It’s been studied pretty well. Possible effective solutions to the US obesity epidemic are pretty much limited to:
1) Radically alter aspects of food culture, work culture, social policy, and business regulation.
2) Magic pill (/injection)
There appears to be no imminent progress on the many parts of #1 that need serious work, so if we want a big turn-around in the next half-century, #2 has suddenly and surprisingly become a real possibility.
Sounds similar to most major world/cultural issues today. You can make the exact same argument about climate change for example.
But at the same time, part of me wants to ask... why is this a problem? Why shouldn't we just use science and technology to fix human problems and remove any unfortunate consequences from society?
What's wrong with a world where anyone can eat as much of anything as they want, do no exercise at all, ignore their dental health and smoke like a chimney, yet still have perfect health without any downsides?
Objectively, it would be a better society, with everyone materially better off and a system that doesn't need anywhere near as many resources to care of its citizens.
Because some of us want the real thing, not the fake thing achieved by cheaters.
I'm the same in other areas of life. I don't take steroids, I work out in the gym. I don't take drugs to have trips and achieve enlightenment, I tried to find Zen on my own.
I wouldn't partner with someone who had a cosmetic surgery ("fake beauty"), nor someone who wears makeup.
Up to every individual of course, I'm not even saying I will never take TRT (probably eventually, when I'm older, for health reasons), but I, above everything else, value (and want) authenticity.
> Possible effective solutions to the US obesity epidemic
Just wanted to mention that this is not a US problem, and framing it as such won't help find solutions. Even in southeast Asia the rates over obesity are steadily increasing. Europe is already much fatter than southeast Asia. This is a worldwide phenomenon.
I would argue that the US has some fault to why other western nations are getting fatter.
All of the US's worst fast food chains and food products have been exported. In my tiny city a Carl's Jr. Just opened! There is McDonald's, Burger King and Starbucks everywhere. There are also Dunkin donuts in the supermarket as well as oreos. In contrast there arent any Asian or Russian restaurants chains here.
Local foods have become sweeter in order to compete and there are so many local burger restaurants now it's like I have moved to the US.
That's par for the course, the world does love to blame us for their problems. Then they bitch when anyone suggests we've made some choices in the last 100 years that made their lives noticeably better (hello Marshall Plan!).
> have been exported
That's a convenient spin on "have been imported." Do you not make your own choices? If you don't want the crappy fast food, quit making your own copies of it!
Since it's kind of on point for this discussion, I just thought I'd mention one amusing thing I noticed in London -- you can buy higher calorie McDonalds food there. I could get a sasusage mcmuffin with two patties, which isn't a thing in the US. I almost wanted to do it just for the laughs, but frankly the UK version of McDonalds tastes even worse than the US version. I'm not sure exactly how that's possible.
Y'all should stop importing the shittiest excuses for 'American' food. A lot of us never eat at these places in spite of them being so prevalent. We have a lot of great restaurants, even some of the ones that qualify as fast food.
> If you don't want the crappy fast food, quit making your own copies of it!
“If alcohol is bad for you, quit drinking it!”
“If crack is bad for you, quit taking it!”
My point is that there is more to it than that. You make like it’s a choice governed by free will when we know that fatty and sweet foods are addictive and harder to resist.
It is global, but the US is among the leaders and people who move here from skinnier countries tend to get fatter. Something about (odds are, a bunch of somethings about) the living environment we’ve created causes more obesity than the environments in most other countries, though yes, it’s getting worse in those other countries, too.
From the article "Estimates suggest GLP-1s can reduce body weight by at least 15% when taken regularly". That's a 5'10" man starting at 250lbs (obese, BMI > 35) and finishing at 220lbs (obese, BMI >30).
Or a 5'10" man starting at 220lbs (obese) and finishing at 187lbs (overweight, BMI > 26).
It ain't nothing, but that's not a magic pill which will fix the obesity epidemic. And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food.
I lost 100 lbs over 18 months. And, I found it much easier to change my lifestyle on a GLP-1 drug. Naturally thin people / people who don't have some environmental sensitivity are super judgy about GLP-1 drugs, and closet judgy about fat people. It's just not so simple as "lazy/poor diet/no exercise."
I went from nutritionist appointments that were like "are you lying about your food intake? because if not, you have some serious problem with something in your environment" to "yep, it was easy to cut out a couple things that bothered me," and weight came off astonishingly rapidly.
And this anecdote a person on HN[1] "reached a peak of 340, and in exactly a year, while maintaining the same CICO, but changing from the SAD to strict non-Keto Paleo, became 214".
(I want to ask this in a non-combative way, but 3 days later I still can't. How did you know the couple of foods(?) which were bothering you, which were the problem, and your nutritionist did not know about them, and you weren't lying to the nutritionist? I can't make sense of that without also accusing you of hiding them from the nutritionist, or the nutritionist being terrible at their job).
This is work in progress, though. 3rd generation medications are already way more efficient than 1st gen. Saxenda ever was. A further increase in efficiency is likely.
"And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food."
That sounds very judgmental of you, like if they were skipping school. Bad truants!
What about "found the necessary changes too hard/complicated to sustain"? That is closer to reality. People juggle all sorts of obligations, some are doing multiple jobs, commuting 90 minutes each way etc. - they may be just too fatigued to exercise regularly and cook healthy meals at home.
There are 110,000,000 overweight people in the USA and another 110,000,000 obese people. Is it really closer to reality that everyone is a two-jobs no time for exercise, or is it more that Starbucks Mocha Frappuccino has 500 Calories and Starbucks has 15,800 stores in the USA and $36Bn annual revenue? And McDonalds, KFC, and all the rest. Is it closer to reality that people are snacking on some snack food on the couch out of habit and not paying attention to how many calories that is in a week, because it's just habit and gone in seconds? Is it closer to reality that Uber Eats and Door Dash and Domino's advertise to manipulate you into believing that you don't have time to cook at home and they are a good option? Is it closer to reality that there are food deserts with only junk easily available?
> "That sounds very judgmental of you, like if they were skipping school. Bad truants!"
It is judgemental of me, like if you want to pass your exams but skip studying, that would be bad. If you aren't exercising and are eating terribly and are obese, this lets you silence the alarm bells while saying "I don't have time to exercise". That doesn't seem as good as eating better and changing your life to include movement.
I don't perceive health as a reward for virtue, so even though I understand your analogy with exams, I cannot really accept it.
Ask yourself where fast food comes from. It is a) fast, b) cheap. Of course it is going to suit people who a) don't have time, b) don't have much money. A union of those two wants covers a big part of the contemporary Western population.
Composition of food is another biggie, I agree with you on that. Too much sugar everywhere. That said: we are naturally wired to crave sugar, only someone more and someone less. If fentanyl was legally sold on every corner in fancy packaging, starting with kids, would you blame the resulting junkies for being weak-willed? Or acknowledge that the environment is really fucked up?
I personally don't respond to sugar that much and I can go weeks without it, but that's not my virtue. It is blind luck of my genome or possibly microbiome. I don't drink much either, but again, that's blind luck of my genome or possibly microbiome which makes me dislike the taste of alcohol. Not my iron will, which I don't have.
It is my experience that a lot of people are judgmental about the fatties because it increases their own perceived self-worth. ("We are the virtuous ones, unlike them.") Pretty arbitrary, but humans be like that.
But is it time to give up just because there hasn't been much progress yet? It seems now that we have #2 there's little incentive for #1, whereas there was plenty incentive for #1 before even if little action.
I think fourish decades was enough time to see if we’d get our shit together on the pile of problems that need to be fixed to solve this the #1 way. We haven’t, even a little.
So no, I’m thrilled to see #2 show up to maybe get our healthcare system to limp along for at least a couple decades longer than it was looking like it would.
I think it's better not to sacrifice the wellbeing of our citizens at the feet of an ideology about exactly how we should be solving an obesity crisis.
Besides, having healthier people will lead to better infrastructure for healthier lifestyles, purely based on demand. It's a virtuous cycle.
Yes. Looking out 30, 50, 100 years science will further resolve the obesity problem that has plagued the US since the 1980s. There is no scenario where you radically alter such a gigantic, disconnected, complex culture such as the US has. The old joke was that the US would solve this with pills (so to speak), and that's what is going to happen.
If you have a tiny, homogeneous culture it is still very difficult to radically alter it in the span of a couple decades (think: Sweden, Finland). For something the scale of the US, with the diversity of the US, there is no possibility. Anything suggested as comprehensive would be fantasy. There are only small changes that could be done, eg relating to sugar consumption limits in drinks and food; some would have a meaningful impact, however you still won't fundamentally change the culture's calorie problem.
Getting thinner will do extraordinary things for rebooting the malfunctioning US. Obesity does a lot of harmful things to work ethic, longevity, quality of longevity, productivity, mental capabilities, to say nothing of course diabetes and cancer and so on.
I know someone who has lost about 60lbs. The reaction of most people is 'what pill did you take'. They find out it is basically no sugar and limited amounts of food with some mild exercise. Pretty much every one of them is 'thats hard' and do not do it. And frankly it is hard. Like 95% of a grocery store has way to much of what you need for your daily intake in some form or another. It is that 5% you have to dig thru the whole mountain of crap to find. Then once you find it hope like hell the manufacture does not stop selling it. Or enjoy making everything from scratch (even that is a pain).
I would not jump on that current pill yet. Wait and see. There are probably serious side effects that we mere plebes do not get to find out about yet (that is for 20 years from now). Like what is the side effects when you stop taking it? What if your dose is too high/low? What is the long term usage like for other parts of the body?
> "Osbourne said when she first began using the drug she felt nauseous for two to three weeks."
> “You don’t throw up physically, but you’ve got that feeling,” she said.
> She was also very thirsty and did not want to eat.
No, it doesn't appear that some famous person almost died. The drug seemed to be effective for her. She noticed some mild nausea - she even said she didn't throw up. That's mild nausea. She was thirsty - this makes sense. Food contains water, so she was probably dehydrated which contributes to the nausea. She should have drank more water. Finally, she did not want to eat. That is the intended effect of the drug. Sounds like it did exactly what it was designed to do.
Yes, gastroparesis can happen. This is not a shocker, as GLP-1 agonists affect the rate of gastric emptying. Gastroparesis is ... a slowing of gastric emptying. 750 out of nearly 150,000 GLP-1 patients experienced gastroparesis. This is about double the incidence in the general population. In very rare cases of gastroparesis you can experience blockages, but that is very much the exception, not the rule. Even so, this is why it's important to meet regularly with your doctor, discuss how you're feeling while on the drug, and get medical attention if you discover you're not shitting and normal methods don't improve things.
There are many useful, common drugs that have side effects that seem scary but are rare. ACE inhibitors are wonderful, well-tolerated drugs for controlling blood pressure, but long term use can cause kidney issues in very rare cases. Monitoring potassium levels allows for this side effect to be controlled well before kidney damage results.
> If there were effects, we'd have seen them by now.
You just authored a screed in response to me pointing out that there are effects.
Sharon Osbourne didn't just have mild nausea she now claims she can't put back the weight she lost that she didn't intend to lose.
> Gastroparesis is ... a slowing of gastric emptying.
I can't help but point out the syntax choice of internet snobbery. I'm not sure when people started sprinkling ellipses for dramatic effect because they seem to think it makes them authoritative but I think it's worth highlighting since it's such a reliable heuristic for internet troll.
? All I can find are a bunch of articles about one or more interviews she gave where she complained it made her too skinny (if you’re on it for weight loss rather than diabetes, you can simply adjust the dose down if you’re finding it too effective), nothing about almost dying.
> “I’m too gaunt and I can’t put any weight on. I want to, because I feel I’m too skinny,” she went on before warning people, “Be careful what you wish for.”
She abruptly stopped after losing much more than she wanted to lose.
1) Radically alter aspects of food culture, work culture, social policy, and business regulation.
2) Magic pill (/injection)
There appears to be no imminent progress on the many parts of #1 that need serious work, so if we want a big turn-around in the next half-century, #2 has suddenly and surprisingly become a real possibility.