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I am very happy that these drugs helped your mother. I do not disparage anything about these drugs or anyone who chooses to take them.
...however.
You, like many others, go too far. Changing your lifestyle does actually work; it's just that many people don't do it. There are a bunch of reasons why they don't do it, and that's okay. They may be perfectly fine using a drug. Nothing wrong with that. But don't tell people that changing their lifestyle doesn't work, because it does.
Let's take something like, I don't know, becoming a doctor. I've heard that this process sucks. I've heard that plenty of folks burn out or fail at some point. I'm sure someone's mother somewhere failed in trying to become a doctor, regardless of how much her family tried to make her do it. Nevertheless, I think there are still fine reasons to say, "Here are the objective things you need to accomplish to become a doctor, and here are a variety of subjective tips to help you pattern your life in a way that is conducive to achieving that goal, if you so choose." Some people won't do it, and that's okay (in fact, the vast majority of people right now don't become doctors). We don't have a pill yet that magically gives people all the required knowledge of a doctor. But even if we did, it wouldn't be a reason to say that the other (true, good) information "doesn't work".
Ah, the good old "all that's needed is just some willpower" argument.
If anything would drive me to be a biological determinist, it's this. Oh, you find it easy to cut down eating, take more exercise, make necessary changes and stick to them?
Do you want a medal for that? Because it's not on you, it's not you making up your mind and applying willpower that does it. It's the genetic luck of the draw of having the fortunate combination of heredity and environment that gave you the physiological and psychological phenotype that means you can eat less, exercise more, and stick to changes.
Both my parents smoked. My father was able to give up smoking and never go back. My mother tried and failed, many times, to give it up and eventually she died of the lung cancer it gave her.
That was not a question of willpower, because my mother was not less strong-willed than my father, or more resistant to change. I don't know why she couldn't stop. She didn't know why she couldn't stop. She wanted to stop, she tried, she failed over and over.
Tell me "all that's needed is just some willpower" about that, and I will spit in your smug face.
Ah, the good old strawman. Actually, very very bad old strawman.
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As much as I hate to intrude on another's discussion, I'm simply going to point at my own experience in terms of weight loss and shrug helplessly.
Like you, I was of a similar attitude. Like you, I felt the majority of weight-gain and weight-loss issues was a matter of people simply not wanting to put in the effort. I still do, to a point - too many people think a diet is like an on-off switch, when I've found it really boils down to actively changing how and what you eat - it's a lifestyle shift, not something you do for a month to fit into your summer bikini. And why not? I did exactly that. I lost 70 pounds from strict CICO and modifying my diet.
However.
I'm not going to go more indepth into my own history of weight loss and weight gain. Instead, I'm going to point to my brother, who has also done the entire weight-loss via keto. And while he was able to lose the weight, there was a plateau, a wall in terms of weight loss he was unable to get past before he simply gave up - the juice wasn't worth the squeeze in terms of the effort he was putting in.
Full disclaimer, he's never been an obese-looking butterball or as heavy as I am, though I'm sure if you put in his BMI stats he'd be labeled as obese.
On semaglutide, he blew through that wall in a few short months and is still loosing weight. He's currently at the weight he was in high school, and hasn't hit a plateau. If things continue as is, both he and I will be at weights we've never been before, ever, and have no idea what we will look like.
I'm no doctor, no medical expert or scientist. I am but a dabbling amateur, stumbling around and trying to piece together a picture of the world. And as time has gone by, I'm becoming more and more convinced that our modern diet has done extreme damage to our bodies, damage that some can adapt to and overcome, and others can't. That we are subject to the cruel tyranny of the flesh that our minds are unable to overcome, even when we fervently wish otherwise. We've learned our lesson, burned our fingers and become wise, but we still carry the scars that we can't fix by ourselves no matter how we wish otherwise.
So we use drugs. Problem solved.
...now, on the gripping hand, I also have experience similar to self_made_human where getting people to loose weight forces you to do the equivalent of making a recalcitrant dog take their medicine, no matter how much they hate it, cause, y'know, they'll die otherwise, but such is life.
I don't think you have accurately captured my attitude. In fact, I think you have gotten it completely wrong.
Perhaps so. Biological processes in general do not seem to be fully-reversible, especially when you include the effects of aging. Nevertheless, that is not an argument against the measurable physiological benefits of certain lifestyle changes.
So educate me, then. Because the phrase 'Changing your lifestyle does actually work; it's just that many people don't do it.' falls pretty well in line with what my attitude would have been a year or more ago.
It isn't meant to be. My point isn't 'lifestyle changes don't work' it's that 'lifestyle changes can sometimes only work to a point'.
You went wrong a single sentence later:
Possibly so. I'd need to see some high quality research on this question to know much either way, where those points might be, whether they can be predicted, etc.
...do you not equate the phrase 'it's just that many people don't do it.' to 'not wanting to put in the effort'? I would think them rather similar.
Compare what I wrote:
I don't know to what extent a clustering can be identified that can be simply labeled "not wanting to put in the effort".
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I'm not denying that lifestyle changes work! If they didn't, why would doctors feel obligated to recommend them?
What I'm saying is that advising lifestyle changes rarely works. I don't have firm figures at hand, but I suspect that the number of people I've recommended such eminently sensible things like losing weight, stopping smoking and going to gym grossly outweigh (pun not intended) the number who actually did anything about it.
If there was a magic pill that did nothing else but make people go to the gym, it would be one of the most revolutionary advances in medicine of all time! It would be Nobel Prize worthy. We now, thankfully, have a pill that, if not literally magical, meets the "sufficiently advanced technology" threshold when it comes to obesity. It certainly beats even the most sage advice in terms of practical utility.
This is much more circumspect than your original comment. The problem of advice-giving is significantly different in nature, and it has significant dependency on a wide variety of external, contingent factors that are not-necessarily related to the typical time-independent, mechanistic processes that the biological and medical sciences study. If you would please kindly continue to be this circumspect in future comments, that would be appreciated.
I'm not being circumspect. I am merely elaborating on a point I've made, which was interpreted in a sense I didn't intend (I'm not accusing you of an intentional, bad faith claim, misinterpretations happen). I don't see any additional hedging, or caveats at play.
I would like to think I'm usually quite clear in what I mean via what I say, not that this is any guarantee of people interpreting it exactly as intended. Even legal documents and contracts, intended to maximize clarity and leave no room for error, often end up in the courts. They also make for riveting reading.
Then by all means, please elaborate on how you intended the following sentence to be interpreted:
That telling people to make lifestyle changes is highly ineffective? That implies nothing about whether or not the changes themselves don't work. I consider it clear enough, in the context of the comment. In fact, the very next sentence is:
The only reason we even bother trying is that telling people to do things is rather cheap and low-effort. In rare cases, they might even listen. It also makes us feel good, and ticks boxes.
So, in this sentence, what is the "problem" that is in need of a solution? Is it, like, "the problem of trying to decide what to tell people"? Or what?
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Sorry, what? You're just off the mark. Aside from the inherent differences between adversarial processes and other dynamic processes.
I don't know how this analogy is supposed to work. The point of the development of military doctrine is to build up a body of professional knowledge, generally to the purpose of, indeed, destroying the enemy (though there are sometimes tweaks for political constraints or other political objectives). This is, indeed, intended to be "what works".
Is the point of your analogy that the endeavor of developing military doctrine is simply fallacious from the get-go? This has other implications that I can think of. For example, rather than moving TRADOC, as Trump did, I think this point of view says that he should have simply eliminated it altogether. Of course, I think you can tell that I don't think that this is the point of the analogy, but I'm kind of struggling to see what the point is.
Maybe, on the other end, it's something along the lines of, "It's not terribly helpful to be a 400lb guy in a bed who just writes somewhere on the internet, 'Hurr durr, have you tried killing the bad guys?'"? I mean, sure? Yeah, I just don't get what you're going for, and I don't get how it's relevant to what I've said.
Mathematically speaking, I would distinguish the two. This may be a complicated and difficult environment, but it is not an adversarial one. There are deep mathematical differences between the two.
Oh, well then this is just the standard, all-too-common, strawman. You're responding to a figment of your imagination, not anything I've written.
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