
Why Are We Still So Fat? - JBReefer
https://www.nytimes.com/2018/11/19/health/obesity-genetics-surgery-diet.html
======
mcfunk
This article is disturbingly enthusiastic about bariatric surgery, an extreme
procedure with limited success and serious side-effects.

The long and short of it is that we understand far too little about the human
body and what drives weight gain and difficulty losing.

For instance, there are complex health and immune issues (e.g., mast cell
disorders) that can drive weight gain and difficulty losing in spite of
healthy diets and high levels of activity (and researchers think mast cell
disorders alone may affect 10% or more of the population, but was named only 5
years ago and is still poorly understood. What else could be similar that we
just don't understand yet?)

Beyond this, what we put in our bodies (various medicines, antibiotics,
ingredients in processed foods, various pesticides etc, even artificial light)
may have effects on our physiology that we don't yet have a strong
understanding of.

Our microbiomes are still a complete mystery to us, deeply impacting how and
what we absorb from our food. The same food does not impact every body in the
same way, period.

Bariatric surgery is a band-aid over a gaping wound. Until we understand the
complexities of human physiology at a more sophisticated level than a high-
schooler in physics class (calories in, calories out just doesn't cut it) --
we are going to continue seeing public health impacts in the form of fat and
disease -- which may often have underlying causes that the fat is simply the
most visible symptom of.

Edit: Seriously guys, is there any other area of science where people are so
convinced that anecdotal and small-sample (both in terms of n and
longitudinality) observations are valid? There's a huge market for delusion
about fat, we're fighting that as much as we're fighting to learn more about
the human body.

~~~
hallidave
I recently read The Obesity Code by Dr. Jason Fung and in it he states that
bariatric surgery is little more than surgically enforced fasting. Most people
can fast without doing the surgery.

I highly recommend the book. It's more like a science book about dieting than
a diet book. Now that I understand that when I eat is as important as what I
eat, I've been able to lose 20 pounds (and still going). And, yes, sugar
(especially fructose) and refined carbs are bad.

~~~
babyslothzoo
> Most people can fast without doing the surgery.

Very few fat people have that level of self control. That's why they're fat in
the first place.

~~~
qnsi
I think a lot of people can fast, but are never told to try this. Most people
are recommended to eat 5 meals 300kcal each - and this is hard to do. Tell
them to fast for 18h and eat in 6h window without calorie counting (but no
shit food) and I would guess more people can do it.

~~~
RPLong
All that does is attach a ritual to the fasting process. People start to think
that it's the ritual doing the work, but really it's the calorie restriction.
Again and again, study after study proves that restricting calories to 700
calories reverses diabetes in obese people and in fact cures their obesity,
too.

It's no surprise that people who put on 100+ pounds of extra weight once would
tend to put on 100+ pounds of extra weight a second time. But it's silly to
claim that there is an underlying medical reason it's happening.

The body gets used to whatever conditions you face. Human beings have thrived
in the Arctic Circle, the North African deserts, and everywhere in between.
Obese people have accustomed themselves to an obese lifestyle. If they can
make a permanent break and embrace the lifestyle of a person with normal
weight then they can stay skinny forever. In the end, most people just don't
want to exercise 2+ times per day and limit their portion sizes. So they
don't.

------
jayroh
The answer, in a word: "Sugar".

Obviously you can't take the word of one random commenter on HN. There's a lot
of reporting around this in good news sources:
[https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-
in...](https://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-
shifted-blame-to-fat.html)

When I say "the answer" I should, instead, state that that's a large part of
the reason. It's not the SOLE reason. Of course it's more nuanced than that.

~~~
wolco
It's more Grains than any type of sugar

~~~
ynniv
Humans have been eating grains for 10,000 years, and sugar for a hundred.

~~~
dekhn
humans were extracting sugar from sugarcane 8,000 years ago. It was consumed
heavily in india 2000 years ago. BUt of course we've been eating free sugars
in foods for as long as we've been around.

~~~
ynniv
Sugar was a rare luxury until recently. Even fruit was a luxury historically.
Yes people ate sugar more than a hundred years ago, but it was a few pounds
per year. Modern intake is more than fifty times as much.

------
eric_b
People are fat because they eat too much, and they have almost no incentive to
stop it. Sure, they are mostly eating the wrong things too, in the wrong
amounts, but the bottom line is the number of calories going in the front
door.

I lost 40 pounds all while drinking gallons of beer in college. I did it by
eating less and moving more. It was not an optimal way to lose weight, but it
was effective.

These days I keep thin by eating high protein/fat, easy-to-digest carbs, and
vegetables, and keeping sugar to a minimum.

There's a million ways to lose weight, and some are easier than others. But I
promise you, if you eat less than your body needs to survive, you will start
losing weight.

Today it's culturally acceptable to be fat, and there is ready access to so-so
quality food in large cheap quantities. I love sugar. I have a massive sweet
tooth. I have to be disciplined to stop from consuming all the candy in the
world. Some people choose not to be disciplined. Their choice I guess.

~~~
untilHellbanned
> Some people choose not to be disciplined. Their choice I guess.

Empathy goes a long way. I think as a society we will get to the solution
faster with the view that some people might have stronger urges to overeat
then you. Congratulations you worked hard. Don't discount what others face.

~~~
eric_b
Please, why do you think I needed to lose 40 pounds in the first place? Not
because I was the paragon of willpower I can tell you. I still go off the
rails and eat an entire package of Oreos in a single sitting sometimes. It’s a
constant struggle for me, but I don’t make excuses and I keep persevering.
Other people can do that too.

------
t0mbstone
There was a direct up-tick in obesity almost immediately after the
government's Food Guide Pyramid was released.

[https://www.bellybelly.com.au/health-lifestyle/did-the-
food-...](https://www.bellybelly.com.au/health-lifestyle/did-the-food-pyramid-
cause-our-obesity-crisis/)

The Food Pyramid And The Food Industry Contributed To A Massive Increase In
Sugar, Carbohydrate And Calorie Intake.

Humans simply aren't supposed to eat so many carbs and so much sugar.

Whenever you eat carbs and sugar, it triggers insulin production. Insulin
causes your body to store fat instead of burning it as fuel.

I've been doing a ton of research on this topic lately, and the /r/keto forum
on reddit has proven to be a very useful resource.

Another one of my favorite resources has been the Youtube channel, "What I've
Learned", which does some pretty amazing breakdowns on the topic, if you are
interested:
[https://www.youtube.com/channel/UCqYPhGiB9tkShZorfgcL2lA/vid...](https://www.youtube.com/channel/UCqYPhGiB9tkShZorfgcL2lA/videos)

------
cm2012
Here's some more evidence for the central conceit of this article:

Every legitimate long term study of major non surgical weight loss shows that
it doesn't happen for the vast, vast majority of people. It's basically
freakish when succesful in the long term.

1) ["In controlled settings, participants who remain in weight loss programs
usually lose approximately 10% of their weight. However, one third to two
thirds of the weight is regained within 1 year, and almost all is regained
within 5 years.
"]([http://www.ncbi.nlm.nih.gov/pubmed/1580453](http://www.ncbi.nlm.nih.gov/pubmed/1580453))

2) Giant meta study of long term weight loss: ["Five years after completing
structured weight-loss programs, the average individual maintained a weight
loss of >3% of initial body
weight."]([http://ajcn.nutrition.org/content/74/5/579.full](http://ajcn.nutrition.org/content/74/5/579.full))

3) Less Scientific: [Weight Watcher's Failure - "about two out of a thousand
Weight Watchers participants who reached goal weight stayed there for more
than five years."]([https://fatfu.wordpress.com/2008/01/24/weight-
watchers/](https://fatfu.wordpress.com/2008/01/24/weight-watchers/))

4) [The reason why it's impossible seems to be that although calories in <
calories out works, the body of a fat person makes it extremely difficult
psychologically to eat
less.]([http://www.nytimes.com/2012/01/01/magazine/tara-parker-
pope-...](http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-...))
This is borne out by the above data.

5) [The only thing that does seem to work in the long term is gastric
surgery.]([http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/))

Moreover, you won't find any reputable study on the web where the average
person lost 10%+ of their body weight and kept it off for five years. Not even
one.

~~~
yuy910616
so if calories in < calories out does not work, what about increasing
exercise?

~~~
lawn
Exercise is also not the easy answer. Your best bet is still to change what
you eat.

But it's not "calories in < calories out" that you should focus on. It's the
quality of what you eat. For instance it's super easy to overeat calories wise
if you eat candy since it doesn't do anything for your hunger, or if it does
it makes you crave even more. While it's much harder to overeat on steak.

------
mevile
I'm down 83 lbs from 2017 and I'm at a healthy BMI for the first time in 15
years. I know I will not gain the weight back. Why? Because I finally figured
out how to manage a routine, how to exercise regularly, how to plan out what I
eat, and I learned to get enough sleep.

Don't want to be fat anymore? Stop eating at restaurants, cook all your own
food, bring in a lunch to work, count your calories. Also exercise, lots. And
get 7+ hours a sleep a night.

That's it, that's all it takes.

~~~
patejam
> count your calories

That's all it really is. Everything else just makes it easier to eat few
enough calories, including any crazy diets.

~~~
qnsi
I can't see myself counting calories for the rest of my life

~~~
rconti
Don't fall victim to all-or-nothing thinking. I actually did it for almost 8
months straight, and then stopped when I went on vacation. The nice thing is,
unlike some forms of data, if you skip a week or three, it won't hurt you. You
just hop on the scale and you know where you're at, you can start again any
day.

But even if you only do it for a few weeks, you'll learn valuable lessons
about your good and bad habits. You might not ever have to do it again. Or you
might prefer to keep doing it. YMMV.

------
edoo
It is pretty simple. Processed carbs that spike your glycemic index lead to a
situation where your body has met its caloric needs for the day but your
satiety mechanisms get wonked so you feel hungry when you should not be eating
again. This is evidenced by things like white bread spiking your glycemic
index higher than raw sugar.

This can be solved by not eating any foods that appreciably spike your
glycemic index, which basically means no processed carbs. Vegetables for
example are almost entirely carbohydrates but are encased in fiber so they do
not get absorbed as fast into your system.

If you eat 'fast' carbs you have no choice but to starve yourself because
listening to your natural instincts will automatically mean overeating.

~~~
RPLong
_People_ don't have glycemic indices. _Foods_ have glycemic indices.

In a normal person with a functional pancreas, no amount of sugar or high-
glycemic foods will cause hunger. It's just not possible. This is because the
body naturally releases insulin and the hunger goes away (so does the blood
sugar).

The reason people become insulin-resistant is because they eat too much, and
put on weight. High-glycemic-index foods are implicated in weight gain because
they are high-calorie foods. The added insulin means that the body is also
absorbing them more readily. Insulin causes people to gain weight; in fact,
one of the side-effects of insulin injections for diabetics is... weight gain!
That's because insulin's sole purpose in the body is to make it absorb
calories and deliver it to cells.

All that is to say that you're conflating effect for cause. Weight gain causes
diabetes, which causes sugar cravings. Sugar doesn't cause diabetes, and it
only causes weight gain if you eat too much of it. There are whole societies
on earth that eat almost nothing but high glycemic index foods: the rice
farmers of Bangladesh; the mango farmers of Central America; the rural people
of Morocco who mostly eat dates; and so on.

Sugar doesn't cause diabetes or weight gain. Weight gain causes diabetes,
which in turn causes sugar cravings.

~~~
edoo
I misspoke, replace glycemic index with insulin and I'm right.

For example if you eat 200 calories of ice cream vs broccoli. The ice cream
will be absorbed so fast into your system that you will get hungry again
before you actually need more calories. Every insulin spike is a notch towards
metabolic syndrome. It is the crazy insulin spiking that leads to diabetes.

~~~
RPLong
_" Every insulin spike is a notch towards metabolic syndrome."_

Completely disagree with this. The best available evidence suggests that it is
visceral fat, not insulin itself, that causes insulin resistance. There is an
underlying autoimmune malfunction at the heart of it. But because people with
diabetes often crave sugar (because their bodies fail to absorb it), people
have conflated cause and effect.

~~~
edoo
There is a growing body of research in this vein. You can find several recent
studies like this if you are interested enough. This one in particular has 20%
of the subjects no longer needing blood sugar medication after 10 weeks.

[https://www.telegraph.co.uk/news/2016/05/31/low-carb-diet-
he...](https://www.telegraph.co.uk/news/2016/05/31/low-carb-diet-helps-
control-diabetes-new-study-suggests/)

------
osdiab
Totally anecdotal, and I wasn't obese but only marginally overweight; but when
I was in the USA, I couldn't seem to get any lighter than 165-170 pounds even
when trying to diet and exercise heavily (like 3-4 times a week of strenuous
exercise for 1-2 hours minimum, and keeping track of all the food I was
eating); but then when I lived in Japan for a few months (probably one of the
skinniest countries in the world), I didn't even try to diet and I lost 15
pounds (now I'm at 150 lbs).

Lifestyle is clearly a big influence here. My understanding is that generally
speaking foods are not sweetened as much there, portions are smaller, and
people walk a hell of a lot more. I've also heard that the quality of
ingredients in general tends to be higher across the board.

The cheap food, which I ate a whole lot of, aren't even something I could
consider "healthy"—lots of fried food like tempura and kara-age, along with
lots of noodles—but even without restraint eating those, I still ended up
losing weight without trying. Interestingly I think my diet got a lot higher
in carbohydrate intake and my protein intake shrank. Probably some amount of
my weight loss involved muscle loss, but my belly shrank considerably as well,
so I don't think it was exclusively that.

I think I just gradually got used to eating less, stimulating myself with
sugar less frequently and intensely (omg, even diet soft drinks and gum are so
powerfully sweet), and being more active, and now that I'm back I realize just
how much of a premium I have to pay to not get huge portions of food
completely saturated with fat and sugar.

------
akurilin
As a 100% sedentary person (I sit for maybe 14-15 hours a day) I've had pretty
good results with a combination of:

* 6 days of gym (4 lifting, 2 HIIT + cardio for 40 min)

* 2-3 days of water fasting every week, sometimes every other week

* reduced calories

* cutting out most foods that have added sugar, sweeteners or refined grains in them

* doing most of the cooking myself with non-processed ingredients (so vegetables and meats you could get at any market)

* 8-9 hours of sleep on a fixed schedule

It takes a significant amount of discipline and lifestyle changes, but it does
lead to also significant results. You generally can't sit in front of a
computer as much as I do and also expect to look a certain way without a
fairly radical approach. 185lbs to about 160ish in ~6 months at 5'11".

I have a ridiculous amount of energy and for once I feel pretty good about how
clothes look on me. Ultimately you have to experiment and see what works for
you, most bodies are different and will react differently in subtle ways to
diet and exercise.

~~~
chrisseaton
You aren’t 100% sedentary if you’re in the gym six days a week!

~~~
vinceguidry
A friend of mine puts it this way. If you don't want to die of a heart attack,
figure out how only sit, sleep, stand or eat for 23 1/2 or fewer hours a day.

~~~
gomox
That's a great way to put it.

------
teekert
FWIW The few times I was in the US I noticed a couple of things different from
my country: 1. We drink water/coffee/tea all day (mostly without sugar), in
the US I see sodas constantly (ok, usually light). Also, US guests here always
ask for the soda machine while we constantly offer black coffee and water. 2.
Portions are huge! One cannot go home with even a trace of hunger. Whereas
here, it's ok if it at least tasted nice. 3. Almost all food was sweet, have
some Asian wok food? Extremely sweet chili sauce on top. 4. Unlimited refills
of soda. It's nice but you drink a lot :) 5. 4 p.m. snack? Out come the
pastries (sugar and flour glued together with butter)! Here we may have a
cookie or some fruit among my colleagues at least. 6. Breakfast? We have
yogurt with muesli or a sandwich (meaning we put a 2 micron thick slice of
cheese on the bread) and perhaps a boiled egg. In the US: The smell of Fried
potatoes fills the room! 7. Pizza: Have a good pizza here and the sauce is
just tomatoes and some garlic. Have a US pizza (sure we also have them here)
it's sugar and salt all the way. Better drink 5 glasses of water 1 hour after
eating over 10 mg of salt or you will get a headache. 8. We usually cook
ourselves, from fresh vegetables and meat or fish. In the US it's much more
common to eat out. It's very unlikely to pile sugar and salt into a home
cooked meal. 9. I haven't seen the situation in schools but one hears these
"pizza is vegetable" stories from the US, here the kids only drink water in
school (at least ours, it's not obligatory but parents provide the drinks and
most of them get water) and a piece of fruit. During lunch they get about 2
slices of bread with meat or cheese or chocolate sprinkles (hagelslag).

At least that was my experience. Of course, I loved the burgers and after a
few days of them you start to get that real craving for them. I love burgers
and I love fries.

------
w323898
I've gone from 255 (BMI 33) down to 185 (BMI 24), back to 205, had an illness
and got up to 225, now back to 210. I resent the article acting like this
long-term weight loss is somehow a freak occurrence.

I just watch what I eat and exercise. Many people with obesity just don't like
to exercise, but I love it. This is a natural advantage I have. But I also go
on days when I don't feel like going, skip office snacks, and so on. It's
neither magical nor impractical.

Ultimately, obesity has been normalized and people don't really care. This is
going to be hard to change, either hard on society in funding education and
support resources, or hard on the obese in cutting them off from health care
and other Draconian measures.

------
arcadeparade
Apparently even animals such as monkeys and rats kept in labs and fed the same
calories under controlled conditions are fatter than the same animals fed the
same decades ago. Xenoestrogens?

~~~
joker3
It might be climate change.
[https://www.theguardian.com/environment/2014/may/07/climate-...](https://www.theguardian.com/environment/2014/may/07/climate-
change-food-crops-nutrition) details how high CO2 levels lead to food crops
with more sugar and less nutrients. As a result, animals fed the same diet
aren't getting the same calories as they used to.

~~~
cwkoss
Soil depletion and optimizing for size has also caused a drop in vitamin and
mineral content

[https://www.scientificamerican.com/article/soil-depletion-
an...](https://www.scientificamerican.com/article/soil-depletion-and-
nutrition-loss/)

------
WD-42
> “This idea that people should eat less and exercise more — if only it were
> so simple,” Dr. Hall said.

Of course pharma companies and the healthcare system don't want it to be that
simple: better to sell drugs to people to fix the problem. Likewise, consumers
would rather take a pill than do something difficult, like eat properly and
exercise.

When you consider how prevalent this kind of attitude is the obesity levels
stop being a mystery.

------
pkaler
>> “This idea that people should eat less and exercise more — if only it were
so simple,” Dr. Hall said.

Well, actually it is that simple.

The problem is: 1) sugar 2) long commutes 3) sitting all day

And the solution is pretty simple, too. 1) Turn sugar down to 0 2) Do 50
burpees per day

The big meta problem is that people talk about it and complain about it and
hand wring about it rather than doing the simplest thing possible.

~~~
WD-42
This applies to way more than just diet. As I've gotten older I've realized
how many people are totally adverse to doing things that are even marginally
difficult or inconvenient. Eating healthy and exercising definitely fall into
that category.

------
gkfasdfasdf
People in the 70s didn't all have bariatric surgery, or access to miracle
drugs to control hunger hormones. Nor did we all develop some mutation that
caused the current obesity epidemic. Clearly something in our environment has
changed. Seems to me that it would be simpler to figure out what's changed
between now and then, rather than try and invent new drugs. I.e. we need to do
root cause analysis rather than flounder for workarounds.

Some have suggested that the carb-heavy government food guide pyramids are to
blame. That seems to be a good place to start.

------
bkovacev
It's the habits.

In the 1970s - people did not have a habit of eating 3 full blown high calorie
meals. They were working physically intense jobs (agriculture, mines,
metallurgy etc). Nowadays the hardest thing we do is think. They'd spent more
time outdoors. They'd rather do sports and spend time in nature actively
resting than binge watching tv-shows and movies on the weekends. People didn't
have as much food available to them as today. They also had less commodity.

Why do people regain fat they lose? It's the habits.

They'll get the bariatric surgery done, but will never change the habits.
They'll go through the 600 calorie liquid diet and will continue to eat the
same things that made them fat initially.

They'll continue binge watching tv shows on the weekends, without lifting
anything heavier than their spoon or the remote.

They'll continue undergoing the fad diets that don't do anything but make
their metabolism slower and make their bodies over compensate due to starving.
People are lazy and refuse to listen to their bodies, but will gladly listen
to the brainbait titles of famous ads/instagram posts.

Why we're fat? We're fat because we look for immediate gratification that
sugar produces rather than the gratification of being able to climb ten floors
of stairs with ease. My dad recently told me that he wants to do bariatric
surgery which will "jumpstart" his weight loss. He unfortunately can't walk
200 meters right now, without getting tired. Do you think something will
change if he undergoes the surgery or will he continue eating the same :) ? I
bet it's the latter, since he won't have an incentive to change something.

~~~
randomFacts
People regain weight because of the hunger hormone Grehlin, which gets high
and stays high after losing weight.

~~~
bkovacev
I believe you can reduce Ghrelin by fasting - I'm not near a computer to fully
support this claim, but can update later with proper links to studies.

~~~
randomFacts
If you go on a Very Low Calorie Diet(usually in the range of 400-700 calories
or less a day), your body goes into starvation mode, thinks that there must
not be enough food to go around so no need to feel hungry. That might be what
you're referring to as fasting should have the same effect. I haven't heard of
the effect continuing after starting to eat 1000+ calories a day again though,
so I'd need to see some data on that.

------
chris_mc
Compare the serving sizes and caloric intakes at a USA restaurant with those
in Japan, for example, and you'll see why. It's not hard to figure out, we put
HFCS and sugar in everything now and people eat 2x as much as they used to.

I lost 30 pounds over 2 years by being hungry non-stop and walking about 3
miles per day to work, so losing weight isn't just a "pill disease" that we
can solve with a pill, it requires a person to have the self-control to be
hungry and exercise, and (from experience) over-eaters don't tend to have much
self-control in that area.

I think obesity should be treated more as a mental health issue than physical
(for most people, there are exceptions), because there is no better way to
lose weight than diet and exercise and doing it at a slow rate.

Obesity is an example of a problem like climate change. We know how to solve
it (less sugar, better food, less calories, more moving) but no one wants to
take those steps. I feel like this will also fall back onto the food
companies, who will probably be reviled in 50 years like the tobacco companies
are today.

------
eezurr
The body (ie the brain) is amazing at adapting to its environment. One thing
to keep in mind is that as unhealthy food becomes the norm for a person, their
brain sets a new baseline for how much of this food it thinks the body can
handle (side effect: more sweets are needed to release pleasure in the brain).

Speaking from my own experience, I eat pretty healthily, and cook most of my
own meals. The few times I've had anything sweet in the last decade, I could
only handle a small amount of it before my brain and stomach were telling me
I've had enough. If I push myself, I began to feel ill. (Example: 4-5 Sweetish
Fish is enough for me)

My own defense mechanism is because of my parents. They never bought soda and
sweet snacks (e.g. gushers, fruit roll ups) at the grocery store, although a
handful times a year I got to go to a candy store and pick out a couple items.

I would guess (based on anecdotal experience though) that a child's diet is
the number one cause/preventative of obesity. It sets the culinary stage that
they will dance on for the rest of their life.

~~~
pmarreck
> I would guess (based on anecdotal experience though) that a child's diet is
> the number one cause/preventative of obesity. It sets the culinary stage
> that they will dance on for the rest of their life.

While this is only anecdotal data, this is not true for me. I was a skinny kid
because I never got soda, I never got ice cream truck, I never got pizza or
pasta, and if I spent more than an hour on the computer (note: I'm a
programmer now) my mom would yell at me to go outside and bike, or drag me to
the local beach or town pool for the day.

Well, all that forcing me to eat "proper" instead of _teaching_ me to eat
"proper" built up quite a bit of resentment apparently, in my freshman year I
gained 20 lbs and kept going (with swings up and down) and I have not seen 185
lbs since then.

I'm currently 6'3" and ~260lb @ 46 years old. Last week I worked out 4 times
(all Orange Theory, which is no joke). I'm about to work out again in a few
minutes. I'm trying to watch what I eat, considering going back to calorie
tracking but IT IS SUCH A PAIN. The tracking is more of a pain than the eating
less, lol. (I'm also ADHD, which might explain why.)

------
babyslothzoo
Let's not forget that obesity is also socially contagious, and there is
tremendous social pressure to conform to obesity, which is why if you're less
fat than fatter people, they will publicly shame you for your lack of
comparable obesity with comments like "you need to eat a cheese burger" or
'get some meat on those bones' etc.

------
ryanmercer
Because we can spend 1$ and get 400-1200 kcals out of a vending machine (that
takes 10-30 seconds to consume), while we sit at a desk all day and evening,
instead of having to plant/weed/harvest/process our food in a field.

 _he says as he eats candy_

We have ridiculously kcal dense food immediately available while we also have,
on average, extremely sedentary lives.

I mean, looking at:

\- Starbucks menu you can get a beverage that comes in at 500 kcals without
even getting fancy.

\- Symphony milk chocolate bar: 149 kcals/ounce.

\- White Castle chicken sandwich (about half the size of a deck of cards) 350
kcals

\- Wendy's Baconator 950 kcals

\- McDonald's double bacon smokehouse burger on artisan roll 1130 kcals (most
of McDonald's value meals can actually easily get into the 1000+ kcal range
without any special modifications)

\- Burger King Whopper 660 kcals

\- 32 ounce Coke 370 kcals

\- Papa Johns sausage pizza 260-410 kcals a slice (depending on the pizza
size)

We can get insane amounts of kcals, with relative ease, in dense little
packages while being largely inactive.

Edit: since this was downvoted to -2, HN is throttling my ability to reply to
the individual that replied to me, in regards to 'first world countries':

[https://obesity.procon.org/view.resource.php?resourceID=0060...](https://obesity.procon.org/view.resource.php?resourceID=006032)

Obesity percentages: US 36.2%, NZ 30.8%, CA 29.4%, AU 29%, UK 27.8% all 'first
world countries' out of the top 10 and if you look at the complete list the
bulk of the 'first world' countries, where convenience foods/fast foods are
readily available, are above 20% obesity.

~~~
twblalock
There aren't very many people in first-world countries who need to farm
anymore, and all first-world countries have desk jobs and vending machines,
yet the rate of obesity varies widely between first-world countries.

~~~
squish78
Likewise, Belize and Qatar have higher obesity rates than the USA, so it's not
necessarily correlated with the development of a nation

------
csours
Because we eat like royalty. I have access to exceedingly tasty food all the
time.

If you look at food we eat every day, they used to be celebration foods: Ice
Cream, Tamales, Cake, etc.

Additionally, if you have a sedentary job, you won't be burning off the carbs.

------
shahbaby
There are so many things wrong with this article, here are some facts.

1\. More insulin causes the body to store fat. Less insulin causes the body to
burn fat.

2\. A low-carb diet lowers insulin levels.

3\. Over the last few decades they started adding sugar (carbs) into almost
every food product while the US government published a food pyramid with a
heavy emphasis on carbs.

4\. As the article states, now we have an obesity problem which was not as
severe in the last few decades.

------
acconrad
> _“This idea that people should eat less and exercise more — if only it were
> so simple,” Dr. Hall said._

For the majority of people, it _is_ that simple. That doesn't mean it's easy.
To give most folks a hall pass on their poor eating habits with bariatric
surgery or a special pill (which are for extreme outliers) is dishonest at
best and harmful or dangerous at worst.

------
annamargot
Counter-acting the factors that made a person fat in the first place seems
very difficult. Especially when compounded by an always-aging body.

Off the top of my head:

    
    
      - genetic pre-dispositions
      - Eating habits during childhood
      - Eating habits during early adulthood
      - the effects on metabolism and body chemistry of the above
      - Many more, I'm sure

------
momentmaker
Mostly it comes from our diet and what we eat.

We've become accustomed to eat for our senses (taste) instead of our survival
(nutrition).

We're addicted to the taste of 'good' food.

Then you have food companies who are engineering that addictive taste for your
senses.

A habit develops and it's hard to shake that off.

------
greenteabee
I've had success getting in shape by tracking what I eat and following a
weight training routine (PPL). Counting macros gives you a flexible diet. Buy
a food scale and eat enough food to hit your macro goals to be at a daily
250-500 calorie deficit.

That means you'll lose 0.5 - 1 pound per week. Once you're lean, eat at a
slight surplus to gain some lean body mass.

Sorry everyone, there's no magic pill that burns all of your fat. There's
steroids, but you'll still have to eat enough and go to the gym.

People want to get fit but don't put in the time nor effort.

------
Rainymood
It takes time, delayed gratification in this era of instant gratification is
tough.

------
sfilargi
> No one really knows why bodies have changed so much

How can one claim this?

------
k__
Eating garbage and sitting aroind all day.

~~~
mmsimanga
Reading HN. Sigh.

------
kzrdude
Health shouldn't have to be hard. It's so simple yet we have a hard time
reaching it in a normal life:

1\. Eat real food (Cook it yourself) 2\. Sleep! 3\. Exercise 4\. Socialise 5\.
Avoid stress

------
randomFacts
I'm currently losing weight with a weight loss specialist. They had an intro
presentation and went over some of the reasons we have such an obesity
epidemic and why it's so hard to keep weight off. Some of the key points they
mentioned:(I'm paraphrasing here because I don't have my notes on me.)

-

There is a hunger hormone called Ghrelin. The amount that your body produces
is based on the highest weight attained that you kept for at least a year.
When you're at that weight, your Ghrelin levels are at about the same as
someone who is 150 pounds lighter that you who is also at their max weight
ever attained. However, once you've lost weight your body starts producing
more Ghrelin which makes you hungrier. This takes decades to reset from
whatever your bodies weight target from 'highest weight held for at least a
year' to your new lower weight so basically your Ghrelin levels will be higher
than average for decades after losing weight(unless you gain it back). There
is also another hormone that was recently discovered to has an effect on
appetite but I can't remember its name and we didn't know much about it yet.

-

Regarding gaining weight, there are three satiety signals that are used to
help you not overeat. One is a feeling of fullness that only lasts for ~15
minutes but kicks in within a bite or two of calories needed to maintain
weight so if you have this signal you may only gain 3 pounds max in a year as
long as you don't wait 20 minutes and then go back for seconds. The second
satiety signal was loss of savor(food just stops tasting good) and lasts for a
couple(~4?) hours. The last was feeling nauseous(not the same as eating so
much you couldn't fit another bite and can't move, we can all get that), and
was triggered by eating a couple bites past the fullness signal level(if you
only have this signal you may gain ~15-20 lbs in a year if I'm remembering
correctly). The problem is that most people only have one or two of these
signals and many don't have any of them. If you've never had to diet to lose
weight and have always had a good weight level then congratulations, you
probably have at least 1 or 2 of these and maybe all three. If you've had
several diets and have lost hundreds of pounds in aggregate over several diets
over a decade plus then chances are you probably don't have any of the 3
signals. Everyone else probably falls in the middle where they only have 1 or
maybe 2 satiety signals.

-

If we were able to determine what gene/set of genes or other processes
determined if you had these signals and were able to give others who don't
have them the ability to receive these same signals we would be able to keep
new people from gaining weight. If we found a way to reset Grehlin levels for
people who have lost weight(hopefully a pill, maybe through gene modification
via crispr) then we'd be able to help people who have lost weight to keep it
off long term. Regarding sugars, etc. yes, it makes it infinitely harder to
diet when there are so many high calorie options out there, but there are
deeper underlying medical reasons out there than just that.

-

Basically, the only people who have been able to be successful at keeping
weight off long term are those who either exercise 2+ hours PER DAY(less time
can help with strength, etc but not with weight loss/maintenance because
you'll just be hungrier and end up eating more calories to make up for the
ones you burned) or those who are perpetually on a diet for the rest of their
lives and work hard to re-lose any pounds gained after a trip, etc. The good
news is we're making some progress in weight loss research(but still have a
long ways to go) and there are decent appetite suppressants, etc. that can
help you lose weight and keep it off if you go to a Dr. that specializes in
this and that this isn't an impossible to solve willpower problem, but a
medical one that can be fixed. The bad news is you'll probably be on a diet
for the rest of your life or until we solve the above questions on satiety
signals and hunger hormones.

-

tldr: it's a medical problem, not a willpower problem, and won't be fully
solved until we treat it like such and invest the resources into finding a
cure. Until then we're just treating the symptoms.

