All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.
1. Posts from folks who diet+exercise, or who have tried diet/exercise and nothing's worked so they then turned to Zepbound ("excited to hit the gym," "my diet is finally starting to work with Zepbound" and similar)
2. Posts from folks who haven't tried diet/exercise and turned to Zepbound first. (e.g. "I'm excited to eat dessert and laze around on my couch all day!" or "Zep is so much easier than before, no more keto for me" and similar)
Which group do you think would have more posts?
Selection bias probably prevents us from being able to count "Zepbound didn't work for me, but diet and exercise did" posts, which is why i suggest this.
Here's my hypothesis: I think self-control is generally uncorrelated to losing weight. Perhaps it's necessary to have self-control to lose weight "the simple way," but certainly not sufficient. I know lots of friends who've struggled and found it's not so simple.
People in the 50s weren't slimmer because they had ironclad determination to stay such.
Deviating from the mean is hard. Bad food and sedentarism are the norm.
I wouldn’t call taking the stairs in a pre-elevator world “effortless”, rather it was just the only option.
I also think better food handling/storage/treatment/blah means we absorb & retain more of the calories that we consume.
Making the good choice the easy/only choice is the only way to solve this problem long-term (without drugs)
It seems clear enough to me that there is something - something - in the ecosystem that messes up the body's weight / energy homeostasis and we haven't identified the culprit. It might be a food additive, but it could be something to do with artificial light in the evening or plasticizers in our plastic products or who knows what.
Just my pov as non-overweight person who doesn't exercise (other than flipping my four year old around), doesn't walk or run long distances (but a 5 mile walk every couple of months doesn't phase me), eats very few fruits and vegetables, generally eats mostly meat, pasta, bread, cheese, cream and potatoes, and ends up in a fast food outlet maybe once a week on average.
https://www.lesswrong.com/posts/NRrbJJWnaSorrqvtZ/on-not-get...
it doesn't have to be just habit, but cultural/learned factors likely play a huge part.
each generation eats more, gets bigger, obesity runs in the family, (many obesity associated genes are mostly expressed in the brain ... the typical cursed environment-gene interaction), portion sizes got bigger, it became normal to gulp down a lot more sugar, etc.
No. They lived in an overall healthier environment. But they were also subject to much greater social pressure to stay slim and could endure fairly intense social judgment and stigmatization for weights that we consider normal (particularly women).
Weak thesis.
There was a far more vicious shaming culture 50-70 years ago about things like being obese. And culturally it's still looked down upon to be obese, it's just not as acceptable to be vicious about it (and of course sometimes people still are).
Today however there is a lot more "always on" pressure: social media is a huge component to social, social acceptance, socializing, social learning & sharing, getting to date people, et al. That's a form of individually focused media pressure that didn't exist back then. And sure you can turn it off, not partake, but there are usually serious consequences especially for younger people.
That's the context.
As recently as the 1980s movies were overloaded with jokes about fat people, it was extremely common. That's stigma in action culturally.
Answer: literally non-existent.
Indeed, we have the inception of Weight Watchers at the start of the next decade, replacing far crazier things like the cabbage diet being used en masse.
Yes, it was easier in some ways to live a healthier life; one reason why was the rampant social policing of each other's weight.
Perhaps, perhaps not. But you'd expect that if there's many different causes making weight gain more common and only one is changes in social pressures (as I've already stipulated in each post).
And, likewise, as stipulated above: overt social stigma is not the only reason why people might prefer to be of a lower weight.
> The success of those efforts has decreased over time.
Well, one reason for this is that we've reduced the use of obviously harmful but effective weight loss techniques like cigarettes and stimulants. The 1950s were the era of the rainbow diet pill clinic, where you'd walk in and get a personalized cocktail of amphetamines and thyroid drugs and laxatives and diuretics to help you control weight.
They lived in a different environment. The universal appetite-reduction drug was nicotine, and the common methods of administration had a number of undesirable side effects.
In the 1950s, malnutrition was a serious issue that many people in poor areas died from. When was the last time someone died because they didn't have access to food? Obviously, the other side of that coin is that food being so plentiful, people eat much, much more than ever before.
Food abundance is good, but it is not the answer to this question. For example, in America today the richest locations tend to be the most physically fit.
For example, I have a routine of going to a group fitness class at my gym in the morning. I don't need to summon willpower, I just have a morning routine that involves doing x thing at y time. No thought required.
Given the abundance of options for fitness classes and meal plan services, you really can just put this on auto-pilot and have a lifestyle that is healthier than 99% of your peers.
It is empirically and demonstrably ineffective as a solution.
Obviously no one is talking about a treadmill concentration camp here, good lord.
I guess what I want to express is habits are one step closer to a lifestyle change and that's what keeps one ultimately healthy (mentally, too). We can't have nightmare commutes to soul-sucking jobs to continually have people addicted to looking at screens and think that there's no fallout. Adding, "but now there are drugs!" isn't an advancement.
This is part of what's fucked up about modern American lifestyles.
We shouldn't be promoting layering healthy behaviors (fresh foods and exercise) on top of our default lives -- we should be doing a better job of engineering our environment to make those things the default for all people.
F.ex. what if we highly taxed automobile entry into urban cores and shopping districts?
But because I live in suburban Australia and eat the same pesticide laden slop as everybody else, I too have a gym membership.
What does this actually mean to you? Walking or even running is certainly not comparable to going to the gym, so what, should we lift heavy weights as part of our regular jobs to keep up our upper body muscle mass?
Ergo, we don't need to turn our jobs or built environment into Ninja Warrior.
We just need to build it to encourage that modest amount of activity.
That being said - I do feel like reducing the amount of willpower needed is the key. I love junk food, but if I never buy it at a grocery store it's much easier to cut it out. If I have no chips in the house I could still get some at the corner store, but I need to be much less disciplined than if the chips were in my pantry
People in the 50s (in the US) had, among other things, fistfuls of benzedrine.
Edit: here is a link for the skeptical folks https://www.smithsonianmag.com/history/speedy-history-americ...
It is a useful and topical period to discuss in a thread about ubiquitous weight loss drug usage.
> James Nye, for example, was one of a family of eleven children raised in rural Sussex in the 1820s and recalled how the ‘the young ones’ in his family went ‘very short of food’. Despite his mother’s best efforts, he rarely had more than ‘half a bellyful’ at mealtimes, and ate scarcely anything other than bread.
> Following the harvest failures of 1816, for example, John Lincoln’s entire family was forced to undergo severe privations. His two children succumbed to disease very easily — their quick deaths from measles were likely owing in part to prior malnourishment.
You can't be obese if you don't have food.
I think they may have taken your prompt and thought about the 1820s, 1400s, 1200s or 200 BCE. Did you mean to direct people to discuss the 1990s by listing the other 4 eras?
It seems like you do not want to discuss any factors relating to obesity in history at all, yet you keep engaging in this topic anyway. It is impossible to have a conversation where one side discusses facts like drug availability or food scarcity and the other says “no think about something else” as a canned response.
What do you think is the cause of the increased level of obesity? What do you think is the solution, if any?
It seems far, far more likely to me that right now is the aberration – in fact we know today is aberrant on several dimensions that are presumably related to obesity, so that's where we should look.
Big, system-wide changes like what we're experiencing are almost always both multicausal and overdetermined.
The causes here are:
1. Production of cheap, extremely palatable, ultra-high caloric density foods (mitigable). Note: This is not the same thing as saying "people used to be thin because they were starving." It is absolutely possible to feed a country amply and not yield the low price/great taste/horrible nutrition profile that dominates the American diet today.
2. Increase in sedentary time due to shift from physically intensive professions (not very solvable), car-centric urban planning (solvable), and the dominance of ass-in-chair leisure activities (probably mitigable)
3. The science is early on this but there's good reason to look further into endocrine-disruptive chemical poisoning (mitigable). We are finding these compounds absolutely everywhere we look and we should be very open to the possibility we are mass-poisoning people and damaging their metabolism: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10003192/
I think they may have taken your prompt and thought about the 1820s, 1400s, 1200s or 200 BCE. Did you mean to direct people to discuss the 1990s by listing the other 4 eras?
On the other hand, if like me, you have ADHD and weight issues, it could be more helpful. Because it could treat your ADHD enough to help you actually establish and follow a structured diet and exercise regime. Especially if your ADHD includes impulsivity. The last time I was on lisdex treatment, I lost about 5kg from the initial boost, a lot of it was probably water weight. Then I managed to cut about 30kg later with calorie counting and regular cardio.
So the physical effects themselves are largely a pisstake.
That's million years of evolution with food scarcity and modern capitalist world which created unprecedented abundance of food (and other things). And before you compare it to Europe — europeans still smoke much more than americans. Tobacco is also just a chemical that decreases effects of obesity, just in a different form.
Countries in Europe with approximately the same obesity problem as the US:
Poland, Croatia, Romania, Britain, Hungary, Georgia, Slovakia, Chechia, Ireland, Greece.
And of course New Zealand, Australia, Canada are all in the same boat as well.
Those are all over 30% obesity and climbing (Romania is 38%, nearly at the US levels). The US is of course the leader of the pack, however it's all the same fundamental problem.
So yeah, culture driven lower portion sizes + meds driven lower appetite is a well-tested combination with known positive outcomes.
Well, heights increased dramatically for a couple decades so what that meant was that many people in the 1950s were starving. In the 1930s, people died of starvation even in the US.
I don't really think that we want to go back to starving our population just to be thin, thanks.
Diet is a way bigger factor in weight control than activity, unless you’re a pro athlete burning thousands of calories a day from exercise because you’re working out nonstop as your job.
You should still walk for general health, but not for weight loss.
EDIT: this report from Time about Japanese food culture rings true.
Diet is the overwhelming deciding factor when it comes to weight gain.
As another commenter posted, the amount of walking even a highly active person does is fairly negligible wrt weight loss/gain. As another anecdote - my ambient walking milage is 5 miles/day and I run an additional 20-30 miles a week and still maintain an obese BMI
>> Unfortunately, I have to drive everywhere, work too many hours to have free time for recreation and have no idea which government subsidy is going to help big ag likely at the expense of my health.
At what point do people stop letting the choice being largely "made" for them and choose something else? The gov subsidy has nothing to do with my personal health choices. My grocery store has the same fresh fruits & vegetable sections grocery stores in Europe have. I am lucky to live in a state whose dominate grocery store sources regional meats & produce, sells their own brand of food made fully or mostly with ingredients I can pronounce, and has complete whole food prepared meals for 1-2 people that take 25mins in the oven. [for the same price as fast food]
It's part of the reason I choose not to move. Other choices are a standing desk with a walking pad, which makes it trivial to walk 3-4+ miles a day. I could make more money studying leetcode and living in "elite" tech valley, or hustling for more work instead of choosing myself over the large house in swank community that society has picked as what is "success" for me. Eventually I chose to take less of what "they" told me to choose; at some point we have to realize the only person that is going to live with our choices is ourself. If GLP-1s is needed to help people get back or get to that point of realization, then maybe it's a blessing to undo all the ills we(society made up of our neighbors) all contributed to creating.
I debated posting because this is the usual response, instead of seeing the point as, "we" continue to create this society not some magical "others". I am where I am because of my choices + the lucky draw of loving computers and a dedicated family that scrapped and saved and sacrificed to buy me my own computer as a teenager which helped me move out of the situation I was born in. And even that was better than many of the people I grew up with. So no, this wasnt some privileged post of someone who never walked 2+ miles to the corner store with their friend to pick up a half gallon of milk and pasty white "bread" with food stamps so they could have sandwiches for dinner. [added: while this situation sounds bad it's better than where they (and many of my other friends) came from as they could have been deported back to there if found]
Instead of being forced to drive everywhere for the most basic possible human needs - like getting groceries, going to the doctor, or dropping kids off at school - as is the case in 90% of America - what if you could walk to those places instead? You would get exercise as part of your every day life, with no extra effort!
What if instead of corn syrup being so heavily subsidized, we could use more filling sweeteners in a lower amount instead? What if people lived closer to agriculture, instead of in faraway suburban tract housing only accessible by car, so they had easier access to fresh meat and vegetables, instead of ultraprocessed package food?
These dreams are not "diet and exercise", they are a fundamental reshaping of American lifestyle that would directly lead to weight loss. We know this, because America used to look like this before, say, 1940. In old photos you see people in huge crowds in streets as they walked to their everyday errands, and menus and recipes of the era are mostly minimally processed food that is mostly local. Americans of the past were not overweight, because the way society arranged its physical existence didn't permit it!
I'm not sure you could really find data to back your anecdotes.
(You’ll quickly end up with another underground white powder economy though…)
Because they were poor and didn't have a choice. Making driving extremely expensive and inconvenient and prohibitively high taxes on processed food etc. might force people to change their lifestyles, I'm just not sure how politically feasible that.
I was that guy. For a variety of reasons that aren’t relevant i developed insulin resistance over a relatively short time that made it increasingly difficult to lose weight. I’m in my mid 40s, which also makes it difficult.
I got on one of the GLP drugs 18 months ago. I am down 80 pounds, and am running 20 miles a week. I’ll be doing a half marathon in March. Ive dropped the dose twice and still going strong.
Taking the pill made exercise possible. Online everyone likes to apply a moral hazard thing to every discussion. GLP medication twiddled my dopamine system and allowed me to achieve my goals. Period. If you think that makes me weak, I cannot think of anything that I care less about.
Choosing to eat fewer processed foods is very effective but does not require that much self-control since appetite will fall automatically.
I don't have a problem with a cure only if it doesn't reduce the focus and effort on prevention.
There has to be a reason why so many more people are obese today than decades ago. I refuse to believe we can't find out why and make changes to reverse it.
But if it's so easy to cure, will enough people care about figuring out how to prevent it?
Presumably people who have good self control and are not prone to developing addictions (due genetic or various semi-immutable cause) do not become obese in the first place. It might be fairly easy easy for them to lose weight they just don't need.
1) Radically alter aspects of food culture, work culture, social policy, and business regulation.
2) Magic pill (/injection)
There appears to be no imminent progress on the many parts of #1 that need serious work, so if we want a big turn-around in the next half-century, #2 has suddenly and surprisingly become a real possibility.
Or a 5'10" man starting at 220lbs (obese) and finishing at 187lbs (overweight, BMI > 26).
It ain't nothing, but that's not a magic pill which will fix the obesity epidemic. And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food.
I went from nutritionist appointments that were like "are you lying about your food intake? because if not, you have some serious problem with something in your environment" to "yep, it was easy to cut out a couple things that bothered me," and weight came off astonishingly rapidly.
(I want to ask this in a non-combative way, but 3 days later I still can't. How did you know the couple of foods(?) which were bothering you, which were the problem, and your nutritionist did not know about them, and you weren't lying to the nutritionist? I can't make sense of that without also accusing you of hiding them from the nutritionist, or the nutritionist being terrible at their job).
"And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food."
That sounds very judgmental of you, like if they were skipping school. Bad truants!
What about "found the necessary changes too hard/complicated to sustain"? That is closer to reality. People juggle all sorts of obligations, some are doing multiple jobs, commuting 90 minutes each way etc. - they may be just too fatigued to exercise regularly and cook healthy meals at home.
> "That sounds very judgmental of you, like if they were skipping school. Bad truants!"
It is judgemental of me, like if you want to pass your exams but skip studying, that would be bad. If you aren't exercising and are eating terribly and are obese, this lets you silence the alarm bells while saying "I don't have time to exercise". That doesn't seem as good as eating better and changing your life to include movement.
Ask yourself where fast food comes from. It is a) fast, b) cheap. Of course it is going to suit people who a) don't have time, b) don't have much money. A union of those two wants covers a big part of the contemporary Western population.
Composition of food is another biggie, I agree with you on that. Too much sugar everywhere. That said: we are naturally wired to crave sugar, only someone more and someone less. If fentanyl was legally sold on every corner in fancy packaging, starting with kids, would you blame the resulting junkies for being weak-willed? Or acknowledge that the environment is really fucked up?
I personally don't respond to sugar that much and I can go weeks without it, but that's not my virtue. It is blind luck of my genome or possibly microbiome. I don't drink much either, but again, that's blind luck of my genome or possibly microbiome which makes me dislike the taste of alcohol. Not my iron will, which I don't have.
It is my experience that a lot of people are judgmental about the fatties because it increases their own perceived self-worth. ("We are the virtuous ones, unlike them.") Pretty arbitrary, but humans be like that.
It is not cheap. Eating fast food regularly would probably more than double my food budget. And yes, I do eat meat regularly.
So no, I’m thrilled to see #2 show up to maybe get our healthcare system to limp along for at least a couple decades longer than it was looking like it would.
If you have a tiny, homogeneous culture it is still very difficult to radically alter it in the span of a couple decades (think: Sweden, Finland). For something the scale of the US, with the diversity of the US, there is no possibility. Anything suggested as comprehensive would be fantasy. There are only small changes that could be done, eg relating to sugar consumption limits in drinks and food; some would have a meaningful impact, however you still won't fundamentally change the culture's calorie problem.
Getting thinner will do extraordinary things for rebooting the malfunctioning US. Obesity does a lot of harmful things to work ethic, longevity, quality of longevity, productivity, mental capabilities, to say nothing of course diabetes and cancer and so on.
Besides, having healthier people will lead to better infrastructure for healthier lifestyles, purely based on demand. It's a virtuous cycle.
I would not jump on that current pill yet. Wait and see. There are probably serious side effects that we mere plebes do not get to find out about yet (that is for 20 years from now). Like what is the side effects when you stop taking it? What if your dose is too high/low? What is the long term usage like for other parts of the body?
She abruptly stopped after losing much more than she wanted to lose.
She looks ill frankly.
No, it doesn't appear that some famous person almost died. The drug seemed to be effective for her. She noticed some mild nausea - she even said she didn't throw up. That's mild nausea. She was thirsty - this makes sense. Food contains water, so she was probably dehydrated which contributes to the nausea. She should have drank more water. Finally, she did not want to eat. That is the intended effect of the drug. Sounds like it did exactly what it was designed to do.
Yes, gastroparesis can happen. This is not a shocker, as GLP-1 agonists affect the rate of gastric emptying. Gastroparesis is ... a slowing of gastric emptying. 750 out of nearly 150,000 GLP-1 patients experienced gastroparesis. This is about double the incidence in the general population. In very rare cases of gastroparesis you can experience blockages, but that is very much the exception, not the rule. Even so, this is why it's important to meet regularly with your doctor, discuss how you're feeling while on the drug, and get medical attention if you discover you're not shitting and normal methods don't improve things.
There are many useful, common drugs that have side effects that seem scary but are rare. ACE inhibitors are wonderful, well-tolerated drugs for controlling blood pressure, but long term use can cause kidney issues in very rare cases. Monitoring potassium levels allows for this side effect to be controlled well before kidney damage results.
> If there were effects, we'd have seen them by now.
You just authored a screed in response to me pointing out that there are effects.
Sharon Osbourne didn't just have mild nausea she now claims she can't put back the weight she lost that she didn't intend to lose.
> Gastroparesis is ... a slowing of gastric emptying.
I can't help but point out the syntax choice of internet snobbery. I'm not sure when people started sprinkling ellipses for dramatic effect because they seem to think it makes them authoritative but I think it's worth highlighting since it's such a reliable heuristic for internet troll.
But at the same time, part of me wants to ask... why is this a problem? Why shouldn't we just use science and technology to fix human problems and remove any unfortunate consequences from society?
What's wrong with a world where anyone can eat as much of anything as they want, do no exercise at all, ignore their dental health and smoke like a chimney, yet still have perfect health without any downsides?
Objectively, it would be a better society, with everyone materially better off and a system that doesn't need anywhere near as many resources to care of its citizens.
Why would it matter what route is chosen here?
I'm the same in other areas of life. I don't take steroids, I work out in the gym. I don't take drugs to have trips and achieve enlightenment, I tried to find Zen on my own.
I wouldn't partner with someone who had a cosmetic surgery ("fake beauty"), nor someone who wears makeup.
Up to every individual of course, I'm not even saying I will never take TRT (probably eventually, when I'm older, for health reasons), but I, above everything else, value (and want) authenticity.
Because this comes at the cost of one's essential humanity.
Just wanted to mention that this is not a US problem, and framing it as such won't help find solutions. Even in southeast Asia the rates over obesity are steadily increasing. Europe is already much fatter than southeast Asia. This is a worldwide phenomenon.
All of the US's worst fast food chains and food products have been exported. In my tiny city a Carl's Jr. Just opened! There is McDonald's, Burger King and Starbucks everywhere. There are also Dunkin donuts in the supermarket as well as oreos. In contrast there arent any Asian or Russian restaurants chains here.
Local foods have become sweeter in order to compete and there are so many local burger restaurants now it's like I have moved to the US.
That's par for the course, the world does love to blame us for their problems. Then they bitch when anyone suggests we've made some choices in the last 100 years that made their lives noticeably better (hello Marshall Plan!).
> have been exported
That's a convenient spin on "have been imported." Do you not make your own choices? If you don't want the crappy fast food, quit making your own copies of it!
Since it's kind of on point for this discussion, I just thought I'd mention one amusing thing I noticed in London -- you can buy higher calorie McDonalds food there. I could get a sasusage mcmuffin with two patties, which isn't a thing in the US. I almost wanted to do it just for the laughs, but frankly the UK version of McDonalds tastes even worse than the US version. I'm not sure exactly how that's possible.
Y'all should stop importing the shittiest excuses for 'American' food. A lot of us never eat at these places in spite of them being so prevalent. We have a lot of great restaurants, even some of the ones that qualify as fast food.
“If alcohol is bad for you, quit drinking it!”
“If crack is bad for you, quit taking it!”
My point is that there is more to it than that. You make like it’s a choice governed by free will when we know that fatty and sweet foods are addictive and harder to resist.
Being fit there is statistically considered an anomaly.
I don't know of any other country where you would be weird because you're fit.
Most likely this means you will be walk-running at the beginning or even just walking up a steep hill. Running is an activity of many small incremental gains. Every week you can go a little tiny bit further but if you amortize that over a year it makes a big difference.
Many go into running too fast and hard which leads them into not liking it because they feel absolutely miserable the entire time or they injure themselves due to bad form.
I had a good physical therapist which took me from nothing and for the first few months I wasn’t even running but doing foot and ankle strengthening because that part of my kinetic chain was so weak.
Which will burn somewhere on the order of 400 excess calories - about as much as a typical North American muffin (or two of the big cookies from Subway). But worse, your body was probably going to use most of those calories on something else (fidgeting, running a higher body temperature, other immune responses including inflammation) anyway, assuming that you haven't been gaining weight with your current habits. Exercise is healthy and reduces stress, but it just isn't effective for weight control. Humans are animals, and animals have on the order of a billion years of homeostasis technology behind them.
>eat reasonably healthy
Hardly anyone has any accurate picture of how much they consume, as measured in calories, except for those with actual explicit experience of measuring and accounting it.
If a pill happens to end up helping you eat an amount that lets you maintain a healthy weight, I'm all for that. But it's important to have your mental model properly calibrated.
That's very idealistic, in my opinion.
There are also native stores that are increasingly entering into low cost produce like Grocery Outlet and then there are the usual like Food4Less but they tend to eventually move upmarket.
The problem isn't that people go to supermarkets and they can't find any healthful ingredients to cook with. The problem is that they go to supermarkets and pass those over in favor of convenience foods that have been optimized for "craveability" [1].
GLP-1 drugs can alter this behavior by reducing food cravings. Someone who's no longer craving the most craveable food can make more objective by-the-numbers buying decisions the next time they go grocery shopping.
[1] https://www.npr.org/sections/thesalt/2015/12/16/459981099/ho...
The only way you're going to get high quality food in the US is if you live where the Amish are.
Maybe I'm too European to understand why not, but seems to me that regulations around food and what companies are allowed to put into it is really helpful in avoiding companies from just stuffing whatever down people's throat.
But I would never do that, since I mostly ate at the Red Light District, and I couldn't possibly generalize the country eating habits with stores in a major tourist area.
The Easy Path is that gentle encouragement to hit up Chipotle for lunch, because it's "right there."
The Easy Path says dinner's hard and you've had a long day, so get something simple, like take-out or microwave.
The Easy Path is entropy. The Easy Path is self-care over struggle. The Easy Path is simple carbs shown on prominent display in store shelves. The Easy Path is advertising.
Hitting the gym isn't on The Easy Path, but forgetting to cancel your gym membership is.
These days, big food companies love "The Easy Path" because it's so easy to commoditize, it's the "Path that Americans are Expected to Take." For financial stewards, being on The Easy Path turns lack of willpower into your ally.
On the other hand, getting good food in the US requires passing the marshmallow test: you have to meal prep, or you have to shop around the sides, or you have to get something on the salad menu. You have to say no to advertising. You have to expend willpower, the most limited of resources to the average American. You have to Go Hungry or Suffer, or have An Upset Stomach. You frequently have to spend more money or time.
Semaglutides are not currently on The Easy Path. Maybe they will be someday. I personally doubt that, because putting GLP-1 on The Easy Path would require big food companies to rethink their entire portfolio.
But you're not wrong in that they could be Easy Path-ajdacent. The dialectic would shift: food companies would shift around to be Organic and Nutritious and Less Calories and find other ways to stay on The Easy Path. Sugar and fat's addictiveness is highly Easy Path-enabling, and that's a pretty big vacuum to fill.
I think the drug industry is more powerful than the food industry, these days.
> RJR Nabisco was formed in 1985 by the merger of Nabisco Brands and R.J. Reynolds Tobacco Company.
At some point blaming society isn’t going to cut it.
Blaming society sounds fatalistic, but yes we absolutely can change society. There are mechanisms to do it, and the first step to utilizing any of them is people getting pissed off about the state of things and talking to other people about how pissed off they are about it.
Even in that place you can do better than ground beef.
Get an instant pot and invest in some rudimentary cooking skills. I’ve spent a whole year making variations on the same dish in 15 minutes, using that cooking as end-of-day stress relief. Shopping for the same handful of things once a week.
It wasn’t fine dining but it was healthy, cheap, and a few steps up from ground beef. Come now.
I promise you if ground beef is all you eat you will be much worse than fat and out of shape.
You could try it for say, two weeks. I’ve done it for two years, so nothing super crazy can happen in two weeks.
Yes, all the processed grains and seed oils and artificial sweeteners and chemicals should never have been invented. But I’m not too fussed about that. What I can do is come here and write these comments about the diet that changed my life for the better. If only one person who reads them tries it out, I will already have succeeded.
The Easy Path is signing up for a fitness class on a regular schedule and baking it into your morning routine.
The Easy Path is not buying extra snacks - just don't have them laying around the house for you to eat when you're bored.
The Easy Path is the path of least resistance. However, you have some agency over the environment you create for yourself, so that path of least resistance is to some degree under your control.
If you count calories and stick to a budget, you will lose weight, even if those calories come from deep-fried fast food. Sure, it's good to eat more whole fruits and vegetables, and you should, but weight loss doesn't require some kind of Edenic perfection. Stick to a calorie budget and you will lose weight, the end.
We can add some second and third order provisos, sure. The next tip would be to go low carb. And to keep a spreadsheet with calorie numbers for everything you eat. Track what you're doing.
But basically, if you eat 1500 kcal/day for nine months, you will be much thinner. We don't have to make it harder than that. It works. Perfection is not required.
People aren't obese just because they can't figure out how to count to 1500.
If we're talking about this as a public health issue, then I agree with you. You can't really expect much of people as a herd or mass.
(Hell, look at the state of elections.)
If we're talking about this as individual, rational people, though, then it's different. You can absolutely maintain a reasonable weight if you just attend to it.
2.
There's actually some knowledge embedded in the "count to 1500", which, if you're not in the habit of thinking about, may be surprising. Specifically, the kcal amounts themselves.
Say you just go with the flow of society, and you eat "normally" without thinking about what you're doing:
You wake up, and you have something marketed as "a meal" for breakfast. A breakfast sandwich can easily be 550 kcal. If you add a venti latte to this, especially one with sugar, then you could easily add another 250 for that. Now you're at 800 kcal just for breakfast.
Then consider lunch. Even a "small" meal from a healthy salad place, like Sweetgreen (which is expensive), is going to be like 900 kcal. Say that's what you eat. Now you're at 1700 kcal.
The afternoon comes, and you have two chocolate-chip cookies. Two cookies isn't excessive, right? Just a little treat. But each one is probably 120 kcal. So that's 240 kcal. Now you're at 1940 kcal.
Finally you have dinner. Some microwaved thing, relatively small. It's probably like 600 kcal. So now we're at over 2,500 kcal for the day.
Everything you did in the course of that day was relatively normal. Probably only the venti latte at breakfast was obviously excessive. But now you're substantially over your calorie budget.
Now, 2,500 kcal is still salvageable. Every mile you walk on flat ground is about 100 kcal. If you live in the city, you could easily have walked a mile and a half during your commute to work, and another mile when you stepped out for lunch, and a mile and a half on your way back, giving you four miles. You're almost at breakeven. Just need a little more exercise, and you'll maintain your current weight.
(In the burbs, though, you probably drove to all these places and now it's on you to go to a gym, which is a pain in the butt.)
Anyway, my point is, if you weren't attending to all this, how would you know? You'd probably just be doing all these habits without thinking about them. Most parts of this routine seem pretty reasonable. But you'd still be getting fat. Because you're going with the flow instead of counting.
So, there's a little (easy) knowledge involved, but mostly it's not an issue of intellectual ability, it's a matter of attention.
If you see this sort of food as "self-care" then that's where the war has been lost.
>or you have to shop around the sides
Sometimes I wonder if I'm the only person in the world who enjoys this. Discovering, for example, the versatility and cost-effectiveness of skim milk powder was a real game changer for me. Similarly for dried legumes and fruits.
Like most of the food that we eat is not really that bad. Its not optimal for sure, especially for sedentary lifestyles, but a lot of the health problems are not directly tied into the actual food, rather the over-consumption of it, and passing down of bad genetics (for example, children of obese people are more likely to be obese).
European obesity tripled in the last 40 years as well, despite higher quality of food.
I would assume that this is related to gut biome and not genetic makeup.
Why is the quality of food in Europe so much worse than southeast Asia?
Because you guys are way, way, way fatter than e.g. the Japanese.
Back on topic -- we have excellent food in the US, but regulations allow for highly processed crap to be sold too. Pretty sure most of the crappy processed foods are easily available in Europe, too.
eu and canada have stringent laws on advertising to children, and laws on nutrition and additives to their products
even things like bread in the US have an insane amount of sugar
but the other reason is suburban/car culture & zoning, which means more hypermarkets and shopping not every few days for fresh food but every week or two for more processed food that lasts longer because going to the store is a bigger PITA than a quick 5 min walk to the neighborhood stores; which also means mroe walking rather than driving, another area of calorie burning and lean muscle maintenance which maintains high metab
There is, in fact, already an enormous, fully endogenous incentive to do those things. The fact many people are not keeping in shape (myself included) suggests the allure of food really is just that appealing.
When I’m really feeling the stress, even though I will tell myself at that time to just hang on and hit the gym later, the food is that much more of an instant fix that it wins out more often than not.
I’m sure that’s not just the actual food itself, but also the easy availability of it, and probably subliminal cultural factors such as advertising. But partly, yeah, it’s that my ancestors evolved to love eating when they had food, and their gift to me is that same desire in a world of endless plenty.
Correction. We live in a system that *rewards* that. The infrastructure and system itself expects us to drive everywhere (because it's either faster or literally at all possible), eat overprocessed food (because it's tastier (literally designed to be hyper-palpable) and faster), and to work for absurd hours.
If you somehow have spoons after all that, then you're expected to workout, etc, to gain the additional benefits; but the systems in play do not facilitate that, at all.
Luckily there's a precise term from economics we can use here to split the difference: Opportunity cost. I can certainly concede that in some people's lives the opportunity cost to working out is higher. In some lives you make a lot more money per hour worked than you do working out, and so it's not a surprise more people on the margin in those situations choose the former over the latter. If you dislike even having that option on the table, the good news is you can move to someplace where you make less money, and then that opportunity cost will go down, because working out is pretty much the same wherever you go.
One more sophisticated take of course is to claim people don't really know what's good for them, and they discount the true value of working out far too heavily. (s/working out/eating less/g, or whatever other health promoting difficult activity you wish to sub in here.) But, if we're going to claim that -- which is actually pretty reasonable -- then why would we consider a miracle drug that seems to directly counteract that irrational discounting a bad thing? That should be a godsend.
It's like well duh of course you'd prefer the impossibly unrealistic miracle.
https://en.m.wikipedia.org/wiki/Obesity_in_the_United_Kingdo...
I find that saying that health initiatives don't work by vaguely gesturing at a country, is not a structurally sound argument. Its like the sentiment here is: "is the fact that we include Pizza as a vegetable in American schools part of the problem? Nooooo, that can't be it. it must be a moral issue!" and thats just one example.
The obesity problem in the US is tied directly to our relationship with highly processed (and CHEAP) food. Along with the stranglehold those companies have over state and federal institutions that allow them to directly sell these foods in schools and institutions, and heavily skirt FDA regulations via lobbying.
The US is uniquely bad when we have a ton of chemicals and ingredients in our foods that are banned in most other countries. It is largely a systemic problem and a problem that can easily be solved. Poorer people tend to eat cheap food, cheap processed food isn't well regulated and is directly tied obesity and a whole host of health problems.
"The UK has seen its obesity rates increase faster than the US. In the UK, obesity has risen sharply since 1990, when it affected only 14% of adults. The UK is also considered one of the most overweight countries in Western Europe."
In addition, since the introduction of Change4Life, the obesity rate has simply continued to climb in the uk (see https://researchbriefings.files.parliament.uk/documents/SN03..., for example).
So yes, other countries (just like the US), have introduced programs to try to encourage healthier behaviors, and have seen similar outcomes from them.
Is a skinny homeless methhead with a great BMI healthy? Or the blue collar dude who has terrible blood pressure from chain smoking and pounding energy drinks on his way to the job site?
How many Americans who are not obese are on their way to becoming obese?
There are lots of paths to unhealthiness and overeating / eating poorly is only one of them
People aren't born obese. They get that way through mistreating their body for a long period of time, and it is quite possible for them to die before they become obese to other maladies related to that mistreatment.
Maybe in passing.
Impossibly unrealistic to get rid of enormous sugar production subsidies that make it insanely cheap?
Impossibly unrealistic to simply tax added sugar?
Those zoning issues are the same reason for any number of other problems, including housing prices that are supposedly the #1 concern for a huge number of voters, and yet voters in many cities have only doubled down over time on making it harder and harder to build in efficient and high-density ways. "Impossible" seems like a fair way to put it.
I haven't done the statistics on it, but I'll bet cities full of people who want zoning reform are more likely to reform than cities full of people who do not want it.
This change ultimately allowed something like 10% more units in the city on a 100 year horizon.
This is what I'm calling out - these changes sound big but they are nearly meaningless. Cities need periods of explosive growth to remain affordable (see Jane Jacobs, 1961 and 1970).
You can read the text change. It allows duplexes and ~doubled the allowed density on almost every residential zoning type.
You can refer to the text changes. They doubled the zoned density in nearly every residential zoning type in the city. It is a huge change, though I suppose you can claim that's not "reform" if you want. It is sufficiently reformative for my purposes of increasing urban density over time.
Changes will take time to kick in, and obviously they should take time to kick in because simply clicking a button and doubling actual built density would crater the economy. It makes no sense. The zoning change removes an artificial restriction on the natural supply/demand curve, so now supply can grow as-needed in the forms desired.
In general, when new construction occurs, it's taking low density and replacing it with more like 10X density. A very tiny amount of land gets developed at once, so you need each new development opportunity to generate as much supply as possible.
What this did was make people think gosh, that means a lot of housing! But in actuality, very few of these ever get built. Only very old housing stock ever makes sense to replace with only a doubling.
I appreciate what you're trying to say, but what I said was actually true. This won't have much impact. I can give you drips and drabs of information this way to help you understand how development works, but I can't give you an entire primer, unless you'd like to get on the Zoom and talk about it for a couple hours.
Can you show me land that is now much more valuable than before? I suspect the places you're thinking of aren't really changing on value or buildability the way you expect.
Naively, you're talking about converting a one story building into a ten story building. That == a tower.
You're skeptical that higher density zoning increases land values?
> Now, let's talk about the multi-family sector. If you thought single-family homes were hot, wait till you hear about this. Land suitable for apartment development in downtown Raleigh and Durham has seen price increases of 50-100% in the last five years alone.
> And it's not just apartments. The demand for townhomes and condos has sent land values for these types of projects through the roof, with increases of 30-40% in prime locations.
https://www.timmclarke.com/resources/are-land-values-increas...
Of course we can quibble about what amount of that appreciation is caused by zoning changes, but from first principles it is obviously the case that given the same exact plot of land, the expected value of developing 10 houses on it is much higher than the expected value of developing 1 house on it, ergo a lot that allows 10 will have a higher price than that same exact lot constrained to 1 home.
All 3 seem to be going swimmingly so far!
There is no material difference between impossible and challenging if the thing doesn’t actually happen.
It’s like Kramer saying he could have levels in his apartment it’s just that he doesn’t want them.
What’s the difference between, “It was hard and we didn’t solve it” and “It was impossible”?
You are aware you can’t tell a hard unsolved problem from an impossible unsolved problem, right?
Zoning changes happen all the time. Tax changes happen all the time. Subsidy changes happen all the time.
The other issue is your personal situation. If you're living in a country with intense conflict or in a war zone, you can’t just try to survive for 40 years while “waiting” for the country to make progress. You move, and that’s it.
Plus, given that people’s freedom is constantly increasing, and they have more and more options available, expecting that everyone will autonomously choose a healthy lifestyle is like waiting for Santa Claus—unless you plan to take that freedom away from them.
https://slatestarcodex.com/2017/04/25/book-review-the-hungry... might be interesting in the same direction.
This evening, go for a one minute walk.
Tomorrow evening do the same.
Next evening do the same.
Repeat.
The journey of a thousand miles begins with the first step.
1 minute will turn into 2 minutes, then 5 minutes.
And 1 minute is infinitely better than 0 minutes.
Start with a minute walk. Make time in your day for it. Extend to a 2 minute walk. 5 minute. 15 minute. Etc.
The point is, make a start.
All that is to say, these two are not mutually exclusive and if people receive this drug everything we already do to promote a healthy lifestyle will become much more realistic for many people, as far as I understand Ozempic removes the desire of hunger, it's not like people can continue their bad habits and take the drug and lose weight. Furthermore once they assume these habits, the generational cycle of raising children and over indulging will likely come to an end and we will probably not need the drugs as much.
TL;DR, people want to be healthy, they just don't have the tools or motivation to do it. Losing weight will likely be a gateway to many health improvements and benefits for future generations
Nobody talked about this in the mainstream conversations in the past.
https://letsmove.obamawhitehouse.archives.gov/
Out from underneath the rock, people have been talking about this nonstop for decades.
Food is the main cause of obesity. Obesity is the main cause of heart disease and cancer.