Once-Weekly Semaglutide in Adults with Overweight or Obesity, 2021, Wilding et al

Jonathan Edwards said:
We will have to agree todisagree. Basically I think it is about addiction to highly contrived products that never sued to exist - like potato crisps and McDonald's.



I don't think obesity has anything to do with inflammation. That sounds like one of the current popular myths in medicine. The problem is addiction. It certainly is for me.
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I disagree with the term “addiction”, far too misleading IMO, but I agree with the inflammation part.

rather than addiction, I would call it satiety imbalance. I agree that McDonald’s is partly responsible...you only have to look at the growth in emerging markets to see a correlation. However correlations are just that not the basis for sound strategies on something that is complicated.

There are probably solutions in the form of regulation (e.g curbing multibuy promotions, limiting portions/portion advice on some types of food) but outright bans seem too extreme and impractical.

I’m hopeful that fibre research will hold some of the answers. I’m probably biased though since that was my main areas of research when I was in that game (b-glucan/cholesterol lowering etc).
 
I have to say I dont understand the appeal of McDonald’s... I’ve never eaten a Big Mac or any other beef burger from any of those chains.
When lockdown lifted in NZ, McDonald’s had queues around the block at 3am and ran out of food. People bought bucket loads of food and ate until they were sick. Lots of people behaved as though they were desperate...
 
Milo said:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507106/
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As someone who worked on inflammation for decades I can assure you that the abstract does not in fact say anything about a link between inflammation and obesity. It relates to cytokines that are used in inflammation and are increased to a a tiny extent in association with obesity as well - but in that case are not associated with inflammation but rather with obesity. This review is typical of the sort of disinformation that science is full of these days. Viruses and seasickness can both cause vomiting but that does not mean there is any association between viruses and seasickness.
 
In the US, in my childhood, there were few obese kids, teens and adults.
I think these factors are relevant:

Food advertising on TV, especially fast food chains.

TV, video games for entertainment, especially if too dangerous to play outside.

High fat/starch food is the cheapest. Corn syrup and sugar added to all processed food.

Lack of exercise in jobs, everyday life (the car)/

Lack of family mealtimes, snacking or eating in the street isn't taboo (French paradox?).

Breakdown of sources of emotional support (family, etc.), food a substitute. More perceived stress in life (food a soother).

The more people gain weight, the more one's own weight gain is perceived as normal, fitting in with the median, the crowd.

Once this drug is off patent, I suppose it will be as common as Metformin for diabetes.
 
Wonko said:
Which just might be why the people who want to sell as much food as possible, put them there.

Doesn't explain my 'liking' for home made wholemeal bread tho ;)
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To me it's easy enough to explain why you like wholemeal bread, your body enjoys food that contain the nutrients it needs. ;) Very simplified :P

Eating nutrient poor diets may lead to increased energy intake as you would need more food to meet your nutrient needs (satiety is not just about energy consumed, but also about the amount of fat/protein/fibre/micronutrients). When the nutrient poor food also has been manipulated to taste good there is a problem..

With obesity there is the addition al problem of leptin resistance. Leptin is a hormone that tells us we are full - if this signalling doesn't work properly of course it will be more easy to eat too much (even healthy foods). We have the set point theory that if someone has been overweight their body "wants" to be at a higher weight and thus you will feel hungry until you are back at this weight again. Some people say weightloss permanently changes your metabolism so you have to eat less calories for life (I don't remember at the moment if this has to do with a change in muscle mass or if it's something else, some may have become more efficient at absorbing energy from food in some way?). If someone is constantly hungry and their body doesn't signal when they should be full, then that is a very different situation than for someone who feels full after a normal meal and just doesn't have to deal with any of that.

And as others have mentioned, food availability (I am thrilled to live somewhere I can finally buy offal again!), advertising, less activity, the way stores are promoting and pricing foods, what we learned about food growing up, knowledge of food, cooking, energy and nutrient requirements... It's complicated. But as obesity is rising all over the world, we can't just place resposibility on the individual - there are structural problems as well.

Feeling a bit tired, my thoughts might be jumbled. :)
 
Another possible reason for why the placebo group didn't lose as much weight is that they could have given up after guessing they were not, in fact, getting the drug. Are people who joins in drug trials for weight loss more likely to believe they need the help of a drug to see results, and thus more likely to give up if they believe they weren't getting the drug/the drug didn't work after all?
 
Jonathan Edwards said:
I am not suggesting anything particularly, I am simply saying that I cannot see the price of good nutritious food as the problem. The problem is availability of harmful foods. And restriction of harmful things is very much part and parcel of our system. You cannot buy tobacco, except with huge taxes at specific outlets. You cannot buy caustic soda to clean drains except at special outlets. You cannot buy acetone at all now. You cannot just buy prescription drugs. You cannot buy cannabis. You cannot buy Chinese medicines containing lead and arsenic, at least in theory. The list goes on for ever. The foods that are the problem are highly contrived addictive substances produced by specialised manufacturing processes that really only serve to shorten people's lives. We got used to these foods in the 1960s when most people had not formed an addiction. We now see that addiction is a huge problem, just as addiction to air travel is destroying the planet and so on.

How you deal with that best I do not know but the example of the shelf length is easy. Just do not stock fizzy drinks. And it is not that retailers are forced to stock these. Some stock a lot more than others and the proportion of obese people walking around different shops varies markedly..

Chicken is nutritious and cheap. If suggest have more chicken content for the same price then it must be even cheaper to have nugget sized pieces with less of whatever is supposed to be bad about nuggets. Surely the objective is to help people lose weight - if what is preventing that is commercial interest that needs to change.
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Happened to glance at the packet of chicken thighs - tonight's dinner - £3.60/2KG or 90 pence for 2 portions (500 grams). OK I go overboard by filleting them and cooking the meat/skin/bone separately in an air fryer. But yes it is cheap. Pre-covid, before I adopted drive through click and collect, I bought free range chicken thighs, they were dearer £1.25 for 2 portions I think.
Breakfast is porridge (£1/KG or about 7pence/portion) with some frozen berries and chopped nuts (teeth issues).
So yes, some food is relatively cheap.
The stories of people who don't have enough to eat are difficult --- shouldn't happen in wealthy countries.

EDIT - should have added that my own experience of changing what I was eating (more fibre etc), and extending my overnight fast, were that it was difficult - but then it became less difficult/normal. I wouldn't dispute the idea that "addiction" to less healthy food/lower fibre foods/processed food is real.
 
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It is interesting that the bogeys in this story - sucrose, salt, starch and fat - are all horrible on their own.
Try eating plain sugar lumps or salt or boiled rice on its own or margarine.
But mix sucrose with fat and wow - you have butterscotch and ice cream, delicious.
Mix starch with fat and salt and hey - you have potato crisps/chips/McDonald fries.
Mix sucrose with starch and you have Mr Kipling.
Mix sucrose with some fruit acid and you have Coke.

The people who sell these things must know all about this but we don't hear about the addictive properties of mixtures in popular debate.

I am pretty sure that there are two different pleasure pathways in our brains. One is for McDonald's and the other is for Wonko's wholemeal bread, well-made muesli or porridge, fresh fruit, vegetable tagine, and so on. I also suspect that at some point in our lives we get used to following one path or the other and very much dependent on influence from family and friends. Once you are on one path the other one tastes more and more terrible. It isn't a matter of more fat or more sugar or more starch or whatever so much as a matter of crucial taste mixtures that give pleasure through different routes.
 
That's a collection of adult taste buds talking tho.

As a child I used to eat sugar lumps whenever I found them, and pocket any that were surplus to my mouths capacity.

I liked sugar - but probably unusually, was never that keen on sweets, or even desserts.

So, mixture theory, not so sure that 5 year old me would agree ;)
 
Jonathan Edwards said:
The people who sell these things must know all about this but we don't hear about the addictive properties of mixtures in popular debate.
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That we don't find this mixture of fat and starch/sugar in whole foods is very much part of the debate, at least where I live. Norway has one of the fastest growing rates of increased visceral fat in Europe :(

Jonathan Edwards said:
I am pretty sure that there are two different pleasure pathways in our brains. One is for McDonald's and the other is for Wonko's wholemeal bread, well-made muesli or porridge, fresh fruit, vegetable tagine, and so on. I also suspect that at some point in our lives we get used to following one path or the other and very much dependent on influence from family and friends. Once you are on one path the other one tastes more and more terrible. It isn't a matter of more fat or more sugar or more starch or whatever so much as a matter of crucial taste mixtures that give pleasure through different routes.
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I don't think things we're not used to eating necessarily tastes "more and more terrible", they are simply not an habitual part of the diet. And a lot of our diet is habit. Dependent on influence, as you say, when we were growing up. There are time windows for when babies and children more easily learn to accept and enjoy different foods, "relearning" food habits as an adult is difficult. Not everyone shares @FMMM1 experience that it gets easier with time.
 
Daisybell said:
I have to say I dont understand the appeal of McDonald’s... I’ve never eaten a Big Mac or any other beef burger from any of those chains.
When lockdown lifted in NZ, McDonald’s had queues around the block at 3am and ran out of food. People bought bucket loads of food and ate until they were sick. Lots of people behaved as though they were desperate...
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I've had a memorable burger --- bacon --- cheese --- in Queenstown South Island. Can't see why you guys would eat McDonalds --- OK it's cheap. You've also got green mussels -- probably the best mussels in the world

Ever get back there I've a list of eats --- elephant fish with chips ---
 
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