This is a very interesting and well-written article. The subject of particular importance to me for a couple reasons.
One is professional. I ran an obesity treatment clinic for several years but it's a clinically important area of practice that fascinated me as far back as undergraduate years. The article correctly states that treatment for obesity is largely unsuccessful, the tools and methods have barely made a dent in terms of solutions.
Surgical procedures for obesity are crude measures to be sure, very frequently associated with severe nutritional deficiencies that are hard to manage. IMO at best surgery is a desperate "last straw" means to stave off fatal outcome, worthy in that sense, but hardly a prescription for the 99% of the population who are not in that condition.
Fact is there's no medical problem more complex than obesity. Hundreds of genetic factors are connected to the many metabolic, endocrine, and immune system alterations from normal found in the obese. There are profound correlations with behavioral disorders and metabolic abnormalities associated with obesity.
An issue in the research that I'll need to learn more about is whether obese patients actually have excess aprosin. The woman who is the subject of the article is deficient, but that doesn't necessarily mean that blocking the hormone will have a favorable effect in obesity. Also, it's apparent the hormone has multiple effects, antagonizing the hormone effect could well cause undesirable outcomes.
I can easily empathize with the woman's plight. While I'm not suffering anything like the devastating condition portrayed, I've always been on the underweight end of the scale. Even as I go forward into my "mature" years, this characteristic hasn't changed. Tall and very thin body build isn't optimal for health and social reasons, then again people say I look good for my age, so it's not the same set of problems as the article describes.
The lesson I take from the article and real-world observations is the incredibly vast range of individual variability among humans, not that we'd have any doubt about it based on even casual observation. But it's a reality we have to constantly remind ourselves about. Our preference of putting things into categories blinds us to the limits of categorizing. Truth is on close examination humans will inevitably fall between the cracks wherever we put the categorical boundaries.
"Anorexia nervosa (AN) is a serious eating disorder characterized by restriction of energy intake relative to requirements, resulting in abnormally low body weight. It has a lifetime prevalence of approximately 1%, disproportionately affects females(1,2), and has no well replicated evidence of effective pharmacological or psychological treatments despite high morbidity and mortality(2). Twin studies support a genetic basis for the observed aggregation of AN in families(3), with heritability estimates of 48%-74%(4). Although initial genome-wide association studies (GWASs) were underpowered(5,6), evidence suggested that signals for AN would be detected with increased power(5). We present a GWAS of 3,495 AN cases and 10,982 controls with one genome-wide significant locus (index variant rs4622308, p=4.3x10-9) in a region (chr12:56,372,585-56,482,185) which includes six genes. The SNP-chip heritability (h_SNP^2) of AN from these data is 0.20 (SE=0.02), suggesting that a substantial fraction of the twin-based heritability stems from common genetic variation. Using these GWAS results, we also find significant positive genetic correlations with schizophrenia, neuroticism, educational attainment, and HDL cholesterol, and significant negative genetic correlations with body mass, insulin, glucose, and lipid phenotypes. Our results support the reconceptualization of AN as a disorder with both psychiatric and metabolic components."
(Of course, you don't need any GWAS hits to do research on the genetics of anorexia nervosa or to look for https://en.wikipedia.org/wiki/Genetic_correlation with other traits, since that can be done with polygenic scores sans any hits or with twin/family studies, but it does help motivate research.)
Here's an idea: a site for people with unusual genes, good or bad. They can describe why they're unusual, and in some cases get asked for more details or even for a DNA sample. All voluntary of course. Forums for people with similar conditions, questions about long term affects or attempted remedies. Feed the data to an AI. Maybe monetize with subscriptions to medical researchers.
Who cares? It would still advance DNA research by identifying the prevalence of false positives.
Incidentally I'm really sick of comments like yours dismissing other people on the sole basis that they're especially interesting to themselves. For all you know that might be indicative of some subtle mental illness. If you can't comment without denigrating other people then maybe you're the one with the problem.
Fwiw, i know what you mean about the typical "HN Comments", but i do think you're being a bit harsh on him/her.
I think their comment/concern is valid, and a meaningful point of discussion. It's not overly critical, and there is no tone. Likewise, yours feels (to me) to have far more of a tone, seemingly directed at (but not soley caused by) ZeroFries.
Anyway, i can tell you're frustrated at "HN Comments".. so, i just ask that you try to be constructive in these types of replies, or you only contribute to the problem.
"Hypochondriac" and "special snowflake" are both heavily judgmental and dismissive terms, at least in my experience. Assuming the comment was expressing genuine concern with no malice, less judgmental language would have been useful.
Your comment seems more denigrating than mine, ironically. How would bad data advance DNA research? Im saying hypochondriacs are not what you'd want when trying to collect accurate medical data. How is this denigrating to those who are interested in themselves?
Wouldn't the principle of charity assume that the creators of such a site put some effort in to filtering the data (at either input or output time or both) to make it manageable? If someone posts an idea here is it necessary for them to add a bunch of caveats so we know they've already thought of the obvious things and have answers?
I don't work there, but I know someone who just left our (EHR) company to join. They're not on the genetic scale (that I know of), but I think it's a great idea to allow opt-in for patients that are curious about potential trials.
No. 23andme.com only provides SNP information on the most common few hundred thousand variants (mine has ~600k called), typically those which are present in >=1% of the population. With these sorts of mutations with serious fatal effects, the mutations are, for obvious reasons, present in <<1% of the population. So 23andMe is very uninformative about rare mutations like in OP. (23andMe does provide an exome sequencing service, which might cover OP's mutation, but it would still miss many other problems, and due to its high price of ~$900, has never been popular - at that price point, you might as well get a whole-genome.)
I started looking into it but I was busy with something else at the time.
I had talked to the mods of /r/nootropics and also the owners of a few domestic suppliers/storefronts and they were definitely very interested. I mean, it is clear that if we are as a community serious about self-experimentation, we have to find a way to consolidate the results of our individual n=1 studies.
I feel like this is a submarine for gastric bypass surgery. I've noticed that in the UK there seems to be a lot more push for these through documentaries (US has them too).
I was able to lose a lot of weight on a whole foods plant based diet. Its a permanent change. With the SAD diet being the dominant form of nutrition - very few people can maintain a healthy weight (25%).
> For instance, the contestants on the “Biggest Loser” TV show became paragons of self-control; some shed more than 100 pounds, something very few of us could ever achieve. And yet a recent study showed that even these incredibly disciplined dieters gained all the weight back.
This study has now become quite famous but it should be noted that the participants where given no help after the show and not surprisingly went back to their old habits.
> “Unfortunately, many contestants are unable to find or afford adequate ongoing support with exercise doctors, psychologists, sleep specialists, and trainers — and that’s something we all need to work hard to change,” -- from http://mobile.nytimes.com/2016/05/02/health/biggest-loser-we...
One participant did manage to keep most of the weight off but only through persistence.
I feel for those with real genetic disorders but for most of us we can lose weight and keep it off. New York Times articles which tell us that it's not our fault, that it's genetics, leptin, metabolism, aging, etc. are exceedingly popular but for most of the population these are just excuses.
Here us how you do it. Drop your daily calories to a very low but still safe level (1500 or less) by counting and writing down the calories of everything you eat. Do this for at least two months. Then start an exercise cycle where you do an hour of highly strenuous cardio at least five days a week. Continue for at least two months. Then go back to dieting. Repeat until you hit your goal weight. Then you can relax until your weight creeps up 10-15 lbs at which point you start the cycle again. This is what it takes for an average person in our modern society to stay healthy.
If this seems extreme consider that for thousands of years most of our ancestors endured much more physical exertion on a regular basis and on less calories. We live in a world of excess which is in itself a sufficient explanation for our obesity problem. Excluding of course those few people who actually suffer from weight related diseases.
> New York Times articles which tell us that it's not our fault, that it's genetics, leptin, metabolism, aging, etc. are exceedingly popular but for most of the population these are just excuses.
The science explains why some people have to work so hard to be thin, while others like myself can eat whatever I want whenever I want and still remain rail-thin.
If I can eat 3k calories a day and be skinny, while someone else needs to drop to 1500 calories to not be fat, it seems the height of unfairness to blame that person for being in that situation.
> "I feel for those with real genetic disorders but for most of us we can lose weight and keep it off. New York Times articles which tell us that it's not our fault, that it's genetics, leptin, metabolism, aging, etc. are exceedingly popular but for most of the population these are just excuses."
Exactly. Don't worry: you're obese, but it's not your fault! Here's a cookie.
Gee, I wonder why the nytimes would publish such "comforting" articles.
I (40s male 5'8") was always normal weight although these days I'd be called thin but in the 1970s and 1980s I was typical for my age and gender.
Within the last 5 years I started to gain weight even though I wasn't eating more I just thought it was age. I track what I eat it's a habit of going to the gym for 20+ years. Even though I slacked off the gym for about five years I was active in the summer.
To make a long story short it was my thyroid failing. I'm not the typical person who has thyroid problems it's usually middle-aged women. That alone is probably why it took so long to spot the problem.
Now on 0.075mg of Synthroid my weight is slowly falling, and yes this still is without any changes to my daily diet.
I feel like I have been reborn and all kinds of weird things have stopped; foggy brain, dry skin, weight gain, dozens of other small things.
While having strong self control is of course important, there are differences between individuals that you're not considering. Many of the people who give this self-control argument have never had theirs tested - it is hard to not eat a lot when you are acutely hungry and eating doesn't stop that, for example.
Also note that your statement doesn't really work in the general case. I have friends who are extremely skinny (to the point that it distresses them) who are trying to get bigger. It doesn't matter how many thousands of calories they eat, how excellent their nutrition is, they struggle to gain anything - and that is someone who naturally only wants to eat ~1500 calories per day. Is it lack of self-control that they don't spend every waking moment stuffing in high-calorie food despite not being hungry?
Have these friends of yours tried talking to e.g. a powerlifting or bodybuilding coach? It's pretty easy to get on a structured low-effort diet to gain weight, and muscle mass with some exercise thrown in.
Getting above 1500 calories isn't some desperate effort of "spend[ing] every waking moment stuffing in high-calorie food". It's a couple of protein shakes a day that take you a couple of minutes to prepare & slurp down.
Eating enough can be a very difficult logistical problem, but not at the 1500 calorie level, but at something like a >5000 calorie level where you're a professional strongman or powerlifter, or someone like Michael Phelps eating 8000 calories a day.
He was drinking lots of protein shakes... It wasn't that he was maxing out at 1500, it is that he didn't seem to want much more than that. With the amount of protein shakes and other things he was eating, anyone else would have gained fat at the very least. He lifted, too, but he wasn't that dedicated, so idk.
Sounds like your friend went through a half-assed ad-hoc diet & exercise program, which unsurprisingly didn't yield results.
Extracting any useful data from "I have friends who..." is impossible. People are notoriously bad at self-evaluating things like their food intake or exercise regiment, and on top of that they're prone to present themselves in a good light.
You'll find few people who'll say "Yeah I could have lost/gained weight, but I lack the dedication and impulse control to manage my diet & exercise", even though that may be the description that best explains the situation.
Absolute, categorical, sweeping, prescriptive assertions like this demand backing citations.
If you had used qualifiers like "...for obesity in most/some/plurality of people...", then you probably wouldn't be getting down voted, but just the ketogenic diet's impact alone for many people is sufficient to disprove your assertion that it is only about self-control. In those cases, it was incredibly poor information distributed by the US food and medical industries about the food pyramid that led to continual failure to control weight for many people who found the weight melting off when they tried a ketogenic approach, or simply started to eat fats again instead of assiduously avoiding it. And before you dismiss ketogenic's thesis that low carb high fat works, Sweden's medical establishment found the evidence compelling enough [1].
This doesn't even get into what we're seeing with some fecal transplants, or many other matters we are just beginning to explore about human metabolism. Once within "normal" BMI or body fat percentage, then yes, self-control, portion control, etc. are necessary when on a cut, for example. But for obese and morbidly obese people, not all of them categorically are in their situation due to lack of self-control. I might concede perhaps many of them are, but categorical assertions like yours are uncharitable to the researchers who are pushing the boundaries of our understanding of our own metabolisms, and I would rather our species explain by real science what happens around us rather than prescribing moral allegations as "just so" explanations of our world.
Shouldn't you have to disprove the obvious explanation (that it's calories consumed that leads to obesity) before we should jump on board with wilder theories?
I read the link you posted about the keto diet, and it seems to all be about how it's better for you with regards to cholesterol and glucose levels. It doesn't seem to negate the idea that weight is still simply related to calories consumed.
(I recognise there are exceptions, i.e. thyroid/hormonal problems).
That's like saying good, on-budget software projects are simply related to number of lines of source code per day. Obviously, you won't get anywhere on zero lines per day for months on end with a 12-month project. Not as obviously, you and I know there are far more other factors to consider than this layman's level metric.
We're at that layman's understanding stage with our grasp of human metabolism. Counter-intuitively, Jason Fung among others have discovered that steady caloric restriction has worse body fat loss long-term outcomes than zero-calorie straight fasting over a span of time of >24-48+ hours, even if the net calorie loss between the two methods is exactly the same.
We don't really know at the molecular biology level why that happens. We have some good hypotheses and experimental evidence about which hormones are involved in this counter-intuitive result. Even weirder: when you break the fast, if you break it by going onto a low-carb, high-fat diet, your odds of consistently keeping the weight loss off go up. Again, we don't really know why at the nuts and bolts molecular biology level.
There are even claims by people on low-carb high-fat diets that they eat more than their computed TDEE as tracked by something like MyFitnessPal's nutritional database, and yet they're still losing weight. I've noticed this tends to be reported more by people who are quite obese; I've yet to see someone who claims this who is in the normal BMI range. I haven't seen any double-blind studies attempting to verify this yet; would be nice if MFP could crunch numbers to share.
At a very, very gross global population level, you are absolutely right that it is CICO (calories in, calories out). Digging deeper though, there is a lot we simply don't know enough about. For very obese people, other hypotheses and mechanisms seem to be helping at least a good number of them to the point where the /r/keto board is quite popular, and just repeating CICO in the face of this empirical evidence doesn't advance human knowledge. We should be saying instead, "hm, that's not what I expected, why is that?"
Your "solution" would solve virtually all the worlds problems... addictions, crime, depression etc. That we still have such problems is evidence that "taking more personal responsibility" this is a deficienct prescription.
It's fine that you want to place the blame on someone, but self-control as advice is an ineffective policy prescription, it's more akin to the strategy that religion promoted. Shaming people to get them to alter their behavior often times has the reverse effect, it worsens their addiction.
This is illogical. There are at least two possible explanations for your evidence. These are: One, that as you say, taking more personal responsibility is ineffective. Two, that taking personal responsibility is effective but modern society is failing to do so. Which of these is correct is up for debate but it's hardly a foregone conclusion.
> Two, that taking personal responsibility is effective but modern society is failing to do so. Which of these is correct is up for debate but it's hardly a foregone conclusion.
(1) That these have been problems plaguing mankind since the creation of society and (2) that this solution has been promulgated since ancient times (through various bibles for one) contradicts your above statement. If you preach and scream about personal responsibility and nothing changes, it has failed as a policy no matter who you want to place the blame on.
If a policy is never widely adopted, despite promotion by activists, it is the activists who have failed, not the policy.
I am not sure whether encouraging more personal 'responsibility' or ownership would help with these issues, but it seems like western societies have been decreasing their support of these ideas since the 60s.
In the future if you think something is a fix, imagine doing it to one group of people, and not doing it to another. If this doesn't make any sense, it's not an intervention or a fix.
Oops, not so fast, there is growing evidence that food addiction is equivalent to opioid addiction which requires a rather large effort and support team to help anyone to "get off the drug".
Some studies have shown addiction to sugar, fat, and overeating. Addiction at both the chemical and also mental level.
You may say that getting off drugs is also a self control issue, but that is a little bit of an over simplification.
A small bit of googling found these results and there seemed to be a lot of results on this topic.
-----
According to researchers from Queensland University of Technology (QUT), excessive sugar consumption increases the dopamine levels in a similar way to other drugs such as cocaine.
The evidence supports the hypothesis that under certain circumstances rats can become sugar dependent. This may translate to some human conditions as suggested by the literature on eating disorders and obesity.
We propose that specific foods, especially those that are rich in fat and/or sugar, are capable of promoting “addiction”-like behavior and neuronal change under certain conditions.
Such consummatory patterns have been associated with increased risk for comorbid conditions such as obesity, early weight gain, depression, anxiety, and substance abuse as well as with relapse and treatment challenges. The topic of food addiction bears study, therefore, to develop fresh approaches to clinical intervention and to advance our understanding of basic mechanisms involved in loss of control.
The YFAS
exhibited adequate internal reliability, and showed good convergent validity with measures of similar
constructs and good discriminant validity relative to related but dissimilar constructs. Additionally, the
YFAS predicted binge-eating behavior above and beyond existing measures of eating pathology, demonstrating incremental validity. The YFAS is a sound tool for identifying eating patterns that are similar to behaviors seen in classic areas of addiction. Further evaluation of the scale is needed, especially due to a low response rate of 24.5% and a non-clinical sample, but confirmation of the reliability and
validity of the scale has the potential to facilitate empirical research on the concept of ‘‘food addiction’’
One is professional. I ran an obesity treatment clinic for several years but it's a clinically important area of practice that fascinated me as far back as undergraduate years. The article correctly states that treatment for obesity is largely unsuccessful, the tools and methods have barely made a dent in terms of solutions.
Surgical procedures for obesity are crude measures to be sure, very frequently associated with severe nutritional deficiencies that are hard to manage. IMO at best surgery is a desperate "last straw" means to stave off fatal outcome, worthy in that sense, but hardly a prescription for the 99% of the population who are not in that condition.
Fact is there's no medical problem more complex than obesity. Hundreds of genetic factors are connected to the many metabolic, endocrine, and immune system alterations from normal found in the obese. There are profound correlations with behavioral disorders and metabolic abnormalities associated with obesity.
An issue in the research that I'll need to learn more about is whether obese patients actually have excess aprosin. The woman who is the subject of the article is deficient, but that doesn't necessarily mean that blocking the hormone will have a favorable effect in obesity. Also, it's apparent the hormone has multiple effects, antagonizing the hormone effect could well cause undesirable outcomes.
I can easily empathize with the woman's plight. While I'm not suffering anything like the devastating condition portrayed, I've always been on the underweight end of the scale. Even as I go forward into my "mature" years, this characteristic hasn't changed. Tall and very thin body build isn't optimal for health and social reasons, then again people say I look good for my age, so it's not the same set of problems as the article describes.
The lesson I take from the article and real-world observations is the incredibly vast range of individual variability among humans, not that we'd have any doubt about it based on even casual observation. But it's a reality we have to constantly remind ourselves about. Our preference of putting things into categories blinds us to the limits of categorizing. Truth is on close examination humans will inevitably fall between the cracks wherever we put the categorical boundaries.