[VS1999]

I'm going to be skeptical of putting millions of on a new drug, permanently, to mask some underlying issue in society. Is there any evidence that people can be weaned off this after losing weight? Or is it expected to be permanent? This was not an issue in the past and whatever the root cause is, it's never going to be treated if we can just drug everyone into acting like they used to.

[idle_zealot]

Are you asking what the root cause of obesity is? It's eating too much and not exercising enough. It's not some mystery. Or is the question about why people behave in this self-destructive way? People on average are bad at impulse control. Snack companies take advantage. People feel varying levels of discomfort vs exhilaration when exercising. For some it ultimately feels nice, for some it is unpleasant. Of those for whom it is unpleasant only some have the forethought and leeway to establish and maintain a healthy lifestyle. Of those for whom it is pleasant some face time or schedueling contraints that make an active lifestyle difficult. If there's a root cause to be fixed its that the human body responds poorly to acting on its impulses in our current built environment. You can solve that by altering the environment, the body, or the impulses. Ozempic seems to work by altering the impulses.

[ericd]

I eat as much as I want and don’t exercise enough, why am I far from obese? I’m currently scarfing down tortilla chips and guacamole.

To me, that suggests that maybe that simplistic (and frequently repeated) mental model is inaccurate or insufficient in some way.

My working theory is that most Americans’ gut microbiome is massively screwed up due to some combination of genetic, dietary, and environmental factors, and it changes what they crave, and how their body reacts to the food they eat. But I’m very much a layman on this topic.

[idle_zealot]

Of course not 100% of people are obese. Individual susceptibility varies, and as you mention could well be influenced by how the environment or common diets impacts the body, and further by how those changes in the body impact the mind. That said, its not really surprising that a decent portion of the population crave food rich in starches, fat, refined sugar, and salt. On an evolutionary timescale these nutrients have been scarse, so desiring them was advantageous. At the same time, problems from overconsumption were likely vanishingly rare, so there was no pressure to develope countermeasures like decreases appetite in responce to long-term abundance. In many ways our bodies and minds are not adapted for modern life, and this is a distinct problem from our inadvertent mass-poisoning ourselves.

[nradov]

Stating that you eat as much as you want is meaningless. How many kcal/day is that exactly? Most people are terrible at estimating their calorie intake.

[ericd]

No idea, don’t care to know. I drink a huge amount of whole milk, eat lots of cheese, dark chocolate, etc, etc, so I’m sure it’s not a small number of calories. The point was that I’m eating as much as I want, and not restraining myself at all, so it’s not a matter of willpower or anything like that. I don’t have to fight cravings to stay thin, and I’m not a spring chicken with a super fast metabolism, so there’s clearly some other difference.

People putting it down to eating less are parroting the food equivalent of abstinence-based sex education, and we’ve been drumming on that for like the last 30 years. We have to find what’s making people want to eat to excess, not just tell people to eat less and exercise more. That obviously doesn’t work.

[nradov]

I'm putting it down to eating less. Regardless of what you think you're eating the reality is that your metabolism and digestion (gut microbiome or whatever) is nothing special. If you actually measure and weigh everything you consume, you'll find the total calories are in the normal range for someone your size.

If you think that there's something else going on, then let's see some hard data.

[DoingSomeThings]

CICO is the mechanical answer. The question OP is getting at is "why" they naturally eat less. The poster is saying "I eat until I'm full and don't gain weight". For other people, they eat until they're full and gain weight.

Personally, my "satiated" level is very low. When trying to gain weight while weightlifting, it was difficult to eat the amount of calories needed. I know others who can easily eat twice as much as me in a sitting and not feel full. Something different in happening in our bodies to signal "stop".

[seabird]

People want to eat to excess because they're psychologically/emotionally rewarded for doing so, because eating whatever and whenever you could was pretty fucking important for tens of thousands of years before we had infinite McDonald's and microwave dinners.

Eating less and exercising more does work. Talk to dedicated lifters about their cutting/bulking, where they want to be, and talk to them about it again in six months if you want to see how effective it is. It doesn't work for a lot of people because in the short, medium, and arguably even long term, it doesn't make you feel good.

There are a handful of people that can struggle to gain or lose weight on a diet appropriate for the amount of exercise they do. You may be one of them. If you are one of those people, asking why other people struggle with it is like being a 6'6" basketball player and wondering why somebody who is 5'9" struggles to dunk like you can.

[ericd]

Yep, of course you lose weight if you starve yourself. But why do so many people seem to have a natural eating “setpoint” that fattens them, and others don’t? My guess is that it’s largely the types of foods they’re eating. Not fatty ones, which have been vilified (like I said, my food mix includes a lot of whole milk, cheese, and other very fatty food), but ones that mess with their digestion and satiety signals. For example, if you drink sweet drinks, they make you hungrier. I’m pretty sure if I eat more McDonald’s and microwave dinners rather than the simple foods I generally eat, I’ll fatten right up, and I’ll join in the ranks of those that crave more food than needed.

[ilikecakeandpie]

> It's eating too much and not exercising enough.

At the very base this is mostly true but it's like saying the reason people die is because they stop living. Framing it as people behaving "in this self-destructive way" also isn't helpful because being obese isn't a moral failing.

The true answer is more complex. At least in the US, consumers have been fighting deceptive marketing/branding for things that have been claimed to be healthy choices but are full of sugar and unrealistic serving sizes. Combine that with unhealthy foods generally being cheaper and/or easier to cook and now more accessible/easier healthy eating also has class issues. Exercise does too as most of the places where obesity is most concentrated in the US (the Southeast) doesn't have walkable cities or sidewalks at all.

This has been a common comment left on HN of "it's just move more, eat less" and yeah, at a fundamental level, sure, but really doesn't take into account how difficult it can be for a person that's in that situation.

[Guid_NewGuid]

But (inserting my own narrative), isn't the point that some deeper societal problem is being masked by this?

> Snack companies take advantage.

I'm uncomfortable with these new drugs but they seem to be a net positive so this is a good thing. But we should also look into legislating junk food companies that hijack people's appetite for a quick buck.

Chile banned sugary food TV advertising to children and saw a roughly 10% drop in purchases high in sugar. An unleashed free market in food has been shown to be harmful and the drugs alone are insufficient. Regulation is necessary.

https://healthpolicy-watch.news/chiles-comprehensive-food-po...

[Almondsetat]

>You can solve that by altering the environment, the body, or the impulses.

Incorrect.

You patch that by altering the environment OR the body OR or the impulses.

To fix that you need to alter all 3

[JumpCrisscross]

> To fix that you need to alter all 3

We have tons of evidence to the contrary in multiple disciplines. Like, have you never made a conscious dietary change?

[Almondsetat]

Most dietary changes fail, I don't think that's a good example actually.

In any case, yes I have, but the only time it has worked was when I changed my environment (stopped slouching at home bored with a full pantry) and my impulses (filled my days with activities so that boredom hunger wouldn't strike). Only changing one would make me last a couple of weeks max

[JumpCrisscross]

> Only changing one would make me last a couple of weeks max

Different people struggle with different impulses. I don’t have much trouble permanently modifying my diet. I struggle, on the other hand, with keeping a normal sleep schedule.

[VS1999]

"Impulses" here means the mind. Medication with side effects also effect the body. You're giving three options of altering the mind, body, or environment. On principle I'm against altering the mind and body of millions of people because their environment is shitty. This also doesn't buy anyone any time, it just makes it the new "baseline" normal as companies and society adapt around it like these snack companies you're saying take advantage of people.

[idle_zealot]

Assuming the change really is just limited to being less suseptible to cravings for unhealthy foods, I don't see an issue. That's a big "if" thought. And yeah, fixing the environment in this case would just be a matter of the FDA or regional equivalent resticting the sale and advertising of unhealthy foods, which personally I view the same as anti-smoking laws and would be all for, but the current regulatory climate makes that seem extremely unlikely.

[maxerickson]

Your principle as stated doesn't apply to a situation where individuals have the agency, which I think is a fair assessment of a drug that they choose to take. They are examining their environment and making a choice, not having their mind and body altered by some exterior force.

Which isn't to say that the overall idea of trying to find other ways to make obesity less common is bad, it just isn't a coherent argument for that.

[jstummbillig]

You fix the immediate problems where you can. You buy time. You find better solutions down the line. When a person is dead, you can't find a better solution.

It's "masking" the issue as much as chemotherapy is "masking" the issue. People are dying. We have tried appeals to salads and quick walks.

Unless you got anything up your sleeve, I recommend we stick to the ol' "keep more people alive with the best stuff we currently got" plan, until information pops up, that makes this look like the morally worse option.

But in that regard preventing death is fairly hard to beat as a baseline.

[squigz]

> We have tried appeals to salads and quick walks.

This bit made me laugh, as if public health initiatives have been taken remotely seriously by the past few decades. It seems quite a jump to go from "maybe try a a salad?" to putting millions of people on medication.

Did that happen with tobacco? Alcohol?

[jstummbillig]

> It seems quite a jump to go from "maybe try a a salad?" to putting millions of people on medication.

It's a hyperbole, meaning to say: The problem is so frustratingly silly and solution is so obvious and simple — just eat a little less, move a little more — that I understand how hard it is to accept that it might just be the completely wrong approach.

What makes it fairly obvious to me is that despite clear and long standing conflicting beauty ideals, the massive societal advantages beauty affords, and an industry build around weight loss (not even drugs, stuff like Weight Watchers), people still struggle.

If you have good insight into why informing about tobacco worked to the degree it did (although lung cancer is still the leading cause of cancer death) other than claiming vague un-seriousness, I am all ears. Otherwise I have a hard time understanding this as an information problem.

[squigz]

> If you have good insight into why informing about tobacco worked to the degree it did

My point here was that we seemed to approach tobacco/alcohol a bit more methodically - taxes (i.e., increasing costs for cigarettes), regulations (i.e., where alcohol can be sold), education (i.e., scary cigarette packaging) - whereas we seem to be saying, "Well, we did very little and got no results, so let's go nuclear!" when it comes to obesity

It seems to me that, if obesity is so harmful to society, places like McDonalds and other (provably) unhealthy food shouldn't be as cheap or as easy to get as it is.

> The problem is so frustratingly silly and solution is so obvious and simple — just eat a little less, move a little more — that I understand how hard it is to accept that it might just be the completely wrong approach.

It certainly is frustrating, and I feel that more than I probably should. Probably something to reflect on.

[pseudalopex]

Millions of people have used medication to quit tobacco and alcohol.

[objektif]

I agree with you that this does not address the underlying issue. But root cause you speak of may not really be that simple to fix. Is the root cause people spend much more time in their offices working and hence are more inactive? Is it the crappy American diet?

For example, many people around me gained weight after they became parents. Especially women after birth. It is just insanely difficult to work hard in an office job, take care of young kids and exercise etc all at the same time. As you age things get very difficult as well. I eat significantly less than what I used to just few years ago but still have 5-10lbs extra.