So incredibly delicious, you can't stay away, can't stop. Buy more now! It's so much better than reading about why it's true!
(This is an abridged version of an essay that was posted on Medium.)
Three years ago in September of 2021 in a blog post titled "Is obesity research too hard?", I observed how difficult obesity research is, and suggested that it might be too difficult for the scientific methods available in the early twenty-first century. It's even harder than that: here's one set of reasons. [Sorry about the malfunctioning link; the post is on page two, and Blogger's HTML anchors don't recognize that it's not on the front page.]
Most animals obtain their energy supplies by eating food - it's essential for survival. Most of the time, animals find themselves in resource-constrained environments, and feeding systems that work by "eat as much as you can, whenever you can" without any upper limits, work just fine at keeping obesity from becoming a problem.
But after eons of biological evolution and technological development, human civilization achieved prosperity, and invented refrigeration and transportation that made more than enough food available all the time. According to the US Bureau of Labor Statistics, in 1901 Americans used 42.5% of their expenditures for food., while by 2002 those expenses had declined to 13.1%., and by 2022 all the way to 6.7%, a reduction of 84%. For North Americans, food is an unlimited resource year round, and we have only ourselves to rely on to keep from getting fat. Our evolutionary history has never before needed to cope with this situation. Without the evolution of new forms of food intake regulation, obesity epidemics are inevitable.
Managing food intake to match energy consumption has two major components: appetite, that is obtaining and ingesting food, and satiation, stopping ingestion when enough has been consumed. These have to balance over the long term.
Then, achieving the balance between appetite and satiation are, at a minimum, five interacting behavior-physiological subsystems. Driving appetite are foraging, which I blogged about earlier, which gets the organism close enough to the food to trigger eating behavior. Eating is closely followed by ingestion, which is succeeded by digestion, which creates circulating nutrients processed by the organism's metabolism.
Each of these stages sends signals to the others to drive or inhibit their activity. One of those feedback loops goes between foraging, eating, and ingestion. This makes
the very acts of finding and consuming food become ends in themselves. Chefs know that the presentation of the food is an important part of the dining experience -- diners simply enjoy looking at a well-composed arrangement of artfully shaped and colored edibles on a plate.
Food producers and processors, whose mission is to sell more of their product without regard for the welfare of their customers, have learned how to make their foods hyperpalatable, exploiting the positive sensory properties and flavors to keep eaters eating, and buying more. The salty snacks industry has been most successful at this takeover of the food consumption behavior system, whose adaptive value is enormous when the organism is in a nourishment scarcity environment. Grilled and smoked meats come in second for hyperpalatability, but their producers have been less successful at creating a mass-distributed product. In a nourishment rich environment, eating for the sake of eating acquires more negative effects than positive ones. This takeover reached what may be its ultimate expression in the slogans that promoted Lay's potato chips: "Bet you can't eat just one," and reaching the end of the bag of chips: "Don't worry, we'll make more." The clear message is to keep eating, and don't stop, ever.
The result of these interactions is that people will eat even when they're not hungry, and keep eating even beyond the point of satiation. Their tissue mass will accumulate faster than it is depleted and their weight will go up, regardless of any steady state energy balance levels.
Medical researchers and pharmaceutical companies have searched for decades for drugs that can affect the weight regulation system. And they've found them: Wikipedia lists 38 different drugs with
appetite suppressant effects. Each of them has many effects in addition to appetite suppression, Which effect is a primary one and which is a side effect inevitably depends on the user's goals and perspectives.
The latest example of this rainbow of capabilities is the family of drugs called
GLP-1 receptor agonists. Originally discovered by studying the causes of the remarkable metabolic capabilities of the Gila monster, a lizard found in the deserts of the Western US, they turn out to be "not only effective in metabolic diseases [such as type 2 diabetes and obesity] but also play a role in
non-metabolic disorders, affecting multiple systems including the
musculoskeletal, nervous, cardiovascular, and digestive systems, and can
even have implications in oncological diseases."
Drug companies are spending major resources promoting GLP-1 receptor agonists as a panacea, of course. In a
tour de force of marketing, one of them, Novo Nordisk, is distributing the single drug semaglutide under three different names: injectable Wegovy for obesity, injectable Ozempic for type-2 diabetes, and oral Rybelsus for type-2 diabetes. It can do this by exploiting the US drug regulation framework, which gives them a set of patents on semaglutide formulation that will
expire over years ranging from 2026 to 2041, and allow them to monopolistically charge prices that may be
more than 250 times its cost to make..
Marketers and enthusiasts will avoid telling you about the side effects of weight loss drugs, which are serious enough that most people who started taking anti-obesity medications
stopped using them within a year. People trying Wegovy were best at staying with the program, but only 44% of them lasted a year.
If you're an American reading this, it's more likely than not that you're overweight. Lots of organizations are happy that you're that way, and few have incentives to help you manage your weight effectively. Food producers want you to eat more of their products, regardless of your weight condition. They're working hard to develop ever more hyperpalatable foods to keep your binge eating bouts going. Drug manufacturers are happy to have more overweight patients who will pay high prices for their weight reduction drugs. Purveyors of diet plans want you to use their plan and avoid other plans, regardless of whether it's the right one for you.
Healthcare providers have lost what benign incentives they ever had. For a brief period in the 1970s researchers had discovered that "health management organizations" (HMOs) that focused on improving health for their clients had less expenses and better patient outcomes than fee-for-service insurance systems. But then HMO managers discovered that care denial strategies were even more profitable than complicated health promotion programs, and now HMOs are just another, more restrictive, insurance offering.
Against these powerful economic forces, individuals who want to reverse their weight increases have a tough road ahead. The idea that there's no royal road to weight loss, and that each person needs to find a path that works for them and may be different from everyone else's is a revolutionary one. Biology may be destiny, but controlling your own biology without the necessary data and personalizable systems analysis tools that have not yet been devised, must be done by trial and error. Keep trying, and don't give up until you find a method that works for you. Good luck!