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A flawed paradigm has derailed the science of obesity (statnews.com)
75 points by statnews 8 months ago | hide | past | favorite | 114 comments

As much as the article wishes to expunge the concept it's a balance disorder all it is actually claiming is an alternative primary explanation for said imbalance. The idea you should not only eat less but healthier (particularly fewer carbohydrates) is not a groundbreaking concept that just came out in the fight of obesity but is the key discovery in this "new paradigm".

The article draws up comparison to defining "wealthy" as "People get rich because they take in more money than they spend." but that's actually a perfectly fine definition of wealthy which explains what it is. Similarly "is an energy imbalance between calories consumed and calories expended" is a fantastic definition of obesity. What the article actually argues against is again the idea the primary causes of imbalance are portion sizes, advertising, culture, abundance, and so on rather processed foods and quality of diet changing the way the body processes and measures energy intake from food.

I agree heavily with the latter part but the it is still describing a consumption/expenditure balance issue. This research isn't replacing that rather trying to find more ways to combat the issue that may not be explored as much previously.

The other thing is intake reduction still works it's just much harder than it may need to be without a proper diet. The article quotes "To attribute obesity to “overeating” is as meaningful as to account for alcoholism by ascribing it to “overdrinking.”" as if that means alcoholism isn't an intake problem. It is, but the best way to fight the intake problem may not be just saying "drink less" and that's the type of thinking actually being proposed in the research.

As an adult, over about 15 years, I've gone from around 140 lbs (nearly clinically underweight) to almost 200 (slightly overweight), but in my case it's a well known side effect of medication I take. So is diabetes.

I hate reading about this topic. I ask (rhetorically) how can it be that people pretend that normal weight is normally achieved through conscious choice?

I like to think even if I had stayed the same weight my own life, I would have insight enough, but in my position, it's really clear to me. I have a thermostat, and ingesting chemicals changed the set point. People who keep on gaining weight until they die must have a broken thermostat set on "high". It can't be psychological.

I feel like there's an awful conspiracy to gaslight people who are obese, because they can't be sure when someone says it's a matter of willpower, if they've always been that way. What to compare to?

But everyone who has spent much or all of their life at a normal weight, should know it doesn't take supreme effort or fanatical accounting. It doesn't require not eating when you feel like you're starving. Empathy should come from properly understanding yourself, even if you can't be philosophically certain what it's like in others' shoes.

People have free will, but you wouldn't tell a person who had a congenital inability to feel pain that they are responsible for injuring themselves, would you? You wouldn't construct a model of them as a person, as someone that enjoyed hurting themselves, right? Because conscious thought is not a replacement for automatic regulation.

I’m formerly obese, controlling my weight at will with healthy food is relatively easy, with junk food it’s very hard. Sugar, salted and fried foods are basically hacks, your brain and body has no idea which quantity is enough so they can be eaten without limit. Whereas with a plate of vegetable, a protein and no added sugar or fat you naturally can’t eat more calorie than you need. In fact I must usually add olive oil to eat enough calories and not lose weight if I eat too healthy. So it’s not willpower in a vacuum, the kind of food is key.

> you wouldn't tell a person who had a congenital inability to feel pain that they are responsible for injuring themselves, would you?

I know people who absolutely do that. The logic is those people don’t have enough faith or care enough to be healed.

People will go a very long way to blame a person who is suffering because it absolves them of responsibility.

> I have a thermostat, and ingesting chemicals changed the set point. People who keep on gaining weight until they die must have a broken thermostat set on "high". It can't be psychological.

This misses something important. If your weight is the thermostat's setpoint, then your BMR is the A/C unit, and your calorie intake is the ambient outdoor temperature. If your A/C unit is out of whack, then you'll need to move to a cooler climate (lower calorie intake) in order to get to a comfortable temperature. For example, women have a lower BMR than men and must eat less to maintain a healthy weight.

> But everyone who has spent much or all of their life at a normal weight, should know it doesn't take supreme effort or fanatical accounting. It doesn't require not eating when you feel like you're starving.

Only it does sometimes. You can't see how someone can slowly adapt unhealthy eating patterns over time? Or, as perhaps in your case, they need medication which changes their BMR? Once your ghrelin production/cycle no longer matches your BMR + physical activity, you may feel like you're starving even though you've already met you're calorie intake needs. Fortunately, we can change how hungry we feel in the long run just as we can change how much we eat, and there are plenty of examples of that. I don't think it's a gaslighting conspiracy to say that much.

What's BMR?

Basal metabolic rate

I don't think it really matters how it's normally achieved. The point is that it can be achieved through conscious choice.

I used to be slightly underweight when I was younger, and could eat endlessly with no consequence. These days I have to consciously watch my calories. It was a bit difficult at first, but I've gotten used to it. Conscious thought is not a replacement for automatic regulation in itself, but you can consciously work to form new habits.

Believe it or not, fat people receive this kind of anecdotal lecture unprompted throughout their lives.

It is precisely these attitudes that the article addresses directly. If you assume the problem is simple and easy to solve, then anyone who hasn't solved it has a character defect. Needless to say, receiving this kind of pep-talk is annoying and unpleasant.

I'd encourage you to read the article or study directly and perhaps ponder what it might feel like to not have been able to eat endlessly from the moment you were born before telling someone else how best to handle a medication actively dis-regulating their metabolism.

You seem to be reading a lot into what I wrote. I never said anything about a "character defect", or that the problem is easy to solve. I'm saying that easy or hard, we do have agency. In particular, I disagree with these two statements from GP:

> People who keep on gaining weight until they die must have a broken thermostat set on "high". It can't be psychological.

> Because conscious thought is not a replacement for automatic regulation.

I skimmed the article, but only because I've already read an entire book on the topic. I understand that there are hormonal effects on weight. That's no reason to throw your hands up and declare that you have no agency in the matter.

Are all people obese due to medication? The article from beginning tries to say it's not due to difference in total calorie taken and used. Is it really not the case? People always chose sugary food over fruits, veg and meat whenever they are hungry.

edit: Want to add that people also eat way too frequently, which makes us feel hungry (falsely) whenever not eating in that schedule. This can be averted by practice of eating less frequently few days. It does not mean starving, we just deviated from the normal and trying to go back.

There are things that have fundamentally changed in our bodies as a whole to make us have a different relationship with food and hunger. This change really started in the mid 19th and 20th century.

Food security can't be the only explanation for this because there were dozens of periods in human civilization where food security was just as good or better.

Not investigating this is causing lives lost and mental anguish. It's like we don't want to admit that fat people might have actually been fat because of other reasons other than being a failure.

> The point is that it can be achieved through conscious choice.

"It's normal and trivial for me; therefore, anyone who doesn't do it right must be lazy/greedy/insufficiently determined!"

There are so many ways that different people's bodies and brains are different, it is patently clear that the idea that it is realistically possible for every human to achieve and maintain what our current society says is an "ideal weight" over the course of years, no matter their physical, psychological, or financial situation is just another way for certain people to see themselves as more worthy and morally upright than others.

Most people are capable of running the marathon after some training but most don’t. The fact, that, theoretically, it is possible to loose weight by conscious choice (I have), does not mean it is reasonable to expect everyone to do it. I know very well how hard it is. Thus, “it is possible” and “you should have done it” are not equivalent statements

You're focusing on the overweight side of the ledger, causing your character judgement to kick into gear. Controlling your weight can be difficult without moral failure. When I was 14 I was desperate to gain weight (5'10" 128lbs) so I was eating nearly 3,000+ calories per day. I was lifting weights a few times per week for maybe 20-30 minutes but not much other exercise. Over the course of 5 years I gained a grand total of 19lbs. Weight gain is definitely not a simple calorie intake vs calories burned formula.

> not a simple calorie intake vs calories burned formula

People have lost weight that way. At 14 your body was in growing phase. Clearly fat does not come from air. I gained weight last year and I know how it happened. What kind of food you eat (sugary packaged vs fruit veg meat) and lifestyle matters.

Surely the experience of it becoming harder can be extrapolated? If it's a little harder for you, then it could be much harder for some people?

Giving up alcohol is way easier for some people than others. Lots of people have written about what alcoholism is like; have you ever read Lawrence Block's Matthew Scudder novels?

I think what the article is trying to say is, yes, there is a behavioural (psychological) component. But there is also a metabolism (physical) component too that is not getting enough attention. (Your own example highlights this well - when you were younger, you could eat more, and / or perhaps lose weight faster too, but now your body's metabolism has changed and you put on weight more easily). For e.g. thyroid imbalances can cause someone to put on weight, and can be addressed medically. The author believes there may be many other similar factors at play behind someone's obesity.

I partly agree with the author. But there is another factor - we also know that processed and / or junk foods definitely contributes to obesity. Yet, many obese people refuse to change their diet. If obese feel that they can't do without 1000 calories in their diet, why can't they eat 1000 calories of vegetables instead of 1000 calories of processed food? If gut bacteria plays a huge role in the kind of food we like to eat, then the author has a solid case ...

This is actually a great analogy. I believe what the article is (more or less succesfully) explaining is that the problem is with your thermostat, which drives you to eat too much, and that over-eating carbs screws up said thermostat.

I'll reuse this.

There are two basic mechanism groups defining the weight of a person: one, that adjusts calorie input based on the weight and one that adjusts output based on weight. Some of these mechanisms are physiological (stress eating), some physical (it is harder to walk for a overweight person). System dynamics basically tells us being over-, or underweight comes from these mechanims being unbalanced. For some reason the automated adjustments do not kick in on time and at sufficient volume.

> The article draws up comparison to defining "wealthy" as "People get rich because they take in more money than they spend." But that's actually a perfectly fine definition of wealthy which explains what it is.

In that analogy, I believe, the article's point is that a definition has been masquerading as an explanation.

Imagine you explained to people in the nineteenth century: the way you do heavier than air flight is to deliver sufficient thrust to overcome gravity and drag. Well, yes, that’s quite true. But how to get that done reliably is the ‘rest of the owl’.

How can people reliably eat a balanced diet despite feeling compelled to smash calories, now that calories are very cheap? The thermodynamic explanation has nothing to say on this.

Yes, but the huge effort to deny the thermodynamic explanation is straight up harmful.

I'd really like to be pointed to someone seriously denying the thermodynamic explanation. I've heard that argument time and time over, it's a strawman.

I've definitely met people, not even fat people, who deny it. They either think they just don't burn many calories because their body is a "different type" or that their body absorbs more calories.

I guess it doesn't deny the physic principle of thermodynamics, but they deny using thermodynamics is a reliable way to predict if you're gonna gain or lose fat.

Well, if their body chemistry is predilected to create fat over healthy muscle or ramping up their metabolism to burn the excess, then there may be a grain of truth to the claim.

Per the article: Carbs + high circulating Insulin + Low Ghrelin+ a certain amount of fat already on the body = body chemistry that prefers to create fat over using the energy for literally anything else.

If that is the case, then that's a hell of a dilemma. If you eat more than your body will burn by the time the food has processed, the excess will go to fat.

Eat one meal a day but have 1,200 calories in a meal (since most dieticians say that no one should eat less than 1,200 calories a day), well, your body can only process so many calories in a certain amount of time, so everything else goes to fat.

True, if your BMR is higher than 1,200 (which it should be if you're not dead) then you will turn around and burn that back away if you stick rigidly to your diet.

But a normal person not afflicted like this might have a body temperature increase as their body ramped up to process the excess calories instead...

A body temperature increase... as in a fever? If eating food gives you a fever, you have bigger issues than losing weight.

The problem with saying everything goes to fat if you eat 1200 calories in 1 shot is that if that happens, you'll actually burn the fat during the day when you need it, and you'll lose energy during the conversion, meaning your body will be overall less efficient than using it straight away and you'll lose even more weight. I don't know how inefficient that really is, all I remember from my biology classes is this is a lot more efficient than burning muscle, but it sure doesn't increase the total amount of energy in your system. That would be breaking thermodynamics laws.

i.e. Just because you store fat, doesn't mean you need any less calories per day. Your body won't just starve itself to death while leaving your fat alone.

See Gary Taubes, i.e. the article we are discussing.

Taubes isn’t denying it, merely saying it’s not explanatory. If you prefer: necessary but not sufficient.

It is an explanation. The article does not propose an alternative to the imbalance explanation rather alternative focus of action to achieve said intake balance. It doesn't even say the existing method of action of enough flat intake reduction as an answer to the imbalance explanation (this action is what the article actually finds flawed not the explanation) won't work just that it is ineffective for the same amount of effort.

I believe the point is that the answer begs another question of "why".

In their drinking example, alcoholism literally is overdrinking, but we accept that there is an underlying mechanism of physical and psychological dependency that exists outside of "they just consciously choose to drink all of the time and other people don't". At this point we generally recognize it as a disease with more nuance than "overdrinking". We recognize that there is a significant neurological component that is, at the point that they are an alcoholic, not under their total conscious control. Their subsconscious is pushing them to do things that the subconsciouses of people without the disease do not push for.

Similarly, you could ask the question, why do some people eat significantly more than they burn? And it then seems not implausible that the problem could be similar to that of alcoholism, that some neurological system is calling for the body to ingest more food, whereas other people's appetites are fundamentally more accurately calibrated at a subconscious level.

Much more speculative, but this would even seem to make sense from a wider lens. Almost our entire evolutionary lineage existed in a world of food scarcity, not overabundance. The selection pressure necessary to evolve a reliable safeguard against overeating would seem plausibly to not be old enough for that mechanism to have evolved to be as reliable and widespread as the one to prevent us from allowing ourselves to starve to death.

The health problems of the 20th and 21st century are still incredibly new from the perspective of the mechanisms that created our instinctual impulses.

Agreed, I'm not sure how any of this disagrees with:

"It is an explanation. The article does not propose an alternative to the imbalance explanation rather alternative focus of action to achieve said intake balance."

I understand the article wishes to point out we should focus on a different action but it spends its time attacking the current definition not because it has a problem with the definition but because it has a problem with the currently popular action associated with the definition.

The popular definition is fine, it's the popular "soluttion" to the definition they attack. The paper is much more clear on this.

There are issues with the imbalance explanation. w.r.t obesity, the least wrong (and most explanatory) equation will relate calories going into adipose tissue, and calories being taken out of adipose tissue.

Then another less wrong equation can relate calories absorbed by the digestive system and the calories burnt by the whole body.

These are not the same equations as calories eaten vs calories burnt. And the quantities are not easily measured.

Depending on exercise, and other potentially unknown environmental or genetic or other conditions, the body will put energy into tissue other than adipose tissue.

Not all energy eaten will be absorbed. There was a recent study which showed how eating fructose expands the gut lining to be able to absorb much more nutrition. We do not know all the regulatory mechanisms that control absorption. Nor all mechanisms that control hunger.

We're far from understanding all aspects of nutrition. The imbalance equations needs to be refined, if people are looking up to laws of physics to explain this matter.

I feel like you might have just skimmed the article, as the points you make here were addressed directly, yet you don't take the points made head on.

Quoting: 'Similarly "[Obesity] is an energy imbalance between calories consumed and calories expended" is a fantastic definition of obesity.'

It isn't though: 'Obesity is a complex disease involving an excessive amount of /body fat/.' is how the Mayo cilic puts it.

Not all energy imbalances in either direction result in a loss or gain of /fat/, which is the point the article is trying to make.

I'll quote from the article: "Although researchers have rarely thought to control for energy intake in their experiments, when they did, testing whether their animals get fatter than lean controls even when eating as little or less food, they almost invariably report that they do. “These mice will make fat out of their food under the most unlikely circumstances, even when /half-starved/ [my italics],” as Jean Mayer wrote about obese mice he studied in the 1950s. This fundamental observation directly challenges the notion that obesity is caused by poorly regulated eating behavior."

Quoting again: "as if that means alcoholism isn't an intake problem"

Explaining why curing alcoholism isn't as simple 'stopping overdrinking' is just as tiresome as explaining why losing weight on a nationwide scale isn't as simple as 'eating less', as the article spills much ink to make clear.

The problem with this theory is that in clinically controlled lab studies, where both food and exertion are measured carefully, the weight gain (or loss) is almost 100% predictable based on the inputs of food, exercise, and Basal Metabolic Rate (BMR). Unless your hypothesis is that the weight gain/loss is going into something else other than /fat/?

I'm guessing the reason nobody runs these studies is that it's solved science?

Not true, for example:



>Basal Metabolic Rate (BMR)

What increases or decreases BMR?

E.g. https://www.scientificamerican.com/article/6-years-after-the...

Why are there very slim people who struggle to gain weight regardless of how much they try to eat more?

What causes hunger pangs for people when they have half a million calories strapped to their waist?

>I'm guessing the reason nobody runs these studies is that it's solved science?

Exactly this type of thinking has stymied research into very interesting questions.

"I'm guessing the reason nobody runs these studies is that it's solved science?"

One of the article's main points is that the obsession with the calorie-only model (with the assumption that it's solved) has stymied even asking these fat-metabolism questions in the first place (outside of veterinary science, where they actively trying to make animals that get fat very quickly).

But yes, your body is free to store/burn mass and energy in muscles, tissue, glycogen and whatnot if it chooses to store the excess at all.

Of course if you force an environment of extreme depletion (like bootcamp as mentioned elsewhere), you body will get to its adipose tissue, but that's not going to solve the obesity epidemic. Most veterans get just as fat as the rest of the population after they leave the service.

I personally can feel when my glycogen has been depleted when working out. Once it's gone I look a bit anemic and /pushing/ beyond certain limits becomes impossible. Normally it's a precursor to me entering ketosis, which pretty much guarantees I'll be burning fat or muscle only from then out.

Now if only Taubes had written this essay with the same clarity and conciseness that your analysis of it just did, it would have gotten a lot more traction with me. I mean, he can at times be a great writer - "Why we get Fat" was a book that I and a lot of friend bought and debated at length - it was revolutionary (to us).

You might prefer the study itself. https://academic.oup.com/ajcn/advance-article/doi/10.1093/aj... Judging from the reactions here, he meandered too much and made his point badly with the majority of the commenting cohort, but there's a fair bit of selection bias to account for.

What I took away from the article is that the standard diet is unhealthy, and that in some people it will cause their insulin production to spike, causing them to create more fat than a person who is not similarly affected.

This then causes a snowball effect as their body craves food, energy, and nutrients that their body fat is effectively hijacking and preventing from getting where it needs to go, so the body sends more hunger signals so that enough food to satisfy you is consumed.

As the fat increases, so too does the hunger, as fat cells also require maintenance calories.

If this is true, (and it seems somewhat more plausible to me than just, "fat people are gut-stuffing pigs with no self control") then the solution to both the obesity crisis and the issue of over-eating is to find systems that shut down that cycle by either chemically manipulating the brain to not respond to the starvation signals caused by the fat cells, (probably effective but not healthy) or to modulate the diet so that the fat cells become the cells that have to beg for calories as the healthy cells get fed first somehow.

Low-carb diets might be a first step to that second path as without carbohydrates to trigger insulin the fat cells will have a harder time taking in sugar. Mayhaps in the future we will learn more about the process and find a pill to make the insulin-carb-fat pathway from working as well as it does.

Don't let the article put you off, the paper, no paywall, is much better and much more concrete:


Thanks, agreed the paper is miles better than the article! And to be honest an easier read... I almost wish it were the post instead.

> but the best way to fight the intake problem may not be saying "drink less" and that's the type of idea actually being proposed in the research

Somewhat comically, drinking more water is a great (as in easy / painless) way to combat both alcoholism and obesity. As well as a bunch of other health issues. I have no idea why we -- as humans -- don't just naturally drink the right amount of water.

Because we do? Most people are not chronically dehydrated, despite what a vocal minority would have you believe.

> not chronically dehydrated

Good job. Taking something to an extreme, just to straw-man it.

I like the negative connotation on vocal minorities too. A+

I grew up in a town with chronically terrible water; we used to joke about the many colors of the water in the school water fountains.

So, I grew up drinking anything but water, and that's a habit that's stuck with me for my entire life.

Many people on this page appear irritated or angry that obesity might be a topic of complexity and nuance, and that simplistic understanding might be at odds with reality.

There are few HN participants who are stunned to find out that quantum physics is counter-intuitive, or who are amazed that proving 1+1=2 might be worth a volume or two of pure logic, but so many are angrily rebutting the idea that obesity might be more than just caloric intake versus caloric expenditure. This speaks volumes.

If this article were right and CICO were wrong, then how is the Twinkie diet able to be effective?

If I answer this by saying - well, it's complex - what does that tell you?

Isn't "well, it's complex" a fully general counterargument?

Not all CI are stored as fat. Not all CO are burned from fat. Obesity specifically, is about excess fat, not bioavailable calories. Imagine, as the article mentions, a person that has a daily calorie excess of exactly 10kcal per day from a potato chip. CICO with a 100% fat conversion dictates that person will gain 8lbs of pure fat every year. Yet this isn't how it works in practice, so we need a better understanding of fat accumulation and loss if we want to address the crisis.

Any sufficiently drastic calorie deficit will result in weight loss, and eventually that loss will get to your fat stores. This is how the Twinkie diets works.

Most folks, myself included, would like to just stay at a healthy weight without thinking too much about 100 calories plus or minus their perceived BMR.

And for lots of folks that works, but clearly for an increasing majority, the 100kcal are stored as fat immediately, and the small 100kcal deficit doesn't burn the fat that was stored. Death by 1000 cuts. Wouldn't it be interesting to discover why that might be and address it directly?

> Imagine, as the article mentions, a person that has a daily calorie excess of exactly 10kcal per day from a potato chip. CICO with a 100% fat conversion dictates that person will gain 8lbs of pure fat every year.

No it doesn't. One of the factors that determines your BMR is your weight, so adding any constant amount of calories every day only affects your weight by a constant amount. Eating an extra 10kcal every day might give you 2lbs, total, ever in your life.

I apologize, I didn't divide that number by 9, so it's a bit less than a lb a year, but that was meant to illustrate what you ended up pointing out.

BMR is variable.

It's why when we talk about deficits and surpluses we are actually doing hand-waving around something critical, on any given day, how do you even know what your BMR/RMR is?

Contestants that starved themselves on the biggest loser showed a 500kcal reduction in RMR 6 years later. If they'd just plugged themselves into a calculator and eaten the prescribed allotment daily, they'd be gaining the weight back quite rapidly. And that's exactly what happened to most of them as it turns out.

> it's a bit less than a lb a year

My whole point was that some amount of weight "a year" isn't how that would work. The only way you keep gaining weight every year is that if every year, you eat more and/or exercise less than you did the prior year. If you eat too much, but the same too much, every year, you'll be overweight, but you won't keep gaining weight every year forever.

> Contestants that starved themselves on the biggest loser showed a 500kcal reduction in RMR 6 years later.

That makes sense, since they lost a bunch of weight and RMR is tied to weight.

You misunderstand me: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/ After 6 years, 41.0±31.3 kg of the lost weight was regained (p=0.0002) while RMR was 704±427 kcal/d below baseline (p<0.0001) and metabolic adaptation was −499±207 kcal/d (p<0.0001)

The lower RMR remained and sometimes continued to drop after they regained the weight.

Any normal person cannot assume that their RMR is something they get off of a website calculator, or that it will behave like linearly. Speaking as someone formerly fat, the metabolic adaptation did persist for years after I lost all the weight, putting me around 400 below where I should have been on the chart. It is still quite annoying, though it has lessened.

If you read the article it says 10kcal over the energy expenditure per day. So BMR going up or down doesn't matter, the 10kcal is on top of whatever it is.

But then you're not just adding one potato chip per day to your diet, as GP said. You're increasing your daily caloric intake every day. Obviously that will make you fat without bound.

This exactly. I highly recommend the podcast Maintenance Phase to anyone interested in learning more. They cover a lot of that nuance and the science behind them. Leave your biases at the door and it's eye opening.

The slimemold authors argued effectively against carbs being _the_ answer for the obesity epidemic. Scroll down to 2.2.2: https://slimemoldtimemold.com/2021/07/11/a-chemical-hunger-p...

I think that's missing the main point of the series. It's saying that carbs aren't the problem as has been previously claimed.

That said if you look for evidence either way you can find it. https://academic.oup.com/ajcn/advance-article/doi/10.1093/aj... it's not saying that carbs are the problem but the WRONG carbs are the problem.

There's some inconsistencies, like the part about the person living of potatoes, since these are a strong source of lithium, but thanks for the link it was an interesting read and certainly makes great point against diet chasing.

I didn’t find any of the “these maps looked similar” (lots of maps look similar) or “wow these two time trends are correlated” (all time series with trends are correlated) tbh

It's a lot of words in that essay to essentially say:

  "The fundamental error in obesity research is the belief that obesity is a function of eating more calories than you exert.  Well, fine - yes, of course weight-gain is a function of eating more calories than you exert, but the real question is *why* do people eat more calories than they exert."
That's literally the entire essay in a nutshell. It's kind of a straw-man though, I think most people get that already so I'm not sure who they thought they were arguing with.

It seems that maybe you didn't read the entire essay as the actual argument it makes is that the dominating theory (which you fabricated and then quoted as if it were from the essay) is incorrect. In my reading, the error of obesity research is that it focuses on energy-balance instead of studying the why and how of fat accumulation in humans. To actually quote the essay:

    "For researchers and public health authorities to make real progress against obesity and the obesity‑diabetes epidemics, they will have to shed their energy-balance thinking, their obsessive focus on how much people eat and exercise. Instead, borrowing again from Hilde Bruch in 1957, they’ll have to focus on fat metabolism and storage itself, “since by definition excessive accumulation of fat is the underlying abnormality.” If they think of obesity as it simply and clearly is, a disorder of excess fat accumulation, they might actually figure it out."

First - yes, I did read the entire essay reasonably carefully. I've been reading this same essay from Taubes/Ludwig for at least 5 if not 8 years. [Edit - Make that 10 years - according to Amazon, I bought "Why we get Fat" in Feb, 2011 - and remember it being revolutionary] The thing is I agree with them wholeheartedl, and have from the first time I read stuff from Taubes 10 or so years ago.

Saying that weight increase is a result of excess caloric consumption is in some ways a distraction, because of course that's the reason why weight increase occurs. The real issue is what does drive caloric consumption, and the side issue is what impact do dietary components have on insulin reactions, metabolic reaction, satiation, etc....

What kind of drives me nuts is how they have an issue with that fundamental, never disproven in a single controlled clinical-condition study, statement of "An excess of caloric input over caloric output will result in weight gain. " It's fine to start off with that, and then move onto the more important questions.

I mean, they could start off by saying, "This statement may be true, but it's only relevant in a laboratory, and mostly irrelevant in free-living scenarios." I would agree with that as well. I think it was Taubes that once wrote, "Our (predetermined) weight determines how much we eat, not the inverse" which I thought was quite clever and backed up with a lot of studies.

This too is a lot of words to say that you either didn't read or didn't comprehend the thesis of the article.

Points for acknowledging you've created a straw-man however.

Like any good essay, it delves into detail to support its claims. In this case, the history of obesity research is reviewed. Specific studies that counter the prevailing wisdom are put forth. This is what makes an essay an essay and not a bumper sticker.

I am somehiw overweight. This is because I do not make the small effort to eat less. That's as simple as that.

On top of that I have medical issues that make it difficult to control weight. But I am not trying to hide behind this: I should just eat less (as I have done, losing 16 kg at some point)

I am luck enough to live in a country where access to vegetables and fruit is easy, so no whining about that either. My blood tests are good, I am just carrying an extra 20 kg because of perdonal choice (which I do not like, but this is still a choice)

To the 0.1% of people who have a medical issue that prevents them from controlling weight, I am truly, honestly sorry for you.

To the x% of people who cannot for a reason or another afford/get healthy food - same.

To the others who theoretize on the philosophic aspects of them being overweight: eat fucking less, drop the heavily processed food and sugar. Yes it is hard but it is not going to happen spontaneously.

It is tiring to see people who get out of MC Donalds or have a gargantuan portion size to say that they suffer.

It is painful to see that in the US morbidly overweight prople drive in a shop, getting more sugar or bad food.

The US already suffers from all alien invasions (at least this is what I get from movies), no need to be the country bringing the distopia of WALL-E in real life.

> I am somehiw overweight. This is because I do not make the small effort to eat less. That's as simple as that.

A causes B. You are saying B thus A. This is incorrect reasoning.

It's like in medieval times when someone had a toothache, the tooth was pulled. Because nobody with pulled teeth has a toothache. Then at some point, someone said: wait, perhaps we can be smarter than this.

I do not understand.

When I eat too much I gain weight. When I eat less I lose weight. This is not theoretical - I eat half and lost 16 kg. I let myself go and gained back.

This is that simple, no need to say how the world is against me.

Let me put this in equations. The basic equation is right:

      ES = CI - CO
ES (energy stored) equals CI (calories in) minus CO (calories out).

CI is all that you eat, but for CO we have

    CO = CO_physical_exercise + CO_excess_burned
The term CO_physical_exercise can be directly measured and is the same for everyone, given the same workload. But CO_excess_burned is different for everyone. E.g. we all know that person that can eat anything, do nothing, but remains slim. It is this term that deserves more attention.

CI also varies dramatically for the same food for different people. Because we don't burn food in a flame to release energy, we break it down using complex chemical processes which vary dramatically depending on the exact contents of our stomachs, our microbiomes, etc.

See https://www.sciencedaily.com/releases/2015/11/151119133230.h... for one example of this.

The article is long, and I'm not sure it did a great job of conveying the core message. Looking at the comments here, I think some people may have missed it.

Here's a paragraph that outlines the issue:

> But even the ob/ob mutants make fat out of their food when, quite literally, half-starved. Friedman’s research was based on Douglas Coleman’s research at the Jackson Laboratory and Coleman, who shared a Lasker Foundation Award in 2010 with Friedman, dedicated two papers to this observation: “Even when maintained on 50 percent of normal food intake,” Coleman reported in 1985, “mutants still become obese.”

Here, ob/ob mutants are mice that become obese and, not coincidentally, have abnormally high amounts of leptin. We often think of leptin as having a role in regulating appetite; something like "too much leptin makes you hungry, hungry people eat too much, people that eat too much get fat"; that matches the thermodynamic "calorie in/calorie out" model.

But studies suggest that ob/ob mutants get obese even when given a restricted diet. In fact, they get obese even when given 50% of a normal food intake. That suggests something quite different is going on. It would seem ob/ob mice cannot realistically be starved into being a normal weight.

Which is rather interesting. There are certainly many who would assume that, for any person who is at a stable weight X, reducing their calorie intake by even 5% would cause a sustained loss in weight and bodyfat percentage. It would seem that's might not be universally true.

I wonder how ob/ob mutant mice behave. Do they move less and sleep more? Is their body set temperature lower? It doesn't make thermodynamic sense that they would get obese on half the diet unless their physical activity and body temperature were either or both impaired.

This is a great example of the "misdefine then vilify" approach.

Next: calories approach doesnt work on gout either! More evidence that calories don't work!

The thing is that "Calories In" varies dramatically from person to person for the same food: https://www.sciencedaily.com/releases/2015/11/151119133230.h...

Taubes has been a big diet proponent for a long time. I’m not sold on his methods (yeah a high fat diet will lose you weight but a high sugar diet <TDEE will too, and 3 kcal raw sugar is unpalatable as is of raw fat)

Energy in and out is completely right. Measuring the in is easy with calories, but the out is nearly unaccountable unless the person stayed in a totally controlled environment, which makes it a trivial academic tautology.

How did blog spam on a 1 hour old account get to the front page so fast?

From that blog:

> This is why I am now a co-author, along with 16 influential academic researchers, of a lengthy review the American Journal of Clinical Nutrition is publishing on Sept. 13. The principal author is David Ludwig, a professor of pediatrics at Harvard Medical School and of nutrition at the Harvard T.H. Chan School of Public Health.

How do you call this "blogspam"?

The site is by the Boston Globe group and the author is Gary Taubes. I wouldn’t call it blog spam.

It got to the front page quickly because it’s a well written article with a thought provoking premise. It feels like a good fit for HN.

statnews is a decent quality website for biotech news and information. Not blogspam. This is an opinion piece and is bad tho

I wonder when this BS will end? At some point in my life I graduated from a military boot camp. At the end of camp all overweight people were lean, slim and muscular. No special diet were given to overweight people to achieve that result.

If you work with kids in an outdoor camp setting - same basic results.

Take away the phones, the ipads, the TVs, the computers, add a (very) healthy diet, literally all day every day outside from morning to night with some small breaks.

No huge weightloss (camp might be a month and half or so) but generally endurance, fitness, etc, kids are remarkable(!) - seriously, their bodies just problem solve it seems overnight for the change (takes about 1 week to start noticing difference).

The idea that high fat / sugar / salt / mental health issues from being plunked in front of screens all day doesn't play a role in all this seems weird. At least with kids, mental health is a big deal actually in lots of behaviors (procrastination / eating etc) and being outside all day does seem to help some kids.

The point of the article is that energy-in/energy-out is the uninteresting aspect of obesity research.

Yep. You have to address the problems that prevent people from "simply eating less and/or being more active" because just telling them that generally doesn't work.

Or, instead of focusing on macroscopic people, you could focus on microscopic cells!

This is evidence that CICO does work, isn't it? Everyone ate the same food and did the same exercising, so they all ended up with the same kind of body. If there were any truth to woo like "setpoints", then the overweight people wouldn't have lost weight by doing what maintained the weight of healthy weight people.

If it was the actual military, there will have been both entry requirements and a fair amount of self-selection to ensure that the people coming in are much more homogeneous to start with than the general population.

This is not even close to a scientific sample.

> I wonder when this BS will end?

The obesity rates of US veterans approaches that of the general population, which is a concern given that the military selection process precludes many people who are likely to become obese in the longer term.

The point of the article is that obesity is not a simple model and that the simplistic idea that kJ in vs kJ out is the same for everyone is flawed. The balance and solutions vary across the affected cohorts.

Treating obesity as a simple issue with simple answers, and claiming that any introduce nuance to the discussion as 'BS', does not really provide any insight or assistance to folk who are struggling with this condition.

I agree with you. I am not young but also not obese. However I did try to lose those last 6-7 kilos for some time. I went through phases where I was trying various things ranging from normal healthy eating to weird stuff (yeah, I now consider them as such) such as low carb, or fasting (note: this can be good for concentration, but not for weight loss) or whatever. I was also going to the gym and doing various random, but tiring things. The result is that I maintained a more or less stable weight (aside from some temporary fluctuations), and never permanently lost those extra kilos. Then I started to take sessions with some kinesiologist. Not sure exactly why, but without ever thinking what I eat (still I eat healthy, but there is pizza, alcohol etc), I gained muscle and lost weight. I welcome this change with humility, but I can't claim that I understand it. The pattern that I see is that there are plenty of exercises that seem easy, with low repetitions, but they seem to challenge the muscles in complicated ways using simple tools (mostly elastic bands and equilibrium tables). It is way more thorough than the crap I was doing alone at the gym and it does seem to affect my appetite. So yeah... maybe good quality exercise is the key, net necessarily a military camp.

Edit: typos

No but they were in military boot camp. They didn't get a special diet but they did get a very special environment. Which actually stresses the point of the article, the question of obesity at the macro level isn't one of "calories in/out" or "diet" but environmental and behavioural.

My dad gained a lot of weight when he was in USMC boot camp, and they had to put him on a diet. Nice anecdote though.


However, my experience in boot camp, though the same in that overweight people were not by the end, was not ideal weight-wise.

I was someone who went in slightly underweight and too lean. I did not gain weight until I got some protein supplements near the end.

I had the exact same experience in bootcamp(Army), and it makes me jaded and uninterested in the monthly "groundbreaking" exercise products or diet programs. Front lean and rest position doesn't cost you anything - just sayin...

Front back go!

come back in 20 years . why do some people seemingly gain much more weight easily then others, you think a 400+ lb man has the same genes for regulating metabolism and other factors as a 150 lb man?

So all you need to do to lose weight is be 18 years old and spend your entire day in PT, with restricted snacks. Sounds practical.

I do think it's strange that so many in the science of obesity think that human biochemistry can be modeled with spherical cows.

Take an overweight person, put them on island where they can only eat survival rations and water, and they will lose weight.

I accept that some people may gain weight differently / faster than others. But if you count calories and exercise you are guaranteed to lose weight. It’s chemistry. Maybe with better nutrition you could eat more volume. But pretending like it isn’t the calories that cause weight gain is being exceptionally nuanced when the basic combo of portion control and exercise does the trick.

Yep.... laws of physics and the conservation of energy.

I'm 45lbs down, in some of the best shape of my life, and to boot I have my second XCO Bike Race this coming weekend! I feel better, I look healthy, and I'm happy.

I don't count anymore, but I do think about the caloric content over everything I eat now and try to keep it reasonable.

Would you characterize the exercise you used to lose weight the "long slow fat burn in zone 2" that is all the rage in trainers, or high intensity anaerobic zone 4 work?

Neither actually.

So my BMR was roughly ~2300 calories. Eating less than that is not actually very difficult. Hardboiled eggs in the morning with some coffee + non sweetened creamer, cold cuts +pickles+cheese for lunch, and a 500cal portioned dinner from a local meal prep service would get me to about 1500-2000 calories. From there, if I wanted a beer or a snack or to eat out, that's where the workouts came in. I would do intermittent sprints on the rower for 45m, roughly 22m of activity, which measured at the rower and verified with my Garmin watch would be between 500-800 calories. Or if it was the summer, 1.5 hours of XCO MTB is worth about the same calorie count (I can only measure that with my Garmin watch, I don't have a power meter on my bike).

The goal was to have a net 500 calorie deficit per day. Whether that deficit was generated by eating less (which some weeks while overseas I had to do) or by exercise it didn't matter. The important thing was to generate that deficit. No idea what "zone" I was in as it didn't matter. Just hitting that calorie deficit is the key.

intermittent sprints probably qualify as interval training more than "long slow distance".

> Although researchers have rarely thought to control for energy intake in their experiments, when they did, testing whether their animals get fatter than lean controls even when eating as little or less food, they almost invariably report that they do. “These mice will make fat out of their food under the most unlikely circumstances, even when half-starved,” as Jean Mayer wrote about obese mice he studied in the 1950s.

It is possible for everything in this quote to be true without contradicing the grandparent, because the quote doesn't explicitly address whether any of these animals were eating a caloric deficit.

It is physically impossible to gain weight while eating a caloric deficit. The same kind of impossible as perpetual motion.

A living body can be quite clever, it can change your BMR (what you assumed was a deficit is now a surplus) perform muscle catabolism, or burn glycogen stores (more than one kind of fuel) during starvation. All the while taking pains to store away the calories you do intake as new fat cells. It's precisely this kind of direct and overly simple appeal to thermodynamics that the article tries to address.

Burning fuel in a calorimeter is not the same thing as a human body. /Fat/ loss and creation aren't the body's /only/ response to calorie deficits and excesses. You can create new /fat/ cells while still losing energy and mass overall without violating thermodynamics. As I said above, all you need to do is have your metabolism prefer your other stores first.

> It is physically impossible to gain weight while eating a caloric deficit.

Is it? As much as I want to agree, what if my body decides that 50% of calories input must be stored? It might mean that I will have to eat 200% of my daily required input just to be functional.

Not saying that this is the case, but I think it’s what the article is arguing.

If your body were doing this, you'd be burning more calories than if it didn't.

Your body requires some number of calories to keep the lights on for a given day--to move, to breath, to run your brain. Google says the average is 1800/day.

If you only eat 1700 calories per day (a 100-calorie deficit) for a month, and you don't stop moving, breathing, or thinking, then your body managed to get those missing 100 calories from somewhere (i.e. from fat).

In your example, say you burn ~1800 calories per day, but you only eat 800 calories (a 1000-calorie deficit)--and your body, because it hates you, stores all 800 calories as fat! Well, your body still used up 1800 calories (assuming you're still breathing, etc). So you would've burned 1800 calories of old fat, and stored 800 calories of new fat. But wait! Turning fat into energy isn't free, that requires energy, too! So you'd actually be burning more than your base rate of 1800, meaning your deficit would be even higher than the expected 1000.

It's all much more complicated than this. Your body has multiple ways of generating energy, storing, and releasing energy. Eating less signals your body that you need to preserve calories, which may lower your metabolism and make it harder to eat a caloric deficit. But at the end of the day, physics dictates that you can't get more energy out of a system than you've put into it.

Your body might make you move less throughout the day, "underclock" your brain, and do other things to push your BMR lower and lower. I've heard of people who end up having to eat so little to lose weight that they get severe nutrient deficiency.

> your body still used up 1800 calories

If you don't eat enough, you'll feel lethargic and unable to perform normally, so I doubt it will still use 1800 calories. According to the article, if you eat 800 calories and your body stores them all, you'll feel as hungry as if you never ate at all.

Of course this likely isn't so drastic ("50%") but it would explain why many people keep gaining weight over their lifetime (or until the body reaches a balance).

As I understand it, the fat mice in the study were fed half the amount of food that other mice were fed and still gained weight. It makes me wonder if a calorie surplus is necessary but not sufficient for weight gain which could also mean that a calorie deficit is not necessary for weight loss.

Just amazed at how many people on this thread are refusing to get the point. There are counterexamples to the idea that we can collectively diet our way out of mass obesity everywhere you look. But, it seems that many people can't shed the comfort of thinking of it a character-flaw problem, rather than the biology problem that it clearly, obviously is.

"...I'm not fat, but..." "...well now I bike 100km a day and watch diet so..." "...just be outside away from tech all day..." "...but in military bootcamp I saw..." "...yeah, but the author did a strawman so..." "...actually, the technical point you made would mean this, so..." "...I didn't read his books or the papers, but everyone knows..." "...but he's got his own 'diet' so he is intrinsically lying..." "...well we've known about this for 200 years, so..."

what bullshit, even on HN. It's pretty much the norm on Obesity articles, but sadly creeps into most others as well.

If you're fat, have done a ton of research, read Taubes, tried CICO, found success, then found failure because it's miserable to do, but you "proved" it works, then tried Keto, and it worked even better, but is still also hard to do, but easier than CICO if you aren't a vegetarian, then sure, make your comments.

I sit around all day at a computer and that's not going to change. I'm not going to workout like crazy or ride a bike 100km a day. I've seen skinny people eat more than me constantly and not gain an ounce being just as inactive. It's hard to understand and easy to judge if you aren't in the situation. It's easy to preach if you are in the middle of a regimen that's giving results, regardless of the method.

It's incredibly hard to keep a lifestyle change that sucks because you are either hungry, always busy working out, being super careful and can't eat anything you like and can never go out to eat again (because going out to eat to get a salad and a plain chicken breast is not going out to eat, it's wasting your money and making you sad at the same time). Constant vigilance is wearing on people, and you know there are literally millions who eat the same as you and don't instantly gain weight, so clearly there is something off.

Articles like this are interesting because they dig into misinformation, even though things like CICO can work, if you read his book you see all the studies on why they knew it's not effective long term for like 100 years, yet it's all people still talk about.

Heaven forbid a guy who lives to study this stuff tries to find and share a solution. In his book he literally doesn't even give you the "diet" until like the last page, where in one sentence he says, you should have figured out what to do by now from reading this book; or at least that's how I remembered it.

Anyway, rant over for now. You could be fat because of a disease where a chicken scratched your ancestor and now you are 20lbs heavier for life. Check out "The Secret Life of Fat" by Sylvia Tara for more interesting info from someone who was fat and a scientist who dedicated their life to figuring out why some people get fat and some don't and why even with extreme CICO tendencies, like she followed. Some wild findings and examples.

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