The "caloric imbalance" theory of obesity is exploded, obesity is complex and not well understood, and related to the endocrine system, microbiome, etc. This is kind of like telling people they wouldn't need antidepressants if they smiled more.
When you say this do you mean "we have to look for the underlying causes of calorie imbalance" or do you mean "the human body is capable of materializing mass out of nothing"?
I can't imagine someone saying "the gravity theory of plane crashes is exploded" even though when we look at how to prevent plane crashes we look at other causes.
"When you say this do you mean "we have to look for the underlying causes of calorie imbalance" or do you mean "the human body is capable of materializing mass out of nothing"?"
when you say this, you reveal your ignorance of the biology that makes it far more challenging for some people to "eat less" than others, and that changes their metabolism to combat the weight loss if they do happen to "eat less" for some time.
BMR varies hugely by person, its not even a minor difference for some.
Yes, calorie imbalance is a thing, but you can be a 300 lb person who eats 2750 calories a day, also be a 200 lb person who eats 2750 calories a day, with each performing a similar amount of exercise.
While calories in/calories out will help anyone lose weight, for some, even with the advantage of math - its still much harder, sometimes an order of magnitude harder.
I've done this before, and I lose around 100 lbs, and I've kept off about 60 of it - but for the entire two years, I had a gnawing, burning pit of hunger whenever I was away. It never stops, and I never stopped being hungry. I just did my best to ignore it.
On top of that, look how many social occasions revolve around food, to stick to any essentially effective diet requires refraining in those situations. That's even harder. "oh, everyone is going for fast food after the thing, I guess I can just have some water? okay, I guess that's okay" because one fast food meal exceeds your calorie goal for the entire day.
Now you tell me, how easy is it to eat less if you never felt satiated, never stopped being hungry?
My point here, is while calorie counting and exercise works, there is clearly more going on than just that.
I'm not disagreeing with never feeling satiated or anything else you're feeling, but what are your thoughts on prevalent obesity being something that's relatively new to humans (~50) and much higher in the US than most other countries?
To me it seems to be a majorityu of cultural & calorie intake thing rather than a medical issue. Not to say it's easy (it's not) and not to say there aren't people with medical issues.
Obesity has historically been a sign of wealth, it's not new in my eyes.
Us having enough calories available and the kinds of work around where people can lead a defacto life of leisure (by comparison to every other period of time).
Any time humans have an extended lack of scarcity the natural biological programming that makes someone fatter, takes over.
I think this is bad faith, but I'll put it like this: There's tribes out there that walk 5+km/day or whatever to get food, but their base calorie consumption isn't significantly higher than a sedentary American even with all their walking. There's something definitely weird going on in the human body in which it can modulate its own calorie burn and I don't think science has gotten that yet. Telling a fatty to eat less might be simple, but if the fat person's body fights them every time it might be helpful to trying to figure out how to make the body stop fighting weight loss.
People really like to believe the ol' 'willpower' thing - and its not completely wrong. But its not everything, like willpower might account for 30-40% of results, the rest are often other factors outside of their control
I’ve trained with bodybuilders for years. I assure you willpower and choosing boring foods is a huge factor. Plain chicken, rice, broccoli, water. Try to gain weight.
The human body has a lot of latitude and how it stores & taps it's reserves. You could eat less than than you expend & lose muscle mass instead of fat, for example.
So yes, humans are a thermodynamic system, but that isn't a model that explains the dynamics of what your body does with it's tissues. It's more complex than that.
It's kind of like saying, "a CPU is just a resistive heater." There's a way in which this is true and it's a useful perspective for designing a cooling system. But it's a useless model to give to someone asking for advice in debugging race conditions, because you've erased the complexity their problems arise from.
Additionally there's a moralizing component where people erase this complexity in order to blame people for their medical problems and frame it as an issue of irresponsibility.
No one has ever said, "aircraft crashes are caused by gravity, and the moral failing of pilots not to understand this most basic principle. Imagine spending so much money on flight school when all you need to do is watch stuff fall, that's all you need to know." There is no gravity theory of airplane accidents in the same way there is a caloric imbalance theory of obesity.
Consider also that airplanes are "simple"[1], well understood, engineered systems which are centrally coordinated, and that bodies are complex, evolved systems, containing autonomous components, many of which are very poorly understood. Aircraft are engineered for consistency, with faulty or expired components swapped out, whereas humans vary dramatically, not only between each other, but over the course of their lives. Other people have very different bodies & experiences than you do; it can be night and day.
I came to understand this when speaking to a friend with executive dysfunction. I kept telling them they were beating themselves up or undermining themselves when they told me about limitations they experienced. Eventually they snapped at me and described their day to day in detail, and I realized their mind as a different place with different demons than mine, and that there were things I could do easily that they struggled with, and things I struggled with that were an ordeal for them. (They're a very smart and capable person who has abilities I do not, and of course I have demons and struggles they do not have as well.) I meant well but what I was doing was really undercutting and devaluing their lived experience, trying to comfort and bolster instead of understand.
Because they lack the willpower do deal with the consequences of losing weight, obsiously it's not fun being hungry.
You had a lot of extra fun stuffing yourself with food, you will have to pay the price for that at some point(either with hunger or with health problems if you don't lose the weight)
There have been lots of thoughtful comments in the subthread under your original comment explaining people's experiences with this and why it isn't so simple. Have you read them? What deficiency do you find in them?
It seems like you're just interested in repeating yourself louder & meaner and not interested in engaging, presumably because you think you already know everything there is to know about other people's lives. Rather solipsistic really.
I hope you'll reconsider but if that's how you're going to behave there's no productive conversation to be had.
there it is, the real reason for your moronic refusal to acknowledge the complexity of obesity. if it's just a matter of willpower alone, you get to get a nice little sense of superiority and an ego boost. everyone else is just stupid and lazy.
It is never an obese person's fault for stuffing themselves, it's always something else. In this thread it's the big bad pharma corps that don't give away for free diabetes drugs to people that don't have diabetes.
I wish you all the best, when you realize the problem is your lack of willpower maybe you'll lose weight and not gain it back.
T2D diagnosis is labeled as something awful a few times in the article, e.g.
>If Kay wanted to continue to lose weight, live pain-free, and stave off a dreaded diabetes diagnosis...
Not having anyone close with diabetes, so I'm quite unfamiliar with that landscape: why is being diagnosed with type-2 "dreaded"? If it's a valid diagnosis, and it would solve many of your problems, it feels like a fairly obvious choice...
I'm sure there are social stigmas around it, but is that all? Or are there some severe insurance implications or something?
Surely that would have been true three months ago as well? $25/month is absurdly affordable for preventing that and that'd have been a truly awesome option... but unless it has increased her diabetes symptoms, she has likely been close to but resisting that diagnosis for years.
Or is it more that they're worried about developing "full" type-2 in a few years if nothing else changes? But if that's the case, trying to get diagnosed with it ASAP seems like a reasonable route, not dreading it.
---
Edit: correction, ignore the below. Rogers here is a diagnosed diabetic who had to stop using it due to shortages.
---
>Due to shortages, Rogers had to stop taking Mounjaro for three weeks. “I was a wreck over it and full of despair,” said the 58-year-old. “I gained several pounds back, but I was surprised at how badly I felt when my [blood glucose] numbers got out of control again. It was a wakeup call to me to realize how sick diabetes makes you.”
Tbh that sounds like resisting diagnosis, not worrying about a future health decline.
I think you're distinguishing between having T2D and being diagnosed with it, when the article is using the latter as an idiom for the former. The implication is that she doesn't currently have T2D.
Usually insurance companies create a list of drug tiers based on cost-effectiveness. Mounjaro is super expensive, so a lot of insurance companies won't cover it.
If we’re not going to nationalize drug manufacturers, they should at least be regulated (competently, as to avoid regulatory capture), but I have little faith in the government to be able to do so effectively.
So we want them to be more competent, so they can regulate harder... so that they won't try promoting off label uses? Isn't that what they're already doing by limiting how you can use the coupons?
In cases of severe harm to multitudes, like the Sacklers, the regulatory regime should strip the perpetrators of all their wealth and income even unto the seventh generation and the fourth degree of relatedness, and salt the earth of all their lands and possessions.
I'm on Mounjaro and was on Ozempic before that - the supply issues for both have been a serious impact on my health. The thing about these meds is, if you miss weekly dose (by more than about 3-4 days), you are essentially going back to the beginning, and your blood sugar will be unstable for 3-4 weeks as you adapt again to the medication. You only see the real benefits from it after being on it continuously for more than a month, but so far, I've not been able to get a consistent supply for more than a month at a time since.. summer I'd guess.
Its been really frustrating for me, and has caused me negative health effects.
So while I get, yes, you should lose weight - and this drug does that (and has a whole bunch of other positive health effects), the idea of this going to someone who might only be 30-40 lbs overweight who does not have T2D, infuriates me.
Without it, even on insulin, even fasting, my liver pumps out glucose constantly, I can fast for close to 24 hours before my blood sugar falls off enough to start to be low.
I have some grief with the supply issues, but there are some pretty obvious logistics limits to how fast you can scale up production, and I suspect with mounjaro the main limiter is the delivery mechanism (its special).
As someone who spends a lot of idle time wondering why these companies don't ramp up production as quickly as possible, I would be genuinely excited to hear your thoughts on what these limits are.
It seems like there are so many billions of dollars in nearly-pure profit to be made, so why is it not a problem that can be solved by throwing money at it?
I suspect its a mix of regulatory and practical limits.
The delivery mechanism on the pens for Mounjaro are.. highly complex spring loaded devices. On top of that, you have the whole License Raj around pharma manufacturing - we only scaled as fast during COVID with the vaccine because some of the rules were functionally waived.
I have no particular insight into the rules, but that makes sense; even if it is frustrating, it's more frustrating to die.
The delivery mechanism part is less convincing, given that the product is already in the market. I'm not saying that it isn't complex/hard, but it's precisely the kind of thing that throwing money around actually can solve.
The other medications in the class use different delivery mechanisms (more of a twist dial pen kinda apparatus) for all I know the delivery mechanism for this was picked because they had excess capacity.
I was on Ozempic for a few months until I got frustrated with the supply chain issues. FWIW I transitioned to just intermittent fasting with a high protein & fiber diet and am finding practically the same results with less of the side effects
Thanks man. Been battling weight issues my whole life. It's just about focus on eating well, drinking less, and working out more and the weight comes off on its own.
First, thank you for your comments in this thread.
Sadly, things are worse in Canada; they won't even give us a timeline on Wegovy availability. I can only imagine what this means for everywhere else in the world.
I've been incredibly frustrated by the lack of support I've received from my slightly fat-shaming MD when it comes to being freaked out by the lack of consistent availability. I've pushed back on starting before supply chain issues are resolved, citing concerns about missing doses being worse than doing nothing at all - even before the cost factor is considered.
It really comes uncomfortably close to the moral failure side of things. "Oh, you won't even try with a reduced dosage? I guess you're not as serious as you said" type BS.
Huge gray market for this stuff. I detailed this in an earlier discussion of the same compounds[0]. It's awful that people like Kay would be forced to non-FDA approved versions with a "mystery-meat" theme to them, but they can be had for $10-90/month, which is a huge improvement over the $1,000/month they're staring at now.
Is it hard for compounding pharmacies to good quality semaglutide/tirzapitide from peptides bought wholesale from China, since you are familiar with this process? Can some generic manufacturers in India make this stuff?
I also see ads for Metformin as a "longevity" and "weight loss" drug. I worry for my mom and other diabetic members of my family potentially not being able to get it if it goes viral like this.
Metformin is suspected to act like a mitochondrial complex I inhibitor, at least under certain conditions. If so, there may be a risk of it causing progressive supranuclear palsy if taken in high doses or long term. If you have diabetes the risk is probably worth it, but if you’re already healthy then taking it for longevity reasons seems more dubious.
It wouldn’t surprise me if in a couple decades some non-trivial percentage of the folks using it for longevity end up with PSP, which is a fatal and untraceable disease.
It seems like Metformin has been used as treatment in some neurological diseases especially where diabetes is a known risk factor (eg Alzheimer's) . And while it has not been shown to be causal, it is correlated with development of palsy by meta-analysis of a large group of studies.
The sad state of affairs in modern medicine is that patients now need to be weary for scams like this where a multinational pharmaceutical conglomerate will pull a bait, addict and switch prices tactic. It leads to patients avoiding what could be the best medical advice in order to avoid predatory business tactics.
"In this randomized, crossover intervention trial among adults with prediabetes or T2DM, the 12-week percentage change in HbA1c, the primary study outcome, improved significantly for participants on both diets"
"From a practical clinical perspective, the performance of [strength training] + [high intensity interval training] may be advised for additional benefits regarding insulin dosage reduction."
In short, cut out the bread, deserts, pizza , lift some weights and do some sprints. Keep doing it.
Pubmed is great resource. Search for terms like "clinical trial" "diabetes", "HIIT", "mediterranean diet", VFKD. [edit: I do want to emphasize the term "clinical trail". Diet and nutrition research has a lot of other types of research. Often the quality suffers. Clinical trials, and hopefully other clinical trials that verify earlier findings, are the best.]
Getting on top of the situation early will save you a lot of grief ( and doctor's visits and paying for drugs).
Low carb diets seem to be a key component of curbing metabolic syndrome, but it’s really never as simple as “diet and exercise…keep doing it”. For some bodies, the amount of diet and exercise needed to avoid metabolic diseases is so high that it impedes quality of life.
> it’s really never as simple as “diet and exercise…keep doing it”
I disagree with "never". I think most people can use diet and exercise to avoid and even reverse type 2 diabetes. An unpopular opinion hereabouts, but likely true.
The exercise part is possible in theory, but in practise not many people have lives in which they can do 4000 kcal of exercise daily, six days a week. 4000 kcal takes a long time. I have heard of a guy who became a security guard and walked around a town for 10 hours each night. Exercise took him from "severely obese" to just above "normal" BMI over the course of 18 months or so.
The diet part is also possible in theory, but many people's family and social environments practically require them to eat muffins, cakes, sweet desserts, and other micronutrient-poor dishes. Refusal to take part gets them ostracized.
>social environments practically require them to eat muffins, cakes, sweet desserts
Most people will let you slide on gorging if you simply say "Doctor's orders". HIIT means sprinting hard 3 times twice a week. Just about anybody can do it.
"Jastreboff said. 'In order to continue to maintain the new re-regulated defended fat mass, and weight reduction, you have to continue taking the medication'..."
Doctors like this are disgusting. Nothing about obesity is incurable for the vast majority of the obese. It is a lifestyle choice.
Score one more for pharma and drugs that "require" lifetime use.
79 comments
[ 0.20 ms ] story [ 143 ms ] threadI can't imagine someone saying "the gravity theory of plane crashes is exploded" even though when we look at how to prevent plane crashes we look at other causes.
when you say this, you reveal your ignorance of the biology that makes it far more challenging for some people to "eat less" than others, and that changes their metabolism to combat the weight loss if they do happen to "eat less" for some time.
Yes, calorie imbalance is a thing, but you can be a 300 lb person who eats 2750 calories a day, also be a 200 lb person who eats 2750 calories a day, with each performing a similar amount of exercise.
While calories in/calories out will help anyone lose weight, for some, even with the advantage of math - its still much harder, sometimes an order of magnitude harder.
I've done this before, and I lose around 100 lbs, and I've kept off about 60 of it - but for the entire two years, I had a gnawing, burning pit of hunger whenever I was away. It never stops, and I never stopped being hungry. I just did my best to ignore it.
On top of that, look how many social occasions revolve around food, to stick to any essentially effective diet requires refraining in those situations. That's even harder. "oh, everyone is going for fast food after the thing, I guess I can just have some water? okay, I guess that's okay" because one fast food meal exceeds your calorie goal for the entire day.
Now you tell me, how easy is it to eat less if you never felt satiated, never stopped being hungry?
My point here, is while calorie counting and exercise works, there is clearly more going on than just that.
To me it seems to be a majorityu of cultural & calorie intake thing rather than a medical issue. Not to say it's easy (it's not) and not to say there aren't people with medical issues.
Us having enough calories available and the kinds of work around where people can lead a defacto life of leisure (by comparison to every other period of time).
Any time humans have an extended lack of scarcity the natural biological programming that makes someone fatter, takes over.
Also, love your username ^^
So yes, humans are a thermodynamic system, but that isn't a model that explains the dynamics of what your body does with it's tissues. It's more complex than that.
It's kind of like saying, "a CPU is just a resistive heater." There's a way in which this is true and it's a useful perspective for designing a cooling system. But it's a useless model to give to someone asking for advice in debugging race conditions, because you've erased the complexity their problems arise from.
Additionally there's a moralizing component where people erase this complexity in order to blame people for their medical problems and frame it as an issue of irresponsibility.
No one has ever said, "aircraft crashes are caused by gravity, and the moral failing of pilots not to understand this most basic principle. Imagine spending so much money on flight school when all you need to do is watch stuff fall, that's all you need to know." There is no gravity theory of airplane accidents in the same way there is a caloric imbalance theory of obesity.
Consider also that airplanes are "simple"[1], well understood, engineered systems which are centrally coordinated, and that bodies are complex, evolved systems, containing autonomous components, many of which are very poorly understood. Aircraft are engineered for consistency, with faulty or expired components swapped out, whereas humans vary dramatically, not only between each other, but over the course of their lives. Other people have very different bodies & experiences than you do; it can be night and day.
I came to understand this when speaking to a friend with executive dysfunction. I kept telling them they were beating themselves up or undermining themselves when they told me about limitations they experienced. Eventually they snapped at me and described their day to day in detail, and I realized their mind as a different place with different demons than mine, and that there were things I could do easily that they struggled with, and things I struggled with that were an ordeal for them. (They're a very smart and capable person who has abilities I do not, and of course I have demons and struggles they do not have as well.) I meant well but what I was doing was really undercutting and devaluing their lived experience, trying to comfort and bolster instead of understand.
[1] In the sense that they are not "complex systems" https://en.wikipedia.org/wiki/Complex_system (obviously aircraft are complex in a general sense)
"just eat less"
it's that easy. the people who don't do it are just stupid or lazy (in the mind of the fat haters)
Yes. Just do it.
You had a lot of extra fun stuffing yourself with food, you will have to pay the price for that at some point(either with hunger or with health problems if you don't lose the weight)
It's very simple to lose weight, it really is, just don't eat. The problem is that it's not fun(hunger is not fun, obviously).
But the bill comes for the extra fun you had with food, it's either hunger or serious health issues.
I hope you'll reconsider but if that's how you're going to behave there's no productive conversation to be had.
It is never an obese person's fault for stuffing themselves, it's always something else. In this thread it's the big bad pharma corps that don't give away for free diabetes drugs to people that don't have diabetes.
I wish you all the best, when you realize the problem is your lack of willpower maybe you'll lose weight and not gain it back.
>If Kay wanted to continue to lose weight, live pain-free, and stave off a dreaded diabetes diagnosis...
Not having anyone close with diabetes, so I'm quite unfamiliar with that landscape: why is being diagnosed with type-2 "dreaded"? If it's a valid diagnosis, and it would solve many of your problems, it feels like a fairly obvious choice...
I'm sure there are social stigmas around it, but is that all? Or are there some severe insurance implications or something?
Or is it more that they're worried about developing "full" type-2 in a few years if nothing else changes? But if that's the case, trying to get diagnosed with it ASAP seems like a reasonable route, not dreading it.
---
Edit: correction, ignore the below. Rogers here is a diagnosed diabetic who had to stop using it due to shortages.
---
>Due to shortages, Rogers had to stop taking Mounjaro for three weeks. “I was a wreck over it and full of despair,” said the 58-year-old. “I gained several pounds back, but I was surprised at how badly I felt when my [blood glucose] numbers got out of control again. It was a wakeup call to me to realize how sick diabetes makes you.”
Tbh that sounds like resisting diagnosis, not worrying about a future health decline.
If we’re not going to nationalize drug manufacturers, they should at least be regulated (competently, as to avoid regulatory capture), but I have little faith in the government to be able to do so effectively.
You mean the current regulations that fine drug makers for promoting off label use, of which handing out coupons arguably constitutes?
https://en.wikipedia.org/wiki/Pfizer#Legal_issues
Scale back proportionately from there.
In these recent cases it’s the non-regulation of celebrity posts on social media and rent-a-docs causing shortages of medicines intended for diabetes.
Its been really frustrating for me, and has caused me negative health effects.
So while I get, yes, you should lose weight - and this drug does that (and has a whole bunch of other positive health effects), the idea of this going to someone who might only be 30-40 lbs overweight who does not have T2D, infuriates me.
Without it, even on insulin, even fasting, my liver pumps out glucose constantly, I can fast for close to 24 hours before my blood sugar falls off enough to start to be low.
It seems like there are so many billions of dollars in nearly-pure profit to be made, so why is it not a problem that can be solved by throwing money at it?
The delivery mechanism on the pens for Mounjaro are.. highly complex spring loaded devices. On top of that, you have the whole License Raj around pharma manufacturing - we only scaled as fast during COVID with the vaccine because some of the rules were functionally waived.
The delivery mechanism part is less convincing, given that the product is already in the market. I'm not saying that it isn't complex/hard, but it's precisely the kind of thing that throwing money around actually can solve.
Sadly, things are worse in Canada; they won't even give us a timeline on Wegovy availability. I can only imagine what this means for everywhere else in the world.
I've been incredibly frustrated by the lack of support I've received from my slightly fat-shaming MD when it comes to being freaked out by the lack of consistent availability. I've pushed back on starting before supply chain issues are resolved, citing concerns about missing doses being worse than doing nothing at all - even before the cost factor is considered.
It really comes uncomfortably close to the moral failure side of things. "Oh, you won't even try with a reduced dosage? I guess you're not as serious as you said" type BS.
0: https://news.ycombinator.com/item?id=34228157
It is really the worst of America, either pay fortune for medication, or nationalize healthcare (with socialism...). There is no middle ground.
These shortages mostly happened because of a patent monopoly.
It wouldn’t surprise me if in a couple decades some non-trivial percentage of the folks using it for longevity end up with PSP, which is a fatal and untraceable disease.
https://drc.bmj.com/content/8/1/e001370
https://www.mdpi.com/1424-8247/14/9/890
1) Diet: Low carbohydrate diets are one technique: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9437985/
"In this randomized, crossover intervention trial among adults with prediabetes or T2DM, the 12-week percentage change in HbA1c, the primary study outcome, improved significantly for participants on both diets"
2) Exercise: High intensity training and strength training improve blood measurements. https://pubmed.ncbi.nlm.nih.gov/30270019/
"From a practical clinical perspective, the performance of [strength training] + [high intensity interval training] may be advised for additional benefits regarding insulin dosage reduction."
In short, cut out the bread, deserts, pizza , lift some weights and do some sprints. Keep doing it.
Pubmed is great resource. Search for terms like "clinical trial" "diabetes", "HIIT", "mediterranean diet", VFKD. [edit: I do want to emphasize the term "clinical trail". Diet and nutrition research has a lot of other types of research. Often the quality suffers. Clinical trials, and hopefully other clinical trials that verify earlier findings, are the best.]
Getting on top of the situation early will save you a lot of grief ( and doctor's visits and paying for drugs).
I disagree with "never". I think most people can use diet and exercise to avoid and even reverse type 2 diabetes. An unpopular opinion hereabouts, but likely true.
The diet part is also possible in theory, but many people's family and social environments practically require them to eat muffins, cakes, sweet desserts, and other micronutrient-poor dishes. Refusal to take part gets them ostracized.
Most people will let you slide on gorging if you simply say "Doctor's orders". HIIT means sprinting hard 3 times twice a week. Just about anybody can do it.
Doctors like this are disgusting. Nothing about obesity is incurable for the vast majority of the obese. It is a lifestyle choice.
Score one more for pharma and drugs that "require" lifetime use.