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Tuesday, May 7, 2024

Obesity is a biochemical problem, not a moral one [Big Food, Bigger Bodies]

Johann Hari, A Year on Ozempic Taught Me We’re Thinking About Obesity All Wrong, NYTimes, May 7, 2024.

Ever since I was a teenager, I have dreamed of shedding a lot of weight. So when I shrank from 203 pounds to 161 in a year, I was baffled by my feelings. I was taking Ozempic, and I was haunted by the sense that I was cheating and doing something immoral.

I’m not the only one. In the United States (where I now split my time), over 70 percent of people are overweight or obese, and according to one poll, 47 percent of respondents said they were willing to pay to take the new weight-loss drugs. It’s not hard to see why. They cause users to lose an average of 10 to 20 percent of their body weight, and clinical trials suggest that the next generation of drugs (probably available soon) leads to a 24 percent loss, on average. Yet as more and more people take drugs like Ozempic, Wegovy and Mounjaro, we get more confused as a culture, bombarding anyone in the public eye who takes them with brutal shaming.

This is happening because we are trapped in a set of old stories about what obesity is and the morally acceptable ways to overcome it.

An experiment:

One scientific experiment — which I have nicknamed Cheesecake Park — seemed to me to crystallize this effect. Paul Kenny, a neuroscientist at Mount Sinai Hospital in New York, grew up in Ireland. After he moved in 2000 to the United States in his 20s, he gained 30 pounds in two years. He began to wonder if the American diet has some kind of strange effect on our brains and our cravings, so he designed an experiment to test it. He and his colleague Paul Johnson raised a group of rats in a cage and gave them an abundant supply of healthy, balanced rat chow made out of the kind of food rats had been eating for a very long time. The rats would eat it when they were hungry, and then they seemed to feel sated and stopped. They did not become fat.

But then Dr. Kenny and his colleague exposed the rats to an American diet: fried bacon, Snickers bars, cheesecake and other treats. They went crazy for it. The rats would hurl themselves into the cheesecake, gorge themselves and emerge with their faces and whiskers totally slicked with it. They quickly lost almost all interest in the healthy food, and the restraint they used to show around healthy food disappeared. Within six weeks, their obesity rates soared.

After this change, Dr. Kenny and his colleague tweaked the experiment again (in a way that seems cruel to me, a former KFC addict). They took all the processed food away and gave the rats their old healthy diet. Dr. Kenny was confident that they would eat more of it, proving that processed food had expanded their appetites. But something stranger happened. It was as though the rats no longer recognized healthy food as food at all, and they barely ate it. Only when they were starving did they reluctantly start to consume it again.

Satiety:

Drugs like Ozempic work precisely by making us feel full. Carel le Roux, a scientist whose research was important to the development of these drugs, says they boost what he and others once called “satiety hormones.”

Once you understand this context, it becomes clear that processed and ultraprocessed food create a raging hole of hunger, and these treatments can repair that hole. Michael Lowe, a professor of psychology at Drexel University who has studied hunger for 40 years, told me the drugs are “an artificial solution to an artificial problem.”

Yet we have reacted to this crisis largely caused by the food industry as if it were caused only by individual moral dereliction. I felt like a failure for being fat and was furious with myself for it. Why do we turn our anger inward and not outward at the main cause of the crisis?

We've got two culture-wide tropes working against us:

When Pope Gregory I laid out the seven deadly sins in the sixth century, one of them was gluttony, usually illustrated with grotesque-seeming images of overweight people. Sin requires punishment before you can get to redemption. [...]

The second idea is that we are all in a competition when it comes to weight. Ours is a society full of people fighting against the forces in our food that are making us fatter. It is often painful to do this: You have to tolerate hunger or engage in extreme forms of exercise. It feels like a contest in which each thin person creates additional pressure on others to do the same. Looked at in this way, people on Ozempic can resemble cyclists like Lance Armstrong who used performance-enhancing drugs. Those who manage their weight without drugs might think, “I worked hard for this, and you get it for as little as a weekly jab?”

The bottom line:

Early indications are that the new anti-obesity drugs are moving people in a similar radically healthier direction, massively reducing the risk of heart attack or stroke. But these drugs may increase the risk for thyroid cancer. I am worried they diminish muscle mass and fear they may supercharge eating disorders. This is a complex picture in which the evidence has to be weighed very carefully.

But we can’t do that if we remain lost in stories inherited from premodern popes or in a senseless competition that leaves us all, in the end, losers. Do we want these weight loss drugs to be another opportunity to tear one another down? Or do we want to realize that the food industry has profoundly altered the appetites of us all — leaving us trapped in the same cage, scrambling to find a way out?

There's more at the link.

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