrelenting thirst, who had to be monitored with their fluid intake or else they would literally drink themselves to death, and even when they got enough to drink would still feel thirsty.
Nobody is going to condemn someone who is guzzling pints of water "Just have some WILLPOWER!", because they realise that's not normal and is indicative of a problem.
Now, for the likes of us that are always hungry and never feel full, even when "but I just ate a full meal a couple of hours ago, I shouldn't be feeling hungry", it's hard. Because yeah, you can visibly see we are gross landwhales. And yes, we are leeching the health services normal people should be using with our horrible diseases of obesity that are all our own fault. And yes, calorie-laden tasty modern processed foods, and yes sedentary lifestyles, and yes over-eating and being greedy, and yes diet and exercise work to a degree, and yes "why don't you just have some WILLPOWER?" and get used to feeling pangs all the time. And yes, "I'm big-boned/it's my glands/it's PCOS/it's a response to trauma" do get used as excuses. Yes to all of that, yes I admit we do contribute to our own problems. Having said that:
Do you really think it's a simple problem of NOT ENOUGH MORAL FIBRE once people are desperate enough to have the likes of this done in order to lose weight?
"Roux-en-Y (roo-en-wy) gastric bypass. This procedure is the most common method of gastric bypass. This surgery is typically not reversible. It works by decreasing the amount of food you can eat at one sitting and reducing absorption of nutrients.
The surgeon cuts across the top of the stomach, sealing it off from the rest of the stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Typically, the stomach can hold about 3 pints of food.
Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. Food then goes into this small pouch of stomach and then directly into the small intestine sewn to it. Food bypasses most of the stomach and the first section of the small intestine, and instead enters directly into the middle part of the small intestine.
Sleeve gastrectomy. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can't hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen the desire to eat.
Advantages to this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than do most other procedures.
Biliopancreatic diversion with duodenal switch. This is a two-part surgery in which the first step involves performing a procedure similar to a sleeve gastrectomy. The second surgery involves connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing the majority of the intestine.
This surgery both limits how much you can eat and reduces the absorption of nutrients. While it is extremely effective, it has greater risk, including malnutrition and vitamin deficiencies."
Reading those comments, they resonate with me. Constantly eating, never feeling 'full', eating until so stuffed I might throw up, And I've tried diets and they've worked - for a time. Then I plateau at a certain weight, and something happens (the last, most successful diet, I got swine flu then the weather was so unseasonably bad I couldn't go out for exercise) and I fall off the wagon and put all the weight back on.
So yeah, maybe all I need is some WILLPOWER, can you tell me where I can obtain a shot of that, because I don't manufacture enough myself? And that's where the "moral failing" angle of the condemnation of the overweight comes in - if we just gritted our teeth and scrunched up our eyes and *willed* hard enough, we could do it!
I don't know if this new drug *is* a miracle cure for weight loss, I think like all new treatments it is being hyped out of enthusiasm. Once it settles down, I think it's more likely to be at the 60% end of the successful treatments scale. And this is something you have to take forever, or else you will put the weight back on. And there probably will be some people for whom it doesn't work - I've had at least two medications prescribed where I was told that a side-effect was weight loss so that would help me, and no, it didn't happen at all.
So yeah, "CICO" - but that's simple. Why people consume a heck of a lot more CI than expend CO is the hard part to solve.
This doesn't respond to most of your very valid points, and it's definitely not meant as a "just exercise more" response, nor to suggest it will solve all your weight problems, but I think it is likely to be more effective and metabolically helpful than most forms of workouts: have you looked into Zone 2 exercise? Peter Attia has a number of podcasts and videos on it, and it's the central plank in his treatment of patients with metabolic disorders.
Briefly, zone 2 exercise is low intensity exertion which stays just within the energy regime at which the mitochondria in muscle cells can burn fat to supply the fuel they need. By training within that zone, not only are you specifically burning fat, but you are also training your mitochondria to be more effective at utilizing fat and less dependent on glucose, thus improving your overall metabolic health.
A simple way to try it is to get a cheap used rowing machine or exercise bike, set it up in front of the TV or computer, and ride them for 45 minutes to an hour at the intensity level that lets you still just barely breathe through your nose or maintain a conversation. Aim for at least 3 hours a week; more is better.
I'm surprised that you, usually a defender of religion and traditionalism, would have such a view on willpower. This isn't a criticism--when people are too predictable in their views, I tend to wonder if they ever think for themselves.
Isn't gluttony one of the seven deadly sins? Sin is part of the human condition, and the seven deadly sins are remarkable for their mundaneness: probably every person who ever lived has been guilty of all of them on a regular basis. But that doesn't mean societies (and not just Christian ones!) don't or shouldn't blame people for being lazy, angry, greedy, arrogant, or gluttonous. The purpose of the blaming and shaming is to discourage the sin by imposing a social cost. Just willpower alone may not be enough for someone to not have bursts of rage or to not eat to excess, but the combined effect of willpower and social disincentives might be enough to make people relatively healthy and well behaved. And so, in moderation, fat shaming is good in the same way that small amounts of sloth-shaming and wrath-shaming are good.
"I'm surprised that you, usually a defender of religion and traditionalism, would have such a view on willpower."
Oh ho, friend! What do you think I am, a Pelagian heretic?
We can do nothing of our own will to be freed from sin, we need the help of grace. Gluttony is a sin, but willpower alone won't free you from that sin.
I haven't enough willpower natively, I need the injection of it from outside to help me . Shaming people and blaming people is not that help.
God alone knows. If I were a totally different person with a totally different personality, maybe I would love exercise, or be able to muster willpower to only eat three slices of carrot and six heads of steamed unbuttered unoiled unsauced* broccoli for every meal.
*I mean white sauces like bread sauce, parsley sauce, cheese sauce, onion sauce, etc . The ones made with flour and butter and hence Bad For You.
Support and encouragement. Seeing visible beneficial effects.
All the nagging, shaming, bullying and so forth as recommended in comments here has never done anything but driven me to emulate a bear getting ready for hibernation: hole up in my cave and eat eat eat.
"I was asking about what works for you as an injection of willpower from the outside."
I have found that having (a) a schedule and (b) a workout partner helps for exercising. There is a SCHEDULE that means that working out is a default for a given place/time and you have a partner to not let down. Neither of you may want to go for any given session, but neither of you wants to be the one to call off the (obviously good or you wouldn't have schedule it!) session.
I have no idea how to make this work for diet modifications.
And I exercise and think it helps with general health, but I'm not convinced that it is terribly useful (long term) for weight loss.
"We can do nothing of our own will to be freed from sin, we need the help of grace. Gluttony is a sin, but willpower alone won't free you from that sin."
My theology is rusty, so forgive me if I'm wrong, but aren't we supposed to at least try? No Christian I've met has ever said "don't worry about it and sin as much as you want, because God will forgive you". At the very least they stress repentance, which doesn't sound very different from accepting blame--and when done publicly, it's not very different from shame.
"Eat less, cook instead of ordering takeout, walk instead of bus, bike instead of car, etc."
Excuse me while I rock in my chair, laughing.
In my 30s-40s I was one of the fittest fat people you'd ever meet. I can't drive, and there isn't a bus service in my town, so I walked everywhere I needed to go. Sometimes I'd cycle. That was my entire life, pretty much (if I needed to go somewhere further than my local town, I'd get the intercity bus or a lift from a family member with a car).
I had tree-trunk calves from about the age of twelve from all that cycling and walking and carrying things while I walked. Did it make me lose weight? No, I was still podgy of body and pudgy of face. But I was *fit*.
So yeah, "just exercise more and it'll drop off" was always a source of amusement to me. I once, due to a screw-up in getting paid, while living away from home spent an entire week living on soup once a day and (of course) walking everywhere. I was at the point of fainting into bed at night, but the one bright spot was that surely I'd lose *some* weight.
Guess what? No. Maybe a pound or two, but nothing significant. My body was grimly hanging on to the fat reserves come hell or high water. The biggest disappointment of my life, but the reality of what the hell my metabolism is and I don't know why. I keep being told my thyroid levels are fine, but I don't know.
In ideal case, the pill should allow you to choose the parts of your body where you want that 5% to remain. (Anecdotally, it seems to be a problem for some women, that when they diet, they start losing fat from the wrong body parts.)
Anyone else remember the heyday of brown fat? Brown fat was the healthy body fat and was the response to cold, so we should all expose ourselves to cold temperatures and that would encourage conversion of body fat to brown fat which would be then be burned off to heat us up and we'd get thin.
I remember sitting in cold rooms until I literally turned blue with the cold. Never started any of that miraculous burning away all your body fat for heat.
They do that already, and indeed that's how one loses (fat) weight. The problem is however that the combustible form of fat (fatty acids) bears no biochemical resemblance to the glucose which apparently is the main component of "have you eaten enough?" signaling pathways to/from the brain. Thus the irony that we can feel "starving" while at the same time having a complete sufficiency of energy available through fatty acid metabolism (and gluconeogenesis).
That is, the problem is not the energy pathways themselves, but the signaling pathways to and from the brain.
[speculation] In men it's mostly testosterone levels. It signals the body to both repair+increase the muscle mass AND not to burn muscle for energy when on a calorie deficit. Some people will never be lean as their bodies prefer shedding muscle before burning fat.
There's also probably some other factor regulating this behavior. IIRC there's a yet unexplained effect of anabolic steroids that makes fat burning more predominant even beyond what would be accounted by the muscle gain. It could be that steroids activate what naturally lean people have going.
Did you grow up food-insecure? Because this sounds pretty in line with the 'thrifty phenotype/epigenotype' hypothesis: your body is hanging on to those fat reserves because experience has told it that reliable access to food is not something it can take for granted. Maybe the hunter gatherer lifestyle that it's adapted for needed all that fat when it was living on raw tubers and bugs for months on end, and it doesn't think a week on soup is an emergency worth burning more than two pounds of fat for.
I wouldn't say that, but there is obesity on one side of the family, so you tell me if it's genetics or what at work.
Also Irish, so... descendant of the people who *didn't* die in the Famine? 😁
Some of it is environmental/genetics, but some of it must be bad habits and no willpower, since I have a sibling who has the opposite problem (they get stressed and stop eating and over-exercise and are always skinny; I get stressed and comfort-eat).
Tangential to your main point (that one can't really lose weight by pure exercise), which so far as I know is quite accurate, I thought it might be worth mentioning that a pound or two is a pretty significant weight loss for a week.
1 lb = 3500 kcal, so if you actually lost 2 lb = 7000 kcal that implies a deficit of 1000 kcal/day, which would be very noticeable indeed. The basal metabolism demands for a 5'4" female age 35 at 135 lb is ~1400 kcal, and walking tends to burn ~200-350 kcal/hour, so to run a 1000 kcal deficit daily one would have to cut the usual ration by two thirds, walk 3-5 hours a day, or some combination of both -- pretty harsh.
I think Gary Taubes in one of his many diatribes against calories in/calories out points to some empirical evidence that if people exercise they almost always boost their intake more than enough to compensate for the calories burned, because exercise makes you hungrier of course.
No, the first weight you lose is water weight. It's easy to 'lose' weight like that, but it's not shifting fat. I was disabused of that the first time I had stuck to a diet (as advised by my doctor to go on a diet), lost a stone, and went back to report all pleased with myself.
Doctor told me that was just water weight, I hadn't really lost fat, and I would have to continue on a lot longer to really start losing weight.
So living on a bowl of soup and lots of water per day for a week got rid of some of that water weight, but didn't kick off the fat-burning. And of course once I got my money sorted out and could buy food, I went back to eating normally so naturally no weight loss. If I stuck to "one bowl of soup a day" for a month, then maybe real fat-burning weight loss would have happened.
Yes, that is also true. Water makes it difficult to assess genuine weight loss over anything less than a few weeks. As a weird illustration, I am in the habit of 72-hour fasts on certain regular occasions, and one thing that is interesting is that, although I am obviously missing ~6000 kcal, so probably have lost ~1.5lb of fat, whether I will actually weigh more, less, or the same afterwards is impossible to predict -- depends too much on what changes may have occured in my state of hydration.
I was just pointing out that if you *had* actually lost "a pound or two" over a week, that would be pretty sizeable.
The amount of water (and of (literal) shit) in your body can fluctuate by more than a pound or two -- you're better off treating the last digit of your weight as a random number generator. See _The Hacker's Diet_.
I don't even have a car or a bike, and since covid I also started avoiding buses. I walk to my work for 40 minutes.
I admit I could work harder about the eating less part.
The meta-point about the traditional advice is that either you need to do it 100% right and mere 90% gets you nowhere (possible, but then it would be nice to admit that following the advice is harder than it seems), or just one part of it is the real advice and the rest is bullshit (also possible, but then please stop telling the bullshit parts).
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family.
2. Replace carbs in your dinner with fat/protein. Eat as early as possible, eat as much as you want. Don't eat bedtime snacks.
3. Over time, extend the time from ending dinner (your "fast" length) til the next time you eat (breakfast? 12:30 lunch? 2:30 lunch?) as much as possible. Eat the next day when you're hungry, but if you're only feeling kinda hungry try drinking a zero-cal electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories a day is impossible. Measuring that you ate 10 minutes later is easy. Don't put any sugar or carbs in your morning drinks.
4. Eventually cut out breakfast or lunch, or eat later lunch. Just like dinner, replace carbs with fat/protein as much as possible. Whatever feels okay.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale.
Hey you have described your weight loss system multiple times here. I think readers get it. You sound like you think the reason we're not all converts is that we do not understand your system, and need to hear it explained again. In fact, people are telling you multiple reasons why things along these lines have not worked for them, and/or multiple reasons why they believe such things generally do not work for many people over the long run. Are you giving any thought to all this testimony and all these ideas?
"Are you giving any thought to all this testimony and all these ideas?"
Absolutely, previous people's testimony and experience (of which all of the versions given in this thread are a subset - not as a critical judgment of them, just that diet advice almost always fails in relatively predictable ways) is the reason this is my plan, instead of being traditional stuff like weight watchers calorie restriction.
"Hey you have described your weight loss system multiple times here. "
Well, not to be rude, but if you're describing it as a weight loss system, then I haven't explained it well, because it's not a weight loss system, it's a "increase healthiness system" and I posted it here because I think focus on specifically weight loss via semiglutides or surgery is part of the problem.
"In fact, people are telling you multiple reasons why things along these lines have not worked for them, and/or multiple reasons why they believe such things generally do not work for many people over the long run."
To be very specific, no one I've seen so far (maybe I missed it) is saying they have tried something like this and failed, (whereas I personally have succeeded, and know dozens of other real live people whose testimony is that it works) and the "such things" they present are often critically different in major ways that are also exactly the reason I present this strategy as an antidote to them. You're essentially saying "well, all these other people have tried such things like, leeches and balancing bodily humors, why do we expect your plan to take antibiotics to work?" Maybe I'm arrogantly assuming my method is superior, but it was created (not by me!) precisely to incorporate what you're saying - the testimony of millions of people saying that previously recommended "diet" advice didn't work. The key is in the "what" is being recommended, and whether it goes against the grain of how we understand humans and their metabolisms to function.
Additionally, when people are saying "diet advice X didn't work for me" in this thread, in every case they have cited weight. This is the part I want to repeat more than my strategy: don't measure success on the scale. You can't timetravel to see if you get diabetes 25 years from now, you have to get bloodwork done, or you have to read all the papers describing the other markers you can see to detect a healthier metabolism, or get a continuous glucose monitor, or you have to take my word for it. (This cost of this measuring indeed a major failure point of my plan, which you should critique)
OK, Brian, I have tried it and failed, and by failed I mean not simply that I did not lose weight, but that I did not stick with the plan. I had been reading about carbs, and how processed carbs and sugar do not really satisfy and you make you crave more of them. So I planned to follow a regimen of eating nothing sweet except fruit, not much refined flour & the like, and lots of protein, fruits and veggies. I did not avoid animal fat. I am a vegetarian, but ate lots of sharp cheddar, an animal fat favorite of mine. I did not count calories. I was not solely focused on losing the 20 pounds I wish I were not carrying, but of course that was on my mind. It is simply impossible not to care about that. And I did deviate from the approach you describe in that I did not make insanely delicious meals that gave me deep satisfaction. I absolutely hate cooking, and am simply not willing to take much time away from activities I value in order to do awesome cooking.
I have stuck with the no-sugar part for several years now, and find that cookies etc. are no longer calling my name when I'm in a bakery. However, I have not stayed with lots of fruits and veggies, I have slid back into eating simple carbs, things like slices of white bread, because I like them and they're easy to grab . And I never did do the part of preparing wonderfully palatable meals. The things that have kept me from sticking to my plan are things like this:
-Most vegetables are not pleasant to eat unless you chop them up and put a nice dressing on them, or cook them. I hate doing food prep. If I'm busy, tired, or preoccupied with something else important to me cooking is the first thing to go.
-I default to eating lots of cheddar cheese and little else -- because I'm out of fruit, and the veggies I have need prep to be bearable. I got busy and did not shop.
-I get busy doing something important to me, miss a meal, then am so hungry I grab whatever's handy that I can stand -- cans of cashews, lumps of cheese, fried stuff from Uber eats.
Obviously I *could* have done other things at those times. I could have made a salad or cooked the veggies or made an awesome delicious meal. I could have shopped more often so there was more healthy stuff in the house. I could have not let myself get so hungry. But it is an illusion that knowing that makes it likely that in the future one will act differently. The same factors that led to suboptimal eating in the recent past are all going to be there in the near future. Habits are hard to break, and the breaking of them draws on the same limited pool of energy and self-monitoring capacity as all the other things we need to accomplish. Eating is a simple pleasure and doing it provides a break from life's demands. Turning it into something that must be done a certain way both reduces the amount of simple pleasure in the day and also adds a new demand. That's a hard sell. There may exist some heaven of healthy eating, zero minutes per day of craving things that are unhealthy, and amazingly delicious meals that satisfy the living daylights out of a person, but then again there may not, for all of us. And even if it does exist, getting there is no easier than accomplishing lots of other goals we have for our careers and relationships, and far more dispensable.
That's.... not my plan? What you're describing is keto, and yeah, while it does work, people have trouble sticking to it, for exactly the reasons you point out. That's.... the entire point of my plan, that things like keto are sometimes hard to do.
I apologize, sometimes on substack it is hard to see which previous comment someone is replying, which makes me think maybe the "plan" we are debating is not the same one. This is my plan:
1. add tasty fat and protein to your dinner. This increases satiety, and therefore the amount of time til you're hungry. Reduce the carbs if convenient/easy, you will likely be forced to, because if you add fat/protein to a meal, you won't have room for the carbs.
2. Over time, extend the time from ending dinner until the next time you eat as much as possible, eventually cutting out breakfast and delaying lunch.
3. Get bloodwork done yearly, and use the metabolic indicators in that to inform your success, rather than weight.
The reason this is the plan is precisely because of the experiences you (and many others) had with a keto diet (or many others). Hunger is powerful. Cravings are powerful. Eating tasty food is enjoyable. People have increasingly little time to select/prepare foods. A diet that works must accept that, which is why "my" plan explicitly caters to those limitations in daily life.
No, I wasn't doing keto. I don't think you read carefully. I said I ate nothing sweet except fruit (should have said fruit and vegs), and nothing with much refined flour. That's a far cry from keto. I ate potatoes, sweet potatoes, grapes, starchy vegs like peas and corn, whole wheat bread, brown rice, oatmeal -- lotsa carby things, just not white-flour based things and nothing with added sugar, corn syrup etc. and I did not limit how much of them I ate. My daily carb count would have been way far out of the keto range. It was not, though, terribly high I think, because I really liked cheese, full fat cheese, by the way, better than most of these things. A typical dinner for me might have been a potato with a LOT of cheese melted on it, and a piece of fruit, maybe a coupla raw carrots. As I mentioned, I do not cook. This meal may sound sort of drab to some people, but I truly enjoyed it. I did not limit quantities. No matter how much I eat in the evening, I need to eat fairly early after waking up the next day. First of all, I wake up hungry. But the big problem is that if I get very far into the day without eating I get a headache, and sometimes that turns into a migraine. Have a couple of my migraines, and you too will lose your enthusiasm for trying to go as long as possible before eating the first meal of the day. (And yes, it happens even if I drink a lot of water to rehydrate for the day.)
Okay, was just trying to slot it based on a few key words.
If you have migraines with triggers based on deviation from your routine, then yeah, this (and many other things that involve changing routines) are going to be difficult. If the migraine trigger is low blood sugar, as it is for some, then it might be possible (no way for me to tell!) to affect it (like the sensation of hunger) based on the blood-sugar-affecting quality of the food you eat. I don't have frequent migraines, but I have had a few that I think are triggered by over-consumption of very specific foods.
While you were doing this, did you happen to get A1c or other indicators taken? There might not be anything that needs fixing!
My a1c is checked yearly at my physical. It has always been normal. Going for a few hours without eating in the morning reliably leads to me feeling tired, slightly dizzy and overall crappy, with a mild headache that gradually worsens. That's consistent, not something that happens occasionally, as though possibly triggered by some food. Maybe 10% of mild headaches turn into migraines for me. That's consistent too. It's how my body works.
If your a1c and other metabolic stuff is within normal ranges, your metabolism is most likely working as it should, and you don't need to *do* anything, except enjoy your life! :) Definitely don't do things that give you migraines! If you have a few "extra" pounds, it probably doesn't matter!
Oh, now carbs are the new sin, and you were a terrible sinner. Professor. Fung would be so disappointed in you!
""They are so high in carbohydrates that they are more like grains than greens. It makes more sense to put them in the same category as breads, rice, or pasta," says dietitian Teresa Fung, adjunct professor in the nutrition department at the Harvard T.H. Chan School of Public Health.
When you eat mashed potatoes you're probably adding butter and other unhealthy ingredients. Or maybe you top a baked potato with sour cream and bacon bits. And it's quite easy to overeat, and you end up eating a lot of calories that aren't so satiating," Fung says.
Fung says that, if you're healthy, you can probably eat one serving of root vegetables every day. "Just make sure it's a side dish or part of another dish, and that it's the only starch on your plate," she advises. In other words, don't have a serving of rice and a serving of sweet potatoes."
So for the ideal diet, you could have had one cup of mashed turnips per day. Or one slice of bread. Or - well, you can figure it out 😀
I think the pendulum has swung back and carbs are OK again, though I stopped being hypnotized by it a long time ago so may be wrong. Mashed turnips sound very nasty indeed, pretty close to bottoming out. I suppose rutabaga might be worse though . . .
isn't the way that semaglutide works is by making you feel full and satiated after eating? of course you need to be changing your diet -- if you continued eating the same way, you wouldn't be able to lose any weight. the hard thing about losing weight is that your body will do anything it can to make you eat the calories you're trying to avoid (and will hold on to the fat it already has, although that can usually be overcome with enough time). the brilliance of this drug is that it basically helps you stick to a diet.
IMO exercise doesn't actually help you lose weight anyway except insofar as it helps you build muscle, which makes your metabolism higher, but it's a good thing that people should do regardless.
re: diet, I think semiglutide might being affecting your metablism too - hence its use as diabetes drug, but I'm not educated enough to know for sure.
re: exercise, yes, it may not make you lose weight (in fact I think you should gain weight, if you're doing strength training) but it makes you healthier.
And to dovetail both: we want to be healthier metabolically, that is the goal. Weight is just a symptom that we only care about as potential signal.
This jives with my experience on the drug earlier this year. I was on living primarily on pre-made keto meals and after starting on semaglutide I felt like it was too much food for a setting, switched to a lower cal option. When shortages of the drug caused me to miss a few weeks, the lighter meals were quickly noticed as not-satiating.
While this is technically true, there are a *lot* of things that would be unnecessary if everyone in the world always made good decisions and showed perfect discipline at all times and experienced no akrasia at all. That world would look extremely alien to the one we actually live in.
Given that we live in a world of imperfect willpower and decision making, finding ways to mitigate the consequences of those failures is both important and valuable.
I will say, though, this is one of the areas where I feel like government intervention may be warranted, or at least could have good outcomes. I don't think people would suffer if there was a tax on fat and sugar above a certain point on all foods such that all their food choices were healthier.
Wait, I've got an idea. Let's put everyone on the diet-that-can't-fail. Then, we can piggyback all the other things people have trouble sticking to onto it, like ornaments onto a Christmas tree: Every time you have a proteiny meal, write down a work goal for the next few hours -- productivity solved! Every time you lose a pound, pay any unpaid bills -- budgeting solved! Every time you lose 5 pounds, spend an afternoon working on that great idea you had that you've been procrastinating on fleshing out -- getting rich and famous solved!
Nope. It is the semaglutide. See my comment below for details. I lost 20% of my weight (55 lbs) in 14 months. I did not change what I ate (good fresh home prepared food) or how much I exercise (mostly an hour a day of walking). I just ate less of the same stuff.
I hate to be that guy, but I do find all these debates about extremely expensive weight loss cures (Matt Yglesias has a recent article about getting [I forget which] surgery) kind of annoying, where there are literally money-saving ways to lose weight - and more importantly than that, improve your metabolic health (where obesity is a potential symptom).
"semaglutide comes heavily recommended with diet and exercise and many stern injunctions about that!"
I wonder what effect that heavily recommending things that cause weight loss alongside your weight loss drug does.... I also wonder "what" diet and exercise is being recommended, when there is so much (conventional wisdom) diet and exercise advice that will definitely not make you lose weight, or worse, make losing weight so unenjoyable that you don't want to do it.
Yes, and that's why just waving the magic totem labeled "do diet and exercise" doesn't work. Exercise done right doesn't make you lose weight, but you should still do it. Diet can, but most diet advice doesn't work, or works, but is too difficult to stick to - giving an out to the Puritans who lecture people for being insufficiently pious. And remember "work" isn't defined as "lose weight" it is "be healthier and less likely to have the bad health outcomes that are currently correlated with being overweight"
This works: https://moore2024.substack.com/p/no?sd=pf
Yeah, my first year Behavioural Psych teacher had a great point when he said imagine a problem in the world (I picked AIDS). Then imagine a behavioural change that would 'cure' it. This idea was revitalised with Scot's post along the lines of technology is possible biology (behaviour change) is not (immutable).
Behavior does change, but that doesn't mean anyone can reliably choose to make it change, for themselves, or large groups, or for everyone.
yes. Human behavior is immutable. That's why we still live in tribal societies of no more than a couple hundred people led by hereditary nobles.
>The same can be said about pregnancy and STDs ("Just don't have sex")
Terrible analogy. Not having sex works 100% (alright let's say 99.999% to account for urban legend-tier accidents) for STDs and pregnancy. It's not a problem of effectiveness, it's a problem of "people don't use it". If a medicine cures a disease, it's not a failure when people who decided to not take the medicine suffer from the disease.
"People don't use it" is very close to "the cure is more unpleasant than the disease", which is a failure of the cure.
Amputating one's hands is 100% effective against carpal tunnel syndrome, both as a cure and for prevention, but I wouldn't say it's not a failure of that treatment that people choose not to do it.
"eat less stuff" is a gold star way to lose weight except that people suck ass at it. I have succeeded in the past, but put back on 20 pounds from my ideal body and am failing currently; it's pretty damn hard. I don't know if that's what you mean by money-saving way to lose weight, but if it is then I think it's an incomplete solution--eat less stuff needs a very firm "how," and that seems to vary person-to-person
Why eating less is so difficult and why losing weight at all by any method is so difficult are questions at the very edges of current neuro- and metabolic research. Most of what we tell the obese is unhelpful.
The real reason it's so difficult is that eating too much has simply become too convenient, whereas not doing so apparently doesn't come natural for many people.
I can see it in my wife: when she had the mental strength to account for everything she ate, counting calories and adjusting her diet to get enough protein, she easily lost weight at exactly the expected rate. As soon as she stopped doing that she started to eat too much calories with too little nutritional value again, as those meals are way more convenient to make, more tastier for her and immediately rewarding for the brain (but don't actually make the hunger go away for long). Despite her noticing how a protein rich diet made her feel full for far longer, allowing her to eat only two meals a day easily, she can't maintain such a diet without dedicating substantial mental strength to it; and she can't properly limit her calories with a more convenient diet either.
The difference between her and me is that she absolutely can't tolerate hunger, like at all. Not eating breakfast when starting early into the day to achieve something is simply not an option for her. Neither is skipping meals when eating her usual diet.
I on the other hand would rather sleep in another 15 minutes than to get up early to find the time to eat something. I can easily skip two meals out of three without any issues for days. I feel hunger sometimes, but I can just ignore it for an hour or two, and then it goes away. For me its absolutely no issue to maintain a BMI of 22-23 without ever stepping on a scale, counting calories or diet adjustment. I just stop eating when it's too much. I also don't stuff in left-overs for the sake of finishing them, which makes my wife mad regularly. She just can't get off the idea that this means wasting food.
A drug that would make the feeling of hunger go away would certainly help. But the real message is: convenient diets are unhealthy. We should have more healthy food options which are convenient to consume. If eating healthy requires extra effort, a lot of people will fail to do so ...
And all of that is without even considering people who simply have to eat whatever is the cheapest option available ...
Sorry, but I'm a little miffed here. "Convenient diets are too easy" is certainly a contributing factor, but the rest of your comment reads like someone lecturing a person suffering from chronic pain.
"Well, *I* don't get sensations like my bones are splintering and turning into knives cutting my flesh, so an occasional aspirin handles things for me just fine! Why do *you* need strong pain-killers? Modern pharmaceuticals have made things way too convenient!"
You say you don't get hungry and can easily skip meals without noticing, or ignore any hunger you do feel. Yes, that means it's easier for you not to eat and to stay at a 'normal' weight.
Try imagining you *do* feel hungry. Not even that - do you get thirsty? Do you drink plenty of fluids during the day? Can you easily ignore being thirsty? The next time you are thirsty, try "no you can't have something to drink right now, you had a glass of water this morning, you have to wait a minimum of four hours before you can have your next glass - and only one!" and see how you hold out.
This is probably not how you intended it to sound, but your comment comes off as "my wife is so over-sensitive and has no grit, she can't handle a little bit of pain/hunger, she just needs to toughen up - me, I could have my hand chopped off and not even notice, *that's* normal!" - see what I mean about the comparison to chronic pain?
You took my post in exactly the opposite way it was meant. I'm not saying that anyone would be at fault in the way you construed it. Quite the opposite. I was saying that the individual experience of hunger was very different; as is btw. the individual experience of pain.
This makes it extremely difficult for my wife to maintain her weight while consuming exactly the same kind of diet which I eat. Where she needs willpower not to eat something, I just need lazyness to prepare food. While she had to adjust her diet to lose weight to a high protein one, I can live as a skinny fat on a low protein diet just fine without any effort (and then still suffer from much of the issues such a bad diet entails). None of this is my achievement or her failure. It's just a simple fact.
I'm sorry if it came off differently. But I feel as if you were reading my comment almost in bad faith here. How would it even be my wife's fault that she experiences hunger far more severely than I do? And how would it be an achievement of mine that my body reacts far more charitably to not getting any food for an extended period of time? Neither of us chose our bodies or our body experiences. And nowhere did I blame her for her way of experiencing it.
I then proceeded to say that the reason this difference leads to that much obesity is that high calorie diets with low nutritional value are much easier to purchase and consume nowadays than diets which are well balanced. My wife, when trying to lose weight, had to go to great lengths to get all the nutrients she needed, while going cal negative for an extended period of time. IMO this is something we as a society could and should address.
Here again I'm under the impression that you are reading my comment in bad faith, as your example with pain killers works exactly the opposite to what I said. So your comparison doesn't even make sense and IMO only serves to discredit my thought.
And to answer your similar bad faith attempt at thirst: yes, I also experience thirst way less severely than my wife. Again: this isn't her fault or my achievement, it's just a plain fact.
Btw.: I am a chronic pain patient, having shattered my left hip a few years ago. I don't have a single day in my life without pain. And I don't use any medication for it (though I had doctors call me out for it, claiming stupidly that no one should ever need to experience any pain at all). Yet I never told anyone that therefor they shouldn't need any either. That would be simply plain stupid. I did need quite a lot of those the day I shattered my hip ...
No worries. It's phrases like "a little too convenient" which, if you've had a lifetime's worth of advice about "don't be fat", sound like the same old "just have some WILLPOWER" scolding.
"Eating too much has simply become too convenient" may indeed be true, but there is the whiff of moral judgement about it. If only you, fat tub of lard, would bother to go out and shop for HEALTHY FOODS LIKE VEGETABLES and then put some effort into COOKING A PROPER MEAL, then you wouldn't over-eat and what you ate would be PROPER FOOD. But instead you are too lazy and greedy and want FAST, CONVENIENT, NO-EFFORT CALORIES.
You know, the popular imagery when you search for "overweight" or "obesity":
https://mexicobariatriccenter.com/wp-content/uploads/2016/11/8-Causes-of-Obesity-Mexico-Bariatric-Center.png
https://www.lalpathlabs.com/blog/wp-content/uploads/2017/07/shutterstock_357740381.jpg
https://images.drlogy.com/assets/uploads/img/admin/health_blog/obesity-symptoms.webp
https://img.freepik.com/free-vector/obesity-health-concept_1284-9906.jpg?w=2000
You know your own home situation better. Is your wife sitting on the couch in front of the TV, cigarette in one hand, bowl of candy on her lap, and sugary soda in the other hand? Does she never cook and eat vegetables?
Or maybe she does that, but still has trouble controlling cravings and habits.
Most of my life, I had no easy access to those sugary snacks or fast food. I grew up eating those healthy veggies and home-cooked meals. And I was a fat kid, a fat teenager, a fat young adult.
"Convenience" is a label that covers a multitude, including accusations, which is why I react badly to it ('you're too LAZY to cook healthy meals!')
I was specifically talking about the convenience of accessing foods with lots of calories but a lack of protein, not about the easy of access to foods in general.
We noticed this when my wife was actively losing weight. Whenever we were searching food on the go, it was essentially impossible for her to get something which would provide her with enough protein, but not add too many calories. She always had to prepare special meals for herself instead of being able to just eat whatever was available. You can do this for some time, but you can't do this all the time. Which is why she did gain everything back pretty quickly once she lacked the time to painfully account for everything she consumed and to plan ahead everything she consumed for several days.
I'm fully aware that I'm not living healthier than her, as we both eat the same things most of the time. I just have it easier than her to stop at the right amount of calories to maintain my weight. That's all ...
I didn't find that your comment at all had that tone, FWIW. Like, it didn't even occur to me to interpret it as dismissive, and I was surprised to see Deiseach reply like that.
A little surprised. It's Deiseach, after all... (Kidding, kidding!)
I too get a bit pissed, sometimes, when people say something is too easy or too convenient or too pleasurable(†) — that's the point of life, as far as I'm concerned: ease and pleasure, mmm! — but in context I thought you clearly meant "too convenient [to easily resist / go with an alternative]", and not any sort of value judgment.
-------------
(†) all that said, I totally disagree with your characterization of the doctor's remark! IMO no one *should* ever need experience pain — both in the sense that there's no moral reason, and in the sense that painkillers are great, heh.
Pain has a very useful function though. It's essentially a stop sign issued by your body meant for you to make adjustments to whatever it is you are doing.
Would I like the pain to go away? Of course I'd like that. But would I want to sacrifice the utility it has? Hell no ...
My pain levels are a clear indicator on how well I've done in the past days to regenerate on (replacement) cartilage. They are a clear reminder to train my joints properly and regularly; and to go slowly when my hip joint is fragile ...
"You took my post in exactly the opposite way it was meant."
I read your post exactly the way you meant it :-)
I sort of get the convenience complaint, but sort of don’t. I think it is mostly just about the raw hedons. A cucumber is pretty good and super convenient, and you can just eat it like an apple.
But people will make a sandwich or cook something in the microwave instead because that food simply tastes better.
I just don’t think convenience is as much of an issue compared to accessibility and the overlap between caloric density and tastiness. Sugar tastes great.
Maybe I phrased it wrong, but I was trying to convey the convenience of foods actually filling you such that you no longer have any cravings.
My wife eats lots of cucumber btw. ;-), but I wouldn't call them a meal. I could eat ten of them and still be hungry. They might help with alleviating thirst though ;-)
I'd consider accessibility the main part of the convenience btw. A major issue, while trying to lose some weight, for my wife was finding something suitable to eat when not eating at home and not having brought our own food along.
No, I totally agree with you and not with Martin Blank. Convenience is the #1 issue for me; if there was anywhere around me that offered quick healthy meals, I'd go there. I don't care too much about how food tastes; I just hate fucking around with it. I end up with fast food mostly because I don't want to take >15min on a meal.
Of course, I'm not obese, so maybe my anecdata doesn't apply to the point Martin was trying to make; but still, I'd certainly be eating *healthier* if it was more convenient, and the same goes for people I know who *are* overweight, I think.
Seriously get some cucumbers then. They are super convenient. Ditto like nuts and berries. Tons of healthy stuff is relatively no fuss.
Cucumbers are great! Water, fiber, and vitamins, all in a portable container. Cucumbers and landjaeger are my go-to travel meal.
Ah, somebody else who hates fucking around with food! Me too. I hate shopping for it, I hate unloading it and storing it, I hate cooking it and I hate cleaning up the mess that cooking makes. I cannot believe how much time per day other people spend on food prep and related labor. I don't look down on them, just have a hard time understanding why it's worth it to them. Like you, I don't care that much how food tastes. So long as it tastes decent I'm fine with it. I just try to find reasonably healthy things that require little prep, like 5 mins. in the microwave, or can be eaten as is. Fruit, bags of nuts, bags of peeled carrots, Trader Joe's frozen pot stickers . . .
> quick healthy meals
I can buy dried fruit without added sugar at shop. That sounds like a combination of "healthy" and "fast food". But it would be better if I could also buy *vegetables* like that. (And preferably, not too expensive.)
Dried fruit can be hard on my blood sugar. My tolerance for it varies, but it would be a bad idea for me to use it as a staple. It's not health food for me.
Your wife's (and yours!) experience is totally normal. Most people cannot (and shouldn't) abide hunger, and that is a huge part of why normal "eat 20% less calories" diets don't work, even for people (like her) who have the capacity to measure it. Eating 20% less at 3 meals is also far more difficult (and will result in those leftovers) than eating less in discrete chunks by eliminating meals. Obesity (or lack of it) does not come from
But yeah, if you feel HUNGRY, a "diet" isn't gonna work, period. No one can manage long term hunger in a world that has so many easy things to eat.
Not to be internet nutritionist, but the the thing that everyone I've spoken to has worked (for varying quantities of "worked") for is adding replacing carbs with fat/protein (eat as much as you want for dinner, earlier is better) and then just extending the time period until you eat next (breakfast, or lunch, or later lunch, etc...) til whenever you feel hungry. If you feel "kinda" hungry, drink a zero-cal electrolyte drink first and then check if you still wanna eat a meal. Measuring whether you ate 1741 calories or 1787 calories is impossible.
And also, I just want to reiterate: obesity is a symptom of underlying nutritional condition, not a disease. Some people who have it are fat, some are not. It has bad effects even if you aren't fat. Semiglutides (being diabetes treatments) may somewhat treat the underlying thing (I don't know for sure) but if you adopt a diet that you enjoy, and your A1c and other metabolic indicators get better, you are HEALTHIER, and much lower risk for a long laundry list of bad outcomes even if you don't lose any weight, or never had much fat in the first place. Depending on *what/when* you eat, you (with your low BMI) might have less healthy A1c/etc... than your wife, with the potential bad outcomes. This entire thread is far too focused on treating the symptom of obesity and pretending that if we removed that, we'd fix the problem. (it is possible that semiglutides DO partially treat the underlying problem) There are too many skinny 60 year olds who die of things and we go "so sad, what bad luck, they were so healthy!" but if they were fat we'd go "oh man, if only he'd kept in shape" but they died of the same thing for the same reasons.
Well, those diets actually do work. Physics can't be cheated. That's a big part of the problem. Because it puts so much guilt onto people to whom it doesn't come naturally. The problem is that hardly anyone can put up with them for long enough to get into another mindset, where those changes suddenly come naturally.
Btw.: my wife never felt hungry during her time of losing weight, simply because she did ensure to always consume enough protein. The problem is that most foods which are easily available don't come with enough protein to do that. Just eating less doesn't cut it most of the time, as your diet then quickly become protein deficient. You have to adjust your food items a lot to do it. And then convenience goes out the window. That's what made my wife fail eventually as well after nearly making it into perfect BMI territory.
As for "Some people who have it are fat, some are not.": that's exactly what the term skinny fat refers to.
Just for the record: I never pressured my wife into doing any of this and love her just the way she is. I'm merely trying to recount her experience when she tried a few yours ago.
Well, depends what we define as "work." I am defining "work" as "reduce unhealthy outcomes," not necessarily as "lose weight."
"Btw.: my wife never felt hungry during her time of losing weight, simply because she did ensure to always consume enough protein. The problem is that most foods which are easily available don't come with enough protein to do that. Just eating less doesn't cut it most of the time, as your diet then quickly become protein deficient. You have to adjust your food items a lot to do it. And then convenience goes out the window. "
Your wife (and you) are doing great, and what you're saying makes great sense: my only suggestion to you specifically is that while protein is great, the only way to really beat back hunger long term is fat. I guess my other recommendation is to get yearly blood work, and look at those numbers instead of the scale. If your wife is eating healthy and exercising and her numbers look good, extra pounds (which absolutely are going to get harder to keep off as we all get older) can be ignored. I don't want to read into people's thoughts but you are absolutely right about the guilt, and for me at least, having good lab numbers (which are more important than BMI) trumps (and should) what the scale says.
"As for "Some people who have it are fat, some are not.": that's exactly what the term skinny fat refers to."
Yes! It's a great term, especially since it emphasizes that we've mentally replaced the word "unhealthy" with "fat".
I agree about the "lab numbers" > "BMI". My wife was only trying because her parents and her sister really struggle hard with obesity, and their lab numbers have become alarming because of it. Prevention is better than trying to deal with the issues later. We both want to grow old ;-)
That is the same motivation my wife and I have. :) I only mention it because there are times, especially for people like us who are.... on that process of growing older already... when you can do all the Right things with regard to health, diet and exercise, and see good lab numbers but still have "bad" weight/BMI numbers or visible fat, and to not worry as much about that.
> Most people cannot (and shouldn't) abide hunger
This seems an extremely weakminded and degenerate statement to make. Hunger is a natural and healthy state we evolved to cope with. Certainly you SHOULD abide hunger if you are an unhealthy weight
That's fine, and I heartily endorse confronting yourself with things like hunger and overcoming them for all kinds of personal reasons, but within the context of "having a goal of reducing bad health outcomes for hundreds of millions of people with a policy to do every day" then adding a cost (suffering hunger) is something that will detract from that goal.
If hunger (there is also some definition difference here, most Americans have no idea what "hunger" actually is, and use the term to describe the blood sugar low of "it is 4:30 and my tummy says it is time to eat dinner" that is fundamentally not "my body is suffering from lack of vital nutrients and is sending a signal to my brain to acquire sustenance" that comes from different, more extreme situations) were necessary (or the most effective) to become healthier, then I'd agree with you. But it's not. If you eat satiating things for dinner, you won't be "hungry" as soon, making it easier to extend that period. Also, the "hunger" is a real sensation, and if you are feeling hunger, your body is too, and will be doing things (reducing metabolic activity and temperature output) in response to it. For our goals in this case, you want your body to not feel hunger too.
It's not a moral judgement, it's a changing the gear ratio on a machine to reduce friction.
Ok, I agree there. I thought you meant we couldn't abide it for moral reasons, which struck me as decadent/degenerate path to take.
Ultimately this doesn't seem all that dissimilar from antidepressants - one one level it probably is possible for many otherwise medicalized people to bootstrap themselves out of depression as well as obesity by personal fortitude, but pharmacological assistance might just lead to the best public health outcome in aggregate.
Pharmaceutical interventions can really help start the bootstrapping, too - A lot of the ruts one can get stuck in are very stable without chemical intervention, but comparatively easy to stay out of once you get out, so taking drugs to get out of the rut doesn't necessarily mean you'll need to keep taking drugs to stay out of it. (though doctors may just keep re-issuing scripts regardless....)
What about, like, peanuts, though? Peanuts are convenient, nutritious, and filling, but eating lots and lots of peanuts isn't very palatable. I don't think we can blame this on convenience, except insofar as convenience is one of several competing, difficult things we're trying to simultaneously optimize for.
Well, good point. What about peanuts? Answer: they are one nutrient, not a meal, and thus lack lots of crucial trace elements. To add insult to injury, opposed to what you said, they aren't convenient at all. Not only don't they solve the issue at hand, but additionally where I live they aren't really readily available. I can easily get french fries, burgers and various other fast food meals on the go. I've never seen peanuts on offer (for obvious reasons). I could go into a super market and buy some; but then again I still wouldn't have a meal, and rather just one ingredient for a meal.
That's the exact opposite of convenient. Rather hard to come by and still lacking all but one ingredients for a meal I still would have to prepare. As opposed to just ordering the Pizza, wait 5 minutes, eat ...
Nuts are kind of weird. I don't know if other people experience this, but when I get a sudden pang of hunger my body completely rejects my suggestions that we eat some nuts. I'll be super hungry, staring into my cupboard, and that bag of peanuts will be completely unpalatable to me. This is in spite of the fact that I love nuts as a snack.
It think it's something where my body doesn't want to deal with a hard and dense fatty food on an empty stomach. Combined with the fact that nuts are quite slow to affect my blood sugar.
In general I think something with starch and fiber is the best remedy when I get that kind of sudden hunger.
I’ve never heard someone else express this. It’s very odd. It’s much easier to eat peanuts with a drink after dinner.
So I am not alone after all!
It's such a pity too, since nuts are so convenient.
I've had a lot more luck with "eat normal portion sizes with fewer calories, and track what you eat." It took me from BMI obese to BMI normal and has kept me there.
Portion control went so disastrously wrong that I'm skeptical of it as dietary advice. It doesn't seem supported by a lot of evidence, either (e.g. https://www.nature.com/articles/ijo201482#Sec11).
Can you elaborate on the distinction you're drawing here? You said you succeeded with a strategy that sounds to me a lot like "portion control", but then say portion control went disastrously wrong?
If the food you eat is smaller in mass, it will make you psychologically feel starved and physiologically feel unfull. Your brain will interpret this as 'you are going through a famine' and flip switches that make you value finding food more, because that was the appropriate response to a famine in the environment our ancestors lived in for millions of years.
If the food is bulky but has few calories, like potatoes, this makes the body and mind feel like you have plenty to eat, even when you are burning fat to sustain yourself.
Evolutionary mismatch, IMHO. No way to get a 3000 calorie diet 200 years ago unless you were a king.
There's also a lot of calorically dense processed food out there.
> To go with the biscuit, sailors in the RN were issued other food on a standard weekly rotation. On Sunday and Thursday, this was a pound of salt pork and a half-pint of dried peas. Monday was a pint of oatmeal, two ounces of butter, and four of cheese. This was also served on Wednesday and Friday, along with a half-pint of peas. Finally, Tuesday and Saturday usually meant 2 pounds of salt beef. Conventionally, this was washed down with a daily gallon of beer. The total came to approximately 5,000 calories a day, an incredible amount to modern eyes but quite appropriate for sailors at the time.
https://www.navalgazing.net/Naval-Rations-Part-1
For comparison, 3000kcal/day is about my current maintenance (180cm 72kg male). And I am _definitely_ way less active (and less muscular) than a sailor or soldier in history (1-2 hours of mostly anaerobic exercise every day).
Absolutely untrue. Bread and lard weren't that expensive, and it's easy to get up there in calories on them.
I think you're right, and the "diet" suggestions tend to be "just eat 10/20% less calories during the day" which isn't gonna work: people don't suck ass at it because they have low discipline, but because it's enormously difficult to measure calories in this scenario, and your behavior/brain/metabolism compensate it. It's not a single-input mechanism black box. Your 20 off, 20 on experience is the absolutely normal failure mode for calorie restriction diets.
Not to be the Weirdo Diet person , but what I mean is: intermittent fasting, cutting out breakfast (and/or lunch) and replacing enough of your daily quick-burn carbs with long-burn fat so you don't feel very hungry while you're doing it. This works because unlike calorie restriction, it doesn't cut against daily Regular American Life behavior (you "fast" every night from after dinner until break-fast, this is just a few more hours) and all the countervailing mechanisms your body has evolved over a billion years to counter generalized calorie restriction.
I don't eat breakfast. I've never felt hungry in the mornings, and when I do eat then, it (ironically) makes me *hungrier*, e.g. at around 11 o'clock I feel like I need a quick snack, whereas without eating breakfast I don't feel that and can even go without lunch.
So all the well-intentioned advice about "skip meals" or "don't skip meals" or "eat more protein" or "eat saturated - I mean unsaturated - I mean polyunsaturated, not monounsaturated - I mean saturated fats" or "just cut out the junk and move more, what's so hard about that?" becomes frustrating.
Human biology is not like a tidy physics experiment. It *should* be "calories in, calories out". It *is* "calories in, calories out* but that is *not* the whole of it, and that is what gets forgotten.
Some people will react beautifully to "I fast X hours a day from this time at night to that time the next morning between meals" but some people will not. Some people will control hunger cravings by eating breakfast, other people will have their appetite stimulated. Some people will tolerate more fat in the diet than others. Potato diet works for one person, packs the pounds on for another.
I think you are right within the realm of the recommendations you are describing, because they're so vague/contradictory. I'm not advocating any of the advice you're mentioning, which you are rightly skeptical about them applying to everyone. Calories in, calories out doesn't "work", as a METHOD of dieting, not as a thermodynamic fact.
But is there any debate at all that replacing carbs with fat/protein in a meal will not result in greater satiety/less hunger later on, and therefore enable one to go longer before their next meal? I think everyone agrees on that, and that it applies to everyone - sure, perhaps in different ways/amounts!
Does it seem acceptable that if you go longer between meals, that your body will spend more time burning energy than storing it? Sort of by definition?
Does it seem acceptable that this would then (regardless of totally weekly calorie consumption) result in storing less energy (fat)?
And again, the goal should not be "weight loss" it should be "reducing the unhealthy outcomes", the likelihood of which can be more accurately measured by metabolic lab values like A1c than at the scale.
If you're someone who's had a good BMI forever and doesn't get their labs done, then you're never gonna notice anything because you aren't measuring anything.
"But is there any debate at all that replacing carbs with fat/protein in a meal will not result in greater satiety/less hunger later on, and therefore enable one to go longer before their next meal?I think everyone agrees on that, and that it applies to everyone - sure, perhaps in different ways/amounts!"
No, not everyone agrees, and it does not apply to everyone. It absolutely does not work for me; restricting carbs triggers middle-of-the-night half-asleep binge eating.
(I'm not normally a binge eater at all; I've only ever had this problem when I've restricted either carbs or eating in the evening.)
"counting calories of every thing one eats, to the gram" is not extremely hard. i know so because I'm doing it, and i do not ever do anything remotely hard.
To do so accurately is hard, because even if you're measuring the weight, you're relying on estimates of calorie density that are potentially many years out of date, wrong in the first place, or that the producer of the food is wrong is assessing.
And ok, that it is easy for you is fine - for millions of other people, it would be A) hard B) sufficiently time-consuming they wouldn't want to do it or C) would result in no measurable effect on their health/weight, so they would stop doing it. Maybe "hard" was the wrong term to use.
The approach you are describing sounds reasonable, but, as with most weight loss approaches, there are a lot of things that will make it hard for people to stick with over the long run:
(1)It is hard to change ones habits, including one's eating habits -- not impossible, of course, but HARD. The effort and attention devoted to that have to come out of the same pot of energy people are using to do all the other hard things in their lives -- do a good job parenting their difficult kid, produce good work in their field, keep their marriage in good shape, budget, ruminate about all the bad stuff in the news. On days when the energy pot's almost empty, most reasonable people are going to choose to reduce their effort to eat in a different way, rather than their effort in other areas which are more clearly crucial
(2) It is a heavy burden to stay continuously aware of something. Take blinking -- if I ask you now to notice your blinks, it's easy as pie, right? But how about if I ask you to stay aware of them continuously for the rest of the day? Very very few could succeed at that, especially while doing all the stuff they need to get done today, and responding to whatever comes at them this evening. Continuously monitoring eating to keep it in compliance with a certain pattern is the same -- easy in the short term, very hard in the longer term.
(3) We are surrounded by highly palatable foods, and our brains are not wired for an environment with that feature. We evolved in settings where it was hard to get enough calories. If you found a honeycomb or were presented with a bunch of roasted animal fat it was desirable to eat as much of that stuff as possible. The parts of our brain that push us to eat the sweet, fatty, salty stuff that is all around us is quite powerful, and the part that understands that it's undesirable to gorge on those things on 2022 cannot reason with the parts that want to gorge. It is possible to simply override them, but it is difficult, and it's probably not possible to override them most of the time if you have other heavy demands on you as well.
1) the goal is not weight loss. That is a side effect. The goal is a healthy diet, and reduction of serious bad outcomes in the future.
2) Yes it is hard to change habits. That's why the method is designed to affect the underlying drives that cause the habits to be hard to change. It IS hard to not eat when you are hungry. It is EASIER to not eat when you have made decisions in the past that mean you are less hungry now. Eating more fat and protein in your past makes you less hungry now.
3) There are immensely palatable foods that are not bad for you, and will provide more satiety so you are not driven to consume more so soon. Animal fat is not (particularly) bad for you. Salt is not bad for you. Replace carbs with them in your meal, eat them, and enjoy not feeling hungry so soon. The goal isn't to override your desire to eat awesome tasty food, it's to hack the system so you eat awesome tasty food that reduces your desire to need to eat ANY food for longer.
This is not a moral system. There are not desires to be overcome. There is not decadence to resist. This is not ascetism. There is no willpower. This is a physical system of chemical reactions that we can affect in different ways. We impute no moral significance to a molecule binding to one molecule instead of another, nor should we.
I do think content is certainly as important as portions, if one wants to control obesity. The national health system is pretty good about listing contents on food products. We respond to heat, salt, and sugar, and food manufacturers exploit that. I think if one adheres to a healthy, lean diet, obesity is easier to control. Another important aspect is the consumption of alcohol. Alcohol can provide energy and calories, but can maintain too much weight in an unhealthy body.
I used to be borderline obese when I drank beer or wine, but I lost 75 lbs. when I came down with pancreatitis. Today, after the most recent flare-up, I'm down to 114 lbs. -- but still 6 feet tall. For a time I thought marijuana might help ease the pain, but now my body objects when I try and ingest it, so I've given that up, too. There are certainly no easy answers, but I think the content of one's diet and the consumption of alcohol are important factors. My stomach emptied with this most recent flare-up, which is unusual, so I'm taking the opportunity to curate what I ingest carefully. I'm drinking kefir and Gatorade.
In this case, the problem with “that guy” is not that he’s stating an uncomfortable truth; the problem is that he’s missing the point.
If you think that we should downplay pharma/surgical interventions because dieting and exercise “work,” it is incumbent upon you to show how we will overcome the fact that people don’t seem to have the willpower required to use these tools longterm. What’s your plan?
Willpower is a choice. In this study alone https://www.cuimc.columbia.edu/news/new-weight-loss-drug-approved-fda-it-right-you, 5% of participants on placebo lost 15% or more of their body weight. The average placebo loss was 2.4%. Granted both of these are hugely less than the treatment group, but they're also hugely less expensive. This is the case in every weight-loss placebo study I'm aware of, just the simple act of taking a pill (sub vitamin or other "healthy" pill they believe could affect weight for placebo in non-lab use) or putting an ab roller in the living room, or anything else that moves diet and exercise slightly closer to the forefront of mind than it was previously can have a significant effect. According to the paper, the lower end fda approved weight loss drugs cause a 4% weight loss, so assuming equal treatment time periods, placebo is 60% as effective on average as some drugs, at 0% of the cost. People are all different, they just need to figure out what best triggers that effect for them, whether it's my examples above (variations of which work for me) or something else.
Again. What’s your plan to get people to actually succeed in exercising willpower?
"just the simple act of taking a pill (sub vitamin or other "healthy" pill they believe could affect weight for placebo in non-lab use) or putting an ab roller in the living room, or anything else that moves diet and exercise slightly closer to the forefront of mind than it was previously can have a significant effect"
Whether you're talking to me or not, the solution is to reduce the thing that is calling on their willpower. It does not take much willpower to not eat if you are not hungry. You achieve being not hungry by increasing the satiety of the food you ate most recently. Food that does that is that which has more fat and protein, and less carbs.
And yet, I was easily overeating and hungry as usual after the first year on a keto diet.
Well, Kenny, just try very hard to try very hard. And if that doesn't work, just try very hard to try very hard to try very hard.
> Granted both of these are hugely less than the treatment group, but they're also hugely less expensive.
Breaking: doing nothing has no effect; is free
> According to the paper, the lower end fda approved weight loss drugs cause a 4% weight loss
Yeah, if you move the goalposts to “the worst drug on the market” the relative effect of the placebo goes up. This doesn’t bear on the article, which is about the best drug on the market.
>Breaking: doing nothing has no effect; is free
Breaking: 16% of the improvement of the best drug on the market from taking a sugar pill is not "doing nothing" and is in fact statistically significant. That's why it's included in this paper, and every paper on weight loss drugs.
> This doesn’t bear on the article, which is about the best drug on the market.
No, if you missed it the article is about the best drug on the market and how unattainable it is to most people (and statistically those who would most benefit from it) due to cost. So if we can get 16% of the benefits for almost zero cost that actually a huge deal on its own, and this could likely be improved significantly with other tweaks, as I've now mentioned twice. Less snark, more reading comp next time👍
What does that even mean? You state that conclusion as if it implies something significant but, I'd argue, it's really just a way to summarize the relation between incentives and behavior. Some things we call choices because they result in different outcomes when you change the incentives (prison for murder decreases murder rater but prison for being short doesn't increase height much). I mean, if you really get down into the details the difference between 'choices' and 'non-choices' isn't that the laws of physics plus initial conditions are any less binding in one than the other or that the biology that happens in the brain obeys some other kind of principle than that in the rest of the body.
But, given that background, saying something is a choice is just a shorthand for describing how responsive it is to incentives. Certainly, choosing not to eat as much is more responsive to incentives than height is but it's a lot less responsive to incentives than many other things.
And once we are made aware of how responsive it is talk of whether it is a choice or not becomes irrelevant. It's like saying something is heavy once you know it weighs 100lbs. It's not adding any information about the thing or helping you figure out what to do with it. Same with weight loss it seems. Absent interventions we aren't willing to make (for good reason) many people don't lose weight but they do on the drug and that's all that's really relevant to deciding policy.
You're exactly right, except that I'm biting the willpower point bullet. Maybe I'm bad at metaphors, sorry.
The plan is this:
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family.
2. Replace carbs in your dinner with fat/protein. Eat as early as possible, eat as much as you want. Don't eat bedtime snacks.
3. Over time, extend the time from ending dinner (your "fast" length) til the next time you eat (breakfast? 12:30 lunch? 2:30 lunch?) as much as possible. Eat the next day when you're hungry, but if you're only feeling kinda hungry try drinking a zero-cal electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories a day is impossible. Measuring that you ate 10 minutes later is easy. Don't put any sugar or carbs in your morning drinks.
4. Eventually cut out breakfast or lunch, or eat later lunch. Just like dinner, replace carbs with fat/protein as much as possible. Whatever feels okay.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale.
These are’t terrible recommendations. I do some of the things you list, and it helps me maintain my bodyweight.
But do you seriously think that an epidemic of 70M obese Americans would be fixed if only people would read your five bullet points about intermittent fasting? As per Scott’s math, you are claiming that your tweet-length comment on ACX is worth 500bil. The market disagrees.
"But do you seriously think that an epidemic of 70M obese Americans would be fixed if only people would read your five bullet points about intermittent fasting? As per Scott’s math, you are claiming that your tweet-length comment on ACX is worth 500bil. "
Yes.
But humbly, my comment is worthless. It's the advertising and execution that matters. Any idiot like me can say "gee, maybe we should build cars in assembly lines with replaceable parts" but it takes Henry Ford to execute. Even tougher, the actual problem here isn't knowing what to do, it's teleporting what to do into the minds and 70M people and then they all have to execute. Which is why I'm babbling my insane, otherwise-worthless ideas in a place run by a person who seems to do a decent job of teleporting ideas into other people's heads.
To elaborate, yes, I really do think it's worth half a trillion, obviously conditional on people actually doing it (though the lack of difficult in doing so is the key feature) and the cost of the advertisement/propaganda to publicize it, and coach people through it. There are companies (look up Virtahealth) that provide physician-led diabetes reversal for a few hundred a year using similar techniques and coaching on it. My only disagreement is you're understating the worth at 500B, because that's only the (estimated) consumer value of "weight loss", because if all 70M people did those 5 things, it would also reduce the downstream occurrence of diabetes, heart disease and cancer as well. (claiming that reducing weight/improving metabolic health reduces those things is a boring conventional medical claim).
Also, re: "the market disagrees", as I pointed out, there are lots of (small) companies providing these services successfully and getting paid for them. Markets can agree in differing amounts, and markets also need information/advertising to match sellers and buyers. If "make cars with assembly lines" was an idea that didn't actually get Ford any money, but rather only gave distributed consumer surplus, he probably wouldn't have executed it.
And while I am a committed free marketeer, markets for services that provide little financial benefits to those who provide them often don't work! I'm not making any money from this. Doctors won't make any money from this - in fact, they will lose money because their gov-mandated quality metrics don't support this type of treatment for obesity or diabetes. Novo Nordisk doesn't make any money recommending this. No supplement or food manufacturer can make money from this. It's not really a product or service to be sold, though some (like Virtahealth) are.
Looked up Virtahealth. Digging in a little it appears to be "we will teach you to eat a keto diet, which will have so few carbs in it that your blood sugar will remain low enough without drugs to call it reversal, except we don't count metformin as a drug because some people like to stay on it".
As someone who took metformin for 3 months and *absolutely could not* tolerate the severe GI side effects, which I never built any tolerance to: lol. lmao, even.
For what it's worth, CoQ`10 settled my stomach (GI tract) when I was starting out with metaformin, but my side effects were never worse than vague queasiness.
They will happily do non-metformin regimes for those who don't want to take metformin, and they will still work.
If your reaction to "this company will, without medication, coach you through reversing your diabetes, which costs millions of Americans billions of dollars a year in insulin, suffering and death" is "lol" then.... what do you want?
I mean, I've been aware of ketogenic diets, and considered trying them, for over half a decade at this point. I know I would not succeed, because like 75% of my favorite foods are incredibly carby and it would be too much of a sacrifice to be sustainable. And I don't have any of the medical conditions that make keto inadvisable for a lot of people.
I also know metformin isn't worth it for me.
I therefore wonder how many of those millions of Americans are in the same spot, and therefore how useful in solving the problem a company whose whole pitch is "keto coaching and maybe keep on metformin" is.
re: Virtahealth, because that's not their "whole pitch." Their method isn't "shove strict keto and metformin down your throat", it's coaching with those as options. If you sign up and say "I don't wanna do those things" they'll work with you. They list those things because they A) do work for many people and B) demonstrate that their goal is metabolic health, rather than counting calories or just losing weight.
"because like 75% of my favorite foods are incredibly carby and it would be too much of a sacrifice to be sustainable."
Which is why I prefer this method to strict, uncoached keto:
1. replace dinner carbs with tasty fat/protein, which are more satiating, therefore you can go longer before being hungry.
2. gradually move back the time you eat your first meal the next day, eventually eliminate breakfast, especially if it's boring crappy cereal. Then push back lunch
3. get your blood work done, if your metabolic indicators (A1c) look good, then you're fine!
Because do you eat those favorite foods at every meal? Maybe you do, congratulations - but most people eat pretty boring and crappy (from a food enjoyment perspective) breakfasts and lunches most of the time. I agree, no diet that says "you can't have your favorite foods at your major dinner time meal with your family" is gonna work. But one that says "maybe you can cut that bland cold cereal in the morning" or "instead of a sugar bomb starbucks latte, get one that just has still-really-awesome-tasting-heavy-cream" or "maybe just push lunch later in the day a bit" can. I'm sure you have favorite foods that have fat and protein instead!
The reason I brought up virtahealth is not "because they force you to do keto/metformin and that is the ONLY WAY" but because they do interactive, working-with-you coaching (that can involve keto or metformin, or intermittent fasting) that provably shows that you can just Talk To People Over Zoom And Get Them To Improve Their Metabolic Health, as a counterpoint to "spend 15k on semiglutide". And I consider the plan above to be an improvement to THAT, because it's something that almost anyone with a messed up metabolism can do even without coaching, in a montessori-sort of "the things that need to be done are simple and intelligible, and you can see for yourself if they are working" way.
I feel like nutrition/metabolism has become very politicized and moralizing. It's just a machine that we can optimize, and I am recommending that we put some oil in the engine to make it run a bit more efficiently. There should be no moral judgements of anyone, except that there is a future where 40% of the nation's GDP goes to insulin and semiglutide and bariatric surgery and.... I judge that as morally inferior to one where we don't?
"1. replace dinner carbs with tasty fat/protein, which are more satiating, therefore you can go longer before being hungry."
Brian, THAT DON'T WORK. Do you think I and other fat people haven't tried that? Now, maybe it's habit, maybe it's a combination of things, but when I do try the "eat meat and veg but no carbs for your meal", then the carb cravings kick in later and I have to eat something carby.
Meat doesn't 'satiate' me the same way potatoes or bread does. I can eat a chicken salad with tasty roast chicken with the skin on (that's your tasty fat and protein combo) and plenty of salad veggies and even a bit of dressing. Lovely. That does me - for a couple of hours. Then I start craving "oh I wish I had eaten some bread with that" and here we go again.
You are pushing the same points over and over in blind fervour that "well it worked for me and a lot of people so it should work for everyone". It doesn't.
"Tasty fat/protein will fill you up so you don't want carbs" does not work for me. I bet it doesn't work for others. It worked for you, great. I hope it continues. But right now even typing this much out and talking about carbs has evoked a sudden craving in me for a heap of mashed carrot and parsnip (bad for all the carbs):
https://www.health.harvard.edu/staying-healthy/the-pros-and-cons-of-root-vegetables
"3. get your blood work done, if your metabolic indicators (A1c) look good, then you're fine!"
No, you/we are NOT. Early on, in the 'honeymoon' phase of being diagnosed Type II diabetic, I had it under control and good HbA1c numbers regularly. Still overweight. Still not good enough for my doctor who was recommending "now lose weight".
Nobody will ever stop at "well you have metabolic indicators of health despite being so fat, so we will take it you are fine as you are". They *will* keep on at you to lose the visible weight so you reach a 'normal' weight, they will keep telling you the bad sides of being overweight, they will keep nagging and shaming and telling you that you *need* to drop all that excess. Holding up "but my bloodwork came back okay!" does *nothing* to change that.
I know someone who says, "People don't need carbs". And then he'll say, "Some pre-menopausal women need carbs to sleep".
Then stop saying, "People don't need carbs"!
Yeah, I mean, Deiseach said basically everything I was going to, but I'll add:
Do you think I have not considered this stuff? Do you think that by the time I'm posting on ACX about digging into a program like Vitahealth when it's linked because at this point I'm open to trying anything *actually new* that I am the kind of person still chugging sugar bomb lattes? I sure as hell hope nobody who gets to the point of trying and rejecting metformin is still at that point.
I'm 5'10, 245, and run an A1C somewhere between 7 and 8, despite not eating any crappy sugar bomb garbage anymore (telling me to cut off cereal as if I haven't already picked that extremely low hanging fruit...) because at this point the damage is done and because yes, despite my frequent consumption of steak and other meaty, fatty meals in the dinner rotation, despite lunch being a very protein loaded sandwich at 1 or 2 pm, and despite actively switching ingredients in things (e.g. did you know croissants as a sandwich enclosure have fewer carbs, and calories, than sandwich buns?) I still eat enough pasta and rice for that to be problem given the state of my metabolism. I'm down 30 pounds since adderall, I did some serious free weight work last year and gained a bunch of muscle (squat topped out at 1.5x bodyweight before I screwed up a joint, so it's not like I "didn't try hard enough" or anything), I'm on supplemental testosterone due to low T levels, all of which are supposed to improve blood sugar and lower A1C, and it doesn't seem to have been enough.
At this point, yeah, if the cinnamon and berberine supplements I'm now trying don't keep me under 7, I'll try semaglutide, because that has a lot more chance of working than *even more aggressive dietary and behavioral modification than I already do and have done for years*. I work a stressful, sedentary, time-consuming job and have a lot of shit that needs to get done around that as it is, I do not have the time or energy budget to micromanage every meal and do 1+ hour of hard 160bpm cardio a day (the way I did when I made a quarter of my current income and had loads of free time and dropped 80 pounds in a year). I know how to do it, I just cannot spare the overhead and still function at this point in my life.
Do not assume everyone with a problem is some uninformed child who can "learn to do the right things" with a little bit of handholding. We don't need Fat Adult Montessori, thank you very much for the patronization.
In re weight being moralized-- an approximate quote-- People have tied health, beauty, virtue, and leanness into one hard knot.
This sounds okey if your goal is to go from obese to just chubby.
I don't care how much fat you have, if you get a good diet your body will figure that out on its own. But also, yes, going from obese to just chubby IS correlated (but not causative!) with better health outcomes.
I want you to be healthier, which isn't measured on the scale, but in your blood work and in long term lack of massive health disasters like diabetes, heart disease and cancer. If you're still "chubby" but you don't get those things, well, great!
You basically call "healthy" being fat but not sick. Better than being morbidly obese and sick, I guess, but that's not saying much.
That's not good enough, people want to be "fit". You are right by accident with "health isn't measured on the scale" because yes, body fat percentage is what actually matters but it's very hard to measure without (other than doing an autopsy). Unless you are extremely muscular or have great bone density, the scale is a good measure of fitness.
If you want to be fit you can't eat ass much you want for a meal. The usual guides of 2000 kcal a day for the average adult male is probably too much already an puts you on a slight calorie surplus.
Healthy in this case is avoiding bad health outcomes, like diabetes, heart disease or cancer or just death. Good metabolic indicators (A1c) predict that better than weight, (or even body fat, which yes, is better than just weight) which is what I'm talking about.
Yes, sure, some people want to be "fit" by whatever they define that. But "just don't eat as much as you want" isn't helpful advice, and calculating what exactly a "slight" calorie surplus is is really difficult. But if you're trying to improve the health outcomes of 300m different people, you need to measure (at least in a sample population) something more concrete, and you have to have a plan to achieve it that's simple and doable for nearly everyone.
2000 kcal a day is a guide for an average human, male or female. Unless you lay in bed all day or have no muscle mass, as a male you'll be at a deficit at 2000.
As advice, that doesn't work for many people because
- it is very hard to measure calorie intake
- very difficult to measure calorie expenditure
- depending on person, your body will decrease your metabolism in response to getting less calories on average over the day
- also depending on person, your body will send you increasing "hunger" signals if it is getting less average steady stream calories than it did before
- human metabolism is not a calories in, calories out mechanism. It is a goal-seeking mechanism, where one of its goals is to be able to see you through a famine. Even if you think "it would be healthier if you react to this calorie deficit by burning fat/producing less fat" it may think that acquiring excess body fat is healthier so you can avoid a famine, and tweak your hunger/metabolic to achieve that instead.
"Just eat 2000 calories" is the diet advice that most people get, and it doesn't often work, which colors their opinion of simple diet advice in general because it has such scientific consensus and wisdom attached to it. Additionally, it does seem to "work" for lots of people who are already at a "good" weight", but they probably would be so even without the advice, and this also colors their views about what advice "works."
I'm a 71 kg, 181cm, 30 years old man. I can do 13 pull ups, 25ish push ups, toes to the bar abs workout, etc. I'm trying to get some more definition (lower back and abs fat are the most stubborn). I think I hit maintenance at something like 1800 kcal, but need to go south of 1500 to lose any weight for sure.
I think 2000 kcal puts me in that sort of slight surplus that makes people skinny fat over time. I don't know if calorie labels are wrong or consumption guidelines are too high though.
If you are that weight/height/age, doing regular muscle-building work outs, and your metabolic indicators are good, I really don't think you need to worry about counting calories or watching your weight. I wouldn't think you'd get "skinny fat" from 2000 cals and doing that, I'd think you'll probably be gaining muscle weight? I mean, I Am Not A Doctor and skinny fat is Not A Medical Condition, but I think you're good?
well I don't need it, I just want to. I'm trying for something like sub 15% body fat to see what it looks like.
> I'd think you'll probably be gaining muscle weight?
You gain muscle extremely slowly. A kilo lean muscle mass a month would be a LOT. You can put on half a kilo of fat a day if you eat enough. So being on even a slight surplus consistely for some time will get you pudgy.
All I'm saying is calorie guidelines are overshot. The usual guidelines would prescribe above averge consumption for someone like me (even if sedentary), yet 2000 kcal is a slight surplus. There's no way the average 165cm office worker adult woman doesn't gain weight above 1500kcal.
> All I'm saying is calorie guidelines are overshot.
I don't think calorie guidelines work at all. They can appear to work for people with a certain subset of metabolic conditions, but your body absolutely can regulate calorie burn, fat buildup and hunger signals in a way that (for at least hundreds of millions of people who ARE attempting to lose weight) swamps "just eat X calories" recommendations.
Fit, healthy, and lean are not the same things.
This comment is not worth $500bil because, like all comments in this vein, it fails to take into account the complexity of human nutrition. There is no list of 5 points that will work for those 70M obese people. For some, the drug will be the only way. For some it will be a completely different diet. For some, your comment will work, but I expect it to be a decisive minority.
Comments like this are more common than you think, and for me they are just too naive.
2. Literally more than half of my meals are just pasta/rice/bread. Seriously, it's a carb fest down here*.
3. My breakfast is literally chocolate chip cookies. It's one step removed to just shove down my throat spoonfuls of sugar. And it's not even that big of a step.
4. I never skipped a meal. The idea alone of skipping breakfast or lunch is abhorrent to my Italian brain.
And yet, I'm chronically underweight. The only point of yours that I feel to thoroughly endorse without a second thought is the first one.
My set of oversimplified comments will be: never eat sodas, almost never drink alcohol (less than one beer / glass of wine per month), keep a super regular schedule (breakfast lunch, snack, dinner) and never eat out of it (forget chips at parties etc), cook your own meals and eat fast food only occasionally in special circumstances (e.g. you're late for your plane).
Will it work for a "random you" reading? Hell no.
* The hate carbs are getting lately is really puzzling to me. Sure, fat isn't as bad as once thought. But this notion that its ills are solely the product of an evil carb industry that captured the government is ridiculous. I'm sure there is no fat industry that has ever tried to manipulate the public, and, if they do, they only have the public's health interest in mind.
Thank you.
A lot of diets will work for a few people, assuming the only purpose is to lose weight.
Normal people believe that quality of life as reposted by fat people is irrelevant.
Do not adopt diets to lose weight. Adopt a diet to be healthier.
This is the hidden problem* with the semiglutide process: if you take it, lose 20 lbs, fit into your old clothes and declare success, but you're still eating a constant stream of crap 3 times a day, you are still gonna have a higher chance of bad outcomes.
* it's possible that semiglutide is actually affecting your metabolism, in which case it might directly affect your metabolic health, in which case, good for it - it overcomes my "hidden problem" above.
"it fails to take into account the complexity of human nutrition. There is no list of 5 points that will work for those 70M obese people. For some, the drug will be the only way. For some it will be a completely different diet. "
Why do you think human nutrition is only complex on the downside (i.e. losing weight) - in reality, human nutrition is so non-complex that hundreds of millions of people - through diet/lifestyle changes alone - became overweight when before they were not. Nutrition is so non-complex that millions of people were able to gain weight literally without even thinking about it, like breathing.
"And yet, I'm chronically underweight. "
This gets back to my main point: don't focus on weight. Don't think I'm focusing on weight. It's a symptom that does not always present when someone has an underlying issue caused by terrible diet. The key is to increase healthiness (the highly costly downstream effects that we associate with obesity), NOT to lose weight - except that it is often an indicator. I'm not going to judge you, but what you describe yourself consuming does seem to be an unhealthy diet. The key is that unhealthy diets do not always result in obesity for, as you point out, a wide array of reasons, especially age. Would I be wrong in guessing that you're probably under 30?
There is no point whatsoever for you to lose weight, in fact, if you are truly the clinical definition of "chronically underweight" *that itself* is an indicator of even worse health outcomes than being mildly overweight! I am telling you that, in this thread about obsessing over spending 15k a year on weight loss, you could probably stand to gain some pounds. You are not the average American, and to the goal of this post (from Alexander's perspective) you are already cured. But not to my goal, because my goal is "be healthy, avoid really bad health outcomes" and there are people (yourself included) that can (again, going only on your self-report) have unhealthy diets, experience the higher likelihood of bad health outcomes, while not displaying obesity.
I recommend getting some blood work and checking your metabolic indicators. It is possible that you have an unhealthy metabolism without displaying obesity. There are all kinds of people who die of a heart attack at 55 and people go "but he was so skinny!". I
"The idea alone of skipping lunch is abhorrent to my Italian brain."
It's not your Italian brain. It's that for breakfast you consumed a great deal of sugar/carbs, which (short version) burn in your body very fast, (or are stored as fat, which obviously your body is not doing) and your body concludes it needs more quickly, so it tells you are hungry for lunch. The chocolate chip cookies are not unusual. Most cold cereal that anyone actually likes has a similar sugar profile. You are absolutely correct about one thing: people have radically different "energy intake -> how much fat they get" curves, and you have (whatever your age) the "18 year old boy" curve. But the underlying metabolism can be healthy or unhealthy, and one that takes in cookies for breakfast probably isn't.
"The hate carbs are getting lately is really puzzling to me."
From me, it's not hate. It's the simple fact (conventional scientific wisdom) that carbs (especially sugar) are (again, short version) burned faster (some types more than others) in your body that fat or protein, remaining available to be consumed for activity for a shorter period of time, and therefore when they're gone (or converted to storage) your body tells your brain it needs more. It is conventional wisdom that fat and protein create more satiety, which is longer time before hunger. Therefore if you wish to spend more time burning energy (in your case, you want this for good metabolism reasons, rather than weight loss) than consuming energy, and to reduce hunger, carbs are just objectively inferior to fat/protein. It's not some theory that carbs infect your body like poison. Well, except for sugary high fructose corn syrup sodas, those are definitely poison.
"I recommend getting some blood work and checking your metabolic indicators."
And if his bloodwork comes back with "he's fine, he's healthy", then what, Brian? Your tidy clockwork explanation has failed.
No, I'm not asserting that "if you aren't doing my plan, you can't have good numbers", human variance in history, age, genes, circumstances, mental states, environment and many others mean that there are tons of people who, by my standards, don't eat well but won't have bad indicators. What I am saying is "IF you have bad numbers and you want to improve them, because they are better correlated with bad outcomes than weight, THEN this is a non-15k a year, non-surgical way to do it that I think is easier to follow than most other diet advice."
The fact that there are tons of highly complex factors that could influence where a specific apple is in the universe: the structure of its tree, terrain, climate, soil, growth patterns, it remains that a simple model: if you pluck it from the tree and throw it up in the air, it will go up, and if you throw down to the ground, it will go down - will work to determine its future position.
What you're saying, effectively, is: "you say you have a plan for someone to do X, but what if they don't NEED to do X? Then you have nothing!" to which I say, yep, ok?
About the complexity, I'm unconvinced that people having tried a million things and still being unhealthy is a proof that nutrition is simple. The two doesn't seem to follow.
Anyway, just because you asked, if you were to see a picture of me, you'd think I'm under 30 -- I've got such a baby face, no wrinkles, no grey hair. But I'm 38. And actually I checked, my BMI is 19 (roughly, I don't own a scale) so I was actually wrong about the underweight thing. I'd love to gain a few pounds, but I'd rather them being muscles rather than just fat, this clashes with my couch potato nature unfortunately.
The bit about being Italian is a poor attempt at conveying the memetic nature of eating. Really, the horror of skipping meals has nothing to do with how fast carbs burn (and, again, in the tangent of the carbs, Deiseach writes better than I can the fact that a model that lumps in the same class coca cola and polenta isn't... great?). It's just that meals are a sacred tradition. So my "one neat trick, nutritionists hate him" is: let's just get better memes about food. Italian memes seem to be working well.
This religious aspect colors my opinion, and then I asked myself: if I were to follow your advice, I'd only have one meal at day (dinner) and it should be mostly fat/protein to cover my entire daily calorie intake. Is that even physically possible?
Other than that, in many things we agree, I don't think the pill treatment is the best, since it's unclear whether a taker will then have to be on it for the rest of their life (15k/year, yikes). But if someone there's no other choice, why deny it?
"And actually I checked, my BMI is 19"
That is kind of on the border of where lower BMI starts to be associated with bad outcomes, but with an imprecise calc, and me not being a doctor, I can't really say.
"a model that lumps in the same class coca cola and polenta isn't... great?)"
They are both "carbs" the way they are both "food" or "made of atoms" but no low carb/keto person would consider them in the same quality from a "should I eat this" diet perspective. Full sugar coke is basically the worst. Polenta has (and is often served with) other stuff than carbs in it!
"It's just that meals are a sacred tradition."
Absolutely, that's the primary motivator of my plan: because family dinner meals are a sacred tradition and you shouldn't ever touch them, except to add more tasty fat/protein. I'm talking about cutting out extremely non-sacred meals like your cold sugary cereal in the morning, or the limp sandwich at lunch, or the junk food candy snack at 330.
"if I were to follow your advice, I'd only have one meal at day (dinner) and it should be mostly fat/protein to cover my entire daily calorie intake. Is that even physically possible?"
It is 100% possible, tons of people follow "One Meal A Day", I've done it hundreds of times - and remember, for a long span of humanity's life, we didn't have time for breakfasts or lunches, everyone worked in the fields all day and gathered at the end for that together, family, sacred meal.
But you don't have to go right to that, and probably shouldn't, because if you currently do eat lots of carbs, you will feel super blood-sugar-low-hungry long before you get to dinner! That's another primary motivator of the advice: that it lets you gradually, slowly, measurably ease yourself into it, as far as you want, and only so long as it feels good. If you get migraines from delaying your meal like another commenter then.... don't do it.
Finally, to your specific situation, which is not the "American average person who is considering semiglutide", have you gotten bloodwork done? If all the metabolic stuff looks good, then you're fine!
"But if someone there's no other choice, why deny it?"
On a diff comment, I totally agree that semiglutide has its place for people who want specifically weight loss, and it may just have straight affect-your-metabolism positive effects, which would be great! But the topic at hand is "70 million other people need something like this and they can't all pay 15k" so that's why I'm offering my solution. Also, as Mr. Yudkowsky points out above, semiglutide comes with an emphatic demand to improve your diet and exercise - people should do that (with GOOD diet advice) regardless of being on it or not!
"The hate carbs are getting lately is really puzzling to me."
Oh, diet recommendations have swung around all over the place. Fats of all kinds are bad for you, replace those fatty foods with (carbs) and (protein). Take the skin off chicken, trim the fat off red meat.
Then it was "not all fats", it was saturated fats, so consume unsaturated fats. Then it was well monounsaturated fats are bad for you, only consume polyunsaturated fats. Omega fats such as found in fish good for you! Well, no, hang on, too much omega-6 is bad for you, you need to up the omega-3 (jury still out on omega-9 for the moment, I suppose).
Dairy bad for you! Dairy good for you! Confused yet?
Then it was red meat is bad for you in excess, so that was (protein) the bad guy. Then smoked meats, because carcinogens.
(Carbs) were still okayish, but then SUGAR - THE PRIME EVILLEST EVIL THAT EVER EVILED. So cut out all the sugary junk (good enough advice). Then that expanded out into other carbs. Simple carbs like potatoes and rice and bread and pasta - bad. Need complex carbs. GI index, so forth and so on.
I think the swinging pendulum of "X is bad, Y is good - now X is good and Y is bad" is down to the complexity of nutrition and metabolism. People are getting fatter and unhealthier, how is this? The simple story of "consuming more calories, and being more sedentary, than past generations" seems not to be the whole picture. So there must be a 'bad' food or class of foods.
Fat makes you fat, right? So fats bad! Cut out fats!
Okay, people still getting fatter - why? how come?
Carbs bad?
Protein bad?
There will be people who eat lots of carbs or fat or protein or whatever, and don't get fat/are chubby but healthy. There will be people who cut out carbs or fat or protein and are fat/unhealthy. There is no simple "one easy fix, just change your portion/plate size and eat six tons of lettuce" cure.
I joke, but it's only half a joke, that the next recommended diet will be "you can only safely consume moss and water".
There's a similar dance around eggs.
I reserve a special rage for the people who said, "Actually, eggs aren't bad for you. You can have one or two per week."
Oh, the thing about eggs!
First, over on this side of the water, there was a push to market 'eat an egg for breakfast' in the 60s/70s:
https://en.wikipedia.org/wiki/Go_to_work_on_an_egg
But then it was discovered eggs were full of cholesterol and cholesterol is bad for you, so this was dangerous and terrible to eat eggs and you should never eat them.
*Then* it was revised to "well, there is some *good* cholesterol and eggs have that, so you can eat a couple a week".
I don't think eating nothing but eggs would be healthy, but neither do I think eating one egg per day is going to do you in. Again, it's the swinging pendulum around dietary advice that causes more confusion than it solves problems.
https://www.healthline.com/nutrition/how-many-eggs-should-you-eat
"Recent observational studies and meta-analyses have found that eating eggs may not increase your risk of heart disease or its risk factors, like inflammation, stiffening of the arteries, and high cholesterol levels "
You know, I gained most of my body weight and reached my fattest point doing exactly that: keto, skipping meals, tons of water and zero calorie drinks. So I'm extremely skeptical of this being useful advice.
My numbers just got worse and worse until I bit the bullet and had them cut out half my stomach and part of my intestines.
Which numbers are we talking about? Weight/BMI? Or ones like A1c?
Weight/BMI, but A1c also got worse. My diabetes had progressed to a point where I couldn't control it with diet and metformin.
Everyone is different. If I could send a letter back to my younger self, the advice I'd put there is to sleep at night and never, ever skip meals.
"Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale."
Yes, Brian, but you are forgetting one thing - people in the street can't see your bloodwork numbers, they can see your double chin.
*That's* the metric by which people, including doctors, judge are you 'healthy' or not. I take your point that people confuse "healthy" and "thin", but given all the messaging about "fat is unhealthy", can you expect any different?
About ten to fifteen years back, I had *great* bloodwork numbers. I was still visibly porky. I still had kids yelling at me in the street about being an elephant. I still had at least one doctor visibly and openly furious with anger that he could not punish me for being fat because my blood work didn't back him up.
If you're pudgy, that is the metric society, and you yourself, judge you on. Have you dropped two dress sizes? No? Then it doesn't matter if you can run a mile or have perfect cholesterol levels, you are part of the obesity epidemic that is blighting our healthcare system.
(There's particular irony at work here; I have a sibling who has a thyroid condition and they have to be ultra-careful about their cholesterol levels and fat intake. They are also 'normal weight'. So anyone looking at the two of us together and being asked "who has the high cholesterol?" is going to pick me, the fat hippo. They'll be wrong, but they still won't change their mind - oh that number doesn't matter, we all know being fat is bad for you).
Improving or maintaining your health is worth doing if feasible.
The simplest thing I can think of to solve the prejudice against fat people is a famine, and it isn't worth it. It might not even work.
An expensive preventative for heart disease might work, but that's another version of turning being fat into a status symbol (perhaps an expensive watch is also required). This is better than a famine (do I need to say that?) but way short of excellent.
Continuous blood glucose monitors that displays the numbers on a big LED across your shirt? :)
Yes, I don't know what to do about that, except advertise the fact that bloodwork is a better indicator than weight. The only thing I do know is that, in the case of "good bloodwork, overweight" the answer is NOT "$15k a year semiglutide" or "high mortality-rate surgery."
Speaking as a Person Of Amplitude, I think obesity isn't one disease (since we are now calling it that) but a range of factors that have been lumped under the one umbrella of "you're a fat pig".
(1) People who are naturally chunky versus those who are naturally skinny. I think we all know or have seen people who are like twigs, who don't put on weight, who have thin little limbs like sticks. That's not because they're dieting themselves down to that weight, it's natural for them. On the opposite end, I submit that there are people who are naturally going to be chunkier than the median, because that's how their metabolism is set up. They will go a few pounds over what is considered optimum weight, and if they go too far over, their doctor harrumphs at them about "diet and exercise" and they do that and lose the weight. It'll be tougher for them to keep off the weight and they will have to make lifestyle changes like "I can't eat birthday cake ever again", but in the main it will work for them. At the worst, they'll be 'pleasantly plump' or a bit chubby, but not grossly overweight.
An example of someone naturally skinny who is not doing cooking episodes about salads:
https://www.youtube.com/shorts/513TiHieN9c
This is the good old "willpower" argument: if Joe can lose ten pounds simply by not stuffing his face with rubbish, why can't you?
That brings me on to:
(2) Slowing-down of metabolism. Middle-aged spread. "When I was younger, I could eat what I liked but now I eat the same and put on weight". People get more sedentary, they eat more convenience food, lifestyle changes.
Again, "diet and exercise" will help here. It'll be tougher, but if you were one of the 'naturally' slim types, it helps. Again, you'll probably have to make some lifestyle changes, but you will be able to get off the weight.
(3) Weight gain due to medication. I think we all know about steroids (my late father was put on a course of them and ballooned up, even though he wasn't eating more) and there are other medications with the same side-effects. It's difficult for people who gain weight like this, because they treated like the rest of us greedy lazy porkers, and get the "oh that's only an excuse" response unless they pull out the prescription to prove what they are saying is true, and who wants to have to reveal that *ackshully*, I'm on anti-psychotics which is why I'm stuffing my face with carbs?
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00500-9/fulltext
Hard case here, since once you don't need to take the meds anymore, you will go back to your natural weight - unless of course you need to constantly be on psych meds, which means increased appetite/weight gain, which gets you the "just have some WILLPOWER" argument from everyone.
(4) And last, the rest of us fat, lazy, greedy slobs with no willpower who just stuff our faces with junk food and never get up off our idle behinds and just go for a walk or something.
The gluttons. The "why don't you just have some WILLPOWER?" people. The "diet and exercise, you moron, never heard of that?" folks.
And you know, there is something to that. Yes, we eat too much. Yes, we don't exercise enough. But, like the anecdote related in Dante, when the bishop asked his servant "What do the people say of me?" "Your Grace, that you are always drinking" "Ah yes, but I am always thirsty" - we're always hungry.
Scott mentioned a few years back examples of patients who suffered from unrelenting thirst, who had to be monitored with their fluid intake or else they would literally drink themselves to death, and even when they got enough to drink would still feel thirsty.
Nobody is going to condemn someone who is guzzling pints of water "Just have some WILLPOWER!", because they realise that's not normal and is indicative of a problem.
Now, for the likes of us that are always hungry and never feel full, even when "but I just ate a full meal a couple of hours ago, I shouldn't be feeling hungry", it's hard. Because yeah, you can visibly see we are gross landwhales. And yes, we are leeching the health services normal people should be using with our horrible diseases of obesity that are all our own fault. And yes, calorie-laden tasty modern processed foods, and yes sedentary lifestyles, and yes over-eating and being greedy, and yes diet and exercise work to a degree, and yes "why don't you just have some WILLPOWER?" and get used to feeling pangs all the time. And yes, "I'm big-boned/it's my glands/it's PCOS/it's a response to trauma" do get used as excuses. Yes to all of that, yes I admit we do contribute to our own problems. Having said that:
Do you really think it's a simple problem of NOT ENOUGH MORAL FIBRE once people are desperate enough to have the likes of this done in order to lose weight?
https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258
"Roux-en-Y (roo-en-wy) gastric bypass. This procedure is the most common method of gastric bypass. This surgery is typically not reversible. It works by decreasing the amount of food you can eat at one sitting and reducing absorption of nutrients.
The surgeon cuts across the top of the stomach, sealing it off from the rest of the stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Typically, the stomach can hold about 3 pints of food.
Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. Food then goes into this small pouch of stomach and then directly into the small intestine sewn to it. Food bypasses most of the stomach and the first section of the small intestine, and instead enters directly into the middle part of the small intestine.
Sleeve gastrectomy. With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can't hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen the desire to eat.
Advantages to this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than do most other procedures.
Biliopancreatic diversion with duodenal switch. This is a two-part surgery in which the first step involves performing a procedure similar to a sleeve gastrectomy. The second surgery involves connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing the majority of the intestine.
This surgery both limits how much you can eat and reduces the absorption of nutrients. While it is extremely effective, it has greater risk, including malnutrition and vitamin deficiencies."
Reading those comments, they resonate with me. Constantly eating, never feeling 'full', eating until so stuffed I might throw up, And I've tried diets and they've worked - for a time. Then I plateau at a certain weight, and something happens (the last, most successful diet, I got swine flu then the weather was so unseasonably bad I couldn't go out for exercise) and I fall off the wagon and put all the weight back on.
So yeah, maybe all I need is some WILLPOWER, can you tell me where I can obtain a shot of that, because I don't manufacture enough myself? And that's where the "moral failing" angle of the condemnation of the overweight comes in - if we just gritted our teeth and scrunched up our eyes and *willed* hard enough, we could do it!
I don't know if this new drug *is* a miracle cure for weight loss, I think like all new treatments it is being hyped out of enthusiasm. Once it settles down, I think it's more likely to be at the 60% end of the successful treatments scale. And this is something you have to take forever, or else you will put the weight back on. And there probably will be some people for whom it doesn't work - I've had at least two medications prescribed where I was told that a side-effect was weight loss so that would help me, and no, it didn't happen at all.
So yeah, "CICO" - but that's simple. Why people consume a heck of a lot more CI than expend CO is the hard part to solve.
This doesn't respond to most of your very valid points, and it's definitely not meant as a "just exercise more" response, nor to suggest it will solve all your weight problems, but I think it is likely to be more effective and metabolically helpful than most forms of workouts: have you looked into Zone 2 exercise? Peter Attia has a number of podcasts and videos on it, and it's the central plank in his treatment of patients with metabolic disorders.
Briefly, zone 2 exercise is low intensity exertion which stays just within the energy regime at which the mitochondria in muscle cells can burn fat to supply the fuel they need. By training within that zone, not only are you specifically burning fat, but you are also training your mitochondria to be more effective at utilizing fat and less dependent on glucose, thus improving your overall metabolic health.
A simple way to try it is to get a cheap used rowing machine or exercise bike, set it up in front of the TV or computer, and ride them for 45 minutes to an hour at the intensity level that lets you still just barely breathe through your nose or maintain a conversation. Aim for at least 3 hours a week; more is better.
I'm surprised that you, usually a defender of religion and traditionalism, would have such a view on willpower. This isn't a criticism--when people are too predictable in their views, I tend to wonder if they ever think for themselves.
Isn't gluttony one of the seven deadly sins? Sin is part of the human condition, and the seven deadly sins are remarkable for their mundaneness: probably every person who ever lived has been guilty of all of them on a regular basis. But that doesn't mean societies (and not just Christian ones!) don't or shouldn't blame people for being lazy, angry, greedy, arrogant, or gluttonous. The purpose of the blaming and shaming is to discourage the sin by imposing a social cost. Just willpower alone may not be enough for someone to not have bursts of rage or to not eat to excess, but the combined effect of willpower and social disincentives might be enough to make people relatively healthy and well behaved. And so, in moderation, fat shaming is good in the same way that small amounts of sloth-shaming and wrath-shaming are good.
"I'm surprised that you, usually a defender of religion and traditionalism, would have such a view on willpower."
Oh ho, friend! What do you think I am, a Pelagian heretic?
We can do nothing of our own will to be freed from sin, we need the help of grace. Gluttony is a sin, but willpower alone won't free you from that sin.
I haven't enough willpower natively, I need the injection of it from outside to help me . Shaming people and blaming people is not that help.
What works?
Semaglutide, apparently
God alone knows. If I were a totally different person with a totally different personality, maybe I would love exercise, or be able to muster willpower to only eat three slices of carrot and six heads of steamed unbuttered unoiled unsauced* broccoli for every meal.
*I mean white sauces like bread sauce, parsley sauce, cheese sauce, onion sauce, etc . The ones made with flour and butter and hence Bad For You.
I was asking about what works for you as an injection of willpower from the outside.
Support and encouragement. Seeing visible beneficial effects.
All the nagging, shaming, bullying and so forth as recommended in comments here has never done anything but driven me to emulate a bear getting ready for hibernation: hole up in my cave and eat eat eat.
"I was asking about what works for you as an injection of willpower from the outside."
I have found that having (a) a schedule and (b) a workout partner helps for exercising. There is a SCHEDULE that means that working out is a default for a given place/time and you have a partner to not let down. Neither of you may want to go for any given session, but neither of you wants to be the one to call off the (obviously good or you wouldn't have schedule it!) session.
I have no idea how to make this work for diet modifications.
And I exercise and think it helps with general health, but I'm not convinced that it is terribly useful (long term) for weight loss.
"We can do nothing of our own will to be freed from sin, we need the help of grace. Gluttony is a sin, but willpower alone won't free you from that sin."
My theology is rusty, so forgive me if I'm wrong, but aren't we supposed to at least try? No Christian I've met has ever said "don't worry about it and sin as much as you want, because God will forgive you". At the very least they stress repentance, which doesn't sound very different from accepting blame--and when done publicly, it's not very different from shame.
> there are literally money-saving ways to lose weight
Too bad you didn't mention them.
Eat less, cook instead of ordering takeout, walk instead of bus, bike instead of car, etc.
"Eat less, cook instead of ordering takeout, walk instead of bus, bike instead of car, etc."
Excuse me while I rock in my chair, laughing.
In my 30s-40s I was one of the fittest fat people you'd ever meet. I can't drive, and there isn't a bus service in my town, so I walked everywhere I needed to go. Sometimes I'd cycle. That was my entire life, pretty much (if I needed to go somewhere further than my local town, I'd get the intercity bus or a lift from a family member with a car).
I had tree-trunk calves from about the age of twelve from all that cycling and walking and carrying things while I walked. Did it make me lose weight? No, I was still podgy of body and pudgy of face. But I was *fit*.
So yeah, "just exercise more and it'll drop off" was always a source of amusement to me. I once, due to a screw-up in getting paid, while living away from home spent an entire week living on soup once a day and (of course) walking everywhere. I was at the point of fainting into bed at night, but the one bright spot was that surely I'd lose *some* weight.
Guess what? No. Maybe a pound or two, but nothing significant. My body was grimly hanging on to the fat reserves come hell or high water. The biggest disappointment of my life, but the reality of what the hell my metabolism is and I don't know why. I keep being told my thyroid levels are fine, but I don't know.
I have a theory people vary in their ability to take fat out of storage and use it for energy.
Yeah, I think the actual pill we need is: "convince the fat cells to release their energy into the bloodstream".
It needs more sophistication than just taking fat out of storage. Even very lean people are at least 5% fat.
In ideal case, the pill should allow you to choose the parts of your body where you want that 5% to remain. (Anecdotally, it seems to be a problem for some women, that when they diet, they start losing fat from the wrong body parts.)
Anyone else remember the heyday of brown fat? Brown fat was the healthy body fat and was the response to cold, so we should all expose ourselves to cold temperatures and that would encourage conversion of body fat to brown fat which would be then be burned off to heat us up and we'd get thin.
I remember sitting in cold rooms until I literally turned blue with the cold. Never started any of that miraculous burning away all your body fat for heat.
They do that already, and indeed that's how one loses (fat) weight. The problem is however that the combustible form of fat (fatty acids) bears no biochemical resemblance to the glucose which apparently is the main component of "have you eaten enough?" signaling pathways to/from the brain. Thus the irony that we can feel "starving" while at the same time having a complete sufficiency of energy available through fatty acid metabolism (and gluconeogenesis).
That is, the problem is not the energy pathways themselves, but the signaling pathways to and from the brain.
So basically keto?
Actually, a pill that instantly throws you into ketosis sounds amazing.
[speculation] In men it's mostly testosterone levels. It signals the body to both repair+increase the muscle mass AND not to burn muscle for energy when on a calorie deficit. Some people will never be lean as their bodies prefer shedding muscle before burning fat.
There's also probably some other factor regulating this behavior. IIRC there's a yet unexplained effect of anabolic steroids that makes fat burning more predominant even beyond what would be accounted by the muscle gain. It could be that steroids activate what naturally lean people have going.
Did you grow up food-insecure? Because this sounds pretty in line with the 'thrifty phenotype/epigenotype' hypothesis: your body is hanging on to those fat reserves because experience has told it that reliable access to food is not something it can take for granted. Maybe the hunter gatherer lifestyle that it's adapted for needed all that fat when it was living on raw tubers and bugs for months on end, and it doesn't think a week on soup is an emergency worth burning more than two pounds of fat for.
I wouldn't say that, but there is obesity on one side of the family, so you tell me if it's genetics or what at work.
Also Irish, so... descendant of the people who *didn't* die in the Famine? 😁
Some of it is environmental/genetics, but some of it must be bad habits and no willpower, since I have a sibling who has the opposite problem (they get stressed and stop eating and over-exercise and are always skinny; I get stressed and comfort-eat).
Tangential to your main point (that one can't really lose weight by pure exercise), which so far as I know is quite accurate, I thought it might be worth mentioning that a pound or two is a pretty significant weight loss for a week.
1 lb = 3500 kcal, so if you actually lost 2 lb = 7000 kcal that implies a deficit of 1000 kcal/day, which would be very noticeable indeed. The basal metabolism demands for a 5'4" female age 35 at 135 lb is ~1400 kcal, and walking tends to burn ~200-350 kcal/hour, so to run a 1000 kcal deficit daily one would have to cut the usual ration by two thirds, walk 3-5 hours a day, or some combination of both -- pretty harsh.
I think Gary Taubes in one of his many diatribes against calories in/calories out points to some empirical evidence that if people exercise they almost always boost their intake more than enough to compensate for the calories burned, because exercise makes you hungrier of course.
No, the first weight you lose is water weight. It's easy to 'lose' weight like that, but it's not shifting fat. I was disabused of that the first time I had stuck to a diet (as advised by my doctor to go on a diet), lost a stone, and went back to report all pleased with myself.
Doctor told me that was just water weight, I hadn't really lost fat, and I would have to continue on a lot longer to really start losing weight.
So living on a bowl of soup and lots of water per day for a week got rid of some of that water weight, but didn't kick off the fat-burning. And of course once I got my money sorted out and could buy food, I went back to eating normally so naturally no weight loss. If I stuck to "one bowl of soup a day" for a month, then maybe real fat-burning weight loss would have happened.
Yes, that is also true. Water makes it difficult to assess genuine weight loss over anything less than a few weeks. As a weird illustration, I am in the habit of 72-hour fasts on certain regular occasions, and one thing that is interesting is that, although I am obviously missing ~6000 kcal, so probably have lost ~1.5lb of fat, whether I will actually weigh more, less, or the same afterwards is impossible to predict -- depends too much on what changes may have occured in my state of hydration.
I was just pointing out that if you *had* actually lost "a pound or two" over a week, that would be pretty sizeable.
The amount of water (and of (literal) shit) in your body can fluctuate by more than a pound or two -- you're better off treating the last digit of your weight as a random number generator. See _The Hacker's Diet_.
I don't even have a car or a bike, and since covid I also started avoiding buses. I walk to my work for 40 minutes.
I admit I could work harder about the eating less part.
The meta-point about the traditional advice is that either you need to do it 100% right and mere 90% gets you nowhere (possible, but then it would be nice to admit that following the advice is harder than it seems), or just one part of it is the real advice and the rest is bullshit (also possible, but then please stop telling the bullshit parts).
Let me fix that failure here:
<< reposted from other comment >>
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family.
2. Replace carbs in your dinner with fat/protein. Eat as early as possible, eat as much as you want. Don't eat bedtime snacks.
3. Over time, extend the time from ending dinner (your "fast" length) til the next time you eat (breakfast? 12:30 lunch? 2:30 lunch?) as much as possible. Eat the next day when you're hungry, but if you're only feeling kinda hungry try drinking a zero-cal electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories a day is impossible. Measuring that you ate 10 minutes later is easy. Don't put any sugar or carbs in your morning drinks.
4. Eventually cut out breakfast or lunch, or eat later lunch. Just like dinner, replace carbs with fat/protein as much as possible. Whatever feels okay.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the health ranges - FORGET YOUR WEIGHT, sell your scale.
Hey you have described your weight loss system multiple times here. I think readers get it. You sound like you think the reason we're not all converts is that we do not understand your system, and need to hear it explained again. In fact, people are telling you multiple reasons why things along these lines have not worked for them, and/or multiple reasons why they believe such things generally do not work for many people over the long run. Are you giving any thought to all this testimony and all these ideas?
"Are you giving any thought to all this testimony and all these ideas?"
Absolutely, previous people's testimony and experience (of which all of the versions given in this thread are a subset - not as a critical judgment of them, just that diet advice almost always fails in relatively predictable ways) is the reason this is my plan, instead of being traditional stuff like weight watchers calorie restriction.
"Hey you have described your weight loss system multiple times here. "
Well, not to be rude, but if you're describing it as a weight loss system, then I haven't explained it well, because it's not a weight loss system, it's a "increase healthiness system" and I posted it here because I think focus on specifically weight loss via semiglutides or surgery is part of the problem.
"In fact, people are telling you multiple reasons why things along these lines have not worked for them, and/or multiple reasons why they believe such things generally do not work for many people over the long run."
To be very specific, no one I've seen so far (maybe I missed it) is saying they have tried something like this and failed, (whereas I personally have succeeded, and know dozens of other real live people whose testimony is that it works) and the "such things" they present are often critically different in major ways that are also exactly the reason I present this strategy as an antidote to them. You're essentially saying "well, all these other people have tried such things like, leeches and balancing bodily humors, why do we expect your plan to take antibiotics to work?" Maybe I'm arrogantly assuming my method is superior, but it was created (not by me!) precisely to incorporate what you're saying - the testimony of millions of people saying that previously recommended "diet" advice didn't work. The key is in the "what" is being recommended, and whether it goes against the grain of how we understand humans and their metabolisms to function.
Additionally, when people are saying "diet advice X didn't work for me" in this thread, in every case they have cited weight. This is the part I want to repeat more than my strategy: don't measure success on the scale. You can't timetravel to see if you get diabetes 25 years from now, you have to get bloodwork done, or you have to read all the papers describing the other markers you can see to detect a healthier metabolism, or get a continuous glucose monitor, or you have to take my word for it. (This cost of this measuring indeed a major failure point of my plan, which you should critique)
OK, Brian, I have tried it and failed, and by failed I mean not simply that I did not lose weight, but that I did not stick with the plan. I had been reading about carbs, and how processed carbs and sugar do not really satisfy and you make you crave more of them. So I planned to follow a regimen of eating nothing sweet except fruit, not much refined flour & the like, and lots of protein, fruits and veggies. I did not avoid animal fat. I am a vegetarian, but ate lots of sharp cheddar, an animal fat favorite of mine. I did not count calories. I was not solely focused on losing the 20 pounds I wish I were not carrying, but of course that was on my mind. It is simply impossible not to care about that. And I did deviate from the approach you describe in that I did not make insanely delicious meals that gave me deep satisfaction. I absolutely hate cooking, and am simply not willing to take much time away from activities I value in order to do awesome cooking.
I have stuck with the no-sugar part for several years now, and find that cookies etc. are no longer calling my name when I'm in a bakery. However, I have not stayed with lots of fruits and veggies, I have slid back into eating simple carbs, things like slices of white bread, because I like them and they're easy to grab . And I never did do the part of preparing wonderfully palatable meals. The things that have kept me from sticking to my plan are things like this:
-Most vegetables are not pleasant to eat unless you chop them up and put a nice dressing on them, or cook them. I hate doing food prep. If I'm busy, tired, or preoccupied with something else important to me cooking is the first thing to go.
-I default to eating lots of cheddar cheese and little else -- because I'm out of fruit, and the veggies I have need prep to be bearable. I got busy and did not shop.
-I get busy doing something important to me, miss a meal, then am so hungry I grab whatever's handy that I can stand -- cans of cashews, lumps of cheese, fried stuff from Uber eats.
Obviously I *could* have done other things at those times. I could have made a salad or cooked the veggies or made an awesome delicious meal. I could have shopped more often so there was more healthy stuff in the house. I could have not let myself get so hungry. But it is an illusion that knowing that makes it likely that in the future one will act differently. The same factors that led to suboptimal eating in the recent past are all going to be there in the near future. Habits are hard to break, and the breaking of them draws on the same limited pool of energy and self-monitoring capacity as all the other things we need to accomplish. Eating is a simple pleasure and doing it provides a break from life's demands. Turning it into something that must be done a certain way both reduces the amount of simple pleasure in the day and also adds a new demand. That's a hard sell. There may exist some heaven of healthy eating, zero minutes per day of craving things that are unhealthy, and amazingly delicious meals that satisfy the living daylights out of a person, but then again there may not, for all of us. And even if it does exist, getting there is no easier than accomplishing lots of other goals we have for our careers and relationships, and far more dispensable.
That's.... not my plan? What you're describing is keto, and yeah, while it does work, people have trouble sticking to it, for exactly the reasons you point out. That's.... the entire point of my plan, that things like keto are sometimes hard to do.
I apologize, sometimes on substack it is hard to see which previous comment someone is replying, which makes me think maybe the "plan" we are debating is not the same one. This is my plan:
https://moore2024.substack.com/p/no
Short version:
1. add tasty fat and protein to your dinner. This increases satiety, and therefore the amount of time til you're hungry. Reduce the carbs if convenient/easy, you will likely be forced to, because if you add fat/protein to a meal, you won't have room for the carbs.
2. Over time, extend the time from ending dinner until the next time you eat as much as possible, eventually cutting out breakfast and delaying lunch.
3. Get bloodwork done yearly, and use the metabolic indicators in that to inform your success, rather than weight.
The reason this is the plan is precisely because of the experiences you (and many others) had with a keto diet (or many others). Hunger is powerful. Cravings are powerful. Eating tasty food is enjoyable. People have increasingly little time to select/prepare foods. A diet that works must accept that, which is why "my" plan explicitly caters to those limitations in daily life.
No, I wasn't doing keto. I don't think you read carefully. I said I ate nothing sweet except fruit (should have said fruit and vegs), and nothing with much refined flour. That's a far cry from keto. I ate potatoes, sweet potatoes, grapes, starchy vegs like peas and corn, whole wheat bread, brown rice, oatmeal -- lotsa carby things, just not white-flour based things and nothing with added sugar, corn syrup etc. and I did not limit how much of them I ate. My daily carb count would have been way far out of the keto range. It was not, though, terribly high I think, because I really liked cheese, full fat cheese, by the way, better than most of these things. A typical dinner for me might have been a potato with a LOT of cheese melted on it, and a piece of fruit, maybe a coupla raw carrots. As I mentioned, I do not cook. This meal may sound sort of drab to some people, but I truly enjoyed it. I did not limit quantities. No matter how much I eat in the evening, I need to eat fairly early after waking up the next day. First of all, I wake up hungry. But the big problem is that if I get very far into the day without eating I get a headache, and sometimes that turns into a migraine. Have a couple of my migraines, and you too will lose your enthusiasm for trying to go as long as possible before eating the first meal of the day. (And yes, it happens even if I drink a lot of water to rehydrate for the day.)
Okay, was just trying to slot it based on a few key words.
If you have migraines with triggers based on deviation from your routine, then yeah, this (and many other things that involve changing routines) are going to be difficult. If the migraine trigger is low blood sugar, as it is for some, then it might be possible (no way for me to tell!) to affect it (like the sensation of hunger) based on the blood-sugar-affecting quality of the food you eat. I don't have frequent migraines, but I have had a few that I think are triggered by over-consumption of very specific foods.
While you were doing this, did you happen to get A1c or other indicators taken? There might not be anything that needs fixing!
My a1c is checked yearly at my physical. It has always been normal. Going for a few hours without eating in the morning reliably leads to me feeling tired, slightly dizzy and overall crappy, with a mild headache that gradually worsens. That's consistent, not something that happens occasionally, as though possibly triggered by some food. Maybe 10% of mild headaches turn into migraines for me. That's consistent too. It's how my body works.
If your a1c and other metabolic stuff is within normal ranges, your metabolism is most likely working as it should, and you don't need to *do* anything, except enjoy your life! :) Definitely don't do things that give you migraines! If you have a few "extra" pounds, it probably doesn't matter!
Oh, now carbs are the new sin, and you were a terrible sinner. Professor. Fung would be so disappointed in you!
""They are so high in carbohydrates that they are more like grains than greens. It makes more sense to put them in the same category as breads, rice, or pasta," says dietitian Teresa Fung, adjunct professor in the nutrition department at the Harvard T.H. Chan School of Public Health.
When you eat mashed potatoes you're probably adding butter and other unhealthy ingredients. Or maybe you top a baked potato with sour cream and bacon bits. And it's quite easy to overeat, and you end up eating a lot of calories that aren't so satiating," Fung says.
Fung says that, if you're healthy, you can probably eat one serving of root vegetables every day. "Just make sure it's a side dish or part of another dish, and that it's the only starch on your plate," she advises. In other words, don't have a serving of rice and a serving of sweet potatoes."
So for the ideal diet, you could have had one cup of mashed turnips per day. Or one slice of bread. Or - well, you can figure it out 😀
I think the pendulum has swung back and carbs are OK again, though I stopped being hypnotized by it a long time ago so may be wrong. Mashed turnips sound very nasty indeed, pretty close to bottoming out. I suppose rutabaga might be worse though . . .
isn't the way that semaglutide works is by making you feel full and satiated after eating? of course you need to be changing your diet -- if you continued eating the same way, you wouldn't be able to lose any weight. the hard thing about losing weight is that your body will do anything it can to make you eat the calories you're trying to avoid (and will hold on to the fat it already has, although that can usually be overcome with enough time). the brilliance of this drug is that it basically helps you stick to a diet.
IMO exercise doesn't actually help you lose weight anyway except insofar as it helps you build muscle, which makes your metabolism higher, but it's a good thing that people should do regardless.
You're spot on, on both diet and exercise.
re: diet, I think semiglutide might being affecting your metablism too - hence its use as diabetes drug, but I'm not educated enough to know for sure.
re: exercise, yes, it may not make you lose weight (in fact I think you should gain weight, if you're doing strength training) but it makes you healthier.
And to dovetail both: we want to be healthier metabolically, that is the goal. Weight is just a symptom that we only care about as potential signal.
This jives with my experience on the drug earlier this year. I was on living primarily on pre-made keto meals and after starting on semaglutide I felt like it was too much food for a setting, switched to a lower cal option. When shortages of the drug caused me to miss a few weeks, the lighter meals were quickly noticed as not-satiating.
While this is technically true, there are a *lot* of things that would be unnecessary if everyone in the world always made good decisions and showed perfect discipline at all times and experienced no akrasia at all. That world would look extremely alien to the one we actually live in.
Given that we live in a world of imperfect willpower and decision making, finding ways to mitigate the consequences of those failures is both important and valuable.
I will say, though, this is one of the areas where I feel like government intervention may be warranted, or at least could have good outcomes. I don't think people would suffer if there was a tax on fat and sugar above a certain point on all foods such that all their food choices were healthier.
My quality of life drops sharply if I don't eat a fair amount of fat, possibly more than some theory of health would permit.
Wait, I've got an idea. Let's put everyone on the diet-that-can't-fail. Then, we can piggyback all the other things people have trouble sticking to onto it, like ornaments onto a Christmas tree: Every time you have a proteiny meal, write down a work goal for the next few hours -- productivity solved! Every time you lose a pound, pay any unpaid bills -- budgeting solved! Every time you lose 5 pounds, spend an afternoon working on that great idea you had that you've been procrastinating on fleshing out -- getting rich and famous solved!
Nope. It is the semaglutide. See my comment below for details. I lost 20% of my weight (55 lbs) in 14 months. I did not change what I ate (good fresh home prepared food) or how much I exercise (mostly an hour a day of walking). I just ate less of the same stuff.