[DEFCON28]

Exactly. I am a strict calorie counter and I am not overweight. (155# 5’10” 55 year old man). Sometimes I have hostess cupcakes for breakfast. (330 calories). Sometimes I have a Big Mac for lunch (550 calories). It’s hilarious when fat people talk about ‘whole foods’ and ‘mindful eating’. It’s calories.

[AnIdiotOnTheNet]

I wouldn't call it hilarious, but as Mel Brooks once said "Tragedy is when I cut my finger. Comedy is when you fall into an open sewer and die".

When you're that obese, food is an addiction in the literal sense. There is a ghrelin/dopamine feedback loop at work and it is not at all fun to break that. People are lured in by these schemes because the addict part of their mind is desperate for excuses not to stop eating. I know how this feels, because I fucking lived it. You wouldn't believe the things you can convince yourself of as an addict. Not to mention that lowered blood sugar is directly correlated with decreased willpower.

It's calories. We know it's calories. We know we shouldn't eat so many calories. That's not the hard part.

[DEFCON28]

But this law is all about calories. And counting calories works. If you’re unable to count calories then of course you need some remedial help. But pretending that it’s about “eating the right foods” is lying to yourself.

[AstralStorm]

Every obese person needs "remedial help", that's the definition of treatment. Even attacking the problem from multiple angles may not be enough. Counting calories combined with accurate monitoring helps but is very often insufficient. And even from just that the drop out rates are big - even without actual caloric restriction.

Increasing base metabolism is known to not work as it does not suppress the appetite or fix reward loop. Though thyroid therapy may be needed for some cases.

Dopamine uptake inhibitors exist but they have other side effects, petty bad. (Among them addiction.) SSRI make the problem worse, as do certain antipsychotics.

Direct appetite suppressants have not been invented yet though you can cheat some with special diets. (Well there are some but they're not stable and pain to inject. Could be done like insulin injections but somehow not considered cost effective and unsafe as ghrelin has additional functions.)

Having accurate data on food contents (including caloric) is vital but insufficient.

[sbenitoj]

This is overly reductionist and places the blame on people attempting diets.

Most people I’ve found have simply been given terrible dietary advice (like eat high carb, low fat), which doesn’t work for the vast majority of people (because it elevates insulin levels, making them hungrier), and then they’re blamed later for not sticking to the program.

It’s completely ridiculous, it’s like putting a faithful man in a whorehouse and forcing him to ingest 4 doses of ecstasy. Sure it’s still his fault if he cheats, but are we going to pretend that the context doesn’t matter?

Ecstasy and whorehouses are a poor plan for fidelity, high-carb low-fat is a poor plan for fat loss.