This is work in progress, though. 3rd generation medications are already way more efficient than 1st gen. Saxenda ever was. A further increase in efficiency is likely.
"And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food."
That sounds very judgmental of you, like if they were skipping school. Bad truants!
What about "found the necessary changes too hard/complicated to sustain"? That is closer to reality. People juggle all sorts of obligations, some are doing multiple jobs, commuting 90 minutes each way etc. - they may be just too fatigued to exercise regularly and cook healthy meals at home.
There are 110,000,000 overweight people in the USA and another 110,000,000 obese people. Is it really closer to reality that everyone is a two-jobs no time for exercise, or is it more that Starbucks Mocha Frappuccino has 500 Calories and Starbucks has 15,800 stores in the USA and $36Bn annual revenue? And McDonalds, KFC, and all the rest. Is it closer to reality that people are snacking on some snack food on the couch out of habit and not paying attention to how many calories that is in a week, because it's just habit and gone in seconds? Is it closer to reality that Uber Eats and Door Dash and Domino's advertise to manipulate you into believing that you don't have time to cook at home and they are a good option? Is it closer to reality that there are food deserts with only junk easily available?
> "That sounds very judgmental of you, like if they were skipping school. Bad truants!"
It is judgemental of me, like if you want to pass your exams but skip studying, that would be bad. If you aren't exercising and are eating terribly and are obese, this lets you silence the alarm bells while saying "I don't have time to exercise". That doesn't seem as good as eating better and changing your life to include movement.