It’s not messed up. It’s just maladapted to our food environment where there is high calorie, highly rewarding, cheap food available to us at all times. Countries where traditional diets predominate don’t have widespread obesity, and we can see obesity rise in developing nations as they adopt Western diets.

Some people, including the Chinese-resident subjects of this study, have hunger responses that are not susceptible to the temptations of our food system.

> It’s just maladapted to our food environment where there is high calorie, highly rewarding, cheap food available to us at all times.

I visited China and they seemed to have plenty of access to high-calorie, highly-rewarding food. What's special about the temptations of our food system?

It's possible that as China transitions to a post-food-scarcity environment like the West it will see high obesity like in the West:

"The unparalleled rise of obesity in China: a call to action"

International Journal of Obesity volume 45, pages 921–922 (2021)

https://www.nature.com/articles/s41366-021-00774-w

While Chinese people may have a low obesity rate, they aren’t significantly healthier in other respects. High cholesterol, blood pressure, and type 2 diabetes (white rice) are a big problem.

IMO this is one of the biggest and most interesting questions of the last century with the widest and most frightening implications.

If literally a majority of people in wealthy nations are what we define as overweight, and we keep finding new ways that is at least somewhat out of our control or difficult to perfectly control, why do we keep framing it as solely a matter of individual discipline or virtue? I have my own guesses about why of course, but pretty much all of the possibilities are unsettling.

This article is a great analysis of the environmental theory of obesity: https://slimemoldtimemold.com/2021/07/07/a-chemical-hunger-p...

"Being hungry" has different definitions and corresponds to two very different body sensations. If you eat at a regular time every day, you'll get "hungry" around that time, whether your body really needs it or not. But if you skip that meal at some point the cravings disappear… so it wasn't really physiological then, just a mind trick from hormones. The other "hungry" you can feel it like a vacuum in your stomach and is painful.

It's interesting how effectively GLP-1 (ozempic, etc.) eliminate that, though.

This entire "you just need to eat better" discussion seems to fall apart badly in the face of medicines like GLP-1 agonists (e.g., Ozempic/Wegovy.)

It's like arguing that pneumonia can be cured through "healthy living" even after you've established the mechanism and effectiveness of penicillin.

It fits into a mode of thought where fat people are fat because of character flaws, and thin people are thin because of superior moral character. Thus, it justifies the better treatment of thin people over fat people.

I've even heard the "thinness is a sign of godliness" folks get really angry at the suggestion of using GLP-1 agonists, because it's "lazy" and "cheating."

Having seen friends and relatives succumb to cardiovascular disease, it's really heartbreaking. I've watched people starve themselves on brown rice and broccoli for years (with only modest results, followed by total failure) because diet-only interventions are completely unrealistic and don't work long term.

Those friends and relatives weren't really starving themselves brown rice and broccoli. They were eating a bunch of other stuff when you weren't looking.

We have existence proofs that diet-only interventions work for some people. I literally know people who have lost large amounts of weight and kept it off for years that way. Medications have risks and side effects, so should only be prescribed if behavior modification has failed.

We have many unsuccessful treatments that work for a small percentage of patients. That's why we measure treatments by effectiveness rather than identifying existence proofs that it worked for someone.

You're really missing the point. Every patient is unique. That's why competent healthcare providers take a step therapy approach and try cheaper, lower-risk treatments first before moving on to more expensive and riskier medication or bariatric surgery.

You seem to have misread my posts as saying that healthcare providers should immediately move to medication rather than try dietary intervention. I didn't say that, I didn't imply that, I didn't even think it.

What I did say is that we are increasingly learning that overeating is a very complex and life-threatening medical concern that often cannot be solved through dietary intervention. Even people who may die if they don't adhere to a diet frequently have difficulty adhering to one. Saying that there are "existence proofs" that diets sometimes they work is a terrible response.

My view is that we should treat diet as one possible medical treatment, and evaluate it apples-to-apples (in terms of efficacy and side effects) against more recent FDA-approved treatments. And now that we've seen how much impact those treatments can have -- and particularly how critical the GLP-1 mechanism is to the sustainability of weight-loss interventions -- we should work our asses off to find more and better treatments that treat overeating as a health condition rather than a question of mind-over-matter.

You seem extremely attached to your position, to the point where defending your position required you to declare that my relatives "were eating a bunch of other stuff when you weren't looking."

It makes sense evolutionarily: if there's lots of food available now, you should eat it, because there might not be enough in winter.

We live in a society where there's always lots of food available for most people in developed countries (who are mainly the people who are overweight), so it makes sense that you will instinctively eat more than you need to.

Hunger is not only about not getting enough food, it’s about not getting enough of the right type of food for you genetically.