Could you please stop posting unsubstantive comments and flamebait? We had to ask you this just recently. Eventually we have to ban such accounts, because this is not what this site is for, and destroys what it is for.
I don't want to ban you! I just want to hopefully persuade you not to break HN's rules.
Not because it's any sort of moral issue but because the default tendency on the internet is for discussion to degrade, and we're hoping to stave that off (https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...). The HN guidelines are designed to discourage the sorts of comment that accelerate that decay, and to encourage the sorts of comment that impede it.
> [When you loose weight], your body looks for ways to conserve energy. Your muscles work more efficiently, for example, Ard says, so walking that normally burned 100 calories might now burn only 90. By making you want to eat more and burning fewer calories, your body is eventually able to slow weight loss down to zero.
How exactly is your body able to accomplish the same task with less energy? What are you giving up? Do you become tired more easily, or wear out your muscles more quickly? Or does loosing weight just turn you into a more efficient super-human (albeit perhaps not in a way you would like)?
Would it be desirable for, say, an ultra-marathon runner (who I assume needs to consume as little energy as possible) to spend a year gaining and then loosing a bunch of weight, to make their body more efficient?
> How exactly is your body able to accomplish the same task with less energy?
Mitochondrial uncoupling proteins [1]. They control how much energy gets converted to ATP in the mitochondria and how much is lost as waste heat. As you enter a caloric deficit, UCP1 is downregulated and the mitochondria adapt to lose less energy to heat.
the funny thing is people (including on HN) have spent years arguing that the human body is a blast calorimeter and that everyone absorbs the same amount of energy from the same amount of food and therefore CICO is the only thing that matters or can help.
and oh look here's the protein which controls how much you absorb from it.
CICO is the only actionable advice for an individual (at least in the absence of such drugs) but there are still major questions about things like endocrine disruptors etc. The rise of obesity is far too broad-spectrum (even in feral cat colonies or lab rat populations that shouldn't be affected) to really be attributable to just "people have desk jobs". Lots of people have desk jobs all over the world and obesity is not evenly distributed, and the story has always been that "exercise doesn't matter, what you eat controls your weight" so things like biking vs driving should have a relatively small effect.
But people wanted to turn it into a moral hazard, and they did. Fat people have always been a socially-acceptable target to punch down on. "I'm actually helping them, you see".
CICO looks like dumb advice ONLY if you think it to mean that you should be literally summing the nutritional labels of the foods you consume and whatever calorie estimates your smartwatch shows you and treat it as gospel.
Both the CI and CO numbers can have very large error margins, however, the fact that their difference, if leading to a caloric deficit, will cause weight-loss is irrefutable truth.
If you do a diet for 14 days and have no change in weight, it just means you need to reduce consumption more.
CICO isn't unfair because it's incorrect. It's unfair because for some people following CICO comes trivially, while for others it's literally the hardest thing they will ever do in their lives.
And that's why I do sympathize with people who find it hard to lose weight. You are fighting against your most primal instincts (the desire to eat).
CICO is thermodynamics. People argue against it because it means that to lose weight, you either burn more or, drum roll, get in less. There is really no way out of physics, argue all you want.
Dynamic bounds doesn't mean no boundary. Maybe we viewed different communities, but I rarely came across people who thought calorie counting was 100% accurate. Human bodies are complex systems. But, calories in is still an upper bound, and calories out is still roughly accurate when tracking exercise. The big contention is the middle part.
The physiological adaptations to caloric restriction in general are extremely broad and not all are related to the tradeoff in thermogenesis. But to answer your question, you basically get cold much more easily, basically all the time. As for why the body isn't always operating as efficiently as it does on CR: it's possible that the "default" state we are in today, due to caloric overabundance, is actually a hyper-active state, characterised by excessive protein synthesis, tissue hypertrophy and libido, among other things. These are all very costly in terms of metabolic resources. When fewer calories are available, developmental processes slow down, metabolism switches to catabolic autophagy (which has the benefit of recycling old and damaged organelles) and reproductive function is deprioritised, in favour of optimising survival. The evolutionary basis is to ensure survival, until comfortable sustenance is found again, so that reproductive concerns can be resumed.
// How exactly is your body able to accomplish the same task with less energy?
Maybe a useful analogy is that my hybrid SUV and a v8 Range Rover sport consume very different amount of gas even for driving the same distance at the same speed.
> With every one kilogram you lose, your appetite goes up above baseline by 90 or so calories per day
If that were the case, it doesn't seem to apply to me.
When I was on a fat-loss journey, I had gone from ~102 kg down to 72.5 kg, which I stayed around for several years. That's a difference in 29.5 kg.
29.5 * 90 = 2,655 kCal
Not that I didn't get very hungry at times, but I'm failing to wrap my head around what this guy was saying. If it's true, then either my daily energy expenditure would be more than twice what it currently is (which I've measured through respiratory gas analysis), or I'm hungrier than I know and I'm just shitting out all those extra "calories" that I'm not turning into fat mass.
> Ard says, so walking that normally burned 100 calories might now burn only 90. By making you want to eat more and burning fewer calories, your body is eventually able to slow weight loss down to zero.
The problem here is in believing that the level of perceived hunger has a linear relation to "calories" burned which, if we are going to be accurate, describes a unit of heat. The body doesn't directly delegate heat because photons have no mass. All the body cares about having different kinds of mass in the optimal places at the current time. Just because you feel more hungry than usual doesn't mean that your body demands to burn X number of calories. Because there's more in play than just energy-in-energy-out, in order to overcome those plateaus, you have to either alter the fuel mixture to optimize for hormone levels, or you have to eat such little mass that it can't make up for all of the mass that your body loses otherwise. This isn't even counting the psychology behind hunger, and how people can think they are hungry with relatively low ghrelin levels because they are relying on food for psychological comfort.
I’ve lost about 100lbs in the past 15 months and my appetite hasn’t really changed at all. I do get hungrier on gym days, but that’s to be expected since I’m expending more energy.
In fact, I recently discussed calorie intake with my trainer, who is extremely fit and about the same height as me - our BMR is nearly identical.
Sorry but this drug really sounds like straight from Margaret Atwood's "Oryx and Crake" dystopia. It has already arrived here, and physicians are eager to offer it (medical insurance covers it from BMI>30 onwards).
Long-term "patient relationships", I guess. The physician I went to until recently always employs 10-20 different doctors, most of them straight from university. And the truth is, they do a terribly bad job at treating diseases like Influenza, diabetes, or generally advising people with common health conditions.
I might be wrong, because obesity really is a terrible lethal health problem, from a certain level upwards it's straight up similar to hard drug addiction (e.g. crack).
But if this is the solution.. oh my.
How about offering people rewarding opportunities for exercise that don't cost a fortune (if you live in a traffic-ridden district, who wants to "go for a walk" really?)
How about educating people more vigorously about food addiction?
No fret towards anyone who feels these drugs help them, but for me, it just reminds me how glad I am to have come off SSRIs. The pharmaceutical industry never had any kind of "don't be evil" facade, and they act like it.
Telling overweight people to eat less or exercise more does not work. There have been countless studies and they all agree. Obesity is clearly a complex subject, but from what I understand some people just experience reality differently in that they're constantly thinking about food. One way it was explained to me is "telling overweight people to eat less is like telling someone to set their thermostat to 40 in the winter to save on their gas bill". It's possible, but extremely uncomfortable and not a realistic solution for most.
At the end of the day heart disease is still the number one killer in this country and reducing obesity is the solution to that problem. With the government paying for the healthcare of a significant portion of the population I think its clear that we need to be pushing these drugs hard, for both the life saving and economic saving aspects.
Looking at weight gain for immigrants and long-term visitors really shows how hopeless this is to fight individually. It’s not that other countries’ citizens are individually making better choices, it’s that… they don’t live in America.
Something’s just totally fucked about our culture when it comes to food and activity. A few can overcome it, but relying on individual willpower to get us out of this mess is clearly never going to work.
That leaves figuring out what’s wrong with our culture and fixing that (hard, probably multiple generations to achieve) or drugs (available now, doesn’t require coordination to achieve, people who need it can just go get it)
nah. "what's wrong with our culture" isn't hard to figure out -- sedentary lifestyles, car centric culture that preempts biking, walking and activity, and lots of cheap, fatty foods. we're seeing that happen in other countries, too; the US just got there first.
rates of diabetes and obesity are getting pretty high in other countries, too. the UK is pretty fat, and much of Europe is heading that direction. behind the US, but it's trending that way.
The middle east is fat as fuck, but is mitigated by overall poverty and high temperatures -- life in a sauna helps drop weight.
China has seen a surge diabetes, as has several other Asian countries.
Well, once we ID the problem there’s still the “fix it” part. The fact that so much of the world is heading the wrong way on this is not reassuring that we have any realistic hope of doing that.
possible, but uncomfortable -- nailed it. life is not supposed to be 100% comfortable. traditional spiritual practices bake in periods of discomfort for a reason.
Baloney. I've been skinny (too skinny for my preference) my whole life. While I used to get a lot more exercise in my youth, I'm (again, unfortunately for my preference) quite sedentary these days.
And for me to stay skinny, I never have to think about my food intake. I don't diet, I simply never get that hungry. I'm not saying this as some sort of weird internet brag, it's the opposite in fact. I fully recognize that my genetics (and also possibly my childhood upbringing) basically have full control over my weight level and hunger level. This idea that we all should be some sort of Zen ascetics to maintain our weight is horse shit.
We can philosophize about what life is suppose to be, but at the end of the day most people do not want to be uncomfortable and will consistently make decisions that reduce their discomfort.
the ability to withstand temporary discomfort for a higher end is trainable. most people do not know any better, and telling them to not even try is rather not charitable.
I'm not saying we should avoid discomfort, but we already encourage lots of forms of discomfort that encourage obesity, such as stress, and discourage the healthy sorts of discomfort like walking to places.
Remember, this is the country that found wearing masks in public for public safety was too onerous a burden and having to inconvenience yourself to help others was met with anger and violence.
I didn't mean that there is an information deficit.
By "educating" I meant that a holistic approach is needed, that's why I compared it to drug addiction. Vulnerable and affected people can only be helped by human consultation, with trust and frequent contact.
i mean yeah, we should be teaching kids better, and should take out sugary vending machines from high schools.
but that's not going to fix the problem, any more than DARE stopped kids from doing drugs. the war on drugs is over -- the drugs won -- and it's pretty damn clear the war on junk food is also over -- the junk food reigns supreme.
So, I don't think exercise is going to have the effect that people are looking for. I have a BMI of a little less than 30 and exercise an hour every day. Like not an aspiration to exercise, documented evidence of doing an hour every day no matter what. I have lost approximately no weight on this program (but I do enjoy it greatly!). I'm definitely planning on asking my doctor about these drugs, because lowering the internal setpoint for "I need to eat or I'm going to smash something" would be highly valuable to my health.
I think what can be hard to understand with disorders of the mind is that you can't really empathize with them if you don't have them. The reality is that there is a lot of documentation that people aren't just suffering from a lack of willpower; they simply don't have it in them to change because of how their brain is wired. Asking people to be less hungry is like asking them to jump over the Empire State Building. You can ask all you want. It's not going to happen. It's literally impossible. The approach for approximately the last 10,000 years of human history is to say "well these people are defective, get them out of here". Only now are we starting to develop treatment options, which can help people live what you and I consider a normal life. I don't think that's some sort of scam from Big Pharma. While they're making a lot of money, people are living measurably better lives. That's the economy. You spend money to get something in return.
Yeah, I mean, we're not resource constrained anymore. It's easy to not gain weight when there are literally no calories available. You also don't contribute much to the economy and you're miserable all the time.
Certainly the wide availability of food, most of it not particularly healthy, isn't helping much. Jobs where you sit in front of a computer all day aren't helping much. But I think it's impossible to give those things up at this point.
Because for thousands of years people had to worry more about starving than overeating. And America may have gotten their first, but obesity rates are skyrocketing in nearly the entire Western (and many parts of the Eastern) world.
I wholeheartedly agree with you that obesity is a modern problem, but if your solution is somehow "we should redesign all American cities so you can bike to work so we can all be like the Netherlands" or "we should all grow our own food", well, that's not really a solution.
It takes only moment to search on Google to find many, many news articles indicating that obesity is rising quickly in Europe, Asia, and the rest of the world.
270 word comment about trying to lose weight and you didn't mention anything about diet. I know people hate trite phrases like "You can't outrun a bad diet" or "The best weightloss exercise is a fork-putdown", but what do you say to people when they literally don't consider diet as a relevant part of weight management and instead focus entirely on exercise?
Personally I'm not doing too well on the whole diet thing. I'm well aware of the importance and make grand plans. Then I get really hungry and like eat a pound of noodles or something. I literally can't sleep if I'm hungry at bedtime, I will lay awake all night! Given that I have to go to work the next morning or won't be able to afford things like "shelter", I usually opt to try and get some sleep.
Having been on the other side of these brain problems, I understand your skepticism. I have many apparently-normal friends that, once a month or so, disappear off the face of the planet and eventually they come back and they're like "I thought everyone hated me so I stopped going to work and talking to my friends". My honest thought is "WTF" but I offer them reassurances that that's not true at all and everyone likes them. Then they're OK for another month. Meanwhile behind the scenes, they're seeing a psychiatrist and a therapist every couple weeks, and the fact that they're around at all, ever, is because of this work with their doctors. You have to accept that people's brains are wired differently, often in harmful ways, and that there are treatment options available. It's totally alien to me to be too unhappy to get out of bed. But it does happen to people, the data says it. So I believe the data and try to be supportive.
I really think not sticking to a diet is the same sort of problem.
Bodybuilders will always say, you lose weight in the kitchen, not the gym. Exercise is for building muscle, and other benefits like cardiovascular health.
Depending on how intense the exercise is and other factors (your weight being a major one) you might burn 300-800 calories for an hour of exercise.
A few cookies/donuts will destroy that in no time.
We need to go beyond education; the FDA should start demanding reductions in non nutritional and fructose sweetened foods;
Ultra filtered milk is an example where we have the means to double protein, convert lactose to sucrose - and has an extensive shelf life; but educating on why one milk is different than the other is extremely difficult.
"Enriched" white bread is an example where wheat bread has less sugar, more protein, more fiber.
Different brands of rice has different fiber contents too; the store brand had 1g of fiber and 1g of protein, but the premium store brand had 5g of fiber and 3g of protein.
And cereal too; Cheerios had 2 fewer carbs, 2g more protein and 2g more fiber than the store brand of whole wheat cereal. (that's a roughly 20% difference)
Exercise is generally part of a weight loss plan but diet (e.g. cutting out carbs, sugar, not drinking calories, intermittent fasting, etc.) will be the biggest contributor. Running for an hour burns a surprisingly small amount of calories.
Sorry, but I couldn't disagree more. We have certainly tried the "diet and exercise" mantra for generations at this point, and they simply do not work for society at large (obviously they can work for individuals). I have 0 belief that "educating people more vigorously about food addiction" would do anything to lower obesity rates. Knowledge is not the problem.
I wholeheartedly agree that the obesity epidemic is a consequence of modern society: it's easy for the average person to go a whole day with nearly no physical activity, and our foods are calorie dense (not to mention literally designed to addict with fat, sugar and salt) and nutrient poor. But loads of people who have, basically for the first time in their lives, lost weight with semaglutide realistically have no other options.
Do I like that we need to cure one problem with modern society with another drug which has side effects of its own? No. But rather that than condemning people to obesity, which has enormous physical and mental health costs.
I think it's great if we have a treatment for obesity, but can we maybe actually certify & test it for that purpose first instead of this off-label thing it seems to be?
Many drugs are prescribed in ways that take advantages of their side effects. Indeed, many drugs are designed for one purpose but perform a second purpose much better.
It’s clear that these drugs cause weight loss (in everyone) so I’m not sure what further certification and testing might show
But they have, right? Wegovy works really well. Ozempic is off label for weight loss only in the sense that it is the semaglutide drug that is marketed for diabetes and that it therefore isn't sold at the same high dose as Wegovy.
I don't understand why we're acting like preventing obesity for society at large is an unsolved problem. Looking at Japan with an obesity rate of 3%, it's clearly possible.
Who's pretending it's unsolvable? The comment was merely pointing out that the current strategy in the US is not working.
Whatever Japan's strategy is, I can guarantee it is not the type of lifestyle that is convenient in the US, and it's not making pleas for changes away from the current dominant lifestyle.
I can't even get my city to allow basic Japanese style housing, or the type of housing that was commonly built a century ago, with daily needs within convenient walking distance and without threat of massive trucks and SUVs running me over. It's not even legal to build a neighborhood that would fit the Japanese lifestyle in the vast majority of the US.
Perhaps that daily amount of activity is the difference in obesity, perhaps not, but following a typical American diet and the allowed types of transportation is clearly not helping us.
Because I don't think it's a realistic solution to say, for example, that in the lifetime of anyone currently alive that we're going to get, say, Dallas, TX to have the built environment and food preferences of Japan.
I said directly in my comment "I wholeheartedly agree that the obesity epidemic is a consequence of modern society". And I'm all for making cities more walkable, for example, and making it easier for people to get healthier foods. But I don't think these are realistic options for making a dent in obesity in America any time soon.
How is it a solved problem? Did Japan have some sort of campaign that shifted their entire culture from a fat one to a skinny one that we can replicate?
If not, are you suggesting you know how to do that? The problem isn't knowing what an individual needs to do. It's knowing how to get an entire country from where we are currently to that point desired point.
You're presenting a false dichotomy. Endocrine health is just one example of where doctors ought to investigate before more extreme interventions like these weight loss drugs.
The false dichotomy is to believe that these new drugs are the more extreme interventions.
Many people who go on semaglutide were on the road to bariatric surgery before these drugs were widely available. Bariatric surgery is a major surgery, with not insignificant rates of complications. I guarantee nearly everyone who gets this surgery considers it a last resort. Yet now, most physicians believe these new drugs will essentially put bariatric surgeons out of business.
I'd be all for any options with fewer side effects, but handwavy "endocrine health" doesn't cut it, again for the society at large.
Imagine if a limited course of Ozempic permanently altered your body’s hunger set point. Or if SSRIs permanently altered your mood even after you stopped taking them.
Then you would face a serious risk of overshoot. It would be more like a chemical lobotomy. Sounds worse to me.
Yet substance abuse and overeating continue to be a common human failing. These people understand their consumption choices are unhealthy but still do them cause of stress, human weakness, and biochemistry.
Honestly absurd premise to think “they just don’t understand junk food makes them fat.”
Honestly - I'm not sure if people actually realise what they eat is bad for them.
And this I mean in the sense that the food industry goes out of its way to make sure food is addictive.
Sorry, the view you're expressing is completely out of touch. You say that obesity is like crack, and then go on to say it just needs more vigorous education. As if going to skid row and starting a DARE problem would all of a sudden stop all addiction.
This is also a... dubious... statement...
> And the truth is, they do a terribly bad job at treating diseases like Influenza, diabetes, or generally advising people with common health conditions.
How would you know they don't treat these issues well? What do you expect the treatment is for influenza, for instance?
obesity is the leading cause of deaths in america, and many of the runner ups are a result of obesity.
replace obesity with the name of any other disease and you see why this is such a bad take.
these drugs have potential to make big impact on quality of life and longevity, and instead were arguing over whether we should instead pursue education, lifestyle and will power
Here’s a peer reviewed study that directly compared semaglutide to placebo with additional lifestyle change support. Semaglutide just worked way, way better.
I totally agree that our lifestyles need to change. Unfortunately, as you note, the factors influencing lifestyle are deeply baked into our society. Like sure, I would love to wholesale rearrange our transportation infrastructure towards walking and biking while also somehow (???) changing American food culture to value healthier meals.
That’s not going to happen in our lifetimes though. Sorry.
In the meantime, tens of millions of people will have hundreds of millions of years cut off their healthy lives by heart disease, diabetes, liver disease, strokes, etc etc etc. Semaglutide will alleviate that. It’s exceptionally distasteful that the only way we get this is by pharma companies extracting as much as possible from us. Nonetheless, I prefer that over having countless lives destroyed while I keep my principles.
I've told this story before, but I'll tell it again.
I spent the first ~20 years of my life being right on the border of under-weight though no specific actions of my own. Yes I was more active as a youth but to put into context how much food I was eating at the time, I could also eat breakfast, lunch, 3 bowls of afternoon cereal and milk, and then 2 super sized meals from a fast food place. In fact, I did that (or the equivalent) on a relatively regular basis. And the important thing is I NEVER felt consistently full when doing all of that. I was always ready to eat more food. Yes, any individual meal I would hit a point of being physically unable to eat more, but an hour later and I was ready for more.
I then spent the next ~20 years gaining weight and sliding into obesity. Yes I was less active, but I also wasn't eating quite as much food (when you have to buy your own, you stop eating a half a box of cereal a day). I did CICO counting, even had some success with it but could never get it to stick longer than about 3 or 4 months, and was miserably hungry the whole time. It was a daily battle to choose to not eat more for any given meal. I did various attempts at exercise, but mostly that just made me so much hungrier that any calories lost via exercise were quickly replaced by calories gained through eating more.
6 months ago I started a medication for a completely unrelated issue, but one of that medication's side effects is a reduced appetite. For the first time in 20 years, I am actively losing weight and what is enabling that is I'm NOT hungry all the time. When I started this medication and that side effect kicked in, I thought I was sick for the first week because of how not hungry I was. It was only after realizing that I still actually got hungry around meal times, but then was properly satiated by a reasonable amount of food that I realized I've never not been hungry since I was a teenager.
Yes, in the end I'm eating less, CICO and all of that. But the key to this is that I'm not feeling that nagging pull all day every day to eat something more. When 10 AM rolls around and I feel a little hungry, I can look at the time, realize I'll be having lunch in 2 hours and then ... just decide to not go get some food and my mind will go find something else to do. Before this medication, from 10 AM to lunch I would be watching the clock and every 10-15 minutes have to have an internal debate over going to get food. It's probably the closest I've ever gotten to being addicted to something and let me tell you, if you have to fight your own body every single hour of every single day you WILL lose eventually, every single time, forever.
For 6 continuous months I've steadily lost weight. Even through the holidays with all the extra sweets and big meals that almost always meant the end of whatever successes I'd had before, I managed to keep a consistent weight level instead of gaining. It is VASTLY easier to manage your weight when your body is responding to normal levels of food the way we expect a normal body to do so. Before this medicine, I would have told you I was just lazy. That I wasn't putting in enough effort and self control and that I was "making a choice" to be where I was. And to whatever extent that is true, the thing I can also say now is I was "choosing" to keep eating under effectively a threat of constant hunger from my body.
We spend way too much time moralizing about obesity and worrying about other people's self control in a way that is exceedingly out of touch with the reality of the world we live in and the health impacts of the condition. Yes, these medications might mean a lifelong treatment, yes you would need to maintain the new behaviors if you went off the medication or your weight would return. Yes it is possible to do this without medication. And so what? Imagine any other condition that had the same primary and secondary health impacts as being obese does, and then imagine we ha...
> How about offering people rewarding opportunities for exercise that don't cost a fortune (if you live in a traffic-ridden district, who wants to "go for a walk" really?)
> How about educating people more vigorously about food addiction?
Finally, an easy question to answer!
Because these do not work, empirically. They do work in theory, and sometimes work anecdotally, but that's evidently not enough to solve the obesity crisis.
"Citation needed!" okay, here's the result of two seconds of Googling:
> Apart from the obvious need to increase energy expenditure relative to intake, none of the strategies that have been proposed to promote weight loss or maintenance of weight loss are universally recognized as having any utility in weight management. The efficacy of individual interventions is poor, and evidence regarding the efficacy of combinations of strategies is sparse, with results varying from one study to another and with the individual
children are taught to eat with a spoon. to tie their shoelaces. to read. to write. to play sports. to play an instrument. to dance. to perform a job. it takes effort, but the rewards are worth it, primarily for the children themselves. same with weight control via exercise and diet. it's learnable, and teachable. we can do much better, while being neither judgmental, nor defeatist.
This is one of a series of articles intended to downplay the benefits of weight loss drugs even to the point of being fostered by those in industries most impacted by weight loss drugs (the traditional weight loss industrial complex).
I support the use of Ozempic for helping diabetics and the obese get back into the overweight range of bmi; Obesity often leads to pre-diabetes which leads to diabetes, which increases demand of insulin -- a much harder/expensive/riskier regimen to administer. It's a better option than a gastro surgery, typically better than extreme dieting.
But, I'm also frustrated at the US food choices; Fast food, even sit down food is often devoid of fiber. Store brand cereals, grains are devoid of fiber unless you pay a premium. Ultra filtering milk doubles protein and halves sugar (by converting lactose to glucose) -- but it costs 8x as much. Why do we even sell "enriched" white bread when whole grain wheat bread has lower sugar, more protein, and more fiber? Margarine - with partially hydrogenated oils - but sold in stores and often at restaurants (waffle house).
On the one hand, reducing obesity by 15-20% with a pill is pretty amazing. That certainly reduces negative outcomes and improves people's lives (and saves society money).
On the other hand, pharmaceutical companies only care about money and the chemistry is pretty straight-forward. They will continue making new drugs, and they will certainly release a "newer and better" version when their patents run out.
But, there will certainly be unintended consequences, and we still don't have a good understanding of the cause of the obesity epidemic.
> and we still don't have a good understanding of the cause of the obesity epidemic.
yes, we do. it's not rocket science. sedentary lifestyle + huge amounts of cheap calories, esp. cheap carbohydrates. the Japanese are much skinnier than the US because the eat ~1000 calories less than the US. much of Asia and the ME are skinnier due to poverty and climate -- easy to be thin when you live in a sauna. and they're rapidly catching up to the US; America just got there first, and hard.
Does this even work in the long run? When you stop using this drug, and you have not adjusted the way you eat/live... don't you just yoyo back up? I'd think so.
Having been morbidly obese, i can say that being told to lose weight doesnt work.
You have to want it, be dedicated to it, and have the mental support.
For me it was exercise and changing your food patterns: more small things to keep you full longer. Not denying yourself anything, but everything - and i mean everything- was weighted, added to a calorie tracking app. Your max is your max. Want crisps? Sure, but that comes out of your food budget.
It requires dedication that i find a lot of people are just not willing to put into it, and hence... the popularity of a drug like Ozempic.
I've lost 70kg (154lbs) and it is nearly a decade in still a struggle, having been obese for 20ish years. But the health benefits alone make it worth it.
Unfortunately different people can need really different takes on diet.
"5 smaller regular portions during the day" is part of how I went from 100 to over 110kg and struggled to walk longer than 20 minutes. Getting back to walking fit required 10 days being fed minimal amounts to prevent collapse of digestive system with a tube through the nose. I still gained weight ultimately, but combined with exercise it allowed me to walk and even run for short distances.
Spent years just trying to figure out what's wrong with endocrine system - still don't really know. One of the things led to being prescribed ozempic, not just for weight loss, but because of its function of lowering insulin levels.
> When you stop using this drug, and you have not adjusted the way you eat/live... don't you just yoyo back up? I'd think so.
Why does it matter? Do we worry that asthmatics will start havin asthma attacks again if they stop their medications? Do we worry that diabetics will struggle with insulin problems if they stop theirs? Do we worry that people with vision problems will suffer again if they stop using their eyewear? If someone has to take ozempic every day for the rest of their lives in order to maintain a healthy weight, why the heck do we think that’s worse than being obese every day for the rest of their lives? Why is it more noble that you “nearly a decade in” struggle every single day of your life to maintain a healthy weight? Wouldn’t it be better if you could both maintain a healthy weight and also stop struggling so much?
Keeping people on this medication for life seems like a really bad thing - atleast until we clearly know what the long term effects are. Those are unknown.
The other medication you mention is known, studied, affordable.
Comparing insulin to Ozempic is .. well, a non-comparison in my book.
Generally speaking - definitely for something that you can treat with a life style change and some inconvenience in the beginning - a life where you can live without a drug is better than one where you keep being dependent on it.
There are scores of medications necessary for chronic conditions that we give to patients without intention of stopping that have not been around for a lifetime of testing for “long-term safety.” If your cardiologist prescribes you an SGLT2-i for heart failure because we have studies that show it has significant mortality benefit, you probably won't bat an eye before taking it---yet they have only been FDA approved since 2013. (As an aside, people also don't generally rag on heart/kidney/liver failure patients for poor lifestyle habits that may have contributed or continue to contribute to their disease, as they do for patients with obesity.) GLP-1 receptor agonists like Ozempic have been on the market since 2005. Obesity is among the most prevalent, morbid diseases that itself accounts for 20% of US health expenditure; it will lead to diabetes, hypertension, OSA, heart failure, arthritis, depression, cirrhosis, even cancer and then some. Our scientific and clinical understanding of obesity is evolving beyond it being a self-imposed and self-treatable lifestyle choice, but as a complex neurohormonal disease; one that is chronic like hypertension, and that must be treated chronically (like hypertension) as well. As doctors, counseling patients to diet and exercise (even offering nutritionist referrals) is the equivalent of sitting idly by as patient after patient rotates through our clinic having tried diet/exercise for years all the while developing obesity-related comorbidities.
>The other medication you mention is known, studied, affordable. Comparing insulin to Ozempic is .. well, a non-comparison in my book.
Ozempic is literally a drug for diabetes. We're already prescribing this to people with the expectation they will be on it for life.
>something that you can treat with a life style change and some inconvenience in the beginning
We have people in this very discussion who are also morally opposed to Ozempic describing how keeping their weight is a decades long daily struggle. That doesn't sound like "some inconvenience in the beginning". We also have decades of research (and the reality of the world we live in) suggesting to us that "lifestyle change and some inconvenience" is not working as a treatment.
As some others are saying here, just telling people to exercise more and eat less is not working.
I exercise at a minimum of 35-45 minutes a day, and when I can get out in the warmer months sometimes as much as 90 minutes a day. While it does have its health benefits, it can just make me hungrier.
And sure, I’ve tried eating less. But I find that leads to me being foggy headed, tired, and irritable. Which the leads to more stress too. And let me tell you as remote developer that is not a great way to live your life.
And in the past when I’ve done all that I still plateau around fifteen pounds lost. And if I slip up any, well, I have to work that much harder to get back again.
I’m not sure I’m ready to resort to medication yet, but I can definitely see the appeal.
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[ 2.9 ms ] story [ 186 ms ] threadIn terms of sites that have produced bad articles in the past: that's true of all major sites. On HN we go by article quality, not site quality: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so....
Not sure what you're talking about.
Not because it's any sort of moral issue but because the default tendency on the internet is for discussion to degrade, and we're hoping to stave that off (https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...). The HN guidelines are designed to discourage the sorts of comment that accelerate that decay, and to encourage the sorts of comment that impede it.
> [When you loose weight], your body looks for ways to conserve energy. Your muscles work more efficiently, for example, Ard says, so walking that normally burned 100 calories might now burn only 90. By making you want to eat more and burning fewer calories, your body is eventually able to slow weight loss down to zero.
How exactly is your body able to accomplish the same task with less energy? What are you giving up? Do you become tired more easily, or wear out your muscles more quickly? Or does loosing weight just turn you into a more efficient super-human (albeit perhaps not in a way you would like)?
Would it be desirable for, say, an ultra-marathon runner (who I assume needs to consume as little energy as possible) to spend a year gaining and then loosing a bunch of weight, to make their body more efficient?
Mitochondrial uncoupling proteins [1]. They control how much energy gets converted to ATP in the mitochondria and how much is lost as waste heat. As you enter a caloric deficit, UCP1 is downregulated and the mitochondria adapt to lose less energy to heat.
[1] https://en.wikipedia.org/wiki/Uncoupling_protein
and oh look here's the protein which controls how much you absorb from it.
CICO is the only actionable advice for an individual (at least in the absence of such drugs) but there are still major questions about things like endocrine disruptors etc. The rise of obesity is far too broad-spectrum (even in feral cat colonies or lab rat populations that shouldn't be affected) to really be attributable to just "people have desk jobs". Lots of people have desk jobs all over the world and obesity is not evenly distributed, and the story has always been that "exercise doesn't matter, what you eat controls your weight" so things like biking vs driving should have a relatively small effect.
But people wanted to turn it into a moral hazard, and they did. Fat people have always been a socially-acceptable target to punch down on. "I'm actually helping them, you see".
Both the CI and CO numbers can have very large error margins, however, the fact that their difference, if leading to a caloric deficit, will cause weight-loss is irrefutable truth.
If you do a diet for 14 days and have no change in weight, it just means you need to reduce consumption more.
CICO isn't unfair because it's incorrect. It's unfair because for some people following CICO comes trivially, while for others it's literally the hardest thing they will ever do in their lives.
And that's why I do sympathize with people who find it hard to lose weight. You are fighting against your most primal instincts (the desire to eat).
But that doesn't mean CICO is incorrect.
Maybe a useful analogy is that my hybrid SUV and a v8 Range Rover sport consume very different amount of gas even for driving the same distance at the same speed.
If that were the case, it doesn't seem to apply to me.
When I was on a fat-loss journey, I had gone from ~102 kg down to 72.5 kg, which I stayed around for several years. That's a difference in 29.5 kg.
29.5 * 90 = 2,655 kCal
Not that I didn't get very hungry at times, but I'm failing to wrap my head around what this guy was saying. If it's true, then either my daily energy expenditure would be more than twice what it currently is (which I've measured through respiratory gas analysis), or I'm hungrier than I know and I'm just shitting out all those extra "calories" that I'm not turning into fat mass.
> Ard says, so walking that normally burned 100 calories might now burn only 90. By making you want to eat more and burning fewer calories, your body is eventually able to slow weight loss down to zero.
The problem here is in believing that the level of perceived hunger has a linear relation to "calories" burned which, if we are going to be accurate, describes a unit of heat. The body doesn't directly delegate heat because photons have no mass. All the body cares about having different kinds of mass in the optimal places at the current time. Just because you feel more hungry than usual doesn't mean that your body demands to burn X number of calories. Because there's more in play than just energy-in-energy-out, in order to overcome those plateaus, you have to either alter the fuel mixture to optimize for hormone levels, or you have to eat such little mass that it can't make up for all of the mass that your body loses otherwise. This isn't even counting the psychology behind hunger, and how people can think they are hungry with relatively low ghrelin levels because they are relying on food for psychological comfort.
I’ve lost about 100lbs in the past 15 months and my appetite hasn’t really changed at all. I do get hungrier on gym days, but that’s to be expected since I’m expending more energy.
In fact, I recently discussed calorie intake with my trainer, who is extremely fit and about the same height as me - our BMR is nearly identical.
I might be wrong, because obesity really is a terrible lethal health problem, from a certain level upwards it's straight up similar to hard drug addiction (e.g. crack).
But if this is the solution.. oh my.
How about offering people rewarding opportunities for exercise that don't cost a fortune (if you live in a traffic-ridden district, who wants to "go for a walk" really?)
How about educating people more vigorously about food addiction?
No fret towards anyone who feels these drugs help them, but for me, it just reminds me how glad I am to have come off SSRIs. The pharmaceutical industry never had any kind of "don't be evil" facade, and they act like it.
At the end of the day heart disease is still the number one killer in this country and reducing obesity is the solution to that problem. With the government paying for the healthcare of a significant portion of the population I think its clear that we need to be pushing these drugs hard, for both the life saving and economic saving aspects.
Something’s just totally fucked about our culture when it comes to food and activity. A few can overcome it, but relying on individual willpower to get us out of this mess is clearly never going to work.
That leaves figuring out what’s wrong with our culture and fixing that (hard, probably multiple generations to achieve) or drugs (available now, doesn’t require coordination to achieve, people who need it can just go get it)
rates of diabetes and obesity are getting pretty high in other countries, too. the UK is pretty fat, and much of Europe is heading that direction. behind the US, but it's trending that way.
The middle east is fat as fuck, but is mitigated by overall poverty and high temperatures -- life in a sauna helps drop weight.
China has seen a surge diabetes, as has several other Asian countries.
And for me to stay skinny, I never have to think about my food intake. I don't diet, I simply never get that hungry. I'm not saying this as some sort of weird internet brag, it's the opposite in fact. I fully recognize that my genetics (and also possibly my childhood upbringing) basically have full control over my weight level and hunger level. This idea that we all should be some sort of Zen ascetics to maintain our weight is horse shit.
Didn't really work with DARE.
By "educating" I meant that a holistic approach is needed, that's why I compared it to drug addiction. Vulnerable and affected people can only be helped by human consultation, with trust and frequent contact.
but that's not going to fix the problem, any more than DARE stopped kids from doing drugs. the war on drugs is over -- the drugs won -- and it's pretty damn clear the war on junk food is also over -- the junk food reigns supreme.
I think what can be hard to understand with disorders of the mind is that you can't really empathize with them if you don't have them. The reality is that there is a lot of documentation that people aren't just suffering from a lack of willpower; they simply don't have it in them to change because of how their brain is wired. Asking people to be less hungry is like asking them to jump over the Empire State Building. You can ask all you want. It's not going to happen. It's literally impossible. The approach for approximately the last 10,000 years of human history is to say "well these people are defective, get them out of here". Only now are we starting to develop treatment options, which can help people live what you and I consider a normal life. I don't think that's some sort of scam from Big Pharma. While they're making a lot of money, people are living measurably better lives. That's the economy. You spend money to get something in return.
Why have people for thousands of years and still in many other countries not had this constant insatiable hunger that you speak of?
The American lifestyle leads to a ~50% morbidly obese rate - not human nature.
Morbidly obese rates throughout all human history were <10% until pretty recently.
What makes you think they didn't? Maybe they just didnt have enough food to satisfy themselves and were constantly uncomfortably hungry.
Europeans can, generally, afford to eat.
The portions at restaraunts are also more reasonable. Not the 1500 calorie abominations (half the calorie budget for an active man) you get in the US
Certainly the wide availability of food, most of it not particularly healthy, isn't helping much. Jobs where you sit in front of a computer all day aren't helping much. But I think it's impossible to give those things up at this point.
I wholeheartedly agree with you that obesity is a modern problem, but if your solution is somehow "we should redesign all American cities so you can bike to work so we can all be like the Netherlands" or "we should all grow our own food", well, that's not really a solution.
if they could have been fat, they would have, but they couldn't get enough to eat to stay alive.
Having been on the other side of these brain problems, I understand your skepticism. I have many apparently-normal friends that, once a month or so, disappear off the face of the planet and eventually they come back and they're like "I thought everyone hated me so I stopped going to work and talking to my friends". My honest thought is "WTF" but I offer them reassurances that that's not true at all and everyone likes them. Then they're OK for another month. Meanwhile behind the scenes, they're seeing a psychiatrist and a therapist every couple weeks, and the fact that they're around at all, ever, is because of this work with their doctors. You have to accept that people's brains are wired differently, often in harmful ways, and that there are treatment options available. It's totally alien to me to be too unhappy to get out of bed. But it does happen to people, the data says it. So I believe the data and try to be supportive.
I really think not sticking to a diet is the same sort of problem.
Depending on how intense the exercise is and other factors (your weight being a major one) you might burn 300-800 calories for an hour of exercise.
A few cookies/donuts will destroy that in no time.
Ultra filtered milk is an example where we have the means to double protein, convert lactose to sucrose - and has an extensive shelf life; but educating on why one milk is different than the other is extremely difficult.
"Enriched" white bread is an example where wheat bread has less sugar, more protein, more fiber.
Different brands of rice has different fiber contents too; the store brand had 1g of fiber and 1g of protein, but the premium store brand had 5g of fiber and 3g of protein.
And cereal too; Cheerios had 2 fewer carbs, 2g more protein and 2g more fiber than the store brand of whole wheat cereal. (that's a roughly 20% difference)
I wholeheartedly agree that the obesity epidemic is a consequence of modern society: it's easy for the average person to go a whole day with nearly no physical activity, and our foods are calorie dense (not to mention literally designed to addict with fat, sugar and salt) and nutrient poor. But loads of people who have, basically for the first time in their lives, lost weight with semaglutide realistically have no other options.
Do I like that we need to cure one problem with modern society with another drug which has side effects of its own? No. But rather that than condemning people to obesity, which has enormous physical and mental health costs.
It’s clear that these drugs cause weight loss (in everyone) so I’m not sure what further certification and testing might show
What works to keep skinny people skinny won't necessarily make fat people skinny.
That's why some people think things like Ozempic are necessary to deal with obesity in America.
Whatever Japan's strategy is, I can guarantee it is not the type of lifestyle that is convenient in the US, and it's not making pleas for changes away from the current dominant lifestyle.
I can't even get my city to allow basic Japanese style housing, or the type of housing that was commonly built a century ago, with daily needs within convenient walking distance and without threat of massive trucks and SUVs running me over. It's not even legal to build a neighborhood that would fit the Japanese lifestyle in the vast majority of the US.
Perhaps that daily amount of activity is the difference in obesity, perhaps not, but following a typical American diet and the allowed types of transportation is clearly not helping us.
I said directly in my comment "I wholeheartedly agree that the obesity epidemic is a consequence of modern society". And I'm all for making cities more walkable, for example, and making it easier for people to get healthier foods. But I don't think these are realistic options for making a dent in obesity in America any time soon.
If not, are you suggesting you know how to do that? The problem isn't knowing what an individual needs to do. It's knowing how to get an entire country from where we are currently to that point desired point.
Many people who go on semaglutide were on the road to bariatric surgery before these drugs were widely available. Bariatric surgery is a major surgery, with not insignificant rates of complications. I guarantee nearly everyone who gets this surgery considers it a last resort. Yet now, most physicians believe these new drugs will essentially put bariatric surgeons out of business.
I'd be all for any options with fewer side effects, but handwavy "endocrine health" doesn't cut it, again for the society at large.
For better or worse. Some of the comments in this thread seem extremely disconnected from reality.
Then you would face a serious risk of overshoot. It would be more like a chemical lobotomy. Sounds worse to me.
Honestly absurd premise to think “they just don’t understand junk food makes them fat.”
This is also a... dubious... statement... > And the truth is, they do a terribly bad job at treating diseases like Influenza, diabetes, or generally advising people with common health conditions. How would you know they don't treat these issues well? What do you expect the treatment is for influenza, for instance?
replace obesity with the name of any other disease and you see why this is such a bad take.
these drugs have potential to make big impact on quality of life and longevity, and instead were arguing over whether we should instead pursue education, lifestyle and will power
https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
I totally agree that our lifestyles need to change. Unfortunately, as you note, the factors influencing lifestyle are deeply baked into our society. Like sure, I would love to wholesale rearrange our transportation infrastructure towards walking and biking while also somehow (???) changing American food culture to value healthier meals.
That’s not going to happen in our lifetimes though. Sorry.
In the meantime, tens of millions of people will have hundreds of millions of years cut off their healthy lives by heart disease, diabetes, liver disease, strokes, etc etc etc. Semaglutide will alleviate that. It’s exceptionally distasteful that the only way we get this is by pharma companies extracting as much as possible from us. Nonetheless, I prefer that over having countless lives destroyed while I keep my principles.
I spent the first ~20 years of my life being right on the border of under-weight though no specific actions of my own. Yes I was more active as a youth but to put into context how much food I was eating at the time, I could also eat breakfast, lunch, 3 bowls of afternoon cereal and milk, and then 2 super sized meals from a fast food place. In fact, I did that (or the equivalent) on a relatively regular basis. And the important thing is I NEVER felt consistently full when doing all of that. I was always ready to eat more food. Yes, any individual meal I would hit a point of being physically unable to eat more, but an hour later and I was ready for more.
I then spent the next ~20 years gaining weight and sliding into obesity. Yes I was less active, but I also wasn't eating quite as much food (when you have to buy your own, you stop eating a half a box of cereal a day). I did CICO counting, even had some success with it but could never get it to stick longer than about 3 or 4 months, and was miserably hungry the whole time. It was a daily battle to choose to not eat more for any given meal. I did various attempts at exercise, but mostly that just made me so much hungrier that any calories lost via exercise were quickly replaced by calories gained through eating more.
6 months ago I started a medication for a completely unrelated issue, but one of that medication's side effects is a reduced appetite. For the first time in 20 years, I am actively losing weight and what is enabling that is I'm NOT hungry all the time. When I started this medication and that side effect kicked in, I thought I was sick for the first week because of how not hungry I was. It was only after realizing that I still actually got hungry around meal times, but then was properly satiated by a reasonable amount of food that I realized I've never not been hungry since I was a teenager.
Yes, in the end I'm eating less, CICO and all of that. But the key to this is that I'm not feeling that nagging pull all day every day to eat something more. When 10 AM rolls around and I feel a little hungry, I can look at the time, realize I'll be having lunch in 2 hours and then ... just decide to not go get some food and my mind will go find something else to do. Before this medication, from 10 AM to lunch I would be watching the clock and every 10-15 minutes have to have an internal debate over going to get food. It's probably the closest I've ever gotten to being addicted to something and let me tell you, if you have to fight your own body every single hour of every single day you WILL lose eventually, every single time, forever.
For 6 continuous months I've steadily lost weight. Even through the holidays with all the extra sweets and big meals that almost always meant the end of whatever successes I'd had before, I managed to keep a consistent weight level instead of gaining. It is VASTLY easier to manage your weight when your body is responding to normal levels of food the way we expect a normal body to do so. Before this medicine, I would have told you I was just lazy. That I wasn't putting in enough effort and self control and that I was "making a choice" to be where I was. And to whatever extent that is true, the thing I can also say now is I was "choosing" to keep eating under effectively a threat of constant hunger from my body.
We spend way too much time moralizing about obesity and worrying about other people's self control in a way that is exceedingly out of touch with the reality of the world we live in and the health impacts of the condition. Yes, these medications might mean a lifelong treatment, yes you would need to maintain the new behaviors if you went off the medication or your weight would return. Yes it is possible to do this without medication. And so what? Imagine any other condition that had the same primary and secondary health impacts as being obese does, and then imagine we ha...
> How about educating people more vigorously about food addiction?
Finally, an easy question to answer!
Because these do not work, empirically. They do work in theory, and sometimes work anecdotally, but that's evidently not enough to solve the obesity crisis.
"Citation needed!" okay, here's the result of two seconds of Googling:
https://www.ncbi.nlm.nih.gov/books/NBK221839/
> Apart from the obvious need to increase energy expenditure relative to intake, none of the strategies that have been proposed to promote weight loss or maintenance of weight loss are universally recognized as having any utility in weight management. The efficacy of individual interventions is poor, and evidence regarding the efficacy of combinations of strategies is sparse, with results varying from one study to another and with the individual
2. magic pill
3. ???
4. profit!
But, I'm also frustrated at the US food choices; Fast food, even sit down food is often devoid of fiber. Store brand cereals, grains are devoid of fiber unless you pay a premium. Ultra filtering milk doubles protein and halves sugar (by converting lactose to glucose) -- but it costs 8x as much. Why do we even sell "enriched" white bread when whole grain wheat bread has lower sugar, more protein, and more fiber? Margarine - with partially hydrogenated oils - but sold in stores and often at restaurants (waffle house).
On the other hand, pharmaceutical companies only care about money and the chemistry is pretty straight-forward. They will continue making new drugs, and they will certainly release a "newer and better" version when their patents run out.
But, there will certainly be unintended consequences, and we still don't have a good understanding of the cause of the obesity epidemic.
yes, we do. it's not rocket science. sedentary lifestyle + huge amounts of cheap calories, esp. cheap carbohydrates. the Japanese are much skinnier than the US because the eat ~1000 calories less than the US. much of Asia and the ME are skinnier due to poverty and climate -- easy to be thin when you live in a sauna. and they're rapidly catching up to the US; America just got there first, and hard.
Having been morbidly obese, i can say that being told to lose weight doesnt work.
You have to want it, be dedicated to it, and have the mental support.
For me it was exercise and changing your food patterns: more small things to keep you full longer. Not denying yourself anything, but everything - and i mean everything- was weighted, added to a calorie tracking app. Your max is your max. Want crisps? Sure, but that comes out of your food budget.
It requires dedication that i find a lot of people are just not willing to put into it, and hence... the popularity of a drug like Ozempic.
I've lost 70kg (154lbs) and it is nearly a decade in still a struggle, having been obese for 20ish years. But the health benefits alone make it worth it.
"5 smaller regular portions during the day" is part of how I went from 100 to over 110kg and struggled to walk longer than 20 minutes. Getting back to walking fit required 10 days being fed minimal amounts to prevent collapse of digestive system with a tube through the nose. I still gained weight ultimately, but combined with exercise it allowed me to walk and even run for short distances.
Spent years just trying to figure out what's wrong with endocrine system - still don't really know. One of the things led to being prescribed ozempic, not just for weight loss, but because of its function of lowering insulin levels.
Why does it matter? Do we worry that asthmatics will start havin asthma attacks again if they stop their medications? Do we worry that diabetics will struggle with insulin problems if they stop theirs? Do we worry that people with vision problems will suffer again if they stop using their eyewear? If someone has to take ozempic every day for the rest of their lives in order to maintain a healthy weight, why the heck do we think that’s worse than being obese every day for the rest of their lives? Why is it more noble that you “nearly a decade in” struggle every single day of your life to maintain a healthy weight? Wouldn’t it be better if you could both maintain a healthy weight and also stop struggling so much?
Keeping people on this medication for life seems like a really bad thing - atleast until we clearly know what the long term effects are. Those are unknown.
The other medication you mention is known, studied, affordable. Comparing insulin to Ozempic is .. well, a non-comparison in my book.
Generally speaking - definitely for something that you can treat with a life style change and some inconvenience in the beginning - a life where you can live without a drug is better than one where you keep being dependent on it.
Unless you're the pharma industry, that is.
Ozempic is literally a drug for diabetes. We're already prescribing this to people with the expectation they will be on it for life.
>something that you can treat with a life style change and some inconvenience in the beginning
We have people in this very discussion who are also morally opposed to Ozempic describing how keeping their weight is a decades long daily struggle. That doesn't sound like "some inconvenience in the beginning". We also have decades of research (and the reality of the world we live in) suggesting to us that "lifestyle change and some inconvenience" is not working as a treatment.
I exercise at a minimum of 35-45 minutes a day, and when I can get out in the warmer months sometimes as much as 90 minutes a day. While it does have its health benefits, it can just make me hungrier.
And sure, I’ve tried eating less. But I find that leads to me being foggy headed, tired, and irritable. Which the leads to more stress too. And let me tell you as remote developer that is not a great way to live your life.
And in the past when I’ve done all that I still plateau around fifteen pounds lost. And if I slip up any, well, I have to work that much harder to get back again.
I’m not sure I’m ready to resort to medication yet, but I can definitely see the appeal.