> "No free lunch" is a reasonable question to ask when evaluating medication, if it would improve the evolutionary fitness of the majority of people. I think this is behind some of the skepticism. If Ozempic is so great then how come our bodies don't just produce more GLP-1?

We can do science and technology on timescales vastly faster than evolution. "Why didn't evolution do it?" is just a very irrelevant question.

> The second point I haven't seen discussed is that weight loss drugs prior to GLP-1 agonists include cigarettes, which (worst case) give you cancer; stimulants, which cause your heart to fail; parasitic intestinal worms, which can kill you but more importantly are just plain gross; and mitochondrial uncouplers, which set you on fire at a cellular level. That's a long history of miracle weight loss drugs which turn out to have horrible side effects.

Cigarettes, parasitic worms, and 2,4-DNP were never medications.