Obesity and Fitness Are Revolutionized By Reddit, Not Doctors

>But, no one has ever put on weight on a calorie deficit. NEVER.

I want to be a pedant and correct that to "body fat" instead of "weight". A change in diet can stress the body into retaining extra water weight, causing a temporary increase in weight.

Western medicine has historically never been focused on preventative medicine; their role has traditionally been to make you healthy, not keep you healthy. It's not the conspiracy some might suggest, it's just that historically you called a doctor when you were ill, not for lifestyle advice. When it comes to fitness, you still don't - unless you're talking to a sports doctor, you're not going to get a useful training programme tailored for your needs.

Regarding GPs in particular - they aren't really about keeping you trim and terrific. They're about dealing with niggling issues while flagging serious ones for referral to specialists. They do know about basic fitness and diet, but they're not specialists in the area - see sports doctors and dieticians.

Also consider that diet is a rapidly moving target at the moment - there's a lot of contradictory opinion and new info coming out all the time. It's not a GP's role to stay at the bleeding edge of medicine. That's what specialists do, and as the specialists settle on the right thing, it filters down to the non-specialists. You can of course find GPs who take special interests in certain areas, and may get lucky and find one that loves fitness and diet.

Also, 'palliative' doesn't mean 'after injury', it means 'relieve symtoms without attempting a cure', and most doctors would rather cure a problem than use the patient as a cash cow (there's enough work out there, even before you get to the ethical issues). Perhaps a better pair of terms would be preventative/proactive vs reactive care.

What's very inspiring are the body transformations posted by members of forums. Just check out the ridiculous before-and-after shots on the following thread from the SomethingAwful Forums' fitness subforum:

http://forums.somethingawful.com/showthread.php?threadid=333...

Threads like these are what inspire people to radically change their lifestyle, start lifting weights, and stay motivated. They go on to keep fitness logs to keep themselves publicly accountable, and also join Fitocracy and weight/diet-tracker sites. There're also a lot of helpful resource threads on such forums, informing newbies on diet, exercises, supplements, etc.

On the scientific side of things, I've spent the last few weeks reading a range of PubMed(Central) articles and various blogs and forums on fitness and diet. There are many schools of thought, but many are mostly supported by anecdotal evidence and not studies.

What I've found most helpful are scientific studies/articles, e.g.

- Evidence-based resistance training recommendations http://baye.com/wp-content/uploads/2011/09/ebrtr-Fisher1.pdf

- ISSN recommendations for supplementation http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853497/?tool=pu...

- Protein per day for muscle-building: 1.6 g/kg of bodyweight (not the 1+g/lb that many sites tout) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129150/

- Reduce saturated fat intake and replace with polyunsaturated fats, not carbs or monounsaturated fats http://www.ncbi.nlm.nih.gov/pubmed/19211817

Scientific bloggers are also good to read, if they assess studies critically - people like Bill Shrapnel, DH Kiefer, Bryan Chung, Stephan Guyenet, Alan Aragon. Check their blogs out if you aren't already following them.

My current understanding of various controversial topics, based (mostly) on studies:

Calories in, calories out - absolute calories matters, but is mediated by the effect of composition of diet. Consuming more protein tends to result in an increased lean-mass-to-fat ratio (whether due to satiety, hormonal effects, or a combination of the two).

Carbs/sugars/starches - high glycaemic-index carbs are riskier than saturated fats for heart disease. They are also associated with weight gain. The endless intake of rice in Asian countries (like mine) makes many of us fat and at risk of heart disease.

Dietary cholesterol - probably not as bad as previously assumed, but having >6 eggs a week actually increases your risk of heart disease/events.

Intermittent fasting - I haven't seen the scientific evidence for this, though a friend assures me it's out there. All I see is Berkhan's leangains.com and I'm not sure I'm convinced. I searched PubMed for a bit but didn't come across anything.

Diet vs exercise for weight loss - diet is the key to weight loss. Neither cardio (whether HIIT or low-intensity) nor resistance training alone is particularly effective at causing weight loss (claims of raised metabolism notwithstanding); you need a calorie deficit as well.

Training to muscular failure - training to failure actually provides more efficient strength gains.

Genetics and muscle - genes play a major, possibly the largest, role in determining how much muscle mass individuals can gain and how easily they do it. "...it appears that those who are naturally lean and muscular to start with, can gain strength and size to a much greater degree than naturally ‘skinny’ individuals." i.e. ectomorphs won't be exploding with muscle in short order, despite their best efforts.

Most rules tend to break down if you take them to extremes. ;) If I really don't feel capable of working out I don't, but if I just feel really crummy I'll at least try to do a reduced workout. Quite often, once I get into it, I have no trouble finishing.

Yes, I buy into the "eat less, move more" idea. But then, I'm a physicist and I believe in the laws of thermodynamics.

I am in complete agreement with you that starvation diets, fad diets, and other cook-book regimens are likely to result in failure. The point I was trying to convey was that this failure comes from the fact that it takes willpower to follow these, while you're much more likely to succeed if you try to form habits that don't require willpower to follow. I was borderline obese once myself, but I never followed any specific diets or regimens. I just learned healthy habits.

Exercise is absolutely crucial for good health. Just being skinny doesn't necessarily make you healthy. Perhaps there was less focus on exercise in the past because people were, on average, much more active in their daily jobs. Today, paper-pushers really need to exercise to be healthy.