> The immediacy of the danger makes things incomparable.

Being obese is an immediate danger. It is an increase in risk for all cause mortality. Being obese today is making you more likely to develop cancer. It's making your more vulnerable to hear attack or stroke. It is one of the highest comorbidities with covid and plenty of other diseases.

It also is taking decades off your lifespan in the long term, of course. Some of that can be reversed by reversing your obesity, but for some the damage is cumulative over time. Maybe we'll get gene therapy or some other advanced medicine and be able to fully reverse, but maybe not.

> It's not "too good to be true". It's "no free lunch" (unfortunate pun), or "conservation of energy":

No free lunch is another aphorism. Conservation of energy is largely true, though some quantum effects, dark energy, etc. mean it might not be on the largest and smallest scales, but at a human size reference frame, is. But... no one is suggesting any physics boggling mechanism of action for these GLP-1 meds. We spend energy manufacturing a chemical that agonizes receptors that have the effects we're looking for.

> the more one wins without apparent loss, the more one should be suspicious.

There's fairly significant economic loss right now, but I know that's not the point you're going for. But iodine in salt has been basically 100% positive. Well studied over decades, it's one of the largest public health wins in human history. Caffeine, consumed in reasonable quantities, is basically universally a health win. You can have contraindications, certainly, but those also exists for GLP-1s - no one suggests they don't. But for the vast majority of people, ingesting caffeine is basically all health benefits - even if we remove the energy/wakefulness portion, we have mountains of research on how moderate amounts of caffeine a day reduce all of the major CVD outcomes, etc. We've been using caffeine for thousands of years - should I be suspicious of another shoe dropping?

> There are furthermore great reasons to be highly skeptical of pharmaceutical compagnies: consider the ongoing opioid crisis in the US, in great part caused by the sale of opioid-based medication (OxyContin) whose addictiveness was purposefully d

To be clear, I'm not a fan of big pharma - despite being generally incredibly pro-capitalism, public health is one of those areas where I think a government that serves the people should be stepping in and handling things. The power imbalance is too high for the market to be free, and profit motives generally lie in treatment vs. cures. If I could wave a magic wand, we'd have socialized medicine and pharma research would be funded by people where the motive is curing disease first and foremost.

But that doesn't mean that I'm going to shun modern medical science. And yeah, stuff like OxyContin is horrific. But for every oxycontin there's a hundred drugs that weren't handled nearly as recklessly.

> Yes, and the people suffering from eating disorders are often psychologically weakened as a result (and/or cause), thus vulnerable to further abuse. Of course such people want to hear about a miracle way to solve this pesky, long-standing issue, of course.

I mean, what's the alternative here? We should just... not use a drug that is succeeding in getting people out of obesity and being overweight? Because something might maybe happen later that will be bad?

We know obesity is one of the absolute worst things you can do to your health. It is 100% an immediate and clear danger to the health of every obese person. I'm not going to say they have to take a GLP-1 drug - that's their own choice. But we know the overwhelming majority of obese people do not succeed in getting the weight off to begin with, much less keep it off, despite being "prescribed" diet and exercise. So what's your proposed solution? Have hundreds of millions of people stay fat for a couple of decades while we wait and see if there might be long term risks that are worse than what is already one of the single most significant risks factors to health and longevity?

I do not believe that is a rational take.