There are plenty of obese people that understand nutrition just fine, there are obese people who understand it well enough to have lost significant weight and gained it all back.
Clearly there is something else going on that we haven't grasped yet.
Though, now that you ask, I do think that many people don't actually know why they are overweight. They say it's because "McDonald's is cheaper than buying good food", not realizing the McDonalds won't satiate them and they will eat/spend more because their body is starved for proper nutrition. Watch the series "Supersize vs. Superskinny" and observe how nearly every participant is utterly clueless as to the underlying causes of their challenges on either size of the disordered-eating scale.
Regaining weight is the primary issue really. Most people are capable of losing weight, but gain it back, and it gets harder going forward. Metabolic adaptation is better understood now and among the factors (.e.g increasing caloric intake too quickly after weight loss), but falling into old habits that are culturally ubiquitous is a glaring part of the problem.
Former drug addicts are told now to sever contact with peers who partook in those indulgences as they're likely to pull them back in. With food, it can be more than a minor subculture. There are regions of the US that have much higher obesity rates than others. Not having family members and a romantic partner on board can be difficult.
Plenty of overweight people really, really, really want to lose weight and do all of the right things, but report that it is difficult to impossible to maintain the weight loss. Many of them gain the weight back, and this is crucial, but don’t continue gaining past a certain point. Combine that with the very regional nature of obesity and I think that there is a VERY strong case to be made that there is an environmental or external cause of obesity that we haven’t identified yet (junk food is too simple of an explanation, and doesn’t adequately explain everything).
The point I’m getting at is that a lot of these drugs also yield some sort of drastic behavioral change like a reduced indulgence in other impulsive harmful behaviors. I really think that there is something that is throwing us out of whack behaviorally, and obesity is a symptom of that.
The fact that a hormonal correction is able to fix both obesity and other addictions is a very interesting result.
This is exactly one of the reasons I think better education around food/diet/nutrition is important. You don't need to cut yourself off from enabler family/friends if they aren't enablers to begin with. It's cultural, too. The portion sizes at all the restaurants in a given region because "we like to eat big meals here", or whatever. There are sooo many factors and the underlying flaw, to me, is ignorance of "how this stuff works".
You can't divorce it from the explanation. People get obese from overconsuming calorie-dense rich foods. These products are manufactured to be as savory and addictive as possible, are highly available, and convenient, and very affordable, and most are non-satiating (especially drinks). So yes there are environmental factors, but the reason they matter in the first place is the impact of junk foods. At the turn of the 20th century even relatively sedentary office workers would not gain much weight, because the American industrial machine did not yet create the landscape we have now. No one was buying several bottles of 2L coke, chip bags, jumbo fries and fried chicken, greasy pizza, starbucks lattes, etc.
And to avoid confusion, I want to make clear that avoiding weight-gain at the outset (to the extent of becoming obese), and losing weight, are different. What's sufficient for the former is insufficient for the latter; you do not need to be mindful of energy balance if you are already at a healthy weight and consume whole foods, but if you are trying to lose weight, that will not be enough to ensure a caloric deficit.
A comparison I like is a bag of chips vs a bag of apples. Bags of potato chips average 1200 calories. One would need to consume 16 apples to get the equivalent. I can probably get through an entire bag of chips if I cared to, and more than half a bag absent-mindedly if I was irresponsible. Try consuming more than a single large apple and see how that feels. Fiber is almost as satiating as protein. It may not keep you full as long, but you certainly reach satiety a lot faster than you would with chips (notwithstanding that in fairness they are less addictive without salt and fat).
No amount of education will change who your parents were or how you were raised. Have you observed a strong correlation between how well educated someone is vs. obesity?
> I speculate that better awareness of diet/nutrition might help to prevent passing on such behaviours, like not feeding the family exclusively a bucket of KFC or McDonalds, or using food as a reward, etc. etc.
I'd encourage you to talk to any reasonably intelligent obese parent to see if they need better awareness of diet/nutrition. Better still, do a survey of obese and non-obese people to compare awareness of diet/nutrition between the two groups.
> I mean, medication won't actually solve what is caused by behaviour, right?
Saying that obesity is caused by behaviour and therefore can't be solved with medication is a bold statement to make in the context of a story about a drug that has been clinically proven to help obese people to lose weight.
Medication is often prescribed to help people who suffer from behavioural problems with positive results. I wouldn't presume medication can solve all problems caused by behaviour, but there is empirical evidence that for some problems it does help. As near as we can tell, human behaviour is regulated by a electrochemical brain & nervous system. Dumping chemicals into that system can of course change human behaviour. We see evidence of that (for better or for worse) all the time. If you have doubts and you don't even need to get a prescription, try taking a hit of acid/cocaine/alchohol and see if behaviour changes.
> If parents know their habits around food are basically ensuring their kids will struggle with obesity, maybe they'll make the effort to do something different?
The US has had a dramatic increase in obesity within a single generation (as in, people who were not obese for much of their lives have become morbidly obese at a rate far exceeding previous generations), let alone cross generational. While food/nutrition/health habits can certainly have a profound effect on someone's weight, there are clearly other factors at play.
Consider, for a moment, the reality of an obese person living in the US today. You get negative feedback about your weight all the time. You suffer negative social outcomes, let alone all the physical ones, so few, if any, want to be obese. There is no lack of motivation to seek out information on how to avoid being obese. There's a $300+ billion industry diet/health/nutrition industry constantly seeking to inform you about products they offer to help with your diet/health/nutrition... and that's not counting the doctors that you are no doubt interacting with regularly. Of course, that's not counting all the education (solicited or otherwise) you get from friends, family, acquaintances and even random strangers. It's hard to get through a day without being "educated" about diet, nutrition and health.
There's a cultural bias to think the problem is simply about behavioural/willpower/education, much the same way we look at poverty. It demonstrates a profound lack of understanding of and empathy for the plight of people who are suffering from obesity.
> I'm suggesting the idea that maybe we as a society should better educate around our relationship with food. I believe it would make a difference - just not immediately.
It's a bit tautological that if we did something better things would be better. Better education around our relationship with food would start with people understanding that better education about our relationship with food won't help people suffering from obesity.
In light of that, and barring the many other ways one can combat obesity themselves, it would probably be beneficial if everyone, in general, knew all about the pitfalls of disordered eating and knew more about how to combat that trap, and knew why that actually matters for themselves and the people they care about. I've observed people enable each others' obesity over and over. I've observed people reinforce horrible habits and be unsupportive of others' efforts to combat those habits. People don't know shit about diet and food and spread their ignorant, lazy attitudes and behaviour to those around them. Why make a real meal when you can just order $50 of takeout to feed the whole party? Then, if you don't eat "enough", everyone is on your case because "you must be starving" and "why are you eating so little?", because they are totally uneducated about the possible challenges people face when it comes to food. The more people know about this stuff, the more it benefits everyone. I still think this also circles back to the "passing it to your kids" thing, because it's now a multi-generational problem.
Maybe we should try educate society on dangers of using heroin. I agree that it is a good thing, and we should continue educating people about its dangers. But clearly that alone didn’t solve the problem, and I think it would be a good idea to utilize alternative options as well (in addition to continuing the education of society on its dangers).
When the person you are arguing with is saying that government induced bans would probably help more, and your are arguing they're wrong and your two examples were resolved by government induced bans, you're going about arguing in a very strange way.