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Comment by HealthNeed | Hacker News Reader

I think you are missing the point. People are not skinny because they "intellectually" know something. Nor are people fat because they are stupid, sometimes sure, but the societal trend towards obesity is not caused by ignorance. Read the article.

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People absolutely are skinny because they intellectually know something, but the word “intellectually” doesn’t mean smart/stupid, it means “apply critical thinking to a situation” as opposed to allowing your animal brain to keep control.

To put it another way, system 1 will eat until its full, system 2 knows what a calorie is, and at least vaguely understands how many calories are in what you just ate against what you need to survive.

Skinny people are not smarter, they’ve either never had an impulse to eat more in the first place, or are able to react to the impulse with the part of the brain that reasons.

I think executive function might be a better way to understand obesity, rather than Kahneman's system 1 and system 2 thinking. Inhibitory control in particular seems more relevant[0].

Applying critical thinking (as opposed to applying inhibitory control) is only useful against obesity insofar as you can make changes to your lifestyle and diet. Lots of people know what a calorie is yet still fail to lose weight, because intellectually understanding something doesn't mean you can do it.

[0] https://www.sciencedirect.com/science/article/abs/pii/S01497...

Making changes to your lifestyle and diet is still the best, most reliable way to lose weight; this article’s science is far from conclusive or “production ready”, as engineers would say.

The "most reliable way to lose weight" doesn't work for most obese people. The studies on tirzepatide seem reasonably conclusive, at least as far as weight loss goes. Is your issue with undiscovered long-term side effects, or with lifelong dependence on a drug that causes unpleasant side effects, or something else?

My position at the moment is that different obesity interventions work for different people. Obesity is the result of a huge number of different factors such that no single intervention will work for everyone. An obvious example would be an obese patient with thyroid problems, vs an obese patient with sleep apnea: both sleep and thyroid function can cause weight gain, but they have different treatments. I don't think we should ignore a drug that works well in some stubborn cases, just because other cases can be fixed with lifestyle and diet changes.

(I say this as someone who lost 15kg, went from obese to normal, and has kept it off for years by occasional calorie tracking. Most evidence suggests this doesn't generally work for obese patients.)

> The "most reliable way to lose weight" doesn't work for most obese people.

Except that it does, for literally every single one of them. They simply don't do it.

Let's take 1000 people above 30 BMI and divide them between us. I give them my intervention of semaglutide and lifecycle changes; you give them your intervention of "work harder you lazy fatties."

I guarantee you an arbitrary amount of money my group will be >10% lighter than your group after 6 months.

Heh, and so there it is; you are insulted and feeling defensive.

Would it blow your mind to hear I agree, and never said anything to the contrary? Probably, if you weren’t feeling defensive.

It can't possibly work for literally every single one of them, because there are still obese people. "They simply don't do it" is a restatement of the problem rather than a solution, and about as helpful as telling coalminers to learn to code.

Maybe I reject the notion of lost causes, and don’t think it’s a good thing to count people out.

I think this is a values disagreement, not a factual one. I view obesity as a medical problem to be solved and not as a moral failure, whereas I think you see obesity as a moral struggle and drugs as a crutch or an admission of defeat. To me it's more about balancing the risks and dangers of an injection and making sure people have tried less risky things first, and "lost cause" is not how I'd describe taking a weekly injection to manage an otherwise-intractable medical problem.

Where did morality come from??? That's entirely injected from your own interpretations, and has absolutely nothing to do with what I said.

Honestly it sounds like you think people who are overweight have "failed" in some way, as I don't believe that at all. "Taking injections weekly" is also doing something about their obesity, which is just fine with me, I'm simply explaining how "willpower" is also a viable possibility. There's no need to take injections if you learn more about willpower and strengthen yours over time, and this is supported by a cornucopia of recent and sound science.

A failure of willpower is not a failure of moral character, why do I even have to say that?

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