This is true as far as it goes, but obesity is not cured by lifestyle changes. More than 90% of people who have lost weight with diet and exercise put it back on in short order. Not b/c of what they eat, but b/c of body chemistry. That's why GLP1 meds are so effective....they target many receptors that contribute to obesity, including glucose absorption, satiety hormones, lipids, and other things that still aren't fully understood. Additionally, I don't know why GLP1 meds get such a bad rap. They decrease the risk of cardiac disease significantly. https://pmc.ncbi.nlm.nih.gov/articles/PMC10739421/
Only read the title but as a GP who regularly stops huge insulin doses in days by suggesting a ketogenic lifestyle many of my patients with type 2 DM can indeed replace insulin with a cooking class. Many docs around the world stopping diabetes meds daily by saying eat less carbs. Even porridge. Currently many T2DM patients are injecting insulin to cover their breakfast cereal and whole grain toast. Swap to eggs 🍳 and stop the insulin. Easy. SO low carb cooking classes replaced insulin.
I disagreed with the title so I wrote a comment about it! The title was #misinformation from my experience. Indeed I have just been checking results and a lovely man with chronic kidney disease previously on 60 units of insulin a day for type 2 DM. He has just had his latest results in after 9 months on a very low carb diet. He has been off all insulin since 1 week after starting this program and his renal function is now normal. As are his triglycerides ( which have been high for as long as I can see back on his pathology). His renal physician is thrilled and his endocrinologist is perplexed. His HbA1c is also normal now. On NO INSULIN. So as a gp who has been doing this for over 6 years and has seen this over and over again the heading to me was WRONG. A low carb cooking class could help people and likely many won’t need their insulin. So I didn’t care about the article I cared about the ignorance of the title. Is that ok??? I read a lot. Just couldn’t be bothered to read this particular article. Please forgive me.
Presumably you have not only not read the article, but also not read any of the scientific studies linked to, or any *other* scientific studies. Everyone can find an example where someone's health improved after an intervention, but the only way to find out if it really works is large-scale studies.
Gideon's provided a bunch that show cooking classes don't work, or don't work much. If you know of any that indicate they do then provide them, rather than just claiming individual cases where, even if they're true, many other things could have been going on.
Pretty sure nothing else was going on in that the insulin is stopped within days. Lots of evidence low carb works in The scientific literature and as such is accepted by the diabetws associations with statements like “ low carb shows the most evidence for improving glucaemia and reducing medication”Maybe Dr Makary wants to fund some research into low carb cooking classes? Perhaps that is what he is suggesting? Absence of evidence is not evidence of absence. Let’s cheer him on because we are going to go broke if we keep ploughing on with the current treatment paradigm.
You obviously didn't read it, or you'd have picked up the part about structural inequalities with food - using eggs is a rather unfortunate example, with their current cost.
This isn’t ignorance. These people are well aware that cooking classes are ineffective.
These people are eugenicists. They want to stigmatise sick people, to present health as a virtue and poor health as a vice.
Cooking classes sound nice and fun for Fox News viewers, but they also put the idea out there that obesity is a choice, therefore we shouldn’t provide healthcare / income assistance to people who sabotage their own health. When they talk about fraud and waste in the system - they mean sick people who can’t prove that they eat five fruits and veg a day and exercise for 30 min 3 x a week.
The reality is that poor health is more often due to poverty, bad luck and genetics is something they don’t like to think about. The fact that these guys good health is more down to wealth and privilege than their personally virtuous lifestyles is knowledge that was stored in the part of RFKs brain the worm ate.
Genetics play a huge role in diabetes, as do viral triggers. Add to that an overly processed food diet sponsored by big wall street companies. Also as a population in my lifetime there has been a major change in jobs. There is less physical activity in most work versus so last century. Also the rise in artificial sweeteners. A cooking class is not going to fix all of that.
Cooking classes don’t address key obesity drivers like food deserts, chronic stress, or endocrine-disrupting chemicals. Environmental toxins and socioeconomic factors influence metabolic health far beyond personal choice or culinary skill.
I like this article and I think "cure diabetes with cooking classes" is silly for the reasons and evidence you stated. However, the underlying idea that behavioral changes (diet and exercise) are ineffective suffers from two issues; one of terminology/syntax and the other of philosophy.
On terminology/syntax, it seems glib but "nothing works if you don't do it." Looking at a population level and previous studies it seems safe to say "diet and exercise are not effective long term in losing weight." However, this is only true if you look only at aggregate outcomes.
At an individual level, it is objectively true that if you take a person, and reduce their calorie intake and increase their calorie expenditure, they lose weight. Basic physics guarantees this 100%.
The issue then is that it doesn't work because people don't actually do it, which is a meaningfully different thing than whether a prescription works if taken as intended.
I recall a similar dynamic playing out with masks and Covid. Some larger scale analyses showed "masks don't work" based on health outcomes between mask mandate areas and non-mandate areas. But digging in found that's because there was no real enforcement and the lack of effectiveness was largely people not actually wearing masks or else wearing them wrong.
Saying, "if people don't wear masks (or wear them on their chin, etc) then masks don't work." Is so obvious as to be stupid. But on a population scale, it comes out to show they "don't work." Much like the diet and exercise outcomes for obesity.
Now, WHY diet and exercise "don't work" comes to the philosophical issue. Why, at a general, population level, can't people actually do this thing? There are many decent-to-good explanations proximately. But every time I scratch at them enough it seems to wind up at a place suggesting free will or volition do not really exist. Maybe that's true, maybe not. But it's a weird place for such a thing to arrive.
To be clear, I do not disagree that developing and maintaining a difficult habit or fighting hunger is not harder for some than others. Nor am I trying to post-hoc valorize difficulty for the sake of difficulty. But it is also true that disparate input effort is not a good reason to not do something.
(Nearly) everyone who has ever been to school has been in a class where the material is much easier for some than others. Yet it's never suggested that education is useless or horrifically unfair for the less gifted. Some people had to study more than others for the same grade. That's not a good reason to not study at all if you're in the former group.
All this said, I am in favor of effectiveness. Obesity is bad and GLP-1s are very effective. They should be widely available. But I also take issue with the idea that nothing can be done otherwise because people don't actually do the thing.
No, they are not a equal measure. But they are phenomenally significant. There are many naturopathic resources that are phenomenally significant that transition people from prediabetes or even struggling badly with diabetes to greater health. And addressing metabolism, eliminative processes, hormonal balance, exercise, stress reduction, as well as lower glycemic diets are remarkable and helpful for those that have adequate support to engage in them.and know once you need insulin you are in a different boat.
You don’t need cooking classes to eat healthy. Most people know what they should be eating, but ice cream and French fries are tastier than cabbage and boneless skinless chicken breasts. People did not evolve to choose nutrition over yummy foods such as Reese’s peanut butter cups and Fritos corn chips.
I can’t believe Makary really believes this is going to work. What he’s fighting is human nature. If all it took was reminding people not to eat processed foods and stay physically active, the obesity epidemic would already be over.
It boggles my mind that Makary doesn’t understand that.
I bet he actually does understand it, but feels the need to kiss the ring of RFK Jr. That is something he will likely live to regret.
More research into the mechanisms of appetite regulation and why my fat cells seem to be waiting in a dark alley just waiting to reattach themselves to my butt every time I lose weight would be great. Not Marty telling me to take a cooking class. I would take a class on how to cook cheesecake. Does that count?
Regardless of which particular diet you subscribe to, as I've pointed out this view is not supported by evidence. Most people are already aware enough to eat a healthy diet if they wanted to, and there are plenty of resources to help if they need. It's not that any one diet is effective or ineffective for weight loss, it is that structural barriers prevent most people from accessing such diets in the first place.
FDA is actually Food and Drig Administration. Not Federal Drug.
The rest of this article- excellent review of how the many different approaches that have been attempted at diet education have failed to actually impact rates of several diseases. Diet is a complex issue and MAHA is a joke approach which will only further erode public confidence in science.
those types of studies are more about the mentality of people that will go to cooking classes than the effects of diet or even on cooking classes. This is a very very common problem with studies and happens over and over. They way the get set up, self select for certain types of people to take them.
Such a criticism does not really apply to randomized trials, particularly given the extremely varied groups of participants that have been a part of these ones.
Randomization with in a sub set doesn't increase the accuracy nor does increasing the number of subsets. The flaw remains. You think you are studying one thing when in reality you are studying something else. In this case it is the behavior patterns of those that take classes. You will find that same effect in people taking financial classes to solve debt. This methodology is deeply flawed.
That is incorrect. The entire purpose of randomization is to remove biases such as you are describing from the equation, so it is not "the behavior patterns of those that take classes". If you want to understand this issue better, read up on the Intention To Treat principle.
You appear to be saying that people that will go to cooking classes don't benefit, but other people would. Who are these other people? People who would not go to cooking classes? If so, how do you propose to get them to go? Will attendance at cooking classes be mandatory? For everyone, or just those with BMIs above a certain level.
Disagree. Though it’s a multi-faceted problem, there is no downside to teaching healthier eating habits. More and more evidence around epigenetics says we can highly impact our health by our lifestyle.
Disagree with the evidence that nutrition education doesn’t result in lasting changes? He isn’t saying that nutrition doesn’t make a difference but rather that people don’t actually implement changes long term to see the impact that dietary patterns can have on overall health.
Your points are true and valuable. Environment (where and how one lives) is a huge factor. People who may succeed in a behavior clinic will regress later unless they change environmental factors.
This one really opens eyes. I liked how thorough you detailed everything. Clever headline btw
This is true as far as it goes, but obesity is not cured by lifestyle changes. More than 90% of people who have lost weight with diet and exercise put it back on in short order. Not b/c of what they eat, but b/c of body chemistry. That's why GLP1 meds are so effective....they target many receptors that contribute to obesity, including glucose absorption, satiety hormones, lipids, and other things that still aren't fully understood. Additionally, I don't know why GLP1 meds get such a bad rap. They decrease the risk of cardiac disease significantly. https://pmc.ncbi.nlm.nih.gov/articles/PMC10739421/
Only read the title but as a GP who regularly stops huge insulin doses in days by suggesting a ketogenic lifestyle many of my patients with type 2 DM can indeed replace insulin with a cooking class. Many docs around the world stopping diabetes meds daily by saying eat less carbs. Even porridge. Currently many T2DM patients are injecting insulin to cover their breakfast cereal and whole grain toast. Swap to eggs 🍳 and stop the insulin. Easy. SO low carb cooking classes replaced insulin.
"Only read the title..."
That speaks volumes.
Honest tho!
Why not read the whole piece before responding ?
I disagreed with the title so I wrote a comment about it! The title was #misinformation from my experience. Indeed I have just been checking results and a lovely man with chronic kidney disease previously on 60 units of insulin a day for type 2 DM. He has just had his latest results in after 9 months on a very low carb diet. He has been off all insulin since 1 week after starting this program and his renal function is now normal. As are his triglycerides ( which have been high for as long as I can see back on his pathology). His renal physician is thrilled and his endocrinologist is perplexed. His HbA1c is also normal now. On NO INSULIN. So as a gp who has been doing this for over 6 years and has seen this over and over again the heading to me was WRONG. A low carb cooking class could help people and likely many won’t need their insulin. So I didn’t care about the article I cared about the ignorance of the title. Is that ok??? I read a lot. Just couldn’t be bothered to read this particular article. Please forgive me.
Presumably you have not only not read the article, but also not read any of the scientific studies linked to, or any *other* scientific studies. Everyone can find an example where someone's health improved after an intervention, but the only way to find out if it really works is large-scale studies.
Gideon's provided a bunch that show cooking classes don't work, or don't work much. If you know of any that indicate they do then provide them, rather than just claiming individual cases where, even if they're true, many other things could have been going on.
Pretty sure nothing else was going on in that the insulin is stopped within days. Lots of evidence low carb works in The scientific literature and as such is accepted by the diabetws associations with statements like “ low carb shows the most evidence for improving glucaemia and reducing medication”Maybe Dr Makary wants to fund some research into low carb cooking classes? Perhaps that is what he is suggesting? Absence of evidence is not evidence of absence. Let’s cheer him on because we are going to go broke if we keep ploughing on with the current treatment paradigm.
You obviously didn't read it, or you'd have picked up the part about structural inequalities with food - using eggs is a rather unfortunate example, with their current cost.
This isn’t ignorance. These people are well aware that cooking classes are ineffective.
These people are eugenicists. They want to stigmatise sick people, to present health as a virtue and poor health as a vice.
Cooking classes sound nice and fun for Fox News viewers, but they also put the idea out there that obesity is a choice, therefore we shouldn’t provide healthcare / income assistance to people who sabotage their own health. When they talk about fraud and waste in the system - they mean sick people who can’t prove that they eat five fruits and veg a day and exercise for 30 min 3 x a week.
The reality is that poor health is more often due to poverty, bad luck and genetics is something they don’t like to think about. The fact that these guys good health is more down to wealth and privilege than their personally virtuous lifestyles is knowledge that was stored in the part of RFKs brain the worm ate.
Genetics play a huge role in diabetes, as do viral triggers. Add to that an overly processed food diet sponsored by big wall street companies. Also as a population in my lifetime there has been a major change in jobs. There is less physical activity in most work versus so last century. Also the rise in artificial sweeteners. A cooking class is not going to fix all of that.
Cooking classes don’t address key obesity drivers like food deserts, chronic stress, or endocrine-disrupting chemicals. Environmental toxins and socioeconomic factors influence metabolic health far beyond personal choice or culinary skill.
I like this article and I think "cure diabetes with cooking classes" is silly for the reasons and evidence you stated. However, the underlying idea that behavioral changes (diet and exercise) are ineffective suffers from two issues; one of terminology/syntax and the other of philosophy.
On terminology/syntax, it seems glib but "nothing works if you don't do it." Looking at a population level and previous studies it seems safe to say "diet and exercise are not effective long term in losing weight." However, this is only true if you look only at aggregate outcomes.
At an individual level, it is objectively true that if you take a person, and reduce their calorie intake and increase their calorie expenditure, they lose weight. Basic physics guarantees this 100%.
The issue then is that it doesn't work because people don't actually do it, which is a meaningfully different thing than whether a prescription works if taken as intended.
I recall a similar dynamic playing out with masks and Covid. Some larger scale analyses showed "masks don't work" based on health outcomes between mask mandate areas and non-mandate areas. But digging in found that's because there was no real enforcement and the lack of effectiveness was largely people not actually wearing masks or else wearing them wrong.
Saying, "if people don't wear masks (or wear them on their chin, etc) then masks don't work." Is so obvious as to be stupid. But on a population scale, it comes out to show they "don't work." Much like the diet and exercise outcomes for obesity.
Now, WHY diet and exercise "don't work" comes to the philosophical issue. Why, at a general, population level, can't people actually do this thing? There are many decent-to-good explanations proximately. But every time I scratch at them enough it seems to wind up at a place suggesting free will or volition do not really exist. Maybe that's true, maybe not. But it's a weird place for such a thing to arrive.
To be clear, I do not disagree that developing and maintaining a difficult habit or fighting hunger is not harder for some than others. Nor am I trying to post-hoc valorize difficulty for the sake of difficulty. But it is also true that disparate input effort is not a good reason to not do something.
(Nearly) everyone who has ever been to school has been in a class where the material is much easier for some than others. Yet it's never suggested that education is useless or horrifically unfair for the less gifted. Some people had to study more than others for the same grade. That's not a good reason to not study at all if you're in the former group.
All this said, I am in favor of effectiveness. Obesity is bad and GLP-1s are very effective. They should be widely available. But I also take issue with the idea that nothing can be done otherwise because people don't actually do the thing.
No, they are not a equal measure. But they are phenomenally significant. There are many naturopathic resources that are phenomenally significant that transition people from prediabetes or even struggling badly with diabetes to greater health. And addressing metabolism, eliminative processes, hormonal balance, exercise, stress reduction, as well as lower glycemic diets are remarkable and helpful for those that have adequate support to engage in them.and know once you need insulin you are in a different boat.
You don’t need cooking classes to eat healthy. Most people know what they should be eating, but ice cream and French fries are tastier than cabbage and boneless skinless chicken breasts. People did not evolve to choose nutrition over yummy foods such as Reese’s peanut butter cups and Fritos corn chips.
I can’t believe Makary really believes this is going to work. What he’s fighting is human nature. If all it took was reminding people not to eat processed foods and stay physically active, the obesity epidemic would already be over.
It boggles my mind that Makary doesn’t understand that.
I bet he actually does understand it, but feels the need to kiss the ring of RFK Jr. That is something he will likely live to regret.
More research into the mechanisms of appetite regulation and why my fat cells seem to be waiting in a dark alley just waiting to reattach themselves to my butt every time I lose weight would be great. Not Marty telling me to take a cooking class. I would take a class on how to cook cheesecake. Does that count?
Very helpful summary but list of references to the studies mentioned would have been helpful.
Too many people can't cook so believe they must order food in, esp. if they grew up that way. So teaching them to:
cook vegetables and meat,
use animal fats not industrial oils falsely sold as vegetable oils,
know that real bread contains only unfortified flour and unfluoridated water,
why never to consume soda or packaged juices
all would improve the health of the nation.
Regardless of which particular diet you subscribe to, as I've pointed out this view is not supported by evidence. Most people are already aware enough to eat a healthy diet if they wanted to, and there are plenty of resources to help if they need. It's not that any one diet is effective or ineffective for weight loss, it is that structural barriers prevent most people from accessing such diets in the first place.
FDA is actually Food and Drig Administration. Not Federal Drug.
The rest of this article- excellent review of how the many different approaches that have been attempted at diet education have failed to actually impact rates of several diseases. Diet is a complex issue and MAHA is a joke approach which will only further erode public confidence in science.
those types of studies are more about the mentality of people that will go to cooking classes than the effects of diet or even on cooking classes. This is a very very common problem with studies and happens over and over. They way the get set up, self select for certain types of people to take them.
Such a criticism does not really apply to randomized trials, particularly given the extremely varied groups of participants that have been a part of these ones.
Randomization with in a sub set doesn't increase the accuracy nor does increasing the number of subsets. The flaw remains. You think you are studying one thing when in reality you are studying something else. In this case it is the behavior patterns of those that take classes. You will find that same effect in people taking financial classes to solve debt. This methodology is deeply flawed.
That is incorrect. The entire purpose of randomization is to remove biases such as you are describing from the equation, so it is not "the behavior patterns of those that take classes". If you want to understand this issue better, read up on the Intention To Treat principle.
You appear to be saying that people that will go to cooking classes don't benefit, but other people would. Who are these other people? People who would not go to cooking classes? If so, how do you propose to get them to go? Will attendance at cooking classes be mandatory? For everyone, or just those with BMIs above a certain level.
Disagree. Though it’s a multi-faceted problem, there is no downside to teaching healthier eating habits. More and more evidence around epigenetics says we can highly impact our health by our lifestyle.
Disagree with the evidence that nutrition education doesn’t result in lasting changes? He isn’t saying that nutrition doesn’t make a difference but rather that people don’t actually implement changes long term to see the impact that dietary patterns can have on overall health.
Not at all what the Sec's comments were conveying. This article is so partisan political that it's no use reading. Unsub.
I am not American and have at best a passing interest in your politics. I also quoted and linked to his full statements, and provided ample context.
Thank you for writing something I have observed,
Your points are true and valuable. Environment (where and how one lives) is a huge factor. People who may succeed in a behavior clinic will regress later unless they change environmental factors.