The fact that there’s a correlation between BMI and lifespan that coresponds to one point of BMI being linked to 0.7 years of lifespan doesn’t mean that if you intervene and take a drug to reduce your weight you will gain 0.7 years of lifespan per point of BMI that you lower your BMI.
There’s unhealthy behavior like eating sugar that does lead to weight-gain but it also messes up the insulin management.
It is, however, worth pointing out that the FDA is vigorous about pulling drugs that have been shown to have even small risks of causing life-threatening conditions
A drug can reduce your life span for by a few years if you take it over decades without “causing life-threatening conditions”.
I suppose. But it’s also true that you should minimize the number of debilitating medical conditions you’re suffering from long-term.
Which brings us back to the thing where we end up having to choose between a chronic condition which is heavily correlated with a whole bunch of secondary health problems and reduced life expectancy, and being on a drug from which we have not (yet) observed long-term ill effects.
The back-of-the-envelope life expectancy calculations were mostly just there to point out that under most plausible assumptions, the risk/benefit calculations seem lopsided to the point where it shouldn’t be a terribly difficult decision.
This conversation has basically recapitulated most of the ideas that lead to the antagonist pleiotropy hypothesis, except over “conscious lifelong health interventions” instead of over “blind mutations retained by natural selection”.
Short term wins often have long term costs.
As clever hack piles on top of clever hacks, the combinatorial explosion of possible interactions goes up pretty fast.
Once wins of this sort pile up, your functional planning horizon shortens. At some point you just say “X will almost certainly get me before the bad parts of Y gets me” and you do Y anyway? But eventually the house of cards topples over.
If your lifelong health meta-strategy is aimed at still being able to ski when you’re 85, you probably want to minimize pills in general? Find tiny repeatable actions with numerous positive effects that fit into a weekly routine in a way that adapts to a variety of contexts and have many positive effects and stick the adherence? Green veggies? Walk a mile every day? And so on?
If you’re overweight and 51 and smoke and are pre-diabetic and walking gives you back pain and you’d still prefer to die in ~12 years of a new thing rather than in ~4 years from the thing your doctor recently mentioned… sure… try some pills maybe? Or maybe bariatric surgery? Lots of stuff works locally in the short run, and the long term, in general, often can’t be touched without running into a morass of interlinked complexity.
This is an interesting argument! I certainly acknowledge that if you can become non-obese via purely dietary means, that is best.
I wonder whether your analogy holds in the circumstance where dietary means have been attempted and failed, as often happens judging by the truly staggering number of posts online on this very topic—whether becoming non-obese via medication constitutes a short-term win outweighed by long-term detriments, and whether the effects of the pills turn out to be more harmful than the original obesity it was meant to treat.
But it’s not totally clear to me that you have attempted to make an affirmative case for this being true, as opposed to suggesting it as a pure hypothetical.
The fact that there’s a correlation between BMI and lifespan that coresponds to one point of BMI being linked to 0.7 years of lifespan doesn’t mean that if you intervene and take a drug to reduce your weight you will gain 0.7 years of lifespan per point of BMI that you lower your BMI.
There’s unhealthy behavior like eating sugar that does lead to weight-gain but it also messes up the insulin management.
A drug can reduce your life span for by a few years if you take it over decades without “causing life-threatening conditions”.
Can you give any examples of that happening, where a drug reduces lifespan but not by causing any specific fatal effect?
There’s very little money into chosing causation in cases like this but sleeping pills would be one example.
In general many drugs cause the liver to have to do extra work and put stress on it.
I suppose that’s reasonable, though i will point out that this is a fully-general argument against taking any drugs long-term at all.
Yes, you should generally minimize the amount of drugs you take long-term.
I suppose. But it’s also true that you should minimize the number of debilitating medical conditions you’re suffering from long-term.
Which brings us back to the thing where we end up having to choose between a chronic condition which is heavily correlated with a whole bunch of secondary health problems and reduced life expectancy, and being on a drug from which we have not (yet) observed long-term ill effects.
The back-of-the-envelope life expectancy calculations were mostly just there to point out that under most plausible assumptions, the risk/benefit calculations seem lopsided to the point where it shouldn’t be a terribly difficult decision.
This conversation has basically recapitulated most of the ideas that lead to the antagonist pleiotropy hypothesis, except over “conscious lifelong health interventions” instead of over “blind mutations retained by natural selection”.
Short term wins often have long term costs.
As clever hack piles on top of clever hacks, the combinatorial explosion of possible interactions goes up pretty fast.
Once wins of this sort pile up, your functional planning horizon shortens. At some point you just say “X will almost certainly get me before the bad parts of Y gets me” and you do Y anyway? But eventually the house of cards topples over.
If your lifelong health meta-strategy is aimed at still being able to ski when you’re 85, you probably want to minimize pills in general? Find tiny repeatable actions with numerous positive effects that fit into a weekly routine in a way that adapts to a variety of contexts and have many positive effects and stick the adherence? Green veggies? Walk a mile every day? And so on?
If you’re overweight and 51 and smoke and are pre-diabetic and walking gives you back pain and you’d still prefer to die in ~12 years of a new thing rather than in ~4 years from the thing your doctor recently mentioned… sure… try some pills maybe? Or maybe bariatric surgery? Lots of stuff works locally in the short run, and the long term, in general, often can’t be touched without running into a morass of interlinked complexity.
This is an interesting argument! I certainly acknowledge that if you can become non-obese via purely dietary means, that is best.
I wonder whether your analogy holds in the circumstance where dietary means have been attempted and failed, as often happens judging by the truly staggering number of posts online on this very topic—whether becoming non-obese via medication constitutes a short-term win outweighed by long-term detriments, and whether the effects of the pills turn out to be more harmful than the original obesity it was meant to treat.
But it’s not totally clear to me that you have attempted to make an affirmative case for this being true, as opposed to suggesting it as a pure hypothetical.