I've told this story before, but I'll tell it again.

I spent the first ~20 years of my life being right on the border of under-weight though no specific actions of my own. Yes I was more active as a youth but to put into context how much food I was eating at the time, I could also eat breakfast, lunch, 3 bowls of afternoon cereal and milk, and then 2 super sized meals from a fast food place. In fact, I did that (or the equivalent) on a relatively regular basis. And the important thing is I NEVER felt consistently full when doing all of that. I was always ready to eat more food. Yes, any individual meal I would hit a point of being physically unable to eat more, but an hour later and I was ready for more.

I then spent the next ~20 years gaining weight and sliding into obesity. Yes I was less active, but I also wasn't eating quite as much food (when you have to buy your own, you stop eating a half a box of cereal a day). I did CICO counting, even had some success with it but could never get it to stick longer than about 3 or 4 months, and was miserably hungry the whole time. It was a daily battle to choose to not eat more for any given meal. I did various attempts at exercise, but mostly that just made me so much hungrier that any calories lost via exercise were quickly replaced by calories gained through eating more.

6 months ago I started a medication for a completely unrelated issue, but one of that medication's side effects is a reduced appetite. For the first time in 20 years, I am actively losing weight and what is enabling that is I'm NOT hungry all the time. When I started this medication and that side effect kicked in, I thought I was sick for the first week because of how not hungry I was. It was only after realizing that I still actually got hungry around meal times, but then was properly satiated by a reasonable amount of food that I realized I've never not been hungry since I was a teenager.

Yes, in the end I'm eating less, CICO and all of that. But the key to this is that I'm not feeling that nagging pull all day every day to eat something more. When 10 AM rolls around and I feel a little hungry, I can look at the time, realize I'll be having lunch in 2 hours and then ... just decide to not go get some food and my mind will go find something else to do. Before this medication, from 10 AM to lunch I would be watching the clock and every 10-15 minutes have to have an internal debate over going to get food. It's probably the closest I've ever gotten to being addicted to something and let me tell you, if you have to fight your own body every single hour of every single day you WILL lose eventually, every single time, forever.

For 6 continuous months I've steadily lost weight. Even through the holidays with all the extra sweets and big meals that almost always meant the end of whatever successes I'd had before, I managed to keep a consistent weight level instead of gaining. It is VASTLY easier to manage your weight when your body is responding to normal levels of food the way we expect a normal body to do so. Before this medicine, I would have told you I was just lazy. That I wasn't putting in enough effort and self control and that I was "making a choice" to be where I was. And to whatever extent that is true, the thing I can also say now is I was "choosing" to keep eating under effectively a threat of constant hunger from my body.

We spend way too much time moralizing about obesity and worrying about other people's self control in a way that is exceedingly out of touch with the reality of the world we live in and the health impacts of the condition. Yes, these medications might mean a lifelong treatment, yes you would need to maintain the new behaviors if you went off the medication or your weight would return. Yes it is possible to do this without medication. And so what? Imagine any other condition that had the same primary and secondary health impacts as being obese does, and then imagine we had a pill that could help someone mitigate that condition, or we could moralize about their poor self control and choices in life and encourage them to instead deal with their condition "naturally". You can deal with diabetes "naturally". You can deal with asthma "naturally". You can deal with gout "naturally". You can deal with poor eyesight "naturally". You can deal with hearing loss "naturally". You can deal with the flu, a cold or COVID-19 "naturally". You can also get many multitudes of modern medical advances to treat any of these, some of which are lifelong continuous treatments, and everyone who can and wants to absolutely should get those treatments because while you can deal with any of these things "naturally", your quality of life and your chances of positive health outcomes are VASTLY improved by the treatments.

It's time we stopped treating obesity as some special class of condition where the only appropriate choice is the "natural" one that the moral scolds provide. Maybe we shouldn't have gotten here in the first place, but now that we are, I'm starting to view people opposed to these treatment options the same way I view fundamentalist religious people who are opposed to various medical drug and addiction treatments for similar moralizing reasons.