I was feeling a little blue. I looked at the psychiatric literature, and they were saying all this weird stuff about neurotrophic factors and cognitive-behavioral therapy. But then that night I had dinner with some friends, went to the gym for an hour, and sure enough I felt a lot better afterwards!
I would have at least three qualms with such an attitude:
First, there are different kinds of low mood. Some differences are obvious; some people are less depressed than others, or depressed for much shorter time periods. But it could also be that there are no visible differences between two people, but that for hidden reasons one person’s depression will respond to some quick exercise and social activity, and another person’s won’t.
Second, even interventions that are known to always work can be hard to task-ify. Exercise is indeed often a very effective treatment for depression, but when you tell a depressed person “just go and exercise”, they usually won’t do that because they’re too depressed. Having a good social support network can be helpful in depression, but depressed people can be unable to make friends because deep down they assume everyone hates them. Part of treating depression is bringing people to the point where they’re able to do the simple interventions. If you get a depressed person who does have the motivation to exercise and make friends, great, but it’s not a point against psychiatry that they sometimes discuss how to help people who don’t.
A third problem is general anti-scientificness. Yeah, sure, you don’t need to understand exactly how neurogenesis occurs in order to treat depression. But it’s neat to know. And in fact exercise may treat depression by increasing neurotrophic factors, so you’re not disagreeing with the scientists, just looking at it from a different angle. And for certain people it might be, in a weird way, sort of inspirational to know the science and help them figure out why they’re doing what they’re doing. If they want to study it, why complain?
I think most of the same issues generalize to your comment.
I would also add one more, which is that it is generally much easier to lose weight on a diet than to keep the weight off for more than a year or two. For example, of people who lost (hey, look at that!) thirty pounds on a diet, one year later they had on average gained back fifteen of them. Longer followups usually find even more of the weight regained; see for example Mann 2007. So you’re declaring something simple before you’ve even started the hard part.
Last I heard, the popular science theory about why it’s easier to lose weight than to keep it off is that appetite increases rather than that metabolism slows. Have you heard anything else that looks plausible?
As you would probably imagine, there is a bit of both, though it seems like the hunger portion is more important. Intuitively, any change in metabolic rate is very easily overshadowed in magnitude by increases or decreases in the amount of food eaten. This is why exercising to “burn calories” is ineffective as a means of weight loss. One tall glass of orange juice is equivalent to ~10-15% of your Basal Metabolic Rate (BMR) or to ~30 minutes on a treadmill.
This turned out a lot longer than I expected, but hopefully it will be useful to some people.
There are two primary hormones involved in hunger and weight management, Ghrelin and Leptin, with Leptin being arguably more important because of all of its downstream effects and because it is the one we can control with diet and exercise interventions:
(One important thing to know here is that the important thing is the level of hormonal “Activity”, not the absolute levels of the hormone. Activity is made up of two factors: How much of the hormone you have and sensitivity to that hormone. For example, obese people with chronically high blood sugar are usually insulin resistant. They have high levels of insulin, but it doesn’t do its job properly because they have low sensitivity to insulin. This is caused by chronically high levels of the hormone.)
Ghrelin: Secreted by adipose (fat) tissue, increases hunger. Ghrelin is “entrained” by your eating habits which is why you usually get hungry at about the same time each day. People who are used to eating breakfast feel hungry if they don’t, because your body releases Ghrelin when you expect to eat. More fat tissue leads to higher Ghrelin levels on average. (More fat ⇒ more hungry) Ghrelin is not known to have “resistance” associated with it.
Leptin: Also secreted by adipose (fat) tissue, decreases hunger. Leptin is also entrained by meal patterns, so having a regular eating schedule is likely effective in controlling excess eating. Low leptin leads to both an increase in hunger and a decrease in metabolic rate. (Less fat ⇒ more hungry). Now you would think that being fatter would increase leptin levels as well. It does. Unfortunately, with chronically high levels of leptin, your body adapts and develops “leptin resistance”. This means that leptin is not as effective at controlling hunger when you are overweight. Naturally thin people have low levels of leptin, but they are very sensitive to it, so it still does its job at controlling hunger.
These are both hormonal systems, so the body takes longer to come to equilibrium after interventions. Also, according to “set-point” theory, your body will vary the levels of these hormones in order to maintain a certain weight range. Set point is thought to have a strong genetic component and it is unclear whether a person’s set point can be changed.
However, there are things that can be done to help get your Leptin system back on track. In the long-term, leptin levels are determined primarily by total fat mass. More fat, more leptin. Less fat, less leptin. If you are overweight, you are likely at least somewhat leptin resistant.
In the short term, leptin is influenced by caloric surplus/deficit and macronutrient ratios (primarily carbohydrates).
So, what does this mean and what can we do about it?
Well, an acute calorie deficit crashes leptin in the short term. This is why you get hungry if you don’t eat. Intermittent refeeds (especially carb refeeds) where you eat a caloric surplus one day before going back to your daily deficit can keep your leptin levels slightly higher to help control hunger over the course of a diet.
If you manage to keep a diet going for long enough to lose a significant amount of fat mass, then your natural long-term leptin levels will be lower. This should make you hungrier. However, your leptin sensitivity will also increase until it gets back to a normal baseline. This helps control hunger.
However, research has not shown any way to increase leptin resistance below an individual’s natural baseline sensitivity. That means that if your set-point is higher than the weight you’ve dieted to, your naturally regulated food intake will lead to slowly gaining weight again up to your set point. However, if you get your leptin sensitivity back to normal by losing weight and keeping it off for a while, then the leptin increase caused by acute overeating can help naturally regulate your hunger to help decrease weight gain.
So the takeaways:
Being overweight makes you leptin resistant. This means even though your body is trying to tell you to stop eating, you can’t hear it. Once you lose weight and give your body time to adjust, your body is sensitive to its own signals again which can help naturally regulate overeating and metabolism.
Acute caloric deficits increase hunger (and lower metabolism by a small amount) via decreased leptin. Having periodic refeeds where you eat higher calorie and higher carb one day can help keep leptin levels higher during a diet and decrease hunger.
Your body probably has a natural “set-point” that it will try to adjust to once it can hear its own signals and your leptin system works properly. This may be higher than you want. Long-term behavioral modifications to induce entrainment of meal patterns, regular exercise, eating less calorie-dense foods, and intermittent fasting can be helpful in allowing you to maintain a weight below your set point.
it is unclear whether a person’s set point can be changed.
It is quite clear that people’s set points change over their lifetime—great many people are trim in their 20s and then succumb to the middle-age spread in their 40s. Looks like one can make an argument that in many (but not all) people their set points drift upwards as they age, at least until the 60s when some revert to losing weight, and not only muscle mass but fat as well.
The interesting question, of course, is whether one can “reset” one’s set point to what it was in the 20s.
leptin is influenced by caloric surplus/deficit and macronutrient ratios (primarily carbohydrates)
Any comments (or links) on how low-carb diets in general and ketosis in particular affect leptin?
Right, I mean by specific interventions. For example, dieting down to very low body fat and then maintaining it does not appear to increase leptin sensitivity (much) beyond that of a normal-weight person, nor does exercise.
As far as ketosis and leptin goes, This study indicates that carbohydrate overfeeding increases leptin and energy expenditure, while fat overfeeding does not. This suggests that eating carbohydrates naturally causes you to get full, while fat does not, which is inline with research on satiety and macronutrients. (Keep in mind that fructose is not metabolized like a normal carbohydrate and has different effects on leptin and so may not cause the leptin increase or induce satiety.)
This study indicates that ketosis blunts ghrelin release even in a caloric deficit which could be the reason that people on ketogenic diets (or doing intermittent fasts, which is a fat-burning state) report lower hunger levels. In this situation, leptin is lower which probably reduces metabolic rate a bit (probably not hugely significant), but its effect on hunger is probably balanced out by the change in ghrelin.
If you are doing a ketogenic or low carb diet, if you reach a plateau with weight loss, it could be because your leptin is too low. Doing a carb refeed with glucose (which includes starches), but not fructose, could be beneficial.
Interesting. So this implies that lower hunger in calorie-deficit ketosis is due to low ghrelin which more than compensates for lower leptin… And yes, carb refeeds (usually weekly) are a component of many low-carb diets.
However, research has not shown any way to increase leptin resistance below an individual’s natural baseline sensitivity. That means that if your set-point is higher than the weight you’ve dieted to, your naturally regulated food intake will lead to slowly gaining weight again up to your set point. However, if you get your leptin sensitivity back to normal by losing weight and keeping it off for a while, then the leptin increase caused by acute overeating can help naturally regulate your hunger to help decrease weight gain.
How long is long enough to increase leptin sensitivity?
Anecdotally, people who keep weight off say it requires constant attention, not that they develop a lower set point.
Anecdotally, people who keep weight off say it requires constant attention, not that they develop a lower set point.
This is correct. That’s what I meant by “That means that if your set-point is higher than the weight you’ve dieted to, your naturally regulated food intake will lead to slowly gaining weight again up to your set point.” If your set-point is higher than your weight, then you will still gain weight back if you’re not careful. Once your leptin system is restored to healthy function though, your body is better at regulating its weight. Weight gain at this point is likely to be slow and gradual rather than the rapid “rebound” weight gain that many dieters get if they completely stop their diet without allowing for this system to recover first. Also, since eating a lot makes your produce leptin, if your body is now sensitive to that signal, it will naturally make you less hungry for a little while, whereas if you’re leptin resistant, you feel hungry even when you’ve had enough. This is the benefit. That means that if you follow sensible lifestyle-diet practices even when you’re done with the intense diet phase, you can greatly slow or prevent weight regain. That would be things such as eating whole foods instead of processed foods, fruits and vegetables for fiber, and limit sugar (fructose is the real culprit) and alcohol consumption.
How long is long enough to increase leptin sensitivity?
This one probably varies a lot with the individual. Also, keep in mind that there are different levels of leptin resistance, so recovery follows a curve. From anecdotal reports, it seems that some people can see significant improvement in 4-6 weeks with most people getting significant improvement within 3 months. I think it’s likely that improvements will continue for 6 months to a year depending on the individual.
I like the analogy, because I can personally relate to depression. I don’t know that it is a great one, though.
We know very well how to cause weight loss. It’s a calorie deficit issue, and we could force it to occur. That is, we can will weight loss.
It has not been my experience that people can will happiness—not even for a short time. They can (sometimes) will themselves to be productive, and smile, and go to work, and even drudge through exercise. But willing happiness is not a possibility I am aware of.
It isn’t my argument that we should “force” weight loss, only that we can. We should be as sciency as we can be in order to come up with more convenient and reasonable ways to help be lose weight. I gamified it. I used some LW-ish principles.
Questions:
I assume you do not consider depression a choice. That is, depressed people cannot chose to become undepressed. They may choose to engage in behaviors that alleviate depression, but certain people are so severely depressed that they cannot summon the will to even engage in the depression-alleviate behaviors. Is this an accurate summary?
If someone’s caloric balance were 100% controlled so that they had a 300 kcal daily deficit, what would happen to that persons weight over the course of 30 days? 90 days? 1 year? What would happen to their appetite? Metabolism? BMI? Assume they are given a careful balance adequate nutrients. Assume they are given freedom to exercise and be active to their heart’s content. An exact 300 kcal deficit is alwasy 100% enforced. What would result?
I think you’ve rescued the rule that depressive people can’t just decide to feel happy. But by your theory, they should still be able to go to work, maintain all their relationships, and otherwise behave exactly like a non-depressed person in every way. In practice this seems very hard for depressed people and a lot of the burden of depression is effects from not being able to do this. The metaphor that just as this is a hard problem and worthy of scientific attention, so weight loss can be a hard problem and worthy of scientific attention still holds.
But why stick with depression? I could just as easily move to obsessive-compulsive disorder. Can’t they just “force” not washing their hands too often? Or social phobia—can’t they just “force” themselves to go out and socialize when appropriate?
Probably the best example is substance abuse—can’t people just “force” themselves not to drink alcohol? And yet not only do therapy-type interventions like Alcoholics Anonymous appear to work, but purely biological interventions like Vivitrol seem to work as well. I am pretty happy that these exist and the more of them people can think up for weight loss, the better.
It isn’t my argument that we should “force” weight loss, only that we can.
I didn’t interpret your original point that way. You said “There seemed to be all sorts of discussion about everything other than the simple math behind weight loss. Lots of super fascinating stuff—but much of it missing the point, I thought...they seem to spin their wheels so badly on a discussion about something as simple as weight loss” It sounded to me like you had negative opinions about the tendency to discuss non-forcing strategies for weight loss. Am I misinterpreting?
But my main objection here would be the word “can”. This word is useful in everyday speech but horrible in subtle philosophical discussions about willpower because it imports a series of assumptions that are exactly what we should be trying to discuss.
It is written: “It’s easy to run a marathon. All you have to do is start running, and not stop until you’ve gone 26.2 miles.” As far as I know this could be correct—whenever I’ve stopped running before reaching a goal, it hasn’t been because my body has literally collapsed, it’s been because I felt really tired and uncomfortable and so decided to stop. I guess it’s possible that if I could ignore that, my body would literally shut down before the 26.2 mark, but I’ve never been able to get that far and my bet is neither have you.
So is it true that I “can” run a marathon but I just don’t “want to”? My guess is that a lot of how inability works is that when your body is getting upset about something, it makes doing that thing more and more unpleasant until doing it passes beyond anyone’s conceivable pain/willpower threshold and that person stops. If that’s true, then looking at things in terms of “could have kept running” is going to totally fail to capture what’s going on.
This answers your first question.
The answer to your second question is that their body would become upset because it’s not getting the calories it needs. It might respond by limiting physical activity, either by making the person involved so tired that they don’t exercise as much as they used to, and thus cutting their caloric expenditure by 300. It might decrease invisible metabolic things to make up for some of the deficit, like making the person fidget less and decreasing body temperature. Between these two things it might be able to balance its caloric budget again.
If that didn’t happen, in healthy people where everything is working properly it would start making adipose tissue release fat to make up the shortfall (I am going to assume these people’s diets are perfectly balanced other than the caloric deficit). I have heard many smart people claim that in some people, this process is deranged, adipose tissue does not release fat effectively, and the body would be forced to go to its backup plan of cannibalizing muscle and vital organs, which over long periods is not compatible with life. I have not investigated this thoroughly enough to see if it is true. In either case they would lose weight.
So by the end of [time period], my current best understanding is that the subjects would either be the same weight, lower weight, or dead, depending on whose theories are correct, what diet they were put on, individual differences, and what the time period was. Sorry I can’t be more specific.
But by your theory, they should still be able to go to work, maintain all their relationships, and otherwise behave exactly like a non-depressed person in every way. In practice this seems very hard for depressed people and a lot of the burden of depression is effects from not being able to do this.
I think you missed my point, or I threw it by you poorly. I don’t think they “should”, I think they sometimes can. I sometimes can, and though I know from LW that not all minds are alike, it’s safe to assume I’m also not wholly unique in my depression.
As you go on to point out, there is some baseline threshold for which people cannot will themselves out of depression or other psychological issues, just as there are weight loss diets and exercise programs they cannot succeed at.
To your analogy of the marathon: There is a right answer to whether you can run X miles in Y minutes and not physically injure yourself. I’d imagine the majority of people never come close to knowing that answer because they do not posses the ability to refrain from rationalizing themselves out of the optimal result as discomfort begins during their run. I’m aware that I’m personally really bad at this—my first .5 mile I’m telling myself I’m Usain Bolt; by mile 2 I’m coming up with manifold reasons to stop pushing. No doubt some are good and rational reasons, but others are bullshit that I need only train my mind to recognize as such in order to push through and be successful.
The answer to your second question is that their body would become upset because it’s not getting the calories it needs...etc...
That’s not really what I was asking. Maybe I asked poorly.
Can you instead imagine a scenario where a controlled calorie deficit was administered to a person where they received a balanced diet with all the nutrients they needed? 300 kcal was arbitrary. Pick any number. Isn’t there some number that would be negligible in terms of the utility of its nutritional value and yet provide a calories deficient sufficient to lead to weight loss?
My point was that depression seems to have no such scenario. You cannot engineer a situation to “make” people be happy. Without excess food, or alcohol, you cannot get to obesity or alcohol addiction, right? Depression has no such outside variable.
I think you missed my point, or I threw it by you poorly. I don’t think they “should”, I think they sometimes can. I sometimes can, and though I know from LW that not all minds are alike, it’s safe to assume I’m also not wholly unique in my depression.
I agree that they sometimes can. I also agree people can sometimes lose weight. As far as I was concerned, our disagreement here (if one exists) isn’t about whether it’s possible in some cases.
Are you willing to agree to a statement like:
“Weight loss is possible in some cases, and in fact very easy in some cases. In other cases it is very hard, bordering in impossible given the marathon-analogy definition of impossible below. This can be negated by heroic measures like locking them in a room where excess food is unavailable and ignoring their appetite and distress, but in the real world you cannot do this. Because of these difficult cases, it is useful to explore the science behind weight loss and come up with more effective strategies.
If so, we agree, but then I’m confused why you were criticizing the Less Wrongers in your original statement. If you don’t agree, please let me know which part we disagree about.
To your analogy of the marathon: There is a right answer to whether you can run X miles in Y minutes and not physically injure yourself. I’d imagine the majority of people never come close to knowing that answer because they do not posses the ability to refrain from rationalizing themselves out of the optimal result as discomfort begins during their run. I’m aware that I’m personally really bad at this—my first .5 mile I’m telling myself I’m Usain Bolt; by mile 2 I’m coming up with manifold reasons to stop pushing. No doubt some are good and rational reasons, but others are bullshit that I need only train my mind to recognize as such in order to push through and be successful.
If we are debating the extremely academic point of whether someone with your muscular structure can complete a marathon in X hours, okay. But suppose we find that of a thousand people who in theory are anatomically capable of completing the marathon, zero actually finish the marathon, due to discomfort. If our goal is to get them to successfully complete marathons, what percent of our resources do you think should be invested in proving they are physically capable of doing so right now and exhorting them to do this, versus coming up with things like training schedules and better diets and better shoes that will make it easier for them?
I felt like your original point was a complaint that we are trying the equivalent of coming up with training schedules rather than the equivalent of telling people they should be able to just keep going 26.2 miles unless their legs collapse, whereas I think this is probably a better strategy. Am I interpreting your complaint correctly, and do you disagree that the former strategy is better?
Can you instead imagine a scenario where a controlled calorie deficit was administered to a person where they received a balanced diet with all the nutrients they needed? 300 kcal was arbitrary. Pick any number. Isn’t there some number that would be negligible in terms of the utility of its nutritional value and yet provide a calories deficient sufficient to lead to weight loss?
I think we’re definitely misunderstanding each other somewhere. I think we may be working off some different assumptions about how the biology here works.
I weigh 185 pounds—plugging this into a metabolism calculator, my weight will stay stable at 2200 calories per day. Suppose I weighed 500 pounds. My weight would stay stable at about 4500 calories per day.
If the 500 pound guy got only 4200 calories per day, it doesn’t matter how balanced the diet is or how many nutrients he has, his body has a caloric deficit and doesn’t have enough energy to live. Hopefully it takes care of that by burning some of his stored fat. If it can’t do that, he’s going to be in big trouble.
I may be wrong about this, but I don’t think the body can actually operate a a true caloric deficit. It WILL make up the deficit (or die, which also technically resolves the deficit). All it can do is do so in more or less problematic ways. The less problematic ways are things like burning fat. The more problematic ways are things like increasing appetite, decreasing exercise, and catabolizing organs.
I think your question corresponds to “But what if the body did just operate at a caloric deficit?”, and I am really getting out of my knowledge comfort zone here but I don’t think that’s possible. Our analogy to economics here fails—we’re not talking money where you can run a loss for a while and just have to worry about the bank coming after you, we’re talking thermodynamics where it’s physically impossible.
Weight loss is caused not by operating at a caloric deficit per se, but by the body avoiding caloric deficit by burning fat or other bodily tissues.
“Weight loss is possible in some cases, and in fact very easy in some cases. In other cases it is very hard, bordering in impossible given the marathon-analogy definition of impossible below. This can be negated by heroic measures like locking them in a room where excess food is unavailable and ignoring their appetite and distress, but in the real world you cannot do this. Because of these difficult cases, it is useful to explore the science behind weight loss and come up with more effective strategies.”
Yes, basically. Though I don’t know if I like the inclusion of “real” world. It isn’t possible to deprive people of excess calories in the practical world, but calories math and weight loss are, as far as I know, a physical law in the real universe.
If so, we agree, but then I’m confused why you were criticizing the Less Wrongers in your original statement.
Since this thread became longer and more involved than I thought, I should go back and find a few examples from the discussion I mention in my original post.
Generally, the discussion seemed to be over-complicating a simple issue. Forgive me if I mentioned this to you already, but I see two distinct discussions in regard to weight loss:
1 - The causal mechanisms that lead to losing weight.
2 - Executing a rational plan with those causal mechanisms in mind.
In my view (I’ll look for examples), the issues were conflated, with 1 receiving the majority of debate. I don’t think 1 is in need of debate, and I now wonder if people were just looking for a way to hack the causal mechanisms because dieting via 2 is super hard.
I sincerely empathize. With depression, I feel sometimes like people try to suggest all sorts of 2-styled help to me, for instance. They sort of come across like, “Just choose these different behaviors and it will alleviate your depression”. In that way, they are telling folks with depression they believe it to be a choice.
Even though I hate it, they are kind of correct. I can’t currently do anything to change the causal mechanisms that lead to obesity or depression. I’d like to, but I can’t. I gotta do 2 to feel happy. If I can’t, I’m gonna be sad, no matter much I pretend I can change 1.
I do think there are hacks for 2. And I’m 100% in favor of exploring them. As I said before, I used many tricks to help my will and motivation while dieting.
But if you want to lose weight, you have to create a calorie deficit. As you go on to say, the body will used stored calories if you don’t eat enough. Living that calorie deficit (dieting) can blow. It blew for me. But it was a trade off in order that I could accomplish the task of losing weight. It was necessary to lose weight.
There seems to be a notion with some here at LW that experiencing some hunger or fatigue or less-than-perfect-happy-functionality is a dieting failure mode. It isn’t. It is like anything else in life. To your analogy, you don’t run faster times by rationalizing about why you can’t run faster times. It DOES hurt a bit—even when it is doing no damage to your body—to push through the rationalization. Of course, you can push too hard—in running or in dieting—but I’m not talking about exceeding what is healthy.
To sum up, somebody replied to me (somewhere on here) with an EY quote that said: “I can starve or I can think. I can’t do both” I assume it was in the context of dieting.
I think(?) it provides a good summary of the attitude I’m criticizing on LW in regard to dieting. You don’t have to starve to diet. But there may be no way in the physical universe to avoid losing some % of your comfort and/or capability during your diet (calorie deficit). You may lose some “think” as you do a little bit of “starve”. Just like you lose a little comfort when you do a little bit faster run… and I lose a little time and sleep when I type a little more. :)
I agree that trying to avoid all pain can be a failure mode. But insisting that pain needs to be plowed through can also be a failure mode.
The advice “You should run a marathon by continuing to run even if it hurts” might perhaps be useful as part of a package of different interventions to a runner who’s hit some kind of a motivational wall.
But in other situations it is completely inappropriate. For example, suppose a certain runner has a broken leg, but you don’t know this and he can’t communicate it to you. He just says “It really really hurts when I run!” And you just answer “Well, you need to run through the pain!”
This is an unreasonable request. If you were more clueful, you might make a suggestion like “You should go to a doctor, wait for your broken leg to heal, and then try running later.”
And if enough people have broken legs, then promoting the advice “You should run a marathon by continuing to run even when it hurts” is bad advice. Even if we assume that people are still capable of running on broken legs and will not collapse, you are generalizing from your own example to assume that the pain they suffer will be minimal and tolerable, rather than excruciating and intolerable.
If some people have metabolic problems—and right now I’m not claiming they do, just creating a possibility proof, and if you agree it’s possible but don’t think it’s real we can get into that later—then they’re like the broken legged people.
Working off Taubes and a few other of the low-carb people, some people’s fat cells do not release energy. If they suffer any caloric deficit at all, even 300 calories or whatever you consider a reasonable small amount, their bodies will immediately start starving and catabolizing muscles or, in the worst case, vital organs. There have been examples (though the implications and generalizability are still debated) of people starving to death while weighing three or four hundred pounds, because for some reason their bodies couldn’t get to their fat and so were forced to catabolize the liver or heart or something.
(this is what “starving to death” tends to mean in real life; you are so starved that your body breaks down important tissues it can’t afford to lose, or builds up too many tissue-breakdown waste products)
Imagine that you are literally starving to death—let’s say you’ve been without food for three months and you’re down to the bone like those heart-wrenching photos out of some African countries. You have no energy and can barely move out of your bed. In theory it is possible for you to use willpower to force yourself to continue going on with your daily activities, and not have complaints like “I can’t starve and think at the same time”. In practice, this seems like a pretty poor plan if you have any other options.
If Taubes et al are correct, fat people who can’t mobilize their body’s energy reserves are in exactly this situation. Any caloric deficit and they’re literally starving, their bodies are trying to figure out whether they should cannibalize the heart or the liver first, and they’re not in the mood for continuing to go about daily activities with a smile on their face any more than that African in the famine is.
If your body has fully functional fat metabolism, and you’re operating at a caloric deficit by successfully burning off fat, and you tell them “Hey, I feel moderately hungry but really this isn’t so hard”, you’re comparing apples to oranges, the same way as the healthy runner to the runner with the broken leg.
A better solution would be to come up with some way to fix the thing where the body can’t mobilize its fat reserves and so either has to stay fat or starve to death. I think this is the project the paleo people are working on: figuring out how to make the body say “Okay, caloric deficit, better burn some fat cells” instead of “Oh no, caloric deficit, better assume I’m starving to death and jack appetite up to eleven while catabolizing all of my muscles”.
So is our disagreement that you don’t think even Taubes’ picture provides a situation in which one should privilege bodyhacking-type solutions over willpower-based solutions, or just that you don’t think Taubes’ picture is correct?
If some people have metabolic problems—and right now I’m not claiming they do, just creating a possibility proof, and if you agree it’s possible but don’t think it’s real we can get into that later—then they’re like the broken legged people.
In that case the interesting question is whether these people who will literally starve to death before losing fat are exceedingly rare metabolic freaks, nothing more than medical curiosities? If their prevalence is in single digits per million they are just a red herring in the discussion of obesity. I suspect that for pretty much any generally accepted and valid health advice there is some exotic medical condition which makes following this advice a horribly wrong thing for that particular individual.
In general, I think it’s highly useful to state that being in energy deficit through (usually) eating less or (less usually) spending more is the only way to lose weight outside of surgery. That’s not the final word on the topic, but it should be the first. Otherwise you get equivalents of alcoholics who believe they’ll fix their dependency by avoiding one particular kind of alcohol and drinking some other kind.
Yes, there are different ways to maintain energy deficit. In some cases you can just bulldoze through on willpower (or sufficient motivation). In some cases your personal biochemistry will be cooperative and in other cases it will not. Sometimes adjusting your hormonal and metabolic balance will do wonders, sometimes it will do nothing.
In that case the interesting question is whether these people who will literally starve to death before losing fat are exceedingly rare metabolic freaks, nothing more than medical curiosities? If their prevalence is in single digits per million they are just a red herring in the discussion of obesity. I suspect that for pretty much any generally accepted and valid health advice there is some exotic medical condition which makes following this advice a horribly wrong thing for that particular individual.
People have literally died of that mistake, so there might be some reason to want to avoid making it—like tracking what’ actually happening to people’s bodies when they’re trying to lose weight.
Also, disorders tend to exist in a range of intensity, so that’s another reason to keep track of the effects of dieting—even if people whose bodies don’t release energy from fat enough to avoid death are very rare, people who who have a lot of difficulty with losing fat shouldn’t be assumed to be lying, and may be losing more muscle mass than is good for them.
Of that mistake? Links, please, to cases where people actually bothered to control their electrolytes, vitamins, minerals, and other essentials—they just denied themselves calories and died from starvation still weighting a few hundred pounds.
people who who have a lot of difficulty with losing fat shouldn’t be assumed to be lying
“Have a lot of difficulty with” and “biochemically cannot” are very different things. A lot of people have difficulty with losing fat—this does not imply that they cannot do it, only that they are unwilling or incapable of paying the price to do it.
may be losing more muscle mass than is good for them
Alternatively they may be accumulating more fat than is good for them.
As a practical matter I am not a big fan of using weight as the target variable. I much prefer either the body fat % or getting naked in front of a full-length mirror.
For example, suppose a certain runner has a broken leg, but you don’t know this and he can’t communicate it to you. He just says “It really really hurts when I run!” And you just answer “Well, you need to run through the pain!” This is an unreasonable request.
Of course. I use the broken leg while trying to run analogy to describe people’s advice to “just keep functioning” during deep depressive bouts.
Working off Taubes and a few other of the low-carb people, some people’s fat cells do not release energy.
Can you provide an estimate to the % of the population this applies to?
So is our disagreement that you don’t think even Taubes’ picture provides a situation in which one should privilege bodyhacking-type solutions over willpower-based solutions, or just that you don’t think Taubes’ picture is correct?
My understanding is that individual metabolism varies pretty significantly from person to person. From my recall, something like 25%-30% of BMR is derived from some unknown variable, probably just genetic pre-disposition.
If that is the case, then it is true that some people are much better—no credit to them or their will—at losing weight. Person A and B could live identical lives from a caloric balance standpoint, one ending up obese while the other is trim and fit.
This is a very useful thing for people to know. Skinny people and obese people might not be doing anything differently in terms of lifestyl, willpower, motivation, etc. I like spreading that idea, because skinny people can act superior and shame obese people for “failing”, and the data suggest that can be bullshit.
However, if you are pre-disposed according to the 25-30% mystery BMR to not have a fast enough metabolism to stay skinny in a culture that so cherishes it, then there is not necessarily much you can do about it other than just (a) eat less or (b) exercise more. Come up with smart 2 ideas, sure. But there is no escaping the reality of 1, and nature has put you at a X% disatvantage in the “staying skinny” dept. (Nature does the same to those with depression in the “staying happy” dept. or those with OCD in the “staying calm and avoiding obsessive thinking” dept. I know first hand.)
I don’t think low carb diets work for the pseudo-scientific reasons that propenents say they do. I think it is nothing more than calorie control.
Look at Atkins. Consider it in light of the average, carb-loaded American diet. If you quit carbs, you create a calorie deficit for very practical reasons. Pretending something mystical is taking place is silly and leads to bad ideas about the nature of weight loss.
I could say, “If you want to increase you chest strength, do 3 sets of bench press 3 times per week PLUS touch your nose 22 times while you are lying in bed waiting to fall asleep.”
If my audience was eager enough for increased chest strength and I presented myself as an expert, they’d follow my instructions, benching and nose-touching themselves to bigger, stronger chests. Likely, someone would branch off my successful work, claiming that 44 nose touches and 2X2 bench presses was a better method. Then 66 and 2X4. Or 51 and 5x1.
Soon a whole market of nose-touching techniques would be created… Books written, seminars seminared.
I sense this is something like what has happened with low-carb diets. It does work. But not for the stated reasons. Low fat diet was a simple heuristic that looked at which macro-nutrient source (fat) was most calorie dense and then demonized it. Low carb diet is a heuristic that identified the macro-nutrient source that made up the highest % of our caloirc intake and then demonized it.
Other diets, like the No-S diet, work for similar reasons. There are just simple #2 hacks that give easy to follow heuristics.
I feel Atkins and other diets are often presented as something more scientificky than that. I expected LWers to recognize the ruse. My views started to change when they seemed to sincerely believe in some stuff I thought was nonsense. I was deferring to higher intelligence as that usually works pretty well for me.
Then I dieted. And it worked exactly how the simple calorie math said it would work. I limited my carbs some. And my fats. I took multivitimans. Ate fruits and vegis. Drank plenty of water. I quit drinking alcohol/soda and eating fast food/dessert. It sucked for about 4-5 weeks. I “starved” a little and limited my ability to “think” a little, I suppose. But then you get used to the new lifestyle. Curb the calorie deficit a bit… then back to equilibrium once you are at your desired weight.
I know my single experience doesn’t prove anything for the general population. Maybe there are factors at play that I’m not accounting for? I herniated a cervical disc and haven’t been able to lift weight. I’ve lost a good amount of muscle I’d suspect. I took a lot of NSAIDS after my injury, maybe that factored in?
My sense, however, is that it is simpler than that. And some LWers were just overcomplicating a simple thing in such a way that I almost listend and missed out on what appears to be, at least in the short term, a positive outcome for me.
(Again, I’m aware some people have a MUCH more difficult time dieting due to factors they cannot control. I hate fat-shaming and I’m a huge advocate of destroying the smugness of skinny punks with hard science.)
“I am pretty sure when the average person argues for or against ketosis having a “metabolic advantage” what they are really arguing is whether or not, calorie-for-calorie, a person in ketosis has a higher resting energy expenditure. In other words, does a person in ketosis expend more energy than a person not in ketosis because of the caloric composition of what they consume/ingest?
Let me save you a lot of time and concern by offering you the answer: The question has not been addressed sufficiently in a properly controlled trial and, at best, we can look to lesser controlled trials and clinical observations to a make a best guess.
Do you have a guess as to what the overall effect ketosis has on weight loss? If I maximize the effect, what % can I increase the efficiency of my diet?
Do you have a guess as to what the overall effect ketosis has on weight loss?
I don’t have proper data, just anecdata—suitable for WAGs (wild-ass guesses) but not much more.
the efficiency of my diet
What do you mean by that?
Besides, being in long-term ketosis tends to lead to many consequences unconnected with weight loss or gain. See e.g. here for some discussion. Anecdotally many people who’s been on VLC diets for a year or so tend to develop problems that go away when they add a bit of glucose (=carbs) to their intake.
I did something of a similar simple nature a couple years back.
I removed soda, alcohol, fast food and anything resembling dessert for 1 year.
I also I added 1 liter of water, 1 raw fruit and 1 raw vegetable to my diet, following this very strictly. (I ate a lot of roma tomatos like apples over the sink late at night before bed to honor the diet...)
I wish I would have tracked my body fat% because I believe it was very effective… and relatively easy to keep the diet.
Consider the following story:
I would have at least three qualms with such an attitude:
First, there are different kinds of low mood. Some differences are obvious; some people are less depressed than others, or depressed for much shorter time periods. But it could also be that there are no visible differences between two people, but that for hidden reasons one person’s depression will respond to some quick exercise and social activity, and another person’s won’t.
Second, even interventions that are known to always work can be hard to task-ify. Exercise is indeed often a very effective treatment for depression, but when you tell a depressed person “just go and exercise”, they usually won’t do that because they’re too depressed. Having a good social support network can be helpful in depression, but depressed people can be unable to make friends because deep down they assume everyone hates them. Part of treating depression is bringing people to the point where they’re able to do the simple interventions. If you get a depressed person who does have the motivation to exercise and make friends, great, but it’s not a point against psychiatry that they sometimes discuss how to help people who don’t.
A third problem is general anti-scientificness. Yeah, sure, you don’t need to understand exactly how neurogenesis occurs in order to treat depression. But it’s neat to know. And in fact exercise may treat depression by increasing neurotrophic factors, so you’re not disagreeing with the scientists, just looking at it from a different angle. And for certain people it might be, in a weird way, sort of inspirational to know the science and help them figure out why they’re doing what they’re doing. If they want to study it, why complain?
I think most of the same issues generalize to your comment.
I would also add one more, which is that it is generally much easier to lose weight on a diet than to keep the weight off for more than a year or two. For example, of people who lost (hey, look at that!) thirty pounds on a diet, one year later they had on average gained back fifteen of them. Longer followups usually find even more of the weight regained; see for example Mann 2007. So you’re declaring something simple before you’ve even started the hard part.
Last I heard, the popular science theory about why it’s easier to lose weight than to keep it off is that appetite increases rather than that metabolism slows. Have you heard anything else that looks plausible?
As you would probably imagine, there is a bit of both, though it seems like the hunger portion is more important. Intuitively, any change in metabolic rate is very easily overshadowed in magnitude by increases or decreases in the amount of food eaten. This is why exercising to “burn calories” is ineffective as a means of weight loss. One tall glass of orange juice is equivalent to ~10-15% of your Basal Metabolic Rate (BMR) or to ~30 minutes on a treadmill.
This turned out a lot longer than I expected, but hopefully it will be useful to some people.
There are two primary hormones involved in hunger and weight management, Ghrelin and Leptin, with Leptin being arguably more important because of all of its downstream effects and because it is the one we can control with diet and exercise interventions:
(One important thing to know here is that the important thing is the level of hormonal “Activity”, not the absolute levels of the hormone. Activity is made up of two factors: How much of the hormone you have and sensitivity to that hormone. For example, obese people with chronically high blood sugar are usually insulin resistant. They have high levels of insulin, but it doesn’t do its job properly because they have low sensitivity to insulin. This is caused by chronically high levels of the hormone.)
Ghrelin: Secreted by adipose (fat) tissue, increases hunger. Ghrelin is “entrained” by your eating habits which is why you usually get hungry at about the same time each day. People who are used to eating breakfast feel hungry if they don’t, because your body releases Ghrelin when you expect to eat. More fat tissue leads to higher Ghrelin levels on average. (More fat ⇒ more hungry) Ghrelin is not known to have “resistance” associated with it.
Leptin: Also secreted by adipose (fat) tissue, decreases hunger. Leptin is also entrained by meal patterns, so having a regular eating schedule is likely effective in controlling excess eating. Low leptin leads to both an increase in hunger and a decrease in metabolic rate. (Less fat ⇒ more hungry). Now you would think that being fatter would increase leptin levels as well. It does. Unfortunately, with chronically high levels of leptin, your body adapts and develops “leptin resistance”. This means that leptin is not as effective at controlling hunger when you are overweight. Naturally thin people have low levels of leptin, but they are very sensitive to it, so it still does its job at controlling hunger.
These are both hormonal systems, so the body takes longer to come to equilibrium after interventions. Also, according to “set-point” theory, your body will vary the levels of these hormones in order to maintain a certain weight range. Set point is thought to have a strong genetic component and it is unclear whether a person’s set point can be changed.
However, there are things that can be done to help get your Leptin system back on track. In the long-term, leptin levels are determined primarily by total fat mass. More fat, more leptin. Less fat, less leptin. If you are overweight, you are likely at least somewhat leptin resistant.
In the short term, leptin is influenced by caloric surplus/deficit and macronutrient ratios (primarily carbohydrates).
So, what does this mean and what can we do about it?
Well, an acute calorie deficit crashes leptin in the short term. This is why you get hungry if you don’t eat. Intermittent refeeds (especially carb refeeds) where you eat a caloric surplus one day before going back to your daily deficit can keep your leptin levels slightly higher to help control hunger over the course of a diet.
If you manage to keep a diet going for long enough to lose a significant amount of fat mass, then your natural long-term leptin levels will be lower. This should make you hungrier. However, your leptin sensitivity will also increase until it gets back to a normal baseline. This helps control hunger.
However, research has not shown any way to increase leptin resistance below an individual’s natural baseline sensitivity. That means that if your set-point is higher than the weight you’ve dieted to, your naturally regulated food intake will lead to slowly gaining weight again up to your set point. However, if you get your leptin sensitivity back to normal by losing weight and keeping it off for a while, then the leptin increase caused by acute overeating can help naturally regulate your hunger to help decrease weight gain.
So the takeaways:
Being overweight makes you leptin resistant. This means even though your body is trying to tell you to stop eating, you can’t hear it. Once you lose weight and give your body time to adjust, your body is sensitive to its own signals again which can help naturally regulate overeating and metabolism.
Acute caloric deficits increase hunger (and lower metabolism by a small amount) via decreased leptin. Having periodic refeeds where you eat higher calorie and higher carb one day can help keep leptin levels higher during a diet and decrease hunger.
Your body probably has a natural “set-point” that it will try to adjust to once it can hear its own signals and your leptin system works properly. This may be higher than you want. Long-term behavioral modifications to induce entrainment of meal patterns, regular exercise, eating less calorie-dense foods, and intermittent fasting can be helpful in allowing you to maintain a weight below your set point.
It is quite clear that people’s set points change over their lifetime—great many people are trim in their 20s and then succumb to the middle-age spread in their 40s. Looks like one can make an argument that in many (but not all) people their set points drift upwards as they age, at least until the 60s when some revert to losing weight, and not only muscle mass but fat as well.
The interesting question, of course, is whether one can “reset” one’s set point to what it was in the 20s.
Any comments (or links) on how low-carb diets in general and ketosis in particular affect leptin?
Right, I mean by specific interventions. For example, dieting down to very low body fat and then maintaining it does not appear to increase leptin sensitivity (much) beyond that of a normal-weight person, nor does exercise.
As far as ketosis and leptin goes, This study indicates that carbohydrate overfeeding increases leptin and energy expenditure, while fat overfeeding does not. This suggests that eating carbohydrates naturally causes you to get full, while fat does not, which is inline with research on satiety and macronutrients. (Keep in mind that fructose is not metabolized like a normal carbohydrate and has different effects on leptin and so may not cause the leptin increase or induce satiety.)
This study indicates that ketosis blunts ghrelin release even in a caloric deficit which could be the reason that people on ketogenic diets (or doing intermittent fasts, which is a fat-burning state) report lower hunger levels. In this situation, leptin is lower which probably reduces metabolic rate a bit (probably not hugely significant), but its effect on hunger is probably balanced out by the change in ghrelin.
If you are doing a ketogenic or low carb diet, if you reach a plateau with weight loss, it could be because your leptin is too low. Doing a carb refeed with glucose (which includes starches), but not fructose, could be beneficial.
Interesting. So this implies that lower hunger in calorie-deficit ketosis is due to low ghrelin which more than compensates for lower leptin… And yes, carb refeeds (usually weekly) are a component of many low-carb diets.
How long is long enough to increase leptin sensitivity?
Anecdotally, people who keep weight off say it requires constant attention, not that they develop a lower set point.
This is correct. That’s what I meant by “That means that if your set-point is higher than the weight you’ve dieted to, your naturally regulated food intake will lead to slowly gaining weight again up to your set point.” If your set-point is higher than your weight, then you will still gain weight back if you’re not careful. Once your leptin system is restored to healthy function though, your body is better at regulating its weight. Weight gain at this point is likely to be slow and gradual rather than the rapid “rebound” weight gain that many dieters get if they completely stop their diet without allowing for this system to recover first. Also, since eating a lot makes your produce leptin, if your body is now sensitive to that signal, it will naturally make you less hungry for a little while, whereas if you’re leptin resistant, you feel hungry even when you’ve had enough. This is the benefit. That means that if you follow sensible lifestyle-diet practices even when you’re done with the intense diet phase, you can greatly slow or prevent weight regain. That would be things such as eating whole foods instead of processed foods, fruits and vegetables for fiber, and limit sugar (fructose is the real culprit) and alcohol consumption.
This one probably varies a lot with the individual. Also, keep in mind that there are different levels of leptin resistance, so recovery follows a curve. From anecdotal reports, it seems that some people can see significant improvement in 4-6 weeks with most people getting significant improvement within 3 months. I think it’s likely that improvements will continue for 6 months to a year depending on the individual.
I like the analogy, because I can personally relate to depression. I don’t know that it is a great one, though.
We know very well how to cause weight loss. It’s a calorie deficit issue, and we could force it to occur. That is, we can will weight loss.
It has not been my experience that people can will happiness—not even for a short time. They can (sometimes) will themselves to be productive, and smile, and go to work, and even drudge through exercise. But willing happiness is not a possibility I am aware of.
It isn’t my argument that we should “force” weight loss, only that we can. We should be as sciency as we can be in order to come up with more convenient and reasonable ways to help be lose weight. I gamified it. I used some LW-ish principles.
Questions:
I assume you do not consider depression a choice. That is, depressed people cannot chose to become undepressed. They may choose to engage in behaviors that alleviate depression, but certain people are so severely depressed that they cannot summon the will to even engage in the depression-alleviate behaviors. Is this an accurate summary?
If someone’s caloric balance were 100% controlled so that they had a 300 kcal daily deficit, what would happen to that persons weight over the course of 30 days? 90 days? 1 year? What would happen to their appetite? Metabolism? BMI? Assume they are given a careful balance adequate nutrients. Assume they are given freedom to exercise and be active to their heart’s content. An exact 300 kcal deficit is alwasy 100% enforced. What would result?
I think you’ve rescued the rule that depressive people can’t just decide to feel happy. But by your theory, they should still be able to go to work, maintain all their relationships, and otherwise behave exactly like a non-depressed person in every way. In practice this seems very hard for depressed people and a lot of the burden of depression is effects from not being able to do this. The metaphor that just as this is a hard problem and worthy of scientific attention, so weight loss can be a hard problem and worthy of scientific attention still holds.
But why stick with depression? I could just as easily move to obsessive-compulsive disorder. Can’t they just “force” not washing their hands too often? Or social phobia—can’t they just “force” themselves to go out and socialize when appropriate?
Probably the best example is substance abuse—can’t people just “force” themselves not to drink alcohol? And yet not only do therapy-type interventions like Alcoholics Anonymous appear to work, but purely biological interventions like Vivitrol seem to work as well. I am pretty happy that these exist and the more of them people can think up for weight loss, the better.
I didn’t interpret your original point that way. You said “There seemed to be all sorts of discussion about everything other than the simple math behind weight loss. Lots of super fascinating stuff—but much of it missing the point, I thought...they seem to spin their wheels so badly on a discussion about something as simple as weight loss” It sounded to me like you had negative opinions about the tendency to discuss non-forcing strategies for weight loss. Am I misinterpreting?
But my main objection here would be the word “can”. This word is useful in everyday speech but horrible in subtle philosophical discussions about willpower because it imports a series of assumptions that are exactly what we should be trying to discuss.
It is written: “It’s easy to run a marathon. All you have to do is start running, and not stop until you’ve gone 26.2 miles.” As far as I know this could be correct—whenever I’ve stopped running before reaching a goal, it hasn’t been because my body has literally collapsed, it’s been because I felt really tired and uncomfortable and so decided to stop. I guess it’s possible that if I could ignore that, my body would literally shut down before the 26.2 mark, but I’ve never been able to get that far and my bet is neither have you.
So is it true that I “can” run a marathon but I just don’t “want to”? My guess is that a lot of how inability works is that when your body is getting upset about something, it makes doing that thing more and more unpleasant until doing it passes beyond anyone’s conceivable pain/willpower threshold and that person stops. If that’s true, then looking at things in terms of “could have kept running” is going to totally fail to capture what’s going on.
This answers your first question.
The answer to your second question is that their body would become upset because it’s not getting the calories it needs. It might respond by limiting physical activity, either by making the person involved so tired that they don’t exercise as much as they used to, and thus cutting their caloric expenditure by 300. It might decrease invisible metabolic things to make up for some of the deficit, like making the person fidget less and decreasing body temperature. Between these two things it might be able to balance its caloric budget again.
If that didn’t happen, in healthy people where everything is working properly it would start making adipose tissue release fat to make up the shortfall (I am going to assume these people’s diets are perfectly balanced other than the caloric deficit). I have heard many smart people claim that in some people, this process is deranged, adipose tissue does not release fat effectively, and the body would be forced to go to its backup plan of cannibalizing muscle and vital organs, which over long periods is not compatible with life. I have not investigated this thoroughly enough to see if it is true. In either case they would lose weight.
So by the end of [time period], my current best understanding is that the subjects would either be the same weight, lower weight, or dead, depending on whose theories are correct, what diet they were put on, individual differences, and what the time period was. Sorry I can’t be more specific.
I think you missed my point, or I threw it by you poorly. I don’t think they “should”, I think they sometimes can. I sometimes can, and though I know from LW that not all minds are alike, it’s safe to assume I’m also not wholly unique in my depression.
As you go on to point out, there is some baseline threshold for which people cannot will themselves out of depression or other psychological issues, just as there are weight loss diets and exercise programs they cannot succeed at.
To your analogy of the marathon: There is a right answer to whether you can run X miles in Y minutes and not physically injure yourself. I’d imagine the majority of people never come close to knowing that answer because they do not posses the ability to refrain from rationalizing themselves out of the optimal result as discomfort begins during their run. I’m aware that I’m personally really bad at this—my first .5 mile I’m telling myself I’m Usain Bolt; by mile 2 I’m coming up with manifold reasons to stop pushing. No doubt some are good and rational reasons, but others are bullshit that I need only train my mind to recognize as such in order to push through and be successful.
That’s not really what I was asking. Maybe I asked poorly.
Can you instead imagine a scenario where a controlled calorie deficit was administered to a person where they received a balanced diet with all the nutrients they needed? 300 kcal was arbitrary. Pick any number. Isn’t there some number that would be negligible in terms of the utility of its nutritional value and yet provide a calories deficient sufficient to lead to weight loss?
My point was that depression seems to have no such scenario. You cannot engineer a situation to “make” people be happy. Without excess food, or alcohol, you cannot get to obesity or alcohol addiction, right? Depression has no such outside variable.
I agree that they sometimes can. I also agree people can sometimes lose weight. As far as I was concerned, our disagreement here (if one exists) isn’t about whether it’s possible in some cases.
Are you willing to agree to a statement like:
“Weight loss is possible in some cases, and in fact very easy in some cases. In other cases it is very hard, bordering in impossible given the marathon-analogy definition of impossible below. This can be negated by heroic measures like locking them in a room where excess food is unavailable and ignoring their appetite and distress, but in the real world you cannot do this. Because of these difficult cases, it is useful to explore the science behind weight loss and come up with more effective strategies.
If so, we agree, but then I’m confused why you were criticizing the Less Wrongers in your original statement. If you don’t agree, please let me know which part we disagree about.
If we are debating the extremely academic point of whether someone with your muscular structure can complete a marathon in X hours, okay. But suppose we find that of a thousand people who in theory are anatomically capable of completing the marathon, zero actually finish the marathon, due to discomfort. If our goal is to get them to successfully complete marathons, what percent of our resources do you think should be invested in proving they are physically capable of doing so right now and exhorting them to do this, versus coming up with things like training schedules and better diets and better shoes that will make it easier for them?
I felt like your original point was a complaint that we are trying the equivalent of coming up with training schedules rather than the equivalent of telling people they should be able to just keep going 26.2 miles unless their legs collapse, whereas I think this is probably a better strategy. Am I interpreting your complaint correctly, and do you disagree that the former strategy is better?
I think we’re definitely misunderstanding each other somewhere. I think we may be working off some different assumptions about how the biology here works.
I weigh 185 pounds—plugging this into a metabolism calculator, my weight will stay stable at 2200 calories per day. Suppose I weighed 500 pounds. My weight would stay stable at about 4500 calories per day.
If the 500 pound guy got only 4200 calories per day, it doesn’t matter how balanced the diet is or how many nutrients he has, his body has a caloric deficit and doesn’t have enough energy to live. Hopefully it takes care of that by burning some of his stored fat. If it can’t do that, he’s going to be in big trouble.
I may be wrong about this, but I don’t think the body can actually operate a a true caloric deficit. It WILL make up the deficit (or die, which also technically resolves the deficit). All it can do is do so in more or less problematic ways. The less problematic ways are things like burning fat. The more problematic ways are things like increasing appetite, decreasing exercise, and catabolizing organs.
I think your question corresponds to “But what if the body did just operate at a caloric deficit?”, and I am really getting out of my knowledge comfort zone here but I don’t think that’s possible. Our analogy to economics here fails—we’re not talking money where you can run a loss for a while and just have to worry about the bank coming after you, we’re talking thermodynamics where it’s physically impossible.
Weight loss is caused not by operating at a caloric deficit per se, but by the body avoiding caloric deficit by burning fat or other bodily tissues.
I could be totally wrong about this.
Yes, basically. Though I don’t know if I like the inclusion of “real” world. It isn’t possible to deprive people of excess calories in the practical world, but calories math and weight loss are, as far as I know, a physical law in the real universe.
Since this thread became longer and more involved than I thought, I should go back and find a few examples from the discussion I mention in my original post.
Generally, the discussion seemed to be over-complicating a simple issue. Forgive me if I mentioned this to you already, but I see two distinct discussions in regard to weight loss:
1 - The causal mechanisms that lead to losing weight.
2 - Executing a rational plan with those causal mechanisms in mind.
In my view (I’ll look for examples), the issues were conflated, with 1 receiving the majority of debate. I don’t think 1 is in need of debate, and I now wonder if people were just looking for a way to hack the causal mechanisms because dieting via 2 is super hard.
I sincerely empathize. With depression, I feel sometimes like people try to suggest all sorts of 2-styled help to me, for instance. They sort of come across like, “Just choose these different behaviors and it will alleviate your depression”. In that way, they are telling folks with depression they believe it to be a choice.
Even though I hate it, they are kind of correct. I can’t currently do anything to change the causal mechanisms that lead to obesity or depression. I’d like to, but I can’t. I gotta do 2 to feel happy. If I can’t, I’m gonna be sad, no matter much I pretend I can change 1.
I do think there are hacks for 2. And I’m 100% in favor of exploring them. As I said before, I used many tricks to help my will and motivation while dieting.
But if you want to lose weight, you have to create a calorie deficit. As you go on to say, the body will used stored calories if you don’t eat enough. Living that calorie deficit (dieting) can blow. It blew for me. But it was a trade off in order that I could accomplish the task of losing weight. It was necessary to lose weight.
There seems to be a notion with some here at LW that experiencing some hunger or fatigue or less-than-perfect-happy-functionality is a dieting failure mode. It isn’t. It is like anything else in life. To your analogy, you don’t run faster times by rationalizing about why you can’t run faster times. It DOES hurt a bit—even when it is doing no damage to your body—to push through the rationalization. Of course, you can push too hard—in running or in dieting—but I’m not talking about exceeding what is healthy.
To sum up, somebody replied to me (somewhere on here) with an EY quote that said: “I can starve or I can think. I can’t do both” I assume it was in the context of dieting.
I think(?) it provides a good summary of the attitude I’m criticizing on LW in regard to dieting. You don’t have to starve to diet. But there may be no way in the physical universe to avoid losing some % of your comfort and/or capability during your diet (calorie deficit). You may lose some “think” as you do a little bit of “starve”. Just like you lose a little comfort when you do a little bit faster run… and I lose a little time and sleep when I type a little more. :)
I’ll look for examples.
I agree that trying to avoid all pain can be a failure mode. But insisting that pain needs to be plowed through can also be a failure mode.
The advice “You should run a marathon by continuing to run even if it hurts” might perhaps be useful as part of a package of different interventions to a runner who’s hit some kind of a motivational wall.
But in other situations it is completely inappropriate. For example, suppose a certain runner has a broken leg, but you don’t know this and he can’t communicate it to you. He just says “It really really hurts when I run!” And you just answer “Well, you need to run through the pain!”
This is an unreasonable request. If you were more clueful, you might make a suggestion like “You should go to a doctor, wait for your broken leg to heal, and then try running later.”
And if enough people have broken legs, then promoting the advice “You should run a marathon by continuing to run even when it hurts” is bad advice. Even if we assume that people are still capable of running on broken legs and will not collapse, you are generalizing from your own example to assume that the pain they suffer will be minimal and tolerable, rather than excruciating and intolerable.
If some people have metabolic problems—and right now I’m not claiming they do, just creating a possibility proof, and if you agree it’s possible but don’t think it’s real we can get into that later—then they’re like the broken legged people.
Working off Taubes and a few other of the low-carb people, some people’s fat cells do not release energy. If they suffer any caloric deficit at all, even 300 calories or whatever you consider a reasonable small amount, their bodies will immediately start starving and catabolizing muscles or, in the worst case, vital organs. There have been examples (though the implications and generalizability are still debated) of people starving to death while weighing three or four hundred pounds, because for some reason their bodies couldn’t get to their fat and so were forced to catabolize the liver or heart or something.
(this is what “starving to death” tends to mean in real life; you are so starved that your body breaks down important tissues it can’t afford to lose, or builds up too many tissue-breakdown waste products)
Imagine that you are literally starving to death—let’s say you’ve been without food for three months and you’re down to the bone like those heart-wrenching photos out of some African countries. You have no energy and can barely move out of your bed. In theory it is possible for you to use willpower to force yourself to continue going on with your daily activities, and not have complaints like “I can’t starve and think at the same time”. In practice, this seems like a pretty poor plan if you have any other options.
If Taubes et al are correct, fat people who can’t mobilize their body’s energy reserves are in exactly this situation. Any caloric deficit and they’re literally starving, their bodies are trying to figure out whether they should cannibalize the heart or the liver first, and they’re not in the mood for continuing to go about daily activities with a smile on their face any more than that African in the famine is.
If your body has fully functional fat metabolism, and you’re operating at a caloric deficit by successfully burning off fat, and you tell them “Hey, I feel moderately hungry but really this isn’t so hard”, you’re comparing apples to oranges, the same way as the healthy runner to the runner with the broken leg.
A better solution would be to come up with some way to fix the thing where the body can’t mobilize its fat reserves and so either has to stay fat or starve to death. I think this is the project the paleo people are working on: figuring out how to make the body say “Okay, caloric deficit, better burn some fat cells” instead of “Oh no, caloric deficit, better assume I’m starving to death and jack appetite up to eleven while catabolizing all of my muscles”.
So is our disagreement that you don’t think even Taubes’ picture provides a situation in which one should privilege bodyhacking-type solutions over willpower-based solutions, or just that you don’t think Taubes’ picture is correct?
I think some of the fat people who starved to death were suffering from mineral deficiencies.
In that case the interesting question is whether these people who will literally starve to death before losing fat are exceedingly rare metabolic freaks, nothing more than medical curiosities? If their prevalence is in single digits per million they are just a red herring in the discussion of obesity. I suspect that for pretty much any generally accepted and valid health advice there is some exotic medical condition which makes following this advice a horribly wrong thing for that particular individual.
In general, I think it’s highly useful to state that being in energy deficit through (usually) eating less or (less usually) spending more is the only way to lose weight outside of surgery. That’s not the final word on the topic, but it should be the first. Otherwise you get equivalents of alcoholics who believe they’ll fix their dependency by avoiding one particular kind of alcohol and drinking some other kind.
Yes, there are different ways to maintain energy deficit. In some cases you can just bulldoze through on willpower (or sufficient motivation). In some cases your personal biochemistry will be cooperative and in other cases it will not. Sometimes adjusting your hormonal and metabolic balance will do wonders, sometimes it will do nothing.
People are different. It’s complicated :-/
People have literally died of that mistake, so there might be some reason to want to avoid making it—like tracking what’ actually happening to people’s bodies when they’re trying to lose weight.
Also, disorders tend to exist in a range of intensity, so that’s another reason to keep track of the effects of dieting—even if people whose bodies don’t release energy from fat enough to avoid death are very rare, people who who have a lot of difficulty with losing fat shouldn’t be assumed to be lying, and may be losing more muscle mass than is good for them.
Of that mistake? Links, please, to cases where people actually bothered to control their electrolytes, vitamins, minerals, and other essentials—they just denied themselves calories and died from starvation still weighting a few hundred pounds.
“Have a lot of difficulty with” and “biochemically cannot” are very different things. A lot of people have difficulty with losing fat—this does not imply that they cannot do it, only that they are unwilling or incapable of paying the price to do it.
Alternatively they may be accumulating more fat than is good for them.
As a practical matter I am not a big fan of using weight as the target variable. I much prefer either the body fat % or getting naked in front of a full-length mirror.
Of course. I use the broken leg while trying to run analogy to describe people’s advice to “just keep functioning” during deep depressive bouts.
Can you provide an estimate to the % of the population this applies to?
My understanding is that individual metabolism varies pretty significantly from person to person. From my recall, something like 25%-30% of BMR is derived from some unknown variable, probably just genetic pre-disposition.
If that is the case, then it is true that some people are much better—no credit to them or their will—at losing weight. Person A and B could live identical lives from a caloric balance standpoint, one ending up obese while the other is trim and fit.
This is a very useful thing for people to know. Skinny people and obese people might not be doing anything differently in terms of lifestyl, willpower, motivation, etc. I like spreading that idea, because skinny people can act superior and shame obese people for “failing”, and the data suggest that can be bullshit.
However, if you are pre-disposed according to the 25-30% mystery BMR to not have a fast enough metabolism to stay skinny in a culture that so cherishes it, then there is not necessarily much you can do about it other than just (a) eat less or (b) exercise more. Come up with smart 2 ideas, sure. But there is no escaping the reality of 1, and nature has put you at a X% disatvantage in the “staying skinny” dept. (Nature does the same to those with depression in the “staying happy” dept. or those with OCD in the “staying calm and avoiding obsessive thinking” dept. I know first hand.)
I don’t think low carb diets work for the pseudo-scientific reasons that propenents say they do. I think it is nothing more than calorie control.
Look at Atkins. Consider it in light of the average, carb-loaded American diet. If you quit carbs, you create a calorie deficit for very practical reasons. Pretending something mystical is taking place is silly and leads to bad ideas about the nature of weight loss.
I could say, “If you want to increase you chest strength, do 3 sets of bench press 3 times per week PLUS touch your nose 22 times while you are lying in bed waiting to fall asleep.”
If my audience was eager enough for increased chest strength and I presented myself as an expert, they’d follow my instructions, benching and nose-touching themselves to bigger, stronger chests. Likely, someone would branch off my successful work, claiming that 44 nose touches and 2X2 bench presses was a better method. Then 66 and 2X4. Or 51 and 5x1.
Soon a whole market of nose-touching techniques would be created… Books written, seminars seminared.
I sense this is something like what has happened with low-carb diets. It does work. But not for the stated reasons. Low fat diet was a simple heuristic that looked at which macro-nutrient source (fat) was most calorie dense and then demonized it. Low carb diet is a heuristic that identified the macro-nutrient source that made up the highest % of our caloirc intake and then demonized it.
Other diets, like the No-S diet, work for similar reasons. There are just simple #2 hacks that give easy to follow heuristics.
I feel Atkins and other diets are often presented as something more scientificky than that. I expected LWers to recognize the ruse. My views started to change when they seemed to sincerely believe in some stuff I thought was nonsense. I was deferring to higher intelligence as that usually works pretty well for me.
Then I dieted. And it worked exactly how the simple calorie math said it would work. I limited my carbs some. And my fats. I took multivitimans. Ate fruits and vegis. Drank plenty of water. I quit drinking alcohol/soda and eating fast food/dessert. It sucked for about 4-5 weeks. I “starved” a little and limited my ability to “think” a little, I suppose. But then you get used to the new lifestyle. Curb the calorie deficit a bit… then back to equilibrium once you are at your desired weight.
I know my single experience doesn’t prove anything for the general population. Maybe there are factors at play that I’m not accounting for? I herniated a cervical disc and haven’t been able to lift weight. I’ve lost a good amount of muscle I’d suspect. I took a lot of NSAIDS after my injury, maybe that factored in?
My sense, however, is that it is simpler than that. And some LWers were just overcomplicating a simple thing in such a way that I almost listend and missed out on what appears to be, at least in the short term, a positive outcome for me.
(Again, I’m aware some people have a MUCH more difficult time dieting due to factors they cannot control. I hate fat-shaming and I’m a huge advocate of destroying the smugness of skinny punks with hard science.)
I feel you’re underappreciating the changes ketosis forces upon your body. See, for example, this and this.
From the second article:
Do you have a guess as to what the overall effect ketosis has on weight loss? If I maximize the effect, what % can I increase the efficiency of my diet?
I don’t have proper data, just anecdata—suitable for WAGs (wild-ass guesses) but not much more.
What do you mean by that?
Besides, being in long-term ketosis tends to lead to many consequences unconnected with weight loss or gain. See e.g. here for some discussion. Anecdotally many people who’s been on VLC diets for a year or so tend to develop problems that go away when they add a bit of glucose (=carbs) to their intake.
*googles*
For the first couple seconds that sounded very silly to me, then I realized it’s pretty much the same as what I’m doing right now.
I did something of a similar simple nature a couple years back.
I removed soda, alcohol, fast food and anything resembling dessert for 1 year.
I also I added 1 liter of water, 1 raw fruit and 1 raw vegetable to my diet, following this very strictly. (I ate a lot of roma tomatos like apples over the sink late at night before bed to honor the diet...)
I wish I would have tracked my body fat% because I believe it was very effective… and relatively easy to keep the diet.
http://skepchick.org/2014/02/the-female-athlete-triad-not-as-fun-as-it-sounds/
Women trying to do the right thing by underfeeding themselves, and being more vulnerable to injury as a result.