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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.
I am not fat. Nearly everyone I know is not fat. None of us put much effort into being not fat, only the fat people struggle. OK, I go for a 20 minute walk most days. I do a few minutes of bodyweight exercise from time to time. I play Beat Saber sometimes (which is fun and energetic, still the best thing to do with a VR headset IMO). I don't think exercise has any effect on my weight, it's just for fitness. I used to do very little exercise and remained thin.
I live in Australia, which is not a terribly thin country. 31% compared to America's 42% obesity rate. There are loads of fat people around, most people live a pretty sedentary lifestyle with a heavy reliance on cars. I spend my day staring at a screen.
I'm convinced that I live the easy pre-1960s lifestyle where I can eat as much as I want to while staying thin. I just eat normal food that our ancestors would've recognized. Brown bread, rice, milk, fresh fruit, carrots, beans, potatoes, rice, beef, chicken, fish, yoghurt... Occasionally I have stuff like ice cream, fruit juice, potato chips, dates and chocolate. I'm not shopping at an organic farmer's market, just a normal supermarket. None of this requires much effort. It tastes fine and I still have sweet things occasionally. Yoghurt with berries in it is quite nice.
But I see what other people buy when they complain about inflation and I immediately think 'this is all processed, plastic crap, it's not really food and you shouldn't be buying it'. Consider shrinkflation: https://old.reddit.com/r/shrinkflation/ It's nearly all Toblerone, cookies, chocolatey cereal, brownies, doughnuts, pizza, pringles, soft drink, McDonalds... I bet that if your diet looks like that subreddit, you will struggle with your weight. They're not complaining about smaller loaves of bread, put it that way.
Food preparation is trivial, you just stick vegetables and meat on a pan and let it cook. Where I live full-cream milk is cheaper than Coca Cola, it's not like there's much price pressure. And food is an acquired taste, you can learn to eat anything. The artificially flavoured chips with all the spices and meat flavouring taste awful to me, I can't stand KFC. The Scots eat haggis, the Nords eat disgusting rotten fish, the Chinese eat anything that moves. The diet of our recent ancestors is not big culinary ask.
Both haggis and surströmming are perfectly fine, I even actively like the Swedish equivalent of haggis (Pölsa) and eat it regularly, and unlike haggis it includes the tendons. The issue with surströmming is the smell, not the taste, but unlike haggis this is more of a meme food anyway.
Our recent ancestors generally weren't that desperate or retarded. The food they made was and is pretty good.
People get freaked out by innards or whatever but it's perfectly fine food. People eat sausages just fine and thats made with intestines.
The 50s and 60s probably literally was a nadir of mass market food quality in the anglosphere for various reasons. Crack open a fifties cookbook sometime; it's often normal foods still eaten today but underseasoned and overcooked.
I agree that innards are perfectly fine(I'll happily leave nordic seafood to nordics) and moderners are squeamish. But there does seem to have legitimately been a generational loss of cooking skills in the anglosphere partially compensated for by eating garbage instead of fresh food. I'm reminded of France's consistently lower obesity rates- they still have a thing about eating fresh food.
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