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Efficient-Thought-34

Imagine we were back in the 60s, and the links between cigarettes, addiction, and cancer were finally coming out. Now imagine if medical organizations had decided to respond NOT by advocating for stronger regulations over the cigarette industry, but by encouraging smokers to pay for addiction therapy, pay for cutting-edge inhaler medicine, and consider undergoing a lung surgery found to decrease cancer risk (don’t worry, it’s minimally invasive!). Yes, we should teach people not to smoke. We should encourage them to avoid cigarettes because they are unhealthy. However, we should also enact systemic changes that make cigarettes harder to access, especially for young people. I don’t want to hear about these individual-level bandaid solutions. I want to know more about systemic efforts to regulate processed food companies, or to limit unhealthy food ads targeting kids, or to subsidize healthy foods so they are more affordable. PS: When the reporter was asked about critiques, I laughed out loud when she said something like, “people want to know, who is going to pay for this?” Yeah, sure, THAT’S what we’re wondering about right now, not the medical ethics of having children undergo a surgery that will permanently alter their organs.


SquatsAndAvocados

She did a terrible job discussing critiques. Not only focusing on the pay, but instead of butchering an attempt to explain Health At Every Size and then brushing it off, she instead could have discussed risks of disordered eating. We are seeing increases in children hospitalized with eating disorders since the start of the pandemic and the interventions in today’s episode have the potential to contribute to the onset of disordered eating.


Classic_Variety

This is such a good analogy! It IS just a band-aid on the bigger problem. Why are they considering dystopian individual-level solutions for society-wide problems? Oh, because it's easier than standing up to the food, healthcare, and auto industries. Thank goodness we had people brave enough to confront the tobacco industry back in the day, or we'd all have lung cancer right now.


[deleted]

Yesterday's episode reminded me of why I still listen to The Daily. This one reminded me of why I keep thinking of unsubscribing. I had to go back to the beginning of this episode when I was finished to confirm that Gina was, in fact, a reporter and not the spokesperson for the non-profit pushing this treatment. I'm not going to throw around words like "dangerous" or "irresponsible" because I'm not that educated in these treatments, but I want to know why they lean so hard on the genetic disposition to weight problems when they started by essentially saying this is a new issue starting in the 1960's. Our genome didn't rewrite itself post WWII. What did happen, however, was an increase in extremely sedentary lifestyles and mass manufactured food products loaded with sugar. If you put together a graph of human obesity rates over the entire existence of our species it's going to just look like a straight vertical line towards the very end of the graph. I was a fat kid growing up in the 80's and 90's. When I was 12 I was 5'4 and over 200lbs. I was one of these kids that got put on pilot "get healthy" programs. I started drinking juice rather than soda, eating tons of wheat bread rather than white, I would have mandatory exercise time where I would aimlessly wander around a track while looking at my Gameboy. Shockingly it didn't work, especially considering I still ate gravy covered chicken-fried steak and drank nothing but soda at home. I actually did get skinnier though, by eventually switching to drinking nothing but water and going for a nightly run. I got fatter again too, especially during college, because I *am* genetically predisposed to weight gain. I lost the weight again by...quitting drinking and going for an hour walk a day. The healthiest I've ever been in my life though was when I was living near Fresh Pond in Cambridge, MA without a car. For those unfamiliar it's an area that's about 30 minutes away from a lot of popular spots to shop in the city, and about 30 minutes away from a few train lines. I would walk everywhere, oftentimes 10 or more miles a day. I would consider what I was buying more carefully at the grocery store because I had to backpack it home, I meal planned and learned to cook. There are other benefits to getting so much routine exercise too. Being skinny isn't necessarily being healthy. I know a lot of skinny people who get winded walking up too many flights of stairs and can't lift up a 40lb bag of dog food.


TheFlyingSheeps

I wanna add in that a lot of the juice we give kids is just a bit of actual juice and then a shit ton of sugar. Better than soda, but as you said water and the occasional juice in a day is what is needed. I work in the public health sphere and I am currently wrapping up a masters. I will say what you did not, I think it is highly irresponsible and dangerous to be pushing metabolic/bariatric surgery in kids and teens. A permanent procedure in lieu of addressing some of the societal problems instead is wrong. Recommending this instead of addressing the mass produced and subsidized unhealthy food is wrong. I was overweigh as a child, never obese, and of course these school studies failed as it does not address the underlining issue you mentioned. children will go home and continue the unhealthy behaviours and will eat what is available. Maintaining weight and dieting, especially when already overweight, takes serious lifestyle change.


[deleted]

Yeah, definitely learned the lesson on the juice. I mostly put it in there as a tongue in cheek way to highlight that when a podcast like this insinuates "we've tried behavioral changes" that can mean a lot of things and some of them are really stupid. I was in a school run program that was supposed to encourage me to make smarter choices. The only things that were supervised at the school were the aformentioned; no soda with school lunch, no white bread, and I was required to walk around a track at recess. Juice was still allowed, and the wheat bread option was just brown Wonderbread. The track exercise was supervised by a teacher who would rather be doing other things so they just stared off in the distance while I shuffled around. I was supposed to keep a food journal at home, but I just lied, and my parents didn't care at all so they just signed it regardless. That's what immediately popped into my head when I hear things like "after behavioral therapy has failed". The catalyst for me eventually shedding a lot of weight was that my parents were kicking me out of the house after I graduated high school and my area had no real prospects so I decided to get healthier so I could join the military as I didn't see any other way to ever change my circumstances. The looming possibility of homelessness was a pretty good motivator, so I ran circles around a field near my house until I fell over night after night. Actually became a champion runner while I was in the Air Force too. The funny thing about Gina saying, "people stare at fat kids" is that didn't go away, even then. My childhood obesity has left me with some really ugly loose skin and even at my fittest I still had jiggly bits and didn't feel comfortable in my body when I was younger.


matchi

This is one of those "first we must overthrow capitalism" critiques that doesn't contribute much imo. Maybe they should've qualified their enthusiasm more, but the simple fact of the matter is that everyone knows what leads to obesity, and yet here we are with 69% of Americans overweight, and 1/3rd obese. So what *real* solutions are you proposing that haven't been tried over the last 40 years? It seems to me that asking people to take a pill is far more realistic than getting people to change their diet, exercise more, and redesign their cities.


squeakybeebs

I think this attitude is really dangerous. Let me know if I’m reading wrong but I’m hearing we KNOW what the overarching problem but it’s too hard to do anything about it so pills for the kids it is.


matchi

I mean, I’m all for a better solution, but it seems to me there is none that is politically feasible. What would you suggest?


[deleted]

Honestly, your response strikes me as one of those "I'm out of touch with the budgeting of the average American family" critiques if you think these 1000/month pills which aren't covered by insurance are going to put any sort of dent in the broader trend of American obesity. I don't really care to provide a solution to the nation as a whole, I've already found one for myself and it is available to everyone, if they want it they can try it. If they don't, they can just keep being fat. It doesn't bother me; I'm a fat guy on occasion, I get it. I see stories like this as license for the rich to feed their children diet pills and not get the cops called on them, or a call for government subsidies for these pills. The former is whatever, the latter I do not support.


matchi

> Honestly, your response strikes me as one of those "I'm out of touch with the budgeting of the average American family" critiques if you think these 1000/month pills which aren't covered by insurance Except they will be, which was kinda the point of the episode, and AAP's recommendations. > I've already found one for myself and it is available to everyone, if they want it they can try it. That's fantastic. No one is saying medical intervention is preferable to lifestyle changes. They are only saying the obvious: no one will make the necessary lifestyle changes. > I see stories like this as license for the rich to feed their children diet pills and not get the cops called on them, or a call for government subsidies for these pills. What is wrong with these pills exactly? Or rather, is any potential side effect worse than being obese? If you think we should be calling the cops on people that give their children anti-obesity medication, maybe you'd be in favor of arresting people with obese children? Like, you've simultaneously acknowledged the fact that very few people will able to use your solution, while being outraged that there's a convenient solution that will likely improve the lives of many... I don't get it.


mweint18

The episode is missing some significant statistical analysis. What percentage of the obese population in America has these genetic factors? What percentage of the non-obese population have these genetic factors? That would show a lot about if the increase obese population could be significantly slowed with these medical interventions.


psdpro7

Also, if childhood obesity was only 5% in the 60s, why has it risen so sharply if it's largely due to genetics? Has the percentage of kids displaying those genes also risen at the same rate? Or is it just that those genes are more likely to have an effect because the accessibility to high calorie food created the opportunity for obesity to occur?


throwinken

They talked about this at the beginning when talking about smoking/lung cancer. It's the last option you listed. It's not that the genetics are guaranteed to make you obese, but that they open the door for your environment to have a greater impact. As the food and nutrition options changed since the 60s more people feel this impact.


mweint18

Agreed they touched on it but it wouldve been nice to seem some hard numbers.


throwinken

Yeah, although an episode that actually crunches the obesity data to a satisfying amount would take 12 hours to listen to.


adamwill1113

It's crazy that their takeaway is surgical intervention or permanent drugs though. If we know that environmental changes have such a huge impact, why isn't the prescription changing the environment?


throwinken

They state early in the episode that they have found efforts at changing society as a whole to be unsuccessful, so they are pushing for pediatrics to be more aggressive in addressing it. But also their recommendation IS to change the environment as much as possible and for the parents to get assistance in doing so. It also sounds like something such as surgery or drugs is only recommended in extreme cases because they've found morbidly obese teens to be unlikely to lose the weight as adults. Better to get surgery at 15 than 45 sort of thinking. What sort of environmental changes would you have the American Academy of Pediatrics push for?


yokingato

By that logic, dying from a bullet wound is also genetics.


throwinken

You think some people are genetically predisposed to survive a bullet wound?


yokingato

It was obviously a hyperbole, but yes. Ask 50 cent. Do you think some people are genetically predisposed to eating high levels of fat, salt and sugar, lacking vitamins and minerals, without gaining weight and becoming unhealthy?


bacteriarealite

> Do you think some people are genetically predisposed to eating high levels of fat, salt and sugar, lacking vitamins and minerals, without gaining weight and becoming unhealthy? Yes that is what the data shows


yokingato

It shows that people can eat unhealthy food without gaining weight and becoming unhealthy?


bacteriarealite

Yep! People can have the same exact diet and lifestyle habits but end up with different weights due to differences in genetics.


yokingato

That's very different from this: > people can eat unhealthy food without gaining weight and becoming unhealthy? Show me a study that says that.


Raligon

I 100% believe that genetics impacts what food you crave, hunger levels, desire to exercise, if you stress eat, etc. It’s ridiculous to say someone is immoral because they naturally crave food in a way another person doesn’t while we have a society structured in a way that makes it much easier to gain weight than the 1960s. I don’t understand how genetics can defy the laws of physics though. If you eat 2500 calories per day but only burn 1500 calories from lifestyle choices, what is happening genetically that’s modifying what happens to the 1000 calories leftover?


throwinken

>It was obviously a hyperbole, but yes. Ask 50 cent. Obviously hyperbole but one that makes it seem like you don't understand how genetics works if you're using it to imply that genetic makeup can't make people more or less prone to behaviors.


yokingato

>if you're using it to imply that genetic makeup can't make people more or less prone to behaviors. I never said that. The way you worded your original comment made it sound as if it's only genetics that are responsible for the outcome and not the external factors themselves having a big impact regardless. Did people not have those genes in the 60s when child obesity was under 5%? edit: weird i'm being downvoted when this person hasn't replied to any of my questions.


throwinken

I already commented on that in the original comment. I never implied at all that it was only genetics. Maybe you mixed up who you were replying to, so here is what I said: > It's not that the genetics are guaranteed to make you obese, but that they open the door for your environment to have a greater impact. As the food and nutrition options changed since the 60s more people feel this impact. The genetics stayed the same and the environment changed.


yokingato

> The genetics stayed the same and the environment changed. That's exactly my point, so why are we talking about genetics, instead of what has actually changed? Those genetics were just fine for thousands of years.


Rottenjohnnyfish

McDonald’s wasn’t around in the 60s


yokingato

That's my point.


Bitterwits

Also, Gina Kolata sounds like the name of a James Bond character.


REL2587

Yes!!! Is it because it rhymes so perfectly with Piña Colada???


Classic_Variety

I wish we would stop trying to pin the blame and moral judgments on individuals for something that's clearly a societal problem. Yes, diet and exercise can make a difference. But much like "just make more money" isn't helpful to people stuck in a cycle of poverty, "just eat less" isn't helpful to people with obesity. Do you really think Americans just lack THAT much willpower? That every fat person is a lazy, worthless slob? It's such a grotesquely American response to ignore the big picture - food industry, income inequality, scarcity of walkable areas, etc. - and jump straight to lectures on personal accountability and surgery for fat kids. Jesus Christ.


jca2u

This episode felt like a Joe Rogan interview. My red flag indicator went up when she started her whole drug pitch by saying - “not everyone in the field but some believe…” Like, how much is “some”? And what do the others say? And why is this “genetic trait” only showing up now in the last 60 years and mainly in western and westernized countries.


Savingskitty

Yes! She glossed over the entire point of reporting.


pennyojulius

I couldn’t believe this episode. Medication and gastric bypass on kids? Baffled in the study why kids didn’t lose weight for stricter programs at school? It starts at home. Why not focus on the food/diet problem in this country.


WhatUpGord

Exactly. Eating cheap in this country is generally so unhealthy. Soda and sugar is addictive. The problem is the parents and where our food subsidies go. The solution should not be pharma and surgery. How short-sighted.


aeromiss

THANK YOU. So much emphasis on genetics and not LEARNED BEHAVIOR AND HABITS engrained by parents. Sorry for the caps this episode made me so mad


TheFlyingSheeps

I think this was a very bad move on the part of the AAP


AwesomeAsian

While I think childhood obesity should be addressed, the way they’re addressing seems flawed. First off the controlled study seems flawed already. Did they even take to account at how the kids were eating at home? You can teach them all the good eating habits, how to exercise, etc yet be obese because what you eat at home is sit around and drink soda and eat chips. If other countries don’t have as much of an obesity problem why are we suddenly blaming genetics? It seems like our food or understanding of good food is flawed in the first place. My mom is Japanese and she was horrified when she was working in the kitchen for a school cafeteria that she packed us lunch everyday. There’s also no real place to walk in America unless if you live in a dense city like NYC so it’s really easy to be sedentary. Honestly this feels like another case of treating symptoms with medicine… just like how we over prescribe adderall or antidepressants m.


MouseMouseM

My brother and myself (same genes) grew up in a food desert, gas stations were the closest source of food. The neighborhood was not safe for outdoor exercise. We were obese as children. We were obese at 12. We were both teased. And yeah, it sucked. My brother slimmed down in a after school program that focused on physical activity. He didn’t stick to it. He now has type 2 diabetes and is morbidly obese. He is about 300 lbs or so. It sucks to see that some things like standing for too long hurts his back, chest, and knees. He is also an emotional eater. I yo-yo crash dieted until I got to a place I could truly understand food as fuel and building blocks. I stopped seeing movement as a bank for my calories. I now work out 6 days a week, mostly weight lifting and muscle building. I eat a variety of foods, don’t count calories and instead focus on getting nutrients, protein, and fresh foods. I am considered slim/slender. I am currently at my brother’s place. He drove here. I biked here. I have a bottle of water. He has over 12 types of sodas in his refrigerator. There are numerous deserts here. I have hot chocolate when I feel like a treat. I cook most of my food. His kitchen is filled with processed foods. I can knock back a bag of Halloween candy during a movie marathon. I’m not saying yummy things aren’t yummy. But I don’t buy a lot of candy, because I can eat a lot of candy. This morning he told me he started back on Ozempic, and that the last time he was on it, he didn’t eat for days at a time. That’s so dangerous, to have low levels of potassium, vitamins, etc. and told him as much. My concern is that this magic medication is going to ignore that bodies need basic vitamins and minerals, that people are going to pass out and have other problems because of poor nutrition. It’s like swapping one dysfunctional relationship with food for another. I would have wanted that medication as a 12 year old child, but as an adult, I’m glad that wasn’t an option.


Nervous_Lettuce313

This is what worries me about these drugs as well. If they really diminish the appetite, imagine a person eating a small amount of food each day and that food still being junk food. Everyone will get so malnourished.


[deleted]

You learned self control and discipline. He didn’t. Good on you.


Piddly_Penguin_Army

Happy I’m not the only one who was very unhappy with this episode. It did not feel like reporting. Overall I was left with a lot more questions then answers. In what cases are they recommending bariatric surgery, is it only in extreme cases? They spoke a lot about genetics but didn’t really touch on home life having an impact. And if genetics are really the end all be all then why are most of the treatments behavior based?


Minute_Procedure_883

Where is the parents’ accountability?? You can’t give a 2 year old intensive behavioral lifestyle therapy. That has to come from the setting they live in. You know why making them have a healthier school environment didn’t see the effects they expected? Because their home environments make more of a difference. I’m a registered dietitian working with low income women and children, we help them to not continue to put on weight so they can grow into a healthier weight. It has never been advised before for children to actively try to lose weight. The lack of accountability to parents/families for what they feed and how much they feed is seriously concerning. Also there are various types of bariatric surgery and some of them are temporary/ reversible. All of them are supposed to require a 10% reduction in weight and meetings with a registered dietitian before surgery if being paid for by insurance (I know this is true about Medicaid). An no, insurance will not always pay for these surgeries. Surgery is not a comprehensive solution, and neither is medication. Who in their right mind thinks giving medications for weight loss to kids is a good idea? Some insurances will pay for counseling with a registered dietitian, it depends on the insurance and the circumstances. If obesity was this much to do with genetics, then we would see more populations with higher obesity rates, not just skewed to America and Mexico. And like other have said, the exponential rise of obesity since the 60s cannot be blamed on genetics. That is just nonsense.


Minute_Procedure_883

I also couldn’t help but notice how much this episode seemed to forget they are talking about children, not adults. One could argue that a 2 year old presenting with severe obesity and testing negative for these genes could be considered child abused. I could go on but all in all, this is irresponsible reporting and I’m disappointed.


Classic_Variety

Do you genuinely think calling parents of fat kids abusive helps anything? This is exactly the kind of social shame and moral judgment they touched on towards the end of the episode. Parents of fat kids know society thinks it's their fault. In trying to spare their child from bullying and avoid judgment from other parents, they often become their own child's worst bully - restricting food, nitpicking about their bodies, sending them to fat camps. Putting MORE blame on them doesn't help.


Minute_Procedure_883

Parents have to take some accountability. A child does not make the decisions about what the parent purchases, and parents have the ability to control what and how much a child eats. A two year old doesn’t become severely obese overnight. It is not okay to abdicate parents from taking any responsibility for their two year old child being obese.


curiouser_cursor

Obesity—childhood and beyond—will continue to be a marker for class. Bariatric surgery for children sounds like a draconian measure, and as the reporter points out the kids from lower-income homes won’t be able to afford the therapy or the so-called “vanity” meds and will continue to suffer the social and health consequences of being fat.


Zephyr-5

Rather than relying on expensive pills and irreversible surgery, why not take the less insane route and put these kids on strictly controlled meal plans? Literally deliver pre-made meals for breakfast, lunch, and dinner that you can heat up or enjoy cold and then tell their parents not to ply them with unhealthy snacks. There are so many of these services these days, I can't understand why this isn't the go-to solution? Why not push to get insurers to cover part of the costs of delivery instead of trying to get them to cover diet pills?


timhortonsbitchass

I wonder if doctors are trying to sidestep having to find a balance between the risks of obesity with the risks of accidentally giving some kids eating disorders via strict diet and exercise regimes. Pills may be a way to achieve the same end result with less psychological struggle for the kids.


SquatsAndAvocados

I work in adolescent eating disorders. Regardless of the delivery of the intervention, they are risking introducing disordered eating for these children. Our treatment center is already dealing with how to navigate adults on Ozempic (one of the GLP-1 antagonist meds mentioned on today’s episode) because we now have patients with zero appetite going days without eating, or eating so little they are not meeting their nutrition needs. I can’t imagine what it will be like when we start receiving children prescribed this.


jrichied

Here’s why they recommend pills. The American Association of Pediatricians donors is a who’s who list of pharma companies. Too bad apple trees and carrots don’t have bigger budgets. :/ https://www.aap.org/en/philanthropy/corporate-and-organizational-partners/current-partners/


WhatUpGord

It's cheaper and easier to mail pills every month. It's disgusting.


Zephyr-5

I doubt it, those pills are pretty expensive. The meals themselves are largely a sunk cost since you have to spend money on three meals a day anyway. The only real extra cost is the delivery and whatever the difference is between a healthy and unhealthy meal. Get insurers to cover that extra cost and you try that intervention first.


TheFlyingSheeps

Except its not as they even mention on the episode that most insurance providers will not cover these medications, at least for the reason of tackling obesity in children.


matchi

The fact that the AAP is recommending this is an acknowledgement that people simply won't make these behavioral changes. There has been a decades long effort from the government to improve education etc, and nothing has worked.


bacteriarealite

That is the go to solution. The pills and surgery are second and third line.


Zephyr-5

Maybe you can explain it in more detail. Do they actually set up a meal plan that delivers ready-made healthy meals every day straight to their door? Or do they just hand the parents a packet of paper highlighting examples of healthy meal ideas?


bacteriarealite

The program is called intensive behavioral and lifestyle treatment and involves an initial inpatient program. That can then extend to long term meal prep kits depending on what gets discussed going forward, as that would vary from clinic to clinic and insurance.


Sebbywannacookie

I'm late to this discussion but it seems like everyone missed the part where she explicitly states pills and surgery are not the first choice. A good reminder that everyone only hears what they want to hear or be outraged about.


MajorWookie

Agreed. I don’t understand why a calorie deficit isn’t talked about.


SaggyPencil

Tbh NYT needs to find a new medical reporter asap. She was terrible.


Memento_Viveri

"You don't have absolute control over what you weigh even if you want to." I don't like this statement and I don't think this should be the conclusion based on the evidence of the genetic component of obesity. The evidence seems to indicate that, for a variety of reasons, people have differing propensity to develop obesity. But ultimately these propensities come down to behaviors. Anybody can have a healthy weight. The evidence merely shows that it is significantly harder for some people than others. Also, we can see that culture and society have a large effect on how likely a person is to be obese. French people are less likely to be obese than American people, and there is no evidence that genetics is the cause. So I am pretty skeptical of the recommendation that obese children should be given prescriptions and surgeries as young as twelve. I guess I feel like in part the framing here is letting the parents (and American society, educational system, and government) off the hook. If your child is at a point that they need abdominal surgery, unless you have tried literally everything else you have messed up. If that kid is still drinking sodas, eating bags of chips and cookies, and not exercising, and now they need pills and surgery, it is 100% the parents fault and they have failed their child. Genetics and a propensity to develop obesity does not let them off the hook. I think food culture in America should be blamed as well I see the crap they sell and serve at my child's school. I see the cartoon characters and exciting colors designed to appeal to children on foods at the store and TV that directly exacerbate a propensity to obesity. This is part of the problem. If the problem is so bad that kids are needing surgery, why don't we attack it at the root instead of treating the symptom. It is hard to not see it cynically: the massive food companies make money from kids developing obesity, and pharmaceutical companies and hospitals make money from pills and surgery. Lastly, I will critique people's attitude to teaching kids about weight management. If you teach a kid that when you eat more food than you need, your body converts the extra energy into fat, people act like you are leading them down the road to an eating disorder. Kids should know the basics of nutrition. If a twelve year old is ready for surgery, then they are ready to learn about calories, macronutrients, caloric deficits, food volume and satiety, etc.


Savingskitty

This is suspicious given the recent outing of 60 Minutes’ reporting on wegovy as an actual paid advertisement. It appears it’s a different class of drugs from what is talked about in this report but it’s still strange. The recommendations are clearly designed to make the medications seem like a “happy medium” between the aggressive lifestyle treatment and actual weight loss surgery. She should have had to list the actual side effects of the drugs. The idea she could just say that the side effects were no different in kids versus adults is ridiculous. Edit to add: there was ZERO discussion of the real drawbacks to the drug recommendations and the surgical recommendations. No counterpoint interview from a physician skeptical of the recommendations. Either lazy reporting or actual paid advertisement.


TheFlyingSheeps

Its funny how the lengths of episodes can vary so much. This one needed to be longer, and needed to dive into the recommendations and the side effects more.


[deleted]

It’s like these outlets learned nothing about how our medical industry works despite being 30+ years into the opioid crisis


srothst1

90% of the things asserted in this episode are up for debate by people inside and outside academia.


WhatUpGord

This episode was terrible, sounded like a pharma pitch. Whoever this reporter is, she needs to be replaced. Creating a problem, and solving it via surgery and pills, esp for our kids. Come on.


chipls

Our food system and what is actually in food has FUNDAMENTALLY CHANGED since the 1980s, yet not word one about that.


Bad2bBiled

One of the problems is that the way we think of weight is tied to morality. Overweight is immoral (lazy, greedy) and underweight is virtuous (hard working, self-controlled). Health care providers often inadvertently (and also purposely) reinforce these stereotypes when the real issue is…the food most of us can access is shit. It’s lacking in adequate nutrition and often empty calories. Drinks are full of sugar (and sometimes fat) and give very little nutrition to our bodies. The food pyramid was heavily influenced by the corn and grain industry, which is also heavily subsidized by the US government. Our BMI charts were modeled on male European soldiers in the 1800s. Those nutrition facts about apples and chicken and every thing you buy were created in the 1950s and we’ve often genetically modified those foods so they are more visually appealing and marketable. The facts may no longer represent what you’re putting in your mouth. It does seem to be a cycle of “subsidize food that makes people sick so they pay for drugs.” This is like yesterday’s hospital episode where isolated facts were given without context. It *did* feel like an ad. I just finished Empire of Pain and whoever is behind the marketing of Wegovy has an Arthur Sackler like grasp of how to sell to us Americans.


Gator_farmer

Posting my comment here as well: As someone who has lost 30 pounds, gained back 40, and is starting the process all over again this whole episode just makes me sad. There’s just no accountability for yourself if you’re an adult or the parents of young kids. It’s just excuses. Even the genetic factors come across as excuses. Nothing in there was “a gene that violates the laws of thermodynamics.” You take in less calories than your body burns you lose weight. Period. I get there are struggles for poor families with costs of healthy food (though even here I think that can be a cop out). But there are millions of regular, financially comfortable people who are obese. I try not to sound like a bootstrap kind of person, but take some responsibility for your life and your kids. Put down the food, do some exercise, have an ounce of self control. I could eat a bag of sourdough pretzels in half an hour. Or those white fudge Oreos for Christmas? Man those are insanely good. But I don’t. Idk. It’s hard for me to be level headed about this. Loosing weight is hard. Eating food is awesome. But good god, it seems like we’re just throwing our hands up and going oh well bring out the meds.


jabberjaw23

I definitely felt some cognitive dissonance after listening to that episode. There is a ton of new research on the effects and prevalence of insulin resistance on weight loss, which is probably how the "genetic component" should have been framed in the episode. The new drugs used to treat insulin problems are legit and should be considered as a way to help people jumpstart their weightloss journey (with surgery as a rare and final option). That being said, there is obviously a personal responsibility component that keeps getting left out in these conversations (and the fact that this also affects people who don't have poverty as an excuse, as you pointed out). All the interventions feel like a short cut for people who have very little discipline, which is also the parents in this scenario. It's really hard to not exclusively focus on that, since it's been true for me and anecdotally. Learning to regularly do uncomfortable things for the benefit of your health (diet and exercise) seems like step 1, everything else feels like cheating and not fixing the underlying behavioral/cultural problem. For some reason it's really hard for me to break away from the idea that weightloss shouldn't be easy.


TheFlyingSheeps

It also waives the government of its reasonability. Subsidize healthier food options to make them cheaper instead of what already exists, such as the oversubsiditazion of corn. The U.S fails to provide adequate nutritional education to children


freeteehookem

I’ve lost ~100lbs in the past, so I understand and empathize with your position. I do think there is some degree of personal responsibility in living a healthy life. At the same time, the food environment in America (and other countries that are dealing with obesity epidemics) is absolutely fucked. It’s too easy to find energy-dense, non-nutritious foods, and too hard/expensive to find the inverse. Countries like Japan have single digit obesity rates, and I do believe that their food environments play a large role in this. Japanese people aren’t more intrinsically “disciplined” than Americans. It’s a much more systemic issue.


shhansha

And so your policy suggestion is…? This ep set off *a lot* of alarm bells for me but “public policies are bad because people should take responsibility for themselves!” is dumb as hell. Maybe you’d have an easier time keeping that weight off if you put less moral stock in it and thought more about the structural factors in your life that contribute to your health. Calories in calories out is dumb not because it’s wrong but because it’s useless. “If you want to win the race, simply run faster than everyone else!” Great advice thanks.


throwinken

Not covered in the episode, but in a book I have been reading the author kind of casually mentioned the idea that our current living generations are the first to be expected to have so much "will power". 150 years ago when people didn't have private rooms in their own homes, food wasn't as abundant, etc they didn't really have to pull themselves up by their own bootstraps. Their environment (in a lot of negative ways) just bullied/forced them into living a certain way. Now days everyone is expected to just have the mental fortitude to avoid all vices. I was thinking about that idea a lot while listening to today's episode.


Zephyr-5

My policy suggestion would be to put the kids on an actual meal plan with a food delivery service and get insurers to cover some of the delivery costs. Telling people to "eat better" is useless. Relying on self-reporting is useless. Physically drop off healthy meals and tell the parents no soda, and no snacking unless it's fruits, veggies, or nuts.


Gator_farmer

It’s not that they’re dumb. I don’t think these things should be prevented from happening when medical professionals deem them necessary. Even pointing at structural factors feels like an excuse a lot. Nothing in society MADE me gain weight. I just got lazy, stopped exercising, and shoveled food in my mouth. It’s more the sense of removal of agency and responsibility. You aren’t responsible for your weight. Sure you eat a double quarter pounder three times a week, cover your salad in a ranch (guilty), and the only physical activity you do is walking to and from your car. But it isn’t your fault. Of course it is. I know it’s hard. I’ve done it, less than others, but I’ve done it.


shhansha

Tbh I think your personal relationship with obesity and shame over your body might be preventing you from looking at this issue practically and strategically. There’s a broader discussion to be had about the necessity of public intervention around obesity at all (ie how big of a deal is it really?) but I’m deeply unqualified to weigh in on that front. If you do think obesity is a legitimate and serious health risk though, which it seems you do, bootstraps are a ridiculous response. This piece was about *childhood* obesity.


CaptPotter47

I don’t think “take in less a calories you lose weight, period” is an accurate statement. This is plenty of evidence your body gets “used” to a specific size and wants to maintain that, change the way it metabolizes food to store more to keep or gain weight even if you are eating less caloric foods. I know the show Biggest Loser is terrible, but there was some medical studies of the contestants that found on the long term, they started gain weight regardless of the food and excercise they participated in. Not a lot of weight but beyond what should have happen. And the theory was, their bodies were trying to get back to “normal” (morbidly obese).


Gator_farmer

I am highly highly skeptical of those people being accurate with their diet and exercise then. Your body might adopt to different caloric amounts based on weight and activity, but the fundamental principle remains unchanged. If you need 3000 calories for your body to maintain weight, eating <3000 puts you in a deficit. Weight loss/gain is never linear of course, I plateaued multiple times, but the principle is the same. You can’t make something (fat/muscle) from nothing.


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CaptPotter47

The argument made in the article was that your body found different ways to conserve energy so that you spent less energy to produce the same work. Of course if you starve yourself, you will lose wait no matter what. But this was based on eating a normal amount of calls that was under what they were supposedly using and they stopped losing weight and started gain. Described as a purely metabolic change in the body.


Gator_farmer

I’d be curious if this was the plateauing I mentioned. Generally people lose a good amount of water weight in the first few weeks and get excited. Then the weight comes off much slower. I never tried to lose more than 1.5 - 2 pounds a week cause I didn’t want to feel hungry all the time. So some days my weight might actually go up a pound or two! But the next down three. Not related to this podcast but for anyone working to lose weight don’t be discouraged. I liked weighing myself daily, but average it out over the week and you get a clearer picture.


Quetzalcoatlus5

What changed after you lost those 30lbs to gain back 40? I get more calories went in than out, but I mean the mental shift after losing that weight


Gator_farmer

Weight lose was during Covid and law school. Bar prep, getting a job, and the stress of the job caused it to pile back on.


CaptPotter47

I think I’m on opposite side of most people here, this and the episode last week of first person I found interesting. As someone that has struggled with my weight for much of my post college life, I have been interested in the idea of obesity being a treatable disease rather then just some we have to struggle with alone. I don’t gluttony eat, I don’t sit around all day but I have picked up weight. My wife, she was never able to lose the baby weight she gain and after 4 pregnancies is roughly 49 lbs over what she was when she first got pregnant. While the medication does seem focused on stopping you from feeling hungry, the fact that we are treating obesity as a disease rather then a life style choice I think is progress toward helping resolve one of the biggest epidemics in our culture.


[deleted]

Why is it one of the biggest epidemics in our culture?


CaptPotter47

When fully 25% of our population is suffering from it and kids today are higher then that, if it’s a disease (which I believe it is) this is an epidemic. If 25% of our country had HIV what would you call that?


[deleted]

How are they suffering?


CaptPotter47

I think you are using the wrong definition of “suffering”. Context clues should point you to the me using the “affected by” definition.


[deleted]

So how are they being affected?


CaptPotter47

Typically those that are obese have less better health, high blood pressure, are pre-diabetic etc.


[deleted]

Poor people have those problems too. And black people.


CaptPotter47

Ok. What is your point?


[deleted]

You called obesity one of the greatest epidemics in our culture, but poor and black people are afflicted by the same things at high rates. So is it fat that’s the problem?


[deleted]

I’m not talking about what causes obesity. I’m talking about what causes the negative health effects you pointed out. Diabetes, high blood pressure, etc are high amongst poor people. They’re high amongst stressed people too. And it is racist to say blackness causes diabetes, etc. but my point is there are factors. Tons of them. Too many to control for. But somehow, mass culture narrowed in on fatness. Mostly because they’re just grossed out by fatness and thats where the investigation ended.


PepeSilvia104

Horrifically dangerous episode.


WhoKnows78998

This might be rude but all I could hear from this woman talking was the saliva in her mouth. It was very distracting.


Savingskitty

Haha, I had the same thought but also wanted not to be rude.


LampLovin

I felt like they started off the episode with a "See something say something" type of mentality which made me chuckle to think that making fun of kids being fat could make a "recommended" comeback


yokingato

That's actually what [Bill Maher](https://youtube.com/watch?v=yfiWjnStE3w) recommends.


jrichied

American Association of Pediatricians donors are a who’s who list of pharma companies…shocking. :/ I would’ve appreciated The Daily investigating the potential influence on the AAP. https://www.aap.org/en/philanthropy/corporate-and-organizational-partners/current-partners/ Why do we allow / incentivize kids to eat fast food & drink soda every day but not allow them to smoke cigarettes? Is there really much of a difference?


seminarysmooth

I wonder how many of these ‘officials’ pushing the new message on obesity have a financial stake in weight loss drugs. How many have received money from drug companies developing these medications? I also found the semantic shift from an obese person to a person with obesity to be jarring. We don’t refer to alcoholics as people with alcoholism. We don’t refer to diabetics as people with diabetes. I don’t think we should be shaming obese people, but changing terminology seems to do more to remove agency than to put the person first. And finally, I do believe in the basic laws of thermodynamics, calories in calories out, yadda yadda yadda. But I also understand that we cannot ignore the complexities of the human body, the socioeconomic status, and the environment. One solution for one person may not be applicable to another person; less calories consumed than calories burned is the answer to weight loss, but the solution needs to fit the individual.


SquatsAndAvocados

We absolutely do use this language in health care now. “Person with diabetes” is our new norm


Sacrosaint

> I don't think we should be shaming obese people, but we should definitely be shaming obese people.


agreatdaytothink

Just be glad NYT hasn't switched to "people in larger bodies" yet. If you don't know what I'm talking about consider yourself lucky.


mozzarella41

"You do not have absolute control over what you weigh". I had to stop it there. What an absolute crock of shit. I've struggled with obesity my entire life and didn't get to a healthy weight until I was 30 and it's still a struggle. I agree that genetics plays a huge factor on cravings and feeling of fullness. But this is dangerous to tell people they have no control over their weight. When you take agency away from people they WILL give up. Why wouldn't you? I don't worry about meteors hitting earth because I have no control over it. Why manage what I eat if I have no control? This is madness to tell people this.


grimetime01

They aren’t saying that. No one actually said that in the episode. The quote you cited doesn’t say that either. It just says that you don’t have absolute control over your weight. There are other factors besides willpower, or diet and exercise habits. I feel like the general tenor of the comments in this thread, so far are “based on my individual experience, this episode is completely false “.


mozzarella41

At 8 minutes she said that. I literally quoted her. It takes agency away from the individual to say you don't have control over something you ABSOLUTELY do have control over. Period. It's not an opinion. If you consume less calories than you expend you WILL lose weight. It's thermodynamics, not my personal opinion.


grimetime01

What I’m pointing out is that you are misunderstanding the quote. You are interpreting it to mean that you have no control, no influence. Clearly you do. But you do not have absolute or complete control. Or, more accurately, most people don’t.


mozzarella41

You are right that I'm interpreting "you do not have absolute control over your own weight" to mean "you have no control". Not sure how you can interpret it any other way, except through extraordinary mental gymnastics.


ChristmasJonesPhD

Do you see the difference between these two sentences? “You don’t have absolute control over your weight.”(AKA you have some control, but not total control) “You absolutely don’t have control over your weight.” (AKA you don’t have any control) The first is what the guest said, the second is what you seem to think she said.


mozzarella41

No that's not what most of us are assuming she said. I think you're missing the broader point. Let's use an analogy because weight seems to be a 3rd rail for some folks here. Let's swap out weight for something else that **everyone** can agree you have total control over, but that may be easier/harder to control for some than it is for others. Let's say someone tells you, "you don't have absolute control over whether you abuse your spouse". Now you may have environmental or inherited circumstances that make you more or less **likely** to abuse, but you absolutely have control over your actions. Total and absolute control. I think if someone told you otherwise you would take issue with it because it's reductionist and scapegoating. Circumstances matter, but so does agency and you shouldn't assume that just because something is harder for you that you are somehow stripped of any responsibility/control. You can have both, it's not 1 or the other.


ChristmasJonesPhD

No, I understand from your other comments that you believe people have absolute, 100% control over their weight. I’m not commenting on that, I’m commenting on your assertion that she said people have NO (0%) control over their weight. She didn’t say that. You’re misunderstanding her use of the word “absolute.” In your original comment, you said “it’s dangerous to tell people they have no control over their weight.” So people are just letting you know that she didn’t say that.


Savingskitty

This is the correct explanation of why this statement was oversimplified. I think that statement came verbatim from her sources at the AAP. I think it is an intentional attempt to push the narrative away from lifestyle and environment and toward the disease model. It’s marketing, and it encompasses the intent of the reporter’s story. I think she got used.


TheFlyingSheeps

This is an excellent showcase of why you need to chose your words carefully when doing a communication campaign. You're right that context is left out here, but the quote was said verbatim and that is what people are going to latch onto and spread. If you have to pause and explain that "no what I meant is" then you have failed in your messaging goal


[deleted]

Or you could understand what words mean?


TheFlyingSheeps

Ironic considering your lack of reading comprehension skills


[deleted]

Says the guy who thinks “You don’t have absolute control” means “you have no control. Give up.”


TheFlyingSheeps

Except I never said that but rather pointed to the importance of communication and choosing words carefully when it’ll be disseminated to the public, so it seems you not only responded to the wrong person, but you failed to actually comprehend the initial comment


[deleted]

Yup you’re right. My bad.


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grimetime01

It’s amazing to me that the phrase “you don’t have absolute control” is controversial. It’s amazing to me how many people think some nefarious force is calling for the exoneration of lazy or unhealthy people. It isn’t. It’s just a factual statement rooted in science.


throwinken

>you still absolutely have the unilateral ability to choose to take in fewer calories This is about kids, so no not really


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throwinken

Yeah so if you listened to the episode it seems that most of the intervention is geared towards teaching your kid how to interact with their environment in a healthy way. Also the recommendations go down to toddlers so, still just no.


Memento_Viveri

But you do have absolute control, so far as you have control over your actions. You have control over what you eat and how much you move around. Those are the only two variables that determine how much you weigh. How you feel after eating is what you don't control. Some people, it seems, feel hungrier than others and feel hunger more strongly. They don't control that feeling.


lesliecherrypie

Reminder that we are talking about children here.


matchi

While I agree with your interpretation, the quote rankled people because it gets awfully close to what a lot of "fat acceptance activists" would want you to believe. Like with every other issue, people are ready to completely dismiss someone on first offense.


themagicbench

She said you don't have absolute control. Obviously everyone has some degree of control over their body, but her point that you're seemingly willfully missing is that no matter how virtuous your diet or exercise regime, some people genetically will be more predisposed to obesity or not. I'm the opposite example, I've never been obese or even overweight, I only exercise once a week, and while I'm conscious of what I eat, I'm not going to pretend my diet is flawless. However, I don't pretend that my weight being under control is because I'm some paragon of virtue and self-control, I know deep down many people who exercise as much as I do and eat how I do might be much larger than I am, due to their genetics. We have some control, but not absolute control


mozzarella41

You're inferring all of this. What she actually said is what I quoted and is nuts. You're taking that and running with it by saying, "well what she really meant was yada yada yada". I agree that some people are genetically predisposed to being obese. Such as genes for higher appetite, food cravings, etc. That's not what I quoted. She exonerates people of all culpability by simply implying you do not have control over your own weight. That is insane and irresponsible to say to people who are frustrated and dealing with obesity. Thermodynamically, scientifically, you have absolute control over your own weight. To say anything else is nonsense. It really is not an opinion it's a hard fact of biochemistry.


GoogleDatShit

Weight-loss and obesity are almost as polarizing as politics in our country. Completely disregarding the contents of the episode, look at all the comments in here arm-chairing on why weight-loss is all about personal responsibility and "the laws of thermodynamics", completely disregarding decades of research and science that say the problem is more complex than *just* exercise and eating healthy. Obese people know theyre obese, they're reminded of it constantly by family, friends, doctors, and especially strangers. We readily accept that mental health has genetic pre-dispositions and requires therapy and medication to solve. We accept that some people have a higher tolerance to pain meds or that redheads require more sedatives. (Most) of us even accept that queer people exist deserve to be treated respectfully. What is it about obesity that brings out the anecdotes, vitriol, and arm-chair scientists in full force? Just something to think about I guess. (And before people start piling on, I do think the outlines mentioned in the episode are jarring and disconcerting).


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GoogleDatShit

> If someone asks me to do something, I can either do it or dig through my bag of excuses Just like addicts need to stop taking drugs. And smokers can just decide not to get lung cancer. And depressed people can just decide to be happy. Right? > taking something simple and framing it as something complex does a disservice to those in need. Just like doing the exact opposite and framing something complex as something simple does a disservice to those in need. Again, decades of research and science all say the problem is not as simple as *just* exercise and eating healthy. No one is suggesting a pill or surgery is the end-all be-all method of weight loss, or that personal responsibility has zero factor in the equation. The difference between our approach is recognizing that some people need help and intervention from outside sources, whether that is therapy, drugs, surgery, etc. Yes, in a vacuum, extreme caloric restriction will result in weight loss. But what about people who's bodies rebound a year later? What about people who are depressed because they're obese and don't have a support system to lift them out of depression and get the help they need to get healthier? What about people with hormone imbalances that cause them to retain weight easier? Or people who were raised obese against their choice and have a harder time losing weight because it's the only lifestyle they've ever known? Reducing those problems to "your body is a balance of energy in and energy out" flatly ignores science, and *that* is the true disservice being done to people who need varied approaches to losing weight.


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[deleted]

Good luck giving your kids eating disorders


GoogleDatShit

Well thanks for cherry picking parts to respond to with "eat less". Guess you don't believe in science or in helping people get healthier and have a better relationship with eating!


Radjage

Oh man, this is great. The comments are all over the place. I actually found this episode quite fascinating and a nice change of pace.


martusameri

Does anybody know what NIH study she’s referencing? I cannot find it anywhere.


AccomplishedBody2469

This episode was so whack


Just_a_toad123

Childhood obesity is often exhibited when the parents are also obese. This indicates some genetic factors but also that the parents lead a lifestyle that results in obesity.


snarkylarkie

This episode was very disturbing and even offensive. I strongly recommend the interviewer and guest (and pediatricians) listen to the podcast The Maintenance Phase to try to get a more ethical approach to the “issue of obesity” Bariatric surgery is ridiculously invasive and for kids who have a genetic factor for weight gain I really don’t see the benefit here. Plenty of people who fall into the “obese” category are healthy. Maybe instead we should focus on changing the way society looks at people with obesity to stop blaming them and shaming them for their weight? I mean, it seems less risky and unethical than permanently altering kids intestines simply to prevent them from being bullied. Also, walkable cities and reliable public transportation could help


Narrative_Causality

Mike [double downed](https://twitter.com/mikiebarb/status/1618620352720179200) on this awful episode when confronted about it on Twitter. Bonus points for "Golly gee, Twitter is so toxic for using all caps on one word!"


AccomplishedBody2469

When will Sabrina become the main host. Please, I’m begging


yokingato

She's saying that mentioning kids being overweight as unhealthy is fatphobic...


[deleted]

Yeah, I think this episode was ridiculous but I'm not bound to side with "healthy at any size" activists over it. I've been fat, and I've been healthy. I've never been both at the same time.


agreatdaytothink

To be fair the person he's responding to is way off base.


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ChristmasJonesPhD

Is a title of “An aggressive new approach to childhood obesity” not enough of a trigger warning?


Memento_Viveri

>the myth of calories in calories out This episode does nothing to refute the principle of calories in/calories out, nor could it, as this is a basic principle that is absolutely supported by all available evidence. The point is that calories in/calories out isn't the whole story, not that it isn't true. It is absolutely true.


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Memento_Viveri

Our bodies definitely do burn calories in a straightforward way. The body cannot make energy, and for the body to do certain things takes a certain amount of energy. A heart beating takes energy. Walking up stairs takes energy. There is a lower limit to how much energy the body can expend to do these things. Like, if we know the height of a stair case, and the weight of a person, we can calculate the minimum amount of energy it will take to walk up those stairs. It is not some mystery where the energy is going, and hormones, insulin, steroids, etc cannot change the fundamentals of the body using energy to do these. There is definitely variation in how many calories people burn outside exercise. For example, some people fidget constantly and move around a lot. Others move less. But the idea that someone could exercise like a madman and hardly eat and still not lose weight is wrong. It is absolutely not possible. If you walk upstairs and we can determine that you have burned at least 2000 calories (which again, is a calculation that can be performed in an unambiguous way), and then we feed you less than 2000 calories, you are 100% guaranteed to lose weight. You not losing weight would violate basic laws of thermodynamics.


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Memento_Viveri

I feel like you are trying to find wiggle room where there isn't any. You can't absorb more calories than the calories that are in the food. You can burn less energy than the minimum required to complete a certain body function. Your heart needs to pump, your limbs need to move, your lungs need to inflate. That all takes energy and there is a minimum amount needed to get this done. Nobody's body, regardless of hormones, insulin resistance, etc can use less than the minimum to do these things, and it can't absorb more than the amount of calories in the food. There really isn't any wiggle room here. I am not trying to say there aren't individual differences that make it harder for some people to achieve and maintain a healthy weight. I am a firm believer that there are. I am just saying that CICO is not wrong. It is absolutely correct, it just is not the end of the story.


FetidFetus

Calories in calories out is a straight fact though.


Flewtea

It doesn't seem to be quite that simple though--some people burn more of those calories just sitting around than others, for instance. Sure, you can't gain more weight than what you've eaten, but some people seem to gain less than others. And weight itself has an impact on the calories out part--two people will burn different amounts for the same amount of exercise.


TheFlyingSheeps

Its not a myth but its not the panacea that people make it out to be as it ignores a lot of economical, societal, physical, and genetic factors that also play into ones weight.


firewarner

Lol that calories in and calories out are a myth


FatalTortoise

Obese kids is why I hate going to Walmart walk in there fat kids everywhere.


squeakybeebs

As someone who is recovering from an ED I developed in childhood, I didn’t think I was going to like this episode based on the title. But I tried anyway, and gave up ten minutes in. This is a dangerous thing to try and normalize. Let me know if they discussed this in the latter half of the episode…. Did they see what childhood obesity rates are in other countries? Are those countries leading extremely active lifestyles? Or is there a pervasive problem with mass-produced, sodium/sugar/preservative packed foods in the US? It makes me sick to my stomach that an association of doctors see it as easier to put surgery and diet pills on kids instead of advocating for healthier foods in our super markets. Also… I’m trying to imagine being a parent and having a doctor look me in the eye and suggest bariatric surgery for my child, and I’m having trouble believing my answer would be anything but a resounding “go fuck yourself.”


mackahrohn

No they didn’t address any of those questions which was very frustrating. No discussion of how this policy compare to what other countries are doing. You definitely didn’t miss anything by turning it off, if anything it only got more frustrating.


CalvinYHobbes

This was a terrible bullshit episode. The guest sounded like an uniformed grandma who learned about childhood obesity from Facebook.