This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
I'm aware that the studies don't show huge effect sizes, but I'm also skeptical of their quality. For example "intention to treat" does not mean the subjects actually adjusted their diet and exercise as much as intended. That people are bad at following the interventions is certainly relevant information to have, but it doesn't mean that diet and exercise aren't relevant, just that people are bad at sticking to these sorts of changes.
Some other limitations to interpreting results like this:
The included studies range in duration from 10 to 52 weeks, average 33, and the meta-analysis reports an average of 13kg or 28 pounds lost with diet and exercise combined. In my mind, that's quite good. It's certainly much more than 4% of body weight. I don't expect these changes produce immediate results; most people who are obese have been slowly adding fat and weight for man years, and it takes time for them to become healthy.
Drop-out rate of included studies ranges from 15-25%.
Out of the included studies, 1 was male-only, 3 were female-only, and 2 had both. So 28 pounds is an even larger relative reduction.
You're definitely right that diet-and-exercise studies include a huge range of effect sizes. I'm not 100% certain how to interpret this; my suspicion is that there's a hidden intervention sliding scale between "doctor says to you, with gravitas, 'eat healthier'" and "nutritionist locks you in a box and hand-feeds you kale that they calorie-counted themselves." And meta-analyses do a poor job differentiating between these, including the one I linked.
I would expect that more dramatic effects combined with heavier fadeout of results is a natural indicator that a particular study is doing an unsustainably aggressive intervention; in the meta-analysis, it indicated that in both diet-only and diet-and-exercise groups everyone regained about half the weight after a year. Which still does leave 14 pounds, and that isn't anything to sneeze at.
You are also right that there are two ways of doing these studies-- "as prescribed" and "intent-to-treat", and as-prescribed results will always show much better effect sizes than intent-to-treat results. In a sense, intent-to-treat isn't measuring the results of the treatment as much as it is measuring the results of prescribing the treatment. And as-prescribed, diet and exercise will always be 100% effective at inducing any amount of weight loss almost by definition. Hard to beat that, really.
But on the other hand... I kinda figure that intent-to-treat is a fairer representation of real life? In the sense that in real life people don't have the option of getting locked in the nutritionist-box indefinitely. And if two treatments are both effective as-prescribed, but the first one has much worse intent-to-treat efficacy, I want the second treatment.
Sure, but that wasn't the point I was making. The point I was making is that obesity is caused, in the first place, by poor diet and lack of exercise.
Yeah, sorry, went on a bit of a tangent there. Anyway.
I feel a lot of skepticism about bad diet and exercise habits being the primary causal drivers of obesity, since on a personal level I know some people who struggle to lose weight in spite of vigorous and frequent exercise and a diet heavy in foods traditionally considered healthy.
I expect that genetics has a hell of a lot to do with whether somebody becomes fat or not, and that "well you probably have bad diet and exercise habits" is a close-to-hand explanation that is both extremely difficult to falsify and which satisfies our instincts toward the Just World Hypothesis. There might also be chemical contaminants involved.
There might be some sort of interaction between genes and environment, where some people are more susceptible to modern lifestyles causing obesity. But the obesity rate has increased rapidly across many countries, so whatever it is, is not wholly genetic.
(Not sure if you got the chemical contaminant hypothesis from Slime Mold Time Mold, but apparently a lot of their claims are not well supported.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link