Obesity drugs coming to market

I am not commenting on the video or article. I am saying that both physical disease (diabetes, for example) and mental disease (lack of control, for example) are biological and are physical at their core. Insulin issues, serotonin issues, gut bacteria issues, or whatever causes a problem is a “disease” of the human body.

It’s not at all surprising. At age 3 we plop them in front of the TV playing a video … with snacks, of course … to keep them occupied. At age 5 we hand them a tablet to watch videos … with snacks as usual … to keep them occupied. At age 9 or 10 we get them a phone … which keeps them occupied for hours a day. As teens they gorge on social media instead of real socializing (that requires walking around and going to places with friends). At 18 they go to college, live in nice dorms with plenty of food … with a car and/or an uberlyft account so they don’t need to walk much. Suddenly in their 20s … boom they’re obese and spending too much time at the food court. I wonder why? Guess what? They’ve been “training” in the art of obesity for 20 years!

2 Likes

Although the examples given in the piece sound persuasive for “the obesity as disease” model, I don’t think it reaches quite the level of type1 diabetes for most.

For sure, with increasing adiposity, the body undergoes a number of metabolic changes that make subsequent attempts at weight loss and maintenence difficult but I doubt it’s quite as extreme as some of the examples given for most.

For instance, the idea of the body defending a set point/resisting weight loss is true to a certain extent but the implication here is that this mechanism can somehow create energy out of thin air. I’m thinking about the example of the obese young woman who appears to work out on a daily basis and eat very little. This doesn’t sound a very plausible explanation of why someone is remaining obese.

Situations like this usually hinge on a self reported workout regimen and eating plan … and individuals are notoriously unreliable at this sort of self assessment. That’s not to say they’re lying … even to themselves…but there are metabolic studies where subjects are under close scrutiny with specially prepared meals for controlled energy intake and the sort of technology that can measure energy expenditure with greater than 99% accuracy. Without fail these confirm that the body obeys the laws of thermodynamics.

2 Likes

But a few posts earlier you were arguing that the slow and steady path to obesity wasn’t easily observable and the result of just a few extra Calories daily over an extended period…65lbs over 20 years was your example

It’s one and the same. Those of us who grew up without constant “screens” (just using that as a shorthand, there are myriad things that enter into the equation) also take many years to work our way up the obesity ladder … relatively small amounts of extra food (not noticeable to an observer of an individual) … and relatively small amounts in decrease of activity (hardly noticeable for an individual, but completely noticeable in society, just stand at the stairs and escalator by a metro/subway system and watch 98% line up for the escalator and 2% use the stairs) slowly result in obesity.

In short, it is not easily observable in an individual, but it is observable across society.

2 Likes

Hardly. In fact, as you go on to point out, it’s the very opposite.

My office manager articulated an example well over 20 years ago. I got back to the office after my lunchtime visit to the gym and she was opening the mail…

“Look at this, Dr N…don’t these meals look great?”

Well, yes they did. Lovely examples of culinary art so it was obviously an ad for a recipe book. Now I love recipe books. Don’t do much with them, mind…but they do look good on my kitchen shelves. Turns out that it was for the South Beach Diet cookbook. I asked why it was necessary to make the food so enticing for folk who don’t need much temptation to eat (only half facetiously)

“Pffft, you,” she said “If everyone ate like you, no one’d get fat in the first place”

There you have it pretty much for most. Folk who follow weight/fat loss diets successfully do so with varying measures of mindfulness and accountability and, for as long as this is maintained, so is the weight loss. One difficulty is that the habits of excess energy consumption are often so longstanding, keeping this degree of dietary surveillance for long enough for mindful eating to become a default is just plain hard (darn near impossible, I’d imagine, if folk are unwilling to accept the concept of energy balance as it pertains to them … and there’s a cottage industry trying to encourage this notion) This is without all the hormonal responses etc that kick in to maintain what the two physicians in the 60 minutes piece call the “set point”. Both of these obesity experts are advisors to the manufacturer of these weight loss drugs, BTW (according to the article) and I imagine are likely to be more inclined to argue the “obesity as disease” model.

I tend to think of the 4 stages of competence model in regard to the behavior change necessary. I think it holds water equally well for weight management as it does for prevention of dental caries and periodontal disease…or better yet, learning to drive a stick shift.

Feel free to doubt all you want. That doesn’t mean your doubts are correct.

I don’t see that. No one is implying that we can create energy. Instead, the mechanism is probably efficiency.

When there is excess food available, our bodies can store the excess as fat, or use up the energy less efficiently, or even extract less than all of the energy from the food consumed. The disease comes in when the body doesn’t limit the storage of excess energy rather than using it for a higher base metabolism or simply discarding the excess energy as waste.

The problem with simple calories in vs out is that not all of the calories in are converted to useful energy. Some people convert more of the calories in to usable energy, and some less. If you are one whose body extracts more of the calories consumed, you will always have weight problems. If your body extracts less, you won’t have a weight problem.

Maybe I’m arguing for a genetic issue more than a disease. But in either case, I believe that approaching the issue with an open mind and compassion is far more likely to be successful than just telling people to eat less and exercise more while implying that their weight problem is a self discipline problem.

—Peter

1 Like

It is a little of both in my opinion.

I’ve seen a few friends/co-workers have gastric sleeve procedures and the weight falls off for awhile but if they don’t change their relationship with food, they eventually learn to eat around the procedure and put the weight back on. That is the mental/psychological/self control portion.

It is a disease in that being overweight changes several aspects of your metabolism/endocrine response that unfortunately becomes a downward spiraling feedback circle.

It takes both to fix the issue.

An interesting aside is the study of epigenetics. There are a lot of things there that we are just know finding out, what turns genes on/off and for following generations. You are what you eat but we are finding out you are what your grandparents ate.

1 Like

Indeed…but this is something of a Straw Man argument. A “true enough” comment to a point no one’s made. At least not me.

Calories In vs Calories Out is certainly a simple heuristic to cover all the factors that influence energy balance but.to use “simple” in the context of this suggests a fundamental lack of understanding on your part.

For sure, no two individuals respond equally to identical foodstuffs…but there’s still a degree of consistency in the degree to which they do. Let me give you an example. Let’s say.a bunch of us volunteered to be guinea pigs in a “metabolism” study of the type that goes on frequently in labs all over the World. We get to sit down to the identical mixed macronutrient meal with the exact same energy content…say 500 Cals. That’s 500 Cals sitting on everyone’s plate. We’re compelled to eat every single morsel to the extent of linking the plates and utensils so that there are no ifs, ands or buts about whether 500Cals … or as close as possible…has passed our lips.

It’s 100% accurate to say that we won’t all extract or assimilate the same amount here whether it’s due to, say, the state of our dental health and ability to chew efficiently, the quality of our saliva to the to the biodiversity of our distal colon …and everything in between. Here’s the thing though…no one will extract so much as a single Calorie more than 500 so, whether you’re one of the lucky ones (in times of plenty) who “squanders” a good bit of the stored energy or whether you’re thrifty, that extracted energy is going to be proportionate to what’s on the plate before you start.

There are quite a few ways for any one individual to move away from the thrifty to the wasteful phenotype. I think that, in their efforts to shill for Wegovy etc, the two obesity experts in the 60 minutes did a disservice to folk who, absent true pathology, could make a enough of a difference to their own body composition which would go a long way to enhance the efficacy of these drugs and set the users up to wean themselves away.

Edit to add a link to an article I’ve found particularly useful over the years to give to folk who’re unconvinced that energy balance is a “thing” or that it pertains to them

1 Like

I was about to write literally the same thing. Luckily I read through to the end before I did.

It is for this reason that when research using self reported ingestion of a maximum of 1200 kcal/day, yet still “putting on weight”, has to be discounted … for reality.

1 Like

Here is a most typical example of obesity progression today.

“Regarding health, I’m focused on losing weight. A shade under six feet tall, I was 165#(?) in college, fairly fit thanks to weight lifting and other exercise. Move forward 35 years to 2010, I was around 248#, quite overweight. I finally have been getting serious about resolving this health timebomb and have lost about 32#. Almost out of the obese range per the BMI. I’d like to get down to 200# this year and if I do better, that’s good too.”

My wife had a gastric bypass (roux-en-Y). And it definitely helped. She lost about 100 lbs. after the surgery (long-term net after the typical rebound). But she got frustrated after a while that no matter how much self-control she exhibited, the weight loss stopped. And she did have good self-control for probably 10 years after the surgery. But she basically gave up about then, telling me she was tired of constantly having to think about what she ate. It was especially hard as our son can eat almost anything and not gain weight. (He also has hypertonic cerebral palsy, which will definitely keep the weight off!)

A drug such as the ones mentioned here might have helped her loose a bit more weight, and forestalled the mobility issues that eventually led to her passing.

–Peter

2 Likes

So, reading through the Body Recomposition link I posted, I realised that I hadn’t eyeballed Lyle McDonald’s site for a while so I thought I’d put another tidbit out for anyone intetested.

Quite relevant in this context since exercise is a really useful tool in the context of weight management…both for the obvious benefit of increasing daily energy expenditure and preserving muscle but especially for mitigating many of the harmful metabolic effects of excess body fat.

1 Like

Noom is able to help people calorie count with a phone app monitoring the daily progress. Most people have about the same responses to how much they can eat based on height, weight and gender. There are some who do not at all.

This conversation is trying to make generalizations on individual conditions. That wont work.

But most people who are overweight will do their best at loosing the weight longer term with calorie counting and some decent information on food and habits.

1 Like

Why is Noom important for doing that. There are plenty of free apps for calorie and movement tracking…and an estimation of energy balance in the two?

1 Like

Veenee,

It may be that there are several route to counting calories. I am not claiming an exclusivity.

I will claim a panacea effect. I bought into Noom. That did take some work on Noom’s part.

1 Like

I’m not dismissing its value and I wouldn’t suggest trading it for anything else if this is what’s working for you but I’m wondering, say, what would make me recommend it over using the free stuff that’s available. They’re very short on specifics on their website.

I’m technically a Precision Nutrition certified coach. I did the training programme years ago…not with any intent to branch out into that line of work but rather to add something extra to my teaching armamentarium. The focus is small incremental behaviour changes which tends to be my style for getting anything done. I’ve found, though, that there are enough folk around who want the grand gesture and promise of speedy weight-loss …forget that this has never worked in the past…or who’re so convinced that the Cals in vs Cals out concept has no merit that it’s hard to see what extra Noom could be offering.

2 Likes

Veenee,

That is the thing, the cost is low. Especially compared to the potential benefit.

It is not a big secret but I wont go into the specifics of the program. The reason is the benefits accrue to those who make a self discovery of the program. If I tell you how it works that diminishes the impact of getting involved with Noom. Perhaps not for you but for someone else reading this.

My experience with my sister was to say upfront I was not going to ruin her experience by telling her about the program. We both did our thing and supported each other in a phone call every Saturday morning for four months. We succeeded.

If you sign up the cost wont bother you in the least. That much I will give you up front.

My condolences.

Possibly. There is still much we are learning about “diet” (food lifestyle?).

I might be oversimplifying things, but all these diabetes drugs being used for weight loss are addressed with a lower carb/Keto type diet. Dealing with insulin sensitivity and decreased response that accompanies overweight/obesity. DW went lower carb 5-6 years ago, dropped maybe 40 pounds, feels much better, more energy, etc.

2 Likes

ah, my BIL an endocrinologist would say use metformin if you can tolerate it. The other diabetes drugs are much more problematic.

Metformin does not really care carb protein or fat. The drug can stop the metabolism of UP TO 30% of your calorie intake. It can aid with some weight loss or stability.

Often even if there is a benefit with the other drugs there might be side effects that are not worth it.

The differences in metabolizing carbs fats and proteins are not enough to make a major difference in weight loss. That is a misnomer that they would. Cut out anything and for a while calories are cut. Think of it this way if I get on a treadmill for an hour and burn 100 extra calories changing from eating carbs to eating fat or protein probably wont save me the equivalent 100 calories. Exercising for 100 calories is not much for weight loss. And exercising for 500 calories in many instance will cause weight gain as people are hungrier.

Individuals differ but for the many cutting calories is the goal along with healthy eating.

1 Like

One of the reasons that so many folk believe that the Cals in vs. Cals out equation doesn’t hold water is that most are really pretty bad at estimating either side of the equation…especially the energy expenditure side. Both from the aspect of energy cost of the exercise itself and the impact on total daily energy expenditure.

In reality, exercising for 100 Cals…i.e. 100 Cals over and above what you’d be burning doing something else is a meaningful amount of energy to expend. Especially for someone significantly overweight and lacking any sort of track record in exercise…someone who wouldn’t actually be able to hack a bout of exercise to the tune of 500 Cals.

Having realistic goals both for Calorie deficit (diet) or expenditure (exercise) can make the difference between sustainable success or epic failure when it comes to long term weight management.

2 Likes