still all weight loss meds should be done as an adjunct to diet and exercise.
The barriers to diet and exercise are myriad though.
1) Policy level issues in which Big Food / Big Agriculture make processed foods ubiquitous. The Rockfeller university studies the ultra-procsessed feds led to greater weight gain compared to an isocaloric organic diet.
See Dr Hall's study from Rockefeller university
We investigated whether ultra-processed foods affect energy intake in 20 weight-stable adults, aged (mean ± SE) 31.2 ± 1.6 years and BMI = 27 ± 1.5 kg/m<sup>2</sup>. Subjects were admitted to the NIH Clinical Center and randomized to receive either ultra-processed or unprocessed diets for 2...
pubmed.ncbi.nlm.nih.gov
Anecdotally as an overweight child whose parents purchased the "40 pack snack pack chips and snacks from Costco because it was 'cheaper per unit'" who could not just settle for one pack at a time and had to eat 3-4 at a time, this all makes sense. those chemicals made it so tasty and wanted to eat more.
2) Inflation from reckless government spending makes it hard for the former middle class and lower class to afford "healthy" foods.
I wont get too political on this one. I will leave it be
3) maintaining calorie deficit is through calorie restriction alone tends to be hard and difficult. I am sure everyone has tried that before and had the "ghrelin ghremlins" creep up on them. The key really is increasing physical activity to augment the calorie deficit from the calories expended half of the equation. But due to many people's jobs, no one has time to "go to a gym all the time." True, but you can make a home gym to lift weights to increase muscle mass. Increasing lean muscle mass is how you increase your VO2 at rest which is "metabolism." Some individuals state "I don't want to get too big." You won't become like The Rock or John cena without a super serious workout regimen, calorie surplus and anabolic steroids. Don't worry about that laypeople. Otherwise just walking more steps is effective over time to help maintain a calorie deficit witohut having to reduce eating too much to avoid that hunger pangs that impair work performance.
For patients with bad joints, just walking is totally fine.
This population-based prospective cohort study using UK Biobank data for 78 500 individuals with 7 years of follow-up examines associations of daily step counts and intensity with all-cause mortality and cancer and cardiovascular disease–related morbidity and mortality.
jamanetwork.com
Of note, no one is spending millions of dollars to do a randomized controlled trial comparing walking 10,000 steps (which originally came from a Japanese exercise advertisement in 1865)
If you’re trying to take 10,000 steps a day, it can be discouraging to miss that well-known target. But why is 10,000 steps the goal? And is it really necessary to take that many steps every ...
www.health.harvard.edu
I find an academic doctor sneering at "walking 10,000 steps per day is not recommended because there is no evidence for it. I will settle for ozempic first" to be asinine. Show me your six pack academic doctor. Yeah i didn't think so.
10,000 steps or more is quite easy for those with a desk job if one does it with a standing desk or a desk riser. Hey it may not be as good as running (
Greater Weight Loss from Running than Walking during 6.2-yr Prospective Follow-up) , but I am certain its better than being a desk jockey or couch potato.
anyway I am getting a bit off track. My stance is I agree with the cardiologists on this forum and the evidence that statins are great for secondary prevention of ASCVD and that cannot be argued.
I tend to take a step back for primary prevention and am not so quick to just "put on the statin because the ACCAHA 2013 r isk score is over 7.5% and then pat myself on the back" without A) open discussion with patient B) trying to get the walking and dietary efforts in knowing most patients do not have the same athletic desire I do C) investigating for subclinical ASCVD based on on guidelines.
My criticism is of patients who are spending so much energy trying to "get their autonomy and power back in their health by defying the physician and resorting to homeopathic remedies." I only wish these individuals would use that same energy to get that 150 minutes of moderate intensity exercise per week as the AHA recommends.
Side note, I looked into the ketogenic diet before and did it for a while. I also read some of the literature from the basic science standpoint and some limited clinical trials
It has the potential to be great but there are a lot of caveats . Many of these caveats are hard to follow for most people and will "instantly ruin the diet."
If one were to follow all of the following
1) COUNT MACRONUTRIENTS (this is hard and time consuming. requires phoen apps and food scales)
2) doing fingersticks for BHB levels and glucose levels
3) adhering to that ratio of 70% fat, 25% protein , 5% carbohydrates
4) eating "healthier unsaturated fats" and not just doing a dirty keto of high sodium bacon and cheese
5) giving up "social events" to eat "boring."
6) not have ANY cheat days to ensure ongoing ketosis
7) staying in calorie deficit (this really requires getting some kind of formal BMR assessment )
I don't personally prescribe this diet as most patients do not count macronutrients, will over eat and not maintain calorie deficit, and will sneak in more carbohydrates and end up just gaining adipose tissue weight.
Some patients get into the ketogenic diet themselves but I realize they are not doing it correctly. They just THINK they are getting healther when in fact they are not. but they "swear by it" because it is a form of "regaining their lost autonomy and power over their health." I tell them your mistrust of physicians is misplaced. You should be more mistrustful of Big Food / Big Agriculture / Big Processed Foods.
But I have seen many RDs and MDs automatically discount this diet without even considering its potential merits to the "right patient."
I think those people are just shills and unless those individuals show me their six pack abs, I cannot take them too seriously.
After this long rambling, I am just saying "what else would we expect from patients who feel disenfranchised about their health other than to resort to articles like those above?"
www.midwesterndoctor.com
