We still don't have quite the clear picture that we think about weight gain. There is some connection to more calories, less exercise, but it's not clean. And there are many nominations for exactly what foods are the problem - or what times of day, or time between meals, and a dozen other things. But there has only been one consistent way to lose weight, and that is fewer calories and more exercise - mostly the former.
Until now. The new weight loss drugs appear to be working, and quite reliably and well. Wegovy, Ozempic, and Mounjaro appear to be the real deal.
Wesley Dudgeon, and exercise science scholar, has come around on their effectiveness, though he is still worried and still thinks it hasn't been locked down.
In my lectures, I present data on the detrimental impacts on personal health of being overweight or obese. Then I show that, aside from surgical intervention, the best way to lower body fat is by starting an exercise program and improving dietary habits.
These new drugs have now altered what I teach in the classroom, and as a researcher I believe they raise many questions about the current approach to weight management and health.
Side effects will keep showing up - they always do. And new medicines turn out to have limitations, such as types of people they work less well on, problems if you start and stop them, other medications that neutralise them or can't be taken with them. But all systems are looking like go at the moment. There is a lot of speculation about what this will mean culturally, but anything that is expected to affect that many people that greatly looks like a wild card to me. I'm not even going to hazard a guess.
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Among our friends is a doctor's wife, a pharmacist by training (still certified but no longer working actively) who got on the wave early, back before it got to be known as 'weight loss to the stars'. She is pre-diabetic and talked her doctor into prescribing treatment, then dropped about 15 lb using Ozempic. But the problem is, with all the people using it for boutique weight loss, there's now a shortage of the drug for the diabetics that really need it to maintain their health - the insurance companies have wised up and no longer are willing to provide coverage for most policies, hers included. Without the coverage, the drug costs around $1000 per month.
Other drug treatments that are similar are now starting to come onto the market apparently, and this is bringing the prices down a little bit.
Yeah, that sort of manipulation by the wealthier works great in the long run, because market forces just do that, and attempts to screw with that are solutions worse than the problem. For example, look at the shortage of n95 masks at the beginning of Covid. Fauci and his advisors, with their smart/not smart desire to protect the temporary supply for hospitals, decided to lie to the entire country. It was part of being caught up in the idea, which many legit epidemiologists assured us was insanity but we wouldn't listen, of "flattening the curve," which had the enormous disadvantage of being partly true. If only it had been entirely insane! But no, it had enough truth to hang on and convince people.
Yet the downstream consequences of the lying was that when the vaccine came out people had already had it with government information. An entirely expectable* series of mutations destroyed all the one-size-fits-all nationwide solutions. We see this happen whenever there are petroleum supply-chain problems and there is a "crisis" which ends up with supposed price gouging that only the rich can afford to get gas for their weekends in the Hamptons. Fixing that screws everyone, but it gives politicians an excuse to pose as defenders of the Little Guy.
This will happen here as well. It sucks. Rich people who want to look better will scoop up medicines that other people need more desperately. We hate that. But attempting to fix it will make things worse, like, as PJ O'Rourke said, that guy who stops to help you when you are broken down on the highway who ends up lighting your car on fire by mistake.
Good lord. You eat more than you burn, you get fat. It is that simple.
I would be very careful with any drug that was fooling with those systems, that regulate this simple fact.
@ Pennie - That's been the myth for decades, yes. It appeals to scientific minds because it sounds elegant.
But scientific minds also should know that you should look at the actual experimental data. It doesn't bear out in the actual, you know, real world. Read up on it. You will find a lot of conflicting information that will make you crazy as you sort through it. But what you will not find is proof of that theory. Look for the unexplainable changes that start around 1980, which do not correspond with the more gradual increase in caloric intake since 1880 through today.
The drugs sound wonderful. Whatever the current pricing issues, eventually the drugs will go off patent and everyone will be able to afford them.
What seems indisputable, as is clear from videos of, say, NYC streets taken in the early 1980s, is that people have been getting fatter over the past few decades. Is this phenomenon simply a function of decreased activity and increased eating, or what? Does anyone know for sure?
Start with deciding who you are going to trust on the subject. Scott Alexander of Astral Codex Ten (previously Slate Star Codex) is very thorough and hyper-objective. He is very willing to look at a problem and say "We think we know X. But do we?" If he has a fault, it is that he is over-thorough and can be a bit daunting. He keeps current and knows how to read research and see through crap. So if you go over and put "obesity" in his search bar you are going to have to click on a lot of links and skim them to find what you think is best to know. Suskind reviewed The Hungry Brain about two years ago, and in my post about that also included a link to another site.
https://assistantvillageidiot.blogspot.com/2021/07/genetic.html Those would be my recommendations
OK. You take the weird drugs. I'll walk up the mountain. ;)
You missed the third variable: metabolism. This is the reason for the yoyo effect. It's why faecal matter transplants are currently the best-known low-effort method.
It is possible to do it by will alone but it's like advising people to breathe out more than they breathe in. Admittedly this is how you actually lose weight. 70% of the fat mass is lost exhaling carbon dioxide.
To lose weight without fighting your system you need to get the system in balance:
a. diet, fasting
b. zone2 exercise
c. sleeping right
Diet https://www.penguinrandomhouse.com/books/593329/the-gut-balance-revolution-by-gerard-e-mullin-md/:
1. starve the carbohydrate-dependent gut flora -- keto + killing spices
2. use pro-biotics on a keto (dairy if you tolerate it and it's real -- gets sour if you leave it, not mouldy)
3. reintroduce carbohydrates,
In the US it might actually be a real challenge. I'm in Eastern Europe and we still have a lot of real food here.
A bit more about metabolism. The way to get more mitochondria is zone 2 -- long, low-intensity training. "It's like revving in red on 1st gear.":
https://www.youtube.com/watch?v=txLrNhv8GW0
The reason why the Western world gets obese, gets vascular disease, cancer and unruly children is we are overloading our insulin system. This guy talks about it a lot:
https://www.youtube.com/@drekberg/search?query=cholesterol
https://www.youtube.com/@drekberg/search?query=salt
https://www.youtube.com/@drekberg/search?query=insulin
So yeah, previous comment. Walk up the mountain and load up on vegetables and fats, avoid carbohydrates and do occasional fasting (adding salt is the key because glycogen binds with water and your blood is flooded with water when you use up your reserves).
https://www.youtube.com/watch?v=KSSBiNPZs8Q
Greetings from Poland, I enjoy your writing a lot. All the best!
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