> It's like if a patient came to their doctor complaining of water retention, and the doctor said "well clearly you're drinking more than you're excreting" and sent the patient home with instructions to drink less and pee more.

I agree that if that were the only thing the doctor said, they would be a pretty terrible doctor. What would happen in the real world is that the doctor would try to diagnose why the person is drinking more than they're excreting, and help stop that from happening, whether it's a psychological reason, an illness, or some other reason.

What the doctor for sure needs to have, though, is a base understanding that if someone is complaining of water retention, the underlying thing that is happening really is that they're drinking more than they're excreting. That's the basis of the diagnosis process. "You drink, then you excrete liquids, and if there's a misbalance there you have a problem" - if the doctor denies that, it's impossible to diagnose anything.

> but the EBM to me just seems hilariously inadequate to explain the obesity crisis.

I'd just like to point out that people usually talk about diet/nutrition in two contexts. One is the context of "how should I personally eat to lose weight" (or gain weight, but losing is more common). The other context is "how do we explain the society-wide obesity epidemic.

Those are very different questions. They both need to start by taking the EBM seriously, since it's completely proven science (both on a theoretical and on a practical level).

But I completely agree with you that the model by itself doesn't explain the obesity epidemic. It doesn't even try to, really - it just says that we know for sure people are eating more calories now, and therefore they are becoming obese. Why they are eating more calories is a separate mystery (though, in my mind, it's not very mysterious - far larger access to far more calorically-dense but nutritionally-poor foods).