I think it rubs plenty of laymen the wrong way to not make it a bit more explicitly known.

The world could use a bit less nuance in our headlines these days.

It's easy to say "just diet ez" and it's hard to "just diet".

If you can administer a treatment as a simple one and done thing, that's alright. If it's a pill you got to take every day, that's pretty bad. More than once a day? Horrible. Why? Because a lot of patients just don't have it in them to take a pill 3 times a day consistently.

If it's purely an "exercise willpower" thing or a "change your lifestyle" thing? You might as well give up.

The medical establishment wants to do things that work. Telling people "go diet" doesn't work. Semaglutide, evidently, does.

You say force a diet change on a patient. OP certainly meant forcing a diet change in the input of American factories. Sugar can be found in fruits. That's the right place. If you need some, use fruits, maybe alcohol. Everything else can be slashed. No sugar in prepared meals anymore. No sugar in pasta anymore. And most of all, no sugar in water. Sugar input makes more damage than cocaine today.

We can call it the Prohibition II. There will be underground bars with sick people binging on sugar. We can change the shape of sugar to prevent restaurants from adding it to food. We can make it bitter. Absolutely need sugar? Eat that lemon-tasting block. We can call it The War On Sugar.

The medical establishment that I have familiarity with (in the US) pretty much only ever treats symptoms, not causes.

Don't believe me? Next time you go to see your primary care physician, ask them what you should be doing to lower your risk of whatever malady tends to run in your family. (Diabetes, cancer, dementia, etc.) They're going to stare at you in blank confusion for a few seconds before making some vague suggestion about a better diet and more exercise. Guaranteed.

The reasons are many, and detailed enough to write MANY books about, but the low hanging fruit is: we don't have a culture of monitoring and improving our own individual health, physicians are trained almost exclusively to solve problems not prevent them, modern nutrition science is a joke, omnipresent health insurance distorts incentives for everyone, doctors are too overworked to get to know their patients, private equity has captured a large chunk of health care, drugs are positioned as the first line of treatment for almost everything, etc.

There was a fringe that said being overweight was not unhealthy, but the more salient points were the following:

1. BMI was basically just pulled out of a hat, and it turns out that for many health concerns, the overweight class does better than the normal weight class, with the actual “clearly worse” outcomes really coming up as you trend into obesity.

2. Environmental and genetic factors are huge contributors to people being overweight. To some degree moralizing about weight loss is a bit like telling kids with asthma they should live in places with less pollution. Or telling someone with breast cancer to not have the BRCA gene.

3. Doctors would regularly miss health problems because they’d blame them on people being overweight / not exercising enough. Especially for difficult to diagnose issues, it’s easy to just point at the number you have that “looks bad”.

4. We still have no firm reason why people are gaining weight. The popular answer is sugar and processed foods but those very much already existed at scale in the 50s.

The tragedy is that it turned into a morality play where fat people were blamed for it, despite in many ways being as genetic as getting breast cancer.

The reality is people who actually study obesity know that basically GLP-1s are the only health intervention other than bariatric surgery that consistently works. At a population level no intervention has reversed fattening anywhere in the world.

> Everyone knows that eating high sugar diets and being overweight is unhealthy.

There is a lack of evidence that the public understands what healthy and healthy effectively mean to their day to day lives,

aside from “looking better”.

> Fructose can cause fatty liver

It is also a large contributor to rising triglycerides levels and uric acid due to the way it is metabolized. Which in turn contributes to high blood pressure. It also makes Acetyl-CoA, which stimulates lipogenesis.

It is not even true that it is 'blood sugar invisible'. 30-50% of the fructose is converted in glucose and that's visible. The rest won't be available until you start burning fat.

> Yeah, a lot of people have bad diets, but infinitely more pressing is sedentary lifestyles.

No, that's only part of it. And a small part at that. The world didn't suddenly decide to get less active all of a sudden. You can blame some of the sedentary behaviors on societal changes (like suburbs and car dependency in the US), but other countries are getting just as unhealthy, metabolically speaking, and fat.

> The biological reality is that eating a big bowl of frosted flakes is perfectly fine if you follow it up with high amounts of activity.

It has to be really high. We are talking about hours to burn up that bowl of frosted flakes. Spend an hour at a treadmill, calculate the calories you spent. Now check the nearest cereal bar nutritional information. You'll be in for a surprise. You cannot outrun a bad diet.

Diet is most of what needs to be controlled for metabolic health. Resistance training will build muscles, and they are a good buffer since they will eat simple carbs even when you are inactive. Add cardio for cardiovascular health. But, unless you are an athlete or you are active the whole day, you should go easy on the frosted flakes.

They've been used for over 20 years but until they became a weight loss drug recently, almost all of the research was on diabetics which introduces two confounding factors: diabetes and the diets diabetics already have to follow to manage the disease. It's hard to draw any conclusions when the results are muddied by those two factors.

IIRC, mostly used to help with type 2 diabetes... But effects on that cohort may not generalize to the general population.