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Comment by robotburrito | Hacker News Reader

It would be interesting if some insurance companies ended up offering you a "healthy life" service where they give you time w/ a nutritionist/therapist or even provide healthy foods. Maybe this would be cheaper for them and would stop you from having to take these pills to begin with.

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This doesn’t work (statistically, for a population—yes, yes, I know it worked for whoever read that and was about to post their own success anecdote, but that’s not relevant).

The drugs do.

Given what happens to healthy-weight immigrants who move here, it sure looks like our viable policy options are “substantial retool our whole society” or “drugs”. The former has approximately no momentum behind it.

Unfortunately, it's not clear that we know what to retool in society even if the will were present. Everyone has their favorite "obvious" cause of Americans getting fat, but few of those hypotheses actually make any sense of the data (in particular the years that most of the increase occurred, the breadth of regions and demographics affected, and the sudden onset compared to the timescales of potentially related trends). The rest usually fail to replicate at different scales and locations that should show a correlation.

Absolutely, it’s not like that’s even a straightforward thing to try to address. Is it food prices? Food regulations? Our food culture? Advertising? City design and zoning?

Smart money’s on the answer being “yes—plus some other stuff”. Where do you even start?

>City design and zoning

More than any one factor, this is one of the biggest, if not thee biggest one. Get people out of cares and walking around to do daily things like going to work, or shopping for groceries etc. and you naturally get more movement (and interaction) in your day. This compounds over time and encourages other movement.

Of course food matters (you can't exercise away a bad diet after all) but we actively encourage stationary activities by not having public spaces that are designed for movement and activity on foot / bicycle / other physically active options

I’d bet our relatively weak social safety net and poor family support, plus low amounts of time off (especially for low-wage workers who will tend to have lots of other sources of stress and demands on their time, too) are also major contributors.

Probably a few of these things wouldn’t have such a bad outcome, but we’ve likely got a lot of problems all contributing to something much worse than the simple sum of their individual harms.

When I was with Kaiser (admittedly a ~decade ago), they offered all sorts of classes and services around this. They were VERY proactive about preventative stuff and reminding you what was available.

Edit: looks like they still have a great program, including mental health, obesity and weight loss counseling, and a variety of other great services! https://healthy.kaiserpermanente.org/southern-california/lea...

In the article:

>North Carolina initially wanted to save money by limiting prescriptions to patients who first tried lifestyle management programs to lose weight

This is exactly the kind of diversion program that the manufacturers are holding over the head of insurers. Manufacturers are basically saying "allow everyone to get it or else we take away your discounts."

In terms of long-term weight loss, the success rates are abysmal for keeping the weight off.

https://www.scientificamerican.com/article/unexpected-clues-...

That doesn't seem that different from the drugs. People lose the weight, and then half of them go on to gain some back.

Through my insurance company (Blue Cross and Blue Shield) I have access to a program they call "ConditionCare" at no extra cost. It's customized support and care plans for asthma, diabetes, COPD, heart disease, and high blood pressure. it includes: - Support from a variety of health experts, including nurses, pharmacists, exercise physiologists and dietitians - Health screenings at no extra cost - Access to educational guides, newsletters and tools - Answers to your health questions, 24/7

Outside of ConditionCare,, they also have monthly webinars (sleeping better, starting a walking program. etc)

Most offer these services, and encourage people to do them, but people hate them.

People, in general, want a shot or pill to make their problem go away. Short of a shot or pill for motivation and self care, commercial solutions will be preferred.

I don't know if people necessarily want a pill. It’s just they feel they have exhausted the other options and are willing to try a new approach.

Every overweight person I know at one point or another has dieted. And lost significant weight.

This is what Google Gemini reports. Seems to line up with my life experience.

"According to a 2022 survey, 44% of Americans are on a diet, and 80% have been on one in the past. "

The difficulty is always in maintaining the long term.

5 years. 10 years. Till you die.

If my insurance company subsidized my gym membership I'd absolutely use it. But here I am, on an expensive insurance plan, which did not cover my physiotherapy sessions after I had an injury while running and trying to stay healthy.

What you are describing would be ineffective and also more than $1k/mo, the list price of Ozempic.

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