You think people are just choosing to not change habits?
Do you also dislike people taking PrEP [0] because they could just change their habits?
If anything this drug has shown is that habits and biology are so intertwined.
“Following dietary advice” is very hard, as evidenced by the 2/3 of the US who are obese or overweight (and the 50% of Western Europe).
It’s also hard to follow economic advice, as evidenced by not everyone making $250k/year.
Similarly, if there was a new drug that cost $10k/year that made people make 30% more annual income, people would definitely take that instead of just studying harder or whatever advice they could follow to increase income.
This is the entire point. The medication exists to change behavior. That’s why this medication exists and the habit changes are possible because of the meds.
It’s like saying that depressed people just need to change their habits. And their anti-depressant meds just make it easier to change habits. But that the meds have nothing to do with habits.
I put on weight in the US no matter what I eat if I eat until I'm full. I naturally drift up by about a pound a year, and faster if I recently dieted. The only way to lose weight is to be constantly hungry. I will sometimes do that for a few months to get my weight under control. It then wanders back up. I've tried all sorts of diets, including plant-based, and it doesn't help. I need to be hungry all the time.
I find it easy to lose weight in less developed countries, even eating what would be considered much less healthy food in the US (fried fatty food, lots of meat, etc.). The food also tastes more, for lack of a better word, real.
I'm not sure we have any clear sense of what, in out hyper-efficient industrial food economy does this. Come to think of it, we don't even know it's the food -- could be something else environmental.
But that's how my own body behaves.
We don't need a complicated explanation, the simple factual explanation for Americans being the fattest people in the world is, they eat more calories than anyone else.
3,600 calories per day is the maintenance weight for 350lbs man who exercises 1-3 days per week.
Depending on distributions there’s some wiggle room, but if the average calorie consumption were anywhere near that high you’d expect to be average weight to be about 150 lbs more than it is.
That's why kids who grow up eating unhealthy can look healthy for a while, but eventually they look like their parents. And once the body is out of buffer, any extra calory goes straight into storage
Basal metabolic rate does go down with age, but basal metabolic rate and total energy expenditure are mostly stable between 20-60. A 60 year old burns about 122 fewer calories than a 20 year old.
What happened is that the kid is either eating more, or is exercising less.
A normal 20 year old who isn’t an exercising a significant amount can’t regularly eat 3600 calories and maintain a healthy weight. That is to say, the average 20 year old with a healthy BMI who exercises 1-3 times per week will gain somewhere around 2 lbs per week eating 3600 calorie per day. They’ll gain less over time if they don’t start eating more as they get closer to 350lbs because their maintenance weight will go up.
And despite individual variation in BMR, I haven’t heard any evidence that some people have the ability to significantly ramp up their metabolism in response to consuming more calories.
But portion sizes are very small. Workers doing heavy construction work will have a large bowl of pho for lunch. That's like 400-500 calories. They are super lean and muscular.
That's not an answer, though. Or at least not a root cause.
Why are American portion sizes bigger?
Why do I need to eat more American food to be satiated?
In China, I'm regularly taken out to banquets, where people stuff themselves until they can't eat anymore. I do too. I still lose weight. Other places, we feast too. I'm then full for a long time.
In the US, I'm back to hunger pangs a lot more quickly.
What does it mean to engineer satiety? An example is Doritos, they are a food which has been very effectively engineered to compel more consumption without making you full. More consumption and less satiety equals more revenue. Lots of American junk food is engineered with this principle in mind.
A roast duck with some rice and vegetables or something at a banquet will have much better satiety per calorie than Doritos and Hot Pockets, or most typical fast food meals, probably even fast casual meals etc.
That's very insightful.
What I don't quite understand, though, is the lack of satiety even from American food not engineered like this. There's a big difference between basic foods like meats and vegetables between the industrial crops of the US and ones from local farms in less industrialized countries.
My hypothesis -- with zero evidence -- is that industrial foods are lower on some nutrient my body needs, and my body wants to eat to get enough.
Protein is notably declining across staples. Protein is not substitutable like carbohydrates. Meaning that your body will trigger you to eat until you get enough protein. Conversely, if you have an abundance of protein and the various micronutrients or vitamins your body can happily convert protein to carbohydrates via ketogenesis. One can subsist on a nearly complete protein diet so long as nutrient deficiencies causing diseases like scurvy are addressed. The same is not true of fat or carbs.
Food or environmental, but in a larger sense, it's likely to be some additives, is my uneducated gut-feel (pun unintended) guess. Here by additives, I don't mean only ones in food, but also fertilizers, pesticides, other synthetic chemicals, and agricultural and industrial effluents.
It feels like there is a pick 2 situation between lean body, being full of energy and being satisfied by food
I’d put money on this not being the case with McDougall, if you follow it strictly. I’ve known several dozens of people personally who have switched, and he has a few published papers on many hundreds of patients. You eat as much as you want. It’s quite hard to keep the pounds on until you hit some natural base weight. (I had to add some fats back into the diet after a while because I otherwise look too thin.)
It should be noted, if you’re on insulin, you need to see a doctor when starting the diet, because you’re likely to need to reduce or eliminate your insulin pretty quickly. Same is true for blood thinners, blood pressure meds, and a number of other drugs. If you’re on a lot of meds, it’s probably worth going through his 12 day program.
I’m unaffiliated— just have personally seen the reversal of supposedly genetic disease and am a fan.
That's such a wrong take. Try something more like: isn't it amazing that we're discovering the underlying biological causes of obesity?
I couldn’t agree more on this point.
I lost ~110 lbs in a year, exciting obesity by eating only meat and dairy with vigorous exercise.
I’ve been able to maintain the weight loss for 2 years, even after entering carbs back into my diet. I gained back 10-15 lbs depending on the week but I’m still at a healthy weight.
It was easy. No side effects. It was cheap — I largely stopped eating out. I feel way better overall everyday.
It’s good that you are able to do this? The challenge is figuring out how 100 million people can. It’s obviously not easy based on how many people struggle and fail.
The hard part is the switch in attitudes and behavior that is very difficult to initiate and maintain.
Saying “I did it through willpower is easy since I did it” is about as accurate and useful as saying “World peace is easy because the Dalai Lama did it through willpower.”
We can take 1,000 people and test out your method vs. semaglutide and see which one has the bigger impact. I’m willing to bet that the semaglutide group will have a greater change.
Eggs are my 1 exception (although I usually throw away the egg yolk - that's where all of the cholesterol is, and the primary reason for eating vegan for me is to reduce cholesterol consumption)
Fish, too. I have a few vegan friends, and fish is the 1st food they reintroduce when cycling off the vegan diet.
Remember no one says you can't make exceptions while dieting. For example, the rules I set for myself are pretty simple "when at the grocery store, only buy vegan foods" but "when eating at a restaurant, no limits!" - I find this is the perfect balance for me, and makes going out to eat very much a treat compared to eating at home!
It kinda sounds to me as if someone said “I’m vegetarian but steaks are my only exception”.
I don't really care what the label is to be honest, it's just how I eat.
Vegetarian is probably closer to being more accurate. But then again I will happily order a steak at a restaurant. So maybe I don't deserve any of these labels at all :)
A better way to put it is I prefer eating vegan rather than I am vegan
But you can be a vegetarian and eat fish apparently.
But my point is that people more or less ignore that there are specific labels with clear meanings and go for labels that have a vibe that they like, regardless of their accuracy.
Like 'vegan' has a philosophical overtone, it isn't just a label for a plant based approach to eating, it's a strict approach rooted in a rejection of (at least perceived) animal exploitation. So someone that eats plants most of the time and grabs the occasional steak as a treat isn't really anywhere close to vegan.
But it never says eggs and fish are unhealthy — just that a plant-based diet is healthy (which is true).
To your point, a high percentage of physical health, as well as some memtal health, could be prevented with changes to dirt and lifestyle. Americans have been (falsely) led to believe their diseases are common everywhere. That's simply not true.
We increase demand and yet expect healthcare costs to fall. Not doubt, the healthcare system could use a makeover, but it's not the HC system's fault the American diet and lifestyle are so pro-ill health.
What you're parrotting is the normalizing of the idea that an individual is not responsible for their own choices for diet, lifestyle and exercise. Outsourcing such basic and foundational aspects of being human is a *very* dangerous direction.
Be careful of the false gods you're buying; be mindful of who is selling that (and how they profit from that sell).
Instead, they’re being downvoted for performing a dimension reduction from “unhealthy weight” to “overeating junk food.” This isn’t the reality for many people, and that assumption (including by doctor) does more harm than good.
It is an interesting thing. I know it is anecdotal but if you ask my mum how to loose weight her mental model is that you have to do more sports. That is her first reaction. And when asked what kind of sports she overwhelmingly defaults to ab crunches. (because your tummy is where you want to lose the weight, obviously that is what you need to exercise)
Now of course we know that you are not going to ab crunch your way to a healthy weight if you are eating too much. And if you try, you are most likely won't do enough exercise consistently enough to make a dent. And if you somehow do, most likely you will unconsciously adjust your caloric intake to maintain your current weight. And lo and behold my mum struggled to maintain a healthy weight all her life.
What I'm saying is that while it is indeed the consensus that eating healthy is the first step in weight control, maybe not everyone has internalised it quite yet? Of course one anecdote is not enough to say anything, but I would not be surprised if my mom is not alone in having unhelpful mental patterns about weight loss.
In fact, just the fact that you said "eating healthy" is tricky in itself. Because my mom would have said she is eating healthy! She read in an article that white sugar is bad, so she replaced it with brown. She heard that red meats are bad, so she only cooked with poultry. She heard that fats are bad, so she only used oil.
Now of course we know that in this context "eating healthy" is mostly about portion sizes. Doesn't matter what kind of sugar your pie is made with if you are eating too much of it.
What I'm saying with this is that even if "people overwhelmingly agree that eating healthy is the first step in weight control" they might have very different notions in their head what it means to "eating healthy". For example my mum would have professed that she is indeed eating healthy, after all there is plenty of vegies under all that cream sauce. (Doing this while serving you a manifestly unhealthy portion, and not even flinching.)
So we just have to be careful what it means when "people overwhelmingly agree" on this or that.
A small percentage of people do, and you see that just walking the streets. The rest are eating and lifestyle'ing themselves to an early grave.
Now there’s a drug and “diet was not a marketable thing anyway!”
Also, as an aside, it’s amazing to me the lengths to which people will go simply to avoid changing their habits.
My endocrinologist has plant-based diet material all over her office. She tells her patients that she’d be out of a job if everyone would eat a healthy (McDougall, Gregor, etc) plant-based diet. Almost none of her patients follow her dietary advice.