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Scott's most recent post had someone linking to an article in the Atlantic about debunking a study, I went and read it and got sucked into the Atlantic rabbit hole.
Link one: Don't avoid romance says more people are single nowadays and unhappier nowadays because more people have avoidant attachment styles in the past, with some (mostly circumstantial) evidence that the amount of avoidant attachment is increasing. Ends with an exhortation to not be avoidant but doesn't examine the question I would have thought would be of interest, which is why more and more people don't have healthy attachment styles. (Aftereffects of higher divorce rate? Internet usage? Weaker community institutions? Microplastics? I'm just spitballing ideas but wouldn't a marked societal-leve change in people's psychology be something you'd want to investigate the causes of?)
Link two: The Ozempic Flip Flop as someone who gets full very quickly and doesn't have a very strong appetite, I've never really had good mental image of what it's like for normal people with normal appetites let alone obese people with obese appetites. This article in particular presents people who lost weight, noticed immediate massive benefits in their life they're desperate to keep, and yet still can't keep the weight from coming back. It is just the satiety setpoint being set so high it's torture for them to not eat to the point of overeating? I'm trying to match it to my own points of reference for "willpower" struggles but failing. I force myself to go to the gym despite not enjoying exercise, but that's forcing myself to do something, not forcing myself not to do something, so generally speaking once I overcome the activation barrier of inertia the hard part is over. I intermittently (deliberately, as opposed to non-deliberately) fast and can be hungry and craving food but to a pretty easily overcome extent. But what makes someone — who for months now has been eating much less — be unable to maintain the amount they've been eating for months but instead be compelled to keep eating more even though it's actively physically hurting them (and costing them in other ways, like socially). How much stronger incentive can you get? It makes me feel like at some level for some people food is an addictive substance like drugs. (And also still trying to understand how this gets spread — is it really hyperpalatable foods? Something else? We can watch countries become more obese... Whatever the underlying thing that makes someone susceptible to this is, it does appear to be something a country can acquire)
Yes.
The mechanism via which the body "hungers" is somewhat complex, but can be usefully simplified down to the action of ghrelin, a hormone produced in the stomach which makes you hungrier, and leptin, which does the opposite.
Surprisingly, obese people have more adipose tissue, which produces leptin. However, it ceases to have the usual satiety inducing effect, as the body becomes resistant to its action. The way this is perceived is the body interpreting the lack of signal for being full as a sign of starvation.
And starvation sucks. Other than disease, it's probably what's killed the most humans in all of history, and you can imagine that it's a very unpleasant state that the individual feels compelled to rectify. The easiest solution being to eat more, till the pain goes away.
They're also being struck with a double-whammy. In lean people, eating causes suppression of the levels of ghrelin, in obese people, it doesn't. So they feel less full, with the same amount of food, as compared to those at a healthy weight. Hence they feel compelled to not just eat, but eat excessive amounts for the sake of relief.
I can only reiterate that starving sucks, and the body will drive you crazy in order to avoid that feeling. It's too dumb to know or care that you are, objectively, perfectly well fed. Waterboarding feels just as bad as actual drowning despite the ~nil risk of death.
While doctors usually feel compelled to tell their patients to watch their weight and diet, this almost never actually works. I consider myself a pragmatic one, and advice that isn't actioned in practise is about as useless as advice that doesn't work at all. I was on the Ozempic hype-train well before it was cool.
My mother is very obese, and has been for over half her life now. She's diabetic, and has developed fatty liver with hepatic fibrosis. Her own commitments to working out and dieting never held. She's a doctor herself, so she knows, on an intellectual level, what the risks are. She's been driven to tears by the scolding she gets from my grandpa or my dad who genuinely care for her and want her to lose weight, and after gentle suggestions failed, were driven to tough love.
None of it worked. She loved to eat, and reducing her caloric intake was pure agony. For a long time, I was resigned to the seeming inevitability that she'd head into cirrhosis, and I'd have to steel myself up for a liver donation. It's a nasty, nasty surgery, nothing like giving away a kidney. It leaves a grossly disfiguring scar, leaving aside the significant risk of death during and after the procedure. I'd do it for my mom, because I do love her.
Eventually, when Ozempic, or oral formulations of semaglutide, became available in the Indian market, I badgered her into seeing her endocrinologist and getting it prescribed. Despite the initial nausea and diarrhea, she eventually adapted, and lost the lost weight she's ever managed, and kept it that way. Right now, my priority is hounding her into going to that gent again and getting that dose upped, it's well overdue.
Exhortations to exercise failed. Asking her to watch her portion size and not snack failed. Driving her to tears failed.
The pill didn't.
When people get on their high horse and claim that using drugs to solve your problems is a crutch, it takes everything I have to not tell them to go fuck themselves with a rusty pole. It saved my mom, fuck you. Nothing you have to offer, including your empty words, comes close.
To hell with willpower. A world where we can power through our problems with pills is a better one as far as I'm concerned.
I'm a doctor for many reasons, but ranking highly among them is that I have an urge to find solutions to problems that actually work. Telling people to use their will to get over depression or diabetes doesn't, and the same is true for obesity. Claiming the moral high ground and virtue signaling? Doesn't beat adding years of healthy lifespan.
Well obviously.
But when I broke my leg I got a crutch.
What the fuck I was supposed to do? Crawl? Walk on leg with broken bone, injure it further and howl in agony?
Crutches exist for a reason! There are stupid way to use them, I guess, but typical use of crutches is extremely useful in an obvious way!
I do not have problems solved by Ozempic as far as I know, but if I could pop a safe pill to solve procrastination issues I would do it!
When people call something "a crutch" they refer to the specific chronic problems they cause in long term use, and in particular that you can get habituated to them in a way that stops you from taking the harder steps required to get back to walking normally.
In this case it seems particularly evident that the issue with drugs that trick you into not feeling hunger at your normal rate is that it becomes that much harder to operate normally without them.
Unlike OP, I think a world where people can only solve their problems by becoming addicted to complex and expensive drugs is a bad one.
Now of course the effects of obesity are so bad that it's probably better to take the drug if you can't muster the willpower, but it's like taking opiates for back pain. Weening yourself off of the drug should be the ultimate goal, otherwise you're just embracing a different kind of slavery.
You simply regain your appetite, and around half the weight back in a year if you stop Ozempic. I don't see how that's not strictly better than not taking it.
The hell is a "complex" drug? Does it have a hard to pronounce name? Does it have a large molecular weight? Does it act on more than one signaling pathway?
Ozempic isn't particularly expensive. Most middle class people in the West can afford it, if it's not covered by insurance. There are legal or grey market sources that are significantly cheaper. And as more alternatives arise, including generics, it'll only get cheaper.
Gym memberships cost money too.
And Ozempic isn't "addictive". Do people not know what that word means?
Is insulin addictive to a diabetic, because they'd fall sick or even die if they stopped?
I would like to see you wean yourself off oxygen and water. Perhaps, to be less challenging or immediately lethal, clothing or shelter. Otherwise what are you but a slave to biological necessity?
This is all such immensely confused thinking that I don't know how such beliefs can even arised. At the very least, it is factually incorrect.
I'm not making the argument against taking the drug, I'm making the argument against being stuck in a local maximum.
One that relies on an international supply chain for its industrial production and the existence of a large enough empire to secure sea lanes. A type-2 technology.
Apparently they don't anymore.
From The Oxford English Dictionary, Volume 1:
From The Oxford Advanced Learner's Dictionary:
Saying diabetics are addicted to insulin because they would die without it is a tautology.
So is saying men are slaves to biological necessity. These are realities well understood since antiquity.
Such addictions may well be natural, but they are cumbersome, and one of the common criticisms of modernity is that it has tricked people into novel addictions under the guise of liberating them from natural ones. I would have thought this line of reasoning to be popular enough as to not demand explanation. But here we are.
I could throw it all back in your direction, but I'm afraid I know too well the source of your confusion, and it is that you think American Psychologists among other colleges of experts have dominion over the English language and its conceptual space. As if they can declare the valence of things by fiat.
It is an all too common sort of delusion that leads people to demand pronouncements from these priests as to whether certain lifestyles are or are not illnesses.
But as we are now in a place that is open to people who are not adherents of this religion, I therefore enjoin you to consider that such authority is not self-evident.
You probably mean minima.
Now, you define a "complex" drug as one that relies on international supply chains and "the existence of a large enough empire to secure sea lanes". I have to admit, this is a.. novel definition. Are you typing this on a "simple" device? The phone or computer you are using relies on a supply chain of such staggering, globe-spanning complexity that it makes Ozempic's look trivial. If you have taken a Tylenol in the past decade, there is an excellent chance it was manufactured in India or China and shipped across those same sea lanes. Unless you are a primitivist writing on handmade parchment, you are a beneficiary of these "complex" systems. It seems strange to draw the line here, at a medication that saves lives.
Oh, not all diabetics would die. They could, in an ideal world, live short but tortured lives! Is that a tautology?
So? Care to reproduce such arguments in full instead of waving at them?
You will not literally die without electricity or information technology. You seem to conveniently enjoy that particular fruit of modernity, while crying about this one.
Once again, the number of people who eschew electricity or computers seems awfully small. Modernity is, on the whole, quite nice. It could still do with improving.
I am not an American Psychologist, nor do I think they have "dominion over the English language". I also happen to think you're twisting that poor thing to your own ends, with willful ignorance of your actions.
Spare me your sophistry. If you Google "definition of addiction", one of the first hits is the Wikipedia article for the same, which says that:
Ozempic doesn't cause "substantial harm". Any negative consequences are grossly outweighed by the upsides of not being obese, let alone diabetic.
Your definition is ridiculously archaic, and by that definition, one could be addicted to collecting stamps, to morning walks, or to breathing. You have diluted the word to uselessness.
I have no "authority" over you, and never claimed to. Short of mod-abuse by banning you, which I've never done and have little inclination to do. I still have little patience for such clearly confused, utterly sloppy thinking, with the added temerity of trying to take the moral high ground through word-play.
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well, the problem here is that people in the first place were unable to operate normally without them, so it is not making worse
I agree, but superior over one where the same problems are unsolvable
which is quite idiotic phrase, given that crutches are not causing this at all AFAIK
Well it's interesting because that connotation actually is a lot more recent than the word and came about alongside new discoveries in neuropsychology and the concept of "productive struggle" through the work of John Dewey and Lev Vygotsky (of "zone of proximal development" fame). The latter actually did inspire the use of that analogy in Bernstein's work on motor development.
To my mind, it's probably more of an artifact of the developing supremacy of Trancendentalism in American culture, and all its ideas of "self-reliance", but you can't quite say the analogy has no scientific backing since it sort of came out of scientific discoveries in the first place.
Crutches don't (that I know of) have anything special to them except that they're an easy to visualize example of the neuropsy phenomenon in question.
Of course, I'm not saying we ought to ban morphine on the sole grounds it is addictive. Simply that the tendency to medicate people for life is a danger and that one should want natural health to be the outcome, even if some of the steps on that path are sticky.
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Precisely. I'm not sure why that terminology even came into the picture, given that it's not a reference to malingering, which is the only other remotely plausible way to misuse a crutch.
May I introduce you to our lord and savior, prescription stimulants? Not sure how I'd have become a doctor without them.
I am risk-avoider (at least in this variety of risk) that they do not seem safe enough for me, or would be really hard to get or are unlikely to work.
But maybe it is procrastination talking.
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