if you want to talk about an evidence-based response to the "obesity epidemic" please invite Ragen Chastain of weightandhealthcare.substack.com to a video conversation with the sensible med crew. Allow her to shed some light on this blind spot. :)
I practiced a form of alternative medicine for many years. I was a licensed acupuncturist with a focus on herbal medicine and nutrition. My experience is that lifestyle medicine does work quite well for all who are able and willing to fully commit to it. However, less than 10% of my patients were both willing and able. In my own case, I was always willing but generally unable until I retired due to the difficulty of adhering to the principles while working 60 hours a week and managing the stress associated with the job.
From my perspective, lifestyle medicine needs to be extremely strict. You need to eliminate all refined sugar and carbohydrates from your diet. No cheap days. Zero alcohol at any time. No regular recreational use of mind altering substances including cannabis. All organic foods prepared at home. At least 50 g of fiber per day. Walk at least 2.5 to 3 miles per day on hilly roads or trails. Do at least 20 minutes of resistance training about four times per week. Meditate every day for at least 30 minutes. Actively practice mindfulness during all stressful encounters. And that's just off the top of my head.
I think you see where I'm going with this. If you're working long hours and raising a family in the modern world, how is this possible unless you have significant financial means? You would need somebody to do your shopping for you as well as your food preparation. You would need a personal trainer to come to your home. You would need a nanny for at least part of every day. The only way a significant percentage of the population would be able to commit to such a lifestyle as if the nature of life overall changed dramatically. And then there's the willingness factor. How many people would actually be willing to live this way?
I think if life changed in a way that gave people the time and wherewithal to commit to a rigorously healthy lifestyle, many might find that they got more pleasure out of the simple things than their former lifestyles. But would most find the appeal? I don't think so.
I think a better question is what's right for children and what's right for adults. There's a strong push to get all overweight children on Ozempic and similar drugs in order to prevent obesity with no consideration of the long-term downside. Children can be quite malleable and responsive to lifestyle interventions. As for obese adults, they are definitely too far gone. I'm with Musk when it comes to them.
Maybe this is off topic, but from a brief review of literature all information on hunger is related to the USDA Food Security index, which is a self reported. In a paper that purported to evaluate the use of the "Index" There is not a single paragraph I could find that indicates otherwise. The reports are taken as gospel by all media outlets. Objections to the measure due to no clear meaning of the index were barely mentioned and dismissed. More hunger serves the purposes of the USDA and big agriculture. There is a proposal at the end of the paper for randomized studies of the efectiveness of programs to relieve food insecurity, but the assumed measure of the outcome is changes in the "USDA Food Security and Hunger Measure!"
The Uses and Purposes of the USDA Food Security and Hunger Measure:
"A Report for the Committee on National Statistics Panel on Food Security Measurement"
By: Parke Wilde
Friedman School of Nutrition Science and Policy, Tufts University
Isn't it surprising that we have an enormous problem with obesity, but also hunger. I think that the data on hunger is lacking, or totally worthless. Probably it is obtained by phone interviews "are you hungry?" I suspect that the need for caloric support is highly unrelated to the answer to the question, "Are you Hungry?" Maybe there are some studies on Hunger that can be debunked!
We are not considering the total big picture!? With GLP1 we will all be free to eat as much as we want, consequently the food prices will increase as well as the environmental consequences of more fertilizer use, more cows emitting methane and etc..... Maybe, of even more concern, might/should be the effect of our overeating on the food supply of the rest of the world. I think the "real" solution to all our medical problems is to train many more psychiatrists in order to train us all to be happy with our lot in life instead of trying to change? I hope no one takes this 100% serious :), but only if you can take RFKj, or Elon 100%!
Lifestyle changes are great. But people also need help to make them and to lose weight now. We know that in our environment today, some people (lots!) won't be able to / don't want to make the lifestyle changes. Why shouldn't they have access to the GLP1 drugs? I'm sure we will find out there are some negatives to them besides costs, but in the meantime the "side effects" are mostly positive ones (less drinking, some evidence they prevent other problems, etc.) There is no need for either/or, we can work on both at the same time.
Some "not so positive side effects" of GLP-1 drugs:
Common Side Effects:
Gastrointestinal Issues (Most Common)
Nausea
Vomiting
Diarrhea
Constipation
Bloating
Abdominal pain
Decreased Appetite
Many users experience reduced hunger, which contributes to weight loss.
Fatigue
Some people report feeling more tired than usual.
Dizziness or Headaches
Can occur, especially when first starting the medication.
Injection Site Reactions (for injectable GLP-1s)
Redness, swelling, or pain at the injection site.
Serious Side Effects (Less Common but Important to Watch For):
Severe Gastrointestinal Issues
Persistent vomiting or diarrhea leading to dehydration.
Bowel obstruction (very rare but serious).
Pancreatitis
Symptoms: Severe abdominal pain that radiates to the back, nausea, vomiting.
This is a rare but potentially life-threatening condition.
Gallbladder Disease (Gallstones)
Some users develop gallstones or gallbladder inflammation.
Kidney Issues
Dehydration from vomiting/diarrhea can worsen kidney function.
Rare cases of kidney failure have been reported.
Thyroid Tumors (Black Box Warning for Some GLP-1 Drugs)
Certain GLP-1 drugs (e.g., semaglutide, liraglutide) carry a warning about a possible increased risk of medullary thyroid cancer in animal studies (not confirmed in humans).
Severe Allergic Reactions
Symptoms: Rash, swelling, difficulty breathing, anaphylaxis (rare but serious).
Changes in Mood or Mental Health
Some people report depression, anxiety, or suicidal thoughts.
While I am a Musk fanboy, I am in agreement with RFK on this one. As you clearly point out, the long-term effects of GLP-1 drugs are not clear at all. Has there been any drug that has had no meaningful side effects? Lifestyle changes are the key to good metabolic health
First mistake was reading NY Times and believing the headlines. But that wasn't the question you asked. We, as a nation ,have become an "easy idiot" nation. Don't be an idiot, take this pill or that...it's easy and it's practically free" I will NEVER trust medical complex for any health advice after the COVID debacle. Most doctors included. We are never going to solve our fat problem with pills. RFK is on the right path of fixing it at the source. That includes shaming people. The idea that body positivity movement morphed into "you're obese but you're healthy" is ridiculous. You can claim "you're obese but you're beautiful" if you'd like. That's a subjective. But obese==healthy is a nonsensical argument. Anyone who agrees is a virtue signaling idiot if you're a lay person. If a doctor clams that? They should be sued for malpractice.
As an obesity specialist, I feel this debate runs afoul of a false dilemma. It’s both/and, not either/or. The lifestyle modification is absolutely essential…the medications help very much in making the former more doable for more people (along with some physiological, neurohormonal benefits). In fact, I’ll go so far as to posit that the degree to which medication doesn’t help impact healthy living/eating, we will see a commensurate lack of sustained, improved health over time in those already suffering from obesity.
That said, we must do a better job at distinguishing between treatment and prevention. I like some of what RFKJr is saying, but he (and most everyone else) is conflating these two aspects of care. The “just changes your lifestyle” approach would be a boon to the long term health of our children. It will NOT alone be sufficient to treat those for whom the horse is already out of the barn.
While I am passionate about healthy unprocessed food and exercise, I have seen enough studies, and with my own eyes in the real world, to know that this is not going to be the solution to obesity and lifestyle diseases. While it is disappointing, I have become a pragmatist. Distribution of low cost anti-obesity medication to the population is going to be the most successful, and in the end economical, strategy.
We keep looking for easy answers and ignore the individual accountability. The vast majority of obesity is self-induced. Adding another exogenous chemical into the body might support the allopathic model of reducing disease but I'd argue it does little to enhance health.
if you want to talk about an evidence-based response to the "obesity epidemic" please invite Ragen Chastain of weightandhealthcare.substack.com to a video conversation with the sensible med crew. Allow her to shed some light on this blind spot. :)
I practiced a form of alternative medicine for many years. I was a licensed acupuncturist with a focus on herbal medicine and nutrition. My experience is that lifestyle medicine does work quite well for all who are able and willing to fully commit to it. However, less than 10% of my patients were both willing and able. In my own case, I was always willing but generally unable until I retired due to the difficulty of adhering to the principles while working 60 hours a week and managing the stress associated with the job.
From my perspective, lifestyle medicine needs to be extremely strict. You need to eliminate all refined sugar and carbohydrates from your diet. No cheap days. Zero alcohol at any time. No regular recreational use of mind altering substances including cannabis. All organic foods prepared at home. At least 50 g of fiber per day. Walk at least 2.5 to 3 miles per day on hilly roads or trails. Do at least 20 minutes of resistance training about four times per week. Meditate every day for at least 30 minutes. Actively practice mindfulness during all stressful encounters. And that's just off the top of my head.
I think you see where I'm going with this. If you're working long hours and raising a family in the modern world, how is this possible unless you have significant financial means? You would need somebody to do your shopping for you as well as your food preparation. You would need a personal trainer to come to your home. You would need a nanny for at least part of every day. The only way a significant percentage of the population would be able to commit to such a lifestyle as if the nature of life overall changed dramatically. And then there's the willingness factor. How many people would actually be willing to live this way?
I think if life changed in a way that gave people the time and wherewithal to commit to a rigorously healthy lifestyle, many might find that they got more pleasure out of the simple things than their former lifestyles. But would most find the appeal? I don't think so.
I think a better question is what's right for children and what's right for adults. There's a strong push to get all overweight children on Ozempic and similar drugs in order to prevent obesity with no consideration of the long-term downside. Children can be quite malleable and responsive to lifestyle interventions. As for obese adults, they are definitely too far gone. I'm with Musk when it comes to them.
Maybe this is off topic, but from a brief review of literature all information on hunger is related to the USDA Food Security index, which is a self reported. In a paper that purported to evaluate the use of the "Index" There is not a single paragraph I could find that indicates otherwise. The reports are taken as gospel by all media outlets. Objections to the measure due to no clear meaning of the index were barely mentioned and dismissed. More hunger serves the purposes of the USDA and big agriculture. There is a proposal at the end of the paper for randomized studies of the efectiveness of programs to relieve food insecurity, but the assumed measure of the outcome is changes in the "USDA Food Security and Hunger Measure!"
The Uses and Purposes of the USDA Food Security and Hunger Measure:
"A Report for the Committee on National Statistics Panel on Food Security Measurement"
By: Parke Wilde
Friedman School of Nutrition Science and Policy, Tufts University
parke.wilde@tufts.edu
September 29, 2004
Isn't it surprising that we have an enormous problem with obesity, but also hunger. I think that the data on hunger is lacking, or totally worthless. Probably it is obtained by phone interviews "are you hungry?" I suspect that the need for caloric support is highly unrelated to the answer to the question, "Are you Hungry?" Maybe there are some studies on Hunger that can be debunked!
We are not considering the total big picture!? With GLP1 we will all be free to eat as much as we want, consequently the food prices will increase as well as the environmental consequences of more fertilizer use, more cows emitting methane and etc..... Maybe, of even more concern, might/should be the effect of our overeating on the food supply of the rest of the world. I think the "real" solution to all our medical problems is to train many more psychiatrists in order to train us all to be happy with our lot in life instead of trying to change? I hope no one takes this 100% serious :), but only if you can take RFKj, or Elon 100%!
I don't think that's how Ozempic works. I thought it decreases the amount of food consumed.
💯!!!
Lifestyle changes are great. But people also need help to make them and to lose weight now. We know that in our environment today, some people (lots!) won't be able to / don't want to make the lifestyle changes. Why shouldn't they have access to the GLP1 drugs? I'm sure we will find out there are some negatives to them besides costs, but in the meantime the "side effects" are mostly positive ones (less drinking, some evidence they prevent other problems, etc.) There is no need for either/or, we can work on both at the same time.
Some "not so positive side effects" of GLP-1 drugs:
Common Side Effects:
Gastrointestinal Issues (Most Common)
Nausea
Vomiting
Diarrhea
Constipation
Bloating
Abdominal pain
Decreased Appetite
Many users experience reduced hunger, which contributes to weight loss.
Fatigue
Some people report feeling more tired than usual.
Dizziness or Headaches
Can occur, especially when first starting the medication.
Injection Site Reactions (for injectable GLP-1s)
Redness, swelling, or pain at the injection site.
Serious Side Effects (Less Common but Important to Watch For):
Severe Gastrointestinal Issues
Persistent vomiting or diarrhea leading to dehydration.
Bowel obstruction (very rare but serious).
Pancreatitis
Symptoms: Severe abdominal pain that radiates to the back, nausea, vomiting.
This is a rare but potentially life-threatening condition.
Gallbladder Disease (Gallstones)
Some users develop gallstones or gallbladder inflammation.
Kidney Issues
Dehydration from vomiting/diarrhea can worsen kidney function.
Rare cases of kidney failure have been reported.
Thyroid Tumors (Black Box Warning for Some GLP-1 Drugs)
Certain GLP-1 drugs (e.g., semaglutide, liraglutide) carry a warning about a possible increased risk of medullary thyroid cancer in animal studies (not confirmed in humans).
Severe Allergic Reactions
Symptoms: Rash, swelling, difficulty breathing, anaphylaxis (rare but serious).
Changes in Mood or Mental Health
Some people report depression, anxiety, or suicidal thoughts.
The FDA is investigating possible links.
While I am a Musk fanboy, I am in agreement with RFK on this one. As you clearly point out, the long-term effects of GLP-1 drugs are not clear at all. Has there been any drug that has had no meaningful side effects? Lifestyle changes are the key to good metabolic health
I guess this debat assumes that there are no side effects or long term negative health impacts from GPL1 drugs? Seems unlikely.......
First mistake was reading NY Times and believing the headlines. But that wasn't the question you asked. We, as a nation ,have become an "easy idiot" nation. Don't be an idiot, take this pill or that...it's easy and it's practically free" I will NEVER trust medical complex for any health advice after the COVID debacle. Most doctors included. We are never going to solve our fat problem with pills. RFK is on the right path of fixing it at the source. That includes shaming people. The idea that body positivity movement morphed into "you're obese but you're healthy" is ridiculous. You can claim "you're obese but you're beautiful" if you'd like. That's a subjective. But obese==healthy is a nonsensical argument. Anyone who agrees is a virtue signaling idiot if you're a lay person. If a doctor clams that? They should be sued for malpractice.
100%
Love the first sentence!
Get rid of the PBMs (and the BS they introduce) and get "best price" for this class of weight loss drugs...
As an obesity specialist, I feel this debate runs afoul of a false dilemma. It’s both/and, not either/or. The lifestyle modification is absolutely essential…the medications help very much in making the former more doable for more people (along with some physiological, neurohormonal benefits). In fact, I’ll go so far as to posit that the degree to which medication doesn’t help impact healthy living/eating, we will see a commensurate lack of sustained, improved health over time in those already suffering from obesity.
That said, we must do a better job at distinguishing between treatment and prevention. I like some of what RFKJr is saying, but he (and most everyone else) is conflating these two aspects of care. The “just changes your lifestyle” approach would be a boon to the long term health of our children. It will NOT alone be sufficient to treat those for whom the horse is already out of the barn.
While I am passionate about healthy unprocessed food and exercise, I have seen enough studies, and with my own eyes in the real world, to know that this is not going to be the solution to obesity and lifestyle diseases. While it is disappointing, I have become a pragmatist. Distribution of low cost anti-obesity medication to the population is going to be the most successful, and in the end economical, strategy.
Less fat (GLP) is good. Organismic health (lifestyle) is good. 'Nuf said!
We keep looking for easy answers and ignore the individual accountability. The vast majority of obesity is self-induced. Adding another exogenous chemical into the body might support the allopathic model of reducing disease but I'd argue it does little to enhance health.