Genuine question: why would you expect at all that there *would* be a non-pharmacological solution to obesity? Given your PhD work I’m surprised that even due to the inefficacy of pretty much everything we are willing to try so far you still seem concerned that there’s a non-technological (“coordination”?) solution out there that would put a dent in obesity with anywhere near the same order of magnitude
I mean, prior to three years ago that would have been a strange question. The pharmacological applications we had, if they worked, came at a substantial cost. No one anticipated GLP-1s to be as effective as they are.
I think more to the point, there are segments of society, typically wealthy and educated, where obesity is much less of an issue. And there are wealthier countries with obesity rates that are a fraction of the US - Italy and Sweden are less than 23% compared to 37% here. There are obviously food environments and cultures that are more protective, even if rates of increase have been steadily rising everywhere. To what extent the issue is cultural (we're more accepting of larger bodies, see e.g. Nicholas Christakis network effects of obesity; food is out everywhere all the time), economic (food is cheap), nutritional (ultra-processed), etc. remains to be teased out. To what extent we can actually do something about it I would argue has only ever been tried in small nudges: package labeling, workplace interventions, very small soda taxes, etc.
Absent GLP-1s, I think we would have continued on a trajectory where the externalities were so high that we were willing to enact some heavier-handed regulations.
I'm glad we have GLP-1s, and I think the fact that they're operating on an individual level is in a lot of ways more palatable than what possible solutions (say very high taxes on ultra-processed food) could have been. But all of that to say just because GLP-1s are easier doesn't mean that coordination is impossible. We didn't do nudges for smoking. We made cigarettes prohibitively expensive, and smoking rates are directly correlated with state tax levels.
And I'm concerned for the reasons I listed: there's still likely to be a huge swath of the population who can't access or don't benefit from such drugs. Whether there's something like a herd-immunity effect (or a social network effect) here will be interesting to see. I didn't write about this but I also think there's ethical complications we haven't thought through very well on children. Being non-obese is better than being obese in my cost-benefit pretty much no matter what, but the idea that we're more likely to accept placing kids on GLP-1s than changing the environment for them is another way to think through this.
Genuine question: why would you expect at all that there *would* be a non-pharmacological solution to obesity? Given your PhD work I’m surprised that even due to the inefficacy of pretty much everything we are willing to try so far you still seem concerned that there’s a non-technological (“coordination”?) solution out there that would put a dent in obesity with anywhere near the same order of magnitude
I mean, prior to three years ago that would have been a strange question. The pharmacological applications we had, if they worked, came at a substantial cost. No one anticipated GLP-1s to be as effective as they are.
I think more to the point, there are segments of society, typically wealthy and educated, where obesity is much less of an issue. And there are wealthier countries with obesity rates that are a fraction of the US - Italy and Sweden are less than 23% compared to 37% here. There are obviously food environments and cultures that are more protective, even if rates of increase have been steadily rising everywhere. To what extent the issue is cultural (we're more accepting of larger bodies, see e.g. Nicholas Christakis network effects of obesity; food is out everywhere all the time), economic (food is cheap), nutritional (ultra-processed), etc. remains to be teased out. To what extent we can actually do something about it I would argue has only ever been tried in small nudges: package labeling, workplace interventions, very small soda taxes, etc.
Absent GLP-1s, I think we would have continued on a trajectory where the externalities were so high that we were willing to enact some heavier-handed regulations.
I'm glad we have GLP-1s, and I think the fact that they're operating on an individual level is in a lot of ways more palatable than what possible solutions (say very high taxes on ultra-processed food) could have been. But all of that to say just because GLP-1s are easier doesn't mean that coordination is impossible. We didn't do nudges for smoking. We made cigarettes prohibitively expensive, and smoking rates are directly correlated with state tax levels.
And I'm concerned for the reasons I listed: there's still likely to be a huge swath of the population who can't access or don't benefit from such drugs. Whether there's something like a herd-immunity effect (or a social network effect) here will be interesting to see. I didn't write about this but I also think there's ethical complications we haven't thought through very well on children. Being non-obese is better than being obese in my cost-benefit pretty much no matter what, but the idea that we're more likely to accept placing kids on GLP-1s than changing the environment for them is another way to think through this.