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Weight loss drugs make it harder to get the nutrients you need – here’s what to do about it
(theconversation.com)
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It's also possible to look thin and yet be unhealthy at the same time. These people are known as being Thin Outside, Fat Inside, and have a lot of visceral fat.
This is nuanced but generally speaking an obese person does not want to be obese, if only because it feels terrible. They know they are in bad shape. There is no way to not be aware of chronic inflammation, skin issues, joint pain, and poor organ function.
They may look like they have a lack of self control to you, but telling them to "just get more self control" doesn't help with anything. Perpetuating the idea that they are obese because they can't control their own habits is reductionist. The process is indeed difficult, but it's not because of lack of trying. It's not always possible to overcome pathology with mental fortitude.
I don't think that they want to be obese, I think that they have an addiction which is making it extremely difficult to make changes. At the end of the day, it is self control. I don't think it's easy though.