Comment by tasuki
21 hours ago
> 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.
This is like saying gambling is a good way to get rich. The issue is that most people don't hit jackpot.
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
Lifestyle changes are essentially standard medical advice. There is nothing wrong with proposing diet and exercise.
It's just that you should probably suggest other treatments in addition to the lifestyle changes that have relatively low long term efficacy.
Of course, that assumes your goal is to actually help the fatties instead of judging them.
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you don’t seem amused so much as annoyed.
perhaps you can elaborate on how systemic death spirals are funny?
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.
It's not even a case of internal/external motivation. Even internally motivated attempts often fail. You can always claim that they just didn't want it enough or lacked willpower, but it still reduces the effectiveness of the approach. You can claim any approach for solving a problem works if you reject all the cases where it doesn't.
> We can only change ourselves.
Being fit and maintaining the normal weight is not the same thing as reaching a BMI of 50 kg/m² then losing it. I've seen fitness influencers take up that challenge only to find that "changing oneself" is significantly harder than it used to be when they were fit.
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.
> If you change your lifestyle temporarily, the effects are temporary.
Not quite.
If the lifestyle deteriorates, then weight regain is expected. However, people might regain only a fraction of the weight lost. It is possible for some of the weight loss to be permanent.
Also, even temporary changes in lifestyle can produce benefits that outlast the intervention, like lower risk of disease such as diabetes. Exercise is notable for providing numerous benefits that persist even if weight is completely unmodified.
> If you change your lifestyle permanently, the effects are permanent.
No. It improves your odds of success, but does not guarantee it.
Body adapts significantly over time when subjected to weight loss. There are compensatory physiological adaptations that favor weight regain, such as changes in energy expenditure and appetite. Even with sustained effort, maintaining the initial weight loss may become progressively more difficult because of those changes. This shows up in research as results like mean weight loss of ~9% at year 1 and ~5% at year 8.
Sad reality is, very few people have the resolve to do permanent changes to their behavior, the older the worse. Too deep in their comfort zone without even realizing this, even with looming heart attack or other massive health issues. Its much easier to end up seeing a grown man crying about how he has to eat that next snickers bar rather than sustaining resolve with some healthy trend.
For the love of god or any other deity I can't grasp this, its trivial for me to muster a tiny fraction of discipline and simply change direction from now on. But people out there are vastly different than me, thats pretty obvious, ie many people detest sports or even sweating. Addictions, and over-eating is an addiction (or some form of stress-coping mechanism) have a way to grasp core of one's existence and not let go.
My wife sees such overweight folks with not-so-much-time-remaining-on-earth as GP regularly. As she says - they basically over-ate themselves into mental disorder (or started with it and their body over time aligned with behavior). To actually fix this, that mental disorder needs to be tackled, no gastric operations or wegovy injections provide permanent solution. But they sure make pharma companies richer and give this warm fuzzy feeling of achieving actually something visible, even if temporary.