> In those taking semaglutide, the average weight loss was 15.3kg (nearly three stone), with a reduction in BMI of -5.54. The placebo group observed an average weight loss of 2.6kg (0.4 stone) with a reduction in BMI of -0.92.
With n=1961, this is well beyond significant.
Also, this is a hunger control drug, and anyone who's been on a diet can tell you that's probably the hardest part.
This is not a miracle drug. It needs to be injected, comes with a risk of serious side effects and we don't have long term safety data. However, diabetes and obesity are also serious so anything that promises to help on that front is welcome news.
Would just loosing weight actually help with diabetes? I thought it had more to do with nutrition than sheer body mass, which explains why so many non-obese people get it while many morbidly obese people never do. I can definitely see how reduced mass would help reduce strain on the heart, though.
There is an oral once-a-day version sold under the brand name Rybelsus. It is very likely that if they did a similar tests for it you would see similar results as for the injection version (Ozempic).
I find it unbelievable that people find it difficult to watch one's weight, and adjust accordingly. I was always very slender in my life, and wore the same size clothes for years. I began working out a few years back, and in just a few months, I started growing out of my old clothes. How can the majority of people in the U.S. not notice their weight gain, and not care at all?
I don't mean to be sarcastic. Thanks for sharing your personal experience, but can I ask if you understand that perhaps you are not like the majority of people with regards to your weight?
The majority of people eat modern food and have modern levels of inactivity. Sure, we evolved in a scenario where our adapted characteristics kept us fit and slim, but the scenario has changed now.
Everyone was probably comparatively lean looking in the circumstances in which humanity evolved; we’re talking about small differences in fat storage and metabolism that are magnified by the environment that we’ve created.
Edited to add: obviously that’s before we consider the interplay between natural selection and sexual selection.
I eat fast food almost everyday. I get the same thing overweight people get, but I just eat less of it, or span it out to eat the rest at a later sitting. I just can't come to terms with how the majority of people completely ignore their weight gain, and just continue to buy larger clothes, without caring at all.
Your comment is likely to get downvoted to minimum because it's out of touch, but it does raise an interesting point. Some people have way more of a compulsion than others. Other people's compulsions don't make any sense to someone who doesn't have them (ever seen someone with OCD do their things?), which explains your experience of bewilderment.
The better question is, what's behind the difference in behavior?
Humans are designed to limit energy expenditure. Its hard wired in us from our hunter-gatherer days. That's not the root cause but it is a trait we all share. Add to that a poor diet, one that makes you feel sluggish and makes you crave more food and drink. Throw in economies of scale to make the food super cheap and accessible. Pack people inside, throw a TV in front of them or any sort of thing that will give them an environment of relaxation and you've got yourself the makings of an obesity problem.
The truth is, humans are lazy and will, by in large, only do work that they have to do.
Yeah, that I can understand, but we also are so based on aesthetics and genetic potential, that I would think more would care about maximizing their potential for reproduction. With most people being overweight/obese (near future), is that going to change what humans are attracted to?
Very ignorant comment. Of course people are aware of their weight. The issue is very complex. A person may not prefer their weight, but not want to change their lifestyle. They may be depressed, causing them to make poor decisions, find comfort in binging, etc. The weight could cause sleep problems which compound the problems.
Your comment basically amounts to: "I've never dealt with this medical issue and don't understand anything about it. I also believe that it's easy to fix if everyone acted like me."
I seriously hope you review your thinking on this and learn more on the subject.
Have you ever considered that some people are genetically predisposed to being overweight, just like you are probably genetically predisposed to being slim? I'm not saying that's the only reason--obviously exercise and diet play a huge role--but not everyone is starting from the same baseline here.
I would guess probably the biggest reason for people being overweight in the US is the abundance of cheap and delicious food and alcohol. It's simply really easy to become overweight living in the US.
It's easy to dismiss people as gluttonous slobs, but the reality is more complicated. Metabolic rate is a big factor: we've all known people that ate with no limits and didn't work out yet were always in shape, as well as people that always watched what they're eating, tried working out and still couldn't lose the pounds.
It takes a lot more willpower and self-control to stay healthy if you're in the 2nd category (Source: I'm fat and lazy).
For the record, I am not one of the people downvoting you. To address your question, this is not a U.S. problem. This is a modern dietary problem. Some countries are just late to the game and the stats have to play catch-up. People are eating a lot of sugar, processes foods, alcohol, excessive carbohydrates, basically sugar sugar and more sugar. This spikes insulin and eventually the cells in the body become resistant to the hormone. It take a while for this to reach the stages of metabolic syndrome, pre-diabetes or diabetes. Because of the time it takes, people do not associate the bad behavior with the bad outcome. Most are either unaware or in denial. [1] The report is from 2017, but this problem is only getting worse and it is not limited to the U.S. It is also not limited to people that are overweight. When people have any of the previously mentioned conditions, the liver becomes fatty. Eventually the liver starts putting fat into other parts of the body. Sometimes it is super obvious large belly but sometimes the fat is stored around the internal organs. This is actually very dangerous, not because of weight, but because of the increased risk in cancer. Working out is a great thing to do, but it will never account for more than about 15% of weight loss. The rest is related to environment and dietary intake, or lack thereof. So many are in denial or unaware that even talking about this in a public forum quickly becomes taboo and results in emotional responses.
I'm definitely aware it's a global issue, but I can't grasp the idea that the majority of people in the world, have no care to how they look or feel, especially with humans being so obsessed with aesthetics and genetic potential.
This basically goes back to what I was saying. It's cause and effect. People can buy things to directly affect their external appearance nearly real time. People don't associate their bad dietary and lack-of-exercise behavior that affects their external appearance. The cosmetic industry is proof of this. There are tens of thousands of cremes that contain vitamins, enzymes and other nutrients. This is not by itself a bad thing, but people are applying these components incorrectly. Applied internally these components have a vast array of long lasting affects throughout the entire body. Applying these things externally has limited short-lasting effects, albeit more real time. That is why those industries are making a killing. Visible affect, limited term efficacy. People also do not associate the bad things they eat with all of the external visible dysfunctions they are creating and compensating for on their skin.
There are some foods I just can not stop eating. The Lindt chocolate balls are a prime example.
The only thing I can do is keep unhealthy food out of the household, which was easier when I was single. Now that I'm married, with kids, and a wife that likes to bake, it's much harder.
BUT: I get that "I find it unbelievable that people find it difficult to watch" feeling when I watch an alcoholic polish off a bottle of booze, or when I see someone with a substance abuse problem polish off a bag of an illegal substance.
Turns out that a lot of people have issues with self-control. I guess I'm lucky that my self-control problems are just food. Could be worse.
I'm in the same boat and I think we are lucky to have good genetics/lifestyle. American culture clearly makes the majority of it's inhabitants fat. Your lack of empathy is understandable but something you can change. I've worked on this to help, rather than criticize overweight people I care about.
I personally find it unbelievable that people don't understand how complex of a topic this is.
For example, you cannot explain why people are overweight people by saying they are:
- generically stupid
- ignorant
- lazy
- self-deprecating
- biologically inferior
- weak willed
Clearly there are other more fundamental issues involved. What psychological needs and stress are involved? What environmental factors are present (or missing)? I think that to a degree you can generalize this to things like drug consumption and addiction.
I believe people have their agency and I greatly admire those who start and sustain significant health improvements of any kind. There is a reason there are so many self-help charlatans: the real key to unlocking success is complex.
Well said. I'm overweight not obese and it takes a very great deal of effort to keep it that way. I don't have problems with lazyness, stupidity or being weak willed in any other aspects of my life, but once I start eating I simply cannot stop.
Fasting has taken me from obese to overweight, not eating is the only thing that works, but when I start up again, I eat for two!
The US is a pretty big place but there are some cultural/regional reasons that explain some of the trends. For starters a lot of the country doesn't have access to nutritious food and grows up eating calorie dense but nutritiously void foods. Then you've got portion sizing/control (or a complete lack thereof). It's still pretty normal to eat meals sized for folks doing manual labor but in a lifestyle that is increasingly sedentary.
But to answer your question directly; some people do notice and do care but feel powerless to halt it, other people do not notice because it's sort of a gradual slide/they are already overweight and do not spend a lot of time thinking about their body.
Casual flippancy and anecdotal experience does not outweigh the countless research that has unveiled the myriad of reasons why people gain unhealthy levels of weight.
Avoiding getting fat was the reason I started lifting weights. Eating is so much fun. Tasting good food is one of the greatest pleasures. The only things standing between me and +50kg are Sport and MyFitnessPal.
Yes, obesity is a risk factor when catching COVID.
Or, if you meant to question the truthfulness of their claims (without offense, is that possible?)... A quick internet search shows that the heaviest person recorded was 50% heavier.
So, yes, the weight described is certainly possible.
At that weight, you are very likely already regularly connected to your doctor, and have probably tried many things, and anything anyone says here will probably sound rude, ill-informed, or trite.
Regardless, you can get through this. Day by day. Good luck.
At the risk of sounding like a proselytizing bastard, but doing it out of genuine concern and sharing what little knowledge of nutrition has personally worked for me: Have you tried a low carb diet like keto?.
It's the only thing that's been able to help me with fast, consistent results and the modest willpower I can dedicate to the problem.
I'm sorry in case you weren't looking for advice.
I lost 70 pounds (nearly a third of my weight) through just restricting my intake to two tiny meals a day. It sucked really hard at first (I was in what felt like physical discomfort and didn't defecate for a week when I started), but it worked and I've kept it off. It takes time (for me the better part of a year), and making a decision and the willpower to stick with it no matter how much it sucks (as long as you know it's safe).
My hunger is still all in my head to this day. I'm sure the challenge of not overeating will last the rest of my life, but the tradeoff of weighing less is worth it.
If you want to read about how far the mind can take you, read David Goggin's book, Can't Hurt Me.
It (Ozempic) has already been approved for treatment of diabetes 2 for a couple of years. Maybe you could qualify.
The trials mentioned is basically just a phase 3 trial of the product specifically for weightloss.
> The drug, semaglutide, works by hijacking the body’s own appetite regulating system in the brain leading to reduced hunger and calorie intake.
So the same weight loss can be accomplished by simply eating less.
Intermittent fasting is great for that[0]:
> I prefer the daily method: Fast for at least 16 hours per day. The aforementioned New England Journal of Medicine study was based on an 18:6 structure: 18-hour fast, six-hour window.
> "16:8 is a great place to start," Stephens says, "but it may not be a weight-loss window for many people. That's because fat-burning ramps up between hours 18 and 24 of the fast. 19:5 was a great weight-loss sweet spot for me, and I lost at about a pound per week when doing it. With 19:5, you fast for 19 hours a day and have an eating window of five hours. Your sweet spot may be different from mine, of course. Maybe it will be 18:6 or 20:4." Experimentation is key, she adds.
I'm on it for the past two years or so. Haven't lost the 20% weight yet. Still waiting. Its kept the blood glucose #s in better check, but it was a nudge vs a big shove.
Then again, i'm on 1mg/week, rather than the 2.4mg that the study used.
What _HAS_ helped me is keeping track of what i'm eating, and making sure i account for the occasional snack, and various things I'd drop on my food (sour cream on tacos for instance).
63 comments
[ 2.1 ms ] story [ 131 ms ] threadhttps://news.ycombinator.com/item?id=26113655
(83 points, 124 comments)
> [...] adhere to the reduced-calorie diet and increased
> physical activity, providing guidance, behavioural
> strategies and motivation. Additionally, participants
> received incentives such as kettle bells or food scales to
> mark progress and milestones.
> In those taking semaglutide, the average weight loss was 15.3kg (nearly three stone), with a reduction in BMI of -5.54. The placebo group observed an average weight loss of 2.6kg (0.4 stone) with a reduction in BMI of -0.92.
With n=1961, this is well beyond significant.
Also, this is a hunger control drug, and anyone who's been on a diet can tell you that's probably the hardest part.
what does that mean?
https://en.wikipedia.org/wiki/Stone_(unit)
https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...
This is not a miracle drug. It needs to be injected, comes with a risk of serious side effects and we don't have long term safety data. However, diabetes and obesity are also serious so anything that promises to help on that front is welcome news.
There is an oral once-a-day version sold under the brand name Rybelsus. It is very likely that if they did a similar tests for it you would see similar results as for the injection version (Ozempic).
Edited to add: obviously that’s before we consider the interplay between natural selection and sexual selection.
Need to treat the causes not the symptom. Magic pill to kill 25% of your weight leaves the causes behind.
Poverty and terrible work culture tend to drive it primarily. I see more fit and healthy people in well balanced jobs.
I did exactly that for years. Until I didn’t. Which happened because I saw what might happen to me if I didn’t stop it.
The better question is, what's behind the difference in behavior?
How do you think it happens?
The truth is, humans are lazy and will, by in large, only do work that they have to do.
Your comment basically amounts to: "I've never dealt with this medical issue and don't understand anything about it. I also believe that it's easy to fix if everyone acted like me."
I seriously hope you review your thinking on this and learn more on the subject.
Have you ever considered that some people are genetically predisposed to being overweight, just like you are probably genetically predisposed to being slim? I'm not saying that's the only reason--obviously exercise and diet play a huge role--but not everyone is starting from the same baseline here.
I would guess probably the biggest reason for people being overweight in the US is the abundance of cheap and delicious food and alcohol. It's simply really easy to become overweight living in the US.
It takes a lot more willpower and self-control to stay healthy if you're in the 2nd category (Source: I'm fat and lazy).
[1] - https://www.cdc.gov/media/releases/2017/p0718-diabetes-repor...
The only thing I can do is keep unhealthy food out of the household, which was easier when I was single. Now that I'm married, with kids, and a wife that likes to bake, it's much harder.
BUT: I get that "I find it unbelievable that people find it difficult to watch" feeling when I watch an alcoholic polish off a bottle of booze, or when I see someone with a substance abuse problem polish off a bag of an illegal substance.
Turns out that a lot of people have issues with self-control. I guess I'm lucky that my self-control problems are just food. Could be worse.
For example, you cannot explain why people are overweight people by saying they are:
- generically stupid
- ignorant
- lazy
- self-deprecating
- biologically inferior
- weak willed
Clearly there are other more fundamental issues involved. What psychological needs and stress are involved? What environmental factors are present (or missing)? I think that to a degree you can generalize this to things like drug consumption and addiction.
I believe people have their agency and I greatly admire those who start and sustain significant health improvements of any kind. There is a reason there are so many self-help charlatans: the real key to unlocking success is complex.
Fasting has taken me from obese to overweight, not eating is the only thing that works, but when I start up again, I eat for two!
I can absolutely relate!
Or, if you meant to question the truthfulness of their claims (without offense, is that possible?)... A quick internet search shows that the heaviest person recorded was 50% heavier.
So, yes, the weight described is certainly possible.
At that weight, you are very likely already regularly connected to your doctor, and have probably tried many things, and anything anyone says here will probably sound rude, ill-informed, or trite.
Regardless, you can get through this. Day by day. Good luck.
https://en.wikipedia.org/wiki/Angus_Barbieri%27s_fast
I lost 70 pounds (nearly a third of my weight) through just restricting my intake to two tiny meals a day. It sucked really hard at first (I was in what felt like physical discomfort and didn't defecate for a week when I started), but it worked and I've kept it off. It takes time (for me the better part of a year), and making a decision and the willpower to stick with it no matter how much it sucks (as long as you know it's safe).
My hunger is still all in my head to this day. I'm sure the challenge of not overeating will last the rest of my life, but the tradeoff of weighing less is worth it.
If you want to read about how far the mind can take you, read David Goggin's book, Can't Hurt Me.
So the same weight loss can be accomplished by simply eating less.
Intermittent fasting is great for that[0]:
> I prefer the daily method: Fast for at least 16 hours per day. The aforementioned New England Journal of Medicine study was based on an 18:6 structure: 18-hour fast, six-hour window.
> "16:8 is a great place to start," Stephens says, "but it may not be a weight-loss window for many people. That's because fat-burning ramps up between hours 18 and 24 of the fast. 19:5 was a great weight-loss sweet spot for me, and I lost at about a pound per week when doing it. With 19:5, you fast for 19 hours a day and have an eating window of five hours. Your sweet spot may be different from mine, of course. Maybe it will be 18:6 or 20:4." Experimentation is key, she adds.
[0] https://www.cnet.com/health/intermittent-fasting-lose-weight...
Then again, i'm on 1mg/week, rather than the 2.4mg that the study used.
What _HAS_ helped me is keeping track of what i'm eating, and making sure i account for the occasional snack, and various things I'd drop on my food (sour cream on tacos for instance).