This is the essence of the moral argument: Someone chooses to abuse a substance, they become a more frequent abuser, and the abuse piles up damage, which the person ignores to continue abusing.

The essence of the argument against drug interventions is that the root cause is personal choice, and therefore a drug is a shortcut or crutch and does not address the root cause.

Many people feel that the real cause is the structural changes to the person's brain, body, and daily routine that reinforce, and are reinforced by the initial tiny over-consumption, which compounds over time. It's like a debt where you are stuck paying interest, no matter how much you'd like to pay off the debt. Addiction is a system in which the person's willpower goes against everything they have set up over decades. It's unreasonably challenging for nearly everyone to walk it all back. Insulin resistance is one of the most pernicious effects of even small over-eating over time. The body and mind do not feel satiated even though enough calories have been consumed. It's not "I would enjoy another slice of pizza", it can be "I am still starving".

And yes, the environment in which we live, where it is less stigmatized to overeat, and food is treated a certain way, more like a drug than fuel, is part of that system.

> How can it be argued that the cause is anything other than behavior when so many others are doing just fine?

Aren’t you are ignoring the way western society influences behavior? eg lack of walkability of suburbs, massive price difference between fresh and processed foods, constant advertising of junk food & alcohol.

> Concerns aside, it's a little hard of an argument to swallow having visited many other countries where these things are simply not an issue.

Which countries? As far as I know, most Western countries have roughly similar issues with obesity, at least directionally.

It seems the article is now behind a paywall (can only get a reddit link w/ a screenshot atm [0]) but there was a study that showed body composition after 25% weight loss in terms of fat mass and fat-free mass (and the portion of fat-free mass that was skeletal muscle mass) after traditional several interventions, and also compared the breakdown of weight lost in terms of FM and FFM for several GLP-1 medications:

- diet alone

- diet + extra protein

- diet + exercise

- retatrutide

- tirzepatide

- semaglutide

tldr is that, despite some muscle loss, muscle as a percentage of body composition is higher (~50% FFM at start, whereas weight lost with GLP-1 meds ranged from 25%-39% of muscle). It also seems like the muscles will likely function better with less insulin resistance:

> Intentional weight loss causes a greater relative decrease in body fat than FFM or SMM, so the ratio of FFM/SMM to fat mass increases. Accordingly, physical function and mobility improve after weight loss despite the decrease in FFM/SMM, even in older adults with decreased FFM and SMM at baseline. In addition, weight loss improves the “quality” of remaining muscle by decreasing intramyocellular and intermuscular triglycerides and increasing muscle insulin sensitivity

https://www.reddit.com/r/tirzepatidecompound/comments/1dtzr2...

Are you saying that us fatties should move to those other countries where our “behavior” will be kept in check?

I think some of the observed muscle loss might be just burning the fat tissue embedded inside muscles (marbling).

The “more to this story” is likely endocrine disruptors in addition to (and associated with) the other “behavior” issues you’re alluding to.

And our answer to it is… another endocrine disruptor. But this time we’ll call it something else (GLP-1 agonists) and laugh all the way to the bank.