Statins are regularly given to people with high cholesterol. I would bet that most older people take or qualify to take a statin. If it happens with statins, therefore, it's not out of the realm to think that most people will eventually be prescribed GLP-1 to reduce weight which will improve overall health. It makes sense.
Statins have gone through several prescribing guideline revisions in the last 10-20 years. Many people were incorrectly prescribed them and some have suffered for it.
Likewise, there can be serious complications when taking GLP-1 agonists and the like. Since they need to be taken in perpetuity (many gain all weight lost upon stopping use) they should be reserved for only people who have exhausted all other opportunities.
Most people over 65 should not be on statins. Most people should not be taking GPL-1 agonists.
I’m just back from the US and watching some TV there in the hotel it seems very much like they’re pushing it into the mainstream, they literally have a commercial where “fat” people congregate in the street to march together picking up Ozempic… So I totally assume it will be widespread in a few years unless they discover some serious side effects.
Meh, you see commercials for all kinds of medicines in the US. There's more being produced than your average general practitioner can keep up with, so the manufacturers appeal directly to consumers.
Given how ineffective it is once you stop, I'm personally expecting it to become a relatively short lived fad. Insurance companies won't cover it if it truly doesn't improve health outcomes long term (throwing money down the toilet) and people will learn to not pay out of pocket for it.
There's a reason insurance companies are loath to cover it for obesity now without prior authorization, which usually requires you seeing a specialist who has ruled out the usual suspects (nutrition and exercise changes).
Pretty much no one should be taking statins. The side effects are well studied, while the benefits are dubious at best.
For example: high cholesterol levels is actually positively correlated with longevity, believe it or not. If you consume a diet low in sugars, thus routinely burning fat when fasted, you will have "high" cholesterol in blood. How do you think fats are moved to cells in need? Through the blood, of course.
I'd go so far as to say that statins are pretty much a scam, that fixes a useless and quite complex metric such as cholesterol levels. Given that cholesterol levels are a diagnostic easily accessible to GPs, they prescribe statins to see this figure go lower, even if it doesn't make the person any healthier. Incidentally it's similar to taking GLP-1 agonists instead of learning to have a healthier relationship with food.
My biggest fear is either there will be long term negative consequences to Ozempic et al, and a huge swath of the population will be dealing with issues 30 years form now - OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight.
There were several side effects related to pancreatic cancer associated with the precursors to GLP-1 drugs. The same companies promoting GLP-1s were responsible for driving up insulin prices. So I'm hedging my bets.
There's a really cool Modern MBA video [1] on this topic btw :)
>Large epidemiological studies have shown the link between obesity and pancreatic cancer. A large population-based case-control study of pancreatic cancer demonstrated that obesity was associated with a statistically significant 50–60% increased risk of pancreatic cancer.
Hedonism is a philosophy that posits that pleasure is the sole objective good and thus pain something bad.
This whole thing is about trying to find shortcuts to get to the pleasure of having a nice body while circumventing the pain and effort.
Pain and efforts are important, they forge character like nothing else. If you want to live in a world where adult-children simply take their soma to get what they want, you're just not thinking about the consequences.
Do you feel this way about everything? Like you shouldn't take an aspirin because you should feel the pain of your headache? You shouldn't wear shoes because you need to feel the pain of the rocks under your feet?
Important != superlative need. I mean, I know this is just rhetoric drivel, but I'm bored enough to reply. My post was clearly about a certain type of pain that the mind knows is a necessary path to achieving a stronger mind.
Also, about headaches and more generally physical pain that you know is only temporary and not a sign of radical bodily malfunction, I say yes: enduring a reasonable amount is important to develop a tolerance to it and willpower.
What I'm saying isn't new anyway, everybody knows some amount of struggle is needed to temper character and not fall to the most insidious poison of our times: constant comfort.
You have the completely wrong take on this. Dieting destroys your relationship with food. Basically every adult woman exhibits some level of disordered eating because of it— "girl dinner" is both funny because it's true and sad.
Being able to lose weight while continuing to eat is a wonderful thing. There is no virtue in spending your willpower making your body do something it desperately doesn't want to do. That's some puritan shit.
It doesn't make you magically lose weight, it just gets you closer to "girl dinnering" with less cognitive load. The weight loss comes from eating less.
Yeah, it's funny, Ozempic sounds utterly useless for me. I know how to lose weight, it's dealing with the side effects of weight loss that is tricky. And the side effects of weight loss sound a lot like the side effects of Ozempic.
The difference is that it puts you in control of your hunger and what/how much you eat. You don't build negative associations with food while you're running a deficit. You don't build the association "hunger/misery means you're doing good and losing weight."
>Basically every adult woman exhibits some level of disordered eating because of it— "girl dinner" is both funny because it's true and sad
This is sexist and absolutely not true, there are plenty of women capable of pre-planning what they're going to eat and sticking with it. It's not "dieting", it's living a healthy lifestyle and not regularly eating junk.
My dude, I'm a woman talking about my experience with myself and other women. Disordered eating is rampant. It's ingrained to the very core of how women are taught to approach food. Denying food and starving yourself is the default behavior.
We are human animals. Our bodies need healthy food and regular exercise. There’s a case that diet and exercise are worth willpower capacity, possibly more so than anything else. That’s just the reality we exist in?
Capitalism disagrees. I need you to work two extra hours today. Also watch this advertisement for Tasty Snack! We've spend a billion dollars of research to ensure you eat this nibblet filled with 350% your daily sugar requirement, 200% of your daily fat intake, and 3000% of your recommended salt. Remember all the beautiful people in the world are eating Tasty Snack! Sold in the impulse buy isle near you.
There is absolutely virtue in spending willpower to make your body do something it doesn’t want to do - maintaining and developing self control and autonomy. Imagine if there was no way to develop self-discipline, you’d be at the whims of your environment and the world would be nothing but chaos.
Normally dieting shouldn't be necessary to maintain healthy weight though? One could eat a whole lot of salad (with some serious dressing) and a piece of meat and even a little starchy side (some potatoes or similar) 3 times a day and not gain weight. Throw in some regular moderate exercise and you're golden.
Granted, once you go past middle age, it can become a bit more complicated.
Someone brought up doughnuts as an example, but that's a ridiculous source of calories: I could probably down half a dozen doughnuts (a daily calorie budget) and then go for a normal meal afterwards.
Eating only becomes disordered if one can't be bothered to eat healthy food as a rule and then freaks out about weight gain as a result.
I don't understand how that analogy is supposed to work, given that the basic mechanism of these drugs is to reduce appetite (and possibly just desire in general).
We're about to see a dramatic fall in the production and consumption of unhealthy food because people who used to want them in large quantities will no longer want them when they're on GLP-1 drugs.
>In October 2023, Walmart became one of the first retailers to correlate Ozempic, food sales, and changing habits. Using internal pharmacy and grocery data, the study found that Ozempic is negatively affecting Walmart’s food sales. Measuring per-unit sales and calories, the retail giant confirmed a long-held belief that patients on GLP-1 drugs buy less food, particularly within the sweets and snack food categories.
I am an academic scientist and generally a careful and skeptical person, but having read the peer reviewed literature myself, I think there is enough evidence to be concerned that water fluoridation at the levels currently used could possibly be causing brain damage or developmental issues. The evidence isn't that strong, but it is strong enough that it would be unethical to continue the practice, or to claim that there is nothing to worry about. The dose/response curves seem to show measurable levels of cognitive defects occurring right around, or just above typical target levels for fluoridation.
Personally, I give my kid water with the flouride filtered out via RO, but will still use topical flouride, e.g. toothpaste and treatments applied by a dentist.
I hate how issues like this are politicized... if I raise this issue anywhere, including on here I expect to be attacked for being a "conspiracy theorist" and "like an anti-vaxxer" etc. There is something really wrong when you aren't allowed to even talk about both sides of an issue- especially if, like in my case, I have a doctorate in the life sciences and am qualified to have my own informed scientific opinion based on the evidence.
It is not in any way related to my own area of research, I looked into it as a parent wondering what would be best for my own kid. However, there is not really that much research out there on this- so I was able to review much of the primary research, as well as various review articles that try to consider all of it together.
How would you define "domain of expertise"? Reviewing literature from other fields I don't research myself and forming an opinion on how it applies to my research is part of my job and something I do almost every day. I am even also called upon to peer review articles and grant proposals that are not within my direct field of research, as is general practice to get "outside opinions."
In cases like this, I am able to be familiar with basically everything published on the issue. However an actual researcher in a specific field will have additional knowledge and opinions from firsthand experience, that cannot be found in literature.
In general, I think it is okay to have your own opinion on something even if you aren't e.g. a professional whose whole life is focused exactly on that one issue. No formal training, credentials, or firsthand experience are necessarily required to have an informed opinion. However, you still have the burden of making sure you really understand the issue deeply - which is probably something like 100x the effort most people think it would be. Anyone can do that if they take the time to do so. I wish more people would.
In any case, this was a few years back when I looked into it, and it seems like these concerns have become more mainstream and less controversial in the last few years, e.g. https://ntp.niehs.nih.gov/publications/monographs/mgraph08
It’s totally reasonable to make this as a simple risk balancing decision: “unknown but probably small risk, vs. known and definitely small benefit” is not the kind of fact pattern that we should persecute people for differing on.
Rural children, who it stands to reason would be more likely to not be drinking fluoridated water, have higher odds of being overweight or obese than urban.
The implication to be thwarted was of "mineral" vs "hormone"; the distinction was moot, as there is no such real thing as a "drug" - all things are chemicals, and can be psychoactive to humans in either their presence or absence.
Most notably (in the context of un-intuitiveness), is Xenon - it is't even a chemical, but an element - a noble one, which is almost nonsensical given most's flawed intuition.
> fluorine is not a noble gas
Correct, although ironically it wasn't much use in direct chemical-warfare, it was used more as a pre-cursor to enrich Uranium.
> Most notably (in the context of un-intuitiveness), is Xenon - it is't even a chemical, but an element - a noble one, which is almost nonsensical given most's flawed intuition.
…what?
I haven’t the faintest clue what you’re talking about. I don’t think you know what the word “psychoactive” means, either. By your definition, water is psychoactive too. Is that what you’re suggesting?
Sure: the popularization of coffee across western Europe in the 1600s and 1700s, and the way it replaced beer as the most common daytime casual drink. Much of the population went from spending all day mildly intoxicated to being mostly sober and with a caffeine pick-me-up.
There are some evidence that Ozempic/Wegovy actually cures more addictions than just food addiction.
>The weight-loss jabs have apparently helped people kick habits from smoking to shopping, although scientists remain wary about recommending it as an addiction treatment
Which makes perfect sense. All addictions are basically* the same thing, an outlet for negative emotion. The "drug" of choice, whether that be food, video games, shopping, etc. is fairly superficial. Often, people who "kick" one addiction simply switch over to another addiction.
Some athletes (especially weightlifters) use Tadalafil, an erectile dysfunction drug, because it also promotes bone density and muscle growth while having few observable side effects. This isn't really surprising, it's basically just a mild vasodilator. A better known drug in the same class Sildenafil (aka Viagra) is less mild, and associated with retinal damage if overused.
I’m skeptical of the idea that across the general population we’d be healthier if we dialed up our insulin production. Serious question but has there ever been a case of humans benefitting from increasing a hormone like this? Since it’s an injection, It wouldn’t be a steady increase, but more likely have bursts of it. I don’t know how healthy that would be in the long run.
After what happened with OxyContin I think wed benefit from some skepticism when a new drug gets oversold.
> Serious question but has there ever been a case of humans benefitting from increasing a hormone like this?
By itself this might be an ok question, but in context it's rather useless....
Diet and obesity changes by both lowering and increasing different hormone outputs in your body. You're balancing the question of "how is this hormone" versus "How bad is obesity on the body". Well, the answer is in, obesity is extremely unhealthy on the body in both the short and long term.
Drug overdoses cause somewhere around 100k deaths per year in the US. Obesity complications related deaths are in the 250-300k deaths per year.
You can be skeptical as you want, but behind smoking, obesity is the worst epidemic in the US.
I can understand this perspective. You're looking at it with healthy eyes.
But for fat people, the calculus looks different.
A decision to take semaglutides is a decision between the long-term negative effects of obesity *now*, or the possibility of long-term negative effects *later.*
Anecdotally, trans people have a similar calculus. Going unmedicated/unsupported brings significant mental health risk now[1], whereas going on hormone replacement may or may not cause complications much later in life (osteoperosis, hepotoxicity issues for some treatments, etc).
Either way, you gotta get to the "later in life" part before you can worry about the outlook there.
1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
I was curious and a bit skeptical that sex change operations materially affected suicide rates for trans people but available papers tended to find significant effect sizes of about 50% reduction
Did that study account for the socioeconomic status of the participants? Common sense suggests that people who can afford to undergo such surgeries would tend to be richer, more supported, and from better neighborhoods.
There's certainly room for more research here, but some of them do attempt to account for other socioeconomic factors.
It's worth noting that surgery isn't the only option. Hormone therapy has also shown to reduce suicide risk, which is more accessible across socioeconomic strata.
The data is poor quality. It's not like you can randomize who gets a sex change operation. And there are major issues with even knowing who to count when people can just decide they're not trans any more. All the research on this is riven with such unhandled problems.
The research is also highly motivated. A researcher who found that sex change operations were harmful would be targeted for endless harassment by gender activists, if they could get published at all.
The effect sizes here are huge and seemingly hold when controlling for the typical factors such as socioeconomic status. They appear to hold both across groups that did not seek treatment and those that did AND in follow up studies checking the rates of how feelings (e.g. ideation) evolve over time for each group. It’s ok to raise concerns about confounding variables but the hypotheses here for such a huge effect size seem limited.
The fact that people can decide they’re not trans is not particularly material. This is very uncommon.
The conspiracy that such research must be politically motivated is a contrived argument and also falsely paints a dichotomy of saying that it must either help or harm. My assumption before doing the research was that they would find no effect.
>The fact that people can decide they’re not trans is not particularly material. This is very uncommon.
You really lost us with this.
Many, MANY people dally with the idea of being trans and decide it's not for them. This is extremely common, and is probably the overwhelming majority outcome for all people who are ever trans-curious.
> The research is also highly motivated. A researcher who found that sex change operations were harmful would be targeted for endless harassment by gender activists, if they could get published at all.
A researcher who found this would be feted by the conservative/evangelical wing of the US political spectrum. They would stand to make a ton of money in the book and personal appearance circuit.
No, they're making a choice between the long-term negative effects of not losing weight naturally, vs the possibility of long-term negative effects of using artificial methods. This isn't polemic, as even things as basic as birth control and advil have negative long term effects.
I think we’re saying the same thing? The only difference is that I personally don’t believe that self-control is sufficient for everyone to lose weight. If you do believe that, then the risk estimates become much easier.
And yet, statistically, caloric restriction has one of the worst success rates in modern medicine.
Depending on which study you look at, up to 80% of people who attempt lifestyle modification end up gaining the weight right back.
So yes, it's theoretically possible for everyone under ideal circumstances, but in the real world most people don't succeed. We can argue over why that happens - but the statistics remain.
So again... given these abysmal odds, for the 80% of people who try and (repeatedly) fail at lifestyle modification, what is the least bad alternative?
> 1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
This paper also finds that 5% of cisgender male and 11% of cisgender female students (out of ~8k surveyed for each) attempted suicide in the past year. It's kind of strange, because the age <=18 suicide rate (of "completed" attempts) is much smaller, approximately 1 in 5,000 to 1 in 10,000 [1].
> a huge swath of the population will be dealing with issues 30 years form now
We've got 20 years of data on this class of drug. Certainly there could be some long term issues that we're not aware of yet, but it's not likely that there are significant issues that affect a large percentage of users after 30 years that didn't affect the small sample of users that have been using it for 20 years or the massive number of users that have been using it for 10.
How much of the data was done independent and how much was done by the same company or companies that benefit from it? We've seen this before. How many decades did people take aspirin thinking it was good for you to take everyday. How many decades did people drink wine thinking it was good for you in small dosage? How many people smoked using it as an appetite suppressant not knowing the long term effects?
The list goes on forever. I'm betting this ends the same way.
Dude, the mortality rates go up at least linearly, maybe super-linearly, to weight over a certain amount. It's not like some mythical / hard to read / later benefit. This is a drug that radically changes those risks NOW, really quickly. It's a different matter than aspirin (helpful if heart disease is a real risk, otherwise no) or wine or smoking, both of which people have a strong interest in thinking of as good for you.
Yes being overweight is horrible for you. But fixing it with a pill that you don't know the long term effects of and not actually fixing the root of the problem. Why you gained the weight in the first place. Is helping no one. If anything you could be fixing something in the short term and causing long term harm in the ladder.
Medical FOMO? I wouldn’t worry too much about it, I mean, there are hypothetical upsides to countless decisions we haven’t made, right? We always miss some chances in life.
OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight
Who the fuck cares? If you're not overweight and are reasonably then you're already winning in physiological terms. If you can maintain a good quality of life into old age and then die, what more do you want? Going through life worrying about whether you're missing out on some marginal health benefit from the drug-of-the-moment is neurotic.
i think overweightness should be seen more as a symptom and I share parent's concerns about ozempic's long term side effects being unknowable in the present
all in all general unease about dealing with symptoms and not the root cause of overweightness except in rare genetic cases, its overwhelmingly a dietary/exercise issue.
in this country the pill/drug is the answer and solution to everything but all this does is pile on more bandages without addressing the root cause which a very American solution.
I do not think the full ramifications are realized or knowable when there are profits to be made on both side of the fence, sort of like the whole opiate crisis in America started out as magazine ads blew up into a major crisis 20~30 years later.
That's why I haven't taken it. I'm probably a guy who should. Overweight, with kidney disease person who, if I became diabetic, it would probably kill me.
I'm not, someone who doesn't really need it. For example, some average weight housewife who just wants to fit in a dress a little better.
And still, I won't use it even though I can afford it cause it's the long term consequences are not entirely understood.
It's a pretty sad thought that everybody will be on a drug that keeps weight in check while most people will still eat a basically toxic diet. Weight is certainly an important factor but there is more to a healthy life.
Sure, but the "unhealthy but not excessively caloric" diet is not a problem ozempic attempts to address. As far as I understand, it simply limits your appetite. Potentially one can go on ozempic, lose weight, and still end up eating unhealthily, because the resulting diet is made up of nutritionally poor foods.
No, but if it helps avoid the discussion because the very visible side effect is lessened, then in some ways things are worse. No squeaky wheel.
I’m glad it’s available for those who need it. But I agree with GP that there is another discussion we need to be having too we’ve avoided for far far too long.
I wasn’t talking about nutrients at all. I was referring to the problems of over processed foods with lots of chemicals to increase shelf life and improve color and make them more addictive.
I’m not against Ozempic. But without it maybe the continued expansion of the obesity epidemic would have pushed the discussion.
If this accidentally prevents that discussion, I think that’s a problem. I’m not suggesting any change to the drug’s availability. Only concern over an important discussion.
Maybe it’s naïve. But it’s getting harder and harder to ignore, and worse and worse.
As we export our food to more and more places, it starts to happen to them.
I hear about people who take trips to Europe. They eat a ton, feel better, and lose weight.
They get back home, start eating food here (even healthy food) and feel worse again. Gain it back despite eating less.
We’ve tried ignoring it. We’ve tried blaming genetics, character, fat in foods, sugar, and willpower. But none of those have explained/fixed it. Because I don’t think that’s the problem.
I want the evidence to keep piling up. I don’t want anyone to suffer unnecessarily, but I don’t want a new excuse to stop progress again.
It doesn’t have to be either/or. But if we give up the chance for the debate because a new miracle drug “solved“ it nothing will change.
And the argument you are replying to is that it's just covering up a symptom and not addressing the root problem holistically. Ozempic isn't a fix, it's a bandaid.
Bandaids serve a genuinely useful health-promoting purpose. I suspect we'll find the same is true of GLP-1s even if it only addresses part of the entire problem.
Only when applied correctly and with other interventions. Using ozempic without diet and exercise changes is like putting a bandaid on a .5" deep wound without sterilizing it.
because ozempic reduces the food cravings, patients are able to implement and stick with a diet change. it's not like "put down that cheeseburger and have a salad" is something they haven't heard before and haven't internalized already, it's just their brain won't do it. ozempic gives them the space on their brain to actually do it.
Sure, but so what? Until we can permanently change aspects of our brain, like our proclivity for addiction, then all interventions are bandaids on top of an underlying problem.
Even behavioral changes like avoiding fast food don't fix the underlying problem in your brain. It's topical.
It's amazing how the subject of Ozempic brings out such trivial claims uttered with a serious face.
The combination of bad diet and lack of exercise. Specifically in the context of this conversation, its about how ozempic will not fix a bad diet. Eating less of a bad diet is better than eating more of a bad diet, but is still a bad diet in the end.
My original impression was that it was suppose to be a crutch, helping you get started on a healthy lifestyle. So if you are to heavy to exercise without hurting yourself it could help you lose that initial weight. Or it can help you with your appetit, while you adjust your diet.
You also can't stay on Ozempic, you have to continuously increase you dose to get the same effect, so it's simply not viable to keep taking it for an extend period of time. That's at least the impression I've been getting from talking to people working at pharmacies.
That's great. We still give crutches to people who break their legs and bandaids to people with wounds. We don't tell them that being completely healed is better than using those aids.
Ozempic does not simply limit your appetite, it seems to also affect how much reward your brain feels from different foods (and activities!), which would make it easier to override those anticipated rewards with conscious choices.
From my understanding GLP-1 agonists can actually modulate the reward pathway reducing people's appetite for toxic diets.
We're not socially caught up yet to this information. I suspect there are folks who believe that regardless of similar outcome (reduction of toxic diet), that changing diet without medication is superior to those who change their behavior through pharmacological intervention. It's like the pre-1990s view on depression or anxiety - chemical intervention is a moral weakness.
That's a trivial claim about any medication that changes behavior. You can achieve the same thing that the medication does by "just" having different behavior.
Have you considered that maybe it is an evolutionary trait that it is hard to do certain things? That the people who can expend the effort and discipline, perhaps have a better configuration than those that can’t or don’t?
The question is how a trait fares in the modern world.
Maybe a trait was useful to an ancestor but not to you today trying to navigate a calorie rich world of convenience. Just like a trait useful to a nomadic hunter might work against you when you're expected to sit at a desk job if you want to make the money necessary to fulfill your ambitions.
It may very well be the case that we end up medicating away traits that were useful at some point in our lineage but not today. I just don't see how it matters much beyond the thought exercise.
The exact same argument can be applied to literally any medical issue, and it is a pointless one.
Someone has an elevated risk of skin cancer due to their genetics? Probably an evolutionary trait that it is more likely for some people to get skin cancer within their lifetime. That doesn’t mean that using sunscreen and providing those people with related medical care (if the need arises) is some crime against nature and will end up hurting evolutionary prospects of the human race.
> Someone has an elevated risk of skin cancer due to their genetics? Probably an evolutionary trait that it is more likely for some people to get skin cancer within their lifetime.
Weird that the ones skinnier foreigners with a “better configuration” get genetically altered (I guess) to a worse configuration when they move to the US, then.
My point is that skinny populations don’t seem to be skinnier than the US population due to greater genetically-backed willpower (better “configuration”). At least, if it’s a factor, it’s overwhelmed by other factors, it seems.
hilariously, the toxic food companies are worried that ozemic will kill their profits. Maybe the pharma industry can fight the food industry conglomerates.
Could you provide some of those papers? I'm interested on what you are saying, but I am not able to find what you are mentioning using the link you provided.
It goes on and on and on. In lab mice, it has been shown you can alter production in as little as 10 days. Human hormone production has similar turn around times.
I eat almost zero processed foods and very little sugar - mostly from fruit. I shop exclusively on the perimeter of the grocery store and eat at a restaurant maybe once a month, with all my meals cooked at home. I try my best to limit portions.
I have been overweight my entire life. I have successfully lost weight with up to eight months of calorie restriction, so my willpower is just fine, thank you. I have always gained it back, and you calling me out for some kind of moral turpitude is not helpful.
Your "eat like an adult" finger waggling is condescending, and claiming anyone who thinks obesity is more complex than "just eat better food, bro" is anti-intellectual and anti-science is just insulting - and not particularly "pro science" either.
In 8 months of losing 2 pounds a week, you would have lost roughly 64 pounds. You could have been losing more than that which is common on diets where added sugar is removed. But you're talking to someone who has worked with people with class 3 obesity and has seen the weight successfully stay off.
You're omitting details. You simply didn't change your eating habits. Statistically, this detail you shared is also overwhelmingly the documented reason why people fail to keep off weight. Almost entirely, people who reside in higher classes of obesity have no idea what their relative consumption habits are in comparison to those with lower BMIs.
This may come as a surprise to you, but most other countries where obesity is not a problem, most sugar consumption is also from fruit and these peoples' diets _don't_ contain anywhere near the amount of added sugar an American diet does. This isn't a special thing to point out, you just think it is because you have no other frame of reference.
2 lbs a week is a 1000 calorie per day deficit. My loss was closer to half a kilo a week. I have fluctuated between 85 and 210 kg since I was 16 or so. I am now 54.
Of course I am not saying my body violates the laws of thermodynamics. After some time I succumb to cravings and begin overeating again, a bit at first and then more. I am not denying this is behaviour driven. My only point with the fruit aside was that I'm not consuming my sugar from chocolate milk or sugary breakfast cereal, not that I think fructose is exempt.
But to suggest that all I have to do is eat healthfully for a few weeks and my cravings will be gone is infuriating. I have eaten healthfully for years and years, and eaten at a calorie deficit (of healthy food) for many months at a time. And the cravings NEVER go away. I always go to bed thinking of food.
Maybe I should get a nutrition degree and then my body will conform to what your textbooks say should happen.
There are a lot of statistics in dietary behavioral studies and dietary reinforcement that are mostly uninteresting because, frankly, people omit details.
You can lose considerable weight at speeds that are actually not recommended simply by dropping added sugar from American diets. So much so that you would need to taper off this removal to stay around 2 pounds of weight loss a week instead of dropping this consumption pattern cold turkey.
The biggest difficulty in sourcing food materials or eating out is that we have sugar in everything. We have added sugar in things that in other countries you would have never added sugar into to begin with.
The reinforcement habit is directly tied to food reward, sugar consumption, and ghrelin production. Anyone who tells you otherwise is lying and is simply refuting what we have come to understand about food science over the years.
And frankly, we as a people have not yet completely matured out of the phase of producing or accepting low-fat foods being replaced with high sugar content. Plenty of other nations never had this problem at all, never inherited it, and as a result, don't have to grow out of it.
It is staggering how much of our food is incompatible with healthy weight homeostasis, and all of our common supermarkets absolutely work against you unless you are otherwise taught differently.
* * *
Edit:
If you're baking bread for your family every day, even without added sugar, and you don't see the problem here, I don't know how anyone can help you.
I'm not calling you a liar. I said you were omitting details. You didn't mention that you're frequently eating carbs. Now you mention that you're baking, and presumably eating, bread every day.
I bake bread for my family every day because I can't get bread in Canada that has no sugar. I'm aware of how insidious sugar is.
You obviously deal with a lot of obesity that is caused by excessive sugar consumption. Your conclusion - and smuggled assumption - is that all obesity is caused by sugar. This is trivially refuted by finding obese people in non-high-sugar societies, or from a time period before sugar became ubiquitous.
Calling me a liar does not make your position stronger.
Response edit: I have four school aged children who get a sandwich for lunch every day. It takes no time at all for a family of six to go through a 650g loaf of bread, and it doesn't require overeating - I'm the only one in my family with a weight problem, and I bake the bread I don't eat it. Your assumption that everyone in the world is exactly like you is truly breathtaking.
> This is trivially refuted by finding obese people in non-high-sugar societies, or from a time period before sugar became ubiquitous.
Those people definitely existed, but were pretty rare. Maybe you are one of them. Statistically, probably not.
> I bake bread for my family every day because I can't get bread in Canada that has no sugar. I'm aware of how insidious sugar is.
That is definitely way, way better than anything store bought, so it's great that you are doing that. However, even without added sugar, bread will start converting to sugar immediately after being in contact with saliva(and will continue once the pancreas enters the picture). So you are eating sugar every day still, possibly quite a lot of it.
I had to severely decrease bread consumption, as well as anything containing simple carbs, to decrease my insulin resistance.
>Those people definitely existed, but were pretty rare. Maybe you are one of them. Statistically, probably not.
Mexico has approximately the same per-capita sugar consumption as Italy, Spain and France, yet the obesity rate exceeds that of the U.S. Norway has 50% more per-capita sugar consumption than the US and very little obesity. I don't think eating little sugar or refined food, yet being overweight makes me a statistical anomaly at all.
I'm not claiming some kind of magic variation in base metabolic rates. I'm only saying that it is too simplistic to point at refined sugar and say that a complex problem has that one simple cause. (And that to solve it one need only learn to be an adult).
I don't eat bread by the way, I bake it for my family. I do revert to eating potatoes and pasta though, which is no doubt to blame for my weight fluctuations. My irritation in this discussion comes only from the ridiculous claim that if I were only to eat like a grown-up for two weeks, food cravings would disappear and my problems would be solved.
Mexican cuisine employs large amounts of fat, directly, or in the form of cheese. Take a trip to Italy, Spain, or France. It's a very different eating atmosphere. The portions and ingredients aren't comparable, and in Europe, there are greater food protections that straight up don't exist in North America.
Carrefour et Monoprix ne ressemblent pas du tout à ceux de WalMart, etc. You can't compare them. Their food selection makes ours in the states look embarrassing, and I wouldn't be surprised if it were the same for Canada. It's superior on all fronts.
It isn't too simplistic to look at sugar or general carbohydrates and say, this ingredient has the highest reconstitution of habit developing behaviors compared to that of any other macronutrient. Your body's ability to reinforce food habituation compared to any other macronutrient on a graphed scale makes every other macro look like peanuts. It's sugar. It's carbs. It's a fact. It's scientifically proven. I implore you to do the reading yourself. Fat also has a high recidivation rate, but it pales in comparison to carbohydrates.
For your own health and the risk that you'll tell others otherwise as well, just dismiss me and read these studies yourself.
It's that easy, and the reality is that no one adjusts for it. Your supermarkets don't care and all of the people around you probably don't realize it either. It's cultural. It's in your beer. It's in your coffee creamer. It's everywhere.
It is the dietary equivalent of global warming denial. Seriously. I have watched people with class 3 obesity drop 40 pounds in one month, which is terribly hard on your body and not recommended, by immediately switching off high carb, high fat diets.
Yes, your food cravings do truly, really, disappear within a span of 2-4 weeks. Within 30 to 60 days, people can and do form rejection habits with little documented "willpower" in the same way these individuals using GLP-1 hormones do.
Because it's the same activation vector. You increase incretins production through rich protein consumption. People suffer from the effects that you describe because of leptin resistance. For people in extreme weight class categories, you don't get off after a few months, fat cells stay in your body for years in dormant, reduced volume form.
Of course I eat carbs when I shouldn't. Not the bread, but I eat potatoes sometimes, and too much fruit. I'm not denying that I eat too much.
The point is you claim that if we gluttons would just cut out sugar for 2 weeks and learn to be an adult, our appetites and cravings would disappear. That's nonsense, and your dismissal of data that doesn't fit your narrative makes your accusations towards others of being anti-science both hollow and ironic.
Not to argue for or against Ozempic, but there is a difference between what motivated individuals can achieve on their own, and what one can expect of the general population.
Do you have the time to seek out and keep healthy food? Can you afford it? Do you have the executive function and impulse control etc to bring to bear the necessary self discipline?
You’re making some pretty casual assumptions about people’s abilities.
Studies show nothing but high-touch interventions by specialists actually works for losing weight and keeping it off for a study cohort (i.e. might represent a population-level solution).
These are impractically expensive and still less effective than one might expect.
Researchers seem to be eager about the promise of supplementing the very-best programs they’ve been able to find… with GLP-1 agonists. Because that might finally make them really effective.
That’s how bad the entire body of all other solutions we’ve looked at is.
> You can literally do the same thing by eating a healthy diet for 2-4 weeks.
You have been downvoted, but that's true(and supported by evidence and science). Statistically, what most people have is sugar addiction. Simple carbs in general completely mess up your hunger hormones.
The problem is that most people don't know what a healthy diet is. The food pyramid isn't it. Drinking a bunch of juice isn't it. Cereal is candy. They try "eating healthy", fail (not realizing what they are eating isn't healthy at all) and give up.
If all it took to get the same feeling of GLP-1 agonists was success at the diet for 2-4 weeks, I would have a lot less experience being successful at diets for 2-4 weeks. A whole lot less.
> GLP-1 agonists can actually modulate the reward pathway reducing people's appetite for toxic diets.
There are also studies out showing that people just up their sugar intake, so I think the results on how it affects peoples diet is still pending. From what I've seen, people are eating less, but more of it is junk food and sugar.
I can absolutely see why people would want to be able to just take a drug and start losing weight, it's hard. My concern is that it takes more than a low body weight to be healthy. You still need exercise, and while that's not an effective weight-lose solution, it is something that most would add when trying to lose weight, and now they're missing out on that part. Arguably exercise is more important than your weight.
Exercise strengths your cardiovascular system, immune system, improves bone strength, builds muscle (which helps you as you age, preventing the risk of falling and fall related injury), improves mental health, reduces stress. If your in good physical shape, it's less of an issue if you carry around a little extra fat.
You can still be in bad health, even if your weight is spot on, but it's rare that you exercise a lot, but is overall unhealthy.
In terms of tangible outcomes, it helps you live longer or something compared to weight loss? greater reported life satisfaction? Or is this more of a personal value?
As a default it is. And that's what it became. We stopped trying any other methods. Come in the door, have a set of symptoms that check all the boxes, walk out in 30 minutes with a prescription, doctor's office gets a bonus. Institutional psychiatric treatment is drugs first actual treatment later.
This is a _social_ problem. It should be discussed and addressed as such. You should not attempt to pervert this concern into an _individual_ issue in an effort to invoke a needless moral defense.
Are chemical interventions designed with the best outcomes for the patient or the best outcomes for society? I suspect it's the latter. It's cheap and if you're lucky it's effective. When it goes bad it can ruin lives and families. As a _default_ it's a moral weakness.
Is this a solvable problem? Yes, but it's monumental, encompassing everything from the way we structure our civil society and work life from the forms of food and entertainment that we incidentally or directly subsidize.
We accidentally built something gross. It moves really fast, though.
Just some notes. This would be a lot easy to take this seriously if it wasn't seeped in moral purity. It is rhetorically unappetizing.
Re-wording it so that you say your end goal was better outcomes for people and restructuring society to achieve that is a noble goal. It's easier for people to want to agree with than being a moral policeman.
If it's a social problem then the non-pharmaceutical cure is obviously not white-knuckling a diet and exercise regimen individually. It needs a holistic, society-level solution. More time off work, less car-dependent suburbs, more bike lanes and subsidies for bikes, more agricultural subsidies for healthy food and less for corn. Realistically we aren't going to get those things.
> not white-knuckling a diet and exercise regimen individually
Obesity rates have not been constant. There are clearly multiple modes to this problem and history suggests that this class of people is the minority of the visible issue.
> more bike lanes and subsidies for bikes
You don't need this so much as you need roundabouts and actual _human_ scale infrastructure in cities. Some smaller towns in the midwest got the memo from Europe and are starting to adapt easily.
> more agricultural subsidies for healthy food and less for corn
I think the amount of subsidy overall is a problem. I think we could to take another page from Europe and start banning food additives. We can stop classifying highly processed foods as foods and instead as desserts and tax them appropriately. A lot of this is already in motion.
> Realistically we aren't going to get those things.
We used to have these things. I don't understand your position of social excuse couched in social pessimism. So instead of addressing the problem just accept that pharmaceutical and insurance companies will now enrich themselves off this created problem?
You know, we can solve _two_ problems at once, if GLP-1 has some short term benefit then great, but to plan on it existing in the long term for weight management is utter madness.
There's a decent amount of evidence that the most toxic thing about modern diets is their amounts: calorie counts and such. Many things (sugars, ultra-processed foods (ugh I hate the NOVA classification), fat, etc) are fine in moderation. The dose makes the poison.
Is it fundamentally any different from something like toothpaste?
Humans have created a technology (mechanised farming) with a side effect we haven't yet evolved to handle (an abundance of tasty calories), so it doesn't seem all that strange we would fix it with a technology (inhibiting the desire for said calories).
I think your statement is very funny. If the drug keeps weight in check on a toxic diet and that has the same outcome as "healthy life", then is that "healthy life" any more healthy then the drug+junkfood combo? Also, what is sad about it?
I've been on wegovy for almost two years now, and I can attest to how much you just DONT want to eat junk anymore. It's one of the most commonly talked about things we discuss with other users over the last few years. That and lower want to drink, and gaining back so much of energy/time due to not having to think about food every 3 seconds of the day.
I'm super satisfied just having an apple or two now. The "omg I need to eat, ohh a burger" is gone.
I'm not arguing at all here but just wanted to say, I've noticed similar effects just focusing on eating healthier over the last few years. I haven't taken anything to help I just wanted to stop eating poorly and now adays it's not "shove the entire box of cookies in my mouth" it's "have 1 cookie and don't finish it because it's too rich" and I haven't eaten fast food in as long as I can remember. I used to see a McDonald's french fry commercial or just think about them and need McDonald's. Now I see it and go "ah they were good but eh" and move on with my life.
Serious question: Why not make toxic diet illegal or cost prohibitive? Lots of manufactured food is designed to be more addictive. Then add in constant advertising bombardment targeted at kids. Why is there up to double the sugar in US bread and soda versus Europe?
> while most people will still eat a basically toxic diet
It's a pretty sadder fact that people just make these wild assertions. Everyone I know (which is about 10 people in real life, myself included) who's used a GLP-1 drug found that they eat healthier because they've less desire for shittier food.
> while most people will still eat a basically toxic diet.
Had to scroll too far to find this. It's a great synergy isn't it? The food industry creates calorie concoctions that can barely be called food, are dirt cheap to make and rakes in profits. People get sick. The pharmaceutical industry sells drugs are stupid high profit margins so that people can keep on living.
It is not a conspiracy, but it's a good feedback loop for corporations. All that money allow them to flood the scientific community with their sponsored studies, dominate news broadcasts (confusing consumers) and even influence the food pyramid, which is almost upside down.
I've been on a slow quest to improve health and lose weight. It's really, really slow, far slower than what most people would like. But cutting added sugars to zero (including and most especially high fructose corn syrup) gave almost immediate benefits that kept me going. Sugars (and carbs in general) make you retain a lot of water. Cut those, and you'll see a major difference in the scale in a couple of weeks. Is it mostly water(but not entirely!) Yes. It doesn't matter, our lizard brains interpret that as success. That also reduces hunger, which is a positive feedback loop.
Only in the US. Other countries are like 90% less expensive. However, Medicare might try to get better deal since the next round of deal making can include it since the drug is 7 years old.
Seven years, December 2031. That's when the patent expires, the kinks and side effects will have been found/ironed out and it becomes a cheap plentiful generic. I'm healthy enough to wait.
This compares Ozempic with past drugs, but sales of past drugs are almost always limited by demand. I'm not sure there's much to learn here for a drug that is limited by supply. Also, this part is silly:
"The announced investments across both companies total $32 billion. GLP-1s were 71% of Novo’s revenue in 2023, 16% of Lilly’s in 2023, and 26% of Lilly’s in 2024Q1. If these sales are proportional to the manufacturing capacity used to create those drugs, then about 40% of Novo and Lilly’s combined estimate of $45 billion in gross PP&E is for GLP-1s, for a total of $18 billion; $25 billion would then mean a 140% increase in GLP-1-relevant PP&E."
Manufacturing investment is not proportional to sales, because there's a fixed cost to making a certain drug regardless of how much you sell. If a rare-disease drug will have a few thousand patients ever - not uncommon! - you still need to figure out a synthesis path for that particular drug, run QC tests on the production line, get regulatory approval, etc. Economies of scale matter a lot (https://en.wikipedia.org/wiki/Experience_curve_effects).
And apparently the pure manufacturing cost for Ozempic is relatively low:
> the active drug in Ozempic can be produced for about 29 cents for a month’s supply, or 7.2 cents for a typical weekly dose, the research found. It’s not cheap to make — semaglutide costs over $70,000 per kilogram. But only a tiny quantity of the drug is used in each weekly dose.
By chance I just talked to someone with deeper knowledge on this and they said the current constraint is actually ramping up supply of the delivery mechanism, not the drug.
I have zero expertise on this, but would be curious if anyone knows what's special about Ozempic delivery that can't be served by a commodity syringe.
"hims" is selling Compound Pharmacy drugs, which will be made illegal soon. Soon your options will be $1000-1500/month from the two big drug companies.
They're meant to have a vial-needle version, but it is $600/month and you can only do it for up to 5-months and a low max dose. So it isn't a real program, but rather a way to avoid critique from legislators.
It’s “legal” because of the lack of supply in critical medications so the FDA gives a variance to allow compound pharmacies to produce/sell critical medications until supply issues are resolved.
> but would be curious if anyone knows what's special about Ozempic delivery that can't be served by a commodity syringe.
They can't charge as much. That's basically it. Generic semaglutide from compounding pharmacies (which have their own issues for sure) is under $150 a month cash-pay these days.
The real issue with syringes and self administration is that the vast majority of the population are not comfortable with it and don't have the diligence to do it correctly every time, so you get under/over dosage or noncompliance.
That being said, the autoinjector format doesn't really solve that problem, it just slightly ameliorates it, in exchange for approximately 8x the cost.
So basically, 99.8% margin the maximum they can charge (at ~15-30cents/mo) or 99.5% margin at $1000/mo for a $2.5 injector? Semaglutide has been in production since 2012 and approved by the FDA since 2017. There's a real chance that specifically as a weight loss drug it's not patentable since it was in off label use before the patent was filed. That's being argued in the PTO now.
>Generic semaglutide from compounding pharmacies (which have their own issues for sure) is under $150 a month cash-pay these days.
...Is that supposed to be impressive? I assume you mean USD, so that works out to more than I pay for my food. Toronto isn't a cheap place to buy food, either.
> By chance I just talked to someone with deeper knowledge on this and they said the current constraint is actually ramping up supply of the delivery mechanism, not the drug.
The article says this:
> Surprisingly, the study found that the biggest cost in producing Ozempic is not the active medicine, called semaglutide, but the disposable pens used to inject it. They can be made for no more than $2.83 per month’s supply, the authors concluded, based on interviews with former employees and consultants to injection device manufacturers. One Ozempic pen is used weekly and lasts a month.
So while the injection pens are significantly more expensive than manufacturing the drug itself, they are still relatively cheap. So it seems to be not a major problem to strongly ramp up production here as well.
Which suggests any supply shortage will be resolved relatively quickly. Perhaps in less than a year? Then the limiting factor will not be the supply but the market price.
There are also doctors that are prescribing vials of semaglutide and commodity needles, and training patients to properly dose up and administer the drug via a standard needle. There's more to it than the auto-injector pens, but not that much more to it. And it does bring costs down, which is important to some. Alternatively, you can just go to the doctor's office weekly and have a nurse there do a traditional injection for you (doesn't help as much with costs, but does bypass the auto-injector shortage).
I agree needles can alleviate the Ozempic shortage, though only if Novo Nordisk decides to sell Ozempic without pens. But not including pens will hardly reduce the price of Ozempic anyway, because pens cost basically nothing (estimated USD 2.83 for a month) compared to the full price of the drug.
The marginal cost to produce the few milligrams of the drug that goes into the pens is much much less than $2.83; it's on the order of cents. Plus, scaling up manufacturing of the drug is easier than scaling up manufacturing of the auto-injectors (which have a decent number of parts in them). The auto-injectors really are the bottleneck, and manufacturing of them so far has not been able to be ramped up quickly enough.
Agreed. Don't forget they're spending on next-gen versions of these too -- Novo is testing a pill form that's apparently twice as effective as semaglutide(!) right now. It's easy to imagine that becomes part of many people's January routine -- stop drinking, take your pills, go to the gym for a month, slowly put the weight back on during the year, no problem.
Not fully true- orphan drug status exists for rare diseases and gives advantages to companies who develop drugs for rare conditions. This includes longer exclusivity periods amongst other incentives, rendering these categories more feasible economically.
I'm shocked that TFA doesn't mention the (massive, booming) market for compounded semaglutide and tirzepatide. The long-term future is uncertain, but since these drugs have been under shortage status, third-party pharmacies can legally compound them to meet increased demand.
9 days ago the FDA declared the tirzepatide shortage over, though the other popular drugs in this class are still eligible for compounding based on shortage status:
> Neither is berberine any version of Ozempic, which is an analogue of glucagon-like-peptide-1 (GLP-1), a natural hormone that regulates blood sugar and helps people feel full. Berberine has nothing to do with GLP-1.
> Perhaps the most interesting laboratory finding, given the rising global tide of type 2 diabetes, is the control that berberine may exert over blood sugar. But there is a problem. Berberine is virtually insoluble in water and has low intestinal absorption which means it has poor bioavailability. […] Because of berberine’s poor bioavailability, supplements on the market are likely to be useless. However, some derivative of berberine, may yet make it to the physician’s prescription pad. But it won’t be for weight loss.
Apparently most of the effect is due to activation of the "bitter taste reception pathways" in the gut. So even though it has very low bioavailibility, it can still stimulate GLP-1 secretion just simply due to its incredible bitterness
Does it only stimulate GLP-1 in the gut, though? As I understand it, most of the positive effects of GLP-1 agonists are the effect they have on the brain's GLP-1 system, not the guts.
Nine of the 15 tested products (60%) failed to meet the potency standards of 90% to 110% of labeled content claim, as commonly required of pharmaceutical preparations by the U.S. Pharmacopeial Convention. Evaluation of the relationship between product cost and the measured potency failed to demonstrate an association between quality and cost. Variability in product quality may significantly contribute to inconsistencies in the safety and effectiveness of berberine. In addition, the quality of the berberine product cannot be inferred from its cost.
Worse still,
"Preparation and Evaluation of Antidiabetic Agents of Berberine Organic Acid Salts for Enhancing the Bioavailability"
Berberine—an isoquinoline alkaloid isolated from the rhizome of Coptidis rhizome, Cortex phellodendri, and other plant species—possesses a variety of pharmacological effects, including anti-cancer, anti-hyperglycemic, anti-hyperlipidemic, antimicrobial, anti-inflammatory, and antioxidant activities. However, its absolute bioavailability is as low as 0.68%. Low bioavailability greatly restricts the clinical development of berberine.
I'd think it more likely that it'll be one of the next generation drugs, but I do agree with the premise that it will be really common.
A few weeks ago I started a low dose of tirzepatide (aka Mounjaro, aka Zepbound) and the side effects are interesting.
The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.
But there are some unexpected positives.
Obviously I am eating less. I have to log food not to keep it in check, but to make sure I'm eating enough and with the right nutrients. There's another possible negative here -- you get a lot of hydration from food, so if you start eating less you should carefully monitor your fluid intake to allow for that.
But I'm also more focused. Not nearly as distracted. I'm getting a lot of things done which I used to just procrastinate on until years had passed in some cases. Man, the garage is going to be clean and superbly organized in a few weeks.
And my emotions are quieter. Not just the food noise, that was expected, but I feel more relaxed. That's not what I expected, and I'm pleasantly surprised.
As an aside, what makes this all really noticeable is that it's a once-a-week injection, and the peaks and valleys are very obvious. Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.
Edit: Before someone asks, yes I have considered there may be long term effects. This is a risk, which I've decided I'm okay with at my age. Nobody gets to live forever anyway, and I was going to end up in an early grave via another route if I didn't do this. "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.
I do hope to taper off at some point if I can figure out an alternate strategy for staying lighter. Though I'll miss some of the positive side-effects.
From my own anecdata, unnecessary impulsive eating probably reinforces the impulsive behavior. You start associating impulsive behavior with a reward.
GLP-1 not only removes that, but adds a slight negative reinforcement. Impulsive eating no longer brings reward, but makes you feel over-full. This can then down-regulates the pathways that lead to increased impulsive behavior.
I won't sugarcoat my problems. I knew I wasn't hungry when I'd eat sometimes. I knew it would keep me overweight. I knew it wouldn't even feel great afterwards. And yet, more often than not I did it. And beat myself up over it every time. Very demoralizing, even without help from moralizing folks on the internet.
On tirzepatide the impulse is just gone. I feel like I can take it or leave it, and since the consequences of eating unnecessarily are quickly negative, I just don't do it.
There are about a dozen published studies using GLP-1 analogues in animal models showing reduction in addictive behaviors (search for papers by Jerlhag, Leggio and Schmidt). The prevailing theory seems to relate to dopamine regulation.
Doesn't losing weight already increases your Testostrone?.. people seriously shouldn't get on TRT unless they need it medically, once you start it, it's for life and also you will be infertile.. (source I am on HCG, an alternative to TRT due to its side effects).
I said a few weeks ;-). The garage is pretty big, but not that big. It's going to be gloriously organized in a few weeks because I spend a half hour or so in the evenings to move the project forward. I'm very relaxed about it. I'm just doing exactly what I kept telling myself I should do to make the garage as organized as I want, rather than finding pretty much anything else to do.
Decades ago I tried phentermine for a couple months. Now that was a ride, and you might call the experience closer to manic. I was a machine. This is not like that.
I read the “in a few weeks” totally differently than the other reply. In my mind, I was thinking, “wow, you’re able to plan that far ahead and stay on track??” And now you say you’re able to accomplish that by dedicating a time block per day?! That’s superhuman level of control that I can only dream of!
It would be interesting to compare the anxiolytic effects of the drug versus the cancer anxiety caused by being on the drug.
The cancer anxiety could be reduced by frequent testing. e.g., having a thyroid ultrasound every 6 months, or a yearly abdominal MRI, just to make sure cancer is not brewing.
There's no evidence that GLP-1s cause cancer in any meaningful amount, but obesity definitely does. Either way the only cancer they found any correlation to was thyroid which is one of the most treatable -- over 99% survival rates.
There's no causative relationship. There is a correlation in some studies. This is not the same thing. Beyond that, some studies have found a very weak association and some have found no association at all. To say with this corpus of evidence they cause anything is very premature.
This 2024 study showed no increase in risk over 3.9 years.
> "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.
Studies show it just doesn't work.
There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 and the likelihood of going from severely obese to normal weight is 1 in 1667.
If you just teleport a fat guy from Bentonville to Manhattan and give him a Metrocard he will lose a pound a week. The people who say nobody can lose weight, it's too hard, cannot explain why there are macroscale populations with lower obesity.
Surely you have a study to support this? Or are we just speculating. The problem with this particular area is that it's not intuitive, and relying on "common sense" guidance is why everyone got fat in the first place.
Generally here if you make a claim it's totally fair to be asked to substantiate it. I already provided the evidence that this individual was wrong, so I'm looking to see why they think otherwise. Maybe they'll teach me something new.
> Generally here if you make a claim it's totally fair to be asked to substantiate it.
Anything is fair. It is a discussion forum. You can say whatever the hell you want. But it is equally nonsensical.
> so I'm looking to see why they think otherwise.
You looked for someone else – someone who prepared a study – to tell you why it might be otherwise. But if you want to talk to someone else, go talk to that someone else. If you want to come here, be happy with the people who are here. They might actually teach you something without having to defer to random other people.
Questioning the person who made the claim, sure. Get them to elaborate. That improves the discussion. But halting discussion until they can come up with the words of someone else to justify their claim, as seen here, just makes you look stupid. If you would rather talk to someone else, go talk to someone else instead. At the end of the day, all is fair in discussion, so go for it – call for someone else to enter the discussion if you want. But as all is fair, we're also going to call out your stupidity when you do.
The bit that you're (intentionally?) missing is that this is just a polite way of saying "you're full of shit". The only person being stupid here is the person making strong empirical claims without qualifying them or providing supporting evidence.
I could see a reasonable complaint that asking for studies is being passive-aggressive, but it's the sort of passive-aggressive that both helps keep the discussion more civil and leaves room to actually substantiate the original claims (that is, it's actively better for keeping the discussion going!). Just saying "lol, no, wrong" kills the discussion far more than talking about (lack of) evidence.
> The bit that you're (intentionally?) missing is that this is just a polite way of saying "you're full of shit".
If someone is full of shit, and assuming you care, then logically you would put in the effort to fix their misunderstanding, not tell them off. Exclaiming that someone is "full of shit", politely or not, is stupid. If you don't care, then why not own it? Don't care.
> The only person being stupid here is the person making strong empirical claims without qualifying them or providing supporting evidence.
There can be more than one stupid party involved.
> I could see a reasonable complaint that asking for studies is being passive-aggressive
It is just straight up nonsensical. I get that is was only ever a silly meme and always understood to be nonsensical, but a meme that has become quite tired. It was funny 20 years ago, perhaps, but at this point it is time to lay it to rest. I mean, anything goes in discussion. If you still think it is edgy, go for it. But the rest of us will still think it is stupid.
"It's too hard" includes "It's too hard to just magically change the environmental factors making it difficult for this specific person". We can't just magically move every obese person to NYC, and unwalkable car-dependent infrastructure cannot be fixed overnight either, even if the people living there all decided to vote for politicians who would legitimately work towards making that happen (still seems unlikely). Unless and until we work towards fixing the societal problems that created the obesity crisis in the first place, we still need short term solutions for the next couple decades at least.
Those same populations are gaining weight at a trajectory that is behind the US but still headed the same direction. AFAIK most western European nations have a majority of people overweight, with 20-25% obese. This is less than the US (though it's very regional within the US), but you don't get to brag about a 1-in-4 obesity rate.
>This is less than the US (though it's very regional within the US), but you don't get to brag about a 1-in-4 obesity rate.
Are you sure?
>In 2023, over 35 percent of adults in the Netherlands were classed as overweight, meaning they had a body mass index (BMI)of between 25 and 30. Furthermore, just under 16 percent of adults were obese
>47 percent of French adults were overweight, of which 17 percent suffered from obesity
>49% of the Belgian population has overweight, of which 18% have obesity.
>Spain: 43% of adults aged 18 years and over were overweight and 16% were living with obesity
>46.6% of women and 60.5% of men in Germany are affected by overweight (including obesity). Nearly one-fifth of adults (19%) have obesity.
For the purposes of this discussion, I will take your numbers as truth and run with it.
Are you arguing that 1:5 is good, but 1:4 is bad?
The only large populations of people in the world that aren't quite fat are southeast Asians. And this is fairly accurate whether they leave in southeast Asia or in the US or western Europe. Not 1:5, closer to 1:20 or in one case 1:50.
Even then, southeast Asian obesity rates are climbing. The US may have led the pack because of a consistently high standard of living, but I don't see any indication that there are macroscale populations anywhere in the world keeping the disease at bay.
Realistically this treatment is just not available to most people (for the simple reason that there are way too few non-car-dependent cities in the US, and the ones that there are are super expensive). But GLP1 agonists are available to most people.
I did that in 2020. May through November. 40 pounds off. Then I sprained my ankle. I apologize for being negative, but come back in a year and let us know how it's going. Many, many people can lose 10%, 20%, even 30% of their body weight with concerted effort. Works for a year or maybe two. It's actually pretty easy, to be honest, most people who've done it will agree with me.
I had the same kind of experience. Not as dramatic as that, but six months of careful dieting lost weight, but then within a month after I stopped calorie-counting I was back at the same original slightly-overweight weight I had previously plateaued at.
>It's not that "eat less and exercise more" doesn't work, it's that nobody does it
There are plenty of examples of people who've managed to lose weight through diet and exercise, it's not "nobody". Sure it's a small % success rate, but that's because it's not easy. Just like squatting or deadlifting 300 lbs, it's not easy to get there, but the vast majority of humans could if they decided to put the time and effort into it.
Would you apply the same analysis to people with depression who cured their depression by smiling more? It's not zero, it's just very hard. Ultimately both are chronic issues of the central nervous system. We know GLP-1s act on the GABAergic central nervous system.
I think that as convenient as it would be, depression and the inability to not eat too much are not the same.
The fact is that you have much more control over one than the other.
I don't disagree that maintaining a healthy weight is a challenge in today's environment, but it's not impossible or inevitable, like so many in this thread are pretending.
> I think that as convenient as it would be, depression and the inability to not eat too much are not the same.
> The fact is that you have much more control over one than the other.
Why do you say that? Studies do not agree. How would you assess the difference? Or are you simply coming at this from the perspective of either someone who has never had a weight problem or was able to get out of a weight problem without issue? If the latter you're in the ~1% and your experience is not that of others in the same way as your experience as someone without depression does not align with that of someone who is depressed.
How would you measure your thesis? Certainly it cannot be based on results because, well, I cited them.
As someone who isn't addicted to cigarettes, it's pretty easy to not smoke. My experience does not align with those addicted to cigarettes, and I can appreciate that. Why do you not appreciate that the experience of those with obesity might be different than your own? I am not obese for the record, and I have never taken GLP-1s, but I have been obese and this just makes sense to me.
Just because you have full control over your diet and I have control over smoking does not mean that there are people out there who cannot control their diets and cannot control their smoking.
Maybe depression and obesity are more similar than you are giving credit. Especially since serotonin inhibits appetite and has an integral role in maintaining energy homeostasis.
Sure, I don't mean literally nobody, just 'nobody' in the statistical sense - from the comment I replied to, "the likelihood of going from severely obese to normal weight is 1 in 1667."
I'm one of those examples. I've never been obese or really even overweight, but mid-2023, I noticed my clothes were no longer fitting, and I decided to take off some weight. I lost 20 pounds over the course a a few months and have managed to keep it off since. Body scans aren't accurate, but the 1 scan I took after losing the weight put me at 13% body fat.
It's one of the hardest things I've done. I'm no stranger to hard physical things - I've run marathons, raced cyclocross, done daily bike commuting through several Chicago winters, and I'd rate the weight loss as up harder than all of those. At the risk sounding too hubristic - if that's the effort it takes to lose weight, doing so is beyond the abilities of large swaths of the population. Not to mention that I have the time and financial resources to weigh my food, buy foods that were optimal for my diet (so much yogurt and chicken!), etc.
(As a side note, exercise isn't a very good way to lose weight in my experience. It's valuable to do for all sorts of other reasons, but I actually gained weight when training for my first marathon, while running 60-70 miles/week).
> As a side note, exercise isn't a very good way to lose weight in my experience.
Generally people who don't normally exercise are going to gain muscle faster than they lose fat. This was the origin of HAES before it got corrupted: Health At Every Size, not "Healthy". Encouragement to keep going because with exercise you'll get healthier even if you're not losing weight.
Also, by weight, muscle burns more calories than fat just by existing. Personally I think that's where most of the weight loss attributed to exercise comes from, rather than the exercise itself. You have to gain the muscle first to actually burn more calories.
That's not a valid argument, though. Firstly nobody lives forever. Second you don't have to exert all the effort at once, so the totality of effort doesn't matter. At any given time you just have to decide whether to have the snickers bar or the apple. And that's not an impossible effort. We don't live our entire lives all at once. We just have to be present for one moment at a time.
Edit: In my opinion it's hard for two reasons. We have cravings for high calorie foods. And no one candy bar will make you fat, so it's easy to think "I'll exercise more tomorrow to make up for this indulgence." But then you don't, because that's hard too.
> At any given time you just have to decide whether to have the snickers bar or the apple.
No, you have to decide to even think about the difference between them instead of thinking about something in your life that feels more important. It's a sort of cognitive opportunity cost. You have to consciously think about food (instead of something useful) forever, because your body's instincts are telling you to do the wrong thing and you need your rational mind to overrule it.
So for the rest of your life, every day, until you die you must decide to stop and expend effort making that decision instead of thinking about work, family, politics, or writing a new bit of code that will change the world. Most human beings can do it for a while, but not forever. The only way to do it forever is to get your body chemistry on your side and reduce that cognitive load.
> "The only way to do it forever is to get your body chemistry on your side and reduce that cognitive load."
That's how all creatures in the wild do it. That's how humans did it for the past quarter million years. And all creatures did it for the past hundred million years. Wait, no, it isn't. Then there must be another way. A way that doesn't involve manipulative abusive capitalists and advertisers destroying health in the name of profit while selling it as freedom.
> "or the rest of your life, every day, until you die you must decide to stop and expend effort making that decision instead of thinking about work, family, politics, or"
How much does that lifestyle sound like freedom to you?
>That's how all creatures in the wild do it... Wait, no, it isn't.
Neither creatures in the wild, or primitive man, have access to unlimited quantities of calorie dense foods. We could go back to that lifestyle, but billions would have to die and the overall human lifespan would decrease rather than increasing.
I think I'd rather take a perfectly safe drug than go back to wiping with leaves and hunting for worm riddled meat.
> How much does that lifestyle sound like freedom to you?
I'm not even sure I understand which lifestyle you're asking about here, but if you mean the modern lifestyle then it's certainly more free than the lives primitive man had. "Might makes right" was the rule of the land back then, and contrary to your imagination, you probably wouldn't have been the mightiest. Certainly not forever.
Hell, it's more free now than the lives most of our grandparents had. 50 years ago about half of all white people surveyed said they'd move away if a black person bought a house in their neighborhood, and gay people were routinely murdered for existing.
There were no "good old days", and Stardew Valley is just a game.
> "Neither creatures in the wild, or primitive man, have access to unlimited quantities of calorie dense foods."
And just like that, you've come up with another way.
> "I think I'd rather take a perfectly safe drug than go back to wiping with leaves and hunting for worm riddled meat."
That is some ridiculously hyperbolic panicked scaremongering at the idea of banning Coca Cola. I have literally no idea how restricting the unlimited calorie dense foods available would lead to hating black people and murdering gay people, but it's some more hyperbolic commentary.
> "I'm not even sure I understand which lifestyle you're asking about here"
The one I mentioned. Comparing the "free" lifestyle where you have adverts for Coca-Cola shoved into your face 24/7 along with adverts selling you a drug to help you ignore the Coca-Cola adverts. Vs. "non-free" where Coca-Cola isn't available for sale and you just don't think about it because you've never had it and don't miss it, and you go about your life doing the things you care about instead.
I interpreted your original comment differently. Based on the votes so did others. At no point did you suggest banning Coca-Cola, or otherwise limiting calorie dense foods. Instead it seemed that you were advocating a return to some mythical past when food was more like it is for wild animals.
I wonder if you confused this thread with another? Or maybe your sarcasm was misinterpreted?
I didn't confuse this thread with another; from the parent comments we have "diet and exercise works but nobody can do it because it's really hard" to "we can't do it because we have to think all the time about resisting ultra processed junk food" to my comment "we wouldn't have to think all the time about it, if we didn't have it".
I do see how it looks like a return to caveman times, and was unnecessarily sarcastic. Practically, the times when I don't have junk food in the cupboards, I don't have to think constantly about resisting junk food because there isn't any to eat and that makes a difference. Extending that out to national levels, schools shouldn't have vending machines full of junk food, hospitals shouldn't have coffee chains, coffee chains should have restrictions on how much sugar can be in coffee, soda shouldn't be a thing, breakfast cereals shouldn't be a thing, and keep going as far as necessary. In the argument between Nanny state and Laissez-faire it's very clear that the food industry will kill millions of people and ruin the quality of life of billions millions, hiding behind smiley friendly packaging, exploiting human biases in ways we have no defenses against, and it's not nanny-stating to regulate killers harshly.
> we wouldn't have to think all the time about it, if we didn't have if we didn't have it ...
You literally did not say those words in the comment I replied to. You didn't even seem to imply it. Either that or there's some kind of shadow ban thing happening and I can't see the same thing you are.
Precisely, the point of Ozempic (or rather Wegovy, Ozempic is for type-1 diabetes) is that it reduces your appetite, making it easier to eat less.
One of the studies done with Wegovy showed that people lost 15% of their body mass in a year, but they also eat 500 Calories less and exercised for 2.5 hours a week.
That's probably counting 'light exercise', aka walking around. That works out to 20 minutes a day, so it could just be the side effect of people being lighter and so walking places being more comfortable.
Honestly I disagree, edits are for spelling and wording. It's important to not edit the content of comments, so that follow up comments and their context remain the same.
It'd be more helpful for edits to be appended to a comment, allowing context of the conversation to still make sense.
Misinformation is also going to be much overused and meaningless if used for situations like a simple mistake. The commenter just misread something - branding it as misinformation seems to imply intent, otherwise why wouldn't you just call it a mistake?
Compared with Type 2, with Type 1 diabetes there are other risks that could occur:
>...While medications such as GLP-1 receptor agonists (Ozempic, Wegovy) and SGLT-2 inhibitors (Jardiance, Farxiga) demonstrated powerful benefits, they quickly were determined to pose too much of a liability for pharmaceutical companies or regulators due to concerns about safety. Specifically, GLP-1s can increase the risk of hypoglycemia (low blood sugar) and SGLT-2s can raise the risk of a serious, life-threatening complication called diabetic ketoacidosis (DKA).
People chanting “If everyone just did X, Y wouldn’t be a problem!” without seriously addressing why everyone doesn’t just do X already, or making a serious proposal for how everyone is going to just do X from now on.
Yep. When 1 or 10 or 100 people do a thing, it's a "them" issue. When 100,000,000+ do a thing - it's a wider issue, and asking those 100,000,000 to do it differently just isn't a useful strategy.
In another vein, if my bank account is $100 short, that's my problem. If my account is $1m short, that's the bank's problem.
Considering it's a societal wide problem, society at large ought to care about resolving it. It's incredibly expensive otherwise to treat chronic, lifelong obesity.
I don't know people who just give the "trite" advice without any actual consideration of the difficulty.
I do see a lot of people ITT who were accused of doing so but who aren't actually doing so.
And I've known quite a few people who get really annoyed at constantly having to hear about how impossible it is to do things that they've personally actually done.
it might be still impossible for others. tell a blind person to just look out for cars. tell a person with paralyzed legs to just get up and walk. tell a type 1 diabetic to just skip insulin.
obesity has a large hereditary component. important genes associated with obesity are expressed in the brain.
is it impossible to live with constant hunger and its consequences? no, likely not, but it's not really a big mystery why millions of people fail to do so.
Given that a few decades ago obesity and overweight rates were nowhere near what they are today, this shows that a large part of the population is weak, fragile, and not very interested in their well-being.
I want to emphasize that a few decades ago, people were much thinner in the Western world and did not hate their lives because they could not eat a triple cheeseburger, go hungry constantly, or feel physically deprived. Those were my parents and my grandparents, I know them.
But if you show them hyper-caloric food that makes them feel like crap, they can't say no. It's disappointing. And the same can be said for addiction to social media, horrible TV series, and constant music everywhere.
Do you think it is because the people before were mentally stronger? No, it is because they lived in a different environment. If you were to transport those people from decades ago to today, the same portion of them would become obese.
That's what I'm saying. It's not that people were stronger then, it's that, as many times throughout life, traits are revealed by circumstances, there's nothing particularly physiological about feeling the need to eat like hippopotamuses that have been deprived of food for months.
The unattractive, low-status man (or woman) has less trouble remaining faithful than the handsome, high-status man (or woman). Not because they are more virtuous, but because they are not as exposed to temptation. But fewer people justify the unfaithful than the “big eater.” And that's something society and culture have decided, for now.
> "there's nothing particularly physiological about feeling the need to eat like hippopotamuses that have been deprived of food for months."
There are many people who don't feel that need. They don't actively resist cramming cake into their mouths, they just glance at the cake disinterestedly and move on. Or eat a bit, and feel that's enough, and don't want more.
https://news.ycombinator.com/item?id=27936016 has discussions about the dramatic rise in obesity after ~1970; refined sugar, chocolate, butter, doughnuts, McDonalds, cars, TV, have been around longer than that. Could there be involvement from Glyphosate pesticide, from reduction in smoking appetite-suppressing cigarettes, Lithium contaminated water supplies, increased Vitamin A added to milk and grain supplies, rise in antibiotics used on farm animals, which causes some people to gain and retain weight more easily?
They are the same people now that they were then. Humanity has not become any more weak, fragile, or uninterested in their well-being — it has simply become harder to resist. TV was appointment viewing and cut off late at night. Before the walkman, there wasn’t much option for music everywhere (the scourge was newspaper-readers! but the paper is only so long). And that triple cheeseburger today wasn’t acceptable or available to eat unless you made it yourself. Healthy eating being hard is a product of collective decisions to make it hard.
By looking at the size and bellies of construction workers, farmers, and people doing all sorts of jobs with significant physical activity, one cannot find much support for this hypothesis.
Back in the day, (almost) everybody was not fat, from the academically inclined to the construction worker. Today, many are overweight, from the professor to the agricultural worker. There used to be more walking, which increased caloric expenditure by 300-700 kcal per day, although sport and recreational physical activity was limited to the young.
The main problems have been the easy availability of cheap and tasty calories, combined with a surprisingly low resistance to the ingestion of those calories.
What the explanation is, that actually requires research. Anything from new food additives, changed lifestyle habits forced by the pandemic, increased chronic stress, screen addiction compromising other opportunities to be active, less walkable neighborhoods, more elevators, higher calorie diet, cost increase in healthy diet to just name a fraction of possible factors.
Or that the situation was different, advertisers hadn’t mastered the 24/7 cycle of selling easy junk food in both home form and fast food form. Every generation thinks they’re superior to the new generation and says “why don’t they just…. “ when a new generational problem comes up. People screaming out against ozempic and friends are just angry that maybe it does work well enough and that people don’t have to struggle for once. Our brains weren’t built for our modern life style. It used to be that people virtually had lots of experience eating Whole Foods, TV was relatively new, parental guidance on “that’s junk food, you can have a little not a lot”, our jobs weren’t built around screens and pecking on keyboards, bombarded by emails and phone calls even after we go home via 1 hour commute each way. It’s easy to say “you’re all a bunch of lazy bums” but it’s also lazy and not true.
> "People screaming out against ozempic and friends are just angry that maybe it does work well enough and that people don’t have to struggle for once"
No, I'm angry in the way that you punching me in the face with my own hand, saying "stop hitting yourself" then offering to sell me a painkiller subscription might make me. The sheer ridiculousness of Big Food vs Big Pharma with humans trapped in the middle. Humans presented by geeks as perfectly spherical rational decision makers, but actually lizard hind-brains wrapped in frontal lobes and language centers, with very exploitable biases, feelings, fears, and base drives and very few defenses against it, and those defenses being undermined at every turn by political lobbying and profit seeking.
It used to be that the devil on the shoulder was the tempter. It isn't depressing that parents and grandparents can't say no to lizard brain instincts, it's depressing that we allow companies to exploit that in a devilishly evil way - to harm people - for money, as much as they can, in almost every way they can think of.
Imagine how much money and time and effort is spent making Doritos 2% more tempting; the crunch, the flavour intensity, the packaging layout, the packaging colours, the mouthfeel, the shelf stability. The same for ice cream and everything else. How far can Kelloggs stretch the gap between the strawberry presented on the packaging and the almost-zero strawberry in the pop tart? Or the honey pictured on the Honey Nut Cheerios box with the "hint of honey" in the description on the back? How To Cook That[1] on YouTube on Kellogg's misleading and potentially misleading claims.
Eating less and exercising more does work, in fact that is how you lose weight. The problem is doing it consistently which is what these drugs help with.
Yes, they clearly mean that it doesn't work at a societal level. If you take a human and force them to exercise more and eat less, they're going to lose weight. And everyone knows that, but pretty much every modern society is increasingly overweight. Ergo, "it doesn't work".
It would work if people would actually do it. It 100% works. Human nature is such that people would rather take a drug than change their lifestyle. I've done it myself but it requires a complete realignment of lifestyle to make lasting change.
Another problem is not doing it enough. Walking a couple miles once a week isn't going to do much. You have to make it a habit, part of your routine, and do it every day.
Also not only is your body very efficient at walking/running (losing 10lbs of fat requires an average person to run from SF to LA) there's evidence of a constrained total energy expenditure model. If you try and create a large caloric deficit through exercise you become more efficient at the exercise (so each incremental step costs less calories) and your metabolism slows down (and your NEAT - non exercise activity thermogenesis - levels drop) to conserve energy for you to expend on exercise.
In 2018 I did an Ironman triathlon. Across 2020 and 2021 I cycled over 20,000 miles. I cycled 200 miles on the hottest day of 2022 in the UK. In 2021 I cycled 200 miles in under 12 hours. In 2023 I ran over 10 half marathons. You simply cannot tell me I didn't completely realign my lifestyle or that I'm not determined.
At my lightest in 2023, I weighed 60kg. Currently I weigh over 95kg. I don't know what else people who hold your view can be told to convince them this problem is not one of willpower. I have the capacity to suffer. I've given up smoking. There is no escape from food.
You described a lot of physical activities, but diet controls your weight. It's natural to have more of an appetite with increased activity. It's also normal to increase your weight a bit due to increased muscle mass.
I’m trying to demonstrate that I’m not this ridiculous (and frankly grossly reductive) caricature of the overweight slob. And yet I still struggle with food. So maybe let’s drop that notion altogether, because it’s not at all helpful.
Yup. I lost 70 lbs in 2017, and I ran my first marathon last month. I'm going out to run a half on Sunday because that's just what I do now, it's nothing to go out and enjoy myself for 2 hours. I'm fit, I know how to lose weight, I know how to be in the suck but I know that this coming winter I'm going to have to fight to keep a decent weight as I fight stress and the holidays. The battle never ever stops and it's exhausting.
Of course, it "doesn't work" because people don't keep it up. I started exercising regularly during covid and didn't stop. I cut out all the soda. It works.
We’re on fluoride from the water our entries lives, iodine in the salt and various B vitamins, iron and calcium in the flour. Why stop there? This has been an overwhelming coup for public health.
I dropped from the mid 300s 10-15 years ago to 260-ish these days. It fluctuates from 250 to 280 over time, but keeping off weight long-term by changing diet is very much doable.
That should be very doable for most people. 250 is overweight for everyone under 7 feet tall, and 280 is obese for everyone under 6 foot 9 inches (that's about 99.997% of the population, if my data source is correct). For the vast, vast majority of people 350 pounds would be somewhere in the mid-40s BMI.
If you want to not be fat, exercise and eat fewer calories. Full stop.
The fact that a certain group of individuals don’t have that self control is just evidence that education and public health have a place. Drugs won’t solve that.
These drugs are needed for people with metabolic disorders caused by years of food abuse or poor genetics. It’s not a population wide solution.
We have 50+ years of incontrovertible evidence that that advice doesn’t work for the overwhelming majority of people.
“Just have self control” is the stupid take imho.
A meta-analysis of 29 long term weight loss studies[1] found:
> By 5 years, more than 80% of lost weight was regained
I think a much better hypothesis is that CICO does work, physically, but there are metabolic, hormonal and mental factors that either predispose towards obesity or make it difficult to escape.
It's a bit like telling gambling addicts to "just stop gambling" or depressed people to "lighten up".
And along comes GLP-1 drugs, where obese people find it easy to lose weight, find new motivation for life, etc. The GLP-1s aren't increasing metabolism, nor are they making people exercise, nor are they making food less available. Yet somehow, a hormonal mediation is greatly successful, hmm.
it's interesting you state "Studies show it just doesn't work."
While we are commenting on an article about a drug which makes you feel less hungry, there by "eating less". The drug doesn't make you use more calories, it simply "makes" you EAT LESS.
Eating less(calories) than your body uses consistently for duration is literally the only way you can lose weight. (outside of literally losing limbs, or surgery to remove mass)
Exercise only augments the process, it all comes back down to EATING LESS(calories).
There are a number of pathways these drugs hit - dopamine receptors, they slow processing of food, and in tirzepatide's case at least increase insulin response. They're not just small portions in a shot.
I take "Studies show it just doesn't work" to mean "Studies show telling people to eat less and exercise more definitely doesn't work," as opposed to "caloric deficits don't work".
People need to understand what activity / exercise really is. The desperation of the medical establishment to get people to do ANY exercise meant the general advice is watered down.
It's the doom of the statistical distribution. Good outcomes are defined in relative terms on the bell curve, not on absolute performance which exercise is actually suited for.
In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. I can imagine farmers back in the days of 12-hour days of physical labor may burn 5000 or 6,000 calories. A pound of fat is 3500 calories.
Meanwhile, people that are generally following some 20 minutes of exercise five times a week, regimen of the medical establishment are likely really only burning about 300 to 400 calories tops in those 20 minutes sessions, if they even do that.
For the sake of argument, we're going to ignore the basal metabolic advantages of people that are burning an extra 1,500 to 3000 calories per day and the stimulated muscle growth that comes with it.
People back in olden days just on activity were burning a third to a half a pound extra of fat per day in terms of energy.
Meanwhile, modern people who "exercise" are burning maybe a tenth of a pound. Only when you get to "athletes" that are "training" do you get to the calorie burns that people's lives used to entail.
So it's important to keep in mind when people say exercise is ineffective in weight loss that they really are talking about very minor amounts of added activity by by modern medical standards.
Exercise is extremely effective at limiting weight if you get to what I call the 1000 calorie Hammer, where your exercise is adding an extra thousand calories or more per day to your activity. And you're simultaneously not going nuts on your diet.
A 1000 calories is a considerable amount of activity. For a 180 lb man, that's 4000 yards of swimming, 7 miles of running, or 25-30 miles of biking.
If you are a 120 lb woman, increase those distances by 50%. Most people consider those loads to be exercise obsessives, but practically that's what's necessary in order to employ exercise as a usable means for weight control and surviving the corn syrup world we're in
> In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles.
Hasn't this idea been studied using modern-but-primitive groups of people who still live much as they have for thousands of years? Their bodies are quite efficient and they do not burn substantially more calories than "civilized" humans in regular society do.
Finally someone posting something that makes sense. I have hormonal issues that make me predisposed to being overweight. When I lived in New York, I was able to keep the pounds off by walking 20 miles per day. That's how evil my body is. That I would literally have to draw green polygons over Manhattan for five hours a day to not be overweight. I stopped doing that when I moved to the Bay Area because it's not as much fun to walk around here. So I'm very excited about Ozempic since it'd be nice to be able to be able to keep the weight off and get most of those five hours back.
I used to do a hard hike every week which burned around 1000 calories. You're not doing anything else that day unless you keep this up for a very long time.
But yes, great way to lose weight I agree, just not practical for a lot of people.
hiking is probably a bit better, but walking only burns 2/3s the calories that running does for a given unit of distance.
So a 190lb man burns 150 calories for running a mile, but only 100 calories for walking it. It will take about 20 minutes to walk a mile, and about 10 minutes to run one.
So this relates to the original complaint about exercise 20 minutes a couple times a week: if you walk 20 minutes, you've burned... 100 calories.
A 1000 calorie hike is probably 10+ miles, and that's about 200 minutes. 3 hours and 20 minutes! Yup, quite the time commitment, however if you ran 7 miles it would only take about an hour.
Eating less and exercising most certainly does work, if the individual sticks to the routine.
I do agree it's difficult to stick to a routine because our modern lives are demanding and so we compromise by eating fast food and avoid going to the gym.
I think the exercise paradox video recently put out by Kurzgesagt has been a net negative for how people think about diet and exercise. The paper the video is based on is highly flawed.
That paper has a few major problems but these are the biggest:
1) The authors didn't control for body mass. The Hadza and Bolivians burned 52kcal per kg of body weight. Americans burned only 38kcal per kg of body weight. That is: the active groups burned significantly more calories than the inactive groups, on a pound-for-pound basis.
2) The active groups were defined as such because they walked ~12km per day. This is significant because the human body is exceptionally efficient at walking. It is certainly true that over a comparable span of time, you will burn less calories walking than you would running, or lifting weights.
GLP-1's are miracle drugs and people should take them if they at are high risk for obesity-related diseases.
But diet and exercise certainly do aid weight loss, and will have fewer negative side effects than a GLP-1 drug.
Homeostasis is a powerful force. Once you gain weight your body has a tendency to keep it, and overcoming that to establish a new equilibrium is difficult and uncomfortable.
That is a simplistic description which is superficially true. The body, however, is quite a bit more complicated than that. Especially when you get to that wrinkly pink lump in your skull.
The point you're missing is that telling people "just eat less" doesn't work, because it's extremely difficult for many people to "just eat less".
That's literally the whole reason that ozempic etc are popular, because they make it easier for most people to just eat less, in the same kind of way that caffeine makes it subjectively easier for someone who's tired to be productive.
It does work. It couldn't not work. Each day of your life, you choose to do one of three things:
1. Consume more calories than your body will need to function
2. Consume as many calories as your body will need to function
3. Consume fewer calories than your body will need to function
When you consume more energy than you require, your body stores the remainder as fat. When you consume less energy than is required, your body converts your fat into usable energy.
Now obviously, this is an over-simplified explanation of nutrition. What you eat, when you eat it, how efficiently your body converts food to energy, and other factors will determine the little details. But the explanation I've provided is not nearly as over-simplified as "it just doesn't work."
To make a comparison, it would be like suggesting that the financial advice "earn more money than you spend" just doesn't work as a method of saving money, on the grounds that some % of Americans who try to save money end up in credit card debt.
So if understanding the equation about how humans can obtain and maintain a healthy diet/weight is as simple as you present here. Why doesn't everybody just do that?
You say yourself, it couldn't not work. And yet there's hundreds of thousands of people that say it didn't work. Explain them, are they lying?
I'd assert, the oversimplified explanation is misleading. It's only true in the same way that drinking cold water will help you lose more weight than warm water. True or not, reality seems to strongly suggest it's irrelevant
It's more likely that hundreds of thousands of people are collectively lying, than it is that trying to find a solution that works for hundreds of thousands of different humans all with different needs, lifestyles, desires, capabilities, and understanding, might be a tad more complicated than just counting intake calories?
Why assume people will do what’s in their own long-term best interests, especially after being presented with a short-term thrill?
Pizza tastes better than granola. Grand Theft Auto is more fun than math homework. Having a Dodge Charger is cooler than having a Hyundai Elantra. Who cares about the costs? I can always fix my bad habits tomorrow.
> Why assume people will do what’s in their own long-term best interests, especially after being presented with a short-term thrill?
So, human behavior is more complicated than just counting? Why would someone eat pizza instead of granola? Are there some physiological reasons for this? I wonder if there might be an evolutionary advantage for a species to develop the desire for high caloric foods? That sounds like something that would make it much easier to make the decision to seek out pizza, and much less likely to choose granola. Especially when you consider that humans are mostly creatures of habit.
Saying just count calories is reductive to the point of absurdity. you can tell it doesn't work because it hasn't worked for society for decades, yet it's such an obvious solution no one stops to account for the astronomical amount of evidence that proves "just try harder" does not work on most humans. So, do you want to be right, or would you like to do something that actually helps humans improve their quality of life? "Just try harder" doesn't work, and it takes wilful ignorance of the evidence to claim otherwise.
let's apply this same logic to writing code, we wouldn't have any more bugs if people just reviewed their changes before committing, and wrote that one extra test, right? Works on my machine, ship it to prod... what do you mean millions of computers now bsod on boot? Surely it was just that one extra test, and it's pointless to do staged rollouts or smoke tests or anything like that?
Just never make a mistake is obviously asinine whether you apply it to writing code, or deciding what to eat. The difference being we don't have a millennia of evolution trying to convince us to write bugs.
I agree with the premise, people are responsible for their diet their decisions and their habits. I just don't agree knowledge of that is enough for everyone to improve their quality of life.
You're letting that word do some very heavy lifting.
> To make a comparison
I think the comparison is very weak, very superficial. The human body is way more complex than CICO. But your comparison does have some intuitive value -- there are more than a few people who consistently spend every penny they make, and sometimes more, just trying to survive. We don't see a lot of them on Hacker News, to be sure.
Genuine quesion - if I eat 1500 calories today and do a measured 2000 calories of work on a treadmill, where did that extra 500 calories of energy come from?
Are you suggesting my body can create energy from nothing?
Generally your liver will store between 12 and 24 hours of calories in the form of glucose. After that, it's likely fat stores from adopose tissue (fat cells)
Given the observational evidence that it doesn't work, what are you really asking?
Imagine a computer with a primary source of power, and a backup supply. You're measuring CICO of the primary supply. And you're tightly regulating the power available on primary to keep a power deficit. Unfortunately, during periods of high load, this computer is able to switch to the backup supply which you aren't able to exert tight control over.
There's a huge number of things that could cause a human to ignore their best interests. Ignorance to consequences, the long-term implications of any decision, degraded mental health, external social pressures, the list goes on and on.
Humans have impulses just like every animal, and proper training can convince a dog not to immediately lunge and eat every morsel of food they can smell. but it takes a lot of work and external pressure to train that into a dog, and even then given the right circumstances a dog will still eat food above their caloric needs. Humans behave the exact same way.
> it's easy for me to regulate my weight using cico, so obviously it should be easy for everybody
I know that's not the claim you're making, but it seems like it is and it is the one many other people in this thread are making. just like it's easy to train some dogs than it is train others. it's easier for some humans to control their caloric intake than it is for others.
CICO doesn't work for most humans. Claiming otherwise is on par with the saying just run this IOS app on Android it's easy it works for me! Perhaps a sufficiently capable engineer could make it work, but most humans aren't sufficiently capable.
> Given the observational evidence that it doesn't work
I think you need to be very careful about your language choice here.
Physics says it has to work. Every athlete on earth knows it works. Everyone that has ever been in a prison camp, concentration camp or had their calories restricted outside of their control knows it works.
It absolutely, factually, 100% works. Our entire understand of mammals and energy depends on it working.
What you are saying, is that people are unable to exercise enough self-control to actually consume less calories. If they did, it would work. But they don't.
That's like saying "pointers in C don't work" because when many people try they get seg faults.
I really don't think it's constructive to say "CICO doesn't work" when what you mean is "many people find CICO difficult to implement, because having the self-control/will power/determination/control to do that is hard."
I became heavily involved in weight watchers (which is essentially just CICO - their "points formula" is basically calories/50). Over many years I watched hundreds of people lose hundreds of pounds by being careful about what they ate. It was hard. There were a lot of tears, there were a lot of false starts and plateaus and hard times.
The people that stuck with it had incredible transformations and live different lives now. My room mate at the time lost almost 200lbs and became head of the WW in that city and when I saw her after 10 years I did not recognize her at all, and actually refused to believe it was her for 5 minutes.
CICO absolutely works. Like most things worth doing in life, it's hard. And it's worth it.
Please don't cross into flamewar like this and please don't get into tit-for-tat spats. It's not what this site is for, and destroys what it is for.
When people start arguing over who said what, who did what to the discussion, and get increasingly personal about it, it was time to stop quite a while ago.
Please don't cross into flamewar like this and please don't get into tit-for-tat spats. It's not what this site is for, and destroys what it is for.
When people start arguing over who said what, who did what to the discussion, and get increasingly personal about it, it was time to stop quite a while ago.
I feel this is an unfair characterization. Which part of my response crossed into flamewar territory? Or is this preemptive because the discussion is trending in that direction?
bah! :( I don't understand how I'm supposed to call attention to the parts of my previous comments that were important to being understood, but disregarded in the reply if that is what was wholly inappropriate. Other than to not reply at all when previous comments are misunderstood or ignored.
Not replying is usually the strongest rhetorical move, for what it's worth. Long threads implicitly elevate the other side of the argument. If you're trying to dispositively conclude a debate, make your case once, dispassionately, and then don't restate anything you've already said.
I mean, it works in the sense that if you keep your calories out higher than your calories in you will lose weight.
Studies show that it's basically impossible to know your calories out without indirect calorimetry (and updating it regularly, no less, since your BMR + NEAT can vary significantly over time and in direct response to contemporary efforts to lose weight) -- and studies show that humans are dreadful at estimating their calories in.
So yes it works in a lab setting where your CI is pre-portioned in the form of milkshakes and your CO is measured via calorimetry. In reality though it makes people hella hungry and your hunger tends to increase in excess of changes to body weight.
Which is why the average weight regain after loss is 80% over 5 years.
So naturally it would seem we would look to develop ways to reduce our CI subconsciously. Enter GLP-1s. This is literally all they do. They reduce your hunger so your CI remains below your CO which studies show almost nobody can do without help.
Yes some people are genetically going to lose 200lbs and become the head of Weight Watchers in the same way that some people are going to win the olympic gold medal in swimming. That doesn't mean that you are going to win an olympic gold medal in swimming and it certainly doesn't mean that if the average person follows Phelps' training plan that they'll get an olympic gold medal in swimming.
Ultimately a treatment that works but nobody can actually maintain is a treatment that does not work. Hence GLP-1s. The question is why they are unable to keep their CI below CO. Not whether that’s how they lose weight.
What word would be better than “choose” in this context? For the majority of people who aren’t prisoners or toddlers, there is a good deal of personal choice that determines what foods we eat and how much.
Even if fate has it that I must end up at a Wendy’s drive thru tomorrow night, couldn’t it be true that I could choose to eat the 400 calorie meal instead of the 800 calorie meal, or order water instead of Sprite?
Will. Will is a better word. Every day you will consume calories less than, equal to, or greater than the amount of calories you expend.
The problem with choose is it implies an intentional, free choice. I can manufacturer plenty of contrived examples to show it's not always the choice of the person. But I'll use a real one I remember.
Yes, you, who I assume has thought deeply about personal responsibility and and willpower and how to obtain the best life for yourself over what I assume to be between years and decades of practice doing that, are able to choose water over Sprite.
but I can tell you from the experience of somebody who strongly believes in the responsibility of your own decisions, and how willpower is a learnable skill, and about being healthy, and about how every decision matters. When I'm tired, and depressed, and feel like I'm about to break. Even knowing, even having the thought that I should choose water over soda, I've still chosen soda.
Fair choice though right? There were no other factors, or influence over why I drank 200 calories of sugar? I should just have remembered water would be healthier?
That's what I assume they said the word choose is doing a lot of heavy lifting. because often choose is presented exactly the way that you did.
> Even if fate has it that I must end up at a Wendy’s drive thru tomorrow night, couldn’t it be true that I could choose to eat the 400 calorie meal instead of the 800 calorie meal, or order water instead of Sprite?
When often, humans tend to be slightly more complex than just that.
The human body is way more complex so as to defy the laws of physics as we know it? The human body cannot create matter. In order for it to increase in mass, you must be inserting extra mass into it.
Sure, a mammal does not HAVE to store excess energy.
But that is entirely irrelevant when a mammal eats less energy than they consume for a while. In that instance they MUST burn some stored reserves or break the laws of physics
It works in the same way as crossing the finish line first works to win a race. Of course it works, do that and you win 100% of the time. It is not that it doesn't work, it is that it is extremely difficult to do.
I hear very often this theory that "it just doesn't work".
To be fair, I had also believed this for many years.
However, all the people who claim that "it just doesn't work", have never made any serious attempt to do "it", so they cannot know whether it does work or not.
I have been obese for more than a decade, during which I have made several attempts to lose weight, which have all failed, because they were not done in the right manner.
Then I have made a final attempt using the correct method, and I have lost about 35% of my initial body weight during about ten months, at a steady rate between 100 g and 150 g per day, i.e. about 1 kg per week.
This was more than 10 years ago and since then I have kept a constant weight. Because I have done this once, now I can control my weight and have any weight I want, even if I gain weight extremely easily. It is enough to eat one day like I was eating when I was obese to gain enough weight to require a week of weight losing diet to go back to the desired weight.
The rules for losing weight and maintaining the weight are very simple, but they must be observed and those who claim that "it doesn't work" never try to observe the rules, so it is entirely predictable that it cannot work for them.
First, it should be obvious that after losing weight one must eat differently as before, otherwise weight will be gained until reaching again the original weight.
To be able to control the weight, anyone who is or has been obese must stop eating until they feel satiated. At each meal, one must plan before beginning to eat how much to eat and then eat only the amount planned, never more than that. One must eat a fixed number of meals per day (preferably few, e.g. only two meals per day should be enough for an adult who has a sedentary lifestyle) and never eat between meals any kind of snacks or drink any sweet of fatty beverages. Between meals, only water or beverages without any calories (e.g. unsweetened herbal teas or tea or coffee) are acceptable intakes.
While losing weight, the most important thing is to weigh oneself every day with precise digital scales (with a resolution of 100 grams or less), at the same hour and in the same physiological conditions, i.e. in the same order with respect to meals and relieving oneself.
Whenever the weight is not less than the previous day, then the quantity of food planned for the current day must be diminished in comparison with the previous day. At the very beginning of losing weight there may be a delay, e.g. of a week or so between starting to eat less every day until the weight begins to decrease, but eventually it is possible to reach a steady state of a constant rate of losing weight per day.
When diminishing the amount of eaten food, only the carbohydrates and the non-essential fats must be reduced. The amount of proteins, essential fatty acids, vitamins and minerals must remain normal. To achieve this, one must eat a source of pure proteins, for example turkey breast or chicken breast or some kind of protein powders, so that eating enough proteins contributes only a minimum amount of calories. The rest of the nutrients can be provided mostly by non-starchy vegetables and perhaps by some supplements like fish oil. One could also eat almost anything that is not recommended, for instance chocolate, with the condition that the quantity is negligible, which can normally be achieved only when such treats are not eaten every day, but e.g. only once or twice per week.
These rules are simple and anyone who follows them will lose as much weight as desired. Obviously, this is easier said than done, because for the entire duration of the weight-losing diet one will be permanently hungry and one would tend to think about food and it will be difficult to resist temptations, so it is better to not keep in the house any kind of food that can be eaten immediately, without requiring some kind of preparation. Unfortunately, this is unavoidable and it is the price that must be paid....
I must say that I really understand what is in the mind of those who claim that "it doesn't work", because this is exactly what I had believed during many years, after many failed attempts to lose weight.
I had become convinced that nothing that I can do could change my weight.
Nevertheless, now, after I had eventually done it, I can see clearly the errors of my previous ways, so I can no longer agree with the opinion that it does not work, when it can actually work very well, as long as you accept that you must be hungry all the time while you are doing it.
I want to add that the feeling of hunger can be diminished a lot when you eat food cooked at home instead of industrially-produced food, especially when you avoid sweetened food. Using modern techniques, like cooking all meat and vegetables in a microwave oven, it is possible to cook food at home in an extremely short time, so the lack of time is no longer a valid excuse for eating junk food.
It got downvoted because it's an anecdote and an anecdote isn't a substitute for a study that covers eighteen million people. We know the odd person can do it, 1 in 1667 per year if you're very overweight. That doesn't mean that 1 is representative of the set. In fact we know it's not representative. Because we have data.
It's like interviewing Michael Phelps and he's like "just swim! I did it! Anyone can win a gold medal by swimming." No, they can't.
And the reality is average weight gain over the 5 years following weight loss is 80%. Everyone who participated in the Biggest Loser weighs almost as much as when they started and has a metabolism an average of 17% slower than would be expected for someone of their new body composition. [1]
I'll push back and say anecdotes need more downvotes because they're actively harmful to the discourse, and are a large part of how we got to this point of just abject unhelpful information being passed off as useful.
This is how we get all sorts of medical misinformation like "I ate some almond seeds and my cancer went away." We don't accept these kinds of anecdotes in direct opposition to medical evidence for any other disease, we shouldn't accept them here either.
It's survivorship bias -- where are the anecdotes from the people who did exactly what parent said and didn't lose weight? They're in the study. Will OP update if they regain weight?
You can look up any of OPs rules, they've all been studied, and they don't work for most people.
You know what works? GLP-1s.
What matters for your health isn't that you tried real hard, what matters is that you lost weight. Nothing wrong with losing weight via GLP-1s then going to the gym and trying real hard to get jacked.
All this study really shows is an analysis of medical records with no background of the peoples' diet or lifestyle. The outcome should be obvious and expected, those who are overweight and obese were found to stay that way.
The fact that the rate of obesity in the US has pretty consistently risen for decades makes that clear, you don't need statistical models of medical records to know that the rate of obesity could only really keep going up if those already obese stay that way.
>There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11
Unsurprising. They ran statistics on arbitrary overweight and obese people, with no idea of who was actively seeking to lose weight or who was just coming away from such an effort. If a significant fraction of the overweight/obese population did lose 5% of body weight/year, we wouldn't be seeing a bunch of overweight/obese people.
> but the broad ranging psychological effects are concerning.
Fwiw, to me the symptoms he and others have described don't seem very different from those of long fasting. And I would definitely prefer those symptoms to the ones I had due to obesity which ranged from extreme fatigue, heart-pain, muscle spasms, depressive shame, restlessness and so forth.
> Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.
Perhaps coincidentally, this is similar to my experience with week long fasts: After 48 hours I feel like a precision missile cruising towards my target until about 5-6 days later.
But I will use a suitable GLP-1 based drug, because, man, fasting feels unbearably brutal for me after 6 days: profuse sweat, increased heart rate, brief but intense panic attacks, an insane level of sad (but not depressed) introspection, a hairpin trigger temper. I become a ridiculous mess. There's got to be a better way!
I definitely am. That first shot took a solid 30 seconds and three false starts before I could jab it in, but it turns out to be a great big nothingburger once you do it. Can barely even feel it, nothing like the intramuscular shots like flu/etc. I could do this shot as often as necessary without batting an eye.
Might have to float this by my tirz-taking partner, especially if it helps with side effects. They always feel a little icky the day immediately after a dose.
These are the same effects I got from doing OMAD and going gluten free. If I fuck up and eat processed food, the "food brain" comes back, and I start chasing dopamine like a fiend.
I'm a fan of these tools helping people get this insight, because otherwise people just accept that cloud as their normal.
> The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.
If you want to be successful long term in your weight loss, especially after stopping the drug, you should really invest in changing your mindset.
This is a massive positive, not at all a negative.
You got fat because you ate too much. If you don't understand what are normal portions now, you'll go back to your starting weight as soon as the drug isn't having effects anymore.
This is a lifestyle change that you MUST embrace to be successful long term.
There's some evidence that Ozempic improves general impulse control, e.g decreasing alcohol consumption [0], which the article mentions.
Also, as Tyler Cowen writes [1], this is probably going to translate into big improvements for animal welfare:
> People lose weight on these drugs because they eat less, and eating less usually means eating less meat. And less meat consumption results in less factory farming. This should count as a major victory for animal welfare advocates, even though it did not come about through their efforts. No one had to be converted to vegetarianism, and since these drugs offer other benefits, this change in the equilibrium is self-sustaining and likely to grow considerably.
So overall, widespread Ozempic adoption seems like progress to me.
While this entire chain of thought seems a bit far fetched, I think the reasoning here is that if you lower the demand for meat, you don’t have to resort to factory farming.
I went through a period of vegetarianism (for health reasons, not directly for ethics), and once I started eating meat again, 1. I eat a lot less, which 2. means that I can be much more intentional about sourcing it.
Right now the bulk of the meat that I eat at home throughout the year comes from 1 or 2 animals that are locally sourced and butchered (normally I share a portion of a pig and a cow), and the occasional wild caught fish. The meat is tastier, and I can go see the actual animals at the farm if I so choose. They are not factory farmed, and the price per pound is about the same as buying industrial meat at the grocery store since I am buying directly from the farmer, and paying a local processor for their services.
As things wane in popularity it might be true that they become more of a commodity, or it might be true that they become more of a niche product where people care more.
I would like to think that if meat consumption becomes more of a treat than an everyday thing, that people would treat it as such, and go out of their way to eat something that tastes better.
I would hope this happens, but merely having fewer animals alive in factory farming conditions would be a welfare gain from me because I think a factory farmed animal's life falls below the "life is worth living" threshold. YMMV.
Maybe. There is some evidence that the decline in fertility rates are associated with overweight and obesity. Social and biological factors leave having children more difficult when one is outside of a "normal" weight range. If everyone is on Ozempic, they might have more children, requiring more overall food and harming even more animals in the process.
> If everyone is on Ozempic, they might have more children, requiring more overall food and harming even more animals in the process.
It's reported it reduces a series of impulsive behaviours. Would it extend to sex? If people are less willing to have sex, maybe broad consumption of the medicine will further drop fertility rates.
This gets into a deep philosophical question people spend too much time arguing about. In short, some would argue suffering is multiplied by the number of sentient beings that experience it, others would argue only the average "amount" of suffering matters. You can end with some absurd paradoxes if you take either to their extremes.
It is perhaps simply the case that such things are inherently paradoxical. There is nothing in the stars that says ethics should obey PnC!
You see a paradox and say "well that's not right, we should do something about it." This has been the story since Kant, but for his part, everyone seems to forget that he doesn't ultimately "solve" his antinomies, he just leaves them as conclusions, "effects of pure reason."
It seems way more unreasonable to assert that, in fact, there is some consistent, complete ethical framework out there, but we havent found it yet, than it is to just accept that some kernels of truth or sense are not formalizable in the classical sense.
> It seems way more unreasonable to assert that, in fact, there is some consistent, complete ethical framework out there, but we havent found it yet, than it is to just accept that some kernels of truth or sense are not formalizable in the classical sense.
We can prove that complete and consistent set of axioms for all mathematics is impossible. An equivalent proof for ethics would itself be useful.
However, we do not need to concern ourselves with infinite sets etc. for ethics the way we do with natural numbers, as there's only relatively (in mathematical terms) small number of real people to interact with or influence the lives of.
We may not be able to reach an optimal outcome with even a limited n, if it turns out to be akin to P != NP. But even knowing that, would itself be useful.
The problem I have with Utilitarianism isn't any of these things, it's that it's simply trying to maximise how much utility there is in the world, then immediately tripping over itself because the terms "utility", "maximise" and "the world" aren't well-defined, and the way it is introduced is simply adding up.
Mere addition, as mentioned by the other user is the primary one I was referring to, but breaking different approaches to utilitarianism only requires one to take them to their extremes.
If average welfare of humans is all that matters, then one happy human living alone in the universe is the equivalent of a million happy humans.
If sum of "welfare" is all that matters, then you can argue an exceptionally large number of people being tortured indefinitely is better than a happy person.
> In short, some would argue suffering is multiplied by the number of sentient beings that experience it
Factored by how cute the animal is. As a producer of plants for human consumption, it's quite obvious that orders of magnitude more animals are harmed in that process than are ever harmed in traditional meat production. But they're mostly ugly insects, so nobody cares.
Yay, more dependence on the people that are causing the problems to begin with!
I swear covid was a personality test. If you came out of the last 4 years and are looking for more dependence on government and pharma… well, the horseshoe is a V I guess.
I think the assertion that "eating less usually means eating less meat" is probably false (though I couldn't read the article cuz paywall).
The first article talks plenty about why: people are eating less of the the things that are addictive to them, such as alcohol and cookies, which are a major source of calories.
Eating animals and animal welfare are two entirely different things. We could all be vegetarians and still be intentionally or unintentionally intolerably cruel to all other life on this planet.
I had a short conversation with an agronomist friend of mine. Crop prices are in the dumps right now, and I was wondering if it's because of these drugs. He said this is being openly discussed.
What percentage of the population is on GLP-1 drugs right now?
Well "According to KFF polling from May 2024, 6% of all adults report that they currently are taking a GLP-1 drug, and 12% report that they've ever taken a GLP-1 drug".
Is 6% enough to affect crop prices? Presumably some ag economist can weigh in. Note it would only be a reduction per person, not a full 6% reduction in consumption.
This matches experience with dieting and impulse control, without these drugs even. Two days of junk food and the food brain is SCREAMING in my head. So I just don't do it. It's also way more obvious when I mess up, that it makes my body feel bad.
But when I say food brain, it's everything. I want to vape, I want to have more coffee, then more beer, then some cannabis to go to sleep. Wake up and hit the dopamine cycle again. I have to take care of myself and ask "why am I doing this, could I just not, and if so I must not".
I don’t want this to come out insensitive or from under the rock, but why is taking a drug a novel & cool idea (all of a sudden/recently) as opposed to good old fashioned working out and not eating more than what you need? okay, this drug is all kinds of great and it’s the next best thing since green grapes, still not eating more and workout is better than taking drugs that effect your brain right? Are doctors required to explain this before prescribing this in US?
Saying that the cure for obesity is to eat less is like saying that the cure for heroin addiction is to stop using heroin. It's both clearly true, and also useless.
And yet most obese people are no more addicted to food than you are addicted to oxygen...
It's so bizarre how many people will pretzel their way into moralistic non sense to find a solution to what is clearly a medical problem.
Obesity as far as we understanding it now is an hunger regulation problem. For unknown reason a lot of people still feel the need to eat even when their body is clearly in calory surplus.
No amount of of impulse control or moderation can make you override billions of years of evolution and not eat when you are starving... if we could... society would be a very different place
My theory is that consuming sugar makes you more hungry. You can eat until you're full, but if you eat desert or a sugary snack a little later, it makes you feel less full and you can eat more. As if your brain notices the sugar source and switches into "full loading mode" and craves more of this historically rare resource.
> And yet most obese people are no more addicted to food than you are addicted to oxygen...
Most obese people seem to be addicted to sugary food, soft drings, desert and all that, which then triggers more eating.
In addition, it might be a gut bacteria thing. If your gut is used to processing lots of sugar, you crave it even more and fighting your gut microbiome requires way too much impulse control and moderation.
The solution might be to recognize this mechanism, remove all sugar from the diet and find a way to control impulses for a few weeks until the gut bacteria changed.
Drinking water and chewing sugar-free gum helps me to remove food cravings temporarily with no downsides. But... I have a normal weight.
I think insulin resistance from excess calorie and carbohydrate consumption has a lot to do with it. One of the symptoms of hyperglycemia is increased hunger, since glucose is staying in your blood stream instead of getting into your cells. 1/3 Americans have prediabetes, and more than that are probably developing insulin resistance.
> For unknown reason a lot of people still feel the need to eat even when their body is clearly in calory surplus.
Boredom, stress, unhappy life, happy life, laziness - it could be anything. You know what it couldn’t be? Exercise. I’m yet to see a person working out hard and eating at the same time.
> I’m yet to see a person working out hard and eating at the same time.
No, but plenty of people have their hunger stimulated by exercise and eat too much after.
You simply can't fix being overweight or obese with exercise alone in the vast majority of people. Even if you don't believe in the constrained total energy model that a good chunk of metabolic research PhDs think is at least somewhat true and instead believe solely in the additive model, exercise stimulates hunger and it's far easier to eat 1000 calories than burn 1000 calories.
You have to do both and exercise doesn't automatically make the other easy.
Ok, in the US start talking about food addiction seriously and see what happens.
Do you remember how long it took to get tobacco mostly banned in the US? Do you remember how much the tobacco industry played the skeptic and introduced bunk science into the mix?
Well Coca Cola, Pepsico, Nestle, and all the other junk food companies have been on this game for years now. Want to change school curriculum?, well your political opponent has $100,000-$1,000,000 more than you from the make people fat industry. Meanwhile there are a crazy number of attack ads against you for being a crazy commie that wants to control peoples lives, you socialist bastard, you're against freedom.
Heroin changes brain chemically, it's (more) serious addiction than obesity, again being a little insensitive to obese people, but they're bad in comparison. And there are degrees of truthfulness & wrongness right!
About the point you're making, two generations before you and me, people where fit, more attentive & generally healthy (outside vaccines that prevent diseases now & positive effects due to advancements in medicine), what changed?
Not as platitude, but go from first principles, the choices you make everyday effects your mind (& the time you spend on particular activities), and if they aren't life affirming (for lack of better words), in due time you limit your options (ie less choices from your mind, bad food or less bad food or multiple bad ways to spend your time?), till you proclaim from high top mountains 'oh god, I'm helpless without acceptance from some higher power!'
This isn't to say, I'll be as preachy and asshole(ish) to a friend or someone I care about in similar need, I'll probably say 'seek medical help etc' like you. But thinking things through & arriving at truth is important, don't you think?
This is different to mental strength or controlling yourself etc, it's more about self reflection & freedom through discipline, respecting your life, decisions & thoughts more than your impulsive emotions in an ever distracting world, that kind of thing..
I don't think I'll change your mind or this will come across in good faith, that's okay, I'm in a reflective mood, and it's awfully chilly outside :-)
> About the point you're making, 2 generations before you and me, people where fit, more attentive & generally healthy (outside vaccines that prevent diseases now & positive effects due to advancements in medicine), what changed?
Air pollution, water quality, pestecide, food/produce quality, plastic particule everywhere...
I find this perspective so bizarre.
Whats the most probable in 2 generation of exponentially increasing and barely regulated technological changes : culture has change so dramatically as to change human nature and makes us all lazy... or... something in the environment/food chain is having phisiolical/biological effects...
People living in country side & eating from organic farming, they're doing alright (similar to our closest ancestors), but that's beside the point
Cultural change over 2/3 even 10 generations will not significantly alter your biology. Pollution & disintegration in modern world you're referring to, they do have negative effects on our health, but it's not the whole story and they possibly cannot have effects on your decisions about what you eat and how you spend your time right?
I'm particularly referring to obesity caused by over eating, bad life style etc (not the other rare serious persistent irreversible kind that happens as side effect of more serious ailments or genetics)
I can't quite understand if you are agreeing or disagreeing with me...
You seem to be restating my point as if you are contradicting my statements.
> People living in country side & eating from organic farming, they're doing alright (similar to our closest ancestors), but that's beside the point
Maybe ( I would love to see some sources for this assertion). But even if I give that to you, you basically saying that modern environment are somewhat obisidigenic... which is what I was saying.
> Cultural change over 2/3 even 10 generations will not significantly alter your biology.
Okay... same., still just restating what i have said.
> they possibly cannot have effects on your decisions about what you eat and how you spend your time right?
They can and they do... let me introduce you to lead in paint and in the environment...
> particularly referring to obesity caused by over eating
All obesity is cause by over eating (all most by definition) the point here is that over eating is not cause by lack of will power or poor decision making
>About the point you're making, two generations before you and me, people where fit, more attentive & generally healthy
Everything.
Two generations ago you didn't eat out 4+ times per week. Portion sizes at restaurants were 50%+ smaller. Food sciences were not as optimized at making junk food as they are today. In general we were poorer and bought less junk food. We were more apt to work jobs that didn't involve sitting in one place for long periods of time.
>I don't think I'll change your mind or this will come across in good faith
I believe it's what you think, but when 74% of the population doesn't subscribe your philosophy then you're tilting at windmills. Yea, maybe someday people will catch on to that and all will be good, but that's not the way the entire world is going. We need solutions we can enact now to solve problems we have now.
Well, of course if you’ve been jacking heroin for 30 years and all your veins are destroyed beyond repair it’s useless. It’ll take as much, or even more, to return back to normal.
Because not everyone has willpower and discipline. People who do have those strengths often think it is just as simple as saying, "Just take care of yourself", but it is not that easy for many people. High blood sugar also increases cravings, which makes it even harder, bringing on a downward spiral.
This drug can help break out of that spiral and fix the craving/willpower problems.
what you say is mostly true, but I will point out that it does not break any spiral. It’s frequently reported that as soon as you stop taking Ozempic, the weight comes back immediately. so unless one resolves the underlying problem, you will be on this drug for life.
That's not unique to Ozempic and (while I know you didn't make this specific argument, but others in this subthread have) is a piss poor reason to tell someone they shouldn't give it a try.
i don’t disagree. Just pointing out that (obviously) this should be a last resort drug. AFTER someone has tried lifestyle interventions for a few years IMO.
The problem is when someone does NOT put in the effort to talk to their doctor, meet with a dietician, learn about healthy eating, and put in an honest effort to improve their life before just popping a pill.
That said, i think it’s great that’s it’s helping people who otherwise would just be obese and have many other health issues due to that. It’s a big risk factor.
This isn't the revelation you think it is. Chronic medical conditions require lifetime treatment. That isn't news to anyone.
It's funny how obesity is the only chronic medical condition that garners a huge volume of your particular kind of comment.
Would you be mentioning this for someone prescribed a diabetic, blood pressure or cholesterol medication? Statistically, likely not. So maybe take a step back, and examine why are you so averse to other people losing weight with medication.
i actually would, if they were caused by bad lifestyle habits or similar issues. I am a firm believer that medication should be used AFTER a serious attempt has been made to address the underlying issue, if possible.
if you are type 2 diabetic, that means you’ve probably been eating poorly for a long time. The happy path here is that one goes to a checkup and learns they are pre-diabetic, and their PCP refers them to a dietician. The patient hopefully learns how to make healthy food choices for themselves. All of this so they don’t develop type 2 diabetes. Maybe even temporarily prescribe a low metformin dose while they figure out the lifestyle changes needed.
If they struggle and lifestyle interventions fail, then of course, they should be prescribed insulin so they don’t have further devastating complications as they get older.
The same can be said for ozempic. What kind of lunatic would suggest starting ozempic without FIRST giving honest education and lifestyle adjustments a try? That should be step 1. And i’m talking proper education from a licensed dietician, not silly blogs or advice people see on tiktok these days. If step 1 fails, proceed to medication.
That’s my perspective at least. Big pharma isn’t your friend. It’s a backup plan and a necessary evil in most cases (with obvious exceptions like vaccines, antibiotics, etc)
> What kind of lunatic would suggest starting ozempic without FIRST giving honest education and lifestyle adjustments a try?
What kind of lunatic would suggest an approach that evidence does not support as being effective? Lifestyle modification, at the population level, just doesn't work. GLP-1 agonists do.
I see the point in this, but do you think it’s marketed as such and perhaps better question, used for exactly that and not more by vulnerable patients etc? (not well informed about long term side effects, some might even be unknown, if I might add)
I take my vaccines and generally gravitate to sanity over conspiracy stuff (that is to say, If I sound like that, i’m not)
I don't think it's just people who have willpower and discipline, it seems to me that for most people it doesn't take as much willpower and discipline to stay at a reasonable weight. These arguments make it sound as if everyone who is at a reasonable weight is there through large amounts of willpower and discipline, but most people I know don't need to exercise X times per week and constantly watch what they eat to keep that weight.
It's much easier when you can trust your body feedback and rely on your regular hunger signals, but for most people who benefit from Ozempic for weight loss if they just trust their bodies they will get fat.
Yea, when you look historically, starvation and food shortages were the norm. If you were a person that could pack on the pounds during the bountiful times, you could survive the lean times. Suddenly we live in the times of never ending plenty and we're told "what's wrong with you".
Every country skinnier than the US is getting faster. Europe is on a linear trajectory upward that hasn't changed since at least 1975. Even the Japanese are getting fatter every year.
A society where over half the population is suffering from the same problem is one that needs systemic change. It doesn't make sense to blame the individual when it's a problem affecting everyone.
Most people don't work out enough, or don't eat well enough. If we had some kind of intervention that would easily cause people to work out, we would use that intervention. If we had some kind of intervention that would easily cause people to eat well, we would use that intervention. The reason working out and good diet are good is because of good health outcomes. If we have some kind of intervention that skips straight to the good health outcomes, we would use that intervention. It seems like Ozempic is _that_ intervention, so we will use it. I will likely choose Ozempic for myself once it is available to me.
I want everyone who says this to submit a picture. Just wearing gym shorts, so we can get a good look. I assume nobody making this a moral issue will have so much as love handles. Because if they do, why aren't they working out harder and eating a bit less?
I've met plenty of skinny fat people who think they're healthy.
Telling people they are morally bankrupt sinners (slothful and gluttonous) and heaping guilt and shame on their shoulders has unsurprisingly failed to stop the issue.
Why do you think that telling people to “just stop being fat” will suddenly start working?
In 2021 I lost a good chunk of weight the old fashioned way. From 250ish to 215. I did it with "good old fashioned working out and not eating more". It was a miserable, white-knuckle experience. I was eating healthy food, enough calories (moderate but sane deficit), but the only thing I thought about at all moments was getting to the next meal. What snack is low enough calories to have to make it. It was miserable. As soon as I let up a bit, everything unraveled and I found myself back in the 250s by the start of this year.
Now I'm on Tirzepatide (Zepbound), and I'm back to 235ish, and trending lower. I still work on eating healthy, but now I'm not just HUNGRY at all moments. My life continues, and I only have to make individual healthy choices at meal times, and grocery times, rather than a constant struggle at all waking moments. It's seriously a big difference.
> I still work on eating healthy, but now I'm not just HUNGRY at all moments.
I think this is something a lot of people pushing back against the GLP-1 agonists don't realize because they don't experience it: back before I started Mounjaro (another GLP-1 agonist) I was constantly hungry if I hadn't eaten a meal in the last 45 minutes. Absolutely zero hyperbole there - I once went to an all you can eat buffet, ate until I was over full, came home, and within about an hour and a half of that I was snacking on something because I was hungry. Not peckish. Not "feeling like a snack". Hungry to the point where that feeling intruded on my every thought until it was sated.
After starting Mounjaro that's GONE. Gone gone. I now have to set an alarm to remember to eat. It's absolutely phenomenal and likely the reason why I'll live past my forties instead of being stuck in that same cycle and dying of the effects of obesity.
> Absolutely zero hyperbole there - I once went to an all you can eat buffet, ate until I was over full, came home, and within about an hour and a half of that I was snacking on something because I was hungry.
I don't have any eating issues but that reminds me of the first time I went on a 7-day cruise.
There's nothing to do on the ship, and the food is free and pretty tasty, so... I basically ended up at the buffet eating and drinking all day long. Sausage and egg biscuits, banana bread, pot roast, steak, pasta, fried rice, cinnamon buns, they had everything. I was stomach-busting full, every minute of every day. I'd gorge myself on a huge plate of Indian food from the buffet, and then a few hours later head to another deck for a lobster dinner. Not to mention, drinking coffee, beer, and wine the entire time.
It was kind of insane. And what was crazier was after a few days of this routine I got used to it, and even looked forward to eating more food the next day. It was sort of like directly embracing one of the seven deadly sins to the maximum extent possible. I'm not sure what that experience means other than it seems like the the human body can comfortably arrange itself into a habitual downward cycle fairly rapidly.
It's because we're evolved for boom-bust cycles. Give it another 500,000 or so years and humans might evolve to cope with food always being available at all times.
Not only that, but type 2 diabetes makes you paradoxically more hungry - your body thinks it is starving because it cannot get sugar into its cells so it makes you MORE hungry which causes you to get heavier which often causes the diabetes to get worse which makes you MORE hungry which means you eat and get heavier and......
As someone who's never struggled with weight, it's been eye opening to hear how food focused a lot of peoples thoughts are. It was like on the same level as finding out some people can't visualize things in their minds.
I don't think I've ever seen someone seriously put forth the argument "all you need is Ozempic".
For context: I am an overweight type 2 diabetic. I lost about 70 lbs before my doctor started me on Mounjaro (another GLP-1 agonist). My diet and exercise routine were far from perfect, and it took me about a year to lose that weight. My doctor started me on Mounjaro, both for type 2 diabetes and weight loss. I have lost 20 lbs in about a month on it, which means I will lose three times the weight if that pace keeps up (very unlikely). When my doctor and I discussed starting Mounjaro (which the doctor suggested, not me) he made it very, VERY clear that diet and exercise were important things to work on as the weight came off.
The key there is that the pace of weight loss will not keep up as the body's caloric needs reduce due to that weight loss. So naturally a GLP-1 user will plateau if they do not adjust their diet (and potentially exercise routine, though diet is much more important) as the weight comes off. You know what really makes it easier to have the energy to a healthy meal, to work out, and to take care of yourself? Losing weight! You know what helps form those healthy habits in people who did not form them during childhood? Reduced cravings for calorie dense food! Both of those things are where Ozempic and other GLP-1 drugs shine. It gives the person on them the space to make those changes without cravings, without feeling hungry, and at a faster pace than they could do naturally.
So yes, in the short term, these drugs are a great catalyst for change, but I don't see many medical professionals saying "oh just stick someone on Ozempic for life and that's that!" because for the vast majority of people who would use those drugs for weight loss cannot achieve their goals with just the drug alone.
Why doesn't everyone play piano? Why isn't every person a super athlete? Why doesn't everyone meditate 40 minutes a day? Why doesn't everyone study super hard in school and become an engineer or doctor or lawyer?
The hard truth: Not everyone is capable of those things. Period.
40% of the US population is considered obese. That is a HUGE number. At a certain point, you can no longer blame individuals. There is something wrong, and we identify it as an environmental problem.
So if we have a drug that will make a huge amount of people healthy, what is the downside? And for the record: Ozempic affects appetite so they eat better, that is part of the drug.
> Why doesn't everyone play piano? Why isn't every person a super athlete? Why doesn't everyone meditate 40 minutes a day? Why doesn't everyone study super hard in school and become an engineer or doctor or lawyer?
The hard truth: Not everyone is capable of those things. Period.
We’re not talking about world class athlete. There a mile difference between world class athletes and not obese.
Treat human beings or any organisms as biological machines. Here, many chemicals (hormones, for instance) regulate many processes in such machines. Whatever one has eaten so far, genetic history, environment, etc have changed hormones to a level where the model of dieting and working out doesn't work any longer. So, semaglutide and tirzepatide work on such regulatory hormones (GLP-1, GIP). In other words, what this research tells us that humans are not controlled by their personal will.
Willpower and discipline don’t seem to be what keeps other countries skinnier than the US (and most of them are also getting fatter…) so I don’t know why we expect that to get the US out of this mess.
Evidence: people from skinnier countries move here and consistently get fatter. It’s a societal/environmental problem, if we’re talking about “what would a policy fix look like?” and not “what can I personally try to do to save myself despite being up against a societal/environmental problem?”
It's just human nature. This is the health equivalent of trying to turn lead into gold. It's my unproven opinion that the negative effects of these treatments are understated and this will be a passing fad.
drug companies have spent millions on destigmatizing pharmaceuticals. its a superpower, apparently. a large swath of this userbase convinced themselves they have adhd and need medication for it. changing tabs on your chrome browser or not being able to do "deep work" = i have an uncurable disease and i require legal meth, for life. you can see how this translates to ozempic.
silicon valley/tech culture has prioritized get rich schemes, cure alls like adhd meds, you don't have to eat just drink soylent for every meal, etc. ozempic falls in line nicely there, and i think among this community and others in this vein, you'll see alot of support for it. its sad, because tech/programmers/IT people use to be very contrarian and open minded. you get in trouble for saying things like "personality responsibility", "discipline', "self-control".
> Are doctors required to explain this before prescribing this in US?
doctors famously aren't trained on nutrition or fitness. ironically the prestige is being a specialist, not well rounded. strange.
Completely missing the point of GLP-1 agonists. The point is that it breaks the cycle by giving you the willpower to eat less. It doesn't magically make the calories you eat not contribute to your weight, it just makes it easier to eat less and still feel full. It also counteracts insulin resistance, which is another problem inherent to obesity.
This article seems to frame things in such a strange way. Maybe instead of trying to get everyone obesity medication, we can instead educate society so we all understand nutrition and diet and can combat the ever-persistent forces of corporations pushing unhealthy food on us?
From my subjective experience in life, what they very often lacked was parents who set the right examples around food. I know that doesn't apply to everyone of course, but I've witnessed it time and time again - an upbringing with deeply disordered routines/practices around food. It's universal among obese people in my life. I speculate that better awareness of diet/nutrition might help to prevent passing on such behaviours, like not feeding the family exclusively a bucket of KFC or McDonalds, or using food as a reward, etc. etc.. I mean, medication won't actually solve what is caused by behaviour, right? Maybe the behaviour can be reduced on a broader scale, over time, via people making better-informed decisions? If parents know their habits around food are basically ensuring their kids will struggle with obesity, maybe they'll make the effort to do something different? Dunno, it seems like a reasonable consideration.
> From my subjective experience in life, what they very often lacked was parents who set the right examples around food.
No amount of education will change who your parents were or how you were raised. Have you observed a strong correlation between how well educated someone is vs. obesity?
> I speculate that better awareness of diet/nutrition might help to prevent passing on such behaviours, like not feeding the family exclusively a bucket of KFC or McDonalds, or using food as a reward, etc. etc.
I'd encourage you to talk to any reasonably intelligent obese parent to see if they need better awareness of diet/nutrition. Better still, do a survey of obese and non-obese people to compare awareness of diet/nutrition between the two groups.
> I mean, medication won't actually solve what is caused by behaviour, right?
Saying that obesity is caused by behaviour and therefore can't be solved with medication is a bold statement to make in the context of a story about a drug that has been clinically proven to help obese people to lose weight.
Medication is often prescribed to help people who suffer from behavioural problems with positive results. I wouldn't presume medication can solve all problems caused by behaviour, but there is empirical evidence that for some problems it does help. As near as we can tell, human behaviour is regulated by a electrochemical brain & nervous system. Dumping chemicals into that system can of course change human behaviour. We see evidence of that (for better or for worse) all the time. If you have doubts and you don't even need to get a prescription, try taking a hit of acid/cocaine/alchohol and see if behaviour changes.
> If parents know their habits around food are basically ensuring their kids will struggle with obesity, maybe they'll make the effort to do something different?
The US has had a dramatic increase in obesity within a single generation (as in, people who were not obese for much of their lives have become morbidly obese at a rate far exceeding previous generations), let alone cross generational. While food/nutrition/health habits can certainly have a profound effect on someone's weight, there are clearly other factors at play.
Consider, for a moment, the reality of an obese person living in the US today. You get negative feedback about your weight all the time. You suffer negative social outcomes, let alone all the physical ones, so few, if any, want to be obese. There is no lack of motivation to seek out information on how to avoid being obese. There's a $300+ billion industry diet/health/nutrition industry constantly seeking to inform you about products they offer to help with your diet/health/nutrition... and that's not counting the doctors that you are no doubt interacting with regularly. Of course, that's not counting all the education (solicited or otherwise) you get from friends, family, acquaintances and even random strangers. It's hard to get through a day without being "educated" about diet, nutrition and health.
There's a cultural bias to think the problem is simply about behavioural/willpower/education, much the same way we look at poverty. It demonstrates a profound lack of understanding of and empathy for the plight of people who are suffering from obesity.
I didn't say "obesity is caused by behaviour and therefore can't be solved with medication". You're arguing against a straw man. I'm suggesting the idea that maybe we as a society should better educate around our relationship with food. I believe it would make a difference - just not immediately.
You're right. You didn't say that. You said (and I quoted) "I mean, medication won't actually solve what is caused by behaviour, right?" in commentary to an article about a medication used to treat obesity, while discussing the need for better awareness about food/nutrition.
> I'm suggesting the idea that maybe we as a society should better educate around our relationship with food. I believe it would make a difference - just not immediately.
It's a bit tautological that if we did something better things would be better. Better education around our relationship with food would start with people understanding that better education about our relationship with food won't help people suffering from obesity.
Yeah, my original post is focused on the idea that "getting everyone on ozempic" isn't a long-term sustainable solution to obesity. It is a reactive, band-aid workaround that will never tackle the underlying causes. It will help someone survive and live a better life, but the moment they stop taking ozempic they are back at square one, haven't gained the wherewithal/discipline to fight the constant urges to eat, and will be right back where they started. I mean, unless this is some miracle drug that has residual/lasting effects?
In light of that, and barring the many other ways one can combat obesity themselves, it would probably be beneficial if everyone, in general, knew all about the pitfalls of disordered eating and knew more about how to combat that trap, and knew why that actually matters for themselves and the people they care about. I've observed people enable each others' obesity over and over. I've observed people reinforce horrible habits and be unsupportive of others' efforts to combat those habits. People don't know shit about diet and food and spread their ignorant, lazy attitudes and behaviour to those around them. Why make a real meal when you can just order $50 of takeout to feed the whole party? Then, if you don't eat "enough", everyone is on your case because "you must be starving" and "why are you eating so little?", because they are totally uneducated about the possible challenges people face when it comes to food. The more people know about this stuff, the more it benefits everyone. I still think this also circles back to the "passing it to your kids" thing, because it's now a multi-generational problem.
In EU they banned the sale of oral tobacco (snus), which is safer than smoking tobacco. Snus once had cancer labeling but that was generally considered not-very-true and labeling was removed. Tobacco smoke causes cancer. Drug bans also built many overfilled prisons and likely contributed to the invention and spread of harmful drugs such as crystal meth and fentanyl. This is a one sided view of course. I like William Blakes work, "Auguries of Innocence".
If educating people didn't work, we'd all be drinking cocaine soda and burning leaded fuel. I mean, there's a reason things have generally greatly improved over time for most of humanity. We know more things and act upon that knowledge. This applies to basically every single thing humans do. Maybe one day we won't be drinking sugar water and adulterating ~every piece of food on the shelf with high-fructose corn syrup?
> If educating people didn't work, we'd all be drinking cocaine soda and burning leaded fuel.
When the person you are arguing with is saying that government induced bans would probably help more, and your are arguing they're wrong and your two examples were resolved by government induced bans, you're going about arguing in a very strange way.
Unfortunately companies make more profit by pushing unhealthy food onto consumers which can be evidenced by the money they spend advertising it. They're exploiting our instincts to seek out high calorie foods which was an advantage when humans didn't have a ready supply of food available at all times, but nowadays leads to a whole host of illnesses.
Maybe we should try educate society on dangers of using heroin. I agree that it is a good thing, and we should continue educating people about its dangers. But clearly that alone didn’t solve the problem, and I think it would be a good idea to utilize alternative options as well (in addition to continuing the education of society on its dangers).
Do you think overweight people don't know why they're overweight?
There are plenty of obese people that understand nutrition just fine, there are obese people who understand it well enough to have lost significant weight and gained it all back.
Clearly there is something else going on that we haven't grasped yet.
Education may involve "finding a strategy that works for you". There are so, so many different ways to combat disordered eating. These are learnable things. My thought around "better education" is that the cycle of disordered eating can be stopped at some point before parents pass it on to their kids, at least (as I just posted in adjacent comment https://news.ycombinator.com/item?id=41811916 ). I absolutely recognize how insanely difficult it is to come back from disordered eating and stay at a lower weight after finally reaching it.
Though, now that you ask, I do think that many people don't actually know why they are overweight. They say it's because "McDonald's is cheaper than buying good food", not realizing the McDonalds won't satiate them and they will eat/spend more because their body is starved for proper nutrition. Watch the series "Supersize vs. Superskinny" and observe how nearly every participant is utterly clueless as to the underlying causes of their challenges on either size of the disordered-eating scale.
Understanding nutrition, and eating habits in practice, are two very different things.
Regaining weight is the primary issue really. Most people are capable of losing weight, but gain it back, and it gets harder going forward. Metabolic adaptation is better understood now and among the factors (.e.g increasing caloric intake too quickly after weight loss), but falling into old habits that are culturally ubiquitous is a glaring part of the problem.
Former drug addicts are told now to sever contact with peers who partook in those indulgences as they're likely to pull them back in. With food, it can be more than a minor subculture. There are regions of the US that have much higher obesity rates than others. Not having family members and a romantic partner on board can be difficult.
That’s kinda part of my point. Cutting yourself off from drug enablers is one thing. Cutting yourself off from your friends and family is another. Especially since eating is something you can’t not do, and is deeply tied to cultural and social customs of everyone. It is impossible to live and never be offered an unhealthy food choice no matter how much support and good decisions there are. Conversely, it is very easy to live my life without being offered heroin.
Plenty of overweight people really, really, really want to lose weight and do all of the right things, but report that it is difficult to impossible to maintain the weight loss. Many of them gain the weight back, and this is crucial, but don’t continue gaining past a certain point. Combine that with the very regional nature of obesity and I think that there is a VERY strong case to be made that there is an environmental or external cause of obesity that we haven’t identified yet (junk food is too simple of an explanation, and doesn’t adequately explain everything).
The point I’m getting at is that a lot of these drugs also yield some sort of drastic behavioral change like a reduced indulgence in other impulsive harmful behaviors. I really think that there is something that is throwing us out of whack behaviorally, and obesity is a symptom of that.
The fact that a hormonal correction is able to fix both obesity and other addictions is a very interesting result.
> Cutting yourself off from your friends and family is another.
This is exactly one of the reasons I think better education around food/diet/nutrition is important. You don't need to cut yourself off from enabler family/friends if they aren't enablers to begin with. It's cultural, too. The portion sizes at all the restaurants in a given region because "we like to eat big meals here", or whatever. There are sooo many factors and the underlying flaw, to me, is ignorance of "how this stuff works".
> external cause of obesity that we haven’t identified yet (junk food is too simple of an explanation, and doesn’t adequately explain everything).
You can't divorce it from the explanation. People get obese from overconsuming calorie-dense rich foods. These products are manufactured to be as savory and addictive as possible, are highly available, and convenient, and very affordable, and most are non-satiating (especially drinks). So yes there are environmental factors, but the reason they matter in the first place is the impact of junk foods. At the turn of the 20th century even relatively sedentary office workers would not gain much weight, because the American industrial machine did not yet create the landscape we have now. No one was buying several bottles of 2L coke, chip bags, jumbo fries and fried chicken, greasy pizza, starbucks lattes, etc.
And to avoid confusion, I want to make clear that avoiding weight-gain at the outset (to the extent of becoming obese), and losing weight, are different. What's sufficient for the former is insufficient for the latter; you do not need to be mindful of energy balance if you are already at a healthy weight and consume whole foods, but if you are trying to lose weight, that will not be enough to ensure a caloric deficit.
A comparison I like is a bag of chips vs a bag of apples. Bags of potato chips average 1200 calories. One would need to consume 16 apples to get the equivalent. I can probably get through an entire bag of chips if I cared to, and more than half a bag absent-mindedly if I was irresponsible. Try consuming more than a single large apple and see how that feels. Fiber is almost as satiating as protein. It may not keep you full as long, but you certainly reach satiety a lot faster than you would with chips (notwithstanding that in fairness they are less addictive without salt and fat).
David Friedberg recently did an All-In Interview with the CEO of Eli Lilly. Interesting conversation over there that also talked about some key points of the article.
> “Is it bad for my liver to be off most of the time?” It's generally not healthy to keep your major organs in the off state. If you never open your eyes, you go blind.
I feel like this is missing the obvious follow up question, “is it bad for my liver to be on most of the time?”
> “is it bad for my liver to be on most of the time?”
That's a good question!
I'm not sure. My guess would be its perfectly healthy (normal actually) to have 10x levels of ketones constantly than an American eating the SAD (Standard American Diet).
Anyone know of long term datasets that have looked at this in animals?
Continuous Ketone Monitors for humans have _just_ come out (AFAIK), so we should know soon.
Yet another drug that patches up symptoms without addressing the root cause. People will be dependent on the drug for life. And we still don't know what the adverse effects are.
I’m just as curious as to why some people are so willing to take numerous medications, while others go to any lengths to avoid them. Some people are happy to be on an SSRI, sleeping pill, statin, low dose aspirin, and a few others, and aren’t bothered by this. Other people seem instinctively revolted by prescription drugs, seeing toxins pushed by evil corporations. Is it a trust issue?
I personally detest and avoid all medicines other than antibiotics and vaccines. Pharmaceuticals have a long track record of harboring “side effects” that only become apparent years later.
In general, why are we surprised that the chronic use of any substance has negative effects? Humans evolved for thousands of years eating food and drinking water. Regularly consuming anything else is an abberration and self-experiment.
I think the answer to your question is that people who avoid drugs understand that drugs do not fix anything permanently, in 99% of cases. They only treat symptoms. The people who avoid drugs attempt to treat the underlying problems.
of course it’s not always practical. For example, some skinny people are simply genetically predisposed to high blood pressure, even if they work out and eat pretty healthy. It’s rare, but these things happen.
You can have an internal locus of control and still believe the benefits of taking something like an SSRI far outweigh the costs of attempting to address depression/anxiety more "naturally." I'd rather take an SSRI if it means more motivation to live healthily, positively, productively for myself and family. If anything, the drug could very well help someone discover their sense of agency.
Nobody ever gets sus about needing to take heart medication every day to stay alive but the moment it becomes about how I take Lexapro every day they get real preachy.
> Other people seem instinctively revolted by prescription drugs, seeing toxins pushed by evil corporations.
You can advertise drugs on TV in the USA. This certainly opens the door for bad drugs to get pushed out and marketed to people who don't have the technical skills to examine the claims and the risks of side effects objectively.
> avoid all medicines other than antibiotics and vaccines
Just because it's been such a hobby horse lately I would have to add pain killers. There is absolutely a large potential for abuse but they also serve an incredible utility to modern medical care.
> Regularly consuming anything else is an abberration and self-experiment.
Ozempic should be for people who are obese and have thoroughly demonstrated that they are not physically capable of exercising themselves enough to lose weight naturally.
Otherwise, this drug gets marketed as an obesity cure, but it's mostly dispensed for cosmetic purposes. If there are any side-effects, it will be a double tragedy for these people.
I'm with you, it's a little revolting, this specific drug.
Ozempic and similar drugs are being used by many to get rid of the food noise and insatiable hunger that have stood in the way of sustainable progress. These drugs are being used as catalysts for healthy living. The fact that they seem to work thus far is evidence that obesity is on some level driven by powerful hormonal forces that influence impulse control and willpower, which addressed, can give people the freedom to make better decisions and effectively pursue a lifestyle they've struggled to maintain.
The cosmetic narrative you're pushing is actually quite disgusting.
> These drugs are being used as catalysts for healthy living.
You have some evidence for this claim?
> is evidence that obesity is on some level driven by powerful hormonal forces
It's suggestive. It's nowhere near evidence.
> the freedom to make better decisions
As long as they're on the drug.
> The cosmetic narrative you're pushing is actually quite disgusting.
No it isn't. It's a valid concern about how this medication is _marketed_ and _dispensed_. It's also an obvious concern to have. Pretending that I'm disgusting because I'm actually worried about the future outcomes for these patients is bullying highroad nonsense. Come off of it.
The obvious countertpoint is that obesity rates have not been constant for the last few decades.
So there are clearly multiple factors here and those should be taken into consideration before uncritically deciding this is a "good thing" that we should "all be on."
I've been on Zepbound since July and have lost 40lbs in that time through calorie restriction, intermittent fasting, and resistance training 3x per week, which all felt like impossibly herculean tasks before starting the medication. I know others who've had similar experiences. Sorry I haven't published a paper on it.
I'm curious why you include antibiotics in your trusted medications list.
Over the past several years we've found that antibiotics have a huge impact on beneficial microbes in your body which then has downstream impacts on your health [0]. Oddly enough for the topic in this article exposure to antibiotics as a child may be linked to obesity[1]. They are also extremely over prescribed for things like viral illnesses [2].
I personally wouldn't take an antibiotic unless whatever malady I was suffering from was proven to not only be bacterial in origin but likely to progress without treatment.
Regarding your larger point some of the distrust of medications can be related to the fact that people know that medication producers' goal is to be profit for the most part.
Because they are for-profit the medicine producers can't be trusted to produce quality products or to produce products which resolve a problem rather than just reducing symptoms as long as the patient continues to pay for the medicine.
As with other problems we have a low trust society because it's a society built on for-profit enterprises rather than enterprises focused on doing the best thing for society.
He is not shooting the gun at all. He's advocating waiting it out. You're the one taking risk and playing russian roulette. He'll take the gun out at the first sign sign of danger.
> seeing toxins pushed by evil corporations. Is it a trust issue?
That sounds a lot like the divide between people who see conspiracies everywhere and those who do not. In that case I would suggest it is just personality, not logical and not solved by improving trust.
you can buy tirzepatide / semaglutide all day long from labs in china for between $4 per injection all the way down to $0.50 per injection depending on quantity and type (prepackaged in vial vs raw powder)
After tirzepatide was taken off the shortage list last week, I notice that there are suddenly a lot more people talking about this route. It will be interesting to see how it plays out.
Probably exceeds my comfort level, and I'm lucky enough that I can pay the $550/month for name brand if necessary. A lot of people will just have to stop, though, and deal with the consequences.
I'm 42 and I've never taken more than the odd painkiller or antibiotic here or there - less than a pill a year on average I'm sure.
The last thing in the world I want is to be permanently on some drug that alters how my body works. I hike, snowboard, go to the gym and eat sensibly. That's all the "weight control" I need.
I think it's a lot simpler than that. US has an abusive relationship with junk/processed food. It's so deeply ingrained due to profit margins, wealth inequities, nonsensical subsidies, etc. that the only feasible solution is to introduce a drug that continues to allow that relationship to continue.
It's a lot easier of a solution than it is to tell companies to stop making garbage or saturating everything with sugar and HFCS. "Easier to see end of the world than end to capitalism" -- its the same shit packaged in a different story... Easier to introduce a drug to treat the symptoms than to solve the actual problem.
Mind you, I'm not implying that it is easy. We have collectively accepted this which makes change difficult if not impossible.
25% is the number you were looking for, and even within that group I think you'd find plenty of people with a healthy BMI that are in fact not living a healthy lifestyle.
` I hike, snowboard, go to the gym and eat sensibly. That's all the "weight control" I need.`
So you are likely in an income bracket that enables you to have an active lifestyle outside of work and take the time outside of work to cook, in addition to probably other hobbies. this is not a criticism of you, but if I had to guess, you simply have a life that many other's do not. I work out and take care of myself because I make $300k+, have less worries and responsibilities, and I actually have an easier job than when I was making less.
A lot of people don't have money or don't have the time for working out and making the correct meal choices. Yes, there are people who have money and time and are still overweight, however that is not the norm as you go up the income brackets. Many poorer people have long work days, with an additional long commute, and are more likely to have kids, meaning they have no time for themselves. They're not gonna go to the gym if they already have a long day and they probably aren't going to make healthy food choices when they're already beat up and have not a lot of time for themselves.
In the moment yes. Do you have an actually reasonable set of laws that could solve these societal level problems that encourage obesity in let's say, the next ten years? Also, they have to be passable.
Here is another disease caused and triggered by society. Asthma. Cars cause tons of pollution and people who live near highways are at much greater risk of experiencing asthma. However, society as a whole suffers from the pollution generated by cars. We all know this. The bay area has something called "spare the air day" which is a day where they ask people to not drive, when it's particularly smoggy. This has never worked. There are always people driving, because they gotta get places and the bay area can't built trains and the buses are awful. So people drive. What is the societal solution to localized pollution (like smog)? Better public transit, higher taxes on gas and on larger vehicles which produce more tire based pollution, and more tolls. But we don't do any of that. We know as a society how to reduce car based smog, which would reduce asthma and other diseases, but we don't do it, so we throw inhalers at people to get them to stop complaining. It's not super different from the weight problem in my eyes.
> Do you have an actually reasonable set of laws that could solve these societal level problems that encourage obesity in let's say, the next ten years?
Sure, Canada banned trans fat.
There is absolutely no reason they couldn't ban drinks that contain more than x% sugar, or portion sizes that are bigger than y calories.
> Here is another disease caused and triggered by society. Asthma. Cars cause tons of pollution
Excellent example!
Internal Combustion Engines will be illegal in new vehicles from 2030 in many jurisdictions around the world (2035 in others).
Yes, it's coming!
Tire and brake particulate is actually a big component of pollution and EVs will cause more pollution from tire and brake debris, which is already a larger portion of pollution than tail pipe emitions. We're increasing one type of pollution and decreasing another type, we'll see if long term it's a net benefit.
Also, they could ban those things in places like SF or more liberal places, however I believe those are politically losing policies and wouldn't pass in places that are actually experiencing obesity.
That's so dystopian. So you are just saying that society doesn't have time to take care of themselves, so we need some drugs to fix our collective horrid lifestyles? It's an easy temporary fix but what cascading effects might that cause on the future? Who knows?
Well, I'm describing how I perceive the world to be right now and ozempic is a technological solution to a societal problem. If as a society we can make steps to fix it (more walkable cities, less work in general, cheaper society, encourage smaller portions) then sure, maybe we don't need ozempic. But people have to organize and get involved in government to make this happen, which is harder than making a pill (it seems).
What society does or does not do has no impact on me consuming less calories on a daily basis.
I have the opportunity to buy soda 50 times a day. I choose not to.
I have the opportunity to buy a burger and fries for lunch. I choose not to.
Society could make many such things illegal or whatever, but at the end of the day what goes into my body is up to me. The buck stops with me and my choices.
One thing that it seems we are just starting to talk about with these drugs is the associated muscle and bone density loss. I'm concerned that this generation of GLP-1 early adopters will wind up more frail and suffer a lower quality of life in old age as a result.
I've seen zero evidence that muscle loss from GLP-1-assisted weight-loss is any different to the muscle loss from simply eating less. Do you have a link to a study I've missed?
Yes, but you would certainly still see some - it's just a consequence of weight loss. Even IFBB bodybuilders on god knows how many steroids see some muscle loss when cutting.
Eat a whole lot of protein, lift, and you're going to be doing more than fine in the muscle loss department.
My program strongly recommends some form of muscle training (pushups/weights/etc) as they see improvements from muscle development for weight loss and to counteract the muscle loss from losing weight.
The fact remains that having to carry around 50+ extra pounds of fat requires more muscle. When that requirement goes away so does your need for that musculature.
It depends how old you are. Skin loses its elasticity after a certain age. So weight is a problem you should spare no expense fixing sooner rather than later. Even if you do something about your weight at a later age, the health benefits for your heart for example will greatly outweigh the loose skin.
One other note: the current peptide-based GLP-1 drugs are not likely to be the permanent solution. Injectables are just too problematic for that.
Several companies are now working on more classic small-molecule drugs targeting the same receptors. So it's likely that in several years we'll get a pill with the same effects.
Yes, there's technically a pill version of Ozempic already (Rybelsus), but it works by making the stomach wall to be slightly permeable to peptides. You can guess that it has pretty unpleasant side effects, and an awesome bioavailability of 0.7%
I'm curious what about injectables makes them specifically problematic for long term use? Diabetics already have to inject insulin for the rest of their lives, and an injectable version of the same drug usually has fewer side effects since it doesn't have to pass through your gut metabolism. I may be biased, I have no fear of needles and have injected myself with sex hormones every week for nearly 7 years, so adding an autoinjector doesn't seem like that big a deal to me.
They are more expensive. Autoinjectors are way more complicated than a pill bottle. You also can't freeze them, but they should be kept in a fridge.
Manufacturing standards also have to be way higher. I have no problem trusting Novo Nordisk to manufacture injectors safely, but I won't trust a random manufacturer from India or China.
The risk of accidental infection from injection also is not neglibible.
Fair considerations, I just disagree that it makes injections inherently problematic for long term use. Primarily because I have doubts about the possibility of a pill that doesn't come with more side effects than an equivalent injectable.
My pet crackpot theory is that within the next 100 years semaglutide is going to be in the drinking water (much like fluoride) because the benefit to society is going to be too hard to pass up on. However, it seems that it's delivered via injection so maybe putting it in the water supply wouldn't even be effective.
It's also relative uncommon in other developed countries; according to Wikipedia, "Out of a population of about three-quarters of a billion, under 14 million people (approximately 2%) in Europe receive artificially-fluoridated water. Those people are in the UK (5,797,000), Republic of Ireland (4,780,000), Spain (4,250,000), and Serbia (300,000)."
The funny thing is that if you live in Portland, famously one of the few large cities without fluoride in the water, the dentist can immediately tell if you grew up here.
I would guess that in today's world a lot of people get enough fluoride through processed foods being made in places that have fluoridated water.
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[ 3.2 ms ] story [ 560 ms ] threadLikewise, there can be serious complications when taking GLP-1 agonists and the like. Since they need to be taken in perpetuity (many gain all weight lost upon stopping use) they should be reserved for only people who have exhausted all other opportunities.
Most people over 65 should not be on statins. Most people should not be taking GPL-1 agonists.
Given how ineffective it is once you stop, I'm personally expecting it to become a relatively short lived fad. Insurance companies won't cover it if it truly doesn't improve health outcomes long term (throwing money down the toilet) and people will learn to not pay out of pocket for it.
There's a reason insurance companies are loath to cover it for obesity now without prior authorization, which usually requires you seeing a specialist who has ruled out the usual suspects (nutrition and exercise changes).
For example: high cholesterol levels is actually positively correlated with longevity, believe it or not. If you consume a diet low in sugars, thus routinely burning fat when fasted, you will have "high" cholesterol in blood. How do you think fats are moved to cells in need? Through the blood, of course.
I'd go so far as to say that statins are pretty much a scam, that fixes a useless and quite complex metric such as cholesterol levels. Given that cholesterol levels are a diagnostic easily accessible to GPs, they prescribe statins to see this figure go lower, even if it doesn't make the person any healthier. Incidentally it's similar to taking GLP-1 agonists instead of learning to have a healthier relationship with food.
There's a really cool Modern MBA video [1] on this topic btw :)
[1]: https://www.youtube.com/watch?v=7sUoZVke_30
In mice.
So in general, if something _doesn't_ cause cancer in mice, then it's probably safe for humans. The reverse is not necessarily true.
Also, GLP-1 was associated with thyroid, not pancreatic cancer.
So does obesity, so there is that.
This whole thing is about trying to find shortcuts to get to the pleasure of having a nice body while circumventing the pain and effort.
Pain and efforts are important, they forge character like nothing else. If you want to live in a world where adult-children simply take their soma to get what they want, you're just not thinking about the consequences.
Why is this particular thing the bad thing?
Also, about headaches and more generally physical pain that you know is only temporary and not a sign of radical bodily malfunction, I say yes: enduring a reasonable amount is important to develop a tolerance to it and willpower.
What I'm saying isn't new anyway, everybody knows some amount of struggle is needed to temper character and not fall to the most insidious poison of our times: constant comfort.
Being able to lose weight while continuing to eat is a wonderful thing. There is no virtue in spending your willpower making your body do something it desperately doesn't want to do. That's some puritan shit.
This is sexist and absolutely not true, there are plenty of women capable of pre-planning what they're going to eat and sticking with it. It's not "dieting", it's living a healthy lifestyle and not regularly eating junk.
Granted, once you go past middle age, it can become a bit more complicated.
Someone brought up doughnuts as an example, but that's a ridiculous source of calories: I could probably down half a dozen doughnuts (a daily calorie budget) and then go for a normal meal afterwards.
Eating only becomes disordered if one can't be bothered to eat healthy food as a rule and then freaks out about weight gain as a result.
We're about to see the nutritional equivalent.
If you are right then there should be money to be made by shorting the stock.
the life expectancy of someone with bmi > 40 is -5 years
and for bmi > 50, -15 years.
So I suspect someone ~ 65 with high BMI should be on it, the side effects would be: living.
Don't think you need to worry about that one.
Personally, I give my kid water with the flouride filtered out via RO, but will still use topical flouride, e.g. toothpaste and treatments applied by a dentist.
I hate how issues like this are politicized... if I raise this issue anywhere, including on here I expect to be attacked for being a "conspiracy theorist" and "like an anti-vaxxer" etc. There is something really wrong when you aren't allowed to even talk about both sides of an issue- especially if, like in my case, I have a doctorate in the life sciences and am qualified to have my own informed scientific opinion based on the evidence.
How would you define "domain of expertise"? Reviewing literature from other fields I don't research myself and forming an opinion on how it applies to my research is part of my job and something I do almost every day. I am even also called upon to peer review articles and grant proposals that are not within my direct field of research, as is general practice to get "outside opinions."
In cases like this, I am able to be familiar with basically everything published on the issue. However an actual researcher in a specific field will have additional knowledge and opinions from firsthand experience, that cannot be found in literature.
In general, I think it is okay to have your own opinion on something even if you aren't e.g. a professional whose whole life is focused exactly on that one issue. No formal training, credentials, or firsthand experience are necessarily required to have an informed opinion. However, you still have the burden of making sure you really understand the issue deeply - which is probably something like 100x the effort most people think it would be. Anyone can do that if they take the time to do so. I wish more people would.
In any case, this was a few years back when I looked into it, and it seems like these concerns have become more mainstream and less controversial in the last few years, e.g. https://ntp.niehs.nih.gov/publications/monographs/mgraph08
https://www.cdc.gov/pcd/issues/2023/23_0136.htm
Most notably (in the context of un-intuitiveness), is Xenon - it is't even a chemical, but an element - a noble one, which is almost nonsensical given most's flawed intuition.
Correct, although ironically it wasn't much use in direct chemical-warfare, it was used more as a pre-cursor to enrich Uranium.…what?
I haven’t the faintest clue what you’re talking about. I don’t think you know what the word “psychoactive” means, either. By your definition, water is psychoactive too. Is that what you’re suggesting?
https://pubmed.ncbi.nlm.nih.gov/15734706/
After what happened with OxyContin I think wed benefit from some skepticism when a new drug gets oversold.
They're not new.
By itself this might be an ok question, but in context it's rather useless....
Diet and obesity changes by both lowering and increasing different hormone outputs in your body. You're balancing the question of "how is this hormone" versus "How bad is obesity on the body". Well, the answer is in, obesity is extremely unhealthy on the body in both the short and long term.
Drug overdoses cause somewhere around 100k deaths per year in the US. Obesity complications related deaths are in the 250-300k deaths per year.
You can be skeptical as you want, but behind smoking, obesity is the worst epidemic in the US.
But for fat people, the calculus looks different.
A decision to take semaglutides is a decision between the long-term negative effects of obesity *now*, or the possibility of long-term negative effects *later.*
Anecdotally, trans people have a similar calculus. Going unmedicated/unsupported brings significant mental health risk now[1], whereas going on hormone replacement may or may not cause complications much later in life (osteoperosis, hepotoxicity issues for some treatments, etc).
Either way, you gotta get to the "later in life" part before you can worry about the outlook there.
1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
It's worth noting that surgery isn't the only option. Hormone therapy has also shown to reduce suicide risk, which is more accessible across socioeconomic strata.
There's a meta-analysis here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10027312/
The research is also highly motivated. A researcher who found that sex change operations were harmful would be targeted for endless harassment by gender activists, if they could get published at all.
The fact that people can decide they’re not trans is not particularly material. This is very uncommon.
The conspiracy that such research must be politically motivated is a contrived argument and also falsely paints a dichotomy of saying that it must either help or harm. My assumption before doing the research was that they would find no effect.
You really lost us with this.
Many, MANY people dally with the idea of being trans and decide it's not for them. This is extremely common, and is probably the overwhelming majority outcome for all people who are ever trans-curious.
Show your research please.
A researcher who found this would be feted by the conservative/evangelical wing of the US political spectrum. They would stand to make a ton of money in the book and personal appearance circuit.
Depending on which study you look at, up to 80% of people who attempt lifestyle modification end up gaining the weight right back.
So yes, it's theoretically possible for everyone under ideal circumstances, but in the real world most people don't succeed. We can argue over why that happens - but the statistics remain.
So again... given these abysmal odds, for the 80% of people who try and (repeatedly) fail at lifestyle modification, what is the least bad alternative?
> 1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
This paper also finds that 5% of cisgender male and 11% of cisgender female students (out of ~8k surveyed for each) attempted suicide in the past year. It's kind of strange, because the age <=18 suicide rate (of "completed" attempts) is much smaller, approximately 1 in 5,000 to 1 in 10,000 [1].
[1] https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf, Figure 3
You’re already benefiting.
We've got 20 years of data on this class of drug. Certainly there could be some long term issues that we're not aware of yet, but it's not likely that there are significant issues that affect a large percentage of users after 30 years that didn't affect the small sample of users that have been using it for 20 years or the massive number of users that have been using it for 10.
The list goes on forever. I'm betting this ends the same way.
Who the fuck cares? If you're not overweight and are reasonably then you're already winning in physiological terms. If you can maintain a good quality of life into old age and then die, what more do you want? Going through life worrying about whether you're missing out on some marginal health benefit from the drug-of-the-moment is neurotic.
all in all general unease about dealing with symptoms and not the root cause of overweightness except in rare genetic cases, its overwhelmingly a dietary/exercise issue.
in this country the pill/drug is the answer and solution to everything but all this does is pile on more bandages without addressing the root cause which a very American solution.
I do not think the full ramifications are realized or knowable when there are profits to be made on both side of the fence, sort of like the whole opiate crisis in America started out as magazine ads blew up into a major crisis 20~30 years later.
I'm not, someone who doesn't really need it. For example, some average weight housewife who just wants to fit in a dress a little better.
And still, I won't use it even though I can afford it cause it's the long term consequences are not entirely understood.
I’m glad it’s available for those who need it. But I agree with GP that there is another discussion we need to be having too we’ve avoided for far far too long.
I’m not against Ozempic. But without it maybe the continued expansion of the obesity epidemic would have pushed the discussion.
If this accidentally prevents that discussion, I think that’s a problem. I’m not suggesting any change to the drug’s availability. Only concern over an important discussion.
It's been forty years, how much longer would it take to admit that's not happening?
As we export our food to more and more places, it starts to happen to them.
I hear about people who take trips to Europe. They eat a ton, feel better, and lose weight.
They get back home, start eating food here (even healthy food) and feel worse again. Gain it back despite eating less.
We’ve tried ignoring it. We’ve tried blaming genetics, character, fat in foods, sugar, and willpower. But none of those have explained/fixed it. Because I don’t think that’s the problem.
I want the evidence to keep piling up. I don’t want anyone to suffer unnecessarily, but I don’t want a new excuse to stop progress again.
It doesn’t have to be either/or. But if we give up the chance for the debate because a new miracle drug “solved“ it nothing will change.
Exercise is recommended for everyone, regardless of weight.
Even behavioral changes like avoiding fast food don't fix the underlying problem in your brain. It's topical.
It's amazing how the subject of Ozempic brings out such trivial claims uttered with a serious face.
My original impression was that it was suppose to be a crutch, helping you get started on a healthy lifestyle. So if you are to heavy to exercise without hurting yourself it could help you lose that initial weight. Or it can help you with your appetit, while you adjust your diet.
You also can't stay on Ozempic, you have to continuously increase you dose to get the same effect, so it's simply not viable to keep taking it for an extend period of time. That's at least the impression I've been getting from talking to people working at pharmacies.
We're not socially caught up yet to this information. I suspect there are folks who believe that regardless of similar outcome (reduction of toxic diet), that changing diet without medication is superior to those who change their behavior through pharmacological intervention. It's like the pre-1990s view on depression or anxiety - chemical intervention is a moral weakness.
The question is how a trait fares in the modern world.
Maybe a trait was useful to an ancestor but not to you today trying to navigate a calorie rich world of convenience. Just like a trait useful to a nomadic hunter might work against you when you're expected to sit at a desk job if you want to make the money necessary to fulfill your ambitions.
It may very well be the case that we end up medicating away traits that were useful at some point in our lineage but not today. I just don't see how it matters much beyond the thought exercise.
Have you wondered why ADHD has exploded?
Have you not realized how many people at hacker news are on SSRIs? Watch this comment, you will.
Someone has an elevated risk of skin cancer due to their genetics? Probably an evolutionary trait that it is more likely for some people to get skin cancer within their lifetime. That doesn’t mean that using sunscreen and providing those people with related medical care (if the need arises) is some crime against nature and will end up hurting evolutionary prospects of the human race.
More than probably, it's called "being white".
(And we evolved that for more vitamin D?)
My complaint is getting addicted to pharma because we’re addicted to toxic food.
https://www.bloomberg.com/news/articles/2023-10-07/ozempic-f...
https://www.wsj.com/business/ozempic-impact-snack-food-compa...
https://www.washingtonpost.com/business/2023/10/09/ozempic-w...
https://www.cnn.com/2023/10/05/investing/ozempic-food-compan...
It goes on and on and on. In lab mice, it has been shown you can alter production in as little as 10 days. Human hormone production has similar turn around times.
I have been overweight my entire life. I have successfully lost weight with up to eight months of calorie restriction, so my willpower is just fine, thank you. I have always gained it back, and you calling me out for some kind of moral turpitude is not helpful.
Your "eat like an adult" finger waggling is condescending, and claiming anyone who thinks obesity is more complex than "just eat better food, bro" is anti-intellectual and anti-science is just insulting - and not particularly "pro science" either.
You're omitting details. You simply didn't change your eating habits. Statistically, this detail you shared is also overwhelmingly the documented reason why people fail to keep off weight. Almost entirely, people who reside in higher classes of obesity have no idea what their relative consumption habits are in comparison to those with lower BMIs.
This may come as a surprise to you, but most other countries where obesity is not a problem, most sugar consumption is also from fruit and these peoples' diets _don't_ contain anywhere near the amount of added sugar an American diet does. This isn't a special thing to point out, you just think it is because you have no other frame of reference.
Of course I am not saying my body violates the laws of thermodynamics. After some time I succumb to cravings and begin overeating again, a bit at first and then more. I am not denying this is behaviour driven. My only point with the fruit aside was that I'm not consuming my sugar from chocolate milk or sugary breakfast cereal, not that I think fructose is exempt.
But to suggest that all I have to do is eat healthfully for a few weeks and my cravings will be gone is infuriating. I have eaten healthfully for years and years, and eaten at a calorie deficit (of healthy food) for many months at a time. And the cravings NEVER go away. I always go to bed thinking of food.
Maybe I should get a nutrition degree and then my body will conform to what your textbooks say should happen.
You can lose considerable weight at speeds that are actually not recommended simply by dropping added sugar from American diets. So much so that you would need to taper off this removal to stay around 2 pounds of weight loss a week instead of dropping this consumption pattern cold turkey.
The biggest difficulty in sourcing food materials or eating out is that we have sugar in everything. We have added sugar in things that in other countries you would have never added sugar into to begin with.
The reinforcement habit is directly tied to food reward, sugar consumption, and ghrelin production. Anyone who tells you otherwise is lying and is simply refuting what we have come to understand about food science over the years.
And frankly, we as a people have not yet completely matured out of the phase of producing or accepting low-fat foods being replaced with high sugar content. Plenty of other nations never had this problem at all, never inherited it, and as a result, don't have to grow out of it.
It is staggering how much of our food is incompatible with healthy weight homeostasis, and all of our common supermarkets absolutely work against you unless you are otherwise taught differently.
* * *
Edit:
If you're baking bread for your family every day, even without added sugar, and you don't see the problem here, I don't know how anyone can help you.
I'm not calling you a liar. I said you were omitting details. You didn't mention that you're frequently eating carbs. Now you mention that you're baking, and presumably eating, bread every day.
This is a big eating habit detail.
You obviously deal with a lot of obesity that is caused by excessive sugar consumption. Your conclusion - and smuggled assumption - is that all obesity is caused by sugar. This is trivially refuted by finding obese people in non-high-sugar societies, or from a time period before sugar became ubiquitous.
Calling me a liar does not make your position stronger.
Response edit: I have four school aged children who get a sandwich for lunch every day. It takes no time at all for a family of six to go through a 650g loaf of bread, and it doesn't require overeating - I'm the only one in my family with a weight problem, and I bake the bread I don't eat it. Your assumption that everyone in the world is exactly like you is truly breathtaking.
Those people definitely existed, but were pretty rare. Maybe you are one of them. Statistically, probably not.
> I bake bread for my family every day because I can't get bread in Canada that has no sugar. I'm aware of how insidious sugar is.
That is definitely way, way better than anything store bought, so it's great that you are doing that. However, even without added sugar, bread will start converting to sugar immediately after being in contact with saliva(and will continue once the pancreas enters the picture). So you are eating sugar every day still, possibly quite a lot of it.
I had to severely decrease bread consumption, as well as anything containing simple carbs, to decrease my insulin resistance.
Mexico has approximately the same per-capita sugar consumption as Italy, Spain and France, yet the obesity rate exceeds that of the U.S. Norway has 50% more per-capita sugar consumption than the US and very little obesity. I don't think eating little sugar or refined food, yet being overweight makes me a statistical anomaly at all.
I'm not claiming some kind of magic variation in base metabolic rates. I'm only saying that it is too simplistic to point at refined sugar and say that a complex problem has that one simple cause. (And that to solve it one need only learn to be an adult).
I don't eat bread by the way, I bake it for my family. I do revert to eating potatoes and pasta though, which is no doubt to blame for my weight fluctuations. My irritation in this discussion comes only from the ridiculous claim that if I were only to eat like a grown-up for two weeks, food cravings would disappear and my problems would be solved.
Carrefour et Monoprix ne ressemblent pas du tout à ceux de WalMart, etc. You can't compare them. Their food selection makes ours in the states look embarrassing, and I wouldn't be surprised if it were the same for Canada. It's superior on all fronts.
It isn't too simplistic to look at sugar or general carbohydrates and say, this ingredient has the highest reconstitution of habit developing behaviors compared to that of any other macronutrient. Your body's ability to reinforce food habituation compared to any other macronutrient on a graphed scale makes every other macro look like peanuts. It's sugar. It's carbs. It's a fact. It's scientifically proven. I implore you to do the reading yourself. Fat also has a high recidivation rate, but it pales in comparison to carbohydrates.
For your own health and the risk that you'll tell others otherwise as well, just dismiss me and read these studies yourself.
It's that easy, and the reality is that no one adjusts for it. Your supermarkets don't care and all of the people around you probably don't realize it either. It's cultural. It's in your beer. It's in your coffee creamer. It's everywhere.
It is the dietary equivalent of global warming denial. Seriously. I have watched people with class 3 obesity drop 40 pounds in one month, which is terribly hard on your body and not recommended, by immediately switching off high carb, high fat diets.
Yes, your food cravings do truly, really, disappear within a span of 2-4 weeks. Within 30 to 60 days, people can and do form rejection habits with little documented "willpower" in the same way these individuals using GLP-1 hormones do.
Because it's the same activation vector. You increase incretins production through rich protein consumption. People suffer from the effects that you describe because of leptin resistance. For people in extreme weight class categories, you don't get off after a few months, fat cells stay in your body for years in dormant, reduced volume form.
The point is you claim that if we gluttons would just cut out sugar for 2 weeks and learn to be an adult, our appetites and cravings would disappear. That's nonsense, and your dismissal of data that doesn't fit your narrative makes your accusations towards others of being anti-science both hollow and ironic.
You’re making some pretty casual assumptions about people’s abilities.
These are impractically expensive and still less effective than one might expect.
Researchers seem to be eager about the promise of supplementing the very-best programs they’ve been able to find… with GLP-1 agonists. Because that might finally make them really effective.
That’s how bad the entire body of all other solutions we’ve looked at is.
You have been downvoted, but that's true(and supported by evidence and science). Statistically, what most people have is sugar addiction. Simple carbs in general completely mess up your hunger hormones.
The problem is that most people don't know what a healthy diet is. The food pyramid isn't it. Drinking a bunch of juice isn't it. Cereal is candy. They try "eating healthy", fail (not realizing what they are eating isn't healthy at all) and give up.
There are also studies out showing that people just up their sugar intake, so I think the results on how it affects peoples diet is still pending. From what I've seen, people are eating less, but more of it is junk food and sugar.
I can absolutely see why people would want to be able to just take a drug and start losing weight, it's hard. My concern is that it takes more than a low body weight to be healthy. You still need exercise, and while that's not an effective weight-lose solution, it is something that most would add when trying to lose weight, and now they're missing out on that part. Arguably exercise is more important than your weight.
I'm curious to hear the argument
You can still be in bad health, even if your weight is spot on, but it's rare that you exercise a lot, but is overall unhealthy.
As a default it is. And that's what it became. We stopped trying any other methods. Come in the door, have a set of symptoms that check all the boxes, walk out in 30 minutes with a prescription, doctor's office gets a bonus. Institutional psychiatric treatment is drugs first actual treatment later.
This is a _social_ problem. It should be discussed and addressed as such. You should not attempt to pervert this concern into an _individual_ issue in an effort to invoke a needless moral defense.
Why?
Is this a solvable problem? Yes, but it's monumental, encompassing everything from the way we structure our civil society and work life from the forms of food and entertainment that we incidentally or directly subsidize.
We accidentally built something gross. It moves really fast, though.
Re-wording it so that you say your end goal was better outcomes for people and restructuring society to achieve that is a noble goal. It's easier for people to want to agree with than being a moral policeman.
Obesity rates have not been constant. There are clearly multiple modes to this problem and history suggests that this class of people is the minority of the visible issue.
> more bike lanes and subsidies for bikes
You don't need this so much as you need roundabouts and actual _human_ scale infrastructure in cities. Some smaller towns in the midwest got the memo from Europe and are starting to adapt easily.
> more agricultural subsidies for healthy food and less for corn
I think the amount of subsidy overall is a problem. I think we could to take another page from Europe and start banning food additives. We can stop classifying highly processed foods as foods and instead as desserts and tax them appropriately. A lot of this is already in motion.
> Realistically we aren't going to get those things.
We used to have these things. I don't understand your position of social excuse couched in social pessimism. So instead of addressing the problem just accept that pharmaceutical and insurance companies will now enrich themselves off this created problem?
You know, we can solve _two_ problems at once, if GLP-1 has some short term benefit then great, but to plan on it existing in the long term for weight management is utter madness.
Humans have created a technology (mechanised farming) with a side effect we haven't yet evolved to handle (an abundance of tasty calories), so it doesn't seem all that strange we would fix it with a technology (inhibiting the desire for said calories).
People in the Netherlands eat such shit food — but they are so healthy because they move a lot and aren’t obese.
I’m not sure that food quality is as important as we sometimes hope it is (after all, we pay for quality)
I'm super satisfied just having an apple or two now. The "omg I need to eat, ohh a burger" is gone.
Glad you're seeing benefits like that!
Even blue state dem voters I know used to whinge about Michelle Obama and her veggies lol.
This is a bullshit term. Even fast food is not "toxic", it's just calorie-dense.
I got overweight eating nothing but "healthy" diet because I have never _liked_ fast food.
It's a pretty sadder fact that people just make these wild assertions. Everyone I know (which is about 10 people in real life, myself included) who's used a GLP-1 drug found that they eat healthier because they've less desire for shittier food.
Had to scroll too far to find this. It's a great synergy isn't it? The food industry creates calorie concoctions that can barely be called food, are dirt cheap to make and rakes in profits. People get sick. The pharmaceutical industry sells drugs are stupid high profit margins so that people can keep on living.
It is not a conspiracy, but it's a good feedback loop for corporations. All that money allow them to flood the scientific community with their sponsored studies, dominate news broadcasts (confusing consumers) and even influence the food pyramid, which is almost upside down.
I've been on a slow quest to improve health and lose weight. It's really, really slow, far slower than what most people would like. But cutting added sugars to zero (including and most especially high fructose corn syrup) gave almost immediate benefits that kept me going. Sugars (and carbs in general) make you retain a lot of water. Cut those, and you'll see a major difference in the scale in a couple of weeks. Is it mostly water(but not entirely!) Yes. It doesn't matter, our lizard brains interpret that as success. That also reduces hunger, which is a positive feedback loop.
https://slate.com/technology/2023/07/ozempic-costs-a-lot-it-...
Although tirzepatide just got knocked off the shortage list last week so it could become harder to get in compounded form.
"The announced investments across both companies total $32 billion. GLP-1s were 71% of Novo’s revenue in 2023, 16% of Lilly’s in 2023, and 26% of Lilly’s in 2024Q1. If these sales are proportional to the manufacturing capacity used to create those drugs, then about 40% of Novo and Lilly’s combined estimate of $45 billion in gross PP&E is for GLP-1s, for a total of $18 billion; $25 billion would then mean a 140% increase in GLP-1-relevant PP&E."
Manufacturing investment is not proportional to sales, because there's a fixed cost to making a certain drug regardless of how much you sell. If a rare-disease drug will have a few thousand patients ever - not uncommon! - you still need to figure out a synthesis path for that particular drug, run QC tests on the production line, get regulatory approval, etc. Economies of scale matter a lot (https://en.wikipedia.org/wiki/Experience_curve_effects).
> the active drug in Ozempic can be produced for about 29 cents for a month’s supply, or 7.2 cents for a typical weekly dose, the research found. It’s not cheap to make — semaglutide costs over $70,000 per kilogram. But only a tiny quantity of the drug is used in each weekly dose.
> https://fortune.com/europe/2024/03/28/ozempic-maker-novo-nor...
I think this makes it likely that strongly ramping up the supply is not a major problem.
I have zero expertise on this, but would be curious if anyone knows what's special about Ozempic delivery that can't be served by a commodity syringe.
They're meant to have a vial-needle version, but it is $600/month and you can only do it for up to 5-months and a low max dose. So it isn't a real program, but rather a way to avoid critique from legislators.
People don't want to use a commodity syringe. People are scared of needles. The autoinjectors take most of the fear out of it.
They can't charge as much. That's basically it. Generic semaglutide from compounding pharmacies (which have their own issues for sure) is under $150 a month cash-pay these days.
The real issue with syringes and self administration is that the vast majority of the population are not comfortable with it and don't have the diligence to do it correctly every time, so you get under/over dosage or noncompliance.
That being said, the autoinjector format doesn't really solve that problem, it just slightly ameliorates it, in exchange for approximately 8x the cost.
...Is that supposed to be impressive? I assume you mean USD, so that works out to more than I pay for my food. Toronto isn't a cheap place to buy food, either.
The article says this:
> Surprisingly, the study found that the biggest cost in producing Ozempic is not the active medicine, called semaglutide, but the disposable pens used to inject it. They can be made for no more than $2.83 per month’s supply, the authors concluded, based on interviews with former employees and consultants to injection device manufacturers. One Ozempic pen is used weekly and lasts a month.
So while the injection pens are significantly more expensive than manufacturing the drug itself, they are still relatively cheap. So it seems to be not a major problem to strongly ramp up production here as well.
Which suggests any supply shortage will be resolved relatively quickly. Perhaps in less than a year? Then the limiting factor will not be the supply but the market price.
https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...
And yes its over the counter....I currently take one dose per day at 1200mg
> Neither is berberine any version of Ozempic, which is an analogue of glucagon-like-peptide-1 (GLP-1), a natural hormone that regulates blood sugar and helps people feel full. Berberine has nothing to do with GLP-1.
> Perhaps the most interesting laboratory finding, given the rising global tide of type 2 diabetes, is the control that berberine may exert over blood sugar. But there is a problem. Berberine is virtually insoluble in water and has low intestinal absorption which means it has poor bioavailability. […] Because of berberine’s poor bioavailability, supplements on the market are likely to be useless. However, some derivative of berberine, may yet make it to the physician’s prescription pad. But it won’t be for weight loss.
Apparently most of the effect is due to activation of the "bitter taste reception pathways" in the gut. So even though it has very low bioavailibility, it can still stimulate GLP-1 secretion just simply due to its incredible bitterness
"Berberine induces GLP-1 secretion through activation of bitter taste receptor pathways"
https://www.sciencedirect.com/science/article/pii/S000629521...
But buyer beware when it comes to getting berberine from over-the-counter supplements:
"Variability in Potency Among Commercial Preparations of Berberine"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807210/
Nine of the 15 tested products (60%) failed to meet the potency standards of 90% to 110% of labeled content claim, as commonly required of pharmaceutical preparations by the U.S. Pharmacopeial Convention. Evaluation of the relationship between product cost and the measured potency failed to demonstrate an association between quality and cost. Variability in product quality may significantly contribute to inconsistencies in the safety and effectiveness of berberine. In addition, the quality of the berberine product cannot be inferred from its cost.
Worse still,
"Preparation and Evaluation of Antidiabetic Agents of Berberine Organic Acid Salts for Enhancing the Bioavailability"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337101/
Berberine—an isoquinoline alkaloid isolated from the rhizome of Coptidis rhizome, Cortex phellodendri, and other plant species—possesses a variety of pharmacological effects, including anti-cancer, anti-hyperglycemic, anti-hyperlipidemic, antimicrobial, anti-inflammatory, and antioxidant activities. However, its absolute bioavailability is as low as 0.68%. Low bioavailability greatly restricts the clinical development of berberine.
A few weeks ago I started a low dose of tirzepatide (aka Mounjaro, aka Zepbound) and the side effects are interesting.
The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.
But there are some unexpected positives.
Obviously I am eating less. I have to log food not to keep it in check, but to make sure I'm eating enough and with the right nutrients. There's another possible negative here -- you get a lot of hydration from food, so if you start eating less you should carefully monitor your fluid intake to allow for that.
But I'm also more focused. Not nearly as distracted. I'm getting a lot of things done which I used to just procrastinate on until years had passed in some cases. Man, the garage is going to be clean and superbly organized in a few weeks.
And my emotions are quieter. Not just the food noise, that was expected, but I feel more relaxed. That's not what I expected, and I'm pleasantly surprised.
As an aside, what makes this all really noticeable is that it's a once-a-week injection, and the peaks and valleys are very obvious. Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.
Edit: Before someone asks, yes I have considered there may be long term effects. This is a risk, which I've decided I'm okay with at my age. Nobody gets to live forever anyway, and I was going to end up in an early grave via another route if I didn't do this. "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.
I do hope to taper off at some point if I can figure out an alternate strategy for staying lighter. Though I'll miss some of the positive side-effects.
Manic behaviors also associated with older, popular diet drugs like meth.
The published stuff I can find seems to be at the level of anecdata, scarcely better than "I know a guy who..."
- What people talk about on social media: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10669484/
- Some people made large "reckless" life choices: https://academic.oup.com/qjmed/advance-article-abstract/doi/...
Not yet. The effect appears to be real, but it's too soon to tell: https://www.science.org/content/blog-post/ozempic-and-other-...
From my own anecdata, unnecessary impulsive eating probably reinforces the impulsive behavior. You start associating impulsive behavior with a reward.
GLP-1 not only removes that, but adds a slight negative reinforcement. Impulsive eating no longer brings reward, but makes you feel over-full. This can then down-regulates the pathways that lead to increased impulsive behavior.
I won't sugarcoat my problems. I knew I wasn't hungry when I'd eat sometimes. I knew it would keep me overweight. I knew it wouldn't even feel great afterwards. And yet, more often than not I did it. And beat myself up over it every time. Very demoralizing, even without help from moralizing folks on the internet.
On tirzepatide the impulse is just gone. I feel like I can take it or leave it, and since the consequences of eating unnecessarily are quickly negative, I just don't do it.
Does it reduce sex drive as well?
Decades ago I tried phentermine for a couple months. Now that was a ride, and you might call the experience closer to manic. I was a machine. This is not like that.
The cancer anxiety could be reduced by frequent testing. e.g., having a thyroid ultrasound every 6 months, or a yearly abdominal MRI, just to make sure cancer is not brewing.
This 2024 study showed no increase in risk over 3.9 years.
https://www.bmj.com/content/385/bmj-2023-078225
To be fair, GLP-1 drugs cause dose-dependent increase in thyroid cancer in mice. But mice are not humans.
I haven't seen any mention of cancer on r/zepbound
Studies show it just doesn't work.
There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 and the likelihood of going from severely obese to normal weight is 1 in 1667.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407685/
[edit] not to mention for those 1 in 11, the average weight regain over 5 years is 80%.
https://www.sciencedirect.com/science/article/pii/S000291652...
If you just teleport a fat guy from Bentonville to Manhattan and give him a Metrocard he will lose a pound a week. The people who say nobody can lose weight, it's too hard, cannot explain why there are macroscale populations with lower obesity.
Anything is fair. It is a discussion forum. You can say whatever the hell you want. But it is equally nonsensical.
> so I'm looking to see why they think otherwise.
You looked for someone else – someone who prepared a study – to tell you why it might be otherwise. But if you want to talk to someone else, go talk to that someone else. If you want to come here, be happy with the people who are here. They might actually teach you something without having to defer to random other people.
I could see a reasonable complaint that asking for studies is being passive-aggressive, but it's the sort of passive-aggressive that both helps keep the discussion more civil and leaves room to actually substantiate the original claims (that is, it's actively better for keeping the discussion going!). Just saying "lol, no, wrong" kills the discussion far more than talking about (lack of) evidence.
If someone is full of shit, and assuming you care, then logically you would put in the effort to fix their misunderstanding, not tell them off. Exclaiming that someone is "full of shit", politely or not, is stupid. If you don't care, then why not own it? Don't care.
> The only person being stupid here is the person making strong empirical claims without qualifying them or providing supporting evidence.
There can be more than one stupid party involved.
> I could see a reasonable complaint that asking for studies is being passive-aggressive
It is just straight up nonsensical. I get that is was only ever a silly meme and always understood to be nonsensical, but a meme that has become quite tired. It was funny 20 years ago, perhaps, but at this point it is time to lay it to rest. I mean, anything goes in discussion. If you still think it is edgy, go for it. But the rest of us will still think it is stupid.
Are you sure?
>In 2023, over 35 percent of adults in the Netherlands were classed as overweight, meaning they had a body mass index (BMI)of between 25 and 30. Furthermore, just under 16 percent of adults were obese
>47 percent of French adults were overweight, of which 17 percent suffered from obesity
>49% of the Belgian population has overweight, of which 18% have obesity.
>Spain: 43% of adults aged 18 years and over were overweight and 16% were living with obesity
>46.6% of women and 60.5% of men in Germany are affected by overweight (including obesity). Nearly one-fifth of adults (19%) have obesity.
Looks like it's actually 1-in-5.
Are you arguing that 1:5 is good, but 1:4 is bad?
The only large populations of people in the world that aren't quite fat are southeast Asians. And this is fairly accurate whether they leave in southeast Asia or in the US or western Europe. Not 1:5, closer to 1:20 or in one case 1:50.
Even then, southeast Asian obesity rates are climbing. The US may have led the pack because of a consistently high standard of living, but I don't see any indication that there are macroscale populations anywhere in the world keeping the disease at bay.
No, I'm saying that 1:4 is something to brag about, and 1:5 is even better.
It's not that "eat less and exercise more" doesn't work, it's that nobody does it, because it's really, really hard.
Calories in/Calories out is both completely true and completely useless for actual humans.
edit: that's unfair, mostly useless
There are plenty of examples of people who've managed to lose weight through diet and exercise, it's not "nobody". Sure it's a small % success rate, but that's because it's not easy. Just like squatting or deadlifting 300 lbs, it's not easy to get there, but the vast majority of humans could if they decided to put the time and effort into it.
The fact is that you have much more control over one than the other.
I don't disagree that maintaining a healthy weight is a challenge in today's environment, but it's not impossible or inevitable, like so many in this thread are pretending.
> The fact is that you have much more control over one than the other.
Why do you say that? Studies do not agree. How would you assess the difference? Or are you simply coming at this from the perspective of either someone who has never had a weight problem or was able to get out of a weight problem without issue? If the latter you're in the ~1% and your experience is not that of others in the same way as your experience as someone without depression does not align with that of someone who is depressed.
How would you measure your thesis? Certainly it cannot be based on results because, well, I cited them.
As someone who isn't addicted to cigarettes, it's pretty easy to not smoke. My experience does not align with those addicted to cigarettes, and I can appreciate that. Why do you not appreciate that the experience of those with obesity might be different than your own? I am not obese for the record, and I have never taken GLP-1s, but I have been obese and this just makes sense to me.
Just because you have full control over your diet and I have control over smoking does not mean that there are people out there who cannot control their diets and cannot control their smoking.
Maybe depression and obesity are more similar than you are giving credit. Especially since serotonin inhibits appetite and has an integral role in maintaining energy homeostasis.
[1] https://academic.oup.com/edrv/article/40/4/1092/5406261
Is there any data I could provide that would change your mind or is this just a "I heard it growing up so it must be true" kind of thing?
It's one of the hardest things I've done. I'm no stranger to hard physical things - I've run marathons, raced cyclocross, done daily bike commuting through several Chicago winters, and I'd rate the weight loss as up harder than all of those. At the risk sounding too hubristic - if that's the effort it takes to lose weight, doing so is beyond the abilities of large swaths of the population. Not to mention that I have the time and financial resources to weigh my food, buy foods that were optimal for my diet (so much yogurt and chicken!), etc.
(As a side note, exercise isn't a very good way to lose weight in my experience. It's valuable to do for all sorts of other reasons, but I actually gained weight when training for my first marathon, while running 60-70 miles/week).
Generally people who don't normally exercise are going to gain muscle faster than they lose fat. This was the origin of HAES before it got corrupted: Health At Every Size, not "Healthy". Encouragement to keep going because with exercise you'll get healthier even if you're not losing weight.
Also, by weight, muscle burns more calories than fat just by existing. Personally I think that's where most of the weight loss attributed to exercise comes from, rather than the exercise itself. You have to gain the muscle first to actually burn more calories.
Obviously, even a small amount of effort becomes impossible when you multiply it by "forever".
Edit: In my opinion it's hard for two reasons. We have cravings for high calorie foods. And no one candy bar will make you fat, so it's easy to think "I'll exercise more tomorrow to make up for this indulgence." But then you don't, because that's hard too.
No, you have to decide to even think about the difference between them instead of thinking about something in your life that feels more important. It's a sort of cognitive opportunity cost. You have to consciously think about food (instead of something useful) forever, because your body's instincts are telling you to do the wrong thing and you need your rational mind to overrule it.
So for the rest of your life, every day, until you die you must decide to stop and expend effort making that decision instead of thinking about work, family, politics, or writing a new bit of code that will change the world. Most human beings can do it for a while, but not forever. The only way to do it forever is to get your body chemistry on your side and reduce that cognitive load.
That's how all creatures in the wild do it. That's how humans did it for the past quarter million years. And all creatures did it for the past hundred million years. Wait, no, it isn't. Then there must be another way. A way that doesn't involve manipulative abusive capitalists and advertisers destroying health in the name of profit while selling it as freedom.
> "or the rest of your life, every day, until you die you must decide to stop and expend effort making that decision instead of thinking about work, family, politics, or"
How much does that lifestyle sound like freedom to you?
Neither creatures in the wild, or primitive man, have access to unlimited quantities of calorie dense foods. We could go back to that lifestyle, but billions would have to die and the overall human lifespan would decrease rather than increasing.
I think I'd rather take a perfectly safe drug than go back to wiping with leaves and hunting for worm riddled meat.
> How much does that lifestyle sound like freedom to you?
I'm not even sure I understand which lifestyle you're asking about here, but if you mean the modern lifestyle then it's certainly more free than the lives primitive man had. "Might makes right" was the rule of the land back then, and contrary to your imagination, you probably wouldn't have been the mightiest. Certainly not forever.
Hell, it's more free now than the lives most of our grandparents had. 50 years ago about half of all white people surveyed said they'd move away if a black person bought a house in their neighborhood, and gay people were routinely murdered for existing.
There were no "good old days", and Stardew Valley is just a game.
And just like that, you've come up with another way.
> "I think I'd rather take a perfectly safe drug than go back to wiping with leaves and hunting for worm riddled meat."
That is some ridiculously hyperbolic panicked scaremongering at the idea of banning Coca Cola. I have literally no idea how restricting the unlimited calorie dense foods available would lead to hating black people and murdering gay people, but it's some more hyperbolic commentary.
> "I'm not even sure I understand which lifestyle you're asking about here"
The one I mentioned. Comparing the "free" lifestyle where you have adverts for Coca-Cola shoved into your face 24/7 along with adverts selling you a drug to help you ignore the Coca-Cola adverts. Vs. "non-free" where Coca-Cola isn't available for sale and you just don't think about it because you've never had it and don't miss it, and you go about your life doing the things you care about instead.
I wonder if you confused this thread with another? Or maybe your sarcasm was misinterpreted?
I do see how it looks like a return to caveman times, and was unnecessarily sarcastic. Practically, the times when I don't have junk food in the cupboards, I don't have to think constantly about resisting junk food because there isn't any to eat and that makes a difference. Extending that out to national levels, schools shouldn't have vending machines full of junk food, hospitals shouldn't have coffee chains, coffee chains should have restrictions on how much sugar can be in coffee, soda shouldn't be a thing, breakfast cereals shouldn't be a thing, and keep going as far as necessary. In the argument between Nanny state and Laissez-faire it's very clear that the food industry will kill millions of people and ruin the quality of life of billions millions, hiding behind smiley friendly packaging, exploiting human biases in ways we have no defenses against, and it's not nanny-stating to regulate killers harshly.
You literally did not say those words in the comment I replied to. You didn't even seem to imply it. Either that or there's some kind of shadow ban thing happening and I can't see the same thing you are.
Lose weight permanently through cremation?
One of the studies done with Wegovy showed that people lost 15% of their body mass in a year, but they also eat 500 Calories less and exercised for 2.5 hours a week.
The point was that the 15% weight lose in a year is in the high end of what you can expect, especially if you change nothing else.
This is especially true if you count light exercise.
Maybe there is a path to using these drugs in a manner to get people healthier so they can exercise more, establish good habits and taper down.
Misinformation is also going to be much overused and meaningless if used for situations like a simple mistake. The commenter just misread something - branding it as misinformation seems to imply intent, otherwise why wouldn't you just call it a mistake?
At the present time, Ozempic is not approved for Type 1 diabetes:
>...Ozempic® is not for use in people with type 1 diabetes.
https://www.ozempic.com
Compared with Type 2, with Type 1 diabetes there are other risks that could occur:
>...While medications such as GLP-1 receptor agonists (Ozempic, Wegovy) and SGLT-2 inhibitors (Jardiance, Farxiga) demonstrated powerful benefits, they quickly were determined to pose too much of a liability for pharmaceutical companies or regulators due to concerns about safety. Specifically, GLP-1s can increase the risk of hypoglycemia (low blood sugar) and SGLT-2s can raise the risk of a serious, life-threatening complication called diabetic ketoacidosis (DKA).
https://diatribe.org/diabetes-medications/why-diabetes-mirac...
A phenomenon not limited to dieting.
Considering it's a societal wide problem, society at large ought to care about resolving it. It's incredibly expensive otherwise to treat chronic, lifelong obesity.
I do see a lot of people ITT who were accused of doing so but who aren't actually doing so.
And I've known quite a few people who get really annoyed at constantly having to hear about how impossible it is to do things that they've personally actually done.
obesity has a large hereditary component. important genes associated with obesity are expressed in the brain.
is it impossible to live with constant hunger and its consequences? no, likely not, but it's not really a big mystery why millions of people fail to do so.
I want to emphasize that a few decades ago, people were much thinner in the Western world and did not hate their lives because they could not eat a triple cheeseburger, go hungry constantly, or feel physically deprived. Those were my parents and my grandparents, I know them.
But if you show them hyper-caloric food that makes them feel like crap, they can't say no. It's disappointing. And the same can be said for addiction to social media, horrible TV series, and constant music everywhere.
The unattractive, low-status man (or woman) has less trouble remaining faithful than the handsome, high-status man (or woman). Not because they are more virtuous, but because they are not as exposed to temptation. But fewer people justify the unfaithful than the “big eater.” And that's something society and culture have decided, for now.
There are many people who don't feel that need. They don't actively resist cramming cake into their mouths, they just glance at the cake disinterestedly and move on. Or eat a bit, and feel that's enough, and don't want more.
https://news.ycombinator.com/item?id=27936016 has discussions about the dramatic rise in obesity after ~1970; refined sugar, chocolate, butter, doughnuts, McDonalds, cars, TV, have been around longer than that. Could there be involvement from Glyphosate pesticide, from reduction in smoking appetite-suppressing cigarettes, Lithium contaminated water supplies, increased Vitamin A added to milk and grain supplies, rise in antibiotics used on farm animals, which causes some people to gain and retain weight more easily?
Service jobs are not conducive to good health.
The main problems have been the easy availability of cheap and tasty calories, combined with a surprisingly low resistance to the ingestion of those calories.
You're looking for "hyperpalatable foods", not hyper-caloric. They're related but distinct.
It shows what it shows.
What the explanation is, that actually requires research. Anything from new food additives, changed lifestyle habits forced by the pandemic, increased chronic stress, screen addiction compromising other opportunities to be active, less walkable neighborhoods, more elevators, higher calorie diet, cost increase in healthy diet to just name a fraction of possible factors.
No, I'm angry in the way that you punching me in the face with my own hand, saying "stop hitting yourself" then offering to sell me a painkiller subscription might make me. The sheer ridiculousness of Big Food vs Big Pharma with humans trapped in the middle. Humans presented by geeks as perfectly spherical rational decision makers, but actually lizard hind-brains wrapped in frontal lobes and language centers, with very exploitable biases, feelings, fears, and base drives and very few defenses against it, and those defenses being undermined at every turn by political lobbying and profit seeking.
Imagine how much money and time and effort is spent making Doritos 2% more tempting; the crunch, the flavour intensity, the packaging layout, the packaging colours, the mouthfeel, the shelf stability. The same for ice cream and everything else. How far can Kelloggs stretch the gap between the strawberry presented on the packaging and the almost-zero strawberry in the pop tart? Or the honey pictured on the Honey Nut Cheerios box with the "hint of honey" in the description on the back? How To Cook That[1] on YouTube on Kellogg's misleading and potentially misleading claims.
[1] https://www.youtube.com/watch?v=suy3wGzQ08g&list=PLPT0YU_0VL...
See e.g.
https://en.wikipedia.org/wiki/Waist%E2%80%93hip_ratio
for recommended values.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803033/
At my lightest in 2023, I weighed 60kg. Currently I weigh over 95kg. I don't know what else people who hold your view can be told to convince them this problem is not one of willpower. I have the capacity to suffer. I've given up smoking. There is no escape from food.
The extra weight is not muscle, to be clear.
Ah, but what is food?
A cake made with sugar, flour, and butter will have a different impact than the equivalent number of calories in blueberries
Eggs and butter will make you feel different and will be treated different by your body than white bread and peanut butter and jelly
food is too general a term, it encompasses too many very different things
Likely, you will at some point revert to unhealthy habits and become fat again.
Long-term weight loss success numbers are abysmal.
Testosterone replacement therapy, highly refined protein powders, nootropics, etc.
We’re all trying to make the best of what’s given, revert mistakes, live longer.
All options are on the table.
That should be very doable for most people. 250 is overweight for everyone under 7 feet tall, and 280 is obese for everyone under 6 foot 9 inches (that's about 99.997% of the population, if my data source is correct). For the vast, vast majority of people 350 pounds would be somewhere in the mid-40s BMI.
If you want to not be fat, exercise and eat fewer calories. Full stop.
The fact that a certain group of individuals don’t have that self control is just evidence that education and public health have a place. Drugs won’t solve that.
These drugs are needed for people with metabolic disorders caused by years of food abuse or poor genetics. It’s not a population wide solution.
Like (a) no shit and (b) the question is why can’t people. Because we know objectively they can’t.
The drugs work by literally solving your self control issue, and to such an extent it works beyond just food.
> By 5 years, more than 80% of lost weight was regained
I think a much better hypothesis is that CICO does work, physically, but there are metabolic, hormonal and mental factors that either predispose towards obesity or make it difficult to escape.
It's a bit like telling gambling addicts to "just stop gambling" or depressed people to "lighten up".
And along comes GLP-1 drugs, where obese people find it easy to lose weight, find new motivation for life, etc. The GLP-1s aren't increasing metabolism, nor are they making people exercise, nor are they making food less available. Yet somehow, a hormonal mediation is greatly successful, hmm.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
To bring it back food, the issue is not the eating, the core issue is the hunger causing the eating and that's what the medication is addressing.
The people you think are eating ea
I take "Studies show it just doesn't work" to mean "Studies show telling people to eat less and exercise more definitely doesn't work," as opposed to "caloric deficits don't work".
It's the doom of the statistical distribution. Good outcomes are defined in relative terms on the bell curve, not on absolute performance which exercise is actually suited for.
In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. I can imagine farmers back in the days of 12-hour days of physical labor may burn 5000 or 6,000 calories. A pound of fat is 3500 calories.
Meanwhile, people that are generally following some 20 minutes of exercise five times a week, regimen of the medical establishment are likely really only burning about 300 to 400 calories tops in those 20 minutes sessions, if they even do that.
For the sake of argument, we're going to ignore the basal metabolic advantages of people that are burning an extra 1,500 to 3000 calories per day and the stimulated muscle growth that comes with it.
People back in olden days just on activity were burning a third to a half a pound extra of fat per day in terms of energy.
Meanwhile, modern people who "exercise" are burning maybe a tenth of a pound. Only when you get to "athletes" that are "training" do you get to the calorie burns that people's lives used to entail.
So it's important to keep in mind when people say exercise is ineffective in weight loss that they really are talking about very minor amounts of added activity by by modern medical standards.
Exercise is extremely effective at limiting weight if you get to what I call the 1000 calorie Hammer, where your exercise is adding an extra thousand calories or more per day to your activity. And you're simultaneously not going nuts on your diet.
A 1000 calories is a considerable amount of activity. For a 180 lb man, that's 4000 yards of swimming, 7 miles of running, or 25-30 miles of biking.
If you are a 120 lb woman, increase those distances by 50%. Most people consider those loads to be exercise obsessives, but practically that's what's necessary in order to employ exercise as a usable means for weight control and surviving the corn syrup world we're in
Hasn't this idea been studied using modern-but-primitive groups of people who still live much as they have for thousands of years? Their bodies are quite efficient and they do not burn substantially more calories than "civilized" humans in regular society do.
That said, modern farmworkers in my town are mostly overweight, for the same reasons as everyone else.
But yes, great way to lose weight I agree, just not practical for a lot of people.
So a 190lb man burns 150 calories for running a mile, but only 100 calories for walking it. It will take about 20 minutes to walk a mile, and about 10 minutes to run one.
So this relates to the original complaint about exercise 20 minutes a couple times a week: if you walk 20 minutes, you've burned... 100 calories.
A 1000 calorie hike is probably 10+ miles, and that's about 200 minutes. 3 hours and 20 minutes! Yup, quite the time commitment, however if you ran 7 miles it would only take about an hour.
Eating less and exercising most certainly does work, if the individual sticks to the routine.
I do agree it's difficult to stick to a routine because our modern lives are demanding and so we compromise by eating fast food and avoid going to the gym.
I think the exercise paradox video recently put out by Kurzgesagt has been a net negative for how people think about diet and exercise. The paper the video is based on is highly flawed.
That paper has a few major problems but these are the biggest:
1) The authors didn't control for body mass. The Hadza and Bolivians burned 52kcal per kg of body weight. Americans burned only 38kcal per kg of body weight. That is: the active groups burned significantly more calories than the inactive groups, on a pound-for-pound basis.
2) The active groups were defined as such because they walked ~12km per day. This is significant because the human body is exceptionally efficient at walking. It is certainly true that over a comparable span of time, you will burn less calories walking than you would running, or lifting weights.
GLP-1's are miracle drugs and people should take them if they at are high risk for obesity-related diseases.
But diet and exercise certainly do aid weight loss, and will have fewer negative side effects than a GLP-1 drug.
https://www.germanjournalsportsmedicine.com/archive/archive-...
Caloric intake and outtake is just that.
That's literally the whole reason that ozempic etc are popular, because they make it easier for most people to just eat less, in the same kind of way that caffeine makes it subjectively easier for someone who's tired to be productive.
Right. To be explicit, "just eat less" means "live your life always hungry." There's a reason this more-or-less never works in practice.
1. Consume more calories than your body will need to function
2. Consume as many calories as your body will need to function
3. Consume fewer calories than your body will need to function
When you consume more energy than you require, your body stores the remainder as fat. When you consume less energy than is required, your body converts your fat into usable energy.
Now obviously, this is an over-simplified explanation of nutrition. What you eat, when you eat it, how efficiently your body converts food to energy, and other factors will determine the little details. But the explanation I've provided is not nearly as over-simplified as "it just doesn't work."
To make a comparison, it would be like suggesting that the financial advice "earn more money than you spend" just doesn't work as a method of saving money, on the grounds that some % of Americans who try to save money end up in credit card debt.
You say yourself, it couldn't not work. And yet there's hundreds of thousands of people that say it didn't work. Explain them, are they lying?
I'd assert, the oversimplified explanation is misleading. It's only true in the same way that drinking cold water will help you lose more weight than warm water. True or not, reality seems to strongly suggest it's irrelevant
Yes.
Pizza tastes better than granola. Grand Theft Auto is more fun than math homework. Having a Dodge Charger is cooler than having a Hyundai Elantra. Who cares about the costs? I can always fix my bad habits tomorrow.
So, human behavior is more complicated than just counting? Why would someone eat pizza instead of granola? Are there some physiological reasons for this? I wonder if there might be an evolutionary advantage for a species to develop the desire for high caloric foods? That sounds like something that would make it much easier to make the decision to seek out pizza, and much less likely to choose granola. Especially when you consider that humans are mostly creatures of habit.
Saying just count calories is reductive to the point of absurdity. you can tell it doesn't work because it hasn't worked for society for decades, yet it's such an obvious solution no one stops to account for the astronomical amount of evidence that proves "just try harder" does not work on most humans. So, do you want to be right, or would you like to do something that actually helps humans improve their quality of life? "Just try harder" doesn't work, and it takes wilful ignorance of the evidence to claim otherwise.
let's apply this same logic to writing code, we wouldn't have any more bugs if people just reviewed their changes before committing, and wrote that one extra test, right? Works on my machine, ship it to prod... what do you mean millions of computers now bsod on boot? Surely it was just that one extra test, and it's pointless to do staged rollouts or smoke tests or anything like that?
Just never make a mistake is obviously asinine whether you apply it to writing code, or deciding what to eat. The difference being we don't have a millennia of evolution trying to convince us to write bugs.
I agree with the premise, people are responsible for their diet their decisions and their habits. I just don't agree knowledge of that is enough for everyone to improve their quality of life.
You're letting that word do some very heavy lifting.
> To make a comparison
I think the comparison is very weak, very superficial. The human body is way more complex than CICO. But your comparison does have some intuitive value -- there are more than a few people who consistently spend every penny they make, and sometimes more, just trying to survive. We don't see a lot of them on Hacker News, to be sure.
Genuine quesion - if I eat 1500 calories today and do a measured 2000 calories of work on a treadmill, where did that extra 500 calories of energy come from?
Are you suggesting my body can create energy from nothing?
So how can CICO not work?
Imagine a computer with a primary source of power, and a backup supply. You're measuring CICO of the primary supply. And you're tightly regulating the power available on primary to keep a power deficit. Unfortunately, during periods of high load, this computer is able to switch to the backup supply which you aren't able to exert tight control over.
There's a huge number of things that could cause a human to ignore their best interests. Ignorance to consequences, the long-term implications of any decision, degraded mental health, external social pressures, the list goes on and on.
Humans have impulses just like every animal, and proper training can convince a dog not to immediately lunge and eat every morsel of food they can smell. but it takes a lot of work and external pressure to train that into a dog, and even then given the right circumstances a dog will still eat food above their caloric needs. Humans behave the exact same way.
> it's easy for me to regulate my weight using cico, so obviously it should be easy for everybody
I know that's not the claim you're making, but it seems like it is and it is the one many other people in this thread are making. just like it's easy to train some dogs than it is train others. it's easier for some humans to control their caloric intake than it is for others.
CICO doesn't work for most humans. Claiming otherwise is on par with the saying just run this IOS app on Android it's easy it works for me! Perhaps a sufficiently capable engineer could make it work, but most humans aren't sufficiently capable.
I think you need to be very careful about your language choice here.
Physics says it has to work. Every athlete on earth knows it works. Everyone that has ever been in a prison camp, concentration camp or had their calories restricted outside of their control knows it works.
It absolutely, factually, 100% works. Our entire understand of mammals and energy depends on it working.
What you are saying, is that people are unable to exercise enough self-control to actually consume less calories. If they did, it would work. But they don't.
That's like saying "pointers in C don't work" because when many people try they get seg faults.
I really don't think it's constructive to say "CICO doesn't work" when what you mean is "many people find CICO difficult to implement, because having the self-control/will power/determination/control to do that is hard."
I became heavily involved in weight watchers (which is essentially just CICO - their "points formula" is basically calories/50). Over many years I watched hundreds of people lose hundreds of pounds by being careful about what they ate. It was hard. There were a lot of tears, there were a lot of false starts and plateaus and hard times. The people that stuck with it had incredible transformations and live different lives now. My room mate at the time lost almost 200lbs and became head of the WW in that city and when I saw her after 10 years I did not recognize her at all, and actually refused to believe it was her for 5 minutes.
CICO absolutely works. Like most things worth doing in life, it's hard. And it's worth it.
When people start arguing over who said what, who did what to the discussion, and get increasingly personal about it, it was time to stop quite a while ago.
https://news.ycombinator.com/newsguidelines.html
When people start arguing over who said what, who did what to the discussion, and get increasingly personal about it, it was time to stop quite a while ago.
https://news.ycombinator.com/newsguidelines.html
Studies show that it's basically impossible to know your calories out without indirect calorimetry (and updating it regularly, no less, since your BMR + NEAT can vary significantly over time and in direct response to contemporary efforts to lose weight) -- and studies show that humans are dreadful at estimating their calories in.
So yes it works in a lab setting where your CI is pre-portioned in the form of milkshakes and your CO is measured via calorimetry. In reality though it makes people hella hungry and your hunger tends to increase in excess of changes to body weight.
Which is why the average weight regain after loss is 80% over 5 years.
So naturally it would seem we would look to develop ways to reduce our CI subconsciously. Enter GLP-1s. This is literally all they do. They reduce your hunger so your CI remains below your CO which studies show almost nobody can do without help.
Yes some people are genetically going to lose 200lbs and become the head of Weight Watchers in the same way that some people are going to win the olympic gold medal in swimming. That doesn't mean that you are going to win an olympic gold medal in swimming and it certainly doesn't mean that if the average person follows Phelps' training plan that they'll get an olympic gold medal in swimming.
Ultimately a treatment that works but nobody can actually maintain is a treatment that does not work. Hence GLP-1s. The question is why they are unable to keep their CI below CO. Not whether that’s how they lose weight.
Even if fate has it that I must end up at a Wendy’s drive thru tomorrow night, couldn’t it be true that I could choose to eat the 400 calorie meal instead of the 800 calorie meal, or order water instead of Sprite?
The problem with choose is it implies an intentional, free choice. I can manufacturer plenty of contrived examples to show it's not always the choice of the person. But I'll use a real one I remember.
Yes, you, who I assume has thought deeply about personal responsibility and and willpower and how to obtain the best life for yourself over what I assume to be between years and decades of practice doing that, are able to choose water over Sprite.
but I can tell you from the experience of somebody who strongly believes in the responsibility of your own decisions, and how willpower is a learnable skill, and about being healthy, and about how every decision matters. When I'm tired, and depressed, and feel like I'm about to break. Even knowing, even having the thought that I should choose water over soda, I've still chosen soda.
Fair choice though right? There were no other factors, or influence over why I drank 200 calories of sugar? I should just have remembered water would be healthier?
That's what I assume they said the word choose is doing a lot of heavy lifting. because often choose is presented exactly the way that you did.
> Even if fate has it that I must end up at a Wendy’s drive thru tomorrow night, couldn’t it be true that I could choose to eat the 400 calorie meal instead of the 800 calorie meal, or order water instead of Sprite?
When often, humans tend to be slightly more complex than just that.
The human body is way more complex so as to defy the laws of physics as we know it? The human body cannot create matter. In order for it to increase in mass, you must be inserting extra mass into it.
But that is entirely irrelevant when a mammal eats less energy than they consume for a while. In that instance they MUST burn some stored reserves or break the laws of physics
To be fair, I had also believed this for many years.
However, all the people who claim that "it just doesn't work", have never made any serious attempt to do "it", so they cannot know whether it does work or not.
I have been obese for more than a decade, during which I have made several attempts to lose weight, which have all failed, because they were not done in the right manner.
Then I have made a final attempt using the correct method, and I have lost about 35% of my initial body weight during about ten months, at a steady rate between 100 g and 150 g per day, i.e. about 1 kg per week.
This was more than 10 years ago and since then I have kept a constant weight. Because I have done this once, now I can control my weight and have any weight I want, even if I gain weight extremely easily. It is enough to eat one day like I was eating when I was obese to gain enough weight to require a week of weight losing diet to go back to the desired weight.
The rules for losing weight and maintaining the weight are very simple, but they must be observed and those who claim that "it doesn't work" never try to observe the rules, so it is entirely predictable that it cannot work for them.
First, it should be obvious that after losing weight one must eat differently as before, otherwise weight will be gained until reaching again the original weight.
To be able to control the weight, anyone who is or has been obese must stop eating until they feel satiated. At each meal, one must plan before beginning to eat how much to eat and then eat only the amount planned, never more than that. One must eat a fixed number of meals per day (preferably few, e.g. only two meals per day should be enough for an adult who has a sedentary lifestyle) and never eat between meals any kind of snacks or drink any sweet of fatty beverages. Between meals, only water or beverages without any calories (e.g. unsweetened herbal teas or tea or coffee) are acceptable intakes.
While losing weight, the most important thing is to weigh oneself every day with precise digital scales (with a resolution of 100 grams or less), at the same hour and in the same physiological conditions, i.e. in the same order with respect to meals and relieving oneself.
Whenever the weight is not less than the previous day, then the quantity of food planned for the current day must be diminished in comparison with the previous day. At the very beginning of losing weight there may be a delay, e.g. of a week or so between starting to eat less every day until the weight begins to decrease, but eventually it is possible to reach a steady state of a constant rate of losing weight per day.
When diminishing the amount of eaten food, only the carbohydrates and the non-essential fats must be reduced. The amount of proteins, essential fatty acids, vitamins and minerals must remain normal. To achieve this, one must eat a source of pure proteins, for example turkey breast or chicken breast or some kind of protein powders, so that eating enough proteins contributes only a minimum amount of calories. The rest of the nutrients can be provided mostly by non-starchy vegetables and perhaps by some supplements like fish oil. One could also eat almost anything that is not recommended, for instance chocolate, with the condition that the quantity is negligible, which can normally be achieved only when such treats are not eaten every day, but e.g. only once or twice per week.
These rules are simple and anyone who follows them will lose as much weight as desired. Obviously, this is easier said than done, because for the entire duration of the weight-losing diet one will be permanently hungry and one would tend to think about food and it will be difficult to resist temptations, so it is better to not keep in the house any kind of food that can be eaten immediately, without requiring some kind of preparation. Unfortunately, this is unavoidable and it is the price that must be paid....
What you did takes a lot of discipline and hard work, and you did it.
Of course eating less calories than you consume results in weight loss, and you stuck with it. Congrats and Thanks for the details
I must say that I really understand what is in the mind of those who claim that "it doesn't work", because this is exactly what I had believed during many years, after many failed attempts to lose weight.
I had become convinced that nothing that I can do could change my weight.
Nevertheless, now, after I had eventually done it, I can see clearly the errors of my previous ways, so I can no longer agree with the opinion that it does not work, when it can actually work very well, as long as you accept that you must be hungry all the time while you are doing it.
I want to add that the feeling of hunger can be diminished a lot when you eat food cooked at home instead of industrially-produced food, especially when you avoid sweetened food. Using modern techniques, like cooking all meat and vegetables in a microwave oven, it is possible to cook food at home in an extremely short time, so the lack of time is no longer a valid excuse for eating junk food.
It's like interviewing Michael Phelps and he's like "just swim! I did it! Anyone can win a gold medal by swimming." No, they can't.
And the reality is average weight gain over the 5 years following weight loss is 80%. Everyone who participated in the Biggest Loser weighs almost as much as when they started and has a metabolism an average of 17% slower than would be expected for someone of their new body composition. [1]
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/
I'll push back and say anecdotes need more downvotes because they're actively harmful to the discourse, and are a large part of how we got to this point of just abject unhelpful information being passed off as useful.
This is how we get all sorts of medical misinformation like "I ate some almond seeds and my cancer went away." We don't accept these kinds of anecdotes in direct opposition to medical evidence for any other disease, we shouldn't accept them here either.
It's survivorship bias -- where are the anecdotes from the people who did exactly what parent said and didn't lose weight? They're in the study. Will OP update if they regain weight?
You can look up any of OPs rules, they've all been studied, and they don't work for most people.
You know what works? GLP-1s.
What matters for your health isn't that you tried real hard, what matters is that you lost weight. Nothing wrong with losing weight via GLP-1s then going to the gym and trying real hard to get jacked.
The fact that the rate of obesity in the US has pretty consistently risen for decades makes that clear, you don't need statistical models of medical records to know that the rate of obesity could only really keep going up if those already obese stay that way.
Unsurprising. They ran statistics on arbitrary overweight and obese people, with no idea of who was actively seeking to lose weight or who was just coming away from such an effort. If a significant fraction of the overweight/obese population did lose 5% of body weight/year, we wouldn't be seeing a bunch of overweight/obese people.
Fwiw, to me the symptoms he and others have described don't seem very different from those of long fasting. And I would definitely prefer those symptoms to the ones I had due to obesity which ranged from extreme fatigue, heart-pain, muscle spasms, depressive shame, restlessness and so forth.
I have been taking tirz for 7 weeks and walking 5 miles a day + exercise. My depression is gone and I have lost 30 lbs. I am loving life.
Perhaps coincidentally, this is similar to my experience with week long fasts: After 48 hours I feel like a precision missile cruising towards my target until about 5-6 days later.
But I will use a suitable GLP-1 based drug, because, man, fasting feels unbearably brutal for me after 6 days: profuse sweat, increased heart rate, brief but intense panic attacks, an insane level of sad (but not depressed) introspection, a hairpin trigger temper. I become a ridiculous mess. There's got to be a better way!
Thanks for sharing your experience and insight!
If you're willing to shoot up more often it moderates the effects better.
I'm a fan of these tools helping people get this insight, because otherwise people just accept that cloud as their normal.
If you want to be successful long term in your weight loss, especially after stopping the drug, you should really invest in changing your mindset.
This is a massive positive, not at all a negative.
You got fat because you ate too much. If you don't understand what are normal portions now, you'll go back to your starting weight as soon as the drug isn't having effects anymore.
This is a lifestyle change that you MUST embrace to be successful long term.
Also, as Tyler Cowen writes [1], this is probably going to translate into big improvements for animal welfare:
> People lose weight on these drugs because they eat less, and eating less usually means eating less meat. And less meat consumption results in less factory farming. This should count as a major victory for animal welfare advocates, even though it did not come about through their efforts. No one had to be converted to vegetarianism, and since these drugs offer other benefits, this change in the equilibrium is self-sustaining and likely to grow considerably.
So overall, widespread Ozempic adoption seems like progress to me.
[0] https://www.npr.org/sections/health-shots/2023/08/28/1194526...
[1] https://www.bloomberg.com/opinion/articles/2024-07-20/animal...
Is it? It might reduce the amount of animals killed, sure, but it won't improve the well-being of the ones that are still raised.
Let's be real. If demand for meat declines, producers will have to double down on "factories" in order to remain solvent.
I went through a period of vegetarianism (for health reasons, not directly for ethics), and once I started eating meat again, 1. I eat a lot less, which 2. means that I can be much more intentional about sourcing it.
Right now the bulk of the meat that I eat at home throughout the year comes from 1 or 2 animals that are locally sourced and butchered (normally I share a portion of a pig and a cow), and the occasional wild caught fish. The meat is tastier, and I can go see the actual animals at the farm if I so choose. They are not factory farmed, and the price per pound is about the same as buying industrial meat at the grocery store since I am buying directly from the farmer, and paying a local processor for their services.
As things wane in popularity it might be true that they become more of a commodity, or it might be true that they become more of a niche product where people care more.
I would like to think that if meat consumption becomes more of a treat than an everyday thing, that people would treat it as such, and go out of their way to eat something that tastes better.
Food for thought?
It's reported it reduces a series of impulsive behaviours. Would it extend to sex? If people are less willing to have sex, maybe broad consumption of the medicine will further drop fertility rates.
The reality is probably somewhere in the middle.
I think such paradoxes demonstrate we probably need a completely different approach than anything we've done so far.
Utilitarianism feels to me like Mill & Bentham discovered basic arithmetic and didn't even realise there was more to maths than that.
You see a paradox and say "well that's not right, we should do something about it." This has been the story since Kant, but for his part, everyone seems to forget that he doesn't ultimately "solve" his antinomies, he just leaves them as conclusions, "effects of pure reason."
It seems way more unreasonable to assert that, in fact, there is some consistent, complete ethical framework out there, but we havent found it yet, than it is to just accept that some kernels of truth or sense are not formalizable in the classical sense.
> It seems way more unreasonable to assert that, in fact, there is some consistent, complete ethical framework out there, but we havent found it yet, than it is to just accept that some kernels of truth or sense are not formalizable in the classical sense.
We can prove that complete and consistent set of axioms for all mathematics is impossible. An equivalent proof for ethics would itself be useful.
However, we do not need to concern ourselves with infinite sets etc. for ethics the way we do with natural numbers, as there's only relatively (in mathematical terms) small number of real people to interact with or influence the lives of.
We may not be able to reach an optimal outcome with even a limited n, if it turns out to be akin to P != NP. But even knowing that, would itself be useful.
The problem I have with Utilitarianism isn't any of these things, it's that it's simply trying to maximise how much utility there is in the world, then immediately tripping over itself because the terms "utility", "maximise" and "the world" aren't well-defined, and the way it is introduced is simply adding up.
and
https://en.wikipedia.org/wiki/Utility_monster
If average welfare of humans is all that matters, then one happy human living alone in the universe is the equivalent of a million happy humans.
If sum of "welfare" is all that matters, then you can argue an exceptionally large number of people being tortured indefinitely is better than a happy person.
Factored by how cute the animal is. As a producer of plants for human consumption, it's quite obvious that orders of magnitude more animals are harmed in that process than are ever harmed in traditional meat production. But they're mostly ugly insects, so nobody cares.
I don't get why that would be a better measure?
[0] https://www.imdb.com/title/tt9664108/
I swear covid was a personality test. If you came out of the last 4 years and are looking for more dependence on government and pharma… well, the horseshoe is a V I guess.
I think it's equally plausible that the US increases food exports rather than lower production. Especially as production is subsidized.
This said, obesity is exploding everywhere else in the world too, so it's not just a US problem.
The first article talks plenty about why: people are eating less of the the things that are addictive to them, such as alcohol and cookies, which are a major source of calories.
Well "According to KFF polling from May 2024, 6% of all adults report that they currently are taking a GLP-1 drug, and 12% report that they've ever taken a GLP-1 drug".
Is 6% enough to affect crop prices? Presumably some ag economist can weigh in. Note it would only be a reduction per person, not a full 6% reduction in consumption.
But when I say food brain, it's everything. I want to vape, I want to have more coffee, then more beer, then some cannabis to go to sleep. Wake up and hit the dopamine cycle again. I have to take care of myself and ask "why am I doing this, could I just not, and if so I must not".
While remaining on the drug.
I expect your impulse control will be even worse after getting off of it, but I don't have a study to back that up.
What if it makes us get a better control over our consumption behavior in general?
Wouldn't some large companies have a problem with that and fight it?
Social media
Drugs and alcohol
Food
Or literally any other addiction. I don't think this is a useless thing to discuss.
It's so bizarre how many people will pretzel their way into moralistic non sense to find a solution to what is clearly a medical problem.
Obesity as far as we understanding it now is an hunger regulation problem. For unknown reason a lot of people still feel the need to eat even when their body is clearly in calory surplus.
No amount of of impulse control or moderation can make you override billions of years of evolution and not eat when you are starving... if we could... society would be a very different place
> And yet most obese people are no more addicted to food than you are addicted to oxygen...
Most obese people seem to be addicted to sugary food, soft drings, desert and all that, which then triggers more eating.
In addition, it might be a gut bacteria thing. If your gut is used to processing lots of sugar, you crave it even more and fighting your gut microbiome requires way too much impulse control and moderation.
The solution might be to recognize this mechanism, remove all sugar from the diet and find a way to control impulses for a few weeks until the gut bacteria changed.
Drinking water and chewing sugar-free gum helps me to remove food cravings temporarily with no downsides. But... I have a normal weight.
Boredom, stress, unhappy life, happy life, laziness - it could be anything. You know what it couldn’t be? Exercise. I’m yet to see a person working out hard and eating at the same time.
No, but plenty of people have their hunger stimulated by exercise and eat too much after.
You simply can't fix being overweight or obese with exercise alone in the vast majority of people. Even if you don't believe in the constrained total energy model that a good chunk of metabolic research PhDs think is at least somewhat true and instead believe solely in the additive model, exercise stimulates hunger and it's far easier to eat 1000 calories than burn 1000 calories.
You have to do both and exercise doesn't automatically make the other easy.
Do you remember how long it took to get tobacco mostly banned in the US? Do you remember how much the tobacco industry played the skeptic and introduced bunk science into the mix?
Well Coca Cola, Pepsico, Nestle, and all the other junk food companies have been on this game for years now. Want to change school curriculum?, well your political opponent has $100,000-$1,000,000 more than you from the make people fat industry. Meanwhile there are a crazy number of attack ads against you for being a crazy commie that wants to control peoples lives, you socialist bastard, you're against freedom.
About the point you're making, two generations before you and me, people where fit, more attentive & generally healthy (outside vaccines that prevent diseases now & positive effects due to advancements in medicine), what changed?
Not as platitude, but go from first principles, the choices you make everyday effects your mind (& the time you spend on particular activities), and if they aren't life affirming (for lack of better words), in due time you limit your options (ie less choices from your mind, bad food or less bad food or multiple bad ways to spend your time?), till you proclaim from high top mountains 'oh god, I'm helpless without acceptance from some higher power!'
This isn't to say, I'll be as preachy and asshole(ish) to a friend or someone I care about in similar need, I'll probably say 'seek medical help etc' like you. But thinking things through & arriving at truth is important, don't you think?
This is different to mental strength or controlling yourself etc, it's more about self reflection & freedom through discipline, respecting your life, decisions & thoughts more than your impulsive emotions in an ever distracting world, that kind of thing..
I don't think I'll change your mind or this will come across in good faith, that's okay, I'm in a reflective mood, and it's awfully chilly outside :-)
Air pollution, water quality, pestecide, food/produce quality, plastic particule everywhere...
I find this perspective so bizarre.
Whats the most probable in 2 generation of exponentially increasing and barely regulated technological changes : culture has change so dramatically as to change human nature and makes us all lazy... or... something in the environment/food chain is having phisiolical/biological effects...
Cultural change over 2/3 even 10 generations will not significantly alter your biology. Pollution & disintegration in modern world you're referring to, they do have negative effects on our health, but it's not the whole story and they possibly cannot have effects on your decisions about what you eat and how you spend your time right?
I'm particularly referring to obesity caused by over eating, bad life style etc (not the other rare serious persistent irreversible kind that happens as side effect of more serious ailments or genetics)
You seem to be restating my point as if you are contradicting my statements.
> People living in country side & eating from organic farming, they're doing alright (similar to our closest ancestors), but that's beside the point
Maybe ( I would love to see some sources for this assertion). But even if I give that to you, you basically saying that modern environment are somewhat obisidigenic... which is what I was saying.
> Cultural change over 2/3 even 10 generations will not significantly alter your biology.
Okay... same., still just restating what i have said.
> they possibly cannot have effects on your decisions about what you eat and how you spend your time right?
They can and they do... let me introduce you to lead in paint and in the environment...
> particularly referring to obesity caused by over eating
All obesity is cause by over eating (all most by definition) the point here is that over eating is not cause by lack of will power or poor decision making
Everything.
Two generations ago you didn't eat out 4+ times per week. Portion sizes at restaurants were 50%+ smaller. Food sciences were not as optimized at making junk food as they are today. In general we were poorer and bought less junk food. We were more apt to work jobs that didn't involve sitting in one place for long periods of time.
>I don't think I'll change your mind or this will come across in good faith
I believe it's what you think, but when 74% of the population doesn't subscribe your philosophy then you're tilting at windmills. Yea, maybe someday people will catch on to that and all will be good, but that's not the way the entire world is going. We need solutions we can enact now to solve problems we have now.
This drug can help break out of that spiral and fix the craving/willpower problems.
The problem is when someone does NOT put in the effort to talk to their doctor, meet with a dietician, learn about healthy eating, and put in an honest effort to improve their life before just popping a pill.
That said, i think it’s great that’s it’s helping people who otherwise would just be obese and have many other health issues due to that. It’s a big risk factor.
It's funny how obesity is the only chronic medical condition that garners a huge volume of your particular kind of comment.
Would you be mentioning this for someone prescribed a diabetic, blood pressure or cholesterol medication? Statistically, likely not. So maybe take a step back, and examine why are you so averse to other people losing weight with medication.
if you are type 2 diabetic, that means you’ve probably been eating poorly for a long time. The happy path here is that one goes to a checkup and learns they are pre-diabetic, and their PCP refers them to a dietician. The patient hopefully learns how to make healthy food choices for themselves. All of this so they don’t develop type 2 diabetes. Maybe even temporarily prescribe a low metformin dose while they figure out the lifestyle changes needed.
If they struggle and lifestyle interventions fail, then of course, they should be prescribed insulin so they don’t have further devastating complications as they get older.
The same can be said for ozempic. What kind of lunatic would suggest starting ozempic without FIRST giving honest education and lifestyle adjustments a try? That should be step 1. And i’m talking proper education from a licensed dietician, not silly blogs or advice people see on tiktok these days. If step 1 fails, proceed to medication.
That’s my perspective at least. Big pharma isn’t your friend. It’s a backup plan and a necessary evil in most cases (with obvious exceptions like vaccines, antibiotics, etc)
What kind of lunatic would suggest an approach that evidence does not support as being effective? Lifestyle modification, at the population level, just doesn't work. GLP-1 agonists do.
I agree that at the population level, this will be a game changer. As you say, the average person struggles with lifestyle adjustments.
I see the point in this, but do you think it’s marketed as such and perhaps better question, used for exactly that and not more by vulnerable patients etc? (not well informed about long term side effects, some might even be unknown, if I might add)
I take my vaccines and generally gravitate to sanity over conspiracy stuff (that is to say, If I sound like that, i’m not)
It's much easier when you can trust your body feedback and rely on your regular hunger signals, but for most people who benefit from Ozempic for weight loss if they just trust their bodies they will get fat.
Despite this assistance (or lack of headwind) they seem to do ok.
But sure, it's a US problem.
I've met plenty of skinny fat people who think they're healthy.
Why do you think that telling people to “just stop being fat” will suddenly start working?
Now I'm on Tirzepatide (Zepbound), and I'm back to 235ish, and trending lower. I still work on eating healthy, but now I'm not just HUNGRY at all moments. My life continues, and I only have to make individual healthy choices at meal times, and grocery times, rather than a constant struggle at all waking moments. It's seriously a big difference.
I think this is something a lot of people pushing back against the GLP-1 agonists don't realize because they don't experience it: back before I started Mounjaro (another GLP-1 agonist) I was constantly hungry if I hadn't eaten a meal in the last 45 minutes. Absolutely zero hyperbole there - I once went to an all you can eat buffet, ate until I was over full, came home, and within about an hour and a half of that I was snacking on something because I was hungry. Not peckish. Not "feeling like a snack". Hungry to the point where that feeling intruded on my every thought until it was sated.
After starting Mounjaro that's GONE. Gone gone. I now have to set an alarm to remember to eat. It's absolutely phenomenal and likely the reason why I'll live past my forties instead of being stuck in that same cycle and dying of the effects of obesity.
I don't have any eating issues but that reminds me of the first time I went on a 7-day cruise.
There's nothing to do on the ship, and the food is free and pretty tasty, so... I basically ended up at the buffet eating and drinking all day long. Sausage and egg biscuits, banana bread, pot roast, steak, pasta, fried rice, cinnamon buns, they had everything. I was stomach-busting full, every minute of every day. I'd gorge myself on a huge plate of Indian food from the buffet, and then a few hours later head to another deck for a lobster dinner. Not to mention, drinking coffee, beer, and wine the entire time.
It was kind of insane. And what was crazier was after a few days of this routine I got used to it, and even looked forward to eating more food the next day. It was sort of like directly embracing one of the seven deadly sins to the maximum extent possible. I'm not sure what that experience means other than it seems like the the human body can comfortably arrange itself into a habitual downward cycle fairly rapidly.
For context: I am an overweight type 2 diabetic. I lost about 70 lbs before my doctor started me on Mounjaro (another GLP-1 agonist). My diet and exercise routine were far from perfect, and it took me about a year to lose that weight. My doctor started me on Mounjaro, both for type 2 diabetes and weight loss. I have lost 20 lbs in about a month on it, which means I will lose three times the weight if that pace keeps up (very unlikely). When my doctor and I discussed starting Mounjaro (which the doctor suggested, not me) he made it very, VERY clear that diet and exercise were important things to work on as the weight came off.
The key there is that the pace of weight loss will not keep up as the body's caloric needs reduce due to that weight loss. So naturally a GLP-1 user will plateau if they do not adjust their diet (and potentially exercise routine, though diet is much more important) as the weight comes off. You know what really makes it easier to have the energy to a healthy meal, to work out, and to take care of yourself? Losing weight! You know what helps form those healthy habits in people who did not form them during childhood? Reduced cravings for calorie dense food! Both of those things are where Ozempic and other GLP-1 drugs shine. It gives the person on them the space to make those changes without cravings, without feeling hungry, and at a faster pace than they could do naturally.
So yes, in the short term, these drugs are a great catalyst for change, but I don't see many medical professionals saying "oh just stick someone on Ozempic for life and that's that!" because for the vast majority of people who would use those drugs for weight loss cannot achieve their goals with just the drug alone.
The hard truth: Not everyone is capable of those things. Period.
40% of the US population is considered obese. That is a HUGE number. At a certain point, you can no longer blame individuals. There is something wrong, and we identify it as an environmental problem.
So if we have a drug that will make a huge amount of people healthy, what is the downside? And for the record: Ozempic affects appetite so they eat better, that is part of the drug.
We’re not talking about world class athlete. There a mile difference between world class athletes and not obese.
Evidence: people from skinnier countries move here and consistently get fatter. It’s a societal/environmental problem, if we’re talking about “what would a policy fix look like?” and not “what can I personally try to do to save myself despite being up against a societal/environmental problem?”
https://www.glamourmagazine.co.uk/article/post-your-pill-tre...
drug companies have spent millions on destigmatizing pharmaceuticals. its a superpower, apparently. a large swath of this userbase convinced themselves they have adhd and need medication for it. changing tabs on your chrome browser or not being able to do "deep work" = i have an uncurable disease and i require legal meth, for life. you can see how this translates to ozempic.
silicon valley/tech culture has prioritized get rich schemes, cure alls like adhd meds, you don't have to eat just drink soylent for every meal, etc. ozempic falls in line nicely there, and i think among this community and others in this vein, you'll see alot of support for it. its sad, because tech/programmers/IT people use to be very contrarian and open minded. you get in trouble for saying things like "personality responsibility", "discipline', "self-control".
> Are doctors required to explain this before prescribing this in US?
doctors famously aren't trained on nutrition or fitness. ironically the prestige is being a specialist, not well rounded. strange.
No amount of education will change who your parents were or how you were raised. Have you observed a strong correlation between how well educated someone is vs. obesity?
> I speculate that better awareness of diet/nutrition might help to prevent passing on such behaviours, like not feeding the family exclusively a bucket of KFC or McDonalds, or using food as a reward, etc. etc.
I'd encourage you to talk to any reasonably intelligent obese parent to see if they need better awareness of diet/nutrition. Better still, do a survey of obese and non-obese people to compare awareness of diet/nutrition between the two groups.
> I mean, medication won't actually solve what is caused by behaviour, right?
Saying that obesity is caused by behaviour and therefore can't be solved with medication is a bold statement to make in the context of a story about a drug that has been clinically proven to help obese people to lose weight.
Medication is often prescribed to help people who suffer from behavioural problems with positive results. I wouldn't presume medication can solve all problems caused by behaviour, but there is empirical evidence that for some problems it does help. As near as we can tell, human behaviour is regulated by a electrochemical brain & nervous system. Dumping chemicals into that system can of course change human behaviour. We see evidence of that (for better or for worse) all the time. If you have doubts and you don't even need to get a prescription, try taking a hit of acid/cocaine/alchohol and see if behaviour changes.
> If parents know their habits around food are basically ensuring their kids will struggle with obesity, maybe they'll make the effort to do something different?
The US has had a dramatic increase in obesity within a single generation (as in, people who were not obese for much of their lives have become morbidly obese at a rate far exceeding previous generations), let alone cross generational. While food/nutrition/health habits can certainly have a profound effect on someone's weight, there are clearly other factors at play.
Consider, for a moment, the reality of an obese person living in the US today. You get negative feedback about your weight all the time. You suffer negative social outcomes, let alone all the physical ones, so few, if any, want to be obese. There is no lack of motivation to seek out information on how to avoid being obese. There's a $300+ billion industry diet/health/nutrition industry constantly seeking to inform you about products they offer to help with your diet/health/nutrition... and that's not counting the doctors that you are no doubt interacting with regularly. Of course, that's not counting all the education (solicited or otherwise) you get from friends, family, acquaintances and even random strangers. It's hard to get through a day without being "educated" about diet, nutrition and health.
There's a cultural bias to think the problem is simply about behavioural/willpower/education, much the same way we look at poverty. It demonstrates a profound lack of understanding of and empathy for the plight of people who are suffering from obesity.
> I'm suggesting the idea that maybe we as a society should better educate around our relationship with food. I believe it would make a difference - just not immediately.
It's a bit tautological that if we did something better things would be better. Better education around our relationship with food would start with people understanding that better education about our relationship with food won't help people suffering from obesity.
In light of that, and barring the many other ways one can combat obesity themselves, it would probably be beneficial if everyone, in general, knew all about the pitfalls of disordered eating and knew more about how to combat that trap, and knew why that actually matters for themselves and the people they care about. I've observed people enable each others' obesity over and over. I've observed people reinforce horrible habits and be unsupportive of others' efforts to combat those habits. People don't know shit about diet and food and spread their ignorant, lazy attitudes and behaviour to those around them. Why make a real meal when you can just order $50 of takeout to feed the whole party? Then, if you don't eat "enough", everyone is on your case because "you must be starving" and "why are you eating so little?", because they are totally uneducated about the possible challenges people face when it comes to food. The more people know about this stuff, the more it benefits everyone. I still think this also circles back to the "passing it to your kids" thing, because it's now a multi-generational problem.
When the person you are arguing with is saying that government induced bans would probably help more, and your are arguing they're wrong and your two examples were resolved by government induced bans, you're going about arguing in a very strange way.
Maybe we should try educate society on dangers of using heroin. I agree that it is a good thing, and we should continue educating people about its dangers. But clearly that alone didn’t solve the problem, and I think it would be a good idea to utilize alternative options as well (in addition to continuing the education of society on its dangers).
There are plenty of obese people that understand nutrition just fine, there are obese people who understand it well enough to have lost significant weight and gained it all back.
Clearly there is something else going on that we haven't grasped yet.
Though, now that you ask, I do think that many people don't actually know why they are overweight. They say it's because "McDonald's is cheaper than buying good food", not realizing the McDonalds won't satiate them and they will eat/spend more because their body is starved for proper nutrition. Watch the series "Supersize vs. Superskinny" and observe how nearly every participant is utterly clueless as to the underlying causes of their challenges on either size of the disordered-eating scale.
Regaining weight is the primary issue really. Most people are capable of losing weight, but gain it back, and it gets harder going forward. Metabolic adaptation is better understood now and among the factors (.e.g increasing caloric intake too quickly after weight loss), but falling into old habits that are culturally ubiquitous is a glaring part of the problem.
Former drug addicts are told now to sever contact with peers who partook in those indulgences as they're likely to pull them back in. With food, it can be more than a minor subculture. There are regions of the US that have much higher obesity rates than others. Not having family members and a romantic partner on board can be difficult.
Plenty of overweight people really, really, really want to lose weight and do all of the right things, but report that it is difficult to impossible to maintain the weight loss. Many of them gain the weight back, and this is crucial, but don’t continue gaining past a certain point. Combine that with the very regional nature of obesity and I think that there is a VERY strong case to be made that there is an environmental or external cause of obesity that we haven’t identified yet (junk food is too simple of an explanation, and doesn’t adequately explain everything).
The point I’m getting at is that a lot of these drugs also yield some sort of drastic behavioral change like a reduced indulgence in other impulsive harmful behaviors. I really think that there is something that is throwing us out of whack behaviorally, and obesity is a symptom of that.
The fact that a hormonal correction is able to fix both obesity and other addictions is a very interesting result.
This is exactly one of the reasons I think better education around food/diet/nutrition is important. You don't need to cut yourself off from enabler family/friends if they aren't enablers to begin with. It's cultural, too. The portion sizes at all the restaurants in a given region because "we like to eat big meals here", or whatever. There are sooo many factors and the underlying flaw, to me, is ignorance of "how this stuff works".
You can't divorce it from the explanation. People get obese from overconsuming calorie-dense rich foods. These products are manufactured to be as savory and addictive as possible, are highly available, and convenient, and very affordable, and most are non-satiating (especially drinks). So yes there are environmental factors, but the reason they matter in the first place is the impact of junk foods. At the turn of the 20th century even relatively sedentary office workers would not gain much weight, because the American industrial machine did not yet create the landscape we have now. No one was buying several bottles of 2L coke, chip bags, jumbo fries and fried chicken, greasy pizza, starbucks lattes, etc.
And to avoid confusion, I want to make clear that avoiding weight-gain at the outset (to the extent of becoming obese), and losing weight, are different. What's sufficient for the former is insufficient for the latter; you do not need to be mindful of energy balance if you are already at a healthy weight and consume whole foods, but if you are trying to lose weight, that will not be enough to ensure a caloric deficit.
A comparison I like is a bag of chips vs a bag of apples. Bags of potato chips average 1200 calories. One would need to consume 16 apples to get the equivalent. I can probably get through an entire bag of chips if I cared to, and more than half a bag absent-mindedly if I was irresponsible. Try consuming more than a single large apple and see how that feels. Fiber is almost as satiating as protein. It may not keep you full as long, but you certainly reach satiety a lot faster than you would with chips (notwithstanding that in fairness they are less addictive without salt and fat).
https://www.youtube.com/watch?v=023exhA9irY
I feel like this is missing the obvious follow up question, “is it bad for my liver to be on most of the time?”
That's a good question!
I'm not sure. My guess would be its perfectly healthy (normal actually) to have 10x levels of ketones constantly than an American eating the SAD (Standard American Diet).
Anyone know of long term datasets that have looked at this in animals?
Continuous Ketone Monitors for humans have _just_ come out (AFAIK), so we should know soon.
I personally detest and avoid all medicines other than antibiotics and vaccines. Pharmaceuticals have a long track record of harboring “side effects” that only become apparent years later.
In general, why are we surprised that the chronic use of any substance has negative effects? Humans evolved for thousands of years eating food and drinking water. Regularly consuming anything else is an abberration and self-experiment.
of course it’s not always practical. For example, some skinny people are simply genetically predisposed to high blood pressure, even if they work out and eat pretty healthy. It’s rare, but these things happen.
You can advertise drugs on TV in the USA. This certainly opens the door for bad drugs to get pushed out and marketed to people who don't have the technical skills to examine the claims and the risks of side effects objectively.
> avoid all medicines other than antibiotics and vaccines
Just because it's been such a hobby horse lately I would have to add pain killers. There is absolutely a large potential for abuse but they also serve an incredible utility to modern medical care.
> Regularly consuming anything else is an abberration and self-experiment.
Ozempic should be for people who are obese and have thoroughly demonstrated that they are not physically capable of exercising themselves enough to lose weight naturally.
Otherwise, this drug gets marketed as an obesity cure, but it's mostly dispensed for cosmetic purposes. If there are any side-effects, it will be a double tragedy for these people.
I'm with you, it's a little revolting, this specific drug.
The cosmetic narrative you're pushing is actually quite disgusting.
You have some evidence for this claim?
> is evidence that obesity is on some level driven by powerful hormonal forces
It's suggestive. It's nowhere near evidence.
> the freedom to make better decisions
As long as they're on the drug.
> The cosmetic narrative you're pushing is actually quite disgusting.
No it isn't. It's a valid concern about how this medication is _marketed_ and _dispensed_. It's also an obvious concern to have. Pretending that I'm disgusting because I'm actually worried about the future outcomes for these patients is bullying highroad nonsense. Come off of it.
The obvious evidence is the result of the drug, i.e., overweight people losing weight because they're eating less.
So there are clearly multiple factors here and those should be taken into consideration before uncritically deciding this is a "good thing" that we should "all be on."
Who, exactly, has claimed that?
Over the past several years we've found that antibiotics have a huge impact on beneficial microbes in your body which then has downstream impacts on your health [0]. Oddly enough for the topic in this article exposure to antibiotics as a child may be linked to obesity[1]. They are also extremely over prescribed for things like viral illnesses [2].
I personally wouldn't take an antibiotic unless whatever malady I was suffering from was proven to not only be bacterial in origin but likely to progress without treatment.
Regarding your larger point some of the distrust of medications can be related to the fact that people know that medication producers' goal is to be profit for the most part.
Because they are for-profit the medicine producers can't be trusted to produce quality products or to produce products which resolve a problem rather than just reducing symptoms as long as the patient continues to pay for the medicine.
As with other problems we have a low trust society because it's a society built on for-profit enterprises rather than enterprises focused on doing the best thing for society.
0: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756738/ 1: https://www.nature.com/articles/ijo2014180 2: https://pubmed.ncbi.nlm.nih.gov/37876436/
Because bacterial infections can be horribly lethal?
That sounds a lot like the divide between people who see conspiracies everywhere and those who do not. In that case I would suggest it is just personality, not logical and not solved by improving trust.
Probably exceeds my comfort level, and I'm lucky enough that I can pay the $550/month for name brand if necessary. A lot of people will just have to stop, though, and deal with the consequences.
I wonder if GLP-1 agonists are going to break gaming addiction too.
I'm 42 and I've never taken more than the odd painkiller or antibiotic here or there - less than a pill a year on average I'm sure.
The last thing in the world I want is to be permanently on some drug that alters how my body works. I hike, snowboard, go to the gym and eat sensibly. That's all the "weight control" I need.
I think it's a lot simpler than that. US has an abusive relationship with junk/processed food. It's so deeply ingrained due to profit margins, wealth inequities, nonsensical subsidies, etc. that the only feasible solution is to introduce a drug that continues to allow that relationship to continue.
It's a lot easier of a solution than it is to tell companies to stop making garbage or saturating everything with sugar and HFCS. "Easier to see end of the world than end to capitalism" -- its the same shit packaged in a different story... Easier to introduce a drug to treat the symptoms than to solve the actual problem.
Mind you, I'm not implying that it is easy. We have collectively accepted this which makes change difficult if not impossible.
The solution is already there. It’s free. It works for everyone, and even 60% of people in the US are doing it!
The right answer to being healthy is not more drugs.
25% is the number you were looking for, and even within that group I think you'd find plenty of people with a healthy BMI that are in fact not living a healthy lifestyle.
Why do you ask?
So you are likely in an income bracket that enables you to have an active lifestyle outside of work and take the time outside of work to cook, in addition to probably other hobbies. this is not a criticism of you, but if I had to guess, you simply have a life that many other's do not. I work out and take care of myself because I make $300k+, have less worries and responsibilities, and I actually have an easier job than when I was making less.
A lot of people don't have money or don't have the time for working out and making the correct meal choices. Yes, there are people who have money and time and are still overweight, however that is not the norm as you go up the income brackets. Many poorer people have long work days, with an additional long commute, and are more likely to have kids, meaning they have no time for themselves. They're not gonna go to the gym if they already have a long day and they probably aren't going to make healthy food choices when they're already beat up and have not a lot of time for themselves.
Here is another disease caused and triggered by society. Asthma. Cars cause tons of pollution and people who live near highways are at much greater risk of experiencing asthma. However, society as a whole suffers from the pollution generated by cars. We all know this. The bay area has something called "spare the air day" which is a day where they ask people to not drive, when it's particularly smoggy. This has never worked. There are always people driving, because they gotta get places and the bay area can't built trains and the buses are awful. So people drive. What is the societal solution to localized pollution (like smog)? Better public transit, higher taxes on gas and on larger vehicles which produce more tire based pollution, and more tolls. But we don't do any of that. We know as a society how to reduce car based smog, which would reduce asthma and other diseases, but we don't do it, so we throw inhalers at people to get them to stop complaining. It's not super different from the weight problem in my eyes.
Sure, Canada banned trans fat.
There is absolutely no reason they couldn't ban drinks that contain more than x% sugar, or portion sizes that are bigger than y calories.
> Here is another disease caused and triggered by society. Asthma. Cars cause tons of pollution
Excellent example!
Internal Combustion Engines will be illegal in new vehicles from 2030 in many jurisdictions around the world (2035 in others). Yes, it's coming!
Also, they could ban those things in places like SF or more liberal places, however I believe those are politically losing policies and wouldn't pass in places that are actually experiencing obesity.
What society does or does not do has no impact on me consuming less calories on a daily basis.
I have the opportunity to buy soda 50 times a day. I choose not to.
I have the opportunity to buy a burger and fries for lunch. I choose not to.
Society could make many such things illegal or whatever, but at the end of the day what goes into my body is up to me. The buck stops with me and my choices.
Muscle loss is associated with _any_ kind of weight loss.
And GLP-1 drugs _improve_ the bone density: https://academic.oup.com/jcem/article/100/8/2909/2836097 It's likely simply because thinner people naturally move more.
I gained muscle mass by doing strength training 2 times a week while on GLP-1 drugs.
Eat a whole lot of protein, lift, and you're going to be doing more than fine in the muscle loss department.
The fact remains that having to carry around 50+ extra pounds of fat requires more muscle. When that requirement goes away so does your need for that musculature.
I read plastic surgeons said it was bad for your skin and people would look much older when they take it for a few months.
Yet, I also read it was generally good for your health, not just in terms of weight loss.
Several companies are now working on more classic small-molecule drugs targeting the same receptors. So it's likely that in several years we'll get a pill with the same effects.
Yes, there's technically a pill version of Ozempic already (Rybelsus), but it works by making the stomach wall to be slightly permeable to peptides. You can guess that it has pretty unpleasant side effects, and an awesome bioavailability of 0.7%
Manufacturing standards also have to be way higher. I have no problem trusting Novo Nordisk to manufacture injectors safely, but I won't trust a random manufacturer from India or China.
The risk of accidental infection from injection also is not neglibible.
It's also relative uncommon in other developed countries; according to Wikipedia, "Out of a population of about three-quarters of a billion, under 14 million people (approximately 2%) in Europe receive artificially-fluoridated water. Those people are in the UK (5,797,000), Republic of Ireland (4,780,000), Spain (4,250,000), and Serbia (300,000)."
And now it's becoming clear that IQ is affected by fluroride https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409983/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285601/ https://www.reuters.com/world/us/epa-must-address-fluoridate...
So how about we keep it out of our drinking water. If you want to put fluoride on your teeth, use fluoridated toothpaste.
In fact, WTF is India doing there? Don't they have limits on it?
I would guess that in today's world a lot of people get enough fluoride through processed foods being made in places that have fluoridated water.