What Obesity Drugs and Antidepressants have in common

[Anonymous]

Good column from health researcher, Indiana University health officer, and occasional New York Times essayist, Aaron Carroll:
https://www.nytimes.com/2023/09/09/opinion/weight-loss-antidepressants-stigma.html?smtyp=cur&smid=tw-nytopinion

He notes his own personal experience with and initial reluctance to use antidepressants or weight loss drugs in part due to the unknowns surrounding their efficacy and in part due to the moral stigma around both mental health problems and weight. In the past, he'd been able to maintain his mental health through counseling and his weight through portion control and exercise. However, his control over both was imperfect and a lot of work.

Because I didn’t know the exact mechanism that caused my anxiety to be uncontrollable (and no one else did either), it seemed as if I must be cheating to use a drug that greatly helped my situation. It felt like a crutch or a shortcut. Especially because, even as a doctor, I can’t explain why the medication works for me or anyone else.

I’ve recently faced a similar scenario with new drugs for obesity. I’ve struggled with my weight for most of my life. I’ve always been overweight, and in the last few years, I’ve slipped into obesity, according to my body mass index. I exercise regularly and carry the weight well, but it bothers me immensely. It especially troubles me because I have a fair amount of self-discipline and eat quite healthfully.
...
Despite all the advances in science, we don’t know why some people, even when they try desperately, can’t seem to lose weight. Because of that, we often assume it must be a lack of willpower. I begged my father, who was also a physician, to lose weight, and he never could. In the back of my mind, I, like many others, blamed him for his failures and considered it a lack of resolve.

I blamed myself, too. I became so disheartened at my inability to affect my weight that it harmed my mental health. I felt like a failure, which led to self-hatred and anger.

We would be well-served to stop regarding these things as morality plays where good people are mentally healthy and fit and only the lazy, undisciplined, and gluttonous are mentally or physically unfit.

[Anonymous]

I don't think there is anything morally wrong with anti-depressants (which I've used) or obesity drugs. But I also think that skepticism about long term impacts of both is warranted, and I get tired of drugs being talked about like miracle cures when we don't have long term studies on them, and when sometimes the downsides or limitations emerge later and get ignored.

I say that as someone who really needed anti-depressants and am glad I got them, but will also do almost anything to avoid having to go on them again because far from the wonder drug they get marketed as, they caused almost as many problems for me as they solved. And I'd also recommend to others that if it's possible to address mental health in other ways (not just therapy -- I've found mindfulness training, float tanks, and EMDR to be useful), I might try those first because that stuff carries fewer side effects than the drugs. I've never considered taking weight loss drugs but I think my attitude would be the same -- great if it's the only thing that works, but still a drug and therefore not perfect and not for everyone, so let's keep talking about other ways to address these problems.

Drugs are morally neutral, but they are not the solution to every problem, either.

[Anonymous]

Anonymous wrote:I don't think there is anything morally wrong with anti-depressants (which I've used) or obesity drugs. But I also think that skepticism about long term impacts of both is warranted, and I get tired of drugs being talked about like miracle cures when we don't have long term studies on them, and when sometimes the downsides or limitations emerge later and get ignored.

I say that as someone who really needed anti-depressants and am glad I got them, but will also do almost anything to avoid having to go on them again because far from the wonder drug they get marketed as, they caused almost as many problems for me as they solved. And I'd also recommend to others that if it's possible to address mental health in other ways (not just therapy -- I've found mindfulness training, float tanks, and EMDR to be useful), I might try those first because that stuff carries fewer side effects than the drugs. I've never considered taking weight loss drugs but I think my attitude would be the same -- great if it's the only thing that works, but still a drug and therefore not perfect and not for everyone, so let's keep talking about other ways to address these problems.

Drugs are morally neutral, but they are not the solution to every problem, either.

That's fair enough. I grew up in a family that taught me that allowing depression or mental health problems of that type to get in the way simply reflected a lack of grit. And being fat simply reflected a lack of self-control. In my personal life, I've been lucky enough to be mentally pretty resilient and not subject to too many highs or lows. My weight has been pretty constant regardless of how much or little I eat or exercise. So, it's taken me a while to shake some of those attitudes I was raised with. But I've seen people battling depression that was utterly beyond any individual's control. And I've seen my wife restrict calories while marathon training and still gain weight.

Better living through chemistry is possible!