Thing is, we have about half a century of consistent clinical findings saying, without exception, no diet-based approach shows long term weight reduction. The most successful have zero effects by 5-10 years out.

Bari surgery is the first and only intervention we’ve had that has shown sustained weight loss over 10 years.

I don’t mean to in any way understate its dangers or its difficulty. But from a medical standpoint, I have to raise a red flag when someone says “hey, instead of using the only treatment that’s ever been shown to have a sustained effect, you should use a variant of a treatment we’ve spent half a century proving doesn’t generally work.”

The linked article phrased it as being for people for whom bari isn’t an option, but even the Lancet article proper - iirc, as I read it at the beginning of the week - phrased it as, “there aren’t enough bari surgeons to go around, so in the meantime...”

But only a small change in metabolic rate can easily produce ten or more pounds of additional weight a year.

Your surgeon's income depends on people getting bariatric surgery. You can add in exercise to increase total calories burned to support a larger food intake and still lose weight.

(2) I’ve never heard a bari surgeon Not recommend lifestyle change. Most will ask you to do your best pre-op, to make the surgery as safe as possible. They will counsel you on the same post-op. Many have in-house dietitians to assist.

(3) Your argument implies the following: Bari surgeons pretend and contend diet doesn’t work, to keep the supply of customers coming. Fact check: diet was failing for decades, and only the resultant epidemic made something as extreme as cutting out pieces of a non-diseased GI tract not entirely insane. Go read another hundred diet books of the week; proclaim their findings from the rooftops. I’m pretty sure the bari surgeons aren’t going to run out of willing customers.

Using only diet, I have successfully lost 90lbs and continue to lose.

I am very fortunate to have fallen in love with a Greek woman who has shared her family's diet with me. It's likely saved me from needing an extreme solution myself.

I think that in North America, we don't know the first thing about eating healthy. A big part of the Mediterranean diet is using high quality, expensive, olive oil with everything. My parents would blow a gasket if they knew that we paid for the fancy stuff. At $10/L it's more than my parents would ever spend, but it's honestly not noticeable as far as my budget is concerned. It's seriously a game changer.

By putting high quality olive oil in all you're food, everything becomes much tastier and satisfying than before. It allows you to eat and be satisfied with much less. The other key is to splurge on expensive, good looking vegetables.

Having delicious vegan recipes allows you to get your kicks without eating tons of saturated fats.

This allows you to be satisfied with less volume. It's made up through quality and taste. This is the foundation of a healthy diet, eating high quality tasty food.

The problem with the North American diet is that we don't have the same traditions of passing down recipes as they do in other parts of the world and so none of us know how tasty a simple dish can be. We then eat this processed crap that gets passed off as identical to the original when it's a fraction as tasty and nutritious. As a result, we compensate by eating far too much of it.

I think that this continent is in dire need of better recipes and respect for their ingredients. Until that gets integrated into the culture, we are doomed to depend on these extreme measures to stay at a healthy weight.

Don't get me started on drive-through culture or eating at your desk. Eating is something to be enjoyed, not rushed. When you rush your meal, you eat more and you aren't taking the time to enjoy any subtlety in the taste. This results, again, in overeating.

Surgeons are usually good at doing other surgeries as well...

This baffles me, because these results are trivially disproved. It's not particularly rare for people to lose weight and keep it off long term by changing their diets. Are the studies poorly constructed or are they just being misinterpreted?

The data show that over ten years average sustained weight loss in diet-and-lifestyle interventions is zero (actually, there’s usually weight gain). That doesn’t rule out particular rare exceptions, but they’re just that, and not useful for evaluating the intervention as a whole.

And 'average sustained weight loss over a cohort' is the wrong measure, especially if your cohort are candidates for bariatric surgery (ie. pre-selected for being medically recognized as incapable of losing weight voluntarily) rather than just overweight people in general (a fair few of whom do choose do get back in shape.)

I can't name a single friend who has successfully dieted short term that has kept it off long term.

Obesity related complication occurr with excess weight. So, if they were at their ideal weight at 50 yrs old and gained it back at 80 when they also incurred high blood pressure and diabetes, then they weren't successful.

That's why it's difficult. Most can lose weight at some point in their lives. But the weight eventually comes back, along with the other complications.

To put it another way, it's a silly bar to use to say that weight-loss programs must move their adherents level of health wrt weight past those of normal slim people, and that any weight gain from a former dieter is proof of a diet's failure of efficacy (while any weight gain from a formerly-healthy-weight, non-dieter is just happenstance).

It's tough to look at just the existing data to tease this out, but if you need to resort to a bar as absurdly stringent as that to make your point, I'm afraid it's not a very convincing one.

They often engage in a bit of semantic game-playing about the meaning of the term "diet."

The problem is a lot of the "diets don't work" conclusions are based on very strict assumptions about "diet" meaning "telling people to just lower their calorie intake" or "telling people not to eat certain foods." They don't necessarily mean giving strategies for lifestyle changes, or ways to avoid increased calorie intake, or replacements.

As a concrete example, one researcher I spoke to is a very publicly prominent advocate that "diets don't work," and gave a talk I attended. She was discussing studies of weight loss and was explaining how studies that instructed participants to do things like use smaller plates (to change perspective on how much food is being consumed) or strategies for coping with parties, etc. were not "diet" studies because they did more than just tell participants to diet out of sheer willpower.

So, in effect, diets, if they are defined as just telling people to lower intake, and nothing else, don't work. However, if you support them, and give them alternative behaviors or foods, or strategies for lowering intake, they do work.

What also became clear to me, and which people on this forum are maybe pointing out, is that there's also a lot of gamesmanship in these papers about individual trends and what counts as a control group. There are in fact people who do reliably lose weight on diets (you can see it in their individual-level-data graphs), but their trends are often explained away by switching controls ad hoc.

I was left very frustrated by these studies, because it wasn't clear to me why these researchers wouldn't be promoting the strategies, etc. more, or advocating more for understanding why people who lose weight on diets do lose that weight, to gain strategies. I got the impression they were trying to be sensationalistic or something, to gain attention, by trying to sound counter-intuitive.

As a side note, I've worked in bariatric clinics, and I can say from my experiences there they have their own brand of burying side effects and defining outcomes in such a way as to achieve success (for example, by only selecting "appropriate" individuals for surgery).

Controlling or having a low calorie diet isn't a medical treatment [1], it's simply a choice an individual (in most cases) makes. They choose to not continue with the original choice after some time, so to club diet-control under 'medical treatment', and say that it doesn't work, is incorrect.

[1] https://www.wisconsin.edu/workers-compensation/coordinators/...

Edit, grammar.

Does "diet" mean counting calories and eating less than you want to eat?

I ask because another approach, as in Susan Robinson's book The I Diet, is to eat as much as you want but just make sure it is foods that are moderately low in calories. In particular, avoid refined carbohydrates, potatoes, and fatty foods.

I have been following this approach for 5 years. I lost 50 pounds, I have no will power when it comes to food, but the pounds have stayed off.

In my case, I cut out refined carbohydrates (white rice, white bread, pasta, potatoes, etc.) and sugar (sweetened beverages, desserts). I still eat plenty of carbs that come with a large dose of fiber, such as oatmeal, peas, and beans.

At the same time, I increased my intake of animal fats and dairy.

Or such is my arm chair hypothesis, at least.

Especially for the target audience of chronically morbidly obese people with diabetes!

Its the same thing that creeps into every drug discussion. Its one of those caddisfly larva conglomerates, where people glue lots of pseudo science onto theire "feel-good" opinions instead of really trying to solve the issue with realistic solutions.

You could sell the realistic solution to these individuals by telling how much the "sinners" suffer after the operation and how heartily they regret taking the left hand path.

It’s not like we can do much more than show “if I introduce this amyloid, beta cells die” in the lab. No one is going to experimentally administer the amyloid to real life patients to see if it kills their pancreas.