Many people make costly mistakes when reasoning about their health. Even most doctors make this mistake, because it’s not a mistake that’s caused by a lack of medical knowledge. Rather, it’s caused by a lack of clear thinking.
I doubt this is caused by lack of clear thinking on the doctors’ part.
The process of identifying root causes you advocate is resource and time intensive. Sure, a determined patient, such as yourself, could go on the journey of finding some root cause, but this is not scaleable.
Consider, a man with insomnia goes to the doctor and hears:
”Instead of doing the foolish thing of stopping at diagnosing you with insomnia, I’ll to the wise thing. Could you tell me in detail about your lifestyle and family history? This interview could take several hours, we wouldn’t like to miss the root cause outside your body, after all. If this fails, I’ll order a vast array of medical tests, it will be expensive and take a while, no guarantees it’ll work. But we MIGHT identify some cause outside the body, wouldn’t that be grand.”
Physicians do this to a much smaller extent, when the expected value is especially positive. But giving the full treatment above for every patient, and for every not-fully explained health problem, would overwhelm the healthcare system and the benefits seem doubtful.
Additionally, the median patient is a constraint as well. You may want to have a doctor such as the one I described above, but I’d expect the median patient to not go along with this arduous and expensive process which may or may not lead to a solution at the end. Even if you identify some root problem in the patient’s lifestyle, this is unlikely to solve much. My understanding is that convincing patients to make even minor lifestyle changes is extremely hard, while convincing them to take pills is easier.
No one said this is the case, though. If you replace “any given fat person” with “the vast majority of fat people”, then the statement clearly holds.
Observing that someone is obese/overweight provides pretty strong evedence that they’re not on GLPs. It could be the case that they are in the small minority of people who get prohibitive side effects or for whom they don’t work, but in no practical circumstance is that the null hypothesis.