It's absolutely a lifestyle problem. Americans have a shitty car-based lifestyle that causes obesity. Go to Manhattan and see how many obese people you see; there aren't many. Or go to any other country where people walk a lot. This is uniquely a western, and especially American problem.

Correlation is not causation. Manhattan has many thins because thins are more likely to make more money and get better jobs in high-standard-of-living areas due to commanding more respect. (Which they mostly do not deserve, being mainly the beneficiaries of good genes, but I digress) Also, most people move out to the ‘burbs to raise kids, so Manhattan is strongly weighted towards the under-40 set.

> any other country

OK let’s pick Germany. (I’m German.) Most Germans are thin because they don’t eat many carbs at all. Orange juice is expensive and piss-poor compared to sugary American OJ. Breakfast typically consists of unleavened-style breads, mustard, and meats. Gas is super expensive so everybody walks or bikes. But guess what? Obesity is steadily rising there too! Gosh, I wonder why, with all that walking and biking? Wait, I know… They just need MORE walking and biking, that must be it!

Lifestyles haven't changed? Come now, in just my lifetime I've seen kids go from being outside everywhere playing until dark, to being mostly inside all day. And I live in a very active community!

With regards to changes in willpower, that seems like a strong assertion, got any sources on that?

100% agree that our diet (generally) has changed drastically.

But I don't get your jump of why medication has to be the solution? Maybe undoing some of the changes that got us here?

Sure, in many cases where they're already well down the road of obesity and experiencing its negative health consequences - yes medication can be useful. But that's far from the only option at hand here.

> With regards to changes in willpower, that seems like a strong assertion, got any sources on that?

How is it a strong assertion that willpower HAS NOT changed? Isn’t that the null hypothesis? It seems to me that you’d need evidence that it HAS changed

Take a look at your average individual from 100 or so years ago: probably working a manual job, lived through a depression and world war. Life was certainly harder for most in many basic ways. Obviously not true for all, but generally speaking quality of life has improved a lot.

Our culture is light years away from that in terms of the resilience that's generally expected from people.

Yes, I think it's fair to question the assumption that willpower has not changed.

> medication that treats it like the medical problem it is

That was the approach in the 50s and 60s with amphetamines as an appetite killer.

That didn't work out well.

That’s because amphetamines were a piss-poor solution. Meds like Mounjaro, which directly eliminate hunger hormonally in the brain instead of simply being a side-effect of brain overstimulation, seem like a significantly better option to me

Disclaimer: Been on Mounjaro for 1 month and have lost 15 pounds absolutely effortlessly and with zero side effects