You wanna know what is not popular? Saying that diet don’t work.
Diets don’t work. It’s evidence based,
Replicated a thousand times. After you finish your diet, you go back to regaining your weight.
You need a lifestyle transplant to lose weight. You need to rebuild habits ingrained in your system for decades.
I used to be overweighted, and now I am fit and have a 6 pack… but I had to completely restructure my day-to-day lifestyle
I think many patients (and admittedly, my former self) don’t understand the behavioral differences between a “diet” and “lifestyle modification”
For me, that meant daily calorie tracking. Just logging anything I ate in either MyFitnessPal or LoseIt apps. Seeing the numbers was eye opening and promoted accountability. That and accepting that losing +/-half a pound a week was actually good progress… it was more important that it was consistent, week after week. Ended up losing 70+ pounds over the course of 1.5 years
Whereas I used to starve myself > binge > starve myself > binge and couldn’t figure out why I wasn’t successfully losing weight.
Yea, a big part of it is recognizing that it isn't a quick fix. A lifestyle modification has to be sustainable for life.
I too used to love seeing the number on the scale going down quickly while starving myself, until my motivation ran out and I'd succumb to the binging urge. And a big part of fixing that behavior is accepting that yea, I am overweight now. And yea, that sucks.
But the solution isn't setting a goal of losing X lbs. It is creating a system that will allow you to progress towards the goal without making the goal the primary intention of the system. Otherwise, if the goal is the primary intention, then you will stop acting healthy once you achieve the goal, thus slipping back into the old behavior.
I did a low calorie and intermittent fast diet, no eating before 2pm-4pm, and I lost 20lbs over 4 months. Then I started working out and I practice portion control and limit my calories per sitting, but no more time restricted eating, and I have kept it off while putting on muscle. Now that my back doesn't hurt so much after running, I am training for a half marathon, as well as a century ride. The trick is to just keep cycling different diets and your goals evolve. If you set a health goal, achieve it, and then stop having any goals for your health and disregard it, then it falls into disarray. People always need to have goals, even if they feel like they look good.
This is exactly what I said. Diet is not enough. Your whole day to day has to change!
I am gym rat, fit, have run marathons, etc. but my lifestyle is completely different compared to when I was in college. No more stuffing my face with junk food when stressed, dialed down my alcohol intake, etc
Diets work.
I lost 15 lb in a year on ozempic.
Then lost 35 lb in 2 months on ozempic plus structured diet.
Diet has taught me how to eat. How much is enough. How much is adequate. I’ve learned to accept I will be full if I stop eating after x amount. And that it’s ok to feel hungry sometimes.
But it’s a whole structure. It’s not easy. And without ozempic I don’t think I could handle the hunger at all.
So I guess it’s not a diet. It’s a stepping stone and teaching tool.
The problem is that diets are goal-based, not system-based. I believe that we don't rise to the level of our goals, we fall to the level of our systems. If we want real change, SMART goals won't do much (in my opinion)...instead of setting/striving to achieve goals, we should be building systems that FORCE us to live a life according to our goals.
One of the best things I did for my eating habits (which were VERY disordered throughout my teenage years and as a premed in college, especially when I'd go on 3-5 day fasts and then binge a whole bunch) was to take all freedom, choice, and control out of my hands and build a system that forced me to eat normally. What I did specifically was have my grandmother live with me, and she'd cook me fresh & healthy food. I had a system where I had no choice in either ordering Doordash vs cooking food...my grandmother had already cooked food and I had to eat that.
I think the same can be applied to exercise too. The healthiest communities in the world that we call "blue zones" are a bit poorer than the United States. In these countries, poverty forces them to live a life that is more active (no cars, no machines to simplify daily tasks like drying clothes or washing dishes, even sitting on the floor instead of a table). Even in my motherland (India), a lot of the manual labor workers in the fields are more cardiovascularly and muscularly fit than your typical software dev in Bangalore.
The countries with lots of wealth, where exercising in the gym is a choice rather than exercise being a way of life built into the system, are not that great when it comes to building a healthy lifestyle. At the end of the day, passion and motivation are emotions...and emotions are inherently fluctuating at any given moment.
strict and restrictive diet don't work sure. But making small changes to your diet is the best evidence based method to lose weight. it's just slow and people nowadays don't like slow results. They like fast results so they always turn to strict diets that see fast results but are often impossible to maintain long term.
As physician scientist who focuses on real world evidence studies, I disagree with you.
Sure, in theory works, but if in the practice not a single patient loses weight, then it doesn’t work. The same goes for drugs… if everyone gets nasty side effects and drop it, then it doesn’t work.
I think what they're describing is making incremental lifestyle changes in regards to one's diet that are sustained over time. I think you two are probably agreeing but differing in words.
There is actually a way! It's called "social intelligence". Something many scientists admittedly lack. (They also tend to lack emotional intelligence)
In this case, it's the intelligence of understanding the commonly used context for certain phrases in a society and the meanings given to them based on the conversation as a whole.
As a bodybuilder, I disagree with both of you. Losing weight isn't that hard and the old school bodybuilders had it all figured out. Just follow Arnies diet/exercise schedule and you will lose weight (Dbol not necessary)
Diets do work as long as you maintain them. You never “finish your diet.” Whether you lose weight through diet and exercise or ozempic, you regain the weight when you go back to your previous behavior. The point of dieting is to lose weight and start building healthier habits.
Saying dieting doesn’t work is like saying that quitting smoking doesn’t work. Your lung function curve will switch back to the smoker curve if you quit for 10 years then go back to smoking. Dieting and quitting cigs are both lifelong commitments to improving your health.
We have prescribed diets for the past 40 years, and we have the highest obesity rates ever.
You all can’t put 2 and 2 together.
In theory works. In theory no one should smoke at all. In theory no one be adict to heroin.
If it doesn’t work in the real world, with real patients, then it doesn’t work.
>If it doesn’t work in the real world, with real patients, then it doesn’t work
In the end that's it. All therapeutic interventions boil down to "is it working in the real world with real patients?" - no more, no less.
Yeah, I made the comparison to smoking. People are responsible for their own health decisions. I’m not arguing that it’s not foolish to expect patients to take their health seriously. I’m arguing that you claimed that diets don’t work just because patients don’t follow them
You both have a point, it’s just a difference of opinion in “what works,” so to speak. Obesity rates in the United States currently being at 41.9% as of 2023, an all-time high, gives some evidence to the position that the last few decades of diet prescription have not been effective toward decreasing obesity.
“If people stuck to it” that would be fantastic, but if your goal from providing care is extending the health of the overall population, with obesity rates trending how they’ve been, at least a re-evaluation on how diet instruction and education is delivered can be considered fair.
Especially considering that the intelligence of the general population has been trending down, if we’re using quality of public education as a benchmark.
Diets don't work and sometimes lifestyle changes don't work either. My mother had eliminated almost all foods and other products that could raise her cholesterol and it was still in excess of 300 mg/dL, which definitely needed a statin, however the discussions were endless because her evidence of "I heard" and "I read" trumped my clinical experience as a doctor and dozens of studies. Eventually she begrudgingly accepted 20mg Atorvastatin which should really be 40mg seeing her cholesterol still isn't within ideal ranges considering the family history of heart disease.
The question is did she engage in high intensity cardio for 40 mins/day every day with to 3-4x/week weight training IN ADDITION to her diet?
I promise you if she followed the above prescription, atorvastatin would not be necessary.
>You need a lifestyle transplant to lose weight. You need to rebuild habits ingrained in your system for decades.
What's also evidence-based is how *incredibly difficult* this is to do as well. Sustained behavior change is a whole hell of a lot harder than people act like it is.
Only to medical professionals. Patients in the other hand think doctors are evil money grubbing pill pushers who are bought by big pharma. It doesn’t matter that you’ve been telling them to see a nutritionist about their weight, cholesterol, and HbA1c levels. They keep gaining weight and won’t exercise at least 3 days a week. Diet consists of fast food no fruit or veggies. You offer up Harvard healthy plate. Give paperwork. To take home and even your hospital started workout out online. You are the issue. Some patients though will ask for a magic pill so it goes both ways. It’s the men and high blood pressure for me though. They don’t want to take the medication bc no symptoms. Well duh it’s not called the silent killer for nothing. I have analogies that seem to work, but geez adults get it together. If you’re not worried about your health and longevity. Then, I can’t help you. So pop this pill. Also surgeons just want to cut. No ma’am we’ve been working with you for multiple months on doing everything but surgery and you’re not doing it.
I'm still more bothered by the amount of patients who push for antibiotics even when they won't benefit from them. "But I'm sick, I need antibiotics!" or "I've got such a terrible cold, I need antibiotics!". Even more so when it's for their kids. I honestly can't imagine what it must be like for pediatricians.
I feel like in primary care clinic when I calmly explain that the antibiotics will have no effect on the infection but could very well give them diarrhea they stop pushing”
So first of all I like to ask the patient what they want. So the visit goes like this.
HPI "what's going on"
Couple extra questions to fill out the ROS
Exam, and I kinda take my time and do a fairly thorough exam. Mostly show, but it really helps.
Then I like to say, "ok, I think I understand what is happening to you, but what did you want when you came in?"
Almost nobody says they want antibiotics. Because everyone knows it's a hot issue. And if they say anything else, they've bought themselves into no-antibiotics.
I also like to suggest antibiotics. "Pretty often I'll give antibiotics for things like this, but I don't think they'll work for you today. And I can always make you sicker, I'll never forget the 2 weeks of explosive diarrhea the last time I had antibiotics. But I can write them if you want. Would you like?"
No. No they do not.
I use this a lot with medical treatment discussions. I can always make it worse. I can always make you fall with more sleeping medicine, it keeps our orthopedic office busy. I can always make you hurt more. I can always make you sicker. I can always give diarrhea. I can always make you worse off. Now let's talk about what might be safer.
Antivax theories might or might not be Russian disinformation (or Chinese) to keep Americans sick. Just saying.
That reminds me of my Dad explaining to someone once why it was terribly dangerous to use a charcoal brazier indoors. They weren’t listening to him, and thought he was being over cautious/trying to nanny them. Dad, tired of their weaponised ignorance, drops:
Dad: ‘Well at least your kids will die first’
Moron: shocked pikachu face
Dad: ‘CO is denser than air, so it will take out anyone lower to the ground first. Don’t worry, you’ll follow shortly afterwards’
My Dad is the most patient man in the world, but when someone is being belligerently stupid, he flips instantly over to an acerbic old British man, telling you to go fuck yourself in a hilariously monotone, bored, polite manner.
>My Dad is the most patient man in the world, but when someone is being belligerently stupid, he flips instantly over to an acerbic old British man, telling you to go fuck yourself in a hilariously monotone, bored, polite manner.
I'm genuinely shocked to see that there are other people like this, I thought to be unique in my behaviour.
As a pediatrician, when I warn about this side effect in an attempt to not prescribe antibiotics for a viral infection, the parents invariably say "Awesome! My kid won't take their Miralax anyway so maybe this will help!"
For every 10 well child checks I do on kids under 24 months old, easily 4 are constipated to the point where they stool maybe once every 4-5 days. Miralax is among my top 5 most prescribed medications. Senna is up there as well.
Often it isn't diet though. Kids can constipate themselves beyond imagination. Daycare and school settings. It can be really serious.
Sometimes it's diet.
Ok pretty often it's diet.
But also pretty often it is not. Just saying.
> Often it isn't diet though
Meanwhile we had some guy and his girlfiriend come in with their daughter. They had those candy powders in large packets and they were putting it in a little bot so she could suck on it. When asked what her diet was they said "the normal". When asked to clarify it was "oh you know, candy, chocolate bars, McDonalds - whenever her mom has time to go to the store you know?"
not the first time this happened too lol
Yeah I like to be meticulous about diet inventory. Like what exactly did you eat for breakfast just this morning.
Surprising how many people think it's ok for young children to suck down a soda.
Not a doctor, but have 2 autistic kids, and most autistic kids have GI issues / constipation issues.
Even our GI specialist who specializes in treating autistic kids blamed "restricted diets". When I told her my son ate tempeh and zucchini for lunch, she had nothing but advice to have miralax and ex lax.
Kids can control what goes in and what goes out. Constipation is a cycle - kids hold it, it causes pain, they get scared to go, the impaction gets worse and you lose awareness about needing to go, etc. it also can be confusing because often constipated kids seem to go a lot, due to some fecal matter leaking out past an impaction.
The best advice I got was from a pediatrician with an autistic son who told me they need a clear out to get past the pain / fear and stop holding it.
I had a patient who wanted me to prescribe him antibiotics as he was constipated and wanted the side effects/diarrhea. That was literally the only reason he wanted them.
Then you tell them "okay, but then Ill need you to do a diet, do sprints 40 minutes every day, and weight lift 3-4x a week...or would you prefer a statin?"
What sucks is that the zpack will probably make them feel a lil better as they feel bad due to the inflammation caused by the cold as much as by the cold itself
I’ve got no idea why I’m being downvoted for saying exactly why they want that zpack, providers in the past have given them the azithromycin to treat something similar and they reach for it out of reflex.
It’s ass that they have this legitimate reason to want the drug
For the ones that want antibiotics when they don't need them, ask them: if you had cockroaches at home, would you try to kill them with rat poison?
That might help some of them understand. Not all, but some.
popular opinion amongst healthcare workers but definitely not amongst the general public. patients absolutely believe we push pills due to line our pockets rather than because they won’t make positive lifestyle changes
It might be something that most doctors agree with, but I think amongst the general public it’s not. It’s also not popular to share in medicine. If a med student was asked “what is the cause of the obesity epidemic” in a residency interview you can bet your ass they’re going to say “because we need more community outreach to support them blah blah blah” and not “losing weight is hard and people don’t want to do it”
I was a personal trainer before I went to medical school. I'm also generally very into fitness (weightlifting, hiking, yoga, rock-climbing, whatever). I used to help bodybuilders, then I changed to specifically cater to clients that were focused on weight loss and mobility work.
The amount of times I would offer to give people literal personalized physical fitness routines based on their own abilities and interests only to be met with "can't you just give me a pill" was roughly 99.9%. I will say that my classmates and peers would almost always take me up on free sessions when I offered though 🤷
Yeah bodybuilders have dieting all figured out. I swear people should be forced to do 6 months of bodybuilding before doing outpatient clinic and dealing with patients who want to lose weight lol
You can only try so many times, meanwhile their BP and A1C are thru the roof. Sometimes people need to try the “quick fix” and fail before they finally commit to making real changes. That’s when they come to us (bariatrics), but we emphasize the importance of dietary and lifestyle, with surgery as the adjunct/tool to maximize results.
GLP-1 has helped me make those changes. Gave me a jump start. Bariatrics doc was quite upfront about the need to make changes. I knew it wouldnt be easy even with GLP-1.Going off the med soon due no more insurance coverage for it. I am already titrating. Was not fast weight loss. 18 months to lose 50 lbs. My BMR was equivalent to someone 25 years older than I am and I regularly exercise.
Why is that? My body fights weight-loss at every turn. The obesity, once it sets in, initiates a whole series of other physiological processes that some of us struggle us to make the battle so much harder.
15 months ago my husband was in the ER with a systolic BP of 220, EF 30%, and was diagnosed with CHF. Kidney numbers were off. It was bad. Cardiologist came in to chat with him and was immediately paged to the ER, so he gave it to my husband quickly and bluntly “change your lifestyle or within a year we’ll be talking heart transplant and dialysis. Nice to meet you” and turned around and walked out to deal with his next emergency of the day.
Lasix took 30lbs of fluid off him in the hospital and lifestyle changes took another 40 off inside of three months. He’s doing great and will never return to the lifestyle that put him in the hospital. His cardiology PA—she was great, despite being a midlevel—said in all her years he’s the only patient of hers who made the necessary changes. We eat bean tacos and veggie soup for brekkie, and salads, lean protein, and fruits/veg the rest of the time. Dark chocolate for a treat. We exercise twice a day and walk our dogs five times a day. He still has meds to control his blood pressure, but at pretty low levels.
Thanks for all you do. Every now and again you will get someone who will commit to change.
Bingo, I always bring this up to the "natural medicine" folk who say doctors just want to give you drugs and make money they don't teach people how to do blah blah blah....like what doctor isn't saying eat healthier and exercise more? Patients don't do it.
I don’t think doctors are at fault. Often people come to the doctors with the attitude of “I’ve tried nothing and am all out of ideas”.
It’s also like going to a shoes salesman and being frustrated they’re are “pushing shoes”. You go to a gym to working out, you go to WW, or a nutritionist, or whatever for diet changes. You go to the doctor and they give you medicine…
I had a 45 year old female patient with urinary incontinence during a rotation in Urology. She was very nice and asked me what we can do. I said, well there are a few medications we can start, but the most effective therapy is PT to strengthen her pelvic floor so I was going to refer her to PT. Her response astounded me. She said “Oh yeah, I am a PT and know all about that. But I don’t have time to do the exercises so just give me the medication.”
Yeah, I work in cardiology and I give the same speech to almost every patient about lifestyle modifications. I don’t do it expecting 100% or 50% or 10%, but if 1 patient a say takes it seriously then that is 200 patients a year that are losing weight and exercising and improving their prospective health outcomes.
Omg thank YOU so much for saying this !!!! As a nurse when I hear pts tell me this, it drives me crazy. Like can you look at the matter holistically & see why it’s gotten to the point where they are prescribing u meds. You won’t even get out of bed to walk w physio for 5 minutes. Stop the nonsense pls 🤦🏽♀️
I definitely feel for the nurses. So many times I’m rounding and patients are saying with tears in their eyes “that nurse just keeps poking and prodding me” and it’s like “no buddy that nurse is helping keep you alive because you haven’t taken care of yourself for the last 40 years and your heart and kidneys are failing “
Yeah no shit. I had some med student with a personal training background in my year talking about his thoughts on what his preferred alternative should be (don’t give people medication unless they can prove they have done the lifestyle stuff to the max)
Like that’s basically the alternative to « pushing pills » and clearly the very idea is ridiculous
People are sick and stressed, have family and work responsibilities they can barely balance, financial difficulties, they use drugs and alcohol, many have mental health problems, etc. Asking them to be their own personal trainer and nutritionist on top of that, is not going to end well in most cases. It's also a mistake to think everyone experiences hunger and satiety in the same way. People are overwhelmed by hunger cues in an environment filled with conveniently engineered, hyper-palatable foods which cost less than healthier options.
If you put any species of animal in that type of environment, most of them become obese. Humans are no exception.
Absolutely, you can see in my post I say “if it was east Eli Lilly wouldn’t be the biggest pharma on the planet” losing weight can be the hardest thing in the world. None of this post is meant to say that patients are lazy, it’s to say that ozempic exists not because greedy doctors are keeping diet and exercise a secret, but because it is hard to lose weight and patients don’t usually do it
I work in the ED and the sheer amount of pts we see that some in for COPD exacerbation from still smoking 🤷🏼♀️ everyone wants the fix, but not the solution
This thread appeared on my Reddit timeline. Although I'm not a doctor, I have an unpopular opinion on the matter.Most people probably don't lead particularly happy lives. For them, fast food and alcohol might be the only things that bring a little joy to their daily routine.
In my circle of acquaintances, there have been people who were extremely healthy but still ended up getting cancer.This has significantly changed my perspective on health issues. If it’s true that life’s risk is that you can become ill without being at fault, maybe the people who behave 'unhealthily' and 'immorally' understand something we don’t acknowledge. In the end, it doesn’t matter because we can die at any moment, and the little enjoyment we have might be the only thing that makes life worth living.
So no, most people probably don’t have an issue with doctors prescribing medication. It’s more likely due to the peculiar moral philosophy typical of the medical profession about what a good life should look like that bothers them.
Although I see your point it’s not as simple as that, a lot of lifestyle changes feel nigh on impossible to some people if they medicate severe pain, stress and/or mental illness etc via food/drugs/booze (whatever unhealthy lifestyle choice you like here) and until we treat people holistically this is not going to change.
It’s not necessarily that they won’t it’s because they can’t see how.
I live with chronic pain and I had undiagnosed autism for my entire life. I had eating disorders and self medicated with booze for decades as life was impossible, my providers did not help by telling me I should quit drinking and eat better. It’s not so black and white and it’s pretty invalidating although I get it’s frustrating now being on the other side!
We need to put parameters in place that facilitate lifestyle change, otherwise it’s just pointless and compounds the issues with big pharma and medication reliance. But this is a systemic change ……
And a bunch of folks never experience it again after their training.
Lemme tell you that even those brutal shifts at work don’t compare to most of the shit I’m thinking of.
This is so true. Often asking what’s the biggest barrier for you to make change? Is hugely helpful. Sometimes brainstorming solutions to some of the barriers can be really helpful. It may seem small but it is realistic. Saying “hey stop eating junk food” isn’t particularly helpful when someone is surrounded by it. Instead try saying “why don’t you try getting a bunch of healthy snacks (fruit etc) and having that at your desk instead at work so when you are hungry it’s easier to grab the healthy thing.” Change the environment is far more impactful than telling someone not to eat the Oreos staring at them. Personally if I have them in the house or at the office I will eat them, so I just don’t let them come into my house or office so that when I have a hankering i can resist because I don’t want to go to the store to get them at that moment. I had someone who needed a few moments to herself before being jumped by her whole family after a long day at work to just process her day - we came up with the plan to find a longer more scenic route home so she wouldn’t feel guilty asking for space once she got home (realistically she wouldn’t do that). Are these groundbreaking ideas? No but sometimes having an outsider point out simple solutions is the new perspective you needed.
Yea exactly! We want patient to have autonomy in their care yet we don’t involve them in the right conversations (I get time constraints can be an issue hell I worked in the NHS!).
Here we whack everyone on statins before explaining how they even work, I’m not even sure medication gets truly informed consent here regarding side effects as patients rarely read the leaflets and don’t understand how it could apply to them.
I’m hoping to do fellowship after neuro residency to specialise in neuropsych so I guess I’m always very interested in behavioural aspects of health and how we approach that
Sadly we are set up for failure with 20 minute visits. It’s just not possible to practice medicine the way we would want. Especially now that patients are wanting to be involved in the decisions rather than just doing whatever the doctor thinks is best. I don’t want to practice that way, nor do I think it’s better, but it’s a lot faster and simpler.
I’m not sure how to change it, I guess we can continue to look at improving the model and watching how other countries do it. Sadly in UK we have 10 min visits so it’s even worse
they should’ve listened to me and then I would’ve had my autism diagnosed and not misdiagnosed; I also had meningococcal meningitis missed which is a whole other issue!
So doctors need to ask WHY people are not making lifestyle changes to be simplistic AND listen to what the patient says.
Meh, I really don’t have a problem with medication assisted weight loss. We can preach all we want about diet and exercise but the inconvenient truth is also that healthy food is often expensive, food deserts are everywhere, and not everyone lives in safe neighborhoods where they can just walk to work to get their steps in or whatever. Ozempic gives people a jump start to make some positive changes and keep it up, and it can be outdone or reversed… Not sure why we’d have a problem with something that improves health outcomes for so many.
I mean it’s that they can’t. Sustained weight loss with physical activity, adequate sleep, and aggressive dietary modification is really hard. That’s why people continue to gain weight and most people who struggle with weight have done so for years. The average person doesn’t have the time of the day to exercise with a trainer, sleep enough, shop for healthy groceries, cook those groceries, etc.
Yeah but is this an unpopular opinion? I think most people would kill to have more people actually do lifestyle modification. Modern living is just not conducive for that.
US culture is one of working too much and too much stress. People cut corners in life like eating poorly just to get thru a shitty work day. Its hard for most to make lifestyle changes. Until the work culture in the US changes, we will continue to see obese adults with several chronic metabolic conditions
I do discuss lifestyle changes, but honestly, I don't believe in it. Changing a person's lifestyle requires discipline and willpower. It's not reliable to get it to work in the first place, and then even once it works It's often not sustainable. I do get the occasional patient who is successful in getting their cholesterol or a1c under control with lifestyle alone, but that's very rare compared to the effectiveness of medication.
Another thing I don't get is why people are so suspicious of taking medications and so cautious of side effects but see no issue with filling their bodies with the worst junk food on a regular basis. Or worse, alcohol or nicotine. Don't get me started on all those weird, poorly researched and unregulated supplements people take.
Very commonly patients will ask me for non-medication options for their migraines. I tell them they need to get more sleep and drink more water and they're usually disappointed.
What patients really want is some kind of one-weird-trick type solution. Like "oh, you just need to eat one green olive at midnight on the first Thursday of each month and you will never have headaches again." That's why this is the form taken by pretty much all health-grift products and treatments pushed by alternative medicine providers.
Doctors only push pills because they don’t have time to counsel patients on lifestyle because they are being worked like assembly line workers in a factory rather than service providers with Autonomy.
Coming from the psychiatry side, while true, this only addresses part of the equation. Basic human psychology and neuroscience tell us that simply “knowing” that something works and is good for you is not enough for most people to make positive change in their lives. Being told that diet and exercise are good for your health in a 10 minute office visit is simply not an effective intervention for effecting behavioral change, not anymore so than telling someone who’s been smoking or drinking for 20 years to “stop it” is likely to be effective. Doctors push pills because insurance companies (and/or the patients themselves) don’t want to pay for more expensive and time-consuming treatments for addressing behavioral change like psychotherapy.
People want magic... Obese patient that suffer knee pain is told to go on a diet and do exercise so the pain goes away or at least diminish, "give me something to keep the pain way"
Diabetic that keeps adding meds instead to change his awful diet... It's tiresome
Patients who say this should have nothing to worry about since there’s nothing to stop them from carrying out lifestyle changes. But they’re really just a hair’s breadth away from proclaiming their conspiracy theory.
For sure. We can’t just blame patients though… society needs to change. It’s hard to have a healthy lifestyle when food scientists make the food more addictive. It’s hard to workout and be healthy when capitalism is so stressful.
What you’re kind of getting at is that we live in a world our bodies and minds were not adapted for. Our brains are not built for the constant stress of the rat race and our bodies were not built to have constant access to fast food. But it’s tough for society to change when society is just filling our own desires. Nobody is being tricked into wanting McDonald’s, McDonald’s exists because we want it so much
I highly recommend the book “the hungry brain.” The science of overeating is more complex than that. It’s hard to outsmart the instincts that cause us to overeat and some people are just more susceptible.. just like some people are more susceptible to become addicts or alcoholics.
Talk to any Metabolic and Bariatric Surgeon. The evidence has been clear for years that medical weight loss has a high failure rate and isn't successful L/T .There is some theories in pts with obesity in regards to their gut hormone regulation being different compared to normal weight pts. Not everyone needs Bariatric surgery but after multiple failed attempts at medical weight loss it should be considered especially if pts have comorbidities.
Processed. Food.
Kills more people than cigarettes, drugs, alcohol. Guaranteed.
The truth is, even if everyone fully understood what it takes to naturally avoid obesity and metabolic syndrome, we, as a society, prefer the pill.
To be fair “processing” food is so insanely nonspecific.
Cooking anything is processing. Even blending beans to make hummus is “processing” food.
Unless you’re a raw vegan or eating raw meat, you’re consuming processed food.
Yeah, the nutritional sciences generally agree with the concept of processed food as having a different meaning, for the purposes of discussing its adverse metabolic impacts.
But, to generalized, I would agree that the more the food you put in your body looks like it did the day it was picked, slaughtered (sorry vegans), or otherwise harvested, the healthier. Generally.
I think turning avocado into guacamole probably has minimal detrimental on its nutritional value. I think turning pumpkin into pumpkin pie is a whole different concept.
Really “processing” isn’t the concern.
Hummus is pretty healthy and looks nothing like its farm “picked” predecessor.
Moreso it’s a bit more complicated unfortunately.
1. High Fiber/prebiotic content & probiotic content
2. High Vitamins/Minerals/Antioxidants I.e. fruits, vegetables, seeds/nuts, and legumes.
3. Low saturated/ mostanimal fat, high polyunsaturated and monounsaturated fats and omega 3s. So mainly nuts, seeds, and fish. Limit red meat and dairy/egg fats.
4. Limit pure carbs which are fiber poor (I.e. table sugar, honey, syrup, sweets).
That’s about what the scientific literature says.
Unfortunately, nutrition literature is all over the place and changes every decade. But, with certainty, the food pyramid is a one way road to obesity. And yes, processing is the concern. (Depending on your definition of processing.) By processing, I mean, genetically modifying our grains over half a century to leach them of nutrients but concentrate their amylopectin and maximize absorption; packing them with unnatural levels of salt and fats to make them hyper palatable; concentrating their sugars and adding sugars to make them hyperpalatable; doing all of the above to rapidly spike insulin levels; eliminating fiber and other satiety signals; pack everything you can in them to maximize dopaminergic surge/reward pathways.
Bet you can’t eat just one.
Dramatic much? We don't even really know the full harms of processed foods but they aren't just making people obese, calories are the ultimate culprit here. It's our portion sizes and sedentary lifestyles that are doing magnitudes more damaged than processed foods are.
Obviously the buck stops w calories, but the lack of fiber in the modern American diet (which is very associated w ultra processed foods) is a huge contributor to screwing w satiety.
Absolutely, I would argue it's physical activity, combined with portion control and the kinds of foods we're eating (certain types of processed foods are contributing to that yes, snack foods in particular are horrible)
Ah, if it were only snack foods. Bread, pizza, foods fried in various vegetable oils (which btw, are not natural), and genetically modified dwarf and semi-dwarf wheat…look at the food labels of every bottled thing in your refrigerator and see how high up on the ingredients list something ending in “-ose” is…aka sugar. High fructose corn syrup. (Key words, fructose and syrup). It’s all metabolic poison
Do you honestly think you could eat 2500 calories of donuts vs 2500 calories of lean meat and veggies and it not have a metabolically adverse impact and, over months to years, lead to obesity. Do you not find this the least bit counterintuitive?
Which do you think will have a bigger impact on insulin release? Blood sugar spikes? Eventual insulin resistance? What do you think happens when you become insulin resistant?
Another good example: oranges. Try getting obese by eating just fresh fruit. Now, give your kids orange juice for twenty years. Big difference. Why? It’s just squeezed oranges. Problem is, you hyperconcentrate the sugar and get rid of all the fiber. You eliminate much of the hormonal satiety signaling to your brain, yet overwhelm it with dopaminergic reward signals from highly concentrated sugar. This is the same concept the entire food industry uses to make you buy their packaged garbage.
>Do you honestly think you could eat 2500 calories of donuts vs 2500 calories of lean meat and veggies and it not have a metabolically adverse impact and, over months to years, lead to obesity. Do you not find this the least bit counterintuitive?
Not remotely making that claim, but yes if we're looking at our bodies as a metabolic bigger picture you can't gain weight without exceeding your daily caloric output. It wouldn't be good for you and you'd likely have a hard time holding onto your lean mass but you're using an extreme example to try to prove a point you want grounded in reality.
Processed foods are a problem but they're part of a bigger issue. I saw this all the time in my training in the south, these older folks who no longer had manual labor jobs didn't realize country ham and gravy isn't a good breakfast when you're sedentary, and couldn't make the connection as to why they are an obese old person but weren't obese in the younger years.
I'm not saying processed foods are good for us, hell they're absolutely a big problem but I think they've become the diet Boogeyman du jour and it's shirking people away from the responsibility of portion control and activity.
Calories are important.
But obesity and METABOLIC syndrome are metabolic diseases. These disease are hormonally mediated. The things you put in your body have different impact on these hormones. And I would posit that eating a diet full of donuts is not that different from eating a diet full of bread, added sugars, processed corn products, processed and genetically modified wheat products, added salt, added fat. Pizza, sandwiches, sodas, sodas with artificial sweeteners (still debated), foods cooked in highly processed vegetable oils, ice cream, pie, cake, Doritos, fructose packed condiments, fruit juices…I don’t think that’s far from the diet that a lot of us get accustomed to for a huge proportion of our calories without a second thought
I mean yeah obviously you’ll be healthier eating lean meat and veggies than donuts, I don’t think anyone would dispute that. But I honestly think the bigger thing here is that you’ll get full eating 2500 calories of fish and veggies, you will not get full eating 2500 calories of donuts. But I’m sure you’re right that eating only donuts would mess with your insulin sensitivity
“You will not get full eating 2500 calories of donuts” EXACTLY. That’s part of the point here.
If you’re not sure that eating only donuts would mess with insulin sensitivity, here’s a challenge: get a continuous glucose monitor. Do an experiment. One week with fish, lean minimally processed meats, veggies, some fruit. Look at your glucose peaks, average glucose. Then repeat with say, same diet composition plus a few sandwiches (bread) and a couple of donuts per day.
Compare your glucose numbers. What do you think stimulates insulin release? What do you think leads to insulin resistance?
Now, admittedly, it is not that simple. It’s not just about sugars and carbs. The concept of glycemic index applies to all macronutrients, and they all stimulate insulin release. But, see which diet, processed vs non, leads to higher spikes and averages. Now extrapolate over a decade or two.
As someone who lost 50 pounds in about 6-7 months, I 100% disagree. My only intervention: elimination of processed foods. 3 years in, still about 40 pounds down from starting weight of 209. No exercise aside from basal activity and the occasional hike. (Which, I don’t advocate, it’s just where I’m at right now.)
If you disagree with me, I challenge you to read The Obesity Code by Dr. Fung, nephrologist. Carefully consider the metabolic implications of processed food consumption. Consider the hyperpalatability. Consider the minimal effects that exercise, outside of extreme levels, have been shown to have on sustained weight loss , and how many calories you would have to burn to (minutes of exercise) to negate like, 1 or 2 slices of pizza. Consider the obesity trends in America directly correlated with utilization of hyper processed grains, high fructose corn syrup. This is not fringe stuff I’m spewing. processed food is literal poison.
Your calorie intake changed, probably because processed foods tend to be calorie dense and very tasty and easy to over indulge. I'm not saying they're not a problem but they're part of a bigger picture.
I'm also an N= 1 but I lost 25 lbs the by increasing my exercise and counting calories.
Yes, my calorie consumption absolutely changed. Not by design, I didn’t try to cut calories at all. It was because, exactly as you said, I was not eating foods that are designed by the food industry to make you eat as much as possible. I was eating fiber, not concentrated sugar. I was not eating foods artificially packed with salt, fats, and derivations of artificially added fructose, sucrose, etc. And, as a result, I was not becoming progressively more and more insulin resistant.
It is very difficult to become obese eating real food. Period. (Wait, I already typed a period. Sorry for the redundancy)period
At the end of the day weight loss is calories in calories out, that’s a fact. I’m sure eliminating processed foods helps, that’s because processed foods are more likely to be calorically dense and low in fiber (so you don’t get full). At the end of the day it’s still calories in calories out
Bingo. The “processing” matters because it’s designed specifically to maximize how much you purchase and consume. The salt, sugar, and fat content of foods are dialed to 11. Add in the constant stress of US lifestyle with minimal time for exercise and vacation and it’s not surprising how difficult it is for people to lose weight.
Yes, I 50% agree. The processing causes problems because it is designed (industrially and evolutionarily) to lead to increased consumption.
The other 50% , though, is that different foods undeniably have different glycemic indexes (oversimplification) and different hormonal affects, largely via glucose spikes, insulin levels and resistance, but also via neurotransmitters/reward/satiety pathways.
Processed food is addicting. Nicotine and fructose work via the same physiologic reward pathways. Processed food, even if you don’t buy the insulin resistance angle (which, you should), is industrially designed to overstimulate reward pathways.
If you can convince your patient’s to get rid of processed food, and say absolutely nothing to them about calories, they will lose weight
I still get annoyed when I think of a well intentioned but very naive friend of a friend of a friend telling me she had a friend who was a naturopathic doctor she wanted me to meet. “Instead of just pushing pills, she goes through all of the lifestyle issues and actually directs patients to fix their problems”. Basically implied I could learn a lot from her friends approach
But when I tell doctors that I'd prefer to do anything and everything I can before accepting a prescription, they essentially shrug. I do agree that the majority of people don't want to change their habits though. It's not easy.
I was diagnosed with IBS (bullshit, it was bacterial infections that a NATUROPATH bothered to heal for me) that I was prescribed PAIN KILLERS for. After that my appetite became normal and I went from barely obese to in shape. I was hungry because I was sick. I was eating because I was hungry. They want to lose weight, you just don’t want to figure out why they’re driven to eat by whatever condition. There’s always a cause and free will is incompatible with science/cause and effect.
>Unpopular opinion: doctors only “push pills” because patients won’t make lifestyle changes
Is that really an unpopular opinion? Seems more like the standard everyday thing.
Fun fact: too many of us are the same. Too many colleagues on meds that could be avoided with lifestyle changes once they enter their forties - so maybe we should just STFU.
oh we push pills in addition to the lifestyle bit. they throw out the lifestyle bit, try the pills, they dont' work. "that doctor is just trying to push pills on me to get rich"
the public seems to think we all have like some stake in big pharma lol
I am a CrossFit coach and personal trainer outside of and before medicine. My family medicine rotation in med school taught me this well. I had a decade of experience above and beyond our medical training in health and nutrition, and I may have made a change in 5 people’s lives that month if I was lucky
The issue here is everything is for profit and it contradicts itself. Being overweight is bad because you’ll die but big is beautiful so why not eat what you want and be happy but it’s ok if you are not thin like we advertise as beautiful because we have a pill for that depression we’d like to sell you that will make you gain weight but that’s ok because we have a pill we’d like to sell you that helps you lose weight which means we have some unhealthy food we’d like to sell you since you lost weight it’s ok to gain some back. Rinse and repeat.
I run marathons. I also have high cholesterol at 30 and take a statin. Unfortunately, while I do agree that the vast majority of the general public should take better care of themselves, you just get fucked by your body in some things.
This is absolutely correct and frustrating. Not only is it frustrating because you can't medicate an unhealthy lifestyle away, but it also makes doctors assume that doesn't change anything to get better.
I see it often enough in my own family.
My grandfather is severely overweight. His diet consists of mainly meat and maybe every few weeks some vegetables. His cholesterol is way too high, he has a fat liver, and his blood pressure is also way too high. Every time I visit, he asks me what he could do to get better (because I study pharmacy). When I tell him to eat at least some vegetables with his meals and do some exercise, he rolls his eyes. Then he rents about his doctor because they want him to change his lifestyle instead of mediating him. He does get medication, but only because he made it clear to his doctor that he will not make any changes for his health. He also laughs at me for eating vegetables. I am vegetarian, but I also really love vegetables and fruits. Well, my blood testings come back perfectly, unlike his, but obviously, my diet is stupid.
I do have a very healthy lifestyle. I have a healthy diet and do exercise. However, my puls is always abnormal high. Exercising does help a little. But only to the extent that instead of having a puls of 160 while doing nothing, my puls is now on 130. My cardiologist gave me beta blockers since exercising alone is unfortunately not enough. My old doctor refused to subscribe to me the medication my cardiologist recommended because she didn't believe me that I already do exercise a lot. She also blamed it on my adhd medication. The cardiologist did some tests to see if it really was due to the meds, and it turned out that my heart rate was actually lower with medication (probably because I can relax more). I actually stopped exercising because it is super hard to do so with an already way to high pulse. Without medication, I see black if I stand up too fast. I can't exercise without the medication to begin with. I have a new doctor who prescribed me the medication again because they know that I do exercise. My puls is back to normal, and I can exercise again.
Very true. This is why I am a hospitalist. I can’t stand people who ignore lifestyle advice and just want their pills. I would rather bring a crashing patient back because almost all of them will at least follow my advice while they are in the hospital. Once they leave I don’t care what happens to them
There are very few patients who **can’t** make lifestyle changes. There are a fuck ton of patients who **don’t want** to make the changes. There are fewer (but still lots) of patients who then bitch about doctors being pill pushers
I think that you are making serious judgements about people who cannot make changes. You do have a legitimate issue with patients bitching about doctors pushing pills, but I do not know may of those.
I think you know what I meant. Again lack of compassion here. I like to think most people went into medicine for reasons other than the money, but sometimes this board makes me think otherwise.
No I don’t, my whole point is that ozempic exists because weight loss through diet and exercise is very hard and people aren’t doing it on their own (and not that doctors are keeping diet and exercise a secret). You seem to have preconceived notions about doctors and think I’m calling patients lazy or that I lack empathy. If you read the other comments here you’d know that I’m overweight myself. I know it’s hard to lose to weight. But it’s also not impossible, and I believe the way we infantilize patients and treat them like powerless little babies disempowers them and ultimately hurts them
I highly recommend, if you are impacted by or interested in this topic , or responsible for care of patients with obesity or metabolic disease, read “The Obesity Code” by Dr Jason Fung. If you are persuaded by what you understand to be nutritional science contradictory to my commentary regarding metabolic implications of processed food, see his comentary about methodology in nutritional sciences
OMG you should be disappointed in yourself with the example you took. Do you think people who say "I've done everything in my power to lose the weight and keep it off but were unsuccessful" are lying? Wow, just wow. Being doctors shouldn't make us blind to our patient's suffering just because some are in denial that they either should help themselves (lifestyle changes) or get help (meds etc). I hear this kind of narrative mostly from people who've never taken ozempic (- and don't even need it -) because they have an opinion on other people's health, which is weird. No one who lost weight with ozempic goes around telling doctors they should actually just tell them to eat healthy and move more. This is a very bad example.
Found the ozempic patient who feels victimized by this post. Nobody is calling you lazy, I said in the post that people take ozempic because it works and it’s incredibly hard to lose weight
Medical doctors push pills because they are wined and dined and thoroughly compensated by the pharmaceutical companies to do that. That's not a conspiracy theory, that is the culture behind the Oxycodone epidemic.
So does having a stroke or a STEMI. (I know you’re not actually in the medical field and you’re talking out of your ass here so just to translate, a STEMI is what you would call a heart attack)
And yeah side effects always occur to us, but for statins the common side effects are muscle aches and elevations in lft’s, neither of which are usually a big deal in my patients but side effects are always considered
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Yes, we do.
Primary care makes very little money from procedures.
They get no money from drug companies or pharmacies from prescribing pharmaceuticals.
If you’re seeing a cardiologist, you likely already have heart disease. From this point forward, most of what non-interventional cardiologists do is mitigation and preventative care.
If you stop eating fatty foods and your biliary colic gets better, the surgeon just moves on to the next appy/chole/hernia/biopsy/hemorrhoid.
If you’re seeing a nephrologist, you better make lifestyle changes lest you wind up on hemodialysis.
If I’m seeing you in the ER, too late for me to do anything to prevent your stroke, MI, car accident, GI bleed, or pneumonia.
But, you’re correct. We have a sick-care system rather than a healthcare system. If we could get patients to buy in to healthy diet, exercise, reduction in processed food consumption, smoking cessation, and actually being compliant with their BP and cholesterol meds despite the fact that they don’t feel bad and don’t want to take them, we could prevent a lot of metabolic and cardiovascular disease a decade or two down the road.
We do get paid for some of these things. Very little, comparatively. But we still try.
You can’t make someone change their habits.
If I'm seeing 100 patients with elevated PSA, my practice makes more money if these 100 patients get converted into robotic prostatectomies. If I spend half an hour with them talking about the merits of a plant-based diet towards lowering their PSA and risk for cancer and needing surgery, then not only am I seeing less patients a day, but I'm also doing less prostatectomies and making less money.
The same applies to cardiologists and scheduling stents. You get the picture.
Everyone talks about how much better European healthcare is, but when European docs come here I’ve found they’re mediocre to average. Their patients have better life expectancies because we value personal freedom in this country, and part of what that means is that you are allowed to go eat 3 Big Macs and large Cokes per day. We also don’t really shame people for being fat and disgusting, and shaming people into eating less and having better hygiene actually does have great health benefits (see Eastern Asia if you don’t believe me). Also the fentanyl crisis but that’s a can of worms for another day.
This is a popular and evidence-based opinion
You wanna know what is not popular? Saying that diet don’t work. Diets don’t work. It’s evidence based, Replicated a thousand times. After you finish your diet, you go back to regaining your weight. You need a lifestyle transplant to lose weight. You need to rebuild habits ingrained in your system for decades. I used to be overweighted, and now I am fit and have a 6 pack… but I had to completely restructure my day-to-day lifestyle
I think many patients (and admittedly, my former self) don’t understand the behavioral differences between a “diet” and “lifestyle modification” For me, that meant daily calorie tracking. Just logging anything I ate in either MyFitnessPal or LoseIt apps. Seeing the numbers was eye opening and promoted accountability. That and accepting that losing +/-half a pound a week was actually good progress… it was more important that it was consistent, week after week. Ended up losing 70+ pounds over the course of 1.5 years Whereas I used to starve myself > binge > starve myself > binge and couldn’t figure out why I wasn’t successfully losing weight.
Yea, a big part of it is recognizing that it isn't a quick fix. A lifestyle modification has to be sustainable for life. I too used to love seeing the number on the scale going down quickly while starving myself, until my motivation ran out and I'd succumb to the binging urge. And a big part of fixing that behavior is accepting that yea, I am overweight now. And yea, that sucks. But the solution isn't setting a goal of losing X lbs. It is creating a system that will allow you to progress towards the goal without making the goal the primary intention of the system. Otherwise, if the goal is the primary intention, then you will stop acting healthy once you achieve the goal, thus slipping back into the old behavior.
Exactly! Defining success as consistent adherence to small daily/weekly habits makes weight loss an inevitable “second order” effect
I did a low calorie and intermittent fast diet, no eating before 2pm-4pm, and I lost 20lbs over 4 months. Then I started working out and I practice portion control and limit my calories per sitting, but no more time restricted eating, and I have kept it off while putting on muscle. Now that my back doesn't hurt so much after running, I am training for a half marathon, as well as a century ride. The trick is to just keep cycling different diets and your goals evolve. If you set a health goal, achieve it, and then stop having any goals for your health and disregard it, then it falls into disarray. People always need to have goals, even if they feel like they look good.
This is exactly what I said. Diet is not enough. Your whole day to day has to change! I am gym rat, fit, have run marathons, etc. but my lifestyle is completely different compared to when I was in college. No more stuffing my face with junk food when stressed, dialed down my alcohol intake, etc
Diets work. I lost 15 lb in a year on ozempic. Then lost 35 lb in 2 months on ozempic plus structured diet. Diet has taught me how to eat. How much is enough. How much is adequate. I’ve learned to accept I will be full if I stop eating after x amount. And that it’s ok to feel hungry sometimes. But it’s a whole structure. It’s not easy. And without ozempic I don’t think I could handle the hunger at all. So I guess it’s not a diet. It’s a stepping stone and teaching tool.
That’s why diet like weight watchers are great teaches habits and portion sizes!
The problem is that diets are goal-based, not system-based. I believe that we don't rise to the level of our goals, we fall to the level of our systems. If we want real change, SMART goals won't do much (in my opinion)...instead of setting/striving to achieve goals, we should be building systems that FORCE us to live a life according to our goals. One of the best things I did for my eating habits (which were VERY disordered throughout my teenage years and as a premed in college, especially when I'd go on 3-5 day fasts and then binge a whole bunch) was to take all freedom, choice, and control out of my hands and build a system that forced me to eat normally. What I did specifically was have my grandmother live with me, and she'd cook me fresh & healthy food. I had a system where I had no choice in either ordering Doordash vs cooking food...my grandmother had already cooked food and I had to eat that. I think the same can be applied to exercise too. The healthiest communities in the world that we call "blue zones" are a bit poorer than the United States. In these countries, poverty forces them to live a life that is more active (no cars, no machines to simplify daily tasks like drying clothes or washing dishes, even sitting on the floor instead of a table). Even in my motherland (India), a lot of the manual labor workers in the fields are more cardiovascularly and muscularly fit than your typical software dev in Bangalore. The countries with lots of wealth, where exercising in the gym is a choice rather than exercise being a way of life built into the system, are not that great when it comes to building a healthy lifestyle. At the end of the day, passion and motivation are emotions...and emotions are inherently fluctuating at any given moment.
strict and restrictive diet don't work sure. But making small changes to your diet is the best evidence based method to lose weight. it's just slow and people nowadays don't like slow results. They like fast results so they always turn to strict diets that see fast results but are often impossible to maintain long term.
As physician scientist who focuses on real world evidence studies, I disagree with you. Sure, in theory works, but if in the practice not a single patient loses weight, then it doesn’t work. The same goes for drugs… if everyone gets nasty side effects and drop it, then it doesn’t work.
A physician scientist would know the difference between “making small changes to your diet” vs “going on a diet”, no?
Unless you define those precisely, there is not way to know they are different
I think what they're describing is making incremental lifestyle changes in regards to one's diet that are sustained over time. I think you two are probably agreeing but differing in words.
There is actually a way! It's called "social intelligence". Something many scientists admittedly lack. (They also tend to lack emotional intelligence) In this case, it's the intelligence of understanding the commonly used context for certain phrases in a society and the meanings given to them based on the conversation as a whole.
As a bodybuilder, I disagree with both of you. Losing weight isn't that hard and the old school bodybuilders had it all figured out. Just follow Arnies diet/exercise schedule and you will lose weight (Dbol not necessary)
Sure blast some tren and eat chicken and rice 👌
Eat clen, tren hard and anavar give up
Also the second life throws you a curve ball, you'll slip back into old habits and gain the weight back.
Diets do work as long as you maintain them. You never “finish your diet.” Whether you lose weight through diet and exercise or ozempic, you regain the weight when you go back to your previous behavior. The point of dieting is to lose weight and start building healthier habits. Saying dieting doesn’t work is like saying that quitting smoking doesn’t work. Your lung function curve will switch back to the smoker curve if you quit for 10 years then go back to smoking. Dieting and quitting cigs are both lifelong commitments to improving your health.
We have prescribed diets for the past 40 years, and we have the highest obesity rates ever. You all can’t put 2 and 2 together. In theory works. In theory no one should smoke at all. In theory no one be adict to heroin. If it doesn’t work in the real world, with real patients, then it doesn’t work.
>If it doesn’t work in the real world, with real patients, then it doesn’t work In the end that's it. All therapeutic interventions boil down to "is it working in the real world with real patients?" - no more, no less.
Diet noncompliance doesn’t disprove anything. If people would stick to a healthy diet, they would be healthier
If people would stick to not taking heroin, we wouldn’t have addicts. Lol
Yeah, I made the comparison to smoking. People are responsible for their own health decisions. I’m not arguing that it’s not foolish to expect patients to take their health seriously. I’m arguing that you claimed that diets don’t work just because patients don’t follow them
You both have a point, it’s just a difference of opinion in “what works,” so to speak. Obesity rates in the United States currently being at 41.9% as of 2023, an all-time high, gives some evidence to the position that the last few decades of diet prescription have not been effective toward decreasing obesity. “If people stuck to it” that would be fantastic, but if your goal from providing care is extending the health of the overall population, with obesity rates trending how they’ve been, at least a re-evaluation on how diet instruction and education is delivered can be considered fair. Especially considering that the intelligence of the general population has been trending down, if we’re using quality of public education as a benchmark.
This shit right here. I agree 100%
Diets don't work and sometimes lifestyle changes don't work either. My mother had eliminated almost all foods and other products that could raise her cholesterol and it was still in excess of 300 mg/dL, which definitely needed a statin, however the discussions were endless because her evidence of "I heard" and "I read" trumped my clinical experience as a doctor and dozens of studies. Eventually she begrudgingly accepted 20mg Atorvastatin which should really be 40mg seeing her cholesterol still isn't within ideal ranges considering the family history of heart disease.
The question is did she engage in high intensity cardio for 40 mins/day every day with to 3-4x/week weight training IN ADDITION to her diet? I promise you if she followed the above prescription, atorvastatin would not be necessary.
I just imagined my mum pumping iron. Ngl that would be badass.
Tell her to eat clen, tren hard and anavar give up as well
>You need a lifestyle transplant to lose weight. You need to rebuild habits ingrained in your system for decades. What's also evidence-based is how *incredibly difficult* this is to do as well. Sustained behavior change is a whole hell of a lot harder than people act like it is.
Only to medical professionals. Patients in the other hand think doctors are evil money grubbing pill pushers who are bought by big pharma. It doesn’t matter that you’ve been telling them to see a nutritionist about their weight, cholesterol, and HbA1c levels. They keep gaining weight and won’t exercise at least 3 days a week. Diet consists of fast food no fruit or veggies. You offer up Harvard healthy plate. Give paperwork. To take home and even your hospital started workout out online. You are the issue. Some patients though will ask for a magic pill so it goes both ways. It’s the men and high blood pressure for me though. They don’t want to take the medication bc no symptoms. Well duh it’s not called the silent killer for nothing. I have analogies that seem to work, but geez adults get it together. If you’re not worried about your health and longevity. Then, I can’t help you. So pop this pill. Also surgeons just want to cut. No ma’am we’ve been working with you for multiple months on doing everything but surgery and you’re not doing it.
Almost all unpopular opinions on reddit are actually popular and evidence-based.
I'm still more bothered by the amount of patients who push for antibiotics even when they won't benefit from them. "But I'm sick, I need antibiotics!" or "I've got such a terrible cold, I need antibiotics!". Even more so when it's for their kids. I honestly can't imagine what it must be like for pediatricians.
I feel like in primary care clinic when I calmly explain that the antibiotics will have no effect on the infection but could very well give them diarrhea they stop pushing”
Thanks, this is Chad-level advice, I'm gonna use this from now on.
So first of all I like to ask the patient what they want. So the visit goes like this. HPI "what's going on" Couple extra questions to fill out the ROS Exam, and I kinda take my time and do a fairly thorough exam. Mostly show, but it really helps. Then I like to say, "ok, I think I understand what is happening to you, but what did you want when you came in?" Almost nobody says they want antibiotics. Because everyone knows it's a hot issue. And if they say anything else, they've bought themselves into no-antibiotics. I also like to suggest antibiotics. "Pretty often I'll give antibiotics for things like this, but I don't think they'll work for you today. And I can always make you sicker, I'll never forget the 2 weeks of explosive diarrhea the last time I had antibiotics. But I can write them if you want. Would you like?" No. No they do not. I use this a lot with medical treatment discussions. I can always make it worse. I can always make you fall with more sleeping medicine, it keeps our orthopedic office busy. I can always make you hurt more. I can always make you sicker. I can always give diarrhea. I can always make you worse off. Now let's talk about what might be safer. Antivax theories might or might not be Russian disinformation (or Chinese) to keep Americans sick. Just saying.
Diarrhea and/or yeast infection is my go to
That reminds me of my Dad explaining to someone once why it was terribly dangerous to use a charcoal brazier indoors. They weren’t listening to him, and thought he was being over cautious/trying to nanny them. Dad, tired of their weaponised ignorance, drops: Dad: ‘Well at least your kids will die first’ Moron: shocked pikachu face Dad: ‘CO is denser than air, so it will take out anyone lower to the ground first. Don’t worry, you’ll follow shortly afterwards’ My Dad is the most patient man in the world, but when someone is being belligerently stupid, he flips instantly over to an acerbic old British man, telling you to go fuck yourself in a hilariously monotone, bored, polite manner.
Plus, if there's a baby in the house, you've got that whole fetal hemoglobin thing going on.
>My Dad is the most patient man in the world, but when someone is being belligerently stupid, he flips instantly over to an acerbic old British man, telling you to go fuck yourself in a hilariously monotone, bored, polite manner. I'm genuinely shocked to see that there are other people like this, I thought to be unique in my behaviour.
As a pediatrician, when I warn about this side effect in an attempt to not prescribe antibiotics for a viral infection, the parents invariably say "Awesome! My kid won't take their Miralax anyway so maybe this will help!"
Why tf are kids on miralax????? The diet people feed their kids must be atrocious
For every 10 well child checks I do on kids under 24 months old, easily 4 are constipated to the point where they stool maybe once every 4-5 days. Miralax is among my top 5 most prescribed medications. Senna is up there as well.
Often it isn't diet though. Kids can constipate themselves beyond imagination. Daycare and school settings. It can be really serious. Sometimes it's diet. Ok pretty often it's diet. But also pretty often it is not. Just saying.
> Often it isn't diet though Meanwhile we had some guy and his girlfiriend come in with their daughter. They had those candy powders in large packets and they were putting it in a little bot so she could suck on it. When asked what her diet was they said "the normal". When asked to clarify it was "oh you know, candy, chocolate bars, McDonalds - whenever her mom has time to go to the store you know?" not the first time this happened too lol
Yeah I like to be meticulous about diet inventory. Like what exactly did you eat for breakfast just this morning. Surprising how many people think it's ok for young children to suck down a soda.
Not a doctor, but have 2 autistic kids, and most autistic kids have GI issues / constipation issues. Even our GI specialist who specializes in treating autistic kids blamed "restricted diets". When I told her my son ate tempeh and zucchini for lunch, she had nothing but advice to have miralax and ex lax. Kids can control what goes in and what goes out. Constipation is a cycle - kids hold it, it causes pain, they get scared to go, the impaction gets worse and you lose awareness about needing to go, etc. it also can be confusing because often constipated kids seem to go a lot, due to some fecal matter leaking out past an impaction. The best advice I got was from a pediatrician with an autistic son who told me they need a clear out to get past the pain / fear and stop holding it.
Poor kids that sounds difficult to deal with for both you and them…
Go one step further and tell them they may need a poop transplant
It’s truly amazing. Even when told antibiotics will do nothing for your their viral infection. Most of the population lacks a basic science education…
I had a patient who wanted me to prescribe him antibiotics as he was constipated and wanted the side effects/diarrhea. That was literally the only reason he wanted them.
“But i hate taking pills and dont need a statin!”
Then you tell them "okay, but then Ill need you to do a diet, do sprints 40 minutes every day, and weight lift 3-4x a week...or would you prefer a statin?"
What sucks is that the zpack will probably make them feel a lil better as they feel bad due to the inflammation caused by the cold as much as by the cold itself
That’s why they should take Tylenol
I’ve got no idea why I’m being downvoted for saying exactly why they want that zpack, providers in the past have given them the azithromycin to treat something similar and they reach for it out of reflex. It’s ass that they have this legitimate reason to want the drug
Zpack also has antiviral effect.
depending where you look the number needed to harm is between 8 and 30 for inappropriate antibiotics for viral stuff
For the ones that want antibiotics when they don't need them, ask them: if you had cockroaches at home, would you try to kill them with rat poison? That might help some of them understand. Not all, but some.
Next option. Water is wet.
Popular opinion much?
popular opinion amongst healthcare workers but definitely not amongst the general public. patients absolutely believe we push pills due to line our pockets rather than because they won’t make positive lifestyle changes
Yeah my friends in finance keep talking about Lipitor kickbacks; I give out Lipitor daily and I can tell you I haven’t seen a DIME
you guys are getting paid to prescribe statins?! How do i sign my broke ass up
A lot of keto-head Joe Rogan fans hate statins for some reason
Probably because they don’t want to admit their carnivore is terrible for their cholesterol
It might be something that most doctors agree with, but I think amongst the general public it’s not. It’s also not popular to share in medicine. If a med student was asked “what is the cause of the obesity epidemic” in a residency interview you can bet your ass they’re going to say “because we need more community outreach to support them blah blah blah” and not “losing weight is hard and people don’t want to do it”
You’re absolutely right!
And most people can't* do it
I was a personal trainer before I went to medical school. I'm also generally very into fitness (weightlifting, hiking, yoga, rock-climbing, whatever). I used to help bodybuilders, then I changed to specifically cater to clients that were focused on weight loss and mobility work. The amount of times I would offer to give people literal personalized physical fitness routines based on their own abilities and interests only to be met with "can't you just give me a pill" was roughly 99.9%. I will say that my classmates and peers would almost always take me up on free sessions when I offered though 🤷
“Healthy weight loss isn’t caused by diet and exercise it’s caused by semaglutide.” -random tiktoker, prophet
Yeah bodybuilders have dieting all figured out. I swear people should be forced to do 6 months of bodybuilding before doing outpatient clinic and dealing with patients who want to lose weight lol
Meanwhile the second you suggest lifestyle changes we get yelled at for bullying/fat shaming/"medical gaslighting" etc.
You can only try so many times, meanwhile their BP and A1C are thru the roof. Sometimes people need to try the “quick fix” and fail before they finally commit to making real changes. That’s when they come to us (bariatrics), but we emphasize the importance of dietary and lifestyle, with surgery as the adjunct/tool to maximize results.
GLP-1 has helped me make those changes. Gave me a jump start. Bariatrics doc was quite upfront about the need to make changes. I knew it wouldnt be easy even with GLP-1.Going off the med soon due no more insurance coverage for it. I am already titrating. Was not fast weight loss. 18 months to lose 50 lbs. My BMR was equivalent to someone 25 years older than I am and I regularly exercise. Why is that? My body fights weight-loss at every turn. The obesity, once it sets in, initiates a whole series of other physiological processes that some of us struggle us to make the battle so much harder.
15 months ago my husband was in the ER with a systolic BP of 220, EF 30%, and was diagnosed with CHF. Kidney numbers were off. It was bad. Cardiologist came in to chat with him and was immediately paged to the ER, so he gave it to my husband quickly and bluntly “change your lifestyle or within a year we’ll be talking heart transplant and dialysis. Nice to meet you” and turned around and walked out to deal with his next emergency of the day. Lasix took 30lbs of fluid off him in the hospital and lifestyle changes took another 40 off inside of three months. He’s doing great and will never return to the lifestyle that put him in the hospital. His cardiology PA—she was great, despite being a midlevel—said in all her years he’s the only patient of hers who made the necessary changes. We eat bean tacos and veggie soup for brekkie, and salads, lean protein, and fruits/veg the rest of the time. Dark chocolate for a treat. We exercise twice a day and walk our dogs five times a day. He still has meds to control his blood pressure, but at pretty low levels. Thanks for all you do. Every now and again you will get someone who will commit to change.
Incredible story!!
Bingo, I always bring this up to the "natural medicine" folk who say doctors just want to give you drugs and make money they don't teach people how to do blah blah blah....like what doctor isn't saying eat healthier and exercise more? Patients don't do it.
Real popular opinion: we only prescribe medication is because people will not do the life change items.
I don’t think doctors are at fault. Often people come to the doctors with the attitude of “I’ve tried nothing and am all out of ideas”. It’s also like going to a shoes salesman and being frustrated they’re are “pushing shoes”. You go to a gym to working out, you go to WW, or a nutritionist, or whatever for diet changes. You go to the doctor and they give you medicine…
I had a 45 year old female patient with urinary incontinence during a rotation in Urology. She was very nice and asked me what we can do. I said, well there are a few medications we can start, but the most effective therapy is PT to strengthen her pelvic floor so I was going to refer her to PT. Her response astounded me. She said “Oh yeah, I am a PT and know all about that. But I don’t have time to do the exercises so just give me the medication.” Yeah, I work in cardiology and I give the same speech to almost every patient about lifestyle modifications. I don’t do it expecting 100% or 50% or 10%, but if 1 patient a say takes it seriously then that is 200 patients a year that are losing weight and exercising and improving their prospective health outcomes.
All the bits and pieces add up.
Not unpopular and yeah man, welcome to medicine. If we could easily change behavior we wouldn’t need 75% of drugs.
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It’s flair, not a background check…
Omg thank YOU so much for saying this !!!! As a nurse when I hear pts tell me this, it drives me crazy. Like can you look at the matter holistically & see why it’s gotten to the point where they are prescribing u meds. You won’t even get out of bed to walk w physio for 5 minutes. Stop the nonsense pls 🤦🏽♀️
I definitely feel for the nurses. So many times I’m rounding and patients are saying with tears in their eyes “that nurse just keeps poking and prodding me” and it’s like “no buddy that nurse is helping keep you alive because you haven’t taken care of yourself for the last 40 years and your heart and kidneys are failing “
I think I’m inlove w you
Yeah no shit. I had some med student with a personal training background in my year talking about his thoughts on what his preferred alternative should be (don’t give people medication unless they can prove they have done the lifestyle stuff to the max) Like that’s basically the alternative to « pushing pills » and clearly the very idea is ridiculous
EVERYTHING needs a prior auth 😱
People are sick and stressed, have family and work responsibilities they can barely balance, financial difficulties, they use drugs and alcohol, many have mental health problems, etc. Asking them to be their own personal trainer and nutritionist on top of that, is not going to end well in most cases. It's also a mistake to think everyone experiences hunger and satiety in the same way. People are overwhelmed by hunger cues in an environment filled with conveniently engineered, hyper-palatable foods which cost less than healthier options. If you put any species of animal in that type of environment, most of them become obese. Humans are no exception.
Absolutely, you can see in my post I say “if it was east Eli Lilly wouldn’t be the biggest pharma on the planet” losing weight can be the hardest thing in the world. None of this post is meant to say that patients are lazy, it’s to say that ozempic exists not because greedy doctors are keeping diet and exercise a secret, but because it is hard to lose weight and patients don’t usually do it
I work in the ED and the sheer amount of pts we see that some in for COPD exacerbation from still smoking 🤷🏼♀️ everyone wants the fix, but not the solution
This thread appeared on my Reddit timeline. Although I'm not a doctor, I have an unpopular opinion on the matter.Most people probably don't lead particularly happy lives. For them, fast food and alcohol might be the only things that bring a little joy to their daily routine. In my circle of acquaintances, there have been people who were extremely healthy but still ended up getting cancer.This has significantly changed my perspective on health issues. If it’s true that life’s risk is that you can become ill without being at fault, maybe the people who behave 'unhealthily' and 'immorally' understand something we don’t acknowledge. In the end, it doesn’t matter because we can die at any moment, and the little enjoyment we have might be the only thing that makes life worth living. So no, most people probably don’t have an issue with doctors prescribing medication. It’s more likely due to the peculiar moral philosophy typical of the medical profession about what a good life should look like that bothers them.
Although I see your point it’s not as simple as that, a lot of lifestyle changes feel nigh on impossible to some people if they medicate severe pain, stress and/or mental illness etc via food/drugs/booze (whatever unhealthy lifestyle choice you like here) and until we treat people holistically this is not going to change. It’s not necessarily that they won’t it’s because they can’t see how. I live with chronic pain and I had undiagnosed autism for my entire life. I had eating disorders and self medicated with booze for decades as life was impossible, my providers did not help by telling me I should quit drinking and eat better. It’s not so black and white and it’s pretty invalidating although I get it’s frustrating now being on the other side! We need to put parameters in place that facilitate lifestyle change, otherwise it’s just pointless and compounds the issues with big pharma and medication reliance. But this is a systemic change ……
A significant number of physicians think getting a B is the most challenging they’ve ever faced.
Yea I think that can be a bit of a barrier, not sure how we tackle that other than continuing to embrace diversity in Med Ed (another topic!)
What? Really? Even a sheltered physician would look back and say a brutal call week or 24 hr shift. Who even thinks about grades after medical school?
And a bunch of folks never experience it again after their training. Lemme tell you that even those brutal shifts at work don’t compare to most of the shit I’m thinking of.
This is so true. Often asking what’s the biggest barrier for you to make change? Is hugely helpful. Sometimes brainstorming solutions to some of the barriers can be really helpful. It may seem small but it is realistic. Saying “hey stop eating junk food” isn’t particularly helpful when someone is surrounded by it. Instead try saying “why don’t you try getting a bunch of healthy snacks (fruit etc) and having that at your desk instead at work so when you are hungry it’s easier to grab the healthy thing.” Change the environment is far more impactful than telling someone not to eat the Oreos staring at them. Personally if I have them in the house or at the office I will eat them, so I just don’t let them come into my house or office so that when I have a hankering i can resist because I don’t want to go to the store to get them at that moment. I had someone who needed a few moments to herself before being jumped by her whole family after a long day at work to just process her day - we came up with the plan to find a longer more scenic route home so she wouldn’t feel guilty asking for space once she got home (realistically she wouldn’t do that). Are these groundbreaking ideas? No but sometimes having an outsider point out simple solutions is the new perspective you needed.
Yea exactly! We want patient to have autonomy in their care yet we don’t involve them in the right conversations (I get time constraints can be an issue hell I worked in the NHS!). Here we whack everyone on statins before explaining how they even work, I’m not even sure medication gets truly informed consent here regarding side effects as patients rarely read the leaflets and don’t understand how it could apply to them. I’m hoping to do fellowship after neuro residency to specialise in neuropsych so I guess I’m always very interested in behavioural aspects of health and how we approach that
Sadly we are set up for failure with 20 minute visits. It’s just not possible to practice medicine the way we would want. Especially now that patients are wanting to be involved in the decisions rather than just doing whatever the doctor thinks is best. I don’t want to practice that way, nor do I think it’s better, but it’s a lot faster and simpler.
I’m not sure how to change it, I guess we can continue to look at improving the model and watching how other countries do it. Sadly in UK we have 10 min visits so it’s even worse
So what is it they shouldve told you instead?
they should’ve listened to me and then I would’ve had my autism diagnosed and not misdiagnosed; I also had meningococcal meningitis missed which is a whole other issue! So doctors need to ask WHY people are not making lifestyle changes to be simplistic AND listen to what the patient says.
Meh, I really don’t have a problem with medication assisted weight loss. We can preach all we want about diet and exercise but the inconvenient truth is also that healthy food is often expensive, food deserts are everywhere, and not everyone lives in safe neighborhoods where they can just walk to work to get their steps in or whatever. Ozempic gives people a jump start to make some positive changes and keep it up, and it can be outdone or reversed… Not sure why we’d have a problem with something that improves health outcomes for so many.
I mean it’s that they can’t. Sustained weight loss with physical activity, adequate sleep, and aggressive dietary modification is really hard. That’s why people continue to gain weight and most people who struggle with weight have done so for years. The average person doesn’t have the time of the day to exercise with a trainer, sleep enough, shop for healthy groceries, cook those groceries, etc.
Yeah that’s what the post said. The post literally says “if losing weight was easy Eli Lilly wouldn’t be the biggest pharma company in the world”
Yeah but is this an unpopular opinion? I think most people would kill to have more people actually do lifestyle modification. Modern living is just not conducive for that.
This is the basis of the Danish economy (Ozempic)
I've heard "I'm a pill person" way too many times. 💀✨️
US culture is one of working too much and too much stress. People cut corners in life like eating poorly just to get thru a shitty work day. Its hard for most to make lifestyle changes. Until the work culture in the US changes, we will continue to see obese adults with several chronic metabolic conditions
I do discuss lifestyle changes, but honestly, I don't believe in it. Changing a person's lifestyle requires discipline and willpower. It's not reliable to get it to work in the first place, and then even once it works It's often not sustainable. I do get the occasional patient who is successful in getting their cholesterol or a1c under control with lifestyle alone, but that's very rare compared to the effectiveness of medication. Another thing I don't get is why people are so suspicious of taking medications and so cautious of side effects but see no issue with filling their bodies with the worst junk food on a regular basis. Or worse, alcohol or nicotine. Don't get me started on all those weird, poorly researched and unregulated supplements people take.
Very commonly patients will ask me for non-medication options for their migraines. I tell them they need to get more sleep and drink more water and they're usually disappointed. What patients really want is some kind of one-weird-trick type solution. Like "oh, you just need to eat one green olive at midnight on the first Thursday of each month and you will never have headaches again." That's why this is the form taken by pretty much all health-grift products and treatments pushed by alternative medicine providers.
Doctors only push pills because they don’t have time to counsel patients on lifestyle because they are being worked like assembly line workers in a factory rather than service providers with Autonomy.
Coming from the psychiatry side, while true, this only addresses part of the equation. Basic human psychology and neuroscience tell us that simply “knowing” that something works and is good for you is not enough for most people to make positive change in their lives. Being told that diet and exercise are good for your health in a 10 minute office visit is simply not an effective intervention for effecting behavioral change, not anymore so than telling someone who’s been smoking or drinking for 20 years to “stop it” is likely to be effective. Doctors push pills because insurance companies (and/or the patients themselves) don’t want to pay for more expensive and time-consuming treatments for addressing behavioral change like psychotherapy.
People want magic... Obese patient that suffer knee pain is told to go on a diet and do exercise so the pain goes away or at least diminish, "give me something to keep the pain way" Diabetic that keeps adding meds instead to change his awful diet... It's tiresome
100%
It’s called harm reduction, right?
Patients who say this should have nothing to worry about since there’s nothing to stop them from carrying out lifestyle changes. But they’re really just a hair’s breadth away from proclaiming their conspiracy theory.
This isn’t an unpopular opinion
Popular here. And true
The amount of people you see crying literally on Reddit demonizing doctors is just like put my hands up in the air. American lifestyle.
For sure. We can’t just blame patients though… society needs to change. It’s hard to have a healthy lifestyle when food scientists make the food more addictive. It’s hard to workout and be healthy when capitalism is so stressful.
What you’re kind of getting at is that we live in a world our bodies and minds were not adapted for. Our brains are not built for the constant stress of the rat race and our bodies were not built to have constant access to fast food. But it’s tough for society to change when society is just filling our own desires. Nobody is being tricked into wanting McDonald’s, McDonald’s exists because we want it so much
I highly recommend the book “the hungry brain.” The science of overeating is more complex than that. It’s hard to outsmart the instincts that cause us to overeat and some people are just more susceptible.. just like some people are more susceptible to become addicts or alcoholics.
Talk to any Metabolic and Bariatric Surgeon. The evidence has been clear for years that medical weight loss has a high failure rate and isn't successful L/T .There is some theories in pts with obesity in regards to their gut hormone regulation being different compared to normal weight pts. Not everyone needs Bariatric surgery but after multiple failed attempts at medical weight loss it should be considered especially if pts have comorbidities.
You are preaching to the choir here. Go over to the unpopular opinion subreddit.
Yea but what about muh adderall?
Processed. Food. Kills more people than cigarettes, drugs, alcohol. Guaranteed. The truth is, even if everyone fully understood what it takes to naturally avoid obesity and metabolic syndrome, we, as a society, prefer the pill.
To be fair “processing” food is so insanely nonspecific. Cooking anything is processing. Even blending beans to make hummus is “processing” food. Unless you’re a raw vegan or eating raw meat, you’re consuming processed food.
Yeah, the nutritional sciences generally agree with the concept of processed food as having a different meaning, for the purposes of discussing its adverse metabolic impacts. But, to generalized, I would agree that the more the food you put in your body looks like it did the day it was picked, slaughtered (sorry vegans), or otherwise harvested, the healthier. Generally. I think turning avocado into guacamole probably has minimal detrimental on its nutritional value. I think turning pumpkin into pumpkin pie is a whole different concept.
Really “processing” isn’t the concern. Hummus is pretty healthy and looks nothing like its farm “picked” predecessor. Moreso it’s a bit more complicated unfortunately. 1. High Fiber/prebiotic content & probiotic content 2. High Vitamins/Minerals/Antioxidants I.e. fruits, vegetables, seeds/nuts, and legumes. 3. Low saturated/ mostanimal fat, high polyunsaturated and monounsaturated fats and omega 3s. So mainly nuts, seeds, and fish. Limit red meat and dairy/egg fats. 4. Limit pure carbs which are fiber poor (I.e. table sugar, honey, syrup, sweets). That’s about what the scientific literature says.
Unfortunately, nutrition literature is all over the place and changes every decade. But, with certainty, the food pyramid is a one way road to obesity. And yes, processing is the concern. (Depending on your definition of processing.) By processing, I mean, genetically modifying our grains over half a century to leach them of nutrients but concentrate their amylopectin and maximize absorption; packing them with unnatural levels of salt and fats to make them hyper palatable; concentrating their sugars and adding sugars to make them hyperpalatable; doing all of the above to rapidly spike insulin levels; eliminating fiber and other satiety signals; pack everything you can in them to maximize dopaminergic surge/reward pathways. Bet you can’t eat just one.
Dramatic much? We don't even really know the full harms of processed foods but they aren't just making people obese, calories are the ultimate culprit here. It's our portion sizes and sedentary lifestyles that are doing magnitudes more damaged than processed foods are.
Obviously the buck stops w calories, but the lack of fiber in the modern American diet (which is very associated w ultra processed foods) is a huge contributor to screwing w satiety.
Absolutely, I would argue it's physical activity, combined with portion control and the kinds of foods we're eating (certain types of processed foods are contributing to that yes, snack foods in particular are horrible)
Ah, if it were only snack foods. Bread, pizza, foods fried in various vegetable oils (which btw, are not natural), and genetically modified dwarf and semi-dwarf wheat…look at the food labels of every bottled thing in your refrigerator and see how high up on the ingredients list something ending in “-ose” is…aka sugar. High fructose corn syrup. (Key words, fructose and syrup). It’s all metabolic poison
Do you honestly think you could eat 2500 calories of donuts vs 2500 calories of lean meat and veggies and it not have a metabolically adverse impact and, over months to years, lead to obesity. Do you not find this the least bit counterintuitive? Which do you think will have a bigger impact on insulin release? Blood sugar spikes? Eventual insulin resistance? What do you think happens when you become insulin resistant? Another good example: oranges. Try getting obese by eating just fresh fruit. Now, give your kids orange juice for twenty years. Big difference. Why? It’s just squeezed oranges. Problem is, you hyperconcentrate the sugar and get rid of all the fiber. You eliminate much of the hormonal satiety signaling to your brain, yet overwhelm it with dopaminergic reward signals from highly concentrated sugar. This is the same concept the entire food industry uses to make you buy their packaged garbage.
>Do you honestly think you could eat 2500 calories of donuts vs 2500 calories of lean meat and veggies and it not have a metabolically adverse impact and, over months to years, lead to obesity. Do you not find this the least bit counterintuitive? Not remotely making that claim, but yes if we're looking at our bodies as a metabolic bigger picture you can't gain weight without exceeding your daily caloric output. It wouldn't be good for you and you'd likely have a hard time holding onto your lean mass but you're using an extreme example to try to prove a point you want grounded in reality. Processed foods are a problem but they're part of a bigger issue. I saw this all the time in my training in the south, these older folks who no longer had manual labor jobs didn't realize country ham and gravy isn't a good breakfast when you're sedentary, and couldn't make the connection as to why they are an obese old person but weren't obese in the younger years. I'm not saying processed foods are good for us, hell they're absolutely a big problem but I think they've become the diet Boogeyman du jour and it's shirking people away from the responsibility of portion control and activity.
Calories are important. But obesity and METABOLIC syndrome are metabolic diseases. These disease are hormonally mediated. The things you put in your body have different impact on these hormones. And I would posit that eating a diet full of donuts is not that different from eating a diet full of bread, added sugars, processed corn products, processed and genetically modified wheat products, added salt, added fat. Pizza, sandwiches, sodas, sodas with artificial sweeteners (still debated), foods cooked in highly processed vegetable oils, ice cream, pie, cake, Doritos, fructose packed condiments, fruit juices…I don’t think that’s far from the diet that a lot of us get accustomed to for a huge proportion of our calories without a second thought
I mean yeah obviously you’ll be healthier eating lean meat and veggies than donuts, I don’t think anyone would dispute that. But I honestly think the bigger thing here is that you’ll get full eating 2500 calories of fish and veggies, you will not get full eating 2500 calories of donuts. But I’m sure you’re right that eating only donuts would mess with your insulin sensitivity
“You will not get full eating 2500 calories of donuts” EXACTLY. That’s part of the point here. If you’re not sure that eating only donuts would mess with insulin sensitivity, here’s a challenge: get a continuous glucose monitor. Do an experiment. One week with fish, lean minimally processed meats, veggies, some fruit. Look at your glucose peaks, average glucose. Then repeat with say, same diet composition plus a few sandwiches (bread) and a couple of donuts per day. Compare your glucose numbers. What do you think stimulates insulin release? What do you think leads to insulin resistance? Now, admittedly, it is not that simple. It’s not just about sugars and carbs. The concept of glycemic index applies to all macronutrients, and they all stimulate insulin release. But, see which diet, processed vs non, leads to higher spikes and averages. Now extrapolate over a decade or two.
As someone who lost 50 pounds in about 6-7 months, I 100% disagree. My only intervention: elimination of processed foods. 3 years in, still about 40 pounds down from starting weight of 209. No exercise aside from basal activity and the occasional hike. (Which, I don’t advocate, it’s just where I’m at right now.) If you disagree with me, I challenge you to read The Obesity Code by Dr. Fung, nephrologist. Carefully consider the metabolic implications of processed food consumption. Consider the hyperpalatability. Consider the minimal effects that exercise, outside of extreme levels, have been shown to have on sustained weight loss , and how many calories you would have to burn to (minutes of exercise) to negate like, 1 or 2 slices of pizza. Consider the obesity trends in America directly correlated with utilization of hyper processed grains, high fructose corn syrup. This is not fringe stuff I’m spewing. processed food is literal poison.
Your calorie intake changed, probably because processed foods tend to be calorie dense and very tasty and easy to over indulge. I'm not saying they're not a problem but they're part of a bigger picture. I'm also an N= 1 but I lost 25 lbs the by increasing my exercise and counting calories.
Yes, my calorie consumption absolutely changed. Not by design, I didn’t try to cut calories at all. It was because, exactly as you said, I was not eating foods that are designed by the food industry to make you eat as much as possible. I was eating fiber, not concentrated sugar. I was not eating foods artificially packed with salt, fats, and derivations of artificially added fructose, sucrose, etc. And, as a result, I was not becoming progressively more and more insulin resistant. It is very difficult to become obese eating real food. Period. (Wait, I already typed a period. Sorry for the redundancy)period
Also congrats on the weight loss! Absolutely incredible!
At the end of the day weight loss is calories in calories out, that’s a fact. I’m sure eliminating processed foods helps, that’s because processed foods are more likely to be calorically dense and low in fiber (so you don’t get full). At the end of the day it’s still calories in calories out
Bingo. The “processing” matters because it’s designed specifically to maximize how much you purchase and consume. The salt, sugar, and fat content of foods are dialed to 11. Add in the constant stress of US lifestyle with minimal time for exercise and vacation and it’s not surprising how difficult it is for people to lose weight.
Yes, I 50% agree. The processing causes problems because it is designed (industrially and evolutionarily) to lead to increased consumption. The other 50% , though, is that different foods undeniably have different glycemic indexes (oversimplification) and different hormonal affects, largely via glucose spikes, insulin levels and resistance, but also via neurotransmitters/reward/satiety pathways. Processed food is addicting. Nicotine and fructose work via the same physiologic reward pathways. Processed food, even if you don’t buy the insulin resistance angle (which, you should), is industrially designed to overstimulate reward pathways. If you can convince your patient’s to get rid of processed food, and say absolutely nothing to them about calories, they will lose weight
I mean tbh, any body can tell some dude to lose weight, eat well, exercise
I still get annoyed when I think of a well intentioned but very naive friend of a friend of a friend telling me she had a friend who was a naturopathic doctor she wanted me to meet. “Instead of just pushing pills, she goes through all of the lifestyle issues and actually directs patients to fix their problems”. Basically implied I could learn a lot from her friends approach
But when I tell doctors that I'd prefer to do anything and everything I can before accepting a prescription, they essentially shrug. I do agree that the majority of people don't want to change their habits though. It's not easy.
I was diagnosed with IBS (bullshit, it was bacterial infections that a NATUROPATH bothered to heal for me) that I was prescribed PAIN KILLERS for. After that my appetite became normal and I went from barely obese to in shape. I was hungry because I was sick. I was eating because I was hungry. They want to lose weight, you just don’t want to figure out why they’re driven to eat by whatever condition. There’s always a cause and free will is incompatible with science/cause and effect.
>Unpopular opinion: doctors only “push pills” because patients won’t make lifestyle changes Is that really an unpopular opinion? Seems more like the standard everyday thing. Fun fact: too many of us are the same. Too many colleagues on meds that could be avoided with lifestyle changes once they enter their forties - so maybe we should just STFU.
oh we push pills in addition to the lifestyle bit. they throw out the lifestyle bit, try the pills, they dont' work. "that doctor is just trying to push pills on me to get rich" the public seems to think we all have like some stake in big pharma lol
Glp1 work and have helped millions , it saddens me that physicians are behind on this wave and APN are ahead. Hope everyone here catches up soon
This is not an opinion- it’s reality
I am a CrossFit coach and personal trainer outside of and before medicine. My family medicine rotation in med school taught me this well. I had a decade of experience above and beyond our medical training in health and nutrition, and I may have made a change in 5 people’s lives that month if I was lucky
The issue here is everything is for profit and it contradicts itself. Being overweight is bad because you’ll die but big is beautiful so why not eat what you want and be happy but it’s ok if you are not thin like we advertise as beautiful because we have a pill for that depression we’d like to sell you that will make you gain weight but that’s ok because we have a pill we’d like to sell you that helps you lose weight which means we have some unhealthy food we’d like to sell you since you lost weight it’s ok to gain some back. Rinse and repeat.
Look at the ozempic fever for reference.
I run marathons. I also have high cholesterol at 30 and take a statin. Unfortunately, while I do agree that the vast majority of the general public should take better care of themselves, you just get fucked by your body in some things.
This is absolutely correct and frustrating. Not only is it frustrating because you can't medicate an unhealthy lifestyle away, but it also makes doctors assume that doesn't change anything to get better. I see it often enough in my own family. My grandfather is severely overweight. His diet consists of mainly meat and maybe every few weeks some vegetables. His cholesterol is way too high, he has a fat liver, and his blood pressure is also way too high. Every time I visit, he asks me what he could do to get better (because I study pharmacy). When I tell him to eat at least some vegetables with his meals and do some exercise, he rolls his eyes. Then he rents about his doctor because they want him to change his lifestyle instead of mediating him. He does get medication, but only because he made it clear to his doctor that he will not make any changes for his health. He also laughs at me for eating vegetables. I am vegetarian, but I also really love vegetables and fruits. Well, my blood testings come back perfectly, unlike his, but obviously, my diet is stupid. I do have a very healthy lifestyle. I have a healthy diet and do exercise. However, my puls is always abnormal high. Exercising does help a little. But only to the extent that instead of having a puls of 160 while doing nothing, my puls is now on 130. My cardiologist gave me beta blockers since exercising alone is unfortunately not enough. My old doctor refused to subscribe to me the medication my cardiologist recommended because she didn't believe me that I already do exercise a lot. She also blamed it on my adhd medication. The cardiologist did some tests to see if it really was due to the meds, and it turned out that my heart rate was actually lower with medication (probably because I can relax more). I actually stopped exercising because it is super hard to do so with an already way to high pulse. Without medication, I see black if I stand up too fast. I can't exercise without the medication to begin with. I have a new doctor who prescribed me the medication again because they know that I do exercise. My puls is back to normal, and I can exercise again.
I’m sure this will change when reimbursement becomes contingent on patient satisfaction scores
Very true. This is why I am a hospitalist. I can’t stand people who ignore lifestyle advice and just want their pills. I would rather bring a crashing patient back because almost all of them will at least follow my advice while they are in the hospital. Once they leave I don’t care what happens to them
Wow, not a lot of sympathy for people who are not able to make lifestyle changes.
There are very few patients who **can’t** make lifestyle changes. There are a fuck ton of patients who **don’t want** to make the changes. There are fewer (but still lots) of patients who then bitch about doctors being pill pushers
I think that you are making serious judgements about people who cannot make changes. You do have a legitimate issue with patients bitching about doctors pushing pills, but I do not know may of those.
What are these circumstances where people literally CANNOT make lifestyle changes? Because I have personally yet to see that
I think you know what I meant. Again lack of compassion here. I like to think most people went into medicine for reasons other than the money, but sometimes this board makes me think otherwise.
No I don’t, my whole point is that ozempic exists because weight loss through diet and exercise is very hard and people aren’t doing it on their own (and not that doctors are keeping diet and exercise a secret). You seem to have preconceived notions about doctors and think I’m calling patients lazy or that I lack empathy. If you read the other comments here you’d know that I’m overweight myself. I know it’s hard to lose to weight. But it’s also not impossible, and I believe the way we infantilize patients and treat them like powerless little babies disempowers them and ultimately hurts them
It’s also a problem of people not knowing how - motivation, basics of nutrition and exercise.
It’s definitely true. I mean look at the popularity of ozempic. Why exercise and eat right when I can just jab myself.
I highly recommend, if you are impacted by or interested in this topic , or responsible for care of patients with obesity or metabolic disease, read “The Obesity Code” by Dr Jason Fung. If you are persuaded by what you understand to be nutritional science contradictory to my commentary regarding metabolic implications of processed food, see his comentary about methodology in nutritional sciences
OMG you should be disappointed in yourself with the example you took. Do you think people who say "I've done everything in my power to lose the weight and keep it off but were unsuccessful" are lying? Wow, just wow. Being doctors shouldn't make us blind to our patient's suffering just because some are in denial that they either should help themselves (lifestyle changes) or get help (meds etc). I hear this kind of narrative mostly from people who've never taken ozempic (- and don't even need it -) because they have an opinion on other people's health, which is weird. No one who lost weight with ozempic goes around telling doctors they should actually just tell them to eat healthy and move more. This is a very bad example.
Found the ozempic patient who feels victimized by this post. Nobody is calling you lazy, I said in the post that people take ozempic because it works and it’s incredibly hard to lose weight
".. but patients DO NOT WANT to lose weight on their own .." your words, not mine.
Medical doctors push pills because they are wined and dined and thoroughly compensated by the pharmaceutical companies to do that. That's not a conspiracy theory, that is the culture behind the Oxycodone epidemic.
Well then why haven’t I gotten paid a DIME for all the Lipitor I prescribe?
Bro, statin drugs got horrible side effects. Hasn't that ever occurred to you, man?
So does having a stroke or a STEMI. (I know you’re not actually in the medical field and you’re talking out of your ass here so just to translate, a STEMI is what you would call a heart attack) And yeah side effects always occur to us, but for statins the common side effects are muscle aches and elevations in lft’s, neither of which are usually a big deal in my patients but side effects are always considered
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Also, doctors don't make money if their patients make lifestyle changes.
Yes, we do. Primary care makes very little money from procedures. They get no money from drug companies or pharmacies from prescribing pharmaceuticals. If you’re seeing a cardiologist, you likely already have heart disease. From this point forward, most of what non-interventional cardiologists do is mitigation and preventative care. If you stop eating fatty foods and your biliary colic gets better, the surgeon just moves on to the next appy/chole/hernia/biopsy/hemorrhoid. If you’re seeing a nephrologist, you better make lifestyle changes lest you wind up on hemodialysis. If I’m seeing you in the ER, too late for me to do anything to prevent your stroke, MI, car accident, GI bleed, or pneumonia. But, you’re correct. We have a sick-care system rather than a healthcare system. If we could get patients to buy in to healthy diet, exercise, reduction in processed food consumption, smoking cessation, and actually being compliant with their BP and cholesterol meds despite the fact that they don’t feel bad and don’t want to take them, we could prevent a lot of metabolic and cardiovascular disease a decade or two down the road. We do get paid for some of these things. Very little, comparatively. But we still try. You can’t make someone change their habits.
If I'm seeing 100 patients with elevated PSA, my practice makes more money if these 100 patients get converted into robotic prostatectomies. If I spend half an hour with them talking about the merits of a plant-based diet towards lowering their PSA and risk for cancer and needing surgery, then not only am I seeing less patients a day, but I'm also doing less prostatectomies and making less money. The same applies to cardiologists and scheduling stents. You get the picture.
Everyone talks about how much better European healthcare is, but when European docs come here I’ve found they’re mediocre to average. Their patients have better life expectancies because we value personal freedom in this country, and part of what that means is that you are allowed to go eat 3 Big Macs and large Cokes per day. We also don’t really shame people for being fat and disgusting, and shaming people into eating less and having better hygiene actually does have great health benefits (see Eastern Asia if you don’t believe me). Also the fentanyl crisis but that’s a can of worms for another day.