Item — HN Reader

Lifestyle changes are essentially standard medical advice. There is nothing wrong with proposing diet and exercise.

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.

1 comments

> Of course, that assumes your goal is to actually help the fatties

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.

You don't believe it's possible? Obviously it's possible! Look around, we have what are essentially miracle drugs available, and you are still pushing ideas that have mostly failed for the last 50 years!

Failed for the past 50 years but worked for the last 300 000 years

I wonder what changed in between? Maybe our food and our relation to it? Who knows right?

Something in the environment changed for sure. There are many theories. Some of them include the rise of ultra-palatable foods, the rise of plasticisers in the environment fucking with our hormones, the greater exposure to lithium, the rise of the "low fat" has in the 70s, and probably others.

> I don't believe that's possible.

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.

Well, the proposed solution works basically 100%, the problem is, as with most issues, people. Tell folks they should not eat sweet things for rest of their lives and half go catatonic when they realize reality of it. The other half go medicating such induced stress with a bucket of ice cream or similar. This is not problem of underlying solution per se, its the problem of expecting too much out of most people.

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.

> But those who stick with regime, it works 100%

No. Even nearly a decade of intensive behavioral treatment has highly variable results.

Here's what the numbers tend to look like in practice:

  ~26% weighed more than at baseline
  ~23% lost >0% to <5%
  ~23% lost 5% to <10%
  ~16% lost 10% to <15%
  ~11% lost ≥15%

As you can see, results cannot be guaranteed.

> positive changes in life, quality, happiness etc are massive

This is generally true. Eating better and exercising will improve your life.

But will you lose weight? How much weight? Those are far more difficult questions.

Then they didn't stick to it, simple as that. Eat less than you burn = lose weight. Unless they broke physics, in which case we should put them in a sterile room and study them

> we should put them in a sterile room and study them

We have.

https://news.ycombinator.com/item?id=49319339

> 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.

Frankly, a "solution" to a human problem that does not work with most humans, does not deserve to be called a solution.

Mental issues is a broad category as well. Are food cravings a "mental issue", or a "physiological/hormonal issue"? No clear difference between those two, and given how GLP-1s quench cravings in general - not just food cravings, plenty of people on those report losing their compulsive behaviors, even such as gambling or shopping - the hormonal variant sounds quite plausible.

Which may be actually good. We are a lot better in treating hormonal issues than mental issues.