100% agree on the stomach stretching thing. But I would add we have TWO fullness systems in our body. The stomach stretching one is the fast/short term one (that tells us to STOP eating).
The other one is from fiber in our colon. A healthy microbiome releases short chain fatty acids SCFAs when it digests soluble fiber (mostly from veggies, beans and fruits). When the colon has less fiber in it, it releases less SCFAs. When your brain is getting SCFAs, they make you feel contented and not hungry. This slow/long term process tells you when its time to go find more food. The START eating signal.
Bariatric surgery spoofs the first pathway. Ozempic spoofs the second pathway.
The low fiber diet in the US (processed and fast foods are mostly zero fiber) means the second pathway is telling many Americans its 'time to eat' all the time. Ozempic turns that signal down/off.
Or you can just eat 20+ grams of soluble fiber a day, by eating plenty of veggies, beans and fruit.
I'm guessing that your diet contains a decent amount of whole foods and fiber, that is why you didn't 'need' ozempic. If you were eating more processed junk, your outcome might have been different.
Great post. This is why a salad is way more satiating per calorie than non-whole wheat pasta. Ignoring the dressing, you could probably not finish a salad that had as many calories as 3 cups of macaroni and cheese.
I was just thinking the ratio of calories to fiber would make a good food index. However, such a thing already exists, sort of. Decades ago, the glycemic index became a useful way for measuring the blood sugar impact of foods. All else equal, it is lower the higher the fiber content.
I went from 85kg to 110kg with a side order of hypertension over the last five years with covid lockdowns and trying to get a business off the ground. Started liraglutide (not sure what it's called in the US) in Feb and lost around half of it since then. It's been life changing and aside from my doctor and my wife (also a doctor!), I couldn't care less about what other people think of it.
I love GLP1 drugs. I particularly loved Matt Levine’s discussion of the economic ramifications of these drugs. Using that as a starting point, consider Doritos: a chip built by teams of scientists to hit a pleasure center in a way that you can’t stop eating them. I say Doritos but that’s a stand-in for an entire industry built to make you snack. And drink, and smoke, and gamble, and online shop. We eat poorly and we gain weight (or go broke or get lung cancer or whatever). A rational society might stop making irresistible Doritos, but we create a drug that allows us to resist the irresistible Doritos that we make! It’s so wonderfully Us. GLP1 drugs are fascinating!
Why can’t we have both? Doritos and GLP-1s. Their effects on everything -
weight, drinking, gambling other addictive behaviors - are impressive. Don’t get me started on ubiquitous sports gambling!
As these drugs become more refined, more competitors enter the market, come off patent, and prices drop, I imagine they will become as common as SSRIs, birth control, etc. Those drugs seem to have a lot more side effects (including weight gain). If 30 year users of GLP-1s develop side effects, those would have to be pretty catastrophic for the cost benefit to have not been worth it, considering all the avoided heart attacks, strokes, diabetes, diabetes related conditions, and being unable to fit into an airline seat.
Thank you for sharing your weight loss story! I'm sincerely happy for you.
You make a great point about willpower consisting of attention and pain resistance. As a counterpoint to your story, I want to share a bit about my weight loss attempts, which were very, very different from yours. (I'm a woman, so that probably makes a big difference because of lower BMR.)
I would absolutely freaking *love* my weight loss to be as easy as, "Pay attention = eat less = lose weight without ever feeling hungry." That's just not how my body works.
When I eat until I'm not hungry anymore, I maintain my current (excessive) weight. When I try to cut back "just a bit," it's the worst of both worlds: I'm hungry enough for it to be annoying, but my caloric intake is still high enough that any weight loss is too slow to be noticeable. It's extremely demoralizing and I give up.
The only times I actually succeeded in losing weight was when I was extremely strict about imposing eating limits. None of that namby-pamby feel-good "listen to your body" stuff, because my body clearly wants to be fat. No, it was "this is how much you're having for lunch, body, and if you don't like it too effing bad."
And it sucked absolute ass.
I would sit at my desk, trying to focus on the grant I was writing or the experiments I was planning, and all the time there would be a dialogue in my head:
"I'm hungry."
"You had lunch an hour ago."
"Yeah, but it wasn't enough and I'M FREAKING HUNGRY!"
"Quiet down. Snack is in two hours, you know this. You just have to last till then."
"But I'M HUNGRY NOW!!!!!"
And on and on like this, pretty much around the clock. You can imagine what it did for both my mood and my productivity. I couldn't just make those thoughts stop; they came unbidden. I could only resist them.
To make it extra fun, if I didn't eat enough I would get what I called a "hypoglycemic headache" - a really bad, unpleasant headache that made me useless for anything except menial tasks (no focusing on intellectual work with a hypoglycemic headache). Weight loss, for me, was surfing the very thin line between "hungry enough to lose weight at an appreciable rate" and "not so hungry that I trigger a hypoglycemic headache" (I learned to read the early warning signs).
So, Noah, I applaud your accomplishment and also ask you to recognize that you were extraordinarily lucky in how easy weight loss turned out for you, judging by your description.
This is so similar to my experience. Being able to afford a GLP-1 changed this for me within weeks of starting. I wish they were more accessible to more people.
Interesting post...I shed 60lbs more or less the same way Noah did. I began my weight loss before Ozempic type meds by focusing on permanently changing my eating *habits*. On advice, I deliberately never thought of myself as *on a diet* (the temporary kind). Things that were helpful - two big ones - I learned to identify and avoid empty calories, and that there was no social or moral obligation to eat everything on my plate, that it's okay to stop when you feel satisfied (not stuffed).
I certainly do not feel smug or righteous about my success. I do feel thankful I found a path, with medical input, that I was able to follow. And I still enjoy eating, just more mindfully.
Sure, and heck, while we are at it, why not “automate” love with a micro-dose of an empathogen like MDMA; automate our attention with Adderall; automate our religious experience with psilocybin or LSD; automate handling our depression with Prozac? There is no limit to what we could do!
At some point we could get so good at turning our inner life into a problem of technique that we would all have access to our own biochemical profiles from as early as 3rd grade and instead of being sent to the principal for a talking to, we’d be sent to the school nurse to check our dosages. It would be a pharmacological paradise!
Why didn’t I think of this?! Just offload the whole infuriating, messy, difficult project of BEING HUMAN to the ever-reliable technocracy. Why muck about in the dusty old scrolls of Aristotle, the Buddha, Marcus Aurelius, Patangali, Augustine, Pascal, Jesus, or any of the other old farts when a Techbro can save us with a pill?
"Just offload the whole infuriating, messy, difficult project of BEING HUMAN to the ever-reliable technocracy."
There are so many ways to be human that offloading some frustrations of, say, having a body onto technology doesn't cramp our scope for humanity. In fact (as should be obvious), it can expand it.
I just avoided antihistamines during a week of wildfire smoke and pollen. I did it because a new doc told me to, for testing. The maddening itching and wheezing did not make me more human. It made me more slothful and stupid. While I spent some of that slothful time distracting myself with edifying cultural activities, my ability to shoulder my ordinary responsibilities was reduced, and my family suffered for it.
I happen to be religious. It's possible having some formative experience with suffering that medicine wasn't good at addressing made religion more attractive to me than it otherwise would have been. On the other hand, religion is also how I formatively interpreted peak life experiences, so maybe not?
However I got religious, now that I am, misery and incapacitation don't make me more religious. What misery and incapacitation achieve are misery and incapacitation. Humans are called to bear up under those challenges the best they can, but can we be honest that misery and incapacitation aren't particularly edifying challenges? If they're unavoidable, we should make the best of them, but if they *are* avoidable, avoiding them so that we're free to tackle more edifying challenges (more career and family responsibilities, more community involvement, even more challenging hobbies – in short, all the *other* worthwhile challenges of life) seems the better path to human flourishing.
Yes, Midge, I agree. There's no virtue in suffering per se. But allergies are long way from gluttony. Allegra is one thing; Ozempic is another. I eat my feelings. In a bout of anxiety, boredom, sadness, frustration, or stress, I've gone to a slice of coconut cake like some people go to Jesus. Unlike allergies, overeating stems from a real grab bag of psychological and spiritual issues--at least for me. Popping a pill or sewing my stomach up would help me avoid these issues. I wouldn't like to do that. It doesn't seem like the way to any lasting happiness.
I wish you well in figuring out how to maintain healthy habits for yourself. Building appropriate habits in the face of life's contingencies *is* a struggle, as I, too, know – a struggle I doubt technology eliminates, only changes the terrain of. We still need practical wisdom (phronesis? I think philosophers – which I'm not – call it phronesis) to live well.
Like many young women, I had a fair amount of my time wasted by having certain physically-rooted symptoms attributed to my psychology. Physical and mental health are obviously mutually reinforcing – good health of one sort supports the other and poor health of one sort can easily worsen the other. But teasing out causality here can be harder than we think, and sometimes we've got to troubleshoot with whatever's handy until we find some arrangement – *any* arrangement that's not positively unethical – which works.
"Allergic toxemia" is an outdated phrase to describe the general malaise – including mental – that comes with allergic flares. "Toxemia" is definitely the wrong word – the problem isn't blood toxins per se – and so now only quacks use the phrase, sort of a pity, since there really should be a term for this phenomenon – I might call it "histamine crazies". "Histamine crazies" are *definitely* crazy – they impair judgment, including judgment curbing mindless eating. When I hear others describe what they call "food noise", the phenomenon they're describing doesn't sound so different from "histamine crazies" to me. Maybe the two share similarly physical roots.
Ideally, symptom control helps promote good habits rather than being a substitute for them.
Before I had kids, I successfully stuck to fairly punishing dietary restrictions in hopes they'd help me in some way. (I think some did, though not necessarily for the reasons I was told.) Pregnancy was for me what Noah describes his migraines being for him – a time when continual snacking went from being bad nutrition to positively medically advised as a drug-free (keeping pregnant women drug-free is such a high priority!) means of symptom control. Pregnancy also worsened my underlying asthma, which was "treated" with inactivity – since, hey, at least inactivity is also drug-free! Eat more, move less, with predictable results...
Frustratingly, increased adiposity can by itself worsen asthma. But it's also true that continually being interrupted by malaise from respiratory-related immune response on a hair trigger makes sticking to healthy habits much, much harder. So I'm going on an injectable now – but a MAb for asthma, not a GLP-1 agonist. Hopefully, symptom control makes returning to my previously-healthier habits easier – as in actually feasible, since I sure ain't succeeded for long enough lately to escape the vicious cycle!
Still, I wouldn't rule out trying a GLP-1 agonist if, after giving other strategies a fair trial, I was still struggling. Part of that's because of reports that GLP-1 agonists have pluripotent anti-inflammatory effects beyond what's simply explained by induced weight loss, and inflammation was already limiting my life back when I was thinner.
What's a "fair trial"? When do you decide that lifestyle modifications just aren't practical in particular situations without adding artificial help? These are questions of practical wisdom. Technology changes the terrain phronesis navigates, but doesn't render it obsolete.
Besides living the life of a junkie and enslaving oneself to Big Pharma? Besides freely choosing complete ignorance of one’s own inner life—the impulses, feelings, fears and desires that move us for good and bad? Besides offshoring the challenge and joy of forming one’s self and deepening one’s humanity? Lemme think.
Exactly. From the moment we had to invent culture to avert a head-on collision between our big heads and our narrow hips, we stopped being anything in capital letters and became an ongoing wager against extinction. Jesus, the Buddha, Marcus Aurelius, Augustine were the Techbros of their day, devising solutions to the problem of human suffering using the cultural resources available to them.
"Jesus, the Buddha, Marcus Aurelius, Augustine were the Techbros of their day."
Maybe. Mmm. "Devising" "solutions" to "problems" with "resources." That's techbro talk. I doubt these great men would agree with the framing such language implies. Maybe the Buddha or MC might not mind; they did seem to have a kind of spiritual technology approach.
" social distancing, lockdowns, universal masking — weren’t valueless, "
But they were symptomatic of policy made without regard for cost benefit analysis.
I've been back and forth on whether this was more the fault of CDC for not giving individuals and local policy makers the information with which to make cost-benefit decisions or the individuals and local policy makers for politicizing/moralizing these decisions and would not have executed cost benefit version of NPI if they'd been available.
Just because you don’t agree with the outcome of someone else’s cost-benefit analysis doesn’t mean there wasn’t one done.
It’s pretty insane to assume that policy makers were all just acting in bad faith and making decisions willy-nilly rather than trying to do their best in a fluid situation with imperfect information.
I’m not saying bad faith. But closing venues by activity rather than indicators like airflow per person, and apparently giving little or no consideration to the value of school attendance lost (not to mention advice not to go outdoors, to mask outdoors) gives the impression of not weighing costs and benefits.
As for the imperfect information, CDC coud have done a much better job of providing that better information.
They could also have done better rolling out vaccines if they had put more effort explaining the benefits rather than defending the safety. I can’t think of a less persuasive marketing pitch than “This won’t kill you, promise!” and “This stuff is so good you are required to take it.”
Hindsight is 20/20 and it’s easy to spot the things now that could have been done better then. People make mistakes, and institutions, which are just collections of people, do too.
It’s definitely the case that some of the policies could have and maybe should have evolved sooner than they did. But it didn’t help that so many of these issues were immediately turned into political footballs by people looking to score points.
I think lockdown and the other measures were simply the right choice. It might seem with hindsight that the threat of covid would have died back even if we hadn't locked down. But unchecked viral spread significantly raises rates of replication and with it the probability of more harmful, more drug and vaccine-resistant mutations. Given how contagious the virus was and the fact that even in the first wave, health services were being overloaded, I really don't think they had any option but to do what they did. Sweden, that didn't lockdown, had higher excess deaths than either of its neighbours both of which did lockdown and it was probably lucky that the rates weren't higher.
I am a retired doctor studying obesity 50 years. Experts have found there is a set point for chronic weight. Your body resists losing ang gaining weight if you ave been steady for several years. Oprah and millions of diets have lost tons off and on for years. Most doctor diets/clinics have a 5% success for long term (1 year). Weight Watchers, the best, was at 10% and now bankrupt. Wegovy (double the dose of Ozempic) stimulates a gut hormone that makes you feel full earlier. Most people overeat from stress. Food is very rewarding.
Good post. I think a key aspect of what you experienced is the importance of just being aware of what and how much you are eating. If you make good choices, you can eat more with less adverse effects. But if you want to eat some ice cream, do it intentionally and knowing this is a treat. I wolfed down my entire breakfast while reading your post. Eating while distracted is not generally good because you tend to eat faster and eat more. But I made a good choice before starting to read, because breakfast was a bowl of oatmeal, with sliced strawberries mixed in and a few walnuts.
Most of my friends and family who have battled weight issues have leaned that mindfulness and focus are key. Very easy to get into an eating frenzy or to use food as a distraction or part of nervous or stress energy (eating standing up, in the car, etc). I remember coming home from school as a kid and eating most of a whole box of cookies regularly- wasn’t really aware of what I was doing while I was doing it- just a frenzy.
For some it was and is still difficult to put themselves into that attention mindset.
What seems to work in that case (other than Ozempic) is finding ways to cut out the most dangerous times for mindless eating. If late binges from the fridge are an issue, then establishing a rule that the kitchen is closed after 8pm helps. If you can’t be aware of what you are eating and how you are feeling then don’t start eating, in other words.
Another, for a relative that had a habit of eating standing up or on the go was to establish that food had to be consumed sitting down, and each bite chewed “x” number of times. This methodology worked better than textbook mindfulness exercises for him.
Sounds like you're happy about the changes you've been able to make, so congrats on that. On a societal level you're not offering much of a solution though, by suggesting that people should just pay attention to not eating too much (or to otherwise buy drugs). Like you already mentioned, there is a cost. Many people who are obese can't handle the additional mental load, or the financial expenses, required to make changes because of social/relational problems, work related stress or time issues (like your dissertation), debt related stress, health issues (as you also experienced), etc. The dissertation was a temporary issue with a relatively well paid job following on that. Tell someone with (sub-)minimum wage, a sick kid, and no health insurance (or one that doesn't cover all expenses), that they should just 'pay attention', especially when the crappy food that is most affordable and most heavily marketed is void of nutrients, so there's really not much signaling from your stomach actually happening. Same with just 'buying the drugs' when it's not covered by a (possibly non-existent) health insurance.
And your metabolism is to some extent determined by what you ate and how fat you were as a kid, meaning that those who grew up poor or with parents who were simply unaware of what a healthy lifestyle entails, will have a much harder time keeping a healthy weight later on in their lives. (People who didn't have enough to eat when they were young also suffer from that for the rest of their lives).
Any serious effort to tackle the obesity problem is going to require a huge societal effort at multiple fronts, from healthy and free school meals, cooking lessons, regulating/banning the most unhealthy food or subsidizing healthy meals, and much more. The other solution could be to give everyone who wants it Ozempic, or alternatives, for free. One of these is easier to do than the other (although in the US they're both unlikely), one of them I would consider the healthier, more sane, solution. I'm afraid those two are not the same.
What can the Western world (including all the Americas) along with the Middle East learn from the countries of East Asia where obesity rates are much lower?
Speaking of attention, I notice that when I use a calorie tracking app, I can hit my budget and not be hungry by being careful, and learning that eating 4 slices of pizza is totally fucking up, costing half my daily budget and leaving me hungry for more. I also notice that without calorie tracking I get too hard core and eat to little, only to cave a couple days in, shoveling peanut butter straight from the jar just before bedtime. So it takes the learnings from a book like “The Hungry Brian” with knowledge of what my current budget situation is, then it is east to maintain or lose a little weight. In addition to glp1s, which seem like a vaccine against the hyperstimulating food environment capitalism has delivered us, I wonder if realtime automatic calorie counting embedded into our vision could work. I hate the idea of wearing smart glasses but if I got an alert letting me know that if I grab that donut from the company break room at 10am I will be through like 60% of my calorie budget for the day, or conversely, that hey, you actually can have that quick toaster oven quesadilla at 8pm, it would be awesome, and be way more sustainable that entering shit in to My Fitness Pal all the time.
There is nothing like a lifetime in engineering to make you realize that "You just need to be diligent", "You just need to have more willpower" and "We just need to come together as a society" are different ways of saying "We haven't solved this problem, and in particular the person saying this has no idea of how to solve this problem". Solutions that rely on willpower or diligence have horrendous failure rates (often >90%, as seen with some measures of obesity), and never, ever, improve beyond that.
The vast corpus of evidence suggests you’ll be fat again within 3 years. I mean seriously how many times have you heard some friend, “Oh I lost 50 lbs!” Great. And then you see them later and they are fatter than they ever were.
GLP and gastric bypass are the only things that have proven to work long term.
The US spends 5% of it's GDP on health related programs like Medicaid, Medicare, etc. These programs would be a lot cheaper if a lot more people were skinnier!
Right now Ozempic is expensive and tough to obtain.
My modest proposal is that the US should acquire Novo Nordisk, share the patent for Ozempic, and let anyone produce it as a generic. It will pay for itself within a few years.
Great post, glad you're healthier now.
100% agree on the stomach stretching thing. But I would add we have TWO fullness systems in our body. The stomach stretching one is the fast/short term one (that tells us to STOP eating).
The other one is from fiber in our colon. A healthy microbiome releases short chain fatty acids SCFAs when it digests soluble fiber (mostly from veggies, beans and fruits). When the colon has less fiber in it, it releases less SCFAs. When your brain is getting SCFAs, they make you feel contented and not hungry. This slow/long term process tells you when its time to go find more food. The START eating signal.
Bariatric surgery spoofs the first pathway. Ozempic spoofs the second pathway.
The low fiber diet in the US (processed and fast foods are mostly zero fiber) means the second pathway is telling many Americans its 'time to eat' all the time. Ozempic turns that signal down/off.
Or you can just eat 20+ grams of soluble fiber a day, by eating plenty of veggies, beans and fruit.
I'm guessing that your diet contains a decent amount of whole foods and fiber, that is why you didn't 'need' ozempic. If you were eating more processed junk, your outcome might have been different.
Great post. This is why a salad is way more satiating per calorie than non-whole wheat pasta. Ignoring the dressing, you could probably not finish a salad that had as many calories as 3 cups of macaroni and cheese.
I was just thinking the ratio of calories to fiber would make a good food index. However, such a thing already exists, sort of. Decades ago, the glycemic index became a useful way for measuring the blood sugar impact of foods. All else equal, it is lower the higher the fiber content.
I went from 85kg to 110kg with a side order of hypertension over the last five years with covid lockdowns and trying to get a business off the ground. Started liraglutide (not sure what it's called in the US) in Feb and lost around half of it since then. It's been life changing and aside from my doctor and my wife (also a doctor!), I couldn't care less about what other people think of it.
I love GLP1 drugs. I particularly loved Matt Levine’s discussion of the economic ramifications of these drugs. Using that as a starting point, consider Doritos: a chip built by teams of scientists to hit a pleasure center in a way that you can’t stop eating them. I say Doritos but that’s a stand-in for an entire industry built to make you snack. And drink, and smoke, and gamble, and online shop. We eat poorly and we gain weight (or go broke or get lung cancer or whatever). A rational society might stop making irresistible Doritos, but we create a drug that allows us to resist the irresistible Doritos that we make! It’s so wonderfully Us. GLP1 drugs are fascinating!
Why can’t we have both? Doritos and GLP-1s. Their effects on everything -
weight, drinking, gambling other addictive behaviors - are impressive. Don’t get me started on ubiquitous sports gambling!
As these drugs become more refined, more competitors enter the market, come off patent, and prices drop, I imagine they will become as common as SSRIs, birth control, etc. Those drugs seem to have a lot more side effects (including weight gain). If 30 year users of GLP-1s develop side effects, those would have to be pretty catastrophic for the cost benefit to have not been worth it, considering all the avoided heart attacks, strokes, diabetes, diabetes related conditions, and being unable to fit into an airline seat.
Hi Noah,
Thank you for sharing your weight loss story! I'm sincerely happy for you.
You make a great point about willpower consisting of attention and pain resistance. As a counterpoint to your story, I want to share a bit about my weight loss attempts, which were very, very different from yours. (I'm a woman, so that probably makes a big difference because of lower BMR.)
I would absolutely freaking *love* my weight loss to be as easy as, "Pay attention = eat less = lose weight without ever feeling hungry." That's just not how my body works.
When I eat until I'm not hungry anymore, I maintain my current (excessive) weight. When I try to cut back "just a bit," it's the worst of both worlds: I'm hungry enough for it to be annoying, but my caloric intake is still high enough that any weight loss is too slow to be noticeable. It's extremely demoralizing and I give up.
The only times I actually succeeded in losing weight was when I was extremely strict about imposing eating limits. None of that namby-pamby feel-good "listen to your body" stuff, because my body clearly wants to be fat. No, it was "this is how much you're having for lunch, body, and if you don't like it too effing bad."
And it sucked absolute ass.
I would sit at my desk, trying to focus on the grant I was writing or the experiments I was planning, and all the time there would be a dialogue in my head:
"I'm hungry."
"You had lunch an hour ago."
"Yeah, but it wasn't enough and I'M FREAKING HUNGRY!"
"Quiet down. Snack is in two hours, you know this. You just have to last till then."
"But I'M HUNGRY NOW!!!!!"
And on and on like this, pretty much around the clock. You can imagine what it did for both my mood and my productivity. I couldn't just make those thoughts stop; they came unbidden. I could only resist them.
To make it extra fun, if I didn't eat enough I would get what I called a "hypoglycemic headache" - a really bad, unpleasant headache that made me useless for anything except menial tasks (no focusing on intellectual work with a hypoglycemic headache). Weight loss, for me, was surfing the very thin line between "hungry enough to lose weight at an appreciable rate" and "not so hungry that I trigger a hypoglycemic headache" (I learned to read the early warning signs).
So, Noah, I applaud your accomplishment and also ask you to recognize that you were extraordinarily lucky in how easy weight loss turned out for you, judging by your description.
This is so similar to my experience. Being able to afford a GLP-1 changed this for me within weeks of starting. I wish they were more accessible to more people.
Interesting post...I shed 60lbs more or less the same way Noah did. I began my weight loss before Ozempic type meds by focusing on permanently changing my eating *habits*. On advice, I deliberately never thought of myself as *on a diet* (the temporary kind). Things that were helpful - two big ones - I learned to identify and avoid empty calories, and that there was no social or moral obligation to eat everything on my plate, that it's okay to stop when you feel satisfied (not stuffed).
I certainly do not feel smug or righteous about my success. I do feel thankful I found a path, with medical input, that I was able to follow. And I still enjoy eating, just more mindfully.
Sure, and heck, while we are at it, why not “automate” love with a micro-dose of an empathogen like MDMA; automate our attention with Adderall; automate our religious experience with psilocybin or LSD; automate handling our depression with Prozac? There is no limit to what we could do!
At some point we could get so good at turning our inner life into a problem of technique that we would all have access to our own biochemical profiles from as early as 3rd grade and instead of being sent to the principal for a talking to, we’d be sent to the school nurse to check our dosages. It would be a pharmacological paradise!
Why didn’t I think of this?! Just offload the whole infuriating, messy, difficult project of BEING HUMAN to the ever-reliable technocracy. Why muck about in the dusty old scrolls of Aristotle, the Buddha, Marcus Aurelius, Patangali, Augustine, Pascal, Jesus, or any of the other old farts when a Techbro can save us with a pill?
"Just offload the whole infuriating, messy, difficult project of BEING HUMAN to the ever-reliable technocracy."
There are so many ways to be human that offloading some frustrations of, say, having a body onto technology doesn't cramp our scope for humanity. In fact (as should be obvious), it can expand it.
I just avoided antihistamines during a week of wildfire smoke and pollen. I did it because a new doc told me to, for testing. The maddening itching and wheezing did not make me more human. It made me more slothful and stupid. While I spent some of that slothful time distracting myself with edifying cultural activities, my ability to shoulder my ordinary responsibilities was reduced, and my family suffered for it.
I happen to be religious. It's possible having some formative experience with suffering that medicine wasn't good at addressing made religion more attractive to me than it otherwise would have been. On the other hand, religion is also how I formatively interpreted peak life experiences, so maybe not?
However I got religious, now that I am, misery and incapacitation don't make me more religious. What misery and incapacitation achieve are misery and incapacitation. Humans are called to bear up under those challenges the best they can, but can we be honest that misery and incapacitation aren't particularly edifying challenges? If they're unavoidable, we should make the best of them, but if they *are* avoidable, avoiding them so that we're free to tackle more edifying challenges (more career and family responsibilities, more community involvement, even more challenging hobbies – in short, all the *other* worthwhile challenges of life) seems the better path to human flourishing.
Yes, Midge, I agree. There's no virtue in suffering per se. But allergies are long way from gluttony. Allegra is one thing; Ozempic is another. I eat my feelings. In a bout of anxiety, boredom, sadness, frustration, or stress, I've gone to a slice of coconut cake like some people go to Jesus. Unlike allergies, overeating stems from a real grab bag of psychological and spiritual issues--at least for me. Popping a pill or sewing my stomach up would help me avoid these issues. I wouldn't like to do that. It doesn't seem like the way to any lasting happiness.
I wish you well in figuring out how to maintain healthy habits for yourself. Building appropriate habits in the face of life's contingencies *is* a struggle, as I, too, know – a struggle I doubt technology eliminates, only changes the terrain of. We still need practical wisdom (phronesis? I think philosophers – which I'm not – call it phronesis) to live well.
Like many young women, I had a fair amount of my time wasted by having certain physically-rooted symptoms attributed to my psychology. Physical and mental health are obviously mutually reinforcing – good health of one sort supports the other and poor health of one sort can easily worsen the other. But teasing out causality here can be harder than we think, and sometimes we've got to troubleshoot with whatever's handy until we find some arrangement – *any* arrangement that's not positively unethical – which works.
"Allergic toxemia" is an outdated phrase to describe the general malaise – including mental – that comes with allergic flares. "Toxemia" is definitely the wrong word – the problem isn't blood toxins per se – and so now only quacks use the phrase, sort of a pity, since there really should be a term for this phenomenon – I might call it "histamine crazies". "Histamine crazies" are *definitely* crazy – they impair judgment, including judgment curbing mindless eating. When I hear others describe what they call "food noise", the phenomenon they're describing doesn't sound so different from "histamine crazies" to me. Maybe the two share similarly physical roots.
Ideally, symptom control helps promote good habits rather than being a substitute for them.
Before I had kids, I successfully stuck to fairly punishing dietary restrictions in hopes they'd help me in some way. (I think some did, though not necessarily for the reasons I was told.) Pregnancy was for me what Noah describes his migraines being for him – a time when continual snacking went from being bad nutrition to positively medically advised as a drug-free (keeping pregnant women drug-free is such a high priority!) means of symptom control. Pregnancy also worsened my underlying asthma, which was "treated" with inactivity – since, hey, at least inactivity is also drug-free! Eat more, move less, with predictable results...
Frustratingly, increased adiposity can by itself worsen asthma. But it's also true that continually being interrupted by malaise from respiratory-related immune response on a hair trigger makes sticking to healthy habits much, much harder. So I'm going on an injectable now – but a MAb for asthma, not a GLP-1 agonist. Hopefully, symptom control makes returning to my previously-healthier habits easier – as in actually feasible, since I sure ain't succeeded for long enough lately to escape the vicious cycle!
Still, I wouldn't rule out trying a GLP-1 agonist if, after giving other strategies a fair trial, I was still struggling. Part of that's because of reports that GLP-1 agonists have pluripotent anti-inflammatory effects beyond what's simply explained by induced weight loss, and inflammation was already limiting my life back when I was thinner.
What's a "fair trial"? When do you decide that lifestyle modifications just aren't practical in particular situations without adding artificial help? These are questions of practical wisdom. Technology changes the terrain phronesis navigates, but doesn't render it obsolete.
Well, why not?
Besides living the life of a junkie and enslaving oneself to Big Pharma? Besides freely choosing complete ignorance of one’s own inner life—the impulses, feelings, fears and desires that move us for good and bad? Besides offshoring the challenge and joy of forming one’s self and deepening one’s humanity? Lemme think.
Have fun with that.
I am and will! Thanks, BZC.
Exactly. From the moment we had to invent culture to avert a head-on collision between our big heads and our narrow hips, we stopped being anything in capital letters and became an ongoing wager against extinction. Jesus, the Buddha, Marcus Aurelius, Augustine were the Techbros of their day, devising solutions to the problem of human suffering using the cultural resources available to them.
"Jesus, the Buddha, Marcus Aurelius, Augustine were the Techbros of their day."
Maybe. Mmm. "Devising" "solutions" to "problems" with "resources." That's techbro talk. I doubt these great men would agree with the framing such language implies. Maybe the Buddha or MC might not mind; they did seem to have a kind of spiritual technology approach.
Your proposal is acceptable.
" social distancing, lockdowns, universal masking — weren’t valueless, "
But they were symptomatic of policy made without regard for cost benefit analysis.
I've been back and forth on whether this was more the fault of CDC for not giving individuals and local policy makers the information with which to make cost-benefit decisions or the individuals and local policy makers for politicizing/moralizing these decisions and would not have executed cost benefit version of NPI if they'd been available.
Just because you don’t agree with the outcome of someone else’s cost-benefit analysis doesn’t mean there wasn’t one done.
It’s pretty insane to assume that policy makers were all just acting in bad faith and making decisions willy-nilly rather than trying to do their best in a fluid situation with imperfect information.
I’m not saying bad faith. But closing venues by activity rather than indicators like airflow per person, and apparently giving little or no consideration to the value of school attendance lost (not to mention advice not to go outdoors, to mask outdoors) gives the impression of not weighing costs and benefits.
As for the imperfect information, CDC coud have done a much better job of providing that better information.
They could also have done better rolling out vaccines if they had put more effort explaining the benefits rather than defending the safety. I can’t think of a less persuasive marketing pitch than “This won’t kill you, promise!” and “This stuff is so good you are required to take it.”
Hindsight is 20/20 and it’s easy to spot the things now that could have been done better then. People make mistakes, and institutions, which are just collections of people, do too.
It’s definitely the case that some of the policies could have and maybe should have evolved sooner than they did. But it didn’t help that so many of these issues were immediately turned into political footballs by people looking to score points.
I agree completely.
I think lockdown and the other measures were simply the right choice. It might seem with hindsight that the threat of covid would have died back even if we hadn't locked down. But unchecked viral spread significantly raises rates of replication and with it the probability of more harmful, more drug and vaccine-resistant mutations. Given how contagious the virus was and the fact that even in the first wave, health services were being overloaded, I really don't think they had any option but to do what they did. Sweden, that didn't lockdown, had higher excess deaths than either of its neighbours both of which did lockdown and it was probably lucky that the rates weren't higher.
It’s not either or. And policy changed or should have changed over time.
I am a retired doctor studying obesity 50 years. Experts have found there is a set point for chronic weight. Your body resists losing ang gaining weight if you ave been steady for several years. Oprah and millions of diets have lost tons off and on for years. Most doctor diets/clinics have a 5% success for long term (1 year). Weight Watchers, the best, was at 10% and now bankrupt. Wegovy (double the dose of Ozempic) stimulates a gut hormone that makes you feel full earlier. Most people overeat from stress. Food is very rewarding.
Andrew MitchellMD
Good post. I think a key aspect of what you experienced is the importance of just being aware of what and how much you are eating. If you make good choices, you can eat more with less adverse effects. But if you want to eat some ice cream, do it intentionally and knowing this is a treat. I wolfed down my entire breakfast while reading your post. Eating while distracted is not generally good because you tend to eat faster and eat more. But I made a good choice before starting to read, because breakfast was a bowl of oatmeal, with sliced strawberries mixed in and a few walnuts.
Congrats - and great point about attention.
Most of my friends and family who have battled weight issues have leaned that mindfulness and focus are key. Very easy to get into an eating frenzy or to use food as a distraction or part of nervous or stress energy (eating standing up, in the car, etc). I remember coming home from school as a kid and eating most of a whole box of cookies regularly- wasn’t really aware of what I was doing while I was doing it- just a frenzy.
For some it was and is still difficult to put themselves into that attention mindset.
What seems to work in that case (other than Ozempic) is finding ways to cut out the most dangerous times for mindless eating. If late binges from the fridge are an issue, then establishing a rule that the kitchen is closed after 8pm helps. If you can’t be aware of what you are eating and how you are feeling then don’t start eating, in other words.
Another, for a relative that had a habit of eating standing up or on the go was to establish that food had to be consumed sitting down, and each bite chewed “x” number of times. This methodology worked better than textbook mindfulness exercises for him.
Sounds like you're happy about the changes you've been able to make, so congrats on that. On a societal level you're not offering much of a solution though, by suggesting that people should just pay attention to not eating too much (or to otherwise buy drugs). Like you already mentioned, there is a cost. Many people who are obese can't handle the additional mental load, or the financial expenses, required to make changes because of social/relational problems, work related stress or time issues (like your dissertation), debt related stress, health issues (as you also experienced), etc. The dissertation was a temporary issue with a relatively well paid job following on that. Tell someone with (sub-)minimum wage, a sick kid, and no health insurance (or one that doesn't cover all expenses), that they should just 'pay attention', especially when the crappy food that is most affordable and most heavily marketed is void of nutrients, so there's really not much signaling from your stomach actually happening. Same with just 'buying the drugs' when it's not covered by a (possibly non-existent) health insurance.
And your metabolism is to some extent determined by what you ate and how fat you were as a kid, meaning that those who grew up poor or with parents who were simply unaware of what a healthy lifestyle entails, will have a much harder time keeping a healthy weight later on in their lives. (People who didn't have enough to eat when they were young also suffer from that for the rest of their lives).
Any serious effort to tackle the obesity problem is going to require a huge societal effort at multiple fronts, from healthy and free school meals, cooking lessons, regulating/banning the most unhealthy food or subsidizing healthy meals, and much more. The other solution could be to give everyone who wants it Ozempic, or alternatives, for free. One of these is easier to do than the other (although in the US they're both unlikely), one of them I would consider the healthier, more sane, solution. I'm afraid those two are not the same.
What can the Western world (including all the Americas) along with the Middle East learn from the countries of East Asia where obesity rates are much lower?
Speaking of attention, I notice that when I use a calorie tracking app, I can hit my budget and not be hungry by being careful, and learning that eating 4 slices of pizza is totally fucking up, costing half my daily budget and leaving me hungry for more. I also notice that without calorie tracking I get too hard core and eat to little, only to cave a couple days in, shoveling peanut butter straight from the jar just before bedtime. So it takes the learnings from a book like “The Hungry Brian” with knowledge of what my current budget situation is, then it is east to maintain or lose a little weight. In addition to glp1s, which seem like a vaccine against the hyperstimulating food environment capitalism has delivered us, I wonder if realtime automatic calorie counting embedded into our vision could work. I hate the idea of wearing smart glasses but if I got an alert letting me know that if I grab that donut from the company break room at 10am I will be through like 60% of my calorie budget for the day, or conversely, that hey, you actually can have that quick toaster oven quesadilla at 8pm, it would be awesome, and be way more sustainable that entering shit in to My Fitness Pal all the time.
There is nothing like a lifetime in engineering to make you realize that "You just need to be diligent", "You just need to have more willpower" and "We just need to come together as a society" are different ways of saying "We haven't solved this problem, and in particular the person saying this has no idea of how to solve this problem". Solutions that rely on willpower or diligence have horrendous failure rates (often >90%, as seen with some measures of obesity), and never, ever, improve beyond that.
The vast corpus of evidence suggests you’ll be fat again within 3 years. I mean seriously how many times have you heard some friend, “Oh I lost 50 lbs!” Great. And then you see them later and they are fatter than they ever were.
GLP and gastric bypass are the only things that have proven to work long term.
Noah good writing again. Thank you. L
The US spends 5% of it's GDP on health related programs like Medicaid, Medicare, etc. These programs would be a lot cheaper if a lot more people were skinnier!
Right now Ozempic is expensive and tough to obtain.
My modest proposal is that the US should acquire Novo Nordisk, share the patent for Ozempic, and let anyone produce it as a generic. It will pay for itself within a few years.