[plgonzalezrx8]

If dieting doesn't work, how come the procedure he's talking about is basically reducing the volume of his stomach? Sort of a "Forced" dieting if you will?

Dieting and exercise ABSOLUTELY work. Calorie deficit will make you lose weight. You can't create/add matter to your body from nothing. Every atom that your body gained in order to gain weight, came from somewhere, namely, food.

99% of the time when people say the diet didn't work, they were doing a half assed diet with "cheat" days every couple days where they down a 2,000 calorie milkshake.

Source: I used to be that guy making excuses and blaming genetics for being overweight.

[Enginerrrd]

It's not that dieting doesn't work. It's that telling people to diet, as a medical intervention, doesn't work. The science of dieting is refined. The science of getting people to diet however has not been very fruitful. It's probably one of the least successful interventions in all of modern medicine, so we obviously need to do better.

[TheNewsIsHere]

I’ll preface my comment with the acknowledgment that there will always be medical and non-medical cases preventing dieting from working.

I think on the whole it’s a good thing to have psychological and physiological solutions to obesity. But I don’t think that changes anything. Ultimately the medical advice has remained consistent: the best way to lose and maintain weight is a healthy diet and/or physical activity. Calories in must be less than calories out to lose.

Unless someone has a truly impactful psychological or physiological obstacle to implementing that advice, what is gained pursuing any other end?

I agree with you but theoretically isn’t this kind of like “take your medicine” advice? If you don’t take the medicine, you don’t get better. To what end should we invest society’s resources into ever cleverer ways to get people to “take their medicine”?

[andrewla]

> the best way to lose and maintain weight

Why is this "better" than GLP-1 agonists or bariatric surgery or non-surgical procedures? All of these are accepted procedures approved for use by medical board around the world.

[AnIdiotOnTheNet]

> Unless someone has a truly impactful psychological or physiological obstacle to implementing that advice

As someone who lost about half their body weight, I feel very much that just about everybody who has a problem with weight loss meets this criteria.

The question is: why is it so easy for so many people to stay a healthy weight without even paying attention to it, and for others it require constant attention and suffering?

Until we can answer and that, weight loss is most definitely not a solved problem.

[plgonzalezrx8]

> why is it so easy for so many people to stay a healthy weight without even paying attention to it, and for others it require constant attention and suffering?

Society and the easy access to indulging high caloric and straight up unhealthy food. You don't see a lot (if any) fat people in certain parts of the world where access to cheap, unhealthy, highly caloric food is not as readily available as it is in the US. The literal problem around here is "I have too much access to food, and I'm unable to stop myself from eating it".

Some people get addicted to cocaine, others to meth, heroine, others to alcohol, and others, to food (Sugar has been found to be MORE addicting than cocaine BTW). So it is an addiction problem, but because it is tabboo to tell someone they should eat that much, it becomes a hard problem to address.

They appeal to emotion, i.e. "I will be hungry, do you know how hard is to go hungry?", yeah, thats your body craving its addiction, you know how hard is to quit alcohol cold turkey? It literally can kill you, so its almost the same with food.

Someone else commented that some people lose a lot of weight, and then they gain it again 5 years down the road. Thats because the adiction won, at that point you gotta treat your food habits like an addiction. At least with alcohol and drugs, you can literally avoid it and not go near it, and still live fine. You cannot live without food so it makes the tempation of overindulging even higher.

[AnIdiotOnTheNet]

> You don't see a lot (if any) fat people in certain parts of the world where access to cheap, unhealthy, highly caloric food is not as readily available as it is in the US

The word "unhealthy" is doing a lot of lifting in that sentence. For instance, there's the Kitvian people, who have no food scarcity whatsoever and a diet that consists of 70% carbohydrates, which a lot of nutrition "science" tells us is bad, yet obesity is completely unknown to them.

Or the Maasai diet, which is about 66% fat, yet they also don't have an obesity problem.

Sugar consumption in Austrailia between 1980 and 2003 dropped 23% but obesity nearly trippled.

The idea that this is merely due to food addiction caused by some "unhealthy" quality of what we're eating is not well supported by the data. Or at least we haven't isolated what exactly the "unhealthy" part of that is yet.

[ashwagary]

How hard is it to gather self discipline stats for those groups you mentioned? Not all populations put the same pressure on themselves to stay healthy. There is a massive safety net in Australia that doesnt exist in most of the world.

[browningstreet]

I think our issues with homelessness and obesity are pretty similar -- targeting the late state symptoms is not effective. Dealing with the root causes will yield the actions for improvement. But both are creeping issues -- they've been going the wrong way for a long time and at least in our American society, we haven't seen any significant improvements. Our structural society doesn't value or recognize well-being.

[andrewla]

This is similar to condoms -- condoms are nearly 100% effective in preventing pregnancy. But as a method of birth control (that is, as a medical intervention), they are only 80% effective in preventing pregnancy because people don't always comply.

[colpabar]

But how can we do better? At the end of the day, dieting is just hard. Unhealthy food is delicious, and choosing healthier options and eating less in general requires a good bit of willpower.

But I don't see what else can be done. Ultimately, dieting is an individual effort, because only you control what you eat. You can be given all the advice and meal plans and other information in the world, but the hardest part is choosing a side salad over fries, or not buying the snacks you love but know aren't good for you. If a doctor said "take this medicine because you have condition X" and the patient doesn't do it, is it the doctor's fault?

[Enginerrrd]

> If a doctor said "take this medicine because you have condition X" and the patient doesn't do it, is it the doctor's fault?

Think about it from the doctor's perspective.

The doctor prescribes medicine X as a first line intervention and it doesn't work. The patient is unable to tolerate it.

After multiple failed attempts trying medicine X, the doctor opts to recommend that the patient consider medicine Y as a second line intervention, which has a much higher success rate but significant additional risks.

Makes sense, right? Doctor wants to help the patient.

Now swap "medicine X" for "dietary counseling" and "medicine Y" for say "bariatric surgery". That's not really unreasonable.

[plgonzalezrx8]

Treat it like the addiction it is, and you said it yourself.

Here's a copypasta from another comment I made.

Society and the easy access to indulging high caloric and straight up unhealthy food. You don't see a lot (if any) fat people in certain parts of the world where access to cheap, unhealthy, highly caloric food is not as readily available as it is in the US. The literal problem around here is "I have too much access to food, and I'm unable to stop myself from eating it".

Some people get addicted to cocaine, others to meth, heroine, others to alcohol, and others, to food (Sugar has been found to be MORE addicting than cocaine BTW). So it is an addiction problem, but because it is tabboo to tell someone they should eat that much, it becomes a hard problem to address.

They appeal to emotion, i.e. "I will be hungry, do you know how hard is to go hungry?", yeah, thats your body craving its addiction, you know how hard is to quit alcohol cold turkey? It literally can kill you, so its almost the same with food.

Someone else commented that some people lose a lot of weight, and then they gain it again 5 years down the road. Thats because the adiction won, at that point you gotta treat your food habits like an addiction. At least with alcohol and drugs, you can literally avoid it and not go near it, and still live fine. You cannot live without food so it makes the tempation of overindulging even higher.

[SyzygistSix]

>But how can we do better? At the end of the day, dieting is just hard. Unhealthy food is delicious, and choosing healthier options and eating less in general requires a good bit of willpower.

Healthy food also tastes delicious. And while changing one's diet - or any habit - requires willpower, if one has healthy standards set early in life it is not that difficult to continue with them or pick them back up.

One commonality between diets as different as a vegan one or all beef one is the emphasis on eating real food rather than processed garbage.

However I think the idea that there is something present environmentally that is causing a systemic issue should not be discounted. People in the 70s did not eat particularly healthy. They liked to watch tv, had Doritos and snack cakes, were just as lazy, and did not have any more willpower, discipline, or education than people do now.

[ferrumfist]

> Unhealthy food is delicious, and choosing healthier options and eating less in general requires a good bit of willpower

Just want to say that, in my experience, this is only if you're in the habit of regularly eating unhealthy food. Once you break that habit and your body adjusts to eating healthier food, eating unhealthy food regularly becomes too rich/heavy/sweet.

For example: I used to eat a ton of Reese's pieces when I was younger. This weekend over Thanksgiving, I had a few pieces and came to find that they were now WAY too sweet. Same goes for soda, once water is your baseline drink soda becomes far too syrupy and sweet.

[SyzygistSix]

>Once you break that habit and your body adjusts to eating healthier food, eating unhealthy food regularly becomes too rich/heavy/sweet.

Definitely.

[AnIdiotOnTheNet]

If the medication tastes like human waste, can you blame the patient for a low compliance rate?

[Sparkle-san]

And even when dieting is done successfully, most people regain the majority of weight lost within 5 years. It takes permanent lifestyle changes to make weight loss persist over time which is not a simple thing to do.

[plgonzalezrx8]

Same with alcoholics, drug addicts, or anyone with any other addiction (In this case food). They can go sober for years, then BAM, back to square one.

With food is harder because your addiction is right in your face every day.

[sasaf5]

The problem is the food supply. Sugary, fatty food, constantly available.

[hunter-gatherer]

I've recently wondered if more strict food regulation would help. Maybe heavily tax sugars (a nuance-lacking example, of course). I mean, we effectively regulate tobacco and alcohol to some degree and limit consumption thus. I wonder if regulation that encourages strict whole food consumption is possible. Of course, even the thought excersise is probably wasteful because it will never happen. Too much money in cheesecake and chips

[anonuser123456]

The procedures and drugs the author discusses affect the regulatory mechanisms at the heart of the drive to eat. People on GLP-1 agonists eat less because they don't want to eat. People with bariatric surgery eat less because they don't want to eat. These procedures are effectively diets.

[vadansky]

>You can't create/add matter to your body from nothing

Sure you can, imagine two scenarios:

1. You eat 100 calories, and you have a 70 calorie deficit in your cells. 70 calories go to your cells to make ADP (this makes you feel full) and the extra 30 goes to fat.

2. You eat 100 calories of HFCS, it spikes your insulin and your body take 90 calories into fat FIRST and 10 calories into your cells to make ADP. You are still hungry because you have a 60 calorie deficit because your cells still lack ADP, you still feel tired and you got fatter.

It is fully possible to eat nothing but trash food that freaks your body out. The problem is for a lot of people we were though the wrong facts about nutrition, like "Fat is bad and (highly processed) carbs are good".

[laweijfmvo]

This ultimately does violate physics if your caloric output is the same in both scenarios. Maybe the HFCS makes you more tired/lazy like you said and that causes your output to drop dramatically, but then it's no longer the same comparison.

[AnEro]

100% agree, however I do think we have to apply way more empathy cause losing weight is extremely hard and there are bigger factors that make it harder even if your fully educated and have good will power. Like time and money

I went from 250 to 200 then 200 to 170 pounds, first run I could afford the healthy alternative foods the second time I couldn't. It was 10x harder to lose the 30 pounds than the 50, not just cause higher body fat caused it to be easier to lose but cause the food filled me up. I couldn't afford to get the ideal ratio of protien or even really get about 90g of protein a day on my budget. I then had to be making all this food myself in order to have any filling meals, which took up the last bits of my free time as I was struggling to find contract work.

Of course you can make it yourself, but now you have to learn a bunch about nutrition and cooking, then also have the time to cook it. The super high calorie foods are exponentially cheaper, when you factor your time into it. Mcdoubles have a similar macro density if not better than a protein bar and are more filling. Before a price raise I could eat for 5 bucks in 10 minutes or eat for 1.5-2.5 be filled but lose 1-2hours research, gorceries, prep, and cooking. all of which is cheaper than giving up time you could be working or resting to work better.

I think the time and money to put to dieting is a luxury. I do agree we need to cut the BS excuses, but I do think that someone has a choice to be over weight if they only have a few hours to themselves opt to not spend those hours working but for their health and accept the consiquences. I think we need to focus on finding solutions for that person not the person with no drive to figure it out

[hedgehog]

This simplistic model sounds nice but (and he notes this in the article) doesn't pass the test of explaining the dynamics of weight/gain loss in live humans. Lots of people have pet theories ("just eat meat" or whatever) but researchers who work on this stuff don't seem to think it's such a simple or settled question. I'm an unexceptional counterexample: Despite substantial variation in how I eat and exercise over the last 20 years or so, not disciplined at all, my weight has varied by less than 10%. Is there some secret thing I'm doing that protects me? I doubt it, I think there's just a lot of variation in how different people's bodies run that means some people's lives are a lot harder and there's no silver bullet.

[JackFr]

> If dieting doesn't work, how come the procedure he's talking about is basically reducing the volume of his stomach? Sort of a "Forced" dieting if you will?

It's pretty simple actually. The forced reduction of stomach volume results in a different physiological response to eating moderate amounts.

[ebiester]

You are mixing diet effectiveness (physics) and adherence. Let me give you an example.

I just had a giant mound of quinoa with a mix of sauteed vegetables and a little more raw olive oil. It met my calorie requirements, but was slightly low in ideal protein. (I've had the same meal with a chicken breast, with the same effect.) I've hit my calorie limit and I'm still hungry.

Sure, it's as simple of CICO, but if CICO with a high vegetable diet leaves me hungry for 14 hours a day to maintain my current weight, it's going to be incredibly hard to maintain adherence. (Let me tell you, it's awesome to wake up at 3AM and so hungry you can't get back to sleep. I will choose sleep over my calorie deficit every time.)

Diets don't work because they are hard to adhere to, even if you are not eating junk food.