Think of our ancestors whose daily food intake was far from guaranteed. Ancient humans had to work hard to get some occasional fatty, salty or sweet foods. Survival depended on getting as much as possible. Low-calorie plants not so much. Those who were willing to go the extra distance for the fats, salt and sweetness produced more offspring. Also those who could store the extra against times of scarcity were better off. Ditto those whose metabolism changed with age so they did not need as much to survive.
Cut to the present time and it’s now easier to get that yummy stuff than the fresh plants for a lot of reasons. We are still physically and metabolically the same as our prehistoric ancestors.
Honestly, I did not mean for this thread to turn into yet another series of people parading their weight loss accomplishments.
Nor is this a, “wah, losing weight is hard for me so let me find excuses” thread.
I absolutely agree that diet and exercise work on an individual level. But my question is, societally, lots of people are still overweight. Clearly there is something unpleasant about diet and exercise that make people not want to do it.
With any other treatment plan that people don’t comply with, for whatever reason, docs and scientists search to come up with a better one. But it seems like for overweight/obesity, everyone is still stuck on “exercise less, eat more,” and I’m wondering why that is.
I do think many of the points that I’ve made have been addressed by people. I really like WhyNot’s point about how all the diet plans are essentially “eat less” in different packages.
Yup, from my healthcare provider POV, “It doesn’t work because … it doesn’t work.” is clinically what we need to know. If it doesn’t work then using it as a guideline approach is of little utility, no matter why it doesn’t work.
Scientifically there are good reasons why it doesn’t consistently work and we have covered them on these boards before. The bottom line is that adipose tissue is an endocrine organ and functions as part of the endocrine system to maintain its current state, altering appetite and decreasing the metabolic rate. Once a body is obese, and many have been that way since well before adulthood, it works very hard to maintain itself in that state.
Again, medically, taking the position the lack of treatment efficacy is because all of my patients with that condition are too lazy or weak to comply with my recommendations would be and should be laughed at. I am obligated to deal with the patients I have and to use what has been proven to work with that population to keep them/get them as healthy as they can be.
So in terms of a medical guideline that does not mean that we absolve individuals of personal responsibility, but it does mean that we try to advise away from things like that Twinkie diet, that long term are likely to cause significnat harm, and do that which is shown by the evidence to actually result in the most beneficial long term health outcomes.
Help the individuals and those in their support systems develop the habits of eating healthy foods in moderate servings in a healthy way. There are lots of variations of how to do this and it is important to try to match the exact approach to the patient’s individual circumstances and needs.
Set a realistic goal - Long term loss of 10% of body weight with preservation of those healthier lifestyle choices (nutrition and exercise).
Be aware of the place for surgical intervention in the morbidly obese who have not been successful with the first line approaches.
Most important from my pediatric POV, focus, both as medical professionals and as communities, on primary prevention. Preventing obesity is much less difficult than reversing it.
I think this is simply wrong. The pharmaceudical industry spends millions, if not tens or hundreds of millions, looking for a little a pill that people could take that would stop them from getting fat. There is a billion dollar industry for “alternative medicine” to treat obesity. And the treatment of the consequences of obesity (diabetes, heart disease, strokes, and on and on and on) are all likewise the subject of research and development. Thousands of pages of medical journals have been published about obesity and its treatment options. It seems to me that the very basic assumption you’re making, that somehow “medicine” has stopped looking for other ways to treat obesity and the consequences of obesity, if simply wrong.
Except that it does work. I see that Gestalt doesn’t like to see people “parading their weight loss accomplishments,” but the reality is that people who stick it out with determination will almost invariably see results.
It’s not a question of parading one’s accomplishments, BTW. Rather, it’s a case of people personally attesting to the fact that these methods have worked for them. If people can exclaim, “Why doesn’t watching one’s diet work for me?” then it’s equally legitimate for other people to say, “But it does work. I’m living proof thereof.”
You have to look at it as a delayed vs immediate gratification choice. (It’s obviously not as binary as that, but for argument’s sake, let’s use that paradigm.) Do you want the Doritos/Chimichanga/4 hours of TV or do you want the salad/walk/exercise?
Do you remember the Stanford marshmallow experiment? In the study, a marshmallow was offered to each child. If the child could resist eating the marshmallow, he was promised two instead of one. The scientists analyzed how long each child resisted the temptation of eating the marshmallow, and whether or not doing so had an effect on their future success. The results provided researchers with great insight on the psychology of self control.
I’m assuming that’s a misquote there. But it’s simply because it’s been the most effective. Unfortunately, we’re more in a world of increasing immediate gratification. Look at the media shift in the US for instance. Buying a book, renting a movie, getting an album have all been moved to instant Kindle downloads, streaming Netflix and an iTunes purchase. We don’t want to wait for the second marshmallow and that’s why some are glossing over the long term results of eat less/exercise more and going for the Roux-en-Y or going down to Target to get another bottle of Alli.
Eating fewer calories than you burn works 100% of the time. It is incorrect to say it doesn’t work. It confuses the issue. What you mean to say is that some people lack the willpower and self control to make those life changes.
That doesn’t mean that eating less and burning more is unsuccessful. It does work and many people do have success with that exact strategy. Eating less and burning more is a safe and healthy way to lose weight. Don’t shout it doesn’t work and discourage people from trying it first.
I lost 25 pounds doing that exact thing. It’s now 10 years later and I haven’t gained it back. According to your thesis, I’m lying since that strategy DOESN’T WORK.
Why do people drive 1/2 a mile to be handed a bag of corn syrup and fat through a drive through window instead of walking a mile to get a healthy sandwich? That’s the reason most people fail. What pill is going to make people want to walk 20 minutes to get a light lunch?
Yeah, upon reflection, I think I have more than one topic of debate in this thread.
One is, “Why isn’t there yet a good drug to combat obesity?” I think a lot of people have raised good points to this: metabolism is very complicated and something of a “natural state” that the body wants to return to, and obesity is a relatively new disease
Another question is, “Why isn’t there a more rigorous standardized treatment for overweight?” I think good answers that have been mentioned is that there are guidelines for many things, and the first line treatment available is diet and exercise, followed by drugs and surgery, but none of it is very effective. There is much research going into finding a better treatment.
Another question is, “why are there so many different options out there for weight loss?” I think WhyNot addressed this very well in saying that, 1) they are all different packages of “eat less” and 2) there are many different options for other disorders as well. Also, more people seem to suffer from overweight than any other disorder.
It worked for you, yes, but it doesn’t work for other people. I’m not saying that if you put people under lockdown, forced them to exercise, and strictly controlled their diet, they wouldn’t lose weight. They would.
However, in the real world, people are not exercising enough or eating properly. This is because they lack the willpower, or dieting is exceedingly unpleasant to them, or whatever. The question then is what can we do about this? Just repeating, “eat less and exercise more” is not going to work.
Since you posted basically the same thing as JThunder, I’m going to post the same reply to you as I posted to him:
It worked for you, yes, but it doesn’t work for other people. I’m not saying that if you put people under lockdown, forced them to exercise, and strictly controlled their diet, they wouldn’t lose weight. They would.
However, in the real world, people are not exercising enough or eating properly. This is because they lack the willpower, or dieting is exceedingly unpleasant to them, or whatever. The question then is what can we do about this? Just repeating, “eat less and exercise more” is not going to work.
Let’s suppose that your statement is correct. If anything, this disproves your earlier claim – namely, that “current methodology to treat overweight/obesity just doesn’t work.” It shows that your claim is, at best, inaccurate.
And as I took great pains to emphasize, people ARE doing a great deal to make weight loss easier for folks. I don’t see anybody here saying that we should simply repeat “eat less and exercise more.” I certainly did not, and I think it’s clear that you’re arguing against a position that nobody here is advocating.
It’s up to the individual. We, as a society, should not be forcing a person to be on a diet or to exercise. That’s a choice that should be left up to the adult.
You keep repeating that it’s not going to work but it has been proven to work.
If you want to get off topic from your thread and start talking about some of the root causes for obesity, then fine.
Studies into willpower and its ties to obesity are starting to show up. Roy Baumeister has been studying this and some of the findings are showing a tie ofwillpower to blood glucose levels. Unfortunately, blood glucose levels are tied into diet which makes this a circular regenerating problem that could be easily cut off without drugs but with exercise and diet.
Of course, as mentioned earlier in the thread, metformin is a drug that reduces blood glucoseand would then, theoretically, increase willpower making it easier to diet. But it’s still up to the psychology and commitment of the individual to make his or her own fatty choices.
Okay, maybe I was unclear before. I agree that the way to lose weight is to expend more calories than you consume.
When I say that “eat less, exercise more” doesn’t work, what I mean is that Americans have been told that forever, and we are still fat.
Americans are pretty good at lots of things. I think the fact that we have the largest economy in the world shows that we can be productive and disciplined in some areas. But we’re not in the weight loss arena. What can we do to address this?
Because millions of people have tried to diet away weight without success over decades. They have not succeeded, over time the weight returns in 95% plus of cases. At some point you have realize that dieting does not work. Now there may be some new discovery down the road that may change that, but really, to stick to a plan that clearly does not work is just, well … not very intelligent, y’know?
Sigh. Go back. Read the thread. You appear to have totally failed to understand this quote from the WebMD article in Dseid’s post:
If you have a cogent response, respond. If your response is NOT cogent, I will not respond to you.
Because you are really just looking to guilt people. You are not looking at the facts and making a dispassionate evaluation. So, yeah, my mileage varies.
Go to my previous post, read the WebMD post. it said that for 95% of people weight loss returns within five years. So the person who has lost weight and kept it off is an outlier. Huzzah for her! But so what? A solution that only works for 5% of victims is not MUCH of a solution … is it … however well it works for that 5 percent.
Here it is:
When you isolate ‘diet’ you are changing nothing except for the minimalistic period you are actually ‘losing weight’.
If you wish to keep that weight off you must change your lifestyle (see: this is where exercise and proper nutrition come in)
It really isn’t rocket science yet you and apologists like you passing out the woe is me rhetoric is what causes billions of dollars to be made on shit that doesn’t work because it allows you to sit and watch TV and ‘eat all you want’
Again, when it comes to medical guidelines anecdotes are worthless. We know that a very small number will respond to any intervention, even the Twinkie diet. Maybe you are one of them and more power to you. Maybe you know someone who was one of those people, fantastic for him or her. But the evidence is solid that very few of the seriously obese will become non-obese in a lasting manner with even the very best weight loss plans, even though a larger number do lose weight initially. And some do themselves real harm trying to lose weight with ill considered approaches. If it makes you feel better about yourself to say that the obese are just weak willed and have been since they were children, then go at it. Such assessments do *not *belong as part of a discussion about *medical treatment guidelines *however. Not unless you have a treatment intervention for being weak willed and evidence that such is effective care.