This is stated as biological fact when it's simply not. Sleep apnea doesn't change the laws of thermodynamics - if you are gaining weight you need to eat less or move more. It's not stigma, it's simply the way it is for the vast majority of people (the rest being covered by rare hormonal conditions that require a doctor to treat).
Being tired may cause you to eat more but being tired isn't making you gain weight, it's the overeating that is.
People love to think of the body as a simple energy-in->energy-out equation, but it's definitely more complex than that, as the body can change what it's deciding to hold on to and what it's deciding to burn or expel.
I am one of those that stayed skinny as a rake throughout my childhood and mid-adulthood (in my mid-40s I'm starting to become more normal sized). I wasn't particularly active, and I ate voraciously -- third or fourth helpings of pasta bowls. But the food never stuck to my ribs. (And it wasn't a worm or anything -- the whole side of my mother's family is the same, while my dad's side is the opposite.)
No one should look at my body and say "clearly he is exercising more than he is eating" because it wouldn't have been true at all, and yet that's what the simplistic energy-in and energy-out conclusion would say.
>People love to think of the body as a simple energy-in->energy-out equation, but it's definitely more complex than that, as the body can change what it's deciding to hold on to and what it's deciding to burn or expel.
If calories-in/calories-out didn't work, then it would be impossible to starve to death.
Where people get confused is that the number of calories changes as your metabolism speeds up or slows down.
If you are ingesting fewer calories than your body requires, you will lose some combination of fat and muscle. There is no possible way for this to be false.
It's the flip side that is quite possible to be false. You can certainly eat more calories than your body requires and yet not gain weight. Your gut could absorb less, so you excrete otherwise-digestible carbs. You could have a parasite.
Further, you could be burning more calories without doing more exercise or otherwise doing anything "useful" with the energy -- i.e. having a higher basal metabolic rate. These calories can be burned doing all sorts of things that the person has no control over: you could have a higher core body temperature, you could be spending more energy on cellular repair and other cellular processes, you could be synthesizing more hormones, you could be spending more energy metabolizing foods, etc etc.
These latter causes are obviously on the "energy out" side of the equation, but they do not relate to things under our control. Further, they can change with age, stress, and (relevant to TFA) sleep.
So a body that has been coasting by eating 2200 calories per day and never gaining a pound could suddenly change and start putting on weight, even though the person's diet and activities haven't changed.
The point is that two people could eat the exact same calories, and do the exact same exercise, and one of them go up in weight and the other go down. The "calories in vs calories out" idea usually simplistically makes people think this couldn't be true, because "calories out" is simplistically taken as "exercise."
The reason I shared my story is that so many people just quote "calories in vs calories out" as if both sides of the equation were perfectly under control, and those people are also often like me: they find it easy to keep the pounds off (because of a high metabolic rate) and so they look down on people who have trouble shedding weight and figure that those people could live just like them. But those heavier people could well be eating less and doing more exercise than them.
> It's the flip side that is quite possible to be false. You can certainly eat more calories than your body requires and yet not gain weight. Your gut could absorb less, so you excrete otherwise-digestible carbs. You could have a parasite.
Is the flip-side really debated that much tho? I feel like when people talk about CICO they're primarily talking about reducing CI to lower than your CO. No?
The complexity in CICO of course is measuring your CO. Ie you could estimate your CO, reduce your CI to what you believe your CO is - and still not lose weight. But does that undermine CICO? Because as the other commenters mentioned, it's "impossible" for you to burn more than you take in without losing mass, so our issue in this example is incorrectly asserting the output (assuming of course we're not also underestimating the input).
Note my questions here are generally questions. I am not an expert here, so please correct me if i'm wrong.
> The reason I shared my story is that so many people just quote "calories in vs calories out" as if both sides of the equation were perfectly under control, and those people are also often like me: they find it easy to keep the pounds off (because of a high metabolic rate) and so they look down on people who have trouble shedding weight and figure that those people could live just like them. But those heavier people could well be eating less and doing more exercise than them.
Fwiw, i don't dispute that some people have the wrong ideas with CICO. Perhaps frequently even. But i thought it still stood as a foundational truth nonetheless; that you have to "simply" burn more than you take in. If you gain weight (ignoring water weight for simplicity), then you have ate more then you burned, always.
My takeaway with CICO is that the hardest question seems to be correctly figuring out how much you're burning. Which i feel like usually, especially for overweight people, it's much less than they think. You can't outrun a bad diet, as they say. Rarely do people actually want to exercise enough to truly compensate for the thing they want to eat. Hence why i like CICO, as to me it signals the only effective action is in restricting your CI, since increasing CO is so difficult.
I believe you confuse an inequality of Energy(Fat) ≤ Energy(Food) - Energy(Activity) with an equation and are trying to disprove it with a counter-example. People saying "calories in, calories out" don't help with this confusion too. Another variant of your argument is "but different people extract different amounts of energy from the same food so there!". This being an equality, both arguments make no sense. I give you more - the "Energy(Food)" is calculated by burning the food in question and measuring the energy produced. It's guaranteed to be more than most humans could extract from the food as most humans excrete more complex chemicals than carbon dioxide and water, which burning food produces. But it does not matter because this is an inequality and not an equation. E.g. in your example the inequality still holds, you allegedly increased the Energy(Food) but the energy stored in fat did not increase, as asserted in the inequality.
A counter example to disprove this would be somebody gaining more weight in fat than the weight of fat needed to store energy from consumed food. Of course, this would have been broken pretty fundamental laws of nature and would have caused some kind of revolution in physics.
In my Indian family, this sort of skinny phenotype with a voracious appetite had a simple folk explanation - you eat so much that the food doesn't have time to be absorbed.
I can second this. I get routinely mistaken for a runner because of my size. I do strive for 10k steps a day, but generally, my activity levels would not easily reflect my BMI.
And yet, if you want to lose weight, it’s almost always (outside of medical conditions) as simple as getting into a caloric deficit that matches the deficit necessary to induce weight loss.
If you have a 500cal deficit per day, you lose a pound of weight (fat) per week. It’s literally that simple.
There’s some auto regulation of caloric burn rate, but it’s not some impossible problem to solve.
If you knew your exact metabolic requirements as well as the exact calorie count of every food you ingested, then it would be that simple. But what if you take the elevator one day instead of the stairs and don't burn off the 30 or so calories it might take to go up them? What if someone went a little heavy on the dressing on a salad you ordered and added 100 calories or so?
I've manipulated my body weight a few times and the real world is vastly different from a simple model of CI/CO.
On average this doesn’t matter. Humans are a whole lot more predictable and pattern based than you seem to be implying.
Also, if you’re trying to aim to a specific deficit, you should be calorie counting your food. If you got fatty dressing, you should be counting that. Even estimating is relatively easy once you do it for awhile. And if you don’t get it quite right, being a little off shouldn’t impact your overall average too much. It keeps you honest, which I think is by and large the main reason people don’t think they can lose weight: dishonest assessments of food consumption.
I've been tracking my weight weekly and all calories (even with crude estimates in some cases) for a year and a half, and have been experimenting with exactly this: I made a scatter plot and linear regression of average calories per day on the X axis, and weight change for that week on the Y axis.
Week to week weight has extra fluctuations that make it difficult to tell what's going on, but after around 6 months of data it stabilizes, and has been consistent for any 6-month period over the last year and a half: I burn around 2200 - 2300 calories per day on average (way higher than the online estimator tools think I burn, 1600 - 1700).
Knowing this I've also been reliably able to control my weight up or down at the rate I want as long as I'm looking at it for over a month span - because as above, week to week there's too much fluctuation (fullness of stomach and bowels mostly).
That it takes that much data to see the result pretty much proves my point - maintaining a 500 calorie per day deficit is just very difficult for me and I suspect most people. I don’t mean the hunger - when I do lose weight the deficits are easily above 1000, but 500 is too marginal for me to resolve.
Reliably losing one pound a week (beyond the initial 1-2 week period where your weight is going to go all over the place due to water weight fluctuations) is as simple as cutting calories until you see the weight (on average, ignore fluctuations) drop by 1 lb a week. You have to average extensively. Bodies are very temperamental at this, unfortunately. My scale weight swings 0.5-1 lb quite frequently mainly due to sodium changes in my diet. It’s all about trend weight, though.
The body is far more complex than simple thermodynamics however, and to pretend the dozens of biological feedback loops are fully under ones control betrays a lack of understanding.
Reducing getting fat to thermodynamics is like reducing computing to adding numbers. While that may be the basic building block, only a fool thinks that merely by comprehension of the add operator, one is also able to debug hugely complicated soft- and hardware stacks.
I actually like the computing and adding numbers analogy because "Sleep apnea makes people overweight" is the nutritional equivalent of saying "1 + 1 = hammer."
The root cause of weight gain is either overeating or lack of sufficient exertion in almost every case. Sleep apnea may absolutely cause someone to overeat in part because of those dozens of biological feedback loops you mention. But that doesn't mean that sleep apnea makes people gain weight. It's still too much food at the end of the day.
The problem with that is you can reach a point were trying to reduce calories further will only further sabotage your metabolism and makes you feel like shit. Which is why treating the symptom repeatedly fails to work long term.
I’m a 5’11” male who gained weight up to ~220 pounds on ~1800 calories eating a very consistent meal rotation. I now maintain ~190 pounds at ~2100 calories. My problem was likely a combination of my food acting as a chemical signal to gain weight (high in branch chain amino acids, polyunsaturated fats from fatty pork and chicken), work stress, bad sleep, and possibly even chronically elevated blood sugar or thyroid effects from essentially what was an almost carnivore one meal a day sort of diet. My body temperature was hitting lows of 96.3 degrees F. It’s now roughly two degrees higher, which seems small, but feels so much better.
> But that doesn't mean that sleep apnea makes people gain weight
I gather that you are unaware of how sleep apnea causes poor sleep, which in turn causes insulin resistance, which in turn causes an elevated production of insulin, which in turn forces glucose into your adipose tissue, which in turn makes the rest of your tissues starved for energy, which in turn causes you to be hungrier, overeat and gain weight.
This is an oversimplification, of course, as there are hormones other than insulin and cortisol involved in the complex process of insulin resistance, but it is at least a starting point that goes beyond the useless truism that "people gain weight because they overeat". Of course they do, but the mechanisms why they are hungrier than they need to be are crucial if you want to address the problem, because in the long run every human being with free access to food will eat precisely until they are no longer hungry, whether or not they are metabolically healthy or not.
But that’s not what he’s saying. Being hungry does not cause you to eat. Regardless of hunger, a caloric deficit will result in weight loss.
There definitely is the issue of how to reliably maintain a caloric deficit when your body is screaming at you to eat more, but the underlying mechanism is much simpler.
At the most basic levels, food choice doesn’t even really matter (specifically for weight loss, not general health), but choosing satiating foods with low calories is going to help with implementation. Eating 2,000 calories of oranges (45) is going to be a lot harder than 2,000 calories of fast food hamburgers (2).
The problem isn't that CICO isn't true, it's that it's not useful. It can't even explain why fat people are still hungry when they have enough calories stored in their bodies to last them for months.
> Being hungry does not cause you to eat
Yes, it does. That's why people eat: to alleviate hunger. You may will power your way to a caloric deficit for some months, maybe a couple of years, but eventually hunger will win and you will eat until satiety.
Metabolically healthy people aren't slim by being hungry all the time. They eat to satiety, and they are lucky enough that their satiety signalling is still working well enough. If you make them chronically hyperinsulinemic, they will be hungrier and they will gain weight -- it happens in humans and in animal models when allowed to eat ad libitum.
> At the most basic levels, food choice doesn’t even really matter (specifically for weight loss, not general health), but choosing satiating foods with low calories is going to help with implementation
As long as you are hyperinsulinemic, you will store a portion of the energy you consume in your adipose tissue, because that is one of the major effects of insulin in the body. The remaining energy left in you will not be sufficient to supply the energy needs of your body, and as a result you will be cold, tired and hungry.*
> Yes, it does. That's why people eat: to alleviate hunger. You may will power your way to a caloric deficit for some months, maybe a couple of years, but eventually hunger will win and you will eat until satiety.
If this is the premise of your argument, it is flawed.
You have no idea if “eventually” happens to everyone. You’re making a wildly strange assumption.
>> You may will power your way to a caloric deficit for some months, maybe a couple of years, but eventually hunger will win and you will eat until satiety.> You have no idea if “eventually” happens to everyone
Have you tried? Are you willing to try? How many people do you know that intentionally remain hungry every day for more than a couple of years, while otherwise having free access to food?
Any weight loss advice that does not adequately address hunger and satiety is naive to the point of ridicule. And any person who advises others to address their weight by telling them to be hungry in perpetuity hasn't given much thought to what they are asking for.
Nearly 1:10 people in the world are chronically hungry. Being hungry has no impact on their ability to eat. Likewise, those with access to food eat when not hungry and (believe it or not) may not eat when hungry.
I really think you’re missing the point, though. We have a host of signals in our body that can misfire due to various conditions and people cope with them. Hunger is no different and many of us have spent months ignoring it to our own benefit (and some to their own peril).
Caloric intake in excess of expense causes weight gain. What factors lead to that excess do not.
There are certainly those with a variety of issues that make caloric deficit difficult. Fortunately, that’s not most people.
I know you’re being downvoted into oblivion, but I agree. I’m not overweight, but had put on nearly 40lbs more than my historic average. There’s all kinds of advice, but the best I found was: the only way to lose weight is to have a caloric deficit.
That meant measuring calories until I could generally estimate what I was taking in each day. 1000-1500 calories a day sucks at first, but seeing the scale drop is motivating. I dropped 30lbs in about 6 months.
You can’t gain weight if you are taking in less calories than you expend. That’s pretty simple. Not eating that cheesecake, on the other hand, not so easy.
I'd like to contribute by saying that even when you are sleeping, body burns calories for various neurobiological processes. That automatically translates to bad sleep equals decreased calorie utilization (than a healthy baseline)
I think one of the issues with this is that most people have pretty terrible diets, most people have pretty terrible diets that can be improved pretty easily, and when dietary improvements are suggested a lot of time the response is “this is just really complicated, it’s not that simple.” Not everything is simple, but, say, giving up soda is something that’s healthy and going to have a positive impact on people’s lives. People who are saying “don’t tell me to give up soda because I have sleep apnea” are looking for excuses for their bad habits.
If someone is eating healthy foods and making a genuine effort to get good exercise, then we can talk about other factors. But too many people use “this is so complex” to avoid the very basics of healthy living.
Lack of sleep and stress are associated with overeating, and not only that, they also trigger hormons that promote the body to prioritize building up fat reserves.
I'm on mobile and don't have time to link, but a quick google search should give medical studies on this.
The "energy" thing is a simplification, but as a description of how this feels, it is apt in my view.
People do not live on a thermodynamic knife edge. There is a very wide leeway of excess intake that allows our body to burn energy “wastefully” or store it based on a hideously complex set of factors.
The idea that everyone is fat because we’re somehow more sinful (gluttonous, slothful) than in the past has repeatedly failed to resolve any problem except for the need for smug people to pat themselves on the back for using thermodynamics in a sentence.
> if you are gaining weight you need to eat less or move more
You could do a little experiment: set up an alarm to wake you up 15-30 times every hour while you try to sleep. That is what moderate sleep apnea does to you. Try this for, say, a year. See what happens to your overall health and your weight in particular. Don't forget to "eat less or move more".
Being tired changes how your body uses and stores energy. Your body might be permanently trying to save up for bad times (because the times are always bad) and so you're getting fat even if you eat very little.
Uh, no? The whole point is that the entire system breaks down. So you get sleep deprived humans who can't process food properly and have no energy as a result. Sounds like a big failure.
can you point to examples of otherwise healthy individuals under moderate to high calorie restriction that gain weight due to chronic poor quality sleep?
it's not something I have ever been made aware of, and I don't understand how it could be the case.
A lot of things about your body changes when you're extremely tired.
I don't have anything specific to link - it's just my own personal experience and what the doctor said.
In my own case, I had to eat much more than I theoretically should because my body wasn't able to process the food as well as it should (less than 50% of usual efficiency). And yet I was fat - not obese, but definitely not thin. The body redirected some of my food to storage even though I didn't have enough energy (glucose etc) as measured by blood screening. And it didn't use the reserves properly when I stopped eating.
What is mentioned in a couple of these comments about your body's response to external stressors changing how it allocates calories is absolutely true, but it's at the margins. If you're at maintenance caloric intake and ± a couple hundred calories a day, over years this can have an effect. But it's not going to meaningfully impact a 500-1000 calorie/day deficit to the point where you're still gaining weight.
> Effects of moderate sleep restriction during 8-week calorie restriction on lipoprotein particles and glucose metabolism
Because the conclusion starts with,
> In this study, 8 weeks of calorie restriction with and without sleep restriction of less than 90 minutes per day on 5 days with 2 days of ad libitum sleep per week, resulted in similar degrees of weight loss
Let me be clear that sleep deprivation doesn’t seem to be good for your circulating lipoprotien levels or insulin sensitivity based on that study, but they didn’t gain weight.
Not gonna try to find a specific example, but just from having listened so much to the Stronger by Science and Iron Culture podcasts for the past few years, there have at least been numerous studies and metas over the last decade examining the effects of sleep on weight loss and weight gain as it pertains to bodybuilding goals. I don't recall any having showed an impact on the rate of gain or loss but duration of sleep opportunity definitely has an impact on the quality of gain or loss. That is, you lose more muscle and less fat losing weight while sleeping poorly, and gain more fat and less muscle when gaining weight while sleeping poorly.
Maybe the end result is the same but it's an important distinction. It's too easy to say "oh yeah I'm gaining weight because I have sleep apnea" while you're snacking on donuts at your desk at all. The people who are tricked into believing it think that if they "cure" their apnea they'll be back to a healthy weight when a) they could be at a healthy weight despite their apnea with some effort, and b) they're building habits that even if their apnea disappears a year from now they will stay at the same weight.
Sidenote, i'm in your camp and agree with you - BUT, hypothetically there's a side to this i've not seen discussed here. That you can lose sleep and it causes a weight gain, with no other change to your CI or CO. Notably, you were previously not processing a portion of your potential CI and it was just passing through you.
In that case you didn't change how much you ate or how many calories passed your lips, but you did change your CI by way of changing your sleep.
Is this a real example or a contrived edge case from a software dev? No clue. I'll let better minds decide that hah.
It's entirely possible to eat less food and have your body decide that food is more scarce and choose to strip more calories from your food than it was when you were eating more.
Thermodynamics is an asinine thing to bring up in a system that can reconfigure its efficiency on the fly to optimize for different environments.
Sure, but it's still unhelpful to say that overeating is what makes you gain weight when other people eating the same amount and with the same amount of activity are not gaining weight, especially when eating less could cause you to gain more weight until you hit a threshold.
I don't think many people disagree with "If you starve yourself enough your body will eventually start burning fat", they disagree that it's as simple as "anyone gaining weight is necessarily doing it to themselves by eating more than other people".
And starving yourself isn't easy. It's one of the top like five things your body is designed not to let you do. So how on earth is it helpful when people are talking about factors that can influence your appetite and can literally influence the number of calories your body chooses to extract from the exact same food to say "just eat less lol"?
I might add that overwhelming research suggests that social pressure on people's weight causes people to gain weight. So even if you were right, bringing it up would be counterproductive.
> when other people eating the same amount and with the same amount of activity are not gaining weight, especially when eating less could cause you to gain more weight until you hit a threshold
That's part of the "calories out" side of the equation, that few people put in the effort to find (if they even know how). And I've found online estimators aren't very useful here, you need to find it for yourself - they say mine is around 1600 when it's actually more like 2200.
Ignoring half of CICO just because people only like talking about CI doesn't make it false.
It's even harder to change CO than CI, that's why people talk about CI. You lose a bit over 100 calories per mile run, and then you have to not compensate by eating them when you're finished. Everyone has a different metabolic set point for how many calories they burn, true.
No one said not eating is easy, especially when there's a lot of food around! I struggle with it. The laws of physics are not kind.
What I will say though, is if I exercise moderate amounts, it makes appetite control easier, at least for me. YMMV. I believe this is because insulin is more level throughout the day.
He's not entirely wrong, but perhaps not for the stated reason. Sleep deprivation can skew the ghrelin/leptin hormonal balance, which can make appetite control difficult.
You reference the laws of thermodynamics, but I'm not sure which laws you're applying to the human body? Is it the first which requires the measured system to be closed which a human body is not? Is it the second about entropy always increasing? Or is it the third defining perfect entropy at 0 Kelvin?
Bringing up thermodynamics as a generalization for biological systems is pseudo-intellectual. We aren't all equal machines that take in a fuel stock and output work. How do you account for differences in peoples' resting metabolic rates? How do you account for the difference in available energy in the foods you chose to eat, and in the differences in peoples' biological processes that extract that energy? Stress is a common hormonal modifier that impacts how the body stores fat; no where near a "rare" condition that many people experience nowadays, and yeah caused by things like sleep apnea. You betray your own argument anyway by adding an the "hormonal condition" exception (I don't see any exceptions referenced in the laws of thermodynamics, lol).
Biology has more dimensions than you are choosing to look at, and using thermodynamics as a "gotcha" when it comes to others' bodies reveals your lack of understanding and intuition.
Yes the first one. The energy contained in ingested food is far and away the dominant metabolic input.
There is no need to get into the weeds of various details of how that breaks down; the main problem is that calories are way too cheap in the modern day and age, and people's habits and instincts developed in far different eras lead to easily ingesting more than is expended. Yes the OP is not wrong, but it's not a very useful argument unless we're going to roll back the modern civilization.
This is the truth, even if people don't like it so you're receiving downvotes for it. Weight gain or loss is calories in vs calories out. Nobody's body is so special that you're defying thermodynamics and creating mass that you didn't intake as food. And that's definitely not changed by sleep apnea.
That said, there is the point that calories ingested doesn't necessarily equal calories absorbed, and sleep apnea could indeed affect that. But if you're relying on that thin margin for the difference between staying at a healthy weight or not, that's a fragile state of affairs, and you could fix your diet more to be more comfortably on the right side of it.
(My own, unscientific, hypothesis: far too many people are indeed unknowingly relying on that. I think a ton of people cram in 3k calories a day while absorbing 2k because there's just too much mass for the body to process, and then when they do cut ingestion to 2k, that doesn't change absorption and that's why they don't lose weight. (Numbers here are approximate.) It's actually pretty amazing how little food the human body actually needs and how little mass 1500 calories is.)
Or how much, depending on what you’re eating. It would be physically impossible for me to eat 1500 calories of lettuce in a day (10kg worth) but it definitely aids in “feeling full” when added to a meal.
Being tired may cause you to eat more but being tired isn't making you gain weight, it's the overeating that is.