HEALTHCARE IS ALL ABOUT WHO PAYS FOR WHAT

[jaeger19]

It's not a fad....

I agree - as I said very early on, our system is broken, and all the incentives are to ignore the obesity, let the obese stay that way, then make money treating all the chronic illnesses.

Epidemiological evidence is very, very weak. If you spend 5 minutes you'll find studies of the same data set that find no association between carbs and risk of disease/death, and that if one controls for diet quality - i.e. treats those who eat whole foods as a different diet than those whose carbs came from cokes and white bread and cake - that low carb diets reduce risk, and that high carb diets can also reduce risk, if the carbs are quality/whole foods. So what kind of carbs matters - broccoli =/= cake with frosting =/= sweet potato/carrots/squash =/= waffle with maple syrup. That's ****ing obvious, but your study ignored that entirely.

So you can find what you want in the data, which makes them virtually useless for nutrition. We found "associations" between fat and heart disease 60 years ago and that myth still won't die. They forgot to account for smoking.... So we got low fat foods, laced with sugar, recommendations to BASE our diets on highly refined carbs, breads, pastas, which is garbage food for the keto crowd and vegans, something everyone can agree on today. We still live with that mistake - look at your 'yogurt' aisle. Lots of fat free yogurt, with 25g of added sugar. HEALTHY!!! That's from epidemiological studies and 'associations.'

But 220g of carbs per day, 40% of caloric intake per day - what the study called "low carb" - is NO ONE'S DEFINITION OF LOW CARB. You can't have any grasp of the theory behind LCHF or keto and expect any of the benefits of an LCHF diet consuming 220g of carbs per day, and the authors knew it. The upper limit is something like 100g per day, and that's for people in reasonably good metabolic health, which would exclude the 122 million in this country with T2 or pre-T2, and that's who the diet is aimed at.

The reason they should be tried is they work, they actually reverse diabetes, get people off drugs, off insulin, no longer subject to wild swings in blood sugar. People feel better, they lose weight, mental health often improves, the diet reverses NALFD, lowers blood pressure.

We also know what doesn't work in the long run - the alternatives. Using the standard treatment, diabetes is chronic and progressive, more insulin, more weight gain, more insulin, more weight gain, hacked off limbs, blindness, and a dozen or so chronic conditions tied directly to obesity and T2, including a greater risk of cancer, heart attack, stroke.

No, the diets aren't for everyone, but they ought to be a standard, recommended option, because they work better than anything else. And you can't have long term data until people in enough numbers are on the diet long term, and have support from their doctors, nutritionists, counselors, etc. along the way.

1. We will see.
2. The system isn't broken. The healthcare system has never been designed for preventative medicine.
What's the problem is huge societal changes that have led to an explosion of obesity.
3. Yeah no. There are good studies out there.
The problem is always the fads that build around them by lay people that want to capitalize on the findings.
Frankly..we may find out some of these low carb high fat diets are more of the same.
4. If the only way that a low carb high fat diet can show long term gains is if" have support from their doctors, nutritionists, counselors, etc. along the way."
Then frankly it's impractical.

 

[jaeger19]

Around me, about 80% of the over 50 are vaccinated. That's different than less than 1%.

I asked you to show me where the ADA does, and you cannot. You can try the AHA, or any other mainline group. You'll fail. You can't find those recommendations in FDA recommendations or CDC recommendations. Here's the CDC page on diet for diabetes. 3/4 of that plate is carbs - non-starchy is half, starch like high carb potatoes, carrots, etc. is 1/4. 1/4 is lean meats/proteins. There's no fat recommendation - lean meat. That's a high carb, low fat diet plan.

And I don't want to make this combative, but when you refer to keto as a fad, you really cannot be recommending it to your patients, because you don't believe in it, either don't want to recognize or reject the entire theory behind the diets.

Again, if you're interested listen to some podcasts by people, doctors like you, doing this every day. One tool that many find near miraculous in teaching patients are CGMs. People can see, in real time, all day, every day, how what they eat affects their glucose levels. If they try keto, they can see nearly straight lines for DAYS. Or they can see 'heart healthy' oatmeal, with bananas and some OJ shoots glucose over 200. Then try bacon and eggs - nothing, not a blip. Is bacon and eggs for breakfast, giving up your latte with skim milk, or cream and sugar in coffee, but all the heavy cream you want, worth rock solid glucose levels, no insulin? It will be for some people, although it's very hard at times. I miss pizza, ice cream, bread, cookies, cake, crackers....



Then when they KNOW, maybe they make the commitment. They can choose - shooting insulin every day, OR a pretty drastic lifestyle change that makes them healthy, feel better, etc.

1. Good for your area. We are at 40%. For vaccination. Guess it's the fault of the medical providers huh?
2. Naw..I call it a fad because it's over tge top. Look at you practically frothing at the mouth about how great it is for you..and look at these doctors recommending it.oh and their pod casts about it...gosh it's a game changer..oh and let's just ignore any evidence that it might not be healthy in the long term
I am honest with my patients. Keto diet/ low carb high fat diets have shown short term gains. They work for some people..if it works for them great. However I certainly also tell them that there may be problems with the diet long term. There also other diets that also show results. The best thing is to try.
Sorry that it upsets you that I am skeptical of the holy grail you have found. But I have read the research..not just what those that like and have a fiduciary interest in keto/lchf diets present.
3. Sure. Cgms.. because of course my poor patients can pay for a cgm.. when insurance doesn't pay because they are not clinically diabetic yet. Even if diabetic ..if on Medicaid they may not qualify.

 

[JasperL]

Some of them care, just not enough to change. It's that simple. It is no different than smoking. They are addicted to eating, they generally enjoy it, and changing that is difficult and they are too mentally weak to manage it.

Ok, 80%? 90%? 98%? It is the overwhelming majority who have it in their power to get it under control but just don't.

You really don't have any understanding of the issue, and I know you don't really care to learn. If you're only interested in fat shaming, you can have it.

Fair or not, it is the person's responsibility to manage their weight through diet and exercise. Look at your position on this entire topic. America needs to reduce healthcare costs, you then go on to defend the patients who are driving the vast majority of healthcare spending. Do you know how much of our healthcare system is built around taking care of people not taking care of themselves?

To the bolded, yeah, I do, which is why I pointed out that the financial incentives, across the board really, for the FDA, USDA, hospitals, doctors, drug companies, food companies, corn farmers, wheat farmers, and much more are for the obese to remain obese and treat their problems. It's a ****ing national disgrace.

I defend the obese because our entire system fails them. I live in the south and about 70% are overweight, and go into deep red state rural areas where there's lots of blue collar manual labor, and every other person is obese, and I know they work their asses off and are good people. I hate their politics, but I know they're hard working, decent people who are fat and they'd rather not be fat. They can work two jobs, raise their kids, but you're telling me they're worthless, fat, POS slobs with no self discipline. if you want to tell them that to their face, please do. Let me know so when and where, which Baptist Church you'd like to visit and let them know what you think about half the congregation, so I can watch. Or you can go to a UT football game, and start calling them out as they enter the stadium. There will be about 40,000 clinically obese - you'll have plenty of targets. Tell me the game and the gate number!

 

[JasperL]

1. We will see.
2. The system isn't broken. The healthcare system has never been designed for preventative medicine.
What's the problem is huge societal changes that have led to an explosion of obesity.

Right, but it we can't identify the problem, and it sure looks like refined carbs and sugar to me, for starters, then we cannot hope to solve it. That's why the CIM theory makes sense. It explains how we got there - look at the middle aisles of your local grocery, and about everything in a box is that - and so how to solve it. Keto isn't the only answer, just cutting out refined, processed garbage would do the heavy lifting on any carb level. Fasting works great too, and that's easy - don't eat for 16-18 or 20 hours a day. Then eat whatever. Doesn't work for everyone but the insulin drops, allows us to access stored fat, and that's the goal.

3. Yeah no. There are good studies out there.
The problem is always the fads that build around them by lay people that want to capitalize on the findings.
Frankly..we may find out some of these low carb high fat diets are more of the same.

The diets are not the product of "lay people" but incredibly bright scientists, researchers, doctors. You are clearly dismissing something that you've not really investigated. Seriously - read the Obesity Code, or get it on tape and listen while you're driving. Gary Taubes has several books - any of those on this topic will do. If you have an open mind, I think you'll be persuaded it's not just a fad. The science is compelling, the studies are there, the theory makes sense. Lots of researchers don't agree, obviously, but the more I look and read the more I'm convinced a lot of that are people defending their turf, not wanting to admit they've got it so wrong for decades.

4. If the only way that a low carb high fat diet can show long term gains is if" have support from their doctors, nutritionists, counselors, etc. along the way."
Then frankly it's impractical.

You missed my point. You are showing me that the diet does not have your support, at all. Nutritionists recommend CICO, say a calorie is a calorie, doesn't matter what you eat. Avoid fat - too many calories per gram, heart disease!! What's that gotten us? Five decades of health getting worse every single year, with no let up in sight. Why defend that? It's failed.

 

[jaeger19]

Right, but it we can't identify the problem, and it sure looks like refined carbs and sugar to me, for starters, then we cannot hope to solve it. That's why the CIM theory makes sense. It explains how we got there - look at the middle aisles of your local grocery, and about everything in a box is that - and so how to solve it. Keto isn't the only answer, just cutting out refined, processed garbage would do the heavy lifting on any carb level. Fasting works great too, and that's easy - don't eat for 16-18 or 20 hours a day. Then eat whatever. Doesn't work for everyone but the insulin drops, allows us to access stored fat, and that's the goal.

The diets are not the product of "lay people" but incredibly bright scientists, researchers, doctors. You are clearly dismissing something that you've not really investigated. Seriously - read the Obesity Code, or get it on tape and listen while you're driving. Gary Taubes has several books - any of those on this topic will do. If you have an open mind, I think you'll be persuaded it's not just a fad. The science is compelling, the studies are there, the theory makes sense. Lots of researchers don't agree, obviously, but the more I look and read the more I'm convinced a lot of that are people defending their turf, not wanting to admit they've got it so wrong for decades.

You missed my point. You are showing me that the diet does not have your support, at all. Nutritionists recommend CICO, say a calorie is a calorie, doesn't matter what you eat. Avoid fat - too many calories per gram, heart disease!! What's that gotten us? Five decades of health getting worse every single year, with no let up in sight. Why defend that? It's failed.

1. Well there you go. A large part of the problem isn't that doctors give bad advice..its because of societal changes.
Like going into a store and seeing boxes of cereal made with high fructose corn syrup.
Like sending my kids off to school and their school breakfast consists of a cinnamon pastry..or a breakfast burrito filled with mostly potato..
Oh and lunch is fries and a corn dog and if you want something to drink you can find energy drinks and soda in the vending machines..
2. No the diets are often by lay people who market their books and products. And many food crazes..like " look low fat frozen yogurt that has to be a healthy snack it's low fat" comes from marketing lay people not scientists .
3. Nutritionists don't recommend a calorie is a calorie. Good Golly miss may is that wrong. Seriously do you really think a nutrientionist is saying..
" look go ahead and drink a can of Pepsi because it has the same calories as non fat milk ???
Come now man..stop being silly.
Calories do matter though. If you eat 6000 calories a day on your keto diet..
And your metabolic burn is 2000 calories a day...you gonna gain weight.

 

[JasperL]

1. Good for your area. We are at 40%. For vaccination. Guess it's the fault of the medical providers huh?

99% failure is evidence the advice fails. If it fails 99% how can you possible defend it as good advice?

2. Naw..I call it a fad because it's over tge top. Look at you practically frothing at the mouth about how great it is for you..and look at these doctors recommending it.oh and their pod casts about it...gosh it's a game changer..oh and let's just ignore any evidence that it might not be healthy in the long term

Show me that evidence, and no, a epidemiological study that looks at people not on a LCHF diet isn't evidence the diet they are not following is harmful.

I am honest with my patients. Keto diet/ low carb high fat diets have shown short term gains. They work for some people..if it works for them great. However I certainly also tell them that there may be problems with the diet long term. There also other diets that also show results. The best thing is to try.

What diets are those? The ones that fail 99%? Show me a study of the diets that work....

Sorry that it upsets you that I am skeptical of the holy grail you have found. But I have read the research..not just what those that like and have a fiduciary interest in keto/lchf diets present.

You're dismissing without examination. And it's irrational on that basis. The bariatric surgeon has a "fiduciary interest" in a steady stream of obese patients, as does the endocrinologist and the drug makers and the hospital chains and the orthopedics replacing joints for the obese who wear them out, the biggest food companies in the world selling garbage foods, the corn farmers getting huge subsidies, the soda companies, etc..... The doctors doing the podcasts are hurting their professional practices by choosing to do something not paid for by insurance, as you acknowledge. They are not following the money. It's much easier to give a 3 minute lecture, prescribe a statin, then blood pressure meds, then metformin, then insulin, and get to see hot drug reps every day for the parade of drugs those patients need.

Some of these guys in other countries have had their licenses threatened for this advice. The attempts failed because at trial they had the evidence the diets work. Studies. Science. So they are not doing that for the money but because they care about helping patients.

3. Sure. Cgms.. because of course my poor patients can pay for a cgm.. when insurance doesn't pay because they are not clinically diabetic yet. Even if diabetic ..if on Medicaid they may not qualify.

There are lots of patients who CAN afford the $300 or whatever and then save their lives. The point was these people are trying to make it work. Anything. I mentioned many other strategies they’re trying.

 

[jaeger19]

99% failure is evidence the advice fails. If it fails 99% how can you possible defend it as good advice?

Show me that evidence, and no, a epidemiological study that looks at people not on a LCHF diet isn't evidence the diet they are not following is harmful.

What diets are those? The ones that fail 99%? Show me a study of the diets that work....

You're dismissing without examination. And it's irrational on that basis. The bariatric surgeon has a "fiduciary interest" in a steady stream of obese patients, as does the endocrinologist and the drug makers and the hospital chains and the orthopedics replacing joints for the obese who wear them out, the biggest food companies in the world selling garbage foods, the corn farmers getting huge subsidies, the soda companies, etc..... The doctors doing the podcasts are hurting their professional practices by choosing to do something not paid for by insurance, as you acknowledge. They are not following the money. It's much easier to give a 3 minute lecture, prescribe a statin, then blood pressure meds, then metformin, then insulin, and get to see hot drug reps every day for the parade of drugs those patients need.

Some of these guys in other countries have had their licenses threatened for this advice. The attempts failed because at trial they had the evidence the diets work. Studies. Science. So they are not doing that for the money but because they care about helping patients.

There are lots of patients who CAN afford the $300 or whatever and then save their lives. The point was these people are trying to make it work. Anything. I mentioned many other strategies they’re trying.

1. 99% is evidence of non compliance. Do you seriously belief if a doctor in the 15 minutes to discuss the patients knee pain and says ..you should lose weight ..here is a keto diet plan..the vast majority of the patients will comply? But if he says you should lose weight diet and exercise ..they won't.
All I have to do is say the magic words " keto" and the pstient complies? Or do I have to click my ruby red slippers first ?

2. Yeah a study that shows a reduction in carbohydrate versus fats potentially causes long term problems is evidence that perhaps a keto diet is not beneficial long term.
What's your argument...smoking 1 pack a day may be harmful but that in no way suggests 2 packs a day is harmful. ?
3. The only one dismissing without critical examination here is you.
You don't go to see a bariateic surgeon as the first stop. The general practitioner does not have a fiduciary interest.
The hospital does not have a fiduciary interest in obese patients. They cost more without reimbursement..need more services without reimbursement and have way more liability. A healthy patient with a bad knee..is in and out of surgery and home and garners far more profit than the obese patient that has the same drg..but more complications..like sn over night stay and more therapy etc.
In fact many of my colleagues will not do orthopedic surgeries on knees and hips and backs unless the patient loses weight first.
4. You know..I figured it out..
You keep talking about what med ical providers and nutritionists and the medical system..but you are in no position to know
What these people think or the system..
I get it now.. you are listening to these podcast doctors who are telling you how the medical system is broken..and a the doctors and nutritional is have got it wrong
And just these podcast doctors have the answer...yep..follow the money..the podcast money...the advertisement money..speaking honorarium.. not to mention book deals speaking engagements..join my website and download my " free app"
( which pays them )

 

[bave]

You really don't have any understanding of the issue, and I know you don't really care to learn. If you're only interested in fat shaming, you can have it.

Self discipline. If you don't have it, I don't care and it shouldn't be my problem. You can try and blame everyone around you all day, but it doesn't change the fact that no one forced you to put that down your gullet.

To the bolded, yeah, I do, which is why I pointed out that the financial incentives, across the board really, for the FDA, USDA, hospitals, doctors, drug companies, food companies, corn farmers, wheat farmers, and much more are for the obese to remain obese and treat their problems. It's a ****ing national disgrace.

Ah yes, it is a massive conspiracy. All the doctors, providers, hospitals, employees, insurance companies, everyone wants fat people to stay fat, right? Again, there are a lot of people trying to take advantage of you every day. Whose fault is it when you let it happen? Do you blame the drug dealer for selling you drugs? The telemarketer for selling you an extended car warranty? No. Have some self control and respect.

I defend the obese because our entire system fails them. I live in the south and about 70% are overweight, and go into deep red state rural areas where there's lots of blue collar manual labor, and every other person is obese, and I know they work their asses off and are good people. I hate their politics, but I know they're hard working, decent people who are fat and they'd rather not be fat. They can work two jobs, raise their kids, but you're telling me they're worthless, fat, POS slobs with no self discipline. if you want to tell them that to their face, please do. Let me know so when and where, which Baptist Church you'd like to visit and let them know what you think about half the congregation, so I can watch. Or you can go to a UT football game, and start calling them out as they enter the stadium. There will be about 40,000 clinically obese - you'll have plenty of targets. Tell me the game and the gate number!

Yea, when you are morbidly obese you are completely lacking in self discipline, period, full stop. I live in Brentwood, I know all about Tennessee. You call someone fat nowadays and you are getting ripped apart on social media. Hell, they had to change the *medical* terms for obesity because of butt hurt fatties.

 

[bave]

That's a laughable concept since capitalism doesn't work that way. Did you think anyone wouldn't notice that?

Really? What % of the top 10% do you think are working 40 hour weeks? What % do you think got joke degrees from joke schools?

Where the easy money is. So much for 'work harder, get paid more'. You just debunked yourself.

Who said anything about easy? It is simply about better career paths.

Subtract healthcare costs from income in the US. Not to mention student debt, which follows you until you're dead.

Oh, you're another one of those "I want free stuff kids"? Got it. Make better decisions and you won't need to keep your hand out your whole life.

 

[Dans La Lune]

Really? What % of the top 10% do you think are working 40 hour weeks?

You didn't say how long, but how hard. I guarantee that an Amazon warehouse worker making $15/hour -- forced to work through bathroom breaks by wearing a diaper -- works harder than Jeff Bezos.

What % do you think got joke degrees from joke schools?

Not sure what you mean here, but elite schools are a means to foster connections with fellow elites so you don't HAVE to work had (compared to the lower classes).

Who said anything about easy? It is simply about better career paths.

If you can make 1000x more money than someone at a lower wage job who works just as hard, that's by definition easy money. Capitalism doesn't reward hard work and has. In fact, the very nature of capitalism is to have employees receiving less payment than their work is worth (thereby generating profit).

Oh, you're another one of those "I want free stuff kids"? Got it. Make better decisions and you won't need to keep your hand out your whole life.

We can safely say that I've debunked your original claim that hard work = more pay. This is not true, has never been true, and never will be true in the current system.

 

[bave]

Not sure what you mean here, but elite schools are a means to foster connections with fellow elites so you don't HAVE to work had (compared to the lower classes).

You think you are getting into an elite program without working hard? That's cute. No one walks through Wharton, Sloan, Yale Law, etc.

If you can make 1000x more money than someone at a lower wage job who works just as hard, that's by definition easy money. Capitalism doesn't reward hard work and has. In fact, the very nature of capitalism is to have employees receiving less payment than their work is worth (thereby generating profit).

You think there is someone making $15,000/hr (using your amazon distribution center example) that isn't working hard?

We can safely say that I've debunked your original claim that hard work = more pay. This is not true, has never been true, and never will be true in the current system.

This is precisely what someone who can't cut it would say. Blame the system instead of themselves. I have been a hiring director at some prestigous firms, you know what gets people in and up the ladder? Hard work and ability. You don't see people moving up who aren't putting in the work. There is an old saying "Hard work makes its own luck". What that means is that people higher up notice someone who is working harder than their peers and it is often rewarded.

 

[Dans La Lune]

You think you are getting into an elite program without working hard? That's cute. No one walks through Wharton, Sloan, Yale Law, etc.

How did ‘less than stellar’ high school student Jared Kushner get into Harvard? | Daniel Golden

Donald Trump’s son-in-law was accepted into the Ivy League university in the wake of a $2.5m pledge made by his parents

www.theguardian.com

College Admissions: How Billionaires (Legally) Pump Millions Of Dollars Into Their Children’s Schools

Unlike those caught up in the FBI college admissions sting this week, America’s billionaires don’t have to break the law to help their children get into the best universities—they can and often do wield their legacy and money instead. And they’ve been doing so for generations.

www.forbes.com

You think there is someone making $15,000/hr (using your amazon distribution center example) that isn't working hard?

Look, you put down the equation. Harder work = Better Pay. Are you saying that someone making $15,000 / hr is working 1000x harder than an Amazon warehouse worker?

This is precisely what someone who can't cut it would say. Blame the system instead of themselves. I have been a hiring director at some prestigous firms, you know what gets people in and up the ladder? Hard work and ability. You don't see people moving up who aren't putting in the work. There is an old saying "Hard work makes its own luck". What that means is that people higher up notice someone who is working harder than their peers and it is often rewarded.

Meanwhile the richest man in the world (Elon Musk) is the world's biggest fraud. But he works hard at it.

 

[bave]

Look, you put down the equation. Harder work = Better Pay. Are you saying that someone making $15,000 / hr is working 1000x harder than an Amazon warehouse worker?

Of course not, but that person is bringing the value to justify that compensation. What I am saying is that two people with equal skill sets, but one works harder will do better financially in life.

 

[danielpalos]

Of course not, but that person is bringing the value to justify that compensation. What I am saying is that two people with equal skill sets, but one works harder will do better financially in life.

Why not the one who is more moral and bears false witness the least?

 

[JasperL]

1. Well there you go. A large part of the problem isn't that doctors give bad advice..its because of societal changes.
Like going into a store and seeing boxes of cereal made with high fructose corn syrup.
Like sending my kids off to school and their school breakfast consists of a cinnamon pastry..or a breakfast burrito filled with mostly potato..

Oh and lunch is fries and a corn dog and if you want something to drink you can find energy drinks and soda in the vending machines..

2. No the diets are often by lay people who market their books and products. And many food crazes..like " look low fat frozen yogurt that has to be a healthy snack it's low fat" comes from marketing lay people not scientists .

That’s wrong. The products followed the low fat, high carb, sugar is fine official FDA dietary guidelines that control that school lunch, the one that said the core of a healthy diet was highly refined wheat, breads, pastas. That was THE standard for doctors and dieticians. The food pyramid.

3. Nutritionists don't recommend a calorie is a calorie. Good Golly miss may is that wrong. Seriously do you really think a nutrientionist is saying..
" look go ahead and drink a can of Pepsi because it has the same calories as non fat milk ???
Come now man..stop being silly.

The study you cited treats calories from sugar, or cake, or a bagel, the same as that from broccoli or sweet potatoes or squash. That's one reason of several it's garbage, and I pointed this out. Now you tell me the source of carbs does matter. Tell that to that research team - they didn't think it was worth caring.

And you keep missing the bigger point because I don't think you understand the theory of low carb. Yeah, to the nutritionist, soda is bad because the calories are 'empty' or whatever. That's one issue, but soda also is bad, under low carb theories, because of the fructose, which contributes to NAFLD, and that impairs insulin sensitivity. So that fruit box we give kids is as bad or worse than soda, even though the apple juice is full of those vitamins... Etc. Then they wonder - gosh, why do we see NAFLD in kids now? Something something calories... Mystery!! Here's a juice box.

Carbs spike insulin and high insulin impairs your ability to access stored fat, so under LCHF we avoid carbs to make that access easy, and so if I skip a meal my body easily converts to body fat as fuel, and so without triggering hunger, etc. To the standard nutritionist, none of that matters. Cut calories however you want, and you'll be fine...

Calories do matter though. If you eat 6000 calories a day on your keto diet..
And your metabolic burn is 2000 calories a day...you gonna gain weight.

Right. But what matters for weight is if I burn 2000 calories per day whether I can be satisfied eating 2000 calories or not. It's easier to eat and less satisfying to consume 2,000 in refined carbs than meat, eggs, butter, nuts. The latter signal satiety hormones, tuned over millions of years to tell us when to eat, and how much. The former doesn't. That's what matters.

 

[bave]

Right. But what matters for weight is if I burn 2000 calories per day whether I can be satisfied eating 2000 calories or not. It's easier to eat and less satisfying to consume 2,000 in refined carbs than meat, eggs, butter, nuts. The latter signal satiety hormones, tuned over millions of years to tell us when to eat, and how much. The former doesn't. That's what matters.

No. This is precisely my point.

This is a classic example of poor discipline and self control. You don't *need* to feel satisfied. A responsible adult knows when they *need* to eat and *what* they need to eat.

 

[JasperL]

Ah yes, it is a massive conspiracy. All the doctors, providers, hospitals, employees, insurance companies, everyone wants fat people to stay fat, right? Again, there are a lot of people trying to take advantage of you every day. Whose fault is it when you let it happen? Do you blame the drug dealer for selling you drugs? The telemarketer for selling you an extended car warranty? No. Have some self control and respect.

I didn't say it's a "massive conspiracy" just pointed out what the financial incentives are. If you don't think that matters, that's fine, but I don't agree. Treating the obese and their many chronic illnesses makes a lot of people a whole lot of money. So there's no incentive for the drug industry to care whether we get obesity under control. Hospitals are not paid to care - they're paid to operate, treat. Same for the endocrinologists, etc..... So when $200 billion in incentives are to treat chronic illness, not to prevent it, that matters to where our efforts as a country are directed. It's clearly NOT in preventing obesity....

If you're a GP and give your patient effective advice that gets him off all his diabetes meds, what do you make out of that incredibly successful action? What does a GP, then endocrinologist, then orthopedic, and the anesthesiologist, and the hospital chain, get paid to first treat diabetes related gout for that lower limb that is dying, then when that fails hack off a foot, then the weeks of rehab? Compare and tell me where the financial incentives are in our system.

Yea, when you are morbidly obese you are completely lacking in self discipline, period, full stop. I live in Brentwood, I know all about Tennessee. You call someone fat nowadays and you are getting ripped apart on social media. Hell, they had to change the *medical* terms for obesity because of butt hurt fatties.

And you are ignorant of the actual physiological barriers to losing weight, what it means to be metabolically sick, how diabetes affects weight, the impact of insulin, etc. Full stop. If you care, do some research. I'm sure you don't care.

 

[JasperL]

No. This is precisely my point.

This is a classic example of poor discipline and self control. You don't *need* to feel satisfied. A responsible adult knows when they *need* to eat and *what* they need to eat.

Of course you need to feel satisfied. We are not designed to function well while hungry. For many 10s of thousands of years, our body adapted to tell us through a series of hormones when and how much to eat to maintain a healthy body weight. Any 'plan' that expects a person to be hungry after every meal is going to fail. It's not "if" but "when". That's why CICO fails about 99% or so of the obese.

Just to start with basics, if you cut calories, and your body is screaming "feed me" it doesn't just allow that condition to continue. No, our body then says, well, you're only eating 1,500 calories per day, down from 2,000, so let's try to lower metabolism so we only burn 1,500 calories per day, and over time your metabolism burns 1700 calories, not 2,000. Now your CICO diet that began as a 500 calorie per day deficit and is projected to lose a pound a week goes to a 100 or 200 calorie deficit per day, and you need 17 or 35 days to lose a single pound. So you cut some more calories, and then you lose weight for a few weeks, but metabolism slows again, to 1500, and now eating 1300 calories per day you're in a 200 calorie deficit. Etc.. So you're some guy who weighs 250lbs eating 1300 calories per day, and starving all the time, and barely budging the scale.

Gosh, wonder why people can't keep that up for years? They're cold, hungry, irritable, fogged brains, every day. They just need to power through that for years is all.

It's not that simple, obviously, but that general description is entirely accurate. They've done the studies on Biggest Loser participants, and their metabolism slowed dramatically and stayed depressed years after the program was over. No surprise nearly every one regained nearly all the weight lost. The only person who didn't had bariatric surgery, so had to mutilate his body to maintain weight loss. And the studies show that fails most patients over time.

 

[bave]

I didn't say it's a "massive conspiracy" just pointed out what the financial incentives are. If you don't think that matters, that's fine, but I don't agree. Treating the obese and their many chronic illnesses makes a lot of people a whole lot of money. So there's no incentive for the drug industry to care whether we get obesity under control. Hospitals are not paid to care - they're paid to operate, treat. Same for the endocrinologists, etc..... So when $200 billion in incentives are to treat chronic illness, not to prevent it, that matters to where our efforts as a country are directed. It's clearly NOT in preventing obesity....

This is where you are wrong. The actual providers at the ground level, those actually interacting with patients are going to be constantly going after the obese with recommendations and discussions. It is only when the physicians realize these patients aren't following instructions that they give up and throw up their hands. The hospitals/pharma companies etc all have nothing to do with patient directives. It isn't like HCA or Pfizer is somehow coercing physicians to not tell people to eat less and exercise more.

If you're a GP and give your patient effective advice that gets him off all his diabetes meds, what do you make out of that incredibly successful action? What does a GP, then endocrinologist, then orthopedic, and the anesthesiologist, and the hospital chain, get paid to first treat diabetes related gout for that lower limb that is dying, then when that fails hack off a foot, then the weeks of rehab? Compare and tell me where the financial incentives are in our system.

They.don't.care.

There is no shortage of patients. They don't need the customers, any *remotely decent* physician out there is sitting with a many many month backlog of patients trying to get in. I have never in my life heard any level of healthcare institution, business, or provider push the idea that getting people to lose weight is bad for business. I can't even tell you how many medical boards, businesses, and institutions I have advised.

And you are ignorant of the actual physiological barriers to losing weight, what it means to be metabolically sick, how diabetes affects weight, the impact of insulin, etc. Full stop. If you care, do some research. I'm sure you don't care.

All of those barriers are relatively easily overcome. People choose not to do it. You keep pushing the idea that the obstacles are insurmountable and related to outside obstacles. The obstacles are all within the individuals controls. They can eat better, manage their blood sugar, manage their macros, exercise etc. They don't.

 

[bave]

Of course you need to feel satisfied. We are not designed to function well while hungry. For many 10s of thousands of years, our body adapted to tell us through a series of hormones when and how much to eat to maintain a healthy body weight. Any 'plan' that expects a person to be hungry after every meal is going to fail. It's not "if" but "when". That's why CICO fails about 99% or so of the obese.

Lol. This is why we have massive failures. Everyone expects things to be easy, comfortable, and convenient. That ain't life. You are supposed to spend a reasonable portion of your day hungry. You are supposed to stop eating when you have eaten the right amount. That just isn't what gets done anymore.

Just to start with basics, if you cut calories, and your body is screaming "feed me" it doesn't just allow that condition to continue. No, our body then says, well, you're only eating 1,500 calories per day, down from 2,000, so let's try to lower metabolism so we only burn 1,500 calories per day, and over time your metabolism burns 1700 calories, not 2,000. Now your CICO diet that began as a 500 calorie per day deficit and is projected to lose a pound a week goes to a 100 or 200 calorie deficit per day, and you need 17 or 35 days to lose a single pound. So you cut some more calories, and then you lose weight for a few weeks, but metabolism slows again, to 1500, and now eating 1300 calories per day you're in a 200 calorie deficit. Etc.. So you're some guy who weighs 250lbs eating 1300 calories per day, and starving all the time, and barely budging the scale.

Right. You let me know when that BMI-50 individual on a 1300 calorie a day diet is stuck at 250#.

Gosh, wonder why people can't keep that up for years? They're cold, hungry, irritable, fogged brains, every day. They just need to power through that for years is all.

Yup. The body is all about conditioning. You get used to having a certain diet, sleep, rest, etc. It is hard to get up before the sun, work long hours, exercise, and eat things that are good for you in the right proportion. People are lazy and weak, plain and simple.

It's not that simple, obviously, but that general description is entirely accurate. They've done the studies on Biggest Loser participants, and their metabolism slowed dramatically and stayed depressed years after the program was over. No surprise nearly every one regained nearly all the weight lost. The only person who didn't had bariatric surgery, so had to mutilate his body to maintain weight loss. And the studies show that fails most patients over time.

Look, we can make it easy. Just stop providing expensive and invasive healthcare to the fat and see what happens. Right now we are throwing money into lost causes at the expense of those that are actually viable. Sorry, the 400lb 35 year old isn't worth the investment of public dollars.

 

[JasperL]

This is where you are wrong. The actual providers at the ground level, those actually interacting with patients are going to be constantly going after the obese with recommendations and discussions. It is only when the physicians realize these patients aren't following instructions that they give up and throw up their hands. The hospitals/pharma companies etc all have nothing to do with patient directives. It isn't like HCA or Pfizer is somehow coercing physicians to not tell people to eat less and exercise more.

You're ignoring the point. Yeah, over time patients "ignore" advice that predictably will fail. Not that mostly fails, but is a complete disaster as advice, has failed for fifty years, and we know why. You don't care about that.

And you're not rationally addressing the problem with incentives. Pfizer will easily spend a $billion (that's the average cost) or $billions researching and testing to develop a drug and bring it to market, then $billions more to market that drug, pay off the doctors to promote it, then prescribe it, to write articles about it, TV and print advertising. Who will spend a fraction of that researching diets for the obese? Who has the financial incentive to fund the long term studies? HCA et al. sure as hell don't have an incentive to spend a $5 billion in research that will LOWER ITS PROFITS. If they tried shareholders would clean house, rightfully so.

Also, as I said early on, I'm positive doctors would give better advice if they knew it would work. My point is that if they care, if they do the hard work to get a patient through long term weight loss, they are not only not compensated for all that extra work, they lose money, it costs them the time they could spend on 12 more appointments with new patients and time that is not compensated by anyone in our system, except private pay, outside the system.

There is no shortage of patients. They don't need the customers, any *remotely decent* physician out there is sitting with a many many month backlog of patients trying to get in. I have never in my life heard any level of healthcare institution, business, or provider push the idea that getting people to lose weight is bad for business. I can't even tell you how many medical boards, businesses, and institutions I have advised.

Great, then "advise" them to part with some shareholder cash to fund a study on how to effectively lose weight, and see how that goes for you. They'll look at you like you're an idiot because you cannot show them how doing so increases their cash flow, profit margins. The opposite is true.

While you're at it, next time you're at a hospital for a board meeting, check out the garbage junk food sold in the cafeteria, and the Starbucks on site, and the vending machines selling ice cream (literally in my local hospital) and desserts and candy and cokes. Have you spent a few days eating in the hospital lately? If you want to become obese, all the food you need is right there, in the hospital, making money for the hospital with every sale. You can find all the sugar and crap processed carbs you need to fuel the epidemic of obesity in this country, right there in the place where all the chronic conditions resulting from it are treated.

All of those barriers are relatively easily overcome. People choose not to do it. You keep pushing the idea that the obstacles are insurmountable and related to outside obstacles. The obstacles are all within the individuals controls. They can eat better, manage their blood sugar, manage their macros, exercise etc. They don't.

The barriers are not easily overcome. You are ignorant of the issues that are incredibly well documented in the literature.

 

[JasperL]

I can't even tell you how many medical boards, businesses, and institutions I have advised.

Just imagine if you were hired to advise for a hospital bleeding cash and looking at insolvency. They pay you $10,000 and you show up for the first meeting with one slide in your presentation. It reads -
Profits = cash in minus cash out.
CICO.

You explain to them that this is an economic principle, a truism, that works every time it's tried. Spend less than you bring in and you'll make a profit! So you advise them to spend less than they collect!

Then you adjourn the meeting, and set up a follow up in month. Good luck!! you say as you exit. How hard is that - just spend less than you make, and you'll be profitable in no time. So easy a child can understand it!!

That's what the typical doctor gives out as "diet" advice, and then blames the patient for failing....

 

[JasperL]

Lol. This is why we have massive failures. Everyone expects things to be easy, comfortable, and convenient. That ain't life. You are supposed to spend a reasonable portion of your day hungry. You are supposed to stop eating when you have eaten the right amount. That just isn't what gets done anymore.

Great. Tell me how a person knows what's the "right amount?" Well for 10s of thousands of years our finely tuned hormones did an awesome job of that. And when we ate a little less than needed, our bodies turned to stored fat as fuel - effortlessly. When we ate a bit more than needed, our metabolism ramped up a little and burned it off, or put some on storage. Normal weight took no effort, no thought, just eating when hungry, until full.

Now flood your system with insulin - a permanent state of affairs for a diabetic on a typical diet of half the calories from carbs or more - and your body CANNOT access stored fat. So you eat less at breakfast, and it runs out of glucose in your blood, and so your body screams at you to eat more glucose because it cannot access fat stores and needs fuel NOW. If you don't eat you get light headed, dizzy, cannot think, are irritable, weak, if it goes too low, it's a medical emergency. That's the life of a diabetic. That has nothing to do with "easy, comfortable, convenient" but ignoring your body telling you it's in a crisis state, so eat now, and so they do.

The idea behind LCHF (and fasting...) is you adapt to burning fat, all day, every day, whether it's fat you eat or your body fat makes little difference. If you don't eat carbs (or don't eat anything, aka fasting), insulin stays low and allows easy access to fat stores. So when you don't eat, there's no emergency - the obese person has in most cases at least 400,000 calories stored as fat. Your body effortlessly turns to that tanker truck full of fuel, and burns that. It doesn't care if you eat that meal, and the person after a while isn't really even hungry. Missing meals is a nothing.

It's about 1:30pm, and I've been up since 5:20am. I've had no calories, and it's not because I want to lose weight - I am at my goal weight. So I've had two cups of black coffee. I'm just not hungry, and so haven't eaten and my body doesn't care at all. In fact, I'm mentally sharper fasted than after a meal. That's how LCHF diets work for many people.

Right. You let me know when that BMI-50 individual on a 1300 calorie a day diet is stuck at 250#.

Do some reading, the numbers are illustrative.

Look, we can make it easy. Just stop providing expensive and invasive healthcare to the fat and see what happens. Right now we are throwing money into lost causes at the expense of those that are actually viable. Sorry, the 400lb 35 year old isn't worth the investment of public dollars.

Cool, so your 'advise' is to tell half the country to **** off and die. Good plan. Write your Congressman.

 

[bave]

You're ignoring the point. Yeah, over time patients "ignore" advice that predictably will fail. Not that mostly fails, but is a complete disaster as advice, has failed for fifty years, and we know why. You don't care about that.

We know why, you are already illuminated that point, it's hard.

And you're not rationally addressing the problem with incentives. Pfizer will easily spend a $billion (that's the average cost) or $billions researching and testing to develop a drug and bring it to market, then $billions more to market that drug, pay off the doctors to promote it, then prescribe it, to write articles about it, TV and print advertising. Who will spend a fraction of that researching diets for the obese? Who has the financial incentive to fund the long term studies? HCA et al. sure as hell don't have an incentive to spend a $5 billion in research that will LOWER ITS PROFITS. If they tried shareholders would clean house, rightfully so.

There are tons of studies on obesity via NIH etc. Guess what, all the same thing. There really isn't all that much to it. You don't see pfizer paying people to not fix obesity, or hospitals, or anyone else. Hell, there are tons of insurer programs incenting physicians to reduce obesity, they still can't do it.

Also, as I said early on, I'm positive doctors would give better advice if they knew it would work. My point is that if they care, if they do the hard work to get a patient through long term weight loss, they are not only not compensated for all that extra work, they lose money, it costs them the time they could spend on 12 more appointments with new patients and time that is not compensated by anyone in our system, except private pay, outside the system.

Jesus christ, it's always someone else's fault. Patients can get referrals to nutritionists and a variety of other people to help. The problem is they are not going to hand hold and police the patient, they can't, so the patient fails over and over. Meanwhile, look at the people who are disciplined and truly change they can do it. You don't see fatties in the military, do you? You know why? Mandatory PT, fitness tests, in a word... discipline.

Great, then "advise" them to part with some shareholder cash to fund a study on how to effectively lose weight, and see how that goes for you. They'll look at you like you're an idiot because you cannot show them how doing so increases their cash flow, profit margins. The opposite is true.

While you're at it, next time you're at a hospital for a board meeting, check out the garbage junk food sold in the cafeteria, and the Starbucks on site, and the vending machines selling ice cream (literally in my local hospital) and desserts and candy and cokes. Have you spent a few days eating in the hospital lately? If you want to become obese, all the food you need is right there, in the hospital, making money for the hospital with every sale. You can find all the sugar and crap processed carbs you need to fuel the epidemic of obesity in this country, right there in the place where all the chronic conditions resulting from it are treated.

It is there because the demand is there. There is also healthy food there as well, but no one wants that crap, amiright?

The barriers are not easily overcome. You are ignorant of the issues that are incredibly well documented in the literature.

Yea, they are, stop shoveling shit into your gullet. Walk. Exercise. It ain't hard. It is people like you excusing POS monstrously obese people from their failings. This country needs shame as a tool again. Shame when you are in trouble with the law. Shame when you can't control yourself. Shame when you can't support yourself. Now, any of these things are someone else's fault. Every.damned.time.

 

[bave]

Just imagine if you were hired to advise for a hospital bleeding cash and looking at insolvency. They pay you $10,000 and you show up for the first meeting with one slide in your presentation. It reads -
Profits = cash in minus cash out.
CICO.

You explain to them that this is an economic principle, a truism, that works every time it's tried. Spend less than you bring in and you'll make a profit! So you advise them to spend less than they collect!

Then you adjourn the meeting, and set up a follow up in month. Good luck!! you say as you exit. How hard is that - just spend less than you make, and you'll be profitable in no time. So easy a child can understand it!!

That's what the typical doctor gives out as "diet" advice, and then blames the patient for failing....

Bad analogy. There are immeasurable market forces beyond the control of any business.

With an individual it is quite literally calories in < calories out = weight loss. There will be metabolic changes and variations, but as a whole that answer stands.