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Getting close to a year ago, I talked about GOLO, a weight loss program that I heard about from an ad in a podcast I was listening to. I found it oddly satisfying, because they were trying to launder the standard science on CICO through explicit anti-CICO messaging; truly a beauty of capitalism. Their biggest tag line for what they think is going wrong with a lot of people was insulin resistance. Whelp, while I was at the gym this morning, what popped up in my podcast list? A two hour long Peter Attia podcast specifically on insulin resistance with MD/PhD Gerald Shulman, an academic researcher on the topic.
They talked about the prevalence of insulin resistance in the population. No, it is not obscure. Obesity basically causes it directly, and yeah, the population obesity numbers are high. They also talked about diabetes, both Type I and Type II, as well as some studies on healthy, lean young adults who had two parents with Type II diabetes and who displayed insulin resistance (i.e., at high risk of developing Type II diabetes). But yeah, lots of people do have insulin resistance, so things like GOLO are at least capturing a slice of reality, even though it's clear that they're not really specially targeting insulin resistant individuals. They're not testing people for insulin resistance and then tailoring their program accordingly; they're again just laundering the standard advice and giving it to all comers, whether they're actually insulin resistant or not.
They talked a lot about molecular mechanisms, evolutionary explanations, etc., in great gory detail, far more than I could do justice trying to reproduce here. I'll hopefully suffice by describing one concept; they distinguish between insulin resistance in muscle versus what happens in the liver down the chain (which can cause fatty liver disease, which is now working its way up to being one of the leading causes of death or other conditions that cause death). Apparently, many folks develop muscle insulin resistance, so glucose is not able to be deposited in muscle as glycogen, so it ends up in the liver, and all sorts of problems follow.
What can we do about this? "Exercise reverses this muscle insulin resistance ... exercise in muscle actually will prevent fatty liver and liver insulin resistance". [EDIT:
They talked about a couple different studies, butUpon further review in the comments below; I think this part was just one study. They did talk about other studies generally, but I had interpreted this section as referring to two different studies, but now I think it refers to just one] remember that population of otherwise healthy, lean, young adults with parents who have Type II diabetes? They had them do a singleboutsession of exercise (45min3 sets of 15min at 65% VO2Max), and that was sufficient to open up the necessary translocation pathway, resulting in "more glucose deposition as muscle glycogen and significant reductions in [something too technical for me to try to explain in this comment] and significant reductions in liver triglyceride."What about beyond that population, thinking about just other obese people? "What can we do about this? If we can get our patients to lose weight; this of course is the best. Diet and exercise of course is the best thing, and that's the first thing I tell my patients. We really drill into them how we can really fix everything that's wrong with them through this process. [Emphasis added; italics felt true to the audio; bold is my own focus]"
We know a lot about how this works. We know how to fix it. Exercise still is the single most effective medical intervention we know of. If exercise were a pill being prescribed, it would be hands down the most effective thing for all-cause mortality. Paired with diet, it's basically a superpower against a vast swath of modern maladies. Doctors know this, they know how it works and why, they've known this for a long time now, and they'll say it in public. Some, like this guy, will even say it so bluntly to patients. But many doctors know that patients don't want to hear it. They don't want to hear the science; they don't want to "follow the science" (i.e., actually do the thing). He also mentions that even though they try to drill this into patients, many of them still just don't do it. Patients get annoyed with doctors telling them the truth, and this results in a lot of doctors giving up and not even telling them anymore. Just avoid the topic. I had one obese friend tell me that she practically begged her doctor for advice with her weight, and he said, "You know, you're just getting older..."
You don't have to believe the GOLOs of the world. You don't have to believe the sign on the gym swearing that they'll help you lose 20lbs in 30 days. They're grifting, and they're helping to confuse many many people about how their bodies work. But the evidence is pretty solid that basically whatever the excuse is, in this case insulin resistance, the most well-documented and scientifically-supported solution is still diet and exercise.
If “just exercise” were useful advice then there would be no fat people, as everyone has learned how important exercise is in school, universally every human has exercised before, and exercise has never been so easy — you can turn on a guided video with music to do calisthenics in approximately 8 seconds. Half of our military servicemen are obese, people who have gone the gauntlet of an exercise bootcamp, and three fourths of our veterans are obese. Fat people read “go to the gym” on every trending video of a fat person. So whatever the solution to obesity, it is absolutely not telling fat people to exercise, which has been conclusively disproven through the largescale population experiment colloquially known as “Reality” over the past two decades.
And if willing oneself to exercise were possible, then willing oneself to fast should be significantly easier than that, because the latter is willing oneself to omit an action and the former is willing oneself to engage in complex motor behaviors. If these humans can’t fast, these humans can’t will themselves to run fast either.
Obese Americans by the age of 35 have likely seen the horrors of obesity inflicted on their relatives. If this were a simple knowledge-motivational issue (“I do not want to become The Whale”) then obesity should be solved by seeing your parent suffocate from their own fat when they got COVID. But this doesn’t seem to be how it works at all. It seems to be something either beyond willpower altogether, or something so intrinsic to willpower that it requires a deliberate longterm regimen of enhancing willpower before tackling exercise. Why is it that fat people are so resilient to exercising? This is a more serious question. Clearly it is displeasing to them especially. Is that because of the microbiome? Is the longterm effect of pollution? Is it because of a insufficiency in the cognitive practice of willpower?
This is like saying "If 'just stop doing drugs' were useful advice, there would be no drug addicts." Just stop doing drugs is the correct answer. That doesn't mean it's easy, or that a drug addict can "just" choose to do that without great effort and support.
It's 100% true that "Just exercise (and improve your diet)" is the correct answer. It's also 100% true that this is actually very hard and most people don't do it, because exercise is uncomfortable and boring and we live in a world of superstimuli and abundant high-calorie, low quality foods.
No, it's not as simple as "fat people lack willpower." Just like it's not as simple as "alcoholics lack willpower." This is literally true, but most people lack the willpower to overcome something like an addiction or the incredible pull of comfortable, sedentary living and infinite snacks over deprivation and effort.
Maybe we might find something biological that makes some people more successful at dieting and exercise than others, and maybe some people do have metabolic conditions that make them more prone to obesity. But ultimately, the answer is that what they need to do is actually very simple but very difficult, hence most people don't.
This is the view that I disagree with. It strikes me as a just so story. If you succeed in exercising, you were able to do the very hard thing because of your implied moral superiority; if you weren’t, you had to try harder, but you could have. The problem with this kind of thinking is manifold. Trump and Elon Musk are extremely goal-driven people (I am choosing them because they are household names). Why are they both fat? Marines went through boot camp. Why can’t they exercise for something more valuable than that? Normally people want to impress others and secure mates and enjoy life. So why can’t they exercise when this enables that? A 30yo fat person may see their obese parents die a slow agonizing death. What human would experience that and not be motivated to avert that state?
It’s very easy to just morally impugn fat people — it’s hard, it’s uncomfortable, you could do it but you don’t want to. The problem is that there is no evidence for this assumed phenomenon. Where is the study showing that fat people don’t wish to be healthier more than those who do exercise? Fat people probably want to exercise even more than those who do exercise. But clearly there is something in the way: more pain when exercising (?); a microbiome which especially wants to be sedentary (?); an extreme deficit in willpower as it relates to physical exertion which requires a dedicated program…
But maybe I’m misunderstanding what you are saying. “ultimately, the answer is that what they need to do is actually very simple but very difficult, hence most people don't”, this to me implies a universality in how difficult exercise is, but I seriously doubt that’s the case.
The wrinkle here is that every person who exercises has the experience of using their willpower to overcome the impulse to be sedentary. I get what you're saying, but when I look back on me thinking to myself "it seems like a lot nicer to just sit on the couch than go to the gym, but i gotta go" or "yeah i'm exhausted, but I'm going to do one more set" what I see is me making the hard decision to overcome those sedentary instincts. In every way, it looks like I used to my willpower to dictate my own behavior, and every time I fail at doing so, it looks like a failure of will to me. I personally don't see any reason to think it isn't exactly as it appears to me.
It reminds a lot of CICO discussions: it is obviously true that if you eat less calories than you burn, you will lose weight. There are all kinds of additional layers of complication and justification and difficulty and most of all copes on top of that, but the fundamental facts are simple.
It's the same with willpower and exercise: it is obviously true that whether or not you exercise depends on whether or not you do it (tautological, obviously), and doing it is a matter of applied will against pressures to the contrary. Whether or not you overcome those pressures by force of will does, in fact, determine whether or not you exercise. So while yes, there are lots of different complications and justifications and difficulties and most of all copes on top of that, they're all really just inputs to the equation [willpower]-[forces against]=[do you work out].
When you say that there isn't a universality in how difficult exercise is, what you're saying is that [forces against] has a different value for different people. Obviously that is true. Some people find exercise easy, some people find it difficult, some people have physical ailments that make it painful to exercise, etc etc. It is obviously also true that some people have significantly greater willpower than others. But that doesn't change the fundamental question, which is "is [willpower]>[forces against]".
And in the end, what the inputs are to the equation doesn't matter, what matters is whether or not you can get over the threshold and exercise. Does this have lots of potentially nasty implications about some people getting a shit deal in life because they're mentally weak, or physically afflicted, or even just born lazy? Yep. Not only are there health implications, but like you said, there are massive moral implications to whether or not you are able to overcome your own weakness and destructive instincts. Nobody's burden is the same, life's not fair, sucks to suck.
It does in the sense that I am alleging “forces against” are of exclusive importance and “willpower” is of negligible importance (on a population scale). We can measure the former but I don’t know any attempt to measure the latter. Do we see that fat people with similar intelligences and backgrounds perform worse on typical willpower tasks? I don’t recall reading this. It would be a big finding if so.
If willpower can be summed up as anything which is in our control, frankly it’s the felt salience of death and the patient hope in deliverance from that death. That’s the experience of the morbidly obese, though. Every trip to doctor is memento mori along with a hopeful plan and a page about resources to help them. So… what exactly are we talking about when we talk about willpower, if it doesn’t spring out of such experiences? At this point we are now talking about such an internal source of willpower that the most serious real life experiences don’t result in it, I do feel we are just impugning the souls of these people at this point. Like: no brush with death can save them, no hopeful lecture can save them, no inspiring figure can save tnem — they are damned. I am not comfortable saying that. Are we saying that these morbidly obese people have never cried tears of desire for salvation and at the worst case scenario attempted to kill themselves out of shame? How is that not a “highly motivated” state of willpower?
Meanwhile in my own personal experiences, here I am with the willpower of a sloth, but I have never been overweight — my body wants to fidget and pace frequently. It is non-volitional. After making my parent comment I went and got a burger and fries after fasting in the morning because I wasn’t hungry. Willpower doesn’t factor in at all here, just “forces out of my control”. What caused my body to like movement and not like eating frequently? An early life experience, something in my microbiome, genes? It’s definitely not willpower.
Tritely: that doesn't make it untrue.
I don't need a scientific study to prove that fat people tend to perform worse on typical willpower tasks like "don't eat a second piece of pie, even though you want to and you know it will be bad for you."
The reason that advice at a population scale tends to be different from personal advice is that the majority of people are, as you put it, damned. "No brush with death can save them, no hopeful lecture can save them, no inspiring figure can save them." When you give advice to an individual, you give them the benefit of the doubt that they don't suck. When you deal with populations, the unavoidable fact is that enough people obviously suck enough that you can't give them the benefit of the doubt (plus there's no politeness or interpersonal charity to consider). The stats don't lie. They are weak, they are lazy, they have high time preference, they are stupid, and they are never not going to be any of those things. I think this is a major failure point of most high functioning people: they don't grok how low-functioning most people are.
It is probably simply true that there is a ceiling for [willpower] for many people that is less than [forces against]. Just like how someone might be condemned by being 80 IQ to a life of poverty, never working anything but the most menial and low paying jobs, one might be condemned to a life of fatness, never being able to control their own eating due to a weak will. To quote George Carlin: "The mayfly only lives one day, and some days it rains." Most people get dealt a bad hand, and as I said before, it sucks to suck.
That being said, I think there is some hope, and that hope is (ironically?) shame. "the felt salience of death and the patient hope in deliverance from that death" are clearly insufficient motivating factors to get people to not be fat. I respond to that by pointing out the truism that many people fear public speaking more than death. I believe that people (at a population level, ha) tend to respond to their incentives. Clearly death and disfigurement and the quiet shame of fatness is an insufficient incentive. However, I notice that countries that have a strong culture of overt shame around fatness like China or Japan tend to be significantly less overweight statistically than countries that don't, like the US. I think that for most, the incentive of overt social shaming is actually a stronger incentive than death, and that therefore perhaps the best way to incentivize people to be a healthy weight is to shame them for being fat.
Both you and /u/Gaashk brought up in your replies the example of people who are just "naturally" skinny without any willpower. I don't think that invalidates my model, I think those people, including yourself, just happened to be born with/live with factors that lead to an extremely low value of [forces against] or a very high level of [willpower] such that it doesn't feel like willpower. That could be because of a low lipostat "body set weight", or natural hyperactivity, or a default low level of hunger, or any number of factors. Your coefficients are different, but that doesn't change the equation.
Of course, it's then very possible that their failure is wanting it more, not resisting it less.
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If someone has capable willpower in many areas of life but still finds himself fat then we should consider whether being fat is mostly unrelated to willpower. They have excellent willpower in many domains but not in this one. So either we are now alleging domain-specific willpower, or the concept of willpower is nonsensical altogether. If there is domain-specific willpower regarding exercise, why are former military service members fat? If there is domain-specific willpower regarding dieting, then why is it that the 30-day yearly Ramadan fast does not result in sustained weight loss?
So neither intensive physical regimens nor intensive fasting regimens affect weight loss in large scale populations. We are left with motivation, but as I’ve written, it doesn’t appear that there is any experience an obese human can have that will reliably result in weight loss, given just how many bad experiences they have. Now you note —
but fat people are already shamed explicitly and implicitly. They are shamed more today implicitly than in the past, with social media giving them a peer ranking of their popularity and male interest where it is plainly obvious that their weight is a deciding factor. If you are fat in school you will get comments. Re: China, China’s obesity is increasing. But Chinese Americans also have genetically lower obesity rates.
Well it’s very important to determine whether obesity is a generally volitional health state before we launch our campaign to shame half the population. That’s why this topic is important actually. If the willpower theory is unevidenced then we want to focus our efforts somewhere else — not on hating fat people but perhaps hating the ultrawealthy who sell poison in stores. Perhaps it is the department of education for making schools too sedentary. Perhaps it is neighborhood designers. Perhaps it is feminism. Perhaps these are damned and the fats are the victims?
Apart from microbiome, some other hypotheses I wonder about are —
Poor or insufficient breastfeeding, already associated with obesity
accidentally reinforcement of food at an early age through conversation, snacking, social / comfort associations
the de-reinforcement of physical activity due to a loss in communal dancing, physical play in kids, and destinations which can only be reached by long walks
A divine curse placed on our stock because of the way we treat livestock, taking the form of metabolic and DNA changes we aren’t familiar with yet
Are you alleging that sustained work on any goal is equally easy as any other goal for every single person?
Based on my experience I am much better at being focused on some tasks, much worse on some other and my willpower as far as not eating myself to death seems to be a bit above average.
There is also no experience that will reliably make people honest, reliable, punctual, less rude, not wasting their life on computer games etc.
Nevertheless, keeping asshole tendencies in church and not being habitually late is partially function of willpower.
Keeping yourself away from drugs and slot machines is also function of willpower, complete destruction of regulation here for some people does not change it is function of willpower.
People are complicated, influencing them reliably is hard. It is hardly novel.
And yes, consistently eating less will make you less fat.
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I think that generally speaking, this person does not exist. Everyone I know who is fat is also weak-willed in other domains of their life.
Incentives are certainly an input to [willpower], hence the section about shaming as societal intervention. The veteran was skinny in the military because there are strong incentives that helped increase his [willpower], the muslim is able to abstain from eating during ramadan for the same reason. You might think of it as [incentives]+[mental strength]=[willpower]. As circumstances change and they leave the military, or ramadan ends, or society starts shaming them less for being fat, the magnitude [incentive] reduces enough that they can't make it over the threshold and overcome [forces against].
No, there are plenty of obese people who become fit. I think if you ask them, they will pretty much universally describe it as requiring an intense exertion of willpower to achieve. And I would be willing to bet that very many obese people would be able to lose weight if they were given sufficient incentive. Take an extreme example: if every time they ate a meal greater than 500 calories they were shocked with a cattle prod, it seems obvious that most people would choose eating smaller meals and being hungry over being zapped and they would lose weight.
it does not seem to me to be a coincidence that the reduction in explicit shaming has coincided with an increase in BMIs. Clearly implicit shaming results in a lower [incentive] than explicit shaming. Hence my argument that we re-implement more explicit shaming. I do want to note that you don't have to hate someone to shame them for something, and that shame can be a strong pro-social force (that's why it exists). "Love the sinner, hate the sin" and all that.
To put it plainly, it is incredibly obviously a volitional health state. It's obviously a choice whether or not to go back for a second portion, it's obviously a choice to exercise or not. The only out here is some form of argument against free will, but people who argue the choice to eat the whole pie isn't actually a choice never live the rest of their lives like they don't have free will. It's pure cope.
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Why? Some people want some things more than they want other things.
Because temporarily restricting your caloric intake does not permanently change your weight. This is well known. Everyone knows a fat person who dieted for a month and lost 20 pounds. What happens when they go back to eating the way they were before? They regain the weight. Permanent weight loss requires permanently changing your CICO equation.
Believing that people have agency and that losing weight is mostly a matter of finding the will to do it does not require hating fat people. Sure, a lot of people do hate fat people, and justify it with variations on "They could just put the fork down," but you can recognize that losing weight is very hard without either shaming those who fail or inventing ways in which fat manifests out of the aether.
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