Diabetic mother-in-law is on it. Lost a ton of weight, is moving around better, and when I saw her over the holidays last week I felt she was mentally sharper than before.
My wife has been worried about her mental acuity declining over the last few years and I kept saying I felt like the diabetes was taking a toll on her brain. Perhaps it was? And perhaps it's slowly reversing a bit?
Last year my wife got the “you need to lose weight now or else” speech from her doctor. Diabetic signs starting to appear in her numbers. I was terrified for her.
12 months of Wegovy and she is down 52 pounds, and all diabetic signs have disappeared. Her doctor is thrilled.
And, (not that this matters much to me) her looking like a million bucks is a nice bonus too.
Losing weight when body has extra fat to cushion caloric deficit can improve a bunch of indicators, for me it's eliminate acid reflux -> better sleep -> less fatigue more sharpness. Losing weight without much fat can do the opposite when body feels full brunt of deficit. Worse sleep, more fatigue, less accuity. I wonder with how accessible these drugs are going to be, if general productivity is going to crash leading up to summer beach bod weather as more people cycles on and off every year.
Also anecdotal, but I have a close pre diabetic relative taking it for past 6 months without any positive effects. Looks like it doesn't work on everyone while I see success stories everywhere else.
Years ago before it was popular my doctor gave me an rx for it and I tried it, I knew it was a game changer, but those side effects? Might have just been me but I could not tolerate the nausea.
In the end I didn't need Ozempic, I just started working out several times a week and holding myself accountable to my eating habits. I think for the majority of people diet and exercise is enough. But for those who need more help, even Oprah, it's a miracle drug.
> I think for the majority of people diet and exercise is enough
As far as I understand it, in the wild for the majority of the people there’s very little evidence that obese people can diet and exercise themselves to a healthy weight. It just statistically doesn’t happen very often. For whatever reason, they need the hormone regulating drugs.
They can, they just don’t want it enough to make the necessary sacrifice. I agree it doesn’t happen much, but that isn’t because it can’t work, it does for almost everyone that can make permanent change in their diet and lifestyle, most people just want the easy way out.
I don’t think that being obese is a moral failing at all. But caloric deficit does result in weight loss.
Anyways, there are plenty of other benefits that come from exercise and a healthy diet, besides weight loss. Hopefully these drugs can be used as part of a more holistic improvement in lifestyle, and not as a sole treatment.
I was clinically obese (32 BMI when I checked, I think it could have been higher). The hunger when on calorie restrictions was debilitating, making it impossible to work in the afternoons.
The thing that helped was a complete, week-long fast (I had 13 weeks of PTO per year so sacrifing 2 wasn't a huge deal then), that I prepared with my family (lot of them are either doctors or PT). The second day was worse than when I dislocated my ankle, except in my whole body, without the adrenalin/shock to help with the pain. The pain came in waves. Once that passed I was mostly fine, and the third day until the last I was mostly functioning (I tired easily, and couldn't work or really exercise, but I was mostly fine and could go out and walk).
If I knew those drug existed, I think I couldn't have passed that second day, and taken those instead.
I mean quite literally something is wrong with obese people that statistically they cannot “want it enough”, like an addiction. The fact that obese people suddenly are able to “want it enough” when they take a hormone regulating drug points to this imo. It’s unhelpful to simplify this into a will thing, because it just doesn’t make sense that fat people love eating so much they’re totally cool with losing their feet to diabetes. That’s clearly something deeply wrong with the fat person, in the way that something is clearly wrong with a hoarded out house, or a homeless gambler.
Talking about things that are feasibly solved with willpower as if they should be achievable because people ought to be able to willpower their way through any plausible challenge is just bullshit. The world is full of people who are so eager to say that they did it ergo everyone else is just being lazy. But just… shut up. Everyone has different circumstances. Things that are very mentally hard are very mentally hard and we don’t need to pretend otherwise. It’s complete bullshit and moral high grounding. It’s not helpful in the slightest. It’s not an easy way out. It’s a way out.
Also we’ve stacked our whole culture against health and nutrition. Just compare 7/11 in the US vs Japan. This goes far deeper than saying everyone just needs to pull a small easy lever in their life. To come back from the brink in the US you have to win the fight every second of the day forever and inoculate yourself against a world poised against you.
1 in 50 obese people being able to escape obesity on their own is still tens or hundreds of thousands of people.
Telling people who've lost weight through willpower to just shut up is rude and unhelpful.
I lost 90 lbs through diet and exercise. When I say that others could do what I did - which is true for many - I often get people asking me for advice, which I give. What's wrong with that?
Telling people who couldn't muster the sustained willpower to lose weight through diet and exercise that they "just didn't want it enough" is rude and unhelpful. It's a little bit like telling bereaved parents they didn't pray hard enough for their deity to save the child. I'm happy for you, and hopefully the advice you're giving isn't some form of willpower woo-woo. The hard truth is that you were lucky; none of us can truly account for why we did or did not succeed at a practically achievable long-term goal. If the other 49 obese people had the capability to will themselves to health, they would have done so.
Your advice is shit that’s what’s wrong. Your situation is not the same as others. Everyone knows what you’re saying. You’re not giving useful info saying “power through it”. You’re bragging.
So good job. But shut up. Whatever rudeness you feel from me saying shut up is FAR less rude and unhelpful than the poor people you’re telling to “power through it” who are certain that they cannot. Because you are implicitly calling them weak. And that’s fucked up.
Because for the third time, it might be MUCH harder for them to lose weight than you.
You admit you don't know what advice I'm giving, yet you insist it's me just telling them to power through it and my motivations are as a braggart.
You can't see how presumptuous and rude this is? And how weak you are presuming all of these people are? Treating them as if they have no agency and they cannot handle hearing someone else's life experience.
While I don't doubt for many people it would be harder to lose weight than it was for me, you also have no idea how hard it was for me to lose weight. So what? Other people like me exist.
I lost weight by listening to other people who lost weight and learning from their experience, and I'm available to do the same for others. Why you think this is "fucked up" and demand I shut up is just bizarre.
I have no issue telling you where to shove your unsolicited advice. Especially when the advice is suggesting people, who have almost certainly tried suffering through to suffer through it in the context of looking at an alternative that works for people that have struggled with the approach you’re injecting here.
If people want your advice on diet and exercise they can ask for it. Otherwise, I trust they know it’s an option
100%.
after a lifetime of being overweight I found the will to make diet changes and ended up losing about 90lbs. The thing that's missed in these 'it's just calories in, calories out and will power' types of comments is that the commitment required to accomplish the weight loss is nothing compared to life consuming commitment required to maintain the loss over multiple years.
After 5 years of vigilance the mental and social toll was just too much and I gradually let down my guard within about 3 years I was up 50+lbs.
So now 10 years on it's corner cutting because there's a medical intervention that can help or just weakness because I can't find the will to do it to myself and people around me all over again?
Why shouldn't they want the easy way out? I was obese twenty years ago, and lost the weight via diet and exercise. Keeping that weight off is the single hardest thing I have ever done, and a battle I still have to consciously fight every single day. Why should it be that difficult? So that I can pass some kind of purity test?
The fact is that the food we eat has evolved over time, and is too hard to resist overconsuming for a large fraction of our population. If we can create more addictive food, why not create antidotes? If we could easily treat alcohol addiction with a pill, would we tell alcoholics to just apply willpower instead?
If at best only one in fifty can do such a thing, when the entire world is screaming at them to do so then you must re evaluate your position that it’s about just making some changes and having it all work out. Becoming a normal weight is just not something that you can expect for most currently obese people to achieve. The facts were have seen do not support the idea that it’s something that people can knuckle down and do in the majority of cases.
Whether the causes are biological, social, or whatever it’s something that we have not been able to even slow down as a society yet. The article mentions the abject failure of decades of efforts from doctors, government and individuals that have lead only to greater rates of obesity.
Even these drugs won’t be enough, given the best results in studies only show something like a 20% loss after more than a year. For many obese people, that leaves them still obese but $15k poorer if their insurance doesn’t cover the drug.
If you managed to lose a bunch of weight, congrats. But the experience is not generalizable, unfortunately. It’s really not for lack of effort on anyone’s part.
> the best results in studies only show something like a 20% loss after more than a year
The health benefits of losing that amount are enormous. In fact, they may get ~80% of the health benefits of a healthy fat percentage. Their blood pressure will plummet, their salt intake will drop, they’ll eat less sugar but more lean protein (it’s common to crave it). Because of this their blood work will improve and they’ll be at significantly lower risk of diabetes and heart disease etc. Don’t let perfect be the enemy of the waaaay better!
You can say the same thing about sex and contraceptives. It's probably way easier to abstain from sex than food. Yet no one is blamed for taking 'the easy way out' and using contraceptives instead. Why the double standard?
What a cruel usage of the term "just". None of us is lucky enough to want what we should want in every important facet of our lives. If you "just" wanted something enough to make "the necessary sacrifice", then you were lucky.
My view into the issue like this: Until this is part of state education (i.e. nutrition, exercise, stoicism, personal care, hygiene - Whatever - are 'appropriately' into syllabuses), we can't expect everyone to take care of themselves.
1. There will always be parents/guardians that are unable to teach this - That's why the education and children arm of government exists.
2. Ignorance IS an excuse here (people can't know that they don't know, if they don't even know that they SHOULD know!)
3. Even if we were to clamp down on unhealthy food advertising etc., our bodies still crave sugar binging etc. So regardless of success in that area, state education is still the keystone.
But that's it... I just don't know where to go from there. Is state education getting better at teaching these life skills over time? (Personal finance too, while we are at it). Are there things I could be doing to amplify this message? Is this the correct angle, even?
Congratulations on such a massive achievement by the way!
State sex education has been saturating youth in all the sex related artificial interventions while treating self-control as unrealistic at best and religious nonsense at worst. When do you think we’ll get an eruption of stoic self denial virtue from the state?
> Not sure what nation's syllabus you refer to though
There’s no need to bring gender ideology into this, the analogy is perfectly valid just referring to prophylaxis, hormonal medication, implants, and abortion. Those are commonly taught in schools around the globe.
> scientists at Novo Nordisk developed their own GLP-1 analogue and, in 2010, released a once-daily injection called liraglutide, or Victoza, for Type 2 diabetes. The GLP-1 drugs had another effect, too: people taking them lost a little weight.
A lot of people miss the fact that GLP-1 agonists have been on the market for 13 years. That’s still relatively young in drug terms, but not nearly as young as some of the GLP-1 critics would suggest. Just because you didn’t hear about it until last year doesn’t mean it’s a brand new drug without a track record.
That said, these also aren’t quite as free of side effects as some people want to think. For most, the minor side effects are more than worth the benefits of significantly reduced body weight. I do worry about the people who are using these to drop weight and then throwing all caution to the wind with the content of their diet, though. There’s more to eating healthy than body weight, and I’ve watched a few close friends go from planning their diet to eating pure junk and fast food because their GLP-1 agonist will keep their body weight in check. That’s not a problem with the drug, though. These people would be eating junk food if they were “naturally” skinny too.
I wonder about this - is it possible to “defeat” the drug? People eat for other reasons than pure hunger; there may be social or other reasons to over-consume. Perhaps an even a “clean your plate” ethos that many people were raised with and combined with an American tendency for over-large portions?
When I was eating my most on the drug, I maintained my weight but it never went up. I'm sure it's possible with an extremely calorie-dense diet, though.
Regarding social reasons for overconsumption - this drug makes you totally full with small servings. Even in social settings you will not overconsume unless you fancy throwing up.
As a person who is using one of those drugs, it’s interesting how fast food has become unpleasant. I used to enjoy going to such places regularly, but now it’s just not good tasting and results in reflux and unhappiness later.
I might have been thinking that I could just do whatever at the start, but I’ve drifted into eating more healthily because it’s what tastes and feels good to eat. Even nominally healthy packaged food tastes more like ash, while things cooked from whole ingredients taste better than ever. My experience is that I find myself enjoying food more and making better choices than before.
I’m sure your friends will have their own experiences and relationships with food that may differ from mine, but how people behave when they are freed from their constant hunger may surprise you.
One concern people have with these drugs is -- it seems like GLP-1 users who do not exercise disproportionately lose lean body mass. So their total weight goes down but their body fat percentage goes up. I don't think it's a huge effect and is basically expected for a low calorie diet with no exercise -- the solution is to exercise.
I’ve seen more than a handful of acquaintances that I follow on social media in the past year or so who have lost incredible amounts of weight. I wonder if it can be attributed to Ozempic. Suspiciously I don’t really see any other evidence of them adopting new workout regiments or something like that. It could be that they keep that stuff private… but I doubt it.
It's a good guess that if you see someone who has lost a considerable amount of weight, they are on ozempic or mounjaro. There's nothing wrong with that. American diet and lack of activity is a hard thing to turn around for a solid 6 months. Losing weight safely happens slowly with a caloric deficit, but not too big of a deficit that negatively impacts metabolism. Success stories like Ethan Suplee usually involve a consistent ongoing training program involving resistance training. https://www.youtube.com/watch?v=O7SLwIDyYrk
I lost 50 pounds this year without actually taking anything, but I figured I’d everyone is going to lose weight on it, I might as well too. People didn’t really see me going to the gym or eating less because I didn’t advertise it and it’s not something people really pay attention to, but I did do those things.
If ozempic was $100/month or something like that, I’d probably go for it, but I was trying not to blow my high deductible health plan and that stuff is not cheap.
I assume prices will eventually fall via competition or generic which should be pretty cool for lots of people.
Not a bad idea actually - I live in South Texas so it should be pretty feasible. I’ve never gone there for any medical reasons but have known people to do that.
Anyone can also buy it from Nevada from a website that has the word peptide and the other word sciences in the name. A few popular youtube people have pointed out the same, although they can’t say the name but they do show the label. If one is concerned about it, compound pharmacies will provide it with a prescription from an HRT clinic.
The thing is, if I were to buy a vial of some research chemical and disregard the warnings and actually want to take them, I’d still have no idea what to do with a vial of liquid. Presumably it involves needles which I’ve never prepared. What’s in there could be totally safe to take and I might still end up with an infection or some other nonsense because I don’t know what I’m doing. I do appreciate a certain hacker spirited, DIY approach to medicine, but it could be a bridge too far for me.
There is an oral name-brand formulation of semaglutide. If the peptide people can reproduce that, it should not (need to) involve needles. The company GP is talking about only sells an injectable formulation, though.
I'd say there is some anecdotal truth to it. Two of my close friends both had a fairly large reduction in weight and both of them admitted to using Ozempic.
One of my friends, I would consider heavily overweight if not obese (I'm not sure what the specific definition is). The other was certainly heavier but not by anything I would consider crazy. She however was working out religiously and watching her food intake and still struggled. She admitted to using it and it helped kick start her journey.
My other friend (heavier one) took it to lose weight for a wedding. Dropped a lot of weight, but didn't work out or change eating habits, stopped taking it and gained weight back.
So long story, I would say it's fairly likely that some of your acquaintances are taking/using it.
Ozempic (semaglutide) and Mounjaro (tirzepatide) are the main peptides gaining popularity but there's a big following of other peptides that help produce growth harmone naturally such as sermorelin, ipamorelin and cjc-1295. There's also BPC-157 which helps with angiogenesis and healing. The reddit peptides sub has a lot of user content and opinions, as does podcasters such as Andrew Huberman.
Since these are not fda approved, you will most likely get turned down by your primary doctor if you start asking about them. HRT clinics seem to be leading the way to trying these out. FYI - generic semaglutide is very cheap if you get it via HRT clinic as opposed to name brand and pre-mixed ozempic.
I know that, except for a few of us, we're just kibbitzing about this stuff, but: isn't that kind of a terrifying prospect? Like, you don't know if you have any undetected neoplasms that this could accelerate?
Regardless, my comment along with everyone else’s comment on this topic is UGC content. It is ones own responsibility to do their own research and come to their own conclusions.
I’ve followed this scene since peptides first started getting produced by UGLs (underground labs) and now by domestic companies operating in the gray area of unregulated chemicals (for “research use only” is the euphemism)
Years ago people started with great enthusiasm and then slowly realized that the effects over the long term aren’t always predictable. Some of these compounds make people feel great in the first few doses and then the negatives only appear much later. There are numerous stories of people getting burned out or stuck in long-lasting depressive states following experimentation, but they’re often waved away as contamination or blamed on something else they were taking.
Mainstream influencers like Huberman are now flirting with these chemicals after they’ve run out of interesting basic content to talk about for 3 hours on a weekly podcast. I’d caution anyone listening to the likes of Huberman to be extremely cautious about influencers who only tell the positives with a minimal caution to CYA and a wink wink suggestion that you don’t use them. The same story has been playing out for decades with fitness influencers and new chemicals, and every generation has had their too good to be true moment where the newest chemicals were assumed to be free of side effects.
Gastroparesis, and mostly found when on liraglutides (Saxenda),[1] though that hasn't stopped lawsuits against semaglutides.[2]
There's some interest in GLP-1 receptor agonists as IBS _treatments_, specifically for pain relief in IBS-C and IBS-M, though it's way too early to talk about meaningfully.[3][4]
> [Gila monster] venom helped to turn an obscure hormone into potent diabetes medications, and then into the most promising weight-loss treatments in history. We’re still discovering how much they’ll change our lives.
How many times have I heard someone complain about the weird things we spend our research dollars on?
You just never know what discovery or insight is out there, so we have to go look everywhere. Remember this the next time we’re voting to cut research dollars on some gross bug in a jungle you’ve never heard of.
I always wonder when I see things like this: how many cures are gone forever because the animal that could have shown us the path is now extinct?
It saddens me the number of folks on this planet that completely disregard animals and plants that they don’t get immediate enjoyment or sustenance from.
This is what upsets me so much about climate change. Humans aren't facing an existential crises, but millions of species of plant and animal are. Once gone, we'll never know what clever evolutionary secrets they contained.
exactly. nobody knows what some completely neglected or overlooked line of research will result in. this is why we should ban all research. its very possible that a seemingly innocuous research could result in AGI that will make humans obsolete and enable perpetual dictatorships and other nightmares. or result in a bomb that is very cheap and simple to make that unleashes enough energy to destroy the world in one shot, thus dooming us all. almost all of the worlds problems could be solved without new research. world hunger and war is not a technology problem. so doesnt it make the most sense to stop researching?
Best way to get a quick cheap laugh is to accuse the pharmaceutical industry of only being interested in "bonor pills for old men". Probably doesn't work as well post-COVID but you can work that into the joke!
A couple years ago I lost 80lbs in one year without any drugs. It was the hardest thing I had ever done. It required frankly extreme amounts of willpower.
More recently, I've lost about 25lbs on Mounjaro in two months. Zero effort. I was (quite literally) losing weight in my sleep.
I never felt full/satiated before in my life eating normally before starting Ozempic. Now I understand what it means to be satiated. I wonder if this is why it was easy for me to gain and hard for me to lose weight.
These drugs will be game-changers for many Americans. I think they are the solution to the obesity crisis. Now the big question: is it all priced into the stock already?
I wonder how it would work for people who have low metabolisms. I don’t eat much. Maybe twice a day, and at that, it’s usually half a ration (I’m frankly not hungry beyond that). Yet I would say I’m above a healthy weight. Maybe 20 pounds over.
Not sure what this drug would do. I’ve heard it curbs appetites but if I curb my appetite anymore, I’m not eating at all.
Yeah, in my experience the drug can curb appetites to somewhat dangerously low levels. I get pretty full on 650-800 cals/day and eat one meal a day. My TDEE is around 2100 cals/day.
Frankly speaking, while I enjoy the weight loss, it's not healthy at this rate. This is probably just a dosage issue. Still, I can't imagine a drug that curbs appetite would be good for someone that already doesn't eat much.
Out of curiosity, have you tried logging everything how much you eat? For me, after trying to lose weight through smaller meals and failing, cutting out all those seemingly-tiny, seemingly-healthy snacks (a handful of nuts etc) between meals is what moved the needle.
Yep. I got in the habit around the time I last lost a ton of weight (about 45lbs or 20% of my weight). Only way I could do it then was working out every day and eating under 1000 calories a day.
Obviously that’s not sustainable so I’ve leveled out and work out less because life.
strong conviction these impacts have been telegraphed from miles away and priced in. At one point, the GDP of Norway had to be presented independently off Novo Nordisk given how massive their market cap was. Also has led to bloating of adjacent companies that should be pummeled (instead of rising) such as Weight watchers. Time will tell.
I'm in the same boat. I had to literally starve myself
in order to lose weight and I did it but it was the most miserable experience and absolutely fucked me up mentally. My tipping point for actually losing weight is 800 calories a day with exercise, my body will kick scream and shuts down all major functions to avoid it any higher than that, I just get to be miserable with negative energy and still not lose weight. I now get to live the rest of my life with an eating disorder so that's fun but I did it I'm skinny yayyy :( I'm fiercely jealous of anyone whose metabolism let's them
run a deficit and just burn fat to make up the difference instead of just passing out.
Being able to just lose weight while maintaining a healthy relationship with food is going is going to be a night and day generational shift for women.
I'm the same way. Recently after a lot of painful effort, at a healthy weight after a lifetime of overweight/obesity, but at what cost to my mental health?
Ozempic (and similar drugs) are such a big deal. In 20 years time you'll be able to look back at all kinds of different trend charts (weight, life span, heard disease, alcohol consumption, fast food revenue, etc.) and see 2023 as a turning point.
The turning point was right around 1980. If we can figure out what changed then, we can correct course. I think what happened around 1980 was only a spark to the kindling that'd been prepared by a series of mistakes starting in the 1950's.
We started piling up mountains of debt government, commercial and consumer
As a society we started to party, it hasn’t stopped since, people are so stupid rich that they support several multi billion dollar corporations which do nothing but ferry food someone else makes to your grubby little paws. To add insult to injury they charge service fees, and markup menu items and on top of all that you have to tip the driver. you spend 2x the cost of the food to get it delivered half cold and soggy.
This is all normal and celebrated even, and then we wonder why everyone is overweight
Society, as a complex system, is always undergoing turning point transformation on sets of sub systems. It's possible to construe 'turning point' narratives about any well documented time period.
GP is not completely off. The middle class was squeezed after the Reagan administration and inequality soared. If you have two parents working multiple jobs to make ends meet, you end up consuming more processed foods (that save time and money) and having a less healthy diet.
Can someone help me understand what the science says about obesity, because it seems to change daily.
We're being told that people are healthy at any size. So why sell people Ozempic?
How is it okay to encourage weight loss with an expensive and possibly (likely) harmful drug, but not okay to encourage weight loss with a sensible diet?
Is being overweight a bad or a good thing? Despite all of the research, that part is unclear.
As far as I know, healthy at every size was originally a motivating saying to encourage fat people to still eat healthy and exercise, even if they don’t actually lose weight. This on its face makes a ton of sense, otherwise a fat person can just give up entirely which is obviously bad.
Healthy is a nebulous term, but most of the goals humans have e.g living long enough to meet your grandkids, or perform cognitively well enough to earn a living, implicitly include the instrumental goals of staying lean, and using your muscles regularly and vigorously. This is uncontroversial among scientists, and only called into question in the media.
No one is quite sure why obesity has become such a problem, but I'll give you several hypotheses all with reasonable mechanisms, and each with at least some data for you to argue about.
All of these things have changed in the last 100 years.
- Base metabolic rates have declined. We burn fewer calories doing nothing. Body temperatures are lower. No one is sure of the cause, it might be downstream from one of these other ones.
- We are more sedentary.
- Antibiotics have caused extinction of gut microbes, which were previously endemic, and passed through the maternal line.
- We take seeds, heat them up to extract oil, and put that oil in pretty much everything. This has significantly shifted the kind of fat in the food supply.
> We're being told that people are healthy at any size.
Literally nobody in the medical community is saying this. Obesity is unequivocally bad for your longevity.
There is a healthy range, which is a little fuzzy. Some people are healthy at a slightly heavier build, and we know there's some flaws in the way the BMI calculation works for certain groups of individuals. However, there is still always a point where you are medically obese and health problems begin.
It absolutely kills people. Heart disease, stroke, diabetes. There's some studies that suggest it might even be a causal factor for Alzheimers.
> How is it okay to encourage weight loss with an expensive and possibly (likely) harmful drug, but not okay to encourage weight loss with a sensible diet?
First, weight loss through diet and exercise is certainly encouraged. The exercise is intrinsically good for you. Improving your diet is intrinsically good for you. The weight loss adds even more benefits on top of that. If this works for someone, that's literally perfect.
However, diet and exercise clearly do not work for many people. Lifestyle modification is hard, for a whole lot of reasons... some social, some biological. We know this as fact.
If diet and exercise fail, then using drugs to combat the biological (hormonal) drivers of obesity is the current second-line option. And even if there's some side effects, the overall increase in life expectancy makes it worth it.
> Is being overweight a bad or a good thing? Despite all of the research, that part is unclear.
Medically, it's very bad. The research is very clear.
Now, that said, if somebody's overweight they should still feel good about themselves as a person. Shifting the conversation from "you're overweight because you're not good enough, and you should feel bad about yourself" (which is both bad for mental health and counterproductive) to "you're overweight because obesity is a disease, not a personal failing - and the fitness+medical community is here to help you be a better you" is a much better approach.
> Literally nobody in the medical community is saying this.
This is disingenuous . Healthy at any size and body positivity are both significant movements with noticeable media campaigns on commercials, TV news, social media. Dismissing the confusing messaging is only adding to the confusion.
American's don't absorb messaging through scientific journals, their beliefs are first distilled through the above media channels. Plus there are plenty of bogus journals pushing "healthy at any size" and "body positivity"
Is being fat good or bad? If it's bad enough to take a drug, then we should also encourage other ways to discourage it.
Just because people don't diet, doesn't mean it's hard to do. People do a lot of unhealthy things where choosing the better alternative is just as easy.
Exercise improves health outcomes even more than going from obese to non-obese, so we want to encourage even fat people to exercise. But it is also good to not be obese.
So my wife and I have been talking about this recently. She is not overweight, but after we had our child, she put on some extra weight. She's keen on losing it now and going back to her pre-pregnancy weight.
She's been very consistent in going to the gym and has seen some good results. But it does require a lot of motivation and effort.
She's tempted to ask our GP about Ozempic, but also afraid of unknown risks that comes with going off-label.
My opinion is that she should continue in the old-fashioned-way because it's been working well, not just for weight-loss, but also as an escape from childcare.
But now seeing people lose weight very much faster than her, I almost see her lose the motivation to do it the old-fashioned way. Some of her gym friends are on it, and so is a daily reminder for her.
So I am a bit mixed on this. We're also planning to have another child soonish, so unsure if this even factors in.
I am worried that collectively, the world has gone a bit too fast in using this for minor weight-loss.
The thing to keep in mind with Ozempic (and other GLP-1 agonists) is that it's essentially a forever drug. The data is clear that when you stop taking it, you will gain the weight back, rapidly, with almost near certainty.
For folks who are risking health complications due to obesity and yet still struggle to achieve meaningful weight loss, this can be an acceptable tradeoff. Especially considering the increased life expectancy. The health benefits of being in a normal weight range can't be overstated.
But if you're "not overweight", or are fortunate enough to make progress through diet and exercise, you probably don't want to be taking this for the rest of your life. It's not cheap and there can be side effects.
And if you're not planning to take it for the rest of your life, there's no point.
There's a hormonal component to weight loss. Some people literally do not get a reliable "I'm full, stop eating" signal from their bodies. For other people, eating is stress response. (Sometimes one becomes the other.)
If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive - it's literally one of our most basic hardwired instincts. Even more so if you have a particularly stressful life or get poor sleep, which also feeds into the hormone issues.
So yes, it is always "calories in - calories out"... but unless you're willing to lock people in a lab and have a third-party control the diet, you also have to consider the mental and biological factors that drive how many calories people's bodies are seeking out.
Diet and exercise do work for some people, and is always the best option when it works. But we also know from decades of failed diets that they do not work for many people - lifestyle modification has a terrible success rate.
> If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive
Trying to ignore being hungry it is a poor strategy. The solution is to to make peace with the sensation of hunger.
I do think most obesity should be treated as a mental health issue rather than a physical health issue.
The issue isn't that the person is obese - that's the symptom. The issue is that they're overheating. "What's driving me to overeat?" is the question they need to be asking themselves, and that answer will be the first piece of the puzzle.
It is the literal feeling of incredible hunger. That is not a normal thing to expect people to live with. The average person does not feel constantly hungry and thus not the urge to overeat.
Most obese people became obese in childhood. In obese people, especially those from childhood that were forced to always clean their plate, signaling pathways for satiation tend to stop working, so consuming a "normal" amount of food becomes difficult. Furthermore, mechanisms for hunger in obesity function very similarly to mechanisms for cocaine or alcohol addiction.
Drugs like Ozempic finally allow their biological signals for "you've had enough food" to actually work, so obese people can lose weight because they feel satiated like normal people do.
FWIW I have lost weight both ways - 80lbs through sheer will, and 25lbs through Mounjaro. I vastly prefer the second. The former is the hardest thing I have ever done (or will likely ever do) in my life. It was harder than getting into a top college, harder than anything relating to my career, harder than literally any other endeavor I've taken. It is definitely unreasonable to expect the average person to expend so much extreme mental effort when alternatives exist to become healthy.
I've felt incredible hunger and pain. I've had a lifetime of voluntary fasting, sure, but I've also had an experience this year where I spent weeks starving while already underweight and sick as hell withdrawing from a couple drugs, unable to sleep for more than 20-30 minutes tops, and suffering from a (still mostly mystery) intestinal issue.
I was SO hungry, it was indeed one of my dominant thoughts other than wanting to kill myself (or distract myself with hot hand warmers in between puking). It virtually never truly went away, other than when I was distracted by even worse senations.
What I then struggle to understand is why my obese and well-off father with a LOT of free time can't make the decision to stop eating fast food, can't consistently stick with not buying presumably very immediately gratifying and pleasurable fast food that often makes him feel sick later. Why I could actually have made radical changes to my diet years before I ever had that level of extreme suffering, or consistently rejected taking any opioids or weed even when my tolerances were probably more reset 1 or 2 weeks in and they could've provided substantial short-term escape from that hell.
I ask in this manner not to try to "brag", as if there's some achievement in meaningless and random suffering, but rather to ask about and understand how you might interpet it. I feel like I've experienced severe and truly engulfing hunger + pain. Coming out of that, I don't understand why some people can't escape the "addiction" of overeating unhealthy food, let alone too much of it, and others can escape the throes of drug dependency.
What could be so alien about someone like me compared against my own father, as opposed to his being in an active refusal to try?
Ultimately, it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure, and yet given the same opportunities of similar constant cheap pleasures I've mostly avoided them in seeing the longer term pain lying in wait behind their facade. I feel as though the only definitive observation I can make there is that most obese people can't seem to see their condition similarly. They can get hyped up selling themselved and those around them a meme "diet plan" while its easy in their mind, but once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
> I don't understand why some people can't escape the "addiction" of overeating unhealthy food, let alone too much of it, and others can escape the throes of drug dependency. [...] What could be so alien about someone like me compared against my own father, as opposed to his being in an active refusal to try?
Well, addiction is a difficult thing. Most people with a serious addiction will never be able to overcome it. A small number of people will have the willpower to get through the withdrawal and engulfing suffering related to it.
> it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure
People that are addicted to food, cocaine, or alcohol don't want to be addicted to it. They hate their constant urges. When I was at my worst I didn't want to eat the food I was eating. But fighting that urge requires a monumental amount of willpower people often simply don't have. It's not a "willpower deficiency" just as we wouldn't call a normal person willpower-deficient if they couldn't kick a cocaine addiction.
> once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
Yeah, they give up - which to me is completely unsurprising given how hard losing weight and kicking that addiction is for some people. See, given how addicted you are to food, a diet plan could range from merely "hard work" to "so ridiculously hard that your psychology can't handle it".
This is why I think medicines like Ozempic are critical. They enable you to lose weight without needing to exercise Herculean feats of willpower if you are very addicted to food (especially if you have been since childhood.)
Willpower is a muscle, though - if you don't flex it, it atrophies pretty quickly.
Exercising the willpower to not eat when you're hungry is only a Herculean effort if you've stopped exercising it regularly for a long time.
At any given moment, we might have multiple conflicting desires (e.g. "I want to eat this pizza," and "I want to lose weight"), and it takes a lot of mental practice to be able notice when this is happening, and take a moment to identify which of your wants are base urges and which are real, higher-order desires, then align your actions with the higher-order ones. Meditation helps, and for those that really struggle with exercising executive function, therapy can help as well. But it takes a lot of practice and sustained effort. Habits change quite slowly and most of the work of losing weight is building the right mental frameworks so that you can start changing habits. Trying to brute force weight loss is like trying to swim the English channel with no training - you're going to fail and might hurt or even traumatize yourself in the process, which will make it even harder if you try again later.
Medication does work and it has its place, but because it comes with side effects and does not resolve the underlying mental issues that are driving the addictive behavior, I really do feel it should be a last resort for the most serious cases of addiction, not the first line of attack. It's possible you and I may agree on this point, but many don't, and refusing to acknowledge that obesity is primarily a psychological issue is doing more harm than good.
> Exercising the willpower to not eat when you're hungry is only a Herculean effort if you've stopped exercising it regularly for a long time.
Addiction mechanics play a role here. It's not just willpower, it's willpower minus addiction. The second variable is absolutely massive, it snowballs over time, and it's why addiction treatments often have more interventions than just willpower.
As such, it's a thousand times more difficult for an obese person to "simply not eat" than it is for a normal person to "simply not eat." To the normal person, not addicted to food, it might seem simple, like the obese person simply lacks willpower, but in the obese person's shoes the normal person would likely end up the same way.
Hence, the obesity epidemic - it sneaks up on you.
Sure but it's like trying to hide the keys to the liquor cabinet from yourself. Ultimately it's the root cause that interests people not the consequence of it.
I don’t understand the mechanics of the weight coming back, like you use this, your appetite changes you eat less etc, doesn’t your body adjust to the lower caloric intake and all that.
How is it that once you stop taking everything reverts?
Look at it this way: Your body secrets a certain amount of hunger hormones. The GLP-1 drugs act in a way that blocks those hormones. (I'm greatly simplifying here.)
In response, your body secretes more hormones, so you take more GLP-1 drugs. Increase until you reach a stable balance that adequately controls the hunger.
Now, when you stop taking the GLP-1 drugs, you have a flood of surplus hunger hormones... and the hunger comes back with a vengeance. Plus, you probably haven't learned any effective coping skills for dealing with that hunger while taking the drug - so you're likely to revert to old lifestyle practices.
Or at least that's my understanding. The endocrine system is complicated. However, mechanism aside, the data is clear that people regain the weight once they stop. There's a relevant study here:
Not necessarily. When you get to the target weight, you don't need to go straight from the dose you are on to zero, you can, and probably should, lower the dose little by little, just like you raised the dose at the beginning of the regimen. If you are at 2mg, you first go to 1mg, see if your weight is stable, then if it is, go to 0.5 mg, then 0.25 mg. In the near future there will be oral versions of the GLP-1 antagonists, to you will be able to fine-tune even more precisely the dose, for example, you could figure if you can skip some days.
The body has some "weight memory". But I heard this memory disappears after about 10 years. If you take Ozempic for 2 years, go in very low dose maintenance mode for 8 years, and then stop taking it, but keep an eye to see if you need to start again, what other dieting option offers you this type of choice?
> if you're not planning to take it for the rest of your life, there's no point
I'm at the age where I'm attending a ton of weddings, and many of the brides and grooms go on Ozempic for a few months before the wedding, fully acknowledging they'll probably gain all the weight back afterward (despite their best efforts to keep it off!)
The weight loss may not be permanent, but it's a day where most people are probably photographed and recorded more than any other day in their lives, and those captured images are indeed pregnant. The added stress and hectic nature of planning a large wedding makes it quite difficult to diet, exercise, and lose weight the natural way as well (I imagine).
I was under the impression that to use these drugs medically, you do need to be overweight - BMI 27 and some related condition like high blood pressure or you need to be obese (BMI 30+) or have diabetes. I wonder what people are saying to get them prescribed for more trivial weight loss.
I wonder what this is doing to our insurance premiums because it sure isn't cheap, but other than that, I say if you want to take it, then go for it. I probably would if the cost was reasonable.
I have seen people gain weight just to push themselves over the edge to get the drug. Once they are on it, they more a quickly reach their goal weight than they would have otherwise.
Others will simply lie about their weight to their primary care, increasing it slightly to match the BMI bar.
Finally, some people will get the drug from compound pharmacies.
TL;DR - yes, it probably impacts premiums, but insurance companies are somewhat evil for attaching so many restrictions around a drug that every overweight person should have free access to.
It is frankly ridiculous that these companies have the power to get between a doctor and patient, and what the doctor deems medically necessary.
Please understand, the gym is NOT for weight loss! This is a myth perpetuated by both food and gym industries. Weight loss happens 90% in the kitchen (what you eat). Exercise is important for health, but do not expect to lose weight. Make sure you/she are doing the right things that will lead to the expected goal.
Gym is great for increasing your metabolism (muscle consume more than fat). Is good for the last 2-3 kilos, useless for the first 20s (I know, I was obese). Another solution for the last 2-3 kilos is going below necessary kcal, but this can have consequences, especially if you're not young.
Even after losing some weight with diet, it's nice knowing these drugs exist as a backup plan. It's not a moral failing to use these drugs, just as drugs are used to treat other things, too.
Despite endless diet and fitness apps/trackers and content on social media, as well as the rise of the so-called health-conscious consumer, there is no evidence to suggest anything is improving. Why people got so fat is up to debate, but this is where we're at, and we need these drugs more than ever. People's metabolisms are broken or something. Or small caloric surpluses over a decade leads to obesity. Regaining weight is ridiculously easy for formerly obese people, too.
I have several friends who are on one or more variations of this drug and have been losing weight successfully. Like TFA mentions, they've reported reduction in "impulsivity" -- eg less need for alcohol, less desire for gambling and, in one case, less desire for hookups/one-night-stands/sex.
My first fear is that these psychological side effects are going to be more impactful in the long term than any physical side effects.
My other and more immediate fear is that we don't know the full ramifications of what "reduced impulsivity" actually means. Does that mean you're going to seek out dopamine less? Does that mean you won't enjoy your hobbies as much? Does that mean you're going to be slightly less motivated to work on that satisfying side project or startup? Does that mean you'll be slightly less desirous to fix tha one extra bug which otherwise might be so very satisfying and will drive your project forward?
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[ 5.4 ms ] story [ 220 ms ] threadMy wife has been worried about her mental acuity declining over the last few years and I kept saying I felt like the diabetes was taking a toll on her brain. Perhaps it was? And perhaps it's slowly reversing a bit?
Last year my wife got the “you need to lose weight now or else” speech from her doctor. Diabetic signs starting to appear in her numbers. I was terrified for her.
12 months of Wegovy and she is down 52 pounds, and all diabetic signs have disappeared. Her doctor is thrilled.
And, (not that this matters much to me) her looking like a million bucks is a nice bonus too.
Losing weight when body has extra fat to cushion caloric deficit can improve a bunch of indicators, for me it's eliminate acid reflux -> better sleep -> less fatigue more sharpness. Losing weight without much fat can do the opposite when body feels full brunt of deficit. Worse sleep, more fatigue, less accuity. I wonder with how accessible these drugs are going to be, if general productivity is going to crash leading up to summer beach bod weather as more people cycles on and off every year.
In the end I didn't need Ozempic, I just started working out several times a week and holding myself accountable to my eating habits. I think for the majority of people diet and exercise is enough. But for those who need more help, even Oprah, it's a miracle drug.
As far as I understand it, in the wild for the majority of the people there’s very little evidence that obese people can diet and exercise themselves to a healthy weight. It just statistically doesn’t happen very often. For whatever reason, they need the hormone regulating drugs.
I don’t think that being obese is a moral failing at all. But caloric deficit does result in weight loss.
Anyways, there are plenty of other benefits that come from exercise and a healthy diet, besides weight loss. Hopefully these drugs can be used as part of a more holistic improvement in lifestyle, and not as a sole treatment.
The thing that helped was a complete, week-long fast (I had 13 weeks of PTO per year so sacrifing 2 wasn't a huge deal then), that I prepared with my family (lot of them are either doctors or PT). The second day was worse than when I dislocated my ankle, except in my whole body, without the adrenalin/shock to help with the pain. The pain came in waves. Once that passed I was mostly fine, and the third day until the last I was mostly functioning (I tired easily, and couldn't work or really exercise, but I was mostly fine and could go out and walk).
If I knew those drug existed, I think I couldn't have passed that second day, and taken those instead.
Talking about things that are feasibly solved with willpower as if they should be achievable because people ought to be able to willpower their way through any plausible challenge is just bullshit. The world is full of people who are so eager to say that they did it ergo everyone else is just being lazy. But just… shut up. Everyone has different circumstances. Things that are very mentally hard are very mentally hard and we don’t need to pretend otherwise. It’s complete bullshit and moral high grounding. It’s not helpful in the slightest. It’s not an easy way out. It’s a way out.
Telling people who've lost weight through willpower to just shut up is rude and unhelpful.
I lost 90 lbs through diet and exercise. When I say that others could do what I did - which is true for many - I often get people asking me for advice, which I give. What's wrong with that?
So good job. But shut up. Whatever rudeness you feel from me saying shut up is FAR less rude and unhelpful than the poor people you’re telling to “power through it” who are certain that they cannot. Because you are implicitly calling them weak. And that’s fucked up.
Because for the third time, it might be MUCH harder for them to lose weight than you.
You can't see how presumptuous and rude this is? And how weak you are presuming all of these people are? Treating them as if they have no agency and they cannot handle hearing someone else's life experience.
While I don't doubt for many people it would be harder to lose weight than it was for me, you also have no idea how hard it was for me to lose weight. So what? Other people like me exist.
I lost weight by listening to other people who lost weight and learning from their experience, and I'm available to do the same for others. Why you think this is "fucked up" and demand I shut up is just bizarre.
If people want your advice on diet and exercise they can ask for it. Otherwise, I trust they know it’s an option
After 5 years of vigilance the mental and social toll was just too much and I gradually let down my guard within about 3 years I was up 50+lbs.
So now 10 years on it's corner cutting because there's a medical intervention that can help or just weakness because I can't find the will to do it to myself and people around me all over again?
Not helpful.
The fact is that the food we eat has evolved over time, and is too hard to resist overconsuming for a large fraction of our population. If we can create more addictive food, why not create antidotes? If we could easily treat alcohol addiction with a pill, would we tell alcoholics to just apply willpower instead?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539812/
If at best only one in fifty can do such a thing, when the entire world is screaming at them to do so then you must re evaluate your position that it’s about just making some changes and having it all work out. Becoming a normal weight is just not something that you can expect for most currently obese people to achieve. The facts were have seen do not support the idea that it’s something that people can knuckle down and do in the majority of cases.
Whether the causes are biological, social, or whatever it’s something that we have not been able to even slow down as a society yet. The article mentions the abject failure of decades of efforts from doctors, government and individuals that have lead only to greater rates of obesity.
Even these drugs won’t be enough, given the best results in studies only show something like a 20% loss after more than a year. For many obese people, that leaves them still obese but $15k poorer if their insurance doesn’t cover the drug.
If you managed to lose a bunch of weight, congrats. But the experience is not generalizable, unfortunately. It’s really not for lack of effort on anyone’s part.
The health benefits of losing that amount are enormous. In fact, they may get ~80% of the health benefits of a healthy fat percentage. Their blood pressure will plummet, their salt intake will drop, they’ll eat less sugar but more lean protein (it’s common to crave it). Because of this their blood work will improve and they’ll be at significantly lower risk of diabetes and heart disease etc. Don’t let perfect be the enemy of the waaaay better!
1. There will always be parents/guardians that are unable to teach this - That's why the education and children arm of government exists.
2. Ignorance IS an excuse here (people can't know that they don't know, if they don't even know that they SHOULD know!)
3. Even if we were to clamp down on unhealthy food advertising etc., our bodies still crave sugar binging etc. So regardless of success in that area, state education is still the keystone.
But that's it... I just don't know where to go from there. Is state education getting better at teaching these life skills over time? (Personal finance too, while we are at it). Are there things I could be doing to amplify this message? Is this the correct angle, even?
Congratulations on such a massive achievement by the way!
State sex education has been saturating youth in all the sex related artificial interventions while treating self-control as unrealistic at best and religious nonsense at worst. When do you think we’ll get an eruption of stoic self denial virtue from the state?
Not sure what nation's syllabus you refer to though, I would guess that it is USA based
(edited because my wording seemed weird and pointed)
There’s no need to bring gender ideology into this, the analogy is perfectly valid just referring to prophylaxis, hormonal medication, implants, and abortion. Those are commonly taught in schools around the globe.
I'm pro-sex-ed but not sure what that looks like in your locale.
What? US sex education advice is to be forceful and rapey because 'guys can't control themselves' or any other bullshit reason like this?
On a population level, it has failed miserably. Sure, some can force themselves through the process, but that number is not that many.
Being nauseous is a very effective appetite killer
A lot of people miss the fact that GLP-1 agonists have been on the market for 13 years. That’s still relatively young in drug terms, but not nearly as young as some of the GLP-1 critics would suggest. Just because you didn’t hear about it until last year doesn’t mean it’s a brand new drug without a track record.
That said, these also aren’t quite as free of side effects as some people want to think. For most, the minor side effects are more than worth the benefits of significantly reduced body weight. I do worry about the people who are using these to drop weight and then throwing all caution to the wind with the content of their diet, though. There’s more to eating healthy than body weight, and I’ve watched a few close friends go from planning their diet to eating pure junk and fast food because their GLP-1 agonist will keep their body weight in check. That’s not a problem with the drug, though. These people would be eating junk food if they were “naturally” skinny too.
Regarding social reasons for overconsumption - this drug makes you totally full with small servings. Even in social settings you will not overconsume unless you fancy throwing up.
I might have been thinking that I could just do whatever at the start, but I’ve drifted into eating more healthily because it’s what tastes and feels good to eat. Even nominally healthy packaged food tastes more like ash, while things cooked from whole ingredients taste better than ever. My experience is that I find myself enjoying food more and making better choices than before.
I’m sure your friends will have their own experiences and relationships with food that may differ from mine, but how people behave when they are freed from their constant hunger may surprise you.
If ozempic was $100/month or something like that, I’d probably go for it, but I was trying not to blow my high deductible health plan and that stuff is not cheap.
I assume prices will eventually fall via competition or generic which should be pretty cool for lots of people.
Here it is for $211 per month: https://www.farmaciasguadalajara.com/ProductDisplay?urlReque... though that’s only a deal if your insurance won’t cover it in the states.
I bet it’s not in stock.
One of my friends, I would consider heavily overweight if not obese (I'm not sure what the specific definition is). The other was certainly heavier but not by anything I would consider crazy. She however was working out religiously and watching her food intake and still struggled. She admitted to using it and it helped kick start her journey.
My other friend (heavier one) took it to lose weight for a wedding. Dropped a lot of weight, but didn't work out or change eating habits, stopped taking it and gained weight back.
So long story, I would say it's fairly likely that some of your acquaintances are taking/using it.
Since these are not fda approved, you will most likely get turned down by your primary doctor if you start asking about them. HRT clinics seem to be leading the way to trying these out. FYI - generic semaglutide is very cheap if you get it via HRT clinic as opposed to name brand and pre-mixed ozempic.
Regardless, my comment along with everyone else’s comment on this topic is UGC content. It is ones own responsibility to do their own research and come to their own conclusions.
Years ago people started with great enthusiasm and then slowly realized that the effects over the long term aren’t always predictable. Some of these compounds make people feel great in the first few doses and then the negatives only appear much later. There are numerous stories of people getting burned out or stuck in long-lasting depressive states following experimentation, but they’re often waved away as contamination or blamed on something else they were taking.
Mainstream influencers like Huberman are now flirting with these chemicals after they’ve run out of interesting basic content to talk about for 3 hours on a weekly podcast. I’d caution anyone listening to the likes of Huberman to be extremely cautious about influencers who only tell the positives with a minimal caution to CYA and a wink wink suggestion that you don’t use them. The same story has been playing out for decades with fitness influencers and new chemicals, and every generation has had their too good to be true moment where the newest chemicals were assumed to be free of side effects.
Compounding pharmacies are good too.
There's some interest in GLP-1 receptor agonists as IBS _treatments_, specifically for pain relief in IBS-C and IBS-M, though it's way too early to talk about meaningfully.[3][4]
1: https://jamanetwork.com/journals/jama/fullarticle/2810542
2: https://www.nbcnews.com/health/health-news/makers-ozempic-mo...
3: https://pubmed.ncbi.nlm.nih.gov/35234561/
4: https://pubmed.ncbi.nlm.nih.gov/31602785/
How many times have I heard someone complain about the weird things we spend our research dollars on?
You just never know what discovery or insight is out there, so we have to go look everywhere. Remember this the next time we’re voting to cut research dollars on some gross bug in a jungle you’ve never heard of.
It saddens me the number of folks on this planet that completely disregard animals and plants that they don’t get immediate enjoyment or sustenance from.
More recently, I've lost about 25lbs on Mounjaro in two months. Zero effort. I was (quite literally) losing weight in my sleep.
I never felt full/satiated before in my life eating normally before starting Ozempic. Now I understand what it means to be satiated. I wonder if this is why it was easy for me to gain and hard for me to lose weight.
These drugs will be game-changers for many Americans. I think they are the solution to the obesity crisis. Now the big question: is it all priced into the stock already?
Not sure what this drug would do. I’ve heard it curbs appetites but if I curb my appetite anymore, I’m not eating at all.
Frankly speaking, while I enjoy the weight loss, it's not healthy at this rate. This is probably just a dosage issue. Still, I can't imagine a drug that curbs appetite would be good for someone that already doesn't eat much.
Obviously that’s not sustainable so I’ve leveled out and work out less because life.
Being able to just lose weight while maintaining a healthy relationship with food is going is going to be a night and day generational shift for women.
Obesity in Females: https://en.wikipedia.org/wiki/Obesity_in_the_United_States#/...
Obesity in Males: https://en.wikipedia.org/wiki/Obesity_in_the_United_States#/...
(graphs from https://en.wikipedia.org/wiki/Obesity_in_the_United_States )
"Trends in obesity among children and adolescents ages 2–19 years, by age: United States, 1963–1965 through 2017–2018": https://www.niddk.nih.gov/-/media/Images/Health-Information/... (from https://www.niddk.nih.gov/health-information/health-statisti... )
Cable TV started growing as did Satellite TV
The baby boomers started coming of age
We started piling up mountains of debt government, commercial and consumer
As a society we started to party, it hasn’t stopped since, people are so stupid rich that they support several multi billion dollar corporations which do nothing but ferry food someone else makes to your grubby little paws. To add insult to injury they charge service fees, and markup menu items and on top of all that you have to tip the driver. you spend 2x the cost of the food to get it delivered half cold and soggy.
This is all normal and celebrated even, and then we wonder why everyone is overweight
We're being told that people are healthy at any size. So why sell people Ozempic?
How is it okay to encourage weight loss with an expensive and possibly (likely) harmful drug, but not okay to encourage weight loss with a sensible diet?
Is being overweight a bad or a good thing? Despite all of the research, that part is unclear.
Who told you this? Where are you getting your news from?
If you're not noticing this messaging, I would ask where you are getting your news from.
https://www.nature.com/articles/s41366-022-01165-5
No one is quite sure why obesity has become such a problem, but I'll give you several hypotheses all with reasonable mechanisms, and each with at least some data for you to argue about.
All of these things have changed in the last 100 years.
- Base metabolic rates have declined. We burn fewer calories doing nothing. Body temperatures are lower. No one is sure of the cause, it might be downstream from one of these other ones.
- We are more sedentary.
- Antibiotics have caused extinction of gut microbes, which were previously endemic, and passed through the maternal line.
- We take seeds, heat them up to extract oil, and put that oil in pretty much everything. This has significantly shifted the kind of fat in the food supply.
Literally nobody in the medical community is saying this. Obesity is unequivocally bad for your longevity.
There is a healthy range, which is a little fuzzy. Some people are healthy at a slightly heavier build, and we know there's some flaws in the way the BMI calculation works for certain groups of individuals. However, there is still always a point where you are medically obese and health problems begin.
It absolutely kills people. Heart disease, stroke, diabetes. There's some studies that suggest it might even be a causal factor for Alzheimers.
> How is it okay to encourage weight loss with an expensive and possibly (likely) harmful drug, but not okay to encourage weight loss with a sensible diet?
First, weight loss through diet and exercise is certainly encouraged. The exercise is intrinsically good for you. Improving your diet is intrinsically good for you. The weight loss adds even more benefits on top of that. If this works for someone, that's literally perfect.
However, diet and exercise clearly do not work for many people. Lifestyle modification is hard, for a whole lot of reasons... some social, some biological. We know this as fact.
If diet and exercise fail, then using drugs to combat the biological (hormonal) drivers of obesity is the current second-line option. And even if there's some side effects, the overall increase in life expectancy makes it worth it.
> Is being overweight a bad or a good thing? Despite all of the research, that part is unclear.
Medically, it's very bad. The research is very clear.
Now, that said, if somebody's overweight they should still feel good about themselves as a person. Shifting the conversation from "you're overweight because you're not good enough, and you should feel bad about yourself" (which is both bad for mental health and counterproductive) to "you're overweight because obesity is a disease, not a personal failing - and the fitness+medical community is here to help you be a better you" is a much better approach.
This is disingenuous . Healthy at any size and body positivity are both significant movements with noticeable media campaigns on commercials, TV news, social media. Dismissing the confusing messaging is only adding to the confusion.
American's don't absorb messaging through scientific journals, their beliefs are first distilled through the above media channels. Plus there are plenty of bogus journals pushing "healthy at any size" and "body positivity"
Is being fat good or bad? If it's bad enough to take a drug, then we should also encourage other ways to discourage it.
Just because people don't diet, doesn't mean it's hard to do. People do a lot of unhealthy things where choosing the better alternative is just as easy.
> an adolescent who has been mercilessly bullied for her weight arrives in an emergency department with suicidal thoughts
She's been very consistent in going to the gym and has seen some good results. But it does require a lot of motivation and effort.
She's tempted to ask our GP about Ozempic, but also afraid of unknown risks that comes with going off-label.
My opinion is that she should continue in the old-fashioned-way because it's been working well, not just for weight-loss, but also as an escape from childcare.
But now seeing people lose weight very much faster than her, I almost see her lose the motivation to do it the old-fashioned way. Some of her gym friends are on it, and so is a daily reminder for her.
So I am a bit mixed on this. We're also planning to have another child soonish, so unsure if this even factors in.
I am worried that collectively, the world has gone a bit too fast in using this for minor weight-loss.
For folks who are risking health complications due to obesity and yet still struggle to achieve meaningful weight loss, this can be an acceptable tradeoff. Especially considering the increased life expectancy. The health benefits of being in a normal weight range can't be overstated.
But if you're "not overweight", or are fortunate enough to make progress through diet and exercise, you probably don't want to be taking this for the rest of your life. It's not cheap and there can be side effects.
And if you're not planning to take it for the rest of your life, there's no point.
If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive - it's literally one of our most basic hardwired instincts. Even more so if you have a particularly stressful life or get poor sleep, which also feeds into the hormone issues.
So yes, it is always "calories in - calories out"... but unless you're willing to lock people in a lab and have a third-party control the diet, you also have to consider the mental and biological factors that drive how many calories people's bodies are seeking out.
Diet and exercise do work for some people, and is always the best option when it works. But we also know from decades of failed diets that they do not work for many people - lifestyle modification has a terrible success rate.
Trying to ignore being hungry it is a poor strategy. The solution is to to make peace with the sensation of hunger.
I do think most obesity should be treated as a mental health issue rather than a physical health issue.
The issue isn't that the person is obese - that's the symptom. The issue is that they're overheating. "What's driving me to overeat?" is the question they need to be asking themselves, and that answer will be the first piece of the puzzle.
Most obese people became obese in childhood. In obese people, especially those from childhood that were forced to always clean their plate, signaling pathways for satiation tend to stop working, so consuming a "normal" amount of food becomes difficult. Furthermore, mechanisms for hunger in obesity function very similarly to mechanisms for cocaine or alcohol addiction.
Drugs like Ozempic finally allow their biological signals for "you've had enough food" to actually work, so obese people can lose weight because they feel satiated like normal people do.
FWIW I have lost weight both ways - 80lbs through sheer will, and 25lbs through Mounjaro. I vastly prefer the second. The former is the hardest thing I have ever done (or will likely ever do) in my life. It was harder than getting into a top college, harder than anything relating to my career, harder than literally any other endeavor I've taken. It is definitely unreasonable to expect the average person to expend so much extreme mental effort when alternatives exist to become healthy.
I was SO hungry, it was indeed one of my dominant thoughts other than wanting to kill myself (or distract myself with hot hand warmers in between puking). It virtually never truly went away, other than when I was distracted by even worse senations.
What I then struggle to understand is why my obese and well-off father with a LOT of free time can't make the decision to stop eating fast food, can't consistently stick with not buying presumably very immediately gratifying and pleasurable fast food that often makes him feel sick later. Why I could actually have made radical changes to my diet years before I ever had that level of extreme suffering, or consistently rejected taking any opioids or weed even when my tolerances were probably more reset 1 or 2 weeks in and they could've provided substantial short-term escape from that hell.
I ask in this manner not to try to "brag", as if there's some achievement in meaningless and random suffering, but rather to ask about and understand how you might interpet it. I feel like I've experienced severe and truly engulfing hunger + pain. Coming out of that, I don't understand why some people can't escape the "addiction" of overeating unhealthy food, let alone too much of it, and others can escape the throes of drug dependency.
What could be so alien about someone like me compared against my own father, as opposed to his being in an active refusal to try?
Ultimately, it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure, and yet given the same opportunities of similar constant cheap pleasures I've mostly avoided them in seeing the longer term pain lying in wait behind their facade. I feel as though the only definitive observation I can make there is that most obese people can't seem to see their condition similarly. They can get hyped up selling themselved and those around them a meme "diet plan" while its easy in their mind, but once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
Well, addiction is a difficult thing. Most people with a serious addiction will never be able to overcome it. A small number of people will have the willpower to get through the withdrawal and engulfing suffering related to it.
> it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure
People that are addicted to food, cocaine, or alcohol don't want to be addicted to it. They hate their constant urges. When I was at my worst I didn't want to eat the food I was eating. But fighting that urge requires a monumental amount of willpower people often simply don't have. It's not a "willpower deficiency" just as we wouldn't call a normal person willpower-deficient if they couldn't kick a cocaine addiction.
> once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
Yeah, they give up - which to me is completely unsurprising given how hard losing weight and kicking that addiction is for some people. See, given how addicted you are to food, a diet plan could range from merely "hard work" to "so ridiculously hard that your psychology can't handle it".
This is why I think medicines like Ozempic are critical. They enable you to lose weight without needing to exercise Herculean feats of willpower if you are very addicted to food (especially if you have been since childhood.)
Exercising the willpower to not eat when you're hungry is only a Herculean effort if you've stopped exercising it regularly for a long time.
At any given moment, we might have multiple conflicting desires (e.g. "I want to eat this pizza," and "I want to lose weight"), and it takes a lot of mental practice to be able notice when this is happening, and take a moment to identify which of your wants are base urges and which are real, higher-order desires, then align your actions with the higher-order ones. Meditation helps, and for those that really struggle with exercising executive function, therapy can help as well. But it takes a lot of practice and sustained effort. Habits change quite slowly and most of the work of losing weight is building the right mental frameworks so that you can start changing habits. Trying to brute force weight loss is like trying to swim the English channel with no training - you're going to fail and might hurt or even traumatize yourself in the process, which will make it even harder if you try again later.
Medication does work and it has its place, but because it comes with side effects and does not resolve the underlying mental issues that are driving the addictive behavior, I really do feel it should be a last resort for the most serious cases of addiction, not the first line of attack. It's possible you and I may agree on this point, but many don't, and refusing to acknowledge that obesity is primarily a psychological issue is doing more harm than good.
Addiction mechanics play a role here. It's not just willpower, it's willpower minus addiction. The second variable is absolutely massive, it snowballs over time, and it's why addiction treatments often have more interventions than just willpower.
As such, it's a thousand times more difficult for an obese person to "simply not eat" than it is for a normal person to "simply not eat." To the normal person, not addicted to food, it might seem simple, like the obese person simply lacks willpower, but in the obese person's shoes the normal person would likely end up the same way.
Hence, the obesity epidemic - it sneaks up on you.
How is it that once you stop taking everything reverts?
In response, your body secretes more hormones, so you take more GLP-1 drugs. Increase until you reach a stable balance that adequately controls the hunger.
Now, when you stop taking the GLP-1 drugs, you have a flood of surplus hunger hormones... and the hunger comes back with a vengeance. Plus, you probably haven't learned any effective coping skills for dealing with that hunger while taking the drug - so you're likely to revert to old lifestyle practices.
Or at least that's my understanding. The endocrine system is complicated. However, mechanism aside, the data is clear that people regain the weight once they stop. There's a relevant study here:
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
Not necessarily. When you get to the target weight, you don't need to go straight from the dose you are on to zero, you can, and probably should, lower the dose little by little, just like you raised the dose at the beginning of the regimen. If you are at 2mg, you first go to 1mg, see if your weight is stable, then if it is, go to 0.5 mg, then 0.25 mg. In the near future there will be oral versions of the GLP-1 antagonists, to you will be able to fine-tune even more precisely the dose, for example, you could figure if you can skip some days.
The body has some "weight memory". But I heard this memory disappears after about 10 years. If you take Ozempic for 2 years, go in very low dose maintenance mode for 8 years, and then stop taking it, but keep an eye to see if you need to start again, what other dieting option offers you this type of choice?
I do think they'll probably be available eventually, but I don't think it's as trivial a problem to solve as you're implying.
I'm at the age where I'm attending a ton of weddings, and many of the brides and grooms go on Ozempic for a few months before the wedding, fully acknowledging they'll probably gain all the weight back afterward (despite their best efforts to keep it off!)
The weight loss may not be permanent, but it's a day where most people are probably photographed and recorded more than any other day in their lives, and those captured images are indeed pregnant. The added stress and hectic nature of planning a large wedding makes it quite difficult to diet, exercise, and lose weight the natural way as well (I imagine).
I wonder what this is doing to our insurance premiums because it sure isn't cheap, but other than that, I say if you want to take it, then go for it. I probably would if the cost was reasonable.
Others will simply lie about their weight to their primary care, increasing it slightly to match the BMI bar.
Finally, some people will get the drug from compound pharmacies.
TL;DR - yes, it probably impacts premiums, but insurance companies are somewhat evil for attaching so many restrictions around a drug that every overweight person should have free access to.
It is frankly ridiculous that these companies have the power to get between a doctor and patient, and what the doctor deems medically necessary.
It will figure out your TDEE and give you the information you need to hit a particular rate of weight loss or gain.
Strength and endurance training now is still a great idea for the health benefits and for building her body up before the next pregnancy.
Despite endless diet and fitness apps/trackers and content on social media, as well as the rise of the so-called health-conscious consumer, there is no evidence to suggest anything is improving. Why people got so fat is up to debate, but this is where we're at, and we need these drugs more than ever. People's metabolisms are broken or something. Or small caloric surpluses over a decade leads to obesity. Regaining weight is ridiculously easy for formerly obese people, too.
My first fear is that these psychological side effects are going to be more impactful in the long term than any physical side effects.
My other and more immediate fear is that we don't know the full ramifications of what "reduced impulsivity" actually means. Does that mean you're going to seek out dopamine less? Does that mean you won't enjoy your hobbies as much? Does that mean you're going to be slightly less motivated to work on that satisfying side project or startup? Does that mean you'll be slightly less desirous to fix tha one extra bug which otherwise might be so very satisfying and will drive your project forward?