My Constituency: Tough Obesity Cases

The arc of obesity is long and it bends towards 0,0

I recently got involved in a Twitter thread that reminded of the true purpose of this blog:

Maybe “Experimental Fat Loss” isn’t quite precise enough as a name. I mainly think about a certain type of fat loss, for a certain type of person.

Maybe I should’ve called the blog “Experimental Un-Obesing for Those Who Tried all the Mainstream diets.” Just doesn’t quite roll off the tongue the same way.

People I don’t care about

There are plenty of people losing weight, or interested in losing weight, that I don’t consider “my tribe” much:

• People who’ve never struggled with weight loss

• Those for whom simple tricks like “cutting out dessert” or “giving up soda” worked well enough

• People who just “stopped eating so much junk food, and started cooking whole foods” and that was enough to reverse their obesity

• People who just stopped drinking and that reversed their obesity

• People who are already lean and are trying to get six-pack abs

I know plenty such people. One time in college, after summer break, a friend of mine came back and was obviously 30-40lbs lighter than before we left for break. His secret? He cut out soda.

I had to laugh. At that point, I’d been several years into Paleo and hadn’t had soda (or most candy) in years. And yet I hadn’t even lost 10lbs doing it.

If this is you, congrats. I don’t mean to be rude, but you don’t need help. You can probably just do about anything and lose weight, and good for you!

It’s just not the type of case I’m focused on, because you don’t need the help and there really is not much of a mystery to solve.

People I care about but probably can’t help

There’s another group of people. I think they’re more rare, but they definitely exist. Mr. Yudkowsky from the Twitter screenshot above might be one of them.

These are people who are metabolically unique, or metabolically messed up in a pretty unique way. So unique that solutions for them might look completely different.

As an example, when nutrition scientists discovered the hormone leptin, they first assumed that obese people weren’t making enough leptin and were thus constantly hungry.

But as soon as they tested this hypothesis, it fell apart: 99.99% of obese people had perfectly normal leptin levels, or even high levels.

BUT: they did find a small minority of people who had genetic problems producing leptin, and were thus insatiable and morbidly obese. These people do exist, and injecting leptin into them fixes their appetite and obesity.

These leptin-deficient people are metabolically unique enough that my personal experimentation probably won’t help them.

In a way, this sort of anomaly is a little bit like my own Non-24 circadian rhythm disorder: it’s just too rare, and it doesn’t generalize to almost anyone else’s sleep.

Just like sleep advice from regular people wouldn’t have helped my Non-24, I don’t expect my experiments to solve anything for these uniquely metabolically messed up people, e.g. the genetically leptin deficient ones.

Is Mr. Yudkowsky such a case when it comes to obesity? I’m not sure, of course, because we don’t know what his exact metabolic issue is.

But he’s “successfully” beaten Ozempic, Mounjaro (Tirzepatide), and now the 3rd gen GLP-1 agonist Retatrutide - last I heard, he was still gaining weight while taking it.

He has also tried ex150 and similarly extreme diets, like the potato diet, and didn’t lose weight on those.

It therefore wouldn’t be crazy to assume that he is, metabolically speaking, even more uniquely messed up than me.

After all, while I rapidly gain weight & reached morbid obesity around 300lbs on keto, I do also react very favorably to certain restrictive diets, like low-PUFA and low-protein.

So far, Mr. Yudkowsky has not found such a “miracle” hack for himself, and he’s tried a lot, including pretty much everything I’ve tried.

My Constituency: Tough Cases of Slightly Complicated Obesity

But I believe that neither the “cut out junk food” nor the “uniquely metabolically messed up” people make up the majority of the modern obesity epidemic.

I believe there’s a vast majority in the middle, and it’s growing since more and more Americans (and people world wide) are metabolically unwell, be it obesity, diabetes, or other “diseases of civilization.”

The solution for these people is probably only slightly complicated.

I think of the whole distribution of obesity like a long-tail distribution:

The long-tail idea comes from sales, I think, but it fits pretty well here.

My focus is the big chunk of people in the middle: “tough cases” for whom simply “eating less & moving more” or “cutting out junk food” doesn’t work, but who aren’t so metabolically unique as to require leptin injections or other hyper-specialized solutions.

Who counts as a metabolic tough case?

Where do metabolically “tough cases” begin and where do they end? There is no clear objective border on either side, I suspect, but here are some thoughts:

1. You’ve tried many different diets and are getting into the more “esoteric” ideas out there beyond “whole foods” and maybe even “low-carb” or “low-fat”

2. Definitely if you didn’t react well to medium-effort restrictive diets like low-carb or low-fat, yet the more hardcore variants like keto or near-zero-fat Whole Foods Plant Based diets work for you.

3. You do well on relatively complex time-restricted eating.

4. You’ve experimented with prolonged water fasting, or even dry fasting.

5. You have experimented with cutting out very specific foods like dairy, nightshades, certain types of meat (chicken/pork), or even all meats or all plants.

6. You’ve tried more than 5-10 diets seriously, giving it everything, and you didn’t lose more than 5-10lbs.

7. You suddenly hit that “magic” diet and dropped 30lbs, 50lbs, or even 100lbs nearly effortlessly, and largely kept it off.

8. You know you could easily regain 10-20lbs per month if you were to go back to your old diet, or the Standard American Diet.

For the record, I would intuitively placed myself near the far end of the “tough cases” spectrum. I tend to get obese way faster than almost anyone I know, and I had to try some really crazy stuff to find a diet that worked for me.

But I did find such a diet, potentially now even several, and once I hit on the mother lode everything just fell into place.

In that sense, I’m lucky - some people have it worse!

What’s no longer just a “tough case” but a “unique” one?

Again it’s hard to draw strict lines, but here’s what I would consider indicative:

1. You’ve tried a 90% fat ketogenic diet like ex150 to no avail

2. Even near-zero high-carb/low-fat/low-protein diets haven’t helped you at all

3. You did the potato diet and didn’t lose any weight

4. You can water fast for 5 days straight and not lose more than 2-3lbs

5. You regularly take months off of work to starve yourself down, the symptoms leaving you unable to work during this time (like Mr. Yudkowsky does every few months)

6. You’ve tried all the GLP-1 drugs and haven’t lost ANY weight, and maybe even gained weight on them

Now I personally fulfill some of these, but still consider myself “only” a tough case. Then again, I did put myself toward the far end of the spectrum. And some of these did work for me like a charm, e.g. ex150.

There might still be solutions out there that don’t involve injecting newly-discovered hormones like leptin. E.g. maybe you’re uniquely allergic to something in your food, and you just haven’t found the culprit yet.

But these cases are starting to drift from the “slightly complicated” into the “really complicated” and will probably translate less and less to the experience of others.

As an example, dairy intolerance is relatively widespread among humans. Nightshade intolerance is probably not as common, but it’s a known quantity and attempting to cut those out is a common suggestion on diet forums.

Being dairy or nightshade intolerant is therefore only “slightly complicated” in my book.

But very few people, even in the esoteric diet world, seem to be nearly entirely intolerant of specifically potatoes, like I am.

There are also people that are histamine intolerant, which can materialize over a relatively wide variety of foods that seem at first glance to be unconnected, like aged meat, certain cheeses, certain types of fish, or tomatoes.

My friend John has a sulphite intolerance, which he only found out in his 40s.

If that was your issue, and you found out you’d been obese your entire life because your diet always somehow involved potatoes, or histamines, or sulphites, and even tiny amounts of those kept giving you trouble, I would call that “metabolically unique.”

If only in the sense that my personal experiments, no matter what I try, would never help uncover your issue.

Slow Drift

I strongly suspect that, over time, more and more people have shifted to the right on our little scale of metabolic difficulty.

There were obese people in 1900, and probably in 1800 and always. But I suspect that it used to be mostly “metabolically unique” cases.

The reason that we used to have an obesity rate of <1% in the 1800s was that people’s metabolisms largely worked, and if they ate “too much” they were just less hungry the next day.

Those that somehow managed to get fat, or even obese, could simply “eat less & move more” or cut out desserts or alcohol for a while, and would quickly return to normal weight.

The people who were truly obese and had trouble losing it were so rare, they were sometimes put in the circus.

But over time, more and more people seem to be shifting to the right, and a huge chunk of them are now stuck in the “metabolic tough cases” area.

This is evidenced by the fact that, although “only” ~45% of Americans are obese and ~75% obese or overweight, a full 93% or so are not in “optimal cardiometabolic health” as defined by “has at least one symptom of Metabolic Syndrome.” This includes being overweight, having at least prediabetic fasting blood glucose, hypertension, or elevated fasting triglycerides (essentially the fatty version of diabetes).

That means simple solutions, like “eat less & move more” work for fewer and fewer people, and more and more of us have to reach for “extreme” solutions to fix our slightly complicated obesity & metabolic health.

And, unfortunately, I suspect that we’re also pushing more and more people into the “uniquely metabolically impacted” area by exposing them to who knows what in utero, as small children, making soybean oil pretty much mandatory in baby formula, dosing the entire planet & population with microplastics, forever plastics, and other endocrine disruptors, ..

Just as rates of previously rare conditions like autism seem to have risen, I suspect that enough area under the curve of the “modern condition,” given early enough to a child, can do permanent damage.

Good times!

In Summary: for 85% of us, it’s Slightly Complicated

This is my line and I’m sticking to it. I don’t have exact numbers of course, but I think 85% is roughly right.

While life is trying to wreck our metabolisms via all sorts of nonsense every day, the human body is incredibly resilient, and we see TONS of people having “miraculous” and spontaneous recoveries, losing hundreds of pounds, completely beating their type 2 diabetes, even some type 1 diabetes.

This is the sort of thing I’m pretty good at: I’m autistic enough to very strictly try stupid internet diets, eating the same thing over and over, and recording results.

Genetically, I’m probably like those lab mice engineered to react with wild obesity to any sort of “Western Diet” - making me a great canary in the coal mine.

I can thus show you if a person prone to obesity, who needs interventions similar to what you might need, can lose weight on X diet if he stuck to it very strictly. Cause a lot of these diets don’t work even if you do stick to them, but you never notice cause you “don’t have the willpower.” Autistic, broken preference curves to the rescue!

The lucky 5% or so who can just “eat less & move more” don’t need me, you guys are already taken care of.

The 10% or so having to fight a unique metabolic boss fight, my heart goes out to you, but unless I happen to have the exact same issue (Non-24, potato starch intolerance) you have to find the solution on your own.

My constituency: the ~85% of people who are slightly metabolically fucked, and who are just 2-3 experiments away from miraculous reversal of their massive obesity.

In the footsteps of Walter Kempner?