Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the first place. It's way easier to take a pill than cut to 1500 calories a day for 2 years.
It is a harmful stereotype to label obese people as lacking willpower as you have done. Many obese people don’t have the resources (time, money) or tools (nutrition understanding) to improve their situation. Many have metabolic or familial history of obesity which has both physical and psychological (normalization) impact on their ability to control their weight. The former can be helped with diet and/or medication, the latter often causes them not to seek help.
Most people in the US live in poverty and make marginal spending food decisions based on money per dopamine reward unit rather than optimizing nutrition. McDonalds is cheap and unhealthy; fresh fruits and vegetables and the free time to educate oneself on proper nutrition, then cook healthy meals and do meal prep often cost more money and time than most can afford. As does proper exercise when you’re working 12 hours per day trying to make ends meet.
A less harmful way to phrase your point is that medication can help people who self-medicate with food overcome metabolic efficiency. I lost 40 pounds on semaglutide (Wegovy) so far this past year and dropping; exercise and diet alone didn’t work for me. I hope to eventually not rely on medication to maintain a healthy weight.
I would say it’s much more harmful to rationalize obesity as something that afflicts people according to their circumstances, rather than what it actually is, a direct outcome of a person’s intentional choices.
It’s also quite harmful to dramatize the solutions out to be something unattainable to many people. They are attainable to all people. The healthiest diet I’ve ever eaten was also the cheapest diet I’ve ever eaten, and almost everybody can get 30 minutes of low intensity exercise a day.
Nutrition and fitness are hardly a one-size-fits-all problem.
To take an example, my self, I am doing intermittent fasting and do moderate intensity exercise everyday for at least 30 minutes(gym, cycling, bouldering, etc). No matter what I do, I still have a muffin belly.
I also believed that for many years, that no matter what I do, I cannot control my weight.
Until one day I began to both weigh myself each day at the same hour with a precise digital scale and also weigh or measure by volume all the food that I eat.
After that moment, I reduced my weight by 2/3 and I have maintained easily any target weight. Even now, after some culinary orgy I easily gain a couple of pounds in a day, but then, by eating only measured quantities of food, I lose them after a week.
The reason why I have failed to control my weight during many years and most people also fail, is that if you eat until you are satiated, then it is guaranteed that you will not be able to control your weight, no matter how much exercise you do.
If you measure what you eat and you only eat pre-planned quantities, it is trivial to reduce how much you eat until you see that the next day you weigh slightly less (e.g. 100 grams less). Then you must keep eating such quantities until you reach the target.
If you do not respect your plan and you eat random extra snacks or drink sweet beverages, then of course you have no chance to control your weight.
It is much easier to follow a plan when you eat less meals per day, because they can be larger. When eating small meals many times per day it is far more difficult to stop after eating just a little. It is much easier to not start eating.
If you want to lose body fat you need a caloric deficit, squeezing a caloric surplus into a smaller window of the day isn’t going to do anything productive. Intermittent fasting itself has absolutely no benefit, it can only be useful if the fasting routine helps you maintain a caloric deficit.
Absolute nonsense. Your food contains calories in the form of carbohydrates, protein and fat. None of those macronutrients are metabolized in a way that is likely to lead to obesity. Obesity comes from consuming more calories than you burn. It doesn’t matter at all where those calories come from.
I agree. After living and traveling abroad, it's easy to see America has an obese-default culture.
Most cities and towns have little walking or public transportation. Cheap, high-calorie, nutrient-poor food is easily available anywhere 24 hours a day. Restaurants have an abundance of large amounts of meat and carbohydrates drenched in low-quality oils and sugary seasonings.
You have to be consciously active to stay fit or cook the majority of your own food. People in a lot of other countries stay lean and aren't as obsessed with fitness as we are.
Agree, mostly. Primary care doctors in the US are often limited to 15-30 minutes per patient for routine matters. Referrals to nutritionists / dieticians and other expensive options often lack follow through, or aren’t offered in the first place because prescribing is so much easier. Medical professionals have a duty to arm patients with the information needed to make good choices about their health, but often shirk that duty due to inconvenience or these kinds of time limits. In a perfect world, access to medical professionals would be less scarce and at least the tools (nutrition info) would not be an issue. The medical system really isn’t designed for obese people on multiple levels in the US, and it isn’t designed for good long-term outcomes…yet.
Most systems, like Epic, will print out the standard info and counseling related to your conditions and medications when you get your paperwork at the end of the visit. That's easy and takes almost no time.
Considering the root(?) commenter said that a low carb diet did in fact work for them even though they had to go research it on their own, it sounds like it was effective.
There's no talk of completion. This isn't a "diet", it's a diet. We aren't using it as some colloquial meaning for losing weight, etc. This is about a lifelong dietary change to address excessive carbohydrate intake.
If it doesn't have "any effect" then I guess all type 1 diabetics are already dead?
The point still stands - doctors should be counseling diabetics on dietary changes, even if they are being prescribed medication. Some patients can improve their condition and overall health to the point that they can stop the medication. If you disagree with this, please, show me some sources. As for mine, you can check the AMA, AHA, ADA, and PubMed (American Medical/Heart/Diabetes Associations).
People didn’t have McDonalds and cars ages ago. Barn-raising, (manual) farming, and hunting are hard energy-intensive work. Our calorie output required to survive dropped while the calorie inputs available cheaply dramatically increased. That is all part of “overcome metabolic efficiency.” :-)
It's easy to demonize fast-food but that's not even the worst of it.
High-fructose corn syrup has been added to so many foods that didn't have it 10-20 years ago.
The second or third ingredient on a bottle of ketchup, for example, is high-fructose corn syrup. You can get ketchup that doesn't have high-fructose corn syrup added to it; often it's a natural or organic brand that often costs more than the regular brand.
And depending on where someone lives, brands without refined sugars may not be readily available. Google "food desert" and see what comes up.
It was literally impossible a generation or two ago to ingest the amount of carbohydrates the average American gets just from eating prepared and processed foods today.
> It's easy to demonize fast-food but that's not even the worst of it. High-fructose corn syrup has been added to so many foods that didn't have it 10-20 years ago.
We should just count ready-meals etc. as 'fast-food' too, no good reason that it implicitly refers to 'restaurants' only really.
> The second or third ingredient on a bottle of ketchup, for example, is high-fructose corn syrup.
> People didn’t have McDonalds and cars ages ago. Barn-raising, (manual) farming, and hunting are hard energy-intensive work. Our calorie output required to survive dropped
Not saying I know any better, but at it's face I don't buy this. The change in day-to-day activity doesn't feel like it would account for the difference from just the 80s to now.
> while the calorie inputs available cheaply dramatically increased.
This I buy much more, confounded with maybe the specifics of the nutrients available.
Even a small change in average daily activity can account for a large difference. If you cut your total daily energy expenditure by just 50 kcal (the equivalent of walking less than a mile) while keeping intake the same then you can gain up to 5 lb in one year. Add that up over a few years and suddenly you're obese.
You're right in one way, but not another. Small increases in caloric content can have a large and counter-intuitive impact due to the nature of systems in equilibrium: just one small soda or candy bar a day above your equilibrium will drive large weight gains.
But you're not factoring in the fact that as your weight increases so does your idle energy costs, meaning that as you gain weight you burn more calories doing nothing. Put another way, if today you burn 1500 calories a day idle, and you start eating 2000 calories a day - at some point you will reach an equilibrium, likely well before you're obese.
I'm also in the camp that thinks that lifestyle explanation for rises in obesity is completely unsubstantiated.
Not to mention increase in sugars in foods; soda pops also drastically increased from 8oz to 20oz. Combined with even small decreases in activity can add up quickly.
Robert Lustig talks about this quite a bit. The data shows widespread obesity in modern times is a direct result of all the added sugars in the standard American diet.
What about other countries? America might be leading the way, but a lot of European countries brag about "only" having a 1 in 4 obesity rate, which is still incredible.
It's much more harmful to obsess over the optics of something potentially offensive at the expense of reality. None of the excuses you listed hold any ground.
Time: it costs about 20 minutes to cook a simple, basic fresh meal. With a single weekly groceries delivery (or visit to the store), you're covered for some 5-6 main meals as well as breakfast and lunch. Are you telling me Americans don't have 20 minutes to prepare a meal yet do have that time, or more, to eat out? I've been home cooking 6 days a week for 2 decades. It costs LESS time, not more.
The average American watches over 3 hours of TV, or TV-like experiences in their leisure time, but they don't have 20 mins to cook a meal? I guess they all get home from work and fall asleep?
Costs: Rice, potatos, bread, vegetables and lean meats...please do the math for me how this is unaffordable? They are incredibly cheap commodities.
"Most people in the US live in poverty".
Now they do not. The US is in the top 5 of median incomes worldwide, one of the richest countries in the world. If you dismiss Luxembourg and UAE, the USA is in the top 3. It's not a monetary issue.
Further, 12 hour work days are an anomaly, not a standard. And even 12 hours is not an excuse. Exercise isn't the core of the issue, junk food is.
Time needed to educate on nutrition: your parents or school should have done that, but here goes: don't eat garbage. Cut down on fats, sugars. Education completed. But it's not an educational issue as the person sitting in McDonalds knows exactly what's up.
It most definitely is a willpower issue as every other excuse does not hold ground. People in other countries have less time and less money, and still don't have this issue at this scale.
Please know that this is a not a burn at obese people, I fully sympathize with the difficulty of lifestyle changes, even more so in a culture like the US where the environment seems stacked up against healthy eating.
But we need to attempt to come to real and realistic root causes, and time and money are not the core issues. It creates this illusion that if only economic conditions would improve, we'd all be eating healthier, which is false.
Youve identified the chain but keep it going: stress and lack of sleep!
Ubiquitous coffee, economic pressure, overpriced and weak preventative healthcare system, social pressure, status anxiety, housing insecurity, political threats, public-facing crimes, rampant racism. These all test our self-control around food.
None of those things help, yet none of those things prevent healthy living. For the simple reason that healthy living does not cost a lot of time or money.
Like I said, home cook 5-6 days per week, which costs little time or money. None of the issues you mention prevent you from doing it. Exercise costs no money at all.
I don't mean to dismiss your reasons as if they don't matter at all, I'm stating they are a trap. They provide a shield to hide behind. If only all of that would improve, I'd be healthier. This imaginary utopian society will not make you healthier. You become healthier by stop eating crap.
I agree abt the importance of home cooking, bit if you have a chance, look into how stress affects digestion. The same food can affect the body differently based on its stress state.
No, it's the lack of will power, with few exceptions. Most of the food these days, even expensive food, has atrocious amount of calories, so to burn one cookie-worth of energy one would have to do a stupid amount of weight lifting. For example, lifting a 50 lbs dumbbell 3 feet high burns just 5 calories, while a small cookie I have on my plate has 200 calories. That's 40 times to lift that dumbbell just to burn 1 cookie.
Edit: or let's take a look at cheese. I've found some pretty expensive cheese in my fridge, packed into small cube boxes, because otherwise its price per pound would be offensive. So we might expect that cheese would do better than cookies. The nutrinion facts label on its reverse begins with "serving size: 2 table spoons, 120 calories" - a borderline fradulent label that's trying to hide the fact that the small chunk of cheese has 600 calories in it.
Bullshit, and my response is a bit tangential, sorry. Obesity isn't a defect of self-control, it's a systematic metabolic disease that makes these people ravenous yet ingest enormous amount of calories.
Low carb eating has been successful outside of the mainstream lie of "eat more whole grains" because it simply avoids the foods that worsen runaway metabolic syndrome; the common advice is just to "eat less", while these poor people are ravenous and gain fat on whole foods 2,000 kcal diets. CICO doesn't mean anything in a vacuum if one way of eating causes you to be constantly hungry, and the other teaches your body to make use of its great amount of stored energy.
Obesity is eating the same food that previously kept you healthy, but now makes you sick and hungry.
> Prescriptions of diet and exercise are ineffective because many obese / type 2 diabetic people can't exercise self-control. That's why they're obese in the first place.
Research continues its trend against this statement.
1) One problem is the fact that the number of fat cells in the body is conserved after some point. So, if you grew lots of fat cells as a child, sucks to be you, you're now stuck with them as an adult.
2) Caloric consumption has been tracked and cross referenced between countries, and obesity doesn't always correlate with it. Apparently, there are other things going on. Some of these seem to be environmental.
3) Fat cells "remember" your weight when they were formed. Once you become obese, your body fights your attempts to lose weight all the way down until those cells die off and are replaced (about 10% per year or so). It takes MASSIVE amounts of willpower to fight your own body over years.
4) Exercise is practically useless for weight loss. The body demands a fixed number of calories (up until you're doing something at the level of extreme training) and shunts the available calories between systems. Exercise has lots of benefits. Weight loss just isn't one of them.
5) I do agree that nothing in the US helps you avoid gaining weight. Portion sizes are gigantic (a "personal" pizza in the US is a full pizza in Naples). Walking or bicycling is rarely useful for most people. Sugar gets added to everything (For example: Austin, TX has been a particular victim of this--gigantic glasses of unsweetened iced tea used to be the default a decade or so ago but has been replaced by sweetened or double-sweetened iced tea (which used to be limited to the Southeastern states)).
#4 is t correct, or rather it’s helpful but in a counter intuitive way. On its face, it’s very hard to exercise away a donut, but daily exercise causes your metabolism to pickup and you burn more calories for the rest of the day. Additionally, the more muscle you have the more your body will burn calories, so for weight loss it’s best to start with strength training (and not bullshit “toning” exercises) and then move into cardio.
I agree with a part of what you say, e.g. that exercise is almost useless for weight loss.
I know these theories about the number of fat cells and about their slow replacement, etc. Nevertheless, they do not match my experience.
I have been obese during about 15 years. Then I began to measure precisely the quantities of food that I eat and after almost a year I reduced my weight to only two thirds from that of the previous year. Since then, another 15 years have passed, during which I controlled easily my weight, also by eating most of the time only carefully measured quantities of food.
During my weight loss, I was concerned about possible problems, precisely because I had also heard these theories about the fat cells that you have mentioned.
However, I have not seen any evidence for them. Before losing weight, climbing stairs was difficult, it felt like carrying a huge backpack, and I could not even see my lower body due to my belly.
After losing weight, not only all physical activities became easy, but even if there was a very large reduction in waist circumference, so initially the skin remained rather loose, after not a long time it adjusted, so no signs of the former size remained.
There were no problems whatsoever caused by the weight loss, but I had to retain forever the habit of eating according to a plan, because any day when I eat outside the plan, I immediately gain weight.
If you do not eat enough food to keep alive all your cells, some cells must die (after you have already consumed most of the internal energy supplies stored in fat). It is very unlikely that your internal regulation mechanisms will not ensure that the unused fat cells will die before cells that are in active use, e.g. muscle cells. So that theory about the constancy of the fat cell number can be true only while you are still eating some excess food or while you have not lost most of the fat reserves yet.
> Exercise is practically useless for weight loss. The body demands a fixed number of calories (up until you're doing something at the level of extreme training) and shunts the available calories between systems. Exercise has lots of benefits. Weight loss just isn't one of them.
This is sort of true but also sort of not. The body doesn't require a fixed amount of calories exactly, a specific body composition does. If you put on muscle the amount of calories the body demands goes up.
One of my scariest adulthood realizations is that doctors are like everybody else; fallible. And that being certified means you're good at studying, but doesn't always mean you're good at what you've studied.
Not trying to discredit medical professionals or the amount of work they put in. I'm sure the majority are intelligent, conscientious and good at their jobs.
I have encountered a large number of excellent medical professionals, to whom I am greatly indebted for how they helped members of my family or myself.
Unfortunately I have also encountered an about equal number of medical professionals who have been grossly incompetent.
What I consider to have been by far the greatest mistake that I have made in my life, a mistake which had irremediable consequences, was to have excessive faith in the competence of some well-paid medical professionals.
Both my parents had the bad luck of being misdiagnosed the first time when they had some medical problems (for completely unrelated causes). In both cases the correct diagnostic was discovered by other medical doctors, but only after many months, when their conditions had become much worse.
Because of the delayed diagnostics, both their lives were shortened by maybe 4 to 5 years.
After the correct diagnostics, I have read the appropriate medical textbooks and I have discovered that in both cases my parents had presented the typical ensemble of symptoms described in the textbooks, they were not some weird cases, easily misdiagnosed.
For the correct diagnostics, the first doctors should have recognized the textbook symptoms and they should have sent them to the appropriate investigations that were necessary to confirm their maladies.
Instead of that, they have chosen the lazy way of saying that they do not need any further investigations because old people complain all the time for various minor problems and they have prescribed them some useless treatments.
If I would have been more skeptical about medical fallibility, I should have sought a second opinion since the beginning, but unfortunately I did not.
True, the field is vast. But I expect that a doctor should know the basics of a common condition. If they aren't counseling diabetics about carbs... wtf is going on? It would be different if it were a rare or complex topic, but even then the Epic system that most places use have standard printouts with information for patients.
It might be much like a dentist lecturing you on brushing your teeth.
You’re in there because you don’t. The dentist might resent this, stuck with disgusting idiot after disgusting idiot in their mind. Alan watts says the dentist should make peace with it.
Maybe you know you’re meant to brush your teeth but you don’t remember to, or a tooth fell out after brushing once and you thought it caused it etc.
Some people avoid the dentist completely because of being ashamed of that lecture/disappointment. Then there’s the seeming popular “victim blaming is a hate crime” angle of doing anything more than prescribing something.
Anecdotally, the super rare, in tales: old man doctor, who calls you a dumbass and tells you how it is straight is a treasured item. Various comedians have bits as such. Much like a professor who sees right through your self deceptions and justifications. They want their delusions shattered.
To other people though the insolence and condescension that they perceive from that same person is seen as trash, doctors and professors should of course empathise with me instead of putting me down kind of thing. They don’t want their delusions handled too roughly.
Trash or treasure.
It’s not an even field though because if you did the “wrong” thing, the former doesn’t get the most useful help to them but the latter may try and bring down professional consequences upon thee. Which is probably why the mystical “no heck’s given” doctor is always old/bitter in the stories.
I don't have a source since I read it in a magazine at a doctors office 10 years ago, but I recall an article about how recommending diet and exercise had no meaningful increase in patients actually doing those things in a study. Combined with some patients being offended by the suggestion, the article made the case to no longer make the recommendation because it didn't work anyway!
Of course they start with diet/exercise - but ask yourself how many patients you think take that advice… high blood sugar is a really serious problem and the unfortunate reality is that people are very resistant to lifestyle changes — so the least harm is often to medicate.
Sure, but that's almost certainly an exaggeration where OP gets to cosplay as the 'hero' in their story -- every single treatment protocol in every single medical setting for diabetes starts with a low-carb diet and exercise.
Literally the top of the 'treatment' section on WebMD:
> Managing type 2 diabetes includes a mix of lifestyle changes and medication. Lifestyle changes: You may be able to reach your target blood sugar levels with diet and exercise alone.
And the section on preventing type 2:
> Adopting a healthy lifestyle can help you lower your risk of diabetes.
> Lose weight. Dropping just 7% to 10% of your weight can cut your risk of type 2 diabetes in half.
> Get active. Thirty minutes of brisk walking a day will cut your risk by almost a third.
> Eat right. Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.
It was not an exaggeration. I was morbidly obese at the time, and the doctor almost completely ignored that condition for the roughly five years that I saw him. He did once recommend that I always eat a salad at the start of dinner. That was it.
When he saw that I was losing weight and that my A1C was heading downward, he asked what I was doing. I told him about the carb restriction. He looked down, smiled, shook his head, and said nothing. That was the end of it.
Try and Spend some time on any forum related to chronic illness.
Tons of doctors who don’t keep up with even basic research / guidelines on their own speciality.
High blood sugar levels are doing damage right now.
Nothing wrong with starting on a therapy while trying to institute a diet and exercise change. The doctor would be negligent if they said "let's try diet and exercise", then after 6 months of damage say "nope, that didn't work, let's try metformin".
Yeah, I sort of mentioned that in one of the other comments. Even when they start the meds, they should be trying to fix the underlying cause like dietary issues. Hopefully it would help make the medication more effective.
It's something else to not even counsel a diabetic about carbs.
You will be hard pressed to find a doctor that talks nutrition.
It took me four years to force my doctor to test my serum zinc levels. When she did they found I was deficient. She did not know what to do, nor did it even seem to impact or shock her.
Zinc sulphate gave my life back to me. (Lupus, mood disorder) You would think that my doctor would share this with everyone. But no.
Interesting. A family member was having memory issues and the doctors were very supportive of our idea to look at the possibility of testing blood levels and taking supplements or changing diet based on the findings.
Medical care is not distributed evenly in the U.S.
I think my issue was I was already disabled and on Medicare diagnosed with Bipolar disorder which is caused by my immune disregulation, probably Lupus.
Anyway, it is difficult for the doctors to get medicare to cover these tests. I also insisted she perform a serum amino acid test which revealed several high amino acids including all of the branched chain amino acids. She had to make up reasons to get them to cover the tests even though I have all these issues, including poor kidney function.
There is defiantly a stigma with how they treat people with mood disorders. Any physical complaint was always treated as it it were something I was imagining. I was only luckyy that my mother and brother has Ankylosing Spondylitis because even though I still had to fight to get an MRI for my lower back pain and they found I was in the early stages of the disease as well.
She said now that she had the nutritional results she did not know what to do with them and she could not even send me to a specialist.
Ah, true, coverage can be an issue. We were willing and able to pay out of pocket for tests, if needed.
So were they hesitant to do the test at all, or was it that they didn't know how to order it for your insurance to cover it? That would be a big difference in my mind. Most doctors don't fight having blood tests done if there's at least some rationale for why to do it. They're so common and low risk.
Yeah, I have had doctors just totally dismiss things when they know nothing about them (like saying things that are unsupported and contrary to new research). I have also had doctors say they didn't know but would do some research (good sign, but less common).
She was hesitant because of my mood disorder diagnosis. She frankly admitted that. What I feel changed her mind is that I asked here what caused my mood disorder. She said she did not know. So I asked why she is not doing everything to help me find out.
But all this too extensive logging, research, and persuasion on my part.
To emphasize the issue I have had with doctors on medicare; I had IBS-D, a flare up so bad, for over a month. I went to a doctor, they took one fecal test which showed nothing. They did not reply to my continuing issue so I went back to them. The doctor said exactly this; "What do you want me to do about it?" I lost it. Yelled at him so loudly others came into the office. They never sent me to a gastro doc. I need up curing it on my own by using my understanding of my genetics and diet changes.
Assumption makes an ass, but I think he means first line treatment when it comes to medicine. I’m sure that both nurse & doctor wholly recommended lifestyle changes.
If you read the comment they said there was mention of losing weight but nothing about a low carb diet. Carbs are something any diabetic person should be counseled on, even if being placed on a medication.
If they are in that situation it stands to reason they might not have that knowledge. It seems the grandparent(?) is an example of that when it came to low carb diet.
