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This is all true, but if overweight is your most urgent health issue, and if the excess fat is causing other health issues, simply reducing weight by whatever means can improve health, and there are virtuous cycles too, if you are lighter you can move more, maybe you feel better about your body and treat it better, an upward spiral. The epidemic of overweight (or more specifically over-fat) is causing so many cascade effects here that it's well worth treating aggressively.
What I'd like to know is are these beneficial side effects just due to the weight loss, or are they available to normal weight people who take the drug? Is it actually the drug, or would they get the same benefits by losing weight some other way?
Anecdotal, but I think this tracks with what you're asking. I have never been obese, but due to family history of both connective tissue disorders and diabetes it has always been extremely important to me that I keep my weight in a normal range. It took an intense amount of mental effort on my part, religious food tracking and extensive exercise for decades.
When I started on a GLP-1 (due to a weird health situation that's not really relevant), the amount of mental energy I needed to expend to maintain my weight was suddenly gone. I don't feel sugar cravings like I used to, so I don't need to stay so vigilant about my diet. I don't spend my days monitoring my intake, planning out a rigorous fasting schedule, working out more than I'm naturally inclined to just to counteract that brownie I couldn't stop myself from eating. It's both a literal and emotional weight off. I am taking a very low dose but even so I honestly can't believe the difference. I am one of the ones who was will-powering through calories in/calories out and it was miserable. Now it's just...not.
Fair points, thanks! You raise a good point that if the weight-loss itself is inhibiting your capacity to otherwise want to, say, go running or be more active then you can break the destructive feedback loop and give it another go. In that respect, I'm curious if these drugs are generally prescribed with no limit or prescribed until reaching a target weight? I don't know.
To your second paragraph, I'd like to know too. My guess is the benefits at least in the short-term are similar to what can be achieved by maintaining a healthy diet (Mediterranean / dash / mind diet, notably) — again, at least in the short-term. If poor eating habits persist even if at a lower caloric level, then eventually as those nutrients run out, things will wear down no differently than a poorly maintained engine.
I do agree with the consensus here - it's weirdly moralistic to say fat people should just do willpower harder, if there a drug that works for so many. It's a lot like telling an anorexic to just eat more. Eating disorders are complicated. A drug that fixes the appetite and improves blood sugar handling is an enormous improvement compared to what we had before.
I've never been fat, but have been eating disordered in the other direction and there is no way I could have been convinced to eat more just because it would have been healthier. If there had been some drug to fix my relationship to food back then, I feel like nobody would have said "just use willpower and eat better."
It's interesting that this strikes at the heart of left vs right mindset, at least in America. Conservatives have a tendency to romanticize the notion of free will and individual freedom; that you alone are responsible for the choices you make absent of anything else like — will over systemic forces or regions of your own brain working against you. Whereas the left has a stronger tendency to recognize these other variables that apply pressure in such a way as to shape the path of least resistance in what you may choose to do.
It's like a story I heard about the mindset of Americans vs. Germans when they have a vehicular accident. In America, blame is often quickly pointed to the person for skidding off the road while in Germany they may send a team of engineers to assess how to reduce the environment to prohibit this from being possible in the first place (e.g., putting up a guard-rail). This is surely exaggerated and America of course has civil engineers, but you get the idea of a default state of responsibility.
Maybe the reality of executive responsibility and external forces is somewhere in the middle. Nevertheless, a systemic problem tends to require a systematic solution. So I definitely don't fault obese people for not being able to get skinny. I agree: definitely the wrong mindset!
My main concern is that if the cost of this weight loss is a masking of symptoms and warning-signs of other poor dietary habits, could that result in even more people suffering ailments kicked under the rug just because they perceive themselves to be healthy when looking in a mirror? (e.g., the smoker arguments of old).