[AdrianB1]

A friend that is a doctor specialized in metabolic problems told me that around 5% of the cases of obesity have some medical cause, not eating too much. 5% is low, but it is a lot more than "very few exceptions". (Disclaimer: the number is for Europe, I have no idea what is in US)

[HyperSane]

All obesity is fundamentally caused by eating too much because fat contains energy that HAS to come from food.

[Dove]

Well, blood sugar contains energy that has to come from somewhere, too, but one would hardly say this means type 2 diabetes is fundamentally caused by eating too much. Shoot, tumors contain energy that has to come from somewhere...

Of course, you could rightly reply that there are a lot of complicated things that happen between the food and the problem, and while those diseases require an energy surplus, that neither causes them, nor does trying to naively eliminate the energy surplus fix them. Contrary to popular wisdom, the same is true of obesity.

The idea that obesity could be avoided or cured with a little bookkeeping and self control is laughable to just about anyone who has tried. Telling obese people to eat less is like telling depressed people to get over it. You'd be astonished by how ultimately impossible that is if you haven't been there.

[HyperSane]

The entire purpose of fat is to store excess energy for future use because over human evolution food supply was unreliable enough for this to create an evolutionary advantage. Getting fat from eating a lot of food is completely predictable.

"The idea that obesity could be avoided or cured with a little bookkeeping and self control"

It absolutely can. Again people just don't want to feel bad about not having enough self control.

[Dove]

>>"The idea that obesity could be avoided or cured with a little bookkeeping and self control"

> It absolutely can.

No it can't. ;)

Well, not always. I've experienced both sides of this: an effortless loss of 60 lbs with easy diet changes and bookkeeping over the course of a year and a half. And a few years later, an abject failure as the same strategy -- a moderate calorie restriction -- resulted in such profound physical distress that I developed psychological problems long before I made any physical progress.

Sometimes it's easy. Sometimes it's impossible.

My story is far from atypical. It's common. Practically universal. Everyone, just about everyone, who tries to lose weight, using any strategy, succeeds over a period of months, and fails over a period of years. The reason is that the underlying control mechanism is in a different condition, in different people who may be the same weight.

> people just don't want to feel bad about not having enough self control.

I know you're really attached to the energy imbalance theory of obesity. People often are. But I'd like to suggest that this comment suggests you may have a different motivation for believing in it than just that you find the evidence persuasive.

I often wonder why people get so attached to a theory that I think is in such obvious evidential crisis. A need to believe a simple solution will be there when they need it? A traumatic dieting experience that they need to believe was necessary and useful and healthy? Maybe it worked for them once and they're universalizing their experience? A desire for moral superiority? The fact that deliberately oversimplifying things makes for slam dunk messages on forums?

I don't know, but diet is one of those weird topics where people are attached to their opinion with the religious fire of a thousand suns. While I know I won't change your mind, it does seem fair to point out that your statements are both hyperbolic and inaccurate, and that's not a good sign.

[HyperSane]

"I know you're really attached to the energy imbalance theory of obesity. "

It isn't a theory, it is a fact. It is basic thermodynamics. The human body requires a constant amount of energy for basic operation and activity. Any excess is stored as fat for future use. Creating fat requires calories that HAVE to come from food. Eat few enough calories and you WILL lose weight. Eat zero and you WILL die. Eat 20,000/day for a year and you WILL get very fat.

A good example of this is this man went 382 days without eating

https://www.diabetes.co.uk/blog/2018/02/story-angus-barbieri...

He had a calories surplus for long enough to weigh 207kg. While not eating his body consumed energy in his fat to stay alive and he got down to 81kg. ((207-87)kg * 7700 calories/kg)/382 days = 2539 calories/day, which is a very plausible number.

[hgomersall]

The problem, which I can't work out if you know about but ignoring or are ignorant of, is that humans have inordinately strong control systems to maintain some state, as well as hugely influential effects from e.g. a gut biome.

To say "it's just thermodynamics" might be right as far as the physics goes, but it doesn't recognise that biological drives overwhelm everything. It's hugely complicated how energy expenditure and steady state energy consumption interacts with weight gain, not least because the body will invariably work to make your actions as efficient as possible to maintain weight. For example, observational studies of hunter societies that might travel large distances daily, energy requirements bear little relation to daily activity after any transition time has elapsed when compared to relatively inactive Western counterparts. These people can't just will their activities to be less efficient if they hypothetically wanted to consume more energy.

Ultimately, the biology will decide what the effect of any intervention is, regardless of how motivated or not you are. Any advice that doesn't explicitly factor that in is just hot air.

[argella]

"The human body requires a constant amount of energy for basic operation and activity. "

no, it doesn't. the amount it uses for basic operation and activity will change. shrinking in response to your attempts to lose weight.

[Dove]

> The entire purpose of fat is to store excess energy for future use

That isn't true. Though it's a primary use, the opening paragraph of the wikipedia article on fat outlines that it actually has many biological functions (and is properly thought of as an organ!): https://en.wikipedia.org/wiki/Adipose_tissue

> ... because over human evolution food supply was unreliable enough for this to create an evolutionary advantage. Getting fat from eating a lot of food is completely predictable.

Not at all. While fat does have a primary function as an energy reserve, that does not mean that unregulated growth is a simple matter of putting too much energy into the system. After all, just as in nature there are times of famine, there are also times of feast. It would be pretty disadvantageous for animals to have no regulation on their fat growth in times of abundance. Something more has to go wrong to cross the line from "saving for a rainy day" to "killing you". Animals don't eat until they damage their stomachs, do they? Not generally. Why does it make any more sense that they should eat until they damaged their endocrine systems?

An interesting counterpoint: bears hibernate. In preparation for doing so, they become fat by eating a lot. Now, they do this, not just any time of the year when food is abundant, but specifically in the fall as they prepare for the winter. Are they just lucky that food happens to be abundant every fall? Or is something else going on? What happens in years of famine? Do they still manage to get fat so they can hibernate?

Another interesting counterpoint: Pregnant women eat a lot and put on weight. Why do they do that? Is it because more food is available? Or is something else going on?

One last counterpoint. Bodybuilders put on a lot of muscle, which also takes energy, and they eat a ton to support that growth. Why is it that if I eat an extra steak, my flab gets bigger, but when Ahnold eats one, his biceps get bigger?

Obesity is dysregulated growth. While growth does require energy, it is in the failed regulation of that growth that you will find the best explanation for the disease.

[HyperSane]

" It would be pretty disadvantageous for animals to have no regulation on their fat growth in times of abundance. Something more has to go wrong to cross the line from "saving for a rainy day" to "killing you". ""

I really can't blame you for assuming this, but it actually turns out that food was scarce enough in human history that humans never actually evolved a limit on how much fat we will store. If we keep consuming a caloric surplus the body will keep creating fat to store it. This is the body working as intended. Things would be different if humans had a more reasonable max body fat percentage.

https://en.wikipedia.org/wiki/List_of_heaviest_people

[nradov]

You have mixed up a few facts with a lot of "bro-science" there. What you have described is not consistent with our current understanding.

https://peterattiamd.com/rickjohnson2/

Anyone can build muscle instead of flab if they do sufficient resistance training and eat enough protein. Gains will tend to be slower for women and older people. Arnold Schwarzenegger used a lot of steroids and other PEDS which can certainly accelerate gains, but aren't worth the side effects and legal risks for most people.

https://www.essentiallysports.com/us-sports-news-bodybuildin...

[yunwal]

> It absolutely can

It can’t. There are many people who, if they simply scaled down their diet without otherwise modifying their nutrient intake/lifestyle, start having health problems well before they lose weight. Hot flashes, fainting, severe stomach pains, nausea.

[HyperSane]

This sounds false to me. I suppose for someone used to eating 10 to 20 thousand calories per day suddenly going to 1500 would be stressful but if gently tapered no one should have any issues.

[yunwal]

I mean the obvious counterexample is someone who eats 1500 calories of real food and 2500 calories of junk food a day. If you scale that down by half you start getting all sorts of nutrient deficiencies well before hitting your target weight.

But there are subtler versions of this. People who live in food deserts, only have access to iceberg lettuce and freezer-burned tomatoes as produce are gonna have a tough time getting all the nutrients they need in 2000 calories or less. There’s also others who have very specific dietary needs that they’re not yet aware of.

[nradov]

Type 2 diabetes is fundamentally caused by eating too much of carbohydrates. Most type 2 diabetics can put the condition into remission by changing their diet.

https://www.virtahealth.com/research

There are many people who have cured their obesity with a little bookkeeping and self control. Sue Reynolds and David Goggins are a couple of prominent examples, but there are many others. It's not easy, but it's certainly possible.

https://suereynolds.net/book/ https://davidgoggins.com/book/

[Dove]

> Type 2 diabetes is fundamentally caused by eating too much of carbohydrates. (Emphasis mine)

Fructose, specifically, is the going theory. And I'm a big fan of Virtahealth specifically, and Dr. Fung's approach for treating type 2 diabetes generally. :)

However, I'd disagree that we know that that's what causes it. We know that treats it. Cancer is not caused by a lack of chemotherapy, and I think chemotherapy is a good analogy for the fasting and low carb approach in this situation. It is a treatment, not a generally normative lifestyle.

But my point is actually more limited, and you actually sort of made it for me by adding the detail about carbohydrates. To wit: just because sugar requires energy, does not mean that you got too much sugar by bringing in too much energy. It's not that simple. You won't get the disease by eating too much protein, for example (you'll get protein poisoning ;) ). You get the disease as a result of liver dysfunction, which you exacerbate and possibly cause by eating too much fructose. It's a control mechanism problem and an injury problem -- the fact that energy is involved (even required!) does not make that the central issue.

Cancer requires energy for growth, but that doesn't make energy the central problem. Blood sugar requires energy for dysregulated high levels, but that doesn't make energy the central problem. Fat requires energy for dysregulated growth, but that doesn't make energy the central problem. That's something you have to demonstrate, and rigorous attempts to demonstrate it fail.

> There are many people who have cured their obesity with a little bookkeeping and self control ... David Goggins

Citing David Goggins as an example of "a little bookkeeping and self control" is hilarious to me. I've read his book. I love his talks. But the guy is about as heroic and extreme as it is possible to get, and that is far from the only thing he did.

[nradov]

I have yet to see a type 2 diabetic who didn't eat excessive quantities of carbohydrates before developing the condition. The details of the exact causative mechanism are interesting, but largely irrelevant from a prevention perspective.

My point is that David Goggins is nothing special. He isn't a superhero from the planet Krypton. Anyone can choose to do those things (or at least lesser versions of them). Some people just prefer to sit on the couch eating cookies.

[unmole]

> but one would hardly say this means type 2 diabetes is fundamentally caused by eating too much.

Eating too much is literally what causes type 2 diabetes.

[swatcoder]

Technically right is the most reliable kind of right, but in this case “too much” means that someone’s body responds differently than expected to the same amount of food.

It’s true that the extra stored fat might must come from calories not used or excreted elsewhere, but that might be because their body is very poor at making immediate use of the calories as energy or is unusually efficient at storing energy that might otherwise be used. To put a number to it, a 2000 calorie diet as normally recommended may leave them depleted of energy and increasingly fat.

It can take years to discover that kind of “outside the norm” issue, and obesity can easily set in before its recognized let alone addressed. And of course, once obesity does become a part of someone’s life, there’s a whole spiral of challenges that make it hard to overcome. Even moreso when your body doesn’t work normally.

[perfecthjrjth]

Calories In Calories Out (CICO) doesn't explain obesity. You are dealing with biochemical machines (humans). CI enters this biochemical machine; here, the signal system should be effective to 'equalize'. Otherwise, you get all kinds of problems: obesity, t2d, cardiovascular events, etc.

These new generation of drugs (semaglutide, tirzapatide) deal with the signaling system (endocrine signaling, that is).

[HyperSane]

"Calories In Calories Out (CICO) doesn't explain obesity."

Yes it does, because it is basically just repeating basic laws of thermodynamics. Obesity is actually just the body working as intended by storing the excess energy for future use during a famine. CICO is why obesity used to be very rare in past when calories were expensive and is now common when calories are very cheap and artificially delicious.

[perfecthjrjth]

Well, two conceptions of human beings are in conflict: (a) humans are controlled by their own "will" (b) signaling system (biochemical interactions) control stuff. (a) is a cultural intuition. Now many life sciences researchers sell us a hybrid version: both (a) and (b) are true.

[HyperSane]

https://www.diabetes.co.uk/blog/2018/02/story-angus-barbieri...

[kilgnad]

No. Absorption rates are different. Liquefied fat of the same calories translates to more fat then plant with the same calories.

That's just an extreme example. The real culprit is processed foods.

[HyperSane]

The difference should not be enough to be the difference from a body fat percentage of 15% to 80%.

[kilgnad]

https://www.theatlantic.com/health/archive/2015/09/why-it-wa...

You don't know that.

[HyperSane]

I very much doubt the accuracy of calorie consumption data that article is based on. CICO is so fundamental that I would propose that the current rate of obesity is proof that average net calorie surplus has increased.

[kilgnad]

let's keep it to one thread. I'm ending it here.