The problem is she swallowed everything else too. The obesity is a massive problem that needs to be remedied and yes there may be side effects along the way but literally nothing else works for obesity except roux-en-Y gastric bypass. Palid skin is nothing compared to losing your foot to diabetes.
Nothing besides GLP-1s and roux-en-Y has been shown to help people lose a clinically significant (>5%) amount of their body weight and keep it off long term (>5y). Exercise does roughly speaking nothing to help you lose fat (it's great for all sorts of other things), and diet has not been shown to work long-term either due to changes in metabolic rate and hunger leading to ~zero compliance. Most people reverse trajectory around the 6 month mark, and average weight regain after 5 years is 80%.
Exercise most certainly helps you lose fat, and it helps you keep your blood sugar in check.
Exercise is often not good at helping people lose weight, but it is good at helping them lower their body fat and increase lean body mass.
You'd much rather someone be a muscular, overweight person than skinny-fat person. In particular, if you got someone lifting weights three times a week, it would have a noticeable impact on their body composition and overall health, regardless of weight.
The studies are pretty clear: aerobic exercise leads to some tepid reduction in body fat in exchange for massive effort, and resistance training increases fat-free mass but doesn't reduce fat.
> [aligned] with literature from the previous decade and recent systematic reviews concluding that participation in an exercise training program does favor weight loss, although of only modest magnitude. [1]
> Resistance training was the only exercise modality that failed to significantly decrease visceral adipose tissue. [1]
You suggest that "you'd much rather someone be a muscular, overweight person than skinny-fat person" -- but that's not really the case. Sheer fat mass, especially visceral adipose tissue, is what is associated with negative health consequences.
[edit] Even the article you linked to via the Times says the following.
> However, the amount of weight loss from exercise training is often disappointingly less than expected. [2]
Which aligns with their own findings that after 12 weeks of 3000kcal/week energy deficit they only lost about 5 pounds, see Table 2. So to lose 50 pounds you'd have to spend 2 years with a 3000kcal/week deficit, and keep adjusting periodically. The chances of compliance here are literally zero, and compliance is a major issue. In some senses, it's the major issue.
Also this study committed a major sin: they didn't follow up. Any study that shows anything meaningful in re: weight loss reverses after 6 months.
