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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?
Exercise may be simple, but it is not easy. It cannot be easy, because the way it works is by being hard. If your exercise is easy, it's probably not burning significant calories.
This isn't true at all and is one of the mistakes people make that damages their long-term fitness improvements. Zone 2 aerobic exercise is definitionally easy. I can burn 700 calories/hour running at a pace that feels almost artificially easy and having a conversation. People that focus more on cycling tend to go even easier. If most of your aerobic activity feels hard, you're either out of shape or doing it wrong.
Getting started on exercise is difficult, maintaining it isn't.
Think of the fattest person you know. Burning 700 calories an hour by running certainly isn’t going to be easy for them.
Oh, I'm well aware of that. The point I'm addressing is the claim that exercise "cannot be easy, because the way it works is by being hard", which is just not even close to true. Aerobic fitness is developed primarily from easy efforts, not pain tolerance.
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