Gobsmacked, flabbergasted
We should take inventory of the brave new world of incretins and the impact that this alternative universe has on the seven storey mountain of fat science.
For those of you who are not paying attention, the incretins are hormones made by the intestines that do many things many of which are still not clarified. But astoundingly, the incretins and the man-made versions of the incretins also talk to the brain and cause you to stop eating and lose about a quarter of you weight. That is to say, these hormones work about as well as gastric bypass surgery for weight loss. (1)
The lessons we should learn from this breakthrough treatment of obesity are lessons we should have already learned about fat science but didn't. Maybe we still can't learn because the massive lucrative infrastructure of our stupidity is still too entrenched. It's kind of like the internal combustion engine. We don't drive steam engine cars or electric cars because of a freakish accident of history. But now what are we going to do with all those gas stations and all that engineering expertise and industry dedicated to the internal combustion engine?
We still see too many expensive ads on TV for dumb new weight loss schemes. That can only mean that there is still a lot of money to be made.
When can we stop talking about the psychology of obesity? When can we stop blaming the veterans of obesity for being lazy and gluttonous? Dr. Abert Stunkard taught us long ago that excessively round people do not have any culture or psychiatric diagnosis that is different from skinny people except insofar as they have to deal with the disdain and prejudice that is constantly raining down on their heads.
When can we stop talking about dietary fats and sugars and proteins? Well, maybe we are getting fatter because we eat too much protein. (2) But that doesn't seem to have anything to do with mechanism of action of semaglutide, currently the most famous incretin medication.
When can we stop saying that it's the fast food or the highly processed food or the food industry or the government or a vast communist conspiracy? - Ok maybe not a vast communist conspiracy.
One part of the prevailing wisdom of fat science is that obesity is too complicated. It is caused by redundantly powerful mechanisms and it is impossible to beat with any one or any ten kinds of treatment. In 1994 leptin was discovered. A lack of this single hormone was the cause of extreme obesity in experimental mice and in one in a million extremely obese people and just replacing it cured the obesity quick and easy. That didn't work in all the other people with obesity and it didn't help people without leptin deficiency to give them big doses of leptin. But this discovery of leptin was a harbinger that maybe there could be a quick and easy fix that did not involve excruciating exercise and severe relentless hunger pain.
There is an ancient tradition in the practice of medicine whereby whatever we are doing today is going to look pretty quaint and silly in 10 years, or maybe even 5 years. Right now I am sitting in my office bunkered down behind a mountain range of books and papers devoted to fat science and collected over 40 years. "So here I sit with all my lore, poor fool no wiser than before."
1. https://johnditragliamd.substack.com/p/gastric-bypass-in-a-pill
2. https://johnditragliamd.substack.com/p/protein-problem
3. https://johnditragliamd.substack.com/p/the-leptin-story