Launch HN: Fella (YC W20) – Tackling men's obesity using medication and coaching
I personally struggled with stress eating for 6 years. During that time, I was at Cambridge University, then built and sold my first company working with the UK government. It was tough, and poor eating habits as a teenager became a coping mechanism as an adult.
Fella first started as a "CBT+community" product to help men battling stress eating. It resonated due to the stigma around men's eating struggles. But we realized we were only half-serving most of our customers: even when no longer stress eating, most guys weren't getting to a healthier weight.
So we started researching effective, evidence-based treatments for obesity. When I say "we", I really mean my co-founder Luke. He studied medicine at Cambridge University, developing a patented AI approach to detecting cancer at a YC bio company, before moving to Microsoft Research. He parses bio papers better than me...
Obesity treatment is about to radically change. This is thanks to a breakthrough medication — NY Times called it a "game changer" in Feb 2021 [1]. The medication was approved by the FDA in June 2021 [2]. It leads to an average 15% decrease in body weight, efficacy close to bariatric surgery [3]. However, medication-assisted treatment for obesity is still stigmatized by family doctors and therefore hard to access.
Moreover, only 10% of those using weight management services are men, despite men representing 50% of those with obesity. This is because almost all programs market to women, placing too much emphasis on looks and not enough on health for a male audience. Stress eating is widespread among bigger guys, but mostly ignored — with too much focus on willpower and "eat less, move more". This needs to change.
So we pivoted to the Fella you see today: a telehealth experience with a board-certified obesity doctor for FDA-approved medication, combined with personalized health coaching. We went live in Texas in July, and are soon to be live in California and New York. Fella is a 12-month program and costs $149/month, paid quarterly. We’ll bring costs down over time to improve accessibility.
We still have lots of difficulties ahead. The main one could be insurance reimbursement: the latest wave of medications are expensive and insurers don't like to cover them [4].
We’re excited to hear your ideas, questions, concerns, feedback — and maybe any personal stories. I’ll be responding to comments all day, or feel free to shoot me an email at richie@joinfella.com.
[1] https://www.nytimes.com/2021/02/10/health/obesity-weight-los...
[2] https://www.fda.gov/news-events/press-announcements/fda-appr...
[3] https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
[4] https://www.bloomberg.com/opinion/articles/2021-07-19/weight...
317 comments
[ 5.5 ms ] story [ 375 ms ] threadIf you'd like to check out the site: https://www.joinfella.com/
https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
What would you say the biggest learning is you’ve had since starting this journey?
Few things:
1. As we said in the post, men represent only ~10% of those using weight management services in the US, despite representing ~50% of those with obesity. Pretty fascinating to reflect on the reasons why.
2. There are only ~5000 board-certified obesity doctors in the US, roughly one for every 70000 Americans.
3. Binge Eating Disorder is the most common eating disorder, and has above 20% clinical prevalence in those above 40 BMI.
Maybe most importantly: the bias towards willpower and the stigma against medical treatment for obesity (medication or surgery) is very real, especially among family doctors. This will change over the coming decade, but it's deeply routed.
You mentioned the medication is as effective in women as it is in men. While I understand men are underserved in this space and so I respect the decision to focus on that population on that basis, I'm curious if there are business elements to that decision as well? Would you ever expand to serving women, given that they seem to be a larger potential customer pool?
It's obviously a great question about the focus on men, and something we think a lot about.
My take: the whole industry is focused on women, and there are already cool companies taking a medication approach with branding clearly focused on women: https://www.joincalibrate.com/, https://joinfound.com/, https://www.formhealth.co/
I'm a fan of what these folks are doing. But you speak to any Fellas (our name for our customers!) and they know those programs aren't aimed at them. Every week we hear something like "I'm fed up of being the only guy in the group".
From a business side, the bet we're taking is that if we manage to crack the messaging/framing/branding for the male audience, that's a great business. Plus how men think about their health is drastically changing as concepts of masculinity change, so the potential customer pool is growing rapidly.
In terms of future expansion: we don't know yet. At least not for the coming few years - there are a lot of bigger guys out there we want to help (35 million men have obesity)!
Sorry, if I'd had the foresight to use a throwaway I'd drop a link to our group, but I prefer not to publicly associate my HN account with work. We're a small team of software and data engineers, machine learning scientists, and health policy folks at a large research institution in Canada that take on clients to work on stuff like this (from early stage research to approvals to deployment). I'd be happy to reach out with my contact info privately if you're interested, just let me know.
That makes sense! I wondered if it had something to do with the group component, and I agree that the customer pool is growing.
Congratulations on the launch!
To reiterate thought: I have nothing against these programs, from the outside they look really solid & I overall really support the direction of treatment.
I'm in the UK and would love to try Fella, especially if I could get it on the NHS with a GP referral.
Both my parents, my sister and my brother-in-law work in the NHS - so lots of interesting family conversations about this!
Might have something to do with exorbitant amount of money in the US healthcare.
Are you considering expanding services for other chronic eating disorders? For example, chronic under eating.
A impressive co focused on serious, udner-eating EDs is https://equip.health/ if you're interested
> So we started researching effective, evidence-based treatments for obesity
Fasting has a tremendous amount science supporting it [1], can you articulate why you're pursuing the prescribed semaglutide approach instead?
[1] Fasting: Molecular Mechanisms and Clinical Applications https://www.sciencedirect.com/science/article/pii/S155041311...
The issue is we're starting to have a more nuanced understanding of the metabolic resistance people face when they undergo dietary changes - basically the body fights hard against you as you try to lose weight by dieting.
So it's now industry-standard among obesity specialist doctors to see obesity as a "metabolic disease" which, for the vast majority of people, needs a medical approach which doesn't rely on willpower.
2. When stressed, we look for relief - and for a lot of people that relief comes as food, or the act of eating itself.
Both of these often lead to overeating which is a cause of metabolic disease.
I used to weigh 310lbs, now I'm 215lbs. All I did was count calories to maintain a deficit and the results were essentially the same as predicted by the math. I was a bit hungry sometimes at first as I adjusted to it but that's really it. Prioritizing protein and fat over carbs helps with that.
What ways does the body tend to fight against people?
Sounds counter-intuitive but after getting over the initial extreme hunger I found that the hunger sensations would diminish into a background noise, of sorts. That and the rules are easy to follow: eat nothing. When I'd eat at a deficit I'd frequently justify to myself that eating a little bit more than I was planning on doing was ok because it was only a little. And then I'd do that several times until I felt completely satiated, defeating the purpose.
The issue comes when you therefore become so hungry your body drives you to eat a lot of food all at once. But I'm interested that you notice your hunger sensations actually diminish over time.
Only solution I found that worked was go for pure weightlifting, literally train as if I was aiming to he an Olympic champion, and even then I still ended overweight (I am 1.75m tall, smallest weight I managed, that was then I was training heavily and had a diet that was almost 100% protein, was 98kg)
For me the caloric restriction leads to so much cortisol that I can’t really sleep properly no matter how much I try to exhaust myself.
Keto seems to be kinder (in week 3, of trying it for the 3rd time, previous times unsuccessful). But too early to say for sure.
> Starvation caused a rise in plasma cortisol [...] but no change in total urinary cortisol metabolites. [1]
> very low calorie diet (VLCD) did not alter plasma cortisol and markedly reduced cortisol metabolite excretion [...]. [1]
> Overall, caloric restriction significantly increased serum cortisol level in 13 studies (357 total participants). Fasting showed a very strong effect in increasing serum cortisol, while VLCD and LCD did not show significant increases. [2]
> The meta-regression analysis showed a negative association between the serum cortisol level and the duration of caloric restriction, indicating serum cortisol is increased in the initial period of caloric restriction but decreased to the baseline level after several weeks. [2]
[1] Influence of short-term dietary weight loss on cortisol secretion and metabolism in obese men https://www.researchgate.net/profile/Alexandra-Johnstone/pub...
[2] Systematic review and meta-analysis reveals acutely elevated plasma cortisol following fasting but not less severe calorie restriction https://www.tandfonline.com/doi/abs/10.3109/10253890.2015.11...
[1] is an interesting paper which gives you some hormonal examples. Effectively when you try and lose weight your body responds by increasing the hormones associated with greater satiety and weight regain. And these change may persists for a while — this papers documenting the change lasting past a a year. This will very by person however so if you have something which works for you keep going.
[1] https://pubmed.ncbi.nlm.nih.gov/22029981/
Apparently some people don't have this problem, which makes me incredibly envious (or would if I could feel anything).
It's this nagging thought of "JESUS CHRIST YOU'RE GONNA DIE IF YOU DON'T EAT A LOT RIGHT NOW!"
I've experienced it after hard days at work (construction), multi hour lifting, cycling 50km. Same shit every time. Surprisingly, unlike what my dumbass brain says, I don't die if I eat only a little and just go to sleep.
Counting calories didn't work btw. It actually made it worse as my primitive brain would know it's "starving".
I too have experienced this sensation my whole life under such situations. In fact, one of my favorite things to do in life is go for a 6-7 mile run, come home and lift weight for an hour or two... then... wait until I'm hungry (usually about 45 min) and eat an insane amount of food. The food tastes 10x better, and the sensation when eating it is pure bliss.
Always have felt great doing that, and I'm really skinny. We clearly don't have any idea why some people can do that, and others cant. It's probably not until we understand that difference that we'll have any sense what metabolically is happening.
This stuck out for me. Especially interesting that taste & eating sensation are both heightened.
Someone here or on reddit once had a problem with their mind keeping them up for either hunger or to check their phone or something, and they started doing pushups every time it happened, and some part of the brain learned the association and cut it out. I never did that but it might be worth trying.
When I haven't eaten in a while and know food isn't coming, I don't really feel hungry, I just feel tired.
"hunger" is a simple word for a pretty complex mix of biological, psychological, and environmental factors.
In other words, my metabolic burn rate at rest and while active seems to go down significantly.
While there are no doubt plenty of people that could lose weight fairly readily if they gave it some basic effort, most of the people who are actively trying to do so (enough to pay for a service that supports that, for example) are in the second and third categories. And yet every time anyone posts in a non-dedicated forum anything about systems and plans to help that group solve their problems, there are a dozen people like you popping in to tell us "it's not that hard, just give it a try!"
I regularly make 60 mile bike rides, I can jog 10 miles (though I can't walk the next day when I do), I play tennis about 7 hours a week. I weigh 465 pounds. Trust me, I've tried the approach you're describing here. I once managed to hold onto it for 8 months, during which I lost about thirty pounds and then plateaued, while constantly fighting my body. I was sick twice as often as usual, and I had to carefully micromanage my calorie intake to make sure I had available calories for any physical activity I wanted to engage in, all while constantly battling cravings for dozens of foods _I don't even like_.
It would be a simpler world if all of us fat people were just fat because we're lazy, but the truth is that people vary really a lot, physically and metabolically. Your experience of the world is valid, but not universal.
You just explained and expanded on my thoughts and conversations about my ADHD very well.
We're not offering anything magic. The medication side has a compelling & growing evidence base: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
For the vast majority obesity doctors, a medication-assisted approach is now the gold standard.
The program side is also no magic. We do tough work, but with a strong evidence base, a powerful support structure and we give ourselves enough time (12-month program). We focus on the root causes of poor metabolic health: stress, sleep, exercise, dietary. From both the behavioral & psychological angles.
No magic here, just evidence-based interventions.
Virtually every _controlled_ study shows that metabolic differences between adults are within a margin of +/- 15%, with essentially no way to eat the same amount of calories as a 200lb person and stay at 465lbs. Not least of which because your basal metabolic rate is much higher at that weight.
Virtually every study shows that overweight people significantly underestimate their input (whether intentionally deceptive or simply unaware) and overreport their physical activity, like "I can jog 10 miles", or "I play tennis about 7 hours a week", or "I regularly make 60 mile bike rides". If you do, you're the extreme outlier, and it doesn't change the data. Assuming you can do those things, you're almost certainly still in your 20s, and the health effects of your weight haven't really caught up with your body yet.
Very simply, it's far more likely that you miss some of the calories you consume, either because you don't actually weigh your food or you discount the signficance of "small" things. A pound of fat is 3500 calories. That's more complicated inside metabolic processes, but it means that "an apple a day" is 10lbs per year.
That isn't to say that "prescribe more medication instead of correcting the underlying issue" (trauma, self-medication, dopamine flush, whatever) is the answer, but that diets perform poorly for a large fraction and fail abysmally for another third because we are bad at tracking things, we are bad at being uncomfortable, and we bad at self control, etc. Diets do work. It's sticking to the diet and recognizing when you're off the rails which is difficult.
It's also difficult to acknowledge that this "diet" is not temporary and you can go back to old eating habits once the weight is off. The new caloric consumption is forever, because that's what brought you to the new homeostatis.
I'm 37, and 6'5". and if you're calling me a liar, you can fuck right off.
>within a margin of +/- 15%, with essentially no way to eat the same amount of calories as a 200lb person and stay at 465lbs. Not least of which because your basal metabolic rate is much higher at that weight.
I was not trying to indicate that the actual metabolic burn rate of humans varies by huge factors, "metabolism" is a colloquial term that encompasses a poorly defined set of features. The physical, psychological, and emotional components of your experience of a calorie deficit are what causes the experiential variance I'm describing.
Of course if I could eat a 2000 calorie diet consistently for a long period of time I would lose weight! I've performed that process numerous times, with various caloric deficits (my basal is a bit past 3k, so 2k is a pretty serious deficit - I wasn't able to hold that one past three weeks). This is when most thin people start rambling about "willpower", but maybe just skip that part this time? It's not useful to any of us actual fat people.
At 6'5", you are an outlier. 2kcal is too low, much as it's too high for the average woman. This doesn't mean that metabolism is a "colloquial" term. It means that "the physical, psychological, and emotional components" is a long way of saying "it's hard", and "the experiential variance I'm describing" is "the payoff did not seem to be worth the cost".
In general, my post wasn't intended to be an attack on you. It's that "I cut calories and I lost weight" is not anecdotal. It's factual. The anecdote, if any, is "I'm larger than the largest professional athletes and I can still perform". Since it's hard to stick with cutting calories for many people, throwing drugs at it with Fella is not the right answer.
A holistic approach which addresses trauma, reasons for emotional eating, lifestyle replacements, recalibration of palate, satiation even at a deficit, and all the rest should be explored alongside drugs so "I cut calories and I lost weight" is easier to stick with.
It simplifies the problem though, because for many, that approach has side-effects that seriously affect quality of life, like sleep, concentration, mood swings, depression etc.
Speaking of depression, I often get a similar vibe in those threads, where undoubtedly someone will jump in and say "all you have to do is lift heavy weights and change your diet a bit". It feels like they haven't experienced what other people have, so their advice sounds tone-deaf, a version of "let them eat cake".
> Since it's hard to stick with cutting calories for many people, throwing drugs at it with Fella is not the right answer.
If it works, it's great. Because obviously the "just change your life to be like me and hope for the best" approach doesn't work for most people, or they'd do it.
I've wanted to bring up how physicians treatment of depression has radically changed in the last few decades (to have a much greater appreciation of the medication-assistance), but I didn't want to bring it up myself as I thought it may be too confusion/controversial.
These are problems of application which are easy to fix with a food journal and perhaps a bit of research, not really a great argument against calorie restrictions effectiveness.
We designed Fella because "throwing drugs at it" is not the best solution for patients.
The crucial difference to your approach is the addition of the medication. Which if you speak to any obesity specialist MD, is exactly what they'd recommend: pharmacotherapy + psychological & behavioral intervention.
Please do not let moral posturing cause you to underrate the importance of a holistic approach which includes medication-assistance.
I get that you're a founder. It would be great to not cast aspersions on people. "I think your approach sucks" is not "moral posturing", and I'd question how many ethical doctors would recommend something insurance will not cover with an unknown end date to the treatment plan as "pharmacotheraphy" out of the gate.
For those who cannot gain muscle mass, injecting testosterone would also work (and would work for weight loss). Messing about with the endocrine system is tricky. Your body is really good at homeostasis. It's also really good at saying "welp, I guess that's covered, so I'm good" when exogenous sources of hormones are introduced.
Is this part of the treatment plan? What about diabetic patients (who appear to be a small part of the studies leading to approval)? How are you going to control for hyperglycemic ketoacidosis?
What's the long term effect of this on alpha cells and pancreatic health? How long is the titration for normal pancreatic function to resume? When exogenous glucagon is removed, what are the hunger levels of patients? Bounceback effect on weight if appetite is increased in the meantime?
Yes, use every tool in your toolbox, but there are a lot of unanswered questions about the medication in question, and a lack of insurance coverage. I've been overweight. Your body is not a formula in the "I calculated CICO, and...", but it does follow basic rules in a "I tracked my calories religiously, and over the last 2 weeks, my average daily intake was X, and the scale change was Y, so I need to modulate intake/activity up/down/stay the same" until you reach your goal.
That's hard for some (many) people. It's also completely sustainable. We want an "easy" way to do things. Sometimes "easy" things have detrimental effects in the long term, which are not apparent during clinical trials or short (let's say 3-5y or less) term, medically speaking.
Doctors would recommend pharmacotheraphy for obese patients because the health effects of being obese are dramatic, and almost certain to be worse than whatever the health effects of the drug are, because they have relationships with the vendors, because they are not sure whether the patient could affect the same change in health without them, etc.
However, if presented with the choice of "Patient X is able to achieve the desired outcome without the addition of medication", that would be the choice every time. You can filter that through the scale to "Patient X is unable to achieve the desired outcome without incurring significant financial burden/hardship by taking a new-to-market drug with unknown long-term consequences and an unpredictable prognosis once pharmaceutical intervention ceases, but the outcomes are so much better that this risk is warranted", which seems to be close to the starting point of the pitch here.
Medical ethics are not moral posturing.
Edit: your cofounder is doing a great job (https://news.ycombinator.com/item?id=28260302) addressing the tradeoffs here.
Not to put too fine a point on it, but this is not the greatest venue for comments like the last one in that chain (yours) (https://news.ycombinator.com/item?id=28261777). People here want to know how it works, why it works, what your pitch is, why we should recommend it, etc.
I am not your target demographic and never would be for a variety of reasons, not least of which being that I've been a competitive athlete in weight-class based sports for almost my entire life (outside of the 5-6 year period where i stopped training and became obese). I am here com...
I think perhaps you're misunderstanding what "anecdote" means? Anecdotes can certainly be factual - the point is not that it's false, it's that it's not sufficiently representative. In particular, I wasn't challenging his assertion that cutting calories allowed him to lose weight, only the implicit claim that doing so is a universally straightforward and successful approach to effecting actual weight loss.
> and all the rest should be explored alongside drugs
Well yes! That's my position! I don't think "drugs will solve this problem", I think the problem is solvable, and that we need to understand it and its context better in order to do so. I'm a tinkerer, I've been experimenting with my own habits, diet, and activities constantly trying to better understand how I can be healthier and still happy, and there have been some real gains from that process.
I feel like (a) you don't agree with the approach Fella is taking (which is fine, you've clearly looked into it more than I have), and (b) you've decided that my opinions about the effectiveness of diets are somehow "on their side". I think I've been really clear about this, but I have no stake in their game, aside from being excited to see that people are trying to do something other than convince fat people that this diet will totally work (and if it doesn't it's because they were yet again bad people that deserve to be fat.)
> "the physical, psychological, and emotional components" is a long way of saying "it's hard", and "the experiential variance I'm describing" is "the payoff did not seem to be worth the cost".
Not even close. But you seem intelligent, so I'm left wondering if you're intentionally misinterpreting me to score some kind of internet points?
The intent of those phrases is to emphasize that the costs to the humans involved vary. They are different. So yeah, "the payoff did not seem to be worth the cost", in the same sense that a man with a bad knee would evaluate the cost/value of paying for a taxi differently.
Asserting that, for some unspecified (but large) fraction of the population, tracking your caloric intake and energy expenditure versus the number on the scale is inherently flawed is dangerous, misleading, and probably false. At least partly because overweight people may lie to themselves.
In this sense, and in the context of Fella, throwing more drugs at the problem isn't a solution any more than throwing additional hardware at an application because the developer insists that database indexes don't work everywhere. It's true, but requires extraordinary evidence, and should not be the baseline assumption.
My take: a approach focused only on changing behavior has good parts, but traditionally been way too much reliance on this and not enough on the psychological/cognitive side.
I know personally because I used to believe a puritan CICO, but had a "viewquake" moment speaking with them and had to change a lot about what I believe!
Importantly they try to focus exclusively on practical solutions for the population: what will actually work in the world. They detach themselves from a lot of the moralizing we see.
As a thought experiment, imagine if, for every 100 calories of deficit in their daily consumption, a random tenth of the population felt substantial and increasing physical pain. Would you describe their inability to consistently lose weight as a 'failure' on their part? As essentially due to a lack of sufficient discipline? What if it were nausea? Exhaustion?
Now picture a world in which that is the actual norm, and those people are subjected to frequent ridicule for their lack of willpower and bombarded with the message that they are inferior because of it. If they'd just man up and stomach the pain for the rest of their lives, they'd have no trouble losing weight, it's simple physics.
This isn't an accurate representation of reality of course. I don't feel physical pain when I run a hundred calorie deficit, I just feel tired most of the time, and I lose the energy to enjoy physical pursuits. I'm confident that if I applied enough effort (again), I'd lose some weight (again), and keep it off for as long as I continued spending that effort. Again.
> Asserting that .. tracking your caloric intake and energy expenditure versus the number on the scale is inherently flawed is dangerous, misleading, and probably false.
That's not what I'm asserting. And I think that's been pretty clear, really! There are millions of fat people who are actively trying to be thinner in various ways and repeatedly "failing". Do you really think that telling all of those people to "just try harder" is a useful thing to do?
I don't personally expect drugs to be the answer to the problem, and I don't have any opinion on the "Fella" business model or likely effectiveness. My position this whole time has just been that fat people are mostly not fat because they don't understand that restricting calories will make them thinner. Understanding the actual reasons is important, and it's far more difficult to do when any real conversation on the topic is inundated with comments to the effect of "have you tried not eating as much? It's really easy, just eat less."
> Diets don't fail because they're inherently flawed and the system is more complex than we think it is. Diets fail because people fail.
The system includes the people. If the people "fail", that is relevant information, and should be used to evaluate the 'effectiveness' of the approach. The system is extremely complex, including as it does all of human psychology and physicality, and yet every one of these discussions is dogged by people like you, that think that the problem is just that people don't try hard enough.
Well sure they don't, that's also the reason they can't all bench 400 pounds - "hard enough" is the critical phrase here, and your language and attitude place all of the blame on the individual. It's a lot like explaining that depressed people are responsible for their own emotional state, and should just start exercising and cheer up - it's factually true, and yet also unhelpful, counterproductive, and insulting.
That sound a bit wrong to me. Fat needs energy to maintain itself? Isn't it just an energy store? If you're 465lbs with the same muscle percentage as someone 200lbs maybe that's how it works, but no one at 465lbs has less than 15/20% body fat.
To change the subject, do you plan on expending Fella to Europe at some point? I really like your approach.
Yep we're British founders so would love to expand to Europe in the future. Sadly won't be for a couple of years though - lots of work to be done first in the US!
Yes. Stored fat isn't just inert fat, but fatty tissue. Made of cells that need energy to stay alive.
> basically the body fights hard against you as you try to lose weight by dieting
Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes.
> So it's now industry-standard among obesity specialist doctors to see obesity as a "metabolic disease" which, for the vast majority of people, needs a medical approach which doesn't rely on willpower.
I agree that the current standard of care is largely focused on prescription medication. Is there strong evidence supporting the claim that the majority of people need treatment that doesn't rely on willpower? I'm particularly interested in the well documented association between obesity and mental health [1], and I think Fella would be especially compelling if a holistic approach to treatment was offered.
[1] The High Prevalence of Poor Physical Health and Unhealthy Lifestyle Behaviours in Individuals with Severe Mental Illness https://www.researchgate.net/profile/David-Scott-76/publicat...
You're spot on with the link between mental health and obesity and the need for a holistic approach.
For many of the guys stress and anxiety will play a key part in their food habits. This is something that our coaches actively ask about and help manage if relevant. For other guys it might be sleep [1] or it might be macro-nutrients. The coaching will depend on the person and we make these changes supported by their medical team.
> Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes.
"Long-term persistence of hormonal adaptations to weight loss" [2] and [3] are both interesting papers on this. With the summary being that weight loss results in prolonged changes in your hormones associated with increased appetite and thus weight regain. This results in a strong negative feedback cycle.
[1] https://pubmed.ncbi.nlm.nih.gov/28164452/ [2] https://pubmed.ncbi.nlm.nih.gov/22029981/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
If you're interested in some research behind this:
"Long-term persistence of hormonal adaptations to weight loss" - [1] and [2] are both interesting papers on this. With the summary being that weight loss results in prolonged changes in your hormones associated with increased appetite and thus weight regain. This results in a strong negative feedback cycle.
[1] https://pubmed.ncbi.nlm.nih.gov/22029981/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
tldr: our bodies make it v difficult for folks!
Now I started losing weight by just balancing macro-nutrients; more protein, more vegetables, less carbs as opposed to absolutes "no" and "only" except for no sugary drinks and beer and deserts except in social occasions. Also big emphasis on weight lifting as opposed to cardio. Cardio helps with its own health benefits but is very poor for muscle growth and fat loss and should be seen as a compliment.
By using electrolyte powder I only really had one or two really miserable days this time round.
I hear people can hit a wall about 8 weeks in, but also hear that could be down to over-consuming seed oils. Will see how it goes.
My point being: there is no "one size fits all" approach to weight loss.
And your sob story? Do you think you are the only person in the world who has had to deal with stress? This is ridiculous. How about this for stress: My grandparents were genocide survivors. They saw portions of their family killed in the most horrific ways. And they somehow managed that and moved on. Me, personally, I've had one pretty horrific business failure that drove me to the edge of understanding why people take their own lives after ending-up in the hospital twice due to stress.
WE DO NOT NEED PILLS!
Yes, I am yelling.
We need action on better food quality and education. People are filling themselves up with nothing but crap. Ketogenic diets and balanced living work, 100% of the the time. Exercise and activity is the magic "pill" that manages stress.
Frankly, I am astounded that YC would fund and support something like this. I don't care about your credentials and sob story. This is an abomination. Yes, you are likely to make billions. Congratulations. You are not going to fix a damn thing. All you are going to accomplish is to get millions of people hooked on yet another "once daily" legal drug of some sort.
If you truly cared about helping people you would work towards fixing what's actually wrong rather than getting millions of people to pop pills.
What when they stop? Huh?
They will have developed no good habits at all. They will not have a clue as to how to manage stress. They sure as fuck are not going to understand that exercise is important and necessary. They are not going to become discerning about what they eat. And our industrialized toxic food industry isn't going to change a thing. They will pop your pills as they suck-in a two liter drink with insane amounts of sugar and inhale cheap carbohydrates in their burritos, burgers, pizza, etc.
Weight management isn't at all about eating less. It's about not eating food that actively want to slowly kill you and, yes, engaging in a modicum of exercise in order to deal with insulin resistance, keep bones strong, etc.
I've had my own battles with this. Lots of people do. Until I finally listened to my wife (an MD). So I proposed an experiment: I would do no exercise at all other than taking walks with her a few evenings per week. She was pushing me to take-up a low carb ketogenic-style diet. As an engineer, I wanted to isolate exercise from a change in eating habits. That's what we did. And the results were hard to ignore. It was slow going, but the fat just came off --without having to run a marathon every day to burn extra calories. I eat as much as I want. No restrictions other than "don't eat garbage/sugars/simple carbs, etc.". After dropping two pant sizes and feeling "normal" again I can now go for the finishing touch and add exercise to this in the form of strength training.
The most important outcome was to reeducate myself about what and how I should be eating. That's it. It's as simple as that. No drug is going to do that. Ever. Unless the intent is to hook people for their $149 per month in perpetuity.
Sorry, to take such an aggressive tone. This is, to use the term, deplorable. Shame on you. Invest the money educating people on how NOT to use a drug to improve their lives. Pills isn't a long term sustainable solution. You are bound to ruin more lives than you save. And you are not going to do anything about improving the quality of the food that our population consumes.
Think of kids. Their food choices --particularly in the case of lower education parents-- boil down to choices between different kinds of toxic garbage. By the time they leave high school they have already imprinted horrible habits and done damage to their bodies. ...
Sure, there are medical conditions that sometimes play a role. But how often is that the case? I actually don't know. Maybe your company could help with that?
Good luck. There's obviously a market for your services.
https://en.wikipedia.org/wiki/First_law_of_thermodynamics
Yes, it works, and maybe it works easy & side-effect free for some, but tbh I'd rather be overweight and die 10 years earlier, than live like that.
An important takeaway from all this is that people react very differently to similar regimes, and projecting our own (successful) experience of a regime onto someone else is likely to not represent their experience.
Far from ignorant. It is an absolute fact --thermodynamics-- that no human being needs a pill to lose weight. So, stop with the holier-than-thou come-back and think.
This is no different from selling crap weight loss supplements to people. Why? Because they do not need that either. The fact that something is clinically proven means nothing. Why? Because people don't need it.
> Your approach is, like the others, one among many that will work for some people.
It isn't my approach. I only had to lose about 30 lbs. I could have done that going back to strength training, which was I was into before the pandemic hit. I decided to see if there was any merit to what my wife, the MD, was telling me.
Major "duh" moment: Of course it had merit! And of course it can work for absolutely everyone!
And, guess what, it does not cost $150 per month. No pills necessary.
The problem with obesity, particularly in the US, is systemic. Our food is unmitigated garbage and we train our kids to eat and crave this garbage from early childhood times. By the time they become young adults they are well on their way to a life of dealing with weight problems and a straight line into diabetes and other ailments.
You can't fix inflammation from food with pills, unless you want to be popping them for the rest of your life and end-up with other problems because of it.
This is going to sound weird: I am always astounded by how much I have learned by raising and training GSD's (German Shepherd Dogs). Stay with me for a second.
One of our GSD's developed a very serious problem a number of years ago. His skin smelled horrible and he lost all hear from his chest and belly. His coat looked dull, almost dead.
Not knowing what was going on I sought advice from our vet. He suggested I take him to a veterinary dermatologist. $2,500 and bunch of shots and pills later, we went home with a plan. Pop pills every day. Get this magical shot once a month.
Sure enough, in about four weeks his coat was nice and shinny again, his skin didn't smell and hair started to come back to his chest.
Back we went for another shot and more pills. This was running about $600 per month. The dermatologist said he'd have to be on this program for the rest of his life. Wow.
I decided to reach out to a number of GSD groups and breeders. A theme emerged from these conversations very quickly: Change his food. He is having allergic reaction to his food. Stop the nonsense the dermatologist is selling you.
So, I did. I figured I could try for a couple months and, if nothing changed, go back to the treatment.
We went with a high quality food with twice the protein content and far less junk carbs, etc.
Less than a month later this dog was in what I might describe as the best shape of his life. He looked great, was happy, didn't have smelly skin, his coat grew back on this chest and belly and was pretty much the picture of a healthy dog. This was many years ago. He has been on this better-food diet every since and looks and feels wonderful.
We have lost sense of just how important good food is for our bodies and minds. We accept that the garbage we buy at the market and restaurants is normal. Well, it isn't. This is the problem. The vet dermatologist was administering a government approved drug to my dog. It worked. And yet that was not really the solution, because it did not address the underlying problem. And that's the issue I have this startup. It isn't a solution. At all. Nobody needs this to lose weight.
My prompt for you: do you care about the people suffering, or do you care more about moral posturing & fist shaking?
If you care about the people suffering, drop me an email on richie@joinfella.com and I will help you however I can to empower you to tackle whatever you see as the root cause.
You: Nonsense, and to prove it, here's another long personal anecdote.
The obesity epidemic in this nation isn't caused by people are eating good food and exercising. It is caused by the kinds of things my examples illustrate. And yes, in this case, there happens to be a single basic truth: People are eating too much and too much crap.
You might want to poke fun at what I am saying, come back with contemptuous responses, kill me with downvotes and flagging. And yet, the obesity epidemic has rendered every single weight loss program, drug or magical juju bean "solution", ineffective, even harmful. I wonder how many people have been hurt badly by horrendous weight loss/gain cycles as a direct result of these "solutions"?
Our problem is not solved with drugs, supplements and magical programs.
Our obesity problem is a far deeper issue that requires intervention into our industrialized food system as well as a rethink of our educational choices.
What's really interesting to me is that in this entire incident NOT ONE PERSON has countered my claim that the real problem is bad food and bad habits. That's interesting.
Also, not one person has said something like "No, you are wrong, thermodynamics doesn't work that way...you can eat four times the carb/sugar-laden food you should eat on a daily basis, sit in front of the TV and still maintain good health".
No, all the negative reaction is pretty much about being offended for my strong reaction to yet another easy weight loss scheme that, based on recorded weight loss industry history is going to be no different from everything else we have seen. Only this time it is YC backed, so, I guess that's OK.
In engineering we are trained (or should be trained) to perform real --not imaginary-- root cause analysis in order to understand how to solve a problem. When you do that with regards to obesity, absolutely everything points to bad food, bad choices, bad personal habits and bad education. That's it. This is the root cause package, if you will. And none of this is fixed with a pill. Temporarily, maybe. Long term? No way.
>Yes, I am yelling.
If pills work then what's the problem? It seems to me that you're making an appeal to nature (https://yourlogicalfallacyis.com/appeal-to-nature). Given all the health problems associated with obesity from cancer to cardiovascular problems then whatever side effects the pills have are probably negligible in comparison.
> Weight management isn't at all about eating less. It's about not eating food that actively want to slowly kill you and, yes, engaging in a modicum of exercise in order to deal with insulin resistance, keep bones strong, etc.
Yes nutrition and exercise are important, but even if it's common knowledge it's obviously working like abstinence based sexual education is working to prevent STDs and teenage pregnancy because like we have a natural urge to sex we also have a natural urge to eat calories and while saving energy.
> "Take this pill...we will save you". Sick.
A lot of pills are necessary to prolong and maintain quality of life. What's "sick" about this?
This includes myself. I recently put on a bit of weight and I know exactly why: second servings, having a few beers, difficulties sticking to a diet with kids and dietary allergies in the house, no time or too lazy for exercise. It's all on me.
Something that can be fixed by just putting your mind to it shouldn't have to be treated with pills.
For some people it will probably be the hardest thing they ever do - I'm not downplaying this. So, for people who don't have the willpower pills is probably the best solution.
Important to emphasize there is a large variety of causes: stress eating is certainly a big part for a lot of people, but it's far from universal & far from the whole story.
"Something that can be fixed by just putting your mind to it shouldn't have to be treated with pills" is I think an interesting statement. I'm unconvinced "putting your mind to it" is as simple as it's made out to be.
Back when I was in university, I decided to simply "put my mind to it" and went from 100kg->65kg in one year. That weight stayed off for the better part of half a decade.
"Simply" doing the same thing now, though, with all of the competing priorities I have (young child, growing business, burned out wife and a constantly shifting set of rules and uncertainty with the pandemic), is a different story. I think men especially are hesitant to come to terms with this because it means admitting weakness.
Thanks for creating this product, Rich. I really wish you success.
Obesity increased with the increase of meal size, average caloric intake and urbanization based around cars.
Even for those, should'nt the solution be a stronger detox, intervention, stricter regimen to have external help in supplementing their willpower, etc?
Should'nt this be preferred over pills?
Same for things like anxiety, insomnia, ...
I'll focus on one area of your post: "They will have developed no good habits at all. They will not have a clue as to how to manage stress. They sure as fuck are not going to understand that exercise is important and necessary. They are not going to become discerning about what they eat...They will pop your pills as they suck-in a two liter drink with insane amounts of sugar and inhale cheap carbohydrates in their burritos, burgers, pizza, etc."
I want to emphasize how wrong you are here.
Fella is a 12-month program, with continued support for the rest of your life after that first year. The program is focused on:
- building resilience to stress & other testing emotions
- building a sustainable exercise habit which is enjoyable and sustainable
- building healthier eating habits which are realistic & sustainable
- building sleep habits which help improve metabolic health
In terms of the medication, it's really important to listen to obesity specialists here. They are trying to find practical solutions to help people. It's clear that moral indignation isn't working so far.
These are all legitimate concerns you raise. Know that I have researched this deeply, and genuinely believe this is the best practical solution to help the most amount of people.
Please let me know your thoughts.
This is my favorite HN line in ages, kudos!
PS - in California and signed up for the wait list.
I've seen this so many times I don't even bother to comment any more. The typical case is the person who will, for example, claim to have started a ketogenic diet and next time you see them they ingest three slices of pizza. What's amazing to me is that they actually think they are doing everything they are supposed to do.
> what would you recommend to them?
I would put it in a very different way using a hypothetical case.
Let's assume that a person has 90 days to loose a bunch of weight or they are going to die. Not muscle, fat. In other words, improve their body composition to trim both visceral and other fat.
What would I recommend they do?
Take a pill? Nope.
I would make sure they could not eat as much as they have been eating and would add moderate exercise. We could argue about what they should and should not be eating, but even if all you eat is ice cream and candy, if I put you on a 100 calorie daily diet of ice cream for 90 days straight, you are going to lose weight at an alarming rate.
Not that I am proposing this at all. It would not be healthy. A balanced diet is important for a range or reasons having nothing to do with weight loss. The point is that people who claim to have tried everything are lying to themselves, they have not, because, at the end of the day, if you eat less (a little to a lot less, depending on circumstances) you will lose weight.
It really isn't that complicated. It isn't easy because of a range of factors, including what ingesting so much sugar and simple carbs does to your body and brain, but it isn't complicated.
Who are you referring to with these wide-sweeping, derogatory stereotypes, who are "they"? I genuinely find it shocking that you find it appropriate to group together the millions of people who struggle with obesity for various and legitimate reasons as "they".
Maybe also think about your privilege as an "engineer" with a wife who is a doctor before offering these unneeded criticisms on "lower educated parents".
It's narratives like those in this post which alienate people who are already struggling, and paint obesity as a moral failing. You are the one with a moral failing right now.
So I guess I'm yelling too..
WE DO NOT NEED TO DEMONIZE AND DEHUMANIZE MILLIONS OF PEOPLE BASED ON THEIR SOCIOECONOMIC BACKGROUND, EDUCATION OR HEALTH.
Breaking the HN guidelines will get you banned here, regardless of how right you are, or feel you are, about obesity and other topics. No more of this, please.
https://news.ycombinator.com/newsguidelines.html
You might object to my lashing out. Well, sometimes it is important to take a strong stance. And, yes, sometimes those promoting magical solutions are culpable and should be scolded.
Am I wrong? I do not think so. Nobody needs pills to lose weight. Nobody. That is a matter of both biology and physics. I'll defy anyone to prove otherwise. Have we become insane?
The problem is that we have industrialized bad food choices and have created a marketplace where it is actually difficult to escape stuff that is bad for you.
Just last night we were at a restaurant. A few tables over was a family where every single member, kids included, were twice the size of a normal and healthy person. Their table was full of all of the wrong choices. And, on top of that, large free-refill glasses of soft drinks. At the end of their meal they all had cake and ice cream. Wow.
My youngest kids just started in-person high school again. The school has free food for every student. Its absolute garbage. The word "junk" doesn't even begin to cover it. The healthiest thing they have is apple juice, with nearly 40 grams of sugar per serving. My kids pack a lunch, just a simple sandwich them make themselves every morning. Not very expensive at all. Not hard to make. We don't make them, the kids do and have been doing so for years. They also drink water. We have no soft drinks at home. The kids grew up drinking water and have no cravings whatsoever for soft drinks, candy, ice cream, etc. Sure, we occasionally have the stuff at parties, but that's the exception rather than the rule. And, no, they are not deprived. They simply do not care for the stuff because they did not become addicted to any of it as they grew up.
Every family relying on the State/City/County/School district to feed their kids is, in return, having their kids poisoned. Worse yet, their kids are being programmed to become addicted to food that is absolutely horrible for them. When they come out of school they are well on their way to diabetes and other problems.
Pills?
Please.
Our kids are coming into adulthood biologically programmed for high levels of sugar and carbohydrate consumption. It's all they eat since they are done with breast feeding. No pill is going to fix that level of programming.
People who reach high levels of obesity are susceptible to the kinds of things that are going to cause them to spend money popping all kinds of pills every day. They are suffering, lots of them are depressed and our government and regulatory agencies have failed them --which is part of the reason they got there.
We don't need pills. The problem is systemic. Fund startups who will deal with this and not ones that are no different from any other yo-yo diet program by any other name.
Does anyone really think someone is going to change life-long habits after popping pills for a year? What is far more likely to happen is that they will become dependent on said pills, which is great for a revenue stream and a billion dollar exit to a pharmaceutical giant, not so great for the individual.
What is beyond the pale here isn't my choice of language or intensity, it's the ultimate significance of what this startup represents. No different from the abomination that bariatric surgery is. Great business. Horrible for the individual. I know two people who nearly died after having it.
Who am I kidding. There's money in suffering. I'll bet it will be a fantastic IPO one day. Maybe you should start marketing outside schools. Just like smoking, that's your future user base. Congratulations.
My prompt for you: do you care about the people suffering, or do you care more about moral posturing & fist shaking?
If you care about the people suffering, drop me an email on richie@joinfella.com and I will help you however I can to empower you to tackle whatever you see as the root cause.
Definitely interested in this!
We'll have to see. We have a long way to go in the coming years reaching the 35 million men in the US who are fighting obesity.
It's certainly something we tackle head on in our program.
But food addiction is not representative of everyone's struggles.
Fella works just as well for younger guys. Any more questions I can answer?
Important to emphasize that diet & exercise are only two parts of broader metabolic health. Sleep also very important.
And something our program focuses a lot on is stress eating. Very prevalent and a big factor, but normally overlooked.
To be honest we sadly don't have any useful advice for US visas: it's not a fun system.
Only thing is it's now more possible than ever to soak up US culture, run a US-focused company, but not be based in the US. But that's not what you wanna hear if you've built your life there. I'm sorry we can't be more helpful
If you're fasting and feel hungry while carrying body fat it means your metabolism is broken. Insulins levels are high and thus prevent the use of stored body fat for energy. It's possible to reverse this condition but it can take time up to 6 months approx.
I really recommend to watch a pod cast with Dr. Benjamin Bikman.
https://www.youtube.com/watch?v=TfSJFPu50_A
It's incredible how fasting just works. I've lost 10kg of bf and 10cm from my waistline without counting a single calorie or feeling hungry at all over the course of 6 months. And I haven't lost strength either and my workouts are as intense as before. After i started fasting it took me a about 6 weeks to start seeing visible changes.
The best approach for getting to a healthier weight will vary by person. If you've put on a few pounds over the holidays but are otherwise fine then Fella is not for you. We're focusing on guys with a higher BMI (30+), they've tried everything including intermittent fasting, keto, Weight Watchers, etc. Normally they will have had short term results (even losing 60lbs+) but then put the weight back on. This is often the case for the guys that have been at a higher weight for a longer period of time as their metabolism is in a different place.
I will say, don’t be too hard on yourself. My stress eating would spiral (and still does!) when I get too hard on myself. Set small goals and objectives (no eating after dark, be mindful of what you put on your plate, no second helpings, etc) because completing these always feels good.
The "small goals" is also critical to counter all-or-nothing thinking. We use a mix of behavioral & cognitive approaches to try to cement the improved habits & ways of thinking.
I tried low carb and keto. It works fine for me, but selling my wife on a breakfast that consists of 6 eggs and a pound of bacon is a hard sell. So there’s always bread and pasta in the house, which makes it harder to resist.
How the coaching works in the program is that we dive in at the start to really understand the 1-3 key leverage points where we can make the most impact - then focus all our coaching time on these.
It helps a lot that I do the grocery shopping, I try to avoid buying stuff that I'll be too tempted by - like regular carb tortillas or plain tortilla chips.
Important to say not everyone struggles with stress eating, which is why our coaching program goes much broader than that.
The metabolic medication aspect is also really helpful, which is why we combine the two for Fella.
As I am sure you are aware, obesity is a complex issue and many of the suggestions sufferers get such as eat less, exercise more, try fasting, go keto, etc. are simply not helpful in and of themselves. Neither is just prescribing the latest medications without other forms of support.
I hope your concept of telehealth, medical supervision and personal coaching is one that will get results. Obesity is a serious issue that is robbing society of people and potential.
What was the previous startup by the way? Always interested in improving my knowledge of the space!
People can argue until they're blue in the face but if you eat less calories than you burn you will lose weight. The problem is people with trauma plus a food addiction are not able to do this.
Is there any research around where you live and propensity for morbid obesity - especially living by the sea? I could only find one study which did support this theory but it was in the UK. I live in Bondi Beach where socialising is essentially exercising - surfing, swimming, kayaking etc etc and anecdotally I don't think I've ever seen a morbidly obese person in over 30 years (I know this sounds ridiculous and maybe it's because they never leave the house but it's true).
That said, important to state a psychological-only approach sadly isn't sufficient for the majority of people.
I've never looked for research on this, but the environmental & social pressures are definitely believable why they may produce this outcome. I also wonder how important selection effect is here for your Bondi Beach example.
Also, can you give some ELI5 background on how the medication works in the body?
> Semaglutide acts like human glucagon-like peptide-1 (GLP-1) such that it increases insulin secretion, thereby increasing sugar metabolism. It is distributed as a metered subcutaneous injection in a prefilled pen or as an oral form. One of its advantages over other antidiabetic drugs is that it has a long duration of action, thus, only once-a-week injection is sufficient. [1]
> Side effects including nausea, vomiting, diarrhea, abdominal pain, and constipation may occur. In people with heart problems, it can cause damage to the back of the eye (retinopathy). Side effects include kidney problems, diabetic retinopathy, allergic reactions, low blood sugar, and pancreatitis. [1]
> Warning: Risk of Thyroid C-Cell Tumors - In rodents semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether semaglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. [2]
[1] https://en.wikipedia.org/wiki/Semaglutide
[2] https://www.drugs.com/sfx/semaglutide-side-effects.html
Semaglutide was FDA approved for diabetes in 2018 (3 years ago) and in June this year for weight management. It's part of a class of medication called GLP-1 RAs which operate in a similar way (they all stimulate the same GLP-1 receptor). Liraglutide is another common one that was approved by the FDA in 2010 (11 years ago) for diabetes (by the EU in 2009) and for weight management in 2014. So there is a 3 year of history with this particular medication and an 11 year history for this class of medication.
Here's more about the history of GLP-1s and other weight loss if you'd like: https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...
The main side effects that people seem to get are nausea and vomiting when adjusting to the dose, this is likely due to the slowing down of food leaving your stomach. This is documented in the study of nearly two thousand people which lasted for 68 weeks here [1] (where you can also see the other side effects).
It's worth noting that, as with any medication, there is a cost-benefit trade-off. In this case it will depend on someone's current weight, what they've tried in the past, and the risks of other conditions e.g. heart disease, diabetes, and their past medical history. Each person that joins Fella has an in-depth discussion about this with an independent obesity physician and is welcome to speak it through with their own PCP too.
https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
I'm not at a weight where I'd want to add additional cancer risk in order to lose weight, and unfortunately the data on this sort of incremental risk probably takes decades to be fully realized. Perhaps I'd feel comfortable taking a smaller dose if there were a shorter-than-ideal track record of people taking larger doses without much additional risk.
The papers show consistent weight loss for ~52 weeks, then plateauing off onto 68 weeks. If you suddenly stop taking the medication, the weight creeps back on. The research therefore suggests you can likely slowly taper off the medication after year 1, but with medical supervision to ensure that doesn't lead to weight gain. This is also why improved mindset & habits are also important.
https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
ELI5: increases satiety, decreases appetite.
> ELI5 for how it works in the body:
GLP-1 RAs such as Semaglutide are increasingly looking like the best class of medication for weight management [1]
GLP-1 RA = Glucagon-like peptide 1 receptor agonist.
These medications stimulates a receptor in your body which results in a reduction in body weight and three main effects: 1 - Slowing down gastric emptying so food stays in your stomach for longer (this is thought to be why there is sometimes nausea when starting the medication) 2 - Making you feel full by working on your central nervous system 3 - Managing glucose control (which is why it's used for people with diabetes too)
[1] gives you a great summary of the field up to now and how it works.
> Is it something that you anticipate someone would take indefinitely, or only to get down to a target weight?
This will depend on the person, whether they are also diabetic and how much weight they have to lose and is decided through a conversation with their obesity doctor. After around 12-months on these medications the weight loss plateaus (at an average of 15% body weight). If one stops the medication then but hasn't made any changes to their lifestyle they'll likely put the weight back on. But during the 12 months of the program we will be tackling the other factors with the coach: sleep, stress, nutrition. And so after the first year it might well make sense to reduce the medication or stop completely.
Let me know if you have any more questions.
[1] https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...
I've tried various brands of keto (Atkins/4 Hour Body), Weight Watchers, eating slowly, cutting out sugar and wheat, juice fasts. Everything has worked for a time, but the weight has eventually crept back. I have really good willpower, but I've read the research on willpower being a resource that you use up, and definitely agree with it.
For the past couple of months I have been on Noom. I have stuck to it, and I'm now thinner than I have been in a long time, but I'm a little bit skeptical that it's going to last long-term. But I'm getting married in less than 2 months, so I only need to stay where I am until the wedding, and then I can gain a few pounds.
I don't enjoy subjecting you to cognitive dissonance here...but some highly cited research shows this belief may be a self fulfilling prophecy.
> Study 1 found that individual differences in lay theories about willpower moderate ego-depletion effects: People who viewed the capacity for self-control as not limited did not show diminished self-control after a depleting experience. [1]
> Study 2 replicated the effect, manipulating lay theories about willpower. [1]
> Study 3 addressed questions about the mechanism underlying the effect. [1]
> Study 4, a longitudinal field study, found that theories about willpower predict change in eating behavior, procrastination, and self-regulated goal striving in depleting circumstances. [1]
> Taken together, the findings suggest that reduced self-control after a depleting task or during demanding periods may reflect people’s beliefs about the availability of willpower rather than true resource depletion. [1]
[1] Ego Depletion—Is It All in Your Head? Implicit Theories About Willpower Affect Self-Regulation http://icelab.psych.uw.edu.pl/wp-content/uploads/2016/02/job...
[2] Beliefs about willpower determine the impact of glucose on self-control https://www.pnas.org/content/pnas/110/37/14837.full.pdf