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"That is true," Barrett responded.

California Sen. Dianne Feinstein, the Judiciary Committee's top Democrat, also asked the nominee about the severability doctrine. Barrett explained to Feinstein that the doctrine was like a game of "Jenga," where a court must decide whether a law can stand if it pulls out part of it.

Vermont Democratic Sen. Patrick Leahy said that Barrett had not written or spoken in defense of the ACA but had publicly criticized the court and Chief Justice John Roberts for voting to uphold sections of it. Barrett said on Wednesday she had previously spoken as an academic rather than as a judge, and had "never had occasion to speak on the policy question."

Barrett later told Minnesota Democratic Sen. Amy Klobuchar, "I have no animus to, or agenda for, the Affordable Care Act."

Barrett said, "No one is above the law," but declined to answer the question, saying it "has never been litigated."

"So because it would be opining on an open question when I haven't gone through the judicial process to decide it, it's not one in which I can offer a view."

Delaware Democratic Sen. Chris Coons asked Barrett if she agreed with her mentor and former boss, the late Justice Antonin Scalia, that Griswold v. Connecticut, which established that married couples have a right to obtain and use contraception in the privacy of their own home, was wrongly decided.

She explained that it's "unthinkable that any legislature would pass such a law" prohibiting the use of birth control and that it's "very unlikely" a lower court would buck the Supreme Court precedent.

Barrett said that "the only reason that it's even worth asking that question" is because the 1965 case underpins the 1973 landmark case Roe v. Wade, which found a constitutional right to abortion. "So because Griswold involves substantive due process, an area that remains subject to litigation to the country, I don't think it's an issue or case that I can opine on," she said. "But nor do I think Griswold is in danger of going anywhere."

California Sen. Kamala Harris, the Democratic vice presidential nominee, asked Barrett about Shelby County v. Holder, which allowed some jurisdictions with a history of voter suppression to escape additional federal scrutiny under the 1965 Voting Rights Act.

"I think racial discrimination still exists in the United States, and I think we've seen evidence of that this summer," added Barrett.Harris later asked Harris if Covid-19 is infectious, whether smoking causes cancer and whether climate change is "happening and is threatening the air we breathe and the water we drink."

"I will not do that," she said. "I will not express a view on a matter of public policy, especially one that is politically controversial because that's inconsistent with the judicial role as I have explained."

Republican senators appeared confident on Wednesday that they will confirm the Notre Dame law professor and judge on the 7th US Circuit Court of Appeals by the end of the month, giving conservatives a strong 6-3 majority on the Supreme Court.

Biden is also in better position than Clinton was in swing states – and could even win the race on or shortly after election night if his large leads hold – but pathways to a Trump victory remain. 

The simplest pathway for Biden to win the election is through Big Ten country, by winning three states that Trump won in 2016 by razor-thin margins: Michigan, Pennsylvania and Wisconsin.

"The blue wall has to be reestablished,” he said.

"You've got almost a counter-trend going in those battlegrounds states where the average is going up for Biden. Trump has to break into one of those three states unless he can pick up a Clinton state from 2016,

If Biden wins all three and carries each of the states that Clinton won, he's the next president.

"That (Rust Belt) wall is really the first line of defense for Biden, and right now that looks pretty solid, but anything could change," Paleologos said.

The reason: Pennsylvania and Wisconsin don't allow the processing of mail-in ballots to begin until Election Day and Michigan only has a 10-hour start, compared to other states that start that can start the process days or weeks in advance

Trump won each of these states in 2016 by less than 4 percentage points. But Biden has polling leads, albeit small, in all three.

Conversely, Biden would still have life if Trump were to carry Florida, Arizona and North Carolina. The former vice president would need to carry every state that Clinton won in 2016 and flip Michigan, Wisconsin and Pennsylvania.

Texas and Georgia have long been targets of Democrats because of diverse demographics and growing populations in suburbs.

Minnesota, with 10 delegates just like neighboring Wisconsin, last voted for a Republican president in 1972, but the Trump campaign continues to tout its chances there.

Infection numbers in Massachusetts are eight times what they were on Labor Day and hospitalizations have quadrupled.

In Illinois, the virus is now the third leading cause of death behind heart disease and cancer.

More than 250,000 Americans have so far died of the virus -- a higher death toll than any other country -- and a forecast by the US Centers for Disease Control and Prevention projects that number could rise up to 298,000 by December 12.

"It's all about absolute adherence to wearing a mask, avoiding crowds, and yes, we can keep the economy open but we're going to have to diminish indoor places like indoor dining and restaurants."

Only one US state, Hawaii, is showing a decrease in new cases greater than 10% compared to the previous week. Five others -- Idaho, North Dakota, Iowa, Illinois and Arkansas -- are holding steady, while the remaining 44 states are showing increases in new cases greater than at least 10% compared to the week prior.

the 7-day average of new cases is at its highest ever: 161,165 cases a day. That's up 27% compared to last week.

"Virtual gatherings remain the safest way to bring friends and family together from distant points. Outdoor settings can reduce the risks of gatherings with people outside of your household," the group said, also highlighting the importance of face coverings.

New Jersey Gov. Phil Murphy told CNN he wanted people to stay with their immediate family on Thanksgiving and to keep gatherings small -- "not just for next Thursday ... but for the next couple of months."

"This is not a normal year, it's not a normal Thanksgiving, Hanukkah, Christmas, New Year's. Folks have got to stay small, stay within the bubble of their own loved ones, and if we do that, that will be a down payment on a back-to-normal holiday season next year."

There were 79,410 hospitalizations reported on Wednesday, a record high for the United States, according to the Covid Tracking Project. The country is now averaging 72,120 hospitalizations over the last 7 days -- a 19.76% increase compared to last week.

"As a health care provider we are on 250 days of having a Covid patient in our ICU right now,"

"So every day, you walk into work, someone is super sick, someone is potentially dying that day."

"On a normal day, I don't have people dying every day," she said, adding that first week she had three people die in one day -- two of them, from Covid-19.

Students in the country's largest school district are transitioning to remote learning on Thursday following the closure of New York City schools. The decision came after the city's test infection rate reached 3%, a threshold Mayor Bill de Blasio said would trigger such a closure.

Kentucky Gov. Andy Beshear also announced new measures that will go into effect Friday, including limiting social gatherings to a maximum of two people from no more than two households, and prohibiting indoor service for restaurants and bars. And starting Monday, schools should begin remote learning, the governor said.

In Minnesota, the governor said the state is at a "breaking point" and announced a four-week dial back that will "help prevent more families from losing a loved one and ensure our hospitals can treat those who fall ill."

"As hospitals near the crisis of turning away new patients, continuing as things are is simply not sustainable," Gov. Tim Walz said.

A final analysis of the Phase 3 trial of Pfizer's Covid-19 vaccine shows it was 95% effective in preventing infections, even in older adults and caused no serious safety concerns, the company said Wednesday. It said it will seek a US Food and Drug Administration emergency use authorization "within days."

The Pfizer analysis came just days after a separate vaccine maker, Moderna, released early data showing its vaccine was about 95% effective.

Distribution is expected to begin within 24 hours after a vaccine receives the green light, according to Gen. Gustave Perna, who is helping oversee Operation Warp Speed.

"We'll be more ready next week, and if the vaccine is available, we have to go with what we have. We may not be perfect, but every day we're more prepared than we were the day before," he added.

“We said yes to science. We said yes to vaccines. We said yes to ending this pandemic. We said yes to people’s right to vote without fear of fake fraud and voter suppression

“As a health care worker, it was important to me to have a governor who follows science,” said Marc Martino, 26, who was dressed in blue scrubs as he dropped off his ballot in Irvine.

it was the politicization of the pandemic that propelled it onto the ballot as Californians became impatient with shutdowns of businesses and classrooms

Initially, Mr. Heatlie’s petition had difficulty gaining traction. But it gathered steam as the pandemic swept California and Mr. Newsom struggled to contain it

Though polls showed that the recall was consistently opposed by some 60 percent of Californians, surveys over the summer suggested that likely voters were unenthusiastic about Mr. Newsom.

President Biden, Vice President Kamala Harris and Senators Elizabeth Warren of Massachusetts and Amy Klobuchar of Minnesota traveled to California to campaign for Mr. Newsom, while Senator Bernie Sanders of Vermont and former President Barack Obama appeared in his commercials

The governor charged that far-right extremists and supporters of former President Donald J. Trump were attempting a hostile takeover in a state where they could never hope to attain majority support in a regular election.

Democrats outnumber Republicans two to one in California, and pandemic voting rules encouraged high turnout, allowing ballots to be mailed to each of the state’s 22 million registered, active voters with prepaid postage. More than 40 percent of those Californians voted early.

Recall attempts are common in California, where direct democracy has long been part of the political culture.

We said yes to women’s fundamental constitutional right to decide for herself what she does with her body, her fate, her future. We said yes to diversity.”

Californians who at first were supportive of the governor’s health orders wearied of shutdowns in businesses and classrooms, and public dissatisfaction boiled over in November when Mr. Newsom was spotted mask-free at the French Laundry, an exclusive wine country restaurant,

The recall campaign, the two men said, had expanded the small cadre that began the effort into a statewide coalition of 400,000 members who are already helping to push ballot proposals to fund school vouchers, forbid vaccine mandates in schools, and abolish public employee unions, which have been a longstanding Democratic force in California.

About one-quarter of the state’s registered voters are Republicans, and their numbers have been dwindling since the 1990s,

He took note of the voter fraud accusations that some in his party began to make well before the polls closed, echoing Mr. Trump, who claimed without evidence that Democrats had “rigged” the recall election.

Some Democratic observers were circumspect, warning that the disruption caused by the recall effort hinted at deeper problems.

And until the issues that created it get dealt with, people in power are in trouble. There’s a lot of anger and fear and frustration out there.

the governor moved aggressively to demonstrate that the state could both protect its economy and curb the virus. In recent months, he has rolled out vaccinations, cleaned up trash in neighborhoods neglected by pandemic-worn Californians, thrown motel rooms open to homeless Californians, announced stimulus checks and rent assistance for poor and middle-class Californians and stood repeatedly in front of a gold lamé curtain to host one of the nation’s largest vaccine lotteries.

Mr. Newsom and his team quickly cleared the field of potential Democratic alternatives.

Mr. Newsom painted the recall effort in national, partisan terms and rejected a defensive posture. His strategy galvanized major donors and his base.

Millions of voters chose not to answer the ballot’s second question, with Mr. Elder receiving about 44 percent of the vote from those who did. Kevin Paffrath, a Democrat, and Kevin Faulconer, a Republican and former mayor of San Diego, each had about 10 percent of the vote as of 10 p.m. Pacific time.

California has no limits on donations to committees for and against recalls, but the state caps contributions to candidates from individual donors.

Mr. Newsom capitalized on the rules, raising more than $50 million just in donations of more than $100,000 to oppose the recall.

For many patients and their families, hospital fees are already complicated, opaque and stressful. The Kingsburys show just how little control consumers have.

None of this has been clear to consumers—until this year. Hospitals and insurers have long set prices through confidential negotiations. Starting Jan. 1, hospitals were required to make their prices public under a Trump administration policy that sought to expose the sector’s pricing to greater market pressure.

Compliance with the rule has been spotty, but the available data show that prices vary widely among the plans that negotiate contracts with hospitals. While the data remains difficult for consumers to use, knowing the full range of rates could ultimately help patients negotiate their bills.

Healthcare economists note that prices in other sectors, such as airlines, can also vary for the same service, but hospitals’ steep prices mean the dollar difference between the highest and lowest rates can amount to tens of thousands of dollars. “The order of magnitude of healthcare costs is different,”

Even within an insurance plan, prices aren’t consistently low or high. A plan’s prices for one service can be among the lowest a hospital negotiates, but among the highest for another,

A person insured by Minnesota-based HealthPartners would have received the most favorable price for a hospital stay because of back problems, but the cost of an emergency room visit with the same insurance was among the highest, according to the Journal’s analysis of the data.

When insurance didn’t cover some treatments, the Journal found, Avera McKennan Hospital set its own prices that ranked among the highest anywhere in the U.S. in the Journal’s analysis.

The LifeShield price of about $780 amounted to a discount of 53% off the hospital’s charge. Ms. Kingsbury paid all of it because her plan’s benefits didn’t cover the rest of the bill. The insurance was exempt from some federal rules that protect healthcare consumers. LifeShield didn’t respond to requests for comment.

Ms. Kingsbury earned roughly $17,700 last year, tax records reviewed by the Journal show. Her husband, who is retired, received about $22,800 in yearly income from Social Security. They bought insurance in 2019 from LifeShield National Insurance Co.

The range of prices is the product of a complex interplay of multiple payers and hospitals, and a lack of competitive pressure to hold down costs, economists said. Rates have been determined by trade-offs at the bargaining table between hospitals and insurers—such as an offer of cheaper prices in return for more business—and by market power, with higher prices where hospitals dominate.

Hospitals and insurers ultimately bargain for prices to meet financial targets for revenue and profit, said David Dillon, a healthcare actuary with the consulting firm Lewis & Ellis Inc. “It is kind of as simple as both sides of the table have their revenue requirements,” he said.

“The market for healthcare just doesn’t look at all like the market for tomatoes because somebody else is literally negotiating and purchasing on your behalf,” Mr. Cooper said.

The cost for the scan under LifeShield was $1,497, almost half the price charged under Avera. However, Ms. Kingsbury’s plan at LifeShield was exempt from Affordable Care Act rules to prevent gaps in coverage. LifeShield didn’t cover this scan. So Avera charged Ms. Kingsbury the price it sets for patients not covered by insurance, at $8,451, one of the highest prices in the Journal’s analysis of publicly available rates nationwide.

“Healthcare is a service and it can be an expensive service, especially for a serious condition. That’s why health insurance exists,” said Avera spokeswoman Ms. Meyers. “It is important for consumers to understand what they are buying and the coverage it provides.”

The Journal compared Avera McKennan’s 2019 PET CT price for Ms. Kingsbury with the price Medicare would pay, as calculated by price-comparison startup Turquoise Health Co. The hospital’s cash price for Ms. Kingsbury in 2019 was 5.7 times the Medicare rate, according to the Journal’s analysis using newly public data collected by Turquoise. That’s one of the highest multiples of any of the more than 1,200 U.S. hospitals in the analysis.

The economic and social costs of the Chinese strategy have climbed with the rise of more easily transmitted variants. Retail sales, tourism and manufacturing have suffered from residential lockdowns, business closures and travel bans. A population that largely supported zero-Covid measures early on has tired of tight limits on the routines of daily life.

Her food is running low, she said. On Monday, Ms. Wang got her first food delivery from the government: two zucchini, a carton of milk, 10 sausages, noodles and a can of Spam. “As someone who hasn’t been infected by the virus, my biggest question is, ‘How long do we have to endure such lack of freedom?’ ” she said.

Before the latest outbreak, Mr. Xi and other top officials saw Shanghai as a model for China’s long-term goal of living with the virus, according to the people close to government decision-making. 

Shanghai, run by a close ally of Mr. Xi, never had serious problems. The few cases that had surfaced in the past two years were secured with limited apartment and neighborhood closures. Unlike the rest of China, mask-wearing wasn’t widely adopted by city residents.

Then an influx of visitors arrived from Hong Kong, hoping to escape an outbreak there. Many stayed at a Shanghai hotel where officials say the virus spread in early March to the staff and beyond. At the time, city authorities said wide-ranging lockdowns wouldn’t be necessary.

in undisclosed comments to members of the Politburo Standing Committee, Mr. Xi made clear that China couldn’t back down from its stringent Covid approach, even if it meant slower economic growth, according to a person close to decision-making who was briefed on the remarks.

A few days later, Shanghai initiated a two-stage lockdown. Speaking at a teleconference with other infectious-disease experts around that time, Mr. Wu, China CDC’s chief epidemiologist, said Shanghai didn’t act decisively enough in the latest outbreak and missed its chance to control the outbreak,

In Shanghai, people with Covid-19 are confined to home, and access to medical care for those with other illnesses has been limited. Food deliveries, arranged by local authorities, have been delayed in some neighborhoods, according to interviews with more than a dozen residents.

Local officials have reported no Covid-related fatalities. The Journal learned that at least two elder-care hospitals have been battling an outbreak, with more than 20 deaths at one of the facilities.

Thousands of users of Weibo, China’s Twitter-like social media platform, have shared stories of people with life-threatening illnesses such as cancer unable to get treatment, adding to citywide feelings of helplessness.

“Fighting all the previous variants was like putting out a forest fire, it can be done,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “But Omicron is like the wind. How do you stop the wind?”

The threats have had an impact on her and she worries that speaking out about it could make her more of a target. Other lawmakers declined to speak with CBS News because they didn't want to normalize the violent threats. "I'm trying not to let it get to me," Dingell said. "But it doesn't mean that some nights when you're home and alone and you don't have the husband you love anymore, you don't get scared."A year after the January 6 riot, the Capitol Police says the threats to lawmakers are at an all-time high. Roughly 9,600 threats were referred to the agency in 2021, about 100 more than in 2020. 

"We're being stretched. Let's be blunt. We're being stretched. We're keeping up, but this is not an ideal situation," he added. Capitol Police flagged about 460 threats against lawmakers' lives last year. 

Threats against lawmakers rise when members of Congress take rhetorical aim at colleagues, according to Scalora. After Colorado Republican Lauren Boebert likened Minnesota Democrat Ilhan Omar to a suicide bomber, both received threats.

The Capitol Police is now looking to investigate more of those threats itself and rely less on other agencies. Manger's intelligence unit has doubled the number of analysts available to monitor the threat landscape, especially online. The department is also looking to add 280 new officers this year and is opening field offices in California and Florida to investigate these threats more efficiently. 

ucing snowfall in the northern Plains and the Upper Midwest, with heavy snow in parts of Minnesota and Iowa coming down at rates of one to two inches per hour

In a weekend forecast, NBC’s "TODAY" weather anchor Al Roker said the storm system could bring 6 to 12 inches of snow stretching from the Dakotas down to Missouri.

Snow is also expected to develop over parts of the central and southern Appalachians, with pockets of rain and freezing rain potentially developing over the Carolinas and the southern Appalachians overnight Saturday into Sunday morning.

Roker said the system was expected to move south before making its way up the Eastern coast into Sunday and Monday, bringing heavy wind and rain if it continues along its expected track. On Sunday, a wintry mix is expected to hit parts of the Southeast, including Atlanta, as a significant ice storm unfolds across the Carolinas.

But after the number changes to 988 — a shift that involves upgrading telecom infrastructure and bringing more call centers online — use of the hotline is expected to grow exponentially over the next few years. (The current number is 800-273-8255.)

The only call center in South Carolina, for instance, until recently operated out of an old, dark basement, near a boiler room. The last remaining one in Louisiana has struggled to keep up with an influx of calls after another center closed and its replacement went offline during the pandemic. Minnesota and Wyoming have had periods with no centers at all. When local centers cannot pick up, calls are pushed to national backup centers, where counselors are less likely to be familiar with local resources and wait times can be too long for people in crisis.

As a teenager, she made dozens of late-night calls to the Lifeline. A volunteer named Chris, who worked the late shift, usually would pick up and talk her to safety. But during the last several years, she has found it increasingly difficult to reach a counselor. Several times, she said, she hung up and harmed herself.

A woman from Michigan, who said she waited twice for over an hour before hanging up, likened the experiences to calling airline customer service — except that she was seeking suggestions on “not killing myself.” A teenager from Mississippi recounted calling three times one night without getting through, and then overdosing.

For 988, such fees could also help pay for mobile response teams that can be dispatched to people in crisis, as well as for specialized triage centers — both significant, and costly, elements of what advocates see as a watershed opportunity to recast the delivery of mental health care.

“Our concern is very much about whether there will be someone to answer that call when someone is in crisis,” said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness.

“There are thousands of users — many of whom may be in suicidal crisis — who seek assistance and are unable to get the lifesaving help they deserve,” the report said.

Paying for 988, and what comes with it, has emerged as a contentious issue for states. Some lawmakers are wary of adding what they see as a new tax. Others think 988 is redundant with other resources. And telecommunications lobbyists, while broadly supportive of 988, have pushed back on some proposed fees.

“It is just like the United States Congress, though, to send us something like this” — with instructions that “you are going to fund it,” he said.

“With all due respect, 988 is going to save the taxpayers a whole lot of money,” he said.

“The crisis centers are like, ‘You don’t get any of those other things if people aren’t here to answer the phone,’” said Ms. Battle, director of access at the Harris Center, which provides services for mental health issues and developmental disabilities.

One goal of 988 is to eventually answer 95 percent of all incoming calls within 20 seconds. The data analysis showed that only two states had Lifeline answer rates above 95 percent in the fourth quarter of last year. Thirty-three states had more than 15 percent of their calls abandoned.

“People call in their most dire state of need.”

West Virginia’s lone call center answering the Lifeline, First Choice Services, also answers more than 15 other numbers, including ones for gambling, tobacco and drug and alcohol addiction, most with volume rising during the pandemic.

“We have a very real fear that without funding our program in a substantial way,” she said, “our West Virginia callers will suddenly be facing what has been a problem nationally.”

ne thing I’ve learned in my years of whining about Florida’s unsustainable trajectory in the climate era is that most Floridians don’t care.

especially if they’re newly retired to Florida. They’re here to enjoy the warm weather in a state with no income tax, not to build a better tomorrow for future generations.

Usually, it’s just nice. It’s certainly way nicer than Boston or Brooklyn, or Michigan or Minnesota, in the winter.

DeSantis has risen to national prominence behind a very Florida form of now-mine-more messaging, proclaiming this the “free state” of Florida, where you don’t have to worry about public-health scolds telling you to wear a mask or get a vaccine, or pointy-headed planners telling you where to build your house or when to water your lawn. He’s selling irresponsibility as a virtue. Worrying about consequences is for losers.

My insurer went bankrupt last month, one of six to go under in Florida this year, and the state took over my policy, as it surely did for thousands of Floridians who will now file claims. But the Republican leaders who have assumed for the past quarter-century that the feds will bail us out after the Big One were probably right. We’ve gotten too big to fail.

Mr. Christie’s criticism of the former president’s Middle East record is significant. The peace agreements struck by Israel with the United Arab Emirates, Bahrain, Sudan and Morocco, collectively known as the Abraham Accords, are widely seen as perhaps Mr. Trump’s most important diplomatic accomplishment. And Republicans have offered high praise for decisions like moving the United States Embassy in Israel to Jerusalem from Tel Aviv.

Mr. Christie offered higher praise for Mr. Biden’s handling of the Israel-Gaza crisis, including his Oct. 18 visit to Israel, where he met with Prime Minister Benjamin Netanyahu.

He accused Mr. Trump of cynicism in his handling of the once broadly bipartisan U.S.-Israel relationship and held him responsible for fractures over Israel within the Democratic Party.

Mr. Christie was quick to say that he did not blame Mr. Trump for the bloody hostilities in Israel. The timing of Hamas’s attack reflected larger geopolitical dynamics with Iran, Russia and China, he said.

He wholeheartedly embraced every policy pressed by Israel’s conservative government, including moving the embassy, recognizing Israel’s annexation of the Golan Heights, withdrawing from Mr. Obama’s deal with Iran to temper its nuclear ambitions and pursuing regional peace agreements between Israel and the Persian Gulf states that isolated Palestinians and marginalized their demands for political autonomy.

Mr. Christie argued that Democratic voters, in turn, had reflexively opposed anything embraced so wholeheartedly by Mr. Trump, including by electing representatives to Congress like Rashida Tlaib of Michigan and Ilhan Omar of Minnesota, whom they saw as fierce opponents of Mr. Trump. Those new lawmakers on the Democratic left then opened an anti-Israel wing of the Democratic Party that is straining the U.S.-Israel alliance.

Meanwhile, he said, the cause of Israeli-Palestinian peace, once considered the holy grail of presidential diplomacy, was all but forgotten.

Mr. Christie said that President Barack Obama’s policies had been perceived as favoring Israel’s enemies and that Mr. Trump had seized the political opening that presented:

“I don’t think he was equipped to deal in a foreign policy way with a very difficult, if not impossible, issue, right? And I don’t think he has any ambition,” Mr. Christie said. “I think he was looking for what would be relatively direct and easy scores because his view always was political.”

Before arriving in Israel, he spoke of the difficult balancing act between the vital need for Israel to defend its territory and its people and concerns about the growing backlash around the globe.

“We’ve been there after 9/11,” he said. “We understand the visceral need and the practical need to retaliate and degrade Hamas.

“But don’t have exclusively a near-term view,” he advised. “And that’s tricky for somebody like Netanyahu and the political position he’s in at the moment, because, you know, there’s certainly going to be a reckoning whenever the war is considered concluded, as to how Israel got there in the first place.”

“Ultimately, it’s in Israel’s best interest and the world’s best interest. But I think the actions that Hamas took on Oct. 7 has made that resolution significantly more difficult and more long-term. And I think that’s one of the real shames of their actions,”

“I don’t think Trump’s an antisemite,” even though he has routinely espoused stereotypes of Jews, Mr. Christie said. But, he added, Mr. Trump’s “intolerance of everybody” is “what’s contributed to” the surging bigotry.

“He says what he says, without regard to the fact that he’s perceived as a leader and that his words matter,” Mr. Christie said. The bigots “think you’re giving them permission be a bigot,” he added, “and that’s even worse than them thinking you are one.”

“I think he’s a guy of the 1960s from Queens, New York, with certain attitudes that he probably learned from his parents,” Mr. Christie said.

But he was less sympathetic about the bigotries that he said Mr. Trump had unleashed.“His rhetoric contributes to it,” he said. “By his rhetoric, I mean, his intolerance of everybody. Everybody hears that dog whistle a different way.”

I think that the age of the New Democrats, which was a very successful political project for the Democratic Party, has come to an end. The assumption of that politics, which began in earnest in the late 1980s and early 1990s, was that the Cold War had been settled, that democracy had prevailed, that the West was ascendant. But with China’s decision to take the route that they’ve gone on, with Russia now having waged this intense insurgency against the West, the assumption that that system is going to prevail in the world is now under question.

Rosenberg: Any honest assessment of the New Democrat project has to view it as wildly successful, because when I went to work for Clinton in 1992, Democrats had lost five out of the six previous presidential elections. And the central project of the New Democrats was to make the Democratic Party competitive at the presidential level again. Since then, we’ve won more votes in seven of eight presidential elections

I think that it’s birthing now for the United States a different era of politics, where we must be focused on two fundamental, existential questions. Can democracy prevail given the way that it’s being attacked from all sides? And can we prevent climate change from overwhelming the world that we know?

I want to try to write a book and to take the perspective of having been part of the beginning of the last big shift in American politics, the emergence of the New Democrats, and start imagining what’s going to come next for the center left in the United States and around the world.

Simon Rosenberg:

We’ve also seen three Democratic presidents that have served [since then]—Clinton, Barack Obama, and Joe Biden have also made the country materially better during their presidencies.

what’s the main lesson you take from his emergence?

Rosenberg: Yeah, it’s obviously disappointing. The emergence of what I call “Greater MAGA” has been a dark period in our history.

You have to recognize just how central to that is this narrative of the white tribe rallying around itself, and the sense of grievance, the sense of loss, the sense of decline. That’s what MAGA is. That’s all it is

We know from history, we know from other countries, when countries go into sectarian or tribal warfare, it can destroy a country, pull it apart. And Trump has created a domestic argument here that could potentially destroy the U.S. Look at Marjorie Taylor Greene this week—advocating for the country to split into two, red and blue.

Part of the reason I’m taking a step back from NDN is that I don’t think that we have yet figured out how to talk to the American people about the nature of the conflict we’re in right now, with rising authoritarianism around the world, the weakening of democratic institutions here and in other places.

My hope is that because Biden won’t be able to legislate very much for the next two years, he’ll spend his time talking to the American people and the West about the necessity of winning this conflict.

Rosenberg: The threat is still here. Look, I think [Florida Governor] Ron DeSantis is even more MAGA than Trump. This idea that in 2024, Republicans are going to end up with a moderate, center-right candidate and distance themselves from the insanity of the Trump years, that’s just fantasy talk.

DeSantis has decided to double down on extremism and on MAGA. We will learn in the next year and a half about how it all plays out. But I think he misread the room; he’s misread the moment in history. He needed to become an anti-Trump; instead, he became more Trump than Trump

In this last election, there were really two elections. There was a bluer election inside the battlegrounds, and there was a redder election outside the battlegrounds. We actually gained ground in seven battleground states: Arizona, Colorado, Georgia, Michigan, Minnesota, New Hampshire, and Pennsylvania. It’s an extraordinary achievement given high inflation, a low Biden approval rating, traditional midterm dynamics. My view is, that happened because the fear of MAGA has created a supercharged grass roots; our candidates are raising unprecedented amounts of money; we have more labor to work in these races than we’ve ever had before. And where we have these muscular campaigns, we were able to control the information environment. And also push turnout up through the roof.

But outside the battlegrounds, we fell back in New York and California, and in Florida and Texas, the four biggest states in the country. And the admonition to us is that we are still not competitive enough in the national daily discourse;

Republicans, because of this incredible noise machine that they built, are still far louder than we are. Democrats have to become obsessive about being more competitive in the daily political discourse in the country.

We have to build more media institutions. Republicans use ideological media to advance their politics in a way that we’ve never done. And we’re going to have to match that to some degree.

The second piece is that average Democratic activists have to recognize that they need to become information warriors daily

I think the way we have to think of the war room now, it’s 4 million proud patriots getting up every day, spending a little bit of their day putting good information into our daily discourse to try to crowd out the poisonous information and right-wing propaganda. There’s a lot that average citizens can do in this.

The key is to defeat MAGA in such a definitive and declarative way that Republicans move on to a different kind of politics and become something more like a traditional center-right political party.

We must stick together as a party because what will cause far-right political parties to succeed is when the prodemocracy coalition splits, and we can’t allow that to happen. As much as sometimes we want to have interfamily battles, those are self-indulgent at this point.

I don’t think that this emerging criticism is entirely wrong, but it’s only half right. The goal should be to expand, not to reposition. There are four areas that I think we have to bear down on in the next two years for a potential Democratic expansion: young voters, Latinos, Never-MAGA or -Trumpers, and young women, post-Dobbs.

The No. 1 job is we just need more young people voting, period. It’s more registration, more communications, targeting them more in our campaigns. In the Democratic Party, young people are still at the kids’ table; they have to become the center of our politics now.

I think that we’re favored in the presidential election. For us to win next year, the economy has to be good. And we have to look like we’ve been successful in Ukraine. Those two things are going to be paramount in him being able to say, “I’ve been a good president, and I may be a little bit old, but I still got 90 miles an hour on my fastball, and I’m able to get the job done right versus they’re still a little bit too crazy.”

What the Republicans should be worried about is we’ve had three consecutive elections where the battleground states have rejected MAGA. And so, if the Republicans present themselves as MAGA again, which looks almost inevitable, it’s going to be hard for them to win a presidential election in 2024 given that the battleground has muscle memory about MAGA and has voted now three times against it.

The western world kept a buzz going for twelve years, and that’s an accomplishment. It must also be said that the 1990s weren’t squandered, because even in the dark years they were fun. They weren’t complicated.

the 1990s make great nostalgia bait: simpler politics, plus great music, plus cool fashion cues. And maybe we can create another halcyon bubble again one day!

The generation that came of age in the 1990s, now well into middle age, have a lot of happy memories of a sort that may never be possible to have again. At the moment any possibility of collective joy seems about as realistic as a Miss America contestant trying to wish world peace into existence

n the 1990s we still had the future, a place that you could travel to, that would be cool when you got there, like Australia or the South Pole. Right now we merely have a future, and a murky one at that, and it’s probably more like Kenosha, Wisconsin than Sydney.

I remember doing a book tour and ending up on a local AM radio station’s podium at the grand opening of Mall of America in Bloomington, Minnesota on 11 August 1992. It was full of Americans in alpha consumption mode, eating ice cream, faces beaming, walking around in unselfconscious bliss. The local radio jock said to me, “You must think all of this is pretty silly”. He motioned towards the crowd and then to a rollercoaster directly beside us that came screeching at our heads every 95 seconds.

But I said, “No. In a century people are going to look back on right now as a sort of magic era, a charmed time of peace and prosperity and freedom from fear, as something that can never happen again, no matter how much they wish it would”.

The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started

Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.

The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.

Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”

Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.

In the United States, an estimated 189 million adults are classified as having obesity or being overweight

The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight

For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.

The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify

if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”

How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk

The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years

the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.

adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?

“All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”

in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.

The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.

But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.

Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.

Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent

National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.

Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.

In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”

In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.

It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.

the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”

News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.

Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.

“I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”

She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”

For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.

In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.

In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.

he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.

Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.

Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.

An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.

when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.

The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.

although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.

sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,

that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.

Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.

From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.

obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”

she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions

Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.

if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it

She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.

Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size & Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.

“Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.

Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.

As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid

By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners

But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.

Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look

The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.

In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”

that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.

That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism

But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”

Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.

As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.

Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.

In the meantime, thinness was coming back into fashion

In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.

Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.

If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.

Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.

Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”

When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.

the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now

Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.

“The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”

The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways

When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”

why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.