Scott Alexander and his high quality commenters have a big discussion on semiglutides, a “new” weight loss drug type. No point to excerpt, just read it.
Okay, now that you’re back, I want to tell you: you just wasted a ton of time, the whole thing is stupid. Not the author, not the commenters, but the topic. Well-intentioned people have screwed up the “obesity epidemic” topic so badly that well-written, well-argued, well-informed articles like this are just completely off-base in determining the all important: “What Should We Do?” If Alexander wrote the final word on astrology and won the Pulitzer for it, he should be applauded for his fiction-writing skills, but it wouldn’t make the whole thing any less stupid or less productive for society. Again, no fault of his own, his commenters or anyone else who are honestly trying to figure out how to fix a genuine problem. But almost everyone, including the author, is a person who either has never had to lose weight, or has tried ineffectual methods and had them fail (or more commonly, revert after time). Do I know this for sure? No, but after reading enough stuff like this, you start to be able to detect it.
His headline point is correct: there are 140 million obese Americans, and semiglutide costs $15,000 a year, therefore this solution (even ignoring those for whom it doesn’t work, or has too many side effects) to the obesity epidemic won’t work. Thanks for figuring that out, this is a genuinely important conclusion. The problem is, like that Pulitzer prize winning article about astrology which concluded that call-in astrology services were too expensive for the 300 million Americans who need to know if today is an auspicious day to start a new venture. All very true, all very pointless. But why?
First thing, let’s establish what we are actually talking about. When we say “obesity is a problem” we don’t actually mean “obesity.” Yes, being very overweight can have specifically weight-related problems, but the real cost (many billions of dollars, significant %’s of GDP) is in all the other things we consider obesity to be correlated with: diabetes, heart disease, cancer and so many other things. If we waved a magic wand and solely returned everyone to their perfect weight, we’d save money being able to wear our college jeans again, but if the underlying mechanism that caused all that other bad stuff still existed, we’d still have an epidemic of bad things, with massive costs. Obesity is just one, not always present, symptom of an underlying problem. There’s a million articles debating this (often using the term “metabolic syndrome X”) which you can read, but grant me this one assertion. If you don’t like it, fine, I don’t care.
Second: exercise. Exercise is awesome, it is 100% beneficial and everyone should do it, and it CAN cause you to lose some weight. But it does not do so reliably, and if you are strength training (which you should) you will likely gain weight, as muscle is heavier than fat. So go ahead and do it, but it’s largely irrelevant to arguments about weight loss, though it will help underlying issues and make you healthier. Again, you can read a million articles about “does exercise help you lose weight” but you’re wasting your time.
Now the meat: the reason the whole debate semiglutide (and also dangerous weight loss surgery) is stupid is because there is a negative-cost, method to improve your health AND likely (but irrelevantly) lose weight along the way. Here goes:
1. Forget calorie restriction of the "just eat 20% less calories" form. It requires too much calculation and willpower, and your body will compensate. Forget any diet that stops you from participating in normal social rituals with friends, coworkers or family. Forget any “diet” that is something that requires more than trivial willpower to stick with, or that is intolerant of exceptions/cheats to work. Forget anything that says you can’t eat when you’re hungry: the entire point is to change when you are hungry.
2. Replace carbs in your dinner with fat/protein as much as possible - slowly, quickly, gradually - whatever works best for you. Eat as early as possible, eat til you’re full. Don't eat after that - i.e. bedtime snacks. You will find the more fat/protein you eat for dinner, the less you will want those snacks. This is something anyone can do, it doesn’t require much willpower, it doesn’t change your your daily life. It’s also the part that probably does have some higher cost: fat and protein do probably cost a bit more, though you tend to eat less of them because they’re filling. But not $15,000 a year.
3. Over time, extend the time from ending dinner until the next time you eat as much as possible. Breakfast at 9 instead of 8? Lunch at 2 instead of 12? Eat the next day when you're hungry, but also try drinking a zero-calorie electrolyte drink and see if you still want to eat. Measuring exactly 50/100/150 less calories across three meals a day for a year is impossible. Measuring that you ate your first meal of the day 10 minutes later than yesterday is easy. Don't put any sugar/carbs in your morning drinks. Again, anyone can do this. You already don’t eat for long spans every day - from when you finish dinner, go to sleep and wake up - this can be between 8 and 12 hours already. It’s easy to imagine (and to do!) going a few hours longer, especially if you are going to be less hungry because you ate more (scientifically) satiating (defined as: prevents onset of hunger for longer) stuff for dinner the night before.
4. Eventually cut out breakfast. Maybe also lunch, (this is also a cool productivity booster!) or just eat a later lunch. Don’t get triple sugar bomb mocha lattes at Starbucks. If you’re having something special for lunch, or it’s important to hang out with co-workers, then just eat it! I’m talking skipping the boring stupid lunches that most people eat each day. Don’t interfere with your life. Just like dinner, when you do eat: replace carbs with more satiating fat/protein as much as possible. Whatever feels okay. This is the part that saves you money. Spend it on a subscription to this Substack. Surprise, that’s also zero dollars, oh well. Again, anyone can do this: unless you are currently waking up at 4am starving, then you know you can already go many, many hours without eating. And everyone knows that some foods (carbs) mean you’re hungrier earlier rather than later - it’s literally the butt of a hundred jokes - so of course if you ate the ones that make you hungrier later (fat, and to a lesser extent, protein), you’d feel the need to eat later. There’s no magic willpower ingredient, you’re revising the things that are placing the demands on your willpower.
5. Get your yearly blood work done so you can see the improvement in your metabolic indicators. Most importantly: if your numbers get better - whoever you get the labs from will tell you the healthy/good ranges - FORGET YOUR WEIGHT, sell your scale. Weight is just a signal. It is not your health itself.
This Is The Way. Every American can do this. It costs negative money. It has few, or positive side effects. For the millions of average somewhat-overweight American, it doesn’t require expensive drugs (Semiglutide still has a purpose - there are people who want to lose even more weight for purely cosmetic reasons, or who just actually prefer a pill to even the reasonably easy-to-implement above list - fine!) or surgery (which also has a purpose in rare, extremely obese cases who need immediate, profound intervention). It’s not dependent on willpower, money, genes, body type, sex, ethnicity, age or intelligible lifestyle advice from your doctor.
You can do it. You don’t need expensive drugs or surgery. In all kindness and humility: please stop wasting your time writing articles about expensive drugs or surgery and just tell people what works.