Medical interventions work, among other things
From sometime during the winter of lockdown to the summer after high school I dropped and kept off thirty pounds. My father asked me how I did it a few years ago and I apparently told him that “I got tired of being fat.”
First year of college my diet was shit: I didn’t eat enough normally and then pigged out when I went out. I drank like 3-4 nights per week, and went to the gym 3-4 days per week. But because I was a 19 year old male it worked out fine and I put on maybe 10 pounds of mostly muscle.
Now I have a much better diet and a more balanced lifestyle and I’m in the best shape of my life, hands down. The goal is to make sure these habits get deeply ingrained over the next 3 years so they stick with me for the rest of my life.
“If food is on the plate and it’s any good, I’m going to eat it.”
This. So much this.
I don’t understand how people can leave food on their plates. I will eat food in front of me even if it’s *not* particularly good. I was at a restaurant recently and there were fries that someone ordered for the table and after a while I realized I was the only one eating them. They weren’t very good fries, but they were there! In front of me!
I ended up asking if my table mates wanted any more, because if not, I was going to dump my water on them to make them inedible, because I wanted to stop eating them. People laughed, thinking I was joking, but when I picked up my glass someone said “Joe, you could just *stop* eating them.”
But I can’t. I mean, of course, yes, physically, I could stop eating them. But to me, dumping water on them was by far the easier way.
Why isn’t everyone like this? How can I not be like this?
Cool article, appreciate you putting yourself out there to write it. Generally I think everyone can use more empathy. I work in a non medical profession where my job leads my to have deep insight into many individuals and families lives. I’m not sure I’ve ever met someone that has no self control issues anywhere in their life: substance abuse, overeating, but also compulsive working, or shopping, or a lack of ability to budget, or totally unchecked anxiety/lack of mental discipline. I’ve seen people spiral in self destructive relationship patterns, knowing full well they weren’t behaving well, but not having the self control to “do the right thing.” Being overly egotistical and argumentative in an antisocial way. The list goes on and on.
I’ve noticed, most people have a “thing,” and they always seem to “value” most the character traits that they themselves have: “sure I drink a lot, but I’m a good dad and my family loves me”. “Yes I’m a bit overweight, but look at the business I built.” “Sure, I can’t keep a steady relationship or be an adequate companion, but look at the great things I’ve built”.
More than GLP-1 or barometric surgery, I think more people could take to heart the sentiment behind this post. Very cool to see a wildly successful person volunteer to air their personal challenges publicly instead of moralizing about how other people *should* be.
Thank you, Matt!
I feel like discussions about weight loss often end up extremely unproductive because so many people seem to struggle with the ideas that:
1. Weight loss is actually simple. Take in fewer calories than you expend (CICO) and you’ll lose weight.
2. Weight loss for many people isn’t easy. Hunger can be a huge enemy to eating less, an exercising more can worsen that.
Really enjoyed this one. I think there is a serious lack of empathy from many slimmer people that fails to consider the possibility that anyone’s experience with weight could *possibly* differ from their own—“it’s simple: calories in, calories out. Why isn’t it as easy for you as it is for me?!” But when the rebuttal from the fat acceptance side of the house is to completely ignore medical truths about obesity by highlighting individual exceptions to aggregate correlations, it doesn’t do anything to advance the conversation.
One of my most validating experiences was going on a weight loss medication called Contrave (well, sort of; Contrave is a mix of bupropion, or Wellbutrin, an antidepressant, and naltrexone, an opioid receptor inhibitor used for treating alcohol use disorder and drug withdrawal—I was already taking Wellbutrin so I added the naltrexone separately). The experience was crazy. I suddenly became way more in tune with the feeling of fullness. Like, I would be in the middle of a meal and realize I’d had enough to eat. For whatever reason, I had just become numb to that feeling over the years and this brought it to the forefront. Of course, no medication can make you choose salad for dinner, but for me, this one helped me realized midway through that second slice of pizza that, oh, I’m starting to hit my wall.
My weight went down a bit, and had gone up or down since based on various factors, but my god, it was just one of those moments where you think... “is this what other people experience all the time?” It just drove home for me how true it is that the conversation is much more nuanced than simply willpower, and it’s not a conversation we can have in any meaningful way if we refuse to accept that we don’t all experience food and hunger the same way.
Thanks for offering this personal story, I can imagine it being difficult to do.
And you did a great job illustrating how all three major arguments surrounding weight--dieting vs. fat acceptance vs. medical technology--all have some truth to them, but also each have considerable limitations that thus can't let any one of them dominate the discourse. I wish more people have the nuance like you do.
To me, the evolutionary mismatch point is key. Almost every human in history lived and died consuming zero refined sugar. An apple or bit of honeycomb was the sweetest thing they ever ate. It’s wild to think that in the modern day, there are entire research labs at major corporations dedicated to making snacks that are optimally compulsive with almost no constraints. It’s kind of a miracle that anyone’s brain is able to withstand that kind of sustained assault.
Hey Matt. Thanks for writing this up. I had been wanting to write you about your experience. You are one of the reasons I finally decided to lose weight. So thank you for the motivation and giving me hope that I could do it too. :) My weight had gone up quite a bit as covid was winding down (March 2022) to 285 at my doctors appointment. That freaked me out and the doctor encouraged me to try Weight Watchers. So I signed up in the car before I left her parking lot. I've currently lost 78.3 lb and am down to 206.7 lb.
I remember learning when you explained on your podcast that you did the surgery after I had been on WW for a while, and I laughed. Had I known there were alternatives, I might have picked another route. I do love WW. It has taught me a ton about food and updated my priors on food. I now think in points. When I learned a grilled cheese was basically 2 pieces of pizza (I frame everything against my favorite food of all time), I realized it wasn't worth it. I eat a ton more fruits and vegetables (I've always liked them so that was easy) and lots of air popped popcorn now. I eat a lot less pizza and other bad stuff, but when I do eat it, I eat only delicious, well made stuff. Same with desserts. Why bother eating something bad that's also insanely unhealthy?
The one issue I have is that I still have basically the same appetite as before. I just eat a lot of healthy choices now and enjoy that. It would be even better if I could eat those healthy choices and also eat a little less. I'd like to know if your appetite is still less.
As an aside, it's weird to buy "L" sized clothes and have them fit fine! It's weird to basically feel good a lot of the time, physically/mentally/emotionally. It's weird to have people come up and comment on how good I look; I try to recommend they go see an eye doctor.
Also, I've kinda plateaued at this weight. I'm not sure why I want to get to 200, but I really do. Anyway, thanks again for the push. Never thought someone I'd never met would get me to make a dramatic change...oh wait... I realize as I write that I'm a Catholic. It's incredibly normal for me to make a change because of someone I've never met saying or doing something. Haha.
There is a stigma against what I call self improvement medicine.
I got diagnosed with Low Testosterone a year and a half ago. I had gained 20lbs, zero sex drive, low energy, etc...
I ended up on TRT. Specially Jatenzo, an oral testosterone replacement. All my symptoms have been relieved, my quality of life is better. Yet, there is a serious pushback I have received from a certain set of testosterone is toxic masculinity crowd.
I see the same sort of pushback against the new weight loss drugs out there.
I got prescribed Rybelsus for weight loss, but insurance companies won’t pay for it. Over the counter it costs 1000 a month. Luckily I work overseas where I am able to get it for $100 a month.
For the record it works. Kills your appetite. Ask me if u want to know more.
Anyway. I am now basically a bodybuilder. I am training to do a show next year. In fact today I have an appointment at Boise State to have my body fat measured. I suspect I am down to 18 percent. I actually have a
Six pack starting to develop.
On a side note, weightlifting is much better in my opinion for body composition than cardio, and is way more beneficial for us as we age.
I think the only thing left to do is challenge one of your numerous progressive nemeses to a cage fight.
When I was 24 and about to graduate from law school, I was 6,3” and weighed 280 pounds. I somehow got a job offer and decided if I was going to be a professional I should look like one. I also leased a harbor view apartment and resolved to have plenty of young women visit. I ate 2,000 calories a day and worked out five hours a week. The weight came off asymptomatically, first four pounds a week, then three then two. In six months, I lost 80 pounds. The day before I met my future wife, I weighed 198.
Then I fell in love with her and got comfortable and no longer had a young bachelor’s incentives towards discipline. I went back up to 225. Absent very good reasons to be disciplined, I have trouble keeping my weight under control while working a full time job. I simply like food and wine too much. They represent a very material portion of the pleasure I get from life and I want to enjoy them. When I was 30, I started my own law practice. I have never worked consecutive 40-plus hour weeks since I began it. I exercise 15-20 hours a week, and that keeps my weight in the 218-223 range. In the years after my son was born, I cut back to 8 hours a week, my weight shot up to 245, and I felt like shit.
As I have the culinary instincts of a Pleistocene era hunter gatherer, I need to exercise as much as a hunter gatherer. The only alternatives are self-abnegation, obesity and medical interventions.
My lifestyle is certainly quirkier with Matt’s. By the time I began my practice, I was married to a successful CPA, it was clear to me my career was unlikely to sparkle, that I could make enough money working part time, and that focusing on my body and intellectual interests would be more edifying than trying to get rich. Matt’s career has sparkled, his time commitment to working has probably been worth it, and bariatric surgery may have been a good choice for him. He could never have built his career to the point he has while getting as much exercise as hunter gatherers need. I’m ok with someone like Matt having surgery when his writing is actually important, but I would hate to see a middling lawyer get cut up to bill more hours or a real estate agent have surgery to sell more houses. Better to work less and live more.
My understanding (and personal experience) is that it is possible to lose weight just by exercising, but the amount of exercise you need to do is pretty impractical for most people with jobs and/or kids.
A lot of commentators have sort of alluded to this and Matt sort of did as well; but so much of eating habits are ingrained cultural habits. Matt alluded to this with observation that so much of our instincts in regards to eating are a result of the fact that for vast majority of human history, having enough food to eat was a real challenge for most of the population. We live in a different paradigm as far as food scarcity now and unfortunately our dietary instincts can't just be reformed on a whim absent medical intervention.
I say alluded to, because I think it's worth emphasizing how much food insecurity leads to pretty ingrained cultural habits that likely lead to overeating today. I think my own story is instructive and I actually think a fairly common one. My dad's side of the family is Bengali. And eating and meals are such huge part of cultural norms. If someone comes over, you must have a full meal prepared. And if you are a guest, you better most of that meal or you can come across as insulting. If you're the host? If someone is finished with their food, you keep putting more food on the plate until the person literally says "stop stop" and physically covers their plate (saw my mother do this more than once). I remember years ago my cousin and I around Christmas time had three different sets of people to see in one night (Friends and family) and we both had to game plan how much to eat at each place so we weren't too full to eat at the last gathering we went. My grandmother would all the time admonish "you must eat, eat!". If I stopped eating she would say "You not eat?"* She said this very lovingly, but I had to all the time say back "yes yes, I've eaten, I'm just full".
But the reason this cultural norm existed and the reason my grandmother admonished me like this was because food scarcity was such a big part of life in India (and still is for large segments of society). Eating as much as you can and having plenty of food for any guests is very clearly an outgrowth of this reality. And for my own family. My father was basically born a refugee in 1947; my family had to flee Dhaka to Kolkata. In addition, there was a man made famine induced in the Bengal region during WWII**. So combine all this together, you can see why my grandmother decades later is admonishing her grandson to keep eating all the time.
* I never learned Bengali for reasons that are probably worth it's very own separate comment one day. But of the many reasons I lament not learning Bengali, not being able to have full conversations with my grandmother is near the top of the list.
**The proximate cause of the famine was due to WWII and all it's attendant disruptions. But it can't be emphasized enough that the famine was much worse than it should have been due to deliberate and unnecessary policy decisions from the British government and Winston Churchill himself. https://en.wikipedia.org/wiki/Bengal_famine_of_1943
I feel like CICO is a perfect microcosm for so many issues where people are smugly sure they understand the issue because they’re absolutely correct by the numbers, but they assume because their math checks out, they can ignore everyone’s squishy lived experience.
CICO is 100% true, the problem is that the more salient math is something closer to “Natural weight next year“ = “The most you’ve ever weighed” + 2lbs - “Willingness to count calories/restrict portions very close to 100% of the time - “Level of hunger you’re willing to be all the time”. The exciting part about drugs and surgery is they actually change that math (by reducing hunger).
For most people, counting calories is the easy(er) part, it’s the “I’m starving/feel light headed and I know my body is lying to me but this is miserable so I’m going to have a snack” that’s the hard part. Exercise generally is accepted not to help people lose weight because every calorie burned makes you hungrier, so unless you are on a diet where you completely ignore your hunger cues forever, you will just eat more to make up for the exercise. And the fact that your default weight ratchets up to the most you ever weighted means that for people who have gotten fat, they will (absent medical intervention), be both hungrier (and have a lower baseline metabolism, so have a lower CO) for all of their life than someone of the same weight who never put on the pounds to start with—which I think leads to the empathy gap a lot of people have. I have 5 million times more respect for someone who went from obese to overweight than someone who’s been normal weight their entire life.
Happy to hear the surgery was largely a success. Discussions about weight sometimes remind me of discussion on climate change: the climate doesn’t care if you believe in it or not. Heart disease doesn’t care that you’ve convinced yourself it’s healthy to be overweight.
Curious- while we wait to find out the longer term side effects and dollar cost of drugs like ozympic, are there any ongoing medical costs to the surgery you had? I’m wondering about the short and medium term dollar cost comparisons between the two (when ozympic is $1K a month)
🙏❤️- good luck with your journey, love you guys. And thank you for this article, it’s really helpful and insightful. I continue to be on my own weight journey, with the general idea “eat less, move more”; designing more continuous walking into our lifestyles has really helped (eg driving less, using public transportation more).