Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the first place. It's way easier to take a pill than cut to 1500 calories a day for 2 years.
Most people in the US live in poverty and make marginal spending food decisions based on money per dopamine reward unit rather than optimizing nutrition. McDonalds is cheap and unhealthy; fresh fruits and vegetables and the free time to educate oneself on proper nutrition, then cook healthy meals and do meal prep often cost more money and time than most can afford. As does proper exercise when you’re working 12 hours per day trying to make ends meet.
A less harmful way to phrase your point is that medication can help people who self-medicate with food overcome metabolic efficiency. I lost 40 pounds on semaglutide (Wegovy) so far this past year and dropping; exercise and diet alone didn’t work for me. I hope to eventually not rely on medication to maintain a healthy weight.
> Prescriptions of diet and exercise are ineffective
Which seems to be true. If any advice your doctor could give yields no measurable difference, is there really a point to giving it?
That's very much _not_ the same thing as a doctor recommending or prescribing them having any effect.
If it doesn't have "any effect" then I guess all type 1 diabetics are already dead?
The point still stands - doctors should be counseling diabetics on dietary changes, even if they are being prescribed medication. Some patients can improve their condition and overall health to the point that they can stop the medication. If you disagree with this, please, show me some sources. As for mine, you can check the AMA, AHA, ADA, and PubMed (American Medical/Heart/Diabetes Associations).
It's a multifactorial problem.
Not saying I know any better, but at it's face I don't buy this. The change in day-to-day activity doesn't feel like it would account for the difference from just the 80s to now.
> while the calorie inputs available cheaply dramatically increased.
This I buy much more, confounded with maybe the specifics of the nutrients available.
But you're not factoring in the fact that as your weight increases so does your idle energy costs, meaning that as you gain weight you burn more calories doing nothing. Put another way, if today you burn 1500 calories a day idle, and you start eating 2000 calories a day - at some point you will reach an equilibrium, likely well before you're obese.
I'm also in the camp that thinks that lifestyle explanation for rises in obesity is completely unsubstantiated.
High-fructose corn syrup has been added to so many foods that didn't have it 10-20 years ago.
The second or third ingredient on a bottle of ketchup, for example, is high-fructose corn syrup. You can get ketchup that doesn't have high-fructose corn syrup added to it; often it's a natural or organic brand that often costs more than the regular brand.
And depending on where someone lives, brands without refined sugars may not be readily available. Google "food desert" and see what comes up.
It was literally impossible a generation or two ago to ingest the amount of carbohydrates the average American gets just from eating prepared and processed foods today.
We should just count ready-meals etc. as 'fast-food' too, no good reason that it implicitly refers to 'restaurants' only really.
> The second or third ingredient on a bottle of ketchup, for example, is high-fructose corn syrup.
Interesting, that didn't sound right to me (but it has been a long time since I've had it) - found this: https://www.truthorfiction.com/heinz-ketchup-ingredients-u-s... (tldr just sugar in the UK)
Edit: or let's take a look at cheese. I've found some pretty expensive cheese in my fridge, packed into small cube boxes, because otherwise its price per pound would be offensive. So we might expect that cheese would do better than cookies. The nutrinion facts label on its reverse begins with "serving size: 2 table spoons, 120 calories" - a borderline fradulent label that's trying to hide the fact that the small chunk of cheese has 600 calories in it.
It’s also quite harmful to dramatize the solutions out to be something unattainable to many people. They are attainable to all people. The healthiest diet I’ve ever eaten was also the cheapest diet I’ve ever eaten, and almost everybody can get 30 minutes of low intensity exercise a day.
To take an example, my self, I am doing intermittent fasting and do moderate intensity exercise everyday for at least 30 minutes(gym, cycling, bouldering, etc). No matter what I do, I still have a muffin belly.
Until one day I began to both weigh myself each day at the same hour with a precise digital scale and also weigh or measure by volume all the food that I eat.
After that moment, I reduced my weight by 2/3 and I have maintained easily any target weight. Even now, after some culinary orgy I easily gain a couple of pounds in a day, but then, by eating only measured quantities of food, I lose them after a week.
The reason why I have failed to control my weight during many years and most people also fail, is that if you eat until you are satiated, then it is guaranteed that you will not be able to control your weight, no matter how much exercise you do.
If you measure what you eat and you only eat pre-planned quantities, it is trivial to reduce how much you eat until you see that the next day you weigh slightly less (e.g. 100 grams less). Then you must keep eating such quantities until you reach the target.
If you do not respect your plan and you eat random extra snacks or drink sweet beverages, then of course you have no chance to control your weight.
It is much easier to follow a plan when you eat less meals per day, because they can be larger. When eating small meals many times per day it is far more difficult to stop after eating just a little. It is much easier to not start eating.
You mean like a politician promoting obesity inducing foods?
If it is really about individuals then obesity shouldn't be going up in African nations that quickly.
This is false. Of course certain foods are metabolized in ways that are more likely to lead to obesity than others.
Most cities and towns have little walking or public transportation. Cheap, high-calorie, nutrient-poor food is easily available anywhere 24 hours a day. Restaurants have an abundance of large amounts of meat and carbohydrates drenched in low-quality oils and sugary seasonings.
You have to be consciously active to stay fit or cook the majority of your own food. People in a lot of other countries stay lean and aren't as obsessed with fitness as we are.
I don’t really have a point, but there is a lot of poison for body and mind in that country.
Time: it costs about 20 minutes to cook a simple, basic fresh meal. With a single weekly groceries delivery (or visit to the store), you're covered for some 5-6 main meals as well as breakfast and lunch. Are you telling me Americans don't have 20 minutes to prepare a meal yet do have that time, or more, to eat out? I've been home cooking 6 days a week for 2 decades. It costs LESS time, not more.
The average American watches over 3 hours of TV, or TV-like experiences in their leisure time, but they don't have 20 mins to cook a meal? I guess they all get home from work and fall asleep?
Costs: Rice, potatos, bread, vegetables and lean meats...please do the math for me how this is unaffordable? They are incredibly cheap commodities.
"Most people in the US live in poverty".
Now they do not. The US is in the top 5 of median incomes worldwide, one of the richest countries in the world. If you dismiss Luxembourg and UAE, the USA is in the top 3. It's not a monetary issue.
Further, 12 hour work days are an anomaly, not a standard. And even 12 hours is not an excuse. Exercise isn't the core of the issue, junk food is.
Time needed to educate on nutrition: your parents or school should have done that, but here goes: don't eat garbage. Cut down on fats, sugars. Education completed. But it's not an educational issue as the person sitting in McDonalds knows exactly what's up.
It most definitely is a willpower issue as every other excuse does not hold ground. People in other countries have less time and less money, and still don't have this issue at this scale.
Please know that this is a not a burn at obese people, I fully sympathize with the difficulty of lifestyle changes, even more so in a culture like the US where the environment seems stacked up against healthy eating.
But we need to attempt to come to real and realistic root causes, and time and money are not the core issues. It creates this illusion that if only economic conditions would improve, we'd all be eating healthier, which is false.
The issue is cultural.
Ubiquitous coffee, economic pressure, overpriced and weak preventative healthcare system, social pressure, status anxiety, housing insecurity, political threats, public-facing crimes, rampant racism. These all test our self-control around food.
Like I said, home cook 5-6 days per week, which costs little time or money. None of the issues you mention prevent you from doing it. Exercise costs no money at all.
I don't mean to dismiss your reasons as if they don't matter at all, I'm stating they are a trap. They provide a shield to hide behind. If only all of that would improve, I'd be healthier. This imaginary utopian society will not make you healthier. You become healthier by stop eating crap.
Nobody's going to do that for you, but you.
Low carb eating has been successful outside of the mainstream lie of "eat more whole grains" because it simply avoids the foods that worsen runaway metabolic syndrome; the common advice is just to "eat less", while these poor people are ravenous and gain fat on whole foods 2,000 kcal diets. CICO doesn't mean anything in a vacuum if one way of eating causes you to be constantly hungry, and the other teaches your body to make use of its great amount of stored energy.
Obesity is eating the same food that previously kept you healthy, but now makes you sick and hungry.
Here's abundance of doctors and researchers talking about it: https://www.youtube.com/c/lowcarbdownunder/search?query=diab...
Here's one I've watched and can recommend: Prof. Robert Lustig - 'Sugar, metabolic syndrome, and cancer': https://www.youtube.com/watch?v=jpNU72dny2s
Research continues its trend against this statement.
1) One problem is the fact that the number of fat cells in the body is conserved after some point. So, if you grew lots of fat cells as a child, sucks to be you, you're now stuck with them as an adult.
2) Caloric consumption has been tracked and cross referenced between countries, and obesity doesn't always correlate with it. Apparently, there are other things going on. Some of these seem to be environmental.
3) Fat cells "remember" your weight when they were formed. Once you become obese, your body fights your attempts to lose weight all the way down until those cells die off and are replaced (about 10% per year or so). It takes MASSIVE amounts of willpower to fight your own body over years.
4) Exercise is practically useless for weight loss. The body demands a fixed number of calories (up until you're doing something at the level of extreme training) and shunts the available calories between systems. Exercise has lots of benefits. Weight loss just isn't one of them.
5) I do agree that nothing in the US helps you avoid gaining weight. Portion sizes are gigantic (a "personal" pizza in the US is a full pizza in Naples). Walking or bicycling is rarely useful for most people. Sugar gets added to everything (For example: Austin, TX has been a particular victim of this--gigantic glasses of unsweetened iced tea used to be the default a decade or so ago but has been replaced by sweetened or double-sweetened iced tea (which used to be limited to the Southeastern states)).
I know these theories about the number of fat cells and about their slow replacement, etc. Nevertheless, they do not match my experience.
I have been obese during about 15 years. Then I began to measure precisely the quantities of food that I eat and after almost a year I reduced my weight to only two thirds from that of the previous year. Since then, another 15 years have passed, during which I controlled easily my weight, also by eating most of the time only carefully measured quantities of food.
During my weight loss, I was concerned about possible problems, precisely because I had also heard these theories about the fat cells that you have mentioned.
However, I have not seen any evidence for them. Before losing weight, climbing stairs was difficult, it felt like carrying a huge backpack, and I could not even see my lower body due to my belly.
After losing weight, not only all physical activities became easy, but even if there was a very large reduction in waist circumference, so initially the skin remained rather loose, after not a long time it adjusted, so no signs of the former size remained.
There were no problems whatsoever caused by the weight loss, but I had to retain forever the habit of eating according to a plan, because any day when I eat outside the plan, I immediately gain weight.
If you do not eat enough food to keep alive all your cells, some cells must die (after you have already consumed most of the internal energy supplies stored in fat). It is very unlikely that your internal regulation mechanisms will not ensure that the unused fat cells will die before cells that are in active use, e.g. muscle cells. So that theory about the constancy of the fat cell number can be true only while you are still eating some excess food or while you have not lost most of the fat reserves yet.
Strength training, on the other hand, is (at least I hear) helpful in losing weight.
This is sort of true but also sort of not. The body doesn't require a fixed amount of calories exactly, a specific body composition does. If you put on muscle the amount of calories the body demands goes up.