I've been on tirzepatide (Mounjaro) for 4 months now. I'm down 13% of my body weight. I realized that frequent cannabis consumption interferes with the weight loss, so I've kicked the habit from daily to occasionally on weekends. I've started walking 2-3 miles a day, 2-3 days a week regularly, in addition to eating less and being more motivated to calorie count.
All this to say, this drug has been life changing for me. I spend more time doing things I want to do, depression and anxiety have less of a hold on me now. I feel that this drug has allowed me to be the best version of myself I have been in a long time. The only side effects so far have been positive. I do worry about what I will do once it's time to titrate off the weekly dose and the best I can think of is that the habits I'm forming in the time on the drug I will have the resolve to continue after cessation.
I say this because I have battled depression, anxiety and obesity issues my entire life. I've had many failed attempts at getting back to a healthy, productive and non-obese lifestyle. I don't know what is so different about having the drug help me, but I can tell you that it has been different.
Tirzepatide and Semaglutide are both known to reduce addiction / substance ingestion. I noticed I was just less interested in Alcohol when I started on Wegovy, and didn't realize it's a common effect until much later. I retained most of my disinterest after going off, too, FWIW.
The problem with this (and all diet plans/drugs) is the lifestyle that led to problem in the first place.
If you do not change your lifestyle, for real and not just superficially, then you will relapse with a vengeance.
That is to say, be careful with using a drug as a crutch. Sure, it can artificially make you much more interested in not consuming so many calories and/or perhaps being more active than before - but you have to continue that lifestyle after stopping the drug.
Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?
> Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?
Have alcoholics using Naltrexone? Or opioid addicts using Methadone, or smokers using nicotine gum/patches?
See I'm bringing this up to point out the obvious double standard, people suffering from food addiction (i.e. literally the high from food) or binge-eating disorder, who finally have an effective treatment, are treated like it isn't addiction or illness, but a "lifestyle," but if you said this stuff about any other addiction people would call you out and be horrified.
For people mildy overweight or accidentally obese, it is a wildly different illness for people with lifetime problems who have lost/regained weight tens of times and likely know more about nutrition than most healthy-weight people ever will.
The concern regarding a drug as a crutch is stil valid. Smokers/drinkers may deal with stress by smoking/drinking. After cessation, ways to deal with stress need to be learned from a new.
"Addiction" is ambiguous and a term almost better not used. "Addiction" may constitute chemical dependency but can also be largely a set of habits. A set of habits and lifestyle are pretty much the same thing.
Some things simply are negative, sure. I think we can all agree that murder is negative on the whole, for example.
But you are making a HUGE leap here in assuming that GLP1 agonists "simply are negative". You have not remotely supported this logical leap. All studies in fact have shown that GLP1 agonists are significantly positive: That they improve health, reduce obesity, reduce all-cause mortality, etc. You are denying observed reality across a large number of double blinded, objective clinical trials.
I just keep following your comments down the page and giving you upvotes.
I think folks using drugs (or meditation or habits or diet or any other thing) to intentionally make their life better is amazing and should be celebrated.
If some things are easy for you but not others try to be grateful for yourself without having to be petty or wanting others to be worse off.
To be clear, I don't think GLP1 agonists are "negative." I think the blend of environmental, food supply, and other factors that led many adults, in the US and elsewhere, to need obesity intervention is the negative. GLP1 agonists are an inherent crutch.
Much like if we geoengineered cloud seeding or similar light blocking and fail to reduce CO2, the treatment masks the cause and can lead to worse outcomes globally (even if some folks are better off - and I hope they are!).
However, if they are, then modern life is a sledge hammer that’s constantly breaking your legs.
Our (US, UK, Australia and so on) life styles and food chain have created this obesity problem.
We are now a sedentary population, and low-nutrient high-calorie food is being made readily available to stressed, tired, overworked, and economically challenged people. When you are stressed and tired, you don’t make the best choices!
These drugs are not so much a crutch as they are a rescue helicopter!
We still need education though.
These drugs might reduce hunger, but they won’t stop you from consuming junk-food. People are used to overeating, and a feeling full isn’t always what’s stopping them from eating!
So we do absolutely need to address the root of problem….
>These drugs are not so much a crutch as they are a rescue helicopter!
Yes, but once you’re rescued you hopefully try to avoid falling in the same situation that lead you to have to be rescued the first time. This should be a double approach solution, a short term (the drug) and a long term ( lifestyle changes) it can be done with the second only but personal commitment is required. Besides that we, as a society, are not accustomed to “subtractive solutions” they’re simply never considered or pushed by anyone because there’s no money on them. Money is in “creating solutions” not in “eliminating problems”
> Here I am looking from western Europe at 100% self-inflicted US obesity epidemics and shaking my head in disbelief, what kind of garbage and in what massive quantities you guys consume daily.
26% and climbing in the UK. 19% and climbing in Germany. 17% in France. 11% in Switzerland - and another 30% overweight. 20 years ago America was 32% obese. Do you want to bet that this is a uniquely American thing? That these numbers won't continue to climb in Europe? Hell, we're seeing them climb in Asia - South Korea's obesity rate among men went from 3.26% to 7.3% from 2009 to 2019, though women increased at a much slower rate.
> Sure, you can just literally throw money at the problem that is too scary for you to tackle it headfirst, or you can have a wake up call and make your life significantly better from now on and live longer. All is connected - it leads to higher confidence, happier healthier life. The key is to walk the hard path - overcome such a challenge will redefine who you are for the better. Taking pills every day because you can't avoid eating a cookie under stress won't, in contrary.
And plenty of people can keep moralizing about how everyone should do it The Proper Way and refusing to understand that while, yes, it is within the power of humans to overcome things with willpower, that there are situations that cause it to require significantly more willpower for some.
> Kids don't eat garbage because parents don't give them garbage, because parents don't eat and overeat on garbage.
This is a great example. A significant number of people end up obese because they're poor. This seems silly at first, right? Go to the grocery store, buy good whole food, cook, save money! There's problems with this: Many poor people work long hours and have difficulty finding the time or energy to cook. Even when they do, many of the cheapest food items are also the most calorie dense and worst calorie:satiety ratios. So this starts them on a cycle of eating the sort of food that makes you fat. And then the fatter you get, the more feedback cycles you have encouraging you to continue getting fatter - such as the well researched links between obesity and leptin. So they get fat, their kids get fat, and it becomes ever more difficult to stop being fat, all because that's the food they could afford to feed their families with.
> A significant number of people end up obese because they're poor... Many poor people work long hours and have difficulty finding the time or energy to cook.
Every one of those poor Americans has a vote. One vote per person, same as rich people. Experts have long noted that there are more poor people than rich people. There's nothing stopping them from doing what western Europeans did, vote in leaders who provide better working conditions, better worker protections and better pay, and other policies that reduce poverty.
If only there were a drug that suppressed political defeatism.
> There's nothing stopping them from doing what western Europeans did, vote in leaders who provide better working conditions, better worker protections and better pay, and other policies that reduce poverty.
On the local level, gerrymandering can quite literally stop them from doing that.
It is easy to call taking the medication easy, but nothing about it actually is.
Eating right, lifting, trying to be active… all of that on top of the nausea created by the medication itself.
Obesity is such a massive epidemic, and shaming people into feeling bad about it has clearly not worked. And that’s before you consider the genetic factors, environmental factors, food deserts, and the other dozen reasons it’s so hard to stay fit for some people.
I am genetically gifted in some ways; an athlete’s metabolism was not one of them. I can be extremely disciplined, but the constant vigilance creates this “food noise” in your head that’s hard to explain, but extremely stressful, and causes you to constantly be seeking the next meal.
It used to be that every single food I put in my mouth tasted amazing (within reason). Apparently this is not true for everyone, and they have a greater and sharper distinction between “foods that are amazing” and “foods that are just fine”. That distinction exists for me now, and never really did before this medication.
There are so many ways it has helped me. My blood labs are perfect, and my liver was definitely not perfect before. My A1C was just on the cusp of prediabetic, at 5.7%. My triglycerides, ALT, AST… all were wayyyyy higher than they should have been.
A1C at last test a few months ago was 5.0%, and all the other numbers are well within low-mid range of where they should be.
Anyone that looks at someone using GLP-1 medications and thinks they’re “cheating” is a child. You still have to put in the work; you still have to eat right and work out and lift. It just makes it actually possible to do that for the first time in many people’s lives. I don’t know if you’ve ever put on a realistic “fat suit,” but trust me when I say that everything is harder when you’re heavier. A walk around the block is an insane workout if you are 450lbs and haven’t walked in years. It’s not where you should end, but it is a start, and if there is a medication that helps someone start… everyone else can fuck right off. You will never find me shaming someone else or judging them for getting healthy, which is the actual point more than just losing weight.
There is one way to get off the medication in the future (or get on the lowest dose, etc): build significant muscle mass. That’s why it’s so important to lift.
One common argument I’ve heard against GLP-1 meds is the idea that you’ll have to be on the meds forever. And for some people, maybe even most, that may be true. We don’t know yet.
But you know what’s worse than being on a GLP-1 med forever? Being obese forever. We know precisely just how that kills so many of us.
But you’re right, we should just go back to the way it was. That seemed to work just fine. :/
I don't think the point is that GLP-1 inhibitors are "cheating," but that maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life. So many people regain all the weight they lost after stopping these drugs, so it doesn't make meaningful progress and just covers the problem.
At some point, we may find that these drugs cause long-term health problems of their own, too.
> maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life.
It doesn't work for nearly as many people as GLP-1 agonists do. There are many different treatment methods that have been tested and evaluated, and being told to diet and exercise through therapy barely works at all. GLP-1 by contrast works very well.
> At some point, we may find that these drugs cause long-term health problems of their own, too.
Almost sounds like wishful thinking on your part -- you might want to stop and consider why you're so invested in these drugs having long-term side effects.
CBT is very good at breaking addictions and other bad thought patterns, and it is the scientific basis on which most hard drug rehabs work. There's no reason to suggest that it works less on food than on heroin.
> There's no reason to suggest that it works less on food than on heroin.
And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related.
The people who GLP-1 drugs help have not “never tried anything,” including but not limited to “real therapy.”
If CBT and other modalities help someone, great! But they often don’t, and when they don’t, it’s absurd to want them to continue to suffer instead of get help with medication.
> And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related.
Citation needed. As I understand it, serious therapeutic psychological treatments for obesity are highly stigmatized in the US. You may be projecting your own experience onto a group that does not share it.
By the way, CBT as used for depression and for obesity are totally different types of CBT. CBT methods are highly tailored to the specific thought pattern you want to prevent.
> I don't think the point is that GLP-1 inhibitors are "cheating," but that maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life.
There is no guarantee that I’ll have to be on it for the rest of my life. But also, I was not “addicted” to food.
I spent 18 months changing my lifestyle, nutrition, and exercise habits, and I lost zero weight. I gained health (hikes were no longer a problem, I was fully capable of working out after enough time doing it, etc.), but no weight loss.
Yes, I tracked. Yes, I ate below my expenditure. My body holds onto weight.
So yeah, I agree with more help for people with addictions, period. I do not see how it is a “replacement” for a medication that is clearly helping people.
A lack of therapy was not my problem.
> So many people regain all the weight they lost after stopping these drugs, so it doesn't make meaningful progress and just covers the problem.
> At some point, we may find that these drugs cause long-term health problems of their own, too.
Or we may not; these drugs have been around since 2005. They’re not new, despite most people having just heard of them now.
But we know for a fact that obesity kills.
Again: your contention is that instead of using this medication that helped me get healthier over the last 7 months and will help me get healthier yet over the next 7-8, you would have preferred that I “accept” that I have a problem imbued with negative morals (“addiction”) and try my hardest to break it. The thing is, I had already done that for the entirety of my life, remained obese, and would have died of it eventually.
Can I be disciplined? Absolutely. I even lost 55 lbs doing keto for 10 months. I ran a startup, and successfully sold it.
Discipline wasn’t my issue.
I’m not suggesting you should use a GLP-1 med. I’m suggesting you shouldn’t be the arbiter of whether it is helpful or not; it’s effects should be.
I was not talking about your personal experience. You may have actually benefitted from the main intended pharmacological effects of this drug, since it appears to be affecting your metabolism (your "body holds onto weight" comment suggests that). This is a diabetes drug, remember.
The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food. Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns.
> The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food.
Citation needed. This is the main assumption you are making that I, and others, vehemently disagree with.
The implication is that this is the first time people have suddenly decided they don’t like being obese. That’s absurd. The people on these medications have tried everything. Talk to literally any obesity doctor and ask them about their patients.
This assumption is the problem. Nothing about the meds is easy. It just makes it possible for people to change when they couldn’t before.
I don’t know why people feel a need to argue against that.
> Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns.
Sure, and I don’t disagree. And I’m all for people doing that too. If it works, great!
On average, it doesn’t, for the vast majority of people, though it does work for some, and that’s great. I agree it’s a preferable approach. But if it worked for most people, it would have worked.
But if it doesn’t work? Previously, people just accepted that they were going to be obese and miserable, and that it was their fault, which led to depression, etc., further making it “impossible” to ever fix.
So if there is a medication that helps people change their lifestyle to get healthy, and also appears to be extremely effective, and has a good safety profile… that’s bad?
> The people on these medications have tried everything. Talk to literally any obesity doctor and ask them about their patients.
Citation needed on this one. Almost all the obese people I know have never seen a specialist doctor about it, so I assume your anecdata have selection bias. The people who see obesity doctors are the ones who have tried everything. Not the average obese person.
I don't personally mind if you or anyone who really needs it and gets prescribed the thing by a specialist takes Ozempic. I don't think any drug use, be it Ozempic, abortion pills, or estrogen, should be stigmatized for the individuals taking it. I do think it's a sign of a societal ill that a large majority of the people taking Ozempic are not in that situation.
> Citation needed on this one. Almost all the obese people I know have never seen a specialist doctor about it, so I assume your anecdata have selection bias.
You sure? Nearly every single one I know has seen their primary about it every time they go in and if the primary referred them to a specialist they went.
What they don’t do, though, is talk about it.
Have you asked them?
> I don't personally mind if you or anyone who really needs it and gets prescribed the thing by a specialist takes Ozempic. I don't think any drug use, be it Ozempic, abortion pills, or estrogen, should be stigmatized for the individuals taking it.
Great, agreed.
> I do think it's a sign of a societal ill that a large majority of the people taking Ozempic are not in that situation.
I don’t think it’s true that “a large majority” of the people taking it are just handed the pills for fun, to lose a few pounds. Your assumption about to whom they are prescribed is my whole issue, as it assumes they don’t need it to lose weight and can “just eat right and work out,” and that is not true.
People who are obese don’t like being obese. They aren’t that way because they don’t care. They aren’t that way because they are lazy. (On average)
No, Wegovy and Zepbound are not diabetes drugs. They are weight loss drugs.
> ... but problems with controlling themselves around food.
Problems that Wegovy and Zepbound solve for most people taking them, when no other solution worked for those people.
> There are hugely beneficial approaches that rely on CBT,
CBT is much more expensive, time-intensive, and less effective for weight loss than GLP-1 drugs. It also scales incredibly poorly, as you need a huge number of therapists. There are roughly a hundred million obese Americans. We can make enough drugs to treat all them, but can we make and pay for several million therapists to perform CBT on all of them, all for less efficacy than the GLP-1 agonists? Fat chance.
Exactly! For many drugs it's essentially a funny accident of history that they were originally discovered while attempting to cure something completely unrelated to what is now their primary usage.
>The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food
Quite frankly this is an incredibly absurd statement. Do you realize that our brains entirely control our behavior? An issue with self control is a brain issue, and very well may be an endocrine issue. Are you an endocrinologist?
Even if you were completely right, you might as well start shaming Africans for "needing" malaria vaccines. Europe is not America. What you call a self inflicted epidemic is generally accepted as a disastrous food situation because of market forces with no government incentives to foster a culture of healthy eating. And I'm underweight FYI before your European high horse starts lobbing more uncalled for insults.
What's the explanation for why GLP1 medications are negative things? There are a very minor subset of people that have some medically significant adverse reactions, but it is VERY small. We don't have any evidence to my knowledge of any long term risks with being on it.
The GI issues tend to be minor. Unpleasant, but not exactly any more debilitating than a lactose intolerant person deciding that they really really wanted that extra large milkshake. Some people have it worse - but those, to my understanding, very much are in the minority.
Tirzepatide also has significantly fewer GI issues.
Muscle mass loss happens in any sort of weight loss where you don't eat enough protein and get enough exercise. There's no current evidence that when you control for calorie deficit, diet macros, level of exercise, bmr, etc., that people lose more muscle mass on GLP1 agonists to my knowledge.
This. You'll need studies to prove that semaglutide causes muscle mass -so you need to have a group that loses weight using semaglutide and another group that loses weight without it and compare the muscle loss. I'm willing to bet you'll see similar numbers. If you don't exercise, you will lose muscle mass when reducing weight - which is why trainers recommend resistance training and higher than usual protein while cutting.
GI issues are almost always minor. Folks are used to zero discomfort in their lives so the social media reporting of such is wildly overdone.
Tirzepatide is being investigated as a therapy for IBS. Within two weeks of being on the drug I was able to start living a life not scheduled around being near a restroom. This was suggested as a potential side effect by my doctor before taking it for weight loss, due to the GIP component in the drug which slows down your digestive track.
It could be I’m eating less. However I have went on crash diets before with absolutely no change to my constant lifetime GI issues, and have eaten extremely clean the past half decade due to a partner who cooks amazing healthy meals that would exceed most definitions of the term.
I’ve long since reached my goal weight and target body composition- but I plan on sticking to a low dose of Tirzepatide for the rest of my life since it gave me my life back. No more popping Imodium every few hours on vacation while simultaneously fasting. Just a normal life these days. I can enjoy a breakfast if I feel like it without it ruining the rest of my morning. Heck, I can even eat shitty greasy food at the state fair with only mild discomfort most folks would have from such poor choices.
Every study (still limited in number) I’ve read more or less refutes all the social media hysteria. There is a whole lot of smoke but no fires yet to be seen. They may still be coming.
The things that are not wholesale misinformation seem to be the requirement to cease use many weeks before going into surgery, potentially needing to be on it for your whole life, and the side effect it currently has on your finances. Nothing else seems to hold up under scientific scrutiny yet.
Perhaps I will regret this decision in 20 years, but I’m willing to take that risk to have some of the best quality of life years I’ve had yet.
Sure. But what's the proposed mechanism? For many - not all, obviously - medications, we have an understanding of potential long term risks. Animal studies catch some of them, others we know are potentially risky even without animal studies, e.g. drugs that increase angiogenesis have a risk of increasing tumor growth.
But no one has proposed mechanisms for GLP1 peptides.
Meanwhile, we know obesity is one of the largest long term risks to health in existence, and one of the most prevalent.
> But no one has proposed mechanisms for GLP1 peptides.
I'm worried about long term malnutrition leading to significant loss of muscle mass, osteoporosis, and other deficiencies that eventually lead to infirmity and brings forward the immobility death spiral much earlier in late age through weak muscles and bones. Most of the long term studies on GLP-1 agonists that I've reviewed have been on diabetic patients who already had to carefully control their diets and we still don't know what decades of poor diet on Ozempic will do.
For very obese people the tradeoff is still pretty damn good though.
Probably more or less the same as to what happens with skinny people who have a garbage diet but just eat less or have significantly higher metabolisms.
It's not great.
The good news is it's quite commonly reported (and I can add my anecdotal experience to the chorus) that I don't crave the food that's worst for me in any real quantity anymore. Even if I'm busy and need to scroll through uber eats, I'm not using it as an excuse to get a delicious but large, fried, high in carbs, high in fat meal. It's way easier for me to say "yeah that tastes good, but I'll grab the grilled chicken wrap and brown rice."
I'm not sure on what causes this - we have some preliminary studies around GLP1 peptides, dopamine, addiction, etc., so it might be something there. But the sheer number of people you hear talking about it makes me believe we'll have some studies that do look into it in the future. It might not happen to everyone, and some people might still just choose to eat poorly even if it does, but in both situations people's longterm health depends on them listening to advice on how to eat better and exercise, and I think most people would rather be average weight and metabolically unhealthy than obese and metabolically unhealthy.
One obvious risk would be blunting of longer term GLP-1 receptor activation. Imagine type 2 diabetes but for ghrelin.
To use an analogy amphetamines have a honeymoon period, and it feels like a lot of people on these weight loss drugs haven’t been on them long enough to get past the honeymoon period and see what the effects are after 10, 20, etc years
It's possible. But, we've had another GLP-1 medication in use for about a decade and a half now - liraglutide. So far, we haven't seen evidence of that occurring.
I don't think anyone who is both informed and sane would suggest that it is impossible that there are negative long term impacts from taking the medication. Just that we have no current indication of them, and that being afraid about a "what if" without any concrete concerns when the alternative is the "continue being in one of the riskiest states possible for human health" is silly.
People don't realize that Ozempic is already a third generation GLP drug, Mounjaro is a 4th, and the try generation drugs are already in wide scale clinical trials.
We do in fact know a lot about how these drugs affect people by now, and as you point out, we have well over a decade of data on them.
That's the danger of any rapid weight loss where you don't exercise and ingest additional protein.
I knew about it from prior research, but my doctor made sure to mention it to me as well. He's also monitoring the speed of my weight loss to determine if I should go on ursodiol to prevent gallstones - another potential side effect of rapid weight loss.
But the same could happen on any sort of caloric deficit. The GLP1 drug isn't causing you to lose muscle through some reaction occurring inside your body - it's your body just doing what it does in a calorie deficit when you aren't overindexing on protein and working out.
All significant weight loss includes some loss of muscle mass. Minimizing that is why every patient is advised and counseled to lift and work out, change their lifestyle and diet, and so on.
The pill alone isn’t magic. It just makes it possible to do the right things for people who found it impossible to do before.
Crutch (n)
a : a support typically fitting under the armpit for use by the disabled in walking
b : a source or means of support or assistance that is relied on heavily or excessively
Use a is a neutral, non-judgmental, literal use of the word. Use b is clearly a pejorative, judgmental, metaphorical use of the word. The two are not the same.
That _OR_ is doing a lot of work. I believe that 'or' makes the word not objectively pejorative. Context is important. A no-true-scotsman insinuation, or an insinuation that the crutch will never be removed does lack empathy and would seem pejorative to me.
Though, an empathetic concern that the crutch will never be removed - is not necessarily pejorative IMO. Either way, the crutch is a tool to "healing." Context matters.
Is this an argument that you should use crutch and everyone ever will always read it as version b?
It might be more good faith to just pick language that is more clear. The alternative feels a lot like pretending to be one thing while trying to make people think something else - it rings just like a bad faith "Im just asking questions"
To be clear, version a is referring to literal (non-metaphorical) crutches, and is not the version being used here because GLP-1 agonists are not literal crutches. Version b is the only possible use of the word being used in this conversation, and is always pejorative. "Oh, you broke your foot, you're getting around on a crutch" = Always version A, literal, non-pejorative. "Oh, you're obese, you're using medicine as a crutch to cure it" = Always version B, metaphorical, pejorative. There's no confusion.
I'm a bit confused. Would you mind clarifying whether you think using "crutch" is the more clear vocabulary, or whether alternative vocabulary would be more clear?
The negative connotation of a crutch implies that you are past the point of needing it and should be standing on your own two feet. If a thing is not meant to be temporary, or if you'll never be able to perform a task as well without it as you could with it, then it's a tool rather than a crutch.
Thus, calling GLP-1 meds a “crutch” implies that they are unnecessary, and that the patient should be able to do it without medication, which then creates guilt and shame where there shouldn’t be any.
Reflecting on this, I think that 'for-life' aspect is very key. A 'seeing aid' vs 'seeing crutch'. Crutches are usually meant to be temporary. A walking stick is the walking aid equivalent. Hence, for weight loss, is medication meant to be the life long solution? As a facilitator to move the needle for people - very helpful. The underlying question about lifestyle and habits never changing is where the life long crutch concern comes in.
All these people are calling it a crutch are moralizing tongue clicking, holier than thou Calvinists who think you shouldn’t be able to be thin unless you bootstrapped yourself to thinness with your own blood sweat and tears, as though this viewpoint represents some abstract understanding of the world instead of merely a smug sense of self righteousness.
Crutch and “weight loss aid” aren’t synonymous at all. You can’t ask someone to use a word that has a less negative connotation if they mean completely different things. They intentionally said crutch because they’re specifically talking about people who use it as a crutch. Not people who just use it as a weight loss aid.
What's wrong eith a medicine as a crutch? If you break your leg you use a damn crutch and that's good. If you suffer from an illness and we have a medicine that's worse than the illness and affordable - go for it.
Phrasing it as a crutch suggests it is somehow only a temporary that prevents you from finding a "real" solution by changing your "lifestyle". It doesn't matter, only outcomes matter.
Agreed. After I broke leg the physical therapist saw me walking without aids and said I should go back to using a cane and explained that I'll heal better and faster if I use help than if I don't. Made me realize that the expression "using x as a crutch" doesn't make sense if it's supposed to imply that x is an impediment to progress.
> The concern regarding a drug as a crutch is stil valid.
People with pacemakers can't get off of them either, but it doesn't have the same stigma. Diabetics often need regular insulin injections, but it doesn't have the same stigma. People with high-blood pressure often need regular medication, but it doesn't have the same stigma. It's mostly antidepressants and now Ozempic which have this stigma.
> A set of habits and lifestyle are pretty much the same thing.
I believe the DSM does not consider them "pretty much the same thing".
I think the difference is with food you have to eat it. You don't need alcohol, opioids or nicotine to live. With food it's much easier to fall back into similar or the same pattern as before because you can't avoid it.
The other problem being the availability of healthy food.
Those without the time or facility to cook are dependent upon stores selling convenience foods which are anything but healthy, those foods labelled as such being some of the worst examples.
Despite not being overweight and taking regular exercise, I have recently been diagnosed as diabetic and now see the world in a different light. It really is quite shocking how many aisles in. a typical supermarket are stocked with complete junk food.
>The other problem being the availability of healthy food. Those without the time or facility to cook are dependent upon stores selling convenience foods which are anything but healthy, those foods labelled as such being some of the worst examples.
Is it impossible to buy healthy food in your region? The average American spends six hours a day watching TV, do they really not have enough time to cook a meal? Just how many people do not have a cooker in their home? Is it cheaper to buy preprocessed food rather than the raw ingredients in that meal?
It seems to me the real problem is the supply of food is abundant and corporations have gone to extraordinary lengths to make it very palatable. Add in peoples tendency to chose the easy option (ready meals, eating out) and you get an obesity epidemic.
Everyone has 24 hours a day. We could all move to the cheapest CoL areas, grow our own food, and run marathons all day every day. Everyone, including you, could sneak one more rep in instead of some activity in the day. This holier-than-thou attitude of dismissing people is lame.
Empathy can go a long way and the more we can have for each other the better we will collectively be.
>This holier-than-thou attitude of dismissing people is lame.
If you want to solve the problem you have to understand it. I see lots of dubious suggestions like lack of time when working hours have reduced massively in recent history[1].
>Empathy can go a long way and the more we can have for each other the better we will collectively be.
If our read my second paragraph then you will see I'm not laying the blame at individuals.
Chemical dependency I believe can confuse the brain, where it actually does think you need the drug to live.
It can be very hard to avoid booze or cigarettes. They are everywhere. Potentially throughout all of a person's social group. Maybe at home if spouse or parents smoke.
As a former smoker, changing diet was easier for me than to change a smoking habit
While you're chemically addicted to a substance, yes, the body thinks you literally need it to survive. The point is what happens after you break the chemical addiction, you go through withdrawal, and can function again. The brain stops feeling you need it in that same way after this process. But it's almost impossible for someone who went through alchohol or nicotine or opioid withdrawal to ever consume that again and not relapse into addiction.
If the same logic applies to a "food addiction", then discontinuing the drug that helped you go over the initial addiction is going to be almost impossible, since you can't abstain from food.
Withdrawal can often be both a mental and chemical process. The desire to do something and constantly thinking about it can be just as much habit as it is chemical.
We are mostly on the same page I think. To the point though, re: food - it is not all equal. Fast food, ice cream, fried food, candy, chips- it is quite different from cooking your own meals and snacking on things like fruit, veggies and hummus (etc..)
Similar to your first point, I can't buy ice cream because I have no self control over it. (I would not say I have a food problem, it would therefore be a lot harder for others I believe)
While I agree "you can't abstain from food", it might be a bit overly reductive. Not all food is responsible for 'problem' eating. Similar to near absolutely (or absolutely) avoiding booze/nicotine, there might be similar foods that must be avoided. Which comes back to habits, changes to how a person snacks, when they eat, how long is spent in food prep,more grocery store trips, how they shop in the grocery store (etc)
I think smoking is particularly hard because most of the really bad effects come much further down the line.
You can smoke for years (even tens of) without much problem and if you do some sports even the cardio/breathing effects are largely mitigated (I know, this is what I do).
So, it's easy to only think about how good it makes you feel at the moment.
But alcohol will show nasty side effects rather sooner than later, it will show on your face, you will feel liver problems very fast and since you are in a secondary state when inebriated you will seem out of place when not in that state.
Both of those substances have the particular effect that if you use them repeatedly over a short (1-2 week) period of time in moderate but sustained quantities, you will get chemically addicted.
This is nasty and the reason why every parent tries to make this fact known to their children (more or less successfully depending on method).
Food addiction in my opinion is very different, it comes purely from psychological factors and should be very easy to correct on time.
It's not something that comes around in 1 week or 2. Even if you overeat 1000 kcal (1/3 more than the average of 2000) over the course of 2 weeks, you would only gain 2kg of body fat at worse.
It's really a very long sustained process to really become obese, it's not like chemicals that can get you in 2 weeks max.
While it's hard to lose what you gained (you basically need to starve a little bit) it's not that hard to make adjustment to life choice to avoid making the situation much worse.
Actually not true. All addicts develop lifestyles around their addictions. Alcoholics often have many social connections that involve alcohol, what they do for fun involves alcohol, etc. A successful recovery typically involves changing this lifestyle to make the problem behaviors easier to avoid.
People that move out of the USA generally lose weight. Especially if they move to a country with snaller portions and more walking. People that move to the USA generally gain weight. Evidence that it's lifestyle.
An environment that physically makes you more sedentary as, outside of a couple of cities, many things that would be sensibly done through walking in other countries involve driving.
You can easily tell this is the case by seeing where the obesity is less prevalent
I would suggest that you look at food labels of "equivalent" products on both sides of the Atlantic. US packaged foods have a lot more sugar (and general calories) than those in Europe, even when they are the "same."
This is bunk. An actual chemical addiction is not the same as feeling an urge to drink 8 cans of coke a day, or being unable to not buy a bag of chips at the gas station.
Your entire body and brain is a complex and messy chemical reaction.
The opening sentence of the wikipedia article on addiction currently reads: "Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences."
The page then lists "eating or food addiction" as examples, with food addiction being its own entire page.
> That is just not the reality though. You make a choice.
Brains are fascinating. There is a choice being made every time someone with gambling addiction goes to gamble or someone with a smoking addiction goes to smoke, but that doesn't mean they're not experiencing addiction/withdrawal distorting the ability to make that choice in a healthy fashion. Some people do manage to quit smoking by just making a decision one day to stop and sticking with it, with no assistance whatsoever; that doesn't mean they weren't experiencing addiction/withdrawal. There are, in fact, mechanisms that encourage addictive behavior, ranging from social media use to alcohol to food to MMORPGs. Not everyone who uses those things, even to excess, has an addiction. But some do. And breaking that addiction is laudable, whether with or without assistance.
> I realize people are trying to make over opiod abuse into some sort of addiction. It makes it easier to not blame the person and absolves them of all personal responsibility for their condition - they just can't help themselves, don't ya know!
I change one addiction to another addiction. If people find the above distasteful, I agree, but my question is why do you believe one thing for food addiction and another thing for other addictions?
It's well established science that chemical reactions, hormones, etc. in the body 100% influence your hunger and cravings.
That doesn't mean that it's not within the means of human willpower to overcome it - everyone has the power to not be obese. But that doesn't mean that it isn't significantly harder for some people based on their genetics, biochemistry, the feedback loop of being obese, etc.
Some people get out of opioid addictions cold turkey, by just not consuming more opioids, enduring the withdrawal symptoms, and then getting rid of the chemical dependency.
Since we know this phenomenon is real, this means that, even with a chemical dependency, people choose whether to take the drug or not. So, by your logic, they are not really addicted, they can just choose to stop at any time, they're just silly and weak people, right?
Of course this is reductive and simplistic. Ultimately your choices are a computation that your entire nervous system makes, and urges and cravings are a component of that, just like rational processes are. Different people's nervous systems weigh these factors differently, and have more or less powerful cravings and urges to begin with. It's absurd to think that your rational thinking can overwrite anything in any condition, and it's absurd to think that all people experience these thinks to the same extent.
If they started using them without informed consent, was it a choice?
And even then, you do have a chemical dependancy on enough calories, that dependency led to an evolved response mechanism, that mechanism is exploited by junk food manufacturers. That the substances your body and brain produce in response to food stimuli are endogenous (made in your own body) rather than exogenous (made outside) doesn't make them magically less potent — some of us can get past this with our willpower*, but observationally it's obvious that most of us can't.
* I seem to have a lot of willpower, but I suspect that's mainly that my conscious self is fairly oblivious to my body's needs, as my willpower also leads to me pushing myself too hard in various different ways.
> chemical dependency from eating two cheeseburgers for dinner
Wouldn't the initial dependency be almost purely psychological for opioids as well? Most people certainly wouldn't develop a chemical dependency after just two doses as well.
> developed a chemical dependency which is no longer a choice.
Why? They still have a choice. Of course it might be much harder for them to stick with that choice than for someone suffering from a mainly psychological addiction.
Can you acknowledge your own bias in condemning people who don't achieve the same thing you have achieved? Can you acknowledge any advantages you may have had that made it easier for you to succeed in this particular endeavor?
This is not about that.
This is about why you consider some bad habits are addictions and some others are not.
I don't know, maybe you are right, but you haven't provided any beginning of an answer yet.
Rather, you sound like you would be saying that "quitting alcohol is merely a question of personal choice" if you had struggled with alcohol rather than weight.
Why do you think people persistently, for years, keep choosing something that harmed their bodies?
Just because you can do something, doesn't make it a "just" for everyone:
• Without any training, one day I decided to put one foot in front of the other and keep going, and managed 42 km, a literal marathon in distance — but it's obvious that, even though I was walking, most people can't do that.
• When I was at university, I gamified my diet to be the lowest cost without feeling hungry, and in retrospect that was probably 1100 kcal/day and only even safe because it was limited to term time, and it's really obvious that most people can't do that.
• Concersely, when I was on antidepressants and did graze myself into obesity, there simply wasn't a part of my mind aware of what I was doing to myself. I've lost that weight, but the strech marks are still there a decade later.
Right, or you can just own up to the fact that you do not have discipline and are indeed making detrimental choices for yourself. That alone is transformative, accepting responsibility.
These are all things that we acknowledge are possible to be addicted to to that are not substances. Not to mention that coke has caffeine which is a chemical substance just as much as anything.
You can pin addiction to anything as a personal weakness, including drugs. Why are some people able to smoke a few cigarettes or do a little bit of cocaine without ever getting addicted, when others are hooked on day one?
If there's one thing that's been fun to see as the outcome of GLP-1 drugs, it's that a lot of people seem to have a real problem seeing people better themselves the "easy way".
A good way to frame addiction is via perceived rewards. You can be addicted to many things if you look at it as “the person expects a reward for an activity, often errantly”. The worse addictions get into “the reward isn’t even expected with a moment’s clarity, but you do it anyway” territory.
It doesn’t matter what the actual addiction is, the reward circuitry in the brain is pretty much similar.
Addiction is basically highjacking our brain wiring that’s meant to help us expend energy chasing things that we need for survival (food, reproduction), and using it to chase other things
I find this attitude strange. I am a very physically fit man, I do not know what it is like to walk in the shoes of someone who has an addiction to food, but I do know people eat themselves to death. People deal with debilitating diseases that are directly linked to the amount they are eating. People literally destroy their body and live in the wreckage, and you think that it's not an addiction? If not an addiction what exactly is going on?
Addiction is this really scary thing I saw on tv about downtown Philadelphia and fentanyl killing people buy that's far away and couldn't happen here. Sure, I have friends who are fat and are unable to stop themselves from drinking 8 cans of coke a day but they're not shooting up with needles and I know them so they can't be this scary kind of person called an addict. Also I know this one girl who's glued to her phone all day and can't do anything else and she's also definitely not an addict.
Addiction hits the same part of the brain, no matter if it's chemical, physical, or digital. Just because our culture sees them differently doesn't make it the same underlying problem.
Seed oils (used in almost everything these days) contain a lot of linoleic acid, which is a precursor to endocannabinoids, potentially giving you the munchies. If eating gives you the munchies, making you want to eat more, I'd call that a chemical addiction.
I think avoiding bad foods is a better solution than reaching for drugs, but if the drugs help break the cycle, it could be beneficial.
>Seed oils (used in almost everything these days) contain a lot of linoleic acid, which is a precursor to endocannabinoids, potentially giving you the munchies. If eating gives you the munchies, making you want to eat more, I'd call that a chemical addiction.
If you listen to nutrition gurus, you'll hear claims like "food X contains chemical Y and chemical Y is either itself toxic or metabolizes to something toxic, therefore you shouldn't eat X". I promise you I can find videos where somebody has found something bad about spinach and will try to convince you not to eat it. It's a bad way to reason.
Identifying individual biological pathways isn't enough to make (dietary) prescriptions. Often, the metabolites of the food aren't produced in high enough quantities to make a measurable effect (on health, or this case behavior). This kind of thing has to be studied at the level of behavior.
As much as we pretend otherwise and rationalize stuff because the greatest sin for our generation is being judgemental, I am pretty sure this is the case in a lot of instances.
Shaming people is fantastic at making me feel self-righteous, though, which is the best metric by which I can evaluate treatments and interventions for other people.
(When I feel charitable, I can instead wring my hands and hemm and haww about the unknown consequences of people using medication to solve their health problems. I can't outline what exactly those consequences are, but I can certainly hemm and haww.)
This is the example I'm shocked more people don't invoke in these discussions. Gambling addiction is indisputably real, and slot machines (or craps tables or the ponies down at the track) don't even have stick a needle in you to get you hooked. Actions and reactions are more than enough.
Compulsive overeating relies on the same behavioral/reward mechanisms, with the added bonus of food being something you do physically ingest in the process.
Gambling addiction also has the highest suicide rate among addictions, so definitely serious.
The Atlantic had an article recently arguing that allowing sport gambling in the USA was a mistake, imposing huge costs on the most vulnerable.
It’s also popular in other forms these days. Wallstreetbets options gambling, most of crypto, the way many people are “trading” these is purely gambling with some bro-astrology.
When I was a poor teenager I was gambling online and it is an incredible way to lose money unlike anything. With the click of a button you can throw $100 or $1000 into the void- and you often follow it up until your account is empty. Hard to do with many other substances.
It’s the same thing. Obviously withdrawals and such are different but the core mechanism of disregulated reward processing leading to compulsive behavior engagement is exactly the same.
>If you do not change your lifestyle, for real and not just superficially, then you will relapse with a vengeance.
Longterm glp-1 agonist research doesn't agree with this.
> but you have to continue that lifestyle after stopping the drug.
Why stop the drug?
>Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?
A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term. We've been trying to solve obesity this way for a 50 years and have bubkis to show for it. If someone has high cholesterol we give them a statin, if they have high blood sugar we give them diabetes. Now if they're overweight we give them ozempic.
"For the two in every five patients who discontinue the treatments within a year, according to a 2024 JAMA study, this means that they are likely to rebound to their original weight with less muscle and a higher body fat percentage."
The other issue is the muscle loss on being on these drugs as "Clinical data shows that 25 per cent of weight loss from Eli Lilly’s shot resulted from a reduction in lean body mass, including muscle, while 40 per cent of Novo Nordisk’s jab was due to a drop in lean body mass."
Via https://www.ft.com/content/094cbf1f-c5a8-4bb3-a43c-988bd8e2d...
Right, so we doom some portion of the population to forever take a pill from big pharma? How is that acceptable with anyone?
The goal should be to use Ozempic until you are in a better place to manage things yourself. The goal should not be to get people hooked on Ozempic for their entire lives.
Perhaps Ozempic prescriptions should come with prescribed exercise with check-in and monitoring, or something.
I guess young people don't always know this, but there are plenty of medications a lot of people take for the rest of their lives. Blood pressure and cholesterol pills are maybe the most common.
This gives a vast number of people 5-10 years longer lives, and I think this is great thing, even if some pharma executives end up getting rich.
Or insulin. I’ve been shortsighted since childhood and will need to wear glasses for the rest of my life (unless I get laser corrective surgery, I guess).
Many people in my wife’s family have thyroid gland dysfunction and have to take thyroid hormones their whole lives.
Not just young people. High blood pressure runs in our family. A cousin, despite being healthy in most indicators, developed high blood pressure at 23. She's still going in her 50s just fine but has had to take blood pressure meds for the last 27 years.
This thread has multiple people relating their personal stories of using ozempic to start building those healthy habits. Also, it doesn't just magically get rid of fat so you can eat more, its supposed to make you feel full longer (as I understand it, someone feel free to correct me on that).
Plus, even if it did magically get rid of fat temporarily, I'd rather encourage people to do something rather than simply shaming them for giving into a very human addiction.
Your biggest concern around glp-1 drugs shouldn't be the overweight people successfully slimming down, it should be people who are already a healthy enough weight who think they need to be even skinnier (something I've encountered plenty of).
> its supposed to make you feel full longer (as I understand it, someone feel free to correct me on that).
It's complicated. This is commonly reported by people taking it, but it's not the only mechanism. Also commonly reported are that it reduces hunger levels flat out across the board, makes you feel full after eating less food, and that as you get used to eating less food your stomach physically gets smaller and you can't even eat as much food at all even if you tried to force yourself to (e.g. at a big holiday meal full of delicious food where you want to eat everything so long as physically able to, well past the point of hunger).
Yes, it is within the realm of human power for every individual to not be obese.
But the fact of the matter is... a huge chunk of people don't succeed. 42% of American adults are obese. "Eat better and exercise" has not resolved the issue.
I spent a good chunk of my adult life eating well, doing cardio, lifting weights and loving it. Then I got busy with life and stopped. And it has been incredibly difficult to get back to that and gets harder as I get older. I don't think I'm some paragon of willpower - if so, I wouldn't have fallen off the wagon. But I think it would also be silly to think that if someone who has a proven track record of maintaining that for years can struggle with maintaining it for a lifetime, there's probably a lot of people who have never even had that much success who are going to have even worse of a time.
Are we going to moralize over bp meds and statins too? If people can't adapt, fuck 'em, let 'em die young?
We don't get pissed that elephants don't climb trees. What value is it to characterize people's obesity entirely as slovenness and gluttony? While there are certainly some slobs and glutton, dismissive judgmentality of everyone doesn't make sense.
For this reason, I believe your comment is lacking in empathy for people who may struggle differently than you, yet struggle all the same.
Sure of the almost 8 billion people in the world there are plenty who have successfully lost and kept off weight.
But if you want to see if there is a reproduceable lifestyle intervention that treats obesity successfully in the long term you can look here. After a few hours of searching you will probably find the same thing I and almost all obesity researchers have concluded. There isn't one.
There are two ways to lower weight. Eat less, and Ozempic. I don't think it's any of my business which one people pick. The important thing is that they become healthy.
I've realized people are very different. Some can just decide to eat less by applying a little willpower. For others, that's incredibly hard. If you're in group 1, it's easy to think everyone is and be appalled how others can't even put in that little bit of effort.
Can you provide evidence that a statistically significant portion of the population have managed to maintain weight loss in the manner you describe?
The evidence I see does not support your claim. Obesity rates have only gone up during my lifetime and the folks I know in the medical field have consistently mentioned how diet and exercise simply does not have any sort of patient compliance. The folks who successfully do it are outliers.
I will go for the harm reduction principle on this one. The molecules themselves are trivially mass produced for less than $10 a dose and are already being sourced for that cost by folks who are willing to take a bit more risk to do so. Cost seems to be about the only major side effect so far.
> doom some portion of the population to forever take a pill from big pharma
That is temporary. The effects are real. The fact that you don't think big pharma should profit handsomely for making it happen is not the only alternative. Before too long semaglutide, as one example, will be out of patent and available as a generic. It won't cost a thousand bucks a month to big pharma, it'll be practically free. Cheap enough that most insurance plans will likely subsidize it all the way to zero out-of-pocket cost just because the ROI is so good.
How my decisions will affect some company's bottom line is way behind "will this help me live a better, longer life" in my list of priorities, but I'm already on other medications that are generic for the rest of my life for other genetic defects I've been blessed with, though I'm not on Ozempic.
Why not? What would you rather be: Fat to your death, or healthy and dependent on modern technological society in yet another way? How is it any different to diabetes treatment?
I take a statin as something in my body produces high levels of cholesterol even on a low fat diet. I will always take a statin. It works well and there are few side effects.
My spouse must take a thyroid medicine every day for life.
Not taking these pills is life threatening. How is taking them not acceptable?
Why would you want to continue using a drug for the rest of your life?
> Longterm glp-1 agonist research doesn't agree with this.
Please explain. If you stop using the drug, because you've achieved your goals, what stops you from relapsing other than your own personal habits and lifestyle?
> A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term. We've been trying to solve obesity this way for a 50 years and have bubkis to show for it. If someone has high cholesterol we give them a statin, if they have high blood sugar we give them diabetes. Now if they're overweight we give them ozempic.
Yes, a pill for this, a pill for that... and there's no chance we'll discover these drugs have negative effects when used by a person for 50 years.
> Why would you want to continue using a drug for the rest of your life?
It's better than being obese. This is true of most drugs for chronic conditions. very few of them are curative, almost all of them treat the condition.
> Longterm glp-1 agonist research doesn't agree with this.
Sorry I wasn't clear, I meant with continued treatment you don't rebound.
> Yes, a pill for this, a pill for that... and there's no chance we'll discover these drugs have negative effects when used by a person for 50 years.
They might have negative side effects but obesity has very large negative side effects. I would be incredibly surprised if any of these drugs that have been used in diabetes treatment for a long time have anywhere close to the negative side effects of obesity.
Hot take: "choice" is a myth when it comes to long-term executive processing, one doesn't choose to be obese/not, drug addicted/not, etc, the same way one chooses whether they want chicken or beef ramen for lunch. It's an unending grind of executive functioning against more basal impulses, that is heavily influenced by the blend of nature and nurture and life events.
False. (All) People crave for food. Some people have stronger craving than others. In healthy people you call it "hunger". In obese people it is more like an addiction. Do you know people can be addictes to sex and to work, too?
If you insist on the choice argument, the only way an addict can stop consuming is locking himself in a room and throwing away the key. Other than that, much help is needed, many changes are needed, and even chemicals are needed.
All you're saying is the it's harder to make some choices depending on situation. They are still 100% choices. Choices don't have to be trivially easy.
It doesn't work. I keep trying to get off the diabetes and I just relapse after a few weeks. It doesn't help that my body tries to hide the glucose everywhere, like attached to hemoglobin or in my liver in the form of glycogen so it can share a hit with me first thing every morning.
Nope, not going back to the doctor that gave me diabetes. That was a mistake.
> A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term.
Ozempic is only fighting symptoms of that, not the root of the problem which is the stigma around weightgain, being a big person, just fatphobia being extremly generalized and a lot of shame surrounding weight. While it's amazing for people who have medical conditions making them gain a lot of weight, just saying that they should take ozempic will not change people gaining too much weight. It's not anything like high cholesterol or high blood sugar in most cases.
I'm someone that has spent many years of my life eating well and exercising regularly, including weightlifting. I'm also someone who has spent the past decade doing neither of those things, with one attempt in the middle to correct my behavior interrupted by a knee injury.
I'm currently on tirzepatide and have also started to resume exercise, and I'm enjoying it like I did when I was younger - I expect I'll be able to go off of it when I get to my goal weight.
But at the same time, there's not any real reason that people would need to go off the drugs, outside of cost. So far we don't see any adverse reactions in the vast majority of people. Some people have reactions from rapid weight loss - gallstones, hair loss, etc. but these are also risks in crash diets, etc.
We accept that people will need lifelong medication (often with worse side effects) for other illnesses that have less risk to all cause mortality, etc., than obesity. Why would we be unwilling to do it for obesity?
The fact of the matter is that despite the risks and downsides of obesity being well known in America, 42% of American adults are obese. No amount of education or knowledge that has gotten us on the whole to eat better or exercise more. Plainly, being on these GLP1 medications is preferable to being obese based on all current knowledge.
> The fact of the matter is that despite the risks and downsides of obesity being well known in America, 42% of American adults are obese.
It's down to 40% and dropping now, thanks essentially solely to GLP1 agonists! This will, no lie, save our country trillions of dollars in increased years of quality of life (and thus productivity) and reduced healthcare costs.
> The problem with this (and all diet plans/drugs) is the lifestyle that led to problem in the first place.
I don't think we fully know what led to the problem in the first place.
I think it's a complex interaction between the types of foods we eat, and which are more affordable, our gut microbiome, and the amount and frequency of exercise which we are able to fit into our day.
We have some pretty good ideas that reducing intake of high glycemic foods, safely reducing overall calorie intake, and getting regular exercise will help.
However, it's the bad food which many families can most afford. Many people find it difficult to make time for exercise, since they are pretty exhausted from making a living. The foods which are bad for us tend to make us feel good in the short term.
When a person has become obese, it is harder to start exercising, and it's harder to find exercises which don't hurt their feet, joints, back, or other parts of their body.
Ideally, we would all have copious time to exercise, and healthy food would be abundant and affordable. But, that's generally not the case for most people.
And some people seem to be genetically predisposed to gain weight.
If you compare the typical American diet and ingredients to the rest of the world, the answer is clear.
The problem is most Americans (where the obesity crisis is worst) don't know their country's businesses are selling them rubbish and their government is subsidising it.
I don't think you expect to stop taking the drug. It's a for-life kind of thing.
If a prescription for "lifestyle changes" were a drug, it would be one of the least effective drugs ever made. I read something directed at medical professionals that are skeptical of the GLP-1 receptor agonists and it asks, if you prescribe a drug and your patient refuses to take it, why would you keep prescribing that drug? Of course not. That's what lifestyle changes are, and the landscape has changed so that there are alternatives.
(My employer is heavy on the "lifestyle changes" angle. They will not pay for GLP-1s, but they will send you a newsletter about losing weight if you want. Guess who's losing the weight.)
You say this - but not from experience (correct me if I'm wrong and you have taken a GLP-1 agonist).
I say this because as someone who has taken it, I found one of the craziest parts is how they do seem to help you set better habits, and those habits do stick, and it's not like some fake thing.
For example MJ helped me do the following: entirely stopped late night snacking, stopped craving sweets, stop smoking weed. And it doesn't come back when I go off, even after months.
I wasn't especially overweight when I went on (maybe 20lbs), I did it for the incredible immune system benefit which seem to heal my immune disorder, but I was stunned at the results outside of it.
I get that people hate the idea of something that helps you be better without having to "put in work", but in the weirdest and best way possible, it seems to do that, at least in part.
> people hate the idea of something that helps you be better without having to "put in work"
This is kind of an incredible reaction many people seem to have. Isn’t this just a net positive? Even if someone feels like gatekeeping good health, ozempic is only giving you maybe 60% of the benefits of a healthy diet and regular exercise. It’s not taking anything away from people who put in the effort
The genetics of hunger are fascinating, people literally feel very different levels of hunger.
My family are mostly all quite fit and healthy, but this is because exercise and dieting are a cultural obsession in my family to an un-mentally healthy extent, because as I understand through conversation with others
We feel an unusually high level of hunger, I can be full to bursting and hunger does not stop. I tried semaglutide, it was the first time I can recall ever feeling the absence of hunger.
To think that my family and I are likely nowhere near the top of the hunger spectrum astonishes and horrified me
Yes, what's true and often understated about weight-loss is that people usually do lose weight when they decide to, but gain it back. Aside from lifestyle, metabolic adaptation is one factor. Since metabolism is lower, increasing calorie intake too quickly leads to weight-gain, and metabolism remains worse than it was before.
Sounds like it directly affects their lifestyle though? Being less drawn to addictions, and thus less engaged in related activities, is a pretty big lifestyle change.
It really depends. If you break the addiction and it could very well remain.
An example is tobacco/nicotine. If you stop smoking while you are on the drug and you break the addiction and the habit, you aren't going to reform that habit unless you start smoking again. And that's unlikely to occur because you no longer have the habit, you no longer have the chemical compulsion, and you aren't consuming any of it. Maybe stress could force a relapse due to weakness of mind but all things considered that's minor relative to the chemical addiction and the habit forming behavior.
An example where you may see relapse is alcohol or marijuana where the substance comes almost more from a social environment than it does from the chemical draw. Like once the habit is broken, it's still easy to be put into situations where recreational use is common and more or less expected on rare or semiregular occasions. That of course could lead to new habits forming and leading to relapse or it may not depending on what other (hopefully healthy) habits the user is now taking part in, their stress level, and other aspects of their life.
So the answer is of course that it depends but if the drug can reliably help people break habits then it can maybe also be useful in helping them avoid forming new bad habits or relapsing when the urge becomes too strong to resist.
What is the core of your point? That these drugs, that extend life, and reduce associated illnesses should be ignored or not used, because instead people can die sooner in some attempt to cure themselves the "correct" way?
A corpse cannot learn healthy lifestyle habits. A living person who lost weight the immoral way or whatever you're trying to say, can of course.
All the people I know who are on those for-life medications absolutely hate the fact that they have to keep taking those pills every day until they die.
eh, my inner "prepper" is annoyed by the dependency, the rest of me is pleased that I've already lived longer than any of my male ancestors. (Kind of hard to sneer at advanced technology given what I do for a living :-)
I was talking about one of the other "for-life medications" in the previous comment that are more in the "can't get this any more? oops, in 6 months your head explodes" category...
The point is you still need to develop a lifestyle that is healthy. The drug isn't a miracle, it's a band aid. If you do not change your lifestyle, and you discontinue using this drug, you will relapse. This is the same issue many people face when they diet as well, so it is nothing new.
The point of my saying this is to point that out, because a lot of people in this thread seem to think it is totally ok to be on an Ozempic prescription for your entire life. That's horrifying for so many reasons. Others seem to think you take Ozempic until you're "cured" then you just live happily ever after. That's hardly going to be the case for many people who have struggled with weight for their entire lives.
Why? AFAIK Ozempic seems to work by "modifying" behaviour and reducing the appeal of overeating and possibly engaging in other addictive behaviours.
It's not some magic pill that you take and then don't actually have to change anything about your lifestyles. It seems similar to antidepressants, ADHD drugs etc. in that way and a lot of people take those for extended periods or even their entire lives.
Besides potential side-effects etc. what's to horrifying about it?
I think we hear you, we should all take more care about bad lifestyle, everybody should exercise regularly and eat healthy food. But to be fair nobody has promoted a bad lifestyle, or said that, given there is this new drug let's care even less.
At the contrary, given the testimonies it sounds like the drug helps people to adopt better habits, no?
> given the testimonies it sounds like the drug helps people to adopt better habits, no?
No, it helps people live a better lifestyle so long as they remain on this drug. The feeling/impulses are artificially suppressed.
Maybe they come right back if you stop taking the drug. One would hope you can take the drug until in a good place to take over on your own. Time will see - a great experiment is about to take place.
A lot of people are less capable of controlling those impulse on their own and are inherently more prone to developing addictions than others due to genetic/etc. reasons. Yes they can make different choices, change their lifestyles, adopt certain routines etc. all which would require a huge amount of effort just to get on part with people who can achieve those things (relatively) almost effortlessly.
Why should they be forced to suffer due to something they have limited control over?
Yeah, no. Speaking of "personal discipline" makes it obvious you have never seriously dealt with addicts. Solving it long term is basically impossible for some of us; pretty sure because of how our brains are wired at the physical level. I know all the (popular) science, I discussed it with a good doctor whom I personally know, I know you're supposed to change your habits long-term (and how you're supposed to do it), and I recently lost 15 kgs of weight for the fourth time in my life. The longest time I managed to maintain healthy weight was maybe 3-4 years. If Ozempic (or whatever) actually solves this, I'm ready to go on it for the rest of my life.
I also live in a "vodka belt" and know several alcoholics who tried very hard to maintain their "personal discipline". It's impossible for most of them -- almost all relapse in a few years' time.
I'm one of those people who has repeatedly lost weight by managing food intake. I'm talking about losing over 30 pounds, more than once. It might have been three times. Oh yea and I've kept it off for close to a decade now. I didn't use drugs. At times I used a food scale to manage portions. At times I literally just microwaved broccoli for a snack/meal. I still do it periodically if I'm feeling self-conscious. Does it suck? Yep. Have you guys ever tried those things?
I mention this because I feel like you need somebody who has gone through the experience to actually have credibility in the conversation, to tell you that personal discipline is a real thing that can achieve results. I think it's ridiculous how quickly you dismissed the parent post.
I've gone through that experience multiple times as well. Also over 30lbs each time. Also having kept it off for years, although not quite a decade for my longest period. COVID was my last regression, as it was for many who lost it and maintained it the way we both did.
The GLP-1's are a game changer. I will never lose weight the "white knuckle" way again. I can, and I have proven it to myself and others. It's not complicated as you say - it's quite simple.
It's simply such a giant imposition on your life and mental well being that I am thankful others won't have to go through it as their only option in the future. The sheer chunk it takes out of my executive function means I can't perform nearly as well at other tasks in life. The GLP-1 class of drugs make it trivial in comparison. Like a performance enhancer for a diet.
I also have worked out a hell of a lot more taking Tirzepatide than I ever did counting calories on a food scale. This is because I feel so much better it's not even a comparison - primarily mentally, but also physically due to the other positive side effects the drug has associated with it. Plus I don't feel guilty when I go out with friends to a burger joint - I eat half and feel perfectly satiated, no guilt or "cheat day" required. My energy levels are not comparable. I have much more time in my day available for other activities, such as keeping appointments with my personal trainer at the gym or taking 6 miles of walks per day.
Losing weight and maintaining an active healthy lifestyle doesn't have to "suck" any more.
I feel like you need someone who has gone through both experiences to actually have credibility in this conversation. Willpower isn't a special trait, it's not something to lord over other people.
>Willpower isn't a special trait, it's not something to lord over other people.
I'm not special. Look at his post. He quickly dismisses the idea of personal discipline and asserts that keeping weight off is "basically impossible" in the first two lines. What kind of bullshit is that? Because we don't know what it's like? Well I do.
I worded that poorly and deleted a paragraph below it since it maybe was wandering into places I didn’t want it to.
Reading on the topic of self control and personal discipline, and talking with friends with phds on the subject of addiction medicine changed my mind and perspective on it. I can white knuckle pretty much anything - so can most people if properly motivated. I no longer find that interesting or a point of pride.
When you look into addiction at a deeper level you find people who are sober from their drug of choice, but utterly miserable. This is similar to your description of having to lose and maintain weight through self control. The “it sucks” part. I no longer feel it needs to suck, just like a former alcoholic will tell you how it’s relatively easy to be sober but miserable. The hard part is figuring out how to do it while being happy and not constantly in a battle with yourself. I see what you describe as someone who avoids alcohol by not visiting establishments that serve it and keeping it out of the house.
What I realized is that I don’t need to do that with food - there is help available. I’m now like the former alcoholic that can be around booze without a single thought of taking a sip. It’s an entirely different life experience and I’m not miserable or using a portion of my brain to remain in control.
I have done it both ways and the GLP-1s effectively saved my life. Not literally - but it’s now a life worth living vs just surviving.
I firmly believe these drugs will be as society changing as antibiotics were.
Sure, I'm proud of being able to do it. But it's not an ego/pride thing this in this conversation. I don't know how to say this politely, but I think it's dangerous when our own failures warp our world view with regards to possibilities and truth. "I couldn't do it, so it's impossible" Well maybe? But maybe not.
And you're right. I've had to make lifestyle changes where I avoid certain venues. I don't have fast food. I've had chips maybe a handful of times in the past several years. You can call it a battle, but I wouldn't say I'm miserable on a daily basis. I just got used to it.
Using drugs to improve your quality of life is incredibly valuable. At the same time, I still believe that lifelong dependence to drugs should be avoided. I anticipate negative societal and psychological outcomes in the future. But I have to run.
>You only know what it’s like for you You know nothing of anyone else’s experience and pretending otherwise is comical at best.
Well we're all technically different, so nobody knows what it's like to be you. So literally no advice or data can actually apply to you. Those scientific studies studied other people, right? Cool world we've created.
At what point are you willing to concede that it might not be feasible for someone that isn't you? If it were 10% harder do you think you would have stuck through it? 50% harder? The numbers say the proportion of people who are successful is very small and there are sure a lot of people who are trying
Edit: I'll add that I've successfully shed 100lbs through discipline before. With the life I currently as caretaker for my son I don't nearly as much room in my life for the mental overhead that sort of change in diet required me in the past.
I can imagine it being a lot harder. There are all sorts of arrangements that either enable or reinforce the types/volume of food that you eat. Still, I think people should try to be aware of their own situation and try to identify those factors that promote weight gain. Even if it was harder, I still think it's inappropriate to say it's "basically impossible" and to deny common sense.
You talk about common sense and see a sea of people who are trying to lose weight (cdc says about half of adults in the US[1]) at very low success rates (<1% according to this study [2]) and think: they must be ignorant or not trying hard enough. I just don't really see how you could reasonably make that case.
I don't really know what to tell you. Again, I understand weight loss can be extremely difficult. What's the conclusion you're trying to get me to accept?
Telling somebody that they're ignorant or not trying hard enough isn't exactly constructive. But neither is digging up studies trying to convince people that they can't achieve some level of fitness. It's science, but somebody else's failure doesn't determine yours. Again, common sense.
You need to examine your life and figure out what factors contribute to your weight gain. Is that already unreasonable?
I don't think the problem is that people don't know what is making them gain weight. If it were, I don't think the rates of obesity would be as high as they are. I'm not saying it's impossible; you've done it, I've done it. I'm saying that at some point you have to have reasonable expectations about what you can expect from people at large .
So I was, also, a firm believer of the "gotta fix your lifestyle" school of thought regarding weight management until I was introduced to the Maintenance Phase podcast (hosted by Aubrey Gordon and Michael Hobbes).
This podcast, and Aubrey's book "What We Don't Talk About When We Talk About Fat," opened my eyes to the fact that many people are just _born_ hungrier than others.
The body will weigh what the body wants to weigh, no matter how many fad diets or drugs you throw at it.
Unfortunately, those whose bodies that don't conform to our modern, eugenicized definition of "healthy" and don't particularly care for working out at all times are dealt a lifelong sentence of social ostracizing, "have you tried this diet" and "calories in, calories out," mostly against their will.
To wit: I can easily scarf down 3000+ calories per day. EASILY. I also know people who struggle to eat 2000 calories per day. I've seen this dynamic with kids in the same family as well.
I'm not saying that it's impossible to make healthier choices. Everyone can benefit from a balanced diet and more exercise. I'm saying that some people will naturally be heavier than others, and that should be okay.
I figure for some people it will work as a crutch and for some it will work as a prosthetic. I guess that depends on whether you need to take some weight off and allow yourself to heal, or if you are actually missing that appendage. Metaphorically.
Well that's the whole point of the novelty of this drug.
This drug somehow effects our emotional resilience and/or the strength of our response to emotional decisions and/or the way our brain weighs different options regarding to long-term planing.
Basically instead of your suggestion of not treating drugs as a crutch, and trying hard to restructure your life; this drug basically does exactly that. It gives you the decision making of a person that already did fight the addiction and restructured his life. The only thing then is for the person to actually restructure his life by living his newly well-decisioned life for a while.
That's why it is sometimes bad advice to tell people not to use medicine as a 'crutch'. Just like actual crutches, they actually are meant to be able to temporarily support a person. If somebody needs a 'crutch' they should fully use it, especially if it can help them ultimately solve the need for the crutch.
I get what you're trying to say with the crutch thing, but personally this kind of attitude prevented me from considering medication much earlier. Even though we all feel deep in our hearts that standing by yourself is better than relying on some crutch, nobody cares, and nobody is going to give you any bonuspoints if you make it to your death without any help. If any type of medication or treatment can help you, for the love of all that is good, use it.
Did you even read the top level comment here where the person addresses this? Anyway, this sort of moralizing is incredibly inhelpful. Very few people are obese because they lack “discipline”. Certainly they are no less disciplined than most non-obese folks in the world. All sorts of factors play into obesity that have nothing to do with “discipline”: genetics, gut microbiome, local environment, food availability, mental health, physical disease.
There’s some small percentage of people for whom “discipline” is enough, but when people talk like you are with the implicit assumption that all fat people are lazy and immoral due to lack of “discipline”, you only reinforce the misinformation about the causes of obesity and make it harder to address novel causes with novel treatments.
I'd say it's the opposite - if you don't exercise you end up skinny fat which is metabolically unhealthy as well. It helps with super accessible dopamine hits I guess - which is awesome - but need to combine it with exercise for maximum benefit.
I wouldn't be surprised if they come up with a drug for that that's more sideffect free than testosterone/ derivatives. Lean and ripped cocktail
This is true, but I'd qualify it. I'm MUCH more active than when I started, just naturally, and my heart health / true age stats (for what they're worth) are twenty years lower than when I started. I lost a lot of muscle, but as a percentage, my body fat is nearly half what it was when I started. 10/10 would do again.
Recomping is a huge struggle, you just can't eat enough to add muscle bulk. Cycling on and off is tough because if you don't taper off it, your body is like "thanks for ending that long term caloric deficit, have you heard of cake?". So you definitely need to approach the muscle mass question seriously, but in no world was I healthier back when I had an extra 10 to 20lbs of muscle, and the rest in fat.
Would you mind sharing before and after lean/fat percentages and or numbers?
I am really curious if there is a way to optimize bulkng prior to getting on these drugs with a goal of retaining muscle mass(important as we age)
Take a look at the protocol for the protein sparring modified fast which is a form of short to medium term fast that is designed to retain muscle mass by eating tons of protein with a large caloric deficit (1k+ calories a day). You can easily convert it to a more sustainable Ozempic diet by adding more fat/carbs to make the lean protein more palatable.
Fair warning though, this isn't an easy diet if you're not good at cooking and can't easily develop your own recipes. Lots of lean chicken breast so techniques like sous vide really help.
Prefer not -- sorry! I'm here on my real name. If you want my advice, lose the weight then worry about it. A good amount of research indicates you tend to gain muscle mass in the fat/muscle percentage you start with; regardless if you are seriously in need of weight loss, the benefits of doing that far outweigh the (temporary?) downsides of losing some muscle mass for most people I bet.
Turns out it can also be useful during a personal apocalypse: having recently lost about 35lbs from emergency chest-cracking surgery, ended up pretty glad I wasn't at my leanest going into it (sadly, more of the weight lost was probably muscle wasting/deconditioning than fat stores, but on balance it was probably good I had at least 15lbs of fat stores to burn).
Honestly, sounds like our "modern lifestyle" is designed to get everyone addicted to something, and the healthiest possible addiction is, as it turns out, an anti-addiction medication.
It's not a miracle drug. Check this Joe Rogan interview to understand at a deep level all the problems with a drug like Ozempic: https://www.youtube.com/watch?v=G0lTyhvOeJs
I know this going to be blasfemy but the real problem here is carb addiction and we should be treating the root cause not the symptoms with a drug with unpredictable long term consequences.
I'd second this opinion – weight can be lost so easily by dropping the majority of carbs. By that I mean base one's nutrition on meat / fish / eggs / vegetables / fruit, with no pasta, no bread, no sweets, no cake, no chips/crisps, no biscuits / cookies etc (and no booze too, or at least keeping it very minimal or sporadic).
If you do 1000+ calories a day of exercise above your basic metabolic rate / consumption, you will lose 1kg/2lb per week. I'm doing this at the moment (and then will be continuing beyond) and it really does work. I do, however, have the luxury of spending 3-5 hours a day in the gym & fitness classes and swimming pool, and cycle there and back. My Apple Watch is amazing at tracking the calories burned in all these exercises, so I know that I'm burning 3500 - 4800 calories a day from exercise. It's trivial to then only eat around 2000-2500 calories a day. This can barely even be classified as a diet, just healthy choices.
The availability of cheap calories and easy carbs everywhere really is the peril of the western diet. Eating vegetables and protein is a little strange at first but the weight will drop off without having to feel hungry. Hence I'll be joining you in the blasphemy, but this really is a solution to excess weight and it's simple maths that cannot be cheated by the body – unless one has some kind of extreme medical condition, the body simply will not stay heavy while running a deficit and a high protein and low "lazy" carb diet. And I'm saying this as someone who has a decent amount invested in both Novo Nordisk and Eli Lily stocks...
Yet it seems that now these drugs exist, it's easier and quicker to take them as a fast track, because if you're 50kg / 100lb overweight, then to say to someone "you need to exercise quite a lot every day, while not eating cheap carbs, for a whole year and then continue beyond" it simply seems too difficult and hard.
I would listen to what his guests on this particular podcast have to say before jumping into conclusions just because the interviewer is Joe Rogan.
I have no particular opinion on him - I’m just interested in what the interviewees in this specific episode have to say about metabolic health which has direct implications on the massive usage of drugs like ozempic.
I'll start with stating that Joe Rogan has, as the years have gone on, resulted to more and more fringe guests on basically every subject.
Then I'll point out that these guests are MDs, not PhDs.
And then I'll point out this bit from the description:
> Dr. Casey Means is the Co-Founder of Levels Health, which provides insights into metabolic health through real-time data. Calley Means is the Co-Founder of Truemed, which enables HSA spending on healthy food, supplements and exercise. They are the co-authors of "Good Energy."
Their livelihood is based on selling people apps, services, hardware, supplements, etc. around a certain lifestyle. They've got direct financial incentive to be against GLP1 medications.
For any specific claims, well, if you're going to use a video for reference, present the specific claims, timestamps, etc. You can't expect random people on the internet to watch a two and a half hour video off of nothing more than "you'll understand at a deep level the problem with glp1 drugs!"
In contrast with the huge amount of money that the pharma industry spends in marketing GLP1 drugs to people not caring about their long term effects but only on profit.
I wish there were more Casey and Calley Means in this world instead of ever more metabolic and mentally ill society living more like zombies than free human beings.
> In contrast with the huge amount of money that the pharma industry spends in marketing GLP1 drugs to people
Drugs lose their patents and much of the research on novel medications is done in partnerships with universities, etc. Plenty of other scientists unrelated to the drug companies are continuing research through entirely separate funding. But I guess everyone is in the pocket of big pharma?
> not caring about their long term effects but only on profit.
What long term effects? You still haven't elucidated any concerns.
> I wish there were more Casey and Calley Means in this world instead of ever more metabolic and mentally ill society living more like zombies than free human beings.
You can find plenty of them on instagram, youtube, and tiktok. They'll be happy to sell you another fitness device and Yet Another Protein Powder or a pill made out of some plant extract that has minimal to no scientific evidence of efficacy.
Every drug has long term side effects but people are being sold GLP1 as a miracle weight lost pill when the focus should be on reducing all the toxic junk food that is causing the weight gain in the first place.
And yes, many research programs are funded by pharma - the conlict of interests is blatant and getting more people sicker every year.
Honestly, I’m pretty sure you’re very aware of all this so I question your motivations to be openly promoting a drug that interferes directly with cellular metabolism like if you’re selling candy.
You're still not providing any sort of claim as to what actual negative side effects you are concerned about, so I don't really know how to have a serious conversation with you.
"Interfering with cellular metabolism" is a meaningless phrase. Please provide some sort of method of action that you are actually concerned about. What is it that it is doing to cells that we should be concerned about? What scientific evidence is there that this action is unhealthy?
I'm unfortunately expecting this getting worse with massive adoption of the drug but we can start with "Risk of Suicidal Thoughts and thoughts of self-harm with medicines known as GLP-1 receptor agonists,1 including Ozempic (semaglutide), Saxenda (liraglutide) and Wegovy (semaglutide)" - https://www.ema.europa.eu/en/news/ema-statement-ongoing-revi...
By the way - why are you so eager to promote this drug - can you please declare any conflict of interests?
> By the way - why are you so eager to promote this drug - can you please declare any conflict of interests?
The closest thing to a conflict of interest I have is that I am currently seeing great results while taking tirzepatide. I find it significantly easier to choose healthier meals made of whole foods with balanced macros, to eat less in general, and to motivate myself to push back towards the exercise habits I had in my 20s. I have no relation to big pharma, and I have no idea if my index fund tracking retirement plans include Novo Nordisk or Eli Lilly, but if they do, that's the closest thing I have to a financial incentive in these companies doing well.
> we can start with "Risk of Suicidal Thoughts and thoughts of self-harm with medicines known as GLP-1 receptor agonists,1 including Ozempic (semaglutide), Saxenda (liraglutide) and Wegovy (semaglutide)"
Please read the content you are linking. It said that there were some reports so they were beginning to perform a review. The article specifically mentions the review was set to conclude in Nov 2023. Upon seeing this, I figured it would be a good idea to see if the results of the review had come out.
> The PRAC has concluded that the available evidence does not support a causal association between the Glucagon-Like Peptide-1 receptor agonists (GLP-1) – dulaglutide, exenatide, liraglutide, lixisenatide and semaglutide – and suicidal and self-injurious thoughts and actions.
"Yes. I'm a T2 diabetic and have been on an SSRI for years. A couple years ago I was trying to up my dose of Ozempic, as prescribed. Perhaps it was coincidence, but over time I sank into a deep depression and I simply felt like the only reason not to k*l myself was I could never do that to my family. I also developed panic attacks. More fun than a barrel of monkeys!
Since then, I've drastically reduced my carbohydrate intake, stopped the Ozempic, and basically made an almost complete recovery. I haven't had a panic attack in two months, and it was mild."
"Dear Dr Scher. I can confirm a very serious major depressive reaction to Saxenda/Liriglutide. This happened 2 days into 1.8mg dose which was exactly when my appetite diminished. Very, very disappointing . This was in spite of taking long-standing Venlafaxine/Effexor, which for this reaction was useless. After stopping Saxenda, my mental state took about 10 days to restabilize.
I trust this may be of help to other"
"This study was not a random control trial. It was a comparative cohort study, which is an observational study design.
In a randomized control trial, participants are randomly assigned to different groups, with one group receiving the treatment being studied and the other group receiving a placebo or a different treatment. This allows researchers to determine whether the treatment is effective by comparing the outcomes of the two groups.
In a cohort study, researchers observe a group of people over time to see if there is a relationship between certain exposures and outcomes. Participants are not randomly assigned to groups.
The study in the source is specifically a comparative cohort study with an active comparator, new user design.
This means that researchers are comparing the outcomes of two groups of patients: those who are new users of GLP-1 receptor agonists and those who are new users of SGLT-2 inhibitors.
The active comparator is the SGLT-2 inhibitor group. This group is used as a comparison to the GLP-1 receptor agonist group to help researchers determine whether there is an association between the use of GLP-1 receptor agonists and an increased risk of suicide-related and self-harm-related events.
It is important to note that cohort studies, like the one described in the source, can only show an association between exposures and outcomes. They cannot prove that one thing causes another."
"Therefore, while the study aims to contribute valuable insights into this potential safety concern, its design and inherent limitations preclude it from making definitive causal statements.
Even if the study finds no association, further research, potentially using different methodologies, would be needed to strengthen the evidence and confidently assert that GLP-1 receptor agonists do not causally increase the risk of suicide-related and self-harm-related events"
Taking this into account I'm still going to stick with my ketogenic diet, thank you very much.
I take mounjaro because I have T2 diabetes and it is a lot easier to stick to a diabetes appropriate diet. I was already normal weight and I lost 50kg 10 years ago but I could never really eat cleanly even after losing all that weight. The diabetes only improved that slightly.
I'm with you on this, tirzepatide has been life changing for me. I've struggled with my weight my whole life and I can actually imagine a future where I lose enough that I'm no longer ashamed of my weight.
I've been on tirzepatide for just over a year now. Before that, I managed to lose 6% of my body weight over the previous year. With tirzepatide, I've lost an additional 17% of my body weight, for a total of 23% over two years.
Tirzepatide isn't a magic drug that just makes you lose weight, it simply makes it much easier to avoid overeating.
It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.
> It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.
I had this problem as well. Being on tirzepatide I went from 220 to 185 in just six months because my previous insatiable hunger went away. It feels so powerful now choosing when to eat or not.
> It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.
Forgive my ignorance and curiosity, was the feeling of hunger due to drastic reduction in portion size? Could you not eat some low-calories filling food?
I ask cause I've been overweight and sometimes obese most of my adult life, but when on a diet I usually feel "unsatisfied" but rarely actually hungry, e.g. I can eat a couple carrots or whatever and hunger goes away, but I would still crave a hamburger.
Still, I'm happy for you that you found something that works!
> was the feeling of hunger due to drastic reduction in portion size?
While that was sometimes the case, it wasn't always so. Sometimes the feeling of hunger was almost random, and certainly stronger than it should have been. This was likely caused by insulin resistance.
When I got out of bed because I was too hungry to go to sleep I didn't always make great food choices. I'd tend to eat a 200-400 calorie 'snack', which felt like it wiped out any progress.
Now that I'm on tirzepatide I still feel hunger and cravings, but I suspect it's more in line with what regular people feel. Even if I haven't eaten much during the evening and am a little hungry at night, it's not the type of hunger that stops me from being able to get to sleep.
> Still, I'm happy for you that you found something that works!
Thanks!
I'm honestly in the category of people that have considered weight loss surgery, but I've seen enough problems from that that I've never really wanted to risk the associated problems.
From all the reading I've done it sounds like tirzepatide is almost as effective as weight loss surgery. And people are going to have a hard time convincing me that weight loss surgery is 'safer' than a GLP-1 injection.
I think this is such a helpful description of the totality of components working together to spur a positive outcome, which I think, at least in my personal experience, is an under-appreciated aspect of using a drug.
I've sometimes heard it said that it's an unhealthy reliance on a drug in place of curbing behavior, but I think it's important to understand it as, among other things, a stimulant to the activation of beneficial behaviors, which can be as critical as the drug itself.
Have you been recommended an exercise regimen, or taken one up yourself? The one the great things about GLP-1s is that with the weight loss, it's easier to be more active once you've lost some of the weight.
The negatives is that the current breed promote a loss in muscle mass as well as fat loss, so it is very important to do your best to maintain if not increase muscle while on them.
The next generation of drugs are including 2nd molecule...I'm blanking on the name, and a search isn't bringing it to me...which maintains or potentially increases muscle mass.
But curious what your experience with exercise has been.
I also didn't know there was a planned reduction in dosage, but the expectation is that you'll be on some type of GLP1 for life, is that not right?
Cagrilintide (paired with semaglutide) and retatrutide are the next wave, though I'm not aware of any research for either indicating an increase in muscle mass.
My understanding of the literature is that there's nothing special about semaglutide or tirzepatide that promote muscle loss - it's just people who lose weight based purely on diet tend to also lose muscle mass. Even bodybuilders lose some muscle mass when cutting.
It's up to the individual to increase their protein intake and exercise, the same way they would in any caloric deficit.
Bodybuilders lose muscle and they do a lot of hypertrophy training and high protein eating to counteract it. Probably the average ozempic taker does neither of those so they end up losing more
Sure. You're going to lose some muscle mass no matter what you do. And yeah, if you don't do either of those things, you're going to lose even more.
But fat people actually frequently have quite a bit of lean body mass - it takes muscle to carry around all that weight, even if you're sedentary. If I somehow maintained the LBM shown in my DEXA scan at the start of tirzepatide, by the time I got to my goal weight, I'd be looking more jacked than when I was lifting 3 times a week.
Obviously, I won't. I'm adding more and more cardio and lifting back in as my weight is dropping and it becomes more maintainable for my joints, etc., and I've been supplementing protein since the start, and I'm sure I'll still lose plenty. But I have the room to lose A LOT and still be in the healthy range of body fat%.
What is your argument? That losing weight does not result in muscle volume loss? That GLP-1s are somehow special and only losing weight via them causes muscle loss?
IFBB bodybuilders getting weekly DEXA scans and running multiple steroids including cycles specifically designed to help prevent muscle loss during cuts still lose muscle mass when losing weight for shows, despite taking every drug under the sun, working out an obscene amount, eating huge amounts of protein.
Your body will break down muscle when losing weight. You can do a lot to prevent the vast majority of it, but there is going to be some no matter what you do.
None of the GLP1s cause more muscle loss than simply losing the same amount of weight without it. It’s the rapid weight loss without resistance training that causes it.
If you calorie restricted with the same exercise routine without the drug you’d see the same amount of lean muscle mass loss as you would taking the drug. This spreading of misinformation is actively harming people.
Studies have show most people rapidly regain the weight once they stop taking GLP-1 drugs.
The dysfunctional biochemical processes that contributed to overeating are still present if you discontinue the drug. Your body has a natural set-point for the weight it wants to be at, and the hunger and food noise comes right back as your body tries to get you back to your old weight.
It's possible that after after a long enough time at a healthy weight your body's natural weight set-point will regulate itself back down. But this process take years.
"You'll regress if you stop taking the drugs" may be true, but it seems like a double standard to frame it as a knock against weight loss drugs when this also describes countless other interventions for chronic issues...
Your lupus will flare up again if you stop taking Plaquenil! Your eyesight will be bad again when you take off your glasses!
I'm just being objective in stating that the evidence suggests that these drugs need to be taken long term to have lasting effects. Not everyone realizes this.
But I think that's okay if it can get people back down to a healthy weight. The health impact from being overweight is serious, and we know that lifestyle intervention has a stunningly abysmal success rate.
Anything we can do to reverse the obesity epidemic is a good thing.
More than fair :) I may have jumped to conclusions there because I generally see that line of thinking from people who go "...and therefore there's no point in taking meds," but you're right that not everyone realizes these are long-term drugs.
> It's possible that after after a long enough time at a healthy weight your body's natural weight set-point will regulate itself back down. But this process take years.
I've spent a fair amount of time pursuing obesity research and I've never seen that. The closest I've seen is researchers or studies mentioning "Maybe the set-point resets are x years" but never seen any direct evidence of this.
It's still a theory. We definitely don't know the underlying mechanism(s) of action, and it's likely there's more hidden complexity there.
But rapid weight gain after weight loss (until you arrive somewhere near your old weight) is at least a well observed experimental effect. About 80% of people who lose weight, through any means, will revert back to their old weight.
i lost about 30 lbs a couple of years ago, white knuckling my way through starving myself on a medically supervised diet. within two months of going off the diet, i was back at the exact weight i started at, to the pound, and haven’t varied >2lbs since, no matter what i eat. consider me convinced on the setpoint theory.
There are lots of physiological parameters with set-points, such as body temperature. The problem for weight gain/loss is that instead of one set-point for body weight itself, you have maybe 5-10 set and operating points that are indirectly related to body weight, but not direct measurements of it. They don't all have to be "working right" to keep you healthy, but if too many become disordered at once, you're gonna have a problem.
Set-point theory is pretty much settled medical fact. The mechanism involves leptin, and you can easily see processes that defend bodyweight change in both directions. Though it will more aggressively defend weight loss than weight gain.
In addition prey animals will defend against weight gain more aggressively than non-prey animals. Which makes sense from an evolutionary standpoint. If a lion gets fat he doesn't have nearly as much to worry about than if a gazelle gets fat.
Most weight management programs recommend you wean off - and also recommend other drugs if needed (metformin) to for maintenance.
The method of these programs is to use the GLP-1 medications to allow you to change your habits significantly while also reducing your weight. The goal being, you keep the new habits and your reduced metabolic requirements which allows you to keep the lower weight.
Interesting. If we think of effectiveness as maintained weight loss and eventually no longer requiring the drug then the next few years and decades will be fascinating to see how effective they are long-term.
I mean, that's the goal for any weight management plan honestly - to provide the structure for you to make your own change. That GLP-1 meds are so effective will make a huge difference for tons of folks.
I think many people are going to use GLP-1s without a structure - and they may find it's not as easy to taper off without making a meaningful diet change.
Did you notice that cannabis consumption interferes with weight loss due to interfering with motivation to stick to your health goals? Or did it interfere with your metabolism in some way?
I can answer this, I've been on Ozempic in the past and prescribed Mounjaro (Tirzepatide) currently (month 3).
I've had a medical cannabis prescription for many years and vaporise up to 3g a day which is quite a bit. It definitely interferes with my cravings for food, as you know the common 'munchies' effect, making me eat when I'm not really hungry or binge snacks.
I gave up on Semaglutide (Ozempic) after a few months, but Tirzepatide is working a lot more effectively and has been better.
Cannabis also helps a lot with the nausea side effect for me which can be particularly bad the first few days going up a dosage every month. It takes six months to titrate from the starter dose to full strength, if necessary.
Also the downside a lot of people don't talk about is that most people need to be on these drugs for life. They also aren't cheap.
Have you noticed any effect on gastric emptying. As someone with 'tummy issues' ( ibs/gerd ect) i am apprehensive of messing with my digestive systems.
Not the person you were responding to, but yes. Stomach empties much slower, which seems to effectively make it smaller. A normal size (pre-drug) meal will make me uncomfortably full and probably cause reflux.
That said, I've noticed in the past, and also now on this drug, that my gastrointestinal issues abate noticeably when I consume less food. Thought I had IBS and then I went on a significant diet and lost 40 pounds in 2020. The IBS resolved, and not after I lost 40 pounds -- it basically stopped altogether a matter of weeks after I changed my diet. That was educational. YMMV.
I'm still working out my approach to eating while taking tirzepatide. Old habits die hard, and I'm having to cut my meal size way back. This sucks because my problem with eating too much was about eating too often, or not when hungry, not about binging. So I have to eat pretty small meals now. It will take some adjustment to find the right way to get sufficient nutrition while volume limited, but I think it can be done.
If your IBS is the "stuff moves too fast" variety (so, IBS-D) GLP-1s seem to help a lot since they slow things down. If your problems already stem from things moving too slow... maybe not so much :P
My view about obesity has shifted dramatically since Ozempic came out. Before this, I didn't think about it too much (I am not obese myself).
I notice now that there is a LOT of judgement, bias(?), around obesity, that people, obese or not, carry with them [1]. I certainly carried that bias, and the reason I noticed it was because Ozempic is literally an external substance that you take that simply makes obesity go away. So if you believe (like most of us unconsciously do) that obesity is a personal failing or an issue of willpower, an issue of personal merit -- HOW is it possible that a chemical pill, an external chemical process, can SO effectively resolve it? When no amount of hectoring and moralizing and willpower can? My inability to square that circle really changed my thinking about obesity in a fundamental way.
Already there is a reaction to Ozempic -- like people thinking that taking Ozempic is a personal failing, or judging celebrities, for taking it, thinking it's the "easy way out" -- I think the origin of that is this very deep unconscious bias that we all have about what obesity actually is fundamentally.
My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.
It's really heartening to hear your experience. Your post really struck me, I felt exactly the same way after getting on a CGM + Insulin Pump for my Type 1 Diabetes. Nobody EVER thought I had a lack of "personal responsibility" or an "issue of willpower" for going low or high on shots of Humilin and NPH.
This is a very American way of thinking about it - not invented here vibes all over.
Of course people don’t choose to be obese, but the culture and environment inevitably pushes you to it. A proof of that is that there are places in the world, with similar genes, that don’t have the same problem in the degree that US does.
I don’t think it is a personal failing, more a collective one - the society itself has chosen a set of environmental factors as desirable (car centric, hectic, individualistic, processed cheap food etc) and it just results in more obese people.
Loose the cars (change to walk / cycle / public transport), spend on food as much as the rest of the world do (adjusted to PPP) and suddenly you don’t need ozempic.
It is still weird to me how US choose unironically to develop a drug for reducing addiction, and not putting societal pressure to fix the environmental issues. It’s a democracy, people do choose all of that and can’t really blame it on the government.
Obesity is rising rapidly over much of the developed world, both in Europe and Asia, on a trajectory fairly similar to the historical trajectory of it in the US. Obesity in adult men in North Korea more than doubled between 2009 and 2019. The UK is already up to 26% obesity. 36% of adults in Mexico are obese.
America is an unfortunate pioneer in obesity, but it is not even remotely unique to America.
> It is still weird to me how US choose unironically to develop a drug for reducing addiction
Novo Nordisk, the company behind Ozempic, is Danish. (Eli Lilly is American, though, for the tirzepatide drugs.)
I don't disagree with your fundamental premise - a huge amount of the initial conditions for obesity are environmental. But they're incredibly far ranging, incredibly intertwined with modern life in much of the developed world. Unwinding those, even with strong support from the people, would take decades.
We should still do it. But in the mean time, there's a hell of a lot of people that would die earlier than they would if they weren't obese. And a hell of a lot of them can significantly increase their lifespan with the help of these drugs.
> Obesity in adult men in North Korea more than doubled between 2009 and 2019.
Ok, someone needs to explain how thoroughly non-Western, undeveloped countries, more known for starvation and malnutrition than overabundance of food, are developing an obesity problem!
Must be in the air? Seriously, maybe abundant low-quality sources? AI sez:
The diet in North Korea is characterized by a heavy focus on grains, but has changed over time to include more animal protein:
Grains, Rice, wheat, and maize are the main sources of calories in the North Korean diet. In 1961, over 70% of calories came from grains, and that number dropped to 61% five decades later.
Animal protein
Before 2000, North Korea's diet was mostly vegetarian, with meat eaten only a few times a year. However, since 2005, the availability of animal protein has increased, with an emphasis on poultry, pigs, rabbits, sheep, goats, and cattle.
Other foods
Popular foods in North Korea include kimchi, red pepper paste, soybean paste, soup, and rice dishes. A traditional meal might include side dishes, a main course like noodles, porridge, or grilled meat, and rice dishes.
Regional differences
People in rural areas and mountain valleys eat more vegetables and herbs, while people in coastal areas have access to seafood.
Healthy options
The upper class in North Korea favor healthy, balanced diets, including chicken wraps and tofu rice.
> people thinking that taking Ozempic is a personal failing
I expect that the people who hold this viewpoint are afraid that their lack of being overweight will not be seen as badge of honor, a sign of superior morals and willpower.
To them I say -- GLP-1 agonists are good for anxiety, too!
The fact that a drug can cause a shortcut is completely normal I think, alcohol can nearly instantly give you the confidence that months of training would take, hallucinogens can give states of mind that monks spend years meditating and breathwork to achieve, steroids give shortcuts to massive gym gains, etc.
I see Ozempic as "taking the easy way out" the same way I see steroids as "taking the easy way out" (except it brings people closer to the norm of a average healthy person and will probably lengthen lifespans).
If you're in it to show mental fortitude for internet/social points, then it is "cheating", but if you're just in it for results it's perfectly acceptable and even recommended.
> Not unlike diabetes, celiac, or clinical depression.
The latter is, like obesity, considered a personal failing (being one or more of the Seven Deadly Sins, depending on when you look), and medical treatment elicits similar reactions — both against it being ‘too easy’, and in favour of wholesale societal restructuring instead (“That trick never works!” — Rocky the Flying Squirrel).
It's not just willpower but also lifestyle. It's rare for people who are physically active, and have a balanced diet, to suffer from obesity. I can eat A LOT without putting on a ton of weight, and it's because the types of foods I eat and because I do strength training, which means have a fair amount of muscle mass which acts as metabolic furnace. I'm a little overweight, at the moment, but it'd take a lot of effort on my part to become obese. I think treating obesity as a health condition is the wrong approach.
When you eat more than your energy consumption rate, you're less hungry. When you eat less, you're more hungry. You think the activity would stop you getting obese, but it's actually that you aren't hungry enough to overeat, despite high activity.
I'm not overweight, never mind obese. I pay no attention to diet or exercise. If I'm really hungry one day, I can end up overeating something I quickly deep fried from the freezer. And then I barely eat the next day. Not consciously. I'm just not hungry for a long time after I overeat.
Energy homeostasis is the big thing you're not accounting for. Excercise doesn't really do anything much for your weight, just your fitness.
> It's rare for people who are physically active, and have a balanced diet, to suffer from obesity.
Looking at it from the other angle: can obese people be active and have a balanced diet ?
The answer is yes. In particular you can be obese and maintain your BMI at the same level while being fairly active and not overeating, that happens a lot with people gaining weight and reacting to it, but without going down.
From the pool of people physically active and with a balanced diet, what's the split of obesity is a question I don't have the answer to, but the lifestyle part doesn't look like a good differenciator to me if we're solely focusing on current obesity.
PS:if you eat a LOT more without gaining much weight, imagine eating a LOT less and see very little change.
It's weird for you to say that "people who have the habits for not being obese aren't obese." What's the real point?
Note that "have a balanced diet" is doing a lot of work here. Our modern environment is saturated with super calorically dense, hyper palatable food. THAT is the cause of the obesity epidemic -- it's not endocrine disruptors or seed oils or office jobs or anything else.
And the ability to refrain from eating cheap processed food, which has been specifically engineered to hack your brain, requires education, discipline, and willpower. As does hitting the gym.
It's not surprising that most people don't innately have this ability, and have ended up sick from it. That sickness is a medical issue regardless of how we got there.
My understanding is that more research is pointing to obesity as, in some sense, a precursor/reaction to the onset of type 2 diabetes rather than type 1.
Once you get to quite obese you're dealing with physiological factors that make losing weight medically difficult from behavioral changes alone. It also makes the chances of "yo-yoing" the weight higher as well. At that point the treatment for obesity overlaps with the treatment for type 2 diabetes.
There are varying degrees of control over outcomes. The judgment comes from the correlation between an unobserved variable (effort at controlling or preventing obesity) with the observed variable (actual obesity).
> people thinking that taking Ozempic is a personal failing
Considering our society is pushes us toward sedentary highly-caloric lifestyles, I'd say we're set up to fail from the get-go. Therefore the failing is systemic not personal. I wouldn't compare to individual health issues. You can't cure celiac, but you sure could reduce the obesity using policies to drive the food industry toward less-sugar/more-fiber.
For some people it is clinical. For others it is mental/willpower. That said... It's exceptionally difficult in the modern world to do everything necessary to be at a healthy weight. Things are shoved at you constantly that are terrible for you. It's so, so much easier to eat poorly and to excess. Combine that with dopamine hits from consuming sugar/fat? No surprise people overeat.
I was obese myself, and I have different thoughts on that.
For me, it was purely an issue of personal falling and willpower issue. I was obese because of a diet I was indulging in; full of unhealthy things and snacks.
You don’t place any blame on the people that marketed and created that diet? Or the regulators who allowed that to happen? At a certain point people’s well being and health should come before a mega corporation’s profits. The whole world would be better off if unhealthy food was more strictly regulated. Children grow up not learning healthy eating habits that last into adult hood and some never learn them.
For me, personally, it's that we don't really know the long term effects of these drugs ie are you actually "healthier". But we do know that diet and exercise work.
This is "common sense" and the official recommendation, but fundamentally we don't have solid long term reproductible experiments[0], and due to the nature of the problem (humans living their life in a complex society) we'll probably never have a good answer.
I've read many many studies spanning a few months and calling it a day (did the subjects rebound ? who knows), other taking a very small and homogenic pathological group, making it follow a strict regimen and end the experiment right after the subjects are let free again. But nothing with an actually rigorous protocol that gives a clear undisputable result.
In a way I feel a lot of researchers are bound to their common sense and think they either don't need to prove the obvious, or it brings them nothing to let the room for controversial results ? (nobody's paying for research that says current policy is dumb)
[0] If you have any double blind study with more than a hundred subjects taken randomly from the general population (including "healthy" subjects), with a control group, spanning more than 3 years of observations I'd be dying to read it..
If you think that's a high bar, obesity is touted to be the worst health crisis the US has to deal with with tremendous impacts, putting at least that much effort into research doesn't seem outlandish.
Everyone who's obese has been prescribed exercise and a better diet. It's the quintessential doctor cliche, and yet it indeed hasn't worked for them. GLP1 agonists do.
> If you have any double blind study with more than a hundred subjects taken randomly from the general population (including "healthy" subjects), with a control group, spanning more than 3 years of observations I'd be dying to read it
I see a multitude of cases where jumping out of the plane without parachute won't kill me. From the plane being on the ground, to me being equipped with anything other than a parachute that lets me fly enough, jumping from a plane to another etc.
And I'm not just being facetious, that's exactly the issue we have with pathology related diets, there's a myriad of variables and circumstances to take into account, which makes vague common sense dogmas innaplicable.
Think about it: we have very thorough studies of people dying from hitting static surfaces at high velocity. Why don't we have the same level of evidence for long term obesity treatment if it's a obvious as you say it is ?
Sure - if you ignore the incredibly poor % of people who comply with a prescription of diet and exercise. If you include compliance then the drugs are way way way ahead.
We know for sure that obesity is one of the single biggest increases in all-cause mortality. We know it is directly linked to most of the top disease-related causes of death.
> But we do know that diet and exercise work.
Do you think the ~40% of American adults that are obese don't know that they should eat better and exercise more? That they don't understand that they're cutting decades off their life?
Yes, it is 100% within the power of the overwhelming majority of them to fix things. And I think evolution has kept shame with us for a purpose and that it can be a useful emotion. But I also think it's plainly apparent that neither are causing a real reduction in obesity.
So, should all the people in the world that are obese just continue to fail at losing weight despite knowing what they should, in theory, be doing to resolve it? Because, despite being obese being one of the riskiest things you can do in life for your health and lifespan, we don't know if there might maybe be long term effects from something we know will get them to lose weight?
This room is on fire! I could run out that door over there - I know if I open it and go through I'll leave this room that is currently on fire - but, should I? What if whatever is on the other side of the door is just as bad as being on fire, or worse?!
Is not just “having enough”. People in New York had enough to eat for more than 60 years now - more like a 100 years. And ywt, up until the 1980s, obesity was a minor problem.
All standards have since changed. I watched the 1st season of the Simpsons again recently. In one of the episodes, Homer weighs himself and is distressed when discovering he weighs 200 lbs. 30 years later, dieters who cross down from 200 lbs to 199 lbs call it “reaching onederland” and it is considered a huge success.
The real question is why so many people are obese in 2024 in the US while it was a fraction of the population 50 years ago? And other countries have by far not been affected by the same trend. So effectively something is making people really sick on the US.
It's simply not true that this trend isn't impacting other countries. Mexico is only 6% behind the US. The UK is 16%. Obesity is rising rapidly in South Korea - more than doubled in adult males between 2009 and 2019.
America pioneered the obesity epidemic, but a huge chunk of the rest of the developed world is doing their best to catch up.
> I notice now that there is a LOT of judgement, bias(?), around obesity, that people, obese or not, carry with them [1]. I certainly carried that bias, and the reason I noticed it was because Ozempic is literally an external substance that you take that simply makes obesity go away. So if you believe (like most of us unconsciously do) that obesity is a personal failing or an issue of willpower, an issue of personal merit -- HOW is it possible that a chemical pill, an external chemical process, can SO effectively resolve it? When no amount of hectoring and moralizing and willpower can? My inability to square that circle really changed my thinking about obesity in a fundamental way.
I see no contradiction here. That ozempic works doesn't imply that willpower isn't real or that people can't lose weight via diet and exercise.
> My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.
I'm very suspicious of "it's a health condition" applied to obesity, type 2 diabetes, and even depression. I absolutely believe that some people will be able to avoid or cure those "conditions" by changing their behavior. Of course that doesn't imply that there should be a taboo against medication to help people who can't. But my concern is that "it's a health condition" discourages people from examining their choices and making good ones.
>My view: It is a health condition, that people do not choose.
If this is true, then why are we so focused on curing it after the fact?
Are we also working on prevention?
If it's not a choice, then what is the cause? And why shouldn't we work on preventing that cause?
I mean it's clean that more people are obese today than in the past right? So what changed to cause that that isn't about people's choice? Why not work on reversing whatever those changes were that caused obesity to increase?
And a separate question:
If it's really not a choice, what would be the approximate rate of obesity among a group or population that all exercised regularly and ate healthy?
I don't think I can be convinced that not exercising regularly and not eating healthy is not a choice.
I just feel like the number of people that would be obese who are regularly exercising and eating healthy would be rather small. And if we agree that exercising regularly and eating healthy is a choice, then it seems at least for many who are obese, it indeed is choice.
I'm not going to say there aren't outliers or other special circumstances, but I still feel like for more people than not, it is indeed a choice.
Personally, I've never seen obesity as a failure of character or willpower, at least as long as I can remember having any particular views on it at all. I see it as a failure of information and choices.
Obesity was rare until the United States officially decided in 1977 that saturated fats were considered harmful. A few years later, it started rising to the current epidemic level. We've come a long way since the American Heart Association was recommending candy and soda as "healthy" alternatives to real food, but the idea that an optimal diet contains low saturated fat and high complex carbohydrates remains firmly entrenched in present-day nutritional and medical orthodoxy.
Imagine a counterfactual where Congress had reached the opposite conclusion, instead recommending a standard diet full of saturated fats, high in salts (both sodium and potassium), moderate in monounsaturated fats, low in polyunsaturated fats, and sparing in carbohydrates. The population and food industry would have moved in an entirely different direction. We'd have a whole different universe of nutritional advice, diet trends, restaurant menu options, and easily available processed foods. A lot would be the same, but large sections of the grocery store would look like lowcarbfoods.com, maybe burger joints would serve mozzarella sticks instead of fries, maybe instead of potato chips and corn chips people would eat pork rinds and kale chips, and maybe instead of rice or potatoes an average dinner would include all manner of delicious fried vegetables. Instead of a low(er)-fat (i.e. high(er)-carb) diet, doctors would tell fat people to try keto. Maybe that timeline's equivalent to trans fat would be sugar alcohols and artificial sweeteners, and governments would ultimately pressure the industry to transition to stevia, monk fruit, and inulin fiber.
In such an alternate universe, I'm sure the food industry would still work overtime to find ways to make many of its products shitty and addictive, and I'm sure the average person would still lean heavily on processed foods and fast food over home cooking and whole foods. I'm sure that would cause its own set of health issues, but what I highly doubt it would cause is an obesity epidemic. It's simply a lot harder to overeat fats than it is carbs. We'd also inherently have less insulin resistance, which means less type 2 diabetes, less dementia, and probably a good amount less of mental/neurological issues like depression and anxiety.
Unfortunately, we live in this universe. And in this universe, I find it really hard to blame individuals for struggling with obesity when we've practically purpose-built an environment to make us fat and keep us that way. In order to not be fat (by pre-1980 standards), you either have to win the genetic lottery, be extraordinarily physically active, put a high amount of effort into controlling your caloric intake, or be willing to go against the grain (no pun intended) on what you've most likely been led to believe for your entire life by everyone and everything around you. It's great to fall into one of those four buckets, but on a population scale it should be obvious that the majority wouldn't.
I wouldn't say inherently. Trying and failing to quit is plainly a failure of willpower on some level, albeit an understandable one given varying levels of nicotine addiction. Perhaps it could also be a failure of information (helpful techniques, etc.), although I'm not familiar enough to comment in detail on what quitting smoking is like.
On the other hand, is picking up the habit in the first place, or choosing not to attempt to quit, a failure of character? I'm not sure that's for anyone other than the individual to decide. I personally feel it's unwise given that in 2024 smoking tobacco is pretty much universally known and accepted to be wildly unhealthy, but if someone weighs the tradeoffs and decides that maybe it has social and/or professional and/or mental benefits for them that outweigh the downsides, I wouldn't call that a character flaw so much as a decision that I'd highly disagree with. I'd say the same whether we were discussing tobacco or meth.
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Edit: More to the point I now see you were probably getting at, there's a pretty big difference in the knowledge and time/resource investment required to stop buying cigarettes (which costs nothing) and to adopt a low-carb or ketogenic diet that a particular individual would be happy with long-term. I've been keto for over 12 years, and I have a routine that I enjoy, know my way around a kitchen, know what foods I like, and know all the right ingredients and recipes to use to create any food I might want to eat in a keto-friendly form that's as good as or better than what I could otherwise buy at a store or restaurant. For example, I make some of the best ice cream I've had anywhere (sometimes in flavors that I've never seen commercially available), and the one time I cheated for a New York slice I was disappointed because it didn't hold up to the pizza I'd already been making at home.
Maintaining my diet takes zero willpower, because I enjoy it even more than my diet from when I was fat, and I never had to starve myself or give up my sweet tooth. The problem is that for that to work it required not just the inclination to research and adopt keto in the first place (a major hurdle in itself), but turning it into a dedicated hobby with development of knowledge and skills that I wouldn't expect the average person to casually pick up. That may work for me, but isn't a scalable solution for the population at large. On the other hand, if I could magically reformulate every food product in the world based on what I know from experience works, no one would struggle to eat a high-fat diet because that would just be the default instead of high-carb.
The willpower frame actually works pretty well for a lot of people. If not than in our society almost everybody would be obese. This pill will make things worse for the group that hangs out in the treadmills and drinks green and disgusting smoothies.
On topic, very happy this medicine exists, but let's pray god will keep the prescription only for BMI > 35.
> The willpower frame actually works pretty well for a lot of people. If not than in our society almost everybody would be obese.
In the US nearly 75% of the population is overweight and almost half are clinically obese. Sounds like "willpower" isn't working for the vast majority of people.
That is not logical. If willpower fails, how could a pill be a solution? That is like suggesting to give everybody methadon, because the substance dependency issues are just too overwhelming. Or even better, give certain kids from 12 to 6 years old a gun to solve the school shootings issue.
> If not than in our society almost everybody would be obese.
Isn't that already the case. I'm of belief, the failing isn't individual but societal. You have obese toddlers and wild animals in the US.
I don't think this is a failure of willpower, it's a failure to investigate the actual causes of the obesity epidemic. Maybe it's sugar, perhaps it's highly processed oils, etc. Whatever it is, people aren't investigating it thoroughly enough.
I live in lala land. Obese children are rare, however overweight is 11% and declining from 15% post covid.
The school where my kids go to has zero obese and zero overweight kids (n = 300).
We have Starbucks, McDonalds, Dunkin' Donuts and the same brands like Heinz and Coca Cola. Pizza.
So, I am optimistic willpower can prevent us from a new Ozempic disorder. I suggest to go for willpower and not pills. If willpowers falls short, in my country when a child becomes obese, child welfare steps in. So let the government intervene (yep, you will lose your parental power) with a lifestyle program.
> realized that frequent cannabis consumption interferes with the weight loss, so I've kicked the habit from daily to occasionally on weekends
Did you try to reduce your cannabis consumption before using tirzepatide?
Because although you say(feel) like the realization made you reduce your intake, I can hardly imagine that you were totally oblivious to the fact that smoking cannabis is unhealthy in the first place.
Do you feel like you think less about e.g. cannabis, or do you feel like it's easier to say no to that impulse?
Does it seem to mainly influence health choices or are you also less likely to be angry or does it interact work place interactions?
What annoys me is it’s like $100 in Europe and it’s available in a pill form there (so you could presumably easily reduce the dose and therefore the cost by breaking the pill in half). And no US insurance will cover any of it unless you have diabetes. Put another way, if I can find someone in Europe to prescribe it to me, and pay out of pocket for 90 days worth, I could take a free vacation to Europe every 3-4 months in perpetuity.
I feel high on life when I am off the sauce, eat less, and walk more - without any drugs. Healthy lifestyle is the best medicine, and the biggest problem people have is not even genetic predisposition, it's impulse control. We all want that reward, right away.
I’ve had an on and off battle with ad-hoc self medication for anxiety via heavy drinking for like twenty years, by “on and off” I mean that some situations didn’t really trigger it much, and other situations made it life defeating.
As close as I’ve come to an effective remediation was living abroad where the food wasn’t actively adversarial: capitalism can do many good things but it drives the quality of food to “edible plus epsilon”. Rich people eat pasture-raised shit for a reason. For me it just deleted that problem.
But I’m interested in this class of medication because it’s difficult bordering on impractical to eat well in some regions. People say just cook, well, there’s an infrastructure around that which amounts to a declared bias against those who didn’t settle down young. Much like people who met their partner before partnering became monetized, “easy for you to say”.
I hope you have success in your journey either way, and the less meds involved on average probably better, but if it works and has no bad side effects I don’t see why one would stop. Welcome to your new awesome life!
Every SV power player I’ve ever met was enhancing themselves via chemicals. It’s not tweeted about (other than when Garry Tan threatens elected officials), but it’s a quiet norm.
I'm not sure if you tried but add a sport, can be table tenis, jiu-jitsu whatever. I did this too after got comfortable with the walks (that I still do).
You can't imagine how empowering it is to be able to say "No." to food. I stopped eating dessert except once a week. I can be in the company of other people and surrounded by delicious food and not feel the compulsion to eat until I am nauseous.
This is interesting as this is my default, and I am pretty lean. I often have to remember to eat or check if I did, and lament that its a chore. I enjoy food and the dining experience, but I would be fine with that being an entertainment option once a week too.
I wonder if there is enough research on how gut bacteria influences these things, because if this is what people want maybe I could sell mine.
I saw a documentary once about people who effortlessly remain at a healthy weight, and their activities were tracked for a couple of weeks, revealing;
* Unexpected bursts of random activity like dancing for a few minutes or moving heavy furniture, that these people didn't even notice, while still doing no deliberate exercise,
* Binging like suddenly eating a whole pizza, but then eating next to nothing the next day because "too busy", without putting thought into it. This would be bad for you on the scale of months, but fine over one week.
So, of course, they made up for all the calories they seemed to be taking in. There's an implication that this is instinctual, or just fortunate habits. In my case, I also burn energy arguing, puzzling, and worrying, and I naturally radiate more heat than most, and although I'll happily try to eat a whole tiramisu by myself I seem to have a small stomach and don't attempt it often anyway. So although I think of myself as lazy and gluttonous, I guess I'm just fortuitously, circumstantially not. Imprison me in a restaurant, I'd probably get fat.
Edit: right now I'm idly eating chocolate while I type. But I have no other food in the house, except three bananas. That's because I didn't organize it, because I'm lazy, but what "lazy" really means is a complex subconscious strategy, I think.
This is something that I like to ask friends and acquaintances: Would you rather take a pill that gives you perfect nutrition and nullifies your hunger feeling or a pill that the gives you perfect nutrition and nullifies any other calories you eat.
It's pretty much 50/50. Which is weird, as you'd think that eating is only a pleasure when hungry and I'm proposing them a way to get rid of hunger. Even weirder is that I personally would take the second pill and enjoy my gluttonous lifestyle.
Regarding this thread: I personally decided for myself that if I can be stubborn towards my wife, friends and mom (and I am a stubborn SOB) I sure as hell can be stubborn towards my own bodily desires. I removed all meals except once per day and pretty much all desserts. Fuck what my body thinks it desires, if it needs it that much it can go fix a meal while I sleep.
I want both... Some days, in particular when working hard or focusing on something, food is just fuel and not something I want to spend time on. I'd definitely take that first pill for those days.
But I also really like cooking. If I have the time I don't mind spending hours in the kitchen to prepare something. I don't really need that second pill yet, but sometimes you just want to pig out...
That's some philosophical weirdness right there. I guess we're kind of into the biological aspects of the human condition and don't want to part with them, because they're like a fun, mildly disgusting game. There'd have to be some other entertaining lifestyle that you gain in exchange, and you'd have to be sure you could dig it before you'd agree to the switch.
When data and anecdote match, such comments seem unwarranted. Heterodoxy is useless if it isn’t correct. And you haven’t even expressed a clear rebuttal.
Sure, there may be honest and enthusiastic people. But their input would be essentially that of an ad: a product with 100% gain and 0% loss? That's never been observed, never; there's always a trade-off.
A less emotionally grounded, more balanced and nuanced description would be more accurate, honest. But it'd sell way less.
I see a lot of the recommendations expressing anxiety about what will happen when they discontinue - which calls into question the validity of the official treatment plan they are under and isn’t normally something you’d bring up in an ad.
Perhaps I must emphasize that my point is subtly different from the parent's: whether those people are genuine or not fundamentally is irrelevant: a miracle drug with essentially no drawbacks is a fairy tale. It's almost certainly a lie.
(That's why the parent think they could be ads, unless he's deeply cross-referencing South Park…).
The loudness of that lie ITT might also drag people down an unhealthy path: it's irresponsible not to speak up about it.
We know obesity is one of the absolute worst things you can do to yourself as a human.
We know that being prescribed diet and exercise has not helped hundreds of millions of people in the world stop being obese.
We do not catch every long term concern when developing a medicine - but we do catch a decent amount! We know specific mechanisms to be concerned for, e.g. angiogenesis and the likelihood of accelerating tumor growth, lots of others. We do not see any mechanisms that would point towards health risks anywhere near the level of obesity.
So the realm of concern lies around possible long term side effects that we're not aware of.
If you find yourself in a room that is on fire, and you see a door but you're not sure what's on the other side of it, are you going to refuse to open it because there might be something worse on the other side?
"Too good to be true" is also just an aphorism, not a law of nature. It's certainly possible that are negative long term impacts from GLP1 medications, but should all of the people that have been unable to remove one of the single biggest health risk factors in human history via diet or exercise not pursue an option that we know is highly effective at removing that risk factor just because there might maybe be something worse years down the line? We're not talking about acne or hair loss here, man.
The immediacy of the danger makes things incomparable.
> "Too good to be true" is also just an aphorism, not a law of nature.
It's not "too good to be true". It's "no free lunch" (unfortunate pun), or "conservation of energy": the more one wins without apparent loss, the more one should be suspicious.
There are furthermore great reasons to be highly skeptical of pharmaceutical compagnies: consider the ongoing opioid crisis in the US, in great part caused by the sale of opioid-based medication (OxyContin) whose addictiveness was purposefully downplayed. Not to say that things will be as scandalous, merely that pharmaceutical compagnies cannot be trusted.
> We're not talking about acne or hair loss here,
Yes, and the people suffering from eating disorders are often psychologically weakened as a result (and/or cause), thus vulnerable to further abuse. Of course such people want to hear about a miracle way to solve this pesky, long-standing issue, of course.
And that's exactly what they're being sold; it's disheartening.
> The immediacy of the danger makes things incomparable.
Being obese is an immediate danger. It is an increase in risk for all cause mortality. Being obese today is making you more likely to develop cancer. It's making your more vulnerable to hear attack or stroke. It is one of the highest comorbidities with covid and plenty of other diseases.
It also is taking decades off your lifespan in the long term, of course. Some of that can be reversed by reversing your obesity, but for some the damage is cumulative over time. Maybe we'll get gene therapy or some other advanced medicine and be able to fully reverse, but maybe not.
> It's not "too good to be true". It's "no free lunch" (unfortunate pun), or "conservation of energy":
No free lunch is another aphorism. Conservation of energy is largely true, though some quantum effects, dark energy, etc. mean it might not be on the largest and smallest scales, but at a human size reference frame, is. But... no one is suggesting any physics boggling mechanism of action for these GLP-1 meds. We spend energy manufacturing a chemical that agonizes receptors that have the effects we're looking for.
> the more one wins without apparent loss, the more one should be suspicious.
There's fairly significant economic loss right now, but I know that's not the point you're going for. But iodine in salt has been basically 100% positive. Well studied over decades, it's one of the largest public health wins in human history. Caffeine, consumed in reasonable quantities, is basically universally a health win. You can have contraindications, certainly, but those also exists for GLP-1s - no one suggests they don't. But for the vast majority of people, ingesting caffeine is basically all health benefits - even if we remove the energy/wakefulness portion, we have mountains of research on how moderate amounts of caffeine a day reduce all of the major CVD outcomes, etc. We've been using caffeine for thousands of years - should I be suspicious of another shoe dropping?
> There are furthermore great reasons to be highly skeptical of pharmaceutical compagnies: consider the ongoing opioid crisis in the US, in great part caused by the sale of opioid-based medication (OxyContin) whose addictiveness was purposefully d
To be clear, I'm not a fan of big pharma - despite being generally incredibly pro-capitalism, public health is one of those areas where I think a government that serves the people should be stepping in and handling things. The power imbalance is too high for the market to be free, and profit motives generally lie in treatment vs. cures. If I could wave a magic wand, we'd have socialized medicine and pharma research would be funded by people where the motive is curing disease first and foremost.
But that doesn't mean that I'm going to shun modern medical science. And yeah, stuff like OxyContin is horrific. But for every oxycontin there's a hundred drugs that weren't handled nearly as recklessly.
> Yes, and the people suffering from eating disorders are often psychologically weakened as a result (and/or cause), thus vulnerable to further abuse. Of course such people want to hear about a miracle way to solve this pesky, long-standing issue, of course.
I mean, what's the alternative here? We should just... not use a drug that is succeeding in getting people out of obesity and being overweight? Because something might maybe happen later that will be bad?
We know obesity is one of the absolute worst things you can do to your health. It is 100% an immediate and clear danger to the health of every obese person. I'm not going to say they have to take a GLP-1 drug - that's their own choice. But we know the overwhelming majority of obese people do not succeed in getting the weight off to begin with, much less keep it off, despite being "prescribed" diet and exercise. So what's your proposed solution? Have hundreds of millions of people stay fat for a couple of decades while we wait and see if there might be long term risks that are worse than what is already one of the single most significant risks factors to health and longevity?
To take the time to study the root causes of obesity more closely, and treat the genuine causes, instead of slapping medicine on top of it, for an undetermined period of time to millions of people. It's insane.
Obesity at that scale is a recent issue[0], I'm sure we're clever enough to figure it out.
Think about it: as far as we know, the human body has evolved slowly over many thousands of years; how can drafty-patching it at scale over a few decades works? When something as inconspicuous as switching from stale bread to softer bread has had a drastic impact on dental issues[1]?
It's like a junior dev undertaking a major rewrite on his first day of work.
I'm reluctant to argue much further, I doubt it'll change much for either of us.
> To take the time to study the root causes of obesity more closely, and treat the genuine causes, instead of slapping medicine on top of it, for an undetermined period of time to millions of people. It's insane.
What if medication is treating the genuine causes? What if we find out that there are genetic or biological reasons that increase your likelihood of being obese and decrease your ability to take action to resolve it? Medication still no go there?
But either way, your solution is effectively "Leave millions of people in a state that makes them significantly more likely to die until we find a nebulous ~right~ way to treat it."
> Think about it: as far as we know, the human body has evolved slowly over many thousands of years; how can drafty-patching it at scale over a few decades works?
I listed multiple examples of us draft patching the human body in ways that have been overwhelmingly positive in the prior response. Humans did not get iodine supplementation at the levels iodine salt provided until modern history. Regular and consistent access to caffeine for any significant portion of the population is something that we measure by centuries, not millennia. Even if we look at the populations that started getting more irregular access in 1000 BC or so, they don't have statistically significant outcomes than the rest.
> When something as inconspicuous as switching from stale bread to softer bread has had a drastic impact on dental issues
That's an interesting example. Do you think we should make everyone switch back to stale bread and refuse giving them dental and orthopedic work if their issues are caused by not eating soft bread now that we know the cause?
You need to change your attitude if you want to lead a healthy lifestyle. Don't blame your failures and CHOICE to eat junk and not exercise on weed. You know what the healthy choices are, you know when you're not making them. You lack self control.
I don’t usually say something like this on HN, but you are completely and utterly wrong. The obesity epidemic cannot be reduced to some simple moral failure. Multiple twin concordance studies have shown 70%+ inheritability. Those of us who are fortunate enough to not struggle with obesity do so not because of some skillset that we have, but because our bodies do not maintain the same homeostasis.
For those of us old enough to remember what society looked like before the obesity epidemic kicked in, it’s hard to understand how something genetic can suddenly result in a dramatic change over a period of years. Our genetics didn’t change. Our food environment did. Experts disagree on what factors are responsible for this, and any random person had their own pet beliefs.
But this flat-earth-like notion of reducing obesity to an issue of basic willpower needs to be recognized for the drivel it is, along the related notion of calories in & calories out while ignoring the overwhelming role that basal metabolic burn plays and how it dynamically responds to changes in diet and exercise.
If you want to educate yourself, read Posner’s Burn [1], which is firmly grounded in empirical measurements of doubly labeled water to measure true metabolic consumption. Look up the reporting the NYT on past contestants of The Biggest Loser.[2]
> The obesity epidemic cannot be reduced to some simple moral failure.
You're the only one to bring up morality so far in this comment chain.
> Those of us who are fortunate enough to not struggle with obesity do so not because of some skillset that we have, but because our bodies do not maintain the same homeostasis.
That's just utter bullshit. Homeostasis is heavily influenced by lifestyle choices.
> But this flat-earth-like notion of reducing obesity to an issue of basic willpower needs to be recognized for the drivel it is,
No, your incessant need to convince yourself and everyone else that something as straightforward as controlling your calorie intake is in fact a complex and naturally intractable problem that requires drugs and counseling is what's flat-earth-like drivel and utter bullshit.
> If you want to educate yourself, read Posner’s Burn [1], which is firmly grounded in empirical measurements of doubly labeled water to measure true metabolic consumption.
You're cherry picking terrible studies that happen to fit the preconceived notions you desperately want to believe, because they make you feel better about being undisciplined and weak-willed. Your understanding of nutrition, exercise and health are also clearly very minimal.
I'm trying to give them the benefit of the doubt that it is a real experience, but yes it currently reads like marketing material aimed at the obese, depressed tech worker.
It is pretty awesome . I’ve been on tirzepitide for a couple months. I’ve lost about 25lbs which is about 8% of my starting weight. I eat a lot less, but have not spontaneously changed what I eat. 50 years of bad habits take time to change.
But I atleast believe change is possible now. I’d pretty much given up. Every time I tried to go on a diet, I’d end up heavier than when I started. Not joking.
In 2009 I did have a winning streak on low carb keto, lost like 75lbs. Gained it back and more over the next couple years though. I’ve tried many times to get back into keto / low carb but have not been successful for more than a few weeks.
This is the first thing I’ve done for weightloss that has legit results that are personally shocking.
I’m very concerned about how to make changes long term. I don’t have a track record of making long term life changes, but I’m going to do my best with this opportunity.
The experience in that comment is literally my experience w/ a GLP-1 Agonist! Poop fart dong gobbler. A marketing team wouldn't write that, though, so you can believe me!
I've got to say, pretty frustrating seeing answers like this. It just completely ignores all the real, valid difficulty that people have in fighting obesity. If you "just" follow this diet, that requires discipline, strong will, buying correct supplies, 2h of cooking a day, measuring, counting, adhering to strict eating timeline, for months (years for some people), you'll be golden! There is plenty of research into behaviour changes with obesity and mechanisms that prevent good decision making etc - apart from just the practicality of all of the above in one's daily life with work, kids...
I see in other replies that you've had success in losing weight, and congratulations - but that doesn't mean it can work for everyone else.
I don't look at any kind of "pill solution" lightly, and absolutely think lifestyle changes should be made as well - but I can definitely see how medication like this can help get people on track and get back control. It's very encouraging to hear about psychological effects in terms of self-control, decision making etc. I'm just worried that we'll discover serious negative side-effects before too long, as with previous attempts.
Cutting carbs only helps to the extent you’ve reduced calorie intake.
People drop their calories too low, and then they take a cheat week after a year or so where they eat pasta, and suddenly they feel a lot better and they’re back to eating more calories and back to gaining weight, leading to yo-yo dieting, which may even be worse than just having a higher than healthy but static weight.
That’s not true - the ketogenic diet is not a calorie restriction diet. It was invented early last century by a medical doctor to simulate fasting and treat epilepsy in children. Low calorie diet lead to yo-yo dieting which is not the case for keto were you are allowed to eat enough calories to be satiated. The binge eating comes for the oscillating glucose and insulin levels driven by the consumption of refined carbs. Carb addiction is the problem and that’s the root cause we should be addressing to stop the metabolic health epidemic that has only been getting worse despite all the pharma profits.
I’ve done keto a couple times in the past, even back when it was called Atkins. It absolutely was a calorie deficit diet since it was difficult to eat that many calories consistently to go over my BMR for more than a few days at a time.
Friends doing it also had the same experience as I did.
Not saying it isn’t as advertised, but everyone on it I knew (n=14 or so) was getting results from fewer calories after we all decided to start carefully logging food intake.
It’s a great diet that works, but via other mechanisms for many vs ketosis.
It’s still a restriction diet that poses a lot of challenges for most to remain consistent with on a long term basis.
This is about as useful as telling someone who's obese to just eat less. Factually yes, it might help them, but practically they're clearly unable to implement it, probably for a plethora of underlying reasons.
Go see what people are eating in real life. There are a lot of studies.
Americans eat way more meat, almost no fruits and vegetables, and a lot of carbs.
The point is that the food pyramid has absolutely no impact and pointing to it and making correlations with it is like doing astrology to explain why you broke your hand while playing basketball the other day.
Edit: you do a great job to illustrate how little anyone knows about these food guidelines.
It took you 17 years to even learn they’ve changed.
> Edit: you do a great job to illustrate how little anyone knows about these food guidelines.
> It took you 17 years to even learn they’ve changed.
I gave an age range for a very specific reason: That's the age group this food pyramid was pushed hard on kids. I didn't know it changed because I was finishing gradeschool as the change happened.
You don't have to memorize and precisely follow it to have internalized generic things like "lots of carbs = good". They are supposed to be our bodies' main source of energy and there's really no way you can have too much (or so we were taught at the time).
Implementing a ketogenic diet is not the same as a caloric restriction diet - it’s an inversion of the macronutrient pyramid - heavy on fat, moderate on protein and low on carbs.
Even if you consume the same calories as in a traditional diet you’ll likely lose weight. Check the https://metabolicmind.org site for more insightful information.
I read your experience and it is indeed pretty incredible and I'm happy for you. I've used ketosis strategically for athletic reasons, to cut weight. So we both had strong motivations to use it. But for your typical obese person, it is a tremendous challenge to stick with it and at the end of the day, it's adherence that matters.
Put simply, it's easier to adhere to a drug than to a specific, somewhat anti-social diet.
It really helps if you use some LLM tool like ChatGPT or Claude to generate the keto recipes (sometimes with the ingredients you have available).
If you stick to cooking keto recipes for a few weeks you end up internalizing the recipe patterns and you start cooking without even thinking about it.
I also recommend taking a look at this Joe Rogan interview to understand at a deep level all the problems with a drug like Ozempic - https://www.youtube.com/watch?v=G0lTyhvOeJs
Check the https://metabolicmind.org site then - you’ll find plenty of research based evidence on the usage of the ketogenic diet as a metabolic therapy.
This is true, but fat people have a hell of a time cutting out all carbs. For many of them, they'll eat the "low carb" option, and then have an occasional binge and it negates any benifits of low carb, and doesn't put them in ketosis, etc.
I strictly maintain my weight. If I catch it going over over 155# (I'm a 5'10" 61 year3 old male) I'll do a strict cut. And I know that either strictly counting calores OR going to as close to zero carbs will have the same net effect.
But a person who has obesity or is overweight will not be able to follow a diet. They are just incapable of doing so, or will lie to themselves or others about it and claim it's their "metabolism" or a medical condition, etc.
I’m 1.78m, 50 years old, my initial weight 2 month ago before I started the keto diet was 154kg and two months later I’m almost 130kg. Eating the same amount of calories as before.
Yes. But a real keto diet, where you are in ketosis, is impossible for most fat people to follow. They will inevitably cheat (“tee hee hee! It doesn’t count if it’s birthday cake! I’m so naughty”) and be in ketosis.
You can just cut ultra-refined foods i.e. junk foods. No one is getting obese from lentils, broccoli and apples. Even so, avoiding weight gain is one thing and losing weight is another. While it helps to increase ratio of protein and fiber intake for satiety, that in itself does not guarantee a caloric deficit, which is what is necessary for weight loss.
If your primary macro consumption is fat, your body will enter a state of ketosis burning fat instead of glucose. As long as your calorie intake of fat is less than your basal metabolism corrected by some factor, you will lose weight and feel satiated - you do not need to follow a calories restriction. Believe me - I tried both ways and the ketogenic diet never left hungry - always satiated.
I'm aware of how keto works. In fad diets focused on composition, short run WL is typical followed by stagnation. What's one going to do when they stop losing weight, eat negative carbs?
> you do not need to follow a calories restriction.
Weight loss comes down to energy balance. People tend to consume fewer calories at the outset when going low-fat or low-carb (in large part because protein is afforded a higher fraction, and it is more satiating), but clearly that does not mean that you'll always have a caloric deficit. Eventually, you'll need to reduce intake to continue losing weight.
Yes I actually used ChatGPT to calculate what would be the required daily amount of calories to achieve my target weight in 6 months - the big difference is I always feel satiated and that the body being in ketosis ensures I’m not accumulating but burning fat.
1) “obesity” has no clear clinical definition, nor is it really a disease. [1]
2) there has been no evidence yet that weight is at all a primary determinant of health [2]
3) Weight loss drugs must be taken forever or it’s nearly certain you will gain the weight back [3]
There’s a lot of great research these days that shows fatness is not what people think it is, and weight stigma is far more harmful than being fat itself [4].
Also, nobody knows what happens yet if you take these drugs for 30 years, and what we do know is that being fat hasn’t been proven to kill anyone.
As someone who struggled with their weight his whole life, this medication is a god send.
My wife and I cook every evening. We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.
Every morning I wake up and go on a 5 mile hike.
And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.
And you know what it is? It's volume. I eat too much. And I have no cookies at home. I have no chips at home. No soda, no alcohol. I drink black coffee with a splash of milk. I don't eat any sweeteners.
I have had weight loss surgery (lap band) which was later reversed as it hurt 24/7.
Now, on ZepBound I lost 20lbs in 2 months. I am not hungry. My brain can actually focus on the things that matter.
Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?
> Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?
"Getting fit and staying fit" is a form of social capital, because it's extremely hard and only within reach of a small portion of the population. "Being fit" is strongly aligned with "being attractive" which confers all sorts of cross-cutting social benefits.
Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.
I would say my concerns are far more in the range of downstream effects from the medication. Specifically, I am concerned with muscle retention. Concerns aside, it's a little hard of an argument to swallow having visited many other countries where these things are simply not an issue. How can it be argued that the cause is anything other than behavior when so many others are doing just fine? There is more to this story than painting people as evil.
This is the essence of the moral argument: Someone chooses to abuse a substance, they become a more frequent abuser, and the abuse piles up damage, which the person ignores to continue abusing.
The essence of the argument against drug interventions is that the root cause is personal choice, and therefore a drug is a shortcut or crutch and does not address the root cause.
Many people feel that the real cause is the structural changes to the person's brain, body, and daily routine that reinforce, and are reinforced by the initial tiny over-consumption, which compounds over time. It's like a debt where you are stuck paying interest, no matter how much you'd like to pay off the debt. Addiction is a system in which the person's willpower goes against everything they have set up over decades. It's unreasonably challenging for nearly everyone to walk it all back. Insulin resistance is one of the most pernicious effects of even small over-eating over time. The body and mind do not feel satiated even though enough calories have been consumed. It's not "I would enjoy another slice of pizza", it can be "I am still starving".
And yes, the environment in which we live, where it is less stigmatized to overeat, and food is treated a certain way, more like a drug than fuel, is part of that system.
> How can it be argued that the cause is anything other than behavior when so many others are doing just fine?
Aren’t you are ignoring the way western society influences behavior? eg lack of walkability of suburbs, massive price difference between fresh and processed foods, constant advertising of junk food & alcohol.
No, I think force feeding junk food is pretty rare but that seems like a straw man.
Consider children. Their brains are not fully developed and they have little agency in determining the food they have access to. Childhood obesity is on the rise. So blame the children’s choices?
Ok, sure, blame the parents. I agree of course it is the parents responsibility, but the cards are often stacked against parents by big corporations with government subsidies (in the us).
It’s really weird to me to argue that this is completely a problem at the individual level and not a social one—and I see no other way to interpret your comment.
The point is that the isn't some mysterious force we cannot comprehend. If the odds are stacked against us, change the odds instead of medicating everyone.
At the same time, we are all still individuals. We agency to make life decisions. I generally don't subscribe to the notion that people are helpless even in the face of a big scary corporation. There are two competing ideas. Either 1 there is some unknown force creating this problem(but doesn't extended to the entire human population for some reason) or 2 we know there are environmental causes. For #2, why systemically stack a drug on top if we know what the boogy man is? #1 we need to seriously buckle down on research on what the environmental/behavior factor is so we can bring everyone back to human baseline. Using drugs for people already in great suffering is one thing, but that is very different from widespread distribution as a preventative.
I think you lost the thread (literally the context of threads I was responding to), because much of what you’re saying aligns with my point. OP was mocking the idea that environmental factors should be taken into account and advocating a no-excuses policy of individual responsibility.
If you think I am advocating medication or implying that “people” are helpless against corporations, read again. I agree with most of what you say although I am not sure we need more research (although of course I don’t discourage it). Maybe one day we’ll prove that the government subsidizing corn so that big corporations (spun off from former tobacco companies as another comment pointed out) can super cheaply mass produce syrup which our evolutionary biology finds difficult to resist and market directly to children turns out to be bad for health outcomes and good for profits (for the medical industrial complex as well). Oh wait, we already know that.
> Consider children. Their brains are not fully developed and they have little agency in determining the food they have access to. Childhood obesity is on the rise. So blame the children’s choices?
Been there. It’s always bad parenting. I had to fix shitton of issues myself, because of idiot parents.
No, but social conditioning normalises it and those in the lower socioeconomic areas of living buy the cheapest rather than most nutritional food and are way less likely to read informative articles or posts about healthy eating. It really is heavily influenced by a lack of supply of healthy affordable food.
Are we? Because most people have this conversation and talk about people they think are able and unwilling, when in reality the vast majority are willing and unable, for one reason or another.
Not sure why you are downvoted. I had the same question about who’s behavior we are referring to. Attributing obesity simply to individual behavior and choices is pretty myopic. Just look at government subsidies for corn. There are larger forces than the individual at play. This is a social problem.
It can be quite eye-opening to travel from say, the UK to Hungary. Walk down a busy street in London and you'll see many overweight people. Walk down a similar street in Budapest, and you'll see very few.
The numbers don't seem to bear out your impression, Hungary has higher rates overall than the UK. Perhaps there is more social mixing in the neighborhoods you visit in London vs Budapest.
It seems the article is now behind a paywall (can only get a reddit link w/ a screenshot atm [0]) but there was a study that showed body composition after 25% weight loss in terms of fat mass and fat-free mass (and the portion of fat-free mass that was skeletal muscle mass) after traditional several interventions, and also compared the breakdown of weight lost in terms of FM and FFM for several GLP-1 medications:
- diet alone
- diet + extra protein
- diet + exercise
- retatrutide
- tirzepatide
- semaglutide
tldr is that, despite some muscle loss, muscle as a percentage of body composition is higher (~50% FFM at start, whereas weight lost with GLP-1 meds ranged from 25%-39% of muscle). It also seems like the muscles will likely function better with less insulin resistance:
> Intentional weight loss causes a greater relative decrease in body fat than FFM or SMM, so the ratio of FFM/SMM to fat mass increases. Accordingly, physical function and mobility improve after weight loss despite the decrease in FFM/SMM, even in older adults with decreased FFM and SMM at baseline. In addition, weight loss improves the “quality” of remaining muscle by decreasing intramyocellular and intermuscular triglycerides and increasing muscle insulin sensitivity
How will the person have less insulin resistance when GLP-1 medications stimulate the release of insulin?
It seems to me we're curbing eating by flooding with insulin, when one of the big damaging effects of overeating is insulin floods. (Or perhaps I'm misreading, perhaps insulin floods are only bad b/c they cause insulin resistance which causes more overeating?)
You aren’t being flooded with insulin with the GLP-1 meds. You have food in your body, but my insulin levels, on average, are possibly lower than yours (if I’m in need or a GLP-1 med) despite eating the same amount.
A GLP-1 med stimulates the release of insulin slowly over a sustained period of time, not just as a massive spike when I eat.
Everyone (that isn’t diabetic) has a massive insulin spike when they eat something that spikes their glucose. GLP-1 meds don’t make that better in any way.
I don't understand the hostility. I am attempting to discuss the topic on a discussion site. My point is not too instruct any one person on what the exact correct solution is. However, I find the selective vision with this topic to be dishonest and ultimately damaging to the conversation(and progress by extension). One can still come to the conclusion that drugs tip the balance positivity enough to use them without sweeping other realities under the rug.
Some, but sarcopenia caused by rapid weight loss is a well known phenomenon. I think the tie to ozempic is a little overblown, but is is a real issue.
In a “traditional” weight loss strategy, you paired calorie deficit with an increase in physical activity (cardio, resistance training, etc). This increased physical activity helped protect you from muscle loss (your body tended to recognize that muscle was important so it burned fat at a higher rate)
With ozempic, people can lose weight without changing their sedentary lifestyle. Since your muscles are not needed, your body is free to grab energy from wherever it can. In some studies, almost half of weight loss can come from lean tissue.
Is it better to for an obese person to lose weight vs not lose weight? Absolutely. But it would be even better if they also changed their lifestyle to protect their muscle mass.
I'm curious how is lean mass measured and why do we think what we measure is actually lean.
I'm not denying that under some circumstances like in the case of severely obese patients their bodies might think protein is better energy source than fat but in people with normally functioning bodies it shouldn't happen a lot especially if they get enough protein in their weight loss diet.
> Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.
I don't think this is just about a social club. Battling weight loss and habits is foundational to the human experience from the most recent centuries. Be it drugs, or anything else really that changes the nature of these challenges, people are going to feel discomfort because it's an attack on their understanding of the world, and in some ways, their beliefs.
It’s only within reach of a small portion because of industrialized food. Look at a graph of obesity rates in the US over several decades. Find literally any picture of people at any beach in the US in the 60s or 70s versus now.
Something like 15% of the world lives in extreme poverty. This is darn near the best it's been in the history of the world (there used to be much more poverty by percentage), but this group would likely have trouble being fit. They might be skinny, but surely not fit.
Ignoring that extreme the questions maybe different: How many hours does a median person have free from work, commute, and sleep? How much time must be spent managing exercise and diet to achieve fitness?
I think if you took the time to answer those questions for the median or modal non-impoverished person in the world you might find that fitness is actually quite difficult to achieve.
The work-life balance & climate in some areas of the US (and other areas of the world) does make it hard to exercise... but that's only part of the story.
Eating healthier requires very little extra time: perhaps 2-3 hours a week for shopping and meal prep.
- making a salad take 5 minutes.
- baking 10 meals worth of chicken takes 30-45 minutes, with about 5-10 minutes of actual prep time.
- baking a few meals worth of salmon, or some other fish is about the same as chicken.
- cutting up an apple takes 1-2 minutes. Bananas, peaches are ready to go, almost no prep required.
- steaming fresh broccoli takes 3-5 min of prep... and about 15-20 minutes total.
- Equally important is making small decisions to avoid or limit less healthy foods, which requires no time at all and often saves us money [that we can spend on healthier foods instead].
Exercising: 30-60 minutes a day, most days, is ideal but anything is better than nothing. A morning and evening 20 minute walk is great place to start (and can be so relaxing). If a person spends time on Hacker News, they could instead allocate that time to exercise. There are free 15 minutes yoga videos on Youtube. A set of push ups requires 60 seconds. Sometimes I do body weight squats at my desk at work (especially during Teams calls, camera off of course).
Sleep: get at least 7 hours of sleep a night... ideally starting to bed before 11pm. more sleep gives us more energy to put towards being awesome during the day and more energy for exercise and doing the extra work to eat better.
I think almost everyone can set aside 6-10 hours in their week towards building their health. It is a matter of priorities... a person's health should be one of their top priorities.
Parent poster wasn't referring to Ozempic but a general healthy lifestyle. Which requires resources many people do not have such as time, money, education etc.
Fitness is in reach for almost everyone on Hacker News. There are folks who have serious health issues or disabilities that preclude exercise... but the rest of us [the majority?] can walk more, do body weight squats, some form of incline push ups, and so forth and build larger successes on top of smaller ones. We can start by taking a morning and evening walk.
We all can make healthier decision about what food we put into our bodies (a lot could be done to make our food supply healthier, as well). I find I have to be more strict about eating right as I get older to maintain my health.
I feel like folks saying 'fitness' isn't in reach [for most/many of us] is a cop out. This is anecdotal, but i know people who have lost 100+ lbs in their 40's and 50's and completely turned their life around; I know people who have reversed Type-2 diabetes through diet and exercise. These people have busy lives with a lot of responsibility... some of these people live in city areas where access to gyms or outdoor spaces for walking, etc. is not convenient.
I have a few doctors and other medical professionals in my family... knowing what I know, I am 'almost terrified' of becoming metabolically unhealthy and overweight. Many of the maladies that afflict us are metabolic disorders (in whole or in part) due to the long term effects of poor diet, lack of exercise & quality sleep (high stress doesn't help either). Poor metabolic health tremendously increases risk of almost every disease and malady: diabetes, heart disease, heart attack, dementia & Alzhiemer's, many cancers, stroke, depression and other mental illnesses, sleep apnea, susceptibility to infectious disease, etc. Poor metabolic health also indirectly leads to higher likelihood of issues causing chronic pain: e.g., herniated discs in the spine, ankle/knee/hip problems, migraine headaches.
I'm glad Ozempic exists but it is not a cure... it is an aid towards building a healthier life. Use Ozempic as a tool, by all means!!, to start your journey and get yourself into a better situation physically. But please use that good start to pursue the 'best/healthy you'... do it for yourself.
Proving a negative is a hard and sometimes an annoying in itself ask plus you're probably frustrated with the general attitude to this kind of conversation (especially if your main expectation/experience is others don't like the pill answer out of spitefulness) but that doesn't make this kind of response any more okay here.
For others open to listening to why it's often out of reach: Outside the go-to "motivation" type discussion gravitation (and, keep in mind, not everyone can just 'motivate themselves past their addictions' in the first place or they wouldn't be addictions) it is also disproportionately hard for those struggling in other ways of life (financially, mentally, physically/genetically). Some of these can be cascaded effects, like support systems (e.g.not everyone's partner is willing or able to go all in on it like above). Others can be that it is medically not as easy for some people to lose weight at a given intake amount which makes it just that much harder.
Most people would like very VERY much to be fit. That most still aren't fit should be a good indicator it's out of most's reach to "just eat less" independently. All this said as a person who is not overweight themselves but has been around many people in different situations, abilities, and luck that have left them unable to be so as well.
Yeah the problem with providing a study is that proving a negative is so hard. Everyone assumes there exists a successful RCT with a 5-10 year time horizon for weight loss via lifestyle interventions. And there just isn't one, and the only way to know that is to search for one.
Because your metabolism changes. If you ate 700 calories per day it would be harder for you to lose weight than if you ate 1400 and worked out.
You’d still be eating less, but retaining more weight. Why? Because your metabolism slows down significantly if you don’t fuel it, and that makes it harder to lose weight, not easier.
Most things in life are not binary, and are affected by more than just a single choice.
Because working out, alone, is not the solution. You could work out all day and still not lose a pound. Plenty of studies have shown this.
Moreover, have you ever tried to work out at 450 lbs? No? It is an immense effort, often literally impossible for most people at that weight, and the best they can manage is a walk around the block before their cardio can’t keep up.
What then?
See above, where I reminded people (which includes you) that things are rarely binary.
Otherwise, perhaps let people get healthy instead of admonishing them to get healthy the way you think they should, which turns out to be… the same way they have always tried and has not worked.
Bringing up mortally obese 450lb people (a tiny fraction of the population) is not a good faith argument against my position that it's a travesty Ozempic and other "weight loss drugs" are being prescribed to people en masse when most of them actually are very capable of just eating more healthy diets and exercising more. What we actually need to do is un-fuck our food supply and encourage healthier lifestyles... not give big pharma yet another chokehold over the population.
The rest of my argument still holds if you change that.
Your contention of “most of them actually are very capable of just eating more healthy diets and exercising more” is a nonsensical assumption, based on no data, and a prejudiced assumption that they are lazy and haven’t tried, ever.
> What we actually need to do is un-fuck our food supply and encourage healthier lifestyles...
Great. We should do that. I completely agree. It will definitely help our kids.
That won’t help anyone get healthy in this lifetime. It takes too long. Obesity would kill you first.
But you’re right, that’s probably better than taking a medication that is clearly helping people change their habits and get healthy, because you feel it would be better if they didn’t have the problem in the first place.
Nicotine gum and patches help curb smoking and change people’s habits. Why? Why not just force everyone to quit cold turkey, like my dad did? Should we just change the way we talk about smoking and produce fewer cigarettes? Sure.
But nicotine patches and gums saved lives and helped people quit that had never been able to before them, and not for a lack of trying.
GLP-1 meds are an aid. The alternative isn’t fixing the food supply, but dying from obesity.
Cool, I hope you are on your way to a healthier weight. I can see why medication could help in the short-term for someone who has dug a deep hole. My reaction of disgust is towards the premise of "how long until we're all on Ozempic?" and the current state of affairs, where far too many people in the US are being medicated for that and various other things.
> ... where far too many people in the US are being medicated for that and various other things.
What, precisely, does this mean? If medication is appropriately prescribed, by well-educated and well-trained doctors who have, upon actually meeting the patient which neither of us has done, decided that this patient could benefit from said medication... why is that bad?
39.6 percent of U.S. adults are obese. If all of them were prescribed GLP-1 meds (which would definitely never be true, for lots of reasons), and if all of them got healthy because of it... that's bad? Simply because they used medication to help?
Clarify for me, please, why medication is somehow not allowed to be used as a tool to fight illness or injury. Because people should somehow be "stronger" and able to fight it more on our own, despite not having been able to in the past?
GLP-1 is not a get out of jail free card. It will have long-term side effects.
Mass medication is an undesirable state of the world because it doesn’t address the root of any problem. It simply negates or masks some of the effects. The Ozempic situation is just like how kids are now being prescribed Adderall in the millions, when really the problem is they are just given iPads too much and fed unhealthy food that causes ADHD. Adderall doesn’t address the cause. Then you end up with a slave population that needs this medication to function. which is only good for the pharma companies making money on those meds.
> GLP-1 is not a get out of jail free card. It will have long-term side effects.
Source? Because so far it seems like you and others really want it to have long-term negative effects, but that the evidence for that is made up and entirely in your head, to date.
> The Ozempic situation is just like how kids are now being prescribed Adderall in the millions, when really the problem is they are just given iPads too much and fed unhealthy food that causes ADHD. Adderall doesn’t address the cause.
Ah, finally, the mask comes off. Your issue is with people getting help for disorders and illnesses they have, period.
The trope that ADHD is caused by iPads is nonsense. ADHD is caused by an underdeveloped pre-frontal cortex. Plenty of kids actually have it. I did, for sure. I wish I had found out what ADHD was, instead of holding my preconception about what it was, much earlier in life. I didn’t need that struggle against a thing I could never beat, because your brain controls everything you do.
> Then you end up with a slave population that needs this medication to function. which is only good for the pharma companies making money on those meds.
Do you? Show me a “slave population” that “needs adderall to function.”
I think we can just agree to disagree lol. Yeah all of these problems are just naturally occurring and humans were screwed until Ozempic and Adderall were invented. Thank God for the pharma companies!
That isn’t what I said. You are conflating multiple things.
I agree we created many of these problems (food being unhealthy, for example).
I also agree fixing many of them would be good.
I don’t agree that that is the only way to help people, and I don’t agree with the implication that “all pharma is bad,” because I don’t make outlandish binary statements like that.
There's nothing moronic about the argument that calorie deficits can cause weight loss. Most people using Ozempic have never tried multi-day fasting as an alternative. There are plenty of ways to lose weight that don't require taking medicine that might be fucking up your digestive system long-term.
> There's nothing moronic about the argument that calorie deficits can cause weight loss.
That’s not the argument you are making, and that is one I’d agree with.
> Most people using Ozempic have never tried multi-day fasting as an alternative.
Source? This is an assumption that requires data, because it is intuitively not true; and anecdotally, it is also not true.
This is purely a prejudiced assumption.
> There are plenty of ways to lose weight that don't require taking medicine that might be fucking up your digestive system long-term.
Or it might not, and hasn’t, at any meaningful scale, since 2005. Seems like you really want it to, though, and that seems like more a problem with you than it or them.
How do people not realize that the digestive system is dynamic and that as you change the calories in (and the type of calories) that the body changes the out.
You can't outrun thermodynamics. But your body will change its efficiency.
>Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.
Nice one. I think it's a bad idea to be dependent on drugs for something you can achieve on your own, especially if the drugs don't have a long term safety profile. Pretty sure I read somewhere that they don't. If you're going to use them for a short period of time, that's fine. Don't say nobody warned you if that doesn't pan out though (or worse, you have a bad drug response).
This is funny how black & white some folks here want the world to be painted if it suits them.
You know by far the biggest benefit of doing hard workouts or doing extreme sports? Its not muscle mass nor how much they lift. Its about how it changes your personality, resilience to mental or physical suffering and ease of overcoming it. You know, hardest part of doing anything is winning the mental resistance game and just start it. Keep doing this every day in various forms for decades... A very strong resilient personality under various circumstances is almost an unavoidable result if you are putting in enough effort.
If somebody can't even stop themselves buying and paying for junk food at grocery store or has to overeat constantly otherwise getting anxious, that part of personality is missing and another, less desirable is present.
Who would you prefer to have as a close colleague you depend on, life long partner, a close dependable friend? Who do you think women would prefer subconsciously? Societies have always some form of castes, even hardcore communists have/had them, in US one of very popular is based on career/income/wealth. And this is just another dimension or caste, so let's not act like we are not humans with flaws and subjective preferences, we don't give our respect out for free.
These medication help with none of above, in fact they strongly reinforce such behavior and personality traits. But to each their own. One benefit I can see that they could start / help with movement from former to the latter, but that's rarer than people like to admit.
That’s cute. You know nothing about me, but assume I’m not resilient.
I have achieved much, largely due to my resilience. It would be very difficult to argue, after growing up very impoverished and getting to where I am today, that I am not resilient.
I played sports, lots. I competed in martial arts. Resilience isn’t my issue.
But thanks for telling me I have a moral problem I don’t have, instead of perhaps considering that what people are telling you might be the truth.
You don’t always know better, even if it flies in the face of what it is you do know.
"Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?"
I think it is because if 90% of the population did half of what you do (and kudos for you for doing it), they wouldn't have a problem with weight, you just happen to be one of the unlucky few where it doesn't work and these drugs are useful.
This is quite snarky. I was giving kudos because the commentator first exhausted all the lifestyle options that extremely often work in reducing obesity to ensure their issue is more than just lifestyle choice then finally taking the drug, rather than short circuiting the process. This is sensible policy in deciding to take any drug for the rest of your life for a chronic illness.
In other words I was giving kudos that the commentator put in a lot of effort to verify that it was an illness in their case.
> This is quite snarky. I was giving kudos because the commentator first exhausted all the lifestyle options that extremely often work in reducing obesity to ensure their issue is more than just lifestyle choice then finally taking the drug, rather than short circuiting the process. This is sensible policy in deciding to take any drug for the rest of your life for a chronic illness.
> In other words I was giving kudos that the commentator put in a lot of effort to verify that it was an illness in their case.
The illness being addiction/food abuse?
Again we circle back to the question that OP posed. Because I have never seen someone say that they are an alchololic or smoke/tobacco addict and then get told: okay maybe, but first you should put in the work and find out if you really are that.
(Step one: admit that you are an addict. Step two, uh, confirm that you really are?)
It’s your assumption that 90%+ of people don’t do this that is the issue.
People seem to think that once these drugs became popular, suddenly obese people around the world awoke from a deep slumber, like zombies, and decided to see a doctor for the first time in their lives about their weight.
Please. These people are walking into doctor’s office having given up hope because most of them have, to one extent or another, tried everything.
Our society does not make it pleasant to be obese, no matter how you feel about body positivity or anything else.
The implication that obese people have never considered or tried eating less, working out more, etc., is in and of itself the problem. It implies laziness and imbues negative morality, when the reality is that most people who are obese know it, hate it, and have tried most of their lives to overcome it, unsuccessfully.
So now that there’s a medication that can help kickstart their creation of new habits for the first time in their lives, I don’t see how that is a bad thing.
Where did I make assumption that majority of obesity drug users don’t put this effort? I was more saying majority of those who try what the poster tried end up not needing the drug. These two statements are very different and it is a common logical fallacy to conflate them.
> I think it is because if 90% of the population did half of what you do (and kudos for you for doing it), they wouldn't have a problem with weight, you just happen to be one of the unlucky few where it doesn't work and these drugs are useful.
It is simply not true that if 90% of the population “tried to lose weight the right way” that they wouldn’t have a problem with it. That is an assumption you are making, and the underlying postulate is that that same 90% hasn’t tried.
I agree, how can anyone comes at this number ? Is there a study of any kind backing up this number ? Or is it just garbage empirical evidence from what the poster saw around him (which cannot possibly represent 90% of people).
Does the poster know the life of obese people to arrive at this number or is it just a belief/sterotype
I don't think that's particularly charitable, GGP said themselves that their issue is volume, that they're doing well in many other ways. GP is saying if everyone could do what they've done, many fewer would have the problem, and so maybe it would have less stigma.
As a direct reply to the challenge that the original poster made:
> > Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?
They said nah, you were unlucky. In other words just dismiss his point outright.
Is that still uncharitable? Then so be it.
> GGP said themselves that their issue is volume, that they're doing well in many other ways.
Yes they said that they have a food addiction.
- The alcoholic said that his problem is the volume of alcohol intake
- The smoker said that…
Then asked why we won’t help food addicts. Just waffle on about self-discipline or hint at it.
This question is still yet to be answered.
> GP is saying if everyone could do what they've done, many fewer would have the problem, and so maybe it would have less stigma.
Maybe if those people had more self-discipline. Then maybe there would be less of a stigma.
You’re using the rationalized stigma to explain the stigma. This is at best circular.
Maybe we would respect ex-smokers more if they had the discpline to not ingest nicotine gum.
Which studies? I find it hard to imagine that it has been proven that for most people having a low-carb unprocessed meal once a day, no alcohol, and 5-mile daily hikes as the original poster does would would not eliminate sever weight issues.
There are clearly minority of people who can only achieve weight loss using drugs but for most people they can achieve the same effect by a lifestyle change, has this been proven incorrect?
I think the best empirical result for this is to compare US with any other western country (say Japan or France) or even US states with each other, clearly lifestyle plays a huge role in obesity.
I think if the widely available help for alcoholics, smokers, or opioid addicts mainly mitigated the negative consequences - enabling them to drink, smoke, or dope more - it wouldn't be nearly as acceptable.
I personally expect weight loss medication that simply makes people want to eat less will reach cultural acceptance.
Case in point, cigarettes have been known to suppress appetite for ages, and people have elected to smoke to help stay thin for decades. There was never any crushing social stigma attached to doing this as a weight loss strategy (that I know of).
> And you know what it is? It's volume. I eat too much.
100% this.
I lived in Asia for a few years and obesity is rare (though increasing for youth). It's not like they get more exercise (most people don't) or eat healthy (it's mostly carbs), but 100% portion sizes.
I see people who work manual labor jobs eat lunch that is a bowl of noddles, a few thin slices of chicken or pork, and a few veggies. I highly doubt it exceeds 500 kcalories. It's probably half the portion size you'd get in the US.
Mystery solved. If you're only eating 1500 to 1800 kcal per day as an adult male doing manual labor, it's pretty obvious why you're at 10% body fat.
That's insane. It's also not just about calories. The amount of corn syrups used in drinks is crazy too. Your body will just spike your glucose and dump it to fat.
It amazes me that Americans head scratch over their obesity epidemic then reach for a product to solve the issues their food industry and culture made for them.
> And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.
The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss. It's not surprising that it didn't help you lose weight.
> The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss.
That’s not been my experience at all. My dosage absolutely significantly suppresses my appetite and always has. This has directly led to sustained weight loss. It did so badly enough at one point that I was underweight significantly.
I have to force myself to eat on my meds, even though the thought often makes me ill.
I’m on 30mg dexamfetamine daily.
“Dexamfetamine can make you want to eat less, so you may lose weight while taking it.
Some people gain weight, but weight loss is more common.”
Doesn’t seem to be hit everyone but equally doesn’t seem rare.
1. People might want to help, but they don't think taking a pill every day for the rest of your life is a proper solution. I'm not aware of any such things for other addictions you mention,
2. People don't want other people to have it easier than they did. "I had to diet and exercise etc, you should too",
3. People don't want to help. They want other people to be fat because it makes them relatively more attractive.
re: 1, there are plenty of people who take some medication at some interval for most of their life. People with ADHD, people with type 1 diabetes, most women, ... why do we find that totally unproblematic, but as soon as it's medication to help with obesity (which is a serious medical condition in its own right) it's suddenly such a big problem?
EDIT: And to be clear, there may be specifics with these particular drugs which are problematic, maybe they're by necessity expensive or resource intensive to manufacture, maybe they have problematic long-term effects, I don't know. I'm purely talking about the general aversion some people claim to have regarging taking some medication on an interval to help with a health problem. It makes little sense to me.
> People with ADHD, people with type 1 diabetes, most women, ... why do we find that totally unproblematic
ADHD medicine is highly problematic. The medications are controlled to ridiculous levels, and there are strong social stigmas against both the condition and the disorder.
As someone who takes meds for ADHD and would benefit from Ozempic I'm still hesitant. There aren't any non-drug options for my ADHD but there's a proven one for my weight.
> Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?
For the same reason why skinny person taking steroids is frowned upon - it is perceived as a shortcut.
Supra-physiological levels of testosterone and steroids have incredibly well known and well researched short, medium, and long term side effects. They've been well known for forever.
In an alternate world where steroids had a good safety profile, it would be ridiculous to not use them if you were looking to add on muscle mass.
> Supra-physiological levels of testosterone and steroids have incredibly well known and well researched short, medium, and long term side effects. They've been well known for forever.
I’m pretty sure if you have professional pharmacist working on you then you can mitigate the issues and make it semi healthy. The point is that it is being frowned upon not because of health issues, but because it’s not an “honest work”.
You can make short cycles once or twice a year relatively safe for some steroids. Keep close track of your liver enzymes and blood pressure, discontinue if those look bad, otherwise stay on for 4-6 weeks, take half a year off, repeat. Got exposed to people doing that when I was in the gym frequently, still keep up with some now, all their levels look fine.
But even with significant additional intervention, when you move beyond that to the "blast and cruise" setup, those interventions are just mitigating factors, not truly preventative.
I get what you're saying, I've never touched any of them myself, because the juice wasn't worth the squeeze (hah), but if they did have very good safety profiles, I would have zero problem with anyone taking them and would think it would be silly if anyone did.
Would you mind sharing what your diet was like as a child?
I wonder if there's a connection between diet during development and adult processing of and cravings for food. Maybe eating candy for breakfast (cookiecrisp!) every day in elementary school messed a bunch of us up.
Not OP, but I ate sooo much Kellogg's and General Mill's sugary products in high school for breakfast (pop tarts, eggo waffles, all the disgusting cereals you can name...), but I took Centrum daily and played a ton of basketball after school. Almost 1 can of coke a day after school. No heath problems as an adult.
But of course, genetics come into play as well, no overweight parents or relatives.
I think a lot of it is dealing with hunger. If you can't stand being a little hungry, never mind very hungry, no diet will really help. I used to love being very hungry, not sure how I got there, but I wish I can go back there again. Having very little carbs and temptations in the house helps. Unfortunately it's not up to only me.
Perhaps the first person on HN who actively and without shame pays attention to the fact that Adderall is a very nice amphet cocktail. Surprising though you don't loose wait with it, sad also given the circumstances. But I envy you a little cause such ADHD boost is only illegal in EU.
Sometimes I wonder if it was a some neat trick by US gov to diagnose and put 1/5 of the population on amphetamines (2024 data +60mil prescriptions of Adderall), so that most everyone who is actually like smart or sensitive or anything of value to the industry, can (almost) freely microdose on it and as a result increase productivity.
Which... means 1/5 of the population suddenly increases output. Perhaps we all'd be on Aderall at some point, dunno bout the Ozempics...
I think you're incorrectly assuming that one prescription = one person. Far less than 20% of the population is taking Adderall, this CDC study says 4% in 2021.
Yes you are right. One prescription gives one person access to pills and then they resurface for many others on the black market. You can be absolutely sure it’s very popular among STEM students, not the least because they can understand why would they need it. I can only imagine the pressure to stay in Ivy League university, would totally make it reasonable to use one if you do five exams in a row.
Since you can find it being sold at raves in EU I’m absolutely sure a) it works; b) not convinced only one in five prescribed takes it and all other toss it in the toilet; c) there’s a surge in use and demand.
When I also found my high profile friend working FAANG for years, who’s straight edge and goes regularly to church’s is taking it for productivity boost, and happy about it… well I realised what actually is happening.
Indeed the good thing about adhd is tis a very vague diagnosis. And yes it works well on many undiagnosed people, and particularly in countries where ADHD is not a recognised ontology.
So let’s be real and honest.
Besides media is hyping in September’24 about dangerous shortage of Adderall as if people are left with no access to vitals. It is hyped more than the fact that coffee prices are likely to double and triple in months to come.
I’ve heard studies show Adderall doesn’t help people without ADHD… googling now seems to confirm. Apparently lots of people, especially college kids, take it thinking it will help, but it actually can slow them down.
Not a study, but this article was enjoyable. Some of the experiences there say it made their writing overly perseverative on detail, too expansive, too many edits and re-writes. Sort of faster in the short term but slower over the long term?
My understanding is the amph. works the same in everyone - minus the edge cases.
The main difference is that the magnitude is greater in people with ADHD than those without. A reduction in hyperactivity, for example, is not really apparent in people that are not overtly hyperactive to begin with.
Beside, ADHD is kind of a nebulous label for a lot of symptoms. Having ADHD vs. not having ADHD is not exactly binary.
> a new study finds that using these drugs while not suffering from attention-deficit/hyperactivity disorder decreases productivity and increases the amount of time needed to complete tasks.
People using it for studying don’t take adderall to be more productive, they take it to be productive for much longer. It’s a stimulant that keeps you up all night and lets you study, not makes your studying more efficient.
That is not true. Vyvanse, caffeine, etc., helps my brain calm down and focus. I don’t get hyper. In fact, if I have too much caffeine, I start yawning.
My wife, who does not have ADHD (at all), gets hyper from stimulants.
I am not suggesting anyone use their response to stimulants as a diagnosis of ADHD. However, speak to anyone who has it and they will relay that stimulants make them calm, not hyper.
People without ADHD get hyper, not calm. Some others also get calm.
But people with ADHD who take stimulants do not get hyper.
Seconding Zepbound, it has been absolutely life changing for me, and not only in terms of weight loss. It's expensive, but I am blessed with a tech salary that can afford it.
Anyone can list 50 no-no things they don't eat and omit the 5 types of foods they do choose that causes the most damage. Volume & variety are not to blame given most sauces are calorie dense. The issue generally is the person eating for pleasure conflicting with their stated aim to eat for weight maintenance.
If it tastes good spit it out. Countless people ready to tell you no sacrifice is needed in that domain but they have something to sell or trade.
In my experience, as someone who has gone on a small weight loss journey, you can eat things that taste good, you just have to eat less of them and more rarely.
Bingo. I've had this conversation with my girlfriend. She's not overweight by any means (160 cm ~55 kg) but I am quite underweight (182 cm, 65 kg, < 10% body fat) and the conclusion I've arrived at regarding our differences in body composition is because she routinely eats 1.3x to 1.5x the amount I eat. We both exercise and eat little junk food.
I'm convinced it has to do with upbringing. My family never ate a lot and the portions I was served as a kid weren't big. Nobody in my family is anything more than skinny. Her family however, they eat a lot (and healthy too, mind you). This is all influenced by other factors, her parents and grandparents grew up with not a lot to their names and with food scarcity, so when they reached a position in life where they could comfortably afford to eat they gained the habit of having big meals. My family was mostly more privileged in that regard so maybe they never felt the need to focus on food as much.
Have you every using a calorie/macro tracking app like My Fitness Pal or Cronometer? I was never successful losing weight until I scanned, weighed, and measured every single thing I put into my body and stuck to the target calories and macros entered into the app. Just being aware of exactly how much I was eating was often enough to find the motivation to control volume.
>> I scanned, weighed, and measured every single thing I put into my body
Not being snarky, but is this truly "better" than a single weekly injection - 10 seconds and done for the week? I do think our wider society sees medications for overeating as "cheating". Perhaps we might benefit from rethinking that.
There is a reason for that perception. We are regularly finding out how there are damaging ripple effects from drugs that were claimed to be completely safe.
I would compare something like scale measurements to sex education. If kids were all exposed to some period of measurement of foods to learn what they were eating, it would stick. Studies show that ANY form of tracking causes people to make more mindful choices. Everyone I know personally that is taking these drugs uses it as a crutch entirely. They take it and make even worse food choices than before. It's very sad and I worry about the next issue they will cause with this behavior to then stack another medication on top.
>is this truly "better" than a single weekly injection - 10 seconds and done for the week?
Yes, obviously. I'm stunned that it needs to be said, but since it apparently does:
1. You propose taking a medication regularly which is probably completely unnecessary, and paying for it regularly. (This was worse with "metabolism boosters" etc. since the patient would be paying for the medication to have the privilege of eating more, and thus paying more for the extra food.)
2. Knowing what you eat, and being able to denominate it in calories, is knowledge. I thought we were hackers here? My experience has been that ordinary people have some truly absurd ideas about how fattening certain things are or aren't, or about how much they're actually eating, or about what healthy daily intake ranges, portion sizes etc. look like. (They also have absurd ideas about how much it costs to "eat healthy", as well as about the connection between "healthy" food and caloric intake.)
But since when did techniques which obsessive systemizers like us use play out well with the general population..? We're not discussing what works well for a niche community of hackers, but what will work for the hundred million+ on a sustainable long term basis.
I think "perfect is the enemy of good" applies here. People en masse are not controlling their intake. They just aren't. They can't do it. We can rage about it and criticise - and many do for all the good that's doing - or we can explore options. Medications with few side effects have some appeal here. Evolutions will likely reduce those. Eventually that will not be a strong argument against the medication option is my prediction.
For preventable diseases in general, prevention and self control should be attempted before medication. There are health benefits besides being skinny, and all medications have side effects. There's nothing inherently wrong with medication, but addressing the root cause should be tried first, and then medication can be introduced if it doesn't work out. It's not an either-or, binary situation.
Self control has gotten harder as the foods on offer have gotten more sugary and dense compared to traditional foods. Produce is also less available and less nutritious than it once was.
I don't disagree. As I've gotten older though I am just increasingly convinced that for the regular person going about their life, the fight against cheap and terrible and calorie-laden - but tasty! - processed foods is not an even one. Perhaps some form of counter-balance is just not such a bad thing?
Try a very low carb diet. Only eat until 80% full at mealtime. Get down to two meals a day, with a goal of only one. Fast the other times. This sounds hard but once you get to ketosis it is not that hard at all. Not hungry naturally, like the drug response.
Truth is, we really don't need more than one meal a day (maybe a snack) when we get older and our metabolism slows.
You mention types of food but not quantities. A boat load of healthy food is still going to have an effect. Also, I for one don't consider walking to be exercise. It's fake exercise for people who don't like exercise to claim they exercise. My reason is that I cycle for eight months of the year then walk during the rainy months. By the end of the rainy months I get back on the bike and my fitness level is catastrophic - nothing. I've done this for five years, and have to say walking is just not good enough for exercise, not even close.
Can't speak for OP, but generally speaking there's a lot of variability in peoples' perceptions of healthy food and caloric density. For example, a lot of people see nuts as health food, and yet they're some of the most calorically dense foods you can eat! Another example would be to crack open the Ottolenghi cookbook and make the delicious Lamb Siniyah, which among other things calls for a large amount of Tahini mixed with lemon juice to create a delicious crust over the top of the stew. Delicious, but incredibly calorically dense.
I think healthy/unhealthy food dichotomy is psychologically the same as religious dieting. It fosters feelings of purity, self control, and is a form of in-group signaling.
But our bodies grind down substances to extract calories. It’s a simple mechanism. You can eat McDonalds everyday if you manage intake.
What about someone who's carrying 100+ pounds of excess body weight? Would you consider walking to be fake exercise for them? I'd say that's a more heroic workout than joy riding.
I've seen such people jogging - intervals - short jog, short walk, short jog, ... They didn't look comfortable, but when I'm cycling uphill toward the end of a hard ride with nothing left in the burning legs I start grimacing too. What do you want? No free lunch.
walking is exercise in the sense that it burns calories, specially when you're overweight as it's like having a 30kg (or more/less) backpack with you. Bonus points for incline.
But yeah, it's not HIIT. You won't really build up your fitness level by walking - it's not demanding enough. You need to be pushing yourself until you're out of breath, if you want to build up your cardiovascular health.
What kind of food do you and your wife cook? How much meat? How much gluten? Real butter or canola oil infused “spreads”? What oil do you cook with? Vegetable? Sunflower?
If you’re eating the right thing for your body, you’ll be satiated when you eat your full.
Bodies are highly imperfect and suggesting our digestive system and nervous system are geared for being fit and healthy rather than ensuring survival wrt food is absurdly naive.
(I only cook with extra virgin olive oil which I buy in 5L cans for $$ reasons. A lot of these vegetable oils are good for motor engines only!).
It really depends on you and the activity levels.
I used to ride to and from work - and I would ride hard, a solid 1.5 hour of riding every single workday. Yet this just caused me to gain weight as my appetite just shot through the roof. This new drug would have been SO good for me back then.
These days I find it easier to control my weight with regular strength exercise vs riding, as I tend to go too hard on the riding which causes me to feel famished. And then the control is just hard.
However when I just do (Olympic barbell) weights, a bacon, egg and onion + cheese omelette in real butter and EVOO does the trick to break my IF then, along with a WPI/milk shake- I get stronger and also lose weight. No need to keep eating. However, I'll then do cardio a couple of times per week which tends to undo the weight progress; I guess the real trick would be to stop doing the hard intervals I love on the Kickr, but going slow on the bike is nearly impossible for me. :-)
Instead of a system that makes these drug available for purchase, I'd rather live in a system that promotes healthy food and active behavior. Unfortunately, I have to drive everywhere, work too many hours to have free time for recreation and have no idea which government subsidy is going to help big ag likely at the expense of my health.
All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.
If you have an open mind, I'd like to assign you some homework if you like. Take a look around r/zepbound and count the following:
1. Posts from folks who diet+exercise, or who have tried diet/exercise and nothing's worked so they then turned to Zepbound ("excited to hit the gym," "my diet is finally starting to work with Zepbound" and similar)
2. Posts from folks who haven't tried diet/exercise and turned to Zepbound first. (e.g. "I'm excited to eat dessert and laze around on my couch all day!" or "Zep is so much easier than before, no more keto for me" and similar)
Which group do you think would have more posts?
Selection bias probably prevents us from being able to count "Zepbound didn't work for me, but diet and exercise did" posts, which is why i suggest this.
Here's my hypothesis: I think self-control is generally uncorrelated to losing weight. Perhaps it's necessary to have self-control to lose weight "the simple way," but certainly not sufficient. I know lots of friends who've struggled and found it's not so simple.
GP isn't talking about self-control, they're talking about the fact we've created a system that requires obscene amounts of self-control if you wish to maintain physical health.
People in the 50s weren't slimmer because they had ironclad determination to stay such.
Traveling from a fairly walkable, but still car dependent midwestern city to NYC and also Europe in the last few months, it's amazing how much our living environment contributes. My first day in NYC and Europe I put in about 14k steps and at least according to my phone, one of those days I burned 750 cal just walking around to various places. Just by living my life I was WAY more active.
Making the good choice the easy/only choice is the only way to solve this problem long-term (without drugs)
I agree. I lived in West LA for a few years and noticed that I was just walking around a lot more than in previous locations. I measured it to be typically 5 to 10 miles per day (I don't recall the number of steps but I recall getting close to 30k/day on some days). And I wasn't going out of my way to go walking --- it just happened because I walked to work, to get groceries, to visit friends, to go to the movies, etc. To me, the best long-term answer is also to change the environment to be more amenable to walking.
The amount of food you eat isn't a habit. And I don't know what it is that makes people obese, but I don't think it's simply "bad food" as in the stereotype of bad food.
It seems clear enough to me that there is something - something - in the ecosystem that messes up the body's weight / energy homeostasis and we haven't identified the culprit. It might be a food additive, but it could be something to do with artificial light in the evening or plasticizers in our plastic products or who knows what.
Just my pov as non-overweight person who doesn't exercise (other than flipping my four year old around), doesn't walk or run long distances (but a 5 mile walk every couple of months doesn't phase me), eats very few fruits and vegetables, generally eats mostly meat, pasta, bread, cheese, cream and potatoes, and ends up in a fast food outlet maybe once a week on average.
it doesn't have to be just habit, but cultural/learned factors likely play a huge part.
each generation eats more, gets bigger, obesity runs in the family, (many obesity associated genes are mostly expressed in the brain ... the typical cursed environment-gene interaction), portion sizes got bigger, it became normal to gulp down a lot more sugar, etc.
The vast majority of accessible American foods these days are over-processed, poor quality ingredients with fancy marketing on the boxes. (And stories about how the brand was started by a grandmother a century ago...)
Living in Japan has made it clear to me that cultural attitudes towards food make all the difference. It’s not like there’s a dearth of delicious things here, but obesity rates are more or less a rounding error.
There's a confounding factor to your theory: people in Japan are dramatically less likely to use a car for door-to-door travel. The amount of walking a Japanese person does burns a huge number of calories that most people in the US simply don't burn.
I don’t buy it, putting aside the fact that there are many public transit-heavy countries with obesity problems, the amount of calories you burn from walking is a drop in the bucket, you can wipe out a full day of city walking with a small portion of French fries.
Diet is a way bigger factor in weight control than activity, unless you’re a pro athlete burning thousands of calories a day from exercise because you’re working out nonstop as your job.
You should still walk for general health, but not for weight loss.
EDIT: this report from Time about Japanese food culture rings true.
This is certainly true. Others will quote that exercise is not an effective mechanism to maintain healthy weight with 40 studies to back it. The goalposts seem to move a lot in this domain. Nevertheless, there is a ton of evidence of people in various behavior patterns that do not have such obesity issues in their society. It's wild to me how many people reach a conclusion of helplessness given that fact. The real kicker is that we aren't talking about one population being 5-10 lbs too heavy. We are taking about a difference between healthy weight and pervasive obesity. It's wild that such a delta is normalized
Exercise is good for a variety of reasons. It will burn some additional calories. But most scientists that specialize in metabolic research believe that the constrained total energy expenditure model and metabolic adaption are at least broadly true. You can't exercise out of a bad diet - and it's difficult even if you believe in a fully additive energy expenditure model.
Diet is the overwhelming deciding factor when it comes to weight gain.
Only have the anecdata of being in both Tokyo and NYC, but obesity rates are clearly higher in NYC than in Tokyo. I'm not convinced that relative obesity in Japan vs US is primarily due to walking differences.
As another commenter posted, the amount of walking even a highly active person does is fairly negligible wrt weight loss/gain. As another anecdote - my ambient walking milage is 5 miles/day and I run an additional 20-30 miles a week and still maintain an obese BMI
Do we really have enough information about their daily habits, food availability, ability to survive, etc. from those times? Once you go before easy refrigeration and distribution, you get people dying from famine in bad years. It's going be to be hard to make any actionable lessons from those times that still apply now.
> James Nye, for example, was one of a family of eleven children raised in rural Sussex in the 1820s and recalled how the ‘the young ones’ in his family went ‘very short of food’. Despite his mother’s best efforts, he rarely had more than ‘half a bellyful’ at mealtimes, and ate scarcely anything other than bread.
> Following the harvest failures of 1816, for example, John Lincoln’s entire family was forced to undergo severe privations. His two children succumbed to disease very easily — their quick deaths from measles were likely owing in part to prior malnourishment.
>Whatever, set the clock to the 1820s. Or the 1400s. Or the 1200s. Or the 1990's or 200 BCE, I don't care.
I think they may have taken your prompt and thought about the 1820s, 1400s, 1200s or 200 BCE. Did you mean to direct people to discuss the 1990s by listing the other 4 eras?
I mean to say Homo sapiens has existed for 300,000 years. They have not been 70%+ overweight or obese for most of those years. All the way until the 90s, obesity rates have been WAY lower, even in food-abundant societies.
What is your point? I mentioned drug availability in the 1950s and you dismissed it with an arbitrary list of other time periods. Someone else mentioned food scarcity in a period you mentioned, and you shifted the discussion to the 1990s (and now the past 300,000 years ???).
It seems like you do not want to discuss any factors relating to obesity in history at all, yet you keep engaging in this topic anyway. It is impossible to have a conversation where one side discusses facts like drug availability or food scarcity and the other says “no think about something else” as a canned response.
What do you think is the cause of the increased level of obesity? What do you think is the solution, if any?
My point is that people's health has been rapidly deteriorating over the last 30-50 years especially. Your attempted explanation is essentially, "in every prior period, there was a different period-specific thing that was preventing these health outcomes."
It seems far, far more likely to me that right now is the aberration – in fact we know today is aberrant on several dimensions that are presumably related to obesity, so that's where we should look.
Big, system-wide changes like what we're experiencing are almost always both multicausal and overdetermined.
The causes here are:
1. Production of cheap, extremely palatable, ultra-high caloric density foods (mitigable). Note: This is not the same thing as saying "people used to be thin because they were starving." It is absolutely possible to feed a country amply and not yield the low price/great taste/horrible nutrition profile that dominates the American diet today.
2. Increase in sedentary time due to shift from physically intensive professions (not very solvable), car-centric urban planning (solvable), and the dominance of ass-in-chair leisure activities (probably mitigable)
3. The science is early on this but there's good reason to look further into endocrine-disruptive chemical poisoning (mitigable). We are finding these compounds absolutely everywhere we look and we should be very open to the possibility we are mass-poisoning people and damaging their metabolism: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10003192/
>Whatever, set the clock to the 1820s. Or the 1400s. Or the 1200s. Or the 1990's or 200 BCE, I don't care.
I think they may have taken your prompt and thought about the 1820s, 1400s, 1200s or 200 BCE. Did you mean to direct people to discuss the 1990s by listing the other 4 eras?
Amphetamine(which is what benzedrine was) is pretty overrated as a weight loss drug in the general population. It causes a short window of reduced appetite and probably increased catabolism(due to increased heart rate) which peters out after a couple weeks on the same dose. That leads to a short period of rapid weight loss that pretty much grinds to a complete halt, after which regaining the lost weight is quite typical.
On the other hand, if like me, you have ADHD and weight issues, it could be more helpful. Because it could treat your ADHD enough to help you actually establish and follow a structured diet and exercise regime. Especially if your ADHD includes impulsivity. The last time I was on lisdex treatment, I lost about 5kg from the initial boost, a lot of it was probably water weight. Then I managed to cut about 30kg later with calorie counting and regular cardio.
So the physical effects themselves are largely a pisstake.
In my experience fitness is less about self control or will power and more about creating routines that lead to fitness.
For example, I have a routine of going to a group fitness class at my gym in the morning. I don't need to summon willpower, I just have a morning routine that involves doing x thing at y time. No thought required.
Given the abundance of options for fitness classes and meal plan services, you really can just put this on auto-pilot and have a lifestyle that is healthier than 99% of your peers.
> Given the abundance of options for fitness classes and meal plan services...
This is part of what's fucked up about modern American lifestyles.
We shouldn't be promoting layering healthy behaviors (fresh foods and exercise) on top of our default lives -- we should be doing a better job of engineering our environment to make those things the default for all people.
F.ex. what if we highly taxed automobile entry into urban cores and shopping districts?
Right. Design our cities so that getting around while getting exercise is safe and easy. And restaurants/etc should give you healthy portion sizes by default, not rely on your self-control to stop eating. And so on...
Every yuppy feels compelled to remind you they go to the gym, expecting a pat on the head for being a responsible citizen, when it's really a sign of a dysfunctional lifestyle. Cordoning off a discrete slice of time to "be healthy" is pathetic imo. I'd much rather just be healthy. Gorillas don't work out.
But because I live in suburban Australia and eat the same pesticide laden slop as everybody else, I too have a gym membership.
> Cordoning off a discrete slice of time to "be healthy" is pathetic imo.
What does this actually mean to you? Walking or even running is certainly not comparable to going to the gym, so what, should we lift heavy weights as part of our regular jobs to keep up our upper body muscle mass?
The results I've seen, and please correct me if my knowledge is wrong / outdated, are that modest physical activity (i.e. not gym, but more than our sedentary lifestyles) regularly nets most of the health benefit.
Ergo, we don't need to turn our jobs or built environment into Ninja Warrior.
We just need to build it to encourage that modest amount of activity.
Unfortunately we know that simply convincing people to change their behavior is very, very, very fucking hard. Individuals can and do pull it off, yes, but we're talking about a society level change that needs lots of people to succeed at this.
It is empirically and demonstrably ineffective as a solution.
Routines help because they reduce the impact and uniqueness of the good behaviour. Another approach is to do things that have high positive pay-off but include health benefits you wouldn't target but get "for free". Example: I ride my bike to work because it's awesome, faster and makes me feel superior. That I get exercise and help out the earth is a side effect; I'd probably still ride my bike if it was unhealthy and produced more CO2
Habits are great, but I'm in great shape because what I do is fun. When it's not fun I called it "training" and that's usually for some huge goal that'll at least be fun to look back at 10, 20 years down the line to marvel that I did a thing.
I guess what I want to express is habits are one step closer to a lifestyle change and that's what keeps one ultimately healthy (mentally, too). We can't have nightmare commutes to soul-sucking jobs to continually have people addicted to looking at screens and think that there's no fallout. Adding, "but now there are drugs!" isn't an advancement.
There is still a certain degree of willpower involved in routines. I wakeup every morning and workout, and every morning I have to fight my brain to get out of bed. I've been doing that for 10 years.
That being said - I do feel like reducing the amount of willpower needed is the key. I love junk food, but if I never buy it at a grocery store it's much easier to cut it out. If I have no chips in the house I could still get some at the corner store, but I need to be much less disciplined than if the chips were in my pantry
> People in the 50s weren't slimmer because they had ironclad determination to stay such.
Well, heights increased dramatically for a couple decades so what that meant was that many people in the 1950s were starving. In the 1930s, people died of starvation even in the US.
I don't really think that we want to go back to starving our population just to be thin, thanks.
> a system that requires obscene amounts of self-control if you wish to maintain physical health
That's million years of evolution with food scarcity and modern capitalist world which created unprecedented abundance of food (and other things). And before you compare it to Europe — europeans still smoke much more than americans. Tobacco is also just a chemical that decreases effects of obesity, just in a different form.
And of course New Zealand, Australia, Canada are all in the same boat as well.
Those are all over 30% obesity and climbing (Romania is 38%, nearly at the US levels). The US is of course the leader of the pack, however it's all the same fundamental problem.
My running theory is that there’s more weight-discrimination in Europe, so you’re just less likely to see the overweight/obese in customer-facing positions.
Different European countries have different circuimstances, just like their counterparts, american states. But if we're talking about all of Europe and US, then yes, this is the main reason.
Where are you getting this data from? Nicotine is an appetite suppressant but so is caffeine. I find it hard to believe that smoking alone is the reason for the difference.
> People in the 50s weren't slimmer because they had ironclad determination to stay such.
No. They lived in an overall healthier environment. But they were also subject to much greater social pressure to stay slim and could endure fairly intense social judgment and stigmatization for weights that we consider normal (particularly women).
They lived in a different environment. The universal appetite-reduction drug was nicotine, and the common methods of administration had a number of undesirable side effects.
"Overall healthier environment". Meaning, food was relatively scarce. No Starbucks, Dunkin Donuts, convenience store on every corner. Coca-cola was not available in 2-liter bottles or in 24 packs of cans. No Costco-sized mutlipacks of anything.
In the 1950s, malnutrition was a serious issue that many people in poor areas died from. When was the last time someone died because they didn't have access to food? Obviously, the other side of that coin is that food being so plentiful, people eat much, much more than ever before.
Starvation was not a major issue in the US in the 1950s.
Food abundance is good, but it is not the answer to this question. For example, in America today the richest locations tend to be the most physically fit.
That's kind of the point. Poor people today have no problem obtaining and consuming enormous quantities of food, and jave high obesity rates as a result. Unlike prior eras, being rich doesn't provide an advantage when it comes to accessing food (as opposed to housing, leisure time, luxury items, etc)
Then why are people scrambling for Ozempic? If it were true that "people think being fat is totally fine or desirable now" then this wouldn't be a blockbuster drug.
There was a far more vicious shaming culture 50-70 years ago about things like being obese. And culturally it's still looked down upon to be obese, it's just not as acceptable to be vicious about it (and of course sometimes people still are).
Today however there is a lot more "always on" pressure: social media is a huge component to social, social acceptance, socializing, social learning & sharing, getting to date people, et al. That's a form of individually focused media pressure that didn't exist back then. And sure you can turn it off, not partake, but there are usually serious consequences especially for younger people.
I didn't say it isn't true that people were shamed more often in the past, I said it has little to no explanatory power of the current health crisis because obviously there is no lack of desire from people to be slimmer.
I think it's a little bit of a silly thought to think that just because people want to be slimmer now, they want to do so just as much as they would have facing harsher social pressures in the 1950's.
How big were the 'crash diet' and 'smoke cigarettes to stay thin' and 'use amphetamines to stay thin' industries?
Indeed, we have the inception of Weight Watchers at the start of the next decade, replacing far crazier things like the cabbage diet being used en masse.
Yes, it was easier in some ways to live a healthier life; one reason why was the rampant social policing of each other's weight.
> The prevalence of dedicated dieting or weight loss efforts has increased over time.
Perhaps, perhaps not. But you'd expect that if there's many different causes making weight gain more common and only one is changes in social pressures (as I've already stipulated in each post).
And, likewise, as stipulated above: overt social stigma is not the only reason why people might prefer to be of a lower weight.
> The success of those efforts has decreased over time.
Well, one reason for this is that we've reduced the use of obviously harmful but effective weight loss techniques like cigarettes and stimulants. The 1950s were the era of the rainbow diet pill clinic, where you'd walk in and get a personalized cocktail of amphetamines and thyroid drugs and laxatives and diuretics to help you control weight.
Non sense...
There were not a particularly big stigma about being obese 50 or 70 years ago. Socially stigma were more about gender roles, sexuality etc...etc...
There was a huge stigma about being obese 50-70 years ago. It was wholly unacceptable for children, young persons and women in particular. Exclusively older men were allowed to be obese culturally without being shamed about it.
As recently as the 1980s movies were overloaded with jokes about fat people, it was extremely common. That's stigma in action culturally.
The 80's were 40 years ago...
I am not sure where you get your reference from...
Jokes about fat people and stigma about being fat aren't the same thing
I'm not sure how this applies to my comment. I'm not saying anything about self control. I'm not against individuals taking GLP-1s. But, if we're at a point where we're all on drugs to treat lifestyle diseases, we should at least recognize that these lifestyles are largely chosen for us, and we should consider that doing something about that will reap us the benefits we're after.
Those benefits and a billion more! Better state of nature, richer social fabric, probably less political polarization if people were bumping into their neighbors more frequently instead of going from drywall box to steel box back to drywall box day in and day out.
>> Unfortunately, I have to drive everywhere, work too many hours to have free time for recreation and have no idea which government subsidy is going to help big ag likely at the expense of my health.
At what point do people stop letting the choice being largely "made" for them and choose something else? The gov subsidy has nothing to do with my personal health choices. My grocery store has the same fresh fruits & vegetable sections grocery stores in Europe have. I am lucky to live in a state whose dominate grocery store sources regional meats & produce, sells their own brand of food made fully or mostly with ingredients I can pronounce, and has complete whole food prepared meals for 1-2 people that take 25mins in the oven. [for the same price as fast food]
It's part of the reason I choose not to move. Other choices are a standing desk with a walking pad, which makes it trivial to walk 3-4+ miles a day. I could make more money studying leetcode and living in "elite" tech valley, or hustling for more work instead of choosing myself over the large house in swank community that society has picked as what is "success" for me. Eventually I chose to take less of what "they" told me to choose; at some point we have to realize the only person that is going to live with our choices is ourself. If GLP-1s is needed to help people get back or get to that point of realization, then maybe it's a blessing to undo all the ills we(society made up of our neighbors) all contributed to creating.
I'm happy you don't live in a food desert, live in a good neighborhood and have the means to move somewhere else if you wanted to. Not everyone has these advantages. I think we can all agree that these are good things and I hope we will do what we can to allow others enjoy them as well, because no one chooses to be in that situation, but it is largely a policy choice to keep it that way.
> and have the means to move somewhere else if you wanted to. Not everyone has these advantages.
I debated posting because this is the usual response, instead of seeing the point as, "we" continue to create this society not some magical "others". I am where I am because of my choices + the lucky draw of loving computers and a dedicated family that scrapped and saved and sacrificed to buy me my own computer as a teenager which helped me move out of the situation I was born in. And even that was better than many of the people I grew up with. So no, this wasnt some privileged post of someone who never walked 2+ miles to the corner store with their friend to pick up a half gallon of milk and pasty white "bread" with food stamps so they could have sandwiches for dinner.
[added: while this situation sounds bad it's better than where they (and many of my other friends) came from as they could have been deported back to there if found]
The more important point the comment you're replying to makes is not "what if people could diet and exercise" - i.e. accept the modern American lifestyle as given, plus force yourself to go to the gym and eat chicken and broccoli - but rather that the modern American lifestyle in fundamentally structured to lead to people being overweight.
Instead of being forced to drive everywhere for the most basic possible human needs - like getting groceries, going to the doctor, or dropping kids off at school - as is the case in 90% of America - what if you could walk to those places instead? You would get exercise as part of your every day life, with no extra effort!
What if instead of corn syrup being so heavily subsidized, we could use more filling sweeteners in a lower amount instead? What if people lived closer to agriculture, instead of in faraway suburban tract housing only accessible by car, so they had easier access to fresh meat and vegetables, instead of ultraprocessed package food?
These dreams are not "diet and exercise", they are a fundamental reshaping of American lifestyle that would directly lead to weight loss. We know this, because America used to look like this before, say, 1940. In old photos you see people in huge crowds in streets as they walked to their everyday errands, and menus and recipes of the era are mostly minimally processed food that is mostly local. Americans of the past were not overweight, because the way society arranged its physical existence didn't permit it!
IMHO price of calories is the only thing that needs to change. All the talk about wholesome locally grown foods vs. processed industrial stuff is just moralizing and posturing, when the metric that matters is the price. Just look at Coke, which is arguably not even a good example because of pre-war price fixing, but still it costs half as much as in 1950 when adjusted for inflation.
> In old photos you see people in huge crowds in streets as they walked to their everyday errands
Because they were poor and didn't have a choice. Making driving extremely expensive and inconvenient and prohibitively high taxes on processed food etc. might force people to change their lifestyles, I'm just not sure how politically feasible that.
My 1950+s grandparents drove everywhere and were fit. When we try to shoehorn so many agendas into one thing nothing gets resolved. It's also part of why so many people distrust everyone's agenda and truthfulness nowadays. Also 1940s America was mostly rural, not huge crowds of people walking together.
I was that guy. For a variety of reasons that aren’t relevant i developed insulin resistance over a relatively short time that made it increasingly difficult to lose weight. I’m in my mid 40s, which also makes it difficult.
I got on one of the GLP drugs 18 months ago. I am down 80 pounds, and am running 20 miles a week. I’ll be doing a half marathon in March. Ive dropped the dose twice and still going strong.
Taking the pill made exercise possible. Online everyone likes to apply a moral hazard thing to every discussion. GLP medication twiddled my dopamine system and allowed me to achieve my goals. Period. If you think that makes me weak, I cannot think of anything that I care less about.
> Perhaps it's necessary to have self-control to lose weight
> it's not so simple.
Presumably people who have good self control and are not prone to developing addictions (due genetic or various semi-immutable cause) do not become obese in the first place. It might be fairly easy easy for them to lose weight they just don't need.
But don't you think that it's better to make the changes to prevent obesity rather than focus so much on a cure for after?
I don't have a problem with a cure only if it doesn't reduce the focus and effort on prevention.
There has to be a reason why so many more people are obese today than decades ago. I refuse to believe we can't find out why and make changes to reverse it.
But if it's so easy to cure, will enough people care about figuring out how to prevent it?
I’m not obese, just before (1m75 / 82kg) but I have found self control impossible, except when I do intense sports (like musculation 3-6 times a week). Then only, and this is the magic part, I not only eat less, but also enjoy being more brave, with cold showers, being hungry, going to bed early and other efforts in life.
My hypothesis: this is more cultural than people want to admit. Try to skip out on too many engagements, sorry, meals and see how many connections you still have.
counter hypothesis - the amount of self control exhibited by an average human is insufficient to self regulate when placed into a hyper enriched environment , for example the capitalistic profferings of junk food tv porn etc , we did not evolve around these hyper stimulatory activities, how on earth are we meant to adapt to them? drugs are not an answer, they are another bandaid making someone else money and allowing the underlying wounds to fester, the solution is education and awareness of this fucked up situation
It’s been studied pretty well. Possible effective solutions to the US obesity epidemic are pretty much limited to:
1) Radically alter aspects of food culture, work culture, social policy, and business regulation.
2) Magic pill (/injection)
There appears to be no imminent progress on the many parts of #1 that need serious work, so if we want a big turn-around in the next half-century, #2 has suddenly and surprisingly become a real possibility.
Sounds similar to most major world/cultural issues today. You can make the exact same argument about climate change for example.
But at the same time, part of me wants to ask... why is this a problem? Why shouldn't we just use science and technology to fix human problems and remove any unfortunate consequences from society?
What's wrong with a world where anyone can eat as much of anything as they want, do no exercise at all, ignore their dental health and smoke like a chimney, yet still have perfect health without any downsides?
Objectively, it would be a better society, with everyone materially better off and a system that doesn't need anywhere near as many resources to care of its citizens.
Because some of us want the real thing, not the fake thing achieved by cheaters.
I'm the same in other areas of life. I don't take steroids, I work out in the gym. I don't take drugs to have trips and achieve enlightenment, I tried to find Zen on my own.
I wouldn't partner with someone who had a cosmetic surgery ("fake beauty"), nor someone who wears makeup.
Up to every individual of course, I'm not even saying I will never take TRT (probably eventually, when I'm older, for health reasons), but I, above everything else, value (and want) authenticity.
> Possible effective solutions to the US obesity epidemic
Just wanted to mention that this is not a US problem, and framing it as such won't help find solutions. Even in southeast Asia the rates over obesity are steadily increasing. Europe is already much fatter than southeast Asia. This is a worldwide phenomenon.
I would argue that the US has some fault to why other western nations are getting fatter.
All of the US's worst fast food chains and food products have been exported. In my tiny city a Carl's Jr. Just opened! There is McDonald's, Burger King and Starbucks everywhere. There are also Dunkin donuts in the supermarket as well as oreos. In contrast there arent any Asian or Russian restaurants chains here.
Local foods have become sweeter in order to compete and there are so many local burger restaurants now it's like I have moved to the US.
That's par for the course, the world does love to blame us for their problems. Then they bitch when anyone suggests we've made some choices in the last 100 years that made their lives noticeably better (hello Marshall Plan!).
> have been exported
That's a convenient spin on "have been imported." Do you not make your own choices? If you don't want the crappy fast food, quit making your own copies of it!
Since it's kind of on point for this discussion, I just thought I'd mention one amusing thing I noticed in London -- you can buy higher calorie McDonalds food there. I could get a sasusage mcmuffin with two patties, which isn't a thing in the US. I almost wanted to do it just for the laughs, but frankly the UK version of McDonalds tastes even worse than the US version. I'm not sure exactly how that's possible.
Y'all should stop importing the shittiest excuses for 'American' food. A lot of us never eat at these places in spite of them being so prevalent. We have a lot of great restaurants, even some of the ones that qualify as fast food.
> If you don't want the crappy fast food, quit making your own copies of it!
“If alcohol is bad for you, quit drinking it!”
“If crack is bad for you, quit taking it!”
My point is that there is more to it than that. You make like it’s a choice governed by free will when we know that fatty and sweet foods are addictive and harder to resist.
It is global, but the US is among the leaders and people who move here from skinnier countries tend to get fatter. Something about (odds are, a bunch of somethings about) the living environment we’ve created causes more obesity than the environments in most other countries, though yes, it’s getting worse in those other countries, too.
From the article "Estimates suggest GLP-1s can reduce body weight by at least 15% when taken regularly". That's a 5'10" man starting at 250lbs (obese, BMI > 35) and finishing at 220lbs (obese, BMI >30).
Or a 5'10" man starting at 220lbs (obese) and finishing at 187lbs (overweight, BMI > 26).
It ain't nothing, but that's not a magic pill which will fix the obesity epidemic. And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food.
I lost 100 lbs over 18 months. And, I found it much easier to change my lifestyle on a GLP-1 drug. Naturally thin people / people who don't have some environmental sensitivity are super judgy about GLP-1 drugs, and closet judgy about fat people. It's just not so simple as "lazy/poor diet/no exercise."
I went from nutritionist appointments that were like "are you lying about your food intake? because if not, you have some serious problem with something in your environment" to "yep, it was easy to cut out a couple things that bothered me," and weight came off astonishingly rapidly.
And this anecdote a person on HN[1] "reached a peak of 340, and in exactly a year, while maintaining the same CICO, but changing from the SAD to strict non-Keto Paleo, became 214".
(I want to ask this in a non-combative way, but 3 days later I still can't. How did you know the couple of foods(?) which were bothering you, which were the problem, and your nutritionist did not know about them, and you weren't lying to the nutritionist? I can't make sense of that without also accusing you of hiding them from the nutritionist, or the nutritionist being terrible at their job).
This is work in progress, though. 3rd generation medications are already way more efficient than 1st gen. Saxenda ever was. A further increase in efficiency is likely.
"And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food."
That sounds very judgmental of you, like if they were skipping school. Bad truants!
What about "found the necessary changes too hard/complicated to sustain"? That is closer to reality. People juggle all sorts of obligations, some are doing multiple jobs, commuting 90 minutes each way etc. - they may be just too fatigued to exercise regularly and cook healthy meals at home.
There are 110,000,000 overweight people in the USA and another 110,000,000 obese people. Is it really closer to reality that everyone is a two-jobs no time for exercise, or is it more that Starbucks Mocha Frappuccino has 500 Calories and Starbucks has 15,800 stores in the USA and $36Bn annual revenue? And McDonalds, KFC, and all the rest. Is it closer to reality that people are snacking on some snack food on the couch out of habit and not paying attention to how many calories that is in a week, because it's just habit and gone in seconds? Is it closer to reality that Uber Eats and Door Dash and Domino's advertise to manipulate you into believing that you don't have time to cook at home and they are a good option? Is it closer to reality that there are food deserts with only junk easily available?
> "That sounds very judgmental of you, like if they were skipping school. Bad truants!"
It is judgemental of me, like if you want to pass your exams but skip studying, that would be bad. If you aren't exercising and are eating terribly and are obese, this lets you silence the alarm bells while saying "I don't have time to exercise". That doesn't seem as good as eating better and changing your life to include movement.
I don't perceive health as a reward for virtue, so even though I understand your analogy with exams, I cannot really accept it.
Ask yourself where fast food comes from. It is a) fast, b) cheap. Of course it is going to suit people who a) don't have time, b) don't have much money. A union of those two wants covers a big part of the contemporary Western population.
Composition of food is another biggie, I agree with you on that. Too much sugar everywhere. That said: we are naturally wired to crave sugar, only someone more and someone less. If fentanyl was legally sold on every corner in fancy packaging, starting with kids, would you blame the resulting junkies for being weak-willed? Or acknowledge that the environment is really fucked up?
I personally don't respond to sugar that much and I can go weeks without it, but that's not my virtue. It is blind luck of my genome or possibly microbiome. I don't drink much either, but again, that's blind luck of my genome or possibly microbiome which makes me dislike the taste of alcohol. Not my iron will, which I don't have.
It is my experience that a lot of people are judgmental about the fatties because it increases their own perceived self-worth. ("We are the virtuous ones, unlike them.") Pretty arbitrary, but humans be like that.
But is it time to give up just because there hasn't been much progress yet? It seems now that we have #2 there's little incentive for #1, whereas there was plenty incentive for #1 before even if little action.
I think fourish decades was enough time to see if we’d get our shit together on the pile of problems that need to be fixed to solve this the #1 way. We haven’t, even a little.
So no, I’m thrilled to see #2 show up to maybe get our healthcare system to limp along for at least a couple decades longer than it was looking like it would.
I think it's better not to sacrifice the wellbeing of our citizens at the feet of an ideology about exactly how we should be solving an obesity crisis.
Besides, having healthier people will lead to better infrastructure for healthier lifestyles, purely based on demand. It's a virtuous cycle.
Yes. Looking out 30, 50, 100 years science will further resolve the obesity problem that has plagued the US since the 1980s. There is no scenario where you radically alter such a gigantic, disconnected, complex culture such as the US has. The old joke was that the US would solve this with pills (so to speak), and that's what is going to happen.
If you have a tiny, homogeneous culture it is still very difficult to radically alter it in the span of a couple decades (think: Sweden, Finland). For something the scale of the US, with the diversity of the US, there is no possibility. Anything suggested as comprehensive would be fantasy. There are only small changes that could be done, eg relating to sugar consumption limits in drinks and food; some would have a meaningful impact, however you still won't fundamentally change the culture's calorie problem.
Getting thinner will do extraordinary things for rebooting the malfunctioning US. Obesity does a lot of harmful things to work ethic, longevity, quality of longevity, productivity, mental capabilities, to say nothing of course diabetes and cancer and so on.
I know someone who has lost about 60lbs. The reaction of most people is 'what pill did you take'. They find out it is basically no sugar and limited amounts of food with some mild exercise. Pretty much every one of them is 'thats hard' and do not do it. And frankly it is hard. Like 95% of a grocery store has way to much of what you need for your daily intake in some form or another. It is that 5% you have to dig thru the whole mountain of crap to find. Then once you find it hope like hell the manufacture does not stop selling it. Or enjoy making everything from scratch (even that is a pain).
I would not jump on that current pill yet. Wait and see. There are probably serious side effects that we mere plebes do not get to find out about yet (that is for 20 years from now). Like what is the side effects when you stop taking it? What if your dose is too high/low? What is the long term usage like for other parts of the body?
> "Osbourne said when she first began using the drug she felt nauseous for two to three weeks."
> “You don’t throw up physically, but you’ve got that feeling,” she said.
> She was also very thirsty and did not want to eat.
No, it doesn't appear that some famous person almost died. The drug seemed to be effective for her. She noticed some mild nausea - she even said she didn't throw up. That's mild nausea. She was thirsty - this makes sense. Food contains water, so she was probably dehydrated which contributes to the nausea. She should have drank more water. Finally, she did not want to eat. That is the intended effect of the drug. Sounds like it did exactly what it was designed to do.
Yes, gastroparesis can happen. This is not a shocker, as GLP-1 agonists affect the rate of gastric emptying. Gastroparesis is ... a slowing of gastric emptying. 750 out of nearly 150,000 GLP-1 patients experienced gastroparesis. This is about double the incidence in the general population. In very rare cases of gastroparesis you can experience blockages, but that is very much the exception, not the rule. Even so, this is why it's important to meet regularly with your doctor, discuss how you're feeling while on the drug, and get medical attention if you discover you're not shitting and normal methods don't improve things.
There are many useful, common drugs that have side effects that seem scary but are rare. ACE inhibitors are wonderful, well-tolerated drugs for controlling blood pressure, but long term use can cause kidney issues in very rare cases. Monitoring potassium levels allows for this side effect to be controlled well before kidney damage results.
> If there were effects, we'd have seen them by now.
You just authored a screed in response to me pointing out that there are effects.
Sharon Osbourne didn't just have mild nausea she now claims she can't put back the weight she lost that she didn't intend to lose.
> Gastroparesis is ... a slowing of gastric emptying.
I can't help but point out the syntax choice of internet snobbery. I'm not sure when people started sprinkling ellipses for dramatic effect because they seem to think it makes them authoritative but I think it's worth highlighting since it's such a reliable heuristic for internet troll.
? All I can find are a bunch of articles about one or more interviews she gave where she complained it made her too skinny (if you’re on it for weight loss rather than diabetes, you can simply adjust the dose down if you’re finding it too effective), nothing about almost dying.
> “I’m too gaunt and I can’t put any weight on. I want to, because I feel I’m too skinny,” she went on before warning people, “Be careful what you wish for.”
She abruptly stopped after losing much more than she wanted to lose.
I run three miles a day, never drive anywhere (bike or bus), eat reasonably healthy, and I'm still 20 pounds overweight. And what really scares me is that running is the only exercise I enjoy and if my weight fluctuates up just 5 pounds or so, I start getting hip/knee/foot etc pain. If I gain 10 pounds through some lapse in morality, I won't be able to run anymore and I'm cooked. If that happens, I'm banging down my doctor's door for a pill.
Which will burn somewhere on the order of 400 excess calories - about as much as a typical North American muffin (or two of the big cookies from Subway). But worse, your body was probably going to use most of those calories on something else (fidgeting, running a higher body temperature, other immune responses including inflammation) anyway, assuming that you haven't been gaining weight with your current habits. Exercise is healthy and reduces stress, but it just isn't effective for weight control. Humans are animals, and animals have on the order of a billion years of homeostasis technology behind them.
>eat reasonably healthy
Hardly anyone has any accurate picture of how much they consume, as measured in calories, except for those with actual explicit experience of measuring and accounting it.
If a pill happens to end up helping you eat an amount that lets you maintain a healthy weight, I'm all for that. But it's important to have your mental model properly calibrated.
So I'm a distance runner, who is on these drugs.. and yeah, It sucks, I LOVE running.. but running heavy SUCKS. Most people run to lose weight, I lose weight to run.
honest to god i wish i knew what it was like to be like you —i have always hated every step of a run, and im halfway convinced the notion of a runners high is a convenient fiction cooked up by nike.
There are a few things that happen here, but the most common one is not having someone helping you with form, and running much too fast. If you talk to a physical therapist and run with a distance runner and have them help you keep your heart rate in zone 2, you will probably feel much better.
This took me a long time to figure out: it's ok to not like running. There are other forms of physical activity that may appeal more to you, which you can do in place of running. I'm personally into biking, which gets me more than enough exercise.
Second the other commenter. Measure your heart rate and stay within a lower zone.
Most likely this means you will be walk-running at the beginning or even just walking up a steep hill.
Running is an activity of many small incremental gains. Every week you can go a little tiny bit further but if you amortize that over a year it makes a big difference.
Many go into running too fast and hard which leads them into not liking it because they feel absolutely miserable the entire time or they injure themselves due to bad form.
I had a good physical therapist which took me from nothing and for the first few months I wasn’t even running but doing foot and ankle strengthening because that part of my kinetic chain was so weak.
To paraphrase: Instead of relying on medication that helps with issues caused by our society, let's completely change the society so it's no longer the issue?
What is a realistic path to this? Being from Europe I visited US last year and was horrified at the quality of your food. You see a lot of documentaries/youtube videos/etc... discussing the problem, but how do you even go about this?
We have good food, but you won't find it on "The Easy Path."
The Easy Path is that gentle encouragement to hit up Chipotle for lunch, because it's "right there."
The Easy Path says dinner's hard and you've had a long day, so get something simple, like take-out or microwave.
The Easy Path is entropy. The Easy Path is self-care over struggle. The Easy Path is simple carbs shown on prominent display in store shelves. The Easy Path is advertising.
Hitting the gym isn't on The Easy Path, but forgetting to cancel your gym membership is.
These days, big food companies love "The Easy Path" because it's so easy to commoditize, it's the "Path that Americans are Expected to Take." For financial stewards, being on The Easy Path turns lack of willpower into your ally.
On the other hand, getting good food in the US requires passing the marshmallow test: you have to meal prep, or you have to shop around the sides, or you have to get something on the salad menu. You have to say no to advertising. You have to expend willpower, the most limited of resources to the average American. You have to Go Hungry or Suffer, or have An Upset Stomach. You frequently have to spend more money or time.
Semaglutides are not currently on The Easy Path. Maybe they will be someday. I personally doubt that, because putting GLP-1 on The Easy Path would require big food companies to rethink their entire portfolio.
But you're not wrong in that they could be Easy Path-ajdacent. The dialectic would shift: food companies would shift around to be Organic and Nutritious and Less Calories and find other ways to stay on The Easy Path. Sugar and fat's addictiveness is highly Easy Path-enabling, and that's a pretty big vacuum to fill.
I think you're making this sound harder than it is.
If you count calories and stick to a budget, you will lose weight, even if those calories come from deep-fried fast food. Sure, it's good to eat more whole fruits and vegetables, and you should, but weight loss doesn't require some kind of Edenic perfection. Stick to a calorie budget and you will lose weight, the end.
We can add some second and third order provisos, sure. The next tip would be to go low carb. And to keep a spreadsheet with calorie numbers for everything you eat. Track what you're doing.
But basically, if you eat 1500 kcal/day for nine months, you will be much thinner. We don't have to make it harder than that. It works. Perfection is not required.
If we're talking about this as a public health issue, then I agree with you. You can't really expect much of people as a herd or mass.
(Hell, look at the state of elections.)
If we're talking about this as individual, rational people, though, then it's different. You can absolutely maintain a reasonable weight if you just attend to it.
2.
There's actually some knowledge embedded in the "count to 1500", which, if you're not in the habit of thinking about, may be surprising. Specifically, the kcal amounts themselves.
Say you just go with the flow of society, and you eat "normally" without thinking about what you're doing:
You wake up, and you have something marketed as "a meal" for breakfast. A breakfast sandwich can easily be 550 kcal. If you add a venti latte to this, especially one with sugar, then you could easily add another 250 for that. Now you're at 800 kcal just for breakfast.
Then consider lunch. Even a "small" meal from a healthy salad place, like Sweetgreen (which is expensive), is going to be like 900 kcal. Say that's what you eat. Now you're at 1700 kcal.
The afternoon comes, and you have two chocolate-chip cookies. Two cookies isn't excessive, right? Just a little treat. But each one is probably 120 kcal. So that's 240 kcal. Now you're at 1940 kcal.
Finally you have dinner. Some microwaved thing, relatively small. It's probably like 600 kcal. So now we're at over 2,500 kcal for the day.
Everything you did in the course of that day was relatively normal. Probably only the venti latte at breakfast was obviously excessive. But now you're substantially over your calorie budget.
Now, 2,500 kcal is still salvageable. Every mile you walk on flat ground is about 100 kcal. If you live in the city, you could easily have walked a mile and a half during your commute to work, and another mile when you stepped out for lunch, and a mile and a half on your way back, giving you four miles. You're almost at breakeven. Just need a little more exercise, and you'll maintain your current weight.
(In the burbs, though, you probably drove to all these places and now it's on you to go to a gym, which is a pain in the butt.)
Anyway, my point is, if you weren't attending to all this, how would you know? You'd probably just be doing all these habits without thinking about them. Most parts of this routine seem pretty reasonable. But you'd still be getting fat. Because you're going with the flow instead of counting.
So, there's a little (easy) knowledge involved, but mostly it's not an issue of intellectual ability, it's a matter of attention.
>The Easy Path says dinner's hard and you've had a long day, so get something simple, like take-out or microwave. The Easy Path is entropy. The Easy Path is self-care over struggle.
If you see this sort of food as "self-care" then that's where the war has been lost.
>or you have to shop around the sides
Sometimes I wonder if I'm the only person in the world who enjoys this. Discovering, for example, the versatility and cost-effectiveness of skim milk powder was a real game changer for me. Similarly for dried legumes and fruits.
The Easy Path is a meal service like Factor that delivers healthy food directly to your door step.
The Easy Path is signing up for a fitness class on a regular schedule and baking it into your morning routine.
The Easy Path is not buying extra snacks - just don't have them laying around the house for you to eat when you're bored.
The Easy Path is the path of least resistance. However, you have some agency over the environment you create for yourself, so that path of least resistance is to some degree under your control.
Get ground beef in the supermarket, it’s cheap and takes 7 minutes to cook. If that’s all you eat you can’t be fat and out of shape. You also won’t be hungry.
At some point blaming society isn’t going to cut it.
At some point "have willpower" isn't going to cut it. That point was decades ago.
Blaming society sounds fatalistic, but yes we absolutely can change society. There are mechanisms to do it, and the first step to utilizing any of them is people getting pissed off about the state of things and talking to other people about how pissed off they are about it.
I’ve done plenty of grinding it out in my life with no energy or time to spare.
Even in that place you can do better than ground beef.
Get an instant pot and invest in some rudimentary cooking skills. I’ve spent a whole year making variations on the same dish in 15 minutes, using that cooking as end-of-day stress relief. Shopping for the same handful of things once a week.
It wasn’t fine dining but it was healthy, cheap, and a few steps up from ground beef. Come now.
I love fatty meat and salt. I can’t think of many things better than that. It’s also the only staple us and our ancestors have eaten for millions of years.
I think the instant pot is too imprecise a tool for cooking by recipe, it’s for speed and convenience. I’ll improvise a curry with what’s on hand, sometimes the result is fine and sometimes it’s great :)
It’s not the only thing. You can eat any meat, eggs, or many dairy products. Probably most fruit is fine too, although I don’t eat carbs myself.
Yes, all the processed grains and seed oils and artificial sweeteners and chemicals should never have been invented. But I’m not too fussed about that. What I can do is come here and write these comments about the diet that changed my life for the better. If only one person who reads them tries it out, I will already have succeeded.
The US is a huge country (9,833,520 square kilometers!), so I find it curious that such generalization can be made about the food available here, or even the eating habits of 334,914,895 humans. I could say that I visited Amsterdam 2 years ago and I was shocked with the quality of the food.
But I would never do that, since I mostly ate at the Red Light District, and I couldn't possibly generalize the country eating habits with stores in a major tourist area.
Maybe I'm too European to understand why not, but seems to me that regulations around food and what companies are allowed to put into it is really helpful in avoiding companies from just stuffing whatever down people's throat.
There's plenty of high quality food, you just have to know where to look. For example, come to the Bay Area and check out Whole Foods and any number of high-end restaurants.
That's overkill. There are very marginal health benefits to eating organic watercress vs. eating whatever dark leafy green is currently on sale at the discount supermarket.
The problem isn't that people go to supermarkets and they can't find any healthful ingredients to cook with. The problem is that they go to supermarkets and pass those over in favor of convenience foods that have been optimized for "craveability" [1].
GLP-1 drugs can alter this behavior by reducing food cravings. Someone who's no longer craving the most craveable food can make more objective by-the-numbers buying decisions the next time they go grocery shopping.
was in greece for three months. the quality of the BASIC fruits and vegetables at the regular local market down the street from where I was staying was on par with wholefoods. It was surreal how cheap it was to eat HEALTHY.
Almost any ethnic grocery store will do since they cater to immigrant communities that are likely to be lower income. Here in SoCal some are cheaper than others but they're all way cheaper than Ralphs/Vons/Trader Joes/Costco/etc (I don't shop at WalMart so I'm not sure how they compare)
There are also native stores that are increasingly entering into low cost produce like Grocery Outlet and then there are the usual like Food4Less but they tend to eventually move upmarket.
Why is the quality of food in Europe so much worse than southeast Asia?
Because you guys are way, way, way fatter than e.g. the Japanese.
Back on topic -- we have excellent food in the US, but regulations allow for highly processed crap to be sold too. Pretty sure most of the crappy processed foods are easily available in Europe, too.
eu and canada have stringent laws on advertising to children, and laws on nutrition and additives to their products
even things like bread in the US have an insane amount of sugar
but the other reason is suburban/car culture & zoning, which means more hypermarkets and shopping not every few days for fresh food but every week or two for more processed food that lasts longer because going to the store is a bigger PITA than a quick 5 min walk to the neighborhood stores; which also means mroe walking rather than driving, another area of calorie burning and lean muscle maintenance which maintains high metab
The first thing that would help is actually having a realistic discourse about food, and not the idiotic - "You shouldn't be eating processed food, its not good for you".
Like most of the food that we eat is not really that bad. Its not optimal for sure, especially for sedentary lifestyles, but a lot of the health problems are not directly tied into the actual food, rather the over-consumption of it, and passing down of bad genetics (for example, children of obese people are more likely to be obese).
European obesity tripled in the last 40 years as well, despite higher quality of food.
But you already live in a system that promotes that, quite heavily. Healthy food and active behavior make you more physically attractive, which is in turn linked to better life outcomes along almost every metric you can care to think of.
There is, in fact, already an enormous, fully endogenous incentive to do those things. The fact many people are not keeping in shape (myself included) suggests the allure of food really is just that appealing.
> But you already live in a system that promotes that
Correction. We live in a system that *rewards* that. The infrastructure and system itself expects us to drive everywhere (because it's either faster or literally at all possible), eat overprocessed food (because it's tastier (literally designed to be hyper-palpable) and faster), and to work for absurd hours.
If you somehow have spoons after all that, then you're expected to workout, etc, to gain the additional benefits; but the systems in play do not facilitate that, at all.
I see no difference between "promotes" and "rewards" here. If it's a difference of intent, I'll point to everyone in this thread consciously "promoting" a lifestyle of fewer working hours, cleaner food, and less driving as a much more salient viewpoint than the opposite. And if the difference is because of "the system", well, you're going to have to differentiate between the system of living in human society and ... some subset of that system, I guess. Some subset
Luckily there's a precise term from economics we can use here to split the difference: Opportunity cost. I can certainly concede that in some people's lives the opportunity cost to working out is higher. In some lives you make a lot more money per hour worked than you do working out, and so it's not a surprise more people on the margin in those situations choose the former over the latter. If you dislike even having that option on the table, the good news is you can move to someplace where you make less money, and then that opportunity cost will go down, because working out is pretty much the same wherever you go.
One more sophisticated take of course is to claim people don't really know what's good for them, and they discount the true value of working out far too heavily. (s/working out/eating less/g, or whatever other health promoting difficult activity you wish to sub in here.) But, if we're going to claim that -- which is actually pretty reasonable -- then why would we consider a miracle drug that seems to directly counteract that irrational discounting a bad thing? That should be a godsend.
I’m a standard-issue stress eater. I also like to work out.
When I’m really feeling the stress, even though I will tell myself at that time to just hang on and hit the gym later, the food is that much more of an instant fix that it wins out more often than not.
I’m sure that’s not just the actual food itself, but also the easy availability of it, and probably subliminal cultural factors such as advertising. But partly, yeah, it’s that my ancestors evolved to love eating when they had food, and their gift to me is that same desire in a world of endless plenty.
Of course it is impossible to live a healthy lifestyle and have healthy weight, if you ignore the 3/5ths of Americans that are not obese and the 7/8th of the global population.
Are the 3/5ths of Americans who are not obese actually living a healthy lifestyle? Or are they just living a different unhealthy lifestyle?
Is a skinny homeless methhead with a great BMI healthy? Or the blue collar dude who has terrible blood pressure from chain smoking and pounding energy drinks on his way to the job site?
How many Americans who are not obese are on their way to becoming obese?
There are lots of paths to unhealthiness and overeating / eating poorly is only one of them
Yes of course, but the point I'm making is that people who aren't obese aren't necessarily healthy.
People aren't born obese. They get that way through mistreating their body for a long period of time, and it is quite possible for them to die before they become obese to other maladies related to that mistreatment.
> Impossibly unrealistic to change zoning to disincentivize car-dependent urban design?
Those zoning issues are the same reason for any number of other problems, including housing prices that are supposedly the #1 concern for a huge number of voters, and yet voters in many cities have only doubled down over time on making it harder and harder to build in efficient and high-density ways. "Impossible" seems like a fair way to put it.
Yet some cities are making progress on exactly that issue.
I haven't done the statistics on it, but I'll bet cities full of people who want zoning reform are more likely to reform than cities full of people who do not want it.
No city has implemented anything like zoning reform. There are a handful of cities which, to great fanfare, have made tiny changes. Minneapolis has made the most impact, but it's hard to rule out correlation with falling demand for that city.
This change ultimately allowed something like 10% more units in the city on a 100 year horizon.
This is what I'm calling out - these changes sound big but they are nearly meaningless. Cities need periods of explosive growth to remain affordable (see Jane Jacobs, 1961 and 1970).
I said "Raleigh doubled its zoned density overnight." You said "No they did not" and "No city has implemented anything like zoning reform." Both of these are false.
You can refer to the text changes. They doubled the zoned density in nearly every residential zoning type in the city. It is a huge change, though I suppose you can claim that's not "reform" if you want. It is sufficiently reformative for my purposes of increasing urban density over time.
Changes will take time to kick in, and obviously they should take time to kick in because simply clicking a button and doubling actual built density would crater the economy. It makes no sense. The zoning change removes an artificial restriction on the natural supply/demand curve, so now supply can grow as-needed in the forms desired.
I don't think it really does to the supply/demand curve what you think it does.
In general, when new construction occurs, it's taking low density and replacing it with more like 10X density. A very tiny amount of land gets developed at once, so you need each new development opportunity to generate as much supply as possible.
What this did was make people think gosh, that means a lot of housing! But in actuality, very few of these ever get built. Only very old housing stock ever makes sense to replace with only a doubling.
I appreciate what you're trying to say, but what I said was actually true. This won't have much impact. I can give you drips and drabs of information this way to help you understand how development works, but I can't give you an entire primer, unless you'd like to get on the Zoom and talk about it for a couple hours.
Maybe true in an area that requires redevelopment to grow, but in Raleigh there are huge, huge swaths of totally undeveloped land that are now much more valuable even within the same zones. You do not need ultra-high density towers to create true urban density.
I think you're setting up a false premise there about towers? Not sure where that came from.
Can you show me land that is now much more valuable than before? I suspect the places you're thinking of aren't really changing on value or buildability the way you expect.
> In general, when new construction occurs, it's taking low density and replacing it with more like 10X density. A very tiny amount of land gets developed at once, so you need each new development opportunity to generate as much supply as possible.
Naively, you're talking about converting a one story building into a ten story building. That == a tower.
You're skeptical that higher density zoning increases land values?
> Now, let's talk about the multi-family sector. If you thought single-family homes were hot, wait till you hear about this. Land suitable for apartment development in downtown Raleigh and Durham has seen price increases of 50-100% in the last five years alone.
> And it's not just apartments. The demand for townhomes and condos has sent land values for these types of projects through the roof, with increases of 30-40% in prime locations.
Of course we can quibble about what amount of that appreciation is caused by zoning changes, but from first principles it is obviously the case that given the same exact plot of land, the expected value of developing 10 houses on it is much higher than the expected value of developing 1 house on it, ergo a lot that allows 10 will have a higher price than that same exact lot constrained to 1 home.
These are two completely different things.
One thing is solving the problem for the world as a whole. That’s the ideal scenario, the one we should aim for. It might get resolved, it might not, but it will definitely take a good amount of time, maybe a very long time.
The other issue is your personal situation.
If you're living in a country with intense conflict or in a war zone, you can’t just try to survive for 40 years while “waiting” for the country to make progress. You move, and that’s it.
Plus, given that people’s freedom is constantly increasing, and they have more and more options available, expecting that everyone will autonomously choose a healthy lifestyle is like waiting for Santa Claus—unless you plan to take that freedom away from them.
Well no, you often can actually. You can have positive information about the impossibility of something, for example the prospect of winning a chess game after losing your king. You don't need to play billions of games of chess to see whether it's possible.
Zoning changes happen all the time. Tax changes happen all the time. Subsidy changes happen all the time.
"The UK has seen its obesity rates increase faster than the US. In the UK, obesity has risen sharply since 1990, when it affected only 14% of adults. The UK is also considered one of the most overweight countries in Western Europe."
So yes, other countries (just like the US), have introduced programs to try to encourage healthier behaviors, and have seen similar outcomes from them.
the UK has basically become the US by most metrics. This includes the increasing privatization of health services, transport, etc... and the excessive commodification of basic necessities like housing.
I find that saying that health initiatives don't work by vaguely gesturing at a country, is not a structurally sound argument. Its like the sentiment here is: "is the fact that we include Pizza as a vegetable in American schools part of the problem? Nooooo, that can't be it. it must be a moral issue!" and thats just one example.
The obesity problem in the US is tied directly to our relationship with highly processed (and CHEAP) food. Along with the stranglehold those companies have over state and federal institutions that allow them to directly sell these foods in schools and institutions, and heavily skirt FDA regulations via lobbying.
The US is uniquely bad when we have a ton of chemicals and ingredients in our foods that are banned in most other countries. It is largely a systemic problem and a problem that can easily be solved. Poorer people tend to eat cheap food, cheap processed food isn't well regulated and is directly tied obesity and a whole host of health problems.
The claim was about promotion, not effective promotion. (As a sibling comment points out, effective promotion is not unrealistic either. It won't happen on its own, but nothing does.)
As compelling as the theory that "unhealthy behavior" is root cause of the obesity epidemics, at this point it seems to me that the weight of evidence suggests an actual physical disruption. It's not supposed to be _this hard_ for (some) people to maintain their weight; something is actually not working right.
It would be interesting to run an experiment where everyone in first world countries was able to (and had to) walk to the grocery store to buy their groceries. It seems like that would promote useful exercise while self regulating consumption.
I walk to the grocery store all the time. This was part of my weight loss strategy and I chose to walk to a farther grocery store. And yes, I did attain my weight loss goals.
I choose to interpret the post as saying "start small, and be consistent". If you were to tell someone to go for an at least 30 minute walk every day many people would balk at you.
Start with a minute walk. Make time in your day for it. Extend to a 2 minute walk. 5 minute. 15 minute. Etc.
When the majority of the population is so far gone from being in a healthy weight, promoting healthy food for the masses is not going to help that majority. Yes, walkable cities and so on would be great, and promotion of healthy food and habits is great (remember Michelle Obama asking "why are you people so fat wtf?") for future generations, but Ozempic et al. provides a solution where otherwise, a lot of people are simply "lost".
The problem is that you can't undo millennia of evolution that has pushed us towards the situation where people are obsessed with food and struggle to limit themselves. We also shouldn't forget that not more than a century ago famine and rationing was still commonplace. Certainly my parents were still raised in an environment that hadn't gotten used to food being plentiful and were always forced to eat everything they had at all times and rewarded with food, this has been engrained in myself since I was young as well. I'm lucky that I managed to move away and isolate myself and lose a lot of weight but the important thing to note is that once I got down to a lower weight, everything was easier, getting up in the morning, walking, jogging, working out, talking to people, going outside. Now I've probably gained back 30% of what I lost and if I could take Ozempic to lose 5kg the rest would come a lot quicker because I'd be able to run further and have more energy generally.
All that is to say, these two are not mutually exclusive and if people receive this drug everything we already do to promote a healthy lifestyle will become much more realistic for many people, as far as I understand Ozempic removes the desire of hunger, it's not like people can continue their bad habits and take the drug and lose weight. Furthermore once they assume these habits, the generational cycle of raising children and over indulging will likely come to an end and we will probably not need the drugs as much.
TL;DR, people want to be healthy, they just don't have the tools or motivation to do it. Losing weight will likely be a gateway to many health improvements and benefits for future generations
I've struggled with weight loss my entire life. It's gotten to the point where I'm on multiple blood pressure medications, and the dosages are creeping up. And yet I still find myself thinking about eating constantly. Then I took Zepbound. It was revelatory. It was like a curse was lifted, and my hunger was silenced. I'm down 45 lbs in 4 months.
Perhaps if I didn't have responsibilities or trauma or stress or a thousand other things I could put all my energy into self control. Unfortunately, I only get so many years on this planet, so I'm going to keep taking the drug and spend my mental energy on other persuits.
> Perhaps if I didn't have responsibilities or trauma or stress or a thousand other things I could put all my energy into self control.
This is so relatable. Right before Covid, I was working really hard at counting calories and was looking at going below 200 lbs for the first time in my adult life. Then Covid hit, my life was upended, and I prioritized other things; I'm up about 40 lbs from then.
I can only devote so much energy to this kind of intensive lifestyle change, and other things have been taking precedence (including, recently, working out—that's been a huge lifestyle improvement [other than Wednesday being leg day and my legs still yelling at me], but hasn't led to weight loss).
As with everything I'm sure there is a spectrum. There are surely folks who have food addictions, there are surely folks who are not taking accountability for their habits, and there are possibly folks for whom this could be the best or safest option.
What a naive way of looking at things. Sure, everyone that's fat is lazy! There cannot be any other explanations, right?
You seemingly forget not everyone is as privileged as you are. Clearly by your take, you can afford to eat healthy and have the leisure time to exercise. A lot more people can't.
It doesn't follow that your body, when running at a calorific deficit, will continue to run the life support systems at optimal levels. In principle, it's possible (unless you're actually fasting, which is a whole different kettle of fish) for a reduction in energy-in to lead to putting on more weight, if your basal metabolic rate drops more than the food did.
It's complicated. What's true for some people isn't necessarily true for all people. Sure, I'm willing to bet a lot of people – probably most people – are able to choose how fat they are by adjusting their diet and exercise regime, without adverse effects on their health, but that's not a law of biology. I know as many people who struggle to put on weight as struggle to lose it.
I've been running distance most my life. I stopped when my wife had our first kid to concentrate on working hard and give her as much time off from the kid as I could, then after 6 years I had enough and started running. Two years ago, I hadn't been losing any weight, and I was put on these drugs to help me.
I lost more weight.
I run, walk, and move more than you imagine. It didn't work, but these drugs worked.
Not everything is black and white or fits into your preconceived notions.
> Like..you can't bother to take a walk, eat healthier, so you shell thousands on drugs..
For many of us in the United States (and elsewhere, I'm sure), our built environment makes driving the only feasible mode of transportation. Sure, we can walk for recreation, but at some phases of life carving out that time is extremely difficult.
Regarding food: there are brilliant people devoting their careers to coopting our natural processes to buy their products—and many of those products are unhealthy foods. Fruits and veggies don't have that kind of marketing.
Late stage capitalism is what got us in this place.
Add sugar to everything, advertise anything and everything to kids so they are hooked up early, make healthy food expensive so the poor have no choice but to eat unhealthy and so on. Profit!
Now they'll profit once again at the other end "fixing" the issues they caused in the first place. Genius. There's no limit on human ingenuity when it comes to exploiting others.
That's not even close to true. I can easily pop into HN for 5 minutes while taking a mental break at work, that's not an option (and would be utterly ineffective) for the gym.
> If you truly only have 5 minutes of free time in your entire week,
I was responding to your claim that if you can browse HN you can go to the gym, and it's obvious with any sort of thought that they are not similar activities.
> then why is it ineffective to do 5 minutes of pushups?
What is your goal? Fitness or weight loss? Either way, that won't be effective. Sure, it can be part of a larger fitness regimen, but just 5 minutes of push-ups ain't cutting it.
Pointing out the obvious: the conversation isn't about GP and their own time allocation. It's about the empirically observable fact that we've built a civilization that turns people into lethargic, sedentary, chronically afflicted mush.
People and officials have been talking about healthy eating for generations. Hard to get more mainstream than every doctor talking about diet and exercise.
Politicians have been protecting big ag for decades. Now independent farmers are getting criminally prosecuted for selling their raw foods directly to consumers.
This compares Ozempic with past drugs, but sales of past drugs are almost always limited by demand. I'm not sure there's much to learn here for a drug that is limited by supply. Also, this part is silly:
"The announced investments across both companies total $32 billion. GLP-1s were 71% of Novo’s revenue in 2023, 16% of Lilly’s in 2023, and 26% of Lilly’s in 2024Q1. If these sales are proportional to the manufacturing capacity used to create those drugs, then about 40% of Novo and Lilly’s combined estimate of $45 billion in gross PP&E is for GLP-1s, for a total of $18 billion; $25 billion would then mean a 140% increase in GLP-1-relevant PP&E."
Manufacturing investment is not proportional to sales, because there's a fixed cost to making a certain drug regardless of how much you sell. If a rare-disease drug will have a few thousand patients ever - not uncommon! - you still need to figure out a synthesis path for that particular drug, run QC tests on the production line, get regulatory approval, etc. Economies of scale matter a lot (https://en.wikipedia.org/wiki/Experience_curve_effects).
And apparently the pure manufacturing cost for Ozempic is relatively low:
> the active drug in Ozempic can be produced for about 29 cents for a month’s supply, or 7.2 cents for a typical weekly dose, the research found. It’s not cheap to make — semaglutide costs over $70,000 per kilogram. But only a tiny quantity of the drug is used in each weekly dose.
By chance I just talked to someone with deeper knowledge on this and they said the current constraint is actually ramping up supply of the delivery mechanism, not the drug.
I have zero expertise on this, but would be curious if anyone knows what's special about Ozempic delivery that can't be served by a commodity syringe.
> but would be curious if anyone knows what's special about Ozempic delivery that can't be served by a commodity syringe.
They can't charge as much. That's basically it. Generic semaglutide from compounding pharmacies (which have their own issues for sure) is under $150 a month cash-pay these days.
The real issue with syringes and self administration is that the vast majority of the population are not comfortable with it and don't have the diligence to do it correctly every time, so you get under/over dosage or noncompliance.
That being said, the autoinjector format doesn't really solve that problem, it just slightly ameliorates it, in exchange for approximately 8x the cost.
So basically, 99.8% margin the maximum they can charge (at ~15-30cents/mo) or 99.5% margin at $1000/mo for a $2.5 injector? Semaglutide has been in production since 2012 and approved by the FDA since 2017. There's a real chance that specifically as a weight loss drug it's not patentable since it was in off label use before the patent was filed. That's being argued in the PTO now.
>Generic semaglutide from compounding pharmacies (which have their own issues for sure) is under $150 a month cash-pay these days.
...Is that supposed to be impressive? I assume you mean USD, so that works out to more than I pay for my food. Toronto isn't a cheap place to buy food, either.
> By chance I just talked to someone with deeper knowledge on this and they said the current constraint is actually ramping up supply of the delivery mechanism, not the drug.
The article says this:
> Surprisingly, the study found that the biggest cost in producing Ozempic is not the active medicine, called semaglutide, but the disposable pens used to inject it. They can be made for no more than $2.83 per month’s supply, the authors concluded, based on interviews with former employees and consultants to injection device manufacturers. One Ozempic pen is used weekly and lasts a month.
So while the injection pens are significantly more expensive than manufacturing the drug itself, they are still relatively cheap. So it seems to be not a major problem to strongly ramp up production here as well.
Which suggests any supply shortage will be resolved relatively quickly. Perhaps in less than a year? Then the limiting factor will not be the supply but the market price.
There are also doctors that are prescribing vials of semaglutide and commodity needles, and training patients to properly dose up and administer the drug via a standard needle. There's more to it than the auto-injector pens, but not that much more to it. And it does bring costs down, which is important to some. Alternatively, you can just go to the doctor's office weekly and have a nurse there do a traditional injection for you (doesn't help as much with costs, but does bypass the auto-injector shortage).
I agree needles can alleviate the Ozempic shortage, though only if Novo Nordisk decides to sell Ozempic without pens. But not including pens will hardly reduce the price of Ozempic anyway, because pens cost basically nothing (estimated USD 2.83 for a month) compared to the full price of the drug.
The marginal cost to produce the few milligrams of the drug that goes into the pens is much much less than $2.83; it's on the order of cents. Plus, scaling up manufacturing of the drug is easier than scaling up manufacturing of the auto-injectors (which have a decent number of parts in them). The auto-injectors really are the bottleneck, and manufacturing of them so far has not been able to be ramped up quickly enough.
"hims" is selling Compound Pharmacy drugs, which will be made illegal soon. Soon your options will be $1000-1500/month from the two big drug companies.
They're meant to have a vial-needle version, but it is $600/month and you can only do it for up to 5-months and a low max dose. So it isn't a real program, but rather a way to avoid critique from legislators.
It’s “legal” because of the lack of supply in critical medications so the FDA gives a variance to allow compound pharmacies to produce/sell critical medications until supply issues are resolved.
I'm shocked that TFA doesn't mention the (massive, booming) market for compounded semaglutide and tirzepatide. The long-term future is uncertain, but since these drugs have been under shortage status, third-party pharmacies can legally compound them to meet increased demand.
9 days ago the FDA declared the tirzepatide shortage over, though the other popular drugs in this class are still eligible for compounding based on shortage status:
Not fully true- orphan drug status exists for rare diseases and gives advantages to companies who develop drugs for rare conditions. This includes longer exclusivity periods amongst other incentives, rendering these categories more feasible economically.
Agreed. Don't forget they're spending on next-gen versions of these too -- Novo is testing a pill form that's apparently twice as effective as semaglutide(!) right now. It's easy to imagine that becomes part of many people's January routine -- stop drinking, take your pills, go to the gym for a month, slowly put the weight back on during the year, no problem.
I'd think it more likely that it'll be one of the next generation drugs, but I do agree with the premise that it will be really common.
A few weeks ago I started a low dose of tirzepatide (aka Mounjaro, aka Zepbound) and the side effects are interesting.
The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.
But there are some unexpected positives.
Obviously I am eating less. I have to log food not to keep it in check, but to make sure I'm eating enough and with the right nutrients. There's another possible negative here -- you get a lot of hydration from food, so if you start eating less you should carefully monitor your fluid intake to allow for that.
But I'm also more focused. Not nearly as distracted. I'm getting a lot of things done which I used to just procrastinate on until years had passed in some cases. Man, the garage is going to be clean and superbly organized in a few weeks.
And my emotions are quieter. Not just the food noise, that was expected, but I feel more relaxed. That's not what I expected, and I'm pleasantly surprised.
As an aside, what makes this all really noticeable is that it's a once-a-week injection, and the peaks and valleys are very obvious. Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.
Edit: Before someone asks, yes I have considered there may be long term effects. This is a risk, which I've decided I'm okay with at my age. Nobody gets to live forever anyway, and I was going to end up in an early grave via another route if I didn't do this. "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.
I do hope to taper off at some point if I can figure out an alternate strategy for staying lighter. Though I'll miss some of the positive side-effects.
> "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.
Studies show it just doesn't work.
There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 and the likelihood of going from severely obese to normal weight is 1 in 1667.
People chanting “If everyone just did X, Y wouldn’t be a problem!” without seriously addressing why everyone doesn’t just do X already, or making a serious proposal for how everyone is going to just do X from now on.
Yep. When 1 or 10 or 100 people do a thing, it's a "them" issue. When 100,000,000+ do a thing - it's a wider issue, and asking those 100,000,000 to do it differently just isn't a useful strategy.
In another vein, if my bank account is $100 short, that's my problem. If my account is $1m short, that's the bank's problem.
Considering it's a societal wide problem, society at large ought to care about resolving it. It's incredibly expensive otherwise to treat chronic, lifelong obesity.
I don't know people who just give the "trite" advice without any actual consideration of the difficulty.
I do see a lot of people ITT who were accused of doing so but who aren't actually doing so.
And I've known quite a few people who get really annoyed at constantly having to hear about how impossible it is to do things that they've personally actually done.
it might be still impossible for others. tell a blind person to just look out for cars. tell a person with paralyzed legs to just get up and walk. tell a type 1 diabetic to just skip insulin.
obesity has a large hereditary component. important genes associated with obesity are expressed in the brain.
is it impossible to live with constant hunger and its consequences? no, likely not, but it's not really a big mystery why millions of people fail to do so.
Precisely, the point of Ozempic (or rather Wegovy, Ozempic is for type-1 diabetes) is that it reduces your appetite, making it easier to eat less.
One of the studies done with Wegovy showed that people lost 15% of their body mass in a year, but they also eat 500 Calories less and exercised for 2.5 hours a week.
Compared with Type 2, with Type 1 diabetes there are other risks that could occur:
>...While medications such as GLP-1 receptor agonists (Ozempic, Wegovy) and SGLT-2 inhibitors (Jardiance, Farxiga) demonstrated powerful benefits, they quickly were determined to pose too much of a liability for pharmaceutical companies or regulators due to concerns about safety. Specifically, GLP-1s can increase the risk of hypoglycemia (low blood sugar) and SGLT-2s can raise the risk of a serious, life-threatening complication called diabetic ketoacidosis (DKA).
It'd be more helpful for edits to be appended to a comment, allowing context of the conversation to still make sense.
Misinformation is also going to be much overused and meaningless if used for situations like a simple mistake. The commenter just misread something - branding it as misinformation seems to imply intent, otherwise why wouldn't you just call it a mistake?
Honestly I disagree, edits are for spelling and wording. It's important to not edit the content of comments, so that follow up comments and their context remain the same.
That's probably counting 'light exercise', aka walking around. That works out to 20 minutes a day, so it could just be the side effect of people being lighter and so walking places being more comfortable.
That's not a valid argument, though. Firstly nobody lives forever. Second you don't have to exert all the effort at once, so the totality of effort doesn't matter. At any given time you just have to decide whether to have the snickers bar or the apple. And that's not an impossible effort. We don't live our entire lives all at once. We just have to be present for one moment at a time.
Edit: In my opinion it's hard for two reasons. We have cravings for high calorie foods. And no one candy bar will make you fat, so it's easy to think "I'll exercise more tomorrow to make up for this indulgence." But then you don't, because that's hard too.
> At any given time you just have to decide whether to have the snickers bar or the apple.
No, you have to decide to even think about the difference between them instead of thinking about something in your life that feels more important. It's a sort of cognitive opportunity cost. You have to consciously think about food (instead of something useful) forever, because your body's instincts are telling you to do the wrong thing and you need your rational mind to overrule it.
So for the rest of your life, every day, until you die you must decide to stop and expend effort making that decision instead of thinking about work, family, politics, or writing a new bit of code that will change the world. Most human beings can do it for a while, but not forever. The only way to do it forever is to get your body chemistry on your side and reduce that cognitive load.
> "The only way to do it forever is to get your body chemistry on your side and reduce that cognitive load."
That's how all creatures in the wild do it. That's how humans did it for the past quarter million years. And all creatures did it for the past hundred million years. Wait, no, it isn't. Then there must be another way. A way that doesn't involve manipulative abusive capitalists and advertisers destroying health in the name of profit while selling it as freedom.
> "or the rest of your life, every day, until you die you must decide to stop and expend effort making that decision instead of thinking about work, family, politics, or"
How much does that lifestyle sound like freedom to you?
>That's how all creatures in the wild do it... Wait, no, it isn't.
Neither creatures in the wild, or primitive man, have access to unlimited quantities of calorie dense foods. We could go back to that lifestyle, but billions would have to die and the overall human lifespan would decrease rather than increasing.
I think I'd rather take a perfectly safe drug than go back to wiping with leaves and hunting for worm riddled meat.
> How much does that lifestyle sound like freedom to you?
I'm not even sure I understand which lifestyle you're asking about here, but if you mean the modern lifestyle then it's certainly more free than the lives primitive man had. "Might makes right" was the rule of the land back then, and contrary to your imagination, you probably wouldn't have been the mightiest. Certainly not forever.
Hell, it's more free now than the lives most of our grandparents had. 50 years ago about half of all white people surveyed said they'd move away if a black person bought a house in their neighborhood, and gay people were routinely murdered for existing.
There were no "good old days", and Stardew Valley is just a game.
> "Neither creatures in the wild, or primitive man, have access to unlimited quantities of calorie dense foods."
And just like that, you've come up with another way.
> "I think I'd rather take a perfectly safe drug than go back to wiping with leaves and hunting for worm riddled meat."
That is some ridiculously hyperbolic panicked scaremongering at the idea of banning Coca Cola. I have literally no idea how restricting the unlimited calorie dense foods available would lead to hating black people and murdering gay people, but it's some more hyperbolic commentary.
> "I'm not even sure I understand which lifestyle you're asking about here"
The one I mentioned. Comparing the "free" lifestyle where you have adverts for Coca-Cola shoved into your face 24/7 along with adverts selling you a drug to help you ignore the Coca-Cola adverts. Vs. "non-free" where Coca-Cola isn't available for sale and you just don't think about it because you've never had it and don't miss it, and you go about your life doing the things you care about instead.
I interpreted your original comment differently. Based on the votes so did others. At no point did you suggest banning Coca-Cola, or otherwise limiting calorie dense foods. Instead it seemed that you were advocating a return to some mythical past when food was more like it is for wild animals.
I wonder if you confused this thread with another? Or maybe your sarcasm was misinterpreted?
I didn't confuse this thread with another; from the parent comments we have "diet and exercise works but nobody can do it because it's really hard" to "we can't do it because we have to think all the time about resisting ultra processed junk food" to my comment "we wouldn't have to think all the time about it, if we didn't have it".
I do see how it looks like a return to caveman times, and was unnecessarily sarcastic. Practically, the times when I don't have junk food in the cupboards, I don't have to think constantly about resisting junk food because there isn't any to eat and that makes a difference. Extending that out to national levels, schools shouldn't have vending machines full of junk food, hospitals shouldn't have coffee chains, coffee chains should have restrictions on how much sugar can be in coffee, soda shouldn't be a thing, breakfast cereals shouldn't be a thing, and keep going as far as necessary. In the argument between Nanny state and Laissez-faire it's very clear that the food industry will kill millions of people and ruin the quality of life of billions millions, hiding behind smiley friendly packaging, exploiting human biases in ways we have no defenses against, and it's not nanny-stating to regulate killers harshly.
> we wouldn't have to think all the time about it, if we didn't have if we didn't have it ...
You literally did not say those words in the comment I replied to. You didn't even seem to imply it. Either that or there's some kind of shadow ban thing happening and I can't see the same thing you are.
Given that a few decades ago obesity and overweight rates were nowhere near what they are today, this shows that a large part of the population is weak, fragile, and not very interested in their well-being.
I want to emphasize that a few decades ago, people were much thinner in the Western world and did not hate their lives because they could not eat a triple cheeseburger, go hungry constantly, or feel physically deprived. Those were my parents and my grandparents, I know them.
But if you show them hyper-caloric food that makes them feel like crap, they can't say no. It's disappointing. And the same can be said for addiction to social media, horrible TV series, and constant music everywhere.
Do you think it is because the people before were mentally stronger? No, it is because they lived in a different environment. If you were to transport those people from decades ago to today, the same portion of them would become obese.
That's what I'm saying. It's not that people were stronger then, it's that, as many times throughout life, traits are revealed by circumstances, there's nothing particularly physiological about feeling the need to eat like hippopotamuses that have been deprived of food for months.
The unattractive, low-status man (or woman) has less trouble remaining faithful than the handsome, high-status man (or woman). Not because they are more virtuous, but because they are not as exposed to temptation. But fewer people justify the unfaithful than the “big eater.” And that's something society and culture have decided, for now.
> "there's nothing particularly physiological about feeling the need to eat like hippopotamuses that have been deprived of food for months."
There are many people who don't feel that need. They don't actively resist cramming cake into their mouths, they just glance at the cake disinterestedly and move on. Or eat a bit, and feel that's enough, and don't want more.
https://news.ycombinator.com/item?id=27936016 has discussions about the dramatic rise in obesity after ~1970; refined sugar, chocolate, butter, doughnuts, McDonalds, cars, TV, have been around longer than that. Could there be involvement from Glyphosate pesticide, from reduction in smoking appetite-suppressing cigarettes, Lithium contaminated water supplies, increased Vitamin A added to milk and grain supplies, rise in antibiotics used on farm animals, which causes some people to gain and retain weight more easily?
They are the same people now that they were then. Humanity has not become any more weak, fragile, or uninterested in their well-being — it has simply become harder to resist. TV was appointment viewing and cut off late at night. Before the walkman, there wasn’t much option for music everywhere (the scourge was newspaper-readers! but the paper is only so long). And that triple cheeseburger today wasn’t acceptable or available to eat unless you made it yourself. Healthy eating being hard is a product of collective decisions to make it hard.
It used to be that the devil on the shoulder was the tempter. It isn't depressing that parents and grandparents can't say no to lizard brain instincts, it's depressing that we allow companies to exploit that in a devilishly evil way - to harm people - for money, as much as they can, in almost every way they can think of.
Imagine how much money and time and effort is spent making Doritos 2% more tempting; the crunch, the flavour intensity, the packaging layout, the packaging colours, the mouthfeel, the shelf stability. The same for ice cream and everything else. How far can Kelloggs stretch the gap between the strawberry presented on the packaging and the almost-zero strawberry in the pop tart? Or the honey pictured on the Honey Nut Cheerios box with the "hint of honey" in the description on the back? How To Cook That[1] on YouTube on Kellogg's misleading and potentially misleading claims.
By looking at the size and bellies of construction workers, farmers, and people doing all sorts of jobs with significant physical activity, one cannot find much support for this hypothesis.
Back in the day, (almost) everybody was not fat, from the academically inclined to the construction worker. Today, many are overweight, from the professor to the agricultural worker. There used to be more walking, which increased caloric expenditure by 300-700 kcal per day, although sport and recreational physical activity was limited to the young.
The main problems have been the easy availability of cheap and tasty calories, combined with a surprisingly low resistance to the ingestion of those calories.
What the explanation is, that actually requires research. Anything from new food additives, changed lifestyle habits forced by the pandemic, increased chronic stress, screen addiction compromising other opportunities to be active, less walkable neighborhoods, more elevators, higher calorie diet, cost increase in healthy diet to just name a fraction of possible factors.
Or that the situation was different, advertisers hadn’t mastered the 24/7 cycle of selling easy junk food in both home form and fast food form. Every generation thinks they’re superior to the new generation and says “why don’t they just…. “ when a new generational problem comes up. People screaming out against ozempic and friends are just angry that maybe it does work well enough and that people don’t have to struggle for once. Our brains weren’t built for our modern life style. It used to be that people virtually had lots of experience eating Whole Foods, TV was relatively new, parental guidance on “that’s junk food, you can have a little not a lot”, our jobs weren’t built around screens and pecking on keyboards, bombarded by emails and phone calls even after we go home via 1 hour commute each way. It’s easy to say “you’re all a bunch of lazy bums” but it’s also lazy and not true.
> "People screaming out against ozempic and friends are just angry that maybe it does work well enough and that people don’t have to struggle for once"
No, I'm angry in the way that you punching me in the face with my own hand, saying "stop hitting yourself" then offering to sell me a painkiller subscription might make me. The sheer ridiculousness of Big Food vs Big Pharma with humans trapped in the middle. Humans presented by geeks as perfectly spherical rational decision makers, but actually lizard hind-brains wrapped in frontal lobes and language centers, with very exploitable biases, feelings, fears, and base drives and very few defenses against it, and those defenses being undermined at every turn by political lobbying and profit seeking.
>It's not that "eat less and exercise more" doesn't work, it's that nobody does it
There are plenty of examples of people who've managed to lose weight through diet and exercise, it's not "nobody". Sure it's a small % success rate, but that's because it's not easy. Just like squatting or deadlifting 300 lbs, it's not easy to get there, but the vast majority of humans could if they decided to put the time and effort into it.
I'm one of those examples. I've never been obese or really even overweight, but mid-2023, I noticed my clothes were no longer fitting, and I decided to take off some weight. I lost 20 pounds over the course a a few months and have managed to keep it off since. Body scans aren't accurate, but the 1 scan I took after losing the weight put me at 13% body fat.
It's one of the hardest things I've done. I'm no stranger to hard physical things - I've run marathons, raced cyclocross, done daily bike commuting through several Chicago winters, and I'd rate the weight loss as up harder than all of those. At the risk sounding too hubristic - if that's the effort it takes to lose weight, doing so is beyond the abilities of large swaths of the population. Not to mention that I have the time and financial resources to weigh my food, buy foods that were optimal for my diet (so much yogurt and chicken!), etc.
(As a side note, exercise isn't a very good way to lose weight in my experience. It's valuable to do for all sorts of other reasons, but I actually gained weight when training for my first marathon, while running 60-70 miles/week).
> As a side note, exercise isn't a very good way to lose weight in my experience.
Generally people who don't normally exercise are going to gain muscle faster than they lose fat. This was the origin of HAES before it got corrupted: Health At Every Size, not "Healthy". Encouragement to keep going because with exercise you'll get healthier even if you're not losing weight.
Also, by weight, muscle burns more calories than fat just by existing. Personally I think that's where most of the weight loss attributed to exercise comes from, rather than the exercise itself. You have to gain the muscle first to actually burn more calories.
Sure, I don't mean literally nobody, just 'nobody' in the statistical sense - from the comment I replied to, "the likelihood of going from severely obese to normal weight is 1 in 1667."
Would you apply the same analysis to people with depression who cured their depression by smiling more? It's not zero, it's just very hard. Ultimately both are chronic issues of the central nervous system. We know GLP-1s act on the GABAergic central nervous system.
I think that as convenient as it would be, depression and the inability to not eat too much are not the same.
The fact is that you have much more control over one than the other.
I don't disagree that maintaining a healthy weight is a challenge in today's environment, but it's not impossible or inevitable, like so many in this thread are pretending.
> I think that as convenient as it would be, depression and the inability to not eat too much are not the same.
> The fact is that you have much more control over one than the other.
Why do you say that? Studies do not agree. How would you assess the difference? Or are you simply coming at this from the perspective of either someone who has never had a weight problem or was able to get out of a weight problem without issue? If the latter you're in the ~1% and your experience is not that of others in the same way as your experience as someone without depression does not align with that of someone who is depressed.
How would you measure your thesis? Certainly it cannot be based on results because, well, I cited them.
As someone who isn't addicted to cigarettes, it's pretty easy to not smoke. My experience does not align with those addicted to cigarettes, and I can appreciate that. Why do you not appreciate that the experience of those with obesity might be different than your own? I am not obese for the record, and I have never taken GLP-1s, but I have been obese and this just makes sense to me.
Just because you have full control over your diet and I have control over smoking does not mean that there are people out there who cannot control their diets and cannot control their smoking.
Maybe depression and obesity are more similar than you are giving credit. Especially since serotonin inhibits appetite and has an integral role in maintaining energy homeostasis.
Eating less and exercising most certainly does work, if the individual sticks to the routine.
I do agree it's difficult to stick to a routine because our modern lives are demanding and so we compromise by eating fast food and avoid going to the gym.
I think the exercise paradox video recently put out by Kurzgesagt has been a net negative for how people think about diet and exercise. The paper the video is based on is highly flawed.
That paper has a few major problems but these are the biggest:
1) The authors didn't control for body mass. The Hadza and Bolivians burned 52kcal per kg of body weight. Americans burned only 38kcal per kg of body weight. That is: the active groups burned significantly more calories than the inactive groups, on a pound-for-pound basis.
2) The active groups were defined as such because they walked ~12km per day. This is significant because the human body is exceptionally efficient at walking. It is certainly true that over a comparable span of time, you will burn less calories walking than you would running, or lifting weights.
GLP-1's are miracle drugs and people should take them if they at are high risk for obesity-related diseases.
But diet and exercise certainly do aid weight loss, and will have fewer negative side effects than a GLP-1 drug.
It does work. It couldn't not work. Each day of your life, you choose to do one of three things:
1. Consume more calories than your body will need to function
2. Consume as many calories as your body will need to function
3. Consume fewer calories than your body will need to function
When you consume more energy than you require, your body stores the remainder as fat. When you consume less energy than is required, your body converts your fat into usable energy.
Now obviously, this is an over-simplified explanation of nutrition. What you eat, when you eat it, how efficiently your body converts food to energy, and other factors will determine the little details. But the explanation I've provided is not nearly as over-simplified as "it just doesn't work."
To make a comparison, it would be like suggesting that the financial advice "earn more money than you spend" just doesn't work as a method of saving money, on the grounds that some % of Americans who try to save money end up in credit card debt.
So if understanding the equation about how humans can obtain and maintain a healthy diet/weight is as simple as you present here. Why doesn't everybody just do that?
You say yourself, it couldn't not work. And yet there's hundreds of thousands of people that say it didn't work. Explain them, are they lying?
I'd assert, the oversimplified explanation is misleading. It's only true in the same way that drinking cold water will help you lose more weight than warm water. True or not, reality seems to strongly suggest it's irrelevant
It's more likely that hundreds of thousands of people are collectively lying, than it is that trying to find a solution that works for hundreds of thousands of different humans all with different needs, lifestyles, desires, capabilities, and understanding, might be a tad more complicated than just counting intake calories?
Why assume people will do what’s in their own long-term best interests, especially after being presented with a short-term thrill?
Pizza tastes better than granola. Grand Theft Auto is more fun than math homework. Having a Dodge Charger is cooler than having a Hyundai Elantra. Who cares about the costs? I can always fix my bad habits tomorrow.
> Why assume people will do what’s in their own long-term best interests, especially after being presented with a short-term thrill?
So, human behavior is more complicated than just counting? Why would someone eat pizza instead of granola? Are there some physiological reasons for this? I wonder if there might be an evolutionary advantage for a species to develop the desire for high caloric foods? That sounds like something that would make it much easier to make the decision to seek out pizza, and much less likely to choose granola. Especially when you consider that humans are mostly creatures of habit.
Saying just count calories is reductive to the point of absurdity. you can tell it doesn't work because it hasn't worked for society for decades, yet it's such an obvious solution no one stops to account for the astronomical amount of evidence that proves "just try harder" does not work on most humans. So, do you want to be right, or would you like to do something that actually helps humans improve their quality of life? "Just try harder" doesn't work, and it takes wilful ignorance of the evidence to claim otherwise.
let's apply this same logic to writing code, we wouldn't have any more bugs if people just reviewed their changes before committing, and wrote that one extra test, right? Works on my machine, ship it to prod... what do you mean millions of computers now bsod on boot? Surely it was just that one extra test, and it's pointless to do staged rollouts or smoke tests or anything like that?
Just never make a mistake is obviously asinine whether you apply it to writing code, or deciding what to eat. The difference being we don't have a millennia of evolution trying to convince us to write bugs.
I agree with the premise, people are responsible for their diet their decisions and their habits. I just don't agree knowledge of that is enough for everyone to improve their quality of life.
You're letting that word do some very heavy lifting.
> To make a comparison
I think the comparison is very weak, very superficial. The human body is way more complex than CICO. But your comparison does have some intuitive value -- there are more than a few people who consistently spend every penny they make, and sometimes more, just trying to survive. We don't see a lot of them on Hacker News, to be sure.
What word would be better than “choose” in this context? For the majority of people who aren’t prisoners or toddlers, there is a good deal of personal choice that determines what foods we eat and how much.
Even if fate has it that I must end up at a Wendy’s drive thru tomorrow night, couldn’t it be true that I could choose to eat the 400 calorie meal instead of the 800 calorie meal, or order water instead of Sprite?
Will. Will is a better word. Every day you will consume calories less than, equal to, or greater than the amount of calories you expend.
The problem with choose is it implies an intentional, free choice. I can manufacturer plenty of contrived examples to show it's not always the choice of the person. But I'll use a real one I remember.
Yes, you, who I assume has thought deeply about personal responsibility and and willpower and how to obtain the best life for yourself over what I assume to be between years and decades of practice doing that, are able to choose water over Sprite.
but I can tell you from the experience of somebody who strongly believes in the responsibility of your own decisions, and how willpower is a learnable skill, and about being healthy, and about how every decision matters. When I'm tired, and depressed, and feel like I'm about to break. Even knowing, even having the thought that I should choose water over soda, I've still chosen soda.
Fair choice though right? There were no other factors, or influence over why I drank 200 calories of sugar? I should just have remembered water would be healthier?
That's what I assume they said the word choose is doing a lot of heavy lifting. because often choose is presented exactly the way that you did.
> Even if fate has it that I must end up at a Wendy’s drive thru tomorrow night, couldn’t it be true that I could choose to eat the 400 calorie meal instead of the 800 calorie meal, or order water instead of Sprite?
When often, humans tend to be slightly more complex than just that.
The human body is way more complex so as to defy the laws of physics as we know it? The human body cannot create matter. In order for it to increase in mass, you must be inserting extra mass into it.
Sure, a mammal does not HAVE to store excess energy.
But that is entirely irrelevant when a mammal eats less energy than they consume for a while. In that instance they MUST burn some stored reserves or break the laws of physics
Genuine quesion - if I eat 1500 calories today and do a measured 2000 calories of work on a treadmill, where did that extra 500 calories of energy come from?
Are you suggesting my body can create energy from nothing?
Generally your liver will store between 12 and 24 hours of calories in the form of glucose. After that, it's likely fat stores from adopose tissue (fat cells)
Given the observational evidence that it doesn't work, what are you really asking?
Imagine a computer with a primary source of power, and a backup supply. You're measuring CICO of the primary supply. And you're tightly regulating the power available on primary to keep a power deficit. Unfortunately, during periods of high load, this computer is able to switch to the backup supply which you aren't able to exert tight control over.
There's a huge number of things that could cause a human to ignore their best interests. Ignorance to consequences, the long-term implications of any decision, degraded mental health, external social pressures, the list goes on and on.
Humans have impulses just like every animal, and proper training can convince a dog not to immediately lunge and eat every morsel of food they can smell. but it takes a lot of work and external pressure to train that into a dog, and even then given the right circumstances a dog will still eat food above their caloric needs. Humans behave the exact same way.
> it's easy for me to regulate my weight using cico, so obviously it should be easy for everybody
I know that's not the claim you're making, but it seems like it is and it is the one many other people in this thread are making. just like it's easy to train some dogs than it is train others. it's easier for some humans to control their caloric intake than it is for others.
CICO doesn't work for most humans. Claiming otherwise is on par with the saying just run this IOS app on Android it's easy it works for me! Perhaps a sufficiently capable engineer could make it work, but most humans aren't sufficiently capable.
> Given the observational evidence that it doesn't work
I think you need to be very careful about your language choice here.
Physics says it has to work. Every athlete on earth knows it works. Everyone that has ever been in a prison camp, concentration camp or had their calories restricted outside of their control knows it works.
It absolutely, factually, 100% works. Our entire understand of mammals and energy depends on it working.
What you are saying, is that people are unable to exercise enough self-control to actually consume less calories. If they did, it would work. But they don't.
That's like saying "pointers in C don't work" because when many people try they get seg faults.
I really don't think it's constructive to say "CICO doesn't work" when what you mean is "many people find CICO difficult to implement, because having the self-control/will power/determination/control to do that is hard."
I became heavily involved in weight watchers (which is essentially just CICO - their "points formula" is basically calories/50). Over many years I watched hundreds of people lose hundreds of pounds by being careful about what they ate. It was hard. There were a lot of tears, there were a lot of false starts and plateaus and hard times.
The people that stuck with it had incredible transformations and live different lives now. My room mate at the time lost almost 200lbs and became head of the WW in that city and when I saw her after 10 years I did not recognize her at all, and actually refused to believe it was her for 5 minutes.
CICO absolutely works. Like most things worth doing in life, it's hard. And it's worth it.
> What you are saying, is that people are unable to exercise enough self-control to actually consume less calories. If they did, it would work. But they don't.
That is not what I'm saying. It seems like you stopped reading at "doesn't work" when what I said was "doesn't work for most humans".
For many people, it feels impossible, so they give up. Why are you advocating for doing something hard, instead of doing something easy, there are definitely other reasons you might want to argue for that. But you didn't argue any of them. You parroted the exact same thing again, trying to get your point across, while ignoring mine.
> CICO absolutely works. Like most things worth doing in life, it's hard. And it's worth it.
Why stubbornly refuse to entertain the idea it's too hard for many people? Because it's does work, so everyone who's life or health isn't in the state where they can do the thing you admit is hard can just get fucked?
Nah, fuck that! If there's anything you can do, that will improve your quality of life, you should do that. If you can get into a more healthy physical shape in 1 year instead of 5. You should!
I'm an advocate of doing things the hard way. I'm even the same type that mocks people who claim cpointers are impossible. But I'm also the type who will take as long as it takes to teach someone how to understand and use them. And if all you want is to make a fun jumping game. I'll suggest trying python. and won't demand you write everything in c including your own input lib, even though that's what I would do just for fun.
You should do things the hard way. Because it will make you stronger. But for so many people who have been beaten down, they believe it's impossible; so demanding they're only allowed to achieved success exclusively by doing it the hardest way, is fucked up.
The options aren't the hard way, or nothing. But by repeating CICO over and over without nuance, that's the message you're sending. Do it the hard way, or give up.
Nah, fuck that. Try the hard way, then try something else, then try something else. Then keep trying until you improve your life. Then do it all over again with something else you want to improve.
Please don't cross into flamewar like this and please don't get into tit-for-tat spats. It's not what this site is for, and destroys what it is for.
When people start arguing over who said what, who did what to the discussion, and get increasingly personal about it, it was time to stop quite a while ago.
I feel this is an unfair characterization. Which part of my response crossed into flamewar territory? Or is this preemptive because the discussion is trending in that direction?
bah! :( I don't understand how I'm supposed to call attention to the parts of my previous comments that were important to being understood, but disregarded in the reply if that is what was wholly inappropriate. Other than to not reply at all when previous comments are misunderstood or ignored.
Not replying is usually the strongest rhetorical move, for what it's worth. Long threads implicitly elevate the other side of the argument. If you're trying to dispositively conclude a debate, make your case once, dispassionately, and then don't restate anything you've already said.
What you're trying to say is "it works, it's just very hard for less than half of all people." (43% of all humans were overweight in 2022) [1]
> For many people, it feels impossible, so they give up.
Yes, I agree completely. If they stuck with it, CICO would work, but they don't because it's hard for them.
> Why are you advocating for doing something hard, instead of doing something easy
Now you're derailing the discussion into something entirely else. This thread is about if CICO works or not. I understand there are a lot of emotions wrapped up here, but you know that it works, it's just hard for some people.
At NO point did I say people should do something hard instead of something easy. I was making it clear that CICO does it fact work (and is hard).
Please don't cross into flamewar like this and please don't get into tit-for-tat spats. It's not what this site is for, and destroys what it is for.
When people start arguing over who said what, who did what to the discussion, and get increasingly personal about it, it was time to stop quite a while ago.
I mean, it works in the sense that if you keep your calories out higher than your calories in you will lose weight.
Studies show that it's basically impossible to know your calories out without indirect calorimetry (and updating it regularly, no less, since your BMR + NEAT can vary significantly over time and in direct response to contemporary efforts to lose weight) -- and studies show that humans are dreadful at estimating their calories in.
So yes it works in a lab setting where your CI is pre-portioned in the form of milkshakes and your CO is measured via calorimetry. In reality though it makes people hella hungry and your hunger tends to increase in excess of changes to body weight.
Which is why the average weight regain after loss is 80% over 5 years.
So naturally it would seem we would look to develop ways to reduce our CI subconsciously. Enter GLP-1s. This is literally all they do. They reduce your hunger so your CI remains below your CO which studies show almost nobody can do without help.
Yes some people are genetically going to lose 200lbs and become the head of Weight Watchers in the same way that some people are going to win the olympic gold medal in swimming. That doesn't mean that you are going to win an olympic gold medal in swimming and it certainly doesn't mean that if the average person follows Phelps' training plan that they'll get an olympic gold medal in swimming.
Ultimately a treatment that works but nobody can actually maintain is a treatment that does not work. Hence GLP-1s. The question is why they are unable to keep their CI below CO. Not whether that’s how they lose weight.
it's interesting you state "Studies show it just doesn't work."
While we are commenting on an article about a drug which makes you feel less hungry, there by "eating less". The drug doesn't make you use more calories, it simply "makes" you EAT LESS.
Eating less(calories) than your body uses consistently for duration is literally the only way you can lose weight. (outside of literally losing limbs, or surgery to remove mass)
Exercise only augments the process, it all comes back down to EATING LESS(calories).
There are a number of pathways these drugs hit - dopamine receptors, they slow processing of food, and in tirzepatide's case at least increase insulin response. They're not just small portions in a shot.
I take "Studies show it just doesn't work" to mean "Studies show telling people to eat less and exercise more definitely doesn't work," as opposed to "caloric deficits don't work".
People need to understand what activity / exercise really is. The desperation of the medical establishment to get people to do ANY exercise meant the general advice is watered down.
It's the doom of the statistical distribution. Good outcomes are defined in relative terms on the bell curve, not on absolute performance which exercise is actually suited for.
In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. I can imagine farmers back in the days of 12-hour days of physical labor may burn 5000 or 6,000 calories. A pound of fat is 3500 calories.
Meanwhile, people that are generally following some 20 minutes of exercise five times a week, regimen of the medical establishment are likely really only burning about 300 to 400 calories tops in those 20 minutes sessions, if they even do that.
For the sake of argument, we're going to ignore the basal metabolic advantages of people that are burning an extra 1,500 to 3000 calories per day and the stimulated muscle growth that comes with it.
People back in olden days just on activity were burning a third to a half a pound extra of fat per day in terms of energy.
Meanwhile, modern people who "exercise" are burning maybe a tenth of a pound. Only when you get to "athletes" that are "training" do you get to the calorie burns that people's lives used to entail.
So it's important to keep in mind when people say exercise is ineffective in weight loss that they really are talking about very minor amounts of added activity by by modern medical standards.
Exercise is extremely effective at limiting weight if you get to what I call the 1000 calorie Hammer, where your exercise is adding an extra thousand calories or more per day to your activity. And you're simultaneously not going nuts on your diet.
A 1000 calories is a considerable amount of activity. For a 180 lb man, that's 4000 yards of swimming, 7 miles of running, or 25-30 miles of biking.
If you are a 120 lb woman, increase those distances by 50%. Most people consider those loads to be exercise obsessives, but practically that's what's necessary in order to employ exercise as a usable means for weight control and surviving the corn syrup world we're in
> In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles.
Hasn't this idea been studied using modern-but-primitive groups of people who still live much as they have for thousands of years? Their bodies are quite efficient and they do not burn substantially more calories than "civilized" humans in regular society do.
Finally someone posting something that makes sense. I have hormonal issues that make me predisposed to being overweight. When I lived in New York, I was able to keep the pounds off by walking 20 miles per day. That's how evil my body is. That I would literally have to draw green polygons over Manhattan for five hours a day to not be overweight. I stopped doing that when I moved to the Bay Area because it's not as much fun to walk around here. So I'm very excited about Ozempic since it'd be nice to be able to be able to keep the weight off and get most of those five hours back.
I used to do a hard hike every week which burned around 1000 calories. You're not doing anything else that day unless you keep this up for a very long time.
But yes, great way to lose weight I agree, just not practical for a lot of people.
hiking is probably a bit better, but walking only burns 2/3s the calories that running does for a given unit of distance.
So a 190lb man burns 150 calories for running a mile, but only 100 calories for walking it. It will take about 20 minutes to walk a mile, and about 10 minutes to run one.
So this relates to the original complaint about exercise 20 minutes a couple times a week: if you walk 20 minutes, you've burned... 100 calories.
A 1000 calorie hike is probably 10+ miles, and that's about 200 minutes. 3 hours and 20 minutes! Yup, quite the time commitment, however if you ran 7 miles it would only take about an hour.
Of course, it "doesn't work" because people don't keep it up. I started exercising regularly during covid and didn't stop. I cut out all the soda. It works.
We’re on fluoride from the water our entries lives, iodine in the salt and various B vitamins, iron and calcium in the flour. Why stop there? This has been an overwhelming coup for public health.
I dropped from the mid 300s 10-15 years ago to 260-ish these days. It fluctuates from 250 to 280 over time, but keeping off weight long-term by changing diet is very much doable.
That should be very doable for most people. 250 is overweight for everyone under 7 feet tall, and 280 is obese for everyone under 6 foot 9 inches (that's about 99.997% of the population, if my data source is correct). For the vast, vast majority of people 350 pounds would be somewhere in the mid-40s BMI.
If you want to not be fat, exercise and eat fewer calories. Full stop.
The fact that a certain group of individuals don’t have that self control is just evidence that education and public health have a place. Drugs won’t solve that.
These drugs are needed for people with metabolic disorders caused by years of food abuse or poor genetics. It’s not a population wide solution.
We have 50+ years of incontrovertible evidence that that advice doesn’t work for the overwhelming majority of people.
“Just have self control” is the stupid take imho.
A meta-analysis of 29 long term weight loss studies[1] found:
> By 5 years, more than 80% of lost weight was regained
I think a much better hypothesis is that CICO does work, physically, but there are metabolic, hormonal and mental factors that either predispose towards obesity or make it difficult to escape.
It's a bit like telling gambling addicts to "just stop gambling" or depressed people to "lighten up".
And along comes GLP-1 drugs, where obese people find it easy to lose weight, find new motivation for life, etc. The GLP-1s aren't increasing metabolism, nor are they making people exercise, nor are they making food less available. Yet somehow, a hormonal mediation is greatly successful, hmm.
I did that in 2020. May through November. 40 pounds off. Then I sprained my ankle. I apologize for being negative, but come back in a year and let us know how it's going. Many, many people can lose 10%, 20%, even 30% of their body weight with concerted effort. Works for a year or maybe two. It's actually pretty easy, to be honest, most people who've done it will agree with me.
I had the same kind of experience. Not as dramatic as that, but six months of careful dieting lost weight, but then within a month after I stopped calorie-counting I was back at the same original slightly-overweight weight I had previously plateaued at.
If you just teleport a fat guy from Bentonville to Manhattan and give him a Metrocard he will lose a pound a week. The people who say nobody can lose weight, it's too hard, cannot explain why there are macroscale populations with lower obesity.
"It's too hard" includes "It's too hard to just magically change the environmental factors making it difficult for this specific person". We can't just magically move every obese person to NYC, and unwalkable car-dependent infrastructure cannot be fixed overnight either, even if the people living there all decided to vote for politicians who would legitimately work towards making that happen (still seems unlikely). Unless and until we work towards fixing the societal problems that created the obesity crisis in the first place, we still need short term solutions for the next couple decades at least.
Those same populations are gaining weight at a trajectory that is behind the US but still headed the same direction. AFAIK most western European nations have a majority of people overweight, with 20-25% obese. This is less than the US (though it's very regional within the US), but you don't get to brag about a 1-in-4 obesity rate.
>This is less than the US (though it's very regional within the US), but you don't get to brag about a 1-in-4 obesity rate.
Are you sure?
>In 2023, over 35 percent of adults in the Netherlands were classed as overweight, meaning they had a body mass index (BMI)of between 25 and 30. Furthermore, just under 16 percent of adults were obese
>47 percent of French adults were overweight, of which 17 percent suffered from obesity
>49% of the Belgian population has overweight, of which 18% have obesity.
>Spain: 43% of adults aged 18 years and over were overweight and 16% were living with obesity
>46.6% of women and 60.5% of men in Germany are affected by overweight (including obesity). Nearly one-fifth of adults (19%) have obesity.
For the purposes of this discussion, I will take your numbers as truth and run with it.
Are you arguing that 1:5 is good, but 1:4 is bad?
The only large populations of people in the world that aren't quite fat are southeast Asians. And this is fairly accurate whether they leave in southeast Asia or in the US or western Europe. Not 1:5, closer to 1:20 or in one case 1:50.
Even then, southeast Asian obesity rates are climbing. The US may have led the pack because of a consistently high standard of living, but I don't see any indication that there are macroscale populations anywhere in the world keeping the disease at bay.
Surely you have a study to support this? Or are we just speculating. The problem with this particular area is that it's not intuitive, and relying on "common sense" guidance is why everyone got fat in the first place.
Generally here if you make a claim it's totally fair to be asked to substantiate it. I already provided the evidence that this individual was wrong, so I'm looking to see why they think otherwise. Maybe they'll teach me something new.
> Generally here if you make a claim it's totally fair to be asked to substantiate it.
Anything is fair. It is a discussion forum. You can say whatever the hell you want. But it is equally nonsensical.
> so I'm looking to see why they think otherwise.
You looked for someone else – someone who prepared a study – to tell you why it might be otherwise. But if you want to talk to someone else, go talk to that someone else. If you want to come here, be happy with the people who are here. They might actually teach you something without having to defer to random other people.
Questioning the person who made the claim, sure. Get them to elaborate. That improves the discussion. But halting discussion until they can come up with the words of someone else to justify their claim, as seen here, just makes you look stupid. If you would rather talk to someone else, go talk to someone else instead. At the end of the day, all is fair in discussion, so go for it – call for someone else to enter the discussion if you want. But as all is fair, we're also going to call out your stupidity when you do.
The bit that you're (intentionally?) missing is that this is just a polite way of saying "you're full of shit". The only person being stupid here is the person making strong empirical claims without qualifying them or providing supporting evidence.
I could see a reasonable complaint that asking for studies is being passive-aggressive, but it's the sort of passive-aggressive that both helps keep the discussion more civil and leaves room to actually substantiate the original claims (that is, it's actively better for keeping the discussion going!). Just saying "lol, no, wrong" kills the discussion far more than talking about (lack of) evidence.
> The bit that you're (intentionally?) missing is that this is just a polite way of saying "you're full of shit".
If someone is full of shit, and assuming you care, then logically you would put in the effort to fix their misunderstanding, not tell them off. Exclaiming that someone is "full of shit", politely or not, is stupid. If you don't care, then why not own it? Don't care.
> The only person being stupid here is the person making strong empirical claims without qualifying them or providing supporting evidence.
There can be more than one stupid party involved.
> I could see a reasonable complaint that asking for studies is being passive-aggressive
It is just straight up nonsensical. I get that is was only ever a silly meme and always understood to be nonsensical, but a meme that has become quite tired. It was funny 20 years ago, perhaps, but at this point it is time to lay it to rest. I mean, anything goes in discussion. If you still think it is edgy, go for it. But the rest of us will still think it is stupid.
Realistically this treatment is just not available to most people (for the simple reason that there are way too few non-car-dependent cities in the US, and the ones that there are are super expensive). But GLP1 agonists are available to most people.
It works in the same way as crossing the finish line first works to win a race. Of course it works, do that and you win 100% of the time. It is not that it doesn't work, it is that it is extremely difficult to do.
All this study really shows is an analysis of medical records with no background of the peoples' diet or lifestyle. The outcome should be obvious and expected, those who are overweight and obese were found to stay that way.
The fact that the rate of obesity in the US has pretty consistently risen for decades makes that clear, you don't need statistical models of medical records to know that the rate of obesity could only really keep going up if those already obese stay that way.
>There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11
Unsurprising. They ran statistics on arbitrary overweight and obese people, with no idea of who was actively seeking to lose weight or who was just coming away from such an effort. If a significant fraction of the overweight/obese population did lose 5% of body weight/year, we wouldn't be seeing a bunch of overweight/obese people.
Homeostasis is a powerful force. Once you gain weight your body has a tendency to keep it, and overcoming that to establish a new equilibrium is difficult and uncomfortable.
It would work if people would actually do it. It 100% works. Human nature is such that people would rather take a drug than change their lifestyle. I've done it myself but it requires a complete realignment of lifestyle to make lasting change.
In 2018 I did an Ironman triathlon. Across 2020 and 2021 I cycled over 20,000 miles. I cycled 200 miles on the hottest day of 2022 in the UK. In 2021 I cycled 200 miles in under 12 hours. In 2023 I ran over 10 half marathons. You simply cannot tell me I didn't completely realign my lifestyle or that I'm not determined.
At my lightest in 2023, I weighed 60kg. Currently I weigh over 95kg. I don't know what else people who hold your view can be told to convince them this problem is not one of willpower. I have the capacity to suffer. I've given up smoking. There is no escape from food.
You described a lot of physical activities, but diet controls your weight. It's natural to have more of an appetite with increased activity. It's also normal to increase your weight a bit due to increased muscle mass.
I’m trying to demonstrate that I’m not this ridiculous (and frankly grossly reductive) caricature of the overweight slob. And yet I still struggle with food. So maybe let’s drop that notion altogether, because it’s not at all helpful.
Yup. I lost 70 lbs in 2017, and I ran my first marathon last month. I'm going out to run a half on Sunday because that's just what I do now, it's nothing to go out and enjoy myself for 2 hours. I'm fit, I know how to lose weight, I know how to be in the suck but I know that this coming winter I'm going to have to fight to keep a decent weight as I fight stress and the holidays. The battle never ever stops and it's exhausting.
Another problem is not doing it enough. Walking a couple miles once a week isn't going to do much. You have to make it a habit, part of your routine, and do it every day.
Also not only is your body very efficient at walking/running (losing 10lbs of fat requires an average person to run from SF to LA) there's evidence of a constrained total energy expenditure model. If you try and create a large caloric deficit through exercise you become more efficient at the exercise (so each incremental step costs less calories) and your metabolism slows down (and your NEAT - non exercise activity thermogenesis - levels drop) to conserve energy for you to expend on exercise.
Eating less and exercising more does work, in fact that is how you lose weight. The problem is doing it consistently which is what these drugs help with.
Yes, they clearly mean that it doesn't work at a societal level. If you take a human and force them to exercise more and eat less, they're going to lose weight. And everyone knows that, but pretty much every modern society is increasingly overweight. Ergo, "it doesn't work".
I hear very often this theory that "it just doesn't work".
To be fair, I had also believed this for many years.
However, all the people who claim that "it just doesn't work", have never made any serious attempt to do "it", so they cannot know whether it does work or not.
I have been obese for more than a decade, during which I have made several attempts to lose weight, which have all failed, because they were not done in the right manner.
Then I have made a final attempt using the correct method, and I have lost about 35% of my initial body weight during about ten months, at a steady rate between 100 g and 150 g per day, i.e. about 1 kg per week.
This was more than 10 years ago and since then I have kept a constant weight. Because I have done this once, now I can control my weight and have any weight I want, even if I gain weight extremely easily. It is enough to eat one day like I was eating when I was obese to gain enough weight to require a week of weight losing diet to go back to the desired weight.
The rules for losing weight and maintaining the weight are very simple, but they must be observed and those who claim that "it doesn't work" never try to observe the rules, so it is entirely predictable that it cannot work for them.
First, it should be obvious that after losing weight one must eat differently as before, otherwise weight will be gained until reaching again the original weight.
To be able to control the weight, anyone who is or has been obese must stop eating until they feel satiated. At each meal, one must plan before beginning to eat how much to eat and then eat only the amount planned, never more than that. One must eat a fixed number of meals per day (preferably few, e.g. only two meals per day should be enough for an adult who has a sedentary lifestyle) and never eat between meals any kind of snacks or drink any sweet of fatty beverages. Between meals, only water or beverages without any calories (e.g. unsweetened herbal teas or tea or coffee) are acceptable intakes.
While losing weight, the most important thing is to weigh oneself every day with precise digital scales (with a resolution of 100 grams or less), at the same hour and in the same physiological conditions, i.e. in the same order with respect to meals and relieving oneself.
Whenever the weight is not less than the previous day, then the quantity of food planned for the current day must be diminished in comparison with the previous day. At the very beginning of losing weight there may be a delay, e.g. of a week or so between starting to eat less every day until the weight begins to decrease, but eventually it is possible to reach a steady state of a constant rate of losing weight per day.
When diminishing the amount of eaten food, only the carbohydrates and the non-essential fats must be reduced. The amount of proteins, essential fatty acids, vitamins and minerals must remain normal. To achieve this, one must eat a source of pure proteins, for example turkey breast or chicken breast or some kind of protein powders, so that eating enough proteins contributes only a minimum amount of calories. The rest of the nutrients can be provided mostly by non-starchy vegetables and perhaps by some supplements like fish oil. One could also eat almost anything that is not recommended, for instance chocolate, with the condition that the quantity is negligible, which can normally be achieved only when such treats are not eaten every day, but e.g. only once or twice per week.
These rules are simple and anyone who follows them will lose as much weight as desired. Obviously, this is easier said than done, because for the entire duration of the weight-losing diet one will be permanently hungry and one would tend to think about food and it will be difficult to resist temptations, so it is better to not keep in the house any kind of food that can be eaten immediately, without requiring some kind of preparation. Unfortunately, this is unavoidable and it is the price that must be paid. After the first few weeks, the hunger sensation diminishes in intensity and it always disappears for a few hours whenever you find some work to do that captures your attention.
As long as you do not want to follow such rules, you will not lose weight, but that is because you do not want to do it, not because it does not work.
Not wanting to do it is a valid reason, because one may abhor more the feeling of hunger during many months than being obese, but this decision must be described correctly and not be justified by the false claim that "it doesn't work". At least in my case, the improvement in my health and in what I was able to do (e.g. before losing weight climbing a few stairs would make me tired and sweaty) has made worthwhile any displeasure felt during losing weight and I have been very happy to have achieved that.
I must say that I really understand what is in the mind of those who claim that "it doesn't work", because this is exactly what I had believed during many years, after many failed attempts to lose weight.
I had become convinced that nothing that I can do could change my weight.
Nevertheless, now, after I had eventually done it, I can see clearly the errors of my previous ways, so I can no longer agree with the opinion that it does not work, when it can actually work very well, as long as you accept that you must be hungry all the time while you are doing it.
I want to add that the feeling of hunger can be diminished a lot when you eat food cooked at home instead of industrially-produced food, especially when you avoid sweetened food. Using modern techniques, like cooking all meat and vegetables in a microwave oven, it is possible to cook food at home in an extremely short time, so the lack of time is no longer a valid excuse for eating junk food.
It got downvoted because it's an anecdote and an anecdote isn't a substitute for a study that covers eighteen million people. We know the odd person can do it, 1 in 1667 per year if you're very overweight. That doesn't mean that 1 is representative of the set. In fact we know it's not representative. Because we have data.
It's like interviewing Michael Phelps and he's like "just swim! I did it! Anyone can win a gold medal by swimming." No, they can't.
And the reality is average weight gain over the 5 years following weight loss is 80%. Everyone who participated in the Biggest Loser weighs almost as much as when they started and has a metabolism an average of 17% slower than would be expected for someone of their new body composition. [1]
I'll push back and say anecdotes need more downvotes because they're actively harmful to the discourse, and are a large part of how we got to this point of just abject unhelpful information being passed off as useful.
This is how we get all sorts of medical misinformation like "I ate some almond seeds and my cancer went away." We don't accept these kinds of anecdotes in direct opposition to medical evidence for any other disease, we shouldn't accept them here either.
It's survivorship bias -- where are the anecdotes from the people who did exactly what parent said and didn't lose weight? They're in the study. Will OP update if they regain weight?
You can look up any of OPs rules, they've all been studied, and they don't work for most people.
You know what works? GLP-1s.
What matters for your health isn't that you tried real hard, what matters is that you lost weight. Nothing wrong with losing weight via GLP-1s then going to the gym and trying real hard to get jacked.
The point you're missing is that telling people "just eat less" doesn't work, because it's extremely difficult for many people to "just eat less".
That's literally the whole reason that ozempic etc are popular, because they make it easier for most people to just eat less, in the same kind of way that caffeine makes it subjectively easier for someone who's tired to be productive.
That is a simplistic description which is superficially true. The body, however, is quite a bit more complicated than that. Especially when you get to that wrinkly pink lump in your skull.
> Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.
Perhaps coincidentally, this is similar to my experience with week long fasts: After 48 hours I feel like a precision missile cruising towards my target until about 5-6 days later.
But I will use a suitable GLP-1 based drug, because, man, fasting feels unbearably brutal for me after 6 days: profuse sweat, increased heart rate, brief but intense panic attacks, an insane level of sad (but not depressed) introspection, a hairpin trigger temper. I become a ridiculous mess. There's got to be a better way!
Might have to float this by my tirz-taking partner, especially if it helps with side effects. They always feel a little icky the day immediately after a dose.
I definitely am. That first shot took a solid 30 seconds and three false starts before I could jab it in, but it turns out to be a great big nothingburger once you do it. Can barely even feel it, nothing like the intramuscular shots like flu/etc. I could do this shot as often as necessary without batting an eye.
These are the same effects I got from doing OMAD and going gluten free. If I fuck up and eat processed food, the "food brain" comes back, and I start chasing dopamine like a fiend.
I'm a fan of these tools helping people get this insight, because otherwise people just accept that cloud as their normal.
> The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.
If you want to be successful long term in your weight loss, especially after stopping the drug, you should really invest in changing your mindset.
This is a massive positive, not at all a negative.
You got fat because you ate too much. If you don't understand what are normal portions now, you'll go back to your starting weight as soon as the drug isn't having effects anymore.
This is a lifestyle change that you MUST embrace to be successful long term.
> but the broad ranging psychological effects are concerning.
Fwiw, to me the symptoms he and others have described don't seem very different from those of long fasting. And I would definitely prefer those symptoms to the ones I had due to obesity which ranged from extreme fatigue, heart-pain, muscle spasms, depressive shame, restlessness and so forth.
I said a few weeks ;-). The garage is pretty big, but not that big. It's going to be gloriously organized in a few weeks because I spend a half hour or so in the evenings to move the project forward. I'm very relaxed about it. I'm just doing exactly what I kept telling myself I should do to make the garage as organized as I want, rather than finding pretty much anything else to do.
Decades ago I tried phentermine for a couple months. Now that was a ride, and you might call the experience closer to manic. I was a machine. This is not like that.
I read the “in a few weeks” totally differently than the other reply. In my mind, I was thinking, “wow, you’re able to plan that far ahead and stay on track??” And now you say you’re able to accomplish that by dedicating a time block per day?! That’s superhuman level of control that I can only dream of!
There are about a dozen published studies using GLP-1 analogues in animal models showing reduction in addictive behaviors (search for papers by Jerlhag, Leggio and Schmidt). The prevailing theory seems to relate to dopamine regulation.
From my own anecdata, unnecessary impulsive eating probably reinforces the impulsive behavior. You start associating impulsive behavior with a reward.
GLP-1 not only removes that, but adds a slight negative reinforcement. Impulsive eating no longer brings reward, but makes you feel over-full. This can then down-regulates the pathways that lead to increased impulsive behavior.
I won't sugarcoat my problems. I knew I wasn't hungry when I'd eat sometimes. I knew it would keep me overweight. I knew it wouldn't even feel great afterwards. And yet, more often than not I did it. And beat myself up over it every time. Very demoralizing, even without help from moralizing folks on the internet.
On tirzepatide the impulse is just gone. I feel like I can take it or leave it, and since the consequences of eating unnecessarily are quickly negative, I just don't do it.
Doesn't losing weight already increases your Testostrone?.. people seriously shouldn't get on TRT unless they need it medically, once you start it, it's for life and also you will be infertile.. (source I am on HCG, an alternative to TRT due to its side effects).
It would be interesting to compare the anxiolytic effects of the drug versus the cancer anxiety caused by being on the drug.
The cancer anxiety could be reduced by frequent testing. e.g., having a thyroid ultrasound every 6 months, or a yearly abdominal MRI, just to make sure cancer is not brewing.
There's no evidence that GLP-1s cause cancer in any meaningful amount, but obesity definitely does. Either way the only cancer they found any correlation to was thyroid which is one of the most treatable -- over 99% survival rates.
There's no causative relationship. There is a correlation in some studies. This is not the same thing. Beyond that, some studies have found a very weak association and some have found no association at all. To say with this corpus of evidence they cause anything is very premature.
This 2024 study showed no increase in risk over 3.9 years.
My biggest fear is either there will be long term negative consequences to Ozempic et al, and a huge swath of the population will be dealing with issues 30 years form now - OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight.
I can understand this perspective. You're looking at it with healthy eyes.
But for fat people, the calculus looks different.
A decision to take semaglutides is a decision between the long-term negative effects of obesity *now*, or the possibility of long-term negative effects *later.*
Anecdotally, trans people have a similar calculus. Going unmedicated/unsupported brings significant mental health risk now[1], whereas going on hormone replacement may or may not cause complications much later in life (osteoperosis, hepotoxicity issues for some treatments, etc).
Either way, you gotta get to the "later in life" part before you can worry about the outlook there.
1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
> 1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
This paper also finds that 5% of cisgender male and 11% of cisgender female students (out of ~8k surveyed for each) attempted suicide in the past year. It's kind of strange, because the age <=18 suicide rate (of "completed" attempts) is much smaller, approximately 1 in 5,000 to 1 in 10,000 [1].
No, they're making a choice between the long-term negative effects of not losing weight naturally, vs the possibility of long-term negative effects of using artificial methods. This isn't polemic, as even things as basic as birth control and advil have negative long term effects.
And yet, statistically, caloric restriction has one of the worst success rates in modern medicine.
Depending on which study you look at, up to 80% of people who attempt lifestyle modification end up gaining the weight right back.
So yes, it's theoretically possible for everyone under ideal circumstances, but in the real world most people don't succeed. We can argue over why that happens - but the statistics remain.
So again... given these abysmal odds, for the 80% of people who try and (repeatedly) fail at lifestyle modification, what is the least bad alternative?
I think we’re saying the same thing? The only difference is that I personally don’t believe that self-control is sufficient for everyone to lose weight. If you do believe that, then the risk estimates become much easier.
I was curious and a bit skeptical that sex change operations materially affected suicide rates for trans people but available papers tended to find significant effect sizes of about 50% reduction
Did that study account for the socioeconomic status of the participants? Common sense suggests that people who can afford to undergo such surgeries would tend to be richer, more supported, and from better neighborhoods.
There's certainly room for more research here, but some of them do attempt to account for other socioeconomic factors.
It's worth noting that surgery isn't the only option. Hormone therapy has also shown to reduce suicide risk, which is more accessible across socioeconomic strata.
The data is poor quality. It's not like you can randomize who gets a sex change operation. And there are major issues with even knowing who to count when people can just decide they're not trans any more. All the research on this is riven with such unhandled problems.
The research is also highly motivated. A researcher who found that sex change operations were harmful would be targeted for endless harassment by gender activists, if they could get published at all.
> The research is also highly motivated. A researcher who found that sex change operations were harmful would be targeted for endless harassment by gender activists, if they could get published at all.
A researcher who found this would be feted by the conservative/evangelical wing of the US political spectrum. They would stand to make a ton of money in the book and personal appearance circuit.
The effect sizes here are huge and seemingly hold when controlling for the typical factors such as socioeconomic status. They appear to hold both across groups that did not seek treatment and those that did AND in follow up studies checking the rates of how feelings (e.g. ideation) evolve over time for each group. It’s ok to raise concerns about confounding variables but the hypotheses here for such a huge effect size seem limited.
The fact that people can decide they’re not trans is not particularly material. This is very uncommon.
The conspiracy that such research must be politically motivated is a contrived argument and also falsely paints a dichotomy of saying that it must either help or harm. My assumption before doing the research was that they would find no effect.
>The fact that people can decide they’re not trans is not particularly material. This is very uncommon.
You really lost us with this.
Many, MANY people dally with the idea of being trans and decide it's not for them. This is extremely common, and is probably the overwhelming majority outcome for all people who are ever trans-curious.
> a huge swath of the population will be dealing with issues 30 years form now
We've got 20 years of data on this class of drug. Certainly there could be some long term issues that we're not aware of yet, but it's not likely that there are significant issues that affect a large percentage of users after 30 years that didn't affect the small sample of users that have been using it for 20 years or the massive number of users that have been using it for 10.
How much of the data was done independent and how much was done by the same company or companies that benefit from it? We've seen this before. How many decades did people take aspirin thinking it was good for you to take everyday. How many decades did people drink wine thinking it was good for you in small dosage? How many people smoked using it as an appetite suppressant not knowing the long term effects?
The list goes on forever. I'm betting this ends the same way.
Dude, the mortality rates go up at least linearly, maybe super-linearly, to weight over a certain amount. It's not like some mythical / hard to read / later benefit. This is a drug that radically changes those risks NOW, really quickly. It's a different matter than aspirin (helpful if heart disease is a real risk, otherwise no) or wine or smoking, both of which people have a strong interest in thinking of as good for you.
Yes being overweight is horrible for you. But fixing it with a pill that you don't know the long term effects of and not actually fixing the root of the problem. Why you gained the weight in the first place. Is helping no one. If anything you could be fixing something in the short term and causing long term harm in the ladder.
OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight
Who the fuck cares? If you're not overweight and are reasonably then you're already winning in physiological terms. If you can maintain a good quality of life into old age and then die, what more do you want? Going through life worrying about whether you're missing out on some marginal health benefit from the drug-of-the-moment is neurotic.
i think overweightness should be seen more as a symptom and I share parent's concerns about ozempic's long term side effects being unknowable in the present
all in all general unease about dealing with symptoms and not the root cause of overweightness except in rare genetic cases, its overwhelmingly a dietary/exercise issue.
in this country the pill/drug is the answer and solution to everything but all this does is pile on more bandages without addressing the root cause which a very American solution.
I do not think the full ramifications are realized or knowable when there are profits to be made on both side of the fence, sort of like the whole opiate crisis in America started out as magazine ads blew up into a major crisis 20~30 years later.
I’m skeptical of the idea that across the general population we’d be healthier if we dialed up our insulin production. Serious question but has there ever been a case of humans benefitting from increasing a hormone like this? Since it’s an injection, It wouldn’t be a steady increase, but more likely have bursts of it. I don’t know how healthy that would be in the long run.
After what happened with OxyContin I think wed benefit from some skepticism when a new drug gets oversold.
> Serious question but has there ever been a case of humans benefitting from increasing a hormone like this?
By itself this might be an ok question, but in context it's rather useless....
Diet and obesity changes by both lowering and increasing different hormone outputs in your body. You're balancing the question of "how is this hormone" versus "How bad is obesity on the body". Well, the answer is in, obesity is extremely unhealthy on the body in both the short and long term.
Drug overdoses cause somewhere around 100k deaths per year in the US. Obesity complications related deaths are in the 250-300k deaths per year.
You can be skeptical as you want, but behind smoking, obesity is the worst epidemic in the US.
There are some evidence that Ozempic/Wegovy actually cures more addictions than just food addiction.
>The weight-loss jabs have apparently helped people kick habits from smoking to shopping, although scientists remain wary about recommending it as an addiction treatment
Which makes perfect sense. All addictions are basically* the same thing, an outlet for negative emotion. The "drug" of choice, whether that be food, video games, shopping, etc. is fairly superficial. Often, people who "kick" one addiction simply switch over to another addiction.
Rural children, who it stands to reason would be more likely to not be drinking fluoridated water, have higher odds of being overweight or obese than urban.
I am an academic scientist and generally a careful and skeptical person, but having read the peer reviewed literature myself, I think there is enough evidence to be concerned that water fluoridation at the levels currently used could possibly be causing brain damage or developmental issues. The evidence isn't that strong, but it is strong enough that it would be unethical to continue the practice, or to claim that there is nothing to worry about. The dose/response curves seem to show measurable levels of cognitive defects occurring right around, or just above typical target levels for fluoridation.
Personally, I give my kid water with the flouride filtered out via RO, but will still use topical flouride, e.g. toothpaste and treatments applied by a dentist.
I hate how issues like this are politicized... if I raise this issue anywhere, including on here I expect to be attacked for being a "conspiracy theorist" and "like an anti-vaxxer" etc. There is something really wrong when you aren't allowed to even talk about both sides of an issue- especially if, like in my case, I have a doctorate in the life sciences and am qualified to have my own informed scientific opinion based on the evidence.
It is not in any way related to my own area of research, I looked into it as a parent wondering what would be best for my own kid. However, there is not really that much research out there on this- so I was able to review much of the primary research, as well as various review articles that try to consider all of it together.
How would you define "domain of expertise"? Reviewing literature from other fields I don't research myself and forming an opinion on how it applies to my research is part of my job and something I do almost every day. I am even also called upon to peer review articles and grant proposals that are not within my direct field of research, as is general practice to get "outside opinions."
In cases like this, I am able to be familiar with basically everything published on the issue. However an actual researcher in a specific field will have additional knowledge and opinions from firsthand experience, that cannot be found in literature.
In general, I think it is okay to have your own opinion on something even if you aren't e.g. a professional whose whole life is focused exactly on that one issue. No formal training, credentials, or firsthand experience are necessarily required to have an informed opinion. However, you still have the burden of making sure you really understand the issue deeply - which is probably something like 100x the effort most people think it would be. Anyone can do that if they take the time to do so. I wish more people would.
In any case, this was a few years back when I looked into it, and it seems like these concerns have become more mainstream and less controversial in the last few years, e.g. https://ntp.niehs.nih.gov/publications/monographs/mgraph08
It’s totally reasonable to make this as a simple risk balancing decision: “unknown but probably small risk, vs. known and definitely small benefit” is not the kind of fact pattern that we should persecute people for differing on.
The implication to be thwarted was of "mineral" vs "hormone"; the distinction was moot, as there is no such real thing as a "drug" - all things are chemicals, and can be psychoactive to humans in either their presence or absence.
Most notably (in the context of un-intuitiveness), is Xenon - it is't even a chemical, but an element - a noble one, which is almost nonsensical given most's flawed intuition.
> fluorine is not a noble gas
Correct, although ironically it wasn't much use in direct chemical-warfare, it was used more as a pre-cursor to enrich Uranium.
> Most notably (in the context of un-intuitiveness), is Xenon - it is't even a chemical, but an element - a noble one, which is almost nonsensical given most's flawed intuition.
…what?
I haven’t the faintest clue what you’re talking about. I don’t think you know what the word “psychoactive” means, either. By your definition, water is psychoactive too. Is that what you’re suggesting?
Sure: the popularization of coffee across western Europe in the 1600s and 1700s, and the way it replaced beer as the most common daytime casual drink. Much of the population went from spending all day mildly intoxicated to being mostly sober and with a caffeine pick-me-up.
Some athletes (especially weightlifters) use Tadalafil, an erectile dysfunction drug, because it also promotes bone density and muscle growth while having few observable side effects. This isn't really surprising, it's basically just a mild vasodilator. A better known drug in the same class Sildenafil (aka Viagra) is less mild, and associated with retinal damage if overused.
Medical FOMO? I wouldn’t worry too much about it, I mean, there are hypothetical upsides to countless decisions we haven’t made, right? We always miss some chances in life.
That's why I haven't taken it. I'm probably a guy who should. Overweight, with kidney disease person who, if I became diabetic, it would probably kill me.
I'm not, someone who doesn't really need it. For example, some average weight housewife who just wants to fit in a dress a little better.
And still, I won't use it even though I can afford it cause it's the long term consequences are not entirely understood.
There were several side effects related to pancreatic cancer associated with the precursors to GLP-1 drugs. The same companies promoting GLP-1s were responsible for driving up insulin prices. So I'm hedging my bets.
There's a really cool Modern MBA video [1] on this topic btw :)
>Large epidemiological studies have shown the link between obesity and pancreatic cancer. A large population-based case-control study of pancreatic cancer demonstrated that obesity was associated with a statistically significant 50–60% increased risk of pancreatic cancer.
You have the completely wrong take on this. Dieting destroys your relationship with food. Basically every adult woman exhibits some level of disordered eating because of it— "girl dinner" is both funny because it's true and sad.
Being able to lose weight while continuing to eat is a wonderful thing. There is no virtue in spending your willpower making your body do something it desperately doesn't want to do. That's some puritan shit.
Normally dieting shouldn't be necessary to maintain healthy weight though? One could eat a whole lot of salad (with some serious dressing) and a piece of meat and even a little starchy side (some potatoes or similar) 3 times a day and not gain weight. Throw in some regular moderate exercise and you're golden.
Granted, once you go past middle age, it can become a bit more complicated.
Someone brought up doughnuts as an example, but that's a ridiculous source of calories: I could probably down half a dozen doughnuts (a daily calorie budget) and then go for a normal meal afterwards.
Eating only becomes disordered if one can't be bothered to eat healthy food as a rule and then freaks out about weight gain as a result.
>Basically every adult woman exhibits some level of disordered eating because of it— "girl dinner" is both funny because it's true and sad
This is sexist and absolutely not true, there are plenty of women capable of pre-planning what they're going to eat and sticking with it. It's not "dieting", it's living a healthy lifestyle and not regularly eating junk.
My dude, I'm a woman talking about my experience with myself and other women. Disordered eating is rampant. It's ingrained to the very core of how women are taught to approach food. Denying food and starving yourself is the default behavior.
We are human animals. Our bodies need healthy food and regular exercise. There’s a case that diet and exercise are worth willpower capacity, possibly more so than anything else. That’s just the reality we exist in?
Capitalism disagrees. I need you to work two extra hours today. Also watch this advertisement for Tasty Snack! We've spend a billion dollars of research to ensure you eat this nibblet filled with 350% your daily sugar requirement, 200% of your daily fat intake, and 3000% of your recommended salt. Remember all the beautiful people in the world are eating Tasty Snack! Sold in the impulse buy isle near you.
It doesn't make you magically lose weight, it just gets you closer to "girl dinnering" with less cognitive load. The weight loss comes from eating less.
The difference is that it puts you in control of your hunger and what/how much you eat. You don't build negative associations with food while you're running a deficit. You don't build the association "hunger/misery means you're doing good and losing weight."
Yeah, it's funny, Ozempic sounds utterly useless for me. I know how to lose weight, it's dealing with the side effects of weight loss that is tricky. And the side effects of weight loss sound a lot like the side effects of Ozempic.
There is absolutely virtue in spending willpower to make your body do something it doesn’t want to do - maintaining and developing self control and autonomy. Imagine if there was no way to develop self-discipline, you’d be at the whims of your environment and the world would be nothing but chaos.
Hedonism is a philosophy that posits that pleasure is the sole objective good and thus pain something bad.
This whole thing is about trying to find shortcuts to get to the pleasure of having a nice body while circumventing the pain and effort.
Pain and efforts are important, they forge character like nothing else. If you want to live in a world where adult-children simply take their soma to get what they want, you're just not thinking about the consequences.
Do you feel this way about everything? Like you shouldn't take an aspirin because you should feel the pain of your headache? You shouldn't wear shoes because you need to feel the pain of the rocks under your feet?
Important != superlative need. I mean, I know this is just rhetoric drivel, but I'm bored enough to reply. My post was clearly about a certain type of pain that the mind knows is a necessary path to achieving a stronger mind.
Also, about headaches and more generally physical pain that you know is only temporary and not a sign of radical bodily malfunction, I say yes: enduring a reasonable amount is important to develop a tolerance to it and willpower.
What I'm saying isn't new anyway, everybody knows some amount of struggle is needed to temper character and not fall to the most insidious poison of our times: constant comfort.
I don't understand how that analogy is supposed to work, given that the basic mechanism of these drugs is to reduce appetite (and possibly just desire in general).
We're about to see a dramatic fall in the production and consumption of unhealthy food because people who used to want them in large quantities will no longer want them when they're on GLP-1 drugs.
>In October 2023, Walmart became one of the first retailers to correlate Ozempic, food sales, and changing habits. Using internal pharmacy and grocery data, the study found that Ozempic is negatively affecting Walmart’s food sales. Measuring per-unit sales and calories, the retail giant confirmed a long-held belief that patients on GLP-1 drugs buy less food, particularly within the sweets and snack food categories.
It's genuinely quite depressing that so many people in the United States have a weight problem that the overwhelming majority of the population would benefit from this and headlines including "we are all" are not inaccurate.
I don't think other countries are necessarily perfect here, but 74% of Americans don't have a healthy weight when you look at their BMI. That's a staggering statistic. Something is seriously wrong societally, and the priority should absolutely be non-pharmaceutical interventions.
I agree. I think the conversation has unfortunately been dominated by an individualistic strain of moral judgement. Whether so and so, this person or that person, should take Ozempic-like drugs is often discussed in binary terms of near moral and personal failing or not. I think the drugs are helpful to people who really need them --- so long as the people really need them.
The problem is that conversation overshadows the much more important big picture conversation: An entire nation is now becoming synonymous with poor health from obesity and we're not addressing many of the core nationwide reasons for that.
America was once proud of and eager to prove how fit and able its people were. Now the very idea of proper nutrition and exercise is deemed a nonstarter, "impossible", or an imposition on personal liberties. The existence of Ozempic-like drugs should not absolve us from the imperative to change how we live as a nation for the sake of our health.
It really is a sad situation. As an American who spent the first 30 years of life in the US and over 20 in Europe, the difference is striking. However... here in the UK I see more and more "American-sized" people every year. _Something_ is changing. In the food and/or habits of the average Brit.
Anecdotally I would say Europeans as whole are getting ever so slighty larger. But just not at the rate as Americans. Ozempic seems like a god-send.
The rate is probably comparable, it's the offset that's different. Won't be long until Europe is where the US is today (though I need to mention, this is regional, for example Colorado is at about 25%, and some European countries are already there).
Even Japan is getting steadily fatter, though they are way, way behind Europe and the US.
> It's genuinely quite depressing that so many people in the United States have a weight problem
I agree.
I'm 51 y/o and still totally fit. Always have been. I am completely in control of what my body intakes. I can fast for 12 hours from waking up until dinner: I do it regularly (as in at least five times a month, probably a bit more).
I did do sport like crazy when I was young but don't even bother that much. Some walking, taking the stairs instead of the elevator, some bicycling, some tennis. But at a gentle pace. "More haste, less speed" (thousands of years old saying).
It's crazy to poison oneself to the point where another poison (that Ozempic drug) is needed to counter the first poison.
I'm not saying it cannot help but sadly there's no way to say it nicely: if you need that, your body controls your mind.
It should be the contrary.
> Something is seriously wrong societally ...
The biggest issue to me is we live in societies (not just in the US) where we victimize everyone. Nothing is never nobody's fault. We find excuses for just about everything.
We should go back thousands of years and read the classics: "healthy mind in a healthy body". Greek philosophers had already figured that in the Antiquity.
>I don't think other countries are necessarily perfect here,
America first... the rest of the world is playing catch up as quickly as possible.
>In March of 2023, the World Obesity Federation (WOF) released a report(Link downloads document) stating that by 2035 over 4 billion people – more than half the world’s population – will be obese.
>and the priority should absolutely be non-pharmaceutical interventions.
Illegal. Or is should say Coca Cola can and will fight you to the death the moment you try. If you stand between the junk food companies and advertisers you will have an army of lawyers fighting you 'tobacco industry' style for the next 50 years.
Until the shit is off our shelves and out of our ads nothing will change.
This is not exclusive to the US. The world is trending towards those, and different countries seem to only be at different distances from it, but the same velocity.
Also, industrialized food seems to be much more effective in causing dependency. Food preparation has overwhelmingly shifted into less healthy alternatives (even when they sound healthier in a naive review)... And there's a multitude of low probability high impact possible contributors that nobody knows if are important or not.
I have always and continue to feel this view of “food is an escape for cuz” model is wrong in line with the the “it’s about lack of will power” we are seeing with all these glp-1 drugs that are helping people that a big proportion of our population have what amounts to a hunger/craving defect and are just living how we all naturally do when listening to our body, but because something has messed up their balance they end up overweight instead of just maintaining their weight.
I’m hoping we at some point have a “lead in gas” moment and discover some culprit in softening agents in plastics or preservatives in foods that we find out is messing up peoples systems. I could imagine that there is something that has a minute effect on the short term and doesn’t show up if you only look at people for 1-2 years but causes significant disruption on the timescale of 5-10 years of exposure.
The obesity epidemic seems to have started in the 1960-1970, so the sedentary lifestyle of computer focused work came later, but it is still recent enough that culprits in the mass produced uniform product market could be a cause, or the advent of one type of fertilizer or antibiotic given to animals etc.
important to note that food intake increased linearly over the century, but then people started to cross the diagnostic threshold and so the percent of obese people started to shoot up
unfortunately it seems the problem is a lot more prosaic than mystical contamination in the environment, it seems evolution never had to worry about this, and here we are.
I think Ozempic is a treatment of a symptom but not the underlying condition, but unlike many of the posters here, I do not think the underlying condition is "obesity". The below is mostly speculation.
Research especially into people with healthy body weight seems to indicate that there is something going on that is causing widespread obesity. That is, there's some sort of environmental "GLP-1 Turbocharger".
Maybe it relates to processed food, maybe it relates to microplastic contamination, maybe it's in the cheese, maybe it's an innocuous viral agent, maybe it's gut biome, maybe it's ADHD drugs, maybe it's SSRIs.
I suspect that Ozempic is helping us get back to a baseline level of exposure by counteracting this. And in the future if we're lucky we'll figure out what it is and try to correct it at the source.
Out of curiosity, last year, I purchased some test strips to test my drinking water. The strips showed typical contaminates: arsenic, lead, copper etc. they all registered in the "acceptable range". In the test, there was a test strip for QUATs (https://en.wikipedia.org/wiki/Quaternary_ammonium_cation), which caught my attention. It wasn't something that I would have thought to test for, but my water tested positive. I was curious, so I started testing other local water sources including bottled water from various brands; to my surprise they all tested positive for QUATs. The only local water I could find that didn't contain QUATs was distilled.
I thought maybe it was just in my area, so I started taking the test strips with me when I traveled. In the last year, I've tested the drinking water in multiple states and countries, and only one source has tested negative for QUATs. It was the water from a drinking fountain in the San Francisco Airport, interesting enough.
My suspicion is that QUATs are often flushed down the drain, and the molecules must be too small to be filtered out in the water treatment process.
I haven't found much research on the impact of QUATs on the human body, but I can help but think our mitochondria would be susceptible to damage.
I could suppose it's some of all of this. But my money is on UPF. The author of Ultra Processed People has an identical twin in NJ while he lives in the UK and their weights are vastly different.
A lizard whose bite makes its prey eat less is crazy but it exists.
A lizard whose bite makes its prey eat more is also crazy, but maybe it exists?
The first lizard is literal, the second lizard is a stand-in for whatever mystery force I am postulating the existence of.
When you look at the historic literature on diet and nutrition from the first half of the century it's like looking into another universe. People are obsessed with getting people to eat more to prevent malnutrition even when food is freely available. Something changed.
The food changed substantially. Lot's of other stuff changed too, but we're talking about the transition from malnutrition to obesity over a few generations and the make up of what we ingest strongly impacts that.
Mass production and consumerism of food created perverse incentives that resulted in drastic changes to diets - different macronutrient profiles, new ingredients (emulsifiers, artificial sweeteners), and new manufacturing byproducts (residual solvents, pfas, plastic). You can still opt-out of mass produced food and move to the bush to live a subsistence life, and you'll still be ingesting plastic and pfas.
Part of the reason this is so hard to grapple with is that (in the USA) almost no one alive was an adult before the food industry industrialized. I'm 40 and my parents and grandparents rode the initial waves of processed garbage.
I feel it’s still not clear if you understand that ozempic causes weight loss because it causes reduced eating or if you believe ozempic causing less eating is incidental to the weight loss
So yes, it "causes reduced eating". That's a hell of a crazy thing though.
Someone joked on twitter that you can save a lot of money if you just eat the same amount of food that you would eat if you were on ozempic, because you'd see the same weight loss.
My only point is that it is not absurd to think that just as ozempic causes you to eat less, it is not ridiculous to speculate that other agents that can cause you to eat more.
There isn't anything even remotely close to a scientific consensus on any of those.
There are plenty of scientists who tell you to stop exercising when you want to lose weight, because the exercise leads you to eat more than you would otherwise, and is ultimately self-defeating -- to focus entirely on eating less, and then only add exercise back in once you've reached you target weight. And "processed food" is a highly non-scientific category that is way, way too disparate to be useful at all.
Organic vegetables might be nice, but there's zero evidence that organic vegetables are better at weight loss than non-organic. Also zero evidence regarding lean protein as opposed to fatty -- there's a big argument that fatty meat is better for weight loss, because the fat satiates so you wind up eating less calories overall.
Yes a scientific consensus for these things would be nice, but in a world where manufacturers of such poisonous garbage control so much of the “science” and research space, can you ever really hope for an honest and realistic one? No.
Maybe? I don't think we all know this. And some research, especially into people with unusual metabolism (but not necessarily known metabolic disorders) indicates that even with these restrictions, they need to operate at a significant calorie deficit simply to maintain a healthy weight. [1]
It might be that they are already exposed to enough processed food and pesticides that simply getting those things out of their diet is not sufficient, but I think it's clear that there's more going on here than a simple answer.
And, I think, most damningly, there are many people who maintain a healthy weight with no active efforts to maintain that weight, including a lack of exercise and consumption of processed food. It might be that a significant fraction of people are resistant to this effect or might just not enjoy the taste of processed food so naturally gain the benefits of avoidance.
You are doing an awful lot of mental gymnastics in search of a boogeyman that does not exist.
How mammals ingest, process, store and burn energy has been well understood for a very long time.
You know why some domestic dogs and cats are overweight? Is it ADHD or microplastics? Of course not, it’s because they’ve been eating more energy thaN they have been burning for a while.
Ozempic only stops you wanting to eat more, which perfectly proves the point. The boogeyman you are searching for is eating more energy than you burn.
I’m pretty sure all the Shortages of Ozempic and mounjaro are due to injector mechanism production factors and the fact that when the drug is transported in a reconstituted fashion in the injector, it needs to be kept in cold chain storage the whole way which makes logistics much much harder
My friends and I all live outside of the USA and we can get basically unlimited ampoules of powdered Mounjaro from China. It is very simple to reconstitute with Sterile water in a no touch way and works great. We have all had significant weight loss and improvement in blood pressure and glucose levels etc.
Waiting for these companies to get their act together, especially when mounjaro is a copycat drug is not acceptable. these drugs are biochemically very simple peptides with a couple of cross linkages and very easy to make in high quantities so there is no excuse for everyone who needs them to not be on them. a large portion of the world not having access to these drugs for the patent period and continuing to suffer all the effect of obesity is not morally acceptable.
Arguably it is morally acceptable for them to charge high prices because drug development and doing phase 1/2/3 trials is very expensive. It's also risky, as most drugs fail. If companies aren't allowed to make a big profit when they finally struck gold means to remove the incentive of trying to develop ambitious new drugs.
I think we desperately need to answer the question of why GLP-1 agonists are so effective, and particularly whether it's counteracting something in the environment that has been acting to reduce GLP-1 (or other glucagon-related pathway) activity without us realizing it. The obesity data practically screams that something happened in North America ca. 1980 that messed up our metabolisms, and it may have spread to Europe after a delay. Unfortunately, it seems like one of those things where there are various people with pet theories and little substantial effort to get to the ground truth. Perhaps the inevitable search for "me-too drugs" will uncover something.
> I’d be curious about side effects of the Depression and WW2 that took an extra generation to show up.
While there might be a time span involved that could be described that way, as far as I've read there weren't any statistics that were "generational" in the usual sense of the term. Obesity rates started rising among all age groups at roughly the same time.
Hormones in meat. And I expect the women's pregnancy pill plays a part in this as well to why we have over emotional disorders. This has all originated from the 70's both.
The demand for cattle are so high that they force feed them growth hormones. You eat the meat, you end up with injected mutations and then over generations you then end up with people with growth hormones and obesity because of.
How can hormone bated meat not affect the human body?
As well, women have been taking a pill, since the 70's, it does its thing, they pee. That mixes with the water and overtime pollutes the generations.
Seven years, December 2031. That's when the patent expires, the kinks and side effects will have been found/ironed out and it becomes a cheap plentiful generic. I'm healthy enough to wait.
Novo Nordisk just settled with Viatris, a company which was trying to have the Ozempic patent cancelled.[1] That would have killed their monopoly. "Terms of the settlement are confidential".
They just did the same thing with Mylan.[2]
And may have done something similar with Rio Pharmaceuticals.[3]
The Federal Trade Commission is also fighting that.[4]
> One person told me, "No matter how much I eat or exercise, I have been 'hungry' my entire life. That ended when I started taking these drugs."
I would change this to "No matter how much I eat, I have been hungry my entire life", because that's what my experience is.
I'm nearly always hungry. Doesn't matter what I eat or how much of it. High protein, high fiber, moderate fat, low carb, all the steps people say cures hunger, and I'm still hungry. 20 oz steak and a massive portion of broccoli, and I'll still get munchies an hour later. And before someone says "You're probably actually thirsty, but making the common mistake of thinking it's hunger", no, that's not it. I'm drinking plenty of water. My urine is almost clear.
People say things like "If you're hungry between meals, just eat a handful of nuts!", and I don't know if I want to laugh or cry, because I'll eat a handful, then another, and another, next thing I know, I've eaten literally 1,000 calories and I'M STILL FUCKING HUNGRY.
And so I get incredibly angry whenever someone says something like "omg these fatties have to take drugs because they don't know how to stop eating" as if everyone has the same experiences as them.
No, my hunger sensor is miscalibrated. Some of ya'll might go out to lunch and end up eating a large meal and not end up hungry for dinner and skip it. I'll go out to lunch, eat the large meal, and end up hungry 2 hours later. If I get the smaller meal, I'll leave the restaurant still being hungry.
I even tried keto. I did it for 9 months and went from 270 to 205 lbs, but even after 9 months, my hunger was not recalibrated. I was still hungry after every meal. After 9 months, I ran out of willpower. Gave into the hunger again. Slowly came back to 245 lbs and stayed there.
I wish I could try Ozempic. Maybe it would fix me. But I'm not diabetic, so my doc won't give it to me.
Ozempic (or better, Zepbound) will solve that problem. I feel just like you, have had a similar experience, and I'm taking tirzepatide (Zepbound, basically) now.
Ignore the haters. Focus on what will make you successful.
> my doc won't give it to me
Get another one. You can have more than one. Go to one biased in favor of selling you the drug, if that is what works. It is your health. Your doc is not your mom, he is your advisor, it is your body and your choice what to take.
Compounded semaglutide is relatively inexpensive. And over time the brand name stuff will start to come down because they are being undercut by the compounds. Zepbound, for example, is now available direct to consumer for $550/month (5mg, and not an autopen so you can easily split the dose to make it last longer if that still works for you). Still pretty expensive, but for a life changing drug it is worth it. I also expect the price will continue to drop, probably quite a lot in the upcoming years.
> I wish I could try Ozempic. Maybe it would fix me. But I'm not diabetic, so my doc won't give it to me.
Wegovy (which is the same drug, with a different name) is licensed for weight loss, if you fulfill certain criteria:
adult patients with an initial body mass index (BMI) of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia) [0]
I gained about 50 pounds the past decade and the past year I’ve been trying to lose it.
I weighed myself at the beginning: 205 lbs
I started running 30 minutes per day (heartrate training targeting about 140-150), every day, for 10 months. I kept my diet the same as before (though with a protein bar after the run). Weighed myself every week or two, always within a couple pounds of 205.
In March I ramped up my runs to 45 minutes per day with better interval planning. Still 205. I injured my ankle in May: 205. I’ve been busy and haven’t gotten back into running yet, just weighed myself, and after months of no activity: 205
Weight loss is hard. It is possible to put in a pretty strenuous amount of effort and willpower and see exactly zero results.
Exercise by itself doesn't increase calorie burn all that much, it just strengthens your body in other ways. It's still very important, but to have a healthy weight you need to eat healthy (for most people this just translates to eating less) and diverse foods with good macro coverage.
You not changing your diet is the problem in this case, and that protein bar has so much sugar that by itself it's counteracting whatever effort the exercise had in the first place.
Also in my experience most people who say this kinda stuff (I train and eat healthy but can't lose weight!) actually don't eat healthy at all, because they simply don't know what that actually looks like.
Its a pretty well known fact that exercise alone (unless you are doing extreme athlete training) is not going to change your weight without a change in diet.
You can get healthier with exercise, but not smaller. That is almost entirely based on diet.
Just think about it; your thirty minutes of running probably burned between 300-500 calories. That one protein bar probably has about 300 calories by itself.
And that's where the GLP-1 meds come in. You get physically sick from eating your current (oversized) meal size. You don't have cravings. You can lose weight using GLP-1 even if you don't exercise strenuously/daily. However you lost a lot more if you have a regimen.
If his weight is stable then his meal size is probably in the norm. That's the hard part of losing weight. Only a small sustained calorie excess will make you gain weight but you need a large sustain calorie deficit to lose it. And your brain and body will fight as hell against this.
Speaking from experience, that assume that you are currently maintaining your weight. I think a lot of people are gaining weight slowly, so burning those calories actually just keeps you at your existing weight, not decreasing it.
It's also really hard to not overeat after working out, especially if you do something like swimming, which makes you just so hungry. The hunger reduction is I'd like to try ozempic. I am active (I swim 3-4k yards hard 2-3 times a week and surf once a week + walking generally), the hunger I have after swimming is so huge I just can't not eat something huge, even though I drink a ton of water and do all the other things people say to do to not get hungry.
I've been a lifetime swimmer, so I can relate. There's a reason a lot of swimmers and waterpolo players gain tons of weight as soon as they stop training.
Usually if you can fight through the "hunger" it'll calm down in its own after about an hour or so in my experience.
Running for 30 minutes is maybe 200-400 calories. If you trigger your body to eat more because of that or you are more lazy throughout the day because you’re tired after running, it’s a wash. Exercise is not the route to weight loss. It’s like 80-90% diet.
And if you diet, you lose weight temporarily and trigger your body to eat more because you're hungry. Your body doesn't want there to be a route to weight loss, so it blocks them pretty effectively.
a diet doesn't mean starving yourself, it means have balanced nutrition that doesn't rely on fast carbs, if you burn 2000cal a day for example you still eat 2000cal but not in sugar/fast carbs but adequete protein, fats, and high fiber/slow carbs; insulin resistance is the biggest reason people will feel that hunger right at the start but once your body starts gets used to the slower carbs that don't constantly spike your insulin the resistence goes down
a lot of time it seems like people absolutely don't track what they eat or sort of tell lies to themselves (this doesn't include people with illnesses that impacts their metabolism)
once you start doing a medium amount of working out, just going for 30min walks everyday, you will start to build some lean muscle which will increase your base metabolism and this is where the weight loss kicks in
What do you eat? I bet $10 either it's calorie-counted standard high carb diet or something that is low in protein and fats.
The physiology of dieting, and avoiding hunger, is pretty well understood at this point. Just don't ask your GP or they'll just tell you to stop eating red meat and eat more cereals as the "solution".
Not the OP but I have tried to reduce my sugar intake, I'm walking more than before, and I still basically gain half a pound every year. I'd lose some weight for a few days, and gain it all back on the one day I'm a bad boy. It seems like there's an internal dial that decides what my weight is supposed to be, no matter how much I fight it. And the dial adds half a pound every year. I guess the dial is my metabolism as I age.
Eh, in a clinical setting only eating "good food" works fine.
In the real world this is not what people experience. Especially those that experience mental food noise.
Imagine there is a donut in a box at work. It's free, you can have it at any point. It's junk food, it's bad for you, it's not part of your diet and you don't want it. I mean you ate a high fiber food and protein earlier, you shouldn't be hungry at all. Now imagine there's an additional voice in your head that just slips in "Ok, finish that page your on and go pick up that donut". How long can you resist it? You probably won't even notice it since it's the normal stream of thought you have. At some point you'll end up with that donut in your hand.
Now take a GLP-1. The voice gets silenced. If you smoke or drink you'll notice that you don't really want to do that either.
Just doing more exercise doesn't actually help much with losing weight, as it turns out. The human body will optimize around even intense exercise to reduce calorie burn to a homeostatically stable level. The exercise will still make you healthier (and have some marginal extra calorie burn from e.g. extra muscle mass), but you'll only lose serious weight if you also reduce what you eat.
There are a couple things missing from routine. That protein bar is sabotaging your run. Those things are filled with sugar. You need to do 2 things. Change what your eating and do intermittent fasting to jump start your metabolism.
Exercising won't work, weight loss happens in the kitchen.. You can do some moderate exercise of course but you should count calories and eat less (don't forget to recalculate your requirements as you lose weight!).
>eating healthy and exercising is not enough for a lot
That's because both these interventions when followed in the way they are commonly understood are near completely incorrect. I blame the govt/medical profession for this.
Other factors: again I blame govt/medical profession for this - example it's difficult to get unprocessed food unless one reads labels carefully. For example it is near impossible to get milk that is not fortified with vitamin D. As they say: the road to hell is paved with good intent.
Granted that even after doing everything right there will be some people who will be obese, but that would be the minority. Again the govt/medical profession is to blame - for example I've heard that infants/kids are now given around 30 vaccines. With so many variables that have changed in the environment it now becomes difficult to isolate what is causing the health issues that predispose people to a lifetime of ill health
It doesn't exactly bode well for your argument when there's a wide body of evidence disagreeing with what you're saying, and you also cannot find the source of your claim.
In general it's all in the "Potentially a thing, more research needed before we start a mass panic" bucket. I personally wouldn't go buy a bucket of "ULTRASUPPLEMENT 10000 IU VITAMIN D HORSE PILLS," though.
Disclaimer I have never been obese or suffered obesity.
If it was easy no one would be fat. The whole body acceptance movement is a sham and always will be. We dont find obesity attractive and we do not want to be obese.
However for some reason 60% of us in the west are overweight.
And it is extremely hard to lose the kilos.
We are eating too much and we shame eachother for eating small portions or skipping meals.
But put simply, we have normalized large portions and eating five times per day.
And its super hard to cut the volume after a lifetime of large portions and eating ever two hours nonsense.
I sympathise with obesity sufferers and hope that the outcome of all of this is to normalise smaller portions and fewer meals again.
The population level statistics show that you're the exception and not the rule. Obviously if the side-effects are unpleasant, the alternative health implications must be even worse: Which they are.
This may sound cynical, but I believe it is also factual: in a capitalist society, generating revenue by making people sick (junk food), and then generating more revenue by curing them, and finally making a big pile by keeping them alive for a few more weeks, is the way it's "supposed" to work.
If everyone stayed healthy and then peacefully died one day in their sleep, I can't imagine how many $$$trillions that would remove from the US economy. (I know, there's an argument that healthy people would find other ways to generate revenue, but we have no path to realize that.)
Of course, a century of non-capitalist societies don't have a great track record either!
Thank goodness for all those countries that are neither the US nor puely non-capitalist (not that the US is an example of a pure capitalist society).
Just how blinkered is American Exceptionalism anyway? Surely you're knowingly playing up the false { US | not-US } dichotomy.
eg: "American junk food" as seen in the US is largely regulated away in Australia, food labelling is better, overall health and life expectancy is better, etc.
I don't know enough about other countries to comment on them in detail.
I do know that food multinationals are very active in almost all countries, and that obesity rates have skyrocketed in almost all countries, except for Japan, S Korea, and poor countries where people literally don't have enough to eat.
In Australia the obesity rate is >32%. That must be junk-food companies at work - I'm not aware of any other explanation.
> The information is freely available, now more than ever.
Given the progress of the threads here, do you have any recommendations for cutting through the noise and finding good scientific information on weight loss, healthy eating, lifestyle, etc?
I agree with you that all the information is out there, but there seems to be an enormous amount of resistance in the threads here to threads to even simple things like:
- Fresh fruits and vegetables
- Lean proteins
- Cut out processed foods
- Cut out smoking, rec. drugs, and booze
- Eat less in general
- Stay hydrated - water is the only drink you really need
- Find ways to move more, esp. for people with sedentary jobs / lifestyles
I don't have a silver bullet of health advice. Your list looks good.
The only things I'd change (what works for ME) is to reduce fruit (sugar). But if I could eat fruit all the time, I would.
And I eat as much fat as I want, definitely not just lean protein. Food should taste good!
And I practice intermittent and (sometimes) extended fasting. Dr. Jason Fung is an excellent resource.
You have to find what works for you. But for the majority who are overweight and obese while also on multiple meds and maybe also in pain and also self-medicated on booze and weed ... well, IMHO that's not really "working."
> The information is freely available, now more than ever
You have to believe it to find it.
Noise is everywhere, now more than ever. I think finding proper information is going to be exponentially harder.
A couple of days ago I was "fighting" on Reddit about something that is as clear as day, with proof and all, with people who were completely sure of the opposite (side note: this is when I deleted my Reddit accounts)
I just read that MTG and other Republican operatives are tweeting that hurricanes are created by the US government; now the MAGA want to kill meteorologists.
And despite all this, Trump has a 50-50 chance of winning the election.
You ever hear the saying "If you owe the bank $1000 dollars, that's your problem. If you owe the bank a million it's theirs"
This is a public health epidemic and no matter how much you scream "But I'm special" the rest of the world is going to fall apart around you. And yes, this issue is spreading to the entire world and not just the US.
Statins are regularly given to people with high cholesterol. I would bet that most older people take or qualify to take a statin. If it happens with statins, therefore, it's not out of the realm to think that most people will eventually be prescribed GLP-1 to reduce weight which will improve overall health. It makes sense.
Statins have gone through several prescribing guideline revisions in the last 10-20 years. Many people were incorrectly prescribed them and some have suffered for it.
Likewise, there can be serious complications when taking GLP-1 agonists and the like. Since they need to be taken in perpetuity (many gain all weight lost upon stopping use) they should be reserved for only people who have exhausted all other opportunities.
Most people over 65 should not be on statins. Most people should not be taking GPL-1 agonists.
Pretty much no one should be taking statins. The side effects are well studied, while the benefits are dubious at best.
For example: high cholesterol levels is actually positively correlated with longevity, believe it or not. If you consume a diet low in sugars, thus routinely burning fat when fasted, you will have "high" cholesterol in blood. How do you think fats are moved to cells in need? Through the blood, of course.
I'd go so far as to say that statins are pretty much a scam, that fixes a useless and quite complex metric such as cholesterol levels. Given that cholesterol levels are a diagnostic easily accessible to GPs, they prescribe statins to see this figure go lower, even if it doesn't make the person any healthier. Incidentally it's similar to taking GLP-1 agonists instead of learning to have a healthier relationship with food.
I’m just back from the US and watching some TV there in the hotel it seems very much like they’re pushing it into the mainstream, they literally have a commercial where “fat” people congregate in the street to march together picking up Ozempic… So I totally assume it will be widespread in a few years unless they discover some serious side effects.
Meh, you see commercials for all kinds of medicines in the US. There's more being produced than your average general practitioner can keep up with, so the manufacturers appeal directly to consumers.
Given how ineffective it is once you stop, I'm personally expecting it to become a relatively short lived fad. Insurance companies won't cover it if it truly doesn't improve health outcomes long term (throwing money down the toilet) and people will learn to not pay out of pocket for it.
There's a reason insurance companies are loath to cover it for obesity now without prior authorization, which usually requires you seeing a specialist who has ruled out the usual suspects (nutrition and exercise changes).
For the longest time people argued if overweight people ate too much or not. I’ve heard plausible sounding arguments on both sides.
It seems Ozempic has answered that question decisively, no? The solution to being overweight is eating less in almost all cases it seems. And feeling less hungry with Ozempic can help get you there.
> For the longest time people argued if overweight people ate too much or not.
Maybe uneducated people, but when was the last time anyone seriously doubted that excess calories make you fat? For serious people the discussion has always been about how to reduce the calories, because "just eat less" is provably ineffective. Simple minded people continuously suggest otherwise, but data really doesn't support their intuition at all.
> when was the last time anyone seriously doubted that excess calories make you fat
There's quite a few people here on this page.
Although part of the problem is poor word choice. Eating less absolutely works. Telling people to eat less absolutely doesn't work, because people won't do it (if they did do it, then it absolutely would work).
It’s never been as black and white as you’re saying.
Lot’s of medical practitioners will even advise you that it’s the quality of food you eat, more so than the quantity. Look at all the published research around processed foods and ultra-processed foods.
Other nutritionists will advise you that obesity is all about your macros. And that if you want to lose weight you need to increase fat and protein intake and limit carbs.
Others have argued it’s less about diet and more about exercise and having an active lifestyle.
There’s also a bunch of research showing that poor sleep might cause obesity.
Ozempic seems to have thrown all that out the window and says that one just needs to eat less if one is overweight.
It has always been black and white that the number of calories consumed relates directly to weight gain or loss.
Everything else is about tangentially-related issues. Eating 'better' food (and there are many definitions of 'better') may be healthier. Eating unprocessed food may be healthier, and/or digest more slowly, and/or reduce hunger. Eating different food groups in different balances (e.g. high protein, whatever) may affect how quickly you become hungry, or support certain exercise better. Low/no-carb/keto diets may help some people lose weight more quickly/easily, and probably results in a steadier blood sugar profile. Limiting eating to certain time windows and/or fasting may have some health benefits, and also contribute to weight loss. (And some types of regimen may suit some personalities better.) Eating certain types of food (fat, protein, low-GI carbs) which are also not processed may digest more slowly, resulting in a steadier blood sugar profile and less hunger. Etc.
And despite all of this, it's also possible to lose weight by eating the worst food in the right quantities. See [0] or just Google the "Twinkie diet".
All of those are permutations on the fundamental argument, not standalone arguments themselves. The idea with changing the quality of the food is that you'll eat less overall. Same with trying to adjust macros -- only unserious people suggest that calories are somehow different depending on source. The argument is that empty calories are less satisfying and will you to eat more overall. It is all just different approaches to finding a strategy for eating fewer calories overall.
One lurking concern I've had around this space is that junk food makers simply find a way to make their food even more addicting.
Arguably though, ozempic'd customers and shrinkflation'd products would be a recipe for amazing margin improvement. And they can dress it up as doing good because its better for people, (like the 100 calorie snack packaging).
You can see that in the lab-grown burger space already: it is a massive opportunity for companies to create an ultra-processed version of meat, and label it as healthy as the public opinion has gone blindly against meat and on the vegan bandwagon. They'll claim it's more eco-friendly, they can sell it 5x the price of beef and rake billions.
Only if you spend too much time online. In the grocery store, I don't see any indication that meat substitutes are gaining traction. If anything, popularity seems to be ebbing. The people choosing fake beef for their burgers are a tiny minority.
True, the point is that the online minority is the loudest and in this day and age they drive change. I heard talks of taxing red meat in UK, for example, which is absolutely ludicrous.
I find it hilarious that the "vegan mafia" has downvoted my comments with no explanation, while the people that actually replied seem to agree with me.
As far as I can tell, the intended meaning of the question in the title is "how long until everyone who wants Ozempic can have it?".
But at first I read it in a more cynical and sinister way, the more literal interpretation - how long until everyone is on weight loss drugs?
In a world where such medications are normalized, fast-food/processed-food companies might just work harder to make their products more addictive and pervasive, and then we're all back to square one.
Seems like all the incentives have been in place for us to have already maximized food addictiveness. We have to at least be pretty far up the S curve. I’d guess just the opposite actually, that companies will refocus on the healthfulness of their products now that customers aren’t as susceptible to the addictive aspects.
There's some evidence that Ozempic improves general impulse control, e.g decreasing alcohol consumption [0], which the article mentions.
Also, as Tyler Cowen writes [1], this is probably going to translate into big improvements for animal welfare:
> People lose weight on these drugs because they eat less, and eating less usually means eating less meat. And less meat consumption results in less factory farming. This should count as a major victory for animal welfare advocates, even though it did not come about through their efforts. No one had to be converted to vegetarianism, and since these drugs offer other benefits, this change in the equilibrium is self-sustaining and likely to grow considerably.
So overall, widespread Ozempic adoption seems like progress to me.
I had a short conversation with an agronomist friend of mine. Crop prices are in the dumps right now, and I was wondering if it's because of these drugs. He said this is being openly discussed.
What percentage of the population is on GLP-1 drugs right now?
Well "According to KFF polling from May 2024, 6% of all adults report that they currently are taking a GLP-1 drug, and 12% report that they've ever taken a GLP-1 drug".
Is 6% enough to affect crop prices? Presumably some ag economist can weigh in. Note it would only be a reduction per person, not a full 6% reduction in consumption.
This matches experience with dieting and impulse control, without these drugs even. Two days of junk food and the food brain is SCREAMING in my head. So I just don't do it. It's also way more obvious when I mess up, that it makes my body feel bad.
But when I say food brain, it's everything. I want to vape, I want to have more coffee, then more beer, then some cannabis to go to sleep. Wake up and hit the dopamine cycle again. I have to take care of myself and ask "why am I doing this, could I just not, and if so I must not".
Eating animals and animal welfare are two entirely different things. We could all be vegetarians and still be intentionally or unintentionally intolerably cruel to all other life on this planet.
This gets into a deep philosophical question people spend too much time arguing about. In short, some would argue suffering is multiplied by the number of sentient beings that experience it, others would argue only the average "amount" of suffering matters. You can end with some absurd paradoxes if you take either to their extremes.
It is perhaps simply the case that such things are inherently paradoxical. There is nothing in the stars that says ethics should obey PnC!
You see a paradox and say "well that's not right, we should do something about it." This has been the story since Kant, but for his part, everyone seems to forget that he doesn't ultimately "solve" his antinomies, he just leaves them as conclusions, "effects of pure reason."
It seems way more unreasonable to assert that, in fact, there is some consistent, complete ethical framework out there, but we havent found it yet, than it is to just accept that some kernels of truth or sense are not formalizable in the classical sense.
> It seems way more unreasonable to assert that, in fact, there is some consistent, complete ethical framework out there, but we havent found it yet, than it is to just accept that some kernels of truth or sense are not formalizable in the classical sense.
We can prove that complete and consistent set of axioms for all mathematics is impossible. An equivalent proof for ethics would itself be useful.
However, we do not need to concern ourselves with infinite sets etc. for ethics the way we do with natural numbers, as there's only relatively (in mathematical terms) small number of real people to interact with or influence the lives of.
We may not be able to reach an optimal outcome with even a limited n, if it turns out to be akin to P != NP. But even knowing that, would itself be useful.
The problem I have with Utilitarianism isn't any of these things, it's that it's simply trying to maximise how much utility there is in the world, then immediately tripping over itself because the terms "utility", "maximise" and "the world" aren't well-defined, and the way it is introduced is simply adding up.
Mere addition, as mentioned by the other user is the primary one I was referring to, but breaking different approaches to utilitarianism only requires one to take them to their extremes.
If average welfare of humans is all that matters, then one happy human living alone in the universe is the equivalent of a million happy humans.
If sum of "welfare" is all that matters, then you can argue an exceptionally large number of people being tortured indefinitely is better than a happy person.
> In short, some would argue suffering is multiplied by the number of sentient beings that experience it
Factored by how cute the animal is. As a producer of plants for human consumption, it's quite obvious that orders of magnitude more animals are harmed in that process than are ever harmed in traditional meat production. But they're mostly ugly insects, so nobody cares.
While this entire chain of thought seems a bit far fetched, I think the reasoning here is that if you lower the demand for meat, you don’t have to resort to factory farming.
I went through a period of vegetarianism (for health reasons, not directly for ethics), and once I started eating meat again, 1. I eat a lot less, which 2. means that I can be much more intentional about sourcing it.
Right now the bulk of the meat that I eat at home throughout the year comes from 1 or 2 animals that are locally sourced and butchered (normally I share a portion of a pig and a cow), and the occasional wild caught fish. The meat is tastier, and I can go see the actual animals at the farm if I so choose. They are not factory farmed, and the price per pound is about the same as buying industrial meat at the grocery store since I am buying directly from the farmer, and paying a local processor for their services.
As things wane in popularity it might be true that they become more of a commodity, or it might be true that they become more of a niche product where people care more.
I would like to think that if meat consumption becomes more of a treat than an everyday thing, that people would treat it as such, and go out of their way to eat something that tastes better.
I would hope this happens, but merely having fewer animals alive in factory farming conditions would be a welfare gain from me because I think a factory farmed animal's life falls below the "life is worth living" threshold. YMMV.
Maybe. There is some evidence that the decline in fertility rates are associated with overweight and obesity. Social and biological factors leave having children more difficult when one is outside of a "normal" weight range. If everyone is on Ozempic, they might have more children, requiring more overall food and harming even more animals in the process.
> If everyone is on Ozempic, they might have more children, requiring more overall food and harming even more animals in the process.
It's reported it reduces a series of impulsive behaviours. Would it extend to sex? If people are less willing to have sex, maybe broad consumption of the medicine will further drop fertility rates.
I think the assertion that "eating less usually means eating less meat" is probably false (though I couldn't read the article cuz paywall).
The first article talks plenty about why: people are eating less of the the things that are addictive to them, such as alcohol and cookies, which are a major source of calories.
Yay, more dependence on the people that are causing the problems to begin with!
I swear covid was a personality test. If you came out of the last 4 years and are looking for more dependence on government and pharma… well, the horseshoe is a V I guess.
As every conversation with weigth management/obesity treatment, there are still people thinking that just more willing power / better habits is what's needed.
To those people I suggest you run an experiment : what ever your current body weigth is right now. Try loosing and keeping off 20%.
Because they seem have a society deeply structured around health, exercise and good eating habits. And they tend to have a "just do X, it's so easy" kind of attitude, forgetting they are benefitting massively from their environment and society and not just will power alone
I find it fascinating how many things like this just completely gloss over the fact that some people have side-effects to these drugs that make them completely non-useable, and often it's some of the people who could most benefit.
I have ADHD, and have tried all the current generation of these drugs and absolutely CANNOT take them, they basically prevent my ADHD medication from working and I end up depressed and wanting to kill myself.
This idea of these drugs being a "cure-all" that we'll all just be taking one day proactively scares the shit out of me, because I worry it will mean that medical science will stall (as far as it relates to these types of conditions) for those of us who simply can't take these drugs.
One thing that it seems we are just starting to talk about with these drugs is the associated muscle and bone density loss. I'm concerned that this generation of GLP-1 early adopters will wind up more frail and suffer a lower quality of life in old age as a result.
Yes, but you would certainly still see some - it's just a consequence of weight loss. Even IFBB bodybuilders on god knows how many steroids see some muscle loss when cutting.
Eat a whole lot of protein, lift, and you're going to be doing more than fine in the muscle loss department.
My program strongly recommends some form of muscle training (pushups/weights/etc) as they see improvements from muscle development for weight loss and to counteract the muscle loss from losing weight.
The fact remains that having to carry around 50+ extra pounds of fat requires more muscle. When that requirement goes away so does your need for that musculature.
I've seen zero evidence that muscle loss from GLP-1-assisted weight-loss is any different to the muscle loss from simply eating less. Do you have a link to a study I've missed?
I'm 42 and I've never taken more than the odd painkiller or antibiotic here or there - less than a pill a year on average I'm sure.
The last thing in the world I want is to be permanently on some drug that alters how my body works. I hike, snowboard, go to the gym and eat sensibly. That's all the "weight control" I need.
` I hike, snowboard, go to the gym and eat sensibly. That's all the "weight control" I need.`
So you are likely in an income bracket that enables you to have an active lifestyle outside of work and take the time outside of work to cook, in addition to probably other hobbies. this is not a criticism of you, but if I had to guess, you simply have a life that many other's do not. I work out and take care of myself because I make $300k+, have less worries and responsibilities, and I actually have an easier job than when I was making less.
A lot of people don't have money or don't have the time for working out and making the correct meal choices. Yes, there are people who have money and time and are still overweight, however that is not the norm as you go up the income brackets. Many poorer people have long work days, with an additional long commute, and are more likely to have kids, meaning they have no time for themselves. They're not gonna go to the gym if they already have a long day and they probably aren't going to make healthy food choices when they're already beat up and have not a lot of time for themselves.
That's so dystopian. So you are just saying that society doesn't have time to take care of themselves, so we need some drugs to fix our collective horrid lifestyles? It's an easy temporary fix but what cascading effects might that cause on the future? Who knows?
Well, I'm describing how I perceive the world to be right now and ozempic is a technological solution to a societal problem. If as a society we can make steps to fix it (more walkable cities, less work in general, cheaper society, encourage smaller portions) then sure, maybe we don't need ozempic. But people have to organize and get involved in government to make this happen, which is harder than making a pill (it seems).
What society does or does not do has no impact on me consuming less calories on a daily basis.
I have the opportunity to buy soda 50 times a day. I choose not to.
I have the opportunity to buy a burger and fries for lunch. I choose not to.
Society could make many such things illegal or whatever, but at the end of the day what goes into my body is up to me. The buck stops with me and my choices.
In the moment yes. Do you have an actually reasonable set of laws that could solve these societal level problems that encourage obesity in let's say, the next ten years? Also, they have to be passable.
Here is another disease caused and triggered by society. Asthma. Cars cause tons of pollution and people who live near highways are at much greater risk of experiencing asthma. However, society as a whole suffers from the pollution generated by cars. We all know this. The bay area has something called "spare the air day" which is a day where they ask people to not drive, when it's particularly smoggy. This has never worked. There are always people driving, because they gotta get places and the bay area can't built trains and the buses are awful. So people drive. What is the societal solution to localized pollution (like smog)? Better public transit, higher taxes on gas and on larger vehicles which produce more tire based pollution, and more tolls. But we don't do any of that. We know as a society how to reduce car based smog, which would reduce asthma and other diseases, but we don't do it, so we throw inhalers at people to get them to stop complaining. It's not super different from the weight problem in my eyes.
> Do you have an actually reasonable set of laws that could solve these societal level problems that encourage obesity in let's say, the next ten years?
Sure, Canada banned trans fat.
There is absolutely no reason they couldn't ban drinks that contain more than x% sugar, or portion sizes that are bigger than y calories.
> Here is another disease caused and triggered by society. Asthma. Cars cause tons of pollution
Excellent example!
Internal Combustion Engines will be illegal in new vehicles from 2030 in many jurisdictions around the world (2035 in others).
Yes, it's coming!
Tire and brake particulate is actually a big component of pollution and EVs will cause more pollution from tire and brake debris, which is already a larger portion of pollution than tail pipe emitions. We're increasing one type of pollution and decreasing another type, we'll see if long term it's a net benefit.
Also, they could ban those things in places like SF or more liberal places, however I believe those are politically losing policies and wouldn't pass in places that are actually experiencing obesity.
25% is the number you were looking for, and even within that group I think you'd find plenty of people with a healthy BMI that are in fact not living a healthy lifestyle.
I think it's a lot simpler than that. US has an abusive relationship with junk/processed food. It's so deeply ingrained due to profit margins, wealth inequities, nonsensical subsidies, etc. that the only feasible solution is to introduce a drug that continues to allow that relationship to continue.
It's a lot easier of a solution than it is to tell companies to stop making garbage or saturating everything with sugar and HFCS. "Easier to see end of the world than end to capitalism" -- its the same shit packaged in a different story... Easier to introduce a drug to treat the symptoms than to solve the actual problem.
Mind you, I'm not implying that it is easy. We have collectively accepted this which makes change difficult if not impossible.
My pet crackpot theory is that within the next 100 years semaglutide is going to be in the drinking water (much like fluoride) because the benefit to society is going to be too hard to pass up on. However, it seems that it's delivered via injection so maybe putting it in the water supply wouldn't even be effective.
It's also relative uncommon in other developed countries; according to Wikipedia, "Out of a population of about three-quarters of a billion, under 14 million people (approximately 2%) in Europe receive artificially-fluoridated water. Those people are in the UK (5,797,000), Republic of Ireland (4,780,000), Spain (4,250,000), and Serbia (300,000)."
The funny thing is that if you live in Portland, famously one of the few large cities without fluoride in the water, the dentist can immediately tell if you grew up here.
I would guess that in today's world a lot of people get enough fluoride through processed foods being made in places that have fluoridated water.
One other note: the current peptide-based GLP-1 drugs are not likely to be the permanent solution. Injectables are just too problematic for that.
Several companies are now working on more classic small-molecule drugs targeting the same receptors. So it's likely that in several years we'll get a pill with the same effects.
Yes, there's technically a pill version of Ozempic already (Rybelsus), but it works by making the stomach wall to be slightly permeable to peptides. You can guess that it has pretty unpleasant side effects, and an awesome bioavailability of 0.7%
I'm curious what about injectables makes them specifically problematic for long term use? Diabetics already have to inject insulin for the rest of their lives, and an injectable version of the same drug usually has fewer side effects since it doesn't have to pass through your gut metabolism. I may be biased, I have no fear of needles and have injected myself with sex hormones every week for nearly 7 years, so adding an autoinjector doesn't seem like that big a deal to me.
They are more expensive. Autoinjectors are way more complicated than a pill bottle. You also can't freeze them, but they should be kept in a fridge.
Manufacturing standards also have to be way higher. I have no problem trusting Novo Nordisk to manufacture injectors safely, but I won't trust a random manufacturer from India or China.
The risk of accidental infection from injection also is not neglibible.
Fair considerations, I just disagree that it makes injections inherently problematic for long term use. Primarily because I have doubts about the possibility of a pill that doesn't come with more side effects than an equivalent injectable.
Ozempic is just scratching the surface, the pipeline is bursting...
>...combinations of GLP-1 with other entero-pancreatic hormones with complementary actions and/or synergistic potential (such as glucose-dependent insulinotropic polypeptide (GIP), glucagon, and amylin) are under investigation to enhance the WL and cardiometabolic benefits of GLP-1 RA.
Thanks for sharing that link. Retatrutide looks especially promising since it targets three different receptors (GLP-1, GIP, and glucagon) instead of just GLP-1 like Ozempic. This triple action appears to have a more comprehensive effect on metabolism. So it may increase energy expenditure in addition to reducing calorie intake. This drug also showed significant improvements in lipid profiles, blood pressure, and liver fat reduction. If all goes well we should expect to have it in 3-4 years.
There are some concerns with retatrutide - it's popular among the bolder people willing to buy it as a research chemical, and both their reports and the clinical trials do show significantly higher resting heart rates as a common side effect.
Not a huge deal for people that have good heart health already, but since obesity tends to cause poor heart health...
I expect we'll still get it approved for weight loss use, but it'll be one that is going to take more observation on the patients using it
This article seems to frame things in such a strange way. Maybe instead of trying to get everyone obesity medication, we can instead educate society so we all understand nutrition and diet and can combat the ever-persistent forces of corporations pushing unhealthy food on us?
Do you think overweight people don't know why they're overweight?
There are plenty of obese people that understand nutrition just fine, there are obese people who understand it well enough to have lost significant weight and gained it all back.
Clearly there is something else going on that we haven't grasped yet.
Understanding nutrition, and eating habits in practice, are two very different things.
Regaining weight is the primary issue really. Most people are capable of losing weight, but gain it back, and it gets harder going forward. Metabolic adaptation is better understood now and among the factors (.e.g increasing caloric intake too quickly after weight loss), but falling into old habits that are culturally ubiquitous is a glaring part of the problem.
Former drug addicts are told now to sever contact with peers who partook in those indulgences as they're likely to pull them back in. With food, it can be more than a minor subculture. There are regions of the US that have much higher obesity rates than others. Not having family members and a romantic partner on board can be difficult.
That’s kinda part of my point. Cutting yourself off from drug enablers is one thing. Cutting yourself off from your friends and family is another. Especially since eating is something you can’t not do, and is deeply tied to cultural and social customs of everyone. It is impossible to live and never be offered an unhealthy food choice no matter how much support and good decisions there are. Conversely, it is very easy to live my life without being offered heroin.
Plenty of overweight people really, really, really want to lose weight and do all of the right things, but report that it is difficult to impossible to maintain the weight loss. Many of them gain the weight back, and this is crucial, but don’t continue gaining past a certain point. Combine that with the very regional nature of obesity and I think that there is a VERY strong case to be made that there is an environmental or external cause of obesity that we haven’t identified yet (junk food is too simple of an explanation, and doesn’t adequately explain everything).
The point I’m getting at is that a lot of these drugs also yield some sort of drastic behavioral change like a reduced indulgence in other impulsive harmful behaviors. I really think that there is something that is throwing us out of whack behaviorally, and obesity is a symptom of that.
The fact that a hormonal correction is able to fix both obesity and other addictions is a very interesting result.
> Cutting yourself off from your friends and family is another.
This is exactly one of the reasons I think better education around food/diet/nutrition is important. You don't need to cut yourself off from enabler family/friends if they aren't enablers to begin with. It's cultural, too. The portion sizes at all the restaurants in a given region because "we like to eat big meals here", or whatever. There are sooo many factors and the underlying flaw, to me, is ignorance of "how this stuff works".
> external cause of obesity that we haven’t identified yet (junk food is too simple of an explanation, and doesn’t adequately explain everything).
You can't divorce it from the explanation. People get obese from overconsuming calorie-dense rich foods. These products are manufactured to be as savory and addictive as possible, are highly available, and convenient, and very affordable, and most are non-satiating (especially drinks). So yes there are environmental factors, but the reason they matter in the first place is the impact of junk foods. At the turn of the 20th century even relatively sedentary office workers would not gain much weight, because the American industrial machine did not yet create the landscape we have now. No one was buying several bottles of 2L coke, chip bags, jumbo fries and fried chicken, greasy pizza, starbucks lattes, etc.
And to avoid confusion, I want to make clear that avoiding weight-gain at the outset (to the extent of becoming obese), and losing weight, are different. What's sufficient for the former is insufficient for the latter; you do not need to be mindful of energy balance if you are already at a healthy weight and consume whole foods, but if you are trying to lose weight, that will not be enough to ensure a caloric deficit.
A comparison I like is a bag of chips vs a bag of apples. Bags of potato chips average 1200 calories. One would need to consume 16 apples to get the equivalent. I can probably get through an entire bag of chips if I cared to, and more than half a bag absent-mindedly if I was irresponsible. Try consuming more than a single large apple and see how that feels. Fiber is almost as satiating as protein. It may not keep you full as long, but you certainly reach satiety a lot faster than you would with chips (notwithstanding that in fairness they are less addictive without salt and fat).
Education may involve "finding a strategy that works for you". There are so, so many different ways to combat disordered eating. These are learnable things. My thought around "better education" is that the cycle of disordered eating can be stopped at some point before parents pass it on to their kids, at least (as I just posted in adjacent comment https://news.ycombinator.com/item?id=41811916 ). I absolutely recognize how insanely difficult it is to come back from disordered eating and stay at a lower weight after finally reaching it.
Though, now that you ask, I do think that many people don't actually know why they are overweight. They say it's because "McDonald's is cheaper than buying good food", not realizing the McDonalds won't satiate them and they will eat/spend more because their body is starved for proper nutrition. Watch the series "Supersize vs. Superskinny" and observe how nearly every participant is utterly clueless as to the underlying causes of their challenges on either size of the disordered-eating scale.
From my subjective experience in life, what they very often lacked was parents who set the right examples around food. I know that doesn't apply to everyone of course, but I've witnessed it time and time again - an upbringing with deeply disordered routines/practices around food. It's universal among obese people in my life. I speculate that better awareness of diet/nutrition might help to prevent passing on such behaviours, like not feeding the family exclusively a bucket of KFC or McDonalds, or using food as a reward, etc. etc.. I mean, medication won't actually solve what is caused by behaviour, right? Maybe the behaviour can be reduced on a broader scale, over time, via people making better-informed decisions? If parents know their habits around food are basically ensuring their kids will struggle with obesity, maybe they'll make the effort to do something different? Dunno, it seems like a reasonable consideration.
> From my subjective experience in life, what they very often lacked was parents who set the right examples around food.
No amount of education will change who your parents were or how you were raised. Have you observed a strong correlation between how well educated someone is vs. obesity?
> I speculate that better awareness of diet/nutrition might help to prevent passing on such behaviours, like not feeding the family exclusively a bucket of KFC or McDonalds, or using food as a reward, etc. etc.
I'd encourage you to talk to any reasonably intelligent obese parent to see if they need better awareness of diet/nutrition. Better still, do a survey of obese and non-obese people to compare awareness of diet/nutrition between the two groups.
> I mean, medication won't actually solve what is caused by behaviour, right?
Saying that obesity is caused by behaviour and therefore can't be solved with medication is a bold statement to make in the context of a story about a drug that has been clinically proven to help obese people to lose weight.
Medication is often prescribed to help people who suffer from behavioural problems with positive results. I wouldn't presume medication can solve all problems caused by behaviour, but there is empirical evidence that for some problems it does help. As near as we can tell, human behaviour is regulated by a electrochemical brain & nervous system. Dumping chemicals into that system can of course change human behaviour. We see evidence of that (for better or for worse) all the time. If you have doubts and you don't even need to get a prescription, try taking a hit of acid/cocaine/alchohol and see if behaviour changes.
> If parents know their habits around food are basically ensuring their kids will struggle with obesity, maybe they'll make the effort to do something different?
The US has had a dramatic increase in obesity within a single generation (as in, people who were not obese for much of their lives have become morbidly obese at a rate far exceeding previous generations), let alone cross generational. While food/nutrition/health habits can certainly have a profound effect on someone's weight, there are clearly other factors at play.
Consider, for a moment, the reality of an obese person living in the US today. You get negative feedback about your weight all the time. You suffer negative social outcomes, let alone all the physical ones, so few, if any, want to be obese. There is no lack of motivation to seek out information on how to avoid being obese. There's a $300+ billion industry diet/health/nutrition industry constantly seeking to inform you about products they offer to help with your diet/health/nutrition... and that's not counting the doctors that you are no doubt interacting with regularly. Of course, that's not counting all the education (solicited or otherwise) you get from friends, family, acquaintances and even random strangers. It's hard to get through a day without being "educated" about diet, nutrition and health.
There's a cultural bias to think the problem is simply about behavioural/willpower/education, much the same way we look at poverty. It demonstrates a profound lack of understanding of and empathy for the plight of people who are suffering from obesity.
I didn't say "obesity is caused by behaviour and therefore can't be solved with medication". You're arguing against a straw man. I'm suggesting the idea that maybe we as a society should better educate around our relationship with food. I believe it would make a difference - just not immediately.
You're right. You didn't say that. You said (and I quoted) "I mean, medication won't actually solve what is caused by behaviour, right?" in commentary to an article about a medication used to treat obesity, while discussing the need for better awareness about food/nutrition.
> I'm suggesting the idea that maybe we as a society should better educate around our relationship with food. I believe it would make a difference - just not immediately.
It's a bit tautological that if we did something better things would be better. Better education around our relationship with food would start with people understanding that better education about our relationship with food won't help people suffering from obesity.
Yeah, my original post is focused on the idea that "getting everyone on ozempic" isn't a long-term sustainable solution to obesity. It is a reactive, band-aid workaround that will never tackle the underlying causes. It will help someone survive and live a better life, but the moment they stop taking ozempic they are back at square one, haven't gained the wherewithal/discipline to fight the constant urges to eat, and will be right back where they started. I mean, unless this is some miracle drug that has residual/lasting effects?
In light of that, and barring the many other ways one can combat obesity themselves, it would probably be beneficial if everyone, in general, knew all about the pitfalls of disordered eating and knew more about how to combat that trap, and knew why that actually matters for themselves and the people they care about. I've observed people enable each others' obesity over and over. I've observed people reinforce horrible habits and be unsupportive of others' efforts to combat those habits. People don't know shit about diet and food and spread their ignorant, lazy attitudes and behaviour to those around them. Why make a real meal when you can just order $50 of takeout to feed the whole party? Then, if you don't eat "enough", everyone is on your case because "you must be starving" and "why are you eating so little?", because they are totally uneducated about the possible challenges people face when it comes to food. The more people know about this stuff, the more it benefits everyone. I still think this also circles back to the "passing it to your kids" thing, because it's now a multi-generational problem.
Unfortunately companies make more profit by pushing unhealthy food onto consumers which can be evidenced by the money they spend advertising it. They're exploiting our instincts to seek out high calorie foods which was an advantage when humans didn't have a ready supply of food available at all times, but nowadays leads to a whole host of illnesses.
Maybe we should try educate society on dangers of using heroin. I agree that it is a good thing, and we should continue educating people about its dangers. But clearly that alone didn’t solve the problem, and I think it would be a good idea to utilize alternative options as well (in addition to continuing the education of society on its dangers).
In EU they banned the sale of oral tobacco (snus), which is safer than smoking tobacco. Snus once had cancer labeling but that was generally considered not-very-true and labeling was removed. Tobacco smoke causes cancer. Drug bans also built many overfilled prisons and likely contributed to the invention and spread of harmful drugs such as crystal meth and fentanyl. This is a one sided view of course. I like William Blakes work, "Auguries of Innocence".
If educating people didn't work, we'd all be drinking cocaine soda and burning leaded fuel. I mean, there's a reason things have generally greatly improved over time for most of humanity. We know more things and act upon that knowledge. This applies to basically every single thing humans do. Maybe one day we won't be drinking sugar water and adulterating ~every piece of food on the shelf with high-fructose corn syrup?
> If educating people didn't work, we'd all be drinking cocaine soda and burning leaded fuel.
When the person you are arguing with is saying that government induced bans would probably help more, and your are arguing they're wrong and your two examples were resolved by government induced bans, you're going about arguing in a very strange way.
I don’t want this to come out insensitive or from under the rock, but why is taking a drug a novel & cool idea (all of a sudden/recently) as opposed to good old fashioned working out and not eating more than what you need? okay, this drug is all kinds of great and it’s the next best thing since green grapes, still not eating more and workout is better than taking drugs that effect your brain right? Are doctors required to explain this before prescribing this in US?
In 2021 I lost a good chunk of weight the old fashioned way. From 250ish to 215. I did it with "good old fashioned working out and not eating more". It was a miserable, white-knuckle experience. I was eating healthy food, enough calories (moderate but sane deficit), but the only thing I thought about at all moments was getting to the next meal. What snack is low enough calories to have to make it. It was miserable. As soon as I let up a bit, everything unraveled and I found myself back in the 250s by the start of this year.
Now I'm on Tirzepatide (Zepbound), and I'm back to 235ish, and trending lower. I still work on eating healthy, but now I'm not just HUNGRY at all moments. My life continues, and I only have to make individual healthy choices at meal times, and grocery times, rather than a constant struggle at all waking moments. It's seriously a big difference.
> I still work on eating healthy, but now I'm not just HUNGRY at all moments.
I think this is something a lot of people pushing back against the GLP-1 agonists don't realize because they don't experience it: back before I started Mounjaro (another GLP-1 agonist) I was constantly hungry if I hadn't eaten a meal in the last 45 minutes. Absolutely zero hyperbole there - I once went to an all you can eat buffet, ate until I was over full, came home, and within about an hour and a half of that I was snacking on something because I was hungry. Not peckish. Not "feeling like a snack". Hungry to the point where that feeling intruded on my every thought until it was sated.
After starting Mounjaro that's GONE. Gone gone. I now have to set an alarm to remember to eat. It's absolutely phenomenal and likely the reason why I'll live past my forties instead of being stuck in that same cycle and dying of the effects of obesity.
> Absolutely zero hyperbole there - I once went to an all you can eat buffet, ate until I was over full, came home, and within about an hour and a half of that I was snacking on something because I was hungry.
I don't have any eating issues but that reminds me of the first time I went on a 7-day cruise.
There's nothing to do on the ship, and the food is free and pretty tasty, so... I basically ended up at the buffet eating and drinking all day long. Sausage and egg biscuits, banana bread, pot roast, steak, pasta, fried rice, cinnamon buns, they had everything. I was stomach-busting full, every minute of every day. I'd gorge myself on a huge plate of Indian food from the buffet, and then a few hours later head to another deck for a lobster dinner. Not to mention, drinking coffee, beer, and wine the entire time.
It was kind of insane. And what was crazier was after a few days of this routine I got used to it, and even looked forward to eating more food the next day. It was sort of like directly embracing one of the seven deadly sins to the maximum extent possible. I'm not sure what that experience means other than it seems like the the human body can comfortably arrange itself into a habitual downward cycle fairly rapidly.
It's because we're evolved for boom-bust cycles. Give it another 500,000 or so years and humans might evolve to cope with food always being available at all times.
Not only that, but type 2 diabetes makes you paradoxically more hungry - your body thinks it is starving because it cannot get sugar into its cells so it makes you MORE hungry which causes you to get heavier which often causes the diabetes to get worse which makes you MORE hungry which means you eat and get heavier and......
As someone who's never struggled with weight, it's been eye opening to hear how food focused a lot of peoples thoughts are. It was like on the same level as finding out some people can't visualize things in their minds.
Saying that the cure for obesity is to eat less is like saying that the cure for heroin addiction is to stop using heroin. It's both clearly true, and also useless.
And yet most obese people are no more addicted to food than you are addicted to oxygen...
It's so bizarre how many people will pretzel their way into moralistic non sense to find a solution to what is clearly a medical problem.
Obesity as far as we understanding it now is an hunger regulation problem. For unknown reason a lot of people still feel the need to eat even when their body is clearly in calory surplus.
No amount of of impulse control or moderation can make you override billions of years of evolution and not eat when you are starving... if we could... society would be a very different place
> For unknown reason a lot of people still feel the need to eat even when their body is clearly in calory surplus.
Boredom, stress, unhappy life, happy life, laziness - it could be anything. You know what it couldn’t be? Exercise. I’m yet to see a person working out hard and eating at the same time.
> I’m yet to see a person working out hard and eating at the same time.
No, but plenty of people have their hunger stimulated by exercise and eat too much after.
You simply can't fix being overweight or obese with exercise alone in the vast majority of people. Even if you don't believe in the constrained total energy model that a good chunk of metabolic research PhDs think is at least somewhat true and instead believe solely in the additive model, exercise stimulates hunger and it's far easier to eat 1000 calories than burn 1000 calories.
You have to do both and exercise doesn't automatically make the other easy.
My theory is that consuming sugar makes you more hungry. You can eat until you're full, but if you eat desert or a sugary snack a little later, it makes you feel less full and you can eat more. As if your brain notices the sugar source and switches into "full loading mode" and craves more of this historically rare resource.
> And yet most obese people are no more addicted to food than you are addicted to oxygen...
Most obese people seem to be addicted to sugary food, soft drings, desert and all that, which then triggers more eating.
In addition, it might be a gut bacteria thing. If your gut is used to processing lots of sugar, you crave it even more and fighting your gut microbiome requires way too much impulse control and moderation.
The solution might be to recognize this mechanism, remove all sugar from the diet and find a way to control impulses for a few weeks until the gut bacteria changed.
Drinking water and chewing sugar-free gum helps me to remove food cravings temporarily with no downsides. But... I have a normal weight.
I think insulin resistance from excess calorie and carbohydrate consumption has a lot to do with it. One of the symptoms of hyperglycemia is increased hunger, since glucose is staying in your blood stream instead of getting into your cells. 1/3 Americans have prediabetes, and more than that are probably developing insulin resistance.
Ok, in the US start talking about food addiction seriously and see what happens.
Do you remember how long it took to get tobacco mostly banned in the US? Do you remember how much the tobacco industry played the skeptic and introduced bunk science into the mix?
Well Coca Cola, Pepsico, Nestle, and all the other junk food companies have been on this game for years now. Want to change school curriculum?, well your political opponent has $100,000-$1,000,000 more than you from the make people fat industry. Meanwhile there are a crazy number of attack ads against you for being a crazy commie that wants to control peoples lives, you socialist bastard, you're against freedom.
Well, of course if you’ve been jacking heroin for 30 years and all your veins are destroyed beyond repair it’s useless. It’ll take as much, or even more, to return back to normal.
Heroin changes brain chemically, it's (more) serious addiction than obesity, again being a little insensitive to obese people, but they're bad in comparison. And there are degrees of truthfulness & wrongness right!
About the point you're making, two generations before you and me, people where fit, more attentive & generally healthy (outside vaccines that prevent diseases now & positive effects due to advancements in medicine), what changed?
Not as platitude, but go from first principles, the choices you make everyday effects your mind (& the time you spend on particular activities), and if they aren't life affirming (for lack of better words), in due time you limit your options (ie less choices from your mind, bad food or less bad food or multiple bad ways to spend your time?), till you proclaim from high top mountains 'oh god, I'm helpless without acceptance from some higher power!'
This isn't to say, I'll be as preachy and asshole(ish) to a friend or someone I care about in similar need, I'll probably say 'seek medical help etc' like you. But thinking things through & arriving at truth is important, don't you think?
This is different to mental strength or controlling yourself etc, it's more about self reflection & freedom through discipline, respecting your life, decisions & thoughts more than your impulsive emotions in an ever distracting world, that kind of thing..
I don't think I'll change your mind or this will come across in good faith, that's okay, I'm in a reflective mood, and it's awfully chilly outside :-)
>About the point you're making, two generations before you and me, people where fit, more attentive & generally healthy
Everything.
Two generations ago you didn't eat out 4+ times per week. Portion sizes at restaurants were 50%+ smaller. Food sciences were not as optimized at making junk food as they are today. In general we were poorer and bought less junk food. We were more apt to work jobs that didn't involve sitting in one place for long periods of time.
>I don't think I'll change your mind or this will come across in good faith
I believe it's what you think, but when 74% of the population doesn't subscribe your philosophy then you're tilting at windmills. Yea, maybe someday people will catch on to that and all will be good, but that's not the way the entire world is going. We need solutions we can enact now to solve problems we have now.
> About the point you're making, 2 generations before you and me, people where fit, more attentive & generally healthy (outside vaccines that prevent diseases now & positive effects due to advancements in medicine), what changed?
Air pollution, water quality, pestecide, food/produce quality, plastic particule everywhere...
I find this perspective so bizarre.
Whats the most probable in 2 generation of exponentially increasing and barely regulated technological changes : culture has change so dramatically as to change human nature and makes us all lazy... or... something in the environment/food chain is having phisiolical/biological effects...
People living in country side & eating from organic farming, they're doing alright (similar to our closest ancestors), but that's beside the point
Cultural change over 2/3 even 10 generations will not significantly alter your biology. Pollution & disintegration in modern world you're referring to, they do have negative effects on our health, but it's not the whole story and they possibly cannot have effects on your decisions about what you eat and how you spend your time right?
I'm particularly referring to obesity caused by over eating, bad life style etc (not the other rare serious persistent irreversible kind that happens as side effect of more serious ailments or genetics)
I can't quite understand if you are agreeing or disagreeing with me...
You seem to be restating my point as if you are contradicting my statements.
> People living in country side & eating from organic farming, they're doing alright (similar to our closest ancestors), but that's beside the point
Maybe ( I would love to see some sources for this assertion). But even if I give that to you, you basically saying that modern environment are somewhat obisidigenic... which is what I was saying.
> Cultural change over 2/3 even 10 generations will not significantly alter your biology.
Okay... same., still just restating what i have said.
> they possibly cannot have effects on your decisions about what you eat and how you spend your time right?
They can and they do... let me introduce you to lead in paint and in the environment...
> particularly referring to obesity caused by over eating
All obesity is cause by over eating (all most by definition) the point here is that over eating is not cause by lack of will power or poor decision making
I don't think I've ever seen someone seriously put forth the argument "all you need is Ozempic".
For context: I am an overweight type 2 diabetic. I lost about 70 lbs before my doctor started me on Mounjaro (another GLP-1 agonist). My diet and exercise routine were far from perfect, and it took me about a year to lose that weight. My doctor started me on Mounjaro, both for type 2 diabetes and weight loss. I have lost 20 lbs in about a month on it, which means I will lose three times the weight if that pace keeps up (very unlikely). When my doctor and I discussed starting Mounjaro (which the doctor suggested, not me) he made it very, VERY clear that diet and exercise were important things to work on as the weight came off.
The key there is that the pace of weight loss will not keep up as the body's caloric needs reduce due to that weight loss. So naturally a GLP-1 user will plateau if they do not adjust their diet (and potentially exercise routine, though diet is much more important) as the weight comes off. You know what really makes it easier to have the energy to a healthy meal, to work out, and to take care of yourself? Losing weight! You know what helps form those healthy habits in people who did not form them during childhood? Reduced cravings for calorie dense food! Both of those things are where Ozempic and other GLP-1 drugs shine. It gives the person on them the space to make those changes without cravings, without feeling hungry, and at a faster pace than they could do naturally.
So yes, in the short term, these drugs are a great catalyst for change, but I don't see many medical professionals saying "oh just stick someone on Ozempic for life and that's that!" because for the vast majority of people who would use those drugs for weight loss cannot achieve their goals with just the drug alone.
Because not everyone has willpower and discipline. People who do have those strengths often think it is just as simple as saying, "Just take care of yourself", but it is not that easy for many people. High blood sugar also increases cravings, which makes it even harder, bringing on a downward spiral.
This drug can help break out of that spiral and fix the craving/willpower problems.
I don't think it's just people who have willpower and discipline, it seems to me that for most people it doesn't take as much willpower and discipline to stay at a reasonable weight. These arguments make it sound as if everyone who is at a reasonable weight is there through large amounts of willpower and discipline, but most people I know don't need to exercise X times per week and constantly watch what they eat to keep that weight.
It's much easier when you can trust your body feedback and rely on your regular hunger signals, but for most people who benefit from Ozempic for weight loss if they just trust their bodies they will get fat.
Yea, when you look historically, starvation and food shortages were the norm. If you were a person that could pack on the pounds during the bountiful times, you could survive the lean times. Suddenly we live in the times of never ending plenty and we're told "what's wrong with you".
what you say is mostly true, but I will point out that it does not break any spiral. It’s frequently reported that as soon as you stop taking Ozempic, the weight comes back immediately. so unless one resolves the underlying problem, you will be on this drug for life.
That's not unique to Ozempic and (while I know you didn't make this specific argument, but others in this subthread have) is a piss poor reason to tell someone they shouldn't give it a try.
i don’t disagree. Just pointing out that (obviously) this should be a last resort drug. AFTER someone has tried lifestyle interventions for a few years IMO.
The problem is when someone does NOT put in the effort to talk to their doctor, meet with a dietician, learn about healthy eating, and put in an honest effort to improve their life before just popping a pill.
That said, i think it’s great that’s it’s helping people who otherwise would just be obese and have many other health issues due to that. It’s a big risk factor.
This isn't the revelation you think it is. Chronic medical conditions require lifetime treatment. That isn't news to anyone.
It's funny how obesity is the only chronic medical condition that garners a huge volume of your particular kind of comment.
Would you be mentioning this for someone prescribed a diabetic, blood pressure or cholesterol medication? Statistically, likely not. So maybe take a step back, and examine why are you so averse to other people losing weight with medication.
i actually would, if they were caused by bad lifestyle habits or similar issues. I am a firm believer that medication should be used AFTER a serious attempt has been made to address the underlying issue, if possible.
if you are type 2 diabetic, that means you’ve probably been eating poorly for a long time. The happy path here is that one goes to a checkup and learns they are pre-diabetic, and their PCP refers them to a dietician. The patient hopefully learns how to make healthy food choices for themselves. All of this so they don’t develop type 2 diabetes. Maybe even temporarily prescribe a low metformin dose while they figure out the lifestyle changes needed.
If they struggle and lifestyle interventions fail, then of course, they should be prescribed insulin so they don’t have further devastating complications as they get older.
The same can be said for ozempic. What kind of lunatic would suggest starting ozempic without FIRST giving honest education and lifestyle adjustments a try? That should be step 1. And i’m talking proper education from a licensed dietician, not silly blogs or advice people see on tiktok these days. If step 1 fails, proceed to medication.
That’s my perspective at least. Big pharma isn’t your friend. It’s a backup plan and a necessary evil in most cases (with obvious exceptions like vaccines, antibiotics, etc)
> What kind of lunatic would suggest starting ozempic without FIRST giving honest education and lifestyle adjustments a try?
What kind of lunatic would suggest an approach that evidence does not support as being effective? Lifestyle modification, at the population level, just doesn't work. GLP-1 agonists do.
I see the point in this, but do you think it’s marketed as such and perhaps better question, used for exactly that and not more by vulnerable patients etc? (not well informed about long term side effects, some might even be unknown, if I might add)
I take my vaccines and generally gravitate to sanity over conspiracy stuff (that is to say, If I sound like that, i’m not)
A society where over half the population is suffering from the same problem is one that needs systemic change. It doesn't make sense to blame the individual when it's a problem affecting everyone.
Every country skinnier than the US is getting faster. Europe is on a linear trajectory upward that hasn't changed since at least 1975. Even the Japanese are getting fatter every year.
Why doesn't everyone play piano? Why isn't every person a super athlete? Why doesn't everyone meditate 40 minutes a day? Why doesn't everyone study super hard in school and become an engineer or doctor or lawyer?
The hard truth: Not everyone is capable of those things. Period.
40% of the US population is considered obese. That is a HUGE number. At a certain point, you can no longer blame individuals. There is something wrong, and we identify it as an environmental problem.
So if we have a drug that will make a huge amount of people healthy, what is the downside? And for the record: Ozempic affects appetite so they eat better, that is part of the drug.
> Why doesn't everyone play piano? Why isn't every person a super athlete? Why doesn't everyone meditate 40 minutes a day? Why doesn't everyone study super hard in school and become an engineer or doctor or lawyer?
The hard truth: Not everyone is capable of those things. Period.
We’re not talking about world class athlete. There a mile difference between world class athletes and not obese.
Willpower and discipline don’t seem to be what keeps other countries skinnier than the US (and most of them are also getting fatter…) so I don’t know why we expect that to get the US out of this mess.
Evidence: people from skinnier countries move here and consistently get fatter. It’s a societal/environmental problem, if we’re talking about “what would a policy fix look like?” and not “what can I personally try to do to save myself despite being up against a societal/environmental problem?”
Telling people they are morally bankrupt sinners (slothful and gluttonous) and heaping guilt and shame on their shoulders has unsurprisingly failed to stop the issue.
Why do you think that telling people to “just stop being fat” will suddenly start working?
Most people don't work out enough, or don't eat well enough. If we had some kind of intervention that would easily cause people to work out, we would use that intervention. If we had some kind of intervention that would easily cause people to eat well, we would use that intervention. The reason working out and good diet are good is because of good health outcomes. If we have some kind of intervention that skips straight to the good health outcomes, we would use that intervention. It seems like Ozempic is _that_ intervention, so we will use it. I will likely choose Ozempic for myself once it is available to me.
Treat human beings or any organisms as biological machines. Here, many chemicals (hormones, for instance) regulate many processes in such machines. Whatever one has eaten so far, genetic history, environment, etc have changed hormones to a level where the model of dieting and working out doesn't work any longer. So, semaglutide and tirzepatide work on such regulatory hormones (GLP-1, GIP). In other words, what this research tells us that humans are not controlled by their personal will.
drug companies have spent millions on destigmatizing pharmaceuticals. its a superpower, apparently. a large swath of this userbase convinced themselves they have adhd and need medication for it. changing tabs on your chrome browser or not being able to do "deep work" = i have an uncurable disease and i require legal meth, for life. you can see how this translates to ozempic.
silicon valley/tech culture has prioritized get rich schemes, cure alls like adhd meds, you don't have to eat just drink soylent for every meal, etc. ozempic falls in line nicely there, and i think among this community and others in this vein, you'll see alot of support for it. its sad, because tech/programmers/IT people use to be very contrarian and open minded. you get in trouble for saying things like "personality responsibility", "discipline', "self-control".
> Are doctors required to explain this before prescribing this in US?
doctors famously aren't trained on nutrition or fitness. ironically the prestige is being a specialist, not well rounded. strange.
Completely missing the point of GLP-1 agonists. The point is that it breaks the cycle by giving you the willpower to eat less. It doesn't magically make the calories you eat not contribute to your weight, it just makes it easier to eat less and still feel full. It also counteracts insulin resistance, which is another problem inherent to obesity.
It's just human nature. This is the health equivalent of trying to turn lead into gold. It's my unproven opinion that the negative effects of these treatments are understated and this will be a passing fad.
I want everyone who says this to submit a picture. Just wearing gym shorts, so we can get a good look. I assume nobody making this a moral issue will have so much as love handles. Because if they do, why aren't they working out harder and eating a bit less?
I've met plenty of skinny fat people who think they're healthy.
To anyone thinking that exercise will fix anything: I've owned a Concept 2 rowing machine since 2005. In that time I've done an average of 100 workouts per year, for a total of over 35 days of rowing. Some workouts were relatively easy 120bpm heart rate; some were at a relatively brutal 160bpm. Concept 2 estimates I've burned just over 600,000 calories, or about 1,000 Big Macs. Could I have eaten 1,000 Big Macs in 19 years? I think so.
I've had kettlebells, and I've lifted weights. But to be clear, I never said I have a "problem" -- I have a reasonable weight, and at times I've been in the top half of the worldwide rankings on Concept 2's site. I'm just saying that rowing isn't (solely, if we're going to be picky) the reason I have a reasonable weight.
I don't share the American enthusiasm for pharmaceuticals. Exercise and healthy eating. I also don't have the other issues mentioned. Maybe the title is a bit clickbaity and I shouldn't be taking it so literally.
I hope that these drugs pull people back from nasty habits such that they eventually build the strength to do without them. As of yet, I do not see why it has to be a win-lose situation one way or the other. Crutches aren't evil - they are expedient while they are expedient.
Sometimes when you have a really strong habit, it becomes really hard to imagine yourself being otherwise. I welcome anything that helps people see beyond a prison they've put themselves in, as long as it doesn't put them in a worse prison.
Does Ozempic or whatever put one in a worse prison? This seems personal, and not a categorical matter.
Those who take it have a choice of how to develop their sense of identity in relationship to their treatment. It is here where the rubber hits the road - these abstract extremes of "you're suppressing your ability to grow" and "you're hopeless without it" are short-sighted and serve no good purpose.
The headline here seems like an extremely baity one.
A ton of people don’t have this issue at all. I hesitate to say “most” because both in the US and UK it seems the majority do.
But it still feels like a hack to me. The issue seems like it’s that most people are now basically sedentary. So we can solve the excess hunger via drugs, but is that really what we should be doing?
It feels to me that if we must have a wonder drug - it’d be one that gets people up and about and enjoying exercise. It seems really sad to me that so many feel that their physical form and embodiment is an annoyance rather than the gift it truly is.
It's pretty crazy to me that that we aren't already all on Ozempic. The cost to the country for all chronic conditions obesity causes will bankrupt the country. Insurers should basically be forced to cover all the downstream costs their policies create or they'll continue to kick the can.
Ideally we didn't addict our country to cheap junk food but that ship has sailed. If it were up to me I'd tax the shit out of any company selling a product with more than five grams of sugar and use that to buy the patent to tirzepatide and make generic medications available asap.
It will be interesting to see how health insurance companies deal with Ozempic. A few days ago a top article on HN posed the question: Millions of Americans could benefit from drugs like Ozempic; will they bankrupt the healthcare system?
Of course there are many health benefits to losing weight. Given there are clear, healthy, non-drug assisted ways to lose weight, should drug-assisted weight loss be considered an 'elective' procedure, so to speak (similar to liposuction). With so many people qualifying for this drug, would it be fair to increase insurance premiums for overweight individuals? (I say this as someone who could lose a few lbs). Should healthy active folks who keep their weight in-check naturally be required to foot some of the insurance premium bill for those who use this drug to lose weight? If someone rebounds multiple times after going off Ozempic do we continue to collectively pay? Will we be required to collectively pay for people to stay on Ozempic indefinitely to maintain a healthy weight?
I'd have to see some data to be convinced. There is nothing more problematic to health than aging. If we make all "fatties" thin we'll eventually get a bunch of geriatric cancer or dementia patients, or some other expensive age-related health problem (e.g. what is the lifetime healthcare cost-burden of obese people who live on average to 65 vs. thin people who live on average to 85 - just making up numbers here)
I agree. Fat people dropping dead in their 50s and 60s are way cheaper than the folks who hang on into their 90s getting steadily more infirm with chronic disease.
I still expect that the cost will reach a point where insurance companies opt to 100% subsidize so everyone who wants it will get it.
Yeah, right now the cost of the drug itself is high, but as that comes down and/or once the patents expire, it's a no brainer for insurance companies to fund it, in the same way that even the worst health insurance plans usually allow for cheap office visits and free flu vaccinations.
I agree if the cost becomes negligible or whenever it becomes cost effective (I'm sure the insurance companies will be tracking the data closely) - until then though?
Another option: Move to a healthcare system that allows the government to negotiate drug prices with pharmaceutical companies so ozempic is no longer so expensive that it bankrupts us.
The UK gets their semaglutide meds from Novo Nordisk for ~£75 to ~£175 depending on the dosage for a month supply. It starts at ~$1k in the US. Tons of other countries with similar or better negotiated pricing.
Instead of implementing a system that would allow our government to have leverage to prevent this sort of thing from happening to begin with, we sit around, wait for enough everyday people to get screwed over by it to start raising a ruckus, and then some federal agencies fine you a infinitesimal amount compared to the profits you made, your CEO goes and testifies in front of Congress for a few minutes, and even on the most positive outcome side, they then reduce the prices, and basically never to the levels they negotiated with other countries.
Meanwhile they keep the overwhelming amount of money they made selling it to Americans at outrageous prices. And hell - that's capitalism, baby! I can't say I have any expectation of a company behaving any differently when this is a valid way to operate.
Just my own preference but I stopped doing tinker drugs some time ago and focus on things that make semi-permanent changes even if they are much smaller incremental changes. I call any drug that tinkers with feedback loops a tinker drug. An example for me personal was hypertension. I focused on finding the root cause which took a long time but now if I can't get a hold of the things I used to make changes I don't have to worry about a hard rebound swing back to and beyond where I was, something that BP drugs did when I could not get a hold of the drugs because of doctors screwing with me.
For weight I went with Berberine, prolonged fasting and paleo. It's slow but steady and for me personally slow and steady has been winning the race without side effects. That's just my methodological preference and not meant to be any form or fashion of advice for anyone else. I support people doing whatever they find works for them. This was just my long way of answering the question.
My wife was interested in taking the Ozempic route, and I am not fond of drugs.
We then started intermittent fasting together as a lifestyle, and it's been great. Losing weight while not restricting what we eat and feeling great as our body adapts and doesn't let us overeat. I just wonder about the long-term effects, but I'd rather take this risk than a drug like Ozempic.
We did this, this happened to us: after a while you or her may get extremely obsessed with food and eventually get to the point where you overeat as a form of 'freedom' until you just can't stop.
IF works until it doesn't, then it REALLY doesn't work. My wife had a breakdown before we realized something was incredibly wrong. YMMV.
Many in the thread have asked “why get off the drug?”
Regeneron is pursuing its own version of a magic weight loss drug and is arguing that the current batch of GLP1 drugs reduce muscle mass, which is one of the most important things to maintain as one passes middle age (comorbidity etc.)
The co-founder of Regeneron has warned that blockbuster weight-loss drugs could cause “more harm than good” unless the rapid muscle loss associated with the treatments is solved...
Clinical studies suggest that patients treated with the new class of weight- loss drugs, known as GLP-1s, lose muscle at far faster rates than people losing weight from diet or exercise, exposing them to health problems, said George Yancopoulos, who also serves as Regeneron’s chief scientific officer.
One very understated aspect that I haven't seen brought up:
If part of the obesity epidemic is trying to consume food to make up for nutrient deficiencies, these drugs will only worsen these nutritional deficiencies. You'll lose weight short-term, but long-term sabotaged your body trying to attain these. We've seen declining vitamins and minerals in natural food (industrial produce growth). Maybe some people make it up with a heavy supplement regimen, but I wouldn't be surprised to see a lot of now-normal-weight people on Ozempic having major health problems due to increasingly deficient Vitamin A (already 51%), K (71%), E (94%), Magnesium (61%), Potassium (97%), Calcium (49%).
If you are on a weight loss drug like Ozempic, make sure you are doing resistance training. Ozempic reduces your appetite and help you go into a calorie deficit. Bone mass, muscle mass, ligament and tendon mass can all suffer on a calorie deficit unless your body is get regular stimulus that 'muscle, bone, and connective tissue strength are still important.'
Also, changing your diet while on Ozempic to (1) cut down carbohydrate intake and (2) include more healthy protein (meat, eggs, fish, etc.), fats (nuts, olive oil, etc.) and fruits/veggie will supercharge your weight loss and your overall health gains.
One trend I noticed, whenever this topic is discussed in public forums, it attracts a lot of negativity from "just exercise and eat less" crowd (generalizing here). I wonder why it caused so much negative reaction? On the surface it shouldn't matter much, since it does not appear to harm ones who found a way to maintain healthy body without drugs. Yet it reliably causes a quite noticable number of folks to be quite aggressive towards either people using these drugs or companies making these. (Similar trend can be seen in other drugs like THC for example)?
> I wonder why it caused so much negative reaction? On the surface it shouldn't matter much, since it does not appear to harm ones who found a way to maintain healthy body without drugs. Yet it reliably causes a quite noticable number of folks to be quite aggressive towards either people using these drugs or companies making these.
It's a combination of people thinking it violates the 'no free lunch' axiom of the universe and also deriving significant personal status and satisfaction from exerting discipline in eating and exercising religiously.
The 'no free lunch' axiom is a curious thing and seems derivative of western Puritanism and similar philosophies. It violates many people's intuitions that very good things might be obtained with relative ease, and also devalues said things. Some of these are the same people who cannot comprehend (or even accept) a post-singularity world without work. The peculiar morality that produces that belief overlaps rather substantially with the one that rejects the possibility of an easy solution to the problem of obesity.
Further, some of these people have the (perhaps unconscious) belief that they are morally superior to others who are less dedicated to health and fitness, and in particular to the obese.
If obesity can be resolved so fluidly and categorically, then at least two painful things happen for them: (1) their excessive effort towards weight control seems foolish and inefficient (i.e. devalued, as noted above) and (2) they lose a great deal of personal status. The latter is a consequence of the reasonably established notion that a significant proportion of many peoples' happiness is contingent on their relative frames of reference (i.e. not their position in an absolute sense). Again, this is often unconscious. These are not "bad" people, but rather merely victims of human instinct.
Personally, I'd never take Ozempic. I agree it definitely makes the 'eat less' goal achievable almost automatically for most people. But I think there's a real downside which is that any rapid weight loss will take muscle and bone density with it. Typically when you're using exercise to lose weight, you'll naturally end up building some muscle mass back. I think the side effects for people who take the drug and stay sedentary is going to be disastrous.
you can buy tirzepatide / semaglutide all day long from labs in china for between $4 per injection all the way down to $0.50 per injection depending on quantity and type (prepackaged in vial vs raw powder)
After tirzepatide was taken off the shortage list last week, I notice that there are suddenly a lot more people talking about this route. It will be interesting to see how it plays out.
Probably exceeds my comfort level, and I'm lucky enough that I can pay the $550/month for name brand if necessary. A lot of people will just have to stop, though, and deal with the consequences.
FWIW, junk food makers are thinking up new ways to stay relevant and still sell a modified version of their junk foods adapted to people on GLP-1 medicine… Nestle, Mondelez, etc are all scrambling to do so. Here is an article (in French) on the matter: https://www.letemps.ch/economie/ozempic-wegovy-mounjaro-nest...
Most of us should probably be on appetite suppressors due to the industrial revolution making food more than abundant while pumping it full of empty calories.
Just eat regular food. Hardly anything in my diet would be mysterious to a time traveler from 100 years ago, or indeed 200 years ago. Occasionally I enjoy chocolate or instant noodles but mostly it's just fruit, veg, meat, dairy, and grains. If you don't know what something is made out of or how, then don't eat it.
Not a panacea. I stay fat no problem without junk food. Processed foods make me ill, so I make almost all my own meals from whole ingredients. Too many calories is too many calories no matter how you get it.
Obviously one should not eat too much, but I was responding specifically to the comment about the industrial revolution leading to engineered foods full of empty calories in the grandparent comment. I would personally like to see such food regulated mostly out of existence, but in the meantime I just encourage people not to eat it.
Stupid question but I wonder if the side-effects are a partial contributor to its success: feeling nauseous, upset stomachs, bloating, acid reflux etc? And are there similar, cheaper supplements/drugs that can induce nausea etc?
I know my appetite falls off a cliff if I'm nauseous/have an upset stomach/suffering from reflux.
From my experience, it is probably contributing, but certainly not the major way glp-1 work. And I certainly had periods where I would overeat while already feeling bloated or nauseated. Glp-1 certainly does something to the body, that regulate eating on hormonal or neuronal level.
Obesity rates are on the rise in all modern countries, and although the rate of growth is different, in no country does it show any signs of slowing down.
Are these drugs good?
I'm not sure, but I think a lot of these drugs seem to be reducing how much people eat -- helping people break from the life time of bad habits they've learned since childhood from their parents/friend/media/fast food industry. I don't know if eating habits in childhood can embed themselves as permanent alterations to the person's biology, like myopia in eye sight. But if it does, then these drugs might be the "glasses" equivalent for metabolism/eating. Citation needed. But if so, then let's see if we can learn from our mistake with how glasses are perscribed, and instead of leaving children in the same environment that results in the development of the same diagnosis which will then require them to also take ozempic/use glasses/etc, and instead raise them so that they never develop the problem in the first place.
Note: even the myopia link is still being researched I believe, but more papers seem to be showing this potential relationship.
Variables:
- unhappiness increasing (citation needed)
- low income people buy cheap, processed food
- middle class people eat out at restaurants more since they can afford it
- upper class people likely the healthiest?
- unhealthy processed foods have become regular standard snacks (eg chips, cola) taking the place of healthy snacks like fruits/veg
- portion size increases in the home and at restaurants
- the fast food industries incentive to get people to eat more
- people developing bad eating habits at young ages, which are significantly harder to break later in life and could potentially result in permanent changes to metabolism (similar to how myopia has been linked to children spending a lot of time inside/books/screens)
- low availability of healthy fresh food -- when was the last time you got fruit as a snack in the middle of the day? Or for dessert?
- reduced mobility; sitting jobs, order to your door, work from home
Only in the US. Other countries are like 90% less expensive. However, Medicare might try to get better deal since the next round of deal making can include it since the drug is 7 years old.
David Friedberg recently did an All-In Interview with the CEO of Eli Lilly. Interesting conversation over there that also talked about some key points of the article.
Well the title is a little silly even if it's meant to be provocative. There's a limit to just how many people would benefit from the drug, since those who exercise frequently enough wouldn't have the need for it ever.
It's a pretty sad thought that everybody will be on a drug that keeps weight in check while most people will still eat a basically toxic diet. Weight is certainly an important factor but there is more to a healthy life.
I've been on wegovy for almost two years now, and I can attest to how much you just DONT want to eat junk anymore. It's one of the most commonly talked about things we discuss with other users over the last few years. That and lower want to drink, and gaining back so much of energy/time due to not having to think about food every 3 seconds of the day.
I'm super satisfied just having an apple or two now. The "omg I need to eat, ohh a burger" is gone.
I'm not arguing at all here but just wanted to say, I've noticed similar effects just focusing on eating healthier over the last few years. I haven't taken anything to help I just wanted to stop eating poorly and now adays it's not "shove the entire box of cookies in my mouth" it's "have 1 cookie and don't finish it because it's too rich" and I haven't eaten fast food in as long as I can remember. I used to see a McDonald's french fry commercial or just think about them and need McDonald's. Now I see it and go "ah they were good but eh" and move on with my life.
From my understanding GLP-1 agonists can actually modulate the reward pathway reducing people's appetite for toxic diets.
We're not socially caught up yet to this information. I suspect there are folks who believe that regardless of similar outcome (reduction of toxic diet), that changing diet without medication is superior to those who change their behavior through pharmacological intervention. It's like the pre-1990s view on depression or anxiety - chemical intervention is a moral weakness.
As a default it is. And that's what it became. We stopped trying any other methods. Come in the door, have a set of symptoms that check all the boxes, walk out in 30 minutes with a prescription, doctor's office gets a bonus. Institutional psychiatric treatment is drugs first actual treatment later.
This is a _social_ problem. It should be discussed and addressed as such. You should not attempt to pervert this concern into an _individual_ issue in an effort to invoke a needless moral defense.
If it's a social problem then the non-pharmaceutical cure is obviously not white-knuckling a diet and exercise regimen individually. It needs a holistic, society-level solution. More time off work, less car-dependent suburbs, more bike lanes and subsidies for bikes, more agricultural subsidies for healthy food and less for corn. Realistically we aren't going to get those things.
> not white-knuckling a diet and exercise regimen individually
Obesity rates have not been constant. There are clearly multiple modes to this problem and history suggests that this class of people is the minority of the visible issue.
> more bike lanes and subsidies for bikes
You don't need this so much as you need roundabouts and actual _human_ scale infrastructure in cities. Some smaller towns in the midwest got the memo from Europe and are starting to adapt easily.
> more agricultural subsidies for healthy food and less for corn
I think the amount of subsidy overall is a problem. I think we could to take another page from Europe and start banning food additives. We can stop classifying highly processed foods as foods and instead as desserts and tax them appropriately. A lot of this is already in motion.
> Realistically we aren't going to get those things.
We used to have these things. I don't understand your position of social excuse couched in social pessimism. So instead of addressing the problem just accept that pharmaceutical and insurance companies will now enrich themselves off this created problem?
You know, we can solve _two_ problems at once, if GLP-1 has some short term benefit then great, but to plan on it existing in the long term for weight management is utter madness.
Are chemical interventions designed with the best outcomes for the patient or the best outcomes for society? I suspect it's the latter. It's cheap and if you're lucky it's effective. When it goes bad it can ruin lives and families. As a _default_ it's a moral weakness.
Is this a solvable problem? Yes, but it's monumental, encompassing everything from the way we structure our civil society and work life from the forms of food and entertainment that we incidentally or directly subsidize.
We accidentally built something gross. It moves really fast, though.
Just some notes. This would be a lot easy to take this seriously if it wasn't seeped in moral purity. It is rhetorically unappetizing.
Re-wording it so that you say your end goal was better outcomes for people and restructuring society to achieve that is a noble goal. It's easier for people to want to agree with than being a moral policeman.
> GLP-1 agonists can actually modulate the reward pathway reducing people's appetite for toxic diets.
There are also studies out showing that people just up their sugar intake, so I think the results on how it affects peoples diet is still pending. From what I've seen, people are eating less, but more of it is junk food and sugar.
I can absolutely see why people would want to be able to just take a drug and start losing weight, it's hard. My concern is that it takes more than a low body weight to be healthy. You still need exercise, and while that's not an effective weight-lose solution, it is something that most would add when trying to lose weight, and now they're missing out on that part. Arguably exercise is more important than your weight.
Exercise strengths your cardiovascular system, immune system, improves bone strength, builds muscle (which helps you as you age, preventing the risk of falling and fall related injury), improves mental health, reduces stress. If your in good physical shape, it's less of an issue if you carry around a little extra fat.
You can still be in bad health, even if your weight is spot on, but it's rare that you exercise a lot, but is overall unhealthy.
In terms of tangible outcomes, it helps you live longer or something compared to weight loss? greater reported life satisfaction? Or is this more of a personal value?
That's a trivial claim about any medication that changes behavior. You can achieve the same thing that the medication does by "just" having different behavior.
I eat almost zero processed foods and very little sugar - mostly from fruit. I shop exclusively on the perimeter of the grocery store and eat at a restaurant maybe once a month, with all my meals cooked at home. I try my best to limit portions.
I have been overweight my entire life. I have successfully lost weight with up to eight months of calorie restriction, so my willpower is just fine, thank you. I have always gained it back, and you calling me out for some kind of moral turpitude is not helpful.
Your "eat like an adult" finger waggling is condescending, and claiming anyone who thinks obesity is more complex than "just eat better food, bro" is anti-intellectual and anti-science is just insulting - and not particularly "pro science" either.
In 8 months of losing 2 pounds a week, you would have lost roughly 64 pounds. You could have been losing more than that which is common on diets where added sugar is removed. But you're talking to someone who has worked with people with class 3 obesity and has seen the weight successfully stay off.
You're omitting details. You simply didn't change your eating habits. Statistically, this detail you shared is also overwhelmingly the documented reason why people fail to keep off weight. Almost entirely, people who reside in higher classes of obesity have no idea what their relative consumption habits are in comparison to those with lower BMIs.
This may come as a surprise to you, but most other countries where obesity is not a problem, most sugar consumption is also from fruit and these peoples' diets _don't_ contain anywhere near the amount of added sugar an American diet does. This isn't a special thing to point out, you just think it is because you have no other frame of reference.
There are a lot of statistics in dietary behavioral studies and dietary reinforcement that are mostly uninteresting because, frankly, people omit details.
You can lose considerable weight at speeds that are actually not recommended simply by dropping added sugar from American diets. So much so that you would need to taper off this removal to stay around 2 pounds of weight loss a week instead of dropping this consumption pattern cold turkey.
The biggest difficulty in sourcing food materials or eating out is that we have sugar in everything. We have added sugar in things that in other countries you would have never added sugar into to begin with.
The reinforcement habit is directly tied to food reward, sugar consumption, and ghrelin production. Anyone who tells you otherwise is lying and is simply refuting what we have come to understand about food science over the years.
And frankly, we as a people have not yet completely matured out of the phase of producing or accepting low-fat foods being replaced with high sugar content. Plenty of other nations never had this problem at all, never inherited it, and as a result, don't have to grow out of it.
It is staggering how much of our food is incompatible with healthy weight homeostasis, and all of our common supermarkets absolutely work against you unless you are otherwise taught differently.
* * *
Edit:
If you're baking bread for your family every day, even without added sugar, and you don't see the problem here, I don't know how anyone can help you.
I'm not calling you a liar. I said you were omitting details. You didn't mention that you're frequently eating carbs. Now you mention that you're baking, and presumably eating, bread every day.
I bake bread for my family every day because I can't get bread in Canada that has no sugar. I'm aware of how insidious sugar is.
You obviously deal with a lot of obesity that is caused by excessive sugar consumption. Your conclusion - and smuggled assumption - is that all obesity is caused by sugar. This is trivially refuted by finding obese people in non-high-sugar societies, or from a time period before sugar became ubiquitous.
Calling me a liar does not make your position stronger.
Response edit: I have four school aged children who get a sandwich for lunch every day. It takes no time at all for a family of six to go through a 650g loaf of bread, and it doesn't require overeating - I'm the only one in my family with a weight problem, and I bake the bread I don't eat it. Your assumption that everyone in the world is exactly like you is truly breathtaking.
> This is trivially refuted by finding obese people in non-high-sugar societies, or from a time period before sugar became ubiquitous.
Those people definitely existed, but were pretty rare. Maybe you are one of them. Statistically, probably not.
> I bake bread for my family every day because I can't get bread in Canada that has no sugar. I'm aware of how insidious sugar is.
That is definitely way, way better than anything store bought, so it's great that you are doing that. However, even without added sugar, bread will start converting to sugar immediately after being in contact with saliva(and will continue once the pancreas enters the picture). So you are eating sugar every day still, possibly quite a lot of it.
I had to severely decrease bread consumption, as well as anything containing simple carbs, to decrease my insulin resistance.
>Those people definitely existed, but were pretty rare. Maybe you are one of them. Statistically, probably not.
Mexico has approximately the same per-capita sugar consumption as Italy, Spain and France, yet the obesity rate exceeds that of the U.S. Norway has 50% more per-capita sugar consumption than the US and very little obesity. I don't think eating little sugar or refined food, yet being overweight makes me a statistical anomaly at all.
I'm not claiming some kind of magic variation in base metabolic rates. I'm only saying that it is too simplistic to point at refined sugar and say that a complex problem has that one simple cause. (And that to solve it one need only learn to be an adult).
I don't eat bread by the way, I bake it for my family. I do revert to eating potatoes and pasta though, which is no doubt to blame for my weight fluctuations. My irritation in this discussion comes only from the ridiculous claim that if I were only to eat like a grown-up for two weeks, food cravings would disappear and my problems would be solved.
Mexican cuisine employs large amounts of fat, directly, or in the form of cheese. Take a trip to Italy, Spain, or France. It's a very different eating atmosphere. The portions and ingredients aren't comparable, and in Europe, there are greater food protections that straight up don't exist in North America.
Carrefour et Monoprix ne ressemblent pas du tout à ceux de WalMart, etc. You can't compare them. Their food selection makes ours in the states look embarrassing, and I wouldn't be surprised if it were the same for Canada. It's superior on all fronts.
It isn't too simplistic to look at sugar or general carbohydrates and say, this ingredient has the highest reconstitution of habit developing behaviors compared to that of any other macronutrient. Your body's ability to reinforce food habituation compared to any other macronutrient on a graphed scale makes every other macro look like peanuts. It's sugar. It's carbs. It's a fact. It's scientifically proven. I implore you to do the reading yourself. Fat also has a high recidivation rate, but it pales in comparison to carbohydrates.
For your own health and the risk that you'll tell others otherwise as well, just dismiss me and read these studies yourself.
It's that easy, and the reality is that no one adjusts for it. Your supermarkets don't care and all of the people around you probably don't realize it either. It's cultural. It's in your beer. It's in your coffee creamer. It's everywhere.
It is the dietary equivalent of global warming denial. Seriously. I have watched people with class 3 obesity drop 40 pounds in one month, which is terribly hard on your body and not recommended, by immediately switching off high carb, high fat diets.
Yes, your food cravings do truly, really, disappear within a span of 2-4 weeks. Within 30 to 60 days, people can and do form rejection habits with little documented "willpower" in the same way these individuals using GLP-1 hormones do.
Because it's the same activation vector. You increase incretins production through rich protein consumption. People suffer from the effects that you describe because of leptin resistance. For people in extreme weight class categories, you don't get off after a few months, fat cells stay in your body for years in dormant, reduced volume form.
Of course I eat carbs when I shouldn't. Not the bread, but I eat potatoes sometimes, and too much fruit. I'm not denying that I eat too much.
The point is you claim that if we gluttons would just cut out sugar for 2 weeks and learn to be an adult, our appetites and cravings would disappear. That's nonsense, and your dismissal of data that doesn't fit your narrative makes your accusations towards others of being anti-science both hollow and ironic.
2 lbs a week is a 1000 calorie per day deficit. My loss was closer to half a kilo a week. I have fluctuated between 85 and 210 kg since I was 16 or so. I am now 54.
Of course I am not saying my body violates the laws of thermodynamics. After some time I succumb to cravings and begin overeating again, a bit at first and then more. I am not denying this is behaviour driven. My only point with the fruit aside was that I'm not consuming my sugar from chocolate milk or sugary breakfast cereal, not that I think fructose is exempt.
But to suggest that all I have to do is eat healthfully for a few weeks and my cravings will be gone is infuriating. I have eaten healthfully for years and years, and eaten at a calorie deficit (of healthy food) for many months at a time. And the cravings NEVER go away. I always go to bed thinking of food.
Maybe I should get a nutrition degree and then my body will conform to what your textbooks say should happen.
Could you provide some of those papers? I'm interested on what you are saying, but I am not able to find what you are mentioning using the link you provided.
It goes on and on and on. In lab mice, it has been shown you can alter production in as little as 10 days. Human hormone production has similar turn around times.
Have you considered that maybe it is an evolutionary trait that it is hard to do certain things? That the people who can expend the effort and discipline, perhaps have a better configuration than those that can’t or don’t?
The exact same argument can be applied to literally any medical issue, and it is a pointless one.
Someone has an elevated risk of skin cancer due to their genetics? Probably an evolutionary trait that it is more likely for some people to get skin cancer within their lifetime. That doesn’t mean that using sunscreen and providing those people with related medical care (if the need arises) is some crime against nature and will end up hurting evolutionary prospects of the human race.
> Someone has an elevated risk of skin cancer due to their genetics? Probably an evolutionary trait that it is more likely for some people to get skin cancer within their lifetime.
The question is how a trait fares in the modern world.
Maybe a trait was useful to an ancestor but not to you today trying to navigate a calorie rich world of convenience. Just like a trait useful to a nomadic hunter might work against you when you're expected to sit at a desk job if you want to make the money necessary to fulfill your ambitions.
It may very well be the case that we end up medicating away traits that were useful at some point in our lineage but not today. I just don't see how it matters much beyond the thought exercise.
Weird that the ones skinnier foreigners with a “better configuration” get genetically altered (I guess) to a worse configuration when they move to the US, then.
hilariously, the toxic food companies are worried that ozemic will kill their profits. Maybe the pharma industry can fight the food industry conglomerates.
My point is that skinny populations don’t seem to be skinnier than the US population due to greater genetically-backed willpower (better “configuration”). At least, if it’s a factor, it’s overwhelmed by other factors, it seems.
Studies show nothing but high-touch interventions by specialists actually works for losing weight and keeping it off for a study cohort (i.e. might represent a population-level solution).
These are impractically expensive and still less effective than one might expect.
Researchers seem to be eager about the promise of supplementing the very-best programs they’ve been able to find… with GLP-1 agonists. Because that might finally make them really effective.
That’s how bad the entire body of all other solutions we’ve looked at is.
Not to argue for or against Ozempic, but there is a difference between what motivated individuals can achieve on their own, and what one can expect of the general population.
Do you have the time to seek out and keep healthy food? Can you afford it? Do you have the executive function and impulse control etc to bring to bear the necessary self discipline?
You’re making some pretty casual assumptions about people’s abilities.
If all it took to get the same feeling of GLP-1 agonists was success at the diet for 2-4 weeks, I would have a lot less experience being successful at diets for 2-4 weeks. A whole lot less.
> You can literally do the same thing by eating a healthy diet for 2-4 weeks.
You have been downvoted, but that's true(and supported by evidence and science). Statistically, what most people have is sugar addiction. Simple carbs in general completely mess up your hunger hormones.
The problem is that most people don't know what a healthy diet is. The food pyramid isn't it. Drinking a bunch of juice isn't it. Cereal is candy. They try "eating healthy", fail (not realizing what they are eating isn't healthy at all) and give up.
Sure, but the "unhealthy but not excessively caloric" diet is not a problem ozempic attempts to address. As far as I understand, it simply limits your appetite. Potentially one can go on ozempic, lose weight, and still end up eating unhealthily, because the resulting diet is made up of nutritionally poor foods.
Ozempic does not simply limit your appetite, it seems to also affect how much reward your brain feels from different foods (and activities!), which would make it easier to override those anticipated rewards with conscious choices.
And the argument you are replying to is that it's just covering up a symptom and not addressing the root problem holistically. Ozempic isn't a fix, it's a bandaid.
That's great. We still give crutches to people who break their legs and bandaids to people with wounds. We don't tell them that being completely healed is better than using those aids.
Bandaids serve a genuinely useful health-promoting purpose. I suspect we'll find the same is true of GLP-1s even if it only addresses part of the entire problem.
Only when applied correctly and with other interventions. Using ozempic without diet and exercise changes is like putting a bandaid on a .5" deep wound without sterilizing it.
because ozempic reduces the food cravings, patients are able to implement and stick with a diet change. it's not like "put down that cheeseburger and have a salad" is something they haven't heard before and haven't internalized already, it's just their brain won't do it. ozempic gives them the space on their brain to actually do it.
My original impression was that it was suppose to be a crutch, helping you get started on a healthy lifestyle. So if you are to heavy to exercise without hurting yourself it could help you lose that initial weight. Or it can help you with your appetit, while you adjust your diet.
You also can't stay on Ozempic, you have to continuously increase you dose to get the same effect, so it's simply not viable to keep taking it for an extend period of time. That's at least the impression I've been getting from talking to people working at pharmacies.
Sure, but so what? Until we can permanently change aspects of our brain, like our proclivity for addiction, then all interventions are bandaids on top of an underlying problem.
Even behavioral changes like avoiding fast food don't fix the underlying problem in your brain. It's topical.
It's amazing how the subject of Ozempic brings out such trivial claims uttered with a serious face.
The combination of bad diet and lack of exercise. Specifically in the context of this conversation, its about how ozempic will not fix a bad diet. Eating less of a bad diet is better than eating more of a bad diet, but is still a bad diet in the end.
No, but if it helps avoid the discussion because the very visible side effect is lessened, then in some ways things are worse. No squeaky wheel.
I’m glad it’s available for those who need it. But I agree with GP that there is another discussion we need to be having too we’ve avoided for far far too long.
I wasn’t talking about nutrients at all. I was referring to the problems of over processed foods with lots of chemicals to increase shelf life and improve color and make them more addictive.
I’m not against Ozempic. But without it maybe the continued expansion of the obesity epidemic would have pushed the discussion.
If this accidentally prevents that discussion, I think that’s a problem. I’m not suggesting any change to the drug’s availability. Only concern over an important discussion.
Maybe it’s naïve. But it’s getting harder and harder to ignore, and worse and worse.
As we export our food to more and more places, it starts to happen to them.
I hear about people who take trips to Europe. They eat a ton, feel better, and lose weight.
They get back home, start eating food here (even healthy food) and feel worse again. Gain it back despite eating less.
We’ve tried ignoring it. We’ve tried blaming genetics, character, fat in foods, sugar, and willpower. But none of those have explained/fixed it. Because I don’t think that’s the problem.
I want the evidence to keep piling up. I don’t want anyone to suffer unnecessarily, but I don’t want a new excuse to stop progress again.
It doesn’t have to be either/or. But if we give up the chance for the debate because a new miracle drug “solved“ it nothing will change.
There's a decent amount of evidence that the most toxic thing about modern diets is their amounts: calorie counts and such. Many things (sugars, ultra-processed foods (ugh I hate the NOVA classification), fat, etc) are fine in moderation. The dose makes the poison.
Is it fundamentally any different from something like toothpaste?
Humans have created a technology (mechanised farming) with a side effect we haven't yet evolved to handle (an abundance of tasty calories), so it doesn't seem all that strange we would fix it with a technology (inhibiting the desire for said calories).
Serious question: Why not make toxic diet illegal or cost prohibitive? Lots of manufactured food is designed to be more addictive. Then add in constant advertising bombardment targeted at kids. Why is there up to double the sugar in US bread and soda versus Europe?
I think your statement is very funny. If the drug keeps weight in check on a toxic diet and that has the same outcome as "healthy life", then is that "healthy life" any more healthy then the drug+junkfood combo? Also, what is sad about it?
> while most people will still eat a basically toxic diet
It's a pretty sadder fact that people just make these wild assertions. Everyone I know (which is about 10 people in real life, myself included) who's used a GLP-1 drug found that they eat healthier because they've less desire for shittier food.
> while most people will still eat a basically toxic diet.
Had to scroll too far to find this. It's a great synergy isn't it? The food industry creates calorie concoctions that can barely be called food, are dirt cheap to make and rakes in profits. People get sick. The pharmaceutical industry sells drugs are stupid high profit margins so that people can keep on living.
It is not a conspiracy, but it's a good feedback loop for corporations. All that money allow them to flood the scientific community with their sponsored studies, dominate news broadcasts (confusing consumers) and even influence the food pyramid, which is almost upside down.
I've been on a slow quest to improve health and lose weight. It's really, really slow, far slower than what most people would like. But cutting added sugars to zero (including and most especially high fructose corn syrup) gave almost immediate benefits that kept me going. Sugars (and carbs in general) make you retain a lot of water. Cut those, and you'll see a major difference in the scale in a couple of weeks. Is it mostly water(but not entirely!) Yes. It doesn't matter, our lizard brains interpret that as success. That also reduces hunger, which is a positive feedback loop.
It depends how old you are. Skin loses its elasticity after a certain age. So weight is a problem you should spare no expense fixing sooner rather than later. Even if you do something about your weight at a later age, the health benefits for your heart for example will greatly outweigh the loose skin.
The absurdity of creating a drug to curb obesity instead of forcing industrials to make food healthier.
The ravage of corruption, sorry lobbying, still killing us all for greed.
> Neither is berberine any version of Ozempic, which is an analogue of glucagon-like-peptide-1 (GLP-1), a natural hormone that regulates blood sugar and helps people feel full. Berberine has nothing to do with GLP-1.
> Perhaps the most interesting laboratory finding, given the rising global tide of type 2 diabetes, is the control that berberine may exert over blood sugar. But there is a problem. Berberine is virtually insoluble in water and has low intestinal absorption which means it has poor bioavailability. […] Because of berberine’s poor bioavailability, supplements on the market are likely to be useless. However, some derivative of berberine, may yet make it to the physician’s prescription pad. But it won’t be for weight loss.
Apparently most of the effect is due to activation of the "bitter taste reception pathways" in the gut. So even though it has very low bioavailibility, it can still stimulate GLP-1 secretion just simply due to its incredible bitterness
Does it only stimulate GLP-1 in the gut, though? As I understand it, most of the positive effects of GLP-1 agonists are the effect they have on the brain's GLP-1 system, not the guts.
Nine of the 15 tested products (60%) failed to meet the potency standards of 90% to 110% of labeled content claim, as commonly required of pharmaceutical preparations by the U.S. Pharmacopeial Convention. Evaluation of the relationship between product cost and the measured potency failed to demonstrate an association between quality and cost. Variability in product quality may significantly contribute to inconsistencies in the safety and effectiveness of berberine. In addition, the quality of the berberine product cannot be inferred from its cost.
Worse still,
"Preparation and Evaluation of Antidiabetic Agents of Berberine Organic Acid Salts for Enhancing the Bioavailability"
Berberine—an isoquinoline alkaloid isolated from the rhizome of Coptidis rhizome, Cortex phellodendri, and other plant species—possesses a variety of pharmacological effects, including anti-cancer, anti-hyperglycemic, anti-hyperlipidemic, antimicrobial, anti-inflammatory, and antioxidant activities. However, its absolute bioavailability is as low as 0.68%. Low bioavailability greatly restricts the clinical development of berberine.
I long for something that would help me. I have a rare metabolic disorder where the recommendation is high carbohydrates, very high, and to never diet. Even a ten percent reduction in caloric intake can end in hospitalization, during which I am put on a frankly enormous amount of glucose or sucrose, among other things. The end result has been an insidious weight gain. Exercise? Well, aside from the fact that you can't outrun your fork, it sets off the same metabolic pathways that caloric restriction does and I am back to square one.
I’m just as curious as to why some people are so willing to take numerous medications, while others go to any lengths to avoid them. Some people are happy to be on an SSRI, sleeping pill, statin, low dose aspirin, and a few others, and aren’t bothered by this. Other people seem instinctively revolted by prescription drugs, seeing toxins pushed by evil corporations. Is it a trust issue?
I personally detest and avoid all medicines other than antibiotics and vaccines. Pharmaceuticals have a long track record of harboring “side effects” that only become apparent years later.
In general, why are we surprised that the chronic use of any substance has negative effects? Humans evolved for thousands of years eating food and drinking water. Regularly consuming anything else is an abberration and self-experiment.
I think the answer to your question is that people who avoid drugs understand that drugs do not fix anything permanently, in 99% of cases. They only treat symptoms. The people who avoid drugs attempt to treat the underlying problems.
of course it’s not always practical. For example, some skinny people are simply genetically predisposed to high blood pressure, even if they work out and eat pretty healthy. It’s rare, but these things happen.
Nobody ever gets sus about needing to take heart medication every day to stay alive but the moment it becomes about how I take Lexapro every day they get real preachy.
I'm curious why you include antibiotics in your trusted medications list.
Over the past several years we've found that antibiotics have a huge impact on beneficial microbes in your body which then has downstream impacts on your health [0]. Oddly enough for the topic in this article exposure to antibiotics as a child may be linked to obesity[1]. They are also extremely over prescribed for things like viral illnesses [2].
I personally wouldn't take an antibiotic unless whatever malady I was suffering from was proven to not only be bacterial in origin but likely to progress without treatment.
Regarding your larger point some of the distrust of medications can be related to the fact that people know that medication producers' goal is to be profit for the most part.
Because they are for-profit the medicine producers can't be trusted to produce quality products or to produce products which resolve a problem rather than just reducing symptoms as long as the patient continues to pay for the medicine.
As with other problems we have a low trust society because it's a society built on for-profit enterprises rather than enterprises focused on doing the best thing for society.
He is not shooting the gun at all. He's advocating waiting it out. You're the one taking risk and playing russian roulette. He'll take the gun out at the first sign sign of danger.
You can have an internal locus of control and still believe the benefits of taking something like an SSRI far outweigh the costs of attempting to address depression/anxiety more "naturally." I'd rather take an SSRI if it means more motivation to live healthily, positively, productively for myself and family. If anything, the drug could very well help someone discover their sense of agency.
> seeing toxins pushed by evil corporations. Is it a trust issue?
That sounds a lot like the divide between people who see conspiracies everywhere and those who do not. In that case I would suggest it is just personality, not logical and not solved by improving trust.
> Other people seem instinctively revolted by prescription drugs, seeing toxins pushed by evil corporations.
You can advertise drugs on TV in the USA. This certainly opens the door for bad drugs to get pushed out and marketed to people who don't have the technical skills to examine the claims and the risks of side effects objectively.
> avoid all medicines other than antibiotics and vaccines
Just because it's been such a hobby horse lately I would have to add pain killers. There is absolutely a large potential for abuse but they also serve an incredible utility to modern medical care.
> Regularly consuming anything else is an abberration and self-experiment.
Ozempic should be for people who are obese and have thoroughly demonstrated that they are not physically capable of exercising themselves enough to lose weight naturally.
Otherwise, this drug gets marketed as an obesity cure, but it's mostly dispensed for cosmetic purposes. If there are any side-effects, it will be a double tragedy for these people.
I'm with you, it's a little revolting, this specific drug.
Ozempic and similar drugs are being used by many to get rid of the food noise and insatiable hunger that have stood in the way of sustainable progress. These drugs are being used as catalysts for healthy living. The fact that they seem to work thus far is evidence that obesity is on some level driven by powerful hormonal forces that influence impulse control and willpower, which addressed, can give people the freedom to make better decisions and effectively pursue a lifestyle they've struggled to maintain.
The cosmetic narrative you're pushing is actually quite disgusting.
> These drugs are being used as catalysts for healthy living.
You have some evidence for this claim?
> is evidence that obesity is on some level driven by powerful hormonal forces
It's suggestive. It's nowhere near evidence.
> the freedom to make better decisions
As long as they're on the drug.
> The cosmetic narrative you're pushing is actually quite disgusting.
No it isn't. It's a valid concern about how this medication is _marketed_ and _dispensed_. It's also an obvious concern to have. Pretending that I'm disgusting because I'm actually worried about the future outcomes for these patients is bullying highroad nonsense. Come off of it.
I've been on Zepbound since July and have lost 40lbs in that time through calorie restriction, intermittent fasting, and resistance training 3x per week, which all felt like impossibly herculean tasks before starting the medication. I know others who've had similar experiences. Sorry I haven't published a paper on it.
The obvious countertpoint is that obesity rates have not been constant for the last few decades.
So there are clearly multiple factors here and those should be taken into consideration before uncritically deciding this is a "good thing" that we should "all be on."
For a second I thought it said Asterix Mag and started daydreaming about a story where Getafix invents a special magic potion which Obelix can use but it causes him to lose weight. Dargaud, I am available.
Those of us who find calorie-counting easy and effective are the blessed few. Most people appear to find it even harder than other behavior-change approaches to weight management.
I think there will be a time when engineered chemicals will beat natural food, but right now this isn’t it. I’m talking about longetivity tech in the far/ or near future
The farmers are subsidized to grow the corn. 10% of SNAP benefits are spent on sugary drinks. Yet we're expected to believe that these children were born w/ the chronic disease of obesity and they'll need to be on these drugs their whole lives.
Moral hazard has never been a good reason for any sort of regulation, the same principle can be used to justify not covering motorcycle riders, people who trad climb, people who do snow sports, people who jaywalk, people who work at a desk and drive everywhere, etc etc etc
Thats like your opinion man. I personally don't want to pay for gluttony via my tax dollars. I don't care about smokers, junkies, or gambling addicts. If people want to donate to some ozempic fund, by all means.
And, motorcycles require special insurance, as does high-risk recreational sports like climbing. If you drive/commute to work, thats factored into your premiums. If you get hit by a car jaywalking, that is usually on you. Those examples have nothing to do with the prospect of tax-funded anti-fat pills.
Fuck that. Just have some willpower! Some of us have been doing OMAD without assistance, just grunting through the stress and pain for years. It's much healthier than drugging up.
Can you keep the weight off once you stop using it? I don't particularly want to have my personal health be in the hands of one company especially if the culture stratifies into those who can afford to be the right weight and those that can't. Especially when it enters it's "enshittification" stage.
It's hard to keep weight off once you stop using it, but I've not seen anything to suggest it's harder to keep it off if you lost using GLP-1 than if you lost the weight the normal way. Most fat people I know have lost weight successfully more than once "the hard way" and then regained it.
Seems to me this drug is an antidote for an unregulated capitalist system creating an environment that preys on the human condition and as a result makes people unhealthy.
It's just now selling you the antidote to the problems it made. Profit.
The number of 'smart' people in this thread advocating for the use of a drug instead of doing the obvious which is STOP EATING JUNK FOOD is staggering.
Also the article is nothing more than a pharma ad.
Idiotic and corrupt.
Yet another drug that patches up symptoms without addressing the root cause. People will be dependent on the drug for life. And we still don't know what the adverse effects are.
Maybe when food shortages become a thing, we can add Ozempic to the water supply to curb people’s appetites and reduce demand. \s
Kidding aside, I still think it’s extreme for off-label usage. Short term results are nice. But what about the long term? Once patients reach a desirable state, can they be titrated off the medication while maintaining their ideal labs and weight? What’s the rate of recidivism?
I don't like processed foods and sugar in anything more than minimal quantities makes me ill. But I still get too many calories, at least as evidenced by my waistline.
Are you sure the insanity isn't the assumption that it's just insufficient willpower or poor habits?
Have you tried actually counting calories? Because most people aren't really aware of the caloric contents of the foods they eat, and when they start counting calories it can be pretty shocking to see the realities. Especially if we're talking carbs like rice, bread, pasta etc., people tend to really underestimate the calories involved there.
A big shocker for many people is that 30g of peanuts is roughly ~100-130kcal, for example, which is maybe a ~handful of nuts.
A large portion of losing weight really does come down to CI/CO. There's a reason the common adage of "the waistline is molded in the kitchen, not the gym" exists. It's good to supplement a diet with exercise for various reasons, big one of them being reduction in muscle mass and bone density that accompanies weight loss, but if your goal is simply to lose a bit of weight, then decreasing your calories is the most reliable way of achieving it.
> “Is it bad for my liver to be off most of the time?” It's generally not healthy to keep your major organs in the off state. If you never open your eyes, you go blind.
I feel like this is missing the obvious follow up question, “is it bad for my liver to be on most of the time?”
> “is it bad for my liver to be on most of the time?”
That's a good question!
I'm not sure. My guess would be its perfectly healthy (normal actually) to have 10x levels of ketones constantly than an American eating the SAD (Standard American Diet).
Anyone know of long term datasets that have looked at this in animals?
Continuous Ketone Monitors for humans have _just_ come out (AFAIK), so we should know soon.
So basically eat shit and then take drugs to lose the weight you accumulated because of your bad diet ??
Am I the only one to realize how this is so wrong?
You would think When a pipe leaks, you fix it. You're not going to put a basin under it, empty it every day, pay for a new basin every few week and continue to have your damn pipe leak.
Oh man... If only you could teach people how to eat better instead.
You are wrong because being overweight means that your endocrine system is very messed up and can make it extremely difficult to make meaningful changes to your diet and habits. Take a look at the preponderance of folks who have taken GLP-1s here and have affected tremendously positive changes to their diet and exercise habits.
What is inherently wrong with taking a pill for weight loss?
I can understand being cautious about side-effects or efficacy, but if a pill existed that resulted in weight loss and was side-effect free, I can't imagine what would be inherently wrong about taking it.
Would it be preferable if it were a powder, or a cream? Is it the specific delivery format that has you concerned?
I'm old enough to remember when "weight loss pills" was a cliche punch line. Thank God there's no way these miracle drugs will turn out to have some terrible long-term side effects!
Don't think the hype will last long at all, since this ridiculous drug has extremely bad side effects, and works by enriching the body with millions of small fat cells that are all ready to blow up the moment you stop taking the drug. Or in orher words, it's a trap. If you take it, you have to take it forever and suffer extreme side effects, if you stop taking it, you will turn into a fat pig, worse than before, and you gained nothing.
It absolutely boggles my mind to always see Americans swallow everything and anything that big pharma serves them. It's insane behaviour.
It disables your stomach... its like taking PPIs for gerd only to later find out the problem was low stomach acid and now your acid production capability has been permanently damaged by meds
All this to say, this drug has been life changing for me. I spend more time doing things I want to do, depression and anxiety have less of a hold on me now. I feel that this drug has allowed me to be the best version of myself I have been in a long time. The only side effects so far have been positive. I do worry about what I will do once it's time to titrate off the weekly dose and the best I can think of is that the habits I'm forming in the time on the drug I will have the resolve to continue after cessation.
I say this because I have battled depression, anxiety and obesity issues my entire life. I've had many failed attempts at getting back to a healthy, productive and non-obese lifestyle. I don't know what is so different about having the drug help me, but I can tell you that it has been different.