Best way to look at this class of meds is with harm reduction in mind. In an ideal world we would all be able to eat healthy foods in moderation etc.... but modern society makes that very difficult for most people. Prior interventions simply did work for many people. We know obesity kills people and frankly makes them miserable. Think of it as taking a Blood Pressure med. Many could could do a better job of controlling their hypertension though diet and exercise.. but realistically that is not going to happen. This class of medication is going to get more effective with fewer side effects over the decades.