The problem is appetite control is not something you can simply will yourself to have. Being hungry all the time is pretty awful. I'm not saying this is a good alternative, but the whole "just stop eating so much" sounds a hell of a lot easier than it is for many people.
As someone trying to get insurance to pay for one of these drugs, you've pretty much listed the reason. I spent so long trying to find a pattern but have given up, going back to my childhood I've never felt satiated. I never feel full, so I have to rely on other cues. I can eat a huge meal, of any variety, and I'll still feel hungry after (and during). The only modes my appetite has are "hungry" and "if you don't eat you'll die". I've had various meds "help" in one way or the other but none lasted, and none have changed the sensation of hunger. The thought of not feeling hungry makes me want to cry, it sounds so surreal.
There are other problems. Margaret Cho has talked about how the "just don't eat" thing being told to her constantly while she was on a TV show eventually caused her to have an eating disorder which basically destroyed her kidneys. When she finally got over being hungry all the time, she had an eating disorder.
That's why you can't fix the problem without exercise.
You can justify eating more when you're burning more calories.
When I burn 4000 or 5000 calories in a day, I can eat an unlimited amount of food, and often don't make up the deficit. So, it becomes all-you-can-eat with weight loss.
Also, it's important to note that "being hungry all the time" is a symptom of poor eating habits and undernutrition. A lesson in how to eat is going to help someone more than pills.
I think the credibility of the argument that "it's not easy to just lose weight" goes down when the contenders for solutions are "more pills" vs. "Lifestyle change".
Its always better to try the non-pill option before deciding the pills are needed. American policies and support structures need massive overall. Even things that seem totally unrelated like more mixed use and walkable city Zoning policies will make Americans more active and less dependent on meds.
But just saying 'lifestyle change' as if it's some simple thing is the problem. You wouldn't tell a heroin addict to just stop taking heroin. A lot of people are addicted to eating (psychologically, not physically), which is why they feel hungry all the time. Just expecting them to change that like it isn't an addiction is not the way to do it and trying to shame them into it is certainly not the way to do it. There has to be a way to get people to make those changes in a way that eases them out of the addiction. And, of course, like any other addiction, they have to want to change.
I never said it was impossible and I specifically said I didn't think the medications were the way to do it, so I'm not sure what the point of your response is.
It is the least complicated thing on earth. If you burn more calories than you consume, you will lose weight. It is a scientific law and while I'm no doctor, I'm certain that 99.9% of the population is beholden to it.
I assure you it is much more complicated than you suggest. To the point that is an active point of research and debate.
It has been shown that a person's base metabolic rate is not a fixed number which can be affected by things such as caloric intake, types of calories and exercise(independent of the calories consumed during exercise). A simple reduction in calories intake will often result in a crash in the metabolic rate and then the sequential rapid gain weight when normal calorie intake is resumed.
In addition to this it has been shown that people are getting fatter on less food than they did 40 years ago. This is vastly more complicated than a Newtonian model of the body would suggest. Yes, diet and exercise can help reduce being overweight. But to merely suggest somebody should quote eat less is ineffective and is not shown to hold up in studies.
Oh and sorry about the pay wall.
A simple reduction in calories intake will often result in a crash in the metabolic rate and then the sequential rapid gain weight when normal calorie intake is resumed.
That's the problem, the 'normal' caloric intake should become the reduced amount, not what was being consumed previously.
It is not more complicated than that. If you eat less you will lose weight. I was almost 350 lbs after years of eating too much. I decided it was enough and started intermittent fasting. Lost 90 pounds in the first year or two. I did not change my diet, just lowered my calories.
After about a year I hit a wall at 60 pounds lost and wasn't going down anymore. So I just shortened my eating window and started losing again. I've been fasting for about 6 years now and it's completely changed how I handle food. I am able to tell my body when it is and isn't time to eat. I rarely feel hunger anymore.
My 60+ year old father and mother both saw the results I had and started fasting as well. My father has lost more weight than me.
How dramatically does the base metabolic rate change? Surely you can reduce caloric intake more than base metabolic rate would go down. I restrict my calories with great results, sometimes I'll do a 24 hour fast if I've eaten too much junk and I feel great afterward. I've kept my weight in check for years while restricting caloric intake. This is all diet, since I don't do exercise (I need to get better at that). I can see myself gaining all that weight back if I get into the mindset of "well, I lost that weight, I'm free to enjoy food without restriction again!" It's kind of like sobriety, it takes continual diligence to keep your progress.
Well sadly the answer is it depends. There are a lot of environmental variables along with a few biological variables. It is much easier for men than women to lose weight simply by cutting intake. How fast you cut calories can trigger starvation mode. People who eat a lot of refined sugar have a harder time. What your down time looks like(do you sit all day or do you have an active job) and one that we know has an effect but don't really know how much, is exposure to endocrine disruptors (like BPA). The biological machine is different for everyone.
But the short answer to your question is for people who are of low activity levels and difficulty with weight. It is usually recommended for them to have a slow reduction in intake to keep from triggering a starvation response and a slow increase in activity until your body adjusts to its new normal.
Oh and thank you for asking a question instead of just saying that you think this is dumb.
Thanks for the detailed response. Yeah, a lot of it varies from person to person which makes it tricky and prevents one-solution-fits-all advice. I looked up the change in starvation response and it seems like on average people will miss out on around 180 calories burned daily from this response. It's significant, but may be manageable depending on the person. All I know is that this approach has been working for me for 5+ years now.