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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.

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.