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I recently (and by recently, I mean two weeks ago) started water fasting, and to displace the constant feelings of food cravings I started watching food-related videos, most notably: TLC's 600lb Life. It is extraordinarily trashy TV, but illuminating.
Before I describe the negative observations, here's the positive ones: A) All of the successful patients had a good attitude to begin with (they wanted to lose the weight, and were willing to commit) B) They followed the doctor's instructions (important.) C) They had friends and family who were supportive and were generally affable individuals to begin with (likeable!)
As a representative slice of the people who get really, really fat, they're about 5% of the population. The rest that follows is the generalizations of everyone else.
Now. For the hot takes:
THE OBESE ARE IGNORANT
Do you remember the much-maligned food pyramid from your health classes, the one that put way too many grain carbs at the bottom? At the very least, it puts vegetables on the second tier, and fast food at the very tippy top. And these people don't even know that. The very concept of CICO they stubbornly defy. They don't seem to know anything about basic nutrition that even a kid would know. And it's not like they're getting fat off good cuisine, either. (A fat gourmand with a diverse palette would be, at the very least, a good friend to have to ask for recommendations.) They're just eating fast-food slop paid by their welfare checks. And speaking of...
THE OBESE ARE ENTITLED
There is a certain childlike narcissism that accompanies each and every one of these patients, that demands the world bend around them: that they should be fed, bathed, and cared after without giving anything back in return. They frequently manipulate their family members and spouses to look after them, hand and foot, even their children. They're rude and throw tantrums, and their ignorance only strengthens their stubbornness. (They even disagree with their own doctor, a man they're self-selected to seek out!) They continue their bad eating habits - even in the hospital itself! - and have food snuck in for them to eat. This inevitably leads to...
THE OBESE ARE STUPID
In wrestling, where the tiers are segmented by weight class, in order to hit the weight limits, athletes often go to extraordinarily lengths to temporarily lose 5-10 pounds before weigh-in to get as much of an advantage as they can. In the show, in order to qualify for bariatric surgery, patients need to lose a certain amount of weight so that it is safe for them to go into surgery. Now, admittedly, going to 1200 calorie diet when you're used to 10k+ is pretty hard, but even going to 5,000 - twice the amount of a healthy adult - would guarantee weight loss without significant dietary changes, other than portions.
Do they do this? Of course not.
In fact, I'm pretty sure they don't even weigh themselves beforehand. It's always a surprise and a shock when - surprise of surprises - that eating the same amount as you did before would maintain it. (In fact, some of them even gained weight.) The tantrums, the lies, the threats - all are laid bare before the uncaring measure of the livestock scale.
Of course they don't get the surgery. And they're always left wondering why, the poor buggers.
So, in conclusion, I have come into belief that you should judge people for being obese. Not to say that all fat people are ignorant, entitled, and stupid. But they definitely have at least one of these traits, and should be avoided at all costs.
I think a lot of what you’re seeing— at least the parts that aren’t exaggerated for TV — are evidence of food addiction. Sugar, simple carbs, fat, and salt trigger the reward centers of your brain. And if you do so often enough, you’ll become at least mildly addicted. And the stuff they’re doing absolutely looks like any other addiction— lying, denial, manipulation. This can happen with things like screens, obviously drugs, alcohol. They don’t think they’re doing it too much, they’re in control, and they want other people to help them.
This is something I think needs to be addressed in general. I’m not convinced people are aware just how psychologically addicted you can get to food. And like any other addiction, if you’re not dealing both with the addiction and the psychological symptoms that got you addicted in the first place, it’s almost impossible to sustain the diet and lifestyle changes that you are making. You don’t get to 600 lbs and a cattle scale by having a normal relationship with food. I’d be surprised if there’s no underlying trauma that they’re treating with the dopamine rush that their food is providing.
Food addiction is very real.
I've gone cold turkey on things before. Alcohol, sex, masturbation, porn, internet, reddit, video games, etc. Of all of them going cold turkey on sugar was the absolute hardest thing I've ever done. And unlike quitting most of those things it remains difficult to continue.
I found with most addictions there there is a one to two week hump where your brain is resetting and still craving the thing you want. If you can make it through that one to two week hump you are usually fine. With sugar that hump was more like a month. Probably because my body can still produce it from other things I'm eating, so unless you are literally starving to death for two weeks you can't go full cold turkey on sugar.
The other unique difficulty I've had is what I call "food depression". Its usually when I start getting a little bit hungry, but not hungry enough to desire any of the foods I'm supposed to eat. Or it happens when I'm shopping and go down an isle with a bunch of forbidden foods. I get overcome with an extreme sense of sadness and loss. I've been on the verge of tears.
I always have to just wait it out. Its either real hunger, and I'll be hungry enough in an hour to eat the healthy thing. Or its just a craving and it will go away and I won't be hungry in an hour.
One oddly helpful thing is having young children. I can usually see in real-time how much hunger and food impacts their moods, and its made me far more aware of my own hunger and mood connections. Especially when that connection is negative and harmful.
I want to preface this comment by saying that I think addiction/habituation mechanisms of sugar are still not all that well studied scientifically and that I don't think there is strong scientific evidence for almost any recommendation here. That is, unlike some of my other comments on the general topic area, which are strongly backed by large bodies of published research, this comment is indulging in some mere speculation.
One thing I tried long long ago, in a location far far away from where I currently live, was a weird recommendation that I saw on the internet before I really had any sense of any of the science in these worlds. A quick search doesn't show up any real science for it, only mostly returning results for one study that basically does nothing to actually support the hypothesis. Anyway, the idea was to have one small piece of chocolate basically immediately after you woke up in the morning. The idea was that your reward circuits aren't reared up to go nuts over sugar at that time, so it would be sort of 'training' your brain to think that sugar is less rewarding in general, which could reduce cravings later in the day. I did it, and it seemed to kinda help, but again, totally anecdote and no science. It could have even been somewhat harmful, but overtaken by other changes in my life at the time.
Another thing that I've heard from medical folks like Peter Attia, but haven't gone to look if there is any good science, is to pay attention to the time concentration of consumption. That is, you can down a glass of orange juice or sugary beverage super quickly, and that gives a massively concentrated rush in a way that doesn't happen by, say, getting about the same amount of sugar in the time that it takes to eat that sugar in apple form. (He actually talked about having a continuous glucose monitor and spoke about different foods causing different kinds of spikes; I recall him saying that basically the biggest, quickest spike he ever saw was something like raisins that were coated in some yogurt or candy or something that he had on an airplane.) After getting married, the wife is a big fan of fruits, and I definitely eat more of them now than I used to. Still not a lot, and I definitely can't binge on fruit the way I used to binge on various sugary products wayyyy back in the day. There is some intuitive plausibility to something like this if you think about comparisons to nicotine. There seems to be pretty significant differences in addictiveness of nicotine rushes from smoking/vaping compared to slower delivery mechanisms like gums/lozenges/patches. Again, I haven't taken the time to see if there is any not-bad science here.
I will also note that I don't remember the timeline of how long I had cravings after I got 'off sugar'. But now that most of it comes from fruits or the occasional single piece of chocolate after dinner, I absolutely notice a difference if I go to an event and have basically a 'whole dessert'. I'll likely have some minor cravings the next day, but they go away pretty quickly.
That blood sugar level spike is the glycemic index. I believe most people would benefit by eating more foods that are lower glycemic index. Which approximates to the obvious advice of avoiding simple carbs, but with some counterintuitive foods that are surprisingly high or low. Sweet fruits that don't spike your blood sugar that much, etc.
That blood sugar spike and following crash is not good for our moods or satiation. And also makes your body release lots of insulin.
And I hope this is real rather than yet another fake understanding of nutrition from the raggedy and untrustworthy discipline of nutrition science.
There was a flurry of activity trying to make glycemic index do a bunch of things. I don't recall much conclusive coming out of it. For particular questions of addiction/rewards pathways, I don't think the work really got very far out of the stage of some basic theoretical mechanism conjectures. I also haven't followed up enough to see if any of them were busted by empirics.
FWIW, when I lost my weight, many years ago, I did so by following the "GI Diet" which basically recommends you eat mostly low-GI foods. The theory being that it would reduce sugar spikes and regulate your metabolism. Of course it also just happens to mean you are eating mostly lower carb and low sugar foods, and to some degree I suspect any reasonably healthy diet combined with exercise will work.
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