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I wouldn’t call you cynical; I’d go so far as to call you conspiratorial.
That is, i wonder if the article possibly mentioned the eyeball-attracting names of the weight-loss drugs as more enticing than just saying "cut out added sugars and these livers may well fix themselves".
What are you basing this on? Everyone I know who went on and off Ozempic kept off clinically-meaningful amounts of weight.
There is religious intensity to this popular unsaid (and blatantly incorrect) assumption that the human body left alone is perfectly made, and that any intervention in its mechanism is prima facie evil.
The human body left alone in a modern supermarket world is way off its original evolutionary envelope. I am a descendant of 300 generations of agricultural people and I still struggle with processing of milk. Most of our commercially sold foods aren't 300, but 1-2 generations old. We just cannot be adapted to that.
One, we don't know that. But two, it's fair to assume they didn't because their constraint was starvation.
Look, metabolic disease makes sense from a preservation angle. It's a safe assumption, in the wild, that one will not suddenly come across permanent sources of excess calories. So if one assumes starvation is the enemy, and the body finds itself amidst excess calories, it must assume this is a finite resource to be competed for. Herego, stuff your face. Build fat cells. And under no circumstance shoud you give up a fat cell. No, reduce voluntary motion and--if necessary--cut basal metabolism to ensure we can get these calories into our bodies before someone else exhausts them.
For what it's worth, I'm on the other end of the spectrum. My body happily burns away fat stores. This is frankly great in the modern world! But if I get seriously sick (or thrust into a starvation environment), my odds of dying are high--it's why folks with a mid-twenties BMI have a longer life expectancy than those of us closer to twenty. Not techhnically underweight, and with plenty of muscle. But also with less of a buffer.
> human body left alone in a modern supermarket world is way off its original evolutionary envelope
It's arguable that the evolutionary envelope was leapt off around the development of agriculture and animal breeding. (We're still on patch Tuesday from c.a. 10,000 BCE on lactase.)
What you are describing is so-called "thrifty gene hypothesis", it makes a lot of sense, but it hasn't been corroborated by actual genomic observations yet.
The problem with thrifty genotype is hunter-gatherers seem to have had less caloric volatility (if we control for habitat quality) [1]. So to the degree such genes might have emerged, it would have had to have been selected for during migrations. That, in turn, requires it be a relatively human-specific adaptation, which frankly makes me sceptical.
There is a lot of money riding on these drugs, and there is a story as to how we have got here. The drug companies that are marketing these weight loss drugs switched up their game after their previous cash cow, insulin, ran out of patent protection. Sure, they have got a new fix, but they care about their shareholders, not anyone's waistline. This does not make them evil, it is just business.
Standard practice for all drugs is to get them through the regulatory hoops for one thing, in this case diabetes (2) and then go off label, to get them prescribed for weight loss and now, fatty liver disease.
All of these conditions are one an the same, metabolic syndrome. So it does make sense to have these 'off label' uses, but you have got to respect the hustle.
If the article was properly researched then it would have outlined how that lifestyle interventions are preferable to prescription drugs, and that plenty of research papers have shown that Mediterranean and whole food, plant based diets (devoid of processed foods and animal products) have had some success at reversing fatty liver disease and enabling patients to obtain a healthy BMI.
I know some people throw a temper tantrum if a banana or a chickpea is placed on their plate, but the heart of the problem is lifestyle choices. Nobody is selected by a cruel roll of the dice to get metabolic syndrome, it is a lifestyle of car dependency, processed foods and saturated fats from animal products, probably washed down with fizzy drinks and alcohol.
Your mates that took Ozempic is anecdotal. Also anecdotal, everyone I know that follows Michael Pollan's advice to eat (mostly) plants has a healthy BMI.
Are you disputing GLP-1's efficacy?
> If the article was properly researched then it would have outlined how that lifestyle interventions are preferable to prescription drugs
This would have struck me as CYA filler. We know diet and exercise work. Nobody reading Lancet is confused about that. And if they're reading The Guardian and are confused about that, they're not going to have the ephiphany halfway through a medical opinion.
> plenty of research papers have shown that Mediterranean and whole food, plant based diets (devoid of processed foods and animal products) have had some success at reversing fatty liver disease and enabling patients to obtain a healthy BMI
Compared to GLP-1?
I have a sore throat right now. I'm eating lots of ginger and garlic and foods rich in vitamin C and zinc. (Taken with hot teas.) If it were to progress into serious tonsillitis, I'd be pretty pissed off at the surgeon throwing a honey-lemon tea reference into their briefing.
> the heart of the problem is lifestyle choices. Nobody is selected by a cruel roll of the dice to get metabolic syndrome
Sure. Yes. If people made better decisions in the past we'd have fewer problems today.
In reality we have a lot of people who didn't make good decision in the past. Their bodies are failing. If GLP-1 works, it works. Getting conspiratorial about Big Pharma or butthurt that nobody mentioned feta cheese and hummus isn't useful for the targets of such an article, people thinking about the health of their loved ones as well as the arc of public policy.