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Wellness Wednesday for March 8, 2023

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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I have to say, it's incredible how well semaglutide is working for me. Literally the only effect I notice is a massive decrease in general hunger and a massive increase in how full I feel after every meal, with no side-effects that I can notice. No more desire to go buy chocolate bars each time I pass by a convenience store. No more finishing a 12 incher from subway and still looking for stuff to eat. No more going to sleep hungry. The other day at subway I finished half of my sandwich and was absolutely amazed to find out that I didn't especially want to eat the second half. To be clear, I still get hungry, it's just that my hunger levels now automatically lead to me eating 2000 calories per day, instead of my old 3500.

I'm simultaneously amazed that I finally found the solution that I've been looking for, and angry at the prevalent "willpower hypothesis of weight loss" that I've been exposed to my whole life. I spent a decade trying to diet with difficulty set on nightmare mode, and now that my hunger signalling seems to have been reset to normal levels, I realise just how trivial it is to be skinny for people with normal hunger levels. All the people who teased me in high school didn't somehow have more willpower than me, they were fucking playing on easy mode!

Glad it's working for you! Honesty, that sounds amazing.

I've become a convert to "set point theory" of hunger and, with a convert's fervor, I now view the opposite view as imbecilic and harmful. Almost no one can sustain weight loss for long periods of time via calorie counting and exercise. The fact that so many people believe otherwise is troubling. How long can a society be so obviously wrong and double down on failure? At least several decades, apparently.

In good news, we finally have something which actually works. As this becomes widespread, I expect obesity to peak soon and then decline - similar to the decline in HIV deaths starting in the 1990s. Life expectancy will increase as well.

As for myself, since I'm only about 20 pounds over my ideal weight, I'll hold off for a few years just in case there are unknown risks.

My guess is that people believe that diet can work both in the short and long term because they see it all the time, because I do. There are people for whom it doesn't work, for some reason, but that doesn't mean it doesn't work.

I also believe that in version of set point theory but in my version that set point is possible to affect for the vast majority through persistent weight change.

I'm excited about the new medications though.

Dieting works in the short term. It almost never works in the long term. There are numerous studies which demonstrate this.

To steelman the status quo, there wasn't (until semaglutide) anything that reliably worked. Diet and exercise aren't bad things, and even short term weight loss might have positive benefits. Similarly it's very rare for alcoholics to quit over long periods of time. It doesn't mean that they shouldn't at least try.

If we just ignore the large and unsolved issue of selection bias in weight loss studies we can still observe that some 20% sustain weight loss long term.

Similarly, for people with so severe alcoholism that they seek treatment the people that stay sober long term seem to be a bit more than 1/3.

Neither of these qualify as "almost never" in my mind.

I have a hard time believing that diet efficacy is much greater than zero given that a large percentage of people diet and obesity is only increasing. Is it possible for dieting to have negative efficacy? Perhaps.

Speaking of selection bias, choosing people who have already lost large amounts of weight selects for people who have HUGE amounts of self-control and probably wealth and free time as well. If, even among this august group, only 20% maintain the weight loss that's pretty damning.

I'm not sure where you are getting your alcohol stats, but the number I remember is 8% of AA users successfully quit. And indeed my memory is correct according to this source:

https://www.npr.org/2014/03/23/291405829/with-sobering-science-doctor-debunks-12-step-recovery

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent.

Fortunately, the Sinclair Method exists and seems much more promising. Are there other treatment options that work? Maybe. But I wouldn't trust the stats produced by these groups given the they would be so self-interested.

I have a hard time believing that diet efficacy is much greater than zero given that a large percentage of people diet and obesity is only increasing. Is it possible for dieting to have negative efficacy? Perhaps.

It might be the case that the obesity rates would be increasing even faster if people weren't dieting. In this scenario whatever bad stuff is causing obesity is steadily increasing with time, and dieting is working against the bad stuff, just not fast enough.