314 ‒ Rethinking nutrition science: obesity treatment, GLP-1 agonists, protein, & better research

[@PeterAttiaMD]

In this episode, we discuss: 0:01:59 - The complex relationship between nutrition, body weight, and body composition 0:07:27 -The slow progress in addressing obesity and public health despite substantial effort and investment 0:18:18 - The very limited success of public health initiatives in curbing obesity 0:28:10 - The evolving landscape of obesity research: public health initiatives and the impact of pharmacological success 0:34:52 - Rethinking obesity solutions: the need for a paradigm shift 0:44:42 - Understanding environmental triggers and embracing a balanced approach to addressing obesity that includes both pharmacological treatments and realistic lifestyle changes 0:56:18 - The need for higher standards in obesity research 1:08:01 - The rapid success of GLP-1 receptor agonists for weight loss: a discussion on the societal impact and controversy of their growing usage 1:18:08 - The ethical and practical considerations of obesity drugs: risks, benefits, and motivations for usage 1:31:48 - The use of GLP-1 agonists by athletes as performance enhancers 1:39:31 - Unanswered questions about protein intake and health 1:55:19 - Future research needed to understand basic questions around protein intake 2:01:55 - David’s weekly newsletter: “Obesity and Energetics Offerings”

[@RobertBurg-o1z]

They seem to be ignoring the elephant in the room. “Palatable/addictive fast-acting carbs and processed foods” have been known to cause weight gain since the 1700s when indigenous populations started eating sugar and flour. Sugar and flour are economical ‘survival’ or ‘prisoner’ foods, not the best for nutrition and health. See the 1860s “Letter on Corpulence”, etc. Prior to insulin in the 1920s, a very low-carb diet was the treatment for type 1 diabetes. Although they mention Gary Taubes writings in passing (excellent 300-year history leading to now), they seem to ignore any data prior to the 1980s. The cause seems to be clear; the cure may be easier for an individual to implement and more difficult at a society level.

[@brute_force_and_ignorance]

re obesity, i.e., we getting fatter, I think the big difference is that we don't have a bunch of companies actively working to cause airplane crashes, while it's become increasingly obvious that most of the food industry is actively trying to get people to eat more junky food and not eat healthy food. "You can't eat just one" is the overt motto that companies follow to try and ensure that people eat more and more of their junk.

[@angryprincessunikitty]

They start off talking about the epidemic of obesity and then in 2 hours never seem to consider that it really is a viral epidemic causing lifelong post viral syndrome (just like long covid) in some people but not others. There was real research into adenovirus36 in 2006-2008 and then it fizzled out, likely because it was not pointing toward a treatment for existing patients. I wonder if a viral cause could reduce the stigma and moral panic around punishing gluttony.

[@suzh665]

I'm 1 hour into this episode and it feels as though they are scared to point the main finger at the power and marketing of processed food mega-corporations - some of the most lucrative and influential companies in the world. We (mostly) know the answers for how to improve peoples' health, but we are constantly being pushed towards ultra processed foods from all directions - advertisements, affordability, accessibility, endorsements, corporate 'research' and influence in government, etc. To repeatedly ask the question 'what is the main driver of the modern obesity epidemic' without mentioning this seems absurd. We know HOW to lose weight as humans - but actually putting it into practice in our modern world is a different story.

[@robertusga]

True. Obesogenic environment is one of the main causes of obesity.

[@jordanslingluff287]

You don't have to eat heavily processed food. I don't. The reality is any food that is made for long term dry storage is just not good to eat on a regular basis. What you are talking about is an excuse to take the blame off individuals and place it on an evil Boogeyman.

[@aliciastanley5582]

I agree. This is just BS. The guest is in denial. Why is it not an issue that today 1 out of 5 women have significant thyroid problems and 1 out of 10 men? Let’s start with the too difficult conversation with this guy about fluoride & chloride added into our water systems.

[@patrickodonnell2010]

I agree and in a word the difference in the mid 20th century was ADVERTISING! all you have to do is look at how smoking rates were reduced in North America, by removing advertising, changing package design, taxing the hell out of it, making it socially unacceptable rather than the cool thing to do as you see in the movies of the early 20th century...restricting where you can smoke, and educating everyone about the affects on your health and the affects of the loved ones around you. Those were public health policies that actually worked!

[@lawrenceraponi2302]

Yep, I'm 2 hours in, and only once I heard a reference to "very palatable" foods. Relatively inexpensive, widely available, hyper-paletable, over-processed foods - compounded with a lack of sufficient daily exercise - are responsible for obesity in adults and children. Now, addressing these issues is complex (ranging from societal, psychological, and regulatory reasons), but few causes can be adequately addressed by "doctors" with their current level of incentives, and nutritional knowledge (doctors know embarrassingly little about nutrition - they aren't trained on it). I'm not smart enough to know what the solution is, but it seems I know what the problem is better than what this podcast is purporting, which is sad because I very highly respect Dr. Attia (this podcast notwithstanding). Hello from Canada Peter - keep pressing on this issue. Dig deep until it hurts, (then you'll know you're digging in the right place) then dig deeper.

[@joecotter6803]

McDonalds have announced the opening of 200+ new outlets in the UK and Ireland. Their marketing budgets are enormous. This, on its own, is more influential than any public health initiative.

[@susancotter8870]

i never have commented on a podcast… and usually don’t even read the comments… but i felt like??? am i crazy for thinking this person is so vague and unhelpful ! I see i am not alone !

[@robertsummers295]

No feel exactly the same and I love Attia and related media

[@nancystalik6828]

Same, my friend. This person seems like a calm-spoken charlatan. I am a bit ... amazed and disappointed that this podcast has been posted. This guest is misleading in a very charismatic way. ... And why is no one talking about the sugars in all processed foods? And the lack of laws against it? I could go on and on but you have probably thought of all the things racing through my head... And everyone here... What if we all said, "Smoking cannot be health with in the Public Health Realm?" This is the same. What we are eating IS a public health problem just as smoking was (is). People need to learn what Ultra Processed Foods actually have in them and what they are doing. And laws need to be made that stop them from being offered to the public... but, just as the tobacco lobby, ... Follow the Money.

[@BighouseSix]

Why don’t we talk more about the public policy in Japan, which has stopped and stemmed the growth of obesity. We should look for positive deviants in this space and attempt to emulate. I’m surprised we don’t talk more about this.

[@RobertBurg-o1z]

Thank you. Excellent reminder. Find and emulate the successful practices.

[@Suzoebas]

Japan also teaches children how to eat healthy in school. They actually participate and help prepare the food.

[@LukeMosse]

What did they do in Japan?

[@BighouseSix]

@@Suzoebas yes I have heard of this, with a dedicated nutritionist assigned to each school. Really puts the American food choice of schools to shame. Of all the stuff our schools spend money on, I’d honestly think food should high on the list of priority.

[@RobertBurg-o1z]

They seem to be ignoring the elephant in the room. “Palatable/addictive fast-acting carbs and processed foods” have been known to cause weight gain since the 1700s when indigenous populations started eating sugar and flour. Sugar and flour are economical ‘survival’ or ‘prisoner’ foods, not the best for nutrition and health. See the 1860s “Letter on Corpulence”, etc. Prior to insulin in the 1920s, a very low-carb diet was the treatment for type 1 diabetes. Although they mention Gary Taubes writings in passing (excellent 300-year history leading to now), they seem to ignore any data prior to the 1980s. The cause seems to be clear; the cure may be easier for an individual to implement and more difficult at a society level.

[@ClassicJukeboxBand]

That's because Attia is an dolt, a science-chaser and GLP 1 advocate...he chases money and clicks, not health...

[@grheryford]

Not “ignoring”. This “expert” is not even “avoiding”… he appears to be intentionally misleading. Keeping BIG Food & those associated out of the spotlight. Based upon his background, I wouldn’t be surprised To find out he’s one of the “experts” who told Americans all the complete BS that has led to the current obesity epidemic.

[@evec2022]

The physiology hasn't changed in humans. But the behaviours have. America has the worst epidemic in the world but the rest of the world also has palatable/addictive foods as well. Food isn't the problem. Eating it is. So for me, the issue is how to get people to eat appropriately to maintain a healthy body. I agree with Dr. Attia... all these diets are just avoiding the problem which is why are people not able to eat reasonable amounts and appropriate foods.

[@skyjacobs]

As others have said here, there's a huge omission, which is discussion about the food systems that have come to dominate much of the earth. What people eat does not come down to personal choice only, much of it has to do with what's available, affordable, and what they've been brought up eating and learning about through advertising and dominant culture. Of course eating calorie-dense foods composed of sugars/simple carbs, fats, and salt are appealing, influencing personal choice... hard to combat from a public education standpoint, but that cannot be blamed as the only culprit here. In a world where better choices were considered normal and more available, people would make better and different choices. Food conglomerates should take some of the blame and should be in the sights of public health efforts. They intentionally load food with sugar, produce huge amounts of advertising, make careful efforts to create "hyper-palatable" and addictive "foods", influence and write regulation, utilize vast amounts of food subsidies to make corn syrup (the literal stuff contributing to the fat in actual people's bodies), among other efforts. Also saying public health efforts have totally failed may seem true at first thought, but what would obesity rates be without those past efforts... I don't know the answer, but we can't assume they didn't have any impact... perhaps rates would be even higher now.

[@RobertBurg-o1z]

Thank you. One story is that 'personal choice' started as a marketing strategy by the tobacco companies to offset the cancer connection. RJ Reynolds Tobacco Company became RJR, then became RJR Nabisco, and now uses the same 'personal choice' ploy to get and keep people eating highly processed food-like products.

[@markwimmer3647]

Listen to this podcast for around 45 minutes this guy maybe a good person don’t know but. He said a lot of words and said nothing of usefulness can’t stand to listen to anymore hopefully you get more information out of it than I could

[@mariad1151]

Yeah 👍 I've seen him before. He advocates for bariatric surgery even in the very young. Says that's all that will work statistically. Very cold & no ideas.

[@theperipateticgumshoe9047]

What information are you looking for specifically?

[@olafstorbeck4777]

I agree, what I hear - maybe wrongly - it's maybe genetics, eating patterns don't play a roll, people just overeat, low carbers are zealots, let's do surgery and Ozempic. Not that helpful, IMHO. But that's his opinion, why not, I have mine...

[@theperipateticgumshoe9047]

@@olafstorbeck4777What information are you looking for that you think is lacking? Is there something you’re looking to incorporate or is this purely academic?

[@mariad1151]

@@markwimmer3647 I think now that drug companies are involved, the science will advance. No one else was willing to put $$ in, but pharma is profit seeking & can do it. the more the subject is looked into, the more hunger & satiety are proven to be hard wired unconscious behaviors. in an environment of food scarcity, it didn't matter. Folks went hungry. Now folks don't have to. Some interesting work has been done by Rudy Liebel & Kevin Hall that shows anyone w a large weight loss must eat 30% less to maintain normal weight & are the equivalent if 200 calories hungrier (Hall) vs those who never lost weight of same sex & size. If I can get this info as an ordinary person, why don't these guys have it? Not listening? don't care? Attitudes take many generations to change & some folks will stick to backward beliefs. Read Taubes

[@Jorgie1944]

Personally, I think we have to keep in mind that human physiology/metabolism evolved under conditions of scarcity, while we currently live in an environment of abundance. We have to figure out a way to recreate scarcity for optimal health.

[@jordanslingluff287]

Eat a high fiber food diet from fruits. It slows down your digestion just like these weight loss drugs. In the process the microbes in your gut consume 20-30% of the calories from the food item. We already have the answers. You're a monkey. Eat more like one and you won't be over weight. We evolved to be narcissistic and think we don't have to answer to nature like our other primate relatives.

[@Dynamicdiscdesigns]

Yes! Seven hormones to raise blood glucose and only one ( insulin ) to reduce it. This should tell us how we are designed. Designed to deal with deficits.

[@mariad1151]

Inflation is doing it for a lot of us!

[@JBBII]

This was an extremely good interview. I hope there is a part II. The points Dr Allison made on what we don’t know on protein show the enormous blind spots we face when making even the simplest nutritional recommendations. He also alluded to what we don’t know about exercise, I’m hoping you can explore that point further with the humility of a good scientist. Thank you for the content.

[@r.davidyoung7242]

35 minutes into this... "we need paidigm shifts within paridigm shifts" what?! How about this viewpoint: get us off the junk food. Stop marketing MTN Dew as an amazing health drink.

[@lindajones4849]

Absolutely!! Stop eating crap ultraprocessed food that has pharmacological doses of added sugars. See Dr Robert Lustig , Dr Mark Hyman.

[@AnnMitt]

Stop drinking sugary liquids, energy drinks, and alcohol. Stop eating chips and cookies. Return to eating whole single foods and drinking water. Walk 30 minutes per day or play a sport. Weight lift 5 days a week.

[@williamhenry3337]

Fat chance. People just aren't going to do it.

[@nichtsistkostenlos6565]

Effectively 95% of the obese population knows exactly what they need to do to lose weight, they just won't do it. They were all taught this in health education as early as middle school, so yelling at them now about it isn't going to change their behavior.

[@mariad1151]

Read Taubes. Educate yourselves. Listen to Oprah, one of the most successful & determined people on the planet. Look at the stats. Folks wouldn't be out there getting their bellies slit open like the catch of the day if any of that shit worked. Get real!

[@jessehudson1318]

The reason why all of these things seem both simple and also challenging is that 100 years ago these things just happen naturally. People did manual labor jobs and this stressed their bodies enough to not need to intentionally exercise. People ate single ingredient whole foods, because there weren’t readily available process foods and they didn’t have enough money to buy a bunch of sugary foods or alcohol very often. Now these are all conscious choices that are actually harder than defaulting into the standard American diet and activity levels. Our willpower hasn’t gotten worse. Our default settings have gotten substantially worse.

[@orbifold4387]

Perhaps the reason why obesity research has been so slow is that almost every obesity expert gets money from Coca Cola, Kraft, McDonald's, General Mills, Kellogg's, Mars, Nabisco, etc.

[@mariad1151]

It's bc even in the last generation, food was scarce. We're a breath away from going back in this economy...

[@orbifold4387]

@@mariad1151 I don't disagree with that, but we still need to understand why not everyone falls into the temptation of buying and consuming more food than they need.

[@mariad1151]

@orbifold4387 it's exactly because of that. Our brains are hard wired to do it; it's a survival mechanism. Neuroscience states 50% of the population have the obesity genes, but they can only express/manifest during food abundance.

[@orbifold4387]

@@mariad1151 The thrifty gene hypothesis was discussed in a previous episode https : / / www . youtube . com / watch?v=oJIIvYerKbc

[@helenaquin1797]

​@@orbifold4387They are.. They have found dysfunction in the hormones around hunger stimulation and satiety and the brain in certain children who will literally eat themselves sick, (parents need to put locks on the fridge, cupboards, etc.) These studies point to less severe but nonetheless impactful dysfunction in these hormones of obese patients.

[@pobishop235]

With researchers like Allison it's not surprising that so little progress has been made. He seems disinterested in understanding the causes of obesity and never to have looked at an ingredient label of the foods that are available.

[@lindajones4849]

Exactly!!!!

[@groove9tube]

I worked in pharma. The level of quality checking and compliance is over the top. The average academic researcher has no idea the scrutiny involved. When there is occasional fraud the consequences for the person are severe, and they are quickly terminated from the company.

[@karlpk3907]

I do some consulting work in the pharma space and I couldn't agree more. Not only what you say, but that people in the business really want to do right by patients, and patient results are what drives the people in the business. Do things always work out? No. But when they do, it is game changing for patients. The examples are too numerous to mention.

[@gymjoedude]

I worked at a CMO and my work was reviewed by at least 8 people. Everything I did. Everything I wrote. People have no clue how strict it is and how dedicated researchers are to help other humans.

[@EvilMAiq]

lol, lmao even Those audits are all performed by parties invested (sometimes literally) in the pharma company's success. Get a million people to review your papers, if they're all incentivized to report a certain outcome it doesn't matter a bit. Only upshot is drones like you feeling legitimized and validated in your echo chambers

[@r.davidyoung7242]

Minute 103. I don't trust the FDA nor pharma's research nor academia. Each study no matter how it's funded or done by, needs to be independently evaluated.

[@samuelstephens6904]

And who is going to evaluate it? Who are the best and most qualified people to evaluate it? All those people you don’t trust.

[@jburt1100]

Not nearly as educated as these gentlemen but it did dawn on me that I really haven’t seen anyone talk about the how the psychology of the human organism might contribute to modern obesity problems. As far as we can tell in history, it was the kings and queens( or their equivalent) in society would be likely to be the fat ones in the room. Since the cost per calorie was so low to them…(they owned everything), they would over consume. The human animal is hardwired to seek max caloric impact just like most other animals…so the process of creating body fat exists to help survive the lean times. But those ancient kings and emperors did not have lean times so they tended towards heavy…and in many societies being heavy was a sign of wealth. To sum up my rambling…modern cost per calorie and availability of calories has led us to consume much like the Uber wealthy used to…and so more obesity. Most of us have no idea what being really hungry feels like. Sorry to ramble…I was typing and thinking as I went along.

[@temp4miller]

Look at the timing of cable, the internet, video games and social media. When I was growing up there were Oreos, Hostess cupcakes and wonder bread. But only 3 channels and you had to get up and change channels! Nothing good on so go outside and play. Cable provided a lot more options to stay on the couch, video game graphics became better and games more addictive, I remember when yahoo groups started and I would spend hours following discussions. Cooking takes time, easier to grab a snack food while sitting in front of the computer. Now we have KZbin, TikTok, etc that is addictive to scroll through. Jobs are more sedentary and computer focused. We have had ultra-processed ultra palatable foods around for decades. But activity levels have dropped. You can order food from your computer, you don't even have to walk around a grocery store or walk or drive to a restaurant. I was listening to the podcast while working out and admit I haven't finished it but there was no mention of the huge increase in screen time, and the snack eating that often goes with it, being a factor.

[@faimohkihfaimohkih8223]

The reason public health interventions have “failed” to improve the obesity epidemic is because they haven’t even been carried out. Smoking was significantly reduced by prohibiting cigarette ads on TV and marketing aimed at American youth while also increasing ads educating the public on the dangers of smoking. We still see junk food and fast food commercials targeting children and on prime time television and there has never been a commercial educating the public on the dangers of added sugar in foods or highly processed food. It is very clear that the processed food industry has made effective public health interventions impossible so it is unfair to say that they haven’t worked.

[@nancystalik6828]

Exactly! I agree 100 percent!

[@kennyx8482]

one profound question they didtn talked about is: If we were fine tuned over millions of years of evolution for our body mechanisms to behave a certain way...and a drug drastically changes those mechanisms, essentially overnight in a human evolutionary scale...then, the question is, how can that "cheating" NOT be bad for whoever takes the drugs, in some MAJOR way? cos the thing is, all the mechanisms in our body are so inextricably linked..u mess one up..and that messes everything up. such is how intricately fine tuned and interconencted our body mechanisms are..by courtesy of a long long time of evolution

[@nancystalik6828]

Right! I keep thinking... okay. If you "solve" this with a drug, let's see what the true results of this drug is fifteen years down the road. It is not going to be a pretty picture.

[@pobishop235]

I think I just heard Allison say that he thinks there isn't a right way to eat, i.e., what we eat doesn't matter. We just have to take drugs. Unbelievable. approx 55 min in.

[@samuelstephens6904]

That’s not what he was saying. He was talking about people who, for example, think there is an one optimal ratio of macros or time of day to eat and things like that. There is a difference between saying there are _better_ and _worse_ ways to eat (which he probably doesn’t deny) and saying there is a “right” and a “wrong” way to eat. Edit: And he is obviously right. Anyone is has actually dieted knows you can’t have it all. There’s no perfect way to diet or maintain weight and completely eliminate cravings or eat foods that are equally as tasty as what you were eating before or eat as much as you want. As someone who was once overweight, there are things that I miss that I wish I could eat more of and more often than I do now. Those desires and dissatisfactions will probably never go away and there is no hack that will fix it. It’s just a sacrifice I and everyone who wants to be healthier have to make (unless there is some pharmaceutical solution which eliminates those things).

[@TamarChitashvili]

Thank you for amazing discussion! I agree with you Peter: perhaps two things we so not consider in the discussion: public health interventions do work and the example is a smoking for example. I see substantial difference in smoking in US and European countries for example, where public health interventions were lacking in terms of smoking rates, especially among adolescents. If the intervention does not work, why we throw it in the garbage without careful analysis what worked and what did not, including whether these interventions were executed as planned to better understand the problem was in the intervention or the implementation. Clearly food environment we live in has impact on us. The second, we forget people, as producers their own health and the power they have in changing it. The fact that after 2 days of posting 18K people watched this conversation is a testimony of effectiveness of some public health interventions to educate public. We just need to make these massages reaching relevant audiences…..

[@Dynamicdiscdesigns]

Great discussion. We have it, a push to re-teach the first law of thermodynamics. Back to school on the basics of human energetics.

[@kimberlyf4888]

None of this takes into account the massive change in light/environment we've experienced since the advent of technology and LED, low E windows, moving indoors for most jobs, etc.

[@SirGalaEd]

Ok, how awesome is it that Dr. Allison wore a suit and tie for this podcast. Much Respect !

[@Sold_a_dummy]

I am from Jamaica and I lived in the country. Protein is not a big part of people's meals there. In fact, protein is more of a side piece where the yams different types of yams, green bananas and so forth are the main course. Generally, especially women because they don't drink a lot, etc. Live into their '90s easily. So just as an anecdote there are a lot of societies where protein isn't consumed. Even close to what the FDA recommends here. And the people live very healthy and live long. And they're able to work work hard because I come from a farming community.

[@markotrieste]

"The mean per capita daily energy and protein accessibility levels were 2,170 calories and 64 gm, respectively. This can be compared to reference requirements of 2,250 calories and 43 gm protein" "The results show that boiled green bananas and wheat bread were the most common high carbohydrate foods consumed by Jamaicans. Chicken was the most popular meat, while carrots and callaloo the most highly consumed vegetables. It was evident that Jamaicans eat a sizeable amount of foods high in fat - cheese, eggs and butter. "

[@libragoddess333]

What A Great Collaboration...Thank You Dr. Attia for Sharing🥰

[@Philusteen]

I really would like to see more about extended fasts in obese people - i was well over 300 at the beginning of the year and am around 250 now, with weight training, high-protein low carb, and 3-5 fasted days per week supported by minerals, fermented brine, and light, consistent movement.

[@pobishop235]

Nice try, Peter, in trying to get Allison to address the question of what is causing the rapid growth of obesity. Multiple times. And every time he dodged it. How can one be a serious researcher into a problem while refusing to look at what is causing the problem. Allison only talks about 'solutions' without understanding the causes. This surely is futile.

[@DILFDylF]

The "cause" is eating feels good and people can't control themselves. And they're lazy. Start cooking your own healthy meals and you can lose weight while eating tasty food. There's no conspiracy, like you seem to imply

[@aliciastanley5582]

@@DILFDylF BS there certainly is. Your willingly blind

[@agpie9]

What answer are you looking for outside of the mentioned abundance of hyperpalatable food? Do you have a different hypothesis?

[@MsKelle123]

Thank you Dr. Attia for your clear statement about why you would not choose to take these drugs now. That's my fear about taking the drugs even though losing 10-20 lbs less would be lovely. I am, according to my cardiologist, in perfect health. I would just like to be thinner and not hungry or deprived. At 70, I'm just not willing to take the chance of the side effects.

[@IvicaOS]

fantastic pod, guest and everything as usual, I subbed at that newsletter ❤️👊🏻💯

[@elliek5350]

In the segment between 7th and 18th minutes , P.A. is asking the same very good question at least 3 times, still didn't receive an answer.. thank you for your persistence.

[@happynjoyousnfree]

As others have noted, food advertising coupled with biased researchers who have had a powerful influence over public policy are at least as responsible for the obesity epidemic as the ready availability of hyper palatable, highly refined carbohydrate foods. I agree that is rather shocking that advertising as a highly profitable public information "campaign" wasn't mentioned here.

[@borutbezgovsek4937]

This guest is a doctor of dodging political hotspots. Uses a lot of words to describe everything but concludes nothing.

[@KJSvitko]

Processed food manufacturers need to hear from consumers that less ADDED chemicals, sugar, oil and salt is wanted in their food products. Why is there so much ADDED sugar in everything, even bread. That's just crazy Email, text, tweet or phone your favorite producer of poison and let them know consumers want less salt, oils and sugars in their products. Let their customer service department know that all the extra added salt, oil and sugar is not necessary or desired and is causing health issues. Reduce or eliminate highly processed food from your diet if you can.

[@inkoftheworld]

they put it in because those are things that make food taste good and are addictive.

[@PhillipGrobler]

Many Dr focus on calories in calories out. But that would be the same as the Wright brothers focusing on gavity. They did not fly by making less gravity. The did it by using a complete different force air pressure bellow and above the wing. And that force overpowered gravity. GLP1 is a similar shift it's not trying to fix calories in and out it focus on another force ( hunger) and the CICO is overcome as a side effect when hunger is controlled. Hopefully the drug intervention will shift the paradime, and we will realised it will be possible to use natural levers to address other forces that will address cico

[@bonnieschmidt5882]

I agree, but my feeling of hunger was dramatically impacted by going keto. People also need to be willing to stop eating all the highly processed junk foods and desserts instead of expecting a drug to create that effect without any change of behavior on their part.

[@nichtsistkostenlos6565]

Your analogy is bad because gravity is a variable that is not controllable, not in any meaningful way. Both calories in and calories out are controllable, and should be both controlled in any appropriate dietary plan.

[@cactuscanine3531]

The whole purpose of a GLP1 is to decrease calories in.

[@mariad1151]

Why isn't the fact that food has always been scarce ever considered? My gen had supermarkets, but even just one generation back, my mom growing up in NYC, talked about having to go to different stores for different things: butcher, vegetable stand, no junk food or soda...jobs were physical, even the proliferation of the personal automobile in the last 100 years has to be considered. Women started driving in equal #s in the 70s...

[@mr0glass]

It is weird so many people are against GLP1 agonists. They give advice like eat unprocessed food, exercise, etc. Duh! The point is that some people have such an appetite and anxiety related to food that it creates a situation where it is impossible to do those things consistently. Anyone who has taken these medicines knows that it changes your brain. You start to have less of that NEED for SOMETHING. I started one 2 months ago and I drink less coffee, feel less anxious, don't need as much food - the food noise is more or less gone. I hate alcohol but I recognize some people have a problem with alcohol, their need for it is different than mine. Therefore I won't tell them "just stop drinking" or "just have one beer a day". Doesn't work like that. Frankly these drugs are almost a miracle and they should be more widely available. Our environment is extremely unnatural and not conducive to healthy living, so an unnatural solution may be best.

[@-astrangerontheinternet6687]

Not against glp1 agonists… just against their side effects and recognize they aren’t necessary.

[@kathrynmorgans2413]

Exercise and eating healthy foods would help a lot of physical and mental/psychological disorders but no one rags on them for taking meds or tells them to "just" eat better and exercise.

[@paulwitt8186]

Thank you for sharing your experience. It is important for others to hear real life testimonials as they weigh their options. Good luck on your personal journey.

[@lewynld]

You make really good points and I don't think most people are against glp-1 drugs. I think they are dismayed about the cost and also that they are sort of a short term solution. You used the example of alcohol and that you cannot simply say stop drinking and of course this is true. Nevertheless an alcoholic has to find a way to stop, or suffer horrible consequences. Likewise I think these drugs are very useful but not a long term solution. It is hard and painful but I think retraining, so to speak, is the answer to the food problem. Maybe the will find better drugs. It appears that food literally causes brain damage in some people, in that it seems extraordinarily difficult for some people to change their diet. How to find a sustainable way to change this is obviously not easy. Clearly glp1 is a great first step and very helpful and hopefully they can do better as this science evolves

[@mariad1151]

I like your post. The problem is that the cause of obesity is not known, and tho glp1s seem to work, no one understands why or exactly how they work, & long term side effects. (Like phen phen or lobotomy). The questions are more plentiful than the answers. As a friend of mine once said... folks can be hundred of pounds overweight & live, but the reverse cannot occur. Look at the anorexics by contrast....maybe less than 30 lbs underweight & they die. Guess nature takes this into consideration.

[@Chemistry4A]

Global change in the obesity epidemic requires a significant amount of self driven psychological and behavioral change. Which is probably one of the primary reasons we haven’t seen the science of metabolism and nutrition translate into observable positive outcomes in obesity. In addition, the knowledge most individuals have about their health and wellness comes from advertising. Need I say more?

[@mtman2025]

Obesity is a psychosocial problem. We already know everything we need to know about it on a physical level to treat it effectively.

[@gymjoedude]

Just look at what people are eating. They eat enormous amounts of food)/calories. I grew up in the 60's 70's and 80's. One meal a day was processed food like canned spaghetti, canned tomato soup with white bread and crackers. Dinner was almost started home cooked and fairly nutritious. I was never overweight and my entire family of 10 was not overweight. Years and generations later, no one is overweight. We all eat the same amount of food we did growing up. What was normal before 1980 to centuries earlier.

[@mariad1151]

Obesity is 80% heritable. It's the 2nd most heritable trait; 1st is height. You must have good genes or poverty. The "holier than thou"attitude is pernicious & unjustifiably.

[@Re3iRtH]

​@@mariad1151 Really obesity is heritable, yet in a poor country like Colombia only 8% of the population is obese. Oh wait, Japan is a rich country and obesity is extremely low there as well. Heritable? If only the rate of logic in Americans was as high as our obesity rate.

[@mariad1151]

@Re3iRtH your comment displays only your ignorance of the subject. So read up; I'm not going to give the answer to you. Persist in ignorance. Joke's on you.

[@Re3iRtH]

@@mariad1151 yes of course it's some big secret you are correct only in your own little mind

[@Re3iRtH]

@@mariad1151 everyone in Colombia and Japan have good genes, right? Oh wait when they emigrate to the United States and live there long enough there obesity rate becomes the same as other Americans. Funny how that works.

[@Vronihetherly]

Thank you for the thoughtful discussion, but this discussion did not even mention the microbiome and that it might contribute to weight issues. As long as we don‘t consider how food and microbiome influence the signaling in our bodies, our nutrition studies will have unreliable results in my opinion

[@groove9tube]

I believe it’s frequent eating of restaurant food, you have no idea what is the nutritional or caloric content. Online ordering and delivery has decreased the barrier to get it. Even upscaled coffee drinks have hidden, abnormal amounts of calories.

[@Crazydoglady55]

With all do respect. Our environment drastically changed within the last 40 years. For example, physical education in schools is non-existent. School lunches consist of overly processed food and are high in sugar. I can keep listing other causes. It's interesting that Europeans are not jumping on the glp-1 agonist bandwagon. As usual if we can medicate and make a ton of money in the US then it's not a problem, it's a solution. Our money would be better spent improving the quality of our food supply.

[@lindajones4849]

I agree, stop eating lousy ultraprocessed food,they are purposely formulated to be addictive. Moderation with ultraprocessed food won't work. You will always want more.Big Soda / Big Food controls the research and researchers. Eating sugar laden foods in moderation won't work, the hormonal changes provoked by the sugar overdose will drive you to eat more.

[@wonderhoff6894]

I have been on and off Tirz for a year. I have never noticed a resting heartbeat increase. Always around 60.

[@elliek5350]

Their voices are actually quite similar

[@DanielF-sw2px]

Thanks for your interesting content! There are several things, I Would have to disagree on. First: As far as I understand the energy balance model is not just a reformulation of the first law of Thermodynamics. It is a far more complex model that includes central nervous processes and other physiological responses of the body. K. Hall et al. have written quite extensively on the model and why it is a misnomer. Second: Though the comparison with aviation safety is clearly an entertaining one, there is no antagonistic player in this area who stands to profit from crashed airframes (except maybe for some lawyers). Whereas there is a huge sector of the industry that profits from selling nutrient dense, hyperpalatable and, frankly, unhealthy food that you would probably refrain from consuming. Thanks again and best regards.

[@joecotter6803]

Nudge allows politicians to avoid taking any action that will upset the food and drink industry.

[@lizlowebodyworks]

Also, the person who gets the nose job may or may not feel better about themselves after the nose job. One person may stop at the one surgery and feel better about themselves while another person will not stop at one surgery and will continue to try to “fix” their appearance to find happiness and never do so.

[@grheryford]

Not that he’d care, at all, but I lost some significant respect for Peter with this interview. I’m going to continue to lean into his teaching around exercise physiology but NOT around ANYTHING to do with nutrition.

[@johndinsdale1707]

So, in the USA the price of medical treatment is so prohibitory expensive, lots of middle income people will try to self medicate. They have read the experiences of lots of serious journalists and writers of their experiences with 'Ozempic' type treatments. They will make value judgements and back channels will prolificate. Wait until the 'oral' versions become mainstream and the floodgate will open. Many 'interesting' outcomes will follow?

[@r.davidyoung7242]

Minute 52 forward omg. There is a right way to eat. Whole foods. And the individual can decide their macro ratio of the whole food diet while getting their micro nutrition and while healing their leaky gut. Plus there's the need for sunlight a whole other important conversation.

[@cactuscanine3531]

None of what you’re saying necessarily changes calories in or out.

[@IvicaOS]

9:22 the progress is greater because a few people have made an effort so that the whole world has benefit but without effort, with obesity the whole world should make an effort, and the greatest effort is needed by the end user

[@DavidAnnett-f2m]

1. Corporate profit matters more than people. Big companies have no checks on feeding us highly addictive foods. Heaven forbid policy might negatively effect my 401k (despite being morbidly obese the last 10 years of life with no quality). 2. Our dependence on cars/car culture has something to do with it. Fast food with drive ins, everything is so spread out walking is not only difficult but unsafe, people drive around the parking lot for ages waiting for the "perfect spot". Average steps per day in middle america is tough to get over 6k steps without dedicated intervention. What ever happened to the "gym of life". Calories in must be less than or equal to calories out. Its pretty simple. Weve designed a society that values that unavoidable fact less than profit and convenience. And we are unwilling to infringe on our freedom to be obese to change the tragectory. Oh wait! I have an idea!!! Lets make pharmacological treatments to help out our 401ks instead!

[@macfin4862]

Surprised this interview is getting so knocked. Personally have found it interesting

[@marcryan5399]

Juicing with GLP-1 maybe the greatest performance enhancing advance ever. I'm (Assuming) a younger heart can take a extra 10 beats at night. So now we wait to see a spike in Thyroid issues.

[@KarlKrassnitzer-mm8wb]

On ice age to be fat was a tremendous advantage to survive the cold and many months of food scarcity. That genes live in some of us. There are many living healthy fat people. E.g. for ice swimming fat people endure the cold water 4 times longer than skinny people

[@mariad1151]

Yes, far storage is an evolutionary advantage. Plus folks die at the other end w a much more subtle challenge in mass (anorexia).

[@mariad1151]

❤❤ that Peter is backing up even if Taubes doesn't lol. Look to neuroscience for the answer to obesity, Peter. They dont have it yet either tho. You interviewed Guyinet. Gotta be more neuro guys, & now w $$ from pharma, the science will inadvertently be advanced. You did good despite the dullness of your guest; the meat is gone from that coconut. He's just a shell. I've heard this guy before. He'd like to see everyone slit open "bc it works.". He thinks it in the control of the individual. Listen for where he says that regardless of diet, you cannot eat to satiety

[@stevenmatta1034]

While I always appreciate someone going to bat for the team I feel Peter has far too much confidence in his fellow physicians than is warranted. Suggesting that most physicians would suggest therapy in conjunction with the anti anxiety meds or antidepressants they are prescribing is - at least in my experience - never the case. I personally know over 20 individuals on one or both med types and all have said unequivocally that their GP or OB/Gyn never suggested they consult a therapist. They either up the dose or switch the med, that’s it. In most things it seems the approach is treat or numb the symptom and don’t worry much about the cause.

[@muscleNPmama]

If we want to be less dependent on meds we have to focus on the food industry as well as behavioral science. Much of what he is talking about that fails don’t address that. He’s suggesting we paradigm shift towards pharmaceutical and surgical options but e haven’t begun to understand what drives human behavior that leads to obesity…

[@PilgirmsMaster]

It's the first time on a Drive cast that I felt I was being whitewashed that man is Pure bureaucrat ...Dr Peter hit the nail on the head at the beginning about the progress in nutritional science....in my own words pathetic

[@blein8988]

if big food profited from planes dropping out of the sky.....

[@RobertBurg-o1z]

The lawsuits already are starting regarding Ozempic and gastroparesis. It takes time for side effects to show up in humans.

[@nancystalik6828]

This discussion is making me very uncomfortable. There manner of speech is so calm. And yet this guest is saying such carefully chosen words to purport dangerous untruths. If our current state of health (high rates of obesity and poor metabolic health) cannot be dealt with via Public Health channels then why did campaigns against smoking help? We DO need Public Health initiatives. Massive and continuous. But we also need laws to regulate the processed food industry. It is another Follow The Money issue. I am only a third through this podcast and I really want Dr. Attia to take off the Kidd Gloves. Truly, this guest is making my skin crawl.

[@natalie8NB]

It has to be recognized that food science has - like sub-atomic physics - developed rapidly. However, like nuclear weapons grabbed the stage and cleaner energy was vilified, food science knowledge went the way of industry, market, money and power - contributing to our destruction similarly.

[@AndrewJohnson-e1v]

The great thing about the GLP-1‘s are that they augment and reinforce traditional methods- portion control, limiting snacking, avoiding processed foods, etc. The opportunity is to use these medications to make these prior objectives much more achievable and reasonable, not to replace them.

[@jakubchrobry3701]

For Peter Attia, 1.3 g/kg of protein equals 2.2 g/kg. All the studies that show higher protein diets are better for longevity top out at about 1.3 g/kg. Examples are the recent Nurses Health Study results and epidemiological studies showing wealthy people eating more protein live longer as mentioned in the video. Somehow Dr. Attia extrapolates this to 2.2 g/kg and then references Baum, Kim, and Wolfe (2016) who say nothing about health and longevity.

[@gewurztramina]

Peter Attia, please interview Dr Robert Lustig or collab somehow with him

[@shneider177]

@5:18 he mentions marketing and pricing and the influence it has on intake? And I'm listening to it as double speed. You ppl werent paying attention.

[@KyraShalise]

Why is the heart rate bump doing? Does it stay forever after taking the med?

[@ThePlaylists001]

Peter telling this guy that his 30 year career in obesity has been a failure.

[@pxp175]

An excellent speaker!!

[@Athenaikos]

The guest is uber confused.

[@jfriedman028]

What is the "nudge stuff" he spoke about with Daniel Kahneman at 39:48?

[@paulwitt8186]

I think he is referring to Nudge theory. It has to do with giving people the ability to chose options, but "nudging" them in the right direction. en.wikipedia.org/wiki/Nudge_theory

[@janetkonshuk2825]

There’s a book on this called nudge. It’s awful!

[@russelljacobs9526]

The drugs don't fix metabolic dysfunction.

[@emma.muhleman]

One has to wonder if the drugs are taken by a metabolically healthy individual, such as myself, say for an entire year, perhaps I’d become less capable of managing insulin (which I do very well now). As an analogy, if you haven’t been diagnosed with any defects in your vision (ie your eyesight tests 20/20), but you’d prefer not to have to squint every so often when reading small texts or trying to see with clarity distant objects, should you go buy Cheaters? If you have good eyes like me, try it: you’ll be able to see with precision the texture of a wall on the other side of a Walmart and it may (as in my case) make you nauseous - those who takeup the use of cheaters no longer engage or use the optical fibers and neuronal systems needed for the normal functioning of the visual cortex, after which those neuronal connections degrade until the once 20/20 visual system relies on these magnifier goggles. Studies show that the best way to maintain and improve one’s eyesight is to wake up in the morning, do not pickup the phone, but look as far as you can into the distance and try and identify what you’re seeing, beyond your limits. Indeed, “they” now recommend ppl who work behind a computer stop EVERY 20 MIN to look far away at a distant object in the office for 20-30 seconds, after which they may return to the screen. Same idea, when we push at the boundaries of our existing range for short focused intervals on a regular basis, we expand that range over time, much faster than one might imagine (whether it’s our range of sight, mathematical talent, public speaking skills, ability to read, I could name about anything). Tying this back to the ozempic debate, I find it hard to believe that someone with a perfectly functioning metabolism and cardiovascular system, one which properly, without GLP-1 agonists, regulates insulin, et cetera, wouldn’t be at risk of damaging this system and becoming reliant to some extent on GLP1 agonists. Do you guys follow?

[@markwimmer3647]

I listen to 45 minutes of this guy talk and say nothing hopefully you get more out of it this than I did

[@universeusa]

Alcohol does contain calories-specifically, about 7 calories per gram, which is more than carbohydrates and protein (4 calories per gram each) but less than fat (9 calories per gram). Here’s how alcohol affects fat metabolism and the liver: ### 1. **Caloric Contribution**: - Alcohol adds additional calories to your diet. Consuming alcohol can contribute to a caloric surplus, which can hinder fat loss if you’re not accounting for those calories. ### 2. **Liver Function**: - The liver metabolizes alcohol before other nutrients. When you consume alcohol, your body prioritizes breaking it down, which can temporarily impair its ability to oxidize fat effectively. ### 3. **Fat Storage**: - Excessive alcohol consumption can lead to fat accumulation in the liver (fatty liver disease) and can disrupt normal metabolic processes, making it harder for the body to utilize stored fat. ### 4. **Hormonal Effects**: - Alcohol can influence hormones related to appetite and metabolism, potentially increasing cravings for high-calorie foods and affecting how your body regulates fat storage. ### Conclusion: While moderate alcohol consumption can fit into some diets, excessive intake can hinder fat metabolism and contribute to weight gain. If your goal is to lose fat, being mindful of alcohol consumption and its caloric content is important. 🙏 👌👍👏

[@cactuscanine3531]

Lots of comments here about eating healthy and exercising, but how do you get a huge lazy uneducated population to do that?

[@Linda-dk5kp]

Sounds like someone is aiming to make a lot of money off this drug

[@markotrieste]

Very little actionable information, lots of philosophical discussions, and not addressing the elephant in the room, i.e. the corruption of the nutrition world (industry, researchers, government). About drugs: sure if there is no other way, then use them. But first cut out all the carbs and the ultra-processed food and have an 8 hour eating window, no more. If that's not enough, then search for further interventions.

[@WORKOUTSOLUTIONS]

❤✝ CHRIST IS RISEN ☦❤ ❤💪🏋‍♀🙏✝ GOD GIVES US STRENGTH ☦🙏🥗🦾

[@mike2986]

Lol, body composition will be solved when pharma can make money out of it.

[@mariad1151]

That time is at hand!

[@Torch_Vs]

Jesus what boring episode...

[@helenaquin1797]

Yes a whole lotta' words. Around the 1:12 mark, the lack of regard around needing the drugs over a lifetime? And the guest commenting, who said the drug should be teaching anybody anything (about healthier diet, lifestyle, etc.)? And then comparing it to drugs for schizophrenia?! Holy Mackeral. Big Pharma is likely salivating at the chance to medicate ppl beginning in their youth. This guy is a big pharma mouthpiece imo.

[@Alenasnow07]

Didn’t like the guest. A word salad without any take home points. Thanks Dr. Attia for clinical judgement on Ozempic. Ppl got fat due relatively cheap and palatable food.

[@gramaalexandra3596]

I’m really struggling to understand the purpose of this episode. It feels like it was deliberately created to confuse people and push a pro-pharma agenda. Honestly, I’m very disappointed.

[@JakeRoselli]

I find it disgusting that any expert would advocate prescribing Ozephic to mildly overweight people who simply want it.

[@kathrynmorgans2413]

Why?

[@SanjaySanjay-mf6gl]

Why is it disgusting?

[@JakeRoselli]

@SanjaySanjay-mf6gl A medical professional that would prescribe drugs over proper diet and healthy lifestyle for mildly overweight people should not be practicing. Is it necessary to get into the downside and the permanence of pharmaceutical interventions?

[@MichaelHorstmann]

​@JakeRoselli I don't think it's fair to say all pharmaceuticals cause life altering side effects, let alone permanent ones. Any drug that has effects will have side effects. It's about weighing cost/benefit

[@JakeRoselli]

@MichaelHorstmann I'm talking specifically about ozempic. Knowing what we know it's a terrible cost benefit fail to choose it.

[@johnnyloreti]

This was incredibly frustrating to listen to. Allison seems reluctant to share any sort of real information or opinion. Any topic

[@dragankuzma5998]

I feel like this Interview is a little disappointing. It seems to me that Peter is trying to get to the truth which is being ignored and distorted all the time. Quite annoying honestly. I guess those Dollars From These companies do matter quite a bit. When you are having not independent people talk about facts, its not the easiest way to get to the truth. I do love Peter attia. But He should Grill some of These guys a little bit more. Or not invite them. Invite the truth seekers. You cant Tell me its not processed foods and sugar. But I guess this is my opinion. Also quite annoying when you ask a question about something actually interessting but only get a Wikipedia citation about something unimportant. These guys should have had this convesation privately and Tell Each other the truth. Having a conclusion that you have to treat a disease only symptomatically doesnt make any sense to me. Even though they are both much smarter then me, its the result they get From this conversation. Its the same as with cigarettes, until people admit its Bad its going to take decades.

[@tylerlangley1786]

Apparently David Allison is a pill pusher who won't admit his failure in his obesity fight.

[@janetderouin9533]

This obesity expert is talking down to every person who is obese. I am offended by his presence and his superiority. In the last year I have lost over 30 pounds and did it my way..

[@janetderouin9533]

I read, exercised and changed my attitude towards eating..I now love my life and able to know I can change my ways thru reading the latest information on food. Thanks!

[@mariad1151]

Agreed. He won the genetic lottery & thinks his actions cause him to be slim. He is very cold & superior & sees folks as lab rats I'm shocked to hear that Attia gains easily ..

[@williamhenry3337]

Why do we care? Each one of us are responsible for our OWN health. I am 75 years old and I weigh (plus or minus a few pounds) of what I weighed when I graduated High School in 1967 (140 lbs). Still wear 29" waist jeans. If someone wants to smoke, drink or become obese that's THEIR decision. Put the information out there on how to be healthy but after that it's each person's responsibility.

[@kathrynmorgans2413]

Right, but obesity drives up financial costs for all.

[@mariad1151]

Living proof that getting older doesn't mean getting smarter. Don't pat yourself on the back for getting lucky in the gene pool.

[@mariad1151]

It's bc we quit 🚭😂

[@mauriciofraga9708]

Fast

[@KJSvitko]

You are what you eat. Your diet impacts your health. Lower stress, reduce obesity, get enough sleep and more exercise are key to a healthy life. Obesity in children and adults is rising across the world. Fast food and sugary drinks including fruit juices are contributing to the problem of poor health and obesity. Eat a healthy plant based diet and exercise regularly. Reduce or ELIMINATE cows milk, eggs, cheese and meat. Eat more salad greens, beans, fruit and vegetables. Eliminate fast food, snacks like cookies, cakes, chips, and sugary drinks and juices. Every adult and child should own a bicycle and ride it regularly. Regular exercise will help you sleep better. Yoga is a great stress reducer. Obesity is all too common today. Get off the couch. Get off the phone, ipad or video game. A variety of stretching and other exercises help with increased mobility. Ride to work, ride to school, ride for fun. Every city should be a bicycle city. Speak up for bicycles in your community

[@Therealmathilda]

Wow, you have solved the problem. Congrats.

[@inkoftheworld]

1:24:30 The comparison to a depressed/anxious person with a person who wants to lose 10 pounds is off the mark. A person with a mood disorder takes those heavy duty drugs because the depression or anxiety is getting in the way of their ability to live a normal life, to do normal things. The drugs are just getting them to "normal". A person who wants to lose 10 pounds is a trivial issue in comparison, 10 pounds more or less is not going to drastically change their ability to live a normal life.