In reply to: Miracle Weight-Loss Drug Also a Major Budgetary Threat posted by FL_Irish
...If you mean a personal sense of shame that motivates a change in behavior, maybe, but shame coming from without is well known to be a poor motivator. All the addiction treatment people seem to agree that strong self-motivation is the key to success.
I'd have no problem, on the other hand, with shaming our food industry, which makes us believe that convenience (along with copious amounts of salt, sugar, and grease) is better than sound nutrition.
Some folks need external feedback. i agree that positive feedback is superior to negative feedback. Normalizing gluttony and indolence will not help those folks who are suffering metabolic disease due to their dietary choices. The four women on that page are gluttons. It used to be that we took no qualms with pointing out cupidity, gluttony, sloth, etc. Apparently that era is over. At a minimum then I ask that we not endorse their lifestyles and we use words that have clear meaning: gluttony is bad, balance is good. Obesity is unhealthy, etc.
I agree we should shame the food industry who has made "whole food" prohibitively expensive and unpopular while stuffing lower income people with sugar and other insulin spiking crap that is manifestly unhealthy. An typical container of fresh spinach costs $6 and contains 35 calories. One would have to consume 57 servings to get 2000 calories. But if you take that same container and saute the spinach in butter and then serve it along fried chicken you may think you just "ate healthy" when you basically consumed 400 calories of butter.
The less we shame these producers and the more we normalize these awful eating habits the longer we will have to endure obesity. What is the solution? I am a simple man and like simple solutions so I simply refuse to endorse gluttons who say ridiculous shit like "if I 'fits' I 'sits.'" Maybe that is too on the nose with some of our obese posters. I recommend they look in the mirror and grab some fat. If they can do so by the handful they ought to consider they aren't going to be on this planet much longer.
I weigh 245 lbs. When I diet and walk a lot I can get down to 230. The lightest I have been is 200 lbs when I came back from Iraq and looked like a skeleton with no body fat. I "work out a lot" because I could easily look like Jason Kelce and I know that I won't be among the living long if I go that route. I'm not naturally thin. I drank coke and ate bread by the loaf as a kid. My insulin resistance is not geared towards easily maintaining a healthy weight.
I appreciate how hard it is to eat healthy. I gave up booze for 90 days easily but can't nail sticking to a healthy eating plan for more than 3 days at a time. Is this futile? I don't know. But telling people "hey just have a pill" enables the food industry to keep pumping out poison and ignores that at some point one must manifest a modicum of will power and put down the artificial maple syrup and mountain dew.
Call that a sense of shame, or call it what you will but it is keeping me alive.
It's been studied quite a bit in a number of contexts.
In this instance in particular, given that it increases stress and many people who overeat do so as a maladaptive stress response, it can make things worse.
when you swiped something that did not belong to you and realized the severity of your actions later? Is that not shame? Did that not work to modify your behavior? It worked for me in spades. That's what I mean by shame.
I don't mean bullying, which would be the Connie Stinson route:
https://www.dailymotion.com/video/x126upn
It's actually a meaningful distinction.
Guilt is: I *did* something bad. Shame is: *I* did something bad.
The point being that guilt is more a reaction to the action, and lends itself to correction, whereas shame is a conclusion about oneself which is much harder to overcome.
So, yes, I do agree that guilt is useful, and by extension I think your point is that we encourage people to feel no guilt about things they are doing that are wrong, in many ways, and I agree that it's inappropriate. If someone is overweight, they should not feel like they are a worthless person but they should feel like "there are better choices. " incidentally, I'm in this boat and that's the way I've come to start making better choices.
I will say that guilt is hard to manifest absent overt projections of values. I disagree with everyone here who says negative reinforcement does not work. That is simply stupid. We have tickets, fines, etc in addition to carrots such as ribbons and praise. Positive reinforcement works. Loss of privileges work.
Telling someone who is fat that he is unhealthy and needs to get his shit together should not be controversial. Obviously we should also couple that with “you can change, you can get healthy, it won’t happen overnight but one day you can look back on this and be proud of your health and body.”
I was going to say growth mindset but won’t for obvious reasons.
Several of us are clinicians. We've seen the studies that describing negative consequences of disease does not lead to behavior change, while teaching the patient to find positive outcomes of behavior change does work, and we've practiced that same technique (called motivational interviewing) with our patients and find it much more successful.
It's possible that the patients who would change because of negative possibilities have already changed (thus any reminders are not helpful) but I think it's a stronger thing than just that, I think it's something intrinsic to the psyche.
I'll use myself as an example. I am all too aware of the negative outcomes of being overweight, but that didn't keep me from getting overweight. The problem is not intent, it's not lack of knowledge, it's the need to stick consistently to a goal all the time. I finally took a page from my own book and started to think of positive things I want to do, like hike isle royale with my kids. I signed up for a flight for us and listed a weight 40 lbs lighter than I was, with the intent of getting to that weight. I've lost most of the 40 already in under 2 months so by the time this summer rolls around, I'll be both lighter and stronger than i originally anticipated. My diet and exercise are easy, because I have something I want to do. Before, it was too nebulous. So seeing desirable positive outcomes is a successful strategy, it's been well studied.
Now an actual negative consequence, like a heart attack, might have also kicked my butt in gear, but thankfully I didn't wait for that. What I will say is simply that negative consequences are experienced, whereas negative possibilities are only imagined, and most people struggle to imagine vividly enough to change our everyday behavior, ESPECIALLY when we don't really want to.
Both guilt and shame are not effective Behavior changers. In medical literature and psychology it is known that positive reinforcement is much more successful.
In medicine we speak of motivational interviewing, what we see is that when you tell patients the negative consequences of their behaviors they almost never change, meanwhile if you point to the positive consequences of behavior change they will often improve. For instance, I have many patients who tell me that the reason why they keep their diabetes under control, exercise reduce blood pressure, Etc is that they want to see their grandkids graduate from high school or college, Etc. In fact, even the examples I can think of where a negative consequence led someone to really change your behavior, when you talk to them they often identify that they're doing for positive reasons. For instance, I once showed a patient who was smoking how they were some changes as long x-ray, and he ended up quitting smoking on the spot, later he described that his main motivation was that he wanted to be around for his kids.
So, with the topic at hand, when you ask the question how do you get people to eat healthy and lose weight, beating them over the head with the consequences of that behavior does not work, it just makes you and them angry, and maybe depressed. Showing them potential benefits of more healthy eating is much more successful strategy, and also much more pleasant.
In fact, technically, it's not that you show them the positive benefits, you have to help them identify what they would appreciate about the healthier Behavior.
Self rumplooking?
I really think you have some strange issues. A lot of anger about corpulence and masks.
Obesity has a lot of causes, and it not just someone being lazy. These meds are real game changers for a lot of people and could do a tremendous good for our society. If we can avoid cardiovascular disease complications, renal failure and a host of other issues it will ultimately save money in the long run.
Thats not to say for some people need psychological help but shame hasn’t worked, still doesn’t work and will never work.
the, biggest causes of the obesity epidemic.
Anyone who has been to Disney would say "holy shit who eats this much?"
Why did you eat that last go ho?
Oh no!
Why did you have to grow?
I'm sorry that fat adults at disney world triggered you. These women should be shamed for gorging on dessert for breakfast and their chosen unhealthy lfiestyle.
I treat these people all the time, shame doesn’t work. You don’t know what you’re talking about.
most of my adult life, I have to say, that's a pretty bizarre characterization of obese/overweight people.
That said, I own my weight problem and would never consider taking a drug to control it. I've also never in my life "gorged on dessert for breakfast", or probably few, if any, of the other behaviors that run through your mind regarding people with weight issues.
airborne doesn't realize that he really is a peculiar cat, with not a small amount of obsessive compulsive tendencies. He devotes a lot of time to exercise, especially given he has 6 kids, is a very involved parent, and his a very successful guy with a difficult job. Kudos to him. But most people don't share his obsessions or quirks or priorities.
SEE posted a link to some insane guy's twitter feed. He called himself a doctor. Of course, he wasn't a doctor, as in physician, as he tried to insinuate on his diet/training/hooey blog. He was a former physical therapist (unclear if he ever actually had a PT license) and has no credentials at all in the science he was pontificating about, but hey, he did do a bunch of ironmans, which is hard for me to fathom any otherwise employed father training for.
Then again,, one our better posters could run from here to Silver Dollar City without breaking a sweat, and I know he coaches soccer and baseball and all the run of the mill geeky dad stuff I do because his kids play in the same CYC league as mine, so what do I do.
I don't think Chadwick gets angry at the portly.
error. I am not angry at fat people. I am angry at fat people who are trying to normalize their unhealthy condition. There are ample data showing that their lifestyle is bad for them and the economy. Yet their ranks grow and their champions want to convince us that "obese" is a slur.
FWIW I think bodybuilders are insane and just as unhealthy as morbidly obese people. Due to injuries I have not been able to consistently train at anything other than a marathon run for three years. That said I walk a lot and avoid unhealthy eating.
I get accused of taking PEDs but I assure you I'm just naturally a giant human and in fact I have not been in the gym more than 1 or two days a week for three years.
Unhealthy eating - how do you define that?
Foie gras? Ribeye steak? Osso bucco?
Cheeseburger? Burrito? Bacon and eggs?
I don’t believe plump people try to normalize their condition. But I hear you when I see people my age riding a scooter around Target.
I get accused of shooting heroin but in reality I am just really dope.
which is actually true.
Sounds like a sexy hamburger.
I think being online too much/staring at a TV/pop culture inhalation is a detriment to our well-being. Cults, whether they're twitter, NDNation, or cross-fit, are best enjoyed in moderation.
The fashion industry threw near-impossible standards of "thin" and beauty on us for years. One of my friends growing up was bulimic. Another was harassed for being a "tomboy". I'm sure I only saw the tip of the psychological damage.
There is absolutely a problem with obesity in America, but it's not solved by doing more psychological damage, nor is it encouraging people to do nothing. If only there were a path of moderation that encouraged people to make better choices and be the best individual they can. We should encourage the journey via whatever method works, be it weight loss drugs or otherwise.
Similarly, the medical industry is suffering from a pseudo-populist loss of belief in expertise, as you mentioned in the SEE post. People rush the fill the gaps with a bunch of bullshit because it's far more profitable to tell people you have the answer to all their problems if you just take x y z and BIG MEDICAL PHARMA doesn't want you to know it! Non-diabetics are wearing glucose monitors now, for chrissake. Any type one diabetic should be pissed, kind of like celiacs are annoyed at people who state they are "gluten free".
Get a good doctor, listen to them (unless they say to eliminate drinking, then get a new doctor).
Anyway, it's almost street hockey season and you'll see me out there running up and down the court. I'm a little slower, I'm about 5 lbs heavier than I should be, but I am absolutely devious. Get off my lawn, young people.
that Celiac's are annoyed by people who are GF without having Celiac's.
My almost-4 year old was formally diagnosed with Celiac's about 2 months ago, and it is a real motherfucker to build a decent diet with it. I never realized how pervasive wheat and byproducts are in all of our food until this, and I am really grateful that the GF market has grown to the point where there are good options for GF bread, pizza crust, Oreos, macaroni, etc. His (and ours to a degree) life would be kind of miserable without those options which likely wouldn't be available if there wasn't such a large market of non-Celiac's GF people.
As an aside, while going gluten-free was the last thing I ever thought I would do or needed, I do notice it helps a bit with inflammation. We are by necessity largely a GF household, though I will sneak my 1 year old some goldfish or graham crackers now and then. I'll eat a sub sandwich or pasta or something along those lines if I am on my own, but the dramatic reduction in wheat intake has helped a bit how I feel when I wake up, after I work out, etc. But for the record, I still wouldn't do this shit if I didn't have to.
Think of all the restaurants that now have gluten free and vegetarian options now that didn't before. It provides options when previously it was "I'll scrape em off for ya's".
I didn't consider the scenario of having to contend with a household member having dietary restrictions - I was thinking of restaurants. Still, my mistake - sorry about that!
My general defensiveness comes from having in laws that were type 1 diabetic. People using equipment not intended for them in a medical context because some internet doctor told them irks me a bit.
I also think the general "ha ha diabetes will come for them!" sentiment around type 2 diabetics causes some splash damage to type 1 families, and it's frustrating.
I'd made (maybe incorrect?) assumptions that hearing someone wax poetic about being gluten free would rankle you a bit when you have someone with a medical condition, but maybe I'm just amped up unnecessarily.
Something fishy under all that.
Nice guy? I try and fail a lot! And I definitely break a sweat when I run. THR knows most of my bad habits.
Having just returned from Las Vegas, if there was ever a time I was going to get angry at the portly, it was in attempting to walk down the Strip on a Saturday afternoon while in a rush to get somewhere.
As for the underlying debate, I see both sides of the argument here. I think we're far too quickly turning to the miracle drugs to fix some problems that could be solved with better diet, less alcohol, more exercise. At the same time, I'm settling into middle age and no longer able to cut 5-10 pounds simply by running an extra 10-15 miles in my weekly training cycle. I'm much shorter, less muscular, and nowhere near as handsome as my friend Airborne, and he's only got me by about 30-35 pounds. I certainly wouldn't want to get in a fistfight with him. If he's pulling that off with some walking, keeping busy, and a decent diet, more power to him. I know he doesn't need Ozempic, just like most of the moms I know at my kids' school don't need it either. But many of them are taking it. The dads now, too, though I'll note it's mostly the most vain among them that are doing so.
Right now I'm angry at Andy for getting that grill discussion going in the BR, because it caused me to buy a new Weber last night that I now have to find time to put together.
You wouldn't like it and would probably adjust to lose it. Lifestyle is a choice. My kids see photos of me when I was 29 - 32 and say I look older than I do now. I agree. That said my tendons and ligaments know the truth. Keep putting up those miles. The second you stop the little support players atrophy and it makes it VERY hard to boot up the system again.
Onward
If I learned anything, it's that I need to either clean the hell out of it or get a new one because I probably came thisclose to a grease fire explosion in my backyard.
But I sure as shit will have Forshaw put mine together.
FYI Billy is going to Ladue Fifth Grade Center next year but James will remain at STC. No idea about HS for either. Priory, Chaminade, Ladue and maybe CBC and SLU all in play.
We need to get to get with Jinx soon.
p.s. Were you in Las Vegas for U2? I thought you already saw it?
Costco had a pretty good deal on the larger Genesis. The movers broke something in my 16 year old Weber something or other (maybe a small Genesis?), and I figured it was about time to replace it anyway.
No DeSmet on that HS list? I'd otherwise consider SLUH for my boys, but Charlie is drawn to my FIL's alma mater (DeSmet) through their summer camps and the possibility that he may move over in 7th grade when it opens in Fall 2025. I can't see us going to Priory or Chaminade, and I suppose CBC could happen under certain circumstances. G13 is definitely going to SJA like her mom unless something crazy happens.
And yes, I went back to Vegas for a second U2 show. The Missus didn't go first trip, so I took her on a return one.
I'd love to get together with you guys - you know where to find me!
Isn't the point of the linked analysis that it won't actually save money in the long-run? That the savings associated with avoiding cardiovascular disease complications, etc. are dwarfed by the cost of the drugs at current prices?
Now obviously I haven't looked at the underlying analysis to evaluate its rigor. But Brian Deese and Jonathan Gruber aren't idiots.
At some point these will be like Statins and be cheap/ubiquitous.
The real question is how we get there. Wait for the patents to expire? Pay the companies only for the cost savings they give the system? Buy out the early patents?