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Comment by TFYS | Hacker News Reader

I think the incentive of not getting a life altering or threatening disease is much stronger than having to pay for the treatment yourself. If the cost has any effect on choices, it must be very small because it does not show in statistics.

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Then explain the trend in overweight/obesity/diabetes/heart disease statistics?

It has long been known that over consuming carbs and sat fats leads to long term health issues, easily measured by excess weight.

And yet, the vast majority of people over consume.

Sure, but making people pay for those treatments themselves does not change anything. For many the quick satisfaction of good food is simply a stronger incentive than a healthy body or a fatter wallet 10 years later.

1) Excess calorie consumption has only been true since about 1990. Up until that point, average heights were still increasing, so that meant that a significant chunk of the population were still undernourished. We are only about one generation from that mark, so people's social habits still haven't moved on from scarcity.

2) Nicotine, in particular, is quite good for appetite suppression. Unfortunately, the delivery system most people choose (smoking) causes more problems that the obesity it suppresses.

3) How easily people lose weight on GLP-1 agonists shows that obesity isn't just lack of willpower. The human body has a lot of systems encouraging you to hoard calories metabolically and very few systems telling you to stop. It is quite impressive that a single drug can somehow flip those metabolic systems completely in the other direction.

> 3) How easily people lose weight on GLP-1 agonists shows that obesity isn't just lack of willpower

What? I’m about as pro-GLP1 as it gets - see past comments on the subject.

But if anything it absolutely slams the door shut on obesity about being anything but overeating when the environment made it so damn easy to do so. The method of action is you are less hungry and eat less. Full stop. Secondary effects are a rounding error.

Sure, there are societal reasons people are fat now. I don’t actually believe willpower is a real thing when surrounded by unhealthy addictive choices. But being able to turn off the hunger switch and turn to easy mode is absolutely the reason these drugs work and are life changing.

I’m not ashamed to admit my being fat was due to lack of willpower to not eat excessively. Having a way to make it so I didn’t need to engage said willpower even half as much was the reason I’m now down to 12% body fat and am in shape from working out heavily. It’s not like you take the drug and you magically get thin - you still need to work at it and make healthy choices. They simply become easier to do.

Pretending it’s otherwise for the vast majority of people is a disservice.

The best most honest way I’ve come up with to describe these drugs is a performance enhancing drug for your diet.

Changing society at a root cause level would of course be far better, but that’s not realistic on any human lifetime sort of scale. This is the best we have for people alive today.

I eat whatever I want, don't really exercise and I'm not fat. I guess I just have awesome willpower.

One of the things that blew my mind when I moved to the US from Europe were the enormous portions and the amount of grease in every single dish when eating out. Even simple salads were shiny and drenched in oil. It only takes a small percentage of excessive calories over long periods to explain the obesity epidemic.

I agree with your comment, except that framing it as "lack of willpower" is unfortunate, because it implies that you should somehow be able to ignore these signals - if only you had enough "willpower". It seems to require an untenable amount of willpower to sustain a resistance to these signals, so perhaps it isn't realistic.

I think the main unhelpful thing is the implication that a lack of willpower is some kind of moral failing that means you deserve the results.

(The other fiction which causes problems is the idea that the amount of willpower required is the same for everyone)

The idea of individual locus of control is how western society has made so much progress. The idea of determinism that a certain subset of the "political left" has embraced is detrimental to the functioning of society, no matter how true it actually is. When people are not invested in their outcomes through a society-wide belief in individual control, we end up with situations like collective farming. Taken to its extreme, the idea of determinism results in "from each according to his abilities, to each according to his needs", equal outcomes for disparate effort and ability.

Carbs correct, saturated fats wrong.

Source: try keto diet with only saturated fats (like I do) and its great for weight loss (animal fat, coconut oil).

For whatever reason, mentioning keto or calories in, calories out around here is extremely unpopular.

I have watched many people lose weight with one or both of these methods, naturally.

I’ll never understand the pushback.

It's a bit like "just do some exercise" for depression. It's not wrong in that if you achieve it it'll help, but it's also something that's common knowledge and a lot easier said than done in practice, so it's not useful advice and kind of irritating when you hear it over and over again.

Keto also helps (sometimes) with depression though: https://www.youtube.com/watch?v=q7jg6wlD6gY (The Truth About Treatment Resistant Depression: Part One (Breaking the Myth))

And it's not "just do some keto" in this case. You have to be very strict.

But there are many dosages of keto diet and you have to do it correctly.

Epilepsy keto is hard for real and takes commitment. You will never eat modern food again in your life. But better than life-long-suffering just to eat cake.

So, because it’s hard to lose weight, solutions that work (which are hard) get shunned and argued against?

This feels like a “the truth hurts” kind of thing. Or a “personal responsibility isn’t my problem!” thing.

Maybe that’s the whole point though, anything that requires personal responsibility and accountability is rebuked.

What's your definition of 'solution that works'? Because yes, running a calorie deficit is a solution that works (for losing weight, it may cause problems for other, perhaps more important, goals for some people), but telling someone 'run a calorie deficit' is not, in general, a solution that works if your goal is to help the person lose weight (it can actually do the opposite, in fact, if you're sufficiently obnoxious about it). It works fine if you want to just blame them for not losing weight, though.

So yes, at certain point a person is responsible for themselves, but on the other hand, if you have a goal of reducing obesity, you're not going to get anywhere by just saying 'well, everyone who's obese is responsible, and I am going to do nothing about it but remind them of it'.

The whole world has been against saturated fat and pro carbs.

It will take some years for people to change.

What's funny is weight loss is extremely easy (with keto) and people still fail at large doing it inefficiently (with carbs).

I highly doubt the people overeating are picking up the fork, then considering "oh, I'll be really unhealthy when I'm older, but at least I won't be out any money for it" before they take their bite. Much like harsher punishments for crimes, this kind of thinking doesn't work because it's just not something people factor into their behaviour anywhere near as much as you would think.

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