# New drugs for obesity treatment. A good thing? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [July 18, 2012, 1:33am UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583 "2012-07-18T01:33:29Z")\ **Posts on this page:** 16\ **Page:** 4
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [July 20, 2012, 2:13pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/61 "2012-07-20T14:13:00Z")
> [@even\_sven](#): > > If it is safe and effective, the pill will no doubt be very helpful to many individuals. > > But it will not address the obesity epidemic, because the obesity is not a biological problem. The whole world didn’t suddenly develop weird reward circuits or screwed up metabolism. China isn’t just now getting childhood obesity because they had some crazy genetic shift. What has changed is our relationship with food, and that is a public health problem, no a problem of individual biology. > > The US has fat cities and skinny cities (even corrected for ethnicity, gender, etc.) There are parts of the US where nearly everyone is overweight, and other places where it is still rare to see much obesity. If we are really interested in promoting health, we should be figuring out what those differences are (and I’ve got my opinions on that _ahem transportation_). This is especially true now that the link between childhood and adult obesity is so well understood. Wouldn’t it be better to look at places with low rates of childhood obesity, figure out what they are doing that is different, and promote those practices? Isn’t that better than pre-disposing our kids to obesity and then giving them a pill to buy? > [@even\_sven](#): > > 1. We implement common-sense solutions that will gradually transform our communities into places where it is easy to do the healthy thing. Whenever anyone builds something new, they have to account for all kinds of things, including how their development is going to affect traffic and parking. Why shouldn’t new development also account for how it affects the walking population? When you lay down a road, it stays there forever, so why should we decide to lay down roads that can never be adapted for public transit, rather than taking a few simple steps to ensure that one day in the future it’s a possibility? > > For example, the very nice new supermarket near my hometown is separated from the sidewalk by a small but impassible ditch. Cars reach the parking lot through a scenic windy little access road. But it’s a good half-mile of road with no sidewalk. Why should they be allowed to do that? They wouldn’t be able to decide to up and build a supermarket with no parking, so why can they build one with no reasonable sidewalk access? How hard would it be for them to build a small pedestrian bridge over the literally four foot wide ditch? > > I live in California, and I’ve seen a lot of brand new suburbs go up. The trend has been to surround the suburb with a greenbelt, and then build parks, schools, and shopping areas (all of which developers are required to account for) outside of the greenbelt along the main access road. This makes it impossible for kids to walk to school, or for people to take a quick walk to the store. How hard would it be to build this critical infrastructure towards the center of the development, where it would be accessible by foot? > > My friend lives in a new housing development that is basically built around one long snake-like road that winds about two miles in a small area. He lives smack in the middle of it, so to get to the main road (only a block or two away as the crow flies) he has to walk a solid mile. It would have taken nothing at all to build a couple of small pedestrian paths that would have made the place a walkable, transport-friendly community. But instead, for the next hundred years or however long that place stands, people who live there are going to have a huge disincentive towards walking as a part of their daily life. > > Rome wasn’t build in a day, and it will take decades for the average American city to be truly walkable. But the things we are doing now are literally so bonehead dumb that even the smallest attempt will bring huge returns. Let’s make it possible for kids to walk to school. Let’s bring back recess and real food in our schools. Let’s stop making it easy to build cities that kill and cripple their inhabitants, and instead encourage infrastructure that makes a healthy and active lifestyle a seamless, effortless thing. I think this solution is basically my #1. I don’t think that changing our landscapes somewhat to encourage healthier lifestyles is a bad thing. Let’s say it takes 50-75 years to do this to the point where “fat city” people walk 3.5 miles a day as well. What about all the fat people who are living in America now? Why can’t we also offer them medications to help in weight loss? ---
**Author:** ![Gestalt](https://avatars.discourse-cdn.com/v4/letter/g/90ced4/32.png) [@Gestalt](https://boards.straightdope.com/u/Gestalt)\ **Post date:** [July 20, 2012, 2:16pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/62 "2012-07-20T14:16:06Z")
> [@DSeid](#): > > **Gestalt** may I extend your allergy analogy some? > > Controlling the environment is reasonable ways _is_ the first line for allergy control: keep the windows shut and the AC on; keep the pets out of the bedroom at all times; so on. And for many that is not enough and then medication is a godsend. But it will only do so much good for someone who is allergic to cats and won’t give their cat away. Medication for obesity _may_ be like that. If it is used as a substitute for altering or having nutrition and exercise plans then it will not work too well. (And if the nutrition and exercise plan is followed the health benefits will like be there even if obesity persists.) > > Also if a city found that a majority of its citizens were allergic to the elm trees they were planting, I’d think it would make long term sense to start picking different trees to plant in the future. Such would not be a quick fix but longer term it would be more effective than developing better allergy meds and having individuals get better at keeping their windows shut and AC on. Not a substitute for though. I agree that medication alone is not a magic bullet, and that many people will take the med and continue to gain weight, just as so many bariatric surgeries fail. But any systemic solution will take a long-time to implement and I do think that medicine can be part of a good immediate toolkit to help weight loss. I have heard you only need to lose 20% of your excess weight to create significant health benefits. If meds can get you 3% of that, and cutting out all doritos and oreos can get you another 2%, and walking an extra mile a day gets you another 2%, why not let medicine be one of your tools? Again, assuming that overall the health benefits of the pill outweigh the risks. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [July 20, 2012, 2:55pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/63 "2012-07-20T14:55:55Z")
Actually it is 5 to 10% _achieved by implemented and maintained improved nutrition and exercise plans._ Bariatric surgery also has documented improved outcomes in the morbidly obese and the obese with diabetes (the mechanisms including some above and beyond the weight loss alone, which is interesting research). Will losing the same 10% by medication give the same results? We do not know. We are for now just trying to prove it won’t make things worse health wise. I guess it rubs me the wrong way mainly because it defines the weight as the problem rather than as a marker for the problem. The goal that matters most is not the weight or even the adiposity but the behaviors themselves. Sure achieving those behavior changes will decrease adiposity too, but rarely totally eliminate the obesity. Preventing obesity, achieving better choices in the first place, is the greater goal. ---
**Author:** ![elmwood](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/elmwood/32/3060_2.png) [@elmwood](https://boards.straightdope.com/u/elmwood)\ **Post date:** [July 20, 2012, 3:12pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/64 "2012-07-20T15:12:12Z")
> [@even\_sven](#): > > The US has fat cities and skinny cities (even corrected for ethnicity, gender, etc.) There are parts of the US where nearly everyone is overweight, and other places where it is still rare to see much obesity. If we are really interested in promoting health, we should be figuring out what those differences are (and I’ve got my opinions on that _ahem transportation_). Transportation _and_ lifestyle. Some cities are self-selecting for a fit population. Denver and Boulder, for example, which attract a large number of outdoorsy folks. Nothing is stopping an obese person from moving to Denver, or a thin person from moving to Houston. Still, for a fit mountain-climbing helicopter-skiing triathlon-running type, Denver is far more likely to be on their short list than Houston. If I’m sedentary, the mountains and climate aren’t going to be as important to me. and I’ll be less likely to move to a place like Denver. I don’t think obese people self-select to Houston because “the food is great, and really cheap”. It’s just that the mountains probably don’t matter as much to them, and the outdoorsy crowd really isn’t flocking there. ---
**Author:** ![elmwood](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/elmwood/32/3060_2.png) [@elmwood](https://boards.straightdope.com/u/elmwood)\ **Post date:** [July 20, 2012, 3:18pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/65 "2012-07-20T15:18:06Z")
> [@Gestalt](#): > > I am totally baffled by people who are against taking medications for this. So many things that we take medications for could also be handled by making lifestyle changes that we simply find too onerous. Do you take claritin? Just don’t expose your self to allergens! Etc. Maybe they see themselves as part of a “fat culture” that’s being threatened, much like many deaf people are against cochlear implants. Some deaf people believe that that deafness is not some disorder that should be cured. Perhaps some view obesity in the same way; consider fat advocacy, and the popularity of enabling terms like "big beautiful woman and “real woman”. ---
**Author:** ![Sicks\_Ate](https://avatars.discourse-cdn.com/v4/letter/s/258eb7/32.png) [@Sicks\_Ate](https://boards.straightdope.com/u/Sicks_Ate)\ **Post date:** [July 20, 2012, 3:19pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/66 "2012-07-20T15:19:10Z")
> [@elmwood](#): > > Maybe they see themselves as part of a “fat culture” that’s being threatened, **much like many deaf people are against cochlear implants. Some deaf people believe that that deafness is not some disorder that should be cured**. Perhaps some view obesity in the same way; consider fat advocacy, and the popularity of enabling terms like "big beautiful woman and “real woman”. Seriously?? ---
**Author:** ![elmwood](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/elmwood/32/3060_2.png) [@elmwood](https://boards.straightdope.com/u/elmwood)\ **Post date:** [July 20, 2012, 3:26pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/67 "2012-07-20T15:26:39Z")
> [@DSeid](#): > > Also if a city found that a majority of its citizens were allergic to the elm trees they were planting, I’d think it would make long term sense to start picking different trees to plant in the future. Such would not be a quick fix but longer term it would be more effective than developing better allergy meds and having individuals get better at keeping their windows shut and AC on. Not a substitute for though. Some cities are doing that. In their landscaping ordinances, they may allow female trees of a certain genus, but not more heavily pollinating male trees. A zoning code I wrote for a suburb of Austin bans some male trees of certain genera, along with all cedar trees. Why cedar? [This](http://www.kvue.com/news/Cedar-Fever-hits-Central-Texas-136401528.html). ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [July 20, 2012, 4:00pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/68 "2012-07-20T16:00:19Z")
> [@Sicks\_Ate](#): > > Seriously?? Given what you bolded in that quote - [yes, seriously.](http://www.cbsnews.com/2100-3445_162-10794.html) But I do not that applies by way of comparison. So far the arguments against have been my concern over whether it actually will lead to improved health outcomes even if safe, and cost concerns; an argument that since all a fat person needs to do is eat less and exercise more that a medication approach is superfluous, might even result in making behavioral changes less likely; and those who believe that the problem is not in their reward system or in how many calories they take in so a medication that impacts those systems wouldn’t work for them. Not one taking a “fat advocacy” position. The closest to that would be my argument that fat is not the problem as much as it is a risk marker and that the focus should be on modifying _the behaviors_ whether or not doing such resolves the obesity. Not quite fat advocacy. (The obvious counterpoint being that the drug may make part of the behaviors _easier_ to modify …) Interesting though about the trees, **elmwood** and point well made about the potential of confounding population biases and self-segregation in any environmental analysis done. ---
**Author:** ![elmwood](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/elmwood/32/3060_2.png) [@elmwood](https://boards.straightdope.com/u/elmwood)\ **Post date:** [July 20, 2012, 4:51pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/69 "2012-07-20T16:51:11Z")
> [@even\_sven](#): > > I live in California, and I’ve seen a lot of brand new suburbs go up. The trend has been to surround the suburb with a greenbelt, and then build parks, schools, and shopping areas (all of which developers are required to account for) outside of the greenbelt along the main access road. This makes it impossible for kids to walk to school, or for people to take a quick walk to the store. How hard would it be to build this critical infrastructure towards the center of the development, where it would be accessible by foot? [Not very hard](http://www.cnu.org/). It’s just that many cities and towns choose not to encourage traditional neighborhood development, or make it mandatory. Many communities still have older plans or zoning codes where more walkable, interconnected, mixed-use neighborhoods are _illegal_. The market is changing, though, which can be seen in the preferences of Generation X and Y ror urban living, compared to more suburban-oriented Baby Boomers. Eventually, the codes will need to catch up to recognize that; the communities that are holdouts will fall behind. We just finished up the first draft of a new comp plan for the community where I work. Among many other goals, one is making TND mandatory for new greenfield development. The sprawly, low-density, vehicle-oriented, single use subdivisions will remain; there just won’t be any more of them. Again, though, you might have some self-selection. More active people will chose to live in more walkable communities, while for the more sedentary, walkability might not be as important to them. TNDs and new urbanism developments could be the new Denvers; loop-and-lollypop subdivisions the Houstons. There’s already some ideological self-selection in TND/NU development. ---
**Author:** ![rhubarbarin](https://avatars.discourse-cdn.com/v4/letter/r/eb9ed0/32.png) [@rhubarbarin](https://boards.straightdope.com/u/rhubarbarin)\ **Post date:** [July 21, 2012, 1:56am UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/70 "2012-07-21T01:56:48Z")
I predict that these drugs will prove ineffective for maintaining weight loss, so I see little point. There’s certainly a lot of research that indicates that it’s much healthier in the long run to maintain ‘weight stability’, fat or not, than it is to ‘yo-yo’ up and down 20 or 100 lbs. Weight, body fat percentage, and appetite is totally governed by hormones, though the causes of the hormonal imbalances that lead to problems such as obesity and eating disorders are many, varied and often misunderstood. Research on relatively recently-discovered hormones that have a huge influence on body mass and composition, appetite, energy expenditure etc is fascinating. Including but not limited to leptin, ghrelin, amylin, and resistin. I doubt that there will ever be a drug or cocktail of drugs which can reproduce the healthy results that eating and moving in a way that will restore normal hormonal balance along with a healthy appetite and weight, will - so it sadly does come back to knowledge and willpower (or access). ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [July 21, 2012, 2:38am UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/71 "2012-07-21T02:38:28Z")
> [@rhubarbarin](#): > > though the causes of the \*\*hormonal imbalances \*\*that lead to problems such as eating disorders are many, varied and often misunderstood. So hormonal imbalances are what cause eating disorders? Do you have a cite for this? (my bold) ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [July 21, 2012, 3:05am UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/72 "2012-07-21T03:05:18Z")
And that yo-yo up and down is more harmful than staying fat (assuming poor behaviors during fat phases) … ---
**Author:** ![rhubarbarin](https://avatars.discourse-cdn.com/v4/letter/r/eb9ed0/32.png) [@rhubarbarin](https://boards.straightdope.com/u/rhubarbarin)\ **Post date:** [July 21, 2012, 9:26pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/73 "2012-07-21T21:26:28Z")
> [@Ambivalid](#): > > So hormonal imbalances are what cause eating disorders? Do you have a cite for this? (my bold) Eating disordered behavior and abnormal weight are tightly linked with hormonal imbalances. But it’s not a chicken-or-egg scenario. Here’s a random study out of hundreds. [The role of leptin and orexins in the dysfunction of hypothalamo-pituitary-gonadal regulation and in the mechanism of hyperactivity in patients with anorexia nervosa - PubMed](http://www.ncbi.nlm.nih.gov/pubmed/18283238) ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [July 21, 2012, 10:28pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/74 "2012-07-21T22:28:22Z")
> [@rhubarbarin](#): > > … the hormonal imbalances that lead to problems such as obesity and eating disorders … > [@rhubarbarin](#): > > Eating disordered behavior and abnormal weight are tightly linked with hormonal imbalances. But it’s not a chicken-or-egg scenario. … Second time around stated with more accuracy I think. ---
**Author:** ![rhubarbarin](https://avatars.discourse-cdn.com/v4/letter/r/eb9ed0/32.png) [@rhubarbarin](https://boards.straightdope.com/u/rhubarbarin)\ **Post date:** [July 21, 2012, 10:55pm UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/75 "2012-07-21T22:55:16Z")
Yes, my mistake. 🙂 ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [July 22, 2012, 5:19am UTC](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583/76 "2012-07-22T05:19:17Z")
You post with honor sir. 🙂 [Previous page](https://boards.straightdope.com/t/new-drugs-for-obesity-treatment-a-good-thing/628583.md?page=3)