the issue here is preventing obesity in the first place instead of doing nothing and then using medication to treat it. it's explicitly not about denying medication to those who need it.

I think he would agree with you that many don't have good choices

He said the food available on high streets in places like Wigan or Blackpool was "completely different" to equivalent towns in France and it was not the fault of people living there when presented with "wall to wall" junk food.

And if the full social cost of preventing obesity in the first place is higher than the full cost of a medication approach?

We need to be careful not to turn this into an issue of judging the obese as moral failures and treating them with the same harsh attitude we (unduly imo) apply to drug addicts.

i think we have to differentiate between the scientific (which is difficult in it's own right) and the social discourse. my (hazy) recollection from uni is that prevention is (almost?) always more effective and efficient than treatment, smoking, drinking, sex ed, etc come to mind.

unfortunately, prevention is heavily underused, as a public health method. i guess there's not enough money to be made in preventing disease instead of curing it. come to think of it, this type of medication is actually gold, as it does not cure anything, but requires constantly taking it. to be clear: the issue is not taking medication which does not cure the underlying issue (your insulin example), but taking medication in lieu of attacking the underlying issue.

(sorry for rambling a lil bit)

I think we agree, really. Prevention is preferred of course, but we need to be realistic as well. For many years the benefits of a good diet and exercise have been known and promoted. I would not be surprised of the majority of people felt they should better follow healthy living guidelines. But in practice, we are falling short of our goals for many and complex reasons.

I mean, in a way yes, but also the NHS seems to have coverage problems nevertheless. Both things can be true.

The US model is use TV to sell fast food, cheese and beef, fried everything, then OTC drugs for acid and constipation and diarrhea, and finally ozempic to lose weight.

The US diet requires drugging to consume.

What would not stopping obesity say about us if we have a drug that can do it?

yeah i agree. but I'd like to highlight that prevention is not a necessarily a question of individual responsibility only. in my mind it's more an issue of society deciding to take action on an issue and using the power of regulations to make them come true. e.g., simply disallowing smoking in certain places, adding these rather gruesome images to cigarette packs (I'm no fan of the increased taxes, as they make cigarettes smuggling attractive).
or limiting alcohol advertisement in the public.
another example might be the French national(!) government deciding that the number of drownings had become intolerable and that therefore state sponsored swimming pools had to be built.
back to obesity: i think the opposition of the food industry to any kind of regulation is quite telling. they gaslight us into believing that it's all a question of individual responsibility and that coca cola can be part of a healthy diet, or that a single serving of chips is about 23.537g , or that ultra high processed food is dubious as a category of discourse, or whatnot.
so, no. prevention is a societal effort and the individual responsibility take is highlighted by interested parties.

it's really is topic doctors should prescribe for those with low blood pressure.
https://thereader.mitpress.mit.edu/how-coca-colas-calories-out-myth-backfired-spectacularly/

They're not talking about not stopping it or not using the drugs, they're talking about prevention being the prefered way. They say leaning more heavily into prevention is better than letting people get fat and then medicating them for life.