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naraburns  nihil supernum  1yr ago (text post)   3338 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.

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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.

It's not a normie comment to say that not eating too much food works when half the population doesn't seem capable of maintaining a healthy size.

Fat people's opinions on dieting are obviously biased in the worst direction, with thin people's opinions having higher value, and formerly-fat-but-now-durably-thin people's opinions even higher.

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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