To tell people to choose between a pill and death without discussing the underlying cause of the problem _is_ the problem.
Ethics and morality used to be a cornerstone of medicine.
Ethics and morality used to be a cornerstone of medicine.
Every legitimate long term study of non surgical weight loss shows that it doesn't happen for the vast, vast majority of people.
1) ["In controlled settings, participants who remain in weight loss programs usually lose approximately 10% of their weight. However, one third to two thirds of the weight is regained within 1 year, and almost all is regained within 5 years. "](http://www.ncbi.nlm.nih.gov/pubmed/1580453)
2) Giant meta study of long term weight loss: ["Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3% of initial body weight."](http://ajcn.nutrition.org/content/74/5/579.full)
3) Less Scientific: [Weight Watcher's Failure - "about two out of a thousand Weight Watchers participants who reached goal weight stayed there for more than five years."](https://fatfu.wordpress.com/2008/01/24/weight-watchers/)
4) [The reason why it's impossible seems to be that although calories in < calories out works, the body of a fat person makes it extremely difficult psychologically to eat less.](http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-...) This is borne out by the above data.
5) [The only thing that does seem to work in the long term is gastric surgery.](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/)
Moreover, you won't find any reputable study on the web where the average person lost 10%+ of their body weight and kept it off for five years. Not even one.
https://www.europeanpharmaceuticalreview.com/news/165203/weg...
Losing it is easy.
I’ve lost 100lbs five times in my life.
It’s fucked.
It's not impossible; some people do it. But it's not easy to change how you think about food and your body, especially when you're surrounded by your old habits every day.
Sci hub up this paper and check out the citations too.
He returned in 3 months, and shocked the nutritionist is he was exactly on the target weight and had followed the plan. She remarked that nobody had ever followed her plans before.
He never regained the weight.
I've seen statistics that only 5% of dieters keep the weight off more than 5 years. It's not impossible, but it is unusual. I've known a couple others who've done it, too.
I suspect for some people they just gained a little weight cumulatively over time due to a slightly fattening eating habit, and for those it's probably not that big an ask to change/fix.
But for many of the overweight/obese people I know, their eating is a straight up dysfunctional drug abuse-style addiction. Predictably it's as difficult to change these behaviors as it is to get a drug addict to quit their drug of choice.
The whole dogmatic war-on-drugs attitude creates this imaginary boundary around "food" which for many I suspect green-lights abuse of "food" because it's not "drugs".
It makes me wonder how much our societal obesity problems would change if the prevailing attitude towards drugs became more factual and nuanced. If people understood better that cocaine isn't as problematic as psilocybin in terms of addiction, maybe they'll also start thinking more critically about candy bars vs. oranges. Perhaps my optimism is showing.
If combined with a confined window of eating, like 11am to 5pm, you'll lose weight faster.
The following comes from a study on T2D reversal where bariatric surgery was one aspect of the study:
“Furthermore, microbial changes in the human gut have been linked to obesity, and surgical alterations to gastrointestinal anatomy have been associated with dramatic changes in gut microbiota populations with reversion from an “obesogenic” to a lean bacterial population [13,14,16,19,23,24].”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/
It’s a relatively new science and area of study but some of it is fascinating if not hopeful. One in particular looked at identical twins where only 1 suffered from malnutrition finding in all such cases the microbiomes were different between the twins and the malnutrition was successfully treated via the microbiome.
Unfortunately, in modern times the days of short rations never come, at least in First World countries.
That drive functions at a neural level way below the level of the rational mind.
People often make poor choices vis-a-vis sexual activity, too, and for much the same reason.
They passed it on to us before there was a chance to introspect the nutritional and psychological realities of food.
My partner and I are both overweight and we are trying to do a better job with our child - giving them healthy but delicious options, while also not turning any junky food into a reward or a mystery that must be guarded or doled out in careful portions.
So far, we're okay. Not sure how this is going to last once the kid gets into school age...
If I saw people permanently ban junk/fat/sugary food from their homes, do at least 3 hours/week of complete training (weights and cardio), and not being able to stay fit, I would believe that weight loss/being fit is a serious physiological and psychological challenge.
What I observe though, starting from mid-30s, is that the vast majority of people keeps junk food at home (which is, no wonder, "extremely difficult psychologically" not to eat) and/or doesn't do traning (let alone complete training). And invariably blames it on genetics and aging.
(I don't doubt that there is a minority of the people that has serious metabolic disorders, but that's not the general case)
In other words, if you're a doctor, go ahead and tell all your patients the above. You will see negligible impact on their weight, so your advice was useless (worse than useless, since you come across as an asshole).
As an aside, conscientiousness/willpower is highly heritable (as much as height and IQ), so if you're especially good at sticking to a diet, that's also genetics.
Also, who is saying we are calling patients weak willed losers? Should we not tell patients to stop smoking, or to quit heroin, because they might think that we think of them as "weak willed losers"?
*edit for ambiguous wording: By this I mean it seems to work for at least 50% of people, with the average being 3% weight loss.
For the weak willed comment, that was a reference to Pizza234's comment I was responding to earlier, not yours.
It more points to the limitations of studies like these than it does an incontrovertible fact. Some people who are highly internally motivated can lose weight and keep it off.
https://www.nature.com/articles/ijo201094
>More than one out of every six US adults who has ever been overweight or obese has accomplished LTWLM [1y] of at least 10%.
review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/
As far as the doctor's advice is concerned, focusing on weight loss as the sole outcome is misguided. The typical trajectory of an obese individual is to keep gaining weight; if doctors could even make their patients stop gaining weight, that would already be a major development in standards of care.
It's also important to consider the limitations of the metric. Studies don't evaluate sustained cultural shifts like "do doctors regularly talk to the patients about nutrition", because it's hard enough to track a patient for five years, let alone get a doctor to do blinded controlled interventions for five years. So what the study tests is a controlled diet for a short period followed by a period of unsupervised maintenance (with a recipe book), not the consistent availability of nutrition guidance over a period of years.
It's perhaps more important to note that while the results in adults are quite bad, it has been shown possible for adolescents to drop by more than a standard deviation in BMI after an intervention and maintain this for two years:
https://www.sciencedirect.com/science/article/pii/S002234760...
https://www.sciencedirect.com/science/article/pii/S1054139X1...
Professional interventions for weight loss and/or maintenance aren't infeasible, they're just hard, and it pays to start early. It's not too surprising that older people are more reluctant to change their habits.
[fuller2014]: Finds that Weight Watchers underperforms standard national guidelines: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282338/
https://www.cdc.gov/nchs/images/databriefs/351-400/db360-fig...
Those studies on adolescents is heartening though.
Source 1 seems to be from a conference, and they don't list specific numbers or cite sources, so I have no idea what "almost all" means.
"5) [The only thing that does seem to work in the long term is gastric surgery." That study says that gastric surgery works, it says nothing about the other methods for weight loss.
Right, except they'll still be homeless, poor, mentally unstable, or all of the above. Drug use is often the symptom, not the root cause.
It's similar with food. For many people, food becomes the primary source of joy in life. And just like with drugs, the joy shrinks, the high gets shorter, and the health side effects soon start outweighing the benefits. But it's still quite hard to go cold turkey, and just like a recovering addict, even years after establishing a healthy diet it becomes really easy to fall off the wagon.
We can moralize about how starving children in africa have things much worse, but human happiness is contextual to the reality we know. And life in modern western society has a lot of pitfalls, anxiety, and depression. Obesity is in many ways a side effect of people's lived experience.
Giving a diet plan for weight loss is basically an equivalent of giving an exercise plan for depression.
This mostly reflects on what doctors recommend rather than blanket discipline failure across a broad population. I can tell you what my local Kaiser recommended for T2D and obesity:
1) they send you to a Registered Dietician who shows you a modernized food pyramid based heavily on grains. Minimize animal fats, replacing with seed oils. 70% calories as carbohydrate.
2) MD flat tells you "you MUST eat 6 small meals a day so you never get hungry."
What was done instead: Time Restricted Feeding, 4-6 hour window, low carb, limiting to mostly keto first half of window. A1C dropped over 3 points (10.3 to 7) by next labs.
Crazy, that's what I would recommend if you want to become obese.
>2) MD flat tells you "you MUST eat 6 small meals a day so you never get hungry."
I guess that MD really wants his patients to become insulin resistant and eventually develop diabetes.
Everything (hyperbole) you can buy in a supermarket is meant to make you feel full for an hour and then hungry again.
An alternative to surgery would be to just to continuously monitor blood glucose. The patient would immediately know when the food they are eating is messing up their body and the doctor can control the diet of the patient.
The GLP1s have proven to have excellent efficacy for weight loss (and cardiovascular mortality in diabetics). Their numbers approach bariatric surgery (>10% body weight in the obese).
People keep the weight off too. Here's one study showing 5kg on average weight loss at 5 years according to this study: https://www.mdpi.com/1660-4601/17/1/207/pdf
So why do i care about the cause again? I dont. it was a non reversible event