Using a throwaway for the obvious sensitivity. I've struggled with my weight all through adulthood - in my 20s I gained weight just from business travel, stress, eating out all the time, and drinking a lot. This continued through my 30s until around 2018, my wife sat me down and explained that my poor diet and not taking care of myself was stressing her out, especially since my father had died young of heart problems.

At the time, I was 290 pounds, which alone stressed me out - I remember having the same realization as the writer of this piece and feeling dejected.

So, I gritted my teeth, started seeing a trainer and hired a nutritionist. The nutrionist was useless, I assume I just had the wrong person, but that didn't help. Exercise and cutting back on drinking dropped 10 pounds, cutting out breakfast and switching to lighter lunches cut another 10.

After that, though, it got really hard. I had long ago gotten rid of the "easy" adjustments - I never liked sugary soda, never was a big snacker, don't like fruit, and didn't have a big sweet tooth. By cutting out booze entirely and going down to one meal a day I was able to grind out another 5 pounds over a span of months, but it was real work. I tried tracking my macros fanatically and by all measures I should be way below my baseline amount of calories but the weight just didn't want to come off. I stalled out at 265-ish and couldn't get lower.

The next level of commitment would have been to do keto or one of the other very low-carb diets combined with one meal a day, but I was already pretty miserable. When covid hit, I backslid, but eventually got back on track, but same problem - I can grind it out to 265, but couldn't get below it. I did find that I could maintain at around 270 and still enjoy a decent quality of life.

So I stuck there for a year or two, still felt gross, but less gross than I did previously. I got my blood work done earlier this year, and my a1c showed I was pre-diabetic, which I took hard - it felt like I'd done all this work and I was still losing the battle.

My psychiatrist suggested I look at taking Ozempic - I qualified due to my a1c, and thought it might help me lose weight as well. Started taking it about 6 months ago, and I've lost almost 30 pounds. The side effects suck - constipation, nausea, etc., but it's been a game changer. My a1c and cholesterol are back in normal range, and my blood pressure is normal. I'm still losing weight, but more slowly, I don't know when things are going to settle out.

All this to say, from my own struggles to lose weight, I think it's more complicated than CICO - obviously that's a huge part of it, but I think everyone has a baseline below which your body starts to make it increasingly difficult to go and stay beneath, and I think everyone has a different tolerance level for fighting that baseline. I don't think it's very helpful to just tell people "CICO".

For me, it took 1) finding a good therapist, 2) finding a good trainer, 3) taking an expensive and unpleasant medication, and 4) CICO. I'm incredibly fortunate that I have good insurance and a high-income job in a major city with lots of treatment options. I'm starting to gear myself up that I'm going to have to double down on 1, 2, and 4 to keep moving towards a healthier weight, but Ozempic has at least dialed that hunger sensor down far enough that I feel like I can make headway.