# Why so many different treatments for overweight/obesity? **URL:** \ **Category:** Great Debates\ **Created:** [December 14, 2010, 2:20am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071 "2010-12-14T02:20:10Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 15, 2010, 1:39am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/81 "2010-12-15T01:39:11Z")
> [@Wesley\_Clark](#): > > My advice fails because people won’t follow it. The advice itself works. Sigh. Let us take this angle - _assume_ that obesity is due to lack of self-control and will power and a moral failing of sorts. Pretty much like becoming addicted to narcotics is. For years the treatment for heroin addiction was being told to stop using the drug. That worked as long as people followed that advice. Some managed to do that, a very few. Some were able to get through detox but most of them quickly relapsed. For the vast majority the drug use persisted causing a great deal of other harms. The advice failed for most because most did not follow it … it was too haaaard. The advice itself worked, just not for most of the people who were addicted. Then it was discovered that [there was a way](http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.2002.10628.x/full) to allow an addiction to narcotic to persist but to still greatly decrease the harm associated with the drug: substituting methadone for heroin. The addicts did not become free of addiction, but the harms, to themselves and to society were greatly reduced. Current heroin guidelines generally include a role for methadone fairly early in the process. A physician who subscribes to the belief that the guideline for treating heroin addiction should be telling those so affected to stop and that if they fail to do so, well that’s not their problem, the advice works, are not practicing good medicine. Likewise, _even if_ you believe that obesity represents a moral failing that was present from childhood on, a belief that the approach should be “just take in fewer calories than you burn”, in the face of the overwhelming poor outcome of that approach, would be an idiot of a physician. ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [December 15, 2010, 1:58am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/82 "2010-12-15T01:58:43Z")
I think **Wesley Clark** is in agreement with us, **DSeid**. The post you responded to was his response to someone saying his “plan to cure STDs” won’t work. ---
**Author:** ![JThunder](https://avatars.discourse-cdn.com/v4/letter/j/e95f7d/32.png) [@JThunder](https://boards.straightdope.com/u/JThunder)\ **Post date:** [December 15, 2010, 2:04am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/83 "2010-12-15T02:04:52Z")
> [@Stoid](#): > > Losing it is not the issue. Keeping it lost is. > > And for people with real obesity issues, keeping it off generally means trading in the mindset of a compulsive eater for the mindset of an anorexic. Not the body…the mental process: a perpetual, 24/7 lifelong obsession and preoccupation with every morsel of food that you might consider eating. > > This is not simple, not easy, and for most people, simply not possible. Which is why it shouldn’t be the goal. The goal should be to strive to improve the nutrition and diet by finding ways to enjoy more healthful food (not enjoyable is completely doomed), find ways to enjoy movement and activity, and address any emotional issues. That’s certainly true, but I don’t see anyone specifically arguing against that perspective. If anything, I think that your statement contradicts the OP’s claim – namely, that “the current methodology to treat overweight/obesity just doesn’t work.” I don’t see any weight loss professionals arguing that obese people need to start thinking like anorexics. The method you described is what works for me. That’s why I scoff when people say that weight loss methods just don’t work. It’s a completely unnuanced point of view that’s phrased in a manner that absolves one’s self of the need for hard work and personal responsibility. > [@](#): > > It would be tremendously helpful if people with weight issues weren’t treated like worthless garbage because they are fat. That is certainly true, but with all due respect, it’s not relevant to the discussion at hand. Nobody here has condoned such behavior, at least not in this thread. Some have pointed out that people tend to give up on obesity control, and some have even argued that a lack of determination and willpower is part of the problem. That’s hardly the same as saying that these people need to be treated like worthless garbage though, no matter how tempting it may be to ascribe that motivation unto them. ---
**Author:** ![JThunder](https://avatars.discourse-cdn.com/v4/letter/j/e95f7d/32.png) [@JThunder](https://boards.straightdope.com/u/JThunder)\ **Post date:** [December 15, 2010, 2:15am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/84 "2010-12-15T02:15:48Z")
> [@Evil\_Captor](#): > > But it’s just dumb to think that dieting and exercise can cure being overweight, for most people. All the evidence says it cannot, for 90-95 %. It can work for 5-10 percent, and huzzah for them, but that leaves 90 percent out in the cold. Like others, I think we will eventually figure out how to handle weight loss effectively. Until then I am not gonna be one to guilt others out by calling them weak or lacking in willpower. It’s just cheap superiority, and frankly, I can afford the expensive kind of superiority. No, the evidence does not say that. The evidence says that 90 to 95% of people who try dieting and exercise fail, but that does not mean that they CAN NOT work. Methodology and determination have everything to do with it. We all know people who go on crash diets, for example. Such attempts are doomed to fail. We also know people who “diet,” but who habitually cheat on their diets – and I’m not talking about the controlled kind of cheating wherein an occasional treat is allowed. For that matter, most people don’t exercise anywhere near as much as they could or should. A lot of people use incorrect or inefficient techniques, for example. Many people are unprepared for the amount of effort required, and so they either give up or plod along at a low intensity, then wonder why these techniques don’t seem to work. I see that all the time at my gym, and so do the fitness instructors. We’re all familiar with the New Year’s resolutioners – people who show up at the gym in January, and then peter out by the time March rolls around. Many of these people would surely say that they tried exercising, but did they really? Not to any significant degree. Then there are the folks who’ve been attending the cardio classes for years, and yet they make no noticeable progress. As my instructors have observed, these people generally don’t put much “oomph” into their moves, either in terms of intensity or in terms of proper form. Admittedly, this is sometimes due to medical conditions, but there are times when it’s pretty clear that people just give up or don’t want to sweat too hard. That’s human nature; most people just don’t try very hard at the things they do. My best friend tells the story of a woman she met at the gym last summer. This woman said, “I’ve been working out here for years and I haven’t seen any results!” My friend noticed how this woman was barely moving through her exercises, and she said to herself, “I’m not surprised.” That’s why we need to be skeptical when people claim that dieting and exercise will not and can not work for them. A lot of people try to diet and work out. Far fewer learn how to do so properly, and even fewer have the determination to stick it out to the end. ---
**Author:** ![Brown\_Eyed\_Girl](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/brown_eyed_girl/32/3574_2.png) [@Brown\_Eyed\_Girl](https://boards.straightdope.com/u/Brown_Eyed_Girl)\ **Post date:** [December 15, 2010, 2:51am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/85 "2010-12-15T02:51:43Z")
> [@Wesley\_Clark](#): > > Judges, lawyers, scientists, professors, doctors, etc. See if they can lose large amounts of weight and keep it off for 10 years. Almost none will be able to no matter how motivated they are. Motivation and discipline are two different things. One does not necessarily follow the other. The eat less, exercise more plan works for people who are disciplined enough to follow through with it. That not enough people are that disciplined does not mean the plan doesn’t work, but that people are complacent and not motivated enough to make lifelong changes. In other words, while they may very well be motivated to \*lose \*weight, they are not disciplined to eat less and exercise more to \*maintain \*a healthy weight. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [December 15, 2010, 5:42am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/86 "2010-12-15T05:42:05Z")
> [@Brown\_Eyed\_Girl](#): > > Motivation and discipline are two different things. One does not necessarily follow the other. The eat less, exercise more plan works for people who are disciplined enough to follow through with it. That not enough people are that disciplined does not mean the plan doesn’t work, but that people are complacent and not motivated enough to make lifelong changes. In other words, while they may very well be motivated to \*lose \*weight, they are not disciplined to eat less and exercise more to \*maintain \*a healthy weight. Yes, if overweight people were just robots that could be programmed with the characteristics you and JThunder believe you have, and think they should have, then everything would be all right! I think … You know, you remind me EXACTLY of conservatives who think poor people would be all right if they could be programmed with the characteristics the conservatives believe they have, and think the poor should have. And you remind me EXACTLY of the liberals who think the wealthy would be all right if they could be programmed with the characteristics the liberals believe they have, and think the wealthy should have. Oh, I think I am on to something here! ---
**Author:** ![JThunder](https://avatars.discourse-cdn.com/v4/letter/j/e95f7d/32.png) [@JThunder](https://boards.straightdope.com/u/JThunder)\ **Post date:** [December 15, 2010, 5:48am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/87 "2010-12-15T05:48:39Z")
Oh, please. We did not say that it would be easy, nor did we ever deny that it will be more difficult for some. What we ARE saying is that it’s foolish to exclaim, “But it doesn’t work! It doesn’t! It doesn’t!” That claim is utter nonsense. It may be difficult for some – heck, for a great many – but that is obviously not the same thing as saying that it doomed to failure. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [December 15, 2010, 5:58am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/88 "2010-12-15T05:58:09Z")
> [@JThunder](#): > > Oh, please. We did not say that it would be easy, nor did we ever deny that it will be more difficult for some. > > What we ARE saying is that it’s foolish to exclaim, “But it doesn’t work! It doesn’t! It doesn’t!” That claim is utter nonsense. It may be difficult for some – heck, for a great many – but that is obviously not the same thing as saying that it doomed to failure. Clearly there has been a failure to communicate here. The numbers say … clearly, unequivocally … that for 90-95 percent of Americans, dieting and exercise are not workable solutions for long term weight loss. Deny it til you turn blue in the face, the numbers are very, very clear. I don’t know what else I can tell you. It is like talking to a brick wall. It. Does. Not. Work. ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [December 15, 2010, 6:37am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/89 "2010-12-15T06:37:25Z")
I’m feeling the same way as you, **Evil Captor**. I don’t know how to be more clear. Most people could lose weight by diet/exercise. Most people (90%) don’t lose weight by diet/exercise. ERGO, diet/exercise is not effective for most people (YES IT WOULD BE EFFECTIVE IN A VACUUM BUT NOT IN THE REAL WORLD BECAUSE PEOPLE ARE LAZY OR WHATEVER). Where do we go from here? ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [December 15, 2010, 6:43am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/90 "2010-12-15T06:43:10Z")
Okay, here’s another approach. Let’s say there is a clinical trial for a medical treatment to treat condition x. This treatment requires walking for 3 miles a day. Walking is the only method that would work. This method is effective for everyone who walks. There are fifty participants. One of them is a man in a wheelchair who can’t walk. The walking treatment works perfectly for the other 49 participants. Does this method still work? Does it work for him? Would you describe it as an effective treatment for condition x? Now lets switch the proportions and say that 45 of the participants are in wheelchairs, and 5 can walk. Does the treatment still work? Does it work for the people in the wheelchairs? Would you describe this as an effective treatment for condition x? ---
**Author:** ![JThunder](https://avatars.discourse-cdn.com/v4/letter/j/e95f7d/32.png) [@JThunder](https://boards.straightdope.com/u/JThunder)\ **Post date:** [December 15, 2010, 6:47am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/91 "2010-12-15T06:47:33Z")
> [@Evil\_Captor](#): > > Clearly there has been a failure to communicate here. The numbers say … clearly, unequivocally … that for 90-95 percent of Americans, dieting and exercise are not workable solutions for long term weight loss. No, they do not. There is nothing unequivocal about it. As I’ve already explained to you, the numbers simply mean that these people have failed. It does not mean that they are DOOMED to fail. Anybody can go on a diet. Not many do so sensibly, though. Similarly, a great many people exercise, but without much intensity, regularity, or proper technique. Your numbers demonstrate a large failure rate, but they do not demonstrate that exercise and dietary changes do not work. > [@](#): > > Deny it til you turn blue in the face, the numbers are very, very clear. No, they are not, for reasons that have been explained to you repeatedly. > [@](#): > > I don’t know what else I can tell you. It is like talking to a brick wall. It. Does. Not. Work. You know what? If it makes you feel better, you can keep telling yourself that. Common sense, however, show that these numbers do not mean what you insist that they mean. ---
**Author:** ![JThunder](https://avatars.discourse-cdn.com/v4/letter/j/e95f7d/32.png) [@JThunder](https://boards.straightdope.com/u/JThunder)\ **Post date:** [December 15, 2010, 6:52am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/92 "2010-12-15T06:52:18Z")
> [@Gestalt](#): > > Okay, here’s another approach. Let’s say there is a clinical trial for a medical treatment to treat condition x. This treatment requires walking for 3 miles a day. Walking is the only method that would work. This method is effective for everyone who walks. There are fifty participants. One of them is a man in a wheelchair who can’t walk. The walking treatment works perfectly for the other 49 participants. Does this method still work? Does it work for him? Would you describe it as an effective treatment for condition x? Absolutely. The fact that if wouldn’t work for that one individual doesn’t mean that the method is ineffective. It simply means that its effectiveness is limited and does not apply in his atypical situation. When people do not use a method, then this method cannot work for them. I have stated that repeatedly. It doesn’t matter if it’s because they can not use the method or if it’s because they refuse to do so. Besides, your objection is a specious one. The vast majority of people CAN exercise and they CAN make dietary changes. They can make lifestyle changes that are conducive to better health. These people are by no means analogous to the poor unfortunate wheelchair-bound individual in your scenario. I think you know that full well. ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [December 15, 2010, 6:54am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/93 "2010-12-15T06:54:13Z")
> [@JThunder](#): > > Besides, your objection is a specious one. The vast majority of people CAN exercise and they CAN make dietary changes. They can make lifestyle changes that are conducive to better health. These people are by no means analogous to the poor unfortunate wheelchair-bound individual in your scenario. I think you know that full well. I was actually suggesting that they’re more analogous to the wheel-chair bound in the second scenario, to which you didn’t respond. ---
**Author:** ![Stoid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/stoid/32/272_2.png) [@Stoid](https://boards.straightdope.com/u/Stoid)\ **Post date:** [December 15, 2010, 7:14am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/94 "2010-12-15T07:14:05Z")
Again… it’s not about whether they can. It’s about whether they can for the rest of their lives consistently enough to prevent weight gain. Generally speaking: no. ---
**Author:** ![Recliner](https://avatars.discourse-cdn.com/v4/letter/r/a88e57/32.png) [@Recliner](https://boards.straightdope.com/u/Recliner)\ **Post date:** [December 15, 2010, 10:36am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/95 "2010-12-15T10:36:41Z")
Most of the “treatments” are simply scams – thats really what it boils down to. This is, amongst developed nations, probably the biggest thing that people want “solved”: “Why am I so fat?”, and there is simply no easy answer AS OF NOW. Even diet and exercise – which the majority of the population are unable to stick to – aren’t really as effective as people wish. The “diet industry” is happy to help, of course, but they’re in it to make money, not to resolve the issue. A huge part of the problem is that, those who are unlikely to lose weight through diet and exercise, necessarily seek out other solutions – and there aren’t any effective ones. Oh, except maybe taking stimulants, which you really don’t want to do. I believe we’re about 20 years away from a truly-effective “diet pill”. Phen-Fen worked…but it also damaged heart valves. Ouch. Still, this is basically the Holy Grail of pharmaceuticals, and you better believe its in the works. ---
**Author:** ![marshmallow](https://avatars.discourse-cdn.com/v4/letter/m/df705f/32.png) [@marshmallow](https://boards.straightdope.com/u/marshmallow)\ **Post date:** [December 15, 2010, 11:14am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/96 "2010-12-15T11:14:41Z")
> [@shiftless](#): > > Because if you found a method to allow me eat what I want without gaining weight then I would just eat more. The amount I eat isn’t limited by scarcity or money or hardly any other factor. I could eat 20,000 calories today if I want. The one and only limiting factor is my desire to not get any fatter and even that evaporates when confronted by, well, foods too numerous to mention. Were you always like that or did you have to work your way up? I can’t imagine wanting to eat anything after a meal for at least 5 or 6 hours. I don’t understand how people can eat plate after plate of food. It sounds more like torture. I think if I tried that I’d either have horrible stomach cramps or I’d just start vomiting. ---
**Author:** ![Weedy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/weedy/32/301_2.png) [@Weedy](https://boards.straightdope.com/u/Weedy)\ **Post date:** [December 15, 2010, 11:42am UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/97 "2010-12-15T11:42:03Z")
Maybe we could say that diet and exercise _won’t_ work for 90-95% of people, instead of _can’t_ work for 90-95% of people. If that’s true, where do we go from here? ---
**Author:** ![Brown\_Eyed\_Girl](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/brown_eyed_girl/32/3574_2.png) [@Brown\_Eyed\_Girl](https://boards.straightdope.com/u/Brown_Eyed_Girl)\ **Post date:** [December 15, 2010, 1:32pm UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/98 "2010-12-15T13:32:17Z")
> [@Evil\_Captor](#): > > Yes, if overweight people were just robots that could be programmed with the characteristics you and JThunder believe you have, and think they should have, then everything would be all right! I think … > > You know, you remind me EXACTLY of conservatives who think poor people would be all right if they could be programmed with the characteristics the conservatives believe they have, and think the poor should have. And you remind me EXACTLY of the liberals who think the wealthy would be all right if they could be programmed with the characteristics the liberals believe they have, and think the wealthy should have. > > Oh, I think I am on to something here! So what you’re saying is that the people who do successfully lose weight and change their lifestyles to maintain healthy weight are…robots? Huh. Well, that’s an argument I don’t intend to waste my time on. ---
**Author:** ![Hamlet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hamlet/32/2818_2.png) [@Hamlet](https://boards.straightdope.com/u/Hamlet)\ **Post date:** [December 15, 2010, 1:36pm UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/99 "2010-12-15T13:36:31Z")
> [@Stoid](#): > > Again… it’s not about whether they can. > > It’s about whether they can for the rest of their lives consistently enough to prevent weight gain. > > Generally speaking: no. Again, it’s not about “can”, it’s about do. They certainly “can” keep the weight off. But they don’t. ---
**Author:** ![Hamlet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hamlet/32/2818_2.png) [@Hamlet](https://boards.straightdope.com/u/Hamlet)\ **Post date:** [December 15, 2010, 1:46pm UTC](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071/100 "2010-12-15T13:46:56Z")
> [@Weedy](#): > > Maybe we could say that diet and exercise _won’t_ work for 90-95% of people, instead of _can’t_ work for 90-95% of people. If that’s true, where do we go from here? Work to find new ways to make it work. We’ve developed surgical solutions. The pharm companies are researching weight loss drugs. Other scientists are researching how the body works and how it can be made easier to lose weight. There are much more low calorie foods, more places to exercise, and more public knowledge about the issue. Maybe someday, science will develop a pill that will make it easier to lose weight, and soon, everyone will be healthy again. [Previous page](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071.md?page=4) [Next page](https://boards.straightdope.com/t/why-so-many-different-treatments-for-overweight-obesity/564071.md?page=6)