[TIME] The Land That Doesn't Need Ozempic

I thought this was the most intriguing bit;

“So I was surprised to learn that most of Japan’s food culture was invented very recently—in living memory, in fact. Barak Kushner, who is professor of East Asian History at the University of Cambridge, told the writer Bee Wilson, for her book First Bite , that until the 1920s, Japanese cooking was just “not very good.” Fresh fish was eaten only once a week, the diet was dangerously low in protein, and stewing or stir-frying were not much of a thing. Life expectancy was a mere 43.”

Now I’m left wondering it it “worked”.

Granted there is less “obesity”, however that is defined for this article ( according to the linked article I linked "…China and Japan define overweight as a BMI of 24 or higher and obesity a BMI of 28 or higher; in India, overweight is defined as a BMI of 23 or higher, and obesity, a BMI of 27 or higher), and some of the longest living people live there, but I feel like I still need to figure out if most folks, and especially soldiers, live longer, healthier ( and happier?) lives.

Maybe Type 1 people?

No, these are type 2 diabetics.

They are still producing insulin, but they’re just insulin resistant.

The diabetics I know are definitely not slim.

I know many skinny diabetics

Not sure what made you take it as a “lecture”

Your comment was about the prevalence of diabetes in Japan and the related need for Ozempic

The article is almost entirely about obesity and the author’s conjectures on why there is so much less obesity in Japan than in the US, not about diabetes in the two countries

The only reason to use Ozempic in the title and not Wegovy is it’s more effective clickbait

Without spending a lot more time on something that has already occupied more time than it warranted, they mention the sugary drinks tax in Mexico and ban from schools in Amsterdam. Would not have taken much effort to use the NYC example instead or in addition, and why it ultimately failed.

That’s also a generalization. Perhaps portion-sizes are experiencing an Americanization the world over, but I’ve had PLENTY of meals in Germany - at German or Italian restaurants, where the main dish is comically large. And traditional Wirtshäuser and their Schlachtplatten have always been more than generous, long before doggie bags were even a thing.


I grew up in Europe as well, and therefore (? :rofl: correlation? causation?) am also a YUGE fan of science.

Fatness is neither the sole nor a reliable indicator of any person’s health. I don’t know ‘many skinny folks with diabetes,’ but I know a meditating, dry vegan* who’s never smoked & who has diabetes along with several other health issues, high cholesterol, high blood pressure, heart problems, etc. - presumably shitty genetics, none of which any of us can do much about besides trying hard to combat or work with what we were given.

I also have a friend roughly my age who, for some reason or another, has started sliding into anorectic disordered eating, and certainly not due to any weight or health issues. Now there’s a far more dangerous illness to talk about.

Lastly, I figured eventually insurance premiums would be mentioned, since we live in a society where we have decided to carry the weight for those less fortunate than us - SWIDT? - by contributing our share, and AFAIK, smokers already pay a higher premium for health insurance (do correct me if I’m wrong - I’m confident someone will).

*Since the OG article was "just an anecdotal collection of nonsense I mean evidence, I thought I could contribute one of my own :wink:


Some of the skinniest people I know have also had elevated cholestorol (necessiting medication and monitoring) and others I have known with heart disease.

It’s exhausting how many people decide they can diagnose with a mere glance at body-type. (It also reminds me of a time when I was very heavy and experiencing health issues. I sppoke to my doctor, who said “yes, you have health issues, but nothing weight-related”.) Meanwhile, those concern trolling me at the time had little interest in providing support I needed, but instead kept merely suggesting I lose weight to manage X and Y risk. When I gave them my numbers-- all putting me in a place of no risk at all for X and Y-- they suddenly lost all interest.)

I eventually lost weight intentionally, but more so I could finally get diagnoses, which I did. How interesting, though, that so many interested in my health vis a vis my weight in fact had no interest. It was my body size, not my actual conditions that have been the subject of these ostensibly well-meaning gazes. And it’s hardly surprising: It’s much easier to find fault with someone than reflect on the systemic barriers to participation faced by disabled and chronically ill people.

Meanwhile, those with smaller bodies benefit from social approval but also slip past crucial diagnoses (because only fat people, and people who eat X are at risk for heart disease, diabetes, etc.). Don’t even get me started on the fat people with anorexia who go untreated because people assume that no one can be starving themselves and still be fat.

Seriously, fat is a health issue only as far as anti-fat bias is. And usually as an instrument for austerity (as well as racism). I can list my sources, but why? No one will read or is necessary able to access them because of academic paywalls.

I should really not engage, but this topic just gets me riled.


Btw it’s an excerpt from the author’s new book, not an article

Adapted from MAGIC PILL: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs by Johann Hari. Copyright © 2024 by Johann Hari.

So you are saying there is no scientific correlation between obesity and elevated risk factors for diabetes, CVD and overall life expectancy. I would be interested to see your papers as there are plenty of papers pointing towards these correlations

Type 1 & Type 2 have to be viewed completely differently, but very often get conflated in these types of discussions. That’s also where your comment about whether diabetics are thin or not relates – many of the T1 diabetics I know are thin, many of the T2 are not. T2 used to be called “adult onset” until so many children started getting diagnosed with it.

For Type 1, there’s genetics (including insulin production and resistance, and fat ratios and locations) first. For Type 2, behavioral and environmental factors.

You mentioned rice and other carbs as a possible cause. Given your familiarity with Indian food, you know that South India is a heavy rice consumer. However much of the rice eaten there is par-boiled. Much other carb consumption is after fermentation (idlis, dosa, etc).

Science is only recently catching up with how those things impact insulin response — for eg par-boiling converts some of the starch to resistant starch, which dampens insulin response. (See this other thread about sequencing, combinations, etc as well.)

Causality is very complicated, and often not what it appears on the surface.


You might be interested to look up some of the work by the endocrine / weight management / metabolism experts I mentioned on the other thread.

There is a growing body of research over the past several decades as to obesity being a symptom and not a cause. Here is one such article. Here is a discussion of the same by Ludwig (who has talked extensively about why the weight set point in the brain sabotages long-term weight loss).

The body isn’t a passive energy-storage depot, it’s a dynamic organism that fights back against calorie restrictions. So we know that when you cut back calories or you try to burn off more calories with exercise, typically we get hungrier and hungrier. It isn’t just a fleeting feeling. It’s a primal biological signal that your body wants more fuel,” he shared.

And even if someone does have the willpower to ignore their hunger for months or even years, the body will continue to fight back by slowing down its metabolism.

So as we continue to lose weight and metabolism slows down, we need fewer and fewer calories to keep the weight off, even as our hunger and desire for those calories increase,” Dr. Ludwig said. “And unless we understand this alternative view of cause and effect, treatment approaches will be at best symptomatic and not effective over the long term.

But it is an uphill battle to fight ingrained societal bias, even with science.

Much easier to blame people and to buy into a simplistic causal relationship even if it is wrong.


You are writing it as the CIM is a well established model and accepted by the scientific community as the only/leading model. There is a lot of ongoing debate around CIM vs EBM and I don’t think the science is in anyway “settled” there. There is also a lot of criticism of Ludwig, who is one of the low carb gurus (including low carb diet books) - so your conclusion of “ingrained societal bias” is a bit early and just takes those science into account which fits your argument and ignores everything else. It might turn out that CIM will get more established but at this point that is still up for debate and more required data

It could easily be my own bias, but I am confused about why the term “blame” keeps coming up.

I don’t “blame” people for having mental health or substance abuse problems, but I still want them to know what might be contributing. I don’t walk around looking for people to “help”, but when people come to me for help, I do the best I can, even when it’s not something “medicne” doesn’t have easy answers for. Which in my experience is most things.

With regard to health risks of “fat”, I am used to reading about it not ing terms of describing someone’s habitus, but as a risk factor, even if it is not visible. Visceral fat deposition is not usually visible, but is still a risk factor.


I never implied that it is the leading model. It is an alternative model being proposed by people who are well versed (over decades) in the science and practice of diabetes and weight management.

Actually, no. Have you read his book? It is specifically about not dropping weight by extreme low carb measures, but instead slowly increasing fat and complex carbs to fool the brain to change the set-point that usually reverses most weight loss in the long term.

That’s why his method did not catch on vs Atkins or South Beach or other “simple” low carb diets that are easy to follow just by cutting back on simplistic dietary villains – because his takes more mental and practical effort with measuring fat & complex carbs.

It is not early at all. There is extensive research and published papers on bias in actual medical treatment. Pretty sure there was a discussion of it a week or two ago on a different thread (or several), with links to research papers. Found it (there’s more above & below & on other threads you have already participated in):

But it’s easier to ignore all the research and the science, however extensive, that doesn’t simply blame fat people.

That’s what I mean by ingrained societal bias. It’s all over this board, as others have said here & in other threads that are related to the topic.

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No, as I don’t think any diet book (independent of its theory) is worth reading. I pointed out his book as it is controversial to have financial incentives to do academic research in a certain direction for which he was also quite criticized as there is a high risk of result bias

I’d be hard-pressed to find a better demonstration of ingrained bias than your unwillingness to actually read any of the many scientific articles linked here and elsewhere, but to continue to refute them.

Also a good explanation of why the bias exists in well-documented form within the medical community itself.

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I know them and have read then but that doesn’t mean there are other scientific papers which have different results - as I said before there isn’t enough data to clearly determine which model
might be more relevant (or what combination of them)