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.

[1] https://pubmed.ncbi.nlm.nih.gov/24402714/

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.