Yves here. While this Richard Murphy post makes a valid point about the failure to sustain weight loss after going off GLP-1 agonists, I have to take issue with his contention that fatties just need to man (or woman) up and give up their bad habits to get and keep weight off.
I went on my first diet when I was 11. This was my idea, not my parents’. My BMI was in the overweight as opposed to obese category, but I was very large for a kid those days (in height as well, another story). I got 25 lbs off, more than the average weight loss with Ozempic. It came back on over 2 years. I went on another diet, then taking off 30 lbs. It again largely came back over the next two years.
Mind you, this is as a young person when it is theoretically easier to lose weight.
The dirty secret, even with young people, is when you engage in calorie restriction (aka dieting), unless you do in in a very particular way (periodically but far from regularly eating a “normal” calorie level; exercise routines designed to generate lactic acid, which increases growth hormone and therefore raises your metabolism, can also help), your body thinks you are starving and downregulates your metabolism. So when you stop dieting, you are if anything more inclined to gain weight due to the diet-induced slowdown in your metabolism.
As an adult, I found the only way to keep weight off after my see-saw diets in my teens (there were a couple more) was to permanently restrict my intake to 1000 or so calories a day. The NIH should be paying me for being on my own long-term severe calorie restriction experiment (animal studies suggests it increases longevity). And starting at age 25, I was also exercising an hour or more a day (pretty hard cardio + some calisthenics, later cardio + weight training).1
Admittedly, this is n=1. But my own experience illustrates that once you become fat, it is hard to reverse that and sustain the reduction. So I’m not keen about finger-wagging at the overweight, at least on the basis that they should be able to pull themselves up by their bootstraps. Most of the advice about getting and keeping weight off is terrible even before getting to fads. So no wonder the overweight take magic pills.
The key, as RFK, Jr.s MAHA indicates, is to improve diet and lifestyles so fewer people fall into the overweight trap, particularly young people. But neoliberalism and other practices work against that. Children no longer walk to and from school. My impression is that middle and upper class parents drive them to their play dates, rather than the kids getting their under their own power, usually bikes. Recesses are shorter than when I was young.
Neoliberalism also has resulted in less involvement by parents in community activities, like fathers playing softball, which would also serve as a model for their offspring.
Perhaps IM Doc will disagree, or some readers will say it was easy for them to shed pounds and keep them off. But I was diligent as an adult, to the extent that I did things like reading bodybuiding magazines for weight loss and supplement tips (bodybuilders are bleeding edge on weight loss methods, since they have to get “cut” for contests) and experimenting with quite a few diet and supplement fads. And I was still unable to relent on my draconian eating self-discipline, which I doubt many could maintain long-term.
By Richard Murphy, Professor of Accounting Practice at Sheffield University Management School and a director of the Corporate Accountability Network. Originally published at Funding the Future
The Guardian has reported this morning that:
People on weight loss drugs regain all the weight they have lost within a year of stopping the medication, analysis has shown.
Analysis of 11 studies of older and newer GLP-1 weight loss drugs by the University of Oxford found that patients typically lost 8kg on weight loss jabs but returned to their original weight within 10 months of stopping them.
The study, presented at the European Congress on Obesity, found that even for those taking newer, higher-dose weight loss drugs such as Wegovy and Mounjaro, people put weight back on once they stopped treatment.
Why note this? That is because what this evidence makes very clear is what I have been suggesting on this blog for a while, and that is that the purpose of these drugs is not to solve the problem of obesity. It is instead intended to create a new form of dependency, or even addiction. In this case, this dependency is on the weight loss drugs that the person becomes totally reliant upon to maintain their body image, and so their mental health, whatever the physical health side effects might be (and they can be serious, with significant potential long-term costs to the NHS).
The serious medical side effects of these drugs are ignored by most of their users. They want the dopamine hit of being slimmer without having to adjust their lifestyles, or to address the other addictions that they must shake off if they are to achieve sustainable weight loss. Those addictions are most especially to sugar and carbohydrates.
The GLP-1 drug industry is not, I suggest, interested in the side effects of its drugs. These are, as far as it is concerned, an economic externality that they can ignore as someone else (the state) will bear that cost.
And they are definitely not interested in suggesting that the other addictions that those who become dependent on their drugs might have be addressed, because if they were, then the steady flow of new sugar and carbohydrate addicts on which their business model now depends will be impacted.
Most bizarrely, the NHS, whose job it should be to see through all this and rise above it, very clearly does not do so. It has been captured by commercial interests whose only interest is in promoting addiction or dependency, at the very least.
All the GLP-1 drugs have done is add another drug on which people can become dependent, quite possibly for life, to the vast array that the NHS already spends a fortune on to keep the medical-pharmaceutical industry in the extraordinary level of profits to which it has become accustomed, without ever actually solving almost any of our real health problems, to all of which it turns a blind eye, as to address them would reduce their future earnings.
There is a sickness at the heart of the NHS in the form of drug companies, who are fleecing us all.
____
1 I am now weirdly able to eat more but still less than a normal person since moving to Thailand; I attribute it to being in >80 degree temperatures nearly all the time.
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The key to a normal weight is proper nutrition which is nearly impossible to achieve these days due to work-life balance. It requires an enormous effort not only on the part of an individual but the whole family.
I found the following book insightful, it put together lots of things I already new in a broad picture I could comprehend:
https://www.penguin.co.uk/books/464609/what-your-doctor-eats-by-stokholm-dr-camilla/9781785045431
Its about what you cut our or don’t eat e.g. metabolism killing stuff. After that its about intermittent exorcise and not 1 hr hectic gym sessions e.g. treadmills are hamster wheels in more than one way and pumping weights for big muscle for aesthetics is marketing ploy since antiquity.
Yet at the end of the day genetics always is in play …
You likely were never fat.
One you become fat, it takes virtually no calories to maintain it. It is extremely difficult to shed and keep off. There is actually a lot of evidence that supports the existence of that problem. Merely creating a calorie deficit (undereating and/or exercising) downregulates the metabolism (unless you follow particular protocols so as to avoid that). You have to stay at the lower level of intake to keep the weight off.
I was never fat in the way I think you mean YS, albeit as a kid post parents divorce and other factors I did get a gut in mid HS. Lots of factors like height, DNA, environmental social/environmental play parts.
Today its about cutting out refined sugar and processed foods because how they effect ones metabolism, how and when one eats, rest is DNA. Just with the above and some light work out I went from a 32 to 30 inch waste in just over a month. Then again I don’t sit down all day and try to offset for 1 hr in a gym.
Hi YS…
Yes you are correct that going calorie deficit is not a solution as the body goes into survival mode – self defeating and at the same time has negative psychological effects. As I said DNA has a huge influence, so family genealogy is the base line. After that is a long story about life as a kid and its influences, next its the amount of activity in a day, what you eat and when, followed by lots of intermittent exercise.
The gym and physical industry is as bad most things these days …
Calisthenics is the key, nothing hard, just a few times a day for less than 30 min. I use a protein drink in the morning that has metabolism/digestive additives and the effect was noted. Just like on the grandparents farm I don’t eat first up, wake up at 4:45 am, coffee, check NC et al, short calisthenics/stretching, don’t eat anything till about 10 am at work, just some fruit, come home and another short workout, have a big feed around 4 pm [top shelf meat/veg], 6 am and more workout/stretching, even when chilling on the lounge watching TV I do intermittent leg/ab stuff ever 30 min.
So its mental in the first order, next its being committed, when the results come in its a self reinforcing loop. I mean you have seen me on a 16 ft trestle perched on top and painting a window at 63 yrs. All this after a DIA head injury in 08 and a decade of dealing with its physical/psychological effects.
Problem in much of America is they make you fat and mess with brain chem for profit and then tell the individual is at fault. Then Pharma gives you a pill or need endless psychological help and processed via the health industry for rent extraction for investors.
I know you mean to help, but please do not sell simplistic solutions. As a former fattie who struggled for over a decade to get it under control and then has had to treat food as an enemy for the rest of my life (and yes, has also tried many diet fads, all of which were based on “healthy foods” before getting to their claimed special wrinkle), you are insulting just everyone who has had a long-standing issue with weight control and labored earnestly to try to combat it. And that’s before considering another big (in both senses of the word) group, post menopausal women.
I know tons of people in NYC, where it is easy to buy prepared healthy foods, and who are also at an affluent enough level to be able to afford to take time to exercise (on top of normal NYC walking, which is a lot) to disprove your contention. They were obsessively careful and either could not lose the weight or would lose it and have it come back in a year or two.
I even heard one man talking to his daughter (who I inferred was a regular at various fat loss/health oriented residential program): “So how much did it cost you for each pound you lost this time? $1,000?” And I could further infer that she was moaning about how careful she was about following nutritionist advice between her fat loss retreats.
Yes, eating “bad” food causes problems, including often packing on pounds. But if you are overweight, the idea that “eating healthy” is a magic weight loss remedy is a canard.
The most effective diet approach, keto, (by using a metabolic trick, putting your body into ketosis), is almost certain to be unhealthy on a long-term basis, since the restrictions on eating carbs amount to restriction on eating fruit and veg, which contain many micronutrients.
Yves, fellow shortie and early-life ‘chubby’ until I took the control away from insistent ‘you have to eat’ adults. I was age 12. Obesity, along with other ‘addictions’, run rampant in my family history. Call it DNA or habit, I simply don’t care. I just don’t want it.
I chose to NOT follow in the many negative habits.
I had to unlearn and then relearn, as you state above. It took hard work and diligence and the payoff 5 decades later is obvious when you see me and look at my blood test results. My parents died in their early 60s, 2 of my 3 siblings in their 50s! My remaining sibling simply will not change the way she thinks and her obesity is causing more health and emotional problems than necessary.
I chose to look at food as fuel and make nutrient rich choices, and due to my petite stature, almost zero snacking. As I age, I find I am indulging more with sugar. If I relax for a mere 3-4 days, the weight piles on. I fervently exercise, take in lots of sunshine and carefully monitor any disturbance from my routine. It’s not for the fainthearted. People insist on their own way and love to tell me what’s best for me! “You must eat more” or ‘stop eating meat’….nonsense!
I have compassion for people who struggle with food. They lug the evidence of their ‘lack of self control’ on their body for all to see. Other “passions of the flesh” can be hidden until they eventually take their effect and destroy the body, and along with it, one’s soul.
PS I seldom tell people my ‘secret’. Why? They judge. Just like the folks in the comments who are anti-keto, anti-fasting, stating with absolute terms about exercise routines. It’s disheartening. I want to scream, “Stop preaching what works for you and simply be Be glad for those of us who have diligently worked for DECADES to control this passion.
I was fortunate; following the Hacker’s Diet led to a 30 lb reduction, which I was able to keep off. Attempts at further loss over 15 years were more difficult, though.
!! I am also a Hacker’s Diet success story. I lost a LOT of weight following Walker. I fluctuate a little but have never come close to gaining it back.
This was in 2005. And I still use his Weight Log. AND his tool for generating passwords!! Oh. And his “What Me Exercise?” Exercise plan….
Ask your parents about the number of fat people in the population in their days. You will discover that fatties were a relatively rare phenomenon (I speak as an octagenarian Englishman – maybe America has always had this problem).
So, the real culprit in all this is societal changes: television and other easy entertainments, lack of normal life exercise, fast food, massive advertising pressure, work life balance (people often ate their main mean, dinner, at what is now called lunchtime – a proven healthier timing), big pharma, so many fads, and more.
The solution to all this is utterly complex. Rebuilding long lasting older cultural ways that have been destroyed is almost impossible. Additionally, we have no idea about what better new cultural ways will make up the loss. So, I have great sympathy with Yves and others with weight problems.
Apologies for being so lacking in helpful advice.
First, both my parents are dead. And I don’t need to ask them. In the 1960s and early 70s, as a merely fat (not obese) kid, I stood out so much in a bad way as to have decided on my own (as the post says) at age 11 to go on a diet
Second, I was fat before I could possibly have been watching TV (which was a novelty in my childhood, we did have a black and white one, which I ignored except for commercials; when older, I was allowed to view only 1/2 hour a day on the insistence of my ophthalmologist). I weighed 30 lbs at one year old. That’s small pony sized. Even now with heftier babies, it is rare; then it was almost unheard of.
Point taken about your parents and personal awareness. In some unnecessary mildly aggressive manner, I take it you agree with me. I cannot help your TV issues, but the point I make is not about the early rather limited days of TV, but the way it now consumes people’s evenings. Entertainment now consumes peoples lives – just watch all those on a train commute who are absorbed with their phones, often watching videos, wearing headphones: travelling around in their personal bubble.
Now it is more cell phones than TV.
And what is healthy food?
Pasta was good for you before being bad for you.
Coffee was bad for you before now being OK for you.
Beef was bad for you but now is OK or maybe even good for you if grass fed.
Kale was good for you but now maybe isn’t due to heavy metals: https://www.delish.com/food/a43162/kale-poison-thallium/
Low fat was good for you but now maybe isn’t.
Red wine was good for you in moderation but now is bad because any alcohol is now bad.
The jury has long been out on soy products like tofu
Whole eggs were bad for you because cholesterol in the yolk but eggs increasing blood cholesterol is deemed not to be true so eggs are OK.
Tea seems to be ever and always OK but you can’t live on that.
it is scientifically indisputable that laying down fat is an insulin dependent process, this means that the most efficient way to lose weight without particular caloric rstriction is to keep insulin levels down. The way to achieve this is to lower carbohydrate intake, it isn`t necessary to go keto to lower insulin levels enough to stop adding to fat storage and to slowly consume stored fat by adding at least moderate exercise (see the work of Robert Lustig, Ben Bikman and many many others). Cutting carbohydrates seems to be possible for perhaps most people pnce they understand the mechanisms and become motivated to try this. = see Dr David Unwin British GP who has reversed type 2 diabetes and achieved both weight loss and reductions in blood pressure in a large body of his patients. He has published on this and can found in many youtube interviews explaining his approach and results all this. However over time he has found that there are about 20 per cent of his patients who seem to be truly addicted to carbohydrates and have not been able to fottow his protocol. He and his team are currently trying to find ways of helping these patients i e taking the problem seriously.
There is a lot of information to be had re all this and the scientific and practical basis of it by following links related to the above mentioned internet content. I and others have found that gaining this understanding can permanently resolve a lifetime of problems. Excessive (the level varies with the individual) carbohydrate consumption and resulting bad blood glucose control leads to hunger and food cravings, and often obsession with food ….. freedom from these is liberating…
please do look up David Unwin`s journey of discovery triggered by a patient who told him she`d resolved all her health problems (obesity, type 2 diabetes etc) by doing the opposite of what Unwin had advised her…. he listened, and began to learn…. and has now saved I think a third of his annual medication budget and now won awards…
Sorry but see IM Doc below. He disagrees. Patients now seem often to have persistent metabolic issues and their fat resists diligent effort.
And as I said, acting as if there is some simple formula is deeply insulting to those who have tried many many many approaches and not gotten much in they way of results.
Could you explain what you mean by this?
Are you periodically reducing your calorie intake, or eating less in general and periodically increasing it?
No this is not what I did. If I had, I might not have crashed my metabolism in the course of getting thin.
You cycle your eating so as reduce calorie intake overall while not letting your body think you are starving yourself (which = reduced metabolism).
One approach along these lines is diet five days, eat “normally” for two (as in do not go crazy and eat doughnuts or drink beer).
Another is moderate calorie restriction week one, pretty severe week two, eat “normally” week three and keep repeating.
So I just started on one of the GLP-1s. In my mid-50s, certainly not obese but definitely tilting into overweight. I have some problematic arthritis, which the weight was not helping, and my cholesterol was starting to tick up to unhealthy levels. Plus some family members with diabetes and didn’t want to go that route.
I’ve done the diet thing before, successfully, and kept the weight off for extended periods (over a year). But it does take a lot of mental energy (for me anyway, I definitely have a sweet tooth.) Being under stress tends to undermine the ability to keep weight off, and life is exceptionally stressful right now as a matter of course. I exercise reasonably regularly but my experience has been that weight is 90% diet and 10% exercise. Exercise for me is about being fit in cardiovascular and strength terms and has little impact on how I tip the scale.
So, opted to try GLP-1s. Basically my experience is they just make sticking to a lower calorie diet much much easier. My animal brain’s messages to go have a snack, or clean my plate, have been quieted. So my higher brain doesn’t have to play bad cop and can focus on other things. Have experienced zero side effects which is great.
The current plan is to be on them for about six months, get down to my target weight, then get off and see how it goes. Being on the GLP-1 has made it far easier to change my eating routine to be healthier so the plan is to stick to that routine. It’s much easier to keep a routine than it is to start a new one, so I’m optimistic that the weight won’t come zooming back.
You indirectly confirm the issue. You got the weight off but it came back. This is the not-acknowledged problem, that creating a calorie deficit (unless you diet in a particular way to avoid that, and I did not know to do that when young) = downregulation of metabolism = even greater propensity to gain weight once you stop dieting.
The weight didn’t come back immediately – as I said I was able to keep it off for over a year (and this was after losing ~30 lbs, not some trivial number). Then COVID hit and my eating (and drinking) habits changed for the worse.
If the issue is that you diet, and then you stop dieting and go back to your old eating habits, of course the weight is going to come back. Calories in > calories used, weight goes up. I think your point is that when you diet, your body wants to use less calories – which is why (a) exercise is important and (b) when you have reached your target weight, you can adjust calories in back up a little, but not too much (you want calories in = calories used).
The key to long-term success is that the diet isn’t a ‘diet’ but rather than you establish new eating habits that you stick to. That is hard! Stress makes it harder.
No, it is not just calories in, calories out.
Dieting lowers your baseline metabolism.
So you have to eat even less after every dieting and weight gain cycle.
Is there a way to re-raise baseline metabolism after it has been lowered by aggressive dieting?
I have found it a loosing battle with weight. It’s always 3 pounds off – 5 pounds on; uptrend since I hit 40. Low/slow metabolism people have a very tough life weight wise.
All natural diets where we literally make everything at home from raw natural ingredients is possible with a bunch of planning and effort. What I have found is that calories are still calories when it comes to keeping weight off for me.
What’s astonishing and astounding is the cost of these meds. A family of 4 can buy all natural ingredients, fruits and veggies for the cost of what it takes 1 adult to be on these drugs in the US!
I wish we had common sense health policy where we give folks like me time/access to affordable trainers/dietician’s/therapists as needed AND subsidize fresh fruit/veggies/wholesome food instead of burning money on these meds.
Do note, that I am just referring to folks for whom these drugs are a choice not a requirement for medical reasons.
Why are we collectively less smart as humanity, as opposed to having individual intelligence amplified for good outcomes?
This is another example of a medication for something that creates dependency when there are alternatives (albeit with their own costs…. apart from an increasing number of specific areas of cancer, medicines are often a zero sum game).
I started thinking about this when I had to fly to Sydney. Dad and I suffered chronic insomnia from childhood but of course while a GP will give you a “classic” sleeping pill (7-10 days worth in UK) to reset your sleep schedule, they won’t give you more because of dependency and trust you’ll just go away.
I discovered by chance that sub-clinical dose of amitriptyline cured my insomnia. I had been given it for neuropathic pain. GP happy to leave me on it and all was well for 10 years. Then the weird “doing stuff in my sleep” started (long before people like Roseanne blamed adderall etc for night time inflammatory tweets!). Psychiatrist instantly said some people have this reaction and I’m never ever to touch it again. But gave me subclinical dose of quetiapine instead which has worked now for 15 years.
Returning to my core point, out of the box thinking is required. There ARE medications for other things that have known high degree of appetite suppression. They come with a whole host of caveats (why most doctors hate them) but we have had them since 1970s and they work a treat.
Caffeine and stimulants generally are appetite suppressants.
But again at risk of oversharing, I am never hungry. Maybe once in 18 months I’ll get a weird gnawing sensation in my stomach and realize, “Oh, THAT must be what hunger is like.”
Not having any body signals at all as to when to eat (save getting in a bad mood or a headache and realizing it’s low blood sugar) is a problem.
Yeah my MAOI does that (I’ve talked about it before so this isn’t new news to some regulars). Long COVID makes it worse….. I’ll remember to drink coffee to offset the brain fog but I realise my calorie intake is alarmingly low mid afternoon…. hence why I get quieter later in the day as I try to keep my weight up and not stare at a screen for hours and have the brain fog make me type nonsense!
But nobody should ask their doc for an MAOI to suppress appetite. It’s merely a bonus if other antidepressants don’t work…… and if you’re eating processed foods in North America or Australasian subcontinent you really have to check the additives….. loads that could be problematic but are banned in Europe.
In my grandmother’s late life she lost her sense of smell. She said it made eating a chore as nothing really was of interest anymore. She was always quite petite so this didn’t help her from not becoming too frail as she approached 80.
You’re not over sharing. Your personal experience is directly relevant to the question at hand, and you have well-earned credibility.
I used the Noom diet app to help me lose 54 pounds three years ago. That weight has stayed off. Cutting caloric intake over an extended period made this happen. Noom assigns you a daily calorie limit based on a target weight and date that you select. Mine was 1450 calories.
Changing basic habits helped. I went from nine to six beers a week, replaced half & half with milk in my coffee, and cut out most desserts. I designed some basic meals that helped meet the target.
Agreed. Yves has always been very careful about sharing stuff – and if I were living under the US system for significant period of my life I’d probably do the same!
She’s now giving some advice that is easily accessible and (I hope) doable by lots of people.
I’ve possibly over-shared because the implcations for me under the “traditional” NHS in UK and Medicare in Oz are non-existent….but maybe now with US buy-outs of our systems I might have to think more…..
Full disclosure:
I had gained 15 of those pounds back before I went on retreat in mid-March. That was an effective weight reducer. You don’t reach for chips when you are listening to your guru or practicing meditation. I was off alcohol for the duration. Plus, desserts are not much of a thing in Nepal.
I have yet to meet anyone who became a buddhist to lose weight, though.
Wellie, if anyone needs a long term lab rat for Tirzepatide (Zepbound) I’m your huckleberry. I intend to take it until the day there is sad singing, slow driving, and (maybe?) women crying. In 18 months, I am down from 285 to 210, with another 20 or 25 to go. My doctor says my bloodwork has never been better. I would like to hit 185, because among other reasons, that was the weight class I had to wrestle in as an 8th grader when I was 13 years old. I yo-yo dieted and regained my actual bodyweight at least 3 times over the long life.
I started with the less expensive compound pharmacy version for most of the weight loss, but recently was approved by my Medicare supplement plan for the Big Pharma version due to sleep apnea. I am eating clean and am much more active than I was previously. Yes, I am making the requisite lifestyle changes. No, this isn’t a vanity project.
Perhaps I should be more concerned about long term ramifications, but at 71 yo I am chronologiclly running out of runway to begin with. It’s want to be able to walk that ruway without stopping every 50 feet to catch my breath!
Faced with endocrine disruptors added to processed foods and food packaging, crop varieties bred and treated for mechanization/shelf life rather than nutrition, and concentrated feedlot, junk food/endocrine disruptor fed meats, dairy and eggs, the challenges are major. Lack of inexpensive addiction treatment and better foods doesn’t help, while commodity crops are subsidized. Higher PFAS levels in our water is not the answer.
Be kind to yourself and others
You are so right about endocrine disruptions from food. The partioning of the input energy stream to storage (fat accumulation) OR oxidation and immediate use is driven hormonally. GLP-1s are a hormonal crutch to address toxicity problems inherent in our modern food stream.
I was fat for nearly all my life with a BMI of 30 when I was 52 and a waist line of 43 inches. The consulting life style makes it very hard to eat healthily. Although that is also an excuse too!
I then lost over 30 kgs and five years later have been lucky enough to keep it off. My own experience was that restricting processed carbohydrates worked and I never counted calories. I hear the point that keto may not be healthy in other ways and never followed keto. I eat fruit but make sure it is fibre rich and avoid juice (for example) which is sugar suspended in water. Although much of the advice says it is good for you. Avoiding insulin spikes seems essential though for both weight loss and overall health. I come from a family with a history of Type 2 diabetes. Insulin resistance is rarely tested for (at least in the UK) but it is the leading indicator.
I do cycle a lot (circa 250 miles per week) but the weight loss preceded the cycling. As it happens, I am cycling in Denia, Spain this week and you see a lot of over weight cyclists. Often cycling is an excuse to indulge in cakes and other sugary treats! You should see the cycle coffee shops here, which are very “English” in all respects too.
A big problem is that nutrition science is a bit unclear and is influenced by all sorts of food and pharmaceutical industry interests. Fully understand why people may not know what to do. So would never castigate anyone. I was obese for years and constantly worry about returning to that. My own approach was something I stumbled on and then I have ex post rationalized it. It may not work for anyone else. I weigh myself everyday and obsess over small changes now. As someone who is semi retired it is far easier too. Airport lounges are so tempting but the food they offer is disgustingly unhealthy.
Good for you! 30Kg and keeping it off for 5 years is quite an accomplishment,
But yes, success like that often demands vigilance, which can feel wearing.
The vigilance thing resonates. I don’t have to be so careful now back in Europe but taking an MAOI in Australia was a real pain. The two “BP spikes” I had were on successive days at a conference across the Tasman sea in Auckland.
I’d managed to avoid attending the stupid group stuff and meal (which I hated being an introvert and having to work so hard) and had an apartment with kitchenette with microwave. So I went to local supermarket and bought ready meals to eat whilst watching TV. Early days of the MAOI so I cast an eye over the main ingredients: no cheese or soy in top of list. Plus they were “British staples” (Sausages and mash; cottage pie). First one: oh damn, sweating and I knew my BP was spiking, Just hoped I wouldn’t have to go to ED in Auckland. Thankfully it resolved. 2nd night ditto. I looked in detail at ingredients. Ingredient 6 was soy. SOY. WTF was soy doing in there? Probably as a preservative or something to enhance bland flavour but that was the only thing that ever affected me being on MAOI.
You would NEVER see soy in a UK supermarket “british food”. Lesson learnt and I watched ingredient list like a hawk in Australia NZ (much of whose ingredients lists came from USA). Never had a single MAOI problem since.
This is inspiring for me! Well done!
This is the one area on medical practice in which I have no good answers. What is much more frustrating to me over decades is watching the problem of obesity ( and all of its side effects – like Diabetes, fertility issues, liver problems, coronary artery disease among many others ) just explode in incidence. This is especially true in younger people. When I started, this was actually rare until about the 40s or 50s. There were occasional kids and teens that had weight problems – but virtually none of them had progressed to DM by the age of 40. That is certainly no longer true – it is just repeated patients over and over with full blown TYPE 2 DM at age 19, 21, or even 15. This problem must be differentiated with Type I DM – which is a completely different issue, although it too lately has just exploded in incidence.
What is so frustrating as a clinician trying to help these people – 1) I have repeatedly watched as they have done EVERYTHING to change their habits – and I know they are not making it up and be rewarded with failure 2) the constant yo-yo effect – lose weight – gain back more – lose weight – gain back more and to be honest these yo-yo people seem to have much worse medical complications eventually 3) the fad diets and such that are just eventually toxic 4) the quacks who prey on these people 5) the dismal record of big Pharma with this and their preying on these people – I may be cynical but it seems they are just very happy to have life long customers. The GLP1s are just the latest wealth extraction device. I would guess 1/3 cannot even make it a month because of side effects, it works well for about a third ( although they have to stay on them to maintain ) and the other people it just helps a bit – certainly not worth the cost. Being a prescriber of Pharma agents for decades, I have a very bad feeling about these drugs given some of the things I am seeing. Class action lawsuits on the way.
After decades of watching this struggle, and seeing pictures of entire beaches of fit people in the 1940s, etc – I am convinced there is some kind of field effect – with multiple factors involved that may be involving people in different ways. Plastics? Hormones? Pollution? GI flora modifiers? Too many Froot Loops and not enough exercise as children? Something ( s) that we have not even thought of? We should really be focused like lasers on these issues – and not on this or that drug. One only has to look at the pricing of these GLP1 agents to know where the heart of Pharma is. These are simple amino acid chains – it takes about 50 cents per dose to make – and yet they are 1500 dollars a month – soon to be 500 – still way too high. Let me put it simply – there is simply no R&D on this planet that justifies that mark-up. It is greed – and it is an agent they KNOW has to be maintained long term – let the money keep flowing until the lawsuits start flowing. That has been their model for the past 30 years.
I sympathise. As part of the multitude of tests and scans I’ve endured for my long COVID and other stuff, I found it deeply ironic (and slightly disturbing) that the Fibroscan result was “no scarring or cirrhosis, just a high fatty liver at median level for population”.
WTAF? So a really fatty liver is now “the norm” in the UK? We’re in trouble. A friend in Sydney (who was aged 19) told me he had diagnosis of really fatty liver…….back in around 2014 (and told this was the “new normal”…..so it’s not just UK. If I had to generalise I’d say it’s the entire “anglosphere”.
We’re doing some really wrong things in diet etc since I’ve seen enough liver issues unrelated to alcohol to know “this should NOT be happening”.
I have read previously that the USDA meat standard prizes a carcass that exhibits the fatty tissue pathology of a cow with a serious metabolic lifestyle disease (all that disseminated soft white fat marbling rather than discrete margins of dense yellow fat ).
Perhaps we are also being fattened by our alien overlords?
I once sat in on a 4H calf-judging contest at the state fair. At one point the judge pointed to a few lean little animals and announced “Here we have the skinny story, and the moral of that story is spend more time at the feed bucket!”
To Serve Man was a cookbook in the twilightzone as I recall. Metabolically sick cattle fetch a higher price due to their increased weight. The disrupters in the food chain affect us all.
I now measure the quality of my life in Pound-Years to be consistent with big Agriculture.
It’s just anecdotal, but I do see some really well to do folks look much much better from the outside; as in , they are not overweight and they generally look more healthy.
There should be a simple zip code level analysis combined with income or lifestyle level analysis for health markers like BP, Lipid panels and Hormone panels. My gut feel is that there will be extremely strong correlation with positive health and how rich someone is.
It might not all be due to the food, maybe stress or lack of stress, positive outlook, good sleep, access to mental health support etc etc all contribute.
Big tech knows so much about us when it comes to pushing stuff in our faces for advertising dollars or our attention span. In comparison, a rudimentary high school level data analysis for something that actually matters for society – It’s too complex to do.
Here here! I live in one of the wealthiest counties in the country. Most home owners are college educated, very good school system with expensive facilities for sports. Also, a great variety of grocery stores, and many, like Wegmans, have fantastic produce sections. All this adds to my impression that we have far less obesity than other areas. So, yes, I agree that a ZIP code analysis would be most helpful in diagnosing the factors that lead to our obesity and metabolic syndrome crisis.
Finally, just a comment on the perniciousness of childhood obesity. Growing up in the fifties we had three TV channels with kids programming mostly limited to Saturday morning cartoons. So most of our entertainment was provided by getting outdoors and playing with the local kids: hide and seek and tag when we were younger, basketball, touch football, etc. when older. Today kids have tons of TV, computers, tablets, and phones from a very early age. Sadly, this acts as surrogate parenting, and relieves them of the duty to get out and play with their kids. Once they are “normalized” with this entertainment it’s hard to get them to break the habit. Just another factor that bodes ill for our future healthcare system that already seems near collapse.
I think another issue that is rarely discussed wrt eating a “healthy diet” that includes a lots of vegetables is how old vegetables don’t taste good. I live in a traditional ag area with many long-standing farmers markets and even the veggies sold there are likely a few days old before they are sold. Veggies eaten immediately after picking or less than a day old are much different in taste. I grew up with a large vegetable garden from which my family fed ourselves much of the year (eaten fresh in season or frozen immediately after picking). When I left home and tried buying grocery store “fresh” vegetables, I was surprised at how bad they tasted and thus my veggie consumption went way down.
My doctor put me on Ozempic about 10 weeks ago to help control my A1C. This was his recommendation because I told him that I wouldn’t be poking and prodding myself all day to continually check my insulin levels. (Which, I suppose says something about both my stubbornness and selfishness.)
What I have noticed is that Ozempic absolutely kills my appetite. So much so that I have to treat eating as a “job” and not as a reward. It’s the whole “eat to live, not live to eat” syndrome. And Ozempic has definitely made this shift in my thinking much easier.
And, hoping that this doesn’t move the conversation too far off-base, I have noticed that the psychological/mental aspect of this is very similar to my quitting smoking (after over 40 years of more than a pack a day.) I tried to quit smoking on a number of occasions throughout my adult life. And I never had success “quitting.” That is, until the day I began telling myself that “I am a non-smoker.” By shifting the location of my identity (not sure if that is the best way to say it), I found it wonderfully easy to stop smoking.
Now I’m not taking Ozempic to lose weight. I am taking it to help shift my identity towards eating in a similar way to my attitude towards smoking. In my case, less sweets, smaller portions, and I even have to remind myself to eat at times. I have lost about 10-12 pounds since I’ve started with Ozempic, but I was already at a moderately okay 195 lbs. when I started.
So, I’m inclined to agree with Yves on this. Most of this resides between our ears and how we think of ourselves.
I had exactly the same reaction to Ozempic, but that was some years ago. It used to be hard to eat at a restaurant but I seem to have got over that. I have lost some weight but I’ve lost all feeling for these numbers after moving several times between countries with imperial units and those with sane ones.
I do agree with Murphy’s point about Pharma’s preference for pills you have to take forever for everything from weight loss, to BP to autoimmune problems.
And since we’re talking weight histories here, I was too thin in my youth. I don’t think I ever exceeded 130 lbs. through college. When I got married and had quality home cooking, I started to gain weight. Too much junk food and beer over the next 25 years brought me to 200, and I was unhealthy. I took up weigh lifting, unsalted peanuts and cottage cheese to bring it down to 170. Before I had a chance for it to creep up again, we moved to Europe, and the leaner meat, less salt and sugar and lots and lots of walking kept it off for 3 years, but when we came back to the U. S., even with a fair amount of walking being part of the routine, my weight headed up again.
As for weight loss regimens, it’s hard to beat cancer. After chemo put in in the ER, I weighed 130 again. I consider it close to a miracle that I’m almost back to 160, but I think that’s about as high as it’s going to get.
I think is not only the diet, but the sedentary lifestyle that we are mostly subject to that weight us down… A busy, active (not in a chair) life, that leaves little room to even think about snacks would be more conducive to sustained weight loss (or no weight gainto begin with).
We evolved to be on the move and constantly being busy with things, running from or after, moving with the herds, etc.
Someone close to me has been put on Ozempic. I have reasons to believe this won’t end well…….it requires genuine lifestyle changes and a willingness to challenge mental health professionals regarding meds so as to get put onto the one that one that does not cause massive weight gain etc.
My 2nd PhD student did this as part of her thesis……..men dislike mental health meds for “ahem softness” whilst women dislike them for “weight gain”. This is NOT news.
At age 78, last summer, I was finally able to stop two blood pressure meds and metformin for diabetes. Those metabolical illnesses started in my late 60’s. Always inclined to be slightly overweight, which got worse as I aged. Throughout my life I was able to take frequent months long trips overseas…particularly hiking in the Himalayas. I would invariably lose weight to a normal level and normal hunger and satiation signals would return on these trips. Return to US and the weight returned along with losing hunger and satiation signals.
Two years ago I encountered videos of Dr. Robert Lustig, MD whose explanation of metabolic illness seemed to explain what is going on. I’m a vegetarian carboholic in recovery. Still veg…but one meal a day and absolutely no industrial food, especially sugar. No restaurant food. The OMAD is not easy, but getting off BP and Metformin is proof that I am healing from the metabolic illness. It ain’t easy!
Lustig references it in his book “Metabolical”, and I am convinced that the industrial American food supply/ environment is making us metabolically ill and killing us.
He is also very kind to people struggling with this.
FYI, Yves, when I spent time in Thailand, I could eat what I wanted and keep weight off. They generally have a less industrial food supply. And the food is really good.
I am eating pretty the same here in terms of food types and mix (veg, fish, chicken, fat) as I did in the US, so that is not the cause. As in I don’t often eat Thai food. I eat sugar very rarely (desserts <1x a month) and avoid starches (no breads, pasta, grains of any kind) except some sweet potato.
And the Thais very much have industrial farming, see their chicken, eggs, salmon, and shrimp. I studiously avoid the shrimp here.
In fact, here I have great difficulty getting organic food here, importantly fish, chicken, eggs, fruit, vegetables and occasional tofu, grass fed beef and organic lamb. I am luckily able to get wild-caught salmon trim here (from Norway) and I am literally carrying cans of low mercury tuna and canned wild salmon back from the US with me on every trip due to my concerns about the fish here. So I am in fact eating way way way more factory food here than in the US.
“But I was diligent as an adult, to the extent that I did things like reading bodybuiding magazines for weight loss and supplement tips…”
Treating this post as the dedicated NC oversharing thread; I can’t believe Yves and I came to more or less precisely the same problem solving methodology for weight loss in what I have to suspect are very different eras; I know today more than I ever intended to know or had the faintest interest in regarding bodybuilding and the, if you like, associated pharmacology – just because of my rather more mundane personal vanity and desire to attain and retain a slender figure that eluded me after I’d dispensed with chronic starvation dieting in my late teens. Finally I’ve managed a more lingering weight loss via I think a blend of what Yves has mentioned here in the preamble and in other comments – inducing ketosis, oscillating between a fasted state and hitting normal/non diet consumption , and a sort of permanent state of reduced calorie intake (I’ve probably seen the same literature on longevity incidentally – my hypothesis as to why this is is that the digestive process itself is a physiological stressor and managing to do less of it while avoiding starvation signalling is just effective body maintenance).
The upshot of all this though is certainly not to blame the overweight for failing to cut sans prescription intervention. The methodologies I practice are the product of exacting research and a tremendous amount of experimentation, neither of which would’ve been remotely possible if I’d, for example, held a real job with actual stressors rather than my present privileged white collar uselessness – or if I had children or whatever other extremely normal lifestyle tendency. The work I did on my weight is essentially an indulgence of vanity, I can’t imagine anything like a plurality of overweight and obese are in a position to do the same; therefore enter Big Pharma.
It almost makes you nostalgic for the good ol’ days of weight loss via prescription amphetamine…
What has worked best for me is a diet with carbs restricted to legumes, nuts and small amounts of low glycemic fruits (e.g. blueberries), lots of leafy green vegetables, tightly controlled whole grains, and a whey protein supplement. That, and eating six times a day with some protein each time. All but the greens weighed or measured. Maintains a steady metabolism and eliminates those gnawing hunger pangs. It’s a plan suggested by a nutritionist. Combined with regular cardio and some weight training.
Not saying it’s not a b*tch to maintain at times, but I’ve reduced and kept off weight for 10 years.
People like Eric Topol of Scripps keep describing the GLP drugs as miracle drugs because they keep finding unexpected benefits, but I am wary of what will be found later.
First post. I am in the healthcare field and I agree it is a balance between encouraging healthy habits while acknowledging the difficulty of the struggle due to reasons out of patients’ hands such as genetics, hormonal issues etc. All in all I’d lean towards the idea that dietary modification though paramount needs to take into account legitimate patient struggles that go beyond willpower or lack therof. I do hope however that in our efforts to empathize we don’t swing towards the opposite end of the spectrum and adopt too deterministic of an attitude that makes weight loss seem hopeless and thus playing into drug companies looking to make money off of this population. It is our choice to put that food in our mouth though clinicians underestimate the struggle many patients experience (while at the same time themselves enjoying pizza with French fries as toppings in the hospital cafeteria!).
Thanks for piping up. Plus there are plenty of us on here who would endorse this.
I get a huge desire for a Big Mac Meal on average once every 6 months. No problem indulging that, But we do need clinicians who are better trained at encouraging people how to make a stew etc.
I am tied up in the health system a lot due to my sick wife and run into a lot of older people who have tried GLP-1’s and ended up with intractable health problems. These treatments are being used for conditions and populations they were never intended for and show early potential to be tobacco 2.0.
SGLT-2’s are not much better. These sort of things need to be prescribed by experienced specialists not everyday GPs. Anyone who might end up in hospital needs to think long and hard about using them.
How many food choices are available to non-rich people who live in food deserts and food junkyards?
I have had the good fortune to have not had significant weight issues throughout life. Now in my upper sixties, what I have noted is the need to cut my food intake by about half each decade in order to maintain a healthy weight. I don’t see this acknowledged, and it’s tough because eating is pleasurable and social.
Here is a link on GLP-1 and reward signals in addiction and drug use. It’s an online search review though.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7848227/
The articles on GLP-1 on ADHD are even flakier.
But it is an interesting area!
What is maddening is that science reporting in the mainstreams media, including even science story aggregating websites (Science Alerts, Science Daily, Science News, etc.) leads with so many horribly misleading stories about diet and exercise and “do this” to be young and sexy forever, etc. The headlines are the worst, but even the lede in the summaries is often overly dramatized and omits the reservations that can be found down paragraphs into the detail (like, this is in mice, this doesn’t control for social class, this is based on a small sample, etc.). Plus, while we can tell there are certain things that will definitely kill you or make you very sick, there are a vanishingly small number that will make every person healthier and stave off death. You get results based on averages, and people are individuals with different physiologies and varied life circumstances, not averages. So results may predict something about a population, if the study is really done right, but they can’t guarantee you a happy outcome like the headlines promise. Not every recommended intervention works for every person (for instance, in my case, novocaine has never worked for tooth pain with drilling, despite each new dentist saying the last one must not have done it right but they’ll be different, and then trying to claim the pain is psychosomatic, i.e., “your anxiety”, when they fail also…makes me feel like wearing sign that says “I know more about anxiety than you’ll ever know about dentistry, so don’t talk about it!”). It’s nice to know what diets work for other people, but if one doesn’t work you just have to try something different rather than blaming it on your “will power”.
I weighed 155 lbs till my early thirties. Then a 60 llb jumpfat leaped up out of the weeds and attached itself to my body. It kept growing till I weighed 300 pounds. Now I weigh about 285 pounds. If I ever get below 200 pounds by deliberate action, I will write a little comment about how I diddit.