What is it about GLP1s that bring out the kooks who suddenly think diet and exercise are the only valid medical treatment? Is it a moral issue?
Yes, it's a moral issue.
What you need to understand is there are a lot of people where all they have is being skinny and appearing to be healthy. Without that, there's nothing left for them.
For a long time, there has been a moat that they can use as a justification for why they're better. They can say "well I work hard, I eat right, I put in effort!" The idea that others can achieve that without any of that means... well, they did it all for nothing. In their heads.
The dirty little secret? Many of them don't do any of that, it's just a delusion. Always has been. I'm skinny, you think I go to the gym? Fuck no! I should, but I don't. And I eat whatever I want.
But if a lot of people have to face the reality that their most redeeming quality is nothing of their doing, that would ruin them. Ruin them. They could just, like, get achievements or something but that's hard. Continuing the delusion is easy.
Unless we're talking about emergency care, most pharmaceuticals are completely unnecessary and carry serious risks.
There's not a single qualified doctor out there that would promote drugs before preventative measures.
As best as I can tell, people are very attached to having achieved their body weight through whatever means they have determined are valid and derive self value from it, and believe that GLP-1s are cheating to achieve a result they worked harder for.