I would say my concerns are far more in the range of downstream effects from the medication. Specifically, I am concerned with muscle retention. Concerns aside, it's a little hard of an argument to swallow having visited many other countries where these things are simply not an issue. How can it be argued that the cause is anything other than behavior when so many others are doing just fine? There is more to this story than painting people as evil.
This is the essence of the moral argument: Someone chooses to abuse a substance, they become a more frequent abuser, and the abuse piles up damage, which the person ignores to continue abusing.
The essence of the argument against drug interventions is that the root cause is personal choice, and therefore a drug is a shortcut or crutch and does not address the root cause.
Many people feel that the real cause is the structural changes to the person's brain, body, and daily routine that reinforce, and are reinforced by the initial tiny over-consumption, which compounds over time. It's like a debt where you are stuck paying interest, no matter how much you'd like to pay off the debt. Addiction is a system in which the person's willpower goes against everything they have set up over decades. It's unreasonably challenging for nearly everyone to walk it all back. Insulin resistance is one of the most pernicious effects of even small over-eating over time. The body and mind do not feel satiated even though enough calories have been consumed. It's not "I would enjoy another slice of pizza", it can be "I am still starving".
And yes, the environment in which we live, where it is less stigmatized to overeat, and food is treated a certain way, more like a drug than fuel, is part of that system.
> How can it be argued that the cause is anything other than behavior when so many others are doing just fine?
Aren’t you are ignoring the way western society influences behavior? eg lack of walkability of suburbs, massive price difference between fresh and processed foods, constant advertising of junk food & alcohol.
No, I think force feeding junk food is pretty rare but that seems like a straw man.
Consider children. Their brains are not fully developed and they have little agency in determining the food they have access to. Childhood obesity is on the rise. So blame the children’s choices?
Ok, sure, blame the parents. I agree of course it is the parents responsibility, but the cards are often stacked against parents by big corporations with government subsidies (in the us).
It’s really weird to me to argue that this is completely a problem at the individual level and not a social one—and I see no other way to interpret your comment.
The point is that the isn't some mysterious force we cannot comprehend. If the odds are stacked against us, change the odds instead of medicating everyone.
At the same time, we are all still individuals. We agency to make life decisions. I generally don't subscribe to the notion that people are helpless even in the face of a big scary corporation. There are two competing ideas. Either 1 there is some unknown force creating this problem(but doesn't extended to the entire human population for some reason) or 2 we know there are environmental causes. For #2, why systemically stack a drug on top if we know what the boogy man is? #1 we need to seriously buckle down on research on what the environmental/behavior factor is so we can bring everyone back to human baseline. Using drugs for people already in great suffering is one thing, but that is very different from widespread distribution as a preventative.
I think you lost the thread (literally the context of threads I was responding to), because much of what you’re saying aligns with my point. OP was mocking the idea that environmental factors should be taken into account and advocating a no-excuses policy of individual responsibility.
If you think I am advocating medication or implying that “people” are helpless against corporations, read again. I agree with most of what you say although I am not sure we need more research (although of course I don’t discourage it). Maybe one day we’ll prove that the government subsidizing corn so that big corporations (spun off from former tobacco companies as another comment pointed out) can super cheaply mass produce syrup which our evolutionary biology finds difficult to resist and market directly to children turns out to be bad for health outcomes and good for profits (for the medical industrial complex as well). Oh wait, we already know that.
> Consider children. Their brains are not fully developed and they have little agency in determining the food they have access to. Childhood obesity is on the rise. So blame the children’s choices?
Been there. It’s always bad parenting. I had to fix shitton of issues myself, because of idiot parents.
No, but social conditioning normalises it and those in the lower socioeconomic areas of living buy the cheapest rather than most nutritional food and are way less likely to read informative articles or posts about healthy eating. It really is heavily influenced by a lack of supply of healthy affordable food.
Are we? Because most people have this conversation and talk about people they think are able and unwilling, when in reality the vast majority are willing and unable, for one reason or another.
Not sure why you are downvoted. I had the same question about who’s behavior we are referring to. Attributing obesity simply to individual behavior and choices is pretty myopic. Just look at government subsidies for corn. There are larger forces than the individual at play. This is a social problem.
It can be quite eye-opening to travel from say, the UK to Hungary. Walk down a busy street in London and you'll see many overweight people. Walk down a similar street in Budapest, and you'll see very few.
The numbers don't seem to bear out your impression, Hungary has higher rates overall than the UK. Perhaps there is more social mixing in the neighborhoods you visit in London vs Budapest.
It seems the article is now behind a paywall (can only get a reddit link w/ a screenshot atm [0]) but there was a study that showed body composition after 25% weight loss in terms of fat mass and fat-free mass (and the portion of fat-free mass that was skeletal muscle mass) after traditional several interventions, and also compared the breakdown of weight lost in terms of FM and FFM for several GLP-1 medications:
- diet alone
- diet + extra protein
- diet + exercise
- retatrutide
- tirzepatide
- semaglutide
tldr is that, despite some muscle loss, muscle as a percentage of body composition is higher (~50% FFM at start, whereas weight lost with GLP-1 meds ranged from 25%-39% of muscle). It also seems like the muscles will likely function better with less insulin resistance:
> Intentional weight loss causes a greater relative decrease in body fat than FFM or SMM, so the ratio of FFM/SMM to fat mass increases. Accordingly, physical function and mobility improve after weight loss despite the decrease in FFM/SMM, even in older adults with decreased FFM and SMM at baseline. In addition, weight loss improves the “quality” of remaining muscle by decreasing intramyocellular and intermuscular triglycerides and increasing muscle insulin sensitivity
How will the person have less insulin resistance when GLP-1 medications stimulate the release of insulin?
It seems to me we're curbing eating by flooding with insulin, when one of the big damaging effects of overeating is insulin floods. (Or perhaps I'm misreading, perhaps insulin floods are only bad b/c they cause insulin resistance which causes more overeating?)
You aren’t being flooded with insulin with the GLP-1 meds. You have food in your body, but my insulin levels, on average, are possibly lower than yours (if I’m in need or a GLP-1 med) despite eating the same amount.
A GLP-1 med stimulates the release of insulin slowly over a sustained period of time, not just as a massive spike when I eat.
Everyone (that isn’t diabetic) has a massive insulin spike when they eat something that spikes their glucose. GLP-1 meds don’t make that better in any way.
I don't understand the hostility. I am attempting to discuss the topic on a discussion site. My point is not too instruct any one person on what the exact correct solution is. However, I find the selective vision with this topic to be dishonest and ultimately damaging to the conversation(and progress by extension). One can still come to the conclusion that drugs tip the balance positivity enough to use them without sweeping other realities under the rug.
Some, but sarcopenia caused by rapid weight loss is a well known phenomenon. I think the tie to ozempic is a little overblown, but is is a real issue.
In a “traditional” weight loss strategy, you paired calorie deficit with an increase in physical activity (cardio, resistance training, etc). This increased physical activity helped protect you from muscle loss (your body tended to recognize that muscle was important so it burned fat at a higher rate)
With ozempic, people can lose weight without changing their sedentary lifestyle. Since your muscles are not needed, your body is free to grab energy from wherever it can. In some studies, almost half of weight loss can come from lean tissue.
Is it better to for an obese person to lose weight vs not lose weight? Absolutely. But it would be even better if they also changed their lifestyle to protect their muscle mass.
I'm curious how is lean mass measured and why do we think what we measure is actually lean.
I'm not denying that under some circumstances like in the case of severely obese patients their bodies might think protein is better energy source than fat but in people with normally functioning bodies it shouldn't happen a lot especially if they get enough protein in their weight loss diet.
