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PaperclipPerfector  8mo ago (text post)   28930 thread views

Culture War Roundup for the week of August 7, 2023

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Given that obesity is sorta culture war related and in the news a lot, I figured this story would be relevant: Weight-Loss Stocks Soar After Obesity-Drug Study Spurs Investor Frenzy

Weight-loss tied stocks jumped following the update with rival Eli Lilly & Co. surging 15% to a record high. A positive outlook in Lilly’s earnings report also helped fuel the climb. Viking Therapeutics Inc., a drug developer working on a treatment similar to Novo’s Wegovy, jumped 12%. And WW International Inc. — better known as Weight Watchers — which bought a telemedicine firm that prescribes obesity medications earlier this year, soared 13%.

Novo’s Wegovy showed a 20% reduction in heart issues compared to those getting a placebo in a closely watched study. The results cheered Wall Street bulls who called it a best-case scenario. Analysts saw the benefit extending the market for Wegovy as well as Lilly’s Mounjaro and possibly removing an obstacle in insurance reimbursement.

I am more convinced than ever that these drugs are not only the future of wright loss, but similar to Paxil, is also going to a part of culture too and another tool or crutch to mitigate the downsides of modernity, except instead of social anxiety , it's too much food. We're sorta collectively inflicted this on ourselves, as victims of our own success. The pendulum if progress has swung so far towards abundance that we need modern technology just to try to undo it.

The other options were unpopular, to say the least, so it was certainly inevitable we would end up in this position.

I'm posting my reply here at the top level original post, but it is really a reply, or series of replies, to comments further down.

I used to be obese, I've used semeglutide, and I no longer am. There's more too it than that though.

I didn't grow up fat. I've always been a bit on the big side though. When I was 22 I was 6'3" and about 255lbs. I was very active, had a black belt in Judo, competed regularly and had excellent cardio. I was, probably genetically, just big. I was also jacked from 2-4 days a week hitting the weights. My favorite cardio has always been swimming.

About 8 years ago I was diagnosed with cancer. I don't want to get into the finer details but it was rough. After many surgeries I've been cancer free for about 4 years now. There were bad complications from a surgery and I was bed ridden on and off for almost a year with a wheelchair after for a while. During these years my dietary and activity habits of a lifetime vanished. This post is really about habits.

After beating the cancer, regaining my mobility, and returning to the world my appetite came roaring back one day. My ability to be physically active lagged behind. Additionally I became severely depressed. My career trajectory was irrevocably trashed by the cancer. I wasn't "tough" any more, lost my black belt (you have to actually maintain activity in Judo where the belts are competition classes that reflect ability, no ability=no belt). My finances were ok despite being out of work so I consoled myself with snacks. Lots of snacks. You don't really think about your dietary habits, built unconsciously over a lifetime, until they are gone. I was overeating all the time and was constantly starving. I could eat so much that it was physically difficult to stand up and walk around, and I was still starving. All the time.

Obesity is a physical symptom of mental unwellness, and its like quicksand. Or maybe its like any other addiction. Imagine being a heavy smoker, deciding you need to quit, but you still have to smoke 2-3 cigarettes a day for the rest of your life, or you would die. Food addiction can't be "quit" in the classic sense like drugs or alcohol. You can live without those. There also aren't trillions of dollars in advertising to sell you heroin everywhere, nor huge R&D departments to develop super-tobacco. Food has all of these things.

I couldn't be active, I was in constant pain (And still am), got more depressed about it, and ate more. Rinse and repeat until I was about 100lbs overweight. It was impossible to reign in with just "willpower", if such a thing even exists. After returning to my meditative practice I was determined to make a change so I spoke with a doctor who suggested the semeglutide.

It took about 5 weeks for the berserk, constant hunger to switch off. The other primary effect is I felt full faster. Through some mechanism this drug speeds up the internal sensation that says "you're full now". This was enough to reforge my relationship with food. No calorie counting, no "willpower", no tricks.

Being heavy itself is self-reinforcing. Being fat makes you want to eat more. This drug short-circuits this feedback loop and provided the slack in my bad habits I needed to readjust. The body gets used to a certain amount of caloric intake and screams at you if it doesn't get it under normal circumstances, but the body can be "trained" though reduced intake to expect fewer calories. The drug suppresses that "screaming" for more food, the constant hunger that is only reinforced by eating, not sated.

After about 15 months it was largely complete, by body now expects 1500-2000 calories per day. The doctor was pretty alarmed at how little I was eating for someone who is 6'3'', suggesting 2500-2800. I don't know what happened to my metabolism but at 2500 calories a day I immediately began gaining weight again, fast, so I'm back to about 1700 or so daily. I'm not hungry like I was after the cancer anymore, I've been off the drug for about 6 months now and haven't put any of it back, no longer experience constant hunger, and am swimming again for the first time in 8 years.

I could not have done any of this without semeglutide. Obesity is a tailspin of depression and increased hunger that most people cannot pull out of. People who are very self satisfied in their own weight and judgemental of the obese have no understanding of any of these issues. Their bodies are trained to expect a certain amount of calories and activity and are largely on autopilot. They put almost zero effort into their own weight control, congratulate themselves on their moral superiority for being thin, and wallow in their hatred of others.

This last point often gets overlooked in out culture. Many people absolutely hate fat people. They despise them with a vitriol usually reserved for heretics or murderers. They keep it under wraps as its not socially acceptable to express these opinions in our present culture safely, but will pounce on any opportunity to lash out at the hated other, who they are superior too. Maybe there is some evolutionary advantage to this.

I used to be one of these people. I lived in the gym and the dojo. I reveled in defeating my opponents in competition. I had a lifetime of good diet and exercise habits, until I didn't. This is the opportunity these drugs offer, a break in the dysfunctional cycle of poor diet to give the body time to be re-trained. Even this is too much for some people though. Fat people, being morally inferior, deserve nothing but suffering forever until they die in misery apparently.

The drug suppresses that "screaming" for more food, the constant hunger that is only reinforced by eating, not sated.

It's incredible how similar this sounds to my adhd meds, which also happen to be common eating disorder meds.

'The ability to quiet my screaming mind' is exactly how I would describe them. In my case, it is the constant urge to click on whichever interesting thing enters my peripheral vision or peripheral mind-space. I have also noticed something similar. Even when I am off my Adhd meds, I can now quiet my mind a little better than before.

You also had fucking cancer and still struggle with chronic pain; your fatness had rather more to do with bad luck than the median fat person's. Still: I appreciate your story. Respect.

I'll give the pushback while mostly agreeing. There are two sides to the fat people hate.

Yes, there is some latent contempt for fat people. But it didn't come from nowhere, and is not frequently directed at people who just happen to be fat. Nearly every conversation I've seen or heard of people trashing fat people has been in the context of delusional fat people making outlandish claims about how it's impossible to be healthy and the people trashing them nearly universally praise fat people who are recovering by working out and fixing their diet. And this makes sense because the loudest contingent of people who hate on fat people are former fat people where the pushback is against ideas that they see as having hurt them. They see the shame they are heaping on fat people as trying to instill in them the same mentality that got them out of the hole. And in a world without semiglutide, a world we've all had to live in for the majority of our lives, the experience of having your coping about how you're "big boned" or have a "slow metabolism" is bullshit and that there exists a clear, if difficult way out. And once you've found your way out and seen what that mentality was doing to you it can be infuriating to see other people transmit those memes.

Am I saying there is no limit to how much cruelty fat people should endure? Am I saying that it isn't harder for some people than others? No and no. But overcoming them was worth so much more than I can really express. It is simply true that it is much much worse to be fat.

Thanks for sharing your experiences, I can relate to a lot of it. Speaking as an overweight but formerly obese person, I don't think that people in general really hate fat people that much. They hate the idea of themselves being fat, and may resent fat people for getting away with being fat when they wouldn't be able to live with themselves for being fat, but I think that generally people are as accepting of fat people as they are of dwarves or the mentally challenged or some exotic ethnic minority or whatever. Fat people probably hate ourselves more than the average person hates us.

Amazing post, thanks for sharing your experience.

This last point often gets overlooked in out culture. Many people absolutely hate fat people. They despise them with a vitriol usually reserved for heretics or murderers. They keep it under wraps as its not socially acceptable to express these opinions in our present culture safely, but will pounce on any opportunity to lash out at the hated other, who they are superior too. Maybe there is some evolutionary advantage to this.

I used to be one of these people. I lived in the gym and the dojo. I reveled in defeating my opponents in competition. I had a lifetime of good diet and exercise habits, until I didn't. This is the opportunity these drugs offer, a break in the dysfunctional cycle of poor diet to give the body time to be re-trained. Even this is too much for some people though. Fat people, being morally inferior, deserve nothing but suffering forever until they die in misery apparently.

I share the perspective you describe. I know I have an absolutely ravenous appetite but at 6'2" 220lbs with half-assed diet scrutiny but lots of weightlifting and HIIT cardio I'm pretty happy with how I look and what I'm physically capable of at my age. But I also know (and often forget) how easy it is to fall off the wagon. I dislocated a kneecap while giving someone a lapdance (I wish I could say it was worth it but no it fucking wasn't) but it took several months of ineffective physical therapy to find out that I had a complete ACL tear.

Just finding out the news led me to completely give up on all my habits because given how long ACL surgery recovery takes, why bother? My weight ballooned by 15lbs just in the month leading up to the surgery. After the surgery I was stuck on crutches for several weeks and because I was also unemployed at the time, I also had absolutely nothing to do except eat a lot, so I gained another 15lbs on top of that. My surgery recovery took far longer than it needed to, because I'd constantly oscillate between "oh fuck me I don't fit in my clothes anymore, I gotta start cutting NOW" and "oh fuck me I am too fucking exhausted from cutting calories to do any of my physical rehab, and still too debilitated to have the option to go HAM at the gym like I used to. That tension was agonizing to deal with in the moment and eventually resolved with time, but I forget how lucky I am that I have the health and enough positive life circumstances that allow me to turn things around if I need to.

This reminds me of an experience I had. I was on a cycling trip. We were riding all day, every day. I was eating approximately all of the calories, and I saw that it was good. Then one day, I banged up my knee enough that I was going to have to stop riding, potentially for the remainder of the trip. I realized quickly, "Uhhh, damn, my appetite is still yuge, but I just ain't burning that much anymore." Thankfully, I had a pretty deep experience with counting my calories in the past, so I just forced myself to cut back, basically immediately, all the way to where I would have been without all the activity. Also thankfully, I was still spending all my time with a really positive group that I really liked, so my mood was still good, and I was able to just make the switch without too much agony. I'm exceedingly grateful that I wasn't stuck at home by myself or something, because I can imagine the psychological effects wouldn't have been nearly as pleasant.

I think this is perhaps one of the biggest divides between the people who say, "We're not morally judging; we're just saying that this is reality and that you have to find ways to make plans, enforce those plans, and have a proper support system to succeed," and those who think that the first category is simply morally condemning them. Like, no, I feel like most of us genuinely understand that there are strong psychological factors at play. There are strong psychological factors at play when people like, become alcoholics, too. Lots of people can tell stories of how this or that setback led them to the bottle spiral. I get that. But that it doesn't mean there isn't a path out. It doesn't mean that you have zero agency or ability to climb out of the spiral. Nor does it deny the real physiological damage of alcoholism/obesity or the physical effects that can contribute to the spiral. We just want people to succeed. We want them to win. We want them to learn and to overcome. We don't want them to believe the lie that they are totally and completely helpless in the face of some magical force that like, causes some bodies to consume 500cal/day, feel the physical/psychological effects of being in a deep cut, and yet still somehow gain weight. The more that people tell that lie, the more hopeless they will feel, and the worse the psychological spiral will be.

I empathize a lot with this comment. I did not go through a drastic life change like you did. I was just always a skinny guy whatever I ate ... until I turned about 22.

I started gaining weight slowly. An additional 10 to 15 pounds a year, but I went from skinny to pushing the obese BMI weight category in 5 years. And then suddenly I started losing a bunch of weight. I thought it was great until I visited a doctor ... my liver was getting destroyed by sugar. I had type II diabetes and I wasn't even 30.

Its been a few years. I've managed to get my blood sugar levels in line. I completely quit sugar, started intermittent fasting, and I'm on metformin which gives me explosive diarrhea anytime I fail myself and eat too much sugar (and no, the punishment of explosive diarrhea was not enough to really stop me from eating sugar).

I think quitting sugar has easily been the most difficult thing I have ever done in my life. Not that I've racked up a whole bunch of difficult life experiences. But quitting sugar is always gonna be on that list of metrics.

I had a lifetime of good diet and exercise habits, until I didn't.

I had a lifetime of bad diet and mediocre exercise habits. And it took 25 years before I paid the price. In an alternate world where obesity related problems aren't treated as a medical issue, I'd be fucked. The battery of blood tests that diagnosed the diabetes and liver problems wouldn't have existed in that alternate world. I would have just blissfully kept eating sugar for a few more years before organ failure and possibly death.

I'm glad you seem to be doing better. I'm glad there is another tool in toolbox for dealing with obesity.

Holy balls. You might want to talk to your doctor about MODY - maturity-onset diabetes of the young. Is there a strong family history of diabetes? 28 is very young to wind up with diabetes, poor dietary habits or no. I've seen it, at 25...but that person had a BMI of 70.

My dad has diabetes, but he was diagnosed with it in his old age, after me actually.

My A1C is under control these days. But yes it is strange how early it happened, the doctor was very confused.

Congrats on beating cancer (I have a close family member going through that right now), and I'm quite enthused that you broke the cycle and have found your way back toward good habits!

But I have to ask, who are you talking to in this thread? There's like the one guy with one line who was immediately banned, but where is there anyone with anything even approximating vitriol usually reserved for heretics or murderers? Where is there anyone who is saying that fat people are morally inferior or that they deserve nothing but suffering forever until they die in misery? I see literally no one saying anything remotely like this... but I see multiple people claiming that other people think stuff like this. Like, nobody thinks this.

To the crowd, what is the phenomenon that is causing a variety of folks to conjure up cartoonish fat haters?

It kind of feels like the undercurrent to everything @Walterodim has said in this thread.

I cannot imagine someone experiencing the joy of fitness and mastery in a sport and saying, "no, I am too busy getting knowledge". The extent of how weird I find it is that I basically just don't believe people and think it's excuse-making for sloth.

The preference to have subsidized drugs rather than pick a sport and eat reasonably is loathsome to me.

There are other examples but I hate this thread so I don't want to find them. I say I sense that undercurrent in those comments because they are the kinds of things I would say back when I was Flex Mentallo, so I might be typical minding, but I don't think I am. He refuses to try to understand alternative perspectives and simply decides they are lying about their values. That is the behaviour of people who believe themselves morally superior.

The first comment is in response to someone that literally said they "can't imagine people spending hours at a time contracting their muscles presumably for fun, instead of enjoying gathering new knowledge or engaging in the debates with educated people from around the world", as though that's actually a set of interests that compete with cycling. The second is a comment that I stand by. I do think maintaining fitness is superior to neglecting physicality, so no objection there.

That said, the idea that I "despise them with a vitriol usually reserved for heretics or murderers" is absurd and completely unsupported. Yeah, I think obesity is usually a product of gluttony and sloth, but no, I don't hate people for having normal human failings. I do hate that we have a massively subsidized medical system that profits immensely from medicalization of everything from obesity to sadness and dispenses hundreds of billions in drugs per year. I'm sure that there are people, such as the topline commenter in this sub thread, that really do benefit from that, but I'm appalled by pharmaceutical solutions to character issues as a normal matter of course.

You say it's a character issue, but it's difficult for me to credit the modern phenomenon of mass obesity to sudden onset degeneracy rather than the mass availability of Oreo biscuits. Maybe we were always gluttons in search of a buffet big enough to kill us.

You say it's a character issue, but it's difficult for me to credit the modern phenomenon of mass obesity to sudden onset degeneracy rather than the mass availability of Oreo biscuits.

The Oreo dates back to 1912; it was a slightly sweeter of the 1908 Hydrox. The obesity epidemic is not that old.

In 1912 Joe Average couldn't afford to buy a shit ton of Oreos and also did a lot more physical activity.

I assumed 'vitriol reserved for heretics and murderers' was the kind of hyperbole often used by people who feel unjustly despised, because never mind the motte, there are so few people anywhere in Western society who vocally hate fat people on the same level as murderers. It was considered impolite to be visibly disgusted by fat people even before the body positivity movement was created.

Anyway hate is the kind of word everyone rates differently, would I be wrong to assume you consider fat people broken? Or that you think obesity is repugnant? If charles hadn't explained his situation and had just said "I used to be obese, I've used semeglutide, and I no longer am", would you not have assumed he was just taking a lazy shortcut?

Anyway hate is the kind of word everyone rates differently, would I be wrong to assume you consider fat people broken?

I would consider them "broken" in the same way that anyone that has a reparable defect is.

Or that you think obesity is repugnant?

Yes, of course it is.

If charles hadn't explained his situation and had just said "I used to be obese, I've used semeglutide, and I no longer am", would you not have assumed he was just taking a lazy shortcut?

Yes, because the vast majority of obese people are obese for straightforward reasons that don't have much to do randomly distributed crises. The correct prior remains that it's not that complicated of a story - modern food is too delicious, too plentiful, too subsidized, too cheap, and many people just eat too much of it. I still think drug treatments are a shortcut that I'm unconvinced of the long-run efficacy of. If it works and gets people back on track, that's great. I don't think the cornucopia of pharmaceuticals approach to health is actually working out very well and I'm not excited about subsidizing it. I do wish individuals well though.

I wonder what Big Food is going to do. They've spent decades perfecting hyperpalatable foods you can binge on, and now Big Pharma is cutting them off by directly suppressing people's hunger. They are now in direct competition.

There are surprising synergies (I promise the word works in this context) in scenarios like these. You have to start with understanding what metric the consumer optimizes when there are no limitations.

Health and Palatability have always been counter to one another. When given a choice, people have chosen Palatability. So the consumer maximizes palatability until they reach a point where their health falls off a cliff (and sometimes they keep going even after that).

So far, the food industry has worked with this limitation. Create the most delicious food, but stay under a certain calorie limit. If you think that 2000 calorie Cheese-cake-factory pasta was the limit.....hoo boy are you in for a ride. If the new drugs allow us to move the needle on the point where health falls off the cliff, then we are not going to necessarily see healthier people. We might just see unhealthier (and even more palatable) foods while people more or less stay in the same weight bracket. Portion sizes might go down, but calorie counts might stay the same. People might start having Bubble tea / liquid calories with every meal.

When fundamental limitations of industries go away, we often see the culture change dramatically. Once that happens, older intuitions on what industries worked well together and which were in conflict do not work anymore.

What I AM worried about, is drug dependence. If your eating habits only work in a world where you regularly consume these drugs, then you'll never be able to cope without them. Even worse, if the world is built with the assumption that everyone consumes them, then it will be especially hard for a drug-avoider to sustain themselves in that culture.

If the new drugs allow us to move the needle on the point where health falls off the cliff, then we are not going to necessarily see healthier people. We might just see unhealthier (and even more palatable) foods while people more or less stay in the same weight bracket. Portion sizes might go down, but calorie counts might stay the same. People might start having Bubble tea / liquid calories with every meal.

Isn't the whole point of Ozempic and friends that it's not a magic calorie burner, but an appetite suppressant? The market for food will simply shrink.

  • snack manufacturers can start to directly compete with the new drugs by designing the most addictive snacks ever. Like, something so salty and sweet and fatty and umami that you just have to eat it even if you're going to skip lunch and dinner
  • or they can come up with new stuff that's doesn't really trigger satiation because it has no calories. Don't feel like drinking soda? Try some La Croix. The smell of bread no longer makes you hungrier? Have some dietary fiber puffs

You make the assumption that palatibility is infinite with more sweetness and more calories and sugars.

This is a ridiculous claim that needs accompanying sources.

The future of an America that requires weekly injections in order to stay healthy is basically "what's the cost to live an extra ten years?" Well, that cost is looking to be approximately 400$/month.

In my experience cooking (which is decent, but not noteworthily vast), adding extra salt, sugar, and fat is basically a cheat code for making tastier food. Not all tasty food is inherently unhealthy, but when you're eating at a restaurant and not watching them cook (and sometimes when you are, like on cooking shows), marginal extra butter probably improves critics' reviews.

There's a Laffer curve to it though. I love my salt, sugar, and fat, but you can only have so much of those things before it makes the food gross.

I would argue they are not making this claim at all. The world of food is vast, and the arms race of palatability has been applied unevenly.

If a 10oz lasagna previously eschewed butter soaked breadcrumbs for toppings and went light on the mozz, but should now be 6oz with all that added in, then the nutrient density of the food overall has dropped.

That being said, you raise a good point - I'm already disgusted by some of the more exotic foods out there that are terrible for you. There is an upper limit to what empty food people will eat, probably represented by a deep-fried stick of butter. There's a distinct correlation between calories and feeling full, so even if weight loss drugs are only acting on the latter, they'll still reduce how much trash people are eating.

If you assume that our sugar addiction is a palatibility problem and not a physical one, certainly.

With the onset and effectiveness of semaglutide, it's becoming clear that it is a physical problem.

I think if these work it will have a huge cultural impact, particularly in places in the Midwest or South where almost everyone is fat. Fat people don’t particularly like looking at or being with other fat people either. There are probably 50 million or more beautiful faces waiting to be liberated from their fatness. This could be one of the single biggest aesthetic improvements in modern history.

Fat people don’t particularly like looking at or being with other fat people either.

Surely you've heard of gay bears? We love each other. Yes we'd probably all rather be 250 pounds of muscle than fat but we'd still rather be 250 pounds of fat than 90 pounds of twink...

This could be one of the single biggest aesthetic improvements in modern history.

To each their own! We all have our preferences.

One of the best outcomes of feminism for me personally has been all the fat women in advertising and movies.

One of the benefits of Reddit was that I could tag people via RES. Facts like these make me want this feature here, right now.

I had to concatenate multiple tags into acronyms. You could use CCC for primaprimaprima - Confirmed chubby chaser

I had "average BBW enjoyer" in mind, but yours works too.

Personal preferences aside, most men are going to prefer looking at women whose fertility potential is highest. Obese women are less fertile.

And my guess is that you are excluding women who carry weight in their abdomen from your preferences.

Similar to how many women say they like guys with a "dad bod" but are definitely not including guys with big man boobs, or a soft round butt, in their calculations.

And my guess is that you are excluding women who carry weight in their abdomen from your preferences.

I can most certainly assure you that I am not!

Fat? Or Thicc?

I mean it varies I guess. But in some instances, yes, fat.

I'd be rather suspicious of possible side effects.

For this reason, my personal plan is to wait 5 years and then do a cost-benefit analysis.

My BMI is around 26 so I can afford to wait. And yeah, I could get down to 22 or whatever, but then I'd be hungry all the time.

My read of the literature is that a BMI around 26 does not add any meaningful risk and may well be protective in many cases. If you're active, I doubt you have anything to worry about at that weight. Decreasing your weight would be either a vanity or performance project, not a strictly health-based one.

Possibly. I think I remember hearing about a paper that said a BMI of 27 is ideal for lifespan. There were criticisms about confounders. Specifically, a sick person with cancer, or a heroin user or whatever is going to have a low BMI. I'd have to do more research. But when "surprising" scientific data with many confounders goes against common sense, it is nearly always common sense that wins out in the long run.

Mice certainly seem to live longer by eating fewer calories.

There would have to be some truly terrible side effects to be worse than the normal effects of obesity.

crutch to mitigate the downsides of modernity, except instead of social anxiety

Of course, the drugs seem to work like shit compared to be an authentically mentally healthy human being. I expect that Wegovy and similar drugs will wind up similar on a number of dimensions. I genuinely cannot imagine preferring a lifetime of pill popping to just riding a bike.

Really? You can’t imagine why someone might prefer not to spend time on a bike?

Cardio is boring. I’m saying this as someone who grudgingly runs 3x a week anyway, because it is valuable. Much as I choose to drive instead of carrying my groceries, I’m not opposed to a technological solution.

Just curious. Why run 3x a week instead of lifting if you hate running? Many would argue that lifting has better health benefits, and is especially better for male aesthetics.

I have an elevated heart rate and don’t want to rely on beta blockers forever.

Also, my apartment complex has treadmills and free weights, but no squat rack. I miss that in particular.

If you have any recommendations for a free-weight program, I’m all ears.

Dr Mike had some DB exercises for the lower body in one of his latest videos.

Many would argue that lifting has better health benefits

Citation? Maybe I'm lifting wrong (too few reps with too much weight?) but I never get my heart rate up for long while doing it. IIRC exercise-elevated heart rate and breathing are what most directly translate to better cardiopulmonary health and stamina, which is what has the strongest effect on healthspan and lifespan.

There are many studies which conclude that strength, as measured by grip strength, is highly correlated with life span, even for individuals under age 60.

Here's a review: https://pubmed.ncbi.nlm.nih.gov/20829298/

What's your HR when doing squats? I usually got to 80%+ of my max HR when doing 5 reps at my working weight. Now, I do lighter weights and still experience elevated HR, but not to the same level.

My general understanding is that resistance work alone is enough to get someone to a decent level of cardiovascular health. Is there a lifespan benefit to being 95th percentile in resting HR or VO-2 max as opposed to 80th percentile?

I'm not @netstack, but cardiovascular and resistance training are both necessary for ideal health and performance. Even someone that's beautifully sculpted will be fitter and healthier if they mix in some running, biking, or swimming. It only takes a couple hours per week to provide a large boost.

Yes, really, I genuinely can't imagine preferring a sedentary life to a life with some chosen sport. I chose biking because I like biking, but it sure doesn't have to be biking - go swimming, do a hard trail hike, roll on a ju-jitsu mat, do Crossfit, play soccer, just pick something and do it. I cannot imagine someone experiencing the joy of fitness and mastery in a sport and saying, "no, I am too busy getting knowledge". The extent of how weird I find it is that I basically just don't believe people and think it's excuse-making for sloth.

I cannot imagine someone experiencing the joy of fitness and mastery in a sport and saying, "no, I am too busy getting knowledge".

Finally lifting to a point where I can empathise with this and the issue is that the reward is the wrong way round. Assuming someone who is unfit and bad at sports, your main experience of exercise is as a mist of childhood pain and humiliation.

You have to go through that, spending quite a lot of time and money doing something boring and painful before you start getting a reward. And if you don’t have people to help correct your form and technique you might not even get a reward at all. So it’s very easy for people either to conclude it’s not worth it right from the start; or do it for a couple weeks, conclude it’s horrible and doesn’t work, then quit, telling all their friends not to bother.

Personally I blame it on PE. If we taught it like we taught other subjects, paying even the slightest attention to children’s abilities and actually trying to improve them over time, a lot more people would be a lot more active.

Personally I blame it on PE. If we taught it like we taught other subjects, paying even the slightest attention to children’s abilities and actually trying to improve them over time, a lot more people would be a lot more active.

For all that Mottizens complain about American public schooling, I'm surprised that American PE isn't criticized more. I won't say my experience was particularly bad, but I feel like gym class is quite possibly one of the biggest pain points in American childhood.

Not just American public schools. I went to a good school in the UK and the contrast between the high quality of the lessons and the low quality of the PE was pretty stark IMO. The PE wasn't shoddy, they spent lots of money on good facilities. But we used to call it Games rather than PE and I think that highlights the disconnect for me. It was intended to let the sporty children do well at sports and win prizes for the school. There was no real interest in improving children who were in the bottom half, or in physical health as such, and the exercise was very standardised. As a below-par child you learned very quickly how to fake being able to do 20 press-ups and stay on the parts of the team that didn't require lots of running around. If they had sat down with us and explained how you get stronger / fitter, and made any attempt to do progressive training, I think a lot of people could have had big improvements.

I try to go to the gym to run every other day (or every third day), and try to mix in some HIIT here and there as well.

I hate it so much even when it’s less than 10% of my waking hours. If I could be perfectly fit without exercise, sign me the fuck up.

I’m the same way. I’ve exercised now for a while, 3x a week, lift, reformer pilates, run, and I hate all of it. I have never enjoyed exercise, I have never enjoyed the gym, the most I can say is that I feel mildly satisfied after I’m done, the same way I do if I order a salad instead of a cheeseburger and fries, maybe.

I genuinely cannot imagine preferring a lifetime of pill popping to just riding a bike.

As someone currently using semaglutide, and having lost 40 lbs with it after around 10 years of trying to lose the weight, you are severely underestimating the variance in the willpower required for people to lose weight. Of-fucking-course the healthiest choice is to never have been fat in the first place, just like it's better to never start smoking cigarettes, but once you're addicted and fat, it makes no sense at all to insist on trying (and failing) to do it without help. Semaglutide helps you make better choices and dig yourself out of the hole, sure, it might not be healthy by itself (just like nicotine patches), but it sure as shit is healthier than having a 45lb plate strapped to your back all the time.

and dig yourself out of the hole

Are you out of the hole, though? I'd happily pay for 6 months of semaglutide to lose 20 pounds, if I expected the 20 pounds to stay off, but from what I've read it sounds like you basically have to continue taking semaglutide forever if you don't want your appetite and then your equilibrium weight to shoot right back up to its pre-intervention point.

It may be that "continue taking semaglutide forever" is still healthier than "stay 40 pounds overweight forever", though, I admit.

My strategy is a month of semaglutide on, followed by three or so months off, repeat. The cycles let me keep a six pack most of the year and at times of my choosing without having to deal with the psychological effects of a deep cut. The appetite suppression lasts maybe a month after cessation for me.

Of course, this is entirely vanity oriented, and I wouldn't claim it's at all healthy compared to the alternative. Though certainly better than the last weight loss drug I was on...

I am "out of the hole" in the sense that once you've lost all the weight, you can start eating at maintenance again, which is much easier than eating at a deep deficit. So pre-semaglutide my daily maintenance calories might have been like 3500, and I was eating at like 3600, very slowly gaining weight. During semaglutide I'm eating 2300, which is a very deep deficit, made much easier due to the appetite reduction. After semaglutide, my reduced body weight will push my maintenance calories at around 3000, which will be much easier to maintain, either with discipline or with low-dose semaglutide. I think that the state of being obese does some kind of permanent damage to appetite regulation, so that anyone who has ever been significantly overweight will basically need to be on some sort of permanent diet for the rest of their lives, and there's no scenario in which they eat "naturally" and don't gain all the weight back.

I don’t really understand the judgmental tone. Few on this forum would have a problem with using adderall to enhance performance or Lipitor to reduce blood pressure. How is this different?

I do have problems with those things and think fat shaming is the solution to the obesity crisis, not yet more drugs.

I don't respect Adderall use either. That's the point, I think people would be better off fixing what's wrong with them than patching over it with drugs.

This assumes that the model of drug assistance is min(peak natural ability, current ability + drugs assistance). The actual model is max(peak natural ability, current ability + drugs assistance) Both args to the function have domain 0-infinity.

The effects are additive.

Let's say you do focussed work 9 hours a day. Respectable by all means, more than most people, nothing to patch up. But if you really want whatsoever that focus is achieving, why not take Adderall and work 12?

If you are below baseline it's a patch, if you are above, it's a boost.

Everyone I know who took adderall for performance enhancement is insanely burned out mentally and is downright awful physically by their late 30s, just fyi. YMMV but look out.

Walter, I think, is drawing the comparison precisely because he doesn't think they are different.

Exercise doesn't seem to reduce weight by much, though of course it will make you healthier overall.

https://www.nytimes.com/2015/06/16/upshot/to-lose-weight-eating-less-is-far-more-important-than-exercising-more.html

"Which is more important in an internal combustion engine? Oxygen or the flammable substance?"

It's diet and exercise. You have to have both. Together.

These pills won't make people healthier. They will make people feel better about themselves. They aren't weight loss drugs, they're NextGen antidepressants. Metabolic syndrome often does not present as visible obesity. Major stomach and liver issues can go undetected for years. People will start taking these drugs and remain at a lower body weight. Then, one day, they die suddenly and any autopsy performed with reveal superfluous amounts of visceral fat, a leaking stomach, and a liver close to non-function.

Physical fitness is, among many other things, an information feedback loop. If you are in bad shape, you have been making poor health decisions. Sometimes, this can be unavoidable (late nights during crunch time at work or school, what have you). But, mostly, it's a clear indication that you're making poor, poor choices. Using something that covers up the effects of these choices does nothing to alter that decision process. I'd wager that habitual users of Wegovy etc. probably will also habitually (ab)use other substances - alcohol, narcotics, sugar, social media. This is not a road to health.

Nobody is claiming that the pills make people healthier directly.

If you are in bad shape, you have been making poor health decisions.

You are of course, correct. That's the genius of semaglutide - it's a pill that doesn't improve your health, it's a pill that improves your decisions, that leads to measurable changes in behavior that lead in turn to better health.

Then, one day, they die suddenly and any autopsy performed with reveal superfluous amounts of visceral fat, a leaking stomach, and a liver close to non-function.

On what you base this prediction?

Not OP, but I won't be surprised if these new weight loss drugs are trumpeted for a couple of years, then we find complications of some sort with them (skinny-but-unhealthy sounds plausible) and have to memory hole them like the last half dozen wonder solutions we've been sold: Fen-phen and Ephedra both seemed promising in their times but had high incidences of adverse effects showing up later.

It's diet and exercise. You have to have both. Together.

You really don't, at least for weight loss. You can lose weight from diet alone by simply eating X fewer calories. You can't really lose weight from exercise alone unless you're exercising at pro athlete/olympian levels, exercise just doesn't really burn all that many calories.

exercise just doesn't really burn all that many calories.

It does burn calories, sometimes lots of calories. The problem is that your hunger levels increase to compensate for the calories you burn.

I know people constantly insist on this, but running 50 miles per week is actually a lot of calories and isn't even half of what pros are doing. When I ramp up from my typical 40 mile/week schedule to 70+ miles per week during marathon training cycles, I will either lose weight or make a deliberate choice to eat more simple carbs and keep weight. This is even easier in cycling, where long rides are easier to pull off consistently than long runs. Unsurprisingly, the extra ~600-1000 calories per day from exercise makes it much easier to maintain homeostatic calorie intake than what sedentary people would eat; I know this because maintaining my weight required much more conscious choices before I picked up endurance sports.

Exercise presumably helps make diets sustainable. If you want to cut a deficit of say 500 calories per day then cutting out a snack and exercise is one way to tackle it.

I'd wager that habitual users of Wegovy etc. probably will also habitually (ab)use other substances - alcohol, narcotics, sugar, social media. This is not a road to health.

Ozempic reduces alcohol cravings as well, so at least that will also be less of an issue:

https://neurosciencenews.com/ozempic-alcohol-addiction-23422/

Don't take any of those class of drugs. They really fuck with your head.

I don't doubt the science on how many calories cardio burns directly, but there must be something more to it. Why do people who do a lot of exercise just never seem to be obese? Where are all the avid gym goers with double chins? Does exercise also help regulate appetite or something?

The exceptions I can think of are ones where piling on muscle is worth it even if it comes with a lot of fat.

You haven’t met my dad. Obese, pre-diabetic, dad-gut, exercises at the YMCA daily, eats 3 meals a day.

Meanwhile, I don’t exercise and I’m his mirror image.

Yeah, a lot of older guys at the gym lift, run, swim, are ostensibly doing a lot of exercise but are also very fat.

Where are all the avid gym goers with double chins?

Have you never been to Planet Fitness? /s

But seriously, I agree with the explanations by @curious_straight_ca and @hydroacetylene: people that are fat usually don't enjoy exercise.

Why do people who do a lot of exercise just never seem to be obese?

Plenty are!

Several years ago I lost quite a bit of weight by tracking my calories. I made no changes to my exercise routine which had been stable for the previous six months or so and just made sure to keep average consumed calories around 2200 kcal (maintenance level for a person my age and height). I ended up having an average 1000 kcal daily deficit for months while losing around 25 kg overall, meaning I'd been exercising ~1000 kcal worth daily for many months prior to that while having obese BMI and without any weight loss.

Exercise alone really doesn't work for weight loss for most people because they just end up increasing the number of calories eaten without even realising it.

I don't doubt the science on how many calories cardio burns directly, but there must be something more to it. Why do people who do a lot of exercise just never seem to be obese? Where are all the avid gym goers with double chins?

Most likely the causation arrow goes the other way. Obese people don't exercise because it's difficult for them to do so.

Does exercise also help regulate appetite or something?

It does absolutely. It upregulates it. Meaning that those who exercise experience more hunger. If you burn 500 calories on your exercise bike, and respond to your body's natural hunger cues, you'll tend to eat 500 more calories of food. And if you lift weights, you'll tend to increase in weight.

Every bodybuilder will tell you that fitness is made in the gym but physiques are made in the kitchen. It's very difficult to exercise yourself lean, except for at the extremes.

Exercise has many benefits, but for diet matters more than exercise for maintaining a good physique.

I can attest from personal experience that when i take a couple weeks off from the gym junk food is more appealing and when I'm really pushing myself vegetables and lean protein are delicious

Yeah, I actually lost most of my weight from diet but it feels like my regimen was most consistent and sustainable when I was also exercising. Part of it was that early on it seemed to help me fast but I've adapted past that now.

But still, if I fall off the wagon on exercise I seem to fall off with other stuff like diet. Not sure if it's the direct or only cause (there's some interaction with sleep quality but that's a cycle) but still.

It's easier to do it all sometimes.

It might work the opposite direction- exercise is horrifically uncomfortable for fat people, so they don’t do it.

Right, maybe that discomfort is also the feedback by which people are motivated to stay in shape. If I go for a cycle and feel terrible, the cycling itself won't have done much for me but it will be a wake up call for me to cut down on smoking/drinking/gaining weight (or if I'm feeling lazy, a wake up call to quite cycling).

The feedback cycle is not fitting in my damn pants. I don’t need to waste half an hour on the treadmill to tell me that. I spend that time because I want to be healthier.

by which people are motivated to stay in shape

The people who feel that way are not the target demographic. You're not the target demographic.

They're already not in shape. They don't have something they fear to lose, that's the point. Because of rising childhood obesity they may never have been in shape enough to distinguish between 'normal' and 'wakeup call'

Honestly, given that - adults who never even developed basic coping mechanisms - I'd pump this shit into the water supply if it was safe.

Why do people who do a lot of exercise just never seem to be obese

Not necessarily the only explanation but - The kind of person who is willing to do something somewhat uncomfortable for health benefits is the kind of person who will both exercise and intentionally eat less.

I genuinely cannot imagine preferring a lifetime of pill popping to just riding a bike.

More time to do actually enjoyable things instead of faffing around on a child's toy?

So you're an obese person? I'll make sure to disregard everything you post from now on.

  • -20

It's been a while since your last warning, but given that this low effort snarl is even more antagonistic than the last one, I'm kicking you into the corner for a few days. Three day ban.

Fairly sure that's a false dichotomy there.

Why get some exercise and fresh air when I could be whacking it instead?

Or working on something meaningful, spending more time with partners and children, or any number of things.

Reclaiming unenjoyable exercise time would increase productivity and enjoyment of life.

I rode a bike last weekend with my wife and child. We rode with another family and their kids. Of course all those things go together.

Just doesn't seem as fun as laser tag.

To a childless young adults, very well might not.

Exercise with your partner and children.

I can't abide repetitive tasks no matter the company.

You won't be experiencing company of any kind for too long if you avoid exercise and fresh air.

Why are gymlets so vicious when people don't share their boring obsessions?

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Bikes rock. I'm back into bike riding now that my kid has the strength for hills and longer rides.

I'm ride or die for biking.

instead of faffing around on a child's toy?

Is this a jab at the Europeans who cycle to work?

No, if I wanted to do that I would have talked about how ungainly it is to arrive at your destination sweaty and/or soaked from the elements.

I just don't consider bikes to be a serious transport option in general.

how ungainly it is to arrive at your destination sweaty

Ever heard of a shower? Most offices have them. Get up, put on your exercise gear, put your office clothes in your backpack, cycle into work, take a shower and put on your work clothes. You'll likely have cut a huge amount of time out of your commute, and the morning cycle is far more invigorating and refreshing than spending 30-60 minutes in a car or on public transport (and if you live in a warm climate, being stuck in a cramped bus or train during the morning rush hour will probably result in you getting hot and sweaty anyway).

Bikes are the perfect vehicle. A decent bike costs a few hundred bucks, max, and will last you for years. If cycling in a city, traffic won't impede your progress the way it would in a car or bus (or even a motorbike). Even an only moderately fit person can cover immense distances without exhausting themselves (I'm by no means an avid distance cyclist, but am confident I could cycle 100km tomorrow without any training and without exerting myself to any great degree). Calories are your fuel, so you aren't dependent on petrol/gas infrastructure. If so inclined, you can attach panniers or a trailer to your bike to allow you to bring possessions with you that are too big for a backpack. Certain kinds of bike can ride on effectively any terrain, so you aren't dependent on roads. Virtually all repairs and maintenance can be done by anyone after one day's training, unlike modern cars which are so complex that only specialists can repair them (at great expense to the owner). There's no additional cost in GHG emissions. Bicycles take up far less space than motor vehicles: there are bicycle parking centres in Amsterdam which can comfortably fit thousands of bicycles into a space which would accommodate a few hundred cars at most. They're vastly cheaper than cars (in addition to the smaller initial outlay noted above: almost all of the maintenance and upkeep can be done yourself with only one or two specialised tools, you don't need to buy petrol/gas, you don't need insurance). And best of all, the mere act of using one improves the health of the user along multiple metrics (heart rate, blood pressure, muscle mass, life expectancy etc.).

Your comment has inspired more contempt in me than any I've read on this site in months.

Ever heard of a shower? Most offices have them.

So now not only am I leaving even earlier to compensate for my MUCH slower method of transportation, I'm having to leave even earlier again so that I can... shower at work?! I'm really struggling to see what I'm gaining here!

Bikes are the perfect vehicle.

The hardest of disagrees. They're toys for children, and not suitable for serious adults. I like being able to do a full week's shop in one day. I like being able to just nip to IKEA and come back with a new standing mirror, or cabinet, or end table or whatever else without paying their extortionate delivery costs. I like air conditioning. I like playing music and jamming along to it with my partner. I like being able to make phone calls if I need to. Most importantly, I like not looking like an absolute fool. Wearing ugly lycra, or flattening my hair into a helmet, and ugh, sweating -- these things are not for me. To say nothing of how woefully bottom heavy and thunder thighed habitual cyclists become! And even though as you note, attaching a trailer to a bike is an option, the problem is it looks absolutely ridiculous! Like something out of the olden days! The image hit from being a cyclist would be totally insurmountable to me.

Trying to get bikes considered as a serious form of transport gives off the same vibes to me as trying to get hentai to be considered a serious art form. It's fine that you like that stuff, but stop trying to normalise it.

So now not only am I leaving even earlier to compensate for my MUCH slower method of transportation

Assuming you live in an urban centre, when factoring in traffic, cycling will often end up being faster than driving or taking public transport. It takes me an hour to get to my office via public transport, but only half an hour on a bike, and that's maintaining a gentle 12 km/h (not even fast enough to break a sweat, obviating the need for a shower).

I like being able to do a full week's shop in one day.

As I said, you can do this if you attach a trailer to your bike.

I like being able to just nip to IKEA and come back

Obviously there are circumstances in which cars are preferable to bikes, but seriously - how often do you go to IKEA? I can't imagine it's more than once a month.

I like being able to make phone calls if I need to.

It isn't remotely difficult to cycle a bike with one hand and operate your phone with the other. I do it all the time.

Most importantly, I like not looking like an absolute fool. Wearing ugly lycra, or flattening my hair into a helmet, and ugh, sweating -- these things are not for me. To say nothing of how woefully bottom heavy and thunder thighed habitual cyclists become! And even though as you note, attaching a trailer to a bike is an option, the problem is it looks absolutely ridiculous!

I must say, it seems very strange for a person so aggressively averse to apparently all forms of physical exercise to be so hyper image-conscious. Sure, a slim, fit dude in fluorescent Lycra looks a little silly compared to a slim, fit dude not wearing Lycra, but neither of them looks nearly as ridiculous as an obese man huffing and puffing after walking a hundred feet. And I don't own any Lycra clothing at all.

This is a roundabout way of saying: if you get as little exercise as it sounds, you probably look like an absolute fool already, even if you're in denial about it.

stop trying to normalise it

I'm not trying to normalise it. It IS normal where I live, as in most Western nations. Only in America, seemingly, is cycling seen as this weird thing that only losers do.

Assuming you live in an urban centre, when factoring in traffic, cycling will often end up being faster than driving or taking public transport.

Big assumption. My commute is from an outlying town to a city center, a journey that takes 30 minutes by car, along mainly 60mph speed limit roads. I travel along maybe one mile of roads slower than that the entire way there, since the city's main A-road cuts directly through the center.

As I said, you can do this if you attach a trailer to your bike.

At the expense of looking like an utter tool, or a child towing their mobile lemonade stand to the next location. And having to worry about cornering too sharply and tipping the whole thing over.

Obviously there are circumstances in which cars are preferable to bikes, but seriously - how often do you go to IKEA? I can't imagine it's more than once a month.

Whenever I need something, and it's not the only store out there I'd need it for. Carrying a framed painting from an art store back on a bike would be an exercise in frustration and anxiety. Trying to carry a very heavy ornate mirror or light shade from an antiques store would be worse.

It isn't remotely difficult to cycle a bike with one hand and operate your phone with the other. I do it all the time.

And have to shout over the rushing air? It's bad enough when walking near a busy road let alone being in the middle of one.

I must say, it seems very strange for a person so aggressively averse to apparently all forms of physical exercise to be so hyper image-conscious.

Is it so completely out of the realm of possibility that a person can be slim and attractive without boring themselves half to death by doing braindead and repetitive busywork tasks constantly? My experience in the school system left me with less than zero patience for such things.

I'm not trying to normalise it. It IS normal where I live, as in most Western nations. Only in America, seemingly, is cycling seen as this weird thing that only losers do.

I'm in the UK, and among my peers it's considered a niche thing that is mainly the domain of children, eco loons or retirees. Everyone else on the road despises cyclists because they're super slow and utterly entitled.

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What do Europeans have to do with the discussion? Are you under impression that Europeans ride bicycles a lot, including to work? They don’t, except of couple of places, which is no different than in US.

What do Europeans have to do with the discussion?

I just found it to be a funny unintentional marker of the same cultural gap between Americans and Europeans that starts lots of arguments here.

They don’t, except of couple of places, which is no different than in US.

The full bike sheds at my old 6:30am-start factory workplace would seem to indicate otherwise but of course that's anecdotal. Ipsos tells me that 5% of Americans cycle to work, which is on par with Britain, but half or less than half of the number who do in Spain, Italy, Norway or Belgium, a third or less of Germany, Hungary and Poland, a quarter of Sweden and one sixth the number in the Netherlands.

Yes, you are confirming what I said: Europeans don’t cycle to work a lot. Overall, maybe something like 10% does. Large majority of them drives. Sure, the split between driving and cycling is only slightly less lopsided towards driving, but whether 5% cycles or 10% is not substantial difference.

Then we're just debating the meaning of 'a lot'. A substantial minority to me still seems like a lot, a doubling or tripling compared to America seems like 'a lot more'.

They ride/walk to work far more than people in USA.

Not really, though I understand how one might get this impression if one is very online and frequents places like Reddit or HN. Most of Europe is unlike Amsterdam, and even in Netherlands, last I checked, majority of commuters drive.

Note that I wrote "far more than people in USA" not "more often than commuting by a car".

That was intentional.

I am pretty sure that in nearly all or all European countries people commute via walking/cycling at noticeably higher rate than in USA.

Yep, can't imagine it. Riding a bike is enjoyable. I cannot relate to wanting to just pop pills and get back to [enjoyable things], particularly when [enjoyable things] for most people looks a lot like staring at a screen.

There are people who will say the same about all of your proclivities. "I cannot relate to people who don't want to play football every weekend" and so on.

OK. I don't know what your point is. I can look down on the pillpoppers and they can look down on my faffing, we'll be on the same page. I can certainly relate to plenty of preferences that aren't my own (Crossfit isn't appealing to me, but that's fine, people like it), but I'm not going to pretend that I think all preferences are equally virtuous. The preference to have subsidized drugs rather than pick a sport and eat reasonably is loathsome to me.

The point is that fully generalisable sentiments that are really just subjective priorities and values differences underneath it all are not a meaningful topic of conversation. "I like thing" "Well I don't like thing" Ok great, we've achieved absolutely nothing here.

You can phrase everything like this. Oh, can't imagine people spending hours at a time contracting their muscles presumably for fun, instead of enjoying gathering new knowledge or engaging in the debates with educated people from around the world. But I can imagine, it's quite easy to understand that people have different preferences.

Obese people aren't obese because they're minmaxing their knowledge.

The number of obese people doing that is what? 7?

Reading something on the Internet is quite popular activity indeed. As is reading books that is also today involves "staring at a screen".

Reading books is very possible to do while exercising, so...

???? Give me this secret!!!

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I think ultimately, even with the drugs, there’s just no getting around the need for better choices.

In part, I think this is an aesthetic horror for me. We aren’t becoming more emotionally resilient by deadening our emotions, nor are we going to solve our food issues by artificially turning down our hunger thermostat.

You say we need better choices, but turn your nose up at a pill that causes people to make better choices?

nor are we going to solve our food issues by artificially turning down our hunger thermostat.

Is the hunger thermostat of the average American in 2023 really the natural order of things? The obesity epidemic only began in the 1970s and has been increasing in prevalence and severity. Not just in the States, either, but around the world. I don't know why it is, but I haven't read any compelling arguments that it's really due to a massive global loss of character since a century ago.

Suppose it's one of the "contaminants in the environment" theories (all of concrete ones having serious flaws, I know). If so, our hunger thermostat is artificially turned up; although it's less than ideal to counteract it by introducing drugs to artificially turn it down, it's still far better to have that than to be fat. It means more attractive, healthier people who weigh down the medical system less.

I’ll agree that food companies making hyper pallet able foods is a major part of it, but I also think we’ve created a kind of “snacking culture” that really didn’t exist prior to the 1970s. People are almost constantly bombarded with opportunities to eat, with snack foods literally everywhere you go in public, including gyms. And eating between meals is, at least around me, fairly normalized, and you’ll see people in the office or in the break room eating and drinking and stashing snacks in their desks. Food portion sizes have also grown tremendously since then (this started with restaurants but it’s entered the home as well [https://www.yourweightmatters.org/portion-sizes-changed-time/]) to the point that our calorie intake is nearly 125% of what was typical in 1970. Add up nearly constant snacking that’s been more or less normalized, a sedentary lifestyle (most people work desk jobs, rather than more active factory, retail, or skilled labor jobs) and fewer sports leagues for kids and adults who aren’t good enough to play select teams. Surprise, eating 25% more while moving less causes obesity.

Other than the hyper-palatable foods and portion sizes, I don’t think our food has changed as much as people are saying. We’ve had Oreos within $0.50 of their current price for decades, and their recipe hasn’t changed much. What’s changed most of all, at least from what I can see is the normalization of snacking all the time, the normalization of eating an amount of food that would have embarrassed your grandfather, and the loss of social physical activities as a way to meet friends. It’s culture, a culture obviously shaped by marketing, but culture.

I don't think there's a single secret chemical that is making people fat. I think it's the result of many decades of work of food scientists and the growing popularity of eating out.

Take Oreos. A single Oreo cookie is 46 calories here in Russia (53 in the US). The serving size is three cookies, or 150 calories. That's a perfectly reasonable amount, except no one eats three cookies. I am probably limited more by the amount of milk I can drink.

In 1922, Oreos sold for 32 cents per pound. That's 5.83 dollars in 1923 money. Target says I can buy 18.12oz for 4.69, or 4.14 per pound. That's 30% cheaper. Even if nothing has changed in their recipe since 1912, grocery stores in 2023 are stuffed with dozens, hundreds of new brands of cheap hyperpalatable food.

Eating out is no longer a luxury and delivery is much more common. You can't really control your portion sizes when you don't cook for yourself and you aren't limited by the number of dishes you can cook simultaneously, so it's easy to overeat. Restaurants have to compete for customers, so they come up with the tastiest recipes full of sugar, salt and fat that stimulate your appetite.

food is too calorie dense, even healthy food. a few slices of whole wheat bread is 140 calories. i can easily eat a lot of it given it's just mostly air.

Non-starchy vegetables are surprisingly calorie-sparse. If reducing calories is your goal, replacing most starch-based sides with legumes and cruciferous vegetables (and carrots) is a great move.

The obesity epidemic only began in the 1970s and has been increasing in prevalence and severity. Not just in the States, either, but around the world. I don't know why it is, but I haven't read any compelling arguments that it's really due to a massive global loss of character since a century ago.

This is a wonderful straw man. No one argues that it's a massive global loss of character. Instead, people argue that there are factors like how calories have become insanely more abundant to billions of people, how they now have vastly more wealth to enable them to casually consume those calories without concern, how they've been packaged in superstimulating, high-calorie, low-satiety form, and how we've started constantly lying to people about how this all works. It shouldn't be surprising that people start believing the lies when we tell them over and over again, and it shouldn't be surprising when their behavior shifts in accordance with those beliefs.

I mean it would be even better for people to use water filters or whatever it takes to minimize exposure to said environmental contaminants, because said contaminants almost certainly have other effects.

Actually, technologies allowed us making many terrible choices that in the past would have surely killed us. I'm certain that people became more care-free outside and at various worksites after consequences of unlucky cut changed from likely gangrene or tetanus to basically nothing.

Conservatives of course are for all technological wonders apart from the modern ones. Virtuous(ones who got lucky at genetics roulette) people will lose their status gained from being able to remain fit in the modern food environment and these disgusting(visually ergo personally) fatsos will get help to adapt their brains evolved for completely different circumstances to the food abundance of current time. Horrible! I will tell you more, when new drugs appear that will directly boost your metabolism rates and not making you want to eat less, people, regardless of their virtue, will become more hedonistic, healthier and happier, as they already did many times before.

I don’t think hedonism makes people long term happier. If it did, our kids would be happier than we are because they have more cool stuff. Except that we’ve never had so much loneliness or depression and anxiety. Something like 25% of the US population is on a drug for emotional regulation despite our abundant wealth and our higher levels of education.

I'm certain that people became more care-free outside and at various worksites after consequences of unlucky cut changed from likely gangrene or tetanus to basically nothing.

The opposite - life was just cheaper back then, and people tolerated workplace death rates that we wouldn't. The CDC reports a 90% decline in workplace death rates between 1933 and 1997 (and a bigger drop for specific dangerous industries like coal mining). The trend in the UK is even more stark, but I can't find data before the 1980's online. In the current year, workplace deaths in the US are mostly on-the-clock shootings and car crashes - i.e. not deaths amenable to improvements in traditional health-and-safety.

and these disgusting(visually ergo personally) fatsos will get help to adapt their brains evolved for completely different circumstances to the food abundance of current time.

I actually wonder how it'll go. Just like plastic surgery can't really make you younger but instead gives you a distinct post-op look, and Adderall doesn't just restore executive function to baseline, chemically fit people may become a very intriguing new phenotype. Are fat people today unjustly maligned for their looks? Or do they really have systematically different characters which will largely remain even without all the extra adipose tissue? We shall see.

chemically fit people may become a very intriguing new phenotype.

Keep in mind that they won't be chemically fit, they'll just be chemically less fat. Ozempic face is already a thing:

But some have also pointed to an unanticipated side effect: “Ozempic face.”

The buzzy term, coined by a New York dermatologist, describes the gaunt or hollow look of sagging facial skin that can appear when people lose excess fat in their cheeks or neck.

Weight loss always has some unappealing visual side effects, but I would expect weight loss with no improvement in actual underlying fitness to have a particularly unappealing aesthetic. Naturally, there are already plastic surgeons capitalizing on it!

Adderall doesn’t just restore executive function to baseline

What exactly do you mean by this? That Adderall can boost executive function to superhuman (or super-non-enhanced-human) levels?

@2rafa had a decent writeup on this but, as it happened, deleted. In short: no, it's not like having enhanced executive function, it's like being obsessive. I've written a bunch on this too.

There's the entire "Ozempic Face" thing, but that seems to be less a result of the drug itself and more of a result of rapid weight loss.

Character wise, it's fair to say most fat people have bad posture and less attention to hygiene and style, though you can imagine causality working either way.

Character wise, it's fair to say most fat people have bad posture and less attention to hygiene and style, though you can imagine causality working either way.

Honestly having lost about 20 KG from 130~ KG to 110KG at 6'3 and going from 'I need to actively hunt for clothing in my size that isn't a tent' to actually being able to walk into a reasonable department store and buy clothing off the rack that is semi-fashionable, suddenly style became a lot easy to participate in.

Also Big Man's Stores rarely do discounts on their upsized nice clothing, whilst getting to the point of buying from a standard department store means I've suddenly got an ability to participate in deals, clearances and the like. Buying 'nice jeans' would previously have cost about $150 AUD per pair, now it's closer to $50 if I'm at all patient.

nor are we going to solve our food issues by artificially turning down our hunger thermostat.

Why not?

If there was a drug that made people want to eat less, with little side effects; Wouldn't that help? Wouldn't that be part of having better choices?

What does better choices mean, in this context? Is it giving people more choices in their food consumption? Or is it giving them choices you deem as better/removing choices you deem as bad?

What does better choices mean, in this context?

It refers to people exercising intentionality to consume the foods that align with their physical goals. If that's losing weight, it means a caloric deficit. If that's endurance sports, it means eating a bunch of boring sugars and simple carbs out of your back pocket while you're on the bike because it'll go poorly later if you don't. If it's normal homeostasis, it means matching your appetite to your activity. If it's bodybuilding, it means protein shakes, egg slonking, and chicken breast when you don't want anymore because it's necessary to add muscle.

Basically, it means making an actual choice, electing to eat the things that make sense rather than defaulting to absent-minded gluttony.

If it's normal homeostasis, it means matching your appetite to your activity.

I can understand controlling what you eat, but how does one control appetite? It seems that taking medications like this is a real way to match appetite to activity, so I'm not sure what the objection is.

how does one control appetite?

By learning how to be hungry.

"Controlling your appetite" seems harder than "controlling what you eats" in the same way that "controlling what you are afraid of" seems harder than "controlling whether you into the fear", but fears are "controllable" too. Pairing a shock with a stimulus is a good way to condition a fear of said stimulus, and exposing yourself to the stimulus while paying attention to the lack of any bad consequences is the way that therapy can reduce fear.

The same thing works for appetite. Pay attention to what you're eating, how your body feels in response, and what the outcomes are. People are often very mindless about this, craving foods which make them feel bad and lead to undesirable outcomes while flinching away from making the connections. Make the connections, and all of a sudden those foods/quantities of foods no longer seem so appealing -- in the same way that a restaurant no longer seems so appealing after you get food poisoning there, only more subtle because the effects are not so immediate and dramatic. When someone says something horribly fat shaming like "You eat too much", for example, instead of pushing it away with "I know I know don't rub it in I can't help it!", sit with it. Face it. "I do eat too much. I am fat, and look disgusting. My stomach feels disgustingly over full, once I pay attention to it". How hungry are you after sitting through that? How compelling is that same hunger?

Perhaps the easiest way to get a gut level feel for how much your relationship to food can change is to just not eat for a few days. Eventually you get over the neediness and experience the desire for food completely differently, in a way that leaves a lot more perceived freedom to do what you want to do.

how does one control appetite

Low glycemic index food. No breakfast. No snacking after dinner.

Your desire to eat decreases the less your blood sugar spikes and crashes. Also you can train yourself to not eat in the morning or after dinner.

Excessive self-harmful hunger isn't something foisted onto us. You choose to cultivate it or not.

When you eat nutritious foods for a long time, your body starts to crave nutritious foods. Your appetite changes. If you go on a low carb high protein/fat diet for long enough, cake starts to taste disgustingly sweet. Most people dont commit to it long enough to notice this. Or they are following bad diet advice (e.g. egg whites, skim milk, etc)

In my eyes the risk is making the general population take the drug with carrot and stick incentives (health insurance?) in a bid to reduce “climate change” and increase “food security equity”. This tool exists now, it’s only left up to policy makers to misuse it.

There's also the part where the government and insurance providers are now on the hook for $20K per year for a drug that accomplishes the same thing as people not being sedentary and lacking impulse control. If people want to pay it out of their own pocket, more power to them, but subsidizing this is galling.

Yeah this does seem like the inevitable future.

Honestly it was always felt absolutely absurd to me that people blamed individuals completely for their overweight status. Like yes, a portion of this is always going to come down to personal responsibility, but when the overweight proportion of America and the world so high, maybe there's something more going on.

There have always been poor people, there have always been low class people, there have always been those without personal responsibility and those who have terrible impulse control. But it's only in the recent decades that we've seen such a massive rise of country and international obesity levels. Is there somehow something so unique with modern Americans and modern humanity that we lack that simple impulse control as our ancestors did for millennia?

Maybe to some extent, but to this scale? Probably not.

I think it was always obvious the problem was that we are animals. Animals with genetics and a brain that was meant for a much different environment and world. Modern civilization is an artificial construct we've engaged for a blip in the time scale of our species. The problem was obviously the extremely easily available high calorie, extremely unnutritiousness foods found literally at every corner.

Do we blame the gambling addict completely if we transport them to Las Vegas and tell them to be smart? If they end up gambling, yes it's on them, but it's also partly on us for taking them to Las Vegas in the first place.

I feel like this reality was obvious to us at least by the mid 2000's. If you are a person who believes in sin taxes then we should have supported and pushed for the significant taxing of these foods and used that money to directly subsidize healthier food. If not for the betterment of the individuals in society, than for the fact that society has to face the huge costs of generations of obesity in things like ballooning healthcare costs, part of the contribution to the proliferation of incels, increased insurance liabilities, ect.

But since we successfully convinced everyone that fatness was a unique individual moral failing, jack in the box stays open and everyone and everything pays the huge negative externalities. On top of that we get another point of contention and divide between people in this country where everyone argues with each other and blames each other while those that profit off of this just walk around with the fortunes in their pockets.

Thankfully since that is politically untenable for multiple reasons, the pharma companies have come to the rescue and soon enough massive obesity will be a thing of the past.

I genuinely believe that obesity and the modern health crisis resulting from that have had a hand in a number of the biggest modern societal problems and I think on a much, much, much, much smaller scale we might notice in a decade or two where certain societal problems will have decreased and we might statistically be able to tie it to people no longer being as massively obese in the same way we tie lead in the paint with so many problems. Again, on a hugely smaller scale of course. Just trying to make the point that this is an issue that has an impact on a number of different issues and without it, a lot of affected things will change for the better.

I wonder why you and others seemingly have trust in a wonder drug, or a wonder cure. Don't we have ample evidence to the contrary? Morphine, heroin, methamphetamine, Prozac, Zoloft, OxyContin etc. - all of those have catastrophic effects on society. Any social ill that has come into full effect after decades, and is not caused by any drug, surely cannot be solved with another drug in short order.

I have no trust in a wonder drug. I simply have trust that this drug with all of its known and potential side affects will still be better than severe obesity is for most humans in this situation. I don't doubt there will be some more widely taught dangerous outcomes, especially if people end up using this long term even after they lose weight as a method to, "keep off" the weight, but again, if you've seen just how terrible obesity is for individuals and society as a whole, it might still end up being worth it.

And again, I still think if we sin taxed the extremely high calorie, nutritiously trash, banned advertising for fast food, ect and made them pay for the negative externalities of their businesses and subsidized healthy foods for humans, that would be a much better outcome. I just have little hope in that happening, so I expect this or future iterations of this drug to be the best we can hope for in the modern world.

What "catastrophic effects" have Prozac and Zoloft had on society?

The normalization of prescription drug use/overuse/abuse, and widespread addiction to anti-depressants.

I think really, we did have fat shaming in the past, at least among intimates. There was a culture of “not eating like a pig” of not getting seconds let alone thirds of your meal, and of not snacking all the time (or at least choosing better snacks). People in 1960 would definitely say something negative about you eating a quarter of a 16 inch pizza by yourself. They’d notice the kid dragging a 2L soda to class.

Some people have a problem, sure, I’ll agree. I’ll also agree that our food environment is more super stimulating than any other environment in the past. I don’t however think that humans are incapable of choice. In fact, I think the 21st century is one of abdication of responsibility for the choices made. We don’t push kids to study hard, or to achieve things. We don’t push people to be more resilient to stress. We don’t say or do anything about people falling into bad choices and in some cases addiction. I think we can improve the environment, and we should. I just don’t think that it’s only down to “environment” as humans have choices and make them all the time.

Well sure, but did I excuse personal responsibility completely?

I think it is understandable that when addicts for anything from alcohol, drugs, gambling, ect relapse, some of that is hugely on them for not being able to handle temptation and keep better self control. But I think we can all understand how it's much different for a person who's living in Las Vegas to fall back into gambling or someone living in LA to be more easily tempted with drugs than if that same person living in 1970's Salt Lake City.

In my experience a lot of handling self control and responsibility is understanding the importance of building the right environment around you.

In college I found out that I have a temptation to stress eat and when I gained 20 pounds over the course of a semester, I realized that having my kitchen stocked with easy to get snacks and food didn't help. I no longer bought snacks and so made it so that if I wanted to eat anything I would have to make a meal or at the least get up and walk to a store and buy something. I made it a chore and more of an inconvenience to eat food. That simple change made it so that I was back to my healthy skinny weight by the end of the following semester+summer. It worked because food was no longer a momentary snap decision made when I was studying and stressed. It had to be a deliberate action and decision which meant a number of times when I wanted to grasp for the comfort of food I couldn't.

Same thing happened when in the past few years I found myself so easily grabbing my phone anytime things were slow to read some random post, article or book on it. Most of it was meaningless drivel that just helped me pass the time, but wasn't adding to my life and was distracting me more than I liked. When I finally got around to addressing this so that when I wanted to work without distractions and the temptation for a short break I put my phone and it's charger on the other side of the apartment. That way it would require me to get up and walk over to check it. It would have to be a deliberate action which did a lot to cut down on my phone use. Though the biggest help was switching to an iphone se with it's tiny screen which made it a chore to use outside of actual necessity. I would have switched to a dumb phone, but just out of social and work obligation I needed a smartphone and the tiny screen has really helped in cutting down on idle phone use because it's so suboptimal.

Now you could say that yes anyone can do these types of things, but I want to emphasize that I think myself of fairly conscientious and put together and I found it quite hard. It wasn't impossible, but it wasn't easy and I'm not saying that I have the greatest cravings for food as well. I think it's completely understandable in a modern society where people are bombarded and stimulated with food ads everywhere, the cheapness of all of this food, the slight extra difficulty that healthy food has versus fast food, it is more than understandable why many cannot handle the difficulty of managing these things on top of the rigors of life. Especially for those living in higher stress lower income environments where they're worried about their next paycheck, having enough to pay for rent, utilities, and food in general. For those people, having the luxury to add on a new thing to stress and watch about might be much more difficult than my incident in college.

I also think you need to factor in support systems into this. When I was trying to lose the weight in the summer back at home, I mentioned to my mom that I wanted to eat healthier and she was more than happy to help me. Replacing less healthy meals with more chicken dinners and such and we cut out having high calorie processed food snacks in the house. My sister grumbled, but she was understanding.

If you have a supportive family structure, something that generally overlaps more with middle and higher classes, the importance of healthy living and being in shape is taken much more seriously. Requests like mine are things that are understood and taken more seriously. Overweight people are generally lower class and often their families are also overweight. If say one of them decides that they want to be healthier, that plan is severely hampered and made more difficult if the people around them who also are probably overweight are unwilling to also join them. It's not impossible, but you can understand that if their families are not on board, chances are that unhealthy high calorie snacks and foods will still dominate their kitchen making it that much more difficult for the person trying to lose weight. It's easier to stick to a diet if you aren't staring the face of bags of potato chips everytime you get up to get water.

One pound of fat is about 3500 calories. 3500 extra calories is pretty easy to gain over the course of few days for most. I'd argue most won't even notice it significantly if they ingest 800 extra calories a day a for week. That's literally two poptarts a day. Weight loss is a slow gradual process that can be achingly slow. Gaining 3500 calories can happen without notice, but losing 3500 calories? Being on constant calorie deficit can be extremely frustrating. The person must deny themselves the food needed to sate their hunger and force their body to burn that fat inside. You can do everything right for a week and be on pace to lose a pound then on Sunday you go out with friends to watch the game at a bar and a few beers and a couple slices of pizza could mean that you've just ingested 2000 calories and much of the progress you made over that entire week is gone.

I say all of that to simply say that yes, it's doable. Millions of people workout and diet to lose weight and it works. It's a struggle, but it works both historically and the modern day. I did it, you might have at some point, many do it after the holiday season every year and it works out decently well for them.

My point is that I think the idea that the modern day is filled with people who are uniquely bad with self control and temptation out of a individual failing is a lie. Maybe we're worse than people were 80 years ago, but I think you take many of those people from 80 years ago and make them grow up in the modern day, most would struggle similarly. In the past extreme weight gain and obesity was probably more of a personal failing because of yes the environment that might shame them around them, but also just what they could eat to get fat. Advertising and yes human behavior has normalized the huge portions that would be unthinkable previously. The food itself has changed, oatmeal isn't terribly appetizing but honey nut cheerios is.

When the scale is as big as it is in the modern day I'm much more likely to see this as a industrial scaled problem where more of the blame should be on society than individuals. Some of these are people who might have fallen into this behavior, but most are probably people in previous eras would have had an extra piece of pie but would at worse just have slightly chubbier cheeks. I put the blame more on society for fostering a terrible environment where those on the edge to be led astray.

In my opinion obesity is a bigger health crisis than smoking ever was and we should implement the same kind of sin taxes on corporations that push these things. Society pays for obesity through healthcare, mental problems, lower productivity, less polite world, exacerbating class divides, insurance expenses, and a whole lot more. There are so many negative externalities and we should at the least ban advertising for fast food and unhealthy foods like poptarts, ect the same way we banned advertisements for smoking. If people want it then they can get it, but there is great benefit from keeping their messaging from barraging a population that does not need that temptation in front of them constantly. Society would be better for it.

Purchasing power parity is the measurement commonly used in order to compare how much a certain amount of money can buy in a country. I believe there needs to be an additional factor, the technological cost compenesation. For example Americans spend far more money on health care than Turks yet live roughly as long. This is only in part because health care is more expensive. An equally important factor is that it requires a lot more effort to keep an obese person who drives everywhere alive.

Commuting is a similar cost. Urban sprawl is expensive and vast quantaties of money are spent moving people between beds and desks. Having worked with people from the developing world I am fascinated at their relatively affluent life styles despite low salaries and the fact that prices aren't that much lower. They just don't spend tonnes of money on gym cards, commuting, diabetes meds, child care and other expenses that most of humanity never new they needed.

The most extreme examples proposed would be carbon capture from the atmosphere. Partitioning the air to get more than a kg of CO2 out of the atmosphere for each liter of gas burned would cost a fortune. The effort to burn the fossil fuels would be lesser than the effort to reverse the process.

GDP per capita should be measured at (purchasing power parity) * (percentage of money spent not combating progress induced costs)

I’m pretty sure that most people in say, Mexico or China prefer to use cars over walking when they can. It’s just that many can’t afford to.

I mean you can create a metric of ‘is it possible to be poor in this country’, but realistically Mexicans and Chinamen who can afford cars strongly prefer them. It’s not as if there are large numbers of people in these countries who live otherwise affluent lifestyles except for not having cars or whatever; it’s the poor that don’t have cars there.

I mean you can create a metric of ‘is it possible to be poor in this country’, but realistically Mexicans and Chinamen who can afford cars strongly prefer them. It’s not as if there are large numbers of people in these countries who live otherwise affluent lifestyles except for not having cars or whatever; it’s the poor that don’t have cars there.

True of Mexico and China specifically, but not of actually-first-world Asia (mostly Japan, South Korea, Taiwan), where middle class people living in cities without a car (or more commonly with one car shared between multiple employed adults such that most trips are not by private car) is even more normal than it is in Europe.

I mean he did specify the developing world, and that’s why I picked two random large middle income countries. Obviously Taiwanese and Dutch people drive less because they choose to, but his comment seemed much more geared to China and Latin America.

This is an interesting point, although I haven't seen too many people abroad living like kings on low salaries.

Another giant cost that you don't mention is cars and housing. Owning a vehicle is usually the second most expensive thing for a household in the U.S., after housing. Housing in the U.S. is artificially driven up in cost by all sorts of things.

Plus, people are just far less willing to live with roomates/family in the Western world if they have the means. I haven't seen stats but I wouldn't be surprised if the majority of folks in the developing world live with at least two other people.

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