How do people become obese?

[Truetoself]

Before someone is obese, they are overweight. Their clothes sizes also change. Why do they wait until they are obese to try and lose weight? Do the majority of obese people have mental health issues?weigh

Without realising. Believing photos don’t look that bad. Sizing must be wrong in shops. Etc. it’s easy to get there and easy to ignore it

@WhyAmIFatFatFati wish I could say or type something that could rewrite all that for you. Could make you see you matter and how you just deserve so much more.
my inbox is always open x

with high calorie foods and excerising taking time = people getting bigger. i know not everyone is the same etc

I have not read all of the responses but these are my views.

There are strong relationships between trauma and food intake. Here's a paper discussing the link:

Early trauma and adult obesity: Is psychological dysfunction the mediating mechanism? - ScienceDirect

All countries have been really bad at supporting people with trauma. Always. And people find ways to self medicate if they cannot find a way out of their pain. I have PTSD so I can understand the drive. I think that is part of the problem.

In the last 40 years, our food systems have changed. I'm not a proponent of blaming everything on UPFs as the evidence is weak, however, there are strong overlaps between high fat, sugar and salt foods (HFSS) and UPFs. Those HFSS foods now form far more of our diet than they did 40, 50 years ago and far more normalised. Not just supermarkets but takeaways. 40 years ago, you might have had one or two chip shops in your town. Now it's bloody everywhere. Food has never been so available and (despite recent changes) so cheap. If you want something to pep up your mood, there is a hamburger, fried chicken or warm cookie only minutes away, wherever you are.

At the same time, our work has changed to become more sedentary, less active, less physical. People are not doing the exercise they're advised to. While we are also increasing use of drugs to lower blood pressure. Overweight people don't die of heart attacks, they just get more overweight as they get into a vicious circle of insulin resistance, joint pain associated with weight etc.

Then the diet culture and yo-yo dieting risks. We know that diets generally don't work for most people. Most people regain then some. Our bodies often fight against weight loss for good reason. There is a human drive not to starve to death after all.

But there are some great papers out there hypothesising links. Including:

Your gut microbiome retains elements of an obese microbiome even after weight loss: Yoyo Dieting, Post-Obesity Weight Loss, and Their Relationship with Gut Health

Such things like hedonic (reward mechanism) pathways and DNA epigenetics have been proposed: Physiological and Epigenetic Features of Yoyo Dieting and Weight Control

GLP1s are changing the landscape at all but I don't think they're getting rid of the causes of obesity. More that it's now being treated as a deficiency much like the approach to mental health and SSRIs. I'd rather that we changed the environment that we're in that's creating obesity, just as I'd like it if we changed things like work pressures for mental health. But much like mental health, obesity is being pushed down being an individual problem rather than a societal one and that worries me. I have no judgement on people taking GLP1s. If I was obese, especially if I was unable to exercise as a result, I'd take one. But I think it's a sticking plaster for bigger problems that we are at risk of not changing, much as we've not changed mental health either. Just think about all the women on tranquilisers in the 50s. Has that really changed or have we just changed the drugs and approaches? Perhaps throwing in a bit of CBT as well? Or are we all just as frazzled as women were 70 years ago?

https://amzn.eu/d/09biwWl7

Im very fat because most fattening food tastes great.
Im curious about wli as they seem to cut out food noise. The food noise is the reason im fat. Why do some people naturally have no food noise and others have it nipping their brain all the time?
That's the question I have..

There’s no answer that fits everyone - everyone is different.

Firstly, it is true that he locally some people do gain weight more easily than others. I have friends who can eat what they want and never really gain, whereas I can go on holiday for a week and return a stone later. However that’s not an excuse and just means that taking my biology into account, I have to modify my eating to match.

The main issue for me is an unhealthy approach to food and the vicious cycle it causes. I grew up in a dieting household and learned early on about ‘good food’ and ‘bad food’. You were either on a diet (severe restriction, vegetables, water, utterly starving) or off a diet, enjoying ‘normal food’. There was no medium setting - just all or nothing.

I first started gaining weight around age 13 and being short it meant that I had to lower my calories quite significantly to lose. Of course that meant I couldn’t go out with my friends for pizza or whatever as I had to lose weight. I’d lose my 5lbs and within months I’d put it back on again so I was always in a revolving for of restriction/not restriction.

In my 20s, I went travelling for a year and had no scales with me. That’s when I really gained weight but at the time I really didn’t notice it. It was a hot country so I had flowy clothes and when I returned I was 2 stone heavier. I felt so defeated and from there I lost a stone, gained a stone, lost a stone, gained a stone. What I didn’t realise was that my constant dieting was making me a little bit fatter every year. I felt like I was constantly on a diet too but at ages 40, I was 16 stone! It was little by little by little and the shame and sadness at what I’d done to myself was overwhelming. And of course the sadder I was, the more I wanted to eat to make myself feel better. And on and on.

WLIs have made the difference for me. I’ve lost 3.5 stone and still have a few more to go but it’s given me hope. I’m no longer ‘on a diet’, I just eat good healthy food and the internal battle over whether to have dessert too is just gone. I don’t snack, I don’t plan a blowout meal, I just exist and I eat for fuel, nothing else. It’s amazing.

I’m not naive and I know I’ll face a battle when I come off them but I’m hoping that the new slimmer me will want to stay that way!

Keto also quietens food noise. I lost 6 stone on it and it all started with a massive fry up that left me stuffed for 24 hours then I realised keto would work for me.

If you have adhd those meds do also.

its not a case of WLI or nothing. But shutting down that noise is the best thing ever. I would say I’m fairly dispassionate about food now which is a huge relief.

I suspect some of it is our obesogenic environment. It's never been so easy to get food that is delicious and high calorie.

Your gut microbiome changes to adapt to high fat, sugar, salt foods. There are hypotheses out there that these adaptations drive you to crave them more. So it might be that if you changed your diet to move to high fruit and vegetable diets with low refined fats, sugars and carbs and managed to white knuckle it for a few weeks while changing your environment as much as you can, that you can then resist those foods as they won't seem so delicious.

Where Cravings Are Bred | Psychology Today United Kingdom

The above article is possibly overstating where the research is currently but I'd be interested if you give it a try.

There's a post above about learned behaviours from childhood which I found interesting.

I was encouraged to "clean my plate" as a child and after reading about some intuitive eating approaches, I never did that with my son. I encouraged him to eat what he wanted but always offered a wide variety of fruits and vegetables. I still make him packed lunches now (he's 15) and every day he has a minimum of 3 fruits and vegetables in there.

Despite his Dad having had weight issues all of his life, our son has no problems with it. Luck? Possibly. But I also hope I've given him a healthier relationship to food than I had at his age.

I think sometimes when we diet we obsess about what we do eat not what we don't. And diet culture feeds into that.

I wish more people had gone back to the original WHO advice around 5 a day. It was actually 400g of fresh fruits and vegetables a day which did not include root vegetables, juice etc. And that was a minimum not a target. The UK government and others broke this down into 5 x 80g and permitted all kinds of other things in there. Tinned (possibly valid for tomatoes), juice, dried fruit, frozen etc. You can actually eat your 5 a day under UK guidance without a single fresh fruit or vegetable which somewhat misses the point.

But anyway, the point was 400g minimum of fresh fruits and vegetables excluding root crops had better health outcomes. The outcomes are better still if you're actually eating 7-10 (which is up to 800g) a day. Try and eat 800g a day of non root vegetables and fruit and then tell me what your overall diet is like. Trust me, you will not have the appetite for other foods that you had...

I posted a link up thread about this but I'll post it again. Try listening to the short episodes here. Prof Yeo is very interesting on this. It's a hormone deficiency which means some people don't have the chemicals in them that make them feel full. That's what WLI give. For me they've been amazing. Not only do I experience feeling full now but I also have far less food noise, and what I get I can mostly now ignore.

So it's often much more complex than the facile response that people just need to eat less and exercise more (usually given by people who do experience fullness and don't experience food noise!).

https://www.bbc.co.uk/sounds/series/m002r3kd?partner=uk.co.bbc&origin=share-mobile
Episode 4 is particularly interesting.

This is what scares me about GLP1 injections.

Nobody naturally has GLP1 which hangs around for hours or days like the GLP1 agonists do.

I would use a WLI if I was obese but I worry the narrative on it all is pushing us down the route of mistakes we made with mental health. Calling it a "chemical imbalance in the brain".

They work, but that doesn't mean that it's driven by a hormone deficiency.

Prioritised my recovery after SA and violent rape and am on high dose antidepressants.

honestly do you think I don’t know I’ve put weight on?

Maybe try listening to prof Yeo's programme?

Personally I did quite a lot of emotional eating and I think it builds from there really. Weight gain is a complex psychological thing. I don’t think there’s a generic answer.

I eat too much when I feel insecure and sad

The satiety with GLP1s is something else. I used to feel full before but it took a lot to get me there, and most of the time I could eat even if I wasn’t especially hungry. I was quite a lazy and thoughtless eater rather than someone who actively planned binges.

Had a late lunch out yesterday and went for a club sandwich which came with a serving of chips. I know not the best choice when you’re trying to go low carb, but I was feeling pretty hungry and it was Easter weekend. I ate most of the sandwich and maybe a third of the chips but that did me for the rest of the day. I thought I might have a small snack in the evening (piece of fruit or a yoghurt) but couldn’t even face that.

I will.

That worries me a bit I have to admit. (No judgement on what you've shared GO, more a general point.) There's a series on Netflix where they talk about how gym membership is going down in the US. If your desire to eat healthy foods is also reduced and your desire to exercise isn't prompted by a desire to lose weight, what will this do for us? Could we end up with thin but metabolically unhealthy people being more common?

I remember listening to a podcast where they said that people on WLI should increase fibre and protein and weight lift. It did make me think "if you did that without the WLI, wouldn't you lose weight anyway?"

I came across this statistic the other day when I was looking up productivity figures for the NHS - 30% of adults are living with obesity and 66% of adults are overweight or obese in England.

It is not uncommon. So many people have shared their experiences on this thread and many of the posts are sad and some quite harrowing.

This is a conversation that does respectfully, need to be had, because we are also talking about the health of country, about life expectancy, which has gone
down, about productivity and how it effects our health service.

It is obviously a sensitive subject, but all of you PPs that have shared your experiences are clearly willing to have the conversation. I am reading all of your responses.

@Lemonthyme oh, I am generally eating high protein, lots of pulses, fruit and veg and relatively few carbs. Not eating junk and then relying on the drug to do the rest of the work (not sure that would work anyway). Yesterday was an anomaly as we were out and about and I was feeling, uncharacteristically, pretty hungry. I was just taken aback by how full I felt and for how long.

I take your point but I think GLP1s have reset my desires somewhat. It’s rare that I crave cake or chips or bread. It’s like it’s driving me to make better choices 90% of the time. But yesterday was a useful reminder that the old temptations and triggers can still surface, particularly in an unfamiliar setting.

Are you an idiot?

Some people would, others wouldn’t. There are so many complicating factors, as people have eloquently set out on this thread, but it is evident that insulin resistance is key among them, and one which WLIs address head-on. I haven’t yet been able to explore these for myself, given I am being investigated for potential gynae cancer at the moment so don’t want to complicate matters, but I have no doubt they would work for me in a way diet and exercise have laregely failed to do, as my key complicating factor is PCOS and its associated insulin resistance.

I'm trying 24 hour fasting at the moment specifically because of insulin resistance. The evidence on intermittent fasting is pretty mixed but most of the studies I've read lump 5/2, time restricted eating and fasting all together so I'm not surprised because in my mind only one of those is actually fasting.

I did read recently that the largest group of people seeking private WLI prescriptions are age 35-55 year old women. My thoughts, "no sh** Sherlock..." the age when a lot of the advice for diet and exercise suddenly stops working. When I was doing the other stuff without the fast, it wasn't working (totally contradicting my last comment in a way but it did work when I was younger) but weight gain had stopped. Introduce the fast without (as far as I can tell) reducing overall consumption and it's working. My HbA1c was 5.8% which my GP thought was totally fine even though it's only got a +/-0.4% accuracy in measurement and some countries have a cut off of 5.7% as prediabetic (6.0% in the UK).

So with a test subject of 1 that's why I am trying fasting.

Intermittent fasting: is there a role in the treatment of diabetes? A review of the literature and guide for primary care physicians

Good luck on the investigations. Hope you're ok.

I think I struggle with Henry Dimbleby being used on programmes like that. I think he very conveniently paints the food from Leon as "healthy" and no interviewer ever questions him on founding what was basically a fast food chain then becoming a beacon of virtue off the back of that. To my mind that's some branding exercise. I would also have preferred a dietitian to have been given the role he had rather than someone who went to school with Jacob Rees Mogg.

That all said, they made the point that I did that the food system isn't changed by these drugs but that the food industry is preparing for them and already making changes. Problem I see is that while Yeo is stating that some people have a harder time losing weight due to genetics, he didn't make the obvious point that genetics don't change as quickly as weight gain has happened. The government stats put obesity rates in 1993 as 15% and currently c. 30%. Here's the link: SN03336.pdf

What is changing that isn't genetics. It can't be. Many of the people obese in the latest figures will have been alive in 1993 and genetics don't change in a generation of 1 let alone 0.

That's what I mean with the mistakes made with SSRIs. Before SSRIs, people weren't saying "depression is a chemical imbalance in the brain". That way of presenting mental health was created by the drugs and by the people selling them. Where do “chemical imbalance” beliefs come from? Evaluating the impact of different sources - PMC

I'm now starting to see similar forms of communication about WLIs. "Obesity is caused by a hormone imbalance..." Well yes it is but also those hormone imbalances don't come out of nowhere. They've been created by weak regulation and farming systems which have prioritised calories over quality. It's created by town planning that doesn't prioritise walking and cycling. It's created by schools that sold off playing fields. It's created by the fear of kids walking to school alone. There are 101 causes which are about government and society.

Many countries have bucked the trend on obesity through societal and legal approaches. Denmark is fascinating as an example as they've been really successful in increasing fibre intake for example. They also have significantly lower rates of obesity compared with the UK. Genetically Danes and Brits will barely differ. So why focus on what's happening in individuals rather than what's happening in society?

Which makes it really interesting that Novo Nordisk was slow to get their drugs approved for weight loss (seeing it as not an issue). But also fascinating that once the money started rolling in they were found to have been promoting unethically. That was new news.

Anyway interesting podcast. Thank you for sharing it.

No problem. I see your point but it would take a long time to change all the other factors you mention so in the meantime I am happy to tackle the symptoms I have with the WLI.