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.
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?
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.
"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.
Masking reality is not a good way to work within it nor modify it.
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 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.
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….
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”
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.
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.
On the local level, gerrymandering can quite literally stop them from doing that.
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. :/
At some point, we may find that these drugs cause long-term health problems of their own, too.
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.
https://bpsmedicine.biomedcentral.com/articles/10.1186s13030...
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.
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.
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.
And yes, I’m familiar with the differences. I was simply saying they usually walk in with depression, and move on to obesity.
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.
And so many people don’t.
Also, we’re learning. Quit cold turkey and yeah, you’ll gain. Taper, and you likely won’t: https://www.pharmacist.com/Pharmacy-News/coming-off-glp-1s-s...
> 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.
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.
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?
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.
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.
Moreover… who cares? Viagra was a failed angina treatment. Valium was originally a dye
So?
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?
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.
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.
Nobody has yet been on these drugs for an entire lifetime - which is what is being advocated in this thread.
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.
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.
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.
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
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.
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.
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.
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.
Cessation tools are not negative. Yes, root causes of abuse should be addressed, but aids are aids.
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
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.
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"
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.
It is so profoundly disingenuous to pretend not to know what the word "crutch" means or what connotations it has in this context. Like, come on.
What is more, getting hung up on the wording is missing the larger point.
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".
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.
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.
Empathy can go a long way and the more we can have for each other the better we will collectively be.
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.
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
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.
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)
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.
You can easily tell this is the case by seeing where the obesity is less prevalent
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.
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?
So their addiction was a choice - and now they have developed a chemical dependency which is no longer a choice.
There is no such chemical dependency from eating two cheeseburgers for dinner instead of one.
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.
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.
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.
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.
Apparently not in your body, no. Or maybe you just failed to recognize what addiction is, and managed to overcome it. Good job!
Now stop trying to pretend that your lived experience equals everyone else's because it clearly doesn't.
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.
Or if burgers were a thing you had to go to an illegal dealer for.
These are all choices.
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.
More likely it's listed as one so insurance company pay for the drugs.
Addiction treatment gets payed, low self control not.
Half Bake- Thur good goes to rehab NSFW
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".
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
Sure, you don't take the substance directly. But the things you do have your body produce/release the substance.
A dopamine high is a dopamine high. Even though you didn't buy a dopamine pill from a shady dude in the parking lot.
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.
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.
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.
(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.)
Compulsive overeating relies on the same behavioral/reward mechanisms, with the added bonus of food being something you do physically ingest in the process.
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.
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...
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.
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.
Many people in my wife’s family have thyroid gland dysfunction and have to take thyroid hormones their whole lives.
This is literally how almost all medicine works that treats a chronic condition.
> Perhaps Ozempic prescriptions should come with prescribed exercise with check-in and monitoring, or something.
Why?
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).
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).
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?
For this reason, I believe your comment is lacking in empathy for people who may struggle differently than you, yet struggle all the same.
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.
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.
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.
My spouse must take a thyroid medicine every day for life.
Not taking these pills is life threatening. How is taking them not acceptable?
It is really that simple.
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.
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.
12%. Which shows that your intuitions about obesity and the causes are probably wrong.
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.
"Choice" is victim blaming
Because it is a substantial net benefit to your life?
Same reason I might want to continue with, say, a regular exercise routine or meditation practice.
That sounds like a hell of a treatment plan. o_O
Nope, not going back to the doctor that gave me diabetes. That was a mistake.
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.
Taking ozempic will definitely keep people from gaining weight and will help them lose weight.
Can you qualify what you consider to be a 'symptom' vs a 'condition'?
Is high cholesterol a symptom of something, or a condition itself? What about high blood sugar?
Would you say that acid reflux is a symptom or a condition?
Is a person that takes Prilosec daily to treat bad reflux treating the symptoms and not the underlying condition?
What about people using asthma inhalers, or epipens: symptom or condition?
Are people allowed to use the medicines if their underlying conditions are not being treated?
You mean matter is created out of thin air because of a "medical condition" and not by eating too much food?
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.
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.
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.
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.
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.
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
While on the drug. Will those changes remain if the user stops using the drug?
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.
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.
If Ozempic ends up being another such drug, I don't think that's a bad thing.
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.
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?
At the contrary, 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?
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 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.
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.
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.
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.
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 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.
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.
1. https://www.cdc.gov/nchs/products/databriefs/db313.htm#:~:te....
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?
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.
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.
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.
Would we consider insulin a crutch? Think of this as something in the same league. At least that is the case for a good chunk of the target audience.
But yes, there's a reason people are celebrating those drugs.
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
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.
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.
https://www.mayoclinic.org/diseases-conditions/metabolic-syn....
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 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.
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!"
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.
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.
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.
"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?
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.
It took me one google query to find the results: https://www.ema.europa.eu/en/news/meeting-highlights-pharmac...
> 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.
So we can scratch that one off the list.
https://www.youtube.com/watch?v=izqKRo3e31E
"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.
instead of ever more metabolic and mentally ill society living more like zombies than free human beings.
Youtube Videos
https://youtu.be/PeqQd4_xveI?t=43
https://youtu.be/G0lTyhvOeJs?t=421
https://www.youtube.com/@metabolicmind
Books
Now, I can easily stick to a super low carb diet
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.
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.
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!
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'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.
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?
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.
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%.
The idea that caloric restriction is causing all this muscle loss is one of the dumbest ideas we currently have.
It is simply not true.
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.
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.
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.
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.
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.
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.
Source:
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.
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.
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.
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.
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.
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.
Thank fucking god for Novo Nordisk.
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[1] see: this thread!
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.
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.
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!
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.
Obesity in adult men in South Korea more than doubled between 09 and 19.
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!
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.
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).
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.
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.
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.
Had the right approach better results?
If not, why is it the right approach?
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.
As a contrast -- the point was that nobody judges me for having type 1 the way they judge people for having obesity.
As an aside, I notice that sort of "lifestyle/willpower" type framing in discussions about type 2 also.
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 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.
It was due to nobody else but myself.
Stricly speaking we don't.
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.
Yes we do, because it works. Exercise burns more calories. Diet limits your calorie intake.
If you rebound into not doing exercise and overeating, that's on you.
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 ?
> we have very thorough studies of people dying from hitting static surfaces at high velocity
What are those studies?
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.
> 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?!
How about alcohol and smoking ? Is that the same as obesity then
Yes, for the first time in the millions of years of existence of humanity and pre-humanity, we consistently have enough to eat.
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.
America pioneered the obesity epidemic, but a huge chunk of the rest of the developed world is doing their best to catch up.
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.
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.
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.
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.
On topic, very happy this medicine exists, but let's pray god will keep the prescription only for BMI > 35.
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.
If we give up on willpower, we have no plan b.
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.
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.
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?
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 love your tactic about building healthy habits while you have some support and leaning on those to carry you through the future.
Good job!
Aside from the disruption in cravings, the immediate results seem to have motivated you to do more.
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.
* 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.
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.
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...
Because you eat more or is there some other factor?
A less emotionally grounded, more balanced and nuanced description would be more accurate, honest. But it'd sell way less.
(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 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.
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?
I do not believe that is a rational take.
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.
[0]: https://www.ncbi.nlm.nih.gov/books/NBK44656/
[1]: https://www.youtube.com/watch?v=3wWg9Jx-Byw (French, English papers in the description if you want to dig)
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?
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]
[1] https://www.penguinrandomhouse.com/books/603894/burn-by-herm...
[2] https://www.nytimes.com/2016/05/02/health/biggest-loser-weig... (gift link)
Edit: Added links to sources.
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.
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.
Check https://metabolicmind.org for details.
My own experience with the keto diet - https://www.feelingbuggy.com/p/finding-hope-after-decades-of...
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.
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.
That's a lot of carbs. Only like 3 years ago did I learn they changed it around 20 years ago to be less carb-centric.
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.
> 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).
I'm Italian we eat a ton of carbs, but the pyramid I was shown as a kid decades ago had vegetables at the bottom
https://www.alimenti-salute.it/sites/default/files/sites/def...
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.
Put simply, it's easier to adhere to a drug than to a specific, somewhat anti-social diet.
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.
There is heavy research on the usage of the ketogenic diet for the treatment of metabolic and mental illness.
I've written about my personal story here - https://www.feelingbuggy.com/p/finding-hope-after-decades-of...
Youtube Videos
https://youtu.be/PeqQd4_xveI?t=43
https://youtu.be/G0lTyhvOeJs?t=421
https://www.youtube.com/@metabolicmind
Books
As I have been following the ketogenic diet and wrote about it
https://www.feelingbuggy.com/p/finding-hope-after-decades-of...
https://www.feelingbuggy.com/p/my-journey-from-mental-health...
https://www.feelingbuggy.com/p/how-the-ketogenic-diet-helped...
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.
Again, it was not a calorie restriction diet - it was a carb restriction diet.
> 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.
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.
I'd just say follow the money.
[1] https://www.science.org/content/article/obesity-doesn-t-alwa... [2] https://withinhealth.com/learn/articles/why-body-weight-isnt... [3] https://www.bbc.com/future/article/20240521-what-happens-whe... [4] https://bmcmedicine.biomedcentral.com/articles/10.1186/s1291...
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?
"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.
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.
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.
Where there’s a will there’s a way.
> constant advertising of junk food & alcohol.
Nobody is forcing you to eat those.
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.
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.
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.
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.
Yeah? Even if I’m disabled, I should got for a walk, just because I want to?
Pretending the world is binary is a fun exercise, but it is always untrue.
Which countries? As far as I know, most Western countries have roughly similar issues with obesity, at least directionally.
- 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
https://www.reddit.com/r/tirzepatidecompound/comments/1dtzr2...
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?)
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.
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 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.
And our answer to it is… another endocrine disruptor. But this time we’ll call it something else (GLP-1 agonists) and laugh all the way to the bank.
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.
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.
It seems really hard in the US.
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.
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.
Not going to waste my time providing sources to remedy your ignorance. You are more than capable of doing this research yourself.
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.
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.
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.
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.
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?
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.
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 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.
Seems like something you could lead with instead of moronic gut reactions...
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.
You can't outrun thermodynamics. But your body will change its efficiency.
Until next time we meet on the internet. :salute:
Taking a pill doesn't.
That's why it will always be out of reach of some people.
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).
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.
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.
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.
Commenter 2: Kodus to you. Let me just discount your anecdote as being unlucky and keep my current belief. But again, kudos.
HN threads on weightloss are an utter waste of time.
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.
> 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?)
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.
From https://news.ycombinator.com/item?id=41813589
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.
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.
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.
Are you suggesting there are people who can burn more energy than they ingest for a prolonged period of time and not lose weight?
That… would fundamentally rewrite everything we know about how mammals consume energy.
Of course not. Nobody needs drugs to lose weight, they need to consume less energy than they use.
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).
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.
A lot of the sides in your average US restaurant is easily 1000kcal on its own
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.
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.
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.
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.
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.
For the same reason why skinny person taking steroids is frowned upon - it is perceived as a shortcut.
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.
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”.
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.
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.
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...
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.
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.
https://www.forbes.com/sites/darreonnadavis/2023/06/14/takin...
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.
My wife, who does not have ADHD (at all), gets hyper from stimulants.
That’s the difference.
Being tired after drinking caffeine is common.
People without ADHD get hyper, not calm. Some others also get calm.
But people with ADHD who take stimulants do not get hyper.
Weird daydreams on this site.
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.
Have you considered eating less?
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.
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.
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.
I started doing it mostly out of curiosity, and it turned out one of the meals I thought it was high-calorie was actually lower than my other meals.
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.)
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.
Truth is, we really don't need more than one meal a day (maybe a snack) when we get older and our metabolism slows.
> ...
> Yet... the number on the scale kept on creeping up.
That is absolutely terrifying. What oils did you use for cooking?
But our bodies grind down substances to extract calories. It’s a simple mechanism. You can eat McDonalds everyday if you manage intake.
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.
If you’re eating the right thing for your body, you’ll be satiated when you eat your full.
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. :-)
Eat low calorie (and ideally high protein) after exercising. Fruit and Veg are amazing for this.
All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.
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.
People in the 50s weren't slimmer because they had ironclad determination to stay such.
Deviating from the mean is hard. Bad food and sedentarism are the norm.
Making the good choice the easy/only choice is the only way to solve this problem long-term (without drugs)
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.
https://www.lesswrong.com/posts/NRrbJJWnaSorrqvtZ/on-not-get...
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.
I wouldn’t call taking the stairs in a pre-elevator world “effortless”, rather it was just the only option.
I also think better food handling/storage/treatment/blah means we absorb & retain more of the calories that we consume.
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.
Diet is the overwhelming deciding factor when it comes to weight gain.
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
People in the 50s (in the US) had, among other things, fistfuls of benzedrine.
Edit: here is a link for the skeptical folks https://www.smithsonianmag.com/history/speedy-history-americ...
> 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.
You can't be obese if you don't have food.
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?
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?
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/
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?
It is a useful and topical period to discuss in a thread about ubiquitous weight loss drug usage.
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.
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.
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?
But because I live in suburban Australia and eat the same pesticide laden slop as everybody else, I too have a gym membership.
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?
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.
It is empirically and demonstrably ineffective as a solution.
Obviously no one is talking about a treadmill concentration camp here, good lord.
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.
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
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.
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.
Countries in Europe with approximately the same obesity problem as the US:
Poland, Croatia, Romania, Britain, Hungary, Georgia, Slovakia, Chechia, Ireland, Greece.
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.
So yeah, culture driven lower portion sizes + meds driven lower appetite is a well-tested combination with known positive outcomes.
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.
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.
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.
Weak thesis.
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.
That's the context.
Answer: literally non-existent.
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.
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.
As recently as the 1980s movies were overloaded with jokes about fat people, it was extremely common. That's stigma in action culturally.
>> 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 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]
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!
(You’ll quickly end up with another underground white powder economy though…)
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.
I'm not sure you could really find data to back your anecdotes.
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.
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.
Choosing to eat fewer processed foods is very effective but does not require that much self-control since appetite will fall automatically.
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?
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.
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.
Why would it matter what route is chosen here?
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.
Because this comes at the cost of one's essential humanity.
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.
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 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.
Being fit there is statistically considered an anomaly.
I don't know of any other country where you would be weird because you're fit.
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 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.
(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).
"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.
> "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.
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.
It is not cheap. Eating fast food regularly would probably more than double my food budget. And yes, I do eat meat regularly.
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.
Besides, having healthier people will lead to better infrastructure for healthier lifestyles, purely based on demand. It's a virtuous cycle.
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 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?
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.
She abruptly stopped after losing much more than she wanted to lose.
She looks ill frankly.
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.
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.
That's very idealistic, in my opinion.
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 the drug industry is more powerful than the food industry, these days.
> RJR Nabisco was formed in 1985 by the merger of Nabisco Brands and R.J. Reynolds Tobacco Company.
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.
People aren't obese just because they can't figure out how to count to 1500.
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.
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 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.
At some point blaming society isn’t going to cut it.
I promise you if ground beef is all you eat you will be much worse than fat and out of shape.
You could try it for say, two weeks. I’ve done it for two years, so nothing super crazy can happen in two weeks.
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.
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.
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.
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.
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.
[1] https://www.npr.org/sections/thesalt/2015/12/16/459981099/ho...
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.
The only way you're going to get high quality food in the US is if you live where the Amish are.
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
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.
I would assume that this is related to gut biome and not genetic makeup.
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.
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.
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.
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.
It's like well duh of course you'd prefer the impossibly unrealistic miracle.
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
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.
Maybe in passing.
Impossibly unrealistic to get rid of enormous sugar production subsidies that make it insanely cheap?
Impossibly unrealistic to simply tax added sugar?
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.
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.
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).
You can read the text change. It allows duplexes and ~doubled the allowed density on almost every residential zoning type.
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.
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.
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.
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.
https://www.timmclarke.com/resources/are-land-values-increas...
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.
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.
All 3 seem to be going swimmingly so far!
There is no material difference between impossible and challenging if the thing doesn’t actually happen.
It’s like Kramer saying he could have levels in his apartment it’s just that he doesn’t want them.
What’s the difference between, “It was hard and we didn’t solve it” and “It was impossible”?
You are aware you can’t tell a hard unsolved problem from an impossible unsolved problem, right?
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."
In addition, since the introduction of Change4Life, the obesity rate has simply continued to climb in the uk (see https://researchbriefings.files.parliament.uk/documents/SN03..., for example).
So yes, other countries (just like the US), have introduced programs to try to encourage healthier behaviors, and have seen similar outcomes from them.
https://en.m.wikipedia.org/wiki/Obesity_in_the_United_Kingdo...
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.
https://slatestarcodex.com/2017/04/25/book-review-the-hungry... might be interesting in the same direction.
This evening, go for a one minute walk.
Tomorrow evening do the same.
Next evening do the same.
Repeat.
The journey of a thousand miles begins with the first step.
Start with a minute walk. Make time in your day for it. Extend to a 2 minute walk. 5 minute. 15 minute. Etc.
The point is, make a start.
1 minute will turn into 2 minutes, then 5 minutes.
And 1 minute is infinitely better than 0 minutes.
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
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.
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).
Drugs and excuses are merely replacing natural selection.
I've struggled with weight too, and both alcoholic and abusive parents, traumas and stress, and I stuck on discipline and won it.
You should absolutely do what makes you live better, but you aren't solving the root causes, just making excuses.
That's the biggest issue I have, these drugs are just gonna make the world unhealthier and unhappier.
It's like telling people they can't have aspirin during a hangover.
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'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.
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.
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 a lot of pushups.
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.
My point is that with a dash of optimism we can conquer a lot of obstacles in our life.
Nobody talked about this in the mainstream conversations in the past.
https://letsmove.obamawhitehouse.archives.gov/
Out from underneath the rock, people have been talking about this nonstop for decades.
Food is the main cause of obesity. Obesity is the main cause of heart disease and cancer.
"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).
> 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.
> https://fortune.com/europe/2024/03/28/ozempic-maker-novo-nor...
I think this makes it likely that strongly ramping up the supply is not a major problem.
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.
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.
...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.
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.
People don't want to use a commodity syringe. People are scared of needles. The autoinjectors take most of the fear out of it.
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.
https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...
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.
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.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407685/
[edit] not to mention for those 1 in 11, the average weight regain over 5 years is 80%.
https://www.sciencedirect.com/science/article/pii/S000291652...
It's not that "eat less and exercise more" doesn't work, it's that nobody does it, because it's really, really hard.
Calories in/Calories out is both completely true and completely useless for actual humans.
edit: that's unfair, mostly useless
A phenomenon not limited to dieting.
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 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.
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.
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.
At the present time, Ozempic is not approved for Type 1 diabetes:
>...Ozempic® is not for use in people with type 1 diabetes.
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).
https://diatribe.org/diabetes-medications/why-diabetes-mirac...
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?
Maybe there is a path to using these drugs in a manner to get people healthier so they can exercise more, establish good habits and taper down.
This is especially true if you count light exercise.
The point was that the 15% weight lose in a year is in the high end of what you can expect, especially if you change nothing else.
Obviously, even a small amount of effort becomes impossible when you multiply it by "forever".
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.
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.
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?
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.
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 wonder if you confused this thread with another? Or maybe your sarcasm was misinterpreted?
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.
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.
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.
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 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?
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.
[1] https://www.youtube.com/watch?v=suy3wGzQ08g&list=PLPT0YU_0VL...
Service jobs are not conducive to good health.
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.
It shows what it shows.
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.
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.
You're looking for "hyperpalatable foods", not hyper-caloric. They're related but distinct.
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.
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).
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.
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.
> 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.
[1] https://academic.oup.com/edrv/article/40/4/1092/5406261
Is there any data I could provide that would change your mind or is this just a "I heard it growing up so it must be true" kind of thing?
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.
https://www.germanjournalsportsmedicine.com/archive/archive-...
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.
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
Yes.
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.
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.
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?
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.
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?
So how can CICO not work?
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.
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.
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.
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.
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.
To bring it back food, the issue is not the eating, the core issue is the hunger causing the eating and that's what the medication is addressing.
The people you think are eating ea
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".
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
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.
That said, modern farmworkers in my town are mostly overweight, for the same reasons as everyone else.
But yes, great way to lose weight I agree, just not practical for a lot of people.
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.
Likely, you will at some point revert to unhealthy habits and become fat again.
Long-term weight loss success numbers are abysmal.
Testosterone replacement therapy, highly refined protein powders, nootropics, etc.
We’re all trying to make the best of what’s given, revert mistakes, live longer.
All options are on the table.
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.
> 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.
Like (a) no shit and (b) the question is why can’t people. Because we know objectively they can’t.
The drugs work by literally solving your self control issue, and to such an extent it works beyond just food.
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.
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.
Looks like it's actually 1-in-5.
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.
No, I'm saying that 1:4 is something to brag about, and 1:5 is even better.
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.
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.
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.
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.
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.
See e.g.
https://en.wikipedia.org/wiki/Waist%E2%80%93hip_ratio
for recommended values.
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.
The extra weight is not muscle, to be clear.
Ah, but what is food?
A cake made with sugar, flour, and butter will have a different impact than the equivalent number of calories in blueberries
Eggs and butter will make you feel different and will be treated different by your body than white bread and peanut butter and jelly
food is too general a term, it encompasses too many very different things
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.
What you did takes a lot of discipline and hard work, and you did it.
Of course eating less calories than you consume results in weight loss, and you stuck with it. Congrats and Thanks for the details
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'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]
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/
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.
Caloric intake and outtake is just that.
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.
Right. To be explicit, "just eat less" means "live your life always hungry." There's a reason this more-or-less never works in practice.
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!
Thanks for sharing your experience and insight!
If you're willing to shoot up more often it moderates the effects better.
I'm a fan of these tools helping people get this insight, because otherwise people just accept that cloud as their normal.
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.
I have been taking tirz for 7 weeks and walking 5 miles a day + exercise. My depression is gone and I have lost 30 lbs. I am loving life.
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.
Manic behaviors also associated with older, popular diet drugs like meth.
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.
The published stuff I can find seems to be at the level of anecdata, scarcely better than "I know a guy who..."
- What people talk about on social media: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10669484/
- Some people made large "reckless" life choices: https://academic.oup.com/qjmed/advance-article-abstract/doi/...
Not yet. The effect appears to be real, but it's too soon to tell: https://www.science.org/content/blog-post/ozempic-and-other-...
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.
Does it reduce sex drive as well?
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.
This 2024 study showed no increase in risk over 3.9 years.
To be fair, GLP-1 drugs cause dose-dependent increase in thyroid cancer in mice. But mice are not humans.
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].
[1] https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf, Figure 3
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?
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.
There's a meta-analysis here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10027312/
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 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.
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.
Show your research please.
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.
The list goes on forever. I'm betting this ends the same way.
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.
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.
After what happened with OxyContin I think wed benefit from some skepticism when a new drug gets oversold.
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.
Don't think you need to worry about that one.
>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
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.
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
>Fluoride is a mineral.
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
…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?
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's a really cool Modern MBA video [1] on this topic btw :)
So does obesity, so there is that.
In mice.
So in general, if something _doesn't_ cause cancer in mice, then it's probably safe for humans. The reverse is not necessarily true.
Also, GLP-1 was associated with thyroid, not pancreatic cancer.
the life expectancy of someone with bmi > 40 is -5 years
and for bmi > 50, -15 years.
So I suspect someone ~ 65 with high BMI should be on it, the side effects would be: living.
You’re already benefiting.
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.
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.
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.
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.
Why is this particular thing the bad thing?
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.
We're about to see the nutritional equivalent.
If you are right then there should be money to be made by shorting the stock.
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.
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.
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.
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.
Mind over body.
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’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.
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.
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.
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.
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.
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.
We all know the solution: Organic vegetables, lean protein, and lots of exercise.
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.
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.
The person holding the gun is mental issues. Mental issues cause people to eat unhealthily.
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.
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.
https://www.europeandatajournalism.eu/cp_data_news/europe-fa...
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.
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.
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]
[1] https://www.reuters.com/legal/litigation/novo-nordisk-settle...
[2] https://iplaw.allard.ubc.ca/2024/10/08/settlement-of-patent-...
[3] https://www.pacermonitor.com/public/case/52064967/NOVO_NORDI...
[4] https://www.cnbc.com/2024/04/30/ftc-challenges-patents-held-...
Ozempic and Wegovy are game changes and have real, tangible health benefits.
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.
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.
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]
[0] https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/21...
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.
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.
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.
Put another way, up to a pound a week of weight loss, changing nothing about your diet.
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.
Usually if you can fight through the "hunger" it'll calm down in its own after about an hour or so in my experience.
I feel like you just inadvertently explained why dieting is not the answer.
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
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".
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.
There are a bunch of articles out there about it, but Kurzgesagt has a decent pop-science summary: https://www.youtube.com/watch?v=vSSkDos2hzo
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
I cannot find a good article on it at the moment but dig around and you should be able to find it. And yes I know people rave about vitamin D.
https://pubmed.ncbi.nlm.nih.gov/26995293/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986531/ https://pubmed.ncbi.nlm.nih.gov/23109644/ https://pubmed.ncbi.nlm.nih.gov/21406296/
It's far from conclusive, but there is a mechanism of action that makes some sense, so it wouldn't be out of left field if it were the case.
There's also some evidence that vitamin k can be used to help balance out the risk:
https://pubmed.ncbi.nlm.nih.gov/19386744/ (More animal studies on K, too, but god knows how well those will translate to humans)
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.
I do it. Lots of people do it. The information is freely available, now more than ever.
From all I've read, Ozempic isn't a silver bullet, and has many side effects. It just helps people stave off the inevitable for a while.
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.
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!
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 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.
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
- Sleep more
- Reduce stress
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."
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.
Now what about the other 74% of the population.
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.
Literally opposite of what they’re saying. You’re the one who screams “I’m special, diet and exercise don’t work on me, I’m defying physics”.
You are deliberately missing my point: I'm not special.
Go back to reddit, where they appreciate your "style" of discussion.
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.
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.
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).
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.
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.
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).
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.
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".
[0] https://www.huffpost.com/entry/chewing-on-the-twinkie-di_b_7...
What metrics determine quality? How recently were those established?
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).
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.
A product that fits a niche - former meat eaters who miss meat and want to be vegetarians.
Otherwise for true health conscious or longtime vegetarians there are better options.
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.
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.
[0] https://www.npr.org/sections/health-shots/2023/08/28/1194526...
[1] https://www.bloomberg.com/opinion/articles/2024-07-20/animal...
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.
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".
Is it? It might reduce the amount of animals killed, sure, but it won't improve the well-being of the ones that are still raised.
I don't get why that would be a better measure?
The reality is probably somewhere in the middle.
I think such paradoxes demonstrate we probably need a completely different approach than anything we've done so far.
Utilitarianism feels to me like Mill & Bentham discovered basic arithmetic and didn't even realise there was more to maths than that.
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.
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.
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.
Let's be real. If demand for meat declines, producers will have to double down on "factories" in order to remain solvent.
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.
Food for thought?
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 it's equally plausible that the US increases food exports rather than lower production. Especially as production is subsidized.
This said, obesity is exploding everywhere else in the world too, so it's not just a US problem.
What if it makes us get a better control over our consumption behavior in general?
Wouldn't some large companies have a problem with that and fight it?
While remaining on the drug.
I expect your impulse control will be even worse after getting off of it, but I don't have a study to back that up.
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.
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.
To those people I suggest you run an experiment : what ever your current body weigth is right now. Try loosing and keeping off 20%.
Easy peasy. I’d be borderline anorexie if I do that, but wouldn’t be much of a problem to achieve that.
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 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.
Muscle loss is associated with _any_ kind of weight loss.
And GLP-1 drugs _improve_ the bone density: https://academic.oup.com/jcem/article/100/8/2909/2836097 It's likely simply because thinner people naturally move more.
Eat a whole lot of protein, lift, and you're going to be doing more than fine in the muscle loss department.
I gained muscle mass by doing strength training 2 times a week while on GLP-1 drugs.
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'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.
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.
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.
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.
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!
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.
The solution is already there. It’s free. It works for everyone, and even 60% of people in the US are doing it!
The right answer to being healthy is not more drugs.
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.
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)."
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.
And now it's becoming clear that IQ is affected by fluroride https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409983/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285601/ https://www.reuters.com/world/us/epa-must-address-fluoridate...
So how about we keep it out of our drinking water. If you want to put fluoride on your teeth, use fluoridated toothpaste.
In fact, WTF is India doing there? Don't they have limits on it?
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%
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.
>...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.
I count 18 or so here...
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
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.
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.
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.
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".
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).
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.
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'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.
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.
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).
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.
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 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.
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.
Social media
Drugs and alcohol
Food
Or literally any other addiction. I don't think this is a useless thing to discuss.
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
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.
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.
> 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.
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.
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 :-)
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.
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...
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)
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
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.
This drug can help break out of that spiral and fix the craving/willpower problems.
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.
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.
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.
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 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 agree that at the population level, this will be a game changer. As you say, the average person struggles with lifestyle adjustments.
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)
Despite this assistance (or lack of headwind) they seem to do ok.
But sure, it's a US problem.
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.
We’re not talking about world class athlete. There a mile difference between world class athletes and not obese.
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?”
Why do you think that telling people to “just stop being fat” will suddenly start working?
https://www.glamourmagazine.co.uk/article/post-your-pill-tre...
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.
I've met plenty of skinny fat people who think they're healthy.
Well here’s your problem. You should’ve bought barbell 20 years ago. Or at least a couple of kettlebells.
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.
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.
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.
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?
https://www.latimes.com/science/story/2024-05-29/will-ozempi...
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.
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.
So we gotta make it not a valid way to operate.
Actually, no I don't. God bless modern medicine.
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.
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.
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.
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.)
https://www.ft.com/content/094cbf1f-c5a8-4bb3-a43c-988bd8e2d...
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.
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%).
Is there evidence to support this hypothesis?
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.
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.
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.
Thr first few weeks were hard. My body was hungry all the time. Now I feel hungry far less. I don’t get hungry until noon.
The problem is that if I ever cheat and pig out, like, say, this Thanksgiving weekend, it resets and I feel a week or two of miserable hunger again.
If I could cheat my brain in any way, it would be just not feeling hungry until noon, regardless of past actions.
Not eating too close to going to sleep suffices. I'd set the minimum at a good 4h.
I'm a pretty good cook, though.
I know my appetite falls off a cliff if I'm nauseous/have an upset stomach/suffering from reflux.
https://ourworldindata.org/grapher/share-of-adults-defined-a...
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
https://slate.com/technology/2023/07/ozempic-costs-a-lot-it-...
Although tirzepatide just got knocked off the shortage list last week so it could become harder to get in compounded form.
Since WFH, it’s scary to me how sedentary I have become.
It wouldn’t surprise me if I now walk < 1,000 steps per day.
I can easily go a couple of days and never even leave the house.
My waistline shows it. And I’m actually eating less than I did when I went into office.
I guess its basic thermodynamics.
I'm super satisfied just having an apple or two now. The "omg I need to eat, ohh a burger" is gone.
Glad you're seeing benefits like that!
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.
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.
Why?
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.
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.
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.
I'm curious to hear the argument
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.
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.
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.
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.
This is a big eating habit detail.
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.
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.
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.
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.
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.
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.
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.
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.
More than probably, it's called "being white".
(And we evolved that for more vitamin D?)
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.
Have you wondered why ADHD has exploded?
Have you not realized how many people at hacker news are on SSRIs? Watch this comment, you will.
My complaint is getting addicted to pharma because we’re addicted to toxic food.
https://www.bloomberg.com/news/articles/2023-10-07/ozempic-f...
https://www.wsj.com/business/ozempic-impact-snack-food-compa...
https://www.washingtonpost.com/business/2023/10/09/ozempic-w...
https://www.cnn.com/2023/10/05/investing/ozempic-food-compan...
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.
You’re making some pretty casual assumptions about people’s abilities.
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.
Exercise is recommended for everyone, regardless of weight.
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.
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.
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’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.
It's been forty years, how much longer would it take to admit that's not happening?
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.
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).
Even blue state dem voters I know used to whinge about Michelle Obama and her veggies lol.
People in the Netherlands eat such shit food — but they are so healthy because they move a lot and aren’t obese.
I’m not sure that food quality is as important as we sometimes hope it is (after all, we pay for quality)
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.
This is a bullshit term. Even fast food is not "toxic", it's just calorie-dense.
I got overweight eating nothing but "healthy" diet because I have never _liked_ fast food.
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.
I read plastic surgeons said it was bad for your skin and people would look much older when they take it for a few months.
Yet, I also read it was generally good for your health, not just in terms of weight loss.
And yes its over the counter....I currently take one dose per day at 1200mg
> 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
"Berberine induces GLP-1 secretion through activation of bitter taste receptor pathways"
https://www.sciencedirect.com/science/article/pii/S000629521...
But buyer beware when it comes to getting berberine from over-the-counter supplements:
"Variability in Potency Among Commercial Preparations of Berberine"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807210/
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"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337101/
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.
Eat less. Move more.
https://pubmed.ncbi.nlm.nih.gov/34981502/
Imagine only spending $11 with no side effects to spending $300 and up with major side effects.....
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.
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.
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.
0: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756738/ 1: https://www.nature.com/articles/ijo2014180 2: https://pubmed.ncbi.nlm.nih.gov/37876436/
Because bacterial infections can be horribly lethal?
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.
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.
The cosmetic narrative you're pushing is actually quite disgusting.
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.
The obvious evidence is the result of the drug, i.e., overweight people losing weight because they're eating less.
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."
https://publications.aap.org/pediatrics/article/151/2/e20220...
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.
It is a much safer assumption to make than tax evasion.
Jesus. I am glad not to be a US citizen; I moved to Japan and very easily stopped paying taxes to my former country.
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
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.
I didn't even need much if any willpower past the first couple days.
This push for Ozempic is utter madness.
It's just now selling you the antidote to the problems it made. Profit.
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?
Are you sure the insanity isn't the assumption that it's just insufficient willpower or poor habits?
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.
90% of them would fall into overweight in a course of multiple months if they’ve dropped sugar.
I feel like this is missing the obvious follow up question, “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.
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.
No, definitely not. There's a few of you in this discussion.
That’s seems entirely fucked up
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?
It absolutely boggles my mind to always see Americans swallow everything and anything that big pharma serves them. It's insane behaviour.
Blowing up fat cells?
I was "find this page" for side effects, but see little discussion about them. So am honestly intrigued, and would love to hear more.