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PaperclipPerfector  5mo ago (text post)   38063 thread views

Culture War Roundup for the week of July 8, 2024

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Getting close to a year ago, I talked about GOLO, a weight loss program that I heard about from an ad in a podcast I was listening to. I found it oddly satisfying, because they were trying to launder the standard science on CICO through explicit anti-CICO messaging; truly a beauty of capitalism. Their biggest tag line for what they think is going wrong with a lot of people was insulin resistance. Whelp, while I was at the gym this morning, what popped up in my podcast list? A two hour long Peter Attia podcast specifically on insulin resistance with MD/PhD Gerald Shulman, an academic researcher on the topic.

They talked about the prevalence of insulin resistance in the population. No, it is not obscure. Obesity basically causes it directly, and yeah, the population obesity numbers are high. They also talked about diabetes, both Type I and Type II, as well as some studies on healthy, lean young adults who had two parents with Type II diabetes and who displayed insulin resistance (i.e., at high risk of developing Type II diabetes). But yeah, lots of people do have insulin resistance, so things like GOLO are at least capturing a slice of reality, even though it's clear that they're not really specially targeting insulin resistant individuals. They're not testing people for insulin resistance and then tailoring their program accordingly; they're again just laundering the standard advice and giving it to all comers, whether they're actually insulin resistant or not.

They talked a lot about molecular mechanisms, evolutionary explanations, etc., in great gory detail, far more than I could do justice trying to reproduce here. I'll hopefully suffice by describing one concept; they distinguish between insulin resistance in muscle versus what happens in the liver down the chain (which can cause fatty liver disease, which is now working its way up to being one of the leading causes of death or other conditions that cause death). Apparently, many folks develop muscle insulin resistance, so glucose is not able to be deposited in muscle as glycogen, so it ends up in the liver, and all sorts of problems follow.

What can we do about this? "Exercise reverses this muscle insulin resistance ... exercise in muscle actually will prevent fatty liver and liver insulin resistance". [EDIT: They talked about a couple different studies, but Upon further review in the comments below; I think this part was just one study. They did talk about other studies generally, but I had interpreted this section as referring to two different studies, but now I think it refers to just one] remember that population of otherwise healthy, lean, young adults with parents who have Type II diabetes? They had them do a single bout session of exercise (45min 3 sets of 15min at 65% VO2Max), and that was sufficient to open up the necessary translocation pathway, resulting in "more glucose deposition as muscle glycogen and significant reductions in [something too technical for me to try to explain in this comment] and significant reductions in liver triglyceride."

What about beyond that population, thinking about just other obese people? "What can we do about this? If we can get our patients to lose weight; this of course is the best. Diet and exercise of course is the best thing, and that's the first thing I tell my patients. We really drill into them how we can really fix everything that's wrong with them through this process. [Emphasis added; italics felt true to the audio; bold is my own focus]"

We know a lot about how this works. We know how to fix it. Exercise still is the single most effective medical intervention we know of. If exercise were a pill being prescribed, it would be hands down the most effective thing for all-cause mortality. Paired with diet, it's basically a superpower against a vast swath of modern maladies. Doctors know this, they know how it works and why, they've known this for a long time now, and they'll say it in public. Some, like this guy, will even say it so bluntly to patients. But many doctors know that patients don't want to hear it. They don't want to hear the science; they don't want to "follow the science" (i.e., actually do the thing). He also mentions that even though they try to drill this into patients, many of them still just don't do it. Patients get annoyed with doctors telling them the truth, and this results in a lot of doctors giving up and not even telling them anymore. Just avoid the topic. I had one obese friend tell me that she practically begged her doctor for advice with her weight, and he said, "You know, you're just getting older..."

You don't have to believe the GOLOs of the world. You don't have to believe the sign on the gym swearing that they'll help you lose 20lbs in 30 days. They're grifting, and they're helping to confuse many many people about how their bodies work. But the evidence is pretty solid that basically whatever the excuse is, in this case insulin resistance, the most well-documented and scientifically-supported solution is still diet and exercise.

The biggest takeaway I have from the discussion below is how bad American drug prices are. I'm paying around £100 a month ($130) for my tirzapetide by buying high dose pens and then taking half dozes every week. In the end the net cost to me of this medicine is minimal because it means I eat almost £100 less worth of food a month too. One the other hand you guys are having to pay $500+ per month for semaglutide which is worse.

I'm not the biggest fan of the NHS but you can't deny it gets us cheap drugs, their development paid for on the American dime. Long may that continue!

Every medication when prescribed by the NHS is literally £9 per prescription, right? Something like that, I think.

Yeah, but you're not getting GLP-1 agonists prescribed by the NHS unless your BMI is like 35+. You can very easily get a private prescription for them from any of the big online pharmacies and all you have to do is send them a picture where you look fat enough (can do this by wearing three extra shirts and sticking your belly out). This way your monthly pens cost £150-£250 depending on place and strength but the high strength pens can easily be used to dispense half a dose instead of a full doze so you can use them for two months instead of one.

Sounds about right. I remember losing hair when I had to get paracetamol for my ex and it cost me about a hundred times what I pay for it in India.

You can get store-brand paracetamol for like 60p from the grocery store. Presumably that’s still much more expensive than India but you don’t need to be prescribed it.

You can get paracetamol off the shelf very cheaply at any pharmacy, don't need a prescription for it.

I am not fat. Nearly everyone I know is not fat. None of us put much effort into being not fat, only the fat people struggle. OK, I go for a 20 minute walk most days. I do a few minutes of bodyweight exercise from time to time. I play Beat Saber sometimes (which is fun and energetic, still the best thing to do with a VR headset IMO). I don't think exercise has any effect on my weight, it's just for fitness. I used to do very little exercise and remained thin.

I live in Australia, which is not a terribly thin country. 31% compared to America's 42% obesity rate. There are loads of fat people around, most people live a pretty sedentary lifestyle with a heavy reliance on cars. I spend my day staring at a screen.

I'm convinced that I live the easy pre-1960s lifestyle where I can eat as much as I want to while staying thin. I just eat normal food that our ancestors would've recognized. Brown bread, rice, milk, fresh fruit, carrots, beans, potatoes, rice, beef, chicken, fish, yoghurt... Occasionally I have stuff like ice cream, fruit juice, potato chips, dates and chocolate. I'm not shopping at an organic farmer's market, just a normal supermarket. None of this requires much effort. It tastes fine and I still have sweet things occasionally. Yoghurt with berries in it is quite nice.

But I see what other people buy when they complain about inflation and I immediately think 'this is all processed, plastic crap, it's not really food and you shouldn't be buying it'. Consider shrinkflation: https://old.reddit.com/r/shrinkflation/ It's nearly all Toblerone, cookies, chocolatey cereal, brownies, doughnuts, pizza, pringles, soft drink, McDonalds... I bet that if your diet looks like that subreddit, you will struggle with your weight. They're not complaining about smaller loaves of bread, put it that way.

Food preparation is trivial, you just stick vegetables and meat on a pan and let it cook. Where I live full-cream milk is cheaper than Coca Cola, it's not like there's much price pressure. And food is an acquired taste, you can learn to eat anything. The artificially flavoured chips with all the spices and meat flavouring taste awful to me, I can't stand KFC. The Scots eat haggis, the Nords eat disgusting rotten fish, the Chinese eat anything that moves. The diet of our recent ancestors is not big culinary ask.

Both haggis and surströmming are perfectly fine, I even actively like the Swedish equivalent of haggis (Pölsa) and eat it regularly, and unlike haggis it includes the tendons. The issue with surströmming is the smell, not the taste, but unlike haggis this is more of a meme food anyway.

Our recent ancestors generally weren't that desperate or retarded. The food they made was and is pretty good.

People get freaked out by innards or whatever but it's perfectly fine food. People eat sausages just fine and thats made with intestines.

The 50s and 60s probably literally was a nadir of mass market food quality in the anglosphere for various reasons. Crack open a fifties cookbook sometime; it's often normal foods still eaten today but underseasoned and overcooked.

I agree that innards are perfectly fine(I'll happily leave nordic seafood to nordics) and moderners are squeamish. But there does seem to have legitimately been a generational loss of cooking skills in the anglosphere partially compensated for by eating garbage instead of fresh food. I'm reminded of France's consistently lower obesity rates- they still have a thing about eating fresh food.

The Scots eat haggis

I learned that some of the more entrepreneurial of the relatively few South Asian immigrants in Scotland invented the "haggis pakoda".

That convinced me there's such a thing as too much assimilation and fusion of cuisines.

Something changed in the last century, but it's not what you think.

It's not the food.

Caloric availability and palatability isn't much different from 1990, when the obesity rate was half of what it is today. Japanese food is incredible, as is Korean food, and the Japanese and Koreans can afford as much food as they want. They have single digit obesity rates. Italians in Italy have better food than Italian-Americans, with a much lower obesity rate.

It's not willpower. There hasn't been a great willpower monster that suddenly appeared in 1970.

That which changed is obvious to everyone but aspies like us: It's individualism.

Everybody outside of the individualistic world doesn't need to exercise willpower, because everyone else in the planet and in the past simply has no agency. Where you live, what you do for work, when you eat, who you eat with, and what you eat wasn't your choice, and isn't your choice in most of the world. Your elders eat first, and how much you take, what you eat, and how much you eat is governed by elaborate social codes.

The Japanese aren't thin because Japanese food is terrible, or because the Japanese have amazing willpower. The Japanese are thin for the same reason the Japanese commit less crime and have no children out of wedlock. If someone you know in Japan is fat, you're conditioned to call them fat. If you're fat, you're conditioned to listen to them. That keeps the Japanese thin.

If you're an American, you're conditioned not to judge others, and you're conditioned not to respond to other's judgement, because this is 'Murica and you can't tell me what to do.

There's nothing in the individualistic world that can get you out of the obesity crisis, because for many people the only thing stronger than the desire for food is the desire to fit in. We don't have that tool in the toolbox anymore, so only aspies with high agency, people with lucky genetics, and people who still belong to strong communities (anyone from Japanese-Americans to the PMC) will stay thin.

Great post, it’s entirely about social shaming and the lack thereof in the West.

That which changed is obvious to everyone but aspies like us: It's individualism.

The fattest countries (outside of Pacific islands) are mostly Arab countries.

The most individualist countries are Anglosphere or Northern European countries. Arab countries score very low on individualism comparatively.

Moralism is tempting, but the real explanation is more likely to be biological.

But our genetics has not changed since 1970. People who were skinny young adults in 1970 are in their 70s now. They’re riding scooters in Walmart. What has changed drastically in many cases leading to declines in student achievement, more crime, more drug use, and in this case obesity. All of these social vices have increased since the 1960s or so. And it wasn’t genetics that did it.

The patterns you're describing aren't happening. If we take the US as an example, crime has been declining since the early 90s (when people were much skinnier). US PISA scores peaked in 2014 before declining to their 2000 levels today (this is probably related to smartphones). Drug use seems to have peaked around 2000, while alcohol peaked around 1980.

One thing that has skyrocketed is vegetable oil consumption. I think the introduction and ubiquity of an evolutionarily novel food is a greater explanation for obesity than the whole world getting lazier in the 1970s for no reason.

The Arab countries, like the pacific islands, have their own issues with a sudden surge in availability of food, newfound prosperity and biological adaptation to long periods of fasting (in the desert / remote islands respectively) combining to lead to a big surge in obesity. In large parts of MENA there is also a big gender divide in obesity, women are much fatter than men precisely because women are extremely, almost unfathomably (to Westerners) sedentary in those cultures. Overweight women are also considered less unattractive in those regions.

It’s a mistake to assume the cause of obesity is always the same. Nevertheless, when looking at western countries where male and female obesity rates are quite similar, and where beauty standards (correctly) favor slim bodies, and where almost all people have been rich enough to buy more than enough food to get fat for 75+ years, lack of shaming is the most likely explanation.

Pacific islanders also have the additional issue that they are genetically predisposed to higher BMI. In a lot of the rest of the world since the agricultural revolution there has been selection against high BMI over the last 10,000 or so years (we know this by comparing modern vs ancient DNA), however pacific islanders haven't seen the same thing happen. As such today they have more high BMI alleles so it's no surprise they just balloon when exposed to modern highly processed western food.

IIRC the Native Americans who are still full blooded and not just white people with interesting family histories have the same issue.

I don't think this explains it adequately. I've never known someone who was fat and who didn't feel social pressure for it. Yeah some HAES Tumblrinas are out there saying that they're proud to be big, but they're not the modal experience. For most fat people (everyone I've known at any rate), they were ashamed to the very bone to be that way.

  • You can't get dates (at all really - much less attractive dates!)
  • You experience discomfort on a regular basis due to not fitting into seats very well and so on
  • You can't buy clothes at the same store your friends can, so any time you're shopping you get to feel bad about yourself
  • You get openly mocked by people
  • You start to assume that everyone not openly shaming you is doing it silently
  • You feel like you are obviously a bad person, because of your failure to discipline your habits
  • You have health problems which you know are because you're overweight and if you could lose the weight you would feel better

And so on. The reality is, social pressure (and internal pressure from yourself) to not be fat is still very strong and it isn't solving the problem. Perhaps individualism is a piece of the puzzle, but it can't explain the problem by itself.

As a fat person, I am constantly ashamed of myself. Unfortunately, delicious food is the only thing that makes me feel better. Tragic.

I am constantly ashamed of myself. Unfortunately, delicious food is the only thing that makes me feel better.

It’s a vicious cycle.

You can't get dates (at all really - much less attractive dates!)

I have some fat relatives, who have no problem getting dates. They're female, and their dates are male and fat also, so I don't think this is true. Maybe they can't get dates attractive to thin people, but they can definitely date within their weight class, which is large in both senses.

You can't buy clothes at the same store your friends can, so any time you're shopping you get to feel bad about yourself

Fat people tend to have fat friends.

But many doctors know that patients don't want to hear it. They don't want to hear the science; they don't want to "follow the science" (i.e., actually do the thing). He also mentions that even though they try to drill this into patients, many of them still just don't do it.

I want to hear the science. I want desperately to do the science. But opportunities keep disappearing. I’ve become quite bitter, actually.

In early 2000, I had a job where I could eat as much salad as I wanted, for free. I got a Torso Track from late night TV and dropped from 210 to 190 in a single summer. I was in the best shape of my life. Then I moved on from the dishwashing job with free salad to custodial at a gym. I wasn’t allowed to use the equipment, and ironically, I got bursitis of the knee while kneeling to wipe the floor mats under the machines and impingement of the shoulder from all the mopping. I could not use my Torso Track anymore. I went over 210, because I now had muscle weight and a bigger frame to hang fat on.

I had a nightmarish two decades of codependency and sedentary jobs, piling on the weight of another small dog, never making 25% more than minimum wage for Albuquerque despite the dollar amount of my wages rising; trapped in the inflation trap.

I joined a gym with a pool in January 2020, free to me because of the ACA’s gym benefit, planning on swimming my way down from my now larger weight. Then COVID LOCKED THE GYM DOORS.

When I got a new job after the lockdowns lifted, my new schedule included time on Tuesdays and Thursdays after work to go to the YMCA, and I started doing so. Then my schedule shifted again, and I couldn’t anymore. My membership has languished.

Then I saw the 2022 film The Whale in theaters, directed by Darren Aronofsky and adapted for screen by Samuel D. Hunter, the original playwright. The film stars Brendan Fraser, an actor I admire, whose struggles I’d read about. It was like a punch in the gut. I joined an anti-obesity twelve step program and started learning why I had spent twenty years making excuses and drowning my sorrows in calories. I was actually doing things differently with my food consumption, and moving away from seeing overeating as an inevitability.

I had developed an eating plan and started to use it. Then I got a medical issue because I was trying to help someone move a cabinet, and I could no longer use that eating plan, nor is it safe for me to exercise much.

Oh, and I could have afforded GLP-1 after I finish paying off my car this autumn, but my living situation is going to change and the cost will rise by the amount I’ve been paying for my car.

I can’t hear the science over the racket of all my spoons being constantly taken.

The lack of spoons phenomenon feels incredibly cruel. You've felt awful for a while and as though that's not bad enough, your ability to self-motivate is now diminished simply because you've been feeling bad for a while, which makes you fall even deeper down the hole. Our hormonal systems are great at short-term crises but appallingly awful at long-term ones.

I sympathize. I'd love to help, but I can't quite tell from your comment the reason why you can't use that eating plan, so I can't really do much to help point you in the right direction to create a new one that will work for your new situation. I'm not asking you to disclose your medical issue, and I really don't need to know in any way. But you'll likely need to find someone who you can be close enough to to talk about it with and work out a game plan for the future that fits your individual scenario.

It's true that it's "diet and exercise," but even that is not really the best way to specify the solution. Diet is probably an order of magnitude more important than exercise when it comes down to longevity and overall health: if you have a choice between eating healthy and never exercising, versus eating like a pig but constantly exercising, the former will get you 90% of where you want to be, while the latter will get you nowhere.

Telling people to put down the tub of ice cream is, of course, harder than curing cancer. Best we just start mass dumping semaglutide into the water supply and call it a day.

the latter will get you nowhere

Also life disruptions to your exercise pattern/naturally ageing out will tend to eventually strand you anyways. I was an elite athlete in my youth and have generally been super active. The second I stop working out like a professional athlete I tend to stack on weight as a result of those habits, which isn't really sustainable with having kids/time-consuming jobs.

The two fit together quite neatly though. Exercise (both aerobic training and resistance training) modulate appetite and result in the body handling insulin spikes appropriately by replenishing muscular glycogen rather than fat. People that pick a sport and compete become much more acutely aware of their nutrition both as a necessity of fueling their activities, but also in shaping their bodies. The calories burned from an endurance sport are themselves quite helpful in providing a buffer to get away with some genuine splurge days. You're just a lot more likely to successfully stay lean and healthy if you participate in a sport than if you try to accomplish it through self-control around food where your only motivation and frame of reference is weight.

I find it darkly ironic that problems exist at both ends of this spectrum: yes, there are obese people, but the number of serious runners (among other sports) with very real eating disorders isn't zero either.

But for most people, more activity and less gluttony is probably better.

If you want to see a wild ass tale of the problems of being too thin and doing too much cardio, Jonas Abrahamsen is currently in the polka dot jersey at the Tour de France and has a crazy story:

Abrahamsen went from being a 132-pound climber to a 172-pound climber and sprinter. He told StickyBottle.com that in his weight gain journey, his peak power went from 900 watts to a whopping 1,500 watts. And as he gained weight, he told reporters that his body went through a “delayed puberty” where he actually grew a few centimeters and packed on muscle (and finally needed to shave).

Abrahamsen admitted that in his early career, he was focused on staying as light as possible, as many cyclists tend to do. This led to him severely under-fueling, until the nutritionist with Uno-X helped him learn to listen to his body’s hunger cues.

You really do need balance in all things. Bike hard, eat well, enjoy life.

I'm not sure if diet is an order of magnitude more important, so much as it is that it's a lot easier to be 2x off on your diet, producing catastrophic results, than it is to have disastrous results from being 2x off on exercise.

I mostly found it interesting that one of the specific claims for why "diet doesn't work", the specific mechanism mentioned, is insulin resistance, and that lo and behold, exercise pretty much directly fixes that (on top of the other benefits it has). It sort of makes all the arguments about diet, alone, feel like they're missing a huge component. I kinda knew that exercise was important and helpful, but I didn't know before how it very specifically should contribute to the culture war around diet. It was always a bit of an afterthought, an "Oh yeah, it would be nice to exercise, too, but it's more important to get your diet right," but perhaps it should be more prominent and not just sidelined in the discussion.

Never underestimate the power of self-willed delusions.

My brother and I have to deal with our mother effectively killing herself by her lack of exercise. She developed a bloodclot from sitting still too much, and has refused to change her activity level, in addition to her near morbid-obesity. We have begged, pleaded, harassed, done meal prep, purchased equipment - nothing. Meal prep was a special kind of clusterfuck, as it merely resulted in her consuming the prepared meal shakes in addition to her normal food intake.

And yet, despite all this, she still claims she's more than capable of helping out outside with yard chores(she isn't). Commentary on her health and various drugs she's taking will have her brush it off, commenting on how many of her sisters were long-lived. Same with my advise that she needs better self-scheduling and to manage her food intake better(3 meals instead of 2).

All ignored.

The only time, the only time when she lost weight was when her and my father were on strict dietary regime due to his health(and hers).

That's what it takes - someone riding her near 24/7 with shame in order to actually eat properly.

That isn't to say that she hasn't tried to loose weight. Sugar-free snacks, drinks, meal shakes(as mentioned) - all of them treated like magic totems and talismans and potions that if she consumes this, she'll loose weight as if by magic while not altering her diet in the slightest.

I don't know if there's an official term for this. I like to think of it as 'Magic wand' thinking. That somewhere, somehow, something is out there that fixes everything - a magic wand, a golden ticket, that one thing that does it all without them having to expend one iota of effort, one dram of pain.

Mind, there's an aspect of culture, as well. I wonder how my mother would react if America was more like Asia in this regard - that, when getting fat, would have people actually tell her she's getting fucking fat - and, when reaching out to the wider culture as a whole to affirm her delusions, would instead be met with a cacophony of 'You're fat. Loose some fucking weight, fatty.'

Still. Her latest magic potion is ozempic. So, we'll see how that goes.

As for me, well, I've already learned my lesson long ago. And I get re-affirmation of the value of consistent exercise watching my friends barely a year or two older than I am - helping them with projects, seeing their stamina flag and suffering from minor ailments and injuries that I don't have to deal with - yeah, I'll stop exercising when I'm dead, thank you very much, and I intend for that to be a very, very long day off in the future.

(Also, don't think being educated doesn't mean you're immune to self-delusion. I have a friend of mine who's a lawyer, who doesn't believe in CICO dieting. He tends to bluescreen when I tell him how much I lost just by doing that alone.)

Now, as far as dieting goes - y'know what, I've ranted enough. Needless to say, 90% of the people who've I've seen try to diet start off on the entirely wrong foot to only have it crash and burn two weeks later.

I haven't gotten into the ozempic discussion so I don't know if other people have been talking about this, but isn't this going to make people consume 2000 calories of the same corn-syrup-on-soy-flakes diet they were already on?

I worry we're going to have a lot of malnourished people who maintain a BMI of 20 on nothing but Snickers bars and potato chips because their entire appetite regulation system is being overridden.

The idea that obese people eat nothing but junkfood is a strawman. Every single fat person I know tries to eat healthy. Every single one. And they are 95% successful at it too.

I've worked as a grocery store cashier (God help me) and see what foods people buy. I stand by it.

I'm not sure if I mentioned this, but I have a friend of mine who's already on ozempic specifically to loose weight.

Ironically enough, he's not obese - he just knows he eats alot and wants to stay at a healthy weight.

He literally cannot over-eat. As in, physically impossible. It makes him uncomfortable bordering on painful. Solid foods, atleast - does it affect liquids? I don't know.

So there's something there, atleast.

Sorry, I know this is being annoying, but you committed my least favorite spelling mistake. It should be lose, not loose. Loose is pronounced like moose.

I worry we're going to have a lot of malnourished people who maintain a BMI of 20 on nothing but Snickers bars and potato chips because their entire appetite regulation system is being overridden.

Then we throw some vitamins in the snickers bars and call it a day.

but isn't this going to make people consume 2000 calories of the same corn-syrup-on-soy-flakes diet they were already on?

That's not strictly worse than their current diet. Let's say they eat 8 Snickers bars for exactly 2000 calories:

  • 32 g of protein
  • 96 g of fat
  • 224 g of carbs
  • 8 g of fiber

They won't pack on any muscle with paltry 32g of protein, nor will this amount of fiber get them a better score on the Boston stool scale. But they will still lose weight and become much nimbler.

And if you switch them to (still delicious) Snickers Hi-Protein (8 bars for 1960 calories), the macros start to look solid:

  • 160 g of protein
  • 80 g of fat
  • 152 g of carbs
  • 48 g of fiber

This is not exactly the diet of champions, but if you feed someone these bars you can do some body recomposition work on them with resistance training.

their entire appetite regulation system is being overridden.

This is what I was trying to put my finger on. Thank you.

Ozempic etc don't reduce complexity in the system. We're already dealing with complex interactions between the human endocrine, neurological, and gastrointestinal systems and I think we're prematurely celebrating by myopically focusing on the success of appetite suppression. But how does that reverberate through the entire system? People eating fewer calories but also eating lower quality calories? Inconsistent eating timing? Maybe the secondary effects are benign (I'd like that!).

I would imagine the trade off is still worth it. Billions of East Asian peasants lived off almost nothing but rice for thousands of years. They weren’t at optimal health, but they managed.

That isn't to say that she hasn't tried to loose weight. Sugar-free snacks, drinks, meal shakes(as mentioned) - all of them treated like magic totems and talismans and potions that if she consumes this, she'll loose weight as if by magic while not altering her diet in the slightest.

To be fair, switching to sugar-free snacks and drinks is altering one's diet. Depending on your previous habits you can cut out a ton of calories just by switching from regular soda to a zero calorie soda.

But empirically people who switch to diet soda don't lose weight. There's something else going on there.

One would guess that those people are offsetting the change with something else. At my peak, my daily soda habit was something like 6-8 cans of Coke per day, which is 840-1120 calories. It's pretty much impossible to cut that out and not lose weight, as long as everything else stays constant.

"As long as everything else remains constant" is a hell of a loophole. You'd have to measure all of your excrement in a Calorimeter and all of your heat exchange with the environment to be certain that you're not driving a truck through it. That's untenable so we use (preferably tested) heuristics.

'Eat fewer calories' isn't a terrible heuristic, but 'eat foods that engender a stable energy level like complex carbs and vegetables and proteins' is a more nuanced and generally more useful heuristic.

I read it as adding sugar-free snacks and drinks on top her usual diet, rather than substituting for it.

Now that you point it out, I can see how it might be taken that way. If that's what OP meant, then fair enough - that isn't gonna help with weight loss.

Pretty much, yes. Sugar-free snacks don't help much when I clean out her car to find discarded taco bell takeout and ice cream wrappers.

Your 'Magic Wand Thinking' term is eerily familiar. I've internally termed it some variation of 'Tribal Brain' or 'Shaman Brain'. Just that acute sense that how the world must work is that there is Good Stuff and Bad Stuff. You either need to find the good stuff and it will all be better, or you need to excise the bad stuff and it will all be better. "The Dose Makes The Poison" makes no sense in this magic world. Good things are absolutely good and more is always good. Bad things are absolutely bad and the smallest dose will ruin everything.

But it's hard for me to be too harsh, even if it's despairing. Because whenever I read of one of those obscure African tribes that attribute all ills to witches or cargo cults in the Pacific it just feels like that's basement humanity. That's what we all instinctually revert to if we don't have constant social pressure from birth, or predisposition luck, to be otherwise.

I think there is also a gigantic intuition in the brain to go with whatever is the local social default. Human despise figuring thing out from first principles over and over again. Whatever others are having must be what's normal. Whatever others are having must be what you personally should want. Which makes sense in an amazonian, PNG, or savannah tribal context. But portion sizes have shifted to ridiculous extremes and now everyone is trapped is a default = poison context.

I see the same pattern regularly.

  • Not eating X will help.
  • Eating Y in addition to normal meals will help.
  • Eating organic food will help.
  • "This doesn't count."
  • "Actually the household chores I do are all the exercise I need."
  • "No I didn't gobble up half the contents of the fridge in the middle of the night, no idea why it's all gone.".
  • "I only eat 2000 calories a day and even just 800 twice a week, that's why I'm a skinny 350 pounds and my belly sags to the ground when I sit down."
  • the amount of calories in X doesn't count because 'it's good for you'.
  • dividing 4 by 2 is too much math. calories counts are whatever it says in bold. checking serving amounts is an unreasonable and absurd ask
  • "you can't expect me to just not socialize" when it's pointed that dieting and then a full meal at a restaurant twice a week is futile

I mean, you could sneakily inject her with ozempic, if you were unethical. It makes people not want to eat like hogs anymore.

Oh, she's taking it willingly. I didn't even suggest it or bring it up - she did that herself. I'm being just a little bitter when I call it a magical potion - I fully expect it to work.

It's just... one of those things that makes me grind my teeth a little. You'd rather pay 500 dollars a month for a weight-loss drug when you could just... organize your life better?

(To be clear, I don't know exactly how much she spent on her prescription - I'm going off by what a friend of mine pays for his prescription.)

Paying 500 dollars a month for a drug that stops you from feeling intense shame and also improves your health, energy, longevity etc. is supposed to not qualify under "organizing your life better"?

You'd rather pay 500 dollars a month for a weight-loss drug when you could just... organize your life better?

Imagine someone saying to a homeless person “you’d rather wait for the city to give you a tiny home in three years when you could just… organize your life better?” We fatties didn’t choose phantom hunger and akrasic mindsets. Obesity is as NP-hard a problem as chronic homelessness, and we probably share some neural miswiring with those unfortunate folks.

CICO works, indisputably, for anyone who can control their arms and legs against the will to consume.

I grew up obese, by the medical definition of the term. Lost over seventy pounds via CICO, and kept it off. So spare me the 'Oh, you've never been fat, you just don't know.'

I have been fat. Double-chin, no jaw-line, pear-shape. By all rights, I still am obese by strict BMI measurements, and believe you me, I'm constantly going over what would be needed to loose weight even further.

Please understand the PoV I'm coming from, because I've been there. When I say 'organize your life better', it's because I did exactly that, and I have difficulty putting myself in some sort of special, super-human category that can somehow overcome your phantom hunger, akrasic mindsets, and neural miswirings.

Sure, so maybe there's multiple reasons for why people get fat and your having been fat doesn't necessarily give you insight into the difficulties of every fat person?

Very well put. If it was as simple as "just stop eating, bro" then there would be almost nobody who is fat. Fat people aren't stupid - they know damn well that not eating will fix their problem, it's just really hard to accomplish that by sheer willpower. We know (because Grant_us_eyes told us) that his mom has tried many other things and run up against the limits of her willpower. So the choice here is "try this medicine as a tool to help" or "keep on going as things are", not between "try this medicine" and "lose weight without medicine". It's silly to complain that she's making use of a tool to help her in an area she struggles with.

It does seem to me a lot of people suffer quite a bit from hunger. Personally, for some odd reason it takes about 4-6x longer for me to actually be hungry than is the case for a normal person.

Also, there's considerable evidence that junk food messes with satiety and makes people permanently hungrier. Ozempic, maybe fasting/diet change resets this.

I suffer from cravings. I can start wanting food, and despite a running monologue in my car about how not hungry and already full I objectively feel, I find myself ordering food in a drive-through or finding food at my destination.

It’s phantom hunger, as pervasive and obsessive as the phantom pains of fibromyalgia sufferers or the painful sensations of a phantom limb.

Currently the science says this can be treated with GLP-1. I dutifully took Ritalin in my youth for ADHD on shakier science saying it would medicate away my distractibility, so I have absolutely no qualms about medicating away my phantom hunger. Except the cost.

A few people have had luck with switching to a meat heavy low carb diet, fwiw. https://youtube.com/watch?v=mHr51XqJtwE

this woman had a serious weight problem (up to 360 lbs), started doing carnivore diet and over 1.5 years dropped to ~220 with that an exercise.

My husband is having success with Ozempic, after many years of being varying levels of obese. For our first several years together, he was convinced that all diets were either "woo" (ineffective) or "starve yourself" (intolerable). Eventually he decided to try keeping track of his caloric intake and realized that he could lose weight if he kept his daily average to 3000 and exercised vigorously every day, though having a demanding desk job tended to interfere with the latter goal. Cutting the daily intake down below 2500 calories was apparently not feasible until Ozempic chemically altered his appetite.

I agree that there's a lot of magic wand thinking, but as I alluded to, I think this is aided by an absolutely abhorrent culture on the topic. You have the people trying to sell you something, so they're going to promise the moon. Then, when people give up, they turn to a different magic thinking (e.g., @jeroboem's "There's something else going on, IMO") and just imagine that it must be some magic chemical or something. Even when my wife agreed that we would track our calories and see how it went, she would repeatedly have times where her weekly windowed average weight wasn't visibly going down for like a single data point (maybe even two points) and would go off on "MAYBE IT'S NOT WORKING ANYMORE" with no real rational explanation of why it would suddenly stop working. Just some sort of unknown magic. Spoiler: it always kept working. After enough time and then seeing the summary data over a year or two, she said, "I knew, but I didn't know know." Now she "know knows". Before, there was always a gap, a gnawing hole, where magic could constantly sneak in and make her default to thinking that it's just too weird and complicated and that there's probably "something else going on".

Perhaps ozempic will actually be a magic wand for a lot of people. It seems genuinely useful for a lot of folks. I don't think I've seen any indication that ozempic magically causes people to exercise more, though, and exercise has significant bodily benefits beyond just caloric balance.

There clearly is something else going on. People didn't just suddenly lose willpower. Nor did they suddenly lose the knowledge that diet and exercise were important. More importantly, people 50 years didn't have to try to be skinny, they just were.

No one has a compelling theory, supported by evidence, for why the obesity epidemic happened. You might not agree with SlimeMoldTimeMold, but they do a good job of explaining why all the various folk theories are wrong. If you think the problem is simple, then I'd argue you just don't understand it.

Of course this doesn't mean an individual person can't use diet and exercise to lose weight. It just means that, when measured across the population, few will be able to.

To solve the obesity crisis we have to stop trying the same failed ideas from the 1990s that only made the problem worse.

The superpalable foods and people overeating is the best theory and the truth because it fits available evidence. It is also the main scientific theory.

Also fat people genuinely have less willpower to resist overeating because they have greater appetite.

It is EASIER to stay thin that to become thin after becoming obese. But it isnt impossible and there are other societal problems too due to a culture of less discipline.

So, outside of ozembic, the best intervention would have been to try to stop people from becoming fat in the first place, focusing more on ingraining the right habits to children and target the food culture.

The reality a lot of people go along with what is the default. The default changed for whatever reason (because people like eating tasty food with calories, and because people selling food like making more money over people consuming more food being a big reason, and such food became more available and cheaper), and then obesity increased and as it increased it became more acceptable and people mimicked each other.

Now, sure people don't like the results of being fat, but they do like eating in the way that makes them fat, and there is copying of each other. This conformism and copying others habits then leads to escalation of trends. If there is a rising trend to overeat, people increasingly overeat.

Discipline is not everything about it, because a facet of it is careless overeating due to the rise of hyperpalable food. At some point of making mistakes of judgement, it does require more discipline to get out of it. But the level of discipline in the initial stage would be less, and less so if the default food culture was less obesogenic with less high calorie hyperpalable foods around.

Fundamentally, there is a trend in general, not talking about motte specifically, of people talking about such issues who don't want to do something about it. Obviously you are going to have rising drug abuse, obesity, crime epidemic, or other problems (i.e. cultural far leftism, putting such groups on pedestal), if you promote that such issues are unsolvable mysteries, and exaggerate the difficulty and the harm of doing something about it. Same even with fertility issue. Modernity has come along with some problems which do have their difficulties, and also simultaneously there is an ideological trend which is part of the problem which exaggerates the difficulty of solving them, and is in fact against trying to do so.

The superpalable foods and people overeating is the best theory and the truth because it fits available evidence.

The problem I have with this is that foods in the U.S. seem no more superpalatable in 2024 than in 1990. Yet obesity has risen quite a bit. I also think words like superpalatable and hyperprocessed tend to become pretty mushy when we start to examine them.

Fundamentally, there is a trend in general, not talking about motte specifically, of people talking about such issues who don't want to do something about it. Same even with fertility issue. Modernity has come along with some problems which do have their difficulties, and also simultaneously there is an ideological trend which is part of the problem which exaggerates the difficulty of solving them, and is in fact against trying to do so.

I hope you don't put me in that bucket. It's true I think these problems are extremely difficult to solve. But rather than advocating surrender (as I feel Scott did on his homelessness article), I advocate stronger action. That said, it's important that we not merely just double down on solutions that we know don't work. For example, if we want to solve housing affordability (another of those intractable issues) we can't do it by using failed solutions like rent control. And if you want to solve obesity, then telling people to simply diet and exercise won't work. We tried it for 50 years. It failed miserably.

Above all, we should adopt epistemic humility and try a variety of solutions, ideally letting natural experiments play out at state and municipal levels.

U.S. seem no more superpalatable in 2024 than in 1990

This seems wrong, the difference between the average restaurant in Plano Texas from then to now is staggering, and not just in terms of quality, but variety of cuisine as well. This might be controversial, but I think the expected quality you would get from a high-end restaurant in 1990 is what you can expect from basically any restaurant today(controlling for location). Cooking knowledge seems to have really been spread through the information age, and a base line expectation of quality ingredients also spread through the country during this time window. Do you remember when people used to advertise that they used arabica coffee beans, before it just became the standard? Dominos pizza is a particular stark example, and that change happened in 2010, in part because they had fallen behind, because all the other pizza places had been upping their game for years. I think the idea that, because on the surface you could go to a Wendy's and get a burger and fries in 1990 and in 2024, the 'superpalatability' of the food has not changed, is wrong (Wendy's is another place that seriously improved and is constantly tweaking and improving, a few years ago they drastically improved their fries).

I will agree that it is not super cleanly defined, but in general I think the availability of good food has improved pretty significantly since the 90s.

Dominos pizza is a particular stark example, and that change happened in 2010, in part because they had fallen behind, because all the other pizza places had been upping their game for years.

Can you expand on that? I haven't been following trends in American style pizza, but the idea of "upping the game" on pizza seems absurd. The thing has been perfected decades ago. It's yeast dough, tomatoes, meat and cheese.

What could you even change to make it more calorie dense? More cheese? That's called pizza quattro formaggi and has been a classic since basically forever.

The idea behind 'superpalatable' is not necessarily that it is more unhealthy (calorie dense), but that it is more delicious, so you over eat more, or are more likely to want to eat it instead of something else(something healthier). 'Upping the game' here, means tastier sauces, better crust recipes, perfecting baking time/and delivery/heat retention, quality of cheese, cheese blends, herbs, spices. Making more palatable food does not require making it more calorie dense. Can you imagine a world where room-temperature school-cafeteria pizza is the best possible delivery pizza, and how that would effect the frequency with which you order pizza?

Although, you can almost always add calories, one of the headline changes of their 2010 recipe was an herb and garlic butter glaze on the crust.

There's also entirely new categories of commonly consumed foods. How many people in 1995 started their day with a coffee-like milkshake? Even those that don't, energy drinks have more calories than a cup of coffee, even with milk and sugar(and portion sizes were smaller back then, too).

On the other hand, every gas station has sugar-free energy drinks for sale as well. The white Monster is at least iconic enough that Boomerjak is always depicted with one.

The problem I have with this is that foods in the U.S. seem no more superpalatable in 2024 than in 1990. Yet obesity has risen quite a bit. I also think words like superpalatable and hyperprocessed tend to become pretty mushy when we start to examine them.

There's also limitless and ubiquitous digital entertainment. Reddit, X, TikTok, YouTube, PornHub, streaming services, video games, if you get tired of one thing you can switch to another. And just like that, your whole day is gone, and you've been mindlessly snacking on junk food the whole time. Yes, there were people that watched the TV the whole day in the 90's. And these people were morbidly obese, shaped like their armchairs.

No one has a compelling theory, supported by evidence, for why the obesity epidemic happened.

Food got cheaper, especially superpalatable food (count calories that can be bought by median wage).

People in the 1970s weren't skinny because food was too expensive.

The fattest countries in the world aren't the richest countries in the world, nor the countries where food is the cheapest. Look at this list, the fattest countries are Pacific islands (where the necessity of importing food makes it expensive) and Middle Eastern countries (which can be poor like Libya or rich like Qatar). Whatever's causing obesity, it isn't cheap calories.

I personally think that the global obesity epidemic has something to do with the fact that we replaced animal fats with an agricultural waste product that is evolutionarily novel.

Last time I checked Pacific islanders were eating ultra processed food and meager amount of fruits and vegetables, with high caloric intake. And food is still cheap enough there given incomes to easily eat yourself to death.

Is it wrong?

People in the 1970s weren't skinny because food was too expensive.

May depend on location. In Poland it WAS and obesity was far less widespread than nowadays.

Which countries you wanted to use as counterexamples here?

Whatever's causing obesity, it isn't cheap calories.

Cheap calories are at least prerequisite and part of the puzzle. Without that you will not get hordes of fat people

Is there any country where you could spend less than 20% of median income on tasty snacks providing more calories than you need, without obesity epidemic?

Is there any country where you could spend less than 20% of median income on tasty snacks providing more calories than you need, without obesity epidemic?

France and the high income East Asian countries have low obesity rates despite people being easily able to gorge themselves on food that is generally regarded as quite good by outside observers.

People didn't just suddenly lose willpower. Nor did they suddenly lose the knowledge that diet and exercise were important.

This is a bad strawman, and you should feel bad.

You might not agree with SlimeMoldTimeMold, but they do a good job of explaining why all the various folk theories are wrong.

SMTM acknowledges that calories have something to do with it. He just thinks there's some magic 'nonlinearity' somewhere in the middle. Fine, whatever. Give me a model. Tell me how we can design an experiment to confirm or falsify your belief. Imagine that we have enough resources to run a lab-controlled study with a double digit number of subjects for a year or two. What do you do?

You're asking me to explain the obesity epidemic. I can't.

But I can disprove standard medical advice. Honestly, I don't even need to because we are already running the experiment and the results are overwhelming.

But anyway, here's my experiment. We have a control group and an experimental group. The experimental group goes to a location once a week, for one hour, where they receive diet and exercise information provided by you. You can also do anything you want during that hour, including exercise. However, you may not recommend or mention any pharmaceutical intervention. To ensure compliance, each person is paid $50 per hour but people who drop out still count in the experimental group. After 8 weeks, the intervention ends.

Then we check back in 2 years to see how the BMI of the control group and experimental group has changed. I predict with a high degree of confidence that there is no significant difference.

You're asking me to explain the obesity epidemic.

No, I'm not. It would be simple enough for you to just propose an experiment to show that CICO doesn't work. You know, to demonstrate that "something else is going on". For example, you could propose an experiment where subjects are fed maintenance level calories, but gain weight. Or where they're fed deficit level calories, but maintain weight. You could show something specific about a weird nonlinearity that actually contributes to a claim that "something else must be going on". Anything. Literally anything at all that contributes to that. In any way whatsoever.

But I don't think you want to even try to demonstrate that "something else must be going on". You simply want to say that many people don't choose to do a thing, even given extremely mild informational content. That has never been contested, nor does it imply that "something else must be going on".

It would be simple enough for you to just propose an experiment to show that CICO doesn't work.

Who is saying that CICO doesn't work? No one is saying this.

What do you mean when you say, "There's something else going on"? What is the "something other than X"? Please speak plainly and directly about what you are meaning to say. Also, please take into account SMTM's writing on CICO in your description, as that appears to be related to one of the "folk theories" that you said were wrong, according to his explanation.

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No one claims that consistent diet change is easy or that people are easily controlled.

Okay but the problem is that if it's not frictionless enough then it's not a good enough solution for the masses which means not a good enough solution overall for society.

No one has a compelling theory, supported by evidence, for why the obesity epidemic happened.

Massive increase in easily available food combined with a decrease in the amount of physical effort required to live seems like a perfectly sufficient explanation to explain the obesity epidemic.

My crackpot theory: In the beginning, there was scarcity to keep people thin. Rich people tended to fat if they weren't careful. Then food got fairly cheap, but lead and cigarettes (and sometimes amphetamines) kept people's weight down. Now food is still cheap but the lead and cigarettes are gone, so... boom.

That... actually makes a lot of sense. The insane growth in marijuana consumption can't have helped either.

It still doesn't really explain why Japanese women are skinny, given that they don't really smoke.

Comprehensive and massive fatshaming affecting the meme-gender in a conformist culture?

Everything I've ever heard about fatshaming in other times and places reinforces the idea that American fatshaming is ineffective because there's not nearly enough of it.

Smoking is very common in Japan, even among women. And even if you don't smoke, there's a lot of second hand smoke there.

But it's probably more to do with genetics, rice, and walking a lot there.

Could secondhand smoke deliver enough nicotine to meaningfully suppress appetite though?

(I agree that the smoking is probably small potatoes compared to the other factors you mentioned)

Notably, weights were rising that entire time even with lead and cigarettes. The thing is, that was a good thing for the first half of the 20th century because quite a few people were undernourished and underweight.

This is also why I find the simplest theory the best - food got cheap, people got rich, and the people that aren't rich get a bunch of money from the government to buy food. You don't need a complicated story, just a super-rich country that doesn't require much physical labor combined with the human inclination to eat a lot in times of plenty.

If “just exercise” were useful advice then there would be no fat people, as everyone has learned how important exercise is in school, universally every human has exercised before, and exercise has never been so easy — you can turn on a guided video with music to do calisthenics in approximately 8 seconds. Half of our military servicemen are obese, people who have gone the gauntlet of an exercise bootcamp, and three fourths of our veterans are obese. Fat people read “go to the gym” on every trending video of a fat person. So whatever the solution to obesity, it is absolutely not telling fat people to exercise, which has been conclusively disproven through the largescale population experiment colloquially known as “Reality” over the past two decades.

And if willing oneself to exercise were possible, then willing oneself to fast should be significantly easier than that, because the latter is willing oneself to omit an action and the former is willing oneself to engage in complex motor behaviors. If these humans can’t fast, these humans can’t will themselves to run fast either.

patients don't want to hear it

Obese Americans by the age of 35 have likely seen the horrors of obesity inflicted on their relatives. If this were a simple knowledge-motivational issue (“I do not want to become The Whale”) then obesity should be solved by seeing your parent suffocate from their own fat when they got COVID. But this doesn’t seem to be how it works at all. It seems to be something either beyond willpower altogether, or something so intrinsic to willpower that it requires a deliberate longterm regimen of enhancing willpower before tackling exercise. Why is it that fat people are so resilient to exercising? This is a more serious question. Clearly it is displeasing to them especially. Is that because of the microbiome? Is the longterm effect of pollution? Is it because of a insufficiency in the cognitive practice of willpower?

If “just exercise” were useful advice then there would be no fat people

Dr Mike has just released a video that it's true advice, but not actionable advice, which makes it not as useful as "drink diet soda if you like soda", "eat whole fruit instead of processed desserts", "walk 10k steps a day" or "don't eat when you're watching a screen" are.

Very much stuff like this. Obviously, just saying, "Have you considered diet and exercise?" isn't going to accomplish anything, and many criticisms boil the entire category of "diet and exercise" into a version of just saying, "Have you considered diet and exercise?" That's pretty whack, and to use the analogy of alcohol mentioned elsewhere here, it would be about as useful as thinking that the only way to reduce alcoholism is to just say, "Have you considered drinking less alcohol?" Like, naw dawg, people need actionable ways to get there, and that unfortunately needs to be relatively individualized to different folks' lifestyle and preferences, which makes it tough.

exercise has never been so easy

Exercise may be simple, but it is not easy. It cannot be easy, because the way it works is by being hard. If your exercise is easy, it's probably not burning significant calories.

This isn't true at all and is one of the mistakes people make that damages their long-term fitness improvements. Zone 2 aerobic exercise is definitionally easy. I can burn 700 calories/hour running at a pace that feels almost artificially easy and having a conversation. People that focus more on cycling tend to go even easier. If most of your aerobic activity feels hard, you're either out of shape or doing it wrong.

Getting started on exercise is difficult, maintaining it isn't.

Man I'm so fat I sweat when I eat.

I just checked my last Zone 2 workout (on a cycling trainer), and it was ~450 calories in an hour (assuming 25% metabolic efficiency, I believe). And an hour of zone 2 is both intensely boring and not all that easy; certainly I can have a conversation but I'm still sweating. (It's also hard on the butt, but that's cycling specific). Of course if you're much heavier (whether in shape or not) you'll burn more in Zone 2, but if you're out of shape as most fat people are you'll find it to be much harder.

Yeah, it's going to be harder on bike than running. At a typical Z2 running effort, I'll be running a 7:45 pace (assuming cool weather, heart rate drifts fast in the heat), which is pushing close to 800 calories/hour. I don't ride much, but looking back at my last decent Zwift ride, it was apparently 823 calories in 100 minutes.

Of course that's not feasible for people that are out of shape, but the point is that neither getting fit nor maintaining aerobic fitness is actually a no pain, no gain situation. Personally, I enjoy the painful workouts the most, but that's very much an acquired taste. I think one of the huge mistakes that people make is thinking they need to be suffering to build fitness. If I were advising someone just getting started, one of the first things I would be doing is explaining the basics of how zones work, getting them a watch with heart rate on it, and having them keep their HR down. They'll avoid injuries, they won't be miserable from moment to moment, they'll still see pretty rapid fitness improvements, and they're set up to succeed rather than dread the next time they have to get on the bike.

I can burn 700 calories/hour running at a pace that feels almost artificially easy and having a conversation.

Think of the fattest person you know. Burning 700 calories an hour by running certainly isn’t going to be easy for them.

Oh, I'm well aware of that. The point I'm addressing is the claim that exercise "cannot be easy, because the way it works is by being hard", which is just not even close to true. Aerobic fitness is developed primarily from easy efforts, not pain tolerance.

There is a kernel of truth to this, but my understanding is that the data suggest adaptation doesn't require much intensity, and that if "easy" can include even things like a walking pace if enough time is spent on it. Just walking an extra mile or two a day is better than nothing.

Yes, higher intensity is in some ways better, but it doesn't need to be everything.

This is like saying "If 'just stop doing drugs' were useful advice, there would be no drug addicts." Just stop doing drugs is the correct answer. That doesn't mean it's easy, or that a drug addict can "just" choose to do that without great effort and support.

It's 100% true that "Just exercise (and improve your diet)" is the correct answer. It's also 100% true that this is actually very hard and most people don't do it, because exercise is uncomfortable and boring and we live in a world of superstimuli and abundant high-calorie, low quality foods.

No, it's not as simple as "fat people lack willpower." Just like it's not as simple as "alcoholics lack willpower." This is literally true, but most people lack the willpower to overcome something like an addiction or the incredible pull of comfortable, sedentary living and infinite snacks over deprivation and effort.

Maybe we might find something biological that makes some people more successful at dieting and exercise than others, and maybe some people do have metabolic conditions that make them more prone to obesity. But ultimately, the answer is that what they need to do is actually very simple but very difficult, hence most people don't.

"Just exercise (and improve your diet)" is the correct answer It's also 100% true that this is actually very hard and most people don't do it, because exercise is uncomfortable and boring

This is the view that I disagree with. It strikes me as a just so story. If you succeed in exercising, you were able to do the very hard thing because of your implied moral superiority; if you weren’t, you had to try harder, but you could have. The problem with this kind of thinking is manifold. Trump and Elon Musk are extremely goal-driven people (I am choosing them because they are household names). Why are they both fat? Marines went through boot camp. Why can’t they exercise for something more valuable than that? Normally people want to impress others and secure mates and enjoy life. So why can’t they exercise when this enables that? A 30yo fat person may see their obese parents die a slow agonizing death. What human would experience that and not be motivated to avert that state?

It’s very easy to just morally impugn fat people — it’s hard, it’s uncomfortable, you could do it but you don’t want to. The problem is that there is no evidence for this assumed phenomenon. Where is the study showing that fat people don’t wish to be healthier more than those who do exercise? Fat people probably want to exercise even more than those who do exercise. But clearly there is something in the way: more pain when exercising (?); a microbiome which especially wants to be sedentary (?); an extreme deficit in willpower as it relates to physical exertion which requires a dedicated program…

But maybe I’m misunderstanding what you are saying. “ultimately, the answer is that what they need to do is actually very simple but very difficult, hence most people don't”, this to me implies a universality in how difficult exercise is, but I seriously doubt that’s the case.

The problem with this kind of thinking is manifold. Trump and Elon Musk are extremely goal-driven people (I am choosing them because they are household names). Why are they both fat?

Look at Bezos, Thiel, Zuck, Durov if you want extremely goal-driven people that care about their weight and body composition. Neither Trump nor Musk are debilitatingly fat, so my guess is they simply prioritize other goals of theirs. As soon as Musk suffers some health crisis and is told by his doctor that he'll never live to see a space trip to Mars, let alone become the Elon of the Red Planet, I guarantee you he'll hyperfixate on preventing senescence and will quickly adjust his BMI and fat percentage to the values that promise the longest life according to the most recent research.

When talking about the concept of "difficulty" perception is absolutely reality. In fact, in lifting, there's literally the term "RPE" for "Rate of Perceived Exertion"

I don't think fat people are morally inferior, but I do think they lack habituation in exerting effort in a physical sense. I have known a former water polo player who let himself go absolutely transform in about six months because he knew how to (and could endure) 2 hours a day in the gym. On the other hand, I have seen an otherwise focused and driven career type (master degrees, high powered consulting job) fail to make any detectable weight loss progress. I wasn't their personal trainer so I can't evaluate details, but that's besides the point - they obviously had the character traits required to commit to something difficult.

Or did they? Physical exertion is different than mental / emotional exertion. Plenty of very smart people who can pull all-nighters on cognitively demanding tasks, perform in professionally high pressure situations (think arguing in court or giving some large format public address) will fold nearly instantly when something physical confronts them. It's strange and hard to describe, but I've seen it throughout my life. There are simply some otherwise exceptional people who can be defeated with two flights of stairs or a ten block walk.

This is why I feel the elimination of meaningful PE classes in primary schools was such a tragedy. It's some level of habituation to doing stuff with your body (side culture war note: I also think bullying is important. It teaches you that assholes exist and how to deal with them).

Trump and Elon Musk are extremely goal-driven people (I am choosing them because they are household names). Why are they both fat?

Poor impulse control and desire for immediate results. Of course, this has served both men well in a number of ways, but neither is known for their inclination towards gradual, incremental efforts that only yield results when done consistently for long periods of time.

but neither is known for their inclination towards gradual, incremental efforts that only yield results when done consistently for long periods of time.

? This describes exactly both Trump's patient efforts in politics (themselves likely stemming in their modern form from Obama humiliating him in 2012, years prior to his 2016 run, and that's not even getting into that it's something he's been thinking about since at least 2000 since he also ran then) and Musk's investments in SpaceX and Tesla.

An intemperate public persona isn't the same as having no patience. Both Trump and Musk have demonstrated incredible patience with their life paths. Even Trump wanting to run again for president this year shows immense patience.

Patience, or obstinacy? The fact that you're willing to keep trying to do something for 20 years doesn't necessarily show patience and the ability to plan and bide your time. What exactly did Trump do to work on his next bid after his joke 2000 run? Was The Apprentice a genius move to make him a celebrity so he'd have a better shot in 2012? I don't think so - I think it's true Trump has always wanted to be president and that ambition never went away, but I also think he flits from project to project and does whatever he wants to at any given time, with very little forethought. I see no evidence that he's a careful, patient planner.

Musk, I am less sure about. He's certainly smart but the jury is still out on whether all his SpaceX and Twitter and Tesla bets will turn out to be genius or hubris.

You're confusing patience with higher-level executive planning. Totally different.

Fundamentally it comes down to agency. Exercising, getting off drugs, and doing other rewarding but """hard""" things is all agency. I don't really believe in morality, but agency is a personal trait just as much as beauty or strength. Right or wrong, people have little patience for low agency.

an extreme deficit in willpower as it relates to physical exertion which requires a dedicated program

You can train up your will power. Do a little of the hard thing at first. Get into the gym at least once in the week. Drink less for one night. I guess you could say this a chicken and egg problem, invest willpower into developing your will power. You gotta bootstrap from somewhere. If you're unable or unwilling to do this... Isn't that definitionally a personal failing?

Fat people probably want to exercise even more than those who do exercise.

All else aside, this is just not true. If you go to a running club or a Crossfit gym, you will meet people that absolutely love exercising. Whatever the obese individual says about how much he'd like to exercise, he obviously doesn't want to do it more than the people that actual make time to do it.

It’s different, though. I don’t even disagree with you, I enjoy the gym, but I enjoy it because I enjoy the results of it. The whole mindset is altered. The act of exercising, especially as a very fat person, just isn’t enjoyable, I’ve seen it. It’s sweaty, painful, it hurts the joints, it chafes, it is the definition of an unpleasant experience.

The wrinkle here is that every person who exercises has the experience of using their willpower to overcome the impulse to be sedentary. I get what you're saying, but when I look back on me thinking to myself "it seems like a lot nicer to just sit on the couch than go to the gym, but i gotta go" or "yeah i'm exhausted, but I'm going to do one more set" what I see is me making the hard decision to overcome those sedentary instincts. In every way, it looks like I used to my willpower to dictate my own behavior, and every time I fail at doing so, it looks like a failure of will to me. I personally don't see any reason to think it isn't exactly as it appears to me.

It reminds a lot of CICO discussions: it is obviously true that if you eat less calories than you burn, you will lose weight. There are all kinds of additional layers of complication and justification and difficulty and most of all copes on top of that, but the fundamental facts are simple.

It's the same with willpower and exercise: it is obviously true that whether or not you exercise depends on whether or not you do it (tautological, obviously), and doing it is a matter of applied will against pressures to the contrary. Whether or not you overcome those pressures by force of will does, in fact, determine whether or not you exercise. So while yes, there are lots of different complications and justifications and difficulties and most of all copes on top of that, they're all really just inputs to the equation [willpower]-[forces against]=[do you work out].

When you say that there isn't a universality in how difficult exercise is, what you're saying is that [forces against] has a different value for different people. Obviously that is true. Some people find exercise easy, some people find it difficult, some people have physical ailments that make it painful to exercise, etc etc. It is obviously also true that some people have significantly greater willpower than others. But that doesn't change the fundamental question, which is "is [willpower]>[forces against]".

And in the end, what the inputs are to the equation doesn't matter, what matters is whether or not you can get over the threshold and exercise. Does this have lots of potentially nasty implications about some people getting a shit deal in life because they're mentally weak, or physically afflicted, or even just born lazy? Yep. Not only are there health implications, but like you said, there are massive moral implications to whether or not you are able to overcome your own weakness and destructive instincts. Nobody's burden is the same, life's not fair, sucks to suck.

The wrinkle here is that every person who exercises has the experience of using their willpower to overcome the impulse to be sedentary.

Do they, though?

My husband and daughter are fidgeters. If they eat more than they need, they will find some way to move more, subconsciously. They will pace, walk around naked in the snow, run around in circles, then jump up and down, then run and jump until everyone else is upset about it (OK, that's just my daughter, but her father also probably did it as a child). They have been known to run slight fevers for no apparent reason sometimes, or take cold showers in winter to get their bodies to produce more heat.

The other daughter and I are nothing like this, at all.

Yeah, I mean, I guess it's true that at least once in my life I've "used my willpower to overcome the impulse to be sedentary", but the occasions when I've had to use my willpower to bag it when I was having an unproductive session (or not head out in the first place when I was sick, e.g.) are quite a bit more salient.

Do they, though?

Yes.

My friends and I joke that a friend of mine, if we tied him to a chair, would then proceed to vibrate the chair apart.

And given everything I know the man does and has on his plate, it's only half of a joke.

And even he admits there are times he just wants to laze about rather than do what's necessary. It's something everyone goes through. It may not be common or regular, but it still happens.

that doesn't change the fundamental question, which is "is [willpower]>[forces against]".

It does in the sense that I am alleging “forces against” are of exclusive importance and “willpower” is of negligible importance (on a population scale). We can measure the former but I don’t know any attempt to measure the latter. Do we see that fat people with similar intelligences and backgrounds perform worse on typical willpower tasks? I don’t recall reading this. It would be a big finding if so.

If willpower can be summed up as anything which is in our control, frankly it’s the felt salience of death and the patient hope in deliverance from that death. That’s the experience of the morbidly obese, though. Every trip to doctor is memento mori along with a hopeful plan and a page about resources to help them. So… what exactly are we talking about when we talk about willpower, if it doesn’t spring out of such experiences? At this point we are now talking about such an internal source of willpower that the most serious real life experiences don’t result in it, I do feel we are just impugning the souls of these people at this point. Like: no brush with death can save them, no hopeful lecture can save them, no inspiring figure can save tnem — they are damned. I am not comfortable saying that. Are we saying that these morbidly obese people have never cried tears of desire for salvation and at the worst case scenario attempted to kill themselves out of shame? How is that not a “highly motivated” state of willpower?

Meanwhile in my own personal experiences, here I am with the willpower of a sloth, but I have never been overweight — my body wants to fidget and pace frequently. It is non-volitional. After making my parent comment I went and got a burger and fries after fasting in the morning because I wasn’t hungry. Willpower doesn’t factor in at all here, just “forces out of my control”. What caused my body to like movement and not like eating frequently? An early life experience, something in my microbiome, genes? It’s definitely not willpower.

I am not comfortable saying that.

Tritely: that doesn't make it untrue.

Do we see that fat people with similar intelligences and backgrounds perform worse on typical willpower tasks? I don’t recall reading this.

I don't need a scientific study to prove that fat people tend to perform worse on typical willpower tasks like "don't eat a second piece of pie, even though you want to and you know it will be bad for you."

It does in the sense that I am alleging “forces against” are of exclusive importance and “willpower” is of negligible importance (on a population scale).

The reason that advice at a population scale tends to be different from personal advice is that the majority of people are, as you put it, damned. "No brush with death can save them, no hopeful lecture can save them, no inspiring figure can save them." When you give advice to an individual, you give them the benefit of the doubt that they don't suck. When you deal with populations, the unavoidable fact is that enough people obviously suck enough that you can't give them the benefit of the doubt (plus there's no politeness or interpersonal charity to consider). The stats don't lie. They are weak, they are lazy, they have high time preference, they are stupid, and they are never not going to be any of those things. I think this is a major failure point of most high functioning people: they don't grok how low-functioning most people are.

It is probably simply true that there is a ceiling for [willpower] for many people that is less than [forces against]. Just like how someone might be condemned by being 80 IQ to a life of poverty, never working anything but the most menial and low paying jobs, one might be condemned to a life of fatness, never being able to control their own eating due to a weak will. To quote George Carlin: "The mayfly only lives one day, and some days it rains." Most people get dealt a bad hand, and as I said before, it sucks to suck.

That being said, I think there is some hope, and that hope is (ironically?) shame. "the felt salience of death and the patient hope in deliverance from that death" are clearly insufficient motivating factors to get people to not be fat. I respond to that by pointing out the truism that many people fear public speaking more than death. I believe that people (at a population level, ha) tend to respond to their incentives. Clearly death and disfigurement and the quiet shame of fatness is an insufficient incentive. However, I notice that countries that have a strong culture of overt shame around fatness like China or Japan tend to be significantly less overweight statistically than countries that don't, like the US. I think that for most, the incentive of overt social shaming is actually a stronger incentive than death, and that therefore perhaps the best way to incentivize people to be a healthy weight is to shame them for being fat.

Both you and /u/Gaashk brought up in your replies the example of people who are just "naturally" skinny without any willpower. I don't think that invalidates my model, I think those people, including yourself, just happened to be born with/live with factors that lead to an extremely low value of [forces against] or a very high level of [willpower] such that it doesn't feel like willpower. That could be because of a low lipostat "body set weight", or natural hyperactivity, or a default low level of hunger, or any number of factors. Your coefficients are different, but that doesn't change the equation.

I don't need a scientific study to prove that fat people tend to perform worse on typical willpower tasks like "don't eat a second piece of pie, even though you want to and you know it will be bad for you."

Of course, it's then very possible that their failure is wanting it more, not resisting it less.

If someone has capable willpower in many areas of life but still finds himself fat then we should consider whether being fat is mostly unrelated to willpower. They have excellent willpower in many domains but not in this one. So either we are now alleging domain-specific willpower, or the concept of willpower is nonsensical altogether. If there is domain-specific willpower regarding exercise, why are former military service members fat? If there is domain-specific willpower regarding dieting, then why is it that the 30-day yearly Ramadan fast does not result in sustained weight loss?

the weight loss lasted no longer than 2 weeks after Ramadan

So neither intensive physical regimens nor intensive fasting regimens affect weight loss in large scale populations. We are left with motivation, but as I’ve written, it doesn’t appear that there is any experience an obese human can have that will reliably result in weight loss, given just how many bad experiences they have. Now you note —

Shame

but fat people are already shamed explicitly and implicitly. They are shamed more today implicitly than in the past, with social media giving them a peer ranking of their popularity and male interest where it is plainly obvious that their weight is a deciding factor. If you are fat in school you will get comments. Re: China, China’s obesity is increasing. But Chinese Americans also have genetically lower obesity rates.

perhaps the best way to incentivize people to be a healthy weight is to shame them for being fat

Well it’s very important to determine whether obesity is a generally volitional health state before we launch our campaign to shame half the population. That’s why this topic is important actually. If the willpower theory is unevidenced then we want to focus our efforts somewhere else — not on hating fat people but perhaps hating the ultrawealthy who sell poison in stores. Perhaps it is the department of education for making schools too sedentary. Perhaps it is neighborhood designers. Perhaps it is feminism. Perhaps these are damned and the fats are the victims?

Apart from microbiome, some other hypotheses I wonder about are —

  • Poor or insufficient breastfeeding, already associated with obesity

  • accidentally reinforcement of food at an early age through conversation, snacking, social / comfort associations

  • the de-reinforcement of physical activity due to a loss in communal dancing, physical play in kids, and destinations which can only be reached by long walks

  • A divine curse placed on our stock because of the way we treat livestock, taking the form of metabolic and DNA changes we aren’t familiar with yet

So either we are now alleging domain-specific willpower

Are you alleging that sustained work on any goal is equally easy as any other goal for every single person?

Based on my experience I am much better at being focused on some tasks, much worse on some other and my willpower as far as not eating myself to death seems to be a bit above average.

it doesn’t appear that there is any experience an obese human can have that will reliably result in weight loss

There is also no experience that will reliably make people honest, reliable, punctual, less rude, not wasting their life on computer games etc.

Nevertheless, keeping asshole tendencies in church and not being habitually late is partially function of willpower.

Keeping yourself away from drugs and slot machines is also function of willpower, complete destruction of regulation here for some people does not change it is function of willpower.

People are complicated, influencing them reliably is hard. It is hardly novel.

And yes, consistently eating less will make you less fat.

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If someone has capable willpower in many areas of life but still finds himself fat then we should consider whether being fat is mostly unrelated to willpower. They have excellent willpower in many domains but not in this one.

I think that generally speaking, this person does not exist. Everyone I know who is fat is also weak-willed in other domains of their life.

If there is domain-specific willpower regarding exercise, why are former military service members fat? If there is domain-specific willpower regarding dieting, then why is it that the 30-day yearly Ramadan fast does not result in sustained weight loss?

Incentives are certainly an input to [willpower], hence the section about shaming as societal intervention. The veteran was skinny in the military because there are strong incentives that helped increase his [willpower], the muslim is able to abstain from eating during ramadan for the same reason. You might think of it as [incentives]+[mental strength]=[willpower]. As circumstances change and they leave the military, or ramadan ends, or society starts shaming them less for being fat, the magnitude [incentive] reduces enough that they can't make it over the threshold and overcome [forces against].

it doesn’t appear that there is any experience an obese human can have that will reliably result in weight loss, given just how many bad experiences they have.

No, there are plenty of obese people who become fit. I think if you ask them, they will pretty much universally describe it as requiring an intense exertion of willpower to achieve. And I would be willing to bet that very many obese people would be able to lose weight if they were given sufficient incentive. Take an extreme example: if every time they ate a meal greater than 500 calories they were shocked with a cattle prod, it seems obvious that most people would choose eating smaller meals and being hungry over being zapped and they would lose weight.

fat people are already shamed explicitly and implicitly. They are shamed more today implicitly than in the past

it does not seem to me to be a coincidence that the reduction in explicit shaming has coincided with an increase in BMIs. Clearly implicit shaming results in a lower [incentive] than explicit shaming. Hence my argument that we re-implement more explicit shaming. I do want to note that you don't have to hate someone to shame them for something, and that shame can be a strong pro-social force (that's why it exists). "Love the sinner, hate the sin" and all that.

Well it’s very important to determine whether obesity is a generally volitional health state before we launch our campaign to shame half the population.

To put it plainly, it is incredibly obviously a volitional health state. It's obviously a choice whether or not to go back for a second portion, it's obviously a choice to exercise or not. The only out here is some form of argument against free will, but people who argue the choice to eat the whole pie isn't actually a choice never live the rest of their lives like they don't have free will. It's pure cope.

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If someone has capable willpower in many areas of life but still finds himself fat then we should consider whether being fat is mostly unrelated to willpower.

Why? Some people want some things more than they want other things.

If there is domain-specific willpower regarding dieting, then why is it that the 30-day yearly Ramadan fast does not result in sustained weight loss?

Because temporarily restricting your caloric intake does not permanently change your weight. This is well known. Everyone knows a fat person who dieted for a month and lost 20 pounds. What happens when they go back to eating the way they were before? They regain the weight. Permanent weight loss requires permanently changing your CICO equation.

If the willpower theory is unevidenced then we want to focus our efforts somewhere else — not on hating fat people but perhaps hating the ultrawealthy who sell poison in stores.

Believing that people have agency and that losing weight is mostly a matter of finding the will to do it does not require hating fat people. Sure, a lot of people do hate fat people, and justify it with variations on "They could just put the fork down," but you can recognize that losing weight is very hard without either shaming those who fail or inventing ways in which fat manifests out of the aether.

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I agree with your "[willpower]>[forces against]" framing. Two things I want to add to that. First, you can modify both ends of the equation. Using your willpower makes it stronger. You can modify your situation to remove forces against. Second, I think there's a fuzzy split between willpower and what I'm going to tentatively call agency. Willpower seems like actively resisting or continuing: Keeping up a run or powering through the last set. Agency is more like starting in the first place from inactivity. Calling up someone to be a gym buddy, or getting off the couch. I think we have more of a crisis of agency than of willpower.

your description of agency vs willpower seems to be a distinction without a difference to me; I don't see any reason to differentiate between the mental process that has you starting a thing against resistance vs continuing a thing against resistance except for magnitudes, similar to increasing the velocity of an object from 0 to 1 vs increasing it from 1 to 2; it's all just force applied. Perhaps the magnitude of willpower required to start exercising can be greater than the magnitude required to keep exercising when you already are, but it seems to be the same process to me.

The problem with this kind of thinking is manifold. Trump and Elon Musk are extremely goal-driven people (I am choosing them because they are household names). Why are they both fat?

In the past richer people were also fatter, so fat was an indicator of higher social status. This has changed recently, but the rapid rise of prevalence of obesity meant that the inversion of this preference can't be that strong, as it would entail stigmatization of a large majority.

In the past the rich paid for being more able to endulge in the all-present sin of gluttony by worse health outcomes. Today medicine has come far, and both Musk and Trump have sufficent resources to purchase many QALY for themselves.

In the case of executives, I think the explanation is generally that time opportunity cost of exercise is not worth the benefit, and I would guess that social and stress eating is a factor.

This is the view that I disagree with. It strikes me as a just so story. If you succeed in exercising, you were able to do the very hard thing because of your implied moral superiority; if you weren’t, you had to try harder, but you could have.

I do not assert moral superiority and I do not think people who muster the will to exercise and lose weight are morally superior to those who don't. That's all projection on your part.

Willpower is probably another nature/nurture combination, and the will to lose weight specifically probably comes from a combination of inherent ability to stick to a goal, and the level of your motivation to accomplish that goal. I am not morally impugning fat people (though I admit feeling a great deal of disdain for the "fat acceptance" movement and HAES, which I think is 90% cope). I am saying that the solution is the obvious one, we understand the science pretty well, and just so stories like Set Point Theory and "microbiomes that make you want to be more sedentary" are not well-supported scientifically.

But maybe I’m misunderstanding what you are saying. “ultimately, the answer is that what they need to do is actually very simple but very difficult, hence most people don't”, this to me implies a universality in how difficult exercise is, but I seriously doubt that’s the case.

Of course exercise is more difficult for some people than for others. People's bodies undoubtedly affect how enjoyable exercise is and how much aptitude they have for it. People have different metabolisms. And people enjoy different things. There are people who genuinely enjoy exercise; most don't. For fat people in particular, exercise is particularly grueling because they get tired more easily and they probably do experience more pain. Most people who are out of shape find exercising painful (because your body will protest when forced to do things it isn't accustomed to doing) and fat adds extra weight and fatigue to that. All of this is true, and none of this contradicts what I'm saying.

I used to be obese. Now I am slightly overweight (according to my BMI) though I don't look particularly overweight. I took it off with diet and exercise. I don't think I'm a paragon of virtue or willpower; I just reached a point where being fat sucked more than exercise did. Now my weight has remained steady for years (goes up a bit when I get lazy and snack more, goes down a bit when I am more disciplined). Those aren't moral judgments; they are just facts. I exercise regularly despite not particularly enjoying it, because I enjoy the feeling of having exercised, and the fact that I know I feel much better when I exercise regularly than when I don't. (I also do mostly weights and not enough cardio, even though I know I should do more cardio, because I don't like cardio. So obviously, my willpower and ability to do what I know I should be doing is not perfect.) I had back pain and shortness of breath that disappeared after I lost the weight. I am in better health than people much younger than me, just because I'm not fat. This all speaks to my motivation; I could very easily have taken another path (to just accepting that I'm going to be fat, and eating whatever I want) and I very nearly did. I can't tell you why I chose A over B, but I don't think it's because my Willpower stat is inherently higher. I do think my experience is (broadly but not universally) generalizeable; people can choose to do the thing. I don't particularly judge people who don't, because I know it's hard and not fun. But I also know it is a choice.

I do not assert moral superiority and I do not think people who muster the will to exercise and lose weight are morally superior to those who don't. That's all projection on your part.

I'll bite the bullet and be the strawman here - yes, all else equal, people that are fit and maintain their weight are morally superior to those that don't. You can explain to me the complex biological underpinnings of why some people have a harder time doing that and I will still think they are morally inferior to people that do it. I grasp that compulsive liars and addicts may lack the same full capacity for agency as others, but I still think they're morally inferior to people that are honest and temperate. Ultimately, I judge someone's moral positioning by their actions and the traits exemplified by sloth and gluttony are poor ones.

Does this come off as smug, self-satisfied, and self-serving? I'm sure it does, but I'm not inclined to pretend people that ruin their bodies through a lack of agency aren't demonstrating a condemnable moral failing.

I guess, "all else equal," but that's a caveat that pretty much makes the generalization useless. Do you think a skinny smoker is morally superior to a fat non-smoker? Is a very fit guy who cheats on his wife morally superior to a fat guy who's a great husband?

Sure, I understand what you're saying here, and those who maintain (or lose) weight have something that makes them "better" in some sense than those who don't, but I think it's way too easy to get judgmental about such a common human failing. I reserve my scorn for those who make excuses or deny agency.

I suppose you can run those hypotheticals with any traits, but if you're thinking about whether a given trait is an indicator of morality, you pretty much have to consider it in a vacuum unless there's a clear interplay between the two. To my knowledge, fit men are not particularly prone to cheating on their wives. All else equal, men that cheat on their wives are immoral compared to men who are faithful. I'm sure that the cheaters, on average, have more opportunities and stronger sex drives - I don't care, the faithful men are still better men.

In real life, I'm unsurprisingly much less likely to have cause to be strident about the matter, it's not like I'm running up on random fat people to lecture them about their moral inferiority. As your hypotheticals illustrate, many of them will be wonderful people when considered across the totality of their person rather than just through the one lens. But yeah, at the end of the day, I think fitness is an important part of character and tends to build other important parts of character.

lose weight specifically probably comes from a combination of inherent ability to stick to a goal

Way too many successful fat people IMO. Elon, Trump…

the level of your motivation to accomplish that goal

Right, but why do you contend that fat people lack motivation to not be fat, when it’s one of the most salient and omnipresent features of their life? There is nothing that should be more clearly motivating than being fit, which hints to a problem beyond motivation and willpower.

I just reached a point where[…]

But this can be survivorship bias. What do you believe is special about your case that could have been utilized by the average fat American but wasn’t? We have studies on fat people and dieting / exercise regimens that show poor longterm retention.

This all speaks to my motivation

Okay, but why were you more motivated than the average fat 40 year old who has seen relatives die, or who has received dire prognoses from their doctor? This is why motivation is a “just so” story. There’s no way to empirically validate that those who ameliorate or cure their obesity are, indeed, more motivated. And if could just as easily be something that boils down to (1) exercising is less painful, due to something related to health or microbiome, (2) food is less desirable, due to same reason.

Way too many successful fat people IMO. Elon, Trump…

Being able to stick to one goal doesn't necessarily apply to everything. Lots of very successful and driven people become alcoholics or addicts, can't stop smoking, seem unable to resist engaging in trivially discoverable infidelity or corruption, etc. You keep trying to make universal generalizations about the world that don't fit.

Right, but why do you contend that fat people lack motivation to not be fat

I didn't say fat people categorically lack the motivation to not be fat. Most fat people would like to not be fat. Some of them make an effort to lose weight, some don't, and some who make the effort succeed and some don't.

If you put a plate of cookies in front of me, I know I should only eat one and I definitely should not eat half a dozen. I can tell you from experience that sometimes I resist the temptation and sometimes I don't.

But this can be survivorship bias. What do you believe is special about your case that could have been utilized by the average fat American but wasn’t?

There is nothing special about me. The average fat American can do the same thing I did.

We have studies on fat people and dieting / exercise regimens that show poor longterm retention.

Yes, because controlling your diet and exercising for the rest of your life requires effort. The stat that fat activists often throw around ("90% of diets fail") besides not actually being born out in studies, also has a simple explanation: most people who go on a diet do it until they lose some amount of weight. Then they stop the diet, and gain the weight back. Obviously, temporarily decreasing your caloric intake will not be successful long-term.

Okay, but why were you more motivated than the average fat 40 year old who has seen relatives die, or who has received dire prognoses from their doctor? This is why motivation is a “just so” story.

I doubt I was more motivated. Sometimes people attempt to do things and they either succeed or fail, and their success or failure is a combination of numerous factors, some of them random. I don't think I have some special gene or metabolism that makes me able to do what other people cannot.

There’s no way to empirically validate that those who ameliorate or cure their obesity are, indeed, more motivated.

I don't think they are more motivated.

And if could just as easily be something that boils down to (1) exercising is less painful, due to something related to health or microbiome, (2) food is less desirable, due to same reason.

I suppose it could be, but this sounds very unscientific (and probably would have been discovered by now, since we can measure how much pain and desire people feel).

There is nothing that should be more clearly motivating than being fit

Why? There are plenty of things I’m vastly more motivated to do than keeping myself fit, so at least in my case, that statement is clearly inaccurate. I imagine the same holds true for most fat people as well.

I'm 50/50 on all the pop culture theories about metabolic disruptors, but there is always that.

A theory I could get behind with a lot more support is just sedentary lifestyle, and exercise, for most people, being a thing they were made to do. Most probably in gym class, which few people have fond memories of. Maybe the metabolic disruptors, if they exist, exaggerate the effect of those two factors. But I really believe those are the two leading factors.

It's so, so much harder to get in shape, especially in your 30's and 40's, after spending your 20's or god forbid your teens actively ruining your body believing you can get away with it. Shit just doesn't work. Your mobility is fucked, your knees don't work, your posture is ruined, you have no core stability. It takes like a year of what is basically rehab to get you to a point where you could do some honest to god actual exercise.

And seemingly everything about America is oriented towards making eating wrong and staying sedentary the default. Grueling 2-3 hour round trip commutes in your car due to lack of affordable housing near your work and lack of public transit. Losing 2-3 hours of every single day eats into other activities like exercising or preparing your meals, so you eat out and move less. Eating out is a race to the bottom, with the least nutritious, most palatable food being the ideal.

Circling back to how most people are inducted into "exercise", it's terrible. My experience was in elementary school we'd be let out for recess, and forced to do a lap or two around the track before we could play. It instilled a deep seated hatred of running in me. From middle school through grade 10 we had actual PE class, but it was mostly team sports and more running. Weight lifting was actively discouraged since it could stunt your growth supposedly. A concern that never applied to the underfed manlets on the wrestling teams. Probably also some bullshit safety concerns around barbells and dumbbells that don't apply to running and inflated balls. If my only choices for "exercise" were limited to what I was exposed to from grades K-10, I'd have never exercised again in my entire life.

Lucky for me I was blessed by the urge to punch people, which lead to far better life outcomes.

Grueling 2-3 hour round trip commutes in your car due to lack of affordable housing near your work and lack of public transit.

Average commutes are significantly shorter than that.

Yep. US average is like 20-25 minutes each way. And notably places with good public transit have the longest commutes.

Door-car-door is so much faster than door-walk-wait-bus-walk-wait-train-walk-door.

I have a pretty short commute. Usually by car, although I bike sometimes when the weather is nice. There is a bus route with stops near both ends that I've never tried because all the mapping apps tell me it'll take three times as long. The bike is faster than the bus.

And it’s door-walk-wait-bus-walk-wait-train-walk-door that makes the commute 2-3 hours simply because that’s how transit works.

Ultimately, this is why cars make sense, even though you don’t get the 20 minutes of forced walking (going to the gym is more efficient time-wise).

Actual, fat dissipating exercise takes strong commitment in both the will to keep moving as well as time. If you want to walk enough to make an actual difference, you have to be doing it for hours and hours. But most people think they're good if they go a single mile in 20 minutes. And that still puts them above many people these days.

Yeah, if you want to lose 1 pound per week, you have to walk more than 5 additional miles per day. Furthermore, you must consume no additional calories even though the walking will make you much hungrier.

Even though exercise has many benefits, diet is the key to weight loss. A single pastry can undo 5 miles of walking.

While it is possible to lose weight through exercise alone without dieting, it requires much more than most people are willing to do, or even physically capable of beyond a certain age.

Things like this are why I sort of support things like Keto or Paleo. It seems that the main trick is to get people to eat fewer calories (and less processed foods at the same time) while not making it feel like eating less food. Keto and Paleo do this by making people eat rather filling foods that take a while to digest which, while it would lower insulin because you aren’t spiking sugar ten seconds after you eat, also keeps your stomach full longer so you don’t want more food too quickly.

I think the reason that people used to be thinner is at least in part that up until the advent of TV, computers, gaming and the internet, social activities were far more active— recreational sports leagues, roller skating, swimming, dancing, going for walks. People were not overtly exercising the way we think about it, but they were so naturally active that they likely got the equivalent of a workout every day just from the extra walking, the active social activities, and fun sports leagues that kept people busy before we decided that we could socialize over the internet from the couch, and before play devolved into mashing buttons on an Xbox while trash talking over a headset.

I don’t think modern entertainment is bad per se, but I think one rather long term solution to the exercise thing is to stop making it a separate thing to do outside of normal life and more of a side effect of normal living. The biggest problem I see in the exercise thing is just how not fun it is. Playing basketball on a court with your buddies is fun. Going to a gym to do sets is work. Taking your SO on a date and going dancing is fun. Aerobics is work. If we had those kinds of things cheap and available and not segregated by skill level, I think there’s a good chance of people losing more weight. As it sits, I’m watching youth league sports and it’s so competitive so quickly with so much of a time energy and money commitment at very young ages that it’s forcing kids to stop playing sports at very young ages and they just never get to enjoy being physically active. My nephew started with select sports at age 8. And for all the kids that aren’t good enough to do that, they end up not being active in sports because of the lack of church leagues or rec leagues. It’s insane. Our biggest issue is people not being active and we force kids to stop being active by 8-10 unless they’re rich enough for traveling teams and good enough to make those teams.

People were not overtly exercising the way we think about it, but they were so naturally active that they likely got the equivalent of a workout every day just from the extra walking, the active social activities, and fun sports leagues that kept people busy before we decided that we could socialize over the internet from the couch, and before play devolved into mashing buttons on an Xbox while trash talking over a headset.

It’s probably worth mentioning here that one study showed that Amish men walk an average of 18,000 steps per day and Amish women an average of 14,000. Add in basketball, softball, or even bowling leagues on top of that, and almost anyone would end up slender and fit.

Things like this are why I sort of support things like Keto or Paleo.

Same, but for me it's fasting, intermittent or otherwise. The easiest way I've found to cut caloric intake without much effort or unhappiness is to just skip 1-3 meals. I've found that once you've done it a couple times, it becomes pretty easy to avoid getting "hangry", which is the main objection friends have given me when I recommend it. "I could never do that, I get so horrible to be around when I skip a meal."

There's a ton of science about fasting being good for you (e.g. it's great for insulin resistance), and I think it makes sense from an "is it lindy" perspective. Certainly our hunter gatherer ancestors didn't eat three meals a day everyday, so it makes sense to me that our bodies would be optimized for skipping meals.

I've fasted for as long as four days. Longer fasts like that are definitely much more difficult, not because of hunger (you more or less stop being immediately hungry after about 24 hours) and more because you have to deal with some physical weakness, imbalanced electrolytes, things like that. Definitely well worth doing, I strongly recommend it, but definitely much more difficult than just fasting for a day or less.

(you more or less stop being immediately hungry after about 24 hours)

This does not fit my experience at all. I also did a 4-day water fast once and my hunger slowly grew from a 6/10 on day 1 to a 10/10 on day 4. That is to say, from self-torture, to completely unbearable.

Very interesting, that wasn't my experience at all. After the first 24 hours it was mostly a vague "yeah I could definitely eat" rather than the acute "damn I'm hungry". That made it easy for me to gently titrate up my first meals, what did you do for your first meals after, how did that go?

On the night of the 4th day, at 3am, I couldn't get to sleep no matter what I tried. So i went into the kitchen and binged so brutally that I nearly fell into a coma. I can't tell you exactly what I ate but I would summarize as "whatever the hell was inside the fridge and contained carbs".

What do you do to avoid losing (too much) muscle weight during fasts?

Honestly? It's a total non issue on the scale of days. I don't worry about it at all, and I've not noticed any long term decreases in my lifts afterwards or anything like that.

I think the bro science that “your body can only absorb 40 grams of protein per meal”is likely bullshit, so presumably intermittent fasting would be fine provided you just got all the nutrition needed from your one meal a day.

45min at 65% VO2Max

I'm a bit familiar with the literature on endurance sports (mostly cycling, but some running -- the cyclists have better quantitative data), and I'd be curious to know more about this study. Very coarsely (unless you can afford real metabolic testing), my understanding is that VO2Max is roughly a maximal 5 minute effort. For me, 65 percent of that for 45 minutes would be a decently hard workout I'd maybe want an easy day after.

But my understanding is that there is a pretty wide variance of VO2 power and 60 minute power, and that it wouldn't be out of the question for a specialist in middle-distance (VO2-dominant) events to have trouble doing this workout. Was this research on mostly-untrained subjects? I'm not sure how hard an effort this would be for them. Did they report perceived efforts?

Regardless, I would agree on recommending more exercise generally.

Great intuition. I don't do much with endurance sports, so I didn't have a great intuition for that number. His reference to a study or studies in the podcast was a little difficult to follow, and I didn't actually look it up. My first interpretation was that he mentioned two separate studies, one that was a six week intervention, where he spelled out that they had three fifteen minutes "bouts" on a stairmaster at 65% VO2Max. Then, I thought he referred to a different study and said "a single 45 minute bout", which I just tried to interpret as "in a different study, instead of doing three fifteen minutes bouts, we had them do one 45 minute one" (and I only mentioned what I thought was the latter study in my comment). But now I think that interpretation was wrong. I think I found the study, and I think it's just the one study (that is not to say that I have any knowledge of replication/failure or whether there he's a man of one study; just that what I thought was two separate studies is just one study). It looks like in that same paper, they reported data after one session (that is, one day of doing three fifteen minute bouts) as well as data after the full six week intervention. So, I think he just misspoke to use the term "bout" ambiguously. From the paper, it looks like they had a five minute rest between each fifteen minute set. Does this seem more reasonable to you?

Three sets of fifteen minutes seems much more doable (although the original might not be out of the question), and it looks like they scaled it up over the six weeks as fitness improved. It would be interesting to see how much, but I didn't see that in a quick skim.

It doesn't seem that surprising to me generally: endurance exercise uses a lot of energy from blood sugar (and also from fat), and everything I've read suggests that the liver has a huge role in regulating that. I've also heard plenty of anecdotes about diabetes improving (or at least being easier to regulate) with exercise. The idea that reducing blood glucose without using insulin (exercise!) might improve insulin sensitivity sounds pretty reasonable: abstaining from caffeine for a while makes a cup of coffee hit harder when you do have one.

Exercise definitely does things to your insulin system. One of the interesting findings is that taking in sugar while exercising doesn't cause an insulin spike. Normally during exercise at that level you'd be using a combination of muscle glycogen, liver glycogen, and fat. Taking in sugar reduces liver glycogen use in favor of the newly introduced sugar. Then when you're done exercising, insulin sensitivity is increased, which helps replenish muscle glycogen.

Of course diet and exercise works for individuals. But now let's say that you and I are central planners for our respective nations.

  • You air commercials on TV about diet and exercise, give people tax breaks on gyms, open farmers markets, etc...

  • I simply give people free Ozempic.

Whose nation ends up with a higher life expectancy? I predict that my intervention significantly increases life expectancy while yours does nothing at all. The problem isn't that people don't know what to do, it's that our lifestyle makes it difficult to maintain.

Personally, I am very fit, exercise daily, and have a pulse rate in the 40s. But I find it difficult to lose weight and the second I lose discipline on my diet I rocket right up to my body's set weight (BMI around 28). There's something else going on, IMO.

If you’re a dictator with the goal of reducing obesity, you can just punish people for being fat.

People know how to lose weight. They don’t because the consequences for being fat don’t suck as much as weight loss. This may not be an entirely rational decision, but most people can skip desert and snacking and drink water instead of sugar drinks. They just don’t want to.

If I'm a dictator who wants to reduce obesity, a better approach would be to ban sugary drinks and junk-food vending machines, ban food advertising, and heavily (har har) regulate all types of prepared food. It's a whole lot easier to stay slim when you're not constantly bombarded with temptations to overeat.

Coincidentally for this subthread, Robin Hanson just dropped this today. The design space for a central planner is vast. Probably so vast with so many complex, dynamic, game theoretic components so as to make this kind of thought experiment mostly a waste of time.

This may not be an entirely rational decision, but most people can skip desert and snacking and drink water instead of sugar drinks. They just don’t want to.

I can apply this to myself (I have a sweet tooth). I am completely capable of skipping desserts and used to do it regularly. However every time I did this when I wanted to eat the dessert I faced a loss of short term utilons from wanting something but not getting it. Now I was perfectly capable of telling myself I'd get more long term utilons from not eating the kheer and so in the end I didn't mind too much, but the loss of short term utilons still stung.

After wrangling a prescription for tirzapetide I no longer even want to eat the dessert in the first place. I still get the benefit of the long term utilons but I don't have to pay the short term penalty either as there is no intrinsic desire to eat anymore. Even though the previous status quo of me deciding to skip dessert when I wanted to eat it was net positive for me the current situation is still an improvement.

I used to have an awful sweet tooth. After giving up desserts for Lent a few years in a row, it eventually went away. It seems to me that a certain level of self-denial and self-discipline can eventually change one’s attitudes and appetites without resort to drugs.

Even if you're not fat GLP-1 agonists are useful. I decided to start taking low doze tirzapetide after my BMI went above 23. I'm back down to 21 and feel lighter and nimbler, not to mention generally healthier these days. It feels almost like how I used to feel back when I was 18.

It's also helped me control how much time I was spending gaming (it didn't feel anywhere near as fun anymore) and I'm now using it much more productively reading instead.

I've personally found the drugs to be very powerful "Id control" medicine rather than mere appetite suppressants. They get a +1 from me.

Do you think the drug reduces your general factor pleasure/reward feelings? Or is it just only "bad" things? Any effect on sexual pleasure?

It reduces hedonia yes, but doesn't affect eudaimonia in any way. The fact that I'm not chasing hedonia any more leaves me better prepared to achieve eudaimonia. It all depends on how much you value the two things relatively.

That makes me want to try them. I feel so much better and more energetic when my BMI is 25 vs 28. It's interesting to hear that getting even lower still makes a difference.

Oh I definitely recommend them. I do a fair bit of dancing though so shaving those extra few KGs of fat off has higher returns for me than for most people. Also my ethnicity means that the BMI cutoff for "overweight" for me is 22.9 and not 25 so technically I was overweight when I started them and not just "middle of the pack healthy weight".

I do wonder if long term Ozempic use won't result in some pretty disastrous unknown unknowns. Personally, if it were my nation, I'd go with diet and exercise. Maybe after your nation tops mine in life expectancy for a generation or two I'll get on the Ozempic bandwagon.

It sucks getting old. After being pretty fit my whole life, doing competitive martial arts, and non competitive cycling, running, weight lifting, kettlebells, etc, but mostly eating whatever I wanted, on my 40th birthday my annual physical came back that I was borderline prediabetic. Lucky for me I have a wife that gardens fresh vegetables, raises backyard chickens, and makes delicious, healthy, homecooked meals. I also got more serious about indulging in sugary foods, limiting it to about once a week or less. Also cutting out most snacking and not eating outside of an 8 hour window, usually except for one day a week.

Honestly, the changes don't bother me. My household long ago transitioned away from eating out, almost ever. We also as a rule don't bring any junk food into the house. No cookies, chips, etc. Out of sight truly is out of mind.

We'll see how that works out for me come my 41st birthday.

I do wonder if long term Ozempic use won't result in some pretty disastrous unknown unknowns.

My guess is no. Patients have been using it for 7 years now. I think we would have seen something. Also, known positives are piling up. Lower diabetes is just the start. It seems that every other day a new study shows how GLP-1 agonists lower risk of some disease or another. So these unknowns would have to outweigh the known positives. The likelihood of this decreases every day.

That said there does seem to be a serious possible downside : lower feelings of joy from food, alcohol, sex, and other hedonistic activities.

Personally, I am risk adverse and only slightly overweight, so I don't intend to take it for a few years at least.

Your alternate framing seems to come out of nowhere and appears unrelated to my comment.

my body's set weight

This is a theoretically-fraught concept that is not (and perhaps can not be) supported by the data.

my body's set weight

This is a theoretically-fraught concept that is not (and perhaps can not be) supported by the data.

Do you have more detail on that? I've followed the TimeMoldSlimeMold "chemical hunger" theory and most of its in-detail critiques, and I don't remember one disputing the existence of the "Lipostat".

I also predisposed from personal anecdotes to strongly believe in the Lipostat, since I'm fit and very active, but also never have gained a single kilo during the long periods of sports injuries I've suffered through in the past.

Sure, there are a variety of feedback mechanisms, mostly neuropeptides of various flavors, that are involved with the production and regulation of appetite. As someone with a control theory background (hence the name), it's extremely easy to observe something that kinda looks like a feedback mechanism and then just jump all the way to, "THERE MUST BE A EQUILIBRIUM POINT NEGATIVE FEEDBACK CONTROLLER THAT TRACKS A KNOWN REFERENCE POINT!" It's extremely easy to imagine that such a thing is going on. It's vastly more difficult to understand how all the differing systems interact to produce some sort of global behavior.

For a simple example, suppose there is some subsystem that is doing a pretty decent job of doing closed-loop stabilization of a reference equilibrium point. Where does it get that reference from? Well, it's some other biological system, for sure. But which one? How? Does it interact with the environment? Culture? What? Things start to get tricky. What properties does it have? The most ardent supporters will make claims like, "Once you gain weight, it changes your reference point, and so your body 'fights' to defend it (I.e., the lower-level closed loop controller tracks the new reference point)." This is obviously plausible, but then it inspires equally obvious follow-on questions. What happens when you lose weight? Does this again change the reference point, so your body 'fights' to keep the lower weight? Most advocates will disagree. They will say things like that it's 'inevitable' that you will regain that weight, because your body is always and forever still tracking a higher reference point. What is the mechanism involved in this one-way ratchet? Ehhhhh... nobody knows?

Aside: I've also done some neuroscience-related work. Feedback pathways are complicated. Even the ones that seem like they might look simple at first. Even the ones where we can isolate specific neurons involved in what appears to be an extremely local system in simpler animals (various peptide interaction pathways are more complicated). They can be highly state-dependent; they can be highly nonlinear; they can produce oscillatory or bifurcation behavior. Anyway.

So, we could go out and try to set up some studies. Purely observational studies at the level of behavior are super challenging. You basically have just a bunch of different time series for weight. These are, frankly, going to look all sorts of different. Incredibly so if you're just taking a completely hands-off approach, just letting people do what they're going to do in life, but just weigh them on whatever interval. You'll have essentially no ability to say much of anything. So one route you could go is to try to induce a change in the hypothesized 'set point'. Maybe you make some group of folks lose weight; maybe you make another set of folks gain weight; maybe you have some maintain. Then, you let them loose and see what happens after some time. Folks are going to move around, and it's not necessarily going to be correlated. Oh by the way, what did you choose as your sample population? Did you start with obese people and have them lose weight? Or start with lean people and have them gain weight? Huge possible selection bias involved that you're going to have to somehow tease out. How do you go about doing so? Tease out environmental factors? Cultural?

Maybe, hopefully, you can also take some more invasive measurements to get at things like peptide levels, but they're swimming in a vat of all sorts of stuff going on in there, and you're kind of poking around in the dark. It's incredibly difficult to get at something along the lines of, "When you gain weight, it causes an increase in production of peptide X generally, and then losing weight again doesn't reduce such production," especially in a way that teases out a variety of other possible contributors. We've been pretty lucky to be able to see various features of a more direct intervention, like GLP-1 agonists, with regards to a few systems as a whole, but the work so far hasn't really firmed up any more general theory about 'set points'.

Interestingly, because of doubly labeled water measurements, we're actually able to do a lot more on the calories out side of the process. We have pretty good equations that do a pretty good job of estimation, at the population level, how many calories a body uses, as a function of things like fat-free mass, activity level, etc. They're obviously not perfect, and not perfect at the individual level, but they do a pretty good job. They've even told us that people do have some amount of hysteresis after gaining weight, but the dynamics (especially long-term) are about as clear as mud. But that doesn't help us on the side that most people care a lot about, which is calories in.

In the end, if you have basically no idea how the hypothesized 'set point' is getting 'set' (or getting changed), it calls into question the entire model of whether you actually are dealing with a decoupled set of systems, where one system is simply creating a 'set point' and another system is tracking it. Why do you think you have such strong decoupling? How can you demonstrate that such decoupling exists? Maybe they've actually been coupled systems all along. Maybe that coupling is weak; maybe that coupling is strong. You don't know a priori. I've seen all sorts of control theory inspired attempts at explaining all sorts of biological behavior (very different from weight regulation) in all sorts of animal models. Some are more convincing than others, and you always have in the back of your mind the question, "Are we imposing too much structure at a high-level to what is, inside, an incredibly complicated, time-dependent, state-dependent, nonlinear process?" There are a few cases where we have good theoretical reasons to think we can get away with it. See, for example, nonlinear averaging theory with applications to insect flight. But even there, we have it pretty well on the scale of tens-to-hundreds of wing beats, and we start to run into these thorny problems as soon as we try to loop in an higher-level system that includes, for example, visual observation of the environment. We can get some glimpses in some cases, but they really are sort of a case-by-case for how believable the experimental work is.

In the end, I would say that various forms of set point theory are, indeed, plausible at some level. There are huge theoretical and experimental hurdles to overcome in order to verify that it's what's actually going on. Anecdotes aren't the best guide. And even if some form of set point theory works, it mostly pushes the question back a level to how the set point is being set, be it due to inherent biological processes, environment, culture, etc. Perhaps it is some form of contaminant or something; I'm not saying that that idea is wrong. I'm saying that we have to do some hard work to isolate out different possibilities in order to know, first, what the "something" is that is being rejected, understand what the evidence is for rejecting it, and then why the only things left in the "something else" category are things like contaminants. I think SMTM is extremely casual in rejecting everything else and that to spell out the argument in detail shows how many steps were skipped. You really really can't jump directly from, "It appears that perhaps there are some feedback loops operating at some levels," all the way to, "Therefore, it must be a contaminant," in a single bound.

Very interesting, thank's for that detailed reply! I assumed by default that biological systems are full of such feedback loops, however complicated they may be in real life. Is the water equally as muddy for core temperature, blood sugar, testosterone level, serotonin, dopamine? I assume the first two are understood well, and testosterone starts being muddy?

I haven't really looked into all the different areas, so unfortunately, I probably shouldn't conclude much. Even with core temp, which seems like the easiest for likely simplifications, I'm not sure if we have much work to identify and quantify a mechanism for the colloquial sense of things like, "So and so grew up in Climate X, and when they moved to Climate Y, they always felt hot/cold for years until they adapted in some way." But again, that's mostly my ignorance.

For blood sugar/testosterone, I think we have a pretty good ability to 'tap in' to the inputs/outputs in simplified form that makes some sense. But there are some complicated feedback pathways that affect those sources/sinks, especially in the long-term, and I don't really know the state-of-the-art. Mostly just from what I've read from Scott on serotonin/dopamine, there's a lot of mud there.

I'm not sure the data is so high quality that it can overcome the weight of anecdote in this case.

This is the Culture War thread. I'm trying to make conversation. If your comment is "diet and exercise is good" then I agree. But then there's nothing to talk about.

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