The science of obesity was derailed by one experiment
September 13, 2021 11:10 AM   Subscribe

"We argue that the reason so little progress has been made against obesity and type 2 diabetes is because the field has been laboring, quite literally, in the sense intended by philosopher of science Thomas Kuhn, under the wrong paradigm. This energy-in-energy-out conception of weight regulation, we argue, is fatally, tragically flawed: Obesity is not an energy balance disorder, but a hormonal or constitutional disorder, a dysregulation of fat storage and metabolism, a disorder of fuel-partitioning."
posted by rednikki (88 comments total) 73 users marked this as a favorite
 
A subject near and dear to my heart. Thank you for sharing. It's time, once and for all, to put the CICO stuff to rest.
posted by drstrangelove at 11:20 AM on September 13 [5 favorites]


Even more than normally I sure hope people read the article before commenting here. The first link is an accessible editorial, the second is a scientific paper.

I've been following Taubes' writing on the topic for 14 years now, since reading Good Calories, Bad Calories. I appreciate his clear, journalistic efforts to shed light on what is a scientific discussion. I'm impressed he is now co-authoring a paper in a medical journal, working with nutritional experts. I don't honestly know what the answer for obesity is but I do know the "just eat less" dogma both doesn't work and is actively harmful. It's about time to see some change on that and Taubes has been doing the careful work for years to make it happen.

I like the scientific paper's framing that there are two competing models for obesity that can be evaluated.
posted by Nelson at 11:27 AM on September 13 [17 favorites]


One of my old medical school professors (who has a DMD and a PhD in biochemistry and specializes in nutrition) posted this article on his Facebook page where he posts information and answers questions on nutrition from an evidence-based perspective. He knows what he is talking about and has this to say: "An evolving "new" model of obesity...the effect of too much sugar, too much fat, too much highly processed foods on causing obesity...unproven model, as yet, but very interesting to explore. Stay tuned for research on this..."
posted by TedW at 11:30 AM on September 13 [1 favorite]


I am far from qualified to judge the scientific debate, but the good news is that experts on both sides come to basically the same conclusion: "we should cut refined carbs."

(And previously.)
posted by Mr.Know-it-some at 11:32 AM on September 13 [4 favorites]


"we should cut refined carbs."

The full quote ends with "how", whew, Jan 6, BLM and all the good protests, fire in the streets..... all those got nuth'n when they (try to) take away Diet COKE.
posted by sammyo at 11:36 AM on September 13 [3 favorites]




By advocating that we eat fat-rich foods, they were considered dangerous.

I thought the general medical establishment considered Atkins et al a quack because eating fat-rich foods causes actual health problems, like heart disease, and not quality of life issues, like weight gain, which are poor indicators of overall health.

Also because it seems like Atkins has been around for 20 years, but the idea of the diet hasn't put obesity on a downward swing, meaning it's as unsustainable as any other diet.
posted by The_Vegetables at 11:38 AM on September 13 [15 favorites]


Also personally, I think the author keeps asking questions with possible obvious answers [even if the answers are wrong or incomplete] as though they are deep, and wish he had cut all that out of the article, and maybe started with his conclusion, and then given the history.
posted by The_Vegetables at 11:42 AM on September 13 [1 favorite]


The problem here is that time and time again, studies such as this one have shown that both a strictly calorie controlled low-calorie high-carbohydrate diet and a low-calorie low-carbohydrate diet will result in a roughly equivalent weight and fat loss across the study's population, even though it's clear at this point (and was not so a few decades ago) that the low-carbohydrate diet can and will yield positive changes with fasting blood insulin.

As far as I am aware, there are no human studies in which a strictly-controlled low calorie diet has nonetheless resulted in observable weight gain in any population. The mechanisms of the effects of caloric deprivation are very well studied and largely consistent.

Is CICO the only contributing factor to weight gain? Very likely not, and mechanisms to explain why some have so much more trouble controlling their weight than others in a similar food availability environment is important. But variance in caloric intake has pretty indisputably been found to be causal in weight loss and gain overall, and it's bizarre to try and fully discount it as a mechanism as this article does. A "but maybe this other factor causes a significant variance despite CICO" would be a much more reasonable tack to take.
posted by I EAT TAPAS at 11:55 AM on September 13 [29 favorites]


Part of what I appreciate about Taubes article (and the journal article) is that they're not trying to make some simplistic "it's only this and nothing else" argument. The main point is to challenge the orthodoxy that CICO is the only explanation and others are largely dismissed.

Some of the low-carb zealots also make a simplistic "it's only this and nothing else" argument with a different "this". But Taubes is not doing that.
posted by Nelson at 12:02 PM on September 13 [11 favorites]


But variance in caloric intake has pretty indisputably been found to be causal in weight loss and gain overall, and it's bizarre to try and fully discount it as a mechanism as this article does.

I think what's particularly frustrating is that even if caloric intake were the sole cause of obesity, we still have no idea what to do about it. For all our received wisdom about how to deal with obesity, literally none of it covers the basic question, Why am I eating this particular food, in this particular quantity, in the first place? Why am I hungry, when I'm not really hungry? Why am I snacky? What is this urge, why do I feel it, and why is it so decoupled from what my body actually requires?

While I've got problems with Taubes (meat is bad! the solution can't be more meat!), I think the focus on insulin, ghrelin and other hormones (whether we're talking about low-carb, or fasting, or other non-calorie-counting methods) is interesting, because it's an attempt to get at that question. Among the many reasons diets fail, is that they're trying to make a conscious behavior out of something that happens far before conscious thought. It seems like our interventions should take place on that level. So I appreciate what he's doing here.
posted by mittens at 12:17 PM on September 13 [40 favorites]


Hey, and, per my therapist, carbs do improve your mood, and so carb snacking can be self-medicating in a literal sense. Making it worse is that many antidepressants cause weight gain. You're damned either way.

It's definitely something I've observed in myself, and has almost nothing to do with hunger.

If we can treat mental health as a matter of chemical and hormonal imbalances, why can't fat and appetite regulation be the same?
posted by emjaybee at 12:27 PM on September 13 [22 favorites]


From the second article:"The very notion of palatability seems to lack an operational definition beyond “fast foods,” foods high in “fat, sugar, and salt,” or “ultra-processed” foods" Yep, the under-operationalized or possibly un-operationalizeable nature of palatability definitely accounts for a large proportion of the comments on the "Ultra-Processed Foods" post.

I EAT TAPAS and other/future CICO apologists: the problem with CICO isn't that it doesn't adequately describe the world based on observed data. The problem is that it makes predictions about how to cause changes in the world that, statistically speaking, do not work: to wit, permanent weight loss (or weight gain prevention) in large sedentary mammals in a "cafeteria" setting. Geocentric astronomy and Euclidean geometry both describe the world based on a certain set of observations, and work 100% of the time in limited contexts: simple maritime navigation, seasonal cycle timing, travel at non-relativistic speeds, etc. In a limited context, it's totally fair to assume that my body is just a sentient bomb calorimeter. But for a variety of reasons, the problem I (and most people who are willing to read research with the phrase "obesity pandemic" in it) want to solve is one that CICO hand-waves away with underdetermined variables like "palatability." When most people start wanting or needing to travel at near-light speeds, it's time to stop insisting that the most reasonable tack to take is "but maybe gravitational distortion causes a significant variance despite the basic truth of Euclidean geometry at all scales of time and space."
posted by All hands bury the dead at 12:29 PM on September 13 [26 favorites]


To me, the most interesting data point is strength athletes who compete in sports with weight classes. They use diet and exercise to control their weight (both up and down) with impressive precision. This sets a boundary that, at very least, it's *possible* to do that. Some of the most dismissive takes on "diets don't work" are ignoring the experience of this subset of people for whom they work very effectively - which makes the question why these people and not others? Is it entirely psychological?
posted by allegedly at 12:40 PM on September 13 [6 favorites]


Just last week, I came across an ongoing blog series, "A Chemical Hunger," summarizing research about the increase in obesity since about 1980. It looks at both CICO and the carbohydrate-insulin model in part II.

Stephan Guyenet addressed some of the issues with the carbohydrate-insulin model (CIM) a few years ago in a response to an earlier article by two of the authors of this study. His main point seems to be that "In fact, our choice of models is not between the CIM and the Conventional Model." I think Guyenet would agree with Taubes' statement that "Obesity is not an energy balance disorder, but a hormonal or constitutional disorder, a dysregulation of fat storage and metabolism," but I'm not sure the CIM is a complete answer, either.

It's a difficult question, and answers are hard to find because so much nutritional research is based on food frequency questionnaires, which provide pretty low quality data. I took one once, and was pretty much just guessing at my answers. How well can anyone* accurately recall how much of a particular food they ate on a weekly basis over the past 6 months or year?


*Except my neighbor Liz, who has kept a spreadsheet of her daily macros for years. I'd trust her responses on a food frequency questionnaire.
posted by fogovonslack at 12:41 PM on September 13 [8 favorites]


Like the proverbial stopped clock, Taubes may be right on CICO. However, he is famous for misquoting people and misrepresenting research either inadvertently or on purpose (though there is someone who went through the footnotes in one of his books and discovered that they did not match his statements). Several of the scientists in his infamous NYT "Big Fat Lie" article said he completely misrepresented what they told him. Here neuroscientist Stephan Guyenet reviews Taubes The Case Against Sugar. Taubes has managed to make a lot of money and a big name for himself, but he is not a reliable source on nutrition.
posted by FencingGal at 12:47 PM on September 13 [32 favorites]


The problem here is that time and time again, studies such as this one have shown that both a strictly calorie controlled low-calorie high-carbohydrate diet and a low-calorie low-carbohydrate diet will result in a roughly equivalent weight and fat loss across the study's population, even though it's clear at this point (and was not so a few decades ago) that the low-carbohydrate diet can and will yield positive changes with fasting blood insulin.

Yes — in 12-week studies. 3 months. Short term. The changes caused by lowering insulin are hypothesized to have effects in the longer term — specifically regarding metabolic adaptation to lowering calorie intake.

In simpler terms, you can lose weight by restricting calories, but it is extremely hard to keep it off. Over time, your body will reduce its metabolism to compensate for your lowered intake.

Or as TFA states (second link, under heading “Clinical and Public Health Translation”):

Calorie restriction for obesity treatment results in weight loss—initially—giving patients the impression they have conscious control over their body weight. But predictable biological responses oppose weight loss, including decreased metabolic rate and elevated hunger. Therefore, ongoing weight loss requires progressively more severe calorie restriction, even as hunger increases. Few people achieve clinically significant weight loss over the long term with this approach.

Reducing insulin is hypothesized to mean your metabolism stays higher. In other words, “calories out” is not independent of “calories in”. There is a “set point” weight. The hypothesis is that reducing insulin reduces the “set point”, and increasing insulin increases the “set point.”

It certainly seems a hypothesis worth testing rigorously.
posted by snowmentality at 12:58 PM on September 13 [19 favorites]


How well can anyone* accurately recall how much of a particular food they ate on a weekly basis over the past 6 months or year?


I can't speak to the quality of survey data, but I've had a great deal of success using the MyFitnessPal app and website. It's quite easy to track pretty much everything you eat on a daily basis, especially if you tend to eat a lot of the same foods frequently. (The hardest part is when you eat at a restaurant where you don't know exactly what or how much is in a given dish, but even then you can usually get in the right ballpark.)

This is my own personal experience, so nothing scientific about it, but FWIW: CICO has been critical for my own weight control. If I stay below a certain number of calories per day for a week or more, I WILL lose weight.

I'm a middle-aged male of average height in a professional field with very little physical activity involved. I went from 275 lbs to 175 lbs in a year simply by using the MyFitnessPal app to track my total calories, making sure not to exceed my daily calorie cap. More importantly, I have kept off that weight for four years now. I'm still under 175 to this day.

I will say this: By eating a high protein, low-carb diet, I found it much easier to limit my caloric intake, since the former tend to make me feeler fuller for a longer period of time.

Even if you don't use something like MyFitnessPal to limit your caloric intake, I highly recommend using it for a while. Among other things, it helps you identify which foods are really dense in calories, and which foods can make you feel full with fewer calories.

It also helps to know how many calories you tend to eat in a given day/week. Before I started tracking it, I'm sure I was eating more than 3000 cal/day regularly. I had no idea. I didn't even know how many calories I was supposed to be eating (less than 2200 cal/day, for someone of my size/age/activity level).

If I was king, we'd teach kids how to pay attention to these kinds of things at a young age. How many kids know how many calories they're eating, how many they're supposed to eat, or what foods have the most/fewest calories per serving/gram/whatever? Very few, I imagine.

PS: I have no professional/business/monetary connection to MyFitnessPal. I don't even pay for it; I just use the free version.
posted by mikeand1 at 1:05 PM on September 13 [20 favorites]


If I was king, we'd teach kids how to pay attention to these kinds of things at a young age. How many kids know how many calories they're eating, how many they're supposed to eat, or what foods have the most/fewest calories per serving/gram/whatever? Very few, I imagine.
posted by mikeand1 at 1:05 PM on September 13

mikeand1, That's a nice thought but digging a little deeper I think you'd see that you'd need to change the whole discourse around weight, and what is and isn't bad, and eliminate fat-shaming (especially within families) altogether before we could hand kids the ability to calorie count in primary school. Or at least, do some napkin calculations on harm reduction for the kids who would start eating better vs the harm potential for those kids already primed at a young age for eating disorders. Would the amount of obesity reduction in the long term for the healthier kids (on balance) be greater than the harm incurred by the kids who die or suffer long term effects from disordered eating because they learned the tools in school instead of sketchy internet sites or forums?
posted by sharp pointy objects at 1:16 PM on September 13 [35 favorites]


The argument here seems to be pretty easy to test, since it boils down to carbohydrate restriction as the pathway to weight loss. In fact, this has been tested by many through keto and other low-carb diets. From my understanding of the current state of the science, all kinds of different diets all seem to be about equally effective for weight loss and maintenance. I think if keto, Atkins, etc were hugely more effective than other diets, we would know by now. To me, since most diets are roughly equally effective, it makes sense that the common factor they share — caloric restriction — is what is causing weight loss.

Looking at this paper, I'm having a bit of a hard time following and crediting their argument. The claims made in the abstract don't really seem to be significantly argued in the paper itself (especially the claim that "increasing fat deposition in the body [..] drives positive energy balance"). And I think they are misrepresenting and omitting a lot of the science on energy balance and palatability in order to knock it down.

Fundamentally, I don't think many would disagree that sugars and highly refined carbohydrates are a significant problem and a significant factor in the increase in obesity. Everyone agrees we should eat less of them!
posted by ssg at 1:20 PM on September 13 [3 favorites]


To be clear, I'm not for or against the proposal either way, but I'd rather start with intensive classes for all elementary age children teaching basic food and cooking safety and nutrition. You can make yourself a healthy snack, even in second grade (assuming your household has the goods), and carrots and broccoli don't have to taste awful, here's like a half dozen ways to cook them, which ones do you like?
posted by sharp pointy objects at 1:20 PM on September 13 [1 favorite]


....not to mention that your ghrelin release in response to the same fucking food can differ depending on your expectations about the food itself. (In this case, milkshake labeled diet vs milkshake labeled "indulgent".)

One of the thing that drives me nuts, having done some work with leptin, is that people treat fat like a big old sack of inert glorp. It is not. Fat--both brown and white fat--is an endocrine organ in its own right which releases signals that then go on to interact with other signals in your brain. Fat is dynamic, and it communicates with the rest of your body in order to define and respond to resource allocation. Those decisions, including how much in the way of adipose tissue to retain and store, are made on a level that has very little to do with "calories in" or out--after all, one of the changes those decisions make has to do with motivation to seek out calories!

There is a fuck ton of endocrine activity with respect to energy balance that is very sensitive to a lot of factors which have fuck all to do with "CICO." Long term glucocorticoid overactivity--that is, chronic low-grade stress--is an actual mouse model of obesity! There is so little long-term evidence for CICO in terms of long term energy balance that it borders on fucking phrenology at this point.

I am not going to get into obesity research arguing that the obesity epidemic is in fact a chronic stress epidemic. I am not going to get into obesity research. I am not going to get into obesity research....
posted by sciatrix at 1:30 PM on September 13 [96 favorites]


But predictable biological responses oppose weight loss, including decreased metabolic rate...

Change in metabolic rate is indeed predictable in both weight loss and weight gain scenarios due to the simple reduction (or increase) in both lean and fat body mass necessitating fewer (or more) calories to maintain or change weight. Not only has it been shown that those reducing calories over time reduce their metabolic rate due to the loss of body mass, anorexia nervosa patients attempting to gain weight often find that their metabolic rate increases due to increases in body mass, and thus have to increase CI in order to continue to gain weight. This phenomenon is certainly vexing to the dieter long term as weight loss (or gain) slows even with the same levels of calorie consumption, but it's in no way an indictment of the CICO model. It's fundamental and well-studied that basal metabolic rate necessarily changes in accordance with body mass.

... and elevated hunger.

Ahh, now we're talking. Studies on hunger are almost ridiculously lacking, largely due to the inability to objectively measure levels of hunger. We can measure weight and body mass changes, but we can't actually measure hunger except based on self-report, it's largely unknown how reports between different individuals relate, and even then, there's just not a whole lot of research out there. There's far more research on satiety, which is similar but not quite the same thing; satiety after eating is a far more limited measure than hunger over time.

My personal hypothesis is that once an objective method to measure hunger is found, we'll find that the level of hunger in the obese versus those of standard weight is substantially higher even when there are similar levels of consumption commensurate to body mass. I suspect that most obese folks likely eat not because they're gluttons, but because they're rationally attempting to satisfy the signals their bodies are giving them, and ignoring those signals is naturally exhausting and painful at levels that normal weight individuals are completely unfamiliar with.

There have been good studies that show correlation between insulin levels and hunger, and I suspect there's something substantial and important that has yet to be discovered in differences in hormone and insulin levels and levels of hunger in various populations. Of particular interest is that it's being increasingly shown that the use of GLP-1 to control insulin results in very substantial weight loss - but the mechanism of that weight loss is unknown, and is increasingly being shown to have to do with reductions in hunger and increases in satiety. Importantly, that doesn't negate or change the paradigm of CICO in any way - the million dollar question is how to calibrate hunger in relationship to CICO.
posted by I EAT TAPAS at 1:31 PM on September 13 [10 favorites]


That doesn't negate or change the paradigm of CICO in any way - the million dollar question is how to calibrate hunger in relationship to CICO.

How does differential bodily responses to caloric intakes not negate a CICO model? CICO is predicated on there being some linear or static metabolic rate at which a given body converts calories to adipose tissue to energy, assuming that changing the level of calories input will change the total adipose tissue converted. But if restricting caloric intake to a certain level results in slowing a metabolic rate such that the total output of calories changes in order to slow burning of said adipose tissue, clearly restricting the number of calories is not the way to long-term loss of adiposity.

(I have no dog in the fight with respect to the researchers cited--my interests are over in the stress-and-weight-gain glucocorticoid response land, which is a different kettle of fish. But I'm extremely critical of simplistic "calories in = calories out" models, because expectations and emotional associations with food, like familiarity, appear to change our metabolic responses to those foods in unusual ways.)
posted by sciatrix at 1:39 PM on September 13 [10 favorites]


There's a strong undercurrent in the anti-CICO crowd that everyone who believes in the energy-balance model is basically saying the reason we have such high levels of obesity is simply gluttony (this is made explicit in Taubes' article). But no one is actually saying that!

Is any credible source saying that the rise in obesity over the last 50 years in rich countries is simply because their populations suddenly became more gluttonous? That's simply not what anyone is arguing. It's clear that a number of significant factors in our diets and lifestyles have changed: which combination of factors is causative is of course what everyone is trying to figure out. I think we have some pretty good ideas when it comes to ultra-processed foods, sugars and refined starches, activity levels, and so on. It would be great to see more public health measures targeting those factors.
posted by ssg at 1:40 PM on September 13 [8 favorites]


I am not going to get into obesity research arguing that the obesity epidemic is in fact a chronic stress epidemic.

But I mean if you were going to get into it, what sorts of things would you say?
posted by mittens at 1:59 PM on September 13 [21 favorites]


But if restricting caloric intake to a certain level results in slowing a metabolic rate such that the total output of calories changes in order to slow burning of said adipose tissue, clearly restricting the number of calories is not the way to long-term loss of adiposity.

Body mass has been repeatedly shown to be the primary influence on human metabolic rate. The average 150 pound body requires substantially fewer calories to maintain its weight than the average 300 pound body. While metabolism will vary depending on the level of lean mass vs fat mass and levels of physical activity, let's say for the sake of argument that the average sedentary 300 pound body requires around 2200 calories and the average sedentary 150 pound body around 1500 calories/day. While those numbers are not exact, the relation between body mass and metabolic rate is extremely well studied and we have a general understanding of the metabolic needs of different body sizes.

So, if a sedentary 300 pound person restricts calories to a set number of calories per day, let's say 1200, and loses weight to 150 pounds without increasing activity, they will find that weight loss will have slowed tremendously on a day to day basis. At 300 pounds, they have a caloric deficit of 1000 calories a day - they could lose a pound of fat, 3600 calories of energy, in three and a half days. At 150 pounds, they have a deficit of merely 300 calories a day - 12 days to lose the same pound of fat. This is the case even if there is no statistically significant impact of dieting on metabolic rate due to other factors, just the basic impact of the fundamental change in personal body mass.

That's the depressing state of things, but it doesn't in any way invalidate CICO. Is it hard to eat less long term than you're used to after you lose weight? Of course it is. But that doesn't invalidate CICO.
posted by I EAT TAPAS at 2:05 PM on September 13 [2 favorites]


Here is a study saying that when people exercise and burn calories, their bodies compensate by reducing the calories devoted to other functions afterwards, such that people with normal BMI only see a net greater expenditure that day of 72% of the calories they expended in the exercise.

But obese people compensate more, such that they see only see a net greater expenditure that day of ~50% of the calories they expended in exercise.

Which is another dimension of the phenomenon that obese people's bodies seem to be actively defending their fat. Not to mention that if your body shuts down more after exercise than other people's do, you might come to see exercise as debilitating more than other people do.
posted by jamjam at 2:16 PM on September 13 [37 favorites]


To me, the most interesting data point is strength athletes who compete in sports with weight classes. They use diet and exercise to control their weight (both up and down) with impressive precision.

You're assuming a lot about strength athletes! I knew international-level strength athletes--who granted, were on the lower end of international-level--and gaining weight was "eat a lot more, focusing on protein", while losing generally involved crash diets and/or massive dehydration to hit the scale numbers unless you were trying to drop to a lower weight class long term. In that case it was the same slog that any person dieting faces, except they got to eat a bit more than the average person of their weight/height because they had a higher muscle mass percentage and daily activity. They focused on having more protein intake than the average dieter does--but ultimately they were just trying to reduce calories overall. There wasn't any magic to it.
posted by schroedinger at 2:19 PM on September 13 [14 favorites]


I only read the article written by Taubes. I liked his analogy between CICO as an explanatory idea and explaining wealth by saying that rich people make more money than they spend. At a certain level it is obviously true, but it does not get us anywhere.

The article clearly follows the old genre of "let me reveal to you that we have been tricked, and I know how to fix it!". As I read, I could take the slow drip of anecdotes and straw-man-ish arguments, but the final plug in the article is to Virta Health, a $4K a year subscription keto diet startup. Even if he knows what side of the toast his butter is on, maybe he has something interesting to say?

An interview with the Guardian that I found more direct about his views on dieting /keto:

I have a friend I met while researching this book, who comes from a family with a history of obesity, and weighed 400lb (28st 8lb/181.4kg) at age 18. He had never walked away from a meal not still hungry until he started the ketogenic diet. He lost 130lb (59kg) in four months, and the last time I saw him, he weighed about 230lb (104.3kg). So for people who lose 150lb on the diet, get to be lean, mean, and eat to satiety – for them, it’s not too restrictive.

It's not so much that we eat too much, but that we eat the wrong things (too many carbs).
posted by haemanu at 2:24 PM on September 13 [1 favorite]


I thought Taubes had fairly well known trouble substantiating his claims.
posted by Selena777 at 2:30 PM on September 13 [9 favorites]


There's a strong undercurrent in the anti-CICO crowd that everyone who believes in the energy-balance model is basically saying the reason we have such high levels of obesity is simply gluttony (this is made explicit in Taubes' article). But no one is actually saying that!

Wait, really? Cause from a cursory glance around, you know, society and the internet especially, it seems like a LOT of people say this! a LOT of people shame and blame fat people!
posted by entropone at 2:46 PM on September 13 [44 favorites]


meat is bad! the solution can't be more meat!

I do wonder what folks will do if it turns out that actually, meat IS a solution for this particular set of issues. I'm not trying to argue that this is definitely the case, but as someone who developed a number of bizarre digestive issues and gained a lot of weight as a vegetarian/vegan, only to have it all reset when I went back to eating animal products, I have been hesitant to cast a too-jaded eye on keto/high-protein diets. The body, after all, gives zero shits about your politics or your planet. It just wants what it wants.
posted by We put our faith in Blast Hardcheese at 2:50 PM on September 13 [17 favorites]


In April 2021, my doctor asked me during a regular "wellness" check if I wanted some pamphlets about weight loss and I said no. At the time I weighed a legit 187 lbs on a 5'7" frame, which is, yes, too much.

I removed sugar and the 'licious white carbs (potatoes, flour and all breads, white rice, noodles) from my diet. I did not do any more exercise nor did I "cut down" on butter, lard, bacon, cheese, or other fatty food items.

Today, September 13, I weigh 167 lbs. This is just anecdata, but every time I take out sugar and the white carbs, the weight comes off. Sugar and ready-to-be-sugar carbs with insufficient fiber are not foods where I exhibit good control and maybe just not-eating them is the way to go for me. Some folks seem to do fine with these foods, but I am not one of those folks. *sigh*

I've heard of this "It's the carbs, dummy" thing before and I don't know if it's crank "science" or not. I do know that it's pretty easy to try and RELATIVELY safe to attempt if you think it might work for you. The only stumbling block I can see is that there is A LOT of hidden sugar in processed and off-the-shelf food. If you eat those items (and most folks eat at least some of them), you will need to read food labels to make sure you really are limiting your sugar to the 30 grams (or whatever) per day thing.
posted by which_chick at 2:52 PM on September 13 [3 favorites]


Some folks seem to do fine with these foods, but I am not one of those folks. *sigh*

It seemed like the major thrust of the article in the FPP was that nobody is studying what makes you not one of those folks, and Taubes feels that is a far more useful question to study. And I agree! For lack of true knowledge and research everyone's just doing what, so far, right now, works for them, or still trying to find that thing, often making themselves unhappier and unhealthier in the process, and the whole enterprise has a thin sheen of snake oil over it due to profiteers taking unsubstantiated claims and running with them.

It's not unlike skin care, where a small number of things actually do what they say on the tin, but we're not TOTALLY sure why, and it allows any number of unfounded/harmful things to proliferate in the gray area.
posted by We put our faith in Blast Hardcheese at 2:59 PM on September 13 [6 favorites]


Wait, really? Cause from a cursory glance around, you know, society and the internet especially, it seems like a LOT of people say this! a LOT of people shame and blame fat people!

I think you know that I was writing about people who study obesity and nutrition, not the general public. Some people are dicks about it is not a great argument against a theory.

Unfortunately, weight and diet is so incredibly fraught. It can both be true that the only way we know for an individual to lose weight is to reduce their intake or increase their output and that there are population level factors that cause weight gain that are absolutely not the fault of individuals. These are not mutually exclusive. Some jerks definitely conflate these two things and start blaming people, but that doesn't make them not true.

Many of us are in this same difficult place, where we have to reduce intake to reduce weight we consider excess, while also knowing that the factors that cause the weight gain in the first place and that make it hard to lose and keep off weight are often much larger than us and often not readily controllable by us. It sucks.
posted by ssg at 3:18 PM on September 13 [2 favorites]


I read the editorial but not the journal article. And I see the comments saying Taubes is not trustworthy.

He repeatedly mentions studies involving mutant mice that get fat even on starvation diets.

Does anyone know whether Taubes’ characterization of those studies is accurate?

And, if Taubes is not mischaracterizing those studies, how are the mutant mice getting fat even when half starved?
posted by lumpy at 3:21 PM on September 13


Gut microbiome gets one mention in the paper. Seems like that's one thing we need to know more about.
posted by achrise at 3:23 PM on September 13 [8 favorites]


But I mean if you were going to get into it, what sorts of things would you say?

dammit. dammit.

okay, if I was writing a grant proposal tomorrow, which I'm not doing because I'm already throwing myself into the deep end of a new field right now, I would start with glucocorticoid receptor distributions. one of the things people always fucking forget in endocrine work and especially neuroendocrine work is that tissue-specific endocrine signaling is largely mediated through changes in receptor distribution, not changes in whole-body or blood hormone levels. this is because a lot of hormones tend to go all kinds of places in the body pretty quickly and it is often a lot easier to change either how sensitive a given tissue is to a signal or what that tissue does in response to a signal than to change the signal itself.

glucocorticoids--and I am going to say right now that I'm not as comfortable with glucocorticoid signaling as I am my dear, understudied, totally neglected outside of obesity/satiety study leptin--are the obvious place to start because glucocorticoids are both so deeply integrated into stress response that popular journalists and scientists who know better will not stop calling the damn things "stress hormones".... and also intimately involved with metabolism, in that rising cortisol in humans is a direct trigger of gluconeogenesis and also creates increased hunger cues. This is one of the reasons that stress eating is a thing! I would probably start by looking at glucocorticoid and mineralocorticioid receptor imbalances as a result of chronic stress and point out that these changes also impact insulin and glucose signaling in the body, and then start trying to make a historic argument over the past thirty or forty years for increased income inequality, extended work schedules, and decreasing predictability and control of working times for Americans has coincided with the obesity epidemic as we understand it.

I would also almost certainly make an argument that glucocorticoids (and stressful experiences) increase mechanisms for storing calories not only because stressful situations make food difficult to locate but also because predation risk makes foraging potentially dangerous. I would probably build an experiment into that model which uses predator exposure (usually urine) as a stressor for rodent subjects as I dig into the neuroendocrinology. I would also be very explicit about pointing out how risky social stress can be for primates as a survival threat.

I would definitely want to look at direct interactions between leptin and glucocorticoids in stressful and less-stressed situations, because I'm increasingly certain that leptin is doing more than we currently think in terms of allocating resources especially in states of resource intensity, and again leptin is released directly by fat. I would want to look at places in the hypothalamus where corticosterone and leptin receptors co-express, too, in both stressed and un-stressed animals--see if I can get a sense for where these signals are being integrated and a better understanding of which circuits they interact in.

I wold also want to look at the social traumas and microaggressions associated with various foods and how neuroendocrine signaling differs based on previous experiences with food items. Expectations do seem to matter with respect to how we digest new things! And I would look at the stress levels experienced by people who are currently fat, especially people who are currently very fat, with an eye towards measuring some of the additional stressors that people who are trying to interact with food experience; I suspect this might have an amplifying effect when it comes to making weight loss even harder, especially when metabolisms start to slow down again and weight creeps back on. I would note that the extended discomfort of dieting and caloric restriction qualifies as stressful in and of itself, and I would add that social judgement is a massive risk factor for compounded trauma around food and eating in broad populations of humans.

If it was me, I would probably spin up an additional proposal looking at the cognitive effects of dieting and/or long term severe calorie restriction, because all that leptin work and metabolism work makes me suspect that when you cut metabolic function severely, brain function is one of the first things to get cut alongside. I would probably make a stern case for promoting dieting and disordered eating, especially in children, as an epidemic as bad for our collective brain function as obesity might be for our collective heart function.

and that's why I'm not doing this, because I will get totally overwhelmed by the sheer magnitude of the glucocorticoid work I need to absorb and I already need to absorb all the dopamine signaling literature I can find yesterday so I can talk sensibly about motivation, learning, and decision-making on a level of the brain above the hypothalamus. maybe. maybe next postdoc. or something.
posted by sciatrix at 3:52 PM on September 13 [87 favorites]


I was underweight most of my childhood, due to a combination of stomach problems and--legitimately--my mother's cooking being fucking terrible. I moved out and got in-laws who lived close and cooked good food and fattened up to a "healthy" BMI, which is where I stayed for nearly a decade. This despite the fact that I ALWAYS ate past the point where I was hungry, always cleared my plate, always took a little extra, because I was afraid of losing the weight again (and thinking quite logically: if I have been eating past the point of satiation and not gained weight, I must need to do this to stay at a stable weight). I did briefly lose about 10 lbs a few years ago, couldn't tell you why, but I managed to gain it back again. Otherwise, been totally stable.

Then the pandemic hit and I gained 20 lbs that I haven't been able to get off. I'm officially in an "unhealthy" BMI. It's been an extremely bizarre experience for me, as someone who was called all sorts of names for being skinny my whole life. And like, sure, correlation doesn't equal causation, but I think everything sciatrix is talking about makes total sense. There's never been anything else this fucking stressful in my life, except maybe when I moved out of my parent's house (police were involved), which is coincidentally also the time I gained a "healthy" amount of weight.

On the other hand, my partner got sick with a stomach bug that wouldn't go away for two months and lost 20 lbs in that time. They'd been overweight their whole life, tried absolutely everything to get it off, and the only thing that worked was basically not eating anything at all because they felt like throwing up all the time. And now that they've recovered? They have done literally nothing to try and keep the weight off--no exercise, no diet changes, they probably eat worse now than they did before (prior to them getting sick we were trying to stop eating fast food and cook more at home, the only visible result of which was me gaining that 20 lbs, and we've given up on that now). But the weight has stayed off.

And yes, I've noticed that I'm eating more and they're eating less. We've basically swapped places--I used to be the one who could only finish half a portion at restaurants while they'd eat the whole thing. Now it's the other way around. Why? Don't fucking know, because we aren't researching that, because behavioral science is messy and it's much easier to say "well if you just did x..." than try and understand why people aren't doing x.
posted by brook horse at 4:12 PM on September 13 [30 favorites]


To me, the most interesting data point is strength athletes who compete in sports with weight classes. They use diet and exercise to control their weight (both up and down) with impressive precision. This sets a boundary that, at very least, it's *possible* to do that. Some of the most dismissive takes on "diets don't work" are ignoring the experience of this subset of people for whom they work very effectively - which makes the question why these people and not others? Is it entirely psychological?

I am no pro athlete, or even amateur athlete, but from age 35-40 I switched between bulk and cut cycles on a roughly 4 month interval. The cut cycle was always on the ketogenic diet, and the "slow bulk" was fewer carbs than the average American (average probably 100g a day) but a lot more than a keto diet. Typical recommendation for keto is under 20g a day for carbs, and over time I found that I could interocept whether or not I was in ketosis, and the cutoff was around 40g day for my body (there is a noticeable difference in "brain fog" and my body will snap change from wanting 8 hours of sleep down to 6).

The modulation in appetite is fascinating - on the rare occasions where I'd run down to around 10g of carbs a day, I would come very close to losing my appetite fully (as in repulsed by food), and would have to add carbs back in just to meet what I considered bare minimum intake. It modulated with body fat as well - once I'd get down (guessing) to about 12% body fat, my appetite would start ramping up a bit, so given the full state of my person at that time (diet, the various bio-psycho-social factors in my life, gut biome stuff we haven't figured out yet, etc), that seems to be about as low as my body wanted to go.

When on a non-keto diet, my appetite was largely moderated by how much carbs I was taking in, and did not seem to be linked to body fat percentage. Back when I was 20 I was borderline obese; I lost 40 lbs on a low fat diet. I felt desperately hungry most of the time, but my desire to lose the weight won out over my body's desperate plea for more calories. On keto, the weight just kind of comes off with no internal drama.

I find the dismissal of low carb diets due to the lack of positive long term outcomes to be unfortunate, because I think we have to take into account the food environment we find ourselves in, which is somewhat static. Carbs are powerful mood modulators, and not only are sugar and processed carbs everywhere, you have to put in active work to avoid them. It's not a coincidence that my weight right now is at the highest it has been in probably 10 years - I'm still a bit of a mess from the pandemic, and have failed to get back on keto twice now, which has never happened to me before. We have zero-friction access to unlimited junk food and it just melts the stress away, unfortunately.
posted by MillMan at 4:21 PM on September 13 [7 favorites]


My mom was talking about "empty calories" (i.e., sugar and refined white flour) as stuff to be avoided way back in the '80s. I assume that wisdom was learned from her own mother, who worked as a hospital nutritionist in like the early 1940s.
posted by heatherlogan at 5:22 PM on September 13 [2 favorites]


To me, the most interesting data point is strength athletes who compete in sports with weight classes. They use diet and exercise to control their weight (both up and down) with impressive precision.

People who are competing at anything have already self-selected to be good at that thing. If you can't control your weight with precision, you're gonna get out of competitive lifting. Also, sports that depend on one's weight are notorious for disordered and unhealthy eating.
posted by Mavri at 5:59 PM on September 13 [24 favorites]


Gut microbiome gets one mention in the paper. Seems like that's one thing we need to know more about.

That and the effects that plastics and estrogen-like chemicals have on the body, which we are absorbing all the time and have never had available to absorb before in history. It may well be that we, and our pets, and other animals are getting fatter because of these substances.
posted by hippybear at 7:14 PM on September 13 [6 favorites]


Also, sports that depend on one's weight are notorious for disordered and unhealthy eating.

I had a friend in high school who wrestled; I recall he'd wrap himself up in garbage bags and go running to sweat out a last pound or two before weigh-in. God knows what kind of purgatives the team members did; I don't want to.
posted by thelonius at 4:46 AM on September 14 [2 favorites]


The article makes a point that I had never thought about: we literally breed animals to accumulate / not accumulate fat, and to store fat in different ways. That alone should be enough to show that metabolic balance and fat accumulation are more complicated than CICO.
posted by Joe in Australia at 5:33 AM on September 14 [11 favorites]


I would probably make a stern case for promoting dieting and disordered eating, especially in children, as an epidemic as bad for our collective brain function as obesity might be for our collective heart function.

While I'm in no way qualified to comment on the science, I do have thousands of years of experience being anxious about things, which is why my ears perk up any time I hear "stress" and "obesity" in the same sentence. (Coming soon, my NYT Bestseller, "The Ativan Diet.") There are so many similarities in the experience of having anxiety and having hunger--or their pathological, overextended counterparts, that it's difficult to stop noting them, once you're on that line of thinking.

One such similarity is the way the natural feeling--anxiety or hunger--can hide away in the background, while the behavior that seeks to ameliorate the feeling continues. I'm thinking now specifically of compulsive behaviors that aren't strictly happening during an emotional period. Plucking hairs, for example, or fingertip-scanning the face for imperfections to remove, that nit-picking instinct that ramps up during anxiety, can keep going even when a person doesn't consciously note any anxiety, and that sort of shadow-anxiety at least seems a lot like the shadow-hunger that pushes one to eat even reasonably soon after a meal. We're acting as though we're feeling an emotion that we're not actually aware of feeling at that moment.

There's also a...I don't know how to put this, a similarity of narrative, between how it feels to be blocked from an anxiety coping strategy, and how it feels to be blocked from food. If you were a writer you'd chart it out on your whiteboard, a rising line of suspense, of tension, reaching a breaking point at the climax. Something builds up and up and has to be released. If it's not released--if you can't scratch the itch, if you can't eat the chip--the build-up doesn't continue forever, but like a bad movie that overstays its welcome, a sort of mental dullness sets in; it feels like the brain, having been unable to use its strategies to treat the painful emotion, shuts down as much sensation as possible.

And then there's the experience of dieting. You see it on every thread here, it always seems to go one of two ways--"well, there goes another thing that doesn't work" versus an almost religious evangelism, "I read this book, followed this plan, lost this weight"--another way of saying, "I had control of this uncontrollable thing." That's an experience people who panic, people who live in a constant state of worry, are very familiar with, at least familiar by its frequent absence, and I cannot understate the strange pleasure of having that control, when you can, in fact, have it. To deny the body feels...how does it feel? It would be wrong, or at least incomplete, to say it feels good. If it felt good, we'd do it all the time. But it feels something like "good." It feels like grasping a power that has been denied to you. Whether you're obsessively tracking with MyFitnessPal as mentioned above, or writing down every calorie in a notebook you've bought for the occasion, or carefully discerning the carb count of your food, you're controlling something in your environment as an extension of controlling yourself, controlling your experience. My own recent experience with fasting (courtesy of a comment on one of the prior threads here) has been illuminating--setting aside whether it "works," that's not the part that concerns me in this comment, what concerns me is the way it feels. It's immediately obvious how someone could chase this feeling to an unhealthy degree. It slips through the fingers, it's hard to get back--part of the nature of an addictive feeling, I guess, is the combination of its power and its elusiveness.

If I can go too far afield for one last comment, and be vague and handwavy: It's my belief that the core problem is one of attention. That what we are suffering from is a lack of the filters our minds would normally use on the havoc of competing signals from our bodies. Everything is important, every signal is amplified, and we can't stop paying attention to all of it. The little worry at the back of my mind--the equivalent of a sleeping dog raising one ear to see if there's a sound--should in the natural course of things settle itself back down. "Is there danger?" it asks, and normally something would say, "No," but instead, the awareness that there might be danger is activated. It can't settle, because I'm paying attention to it. The little roving signal in my body that asks, "Am I hungry? Am I hungry now? What about now?" would normally receive a frequent stream of gentle answers: "No, not now. Not right this second, no." But the attention focuses on it, and makes the very asking of the question into its answer. I think everyone's mind contains a thousand of these little questions, these little parts whose sole purpose is to bring to possible attention the subject of their question, and the disorder comes in when you can't filter them out. I think this is true whether it comes from a history of trauma--a real need to be constantly vigilant in a dangerous environment--or from an environment that refuses to let itself be ignored. I would go so far as to say that this environment isn't only the more obvious worrisome things like job insecurity, income inequality, precarity, culture wars, but that we have entered an era where even the thing we choose to soothe ourselves is anxiety-provoking: The hyperpalatability of food, the careful color choices of packaging, the intensity of marketing--the overwhelming number of choices, the interlocking concerns of whether a food is healthy, tasty, moral, socially approved: I am saying, finally, that the natural filters we've evolved over time, our ability to make discernments and listen appropriately to ourselves, to answer "no" to the little questions, have been abused out of us, and that our experience of the modern food industry is so overstimulating, so overimportant, that it is being read in the mind as danger, as trauma, in a self-reinforcing spiral where the thing that harms us is the only thing that makes the harm feel better.
posted by mittens at 5:39 AM on September 14 [36 favorites]


Hell, look at fat-tail sheep--we can very specifically breed animals not only for different levels of fat accumulation, we can breed them to specifically deposit fats in different fat pads--fat tail sheep breeds include both sheep breeds that deposit large amounts of fat into their tails and breeds that deposit large amounts of fat into the hindquarters while totally bypassing the tail.
posted by sciatrix at 5:39 AM on September 14 [6 favorites]


The human body is a complicated system. When you're looking at a given effect, it's important to consider how large any given effect is.

That's a big factor in "broscience" where they often take legitimate research and massively overstate its importance. So there's genuine research that shows protein is absorbed better after exercise... but it's a small effect and has at least a couple of hours window. Broscientists who insist on keeping a huge protein shake next to the bench and chugging it the moment they drop the weights on their last set are going a bit far.

Low carb diets have been around for a while. The first popular one was from 1864 and they've drifted in and out of fashion ever since.

If these effects are both real and significant, they're easy to prove. Put two groups in a food lab, one on a low-carb diet, one with the same calories but more carbs. Show that the low carb group lose more weight than a calorie deficit would suggest. Collect Nobel Prize, obesity crisis solved.

The trouble is, whenever scientists do that, the low-carb group lose/gain exactly as much weight as the calorie balance would suggest.

That suggests these effects are either not real, or so small you can't detect them experimentally. Some people swear by low carb, by all means try it out and see if it works for you. But it doesn't seem like low carb diets are a silver bullet for weight loss across the whole population.
posted by TheophileEscargot at 5:42 AM on September 14 [5 favorites]


strength athletes who compete in sports with weight classes. They use diet and exercise to control their weight (both up and down) with impressive precision. This sets a boundary that, at very least, it's *possible* to do that. Some of the most dismissive takes on "diets don't work" are ignoring the experience of this subset of people for whom they work very effectively

Those people need to be under a certain weight for a few hours surrounding their weigh-in. There are no lessons there for people who are trying to be under a certain weight for decades or years.

Or rather, if they *did* have useful lessons, what you'd see is those athletes losing weight for their very first weigh-in, after which they would never ever have to do that again because their diet was effective at keeping them under their chosen weight.
posted by GCU Sweet and Full of Grace at 6:05 AM on September 14 [11 favorites]


I think a lot of people tolerate low carb better than they tolerate low fat or low calorie, but none of that is the same thing as having a generally reliable method of losing fat.
posted by Nancy Lebovitz at 6:22 AM on September 14 [3 favorites]


Even before I got to the end of the article I started feeling like I was being pitch and then poof there is the sell at the end.

I too wish I knew enough to access and understand the mouse studies referenced in the article. Cause it sure seems like "200 mpg carberator" woo the way it was presented.

One of the few reasons I'd like to live to 200 is to see us actually understand this issue. We seem to be still stuck at a 1950s "In the future there will be universal cure for cancer" stage of interaction with obesity. We know that there won't be a cure for "cancer" because cancer isn't one monolithic condition that would respond to a monolithic treatment. Seems obvious that the reason for people being overweight is also multifaceted and that treatment will be just as multifaceted once we actually start developing treatments that don't amount to just eat less you loser.
posted by Mitheral at 6:57 AM on September 14 [5 favorites]


Vista Health is way over priced. Buuuuut.. it’s aimed at type 2 diabetics. I know someone who achieved the same results they promised on his own. It took a complete change in diet and lifestyle and is basically a part-time job. If I were type 2 I would consider using them.
posted by bq at 7:59 AM on September 14


Those people need to be under a certain weight for a few hours surrounding their weigh-in. There are no lessons there for people who are trying to be under a certain weight for decades or years.

I sure this comment is being made in ignorance by someone who hasn't competed in strength sports because there is a tiny little element of truth here but it's almost completely and totally wrong.

I'm a powerlifter. Not a very good one, but I competed (once so far) and have an official total. I also used to be obese and unhealthy. I've lost 80lbs and while I can't yet see my abs I've got some pretty solid "dad bod" and I'm in really good health.

Making weight for weigh-ins is really just about manipulating the amount of water in your body. The stuff you're doing the couple of days leading up to a meet related to your weight are all about water because you have to make weight at a minimum of two-hours before you weigh in (in USAPL, USPA has a 24-hour weigh-in window). A lifter in the 83kg weight class (which is the class I competed in) is probably only going to be 5-10lbs over that the night before weigh-ins (at least for USAPL which has a two-hour weigh in window vs. USPA's 24 hour weigh ins). So usually what you see is "an 83kg lifter" walking around most of the time at about 85kg or a bit higher. They work to maintain about that weight most of the time and then when they get closer to the competition they'll manipulate their diet to get a bit closer so they can be in the range where manipulating the water content of their body will let them make weight.

The work to get to that point is where the real work and the real expertise come in. All else being equal, a person with more muscle mass can move more weight. Since we can't really change the mass of our bones and organs, we pretty much just worry about muscle and fat. Since fat doesn't move weight I want to minimize fat and be as lean as possible. But, unlike a bodybuilder, I actually need maximal performance out of my body on meet day (a body builder on stage is the weakest they've been in months). It turns out that about 12-15% bodyfat is about as lean as you want to get for men and about 15-20% for women.

But you can't easily change your height. Like most sports, at the elite level, the rules of the sport basically select for the idea body type. The height of the top lifter in each weight class scales with uncanny precision. If you have two athletes weighing exactly the same 83kg but one is a lot taller, the differences in the leverages at the various joints used will mean the taller person doesn't lift as much. So that lifter needs to move up into a higher weight class. There are various strategies for accomplishing that. Some folks will eat as much as they can in an attempt to gain a bunch of both muscle and fat and then they'll work to lose fat while keeping the muscle (much like a body builder which makes sense since hypertrophy, or muscle growth, is the goal in both cases) while some will try to stay about the same level of leanness while gaining mostly muscle and just enough fat to stay at the same bf% or something between those two extremes. Either way it takes TONS of work over a long time.

Plenty of lifters also get really big and later decide, for various reasons, to drop down a class. That usually means restricting calories while trying to maintain their current strength level as much as possible. If you're already lean that will necessarily mean losing some muscle mass too but hopefully you end up more competitive at the lower weight class.

Because training for this sport requires a lot of stimulus/recovery cycles in a more...distilled way than a lot of other sports for which strength is just one component, managing nutrition is VERY important regardless. If you don't get enough protein, you're not going to get stronger and you're probably going to beat yourself up and 'cause an injury. Most elite athletes will also track their carb and fat intake. One of the top female lifters in the USAPL uses an insulin monitor just to track insulin levels and use that info to inform what she's going to eat and when.

I had a conversation very similar to this article just yesterday as she was venting a bit about her lack of progress in losing weight. What I told her is that it really is just CICO the problem is that everyone looks at the calories listed on the nutrition label and thinks that's an accurate representation of the "Calories in" piece. It isn't.

You can track the calories that you ingest but there are TONS of variables that influence how your body will process those calories most of which are not well understood or even discovered. So really I think of it as Calories in (your mouth), calories in (your body which you can't meaningfully track), calories out (which you can't meaningfully track).

My take-away from reading all the various diet and nutrition studies is that there are a handful of strategies that seem to work okay for different people so the trick is to try stuff until you work out something that will work and be sustainable for you and stick with that as long as it keeps working. If and when it stops working, try other stuff until something starts working again.

Unsurprisingly, this is also what most successful powerlifters do on both the diet and strength training end of thing.

Diet, nutrition, and controlling weight and body composition are all extremely important to strength athletes. It gets emphasized over and over and over again that strength gains do NOT occur in the weight room, the weight room is where you provide the stimulus for strength gains. The gains themselves happen as a result of managing everything else (and sleep, you need plenty of good quality sleep).

This kind of thing is firmly in the wheelhouse of strength athletes.
posted by VTX at 10:17 AM on September 14 [15 favorites]


I just don't feel that pro athletes have much to offer in terms of long-term diet and nutrition, and I've said before I work with a few former professional athletes (and now two whose children are in pro-sports). They suffer the same issues as the rest of us once retired and once someone is not paid and/or barking at them on a daily basis about their weight and health and generally their careers are too short. Lots of people can stay thin and fit for a decade or more, it doesn't require you to be a pro athlete.

In fact, I'd surmise that it definitely shows that a tightly regimented diet is unsustainable, but I don't know enough former professional athletes to go that far.

I'd also say that sciatrix's ideas about stress sound interesting, but they really don't jive with the rise in obesity at least in the US. If someone has some evidence that population-level stress has increased that much in the past 50 years, I'd like to see it. I'd also say that the fact that high social economic status women are less likely to be obese (men have little variance across social-economic status) than men or lower-SES women means that the performative aspects of high SES sexism reduces obesity to some degree.

" Overshooting on average by just 10 calories a day — the calories in a single potato chip — translates into gaining a pound of fat yearly, 10 pounds of excess fat per decade. In just 30 years, that tiny imbalance will transform anyone from lean to obese. "

I'd also say this paragraph, if we are going to paraphrase the 'wealth' analogy - that the power of compounding, whether weight or money, is extremely poorly understood by the general populace. See Chris Rock's joke "rich" vs "wealthy" from about 20 years ago - lots of the guys he mentioned who were rich then are wealthy now. People tend to assume all wealthy people got that way quickly, but that is an incorrect assumption. For many it took a while, a collection of individual decisions plus time.
posted by The_Vegetables at 10:59 AM on September 14 [3 favorites]


The_Vegetables, I'd argue that high-SES sexism does not reduce obesity, but selects for the already slim. It is not likely that many high-SES women were overweight/obese earlier in their lives, but rather there is a weight barrier for high-SES positions. In fact, if you gain weight, you are more likely to be fired.

The obesity epidemic is largely understood to be the result of increasingly sedentary lifestyles coupled with the rise of processed foods, yet this societal phenomenon is not affecting all people in the same way. I think sciatrix's observations about individual hormone response warrant study. Yes, sitting more and eating carbs is making a lot of people fat, but paradoxically moving more and eating raw foods does not seem to be a sustainable way to reverse it. Metabolic rates among people who have lost significant weight are lower than the rates of slim people who never dieted, even after years of keeping the weight off. And that doesn't even address the subset of the population that seem to be immune to weight gain.
posted by domo at 11:29 AM on September 14 [7 favorites]


It's also worth noting that my arguments about average chronic stress level rising in the past 30-40 years derive from things like rising income inequality, real wage loss, fewer protections for workers, rent hikes, changes in shift scheduling for low wage workers, rises in medical debt, etc cetera. Lots of relatively low grade things that raise stress and insecurity levels, especially among lower SES groups, little by little. I will also note that the prevalence of acute stressful events in the US is also increasing as a simple function of climate change. We see far more extreme weather events now than we used to, and that creates longer term stress points as both individual households and whole communities try to recover on both an acute and chronic scale. We also see more unpredictable weather as climate change sets in on smaller scales. For example, I know that the chronic flash flooding incidents that really kicked the shit out of my own personal resilience in the last few years are a result of changing rainfall patterns. Lots of little draws on people's resilience stockpiles, tugging hardest on people who have the least to give.

If you look at the actual data, that's pretty much what the "obesity epidemic" rise does look like--the distribution doesn't so much change as everyone seems to get a little bit heavier at every place on the BMI distribution. It's not that very thin people are suddenly becoming very fat overnight, but rather that the population is en masse getting a little heavier than it used to be. I really don't love the "epidemic" framing for a bunch of reasons, and one of them is that it encourages the reader to think of fatness as being like having COVID: more and more people are catching obesity! rather than fatness being something that exists on a much larger spectrum and people generally not moving very far along that spectrum over long periods of time, at least as long as they don't get into a cycle of periodic dieting and calorie restriction. That tends to reliably drive weight increases over time, distorting the body's set point.

And obesity is vastly more common among people with low, often very low socioeconomic status, and much rarer among the wealthy. Some of that is probably selection bias, because discrimination against obese people is very real and quite strong. But I suspect some of it is that money can buy a pretty good bulwark against a lot of types of low grade chronic stress.
posted by sciatrix at 11:47 AM on September 14 [12 favorites]


Gut microbiome gets one mention in the paper. Seems like that's one thing we need to know more about.

For a couple of reasons, I am interested in diets. I read a lot, and I have tried a couple or three, never with succes. And too often, I find that doctors and others who do research into diets are tempted by the huge sums offered from the food industry to persuade us hapless lay people that something is good for us. The newish theory of of importance of the gut microbiome is the only theory I find to have some solid evolutionary underpinnings, with no imagined cavemen. There are huge collections of data across cultural divides, convincing twin studies and laboratory experiments, and a holistic, cross-disciplinary approach to the body. It is also consistent with the proved healthy diets of the so-called blue zones. The field is perhaps growing too fast for its own good, and you should probably not buy a poop-test online, but AFAIKS, the foundation is good.

Most of my life, till I was 38, I was very skinny. So skinny I could and would buy my clothes in the boys section of H&M, size 14 years old. It's much cheaper than women's clothes. I was the queen of fat and carbs, my favorite dish was risotto alla Milanese, I ate a lot, and I ate everything (though since I was 26, I have cooked everything from scratch because I discovered I was allergic to some e-numbers). After my second baby, I lost so much weight that I went into early menopause, but I successfully reversed it by eating something like 5000 calories a day and forcing myself to eat desserts. (I don't have a sweet tooth). It wasn't a nice experience, but I knew I was in a cancer risk group and early menopause enhances the risk.

Then suddenly, I put on weight, rapidly. I had no idea why and in the beginning it felt very good. Now I weigh 29 kilos more than my former stable weight, which means I am morbidly obese. (My original weight was so high that my doctor didn't understand I was underweight till the early menopause thing happened. BMI is not a good indicator of health on the individual level). Now, my doctor doesn't think I should think about weight-loss until we have dealt with my mental health. But my blood sugar is too high and my liver is too fat. Again, these things increase my risk of cancer, and in the meanwhile it has been documented that I have the BRCA2 gene.

This year, after years of unsuccessful treatments for depression, stress and anxiety, I have finally been diagnosed with PTSD. And during the diagnostic proces, I have revisited that weight gain back when I was 38. Because that was probably also when the first signs of PTSD appeared. And then I remembered what I actually always knew: that the shorter periods when I gained weight during my skinny youth were times when I was under severe pressure: when I was thrown out of my childhood home at 16 and had to fend for myself, both times I was pregnant, and when I moved out of my marriage and got a divorce. Now here's the thing: I don't remember much of what I ate as a teenager or during a very frightful divorce. But I do know I suffered from hyperemesis gravidarum during both pregnancies. I almost didn't eat, and if I ate, I vomited. Still I put on weight from the daily dosis of one glass of buttermilk and one banana I managed to keep down. My body hung on to them like they were my life, and they were.
The instant I had given birth, both times, I reverted to my gluttonous ways, and I lost weight in a few weeks. The same after the other weight gains. When I was 19 and had found a home and started my educated, I lost 15 kilos in 4 months with no effort. They first day I locked the door to my own apartment after the divorce, I began loosing weight, Within 2 months, I has lost 12 kilos.

So now, in dialogue with the doctors, I am trying to see if I can reverse engineer the seeming correlation between my gut and my brain (whatever those are) that means I am not taking the drugs I've been offered -- I am doing all the therapy -- and I am working towards the diet that can help me improve my gut microbiome (here is a simple explanation). It is something I can handle, because I love cooking and I'm a curious eater, but I won't say it is easy. We put our faith in Blast Hardcheese mentioned above that a vegan/vegetarian diet can do weird things to your stomach. Yes, it can. But you can get over on the other side of that problem if your transition is slow and careful. I'm not yet at a median of 25 grams of fiber pr. day, as recommended for women. For me the variation of vegetable foods is actually quite easy, but others may have the opposite problem. I still eat meat and fish, but much less.

I've not yet lost weight and also not tried at all. But I have a spreadsheet for keeping count of it all, and my weight has become much more stable than when I started, and that's a positive.
posted by mumimor at 12:27 PM on September 14 [1 favorite]


Metabolic rates among people who have lost significant weight are lower than the rates of slim people who never dieted, even after years of keeping the weight off.

Worth noting, since this is potentially very depressing, that this is a contentious issue, with some studies finding significant long-term metabolic adaptation in the long term, some small amounts and some none at all. The 'Biggest Loser' study, which found a massive 500 calorie adaptation is very different from other studies, but it is also a very small study, with atypical participants.
posted by ssg at 12:30 PM on September 14 [2 favorites]


I really like the comparison of CICO as being about as helpful as saying that wealthy people take in more and spend less. While there is some variation in how many calories people absorb from the same foods, it seems like the bigger differences are in how many calories people expend. I’ve read a study where they overfed volunteers by if I remember correctly around 1000 calories/day for a couple months. Some people steadily gained weight; some people gained a little weight then stopped gaining; a few people didn’t gain at all. It seems like the same thing happens when people’s intake is slightly lowered for a couple months, too - some lose weight steadily, some lose weight then stabilize, some stay more or less the same.

From personal experience, I know that if I overeat I tend to get really warm - like a hot flash, almost - which I assume is my body burning off the excess calories/energy as heat. And, though I’ve always been a fidgety person who can’t sit still, when I was underweight many years ago, I noticed that I had entirely stopped fidgeting - which I assume was my body trying to conserve energy. Once I gained weight, the fidgets came back.
posted by insectosaurus at 12:38 PM on September 14


The "imagined cavemen" quip above can perhaps seem a bit disdainful, I'm sorry about that.
We as a species have evolved to be able to eat almost everything, and that's amazing. I can readily imagine that keto feels great for some people, and that is IMO a good thing. Do what works for you.
What the microbiome people are saying is: you should probably literally eat almost everything, but it is OK if you don't do that all the time.
posted by mumimor at 12:42 PM on September 14 [1 favorite]


That biggest loser study was pretty flawed:
The best summation of the science we have available on the topic of post weight loss metabolic rate is a meta-analysis , which looked at 3,000 men and women from 71 weight loss studies tracking metabolic rate.

It found that post weight loss metabolic rates were not slowed beyond what you’d expect for the loss of body mass. The researchers concluded that “Our results show that body weight reduction is not associated with a greater than predicted decrease in resting EE when post-weight loss values of FM and FFM are used to predict resting EE in a large cohort using different weight loss interventions.”

Compared to the biggest loser study, which followed just 14 participants and had a few questionable issues going for it, can’t really compare in terms of statistical power.
During a diet your metabolism does slow down, but only by about 100 calories per day and it returns to normal after you finish the diet.
posted by TheophileEscargot at 12:43 PM on September 14 [1 favorite]


If someone has some evidence that population-level stress has increased that much in the past 50 years, I'd like to see it.

I can give you 1990s to 2010s in the US.
Participants in the 2010s also reported that stressors were more severe and posed more risks to future plans and finances and that they experienced more distress. These historical changes were particularly pronounced among middle-aged adults (e.g., proportion of stressor days increased by 19%, and perceived risks to finances and to future plans rose by 61% and 52%, respectively). As a consequence, age-related linear increases in well-being observed from young adulthood to midlife in the 1990s were no longer observed in the 2010s. If further studies continue to replicate our findings, traditional theories of adult well-being that were developed and empirically tested during times of relative economic prosperity may need to be reevaluated in light of the changes in middle adulthood currently observed in this historic period.
posted by brook horse at 1:11 PM on September 14 [7 favorites]


For those asking about the reliability of Taubes's claims about certain animal models gaining weight when fed controlled diets:

I can't speak to the ob/ob mutant mice, but the discussion of hypothalamic lesion studies from the '40s interested me, and I clicked through to the paper by John Brobeck that Taubes referenced. I think Taubes characterization of Brobeck's work there is somewhat misleading. Taubes writes:
But animals with lesions in the ventromedial region of the hypothalamus would also grow obese, or at least get significantly fatter, when they didn’t eat any more than a lean animal. Prevent the animal from eating excessively — meaning control for the overeating, in the language of experimental science — and these animals get fat anyway. Borrowing from Shaw’s Tarleton, they put on flesh anyway, even at levels of food intake that would not cause weight gain in normal animals. This observation would go unexplained or be ignored entirely.
(My emphasis.) But Brobeck spends something like five pages discussing alternative explanations for the weight gain in these rats, including hyperphagia (increased eating) but also including changes in activity level, changes in intermediate metabolism / nutrient availability in digestion, and changes in heat production. Taubes goes on to write:
[...] Brobeck assumed that overeating (he called it hyperphagia, a term that is still in use) was the reason why these animals with ventromedial lesions in the hypothalamus got fat [...]
But Brobeck is certainly not making any such assumption. He may or may not be correct in his conclusions, but he goes through quite a bit of evidence and argumentation to establish that hyperphagia is the primary cause of weight gain in these rats. (It's also worth noting that while Taubes glosses "hyperphagia" as "overeating," Brobeck is careful to define it in a footnote as "increased eating" explicitly from an intention to focus on the behavior and not the psychology, without implying excess or gluttony as Taubes's choice does. Taubes seems to be implying a certain sort of judgment by Brobeck that Brobeck himself is quite clear in rejecting.) He also is clear that other factors are also likely contributors, but their influence is less. For example, Taubes claims that the animals with hypothalamic lesions got fat even when fed the same amount as a lean animal. This would certainly seem to suggest that hyperphagia is not actually an important factor, but unfortunately it's also not what Brobeck reports from that study:
Twelve paired feeding experiments [in which a test rat was fed only the exact amount of food that was eaten by a paired control rat] were reported [from another laboratory's study]; in nine of them the rat with the lesions gained at the same rate as the control with which it was paired until the time ad libitum feeding was instituted, whereupon the former animal almost immediately began to become obese because it increased its food intake. Here the hyperphagia appeared to be solely responsible for the obesity. In the other three pairs of the series, the rat with lesions gained a little more rapidly than the control during paired feeding, yet when ad libitum feeding was permitted the former animal underwent an abrupt rise both in food intake and in weight gain. Here the hyperphagia, although clearly the most important, was not the only factor responsible for the excess gain.
(My emphasis.) In this case, it seems clear that Taubes is misrepresenting the result of that paired feeding study in order to bolster his argument that the field of obesity research has an unsubstantiated focus on the CICO model that stems from decades-old research and arguments by people like Brobeck. But the reported research does not seem to support Taubes's implication that weight gain in certain animal models is unaffected even when they cannot not increase their eating, nor his argument that researchers at the time failed to consider alternative explanations for their observations.

I should be clear that I didn't dive into this expecting to come away with such a negative view of Taubes. I've never heard of him before, and in general I'm quite sympathetic to the argument that the CICO model is too simplistic and is used to shame people for a physiological problem. I think there is quite a lot of evidence that suggests that in many cases, increased eating is an effect of, rather than a cause of, increased body fat, but because we're talking about biology, there are inevitably many different pathways involved, and many different explanations for why an individual may become obese. So as I read this article I was nodding along for most of it, but the bit about the hypothalamus made me curious, and I was quite surprised to see how badly Taubes had misrepresented it. I don't know anything about the other studies he references, but this certainly makes me question his scholarship and his ability to accurately interpret and report on scientific research in general. After that, I'm interested to see others here indicating that Taubes already has a reputation for misrepresenting scientific research.

It's too bad, because I think work questioning the CICO proponents is important, and this article had a number of really nice arguments. Like others I also particularly liked his analogy to earning more than you spend as a somewhat tautological explanation for wealth. But from what I saw here I'm not inclined to trust what he's written.
posted by biogeo at 1:16 PM on September 14 [15 favorites]


I think there is quite a lot of evidence that suggests that in many cases, increased eating is an effect of, rather than a cause of, increased body fat

I think that almost all of biology is dominated by causality loops.
posted by flabdablet at 2:23 PM on September 14 [1 favorite]


Put two groups in a food lab, one on a low-carb diet, one with the same calories but more carbs.

I’m way out of my depth with this stuff, but It definitely seems as if, in this circumstance, of course the two groups will maintain mostly the same weight, but it doesn’t seem as if that’s what the paper was saying. Rather it suggests that certain dietary choices prime the body for weight gain and they react by eating to that level.

The comparison to pregnancy is interesting, in which a pregnant person will sort of automatically eat enough to support the development of the child. If the analogy holds, it suggests that perhaps the group on the “high-GL” diet, while not gaining weight, would experience other physical effects associated with not having access to the calories their metabolic state demanded, just like there would be problems with the pregnancy if the required calories were not available. Seems to suggest a non-weight-based route to falsifiability, in that there ought to be some measurable difference between the two groups that resembles operating at a calorie deficit in the GL group.
posted by gelfin at 4:19 PM on September 14


I've lost 10-15% of my body mass on diets, and I'll tell you right now if you manage to do the same, be prepared to be hungry constantly as long as you maintain that lower weight level. As far as I can tell there's no adaptation that keeps you from feeling hungry until you return to roughly the maximum weight you've ever been. Yes, it is true in a sense that CICO works for individuals, but for populations any effort at public health based on it seems to be a miserable failure. Whether Keto, weight loss drugs, calorie restriction, etc... be prepared to yoyo your weight unless you make it your life mission or change your career to something like personal trainer or diet coach.

The only way to change your set point seems to be surgical, but that narrative detracts from the one of shame and poor impulse control that our society seems so eager to embrace.

I have no data, but I would not be surprised to find out that people who are below their set point will struggle constantly with energy levels, motivation and mental focus until they return to the weight their biology dictates. We've already seen what happens to children with insufficient caloric intake when compared to well fed peers. Why would it not be the same for adults?
posted by BrotherCaine at 4:20 PM on September 14 [6 favorites]


I'll tell you right now if you manage to do the same, be prepared to be hungry constantly as long as you maintain that lower weight level.

Can confirm.

My current bodyfat control process involves water fasting for three days of every four, essentially just sitting with being constantly hungry in an attempt to learn to be OK with it and thereby mostly replace willpower with habituation.

Only time will tell whether this is any more sustainable than any of the countless other approaches I've tried over the last five decades, all of which have worked well enough that any would have been counted as outstanding successes on any 12 week "scientific" trial, but obviously none of which have had what it takes to stop me from ending up as fat as I am today.
posted by flabdablet at 6:54 PM on September 14 [6 favorites]


I'll tell you right now if you manage to do the same, be prepared to be hungry constantly as long as you maintain that lower weight level.

I’ll “counter” that with the story above about my partner getting sick for two months and losing 20 lbs two years ago. Their hunger seems to have been (thus far) permanently diminished, and we have no idea why. Years and years and years of trying to lose weight and nothing worked. Now they’re able to maintain a lower weight with absolutely zero effort—which is what I used to be able to do until I gained 20 pandemic pounds and now I have to resist cravings and hunger all the time, which I have literally NEVER had to do in my entire life.

It makes no goddamned sense.
posted by brook horse at 8:23 PM on September 14 [4 favorites]


people who are below their set point will struggle constantly with energy levels, motivation and mental focus until they return to the weight their biology dictates. We've already seen what happens to children with insufficient caloric intake when compared to well fed peers. Why would it not be the same for adults?

Absolutely no question that my brain functioned better at my highest weight than it did at my lowest but there are too many confounding factors at work there to say it's definitely the caloric intake: stress, poverty, mental illness, unstable housing, family and relationship conflict were all also present in my eras of lowest caloric intake/lowest weight. I can imagine all of those play a role in the lives of many students who are underfed as well...
posted by We put our faith in Blast Hardcheese at 8:47 PM on September 14


getting sick for two months and losing 20 lbs two years ago. Their hunger seems to have been (thus far) permanently diminished, and we have no idea why

My money's on changes to their gut microbiome.
posted by flabdablet at 9:08 PM on September 14 [4 favorites]


For those trying to sort out what effects cravings at different weights and why, here's some fat cell science (credentials-wise I have an MS in nutrition, but it was a while ago and I don't do active research in this area and I'm totally going to anthropomorphize fat cells).

Each of your fat cells has a little blob of fat, and when it's fat blob starts shrinking and gets too small the cell sends out hormones that make you want to move less, eat more, think about food, be motivated to shop for and prepare food, etc.

When you start losing weight the fat blobs in your fat cells start shrinking, and so all those unhappy fat cells start sending out those hormones. If weight loss continues, your body will start triggering fat cells to self-destruct. Fewer fat cells means everyone left gets a bigger portion of fat, and the fat can fill back up and stop sending out the hormones. But here is the key -- fat cell turnover is only around 10% per in a year. So depending on your starting point, you could be dealing with hunger hormones for a very very long time. (This is normal weight loss, weight loss from illness works differently and involves loss of muscle mass as well, so you can't directly compare the two in all ways).

Gaining weight is a pretty straightforward process -- as the fat blob in a fat cell starts to get too big, that cell is triggered to divide. Now you have more fat cells to get angry when you try to lose weight.

This isn't all on a tight feedback loop, however. In adults the number of fat cells doesn't tend to change much at all, so it actually takes a very large shift for you to gain or lose fat cells, and this is probably why our weight tends to be fairly stable throughout our adult life (again, illness is different).

As for the question of why some people reach a higher weight than others, I personally don't think we'll ever arrive at some magic smoking gun. From everything I've seen it is multifactorial, with roles for your genes, microbiome, built environment, cultural priorities, income level, and yes, stress level as well (cortisol affects fat deposition). None of those things are fully under an individual's control.

But here's a question: what do we gain by using weight as a proxy for health? It leads to fat-shaming, which leads to stress among those who are fat, which .. causes weight gain. So that's not useful. It leads to an overblown diet industry making bank selling people wishful thinking that does more harm than good. It doesn't lead to good medicine -- we already have far better tools to assess health and direct care (blood lipid and blood sugar tests, for instance). Maybe it gets infrastructure that supports a more active lifestyle with more bike lanes and more pleasant stairwells... except, no it doesn't. It's far easier to just blame fat people than to fix our built environment to support physical activity when physical activity is focused on weight loss instead of what it actually does well -- improving brain health and immune health and increasing wellbeing. All focusing on weight does is cause human misery while fattening the wallets of the weight loss industry.
posted by antinomia at 3:40 AM on September 15 [10 favorites]


What focusing on weight does for me is give me some hope of being once again able to do things that I only ever found out I could do during those few brief and wonderful years for which I managed to maintain leanness a quarter century or so ago.

I could be seated cross-legged on the floor and stand up just by straightening my legs. None of this heaving over sideways and shoving myself off the floor with a hand and getting a knee underneath and then going the ungainly upward lurch; I could go straight from seated to standing in one smooth move, just by wanting to, and it was fucking marvellous.

And I could walk and walk and walk without feeling afterwards as if I'd been pounding my hip, knee and ankle joints with sledgehammers. And I could ride my bicycle uphill fast, and if I needed more speed up that hill I could get it just by breathing harder, without the pain and the heaving and the sweating and hurting, and if I wanted to ride 100km in a day I could just do that and not feel like death warmed over for days on end afterwards.

I've spent most of my life obese, but I've also been lean, and lean wins. It just does. Especially when the musculature involved has been trained up by spending a lifetime hauling this lot about.
posted by flabdablet at 4:46 AM on September 15 [10 favorites]


But here's a question: what do we gain by using weight as a proxy for health?

Yes!

Here is another point I dislike about the framing of the 'obesity epidemic', especially assuming I'm right and the broad scale change in American weight levels is a function of changes in chronic stress rather than population scale changes in a bunch of different factors:

we already know that chronically elevated cortisol levels are horrible for long term health. We know that being low grade stressed out--or for that matter high grade stressed out!--is terrible for our bodies. We know that it stresses our hearts and our cardiovascular systems and erodes the strength of our immune systems and encourages addictive behavior and all manner of other awful outcomes; we know it shortens lifespans and increases violence and suicide (which of course have their own impact on population level stress) and hurts our ability to think.

We know these things for humans and for mice and even for every domesticated species we cultivate: we pitch pain control and enrichment initiatives to farmers by pointing out that stressed out livestock grow more slowly, produce less milk, have fewer offspring, every fucking metric for productivity a farmer might collectively care about.

Why do we view rises in obesity as a public health initiative instead of rises in stress, then? After all, chronic stress and severe income inequality are equally expensive to a public health system--or an insurance industry, for that matter--as obesity is. Why have we decided that obesity is the hill to die on?

I'll tell you why: because obesity is visible, conveniently plays to our notions of "personal responsibility" and belief in personal control within a complex society, and places the responsibility--and blame--for population level health outcomes onto individual people. More often than not, they are the people who are least equipped to actually exert personal control over their own environments. Moreover, stress is expensive to ameliorate, and doing so involves diverting money and time into the groups of people with the least political and economic power to advocate for their own needs. The "obesity epidemic" is a convenient distraction from these basic truths about health and wellness, one that redirects questions about population outcomes and responsibility for their answers away from the structural and collective reasons for these outcomes and onto the individuals with the least actual power to resolve them.

It's a neat trick. Pisses me off, too, but there it is.
posted by sciatrix at 5:21 AM on September 15 [9 favorites]


I think in some ways people are looking at the wrong questions, or at least looking at the questions wrong.

As The_Vegetables points out, even a tiny calorie surplus compounds to huge weight gain over decades. The question isn't "why do we get fat" but "how come our weights are so incredibly stable".

In general, lifestyle interventions aren't very effective. 90% of problem gamblers relapse. 93% of people fail to quit smoking. Why do we expect diets to be different?

Article writers love the framing of "behold the great mystery!" But they often take the context out that would let us know whether there is a mystery.

When scientists have investigated "diet-resistant" people who claim that they can go on a diet and not lose weight, they haven't found complex changes to their metabolism or biochemistry or gut biome, but that they were underestimating their calorie intake.

There's a lot of qualitative, theoretical talk about complicated factors. But hardly any research where you actually put people in a food lab and monitor what they eat and find that complicated factors really matter.

If someone's using Newtonian physics to analyse a football game, you can easily say "It's far more complicated than that! Have you accounted for relativistic time dilation effects where a person running experiences time more slowly? How about the Heisenberg Uncertainty Principle effects where you can't tell where the ball is and how fast it's going at the same time?" Those are genuine science... but not actually significant at those scales.

So many people want to sell you a new magic bullet solution for weight loss. Some of them use outright pseudo-scientific nonsense. But others are using genuine science, but at effect sizes that aren't really significant.
posted by TheophileEscargot at 7:10 AM on September 15 [1 favorite]


I just don't feel that pro athletes have much to offer in terms of long-term diet and nutrition

I can't speak for every commenter but I'm not talking about pro athletes. Powerlifting is a niche sport and very stratified. There are very very few meets, even really big meets, that get you anything more than a t-shirt and cheap medal. USAPL is just now (as part of some drama with the international sanctioning body) trying to launch a series of "pro" meets.

We're barely even athletes. Louie Simmons, who invested the "Westside" style of training and is a gigantic asshole, famously said, "Let the athletes compete in other sports, powerlifting is for the rest of us."

That said, the folks at the very top of the sport don't really do all that much differently than all the mid-level competitors do, they just do a lot more of it. This recent meta review of a couple of experiments and a bunch of interviews with powerlifting coaches suggests that you can make strength gains with surprisingly little lifting. The amount and intensity of the work a person needs to do just to get health benefits are even lower.

To Antinomia's point about why we even measure weight, one of the things that really helped me make consistent long term progress was mentally separating diet and exercise. I got into strength training because it seems like the easiest for me to stick with (bought used weights I could have in basement and I work from home) and required the least time for the most benefit. Even if I didn't lose any fat, I'd still be a MUCH healthier person today than I was when I started even though I'd probably weigh more.

I think some/any kind of strength or resistance training is something everyone should do whether it's yoga, powerlifting, or anything else. So I decided that I would lift weights for my health and keep doing it no matter what happened with my weight. Ditto for getting plenty of walks and cardio.

And while there is a TON of overlap between diet and strength training I mostly keep that separate in my head. I keep an eye on my protein intake (and it's not particularly high, I think 120g-180g per day on average is plenty for strength athletes with rare exception) but otherwise I just try to limit my calorie intake and manage my nutrition as best I can while keeping track of my weight AND bodyfat %. The US Navy developed a pretty good model to calculate bf% using just a measuring tape. It's about the same +/-3% error rate as most other methods of measuring it so I don't really trust the number but it's worthwhile to keep track of the measurements because I've spent a month at the same weight but getting leaner so I didn't see progress on the scale but I did see it on the measuring tape.
posted by VTX at 7:41 AM on September 15


When scientists have investigated "diet-resistant" people who claim that they can go on a diet and not lose weight, they haven't found complex changes to their metabolism or biochemistry or gut biome, but that they were underestimating their calorie intake.

The overwhelming majority of people who report that diets don't work for them are not "diet-resistant" in this sense. I have yet to meet another obese person who doesn't have a history of repeated short term success at dieting for weight loss. Diet plans that work are a dime a dozen.

When we the chronically obese report that diets don't work for us, what we're talking about is the dispiriting lifelong failure to discover a weight management regimen that (a) works and (b) keeps on working for a lifetime without causing a debilitating degree of grinding, relentless, cumulative misery.
posted by flabdablet at 8:43 AM on September 15 [14 favorites]


It doesn't lead to good medicine -- we already have far better tools to assess health and direct care (blood lipid and blood sugar tests, for instance).

A few problems with this:

1) Weight gain predicts increases in these metrics. You only see the higher levels for these metrics after you gain the weight, at which point it is much harder to deal with the problem (especially as losing weight and maintaining weight loss is so difficult). Of course our public health measures should be preventative and that should mean trying to prevent obesity before it happens.

2) Is this actually true? There are many negative health outcomes associated with obesity. Do we have blood tests that are better for all of these?
posted by ssg at 8:54 AM on September 15


Personally I've only ever found one regimen that kept me steadily dropping weight while suffering no misery whatsoever, and that was a regular dose of the appetite modification drug sibutramine. I would still be on it today if the manufacturer hadn't withdrawn it from the market.

Living on sibutramine was an absolute revelation: it completely altered my relationship with food, changing it from something I always need to fight against cravings for to something I could just eat moderate amounts of when hungry and enjoy without worry. The relief was inexpressible.

It occurred to me about six weeks in that what I was experiencing for the first time in my life was that "satiety" thing that everybody talks about, and that this must be how normal bodies relate to food, and for a while I became unbelievably furious about all the lazy, thoughtless, hurtful shit that has been flung my way over my lifetime just because mine doesn't work that way.

I'd dropped 15kg at a nice steady pace that was showing no sign of slowing down when sibutramine got withdrawn from the Australian market. Tried ordering it from overseas, got sent something claiming to be modafinil instead. Tossed that and haven't tried again. Sibutramine was quite risky enough for me on its own; fucked if I'm going to base a whole lifestyle on fuck knows what fake-ass chemical slipped past Australian Customs by fuck knows who.
posted by flabdablet at 9:11 AM on September 15 [5 favorites]


flabdablet, I'm taking the liberty of suggesting looking into various methods of learning to move more efficiently. Feldenkrais Method is very powerful, and I'm currently doing qi gong.

I'm not saying efficiency is the same thing as weighing less, but getting better use of your whole body can buy you a lot of slack.
posted by Nancy Lebovitz at 10:54 AM on September 15


Thanks for the kind thoughts, but with a body mass of 155kg I have no option but to move efficiently if I'm to move at all.
posted by flabdablet at 11:36 AM on September 15 [3 favorites]


"The information theoretic content of my stomach can store how many bits of data using /btrfs", I ask.
posted by symbioid at 1:19 PM on September 15


Regarding satiety: one of the biggest revelations to me, upon adopting a keto diet, is that my experience of hunger and satiation changed completely.

I had been able to lose some weight via calorie reduction of my generally healthy diet (fruit and veg, low fat, no junk food) but it just plain was not sustainable due to the miserable and unrelenting hunger. At that time, in my mid 30s, I resigned myself to being over 300 lbs and just committed to getting as much exercise as I could to maintain the best fitness level possible.

When I tried keto in my 40s, after a few weeks of adjustment, my appetite mostly disappeared and my body sent completely novel, inarguable signals of satiation when I did eat. Fat dropped off me like crazy. Over the past several years I have done enough experimentation to confirm that, if I want to lose fat (having lost about 100 lbs, with still more to lose) then I need to keep net carbs under 20 g per day. I wish it were otherwise but it’s just plain not so. Intermittent fasting has also been very helpful as a weight control technique.

I do sometimes decide to have food with carbs, on special occasions. When I do, there are predictable after affects, including raging hunger for about 48 hours. In fact that’s one clear tell that I’ve inadvertently gone over my limit if some carbs have snuck in. Others include leg cramps overnight, and also a few effects that take a few days to resolve—a jump in resting heart rate by about 8 bpm, a few lbs of water weight. When I get right back to keto these clear in four or five days.

In sum, my experience aligns completely with the CIM model.

I often wonder why its advocates don’t also point out that there is no such thing as a nutritionally essential carbohydrate. I also think that carbohydrate regulation as the linchpin of all fuel regulation makes a lot more sense when one understands *why* blood glucose levels need to be so tightly regulated. Short story is that sugars are enormously important for biochemical regulation and signaling. When blood glucose gets out of its normal range, things go haywire—hence diabetes’s horrible effects on every system of the body. Getting a huge load of postprandial glucose out of the bloodstream is an emergency.

I’m also reminded of the (unequivocal and uncontroversial) observation that, after a meal of mixed macronutrients, carbohydrates are metabolized first, then proteins, then fat. This was part of the argument that carbohydrates are the body’s preferred fuel. But there’s one more fuel that the body can burn in large quantities, and that’s ethanol. Ethanol is metabolized even more quickly than carbs. It stands to reason that Ma Nature recognizes the value of using ethanol as fuel *and also* the value of clearing it as fast as possible. Not a stretch to think that clearing carbs from the bloodstream quickly is a similar tradeoff. I think it makes more sense to say that the order of metabolizing means that carbs are *prioritized* in catabolism, rather than *preferred*.
posted by Sublimity at 2:34 PM on September 15 [5 favorites]


I share Sublimity's experience with hunger changes via extreme carbohydrate reduction, achieved both by water fasting and by rigorous limitation of sugary and starchy foods.

I have been breaking my three day fasts with a big bowl of pure luxury made from a 185g can of chili tuna in oil on a bed of 250g of cole slaw, with a whole tomato, half a red capsicum, half an avocado, 125g of Greek yoghurt, a dash of soy sauce, a handful of smoked almonds for crunch, and black pepper and powdered turmeric for zing. This is a large volume of low carb, high protein, high fat, high fibre food. It takes me two glorious hours to consume, after which I am nicely full and don't generally feel like eating anything else for at least another six hours.

Now, there is no way I would ever enjoy eating a meal like that anywhere near as much as I do if I hadn't been fasting for three days beforehand; fasting sharpens up the appetite and makes the whole eating experience so much better. But the point is that I don't wake up on breakfast day all MUST! EAT! NOW! - there's a pleasant anticipation of the breakfast to come but there's no howling urgency to it.

By way of stark contrast, the hunger I experience an hour or two after eating a carb-dominated breakfast, even on "normal" days where I'm not coming off the back of a three day fast, is just brutal and requires applying every bit of my formidable and well-practised willpower to avoid having it trigger a slavering, out-of-control food blowout that feeds back on itself and doesn't stop until my stomach is literally hurting from having too much food in it. It's a quality of hunger that is utterly different from that brought on by mere food deprivation.

Last week I went for an oral glucose tolerance test that my doctor had asked for, and the aftermath three hours after breakfasting on 75g of glucose syrup was not pretty. Had a food hangover the following day that left me completely non-functional; sore, exhausted and unable to do anything but get back in bed and sleep it off for fourteen hours. It was not good.

Haven't had the official test results back yet, but I was wearing a continuous glucose monitor at the time and its readings tell me that my blood glucose levels before, during and after that test were well within the normal range; somewhat astonishingly given my weight and age and family history, I apparently don't have diabetes or even pre-diabetes.

So yeah. For some of us, carbs are just fucking poisonous.

The beauty of sibutramine, for me, was that it got rid of both the deeply pathological hunger response to having eaten carbs and the baseline gnawing hunger that's always there when I'm not literally full of food, and made it so I'd just stop eating without having to exert control to make that happen after consuming quite small portions. It worked really, really well for me and I am so disappointed that it turned out to be too dangerous to sell.

If Big Pharma comes up with another substance with a similar mode of action that doesn't knock people over with heart attacks and strokes, I am so on board.
posted by flabdablet at 10:43 PM on September 15 [3 favorites]


The Future of Weight Loss (on pharmaceutical developments, focusing on semaglutide).
posted by ssg at 1:36 PM on September 16 [2 favorites]


I thought the general medical establishment considered Atkins et al a quack because eating fat-rich foods causes actual health problems, like heart disease, and not quality of life issues, like weight gain, which are poor indicators of overall health.

Okay this is an anecdotal rant, but what I saw happen with Atkins was that, at that time the dietician/nutritionist consensus was more uptight and draconian. And their initial line was not that the Atkins diet was similar to other diets, but that it was utter nonsense and supremely dangerous. It had to be just another silly fad diet because it challenged the consensus ideas about what dieting looked like too (low fat, stringent calorie counting) much.

What happened is that the diet actually worked about as well as anything else. (With, last I saw, some minor differences that were a wash.) It helped some people, who had more success with that kind of diet than with other kinds. This includes a couple people in my family.

The nutrition community was not like, "Wow, neat, huh we're learning things. This is interesting." They were fucking furious. They fucking hated Atikins for being even a little bit correct.

It's definitely a trip to watch the authorities, and authority-wanna-be types, radically change what they say is correct over the course of ~15 years, but with constant condescension and arrogance the whole time. They can't abide that a pop diet fad -- the lowest form of idiocy, to be denounced and sneered at! -- could be more right than they were. So, the narrative had to shift that Atkins did nothing, Atkins must be known as a failure.

The authorities must have always been correct.

Thus like, at the end of his life Atkins slipped on some ice and fell, and was in a coma for a few months. During that time on IV he swelled up in weight, as happens. At the time of his death he was pretty heavy. Someone violated his privacy by leaking the death record to the media, and I remember the gleeful and ghoulish narrative that went around at that time. IIRC Guardian ran an article titled "Atkins was Fatkins".. I can't find it from link rot, but here is record of something similar.

I'm not saying Atkins was some visionary who was right about the mechanisms, or that there weren't annoying faddish aspects. I'm saying that the move from "this diet can't possibly work" to "ok this diet 'works', but there's some way that's still invalid, right? like it works the same as all diets big whoop, or it still actually hurts you, right?" has not exactly been a process of fair and equitable enlightened introspection by the powers that be.
posted by fleacircus at 3:45 PM on September 16 [6 favorites]




I do sometimes decide to have food with carbs, on special occasions. When I do, there are predictable after affects, including raging hunger for about 48 hours. In fact that’s one clear tell that I’ve inadvertently gone over my limit if some carbs have snuck in. Others include leg cramps overnight, and also a few effects that take a few days to resolve—a jump in resting heart rate by about 8 bpm, a few lbs of water weight.

That’s very intriguing, Sublimity; I'd attribute the water weight to insulin's ability to suppress one of the two natriuretic (salt shedding) peptides, since more salt would lead to water retention.

I eat a lot, but it’s always been fairly easy for me to fast, and when I do I lose quite a bit of weight and perhaps not so coincidentally I didn’t ever experience "raging hunger."

Until I started getting migraine headaches. It took me awhile to realize what was happening, but when a migraine starts, I get so hungry I'm literally running back and forth slamming doors and ripping open packages to get food on the plates, and I’ll often eat 3000+ calories before I even sit back from the table.

Migraines apparently are associated with insulin insensitivity and obesity, and seizure disorders also seem to be associated with obesity, so I’m wondering whether emergency matabolic demands by the brain generate an insulin spike and subsequent low blood sugar which leads to the raging hunger.
posted by jamjam at 5:11 PM on September 17


I just listened to this extremely relevant podcast about a study released in February that tested a keto diet vs. a WFPB diet. Spoilers: the people on the WFPB, high carbohydrate low fat diet did not experience increased hunger, the people on the keto diet did not gain weight. This is in sharp contrast to the previous study using similar methodology from the same researchers which showed weight gain from a diet high in ultra-processed foods vs. unprocessed foods. Which confirms my own conclusions after a year of obsessive research into health and nutrition; there’s no magic diet that works for everyone, most diets are ok for most people (although not for all people); and ultra-processed food is the devil.
posted by bq at 6:25 PM on September 18 [4 favorites]


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