colg8r said:
Plenty of other factors at play including disease, but these don’t negate CICO. They adjust your BMR, which is the number of calories your body burns to sustain itself. It is more accurate to say fibromyalgia can lower your BMR, which will have the effect of stopping your weight loss if you don’t either decrease your caloric intake or do something else to raise your BMR.
I’m sure you are working with your medical specialist to find ways to sustainably exercise that will work for you, and Reta at the right dosages can increase that burn rate as you point out. But 99% of weight is lost in the kitchen and not the gym. Cut out those sneaky calories and you’ll get back on track.
None of the diet/exercise advice you are giving is wrong, and I firmly believe CICO is the way the body works. I actually went from 145kg to 75 kg on a very high protein, low calorific density, very low fat, zero high glycemic/highly rewarding /highly palatable/addictive foods diet. So I know from this and previous experience that this approach can work. Even this diet which I designed around maximum satiation per calorie did not solve the maintenance problem. Keeping the weight off for the first year was hard work, and I was hungry most of the time. Only after I added in GLP drugs 2 years after starting, did the process start to become something that might be sustainable long term.
What I do not agree with is that diet and exercise actually works in the real world as a long term solution to obesity, especially severe obesity. It definitely works short term, but long term success rates are really very poor especially for massive weight loss, because hardly anyone ever succeeds in sticking to a difficult diet and exercise program in the very long term once they have been obese. With weight loss energy expenditure goes down from loss of mass and from long term adaptation to low calorie input, and appetite goes up with weight loss, this is a killer combination for weight loss maintenance. So that maintaining the weight loss requires a lower than usual daily calorie intake at the same time as having extra hunger. I have had to stick to a calorie intake of 1600-1900 kcal/day for the past 3.5 years to maintain my weight, the exact same calorie intake that made me lose 70 kg.
This viewpoint is not really in line with current science, but I think obesity treatment is a good example of science that got stuck in a long term rut, of recommending the same treatment for 50 years with very good evidence that it really does not work. ( mainly due to the lack of better options ) It is hard to imagine any other medical treatment with 5-10% long term success ( of maintaining large weight losses ) being considered the best treatment available. ( excluding surgery ) I think GLP's have changed that but the old way of viewing the problem persists.
My viewpoint is to remove as much as possible of the effort involved, as it is the effort itself that is the difficult to sustain part. It is possible to lose large amounts of weight with GLP drugs without modifying diet or exercising, and I think it is important as in the real world people in general are really very bad at modifying long term habits. I do not think any studies have been done with no advice at all on modifying diet or exercising with GLP drugs as it would probably be considered unethical, but I suspect the results over a 2 or more year period would be surprisingly similar.
So my view is to use the GLP drugs to reduce calorie intake. I think using a traditional diet and exercise approach with calorie counting, but with GLP drugs added in is possibly counterproductive , at least in the long term, as it is likely the process will require more effort to stick to, reducing long term compliance, even if it improves short term results. Making better food choices is a good idea, both for health and for weight loss, but it has to be a sustainable process that does not require constant willpower or I think it will fail long term.
No one treats other metabolic disorders the way obesity is treated, people are not expected to make and maintain effort based interventions to manage type 2 diabetes ( mostly as it is also related to obesity ) , hypertension, high lipids etc, as there are effective treatments that do not require this, and results are much more consistent as a result, even if it is equally possible to improve these problems with diet and exercise. Now that effective anti obesity treatments exist and I think even more so when combining agents becomes commonplace, and excellent results can be achieved with a combination of ( for example ) anti myostatin antibodies, plus low dose eloralintide and retatrutide or tirzepatide, I think the diet and exercise component of treating obesity will gradually become less and less relevant, and be looked at in the same way as those treatments are for high blood pressure , something to try first or recommend, but not considered to be essential. ( not because they are a bad idea , but because people are not very good at long term behavior change). And hopefully somewhere along the way, the whole moral fault thing gradually fades with it. This will of course require them to be affordable.
