Being overweight overtakes tobacco smoking as the leading disease risk factor

Obesity trends and GLP‑1 drugs

• Several commenters link recent small declines in obesity to GLP‑1 drugs (Ozempic, Mounjaro, etc.), though access is limited by high US prices and patchy insurance coverage.
• Telehealth + compounded semaglutide are described as relatively cheap and easy to obtain, sometimes via “fudged” BMI data, raising safety and ethics concerns.
• Users report large, previously unattainable weight loss, reduced “food noise,” improved blood sugar, and even remission of IBS‑type symptoms. Others ask about long‑term effects on strength gains and whether benefits persist after tapering.
• Some argue GLP‑1s put healthy eating on “autopilot” vs. years of failed dieting; skeptics say consistent calorie control should be enough and question the need for drugs.

BMI, health risk, and measurement

• Linked Lancet work suggests lowest all‑cause mortality around BMI ~25; cancer mortality minimum is lower, communicable disease minimum slightly higher.
• Some infer “overweight but not obese” might not be very harmful; others counter that overweight still raises risk of quality‑of‑life–reducing conditions (e.g., type 2 diabetes) even if mortality curves are shallow.
• Strong debate over BMI: defenders emphasize it’s cheap, robust at population scale, especially when combined with waist circumference; critics call it crude and misleading for muscular or “jacked” individuals.
• Several note ethnic differences in diabetes risk at “normal” BMI, complicating simple BMI cutoffs.

Diet, sugar, and cancer/metabolism

• Discussion of high‑fructose diets, cancer growth, and whether fruit sugar is problematic; some cite mouse studies on sugar water and rough thresholds for human fructose tolerance.
• Others argue the real issue is cheap, abundant sugar (HFCS or otherwise) and ultra‑processed foods, not fruit.
• Conflicting anecdotes around keto: some see it as cancer‑protective; others describe potential tumor‑promoting effects in specific mutations and warn against simplistic “starve cancer with ketones” claims.

Social attitudes, stigma, and mental health

• Tension between body‑positivity (reduce bullying, accept diverse bodies) and concern that “fat acceptance” normalizes unhealthy weights or deters medical conversations.
• Multiple people stress that shaming is already pervasive, often worsens stress, depression, and disordered eating, and appears ineffective as a population intervention.
• Others credit strong social stigma (e.g., against smoking) with helping them change behavior and question whether we’ve overcorrected on weight stigma.

Policy, economics, and responsibility

• Proposals include: sugar or junk‑food taxes, stricter labelling, limits on advertising to children, and improving food quality in schools/hospitals.
• Counter‑proposals focus on cutting agricultural subsidies (especially for corn) that make simple carbs artificially cheap; there’s extended debate about second‑order effects (fuel, feedstock, price volatility).
• Some suggest obesity‑related insurance surcharges or GLP‑1 coverage if cost‑saving; others denounce this as cruel or note that many weight changes stem from disease or medication, not “choice” alone.
• A recurring theme: overeating is often a symptom of broader structural and psychological issues (stress, despair, sedentary work, poor food environments) rather than just personal failure.

Smoking, nicotine, and substitution effects

• The ranking shift is partly attributed to a >40% fall in tobacco‑attributable burden since 2003 rather than a sudden surge in obesity alone.
• Commenters discuss rising use of vaping and nicotine pouches (e.g., ZYN), with disagreement on how harmful pure nicotine is versus smoked tobacco.
• Some note nicotine’s appetite‑suppressing role and speculate that declining smoking may indirectly raise weight, while warning that trading obesity risk for smoking risk is net harmful.

Individual experiences and strategies

• Many share struggles with sustainable weight loss, the mental difficulty of long‑term 1,200–1,400 kcal diets, and the impact of work stress, parenting, depression, and medications.
• Others report success with fasting (including multi‑day fasts), caloric tracking, resistance training, or strict avoidance of “trigger” junk foods rather than moderation.
• There’s recurring skepticism that any purely behavioral approach has been proven to work at scale over the long term, hence interest in surgery and pharmacological options despite cost and side‑effect concerns.