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Critiquing Gary Taubes, Final: The Truth About Diets and Weight Loss

14 Post author: ChrisHallquist 04 January 2014 05:16AM

Previously: Mainstream Nutrition Science on Obesity, Atkins Redux, Did the US Government Give Us Absurd Advice About Sugar?, What Causes Obesity?

If you've been wondering what these posts are doing on LessWrong and you haven't read this comment yet, I urge you to do so. Thanks to commenter FiftyTwo for suggesting I say something like this.

To recap: so taking in more calories than you burn will cause you to gain weight, though calorie intake and expenditure are in turn controlled by a number of mechanisms. This suggests a couple of options for losing weight. You can try to intervene directly in the mechanisms controlling food intake, one of the most well-known examples of this being gastric bypass surgery, admittedly a bit of a drastic option. But intervening at the point of calorie intake is also an option.

Now it turns out that it's relatively easy to lose weight by dieting. That catch is that it's much harder to keep the weight off. A commonly cited rule (for example here) is that most people who lose weight through dieting will regain it all in five years. However, it's important to emphasize that some people do lose weight through dieting and keep it off long-term. An organization called the National Weight Control Registry has made an effort to track those people, and have published quite a few studies based on their work (many of which can be easily found through Google Scholar).

Unfortunately, the NWCR is working with a self-selected sample and asking them what they did after the fact. They're not randomly assigning people to treatments. So for example, a high percentage of the NWCR group reports successful long-term weight loss following low-fat and/or calorie-restricted diets and exercising a lot. And the percentage following low-carb diets was originally small, but it's risen over time. But both of these observations may just reflect the relative popularity of those approaches in the general population.

We may not be able to conclude anything more from the NWCR data than that a significant minority of dieters do succeed at long-term weight loss, some through calorie-restricted diets, some through low-fat diets, and some through low-carb diets. Remember, though, that as discussed in previous posts there's little reason to think low-fat or low-carb diets could cause weight loss except by indirectly affecting energy balance.

And now, one last time, I'm going to talk about what Taubes has to say about this issue. I'm going to quote from Why We Get Fat (pp. 36-38), though Good Calories, Bad Calories contains similar comments, including about the Handbook of Obesity and Joslin's. Taubes begins by citing a review article covering calorie-restricted diets that found that "Typically, nine or ten pounds are lost in the first six months. After a year, much of what was lost has been regained." He also cites a large study that tested a calorie-restricted diet and reached a similar conclusion: participants "lost on average, only nine pounds. And once again... most of the nine pounds came off in the first six months, and most of the participants were gaining weight back after a year."

Based on this, he concludes that "Eating less—that is, undereating—simply doesn't work for more than a few months, if that." Then it's time to really lay in to mainstream nutrition science:

This reality, however, hasn't stopped the authorities from recommending the approach, which makes reading such recommendations an exercise in what psychologists call "cognitive dissonance," the tension that results from trying to hold two incompatible beliefs simultaneously.

Take, for instance, the Handbook of Obesity, a 1998 textbook edited by three of the most prominent authorities in the field—George Bray, Claude Bouchard, and W. P. T. James. "Dietary therapy remains the cornerstone of treatment and the reduction of energy intake continues to be the basis of successful weight reduction programs," the book says. But then it states, a few paragraphs later, that the results of such energy-reduced diets "are known to be poor and not long-lasting." So why is such an ineffective therapy the cornerstone of treatment? The Handbook of Obesity neglects to say.

The latest edition (2005) of Joslin's Diabetes Mellitus, a highly respected textbook for physicians and researchers, is a more recent example of this cognitive dissonance. The chapter on obesity was written by Jeffrey Flier, an obesity researcher who is now dean of Harvard Medical School, and his wife and research colleague, Terry Maratos-Flier. The Fliers also describe "reduction of caloric intake" as "the cornerstone of any therapy for obesity." But then they enumerate all the ways in which this cornerstone fails. After examining approaches from the most subtle reductions in calories (eating, say, one hundred calories less each day with the hope of losing a pound every five weeks) to low-calorie diets of eight hundred to one thousand calories a day to very low-calorie diets (two hundred to six hundred calories) and even total starvation, they conclude that "none of these approaches has any proven merit."

But look at the actual sources and it turns out that, surprise surprise, mainstream experts aren't idiots after all. The second quote from the Handbook of Obesity comes from a paragraph explaining that given how hard obesity is to treat, doctors face a "Shakespearean" dilemma of whether to attempt to treat it at all. The Joslin's article is even clearer (p. 541, emphasis added):

Successful treatment of obesity, defined as treatment that results in sustained attainment of normal body weight and composition without producing unacceptable treatment induced morbidity, is rarely achievable in clinical practice. Many therapeutic approaches can bring about short-term weight loss, but long-term success is infrequent regardless of the approach.

Suppose for a moment that this is true, that long-term weight loss is rare regardless of the approach. If it is, no "cognitive dissonance" is required to recommend treatments that sometimes work. Furthermore, Taubes commits a serious misrepresentation here. Taubes final quote from the Joslin's article, in context, says that, "There are also many programs that recommend specific food combinations or unusual sequences for eating, but none of these approaches has any proven merit." It's pretty obvious in context that the bit Taubes quotes refers only to the programs that recommend specific food combinations or unusual sequences for eating."

It's also worth mentioning that neither of these sources ignore the debate over low-carb diets. The Handbook of Obesity criticizes Atkins-style low carb diets at some length, but also says that, "Moderate restriction of carbohydrates may have real calorie-reducing properties." And the Joslin's article ends up being fairly positive towards low-carb diets in general (p. 542):

Dietary composition may play a role in long-term success in weight loss and weight maintenance. For example, a study comparing a moderate-fat diet consisting of 35% energy from fat and a low-fat diet in which 20% of energy was derived from fat demonstrated enhanced weight loss assessed by total weight loss, BMI change, and decrease in waist circumference in the group on the moderate-fat diet. Retention in the diet study was greater among those actively participating in the weight loss program in this group compared with 20% in the low-fat diet group.

Recently, increased interest has focused on the possibility that diet content may affect appetite. For example, diets with a low glycemic index may be useful in preventing the development of obesity; subjects given test meals with different glycemic indexes and then allowed free access to food ate less after eating meals with a low glycemic index. Some data suggest that diets with a high glycemic index predispose to increased postprandial hunger, whereas diets focused on glycemic index and information regarding portion control lead to higher rates of success in weight loss, at least among adolescent populations. Low-carbohydrate diets such as the Atkins diet appear to be associated with significant weight loss. However, this diet has not been systematically studied, nor has long-term maintenance of weight loss.

I assume the author of the Joslin's article would say, however, that low-carb diets haven't been shown to completely solve the problem of long-term weight loss being really hard. But would they be right about that? 

To the best of my knowledge, there have been only two randomized, controlled trials of low-carb diets that have covered a period of two years (and none covering a longer period than that). Taubes has cited both in support of his claims. The first, an Israeli study published in 2008, also also included a group assigned to a Mediterranean diet. Here are the results in terms of weight loss: 

So on the one hand, subjects on the low-carb diet did initially lose more weight, about 6.5 kg (14 lbs.) compared to about 4.5 kg (10 lbs.) for the low-calorie diet. On the other hand, both groups started regaining the weight after six months. If, as Taubes claims, data like this shows that low-calorie diets "simply doesn't work for more than a few months," does this data justify saying the same thing about low-carb diets?

Furthermore, if you believe the rule about weight lost to dieting coming back in five years, it seems likely that would happen to both groups. Intriguingly, though, while participants on the Mediterranean diet didn't initially lose as much weight as those on the low-carb diet, the weight regain didn't seem to happen as much on the Mediterranean diet. That makes me wonder what a five-year study of the Mediterranean diet would find.

Note that the Israeli study also found that that participants in all three groups significantly reduced their caloric intake, supporting the hypothesis that even diets that don't explicitly restrict calorie intake work by reducing calorie intake indirectly.

What about the other study, published in 2010, which Taubes has hailed as "the biggest study so far on low-carb diets"? Here are its results (note that the low-fat diet was also a calorie-restricted diet):

That's right, this study found no statistically significant difference between low-fat and low-carb diets in terms of weight loss, and again show the typical pattern of people losing weight in the first six months and then slowly gaining it back. Together, these two studies support the picture painted by Joslin's: low-carb diets may work somewhat better for weight loss, but they don't appear to solve the problem of long-term weight loss being really hard.

One other relevant detail: the second study found that "A significantly greater percentage of participants who consumed the low-carbohydrate than the low-fat diet reported bad breath, hair loss, constipation, and dry mouth." As Taubes' fellow science writer John Horgan has noted, this reveals an apparent inconsistency in how Taubes judges different diets. He goes to great lengths to play up the unpleasantness of calorie-restricted diets, but tells his readers that if they just stick to their low-carb diet theunpleasant side-effects will go away eventually.

So given all this, what should you do if you want to lose weight? I think depends a lot on who you are. I have ethical qualms about consuming animal products, including and in fact especially eggs, which is one strike against low-carb diets for me. Also, while there's some evidence low-carb diets may be better for hunger, my personal experience is that what foods I find filling is kind of random (lentils, black beans, and baguettes all rate highly on the filling-ness measure for me). So maybe just experiment and try to figure out which foods let you personally eat in moderation and not feel hungry. Keep Eliezer's advice in Beware of Other Optimizing in mind, and if one thing doesn't work for you, try something else.

A final point: the truth about weight loss sucks. If your case isn't bad enough to justify something drastic like gastric bypass surgery, your main option is diets which sometimes work but usually don't. Regardless of the approach. Unfortunately, this is not an exciting message to put in a popular book on nutrition. This creates an excellent opportunity for someone like Taubes: imply that if the experts admit they don't have a great solution to the problem, then clearly they don't know what they're talking about, and therefore your solution is sure to work!

Long-time readers of LessWrong, however, will realize that the universe is allowed to throw us problems with no good solution. That's something that may be especially worth keeping in mind when evaluating claims in the vicinity of medicine and nutrition. In a way, Taubes' readers are lucky: following his advice won't kill you, and won't lead to you missing out on any wildly more effective solution. It might have some unpleasant side-effects you could've avoided with another approach, but also might have some advantages. However, I've read enough of the literature on medical quackery to know Taubes' rhetorical tactics can be used for much more dangerous ends.

Just imagine: "It's doctors and pharmaceutical companies that caused your cancer in the first place. That chemotherapy and radiation therapy stuff they're pushing on you is obviously harmful. Don't you now there are all-natural ways you can cure your cancer?" If someone says that to you, then knowing that the universe is unfair, and that sometimes the best solution it gives you to a problem will have serious downsides, well knowing that just might save your life. Or not. Because the universe isn't fair. 


Early on in the process of writing this series, I said when it was over with I'd do a post-mortem to look at how I could have broken it up better. However, Vaniver has given me what seems like good advice on that issue, which I plan to follow in the future. (Unless someone else comes along and persuades me otherwise. You're welcome to try that).

But there are other issues here, the big meta-issue being that downvotes don't help me distinguish between people thinking the posts were completely off-topic for Lesswrong vs. not liking how finely they were broken up vs. me not realizing what a hot-button issue obesity is for some people vs. other things. So suggestions on how I could best solicit anonymous feedback would be especially appreciated.

Comments (86)

Comment author: NancyLebovitz 04 January 2014 03:23:22PM 8 points [-]

Gastric bypass isn't just drastic, it can be deadly or have major life-altering side effects. Weight regain isn't all that rare, either. First reasonable-looking study on the subject that I found.

I haven't seen anything I'd call a rational look at the risk/reward for bariatric surgery, though maybe I haven't been looking in the right places. The world seems to be split between fat acceptance advocates who don't want to hear success stories and will tell you a tremendous amount about the disasters (which definitely do exist) and the people who say they know a moderate number of people in their social circle who are doing well after the surgery. I do run into people who know someone who ended up dead, but that's rare.

Comment author: Error 07 January 2014 03:00:25PM 1 point [-]

If I remember right, gastric bypass has been mostly superseded by other, less risky techniques, like sleeve gastrectomy.

Comment author: Cyan 04 January 2014 10:39:46PM 4 points [-]

You can use Google Docs to create an anonymous feedback form, but I don't know the details of setting it up; I just know that Luke has one.

Comment author: gwern 05 January 2014 12:35:52AM 4 points [-]
Comment author: 9eB1 04 January 2014 07:32:34AM *  11 points [-]

I have been following this series with muted interest. While I am very interested in nutrition and have done much reading on the topic, I'm not a huge fan of Taubes', in spite of that fact that I think low-carb dieting actually is superior for most people and that many of the points he makes about the conventional wisdom are correct. I think this is the first article in the series that appeals to me at all, with its greater focus on the actual available state of our knowledge and a lesser focus on Taubes specifically.

One element which I think is somewhat misleading is the seeming equivalence you are drawing between low-carb and low-fat diets. While you note that low-carb diets have higher prevalence of side effects, they also show statistically significant benefits in areas other than weight loss, including relative improvements in blood pressure, triglycerides, HDL cholesterol, and insulin sensitivity. Notably, in 6 month and longer studies low-carb had better attrition rates, which is the key to the long-term weight loss conundrum if you are making decisions for yourself (source). I recognize that it is rude to say so, but I can't help but suspect that your moral position with regards to eating animal products likely affects the way that you have researched, thought about, and framed this evidence. In the same way that the world is allowed to throw us problems with no good solution, it's also allowed to make any particular "morally desirable" position the more costly, difficult, and unhealthy.

Questions of nutrition often touch on this weird gray area of human knowledge, where even though science has many answers, it still doesn't have the resources to give us ALL the answers with statistical significance. Losing weight is in part a psychological and cultural phenomenon, and I think there is an important aspect which is not captured in the studies which allows people to lose weight with low-carb diets more easily than with low-fat, and the only evidence I have is to tell you to read a few pages of posts at /r/keto and see if they feel extraordinary to you. Better yet, try a low-fat diet for 3 months and a low-carb diet for 3 months and see which feels more natural and which improves your health markers more. It's different when you are a member of a randomized, controlled trial vs. when you are actively going out and looking for the best weight-loss strategies.

Comment author: army1987 04 January 2014 11:10:32AM *  1 point [-]

read a few pages of posts at /r/keto and see if they feel extraordinary to you

Huh, yeeeeah, that's definitely not a self-selected sample at all.

try a low-fat diet for 3 months and a low-carb diet for 3 months and see which feels more natural

Even a few days of not eating much pasta or bread or rice or potatoes or legumes or beer or fruits feels very unnatural to me; conversely I actually get tired of eating meat if I eat lots of it for a few days in a row. (YMMV.) And anyway, that's a false dichotomy.

Comment author: 9eB1 04 January 2014 05:13:12PM 5 points [-]

Huh, yeeeeah, that's definitely not a self-selected sample at all.

Of course it's self-selected. That's part of my point. A gigantic number of people have been able to select themselves for losing truly massive amounts of weight. If you are making decisions for your own weight loss, that is highly relevant information. The studies that have been done show people losing on average 10-20 pounds. If you need to lose 200 pounds, it may just be that those studies don't capture every relevant fact. There never will be large randomized studies on the weight loss of people who need to lose this much weight.

Feeling tired after eating low-carb for only a couple days is an extremely well-known temporary side effect, so I'm surprised you weren't aware of it if you were actually intentionally going on a low-carb diet. It's not really a false dichotomy because the difference between those two modes of weight loss is precisely what I was making a point about, what Gary Taubes is talking about, and what all the researchers have studied. From a public health perspective, the diets that you prescribe can only be of limited complexity and time-cost. The intersection between people who can successfully count calories and explicitly track macronutrients for years and the people who are overweight is small. The intersection between people who are overweight and can successfully eat low-fat or low-carb diets is still apparently small (based on the studies), but larger than those who can track calories.

Comment author: army1987 04 January 2014 05:42:27PM *  -1 points [-]

Of course it's self-selected. That's part of my point.

So, what's wrong with the National Weight Control Registry mentioned in the OP, which is self-selected for persistent weight loss but not for diet used to achieve it?

From a public health perspective, the diets that you prescribe can only be of limited complexity and time-cost.

I can't see how prescribing a low-calorie diet is that much more complex than prescribing a low-fat one or a low-carb one. (And what's up with everybody treating “carbs” as if it was a terribly useful category? If we abolished that word so that people who actually mean to talk of both sugars and starches had to explicitly say “sugars and starches” and everyone else would have to decide which one they actually mean, the amount of nonsense in these discussions would probably be reduced by half an order of magnitude.)

Comment author: 9eB1 04 January 2014 06:41:30PM *  4 points [-]

There's nothing wrong with the National Weight Control Registry. I never said anything was wrong with it, so I'm not really sure what you'd like me to address about it or how it relates to my argument. Low-fat dieting and generic calorie restriction can definitely work to lose weight. According to their research, the percentage of people that have lost weight through low-carb dieting has increased from 5.9% in 1995 to 17.1% in 2003, which is ambiguous with respect to the question of whether low-carb dieters are actually more successful, and is only a measure of the increase in popularity of such diets.

Low-calorie diets are complex because you can eat any food, but you have to track the calories of every item you eat to ensure that you don't go over your daily calorie budget. Low-fat and low-carb diets tend to simply disallow the dieter from eating categories of food, which requires no record-keeping and no-math. The most damaging foods for a dieter are those that are hyper-palatable, generally consisting of high levels of both fat and carbohydrates (think cookies, french fries, doughnuts). Because they are so rewarding to consume, it's very easy to eat an excess of calories. Both low-carb and low-fat diets restrict these foods, one because of the fat content and one because of the carbohydrate content.

When I say carbs I mean both sugars and starches, all carbohydrates. All of the research trials I've read on low-carb diets specifically state the total number of grams or Calories from carbohydrates in the diet. If someone is using low-carb to refer to low-sugar diets they are probably confused themselves, and spreading it to everyone else.

Comment author: Randy_M 07 January 2014 09:03:37PM 0 points [-]

Has there been a comparrison done of the relative micro-nutrient levels of low carb vs low fat diets? I think its very plausible that nutrient deficiency could manifest as hunger, generating weight gain as the body compels oneself to eat enough to fulfill nutrient requirements despite the excess of calories.

Comment author: 9eB1 08 January 2014 12:03:17AM 2 points [-]

Interestingly, I saw on article on the topic of micronutrients and hunger just a few days ago here. He cites two studies on multivitamins that show in one case no impact on appetite, and in another case an increase in fasting desire to eat but no impact on hunger, fullness, or prospective food consumption. With respect to the relative micronutrient levels of low-carb vs. low-fat diets it depends critically on the composition of such diets, and all of the studies that I've seen comparing them have a complete profile, as far as I can remember.

Comment author: Randy_M 08 January 2014 02:13:56PM 0 points [-]

That makes sense. I mean, whether you cut fat or carbs you still have access to a variety of meat and vegetables, and people would want to study one variable at a time.

Comment author: brazil84 07 January 2014 09:23:39PM -1 points [-]

I think its very plausible that nutrient deficiency could manifest as hunger, generating weight gain as the body compels oneself to eat enough to fulfill nutrient requirements despite the excess of calories.

I don't know if it's been studied, but I don't find it plausible at all. Under the micronutrient theory, you could arguably control your weight by eating micro-nutrient fortified doughnuts for breakfast. Or eat a hamburger, french fries, and a micro-nutrient pill for lunch. If it were that easy, surely word would have spread around by now.

Comment author: Randy_M 07 January 2014 09:30:42PM 2 points [-]

Or there's multiple needs that play on the same mechanism, making it harder to tangle out specific causes, rather than simpler. You need calories and nutrients from food to function properly, why should hunger only arise from one?

And also, you are assuming we have identified every micronutrient are are capable of adequately fortifying a donut with them.

Comment author: brazil84 08 January 2014 09:22:13AM 0 points [-]

Or there's multiple needs that play on the same mechanism, making it harder to tangle out specific causes, rather than simpler. You need calories and nutrients from food to function properly, why should hunger only arise from one?

Well there are a lot of possibilities, but if there are multiple micronutrients in play, then doughnuts could be fortified with all of them.

And also, you are assuming we have identified every micronutrient are are capable of adequately fortifying a donut with them.

Not necessarily. If excessive eating results from a deficiency of 10 micronutrients, it's reasonable to expect that supplementing 5 of them would have a marked impact. Besides, it's also reasonable assume that these micronutrients are around in varying amounts in different kinds of foods. If the micronutrient hypothesis were correct, surely someone would have noticed by now that if you eat a serving of miracle foods X and Y every day, then the rest of the day you can eat whatever you want in the amounts you want and get and stay thin. Especially since people have been searching for foods like this for years with little success.

Comment author: RichardKennaway 08 January 2014 09:43:16AM 0 points [-]

If the micronutrient hypothesis were correct, surely someone would have noticed by now that if you eat a serving of miracle foods X and Y every day, then the rest of the day you can eat whatever you want in the amounts you want and get and stay thin. Especially since people have been searching for foods like this for years with little success.

There was a wave of spam some years back for a type of bread that supposedly drastically reduced hunger. So if the spam is to be believed... which of course it isn't. But I'm curious to know if anyone has tried it.

Comment author: army1987 04 January 2014 07:18:07PM -2 points [-]

Low-calorie diets are complex because you can eat any food, but you have to track the calories of every item you eat to ensure that you don't go over your daily calorie budget. Low-fat and low-carb diets tend to simply disallow the dieter from eating categories of food, which requires no record-keeping and no-math.

If rather than keeping track of how many grams of fats (or carbs) you're eating you can just abstain from foods with lots of fats (or carbs), can't you do the same with calories too?

Comment author: Wes_W 10 January 2014 10:35:10PM *  3 points [-]

In principle, yes, of course. That's the "avoid junk food" diet.

Unfortunately, trying to restrict total calories this way without counting gives you a relatively narrow margin of error, and most of us aren't very well-calibrated. A normal calorie deficit for weight loss means eating ~20% below your maintenance level, so if you overshoot by 25% (quite easy to do when you're not measuring portion sizes), you're making zero progress and don't even know there's a problem.

It is comparatively difficult to accidentally eat bread at every meal without noticing.

Comment author: army1987 11 January 2014 09:47:08AM 1 point [-]

Then again, if one day you overshoot by 25% and another day you undershoot by 25%, the (first-order) effects cancel out (there are second-order effects, but they are, well, second-order). Unless there's a systematic error, in which case you will notice in a couple of weeks, because you will gain/lose weight at a rate different than you want to gain/lose weight at.

Comment author: drethelin 07 January 2014 01:19:08AM 1 point [-]

No? once you know that beef has no carbs in it you no longer need to track anything about it. You can just eat it. But tracking calories involves knowing how many calories are in every food item you may want to eat and knowing how much and which you've eaten throughout the day.

Comment author: army1987 10 January 2014 08:05:31PM -2 points [-]

No? once you know that beef has no carbs in it you no longer need to track anything about it. You can just eat it.

And once you know that water has no calories in it you no longer need to track anything about it. You can just drink it. What's the difference?

Comment author: drethelin 10 January 2014 09:59:20PM 0 points [-]

Are you dense or just trolling? You can't live on just water. So you have to eat some food. this food will have varying amounts of calories. If you want to keep your calories below a certain amount, you need to track calories.

Comment author: army1987 10 January 2014 11:05:35PM -2 points [-]

You can't live on just water.

Can you live on just beef? (Possibly, but is it healthy to live on just beef? Is it fun to live on just beef? Is it cheap to live on just beef? Is it convenient to live on just beef?)

If you want to keep your calories below a certain amount, you need to track calories.

What do you mean by “track calories”? Did pre-WW2 Okinawans track calories?

Comment author: army1987 04 January 2014 05:31:05PM *  -2 points [-]

Feeling tired after eating low-carb for only a couple days is an extremely well-known temporary side effect, so I'm surprised you weren't aware of it if you were actually intentionally going on a low-carb diet.

I wasn't; I spent a few weeks in a country whose diet includes much more meat and less grains than mine. And I meant tired as in tired (i.e. bored) of always eating meat, not physically tired.

Comment author: brazil84 04 January 2014 11:47:34AM 2 points [-]

It occurs to me that there are two separate questions:

  1. Do low carb diets work better than other diets?

  2. Do low carb diets work at all?

Even if the answer to the first question is "yes," the answer to the second question is clearly "no." In the sense that the vast majority of people end up regaining weight regardless of the diet they are on.

That's a big problem for Taubes' nutritionistic theory. Let's assume for the moment that Taubes is correct, that if you simply eliminate "refined carbohydrates" (whatever that means) from your diet, you can eat anything else ad libitum and get and stay thin. The fact that low-carb dieters experience weight regain must then mean that they are experiencing difficult-to-resist urges to consume refined carbohydrates. But if you find some way to resist difficult-to-resist urges, then arguably you don't need low carb dieting in the first place.

I imagine Taubes' supporters would respond that a low-carb dieter's difficult-to-resist urges are less difficult to resist than those of other dieter's. Which may be true, but it doesn't change the fact that -- any way you slice it --

(1) The central and essential problem of successful dieting is dealing with the problem of difficult-to-resist urges;

(2) Taubes' approach does not solve this problem.

Comment author: private_messaging 04 January 2014 12:56:31PM *  2 points [-]

Preponderance of research indicates that high carb meals (especially in form of starches) are more satiating for the same calories than high fat meals, so it is probably not even true that the urges are lessened. There are some counter-intuitive immediate effects (loss of water) and certain psychological factors (it's more fun for some people to believe that mainstream is completely wrong) which can explain the appeal of the low carb dieting.

Another issue is that of health. There's no reason what so ever that the easiest to resist diet would be the healthiest one. If anything, we ought to expect ourselves to naturally avoid at least some highly unhealthy meals, and so a diet that is very unhealthy may be easier to resist overeating on.

On the satiation research:

http://www.ncbi.nlm.nih.gov/pubmed/17539869

http://www.ncbi.nlm.nih.gov/pubmed/10435117

http://www.ncbi.nlm.nih.gov/pubmed/7900695

and so on and so forth.

Comment author: brazil84 04 January 2014 02:25:25PM 2 points [-]

Preponderance of research indicates that high carb meals (especially in form of starches) are more satiating for the same calories than high fat meals, so it is probably not even true that the urges are lessened.

Well I suppose that Taubes' supporters would argue that protein provides extra satiation. Not that it really matters, because there doesn't seem to be a magic balance of macronutrients which lets you eat ad libitum; get and stay thin; and avoid the problem of difficult-to-resist eating urges.

There are some counter-intuitive immediate effects (loss of water) and certain psychological factors (it's more fun for some people to believe that mainstream is completely wrong) which can explain the appeal of the low carb dieting.

Yes. You know, I have wondered about the chart which shows an average long term weight loss of 5 extra pounds among low-carb dieters. How much of that 5 pounds is water?

Another issue is that of health. There's no reason what so ever that the easiest to resist diet would be the healthiest one.

I think you mean the "easiest to stick to diet." But anyway, we need to be clear about what "healthiest" means. It occurs to me that "healthy" is multi-dimensional when it comes to food. That said, if your point is that on balance, being a few pounds lighter from low-carb dieting is not necessarily a net benefit in terms of cardiovascular health; metabolic health; etc., I would have to agree with you.

Comment author: private_messaging 04 January 2014 04:01:38PM *  1 point [-]

Not that it really matters, because there doesn't seem to be a magic balance of macronutrients which lets you eat ad libitum; get and stay thin; and avoid the problem of difficult-to-resist eating urges.

Obesity is a very recent problem, though, so there's something that could be done for majority of people - if anything, rolling back a few decades on as many things as you can (within reason of course) should work well.

I think you mean the "easiest to stick to diet."

Sorry, I wasn't clear. I meant, easiest to resist eating too much with. On normal diets, sticking to the diet is all about resisting the slippery slope of eating more of the same things, but on a very weird diet, sticking to the diet is about merely not buying things proclaimed 'bad', which may be easier. After all we all have mechanisms for resisting the urge to eat colourful, tasty looking berries that are known to be poisonous. It could be psychologically easier to label some things as "poisons" and not eat them, than to limit the amounts.

Comment author: brazil84 04 January 2014 04:39:00PM 1 point [-]

Obesity is a very recent problem, though, so there's something that could be done for majority of people - if anything, rolling back a few decades on as many things as you can (within reason of course) should work well.

Agreed, although that sort of subsumes the problem of difficult-to-resist urges. A few decades ago, there were not jumbo slices of pizza available for a dollar on every street corner; there were not hot dogs for a dollar at gas stations and movie theaters; and so on.

It's probably also worth noting that a few decades ago, cigarette smoking was a much more acceptable diet strategy.

On normal diets, sticking to the diet is all about resisting the slippery slope of eating more of the same things, but on a very weird diet, sticking to the diet is about merely not buying things proclaimed 'bad', which may be easier

I agree, except that I might quibble with your definition of "normal diet."

It could be psychologically easier to label some things as "poisons" and not eat them, than to limit the amounts.

Yes, and then the next questions are (1) what foods or types of foods are, if treated as "poison," likely to lead to an effective diet; and (2) what is the health cost to eliminating such foods.

In my non-professional opinion, the answer to the first question is the foods which are normally referred to as "junk food" or "comfort food." The answer to the second question is (again in my non-professional opinion) that there is no health cost at all and in fact you are better off without such food in your life.

Comment author: private_messaging 04 January 2014 04:43:05PM 1 point [-]

It's probably also worth noting that a few decades ago, cigarette smoking was a much more acceptable diet strategy.

A lot of people didn't smoke but didn't get overweight either. And today people routinely consume far more potent stimulants (ADHD medications).

In my non-professional opinion, the answer to the first question is the foods which are normally referred to as "junk food" or "comfort food." The answer to the second question is (again in my non-professional opinion) that there is no health cost at all and in fact you are better off without such food in your life.

Yeah, agreed. Ethics also works - e.g. there's hardly any overweight vegetarians. (At least none that I know)

Comment author: brazil84 04 January 2014 09:41:11PM 2 points [-]

A lot of people didn't smoke but didn't get overweight either.

I agree, I'm not saying that smoking is the main reason people were thinner a few decades ago but surely it played a roll. It was very common back in the 70s and 80s for people to take up smoking as a weight control measure, either intentionally or unintentionally -- it was inexpensive and no prescription was necessary. It was really common to see thin guys walking around with a pack of cigarettes tucked into their shirt sleeve.

Ethics also works - e.g. there's hardly any overweight vegetarians

Assuming that's the case, one can ask why such an approach might be effective. Is it because meat makes you fat? Is it because eliminating meat and meat derived food from one's diet is a good way to cut out junk food? (I wouldn't think so; how hard is it to make vegetarian french fries and donuts?)

I'm inclined to believe that identity is a good way to motivate oneself. If you think to yourself "I'm a vegetarian and vegetarians don't eat that kind of food" or "I'm a foodie and foodies don't eat processed crap" or "I'm a fitness buff and fitness buffs don't pig out on nachos" it seems pretty effective.

It reminds me of the story of the Jewish girl who had a hard time resisting milk chocolate treats in the evening; so what she would do is eat a small piece of meat every night after dinner so that it would be non-kosher to eat the chocolate.

Comment author: private_messaging 04 January 2014 11:35:50PM *  1 point [-]

It's plain difficult to consume a lot of calories if you cut out meat and dairy products, I think (I tried to go vegetarian but couldn't manage to get enough calories, it's just too much work to eat enough not to go underweight. I don't eat junk food). Plus if you are changing your habits for some ethical reasons, you are not a hedonist to begin with.

It seems to me that huge majority of people who are successful at maintaining their weight never subscribe to any defined diets or calorie counting. I think that works like this - as you eat, you feel more and more full. You can just stop eating at an earlier point (when you don't feel entirely full) or at a later point. Also, for the dieters slowly gaining back everything - they still succeed to maintain the weight below the level that makes them take a drastic measure. It's just that this level is quite high, probably because only a level that high can justify a measure so drastic.

Comment author: brazil84 05 January 2014 12:28:28PM 3 points [-]

It's plain difficult to consume a lot of calories if you cut out meat and dairy products,

Is that so? What about french fries, donuts, and soda? Those things can be made without animal products, no?

Plus if you are changing your habits for some ethical reasons, you are not a hedonist to begin with.

Well that may be part of it. Perhaps part of it is that vegetarians spend a lot of mental energy thinking about what they are eating. My impression is that fat people tend to consume a lot of food without being fully consciously aware of it.

It seems to me that huge majority of people who are successful at maintaining their weight never subscribe to any defined diets or calorie counting.

Are you talking about former fat people or never fat people?

Comment author: private_messaging 05 January 2014 12:38:33PM *  0 points [-]

Is that so? What about french fries, donuts, and soda? Those things can be made without animal products, no?

Haven't got a deep frier, not a fan of french fries anyhow (not to the point of eating, what, 600 grams of them a day plus other stuff), prefer to eat at home. Also, sweets are a dessert. edit: and correct me if i'm wrong but with french fries something like half the calories come from fat, which is too much fat. Then, there's silicone oil, trans fats, a wide variety of carcinogenic chemicals produced at high temperatures....

Apparently, it is a common experience

Though I do cook baked potatoes quite often.

Are you talking about former fat people or never fat people?

Never fat or only ever fat due to a depression or the like.

edit: with the presently obese, if they are to lose weight and keep it low, that would imply future behaviour inconsistent with past behaviour under same conditions, i.e. simply is not going to happen without significant psychological changes or the like.

Comment author: army1987 04 January 2014 05:50:41PM 1 point [-]

Yeah, agreed. Ethics also works - e.g. there's hardly any overweight vegetarians. (At least none that I know)

OTOH a sizeable fraction of the ones I've met are visibly underweight.

Comment author: army1987 04 January 2014 05:52:25PM 0 points [-]

And today people routinely consume far more potent stimulants (ADHD medications).

Which fraction of the population takes such medications?

Comment author: byrnema 06 January 2014 05:30:18PM 0 points [-]

Even if the answer to the first question is "yes," the answer to the second question is clearly "no." In the sense that the vast majority of people end up regaining weight regardless of the diet they are on.

I'm just now seeing this discussion, and don't have time to read earlier posts.

Has it already been worked into the model that there are different sub-types of people? Some members of my family have successfully managed our weight, but it definitely wasn't the same solution for each of us, while other members of the family are still needing a better solution. (How useful could it be to look at average results, except to determine that there is no 'one size fits all' strategy?)

Comment author: brazil84 07 January 2014 12:45:48AM 2 points [-]

I'm just now seeing this discussion, and don't have time to read earlier posts.

Maybe you can hire someone to read them for you and prepare an executive summary :)

Comment author: byrnema 07 January 2014 02:58:02AM *  0 points [-]

Sure, that's fair. :)

...curiously, if I did look, would I find that this had been addressed?

I'm not saying you should look. I'm just saying, time spent is not so often rewarded, whereas anyone that has kept with the discussion would readily know.

Furthermore, it helps to keep track of and repeat one's assumptions. To write, "doesn't work at all" doesn't sound right without some qualifications.

Comment author: brazil84 07 January 2014 03:56:56AM 0 points [-]

Dude, the thread has 39 comments at the moment, two of which are yours. If you are too busy to read 37 comments, then I doubt it is worth engaging.

Comment author: byrnema 07 January 2014 05:25:25AM *  0 points [-]

That's very funny. I meant that I hadn't read the previous posts:

Previously: Mainstream Nutrition Science on Obesity, Atkins Redux, Did the US Government Give Us Absurd Advice About Sugar?, What Causes Obesity?

At some point, it was probably discussed in which context it was appropriate to look at averaged data...I was hoping for a recap. I have composed a comment about whether I should have read the previous posts in the open thread.

Comment author: brazil84 07 January 2014 05:57:50AM 0 points [-]

That's very funny. I meant that I hadn't read the previous posts:

Whatever, if there's anything I said which you disagree with or would otherwise like to discuss with me, feel free to quote it and respond.

Comment author: byrnema 07 January 2014 06:06:40AM *  1 point [-]

Ok, I wanted to ask about this bit:

Do low carb diets work at all?

[...] the answer to the [...] question is clearly "no." In the sense that the vast majority of people end up regaining weight regardless of the diet they are on.

If the diet should work for some people, but not most people, why should you say it doesn't work at all?

Comment author: brazil84 07 January 2014 07:09:31AM 0 points [-]

If the diet should work for some people, but not most people, why should you say it doesn't work at all?

To emphasize the fact that even though it might work better than some other diet, it still (generally speaking) does not work.

Anyway, your question is simply about my word choice, right? You do not dispute my substantive point?

Comment author: byrnema 07 January 2014 03:13:10PM *  2 points [-]

There appears to be some substance in the disagreement.

Suppose that there are many different 'metabolic' types of people, and different diets work with different efficacies for these different types. Perhaps any diet works well with a small subset of people (we already know some people don't need to diet). Perhaps particular diets work well with certain subsets of people. Maybe a particular diet works extremely well for one subset, in that they lose weight and keep it off, whereas it only works moderately well for others (they gain the weight back or must combine different diets). This model -- which seems quite likely anyway -- would imply two things:

  1. the effectiveness of a diet for small subsets of people would be completely obfuscated by averaging the data -- for example, in all groups in Figure 2, dieters kept off some of the weight on average. This might mean that some people gained all the weight back, whereas some kept it off, or it might mean that everyone gained some back. (Note that showing standard error, rather than standard deviation, especially hides the role of individual variation.)

  2. it would not be reasonable to expect a diet to work by working for everyone; instead, each person must find which diet, if any, works for them, and then we would say that a diet "works" if it works for any subset of people that would otherwise be overweight

I'm pretty certain that this paradigm is mainstream. Increasingly, we're recognizing that medical solutions (for example, blood pressure medications or cancer therapies) need to be tailored to individual people.

Here's what the authors of the 2008 paper (Figure 2) have to say about individual differences:

We enrolled few women; however, we observed a significant interaction between the effects of diet group and sex on weight loss (women tended to lose more weight on the Mediterranean diet), and this difference between men and women was also reflected in the changes in leptin levels. This possible sex-specific difference should be explored in further studies. The data from the few participants with diabetes are of interest, but we recognize that measurement of HOMA-IR is not an optimal method to assess insulin resistance among persons with diabetes.

Gender and diabetes are individual differences that are easy to recognize. Who knows (yet) how many characteristics are relevant for diet. If someone is sensitive to sugar like me (can't go long periods without eating, tends to put on weight on their belly), the low-carb diet might work for them. Another complication is that changes in gut-bacteria populations over longer time-scales might result in long-term changes in your diet type. For example, over-weight people have different gut bacteria, diets change gut bacteria and gut bacteria might change your equilibrium weight. (The media is dominated by these studies recently.) I find a positive effect -- once I've been on the low-carb diet for a few months, I'm not as sugar-sensitive and can maintain my ideal weight with a higher level of carbs than before I began the diet. Over time I lose the effect (too many holiday parties?) and need to return to a stricter low-carb diet.

I don't fault the discussion for not accounting for gut bacteria yet (the diet science literature is huge, and you have to begin somewhere)...but would you agree that it is complicated enough that we can not infer much of anything from average responses to a diet, other than that a particular diet doesn't work for everyone?

Comment author: hyporational 07 January 2014 06:28:02AM 0 points [-]

Good point. If we applied the same principle to drugs, very few of them would be used at all.

Comment author: byrnema 07 January 2014 03:35:16PM 0 points [-]

What examples were you thinking of?

Comment author: Eugine_Nier 08 January 2014 03:58:06AM *  1 point [-]

To recap: so taking in more calories than you burn will cause you to gain weight,

Consider the sentence: "eating more mass then you excrete (plus the extra carbon you exhale) will cause you to gain weight". It is equally (in fact probably more) true. Do you think it's helpful? Taubes's point is that your version is equally unhelpful.

Comment author: ChristianKl 06 January 2014 04:40:08PM *  1 point [-]

To recap: so taking in more calories than you burn will cause you to gain weight, though calorie intake and expenditure are in turn controlled by a number of mechanisms.

Wrong. If I have diarrhea I lose weight, even through I don't burn more calories. Burning isn't the only way calories can leave the body.

It's an effect that much easier to see in my own weight data than adding 800 kcal per day in maltrodoxin into my tea.

We may not be able to conclude anything more from the NWCR data than that a significant minority of dieters do succeed at long-term weight loss, some through calorie-restricted diets, some through low-fat diets, and some through low-carb diets.

You ignore the issues with self reported diet plans. In general people are not good at reporting what they eat. Given equal diets the person who loses weight is more likely to report that they follow the society approved model of dieting to explain why they have lost weight than the person who doesn't lose weight.

One other relevant detail: the second study found that "A significantly greater percentage of participants who consumed the low-carbohydrate than the low-fat diet reported bad breath, hair loss, constipation, and dry mouth."

If you have high testosterone you are more likely to lose hair than if you have lower testosterone. If you starve the body of fat you lower testosterone and get less hair loss. That not a sign that the low fat diet is good.

I rather eat the diet that gives me high testosterone even if that means I will lose some hair.

I want that my brain can synthesizes steroids as much as it wants even if I have to pay the price in bad breath and lost hair. Most of the paleo crowd is purposefully making that trade.

Just imagine: "It's doctors and pharmaceutical companies that caused your cancer in the first place. That chemotherapy and radiation therapy stuff they're pushing on you is obviously harmful. Don't you now there are all-natural ways you can cure your cancer?" If someone says that to you, then knowing that the universe is unfair, and that sometimes the best solution it gives you to a problem will have serious downsides, well knowing that just might save your life.

We do live in a world where over years doctors engaged in cancer screening procedures that didn't reduce mortality and which produces radiation that does cause some cancer. It took time and good data to get cancer doctors to stop killing people by overtreating them.

The nutrition researchers unfortunately don't have good data.

Comment author: Eugine_Nier 06 January 2014 04:17:23AM -1 points [-]

But there are other issues here, the big meta-issue being that downvotes don't help me distinguish between people thinking the posts were completely off-topic for Lesswrong vs. not liking how finely they were broken up vs. me not realizing what a hot-button issue obesity is for some people vs. other things.

I find it interesting that you refused to mention the possibility of people finding your argument essentially fallacious, despite both myself and Eliezer mentioning this in our replies to your last post, specifically here, here, here, here, here, and here.

Comment author: ChrisHallquist 06 January 2014 04:25:24AM 0 points [-]

I'm just going to point you to my reply to Eliezer, and the fact that many of your own comments have been downvoted into the negatives.

Comment author: Prismattic 08 January 2014 12:29:50AM 1 point [-]

I have ethical qualms about consuming animal products, including and in fact especially eggs,

The chart that this sentence links to assumes that all animal lives are equal. But that seems untenable. We already value, say, primate, dolphin, and elephant life more than most other mammals, and birds and mammals more than insects, so why should we value cows and chickens equally? Cows have demonstrated problem-solving abilities, and in some cases appear to understand that they are headed for the slaughter. Chickens, on the other hand, can lose most of their brain and still behave more-or-less the same as they did when whole.

Comment author: hyporational 08 January 2014 06:50:59AM *  1 point [-]

Chickens, on the other hand, can lose most of their brain and still behave more-or-less the same as they did when whole.

You have a scientific source for that, anyone able to replicate the experiment? It would be incredible if costly tissue like neurons just sat there doing nothing.

Comment author: Jadael 22 May 2014 11:40:51PM 2 points [-]

There was one famous chicken that was beheaded (during a routine slaughter) just high enough to keep the brain stem intact. A clot coincidentally prevented death from blood loss, and it lived for two years as a touring attraction, before finally dying by choking. It spent most of its time attempting to preen and peck.

http://en.wikipedia.org/wiki/Mike_the_Headless_Chicken

Comment author: Vulture 23 May 2014 02:18:40AM 1 point [-]

It would be incredible if costly tissue like neurons just sat there doing nothing.

How big is a chicken's brain, anyway? As Jadael notes, the brain stem was intact. How much more is there to a chicken's brain? Also note that it hardly needed, say, its optical processing systems anymore.

Comment author: byrnema 09 January 2014 04:44:22PM *  1 point [-]

Figure 2, included from the 2008 Israeli study is very interesting. Why do all three diets show a reverse in weight loss at 5 months? (It must be a coincidence that it is at five months for all three groups, perhaps the true number would vary for the diets and be at 5 plus or minus 2, especially for the Mediterranean diet which reverses again at month 8.) But generally weight loss occurs for a handful of months and then reverses.

Maybe this is part of weight loss dynamics. A person loses some weight, and then there is a restorative force to put the weight back. (But all the weight is not gained, the diet was still worthwhile.) But this seems indicative that there is some equilibrium weight and dieting has failed to entirely reset that equilibrium. (With the plateau at 1.5 years at a lower weight, the equilibrium seems to have been adjusted a useful amount.)

This is just one data set, but since the study seems well-designed I'll fold this hypothesis into my paradigm with a tag, 'continue to examine incoming evidence'.

I think that the data shows the diets are very effective: participants lost 3 to 5 pounds over two years. Losing weight is so difficult, losing a few pounds and keeping it off it for a few years is very good. Especially when you consider that you might have instead gained weight without the diet. Having a mechanism to lose a few pounds is what you need to maintain a healthy weight. (I think you are lucky to find such mechanism -- I feel lucky the low-carb diet works for me, given that the low-calorie decisively didn't.)

The diets might have been even more effective if their applications were tweaked. (It's unlikely the diets were perfectly applied.) Since I've found the low-carb diet effective for me, I'll make a few comments on how the low-carb diet in the study would not have been optimized for me. (I've lost 15 pounds three times with this diet, and successfully kept off the weight --between pregnancies. I did not stay on the diet during my pregnancies.)

Further comments on the low-carb diet, based on my experience: (These are my observations, through systematically studying myself, and I predict these wouldn't map exactly to someone else's body and metabolism.)

In their study, they had an induction phase for 2 months, and after that they gradually increased carbs from 20 grams per day to 120 grams per day. Thus it seems that over the 22 months after induction, they increased the number of carbs by 10 grams per month.

  • Induction phase too short Two months is not long enough to reset an equilibrium weight (or change gut flora, or whatever it is that causes reversals.) It takes three or four months in my case, to notice differences indicating I'm ready to change phases. So I think the induction phase needed to be longer, but on the other hand, it perhaps didn't need to be so intense.

  • Induction phase possibly too intense Consider, if the net weight loss over two years was 5 pounds, there was no need to lose that many in the first two months. Looking at the data, there was a transient plateau around months 8--10, indicating that 40 or 50 grams per day might have been low enough to begin losing weight. I would ask myself how I felt about 20 grams per day and whether I could maintain that for four months (no).

  • Increasing carbs too rapidly thereafter The target maintenance level of 120 grams, or the initial slope of the approach towards 120g, might have been too high to continue losing weight and continue lowering the equilibrium weight. Especially the data at 1 year, when the average weight regain was 2 pounds, would have been an indication to stop increasing the daily amount of carbs. Generally, as long as I'm living with my diet satisfactorily, I don't increase my carbs unless I have achieved my target weight. This means I spend about 80% of the year restricting my carbs. This raises eyebrows, because I'm at a healthy weight -- but it seems our culture doesn't place enough value on the continuous effort that is required in our culture to be healthy.

Comment author: ChristianKl 06 January 2014 04:42:49PM 1 point [-]

But there are other issues here, the big meta-issue being that downvotes don't help me distinguish between people thinking the posts were completely off-topic for Lesswrong vs. not liking how finely they were broken up vs. me not realizing what a hot-button issue obesity is for some people vs. other things. So suggestions on how I could best solicit anonymous feedback would be especially appreciated.

Just start a comment with an anonymous poll.

Comment author: army1987 04 January 2014 06:03:19PM 0 points [-]

Furthermore, if you believe the rule about weight lost to dieting coming back in five years, it seems likely that would happen to both groups. Intriguingly, though, while participants on the Mediterranean diet didn't initially lose as much weight as those on the low-carb diet, the weight regain didn't seem to happen as much on the Mediterranean diet. That makes me wonder what a five-year study of the Mediterranean diet would find.

https://en.wikipedia.org/wiki/Mediterranean_diet#Medical_research (doesn't mention long-term effect on weight, but only on diabetes and other disease; it also mentions that in the study you cited 86% of participants were men, and the women lost more weight on the Mediterranean diet than on the low-carb one).