Comment by Aurornis | Hacker News Reader

Comment by Aurornis | Hacker News Reader

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> The medical establishment and big pharma simple ignores the fact that the biggest health risk for a human being is the "modern" high sugar diet

The medical establishment isn’t ignoring this at all. They’ve been pushing for healthier diets forever. Primary doctors have always been pushing for healthy eating.

That doesn’t mean patients welcome the advice or follow it. Everyone knows that eating high sugar diets and being overweight is unhealthy.

There was some short-live resistance to the idea that being overweight was unhealthy, but that wasn’t coming from the medical establishment. That was an anti-science, anti-medicine movement that went mainstream under a misplaced desire to not make anyone feel bad in any way. That movement has lost steam quickly as an easier option has appeared for reducing appetite and inducing weight loss.

I don’t understand how you’re trying to twist this into a claim that big pharma is ignoring the impact of unhealthy eating. GLP-1 drugs work by reducing unhealthy overeating and cravings for unhealthy foods.

There was a fringe that said being overweight was not unhealthy, but the more salient points were the following:

1. BMI was basically just pulled out of a hat, and it turns out that for many health concerns, the overweight class does better than the normal weight class, with the actual “clearly worse” outcomes really coming up as you trend into obesity.

2. Environmental and genetic factors are huge contributors to people being overweight. To some degree moralizing about weight loss is a bit like telling kids with asthma they should live in places with less pollution. Or telling someone with breast cancer to not have the BRCA gene.

3. Doctors would regularly miss health problems because they’d blame them on people being overweight / not exercising enough. Especially for difficult to diagnose issues, it’s easy to just point at the number you have that “looks bad”.

4. We still have no firm reason why people are gaining weight. The popular answer is sugar and processed foods but those very much already existed at scale in the 50s.

The tragedy is that it turned into a morality play where fat people were blamed for it, despite in many ways being as genetic as getting breast cancer.

The reality is people who actually study obesity know that basically GLP-1s are the only health intervention other than bariatric surgery that consistently works. At a population level no intervention has reversed fattening anywhere in the world.

To your point 4, we have lots of good reasons why people are gaining weight: they eat more. It's not exactly rocket science.

Obvious reasons include:

a) food is very cheap, especially processed food

b) portion sizes are comically large in the US

c) ubiquity of snacking and eating on the go, which is mostly high calorie

d) few people smoke now, and cigarettes are potent appetite suppressants

e) less social disapproval of being fat. To fair degree, being overweight is contagious

I agree completely with your last paragraph, at a society level. At an individual level, though, it's all on us to exercise self control for ourselves. Just most people don't want to.

Re point a, cheap calories have been around in abundance for 5 decades. The trend has actually been toward more fresh food being available, not more junk (most candies, sodas, and white bread brands are ancient).

lol at point e.

This is so not true. For a while there was a tiny blip where a corner of the internet was fat friendly.

I know a black lesbian from the south who was obese and managed to lose fat by weightlifting. She said by far being obese was worse socially than either of the other things. As part of getting in shape she started jogging and people mocked her for being fat while exercising.

> despite in many ways being as genetic as getting breast cancer.

This claim is utterly silly on its face. Look at pictures of folks in the US 60 years ago compared to today. The population did not randomly mutate a genetic condition towards the propensity of obesity. Folks who come from societies that are not all that overweight did not magically develop a genetic condition upon immigrating to the US. This claim is entirely non-credulous and most folks claiming such are doing so in bad faith.

Environmental is by far and away the largest factor. Meaning most everyone lives surrounded by highly palatable horrible-for-you food and lives extremely sedentary lifestyles entirely optimized for convenience.

It's really not something that needs ANY more examination than that. Fixing it is the hard bit. Everything else on top of this is a rounding error and not something that needs to even be discussed until the first order factor is fixed. Then we can start discussing nuance, outliers, and details. It's a waste of time otherwise.

GLP-1s are the only thing that has turned the tide even a little bit. Because people eat less. Any other benefit from that is again - secondary and perhaps interesting, but not the primary mode of action. GLP-1s proved it is the American diet that is the problem.

I think it would be enough to ban high fructose corn syrup.

> Everyone knows that eating high sugar diets and being overweight is unhealthy.

There is a lack of evidence that the public understands what healthy and healthy effectively mean to their day to day lives,

aside from “looking better”.

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