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Scott's most recent post had someone linking to an article in the Atlantic about debunking a study, I went and read it and got sucked into the Atlantic rabbit hole.
Link one: Don't avoid romance says more people are single nowadays and unhappier nowadays because more people have avoidant attachment styles in the past, with some (mostly circumstantial) evidence that the amount of avoidant attachment is increasing. Ends with an exhortation to not be avoidant but doesn't examine the question I would have thought would be of interest, which is why more and more people don't have healthy attachment styles. (Aftereffects of higher divorce rate? Internet usage? Weaker community institutions? Microplastics? I'm just spitballing ideas but wouldn't a marked societal-leve change in people's psychology be something you'd want to investigate the causes of?)
Link two: The Ozempic Flip Flop as someone who gets full very quickly and doesn't have a very strong appetite, I've never really had good mental image of what it's like for normal people with normal appetites let alone obese people with obese appetites. This article in particular presents people who lost weight, noticed immediate massive benefits in their life they're desperate to keep, and yet still can't keep the weight from coming back. It is just the satiety setpoint being set so high it's torture for them to not eat to the point of overeating? I'm trying to match it to my own points of reference for "willpower" struggles but failing. I force myself to go to the gym despite not enjoying exercise, but that's forcing myself to do something, not forcing myself not to do something, so generally speaking once I overcome the activation barrier of inertia the hard part is over. I intermittently (deliberately, as opposed to non-deliberately) fast and can be hungry and craving food but to a pretty easily overcome extent. But what makes someone — who for months now has been eating much less — be unable to maintain the amount they've been eating for months but instead be compelled to keep eating more even though it's actively physically hurting them (and costing them in other ways, like socially). How much stronger incentive can you get? It makes me feel like at some level for some people food is an addictive substance like drugs. (And also still trying to understand how this gets spread — is it really hyperpalatable foods? Something else? We can watch countries become more obese... Whatever the underlying thing that makes someone susceptible to this is, it does appear to be something a country can acquire)
I've lost about 160 lbs on semaglutide and have been able to mostly maintain the lower weight for a number of reasons, but I can speak to the difficulty of "not doing something" and the different experience of the sensation hunger that I have now vs in the past.
Before describing my experiences with the sensation of hunger, I think its worth noting that I was relatively healthy and active as a child through my 20s and early 30s, so I always remembered what it felt like to not be fat and I think actually being healthy before I started gaining weight made it somewhat easier to ignore at first. I think people that are fat their entire lives have it harder. I began overeating after surviving cancer and the depression I experienced from the lifelong nerve damage I have now.
On the sensation of hunger and the specific wording I'm using "the sensation of hunger" and not simply the term hunger, this is part of the meditative practice that I think has allowed me to maintain the weight loss. In Buddhism we talk about dependent phenomena and conditional arising, and the fundamental emptiness of all such things. In this understanding, hunger is not an indication of needing to eat, or at all even related to the nutritional state of my organism, its a sensation like the temperature of the air, or ambient sounds. It never, ever, ever goes away. If I am awake, I am hungry. Starving. Even now that I'm "better", I'm hungry from the moment I awake until I return to sleep. No amount of eating of any type of food has any effect whatsoever on my sensation of hunger. In fact, eating generally makes me even hungrier, as well as exhausted. I could eat so much food that I had trouble walking, I would feel like I was on the verge of vomiting from how stuffed I was, and I was still starving. I think something like this drives the behaviors of many, if not all, obese people to some extent. I am fortunate that the same techniques I use to manage chronic pain work pretty well with chronic, inescapable hunger.
Until semaglutide. I knew once it started to work that there was probably always going to be an end date. The normal American medical system was a failure from the very beginning for me here, I've always had to obtain it on the 'gray' market so to speak. (Its actually much cheaper too, about 20% what my clinic's pharmacy would charge w/o insurance, which always refused to pay for it) So, while I still am able to maintain access to a "maintenance dose" now, I knew from the outset that I needed to use the possibly very limited time I had access to retrain my body and my mind to a new relationship with eating. I spend about 30-45 minutes per day meditating, and have for over 20 years now. One of these daily sessions is focused entirely on internalizing the fundamental emptiness of all phenomena, but specifically the sensation of hunger, to mentally sever the relationship between feeling the sensation of hunger and the arising desire to eat. Its now simply another flavor of physical pain. Its been largely successful; I've been able to sign a peace treaty, so to speak, with hunger. I do not attempt to fight it, or suppress it, but simply experience and observe the sensation without it conditioning my behavior. Without the previous experience with meditation for coping with chronic pain I don't think I could have done this. Using meditation to "short circuit" the connection between physical pain and mental suffering was much more difficult than addressing hunger, though the two are similar in many ways, the primary similarity for me being the absolute unavoidability of both. The pain my body produces is just as omnipresent as the hunger, and is likewise a false signal. The depression that I used to feel from chronic pain contributed to my overeating. In a way both of these issues had to be processed together to address either of them individually.
The second set of changes: I had to train my body to accept, and then expect, a completely different relationship with eating. I had to build enduring lifestyle habits that were unique to my situation. I mentioned earlier that actually eating offers no relief to the sensation of hunger and usually just makes it more severe. For me what worked is not eating at all, most of the time. Three meals a day, or even two, is entirely unworkable. Given the very low number of calories I can consume before I start to gain weight again, three meals would all have to be the size of snacks for most people. As I was able to cope with the hunger with the medication, I began to reduce my calorie intake, settling at what my doctor said it appropriate for a 6'3'' man, about 2400cal per day. This is way too much. I'm not sure exactly how people's metabolisms differ, and how much being sedentary due to my disability contributes, but at 2400 calories a day my weight will stabilize at about 330lbs. Even 2000 only gets me to about 290-300lbs. So I stopped counting daily calories for the most part and now account per weekly intake: 8000-9000 calories per week stabilizes my weight at about 235lbs. This generally takes the form of one 1000-1500 calorie meal per day in the evening with one 0 calorie day per week. I buy food once per week based on these limits. If I somehow eat everything before its time to shop again I'm looking at more than one 0 calorie day. I have to eat in the evening as it exhausts me and causes varying levels of brain fog eventually driving me to bed. After about 2 years of this my body is acclimated and I will actually become nauseous if I eat more, though I'm still starving the entire time I'm nauseous. It never goes away.
I think the people that gain the weight right back are largely letting the medication "do all the work" as it were. So, at least while they are on it they have the metabolism and habits of a normal person. Sort of. I suppose its possible to stay on it for life if the supply and price gouging issues can be resolved, but right now most people can't or don't. If you don't use the opportunity provided by the medication to reestablish a new relationship with eating and retrain your body and mind then its likely to only be temporary. In a way I'm fortunate to have already had the toolbox for dealing with chronic pain.
My experience in weight loss is quite different from yours, but this portion sort of speaks to me. I became fat as a child and was obese in my low-20s (around 31 BMI) before dieting down to normal weight levels over the course of about a year (around 22 BMI) and have maintained it for a couple decades now. Before I started dieting in my low 20s, I felt like a slave to my hunger, completely helpless but to eat until I was sated. Then when I started following CICO, I realized that hunger was just a sensation that I could choose to follow or not.
I think that one insight was the one key to helping me to lose weight after I'd failed so much in my teenage/low-20s years. Instead of focusing on strategies to keep me from being hungry, it was just learning to see hunger as just a sensation that can be ignored. I wish there was a way to transfer this to people who constantly complain about how being hungry makes them unfocused, angry, distracted, etc. but it seems to me that, sadly, not everyone is capable of this.
How does it work elsewhere in the world - say Japan, Korea, or Vietnam?
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