How much weight do you actually need to lose? It might be a lot less than you think

Tell that to the Japanese health center that always tells me "metabo" even though in another other country I would be fine! They need to stop only relying on BMI to judge people's health.

They told me I was borderline overweight... My body fat was 6%.

MarkX,

Probably something to do with Japan's "Metabo" Law of 2008 which set strict (some would say too strict) standards for weight measurement, at 85 cms for men. On most English-language websites, low-risk is around

Last year I reduced my weight by 12 kg. Everything is good. Weight gain was from cancer. The target is another 5 kg to lose. Then only back to pre-cancer levels.

(Sorry)

low-risk is around...

Wallace

Go for it bruv, you can do it

Weight loss is possible but difficult and slow. Keeping it off needs a strict regime.

virusrex,

Appreciated. I did use a 'less-than' sign.

I'll say, "less-than 94 cms."

When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several physiological responses to defend our body weight and “survive” starvation.

An overstatement. True "survival / starvation mode" only occurs in people suffering from extreme malnutrition. Even then, it's not a complete effect as people still die from starvation. It's not generally a problem for people attempting sensible weight-loss. Caloric deficit does trigger certain processes that interact to protect energy (fat) stores; by increasing hunger, suppressing energy levels and accessing muscle for energy rather than fat. However, with a bit of awareness and will-power, weight-loss will still occur. The laws of thermodynamics still apply.

Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways.

The best and safest way to maintain healthy weight is to eat right and exercise, according to the medical experts. No need for shots.

The best and safest way to maintain healthy weight is to eat right and exercise, according to the medical experts. No need for shots.

Which experts have said pharmacological help that importantly increase the success rates of changing your life-style are not needed? I could not find even one that supports your claim.

Many experts on the other hand have demonstrated that the failure to reach these changes is a much worse option that comes with much higher risks for the health of the patients.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2307563

In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke.

20% reduction of the risks is a huge better option compared with just trying and failing, this article clearly mentions this outcome (regaining 80% of the lost weight) for people followed for 5 years.

In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke.

That trial was funded by Novo Nordisk.

Two sessions a week in the local city gym.

That trial was funded by Novo Nordisk.

Which is openly recognized, and would explain any problems with the design, data collection, unfounded conclusions, invalid statistical analysis, etc.

Which of those problems have you found?

Many experts on the other hand have demonstrated that the failure to reach these changes is a much worse option that comes with much higher risks for the health of the patients.

Incorrect.

And it is well-documented there are risks with these drugs, so your inability to find a source is no excuse.

Here, let's start with the risks to the over 65 crowd, as detailed by the medical experts:

*The Risks of Taking Drugs Like Ozempic When You’re Over 65*

https://www.nytimes.com/2023/07/17/well/ozempic-wegovy-risks-older.html

And here is the Mayo Clinic promoting healthy eating and exercise--and no drugs. Do you have a source that says the Mayo Clinic is wrong? If not, that means you accept that taking drugs to lose weight is riskier than following the basic plan set out by the actual medical experts:

https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20047752

I find the best way to keep a healthy weight is to avoid oily foods, avoid eating carbohydrates after 6pm and plenty of daily exercise. Never go to sleep on a full stomach. 腹八分目. If you make the above part of your daily life, you will never need to 'diet' or go to a gym. I hear people who go to such places and come back with verrucas! And 'dieting' usually falls by the wayside after a while.

Daily physical exercise is important for health and the mind. Walking, gym, cycling, swimming etc. I don't consider controlling my diet, a "on a diet". We are all on a daily diet. It's a diet discussed with my doctors and required during my current treatment. We have a city gym 5 minutes from home and we use it along with many locals.

I hear people who go to such places and come back with verrucas! 

We don't remove our footwear. We change into our gym shoes. You are more likely to get verrucas from visiting an Onsen or swimming pool than a gym.

My wife is a qualified nutritionist. I am also healthy, so I am lucky in that respect.

I need cardio exercise that I get at the gym.

-- losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight

-- making gradual changes to your lifestyle to ensure you form habits that last a lifetime.

That is standard advice that I would recommend people to follow. Don't rely only on cardio for weight loss.

That is standard advice that I would recommend people to follow. Don't rely only on cardio for weight loss.

I am with you on that.

I don't rely solely on cardio exercise for weight loss. It's just a part of my post-cancer treatment along with my diet, and several drugs I need to take for my treatment. Everything is discussed with my doctors.

It is all working because last week I had my three monthly blood tests and for the first time in four years everything was 100%. Last year I also lost 12 kg so I am very happy with what I am doing.

Which of those problems have you found?

The problem I found is that it was funded by pharma; they have a habit of employing a bunch of dirty tricks.

Or as the Cochrane Library concluded with their large study: the findings of almost all clinical trials funded by industry are favorable to the sponsors' products. And I would add unfavorable to competing generic products.

Eating slower can reduce weight. Research shows that the longer you chew food, the less you consume.

And it is well-documented there are risks with these drugs

Yes, their side effects can be quite horrendous. Plenty of people have died from taking it. And even when it works as intended, much of the weight loss is from lean body mass, much more than from other weight loss strategies.

I still recommend the carnivore diet for weight loss. You always eat until you're full and by far most of the weight you lose is fat.

Incorrect.

And it is well-documented there are risks with these drugs, so your inability to find a source is no excuse.

There is a reference already provided that proves this is not incorrect, you are the one that was unable to find a source, mostly because a source that supports your claim do not exist.

Here, let's start with the risks to the over 65 crowd, as detailed by the medical experts:

And here is the Mayo Clinic promoting healthy eating and exercise

Neither of the sources say the drugs are not needed nor that they benefits do not outweight their risks for most of the patients that can use them to avoid failing in their lifestyle changes.

Why present irrelevant sources when asked for very specific ones? your claim is that these drugs were not needed, (and that for some reason the FDA failed when it approved them), but instead of that you bring references that do not support this claim. That is equivalent to accepting that you understand your position is wrong but want to mislead people with references that say something very different from what you claimed.

For example Here is what the Mayo clinic say about drugs that support weight loss:

https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832

Prescription weight-loss drugs that you can use for more than 12 weeks, called long-term use, lead to major weight loss compared with an inactive treatment that doesn't use medicine, called a placebo. The combination of weight-loss medicine and lifestyle changes leads to greater weight loss than do lifestyle changes alone.

So an institution that you tried to use to support your point actually opposes it.

I would never take drugs for weight loss.

The problem I found is that it was funded by pharma; they have a habit of employing a bunch of dirty tricks.

Not understanding what a COI is do not allow for you to make imaginary claims about the article. Being funded by a pharmaceutical company do not mean that automatically a study is invalid or wrong, that is an illogical claim, it just mean that you take with a grain of salt when the study says you have to trust the authors for something that do not correspond with the scientific consensus, and that it can be used to explain why problems with the study are present.

But when you find no problems with the study that means your appeal is invalid, the essential requisite is for you to identify the problems first before trying to blame funding for them, that is a step you are trying to skip because of personal bias.

Yes, their side effects can be quite horrendous

But much less frequent and horrendous than what is caused by a failure to change lifestyles, which is why they are still a perfectly justified medical intervention for many patients. Saying you have a terribly low percentage of presenting a problem that can be easily and rapidly identified by medical vigilance is not an argument to say it is better to run the almost sure and much more serious health problems that will come from failing to follow a healthy lifestyle. This is why experts do recommend the drugs for patients that would instead fail.

I still recommend the carnivore diet for weight loss. 

This for example is a recommendation that goes contrary to the experts on the field

https://www.mdpi.com/2308-3425/10/7/282

Thus, caution should be taken in consuming diets rich in animal-foods, as this may drive CVD development. Particular concern should be taken with the Atkins, ketogenic or carnivore diets, which maximize the consumption of animal-based foods at the detriment of plant foods. Evidence strongly suggests that the consumption of a plant-based diet will favorably impact CVD risk, and this should remain the predominant public health message. Further clinical research is needed to elucidate other possible mechanisms by which animal products could promote CVDs.

I would never take drugs for weight loss.

And that is perfectly fine, some people have no need for them. The problem is claiming nobody needs them because that is what can be proved false. Many people do benefit a lot from their use under medical vigilance where their benefits are much more important than their risks.

I would not claim that others do not need drugs for weight loss. Each person must decide for themselves about all aspects of their health.

I would not claim that others do not need drugs for weight loss. Each person must decide for themselves about all aspects of their health.

No, that comes from other users that said they could prove the experts said nobody needed those drugs but presented no evidence for that claim.

Another very important thing is that deciding for yourself and deciding for the best option is not the same thing, part of the freedom (and responsibility) of making your own decisions requires understanding that some people make wrong decisions about their health. Going against the medical consensus is a very strong indication of this being the case.

From my own experience: Give up sugar, alcohol and walk 10 km at least 3 times a week. After three months, a miracle happens.

Only a few people in Japan need to lose weight. Obesity and overweightness is not really much of an issue in Japan compared to the US. In the US most people need to lose a lot of weight. Obesity is a major epidemic in the US and causing many health problems and healthcare to be very expensive.

@virusrex

Going against the medical consensus is a very strong indication of this being the case.

A consensus does not mean always mean the science is correct nor the medical opinion. It just means that more people believe it and/or just follow it. Examples: smoking, many medications and vaccines, many dangerous chemicals, foods, etc, etc. Many well known scientists' discoveries were ridiculed and rejected by the scientific consensus. Also, many medical breakthroughs were ridiculed and rejected by medical consensus.

If weight loss is a medical issue for people, they should listen to advice of appropriate medical professionals.

You don't lose weight in the gym.... You lose it in the kitchen.

My advice is as you age avoid injury and excessive exercise risk. If you blow a knee or hurt your back you may be completely unable to exercise for months which could precipitate a downward spiral of weight gain.

If weight loss is a medical issue for people, they should listen to advice of appropriate medical professionals.

Yeah, if it's a trust worthy medical professional. Many make money by selling you drugs.

If you want to buy a car, you can listen to the advice of the car salesperson, but you better remain skeptical.

Yeah, if it's a trust worthy medical professional. Many make money by selling you drugs.

Doctors in hospitals do not make money from drug prescriptions.

Quit telling fat people it’s ok or healthy that they are fat.

they will still die despite you trying to save their feelings.

@Wallace

Doctors in hospitals do not make money from drug prescriptions.

Not sure about Japan, but in the US, drug companies definitely give perks (gifts, dining, etc) to doctors who write a lot scripts for a drug companies' medications.

My dad owned a private pharmacy and I worked there for many years. Drug sales reps would come into the store often and even ask him to try to persuade doctors to write scripts for certain medications. He never did because he thought it was very unethical. He never liked or respected drug company sales reps. Lol.

A consensus does not mean always mean the science is correct nor the medical opinion.

But it is hugely more likely than the opposite when there is no evidence being produced to contradict that consensus.

 It just means that more people believe it and/or just follow it.

No, that is not what a consensus means in the scientific field, that is just being popular. In science a consensus means something the vast majority of the professionals of the field conclude is correct based on the evidence and studies being published. When nobody can refute with evidence what is being claimed then it becomes a consensus and remains that way until it can.

Many well known scientists' discoveries were ridiculed and rejected by the scientific consensus

At times where the evidence was not the basis for such consensus, that do not apply in modern times.

Yeah, if it's a trust worthy medical professional. Many make money by selling you drugs.

And supplements and getting in positions based on popularity, including many that you yourself recommend as trust worthy. They obviously are not.

Again, baselessly contradicting the medical consensus based only on their own personal opinion or on misleading people with false information is what can help identifying those that are not trust worthy.

Every year people buy billions of non-medical diet supplements that never work, snake oil.

Yeah, if it's a trust worthy medical professional. Many make money by selling you drugs.

Doctors in hospitals do not make money from drug prescriptions.

Same thing. The hospitals make money from the drugs they sell. That is why many doctors were fired during the pandemic because they did not prescribe the more profitable drugs.

Same thing. The hospitals make money from the drugs they sell.

In the whole world? that is not true, nor would it contradict the evidence that clearly says use of drugs and other forms of treatment can be beneficial, pretending this is not the case is not an argument.

That is why many doctors were fired during the pandemic because they did not prescribe the more profitable drugs.

Not at all, they were fired for being unprofessional and putting in danger the lives of the people they treated by going against the best available evidence. Dirt cheap drugs like dexamethasone were routinely used without problem by doctors that were not fired, even if options a hundred times more profitable were available, that obviously disproves the conspiracy theory that you are trying to use.

Dirt cheap drugs like dexamethasone were routinely used without problem by doctors that were not fired

Yeah, but dexamethasone did not compete with pharma's new antivirals. It's a glucocorticoid used at a later stage to treat the resulting inflammation. Despite that, it too was very much resisted at first.

Why single out the pandemic, though?

I used the pandemic because there are many well known top doctors who were attacked or fired for choosing to treat their patients as the thought they should. If you want another example, there is Dr Shawn Baker, and orthopedic surgeon who was fired for recommending the carnivore diet to his patients. He found that following a carnivore diet often solves the medical problems he was hired to treat.

Yeah, but dexamethasone did not compete with pharma's new antivirals

It still competed with "pharma's" new steroids, which according to your claim would make every doctor using it lose their jobs, which obviously did not happen. That is because the use of the treatments is actually based on evidence of efficacy, not on some impossible world wide conspiracy of which you offer zero evidence.

This is still a perfectly valid way to demonstrate that the supposed conspiracy is false.

Despite that, it too was very much resisted at first.

You mean not recommended before evidence of efficacy was obtained? that is a good thing, first things are tried on limited scale and when they demonstrate being useful they are used in general. The opposite of anti-scientific propaganda groups that for example kept pushing for the use of HCQ and other drugs even after they were demonstrated useless for covid and ended up causing tousands of extra deaths.

Dr Shawn Baker, and orthopedic surgeon who was fired for recommending the carnivore diet to his patients. 

He lost his licence and specially his good name when he became antiscientifc and made recommendations that put in risk the life of patients by contradicting solid science with personal opinions, pretending cholesterol had no role on cardiac health, something that is not only false, but completely outside of the scope of his medical expertise in the first place, that is a perfectly valid justification to declare him incompetent.

Oh, internet suggestions must certainly be good...

A great part of his unprofessional and mistaken actions have been online, which unfortunately made it very easy to document them and justify the removal of his license. Wrong advice that put in risk the health of a lot of people may be more common, but the same reason that made it so dangerous in his case is why it was so easy to prove it.

It's like when a company asks you to submit your resignation, and they don't really give you a choice.

What made it impossible for him to have a choice is that this was a justified measure, which is why he still is choosing not to discus his hearing. Acting unprofessionally and pretending science must be wrong (but only when it contradicts what he personally profits from) was too much to ignore.

In a way is the opposite of what this article is talking about, the author is contradicting a lot of things that were thought to be correct about weight loss, but does this based on valid evidence that demonstrate even small amounts of weight loss improve health so losing his job for doing it, is the huge advantage from following the science instead of trying to ignore it.

What made it impossible for him to have a choice is that this was a justified measure, which is why he still is choosing not to discus his hearing.

What? He did discuss it, 4 years ago, here:　https://www.youtube.com/watch?v=4b-okpHuaaM

Since you clearly don't want to check it out, here's a summary:

He was head of a surgical group, with an excellent and clean record. They went after him because he was recommending life-style changes. The only choice he had was to continue and spend a fortune and years to fight against the corrupt system or submit his license and get an independent evaluation. He obviously chose the latter, and they found him competent and he got his license back.

His case is a perfect example of how the system's primary concern is profit, and how aggressively they go after doctors whose primary concerns are patient health.

What? He did discuss it, 4 years ago, here

No he does not, he makes excuses and avoids completely discussing the reasons for people to criticize him, he does not explain nor justifies why he pretended lower quality evidence (anecdotes) should count more than epidemiological studies (but only when they support what he wants to sell, if not then he is very happy to say the opposite) or on what evidence he claimed cholesterol had not impact on cardiac health for example.

He acted irresponsibly, made unfounded claims and put in risk the health and lives of patients based only on his personal beliefs contradicting a mountain of evidence without any actual justification. That is an extremely serious offense that he has never explained nor refuted, just keep claiming he is right because you have to trust him, that is not a justification.

He is a perfect example how people can abandon professional standards for fame and profit and why medical associations need to keep vigilance of their members to avoid having people hurt public health with an invalid appeal to authority.

Again, this article is a perfect example how people can go against the current consensus and continue to be respected and supported as long as they do it with actual evidence to support their conclusions, even if those conclusions hurt the profit of people that would insist on the need of much more important weight reduction.

How much weight do you actually need to lose? It might be a lot less than you think

I'll follow the experts' advice. Eat healthily and exercise to maintain weight, and forego any medications with extreme side effects like those "weight loss" drugs gave attached to them. 6-8000 daily steps won't hurt.

This quote from the article is a very important one:

An analysis of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%.

The experts advice is to use any tool available, including pharmacological, to reduce the weight to healthy levels, if that were not the case drugs would not been approved and used with the explicit recommendation from medical associations. Anything that help the patient avoid this rebound inherently helps people avoid also many different risk for their health.

he does not explain nor justifies why he pretended lower quality evidence (anecdotes) should count more than epidemiological studies

I see, so you're saying he should go straight to orthopedic surgery, rather than first suggest or recommend some life-style changes.

And what epidemiological studies are you referring to? I was considering shoulder surgery last year. My doc said there was nothing else to do. I looked into the epidemiological studies and was not impressed, so I decided to avoid the surgery, and I'm very glad I did. BTW, my shoulder issues were not the primary reason for going carnivore...

or on what evidence he claimed cholesterol had not impact on cardiac health for example.

There is ever increasing evidence (not just anecdotes) that much of the "consensus" about cholesterol is false. But we gotta sell those statins....

I see, so you're saying he should go straight to orthopedic surgery, rather than first suggest or recommend some life-style changes.

That is not even remotely related with the text you quoted, he should recognize that epidemiological studies (while not perfect) are a much better source of information than anecdotes, specially because he can't argue against this fact. He may not like what the science can demonstrate about nutrition, but that is not an argument to pretend the worst class of evidence is suddenly better than much more solid evidence. Him being an orthopedic surgeon simply explains why he is so wrong about scientific matters.

And what epidemiological studies are you referring to? 

The ones that disprove everything he tried to push, he literally criticized every epidemiological study when he said scientists gave them too much value over the all mighty anecdotes he liked better (except when he found any study he liked, then he contradicts himself and over and over again).

There is ever increasing evidence (not just anecdotes) that much of the "consensus" about cholesterol is false. But we gotta sell those statins.

No, there is not, at least to any degree that could make the claim that they are not important less false. Neither him or you have been able to present any evidence supporting this claim.

The experts advice is to use any tool available, including pharmacological,

Nowhere in the article is "pharmacological" even mentioned. That is your opinion, not experts who are in the medical field advice.

Not at all, they were fired for being unprofessional and putting in danger the lives of the people they treated by going against the best available evidence. 

No, that is just your opinion.

The ones that disprove everything he tried to push, he literally criticized every epidemiological study when he said scientists gave them too much value over the all mighty anecdotes he liked better (except when he found any study he liked, then he contradicts himself and over and over again).

And yet you have no source for this.

he literally criticized every epidemiological study 

Every one? I doubt it.

I'm sure Mikhaila Peterson would have appreciated to be treated by Dr Baker when she was little. Instead she had doctors who followed the so called consensus, so she had a childhood of hell and multiple joint replacements.

Nowhere in the article is "pharmacological" even mentioned. That is your opinion, not experts who are in the medical field advice.

The reference for this is already in the comments, why pretend this is not the case just because it disproves your point?

For example Here is what the Mayo clinic say about drugs that support weight loss:

https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832

Prescription weight-loss drugs that you can use for more than 12 weeks, called long-term use, lead to major weight loss compared with an inactive treatment that doesn't use medicine, called a placebo. The combination of weight-loss medicine and lifestyle changes leads to greater weight loss than do lifestyle changes alone.

So an institution that you tried to use to support your point actually opposes it. This is not a personal opinion, it is a reference from a source you already accepted valid.

Every one? I doubt it.

His comment was that epidemiological studies (in general, all of them) are not as good as anecdotes, but of course he ended up contradicting himself by "disproving" well characterized cases using... epidemiological studies (that ended up being flawed).

I'm sure Mikhaila Peterson would have appreciated to be treated by Dr Baker when she was little.

Anecdotal, uncontrolled, undetailed "cases" do absolutely nothing to disprove a consensus that is supported by medical science derived data. Cholesterol is still terribly bad even if people try to push for a diet that clearly elevates their level to unhealthy levels. Recent research even point to a different mechanism that explain the observed negative effects of the carnivore diet in more detail, this is not disproved by what one single person says happens without providing proof.

https://www.nature.com/articles/s42255-024-00984-2

@virusrex

But it is hugely more likely than the opposite when there is no evidence being produced to contradict that consensus.

No, that is not what a consensus means in the scientific field, that is just being popular. In science a consensus means something the vast majority of the professionals of the field conclude is correct based on the evidence and studies being published. When nobody can refute with evidence what is being claimed then it becomes a consensus and remains that way until it can.

At times where the evidence was not the basis for such consensus, that do not apply in modern times.

I disagree. I worked in science research at Stanford before. Everything is about funding and grants. Nowadays, everyone's scientific opinions just follow the money. Here is just one example of world renown climate scientists talk about how the funding and grants work with the government and private industry and evidence that changes in CO2 is insignificant in climate changes and the sun is the main driver of any climate changes. Any evidence/studies that changes in CO2 are not the main driver of climate change are suppressed and ignored because the entire multi-trillion dollar climate change industry hinges on the CO2 narrative.

https://www.youtube.com/watch?v=oYhCQv5tNsQ

I disagree. I worked in science research at Stanford before. Everything is about funding and grants.

How would any of this make more likely for something said without any evidence to be correct?

That is as irrational as making an appeal to authority from an anonymous account, what if someone came and said he worked in seven different world class universities as head of department and said you are wrong? would that have more value?

Any evidence/studies that changes in CO2 are not the main driver of climate change are suppressed and ignored because the entire multi-trillion dollar climate change industry hinges on the CO2 narrative.

On the whole planet, and against the interest of the real multitrillion dollar oil industry? and all presenting evidence that is congruent between groups in countries that are enemies? impossible to believe.

Also, using as "evidence" a youtube video in the age of preprints makes as much sense as presenting a hand drawing instead of pictures or video.