This is the same story that's been thrown at fat people for decades! It goes like this:
Diet's make you worse...BUT for a tiny percentage of obsessive compulsive people who can spend huge amounts of energy tracking every bite for the rest of their lives...it might work.
THEREFORE, we should put everyone on a diet and make 80-95% worse! Much worse!
NO! If a diet was a pill, it would have been recalled decades ago. It makes 80-95% of people worse! And I suspect the number is higher than 95%. Most studies are not long enough to truly follow long term success and those who "fail" to keep weight off are most likely to be lost to follow up.
Why? WHY! Do humans look at volumes of evidence and still cling to disproven myths? The world is not flat and diets don't make people less fat! Period. End of story! If, and only if, you can let go of this myth will you be able to truly help people.
Dieter's suffer. A lot. We waste enormous amounts of life energy in an absolutely futile endeavor. Our hopes are dashed again and again. Our bodies get fatter and fatter with less and less food. Stop prescribing dieting in any form! Please! You say you know the science but then refuse to let go of the myth. Stop it. Move on.
We know exercise is good for everyone. Talk about all the ways that exercise can make you feel better. Talk about ways for the fattest of people to find do-able movement in their life. Tell the stupid diet industry idiots and other doctors the truth about the huge complexity of human metabolism and drives to eat. Talk about how all organism must have a drive to eat to survive. How complex and diverse humans, who have evolved to thrive in many environments, will necessarily have multiple, redundant drives to eat. How the expression of those drives will be expected to vary. How epigenetics can activate "thrifty genes." How there are probably 10-20 different forms of metabolic dysregulation syndromes in the fat people of America. But that medicine is so ignorant of these processes that it has failed to learn how to care for people with excess fat. Tell them that 20 years ago we taught doctors that most fat was an inert receptacle. Tell them how we now know it's a highly metabolically active endocrine organ in constant communication with the rest of the body. People need to know this stuff and they need to hear it from medical professionals.
Speak up and advocate for the rights of fat people to have their medical issues taken seriously and treated with real science and not archaic myth. We are a persecuted group. Help be a voice for truth.
Talk about GLP-1's, Januvia's, metformin in conjunction. Give us thought out protocols for primary care. What kind of work up? Ghrelin levels? Neuropeptide-Y? adiponectin? Leptin? Cholesterol profiles, fasting glucose/insulin followed by mixed meal and 30 min retesting of glucose/insulin? What tests might help guide us in developing a treatment protocol for those who are fat with metabolic syndrome vs with diabetes vs fat without insulin resistance but high ghrelin? Once we start treatment how do we follow?
Oh and please do not recommend dieting to people taking these medications. It will only drive up their hunger hormones. They probably need to eat constantly while taking these meds. to lose weight and not get worse.
There is real science out there. It's in its infancy. Help us develop it. If you really want to help you must first give up on the myths so you can then spend your energy pursuing the things that might actually help.
