We're not responsible for being obese?

janejellyroll wrote: »

lemurcat12 wrote: »

The article is annoying, but I think it's important to distinguish between two separate things:

(1) Are you ultimately responsible for your choices and are there things you should and can do to help yourself make better choices? Do you have a significant degree of choice in what you do, including (of course) what you eat? Yes, and that is important for people to realize when it comes to weight loss and maintenance.

(2) Are there also societal (cultural and other) influences on how people as a group act, on average that may affect what we do? Of course this is also true. We aren't just fatter now because we got lazy and weak compared to people in the past. Put us in the same situations as them, and them as us, and you'd probably get the exact same results as you have now (and did then) -- it's not that people are different, but that circumstances do affect behavior. (This can be such things as having no option but to move more, less food availability (which is not inherently good, obviously), and different cultural norms and taught behaviors.) To compare something like addiction (which the CNN piece did, I'm not convinced that's a great comparison here), clearly people ARE responsible for their own behaviors, but that doesn't change the fact that cultural norms and attitudes and availability and family background WILL make a statistical difference in behavior on average. We can acknowledge this and think about whether there is anything that can be done to tilt outcomes in a better direction without absolving people of responsibility. In fact, understanding what the influences are can be very helpful.

I'm of the opinion that trying to identify and understand the influences on my behavior can help me exercise more responsibility.

Trying to make all the "right decisions" without accounting for and understanding your environment is like trying to swim upstream.

A recent example comes to mind: my husband and I watched a news show last year that discussed the trend of over-prescription of strong, potentially addictive painkillers in emergency room settings for patients with things like broken bones who probably didn't need that level of pain management and how it was potentially driving new addictions. A few months later, my husband broke his wrist in a fall. In the emergency room, they gave him a prescription for the exact type of painkiller mentioned in the story. Based on the news story combined with the level of pain that he was feeling, he decided not to fill the prescription. Knowing the overall trend allowed him to make a better decision. I don't doubt his personal responsibility and will power for a minute, but knowing there are all sorts of people struggling with addiction problems with the US I'm glad we were aware and could avoid unnecessarily bringing a highly addictive substance into our lives (we both come from families with histories of addiction).

janejellyroll wrote: »

lemurcat12 wrote: »

The article is annoying, but I think it's important to distinguish between two separate things:

(1) Are you ultimately responsible for your choices and are there things you should and can do to help yourself make better choices? Do you have a significant degree of choice in what you do, including (of course) what you eat? Yes, and that is important for people to realize when it comes to weight loss and maintenance.

(2) Are there also societal (cultural and other) influences on how people as a group act, on average that may affect what we do? Of course this is also true. We aren't just fatter now because we got lazy and weak compared to people in the past. Put us in the same situations as them, and them as us, and you'd probably get the exact same results as you have now (and did then) -- it's not that people are different, but that circumstances do affect behavior. (This can be such things as having no option but to move more, less food availability (which is not inherently good, obviously), and different cultural norms and taught behaviors.) To compare something like addiction (which the CNN piece did, I'm not convinced that's a great comparison here), clearly people ARE responsible for their own behaviors, but that doesn't change the fact that cultural norms and attitudes and availability and family background WILL make a statistical difference in behavior on average. We can acknowledge this and think about whether there is anything that can be done to tilt outcomes in a better direction without absolving people of responsibility. In fact, understanding what the influences are can be very helpful.

I'm of the opinion that trying to identify and understand the influences on my behavior can help me exercise more responsibility.

Trying to make all the "right decisions" without accounting for and understanding your environment is like trying to swim upstream.

A recent example comes to mind: my husband and I watched a news show last year that discussed the trend of over-prescription of strong, potentially addictive painkillers in emergency room settings for patients with things like broken bones who probably didn't need that level of pain management and how it was potentially driving new addictions. A few months later, my husband broke his wrist in a fall. In the emergency room, they gave him a prescription for the exact type of painkiller mentioned in the story. Based on the news story combined with the level of pain that he was feeling, he decided not to fill the prescription. Knowing the overall trend allowed him to make a better decision. I don't doubt his personal responsibility and will power for a minute, but knowing there are all sorts of people struggling with addiction problems with the US I'm glad we were aware and could avoid unnecessarily bringing a highly addictive substance into our lives (we both come from families with histories of addiction).

AnnPT77 wrote: »

Big corporations are in business to make money. They make the most money when they figure out what we collectively really, really want - not what we say we want, but what we really want - and sell it to us cheaply in massive amounts.

When I was in MBA school, the marketing profs made it clear that marketing's magic formula was to figure out what people en masse truly want, then advertise it to us as being what we think we ought to want. This is the explanation of 800-calorie crispy chicken salads (with Newman's Own charity-enhanced dressing) and nutrition-sparse chocolate chip marshmallow caramel nutty granola bars. If they make those ubiquitous, super convenient and cheap enough for us to buy plenty, we will.

A few decades back, there was public compassionate pressure to relax restrictions on strong pain relievers, because it was felt that people with chronic pain were being cruelly under-treated. Pain clinics sprang up, some regs were relaxed. Now we have an opioid crisis. Unrelated?

Walt Kelly, way, way back, got it right in a vintage Pogo comic strip: "We have met the enemy, and he is us."

Individual decisions and actions create the large social forces, as well as being shaped by them. We have substantial control; we have no *baby feline* idea how to wield that force for good.

lemurcat12 wrote: »

There was a good interview on the history of the painkiller epidemic between Russ Roberts (of EconoTalk) and Sam Quinones (who wrote Dreamland, which I've been meaning to read for a while), and it seems there is a transcript of some sections, at least. The first part is on the heroin issue, but scroll down to get to Oxy et al. (you have to scroll to get to the transcript of the interview first).

http://www.econtalk.org/archives/2017/01/sam_quinones_on.html

Beginning:

"Russ Roberts: So, let's switch gears. Let's talk about painkillers. How did painkillers become a problem? It seems like there was this great new set of painkillers out, oxycontin and others. Why did they end up getting misused and abused?

Sam Quinones: Yeah. That was the--I backed into this story. Because of my background in Mexico, I really focused first on the heroin traffickers. But then, of course, I was left with the question: Why is it that they have so much new demand? Because they were now, by then, by the time I doing it, they were now in Ohio, West Virginia, places like that. And so that got me on to this other story that was really the first story, a really far larger story. And that begins, really, in the 1980s as well, about the same time, when pain management is just beginning to be kind of a new discipline within medicine that you study, and a whole group of pain specialists began to form a collective consciousness and believe that we were not treating pain correctly--that there were these pills, opiate painkillers out there, and doctors all across the country were unwilling to use these, and that this was not a reasonable proposition. That these pills ought to be far more liberally used. And at first they made the argument, 'We need to use these for hospice care folks, people dying of cancer, whatnot, in order to improve their last months on earth. What does it matter if they are addicted to these pills? Who cares if they are addicted to these pills if they also live the last 3 months of their lives pain-free?' And that made a lot of sense. That was a very logical argument: that folks would die in utter pain because doctors were afraid they would be addicted. But these folks made a different argument. They, however, kept pushing; and that's why we're here today. They didn't stop with just hospice care. They began to make the argument that virtually all of these pills, 'We now know--science now knows--that, you know, 5000 years of experience with the opium poppy be damned, we now know that these pills are virtually non-addictive when used to treat pain.' And they began to push. They were joined in this after a while by certain pharmaceutical companies who were producing some of these pills, main one being Purdue Pharma, which makes the pill Oxycontin. And they took up the call of these guys. I had one doctor say, 'If it hadn't been for the pain specialists, the pharmaceutical companies would have had nobody to footnote, to use to say this is why we're doing these, we're producing these pills.' But had it not been for the pharmaceutical companies, these pain specialists would have been without a megaphone. And so the combination of those two together, particularly as the 1990s progressed, becomes very, very potent....

31:45
Russ Roberts: And as you point out, millions of people, who were in horrible pain weren't any more. So that was the good side. The bad side was the promised non-addictive aspect of oxycontin, which was the slow-release part--the idea that oxycontin was continuous was supposed to dampen the addictive part. Two things happened. One, people figured out a way to get around that by sucking off the coating that slowed the release; or hitting it with a hammer. So that was problem Number One. Problem Number Two is--I think; correct me if I'm wrong--that there were people who got addicted anyway, even though it was slow-release.

Sam Quinones: Yes. Right. They were following doctors' orders and they would still get addicted. And part of the problem, too, was that along with the idea that these pills were no longer addictive when used to treat pain, came the corollary which was then that there was no limit on dose. So, you began to see all across the country doctors prescribing enormous quantities of these pills for patients to take home with them after acute surgery, for acute pain after surgery. Now, this is pain that is probably going to last you, oh, no more than 3-5 days. If it lasts more than 5 days there's something else wrong. But, they would prescribe 30 days' worth of Vicodin or Oxycontin--these are common--Vicodin is another common opiate painkiller. And so what happened is--and then--and this was happening all across the country--an enormous new supply of opiates was created across the country; and a fair amount of that, a good amount of that leaked out into the black market. I believe this--when I was in Mexico, I believed that all drug stories were demand-driven, and that drug scourges were created by demand for those drugs. Now, when I did this book, this changed my mind, honestly: I came to think that really most drug problems begin because of excess supply--easy, cheap availability of a drug. And that's exactly what happened here. We have a new, a massive new supply of opiate painkillers from coast to coast, all across the country, because it's doctors who buy in to this idea. A couple of generations of doctors buy into the idea that they now need to very aggressively prescribe these things to treat our pain. And some are pushed or pressured. Legally you have to do this: If you don't treat pain, you can be sued. Some, it's insurance pressures; if we don't push people through our clinic we won't be able to reimburse enough to keep the lights on. But, whatever the case, doctors all across the country come to this idea that they need to do this. And that is what creates a massive and continuous new supply of opiate painkillers for the last 20 years, from coast to coast...."