Purely behavioral lifestyle interventions have the lowest long term success rates of all available treatments for obesity. It's especially unreliable if you have weight loss targets higher than 15%.
They are of course still widely recommended due to numerous benefits other than weight loss, but "highly effective" is just wrong in the context of obesity treatments.
I seem to remember a meta analysis a decade ago or so finding that the particulars (high protein, atkins, paleo, whatever) didn't really matter so much as the the willingness and commitment to the change.
It's the same thing for the mental issues epidemic... you can't build a completely hostile environment to human life and well being and then say "welp, I guess we need drugs to make you feel normal now", now they'll sell us the drug and the cure, and you'll be clapping and thanking them for saving you, truly amazing.
You’re right we didn’t evolve since the 80s. But our food has certainly changed. It’s not like some God from above put laziness in peoples brains just now. No… people were always lazy.
It’s just that you could be accidentally skinny before. You can’t be accidentally skinny now, it has to be intentional.
Many jobs used to involve physical labour, huge number of us now are desk jockeys. Decades of prioritising motorists and increasingly large vehicles over active transport mean walking, cycling are a fraction of what they used to be [0].
[0] e.g. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2010.... , https://la.streetsblog.org/2023/04/17/exactly-how-much-less-...
Henry VIII might have a word for you on that one, as would many other of history’s aristocrats. The only thing that’s really changed is the cost of food that used to be reserved for kings.
When I lived, in my childhood, in communistic Bulgaria/Czechoslovakia, nobody was starving. Yes, we did not have bananas and Argentinian steaks, but there was enough basic food, including the protein-rich one (eggs, cheese, even meat, although the best cuts were 'under the counter'). Still, few people were really obese; those were obviously sick.
Nowadays, there is plenty of junk food. The food is not really cheap (especially with the recent inflation), even the junk one. Still, being obese is (almost) the new normal. You can see that everywhere.
Yes, people spend more time indoors - but even in the old times people tended to spend a lot of time behind TV.
My hypothesis is that the junk food just does not have enough real nutrients, just mostly empty calories. So the body signals 'I need more nutrients', to which the typical response is 'here you have more empty calories'.
The quality and type of food also completely changed, you can't ignore that.
5% of supermarket aisles are food, the rest are treats and comfort food you should have less than once a week at best
What really changed is the foodscape. And quite thoroughly so. Even basic agricultural products like wheat, corn or fruit are different from the variants 50+ years ago, there was a concerted effort to make them bigger, pesticide-resistant, more sweet, more energy-dense...
I remember the apples of the 1980s. Nowhere near as sweet as today, some were thoroughly sour. And these are considered the healthy choice now.
"The only solution is behavioural, everything else is cope."
This is like, your opinion, man. An opinion that can make you feel smug, but that is no victory. In practice, GLP-1s are doing what a generation of preachers like you could not - making people more thin and healthier.
In a sense, it is you who is coping hard and defending a "solution" which provably never worked on a population scale.
Alright, then let's continue making food worse and worse over the years, let's keep building a system that is less and less viable for humans. When we'll all be on GLP-1, + depression + ADHD drugs to just cope with days to day life maybe we'll finally wake up and ask ourselves how we ended in such a shit show.
If you really did something material to improve our food choice and food quality, I salute you. But this is rare enough for me to doubt it. Most people are content with wagging their fingers on strangers.
What? Surely changing one's behaviour - particularly the parts of behaviour that caused the obesity in the first place - is a sure way to stop being obese.
Behavioural changes work, the issue is that most people don't actually change their behaviour.
It's funny how proposing an healthy diet is unrealistic and watching fatties eat themselves to death is the new normal, complete value inversion and looser mentality
It's just that you should probably suggest other treatments in addition to the lifestyle changes that have relatively low long term efficacy.
Of course, that assumes your goal is to actually help the fatties instead of judging them.
I don't believe that's possible. They have to choose a healthier lifestyle by themselves.
It's not that people are fat because no one told them to eat healthy and exercise sometimes. They're fat because they have ignored that advice for a long time.
They aren't missing information about diet and exercise, they're missing diet and exercise.
I wonder what changed in between? Maybe our food and our relation to it? Who knows right?
You believe incorrectly.
> They're fat because they have ignored that advice for a long time.
Ah yes, the medical equivalent of "works on my machine".
You've now shifted from "how effective is this treatment" to "whose fault is it when the treatment doesn't work".
You will be able to help the fatties when you shift back into asking the question that matters.
But you are right with the fact that at the end, it mostly doesn't work. But those who stick with regime, it works 100% and positive changes in life, quality, happiness etc are massive.
The real solution - treat underlying mental issues. They are always there with obese people, they are massive (no pun intended), and they manifest as obesity, among plethora of other mental issues.
perhaps you can elaborate on how systemic death spirals are funny?
Running a marathon a month is a sure way to improve your health. However, less than 1% of people would be willing to do that. So it’s not an effective solution.
It’s an effective solution if we just ignore life, sure. But solutions are rooted in pragmatism.
If you change your lifestyle temporarily, the effects are temporary.
If you change your lifestyle permanently, the effects are permanent.
Not quite.
If the lifestyle deteriorates, then weight regain is expected. However, people might regain only a fraction of the weight lost. It is possible for some of the weight loss to be permanent.
Also, even temporary changes in lifestyle can produce benefits that outlast the intervention, like lower risk of disease such as diabetes. Exercise is notable for providing numerous benefits that persist even if weight is completely unmodified.
> If you change your lifestyle permanently, the effects are permanent.
No. It improves your odds of success, but does not guarantee it.
Body adapts significantly over time when subjected to weight loss. There are compensatory physiological adaptations that favor weight regain, such as changes in energy expenditure and appetite. Even with sustained effort, maintaining the initial weight loss may become progressively more difficult because of those changes. This shows up in research as results like mean weight loss of ~9% at year 1 and ~5% at year 8.
For the love of god or any other deity I can't grasp this, its trivial for me to muster a tiny fraction of discipline and simply change direction from now on. But people out there are vastly different than me, thats pretty obvious, ie many people detest sports or even sweating. Addictions, and over-eating is an addiction (or some form of stress-coping mechanism) have a way to grasp core of one's existence and not let go.
My wife sees such overweight folks with not-so-much-time-remaining-on-earth as GP regularly. As she says - they basically over-ate themselves into mental disorder (or started with it and their body over time aligned with behavior). To actually fix this, that mental disorder needs to be tackled, no gastric operations or wegovy injections provide permanent solution. But they sure make pharma companies richer and give this warm fuzzy feeling of achieving actually something visible, even if temporary.
If you opt for it, then yes of course, abstinence-only sex education is a sure way to stop ten pregnancy.
Similarly, if you opt to change your lifestyle and start living healthier, and follow through, it will work.
If someone tries to force you, of course it will fail (in both of these cases). There is no way to stop someone else from being fat. We can only change ourselves.
Being fit and maintaining the normal weight is not the same thing as reaching a BMI of 50 kg/m² then losing it. I've seen fitness influencers take up that challenge only to find that "changing oneself" is significantly harder than it used to be when they were fit.