TLDR: "...evidence so far suggests that, between one and three years after stopping the medication, people will see a "significant proportion of weight" go back on...Somewhere in the region of 60 to 80% of the weight that you lost will return..."
Just like alcoholism, or any kind of other addictions.
I've struggled with alcohol abuse, and once you come to the realization that you're abusing it, the fix FOR ME was relatively simple: I stopped (under medical supervision) drinking, or to be more precise: I stopped starting to drink. I have no problems not drinking, I have a problem that when I start I cannot stop.
I have the same issue with food. Not eating is a lot easier than stopping to eat. But I cannot completely stop eating.
Yet with alcohol people are like: hey, good for you.
With my weight issues people are like: dude, just eat less, or exercise more.
Other medications become lifelong medications but without this level of scrutiny. I am 100% in favor of finding a more permanent treatment, but switching blood pressure meds, and cholesterol meds, and other daily meds for a single once a week med is a massive improvement, especially since the all source mortality data keeps rolling in showing the efficacy here is orders of magnitude better than all the other medications out there. A constant issue here is that we keep calling this a 'weight loss drug' and society views being fat as a moral failing ant that you 'just don't have the will power' to overcome. We need to stop. If this is a lifelong drug it is worth it compared to the relatively ineffective, and just as lifelong, alternatives out there.
This is just as weak as a counter argument. If every argument that concludes that lifestyle changes are necessary, in most situations and for most patients, are just written off as some sort of moral high ground and not necessarily something to take seriously, then what do we have left?
Is there seriously no functional difference between healing a broken bone and getting someone to stop smoking? The only problem is just that we haven't found the right medication for the latter? Evidence of necessary lifestyle changes as part of some moral crusade?
The science is pretty clear on the subject and it is up there as one of the most well studied in medicine. Yes, anyone can stop smoking and anyone can gain or loose weight. Yes, lifestyle changes are the most imporant factor in a treatment being successful.
Interesting link: a company called Fractyl Health is studying a surgical procedure they call "Revita," that they hope can keep weight off for patients after they discontinue GLP-1s.[0]
The premise, IIUC, is that obesity is driven partly by mucosal overgrowth on the duodenum. This thicker-than-expected layer of mucus is less porous, which leads your digestive system to underestimate the number of calories you've consumed. Revita basically re-surfaces the duodenum.
So, the idea is that you get to a lower weight with the GLP-1 drugs, and then Revita can hopefully reset your set point there.
Their first clinical trial is still in progress, but I think it's interesting to watch.
> "The environment that people live in needs to be one that promotes health, not weight gain. […] Obesity is not a GLP-1 deficiency," he says.
This is my biggest issue with weight healthcare, the idea that if only the patient would eat correctly they wouldn’t be overweight. It’s not some moral failing a person often over eats, it very well could be some physiological issue that should be treated. It would be like telling someone with asthma that they just need to get into better shape to breathe better.
I don't count calories. I went off Ozempic (now Mounjaro) and I gain weight at about 0.5-1kg a month.
As I am resistance (gym) training, significant % of that ends up being muscle mass rather than fat.
So I end up taking Mounjaro for about 1-2 months every 3-4 months, approximately 33% of the time being "on".
Funnily, I end up with bulk/cut periods without doing them explicitly. This ends up working well for growing muscles.
Notice all people in the story are women. I guess pairing GLP-likes with bodybuilding works quite well for men. As times goes on, I end up needing mounjaro less due to my increased muscle mass.
We need to start looking at obesity as a hunger disorder, and not as the result of an addiction, a lack of knowledge about nutrition, or a lack of self control.
When an obese person regulates their eating and loses weight, the hunger often doesn't go away - and often increases. This is physical, not psychological hunger. When the obese person almost inevitably returns to eating to fullness, they regain weight.
When a person takes GLP-1s, hunger is greatly reduced, and an obese person can eat less food while still achieving satiety without gaining weight. When they stop taking the GLP-1s, the hunger returns, and when they return to eating to fullness, they regain weight.
Similarly, when a person takes stimulant weight loss medication, they can eat less food while experiencing less hunger, and thus lose weight. Similarly, when they go off of the stimulant (or develop a tolerance), the hunger returns and when they return to eating to fullness, they regain weight.
In many obese people, the hunger is present even when they eat a nutritious meal at the appropriate number of calories to maintain their weight. Common advice is to say "this mix of macros or foods makes me satisfied!" and, well, that's great for you but not universal.
People who naturally feel reasonably satisfied with an appropriate number of calories to maintain their weight still experience hunger, but not with the intensity or insatiability of that hunger that many obese people do.
While it does occur with some who have severe eating disorders, most obese people do not overeat themselves into obesity by continuing to eat long after they're full. They eat until the hunger goes away.
It's the hunger. Take away the hunger, and the weight goes down. Bring back the hunger and the weight goes up. It's simple, it's obvious, and few say it.
Then just continue to take them? The article just once seems to mention side effects and these were suspected to be related to rapid weight loss and less to the drug itself.
Pointless human interest story with some rent-a-quote expert sprinkled in that tries to imply some ominous danger but can't come up with any hard data on that themselves.
If you’re substantially overweight, you have to wonder if the long term side effects of GLP-1 are better than being obese
That said, its a little disheartening to see people who are 10-15kg overweight also resort to these drugs - this kind of excess weight can be fought with simply diet and exercise
I definitely lost weight easily on wegovy and just as easily gained it back when I stopped taking it. The whole experience definitely drove home how I needed to improve my mental health alongside any “purely physical” intervention. Same situation when I lost weight by meticulously calorie counting.
I think obesity is hard to fix even when you are not a “thermodynamics denier” (as another commenter said) because all you can practice is moderation from the get go. How many people would fail to fix their alcoholism if complete abstinence, even just a period of complete abstinence to rewire the brain, was never an option? They actually had to go down to the pub and practice stopping everyday at 1 pint?
Question for people who have trouble losing fat (this was never my problem): have you ever tried instead of dieting to just force yourself to eat more fruits, vegetables, and protein daily while also allowing yourself free range in the remaining appetite room to have whatever? The human mind/brain/whatever doesn't do well with deprivation of a high dopamine reward, but what would happen if you started to shift your tastes by insisting that it get used to a more healthful diet as a precursor to getting what it wants?
I ask this because when I was younger, I also had tastebuds warped by hyper-palatable foods, but after incrementally getting my diet to such a clean and optimized place, I literally feel bad even while chewing and tasting something like a donut, heavily salted and oiled potato chips, or candy. It's probably like how I would have felt if I literally mixed a tablespoon of oil and sugar or salt together and swallowed it.
Is it that hard to shift the system toward better habits by incremental introduction of better ones, and crowding out the bad? Exercise helps here, because once you begin to enjoy fitness, you get a stronger feedback loop with the bad food creating bad outcomes.
I missed doses long enough that I had to start at the beginning, but I avoided that because I had to book and appointment with my doctor and get prescribed the lower dose, etc.
So I gained the weight all back and then lose it again when I got back on the doses.
17 comments
[ 2.9 ms ] story [ 49.0 ms ] threadJust like alcoholism, or any kind of other addictions.
I've struggled with alcohol abuse, and once you come to the realization that you're abusing it, the fix FOR ME was relatively simple: I stopped (under medical supervision) drinking, or to be more precise: I stopped starting to drink. I have no problems not drinking, I have a problem that when I start I cannot stop.
I have the same issue with food. Not eating is a lot easier than stopping to eat. But I cannot completely stop eating.
Yet with alcohol people are like: hey, good for you.
With my weight issues people are like: dude, just eat less, or exercise more.
(I stopped sharing the food story with people).
This is just as weak as a counter argument. If every argument that concludes that lifestyle changes are necessary, in most situations and for most patients, are just written off as some sort of moral high ground and not necessarily something to take seriously, then what do we have left?
Is there seriously no functional difference between healing a broken bone and getting someone to stop smoking? The only problem is just that we haven't found the right medication for the latter? Evidence of necessary lifestyle changes as part of some moral crusade?
The science is pretty clear on the subject and it is up there as one of the most well studied in medicine. Yes, anyone can stop smoking and anyone can gain or loose weight. Yes, lifestyle changes are the most imporant factor in a treatment being successful.
The premise, IIUC, is that obesity is driven partly by mucosal overgrowth on the duodenum. This thicker-than-expected layer of mucus is less porous, which leads your digestive system to underestimate the number of calories you've consumed. Revita basically re-surfaces the duodenum.
So, the idea is that you get to a lower weight with the GLP-1 drugs, and then Revita can hopefully reset your set point there.
Their first clinical trial is still in progress, but I think it's interesting to watch.
[0]: https://www.fractyl.com/our-platforms/revita/
This is my biggest issue with weight healthcare, the idea that if only the patient would eat correctly they wouldn’t be overweight. It’s not some moral failing a person often over eats, it very well could be some physiological issue that should be treated. It would be like telling someone with asthma that they just need to get into better shape to breathe better.
I don't count calories. I went off Ozempic (now Mounjaro) and I gain weight at about 0.5-1kg a month.
As I am resistance (gym) training, significant % of that ends up being muscle mass rather than fat.
So I end up taking Mounjaro for about 1-2 months every 3-4 months, approximately 33% of the time being "on".
Funnily, I end up with bulk/cut periods without doing them explicitly. This ends up working well for growing muscles.
Notice all people in the story are women. I guess pairing GLP-likes with bodybuilding works quite well for men. As times goes on, I end up needing mounjaro less due to my increased muscle mass.
When an obese person regulates their eating and loses weight, the hunger often doesn't go away - and often increases. This is physical, not psychological hunger. When the obese person almost inevitably returns to eating to fullness, they regain weight.
When a person takes GLP-1s, hunger is greatly reduced, and an obese person can eat less food while still achieving satiety without gaining weight. When they stop taking the GLP-1s, the hunger returns, and when they return to eating to fullness, they regain weight.
Similarly, when a person takes stimulant weight loss medication, they can eat less food while experiencing less hunger, and thus lose weight. Similarly, when they go off of the stimulant (or develop a tolerance), the hunger returns and when they return to eating to fullness, they regain weight.
In many obese people, the hunger is present even when they eat a nutritious meal at the appropriate number of calories to maintain their weight. Common advice is to say "this mix of macros or foods makes me satisfied!" and, well, that's great for you but not universal.
People who naturally feel reasonably satisfied with an appropriate number of calories to maintain their weight still experience hunger, but not with the intensity or insatiability of that hunger that many obese people do.
While it does occur with some who have severe eating disorders, most obese people do not overeat themselves into obesity by continuing to eat long after they're full. They eat until the hunger goes away.
It's the hunger. Take away the hunger, and the weight goes down. Bring back the hunger and the weight goes up. It's simple, it's obvious, and few say it.
Pointless human interest story with some rent-a-quote expert sprinkled in that tries to imply some ominous danger but can't come up with any hard data on that themselves.
That said, its a little disheartening to see people who are 10-15kg overweight also resort to these drugs - this kind of excess weight can be fought with simply diet and exercise
I think obesity is hard to fix even when you are not a “thermodynamics denier” (as another commenter said) because all you can practice is moderation from the get go. How many people would fail to fix their alcoholism if complete abstinence, even just a period of complete abstinence to rewire the brain, was never an option? They actually had to go down to the pub and practice stopping everyday at 1 pint?
I ask this because when I was younger, I also had tastebuds warped by hyper-palatable foods, but after incrementally getting my diet to such a clean and optimized place, I literally feel bad even while chewing and tasting something like a donut, heavily salted and oiled potato chips, or candy. It's probably like how I would have felt if I literally mixed a tablespoon of oil and sugar or salt together and swallowed it.
Is it that hard to shift the system toward better habits by incremental introduction of better ones, and crowding out the bad? Exercise helps here, because once you begin to enjoy fitness, you get a stronger feedback loop with the bad food creating bad outcomes.
Also, not everybody enjoys fitness.
I don't like it. I still go 5 times per week and have been doing it consistently for the last 2.5 years
I'm muscular, a bit overweight.
I missed doses long enough that I had to start at the beginning, but I avoided that because I had to book and appointment with my doctor and get prescribed the lower dose, etc.
So I gained the weight all back and then lose it again when I got back on the doses.