Obesity: unknown cause and no known cure.

[Aractus]

Allow me to clarify a point: you can “cure” obesity so long as the patient doesn't mind living with horrible side-effects including a slowed metabolism and a terrible hunger because their body is fighting to regain the weight. But that isn't a true cure. A cure would reverse obesity and return the patient to a healthy weight without such side-effects. There are many other conditions for which we don't have a cure and this isn't the realm of conjecture, this is the scientific reality we face although many academics and clinicians are loathed to admit it. Perhaps the highest quality research done to date on this specific issue was the academic research following contestants of “The Biggest Loser” after their appearance on the reality TV show. In the show the competitors start off as morbidly obese and compete to lose the most weight, effectively producing a cohort of the most successful morbidly obese weight losers. And yet following their time on the show most of the weight comes back on and their metabolism is substantially and permanently reduced. For example, a contestant named Danny Cahill won season 8 of the show. At the start he weighed 195kg/430lbs, at the finale he weighed 86.6kg/191lbs, and six years later he weighed 133.8kg/295lbs, but most significantly of all he requires 3350kJ/800Cal less energy per day than a man of his size is expected to require to maintain their weight - his metabolism has slowed permanently (the data is published in Fothergill et al. 2016 but it wasn't just Cahill - every contestant had a lower metabolism than is expected of a person their size and there have been further studies published on this). We've known that diets don't work to cure obesity for over 30 years, in fact they cause more harm than benefit, so why are they still being promoted today?

As many know, I'm firmly in the camp that disagrees with the conventional wisdom that kilojoules in = kilojoules out. That ignores the science. Or if they're not ignoring it entirely, they're not engaging with it - they're cherry-picking the data or the papers they read. If the conventional paradigm were correct all it would take is an excess of 40 kilojoules (10 Calories) per day stored as fat for a person to become clinically obese by 35, and no one has THAT much control over their diet. For kilojoule counters this falls well below the margin for error. To put it into context, a teaspoon of sugar contains 68kJ and I have measured grocery staples like bread and found that there is often consistently 10-20% more in the packet by weight than is listed on the official package weight - this is because it's illegal to underweigh but legal to overweigh (effectively they can't short-change you but they can give you extra) - so the stated kilojoule content can be off by up to 20%, meaning 20% more kilojoules per serving than the packet says. This is why kilojoule counting is futile, you would have to weigh everything and calculate the energy content precisely otherwise you'll never have accuracy. Ironically it would be more accurate to count kilojoules at McDonalds than at home.

I was delighted to learn that last year there was a significant obesity conference organised by The Royal Society called Causes of obesity: theories, conjectures and evidence. I'm currently working my way through it, here's the video of day 2 of the conference and I'd recommend viewing the first session of day 2 if you're interested in this topic:


Complete day 1 is here. Not sure where day 3 is but the "complete" playlist for all presentations is here but note it doesn't include Q&A's and it isn't entirely complete for example it misses Friedman's presentation on Leptin, and he's the guy that discovered it! That being said his presentation doesn't have THAT much to do with the cause/s of obesity and he ONLY talks about leptin and not the other hunger hormones.

I agree with all of the speakers in day 2's first session and their varied approaches to solving the problem of: what mechanism (or mechanisms) causes obesity? We don't know. You'd think by now we could answer the question but sadly the research has been advancing at a glacial pace. We do know certain foods are associated with positive, or negative, weight change and that's really where the highest quality of evidence we have is. But we don't understand the physiology. We don't understand the why. Why is it that metabolism slows dramatically and permanently after an obese person loses weight? We currently have no answer, other than “the body is fighting back”. Sure, it's fighting back - but why? One hypothesis put forward, though not in this conference as they were exclusively looking at the cause of obesity, that aligns well with the hypothesis put forward by Dr David Ludwig that fat causes obesity, is that it has to do quantity of adipocytes (adipose cells themselves). The idea behind this hypothesis is that when someone experiences obesity the body manufactures more quantity of adipocytes, but when they lose the weight they don't lose any adipocytes they just empty out of fat, but the cells themselves remain and the hypothesis is that this is the mechanism that drives weight regain (MacLean et al. 2015). It's a promising pathway but I personally do not think it can be the whole answer as it fits some of the data well but not all of the data. But if it is a pathway it doesn't have to be the only one - there may be several distinct pathways to the weight regain that can work together. And yes I know I gave the idiot's-version of Ludwig's hypothesis, but it doesn't matter - you don't need to understand the carbohydrate-insulin model that he advocates. Another theory as articulated in the video is that mixing foods that have sugar AND fat causes it because naturally foods are normally only high in one or the other.

But wait - did I not say weight loss is “easy”? Yeah it's easy IF you 1. know the science and you trust the science, 2. do not start off obese or with another condition that makes weight loss difficult such as diabetes, and 3. consequently your aim is to lose a small amount of weight - a fraction of what an obese person would need to lose to become a “healthy weight”. So let's talk about the science, specifically the stuff that the first group of presenters at Day 2 of the conference went over (really this is enough on its own to get a solid understanding - the best paper I've found to date is Mozaffarian et al. 2011 that is a longitudinal study which attributes specific foods with weight change overtime - but please be wary of generalising the data). Foods can be weight-promoting or non weight-promoting, kilojoules are not equal, and while these guys are debating about what the unknown mechanism or mechanisms are that cause this to be the case - there's already a decent understanding about which foods are “obesogenic”/weight-promoting and which aren't. Mentioned in the discussion above including potatoes being weight-promoting, full-fat unflavoured yoghurt being non weight-promoting, olive oil being non-weight promoting, dark chocolate (specifically 70%+ coca) being non weight-promoting, and ultraprocessed foods as being either weight-promoting (eg. white bread) or non-weight promoting (eg Tofu). This is all correct and is exactly what the science shows. We can add soft drinks as weight-promoting, wholemeal bread as non weight-promoting, whole foods as generally speaking non weight-promoting, olive oil as being perhaps the healthiest cooking oil, and full-fat dairy as being fine as well. A lot of this flies in the face of 1. conventional wisdom (because it's not intuitive), and 2. the food pyramid that does not distinguish between foods that are “healthy” and foods that are weight-promoting. Note that most weight-promoting foods are still healthy. They have their place in the diet and do not need to be demonised - and that even includes soft drink. Juice is weight promoting as well, but not as much as soft-drink. Nutrition labelling - in Australia, in the USA, in the UK and in many other countries - is at least 20 years behind the science. It really isn't helpful. Full-fat dairy is no more weight-promoting than fat-reduced unflavoured dairy but we're still being told that fat-reduced is “healthier”. You may say that doesn't sound right - but the data does not support fat-reduced dairy as being “healthier”.

In his presentation, Ludwig goes over some other evidence that is also of use (published version of his presentation is here). In particular energy intake in the US and in Europe has plateaued since the year 2000 (Mozaffarian 2022) or gone down since the 1980's (Speakman et al. 2023), and yet obesity has somehow risen. According to the evidence at hand it is now taking less energy to make us more obese, how is that possible under the conventional paradigm?

So whether we're talking about this Food Pyramid or this one, or another one - while they are based on high quality research, they don't adequately address what we know about which specific foods are more weight-promoting than others. Nutritionists are still trained to tell you that orange juice is just as bad for you as soft drink because of the sugar content, even though the evidence says otherwise. Yes it's weight-promoting - but so what? Whole fruit juice is not as weight-promoting as soft-drink, or even potatoes, and yet potatoes remain a recommended staple of the diet with no caveats (eg. “in moderation”). They also continue to promote healthy dieting as a solution, when we know that doesn't work long-term (as is mentioned in the video above, almost all published academic studies on diets are short-term and do not discuss weight regain or net weight gain following the cessation of a weight-loss diet). And there is also a distinct physiological difference between a person who is obese, or who has previously been obese, and a person who has never been obese - and that reality is now impossible to ignore.

Until we understand what causes obesity the best we can do is work with what we do know, and that is that some foods will protect and others will not. Claims like this are gobbledygook: “The root causes of overweight and obesity are varied and complex. Overweight and obesity mainly occurs when there is a sustained energy imbalance, where too much energy is consumed through food and drink, and not enough is expended through physical activity.” Stating that there is an energy-imbalance does not establish causality - an energy imbalance of 40kJ per day from birth is enough to make someone obese by 35 - that's a tiny imbalance and cannot possibly be the full story. Why is there an energy imbalance, what causes it, and what causes the body to store it as fat rather than just increase resting metabolism to burn it or excrete it? “Conventional wisdom” lacks scientific data, and the science is not advanced enough to tell us what's really going on. I think we know enough, at least at the individual household level, to educate people on how to best protect themselves and prevent obesity, but no one is actually promoting that message effectively as the Food Pyramids reflect. We need to move away from this idea that there are “healthy foods” and “unhealthy foods” - what's unhealthy for one person may be a healthy choice for another, and so-called “unhealthy foods” are fine in moderation or as per a person's individuality or lifestyle permits.

What we know about the biological mechanisms of obesity, even though we don't know for sure what they are, is that obese state of the body is biologically defended. Some researchers are bold enough to claim this is the body's defence against starvation or something similar, but I think we can say for now that even IF that biological mechanism is in place - there appears to be another unique to obese patients. Or multiple others. You're fighting biological reality if you're attempting to reverse it - it could well be that obese patients will require ongoing medication in the same way that type-2 diabetics need insulin or other chronic illnesses require ongoing pharmacotherapy to keep biology at bay. We haven't found a way to biologically reverse eye disorders. They are best treated with tools to manage it like glasses or contact lenses, and while patients can get laser eye surgery it doesn't reverse the biological mechanism that led to the disorder in the first place, and thus it too is a treatment. Note that we haven't been looking at ways to prevent the common and treatable eye disorders like Astigmatism, Hyperopia, Myopia, or Presbyopia because we are quite happy treating them instead. Arguably we don't have the correct treatments yet for obesity, but it could end up being that treatment will be better than pursuing a cure. A true a cure to reverse it may not exist, we don't know and we won't know until we understand the cause or causes of it. Part of the problem with finding the best treatments is that clinicians and researchers alike have spent the past century pursing avenues that are futile - the new wave of pharmacotherapy is actually welcome but really in the very early stages as the drugs themselves have not been specifically designed for obesity and are not designed for life-long use which may be what is required to effectively manage the condition similar to type 2 diabetes and to the eye diseases that I mentioned all of which for all we know are preventable (yes I know there's no known prevention - but people are not looking for it!)

I shall close by quoting Hall & Kahan 2019: “Physiological responses to weight loss
“Outdated guidance to physicians and their patients gives the mistaken impression that relatively modest diet changes will consistently and progressively result in substantial weight loss at rate of one pound for every 3500 kcal of accumulated dietary calorie deficit21–24. For example, cutting just a couple of cans of soda (~300 kcal) from one’s daily diet was thought to lead to about 30 pounds of weight loss in a year, 60 pounds in 2 years, etc. Failure to achieve and maintain substantial weight loss over the long term is then simply attributed to poor adherence to the prescribed lifestyle changes, thereby potentially further stigmatizing the patient as lacking in willpower, motivation, or fortitude to lose weight25.

“We now know that the simple calculations underlying the old weight loss guidelines are fatally flawed because they fail to consider declining energy expenditure with weight loss26. More realistic calculations of expected weight loss for a given change in energy intake or physical activity are provided by a web-based tool called NIH Body Weight Planner (http://BWplanner.niddk.nih.gov) that uses a mathematical model to account for dynamic changes in human energy balance27.

“In addition to adaptations in energy expenditure with weight loss, body weight is regulated by negative feedback circuits that influence food intake28,29. Weight loss is accompanied by persistent endocrine adaptations30 that increase appetite and decrease satiety31 thereby resisting continued weight loss and conspiring against long-term weight maintenance.”

This sums up the situation today perfectly. Outdated guidance based on a fundamentally flawed understanding of the physiological reality of obesity and a scientific ignorance of the biological response to weight loss in obese patients. Anyway I'm hungry now so I'm going out for a Kebab.

[Dom]

Allow me to clarify a point: you can “cure” obesity so long as the patient doesn't mind living with horrible side-effects including a slowed metabolism and a terrible hunger because their body is fighting to regain the weight. But that isn't a true cure. A cure would reverse obesity and return the patient to a healthy weight without such side-effects. There are many other conditions for which we don't have a cure and this isn't the realm of conjecture, this is the scientific reality we face although many academics and clinicians are loathed to admit it. Perhaps the highest quality research done to date on this specific issue was the academic research following contestants of “The Biggest Loser” after their appearance on the reality TV show. In the show the competitors start off as morbidly obese and compete to lose the most weight, effectively producing a cohort of the most successful morbidly obese weight losers. And yet following their time on the show most of the weight comes back on and their metabolism is substantially and permanently reduced. For example, a contestant named Danny Cahill won season 8 of the show. At the start he weighed 195kg/430lbs, at the finale he weighed 86.6kg/191lbs, and six years later he weighed 133.8kg/295lbs, but most significantly of all he requires 3350kJ/800Cal less energy per day than a man of his size is expected to require to maintain their weight - his metabolism has slowed permanently (the data is published in Fothergill et al. 2016 but it wasn't just Cahill - every contestant had a lower metabolism than is expected of a person their size and there have been further studies published on this). We've known that diets don't work to cure obesity for over 30 years, in fact they cause more harm than benefit, so why are they still being promoted today?

As many know, I'm firmly in the camp that disagrees with the conventional wisdom that kilojoules in = kilojoules out. That ignores the science. Or if they're not ignoring it entirely, they're not engaging with it - they're cherry-picking the data or the papers they read. If the conventional paradigm were correct all it would take is an excess of 40 kilojoules (10 Calories) per day stored as fat for a person to become clinically obese by 35, and no one has THAT much control over their diet. For kilojoule counters this falls well below the margin for error. To put it into context, a teaspoon of sugar contains 68kJ and I have measured grocery staples like bread and found that there is often consistently 10-20% more in the packet by weight than is listed on the official package weight - this is because it's illegal to underweigh but legal to overweigh (effectively they can't short-change you but they can give you extra) - so the stated kilojoule content can be off by up to 20%, meaning 20% more kilojoules per serving than the packet says. This is why kilojoule counting is futile, you would have to weigh everything and calculate the energy content precisely otherwise you'll never have accuracy. Ironically it would be more accurate to count kilojoules at McDonalds than at home.

I was delighted to learn that last year there was a significant obesity conference organised by The Royal Society called Causes of obesity: theories, conjectures and evidence. I'm currently working my way through it, here's the video of day 2 of the conference and I'd recommend viewing the first session of day 2 if you're interested in this topic:


Complete day 1 is here. Not sure where day 3 is but the "complete" playlist for all presentations is here but note it doesn't include Q&A's and it isn't entirely complete for example it misses Friedman's presentation on Leptin, and he's the guy that discovered it! That being said his presentation doesn't have THAT much to do with the cause/s of obesity and he ONLY talks about leptin and not the other hunger hormones.

I agree with all of the speakers in day 2's first session and their varied approaches to solving the problem of: what mechanism (or mechanisms) causes obesity? We don't know. You'd think by now we could answer the question but sadly the research has been advancing at a glacial pace. We do know certain foods are associated with positive, or negative, weight change and that's really where the highest quality of evidence we have is. But we don't understand the physiology. We don't understand the why. Why is it that metabolism slows dramatically and permanently after an obese person loses weight? We currently have no answer, other than “the body is fighting back”. Sure, it's fighting back - but why? One hypothesis put forward, though not in this conference as they were exclusively looking at the cause of obesity, that aligns well with the hypothesis put forward by Dr David Ludwig that fat causes obesity, is that it has to do quantity of adipocytes (adipose cells themselves). The idea behind this hypothesis is that when someone experiences obesity the body manufactures more quantity of adipocytes, but when they lose the weight they don't lose any adipocytes they just empty out of fat, but the cells themselves remain and the hypothesis is that this is the mechanism that drives weight regain (MacLean et al. 2015). It's a promising pathway but I personally do not think it can be the whole answer as it fits some of the data well but not all of the data. But if it is a pathway it doesn't have to be the only one - there may be several distinct pathways to the weight regain that can work together. And yes I know I gave the idiot's-version of Ludwig's hypothesis, but it doesn't matter - you don't need to understand the carbohydrate-insulin model that he advocates. Another theory as articulated in the video is that mixing foods that have sugar AND fat causes it because naturally foods are normally only high in one or the other.

But wait - did I not say weight loss is “easy”? Yeah it's easy IF you 1. know the science and you trust the science, 2. do not start off obese or with another condition that makes weight loss difficult such as diabetes, and 3. consequently your aim is to lose a small amount of weight - a fraction of what an obese person would need to lose to become a “healthy weight”. So let's talk about the science, specifically the stuff that the first group of presenters at Day 2 of the conference went over (really this is enough on its own to get a solid understanding - the best paper I've found to date is Mozaffarian et al. 2011 that is a longitudinal study which attributes specific foods with weight change overtime - but please be wary of generalising the data). Foods can be weight-promoting or non weight-promoting, kilojoules are not equal, and while these guys are debating about what the unknown mechanism or mechanisms are that cause this to be the case - there's already a decent understanding about which foods are “obesogenic”/weight-promoting and which aren't. Mentioned in the discussion above including potatoes being weight-promoting, full-fat unflavoured yoghurt being non weight-promoting, olive oil being non-weight promoting, dark chocolate (specifically 70%+ coca) being non weight-promoting, and ultraprocessed foods as being either weight-promoting (eg. white bread) or non-weight promoting (eg Tofu). This is all correct and is exactly what the science shows. We can add soft drinks as weight-promoting, wholemeal bread as non weight-promoting, whole foods as generally speaking non weight-promoting, olive oil as being perhaps the healthiest cooking oil, and full-fat dairy as being fine as well. A lot of this flies in the face of 1. conventional wisdom (because it's not intuitive), and 2. the food pyramid that does not distinguish between foods that are “healthy” and foods that are weight-promoting. Note that most weight-promoting foods are still healthy. They have their place in the diet and do not need to be demonised - and that even includes soft drink. Juice is weight promoting as well, but not as much as soft-drink. Nutrition labelling - in Australia, in the USA, in the UK and in many other countries - is at least 20 years behind the science. It really isn't helpful. Full-fat dairy is no more weight-promoting than fat-reduced unflavoured dairy but we're still being told that fat-reduced is “healthier”. You may say that doesn't sound right - but the data does not support fat-reduced dairy as being “healthier”.

In his presentation, Ludwig goes over some other evidence that is also of use (published version of his presentation is here). In particular energy intake in the US and in Europe has plateaued since the year 2000 (Mozaffarian 2022) or gone down since the 1980's (Speakman et al. 2023), and yet obesity has somehow risen. According to the evidence at hand it is now taking less energy to make us more obese, how is that possible under the conventional paradigm?

So whether we're talking about this Food Pyramid or this one, or another one - while they are based on high quality research, they don't adequately address what we know about which specific foods are more weight-promoting than others. Nutritionists are still trained to tell you that orange juice is just as bad for you as soft drink because of the sugar content, even though the evidence says otherwise. Yes it's weight-promoting - but so what? Whole fruit juice is not as weight-promoting as soft-drink, or even potatoes, and yet potatoes remain a recommended staple of the diet with no caveats (eg. “in moderation”). They also continue to promote healthy dieting as a solution, when we know that doesn't work long-term (as is mentioned in the video above, almost all published academic studies on diets are short-term and do not discuss weight regain or net weight gain following the cessation of a weight-loss diet). And there is also a distinct physiological difference between a person who is obese, or who has previously been obese, and a person who has never been obese - and that reality is now impossible to ignore.

Until we understand what causes obesity the best we can do is work with what we do know, and that is that some foods will protect and others will not. Claims like this are gobbledygook: “The root causes of overweight and obesity are varied and complex. Overweight and obesity mainly occurs when there is a sustained energy imbalance, where too much energy is consumed through food and drink, and not enough is expended through physical activity.” Stating that there is an energy-imbalance does not establish causality - an energy imbalance of 40kJ per day from birth is enough to make someone obese by 35 - that's a tiny imbalance and cannot possibly be the full story. Why is there an energy imbalance, what causes it, and what causes the body to store it as fat rather than just increase resting metabolism to burn it or excrete it? “Conventional wisdom” lacks scientific data, and the science is not advanced enough to tell us what's really going on. I think we know enough, at least at the individual household level, to educate people on how to best protect themselves and prevent obesity, but no one is actually promoting that message effectively as the Food Pyramids reflect. We need to move away from this idea that there are “healthy foods” and “unhealthy foods” - what's unhealthy for one person may be a healthy choice for another, and so-called “unhealthy foods” are fine in moderation or as per a person's individuality or lifestyle permits.

What we know about the biological mechanisms of obesity, even though we don't know for sure what they are, is that obese state of the body is biologically defended. Some researchers are bold enough to claim this is the body's defence against starvation or something similar, but I think we can say for now that even IF that biological mechanism is in place - there appears to be another unique to obese patients. Or multiple others. You're fighting biological reality if you're attempting to reverse it - it could well be that obese patients will require ongoing medication in the same way that type-2 diabetics need insulin or other chronic illnesses require ongoing pharmacotherapy to keep biology at bay. We haven't found a way to biologically reverse eye disorders. They are best treated with tools to manage it like glasses or contact lenses, and while patients can get laser eye surgery it doesn't reverse the biological mechanism that led to the disorder in the first place, and thus it too is a treatment. Note that we haven't been looking at ways to prevent the common and treatable eye disorders like Astigmatism, Hyperopia, Myopia, or Presbyopia because we are quite happy treating them instead. Arguably we don't have the correct treatments yet for obesity, but it could end up being that treatment will be better than pursuing a cure. A true a cure to reverse it may not exist, we don't know and we won't know until we understand the cause or causes of it. Part of the problem with finding the best treatments is that clinicians and researchers alike have spent the past century pursing avenues that are futile - the new wave of pharmacotherapy is actually welcome but really in the very early stages as the drugs themselves have not been specifically designed for obesity and are not designed for life-long use which may be what is required to effectively manage the condition similar to type 2 diabetes and to the eye diseases that I mentioned all of which for all we know are preventable (yes I know there's no known prevention - but people are not looking for it!)

I shall close by quoting Hall & Kahan 2019: “Physiological responses to weight loss
“Outdated guidance to physicians and their patients gives the mistaken impression that relatively modest diet changes will consistently and progressively result in substantial weight loss at rate of one pound for every 3500 kcal of accumulated dietary calorie deficit21–24. For example, cutting just a couple of cans of soda (~300 kcal) from one’s daily diet was thought to lead to about 30 pounds of weight loss in a year, 60 pounds in 2 years, etc. Failure to achieve and maintain substantial weight loss over the long term is then simply attributed to poor adherence to the prescribed lifestyle changes, thereby potentially further stigmatizing the patient as lacking in willpower, motivation, or fortitude to lose weight25.

“We now know that the simple calculations underlying the old weight loss guidelines are fatally flawed because they fail to consider declining energy expenditure with weight loss26. More realistic calculations of expected weight loss for a given change in energy intake or physical activity are provided by a web-based tool called NIH Body Weight Planner (http://BWplanner.niddk.nih.gov) that uses a mathematical model to account for dynamic changes in human energy balance27.

“In addition to adaptations in energy expenditure with weight loss, body weight is regulated by negative feedback circuits that influence food intake28,29. Weight loss is accompanied by persistent endocrine adaptations30 that increase appetite and decrease satiety31 thereby resisting continued weight loss and conspiring against long-term weight maintenance.”

This sums up the situation today perfectly. Outdated guidance based on a fundamentally flawed understanding of the physiological reality of obesity and a scientific ignorance of the biological response to weight loss in obese patients. Anyway I'm hungry now so I'm going out for a Kebab.

Of course, if you starve yourself, you're gonna gain it all back.

I've lost 130 pounds and not gained a one back in 3 years. And I won't, because I eat a sustainable, nutritious diet that always allows you to eat to satiety, even while you are losing.

[Cavebear]

Allow me to clarify a point: you can “cure” obesity so long as the patient doesn't mind living with horrible side-effects including a slowed metabolism and a terrible hunger because their body is fighting to regain the weight. But that isn't a true cure. A cure would reverse obesity and return the patient to a healthy weight without such side-effects. There are many other conditions for which we don't have a cure and this isn't the realm of conjecture, this is the scientific reality we face although many academics and clinicians are loathed to admit it. Perhaps the highest quality research done to date on this specific issue was the academic research following contestants of “The Biggest Loser” after their appearance on the reality TV show. In the show the competitors start off as morbidly obese and compete to lose the most weight, effectively producing a cohort of the most successful morbidly obese weight losers. And yet following their time on the show most of the weight comes back on and their metabolism is substantially and permanently reduced. For example, a contestant named Danny Cahill won season 8 of the show. At the start he weighed 195kg/430lbs, at the finale he weighed 86.6kg/191lbs, and six years later he weighed 133.8kg/295lbs, but most significantly of all he requires 3350kJ/800Cal less energy per day than a man of his size is expected to require to maintain their weight - his metabolism has slowed permanently (the data is published in Fothergill et al. 2016 but it wasn't just Cahill - every contestant had a lower metabolism than is expected of a person their size and there have been further studies published on this). We've known that diets don't work to cure obesity for over 30 years, in fact they cause more harm than benefit, so why are they still being promoted today?

As many know, I'm firmly in the camp that disagrees with the conventional wisdom that kilojoules in = kilojoules out. That ignores the science. Or if they're not ignoring it entirely, they're not engaging with it - they're cherry-picking the data or the papers they read. If the conventional paradigm were correct all it would take is an excess of 40 kilojoules (10 Calories) per day stored as fat for a person to become clinically obese by 35, and no one has THAT much control over their diet. For kilojoule counters this falls well below the margin for error. To put it into context, a teaspoon of sugar contains 68kJ and I have measured grocery staples like bread and found that there is often consistently 10-20% more in the packet by weight than is listed on the official package weight - this is because it's illegal to underweigh but legal to overweigh (effectively they can't short-change you but they can give you extra) - so the stated kilojoule content can be off by up to 20%, meaning 20% more kilojoules per serving than the packet says. This is why kilojoule counting is futile, you would have to weigh everything and calculate the energy content precisely otherwise you'll never have accuracy. Ironically it would be more accurate to count kilojoules at McDonalds than at home.

I was delighted to learn that last year there was a significant obesity conference organised by The Royal Society called Causes of obesity: theories, conjectures and evidence. I'm currently working my way through it, here's the video of day 2 of the conference and I'd recommend viewing the first session of day 2 if you're interested in this topic:


Complete day 1 is here. Not sure where day 3 is but the "complete" playlist for all presentations is here but note it doesn't include Q&A's and it isn't entirely complete for example it misses Friedman's presentation on Leptin, and he's the guy that discovered it! That being said his presentation doesn't have THAT much to do with the cause/s of obesity and he ONLY talks about leptin and not the other hunger hormones.

I agree with all of the speakers in day 2's first session and their varied approaches to solving the problem of: what mechanism (or mechanisms) causes obesity? We don't know. You'd think by now we could answer the question but sadly the research has been advancing at a glacial pace. We do know certain foods are associated with positive, or negative, weight change and that's really where the highest quality of evidence we have is. But we don't understand the physiology. We don't understand the why. Why is it that metabolism slows dramatically and permanently after an obese person loses weight? We currently have no answer, other than “the body is fighting back”. Sure, it's fighting back - but why? One hypothesis put forward, though not in this conference as they were exclusively looking at the cause of obesity, that aligns well with the hypothesis put forward by Dr David Ludwig that fat causes obesity, is that it has to do quantity of adipocytes (adipose cells themselves). The idea behind this hypothesis is that when someone experiences obesity the body manufactures more quantity of adipocytes, but when they lose the weight they don't lose any adipocytes they just empty out of fat, but the cells themselves remain and the hypothesis is that this is the mechanism that drives weight regain (MacLean et al. 2015). It's a promising pathway but I personally do not think it can be the whole answer as it fits some of the data well but not all of the data. But if it is a pathway it doesn't have to be the only one - there may be several distinct pathways to the weight regain that can work together. And yes I know I gave the idiot's-version of Ludwig's hypothesis, but it doesn't matter - you don't need to understand the carbohydrate-insulin model that he advocates. Another theory as articulated in the video is that mixing foods that have sugar AND fat causes it because naturally foods are normally only high in one or the other.

But wait - did I not say weight loss is “easy”? Yeah it's easy IF you 1. know the science and you trust the science, 2. do not start off obese or with another condition that makes weight loss difficult such as diabetes, and 3. consequently your aim is to lose a small amount of weight - a fraction of what an obese person would need to lose to become a “healthy weight”. So let's talk about the science, specifically the stuff that the first group of presenters at Day 2 of the conference went over (really this is enough on its own to get a solid understanding - the best paper I've found to date is Mozaffarian et al. 2011 that is a longitudinal study which attributes specific foods with weight change overtime - but please be wary of generalising the data). Foods can be weight-promoting or non weight-promoting, kilojoules are not equal, and while these guys are debating about what the unknown mechanism or mechanisms are that cause this to be the case - there's already a decent understanding about which foods are “obesogenic”/weight-promoting and which aren't. Mentioned in the discussion above including potatoes being weight-promoting, full-fat unflavoured yoghurt being non weight-promoting, olive oil being non-weight promoting, dark chocolate (specifically 70%+ coca) being non weight-promoting, and ultraprocessed foods as being either weight-promoting (eg. white bread) or non-weight promoting (eg Tofu). This is all correct and is exactly what the science shows. We can add soft drinks as weight-promoting, wholemeal bread as non weight-promoting, whole foods as generally speaking non weight-promoting, olive oil as being perhaps the healthiest cooking oil, and full-fat dairy as being fine as well. A lot of this flies in the face of 1. conventional wisdom (because it's not intuitive), and 2. the food pyramid that does not distinguish between foods that are “healthy” and foods that are weight-promoting. Note that most weight-promoting foods are still healthy. They have their place in the diet and do not need to be demonised - and that even includes soft drink. Juice is weight promoting as well, but not as much as soft-drink. Nutrition labelling - in Australia, in the USA, in the UK and in many other countries - is at least 20 years behind the science. It really isn't helpful. Full-fat dairy is no more weight-promoting than fat-reduced unflavoured dairy but we're still being told that fat-reduced is “healthier”. You may say that doesn't sound right - but the data does not support fat-reduced dairy as being “healthier”.

In his presentation, Ludwig goes over some other evidence that is also of use (published version of his presentation is here). In particular energy intake in the US and in Europe has plateaued since the year 2000 (Mozaffarian 2022) or gone down since the 1980's (Speakman et al. 2023), and yet obesity has somehow risen. According to the evidence at hand it is now taking less energy to make us more obese, how is that possible under the conventional paradigm?

So whether we're talking about this Food Pyramid or this one, or another one - while they are based on high quality research, they don't adequately address what we know about which specific foods are more weight-promoting than others. Nutritionists are still trained to tell you that orange juice is just as bad for you as soft drink because of the sugar content, even though the evidence says otherwise. Yes it's weight-promoting - but so what? Whole fruit juice is not as weight-promoting as soft-drink, or even potatoes, and yet potatoes remain a recommended staple of the diet with no caveats (eg. “in moderation”). They also continue to promote healthy dieting as a solution, when we know that doesn't work long-term (as is mentioned in the video above, almost all published academic studies on diets are short-term and do not discuss weight regain or net weight gain following the cessation of a weight-loss diet). And there is also a distinct physiological difference between a person who is obese, or who has previously been obese, and a person who has never been obese - and that reality is now impossible to ignore.

Until we understand what causes obesity the best we can do is work with what we do know, and that is that some foods will protect and others will not. Claims like this are gobbledygook: “The root causes of overweight and obesity are varied and complex. Overweight and obesity mainly occurs when there is a sustained energy imbalance, where too much energy is consumed through food and drink, and not enough is expended through physical activity.” Stating that there is an energy-imbalance does not establish causality - an energy imbalance of 40kJ per day from birth is enough to make someone obese by 35 - that's a tiny imbalance and cannot possibly be the full story. Why is there an energy imbalance, what causes it, and what causes the body to store it as fat rather than just increase resting metabolism to burn it or excrete it? “Conventional wisdom” lacks scientific data, and the science is not advanced enough to tell us what's really going on. I think we know enough, at least at the individual household level, to educate people on how to best protect themselves and prevent obesity, but no one is actually promoting that message effectively as the Food Pyramids reflect. We need to move away from this idea that there are “healthy foods” and “unhealthy foods” - what's unhealthy for one person may be a healthy choice for another, and so-called “unhealthy foods” are fine in moderation or as per a person's individuality or lifestyle permits.

What we know about the biological mechanisms of obesity, even though we don't know for sure what they are, is that obese state of the body is biologically defended. Some researchers are bold enough to claim this is the body's defence against starvation or something similar, but I think we can say for now that even IF that biological mechanism is in place - there appears to be another unique to obese patients. Or multiple others. You're fighting biological reality if you're attempting to reverse it - it could well be that obese patients will require ongoing medication in the same way that type-2 diabetics need insulin or other chronic illnesses require ongoing pharmacotherapy to keep biology at bay. We haven't found a way to biologically reverse eye disorders. They are best treated with tools to manage it like glasses or contact lenses, and while patients can get laser eye surgery it doesn't reverse the biological mechanism that led to the disorder in the first place, and thus it too is a treatment. Note that we haven't been looking at ways to prevent the common and treatable eye disorders like Astigmatism, Hyperopia, Myopia, or Presbyopia because we are quite happy treating them instead. Arguably we don't have the correct treatments yet for obesity, but it could end up being that treatment will be better than pursuing a cure. A true a cure to reverse it may not exist, we don't know and we won't know until we understand the cause or causes of it. Part of the problem with finding the best treatments is that clinicians and researchers alike have spent the past century pursing avenues that are futile - the new wave of pharmacotherapy is actually welcome but really in the very early stages as the drugs themselves have not been specifically designed for obesity and are not designed for life-long use which may be what is required to effectively manage the condition similar to type 2 diabetes and to the eye diseases that I mentioned all of which for all we know are preventable (yes I know there's no known prevention - but people are not looking for it!)

I shall close by quoting Hall & Kahan 2019: “Physiological responses to weight loss
“Outdated guidance to physicians and their patients gives the mistaken impression that relatively modest diet changes will consistently and progressively result in substantial weight loss at rate of one pound for every 3500 kcal of accumulated dietary calorie deficit21–24. For example, cutting just a couple of cans of soda (~300 kcal) from one’s daily diet was thought to lead to about 30 pounds of weight loss in a year, 60 pounds in 2 years, etc. Failure to achieve and maintain substantial weight loss over the long term is then simply attributed to poor adherence to the prescribed lifestyle changes, thereby potentially further stigmatizing the patient as lacking in willpower, motivation, or fortitude to lose weight25.

“We now know that the simple calculations underlying the old weight loss guidelines are fatally flawed because they fail to consider declining energy expenditure with weight loss26. More realistic calculations of expected weight loss for a given change in energy intake or physical activity are provided by a web-based tool called NIH Body Weight Planner (http://BWplanner.niddk.nih.gov) that uses a mathematical model to account for dynamic changes in human energy balance27.

“In addition to adaptations in energy expenditure with weight loss, body weight is regulated by negative feedback circuits that influence food intake28,29. Weight loss is accompanied by persistent endocrine adaptations30 that increase appetite and decrease satiety31 thereby resisting continued weight loss and conspiring against long-term weight maintenance.”

This sums up the situation today perfectly. Outdated guidance based on a fundamentally flawed understanding of the physiological reality of obesity and a scientific ignorance of the biological response to weight loss in obese patients. Anyway I'm hungry now so I'm going out for a Kebab.

I understand that the body responds to fewer calories by adjusting metabolism. And I understand that the body can operate using stored fat that doesn't always show up as a loss in much weight. But that is still a temporary thing. In the long-run, our bodies will lose weight when the intake of calories is less than the expenditure of calories. And I reiterate that it takes time. If you want to lose 10 pounds in a couple of months so that you look better in a bathing suit at the beach, it probably won't work (or at least it will be bad for your nutritional health).

And it matters what you eat. Eating 500 calories of desserts is not going to help you lose weight as compared to 500 calories of fruits&veggies. The fruits&veggies have benefits aside from mere calories.

[Aractus]

I've lost 130 pounds and not gained a one back in 3 years. And I won't, because I eat a sustainable, nutritious diet that always allows you to eat to satiety, even while you are losing.

You're an outlier though, but in any case it doesn't establish the cause.

I understand that the body responds to fewer calories by adjusting metabolism.  And I understand that the body can operate using stored fat that doesn't always show up as a loss in much weight. But that is still a temporary thing.  In the long-run, our bodies will lose weight when the intake of calories is less than the expenditure of calories.

It's not at all that simple.

And it matters what you eat.  Eating 500 calories of desserts is not going to help you lose weight as compared to 500 calories of fruits&veggies.  The fruits&veggies have benefits aside from mere calories.

Of course, that's the whole point.

[Cavebear]

I've lost 130 pounds and not gained a one back in 3 years. And I won't, because I eat a sustainable, nutritious diet that always allows you to eat to satiety, even while you are losing.

You're an outlier though, but in any case it doesn't establish the cause.

I understand that the body responds to fewer calories by adjusting metabolism.  And I understand that the body can operate using stored fat that doesn't always show up as a loss in much weight. But that is still a temporary thing.  In the long-run, our bodies will lose weight when the intake of calories is less than the expenditure of calories.

It's not at all that simple.

And it matters what you eat.  Eating 500 calories of desserts is not going to help you lose weight as compared to 500 calories of fruits&veggies.  The fruits&veggies have benefits aside from mere calories.

Of course, that's the whole point.

It seemed to me that you were saying opposite. You might be understood better if you didn't write entire pages in commenting. I understand wanting to get your thoughts expressed well, but a bit of succinctness goes a long way.

[Inkubus]

Allow me to clarify a point: you can “cure” obesity so long as the patient doesn't mind living with horrible side-effects including a slowed metabolism and a terrible hunger because their body is fighting to regain the weight. But that isn't a true cure. A cure would reverse obesity and return the patient to a healthy weight without such side-effects.

Losing weight is hard work? Well who would have thought it.

Obese people almost invariably have obese parents. Now if the parents are passing on this "disease" to their children then the genetic markers will stand out like a diamond on a goat's arse. We find no such thing, what we do find is: environmental factors:





Monkey see, monkey do

[Aractus]

It seemed to me that you were saying opposite.  You might be understood better if you didn't write entire pages in commenting.  I understand wanting to get your thoughts expressed well, but a bit of succinctness goes a long way.

Well it's a dense topic and I'm still working my way through last year's conference.

It is there though in paragraph 2: “As many know, I'm firmly in the camp that disagrees with the conventional wisdom that kilojoules in = kilojoules out. That ignores the science. ...”

The point is to be up-to-date with the evidence, not be brief - but that being said the evidence has barely moved since I last looked deeply at it in 2014-2016 while at uni. The conference is very welcome - I wish it had happened sooner. Because you have researchers all agreeing that the cause of obesity is unknown and they wish to explore that to try to identify what the mechanism is. We already know certain foods are weight-promoting and others are not (there's individual variability on that as well which is why I gave the caution not to generalise the data I shared as it's a US-based study so only applies to the cohorts they studied and not to everyone). And I linked to the best study I know on it which is here and definitely shows that not all kilojoules/Calories are equal.

Obese people almost invariably have obese parents. Now if the parents are passing on this "disease" to their children then the genetic markers will stand out like a diamond on a goat's arse. We find no such thing, what we do find is: environmental factors:





Monkey see, monkey do

Ah, you're incorrect there we do find genetic factors and it is talked about in the conference (in Day 1). Basically the hypothesis is that maybe we didn't need to regulate energy expenditure as precisely before we had “highly palatable high energy density foods”. As an example there, Aborigines may have become fat because we brought them the “western diet”. We don't have high quality data, but we do know highly processed grains are obesenogenic and perhaps even wholegrains are for them as well, and perhaps the highly-processed ones are even more obesenogenic for them? That's a perfectly valid hypothesis - and supported by the evidence that they are far more sensitive to the adverse effects of alcohol compared to non-Indigenous Australians.

[Thethingaboutitis]

Super sized portions, eating meals out of buckets are surely a contributory factor in the obesity epidemic.
You don't even need to leave your front door to feed yourself these days.

[Dom]

I've lost 130 pounds and not gained a one back in 3 years. And I won't, because I eat a sustainable, nutritious diet that always allows you to eat to satiety, even while you are losing.

You're an outlier though, but in any case it doesn't establish the cause.

I understand that the body responds to fewer calories by adjusting metabolism.  And I understand that the body can operate using stored fat that doesn't always show up as a loss in much weight. But that is still a temporary thing.  In the long-run, our bodies will lose weight when the intake of calories is less than the expenditure of calories.

It's not at all that simple.

And it matters what you eat.  Eating 500 calories of desserts is not going to help you lose weight as compared to 500 calories of fruits&veggies.  The fruits&veggies have benefits aside from mere calories.

Of course, that's the whole point.

I am not an outlier. There are thousands of people with a low carb lifestyle who can say the same. Plus they can say they reversed type 2 diabetes and high blood pressure. Low carb is a sustainable diet, provides all your body needs, and the fact that it allows consumption of fat keeps people sated, not ever hungry.

It works for those who are now afflicted with obesity, but it's a change in life style, and one has to shake all kinds of things the medical community, drug companies, and big food have drummed into us for a couple of decades. 

Funny that, since the low fat high carb diet is being pushed, we have such an outbreak of obesity...  And read your labels. Everything has sugar in it, from baby food to deli meats to ketchup. You think you control your sugar intake? Try again. They take the fat out and replace it with sugar - the single most harmful thing you can eat. Gotta get some flavor from somewhere I suppose.

[Cavebear]

Allow me to clarify a point: you can “cure” obesity so long as the patient doesn't mind living with horrible side-effects including a slowed metabolism and a terrible hunger because their body is fighting to regain the weight. But that isn't a true cure. A cure would reverse obesity and return the patient to a healthy weight without such side-effects.

Losing weight is hard work? Well who would have thought it.

Obese people almost invariably have obese parents. Now if the parents are passing on this "disease" to their children then the genetic markers will stand out like a diamond on a goat's arse. We find no such thing, what we do find is: environmental factors:





Monkey see, monkey do

See? Succinct and to the point!

OK, yeah, I get it. Losing weight can be hard. Changing your eating habits can be like trying to get off drugs. It takes work. It doesn't make you happy mentally or physically. Your brain complains. Your body complains.

I'm a bit overweight by about 10 pounds. My 42" waist pants felt tight sometimes. But its not because I ate sugary desserts or fast food, or pour gravy on my potatoes. My activity level went down from age and injuries. I might be one of those naturally/genetically inclined to store calories. But I doubt it (only something like 10-20% of obesity is genetically-driven). I probably shouldn't eat so much fresh fruit, but I recognize that as a personal choice. I've eaten less of those recently, and my weight has gone from 172 to 163 the past year and it has changed very gradually.

[Cavebear]

You're an outlier though, but in any case it doesn't establish the cause.


It's not at all that simple.


Of course, that's the whole point.

I am not an outlier. There are thousands of people with a low carb lifestyle who can say the same. Plus they can say they reversed type 2 diabetes and high blood pressure. Low carb is a sustainable diet, provides all your body needs, and the fact that it allows consumption of fat keeps people sated, not ever hungry.

It works for those who are now afflicted with obesity, but it's a change in life style, and one has to shake all kinds of things the medical community, drug companies, and big food have drummed into us for a couple of decades. 

Funny that, since the low fat high carb diet is being pushed, we have such an outbreak of obesity...  And read your labels. Everything has sugar in it, from baby food to deli meats to ketchup. You think you control your sugar intake? Try again. They take the fat out and replace it with sugar - the single most harmful thing you can eat. Gotta get some flavor from somewhere I suppose.

"Carbs" aren't the problem. It's what kind of "carbs" (and I recognize that you mentioned the difference) . I've had a running debate with Dom about that (friendly wink to Dom). Refined sugar is a carb. So is broccoli. But there are differences between the two and most discussions don't note the differences. People are encouraged to avoid "carbs" and that may be one of the worst suggestions ever.

People should eat more broccoli (or beans or spinach or beets); skip the dessert pie... LOL! And fast or processed food is probably a major contributor to obesity (or just those extra 10 pounds). I would love to eat a Big Mac again , but I haven't had one in a decade. I cook almost all my own food, and that matters. I control the sugar content (and don't use much).

And one habit I shook off decades ago are ads. Many involve unhealthy foods. I tune them out these days (and not only food ads, but all ads - but that's another topic).

[Cavebear]

You're an outlier though, but in any case it doesn't establish the cause.


It's not at all that simple.


Of course, that's the whole point.

I am not an outlier. There are thousands of people with a low carb lifestyle who can say the same. Plus they can say they reversed type 2 diabetes and high blood pressure. Low carb is a sustainable diet, provides all your body needs, and the fact that it allows consumption of fat keeps people sated, not ever hungry.

It works for those who are now afflicted with obesity, but it's a change in life style, and one has to shake all kinds of things the medical community, drug companies, and big food have drummed into us for a couple of decades. 

Funny that, since the low fat high carb diet is being pushed, we have such an outbreak of obesity...  And read your labels. Everything has sugar in it, from baby food to deli meats to ketchup. You think you control your sugar intake? Try again. They take the fat out and replace it with sugar - the single most harmful thing you can eat. Gotta get some flavor from somewhere I suppose.

If you don't stop defining all carbs as the same thing, I'm going to keep harping on the differences. Twinkies and broccoli are both "carbs" but there are differences.

[Dom]

I am not an outlier. There are thousands of people with a low carb lifestyle who can say the same. Plus they can say they reversed type 2 diabetes and high blood pressure. Low carb is a sustainable diet, provides all your body needs, and the fact that it allows consumption of fat keeps people sated, not ever hungry.

It works for those who are now afflicted with obesity, but it's a change in life style, and one has to shake all kinds of things the medical community, drug companies, and big food have drummed into us for a couple of decades. 

Funny that, since the low fat high carb diet is being pushed, we have such an outbreak of obesity...  And read your labels. Everything has sugar in it, from baby food to deli meats to ketchup. You think you control your sugar intake? Try again. They take the fat out and replace it with sugar - the single most harmful thing you can eat. Gotta get some flavor from somewhere I suppose.

"Carbs" aren't the problem.  It's what kind of "carbs" (and I recognize that you mentioned the difference) .  I've had a running debate with Dom about that (friendly wink to Dom).  Refined sugar is a carb.  So is broccoli.  But there are differences between the two and most discussions don't note the differences.  People are encouraged to avoid "carbs" and that may be one of the worst suggestions ever.  

People should eat more broccoli (or beans or spinach or beets); skip the dessert pie...  LOL!  And fast or processed food is probably a major contributor to obesity (or just those extra 10 pounds).  I would love to eat a Big Mac again , but I haven't had one in a decade.  I cook almost all my own food, and that matters.  I control the sugar content (and don't use much).

And one habit I shook off decades ago are ads.  Many involve unhealthy foods.  I tune them out these days (and not only food ads, but all ads - but that's another topic).

Veggies like broccoli are low carb and are in a low carb diet. There are no dessert pies in low carb. Try again. Carbs are turned into glucose, no matter how long it takes. People on a low carb diet use fat to generate energy, not glucose. The diet is what the diet is. None of your observations will change how a low carb diet works. I have no idea why you keep introducing this into the discussion of a low carb diet when it has no application in it. It pertains to your personal diet, not low carb. You are just confusing people who sorely need to switch to actual low carb to save their longevity. Obesity is rampant, give people a chance for dogs sake. Are you obese? This is for obese people. Jeesh.

[Cavebear]

"Carbs" aren't the problem.  It's what kind of "carbs" (and I recognize that you mentioned the difference) .  I've had a running debate with Dom about that (friendly wink to Dom).  Refined sugar is a carb.  So is broccoli.  But there are differences between the two and most discussions don't note the differences.  People are encouraged to avoid "carbs" and that may be one of the worst suggestions ever.  

People should eat more broccoli (or beans or spinach or beets); skip the dessert pie...  LOL!  And fast or processed food is probably a major contributor to obesity (or just those extra 10 pounds).  I would love to eat a Big Mac again , but I haven't had one in a decade.  I cook almost all my own food, and that matters.  I control the sugar content (and don't use much).

And one habit I shook off decades ago are ads.  Many involve unhealthy foods.  I tune them out these days (and not only food ads, but all ads - but that's another topic).

Veggies like broccoli are low carb and are in a low carb diet. There are no dessert pies in low carb. Try again. Carbs are turned into glucose, no matter how long it takes. People on a low carb diet use fat to generate energy, not glucose. The diet is what the diet is. None of your observations will change how a low carb diet works. I have no idea why you keep introducing this into the discussion of a low carb diet when it has no application in it. It pertains to your personal diet, not low carb. You are just confusing people who sorely need to switch to actual low carb to save their longevity. Obesity is rampant, give people a chance for dogs sake. Are you obese? This is for obese people. Jeesh.

So differentiate the carbs when you refer to them. Saying "carbs are bad" is too broad a statement.

[Dom]

Veggies like broccoli are low carb and are in a low carb diet. There are no dessert pies in low carb. Try again. Carbs are turned into glucose, no matter how long it takes. People on a low carb diet use fat to generate energy, not glucose. The diet is what the diet is. None of your observations will change how a low carb diet works. I have no idea why you keep introducing this into the discussion of a low carb diet when it has no application in it. It pertains to your personal diet, not low carb. You are just confusing people who sorely need to switch to actual low carb to save their longevity. Obesity is rampant, give people a chance for dogs sake. Are you obese? This is for obese people. Jeesh.

So differentiate the carbs when you refer to them.  Saying "carbs are bad" is too broad a statement.

They all become glucose and on a low carb diet that sabotages everything. They are good and fine on the diet of anyone who is not trying to save their life by eating low carb. Stop trying to sabotage the diet that can save lots of lives. On that diet, everything that ends up glucose is ruining the effect of the diet. Get that in your head.

[Cavebear]

So differentiate the carbs when you refer to them.  Saying "carbs are bad" is too broad a statement.

They all become glucose and on a low carb diet that sabotages everything. They are good and fine on the diet of anyone who is not trying to save their life by eating low carb. Stop trying to sabotage the diet that can save lots of lives. On that diet, everything that ends up glucose is ruining the effect of the diet. Get that in your head.

From" Healthline". If you’re trying to cut back on sugar, you may wonder whether the type of sugar matters.

Sucrose, glucose, and fructose are three types of sugar that contain the same number of calories gram for gram. They’re all found naturally in fruits, vegetables, dairy products, and grains but are also added to many processed foods.

They differ in their chemical structures, the way your body digests and metabolizes them, and how they affect your health.

If you’re trying to cut back on sugar, you may wonder whether the type of sugar matters.

Sucrose, glucose, and fructose are three types of sugar that contain the same number of calories gram for gram. They’re all found naturally in fruits, vegetables, dairy products, and grains but are also added to many processed foods.

They differ in their chemical structures, the way your body digests and metabolizes them, and how they affect your health.  Of the three sugars, fructose has the sweetest taste but the least impact on your blood sugar.

Glucose is absorbed directly across the lining of the small intestine into your bloodstream, which delivers it to your cells).

It raises blood sugar more quickly than other sugars, which stimulates the release of insulin (7Trusted Source).

Insulin is needed for glucose to enter your cells (8Trusted Source).

Once inside your cells, glucose is either used immediately to create energy or turned into glycogen to be stored in your muscles or liver for future use.  Like glucose, fructose is absorbed directly into your bloodstream from the small intestine.   But it raises blood sugar levels more gradually than glucose and does not appear to immediately affect insulin levels.

Just some thoughts on the subject.

[epronovost]

That's a perfectly valid hypothesis - and supported by the evidence that they are far more sensitive to the adverse effects of alcohol compared to non-Indigenous Australians.

While the idea that there is a an important component of genetics in obesity is certainly a valid and interesting hypothesis which is supported by the fact metabolism has strong genetic components, it's not that easy to test and to parse since those factors could also be epigenetic and there is of course a massive social and environmental impact. Obesity rates between Americans of European descent and their European of the same ethnicity is rather important. Regional rates of obesity in a large and climate diverse country like the US is also a thing.

As for alcohol in American Natives and Indigenous Australians, there has been some research focused on a genetic pre-disposition, but most of them came up with nothing probent. These people particularly important alcohol abuse and addiction problem seem to be linked to a higher propensity for binge drinking (which explain more alcohol related death and incident despite lower overall consumption), poverty and social marginalization.

It is probable that like any other major and difficult to alter medical condition obesity has a genetic, epigenetic and environmental component that intertwine in complex fashion making changing weight in a major fashion in a safe and permanent manner very difficult.

[Dom]

They all become glucose and on a low carb diet that sabotages everything. They are good and fine on the diet of anyone who is not trying to save their life by eating low carb. Stop trying to sabotage the diet that can save lots of lives. On that diet, everything that ends up glucose is ruining the effect of the diet. Get that in your head.

From" Healthline". If you’re trying to cut back on sugar, you may wonder whether the type of sugar matters.

Sucrose, glucose, and fructose are three types of sugar that contain the same number of calories gram for gram. They’re all found naturally in fruits, vegetables, dairy products, and grains but are also added to many processed foods.

They differ in their chemical structures, the way your body digests and metabolizes them, and how they affect your health.

If you’re trying to cut back on sugar, you may wonder whether the type of sugar matters.

Sucrose, glucose, and fructose are three types of sugar that contain the same number of calories gram for gram. They’re all found naturally in fruits, vegetables, dairy products, and grains but are also added to many processed foods.

They differ in their chemical structures, the way your body digests and metabolizes them, and how they affect your health.  Of the three sugars, fructose has the sweetest taste but the least impact on your blood sugar.

Glucose is absorbed directly across the lining of the small intestine into your bloodstream, which delivers it to your cells).

It raises blood sugar more quickly than other sugars, which stimulates the release of insulin (7Trusted Source).

Insulin is needed for glucose to enter your cells (8Trusted Source).

Once inside your cells, glucose is either used immediately to create energy or turned into glycogen to be stored in your muscles or liver for future use.  Like glucose, fructose is absorbed directly into your bloodstream from the small intestine.   But it raises blood sugar levels more gradually than glucose and does not appear to immediately affect insulin levels.

Just some thoughts on the subject.

This is a long going convo. The above is never disputed. It is all true.

The fact remains, that low carb means low glucose, and any and all carbs end up as glucose and as such get counted in low carb. Some carbs are allowed, and usually low carbers choose veggies for that. 

It really doesn't matter, on a low carb diet, how long it takes for glucose to be metabolized. It is irrelevant. It is glucose, and it will be limited if the diet is supposed to work. In the context of a normal diet for a person who is not obese, the above are good things to consider. In the context of an obese person trying to normalize via a low carb diet, they are totally irrelevant.

[Cavebear]

From" Healthline". If you’re trying to cut back on sugar, you may wonder whether the type of sugar matters.

Sucrose, glucose, and fructose are three types of sugar that contain the same number of calories gram for gram. They’re all found naturally in fruits, vegetables, dairy products, and grains but are also added to many processed foods.

They differ in their chemical structures, the way your body digests and metabolizes them, and how they affect your health.

If you’re trying to cut back on sugar, you may wonder whether the type of sugar matters.

Sucrose, glucose, and fructose are three types of sugar that contain the same number of calories gram for gram. They’re all found naturally in fruits, vegetables, dairy products, and grains but are also added to many processed foods.

They differ in their chemical structures, the way your body digests and metabolizes them, and how they affect your health.  Of the three sugars, fructose has the sweetest taste but the least impact on your blood sugar.

Glucose is absorbed directly across the lining of the small intestine into your bloodstream, which delivers it to your cells).

It raises blood sugar more quickly than other sugars, which stimulates the release of insulin (7Trusted Source).

Insulin is needed for glucose to enter your cells (8Trusted Source).

Once inside your cells, glucose is either used immediately to create energy or turned into glycogen to be stored in your muscles or liver for future use.  Like glucose, fructose is absorbed directly into your bloodstream from the small intestine.   But it raises blood sugar levels more gradually than glucose and does not appear to immediately affect insulin levels.

Just some thoughts on the subject.

This is a long going convo. The above is never disputed. It is all true.

The fact remains, that low carb means low glucose, and any and all carbs end up as glucose and as such get counted in low carb. Some carbs are allowed, and usually low carbers choose veggies for that. 

It really doesn't matter, on a low carb diet, how long it takes for glucose to be metabolized. It is irrelevant. It is glucose, and it will be limited if the diet is supposed to work. In the context of a normal diet for a person who is not obese, the above are good things to consider. In the context of an obese person trying to normalize via a low carb diet, they are totally irrelevant.

You keep saying "low carb" as if all carbs are the same. It's like saying atheism is a religion.

[Dom]

This is a long going convo. The above is never disputed. It is all true.

The fact remains, that low carb means low glucose, and any and all carbs end up as glucose and as such get counted in low carb. Some carbs are allowed, and usually low carbers choose veggies for that. 

It really doesn't matter, on a low carb diet, how long it takes for glucose to be metabolized. It is irrelevant. It is glucose, and it will be limited if the diet is supposed to work. In the context of a normal diet for a person who is not obese, the above are good things to consider. In the context of an obese person trying to normalize via a low carb diet, they are totally irrelevant.

You keep saying "low carb" as if all carbs are the same.  It's like saying atheism is a religion.

In a low carb diet, all carbs are the same because they convert to glucose, which is a no-no. And now I am done repeating myself. Your observations are cool for you, but irrelevant on a low carb diet. Case closed.

[Thethingaboutitis]

Is it time for health warnings on food packaging? Like the warnings that you get on cigarette packs or alcohol labels?

Maybe an advertising campaign might do a bit of good.

It could go something like this...

"Instead of ordering food online, take a stroll to the takeaway. At least you'll burn a bit of the fat off on the way."

Instead of peeling off a monopoly sticker and winning a free burger maybe McDonald's could offer something more appropriate?

Obviously this isn't all about takeaways and the apparent convenience of them but it plays a massive part in developed countries.

[Cavebear]

You keep saying "low carb" as if all carbs are the same.  It's like saying atheism is a religion.

In a low carb diet, all carbs are the same because they convert to glucose, which is a no-no. And now I am done repeating myself. Your observations are cool for you, but irrelevant on a low carb diet. Case closed.

If you want to keep writing that a Twinkie is the same value as a bowl of broccoli (both seem to be the same "carbs" to you), because they both turn into glucose eventually, that is up to you. I don't agree. But all discussions can come to an end.

But I'm still right.

[c172]

Is it time for health warnings on food packaging? Like the warnings that you get on cigarette packs or alcohol labels?

Maybe an advertising campaign might do a bit of good.

It could go something like this...

"Instead of ordering food online, take a stroll to the takeaway. At least you'll burn a bit of the fat off on the way."

Instead of peeling off a monopoly sticker and winning a free burger maybe McDonald's could offer something more appropriate?

Obviously this isn't all about takeaways and the apparent convenience of them but it plays a massive part in developed countries.

Or like prescription med commercials, at least ion the states. Half of them seem to be about stating every single thing bad that can happen. I actually think this has been a good thing, and doesn't annoy me to listen to. Food commercials could learn from this.

[Thethingaboutitis]

Is it time for health warnings on food packaging? Like the warnings that you get on cigarette packs or alcohol labels?

Maybe an advertising campaign might do a bit of good.

It could go something like this...

"Instead of ordering food online, take a stroll to the takeaway. At least you'll burn a bit of the fat off on the way."

Instead of peeling off a monopoly sticker and winning a free burger maybe McDonald's could offer something more appropriate?

Obviously this isn't all about takeaways and the apparent convenience of them but it plays a massive part in developed countries.

Is it time for health warnings on food packaging? Like the warnings that you get on cigarette packs or alcohol labels?

Maybe an advertising campaign might do a bit of good.

It could go something like this...

"Instead of ordering food online, take a stroll to the takeaway. At least you'll burn a bit of the fat off on the way."

Instead of peeling off a monopoly sticker and winning a free burger maybe McDonald's could offer something more appropriate?

Obviously this isn't all about takeaways and the apparent convenience of them but it plays a massive part in developed countries.

Or like prescription med commercials, at least ion the states. Half of them seem to be about stating every single thing bad that can happen. I actually think this has been a good thing, and doesn't annoy me to listen to. Food commercials could learn from this.

Exactly.
 KFC MacDonald and the like get away with shameless advertising.

Balls to your cardboard straws and your pretending to give a shit. Let's have a bit of transparency.

[Cavebear]

Is it time for health warnings on food packaging? Like the warnings that you get on cigarette packs or alcohol labels?

Maybe an advertising campaign might do a bit of good.

It could go something like this...

"Instead of ordering food online, take a stroll to the takeaway. At least you'll burn a bit of the fat off on the way."

Instead of peeling off a monopoly sticker and winning a free burger maybe McDonald's could offer something more appropriate?

Obviously this isn't all about takeaways and the apparent convenience of them but it plays a massive part in developed countries.

Or like prescription med commercials, at least ion the states. Half of them seem to be about stating every single thing bad that can happen. I actually think this has been a good thing, and doesn't annoy me to listen to. Food commercials could learn from this.

About 20 years ago, the pharm companies learned that if they mentioned all the negative side-effects at the end of a commercial promoting the positives, no one paid attention. And then about 10 years ago, they learned they could actually list some side-effects as positives. My favorite is " X drug may cause some weight loss". Well, damn sure, some people started demanding X drug from their doctors...

In another sense, we are now so inurred to the list of possible negative side-effects that we no longer pay attention. I mean, it seems like every drug causes enough problems (insert your favorite bad side effect here). Its like, what "doesn't" possibly cause vomiting and diarhea or inflammation at the injection site, or itching) ". It may be 1 in a million but people just tune it out as blah-blah fine print... And they should. But it means we don't get the real facts.