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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.
Never underestimate the power of self-willed delusions.
My brother and I have to deal with our mother effectively killing herself by her lack of exercise. She developed a bloodclot from sitting still too much, and has refused to change her activity level, in addition to her near morbid-obesity. We have begged, pleaded, harassed, done meal prep, purchased equipment - nothing. Meal prep was a special kind of clusterfuck, as it merely resulted in her consuming the prepared meal shakes in addition to her normal food intake.
And yet, despite all this, she still claims she's more than capable of helping out outside with yard chores(she isn't). Commentary on her health and various drugs she's taking will have her brush it off, commenting on how many of her sisters were long-lived. Same with my advise that she needs better self-scheduling and to manage her food intake better(3 meals instead of 2).
All ignored.
The only time, the only time when she lost weight was when her and my father were on strict dietary regime due to his health(and hers).
That's what it takes - someone riding her near 24/7 with shame in order to actually eat properly.
That isn't to say that she hasn't tried to loose weight. Sugar-free snacks, drinks, meal shakes(as mentioned) - all of them treated like magic totems and talismans and potions that if she consumes this, she'll loose weight as if by magic while not altering her diet in the slightest.
I don't know if there's an official term for this. I like to think of it as 'Magic wand' thinking. That somewhere, somehow, something is out there that fixes everything - a magic wand, a golden ticket, that one thing that does it all without them having to expend one iota of effort, one dram of pain.
Mind, there's an aspect of culture, as well. I wonder how my mother would react if America was more like Asia in this regard - that, when getting fat, would have people actually tell her she's getting fucking fat - and, when reaching out to the wider culture as a whole to affirm her delusions, would instead be met with a cacophony of 'You're fat. Loose some fucking weight, fatty.'
Still. Her latest magic potion is ozempic. So, we'll see how that goes.
As for me, well, I've already learned my lesson long ago. And I get re-affirmation of the value of consistent exercise watching my friends barely a year or two older than I am - helping them with projects, seeing their stamina flag and suffering from minor ailments and injuries that I don't have to deal with - yeah, I'll stop exercising when I'm dead, thank you very much, and I intend for that to be a very, very long day off in the future.
(Also, don't think being educated doesn't mean you're immune to self-delusion. I have a friend of mine who's a lawyer, who doesn't believe in CICO dieting. He tends to bluescreen when I tell him how much I lost just by doing that alone.)
Now, as far as dieting goes - y'know what, I've ranted enough. Needless to say, 90% of the people who've I've seen try to diet start off on the entirely wrong foot to only have it crash and burn two weeks later.
I haven't gotten into the ozempic discussion so I don't know if other people have been talking about this, but isn't this going to make people consume 2000 calories of the same corn-syrup-on-soy-flakes diet they were already on?
I worry we're going to have a lot of malnourished people who maintain a BMI of 20 on nothing but Snickers bars and potato chips because their entire appetite regulation system is being overridden.
This is what I was trying to put my finger on. Thank you.
Ozempic etc don't reduce complexity in the system. We're already dealing with complex interactions between the human endocrine, neurological, and gastrointestinal systems and I think we're prematurely celebrating by myopically focusing on the success of appetite suppression. But how does that reverberate through the entire system? People eating fewer calories but also eating lower quality calories? Inconsistent eating timing? Maybe the secondary effects are benign (I'd like that!).
I would imagine the trade off is still worth it. Billions of East Asian peasants lived off almost nothing but rice for thousands of years. They weren’t at optimal health, but they managed.
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