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There was a recent HN post about a weight-loss drug where I bit my tongue and did not try to "rebut" stuff there with a comment about diet and lifestyle. Methin

There was a recent HN post about a weight-loss drug where I bit my tongue and did not try to "rebut" stuff there with a comment about diet and lifestyle. Methinks this problem runs deeper than paying doctors to promote drugs. Americans fundamentally seem to see drugs and surgeries as "health care" in a way I find concerning.

deleted 2y ago
[deleted]
spondylosaurus 2y ago
...are drugs and surgeries not healthcare?
- DoreenMichele 2y ago
  Eating right is health care. Exercise is health care. Decent housing is health care. Drugs and surgeries are medical care and I grew up with the weird idea that it's crisis management, not your first line of defense while acting like diet and lifestyle are annoying details you can stop worrying about if you can get the right prescription.
  - nitwit005 2y ago
    We've tried and failed to get people to "eat right" and exercise for the last century or so. We've put a stunning amount of effort into that option, and failed.
    - DoreenMichele 2y ago
      My dream career was urban planning. We used to design walkable cities and now we design a world that is car centric. Designing exercise into our daily lives used to be part of the urban planning profession. Paris was redone to put a stop to health issues in overcrowded slums. Nutritional value of produce has gone down for decades while we strip mine our soils and try to make up for it with chemical fertilizers. I don't think the obesity epidemic is going to be solved with lecturing people like they aren't trying hard enough to starve themselves while we build "fuck you, pedestrian" environments all over the country.
      - 123yawaworht456 2y ago
        cool story bro, but: 1. there are plenty of obese people in rural areas where they have all the walkable space they might desire 2. do you even know how little energy humans need to walk? a single candy bar is enough for a three hour hike 3. pick a random chinese/japanese city, find a youtube video with visible crowds, and count the number of morbidly obese people you see. it would take you a while to find a single mobility scooter tier flesh golem, if you can find one at all "lecturing people like they aren't trying hard enough to starve themselves" is the only solution for the obesity crisis, because the only reason for the obesity crisis is vast abundance of cheap, artificially tasty empty calories. 300+++ lbs blobs of fat virtually did not exist before Standard American Diet
        Jensson 2y ago
        > 1. there are plenty of obese people in rural areas where they have all the walkable space they might desire Rural areas are much less walkable since stuff are so far away, and thus are significantly fatter than walkable areas. When it is easy to walk to places you need to go to people often walk, and such areas have much less obesity.
        s1artibartfast 2y ago
        I get what you are saying, but dind the "no, no, that's too much walking" comments kinda funny. Walking 1/4 mile to a coffee shop every day won't make people skinny.
        shiroiushi 2y ago
        >1. there are plenty of obese people in rural areas where they have all the walkable space they might desire No, they don't. Have you ever spent any significant time in rural American places? There's no place to walk at all, because: 1. everything is too far away for walking to actually be useful for going places, 2. there's no sidewalks even if you don't mind walking 2 hours to the nearest Walmart, and 3. there's no wild places to walk either, contrary to popular belief, because all the land is privately owned and "trespassing" is not allowed (and can get you shot). Rural Americans can only walk places if: 1. they have a lot of land around their house, which granted is more affordable than in more urban places, or 2. they get in their vehicle and drive to a state or national park someplace and use the hiking trails there. It's so weird how many people think rural America is some bucolic place that resembles the Shire of the hobbits, when in fact it's a car-bound hellscape even worse than the worst American car-centric city. It's not like the UK, where you have an absolute right to roam across rural lands.
  - spondylosaurus 2y ago
    I may just be coming at this from a different angle (as someone with chronic genetic conditions), but differentiating between "health care" and "medical care" seems like unnecessarily splitting hairs to me. The place I go every few months to get the drugs that make me a functional human being has "health" in the name :P Like, I understand where you're coming from on the diet angle specifically, but some of this strikes me as painting with strokes that are just a bit too broad for the other thousands of reasons people need drugs or surgery.
    - DoreenMichele 2y ago
      I also have an incurable genetic condition. It's part of why I have spent so much time thinking about this and feel so strongly about it.
  - roywiggins 2y ago
    Okay, but imagine you work in public health. We have decades of attempts at convincing and helping people to make lifestyle changes. There are a thousand diet plans, a thousand attempts at consumer education, and it's gotten us this far, which isn't very. What non-pharmaceutical intervention would you propose- something that could be rolled out as a program- that hasn't been done before, and would work, in say the next decade? Because at a population level, these drugs seem to be doing more than the cumulative efforts of a million dietitians.
  - pessimizer 2y ago
    The idea that if we had a safe drug that made people lose weight (we don't) we shouldn't immediately give it to all fat people without a lecture, borders on a religious belief about virtue. That case could be made for not giving insulin to diabetics or bronchodilators to asthmatics. If there were a safe drug that can make people lose weight and put on muscle, I'd be actively telling people not to exercise unless they enjoy it. It's bad for the joints.
Spastche 2y ago
we are addicted to convenience and ease
- greenchair 2y ago
  [flagged]
  - Spastche 2y ago
    that's part of it, but even fit people are often lazy and crave convenience
arp242 2y ago
This is hardly an American thing; you see the same in Europe, and presumably other places. This is why antibiotics resistance is a problem in many parts of the world. I once overheard a coworker give a doctor a right bollocking over the phone because he wouldn't prescribe antibiotics for her daughter who had the flu, and she then proceeded to tell rant how ridiculous that doctor was. I've rarely had to spend more effort to stop myself from saying some rather unpleasant (albeit true) things.
- t-3 2y ago
  > This is why antibiotics resistance is a problem in many parts of the world. Antibiotic-resistant bacteria are more of an agriculturally-induced problem than a non-farmer-human-induced problem. Almost all commercial livestock are pumped full of antibiotics to make them fat, according to estimates ~2x the amount of antibiotics are used for animals as for humans.
  - arp242 2y ago
    I'm just going by Wikipedia, but it's not clear to me that it's the reason for antibiotic resistance in humans, rather than a reason. Also, "livestock pumped full of antibiotics to make them fat" has been banned in the EU since 2006.
    - t-3 2y ago
      It's also supposed to be regulated in the US, but that hasn't reduced the use of them much.

deleted 2y ago

[deleted]

spondylosaurus 2y ago

...are drugs and surgeries not healthcare?

DoreenMichele 2y ago
Eating right is health care. Exercise is health care. Decent housing is health care. Drugs and surgeries are medical care and I grew up with the weird idea that it's crisis management, not your first line of defense while acting like diet and lifestyle are annoying details you can stop worrying about if you can get the right prescription.
- nitwit005 2y ago
  We've tried and failed to get people to "eat right" and exercise for the last century or so. We've put a stunning amount of effort into that option, and failed.
  - DoreenMichele 2y ago
    My dream career was urban planning. We used to design walkable cities and now we design a world that is car centric. Designing exercise into our daily lives used to be part of the urban planning profession. Paris was redone to put a stop to health issues in overcrowded slums. Nutritional value of produce has gone down for decades while we strip mine our soils and try to make up for it with chemical fertilizers. I don't think the obesity epidemic is going to be solved with lecturing people like they aren't trying hard enough to starve themselves while we build "fuck you, pedestrian" environments all over the country.
    - 123yawaworht456 2y ago
      cool story bro, but: 1. there are plenty of obese people in rural areas where they have all the walkable space they might desire 2. do you even know how little energy humans need to walk? a single candy bar is enough for a three hour hike 3. pick a random chinese/japanese city, find a youtube video with visible crowds, and count the number of morbidly obese people you see. it would take you a while to find a single mobility scooter tier flesh golem, if you can find one at all "lecturing people like they aren't trying hard enough to starve themselves" is the only solution for the obesity crisis, because the only reason for the obesity crisis is vast abundance of cheap, artificially tasty empty calories. 300+++ lbs blobs of fat virtually did not exist before Standard American Diet
      - Jensson 2y ago
        > 1. there are plenty of obese people in rural areas where they have all the walkable space they might desire Rural areas are much less walkable since stuff are so far away, and thus are significantly fatter than walkable areas. When it is easy to walk to places you need to go to people often walk, and such areas have much less obesity.
        s1artibartfast 2y ago
        I get what you are saying, but dind the "no, no, that's too much walking" comments kinda funny. Walking 1/4 mile to a coffee shop every day won't make people skinny.
      - shiroiushi 2y ago
        >1. there are plenty of obese people in rural areas where they have all the walkable space they might desire No, they don't. Have you ever spent any significant time in rural American places? There's no place to walk at all, because: 1. everything is too far away for walking to actually be useful for going places, 2. there's no sidewalks even if you don't mind walking 2 hours to the nearest Walmart, and 3. there's no wild places to walk either, contrary to popular belief, because all the land is privately owned and "trespassing" is not allowed (and can get you shot). Rural Americans can only walk places if: 1. they have a lot of land around their house, which granted is more affordable than in more urban places, or 2. they get in their vehicle and drive to a state or national park someplace and use the hiking trails there. It's so weird how many people think rural America is some bucolic place that resembles the Shire of the hobbits, when in fact it's a car-bound hellscape even worse than the worst American car-centric city. It's not like the UK, where you have an absolute right to roam across rural lands.
- spondylosaurus 2y ago
  I may just be coming at this from a different angle (as someone with chronic genetic conditions), but differentiating between "health care" and "medical care" seems like unnecessarily splitting hairs to me. The place I go every few months to get the drugs that make me a functional human being has "health" in the name :P Like, I understand where you're coming from on the diet angle specifically, but some of this strikes me as painting with strokes that are just a bit too broad for the other thousands of reasons people need drugs or surgery.
  - DoreenMichele 2y ago
    I also have an incurable genetic condition. It's part of why I have spent so much time thinking about this and feel so strongly about it.
- roywiggins 2y ago
  Okay, but imagine you work in public health. We have decades of attempts at convincing and helping people to make lifestyle changes. There are a thousand diet plans, a thousand attempts at consumer education, and it's gotten us this far, which isn't very. What non-pharmaceutical intervention would you propose- something that could be rolled out as a program- that hasn't been done before, and would work, in say the next decade? Because at a population level, these drugs seem to be doing more than the cumulative efforts of a million dietitians.
- pessimizer 2y ago
  The idea that if we had a safe drug that made people lose weight (we don't) we shouldn't immediately give it to all fat people without a lecture, borders on a religious belief about virtue. That case could be made for not giving insulin to diabetics or bronchodilators to asthmatics. If there were a safe drug that can make people lose weight and put on muscle, I'd be actively telling people not to exercise unless they enjoy it. It's bad for the joints.

Spastche 2y ago

we are addicted to convenience and ease

greenchair 2y ago
[flagged]
- Spastche 2y ago
  that's part of it, but even fit people are often lazy and crave convenience

arp242 2y ago

This is hardly an American thing; you see the same in Europe, and presumably other places. This is why antibiotics resistance is a problem in many parts of the world. I once overheard a coworker give a doctor a right bollocking over the phone because he wouldn't prescribe antibiotics for her daughter who had the flu, and she then proceeded to tell rant how ridiculous that doctor was. I've rarely had to spend more effort to stop myself from saying some rather unpleasant (albeit true) things.

t-3 2y ago
> This is why antibiotics resistance is a problem in many parts of the world. Antibiotic-resistant bacteria are more of an agriculturally-induced problem than a non-farmer-human-induced problem. Almost all commercial livestock are pumped full of antibiotics to make them fat, according to estimates ~2x the amount of antibiotics are used for animals as for humans.
- arp242 2y ago
  I'm just going by Wikipedia, but it's not clear to me that it's the reason for antibiotic resistance in humans, rather than a reason. Also, "livestock pumped full of antibiotics to make them fat" has been banned in the EU since 2006.
  - t-3 2y ago
    It's also supposed to be regulated in the US, but that hasn't reduced the use of them much.