[44520297]

Why is obesity the only disease that taking medicine for is “cheating”? Which is more important: instilling your particular version of “discipline” into people, or saving billions in healthcare costs and millions of lives from suffering?

[bryant]

People grew up making fun of others for being overweight. Suddenly a medication making it treatable (and possibly providing an explanation for why the prevalence of obesity skyrockets in developed countries) validates the idea that it's a medical condition.

Relatedly: it validates that people are assholes for making fun of others who are overweight. And not many people like feeling like an asshole.

Edit: starlevel004 is right.

[Starlevel004]

Correction: Lots of people like feeling like an asshole. They don't like being called out for it or being wrong.

[Sparkle-san]

Cheat code was probably not the best term for it, I'll admit. I don't fault anyone for chosing to try GLP-1s and the cause of obeseity isn't particularly on the individual given the prevailance of ultra processed foods and car transportation in our society. That all being said, regaining most, if not all, the weight has been a historical issue around weight loss treatments because they're not durable. The way we're proceeding with GLP-1s feels short-sighted and potentially unethical if we're setting people up for rebound failure to line the pockets of big pharma.

[44520297]

Would you say the same about blood pressure medications, diabetes medications, cholesterol medications, thyroid hormone replacement, antidepressants, mood stabilizers, antipsychotics, anti-anxiety medications, immunosuppressants, DMARDs, corticosteroids, anticonvulsants, Parkinson’s medications, multiple sclerosis treatments, blood thinners, and heart failure medications? All of them set people up for rebound failure if they stop taking them for the chronic condition they started them for.

[Sparkle-san]

I wouldn't group those together at all for the sake the argument. Take antidepressants for example. We're at the point of reexamining if we actually understand the consequences of long term usage of them. My personal experience was that my long term usage definitely came with issues and it's taken me a few years to feel like my emotional range has returned to a stabe baseline after going off them. I likely would have been better off using them short term. Depressiom is also quite similar to obesity in the sense that helping people develop the durable non-medical interventions while being treated with drugs would go further than just treating them with drugs alone.

Contrast this with Parkinson's which is a neurodegenerative disease with no known non-pharmacutical treatments and even the pharmacutical ones lose effectiveness as it progresses as they only treat symptoms, not the disease itself.

[44520297]

> go further than just treating them with drugs alone

This is precisely what the FDA guidance contains: that GLP1s be mixed with lifestyle modifications.

[const_cast]

> That all being said, regaining most, if not all, the weight has been a historical issue around weight loss treatments because they're not durable.

Almost all diets are not durable or sustainable. This is not unique to weightloss drugs - most people who lose weight, regain it.

[Group_B]

It’s usually a self inflicted disease. Your own actions cause it most of the time

[const_cast]

Sure, but the bigger question is: does this matter?

If we think about it longer than, say, 5 seconds, we will realize no, it does not.

Your particular desire for punishment is not really relevant to anything. That's not how medicine operates, and that's a good thing. You're attempting to make a moral argument here. Moral arguments are usually stupid and worthless - try making a different argument.

[44520297]

Which other self-inflicted medical conditions do we deny medical care for?

[animal_spirits]

We prescribe alcoholics with medicine to help them curb their alcohol intake, but if they do not learn the discipline to not drink then they can end up back where they started after getting off the medicine. But I don't think either drugs for alcoholism or obesity should be denied to anyone. However there are other tools to supplement with to help learning discipline.

[44520297]

>However there are other tools to supplement with to help learning discipline.

The current FDA guidelines support your assertion that GLP1s should be prescribed in addition to other tools to help people change their eating habits.

What the FDA does not prescribe is moralism, which is what “help learning discipline” tends to imply. If you didn’t intend to frame your argument in terms of moralism, you might consider a different word choice.

[animal_spirits]

Not sure how else to word it. "help people change their habits" vs. discipline to change their habits - what's charged about the word 'discipline'?

[44520297]

In English, we “instill discipline” in children. When we talk to and about adults, we talk about the confluence of factors that influence habits and help people change them. Discipline implies that an adult, who is otherwise fully functioning and subject to the demands of the world, is lacking an essential attribute. Whatever you might feel about this explanation, we already observe from science and medicine that “instilling discipline” on its own has not stalled the obesity epidemic.

[Group_B]

Good point. The main root cause of obesity is too many calories. Usually, obesity and the symptoms / diseases that come with it improve / go away when eating less calories. Does any human technically need medication to eat less calories?

[44520297]

> Does any human technically need medication to eat less calories?

Chronically obese people, who are prescribed GLP1s to enable them to eat fewer calories. Are you interested in the reasons why people are unable to eat fewer calories without medication? It’s a pretty fascinating problem, one that intersects genetics, environment, and culture.

[mikhailt]

Yes. Gut microbes has already been shown to have a great impact on how we metabolize by what med we take, what we eat or drink and intake from our environments (micro-plastics, etc).

There is no single main root cause for obesity. We just combine it as one because there isn’t a lot of long term research or funding for it right now. There is a lot of sigma against obesity and people keep blaming other people instead.

Thyroid hormone disorders have been linked to cause weight gains. This can’t be fixed by simply eating less, it can literally do far more damage.

Medications have been linked to cause weight gain as side effects. This wouldn’t do anything to eat less until they stop taking meds and for some, they cannot do that.

Americans’ increasing desire for sweets have increased the sugar content in all of our food including the fruits and vegetables over time. We’ve intentionally bred our healthy stuff to be sweeter. So eating less can make us even more hungrier because we go into sugar crush without realizing it. Changing diets is difficult without us doing all sorts of calculations of finding the right cheap healthy food at the right store and that is you are lucky enough to have any.

[mikhailt]

This just pops up in my RSS today, which is an interesting read but not yet relevant to humans: https://newatlas.com/health-wellbeing/amino-acid-cysteine-re...

[kbelder]

It's not. I'd put most addictions in that category. And instilling discipline in people is a good thing that benefits them in myriad ways.

[44520297]

You are free to put addictions in whichever category you prefer. The medical community does not: we treat addiction with medication as well.