Comment by matheusmoreira
1 day ago
> highly effective
Purely behavioral lifestyle interventions have the lowest long term success rates of all available treatments for obesity. It's especially unreliable if you have weight loss targets higher than 15%.
They are of course still widely recommended due to numerous benefits other than weight loss, but "highly effective" is just wrong in the context of obesity treatments.
Hasn't it been found that the best diet is the one you'll actually do?
I seem to remember a meta analysis a decade ago or so finding that the particulars (high protein, atkins, paleo, whatever) didn't really matter so much as the the willingness and commitment to the change.
Why? Information worked for smoking in combination with price increases and forbidden to smoke in certain places. Only 5% in Sweden smoke now.
> Purely behavioral lifestyle interventions have the lowest long term success rates of all available treatments for obesity.
What? Surely changing one's behaviour - particularly the parts of behaviour that caused the obesity in the first place - is a sure way to stop being obese.
Effectiveness is two parts: does it work in isolation, and are people able to do it.
Running a marathon a month is a sure way to improve your health. However, less than 1% of people would be willing to do that. So it’s not an effective solution.
It’s an effective solution if we just ignore life, sure. But solutions are rooted in pragmatism.
The issue is not whether it works; it’s whether someone can stay compliant long enough for it to work
Long enough in this case meaning forever.
Behavioural changes work, the issue is that most people don't actually change their behaviour.
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It's a lifestyle, the optimal basic lifestyle, the one were you don't shorten your life/healthspan by decades. It's how thing were intended to be really.
It's funny how proposing an healthy diet is unrealistic and watching fatties eat themselves to death is the new normal, complete value inversion and looser mentality
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By this reasoning, abstinence-only sex education is a sure way to stop teen pregnancies and spread of STDs.
Your analogy is false.
If you opt for it, then yes of course, abstinence-only sex education is a sure way to stop ten pregnancy.
Similarly, if you opt to change your lifestyle and start living healthier, and follow through, it will work.
If someone tries to force you, of course it will fail (in both of these cases). There is no way to stop someone else from being fat. We can only change ourselves.
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Weight regain is common, especially after isolated lifestyle changes. Most people lose weight but do not keep it off over time.
Weight regain...
If you change your lifestyle temporarily, the effects are temporary.
If you change your lifestyle permanently, the effects are permanent.
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This problem literally did not exist until the 80s. I don't think the human brain/body evolved much since then so surely there is another problem. The only solution is behavioural, everything else is cope.
It's the same thing for the mental issues epidemic... you can't build a completely hostile environment to human life and well being and then say "welp, I guess we need drugs to make you feel normal now", now they'll sell us the drug and the cure, and you'll be clapping and thanking them for saving you, truly amazing.
I think the cope is actually believing that some magic thing made people more lazy between now and the 80s.
You’re right we didn’t evolve since the 80s. But our food has certainly changed. It’s not like some God from above put laziness in peoples brains just now. No… people were always lazy.
It’s just that you could be accidentally skinny before. You can’t be accidentally skinny now, it has to be intentional.
Speaking from experience diet back then was pretty shit, what's changed the most is the levels of physical activity.
Many jobs used to involve physical labour, huge number of us now are desk jockeys. Decades of prioritising motorists and increasingly large vehicles over active transport mean walking, cycling are a fraction of what they used to be [0].
[0] e.g. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2010.... , https://la.streetsblog.org/2023/04/17/exactly-how-much-less-...
> this problem literally did not exist until the 80s.
Henry VIII might have a word for you on that one, as would many other of history’s aristocrats. The only thing that’s really changed is the cost of food that used to be reserved for kings.
Nah, what changed is preponderance of highly processed junk food.
When I lived, in my childhood, in communistic Bulgaria/Czechoslovakia, nobody was starving. Yes, we did not have bananas and Argentinian steaks, but there was enough basic food, including the protein-rich one (eggs, cheese, even meat, although the best cuts were 'under the counter'). Still, few people were really obese; those were obviously sick.
Nowadays, there is plenty of junk food. The food is not really cheap (especially with the recent inflation), even the junk one. Still, being obese is (almost) the new normal. You can see that everywhere.
Yes, people spend more time indoors - but even in the old times people tended to spend a lot of time behind TV.
My hypothesis is that the junk food just does not have enough real nutrients, just mostly empty calories. So the body signals 'I need more nutrients', to which the typical response is 'here you have more empty calories'.
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From 0.01% to 75% people being overweight or obese in the west.
The quality and type of food also completely changed, you can't ignore that.
5% of supermarket aisles are food, the rest are treats and comfort food you should have less than once a week at best
"I don't think the human brain/body evolved much since then so surely there is another problem."
What really changed is the foodscape. And quite thoroughly so. Even basic agricultural products like wheat, corn or fruit are different from the variants 50+ years ago, there was a concerted effort to make them bigger, pesticide-resistant, more sweet, more energy-dense...
I remember the apples of the 1980s. Nowhere near as sweet as today, some were thoroughly sour. And these are considered the healthy choice now.
"The only solution is behavioural, everything else is cope."
This is like, your opinion, man. An opinion that can make you feel smug, but that is no victory. In practice, GLP-1s are doing what a generation of preachers like you could not - making people more thin and healthier.
In a sense, it is you who is coping hard and defending a "solution" which provably never worked on a population scale.
> In practice, GLP-1s are doing what a generation of preachers like you could not - making people more thin and healthier.
Alright, then let's continue making food worse and worse over the years, let's keep building a system that is less and less viable for humans. When we'll all be on GLP-1, + depression + ADHD drugs to just cope with days to day life maybe we'll finally wake up and ask ourselves how we ended in such a shit show.
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