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Zamujasa posted:That's before you get into how different people's bodies work. Some people can eat tons of food with minimal exercise and still not gain a lot of weight, some can eat little and still gain weight. Bodies are hosed up and weird. Outside of very rare cases or specific diseases, there isn't enormous variation in individual metabolism and calorie processing. The latest info I've seen says that at the high end there is a difference of around 200 calories per day. That is about 10%, so not nothing, but that is also the extreme end. If two people both eat 4,000 calories and do not exercise, then they will both gain a similar amount of weight. Edit: Assuming they are the same gender, height, and starting weight. Leon Trotsky 2012 fucked around with this message at 17:33 on Apr 27, 2023 |
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Apr 27, 2023 17:29
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I think the fact that this is a far worse problem in the US than most other places points to several other factors than "willpower." Food deserts, health inequality, overworking, a drastically underfunded education system that can't provide children any sort of useful life skills like budgeting or nutrition, and much more. It would actually be difficult to design a system that would lead to more weight problems than we have here in the US for christ's sake. Absolutely no one should feel bad about themselves for lacking "willpower."
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Apr 27, 2023 17:32
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Placing all of it on the individual allows American society to largely point at the individual for the problems instead of considering the impact of society at large on them; see also climate change. Make sure to use your paper straw, citizen! Turn of that light bulb! Please pay no attention to the freshly deregulated factory behind you barfing out black smoke
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Apr 27, 2023 17:36
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Professor Beetus posted:I think the fact that this is a far worse problem in the US than most other places points to several other factors than "willpower." Food deserts, health inequality, overworking, a drastically underfunded education system that can't provide children any sort of useful life skills like budgeting or nutrition, and much more. It would actually be difficult to design a system that would lead to more weight problems than we have here in the US for christ's sake. Absolutely no one should feel bad about themselves for lacking "willpower." I've ranted about this in other threads, but yeah, the overworking is definitely the biggest contributor for me (at this point in my life anyways. All those hot pockets didn't eat themselves when I was growing up). Between the hours actually being at work and my drive to/from, I'm putting in a 15+ hour day 5 days a week. Sometimes a run through the McDonald's drive-thru is all I have time for before I have to go to bed and do it all over again.
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Apr 27, 2023 17:37
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Mellow Seas posted:I think it's good that people are going to be better able to lose weight if they want - I've been a lot of different weights and less weight definitely feels better. Our definitions of overweight and obese are pretty arbitrary, though. Once you get to a point where 72% of people are "abnormal" it's time to start rethinking what normal is. These definitions are not based on actual health outcomes, they're based on a chart from the 1830s. Obesity has been normal for quite a while now and I think most people know that? What does "abnormality" have to do with anything? zoux posted:Maybe this is because of my own personal failings, but I'm coming around on the idea that "willpower" is something like height or hair color, that if you don't have it you can't get it. And given obesity rates and abysmal success rates of non-medical obesity interventions, most people don't have it. There isn't even really a general thing that can rightly be called "willpower" (there's a large cluster of loosely associated items that be could all be considered such) and I don't think it has all that much impact on most folks weight, but to the extent it exists and isn't just the enivronmental conditions making it easier or harder, it certainly isn't intrinsic - it can be trained, though how much training in one area will help in others is questionable. However, we have built a society that kinda intentionally tries to atrophy it at every turn, which probably isn't good? Combined with requiring more and more of it from people for the same end result.
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Apr 27, 2023 17:39
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Mellow Seas posted:Also, I had heard it before, but forgotten; he was born in a London tube station during the Blitz. What an interesting dude In his autobiography, he talked about the time his mom called him and wanted him to convince his dad to give up his license. So he goes to his dad and says, "Pop, you really need to think about giving your license up. Your health is bad, your vision is bad and I don't know that you're safe to drive." He said he ne et forgot what his dad told him. He said, "Gerald, I know all about my heath problems, and I almost never drive anymore. But I won't give the license up, because you never know when we'll have to get out of here. This, of course, was because his parents fled Germany to escape the Nazis.
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Apr 27, 2023 17:40
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I'm convinced people have very different experiences of hunger and satiation/drive to eat. I quit cigarettes cold turkey many years ago and those cravings had nothing on what I've always had for food. The only way I've ever managed to maintain any sort of healthy weight has been to offset with enough physical activity. Even then I'm still big and technically overweight. At one point I completed a ten-mile road race at ~230 lbs. Edit: I'm 6'2" on a good day
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Apr 27, 2023 17:41
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Professor Beetus posted:I think the fact that this is a far worse problem in the US than most other places points to several other factors than "willpower." Food deserts, health inequality, overworking, a drastically underfunded education system that can't provide children any sort of useful life skills like budgeting or nutrition, and much more. It would actually be difficult to design a system that would lead to more weight problems than we have here in the US for christ's sake. Absolutely no one should feel bad about themselves for lacking "willpower." Plus the amount of sugar we put in everything combined with the low fat options being essentially pure sugar. The medicine is one part of the puzzle but how we handle the food chain is another obviously. edit: plus less free time to exercise or move around compare to previous generations.
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Apr 27, 2023 17:46
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the_steve posted:I've ranted about this in other threads, but yeah, the overworking is definitely the biggest contributor for me (at this point in my life anyways. All those hot pockets didn't eat themselves when I was growing up). Between the hours actually being at work and my drive to/from, I'm putting in a 15+ hour day 5 days a week. Yeah, when I was working retail I ended up picking up Wendy's for dinner on my way home from work at least once a week, because I was so loving exhausted I knew I wouldn't have any time or energy to cook. The issues with obesity in this country are complex and interconnected, but the lines can be traced back to capitalism. If not necessarily the cause, certainly a major contributor to the same social ills.
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Apr 27, 2023 17:48
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Mooseontheloose posted:Plus the amount of sugar we put in everything combined with the low fat options being essentially pure sugar. The medicine is one part of the puzzle but how we handle the food chain is another obviously. My personal pet theory is that any number of the various chemical compounds in our food and water are going to turn out to be the equivalent of lead in the Roman aqueducts.
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Apr 27, 2023 17:49
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Hieronymous Alloy posted:My personal pet theory is that any number of the various chemical compounds in our food and water are going to turn out to be the equivalent of lead in the Roman aqueducts. High fructose corn syrup is already this
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Apr 27, 2023 17:53
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Hieronymous Alloy posted:My personal pet theory is that any number of the various chemical compounds in our food and water are going to turn out to be the equivalent of lead in the Roman aqueducts. Microplastics. Back when it was lead in everything frying brains people knew and were saying as much but they were ignored and now we pretend it was a mysterious thing. It'll be the same for microplastics. Other stuff is pretty nasty but cannot possibly be as omnipresent as microplastics are.
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Apr 27, 2023 17:55
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Leon Trotsky 2012 posted:The shocking effectiveness of these drugs seems to support the idea that weight loss is not entirely about willpower and there are biological and hormonal aspects that make some people much more likely to be overweight. Obviously, willpower and not eating calories will work in reducing weight 100% of the time, but these drugs and research seem to prove that some people have a much easier time maintaining that willpower and lifestyle change due to biological factors. As someone who lost 140lbs in 1996 and has managed to keep it off (yes, sometime I gain weight and have to really cut back) I can confirm the following. 1. As the NYT article on “The Biggest Loser” states, one’s metabolism never comes back to what it was. Even with the cycling (and I’m about 6’3”) I have to eat less than the recommendations. 2. A constant feeling of hunger stays with you. 3. I do a lot of cycling, with difficult climbs, but that’s more about feeling better, although I did 5000+ miles the year I lost that weight so it did help. 4. I had to eliminate a lot of foods even before I dropped the weight due to blood lipid issues (this was before statins showed up), so that helps. I avoid high glycemic stuff, started out with a fish+veggie thing but went full veg over a decade ago. Maintaining that weight is work. Daily weigh in’s, etc. I hope the drugs work. People need this. And I hope we don’t end up with a FenPen situation like we did in the 1990’s. https://www.medpagetoday.com/special-reports/slipperyslope/51044
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Apr 27, 2023 18:00
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Hieronymous Alloy posted:My personal pet theory is that any number of the various chemical compounds in our food and water are going to turn out to be the equivalent of lead in the Roman aqueducts.  there's not much evidence that lead poisoning in the Roman Empire was particularly widespread. The aqueducts didn't have lead, but they did use lead pipes. This still probably didn't cause huge problems most of the time. More concerningly, they did use lead acetate as a sweetener. There was definitely lead poisoning going on, but that doesn't mean it was a massive problem compared to all of the normal disease and misery that goes along with being a premodern urban civilization. As Rome declined, there would be less lead in everyday life if anything, so you can't really draw a direct line there.However, all this plastic and crap will be seen as the equivalent of lead in gasoline, which was probably the main cause of the 60s-80s crime wave.
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Apr 27, 2023 18:01
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Mellow Seas posted:I think it's good that people are going to be better able to lose weight if they want - I've been a lot of different weights and less weight definitely feels better. Our definitions of overweight and obese are pretty arbitrary, though. Once you get to a point where 72% of people are "abnormal" it's time to start rethinking what normal is. These definitions are not based on actual health outcomes, they're based on a chart from the 1830s. Yeah like when the AMA redefined the standards for hypertension such that it drew fully three-fourths of the country into it. Meanwhile every other developed nation is keeping the standard that doesn't lower the threshold for medical intervention. Mellow Seas posted:I think that as neuroscience advances we will ultimately find that almost nothing anybody does is ever actually their fault. Like, including things that we would all consider inexcusable and indefensible with our current understanding of the brain. I tend to agree with this, I believe, and I think it would be pretty common around here anyway, that we are entirely products of our genetics and our upbringing, neither of which we have any control over. But I'm also cognizant that this view also eliminates accountability, and while there may be one day an enlightened society that compassionately views all social, cultural, and legal transgressions as something that merely needs to be corrected without retribution or judgment, we ain't there.
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Apr 27, 2023 18:01
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Leon Trotsky 2012 posted:Not necessarily. Only about 11% of Americans have diabetes and about 60% of the country is overweight. According to Harvard Medical School, about 30% of overweight people end up with diabetes at some point in their lives. Yes, 37.3 million people, or 11.3% of the U.S. population, have diabetes. But an estimated 28.7 million people – or 28.5% of the population – had diagnosed (pre) diabetes. Approximately 8.5 million people have diabetes but have not yet been diagnosed (2022).
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Apr 27, 2023 18:07
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Professor Beetus posted:The issues with obesity in this country are complex and interconnected, but the lines can be traced back to capitalism. If not necessarily the cause, certainly a major contributor to the same social ills. (Tangentially, there weirdly seems to be some push to define obesity in East Asian countries as a BMI over 25 instead of 30, which puts countries like Korea near US obesity rates - I have no idea if there is a valid scientific justification for this.) GlyphGryph posted:Obesity has been normal for quite a while now and I think most people know that? What does "abnormality" have to do with anything? BMI is barely a generation younger than statistics itself, the standards were not made with any kind of statistical rigor whatsoever and yet we’re still using it almost 200 years later. Until recently, on a societal level, the rising rates of excessive weight were correlated with rising life expectancy. Even the downturn in that figure is generally ascribed more to Covid and substance abuse problems than complications of diabetes. And a lot of countries that also have rising obesity rates have not had the same drop in life expectancy. All this suggests that “more fatties = more death” is not quite the simple arithmetic it’s made out to be. I think there are a lot of people who are going to the doctor and being told to lose weight when they should actually focus on generally increasing their activity level and eating nutritiously rather than sweating the extra forty pounds. Mellow Seas fucked around with this message at 18:15 on Apr 27, 2023 |
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Apr 27, 2023 18:13
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zoux posted:I tend to agree with this, I believe, and I think it would be pretty common around here anyway, that we are entirely products of our genetics and our upbringing, neither of which we have any control over. But I'm also cognizant that this view also eliminates accountability, and while there may be one day an enlightened society that compassionately views all social, cultural, and legal transgressions as something that merely needs to be corrected without retribution or judgment, we ain't there. I don't think you can completely rule out environment as you're doing here - and part of the problem is that cultural beliefs are part of the environment that shapes what we do - believing we are in control of our actions might well lead to significantly better outcomes than believing we aren't, even if the second is closer to true.
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Apr 27, 2023 18:17
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VideoGameVet posted:Yes, 37.3 million people, or 11.3% of the U.S. population, have diabetes. But an estimated 28.7 million people – or 28.5% of the population – had diagnosed (pre) diabetes. Approximately 8.5 million people have diabetes but have not yet been diagnosed (2022). I think something about these numbers is off -- 28.7 million cant be 28.5% of the populatuon if 37.3 million is 11.3%. Nonetheless theres a huge amount of people who could hugely benefit from these drugs. Not just stopping diabetes and heart disease, but I wonder how much peoples mental health and self esteem would also improve
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Apr 27, 2023 18:17
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GlyphGryph posted:I don't think you can completely rule out environment as you're doing here - and part of the problem is that cultural beliefs are part of the environment that shapes what we do - believing we are in control of our actions might well lead to significantly better outcomes than believing we aren't, even if the second is closer to true. Upbringing is environment. https://twitter.com/jbendery/status/1651602747165163520 Oh my god dude, retire you moron zoux fucked around with this message at 18:21 on Apr 27, 2023 |
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Apr 27, 2023 18:18
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Mellow Seas posted:Capitalism contributes but isn’t the sole explanation; Cuba’s obesity rates have shot way up over the last 25 years. All the other communist countries are East Asian countries which have extremely low levels of obesity overall, but rates in Japan and the ROK don’t seem all that much higher than in China or Vietnam. Right, which is why I couched it a bit. Some of the causes would exist regardless, some are entirely the fault of capitalism, and some are amplified by capitalism. It's a very complex web of systems that lead to this sort of thing. We haven't even gotten into lookism and how there's a societal feedback loop of most people in media, TV, magazines, movies, etc being fit and attractive, which makes people judge themselves unfairly, which can affect someone's mental state and make it even harder to make choices that would benefit their health.
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Apr 27, 2023 18:21
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zoux posted:Upbringing is environment. The rest of the environment, then.
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Apr 27, 2023 18:21
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Hieronymous Alloy posted:My personal pet theory is that any number of the various chemical compounds in our food and water are going to turn out to be the equivalent of lead in the Roman aqueducts. Epic High Five posted:Microplastics. Back when it was lead in everything frying brains people knew and were saying as much but they were ignored and now we pretend it was a mysterious thing. It'll be the same for microplastics. Other stuff is pretty nasty but cannot possibly be as omnipresent as microplastics are. https://slimemoldtimemold.com/2021/07/07/a-chemical-hunger-part-i-mysteries/ This is a very long set of essays examining the evidence for a chemical contaminant model of the obesity epidemic. The short version is yeah it might be microplastics but there's a slightly better case for lithium as a culprit.
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Apr 27, 2023 18:23
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There’s another thing, I think people, when they hear the word ”obese,” are picturing the 450 pound people shot with their heads out of frame from 1990s TV news magazine stock footage. Like, I’m obese, my BMI is about 32, and I am essentially a “normal shaped” person, if a little soft; I can see my feet/groin without difficulty; I can touch every part of my body; I can walk indefinitely without stopping; I don’t feel uncomfortable in crowds. Outside of Fenway Park (built 1912) I’ve never felt like a chair was too small. Like tl;dr there are a lot of pretty sexy people who fall into the “obese” category. I don’t really know where I’m going with this. I guess to point out that if somebody thinks 30% of Americans are getting Rascal mobility scooters from their insurance companies their view of the situation is pretty off.
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Apr 27, 2023 18:24
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zoux posted:
On the one hand, I do like seeing Dems push back against the "Democrats aren't being bipartisan" crap. On the other hand, who actually is still "bUt Bi-PaRtIsAnShIp!" at this point as opposed to people who say it to justify pulling the lever for Republicans?
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Apr 27, 2023 18:26
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Blue slips were stupid to begin with so, assuming Dems will mirror Republican behavior rather than going back to previous norms, Republicans killing the practice is probably a good thing. (And it’s not like Biden hasn’t been getting a ton of judges through anyway.) It’s good to call attention to it, even if the way Durbin is talking about it does come across whiny and naive.
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Apr 27, 2023 18:29
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Randalor posted:On the one hand, I do like seeing Dems push back against the "Democrats aren't being bipartisan" crap. On the other hand, who actually is still "bUt Bi-PaRtIsAnShIp!" at this point as opposed to people who say it to justify pulling the lever for Republicans? These people get into these storied halls with all the columns and drapery and portraits and they instantly become staunch intuitionalists that place the Concept above the Reality. It's the whole drat point of neoclassical architecture. To wit: https://twitter.com/NBCNews/status/1651303940271505412 No way in hell do Kagan, Sotomayor, and KBJ agree with this opinion before they put on the robes. GlyphGryph posted:The rest of the environment, then. Sorry, I'm not being clear: I'm using the terms synonymously, I'm fine with just using "environment". I don't think we're disagreeing.
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Apr 27, 2023 18:31
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Hungry posted:https://slimemoldtimemold.com/2021/07/07/a-chemical-hunger-part-i-mysteries/ Why would Lithium be more of an issue now than 100 years ago? It's a rock.
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Apr 27, 2023 18:33
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Hieronymous Alloy posted:Why would Lithium be more of an issue now than 100 years ago? It's a rock. https://slimemoldtimemold.com/2021/08/02/a-chemical-hunger-part-vii-lithium/ The essays do a better job of explaining it than I can. Again, short version: industrial processes have put larger quantities of lithium into the water supplies than in the past, the timescale of which happens to line up with the obesity epidemic and also with certain parts of the world which are more obese.
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Apr 27, 2023 18:38
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Mellow Seas posted:There’s another thing, I think people, when they hear the word ”obese,” are picturing the 450 pound people shot with their heads out of frame from 1990s TV news magazine stock footage. Like, I’m obese, my BMI is about 32, and I am essentially a “normal shaped” person, if a little soft; I can see my feet/groin without difficulty; I can touch every part of my body; I can walk indefinitely without stopping; I don’t feel uncomfortable in crowds. Outside of Fenway Park (built 1912) I’ve never felt like a chair was too small. If I maybe so bold to talk for you. The fact is there is A LOT we don't know about weight, health, and it's connections but we've been sold a lot of what it SHOULD seem like. I was running a lot two years ago and maybe got down to 180 pounds and am 5'7" and was doing calorie calculation for like half a year or so. According to the BMI calculator I was overweight. I was consuming something like 1700-1800 calories a day and quite frankly couldn't get lower with getting into some dangerous territory. There is a lot of health science, weight science, and whatever we've been sold that is junk because it's trying to conform to beauty standards essentially.
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Apr 27, 2023 18:40
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I think the main contributor is cable TV, video games and PCs making sitting on your rear end way, way, way more fun than it ever was in the past. There are a lot of other things about the food supply, increase in sedentary work, etc, that contribute, and yeah maybe even water contaminants or viruses, but I really do think it's mostly all the super awesome cool stuff we can now do with our brains while, physically, doing pretty much nothing. Like, what would a "couch potato" even look like before the advent of those forms of entertainment? The term wasn't even coined until the '70s before catching on in the '80s. Now the term is barely even used anymore because the behavior it describes is near-ubiquitous.
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Apr 27, 2023 18:41
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Mooseontheloose posted:If I maybe so bold to talk for you. The fact is there is A LOT we don't know about weight, health, and it's connections but we've been sold a lot of what it SHOULD seem like. I was running a lot two years ago and maybe got down to 180 pounds and am 5'7" and was doing calorie calculation for like half a year or so. According to the BMI calculator I was overweight. I was consuming something like 1700-1800 calories a day and quite frankly couldn't get lower with getting into some dangerous territory. BMI is a population statistic which gets frequently misused as a personal health metric. Nevertheless at 5'7" 180 you probably were still kinda high-ish BF% unless your bones are made of titanium. No shade, you were still probably in the top decile of your age cohort.
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Apr 27, 2023 18:55
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Mellow Seas posted:
Potato President 
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Apr 27, 2023 18:57
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OctaMurk posted:High fructose corn syrup is already this No, HFCS isn't processed differently from other conventional sugars. Hungry posted:https://slimemoldtimemold.com/2021/08/02/a-chemical-hunger-part-vii-lithium/ What is this site, and why would you find it credible.
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Apr 27, 2023 19:03
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I wrote a pretty hefty effort post on obesity and dieting in response to the weight loss drug discussion a few pages ago but it seems like the thread has covered a lot of the ground I would have covered already. Is there appetite for something more substantial and partially cited, even if it goes over ground we've already walked, or should I cut out the bits that have already been discussed?
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Apr 27, 2023 19:03
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pork never goes bad posted:I wrote a pretty hefty effort post on obesity and dieting in response to the weight loss drug discussion a few pages ago but it seems like the thread has covered a lot of the ground I would have covered already. Is there appetite for something more substantial and partially cited, even if it goes over ground we've already walked, or should I cut out the bits that have already been discussed? 
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Apr 27, 2023 19:06
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Leon Trotsky 2012 posted:The shocking effectiveness of these drugs seems to support the idea that weight loss is not entirely about willpower and there are biological and hormonal aspects that make some people much more likely to be overweight. Obviously, willpower and not eating calories will work in reducing weight 100% of the time, but these drugs and research seem to prove that some people have a much easier time maintaining that willpower and lifestyle change due to biological factors. Do you have evidence for the bolded part, here? You call it obvious but it's definitely not obvious to me given that it's been the predominant cultural position in the West for centuries and a cornerstone of public health advice for just as long but has not made any dent in obesity rates. In fact, given that no population has sustainably reduced average weight as a result of policy efforts, I'd suggest that anything we view as obvious in this debate should be viewed with a great deal of skepticism. I'd like to argue for a reexamination of our attitudes towards obesity and dieting more broadly, as well as respond to this part of your post. Not everything I say is specifically aimed at you, but since you've been sharing these weight loss drug articles I'm using it as a jumping off point. Let me first quickly discuss calories in and calories out, the old trope that is usually thrown around in these discussions. If you wish to defend this paradigm, it seems to me that you're trying to say something useful rather than just repeat a truism. That this advice is supposed to be actionable. Thermodynamics is no real help - the human body is not a closed system. If the point is just that if you starve someone long enough, eventually they'll waste away and die, then sure. But I suspect that what you mean by your "obviously," because of your inclusion of willpower, is that calorie restriction is a plausible mechanism for healthy weight loss. It is this point to which I initially respond. Subsequently I will develop a few more points about how we treat overweight in the doctor's office and in public policy, and how we view fat bodies in society. Starvation response to calorie restriction tends to adjust the calories out side of the balance more than the calorie restriction does in the long term, with no meaningful studies on the long term efficacy of calorie restriction showing sustained and sustainable weight loss but many showing sustained damage to the metabolism. Furthermore, even when dieting does reduce weight, there's not good evidence that it improves attendant health outcomes. Obese people on calorie restrictive diets can present with all the symptoms of anorexia, including heart arrhythmias, amenorrhea, hypokalemia, and severe complications from malnutrition in all major organs of the body. In fact, so called "atypical anorexia nervosa" which can be diagnosed in normal and overweight people is somewhere between 3 and 10 times more common than the stereotypical abnormally thin anorexia nervosa presentations. Calorie restriction is not an effective intervention in obesity, it is not good advice for a doctor to give, and in fact it causes substantial concrete harms. Overweight and mildly obese people have no lower life expectancy than normal weight people when controlling for confounders like smoking. Overweight people with healthy biomarkers have lower all cause mortality than underweight people with similar biomarkers and lower all cause mortality than "normal" weight people with unhealthy biomarkers. Though this remains contentious, our best epidemiological studies suggest a mild protective effect of overweight on mortality risk. More specifically, though obesity is a risk factor for all kinds of negative health outcomes, in the medical setting every one of these outcomes has more predictive biomarkers which can be directly measured (ldl-c and apoB for heart disease, a1c for diabetes, crp for certain metabolic disorders and cancers, mobility and strength can be directly measured, etc) and which show a far stronger correlation with the outcomes than weight. These are no harder to build public health campaigns around, and unlike obesity there is good evidence that people can affect these biomarkers positively with lifestyle changes. For mobility or cholesterol, for example, increasing exercise improves these markers and their associated health outcomes irrespective of whether weight change. Focusing on weight makes it less likely that we are able to positively improve health. Weight stigma in the doctor's office contributes to significant avoidance of care by overweight and obese people, resulting in later diagnosis of many chronic and acute conditions including those unrelated to weight. Obese and overweight people are often denied care for unrelated conditions until they lose weight. Anesthesiologists often refuse to work with overweight patients because of systemic and individual anti-fat bias. We have systematically understudied how to provide care for larger bodies and so anesthesiologists are ill equipped to safely sedate larger patients for routine surgeries. Overweight and obese people often have symptoms of physical injuries such as fractures, broken bones, and soft tissue damage from injury blamed on their weight and the underlying physical injury is left untreated. How much all this affects all cause mortality rates and life expectancy is poorly understood and understudied. Weight stigma in the doctor's office also results in chronic over prescription of statins, fibrates, and t2 diabetes drugs to overweight and obese people who do not have biomarker results suggesting their need and for whom studies of these drugs have shown no medical benefit, with resultant side effects and complications of medication contributing to mortality and life expectancy in ways that are also as yet poorly understood. And weight stigma in the doctor's office is the primary reason that eating disorders are both more common and under diagnosed in overweight populations. Finally, weight loss drugs have historically been greeted with fanfare and hailed as being game changing, but there's a reason that we don't have any right now. They all caused far more harm than benefit in the long run. With healthy weight people requesting this new set, I fully expect this story to play out again. Fundamentally, our cultural paradigm that being fat is unhealthy is, at best, a well meaning oversimplification. We no longer need to measure weight to manage almost any major health condition, telling patients to lose weight is an ineffective intervention that has concrete and measurable harms, and it is my belief that the continued focus on weight and weight loss reflects unjustifiable animus towards the fat body and societal shame about appearance. Contrastingly, public health campaigns which focus on dietary improvement or exercise have been shown to have meaningfully positive effects on both biomarkers of chronic disease, health outcomes, and life satisfaction in overweight populations. If we care about health, let's talk about health, and let's design interventions that improve health rather than target weight. We are so locked into our fat-phobic paradigm that I will never judge any overweight or obese person for their efforts to lose weight or encourage any specific action by any individual trying to improve their lot in our broken society, but I do mourn a little every time I hear weight discussed in these terms. I will not cite every point I've made here in detail, though I'm happy to cite any specific point if asked. To get started, here are a few broad citations, though. On the Energy Balance Model of obesity, showing the paucity of a "calories in, calories out" paradigm for weight loss (though, this model does support the notion that energy balance does determine obesity, it just shows how the naive conception of how this is so is incorrect): https://academic.oup.com/ajcn/article/115/5/1243/6522166 On public policy wrt obesity, this piece by Katherine Mayer should end the debate: https://www.proquest.com/openview/4150738197df3b369a81012fa250b3c9/1?pq-origsite=gscholar&cbl=37325 On weight and health outcomes, https://pubmed.ncbi.nlm.nih.gov/19680230/ https://onlinelibrary.wiley.com/doi/10.1002/jcsm.12378 On the lack of efficacy of diets and calorie restriction, this review by Traci Mann et al is clear: https://pubmed.ncbi.nlm.nih.gov/17469900/ On eating disorders in fat people, Erin Nicole Harrop is a relatively approachable authority: https://scholar.google.com/citations?hl=en&user=ABaxAMgAAAAJ&view_op=list_works&sortby=pubdate
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Apr 27, 2023 19:12
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pork never goes bad posted:Do you have evidence for the bolded part, here? You call it obvious but it's definitely not obvious to me given that it's been the predominant cultural position in the West for centuries and a cornerstone of public health advice for just as long but has not made any dent in obesity rates. In fact, given that no population has sustainably reduced average weight as a result of policy efforts, I'd suggest that anything we view as obvious in this debate should be viewed with a great deal of skepticism. I don't mean that it "works" in the sense that it is a specific policy solution. Just that you can absolutely reduce calories to reduce weight. If someone with a 37 BMI restricts their calories to 1,800 per day permanently, then they will lose weight. It's a basic law of thermodynamics. The fact that just telling people to do that doesn't work most of the time is not evidence that calorie intake does not influence weight gain. The problem with weight loss isn't that we don't specifically know how to lose weight. It's that we don't know of a way that works and is easy for most people to follow for their entire life.
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Apr 27, 2023 19:17
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Leon Trotsky 2012 posted:I don't mean that it "works" in the sense that it is a specific policy solution. Just that you can absolutely reduce calories to reduce weight. It's a basic law of thermodynamics. The fact that just telling people to do that doesn't work most of the time is not evidence that calorie intake does not influence weight gain. The problem with weight loss isn't that we don't specifically know how to lose weight. It's that we don't know of a way that works and is easy for most people to follow for their entire life. The basic law of thermodynamics only applies to closed systems, which a human body is not. Furthermore, restricting calories has predictably negative effects on calories burned both in the short and long term. You're either saying something that is false or you're saying something that is so oversimplified that it's useless. See my first citation. And your assertion that we know how to lose weight is, again, either false or a useless oversimplification. We know how to induce weight loss in the short term with real costs. We do not know how to lose weight in the long term. Edit - responding to your edit, please take a look at the Mann review. Your point sounds obvious but it is not demonstrably true and it is actively harmful to discuss. Calorie restriction drives metabolic changes reducing calories burned more effectively than it results in weight loss and weight loss from calorie restriction does not lead to improvements in the health outcomes we purport to care about when we discuss obesity. pork never goes bad fucked around with this message at 19:24 on Apr 27, 2023 |
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Apr 27, 2023 19:21
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Jarmak posted:Even then I'm still big and technically overweight. At one point I completed a ten-mile road race at ~230 lbs. I was “overweight” by BMI when I was an athlete (I was a captain of the swim team at a service academy). During the training trip, one day I ran ten miles, had four hours of practice in the water(so like a marathon’s worth ) and lifted and was like just one day that week. We had one guy on the team who was there because he wanted to be a seal. He was built like brick shithouse. I remember later hearing a radio program about him getting to kick box in a prison match in Thailand. BMI really isn’t any good for looking at athletes weight ratios. Now that I’m old and fat, yeah it accurately reflects my health.
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Apr 27, 2023 19:22
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