Any answer that begins with "if everyone just-" is tantamount to doing nothing and those are the other options available, nothing except for weight loss drugs has managed to put a dent in widespread obesity.
It has nothing to do with spirituality or morals. Skinny-country person moves to the US, they get fatter (statistically speaking). They weren't skinny at home because they were better spiritual warriors or whatever, but because they didn't live in the US.
The options are to fix what are probably a whole bunch of problems across multiple domains at a cost of $(enormous sum) with a project spanning many decades (and which may easily be derailed and set back years and years at any time), so that living in the US doesn't make people gain weight, or... drugs, that work today. From a policy perspective, those are the only options. There's no good reason to think that reversing "moral decline" or whatever will help, since that doesn't seem to be why some other countries are skinnier.
Just to enumerate a few of the sides of this problem:
- economics. Junk food is more available because processed foods last longer and can be stored at mini marts and gas stations. It is true that beans and rice are cheaper than junk food, but junk food is a very cheap way for a dopamine hit.
- time: people have less time to cook due to working and commuting
- urban planning: walkable neighborhoods are few in the US. Lots of daily exercise is foregone for this simple reason.
- culture: the US has a very pleasure-seeking culture. Given the choice of having healthy food vs gratifying food, we tend to the latter.
All of these factors conspire to get us where we are.
> It’s more a spiritual / moral decline of culture in the west.
It's not a question of decline. There's no reason to think that humans today have less self control than in the past. We're dealing with obesity now because tasty, cheap food didn't exist until the second half of the 20th century.
I think there is a long list of reasons to think it is lower.
Self control is a skill which requires practice. A huge amount of our time and practice is devoted to chasing immediate gratification. Doom scrolling, tv, ect. This is all practicing the opposite.
The thing we seem to be learning especially now with GLP-1 drugs is that a lot of skinny people are not skinny because they have iron self control, but because they don't need it, because their bodies aren't constantly sending them screaming chemical signals to eat. These drugs turn those signals down and suddenly people stop wanting to eat so much.
So another hypothesis that seems totally in keeping with the data is that either 1) some group of people have always had this problem in history, they just haven't had access to food like we do now, and/or 2) something about modernity is pushing those chemical triggers up to overdrive in more people.
Self-control really sucks as a solution to anything. When was the last societal problem solved by a national campaign of personal self-control?
Im not saying there isnt a biological component. I think a large portion of the USA has a trashed metabolic and hormonal system. A lot of this damage is irreversible from overconsumption.
unless we start dosing children with GLP-1s preventatively for weight and medicate them for attention we should probably think about how we relate to our environmental conditions long term and prevent patterns from repeating.
There are lots of people out there not living their best lives
It’s not actually that tasty though. Maybe it was 40 or 50 years ago. But now most of it is flavorless. It just commonly available. And it’s not even cheap anymore. For the most part.
If you don't find it tasty, you probably don't have a problem with overeating it. But many people can finish half a bag of Doritos in one binge. I'm one of those people. They're delicious and don't satiate me fast enough to moderate consumption. That's why I don't buy Doritos in the first place. If they're around, I'll eat them.
I just swear that soda pop and junk food tasted better in the 80s. Doritos are actually still pretty solid. But it seems like everything that’s using high fructose corn syrup simply does not taste like the stuff did when they were using cane sugar for everything. I also think they got the food scientists going far deeper than that, and there were changes to the recipes that just continually drove pennies out of the product. But it’s no longer the product that it was back in 1970 or 1980. One example that always comes to mind for me is Sun Drop. He used to be able to see the bits of fruit floating around in one of those bottles. I don’t think Mountain Dew taste good anymore either it has changed.
Sure, our obesity epidemic is because everybody just suddenly decided to start eating more a few decades ago. Much more likely there is some environmental factor causing it. I guess calling it moral decay feels more self-righteous though.
> It’s more a spiritual / moral decline of culture in the west
It's not just the West.
"Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country's population" [1]. (It's about 7% in America [2].) Meanwhile in China, "the incidence of overweight and obesity among school-age children...was 15.5% in 2010, rising to 24.2% in 2019 and soaring to 29.4% in 2022" [2]. Same story in Vietnam: "The prevalence of overweight among children aged under 5 years increased from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, prevalence rose from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively" [3].
OP is right. "If everyone just..." is shorthand for wishing upon a star that the world were different. It's not a serious solution for reality as it is. (To the degree there is a social trust variable at play, it's in folks doing mental gymnastics to reject the clinical data.)
"yet those same people are unable to put less food in their mouths"
And you think that addiction is a moral/spiritual problem? Nope, it is an endocrinological problem. And precisely drugs like Ozempic have made it very clear, because it doesn't just treat obesity, but many other addictive behaviors like compulsive shopping or gambling. By "merely" altering hormonal balance in the target organism.
People once thought that smallpox was divine punishment for sins. It is 2025, we are on Hacker News, and yet the very same pattern of thinking emerges here, against all the scientific knowledge.
Given the "successes" of various prohibitions and wars on drugs all around the world, I don't think this is going to work, at least not with major unintended consequences (hello sugar-smuggling gangs with machetes!). People are really good at trafficking banned substances.
Treating addiction as a disease would probably be less violent and less likely to produce major human rights violations.
There is a middle road of simply taxing highly processed foodstuff more without banning it outright, but that also creates perverse incentives for governments which now have a source of income that they don't want to jeopardize.
Regulating food works relatively well in Europe, despite all its flaws. Like making sure that what we are sold as "food" is actually, you know, food and not something that tastes and smells like food.
I am an European too, and while I agree that overall quality of food in Europe is fairly good, we have been hit by the obesity pandemics pretty hard - which indicates that whatever we do is not a solution.
This is an example of equivocation: Insofar as there is a definition of "drug" for which "Thankfully, dealing drugs is forbidden" is (well, minus the subjective judgement "thankfully") categorically true, it is not one for which either "Addiction needs a drug" or "Drug needs dealers" is also categorically true.
We do know that some punishments were the result of sin. We have scriptural evidence. It’s also possible that smallpox was. The mechanism in which that things occur could very well be naturalistic, of course. These areas of examination are mutually exclusive.
Are you ready to throw stones in glass houses? We can list a thousand sins of people with actual political power that dwarf the sin of “accommodating” so-called lifestyle choices. Then we can talk about how those same people abuse trust at every opportunity.
I love how this is framed as if it's obviously a sinister thing, like some shadowy force made up MASH in order to sell drugs, rather than it being kind of a medical miracle that effective treatment regimes are becoming available.
In the article is this paragraph: Dr Paul Brennan, a co-author of the Lancet paper and a hepatologist at NHS Tayside, said: “GLP-1s (including Wegovy and Mounjaro) offer the potential to resynchronise our metabolism, by introducing feelings of satiety – fullness – and delaying the time the stomach takes to empty. These effects often result in reduced calorie intake, and improvements in how the liver handles nutrients as a result of weight loss, thus reducing scar tissue formation in the liver.”
I haven't been able to cure the fatty liver by self-control, so I'm intending to ask the doctor about a medical solution on my next visit.
This particular article came after that decision!
I know what you mean, and perhaps this is also a signal to "short" stock in sugar companies.
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".
> and then get them on the drugs for life, knowing full too well that they won't make the lifestyle adjustments needed to get them off the drugs.
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 original East African savannah sorta worked, hunters and gatherers don't suffer from metabolic disease much. (Though obviously they still succumb to injuries, infections and random disease such as appendicitis.)
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.
> human body left alone in original East African savannah sorta worked, hunters and gatherers don't suffer from metabolic disease
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.)
We have studied hunters and gatherers which survived into recent times and they indeed seem to be very metabolically healthy. "Starvation" is a strong word, but they certainly don't live in a world of plenty and tend to be lean.
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.
> 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.
The article isn't just poor journalism, it crossed the line into soft propaganda for the weight loss drugs.
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.
> drug companies that are marketing these weight loss drugs switched up their game after their previous cash cow, insulin, ran out of patent protection
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.
