Do you judge your overweight classmates?

[IsleyOfTheNorth]

Still pretty frustrating that people are approaching this problem from the calories in, calories out paradigm.

No disrespect intended, but I don't think physics is a paradigm.

Clearly though, as sb247 said, there are compounding factors that affect the effectiveness of calorie burning.

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[IsleyOfTheNorth]

The fact that you think eating three heads of lettuce and 4 pounds of soybeans a day in order to lose weight shows a profound lack of knowledge about nutrition.

That's a myth that needs to die. I never said that. Re-read my post. What I said is that it is possible to lose weight without "starving", then I choose an intentionally extreme example to prove my point.

 

[TwoHighways]

there are a lot of things that change the effectiveness of the calories in and the efficiency of burning those calories out......but it's still the same in vs out

On a fundamental level, it works. Energy comes into a system, energy is expended. Thermodynamics, yada yada yada. How do you measure it though? How do you get a sense of what a person actually absorbs? How do you measure what energy is being provided from a person’s own fat stores? What are the hormonal responses we have to certain foods? How do type 1 diabetics (without administering insulin) stay thin no matter how much they eat?

 

[Mass Effect]

That's a myth that needs to die. I never said that. Re-read my post. What I said is that it is possible to lose weight without "starving", then I choose an intentionally extreme example to prove my point.

All you did was prove a profound lack of knowledge about nutrition, imo.

 

[deleted480308]

On a fundamental level, it works. Energy comes into a system, energy is expended. Thermodynamics, yada yada yada. How do you measure it though? How do you get a sense of what a person actually absorbs? How do you measure what energy is being provided from a person’s own fat stores? What are the hormonal responses we have to certain foods? How do type 1 diabetics stay thin no matter how much they eat?

how do we measure it? if you're getting fatter you are absorbing more than you are burning. It's not sorcery

 

[TwoHighways]

how do we measure it? if you're getting fatter you are absorbing more than you are burning. It's not sorcery

Duh. But short of locking someone up in a metabolic ward, you can’t measure energy expenditure. The question I ask remains. Is calorie a calorie across all different varieties of sources? Coca Cola would say yes. I don’t subscribe to that idea. That’s the sort of thinking that needs to exit this discussion regarding the obesity epidemic.

 

[IsleyOfTheNorth]

All you did was prove a profound lack of knowledge about nutrition, imo.

Based on what?

 

[deleted480308]

Duh. But is a calorie a calorie across all different varieties of sources? Coca Cola would say yes. I don’t subscribe to that idea.

of course not, but if you take in 800 calories and move throughout the day you will lose weight. Losing weight isn't expensive, self-denial is hard

It really isn't that complicated

 

[TwoHighways]

of course not, but if you take in 800 calories and move throughout the day you will lose weight. Losing weight isn't expensive, self-denial is hard

It really isn't that complicated

Would love to see your thyroid function after a week of 800 calories a day.

 

[VA Hopeful Dr]

Would love to see your thyroid function after a week of 800 calories a day.

Takes longer than that

 

[TwoHighways]

Takes longer than that

likely varies from person to person.

 

[hallowmann]

I mostly agree. I find it hard to get to the store so the veggies I eat tend to be frozen. Even on a trailer-park budget, buying frozen veggies is very inexpensive. (I speak from experience on this one.) Unfortunately education is an issue. I'm not saying that food deserts aren't a thing - they definitely are.

Food deserts are primarily what I was talking about. Other things go into it that I didn't mention though, as opposed to pleasure, that was my primary point. Culture, for example is a pretty strong driving force as well.

On a side note, I actually advise frozen vegetables to the majority of my patients, primarily for that reason (availability and cost). Aldi's got a lot to offer for ~$1. Eating 5 servings of vegetables a day is hard to do if its not a big part of every meal.

 

[TwoHighways]

It's not just about that. I work with eating disordered patients and you'd be amazed at the number of people who have lifelong struggles with food and exercise due to other factors, such as home life, relationships, bullying at school (particularly in college-aged girls), traumatic experiences, etc. Genetics also plays a role. I had a patient who was very well-to-do whose entire family was obese -- parents, grandparents, siblings, aunts/uncles. She actually showed me a family reunion photo at one point and I couldn't believe how heavy that whole family was. When you grow up in a family where your relatives don't have a healthy relationship with food, it follows you no matter how much money you have/how successful you are.



The fact that you think eating three heads of lettuce and 4 pounds of soybeans a day in order to lose weight shows a profound lack of knowledge about nutrition.

There are likely irreversible epigenetic changes that occur as well, which I find deeply disturbing when looking at the prevalence of childhood obesity.

 

[AMEHigh]

The “evidence” may not be there yet, but it gives profound insight to the metabolic state of a person. Most of my own understanding of this comes from the work of Peter Attia. He’s got some great YouTube lectures and has a phenomenal podcast that I can’t speak highly enough of.

How do you define “pretty low carb”? What were your macros like as a vegetarian?

Oh yes I understand that. But until there’s evidence insurance companies won’t pay for those tests during routine visits hence why we don’t check those things now. I was just making sure I wasn’t missing some new recommendation. Thanks for sharing.

I don’t remember my macros when I was a vegetarian, that was many many years ago. We had a nutritionist since I was on a sports team in college and had the cafeteria where you could get any food pretty much so it was easy to stick to that. But once I graduated and was out on my own it was harder to be a vegetarian, working 2 jobs, doing a post-bacc, cook for myself, etc. So I found myself eating more carbs out of convenience.

Now I try to stay around 40/40/20, protein/fat/carbs. But obviously am not perfect. At home I don’t buy thinks like bread, pasta, white rice, etc. My main carbs are during dinner and I typically have quinoa or beans, lentils, etc. I eat out 1-2 times per week and don’t restrict myself when eating out. During super busy weeks I typically workout 2 times a week, but I try to get that up to 5-6 days a week on more normal weeks. That’s a little harder when I travel which is 1-2 times a month but I always bring my running shoes with me so I can at least get in a run. During marathon training my carb intake is a little higher especially during my long run days.

 

[VA Hopeful Dr]

likely varies from person to person.

Naturally, but it still takes longer than a week.

 

[TwoHighways]

Oh yes I understand that. But until there’s evidence insurance companies won’t pay for those tests during routine visits hence why we don’t check those things now. I was just making sure I wasn’t missing some new recommendation. Thanks for sharing.

I don’t remember my macros when I was a vegetarian, that was many many years ago. We had a nutritionist since I was on a sports team in college and had the cafeteria where you could get any food pretty much so it was easy to stick to that. But once I graduated and was out on my own it was harder to be a vegetarian, working 2 jobs, doing a post-bacc, cook for myself, etc. So I found myself eating more carbs out of convenience.

Now I try to stay around 40/40/20, protein/fat/carbs. But obviously am not perfect. At home I don’t buy thinks like bread, pasta, white rice, etc. My main carbs are during dinner and I typically have quinoa or beans, lentils, etc. I eat out 1-2 times per week and don’t restrict myself when eating out. During super busy weeks I typically workout 2 times a week, but I try to get that up to 5-6 days a week on more normal weeks. That’s a little harder when I travel which is 1-2 times a month but I always bring my running shoes with me so I can at least get in a run. During marathon training my carb intake is a little higher especially during my long run days.

Macros aren’t terrible. Without knowing your goals or fasting insulin/OGTT results, it’s difficult to make any recommendations.

 

[TwoHighways]

Naturally, but it still takes longer than a week.

n=1, but by the end of a recent 72 hour fast (supplemented with 10 calorie bullion cubes), I noticed I was much colder than normal. Very different than 800 a day calorie intake, but I would assume my reverse T3 went up markedly. No lab to confirm it though.

 

[PikminOC]

how do we measure it? if you're getting fatter you are absorbing more than you are burning. It's not sorcery

Exactly. Just look at other countries. They eat less and move more

 

[AMEHigh]

Macros aren’t terrible. Without knowing your goals or fasting insulin/OGTT results, it’s difficult to make any recommendations.

Ok. I wasn’t asking for any recommendations though! I’ve had plenty of time with nutritionists and sports coaches. My marathon times are improving, my lifting is improving so I’m pretty happy with my lifestyle and performance. I guess I do wish my swim times were improving, that’s my weakest sport during my triathlons. I exercised regularly all throughout residency and continue to do so now so am perfectly happy and proud of myself, my health and my body

 

[kb1900]

n=1, but by the end of a recent 72 hour fast (supplemented with 10 calorie bullion cubes), I noticed I was much colder than normal. Very different than 800 a day calorie intake, but I would assume my reverse T3 went up markedly. No lab to confirm it though.

Not sure if you are an endocrinologist or something but there are plenty of reasons to feel cold during/after a prolonged stress of fasting.

why do you jump to rT3? Euthyroid sick syndrome?

 

[AMEHigh]

Exactly. Just look at other countries. They eat less and move more

That’s not entirely true. I lived overseas in an African country for a few years and I don’t think they necessarily ate less. Most African countries have a huge helping of carbs with meals 3 times per day. But yes to the move more. Like I said above I think our food sources are a big part of the problem as well. When there is high fructose corn syrup in everything, even "healthy" food it’s hard to not blame the food industry and government for some of these issues as well. That’s why saying calories in and out is only part of the discussion.

 

[ciestar]

That’s not entirely true. I lived overseas in an African country for a few years and I don’t think they necessarily ate less. Most African countries have a huge helping of carbs with meals 3 times per day. But yes to the move more. Like I said above I think our food sources are a big part of the problem as well. When there is high fructose corn syrup in everything, even "healthy" food it’s hard to not blame the food industry and government for some of these issues as well. That’s why saying calories in and out is only part of the discussion.

Going to Amsterdam it was totally true. The portions were much smaller (which is mostly true throughout Europe) and a lot of people bike everywhere.

A MAJORITY of the world is overweight. Americans just do it on a whole other level.

 

[Matthew9Thirtyfive]

Going to Amsterdam it was totally true. The portions were much smaller (which is mostly true throughout Europe) and a lot of people bike everywhere.

A MAJORITY of the world is overweight. Americans just do it on a whole other level.

You should see some of the countries in Micronesia.

 

[AMEHigh]

Going to Amsterdam it was totally true. The portions were much smaller (which is mostly true throughout Europe) and a lot of people bike everywhere.

A MAJORITY of the world is overweight. Americans just do it on a whole other level.

Yes I’ve traveled a lot. I think I’ve been to something like 27 countries (many more to go!), all continents except Antarctica. Plus I’ve lived overseas. So I understand on some level the dietary customs, body frames and weight of some regions. Western style eating and fast food places have definitely had a negative impact on regions. Another aspect of colonization imo....

 

[ciestar]

Yes I’ve traveled a lot. I think I’ve been to something like 27 countries (many more to go!), all continents except Antarctica. Plus I’ve lived overseas. So I understand on some level the dietary customs, body frames and weight of some regions. Western style eating and fast food places have definitely had a negative impact on regions. Another aspect of colonization imo....

Yeah ive been to many as well (not as many continents lol), and yeah, i see it.

Too bad Mcdonald’s fries are so good.. ugh

 

[Cornfed101]

Too bad Mcdonald’s fries are so good.. ugh

Apparently they used to be better when they used beef tallow as the frying agent

 

[TwoHighways]

It won’t shock me at all if linoleic acid intake is implicated as a major contributor in chronic inflammatory conditions.

 

[VA Hopeful Dr]

There are plenty of obese people in Europe. The rates there are lower than here, but there are still plenty of them in much of the UK. The US isn’t even in the top 10 for obesity rates, despite everyone wanting to say we are the fattest country, though we are probably at the top of the list when you don’t count countries that just culturally are larger.

Now if you want to walk around without ever seeing an obese person, go to a place like Japan or Singapore. I deployed out there, and I don’t remember seeing a single overweight person.

We're 12th, and of the top 11 all but 1 are tiny countries in the Pacific ocean: Obesity Rates By Country 2020

Nauru	61.00%	10,756
Cook Islands	55.90%	17,548
Palau	55.30%	18,008
Marshall Islands	52.90%	58,791
Tuvalu	51.60%	11,646
Niue	50.00%	1,615
Tonga	48.20%	104,494
Samoa	47.30%	197,097
Kiribati	46.00%	117,606
Micronesia	45.80%	113,815
Kuwait	37.90%	4,207,083
United States	36.20%	329,064,917

 

[Matthew9Thirtyfive]

We're 12th, and of the top 11 all but 1 are tiny countries in the Pacific ocean: Obesity Rates By Country 2020

Nauru	61.00%	10,756
Cook Islands	55.90%	17,548
Palau	55.30%	18,008
Marshall Islands	52.90%	58,791
Tuvalu	51.60%	11,646
Niue	50.00%	1,615
Tonga	48.20%	104,494
Samoa	47.30%	197,097
Kiribati	46.00%	117,606
Micronesia	45.80%	113,815
Kuwait	37.90%	4,207,083
United States	36.20%	329,064,917

Yeah. We definitely top the list in the larger developed countries. And like I said, in some of those countries that beat us out, being heavier is a cultural thing.

 

[VA Hopeful Dr]

Yeah. We definitely top the list in the larger developed countries. And like I said, in some of those countries that beat us out, being heavier is a cultural thing.

FTFY.

The top 10 countries have a population combined smaller than every state except our smallest 1 (Wyoming).

 

[Matthew9Thirtyfive]

FTFY.

The top 10 countries have a population combined smaller than every state except our smallest 1 (Wyoming).

Are you arguing just to argue?

 

[VA Hopeful Dr]

Are you arguing just to argue?

Not really, I just refuse to accept that the US isn't the best at everything including being fat.

 

[Matthew9Thirtyfive]

Not really, I just refuse to accept that the US isn't the best at everything including being fat.

lmao. I mean, I literally said that we top the list of the large and developed countries. I was referring to the OECD list most people point to when saying we are the fattest, of which all the member countries have a GDP per capita in the third to highest quartile. But yes, we are the world champions at not being thin when you take away the tiny Micronesian countries that beat us out (but they still do ).

 

[VA Hopeful Dr]

lmao. I mean, I literally said that we top the list of the large and developed countries. I was referring to the OECD list most people point to when saying we are the fattest, of which all the member countries have a GDP per capita in the third to highest quartile. But yes, we are the world champions at not being thin when you take away the tiny Micronesian countries that beat us out (but they still do ).

I thought it was interesting, I went looking at individual states to see if any of our states had those countries beat - there's a surprisingly lack of variability in our obesity rates. None quite reach 40%, which being a doctor in one of those states surprised the heck out of me.

 

[Perrotfish]

self-denial is hard

Its not hard, hard implies a success rate. Calorie restriction diets have a zero percent success rate over the long term.

Every study shows that obesity is not a behavior problem. The demographics don't match up to behavior problems. Can you name another issue related to behavior or impulse control that mostly spares adolescents and affects most middle aged adults? n studies behavioral interventions don't work, at all. Massive changes in calorie output don't work. When people do things that should cause enormous changes in their weight, like starting manual labor jobs that quadruple their calorie output, in studies their weight doesn't budge AT ALL. You can't fix obesity with discipline. You shouldn't be telling your patients that you can.

Seriously, dude, read a book on this. You don't need to take the obesity boards, just read 'the obesity code' or 'why we get fat'. Either one will get you through at least the basics of modern obesity medicine.

 

[deleted480308]

Its not hard, hard implies a success rate. Calorie restriction diets have a zero percent success rate over the long term.

Every study shows that obesity is not a behavior problem. The demographics don't match up to behavior problems. Can you name another issue related to behavior or impulse control that mostly spares adolescents and affects most middle aged adults? n studies behavioral interventions don't work, at all. Massive changes in calorie output don't work. When people do things that should cause enormous changes in their weight, like starting manual labor jobs that quadruple their calorie output, in studies their weight doesn't budge AT ALL. You can't fix obesity with discipline. You shouldn't be telling your patients that you can.

Seriously, dude, read a book on this. You don't need to take the obesity boards, just read 'the obesity code' or 'why we get fat'. Either one will get you through at least the basics of modern obesity medicine.

You can, I do, I have

I'm fine with disagreeing on this, we're repeating ourselves

 

[PikminOC]

We're 12th, and of the top 11 all but 1 are tiny countries in the Pacific ocean: Obesity Rates By Country 2020

Nauru	61.00%	10,756
Cook Islands	55.90%	17,548
Palau	55.30%	18,008
Marshall Islands	52.90%	58,791
Tuvalu	51.60%	11,646
Niue	50.00%	1,615
Tonga	48.20%	104,494
Samoa	47.30%	197,097
Kiribati	46.00%	117,606
Micronesia	45.80%	113,815
Kuwait	37.90%	4,207,083
United States	36.20%	329,064,917

Thanks, I was especially interested in India and China. They eat carbs, but their obesity is very small

 

[Matthew9Thirtyfive]

Thanks, I was especially interested in India and China. They eat carbs, but their obesity is very small

I eat almost nothing but carbs, and I'm pretty skinny.

 

[TwoHighways]

Thanks, I was especially interested in India and China. They eat carbs, but their obesity is very small

Visceral fat accumulation and type II diabetes is increasing in prevalence Asian populations...

 

[PikminOC]

Visceral fat accumulation and type II diabetes is increasing in prevalence Asian populations...

Yes especially when they move here and as fast food has hit india

 

[PikminOC]

I eat almost nothing but carbs, and I'm pretty skinny.

Foxy even

 

[TwoHighways]

I eat almost nothing but carbs, and I'm pretty skinny.

Pick high fat or high carbs, but combining both is a bad idea.

 

[VA Hopeful Dr]

I get this same line from anti-vaxxers.

Except the data on vaccines is about the most settled thing in all of medicine.

The data on calorie-in/calorie-out is mixed - some studies show it works, some show it doesn't. Interestingly, some neat research out of the UK shows for best effect you need a fairly complete energy-expenditure history to then decide what the actual calorie goal should be. If you do that, the data so far is pretty good.

So it can work it just has to be done more comprehensively than what is usually done here.

 

[Perrotfish]

Except the data on vaccines is about the most settled thing in all of medicine.

The data on calorie-in/calorie-out is mixed - some studies show it works, some show it doesn't. Interestingly, some neat research out of the UK shows for best effect you need a fairly complete energy-expenditure history to then decide what the actual calorie goal should be. If you do that, the data so far is pretty good.

So it can work it just has to be done more comprehensively than what is usually done here.

Fair enough, and I guess there is no point to arguing on the internet in any event.

 

[IsleyOfTheNorth]

Its not hard, hard implies a success rate. Calorie restriction diets have a zero percent success rate over the long term.

Are you saying that no one is able to successfully keep weight off by maintaining a strict diet?

 

[Matthew9Thirtyfive]

Pick high fat or high carbs, but combining both is a bad idea.

Yeah, I don't eat a lot of fat. Just some of the good stuff. I have a pretty decent diet, and I'm definitely being a little hyperbolic. But I do love my carbs.

*continues to eat giant plate of ziti*

 

[Matthew9Thirtyfive]

Except the data on vaccines is about the most settled thing in all of medicine.

The data on calorie-in/calorie-out is mixed - some studies show it works, some show it doesn't. Interestingly, some neat research out of the UK shows for best effect you need a fairly complete energy-expenditure history to then decide what the actual calorie goal should be. If you do that, the data so far is pretty good.

So it can work it just has to be done more comprehensively than what is usually done here.

Also, a lot of studies are hard to trust, as people lie to themselves and everyone else about what--and how much--they actually eat.

 

[CyrusHabs7695]

I more so judge the kids who talk about smoking weed like they're still in high school, because they were too big of nerds to ever have fun in college.

 

[Matthew9Thirtyfive]

I more so judge the kids who talk about smoking weed like they're still in high school, because they were too big of nerds to ever have fun in college.

When I was out to dinner with my wife for valentine's day, the couple next to us kept talking repeatedly about how much they missed getting high. The woman said she had to stop doing drugs so that she could get a security clearance, and that she has been off for a year, but she just really misses weed and pills (I think MDMA). She then proceeded to tell the guy that she would never touch coke because it killed a family member. lol.

 

[nimbus]

So does anyone here recommend RYGB and sleeve gastrectomies to their patients? We do a ton in our OR’s and we have some staff who have had long lasting significant weight loss. Some you would never guess that they were obese at one time. It seems more effective than other weight loss programs and treatments.