Good! I'm on liraglutide (Saxenda) for almost
3 months now (can't get semaglutide (Ozempic) in my country without being diagnosed with diabetes)
Anyway. Food cravings gone, I was eating like 10 times a day before that. At least, but sometimes even more. Now I'm on intermittent fasting/OMAD and has 0 problems. No hunger, no cravings. Feeling significantly better.
I’ve heard about GLP-1 pills being used for weight loss, and while I haven’t tried them myself, I know they help regulate blood sugar and can suppress appetite, which can be useful for some. It’s important to keep in mind they’re still a medical treatment, so it’s good to speak to a professional before starting.
Personally, I’ve had success with intermittent fasting and HGH therapy. I started HGH treatment due to a deficiency, and it’s made a huge difference for me, especially in terms of energy levels, recovery, and muscle tone. Combining fasting with HGH therapy has really helped me stay on track with my fitness goals, and I feel much more in control of my body and my health.
for those who are interested in a cheaper, partially generic, pill based option for weight loss, i was just referred by a friend to the naltrexone + bupropion + metformin solution offered by hims (not linking because their website is terrible for learning anything without giving all your health info). he lost 30lbs in 3 months on it. i've just started so i cant vouch but just sharing that non GLP1 appetite suppression solutions that work exist.
Naltrexone in high doses takes away all pleasure by blocking opioid receptors (low doses do too, but it is different when only a few hours). So there is no reward for drinking or eating if that is why you are eating. If this is not why you eat it will be less effective.
Bupropion acts as a norepinephrine–dopamine reuptake inhibitor. Importantly it doesn't directly raise your serotonin. If you are a night owl, have trouble falling asleep etc you might have low serotonin to start and this could be bad for you.
Both of these are associated with suicidal thoughts. There is a reason HIMS requires your health info before suggesting drugs. I would flag the parent as providing dangerous information.
I've never heard of combining metformin with the other two drugs. The naltrexone/bupropion combination is sold under the brand name Contrave. As with any weight loss drug, I recommend a healthy amount of scepticism. Contrave's history includes an initial FDA disapproval and two prematurely terminated studies, and the drug changed hands a couple of times.
Some people who come off the GLP-1 meds (acheiving goal weight) are recommended by their docs to take metformin as a maintenance drug to stabilize weight.
Yes. Having used both I can say indeed it is. Not only does GLP-1 slow digestion which limits what you can eat and when it also is being study for its effects on alcoholism etc reducing cravings. I and many people I know noticed the difference in cravings were not limited to food.
Oddly enough, no. It seems to affect a different desire pathway than dopamine and such. It’s not anhedonic, good stuff is still good and you still want it. Even food! It doesn’t make food not-pleasurable, just reduces hunger. It only seems to affect very particular kinds of cravings associated with food and addiction/compulsion, not sex drive (though maybe for “sex addicts”? IDK)
How does it work? Does it reduce the calorie intake by decreasing the appetite? Your body burns more calories because the drug sets the thermostat higher?! Or something else?
I don't know how to feel about the idea that we need treatment for being overweight in general.
> The consistency that I'm hearing from all across patient groups is gain of control, whereas previously, there was a loss of control… All of a sudden they're able to step back and say, 'oh, well I had this shopping phenomenon that was going on, gambling, addiction, or alcoholism, and all of a sudden, it just stopped,' - Dr. Gitanjali Srivastava, Vanderbilt Medical Center
Sidenote, my SO recently started a generic GLP-1 shot. It has far more side effects, at least during ramp up - than just reward center.
Notably a wide array of food either make them sick to their stomach or have colon related issues (diarrhea or constipation).
I suspect i do observe reward changes as well, but especially in the first few weeks it felt like i was observing weight loss strictly because they struggled to eat so much food without getting sick. So many of the foods they still wanted would just make them sick immediately or hours later.
I think they read that much of this is temporary to the ramp-up time, though. So hopefully in ~6 months they'll be on the full dose and won't have so many nausea/diarrhea issues.
Taking GLP-1 meds without a program around them is like taking psychedelics without support/setting.
Before I started taking mine, I had to spend a whole month living the diet I'd be on (I lost 10lbs just with that diet change alone) to prepare. Lots of water, lots more fiber. Avoiding certain foods.
When I started taking the meds, my weight started to drop further and it was a minimal change to eat smaller portions (I felt full earlier). No side effects at starting dose.
Usually the 2nd/3rd tier of dose increases are where people get worse symptoms so your SO may be in for a more difficult time.
Some people don't tolerate the meds. Hopefully your SO is giving feedback to the doctor to course correct.
> Before I started taking mine, I had to spend a whole month living the diet I'd be on (I lost 10lbs just with that diet change alone) to prepare. Lots of water, lots more fiber. Avoiding certain foods.
Problem is i don't know what we could have predicted. The only thing the doctor predicted was the protein, which we did prepare on.
The other things have largely been a surprise and most importantly erratic.
> Usually the 2nd/3rd tier of dose increases are where people get worse symptoms so your SO may be in for a more difficult time.
I believe they're on the 3rd tier atm and the symptoms are lessening, though it's difficult to say if it's that or our successful adjustments.
And yea the doctor is aware - both my SO and their parent had doctors that planned to only increase tiers when they get reduced symptoms. So the doctor was planning for it at least, even if we weren't prepared on the specific foods they'd have issues with.
> Taking GLP-1 meds without a program around them is like taking psychedelics without support/setting.
That's not really my experience. For myself, and the ten or so people I've persuaded to start taking them, nobody has really done much different other than listening to their body. I'd strongly encourage people to count calories to make sure they're eating enough, but I'd strongly encourage that of anyone who can't trust the hunger signals their body is throwing out in either direction.
> many of the foods they still wanted would just make them sick immediately or hours later
Can you name some of the foods? Never been on GLP-1 drugs. But a good amount of fast food leaves me feeling lethargic and, if I eat it too quickly, nauseated afterwards.
Their doctor suggested that they would drop a lot of weight fast, and they wanted to make sure they focused on eating lots of protein. So that's one restriction, medically prescribed meal types.
On top of that, fatty meals, larger meals, and iirc fast carb heavy meals would all cause either nausea or diarrhea. Interestingly their mother is on the identical same generic GLP-1 shot, and has mostly the same side effects. It's kinda difficult to enumerate all the foods that went poorly, and it doesn't always feel logical. We eat a lot (entirely?) home cooked meals, so it's not like i'm even talking fast food here.
Off the top of my head a lot of dark green vegs have been working well. Brassicas and the like.
I should note that they're still quite happy on the drug. They still eat normally enough that it's not like they're only eating broccoli or something. We just have to plan meals very purposefully. It's also a lot of trial and error to find the subset that works.
> On top of that, fatty meals, larger meals, and iirc fast carb heavy meals would all cause either nausea or diarrhea
It's worth pointing out that it's a minority of people who get any side-effects. I felt weird the first few days, but after that I only got myself into trouble if I'd forgotten to eat all day and then was faced with a hyper-satiating food with no natural portions -- an on-table buffet, someone placing endless bowls of chips and dips in front of me at a party, etc.
Interesting to know. My sample size of two both have the same behaviors, and the GLP subreddits seem to validate the side effects finds as well iirc, but i'm just an outside observer so i've not dug deeply on this.
Do we know what the long-term affects are? Is there any lasting benefit if someone stops taking these types of medication? If one does keep taking it indefinitely, does the addiction-suppression effect stay the same, or reduces over time?
There are side effects, but the risk profile is known (is my understanding). It is (at this time) believed to be a forever drug, just like diet and exercise stop working if you stop them. A longer term fix is likely gene therapy (Fractyl Health has a clinical trial in progress, REMAIN-1) vs chronic maintenance.
GLP-1s allow us to poke at the human to see what happens. Gene therapy will, hopefully, allow us to implement a permanent fix vs a hotfix (once the risk profile of such a genetic modification is better understood).
AFAIK Fractyl's "drug" is not gene therapy but a surgery where they remove part of the lining of your colon. It is not currently possible (nor will it likely be) to use gene therapy for obesity treatments. The technology is not suitable for this kind of medical application.
Wasn't my understanding from the contact I spoke to at Fractyl and associated docs. Noted to follow up with a ___domain expert, appreciate the context. Are you available for a paid 30-60 min conversation on the topic? Attempting to fill knowledge gaps, as I am not an expert.
> just like diet and exercise stop working if you stop them
I suppose, but that assumes you are viewing them as temporary weight loss interventions rather than lifestyle.
The key is to want to be healthy, and to arrive at a sustainable balance of nutrition and exercise level that works for you to stay at a healthy weight. Fad diets where you are denying yourself pleasures, or going hungry are not sustainable, nor is any extreme exercise regime that you find unpleasant or does not comfortably fit in with your routine.
Diet and exercise don't have negative side effects and they are free. Exercise is social too and has lots of side effect benefits beyond the obvious fitness ones
> Diet and exercise don't have negative side effects and they are free
They're absolutely not free. They fail at a high rate, which incurs medical costs. And when they work, they require--in practice--a lot of follow-up and coaching.
It's fairy-tale level mindblowing that we can look at the status quo where nearly half of the industrialised world is obese and get haughty about a drug that medically, demonstrably improves patient outcomes.
Tell me how much does it cost to do push ups? How much does it cost to do squats? Failing at doing any of these does not incur medical costs. And yes, it takes effort and willpower (like anything worthwile in this life). But none of those cost money.
It's fairy-tale level mindblowing that we can look at the status quo where nearly half of the industrialised world is obese and get haughty about a free method (see physical exercise) that medically, demonstrably improves patient outcomes with no negative side effects.
That drug is the medical equivalent of a goldberg machine.
Exercising your willpower will have more benefits than physical exercise alone: mental health, cardiovascular and strength fitness and you could go on. And it is free. No big farma making money from you
> It takes time and induces brain fog for at least some time after exercise
Are you serious? How is "taking time" meaning that is not free? And you can't possible use that as a side effect. Brain fog is not even a common side effect. In fact, doing exercise is actually one of the recommended ways to tackle brain fog.
Obesity is primarily a US problem. It's not the same in Europe, where people walk a lot more, and where portion sizes are normal. A ham and cheese sandwich in the UK would have a slice of ham and of cheese. In the US a deli sandwich is a monstrosity with about 1/4 pound of meat in it.
No no no. Obesity is very high in the US, but it's a big problem for lots of the world. It's a hard one to compare because different places use different cut-offs, but bringing this back to the UK: "64.0% of adults aged 18 years and over in England were estimated to be overweight or living with obesity [of which 40% are obese]"[0].
Thing is the US is the world's superpower and it extends its influence everywhere. That includes its language, tech, culture and food habits (however unhealthy) too
If no one does them, their risk profile is immaterial. GLP-1s can be manufactured for $5/month. Cheaper than trying to coax the monkey brain into doing things you can't make it do. I cannot speak to the gene therapy cost; balance against lifetime cost of "Western disease" if not provided.
Engineer for the way the world is, not the way we wish it was. From your comments, you appear to operate under the belief that people can free will their way to success ("The better option seems to be face the appetite head on rather than putting it on a temporal cage"). That is not what the evidence shows, and I wouldn't ask anyone with a brain chemistry imbalance or dysfunction to attempt to will the condition away when proven interventions are readily and inexpensively available.
TLDR We are improving agency in humans using bioengineering, broadly speaking.
I find your language usage curious. "trying to coax the monkey brain into doing things you can't make it do", "the way the world is", "people can free will their way to success", "anyone with a brain chemistry imbalance or dysfunction".
You seem to imply that people have no self-control and are unable to power through difficulties. Because this is what is all about at the end of the day: self-control, one of the main things that separate us from the rest of the animal kingdom. It is the ability to regulate one's emotions, behaviors, and impulses in the face of temptations and urges.
What your parents taught you, your teachers taught you all those years during compulsory education lies on a solid foundation of self-control. Civilisation as we know is built upon it. Depends on it.
Yet your language implies that this is not the case. That humans are effectively, like toddlers, unable to use their self regulating powers to reign upon their emotions for the sake of a much better outcome in the long term. Fully unable to choose healthier foods or foods with lower calories. Fully unable to engage in free physical activities such as walking, jogging or running.
Truly makes you wonder how civilisations exist at all.
The idea that you can improve an individual's agency by having to temporarily disable a part of their brain is nonsensical. Surely, you can temporarily improve a specific decision making outcome (do I eat now?) by doing this. But you are not improving their agency anymore than you can by putting a gun on their head. In both cases, there is an external force temporarily suppressing a part of their normal decision making so they decide not to eat.
The underlying problem: lack of self-control is still there. You just tackled a symptom. There are others (deciding not to engage in physical activity for example).
A better solution would tackle the lack of self-control rather than some of the symptom. There is already some research on this area and some potential suggestions that if further investigated could help provide a better solution. But unfortunately, the solutions are virtually free and don't involve a lifetime subscription (could very well end up like diabetes medication which is arguably more critical for affected people yet with companies endlessly increasing the patents Disney style) to a drug.
So long as an appropriate level of hormone exists in the body (they're injecting hormones doing this) the effect stays the same. This is like wondering if women need to supplement increasing amounts of estrogen over time (as opposed to supplementing only when needed i.e. birth control or menopause). You can take it indefinitely, but you must take it indefinitely in order for it to keep its effectiveness because the body isn't producing enough of the hormone.
What people inject is not the hormone itself, but a secretagogue (aside from people who directly inject insulin).
> You can take it indefinitely, but you must take it indefinitely in order for it to keep its effectiveness because the body isn't producing enough of the hormone.
I don't think we consider this (weight gain due to overeating) to be a GLP-1 deficiency, although I'd be interested to see research on that.
We do know that the benefits stop as soon as you stop taking it. You'll start gaining back weight.
No negative long term effects have been observed in humans yet, but some animals in trials were at a higher risk of cancer.
We haven't observed any evidence that the addiction-suppression effect reduces over time yet. However, we haven't been studying that effect for very long.
> We do know that the benefits stop as soon as you stop taking it. You'll start gaining back weight.
It's more accurate to say that if you're depending on the appetite suppression to eat a sustainable amount of calories, you will begin to gain weight again after stopping the drug.
It's possible to use a GLP-1 agonist to lose weight and then keep it off with a proper diet. I took tirzepatide (Mounjaro) for 6 months, lost ~45 lbs., and have not gained any back after stopping the drug in July.
So what changed for you? Why are you now able to control your calorie intake, but not before (or maybe you could have, but just didn't do it that way)?
Sounds worrying to me as it means this is essentially a lifetime drug. As soon as you stop taking it, your appetite returns and so does your old weight. The better option seems to be face the appetite head on rather than putting it on a temporal cage
> Sounds worrying to me as it means this is essentially a lifetime drug. As soon as you stop taking it, your appetite returns and so does your old weight.
I see this said all the time about GLP-1 agonists, and it's a mischaracterization. It is true that when you stop taking the drug, your appetite is no longer suppressed, but you can still keep the weight off by eating a sustainable amount of calories.
Usually, the biggest challenge with weight loss is sticking with it, since it's normally miserable and takes a very long time. Taking a GLP-1 agonist speeds the process and makes it much more tolerable. I lost ~45 lbs. (~205 to ~160) in 6 months by taking tirzepatide (Mounjaro), and if I had done it without the drug it would have taken at least twice as long and been much more difficult.
It's true that the solution is more complicated than "just eat fewer calories", but it's also true that some people just need their baseline to be reset.
I'm perfectly capable of maintaining my weight at ~160 lbs, but losing a large amount of weight to get there was difficult enough that I didn't try. A friend did pretty much everything to lose weight after she had children but couldn't, went on GLP-1 agonist for a few months, lost it all and kept it off since.
People always lament that, like most drugs, the effects of a GLP-1 agonist stop when you stop taking it. What I'm saying is it doesn't necessarily matter. Some people will need continued support, some won't. Taking the drug isn't a "life sentence" and you aren't guaranteed to re-gain the weight after you stop.
Tirzepatide (aka Zepbound/Mounjaro) is called a dual-action GLP-1/GIP agonist. The GLP-1 action overall makes you feel less hungry, basically. The GIP action slows gastric emptying (how quickly food moves from your stomach to your small intenstine) so you feel full longer. It also has a modest effect on lipolysis, which means it does help somewhat in breaking down adipose tissue (fat) to use for energy more efficiently.
Semaglutide is a GLP-1 agonist only. Retratutide is a newer drug that is triple-action.
Generally on these drugs the action does not induce more "calorie burning", they are used mostly to modulate caloric intake.
>I don't know how to feel about the idea that we need treatment for being overweight in general.
Obesity is by orders of magnitude the worst public health issue facing humanity. Obesity makes every disease worse. Obese people are more likely to develop cancer, cardiovascular issues, respiratory issues, dementia, diabetes, and other afflictions. Obesity often leads to depression, lack of motivation, lower libidos, overall worse moods in general.
Of course there are "levels" to it, it's not to say everyone has to be a bodybuilder to be happy and healthy. Of course not. This is not about being slightly overweight, or "wanting to lose 15 lbs for summer"... But in almost every way, being fat makes life worse for the majority of people.
I have such pills with the same active substance as ozempic. So-so effect, also the protocol is to take one two hours before the first meal, making me delay breakfast.
> Curious if there's been any accounting on the long term impact in terms of cost on the healthcare system
Savings on the order of $100bn per year [1].
> longer life spans impacting Social Security, Medicare, etc.
An obese person dying early may well wind up costing the system more than a healthy person dying old. (Most medical costs are incurred terminally. The obese have more-complicated terminal paths.)
There should certainly be measurements taken, costs considered, alternatives approached when building our healthcare system. No one has ever implied otherwise, ever. To imply that there is some level of healthy after which it doesn't make sense to seek improvement is the dehumanizing and anti-social part. What is the point of building an economy at all if not to improve the lives of the population? Opinions in this thread already seem to be that "people are healthy enough, and if not, it is due to their own choices" rather than "we should carefully consider how to optimize this system for efficiency" while focusing on the actual goal of improving lives for the average person as well as those who need more healthcare.
> imply that there is some level of healthy after which it doesn't make sense to seek improvement is the dehumanizing and anti-social part
No it's not. Every doctor triages. And every medical system has internal cost limits, whether implicit or implict, universal or variable, past which it will not treat. Sometimes that's enforced by gatekeeping entire categories of treatments; in other cases we have patients individually reviewed, e.g. for organ transplants.
If managing obesity is less expensive than treating it, there is a legitimate question around how the cost of that treatment should be split between the public and the individual. (Whether that cost be an explicit split or gatekeeping the treatment to only the most morbidly obese.) Thankfully, that's not the case--treating obesity, even chronically with super-expensive drugs, is still cheaper than the status quo.
Correct, doctors do triage according to need and available resources. When you imply that there is some category of care that doesn't deserve treatment (or is too "costly" to provide), you are triaging and choosing economic growth over healthcare. I think that it is a rational decision to make, although it is certainly not the one that has the most respect for human life.
> When you imply that there is some category of care that doesn't deserve treatment (or is too "costly" to provide), you are triaging and choosing economic growth over healthcare
Yes, every medical system does this. (It's almost the defining difference between medicine and healthcare.)
America does it individually (and inefficiently). Europea by restricting access to expensive treatments. If you don't do this at some level, you'll wind up with edge cases constantly running up bills the economy can't pay for and a collapse of the healthcare system's solvency.
I wrote a few paragraphs of response to this assuming that you are implying that there is a level of death/disease that is acceptable because treating it would not be cost-effective, but I deleted it because it would be uncharitable to assume you think that.
It would be interesting to see this information, but would not be useful to act on. If the answer was "it costs more to keep more people alive" (hint: it does, that is why we let so many die of preventable illness), should we keep less people alive and healthy? The pursuit of economic growth at all costs is a disease far more dangerous than anything you would treat in a hospital.
Health care costs is how individual people’s terrible lifestyle decisions end up impacting everybody else. If somebody wants to live some awful unhealthy lifestyle it really should be their own choice to do so. Except for the fact that it drives up everybody’s insurance premiums, and in countries where the government either partially or entirely subsidises healthcare costs, it gives the government an outright moral mandate to start nannying everybody’s health choices.
If somebody wants to live an obese lifestyle, I really think that’s up to them. But I’d be much happier about it if it didn’t cost me so much money.
Do you think addicts should receive treatment? Do you think that people who make bad decisions deserve to live? Do you extract the exact amount of value from society relative to the amount you put in, or do you take more than you give? Are you sure? Please explain.
Your perspective is frankly disgusting. I hope you don't have any vices. The point of a society is to pool resources together to improve the collective. Different people in different positions of power and ability have different needs. Hopefully you don't personally have any power to exclude people from that group. I hope that the powers that be don't decide that you deserve less for some reason.
I don’t think being addicted to laziness and having a glutinous appetite is exactly comparable to say, being addicted to heroin. But yes, I do think addicts should receive treatment, just as I think obese patients should (and do) receive treatment for all the diseases they end up with. But addicts, like the obese, impose many of the costs of their own bad life decisions onto others. It’s what you’d call a negative externality, and if some magic treatment came along to fix drug addiction, I would also be very happy to see that negative externality addressed.
Well the food addiction or sedentariness addiction diagnosis are a lot more controversial than a heroin addiction diagnosis, though I can see how they have some things in common. I think labelling any observable manifestation of poor impulse control as a medical addiction is more of a social trend than a legitimate scientific discovery.
The bigger difference though is that we all eat food, and for most of us includes at least some absolutely delicious food that would be incredibly unhealthy to eat in large quantities. We’re all (more or less) exposed to the “addictive substance”, it’s just some people have the ability to deprive ourselves constantly indulging that impulse, while others don’t. We don’t however, need to take small doses of heroin every day to survive.
> labelling any observable manifestation of poor impulse control as a medical addiction is more of a social trend than a legitimate scientific discovery
What gives you the confidence to overrule medical professionals on this? (Note: I am not a doctor and have zero medical training.)
> We’re all (more or less) exposed to the “addictive substance”, it’s just some people have the ability to deprive ourselves constantly indulging that impulse, while others don’t
One, I’d challenge we’re all similarly exposed. I grew up in a house with no sugary sodas and plenty of leafy greens with each meal. Many people did not.
Two, we know from drug addiction that there is no global measure of addictiveness. Some people can smoke a cigarette or cigar or two, on average, per year. Others get hooked after their first draw. There is no reason to suspect something similar isn’t happening with obesity.
I’d say it stops being a useful descriptor at that point. If any activity that a person can possibly find rewarding in any way can be addictive, then everything is addictive. Because for any activity that you can possibly think of, you’ll find definitely find somebody who likes doing it.
By this criteria, I’m sure you’ll be able to find at least one eating glass addict somewhere in the world. But if we can stretch the definition to include glass as an addictive substance, then it kinda stops meaning anything at all.
And when I say these innovative addiction diagnoses are controversial, I mean within the community of clinical experts, which they are.
Based on common sense. Not everyone has tried heroin, but most people have overgorged themselves - maybe eaten too much ice cream or candy or pizza. I am guilty of that, and make sure to make it a rare occurrence and keep myself in shape.
> Not everyone has tried heroin, but most people have overgorged themselves
You're assuming everyone who tries heroin becomes an addict. At first glance it looks like "approximately 1 to 12 months after heroin onset, an estimated 23% to 38% of new heroin users have become dependent on heroin" [1]. By coincidence, that seems to mirror American obesity prevalence [2]. (Obviously heroin is more addictive than food. Don't do heroin.)
> I don’t think being addicted to laziness and having a glutinous appetite is exactly comparable to say, being addicted to heroin.
Your opinion is that of a petulant child. Many years of research has shown that obesity is not this simple. Many chemical processes take place that influence one's ability to make better health choices, and many external factors put constraints on those choices as well. This is the exact same thing as hard drugs. Being obese is not a moral failing. When you say things like this, you show your true colors. You are not extending humanity to obese people, and it is very obvious.
I sincerely hope you reconsider your opinions. I hope you don't have any obese people in your life, or at least hope they don't read these messages. I think they would be disappointed to hear what you think of them.
And again, I hope you don't have any vices and are the perfect model of health, otherwise this would be a quite silly opinion to have.
EDIT:
I've been rated limited on comments so I'll post my last response here instead:
I have nothing further to say to this other than that you should consider talking to someone about your clearly deep-seated hatred for those who don't fit your model of participant in society; it doesn't seem healthy. Find an obese friend and show them your comments and watch their face as they read them. I wonder if you will find the humanity in their response that you are lacking here.
I would say that your suggestion that grown adults should be absolved of responsibility for their own decisions is actually a quintessentially childish idea. The fact that you are so deeply offended by any suggestion otherwise is even more childish.
You're both wrong. Obesity increasingly looks like addiction--as with any addiction, it takes two to tango. But once you have an addict, shame is an ineffective treatment. Debating giving an obese person GLP-1 drugs is akin to challenging methadone for heroin addicts.
I never suggested shame as an effective treatment. But refusing to acknowledge the reality of the situation is not an effective way to discuss the problem. Obesity is the result of lifestyle choices, and those choices do impose their costs on everybody in society. Which is why I would be very happy (and I would suggest everybody should be happy) if an effective way to address the problem was discovered.
The fact that an obese person is harming other people as well as themselves might be an uncomfortable truth for them to hear. But ignoring it doesn’t make it go away.
> Obesity is the result of lifestyle choices, and those choices do impose their costs on everybody in society
Granted. But why does it need to be said?
I'm a skiier. That lifestyle choice alone probably has a higher risk-adjusted cost to our healthcare system than if I were fat. I'd still miffed if prior to setting a bone my doctor decided to lecture me on the risks of skiing. I'd be positively furious if I got that from my health insurer.
> fact that an obese person is harming other people as well as themselves might be an uncomfortable truth for them to hear
Why do they need to hear it? There isn't a need. What they need is to not be obese anymore. That's treatment. My point is skipping the lecture and going straight to treatment is how we solve most medical problems.
Because it's literally a large chunk of the economy? Why wouldn't you worry about that. I certainly don't like to see a society where the young are enslaved by the old to pay for their medical treatment.
I mean, I'm contributing to the Social Security system here so I'd like to know how it's going to impact my long term retirement. There's nothing malicious about it; purely a question of accounting and math.
Meh, 10-12 grams of inulin plus a teaspoon of allulose has accomplished the same thing for me. Just be prepared for the fart armageddon that comes with the inulin and will last for 3-4 weeks as your gut biota adjusts.
My regime for informational puprposes, consult your doctor before you try anything obviously:
3 restorafiber gummies in the morning, 3 in the evening a half teaspoon of allulose in the morning and evening (tastes sweet, I just dissolve it on my tongue).
Costco sells 2 large 140 gummie jars for 29 bucks (46 servings) where I live and the "wholesome, non-gmo pure allulose" brand is available from iherb for 19 bucks for 80 daily servings, which puts the cost of this regime ~86 cents a day.
I mean always good to have options, but weekly injection is painless and more convenient, plus no need to worry about dosing inconsistency from taking pills on full vs empty stomach.
There is theory, and then there is practice. A 300lb person will have trouble just "eating less" and "working out", because both of those things put incredible stress on a person's mind and body. Immediately working those lifestyle changes into an obese person's life is not like flicking a light switch, even for the overweight person who looks at themselves in the mirror and cries about how they look, "just eat less" and "just move more" are ideas that are psychologically difficult to put into action.
With GLP-1 medications, it is considerably easier to do the first part of "eating less". An obese person can lose over 20% of their body fat in a year, which will reduce the probability of injury when they begin working out. There is hardly any downside to developing medication to help people manage their weight to below obesity, and incredible upside.
Maybe another example would be: why do you use VSCode to do your programming? Hell, why do you use a computer at all? You should probably do it the hard way, on a sheet of paper... there is no reason to use a keyboard when you could just use your hands, right?
GLP-1 agonists are just tools like anything else. They make difficult tasks easier.
Like much of life it's more complicated than simple rules. It works for some people, but does not for everyone. As someone that has struggled with diet for the last decade or so these drugs have been a life saver. I've been able to eat healthy and feel full instead of being stuck in a cycle of eating right for a while and then eventually breaking under load. I've been able to have a consistency in the last 6 months on the drugs that i never thought I was capable of. I've even been able to build up a weight lifting plan that actually works for me and I feel good after the day.
There are lots of problems with drug reliance still to be worked out, but I'm excited for the chance to rebuild my habits into something good and work my way off to something normal.
If that worked we’d all be skinny and fit. Different people have different capacities to control their ability to balance food/nutritional intake of different qualities than others and it’s traceable both back to nature and nurture.
You can't make this point here. There are so many users of this forum for whom thermodynamics work differently, and they store more energy than they eat.
Plastic surgeons and cosmetic companies are rushing to convince people that the same effects you see from any weight loss are worse with GLP-1 agonists, to court a market with demonstrated willingness to spend money on (among other things) their looks.
Plastic surgeons, I expect, are especially concerned about a large reduction in volume of lipo & related procedures, and are eager to get the message out that “no, you still need to come pay us to cut on you!”
Yeah, a number of independent plastic surgeons are just coming to the same conclusion then, for people who are still going to see them for excess skin removal. OK, sure.
There was a large amount of skepticism in the original HN thread, but it strikes me as weird and dangerous, along the same lines of COVID-19 deniers.
Overconsumption leading to widespread obesity while a large fraction of the world is hungry - the capitalist solution? Let's invent a pill so we can eat EVEN MORE.
I feel like this is a weirdly cynical response. GLP-1s actually inhibit appetite. I took a friend on them once to a nice cafe I’d found and even though he agreed their pastries were delicious he didn’t finish his and took it home. There seem to be pretty clear signs that GLP-1 inhibitors are decreasing overall food consumption.
I’m not even sure this is a capitalist solution. Sure, Novo Nordisk is making a ton of money with these pills at the moment, but at least externally it seems like their decisions are controlled by the foundation (of course, money talks and no one is immune).
I know plenty of people who are scared of needles and I’m not sure they should have to suffer from diabetes if they should develop it.
Separately, and I’m not an expert but slightly more knowledgeable than a layperson, but food scarcity is rarely because of overconsumption in the global West. The blame usually lies with corrupt local organizations working with NGOs and poor quality transmission routes rather than global food markets.
I think of it differently. Capitalism has altered/hijacked peoples reward centers with hyper refined foods and it's a huge struggle for a lot of people to get out of that. We had drug pushers and very little help to get out of the addiction loop.
I used to think people just needed to "eat less", CICO and etc. Just like i thought people needed to just get off drugs. I think that's wrong, now.
These days it seems more apparent that some people are just more prone to addiction. The fact that i don't struggle with drinking or drugs is not due to my own will. Neither do i struggle with food, i'm frankly indifferent to food. So just as much as i seem gifted by nature to not be addicted to these things, others are innately pulled towards addictive substances.
oh hey, big pharma touting a miracle drug to Solve Problems?! This time it's different I'm sure. It's like we are doomed to repeat the same awful cycles again and again instead of dealing with our cultural problem with consumption
I’m commenting on what I’ve actually seen in the US. The portions served when eating out were bigger on average than in most of Europe, and the bread you’re supposed to make savory sandwiches of is somehow sweet in taste.
This has nothing to do with being nationalistic or not. It’s a statement of fact.
It just looks like at least in the US, if you go to the nearest grocery store to buy food or you eat out, and your goal is to decrease caloric intake, you’re playing against a stacked deck, is all I’m saying. You either need to spend extra time, effort, and money to find better places, or overcompensate by exercising extra time.
It becomes nationalistic, in the HN moderation sense of the word, when a comment talks about a country in a pejorative way using snark internet rhetoric.
> Americans could probably start with putting less sugar into bloody everything and reducing portion sizes
It's not just America.
"Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country's population" [1]. (It's about 7% in America [2].) Meanwhile in China, "the incidence of overweight and obesity among school-age children...was 15.5% in 2010, rising to 24.2% in 2019 and soaring to 29.4% in 2022" [2]. Same story in Vietnam: "The prevalence of overweight among children aged under 5 years increased from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, prevalence rose from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively" [3].
Which says that — if you choose to interpret things charitably and leave cost-cutting and profiteering out of it — the culinary tradition lags behind lifestyle changes severely. Urban populations largely don't have physically demanding, very manual jobs from dawn till dusk anymore, yet traditional portion sizes and composition of the dishes stay the same as they would be for heavy duty workers (I'm not speaking of abused workers or slaves here, mind you).
While you may interject that privileged classes used to have larger portions and better quality food without having to work so much at all times, it somehow coincides with fatty bellies being a status symbol in many locales. Being obese used to be a sort of privileged class mark.
as an american who avoids sugar and processed foods (like seed oils) its virtually impossible to eat out or buy anything beyond whole foods. Everything is contaminated.
Combine that with forever chemical use in packaging, pesticides in non-organic produce, our food supply chain is killing us.
I buy eggs from reputable regenerative free range, non-vegetarian fed chickens. I order my poultry and beef from regenerative farms across the country who are verified organic + grass fed + grass finished.
I bake my own bread and cook 95% of the meals I eat at home.
It costs an arm and a leg and isnt convenient but I feel much better.
So what you say means that I’m going the US only for a short visit, I’m basically fucked, because none of your options are easily available when living in a hotel for a week or two.
Huh, apparently this originates with Joe Rogan [1].
In any case, I'm happy you found something that works for you. But you can find the quality you're looking for in restaurants in any Tier 1 city and most wealthy suburbs. (We absolutely have an issue with poorer communities having a choice between canned and fast food, in essence.)
I find it crazy that they were able to do what they did to cigarettes, essentially marginalising them by banning all marketing etc., but rather than do anything about McDonalds, Kellogs and other junk food companies we have to resort to people injecting or taking pills for life.
It may take another 10-20 years but I think this will eventually happen. I agree it’s criminal to permit marketing of this stuff. It took a very long time to get to this point with cigarettes but also realize that in other countries smoking is still a normal thing particularly Europe. Right now there is still a lot of money being made on producing super addictive junk food and therefore strong lobbying.
Anyway. Food cravings gone, I was eating like 10 times a day before that. At least, but sometimes even more. Now I'm on intermittent fasting/OMAD and has 0 problems. No hunger, no cravings. Feeling significantly better.
Lost 43 pounds so far (rougly 3 pounds per week)