Hacker News new | past | comments | ask | show | jobs | submit login
The Weight I Carry (theatlantic.com)
103 points by danso 3 months ago | hide | past | web | favorite | 135 comments

Being significantly overweight is really tough. Body issues and shame make it so much harder. I wish people would understand that better. There’s a pretty nasty cycle of looking in the mirror, feeling like shit, eating to not feel like shit (the key problem step - note that it never actually works), looking and feeling like shit because you eat too much.

I’ve lost 70 pounds in the last ~7 months. 50 pounds to go. I’m successful for the first time because I’ve gotten over my image issues, I’ve accepted that losing weight necessarily involves being hungry at least some of the time, and I had a ‘spiritual’ experience.

They’re damn right that it gets harder to lose weight every time you do. My metabolism is miraculously “efficient”. The insight is that you have to accept that and eat to the amount that hits your goals, not try to find some miracle diet.

Also, IME, exercise makes me hungry for more calories than I burn. Exercise to get healthy, treat the metabolism boost as a bonus. Exercise does not cancel out foods (this is speaking to fat people like me - if you’ve been skinny your whole life your body probably works differently).

> Exercise to get healthy, treat the metabolism boost as a bonus. Exercise does not cancel out foods

Thank you! Exercise should be completely supplemental to overall health, not to lose weight. The amount of times I've seen people eat an awful meal while trying to lose weight because they "worked out extra hard" is astonishing.

Losing weight is almost completely related to what you put in your body. While you can certainly lose weight from exercise, it's by far not the most profound way to do so.

Congrats on your weight loss by the way, former fat kid myself, I know it's not an easy process and keeping it off is just as hard!

Yep, it's the food. I took up running four years ago, but saw no real effect on my weight. (Def helped me from getting winded and made hiking fun, etc. — so exercise is cool, no doubt).

I had a medical emergency early last year that caused me to cut my food intake (I feared too large of a meal would cause another medical emergency). So I looked at the plate of food in front of me, measured out what I thought was a "reasonable amount", and ate only that. No seconds.

Within two or three months I dropped 20 pounds.

Had surgery at that point. After surgery I no longer worried about medical emergencies so I resumed my original eating habits.

And steadily put the 20 pounds back on.

> Also, IME, exercise makes me hungry for more calories than I burn. Exercise to get healthy, treat the metabolism boost as a bonus. Exercise does not cancel out foods (this is speaking to fat people like me - if you’ve been skinny your whole life your body probably works differently).

Conveniently summarized as "You can't outrun your fork". No amount of running replaces a calorie deficit.

Also, props for 70 pounds of weight loss. That's a huge number.

Actually you're more of less agreeing with the conventional wisdom of those who do weight lifting. The vast majority of fat loss is simply diet.

Walking, is helpful. And strength training is good to prevent muscle loss.

Anyway, the above is actually the conventional wisdom of those who go to the gym and try to get lean. This is not the message you hear in pop nutrition however.

Congrats on your progress! If you do ever do strength training (or for anyone reading this), one very simple metric to add is weight + waist measure.

After all, the goal is fat loss, not "weight", per se. When doing lifts, it can be discouraging to see the scale not moving. However, in lost cases the fat is still going away and the waist shrinks.

When I got serious about this stuff, the best decision I made was to focus on performance measures instead of body composition ones. I’m still overweight (but not nearly as much as I once was), but people don’t generally treat me like it because I don’t act overweight— I’ve now got more strength, endurance, and agility than a great many normal-weight people.

So, for most people, my advice is to first focus on how much they’re able to do: it’s faster and more reliable than weight loss, brings comparable health and social benefits, and puts you in a better position to appreciate the fat reduction when you start focusing on that.

That's a great approach. I should add that having only one measure is discouraging: in fitness or anything else.

So your approach broadens beyond weight and gives a win, even in the event weight temporarily increased.

Also per my previous comment, I suspect that if you got stronger, then you probably lowered your weight circumference too. At least if your weight was stable. Muscle mass and bone density take the place of fat as strength increases, at equal weights. Hard to go wrong with functional measures.

The types of fat may change in a good way too as function increases. I looked into the health of sumo wrestlers. Turns out that at an equivalent fat percentage of a non-athlete, they will have much less visceral fat. This is fat around the organs, and is the type of fat most linked to bad health effects.

I think exercise for weight loss/management isn't going to be a good idea for the vast majority of people. As you said, you get hungrier when you burn those calories and it's very easy to spend five minutes and eat all the calories you burned working out for an hour.

When I exercise, it puts me on a health-minded path every day that snowballs into other good decisions. It's like how they say making your bed in the morning helps put you on task the rest of the day.

I find your line of thought unconvincing. The thing in common among everyone I know who is overweight is that they don't even work out at all. The amount of people I know who don't do anything is astonishing. The problem people have with exercise is that they don't build the habit at all. That's where they fail, long before your hypothesis could even be tested.

"Better not exercise so I don't overeat!" sounds like every other self-sabotaging bargaining we do to avoid effort, like not jogging because you can't yet afford nice running shoes. This seems like the last excuse that we need to be peddling to people trying to turn their life around.

I think it goes the other way around -- once people get overweight, they stop exercising.

When I was overweight (I've lost about 80kg), just walking around the shops was a significant exercise, I'd be short of breath. Now I need a 15 mile bike ride to achieve the same level of exertion. Also, after any kind of exercise it used to be every joint would hurt.

I think you're on the right track, but you have to account for the biases in the fat people who need this advice. No amount of exercise can counteract overeating at the scale seriously fat people (like past versions of myself) do.

Often weight is _the_ barrier to exercise. When I was at 300lb it was physically painful to walk more than a few minutes. The small muscles near my ankles just couldn't take it.

After I lost ~25lbs I suddenly could walk without serious trouble. I'm still working on actual exercise beyond walking 30 minutes to and from work each day.

You can use it as an excuse but really I suspect for most people sticking with a diet is actually much easier than sticking to an exercise plan. Especially if you didn't grow up exercising and don't have any happy memories of exercise.

When did you start exercising regularly? Any tips for the rest of us on sticking with it long enough to form a habit?

I lost 50lbs a few years ago.

Walking was a great gateway drug for exercise since I really hated the idea of exercise and sweating, plus I felt so awkward and out of place going to a gym. It always felt like everyone at the gym was staring at me and I felt stupid not knowing how to do things properly. Walking was a solo activity and pretty hard to do wrong, so it eliminated the self confidence barrier at least. Listening to podcasts and audiobooks made the walking more enjoyable, sometimes I’d walk for hours and not realize how sweaty and tired I was until I stopped due to a phone call or something.

Beyond walking, a friend got me into rock climbing. It seemed super daunting since everyone at climbing gyms is so buff and I had no muscle and lots of fat and couldn’t do a pull up to save my life. But it turns out with proper instruction the entry level climbs are pretty easy, no harder than climbing a ladder. But then when you get to the top there’s adrenaline from the height looking down, plus a real sense of accomplishment. It helped me build momentum. Eventually things got easier as I did it more often. And once I started looking in the mirror and seeing actual muscle on my arm it was a huge confidence boost and I doubled down on my efforts. Getting over that initial hump where you don’t see any benefit yet is the hardest part. I never fully lost my belly fat even today, but the visible muscle growth was something I could latch onto to keep motivated.

TL;DR: start small, avoid situations that hurt self-confidence, find things that are enjoyable or exciting, look for signs of progress in order to stay motivated

Edit: to be clear my diet changes made a huge difference as well, I’m not attributing my weight loss entirely to the exercise. But I was responding to the question of how to start exercising. I do think it made a difference. I found regular exercise improved my mood which probably helped me limit overeating from depression/stress.

> The thing in common among everyone I know who is overweight is that they don't even work out at all

Exercise does not help people lose weight, and it may make it harder for people to lose weight.

Exercise is important, and we need to help more people exercise, but we should avoid suggesting that exercise helps weight loss. It does not.

Do you have any sources to back you up? I was never obese, but i definitely was on the "healthier" side back in the day (~182 pounds at 5'8"). Going to gym and running or working out gives you a perspective of how much work you need to do to burn even 100 calories. Iirc, A can of coke contains ~160 calories, two oreo cookies contain around that amount as well. Once you start thinking about how many calories you need to burn to eat those things, your diet becomes significantly healthier. And before someone says anything about not being able to control themselves, i will still finish an entire pack of cookies in one sitting if i buy them. What has helped me is not to buy them outright itself.

It definitely did not worked for me that way. I was never obese, but exercise like lifting weight made me more hungry and that was pretty much impact of it on food. The diet did not became healthier at all - just bigger.

Well yeah, they say weight loss starts in the kitchen/80% of gym is in the kitchen/abs are made in the kitchen. If you aren't informed of what you eat then it's not gonna make a difference. Though your heart will thank you for exercising.

That's extremely wrong and dangerous advice.

Exercise is absolutely essential for healthy weight loss unless your sole focus is on lost mass. Exercising while dieting (meaning restricting calories) minimizes the loss of muscle tissue when trying to lose >1 lb/week. If you're losing >2lb/week dieting without exercise, a sizable portion of the weight loss is actually muscle.

It is possible to take the exercise to an unhealthy extreme, such as on Biggest Loser, where they exercised to the point of causing muscle damage/rhabo, but that's the exceptional case, not the norm.

Exercise absolutely helps weight loss. 100%.

It is not wrong advice. It is not dangerous.

Exercise is essential for health. From a purely scientific numbers perspective, it has little impact on weight loss in the morbidly obese. The vast majority of impact is from food consumption.

Too much Aerobic exercise can be detrimental to weight loss as it encourages metabolic slow down and increases cravings for easy energy. It also has near zero impact on preserving lean body mass. Modest aerobic activity is always healthy, but in the morbidly obese, any more than that is counter productive.

Weight lifting on the other hand does have a major impact on preserving lean body mass during a diet, but it also depends on you eating a lot of protein. Without the protein, you’re also not going to be conserving lean body mass.

Again, what you eat is the most important. You can lose trmeendous fat , water, and muscle mass purely by eating less. It’s going to be fat-loss with with 20-30 minutes of walking 5 days a week, and some modest dumbbells or resistance band work, and a decent amount of lean protein ingestion.

I find protein bars are pretty good at fighting my hunger pangs.

High protein, and (while still calorie restricting) high fat does wonders for appetite.

Also: water! As an obese person I kind of had to learn what thirst is because I almost always interpreted it as hunger. Also vital while your stomach is shrinking if you're used to overeating (as I was).

> and I had a ‘spiritual’ experience.

Obviously no pressure here, but are you willing to share your experience?

LSD, going into it with some specific anxieties and things I wanted to work through.

I ended up a lot more in touch with myself and more in tune with my body. After that it was just unfathomable to not lose weight.

The tricky thing about LSD is you don't learn anything you didn't already know, it just clicks in a real way for the first time. Having a mental model/ knowing something is a distinct process from internalizing it in a way that affecrs behavior.

I feel for the author. I have also struggled with my weight my entire life. At my heaviest, I was 265lbs. I definitely struggled, and continue to struggle with body issues. I was definitely addicted to food and was an emotional eater. I literally had a term called "stress cheeseburgers" as when I was stressed that's what I'd do.

I finally decided to make a significant change last year. It started with me doing meal prep for my lunches. Previously I would eat out for lunch every day, and I would never make good choices. I was able to lose about 35lbs by just doing that and making no other changes in my life.

In August, I decided to start the keto diet. I started not for the weight loss reasons, but for the lifting of the "brain fog". I didn't realize how much carbs controlled my life until then. Eating keto 100% changed my life for the better:

* My relationship with food has completely changed. I am now concerned about what I'm eating, nutritionally speaking, instead of just quantity and taste. I am eating a lot more whole foods.

* My overall pain level has gone down significantly (I have back problems).

* I literally crave vegetables. My first couple of weeks I ate nothing but bacon and other unhealthy meats. After a while, all I wanted was a big plate of broccoli!

* I have much more energy and mental clarity. I also noticed my recovery time from working out is lessened.

As of this morning, I weigh 196lbs. I don't know how long keto is sustainable for, but I plan on sticking to this for the long term. If I do stop, I will definitely apply the lessons I've learned from going keto: mostly eat whole foods and carbohydrates that have nutritional value.

For me, with keto, I have much less of a hunger feeling, making things more manageable (As I've said in another thread). Agree with the mental clarity also.

How did you stick with it though? I can do the diet, but find it hard to do with social stuff. For me, doing keto was quite a lonely thing.

I'll chime in and say, the social stuff has never been a problem when I've done keto. Out at bars, I'll have whiskey + diet cokes, gin + club sodas, basically anything that's a shot and a calorie-free mixer and you're good.

Eating out, most cuisines you can adapt. Nowhere serves a keto pizza, for example, but even stuff like Indian, there's a buffet where if you avoid the rice and legume-based stuff and stick to meats and veg, you're in good shape.

Eating at friends' places is the one tricky thing, but these days people are pretty cool with it if you decline food based on a dietary restriction.

Giving up snacks or junky foods like breakfast cereal is the hardest for me, but there's a great keto porridge recipe I like -- add a handful of berries and it's still 2-3 grams carbs but filling and good.

Longest I stuck with it so far was 6 months, for accelerated weight loss, and now I prefer a lower-carb diet but am no longer strict about keto stuff.

Best outcome was breaking my relationship to food -- like it rewired the part of my brain that was all "satiate your hunger with sugary junk" to where I can satisfy hunger cravings with a handful of nuts, or even a hot tea with cream. That seems to be permanent so far.

It's funny but breakfast was really easy... I never felt hungry at breakfast anyway. I have noticed how well I do if I get a fat coffee (coffee+butter+mct oil, and flavored stevia blended) in the morning over ice though. I do that about once a week or so.

The social piece is hard for me... my GF moved in with me last year... I was eating one meal a day for the most part and doing pretty well, now I'm trying to keep lunch in check and not overdo dinner. The other aspect is the bagels, doughnuts, and birthday cakes etc at work.

Those things have been harder than retraining myself not to eat when watching TV in the evenings.

Yea hunger is completely more manageable, from what I understand it's related to not having severe insulin fluctuations. I'm only ~6 months in, so I can't speak from a point of authority here, but my partner has been doing keto with me which definitely helped get me over the initial hump. Now, I just look at how far I've come and know that if I revert to my old ways I'll thwart the progress I've worked so hard to achieve. Honestly, right now it isn't hard to stick with.

I purposefully broke keto once (for my birthday). I had Pho and some cake. It was deliberate and delicious, and the next day I felt like complete garbage. That also helps motivate me as I like feeling good :)

What social stuff? I have vodka sodas if I need to drink. Almost every restaurant will give plain foods with butter on the side (usually for free).

I agree with vodka sodas, I will also occasionally have a Michelob Ultra (2.4g carbs per bottle). I don't have any issues eating out either.

how long did it take you to go into ketosis - im on day 10 and still havnt not gone in (im not really overweight)

Rule of thumb (Keto for mostly 15+ yrs, from 300lbs to 180) is 2-3 days, and at least Atkins version is those 2-3 days at <20 carbs.

"Being in ketosis" is hard to track; the urine test strips are helpful but not always accurate. Someone came up with a breath analyzer at some point but I lost track of the project.

Some recent stuff has shown that a 24-36hr fast can "kick start" ketosis as well; anecdotally it seems to work for me, but again I have to kind of go by feel. (Or if I note that I suddenly drop the 3-5 lbs of water weight that came on when out of ketosis.)

The breath analyzer that is being hyped right now is called Keyto. You can also get blood testers and prick your finger.

I don't track myself being in ketosis on a daily basis, but I can definitely tell if I go over based on how I feel.

How are you testing... urine strips? For me, I can feel the difference in my brain when I change over. It's subtle, but I'd compare it to the change in feeling when you drink caffeine after not drinking it for too long.

im also drinking exogenous ketones too now


it doesn't take me long at all if i'm very strict on the carb limit, especially if i fast for a day before. maybe 2 or 3 days? but i don't get keto flu at all, so ymmv

How strict are you being with carbs?

< 20 grams per day, basically all i eat is broccoli rabe and grilled chicken. maybe im not eating enough fat.

Too much protein can also kick you off/keep you off keto.

Definitely up the fat, especially cause grilled chicken won't be particularly fatty itself...


Magnesium is known to be depleted when stressed. You should consider adding that as a supplement.

Also high stress = high cortisol = high glucose production (even from fat/gluconeogenesis) = high insulin = increased rate of fat storage and insulin resistance/diabetes


Agreed, there are electrolyte depletion issues with keto. I take a magnesium supplement daily. I eat enough greens & salt that sodium and potassium aren't an issue for me.

Amen. I dropped from 235 to 182 a few years ago doing keto and it definitely was like a fog being lifted.

Unfortunately I’m back up to 225 but my life’s in a different place with new demands and stresses to figure out how to work healthy eating around. It’s a constant struggle!

I feel you. ~260 to 164, back to 215, but on it again! Stay strong!

I have been keto for a little over 2 years in case that is anecdata for length of sustainability.

I've been 400 pounds most of my life. I empathize with every single sentence in this article and cannot imagine making myself write something like this. The vulnerability is incredible.

I'm really glad that exercise is being called out as useless to treat obesity more and more. I hope that trend continues and things like Michelle Obama's "Let's Move" campaigns never happen again.

Carbohydrate addiction is no joke, even though most don't believe it exists.

While I agree exercise isn't very effective to treat obesity, it is still healthy for you to exercise, even if it's not going to help you lose weight. There are a lot of people who are overweight who have healthier hearts and lungs then normal weight people due to exercise.

I can not give you more +1s. If your goal is to be healthy, and not necessarily be pretty, exercise is integral. You can be skinny and be unhealthy. You can be overweight and be heart-healthy, if you exercise.

I am obese according to the BMI, but I run 3 times a week and my resting heart rate grazes into the "athlete" territory. My doctor is very happy. But I don't look it, that's for sure. I do not like running. I see it like brushing my teeth. I don't like it, but I do it because I have to if I want to maintain my body.

While being obese and having a healthy heart is totally viable, it get's harder in the long run as age compounds with weight. Can you be healthier than the lazy? Oh yes, but the extra weight can catch up to you, regardless of lifestyle.

Are you concerned about your joints? Running is pretty hard on the knees even for skinny people.

I have always felt that this is a myth or misconception. Humans probably evolved as distance-running specialists [1] so it would be pretty strange if our knees were some sort of exhaustible resource as seems to be the popular idea. If people have trouble with their knees, I think there are lots of potential explanations, for example running too far or too fast before building fitness, which includes conditioning of stabilizer muscles in the knees, or poor running form caused by lack of fitness or encouraged by modern running shoes. I'm a bit biased, but I don't like to see the sport of running blamed for these things.

[1] https://en.wikipedia.org/wiki/Endurance_running_hypothesis

Humans also evolved to be pretty much useless after their children (or maybe grandchildren) are self-sufficient, so being mostly immobile in your fifties is probably of little concern to evolution.

I recommend swimming laps, if you have a place where you can do that. It's a fantastic workout, and easier on the body.

It's worth noting at that level, it doesn't need to be huge activity... 5-10 minutes a day lifting all you can for a few reps (deadlift, sandbag lift-press, pushups, trx row) and a 15-30 minute walk will yeild huge benefits... you don't increase calories much, but your body response is pretty good.

Eating towards keto macros if you are diabetic and at least intermittent fasting are really helpful too. Not snacking is the hardest part to start with.

edit: as to the exercises, form over function... slow for both up and down movements.

deadlift (hexbar if straight is too difficult) at near max weight for 4-5 reps.

sandbag lift and press, go as heavy as you can handle, for as many slow reps as you can handle. (if you're over 25, increase the bag weight, go s-l-o-w, requires more effort)

trx or regular pushups, 4 sets of 25 reps (100 total)

trx row, or pullups, 4 sets of 25 (100 total)

standing squat / deep knee bends (no extra weight), 4 sets of 25 (100 total)

walk to the nearest convenience store, buy a bottle of water, walk back.

Can generally get it all in well under an hour total.


aside: yes, there is more that you can do, and you may want to increase from a walk to swimming, cycling or an eliptical a few times a week as you are able.

there's also more weight training techniques you can do... that said, if you are over 2x the typical weight for your gender and height (mostly from fat), you are so far off, you can get away with just this. Also, if you are looking for just general health, it's a good place to start from.

I'm curious what the problem with the "Let's Move" effort was. I was only aware of it (I wasn't part of it, and never set out to read about it, just caught reports on news or random articles), but it seemed to emphasize two things: eating healthy (which got a lot of flak from conservative commentators for some reason) and exercise (the "move" in the name).

If it only focused on the latter, I'd agree with you. But nearly everything I heard about it had to do with the former (healthier food options for schools and such).

I am not sure if the person heard a caricature of the program, but it focused on exercise, healthy diets, reduction of empty calories like soda, and public policy efforts such as introducing healthy meals to school.

As an example, here is a PDF with 5 ideas for kids:


1) Exercise 2) Try new fruits and veggies 3) Deink plenty of water 4) Break up TV time with jumping jacks 5) Help make dinner.

Those are headlines, but when you look st the details for exercise, for example, these are the benefits it points to, in order:

Feel less stressed. • Feel better about yourself. • Feel more ready to learn in school. • Keep a healthy weight. 1 • Build and keep healthy bones, muscles and joints. • sleep better at night.

Only the 4th out of 6 benefits of exercise mentions weight.

One of the things I hadn't thought of until now was that I heard of the program as an adult. So everything in it "made sense" to me, but I didn't have any stake in it and, well, I was an adult.

Children don't have the same "big picture" view. They're not going to perceive it the same way. And facilitators have to take that into consideration. All those benefits of exercising are correct. But if the facilitator emphasizes the weight part, then that's what the kids will hold onto as well. If the facilitator doesn't emphasize the diet part (or only emphasizes eating healthy with fruits, vegetables and things, but not portion control), then kids will get only part of the message.

As a child obese person (obese at 2 years old, morbidly by 8), hearing that you're supposed to play more and move more to lose weight and then for years attempting to do that and failing over and over again is not only useless but actively detrimental to young children.

Also, I only ate "healthier food options" during that time. I ate too much of it, sure, but "portion control" doesn't mean much when there's healthy carbohydrates everywhere to eat.

Actually, I didn't think about the portion control part. That makes sense. And there would be differences in how kids (especially) would perceive the emphasis of the program versus how adults might. Then there's which aspects and parts the facilitators emphasize.

> Carbohydrate addiction is no joke

Completely believe it, although I think it depends on an individual's metabolism, which is why it's so tricky.

I stop having an insatiatable hunger after dropping carbs; my hunger feeling is more muted and in turn more managable. I have often wondered if "normal" people simply always feel that way, and so portion control is easier for them. I'd do keto more, but it isn't great for one's social life.

The other thing that helps me was Firas Zahabi's advice on Joe Rogan, that consistency and flow are key (to excercise), not intensity. I think his advice generalises to almost everything, how I became good at programming, playing an instrument, and also how I became fat. None of these happened overnight.

Yes I have the same thought with respect to "normal" people. I've had what feels like years worth of sadness around people not being able to understand what the feeling of insatiable hunger after eating a pizza is like. :)

Hey, thanks for posting. I have a few people close to me who struggle with the same issue, I really feel for them and I truly don't understand their daily battle. I want to help but I don't know what (if anything) I could say or do to help.

Regular exercise can help with metabolism, appetite suppression, overall energy level, and overall feeling of well-being. Eating habits are more important, but exercise is generally beneficial.

I agree with you about carbohydrate addiction.

Exercise, also known as moving your body beyond walking, is the most basic instinct every animal has, yet humans have deprived themselves of this basic principle.

Absolutely! You can put a hamster wheel in a field, and wild animals will use it for fun. The 24-hour record for a wild mouse is 19 miles!


I found this study from 1973 interesting where an extremely obese individual performed a supervised fast for about a year and dropped from 456 to 180 pounds.

> A 27-year-old male patient fasted under supervision for 382 days and has subsequently maintained his normal weight. Blood glucose concentrations around 30 mg/100 ml were recorded consistently during the last 8 months, although the patient was ambulant and attending as an out-patient. Responses to glucose and tolbutamide tolerance tests remained normal. The hyperglycaemic response to glucagon was reduced and latterly absent, but promptly returned to normal during carbohydrate refeeding. After an initial decrease was corrected, plasma potassium levels remained normal without supplementation. A temporary period of hypercalcaemia occurred towards the end of the fast. Decreased plasma magnesium concentrations were a consistent feature from the first month onwards. After 100 days of fasting there was a marked and persistent increase in the excretion of urinary cations and inorganic phosphate, which until then had been minimal. These increases may be due to dissolution of excessive soft tissue and skeletal mass. Prolonged fasting in this patient had no ill-effects.

> During the 382 days of the fast, the patient's weight decreased from 456 to 180 lb. Five years after undertaking the fast, Mr A.B.'s weight remains around 196 lb.

I don't know why I haven't seen more studies where extremely obese individuals just stop eating.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/pdf/pos...

> I don't know why I haven't seen more studies where extremely obese individuals just stop eating.

Primarily because it's not considered medically safe, and a study along those lines would be too dangerous to the patients to be permitted.

In this particular case, the 27yo male patient informed the doctors of his plan and said, "This is what I'm doing, you can monitor me or not." They didn't propose the study themselves.

It may be dangerous. But I imagine being 400+ pounds is even more dangerous, especially at an advanced age. Experimental treatments that may be more risky should be encouraged. Otherwise being that size is a death sentence.

One can imagine what one likes, of course. I personally prefer to base medical decisions on, well, medical advice than on mental meanderings. And the medical advice leans the other direction[1].

> Otherwise being that size is a death sentence.

Being any size is a death sentence. Balancing tradeoffs more or less well determines the appeals process length.

[1] People quibble with for all sorts of reasons, some of them even somewhat reasonable. But

> Experimental treatments that may be more risky should be encouraged.

Eh? Do whatever you like with your body, and more power to you. But this is the same flavor of ignorant social pressure game the anti-vaxxers get up to, and is deeply irresponsible.

Body mass index (BMI) is associated with a reduce lifespan.

Compared to a normal-weight BMI, a BMI of:

40-44.9 leads to a loss of life of 6.5 years

45-49.9 leads to a loss of life of 8.9 years

50-54.9 leads to a loss of life of 9.8 years

55-59.9 leads to a loss of life of 13.7 years

Assuming a 445 pounds at 6 feet tall is a BMI of about 60, at about the top of the highest range. I think extreme obesity is a big enough health risk that it should be studied with more experimental treatments

[0] https://journals.plos.org/plosmedicine/article?id=10.1371/jo...

It's quite ironic that your citation for medical advice is just a mental meandering that you were so dismissive of... maybe don't be so arrogant if you're also unwilling to cite the literature.

Couldn't that work as a sort of citizen science project then?

While not this obese, I have gone through a similar experience in the last couple of years where medication almost completely suppressed my hunger trigger. As a result I kind of "accidentally" did intermittent fasting for over a year. My BMI went from 31 to 24 in the span of half a year, at which point my colleagues were getting worried because of the rapid weight loss and I started to rationally force myself to eat during lunchtime.

Since a couple of months the hunger suppression is no longer an issue, but it has been surprisingly easy to maintain a healthy weight and healthy eating habits since.

I suspect one part of the problem is that the body takes a long time to adjust to what it considers a new "normal" weight, which is why diets often don't work. Maybe if they were specifically oriented towards staying at a certain weight for an extended period of time?

Obviously I have to know what the medication was!

Because 1) doctors are typically against this 2) when eating carbohydrates regular this is extremely extremely difficult today. I have discussed it many many times with my doctors and they have all talked about "starvation mode" and all of these things.

I currently intermittently fast very frequently and that has helped immensely with my weight. I have never done more than a 5 day fast, but even that much can do great things in combination with almost-0-carb.

Hey John! You probably don't remember me, but we met in Malmö a couple of years back when you gave a very nice talk. I remember you being very nervous about Douglas Crockford attending it, haha.

I was being grumpy about the death of Google Reader, and you said that that's what you use Twitter for. So you're basically the reason I'm now on Twitter actually.

Glad to hear the intermittent fasting is working well for you! Hope you'll have to buy a new wardrobe for yourself soon ;)

Hello! I definitely remember having this conversation with someone lol. Thank you so much! I definitely remember being nervous that he was going to be an attendee in my own talk and if he'd ask questions afterward that showed I was a fool. :-) Glad that didn't happen!

I've gratefully already given myself a new wardrobe and another one will be coming in a few years. I'm on a slow descent and have been for over 2 years, since cutting out carbohydrates

That patient did (of course) receive vitamins during the fast.

I read somewhere that people who go on hunger strike, consuming nothing but water, die without becoming completely emaciated: they don't look like chronically underfed people at the end. There are plenty of well-known examples of prisoners dying while on hunger strike: they seem to last about 60 days. If you lost weight for 60 days at a constant rate taken from the 1973 case then you would lose about (456-180)/382*60 =~ 43 pounds. I would guess that most people could survive losing that much weight. But unless your aim is to kill yourself then I would advise not doing it with a hunger strike.

I remember Joe Rogan and Peter Attia talking about this on Joe's podcast.

The patient did supplement with yeast, for the branched-chain amino acids. And strangely, at the end of the fast, he didn't have all of that loose skin that you typically see in those with rapid weight loss. They were speculating if the BCAAs helped with that or not.

This is a phenomenon that's been noted by others regarding weightloss during fasting, so it's probably the fasting itself, rather than the BCAAs.

> I don't know why I haven't seen more studies where extremely obese individuals just stop eating.

It's probably not common because you'd be trying to study the one thing they have the most trouble doing. To understand what I mean, you have to understand that asking an extremely obese person to stop eating is like asking an Alcoholic to stop drinking. All of them know that's what they have to do but that's literally their problem, they can't stop drinking and extremely obese people can't stop eating. More importantly, the drinking and eating in these diseases is not the problem per se, they're typically symptoms of less obvious root problems.

In the case of food, these people get a dopamine rush each time they eat. It makes them feel good. But then they feel bad because they're getting fatter (for various physiological, social and psychological reasons), which then makes them want to eat more because that at least makes them feel good (temporarily). It's pretty easy to spot the mental illness and similarity to drug addiction in this feedback loop.

I know this is hard to swallow for people who find it easy not to be alcoholics or overeaters but here's a journal article that studied the connection:


They say there is strong evidence that food addiction is similar to opiate and other psychoactive drug addictions. It also calls out alcohol and carbohydrate binges as stimulants for the brain's production and utilization of dopamine. The carbohydrates part is interesting since of course, that's literally what pig farmers use to fatten up pigs. So of course, if eating those makes you feel good and eating too many of them makes you fat then problem really starts to make sense.

I used to be obese. When I moved to a new city and found a new doctor, I asked him if there was anyone I could talk to so I could get more help. He told me it's simple, I just need to eat less and exercise more. I've been called a lot of lousy names in my life, but what he said was the most insulting thing I had ever heard... that it was simple.

You don't tell an alcoholic it's simple not to be an alcoholic, "Just stop drinking!" or to a drug addict, "Just stop taking drugs!". It's simple for you, but it's not simple for them. That's what makes them an alcoholic and not you.

I had lost 50lbs about 10 years earlier, so I knew the technical requirements to lose weight. My problem was not with dietary knowledge or exercise. But, as many doctors do, they give you advice/pills/creams/etc to improve the symptoms rather than trying to understand the root problem. I don't blame the doctor though, he didn't understand my problem.

In these cases, it has to be treated as an addiction and that's how I approached it. Once I realized my problem was one of addiction, I started to make some progress. I started to realize I would zombie walk to the kitchen like an addict in a daze, looking for a fix. I was thinking about something else completely but my body was on autopilot looking for food. I had a problem with food itself. Definitely carbs (especially sugar). I read a lot about eating disorders to better understand the problem and hoped to find a solution to the problem and not just the symptom.

I wish I found out about the link between carbs/dopamine a lot sooner. I discovered it accidentally when I found out about the Keto diet around 2013. When I cut out almost all carbs, I quickly discovered my brain fog went away, I felt happy most of the time, I wanted to exercise, I had more energy, and finally... I didn't want to eat all the time.

So, that was the basic solution for me, but even then it wasn't easy or simple. I did a lot of research and it took many false starts to finally make good progress.

I'm sorry for the wall of text, and for hijacking your comment, but I hope this helps some people understand why it's not simple to do (or study) and I hope it helps some people who have an eating disorder find their path or get professional help (if they'll listen).

> You don't tell an alcoholic it's simple not to be an alcoholic, "Just stop drinking!" or to a drug addict, "Just stop taking drugs!". It's simple for you, but it's not simple for them. That's what makes them an alcoholic and not you.

I think this is the point though. You don't tell an alcoholic "just have a couple drinks not the whole bottle," you help them stop drinking completely because they can't handle moderation. It's not simple for an alcoholic to stop drinking, but it's doable in a way that just cutting back (the alcohol equivalent of "eat less and move more") is not.

Obviously, a person will eventually need to eat or will simply starve to death, but I think the point above is that fasting as a way of breaking the cycle is underexplored.

I agree, I was just stating why it would be very challenging (and therefore possibly why it's so underexplored).

This guy sounds a lot like me at my heaviest (468# at 6'1" tall). I have a lot of correlated health issues, the bad knees predate the extreme obesity, and recently discovered via elimination diet that I am allergic to legumes and have trouble with grains in general. I went keto last year (mostly eggs, meat, greens and sometimes nuts and cheese).

Without trying much I dropped to under 380... where I've hovered mostly for the past year. When I'm strict and track I get closer to 350#, but getting below that has been incredibly hard.

Everything I've read and understand leads me to believe that longer fasting periods are what I need to do to break through this. But I tend to get fidgety around day 5 and stop early. I also do pretty consistently when I only eat one meal a day.

I don't think it's for everyone, and it isn't magic. More fat is more sating, and a lot of disinformation starting in the 60's has now been disproven. I do think that the majority of human kind was keto for significant portions of the year for most of human history. I feel that refined sugars are the single biggest factor in terms of obesity, followed by refined grains and vegetable oils.

In general, low fat and lots of sugar has spun society into obesity. Not understanding the role of hormones, or underestimating their effects are another compounding issue. Doctors need to start testing against resting insulin levels as part of a regular checkup. They need to push for changes in diet over supplemental insulin. And absolutely need to convey the message of why refined sugars (mostly the fructose component) are bad for you.

I found one of his fears interesting:

> I’ve never been anything but fat. Is there something in the fat version of me that also makes me likable and creative and a decent human being? Are the best parts of me all knotted up with the worst? Is there some way to untangle it and keep just the good stuff? Most of the time I think of my fat as a husk—something I have to shed so the best part of me can come out. But sometimes I wonder if I’m more like the shells you find on the beach, where the outer part is the attraction, and the animal inside is dull and shapeless.

I think this observation can resonate with anyone who has struggled with changing a of themselves that is so big it is part of their identity. For example people who are chronically depressed sometimes believe (including myself in the past) that taking pills to not be depressed will remove their intellectual edge and prevent them from having the insight of an outsider. It's objectively false, you actually get smarter since the depression isn't interfering with pursuing intellectual interests anymore.

Naltrexone and Bupropion. It doesn't make the other parts of losing weight unnecessary, but it does make it easier to handle cravings. I don't care that I'm getting some willpower in a bottle - I'd simply like to weigh less.

Two years ago, I was ~300. I had been constantly gaining weight since I started taking Seroquel. I also had ankle surgery (unrelated to my weight), and was completely bedridden for 6 months, then in PT for another 5. After that, my doctor put me on those two medications.

I still had to be careful about what I ate, but the occasional snack was occasional; I could eat something bad for me once a week and not lost much progress. After a while the exercise was more pleasant, too.

I hit 220 a few months ago. When I switched jobs and stopped taking the two medications (doctor and I just wanted to see if the weight would stay off without them), my weight jumped back up to 250, but stabilized there. A good bit less than the 300. I started taking the two medications again, and now I'm losing it again.

Out of curiosity - when you stopped taking the meds, do you feel like there was some residual craving-preventive effect that remained? I'm surprised medications like this aren't prescribed more frequently, and my assumption is that payers / doctors aren't keen on having their patients use it indefinitely (which I'm not sure is necessarily a bad thing, if there are no side effects)

I really hope that we start putting some social pressure on parents of very young obese children. It's obvious to me that getting your child obese and getting them set in the habits that will keep them that way is miles worse than things we have already weeded out with social pressure, like smoking in the car with children in it.

I have always been underweight before putting on more muscle just a few years ago. While I logically understand the challenges of being overweight or obese, nothing I've heard or read really drove just how much it weighs on you not just physically but emotionally quite like this article.

I've been way too close to 300 pounds for all of my adult life. This article really hits home hard. I can completely empathize with every statement the author made. I have realized his same struggles with weight loss and how hard it is to keep the weight off. I've had some success with Keto, but I seem to love eating carbs way too much to stick to it for longer than 3 months. I've told myself I'm trying a similar approach to the author: trying to do just enough to reduce slowly, but honestly to me it feels like a cop out. A way I can say that if I mess up then it's OK because most days I'm doing right. Hopefully some day I can finally snap myself into a life-changing mindset.

I think we need to start treating extreme obesity as an addiction. No one in their right mind tells an alcoholic to "just moderate yourself". I think the decisions of food need to be taken out of the hands of the obese. Eat what you're allotted, we promise its enough, and nothing else.

I recommend people lose weight via fasting until they're "normal" weight. Best done with doctor's supervision, but it basically boils down to eat nothing, drink only 0 calorie drinks and take a daily dose of multivitamins and get some sodium + potassium.

  Barbieri took vitamins on various occasions throughout the 
  fast, including potassium and sodium supplements.

  He was allowed to drink coffee, tea, and sparkling water, 
  all of which are naturally calorie-free. He said there was 
  the occasional time that he'd have a touch of sugar or milk 
  in tea, especially in his final few weeks of fasting.

  At the end of his ordeal, Barbieri tipped the scales at 180 
  pounds. Five years later, he'd still kept almost all the 
  weight he'd lost off, weighing in at 196 (89 kg).

I began reducing the carbs in my diet due to what I believe is gluten intolerance. I'm basically doing a Paleo diet. I've lost 25 lbs in the past 3 months, and feel great. I have no cravings. I'm done eating sugar and any high carb food (pizza, etc). My wife feels that I'm very regimented but my intolerance to gluten makes me so. I feel better and hope to have a longer life as a result.

I feel like one of the best things you can do if you're trying to lose weight is to consciously avoid the urge to finish everything on your plate. Try to habitually leave some food on your plate. I call it leaving an offering to the food gods. I think this leads to better mindfulness about what and how much we are eating.

This is deeply engrained in our culture. I honestly cringe when I see my nephews leaving food on their plate.

While it might help with eating less, it does mean you're deliberately wasting food (unless you collect all the scraps into leftovers for a later meal), which is... not good.

Try deliberately reducing your serving size instead.

Yes, you should do that. But, many times you will end up with too much food anyway. When possible, save food, rather than throwing it away, but it's better to waste food than to add to a weight problem.

Here's my understanding, based on a fair amount of reading and thought. First of all, condemning someone for being fat is rarely if ever useful.

In terms of what is useful the first thing is that people need to be eating a diet that is very low in processed carbohydrates, with lots of fiber and moderately low calorie foods, and they should eat until they are full, instead of counting calories.

Now people's bodies are different, so this won't work for everyone, but for most people it will.

If someone isn't eating this way, it is either because they don't know that is the way to go, or they do but they have other problems, like psychological issues, so they need to try to deal with them, if possible.

That's pretty much it.

> and they should eat until they are full, instead of counting calories.

I am curious why you say this. In my experience counting calories works great to put into perspective the caloric cost of everything you consume. You don't have to always do it, but do it for a while and you can eyeball pretty well if you can or cannot handle something in your diet.

Be aware of calorie content of different foods is essential for choosing a healthy diet. But what people usually mean by counting calories is setting a goal for how many calories you eat a day, and then eating only that much, even if it leaves you hungry. That does not work over the long term for most people.

What does work much more often is focusing on eating foods that are filling but low or moderate in calories, and eating when hungry.

I personally enjoyed this article and I wish more people would write things like this. Just reading someone eloquently list their thoughts and anxieties about a certain issue really makes you feel not alone if you are going through the same thing. There was a paragraph where he questioned whether he would lose the good parts of himself by losing weight and I've had that same type of thinking applied to so many other aspects of my life, not necessarily weight, but mental illnesses that I sometimes believe give me insight I wouldn't otherwise have.

I was a bit astonished by how the article started: that this was the first time the author had confronted his weight problem in writing. This is someone who has had a long award-winning writing career in newspapers and online, who has had no problem writing about many other subjects. Just goes to show how deep the personal shame he has felt his whole life.

We've all be gamed by the food industry for years. We should be eating mainly vegetables, some fruit and a little meat.

Hardly anyone eats lots of veg because they taste bland compared to the other processed treats we are sold. It suits the food industry to sell us processed food because it is cheap, it has a long shelf life and they know it tastes so good we will eat loads of it.

I'm not blaming them, they are businesses with a profit to make, but somehow doesn't feel like a fair fight.

It is a complete lifestyle change (nutrition and exercise)...plain and simple. Any other approach sets you up for failure (I need to lose x pounds for new years, I need to lose this for an event, etc).

It is also very much discipline (not motivation..) and hard work to get started and maintain for a while. Like pretty much anything. But after a few years of feeling great you will wonder why you ever lived your previous life.

At least in my experience :)

It might be discipline, but it can't come from a feeling of depriving yourself. It has to be associated with positive feelings, or most people can't stick with it.

Watch the Fed up documentary, explains it so well that no matter how much we try, exercising and eating less wont work. Our environment is saturated with products now which almost all have added sugar, only way is to look at ingredients and change your environment, dont bring these things home and instead bring better stuff home thats not got added sugar.

> no matter how much we try, exercising and eating less won't work

How can that be? If you burn more calories and you take in less calories, then surely at some point your body must start to lose mass. At very least is the equation that you're breathing out carbon and you're not getting that mass back from anything apart from what you eat.

I think weight loss is less of the issue - you're right, that is solved.

Long term weight loss is the big issue.

Let's be honest, anything that you have to maintain indefinitely - relationship, business, health/weight/muscle mass, finances - will eventually fail at some point.

And food does have that unique component of that it can't be totally avoided. You can't just cut it out of your life to become healthier (unlike say alcohol).

They're all hamster wheels. And then we die.

> How can that be?

All else equal, you are right, but practically, for most people who aren't young, or athletes, hard endurance physical exercise triggers eating behavior that overcompensates for the number of calories burned.

Sure, if you force exercise upon and deny the extra calories to someone, they will lose weight, but that's not a desirable solution for most, sustainable for the individual, or scalable in today's society.

Solutions that acknowledge the existence of and work with human eating behaviors are needed.

IMO that would involve reconfiguring our society to enable people to have quotidian implicit forms of exercise (vs dedicated gym sessions), like walking as part of their commutes, or gardening, and of course reducing the amount of sugar in the food environment.

But that's a challenge because the current environment that most people inhabit is configured to encourage the opposite. There certainly appears to be a statistical correlation between car based commute frequency and obesity rates in a given area:


Logically it's the answer, just like drug addiction is solved by stopping the use of drugs but of course knowing that alone doesn't really help.

Because all of this is regulated by hunger. If you move more, you get hungrier.

The issue in the case of most overweight people is that their body is trying to maintain a set point at a high level of body fat. Hunger serves to maintain this weight set point.

The way to sustainable weight loss is to eat in such a way that the body starts to target a lower set point and decreases hunger.

Obviously this also results in less calories taken than expended, but if it were as simple as a math formula most people would have six packs.

I'm taking about sustainable living not crash dieting as one offs which most people can't maintain

> that no matter how much we try, exercising and eating less won't work

Definitely disagree here. These are the only things that work. How else can you lose weight other than by moving more and eating less?

The key is that people actually don't eat less. They feel more hungry when they exercise, which drives them to eat more, which pushes the vicious cycle even further.

Maybe this isn’t common, but I find that exercising indeed leads to me eating less. Further, after exercising, my tastes very obviously gravitate towards more protein and fiber rich foods, and away from sugary chocolates and sweets.

I find that when I am inactive, I am constantly hungry.

Part of this I think is exercise helps me sleep better, and better sleep reduces my appetite.

I agree that exercise can be helpful for appetite suppression. Although, it appears that this effect varies by type of exercise and other factors.


That's like saying, "Cars don't work on roads" but conveniently forgetting to add, "...if you don't step on the gas."

I am speaking as someone who has lost about 75-100 pounds (no clue I was too ashamed to step on a scale) and kept it off for 10+ years. I can guarantee you that exercising more and eating less works even if it's not what anyone wants to hear.

There's also eating less and actually eating less. You can eat less food, but if the food you're eating is higher in calories then you're not going to lose weight. Part of the problem with eating less, is the size / portion of what you eat matters just as much as what you are actually eating. As an extreme example: The size of a slice of cheesecake is roughly equivalent to the size of a breast of chicken however eating the slice of cheesecake is eating a lot "more" than eating that breast of chicken.

That's why if you're going to lose weight you gotta focus on the information and know that what you just ate was x calories / x% of your daily intake and act upon that knowledge.

There's one way out of this vicious cycle.

I substituted the prodigious amounts of refined carbs I used to eat (pasta, rice) with meat, vegetables and a reduced amount of carbs. The proteins definitely helped with the hunger (and being a carnivore, it didn't take much to convince me to eat more meat -- though for me it's mostly white meat and eggs). I actually ended up eating more

I also started lifting weights. Exercising increases appetite for sure, but proteins satiates it.

I didn't lose that much weight (10 lbs), but I managed to convert what used to be flab to muscle.

Exercise + protein/vegetable diet (even if eating more) = body shape change.

Why are you evaluating the effects of eating less by looking at people who aren't eating less?

The point is that for most people "exercise and eat less" doesn't happen. Most people are undisciplined and unable to achieve it.

Totally agree. We have to start with better quality of food. Most Americans eat basically only crap with a lot of sugar, carbs and other stuff.


I would say that this is true in cases when neglecting to exercise and eat appropriately is the cause of excess weight in a normally functioning body.

In severe cases of obesity, something else may be going on. In a nutshell, the bodies of some of these sufferers could be on some sort of fat storage rampage. The fat cells extract an "energy tax" and store it; the body then has to do with what is left.

If there is a broken, runaway fat storage mechanism at play, such that a percentage of your intake is stored as fat, and not easily released again, it will be difficult to overcome the accumulation of fat with diet and exercise.

But, yeah, diet and exercise work for many people. And in many cases when they are reported as not working, they weren't given the proper effort.

Excercise that works is probably 2-3X more voluminous and intense than exercise people think ought to work, damn it! And sane eating plans have to be adhered to forever, not just for a couple of weeks.

If you stick with exercise and become a long-term dedicated athlete, it will change how the body works. You have to change your self-image into one that includes you as an athlete. A durable, self-image that persists even if you take a break from sport which gives you confidence to get back into the game.

Then how come in famine situations there is nobody for whom the restricted calorie intake and exercise does not cause weight loss? Nobody in those situations stays overweight due to 'some sort of fat storage rampage' do they?

Well, firstly, "famine" isn't the same thing as "diet and exercise regime"

Even if famine does work, and does so for everyone, that still plausibly leaves regular diet and exercise not equally effective for everyone.

> Nobody in those situations stays overweight due to 'some sort of fat storage rampage' do they?

I actually have no idea.

Does there exist anyone who died at close to zero fat and muscle in a death camp, or due to famine, who had been confirmed to have been a 450 pounder?

It's imaginable that in such a predicament, such an obese person will die of starvation long before losing the fat; that it simply won't be metabolically available to sustain them.

Without any actual data, "nobody came out fat out of Auschwitz" is just a dumb Internet meme.

There are cases of incredible body transformation from people quite severely obese to basically skin-over-muscle; yet that doesn't prove it's possible for everyone.

I absolutely agree that it's simple math (I did that math myself to lose 60 lbs), but we're people, and the only time math is the hardest part of being human is 3rd grade. Just like any self destructive behaviour we take part in, just because it's a choice doesn't mean that it's an easy one.

It's hard to lose weight.

And even harder to not find it again.


> but there is no reason to bring fried chicken into your house

There obviously is. It's frigging' delicious for once (might sound easily dismissed, but pleasant things are worth being experienced) . And eating a portion is obviously not going to lead you to have 460 pounds.

Your dismissal of "fried chicken" is all the more puzzling considering that 100g of the stuff has 246 calories [1] whereas the 100g "grilled chicken" has 226 calories [2]. Sure, it's a bit less calorie dense, contains more protein, so it is a bit better but by no means the astronomic difference you seem to suggest.

The man obviously has problems, but your dismissal, lack of empathy and misplaced sense of superiority are really not called for.

[1] https://www.google.com/search?client=firefox-b-ab&q=fried+ch... [2] https://www.google.com/search?client=firefox-b-ab&ei=Du84XPT...

Did you post this to let us know how superior you and your family are to the author of the article?

> This is the kind of decisions that lead to being 460 pounds.

And this kind of over-simplification of a complex neurological and physiological disease isn't constructive.

Are you from the South? The author was from Georgia. Believe me, we have plenty of fried chicken around here. It gives us a break from the barbecue.

I stopped all fried food in my life about 15 years ago. I will maybe eat fried fish once a month when in Manhattan but otherwise no fried stuff.


We've banned this account.

Guidelines | FAQ | Support | API | Security | Lists | Bookmarklet | Legal | Apply to YC | Contact