Fat and Happy… Not

Just for grins, compare the latest statistics on the world’s happiest countries and the most obese countries. Recently, writer Frank Jacobs noted,

As usual, the country ranking in the annual World Happiness Report is topped by Nordic countries.

According to the Gallup World Poll, they are Finland, Iceland, Sweden, and Denmark. How do those felicitous lands stack up against the most obese countries? There are different ways to compare the statistics, mainly by “mean BMI of both sexes.” But BMI has been discredited and while most places still go by it, the more advanced have switched to other metrics, like the combined male and female obesity rate.

Still, according to the currently accepted standard of measurement, in the four happiest countries, the percentage of obese adults looks pretty good with these figures: Finland 22.2%, Iceland 21.9%, Sweden 20.6%, Denmark 19.7%.

In contrast: When measured by the combined obesity rates of both sexes, the “percentage of obese adults,” in the world’s direly affected countries is as high as 61% (Nauru), 55.0% (Cook Islands), 55.3% (Palau) and 52.9% (Marshall Islands).

Big picture, little picture

So, on a global scale, and for many reasons, the happiest humans and the most overweight humans constitute very different populations. However, narrowing the assessment down to a certain population, the professional comedians of the world look pretty darn euphoric. Of course, laughter is not always synonymous with happiness, as they will be the first to attest.

An entire sub-genre of professional comedians have suffered from the belief that if they give up their addictions — whether to alcohol, downers, uppers, food, or whatever — they will no longer be able to either mentally generate material, or perform in front of crowds. One way they handle this almost ubiquitous problem is by organizing for mutual help toward the practice of self-help.

In Atlanta, for instance, an outfit called Stand Up 4 Recovery was founded by comic Ricky Satori who, now more than 10 years sober, told reporter Kenny Murry about the early stage of his recovery process:

I could be onstage, I could say something confessional about my drug use … and I could follow it up with a punchline and experience the therapeutic value of not being suffocated with secrecy. Also, if it came up in court, I could say, “I was just kidding!”

This innovator is registered as a Certified Addiction Recovery Empowerment Specialist, and is qualified to train people to use naloxone (which saves users who overdose on opiates). He runs a mobile comedy club that honors individuals celebrating their Soberversaries by giving them support, encouragement, and even gifts. He also created a special array of “mocktails” for customers to enjoy. Collaborators include comedian/actor Taylor Neely, who also hosts the podcast “Sober Boyz.”

Father of them all

Another example of this type of service organization is the Lenny Bruce Memorial Foundation, founded by the legendary comedian’s daughter Kitty Bruce. It provides scholarships for sober living programs aligned with the foundation’s core values, which include education on how to survive daily life without using substances; focus on positivity and spirituality; self-esteem building; volunteer work; and enjoyable sober experiences.

Your responses and feedback are welcome!

Source: “Mapped: The highs and lows of the world’s happiness landscape,” BigThink.com, 05/07/24
Source: “Most Obese Countries 2024,” WorldPopulationReview.com, undated
Source: “Atlanta comedians ‘Stand Up’ for addiction and mental health recovery awareness,” WABE.org, 01/23/24
Source: “The Lenny Bruce Memorial Foundation,” LennyBruce.org, undated
Image by Stand Up 4 Recovery

Dicey Substances and Treacherous Fakes, Part 2

This post continues a recent post, and this one is as disturbing as the other. Last month, Registered Dietitian Catherine Rall told Healthline.com,

Any time you’re taking an unregulated drug, you’re taking a huge risk since it could literally contain anything. The best case scenario, outside of the unlikely idea that someone is selling Ozempic at below-market prices, is that you get an inert placebo. There’s also a huge risk that you’re putting something dangerous into your body.

The article also notes the warning voiced by Registered Nurse Nancy Mitchell, that the customer risks receiving harmful toxins, including heavy metals:

Every year, hundreds of people show up in the ER with severe allergic reactions or lead poisoning that they acquired from some unknown generic source.

Of course, the World Health Organization warns the public about counterfeit websites, but given the high prices of bona fide pharmaceuticals, the widespread shortages, and the human tendency to hope for and believe in the impossible, caution is unlikely to be observed. Face it, most of us are nice people who can’t really believe that someone would sell us fake medicine that might be worse than useless.

Potential users are urged to verify the legitimacy of online pharmacies, but who knows how to do that?

And to be realistic, do people really care? The perils that may result from giving away any personal information online are just beginning to register in the average person’s consciousness. The world is full of endearing, lovely people who trust strangers enough to willingly fill out social media “get to know me” quizzes. Clever criminals collect all kinds of facts, and know more than anyone needs to about a person’s first pet, the color of their first car, and who their prom date was in 1980.

Be afraid… Be very afraid

A VanityFair.com piece by Katherine Eban reinforces all the caveats:

Under US law, drugs are supposed to travel seamlessly from a manufacturer’s loading dock to a distributor’s pristine warehouse to a pharmacy shelf through a protected chain of companies that follow strict requirements for handling medications and documenting sales.

“On the contrary,” says her story which traces the meticulous investigation into a particularly odious and huge batch of thousands of fake Ozempic pens that were dumped on the market last year, and also goes into the matter of drugs that are real enough, but “diverted” from the legitimate channels. Eban writes,

The drugs may well be authentic, but they might also be expired, improperly stored, or contaminated. Under FDA rules, diverted drugs are considered adulterated and not fit for human consumption, because their safety and quality cannot be guaranteed.

The globe is populated with criminals who “have been learning as they go how to breach America’s defenses in order to sell their counterfeit medicine in the most expensive, and lucrative, market in the world.” This market includes the proprietors of some weight-loss spas whose practices are unsavory, to say the least.

The Illinois Poison Center’s medical director, Michael Wahl, M.D., told the reporter that many patients have injected insulin disguised as Ozempic — which for non-diabetics can be seriously life-threatening, because if the body’s glucose level is too low for too long, irreversible brain damage may result.

In addition to the outright fakes and the stolen or “diverted” goods, there is the additional problem of legal but under-scrutinized and possibly untested substances. There are loopholes, under certain conditions of unavailability, that allow licensed “compounders” to manufacture drugs. Their ingredients are sometimes obtained from sources that cannot be described as either impeccable or acceptable:

Not every pharmacy compounder is equal in adherence to the law… The result has been a quality control disaster.

It looks as if people need to seriously ask themselves whether losing some pounds of flesh can be worth the price of losing an organ or even a life, especially when other methods, though difficult, are possible.

Your responses and feedback are welcome!

Source: “WHO Issues Global Warning About Fake Ozempic Being Sold Online,” Healthline.com, 06/24/24
Source: “Why Counterfeit Ozempic Is a Global-Growth Industry,” VanityFair.com, June 2024
Image by Richard Patterson/Attribution 2.0 Generic

Are Important Questions Being Asked?

A ScientificAmerican.com article published last year was not alone in raising a valid point or two. Writer McKenzie Prillaman speculated on the validity of welcoming the GLP-1 drugs as some sort of medical messiah:

Another unknown is who will respond to these drugs — and who won’t. It’s too early to tell now, but the drugs seem to be less effective for weight loss in people with type 2 diabetes than in those without. Conditions such as fatty liver disease and having fat around the organs, known as visceral body fat, might also affect how people respond to different drugs.

Aspersions have been cast by, among others, Matthias Tschöp, a German physician and scientist. Who will respond to these drugs and who won’t? Hesitancy and caution bring up other questions that many professionals feel really must be answered first: exactly who needs to respond to these drugs, and why do they need to? Because there is still doubt in some minds about whether “obesity” is such an enormous problem after all.

The link between excess weight and health is not proven to the satisfaction of everyone. Why?

One study found that nearly 30% of people who are considered obese are metabolically healthy. Another showed that other health problems tend to be a better predictor of someone’s risk of death than is weight, demonstrating the need to consider factors other than weight when judging health.

And indeed, it is possible that a person whose eyelashes fall out or whose fingernails show grooves is more likely to develop some fatal condition than an obese person is. Biology and medicine are two fields that never run out of surprises, so who knows?

Keeping up, or being led by the nose?

Then along comes another expert, like biologist Timo Müller, to point out that times have changed, especially after semaglutide arrived on the scene. Previously, using pharmacology to reduce weight by more than 10% had proven to be unsafe for patients’ overall physical well-being.

Still, these newer drugs held out the promise of performing other services, like improving cardiovascular health. Tirzepatide increased the “wow” factor even more, with its ability to rival the effectiveness of bariatric surgery by enabling the loss of, in some cases, 20% of the patient’s body weight.

And yet… did that individual really need to be changed into four-fifths of their former self? Misgivings were expressed by psychologist Sarah Nutter, whose main areas of interest are body image and weight stigma. The particular concern here is that patients are letting themselves in for a lot of misery, what with nausea and vomiting and so forth — “to escape weight stigma, rather than to serve a true health need.” There is also concern that people are overly influenced by reports from celebrities, and by news stories aiming to convince folks that once they lose weight, all their pesky life problems will disappear.

Celebration or desperation?

There is a feeling in some quarters that the public is being brainwashed into paying well over $1,000 a month to solve what just possibly might be a non-problem. Perhaps these individuals could be better served by spending that money on psychological counseling, or any kind of therapy, rather than ingesting substances that may not offer permanent health, and indeed might cause actual harm.

The insurance companies that balk at dishing out the dollars may not be solely motivated by reluctance to part with the cash. Their reluctance to pay for “vanity drugs” might even indicate genuine concern for the patients’ well-being. After all, stranger things have happened. But then, the other side comes along with multiple proofs of the enormous damage that can be caused by untrammeled obesity.

When a large number of 20-year studies about GLP-1 drugs and their close relatives have been completed, we can rest assured that someone will always say, “That is all well and good, but what about the 30-year studies? We need those.” It might be that some answers will never satisfy.

Your responses and feedback are welcome!

Source: “Breakthrough’ Obesity Drugs Are Effective but Raise Questions,” ScientificAmerican.com, 01/10/23
Image by airpix/Attribution 2.0 Generic

The GLP-1 Drugs — More Questions and Issues

As mentioned in a previous post, there are a lot of things nobody knows very much about. The GLP-1 drugs have been around for a while, although mainly as a diabetes treatment. As weight-loss drugs, however, they are relatively new and untried. Just as with any discovery that comes down the road, questions arise.

Which patients could or will be harmed? Which sufferers will receive the most benefit? How much will they pay? How much would they be willing to pay if they had a lot more money to start with? Where will the funds come from instead? How about the pharmacology? What other drugs does this new thing clash with, causing iatrogenic disaster and/or scandal? Can the team that wrote a particular paper continue to do meaningful work in this area?

Bloomberg journalist Lisa Jarvis raised several questions, such as:

Why do some people on GLP-1s […] experience a total body transformation, while others lose only modest amounts of weight — or nothing at all?

Is there a way to figure out who needs these drugs to avoid a heart attack or diabetes, and who is perfectly healthy in their larger body?

Is constant therapy sustainable — or even required?

Jarvis states, “Some 44% of people taking Wegovy report nausea, and nearly a third experienced diarrhea.” People know this is going on but give it a chance anyway, and a very large number of them seem to stay with it despite the discomfort. The sickness seems to be a feature, not a bug. If that’s what is required, people seem willing to put up with it.

Time out?

Apparently, huge numbers of users want to know if they may self-prescribe a break from their medication regime. The professional consensus on that is, “No.” Resistance understandably crops up a lot, around holiday times. Reportedly, someone who stops their meds abruptly will become ravenously hungry, and prone to eat an enormous amount of barbecued ribs and hot fudge sundaes.

If somebody does take a break, the next big question seems to be whether they should pick up again with the dosage they previously used, or whether they need to fall back to a smaller dose and then crank it up again. Journalist Ross Wollen wrote,

It takes the body some time to adjust to these potent medications, and those infamous gastrointestinal side effects tend to be at their very worst in the first few days of a new higher dose. With longer pauses, the worry is that your body might lose some of the tolerance that originally allowed you to step up your dosage.

Starting over with the high dose that was typical before the break “could be more than your body is ready to handle, resulting in extremely uncomfortable side effects.” Medical professionals prefer to stay on the side of caution, recommending a wary approach before ramping up. Apparently this is not yet verified by published studies — but it is the tactic preferred by doctors, who definitely want to be consulted, rather than see patients improvise their own unauthorized medication calendars.

Patients who go rogue with their dosage schedules might meet with surprises. They may not be aware that it takes at least a week for the last dose to clear their system. If someone wants to devour a big meal on a certain day, careful planning is needed. Even then, the mere ability to chew and swallow a large amount is no guarantee that the organs farther down the line will cooperate. What polite society calls “ugly gastrointestinal side effects” may occur.

Your responses and feedback are welcome!

Source: “Do You Really Have to Take Wegovy Forever?,” WashingtonPost.com, 10/19/23
Source: “Is It Okay to Skip an Ozempic Shot Now and Then?,” EverydayHealth.com, 11/15/23
Image by Camdiluv/Attribution-ShareAlike 2.0