This idea is the natural conclusion of interventionist medicine culture where preventative measures and working the root causes are both disliked.
It has been shown, for example, that statins prevent much of the heart disease that kills middle-aged people, but this medication needs to be taken for decades before. And yet in many countries, although it is a known fact and statins are safe, doctors don’t prescribe it until people have heart failure and it won’t help much anyways.
Our approach to pain management has also shifted a lot in the last 2-4 decades. Managing pain was about finding the root cause and treating it. Now its about hiding the symptoms with paracetamol and ibuprofen.
Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common. We in the West also know the science, but more often than appropriate make fun of Asians exercising in the parks every morning. Then we medicate for all the symptoms of diseases that obesity brings. Doctors do not even prescribe exercise to most obese people. That is a prescription which is very effective with $0 monthly costs.
The goal is not quality of life. It is not to prevent disease, or to holistically treat it. The goal is to do interventions to prevent death.
And maybe that’s more liberal in a way — people can live their lives more consequence-free, enjoy unhealthy habits, and know that some % will be bailed out of their coffins just before things get bad enough. Ozempic is such a bail-out.
Yes, Ozempic is an effective drug in reversing obesity. It is a great drug. It will give people back many years of their lives that would have been lost to obesity. Maybe it is even as effective as good exercise habits, which cost $0 and have about 0 side-effects. It is definitely not a better option than exercise for most of the population. But if it’s the only option possible in our healthcare culture, then it is still very valuable. It just won’t end the obesity epidemic. A health culture that only prevents death simply does not concern itself with improving the quality of life.
Unfortunately, we are also quite proud to have such a dysfunctional culture.
> Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common.
The second sentence. What does this mean? Are you talking about elderly Chinese people doing Tai Chi? It is neither building muscle (resistance training) nor improving cardiovascular health. Sure, it might help with mental health, like yoga, but not for muscles/heart/lungs. And the rest of "the East"? Have you seen India? There are an incredible number of obese people in that country. I would guess that Korean, Japanese, and Vietnamese have lower obesity rates because of portion control and caloric density in their traditional diets. However, in the urban populations of Korea and Japan, obesity is rapidly increasing as processed food increases in their diets.
I was not taking about specifically Tai Chi. But I remember from public health classes in medschool that it is known for increasing flexibility and mobility, as well as improving balance and reducing falls in elderly. I also remember something about backwards walking/sageru exercises in Japan, but it is difficult for me to find much online about it.
I was talking about the broader culture that values Tai Chi. Tai Chi is one of “morning exercises” in China. Others include just walking. But my point was about a culture that incorporates morning exercises as a norm. Japan has “radio taiso”, which is a similar phenomenon. I think the West had a similar culture in the 80s and 90s. I was actually growing up in the Central Europe then, and it was normal in elementary and middle school to start the day with a 30-minute exercise lead by school staff.
I don’t know how to label this culture but “culture where it is the norm to exercise daily”.
Yes, as you say, obesity also has many, many other causes. And many other cures. It’s definitely not so one-dimensional. But exercise is very effective, and a culture that promotes exercise daily for everyone, at all paces, would benefit us a lot in the West.
I think people tremendously underestimate what 30 minutes of daily body weight exercises like push-ups, squats, and sit-ups, plus a little bit of walking can do for the said weight. There are many, many technology workers that now just work from home and barely walk at all. Not the majority, but many. There are many more office workers that just commute to work with their cars and never walk more than that demands. In that context, 30 minutes of morning exercise is quite a lot.
Yes, exactly right. Because they don’t work that well in this interventionist mode when they are prescribed to already treated patients.
The study you shared talks about primary and secondary prevention in a clinical setting. So this is for people who either have heart disease or are likely going to develop it. At that point, it seems like it is already too late and I would say primordial prevention[0] is better. When I say prevention, I speak as not a medical professional, and I mean it in the common sense of the word, which aligns with primordial prevention.
There seems to be extensive research that they work well if prescribed preventatively decades in advance, and it’s covered in a few recently popular books by doctors on the topic of lifespan vs. healthspan. For example, Outlive: The Science and Art of Longevity by L. Attia.
Moreover, the study you quoted shows a 9-29% relative reductions of the outcomes. About 1% is absolute. For the entire population, 1.3% fewer will die from a myocardial infarction. But it is a 29% reduction in the sub-population that would die from it. And those are fantastic results with only primary and secondary prevention. Unless I misunderstand something.
The study you provided is relevant and valuable for critical reading of such books as the aforementioned. Thank you.
The healthier answer simply isn't feasible, unfortunately: it means bulldozing the suburbs, confiscating most cars and handing out bicycles in exchange, and building new, walkable cities and forcing Americans to live in them. Also needed would be strict regulations on food quality, and banning some ingredients.
The drug may be a band-aid solution, but if it actually works for making people lose weight, it's better than telling them to eat better and get more exercise and then being shocked when they don't.
I very strongly disagree. Fixing our food, transit, and social systems is absolutely worth it. There are very simple measures we can take like offering a subsidy for e-bikes like we do for electric cars that would get more people outside. Taking measures to make more healthy food more accessible to people who need it would absolutely be worth it.
Cities all over the country are already assessing which roads can be converted from four lane stroads to two lane streets with protected bike lanes on either side. We can provide federal funds to encourage more of this.
Weight isn’t even the only problem with our culture. Being stuck in cars and eating unhealthy food also affects rates of heart disease and depression. Making those people lose body fat might help with those factors, but I suspect it would do so less than actually making healthier food options more accessible.
For those that really feel medication is their best choice, when we have made sure other options are available, we should also offer free medical care to all people. But that should not be the primary solution to this problem for most people!
The "simple measures" you name are things that require political will, and America doesn't have it. That's why these things are infeasible: American voters have to want them, and have to elect people who will enact them. They're not going to do that, outside of a few select municipalities (where obesity probably isn't a big problem anyway, because the people there are wealthy and educated). Even worse, America is almost certainly going to elect Trump for a 2nd term; the country is swinging conservative, so these "simple measures" you name definitely aren't happening any time soon. Look at NYC for instance: the Democratic state governor just scrapped their congestion charge program, so living in blue states and electing Democrats isn't any kind of guarantee of positive change either.
Honestly most of the stuff I mentioned is pretty in line with Bidens infrastructure plan which did actually pass! But even if you say my proposal is pure political fantasy, so is giving everyone ozempic. If we’re actually going to dream of fantasy proposals, “give everyone drugs to mask one symptom of our many problems” seems to me an impoverished fantasy.
It’s not the cars and it’s not the walking. Ignore the unique cities like LA and NYC, and daily suburban life is the same in Santa Clara or Little Rock or St. Louis or Charlotte. But some cities are full of morbidly obese people, while some (e.g. Bay Area, where you drive everywhere) have basically none of it.
Also exercise really doesn't burn as many calories as people think. You usually need to work out as much as a pro athlete or olympian to burn a noticeable amount of calories from exercise. The reality is that a lot of Americans just eat too much.
Building walkable cities (at large scale) in the US is impossible. Not because of physics or resources, but because of politics and American voters' preferences.
Sure, there's a small portion of the electorate that wants this, but they're a minority and not powerful enough to get real change outside of a few localities.
100 years ago the US had ~76m inhabitants - a fifth of what we have today - plus horses and buggies were used broadly throughout the country. The streets in our older cities weren't born from nothing but aether when cars were invented.
I'd dig one deeper and look at the reasons why it's "not feasible" and the change that first. If people propose "national emergency" as a solution, clearly such options should be on the table.
It's not feasible for various reasons, but they mostly boil down to "political will". There's two main causes I see: food/nutrition, and lifestyle (i.e. not enough exercise, and using cars, which is caused by urban design). There simply isn't enough political will to make any significant change on either of these fronts. Don't forget, the US is almost certainly going to elect Trump for a 2nd term, so obviously there isn't going to be any positive change in either nutrition or urban design for quite some time.
So, basically the US electorate chooses to be obese? If so, the underlying question is: why do they choose this?
I can think of several reasons, but to me the most obvious cause is "runaway capitalism", where a few big corporations lobby and market and (mis)inform, to make people think this is what they want, just so they can sell more cars, sugar, processed (high marging) foods and so on.
Not to make this an anti-capitalist rant, to be clear. Just that I'm fairly sure we're seeing a clear limitation of "free markets", where people simply aren't the rational homo-economicus that many promised we'd be.
There's tons of healthy food options available to consumers these days, even in regular supermarkets. They all have "organic" food aisles now. Some Americans have become more conscious of this and have adjusted their diets. (Of course, there's also some companies trying to profit off this unfairly, like advertising "gluten free" on foods that would never contain gluten anyway, and also pushing gluten-free foods as "healthier" when there's really no evidence for that, they're healthier of course for people with a gluten allergy or sensitivity but that doesn't extend to everyone.)
In a democratic society, it's the people's responsibility to be educated about issues, so they can vote accordingly. Most Americans are making conscious choices to eat bad foods, not exercise, live in suburbs with car-dependent lifestyles, etc. They could move to inner cities and/or push locally for more density and anti-car measures, but they don't, outside of a few select places.
Instead, a large chunk of American society "educates" itself about conspiracy theories and the "importance" of guns and religion, and votes accordingly, and what you get is the society you see now.
Why? It works and is (so far as we can tell, except for a few exceptions like thyroid cancer) completely safe. It would have immediate results. Sure, it would be better to fix the root causes. But we are so far from being in a position where that is feasible.
The general consensus seems to be that obesity is not lifestyle related, those affected can't do anything about it, and the only option is taking a drug (that has other severe side effects imo).
Caloric restriction and exercise of course do not work because thermodynamics are subjective.
Describe as you see it the process and ideal timeline that sees every 500lb and under American lose weight and regain the health benefit that comes from it.
Do you support the use of statins and diabetes medications in this population for this process or do you consider that cheating as well?
