I am really sympathetic to this way of thinking, but it assumes that your issue and the weight problems of the severely obese are the same thing.
After years of working with them, and particularly on this new class of drugs, I'm convinced that they are not.
The intensity of the neurological drive to eat is not the same from one individual to the next. When the severely obese take these medicines, the overwhelming description they give is "I feel normal now." That is, they can still have indiscretions like all of us, but they finally feel as if "I control it with more walking and less eating" works for them on this drug. It's not as though they have no other "effort," or something like that.
These tools are like any other -- high use for some things, low use for others, and mis-use in other cases.
But "traditional exercise and diet" recommendations -- even with intense follow up, counseling, and support -- generally only get about 5% of people to lose medically-significant weight and maintain it.
But then why is this a UNIQUELY USA problem? The VAST majority of Koreans are not fat. Japanese, Singaporeans, and Taiwanese are not fat. Europeans tend to be much skinnier than Americans. So it's not a medical issue, it's a cultural issue. You can argue that they are the same, but you can't "catch fatness" but you can be influenced by culture. That's the point I was making. It's the lack of education that leads to lack of discipline. I had to LAUGH when the Whitehouse rep on 60 min said that "when you see overweight parents, the kids tend to be overweight...so it's genetics" I believe she was a medical doctor. I was aghast. I think any sane person would conclude that parents who eat poorly (health-wise) will lead to children who would do the same. That's the Occam's Razor but of course she pivoted to "it's not your fault, it's your genetics"
Do some people benefit from biome/DNA/something that helps them to be skinnier? Of course. I have a brother who can eat anything and not get fat. It's much harder for me. But I also know that every slice of pizza that I stuff into my mouth is the problem. Not my genetics.
Everyone who doesn't have a true metabolic issue will lose weight if we send them through Ranger School in the Army. Hell even Army basic would be sufficient. So clearly, it's not a medical issue. It's the inability to self regulate. But I'm sure the drug will be a hit given that so many people want to identify as a victim in one way or another.
PS: The average weight loss at Ranger School is 20-30 lbs (it's a 2 month long course). Why? Because it's incredibly physical and rigorous and you don't get to eat much.
I share your frustration. The wake up call for me is looking at the increasing obesity rates over time in one country (e.g., Australia). So in the 1970s everyone became lazy and lost willpower? No. Most people were always lazy and with low willpower. But their environment didn't permit this so they were not obese. People who are normal weight today are the exception. Why aren't their habits being studied more? It's not genetics as they haven't changed since 1970. But I think you're right that the culture of acceptance has exacerbated the problem. In other cultures there is less acceptance of excesses of eating and drinking. Social approval drivers are powerful. I'm not convinced that pretending obesity isn't a problem and that obese people are helpless to change is any more beneficial than it would be for alcoholism. It is an input/output issue. But the reasons people pursue unhealthy behaviours (over eating, inactivity, smoking, drug taking, drinking, sun beds) are complex. It's more likely to be something behavioural science can solve in conjunction with price signals.
I think there's something to be said about larger portions becoming a thing and more people living a sedentary sub-urban life. When you CELEBRATE morbid obesity as a "normal" thing, we've lost the battle. As Bill Maher once said "have you ever seen a fat 90 year old?"
I am really sympathetic to this way of thinking, but it assumes that your issue and the weight problems of the severely obese are the same thing.
After years of working with them, and particularly on this new class of drugs, I'm convinced that they are not.
The intensity of the neurological drive to eat is not the same from one individual to the next. When the severely obese take these medicines, the overwhelming description they give is "I feel normal now." That is, they can still have indiscretions like all of us, but they finally feel as if "I control it with more walking and less eating" works for them on this drug. It's not as though they have no other "effort," or something like that.
These tools are like any other -- high use for some things, low use for others, and mis-use in other cases.
But "traditional exercise and diet" recommendations -- even with intense follow up, counseling, and support -- generally only get about 5% of people to lose medically-significant weight and maintain it.
But then why is this a UNIQUELY USA problem? The VAST majority of Koreans are not fat. Japanese, Singaporeans, and Taiwanese are not fat. Europeans tend to be much skinnier than Americans. So it's not a medical issue, it's a cultural issue. You can argue that they are the same, but you can't "catch fatness" but you can be influenced by culture. That's the point I was making. It's the lack of education that leads to lack of discipline. I had to LAUGH when the Whitehouse rep on 60 min said that "when you see overweight parents, the kids tend to be overweight...so it's genetics" I believe she was a medical doctor. I was aghast. I think any sane person would conclude that parents who eat poorly (health-wise) will lead to children who would do the same. That's the Occam's Razor but of course she pivoted to "it's not your fault, it's your genetics"
Do some people benefit from biome/DNA/something that helps them to be skinnier? Of course. I have a brother who can eat anything and not get fat. It's much harder for me. But I also know that every slice of pizza that I stuff into my mouth is the problem. Not my genetics.
Everyone who doesn't have a true metabolic issue will lose weight if we send them through Ranger School in the Army. Hell even Army basic would be sufficient. So clearly, it's not a medical issue. It's the inability to self regulate. But I'm sure the drug will be a hit given that so many people want to identify as a victim in one way or another.
PS: The average weight loss at Ranger School is 20-30 lbs (it's a 2 month long course). Why? Because it's incredibly physical and rigorous and you don't get to eat much.
I share your frustration. The wake up call for me is looking at the increasing obesity rates over time in one country (e.g., Australia). So in the 1970s everyone became lazy and lost willpower? No. Most people were always lazy and with low willpower. But their environment didn't permit this so they were not obese. People who are normal weight today are the exception. Why aren't their habits being studied more? It's not genetics as they haven't changed since 1970. But I think you're right that the culture of acceptance has exacerbated the problem. In other cultures there is less acceptance of excesses of eating and drinking. Social approval drivers are powerful. I'm not convinced that pretending obesity isn't a problem and that obese people are helpless to change is any more beneficial than it would be for alcoholism. It is an input/output issue. But the reasons people pursue unhealthy behaviours (over eating, inactivity, smoking, drug taking, drinking, sun beds) are complex. It's more likely to be something behavioural science can solve in conjunction with price signals.
I think there's something to be said about larger portions becoming a thing and more people living a sedentary sub-urban life. When you CELEBRATE morbid obesity as a "normal" thing, we've lost the battle. As Bill Maher once said "have you ever seen a fat 90 year old?"