Maggie's Farm

Weight loss. I thought the MD's article good, especially in that he acknowledged that there is not a one-size fits all. But giving any credence to Taubes at this point is not warranted. His ideas were plausible; they have not proved out. One key point is that there is some thumb on the scale, some X-factor, which is changing the weight gain equation increasingly since about 1980. Yes, it is calories-in, calories-burned, but there is something that is screwing up the communication between brain and body on caloric needs. For losing weight, you are stuck with the old formulas. You have to reduce calories, and secondarily, increase burning them. It sucks, but it has been the only thing that works until recently. It may not be your fault how you got there, but you had (have?) only one reality to get out. The new medications seem to correct the signalling. That is huge. You are now not fighting your own brain and body in the battle. They aren't quite yet on your side, but these medications make them at least neutrals, noncombatants.

BTW, I had a PCP who just lovedintense exercise and had ever since she was a X-country runner in school. She waxed rhapsodic about how great it felt to work out really hard. No, there's a Gaussian distribution for that feeling, repeatedly demonstrated for fifty years. She thought everyone could be like that if they just tried. It's not true, it's pure self-congratulation, and she should just stop it. No patient needs that level of arrogance in their life as a supposed "help." Do not listen to these people. Their love for themselves creates hatred for you.

With a first concerted effort to lose weight many people can lose about 10%. With much more effort you might make it to 20%, but frankly, the people who reach that seldom maintain it. If we can just up that 10% to 20% consistently and sustainably with medication, that is tremendous.

Note: When people brag on their weight loss, they are often including some temporary increase because of injury or other special circumstance that pushed their weight up 10 lbs that made them finally decide to diet. But those 10 lbs were likely coming off without effort anyway because of reversion to set point. When you get really strict about definition, losing and sustaining for five years more than a 10% loss from set point is rare. If meds can improve on that even slightly it is wonderful.