[HN Gopher] 'Breakthrough' obesity drugs that have stunned resea...
___________________________________________________________________
'Breakthrough' obesity drugs that have stunned researchers
Author : pseudolus
Score : 222 points
Date : 2023-01-04 14:52 UTC (8 hours ago)
(HTM) web link (www.nature.com)
(TXT) w3m dump (www.nature.com)
| anigbrowl wrote:
| _A class of drugs that quash hunger have shown striking results
| in trials and in practice. But can they help all people with
| obesity -- and conquer weight stigma?_
|
| Who cares? Helping half of people with a problem to overcome it
| is great. Journalists and editors need to push back against
| simplistic concepts like 'one size fits all' and the urge to rank
| everything, which just leads to bimodal distributions and the
| accompanying bad outcomes when they are imposed by economic
| force.
| renewiltord wrote:
| There are startups that can simplify the process of getting this
| drug if you're eligible. They do require you to talk to a doctor
| and nutritionist to see if this is the best thing you should do
| first, but then they can get you the drug.
|
| e.g. https://joinmochi.com
| 1024core wrote:
| > they also carry a hefty price tag: the injections often cost
| upwards of US$1,000 each month.
|
| IMHO, it would be much easier to just stop eating processed foods
| and sugar (and sugar substitutes).
|
| I cut down on sugar drastically and started intermittent fasting,
| losing 20 lbs in about 5 months without doing anything else.
| bioemerl wrote:
| > In the past, scientists and the public often thought that those
| with obesity simply lacked the willpower to lose weight. But
| evidence is growing that most people's bodies have a natural size
| that can be hard to change.
|
| In the context where we have gone from obesity rates of 13
| percent to 40, to suggest that people have a natural weight and
| that's the cause of this seems absurd to me.
| tootie wrote:
| Prior to the 20th century, it was pretty routine for average
| people to have inadequate access to nutrition. The rise in
| obesity corresponded with sweeping changed in agricultural
| policy that backstopped the prices of staple foods with
| subsidies and improved land and water management to prevent
| dust bowls. The result is everybody has enough food available
| cheaply all the time. Rolling any of that back is likely to
| replace obesity with malnutrition which is a much worse
| problem. Pandemic years notwithstanding, life expectancy has
| increased almost hand-in-hand with obesity rates. Obviously
| that's correlation, not causation.
| krona wrote:
| Obesity rates started rising in the 1980's in the US, not the
| turn of the 20th century. This corresponds with poor diet,
| not abundant nutrition.
| rootusrootus wrote:
| They were going up before the 1970s, there was a momentary
| blip in the mid/late 70s before they started going up
| steadily again.
| jdminhbg wrote:
| A sudden change in "natural weight" isn't any more absurd than
| a sudden change in willpower.
| seneca wrote:
| It's just terrible reporting, and equivocation. It being a
| lifestyle problem and having a natural weight can both be true.
| People have a natural weight, and it's difficult to drop below
| it. No one's natural weight is to morbidly obese.
|
| These people are taking a medical finding and blowing it wildly
| out of proportion to support their agenda. It's an
| unfortunately common tactic.
|
| I don't quite think it's entirely fair to blame on willpower in
| modern western society though. We have a food supply that is
| unnaturally calorie dense, and optimized for hyper strong
| flavor, shelf stability, and profit, and rarely for health.
| We're also much more sedentary.
| bscphil wrote:
| IMO it's purely a question of perspective. From the point of
| view of individual health, you need to think like a doctor.
| The important question is "what can this individual do to
| improve their health?" From that perspective it's a
| "lifestyle" problem, as you put it. The individual has a food
| supply that is unnaturally calorie dense and unhealthy. To
| lose weight and improve their health the individual must make
| an effort to shift that; for some it might be impossible. For
| others it might be possible with a great deal of effort or
| with drugs.
|
| From the point of view of public healthy, you need to think
| like a public health expert. From this perspective it makes
| perfect sense to talk about "natural weights" as something
| that can change (and has risen) over time. The calorie dense
| food environment and sedentary lifestyles are things that
| exist in the background here. _Given_ these background facts,
| the weights of the great majority of people (who don 't have
| the time, means, willpower, etc to resist) are going to rise
| to a new higher "natural" point. For some, foods will be so
| calorie dense and provide so little nutrition or satiety that
| they experience runaway obesity. These are just predictable
| downstream effects of the environment, and so the perspective
| of the public health expert is that individuals aren't to be
| blamed and you have to fix the environment. Ban soda in
| public schools, etc etc.
| viro wrote:
| And it makes more logical sense to you that everyone is just
| weak-willed?
| rootusrootus wrote:
| That viewpoint has a strong attraction for people who's
| natural weight is low, because they get to see themselves as
| strong willed and morally superior.
| HDThoreaun wrote:
| Yes, it doesn't to you?
| rootusrootus wrote:
| I think it makes sense to someone who has never tried to
| starve their body. Doing that will change your appreciation
| for the human brain.
| nathas wrote:
| How many times do you check HN each day instead of doing
| work?
| [deleted]
| SketchySeaBeast wrote:
| That's bizarre. Should I be bending my will to exclusively
| work? I work better with breaks, that's not weakness,
| that's realism.
| bioemerl wrote:
| It makes more sense to point to the fact that we have a far
| more calorie dense meal palette and a far less active
| lifestyle.
| ericb wrote:
| Pets, lab rats, and wild animals have gained weight in this
| timeframe.
| Eumenes wrote:
| Both of which are choices one has to make.
| fxtentacle wrote:
| s/weak-willed/addicted/
|
| There. Fixed it for you :) Yes, to me it seems like
| capitalism creates a society where most people get addicted
| just trying to cope with everyday life. For some it's
| alcohol, for some it's OxyContin, for some it's food, for
| some it's all-nighters in World of Warcraft.
|
| "59.3 million (21.4%) people over age 12 used illicit drugs
| in the past year."
|
| "Underage [..] 29% reported drinking alcohol"
|
| https://www.verywellmind.com/rates-of-illicit-drug-abuse-
| in-...
|
| Looks like weed and alcohol already are 50% of all
| citizens... I don't find it difficult to imagine that the
| other half ab-uses food.
| pixl97 wrote:
| So before mass capitalism people didn't drink?
|
| Can I ask that you read a large number of history books
| across any number of cultures on addictive behaviors
| throughout history, because you'll find that anytime a
| society had an excess of time and labor/production that
| people find addictive behaviors to enjoy. This is not
| recent. This is not capitalism. This is humanity.
|
| What capitalism has done is given everybody enough free
| time from starvation to actually follow addictive pursuits.
| happyopossum wrote:
| You can't add two unrelated stats together and say it's 50%
| - there's highly likely some crossover there...
| 8note wrote:
| That two people eating the same thing in the same amounts will
| retain different amounts as weight is something you can
| experiment on, without assigning a cause.
| bioemerl wrote:
| I think we need to really stress here just how bad our
| situation is. We have an obesity rate of 40 plus percent.
|
| Peoples weight just cannot be said to be a "natural number"
| in this environment. Something is causing this and your
| average person is obese because of it, not because of their
| "natural weight"
| rootusrootus wrote:
| We won't solve it so long as we think of it as a moral
| issue.
| paulpauper wrote:
| Highly palatable caloric dense food means that people are more
| incline to gain weight without even trying. 100+ years ago you
| had to make a more an effort to overeat.
| adamsmith143 wrote:
| https://slimemoldtimemold.com/2021/07/07/a-chemical-hunger-p...
|
| TLDR: The modern obesity epidemic is mostly a mystery, things
| like higher caloric food, western diet bad don't tell the whole
| story. Most likely answers are chemical contaminants in our
| foods and water i.e. lithium or PFAS chemicals. Interestingly
| enough both wild animals and lab animals(rats) have been
| getting fatter over time as well which clearly invalidates the
| "bad diet" theory. The Human body has a lipostat, you "natural
| weight" mechanism if you will and it seems these contaminants
| increase the lipostat and this results in widespread obesity.
| paulpauper wrote:
| _TLDR: The modern obesity epidemic is mostly a mystery,
| things like higher caloric food, western diet bad don 't tell
| the whole story._
|
| I think it tells more of the story than contaminants does. A
| candy bar is packed with calories and not that filling. This
| didn't exist a long time ago.
| russdill wrote:
| There are two problems. One is that some people have a body
| that drives then incredibly strongly towards a certain size.
| The other is they there are people that given the opportunity
| to eat whatever they want whenever they want will slowly gain
| weight year after year. Gaining 3-4 pounds in a year isn't a
| problem and a sign that someone has a poor lifestyle. But over
| 2 or 3 decades, that becomes a serious problem.
| buryat wrote:
| people previously just couldnt grow to their natural size
| pessimizer wrote:
| This caused me uncontrollable laughter and the desire to tell
| everyone about it.
| ChadNauseam wrote:
| The implication is that something has happened during the last
| 50-100 years that caused people's "natural weight" to change
| upward. (Someone's "natural weight" is normally called their
| "set point".)
|
| The evidence is a little slim (no pun), but there's one theory
| which I find quite compelling. The theory is that eating foods
| with high flavor-calorie association increases your set point,
| and eating foods with low flavor-calorie association decreases
| your set point.
|
| Flavor-calorie association is when your body knows that a
| particular flavor results in getting lots of calories in the
| near future. The flavor-calorie association will be higher for
| foods that are more flavorful or more calorically dense, and
| flavor-calorie associations can only be developed for foods you
| eat regularly. This explains why I lose a bit of weight
| whenever I go somewhere new - I'm trying new foods, so what I'm
| eating has doesn't have any flavor-calorie association, so my
| body's set point goes down, so I get full more quickly, causing
| me to eat fewer calories overall, causing me to lose weight.
| And since foods have gotten much more flavorful and calorically
| dense in the past half-century, it would explain why people's
| set points have gone up.
|
| There's a simple way to test this theory at home. Extra-light
| olive oil (not extra-virgin) is tasteless and textureless. So,
| find a 2-hour window of your day when you don't taste anything
| with flavor, and have two tablespoons of extra-light olive oil
| right in the middle of that window. Since the oil has no
| flavor, it should have no flavor-calorie association, and your
| set point should go down. I've been doing this, and I've been
| getting full faster and that's been causing me to lose weight.
| (If you want to google more info, it's called the shangri-la
| diet.)
|
| (Note that if you try this, your toothpaste probably counts as
| a flavor.)
| nerdponx wrote:
| I'd be sooner to suspect environmental contaminants (changing
| types of air pollution, microplastics, pesticides on food,
| stress hormones in factory-farmed meat, et al) as a cause.
|
| Although I suspect there's something to your hypothesis as
| well. I don't know about a spoonful of oil, but I have gone
| through phases where food seems less "rewarding" on a
| physiological level, and as a result I feel more satisfied
| with less.
| dcolkitt wrote:
| Air pollution seems unlikely as it's been falling for
| decades, and America has much lower levels than Europe.
| Microplastics are a perennial boogey man, and probably a
| genuine ecological issue, but there has no been mountains
| of studies done and documented health effects are virtually
| non-existent. Livestock and slaughterhouse conditions are
| certainly not good from an animal welfare perspective, but
| we've had similar practices for 100+ years and obesity
| wasn't a major issue in 1960. Pesticides in food products
| have been substantially reduced since the EPA changed
| guidelines in the 1990s, and yet obesity has exploded since
| then.
| adamsmith143 wrote:
| PFAS chemicals are a likely culprit, their presence
| increased dramatically as obesity rates took off and they
| are stubbornly persistent in the water and food supply.
| MajimasEyepatch wrote:
| The term "natural weight" as used here is misleading. It does
| not mean that people are _supposed_ to be a particular weight.
| It refers to the idea that something--whether it 's diet,
| genetics, environmental factors, or something else--influences
| the body's weight regulation mechanisms to "prefer" a certain
| body weight, and changing that is very, very hard.
|
| Think of it like body temperature: normally, your body
| maintains a certain core temperature, and it will respond in a
| negative feedback loop when the temperature deviates from that
| set point. Conditions like infections can induce where your
| body raises that set point to fight the infection, and it takes
| time for that set point to come back down.
|
| Something similar appears to happen with people's weight.
| Hormonal or other changes cause the body to gain weight, and
| once that happens, it resists losing weight in various ways:
| increasing appetite, changes to basal metabolic rate, changes
| to metabolic pathways involved in breaking down nutrients from
| food, all sorts of things. Deviously, fat cells actually
| produce hormones that play into these changes, which is one of
| many reasons why losing weight is usually harder than gaining
| it. And when people do manage to lose weight, often after a
| huge exertion of effort and willpower and major lifestyle
| changes, their set point may not have changed, and so as soon
| as they slip up even a little bit, they quickly regain back to
| their set point.
|
| So they're not suggesting that there's some mystical force out
| there that decides some percentage of the population should be
| overweight. They're referring to the idea of a set point for
| body weight that is difficult to change without drugs or
| bariatric surgery.
| bioemerl wrote:
| If this were true I would not expect that changes in our
| lifestyle would cause broad scale weight increases like they
| have. I'm very skeptical humans are built with an average set
| weight way up in the unhealthy range.
|
| Or maybe this is the case, but it is thrown off hard by our
| modern diets. Our natural set point is in the healthy range,
| but our meal is x calories per Y food now so it ends up
| artificially high.
|
| The explanation just doesn't line up with what we've seen. I
| get that it's hard to lose weight once you've gained it, but
| that's different. This is absolving us of being responsible
| for our obesity as a whole.
| ajkjk wrote:
| https://en.wikipedia.org/wiki/Set_point_theory may help
|
| > but it is thrown off hard by our modern diets.
|
| Yes. I think the dominant theory is that it has something
| to do with gut microbiomes, and in particular sugar and/or
| artificial sweeteners screw it up pretty badly.
| MajimasEyepatch wrote:
| That is a theory, and I think most researchers agree that
| it's a factor, but I don't think most researchers would
| say it's primarily to do with the gut microbiome.
| MajimasEyepatch wrote:
| I think you're misunderstanding. There is no "natural set
| point." The set point moves up and down based on hormones,
| genes, diet, environment, medication, etc. And the very act
| of gaining weight causes your body's set point to move up,
| because of how weight gain affects your hormones.
| Unfortunately the set point is pretty sticky, and once it
| moves up, it does not like to move back down, in part
| because for most of animal history, weight loss is a sign
| of starvation.
|
| Today, there are a bunch of factors that have combined to
| move people's set points higher than they should be:
| calorie-dense diets, sedentary lifestyles, plastics, drugs
| like antidepressants and lithium compounds in the water
| supply, and who knows what else. No one is arguing that the
| "natural" set point is 300 pounds or whatever. The point is
| that there is no natural set point because it's a function
| of many different variables.
| whodatbo1 wrote:
| Absolutely agree. Unironically through the first few paragraphs
| I though this was some very cleverly put satirical take on
| modern society. There is a great book about the effects of
| modern food, primarily on dental health, written back in the
| 30s - Nutrition and Physical Degeneration by Weston Price. Even
| though it's almost a century old, the findings are quite
| fascinating and can be extrapolated to present day. It's quite
| undeniable that modern life has drawbacks and obesity is just a
| symptom.
| bscphil wrote:
| I think it would be most accurate to say that people's bodies
| have a natural size _given_ a particular food and social
| environment. That 's a crucial bit of context that's very
| often neglected. Resisting one's environment is very
| difficult - it often requires you to have money, time,
| medicine, workout obsessed friends, or all of the above.
| Given changes in the environment in western countries over
| the last 50 years or so, weights are rising to their new
| "natural" levels as a consequence.
| pixl97 wrote:
| > It's quite undeniable that modern life has drawbacks and
| obesity is just a symptom.
|
| Yea, people tend to forget pre-green revolution people going
| hungry for longer periods of time and mass starvation were
| really common. We made a trade, between the sudden and
| terrible outcome of starving and hunger to one of long term
| consequences like obesity and disease.
| moffkalast wrote:
| We've gone quite far beyond never starving, we're eating
| far more than the required amount. Just a simple
| consequence of it being cheap and easy to make good tasting
| food by dumping sugar into literally everything. And the
| results are predictable.
| pixl97 wrote:
| >We've gone quite far beyond never starving
|
| I would counter you're incorrect, we're only 2 to 3
| generations (maybe 4 now that I'm getting old) past never
| starving. On an evolutionary timescale this is nothing
| when talking about an impulse hundreds of millions of
| years old.
|
| Our bodies never developed any means to prevent eating
| more than we needed other than "Oh $deity my belly hurts"
| and "Hmm, I better save some of this for tomorrow because
| food could run out then instead".
| moffkalast wrote:
| That's also completely true. I meant far beyond more in
| average lifetime caloric amount than evolutionary time
| spent doing it. We're definitely not adapted to any of
| this.
| cfn wrote:
| That sounds to me like a false equivalence. The cause of
| obesity is not that food is plentiful because different
| rich countries have different obesity rates. There is
| something else driving this issue and, in my opinion, is
| the prevalence of processed foods and use of highly
| processed seed oils.
| sarchertech wrote:
| It's probably a combination of factors, but look at the
| rate of change of obesity rates. Obesity rates have been
| going up almost everywhere. Essentially the rest of the
| world has been catching up to America. America was the
| first country where food was so abundant that it was
| essentially limitless for the majority of the population.
|
| Perhaps the effect of limitless food on obesity rates
| takes time to manifest and is compounded in successive
| generations.
| pixl97 wrote:
| Obesity is 100% caused by food is plentiful, with a
| catch....
|
| There has to be excess calories in the first place, much
| like there must be oxygen for there to be a fire (don't
| you try to get florine involved in this).
|
| Humans eating behavior seems to be driven by the first
| few years of our lives. If you eat like garbage as a kid,
| it follows you into adulthood. The US was (somewhat,
| there are still plenty of other even fatter countries)
| first with the TV to counter advertising that taught us
| that Trix was part of a balanced breakfast and that we
| should carry a coke wherever we go.
|
| Other countries likely had confounding factors that
| slowed the excess calorie uptake. For example common
| traditional meals that were only replaced slowly. Other
| things that can tip the scale are things like higher
| walkability in their cities.(for example higher
| walkability in the US correlates with lower body mass).
|
| But as stated, those confounding factors only slowed the
| fattening, it didn't stop it and the EU now is growing in
| weight just like the US did in the past.
| gadders wrote:
| "The WHO recommends healthier diets and physical activity to
| reduce obesity, but medication might help when lifestyle changes
| aren't enough. The new drugs mimic hormones known as incretins,
| which lower blood sugar and curb appetite."
|
| Isn't eating less food (whether your appetite is curbed or not) a
| lifestyle change? It's not that lifestyle changes aren't enough.
| It's that the size of your change wasn't big enough.
| ceejayoz wrote:
| > It's not that lifestyle changes aren't enough. It's that the
| size of your change wasn't big enough.
|
| Sure, and one of the things we conclusively know about obesity
| is that people struggle enormously to sustain that sort of
| lifestyle change in the long term.
|
| Hence, medications that help with that. In this case, by
| reducing hunger.
| gadders wrote:
| Yeah. It would probably be more accurate to say that the
| medicine makes the lifestyle change easier, not that it
| replaces the lifestyle change.
| PuppyTailWags wrote:
| Have we actually studied if the weight loss is resulting in
| better health outcomes for the people in question? Outside of
| diabetics (there is evidence that significant weight loss can
| relieve the effects of type 2 diabetes), I would like to know if
| just weight loss benefits the cardiovascular system, blood
| pressure, etc. These aren't as intuitive as we'd like, for
| example, it turns out that low fat diets didn't make people less
| fat, and cholesterol-lowering medication doesn't reduce heart
| disease.
|
| I'm hesitant to measure weight loss as a pure good in of itself
| because it isn't evident to me that just losing weight has a
| causative effect on reducing specific diseases.
| ceejayoz wrote:
| My wife lost a hundred pounds via bariatric surgery; resting
| heart rate dropped by 20, cholesterol dropped into normal
| range, knee and hip pain disappeared, and it even helped the
| chronic migraine substantially.
|
| We've got plenty of clear evidence that being significantly
| overweight has health impacts.
| matt_s wrote:
| Yup. On a much lesser note, when I lost 10lbs I noticed acid
| reflux symptoms disappear and blood pressure was lowered. For
| someone that is borderline on need of medication, the doc
| basically said lose some weight and these issues could go
| away (for some time). Its incentive enough for me to keep
| losing so I can push off the major diseases until much later
| in life or never.
| nextlevelwizard wrote:
| Wtf are you on? Of course losing weight results in a better
| life. If nothing else it will make moving a lot easier it
| doesn't need to reduce any diseases if it does that is pure
| bonus
| v4dok wrote:
| >it turns out that low fat diets didn't make people less fat
|
| This is not a "turns out". Anyone who believed that just having
| a "low fat" diet will make them leaner, didn't really know how
| losing fat works. Fat is a macronutrient (and quite useful one)
| just making it lower tells you absolutely nothing on its own.
| [deleted]
| nscalf wrote:
| Yeah, there are a lot of published studies showing this is very
| impactful. Within certain thresholds, losing weight has been
| shown to be the biggest change to all cause mortality rates. If
| you are obese, the most impactful thing on health is losing
| weight. This obviously isn't true for people with very low
| BMIs, but there have been a lot of population level studies
| looking at all cause mortality.
| PuppyTailWags wrote:
| What are the certain thresholds? Can we be more specific than
| lowered all-cause mortality, such as specific diseases we
| know have causal relationships with obesity specifically? I'm
| asking because I'm not that educated, but if you know there
| are studies showing e.g. purely losing weight with no
| lifestyle changes means less heart attacks, less joint
| replacements, less cancer, etc. please share.
| stonogo wrote:
| Caveat: it's generally not possible to "lose weight with no
| lifestyle changes." Even taking anti-obesity drugs results
| in lifestyle changes along with the weight loss.
|
| https://pubmed.ncbi.nlm.nih.gov/12457296/
|
| https://academic.oup.com/ajcn/article/74/5/579/4737391
|
| https://www.cell.com/cell-
| metabolism/fulltext/S1550-4131(16)...
|
| https://www.bmj.com/content/359/bmj.j4849
|
| https://journals.plos.org/plosmedicine/article?id=10.1371/j
| o...
| PuppyTailWags wrote:
| This is exactly what I was looking for, huge thanks.
| gadders wrote:
| >>it turns out that low fat diets didn't make people less fat
|
| Yeah, but low calorie diets (lower than your daily calories
| expenditure) always do.
| matt3210 wrote:
| put it in the water!
| partiallypro wrote:
| I'm not obese, but am not what I'd consider at my ideal weight. I
| wonder how/if doctors would even prescribe this to someone like
| me. I think I've read some Hollywood types are using this to lose
| weight, but those are edge cases. I imagine for normal people
| this would not be easy to get prescribed.
| happyopossum wrote:
| Previous GLP-1 meds are generally not prescribed if you have
| below a 30 BMI
| bedast wrote:
| FDA approves these for use in most people above 30 BMI. Some
| people may be considered for it at 28 BMI. If you're looking
| for last mile weight loss, this may not actually be worth it.
| The side effects, especially getting started, can be really
| rough.
| Tagbert wrote:
| That looks like a "one weird trick" headline.
| ceejayoz wrote:
| So do quite a few medical advances. "Cure any infection with
| this moldy bread!" "Don't want polio? Inject some polio!"
| twawaaay wrote:
| Just making sure everybody understands that these drugs are not a
| solution to the problem. Assuming they work, they just make
| dieting easy.
|
| Look at people who successfully lost weight with diet -- studies
| show that almost all of them will regain most of their weight
| within 5 years. And the basic reason is because almost all
| dieting regimes are shitty, unsustainable way to live and at the
| end people are left tired of the diet and looking to get back to
| the eating habits they love and caused the problem in the first
| place.
|
| Also calorie restriction comes with a host of other problems. You
| need to provide better nutrition while on a diet -- your body
| still needs same things but now there is less food with which it
| has to be delivered. But if you got obese you probably don't know
| how to eat properly.
|
| Prolonged calorie restriction causes muscle wasting. You can
| counteract it to a certain degree for some time with exercise.
| Which if you are obese you probably don't know how to.
|
| Calorie restriction also typically causes basal metabolic rate
| drop. Which means you have to keep tightening the diet to see
| results. And when you are off the diet it will be extremely
| difficult to impossible to keep your weight.
|
| You can still cause a lot of damage to your body by snacking and
| eating wrong foods even if you are on calorie restricted diet. It
| is better to learn to not snack and keep your eating window to
| 4-6 hours every day rather than eat through entire day.
|
| I personally dislike meds like this. It is good it exists but I
| would never take them or recommend to anybody. There are a lot of
| medications that are supposed to help (like metformin) but all
| these meds do not address the main cause of the problem -- which
| is what you eat, how you eat and when you eat it.
|
| --
|
| For background, I got obese once and lost weight. Then regained
| the weight over a decade. Being engineer and problem solver, I
| vowed to understand the shit out of the problem, loose the weight
| properly and never regain it back. Which seems to be working.
| Understanding how to loose weight allowed me to do fantastic
| things like loose weight at 3 times the rate I did it previously
| while not feeling hungry or cold.
|
| The previous time I was on calorie restricted diet loosing and I
| was completely miserable for almost entire year, cold, slow,
| irritated, unable to focus.
|
| This time I completed the same weight loss in 4 months while
| actually feeling better than ever (at least most of the time).
| Most important for me, it is not interfering with my work.
|
| I am also not taking any meds.
|
| I am not preaching any diets here. I am just suggesting that if
| you are feeling hungry throughout your diet you are probably
| doing something wrong and it would be worth the while to
| understand what and how to fix it. And the only way this happens
| is if you get interested. No drug is going to magically fix it
| for you.
| belltaco wrote:
| >For background, I got obese once and lost weight. Then
| regained the weight over a decade. Being engineer and problem
| solver, I vowed to understand the shit out of the problem,
| loose the weight properly and never regain it back. Which seems
| to be working. Understanding how to loose weight allowed me to
| do fantastic things like loose weight at 3 times the rate I did
| it previously while not feeling hungry or cold.
|
| >The previous time I was on calorie restricted diet loosing and
| I was completely miserable for almost entire year, cold, slow,
| irritated, unable to focus.
|
| >This time I completed the same weight loss in 4 months while
| actually feeling better than ever (at least most of the time).
| Most important for me, it is not interfering with my work.
|
| How did you do it?
| twawaaay wrote:
| I would be cautious to give something that could be
| misconstrued as an actual health advice. I have rather
| limited medical knowledge and I am only comfortable
| experimenting on myself.
|
| That said, I red 3-4 dozen books related to weight loss,
| dieting, habit formation, nutrition, metabolism, diabetes,
| etc. and countless articles and youtube videos. I made notes
| of various topics that seemed important and repeated rather
| frequently and then tried cross-referencing to find which
| ideas are bunk and which seemed to be well supported.
|
| Starting the process, my goals were to overdetermine the
| success (ie. do a bunch of things at the same time to ensure
| success) and to build understanding of topics to the point
| where I can see how everything fits together and builds
| confidence I know what I am doing.
|
| Here is an unsorted list of ideas from my memory that I think
| helped me the most:
|
| * building habits and prepare for what to do after achieving
| target weight is super important. Weight loss time should be
| spent learning right habits, building habit chains,
| discovering/learning healthy dishes, etc.
|
| * managing family is also super important -- if your wife and
| kids have habits that will collide with your goals they can
| become worst enemies of the progress achieved,
|
| * become healthy to loose weight rather than loose weight to
| become healthy -- focus on identifying and fixing health
| problems and weight loss should more or less come as a
| consequence
|
| * it is better to do 20% of effort for 80% of benefit in each
| area rather than try to perfect any one of areas at the cost
| of others. Don't plan to become an athlete -- it is enough to
| jog every day for half an hour at comfortable pace. Don't
| plan for perfect diet -- it is enough to eat "healthy" most
| of the time. Etc.
|
| * it is better to learn and get to love new, healthy foods
| and add them to your diet than to try to remove unhealthy
| things you love. Add new foods/dishes and let them slowly
| displace bad ones.
|
| * commit to eating a portion of fresh fruit and vegetables,
| every day, however small. The goal is to build habits so that
| there is always fresh fruit/veggies at home, so that you
| automatically search/reach for them at the grocery, so that
| you have opportunity to test various things and learn new
| dishes.
|
| * commit to doing any amount of exercise every day. As above,
| the goal is to build habits, not to become an athlete. The
| first thing I did was to improve my fitness to the point I
| could be jogging every day.
|
| * don't start all changes at the same time -- introduce
| enough delay for each change to get accustomed and to be able
| to properly focus on that one change
|
| * I found intermittent fasting (4-6 hours eating window,
| 18-20 hours of fasting) to be probably the single most
| important thing to improve health and loose weight. It also
| has benefit of being sustainable and can be additionally
| combined with calorie restriction and/or keto.
|
| * The best eating window is probably somewhere in the middle
| of the day. There needs to be enough time before going to bed
| so that significant portion of fasting happens during sleep
| (aids recovery) but not too much or it might cause cravings
| in the evening and make it difficult to adhere.
|
| * I found there are various _easy_ strategies to decrease
| blood glucose ofter a meal that do not require making huge
| changes in diet: reduce carb intake during meal, precede
| carbs with protein /fat, precede carbs with any kind of acid
| (deactivates enzymes and further reduces blood glucose after
| a meal).
|
| * A physical exercise like a walk immediately after a meal
| helps purge blood sugar. While exercise itself does not make
| the body any less insulin resistant, the effect is as if
| insulin was more effective.
|
| * I found prolonged fasting and/or keto diet to be good
| _temporary_ solutions to various problems. After some
| research I would probably not advise anybody to stay on keto
| for very long, but spending some time on it gives you
| superpower of metabolic flexibility, and this ease of being
| able to hop on and off carbs without ill effects greatly
| helps with being able to adhere to intermittent /prolonged
| fasts.
|
| * Carbs make you crave more carbs. If you have problem with
| hunger while restricting calories, probably the easiest thing
| you can do is to cut carbs temporarily.
|
| * You probably don't need to get on keto diet to get most of
| the benefits. MCT oil in morning coffee is enough to generate
| ketones to stimulate mitochondria to multiply and waste more
| enrgy.
|
| * The main benefit of keto is that it is darn hard to eat so
| much fat and cutting carbs suppresses (unhealthy, extra)
| hunger.
|
| * Running at easy pace (easy = you can still talk easily) for
| at least 20-30 minutes regularly is ideal to cause
| mitochondria to multiply. Mitochondria are your friends when
| loosing weight because this is how your fat gets turned to
| heat. The more mitochondria you have the easier it is to burn
| through fat.
|
| * Running at any higher pace or for much longer probably is
| not advisable. The benefits are incremental but a risk of
| injury grows significantly making it absolutely not worth it
| from purely health/weight loss perspective.
| ceejayoz wrote:
| I think this is too dismissive, and internally inconsistent.
|
| These drugs are not _the_ solution for all people, but they may
| well be a part of it for many. The interventions you 're
| advising - "don't snack", "exercise more", have the same
| pattern you're talking about with dieting - alone, they tend to
| fail in the long-term.
|
| It's easier to learn to eat better (and enjoy things like
| veggies) if you're not feeling starving all the time. It's
| easier to learn to exercise (and enjoy it) if you're not obese.
|
| > all these meds do not address the main cause of the problem
| -- which is what you eat, how you eat and when you eat it
|
| "Just don't do that" hasn't historically had a great track
| record of addressing it, either.
| orblivion wrote:
| The headline sounds like a YouTube ad
| fswd wrote:
| It appears you can do the same thing with 3g of cinnamon
|
| https://pubmed.ncbi.nlm.nih.gov/19158209/
|
| Conclusions: Ingestion of 3 g cinnamon reduced postprandial serum
| insulin and increased GLP-1 concentrations without significantly
| affecting blood glucose, GIP, the ghrelin concentration, satiety,
| or GER in healthy subjects.
| jumpman500 wrote:
| Isn't that a dangerous amount?
| fswd wrote:
| It's about 1/3 of a tablespoon. It's dangerous to the bottom
| line of drug manufactures trying to sell a $1000 injection
| that does the same thing.
| exhilaration wrote:
| If anyone wants to try this, make sure you're NOT using what's
| usually passed off as cinnamon in America (Cassia), you want
| the real thing (Ceylon) -- and from a vendor you can trust.
| That amount of cassia cinnamon is likely to cause liver damage:
| https://www.consumerlab.com/answers/cinnamon-coumarin-liver-...
| glaucon wrote:
| (From a position of significant ignorance) It seems there is not
| a strong consensus on what has caused the great increase in
| obesity of the past fifty years, perhaps throwing greater effort
| in that direction would be a better long term solution ?
|
| To my mind it's strange that there seems to be a circular
| argument which starts with sedentary life style and "bad" foods
| cause obesity so exercise and diet control seems like a fix but
| that is countered by exercise doesn't help (much) and dieting has
| only temporary effects.
|
| If my summary is reasonably correct it seems to me what's needed
| is more understanding of the outcome before using drugs to "fix
| it".
|
| I wonder if a drug is less likely to be lobbied against than the
| types of changes such investigations might suggest.
| curiousllama wrote:
| I would encourage you to revise your summary. We don't know
| what the third-order drivers of obesity are, but we absolutely
| know that caloric surplus is the primary driver, and that
| surplus is driven by both lower energy expenditure (sedentary
| lifestyle) and increased caloric intake (junk food). There are
| other causes for individuals, but not at a population level.
|
| The question is much more: why did people start moving less &
| eating more? Each have complex factors (less physical jobs,
| increased wealth, food addictiveness, cultural shifts, etc.),
| and on THOSE, there's lots of debate.
|
| But we absolutely know what causes obesity at a population
| level.
| luckylion wrote:
| > If my summary is reasonably correct it seems to me what's
| needed is more understanding of the outcome before using drugs
| to "fix it".
|
| The likely reason is the changes in lifestyle thanks to the
| changes in technology. Is "let's just get rid of the past 70
| years of technological advancement" something that we'll
| seriously consider?
| glaucon wrote:
| | The likely reason is the changes in lifestyle
|
| Agreed, that's the commonly held reason but when one attempts
| to reverse what the changes seem to have been, by exercising
| more and eating less, that doesn't seem to work. My point is
| that perhaps we need to better understand what the changes
| have been, that perhaps they are more subtle than they are
| commonly held to be.
| pixl97 wrote:
| To couple on with what the other poster said there are two
| primary changes...
|
| 1. The amount of available cheap calories in convenient
| easy to eat packaging is orders of magnitudes higher than
| it was in the past.
|
| 2. Work and activity has changed so dramatically that we
| would not recognize the world of the past.
|
| Now the nuance here is understanding all the small
| ramifications that are far more invisible to us. Think of a
| coke bottle and how many calories that contains, I mean
| it's a huge amount. But now think about the convenience of
| it. You can carry it with you just about anywhere. The vast
| majority of jobs will let you carry it around work or leave
| it on your desk to drink from all day. It doesn't matter
| how much your work out, if you drink one extra coke per
| day, you've added more calories in than you're working off.
|
| But then add in all the small things that keep us from
| walking/exercising as much. Way fewer of our jobs are 'hard
| work' and been replaced by machines. We tend not to let our
| kids run around like wild creatures outside the house all
| day. Instead they are probably home, on the entertainment
| system of some kind with a coke in their hand. Kids also
| consume junk all day that is specifically marketed to them.
| You have to add all these factors in.
| luckylion wrote:
| From what I understand (which is mostly second hand from a
| health journalist friend), "work out a bit more and eat a
| bit less" doesn't get you anywhere close to how people
| lived up until 1950. In 1920, Americans had 8million cars
| registered (at 106m people), today they have 276 million
| cars to 330m people, and that's basically the same for
| every aspect of life.
| groos wrote:
| It's pretty clear by now that the intake of high amounts of
| fructose, refined carbohydrates and packaged foods has resulted
| in obesity. The much maligned fat in a healthy diet was never
| the culprit. The Chinese on a rice diet were never very obese
| until they became rich and started consuming packaged foods.
| Now their obesity rates rival the US's.
|
| Uncontrolled insulin levels cause obesity because of insulin's
| dual role in fat storage. The key is to change one's diet such
| that insulin levels are lowered and the stored fat can be
| utilized for metabolic needs.
|
| Exercise is important for general health but trying to lose
| weight by exercising doesn't work if the diet stays the same.
| Food is just too calorie rich and the body too calorie
| efficient. The adage 'get fit in the gym, get slim in the
| kitchen' applies.
|
| Genetically, a small number of people might have metabolic
| issues causing obesity.Drugs might be the right choice for them
| but for the vast majority of us, we just need to take a hard
| look at our diet.
| dang wrote:
| Recent and related:
|
| _The FDA will likely approve the diabetes drug tirzepatide for
| weight loss_ - https://news.ycombinator.com/item?id=34220996 -
| Jan 2023 (100 comments)
|
| _Tirzepatide delivered up to 22.5% weight loss in obese or
| overweight adults_ -
| https://news.ycombinator.com/item?id=33221121 - Oct 2022 (21
| comments)
| makeworld wrote:
| Related: https://astralcodexten.substack.com/p/semaglutidonomics
| Communitivity wrote:
| I think it's awesome that there's a new use for these drugs.
| However, obesity kills slowly, when it kills. Diabetes and
| Chronic Kidney Disease kill more quickly if not under control.
| These drugs keep diabetes under control..and diabetics like my
| wife are unable to get their meds because people are buying these
| off the shelf to lose weight.
|
| I don't pretend to know the solution, but I do think drug
| availability should be prioritized to those who need it the most,
| not those who can pay the most (the weight loss brand of the same
| drug is being marketed for 2x-5x the cost of the diabetic brand,
| or so I've been told).
| pjc50 wrote:
| I note the reverse applies: my dad was prescribed Metformin for
| diabetes, and began to lose weight at a significant rate to the
| point where it became unhealthy.
|
| > the weight loss brand of the same drug is being marketed for
| 2x-5x the cost of the diabetic brand, or so I've been told
|
| Drug pricing is a hell of a drug.
| jboy55 wrote:
| > Diabetes and Chronic Kidney Disease kill more quickly if not
| under control. These drugs keep diabetes under control..and
| diabetics like my wife are unable to get their meds because
| people are buying these off the shelf to lose weight.
|
| This seems to be a short term problem, and the solution is to
| simply make more of the drug to match demand.
| charlieflowers wrote:
| > and the solution is to simply make more of the drug to
| match demand
|
| which unfortunately might not align with the incentives of
| capitalism.
| jboy55 wrote:
| If "Capitalism" involved the conscious coordination of all
| industry to maximize consumption, perhaps not. But in the
| terms of, raise money to buy a factory, have factory
| produce goods, sell goods, there seems to be a huge market
| for these, quite expensive, goods.
|
| edit: You could even argue, in a conspiratorial mind, that
| by getting people addicted to sugar ($0.0002 / mg) in order
| to then get them addicted to a drug that costs ($10/mg) is
| peak "Capitalism"
| notJim wrote:
| Why wouldn't it? At $1300 a month, this is going to be a
| massive business for these companies.
|
| I read a statement from Novo Nordisk to their investors
| where they said they simply underestimated demand for the
| drugs. They expected a slow uptake and instead received an
| explosive one. They are working hard to increase
| production.
| VikingCoder wrote:
| I'm on semaglutide. Was on Saxenda, because I couldn't get access
| to Wegovy at the lowest dosage. But now I'm on Wegovy, for half a
| week so far.
|
| I was retching horribly one night at 2 am, but didn't throw up.
| I've felt clammy and dizzy a few times. (Possibly hypoglycemic?)
|
| I honestly feel like it's changing how I feel about food. I don't
| _want_ to eat empty carbs, anywhere near as much. Because I feel
| like they make me feel sick. I 'm eager to have more, smaller
| meals. I'm eager to have protein.
|
| I had previously done a keto diet, except maybe I wasn't really
| in ketosis? It was medically supervised, doing New Direction
| complete meal replacements. I lost a bunch of weight, but...
| gained it back.
|
| So now semaglutide. Dr urging surgery as a possibility. I'm eager
| to not do surgery. Fingers crossed for Wegovy.
| dmix wrote:
| > I don't want to eat empty carbs, anywhere near as much.
| Because I feel like they make me feel sick.
|
| I did a keto diet obsessively for a while and I still have a
| psychological revulsion to drinking coke or eating cake even a
| year later. Those sorts of things are long term wins.
| VikingCoder wrote:
| When I was trying to slowly increase my calories again,
| coming off of low-calorie keto, I definitely wanted coke and
| cake.
|
| I'm happy for you, but I didn't get that benefit you got.
| dmix wrote:
| Oh yeah, I wasn't really expecting it to be a general rule.
| I just built up "carbs = evil" so much in my head I
| developed a physical distaste for it, but I doubt most
| other people would.
| drowsspa wrote:
| I wish I got to this stage where people lose their cravings.
| While I'm at home I can control my diet pretty well, but as
| soon as there's junk food in front of me I look like a pig.
| And I've lost like 30 pounds, to put it into perspective.
| tptacek wrote:
| As a data point: under carb restriction and fasting, I
| won't think about food at all until I happen to eat some
| threshold number of carbs, or I get actual hunger (shaking,
| weakness, headache --- usually around 20 hours in). Once I
| cross that carb threshold, I'll be snacky until I go to
| sleep.
|
| People have different metabolic situations, but if you
| haven't tried fasting+restriction, it's pretty interesting.
| dmix wrote:
| > Once I cross that carb threshold, I'll be snacky until
| I go to sleep.
|
| This is where I struggled with OMAD. It's easy to not eat
| up to the first meal. But not snacking after dinner takes
| some real heart.
| aidenn0 wrote:
| I got to the point where I lost my cravings; it took less
| than a week for them to come back when I reintroduced them
| in small amounts though.
| standardUser wrote:
| I had the opposite outcome, several months of keto left me
| avoiding meat and cheese for a long time.
| VikingCoder wrote:
| My keto diet was chocolate protein shakes, protein bars,
| and powdered soups. New Direction it's called. 3 meals, 2
| snacks a day. 128 oz of water a day.
|
| It worked great as a way to lose weight. And for people who
| need to lose weight to prepare for surgery, I still think
| it's a neat program.
|
| But I was just not equipped to survive returning to normal
| foods. And stress.
| matt3210 wrote:
| Convincing people to not fool around never worked so the birth
| control pill was invented to allow people to indulge with less
| consequences. I recall someone (I forget who) said that things
| that prevent you from eating will never work and the only
| solution is something that allows you to indulge without the
| consequences. Does this drug allow you to indulge without
| consequences or does it make you not want to eat? If its the
| later, I bet that it won't have long term success.
|
| Edit: A drug that allows you to indulge without consequence in
| this context would be a bad thing. It would allow people to eat
| non-stop without the consequences and would increase the demand
| for food in the modern nations to unreasonable levels. If you
| think about it, this kind of drug would have the same outcome as
| bulimia (think, hunger games).
| deburo wrote:
| >Does this drug allow you to indulge without consequences or
| does it make you not want to eat?
|
| Why wouldn't satiety drugs be helpful?
| matt3210 wrote:
| People WANT to indulge. A drug that kills sex drive would
| never work but the drug that lets you have a sex drive
| without consequences already works today.
|
| Edit: It might have novelty support but I'm sure that in the
| long run people will choose to indulge and get the dopamine.
| foruhar wrote:
| $1000/month seems like a decent amount of money for a lot of
| people. I'm guessing a large number of folks would love to lose
| weight miraculously. I wonder how long before we get a bootleg
| analog that can be bought in the non-medical drug market in the
| same way as testosterone can be bought. Now that the mechanism is
| known (GLP-1 inhibition) are these the kind of drug, e.g. LSD,
| valium, or morphine, that is easy to create a facsimile or analog
| of?
| JamesBarney wrote:
| These drugs are way more difficult to manufacture than
| testosterone. I'm sure we'll see things branded as a knockoff
| but I doubt we'll see any true knockoffs.
| 2devnull wrote:
| "when lifestyle changes aren't enough."
|
| People don't want to hear it, but we do nobody any favors by
| pretending this is more complicated than it is. It's actually
| pretty simple. The solution is to adjust calories in vs calories
| out. Fast a few days a week. Cut out bread, sugar and other
| simple carbs.
|
| We don't help alcoholics or opioid addicts by enabling them with
| statements like "when not getting drunk isn't enough..."
|
| The pharma industry will enable addicts because it wants money.
| Fat people need love, though love, and a home without good
| tasting, or high calorie foods.
| epgui wrote:
| > The pharma industry will enable addicts because it wants
| money.
|
| This is a little over-simplistic. The "pharma industry" is not
| a monolith, and is made up in large part by academics who love
| spending their time thinking about how to make the world
| better, and by doctors who have no conflict of interest, etc
| etc.
| mshake2 wrote:
| While I agree, you're right, nobody wants to hear it. There's
| no point telling people to have discipline, because discipline
| is not spread through strangers telling each other to have it.
| Someone either has the capacity to have discipline (instilled
| through upbringing or formative events), or they don't. These
| magic pills are for everyone who doesn't have discipline.
| mirekrusin wrote:
| Eat less shit food and excercise more doesn't work anymore
| nowadays?
| magwa101 wrote:
| [dead]
| [deleted]
| iammjm wrote:
| At a risk of being ignorant: Isn't obesity a function of calories
| intake and calories burn rate? If so, why do we even need a drug
| for that? What should a possible drug target here? Assuming no
| changes in behaviour and thus a continued steady daily caloric
| surplus, would it even work?
| cjbgkagh wrote:
| It would be if people are calorimeters but they're not.
| pjc50 wrote:
| > Assuming no changes in behaviour
|
| It's the other way round: the point of the drug is to change
| behavior. By changing the hunger response.
|
| The hunger response is not _quite_ as low-level as, say, the
| breathing response, but you 'll notice that it's very difficult
| to choose to stop or reduce your breathing below a level that
| your body will accept, and after a very short while your
| conscious will will simply be overridden.
| megiddo wrote:
| It's like treating an addiction by telling the addict "it's ok
| to have some, just pinkie swear you won't overdo it."
|
| People who are obese or grossly obese often aren't just eating
| a "little extra" here and there. Imagine more like "extra pizza
| a day" or "eat a cake once a week because that seems like a
| good idea".
| rhino369 wrote:
| The amount of calories to add an extra 50 lbs isn't that
| crazy. It's around 300 calories a day. So more like 1 *slice*
| of pizza extra.
|
| That is why weight loss is hard to achieve. If you are
| hungry, it's hard to--over an entire day--avoid eating 300
| extra calories.
| thefz wrote:
| ... nah.
|
| 1Kg of human fat is around 8000kcals give or take. 50lbs is
| 22Kg. 176000kcal. It's 586x "extra slices of pizza", almost
| two years of overeating every day.
| rhino369 wrote:
| That's exactly what I said. 300 cals indefinitely. I
| obviously didn't mean you eat one slice of pizza and gain
| 50lbs.
|
| It's easy to say "put down the pizza," but pizza is just
| an example.
|
| 300 calories is also 1/4 a cup of rice (50 cals), 1/3
| service of chicken (100 cals) an egg (78 cals), a
| teaspoon of olive oil (40 cals), and a toast (75 cals).
|
| There are lot of reasons its hard to cut weight.
| Measuring calorie intake to 300 calories is hard enough.
| But also, its easy to eat a bit more at each meal if you
| are hungry (and it adds up).
| kemayo wrote:
| At a really fundamental level, yes, it boils down to calories
| in versus calories out. _However_ , in practice it's more
| complicated than that, partially for psychological reasons.
|
| Anyone will lose significant weight on a strict enough diet.
| Unfortunately, severe calorie restriction does things to your
| metabolism -- basically, your body notices there's not enough
| food, and tries to slow everything down so that your existing
| stores will last as long as possible. This (a) isn't good for
| you, since major organs are having to limp along, and (b) means
| your diet gets less effective, as "calories out" aggressively
| shrinks. There's evidence that this lasts for a fair while
| after a diet stops, making it really easy to regain weight.
|
| Then, psychologically, most people have a hard time sticking
| with any sort of long term diet. Unless you have an abnormally
| low hunger response, ignoring feeling hungry all the time (even
| just a little bit) is _very hard_. Cheating on your diet is
| very alluring, and your body gives you _all the rewards_ for
| doing things that feel like they 're avoiding you slowly
| starving to death.
|
| The latter point is where these drugs come in. By suppressing
| hunger signals, dieting suddenly becomes easy, removing the
| escalating willpower requirement. (Honestly, I'd worry about
| whether you'd still suffer the metabolic effects of calorie
| restriction even if you're not noticing the hunger, but
| hopefully that's being studied and they're only prescribed
| along with a solid nutritional plan...)
| nextlevelwizard wrote:
| When you are so fat your metabolic maintenance rate hovers
| around 4000 kcal per day you lose all sense of what to eat and
| after years of over eating old habits die hard.
|
| On paper dieting is the easiest thing. You literally need to
| watch one hole and it is right under your nose, but in practice
| it isnt that easy.
|
| Appetite is great way to control obesity - if you dont want to
| eat you wont
| bioemerl wrote:
| Drugs can reduce your desire to eat or increase your
| metabolism.
|
| You don't need a drug, but changing habits is very hard and
| obesity very deadly.
| dougmwne wrote:
| Yes, your instinct is correct, you have vastly oversimplified
| it in an unhelpful way. The body is not an energy equation to
| be balanced.
|
| The desire to eat is driven by our hormones and these are not
| easily overridden by willpower. In fact, study after study
| shows that willpower is insufficient for most people. Hunger is
| produced by a complex set of factors that we do not fully
| understand. What we eat and how we live plays a big part in how
| hungry we feel.
|
| Calories should not be counted like some fungible currency.
| Each food is a complex and poorly understood cocktail of
| organic chemistry. Food is not processed by the body in the
| same way or at the same speed. In the most simple sense,
| unprocessed whole foods digest the slowest and provide the most
| even energy to the body, while highly processed food is
| digested quickly and leaves you hungry again soon. And above
| all else, fiber is the most amazing thing that can be in your
| food to regulate your digestion and make you feel more full.
|
| And the consumption of energy is also not a matter of willpower
| to go to the gym. The body regulates is caloric burn to suit
| its environment, again, based on a complex and poorly
| understood web of signals. But in simple terms, trying to eat
| less can also caus your body to go into a "low power mode"
| where you burn less energy, ultimately being counterproductive.
|
| The magic of this drug is that is hijacks one of the important
| hormone pathways involved in hunger and causes you to eat less
| calories without a single conscious thought. If proven out as
| safe and effective, it could be the silver bullet in an obesity
| epidemic that has never had any easy solutions before.
| joe_the_user wrote:
| It's very important to consider "metabolic rate" in these
| considerations. I have been nearly under-weight my entire
| life (I'm in my 60s) and I've eaten as much high-calorie food
| I've felt similarly, usually a large amount (generally
| consuming the most any gathering I'm at, etc, eating three
| meal a day, etc).
|
| The one thing I've always done is avoid foods with added
| sugar and in general processed food. There's good evidence
| that the consumption of "ultra-processed" food is associated
| with the obesity epidemic and that these food are what people
| weight-maintenance processes out of balance.
|
| Given this, adding a drug to solve that problem might not be
| a panacea. What other bad effects could result from a strong
| drug plus a crap diet? We'll start another mass experiment to
| find, I suppose.
| hungryforcodes wrote:
| The body is an energy equation to be balanced. Physics
| defines that.
|
| What you are talking about substantially in your post is
| about willpower with regards to eating and exercise which is
| totally different.
| pixl97 wrote:
| Evolution had no care about the understanding of applied
| physics when we came up the evolutionary tree.
| Understanding physics here _almost_ has no effect on our
| behavior.
|
| Instead look at the evolutionary incentives. If you starve
| you are going to die and it is going to fucking hurt the
| entire time you are dying.
|
| With that one line of information you now understand not
| only humans but the vast majority of animal life on this
| planet and why almost all animals get fat if you leave a
| full food dish around. We are optimized to avoid starving
| at all costs. When winter comes you could die. When the
| summer drought comes you could die. Your animal brain is
| yelling at you to pack on the pounds now that the eating is
| good because the lean times are coming. Our animal brain
| has no understanding or concept that times are good, we
| need to slow down. It has never been a primary evolutionary
| driver.
| kemayo wrote:
| Notably, this is (presumably) why our bodies often think
| it's a _very_ good trade-off to turn everything down
| instead of burning fat. Fat is important long-term
| storage that might be what gets us through the winter
| starvation, and storing /burning it is a lossy process --
| turning down the tap on our energy _usage_ for a little
| while, however, might be all we need to get through a
| lean few weeks.
| dougmwne wrote:
| I am very much not talking about willpower. I am saying it
| is NOT about willpower.
|
| And sure, there is an energy equation here
| thermodynamically, but it is unhelpful. It would be
| something like:
|
| Calories in * X = Calories consumed * Y + Fat stored * Z
| Where X, Y and Z are unknown and barely controllable
| factors related to hunger, type of food, digestion,
| microbiome, hormones, genetics, metabolism, environment,
| society and so on.
| _dain_ wrote:
| > The body is an energy equation to be balanced. Physics
| defines that.
|
| Most equations don't fight back when you try to balance
| them. But this one does.
| bilsbie wrote:
| Let them eat cake (I mean less calories)
| dcolkitt wrote:
| Modern nutrition science has found that each person, at any
| given time, has a "metabolic setpoint". This is basically a
| target weight that their endocrine system is trying to keep
| them at. There's a feedback loop, where below this weight
| hunger hormones will nudge them to eat more and metabolic
| hormones will lower caloric expenditure (lowering body
| temperature, sleeping longer, fidgeting more). And vice versa
| above this weight.
|
| Most people will have a +/- 25 lbs window, where the feedback
| loop is minimal. But once they step outside this window the
| nudges become increasingly strong. This is why it's generally
| easy to lose 15 lbs, but really hard to lose 50 lbs. Also why
| many can lose weight under very targeted lifestyle
| interventions, but rapidly snap back as soon as they relax even
| a little bit. Finally it's why the vast majority of normal
| weight people don't need to count calories, their metabolic
| setpoint intuitively matches their appetite to their caloric
| needs.
|
| "Eat fewer calories" is technically a solution, in the same way
| that "stop drinking alcohol" is a solution for an alcoholic.
| The problem is someone who has an obese-level metabolic
| setpoint will literally be ravenous 24/7 once they get down to
| healthy weight. If you haven't experienced this yourself, try
| fasting for 48 hours, putting out a bowl of chips on the table
| in front of you, and resist the urge to eat even one while you
| try to do something else. That is what it's like to be an obese
| person trying to lose a large amount of weight.
|
| GLP-1 agonists work by short circuiting the hormones that
| regulate hunger. It's basically the equivalent of moving your
| metabolic setpoint 100 pounds lower. The need to explicitly
| count calories no longer exists, because your appetite will
| naturally limit itself well below the point of caloric
| expenditure.
| asdff wrote:
| People have trouble dealing with hunger because we frame it
| all wrong in the western convention. I'm hungry, I should eat
| a little something, is what most people think. An ascetic
| from the east who fasts is not immune to the pain of hunger,
| they just understand that hunger is a sensation that is
| neither good nor bad, and what they choose to do with that
| sensation is up to them, and they are not bound to it and do
| not have to satiate it right then.
|
| I imagine if a prescribed diet from a doctor also came with
| mental health counseling, that overcoming the satiation issue
| could be a lot easier for more people. It really is a frame
| of mind issue that prevents most peoples weight loss from
| being more successful.
| dcolkitt wrote:
| It really is not a frame of mine. We know this because GWAR
| genome studies find that the SNPs most correlated with
| obesity are expressed in the hypothalamus, which has
| nothing to do with higher thought.
| asdff wrote:
| Its not like you black out and the chips are in your
| mouth though, to act on hunger requires conscious effort.
| That is what the ascetics are practicing, resisting these
| primal urges because they can be resisted by the higher
| thinking brain.
| pixl97 wrote:
| And if ascetics were even a significant portion of the
| human population I would say that would be a useful
| measure. Instead their numbers are low enough that they
| are a statistical outlier along with those people that
| seem to eat as much as they want and not gain weight.
|
| The fact is you _can_ choose to starve yourself to death
| if you put your mind to it. I would counter that with
| 'why the hell would you want to'. Wasting a huge portion
| of my brain time to tell myself (oh yea, don't eat) seems
| like a massive waste of time and energy.
|
| >to act on hunger requires conscious effort
|
| Does it? I'd like to develop a test where I starve a
| large people for a little while. Then while I distract
| them with something I put some easy to eat like chips in
| their peripheral view and see how many of them realize
| they started consuming the chips. My ethicist says I
| can't do this unfortunately, but I imagine that a
| significant fraction of the group will not realize when
| they started eating them.
| valarauko wrote:
| As someone from an Eastern country with a strong ascetic
| tradition, I find this framing unhelpful. Yes, our culture
| places a strong emphasis on fasting, but is simultaneously
| also experiencing its own obesity epidemic - and it's not
| because we're adopting a western framework around hunger.
| More and more people can now afford high calorie
| ingredients in our native cuisines that were a luxury a few
| decades ago. When I was a kid, things like ghee were
| prohibitively expensive, and I grew up seeing it as a
| special treat consumed sparingly. I never had to develop
| self-control around expensive, high satiety food because
| access was self limiting. If all we could afford to eat
| daily was rice and lentils, it was hard to be morbidly
| obese. My generation has faced an obesity epidemic, partly
| due to easy access to rich foods my ancestors didn't have
| but my culture and cuisine valorizes. Industrialization of
| food production has made access much more egalitarian, but
| we have yet to develop the collective restraint needed.
| bscphil wrote:
| > Modern nutrition science has found that each person, at any
| given time, has a "metabolic setpoint". This is basically a
| target weight that their endocrine system is trying to keep
| them at.
|
| Citation? This goes against everything I've heard from
| credentialed experts and against my own experience as well.
| For one thing, it's unclear how you'd explain the weight gain
| of the median person in the western world over the last 30
| years. For another, it's very strange that people like me
| (previously) gained 5-10 pounds a year, if our bodies were
| supposedly trying to keep us at a particular set point.
| dcolkitt wrote:
| Metabolic set points can and will drift over time. So if
| somebody starts out with a setpoint at 22 BMI, they might
| naturally be anywhere from 21-24 BMI at any given time. As
| food in the environment becomes more hyper-palatable and
| calorically dense, people are more likely to "settle" at
| the upper end of this range. Over time spending more time
| at the upper end of one's range will "nudge" up the
| setpoint gradually and continuously.
|
| But the point is this is a slow and continuous process that
| occurs over years or even decades. Discontinuously making a
| big shift in weight, up or down, is basically impossible.
| Which is why despite very high rates of obesity, it's
| basically unheard of for someone to gain 50 lbs in a short
| period of time. Almost all weight gain takes the form of 5
| lbs one year, 5 lbs another year, and so on.
| ceejayoz wrote:
| > Isn't obesity a function of calories intake and calories burn
| rate? If so, why do we even need a drug for that?
|
| Because calorie intake is substantially impacted by things like
| satiety. As the article's subtitle heavily hints at, "A class
| of drugs that quash hunger" is beneficial in moving that bit of
| the equation.
| iammjm wrote:
| I understand, but appetite/hunger seems to be just a part of
| the issue. The second part being people (myself included)
| using food to comfort ourselves. I feel bad -> I seek tasty
| food to comfort myself, even if I am not hungry. The whole
| candy-market is built around. How are drugs to address this?
| ceejayoz wrote:
| One drug can't address every situation. You might add in an
| anti-depressant for this aspect, or some sort of behavioral
| therapy.
|
| Consider, though, that quite a few obese people "feel bad"
| at least in part because of the health and social impacts
| of their weight.
| djur wrote:
| One effect of these drugs appears to be weakening that
| "comfort -> food" urge. There's some evidence that it also
| affects similar urges for alcohol.
| starkd wrote:
| By using drugs that manipulate specific hormones to alter a
| person's appetite. So you consume less calories.
| Kon5ole wrote:
| I believe you are correct, but that leaves several
| possibilities for the drugs to be effective. They could work by
| either causing you to lose interest in food/improving impulse
| control so that you eat less, or by increasing your calorie
| burn rate, or by causing your body to absorb less calories from
| the same amount of food.
| 0xB31B1B wrote:
| These drugs modulate your hormones to reduce appetite and
| cravings for unhealthy foods. When people lose weight the
| normal way, their endocrine system sends out a "you are
| starving, eat" hormone response that is extremely difficult to
| overcome and success requires 100% compliance for the rest of
| your life.
| dbspin wrote:
| Success in adjusting diet does not require '100% compliance
| for the rest of your life'. It requires serious changes yes,
| but even frequent slips as part of a largely altered diet
| won't discount it. This perspective - as well as being
| factually inaccurate - feeds into shame spirals and negative
| self efficacy. It's also true that virtuous circles can be
| built on diet and exercise, replacing the endorphin lift
| provided by sugar / carbohydrate load; and in the longer term
| homeostasis can be achieved at a healthier weight. It is
| difficult, but it's absolutely not as impossible as this
| comment implies.
| awillen wrote:
| Because many people just aren't able to get that ratio to a
| point that they're at a healthy weight (for numerous reasons -
| behavioral, medical, etc.).
|
| "Assuming no changes in behavior" doesn't make sense, because
| the drug makes people feel full after a smaller amount of
| calories and thus changes behavior.
| iammjm wrote:
| Don't you ever eat sweets despite of not being hungry? I
| don't think the issue is people overdosing rice or legumes
| because they are so hungry. The issue seems to me like quick
| comfort foods that we eat not to get full but because they
| just feel so good in our mouths. I don't think I've ever
| eaten ice cream out of hunger:)
| awillen wrote:
| Yeah, I agree with all of that, but I would differentiate
| slightly between not being hungry and being full. I snack
| when I'm not necessarily hungry, but I don't snack right
| after I've eaten a full meal and am actively full.
|
| Anyway, semantics of hunger/fullness aside, the effect of
| the drug is behavioral - people taking it do end up eating
| significantly less, which leads to substantial weight loss.
| Ekaros wrote:
| Also it is much easier to pass those snacks and other
| stuff when you are full or not hungry. If this is
| consistent state, it can also effect how accessible at
| other times snacks and such are.
| drowsspa wrote:
| "Stop being poor"
| randomdata wrote:
| _> Isn't obesity a function of calories intake and calories
| burn rate?_
|
| In the same way that the economy is a function of people
| trading things, sure. Why do we even need economic policy?
| iammjm wrote:
| Indeed, we need an economic policy, not an economic drug. I'm
| totally for behavioural policies for obesity, such as don't
| buy sweets, go for a walk each day, or make sure to eat
| vegetables each time you are hungry, etc.
| medvezhenok wrote:
| There is some evidence to show that obesity has been rising
| independently of behavioral changes (even though they do
| contribute), due to deterioration in the food quality. Look
| at obesity rates amongst animals for example, especially
| wild animals that feed off of human food.
| ceejayoz wrote:
| > I'm totally for behavioural policies for obesity, such as
| don't buy sweets, go for a walk each day, or make sure to
| eat vegetables each time you are hungry, etc.
|
| So are physicians, and most patients. It's just a lot
| harder than it sounds to sustain. There's the old adage
| that "the definition of insanity is trying the same thing
| over and over expecting different results"; attempting to
| cure obesity by telling patients "exercise more, eat less"
| is precisely that.
| robertlagrant wrote:
| This is too absolutist. People aren't immutable, unable
| to control themselves at all without drugs. Anyone who
| gives up smoking without a patch has to decide to never
| pick up a cigarette again. They may have "given up" a few
| times before, and the last time they succeeded. By your
| logic they shouldn't have tried more than once.
| pixl97 wrote:
| And you're isn't absolute enough.
|
| Take a 'large enough' population of animals and give them
| an all you can eat buffet for months. What percentage of
| them becomes overweight? It won't be 100%, but the
| numbers should be pretty high. I have a very strong
| feeling (sadly no evidence, they won't let me trap random
| people in cages for months at a time to test this) that
| the human numbers and the animal numbers will look very
| much alike.
| ceejayoz wrote:
| At a population level, we know how effective the various
| kinds of behavioral interventions for obesity are. The
| numbers aren't good.
|
| https://www.cbc.ca/news/health/obesity-research-confirms-
| lon...
|
| > But if we check back after five or 10 years, there's a
| good chance they will have put the weight back on. Only
| about five per cent of people who try to lose weight
| ultimately succeed, according to the research. Those
| people are the outliers, but we cling to their stories as
| proof that losing weight is possible.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
|
| > In a meta-analysis of 29 long-term weight loss studies,
| more than half of the lost weight was regained within two
| years, and by five years more than 80% of lost weight was
| regained.
|
| "Just eat right and exercise more" may work for a small
| number of people, but for most it's setting folks up to
| fail. It's good that we're starting to get medication
| options that can help folks achieve those changes;
| bariatric surgery works, but it's a _big_ deal for the
| body.
| robertlagrant wrote:
| > "Just eat right and exercise more" may work for a small
| number of people
|
| It may work for most people - those studies are performed
| on a fraction of the remainder.
| ceejayoz wrote:
| > It may work for most people
|
| 70% of adult Americans are overweight, so no, probably
| not.
|
| > those studies are performed on a fraction of the
| remainder
|
| Why would you believe that?
| djur wrote:
| Do you have any reason to think that the sample isn't
| representative?
| djur wrote:
| Bariatric surgery also tends to require a period of
| weight loss beforehand as well as extensive behavior
| modification afterward. These new drugs should make that
| process much easier.
| matt_s wrote:
| I had an opinion that this all sounded silly but then watched
| the 60 Minutes segment on the drugs and what the doc talked
| about is, in my layman's recollection, the body remembers its
| weight and wants to get back to that which is why a lot of
| people end up losing and then gaining most of it back. Genetics
| play a role in this, I forget how but something to do with what
| these drugs help change.
|
| I wonder if rather than a placebo they had a control group also
| try to lose with caloric restriction and defined plateaus where
| they maintain a weight for some period of time. For example
| instead of lose 1lb/week for 52 weeks, lose 1lb/week for 12
| weeks, maintain weight for 8 weeks, repeat. Maybe the element
| of the body "remembering" a weight happens when you plateau at
| a weight for a while? Kinda like giving the body some time to
| adjust as you lose.
| pixl97 wrote:
| >try to lose with caloric restriction
|
| Other than this is mostly useless in itself.... Calorie
| restriction really only works well under medical supervision
| (multiple studies show people suck at calorie counting and
| avoiding calorie intake). Once the supervision is over, most
| people gain the weight back.
|
| I have a feeling it may happen with this shot too, and if so
| I foresee it will have primary treatment to lose weight then
| a secondary to maintain status.
| asdff wrote:
| We evolved as hunter gatherers and have been hunter gatherers
| for most of our history. Continuously moving while collecting
| resources, even into old age. Today, most people don't
| continuously move. They go from bed, to work, to the couch at
| home, then to bed, with as little physical movement as they can
| possibly do in between.
|
| Maybe if more people at least simulated how much a hunter
| gatherer moved a day, we'd see a much healthier population
| versus continuing this sedentary behavior that we have not
| evolved to do while remaining healthy. Agriculture which
| enabled a sedentary lifestyle for many people did not happen
| long enough ago for our species to be well adapted to this
| behavior; it was only 10,000 years ago, while our ancestors had
| been hunting and gathering for at least 2 million years, likely
| foraging even longer still.
| 0xB31B1B wrote:
| I'm currently taking one of these drugs and it has been no less
| than a miracle in my life. I became obese when I was around 5,
| topping out around a 34 BMI. When I was 20 I lost a substantial
| amount of weight the old fashioned way (diet and exercise), and
| within 8 months I was BMI 23. Losing weight was extremely
| challenging and socially isolating.
|
| 7 years later, I had a bad ankle injury and regained weight to
| about 29 BMI. This time I lost weight by doing an "eat every
| other day" diet. This was also extremely challenging, but easier
| than just counting calories and working out. After Covid and a
| lack of exercise I was back to BMI 30. I started taking
| tirzeparide this summer and have gone from BMI 31 to BMI 26 and
| still dropping. This is by far the easiest way to lose weight.
| The side effects for the first 3 months are quite bad, and
| include off and on strong nausea, extreme fatigue, brain fog, and
| constipation. I was eating <1k calories per day for a long time
| and feeling full. I expect to be on this drug long term. My blood
| work shows extreme improvements in cholesterol, BP, and other key
| health indicators. I believe that everyone, even the skinny
| folks, should be on GLP1 drugs for the longevity effects. They
| changed they induce in diet reduce the oxidative stress on the
| human body, even if the person is already thin.
| treeman79 wrote:
| I was put on topomax for extreme migraines. Turned out a side
| effect was zero appetite. Unfortunately another side effect was
| to lose of about 60 iq points. Loved the weight loss. Missed
| having a brain.
| onionisafruit wrote:
| That's why it's called dope-a-max. My wife had the same
| experience.
| halfmatthalfcat wrote:
| > When I was 20 I lost a substantial amount of weight the old
| fashioned way (diet and exercise)...Losing weight was extremely
| challenging and socially isolating.
|
| > This time I lost weight by doing an "eat every other day"
| diet. This was also extremely challenging, but easier than just
| counting calories and working out.
|
| I'm not sure at what point in your life weight management was
| lauded as "easy". You have some tools in your toolbox on how to
| lose weight naturally (diet, exercise, different eating cycles)
| but you decided that these are too "hard" and opted for magic
| pills.
|
| Just a shame to see people make progress in their weight loss
| journey the right(er) ways then succumb to weakness and opt for
| voodoo.
|
| Weight loss is a journey and its most salient point is learning
| about how your body works. You have a relationship with your
| body and instead of fighting it artificially, you should
| embrace it. You're stuck with your body for the rest of your
| life. Learning how it works, what it tolerates, what it
| doesn't, how it reacts to different foods is, imo, the keys to
| a more enjoyable and sustainable life. It also builds character
| since you are taking an active role in the maintenance and
| administration of that body.
|
| Oh and just anecdotally, it's been a lifelong journey for me
| too but instead of lipo or drugs, I decided to grind it out
| with exercise, nutrition and therapy.
|
| > I was eating <1k calories per day for a long time and feeling
| full. I expect to be on this drug long term.
|
| This is absolutely terrifying.
| MajimasEyepatch wrote:
| This is a ridiculous comment. Statistically, there is no
| weight loss strategy that has been found to work long term at
| the population level except for bariatric surgery (and now,
| apparently, these drugs, but we'll see how things look in a
| few years). Sure, one individual person can pull it off with
| enough willpower and support and luck. But at a population
| level, we know definitively that "grind it out with exercise,
| nutrition, and therapy" is not an effective public health
| strategy.
|
| We are biochemical machines that evolved in a food
| environment completely unlike the modern world, and that's
| before you get into possible chemical factors in the
| environment. If these drugs continue to prove safe--or even
| they just prove to be less bad than obesity and more
| effective than other techniques--then there's no reason to
| dismiss them.
|
| Congratulations on being better than the rest of us slobs,
| but what works for you may not work for everyone.
| halfmatthalfcat wrote:
| Never said I'm better. My point is that these solutions are
| driven by people looking for easy answers to a hard
| problem. I refuse to believe people _need_ them but only
| want them and that may be enough for some.
| raincom wrote:
| Even people who had bariatric surgery regain weight
| substantially.
| paulpauper wrote:
| _ways then succumb to weakness and opt for voodoo._
|
| The drug has been tested and shows to work in randomized
| controlled trials. Not voodoo.
| 0xB31B1B wrote:
| "Weight loss is a journey" -> it doesn't have to be, and it
| isn't for me anymore.
| halfmatthalfcat wrote:
| Whether it's a pill a day or a run, you are still doing
| _something_ and thus the journey. Some of us are blessed
| with hands-off metabolisms and some of us, it 's a constant
| battle. Best of luck to you tho.
| HDThoreaun wrote:
| How paternalistic.
| halfmatthalfcat wrote:
| I can live with that but it's from passion than from a
| place of judgement.
| jklinger410 wrote:
| Thank you for grand standing about obesity and your
| relationship with your body. We all really needed it and it
| was very helpful.
| sarchertech wrote:
| Maybe losing weight the old fashioned way builds character,
| but so do plenty of other things. Living as a subsistence
| farmer also probably builds character because you're taking
| an active role in producing food that maintains your body.
|
| Instead I choose to take advantage of technology to provide
| food and shelter, so that I can use the extra time to focus
| on other pursuits.
| [deleted]
| _dain_ wrote:
| >I'm not sure at what point in your life weight management
| was lauded as "easy". You have some tools in your toolbox on
| how to lose weight naturally (diet, exercise, different
| eating cycles) but you decided that these are too "hard" and
| opted for magic pills.
|
| Why shouldn't technology make it easy?
|
| >Just a shame to see people make progress in their weight
| loss journey the right(er) ways then succumb to weakness and
| opt for voodoo.
|
| Voodoo doesn't work. These drugs do.
| m_a_g wrote:
| I agree with this for overweight people, but for obese
| people, the chance that they will follow the "right" way is
| near zero.
|
| The alternative comes down to being obese (which is a death
| sentence) or medical interventions. It's true that this only
| solves the symptoms and not the actual problem, but it will
| probably save lives.
| tyleo wrote:
| > Losing weight was extremely challenging and socially
| isolating.
|
| How was it socially isolating? I'm curious because I exercise
| and diet and this is not my experience. I understand it being
| challenging though.
| iLoveOncall wrote:
| Because if you want to lose quickly, and once you get the
| discipline to lose you do want it to be quick, you have to
| restrict your calories A LOT.
|
| I'm not OP but when I was losing, as a 6"2 male, I was eating
| between 1200 and 1400 calories a day. This does not allow you
| to eat anything outside of small meals and drink anything
| outside of water or diet sodas.
|
| I was still going sometimes to the restaurant with friends
| but my choice was limited to the unique salad on the menu
| (which you can't eat whole because it would be too much) and
| my drink would be a diet coke. Same when we were going to the
| bar, I would just have diet soda or water.
|
| I was lucky that all of my friends were absolutely supportive
| and didn't mind at all, but it still limits you. Going to a
| night club without drinking is not fun at all for example.
| HDThoreaun wrote:
| > Going to a night club without drinking is not fun at all
| for example.
|
| This is where coke and mdma come in.
| kasey_junk wrote:
| I would love to know what sort of healthy cut has a 6"2
| male eating that low a calorie count. That is approaching
| weight class athlete cutting numbers which is near
| uniformly considered very bad for you.
| omniglottal wrote:
| OP commented on a weight-loss scheme of eating every other
| day. Given the social attitudes around eating (which I
| suspect to be the #1 most common social activity), this alone
| has the obvious potential to eliminate ~%50 of the most
| likely socializing opportunities.
| HDThoreaun wrote:
| They said every other day was easier than "normal" dieting.
| tyleo wrote:
| I agree that eating every other day would be socially
| isolating but OP stated he ate every other day 7 years
| after his original bout of weight loss which he said he
| did, "the old fashioned way."
| windpower wrote:
| I'm also on one of these drugs (Tirzepatide) and have been for
| a few months. The first time I remember knowing I was fat was
| when a babysitter made fun of me for it at age 6. I've been fat
| ever since and I'm in my late 30s now.
|
| I've lost significant amounts of weight three (60+ pounds)
| times in my adult life, through simple calorie restriction
| (intermittent fasting, including before I'd ever heard the
| term). Every time, I've gained the weight back. At the
| beginning of 2022, I was the heaviest I've ever been.
|
| I've accomplished very hard things in my life, including those
| that take sustained effort. Sufficient willpower isn't a
| problem for me in general. I honestly only ever hear "it's
| easy, just eat less and move more" from people that have never
| actually been fat. "I did it and I lost 15 pounds, no big
| deal!" and the like. 15 pounds is easy for me to temporarily to
| lose too. I've done it enough times I should know ;)
|
| I've heard people say that the solution is to eat (healthy
| food) when you're hungry, and stop when you're full. The thing
| is, I'm _never_ full. I can eat until I physically can 't eat
| anymore (not something I do regularly, of course), and as soon
| as my stomach has emptied a bit, I feel fairly hungry again.
| "Eat until you feel full" is literally a human experience I had
| never really had.
|
| On this drug, I finally know what people are talking about. I
| still like food, and I still get hungry. But it doesn't
| dominate my thoughts. I eat, and don't feel like eating again
| for hours. I eat something that I'd normally easily eat all of
| like a big burrito or whatever, and I feel quite full halfway
| through with no desire to finish. I'm steadily losing weight,
| with none of the usual preoccupation with hunger, ascetic
| adherence to a strict calorie plan, etc. But above all, I feel
| like I must be experiencing what most thin people experience
| all the time. I'll be perfectly happy to take the drug for the
| rest of my life, though I do hope affordability improves.
|
| As for side effects: I've had some heartburn, but none of the
| other commonly reported side effects.
| paulpauper wrote:
| Congrats on this drug working
|
| I lost 45 lbs myself with diet and excise, bmi is 25. Hoping it
| works. If it does not I at least know I have a fallback plan.
| Volundr wrote:
| Congratulations that's fantastic! Best of luck keeping it up!
| SystemOut wrote:
| Have the side effects stopped? Or have you only been on it 3
| months? My wife has been on Ozempic for longer than three
| months and the side effects haven't stopped. The nausea is
| typically bad for a few days after taking each dose but some of
| the others linger most of the cycle. For some I can see that
| tradeoff being okay but I can't see non-obese, non-diabetic
| folks making that trade-off for longevity. I know I wouldn't.
| hackernewds wrote:
| could you elaborate on the trade-off for longevity? is this
| based on the supposition that dieting is good for longevity?
| 0xB31B1B wrote:
| for me, the side effects lessened over time, and are pretty
| low now. Everyone reacts differently though.
| drchickensalad wrote:
| What's the drug?
| 0xB31B1B wrote:
| Trizepatide, brand name is mounjaro. It's a similar drug to
| semaglutide.
| MengerSponge wrote:
| Dulaglutide (Trulicity) is Eli Lilly's first generation
| GLP-1 drug. Semaglutide is of a similar generation.
|
| Tirzepatide (Mounjaro) is Lilly's next generation therapy,
| targeting both GLP-1 and GIP
| dmix wrote:
| https://en.wikipedia.org/wiki/Tirzepatide
| linsomniac wrote:
| FYI: GoodRX says it costs $1K/month.
| Aaronstotle wrote:
| [flagged]
| Nick87633 wrote:
| Less cognitive load... every meal -> "will the extra serving
| of chicken push me over my limit?" versus "it's tuesday, no
| food today." "it's wednesday. Dinner time."
| hsbauauvhabzb wrote:
| I get extreme brain fog after about 16 hours of no
| calories, reducing overall cognitive ability more than
| planning out two days of food compared to just one
| curiousllama wrote:
| Hey, just curious if you noticed that they did exactly what
| you're suggesting, and then chose a different path the second
| time?
|
| FWIW, I've found fasting to be pretty straightforward
| empathy_m wrote:
| I was personally capable of tracking 100% of my caloric input
| and output to manage to a target weight. I lost 25% of body
| weight and kept it off for a long time (years).
|
| However, now that I have a full-time job and am also primary
| caretaker for two young children under age 5 with minimal
| childcare, I have been unable to maintain the weight loss and
| I'm fairly close to lifetime maximum weight (at -5% right
| now).
|
| I notice behaviors like eating snacks between meals (often
| high-calorie), eating the kids' leftover food when I clean it
| up, not tracking my calorie inputs, eating at meals until I'm
| full (which tends to lead to lifetime maximum weight quickly
| in my experience), and eating extra food at night after the
| kids go to bed. This all adds up fast.
|
| A couple of years ago I read the literature about GLP-1
| agonists and started thinking about drugs. The last time I
| asked, a couple years ago, my GP said she had never
| successfully gotten an Rx approved for GLP-1 agonists in a
| patient with obesity. I was also thinking about looking into
| cognitive behavioral therapy as this all feels like it's
| behavioral?
|
| In general I prefer low-intervention approaches to medicine.
| I'd definitely rather rely on diet + exercise alone for
| weight loss. However, I just don't have the time in the day
| to lose enough weight - mechanically it just isn't working.
| It's frustrating because it used to. I'm pretty close to
| looking into the drugs again.
| Volundr wrote:
| Maintaining a healthy weight is not that difficult FOR YOU.
| Many, many people struggle to control their weight. One day
| you might too.
|
| I never had an issue with my weight until I had a thyroid
| infection around 30. I now have "normal" thyroid levels, but
| ever since then maintaining my weight take vigilance and lots
| of discipline. It's possible, but definitely "difficult".
| tayo42 wrote:
| Why? How many calories do you eat in a day?
| rootusrootus wrote:
| Have you ever tried to deliberately eat fewer calories
| every day than your body wants, for an extended period of
| time? Like, months and years, not days.
| tayo42 wrote:
| yes i intentionally eat healthy. I used to get breakfast
| smoothies and large portion breakfast and lunches. i put
| on weight, i cut that out and started to lose weight. i
| had butter with breakfast everymorning. atleast 100
| calories, i noticed that was a mistake and cut it out.
| that isnt calories i need.
|
| Your body wants about 1800-2200 calories. it doesnt need
| chips and soda and chocolate etc.. which push you above
| that
| sarchertech wrote:
| Your body wants your maintenance calories. If you are
| overweight for an any significant time, your body adjusts
| and will push you to consume your new maintenance
| calories. It takes a very long time for you body to
| adjust back down once you lose weight, which is why more
| often than not people gain the weight back.
| Volundr wrote:
| None of your business. I maintain a healthy weight. Even
| that is none of your business.
|
| How many calories I eat does not change it being
| difficult to maintain.
| rootusrootus wrote:
| There's a whole contingent of ignorant (but smug, of
| course) people who like to chant "just eat less" as if
| that simple biological truth is the easy answer. How nice
| it must be for them.
| tayo42 wrote:
| what are you sharing your personal anecdotes then as
| something conclusive about weight management. we know
| nothing about you except take your word that you eat
| healthy?
| Volundr wrote:
| What would knowing my number change? If I say a number it
| becomes "just" eat less. With that just doing a lot of
| heavy lifting.
|
| Just eat less may be easy for some people. It's extremely
| difficult for others. I shared my anecdote to point out
| that even within ones life it can change. It was not an
| invitation scrutinize my life. Too many people think the
| phrase "I have a hard time losing weight" is a
| justification to start quizzing people down about their
| habits and judging them. Fuck that.
| RHSeeger wrote:
| I had a similar issue. I was over the weight I wanted to
| be, but not amazingly so. Then I had a thyroid issue, and I
| lost a bunch of weight; down to my target weight. Then,
| once the thyroid issue was treated, my weight rebounded
| well past it's starting point. I'm still trying to lose the
| extra weight.
| claytongulick wrote:
| This discounts cognitive process and the factors that
| influence it.
|
| You can make the same argument for infidelity - just don't
| cheat on your spouse. Yet, infidelity is an incredibly
| complex issue that stems from multiple biological and social
| variables.
|
| I'm not a big fan of taking drugs to treat weight. You could
| also treat infidelity with hormone treatments that remove all
| of your sex drive - but that's like putting out a fire with a
| bomb.
|
| Much like with infidelity, I believe it's better to address
| the underlying reasons for weight gain and treat those, but
| we shouldn't be under any misconception that it's an easy
| problem.
| swalsh wrote:
| I think the main problem aside from the side effects you listed
| is the fact that frequent injections sounds really
| inconvienent, and the cost is pretty prehibitive unless
| insurance is covering it.
| paulpauper wrote:
| It is expensive but so is treating health consequences of
| obesity
|
| Let's hope this changes and insurance companies cover it
| tptacek wrote:
| If you're getting a ~20% weight loss in 6 months, the cost is
| a _steal_ compared to the alternatives.
|
| I don't think this is the most interesting or curious
| discussion we can be having about these drugs --- the science
| story is much more interesting and relevant than HN's general
| opinions about "big pharma" or the obesity epidemic, and the
| science story stays interesting even if you think the drugs
| are not a net good --- but of the non-science discussions we
| can be having, the pricing seems like the least interesting
| thing happening here. These are injections whose competition
| is major surgery.
| [deleted]
| ceejayoz wrote:
| > frequent injections sounds really inconvienent
|
| So's obesity.
|
| > the cost is pretty prehibitive unless insurance is covering
| it
|
| Given the costs of treating the various obesity side-effects,
| they're pretty likely to. (They'll probably require a few
| hurdles prior, though.)
| notJim wrote:
| I'm taking saxenda, which requires a daily injection and it's
| totally fine. It takes like 2 minutes. The needle is tiny and
| most of the time you barely feel it.
| djur wrote:
| How was the process with insurance? About a year ago I tried to
| get on semaglutide and my insurer shut down every option. It
| was extremely demoralizing.
| JamesBarney wrote:
| I get the opposite of brain fog. I feel sharper on semaglutide
| than off of it.
| Am4TIfIsER0ppos wrote:
| [flagged]
| spillguard wrote:
| > "I don't think it's healthy for a society to rely on large
| pharmaceutical companies."
|
| Fixed it for you. There were so many kind ways that you could
| have phrased your statement; please avoid inflammatory
| comments.
| hackernewds wrote:
| there's a difference between being full and feeling full. is it
| still known that the human body is healthy with this level of
| dieting and lack of nutrition?
|
| clearly can't be the case for someone who is obese so I'm
| wondering if this is true then if it's limited to folks who are
| struggling with obesity that can endure this
| incongruity wrote:
| > there's a difference between being full and feeling full.
|
| Implying that something is off if you "feel" but are "not"
| full? How do you define full? Having a "healthy" amount of
| food in your stomach? However you define it, with asserting
| that, you have to acknowledge the closely related idea that
| there's something off if you are "full" (as you've defined
| it) but still not feeling full - or satiated. It's that
| broken state that so many of us are desperate to solve.
|
| I'm on a GLP-1 agonist after years of diets, gym memberships,
| shame, etc. etc. and this medicine is nothing short of
| amazing for me. It feels like it has fixed things I didn't
| even realize were _wrong_ and it has changed my relationship
| with food in very positive ways. It is now so much easier to
| eat - some food but not _too much_ food - just like I 've
| seen so many of my friends with healthy BMIs do forever and
| have always had to consciously fight to do, day in, day out.
|
| But even more than that, it's changed my desire for alcohol
| and reduced my consumption patterns there as well. Moving is
| easier -- and that effect happened faster than weightless,
| suggesting a reduction in systemic inflammation as well.
|
| The side effects were a little rough for the first two weeks,
| but after ~3 months on it, I'd happily be on this for life
| given the positive impacts I've seen, barring any
| unexpected/unseen side effects.
| hammock wrote:
| For those less familiar with BMI, each point of BMI for a man
| is about 7 pounds. So 34-->23 BMI = -77 lbs. 31-->26 BMI = -35
| lbs
| voisin wrote:
| It depends on height, so how can you say that?
| nindalf wrote:
| It's an approximation
| gretch wrote:
| Probably because height is normally distributed and it's
| easy to predict someone's height within a range.
|
| I'd bet a lot of money the person in the story is not 6
| foot 5 inches
| 0xB31B1B wrote:
| I'm 6 4 though, so not far off
| titanomachy wrote:
| In that case 8 pounds per point of BMI, so it's still a
| reasonable approximation.
| [deleted]
| nradov wrote:
| I would rather die young than deal with those side effects. And
| those of us who are competitive endurance athletes need the
| oxidative stress; it's not necessarily a bad thing depending on
| timing and volume. Plus we will probably find other harmful
| side effects after long term use. There is no free lunch when
| you mess around with basic metabolism; everything has a price
| (not just in money).
| pessimizer wrote:
| You would rather die than suffer through three months of
| occasional strong nausea, constipation and brainfog? I hope
| that's hyperbole or that you have someone to talk to.
| sfusato wrote:
| > I believe that everyone, even the skinny folks, should be on
| GLP1 drugs for the longevity effects.
|
| Are you for real? Serious question.
| scifibestfi wrote:
| We're seeing the most successful Big Pharma marketing
| campaign since OxyContin.
|
| The Promotion and Marketing of OxyContin: Commercial Triumph,
| Public Health Tragedy
|
| > From 1996 to 2001, Purdue conducted more than 40 national
| pain-management and speaker-training conferences at resorts
| in Florida, Arizona, and California. More than 5000
| physicians, pharmacists, and nurses attended these all-
| expenses-paid symposia, where they were recruited and trained
| for Purdue's national speaker bureau.
|
| > One of the cornerstones of Purdue's marketing plan was the
| use of sophisticated marketing data to influence physicians'
| prescribing.
|
| > Purdue "aggressively" promoted the use of opioids for use
| in the "non-malignant pain market." A much larger market than
| that for cancer-related pain, the non-cancer-related pain
| market constituted 86% of the total opioid market in 1999.
| Purdue's promotion of OxyContin for the treatment of non-
| cancer-related pain contributed to a nearly tenfold increase
| in OxyContin prescriptions
|
| > A consistent feature in the promotion and marketing of
| OxyContin was a systematic effort to minimize the risk
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/
| ceejayoz wrote:
| That article starts with:
|
| > Controlled drugs, with their potential for abuse and
| diversion, can pose public health risks that are different
| from--and more problematic than--those of uncontrolled
| drugs when they are overpromoted and highly prescribed.
|
| These drugs are not of that nature.
| hnuser123456 wrote:
| No, but the ADD/ADHD stims are. I also had nausea all day
| and could not eat more than approx 1. slice of pizza for
| lunch and dinner up til age 16 on days that I took the
| smallest dose of methylpenidate. In summer, when I was
| not on it, I actually resumed average eating and growth.
| My growth chart, before age 8 starting it, was right
| around 50th percentile in height/weight, and by age 16,
| was was around bottom 5th percentile.
| cglace wrote:
| Another anecdote, I was on ADD meds from 5th grade
| through college and I'm at 99th percentile height.
| hnuser123456 wrote:
| Did you experience nausea on them? Was it
| methylphenidate? Which formulation and dose? I had 1yr
| ritalin, 1yr adderall, and 6 yrs concerta 18mg. At this
| point the sight of "alza 18" on a small tan cylinder
| makes me want to puke.
| mensetmanusman wrote:
| Those that haven't heard of Chesterton's fence might jump at
| the opportunity to live like no humans in the history of the
| universe.
| xwdv wrote:
| [flagged]
| darreninthenet wrote:
| Unless you're in a country with a proper social healthcare
| system anyway...
| hodgesrm wrote:
| > And even if he was, doctors push pills for commission, so
| don't trust them too much either.
|
| Can you cite sources? Otherwise please don't post such
| claims. It's unworthy of Hacker News.
| [deleted]
| [deleted]
| xwdv wrote:
| It's well known that doctors receive money from pharmacy
| companies in exchange for promoting their products.
| sarchertech wrote:
| My wife is a doctor she's never been paid by a pharmacy
| company.
|
| It's illegal to directly pay doctors for prescribing
| drugs. Pharmaceutical companies do pay some doctors for
| speaking gigs (a very small fraction of them).
|
| The average doctor might get lunch in exchange for
| listening to a presentation. But I guarantee they aren't
| there listening to a boring presentation because of a few
| dollars worth of food.
|
| All these payments are public record, so you can look
| them up for any given doctor.
| mythhouse wrote:
| take GLP1 drugs, NAD , metformin , rapamycin for maximum
| benefits.
| [deleted]
| 0xB31B1B wrote:
| I mean, if you have perfect bloodwork and a marvel movie body
| probably not necessary but otherwise yes. Heart disease,
| hypertension, high cholesterol, colon cancer rates are rising
| amongst everyone, even thin people. These drugs positively
| impact indicators of these things in everyone. Longevity
| makers have been betting on metformin for a long time and
| these drugs are like a supercharged metformin
| watwut wrote:
| I mean yes, the obesity is actually not the only health
| issue in existence. Your weight and your health are two
| different somewhat related variables.
|
| But so, the idea that everyone should take drug designed to
| make you thin by making you not feel hunge including thin
| people is scary.
| dls2016 wrote:
| Big Pharma vs. Big Ag! Fight! Fight! Fight!
| mythhouse wrote:
| > if you have perfect bloodwork
|
| I see a lot of health influencers always say whatever diet
| they are doing is best because nothing bad has shown up on
| their bloodwork.
|
| I am not really sure if bloodwork is all it takes to asses
| your health.
| paulpauper wrote:
| _I am not really sure if bloodwork is all it takes to
| asses your health._
|
| It is not. Steve Jobs had good bloodwork and low BP,
| still died a a few years later.
|
| Steroid-taking health influencers like to show bloodwork
| to convince followers they are still healthy. Let's see
| 20+ years down the road...
| ggm wrote:
| He is reputed to have ignored classical medical treatment
| advice when his condition was discovered and was highly
| treatable.
|
| If true, it suggests being superpower smart ignoring
| advice is a life threatening condition.
| poszlem wrote:
| It's not. The obsession with bloodwork seems to be
| specific to certain countries (like the US). In most
| countries, where the medical system is focused less on
| charging people money and more on evidence based
| treatments, blood tests are done to find something
| specific, not to "see how a person is doing", as they
| care about the effects of overtreatment (unnecessary
| distress, surgeries, treatments).
|
| Many people have this weird view of the "bloodwork" where
| they treat the results of them like a character screen in
| an RPG game.
| mythhouse wrote:
| i disagree because my dad got diagnosed with advanced
| prostate cancer with 300+ PSA values. This could've been
| diagnosed when it could still have been cured ( or
| managed) if they had done a simple blood test to "see how
| a person is doing" . blood tests are evidence based.
|
| > where the medical system is focused less on charging
| people money and more on evidence based treatments, blood
| tests are done to find something specific, not to "see
| how a person is doing"
|
| I am not sure what insurance you are using in USA but my
| insurance is super stingy about approving any blood tests
| that doctor doesn't think are super necessary. All the
| health influencers i mentioned in earlier comment seem to
| be paying out of pocket for tests like 'insulin
| sensitivity' because insurance doesn't pay for those.
| poszlem wrote:
| I am not saying that "no random blood test has ever
| uncovered any dangerous disease", which is obviously not
| true. I am saying that when aggregated, on average many
| of the screening tests, including yearly bloodwork have
| more negative effects than positive.
|
| The fact that your father got diagnosed too late is
| incredibly sad, and I truly feel for you, as that's the
| disease that took my grandfather too. But that does not
| offset the fact that if you screen people "yearly" you
| end up with more unnecessary interventions, painful
| tests, and potential false positives, and generally bad
| outcomes than if you don't do it.
|
| You could just as easily find a story about someone who
| had an unnecessary blood test that revealed something
| potentially troubling, they went to have a more invasive
| tests that resulted in them getting hurt from treating
| what turned out to be a false positive.
| mythhouse wrote:
| Yes thats definitely true. The PSA test i mentioned is
| one such example of blood test causing over treatment. I
| think they used to start PSA tests at 40 but now they
| start much later because it was causing over diagnosis.
| ceejayoz wrote:
| > blood tests are evidence based
|
| Sure, but only one bit of evidence.
|
| For example, there's evidence that _on a population
| level_ routine screening for prostate cancer may do more
| harm than good, because it frequently isn 't lethal, and
| the resulting interventions (often for false positives)
| can have a negative impact themselves.
|
| https://www.nbcnews.com/health/health-news/when-prostate-
| tes...
|
| > The American study found annual screening did not lower
| the chances of dying of prostate cancer.
|
| > A recent Johns Hopkins University study found
| surprisingly high rates of hospitalization after prostate
| biopsies and a 12-fold greater risk of death in those who
| develop infections.
|
| https://www.sciencedaily.com/releases/2013/09/13092914262
| 2.h...
|
| > "Yet in order to prevent one death from prostate cancer
| in the 1,000 men screened for PSA, the number of biopsies
| would double with 154 additional prostate biopsies, and,
| of 35 additional prostate cancers diagnosed, 12
| additional cases of impotence and three additional cases
| of incontinence would occur. Thus, the harm from routine
| PSA testing can have a serious effect on the quality of
| life of patients and provides additional evidence against
| the use of organised screening for prostate cancer," he
| says.
| mythhouse wrote:
| yes recommendation now is not do PSA test but to do PSA
| tests and do something called 'active surveillance' for
| low grade disease. Much has changed since 2013.
|
| My original comment still stands.
|
| https://www.mskcc.org/cancer-
| care/types/prostate/screening/s...
| paulpauper wrote:
| _colon cancer rates are rising amongst everyone, even thin
| people._
|
| Yeah, look at all these super-old people like Alan
| Greenspan, Warren Buffett, Kissinger, Munger who pretty
| much have terrible diets, obese, no exercise yet still
| going strong, productive. Shows the power of genes. "Your
| BMI is below 23, therefore we will skip the colonoscopy and
| prostate/PSA exam and blood work," said no doctor ever
| (unless the doctor wants to get sued, I suppose).
| novok wrote:
| You might think the very rich have bad diets, but I
| guarantee you it's probably way better than the vast
| majority of people. They can and do have personal cooks,
| nutritionists and shoppers give them optimized food all
| the time and drink a coke and have a burger in public
| once in a while to make you think they are 'just like you
| and me!'.
|
| It's that underlying foundation that you don't see that
| gives them the margin to have a burger.
| joe_the_user wrote:
| _These drugs positively impact indicators of these things
| in everyone._
|
| I think people's eagerness to jump from changes in markers
| to actual longevity is quite unfortunate. Medical
| "breakthroughs" often founder on such confusion and
| amateurs approaching things this way. See Goodhart's Law
| [1] (much as I generally regret the hn/geek tendency to
| lean these law, here it's reasonable).
|
| https://en.wikipedia.org/wiki/Goodhart%27s_law
| zerocrates wrote:
| Somewhat inevitable to use surrogates because you're
| going to take absolutely forever to get results on
| longevity (barring things with very strong _negative_
| effects on longevity).
|
| Though communicating the difference between things that
| are only proven on surrogate markers and things shown to
| actually affect the real desired outcome is important, I
| agree.
| yamtaddle wrote:
| > these drugs are like a supercharged metformin
|
| No drinking alcohol, like metformin?
|
| If so, I suspect you could get a large fraction of the
| improvement gained from a population-wide deployment of
| these drugs, _at zero cost_ , if everyone just stopped
| drinking alcohol. "But that's unreasonable!" Right, so if
| that's also required for taking this drug, then....
| rayiner wrote:
| My whole family mostly avoids alcohol (Muslim) and lots
| of people are overweight.
| 1024core wrote:
| It's the sugars that get you. Avoid processed foods at
| all cost. And avoid simple carbs like white bread, white
| rice, etc.
| happyopossum wrote:
| > No drinking alcohol, like metformin?
|
| I take Metformin (not for diabetes, but weight and age)
| and my doc has never said a word about alcohol. A quick
| google suggests the possible bad interactions are
| diabetes related, so probably not applicable.
| yamtaddle wrote:
| Oh, interesting. I guess the cases I know of its use
| _are_ diabetes related, now that I think about it, but I
| 'd seen "I take metformin, so no alcohol" enough times I
| thought it was a drug interaction.
| throwaway5959 wrote:
| Are they rising across the board or for certain ranges of
| BMI/weight?
| 0xB31B1B wrote:
| Across the board
| [deleted]
| mcculley wrote:
| I think I will wait for some version that does not cause
| "strong nausea, extreme fatigue, brain fog, and
| constipation".
| jboy55 wrote:
| I take a GLP-1, I do not feel any of these effects unless
| I eat poorly. I'm not saying these side-effects don't
| happen, but they aren't guaranteed. Testing has also
| shown these aren't prevalent in the majority of users.
| LordDragonfang wrote:
| Those are mostly just second-order symptoms of
| hypoglycemia/running a severe caloric deficit.
| mcculley wrote:
| I have a lot of experience with fasting. I have never
| experienced those symptoms as a result of restricting
| calories.
| mythhouse wrote:
| > I have a lot of experience with fasting.
|
| > I think I will wait for some version that does not
| cause "strong nausea, extreme fatigue, brain fog, and
| constipation".
|
| Did fasting help with weight control. Why are you
| considering these drugs ?
| mcculley wrote:
| Fasting does help me with weight control. I generally eat
| only one meal each day and I find this has many other
| benefits.
|
| I am not considering these drugs. I responded to "I
| believe that everyone, even the skinny folks, should be
| on GLP1 drugs for the longevity effects."
| hallway_monitor wrote:
| In my experience, it seems like these effects may be more
| common in people who are not fat-adapted from low carb
| diets or some type of fasting.
| sarchertech wrote:
| Were you operating at a calorie deficit for a prolonged
| period though. I.e., were you fasting for weeks at a
| time?
| mcculley wrote:
| I have been eating only one meal per day deliberately for
| many years. I have fasted for up to 4 days. I seldom fast
| for more than one day.
|
| When I was doing keto, I never experienced the keto flu
| that many complain about. If these are the same symptoms,
| maybe the same benefits are achieved without taking the
| drug.
| hackernewds wrote:
| despite that wouldn't just undernourishing the body lead
| to shorter lifespans not longer?
| mcculley wrote:
| I have been hearing for at least 20 years that calorie
| restriction increases lifespan [0]. I have not seen
| compelling evidence of this, but I know a lot of people
| believe it.
|
| [0]: https://sitn.hms.harvard.edu/flash/2020/can-calorie-
| restrict...
| ianbutler wrote:
| You forgot the key part of "for the first 3 months" the
| assumption is that they largely tapered off for OP I
| think. That's an easy trade off for me personally.
| mcculley wrote:
| I did not forget that. I am not going to risk brain fog
| for three months.
| novok wrote:
| Brain fog also comes from eating 1000 calories a day for
| many until their body adjusts to a fat metabolism, much
| like keto flu. Also eating less makes your margin of
| error for bad micronutrient density significantly lower.
| You would need to tease out what is the medication and
| what comes from a low calorie diet in these patients by
| giving both groups (placebo vs medicated) the same diet
| and seeing the effects.
| ianbutler wrote:
| Okay that's personal preference but the long term trade
| off seems to heavily out weigh some brain fog for a few
| months. Talking years of improved health.
| Tepix wrote:
| Not if brain fog is a symptom of brain injury.
| mcculley wrote:
| Have there been proven benefits beyond weight loss? I am
| responding to "I believe that everyone, even the skinny
| folks, should be on GLP1 drugs for the longevity effects"
| and assertions about "longevity markers". I am not
| interested in taking a drug to lose weight. I am
| interested in improving my overall health, but I am not
| yet convinced that I should take this drug. The symptoms
| could be a sign that something bad is happening to the
| body.
| Ancapistani wrote:
| I'm unfamiliar with the research around GLP1 drugs, but I my
| past reading about the long-term effects of metformin led me
| to a similar conclusion. Unfortunately, metformin causes me
| severe gastrointestinal issues that don't resolve themselves
| after a few weeks.
|
| There are lots of surprising findings w/r/t pharmaceuticals
| if you start really digging. Lots of missed opportunity for
| overall improvement in the human condition that aren't being
| exploited.
| beckingz wrote:
| Gets into fun tradeoff questions of "Would you live an
| extra 20 years but have diarrhea every day"
| Ancapistani wrote:
| I answered that one with "no" :P
| novok wrote:
| Depends how bad the diarrhea is. I basically kind of
| lived that with the very spicy food in south east asia,
| along with the resultant better health & fat loss from
| the better diet.
| anigbrowl wrote:
| I had the same reaction. I minimize oxidative stress on my
| body by being selective about what I eat: having a bit less
| of some delicious things and eating a bit more of some boring
| foods that I know are good for me.
|
| Also, fuck 'longevity.' The population of the world has
| doubled during my lifetime and this is a Bad Thing which is
| wiping out vast numbers of other species. Call me
| misanthropic if you like but humans are overrated and the
| maximization of our species' footprint is not a desirable
| outcome. I expect to live for a shorter time than my parents
| have (partly due to my own choices, partly environmental
| factors) and while that's disappointing in some ways I've
| been fortunate enough to enjoy reasonably good health and
| resultant quality of life. My idea of biological success is
| no living to the greatest age possible but having sufficient
| fitness and autonomy to be physically and mentally active
| while I'm alive. I have enough experience of injury and near-
| death situations to know that I'm OK with dying, and have no
| intention of begging to escape the inevitable.
| kiba wrote:
| _Also, fuck 'longevity.' The population of the world has
| doubled during my lifetime and this is a Bad Thing which is
| wiping out vast numbers of other species._
|
| More about our socioeconomic and political structure than
| raw population numbers.
|
| Every piece of meat, for example, require the conversion of
| plant matter into meat. There's going to be energy loss. If
| we eat more plants and less meat, we would pollute less,
| and less meat animals and presumably more wild animals.
|
| _My idea of biological success is no living to the
| greatest ago possible but having sufficient fitness and
| autonomy to be physically and mentally active while I 'm
| alive._
|
| Unless you die in an accident, you're going to live longer
| due to being healthier.
| hutzlibu wrote:
| "Unless you die in an accident, you're going to live
| longer due to being healthier."
|
| You are making assumptions, about his lifestyle choices.
|
| Also, medicine might have improved, but so have
| subjectivly stress and fear and terror (economic outlook,
| climate change, etc..) A good reminder to turn that
| smartphone off now.
| anigbrowl wrote:
| I'm not sure that I am healthier than my parents. Some of
| my life/lifestyle choices have likely contributed to
| superior health, others have done the opposite.
| gnicholas wrote:
| > _After decades of work, researchers are finally seeing signs of
| success: a new generation of anti-obesity medications that
| drastically diminish weight without the serious side effects that
| have plagued previous efforts._
|
| ...
|
| > _Nutter is concerned that people might start these treatments
| -- whose side effects, such as nausea and vomiting, can be severe
| -- to escape weight stigma, rather than to serve a true health
| need_
|
| So the side effects aren't "serious" -- they're just potentially
| "severe"? I'm confused.
| gumby wrote:
| > to escape weight stigma, rather than to serve a true health
| need
|
| This is an unfair framing by the researchers
|
| For a while I worked in pharma on a drug program for a
| harmless* "ailment", nail fungus. What I learned is that some
| people suffer serious psychological consequences, such as
| marital issues or avoiding situations where they might be
| barefoot, like the beach. People who have it in their hands may
| avoid social situations all together, which is even worse and
| reduces life expectancy.
|
| We have a natural cultural bias in this regard. It's not just
| the phantom of the opera: in films the hero usually has a clear
| complexion and the villain often does not (not always to the
| extent of Darth Vader of course). Now we understand more about
| disease etiology this bias is no longer helpful, and is in fact
| destructive.
|
| Losing weight addresses true health needs (increased rates of
| cancer, cardiac issues etc) but weight stigma has important
| side effects as well.
|
| * The various fungi that attack skin, scalp, nails etc eat a
| particular shape of squalene which some people make (referred
| to unfairly in the medical literature as a "squalene defect").
| You're not going to catch it from another person -- there's a
| good chance you're breathing the spores right now. Either
| you're genetically predisposed or you're not. And all it does
| is munch on a tiny amount of your body and causes no other
| problem.
| derefr wrote:
| Subtly different subjects to those two sentences: the former is
| talking about the _new generation_ of medications (i.e. the
| general concept of medications targeting this new receptor);
| while the latter is talking about one specific treatment (i.e.
| one specific medication, at one specific dosage, via one
| specific route of administration, at one specific interval.)
|
| The side-effects of this particular treatment "can be severe",
| but that doesn't imply anything about the side-effects of any
| other treatment (combination of medication, dose, RoA, and
| interval) for drugs in this class. Heck, they could probably
| fix the nausea/vomiting just by making a pill that contains an
| adjunct anti-emetic like ondansetron, like they do for cancer
| drugs.
| Izkata wrote:
| Leaking medical jargon and mixing it with regular usage:
| "serious" means needing medical attention, "severe" means
| hospitalization/long-term disability or worse. They seem to be
| using medical "serious" and colloquial "severe", which gives
| the the appearance of reversing their meanings.
| ceejayoz wrote:
| They're substantially _less_ severe (and reversible, and more
| controllable) than the "your heart might stop" ones of the
| past generation of weight loss meds. (For example:
| https://en.wikipedia.org/wiki/Fenfluramine/phentermine)
| [deleted]
| zmmmmm wrote:
| I am curious if drugs that reduce your appetite affect your
| enjoyment of the food you do eat?
|
| It would be incredibly sad if the price to pay for not becoming
| obese is not enjoying any food at all.
| glonq wrote:
| I lost 100 pounds "the hard way" (diet and exercise) a couple
| years ago. Gained back 30 and am fighting to burn that off again.
|
| It would be nice to have an affordable, low dose of one of these
| obesity drugs to make the fight a bit easier.
| beloch wrote:
| _Thought experiment:_ A drug* that reduces people 's weight and
| massively boosts physical fitness with no negative side effects
| is discovered. The discoverer of that drug declines to patent it,
| making it a cheap generic available everywhere. What would your
| reaction be?
|
| Take a moment to consider what your reaction is before
| continuing.
|
| ...
|
| The comments I'm reading here are diverse and fascinating. Weight
| loss, diet, and fitness are almost quasi-religious issues that
| people tend to have strong and personal reactions to. The unfit
| are desperate for a solution, _especially_ an easy one. The very
| fit subconsciously resent the notion that people could achieve,
| with a pill, what they have achieved through discipline and hard
| work (or genetic luck). Others are keen to point out diverse
| evils of modern society that they believe are the true culprits
| which must be tackled instead of masking their effect with a
| pill.
|
| Nutrition and fitness are classic examples of pseudo-science.
| Studies that would meet the bare minimum standards of scientific
| rigour in any other field are practically impossible. Getting a
| statistically significant sample of people to go on special diets
| or exercise regimens long term is just not feasible. Whenever an
| "expert" makes a tentative statement on what they think might be
| the case, media picks it up and amplifies it. Butter is bad for
| you. Butter is good for you. Blueberries are superfood. Keto
| diets. Crossfit. etc. Countless "experts", often with no
| credentials and no compelling data, are happy to write best-
| selling self-improvement books. They assume that what works for
| them (or didn't work, but seems like it should have) will work
| for everyone. Everyone wants to know how to be healthy, fit, and
| happy, so there is insatiable demand for books that are, by
| scientific standards, pure spit-balling.
|
| Then medicine and drug research, which are legally required to be
| at last somewhat scientific but are _always_ profit-motivated,
| enter the fray. They can prove a drug meets safety standards and
| quantify certain specific effects, but interactions with the
| pseudo-science of the greater health industry eventually become
| unavoidable.
|
| Perhaps the first step to becoming more objective about drugs
| like this is to recognize that we really _aren 't_.
|
| *a hypothetical one, not the one being discussed here
| uhtred wrote:
| > Nutrition and fitness are classic examples of pseudo-science
|
| I think it's pretty well agreed upon in the medical community
| (and proven) that a healthy diet (lots of fruit and vegetables,
| not too much sugar, etc) and regular exercise leads to better
| health. It's not pseudo-science. Neither is the statement that
| consuming more calories than you burn will make you put on
| weight.
| rootusrootus wrote:
| > discipline and hard work (or genetic luck)
|
| Let me tell you, the number of thin people I've met who got
| there through discipline and hard work is vanishingly small
| compared to those genetically blessed. This is probably why
| it's such an appealing delusion -- who doesn't want the world
| to think they're disciplined and hardworking, instead of just
| lucky?
| smooth_remmy wrote:
| Petro Dobromylskyj is one of the foremost experts of fat
| metabolism. He has a blog called Hyperlipid where he's been
| blogging about fat metabolism and interpreting research for close
| to 10 years.
|
| He thinks the GLP-1 inhibitor drugs will be a disaster in the
| long term because they 1) cause weight loss but also 2) cause the
| body to create lots of new adipocyte (fat cells). Increasing the
| number of adipocytes is very unusual after puberty. As long as
| you are taking the GLP-1 inhibitor drugs you will lose or
| maintain weight, but as soon as you stop you will gain a lot of
| weight back.
|
| Here is the blog post: https://high-fat-
| nutrition.blogspot.com/2023/01/glp-1-agonis...
| aussiesnack wrote:
| > one of the foremost experts of fat metabolism.
|
| What makes you say that? In my experience, there are no
| 'experts' in empirical fields who are no themselves deeply and
| practically engaged with actual research. Being well-read does
| not make you an expert. Writing blog posts and appearing on YT
| doesn't make you an expert. Critics are not experts. To be an
| expert in anything you have to get your hands dirty.
|
| Nothing I can see from this guys publications or bio make it
| seems like he's an expert in human fat metabolism at all, let
| alone a 'foremost' one. I base this on a fairly cursory survey,
| so I'm happy to be corrected. But convincing corrections would
| absolutely require details regarding what he has contributed to
| the field.
| 1024core wrote:
| Given that injections cost ~ $1000/month, you're saying
| basically that it'll be a great recurring revenue stream for
| the companies. A CFO's wet dream.
| nerdawson wrote:
| I did a little bit of research and for people in the UK it
| appears to be substantially less. I found a few health
| companies offering it for <$250/mo. I'll probably wait until
| it's readily available on the NHS but it is tempting.
| onionisafruit wrote:
| My US doctor recommended it to me last week and said there
| was a way for it to cost about $200/mo if I want to do
| that. I thought it was strange that he said it that way
| instead of just saying the price, but I didn't follow up
| because we were 45 minutes into the appointment and I was
| ready to get out of there.
|
| I'm supposed to book a follow up appointment after I've
| read about it, so I guess I'll find out what he means then.
| ceejayoz wrote:
| Pretty much every expensive medication has a copay
| assistance program in the US.
|
| For trirzepatide: https://www.mounjaro.com/hcp/savings-
| resources
|
| They typically are income blind and make your out-of-
| pocket price negligible. I'm on a med (Skyrizi) that's
| $18k per shot, one every three months; their assistance
| program ensures I don't pay more than $5.
|
| They chip in on the deductible/coinsurance/copay, you
| don't skip the medication due to cost, and they still get
| significant money out of your insurer. Everybody wins,
| until everyone's premiums go up next year.
| sidewndr46 wrote:
| I thought the UK had government healthcare?
| mclouts91 wrote:
| It does but it doesn't mean you get any treatment
| available. They carefully make decisions on what
| treatments they can/should provide. This may be offered
| eventually but at the moment it's a case of be very fat
| and get offered gastric sleeve or just be overweight and
| no treatments are offered other than advice about losing
| weight
| [deleted]
| paulpauper wrote:
| consider that treating obesity-related consequences also
| costs money and enriches companies as well. I think its worth
| it
| newsclues wrote:
| Considering the benefits of good diets and exercise, I
| think it's worth it not trying to hack or shortcut our way
| to a healthy life with weird drugs or whatever.
| wins32767 wrote:
| The only thing I see from him on google scholar is about
| mechanical ventilation for small animals. What's his
| background?
| m_a_g wrote:
| Here is an introduction I found from his blog:
|
| >I am Petro Dobromylskyj, always known as Peter. I'm a vet,
| trained at the RVC, London University. I was fortunate enough
| to intercalate a BSc degree in physiology in to my veterinary
| degree. I was even more fortunate to study under Patrick Wall
| at UCH, who set me on course to become a veterinary
| anaesthetist, mostly working on acute pain control. That led
| to the Certificate then Diploma in Veterinary Anaesthesia and
| enough publications to allow me to enter the European College
| of Veterinary Anaesthesia and Analgesia as a de facto
| founding member. Anaesthesia teaches you a lot. Basic science
| is combined with the occasional need to act rapidly. Wrong
| decisions can reward you with catastrophe in seconds.
| Thinking is mandatory. I stumbled on to nutrition completely
| by accident. Once you have been taught to think, it's hard to
| stop. I think about lots of things. These are some of them.
| rootusrootus wrote:
| Oh man, the first result for him on Google is a link to a
| YouTube video. That makes my BS meter instantly peg.
| Scalene2 wrote:
| What kind of crap do you watch on YouTube that manages to
| taint the entire platform?
| wolverine876 wrote:
| There's a lot of crap on YouTube; that taints things.
| eganist wrote:
| youtube consistently steers everyone who touches it to
| more and more extreme content with the passage of time.
| It's not unique, and often times that content tends to be
| anti-science.
|
| I'm not the OP but youtube is tainted for anything other
| than entertainment and a few _select_ channels like the
| ones by PBS e.g Space Time.
| rootusrootus wrote:
| Every time some rando on the 'net claims "do your own
| research" they'll send a link to a YouTube video of some
| charming BS artist with no qualifications peddling
| ideological garbage to whomever is credulous enough to
| watch it uncritically.
|
| Are there good YT channels? Yeah. But 9 times out of 10
| (or more) when I search for some rando's recommended
| expert and the first result is a YT video, it's crap.
| Utter crap.
|
| I nearly choked when my sister-in-law told me a couple
| years ago about some really convincing anti-vaccine
| information she had read which made her very nervous. I
| asked her what she'd heard, and she gave me a link to a
| YT video by Dr. Shiva. Yes, THAT Dr. Shiva. Ha! I tried
| to break it to her gently, but I'm pretty sure she still
| decided he was a credible source of information.
| wpietri wrote:
| Note that they're also talking about Google search
| ranking. People who are actual experts in things tend to
| have meatier hits at the top than J Random Vlogger.
| [deleted]
| post_break wrote:
| So drug companies should be seeing alarm bells going off. You
| can profit off this drug, and it's an endless supply of
| revenue.
| JamesBarney wrote:
| With every weight loss intervention when you stop you gain back
| the weight. GLP-1 agonists don't seem to be any different than
| another other intervention.
| paulpauper wrote:
| gastric bypass does not have this problem as bad
| JamesBarney wrote:
| Kinda, drugs/diet/exercise you can stop. But most people
| don't undo the gastric bypass surgery. (I don't even know
| if it's possible)
| toomuchtodo wrote:
| A family member has had gastric bypass. You can have
| everything "replumbed" if complications require failing
| back to something similar to previous state.
|
| https://pubmed.ncbi.nlm.nih.gov/27387697/
|
| With that said, I would be interested if new weight loss
| drugs negate the need for gastric bypass in the first
| place. Comes across as medieval and barbaric if the
| hormones/drugs are superior.
| ceejayoz wrote:
| > With every weight loss intervention when you stop you gain
| back the weight. GLP-1 agonists don't seem to be any
| different than another other intervention.
|
| Except for one thing: it's fairly easy to _not_ stop a drug.
| You just... keep taking it. Long-term use of these drugs for
| maintenance purposes looks entirely feasible. Not _quite_ as
| easy to maintain as a gastric bypass, but close enough to be
| a big deal.
|
| The same isn't true for exercise and diet; it's very easy to
| fall off those wagons.
| smooth_remmy wrote:
| The point is that you could gain back the original weight
| plus more. Most adults who become obese have not increased
| their number of fat cells - their fat cells just become
| larger.
|
| The GLP-1 drugs literally increase the number of fat cells.
| JamesBarney wrote:
| They've studied this, they put people om semaglutide then
| took them off of it for a year. Looks like every other
| weight loss intervention.
|
| https://dom-
| pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
| Scoundreller wrote:
| How does liposuction fare in long term fat loss?
| tootie wrote:
| It's what I thought of here also. Most notably,
| liposuction has faired very poorly in studies of long-
| term health outcomes. Without the requisite changes in
| lifestyle or metabolism the fat that gets sucked out is
| replaced very quickly and has almost no decrease in risk
| of obesity-related illnesses.
| Scalene2 wrote:
| > Weight gain was reported in 43 percent of the
| responders, with 56 percent of them gaining between 5 and
| 10 pounds 6 months after their surgery. Fat return was
| reported in 65 percent of the responders.
| https://pubmed.ncbi.nlm.nih.gov/16651945/
| kuhewa wrote:
| Liposuction isn't a solution for fat loss beyond some
| localised cosmetic reduction. You can't use it to put a
| morbidly obese person in normal BMI range.
| Scoundreller wrote:
| My point is that you end up with fewer fat cells, but
| unsure whether this has any impact on weight regain.
|
| (Which is worth assessing if there are concerns about
| these drugs increasing the number of fat cells (otherwise
| unusual in adulthood) and creating a risk of fat volume
| rebound beyond initial levels after discontinuation).
| kuhewa wrote:
| Weight is back to baseline within a few months after
| lipectomy and sometimes greater than baseline. In animal
| models there is regeneration of fat cell number following
| lipectomy along with increase in cell size, and which
| mechanism predominates depends on how large the fat cells
| were before (manipulated by reducing food). This is the
| critical fat cell size hypothesis, and in humans there is
| similarly evidence that fat cell number increases
| (hyperplasia) in advanced stages of obesity after the
| cells reach critical size (hypertrophy) but I'm not aware
| of that being studied in situ in lipectomy recovery. I'd
| make a confident guess that it depends on how obese the
| patient is and perhaps their baseline number of fat
| cells.
|
| But there are a lot of different mechanisms and feedbacks
| at play and I'm not sure how much insight can be gained
| from comparing localised lipectomy to systemic adipocyte
| proliferation resulting from a drug.
| bsder wrote:
| Liposuction is no answer. Your body puts back the removed
| fat cells in other places.
|
| The human body has _VERY_ strong setpoints about weight.
| Fat cells "remember" the weight that you had when they
| were created. You have to hold your weight at a point for
| something like 3-5 _years_ before your body relents
| enough that the setpoint moves.
| npongratz wrote:
| How do fat cells encode the information about one's
| weight when the cells are created?
| JamesBarney wrote:
| It's probably not the fat cells, it's much more likely
| the hypothalamus.
| thomascgalvin wrote:
| > The point is that you could gain back the original weight
| plus more.
|
| This is also common in all weight loss interventions,
| though the reason is generally from metabolic slowdown, not
| the creation of new adipose tissues.
| ansible wrote:
| I suppose the concern goes something like this. Under
| certain metabolic conditions, each fat cell (in a region)
| decides it needs to be size X, and grows / shrinks
| accordingly. And under other conditions, each fat cell
| (in the same region) decides it needs to be size X*3.
|
| If there are more fat cells, then and they all decide to
| increase in size, then that could be a substantial weight
| gain, beyond what would be expected otherwise.
| milleramp wrote:
| I wonder how breaking old habits and establishing new habits
| over a year or so would stop a serious rebound?
| paulpauper wrote:
| The low success rates of diets suggest very hard to establish
| new habits
| s1artibartfast wrote:
| Many things are hard, but that does not mean they should
| not be done.
| pessimizer wrote:
| If there are easy alternatives with the same outcomes,
| hard things absolutely should not be done (unless you're
| practicing for an emergency situation where the easy
| thing is not available.)
| Robotbeat wrote:
| Problem with diets is that your body responds to this new
| habit by panicking, thinking you're going through a
| famine and reduces metabolism to compensate for reduced
| caloric intake while increasing hunger. It's like if
| you're he body responded to brushing your teeth every day
| by making you obsess over caramel corn. Most habit
| changes don't have this "body actively fighting you with
| increasing ferocity" effect that caloric restriction
| does.
| KirillPanov wrote:
| I think the big lesson from Semaglutide is that bad eating
| habits are not the primary cause of obesity. More likely they
| are correlated due to common causation.
| linsomniac wrote:
| It is, in my personal experience, all to easy to fall back
| into the old habits.
| j33zusjuice wrote:
| No doubt. The old habits are easier. It's way easier to
| order in food and lay in bed than to cook and workout. Of
| course, it's overly reductionist to assume weight loss is
| as easy as "stop laying around, eat healthy, and exercise."
|
| It kind of is that simple, but there are so many factors
| that help prevent us from good habits. I think my biggest
| issue is that food is one of the few things in my life
| that's ever evoked a positive response for me. I've gone
| years without being fat, but it comes back because of some
| issue I encounter, and I lack the tools to deal with it in
| a better way. So I get depressed and eat, and eventually
| hate myself for falling apart again, and so we go, forever
| and always.
| wolverine876 wrote:
| > one of the foremost experts of fat metabolism
|
| Is it correct that the source is a veterinary anaesthesiolgist?
|
| https://news.ycombinator.com/item?id=34252195
| jobs_throwaway wrote:
| > The results astonished researchers: a weekly injection for
| almost 16 months, along with some lifestyle changes, reduced body
| weight by at least 20% in more than one-third of the participants
|
| Why would they introduce lifestyle changes alongside the drug?
| Doesn't that complicate the analysis?
| djur wrote:
| One of the expected benefits of the medication is to make it
| easier to comply with recommended lifestyle changes. It
| simplifies the analysis to recommend a specific set of changes
| rather than letting all of the participants improvise their own
| diet and exercise changes.
| Tade0 wrote:
| I suppose it actually makes it simpler, because you control for
| lifestyle changes.
|
| Who says some participants wouldn't just start eating trash? I
| know I did after I lost some weight due to a bad case of
| something my child brought in from daycare.
| carbocation wrote:
| Probably assigned both arms to lifestyle changes, since we know
| those are beneficial. Assuming that's the case, then yes to
| your point, but also it's the right thing to do since there is
| no equipoise about lifestyle.
| ceejayoz wrote:
| The control group will have been asked to make the same
| lifestyle changes, but with a placebo drug.
|
| https://www.nejm.org/doi/10.1056/NEJMoa2032183
|
| > Participants were randomly assigned in a 2:1 ratio, through
| the use of an interactive Web-based response system, to receive
| semaglutide at a dose of 2.4 mg administered subcutaneously
| once a week for 68 weeks or matching placebo, in addition to
| lifestyle intervention...
| maxrev17 wrote:
| A drug to fix what's on supermarket shelves? Lord help us!
| haywood wrote:
| This is good news (probably?), but wanted to chime in with a
| tangent.
|
| Also going to preface this by saying I have struggled with weight
| my entire life and have lost and gained substantial weight
| through diet alone, always gaining it back and then some -- but I
| think I found something that has worked for me and I have been
| reflecting on what I wish I was told a long time ago.
|
| It's not necessarily a problem to be "obese", meaning you can
| have extra fat on top of muscle but also be metabolically
| healthy. In those cases, the extra weight is just causing your
| calfs to be huge.
|
| Instead of focusing on getting skinny, I started focusing on
| getting strong. All of a sudden diet was a supplemental tool to
| this goal, and not the main thing. I just made sure to eat more
| protein, and if I had a "bad day" of eating, I chalked it up to
| my body having more energy to synthesize new muscle :) Before a
| bad day would "undo" days of suffering on an energy deficit, and
| I would just give up. But if you frame it as: look, you have
| struggled your entire life to be 'thin', when in reality, your
| ability to be obese was a hidden superpower. Stop fighting it and
| lift weights, you were probably _made_ for this!
|
| In this context I'm weirdly happy with my genetics? there are so
| many "hard gainers" that do everything in their power to put on
| 10bs so they can gain muscle. I'm gaining muscle without hardly
| trying. How many other obese, inactive people are like me and
| would respond amazingly to resistance training ALONE as well?
|
| I focused on strength training and protein for a long time when I
| started, that was fun and easy, and my body composition started
| to change. Then I started to notice the changes, and now I have
| purposeful short-duration "cuts" in my routine and it seems like
| at some point I'll eventually not be obese.
|
| Just trying to say that I wonder what would happen if people were
| told, "hey, you don't need to diet right now, just come in and
| train twice a week and eat more protein". Of course "energy
| toxicity" is absolutely real, but lean body mass can improve
| health markers A LOT before worrying about that.
| hsbauauvhabzb wrote:
| I too found this valuable, I dropped 15-20kg doing this 5 years
| ago and slowly put it back on due to health problems. I've
| found recently that even cardio works - if I exercise, I don't
| want to waste the effort by eating shitty food, if I do have a
| bad day or two (Xmas period) then it feels like a bank loan I
| must pay off before the interest kicks in.
| psychphysic wrote:
| You really need to suppress appetite rather than avoid hunger.
|
| How many have of us have eaten despite not being hungry?
| tptacek wrote:
| That's what these drugs do.
| psychphysic wrote:
| You're probably right the common side effects are all reason
| to not eat (nausea, GI upset).
| tptacek wrote:
| The other effects (they're not a side effects, since
| they're the intended effects) are satiety and cessation of
| cravings. In the "appetite vs. hunger" dichotomy you set
| up, the drugs seem to be addressing mostly the former; in
| fact, it sounds like, from reports on this thread, pts on
| these meds very much still experience true hunger symptoms
| (weakness, headache, brain fog).
| psychphysic wrote:
| In the UK at least semiglutide is licensed only for
| diabetes.
|
| So it's appetite suppression is a side effect. That's
| good because it means it gets reported.
|
| Looking at the SPC[0] we can see decreased appetite is
| "common" (1~10%), while nausea is "very common"(>10%
| report).
|
| That means more people feel nauseated on semiglutide than
| feel less hungry.
|
| Add in other GI disturbances (diarrhoea is also "very
| common") and one can see why people lose weight with it.
|
| [0] https://www.medicines.org.uk/emc/product/9750/smpc
| nostrebored wrote:
| Very weird to take a country that hasn't kept pace with
| research here and use it as representative, especially
| with a sample of patients with chronic disease.
|
| Having been on semaglutide, it both makes you feel full
| with smaller portions and changes what you want to eat.
| The foods which make you feel nauseous are those that
| make you gain weight. However the change in desire isn't
| only against foods which make you feel nauseous, but also
| towards foods that you might not eat. It's truly very
| interesting.
| tedunangst wrote:
| Are patients equally likely to reliably report appetite
| suppression and nausea?
| rajin444 wrote:
| This drug is a net good for society, but we have to fix the root
| problem. Much of the food we eat is filled with addictive
| ingredients (sugar, excess fats/oils, etc) that provide little
| nutritional value but are highly addictive.
|
| We're subsidizing companies that create unhealthy addictive food
| and subsidizing companies to create drugs to counter the
| unhealthy addictive food. This is an enormous waste of resources.
| drjasonharrison wrote:
| While we are drowning in quick to consume, non-nutritious,
| calories, we also have higher levels of anxiety, stress and
| more distractions.
|
| To your comment, maybe more countries should attempt to
| implement programs similar to the UK's success in lowering
| sodium intake by slowly adjusting the sodium content of all
| manufacturered foods.
| https://www.nature.com/articles/jhh2013105
| WalterBright wrote:
| > we also have higher levels of anxiety, stress
|
| Why should that be true? Your kids aren't going off to WW2 to
| die. You aren't going to starve if bugs ate your crops. You
| aren't going to get clubbed and robbed if you follow a forest
| path.
| pixl97 wrote:
| I would say our 'actual' stressors are far less, but our
| contrived stressors are far more.
|
| The fact I'm not going to die tomorrow from starvation is
| an actual reduction in stress.
|
| The fact that someone on the TV is screaming 24/7 that I'm
| going 'fucking die because THEY are out to get me' is a
| contrived stressor that has a real effect on everybody in
| society.
| kenjackson wrote:
| Isn't all food addictive? Is there something more specific you
| mean about addition when it comes to these foods? It seems like
| it may be more about caloric density than addiction.
| maxlamb wrote:
| You find broccoli addictive?
| tptacek wrote:
| Hell yes. Have you ever roasted it with some lemon slices?
| Or broken up all the individual florets with a mandolin and
| tossed it as a salad? Whirred it into a soup? Broccoli is
| incredible.
| mjmahone17 wrote:
| Not OP but I do. If I had a plate of steamed or roasted
| broccoli available on demand at any time, I would eat it
| like most people do chips. Broccoli tastes great, but
| requires a lot more prep than "junk food" to get there.
|
| I eat junk food mainly because it takes me no effort and
| still tastes good: for me the addiction is not having to
| put in any effort to be satiated, more than the taste
| itself.
| kenjackson wrote:
| I'm OP, and I agree wholeheartedly with you.
|
| And when I do eat junk food I don't eat a crazy amount in
| volume. But the calorie density of them makes it such
| that I ate a crazy amount of calories. It's not that I
| eat a bag of chips per day. But a small bag of chips is
| 240 calories, while carrot chips of the same mass/volume
| are 20 calories.
|
| Do I prefer junk food over some healthy food -- yes,
| probably so (but I love broccoli). But I don't know that
| my eating habits are drastically different between the
| two. To put it another way, if the junk food I ate
| suddenly became healthy for you, I think people say I was
| just eating a healthy diet.
| drdeca wrote:
| In what sense is "all food addictive"?
|
| If you just mean "if you don't eat, you die", I don't think
| that qualifies as an addiction.
|
| If you mean "if you suddenly eat a lot more for some meal
| than you usually do, you will likely be more hungry the next
| day than usual", I also don't think that really qualifies.
| It's not the same kind of thing?
| kenjackson wrote:
| It's not just "if you don't eat, you die". It's that you
| have a strong yearning to eat. Now that's probably an
| evolutionary adaptation to "if you don't eat, you die", but
| nevertheless I want to eat pretty consistently every day.
| Again, how is that different than a nicotine addiction? The
| only difference is that if I don't smoke, I won't die...
| mensetmanusman wrote:
| No, try the potato only diet and see what happens.
| wolverine876 wrote:
| These foods are specifically addictive. I mean, water is
| addictive - I need it every three days, but that's not
| meaningful.
| kenjackson wrote:
| What does "specifically addictive" mean though? People keep
| saying it, but give no definition for it.
|
| And you needing water every three days is meaningful. In
| fact, that's a great definition! Its clear what the meaning
| in the case of water is. I'm not sure what saying "Doritos"
| is addictive means? I love Doritos, but when I traveled
| abroad I went six months without seeing a bag and never
| thought of them. What exactly does "specifically addictive"
| mean?
| CadmiumYellow wrote:
| Once you start eating them it's difficult to stop because
| they override normal satiety mechanisms. Foods like
| Doritos are quite literally engineered for maximum
| pleasure (dopamine) and minimum satiety. I'm sober now
| and I've noticed that it's incredibly hard for me to
| drink more than one or two glasses of juice but
| incredibly easy for me to drink alcohol indefinitely - it
| feels similar to the difference between eating Doritos
| and eating nuts or cheese, where one promotes satiety
| while the other actively drives overconsumption. Relevant
| article: https://www.nytimes.com/2013/02/24/magazine/the-
| extraordinar...
| [deleted]
| moffkalast wrote:
| That really is the core of the issue, and furthermore once
| you've used to a sugar diet you crave it more and regular food
| starts tasting worse in comparison somehow. I bet it's
| something to do with the gut-brain connection and a large glut
| of sugar eating bacteria signalling it's time to feed them.
| Just a theory, but there is some kind of correlated process
| there.
|
| And the reverse is also true, if you go a while without eating
| anything high in sugar, what used to taste normal can taste
| almost unbearably sweet. Exceedingly hard to do with it added
| to just about all things in absurd amounts though.
| CadmiumYellow wrote:
| The first time I tried ketchup after strictly avoiding added
| sugars for several weeks was a WILD experience. It tasted
| sweeter than maple syrup. I used to douse my food in ketchup
| and now I can't even eat it on fries because it's so
| sickeningly sweet. I noticed the same with most bottled salad
| dressings and sauces (barbecue sauce and honey mustard being
| even more egregious than ketchup).
| imranq wrote:
| I agree that we have incredible waste on both sides, but there
| is an even greater culprit: people are lacking true meaning and
| purpose in their lives and are indulging in these foods to
| distract themselves from their inner emptiness.
| mym1990 wrote:
| This is a pretty big leap, what is even "true meaning and
| purpose"? The culprit is that this food is literally
| everywhere and billions of dollars are poured into research
| everywhere to design systems that entice humans to take the
| convenient way out. If I was to go along with your
| hypothesis, I would alter it to say that poor nutrition is
| what contributes to a person's lack of "true meaning and
| purpose".
| skulk wrote:
| > what is even "[lacking] true meaning and purpose"?
|
| Perhaps the alienation of workers from the fruits of their
| labor? It's underrated how depressing it is to not get to
| eat the sausage you broke your back making.
| mym1990 wrote:
| Uhh okay, I can give you 100,000 examples of what is not
| a tree, but that isn't what I asked for is it?
| skulk wrote:
| When we talk about things, we sometimes use their
| relationship to other things to define them rather than
| talking about them directly. I'm not sure how my answer
| is irrelevant and deserving of your snark.
| imranq wrote:
| I agree that society has been designed to make things more
| and more convenient in the name of progress and that we
| haven't made the nutritious food convenient yet. Stated
| another way, poor nutrition is the default choice in most
| of the western world.
|
| Still, I think its possible to make the idea "purpose" more
| concrete. You could define "true meaning and purpose" to be
| goals that are greater than oneself that require one's full
| potential in mind and body and sacrifice of immediate
| pleasures for long-term gain. The widespread nature of
| obesity indicates that many people don't consider a healthy
| body as necessary for their goals and hence don't sacrifice
| immediate food gratification for those goals. Hence most
| people don't have goals that require their full body
| potential.
| D-Coder wrote:
| Reference please?
| salemh wrote:
| [dead]
| paulpauper wrote:
| Even healthy, nutritious food is packed with calories. Anything
| that is not a fruit or vegetable can easily cause weight gain.
| Before civilization, humans had to expend a lot of energy just
| to get food, what little they could obtain.
| plutonorm wrote:
| I think that toxin exposure - unavoidable in the modern world -
| is likely the biggest culprit here. There are plenty of ideas
| about which toxins are causing the problem, but there are so
| many that it would be nigh on impossible to regulate them all
| out of the environment.
| Eisenstein wrote:
| Please define 'toxin' and the mechanism by which they produce
| harm.
| pixl97 wrote:
| I would think you're completely wrong. The green revolution
| was the first time in history that we were able to
| continually produce excess food for (excluding distribution
| issues) the entire earths population. Even more so, the new
| foods we are able to supply via processing are highly
| calorically dense.
|
| Simply put if you take mammalian models and allow them to eat
| all they want they blow up like little balloons. This is no
| different from bears feasting on salmon for the last millions
| of years. Creatures are designed to overconsume because the
| ones that didn't in the past didn't make it thru the lean
| times.
| EamonnMR wrote:
| If we're going to treat calories as addictive and addiction as
| a disease rather than a personal failing it should follow that
| we treat the disease with a drug.
| thatguy0900 wrote:
| If we assume addictions as a disease then we mostly treat
| them with regulation. Smoking companies would have loved if
| we just made a pill that mitigates tar in your lungs instead
| of all but legislating them into obscurity.
| pixl97 wrote:
| At the end of the day you don't have to smoke, not that
| people won't.
|
| At the end of the day, or maybe week, or possible even
| month you have to eat or you're going to die. Simply put
| you require caloric intake to survive. Yea, you can ban
| coke and candybars, and hell that's a good idea. But what
| about bread? Or do you monitor and watch to make sure
| everyone only eats two slices? Make sure foods at
| restaurants only have so many calories per serving and
| ensure they people can only buy one meal per meal?
|
| At some point it still falls apart because it is human
| nature to massively overconsume since the vast majority of
| history we've been calorie short. You're dealing with an
| animal response here that is going to be very difficult to
| override to the under/normal consumption side.
| elcomet wrote:
| But not only. It also follow that we need to regulate the
| industry and stop advertising for sugar for example
| hansonkd13 wrote:
| They didn't say calories are addictive. They clearly said
| certain foods are addictive. Those foods should be more
| regulated like cigarettes and companies take more
| responsibility as a first or at least concurrent step to
| everyone taking more drugs.
| jrockway wrote:
| As far as I can tell, our social policies don't really work
| for managing addiction. We just hook up a vacuum cleaner to
| people's pockets and suck the money out of them if they
| smoke. Call it a "sin tax". But the problem is that people
| prioritize their next fix above other things; would you
| rather get some cigarettes or pay your rent, many people
| choose the cigarettes. I'm not sure how that helps anyone,
| and I'm not sure how expanding it to sodas or doughnuts
| would help anyone.
|
| Regressive taxes also don't work well. I don't always eat
| super healthy. Making unhealthy food cost more wouldn't
| have any measurable impact, except maybe tanking my 401k
| because half the Fortune 500 goes out of business.
| hansonkd13 wrote:
| All the same arguments were said about cigarettes and yet
| in 2022 I almost never smell a cigarette burning outside
| and few young people smoke.
|
| People complained about cigarette taxes wouldn't be
| effective but they are.
|
| The stock market didn't crash either despite the
| multibillion dollar tobacco companies being affected.
| joe_the_user wrote:
| The problem is that we are plausibly looking at the result of
| a change over the last thirty or fifty year in the quality of
| what's considered the normal diet, notably normalizing
| calories through the consumption of sugary drinks but also a
| variety of other things. This has had the side-effect of an
| obesity epidemic.
|
| Now, what are we doing?
|
| * Getting people to stop consuming sugary drinks and other
| very unhealthy items (maybe that would require drugs at this
| point)?
|
| * Or offer people drugs so this side-effect of an unhealthy
| diet can be avoided?
|
| If we're offer a way to continue a bad diet without this
| effect, it seems very likely further bad effects will appear
| X many years from now from a combination of the drugs and the
| bad diet. Because virtually all drugs taken _forever_
| accumulate side-effects over since the body did evolve to
| process them (these drugs may indeed be needed at times but
| the point remains).
| dcolkitt wrote:
| Disagree. People genuinely enjoy those foods, because they're
| tasty and flavorful. And there's zero reason to believe that
| they're substantially unhealthy unless consumed to the point of
| sustained caloric surplus. We know this because we have hunter-
| gatherer populations who consume 50% of their diets in sugar
| (e.g. the Hadza) or fats (e.g. Intuit), and they have none of
| the diseases of abundance found in modern populations because
| they have near zero obesity.
|
| The problem is not the food. The problem is obesity. The food
| is only an issue because some people have overly strong
| appetites relative to the abundance of food. If we can cure
| obesity, then we can literally have our cake and eat it too.
|
| Humans obviously value tasty and flavorful food, and its
| existence adds joy to people's lives. That's why they'll pay
| hundreds of dollars per meal for the best restaurants. In sum
| total the development of GLP-1 agonists has maybe cost $20
| billion in research at most. That's literally less than 0.1% of
| global GDP, hardly an "enormous waste of resources".
| uhtred wrote:
| It seems like you are saying that it would be fine for
| someone to eat nothing but potato chips and candy bars, as
| long as they:
|
| a) don't eat so much they get obese, or b) take an anti-
| obesity drug so they don't get obese
|
| Which is ridiculous. They would still get sick and die early
| due to lack of nutrition.
| steve_adams_86 wrote:
| > We know this because we have hunter-gatherer populations
| who consume 50% of their diets in sugar (e.g. the Hadza) or
| fats (e.g. Intuit), and they have none of the diseases of
| abundance found in modern populations because they have near
| zero obesity.
|
| The often-cited studies suggesting Inuit populations were
| protected from heart disease (Bang and Dyerberg, Feldman et
| al) comes from limited data which has since been refuted as
| unreliable and insufficient. The hypotheses they generated
| don't hold up to the greater balance of data we have, and
| despite attempts to confirm findings, it simply hasn't
| happened.
|
| Some studies have suggested to a lesser degree that Inuit
| populations have marginally smaller rates of coronary artery
| disease (and other cardiovascular complications), but far
| more have determined that rates are the same or in some
| cases/time frames even worse, and risk of stroke has
| generally trended higher as well. These are all incidents of
| mortality which have a very, very high correlation with diets
| which are high in animal fats (as well as salt, regarding
| strokes).
|
| Here is one very good look at this type of data, and if you
| look you can also find others:
| https://pubmed.ncbi.nlm.nih.gov/25064579/
|
| I agree that obesity is a major issue (especially in the case
| of sugar; it appears less harmful to the body when the sugar
| is needed and thus used immediately, but harmful when it
| hangs around and gets turned into fat. This is the main cause
| of the surge in fatty liver disease, for example), but there
| is very little and often very poor evidence that obesity is
| what causes atherosclerosis to occur and become a mortal
| danger. It seems to be dangerous regardless of weight, and
| exercise doesn't appear to be wholly protective against it
| either.
|
| Inuits have actually served as a good example as to why this
| is true. Even when their obesity rates were lower, their
| lifestyles required more activity than average, and when
| studies accounted for BMI, their CAD rates were still on par
| with western populations according to most data.
| philjohn wrote:
| Does the type of sugar, or type of fat not play a part here?
|
| HFCS is notorious for the bad effects on the body, versus
| something like honey.
|
| Same for the Intuit, simpler animal fats vs hydrogenated
| "trans" fats?
|
| I feel like the key difference in their diets is it's not
| overly processed and full of things we've decided to put in
| there for cost reasons (corn subsidies making HFCS cheaper
| than cane sugar, and trans fats are cheaper than more
| expensive animal products).
| dcolkitt wrote:
| Trans fats are indeed unhealthy, but 1) it's been nearly a
| decade since they were basically removed from fast food,
| and 2) they don't contribute to obesity.
|
| As for HFCS, there's basically zero evidence that they're a
| major contributor to obesity versus other types of sugar.
| (In fact, honey consumed by the Hazda has almost the same
| balance as sugar as HFCS). We have multiple points of
| evidence to counteract this. 1) Mexico uses substantially
| less HFCS compared to other types of sugar, but Mexican
| obesity rates are as high as the US. 2) HFCS, and sugar in
| general, consumption has _declined_ over the past 20 years.
| Yet obesity continues to increase. 3) HFCS was widely
| consumed in the 1980s, when the obesity rate was de minims.
| joe_the_user wrote:
| I don't think it's half-plausible to compare Hadza or Intuit
| diets to a Big Mac and a soda. Neither transfats nor
| processed sugars are in the Hadza diet, just for example.
| mensetmanusman wrote:
| We could absolutely decimate the Intuit by introducing free
| Pepsi coolers in every home.
| 8note wrote:
| Isn't honey a processed sugar? The processing being done by
| a bee instead of a machine
| civilized wrote:
| I think "people value tasty food" is an oversimplification.
| It feels good but we regret it when we get fat, our health
| deteriorates, and with our health goes our participation in
| and contribution to everything and everyone we love. For many
| people, junk food starts to feel more like an addiction than
| a choice in line with highest values.
|
| Sadly, this means it can be a problem when food tastes too
| good. The term of art is "hyperpalatable". Studies have shown
| that even lab animals gorge themselves and get fat and
| unhealthy when they get human junk food.
|
| I think many people would be grateful to have hyperpalatable
| food restricted or limited or less visible to them, so the
| temptation is removed or moderated. How we implement that in
| society, in a liberal or authoritarian way or somewhere in
| between, is a separate question.
| CadmiumYellow wrote:
| Also there is plenty of tasty food that isn't
| hyperpalatable. Those foods are more difficult to overeat
| because they're very filling. The problem with
| hyperpalatable junk food is that it's both especially
| pleasurable to eat and especially good at overriding our
| natural satiety cues. There's a world of difference between
| eating 1,000 calories of cheetos and 1,000 calories of brie
| cheese: one of them will make you incredibly full and the
| other will make you feel like you could just keep on
| crunching forever.
| Aloha wrote:
| Peoples appetites are larger than their physical ability
| level provides for.
|
| We transitioned from a hunter gatherer, to an agrarian, to an
| industrial society - because most people needed to do much
| physical activity to survive, even when food was plentiful.
|
| The information age is much more sedentary, but people have
| evolved needs to eat a certain amount of volume to feel
| satiated. The fact that our foods are super
| nutritious/calorie dense makes matters worse.
| yodsanklai wrote:
| > The problem is not the food. The problem is obesity.
|
| Junk food corporations make profit by selling food, and they
| are extremely good at this. They rely on intense advertising,
| making the food addictive, targeting children. As a side
| effect, people get obese since they consume more calories
| that what they need.
|
| I don't know about GLP-1, but my intuition tells me that no
| drug is going to make eating Mac Donald's and drink Coke
| healthy, even if it doesn't make you obese.
| kevinpet wrote:
| I rarely eat junk food, and I'm fat.
|
| Your attitude is the same as a religious person telling
| depressed people they need jesus rather than prozac.
| yodsanklai wrote:
| I didn't say that all fat people ate junk food, and I
| didn't say that obese people shouldn't take medication if
| that could help. Obesity rate in the US didn't got from
| 10% to 40% in a few decades simply because suddenly
| everybody started to develop thyroid issues or other
| condition.
| pessimizer wrote:
| No, what you said is that food marketing and the amount
| of sugars and fats in purchased foods are the cause of
| obesity.
|
| Before the 80s, food also was packed with fat and sugar,
| and advertised constantly. I subjectively feel that
| people saw far _more_ food advertising in the 80s and
| before than they do now. And the government diet
| suggestions were to increase your consumption of carbs
| and reduce fats.
|
| edit: and people definitely drank far more Coke, and
| McDonald's meals were far less healthy.
| yodsanklai wrote:
| > what you said is that food marketing and the amount of
| sugars and fats in purchased foods are the cause of
| obesity.
|
| Yes, I mean the cause of the obesity epidemics we're
| witnessing. Not the reason why every single obese person
| is obese.
|
| My subjective feeling as a European traveling to the US
| is that it's extremely hard to eat healthy food there. In
| some states, it seems everybody is obese, including
| children, and I myself need to fight actively not to gain
| weight there. People there don't seem to realize that
| their diet is very unhealthy, and I'm not even sure they
| make the connection with their obesity. And this trend is
| happening in Europe too, with a few years lag behind the
| US.
|
| But this is only my conviction and I didn't find the data
| to back up my intuition. How do you explain why obesity
| rate went from 10% to 40% in a few decades?
| str1k3 wrote:
| You're fat because of what you're eating, and how little
| your moving, sorry dude but that's 100% true. Some of
| that might be out of your control, but it's reality...
| RHSeeger wrote:
| While those are indeed major factors, there are others
| that come into play. For example, a change in your
| thyroid behavior can cause a loss/gain in weight without
| changing anything else.
| paulpauper wrote:
| The big myth is that healthy food cannot make you fat.
| Basic thermodynamics shows otherwise.
| dcolkitt wrote:
| Non-obese people who eat McDonalds and drink Coke are
| unequivocally healthier than obese people who adhere to the
| healthiest diets. There's absolutely zero academic research
| that disputes that obesity (and exercise) by far is the
| largest risk factor for diabetes, heart disease, etc.
| str1k3 wrote:
| Wow that's some impressive logical gymnastics. If these
| people adhere to the "healthiest diets" they will
| eventually no longer be obese.
|
| American food is shit. Most people have no clue what
| healthy food is, even if they intend to eat a healthy
| diet.
| amanj41 wrote:
| You're strawmanning here. Parent commenter clearly meant
| healthy as in containing only "healthy" foods. If you eat
| 4,000 calories of brown rice, chicken and broccoli a day
| you will get fat. Colloquially, though, their diet would
| be called healthy because of it's constituent foods.
|
| Edit: you will get fat assuming you are like most people
| and do not expend greater than 4k calories / day in total
| michannne wrote:
| This is pseudoscience. As long as you consume a certain
| amount of calories and get your daily nutritions, you can
| eat whatever you want without getting obese. You can
| still become obese eating 3000 kcals of salad every day
| without exercising. Of course, healthy caloric intake
| will only ensure you don't become obese, you'll still be
| consuming way more fat/carbs than you should if you eat
| McDonalds, but it is certainly possible to create a
| "healthy" everyday-McDonalds diet (but you would be
| changing the meal to the point it won't be recognizable)
| pessimizer wrote:
| This is not very impressive logically. Plenty of non-
| obese people eat exclusively shitty food.
| mym1990 wrote:
| Uhhh you're a little disillusioned to think that a very very
| small subset of humans paying hundred of dollars for a meal
| is a baseline for why "humans value tasty and flavorful
| food". Just because some people drive 160mph on a highway
| does not mean its a good idea. The fact that you're arguing a
| box of oreos is equally nutritious to a calorie equal amount
| of say protein and/or vegetables is actually baffling.
| rychco wrote:
| > And there's zero reason to believe that they're
| substantially unhealthy unless consumed to the point of
| sustained caloric surplus.
|
| I have a hard time believing this without some _very_ strong
| evidence for this claim. There 's already existing evidence
| for greatly varying health effects of differences in cooking
| method, oil-type, omega ratios in fats, amino-acid ratios in
| proteins, glycemic index of carbs, sodium content, etc etc.
| It's hard for me to reconcile the suggestion that the
| _content_ of food does not affect whether it is
| "substantially unhealthy"...
| dcolkitt wrote:
| Try to find _any_ major research showing either diet has a
| significant health impact on either 1) non-overweight
| individuals who remain non-overweight; or 2) has a health
| impact after controlling for changes in weight
| /obesity/body fat. It's virtually non-existent. Perhaps
| there are small differences on the margin, but all dwarfed
| by the impact of obesity.
|
| Again this shouldn't shock us, because we know hunter-
| gatherers across the globe eat tremendously varied diets
| that come in all sorts of extremes. Yet, modern diseases of
| affluence (heart disease, diabetes, etc.) are virtually
| non-existent in these populations. The only thing they have
| in common is a lack of obesity and non-sedentary lifestyle.
| CadmiumYellow wrote:
| The point is that certain diets are more likely to
| prevent non-overweight individuals from remaining non-
| overweight. Example study where participants ate two
| different diets, one highly processed and one less
| processed, that were matched for macronutrient and
| calorie content: https://www.cell.com/cell-
| metabolism/pdf/S1550-4131(19)30248...
| dcolkitt wrote:
| So you agree, the overwhelming impact of diet on health
| is from reducing obesity?
|
| And surely you also agree with the science that we now
| have drugs that are far more effective at reducing
| obesity than any diet known to man.
| CadmiumYellow wrote:
| No, I don't agree. We have evidence to suggest that a
| large number of normal weight people have poor metabolic
| health, likely due to diet:
| https://pubmed.ncbi.nlm.nih.gov/30484738/
|
| Not sure about the drugs, particularly if treatment has
| to continue indefinitely in order for people to keep the
| weight off. Someone else on here linked to a blog post
| about how those drugs increase the number of fat cells in
| the body but prevent fat cell hypertrophy, suggesting
| that rebound weight gain after the drugs are stopped
| could potentially leave patients worse off than they
| started. Most adults do not gain new fat cells when they
| gain weight, their existing fat cells merely get bigger.
| Leaving people with more fat cells than they had to begin
| with might make it even harder for them to maintain a
| lower weight without the drugs, given that fat cells are
| metabolically active. Who knows how many people may end
| up stopping them due to side effects or complications
| like the thyroid tumors these drugs are known to cause in
| mice. We know very little about the potential unintended
| consequences of these drugs.
| mensetmanusman wrote:
| It's not some people, it's most people.
|
| We need to tax the ** out of high calorie foods to fund the
| extreme cost on health care/society that overeating is
| causing.
| myshpa wrote:
| > ... there's zero reason to believe that they're
| substantially unhealthy unless consumed to the point of
| sustained caloric surplus. We know this ...
|
| Disagree.
|
| > who consume 50% of their diets in sugar (e.g. the Hadza)
|
| "Their diet is made up almost exclusively of food that they
| forage on the forest and includes fiber rich and highly
| nutritious berries, bananas and honey while any meat they eat
| is hunted and caught wild." (https://healthyfocus.org/the-
| hadza-diet-and-the-key-to-a-hea...)
|
| They don't eat sugar. Fruits & vegetables with lots of fiber,
| wild game. Nothing like westerners diet ... so not really
| comparable, imho.
|
| "... the Inuit's bodies have adapted to better handle the
| process of gluconeogenesis, in which the body turns fat and
| protein into useable glucose. The Inuit have larger livers
| and a larger volume of urine than the average human, which
| helps their bodies to process the byproducts of their diet."
| (https://oureverydaylife.com/486115-the-inuit-diet.html)
|
| Also ... not applicable to a typical westerner.
|
| > The problem is not the food. The problem is obesity.
|
| The food is the problem.
|
| Eat whole foods, mostly plants, minumum fats & sugar, and
| obesity is problem no more.
|
| > the development of GLP-1 agonists has maybe cost $20
| billion
|
| What's the total cost of obesity? The cost of diabetes ? It
| is an enormous waste of resources.
| GLGirty wrote:
| > The food is the problem
|
| Quality of food is certainly declining, but we are also
| seeing weight increases in lab rats with extremely
| controlled diets, so food probably isn't the entire story.
| There's no accepted explanation for this, but good
| candidates that might apply to humans are: subtle toxicity
| by microplastics, and changes in gut microbiomes.
| [deleted]
| spaginal wrote:
| I disagree. Low quality processed foods, typically found in
| western diets, glysophates, high in industrial seed oils,
| processed sugars, and salts, are likely one of the biggest
| reasons for all the negative health effects we are seeing in
| the western diet, calorie numbers be damned.
|
| Any quantity of this food, long term, is likely the reason
| for the explosive amount of health issues in the population,
| including many cancers we now commonly deal with.
|
| One of the biggest changes to my health I ever noticed was a
| switch not in how I ate, but in WHAT I ate.
|
| When I switched my diet over to high quality foods, organic
| and garden grown, meat I purchased from a local hunter, it
| made a substantial impact on my health, helped to fix a lot
| of my cholesterol and blood sugar numbers, and my overall
| health shot through the roof. No pills required, just decent
| ingredients, garden grown food, high quality meat.
| sschueller wrote:
| You know that if you cut all sugar for just 2 days things
| with very little sugar will taste very sweet?
|
| We do not need the excessive amount of sugar in our food to
| fully enjoy it. The general public is just totally numb to it
| because of over consumption and companies are literally
| competing on having the sweater product.
| nostrebored wrote:
| This is an extreme hyperbole. While this does happen, it
| takes much more like 4-8w in my experience.
| darkwater wrote:
| It's an hyperbole but not an "extreme" one. It needs some
| weeks instead of 2 days, but not 2 years either.
| Gatsky wrote:
| There are randomised controlled trials of diets (without
| caloric restriction). They show that some diets are better
| than others for real clinical endpoints, eg mediterranean vs
| low fat diet for secondary prevention of cardiac events [1].
| The effect size in that example is not small, it is large,
| despite most participants already being on a statin. This
| data shows that diets are biologically active and
| significantly impact health. Therefore, the philosophy you
| espouse cannot be correct, or at least needs to be heavily
| modified.
|
| [1] https://www.thelancet.com/journals/lancet/article/PIIS014
| 0-6...
| dcolkitt wrote:
| You haven't controlled for body weight changes though.
| Nobody doubts that diets (if adhered to) can reduce weight.
| So if biomarkers improve relative to an alternative diet,
| the question is it because A) the Med diet is more
| effective at weight loss, or B) the Med diet has benefits
| outside weight loss. The research you linked is
| interesting, but confounded by weight loss. Research that
| has directly tried to control for this has generally found
| that the health benefits of the Med diet are mostly or
| wholly attributable to the mediating impact of weight/fat
| loss.[1]
|
| This is a critical question, because GLP-1 agonists like
| semaglutide are _far_ more effective at weight loss (with
| much lower dropout rates) than any diet known to mankind.
| So if the benefit of the Med diet is mediated by weight
| loss, who cares in the age of GLP-1 agonists? It 's like
| arguing about the fastest hot air balloon after the
| invention of the jet engine.
|
| [1]https://www.semanticscholar.org/paper/Obesity-Mediates-
| the-A...
| darkwater wrote:
| You just forget that there might be side-effects showing
| up in the long-run that we simply don't know yet (and
| possibly), why the mediterrean diet has been tested for a
| few hundred years already (where "diet" means what we
| have access to and eat, and not a small subset of foods
| forced on us that relies on a lot of mental effort to
| follow)
| dcolkitt wrote:
| GLP-1 agonists were discovered in the 1980s, and there
| are already statistically significant population samples
| who have been using them to treat T2D for decades. Any
| serious common side effect would have been already
| discovered from the large-scale clinical trials that have
| been repeatedly conducted.
| Gatsky wrote:
| Incorrect. They controlled for changes in weight, it is
| not confounded by weight loss. RCT >> cross sectional
| analyses.
| jobs_throwaway wrote:
| Jesus christ, why is nature quoting a psychologist in an article
| about biology?
|
| > However, some researchers worry that these drugs play into some
| societies' obsession with being thin. Body size isn't always a
| good predictor of health. "I'm really hesitant to be excited
| about something that I think is potentially harmful from a weight
| stigma perspective"
| carapace wrote:
| Psychology is an epiphenomenon of biology.
| gumby wrote:
| My comment on another thread
| (https://news.ycombinator.com/item?id=34251033) addresses this.
| Psychological issues are real health issues.
| asdff wrote:
| Its an article about weight loss and that plays into body image
| which is a huge mental health issue. People purging themselves
| need a psychologist, not a biologist, and I'm sure a number of
| people affected with bulimia will be buying this drug.
| ethanbond wrote:
| Because this isn't an article about biology, it's about health,
| and health isn't unidimensional
| jobs_throwaway wrote:
| Helping obese people lose weight is unidimensionally a good
| thing
| fnordpiglet wrote:
| Obese doesn't mean unhealthy. Correlation isn't causation.
| There are many obese people who are extremely healthy. I
| for one have had no health issues of any sort, have great
| blood panels, and am in decent physical condition but sit
| stubbornly at a 31BMI. The only "issue" I face is
| psychological, and it's rooted in precisely this statement
| you made.
| [deleted]
| _dain_ wrote:
| Can you run a mile? Do ten pushups?
| dbspin wrote:
| This is unfortunately completely untrue. Obesity,
| especially severe obesity, underlies the diabetes and
| heart disease epidemics. However obese people,
| particularly in the US and Western Europe, now represent
| a sufficiently large lobby (no pun intended) that there
| is significant public messaging parroting the 'healthy at
| any size' propaganda.
| fnordpiglet wrote:
| I didn't say there is no level at which you're clearly
| unhealthy. If you are obese because of unhealthy habits
| or lifestyle, this will impact your overall health. Being
| fat _alone_ , with a healthy eating habit and lifestyle,
| is not indicative of a lack of health. Eating with
| abandon, especially of low quality food, and not
| exercising is what underlies the lack of health. It
| happens you also get fat doing this. People with a high
| metabolism that stay thin no matter what they eat or do
| _still_ develop heart disease and diabetes.
|
| Healthy at any size doesn't mean someone who is morbidly
| obese is healthy - the strain on their heart is
| significant. But that's true for any human of large size
| regardless of "what" constitutes their body mass. But the
| correlation is the fat goes with unhealthy diet and
| lifestyle. But not everyone who is fat is unhealthy.
|
| They even discuss this in the article for goodness sakes.
|
| In another comment I provided these references: In one of
| the reference below, the conclusion is: (i) Higher
| fitness should be considered a characteristic of
| metabolically healthy but obese phenotype. (ii) Once
| fitness is accounted for, the metabolically healthy but
| obese phenotype is a benign condition, with a better
| prognosis for mortality and morbidity than metabolically
| abnormal obese individuals.
|
| https://academic.oup.com/jcem/article/97/7/2482/2834446?l
| ogi... https://academic.oup.com/jcem/article/97/7/2482/28
| 34446?logi... https://diabetesjournals.org/care/article/2
| 8/2/391/24045/Met...
| viraptor wrote:
| The goal of that idea is to push for being being more
| healthy regardless of size, not to validate that you can
| become obese if you want with no downsides. It's
| basically "being obese and having issues dieting doesn't
| stop you from making healthy changes in other ways".
| jobs_throwaway wrote:
| > There are many obese people who are extremely healthy
|
| I don't believe that's true. There are some cases (like
| powerlifters) who can be at an obese BMI but still have
| strong cardiovascular fitness, but unless you are in that
| narrow category, if you are obese you do not have strong
| aerobic fitness. 'Decent physical condition' alone belies
| that you are not 'extremely' healthy. Decently healthy
| maybe, but certainly not extremely. Even if you are still
| metabolically healthy, you are at increased risk for
| adverse long-term outcomes (source:
| https://pubmed.ncbi.nlm.nih.gov/24297192/). That is more
| than just a psychological issue, no matter how much you
| try to handwave it away.
| fnordpiglet wrote:
| Your belief in a fact is unnecessary. The issue with
| these studies is they don't control for lifestyle and
| diet. The notion that you can not be fat while eating a
| high quality low calorie diet and exercising is simply
| false. A valuable study in this space would be measuring
| the impact of diet and exercise on health outcomes while
| holding BMI constant, then comparing across stripes.
|
| In studies where diet and lifestyle are controlled for,
| metabolically health overweight are not at greater risk.
|
| The issue is we are pointing to fatness and not diet and
| exercise. It's causing people to seek ways to get thin
| assuming it'll help. But some people are thin no matter
| what they do, some are fat. However there's a correlation
| between poor lifestyle choices and being fat and good
| life style choices and being thin. This skews
| uncontrolled studies towards fat is bad even with good
| metabolic health, because having a good metabolic health
| but maintaining it with poor inputs will have a long term
| bad outcome.
|
| In one of the reference below, the conclusion is: (i)
| Higher fitness should be considered a characteristic of
| metabolically healthy but obese phenotype. (ii) Once
| fitness is accounted for, the metabolically healthy but
| obese phenotype is a benign condition, with a better
| prognosis for mortality and morbidity than metabolically
| abnormal obese individuals.
|
| https://academic.oup.com/jcem/article/97/7/2482/2834446?l
| ogi... https://academic.oup.com/jcem/article/97/7/2482/28
| 34446?logi... https://diabetesjournals.org/care/article/2
| 8/2/391/24045/Met...
| copperx wrote:
| > There are many obese people who are extremely healthy
|
| I don't think that's true. However, some people can
| withstand bad diets. As an example, I had a morbidly
| obese uncle that ate copious quantities of bacon, white
| bread, and processed food, yet his blood work and lipid
| levels were always in the healthy range, which always
| surprised my family (my mother managed a clinical lab and
| did the bloodwork for my uncle).
|
| My uncle eventually passed away after he became crippled
| after a bathroom fall due to his weight. He became
| depressed and committed suicide (he was a physician and
| had access to morphine). Overweight is always a health
| risk, even if your bloodwork is ok.
| fnordpiglet wrote:
| I didn't say morbidly obese. Likewise, check my other
| comments on parallel replies for several studies showing
| cardiovascular fitness is the predictor for metabolically
| healthy obese people.
| ceejayoz wrote:
| Very little in health is unidimensional. Suppose, for
| example, the presence of an effective weight loss treatment
| caused an increase in suicide rate in those who fail to
| benefit from the drug or can't access it for some reason?
| starkd wrote:
| That's an important consequence to consider. One that
| often gets omitted. Many drugs - like blood pressure
| drugs - often have depression as a side effect but it
| gets overlooked.
| spoiler wrote:
| My mother recently started taking these, and she doesn't
| have a very great mental health history to begin with. Do
| you have more information on this, and/or if this can
| somehow be mitigated?
| ceejayoz wrote:
| She really should discuss with her doctor, if possible.
|
| They can absolutely mess with mood, but in both
| directions. https://www.health.harvard.edu/mind-and-
| mood/blood-pressure-...
| acuozzo wrote:
| > Many drugs - like blood pressure drugs - often have
| depression as a side effect
|
| Any idea if this applies to Amlodipine-Benazepril?
| gadders wrote:
| Life is like a box of chocolates. It doesn't last as long
| if you're fat. --Joe Lycett (British Comedian)
| ethanbond wrote:
| That'd imply it's okay to put obese folks in cages without
| food until they've lost weight and I'd suggest that that's
| fucking insane. We've discovered another dimension!
| bdavis__ wrote:
| There are no fat POW's.
| vadansky wrote:
| That'd imply it's okay to put smokers in cages without
| cigarettes until they've stopped smoking and I'd suggest
| that that's fucking insane. We've discovered another
| dimension!
| jdminhbg wrote:
| Are you saying that it _wouldn 't_ be insane to jail
| smokers to get them to quit?
| derefr wrote:
| The point of the quoted sentence from the psychologist was
| that people who _aren 't_ obese, but who are "large" ("Big
| and Tall", in the clothing phrasing) and who have body-
| dysmorphic disorder, might pursue this drug, and, due to
| being "large", get it prescribed -- and that that's a bad
| thing, because they'd end up with an unhealthily-low BMI.
| balfirevic wrote:
| > people who aren't obese, but who are "large" ("Big and
| Tall", in the clothing phrasing)
|
| What's the difference, just the degree of being
| overweight? And the height of course, but drugs won't
| make anyone shorter.
| derefr wrote:
| The taller you are, the larger your build can be + more
| mass you can carry while still having a very low body fat
| percentage. This is why BMI is normalized by height.
|
| Someone who weighs 150lbs -- but who is 6'8" -- is
| actually underweight. To be that weight at that height,
| they'd have to have so little fat _and_ muscle that they
| 'd be positively scrawny-looking, and would be
| experiencing many of the same problems (e.g. always being
| cold, muscle spasms, brain fog, paresthesia from
| demyelination of nerves) that someone who is 5'8" and
| 90lbs does.
|
| Someone who weighs 200lbs at 6'8" looks, and is, healthy;
| just like someone who weighs 140lbs at 5'8".
| balfirevic wrote:
| Yeah, sure, I didn't get that you were talking about tall
| people with normal BMI.
| watwut wrote:
| Strongly depends on how much they weight in the end and
| what is the price of weight loss. Loosing too much weight
| makes you less healthy, sometimes very damagingly so.
|
| It also depends on what is the price of that weight loss.
| Quite a few diets make you loose weight and simultaneously
| make you much less healthy or less fit - because your body
| is missing nutricients it actually needs.
| the_only_law wrote:
| Let's give them all meth. That should help with weight
| loss.
| fnordpiglet wrote:
| I think surgically removing parts of your organs is more
| extreme frankly.
| bdavis__ wrote:
| I know that you are trying to make a point, but I think
| meth would be a viable treatment option for some people.
| Medically supervised and monitored. If you need to lose
| 100 lbs, it might be worth the other tradeoffs. For a
| short period of time.
| hirvi74 wrote:
| Stimulant medications have been and still are sometimes
| indicated in Binge Eating Disorder.
| _dain_ wrote:
| It is actually prescribed sometimes.
| TylerE wrote:
| Not really that different from the adderall script 80% of
| techbros have.
| lghh wrote:
| Please stop stigmatizing adderall usage. Especially as a
| platitude. The stigma often prevents people who have ADHD
| from seeking things that alleviate it.
| showdeddd wrote:
| [flagged]
| jobs_throwaway wrote:
| what's unnatural about amphetamines?
| jat850 wrote:
| Amphetamines are synthetic, so maybe the reverse of that
| question is better? What is natural about amphetamines?
| hirvi74 wrote:
| You're describing Adderall misuse and/or abuse and not
| Adderall's intended usage.
|
| That would be like damning steroids because some body
| builders misuse them to increase muscle mass regardless
| of the medical benefits when used in the appropriate
| contexts.
| [deleted]
| zafka wrote:
| When Adderall is used as prescribed long term - appetite
| suppression is greatly reduced. Where I work I have an
| N=2 sample that are != skinny by any stretch.
| v4dok wrote:
| Making ADHD a joke is hurting millions of people who
| really have an issue. Yes ADHD medication is reducing
| apetite, but let me tell you, its not always nice,
| especially if you want to gain weight
| TylerE wrote:
| I was going on it for 20 years, I know
| the_only_law wrote:
| Ok and what does that have to do with the topic at hand?
| Or do you just like adding non-sequiturs?
| TylerE wrote:
| We pretty much are giving pharmaceutical grade meth out
| hirvi74 wrote:
| Dosage, not the substance, makes poison.
|
| Do you refuse any and all pharmaceuticals, or are such
| substances only okay when _you_ take them?
| _dain_ wrote:
| Adderall is amphetamine, not methamphetamine.
| Methamphetamine is occasionally prescribed when front-
| line treatments fail. In any case, the dosage is far
| below what is used recreationally. ADHD patients rarely
| get addicted to medically-prescribed amphetamine,
| especially when it's the slow-release preparation.
| jasonmp85 wrote:
| Amphetamines are great, I fail to see your point.
| the_only_law wrote:
| Are you high as shit right now?
|
| GP claimed: _Helping obese people lose weight is
| unidimensionally a good thing_
|
| So I proposed we use powerful, addictive, and potentially
| dangerous stimulants to help people lose weight. Since
| it's unidimensionally good.
| [deleted]
| abeppu wrote:
| The article specifically points out that the link between
| weight and health on its own is in question:
|
| > Some researchers also worry that by offering a weight
| solution in societies that prize thinness, these drugs
| could also inadvertently reinforce the disputed link
| between excess weight and health. One study found that
| nearly 30% of people who are considered obese are
| metabolically healthy.
|
| The abstract from that article also points out that a
| significant share of non-obese people are metabolically
| unhealthy:
|
| > Nearly half of overweight individuals, 29% of obese
| individuals and even 16% of obesity type 2/3 individuals
| were metabolically healthy. Moreover, over 30% of normal
| weight individuals were cardiometabolically unhealthy.
|
| Further, the way that study measures (cardio)-metabolic
| health is itself multi-dimensional:
|
| > Using the blood pressure, triglyceride, cholesterol,
| glucose, insulin resistance and C-reactive protein data,
| population frequencies/percentages of metabolically healthy
| versus unhealthy individuals were stratified by BMI.
|
| https://www.nature.com/articles/ijo201617
|
| I think we may need to admit that weight is a low cost and
| highly visible variable which is a poor proxy for actual
| health and as in business, optimizing for the wrong metric
| will eventually lead to dysfunction.
| hombre_fatal wrote:
| Maybe that paper just shows that BMI isn't the best
| metric. For example, would the results look different if
| the participants were stratified by bodyfat%?
| abeppu wrote:
| An earlier study looked at BF% vs BMI-based obesity
| definitions, when you adjust for fitness (as measured
| with a treadmill test). They compare the all-cause-
| mortality risk for normal weight + metabolically healthy
| vs obese (for each definition) metabolically healthy.
| When adjusting for fitness, the risks / hazard ratios are
| not significantly different.
|
| I.e. if you do someone's bloodwork and a treadmill test,
| and they look metabolically normal, knowing whether their
| BF% is high (or if their BMI is high) doesn't seem to
| tell you more about whether they're going to die. If
| they're fat but fit, trying to lower their BMI or BF%
| doesn't seem to be about making them healthier.
|
| If we're talking about interventions which might involve
| putting someone on medication with side effects for the
| rest of their lives, just do the extra tests! There's no
| reason to reduce the decision input variables to just
| "are they obese?" when better indicators are known.
|
| https://pubmed.ncbi.nlm.nih.gov/22947612/
| jobs_throwaway wrote:
| Metabolic health =/= health. Obese people who are
| metabolically healthy are still at increased risk for
| adverse long-term outcomes (like heart attack) - source:
| https://pubmed.ncbi.nlm.nih.gov/24297192/. Obese people
| are 96% more likely to have heart failure - source:
| https://www.medicalnewstoday.com/articles/317546
|
| Sure, I'll grant that BMI is not the end all be all
| metric of health, but its a hell of a strong indicator,
| and pretending that its okay for your health to be obese
| is farcical.
| __blockcipher__ wrote:
| The correct answer is because it's become very taboo,
| particularly in academic circles, to make any statement that
| implies that it's not good to be fat. So articles like these
| always must include at least one generic quote about how
| being thin is not an end in itself.
| boxed wrote:
| No. That's not it. It's the confused "progressives".
| carrotcarrot wrote:
| A professor I follow once said Nature isn't as prestigious as
| people think, they just publish such a high volume that people
| have gotten that impression
| xkbarkar wrote:
| I subscribed to Nature for a couple of years and although I
| am not a proper academic and maybe not the best judge, the
| articles in Nature sometime looks like they belong on vox.com
| or wired and not in a scientific paper.
|
| As in opinions presented as evidence, from an almost random
| person, without actually providing any.
|
| Especially around social subjects like the BLM protests.
|
| One thing I loved about 60 minutes back in the day, was their
| ability to present a story from multiple points of views.
|
| When I started reading Nature at my former employers, many
| many years ago, I felt their articles were like that.
|
| At some point it started to look like cherrypicking a single
| viewpoint, often with obvious political taint.
|
| Maybe it was always like that and I just used to idolize it.
|
| I still very much love the magazine though but stopped
| subscribing. Its really expensive.
|
| When I get my hands on a copy these days I just filter what I
| perceive as woke crap from the rest and skip those articles.
|
| I wonder if that is such a good thing... Edit: typo and
| context
| LarryMullins wrote:
| Why does this headline from Nature read like a scam advert from
| Facebook?
| tptacek wrote:
| Because what's happening in this field is bananas right now, to
| the point where the results sound like scam adverts from
| Facebook.
| nindalf wrote:
| Because sometimes you're dealing with the real article. This
| isn't a boner pill made of rhino horn. This has been proven in
| double blind studies, FDA approved and has changed the lives of
| thousands of people. This could potentially halt the obesity
| epidemic, preventing many early deaths and improving the
| quality of life of countless others.
|
| At that point, such headlines are justified. What would you
| have written instead? Something lukewarm like "Obesity drugs
| show efficacy in many patients"?
| LarryMullins wrote:
| I'm sure it's possible to formulate a headline for this story
| that doesn't sound like gutter-tier clickbait. Nature must be
| doing a poor job hiring / directing their editors.
| tptacek wrote:
| Too much of this thread is debating whether these drugs are a
| good thing or a bad thing, and not enough is on the
| underlying science story, which is what HN "should" be
| interested in. What's happening with these drugs --- that you
| can replicate much of the effect of bariatric surgery with an
| injection --- is super interesting, and didn't seem to be on
| the horizon 10 years ago.
| nindalf wrote:
| Agreed. I don't think I'll ever need these pills but I
| think in ten years we'll think they're the second most
| impactful thing to happen last year.
| mensetmanusman wrote:
| Another option is to not sit at all, all day.
| obiefernandez wrote:
| Anyone know offhand if these drugs are easily available in
| Mexico? Having a hard time googling the answer
| Izkata wrote:
| > They described the details of an investigation of a promising
| anti-obesity medication in teenagers, a group that is notoriously
| resistant to such treatment. The results astonished researchers:
| a weekly injection for almost 16 months, along with some
| lifestyle changes, reduced body weight by at least 20% in more
| than one-third of the participants1. Previous studies2,3 had
| shown that the drug, semaglutide, was just as impressive in
| adults.
|
| Two immediate thoughts:
|
| How much of it was actually the lifestyle changes? It would be
| more interesting if there were no lifestyle changes...
|
| This apparently works by suppressing appetite, but doesn't
| cocaine do the same thing? Constant needle marks from weekly
| injections might result in more social complications than
| anything else...
| smith7018 wrote:
| Cocaine does the same thing but it only lasts ~20 minutes.
| Ozempic is a once a week injection that curbs appetite and
| makes the user feel fuller faster. It also comes in a pen (like
| an epipen) and is injected into fat stores so the user probably
| won't have "track marks."
| djur wrote:
| Also, these medications aren't stimulants, which is really
| important for people who might be at higher risk for heart
| issues.
| Someone1234 wrote:
| > How much of it was actually the lifestyle changes? It would
| be more interesting if there were no lifestyle changes...
|
| The article answers this further down:
|
| > Those receiving weekly injections of semaglutide lost, on
| average, 14.9% of their body weight after 16 months of
| treatment; those who received a placebo lost 2.4% on average.
|
| Per the article still a lot of work to do in this area, but on
| the face of it this could be an alternative to bariatric
| surgery for 1/3 of people.
| __blockcipher__ wrote:
| The line you quoted:
|
| > Those receiving weekly injections of semaglutide lost, on
| average, 14.9% of their body weight after 16 months of
| treatment; those who received a placebo lost 2.4% on average.
|
| Doesn't really have anything to do with the question about
| lifestyle changes. That question basically centers around
| whether the 14.9% weight loss occurred independent of or as a
| result of lifestyle changes downstream from the semaglutide.
| djur wrote:
| To the extent that lifestyle changes include "not eating as
| much", it seems self-evident that the weight loss was the
| result of lifestyle changes. A drug that makes it easier to
| stick with a diet is a huge deal!
| ceejayoz wrote:
| > How much of it was actually the lifestyle changes?
|
| That's why the placebo group in the trial also gets the same
| lifestyle changes.
|
| > This apparently works by suppressing appetite, but doesn't
| cocaine do the same thing?
|
| Sure. If they were otherwise identical, that'd be a good point,
| but they're not.
|
| > Constant needle marks from weekly injections might result in
| more social complications than anything else...
|
| My daughter has to give herself growth hormone injections every
| day, and has for nearly a decade now. You don't get needle
| marks from these sorts of small dosage subcutaneous injection.
| Izkata wrote:
| > You don't get needle marks from these sorts of small dosage
| subcutaneous injection.
|
| Ah, my only experience is with things like vaccines and
| drawing blood; those marks last around a week on me.
| ceejayoz wrote:
| Yeah, it's very different; vaccinations are generally much
| deeper (into muscle), and drawing blood punctures a vein
| causing leakage into the surrounding tissue.
|
| Daily injections can leave a little under-the-skin scarring
| (feels a little like cellulite) so you have to vary the
| site a bit, but for most folks that's the worst of it. Well
| worth it for these sorts of results.
| carrotcarrot wrote:
| > Sure. If they were otherwise identical, that'd be a good
| point, but they're not.
|
| You can say the same of opium, heroin, morphine, oxycodone,
| fentanyl, and Naloxone. Many of which have had i ical trials
| done and all of which are abused and addictive.
|
| I simply don't trust clinical trials by large pharmaceutical
| companies any longer.
| ceejayoz wrote:
| > You can say the same of opium, heroin, morphine,
| oxycodone, fentanyl, and Naloxone. Many of which have had i
| ical trials done and all of which are abused and addictive.
|
| Cocaine isn't a viable weight-loss drug because its
| downsides outweigh the benefits. The downsides of
| semaglutide and tirzepatide are _nothing_ like that of
| cocaine, and thus the calculus works out better for them.
|
| > You can say the same of opium, heroin, morphine,
| oxycodone, fentanyl, and Naloxone.
|
| Setting aside the fact that including naloxone in that list
| is a bit bizarre - it _counteracts_ the rest of the list,
| everyone should have some in their first aid kit - those
| medications have benefits that make them _sometimes_
| appropriate clinically. (Similarly, cocaine is used
| medically and in a very controlled fashion in rare cases,
| like persistent bad nosebleeds.)
| kens wrote:
| You say that Naloxone is abused and addictive? That is
| completely wrong. Naloxone has no addictive potential and
| has no potential for abuse. I think you have it confused
| with something else.
|
| Ref: https://www.asam.org/docs/default-source/public-
| policy-state...
| [deleted]
| Gatsky wrote:
| I have a theory that the Nature group, ostensibly a bunch of
| academic journals, actually wants to become the NYTimes. They
| have chosen a custom font, they publish increasingly
| editorialised political content, and they produce these hype
| train news pieces which really lack objectivism or scientific
| rigour. Scientists should consider carefully what is appearing
| alongside their research, and the ultimate result of an
| unassailable, centralised academic publisher with opaque
| editorial practices.
| Beaver117 wrote:
| So does this somehow burn fat or does it just lower your
| appetite? There are many others drugs that lower appetite, and
| yet we still have an obesity crisis. Why would this one solve it?
| EamonnMR wrote:
| Doctors are reluctant to prescribe stimulants to their patients
| for various reasons. Also you don't keep the weight off with
| those.
| contravariant wrote:
| You don't necessarily need a stimulant, you can also e.g.
| short the mitochondria using DNP. Doing so does have some
| fairly predictable downsides.
| acuozzo wrote:
| > There are many others drugs that lower appetite, and yet we
| still have an obesity crisis.
|
| Which ones are prescribed in the US, on label, to treat
| obesity?
| ceejayoz wrote:
| > So does this somehow burn fat or does it just lower your
| appetite?
|
| The article's subheadline is "A class of drugs that quash
| hunger".
|
| > There are many others drugs that lower appetite
|
| Not this well and/or not this safely.
| jboy55 wrote:
| There is only one class of drugs that lowers appetite outside
| of these GLP hormone drugs, those are stimulants like
| amphetamines. As someone on one of the GLP drugs for 3-4
| months, and whose body tolerates it well, this is simply
| turning off the hunger switch. I will miss meals because I'm
| not hungry, since starting I have never felt "hangry" and I am
| satiated with small meals and do not feel hungry later. If I
| overeat, I will feel nauseous and sick.
|
| I do not feel wired, foggy or feel like my personality or sleep
| cycle has been affected in the slightest.
| ceejayoz wrote:
| There are others; https://en.wikipedia.org/wiki/Topiramate is
| one. Nowhere near as effective, though.
| r00tanon wrote:
| Unfortunately just diagnosed type 2. Can't find Ozempic anywhere
| due to this crazy drug shortage and off label prescribing.
| jamesgill wrote:
| The best 'obesity drug' I've found is low-carb + intermittent
| fasting. 90 pounds later, I'm not hungry and every aspect of my
| health has improved dramatically.
| thejackgoode wrote:
| How many of obesity cases are caused by eating disorders and
| addiction psyche in general? Treating the symptom in this case
| barely helps. You might lose weight, but it'll pop up in some
| other place in your life. See it as psychological side effect, a
| swap of coping mechanism. Often enough, IMO you need to go deeper
| than a pill.
| nextlevelwizard wrote:
| Thats such bullshit. Sure, yes, there is 100% mental aspect to
| every obese person, but some of that shit is old and already
| dealt with, but since you are already fucked you cant get out
| from the cycle.
|
| Of course we should deal with the mental side but it will be a
| million times easier to deal with after you aren't a fat fuck.
| thejackgoode wrote:
| Case in point, "fat fuck" and "old shit that's dealt with"
| shouldn't normally belong to the same argument
| nextlevelwizard wrote:
| And why not?
| thejackgoode wrote:
| For one, it's a value judgement, and the mind that makes
| it more often than not applies the same judgements to
| oneself, leading to feelings that not everyone can
| convert to constructive action. Hence avoidance by
| addictions, one of which can be food.
|
| Also it implies disrespect and ignorance of the reasons
| why someone eats more than is considered healthy. It's a
| mockery of a person's perceived failure to adapt to
| abstract adversity. And someone who had psychological
| issues with addiction and dealt with them would be very
| unlikely to mock these things.
| curation wrote:
| Obesity drugs treat a North American symptom - obesity. The cause
| remains untreated.
| partiallypro wrote:
| Obesity is now a global problem; I don't know why people view
| this as US centric.
| nextlevelwizard wrote:
| It will help millions of people in life changing ways. Of
| course we should also fix the causes, but that is no reason not
| to pursue easier treatment
| Cupertino95014 wrote:
| > "I'm really hesitant to be excited about something that I think
| is potentially harmful from a weight stigma perspective," says
| Sarah Nutter, a psychologist at the University of Victoria in
| Canada, who specializes in weight stigma and body image.
|
| Putting the word "stigma" on things is a sure sign of a grifter.
| Instead of helping solve it, they're trying to make it a social
| science problem.
|
| Being overweight is unhealthy. There's no serious dispute about
| that. So people recognizing that fact is "stigma?"
| Eumenes wrote:
| Last name is Nutter too, literally a nutter.
| partiallypro wrote:
| The new idea (mostly in the West) that being obese is/can be a
| healthy lifestyle is absolutely maddening. People being obese
| (and I don't mean a few pounds overweight) raises everyone's
| healthcare cost, because it is incredibly unhealthy and obese
| people tend to have more complications which requires more
| treatment, workers and subsidizing.
|
| It's not just an individual problem, it's a societal problem.
| There's a new "Gatorade Fit" commercial with, easily, a 300lb
| woman in it...the brand is literally "Fit," being 300lbs is not
| fit in any way shape or form. Why is this happening? Even
| when/if I'm 10-20lbs overweight, I don't want someone patting
| me on the back saying I'm actually "fit" or anything close to
| it. It's such a weird lie that makes it feel like I'm living in
| a bizzarro world.
| lazide wrote:
| Overton window, and people giving up is why it's happening.
|
| And yeah, we're all living in bizarro world.
| Frost1x wrote:
| >The new idea (mostly in the West) that being obese is/can be
| a healthy lifestyle is absolutely maddening.
|
| We took the extreme of anorexia being healthy to obesity
| being healthy. The fact is neither extreme is healthy. Being
| not anorexic is not the same as being obese, there's a huge
| range of fairly healthy weights in between the two in terms
| of body fat percentages and muscle ratios.
| verdenti wrote:
| [dead]
| Rebelgecko wrote:
| Has the health care cost been studied? I wouldn't be
| surprised if morbidly obese people are cheaper in the long
| run due to a reduced lifespan (kinda like how smokers can be
| cheaper than nonsmokers-they may cost more to ensure before
| retirement age, but it more than evens out when you looked at
| reduced years after that point)
| partiallypro wrote:
| Yes, it has been studied countless times.
|
| https://pubmed.ncbi.nlm.nih.gov/33470881/
|
| "Adults with obesity in the United States compared with
| those with normal weight experienced higher annual medical
| care costs by $2,505 or 100%, with costs increasing
| significantly with class of obesity, from 68.4% for class 1
| to 233.6% for class 3. The effects of obesity raised costs
| in every category of care: inpatient, outpatient, and
| prescription drugs. Increases in medical expenditures due
| to obesity were higher for adults covered by public health
| insurance programs ($2,868) than for those having private
| health insurance ($2,058)."
| oneoff786 wrote:
| Is the woman being shown as fit? Or as someone who would like
| the product with a goal to become more fit?
| hbn wrote:
| Here's Adidas promoting a fat woman as an athlete
|
| https://www.youtube.com/watch?v=6keCE3ab14s
| notinfuriated wrote:
| She is wearing fitness clothing and doing what appears to
| be yoga.
|
| https://www.youtube.com/watch?v=cPgOCWbqjgo
|
| Advertisements used to be aspirational. They either still
| are and people's aspirations have changed, or they are not
| and there's some other more current explanation for why
| this ad and others act as a mirror showing a person who
| they already are (fat) rather than who they aspire to be
| (not fat).
|
| Said another way, there's nothing explicitly stating that
| the woman has a goal of becoming thinner. She is shown as
| well as two other thinner people. They're all doing their
| own form of exercising while clothed in activewear. The
| implication could be that the fat woman's goal is to become
| less fat or that she is comfortable as she is and fits in
| as part of Team Gatorade(tm). I suspect the message they're
| trying to convey is the latter.
| deanCommie wrote:
| > there's nothing explicitly stating
|
| Are the fitness goals of the other 2 actors explicitly
| stated?
|
| Should fitness products only advertise with actors who
| are ALREADY fit and maintaining that fitness?
|
| What exactly are you expecting? How exactly do you want
| fat people to be portrayed in advertisements for fitness
| that allows them to attempt to get fit?
| throwaway1851 wrote:
| I think what's strange about this ad is the fact that
| she's doing a handstand. That isn't a normal part of
| getting fit for most people, and it isn't even safe to
| attempt by most people in the model's weight range. Had
| they shown her using a stationary bike or taking a brisk
| walk in a park, it wouldn't be controversial.
| notinfuriated wrote:
| > Are the fitness goals of the other 2 actors explicitly
| stated?
|
| No.
|
| Reread my comment. I said nothing about how I expect fat
| people to be portrayed or what is right or wrong about
| this ad.
|
| The one thing I suggested is that I believe Gatorade is
| attempting to create an ad that is welcoming toward fat
| people regardless of their goals. At least, that is my
| interpretation given in the current year. Further
| evidence of my interpretation is that fat people were not
| shown in Gatorade ads several decades ago, e.g.:
| https://www.youtube.com/watch?v=Y6xcLDKCzh4
|
| Comparing the ad from the 90s to now shows that the older
| ad was aspirational. I'm sorry if that makes you upset, I
| did not create the Gatorade ad. I only interpreted it.
| yowlingcat wrote:
| In a way, maybe Gatorade is trying to be honest about lying.
| After all, a 20 oz bottle of Gatorade has 36 grams of sugar
| in it and would substantially contribute to type 2 diabetes.
| It would behoove them to fund a narrative that the product
| and the outcome associated with the product are indeed "fit"
| to maximize sales.
|
| Of course, the wrinkle with approach is that that as you
| mention, the reality is that nothing could be furthest from
| the truth. Obesity is fastest growing and most deadly
| American chronic condition. The outsized impact of type 2
| diabetes on payer spend, both medical and pharmacy, cannot be
| overstated.
|
| And when you put that all together, it makes a commercial
| like the one you mentioned seem banal and sinister at the
| same time.
| hirundo wrote:
| Telling people what they want to hear is not a novel way to
| collect cash or votes. It would be bizzarro if there were
| people who wanted to hear it but nobody willing to tell it to
| them.
| LarryMullins wrote:
| > "Gatorade Fit"
|
| 1 gram of sugar per half liter
| https://www.gatorade.com/fuel/hydration/gatorade-
| fit/16-ounc...
|
| At least it's _almost_ sugar free, relative to normal
| gatorade anyway. I think advertising regular sugary gatorade
| to fat people as a fitness product would be tantamount to
| stochastic murder.
| HDThoreaun wrote:
| Japan taxes obesity through a payroll tax, which to my
| understanding is especially effective because of the peer
| pressure exerted by your colleagues and even manager. Being
| fat is seen as letting the team down since you're causing
| their costs to go up, not just your own.
| luckylion wrote:
| > raises everyone's healthcare cost, because it is incredibly
| unhealthy and obese people tend to have more complications
| which requires more treatment, workers and subsidizing.
|
| Is that actually true? From what I understand, obesity will
| cost you dearly in life expectancy, and most of the cost
| comes in the last few years of normal life expectancy.
| Someone who dies of heart attack at 63 isn't going to run up
| huge bills from age 77 to 85.
|
| I believe there was a similar calculation for smokers. The
| health cost in higher cancer rates are outweighed in what you
| save on costly treatment for the elderly + fewer pension
| payments.
| partiallypro wrote:
| Yes, smoking isn't the same at all. People that are
| extremely obese require bigger hospital beds, more
| equipment, more drugs, more operations, etc. That's not
| even remotely comparable to smoking in terms of costs on
| the system. There also aren't a lot of smokers anymore, at
| least not in the US, obesity is a revolving door that is
| constantly taxing the system. Even during COVID obese
| people were the ones taxing the system, not people of
| normal/healthier weights.
|
| https://pubmed.ncbi.nlm.nih.gov/33470881/
|
| "Adults with obesity in the United States compared with
| those with normal weight experienced higher annual medical
| care costs by $2,505 or 100%, with costs increasing
| significantly with class of obesity, from 68.4% for class 1
| to 233.6% for class 3. The effects of obesity raised costs
| in every category of care: inpatient, outpatient, and
| prescription drugs. Increases in medical expenditures due
| to obesity were higher for adults covered by public health
| insurance programs ($2,868) than for those having private
| health insurance ($2,058). In 2016, the aggregate medical
| cost due to obesity among adults in the United States was
| $260.6 billion. The increase in individual-level
| expenditures due to obesity varied considerably by state
| (e.g., 24.0% in Florida, 66.4% in New York, and 104.9% in
| Texas)."
| luckylion wrote:
| My point was that these people tend to live a full decade
| less, and they're missing out the decade when health care
| cost rise to $11k/yr (65+, also when Medicaid kicks in as
| far as I understand).
|
| Only looking at the obesity-related health-care cost
| without looking at the earlier-death-related savings
| doesn't get you a clear picture. All obese people
| becoming healthier might actually cost the health-care
| system more. I understand that's not a comfortable way to
| think about it for some people, but I do believe it's
| useful to consider.
|
| Here's a study on lifetime costs for smokers vs
| nonsmokers:
| https://www.nejm.org/doi/full/10.1056/nejm199710093371506
|
| In Germany, healthcare spending for women is about 20%
| larger per person which is primarily explained by the 5
| years additional life expectancy. You'll see that it's
| not obvious that an obese person dying 10 years earlier
| will necessarily have the same life time cost because
| their life is much shorter, and cost rises rapidly when
| you're past retirement age.
| partiallypro wrote:
| I'm well aware of the stat that you're pushing, I am
| pointing that it does not apply to people that are obese.
| [deleted]
| tootie wrote:
| That's awfully harsh. For one, the person making that statement
| is not the developer of the treatment, she's a psychologist
| expressing concern about the possible downsides. Namely that
| the drug is expensive, doesn't work on everyone and hasn't been
| proven to show long-term beneficial outcomes yet (ie lower
| morbidity). I'm guessing it's also got a high potential for
| abuse from people with dysphoria. Nobody is saying we should
| keep it off the market, just that we need to be prepared for
| potential negative repercussions.
| Cupertino95014 wrote:
| > the person making that statement is not the developer of
| the treatment
|
| and neither is she a doctor or biological scientist. Rather,
| she's trying to get in on a lucrative field which she has no
| expertise in.
| tootie wrote:
| Again, needlessly harsh. She is psychologist with expertise
| in body image and was likely asked by the reporter for an
| opinion. Idk why you think she's trying to cash in on
| anything. It's incredibly cynical.
| Cupertino95014 wrote:
| > expertise in body image
|
| No, needfully harsh. "body image" is an invented term and
| "expertise" just means she got some papers published in
| journals controlled, most likely, by her friends.
| "Getting quoted in journals" would appear on her
| application for tenure, if she doesn't have it already.
|
| Also, reporters don't just _happen_ to call up random
| people and ask for an opinion. You call _them_ and offer
| it. Get on HARO <haro@helpareporter.com> if you want to
| be quoted, too.
| m0llusk wrote:
| Down's Syndrome is also unhealthy. Should we stigmatize that
| also? The main issue is control. Many assume that weight is
| simple and under people's full control. Realistically, though,
| there are all kinds of reasons why weight gain happens and
| scientific measurement shows that wild animals are getting
| bigger too which suggests that pervasive presence of endocrine
| disrupting agents in the environment may be involved. It is not
| clear how we might stigmatize exposure to endocrine disruptors.
| abcc8 wrote:
| It is rather dishonest to compare a chromosomal disorder with
| obesity, don't you think? Trisomy 21 is a condition one is
| born with and has no control over. On the other hand it has
| been demonstrated time and time again that behavioral and
| diet changes can be used to control obesity.
| joshuahedlund wrote:
| > scientific measurement shows that wild animals are getting
| bigger too which suggests that pervasive presence of
| endocrine disrupting agents in the environment may be
| involved
|
| Do you have a good source for this?
| Cupertino95014 wrote:
| And here you are, using the very word I called grifting.
|
| It's not "stigmatizing" to call something unhealthy which is,
| at least potentially, controllable. And you cited no
| information at all about "endocrine disruptors" for the vast
| majority of obese people.
| HDThoreaun wrote:
| Weight is not uncontrollable. It's not easy to control, but
| neither is any other addiction, and they're certainly
| stigmatized.
| m0llusk wrote:
| Could you link to a peer reviewed study concluding that?
|
| Just to point out one potentially complicating factor Dr.
| Robert Lustig's work appears to show that our diets
| increasingly include processed foods which are strongly
| associated with health problems including weight gain and
| metabolic disease. So if you can completely avoid
| institutional food such as served at company canteens and
| figure out and stick to a good diet then maybe. Even then
| it seems like the stigma is just sloppiness that results in
| perfectly respectable contributions to society not being
| recognized.
|
| Early on I made a habit out of becoming friends with fat
| people I met because their exposure to social stigma tended
| to make them strong as individuals.
|
| If anything it seems like the person who is addicted to
| something that should be stigmatized is you.
| poszlem wrote:
| Could you link to a peer reviewed study concluding that
| it's impossible to lose weight similarly to how it's
| impossible to get rid of an additional chromosome?
|
| Asking because as a person who has lost a lot of weight
| (and kept it off) I would like to get them to reconsider
| their review process.
| pbhjpbhj wrote:
| I'm obese. Most people my age at my work are not obese. I
| managed to get back to normal weight pre-pandemic by IF
| (16:8) and ~1hr a day of walking.
|
| Various things have lead to me eating/drinking (alcohol)
| to excess and becoming more overweight than ever.
|
| My long-winded point is that it seems specifically to be
| my personal actions that have caused my obesity -- poor
| food choices and lack of exercise. Others from the same
| background, others at the same workplace, etc., are not
| obese.
|
| I would hate anyone to start telling me being fat is OK
| and that I shouldn't bother to do anything about it.
| [deleted]
| bitwize wrote:
| Why use drugs and lifestyle changes when lifestyle changes alone
| will do the trick? Everybody knows you're not a real Hackernews
| until you adopt a cold, calculating, "food is fuel" mentality
| toward eating, with extensive data collection, strict timing,
| data-driven portion control, and long fasting periods. Once you
| do that you don't need the drugs and can tell Big Pharma where to
| shove it.
| UI_at_80x24 wrote:
| Lifestyle change alone is NOT all it takes. I've been fat all
| of my life, so has everybody in the last 3 generations of
| genetic contributors.
|
| I can easily drop 20-40lbs if I cut sugar out of my diet. Then
| it stops. I've cycled 15miles/day for 7 years (on non-snowy
| days). During that time I went on a water-only fast, (7days on,
| eat one day, then 14days eat one day, then 7 days more of
| fasting before I stopped.) I lost 13 lbs during that period. I
| was doing a keto diet before and after this period. I was
| killing myself trying to have a high energy output with minimal
| caloric intake.
|
| In the end, winter came and I stopped. Total weight loss during
| that time: 35lbs. There is no way I can lose the extra 160lbs
| that I need to drop. My body just won't drop it.
|
| I'm diabetic now. I take metformin and invokana. As of today
| I'm down almost 30lbs since august.
|
| Lifestyle changes maybe enough for you. That's awesome, good
| for you. Don't make blanket assumptions and think that they are
| true.
| PuppyTailWags wrote:
| I wonder if, given the cost of the drugs, we're only going to be
| able moreso to visibly see poorness, i.e. fat people's class will
| be well known and discrimination to follow.
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