My initial plan was to circle back to economic inequality and how it affects political power. There are some timely examples!
As soon as I finished writing the last post, I knew I would have to write more about fat.
That was exacerbated by two articles and a conversation.
Both of the articles were about medications that were initially developed for diabetes but are now being seen as "miracle" weight loss drugs.
https://www.nytimes.com/2024/05/07/opinion/ozempic-weight-loss-drugs.html?utm_source=pocket_saves
The New York Times article is about how the real problem is satiety, and that is caused by poor food quality, so really we should be uniting against the manufacturers of processed foods.
The LA Times article is about how this increases already existing health disparities because the people who don't generally have access to healthy foods and health care also don't have access to the drugs.
I'm not saying they don't have points, but they are missing some points too.
First I am going to backtrack to Metformin.
One nice thing about Metformin is that it has been around since the 1950s in Europe, though it was not approved for use in the United States until 1995. It is generic and cheap.
It also helps some people lose weight, so it gets prescribed a lot for people who do not technically have diabetes yet but might get it.
It does not help everyone lose weight. I know at least two people who have lost weight on it without changing diet or exercising more. It can happen; it's just not guaranteed.
One of Metformin's functions is to suppress your liver from releasing too much stored glucose during fasting periods, like at night. If you are having insulin problems, that release can raise your blood sugar, which can have extra wear and tear on your organs. If you have plenty of insulin, that extra blood sugar can be used or stored as fat.
It totally makes sense that taking Metformin would help with weight loss for some people but not all people.
That makes sense for any drug.
For people getting all excited about a new "miracle" weight-loss drug, it makes sense, but those could be false hopes.
I suspect that is a large part of why the hype keeps migrating. It was Ozempic, but then it was more Mounjaro that was going to give us all our dream body. Then before Wegovy got to really be the big one, Zepbound started stealing its thunder. There are always studies showing this one may be more effective or this one interacts with two receptors instead of only one, and then there's this thing called "super responders" who skew the results.
What really brought it home for me was hearing someone referred to as "skinny fat".
I'd heard the term before, but kind of forgotten about it. In this case, the speaker did not like the person he was talking about, and I think it was just very hard for him to give credit for that undeserved body shape.
I don't know whether the subject in question is healthy or not, but neither does he. It might even be an appropriate description if she has an unhealthy level of visceral fat, but he doesn't know that either.
It frustrates me how little we benefit from what we know. We know that Body Mass Index does not correlate with health, nor was it intended to, but we still use it. We know that things that are health indications -- blood sugar, blood pressure, and cholesterol -- do not automatically correlate with body size.
We still get hung up on it.
Fat people -- especially fat women -- have a hard time getting a diagnosis or remedy beyond "lose weight!"
If we were better at listening to women, we might know a lot more about myalgic encephalomyelitis (Chronic Fatigue Syndrome). Because it was first seen in a hospital environment, the majority of the sufferers were nurses, and women. Even though they were medically-trained, professional women, it was still assumed to be hysteria. If we had paid attention to long-term effects after an infection then, it could be helping us with Long COVID now.
Of course, we have a hard time getting people to believe in that too.
Incidentally, COVID does seem to be bringing on diabetes for many patients. If we are determined to stigmatize diseases, there are more opportunities coming.
The main point I want to make is that if we really want people to be healthy, well, yes, we needed to mentally divorce "healthy" and "thin", but also, we are going to have to include not only access to health care, but also access to healthy food and activity and living conditions.
That will not come from a pharmaceutical company. However, it might take a miracle.
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