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?
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.
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.
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.
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??
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.
Given what you bolded in that quote - yes, seriously.
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.
Not very hard. 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.
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).
So hormonal imbalances are what cause eating disorders? Do you have a cite for this? (my bold)
And that yo-yo up and down is more harmful than staying fat (assuming poor behaviors during fat phases) …
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
Second time around stated with more accuracy I think.
Yes, my mistake. 
You post with honor sir.