> Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?
Have alcoholics using Naltrexone? Or opioid addicts using Methadone, or smokers using nicotine gum/patches?
See I'm bringing this up to point out the obvious double standard, people suffering from food addiction (i.e. literally the high from food) or binge-eating disorder, who finally have an effective treatment, are treated like it isn't addiction or illness, but a "lifestyle," but if you said this stuff about any other addiction people would call you out and be horrified.
For people mildy overweight or accidentally obese, it is a wildly different illness for people with lifetime problems who have lost/regained weight tens of times and likely know more about nutrition than most healthy-weight people ever will.
The concern regarding a drug as a crutch is stil valid. Smokers/drinkers may deal with stress by smoking/drinking. After cessation, ways to deal with stress need to be learned from a new.
"Addiction" is ambiguous and a term almost better not used. "Addiction" may constitute chemical dependency but can also be largely a set of habits. A set of habits and lifestyle are pretty much the same thing.
Some things simply are negative, sure. I think we can all agree that murder is negative on the whole, for example.
But you are making a HUGE leap here in assuming that GLP1 agonists "simply are negative". You have not remotely supported this logical leap. All studies in fact have shown that GLP1 agonists are significantly positive: That they improve health, reduce obesity, reduce all-cause mortality, etc. You are denying observed reality across a large number of double blinded, objective clinical trials.
I just keep following your comments down the page and giving you upvotes.
I think folks using drugs (or meditation or habits or diet or any other thing) to intentionally make their life better is amazing and should be celebrated.
If some things are easy for you but not others try to be grateful for yourself without having to be petty or wanting others to be worse off.
To be clear, I don't think GLP1 agonists are "negative." I think the blend of environmental, food supply, and other factors that led many adults, in the US and elsewhere, to need obesity intervention is the negative. GLP1 agonists are an inherent crutch.
Much like if we geoengineered cloud seeding or similar light blocking and fail to reduce CO2, the treatment masks the cause and can lead to worse outcomes globally (even if some folks are better off - and I hope they are!).
However, if they are, then modern life is a sledge hammer that’s constantly breaking your legs.
Our (US, UK, Australia and so on) life styles and food chain have created this obesity problem.
We are now a sedentary population, and low-nutrient high-calorie food is being made readily available to stressed, tired, overworked, and economically challenged people. When you are stressed and tired, you don’t make the best choices!
These drugs are not so much a crutch as they are a rescue helicopter!
We still need education though.
These drugs might reduce hunger, but they won’t stop you from consuming junk-food. People are used to overeating, and a feeling full isn’t always what’s stopping them from eating!
So we do absolutely need to address the root of problem….
>These drugs are not so much a crutch as they are a rescue helicopter!
Yes, but once you’re rescued you hopefully try to avoid falling in the same situation that lead you to have to be rescued the first time. This should be a double approach solution, a short term (the drug) and a long term ( lifestyle changes) it can be done with the second only but personal commitment is required. Besides that we, as a society, are not accustomed to “subtractive solutions” they’re simply never considered or pushed by anyone because there’s no money on them. Money is in “creating solutions” not in “eliminating problems”
> Here I am looking from western Europe at 100% self-inflicted US obesity epidemics and shaking my head in disbelief, what kind of garbage and in what massive quantities you guys consume daily.
26% and climbing in the UK. 19% and climbing in Germany. 17% in France. 11% in Switzerland - and another 30% overweight. 20 years ago America was 32% obese. Do you want to bet that this is a uniquely American thing? That these numbers won't continue to climb in Europe? Hell, we're seeing them climb in Asia - South Korea's obesity rate among men went from 3.26% to 7.3% from 2009 to 2019, though women increased at a much slower rate.
> Sure, you can just literally throw money at the problem that is too scary for you to tackle it headfirst, or you can have a wake up call and make your life significantly better from now on and live longer. All is connected - it leads to higher confidence, happier healthier life. The key is to walk the hard path - overcome such a challenge will redefine who you are for the better. Taking pills every day because you can't avoid eating a cookie under stress won't, in contrary.
And plenty of people can keep moralizing about how everyone should do it The Proper Way and refusing to understand that while, yes, it is within the power of humans to overcome things with willpower, that there are situations that cause it to require significantly more willpower for some.
> Kids don't eat garbage because parents don't give them garbage, because parents don't eat and overeat on garbage.
This is a great example. A significant number of people end up obese because they're poor. This seems silly at first, right? Go to the grocery store, buy good whole food, cook, save money! There's problems with this: Many poor people work long hours and have difficulty finding the time or energy to cook. Even when they do, many of the cheapest food items are also the most calorie dense and worst calorie:satiety ratios. So this starts them on a cycle of eating the sort of food that makes you fat. And then the fatter you get, the more feedback cycles you have encouraging you to continue getting fatter - such as the well researched links between obesity and leptin. So they get fat, their kids get fat, and it becomes ever more difficult to stop being fat, all because that's the food they could afford to feed their families with.
> A significant number of people end up obese because they're poor... Many poor people work long hours and have difficulty finding the time or energy to cook.
Every one of those poor Americans has a vote. One vote per person, same as rich people. Experts have long noted that there are more poor people than rich people. There's nothing stopping them from doing what western Europeans did, vote in leaders who provide better working conditions, better worker protections and better pay, and other policies that reduce poverty.
If only there were a drug that suppressed political defeatism.
> There's nothing stopping them from doing what western Europeans did, vote in leaders who provide better working conditions, better worker protections and better pay, and other policies that reduce poverty.
On the local level, gerrymandering can quite literally stop them from doing that.
It is easy to call taking the medication easy, but nothing about it actually is.
Eating right, lifting, trying to be active… all of that on top of the nausea created by the medication itself.
Obesity is such a massive epidemic, and shaming people into feeling bad about it has clearly not worked. And that’s before you consider the genetic factors, environmental factors, food deserts, and the other dozen reasons it’s so hard to stay fit for some people.
I am genetically gifted in some ways; an athlete’s metabolism was not one of them. I can be extremely disciplined, but the constant vigilance creates this “food noise” in your head that’s hard to explain, but extremely stressful, and causes you to constantly be seeking the next meal.
It used to be that every single food I put in my mouth tasted amazing (within reason). Apparently this is not true for everyone, and they have a greater and sharper distinction between “foods that are amazing” and “foods that are just fine”. That distinction exists for me now, and never really did before this medication.
There are so many ways it has helped me. My blood labs are perfect, and my liver was definitely not perfect before. My A1C was just on the cusp of prediabetic, at 5.7%. My triglycerides, ALT, AST… all were wayyyyy higher than they should have been.
A1C at last test a few months ago was 5.0%, and all the other numbers are well within low-mid range of where they should be.
Anyone that looks at someone using GLP-1 medications and thinks they’re “cheating” is a child. You still have to put in the work; you still have to eat right and work out and lift. It just makes it actually possible to do that for the first time in many people’s lives. I don’t know if you’ve ever put on a realistic “fat suit,” but trust me when I say that everything is harder when you’re heavier. A walk around the block is an insane workout if you are 450lbs and haven’t walked in years. It’s not where you should end, but it is a start, and if there is a medication that helps someone start… everyone else can fuck right off. You will never find me shaming someone else or judging them for getting healthy, which is the actual point more than just losing weight.
There is one way to get off the medication in the future (or get on the lowest dose, etc): build significant muscle mass. That’s why it’s so important to lift.
One common argument I’ve heard against GLP-1 meds is the idea that you’ll have to be on the meds forever. And for some people, maybe even most, that may be true. We don’t know yet.
But you know what’s worse than being on a GLP-1 med forever? Being obese forever. We know precisely just how that kills so many of us.
But you’re right, we should just go back to the way it was. That seemed to work just fine. :/
I don't think the point is that GLP-1 inhibitors are "cheating," but that maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life. So many people regain all the weight they lost after stopping these drugs, so it doesn't make meaningful progress and just covers the problem.
At some point, we may find that these drugs cause long-term health problems of their own, too.
> maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life.
It doesn't work for nearly as many people as GLP-1 agonists do. There are many different treatment methods that have been tested and evaluated, and being told to diet and exercise through therapy barely works at all. GLP-1 by contrast works very well.
> At some point, we may find that these drugs cause long-term health problems of their own, too.
Almost sounds like wishful thinking on your part -- you might want to stop and consider why you're so invested in these drugs having long-term side effects.
CBT is very good at breaking addictions and other bad thought patterns, and it is the scientific basis on which most hard drug rehabs work. There's no reason to suggest that it works less on food than on heroin.
> There's no reason to suggest that it works less on food than on heroin.
And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related.
The people who GLP-1 drugs help have not “never tried anything,” including but not limited to “real therapy.”
If CBT and other modalities help someone, great! But they often don’t, and when they don’t, it’s absurd to want them to continue to suffer instead of get help with medication.
> And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related.
Citation needed. As I understand it, serious therapeutic psychological treatments for obesity are highly stigmatized in the US. You may be projecting your own experience onto a group that does not share it.
By the way, CBT as used for depression and for obesity are totally different types of CBT. CBT methods are highly tailored to the specific thought pattern you want to prevent.
> I don't think the point is that GLP-1 inhibitors are "cheating," but that maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life.
There is no guarantee that I’ll have to be on it for the rest of my life. But also, I was not “addicted” to food.
I spent 18 months changing my lifestyle, nutrition, and exercise habits, and I lost zero weight. I gained health (hikes were no longer a problem, I was fully capable of working out after enough time doing it, etc.), but no weight loss.
Yes, I tracked. Yes, I ate below my expenditure. My body holds onto weight.
So yeah, I agree with more help for people with addictions, period. I do not see how it is a “replacement” for a medication that is clearly helping people.
A lack of therapy was not my problem.
> So many people regain all the weight they lost after stopping these drugs, so it doesn't make meaningful progress and just covers the problem.
> At some point, we may find that these drugs cause long-term health problems of their own, too.
Or we may not; these drugs have been around since 2005. They’re not new, despite most people having just heard of them now.
But we know for a fact that obesity kills.
Again: your contention is that instead of using this medication that helped me get healthier over the last 7 months and will help me get healthier yet over the next 7-8, you would have preferred that I “accept” that I have a problem imbued with negative morals (“addiction”) and try my hardest to break it. The thing is, I had already done that for the entirety of my life, remained obese, and would have died of it eventually.
Can I be disciplined? Absolutely. I even lost 55 lbs doing keto for 10 months. I ran a startup, and successfully sold it.
Discipline wasn’t my issue.
I’m not suggesting you should use a GLP-1 med. I’m suggesting you shouldn’t be the arbiter of whether it is helpful or not; it’s effects should be.
I was not talking about your personal experience. You may have actually benefitted from the main intended pharmacological effects of this drug, since it appears to be affecting your metabolism (your "body holds onto weight" comment suggests that). This is a diabetes drug, remember.
The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food. Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns.
> The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food.
Citation needed. This is the main assumption you are making that I, and others, vehemently disagree with.
The implication is that this is the first time people have suddenly decided they don’t like being obese. That’s absurd. The people on these medications have tried everything. Talk to literally any obesity doctor and ask them about their patients.
This assumption is the problem. Nothing about the meds is easy. It just makes it possible for people to change when they couldn’t before.
I don’t know why people feel a need to argue against that.
> Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns.
Sure, and I don’t disagree. And I’m all for people doing that too. If it works, great!
On average, it doesn’t, for the vast majority of people, though it does work for some, and that’s great. I agree it’s a preferable approach. But if it worked for most people, it would have worked.
But if it doesn’t work? Previously, people just accepted that they were going to be obese and miserable, and that it was their fault, which led to depression, etc., further making it “impossible” to ever fix.
So if there is a medication that helps people change their lifestyle to get healthy, and also appears to be extremely effective, and has a good safety profile… that’s bad?
> The people on these medications have tried everything. Talk to literally any obesity doctor and ask them about their patients.
Citation needed on this one. Almost all the obese people I know have never seen a specialist doctor about it, so I assume your anecdata have selection bias. The people who see obesity doctors are the ones who have tried everything. Not the average obese person.
I don't personally mind if you or anyone who really needs it and gets prescribed the thing by a specialist takes Ozempic. I don't think any drug use, be it Ozempic, abortion pills, or estrogen, should be stigmatized for the individuals taking it. I do think it's a sign of a societal ill that a large majority of the people taking Ozempic are not in that situation.
> Citation needed on this one. Almost all the obese people I know have never seen a specialist doctor about it, so I assume your anecdata have selection bias.
You sure? Nearly every single one I know has seen their primary about it every time they go in and if the primary referred them to a specialist they went.
What they don’t do, though, is talk about it.
Have you asked them?
> I don't personally mind if you or anyone who really needs it and gets prescribed the thing by a specialist takes Ozempic. I don't think any drug use, be it Ozempic, abortion pills, or estrogen, should be stigmatized for the individuals taking it.
Great, agreed.
> I do think it's a sign of a societal ill that a large majority of the people taking Ozempic are not in that situation.
I don’t think it’s true that “a large majority” of the people taking it are just handed the pills for fun, to lose a few pounds. Your assumption about to whom they are prescribed is my whole issue, as it assumes they don’t need it to lose weight and can “just eat right and work out,” and that is not true.
People who are obese don’t like being obese. They aren’t that way because they don’t care. They aren’t that way because they are lazy. (On average)
No, Wegovy and Zepbound are not diabetes drugs. They are weight loss drugs.
> ... but problems with controlling themselves around food.
Problems that Wegovy and Zepbound solve for most people taking them, when no other solution worked for those people.
> There are hugely beneficial approaches that rely on CBT,
CBT is much more expensive, time-intensive, and less effective for weight loss than GLP-1 drugs. It also scales incredibly poorly, as you need a huge number of therapists. There are roughly a hundred million obese Americans. We can make enough drugs to treat all them, but can we make and pay for several million therapists to perform CBT on all of them, all for less efficacy than the GLP-1 agonists? Fat chance.
Exactly! For many drugs it's essentially a funny accident of history that they were originally discovered while attempting to cure something completely unrelated to what is now their primary usage.
>The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food
Quite frankly this is an incredibly absurd statement. Do you realize that our brains entirely control our behavior? An issue with self control is a brain issue, and very well may be an endocrine issue. Are you an endocrinologist?
Even if you were completely right, you might as well start shaming Africans for "needing" malaria vaccines. Europe is not America. What you call a self inflicted epidemic is generally accepted as a disastrous food situation because of market forces with no government incentives to foster a culture of healthy eating. And I'm underweight FYI before your European high horse starts lobbing more uncalled for insults.
What's the explanation for why GLP1 medications are negative things? There are a very minor subset of people that have some medically significant adverse reactions, but it is VERY small. We don't have any evidence to my knowledge of any long term risks with being on it.
The GI issues tend to be minor. Unpleasant, but not exactly any more debilitating than a lactose intolerant person deciding that they really really wanted that extra large milkshake. Some people have it worse - but those, to my understanding, very much are in the minority.
Tirzepatide also has significantly fewer GI issues.
Muscle mass loss happens in any sort of weight loss where you don't eat enough protein and get enough exercise. There's no current evidence that when you control for calorie deficit, diet macros, level of exercise, bmr, etc., that people lose more muscle mass on GLP1 agonists to my knowledge.
This. You'll need studies to prove that semaglutide causes muscle mass -so you need to have a group that loses weight using semaglutide and another group that loses weight without it and compare the muscle loss. I'm willing to bet you'll see similar numbers. If you don't exercise, you will lose muscle mass when reducing weight - which is why trainers recommend resistance training and higher than usual protein while cutting.
GI issues are almost always minor. Folks are used to zero discomfort in their lives so the social media reporting of such is wildly overdone.
Tirzepatide is being investigated as a therapy for IBS. Within two weeks of being on the drug I was able to start living a life not scheduled around being near a restroom. This was suggested as a potential side effect by my doctor before taking it for weight loss, due to the GIP component in the drug which slows down your digestive track.
It could be I’m eating less. However I have went on crash diets before with absolutely no change to my constant lifetime GI issues, and have eaten extremely clean the past half decade due to a partner who cooks amazing healthy meals that would exceed most definitions of the term.
I’ve long since reached my goal weight and target body composition- but I plan on sticking to a low dose of Tirzepatide for the rest of my life since it gave me my life back. No more popping Imodium every few hours on vacation while simultaneously fasting. Just a normal life these days. I can enjoy a breakfast if I feel like it without it ruining the rest of my morning. Heck, I can even eat shitty greasy food at the state fair with only mild discomfort most folks would have from such poor choices.
Every study (still limited in number) I’ve read more or less refutes all the social media hysteria. There is a whole lot of smoke but no fires yet to be seen. They may still be coming.
The things that are not wholesale misinformation seem to be the requirement to cease use many weeks before going into surgery, potentially needing to be on it for your whole life, and the side effect it currently has on your finances. Nothing else seems to hold up under scientific scrutiny yet.
Perhaps I will regret this decision in 20 years, but I’m willing to take that risk to have some of the best quality of life years I’ve had yet.
Sure. But what's the proposed mechanism? For many - not all, obviously - medications, we have an understanding of potential long term risks. Animal studies catch some of them, others we know are potentially risky even without animal studies, e.g. drugs that increase angiogenesis have a risk of increasing tumor growth.
But no one has proposed mechanisms for GLP1 peptides.
Meanwhile, we know obesity is one of the largest long term risks to health in existence, and one of the most prevalent.
> But no one has proposed mechanisms for GLP1 peptides.
I'm worried about long term malnutrition leading to significant loss of muscle mass, osteoporosis, and other deficiencies that eventually lead to infirmity and brings forward the immobility death spiral much earlier in late age through weak muscles and bones. Most of the long term studies on GLP-1 agonists that I've reviewed have been on diabetic patients who already had to carefully control their diets and we still don't know what decades of poor diet on Ozempic will do.
For very obese people the tradeoff is still pretty damn good though.
Probably more or less the same as to what happens with skinny people who have a garbage diet but just eat less or have significantly higher metabolisms.
It's not great.
The good news is it's quite commonly reported (and I can add my anecdotal experience to the chorus) that I don't crave the food that's worst for me in any real quantity anymore. Even if I'm busy and need to scroll through uber eats, I'm not using it as an excuse to get a delicious but large, fried, high in carbs, high in fat meal. It's way easier for me to say "yeah that tastes good, but I'll grab the grilled chicken wrap and brown rice."
I'm not sure on what causes this - we have some preliminary studies around GLP1 peptides, dopamine, addiction, etc., so it might be something there. But the sheer number of people you hear talking about it makes me believe we'll have some studies that do look into it in the future. It might not happen to everyone, and some people might still just choose to eat poorly even if it does, but in both situations people's longterm health depends on them listening to advice on how to eat better and exercise, and I think most people would rather be average weight and metabolically unhealthy than obese and metabolically unhealthy.
One obvious risk would be blunting of longer term GLP-1 receptor activation. Imagine type 2 diabetes but for ghrelin.
To use an analogy amphetamines have a honeymoon period, and it feels like a lot of people on these weight loss drugs haven’t been on them long enough to get past the honeymoon period and see what the effects are after 10, 20, etc years
It's possible. But, we've had another GLP-1 medication in use for about a decade and a half now - liraglutide. So far, we haven't seen evidence of that occurring.
I don't think anyone who is both informed and sane would suggest that it is impossible that there are negative long term impacts from taking the medication. Just that we have no current indication of them, and that being afraid about a "what if" without any concrete concerns when the alternative is the "continue being in one of the riskiest states possible for human health" is silly.
People don't realize that Ozempic is already a third generation GLP drug, Mounjaro is a 4th, and the try generation drugs are already in wide scale clinical trials.
We do in fact know a lot about how these drugs affect people by now, and as you point out, we have well over a decade of data on them.
That's the danger of any rapid weight loss where you don't exercise and ingest additional protein.
I knew about it from prior research, but my doctor made sure to mention it to me as well. He's also monitoring the speed of my weight loss to determine if I should go on ursodiol to prevent gallstones - another potential side effect of rapid weight loss.
But the same could happen on any sort of caloric deficit. The GLP1 drug isn't causing you to lose muscle through some reaction occurring inside your body - it's your body just doing what it does in a calorie deficit when you aren't overindexing on protein and working out.
All significant weight loss includes some loss of muscle mass. Minimizing that is why every patient is advised and counseled to lift and work out, change their lifestyle and diet, and so on.
The pill alone isn’t magic. It just makes it possible to do the right things for people who found it impossible to do before.
Crutch (n)
a : a support typically fitting under the armpit for use by the disabled in walking
b : a source or means of support or assistance that is relied on heavily or excessively
Use a is a neutral, non-judgmental, literal use of the word. Use b is clearly a pejorative, judgmental, metaphorical use of the word. The two are not the same.
That _OR_ is doing a lot of work. I believe that 'or' makes the word not objectively pejorative. Context is important. A no-true-scotsman insinuation, or an insinuation that the crutch will never be removed does lack empathy and would seem pejorative to me.
Though, an empathetic concern that the crutch will never be removed - is not necessarily pejorative IMO. Either way, the crutch is a tool to "healing." Context matters.
Is this an argument that you should use crutch and everyone ever will always read it as version b?
It might be more good faith to just pick language that is more clear. The alternative feels a lot like pretending to be one thing while trying to make people think something else - it rings just like a bad faith "Im just asking questions"
To be clear, version a is referring to literal (non-metaphorical) crutches, and is not the version being used here because GLP-1 agonists are not literal crutches. Version b is the only possible use of the word being used in this conversation, and is always pejorative. "Oh, you broke your foot, you're getting around on a crutch" = Always version A, literal, non-pejorative. "Oh, you're obese, you're using medicine as a crutch to cure it" = Always version B, metaphorical, pejorative. There's no confusion.
I'm a bit confused. Would you mind clarifying whether you think using "crutch" is the more clear vocabulary, or whether alternative vocabulary would be more clear?
The negative connotation of a crutch implies that you are past the point of needing it and should be standing on your own two feet. If a thing is not meant to be temporary, or if you'll never be able to perform a task as well without it as you could with it, then it's a tool rather than a crutch.
Thus, calling GLP-1 meds a “crutch” implies that they are unnecessary, and that the patient should be able to do it without medication, which then creates guilt and shame where there shouldn’t be any.
Reflecting on this, I think that 'for-life' aspect is very key. A 'seeing aid' vs 'seeing crutch'. Crutches are usually meant to be temporary. A walking stick is the walking aid equivalent. Hence, for weight loss, is medication meant to be the life long solution? As a facilitator to move the needle for people - very helpful. The underlying question about lifestyle and habits never changing is where the life long crutch concern comes in.
All these people are calling it a crutch are moralizing tongue clicking, holier than thou Calvinists who think you shouldn’t be able to be thin unless you bootstrapped yourself to thinness with your own blood sweat and tears, as though this viewpoint represents some abstract understanding of the world instead of merely a smug sense of self righteousness.
Crutch and “weight loss aid” aren’t synonymous at all. You can’t ask someone to use a word that has a less negative connotation if they mean completely different things. They intentionally said crutch because they’re specifically talking about people who use it as a crutch. Not people who just use it as a weight loss aid.
What's wrong eith a medicine as a crutch? If you break your leg you use a damn crutch and that's good. If you suffer from an illness and we have a medicine that's worse than the illness and affordable - go for it.
Phrasing it as a crutch suggests it is somehow only a temporary that prevents you from finding a "real" solution by changing your "lifestyle". It doesn't matter, only outcomes matter.
Agreed. After I broke leg the physical therapist saw me walking without aids and said I should go back to using a cane and explained that I'll heal better and faster if I use help than if I don't. Made me realize that the expression "using x as a crutch" doesn't make sense if it's supposed to imply that x is an impediment to progress.
> The concern regarding a drug as a crutch is stil valid.
People with pacemakers can't get off of them either, but it doesn't have the same stigma. Diabetics often need regular insulin injections, but it doesn't have the same stigma. People with high-blood pressure often need regular medication, but it doesn't have the same stigma. It's mostly antidepressants and now Ozempic which have this stigma.
> A set of habits and lifestyle are pretty much the same thing.
I believe the DSM does not consider them "pretty much the same thing".
I think the difference is with food you have to eat it. You don't need alcohol, opioids or nicotine to live. With food it's much easier to fall back into similar or the same pattern as before because you can't avoid it.
The other problem being the availability of healthy food.
Those without the time or facility to cook are dependent upon stores selling convenience foods which are anything but healthy, those foods labelled as such being some of the worst examples.
Despite not being overweight and taking regular exercise, I have recently been diagnosed as diabetic and now see the world in a different light. It really is quite shocking how many aisles in. a typical supermarket are stocked with complete junk food.
>The other problem being the availability of healthy food. Those without the time or facility to cook are dependent upon stores selling convenience foods which are anything but healthy, those foods labelled as such being some of the worst examples.
Is it impossible to buy healthy food in your region? The average American spends six hours a day watching TV, do they really not have enough time to cook a meal? Just how many people do not have a cooker in their home? Is it cheaper to buy preprocessed food rather than the raw ingredients in that meal?
It seems to me the real problem is the supply of food is abundant and corporations have gone to extraordinary lengths to make it very palatable. Add in peoples tendency to chose the easy option (ready meals, eating out) and you get an obesity epidemic.
Everyone has 24 hours a day. We could all move to the cheapest CoL areas, grow our own food, and run marathons all day every day. Everyone, including you, could sneak one more rep in instead of some activity in the day. This holier-than-thou attitude of dismissing people is lame.
Empathy can go a long way and the more we can have for each other the better we will collectively be.
>This holier-than-thou attitude of dismissing people is lame.
If you want to solve the problem you have to understand it. I see lots of dubious suggestions like lack of time when working hours have reduced massively in recent history[1].
>Empathy can go a long way and the more we can have for each other the better we will collectively be.
If our read my second paragraph then you will see I'm not laying the blame at individuals.
Chemical dependency I believe can confuse the brain, where it actually does think you need the drug to live.
It can be very hard to avoid booze or cigarettes. They are everywhere. Potentially throughout all of a person's social group. Maybe at home if spouse or parents smoke.
As a former smoker, changing diet was easier for me than to change a smoking habit
While you're chemically addicted to a substance, yes, the body thinks you literally need it to survive. The point is what happens after you break the chemical addiction, you go through withdrawal, and can function again. The brain stops feeling you need it in that same way after this process. But it's almost impossible for someone who went through alchohol or nicotine or opioid withdrawal to ever consume that again and not relapse into addiction.
If the same logic applies to a "food addiction", then discontinuing the drug that helped you go over the initial addiction is going to be almost impossible, since you can't abstain from food.
Withdrawal can often be both a mental and chemical process. The desire to do something and constantly thinking about it can be just as much habit as it is chemical.
We are mostly on the same page I think. To the point though, re: food - it is not all equal. Fast food, ice cream, fried food, candy, chips- it is quite different from cooking your own meals and snacking on things like fruit, veggies and hummus (etc..)
Similar to your first point, I can't buy ice cream because I have no self control over it. (I would not say I have a food problem, it would therefore be a lot harder for others I believe)
While I agree "you can't abstain from food", it might be a bit overly reductive. Not all food is responsible for 'problem' eating. Similar to near absolutely (or absolutely) avoiding booze/nicotine, there might be similar foods that must be avoided. Which comes back to habits, changes to how a person snacks, when they eat, how long is spent in food prep,more grocery store trips, how they shop in the grocery store (etc)
I think smoking is particularly hard because most of the really bad effects come much further down the line.
You can smoke for years (even tens of) without much problem and if you do some sports even the cardio/breathing effects are largely mitigated (I know, this is what I do).
So, it's easy to only think about how good it makes you feel at the moment.
But alcohol will show nasty side effects rather sooner than later, it will show on your face, you will feel liver problems very fast and since you are in a secondary state when inebriated you will seem out of place when not in that state.
Both of those substances have the particular effect that if you use them repeatedly over a short (1-2 week) period of time in moderate but sustained quantities, you will get chemically addicted.
This is nasty and the reason why every parent tries to make this fact known to their children (more or less successfully depending on method).
Food addiction in my opinion is very different, it comes purely from psychological factors and should be very easy to correct on time.
It's not something that comes around in 1 week or 2. Even if you overeat 1000 kcal (1/3 more than the average of 2000) over the course of 2 weeks, you would only gain 2kg of body fat at worse.
It's really a very long sustained process to really become obese, it's not like chemicals that can get you in 2 weeks max.
While it's hard to lose what you gained (you basically need to starve a little bit) it's not that hard to make adjustment to life choice to avoid making the situation much worse.
Actually not true. All addicts develop lifestyles around their addictions. Alcoholics often have many social connections that involve alcohol, what they do for fun involves alcohol, etc. A successful recovery typically involves changing this lifestyle to make the problem behaviors easier to avoid.
People that move out of the USA generally lose weight. Especially if they move to a country with snaller portions and more walking. People that move to the USA generally gain weight. Evidence that it's lifestyle.
An environment that physically makes you more sedentary as, outside of a couple of cities, many things that would be sensibly done through walking in other countries involve driving.
You can easily tell this is the case by seeing where the obesity is less prevalent
I would suggest that you look at food labels of "equivalent" products on both sides of the Atlantic. US packaged foods have a lot more sugar (and general calories) than those in Europe, even when they are the "same."
This is bunk. An actual chemical addiction is not the same as feeling an urge to drink 8 cans of coke a day, or being unable to not buy a bag of chips at the gas station.
Your entire body and brain is a complex and messy chemical reaction.
The opening sentence of the wikipedia article on addiction currently reads: "Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences."
The page then lists "eating or food addiction" as examples, with food addiction being its own entire page.
> That is just not the reality though. You make a choice.
Brains are fascinating. There is a choice being made every time someone with gambling addiction goes to gamble or someone with a smoking addiction goes to smoke, but that doesn't mean they're not experiencing addiction/withdrawal distorting the ability to make that choice in a healthy fashion. Some people do manage to quit smoking by just making a decision one day to stop and sticking with it, with no assistance whatsoever; that doesn't mean they weren't experiencing addiction/withdrawal. There are, in fact, mechanisms that encourage addictive behavior, ranging from social media use to alcohol to food to MMORPGs. Not everyone who uses those things, even to excess, has an addiction. But some do. And breaking that addiction is laudable, whether with or without assistance.
> I realize people are trying to make over opiod abuse into some sort of addiction. It makes it easier to not blame the person and absolves them of all personal responsibility for their condition - they just can't help themselves, don't ya know!
I change one addiction to another addiction. If people find the above distasteful, I agree, but my question is why do you believe one thing for food addiction and another thing for other addictions?
It's well established science that chemical reactions, hormones, etc. in the body 100% influence your hunger and cravings.
That doesn't mean that it's not within the means of human willpower to overcome it - everyone has the power to not be obese. But that doesn't mean that it isn't significantly harder for some people based on their genetics, biochemistry, the feedback loop of being obese, etc.
Some people get out of opioid addictions cold turkey, by just not consuming more opioids, enduring the withdrawal symptoms, and then getting rid of the chemical dependency.
Since we know this phenomenon is real, this means that, even with a chemical dependency, people choose whether to take the drug or not. So, by your logic, they are not really addicted, they can just choose to stop at any time, they're just silly and weak people, right?
Of course this is reductive and simplistic. Ultimately your choices are a computation that your entire nervous system makes, and urges and cravings are a component of that, just like rational processes are. Different people's nervous systems weigh these factors differently, and have more or less powerful cravings and urges to begin with. It's absurd to think that your rational thinking can overwrite anything in any condition, and it's absurd to think that all people experience these thinks to the same extent.
If they started using them without informed consent, was it a choice?
And even then, you do have a chemical dependancy on enough calories, that dependency led to an evolved response mechanism, that mechanism is exploited by junk food manufacturers. That the substances your body and brain produce in response to food stimuli are endogenous (made in your own body) rather than exogenous (made outside) doesn't make them magically less potent — some of us can get past this with our willpower*, but observationally it's obvious that most of us can't.
* I seem to have a lot of willpower, but I suspect that's mainly that my conscious self is fairly oblivious to my body's needs, as my willpower also leads to me pushing myself too hard in various different ways.
> chemical dependency from eating two cheeseburgers for dinner
Wouldn't the initial dependency be almost purely psychological for opioids as well? Most people certainly wouldn't develop a chemical dependency after just two doses as well.
> developed a chemical dependency which is no longer a choice.
Why? They still have a choice. Of course it might be much harder for them to stick with that choice than for someone suffering from a mainly psychological addiction.
Can you acknowledge your own bias in condemning people who don't achieve the same thing you have achieved? Can you acknowledge any advantages you may have had that made it easier for you to succeed in this particular endeavor?
This is not about that.
This is about why you consider some bad habits are addictions and some others are not.
I don't know, maybe you are right, but you haven't provided any beginning of an answer yet.
Rather, you sound like you would be saying that "quitting alcohol is merely a question of personal choice" if you had struggled with alcohol rather than weight.
Why do you think people persistently, for years, keep choosing something that harmed their bodies?
Just because you can do something, doesn't make it a "just" for everyone:
• Without any training, one day I decided to put one foot in front of the other and keep going, and managed 42 km, a literal marathon in distance — but it's obvious that, even though I was walking, most people can't do that.
• When I was at university, I gamified my diet to be the lowest cost without feeling hungry, and in retrospect that was probably 1100 kcal/day and only even safe because it was limited to term time, and it's really obvious that most people can't do that.
• Concersely, when I was on antidepressants and did graze myself into obesity, there simply wasn't a part of my mind aware of what I was doing to myself. I've lost that weight, but the strech marks are still there a decade later.
Right, or you can just own up to the fact that you do not have discipline and are indeed making detrimental choices for yourself. That alone is transformative, accepting responsibility.
These are all things that we acknowledge are possible to be addicted to to that are not substances. Not to mention that coke has caffeine which is a chemical substance just as much as anything.
You can pin addiction to anything as a personal weakness, including drugs. Why are some people able to smoke a few cigarettes or do a little bit of cocaine without ever getting addicted, when others are hooked on day one?
If there's one thing that's been fun to see as the outcome of GLP-1 drugs, it's that a lot of people seem to have a real problem seeing people better themselves the "easy way".
A good way to frame addiction is via perceived rewards. You can be addicted to many things if you look at it as “the person expects a reward for an activity, often errantly”. The worse addictions get into “the reward isn’t even expected with a moment’s clarity, but you do it anyway” territory.
It doesn’t matter what the actual addiction is, the reward circuitry in the brain is pretty much similar.
Addiction is basically highjacking our brain wiring that’s meant to help us expend energy chasing things that we need for survival (food, reproduction), and using it to chase other things
I find this attitude strange. I am a very physically fit man, I do not know what it is like to walk in the shoes of someone who has an addiction to food, but I do know people eat themselves to death. People deal with debilitating diseases that are directly linked to the amount they are eating. People literally destroy their body and live in the wreckage, and you think that it's not an addiction? If not an addiction what exactly is going on?
Addiction is this really scary thing I saw on tv about downtown Philadelphia and fentanyl killing people buy that's far away and couldn't happen here. Sure, I have friends who are fat and are unable to stop themselves from drinking 8 cans of coke a day but they're not shooting up with needles and I know them so they can't be this scary kind of person called an addict. Also I know this one girl who's glued to her phone all day and can't do anything else and she's also definitely not an addict.
Addiction hits the same part of the brain, no matter if it's chemical, physical, or digital. Just because our culture sees them differently doesn't make it the same underlying problem.
Seed oils (used in almost everything these days) contain a lot of linoleic acid, which is a precursor to endocannabinoids, potentially giving you the munchies. If eating gives you the munchies, making you want to eat more, I'd call that a chemical addiction.
I think avoiding bad foods is a better solution than reaching for drugs, but if the drugs help break the cycle, it could be beneficial.
>Seed oils (used in almost everything these days) contain a lot of linoleic acid, which is a precursor to endocannabinoids, potentially giving you the munchies. If eating gives you the munchies, making you want to eat more, I'd call that a chemical addiction.
If you listen to nutrition gurus, you'll hear claims like "food X contains chemical Y and chemical Y is either itself toxic or metabolizes to something toxic, therefore you shouldn't eat X". I promise you I can find videos where somebody has found something bad about spinach and will try to convince you not to eat it. It's a bad way to reason.
Identifying individual biological pathways isn't enough to make (dietary) prescriptions. Often, the metabolites of the food aren't produced in high enough quantities to make a measurable effect (on health, or this case behavior). This kind of thing has to be studied at the level of behavior.
As much as we pretend otherwise and rationalize stuff because the greatest sin for our generation is being judgemental, I am pretty sure this is the case in a lot of instances.
Shaming people is fantastic at making me feel self-righteous, though, which is the best metric by which I can evaluate treatments and interventions for other people.
(When I feel charitable, I can instead wring my hands and hemm and haww about the unknown consequences of people using medication to solve their health problems. I can't outline what exactly those consequences are, but I can certainly hemm and haww.)
This is the example I'm shocked more people don't invoke in these discussions. Gambling addiction is indisputably real, and slot machines (or craps tables or the ponies down at the track) don't even have stick a needle in you to get you hooked. Actions and reactions are more than enough.
Compulsive overeating relies on the same behavioral/reward mechanisms, with the added bonus of food being something you do physically ingest in the process.
Gambling addiction also has the highest suicide rate among addictions, so definitely serious.
The Atlantic had an article recently arguing that allowing sport gambling in the USA was a mistake, imposing huge costs on the most vulnerable.
It’s also popular in other forms these days. Wallstreetbets options gambling, most of crypto, the way many people are “trading” these is purely gambling with some bro-astrology.
When I was a poor teenager I was gambling online and it is an incredible way to lose money unlike anything. With the click of a button you can throw $100 or $1000 into the void- and you often follow it up until your account is empty. Hard to do with many other substances.
It’s the same thing. Obviously withdrawals and such are different but the core mechanism of disregulated reward processing leading to compulsive behavior engagement is exactly the same.
Have alcoholics using Naltrexone? Or opioid addicts using Methadone, or smokers using nicotine gum/patches?
See I'm bringing this up to point out the obvious double standard, people suffering from food addiction (i.e. literally the high from food) or binge-eating disorder, who finally have an effective treatment, are treated like it isn't addiction or illness, but a "lifestyle," but if you said this stuff about any other addiction people would call you out and be horrified.
For people mildy overweight or accidentally obese, it is a wildly different illness for people with lifetime problems who have lost/regained weight tens of times and likely know more about nutrition than most healthy-weight people ever will.