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naraburns  nihil supernum  1yr ago (text post)   3352 thread views

Wellness Wednesday for March 8, 2023

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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Glad it's working for you! Honesty, that sounds amazing.

I've become a convert to "set point theory" of hunger and, with a convert's fervor, I now view the opposite view as imbecilic and harmful. Almost no one can sustain weight loss for long periods of time via calorie counting and exercise. The fact that so many people believe otherwise is troubling. How long can a society be so obviously wrong and double down on failure? At least several decades, apparently.

In good news, we finally have something which actually works. As this becomes widespread, I expect obesity to peak soon and then decline - similar to the decline in HIV deaths starting in the 1990s. Life expectancy will increase as well.

As for myself, since I'm only about 20 pounds over my ideal weight, I'll hold off for a few years just in case there are unknown risks.

I think 'almost no one' is an exaggeration. I have lost weight in the past through calorie counting and I know others who have.

That said I think there are fairly profound variations in hunger levels, body weight set points, and efficiency in gaining or losing weight. Some of them are genetic but I think some people who get very fat permanently fuck over their hunger and weight regulation.

I'm aging. In order to prevent weight gain I have given up on breakfast and eat a light lunch. I know a much older and equally lean man who follows similar routine. It obviously and unambiguously works.

Eat less to lose weight, eat more to put on weight. I purposefully ate more while I lifted. I now have a kid and a busy life and cut back on eating.

How long can society be obviously right but people pretend otherwise in order to excuse personal failings leading to the unavoidable consequences?

Would I be correct in saying that your body's natural hunger cues aren't working and you have to exercise willpower to control your weight?

While this may be relatively easy for you, it is probably only because your set point is near your current weight. For people whose set point is much higher, the difficulty is extreme. Imagine being hungry all the time and having no energy. People's bodies will fight to maintain a high weight and energy levels will plummet to reduce expenditure of calories.

https://web.archive.org/web/20230306231743/https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html

Let's say you are a 160 pound man who can maintain his weight with a 2000 calorie diet. How would you feel at 1200 calories? That is the level that some people have to maintain to not gain weight. The difficulty level varies greatly.

I know that intermittent fasting is kind of a fad right now, but following the above program only skipping the lunch about every second day seems to work OK for maintaining a deficit without being obtrusively hungry -- after a week or so the "hungry" signal just seems to kind of recede into the background.

1200 calories every single day does seem extreme -- but is this really a common setpoint for a ~160 lb male?

1200 calories every single day does seem extreme -- but is this really a common setpoint for a ~160 lb male?

No. That would be an extreme case.

I'm suggesting that the grandparent is able to use his willpower to maintain a low weight because his body wants 2050 calories and he only gives it 2000, and that this is something that can be achieved.

A formerly obese person might need to sustain a 1200 calorie diet to maintain the same figure, which (from experience) means being hungry nearly all the time.

My hypothesis is that the calorie/willpower model is appealing because it allows people to be moralistic. Fat people aren't very nice to look at, but if you can tell yourself that they chose to look like this because they wanted to be lazy and gluttonous, well then you can justifiably dislike them.

Me and girlfriend have had this conversation a few times, and what's fascinating is that she doesn't seem to have any particular model of what causes obesity. Instead, when presented with my version of the setpoint hypothesis (personally I think it's the vegetable oils), she reaches into a grab bag of other explanations (laziness, shift work, hyperpalatable food, snacking, processed food) but never settles on one and refuses to assign a weighting to any of them.

Nothing about set point theory suggests that people don't get fat by being lazy and gluttonous. Even if it absolves people of blame for failing to lose weight, they still get fat through sloth and gluttony.

I guess that could technically be correct. But then it just begs the question as to why sloth and gluttony increased linearly in the latter half of the 20th century at the exact time as countries adopted seed oils into their diet.

If it were true, we would also expect to see people who work longer hours get less obese, because they are demonstrably less slothfull than their peers. We don't see this. Instead we see people who are objectively smart and hard working (for example, medical students) getting fatter just like everyone else.

My guess is that people believe that diet can work both in the short and long term because they see it all the time, because I do. There are people for whom it doesn't work, for some reason, but that doesn't mean it doesn't work.

I also believe that in version of set point theory but in my version that set point is possible to affect for the vast majority through persistent weight change.

I'm excited about the new medications though.

I believe that it works because I lost about 20% of my body weight, almost entirely in fat, have remained within a couple pounds of my new weight for a couple decades. To think that this is incredibly difficult is to think that I have a remarkable talent that I don't really perceive myself as having.

Dieting works in the short term. It almost never works in the long term. There are numerous studies which demonstrate this.

To steelman the status quo, there wasn't (until semaglutide) anything that reliably worked. Diet and exercise aren't bad things, and even short term weight loss might have positive benefits. Similarly it's very rare for alcoholics to quit over long periods of time. It doesn't mean that they shouldn't at least try.

If we just ignore the large and unsolved issue of selection bias in weight loss studies we can still observe that some 20% sustain weight loss long term.

Similarly, for people with so severe alcoholism that they seek treatment the people that stay sober long term seem to be a bit more than 1/3.

Neither of these qualify as "almost never" in my mind.

I have a hard time believing that diet efficacy is much greater than zero given that a large percentage of people diet and obesity is only increasing. Is it possible for dieting to have negative efficacy? Perhaps.

Speaking of selection bias, choosing people who have already lost large amounts of weight selects for people who have HUGE amounts of self-control and probably wealth and free time as well. If, even among this august group, only 20% maintain the weight loss that's pretty damning.

I'm not sure where you are getting your alcohol stats, but the number I remember is 8% of AA users successfully quit. And indeed my memory is correct according to this source:

https://www.npr.org/2014/03/23/291405829/with-sobering-science-doctor-debunks-12-step-recovery

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent.

Fortunately, the Sinclair Method exists and seems much more promising. Are there other treatment options that work? Maybe. But I wouldn't trust the stats produced by these groups given the they would be so self-interested.

I believe you misunderstood. Its 20% of those that started the diet that managed to lose weight long term, not 20% of those that managed to lose weight in the first place.

As for alcohol (and substance abuse in general) there are a lot of studies:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1976118/

https://pubmed.ncbi.nlm.nih.gov/29705545/

https://www.hindawi.com/journals/psychiatry/2018/4829389/

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2008.07081308

https://pubmed.ncbi.nlm.nih.gov/27614380/

https://pubmed.ncbi.nlm.nih.gov/30260382/

https://www.nejm.org/doi/full/10.1056/NEJMcp1204714

https://pubmed.ncbi.nlm.nih.gov/30883295

I have a hard time believing that diet efficacy is much greater than zero given that a large percentage of people diet and obesity is only increasing. Is it possible for dieting to have negative efficacy? Perhaps.

It might be the case that the obesity rates would be increasing even faster if people weren't dieting. In this scenario whatever bad stuff is causing obesity is steadily increasing with time, and dieting is working against the bad stuff, just not fast enough.

This feels like playing word games. To me "doesn't work" means "it won't have an effect, no matter how much you do it", not " people will stop doing it after a while".

Doesn't feel that way at all to me. If compliance is < 10%, then the intervention most assuredly doesn't "work" from a public health standpoint.

It's like saying to a smoker "stop smoking" and then saying your intervention is effective. "It would have worked if they had listened".

From a public health standpoint, yes, diets don't work. From an individual standpoint diets work really well.

It's like saying to a smoker "stop smoking" and then saying your intervention is effective.

Obviously that won't work as an intervention. Maybe, and believe me, this is a hypothetical, what if we stopped telling people that eating less didn't work? What if we stopped lying to them by saying that CICO doesn't work?

My wife swears up and down that she "didn't know", even though on one level, you know. You don't know, in your gut. You hear all these tales of how it's this thing or that thing, that you need this special diet or that special diet. That so and so has a magic thyroid that causes a 300 cal/day diet to result in gaining weight. That the sign on the gym which says you can lose 20lbs in 30 days is real. And this isn't just misinformation on the internet; literal doctors are involved in keeping people "ignorant". We have a good friend who is quite obese. She literally asked her doctor for help. She practically begged for an actual plan; something other than, "Well, ya know, maybe you could eat less." I know doctors are constantly afraid to tell their patients that, "Diet and exercise will help with [insert condition here]," because sooo many patients either a) get offended or b) aren't going to do it anyway. So you know what this doctor told her? "You're just getting older." Seriously.

It requires actual education, planning, support, and discipline. For education, if you asked people, "How many calories per day corresponds to a 1lb/week weight gain/loss," do you think you'd get consistent answers? What if it wasn't so pointed, and instead something along those lines was asked in a multiple choice along with a bunch of other options? Like, lithium and thyroids? Maybe perhaps not lying to people anymore might help even a little bit?

For planning, even just estimating calories is surprisingly hard to the raw senses. One tablespoon of Substance A will have the same calories as two cups of Substance B, and they may have vastly different satiety characteristics. You need to have an actual plan for how you're going to measure, compare, and execute. Lying to people and saying that the only possible plan is to do nothing probably isn't going to help.

And, of course, support/discipline matter, too. Why do you think alcohol therapy/rehab deliberately plan support to help with discipline? For a personal example, when I convinced my wife to try tracking our calories and weighing ourselves every morning (putting together an actual plan), she obsessively tried to over-read the noisy line tracking our weight. Sooooooo many times, she whined, "The line looks like it's going up the last few days! Maybe it's not working anymore!" Over and over again, I needed to basically say, "Shut up; keep doing it; in a week or two, you'll see the line is continuing to go down." It always did, but in a few more weeks, she'd complain again that maybe it's not working this time, as if she just forgot the last seven times where no, it definitely still kept working if she just shut up and kept doing it. If I wasn't there to provide support/discipline, she'd probably have gone back to believing people like you and just failed. She has succeeded, by the way, and is incredibly attractive, maintaining her desired weight well, now that she knows how it works and knows how to plan adjustments.

Obviously, not having a plan isn't going to work. Obviously, just casually saying, "Maybe you could eat fewer calories," isn't a real plan and isn't going to work, just like casually saying, "Maybe you could just smoke less/drink less alcohol," isn't a real plan and isn't going to work. But having a real plan that includes actual mechanisms for education, detailed planning, support, and discipline absolutely actually works. It would be frankly stupid to look at the data, say, "Whelp, alcoholics still exist. People still smoke tobacco. The success rates are the success rates. It must just be impossible to stop drinking alcohol or smoking tobacco!"

Well, I suppose I could see it as similar to the "masks don't work" vs. "mask mandates don't work" drama. Still, as pedantic as it may be, if you just said "telling people to diet/exercise doesn't work", I think very few would have objected, as there would be no way to conflate it with "actually exercising and dieting does not work".

Nobody ever tries to put these fat people in work camps.

If WW2 history classes have taught anyone anything, it's that dieting works.

Every time this topic comes up someone posts something like this. Every time.

That's because this argument forces people to disambiguate between two definitions of dieting:

  • consuming fewer calories

  • voluntarily consuming fewer calories in the presence of abundant hyperpalatable food by exercising your willpower

CI<CO works. Yes, BMR goes down as you lose weight, TEF goes down as you eat less food, NEAT goes down if you diet too hard, but that doesn't change the laws of thermodynamics: CI<CO? Weight loss.

Voluntarily staying at the level of CImaint=COmaint works for some people, fails for others. Why? Two options:

  • they let they CO creep below COmaint, probably by dropping EAT. I think it's less probable, since EAT has a small impact

  • they let their CI creep above CImaint

Why do they stay at CI>CImaint? Because they enjoy it, it gives them hedons. But why do they enjoy it more than staying in shape, while others don't?

  • does eating more tasty food simply have a larger weight in their hedonic formula? Is it an endogenous or an exogenous weight?

  • or does their formula discount future hedons/negahedons at a higher rate? Someone might take into account the dieting they will have to do to lose the weight they are gaining by eating this brownie at -6h and eating the brownie at 5h, while someone else might discount the future dieting to -4h

  • or is there this magic "set point" of CIsp, and every CI<CIsp generates negahedons? Some have it high enough that COsp=CIsp means they have to up their EAT to unsustainable levels

Thank you. I should have posted something like this, but got frustrated. Honestly, I thought understanding this concept was table stakes for having this discussion here, and I was disappointed when a typical normie comment entered the conversation.

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If you don't like the Holocaust comparisons, imagine they are references to Hollywood actors cutting for roles. Caloric restriction rock solid works.

Watch any Marvel movie and see the part where the male lead takes his shirt off and shows his cut abs. They aren't all that lean by happenstance.

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