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Comment by antonchekhov | Hacker News Reader

Obesity has become a pervasive problem in the U.S (and parts of the rest of the world). The average waistline of American adult males is now 40.5 inches![https://www.cdc.gov/nchs/fastats/body-measurements.htm] That is jaw-dropping to me. I live in a U.S. state that is well-known for being one of the thinnest states in the country, and people don't seem particularly thin to me here - but when I visit other parts of the country, the obesity is pervasive and extreme. (No need to name states - there are numerous maps of obesity rates online.)

There are strong indicators of several causes for this, but America really needs to get serious about health and overall wellness of the population.

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but America really needs to get serious about health and overall wellness of the population.

We don't need to fat shame, but also we don't need to accept. To say it is OK. To pretend that in 99.9% of circumstances, people have 0 control over it.

Based off the effectiveness of new anti-diabetes drugs that also help in losing weight I actually think people might have much less control over their obesity than we'd like to believe. Fat people might have some kind of hormonal difference happening that they have to manage in a way thin people don't, in the same way women have to manage their menstrual cycles but it would be weird to say they have control over them. Women who want to take control over their periods usually have to take medication to do so, and it seems fat people respond similarly to thin people once they take medication that adjusts their signaling to that of a thin person's.

That is at least somewhat correct. Obesity causes lower testosterone levels and low-T causes growth of adipose tissue in a positive feedback loop. So I'm general, the fatter someone gets the harder it becomes to lose any fat.

But it's not impossible. It just means they have to shift their energy balance even more negative in order to start losing weight. Some medications such as Semaglutide (Wegovy) can be helpful in starting this process if other approaches have failed.

Yeah, I'm not saying that fat people are hapless victims with no agency, I just think they generally seem to have some phenomenon occurring that is making weight loss way, way harder than society is giving credit for. [Like for example I have some friends that struggle to gain weight and are permanently growth stunted because of misdiagnosed gut issues in their childhood, and its clear to me "just eat more" is an unmedical and kinda dumb approach to managing their weight. I think evidence is pointing that fat people also have systemic problems where "just eat less" might also be an unmedical approach to managing the weight of really fat people.]

> We don't need to fat shame, but also we don't need to accept.

I'd be interested to know how you do the latter without the former.

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