What I learned losing 70 pounds: Medical interventions work, among other things

https://www.slowboring.com/p/what-i-learned-losing-70-pounds

by paulpauper • 3 years ago

17 44 3 years ago

paulpauper5• 3 years ago

Within six months of not counting, I’d gained over 20 pounds.

In January of this year, I went back on the program — time-restricted eating, counting calories, 10,000 steps per day, and a new exercise regime with super slow weightlifting.

That is a huge, rapid regain. Yup even with surgery he's back to having the same problems as before and having to be careful to avoid overeating. Hardly a miracle. It also shows how hard it is to fight obesity when even after taking such drastic measures as having surgery the weight comes back so fast.

The problem is surgery is just a temp fix. The stomach gradually expands again to accommodate food, and BMR/TDE falls a bit (metabolic adaptation is common after such procedures). Weight regain is very common 2+ years later ,so without fixing the underlying problem of food addiction/overeating, all or most of the weight will return even with surgery. The type of surgery he had has a higher risk of regain compared to to others. Surgery does not fix the tendency of the body to want to store extra calories, of formerly obese people to want to overeat. GLP-1 drugs help with this to a better extent.

n8henrie3• 3 years ago

Depends on the surgical approach. Roux-en-y for example leverages much more than just stomach volume restriction.

https://www.ncbi.nlm.nih.gov/books/NBK553157/

jokethrowaway• 3 years ago

Nice to read about this experience but there is a missing component:

Modern diet is not what we evolved to eat.

Until recently there was no agricolture, no bread, pasta, pizza or bakery. There was no basket of fruit readily available every day of the week (it was an occasional treat when in season).

I had to lose weight a few times in my life (10kg, not too much) and I always struggled and counted calories like a maniac.

The last time I was not only 10kg overweight but I had some severe stomach pain. After 2 years of struggling I tried the carnivore diet. In a week, all my stomach issues disappeared and I lost 8kg in a couple of months, without counting calories. If I eat animal fat I'm simply not hungry: I can't overeat.

Demonising fats and meats was the worst thing society did and definitely contributed to the overweight epidemics.

wonnor• 3 years ago

It's great that you found a diet that worked for you, but it's strange to say that the article is remiss to not include your specific diet - unless you also think it should include every diet. For any given diet, you can find people whom it helped tremendously, and the carnivore diet is no different. There's also very little evidence for its effectiveness (which is not to say it's not effective, just that it's not particularly well-studied). Personally, I could eat enough meat daily to get very fat if I wasn't counting my calories. When my compliance is struggling, I find high-fiber diets to be the most effective in curbing hunger.

hombre_fatal2• 3 years ago

Agreed. Besides, modern meat is also hyper palatable since it’s engineered to have increasingly high fat content. Also seems weird to talk about what our ancestors ate while buying saran wrapped meat from the market as if you’re going caveman mode. Or that it will give you some magical defense against the explosion of available calories in the modern food economy.

Most social media dietary discourse focuses on magic-trick memes instead of the basic principles. Twitter and HN acts like it’s the hamburger bun and some pasta alfredo making us fat and not the 4000 calories we eat per day altogether. How about eat less, move more, avoid calorie dense foods.

For example, eating out is 1000+ calories. Unless you curb one of your other three meals and don't snack, you're going over your 2300 calorie (or whatever) budget right there.

paulpauper5• 3 years ago

obese ppl gain weight on any diet, short of vegetables. Food is too calorie dense and obese ppl are too hungry.

tiffanyh4• 3 years ago

Why does media think it’s taboo to say “just eat less”.

It’s basic Law of Thermodynamics.

Energy in = energy out.

And if you’re putting more energy into your body than you’re exerting out, it turns into extra weight.

It’s literally that simple, and take that from someone whose done every type of diet plan in existence.

Now yes, there’s food to eat that are very filling but lower in calories (like grilled chicken vs donut).

But it’s still not anything more novel that calorie counting.

lusus_naturae• 3 years ago

Why does media think it’s taboo to say “just eat less”.

On average weight gain is related to overeating for most people, but the reasons for overeating may be complex and varied, so makes saying calories in/calories out inaccurate.

sokoloff• 3 years ago

It makes it unhelpful or not practically actionable, rather than inaccurate.

imagainstit• 3 years ago

These are all topics in the article, which doesn't deny energy in = out at all.

It specifically points out that it's clear that this is how the medical interventions discussed in the article work: reducing calories by altering eating behavior.

Also the article: it isn't taboo to say "just eat less", just that it is as ineffective as telling people with compulsive alcoholic behaviors to "just drink less".

peterashford3• 3 years ago

It's not that simple. If it were simple, no-one would struggle. Overeating is usually a psychological issue.

tiffanyh4• 3 years ago

It’s typically not psychological.

It’s more likely to be a function of people not knowing how many calories are in food.

Eg, a salad from Chick Fila A might sound healthy, but it’s actually 850 calories.

That’s nearly 1/2 of your daily intake.

https://www.chick-fil-a.com/menu/cobb-salad

It’s also the same reason why schools in the US removed soda machines because it was a contributing factor to child obesity.

raincom• 3 years ago

it is physiological, mostly triggered by signals (messed up hormones).

hombre_fatal2• 3 years ago

The third paragraph of the article begins addressing this.

I'm not sure how you think it's taboo when it's been almost the only prong of our society's approach to obesity.

"Guys just eat less lol". And when it doesn't work it's "Man is it taboo to say it or something? Can someone find out if the fats are receiving the message?"

And when people find out society is trying other approaches to fight obesity like surgery or Ozempic, it's "Wait, have we tried the only thing that we've been trying for 100 years?"

dmz73• 3 years ago

To solve famine we can just tell starving people to eat more. It is that simple. To solve expensive rent we can just tell people to pay/charge less for housing. It is that simple. To solve climate change we can just tell people to emit less CO2. It is that simple. To solve global wars we can just tell people to stop fighting. It is that simple. See, I just solved all the world's problems. Simple.

tiffanyh4• 3 years ago

No single person can control rent costs, climate change, or global wars.

But you can control what you eat.

addicted3• 3 years ago

There’s issues with the simple calorie in - calorie out theory (there’s research showing that different bodies digest food differently so multiple people eating the exact same food might not absorb the same amount of calories, and also, all calories are not the same. You can eat 2000 calories in fries and 2000 calories in balanced meals and your body will respond very differently).

But for the sake of argument let’s assume, as you claim, that calories in - calories out is all that matters. Especially if you make that assumption then “Just eat less” is a nonsensical piece of advice. Because “Just eat less” simply restates the problem, which is people eating too much.

Actually useful advice would require helping a person with how they can eat less, and helping resolve the issues that lead them to eating more than they should eat.

n8henrie3• 3 years ago

Can you reference any metabolic ward studies to back up your criticisms of the calorie in calorie out "theory" in otherwise healthy (excluding BMI) individuals?

No doubt some people may have more efficient eg digestion of soluble fiber into SCFA based on their microbiota, but based on usual levels of consumption I would think this would make an absolutely trivial difference.

paulpauper5• 3 years ago

The body is a dynamic system. Predicting how much calories coming out is hard and changes.

derelicta• 3 years ago

Is it simply "eat less" when 40% of a country's population is obese? Are the hundreds of millions "just" stupid, lazy and neglectful? After reaching those historical highs, we should be beyond the casual victim-blaming phase. It's obvious it doesn't lead us nowhere productive and it's just a way to dodge researching/fixing the underlaying issues.

wafer_thin• 3 years ago

This equation is fine, no one doubts it. The issue is why do people who have enough fat stores to last them months get hungry, and why does hunger feel like physical pain. And given these facts why does standard govermnent advice recommend that we constantly eat. I think two meals a day should be the max, and a glance at cereal sugar content makes breakfast the obvious one to drop. I followed this and it reduced my calorie intake and weight (lost 20kg over a couple of years).

nunez2• 3 years ago

Because "just eat less" is basically the same as saying "thoughts and prayers" after a school shooting.

Sure, if everyone could count their calories with razor-sharp accuracy and eat less than they burn, everyone would be at the weight they want to be at, and nobody would need to look at pesky fat people anymore, right?

I mean, I've counted calories with MFP for the last 10 years, and I know my BMR and TDEE and all that. If I can do it, everyone can, right?

Except, ah, right, there's that one thing I forgot: not everyone is mentally wired to log everything they eat every day!

Some (many) people don't even need to log since they don't eat that much anyway (and don't want to).

Oh, and how I could forget? Some people are simply hungry ALL OF THE GOD DAMN TIME. Calorie counting doesn't make the hunger go away, either!

The one thing that many people taking GLP-1 agonists like Ozempic or Manjaro have said over and over is "I didn't know I could just not feel hungry." That is absolutely wild shit!

So, no, telling fat people that your body is a thermodynamic system (it is not, at least not a simple Thermo 101 style one) and CICO and MyFitnessPal is all you need isn't a solution.

A better one, IMO, is to understand and maybe empathize with the fact that every body is different and that an ideal weight means something different to everyone.

Kye• 3 years ago

I remember essentially being hungry non-stop when I was younger. You know what finally fixed it? Resolving stressors! Or at least learning to handle them better. Learning to interrupt stressful thought patterns and replace them with neutral to positive patterns made all the difference. This is no shock to anyone who's actually studied weight issues, but the moralizing crowd still refuses to even acknowledge the science or even actual lived experiences on the subject.

There's still stuff to work on, especially: realizing how many calories are in seemingly innocuous things, how A can lead to B, and prevent C (like buying junk food->can't not eat it if it's in the house->good food doesn't taste good), how certain foods trigger worse hunger rather than resolve it, etc.

Mathematically, it may resolve to "east less," but the mechanics are much more complicated.

helij• 3 years ago

The truth is that for a lot of people 'just eat less' actually works. For majority of overweight and obese people that and speaking to their doctor would be first steps.

addicted3• 3 years ago

I was surprised (but not too surprised, actually, because you hear this all the time) to discover when I got back to America that I didn’t gain any weight in Italy.

Having made a trip to Italy very recently I can second this.

We ate huge amounts of food (not necessarily any huge meals…the slow Italian eating style made it difficult to eat too much at any one meal) but we were eating a lot of different things because there was so much food we wanted to try. And we drank a lot of wine. I don’t usually drink much but Inwas probably averaging a bottle of wine a day in Italy.

Ok returning to America after 10 days I hadn’t gained any weight and had even lost a little (although that was likely just natural variances).

American food (including possibly many fresh ingredients…many fruits, for example, have extremely high sugar contents bred into them) are simply not good for you.

n8henrie3• 3 years ago

Huh. I gained plenty of weight in Italy this summer, in spite of continuing to run a few times per week and doing tons of walking. Thankfully worked it off upon returning home to the states.

addicted3• 3 years ago

In general, I think exercise for weight loss doesn’t work — it just makes you hungrier.

I believe this is wrong in general. The following research, for example, shows at least one form of exercise likely reduces hunger:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761859/

I suspect it depends on the kind of exercise.

paulpauper5• 3 years ago

I can attest exercise is not that helpful. Over summer of 2022 I did 15 days strait of hiking, 33,000 ft worth of elevation gain. Weight loss: 0 pounds. I lost 6 pounds over the following 2 weeks. cause: mild covid. It was Covid that finally broke my plateau, not exercise.

JackMorgan2• 3 years ago

I hiked 1000 miles of the AT last year over three months and didn't lose a pound. No real muscle gain, no real fat loss. Bodies can be extremely resistant to weight loss.

What I learned losing 70 pounds: Medical interventions work, among other things

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