>> For the morbidly obese, exercise carries risk too — to joints and the heart, for instance.
All exercise? Like simply walking 1/2 to 3 miles per day at a leisurely pace? Being morbidly obese carries way more risk, and no amount of meds will help someone who can't bring themselves to even walk somewhere.
I know one person who was morbidly obese, had the surgery to limit their capacity to eat, and yes, they look better in clothes, but they are on a ton of meds, and they refuse to walk more. I was in Mekkah and they took the electric cart instead of walking during umrah.
Anyone I know who is on mental and/or diet pills are not doing well even after years of following this advice. I don't see the long-term benefits. Hell, I just read an add for some heart supplements on Amazon where people say, "I've been taking it for a week, and I don't feel anything yet." The instant gratification of social media and modern conveniences have softened everyone from taking some self responsibility and applying some self discipline. We can't save everyone who is self destructing. Big Pharma is sure making out like a bandit. Last I had cable TV over 10 years ago, all it had were ads for pills with the cliche afterword on the side effects in lower volume and spoken much more quickly. Isn't it obvious?
Many kinds of medicines mitigate not cure. And most people I know do not much discuss medical treatment when it is going well. Especially around people inclined to sanctimonious lectures.
Would any doctor actually tell a morbidly obese person not to exercise, because it would be too risky for their heart?
Maybe in the 1900's, but in modern times?
And the reality is that simply taking in fewer calories will often cause your body to burn fewer calories because your body is meant to conserve energy for the times when it is needed to run away from the bigger predators.
Discipline is easier when you aren't hungry it turns out.
The food labels on your food packages are determined by calorimetry. But your body digests some food more readily than other foods, also affected by what else you eat with it, how you prepare it, etc. Also your body encourages you to eat certain things to get various nutrients: you rarely eat those nutrients alone; typically they come along with a bunch of other stuff. Then peoples' feedback systems are heavily influenced by all sorts of things: signals from your gut biome, your emotions and response to social signals and learning, various kinds of signalling reflecting what you eat (and those signals are empirically hacked by food engineers), and random brain bugs, among others.
Exercise is hardly scientifically measurable either. It's not like that "calories burned" reading on your bike, is comparable to a bike from a different manufacturer, much less a different kind of exercise.