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Comment by AmericanChopper | Hacker News Reader

Health care costs is how individual people’s terrible lifestyle decisions end up impacting everybody else. If somebody wants to live some awful unhealthy lifestyle it really should be their own choice to do so. Except for the fact that it drives up everybody’s insurance premiums, and in countries where the government either partially or entirely subsidises healthcare costs, it gives the government an outright moral mandate to start nannying everybody’s health choices.

If somebody wants to live an obese lifestyle, I really think that’s up to them. But I’d be much happier about it if it didn’t cost me so much money.

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Do you think addicts should receive treatment? Do you think that people who make bad decisions deserve to live? Do you extract the exact amount of value from society relative to the amount you put in, or do you take more than you give? Are you sure? Please explain.

Your perspective is frankly disgusting. I hope you don't have any vices. The point of a society is to pool resources together to improve the collective. Different people in different positions of power and ability have different needs. Hopefully you don't personally have any power to exclude people from that group. I hope that the powers that be don't decide that you deserve less for some reason.

I don’t think being addicted to laziness and having a glutinous appetite is exactly comparable to say, being addicted to heroin. But yes, I do think addicts should receive treatment, just as I think obese patients should (and do) receive treatment for all the diseases they end up with. But addicts, like the obese, impose many of the costs of their own bad life decisions onto others. It’s what you’d call a negative externality, and if some magic treatment came along to fix drug addiction, I would also be very happy to see that negative externality addressed.

> don’t think being addicted to laziness and having a glutinous appetite is exactly comparable to say, being addicted to heroin

Based on what? The reward pathways are remarkably similar. And unlike heroin, you can't go cold turkey on eating.

Well the food addiction or sedentariness addiction diagnosis are a lot more controversial than a heroin addiction diagnosis, though I can see how they have some things in common. I think labelling any observable manifestation of poor impulse control as a medical addiction is more of a social trend than a legitimate scientific discovery.

The bigger difference though is that we all eat food, and for most of us includes at least some absolutely delicious food that would be incredibly unhealthy to eat in large quantities. We’re all (more or less) exposed to the “addictive substance”, it’s just some people have the ability to deprive ourselves constantly indulging that impulse, while others don’t. We don’t however, need to take small doses of heroin every day to survive.

> labelling any observable manifestation of poor impulse control as a medical addiction is more of a social trend than a legitimate scientific discovery

What gives you the confidence to overrule medical professionals on this? (Note: I am not a doctor and have zero medical training.)

> We’re all (more or less) exposed to the “addictive substance”, it’s just some people have the ability to deprive ourselves constantly indulging that impulse, while others don’t

One, I’d challenge we’re all similarly exposed. I grew up in a house with no sugary sodas and plenty of leafy greens with each meal. Many people did not.

Two, we know from drug addiction that there is no global measure of addictiveness. Some people can smoke a cigarette or cigar or two, on average, per year. Others get hooked after their first draw. There is no reason to suspect something similar isn’t happening with obesity.

I’d say it stops being a useful descriptor at that point. If any activity that a person can possibly find rewarding in any way can be addictive, then everything is addictive. Because for any activity that you can possibly think of, you’ll find definitely find somebody who likes doing it.

By this criteria, I’m sure you’ll be able to find at least one eating glass addict somewhere in the world. But if we can stretch the definition to include glass as an addictive substance, then it kinda stops meaning anything at all.

And when I say these innovative addiction diagnoses are controversial, I mean within the community of clinical experts, which they are.

Based on common sense. Not everyone has tried heroin, but most people have overgorged themselves - maybe eaten too much ice cream or candy or pizza. I am guilty of that, and make sure to make it a rare occurrence and keep myself in shape.

> Not everyone has tried heroin, but most people have overgorged themselves

You're assuming everyone who tries heroin becomes an addict. At first glance it looks like "approximately 1 to 12 months after heroin onset, an estimated 23% to 38% of new heroin users have become dependent on heroin" [1]. By coincidence, that seems to mirror American obesity prevalence [2]. (Obviously heroin is more addictive than food. Don't do heroin.)

[1] https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

[2] https://www.cdc.gov/obesity/php/data-research/adult-obesity-...

> I don’t think being addicted to laziness and having a glutinous appetite is exactly comparable to say, being addicted to heroin.

Your opinion is that of a petulant child. Many years of research has shown that obesity is not this simple. Many chemical processes take place that influence one's ability to make better health choices, and many external factors put constraints on those choices as well. This is the exact same thing as hard drugs. Being obese is not a moral failing. When you say things like this, you show your true colors. You are not extending humanity to obese people, and it is very obvious.

I sincerely hope you reconsider your opinions. I hope you don't have any obese people in your life, or at least hope they don't read these messages. I think they would be disappointed to hear what you think of them.

And again, I hope you don't have any vices and are the perfect model of health, otherwise this would be a quite silly opinion to have.

EDIT:

I've been rated limited on comments so I'll post my last response here instead:

I have nothing further to say to this other than that you should consider talking to someone about your clearly deep-seated hatred for those who don't fit your model of participant in society; it doesn't seem healthy. Find an obese friend and show them your comments and watch their face as they read them. I wonder if you will find the humanity in their response that you are lacking here.

I would say that your suggestion that grown adults should be absolved of responsibility for their own decisions is actually a quintessentially childish idea. The fact that you are so deeply offended by any suggestion otherwise is even more childish.

You're both wrong. Obesity increasingly looks like addiction--as with any addiction, it takes two to tango. But once you have an addict, shame is an ineffective treatment. Debating giving an obese person GLP-1 drugs is akin to challenging methadone for heroin addicts.

I never suggested shame as an effective treatment. But refusing to acknowledge the reality of the situation is not an effective way to discuss the problem. Obesity is the result of lifestyle choices, and those choices do impose their costs on everybody in society. Which is why I would be very happy (and I would suggest everybody should be happy) if an effective way to address the problem was discovered.

The fact that an obese person is harming other people as well as themselves might be an uncomfortable truth for them to hear. But ignoring it doesn’t make it go away.

> Obesity is the result of lifestyle choices, and those choices do impose their costs on everybody in society

Granted. But why does it need to be said?

I'm a skiier. That lifestyle choice alone probably has a higher risk-adjusted cost to our healthcare system than if I were fat. I'd still miffed if prior to setting a bone my doctor decided to lecture me on the risks of skiing. I'd be positively furious if I got that from my health insurer.

> fact that an obese person is harming other people as well as themselves might be an uncomfortable truth for them to hear

Why do they need to hear it? There isn't a need. What they need is to not be obese anymore. That's treatment. My point is skipping the lecture and going straight to treatment is how we solve most medical problems.

> Being obese is not a moral failing.

Source?

Well, my not being obese isn't a moral virtue.

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