[HN Gopher] How long til we're all on Ozempic?
___________________________________________________________________
How long til we're all on Ozempic?
Author : thehoff
Score : 213 points
Date : 2024-10-11 17:06 UTC (5 hours ago)
(HTM) web link (asteriskmag.com)
(TXT) w3m dump (asteriskmag.com)
| WheelsAtLarge wrote:
| Statins are regularly given to people with high cholesterol. I
| would bet that most older people take or qualify to take a
| statin. If it happens with statins, therefore, it's not out of
| the realm to think that most people will eventually be prescribed
| GLP-1 to reduce weight which will improve overall health. It
| makes sense.
| zdragnar wrote:
| Statins have gone through several prescribing guideline
| revisions in the last 10-20 years. Many people were incorrectly
| prescribed them and some have suffered for it.
|
| Likewise, there can be serious complications when taking GLP-1
| agonists and the like. Since they need to be taken in
| perpetuity (many gain all weight lost upon stopping use) they
| should be reserved for only people who have exhausted all other
| opportunities.
|
| _Most_ people over 65 should not be on statins. _Most_ people
| should not be taking GPL-1 agonists.
| throwaway63467 wrote:
| I'm just back from the US and watching some TV there in the
| hotel it seems very much like they're pushing it into the
| mainstream, they literally have a commercial where "fat"
| people congregate in the street to march together picking up
| Ozempic... So I totally assume it will be widespread in a few
| years unless they discover some serious side effects.
| zdragnar wrote:
| Meh, you see commercials for all kinds of medicines in the
| US. There's more being produced than your average general
| practitioner can keep up with, so the manufacturers appeal
| directly to consumers.
|
| Given how ineffective it is once you stop, I'm personally
| expecting it to become a relatively short lived fad.
| Insurance companies won't cover it if it truly doesn't
| improve health outcomes long term (throwing money down the
| toilet) and people will learn to not pay out of pocket for
| it.
|
| There's a reason insurance companies are loath to cover it
| for obesity now without prior authorization, which usually
| requires you seeing a specialist who has ruled out the
| usual suspects (nutrition and exercise changes).
| sph wrote:
| Pretty much no one should be taking statins. The side effects
| are well studied, while the benefits are dubious at best.
|
| For example: _high_ cholesterol levels is actually positively
| correlated with longevity, believe it or not. If you consume
| a diet low in sugars, thus routinely burning fat when fasted,
| you will have "high" cholesterol in blood. How do you think
| fats are moved to cells in need? Through the blood, of
| course.
|
| I'd go so far as to say that statins are pretty much a scam,
| that fixes a useless and quite complex metric such as
| cholesterol levels. Given that cholesterol levels are a
| diagnostic easily accessible to GPs, they prescribe statins
| to see this figure go lower, even if it doesn't make the
| person any healthier. Incidentally it's similar to taking
| GLP-1 agonists instead of learning to have a healthier
| relationship with food.
| m0llusk wrote:
| Statins are a good comparison because most end their use after
| one or two years because of the side effects.
| IncreasePosts wrote:
| My biggest fear is either there will be long term negative
| consequences to Ozempic et al, and a huge swath of the population
| will be dealing with issues 30 years form now - OR - there will
| be some long term positive consequence to using Ozempic et al,
| and I'm not getting any of the benefits because I'm not
| overweight.
| sss111 wrote:
| There were several side effects related to pancreatic cancer
| associated with the precursors to GLP-1 drugs. The same
| companies promoting GLP-1s were responsible for driving up
| insulin prices. So I'm hedging my bets.
|
| There's a really cool Modern MBA video [1] on this topic btw :)
|
| [1]: https://www.youtube.com/watch?v=7sUoZVke_30
| cyberax wrote:
| > There were several side effects related to pancreatic
| cancer
|
| In mice.
| copperx wrote:
| Did the drug help pancreatic cancer?
| minifridge wrote:
| If something causes cancer in mice, the curent consensus is
| that it is deemed unsafe for humans.
| cyberax wrote:
| Not really. Mice are naturally genetically pre-disposed
| to cancer.
|
| So in general, if something _doesn't_ cause cancer in
| mice, then it's probably safe for humans. The reverse is
| not necessarily true.
|
| Also, GLP-1 was associated with thyroid, not pancreatic
| cancer.
| akira2501 wrote:
| Were they humanized mice or not?
| the__alchemist wrote:
| This is a good example of a _thought-terminating cliche_.
| sss111 wrote:
| nice, learned something new today, people use this so
| often
| cyberax wrote:
| There used to be a Twitter bot that replied "in mice" to
| all breathless tweets reporting on various studies.
| pixl97 wrote:
| >Large epidemiological studies have shown the link between
| obesity and pancreatic cancer. A large population-based case-
| control study of pancreatic cancer demonstrated that obesity
| was associated with a statistically significant 50-60%
| increased risk of pancreatic cancer.
|
| So does obesity, so there is that.
| BoingBoomTschak wrote:
| Well, the negative consequence on the value of willpower is
| pretty obvious. "In what measure" is the real question.
| zarathustreal wrote:
| Right, and the associated cultural impact of increasing
| hedonism
| cortesoft wrote:
| I am confused as to how a drug that makes you want to
| consume less would increase hedonism? It is basically an
| anti-hedonism drug?
| Spivak wrote:
| You have the completely wrong take on this. Dieting destroys
| your relationship with food. Basically every adult woman
| exhibits some level of disordered eating because of it--
| "girl dinner" is both funny because it's true and sad.
|
| Being able to lose weight while continuing to eat is a
| wonderful thing. There is no virtue in spending your
| willpower making your body do something it desperately
| doesn't want to do. That's some puritan shit.
| Fauntleroy wrote:
| It doesn't make you magically lose weight, it just gets you
| closer to "girl dinnering" with less cognitive load. The
| weight loss comes from eating less.
| lukeschlather wrote:
| Yeah, it's funny, Ozempic sounds utterly useless for me.
| I know how to lose weight, it's dealing with the side
| effects of weight loss that is tricky. And the side
| effects of weight loss sound a lot like the side effects
| of Ozempic.
| Spivak wrote:
| The difference is that it puts you in control of your
| hunger and what/how much you eat. You don't build
| negative associations with food while you're running a
| deficit. You don't build the association "hunger/misery
| means you're doing good and losing weight."
| logicchains wrote:
| >Basically every adult woman exhibits some level of
| disordered eating because of it-- "girl dinner" is both
| funny because it's true and sad
|
| This is sexist and absolutely not true, there are plenty of
| women capable of pre-planning what they're going to eat and
| sticking with it. It's not "dieting", it's living a healthy
| lifestyle and not regularly eating junk.
| Spivak wrote:
| My dude, I'm a woman talking about my experience with
| myself and other women. Disordered eating is _rampant_.
| It 's ingrained to the very core of how women are taught
| to approach food. Denying food and starving yourself is
| the default behavior.
| johnrob wrote:
| We are human animals. Our bodies need healthy food and
| regular exercise. There's a case that diet and exercise are
| worth willpower capacity, possibly more so than anything
| else. That's just the reality we exist in?
| pixl97 wrote:
| Capitalism disagrees. I need you to work two extra hours
| today. Also watch this advertisement for Tasty Snack!
| We've spend a billion dollars of research to ensure you
| eat this nibblet filled with 350% your daily sugar
| requirement, 200% of your daily fat intake, and 3000% of
| your recommended salt. Remember all the beautiful people
| in the world are eating Tasty Snack! Sold in the impulse
| buy isle near you.
| zarathustreal wrote:
| There is absolutely virtue in spending willpower to make
| your body do something it doesn't want to do - maintaining
| and developing self control and autonomy. Imagine if there
| was no way to develop self-discipline, you'd be at the
| whims of your environment and the world would be nothing
| but chaos.
| geoka9 wrote:
| Normally dieting shouldn't be necessary to maintain healthy
| weight though? One could eat a whole lot of salad (with
| some serious dressing) and a piece of meat and even a
| little starchy side (some potatoes or similar) 3 times a
| day and not gain weight. Throw in some regular moderate
| exercise and you're golden.
|
| Granted, once you go past middle age, it can become a bit
| more complicated.
|
| Someone brought up doughnuts as an example, but that's a
| ridiculous source of calories: I could probably down half a
| dozen doughnuts (a daily calorie budget) and then go for a
| normal meal afterwards.
|
| Eating only becomes disordered if one can't be bothered to
| eat healthy food as a rule and then freaks out about weight
| gain as a result.
| optimalsolver wrote:
| You know the way that software bloat expands to consume
| increased computational speed?
|
| We're about to see the nutritional equivalent.
| crooked-v wrote:
| I don't understand how that analogy is supposed to work,
| given that the basic mechanism of these drugs is to reduce
| appetite (and possibly just desire in general).
| petesergeant wrote:
| We're about to see a dramatic fall in the production and
| consumption of unhealthy food because people who used to
| want them in large quantities will no longer want them when
| they're on GLP-1 drugs.
| ninalanyon wrote:
| If this is the case and we believe that markets are
| efficient we should surely soon be seeing a decline in
| the stock price of McDonald's, etc.
|
| If you are right then there should be money to be made by
| shorting the stock.
| pixl97 wrote:
| >In October 2023, Walmart became one of the first
| retailers to correlate Ozempic, food sales, and changing
| habits. Using internal pharmacy and grocery data, the
| study found that Ozempic is negatively affecting
| Walmart's food sales. Measuring per-unit sales and
| calories, the retail giant confirmed a long-held belief
| that patients on GLP-1 drugs buy less food, particularly
| within the sweets and snack food categories.
| gedy wrote:
| Keep in mind a lot of people who'd benefit from this may not
| last another 30 years due to age or health issues due to weight
| either.
| m463 wrote:
| right
|
| the life expectancy of someone with bmi > 40 is -5 years
|
| and for bmi > 50, -15 years.
|
| So I suspect someone ~ 65 with high BMI should be on it, the
| side effects would be: living.
| mritchie712 wrote:
| Has there ever been a case where something like #2 has
| happened?
|
| Don't think you need to worry about that one.
| dustingetz wrote:
| https://en.wikipedia.org/wiki/Water_fluoridation
| logicchains wrote:
| https://www.theguardian.com/us-
| news/2024/oct/04/fluoridation...
| UniverseHacker wrote:
| I am an academic scientist and generally a careful and
| skeptical person, but having read the peer reviewed
| literature myself, I think there is enough evidence to be
| concerned that water fluoridation at the levels currently
| used could possibly be causing brain damage or
| developmental issues. The evidence isn't that strong, but
| it is strong enough that it would be unethical to
| continue the practice, or to claim that there is nothing
| to worry about. The dose/response curves seem to show
| measurable levels of cognitive defects occurring right
| around, or just above typical target levels for
| fluoridation.
|
| Personally, I give my kid water with the flouride
| filtered out via RO, but will still use topical flouride,
| e.g. toothpaste and treatments applied by a dentist.
|
| I hate how issues like this are politicized... if I raise
| this issue anywhere, including on here I expect to be
| attacked for being a "conspiracy theorist" and "like an
| anti-vaxxer" etc. There is something really wrong when
| you aren't allowed to even talk about both sides of an
| issue- especially if, like in my case, I have a doctorate
| in the life sciences and am qualified to have my own
| informed scientific opinion based on the evidence.
| bee_rider wrote:
| Is that an opinion formed on something inside your domain
| of expertise?
| UniverseHacker wrote:
| It is not in any way related to my own area of research,
| I looked into it as a parent wondering what would be best
| for my own kid. However, there is not really that much
| research out there on this- so I was able to review much
| of the primary research, as well as various review
| articles that try to consider all of it together.
|
| How would you define "domain of expertise"? Reviewing
| literature from other fields I don't research myself and
| forming an opinion on how it applies to my research _is_
| part of my job and something I do almost every day. I am
| even also called upon to peer review articles and grant
| proposals that are not within my direct field of
| research, as is general practice to get "outside
| opinions."
|
| In cases like this, I am able to be familiar with
| basically everything published on the issue. However an
| actual researcher in a specific field will have
| additional knowledge and opinions from firsthand
| experience, that cannot be found in literature.
|
| In general, I think it is okay to have your own opinion
| on something even if you aren't e.g. a professional whose
| whole life is focused exactly on that one issue. No
| formal training, credentials, or firsthand experience are
| necessarily required to have an informed opinion.
| However, you still have the burden of making sure you
| really understand the issue deeply - which is probably
| something like 100x the effort most people think it would
| be. Anyone can do that if they take the time to do so. I
| wish more people would.
|
| In any case, this was a few years back when I looked into
| it, and it seems like these concerns have become more
| mainstream and less controversial in the last few years,
| e.g. https://ntp.niehs.nih.gov/publications/monographs/mg
| raph08
| rogerrogerr wrote:
| It's totally reasonable to make this as a simple risk
| balancing decision: "unknown but probably small risk, vs.
| known and definitely small benefit" is not the kind of
| fact pattern that we should persecute people for
| differing on.
| SketchySeaBeast wrote:
| Rural children, who it stands to reason would be more
| likely to not be drinking fluoridated water, have higher
| odds of being overweight or obese than urban.
|
| https://www.cdc.gov/pcd/issues/2023/23_0136.htm
| fourside wrote:
| Not sure that's apples to apples. Fluoride is a mineral.
| IIRC, ozempic is closer to a hormone.
| Jerrrrrrry wrote:
| >Fluoride is a mineral.
|
| Even noble gases can be psychoactive.
| rmellow wrote:
| Adding iodine to salt has greatly increased the population's
| IQ in countries that have adopted it.
|
| https://pubmed.ncbi.nlm.nih.gov/15734706/
| crooked-v wrote:
| Sure: the popularization of coffee across western Europe in
| the 1600s and 1700s, and the way it replaced beer as the most
| common daytime casual drink. Much of the population went from
| spending all day mildly intoxicated to being mostly sober and
| with a caffeine pick-me-up.
| dtquad wrote:
| There are some evidence that Ozempic/Wegovy actually cures
| more addictions than just food addiction.
| >The weight-loss jabs have apparently helped people kick
| habits from smoking to shopping, although scientists remain
| wary about recommending it as an addiction treatment
|
| https://www.theatlantic.com/health/archive/2023/05/ozempic-a.
| ..
| anigbrowl wrote:
| Some athletes (especially weightlifters) use Tadalafil, an
| erectile dysfunction drug, because it also promotes bone
| density and muscle growth while having few observable side
| effects. This isn't really surprising, it's basically just a
| mild vasodilator. A better known drug in the same class
| Sildenafil (aka Viagra) is less mild, and associated with
| retinal damage if overused.
| Blackthorn wrote:
| Going by the results around addiction, I'm betting on #2 with
| reduced alcohol consumption.
| fourside wrote:
| I'm skeptical of the idea that across the general population
| we'd be healthier if we dialed up our insulin production.
| Serious question but has there ever been a case of humans
| benefitting from increasing a hormone like this? Since it's an
| injection, It wouldn't be a steady increase, but more likely
| have bursts of it. I don't know how healthy that would be in
| the long run.
|
| After what happened with OxyContin I think wed benefit from
| some skepticism when a new drug gets oversold.
| aantix wrote:
| GLP-1's have been around since 2005. Exenatide.
|
| They're not new.
| pixl97 wrote:
| > Serious question but has there ever been a case of humans
| benefitting from increasing a hormone like this?
|
| By itself this might be an ok question, but in context it's
| rather useless....
|
| Diet and obesity changes by both lowering and increasing
| different hormone outputs in your body. You're balancing the
| question of "how is this hormone" versus "How bad is obesity
| on the body". Well, the answer is in, obesity is extremely
| unhealthy on the body in both the short and long term.
|
| Drug overdoses cause somewhere around 100k deaths per year in
| the US. Obesity complications related deaths are in the
| 250-300k deaths per year.
|
| You can be skeptical as you want, but behind smoking, obesity
| is the worst epidemic in the US.
| gcr wrote:
| I can understand this perspective. You're looking at it with
| healthy eyes.
|
| But for fat people, the calculus looks different.
|
| A decision to take semaglutides is a decision between the long-
| term negative effects of obesity *now*, or the possibility of
| long-term negative effects *later.*
|
| Anecdotally, trans people have a similar calculus. Going
| unmedicated/unsupported brings significant mental health risk
| _now_ [1], whereas going on hormone replacement may or may not
| cause complications much later in life (osteoperosis,
| hepotoxicity issues for some treatments, etc).
|
| Either way, you gotta get to the "later in life" part before
| you can worry about the outlook there.
|
| 1: a CDC meta-review said that 26% of surveyed US trans
| students attempted suicide this year, N=20,103 surveyed, ~660
| of which were trans. https://archive.ph/0H81G
| jncfhnb wrote:
| I was curious and a bit skeptical that sex change operations
| materially affected suicide rates for trans people but
| available papers tended to find significant effect sizes of
| about 50% reduction
| 0x1DEADCA0 wrote:
| No, they're making a choice between the long-term negative
| effects of not losing weight naturally, vs the possibility of
| long-term negative effects of using artificial methods. This
| isn't polemic, as even things as basic as birth control and
| advil have negative long term effects.
| gcr wrote:
| I think we're saying the same thing? The only difference is
| that I personally don't believe that self-control is
| sufficient for everyone to lose weight. If you do believe
| that, then the risk estimates become much easier.
| epolanski wrote:
| For sure, the consequences at psychological level are dire.
|
| People can't be bothered to take a walk or eat a salad instead
| of a pizza more often, but are willingly working multiple days
| per month to afford these drugs.
|
| This is absurd.
| al_borland wrote:
| > I'm not getting any of the benefits because I'm not
| overweight.
|
| You're already benefiting.
| bryanlarsen wrote:
| > a huge swath of the population will be dealing with issues 30
| years form now
|
| We've got 20 years of data on this class of drug. Certainly
| there could be some long term issues that we're not aware of
| yet, but it's not likely that there are significant issues that
| affect a large percentage of users after 30 years that didn't
| affect the small sample of users that have been using it for 20
| years or the massive number of users that have been using it
| for 10.
| DonnyV wrote:
| How much of the data was done independent and how much was
| done by the same company or companies that benefit from it?
| We've seen this before. How many decades did people take
| aspirin thinking it was good for you to take everyday. How
| many decades did people drink wine thinking it was good for
| you in small dosage? How many people smoked using it as an
| appetite suppressant not knowing the long term effects?
|
| The list goes on forever. I'm betting this ends the same way.
| pixl97 wrote:
| How much data do we have on obesity and the effects of it?
| vessenes wrote:
| Dude, the mortality rates go up at least linearly, maybe
| super-linearly, to weight over a certain amount. It's not
| like some mythical / hard to read / later benefit. This is
| a drug that radically changes those risks NOW, really
| quickly. It's a different matter than aspirin (helpful if
| heart disease is a real risk, otherwise no) or wine or
| smoking, both of which people have a strong interest in
| thinking of as good for you.
| bee_rider wrote:
| Medical FOMO? I wouldn't worry too much about it, I mean, there
| are hypothetical upsides to countless decisions we haven't
| made, right? We always miss some chances in life.
| anigbrowl wrote:
| _OR - there will be some long term positive consequence to
| using Ozempic et al, and I 'm not getting any of the benefits
| because I'm not overweight_
|
| Who the fuck cares? If you're not overweight and are reasonably
| then you're already winning in physiological terms. If you can
| maintain a good quality of life into old age and then die, what
| more do you want? Going through life worrying about whether
| you're missing out on some marginal health benefit from the
| drug-of-the-moment is neurotic.
| pajeets wrote:
| i think overweightness should be seen more as a symptom and I
| share parent's concerns about ozempic's long term side
| effects being unknowable in the present
|
| all in all general unease about dealing with symptoms and not
| the root cause of overweightness except in rare genetic
| cases, its overwhelmingly a dietary/exercise issue.
|
| in this country the pill/drug is the answer and solution to
| everything but all this does is pile on more bandages without
| addressing the root cause which a very American solution.
|
| I do not think the full ramifications are realized or
| knowable when there are profits to be made on both side of
| the fence, sort of like the whole opiate crisis in America
| started out as magazine ads blew up into a major crisis 20~30
| years later.
| julianeon wrote:
| But consider the tradeoff: it's okay to have serious health
| issues in 30 years, if you were projected to die in 20 years
| without it.
| rqtwteye wrote:
| It's a pretty sad thought that everybody will be on a drug that
| keeps weight in check while most people will still eat a
| basically toxic diet. Weight is certainly an important factor but
| there is more to a healthy life.
| habitue wrote:
| Seems like just an orthogonal problem? If calorie input is
| solved, now all the moralizing and shaming can be about
| nutrition instead
| mock-possum wrote:
| And make no mistake we _will_ find something new to moralize
| and shame about because _that's what we do_
| asib wrote:
| Sure, but the "unhealthy but not excessively caloric" diet is
| not a problem ozempic attempts to address. As far as I
| understand, it simply limits your appetite. Potentially one can
| go on ozempic, lose weight, and still end up eating
| unhealthily, because the resulting diet is made up of
| nutritionally poor foods.
| MBCook wrote:
| No, but if it helps avoid the discussion because the very
| visible side effect is lessened, then in some ways things are
| worse. No squeaky wheel.
|
| I'm glad it's available for those who need it. But I agree
| with GP that there is another discussion we need to be having
| too we've avoided for far far too long.
| Blackthorn wrote:
| "visible side effect", dude, modern food is _fortified to
| the hilt_. If you 're overeating on calories it's tough to
| have a deficiency in most places!
| giantg2 wrote:
| And the argument you are replying to is that it's just
| covering up a symptom and not addressing the root problem
| holistically. Ozempic isn't a fix, it's a bandaid.
| sokoloff wrote:
| Bandaids serve a genuinely useful health-promoting purpose.
| I suspect we'll find the same is true of GLP-1s even if it
| only addresses part of the entire problem.
| giantg2 wrote:
| Only when applied correctly and with other interventions.
| Using ozempic without diet and exercise changes is like
| putting a bandaid on a .5" deep wound without sterilizing
| it.
| fragmede wrote:
| because ozempic reduces the food cravings, patients are
| able to implement and stick with a diet change. it's not
| like "put down that cheeseburger and have a salad" is
| something they haven't heard before and haven't
| internalized already, it's just their brain won't do it.
| ozempic gives them the space on their brain to actually
| do it.
| ProfessorLayton wrote:
| The drug works by suppressing appetite. Eating less of
| the same things is still a dietary change.
|
| Exercise is recommended for everyone, regardless of
| weight.
| hombre_fatal wrote:
| Sure, but so what? Until we can permanently change aspects
| of our brain, like our proclivity for addiction, then all
| interventions are bandaids on top of an underlying problem.
|
| Even behavioral changes like avoiding fast food don't fix
| the underlying problem in your brain. It's topical.
|
| It's amazing how the subject of Ozempic brings out such
| trivial claims uttered with a serious face.
| eightysixfour wrote:
| The "obesity is a moral failing" argument has an
| exceptionally strong hold on people.
| giantg2 wrote:
| Way to strawman. That's not what I said.
| eightysixfour wrote:
| Alright, what is the root cause we are putting a band-aid
| on, exactly?
| giantg2 wrote:
| The combination of bad diet and lack of exercise.
| Specifically in the context of this conversation, its
| about how ozempic will not fix a bad diet. Eating less of
| a bad diet is better than eating more of a bad diet, but
| is still a bad diet in the end.
| eightysixfour wrote:
| Right - why do people eat a bad diet?
| giantg2 wrote:
| And using ozempic without those diet changes is the same
| damn thing. You need to work on it from both directions.
| mrweasel wrote:
| > Ozempic isn't a fix, it's a bandaid.
|
| My original impression was that it was suppose to be a
| crutch, helping you get started on a healthy lifestyle. So
| if you are to heavy to exercise without hurting yourself it
| could help you lose that initial weight. Or it can help you
| with your appetit, while you adjust your diet.
|
| You also can't stay on Ozempic, you have to continuously
| increase you dose to get the same effect, so it's simply
| not viable to keep taking it for an extend period of time.
| That's at least the impression I've been getting from
| talking to people working at pharmacies.
| kelseyfrog wrote:
| That's great. We still give crutches to people who break
| their legs and bandaids to people with wounds. We don't
| tell them that being completely healed is better than using
| those aids.
| jprete wrote:
| Ozempic does not simply limit your appetite, it seems to also
| affect how much reward your brain feels from different foods
| (and activities!), which would make it easier to override
| those anticipated rewards with conscious choices.
| kelseyfrog wrote:
| From my understanding GLP-1 agonists can actually modulate the
| reward pathway reducing people's appetite for toxic diets.
|
| We're not socially caught up yet to this information. I suspect
| there are folks who believe that regardless of similar outcome
| (reduction of toxic diet), that changing diet without
| medication is superior to those who change their behavior
| through pharmacological intervention. It's like the pre-1990s
| view on depression or anxiety - chemical intervention is a
| moral weakness.
| andrewmcwatters wrote:
| You can literally do the same thing by eating a healthy diet
| for 2-4 weeks.
| hombre_fatal wrote:
| That's a trivial claim about any medication that changes
| behavior. You can achieve the same thing that the
| medication does by "just" having different behavior.
| SV_BubbleTime wrote:
| Have you considered that maybe it is an evolutionary
| trait that it is hard to do certain things? That the
| people who can expend the effort and discipline, perhaps
| have a better configuration than those that can't or
| don't?
| hombre_fatal wrote:
| Sure. People say the same thing about ADHD.
|
| The question is how a trait fares in the modern world.
|
| Maybe a trait was useful to an ancestor but not to you
| today trying to navigate a calorie rich world of
| convenience. Just like a trait useful to a nomadic hunter
| might work against you when you're expected to sit at a
| desk job if you want to make the money necessary to
| fulfill your ambitions.
|
| It may very well be the case that we end up medicating
| away traits that were useful at some point in our lineage
| but not today. I just don't see how it matters much
| beyond the thought exercise.
| SV_BubbleTime wrote:
| I don't think that's a great comparison.
|
| Have you wondered why ADHD has exploded?
|
| Have you not realized how many people at hacker news are
| on SSRIs? Watch this comment, you will.
| filoleg wrote:
| The exact same argument can be applied to literally any
| medical issue, and it is a pointless one.
|
| Someone has an elevated risk of skin cancer due to their
| genetics? Probably an evolutionary trait that it is more
| likely for some people to get skin cancer within their
| lifetime. That doesn't mean that using sunscreen and
| providing those people with related medical care (if the
| need arises) is some crime against nature and will end up
| hurting evolutionary prospects of the human race.
| ben_w wrote:
| > Someone has an elevated risk of skin cancer due to
| their genetics? Probably an evolutionary trait that it is
| more likely for some people to get skin cancer within
| their lifetime.
|
| More than probably, it's called "being white".
|
| (And we evolved that for more vitamin D?)
| vundercind wrote:
| Weird that the ones skinnier foreigners with a "better
| configuration" get genetically altered (I guess) to a
| worse configuration when they move to the US, then.
| SV_BubbleTime wrote:
| IDK what you mean, but if it isn't clear to anyone that
| our food is poison, it should be.
|
| My complaint is getting addicted to pharma because we're
| addicted to toxic food.
| vundercind wrote:
| My point is that skinny populations don't seem to be
| skinnier than the US population due to greater
| genetically-backed willpower (better "configuration"). At
| least, if it's a factor, it's overwhelmed by other
| factors, it seems.
| fragmede wrote:
| hilariously, the toxic food companies are worried that
| ozemic will kill their profits. Maybe the pharma industry
| can fight the food industry conglomerates.
|
| https://www.bloomberg.com/news/articles/2023-10-07/ozempi
| c-f...
|
| https://www.wsj.com/business/ozempic-impact-snack-food-
| compa...
|
| https://www.washingtonpost.com/business/2023/10/09/ozempi
| c-w...
|
| https://www.cnn.com/2023/10/05/investing/ozempic-food-
| compan...
| andrewmcwatters wrote:
| No, it's an actual documented behavior about human
| consumption habits, but of course Hacker News would have
| a large breadth of nay-sayers despite the volume of
| papers published on the matter on the National Library of
| Medicine (site:ncbi.nlm.nih.gov).
|
| Reforming your dietary patterns alters your production of
| ghrelin. You can do this in as little as a few weeks.
| Most of the issue is related to sugar consumption in
| Western diets.
|
| Downvote me all you want, it's anti-science, anti-
| intellectualism to suggest otherwise. This has been known
| for decades.
|
| But please, lecture us all on how maintaining the Western
| diet of high sugar, high carb, high processed food
| consumption while just offsetting cravings with glucagon-
| like peptide-1 is a superior method to learning how to
| eat like an adult.
|
| What an absolute mockery of dietitian work and a totally
| gross and off-putting sentiment.
| yohannparis wrote:
| Could you provide some of those papers? I'm interested on
| what you are saying, but I am not able to find what you
| are mentioning using the link you provided.
| andrewmcwatters wrote:
| site:ncbi.nlm.nih.gov ghrelin, reward
|
| It goes on and on and on. In lab mice, it has been shown
| you can alter production in as little as 10 days. Human
| hormone production has similar turn around times.
| rfrey wrote:
| I eat almost zero processed foods and very little sugar -
| mostly from fruit. I shop exclusively on the perimeter of
| the grocery store and eat at a restaurant maybe once a
| month, with all my meals cooked at home. I try my best to
| limit portions.
|
| I have been overweight my entire life. I have
| successfully lost weight with up to eight months of
| calorie restriction, so my willpower is just fine, thank
| you. I have always gained it back, and you calling me out
| for some kind of moral turpitude is not helpful.
|
| Your "eat like an adult" finger waggling is
| condescending, and claiming anyone who thinks obesity is
| more complex than "just eat better food, bro" is anti-
| intellectual and anti-science is just insulting - and not
| particularly "pro science" either.
| andrewmcwatters wrote:
| In 8 months of losing 2 pounds a week, you would have
| lost roughly 64 pounds. You could have been losing more
| than that which is common on diets where added sugar is
| removed. But you're talking to someone who has worked
| with people with class 3 obesity and has seen the weight
| successfully stay off.
|
| You're omitting details. You simply didn't change your
| eating habits. Statistically, this detail you shared is
| also overwhelmingly the documented reason why people fail
| to keep off weight. Almost entirely, people who reside in
| higher classes of obesity have no idea what their
| relative consumption habits are in comparison to those
| with lower BMIs.
|
| This may come as a surprise to you, but most other
| countries where obesity is not a problem, most sugar
| consumption is also from fruit and these peoples' diets
| _don't_ contain anywhere near the amount of added sugar
| an American diet does. This isn't a special thing to
| point out, you just think it is because you have no other
| frame of reference.
| rfrey wrote:
| 2 lbs a week is a 1000 calorie per day deficit. My loss
| was closer to half a kilo a week. I have fluctuated
| between 85 and 210 kg since I was 16 or so. I am now 54.
|
| Of course I am not saying my body violates the laws of
| thermodynamics. After some time I succumb to cravings and
| begin overeating again, a bit at first and then more. I
| am not denying this is behaviour driven. My only point
| with the fruit aside was that I'm not consuming my sugar
| from chocolate milk or sugary breakfast cereal, not that
| I think fructose is exempt.
|
| But to suggest that all I have to do is eat healthfully
| for a few weeks and my cravings will be gone is
| infuriating. I have eaten healthfully for years and
| years, and eaten at a calorie deficit (of healthy food)
| for many months at a time. And the cravings NEVER go
| away. I always go to bed thinking of food.
|
| Maybe I should get a nutrition degree and then my body
| will conform to what your textbooks say should happen.
| kelseyfrog wrote:
| Why not get curious instead of litigating someone's
| experience? It's part of the HN guidelines after all
| andrewmcwatters wrote:
| There are a lot of statistics in dietary behavioral
| studies and dietary reinforcement that are mostly
| uninteresting because, frankly, people omit details.
|
| You can lose considerable weight at speeds that are
| actually not recommended simply by dropping added sugar
| from American diets. So much so that you would need to
| taper off this removal to stay around 2 pounds of weight
| loss a week instead of dropping this consumption pattern
| cold turkey.
|
| The biggest difficulty in sourcing food materials or
| eating out is that we have sugar in _everything_. We have
| added sugar in things that in other countries you would
| have never added sugar into to begin with.
|
| The reinforcement habit is directly tied to food reward,
| sugar consumption, and ghrelin production. Anyone who
| tells you otherwise is lying and is simply refuting what
| we have come to understand about food science over the
| years.
|
| And frankly, we as a people have not yet completely
| matured out of the phase of producing or accepting low-
| fat foods being replaced with high sugar content. Plenty
| of other nations never had this problem at all, never
| inherited it, and as a result, don't have to grow out of
| it.
|
| It is staggering how much of our food is incompatible
| with healthy weight homeostasis, and all of our common
| supermarkets absolutely work against you unless you are
| otherwise taught differently.
|
| * * *
|
| Edit:
|
| If you're baking bread for your family every day, even
| without added sugar, and you don't see the problem here,
| I don't know how anyone can help you.
|
| I'm not calling you a liar. I said you were omitting
| details. You didn't mention that you're frequently eating
| carbs. Now you mention that you're baking, and presumably
| eating, bread every day.
|
| This is a big eating habit detail.
| rfrey wrote:
| I bake bread for my family every day because I can't get
| bread in Canada that has no sugar. I'm aware of how
| insidious sugar is.
|
| You obviously deal with a lot of obesity that is caused
| by excessive sugar consumption. Your conclusion - and
| smuggled assumption - is that all obesity is caused by
| sugar. This is trivially refuted by finding obese people
| in non-high-sugar societies, or from a time period before
| sugar became ubiquitous.
|
| Calling me a liar does not make your position stronger.
|
| Response edit: I have four school aged children who get a
| sandwich for lunch every day. It takes no time at all for
| a family of six to go through a 650g loaf of bread, and
| it doesn't require overeating - I'm the only one in my
| family with a weight problem, and I bake the bread I
| don't eat it. Your assumption that everyone in the world
| is exactly like you is truly breathtaking.
| outworlder wrote:
| > This is trivially refuted by finding obese people in
| non-high-sugar societies, or from a time period before
| sugar became ubiquitous.
|
| Those people definitely existed, but were pretty rare.
| Maybe you are one of them. Statistically, probably not.
|
| > I bake bread for my family every day because I can't
| get bread in Canada that has no sugar. I'm aware of how
| insidious sugar is.
|
| That is definitely way, way better than anything store
| bought, so it's great that you are doing that. However,
| even without added sugar, bread will start converting to
| sugar immediately after being in contact with saliva(and
| will continue once the pancreas enters the picture). So
| you are eating sugar every day still, possibly quite a
| lot of it.
|
| I had to severely decrease bread consumption, as well as
| anything containing simple carbs, to decrease my insulin
| resistance.
| rfrey wrote:
| >Those people definitely existed, but were pretty rare.
| Maybe you are one of them. Statistically, probably not.
|
| Mexico has approximately the same per-capita sugar
| consumption as Italy, Spain and France, yet the obesity
| rate exceeds that of the U.S. Norway has 50% more per-
| capita sugar consumption than the US and very little
| obesity. I don't think eating little sugar or refined
| food, yet being overweight makes me a statistical anomaly
| at all.
|
| I'm not claiming some kind of magic variation in base
| metabolic rates. I'm only saying that it is too
| simplistic to point at refined sugar and say that a
| complex problem has that one simple cause. (And that to
| solve it one need only learn to be an adult).
|
| I don't eat bread by the way, I bake it for my family. I
| do revert to eating potatoes and pasta though, which is
| no doubt to blame for my weight fluctuations. My
| irritation in this discussion comes only from the
| ridiculous claim that if I were only to eat like a grown-
| up for two weeks, food cravings would disappear and my
| problems would be solved.
| andrewmcwatters wrote:
| Mexican cuisine employs large amounts of fat, directly,
| or in the form of cheese. Take a trip to Italy, Spain, or
| France. It's a very different eating atmosphere. The
| portions and ingredients aren't comparable, and in
| Europe, there are greater food protections that straight
| up don't exist in North America.
|
| Carrefour et Monoprix ne ressemblent pas du tout a ceux
| de WalMart, etc. You can't compare them. Their food
| selection makes ours in the states look embarrassing, and
| I wouldn't be surprised if it were the same for Canada.
| It's superior on all fronts.
|
| It isn't too simplistic to look at sugar or general
| carbohydrates and say, this ingredient has the highest
| reconstitution of habit developing behaviors compared to
| that of any other macronutrient. Your body's ability to
| reinforce food habituation compared to any other
| macronutrient on a graphed scale makes every other macro
| look like peanuts. It's sugar. It's carbs. It's a fact.
| It's scientifically proven. I implore you to do the
| reading yourself. Fat also has a high recidivation rate,
| but it pales in comparison to carbohydrates.
|
| For your own health and the risk that you'll tell others
| otherwise as well, just dismiss me and read these studies
| yourself.
|
| It's that easy, and the reality is that no one adjusts
| for it. Your supermarkets don't care and all of the
| people around you probably don't realize it either. It's
| cultural. It's in your beer. It's in your coffee creamer.
| It's everywhere.
|
| It is the dietary equivalent of global warming denial.
| Seriously. I have watched people with class 3 obesity
| drop 40 pounds in one month, which is terribly hard on
| your body and not recommended, by immediately switching
| off high carb, high fat diets.
|
| Yes, your food cravings do truly, really, disappear
| within a span of 2-4 weeks. Within 30 to 60 days, people
| can and do form rejection habits with little documented
| "willpower" in the same way these individuals using GLP-1
| hormones do.
|
| Because it's the same activation vector. You increase
| incretins production through rich protein consumption.
| People suffer from the effects that you describe because
| of leptin resistance. For people in extreme weight class
| categories, you don't get off after a few months, fat
| cells stay in your body for years in dormant, reduced
| volume form.
| rfrey wrote:
| Of course I eat carbs when I shouldn't. Not the bread,
| but I eat potatoes sometimes, and too much fruit. I'm not
| denying that I eat too much.
|
| The point is you claim that if we gluttons would just cut
| out sugar for 2 weeks and learn to be an adult, our
| appetites and cravings would disappear. That's nonsense,
| and your dismissal of data that doesn't fit your
| narrative makes your accusations towards others of being
| anti-science both hollow and ironic.
| Chernobog wrote:
| Not to argue for or against Ozempic, but there is a
| difference between what motivated individuals can achieve
| on their own, and what one can expect of the general
| population.
| mock-possum wrote:
| Do you have the time to seek out and keep healthy food? Can
| you afford it? Do you have the executive function and
| impulse control etc to bring to bear the necessary self
| discipline?
|
| You're making some pretty casual assumptions about people's
| abilities.
| vundercind wrote:
| Studies show nothing but high-touch interventions by
| specialists actually works for losing weight and keeping it
| off for a study cohort (i.e. might represent a population-
| level solution).
|
| These are impractically expensive and _still_ less
| effective than one might expect.
|
| Researchers seem to be eager about the promise of
| supplementing the very-best programs they've been able to
| find... with GLP-1 agonists. Because that might finally
| make them _really_ effective.
|
| That's how bad the entire body of _all other solutions
| we've looked at_ is.
| outworlder wrote:
| > You can literally do the same thing by eating a healthy
| diet for 2-4 weeks.
|
| You have been downvoted, but that's true(and supported by
| evidence and science). Statistically, what most people have
| is sugar addiction. Simple carbs in general completely mess
| up your hunger hormones.
|
| The problem is that most people don't know what a healthy
| diet is. The food pyramid isn't it. Drinking a bunch of
| juice isn't it. Cereal is candy. They try "eating healthy",
| fail (not realizing what they are eating isn't healthy at
| all) and give up.
| mrweasel wrote:
| > GLP-1 agonists can actually modulate the reward pathway
| reducing people's appetite for toxic diets.
|
| There are also studies out showing that people just up their
| sugar intake, so I think the results on how it affects
| peoples diet is still pending. From what I've seen, people
| are eating less, but more of it is junk food and sugar.
|
| I can absolutely see why people would want to be able to just
| take a drug and start losing weight, it's hard. My concern is
| that it takes more than a low body weight to be healthy. You
| still need exercise, and while that's not an effective
| weight-lose solution, it is something that most would add
| when trying to lose weight, and now they're missing out on
| that part. Arguably exercise is more important than your
| weight.
| kelseyfrog wrote:
| > Arguably exercise is more important than your weight
|
| I'm curious to hear the argument
| mrweasel wrote:
| Exercise strengths your cardiovascular system, immune
| system, improves bone strength, builds muscle (which
| helps you as you age, preventing the risk of falling and
| fall related injury), improves mental health, reduces
| stress. If your in good physical shape, it's less of an
| issue if you carry around a little extra fat.
|
| You can still be in bad health, even if your weight is
| spot on, but it's rare that you exercise a lot, but is
| overall unhealthy.
| kelseyfrog wrote:
| In terms of tangible outcomes, it helps you live longer
| or something compared to weight loss? greater reported
| life satisfaction? Or is this more of a personal value?
| akira2501 wrote:
| > chemical intervention is a moral weakness.
|
| As a default it is. And that's what it became. We stopped
| trying any other methods. Come in the door, have a set of
| symptoms that check all the boxes, walk out in 30 minutes
| with a prescription, doctor's office gets a bonus.
| Institutional psychiatric treatment is drugs first actual
| treatment later.
|
| This is a _social_ problem. It should be discussed and
| addressed as such. You should not attempt to pervert this
| concern into an _individual_ issue in an effort to invoke a
| needless moral defense.
| crooked-v wrote:
| > As a default it is.
|
| Why?
| triceratops wrote:
| If it's a social problem then the non-pharmaceutical cure
| is obviously not white-knuckling a diet and exercise
| regimen individually. It needs a holistic, society-level
| solution. More time off work, less car-dependent suburbs,
| more bike lanes and subsidies for bikes, more agricultural
| subsidies for healthy food and less for corn. Realistically
| we aren't going to get those things.
| Karrot_Kream wrote:
| There's a decent amount of evidence that the most toxic thing
| about modern diets is their amounts: calorie counts and such.
| Many things (sugars, ultra-processed foods (ugh I hate the NOVA
| classification), fat, etc) are fine in moderation. The dose
| makes the poison.
| Fernicia wrote:
| Is it fundamentally any different from something like
| toothpaste?
|
| Humans have created a technology (mechanised farming) with a
| side effect we haven't yet evolved to handle (an abundance of
| tasty calories), so it doesn't seem all that strange we would
| fix it with a technology (inhibiting the desire for said
| calories).
| lostmsu wrote:
| I think your statement is very funny. If the drug keeps weight
| in check on a toxic diet and that has the same outcome as
| "healthy life", then is that "healthy life" any more healthy
| then the drug+junkfood combo? Also, what is sad about it?
| dr_dshiv wrote:
| It's not clear to me that this is the case.
|
| People in the Netherlands eat such shit food -- but they are so
| healthy because they move a lot and aren't obese.
|
| I'm not sure that food quality is as important as we sometimes
| hope it is (after all, we pay for quality)
| intothemild wrote:
| I've been on wegovy for almost two years now, and I can attest
| to how much you just DONT want to eat junk anymore. It's one of
| the most commonly talked about things we discuss with other
| users over the last few years. That and lower want to drink,
| and gaining back so much of energy/time due to not having to
| think about food every 3 seconds of the day.
|
| I'm super satisfied just having an apple or two now. The "omg I
| need to eat, ohh a burger" is gone.
| chankstein38 wrote:
| I'm not arguing at all here but just wanted to say, I've
| noticed similar effects just focusing on eating healthier
| over the last few years. I haven't taken anything to help I
| just wanted to stop eating poorly and now adays it's not
| "shove the entire box of cookies in my mouth" it's "have 1
| cookie and don't finish it because it's too rich" and I
| haven't eaten fast food in as long as I can remember. I used
| to see a McDonald's french fry commercial or just think about
| them and need McDonald's. Now I see it and go "ah they were
| good but eh" and move on with my life.
|
| Glad you're seeing benefits like that!
| snarf21 wrote:
| Serious question: Why not make toxic diet illegal or cost
| prohibitive? Lots of manufactured food is designed to be more
| addictive. Then add in constant advertising bombardment
| targeted at kids. Why is there up to double the sugar in US
| bread and soda versus Europe?
| steveBK123 wrote:
| The politics of legislating diet are very fraught, let alone
| the implementation is incredible complicated.
|
| Even blue state dem voters I know used to whinge about
| Michelle Obama and her veggies lol.
| cyberax wrote:
| > basically toxic diet
|
| This is a bullshit term. Even fast food is not "toxic", it's
| just calorie-dense.
|
| I got overweight eating nothing but "healthy" diet because I
| have never _liked_ fast food.
| petesergeant wrote:
| > while most people will still eat a basically toxic diet
|
| It's a pretty sadder fact that people just make these wild
| assertions. Everyone I know (which is about 10 people in real
| life, myself included) who's used a GLP-1 drug found that they
| eat healthier because they've less desire for shittier food.
| outworlder wrote:
| > while most people will still eat a basically toxic diet.
|
| Had to scroll too far to find this. It's a great synergy isn't
| it? The food industry creates calorie concoctions that can
| barely be called food, are dirt cheap to make and rakes in
| profits. People get sick. The pharmaceutical industry sells
| drugs are stupid high profit margins so that people can keep on
| living.
|
| It is not a conspiracy, but it's a good feedback loop for
| corporations. All that money allow them to flood the scientific
| community with their sponsored studies, dominate news
| broadcasts (confusing consumers) and even influence the food
| pyramid, which is almost upside down.
|
| I've been on a slow quest to improve health and lose weight.
| It's really, really slow, far slower than what most people
| would like. But cutting added sugars to zero (including and
| most especially high fructose corn syrup) gave almost immediate
| benefits that kept me going. Sugars (and carbs in general) make
| you retain a lot of water. Cut those, and you'll see a major
| difference in the scale in a couple of weeks. Is it mostly
| water(but not entirely!) Yes. It doesn't matter, our lizard
| brains interpret that as success. That also reduces hunger,
| which is a positive feedback loop.
| jaredwiener wrote:
| FWIW, I was prescribed a GLP-1, but my insurance will not cover
| it. It's incredibly expensive out of pocket.
| gadflyinyoureye wrote:
| Only in the US. Other countries are like 90% less expensive.
| However, Medicare might try to get better deal since the next
| round of deal making can include it since the drug is 7 years
| old.
|
| https://slate.com/technology/2023/07/ozempic-costs-a-lot-it-...
| hombre_fatal wrote:
| What about compounding pharmacies like Hims.com? It's $400/mo
| month to month but $200/mo if you pay a year upfront.
| rootusrootus wrote:
| $400/mo will get you tirzepatide (zepbound), if you're okay
| with semaglutide (ozempic) it'll probably be about half that.
|
| Although tirzepatide just got knocked off the shortage list
| last week so it could become harder to get in compounded
| form.
| gandalfian wrote:
| Seven years, December 2031. That's when the patent expires, the
| kinks and side effects will have been found/ironed out and it
| becomes a cheap plentiful generic. I'm healthy enough to wait.
| apsec112 wrote:
| This compares Ozempic with past drugs, but sales of past drugs
| are almost always limited by demand. I'm not sure there's much to
| learn here for a drug that is limited by supply. Also, this part
| is silly:
|
| "The announced investments across both companies total $32
| billion. GLP-1s were 71% of Novo's revenue in 2023, 16% of
| Lilly's in 2023, and 26% of Lilly's in 2024Q1. If these sales are
| proportional to the manufacturing capacity used to create those
| drugs, then about 40% of Novo and Lilly's combined estimate of
| $45 billion in gross PP&E is for GLP-1s, for a total of $18
| billion; $25 billion would then mean a 140% increase in
| GLP-1-relevant PP&E."
|
| Manufacturing investment is not proportional to sales, because
| there's a fixed cost to making a certain drug regardless of how
| much you sell. If a rare-disease drug will have a few thousand
| patients ever - not uncommon! - you still need to figure out a
| synthesis path for that particular drug, run QC tests on the
| production line, get regulatory approval, etc. Economies of scale
| matter a lot
| (https://en.wikipedia.org/wiki/Experience_curve_effects).
| cubefox wrote:
| And apparently the pure manufacturing cost for Ozempic is
| relatively low:
|
| > the active drug in Ozempic can be produced for about 29 cents
| for a month's supply, or 7.2 cents for a typical weekly dose,
| the research found. It's not cheap to make -- semaglutide costs
| over $70,000 per kilogram. But only a tiny quantity of the drug
| is used in each weekly dose.
|
| > https://fortune.com/europe/2024/03/28/ozempic-maker-novo-
| nor...
|
| I think this makes it likely that strongly ramping up the
| supply is not a major problem.
| rory wrote:
| By chance I just talked to someone with deeper knowledge on
| this and they said the current constraint is actually ramping
| up supply of the delivery mechanism, not the drug.
|
| I have zero expertise on this, but would be curious if anyone
| knows what's special about Ozempic delivery that can't be
| served by a commodity syringe.
| davio wrote:
| hims sells the generic version for a fraction of the price
| but you have to do regular injections
| Someone1234 wrote:
| "hims" is selling Compound Pharmacy drugs, which will be
| made illegal soon. Soon your options will be
| $1000-1500/month from the two big drug companies.
|
| They're meant to have a vial-needle version, but it is
| $600/month and you can only do it for up to 5-months and
| a low max dose. So it isn't a real program, but rather a
| way to avoid critique from legislators.
| op00to wrote:
| > what's special about Ozempic delivery
|
| People don't want to use a commodity syringe. People are
| scared of needles. The autoinjectors take most of the fear
| out of it.
| jaggederest wrote:
| > but would be curious if anyone knows what's special about
| Ozempic delivery that can't be served by a commodity
| syringe.
|
| They can't charge as much. That's basically it. Generic
| semaglutide from compounding pharmacies (which have their
| own issues for sure) is under $150 a month cash-pay these
| days.
|
| The real issue with syringes and self administration is
| that the vast majority of the population are not
| comfortable with it and don't have the diligence to do it
| correctly every time, so you get under/over dosage or
| noncompliance.
|
| That being said, the autoinjector format doesn't really
| solve that problem, it just slightly ameliorates it, in
| exchange for approximately 8x the cost.
| vessenes wrote:
| Agreed. Don't forget they're spending on next-gen versions of
| these too -- Novo is testing a pill form that's apparently
| twice as effective as semaglutide(!) right now. It's easy to
| imagine that becomes part of many people's January routine --
| stop drinking, take your pills, go to the gym for a month,
| slowly put the weight back on during the year, no problem.
| Dumblydorr wrote:
| Not fully true- orphan drug status exists for rare diseases and
| gives advantages to companies who develop drugs for rare
| conditions. This includes longer exclusivity periods amongst
| other incentives, rendering these categories more feasible
| economically.
| spondylosaurus wrote:
| I'm shocked that TFA doesn't mention the (massive, booming)
| market for compounded semaglutide and tirzepatide. The long-
| term future is uncertain, but since these drugs have been under
| shortage status, third-party pharmacies can legally compound
| them to meet increased demand.
| philipkglass wrote:
| 9 days ago the FDA declared the tirzepatide shortage over,
| though the other popular drugs in this class are still
| eligible for compounding based on shortage status:
|
| https://www.fda.gov/drugs/drug-safety-and-
| availability/fda-c...
| fredgrott wrote:
| for those that do not know there is a herb that targets
| GLP-1...its called Berberine
|
| And yes its over the counter....I currently take one dose per day
| at 1200mg
| aleksiy123 wrote:
| How effective is it?
| wizzwizz4 wrote:
| Source? https://www.mcgill.ca/oss/article/medical-critical-
| thinking/... (2023) disagrees with you:
|
| > Neither is berberine any version of Ozempic, which is an
| analogue of glucagon-like-peptide-1 (GLP-1), a natural hormone
| that regulates blood sugar and helps people feel full.
| Berberine has nothing to do with GLP-1.
|
| > Perhaps the most interesting laboratory finding, given the
| rising global tide of type 2 diabetes, is the control that
| berberine may exert over blood sugar. But there is a problem.
| Berberine is virtually insoluble in water and has low
| intestinal absorption which means it has poor bioavailability.
| [...] Because of berberine's poor bioavailability, supplements
| on the market are likely to be useless. However, some
| derivative of berberine, may yet make it to the physician's
| prescription pad. But it won't be for weight loss.
| zonkerdonker wrote:
| I was able to find this: https://www.sciencedirect.com/scienc
| e/article/abs/pii/S00062....
|
| Apparently most of the effect is due to activation of the
| "bitter taste reception pathways" in the gut. So even though
| it has very low bioavailibility, it can still stimulate GLP-1
| secretion just simply due to its incredible bitterness
| rootusrootus wrote:
| Does it only stimulate GLP-1 in the gut, though? As I
| understand it, most of the positive effects of GLP-1
| agonists are the effect they have on the brain's GLP-1
| system, not the guts.
| philipkglass wrote:
| Interesting.
|
| "Berberine induces GLP-1 secretion through activation of bitter
| taste receptor pathways"
|
| https://www.sciencedirect.com/science/article/pii/S000629521...
|
| But buyer beware when it comes to getting berberine from over-
| the-counter supplements:
|
| "Variability in Potency Among Commercial Preparations of
| Berberine"
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807210/
|
| _Nine of the 15 tested products (60%) failed to meet the
| potency standards of 90% to 110% of labeled content claim, as
| commonly required of pharmaceutical preparations by the U.S.
| Pharmacopeial Convention. Evaluation of the relationship
| between product cost and the measured potency failed to
| demonstrate an association between quality and cost.
| Variability in product quality may significantly contribute to
| inconsistencies in the safety and effectiveness of berberine.
| In addition, the quality of the berberine product cannot be
| inferred from its cost._
|
| Worse still,
|
| "Preparation and Evaluation of Antidiabetic Agents of Berberine
| Organic Acid Salts for Enhancing the Bioavailability"
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337101/
|
| _Berberine--an isoquinoline alkaloid isolated from the rhizome
| of Coptidis rhizome, Cortex phellodendri, and other plant
| species--possesses a variety of pharmacological effects,
| including anti-cancer, anti-hyperglycemic, anti-hyperlipidemic,
| antimicrobial, anti-inflammatory, and antioxidant activities.
| However, its absolute bioavailability is as low as 0.68%. Low
| bioavailability greatly restricts the clinical development of
| berberine._
| rootusrootus wrote:
| I'd think it more likely that it'll be one of the next generation
| drugs, but I do agree with the premise that it will be really
| common.
|
| A few weeks ago I started a low dose of tirzepatide (aka
| Mounjaro, aka Zepbound) and the side effects are interesting.
|
| The biggest negative, which just takes adjustment, is drastically
| lower stomach capacity. Used to be that two eggs and two pieces
| of toast was breakfast. Now I better skip at least one of those
| pieces of toast or I'm going to feel overfull and might get
| reflux as punishment.
|
| But there are some unexpected positives.
|
| Obviously I am eating less. I have to log food not to keep it in
| check, but to make sure I'm eating enough and with the right
| nutrients. There's another possible negative here -- you get a
| lot of hydration from food, so if you start eating less you
| should carefully monitor your fluid intake to allow for that.
|
| But I'm also more focused. Not nearly as distracted. I'm getting
| a lot of things done which I used to just procrastinate on until
| years had passed in some cases. Man, the garage is going to be
| _clean_ and superbly organized in a few weeks.
|
| And my emotions are quieter. Not just the food noise, that was
| expected, but I feel more relaxed. That's not what I expected,
| and I'm pleasantly surprised.
|
| As an aside, what makes this all really noticeable is that it's a
| once-a-week injection, and the peaks and valleys are _very_
| obvious. Saturday is injection day, but Sunday is where it
| _really_ becomes quite noticeable that I took it. Monday-
| Wednesday is cruising altitude and the effects are good but not
| over the top. Thursday I can feel it tapering, and today ...
| well, I 'm looking forward to tomorrow's injection. I might
| switch to a twice-a-week split dose at some point to ease the
| peaks and valleys.
|
| Edit: Before someone asks, yes I have considered there may be
| long term effects. This is a risk, which I've decided I'm okay
| with at my age. Nobody gets to live forever anyway, and I was
| going to end up in an early grave via another route if I _didn
| 't_ do this. "Just eat less and exercise more" is trite. If it
| were _that_ easy, we 'd all be in fantastic shape.
|
| I do hope to taper off at some point if I can figure out an
| alternate strategy for staying lighter. Though I'll miss some of
| the positive side-effects.
| jeffbee wrote:
| > Man, the garage is going to be clean and superbly organized
| in a few weeks.'
|
| Manic behaviors also associated with older, popular diet drugs
| like meth.
| cyberax wrote:
| It's not the manic behavior, but the opposite. GLP-1 agonists
| appear to reduce the impulsive behavior.
| abeppu wrote:
| Does anyone have references on any explanation, or even
| partial explanation, on why this might be the case?
|
| The published stuff I can find seems to be at the level of
| anecdata, scarcely better than "I know a guy who..."
|
| - What people talk about on social media:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10669484/
|
| - Some people made large "reckless" life choices:
| https://academic.oup.com/qjmed/advance-article-
| abstract/doi/...
| cyberax wrote:
| > Does anyone have references on any explanation, or even
| partial explanation, on why this might be the case?
|
| Not yet. The effect appears to be real, but it's too soon
| to tell: https://www.science.org/content/blog-
| post/ozempic-and-other-...
|
| From my own anecdata, unnecessary impulsive eating
| probably reinforces the impulsive behavior. You start
| associating impulsive behavior with a reward.
|
| GLP-1 not only removes that, but adds a slight negative
| reinforcement. Impulsive eating no longer brings reward,
| but makes you feel over-full. This can then down-
| regulates the pathways that lead to increased impulsive
| behavior.
| rootusrootus wrote:
| Great description, thanks!
|
| I won't sugarcoat my problems. I _knew_ I wasn 't hungry
| when I'd eat sometimes. I _knew_ it would keep me
| overweight. I _knew_ it wouldn 't even feel great
| afterwards. And yet, more often than not I did it. And
| beat myself up over it _every time_. Very demoralizing,
| even without help from moralizing folks on the internet.
|
| On tirzepatide the impulse is just gone. I feel like I
| can take it or leave it, and since the consequences of
| eating unnecessarily are quickly negative, I just don't
| do it.
| AlanYx wrote:
| There are about a dozen published studies using GLP-1
| analogues in animal models showing reduction in addictive
| behaviors (search for papers by Jerlhag, Leggio and
| Schmidt). The prevailing theory seems to relate to
| dopamine regulation.
| Qem wrote:
| > GLP-1 agonists appear to reduce the impulsive behavior.
|
| Does it reduce sex drive as well?
| firesteelrain wrote:
| No it doesn't but some people have started TRT therapy
| too which will increase testosterone and then sex drive
| too
| swat535 wrote:
| Doesn't losing weight already increases your
| Testostrone?.. people seriously shouldn't get on TRT
| unless they need it medically, once you start it, it's
| for life and also you will be infertile.. (source I am on
| HCG, an alternative to TRT due to its side effects).
| firesteelrain wrote:
| That's correct - you need to be seen by a doctor before
| embarking on TRT. For me, I have no intent of having any
| more kids. Infertile can be reversed.
| rootusrootus wrote:
| TMI, but no.
| rootusrootus wrote:
| I said a few _weeks_ ;-). The garage is pretty big, but not
| _that_ big. It 's going to be gloriously organized in a few
| weeks because I spend a half hour or so in the evenings to
| move the project forward. I'm very relaxed about it. I'm just
| doing exactly what I kept telling myself I should do to make
| the garage as organized as I want, rather than finding pretty
| much anything else to do.
|
| Decades ago I tried phentermine for a couple months. Now
| _that_ was a ride, and you might call the experience closer
| to manic. I was a _machine_. This is not like that.
| copperx wrote:
| It would be interesting to compare the anxiolytic effects of
| the drug versus the cancer anxiety caused by being on the drug.
|
| The cancer anxiety could be reduced by frequent testing. e.g.,
| having a thyroid ultrasound every 6 months, or a yearly
| abdominal MRI, just to make sure cancer is not brewing.
| arcticbull wrote:
| There's no evidence that GLP-1s cause cancer in any
| meaningful amount, but obesity definitely does. Either way
| the only cancer they found any correlation to was thyroid
| which is one of the most treatable -- over 99% survival
| rates.
| copperx wrote:
| While thyroid cancer is highly treatable, the type of
| thyroid cancer that GLP-1 drugs cause is the rare and
| untreatable variety.
| arcticbull wrote:
| There's no causative relationship. There is a correlation
| in some studies. This is not the same thing. Beyond that,
| some studies have found a very weak association and some
| have found no association at all. To say with this corpus
| of evidence they cause anything is very premature.
|
| This 2024 study showed no increase in risk over 3.9
| years.
|
| https://www.bmj.com/content/385/bmj-2023-078225
| cyberax wrote:
| > There's no causative relationship.
|
| To be fair, GLP-1 drugs cause dose-dependent increase in
| thyroid cancer in mice. But mice are not humans.
| gcr wrote:
| Is cancer anxiety a common response?
|
| I haven't seen any mention of cancer on r/zepbound
| arcticbull wrote:
| > "Just eat less and exercise more" is trite. If it were that
| easy, we'd all be in fantastic shape.
|
| Studies show it just doesn't work.
|
| There was a massive (18,000,000 people) cohort analysis
| published in 2023 that showed the likelihood of someone losing
| 5% of their body weight in any given year was 1 in 11 and the
| likelihood of going from severely obese to normal weight is 1
| in 1667.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407685/
|
| [edit] not to mention for those 1 in 11, the average weight
| regain over 5 years is 80%.
|
| https://www.sciencedirect.com/science/article/pii/S000291652...
| pfdietz wrote:
| I've lost 27 pounds since May (12%). Eliminating most carbs
| and doing lots of walking. I think being on metformin helped.
| jeffbee wrote:
| > and doing lots of walking
|
| If you just teleport a fat guy from Bentonville to
| Manhattan and give him a Metrocard he will lose a pound a
| week. The people who say nobody can lose weight, it's too
| hard, cannot explain why there are macroscale populations
| with lower obesity.
| arcticbull wrote:
| Surely you have a study to support this? Or are we just
| speculating. The problem with this particular area is
| that it's not intuitive, and relying on "common sense"
| guidance is why everyone got fat in the first place.
| randomdata wrote:
| Does it matter? This is a discussion forum, not a
| scientific journal. If you have something more
| informative to add, just do it.
| arcticbull wrote:
| Generally here if you make a claim it's totally fair to
| be asked to substantiate it. I already provided the
| evidence that this individual was wrong, so I'm looking
| to see why they think otherwise. Maybe they'll teach me
| something new.
| randomdata wrote:
| _> Generally here if you make a claim it 's totally fair
| to be asked to substantiate it._
|
| Anything is fair. It is a discussion forum. You can say
| whatever the hell you want. But it is equally
| nonsensical.
|
| _> so I 'm looking to see why they think otherwise. _
|
| You looked for _someone else_ - someone who prepared a
| study - to tell you why it might be otherwise. But if you
| want to talk to someone else, go talk to that someone
| else. If you want to come here, be happy with the people
| who are here. They might actually teach you something
| without having to defer to random other people.
| tikhonj wrote:
| Questioning questionable claims is as much discussion as
| anything else.
| SketchySeaBeast wrote:
| I'm taking a moment to enjoy your username in the context
| of this back and forth.
| connicpu wrote:
| "It's too hard" includes "It's too hard to just magically
| change the environmental factors making it difficult for
| this specific person". We can't just magically move every
| obese person to NYC, and unwalkable car-dependent
| infrastructure cannot be fixed overnight either, even if
| the people living there all decided to vote for
| politicians who would legitimately work towards making
| that happen (still seems unlikely). Unless and until we
| work towards fixing the societal problems that created
| the obesity crisis in the first place, we still need
| short term solutions for the next couple decades at
| least.
| rootusrootus wrote:
| Those same populations are gaining weight at a trajectory
| that is behind the US but still headed the same
| direction. AFAIK most western European nations have a
| majority of people overweight, with 20-25% obese. This is
| less than the US (though it's very regional within the
| US), but you don't get to brag about a 1-in-4 obesity
| rate.
| mmsc wrote:
| >This is less than the US (though it's very regional
| within the US), but you don't get to brag about a 1-in-4
| obesity rate.
|
| Are you sure?
|
| >In 2023, over 35 percent of adults in the Netherlands
| were classed as overweight, meaning they had a body mass
| index (BMI)of between 25 and 30. Furthermore, just under
| 16 percent of adults were obese
|
| >47 percent of French adults were overweight, of which 17
| percent suffered from obesity
|
| >49% of the Belgian population has overweight, of which
| 18% have obesity.
|
| >Spain: 43% of adults aged 18 years and over were
| overweight and 16% were living with obesity
|
| >46.6% of women and 60.5% of men in Germany are affected
| by overweight (including obesity). Nearly one-fifth of
| adults (19%) have obesity.
|
| Looks like it's actually 1-in-5.
| rootusrootus wrote:
| For the purposes of this discussion, I will take your
| numbers as truth and run with it.
|
| Are you arguing that 1:5 is good, but 1:4 is bad?
|
| The only large populations of people in the world that
| aren't quite fat are southeast Asians. And this is fairly
| accurate whether they leave in southeast Asia or in the
| US or western Europe. Not 1:5, closer to 1:20 or in one
| case 1:50.
|
| Even then, southeast Asian obesity rates are climbing.
| The US may have led the pack because of a consistently
| high standard of living, but I don't see any indication
| that there are macroscale populations anywhere in the
| world keeping the disease at bay.
| mmsc wrote:
| >Are you arguing that 1:5 is good, but 1:4 is bad?
|
| No, I'm saying that 1:4 is something to brag about, and
| 1:5 is even better.
| dmonitor wrote:
| Giving fat guys ozempic is significantly easier than
| teleporting them all to Manhattan
| rootusrootus wrote:
| I did that in 2020. May through November. 40 pounds off.
| Then I sprained my ankle. I apologize for being negative,
| but come back in a year and let us know how it's going.
| Many, many people can lose 10%, 20%, even 30% of their body
| weight with concerted effort. Works for a year or maybe
| two. It's actually pretty easy, to be honest, most people
| who've done it will agree with me.
| crooked-v wrote:
| I had the same kind of experience. Not as dramatic as
| that, but six months of careful dieting lost weight, but
| then within a month after I stopped calorie-counting I
| was back at the same original slightly-overweight weight
| I had previously plateaued at.
| pfdietz wrote:
| Not going to claim that won't happen.
| patmcc wrote:
| >>>Studies show it just doesn't work.
|
| It's not that "eat less and exercise more" doesn't work, it's
| that nobody does it, because it's really, really hard.
|
| Calories in/Calories out is both completely true and
| completely useless for actual humans.
|
| edit: that's unfair, mostly useless
| petesergeant wrote:
| The best way to stop smoking is to never have another
| cigarette!
| logicchains wrote:
| >It's not that "eat less and exercise more" doesn't work,
| it's that nobody does it
|
| There are plenty of examples of people who've managed to
| lose weight through diet and exercise, it's not "nobody".
| Sure it's a small % success rate, but that's because it's
| not easy. Just like squatting or deadlifting 300 lbs, it's
| not easy to get there, but the vast majority of humans
| could if they decided to put the time and effort into it.
| arcticbull wrote:
| Would you apply the same analysis to people with
| depression who cured their depression by smiling more?
| It's not zero, it's just very hard. Ultimately both are
| chronic issues of the central nervous system. We know
| GLP-1s act on the GABAergic central nervous system.
| patmcc wrote:
| Sure, I don't mean _literally_ nobody, just 'nobody' in
| the statistical sense - from the comment I replied to,
| "the likelihood of going from severely obese to normal
| weight is 1 in 1667."
| gensym wrote:
| I'm one of those examples. I've never been obese or
| really even overweight, but mid-2023, I noticed my
| clothes were no longer fitting, and I decided to take off
| some weight. I lost 20 pounds over the course a a few
| months and have managed to keep it off since. Body scans
| aren't accurate, but the 1 scan I took after losing the
| weight put me at 13% body fat.
|
| It's one of the hardest things I've done. I'm no stranger
| to hard physical things - I've run marathons, raced
| cyclocross, done daily bike commuting through several
| Chicago winters, and I'd rate the weight loss as up
| harder than all of those. At the risk sounding too
| hubristic - if that's the effort it takes to lose weight,
| doing so is beyond the abilities of large swaths of the
| population. Not to mention that I have the time and
| financial resources to weigh my food, buy foods that were
| optimal for my diet (so much yogurt and chicken!), etc.
|
| (As a side note, exercise isn't a very good way to lose
| weight in my experience. It's valuable to do for all
| sorts of other reasons, but I actually gained weight when
| training for my first marathon, while running 60-70
| miles/week).
| stevenAthompson wrote:
| Right. It works, it isn't sustainable because it doesn't
| just take effort it takes effort multiplied by time (effort
| x time = permanent weight loss).
|
| Obviously, even a small amount of effort becomes impossible
| when you multiply it by "forever".
| wilburTheDog wrote:
| That's not a valid argument, though. Firstly nobody lives
| forever. Second you don't have to exert all the effort at
| once, so the totality of effort doesn't matter. At any
| given time you just have to decide whether to have the
| snickers bar or the apple. And that's not an impossible
| effort. We don't live our entire lives all at once. We
| just have to be present for one moment at a time.
|
| Edit: In my opinion it's hard for two reasons. We have
| cravings for high calorie foods. And no one candy bar
| will make you fat, so it's easy to think "I'll exercise
| more tomorrow to make up for this indulgence." But then
| you don't, because that's hard too.
| stevenAthompson wrote:
| > At any given time you just have to decide whether to
| have the snickers bar or the apple.
|
| No, you have to decide to even think about the difference
| between them instead of thinking about something in your
| life that feels more important. It's a sort of cognitive
| opportunity cost. You have to consciously think about
| food (instead of something useful) forever, because your
| body's instincts are telling you to do the wrong thing
| and you need your rational mind to overrule it.
|
| So for the rest of your life, every day, until you die
| you must decide to stop and expend effort making that
| decision instead of thinking about work, family,
| politics, or writing a new bit of code that will change
| the world. Most human beings can do it for a while, but
| not forever. The only way to do it forever is to get your
| body chemistry on your side and reduce that cognitive
| load.
| jodrellblank wrote:
| > " _The only way to do it forever is to get your body
| chemistry on your side and reduce that cognitive load._ "
|
| That's how all creatures in the wild do it. That's how
| humans did it for the past quarter million years. And all
| creatures did it for the past hundred million years.
| Wait, no, it isn't. Then there must be another way. A way
| that doesn't involve manipulative abusive capitalists and
| advertisers destroying health in the name of profit while
| selling it as freedom.
|
| > " _or the rest of your life, every day, until you die
| you must decide to stop and expend effort making that
| decision instead of thinking about work, family,
| politics, or_ "
|
| How much does that lifestyle sound like freedom to you?
| stevenAthompson wrote:
| >That's how all creatures in the wild do it... Wait, no,
| it isn't.
|
| Neither creatures in the wild, or primitive man, have
| access to unlimited quantities of calorie dense foods. We
| could go back to that lifestyle, but billions would have
| to die and the overall human lifespan would decrease
| rather than increasing.
|
| I think I'd rather take a perfectly safe drug than go
| back to wiping with leaves and hunting for worm riddled
| meat.
|
| > How much does that lifestyle sound like freedom to you?
|
| I'm not even sure I understand which lifestyle you're
| asking about here, but if you mean the modern lifestyle
| then it's certainly more free than the lives primitive
| man had. "Might makes right" was the rule of the land
| back then, and contrary to your imagination, you probably
| wouldn't have been the mightiest. Certainly not forever.
|
| Hell, it's more free now than the lives most of our
| grandparents had. 50 years ago about half of all white
| people surveyed said they'd move away if a black person
| bought a house in their neighborhood, and gay people were
| routinely murdered for existing.
|
| There were no "good old days", and Stardew Valley is just
| a game.
| card_zero wrote:
| > Firstly nobody lives forever
|
| Lose weight permanently through cremation?
| gcr wrote:
| Giving whole new meaning to burning those carbs!
| mrweasel wrote:
| Precisely, the point of Ozempic (or rather Wegovy, Ozempic
| is for type-1 diabetes) is that it reduces your appetite,
| making it easier to eat less.
|
| One of the studies done with Wegovy showed that people lost
| 15% of their body mass in a year, but they also eat 500
| Calories less and exercised for 2.5 hours a week.
| jnwatson wrote:
| Wait, Wegovy makes people exercise more?
| crooked-v wrote:
| That's probably counting 'light exercise', aka walking
| around. That works out to 20 minutes a day, so it could
| just be the side effect of people being lighter and so
| walking places being more comfortable.
| mrweasel wrote:
| Oh, no sorry, the study I read had people on Wegovy, but
| it also had them exercise 2.5 hours per week at the same
| time.
|
| The point was that the 15% weight lose in a year is in
| the high end of what you can expect, especially if you
| change nothing else.
| odo1242 wrote:
| Weight gain makes it harder to exercise. In any
| particular day, eating more also makes exercise harder
| (because it tanks your energy levels).
|
| This is especially true if you count light exercise.
| Scoundreller wrote:
| Being full of food also makes it hard to exercise.
| rblatz wrote:
| It's hard to exercise when you are overweight. It puts
| more strain on your joints, makes injury more likely, and
| it's all around harder.
|
| Maybe there is a path to using these drugs in a manner to
| get people healthier so they can exercise more, establish
| good habits and taper down.
| rstupek wrote:
| Correction type-2 diabetes not type-1
| mrweasel wrote:
| Yes, sorry, I misread when I looked it up. You're
| correct, it's for type 2.
| opo wrote:
| >...Ozempic is for type-1 diabetes
|
| At the present time, Ozempic is not approved for Type 1
| diabetes:
|
| >...Ozempic(r) is not for use in people with type 1
| diabetes.
|
| https://www.ozempic.com
|
| Compared with Type 2, with Type 1 diabetes there are
| other risks that could occur:
|
| >...While medications such as GLP-1 receptor agonists
| (Ozempic, Wegovy) and SGLT-2 inhibitors (Jardiance,
| Farxiga) demonstrated powerful benefits, they quickly
| were determined to pose too much of a liability for
| pharmaceutical companies or regulators due to concerns
| about safety. Specifically, GLP-1s can increase the risk
| of hypoglycemia (low blood sugar) and SGLT-2s can raise
| the risk of a serious, life-threatening complication
| called diabetic ketoacidosis (DKA).
|
| https://diatribe.org/diabetes-medications/why-diabetes-
| mirac...
| blargey wrote:
| People chanting "If everyone just did X, Y wouldn't be a
| problem!" without seriously addressing why everyone doesn't
| just do X already, or making a serious proposal for how
| everyone is going to just do X from now on.
|
| A phenomenon not limited to dieting.
| brianmcc wrote:
| Yep. When 1 or 10 or 100 people do a thing, it's a "them"
| issue. When 100,000,000+ do a thing - it's a wider issue,
| and asking those 100,000,000 to do it differently just
| isn't a useful strategy.
| borroka wrote:
| Given that a few decades ago obesity and overweight rates
| were nowhere near what they are today, this shows that a
| large part of the population is weak, fragile, and not very
| interested in their well-being.
|
| I want to emphasize that a few decades ago, people were
| much thinner in the Western world and did not hate their
| lives because they could not eat a triple cheeseburger, go
| hungry constantly, or feel physically deprived. Those were
| my parents and my grandparents, I know them.
|
| But if you show them hyper-caloric food that makes them
| feel like crap, they can't say no. It's disappointing. And
| the same can be said for addiction to social media,
| horrible TV series, and constant music everywhere.
| cortesoft wrote:
| Do you think it is because the people before were
| mentally stronger? No, it is because they lived in a
| different environment. If you were to transport those
| people from decades ago to today, the same portion of
| them would become obese.
| borroka wrote:
| That's what I'm saying. It's not that people were
| stronger then, it's that, as many times throughout life,
| traits are revealed by circumstances, there's nothing
| particularly physiological about feeling the need to eat
| like hippopotamuses that have been deprived of food for
| months.
|
| The unattractive, low-status man (or woman) has less
| trouble remaining faithful than the handsome, high-status
| man (or woman). Not because they are more virtuous, but
| because they are not as exposed to temptation. But fewer
| people justify the unfaithful than the "big eater." And
| that's something society and culture have decided, for
| now.
| freeone3000 wrote:
| They are the same people now that they were then.
| Humanity has not become any more weak, fragile, or
| uninterested in their well-being -- it has simply become
| harder to resist. TV was appointment viewing and cut off
| late at night. Before the walkman, there wasn't much
| option for music everywhere (the scourge was newspaper-
| readers! but the paper is only so long). And that triple
| cheeseburger today wasn't acceptable or _available_ to
| eat unless you made it yourself. Healthy eating being
| hard is a product of collective decisions to _make_ it
| hard.
| FuriouslyAdrift wrote:
| We used to smoke a lot (an appetite suppressant and mood
| stabilizer) and also worked physical jobs in factories or
| farms.
|
| Service jobs are not conducive to good health.
| borroka wrote:
| By looking at the size and bellies of construction
| workers, farmers, and people doing all sorts of jobs with
| significant physical activity, one cannot find much
| support for this hypothesis.
| FuriouslyAdrift wrote:
| Just look any picture from the 60's 70's or 80's...
| everyone was skinny
| CooCooCaCha wrote:
| Eating less and exercising more does work, in fact that is
| how you lose weight. The problem is doing it consistently
| which is what these drugs help with.
| thfuran wrote:
| Yes, they clearly mean that it doesn't work at a societal
| level. If you take a human and force them to exercise more
| and eat less, they're going to lose weight. And everyone
| knows that, but pretty much every modern society is
| increasingly overweight. Ergo, "it doesn't work".
| CooCooCaCha wrote:
| No, everyone does not know that. That's why the phrasing
| is harmful.
| lukasb wrote:
| Are there any studies that look at body fat % instead of
| weight? I don't care how much I weigh.
| adrian_b wrote:
| A good proxy for body fat %, especially for males, is the
| waist circumference / hip circumference ratio.
|
| See e.g.
|
| https://en.wikipedia.org/wiki/Waist%E2%80%93hip_ratio
|
| for recommended values.
| potta_coffee wrote:
| It would work if people would actually do it. It 100% works.
| Human nature is such that people would rather take a drug
| than change their lifestyle. I've done it myself but it
| requires a complete realignment of lifestyle to make lasting
| change.
| icedchai wrote:
| Another problem is not doing it enough. Walking a couple
| miles once a week isn't going to do much. You have to make
| it a habit, part of your routine, and do it every day.
| arcticbull wrote:
| Also not only is your body very efficient at
| walking/running (losing 10lbs of fat requires an average
| person to run from SF to LA) there's evidence of a
| constrained total energy expenditure model. If you try
| and create a large caloric deficit through exercise you
| become more efficient at the exercise (so each
| incremental step costs less calories) and your metabolism
| slows down (and your NEAT - non exercise activity
| thermogenesis - levels drop) to conserve energy for you
| to expend on exercise.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803033/
| asib wrote:
| In 2018 I did an Ironman triathlon. Across 2020 and 2021 I
| cycled over 20,000 miles. I cycled 200 miles on the hottest
| day of 2022 in the UK. In 2021 I cycled 200 miles in under
| 12 hours. In 2023 I ran over 10 half marathons. You simply
| cannot tell me I didn't completely realign my lifestyle or
| that I'm not determined.
|
| At my lightest in 2023, I weighed 60kg. Currently I weigh
| over 95kg. I don't know what else people who hold your view
| can be told to convince them this problem is not one of
| willpower. I have the capacity to suffer. I've given up
| smoking. There is no escape from food.
| manfre wrote:
| You described a lot of physical activities, but diet
| controls your weight. It's natural to have more of an
| appetite with increased activity. It's also normal to
| increase your weight a bit due to increased muscle mass.
| asib wrote:
| I'm trying to demonstrate that I'm not this ridiculous
| (and frankly grossly reductive) caricature of the
| overweight slob. And yet I still struggle with food. So
| maybe let's drop that notion altogether, because it's not
| at all helpful.
|
| The extra weight is not muscle, to be clear.
| SketchySeaBeast wrote:
| Yup. I lost 70 lbs in 2017, and I ran my first marathon
| last month. I'm going out to run a half on Sunday because
| that's just what I do now, it's nothing to go out and
| enjoy myself for 2 hours. I'm fit, I know how to lose
| weight, I know how to be in the suck but I know that this
| coming winter I'm going to have to fight to keep a decent
| weight as I fight stress and the holidays. The battle
| never ever stops and it's exhausting.
| GeoAtreides wrote:
| >There is no escape from food.
|
| Ah, but what is food?
|
| A cake made with sugar, flour, and butter will have a
| different impact than the equivalent number of calories
| in blueberries
|
| Eggs and butter will make you feel different and will be
| treated different by your body than white bread and
| peanut butter and jelly
|
| food is too general a term, it encompasses too many very
| different things
| icedchai wrote:
| Of course, it "doesn't work" because people don't keep it up.
| I started exercising regularly during covid and didn't stop.
| I cut out all the soda. It works.
| aantix wrote:
| Report back in 10, 15 and 20 years.
|
| Likely, you will at some point revert to unhealthy habits
| and become fat again.
|
| Long-term weight loss success numbers are abysmal.
| doublepg23 wrote:
| So we should be on drugs the rest of our lives?
| soulbadguy wrote:
| Aren't we already ?
| WorkerBee28474 wrote:
| I dropped from the mid 300s 10-15 years ago to 260-ish
| these days. It fluctuates from 250 to 280 over time, but
| keeping off weight long-term by changing diet is very
| much doable.
| rootusrootus wrote:
| > 250 to 280
|
| That should be very doable for most people. 250 is
| overweight for everyone under 7 feet tall, and 280 is
| obese for everyone under 6 foot 9 inches (that's about
| 99.997% of the population, if my data source is correct).
| For the vast, vast majority of people 350 pounds would be
| somewhere in the mid-40s BMI.
| nahnahno wrote:
| This is so stupid.
|
| If you want to not be fat, exercise and eat fewer
| calories. Full stop.
|
| The fact that a certain group of individuals don't have
| that self control is just evidence that education and
| public health have a place. Drugs won't solve that.
|
| These drugs are needed for people with metabolic
| disorders caused by years of food abuse or poor genetics.
| It's not a population wide solution.
| arcticbull wrote:
| "This is so stupid, if you want to stop smoking put down
| the cigarette! Full stop."
|
| Like (a) no shit and (b) the question is why can't
| people. Because we know objectively they can't.
|
| The drugs work by literally solving your self control
| issue, and to such an extent it works beyond just food.
| dalyons wrote:
| We have 50+ years of incontrovertible evidence that that
| advice doesn't work for the overwhelming majority of
| people. "Just have self control" is the stupid take imho.
| avidiax wrote:
| A meta-analysis of 29 long term weight loss studies[1]
| found:
|
| > By 5 years, more than 80% of lost weight was regained
|
| I think a much better hypothesis is that CICO does work,
| physically, but there are metabolic, hormonal and mental
| factors that either predispose towards obesity or make it
| difficult to escape.
|
| It's a bit like telling gambling addicts to "just stop
| gambling" or depressed people to "lighten up".
|
| And along comes GLP-1 drugs, where obese people find it
| easy to lose weight, find new motivation for life, etc.
| The GLP-1s aren't increasing metabolism, nor are they
| making people exercise, nor are they making food less
| available. Yet somehow, a hormonal mediation is greatly
| successful, hmm.
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
| oremolten wrote:
| it's interesting you state "Studies show it just doesn't
| work." While we are commenting on an article about a drug
| which makes you feel less hungry, there by "eating less". The
| drug doesn't make you use more calories, it simply "makes"
| you EAT LESS. Eating less(calories) than your body uses
| consistently for duration is literally the only way you can
| lose weight. (outside of literally losing limbs, or surgery
| to remove mass) Exercise only augments the process, it all
| comes back down to EATING LESS(calories).
| soulbadguy wrote:
| "Telling people to eat less" doesn't work the same way
| telling people to relax doesn't work. It assumes that
| relaxing is under voluntary control.
|
| To bring it back food, the issue is not the eating, the
| core issue is the hunger causing the eating and that's what
| the medication is addressing.
|
| The people you think are eating ea
| vessenes wrote:
| There are a number of pathways these drugs hit - dopamine
| receptors, they slow processing of food, and in
| tirzepatide's case at least increase insulin response.
| They're not just small portions in a shot.
|
| I take "Studies show it just doesn't work" to mean "Studies
| show telling people to eat less and exercise more
| definitely doesn't work," as opposed to "caloric deficits
| don't work".
| AtlasBarfed wrote:
| People need to understand what activity / exercise really is.
| The desperation of the medical establishment to get people to
| do ANY exercise meant the general advice is watered down.
|
| It's the doom of the statistical distribution. Good outcomes
| are defined in relative terms on the bell curve, not on
| absolute performance which exercise is actually suited for.
|
| In days of manual labor jobs and lots of walking, people
| likely burned 1500-4000 calories more per day than sedentary
| modern lifestyles. I can imagine farmers back in the days of
| 12-hour days of physical labor may burn 5000 or 6,000
| calories. A pound of fat is 3500 calories.
|
| Meanwhile, people that are generally following some 20
| minutes of exercise five times a week, regimen of the medical
| establishment are likely really only burning about 300 to 400
| calories tops in those 20 minutes sessions, if they even do
| that.
|
| For the sake of argument, we're going to ignore the basal
| metabolic advantages of people that are burning an extra
| 1,500 to 3000 calories per day and the stimulated muscle
| growth that comes with it.
|
| People back in olden days just on activity were burning a
| third to a half a pound extra of fat per day in terms of
| energy.
|
| Meanwhile, modern people who "exercise" are burning maybe a
| tenth of a pound. Only when you get to "athletes" that are
| "training" do you get to the calorie burns that people's
| lives used to entail.
|
| So it's important to keep in mind when people say exercise is
| ineffective in weight loss that they really are talking about
| very minor amounts of added activity by by modern medical
| standards.
|
| Exercise is extremely effective at limiting weight if you get
| to what I call the 1000 calorie Hammer, where your exercise
| is adding an extra thousand calories or more per day to your
| activity. And you're simultaneously not going nuts on your
| diet.
|
| A 1000 calories is a considerable amount of activity. For a
| 180 lb man, that's 4000 yards of swimming, 7 miles of
| running, or 25-30 miles of biking.
|
| If you are a 120 lb woman, increase those distances by 50%.
| Most people consider those loads to be exercise obsessives,
| but practically that's what's necessary in order to employ
| exercise as a usable means for weight control and surviving
| the corn syrup world we're in
| rootusrootus wrote:
| > In days of manual labor jobs and lots of walking, people
| likely burned 1500-4000 calories more per day than
| sedentary modern lifestyles.
|
| Hasn't this idea been studied using modern-but-primitive
| groups of people who still live much as they have for
| thousands of years? Their bodies are quite efficient and
| they do not burn substantially more calories than
| "civilized" humans in regular society do.
| klooney wrote:
| Studying pre agriculture societies doesn't say anything
| about agriculture labor in the 1940s, which is what the
| grandparent comment was about.
|
| That said, modern farmworkers in my town are mostly
| overweight, for the same reasons as everyone else.
| rybosworld wrote:
| > Studies show it just doesn't work.
|
| Eating less and exercising most certainly does work, if the
| individual sticks to the routine.
|
| I do agree it's difficult to stick to a routine because our
| modern lives are demanding and so we compromise by eating
| fast food and avoid going to the gym.
|
| I think the exercise paradox video recently put out by
| Kurzgesagt has been a net negative for how people think about
| diet and exercise. The paper the video is based on is highly
| flawed.
|
| That paper has a few major problems but these are the
| biggest:
|
| 1) The authors didn't control for body mass. The Hadza and
| Bolivians burned 52kcal per kg of body weight. Americans
| burned only 38kcal per kg of body weight. That is: the active
| groups burned significantly more calories than the inactive
| groups, on a pound-for-pound basis.
|
| 2) The active groups were defined as such because they walked
| ~12km per day. This is significant because the human body is
| exceptionally efficient at walking. It is certainly true that
| over a comparable span of time, you will burn less calories
| walking than you would running, or lifting weights.
|
| GLP-1's are miracle drugs and people should take them if they
| at are high risk for obesity-related diseases.
|
| But diet and exercise certainly do aid weight loss, and will
| have fewer negative side effects than a GLP-1 drug.
|
| https://www.germanjournalsportsmedicine.com/archive/archive-.
| ..
| bdndndndbve wrote:
| Homeostasis is a powerful force. Once you gain weight your
| body has a tendency to keep it, and overcoming that to
| establish a new equilibrium is difficult and uncomfortable.
| bozhark wrote:
| This is absurd.
|
| Caloric intake and outtake is just that.
| rootusrootus wrote:
| That is a simplistic description which is superficially
| true. The body, however, is quite a bit more complicated
| than that. _Especially_ when you get to that wrinkly pink
| lump in your skull.
| crooked-v wrote:
| The point you're missing is that telling people "just eat
| less" doesn't work, because it's extremely difficult for
| many people to "just eat less".
|
| That's literally the whole reason that ozempic etc are
| popular, because they make it easier for most people to
| just eat less, in the same kind of way that caffeine makes
| it subjectively easier for someone who's tired to be
| productive.
| rootusrootus wrote:
| > it's extremely difficult for many people to "just eat
| less"
|
| Right. To be explicit, "just eat less" means "live your
| life always hungry." There's a reason this more-or-less
| never works in practice.
| pugets wrote:
| It does work. It couldn't not work. Each day of your life,
| you choose to do one of three things:
|
| 1. Consume more calories than your body will need to function
|
| 2. Consume as many calories as your body will need to
| function
|
| 3. Consume fewer calories than your body will need to
| function
|
| When you consume more energy than you require, your body
| stores the remainder as fat. When you consume less energy
| than is required, your body converts your fat into usable
| energy.
|
| Now obviously, this is an over-simplified explanation of
| nutrition. What you eat, when you eat it, how efficiently
| your body converts food to energy, and other factors will
| determine the little details. But the explanation I've
| provided is not nearly as over-simplified as "it just doesn't
| work."
|
| To make a comparison, it would be like suggesting that the
| financial advice "earn more money than you spend" just
| doesn't work as a method of saving money, on the grounds that
| some % of Americans who try to save money end up in credit
| card debt.
| grayhatter wrote:
| So if understanding the equation about how humans can
| obtain and maintain a healthy diet/weight is as simple as
| you present here. Why doesn't everybody just do that?
|
| You say yourself, it couldn't not work. And yet there's
| hundreds of thousands of people that say it didn't work.
| Explain them, are they lying?
|
| I'd assert, the oversimplified explanation is misleading.
| It's only true in the same way that drinking cold water
| will help you lose more weight than warm water. True or
| not, reality seems to strongly suggest it's irrelevant
| rybosworld wrote:
| > Explain them, are they lying?
|
| Yes.
| grayhatter wrote:
| It's more likely that hundreds of thousands of people are
| collectively lying, than it is that trying to find a
| solution that works for hundreds of thousands of
| different humans all with different needs, lifestyles,
| desires, capabilities, and understanding, might be a tad
| more complicated than just counting intake calories?
| pugets wrote:
| Why assume people will do what's in their own long-term
| best interests, especially after being presented with a
| short-term thrill?
|
| Pizza tastes better than granola. Grand Theft Auto is
| more fun than math homework. Having a Dodge Charger is
| cooler than having a Hyundai Elantra. Who cares about the
| costs? I can always fix my bad habits tomorrow.
| rootusrootus wrote:
| > choose
|
| You're letting that word do some very heavy lifting.
|
| > To make a comparison
|
| I think the comparison is very weak, very superficial. The
| human body is way more complex than CICO. But your
| comparison does have some intuitive value -- there are more
| than a few people who consistently spend every penny they
| make, and sometimes more, just trying to survive. We don't
| see a lot of them on Hacker News, to be sure.
| grecy wrote:
| > * The human body is way more complex than CICO*
|
| Genuine quesion - if I eat 1500 calories today and do a
| measured 2000 calories of work on a treadmill, where did
| that extra 500 calories of energy come from?
|
| Are you suggesting my body can create energy from
| nothing?
| pugets wrote:
| What word would be better than "choose" in this context?
| For the majority of people who aren't prisoners or
| toddlers, there is a good deal of personal choice that
| determines what foods we eat and how much.
|
| Even if fate has it that I must end up at a Wendy's drive
| thru tomorrow night, couldn't it be true that I could
| choose to eat the 400 calorie meal instead of the 800
| calorie meal, or order water instead of Sprite?
| confidantlake wrote:
| It works in the same way as crossing the finish line first
| works to win a race. Of course it works, do that and you win
| 100% of the time. It is not that it doesn't work, it is that
| it is extremely difficult to do.
| adrian_b wrote:
| I hear very often this theory that "it just doesn't work".
|
| To be fair, I had also believed this for many years.
|
| However, all the people who claim that "it just doesn't
| work", have never made any serious attempt to do "it", so
| they cannot know whether it does work or not.
|
| I have been obese for more than a decade, during which I have
| made several attempts to lose weight, which have all failed,
| because they were not done in the right manner.
|
| Then I have made a final attempt using the correct method,
| and I have lost about 35% of my initial body weight during
| about ten months, at a steady rate between 100 g and 150 g
| per day, i.e. about 1 kg per week.
|
| This was more than 10 years ago and since then I have kept a
| constant weight. Because I have done this once, now I can
| control my weight and have any weight I want, even if I gain
| weight extremely easily. It is enough to eat one day like I
| was eating when I was obese to gain enough weight to require
| a week of weight losing diet to go back to the desired
| weight.
|
| The rules for losing weight and maintaining the weight are
| very simple, but they must be observed and those who claim
| that "it doesn't work" never try to observe the rules, so it
| is entirely predictable that it cannot work for them.
|
| First, it should be obvious that after losing weight one must
| eat differently as before, otherwise weight will be gained
| until reaching again the original weight.
|
| To be able to control the weight, anyone who is or has been
| obese must stop eating until they feel satiated. At each
| meal, one must plan before beginning to eat how much to eat
| and then eat only the amount planned, never more than that.
| One must eat a fixed number of meals per day (preferably few,
| e.g. only two meals per day should be enough for an adult who
| has a sedentary lifestyle) and never eat between meals any
| kind of snacks or drink any sweet of fatty beverages. Between
| meals, only water or beverages without any calories (e.g.
| unsweetened herbal teas or tea or coffee) are acceptable
| intakes.
|
| While losing weight, the most important thing is to weigh
| oneself every day with precise digital scales (with a
| resolution of 100 grams or less), at the same hour and in the
| same physiological conditions, i.e. in the same order with
| respect to meals and relieving oneself.
|
| Whenever the weight is not less than the previous day, then
| the quantity of food planned for the current day must be
| diminished in comparison with the previous day. At the very
| beginning of losing weight there may be a delay, e.g. of a
| week or so between starting to eat less every day until the
| weight begins to decrease, but eventually it is possible to
| reach a steady state of a constant rate of losing weight per
| day.
|
| When diminishing the amount of eaten food, only the
| carbohydrates and the non-essential fats must be reduced. The
| amount of proteins, essential fatty acids, vitamins and
| minerals must remain normal. To achieve this, one must eat a
| source of pure proteins, for example turkey breast or chicken
| breast or some kind of protein powders, so that eating enough
| proteins contributes only a minimum amount of calories. The
| rest of the nutrients can be provided mostly by non-starchy
| vegetables and perhaps by some supplements like fish oil. One
| could also eat almost anything that is not recommended, for
| instance chocolate, with the condition that the quantity is
| negligible, which can normally be achieved only when such
| treats are not eaten every day, but e.g. only once or twice
| per week.
|
| These rules are simple and anyone who follows them will lose
| as much weight as desired. Obviously, this is easier said
| than done, because for the entire duration of the weight-
| losing diet one will be permanently hungry and one would tend
| to think about food and it will be difficult to resist
| temptations, so it is better to not keep in the house any
| kind of food that can be eaten immediately, without requiring
| some kind of preparation. Unfortunately, this is unavoidable
| and it is the price that must be paid. After the first few
| weeks, the hunger sensation diminishes in intensity and it
| always disappears for a few hours whenever you find some work
| to do that captures your attention.
|
| As long as you do not want to follow such rules, you will not
| lose weight, but that is because you do not want to do it,
| not because it does not work.
|
| Not wanting to do it is a valid reason, because one may abhor
| more the feeling of hunger during many months than being
| obese, but this decision must be described correctly and not
| be justified by the false claim that "it doesn't work". At
| least in my case, the improvement in my health and in what I
| was able to do (e.g. before losing weight climbing a few
| stairs would make me tired and sweaty) has made worthwhile
| any displeasure felt during losing weight and I have been
| very happy to have achieved that.
| nullc wrote:
| Glad you're having a good time, but the broad ranging
| psychological effects are concerning.
| noch wrote:
| > but the broad ranging psychological effects are concerning.
|
| Fwiw, to me the symptoms he and others have described don't
| seem very different from those of long fasting. And I would
| definitely prefer those symptoms to the ones I had due to
| obesity which ranged from extreme fatigue, heart-pain, muscle
| spasms, depressive shame, restlessness and so forth.
| firesteelrain wrote:
| What kinds?
|
| I have been taking tirz for 7 weeks and walking 5 miles a day
| + exercise. My depression is gone and I have lost 30 lbs. I
| am loving life.
| noch wrote:
| > Saturday is injection day, but Sunday is where it really
| becomes quite noticeable that I took it. Monday-Wednesday is
| cruising altitude and the effects are good but not over the
| top. Thursday I can feel it tapering, and today ... well, I'm
| looking forward to tomorrow's injection. I might switch to a
| twice-a-week split dose at some point to ease the peaks and
| valleys.
|
| Perhaps coincidentally, this is similar to my experience with
| week long fasts: After 48 hours I feel like a precision missile
| cruising towards my target until about 5-6 days later.
|
| But I will use a suitable GLP-1 based drug, because, man,
| fasting feels unbearably brutal for me after 6 days: profuse
| sweat, increased heart rate, brief but intense panic attacks,
| an insane level of sad (but not depressed) introspection, a
| hairpin trigger temper. I become a ridiculous mess. There's got
| to be a better way!
|
| Thanks for sharing your experience and insight!
| pixl97 wrote:
| >I might switch to a twice-a-week split dose at some point to
| ease the peaks and valleys.
|
| If you're willing to shoot up more often it moderates the
| effects better.
| rootusrootus wrote:
| I definitely am. That first shot took a solid 30 seconds and
| three false starts before I could jab it in, but it turns out
| to be a great big nothingburger once you do it. Can barely
| even feel it, nothing like the intramuscular shots like
| flu/etc. I could do this shot as often as necessary without
| batting an eye.
| spondylosaurus wrote:
| Might have to float this by my tirz-taking partner,
| especially if it helps with side effects. They always feel a
| little icky the day immediately after a dose.
| nixosbestos wrote:
| These are the same effects I got from doing OMAD and going
| gluten free. If I fuck up and eat processed food, the "food
| brain" comes back, and I start chasing dopamine like a fiend.
|
| I'm a fan of these tools helping people get this insight,
| because otherwise people just accept that cloud as their
| normal.
| setgree wrote:
| There's some evidence that Ozempic improves general impulse
| control, e.g decreasing alcohol consumption [0], which the
| article mentions.
|
| Also, as Tyler Cowen writes [1], this is probably going to
| translate into big improvements for animal welfare:
|
| > People lose weight on these drugs because they eat less, and
| eating less usually means eating less meat. And less meat
| consumption results in less factory farming. This should count as
| a major victory for animal welfare advocates, even though it did
| not come about through their efforts. No one had to be converted
| to vegetarianism, and since these drugs offer other benefits,
| this change in the equilibrium is self-sustaining and likely to
| grow considerably.
|
| So overall, widespread Ozempic adoption seems like progress to
| me.
|
| [0] https://www.npr.org/sections/health-
| shots/2023/08/28/1194526...
|
| [1]
| https://www.bloomberg.com/opinion/articles/2024-07-20/animal...
| tredre3 wrote:
| > big improvements for animal welfare
|
| Is it? It might reduce the amount of animals killed, sure, but
| it won't improve the well-being of the ones that are still
| raised.
| exitb wrote:
| While this entire chain of thought seems a bit far fetched, I
| think the reasoning here is that if you lower the demand for
| meat, you don't have to resort to factory farming.
| randomdata wrote:
| When was the last time you saw profitability increase, even
| remain stagnant, when demand declined?
|
| Let's be real. If demand for meat declines, producers will
| have to double down on "factories" in order to remain
| solvent.
| exitb wrote:
| Yes, I agree. As I said, that entire argument is far
| fetched at a few different points, this being one of
| them.
| dghlsakjg wrote:
| Anecdotally, I disagree.
|
| I went through a period of vegetarianism (for health
| reasons, not directly for ethics), and once I started
| eating meat again, 1. I eat a lot less, which 2. means
| that I can be much more intentional about sourcing it.
|
| Right now the bulk of the meat that I eat at home
| throughout the year comes from 1 or 2 animals that are
| locally sourced and butchered (normally I share a portion
| of a pig and a cow), and the occasional wild caught fish.
| The meat is tastier, and I can go see the actual animals
| at the farm if I so choose. They are not factory farmed,
| and the price per pound is about the same as buying
| industrial meat at the grocery store since I am buying
| directly from the farmer, and paying a local processor
| for their services.
|
| As things wane in popularity it might be true that they
| become more of a commodity, or it might be true that they
| become more of a niche product where people care more.
|
| I would like to think that if meat consumption becomes
| more of a treat than an everyday thing, that people would
| treat it as such, and go out of their way to eat
| something that tastes better.
|
| Food for thought?
| setgree wrote:
| I would hope this happens, but merely having fewer animals
| alive in factory farming conditions would be a welfare gain
| from me because I think a factory farmed animal's life
| falls below the "life is worth living" threshold. YMMV.
| elif wrote:
| It also reduces the number of animals that suffer if the
| suffering is more important to your ethics.
| randomdata wrote:
| Maybe. There is some evidence that the decline in fertility
| rates are associated with overweight and obesity. Social
| and biological factors leave having children more difficult
| when one is outside of a "normal" weight range. If everyone
| is on Ozempic, they might have more children, requiring
| more overall food and harming even more animals in the
| process.
| Qem wrote:
| > If everyone is on Ozempic, they might have more
| children, requiring more overall food and harming even
| more animals in the process.
|
| It's reported it reduces a series of impulsive
| behaviours. Would it extend to sex? If people are less
| willing to have sex, maybe broad consumption of the
| medicine will further drop fertility rates.
| randomdata wrote:
| Maybe. If more people are less willing to have sex, does
| that harm the animals (meaning humans) who still seek
| it/want more of it?
| eightysixfour wrote:
| This gets into a deep philosophical question people spend too
| much time arguing about. In short, some would argue suffering
| is multiplied by the number of sentient beings that
| experience it, others would argue only the average "amount"
| of suffering matters. You can end with some absurd paradoxes
| if you take either to their extremes.
|
| The reality is probably somewhere in the middle.
| ben_w wrote:
| > The reality is probably somewhere in the middle.
|
| I think such paradoxes demonstrate we probably need a
| completely different approach than anything we've done so
| far.
|
| Utilitarianism feels to me like Mill & Bentham discovered
| basic arithmetic and didn't even realise there was more to
| maths than that.
| beepbooptheory wrote:
| It is perhaps simply the case that such things are
| inherently paradoxical. There is nothing in the stars
| that says ethics should obey PnC!
|
| You see a paradox and say "well that's not right, we
| should do something about it." This has been the story
| since Kant, but for his part, everyone seems to forget
| that he doesn't ultimately "solve" his antinomies, he
| just leaves them as conclusions, "effects of pure
| reason."
|
| It seems way more unreasonable to assert that, in fact,
| there _is_ some consistent, complete ethical framework
| out there, but we havent found it yet, than it is to just
| accept that some kernels of truth or sense are not
| formalizable in the classical sense.
| ben_w wrote:
| I don't know what you mean by PnC, and the Wikipedia
| disambiguation page didn't help:
| https://en.wikipedia.org/wiki/PNC
|
| > It seems way more unreasonable to assert that, in fact,
| there is some consistent, complete ethical framework out
| there, but we havent found it yet, than it is to just
| accept that some kernels of truth or sense are not
| formalizable in the classical sense.
|
| We can prove that complete and consistent set of axioms
| for all mathematics is impossible. An equivalent proof
| for ethics would itself be useful.
|
| However, we do not need to concern ourselves with
| infinite sets etc. for ethics the way we do with natural
| numbers, as there's only relatively (in mathematical
| terms) small number of real people to interact with or
| influence the lives of.
|
| We may not be able to reach an optimal outcome with even
| a limited n, if it turns out to be akin to P != NP. But
| even knowing that, would itself be useful.
|
| The problem I have with Utilitarianism isn't any of these
| things, it's that it's simply trying to maximise how much
| utility there is in the world, then immediately tripping
| over itself because the terms "utility", "maximise" and
| "the world" aren't well-defined, and the way it is
| introduced is simply adding up.
| wholinator2 wrote:
| I'm curious about the paradoxes, if you have any on hand
| ben_w wrote:
| https://en.wikipedia.org/wiki/Mere_addition_paradox
|
| and
|
| https://en.wikipedia.org/wiki/Utility_monster
| eightysixfour wrote:
| Mere addition, as mentioned by the other user is the
| primary one I was referring to, but breaking different
| approaches to utilitarianism only requires one to take
| them to their extremes.
|
| If average welfare of humans is all that matters, then
| one happy human living alone in the universe is the
| equivalent of a million happy humans.
|
| If sum of "welfare" is all that matters, then you can
| argue an exceptionally large number of people being
| tortured indefinitely is better than a happy person.
| randomdata wrote:
| _> In short, some would argue suffering is multiplied by
| the number of sentient beings that experience it_
|
| Factored by how cute the animal is. As a producer of plants
| for human consumption, it's quite obvious that orders of
| magnitude more animals are harmed in that process than are
| ever harmed in traditional meat production. But they're
| mostly ugly insects, so nobody cares.
| ben_w wrote:
| Sounds like you're valuing <mean harm per animal> over
| <integral of harm over all animals>?
|
| I don't get why that would be a better measure?
| Tempat wrote:
| I suppose thinner people do probably walk their dogs more
| often...
| throwaway888abc wrote:
| How long till we become voluntary Voyagers [0] ?
|
| [0] https://www.imdb.com/title/tt9664108/
| SV_BubbleTime wrote:
| Yay, more dependence on the people that are causing the
| problems to begin with!
|
| I swear covid was a personality test. If you came out of the
| last 4 years and are looking for more dependence on government
| and pharma... well, the horseshoe is a V I guess.
| user395929935 wrote:
| Naltrexone will do the same thing. For alcohol, opioid, or
| binge eating control. Improve T3 and helps with blood sugar,
| and its orally bioavailable.
| WhatIsDukkha wrote:
| https://en.wikipedia.org/wiki/Naltrexone#Controversies
| elif wrote:
| That sounds speculative and would require some deep research to
| find if it's even happening.
|
| I think it's equally plausible that the US increases food
| exports rather than lower production. Especially as production
| is subsidized.
| pixl97 wrote:
| If this increases food stability around the world, then in
| general it's a good thing.
|
| This said, obesity is exploding everywhere else in the world
| too, so it's not just a US problem.
| kornork wrote:
| I think the assertion that "eating less usually means eating
| less meat" is probably false (though I couldn't read the
| article cuz paywall).
|
| The first article talks plenty about why: people are eating
| less of the the things that are addictive to them, such as
| alcohol and cookies, which are a major source of calories.
| akira2501 wrote:
| Eating animals and animal welfare are two entirely different
| things. We could all be vegetarians and still be intentionally
| or unintentionally intolerably cruel to all other life on this
| planet.
| pfdietz wrote:
| I had a short conversation with an agronomist friend of mine.
| Crop prices are in the dumps right now, and I was wondering if
| it's because of these drugs. He said this is being openly
| discussed.
| nixosbestos wrote:
| This matches experience with dieting and impulse control,
| without these drugs even. Two days of junk food and the food
| brain is SCREAMING in my head. So I just don't do it. It's also
| way more obvious when I mess up, that it makes my body feel
| _bad_.
|
| But when I say food brain, it's _everything_. I want to vape, I
| want to have more coffee, then more beer, then some cannabis to
| go to sleep. Wake up and hit the dopamine cycle again. I have
| to take care of myself and ask "why am I doing this, could I
| just not, and if so I must not".
| kbelder wrote:
| >There's some evidence that Ozempic improves general impulse
| control
|
| While remaining on the drug.
|
| I expect your impulse control will be even worse after getting
| off of it, but I don't have a study to back that up.
| indiebat wrote:
| I don't want this to come out insensitive or from under the rock,
| but why is taking a drug a novel & cool idea (all of a
| sudden/recently) as opposed to good old fashioned working out and
| not eating more than what you need? okay, this drug is all kinds
| of great and it's the next best thing since green grapes, still
| not eating more and workout is better than taking drugs that
| effect your brain right? Are doctors required to explain this
| before prescribing this in US?
| apsec112 wrote:
| Saying that the cure for obesity is to eat less is like saying
| that the cure for heroin addiction is to stop using heroin.
| It's both clearly true, and also useless.
| chrismarlow9 wrote:
| The cure is to teach from an early age about impulse control,
| moderation, and how to spot signs of addiction in yourself
| early. This goes for:
|
| Social media
|
| Drugs and alcohol
|
| Food
|
| Or literally any other addiction. I don't think this is a
| useless thing to discuss.
| soulbadguy wrote:
| And yet most obese people are no more addicted to food than
| you are addicted to oxygen...
|
| It's so bizarre how many people will pretzel their way into
| moralistic non sense to find a solution to what is clearly
| a medical problem.
|
| Obesity as far as we understanding it now is an hunger
| regulation problem. For unknown reason a lot of people
| still feel the need to eat even when their body is clearly
| in calory surplus.
|
| No amount of of impulse control or moderation can make you
| override billions of years of evolution and not eat when
| you are starving... if we could... society would be a very
| different place
| WA wrote:
| My theory is that consuming sugar makes you more hungry.
| You can eat until you're full, but if you eat desert or a
| sugary snack a little later, it makes you feel less full
| and you can eat more. As if your brain notices the sugar
| source and switches into "full loading mode" and craves
| more of this historically rare resource.
|
| > And yet most obese people are no more addicted to food
| than you are addicted to oxygen...
|
| Most obese people seem to be addicted to sugary food,
| soft drings, desert and all that, which then triggers
| more eating.
|
| In addition, it might be a gut bacteria thing. If your
| gut is used to processing lots of sugar, you crave it
| even more and fighting your gut microbiome requires way
| too much impulse control and moderation.
|
| The solution might be to recognize this mechanism, remove
| all sugar from the diet and find a way to control
| impulses for a few weeks until the gut bacteria changed.
|
| Drinking water and chewing sugar-free gum helps me to
| remove food cravings temporarily with no downsides.
| But... I have a normal weight.
| pixl97 wrote:
| Ok, in the US start talking about food addiction seriously
| and see what happens.
|
| Do you remember how long it took to get tobacco mostly
| banned in the US? Do you remember how much the tobacco
| industry played the skeptic and introduced bunk science
| into the mix?
|
| Well Coca Cola, Pepsico, Nestle, and all the other junk
| food companies have been on this game for years now. Want
| to change school curriculum?, well your political opponent
| has $100,000-$1,000,000 more than you from the make people
| fat industry. Meanwhile there are a crazy number of attack
| ads against you for being a crazy commie that wants to
| control peoples lives, you socialist bastard, you're
| against freedom.
| indiebat wrote:
| Heroin changes brain chemically, it's (more) serious
| addiction than obesity, again being a little insensitive to
| obese people, but they're bad in comparison. And there are
| degrees of truthfulness & wrongness right!
|
| About the point you're making, two generations before you and
| me, people where fit, more attentive & generally healthy
| (outside vaccines that prevent diseases now & positive
| effects due to advancements in medicine), what changed?
|
| Not as platitude, but go from first principles, the choices
| you make everyday effects your mind (& the time you spend on
| particular activities), and if they aren't life affirming
| (for lack of better words), in due time you limit your
| options (ie less choices from your mind, bad food or less bad
| food or multiple bad ways to spend your time?), till you
| proclaim from high top mountains 'oh god, I'm helpless
| without acceptance from some higher power!'
|
| This isn't to say, I'll be as preachy and asshole(ish) to a
| friend or someone I care about in similar need, I'll probably
| say 'seek medical help etc' like you. But thinking things
| through & arriving at truth is important, don't you think?
|
| This is different to mental strength or controlling yourself
| etc, it's more about self reflection & freedom through
| discipline, respecting your life, decisions & thoughts more
| than your impulsive emotions in an ever distracting world,
| that kind of thing..
|
| I don't think I'll change your mind or this will come across
| in good faith, that's okay, I'm in a reflective mood, and
| it's awfully chilly outside :-)
| soulbadguy wrote:
| > About the point you're making, 2 generations before you
| and me, people where fit, more attentive & generally
| healthy (outside vaccines that prevent diseases now &
| positive effects due to advancements in medicine), what
| changed?
|
| Air pollution, water quality, pestecide, food/produce
| quality, plastic particule everywhere...
|
| I find this perspective so bizarre.
|
| Whats the most probable in 2 generation of exponentially
| increasing and barely regulated technological changes :
| culture has change so dramatically as to change human
| nature and makes us all lazy... or... something in the
| environment/food chain is having phisiolical/biological
| effects...
| indiebat wrote:
| People living in country side & eating from organic
| farming, they're doing alright (similar to our closest
| ancestors), but that's beside the point
|
| Cultural change over 2/3 even 10 generations will not
| significantly alter your biology. Pollution &
| disintegration in modern world you're referring to, they
| do have negative effects on our health, but it's not the
| whole story and they possibly cannot have effects on your
| decisions about what you eat and how you spend your time
| right?
|
| I'm particularly referring to obesity caused by over
| eating, bad life style etc (not the other rare serious
| persistent irreversible kind that happens as side effect
| of more serious ailments or genetics)
| soulbadguy wrote:
| I can't quite understand if you are agreeing or
| disagreeing with me...
|
| You seem to be restating my point as if you are
| contradicting my statements.
|
| > People living in country side & eating from organic
| farming, they're doing alright (similar to our closest
| ancestors), but that's beside the point
|
| Maybe ( I would love to see some sources for this
| assertion). But even if I give that to you, you basically
| saying that modern environment are somewhat
| obisidigenic... which is what I was saying.
|
| > Cultural change over 2/3 even 10 generations will not
| significantly alter your biology.
|
| Okay... same., still just restating what i have said.
|
| > they possibly cannot have effects on your decisions
| about what you eat and how you spend your time right?
|
| They can and they do... let me introduce you to lead in
| paint and in the environment...
|
| > particularly referring to obesity caused by over eating
|
| All obesity is cause by over eating (all most by
| definition) the point here is that over eating is not
| cause by lack of will power or poor decision making
| pixl97 wrote:
| >About the point you're making, two generations before you
| and me, people where fit, more attentive & generally
| healthy
|
| Everything.
|
| Two generations ago you didn't eat out 4+ times per week.
| Portion sizes at restaurants were 50%+ smaller. Food
| sciences were not as optimized at making junk food as they
| are today. In general we were poorer and bought less junk
| food. We were more apt to work jobs that didn't involve
| sitting in one place for long periods of time.
|
| >I don't think I'll change your mind or this will come
| across in good faith
|
| I believe it's what you think, but when 74% of the
| population doesn't subscribe your philosophy then you're
| tilting at windmills. Yea, maybe someday people will catch
| on to that and all will be good, but that's not the way the
| entire world is going. We need solutions we can enact now
| to solve problems we have now.
| codingdave wrote:
| Because not everyone has willpower and discipline. People who
| do have those strengths often think it is just as simple as
| saying, "Just take care of yourself", but it is not that easy
| for many people. High blood sugar also increases cravings,
| which makes it even harder, bringing on a downward spiral.
|
| This drug can help break out of that spiral and fix the
| craving/willpower problems.
| lurking_swe wrote:
| what you say is mostly true, but I will point out that it
| does not break any spiral. It's frequently reported that as
| soon as you stop taking Ozempic, the weight comes back
| immediately. so unless one resolves the underlying problem,
| you will be on this drug for life.
| DrillShopper wrote:
| That's not unique to Ozempic and (while I know you didn't
| make this specific argument, but others in this subthread
| have) is a piss poor reason to tell someone they shouldn't
| give it a try.
| lurking_swe wrote:
| i don't disagree. Just pointing out that (obviously) this
| should be a last resort drug. AFTER someone has tried
| lifestyle interventions for a few years IMO.
|
| The problem is when someone does NOT put in the effort to
| talk to their doctor, meet with a dietician, learn about
| healthy eating, and put in an honest effort to improve
| their life before just popping a pill.
|
| That said, i think it's great that's it's helping people
| who otherwise would just be obese and have many other
| health issues due to that. It's a big risk factor.
| mrshadowgoose wrote:
| This isn't the revelation you think it is. Chronic medical
| conditions require lifetime treatment. That isn't news to
| anyone.
|
| It's funny how obesity is the only chronic medical
| condition that garners a huge volume of your particular
| kind of comment.
|
| Would you be mentioning this for someone prescribed a
| diabetic, blood pressure or cholesterol medication?
| Statistically, likely not. So maybe take a step back, and
| examine why are you so averse to other people losing weight
| with medication.
| lurking_swe wrote:
| i actually would, if they were caused by bad lifestyle
| habits or similar issues. I am a firm believer that
| medication should be used AFTER a serious attempt has
| been made to address the underlying issue, if possible.
|
| if you are type 2 diabetic, that means you've probably
| been eating poorly for a long time. The happy path here
| is that one goes to a checkup and learns they are pre-
| diabetic, and their PCP refers them to a dietician. The
| patient hopefully learns how to make healthy food choices
| for themselves. All of this so they don't develop type 2
| diabetes. Maybe even temporarily prescribe a low
| metformin dose while they figure out the lifestyle
| changes needed.
|
| If they struggle and lifestyle interventions fail, then
| of course, they should be prescribed insulin so they
| don't have further devastating complications as they get
| older.
|
| The same can be said for ozempic. What kind of lunatic
| would suggest starting ozempic without FIRST giving
| honest education and lifestyle adjustments a try? That
| should be step 1. And i'm talking proper education from a
| licensed dietician, not silly blogs or advice people see
| on tiktok these days. If step 1 fails, proceed to
| medication.
|
| That's my perspective at least. Big pharma isn't your
| friend. It's a backup plan and a necessary evil in most
| cases (with obvious exceptions like vaccines,
| antibiotics, etc)
| bloopernova wrote:
| Perfectionism prevents progress.
| indiebat wrote:
| > Break out from the spiral
|
| I see the point in this, but do you think it's marketed as
| such and perhaps better question, used for exactly that and
| not more by vulnerable patients etc? (not well informed about
| long term side effects, some might even be unknown, if I
| might add)
|
| I take my vaccines and generally gravitate to sanity over
| conspiracy stuff (that is to say, If I sound like that, i'm
| not)
| tjader wrote:
| I don't think it's just people who have willpower and
| discipline, it seems to me that for most people it doesn't
| take as much willpower and discipline to stay at a reasonable
| weight. These arguments make it sound as if _everyone_ who is
| at a reasonable weight is there through large amounts of
| willpower and discipline, but most people I know don 't need
| to exercise X times per week and constantly watch what they
| eat to keep that weight.
|
| It's much easier when you can trust your body feedback and
| rely on your regular hunger signals, but for most people who
| benefit from Ozempic for weight loss if they just trust their
| bodies they will get fat.
| pixl97 wrote:
| Yea, when you look historically, starvation and food
| shortages were the norm. If you were a person that could
| pack on the pounds during the bountiful times, you could
| survive the lean times. Suddenly we live in the times of
| never ending plenty and we're told "what's wrong with you".
| bryankaplan wrote:
| Like a muscle, it strengthens with incremental practice.
|
| Disciplined control of one's willpower is a required
| dependency of adulthood.
|
| A society that provides drugs to mask the widespread failure
| of nominal adults to control their urges is a society in
| rapid decline.
| vundercind wrote:
| _Something_ is aiding the willpower of people in countries
| skinnier than the US. They move here, they get fatter.
|
| Despite this assistance (or lack of headwind) they seem to
| do ok.
| edmundsauto wrote:
| A society where over half the population is suffering from
| the same problem is one that needs systemic change. It
| doesn't make sense to blame the individual when it's a
| problem affecting everyone.
| pixl97 wrote:
| Na, it makes people feel that their special and that
| they've won by posting stuff like that without having to
| understand the problem at hand.
| xvedejas wrote:
| Most people don't work out enough, or don't eat well enough. If
| we had some kind of intervention that would easily cause people
| to work out, we would use that intervention. If we had some
| kind of intervention that would easily cause people to eat
| well, we would use that intervention. The reason working out
| and good diet are good is because of good health outcomes. If
| we have some kind of intervention that skips straight to the
| good health outcomes, we would use that intervention. It seems
| like Ozempic is _that_ intervention, so we will use it. I will
| likely choose Ozempic for myself once it is available to me.
| rootusrootus wrote:
| I want everyone who says this to submit a picture. Just wearing
| gym shorts, so we can get a good look. I assume nobody making
| this a moral issue will have so much as love handles. Because
| if they do, why aren't they working out harder and eating a bit
| less?
|
| I've met plenty of skinny fat people who think they're healthy.
| rootusrootus wrote:
| Man, some folks just don't want to be held to the same
| standard they want to hold everyone else to. Cowards ;-)
| Modified3019 wrote:
| Telling people they are morally bankrupt sinners (slothful and
| gluttonous) and heaping guilt and shame on their shoulders has
| unsurprisingly failed to stop the issue.
|
| Why do you think that telling people to "just stop being fat"
| will suddenly start working?
| cschneid wrote:
| In 2021 I lost a good chunk of weight the old fashioned way.
| From 250ish to 215. I did it with "good old fashioned working
| out and not eating more". It was a miserable, white-knuckle
| experience. I was eating healthy food, enough calories
| (moderate but sane deficit), but the only thing I thought about
| at all moments was getting to the next meal. What snack is low
| enough calories to have to make it. It was miserable. As soon
| as I let up a bit, everything unraveled and I found myself back
| in the 250s by the start of this year.
|
| Now I'm on Tirzepatide (Zepbound), and I'm back to 235ish, and
| trending lower. I still work on eating healthy, but now I'm not
| just HUNGRY at all moments. My life continues, and I only have
| to make individual healthy choices at meal times, and grocery
| times, rather than a constant struggle at all waking moments.
| It's seriously a big difference.
| DrillShopper wrote:
| > I still work on eating healthy, but now I'm not just HUNGRY
| at all moments.
|
| I think this is something a lot of people pushing back
| against the GLP-1 agonists don't realize because they don't
| experience it: back before I started Mounjaro (another GLP-1
| agonist) I was _constantly_ hungry if I hadn 't eaten a meal
| in the last 45 minutes. Absolutely zero hyperbole there - I
| once went to an all you can eat buffet, ate until I was over
| full, came home, and within about an hour and a half of that
| I was snacking on something because I was hungry. Not
| peckish. Not "feeling like a snack". Hungry to the point
| where that feeling intruded on my every thought until it was
| sated.
|
| After starting Mounjaro that's _GONE_. Gone gone. I now have
| to set an alarm to _remember_ to eat. It 's absolutely
| phenomenal and likely the reason why I'll live past my
| forties instead of being stuck in that same cycle and dying
| of the effects of obesity.
| pton_xd wrote:
| > Absolutely zero hyperbole there - I once went to an all
| you can eat buffet, ate until I was over full, came home,
| and within about an hour and a half of that I was snacking
| on something because I was hungry.
|
| I don't have any eating issues but that reminds me of the
| first time I went on a 7-day cruise.
|
| There's nothing to do on the ship, and the food is free and
| pretty tasty, so... I basically ended up at the buffet
| eating and drinking all day long. Sausage and egg biscuits,
| banana bread, pot roast, steak, pasta, fried rice, cinnamon
| buns, they had everything. I was stomach-busting full,
| every minute of every day. I'd gorge myself on a huge plate
| of Indian food from the buffet, and then a few hours later
| head to another deck for a lobster dinner. Not to mention,
| drinking coffee, beer, and wine the entire time.
|
| It was kind of insane. And what was crazier was after a few
| days of this routine I got used to it, and even looked
| forward to eating more food the next day. It was sort of
| like directly embracing one of the seven deadly sins to the
| maximum extent possible. I'm not sure what that experience
| means other than it seems like the the human body can
| comfortably arrange itself into a habitual downward cycle
| fairly rapidly.
| crooked-v wrote:
| It's because we're evolved for boom-bust cycles. Give it
| another 500,000 or so years and humans might evolve to
| cope with food always being available at all times.
| DrillShopper wrote:
| Not only that, but type 2 diabetes makes you
| paradoxically more hungry - your body thinks it is
| starving because it cannot get sugar into its cells so it
| makes you MORE hungry which causes you to get heavier
| which often causes the diabetes to get worse which makes
| you MORE hungry which means you eat and get heavier
| and......
| sct202 wrote:
| As someone who's never struggled with weight, it's been eye
| opening to hear how food focused a lot of peoples thoughts
| are. It was like on the same level as finding out some
| people can't visualize things in their minds.
| DrillShopper wrote:
| I don't think I've ever seen someone seriously put forth the
| argument "all you need is Ozempic".
|
| For context: I am an overweight type 2 diabetic. I lost about
| 70 lbs before my doctor started me on Mounjaro (another GLP-1
| agonist). My diet and exercise routine were far from perfect,
| and it took me about a _year_ to lose that weight. My doctor
| started me on Mounjaro, both for type 2 diabetes and weight
| loss. I have lost 20 lbs in about a month on it, which means I
| will lose _three times_ the weight if that pace keeps up (very
| unlikely). When my doctor and I discussed starting Mounjaro
| (which the doctor suggested, not me) he made it very, VERY
| clear that diet and exercise were important things to work on
| as the weight came off.
|
| The key there is that the pace of weight loss will not keep up
| as the body's caloric needs reduce due to that weight loss. So
| naturally a GLP-1 user will plateau if they do not adjust their
| diet (and potentially exercise routine, though diet is much
| more important) as the weight comes off. You know what really
| makes it easier to have the energy to a healthy meal, to work
| out, and to take care of yourself? Losing weight! You know what
| helps form those healthy habits in people who did not form them
| during childhood? Reduced cravings for calorie dense food! Both
| of those things are where Ozempic and other GLP-1 drugs shine.
| It gives the person on them the space to make those changes
| without cravings, without feeling hungry, and at a faster pace
| than they could do naturally.
|
| So yes, in the short term, these drugs are a great catalyst for
| change, but I don't see many medical professionals saying "oh
| just stick someone on Ozempic for life and that's that!"
| because for the vast majority of people who would use those
| drugs for weight loss cannot achieve their goals with just the
| drug alone.
| honkycat wrote:
| Why doesn't everyone play piano? Why isn't every person a super
| athlete? Why doesn't everyone meditate 40 minutes a day? Why
| doesn't everyone study super hard in school and become an
| engineer or doctor or lawyer?
|
| The hard truth: Not everyone is capable of those things.
| Period.
|
| 40% of the US population is considered obese. That is a HUGE
| number. At a certain point, you can no longer blame
| individuals. There is something wrong, and we identify it as an
| environmental problem.
|
| So if we have a drug that will make a huge amount of people
| healthy, what is the downside? And for the record: Ozempic
| affects appetite so they eat better, that is part of the drug.
| raincom wrote:
| Treat human beings or any organisms as biological machines.
| Here, many chemicals (hormones, for instance) regulate many
| processes in such machines. Whatever one has eaten so far,
| genetic history, environment, etc have changed hormones to a
| level where the model of dieting and working out doesn't work
| any longer. So, semaglutide and tirzepatide work on such
| regulatory hormones (GLP-1, GIP). In other words, what this
| research tells us that humans are not controlled by their
| personal will.
| vundercind wrote:
| Willpower and discipline don't seem to be what keeps other
| countries skinnier than the US (and most of them are also
| getting fatter...) so I don't know why we expect that to get
| the US out of this mess.
|
| Evidence: people from skinnier countries move here and
| consistently get fatter. It's a societal/environmental problem,
| if we're talking about "what would a policy fix look like?" and
| not "what can I personally try to do to save myself despite
| being up against a societal/environmental problem?"
| potta_coffee wrote:
| It's just human nature. This is the health equivalent of trying
| to turn lead into gold. It's my unproven opinion that the
| negative effects of these treatments are understated and this
| will be a passing fad.
| Eumenes wrote:
| > why is taking a drug a novel & cool idea
|
| https://www.glamourmagazine.co.uk/article/post-your-pill-tre...
|
| drug companies have spent millions on destigmatizing
| pharmaceuticals. its a superpower, apparently. a large swath of
| this userbase convinced themselves they have adhd and need
| medication for it. changing tabs on your chrome browser or not
| being able to do "deep work" = i have an uncurable disease and
| i require legal meth, for life. you can see how this translates
| to ozempic.
|
| silicon valley/tech culture has prioritized get rich schemes,
| cure alls like adhd meds, you don't have to eat just drink
| soylent for every meal, etc. ozempic falls in line nicely
| there, and i think among this community and others in this
| vein, you'll see alot of support for it. its sad, because
| tech/programmers/IT people use to be very contrarian and open
| minded. you get in trouble for saying things like "personality
| responsibility", "discipline', "self-control".
|
| > Are doctors required to explain this before prescribing this
| in US?
|
| doctors famously aren't trained on nutrition or fitness.
| ironically the prestige is being a specialist, not well
| rounded. strange.
| connicpu wrote:
| Completely missing the point of GLP-1 agonists. The point is
| that it breaks the cycle by giving you the willpower to eat
| less. It doesn't magically make the calories you eat not
| contribute to your weight, it just makes it easier to eat less
| and still feel full. It also counteracts insulin resistance,
| which is another problem inherent to obesity.
| orangecat wrote:
| Why are we bothering with contraception and STD vaccines when
| people should just not have sex unless they're trying to get
| pregnant?
| amatecha wrote:
| This article seems to frame things in such a strange way. Maybe
| instead of trying to get everyone obesity medication, we can
| instead educate society so we all understand nutrition and diet
| and can combat the ever-persistent forces of corporations pushing
| unhealthy food on us?
| gedy wrote:
| Look we've been educating people about this for the past 50
| years at least - education doesn't work with base impulses.
| cbsmith wrote:
| Yes, because what obese people lack is education.
| amatecha wrote:
| From my subjective experience in life, what they very often
| lacked was parents who set the right examples around food. I
| know that doesn't apply to everyone of course, but I've
| witnessed it time and time again - an upbringing with deeply
| disordered routines/practices around food. It's universal
| among obese people in my life. I speculate that better
| awareness of diet/nutrition _might_ help to prevent passing
| on such behaviours, like not feeding the family exclusively a
| bucket of KFC or McDonalds, or using food as a reward, etc.
| etc.. I mean, medication won 't actually solve what is caused
| by behaviour, right? Maybe the behaviour can be reduced on a
| broader scale, over time, via people making better-informed
| decisions? If parents know their habits around food are
| basically ensuring their kids will struggle with obesity,
| maybe they'll make the effort to do something different?
| Dunno, it seems like a reasonable consideration.
| lostmsu wrote:
| Educating people will hardly work. Bans on junk foods at
| government level might.
| eniwnenahg wrote:
| In EU they banned the sale of oral tobacco (snus), which is
| safer than smoking tobacco. Snus once had cancer labeling but
| that was generally considered not-very-true and labeling was
| removed. Tobacco smoke causes cancer. Drug bans also built
| many overfilled prisons and likely contributed to the
| invention and spread of harmful drugs such as crystal meth
| and fentanyl. This is a one sided view of course. I like
| William Blakes work, "Auguries of Innocence".
| ndsipa_pomu wrote:
| Unfortunately companies make more profit by pushing unhealthy
| food onto consumers which can be evidenced by the money they
| spend advertising it. They're exploiting our instincts to seek
| out high calorie foods which was an advantage when humans
| didn't have a ready supply of food available at all times, but
| nowadays leads to a whole host of illnesses.
| filoleg wrote:
| Why either/or?
|
| Maybe we should try educate society on dangers of using heroin.
| I agree that it is a good thing, and we should continue
| educating people about its dangers. But clearly that alone
| didn't solve the problem, and I think it would be a good idea
| to utilize alternative options as well (in addition to
| continuing the education of society on its dangers).
| dghlsakjg wrote:
| Do you think overweight people don't know why they're
| overweight?
|
| There are plenty of obese people that understand nutrition just
| fine, there are obese people who understand it well enough to
| have lost significant weight and gained it all back.
|
| Clearly there is something else going on that we haven't
| grasped yet.
| amatecha wrote:
| Education may involve "finding a strategy that works for
| you". There are so, so many different ways to combat
| disordered eating. These are learnable things. My thought
| around "better education" is that the cycle of disordered
| eating can be stopped at some point before parents pass it on
| to their kids, at least (as I just posted in adjacent comment
| https://news.ycombinator.com/item?id=41811916 ). I absolutely
| recognize how insanely difficult it is to come back from
| disordered eating and stay at a lower weight after finally
| reaching it.
|
| Though, now that you ask, I do think that many people don't
| actually know why they are overweight. They say it's because
| "McDonald's is cheaper than buying good food", not realizing
| the McDonalds won't satiate them and they will eat/spend more
| because their body is starved for proper nutrition. Watch the
| series "Supersize vs. Superskinny" and observe how nearly
| every participant is utterly clueless as to the underlying
| causes of their challenges on either size of the disordered-
| eating scale.
| 2snakes wrote:
| Psychology of hunger behaviors.
| triceratops wrote:
| If we could do that through education, then we'd have made it
| illegal for corporations to push unhealthy food.
| winterrx wrote:
| David Friedberg recently did an All-In Interview with the CEO of
| Eli Lilly. Interesting conversation over there that also talked
| about some key points of the article.
|
| https://www.youtube.com/watch?v=023exhA9irY
| breck wrote:
| All you have to do is turn your liver on:
|
| https://breckyunits.com/liver.html
| mock-possum wrote:
| > "Is it bad for my liver to be off most of the time?" It's
| generally not healthy to keep your major organs in the off
| state. If you never open your eyes, you go blind.
|
| I feel like this is missing the obvious follow up question, "is
| it bad for my liver to be _on_ most of the time?"
| breck wrote:
| > "is it bad for my liver to be on most of the time?"
|
| That's a good question!
|
| I'm not sure. My guess would be its perfectly healthy (normal
| actually) to have 10x levels of ketones constantly than an
| American eating the SAD (Standard American Diet).
|
| Anyone know of long term datasets that have looked at this in
| animals?
|
| Continuous Ketone Monitors for humans have _just_ come out
| (AFAIK), so we should know soon.
| tonymet wrote:
| Yet another drug that patches up symptoms without addressing the
| root cause. People will be dependent on the drug for life. And we
| still don't know what the adverse effects are.
| jaco6 wrote:
| I'm just as curious as to why some people are so willing to take
| numerous medications, while others go to any lengths to avoid
| them. Some people are happy to be on an SSRI, sleeping pill,
| statin, low dose aspirin, and a few others, and aren't bothered
| by this. Other people seem instinctively revolted by prescription
| drugs, seeing toxins pushed by evil corporations. Is it a trust
| issue?
|
| I personally detest and avoid all medicines other than
| antibiotics and vaccines. Pharmaceuticals have a long track
| record of harboring "side effects" that only become apparent
| years later.
|
| In general, why are we surprised that the chronic use of any
| substance has negative effects? Humans evolved for thousands of
| years eating food and drinking water. Regularly consuming
| anything else is an abberration and self-experiment.
| lurking_swe wrote:
| I think the answer to your question is that people who avoid
| drugs understand that drugs do not fix anything permanently, in
| 99% of cases. They only treat symptoms. The people who avoid
| drugs attempt to treat the underlying problems.
|
| of course it's not always practical. For example, some skinny
| people are simply genetically predisposed to high blood
| pressure, even if they work out and eat pretty healthy. It's
| rare, but these things happen.
| jackcosgrove wrote:
| To address the question in your first paragraph, I think it's
| due to whether you think your locus of control is internal or
| external.
| poorinterview wrote:
| You can have an internal locus of control and still believe
| the benefits of taking something like an SSRI far outweigh
| the costs of attempting to address depression/anxiety more
| "naturally." I'd rather take an SSRI if it means more
| motivation to live healthily, positively, productively for
| myself and family. If anything, the drug could very well help
| someone discover their sense of agency.
| Blackthorn wrote:
| Nobody ever gets sus about needing to take heart medication
| every day to stay alive but the moment it becomes about how I
| take Lexapro every day they get real preachy.
| poorinterview wrote:
| Which is sorta funny because some antihypertensives are known
| to decrease anxiety.
| rootusrootus wrote:
| Maybe we can find a medication people will take that solves
| the preachy problem instead. That might achieve significant
| population-wide improvements.
| akira2501 wrote:
| > Other people seem instinctively revolted by prescription
| drugs, seeing toxins pushed by evil corporations.
|
| You can advertise drugs on TV in the USA. This certainly opens
| the door for bad drugs to get pushed out and marketed to people
| who don't have the technical skills to examine the claims and
| the risks of side effects objectively.
|
| > avoid all medicines other than antibiotics and vaccines
|
| Just because it's been such a hobby horse lately I would have
| to add pain killers. There is absolutely a large potential for
| abuse but they also serve an incredible utility to modern
| medical care.
|
| > Regularly consuming anything else is an abberration and self-
| experiment.
|
| Ozempic should be for people who are obese and have thoroughly
| demonstrated that they are not physically capable of exercising
| themselves enough to lose weight naturally.
|
| Otherwise, this drug gets marketed as an obesity cure, but it's
| mostly dispensed for cosmetic purposes. If there are any side-
| effects, it will be a double tragedy for these people.
|
| I'm with you, it's a little revolting, this specific drug.
| poorinterview wrote:
| Ozempic and similar drugs are being used by many to get rid
| of the food noise and insatiable hunger that have stood in
| the way of sustainable progress. These drugs are being used
| as catalysts for healthy living. The fact that they seem to
| work thus far is evidence that obesity is on some level
| driven by powerful hormonal forces that influence impulse
| control and willpower, which addressed, can give people the
| freedom to make better decisions and effectively pursue a
| lifestyle they've struggled to maintain.
|
| The cosmetic narrative you're pushing is actually quite
| disgusting.
| akira2501 wrote:
| > These drugs are being used as catalysts for healthy
| living.
|
| You have some evidence for this claim?
|
| > is evidence that obesity is on some level driven by
| powerful hormonal forces
|
| It's suggestive. It's nowhere near evidence.
|
| > the freedom to make better decisions
|
| As long as they're on the drug.
|
| > The cosmetic narrative you're pushing is actually quite
| disgusting.
|
| No it isn't. It's a valid concern about how this medication
| is _marketed_ and _dispensed_. It's also an obvious concern
| to have. Pretending that I'm disgusting because I'm
| actually worried about the future outcomes for these
| patients is bullying highroad nonsense. Come off of it.
| crooked-v wrote:
| > You have some evidence for this claim?
|
| The obvious evidence is the result of the drug, i.e.,
| overweight people losing weight because they're eating
| less.
| akira2501 wrote:
| The obvious countertpoint is that obesity rates have not
| been constant for the last few decades.
|
| So there are clearly multiple factors here and those
| should be taken into consideration before uncritically
| deciding this is a "good thing" that we should "all be
| on."
| crooked-v wrote:
| > that we should "all be on."
|
| Who, exactly, has claimed that?
| poorinterview wrote:
| I've been on Zepbound since July and have lost 40lbs in
| that time through calorie restriction, intermittent
| fasting, and resistance training 3x per week, which all
| felt like impossibly herculean tasks before starting the
| medication. I know others who've had similar experiences.
| Sorry I haven't published a paper on it.
| dopylitty wrote:
| I'm curious why you include antibiotics in your trusted
| medications list.
|
| Over the past several years we've found that antibiotics have a
| huge impact on beneficial microbes in your body which then has
| downstream impacts on your health [0]. Oddly enough for the
| topic in this article exposure to antibiotics as a child may be
| linked to obesity[1]. They are also extremely over prescribed
| for things like viral illnesses [2].
|
| I personally wouldn't take an antibiotic unless whatever malady
| I was suffering from was proven to not only be bacterial in
| origin but likely to progress without treatment.
|
| Regarding your larger point some of the distrust of medications
| can be related to the fact that people know that medication
| producers' goal is to be profit for the most part.
|
| Because they are for-profit the medicine producers can't be
| trusted to produce quality products or to produce products
| which resolve a problem rather than just reducing symptoms as
| long as the patient continues to pay for the medicine.
|
| As with other problems we have a low trust society because it's
| a society built on for-profit enterprises rather than
| enterprises focused on doing the best thing for society.
|
| 0: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756738/ 1:
| https://www.nature.com/articles/ijo2014180 2:
| https://pubmed.ncbi.nlm.nih.gov/37876436/
| pfdietz wrote:
| > I'm curious why you include antibiotics in your trusted
| medications list.
|
| Because bacterial infections can be horribly lethal?
| rootusrootus wrote:
| > seeing toxins pushed by evil corporations. Is it a trust
| issue?
|
| That sounds a lot like the divide between people who see
| conspiracies everywhere and those who do not. In that case I
| would suggest it is just personality, not logical and not
| solved by improving trust.
| jijji wrote:
| you can buy tirzepatide / semaglutide all day long from labs in
| china for between $4 per injection all the way down to $0.50 per
| injection depending on quantity and type (prepackaged in vial vs
| raw powder)
| rootusrootus wrote:
| After tirzepatide was taken off the shortage list last week, I
| notice that there are suddenly a lot more people talking about
| this route. It will be interesting to see how it plays out.
|
| Probably exceeds my comfort level, and I'm lucky enough that I
| can pay the $550/month for name brand if necessary. A lot of
| people will just have to stop, though, and deal with the
| consequences.
| optimalsolver wrote:
| What happened to self-control?
| crooked-v wrote:
| The same thing that always happened to it: for a lot of people
| it just doesn't work.
| DCH3416 wrote:
| Screw that
| moogly wrote:
| Turns out "just stop being fat lol" isn't very effectual
| advice.
| pfdietz wrote:
| It's the "git gud" of diet advice!
|
| I wonder if GLP-1 agonists are going to break gaming
| addiction too.
| triceratops wrote:
| If you got it, use it. If you don't got it, there's a little
| help now.
| avelis wrote:
| That's not a thing when considering how UPF creates addiction
| to food in the brain. Big Food knows this.
| hipadev23 wrote:
| Who has time to eat? Founder mode all day every day.
| grecy wrote:
| My god no.
|
| I'm 42 and I've never taken more than the odd painkiller or
| antibiotic here or there - less than a pill a year on average I'm
| sure.
|
| The last thing in the world I want is to be permanently on some
| drug that alters how my body works. I hike, snowboard, go to the
| gym and eat sensibly. That's all the "weight control" I need.
| honkycat wrote:
| Good for you man. 40% of the US is obese, we need a solution
| for better health outcomes.
| ocular-rockular wrote:
| So drugs?
|
| I think it's a lot simpler than that. US has an abusive
| relationship with junk/processed food. It's so deeply
| ingrained due to profit margins, wealth inequities,
| nonsensical subsidies, etc. that the only feasible solution
| is to introduce a drug that continues to allow that
| relationship to continue.
|
| It's a lot easier of a solution than it is to tell companies
| to stop making garbage or saturating everything with sugar
| and HFCS. "Easier to see end of the world than end to
| capitalism" -- its the same shit packaged in a different
| story... Easier to introduce a drug to treat the symptoms
| than to solve the actual problem.
|
| Mind you, I'm not implying that it is easy. We have
| collectively accepted this which makes change difficult if
| not impossible.
| grecy wrote:
| You make it sound like it's out of your control.
|
| The solution is already there. It's free. It works for
| everyone, and even 60% of people in the US are doing it!
|
| The right answer to being healthy is not more drugs.
| crooked-v wrote:
| Do you drink coffee or tea?
| grecy wrote:
| Coffee really affects me, so I gave it up. I drink decaf tea
| these days.
|
| Why do you ask?
| ironman1478 wrote:
| ` I hike, snowboard, go to the gym and eat sensibly. That's all
| the "weight control" I need.`
|
| So you are likely in an income bracket that enables you to have
| an active lifestyle outside of work and take the time outside
| of work to cook, in addition to probably other hobbies. this is
| not a criticism of you, but if I had to guess, you simply have
| a life that many other's do not. I work out and take care of
| myself because I make $300k+, have less worries and
| responsibilities, and I actually have an easier job than when I
| was making less.
|
| A lot of people don't have money or don't have the time for
| working out and making the correct meal choices. Yes, there are
| people who have money and time and are still overweight,
| however that is not the norm as you go up the income brackets.
| Many poorer people have long work days, with an additional long
| commute, and are more likely to have kids, meaning they have no
| time for themselves. They're not gonna go to the gym if they
| already have a long day and they probably aren't going to make
| healthy food choices when they're already beat up and have not
| a lot of time for themselves.
| pyrophane wrote:
| One thing that it seems we are just starting to talk about with
| these drugs is the associated muscle and bone density loss. I'm
| concerned that this generation of GLP-1 early adopters will wind
| up more frail and suffer a lower quality of life in old age as a
| result.
| petesergeant wrote:
| I've seen zero evidence that muscle loss from GLP-1-assisted
| weight-loss is any different to the muscle loss from simply
| eating less. Do you have a link to a study I've missed?
| cyberax wrote:
| > One thing that it seems we are just starting to talk about
| with these drugs is the associated muscle and bone density
| loss.
|
| Muscle loss is associated with _any_ kind of weight loss.
|
| And GLP-1 drugs _improve_ the bone density:
| https://academic.oup.com/jcem/article/100/8/2909/2836097 It's
| likely simply because thinner people naturally move more.
| ploppyploppy wrote:
| Can these negative effects be countered/offset by continuing
| weight training? I lift 2-4 days a week.
| cyberax wrote:
| Certainly, just like with any other diet.
|
| I gained muscle mass by doing strength training 2 times a
| week while on GLP-1 drugs.
| r00fus wrote:
| My program strongly recommends some form of muscle training
| (pushups/weights/etc) as they see improvements from muscle
| development for weight loss and to counteract the muscle loss
| from losing weight.
|
| The fact remains that having to carry around 50+ extra pounds
| of fat requires more muscle. When that requirement goes away so
| does your need for that musculature.
| k__ wrote:
| How are the side effects?
|
| I read plastic surgeons said it was bad for your skin and people
| would look much older when they take it for a few months.
|
| Yet, I also read it was generally good for your health, not just
| in terms of weight loss.
| logicchains wrote:
| I'm not a fan of the drug but that aging could just be due to
| the weight loss: skin generally looks more wrinkly (older)
| after losing weight.
| cyberax wrote:
| One other note: the current peptide-based GLP-1 drugs are not
| likely to be the permanent solution. Injectables are just too
| problematic for that.
|
| Several companies are now working on more classic small-molecule
| drugs targeting the same receptors. So it's likely that in
| several years we'll get a pill with the same effects.
|
| Yes, there's technically a pill version of Ozempic already
| (Rybelsus), but it works by making the stomach wall to be
| slightly permeable to peptides. You can guess that it has pretty
| unpleasant side effects, and an awesome bioavailability of 0.7%
| connicpu wrote:
| I'm curious what about injectables makes them specifically
| problematic for long term use? Diabetics already have to inject
| insulin for the rest of their lives, and an injectable version
| of the same drug usually has fewer side effects since it
| doesn't have to pass through your gut metabolism. I may be
| biased, I have no fear of needles and have injected myself with
| sex hormones every week for nearly 7 years, so adding an
| autoinjector doesn't seem like that big a deal to me.
| cyberax wrote:
| They are more expensive. Autoinjectors are way more
| complicated than a pill bottle. You also can't freeze them,
| but they should be kept in a fridge.
|
| Manufacturing standards also have to be way higher. I have no
| problem trusting Novo Nordisk to manufacture injectors
| safely, but I won't trust a random manufacturer from India or
| China.
|
| The risk of accidental infection from injection also is not
| neglibible.
| connicpu wrote:
| Fair considerations, I just disagree that it makes
| injections inherently problematic for long term use.
| Primarily because I have doubts about the possibility of a
| pill that doesn't come with more side effects than an
| equivalent injectable.
| djsavvy wrote:
| My pet crackpot theory is that within the next 100 years
| semaglutide is going to be in the drinking water (much like
| fluoride) because the benefit to society is going to be too hard
| to pass up on. However, it seems that it's delivered via
| injection so maybe putting it in the water supply wouldn't even
| be effective.
| cooljacob204 wrote:
| I don't think anything that can influence our choices would
| ever get enough public approval for that.
| logicchains wrote:
| It's funny you say that because just now the US is starting to
| re-consider water fluoridation: https://www.theguardian.com/us-
| news/2024/oct/04/fluoridation... .
|
| It's also relative uncommon in other developed countries;
| according to Wikipedia, "Out of a population of about three-
| quarters of a billion, under 14 million people (approximately
| 2%) in Europe receive artificially-fluoridated water. Those
| people are in the UK (5,797,000), Republic of Ireland
| (4,780,000), Spain (4,250,000), and Serbia (300,000)."
| supportengineer wrote:
| The benefits of fluoridation were amazing. I didn't have a
| single cavity until I was 25 and had moved away from that
| area to a non-fluoridated area.
| ninalanyon wrote:
| Don't you clean your teeth with a fluoridated toothpaste?
| That should be plenty good enough, no need to put it in the
| drinking water.
| calculatte wrote:
| Even if that is true, there's no reason to bathe in it,
| cook with it, water our lawns with it.
|
| And now it's becoming clear that IQ is affected by
| fluroride
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409983/
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285601/
| https://www.reuters.com/world/us/epa-must-address-
| fluoridate...
|
| So how about we keep it out of our drinking water. If you
| want to put fluoride on your teeth, use fluoridated
| toothpaste.
| marcosdumay wrote:
| Keep in mind that the fluoride concentration on those two
| papers is way larger than what most of the world
| practices.
|
| In fact, WTF is India doing there? Don't they have limits
| on it?
| rootusrootus wrote:
| The funny thing is that if you live in Portland, famously one
| of the few large cities without fluoride in the water, the
| dentist can immediately tell if you grew up here.
|
| I would guess that in today's world a lot of people get
| enough fluoride through processed foods being made in places
| that have fluoridated water.
| Eumenes wrote:
| The day Ozempic/similar drugs become approved for weight loss
| under ACA/Medicare is the day I stop paying taxes.
| pfdietz wrote:
| Good news! You'll probably be able to get GLP-1 agonists in
| prison.
| valunord wrote:
| Fuck that. Just have some willpower! Some of us have been doing
| OMAD without assistance, just grunting through the stress and
| pain for years. It's much healthier than drugging up.
| steveBK123 wrote:
| One lurking concern I've had around this space is that junk food
| makers simply find a way to make their food even more addicting.
|
| Arguably though, ozempic'd customers and shrinkflation'd products
| would be a recipe for amazing margin improvement. And they can
| dress it up as doing good because its better for people, (like
| the 100 calorie snack packaging).
| sph wrote:
| You can see that in the lab-grown burger space already: it is a
| massive opportunity for companies to create an ultra-processed
| version of meat, and label it as healthy as the public opinion
| has gone blindly against meat and on the vegan bandwagon.
| They'll claim it's more eco-friendly, they can sell it 5x the
| price of beef and rake billions.
| rootusrootus wrote:
| > public opinion has gone blindly against meat
|
| Only if you spend too much time online. In the grocery store,
| I don't see any indication that meat substitutes are gaining
| traction. If anything, popularity seems to be ebbing. The
| people choosing fake beef for their burgers are a tiny
| minority.
| steveBK123 wrote:
| Indeed, a COVID era ZIRP funded fad that has fallen on hard
| times.
|
| A product that fits a niche - former meat eaters who miss
| meat and want to be vegetarians.
|
| Otherwise for true health conscious or longtime vegetarians
| there are better options.
| dfxm12 wrote:
| Instead of a system that makes these drug available for purchase,
| I'd rather live in a system that promotes healthy food and active
| behavior. Unfortunately, I have to drive everywhere, work too
| many hours to have free time for recreation and have no idea
| which government subsidy is going to help big ag likely at the
| expense of my health.
|
| All things being equal, I'd prefer to spend less money on
| prescriptions and have fewer trips to the doctor.
| from-nibly wrote:
| You don't have to worry about which government subsidy is going
| to help big ag at the expense of your health. It's all of them.
| paulcole wrote:
| This is like saying, "All things being equal, I'd prefer Santa
| Claus bring presents on Christmas Eve than have to go shopping
| for my kids."
|
| It's like well duh of course you'd prefer the impossibly
| unrealistic miracle.
| wizzwizz4 wrote:
| Other countries do it.
| https://en.wikipedia.org/wiki/Change4Life
| sbelskie wrote:
| Is there any evidence it's effective?
|
| https://en.m.wikipedia.org/wiki/Obesity_in_the_United_Kingd
| o...
| wizzwizz4 wrote:
| The claim was about _promotion_ , not effective
| promotion. (As a sibling comment points out, _effective_
| promotion is not unrealistic either. It won 't happen on
| its own, but nothing does.)
| card_zero wrote:
| So other countries would _officially_ prefer the
| impossibly unrealistic miracle.
| sweeter wrote:
| the UK has basically become the US by most metrics. This
| includes the increasing privatization of health services,
| transport, etc... and the excessive commodification of
| basic necessities like housing.
|
| I find that saying that health initiatives don't work by
| vaguely gesturing at a country, is not a structurally
| sound argument. Its like the sentiment here is: "is the
| fact that we include Pizza as a vegetable in American
| schools part of the problem? Nooooo, that can't be it. it
| must be a moral issue!" and thats just one example.
|
| The obesity problem in the US is tied directly to our
| relationship with highly processed (and CHEAP) food.
| Along with the stranglehold those companies have over
| state and federal institutions that allow them to
| directly sell these foods in schools and institutions,
| and heavily skirt FDA regulations via lobbying.
|
| The US is uniquely bad when we have a ton of chemicals
| and ingredients in our foods that are banned in most
| other countries. It is largely a systemic problem and a
| problem that can easily be solved. Poorer people tend to
| eat cheap food, cheap processed food isn't well regulated
| and is directly tied obesity and a whole host of health
| problems.
| ahahahahah wrote:
| hahaha.
|
| "The UK has seen its obesity rates increase faster than the
| US. In the UK, obesity has risen sharply since 1990, when
| it affected only 14% of adults. The UK is also considered
| one of the most overweight countries in Western Europe."
|
| In addition, since the introduction of Change4Life, the
| obesity rate has simply continued to climb in the uk (see h
| ttps://researchbriefings.files.parliament.uk/documents/SN03
| ..., for example).
|
| So yes, other countries (just like the US), have introduced
| programs to try to encourage healthier behaviors, and have
| seen similar outcomes from them.
| SapporoChris wrote:
| Of course it is impossible to live a healthy lifestyle and
| have healthy weight, if you ignore the 3/5ths of Americans
| that are not obese and the 7/8th of the global population.
| Teever wrote:
| Are the 3/5ths of Americans who are not obese actually
| living a healthy lifestyle? Or are they just living a
| different unhealthy lifestyle?
|
| Is a skinny homeless methhead with a great BMI healthy? Or
| the blue collar dude who has terrible blood pressure from
| chain smoking and pounding energy drinks on his way to the
| job site?
|
| How many Americans who are not obese are on their way to
| becoming obese?
|
| There are lots of paths to unhealthiness and overeating /
| eating poorly is only one of them
| valval wrote:
| Obesity and poor metabolic health is by far the greatest
| predictor of an early death.
| Teever wrote:
| Yes of course, but the point I'm making is that people
| who aren't obese aren't necessarily healthy.
|
| People aren't born obese. They get that way through
| mistreating their body for a long period of time, and it
| is quite possible for them to die before they become
| obese to other maladies related to that mistreatment.
| hackable_sand wrote:
| True. I do not think I have not yet met a person who is
| completely healthy.
|
| Maybe in passing.
| llamaimperative wrote:
| Impossibly unrealistic to change zoning to disincentivize
| car-dependent urban design?
|
| Impossibly unrealistic to get rid of enormous sugar
| production subsidies that make it insanely cheap?
|
| Impossibly unrealistic to simply tax added sugar?
| crooked-v wrote:
| > Impossibly unrealistic to change zoning to disincentivize
| car-dependent urban design?
|
| Those zoning issues are the same reason for any number of
| other problems, including housing prices that are
| supposedly the #1 concern for a huge number of voters, and
| yet voters in many cities have only doubled down over time
| on making it harder and harder to build in efficient and
| high-density ways. "Impossible" seems like a fair way to
| put it.
| llamaimperative wrote:
| Yet some cities are making progress on exactly that
| issue.
|
| I haven't done the statistics on it, but I'll bet cities
| full of people who want zoning reform are more likely to
| reform than cities full of people who do not want it.
| paulcole wrote:
| All 3 seem to be going swimmingly so far!
| llamaimperative wrote:
| Do you need an explanation of the difference between
| "impossible" and "challenging?"
| TeeMassive wrote:
| I'm glad for RFK Jr. for this reason.
|
| Nobody talked about this in the mainstream conversations in the
| past.
| labster wrote:
| People and officials have been talking about healthy eating
| for generations. Hard to get more mainstream than every
| doctor talking about diet and exercise.
| llamaimperative wrote:
| If you like RFK Jr "for this reason," you oughta _looove_
| Michelle Obama!
|
| https://letsmove.obamawhitehouse.archives.gov/
|
| Out from underneath the rock, people have been talking about
| this nonstop for decades.
| gcr wrote:
| If you have an open mind, I'd like to assign you some homework
| if you like. Take a look around r/zepbound and count the
| following:
|
| 1. Posts from folks who diet+exercise, or who have tried
| diet/exercise and nothing's worked so they then turned to
| Zepbound ("excited to hit the gym," "my diet is finally
| starting to work with Zepbound" and similar)
|
| 2. Posts from folks who haven't tried diet/exercise and turned
| to Zepbound first. (e.g. "I'm excited to eat dessert and laze
| around on my couch all day!" or "Zep is so much easier than
| before, no more keto for me" and similar)
|
| Which group do you think would have more posts?
|
| Selection bias probably prevents us from being able to count
| "Zepbound didn't work for me, but diet and exercise did" posts,
| which is why i suggest this.
|
| Here's my hypothesis: I think self-control is generally
| uncorrelated to losing weight. Perhaps it's necessary to have
| self-control to lose weight "the simple way," but certainly not
| sufficient. I know lots of friends who've struggled and found
| it's not so simple.
| llamaimperative wrote:
| GP isn't talking about self-control, they're talking about
| the fact we've created a system that _requires_ obscene
| amounts of self-control if you wish to maintain physical
| health.
|
| People in the 50s weren't slimmer because they had ironclad
| determination to stay such.
| nextos wrote:
| Exactly, good systems do not rely on willpower. They rather
| make obvious habits effortless.
|
| Deviating from the mean is hard. Bad food and sedentarism
| are the norm.
| jsrcout wrote:
| Agree. "Defaults matter".
| Scoundreller wrote:
| > They rather make obvious habits effortless.
|
| I wouldn't call taking the stairs in a pre-elevator world
| "effortless", rather it was just the only option.
|
| I also think better food handling/storage/treatment/blah
| means we absorb & retain more of the calories that we
| consume.
| ethbr1 wrote:
| The vast majority of accessible American foods these days
| are over-processed, poor quality ingredients with fancy
| marketing on the boxes. (And stories about how the brand
| was started by a grandmother a century ago...)
| xcskier56 wrote:
| Traveling from a fairly walkable, but still car dependent
| midwestern city to NYC and also Europe in the last few
| months, it's amazing how much our living environment
| contributes. My first day in NYC and Europe I put in
| about 14k steps and at least according to my phone, one
| of those days I burned 750 cal just walking around to
| various places. Just by living my life I was WAY more
| active.
|
| Making the good choice the easy/only choice is the only
| way to solve this problem long-term (without drugs)
| mlyle wrote:
| > People in the 50s weren't slimmer because they had
| ironclad determination to stay such.
|
| No. They lived in an overall healthier environment. But
| they were also subject to much greater social pressure to
| stay slim and could endure fairly intense social judgment
| and stigmatization for weights that we consider normal
| (particularly women).
| llamaimperative wrote:
| Then why are people scrambling for Ozempic? If it were
| true that "people think being fat is totally fine or
| desirable now" then this wouldn't be a blockbuster drug.
|
| Weak thesis.
| adventured wrote:
| Both things are true.
|
| There was a far more vicious shaming culture 50-70 years
| ago about things like being obese. And culturally it's
| still looked down upon to be obese, it's just not as
| acceptable to be vicious about it (and of course
| sometimes people still are).
|
| Today however there is a lot more "always on" pressure:
| social media is a huge component to social, social
| acceptance, socializing, social learning & sharing,
| getting to date people, et al. That's a form of
| individually focused media pressure that didn't exist
| back then. And sure you can turn it off, not partake, but
| there are usually serious consequences especially for
| younger people.
|
| That's the context.
| soulbadguy wrote:
| Non sense... There were not a particularly big stigma
| about being obese 50 or 70 years ago. Socially stigma
| were more about gender roles, sexuality etc...etc...
| adventured wrote:
| There was a huge stigma about being obese 50-70 years
| ago. It was wholly unacceptable for children, young
| persons and women in particular. Exclusively older men
| were allowed to be obese culturally without being shamed
| about it.
|
| As recently as the 1980s movies were overloaded with
| jokes about fat people, it was extremely common. That's
| stigma in action culturally.
| soulbadguy wrote:
| The 80's were 40 years ago... I am not sure where you get
| your reference from... Jokes about fat people and stigma
| about being fat aren't the same thing
| llamaimperative wrote:
| I didn't say it isn't _true_ that people were shamed more
| often in the past, I said it has little to no explanatory
| power of the current health crisis because obviously
| there is no _lack of desire_ from people to be slimmer.
| mlyle wrote:
| I think it's a little bit of a silly thought to think
| that just because people want to be slimmer now, they
| want to do so _just as much_ as they would have facing
| harsher social pressures in the 1950 's.
| golergka wrote:
| They smoked.
| kps wrote:
| > They lived in an overall healthier environment.
|
| They lived in a _different_ environment. The universal
| appetite-reduction drug was nicotine, and the common
| methods of administration had a number of undesirable
| side effects.
| mlyle wrote:
| Yup. Don't forget that using amphetamines for the same
| purpose was socially accepted/considered a worthwhile
| tradeoff.
| Scoundreller wrote:
| And ample availability of calorie-free barbituates
| instead of just calorie-rich (and appetite-stimulating)
| ethanol
| listenallyall wrote:
| "Overall healthier environment". Meaning, food was
| relatively scarce. No Starbucks, Dunkin Donuts,
| convenience store on every corner. Coca-cola was not
| available in 2-liter bottles or in 24 packs of cans. No
| Costco-sized mutlipacks of anything.
|
| In the 1950s, malnutrition was a serious issue that many
| people in poor areas died from. When was the last time
| someone died because they didn't have access to food?
| Obviously, the other side of that coin is that food being
| so plentiful, people eat much, much more than ever
| before.
| squidlogic wrote:
| In my experience fitness is less about self control or will
| power and more about creating routines that lead to
| fitness.
|
| For example, I have a routine of going to a group fitness
| class at my gym in the morning. I don't need to summon
| willpower, I just have a morning routine that involves
| doing x thing at y time. No thought required.
|
| Given the abundance of options for fitness classes and meal
| plan services, you really can just put this on auto-pilot
| and have a lifestyle that is healthier than 99% of your
| peers.
| llamaimperative wrote:
| Unfortunately we know that simply convincing people to
| change their behavior is very, very, _very_ fucking hard.
| Individuals can and do pull it off, yes, but we 're
| talking about a society level change that needs lots of
| people to succeed at this.
|
| It is empirically and demonstrably ineffective as a
| solution.
| nightski wrote:
| Nothing "needs" to happen. People don't have to live how
| you want them to.
| llamaimperative wrote:
| Thanks for your insight. What are you even doing here
| having a conversation if one person has no legitimate
| bearing on another?
|
| Obviously no one is talking about a treadmill
| concentration camp here, good lord.
| justinator wrote:
| Habits are great, but I'm in great shape because what I
| do is fun. When it's not fun I called it "training" and
| that's usually for some huge goal that'll at least be fun
| to look back at 10, 20 years down the line to marvel that
| I did a thing.
|
| I guess what I want to express is habits are one step
| closer to a lifestyle change and that's what keeps one
| ultimately healthy (mentally, too). We can't have
| nightmare commutes to soul-sucking jobs to continually
| have people addicted to looking at screens and think that
| there's no fallout. Adding, "but now there are drugs!"
| isn't an advancement.
| ethbr1 wrote:
| > _Given the abundance of options for fitness classes and
| meal plan services..._
|
| This is part of what's fucked up about modern American
| lifestyles.
|
| We shouldn't be promoting _layering_ healthy behaviors
| (fresh foods and exercise) on _top_ of our default lives
| -- we should be doing a better job of engineering our
| environment to make those things the _default_ for all
| people.
|
| F.ex. what if we highly taxed automobile entry into urban
| cores and shopping districts?
| ryukafalz wrote:
| Right. Design our cities so that getting around while
| getting exercise is safe and easy. And restaurants/etc
| should give you healthy portion sizes by default, not
| rely on your self-control to stop eating. And so on...
| jim-jim-jim wrote:
| Every yuppy feels compelled to remind you they go to the
| gym, expecting a pat on the head for being a responsible
| citizen, when it's really a sign of a dysfunctional
| lifestyle. Cordoning off a discrete slice of time to "be
| healthy" is pathetic imo. I'd much rather just be
| healthy. Gorillas don't work out.
|
| But because I live in suburban Australia and eat the same
| pesticide laden slop as everybody else, I too have a gym
| membership.
| hooverd wrote:
| Gorillas can also digest cellulose.
| skeeter2020 wrote:
| Routines help because they reduce the impact and
| uniqueness of the good behaviour. Another approach is to
| do things that have high positive pay-off but include
| health benefits you wouldn't target but get "for free".
| Example: I ride my bike to work because it's awesome,
| faster and makes me feel superior. That I get exercise
| and help out the earth is a side effect; I'd probably
| still ride my bike if it was unhealthy and produced more
| CO2
| jrflowers wrote:
| > People in the 50s weren't slimmer because they had
| ironclad determination to stay such.
|
| People in the 50s (in the US) had, among other things,
| fistfuls of benzedrine.
|
| Edit: here is a link for the skeptical folks
| https://www.smithsonianmag.com/history/speedy-history-
| americ...
| llamaimperative wrote:
| Whatever, set the clock to the 1820s. Or the 1400s. Or
| the 1200s. Or the 1990's or 200 BCE, I don't care.
| golergka wrote:
| They didn't have that much food available.
| jrflowers wrote:
| I didn't bring up the 1950s, you did. (???)
|
| It is a useful and topical period to discuss in a thread
| about ubiquitous weight loss drug usage.
| viraptor wrote:
| Do we really have enough information about their daily
| habits, food availability, ability to survive, etc. from
| those times? Once you go before easy refrigeration and
| distribution, you get people dying from famine in bad
| years. It's going be to be hard to make any actionable
| lessons from those times that still apply now.
| llamaimperative wrote:
| Yes we know that 50%+ of the population was not obese.
| viraptor wrote:
| https://academic.oup.com/past/article/239/1/71/4794719
|
| > James Nye, for example, was one of a family of eleven
| children raised in rural Sussex in the 1820s and recalled
| how the 'the young ones' in his family went 'very short
| of food'. Despite his mother's best efforts, he rarely
| had more than 'half a bellyful' at mealtimes, and ate
| scarcely anything other than bread.
|
| > Following the harvest failures of 1816, for example,
| John Lincoln's entire family was forced to undergo severe
| privations. His two children succumbed to disease very
| easily -- their quick deaths from measles were likely
| owing in part to prior malnourishment.
|
| You can't be obese if you don't have food.
| varjag wrote:
| 1820s? Oh yes a ton.
| viraptor wrote:
| Yeah, I meant before that. The records for the earlier
| years mentioned were not really kept that well for every
| segment of population.
| kemitche wrote:
| So, eras of food scarcity?
| presentation wrote:
| Or choose a country with a low obesity rate today and
| analyze that.
| mtlmtlmtlmtl wrote:
| Amphetamine(which is what benzedrine was) is pretty
| overrated as a weight loss drug in the general
| population. It causes a short window of reduced appetite
| and probably increased catabolism(due to increased heart
| rate) which peters out after a couple weeks on the same
| dose. That leads to a short period of rapid weight loss
| that pretty much grinds to a complete halt, after which
| regaining the lost weight is quite typical.
|
| On the other hand, if like me, you have ADHD and weight
| issues, it could be more helpful. Because it could treat
| your ADHD enough to help you actually establish and
| follow a structured diet and exercise regime. Especially
| if your ADHD includes impulsivity. The last time I was on
| lisdex treatment, I lost about 5kg from the initial
| boost, a lot of it was probably water weight. Then I
| managed to cut about 30kg later with calorie counting and
| regular cardio.
|
| So the physical effects themselves are largely a
| pisstake.
| golergka wrote:
| > a system that requires obscene amounts of self-control if
| you wish to maintain physical health
|
| That's million years of evolution with food scarcity and
| modern capitalist world which created unprecedented
| abundance of food (and other things). And before you
| compare it to Europe -- europeans still smoke much more
| than americans. Tobacco is also just a chemical that
| decreases effects of obesity, just in a different form.
| soulbadguy wrote:
| So that's your explanation ? European are slimmer because
| they smoke more ??
| adventured wrote:
| Which Europeans?
|
| Countries in Europe with approximately the same obesity
| problem as the US:
|
| Poland, Croatia, Romania, Britain, Hungary, Georgia,
| Slovakia, Chechia, Ireland, Greece.
|
| And of course New Zealand, Australia, Canada are all in
| the same boat as well.
|
| Those are all over 30% obesity and climbing (Romania is
| 38%, nearly at the US levels). The US is of course the
| leader of the pack, however it's all the same fundamental
| problem.
| golergka wrote:
| Different European countries have different
| circuimstances, just like their counterparts, american
| states. But if we're talking about all of Europe and US,
| then yes, this is the main reason.
| soulbadguy wrote:
| Source ?
| screye wrote:
| Your point is correct. But 50% of people in 50s also smoked
| cigarettes, a known appetite suppressant.
|
| So yeah, culture driven lower portion sizes + meds driven
| lower appetite is a well-tested combination with known
| positive outcomes.
| danbolt wrote:
| Yeah, they had nicotine!
| bsder wrote:
| > People in the 50s weren't slimmer because they had
| ironclad determination to stay such.
|
| Well, heights increased dramatically for a couple decades
| so what that meant was that many people in the 1950s were
| _starving_. In the 1930s, people _died_ of starvation even
| in the US.
|
| I don't really think that we want to go back to starving
| our population just to be thin, thanks.
| presentation wrote:
| Living in Japan has made it clear to me that cultural
| attitudes towards food make all the difference. It's not
| like there's a dearth of delicious things here, but obesity
| rates are more or less a rounding error.
| dfxm12 wrote:
| I'm not sure how this applies to my comment. I'm not saying
| anything about self control. I'm not against individuals
| taking GLP-1s. But, if we're at a point where we're _all_ on
| drugs to treat lifestyle diseases, we should at least
| recognize that _these lifestyles are largely chosen for us_ ,
| and we should consider that doing something about that will
| reap us the benefits we're after.
| llamaimperative wrote:
| Those benefits _and_ a billion more! Better state of
| nature, richer social fabric, probably less political
| polarization if people were bumping into their neighbors
| more frequently instead of going from drywall box to steel
| box back to drywall box day in and day out.
| briandear wrote:
| Not having to bump into neighbors is a feature not a bug.
| llamaimperative wrote:
| Not for civilization it isn't.
| cvwright wrote:
| This depends entirely on the neighbors
| 1659447091 wrote:
| > these lifestyles are largely chosen for us
|
| >> Unfortunately, I have to drive everywhere, work too many
| hours to have free time for recreation and have no idea
| which government subsidy is going to help big ag likely at
| the expense of my health.
|
| At what point do people stop letting the choice being
| largely "made" for them and choose something else? The gov
| subsidy has nothing to do with my personal health choices.
| My grocery store has the same fresh fruits & vegetable
| sections grocery stores in Europe have. I am lucky to live
| in a state whose dominate grocery store sources regional
| meats & produce, sells their own brand of food made fully
| or mostly with ingredients I can pronounce, and has
| complete whole food prepared meals for 1-2 people that take
| 25mins in the oven. [for the same price as fast food]
|
| It's part of the reason I _choose_ not to move. Other
| choices are a standing desk with a walking pad, which makes
| it trivial to walk 3-4+ miles a day. I could make more
| money studying leetcode and living in "elite" tech valley,
| or hustling for more work instead of choosing myself over
| the large house in swank community that _society_ has
| picked as what is "success" for me. Eventually I chose to
| take less of what "they" told me to choose; at some point
| we have to realize the only person that is going to live
| with our choices is ourself. If GLP-1s is needed to help
| people get back or get to that point of realization, then
| maybe it's a blessing to undo all the ills we(society made
| up of our neighbors) all contributed to creating.
| dfxm12 wrote:
| I'm happy you don't live in a food desert, live in a good
| neighborhood and have the means to move somewhere else if
| you wanted to. Not everyone has these advantages. I think
| we can all agree that these are good things and I hope we
| will do what we can to allow others enjoy them as well,
| because no one chooses to be in that situation, but it is
| largely a policy choice to keep it that way.
| 1659447091 wrote:
| > and have the means to move somewhere else if you wanted
| to. Not everyone has these advantages.
|
| I debated posting because this is the usual response,
| instead of seeing the point as, "we" continue to create
| this _society_ not some magical "others". I am where I
| am because of my choices + the lucky draw of loving
| computers and a dedicated family that scrapped and saved
| and sacrificed to buy me my own computer as a teenager
| which helped me move out of the situation I was born in.
| And even that was better than many of the people I grew
| up with. So no, this wasnt some privileged post of
| someone who never walked 2+ miles to the corner store
| with their friend to pick up a half gallon of milk and
| pasty white "bread" with food stamps so they could have
| sandwiches for dinner. [added: while this situation
| sounds bad it's better than where they (and many of my
| other friends) came from as they could have been deported
| back to there if found]
| acabal wrote:
| The more important point the comment you're replying to makes
| is not "what if people could diet and exercise" - i.e. accept
| the modern American lifestyle as given, plus force yourself
| to go to the gym and eat chicken and broccoli - but rather
| that the modern American lifestyle in fundamentally
| structured to lead to people being overweight.
|
| Instead of being forced to drive everywhere for the most
| basic possible human needs - like getting groceries, going to
| the doctor, or dropping kids off at school - as is the case
| in 90% of America - what if you could walk to those places
| instead? You would get exercise as part of your every day
| life, with no extra effort!
|
| What if instead of corn syrup being so heavily subsidized, we
| could use more filling sweeteners in a lower amount instead?
| What if people lived closer to agriculture, instead of in
| faraway suburban tract housing only accessible by car, so
| they had easier access to fresh meat and vegetables, instead
| of ultraprocessed package food?
|
| These dreams are not "diet and exercise", they are a
| fundamental reshaping of American lifestyle that would
| directly lead to weight loss. We know this, because America
| used to look like this before, say, 1940. In old photos you
| see people in huge crowds in streets as they walked to their
| everyday errands, and menus and recipes of the era are mostly
| minimally processed food that is mostly local. Americans of
| the past were not overweight, because the way society
| arranged its physical existence didn't permit it!
| _DeadFred_ wrote:
| My 1950+s grandparents drove everywhere and were fit. When
| we try to shoehorn so many agendas into one thing nothing
| gets resolved. It's also part of why so many people
| distrust everyone's agenda and truthfulness nowadays. Also
| 1940s America was mostly rural, not huge crowds of people
| walking together.
| foobarian wrote:
| IMHO price of calories is the only thing that needs to
| change. All the talk about wholesome locally grown foods
| vs. processed industrial stuff is just moralizing and
| posturing, when the metric that matters is the price. Just
| look at Coke, which is arguably not even a good example
| because of pre-war price fixing, but still it costs half as
| much as in 1950 when adjusted for inflation.
| Scoundreller wrote:
| Tax each calorie $1 and give everyone $2000/day.
|
| (You'll quickly end up with another underground white
| powder economy though...)
| eastbound wrote:
| I'm not obese, just before (1m75 / 82kg) but I have found
| self control impossible, except when I do intense sports
| (like musculation 3-6 times a week). Then only, and this is
| the magic part, I not only eat less, but also enjoy being
| more brave, with cold showers, being hungry, going to bed
| early and other efforts in life.
| Gee101 wrote:
| What is musculation?
| Spooky23 wrote:
| The people in #1 won't express it that way.
|
| I was that guy. For a variety of reasons that aren't relevant
| i developed insulin resistance over a relatively short time
| that made it increasingly difficult to lose weight. I'm in my
| mid 40s, which also makes it difficult.
|
| I got on one of the GLP drugs 18 months ago. I am down 80
| pounds, and am running 20 miles a week. I'll be doing a half
| marathon in March. Ive dropped the dose twice and still going
| strong.
|
| Taking the pill made exercise possible. Online everyone likes
| to apply a moral hazard thing to every discussion. GLP
| medication twiddled my dopamine system and allowed me to
| achieve my goals. Period. If you think that makes me weak, I
| cannot think of anything that I care less about.
| huijzer wrote:
| > I think self-control is generally uncorrelated to losing
| weight
|
| Choosing to eat fewer processed foods is very effective but
| does not require that much self-control since appetite will
| fall automatically.
| SirMaster wrote:
| But don't you think that it's better to make the changes to
| prevent obesity rather than focus so much on a cure for
| after?
|
| I don't have a problem with a cure only if it doesn't reduce
| the focus and effort on prevention.
|
| There has to be a reason why so many more people are obese
| today than decades ago. I refuse to believe we can't find out
| why and make changes to reverse it.
|
| But if it's so easy to cure, will enough people care about
| figuring out how to prevent it?
| paulmist wrote:
| What is a realistic path to this? Being from Europe I visited
| US last year and was horrified at the quality of your food. You
| see a lot of documentaries/youtube videos/etc... discussing the
| problem, but how do you even go about this?
| supportengineer wrote:
| There's plenty of high quality food, you just have to know
| where to look. For example, come to the Bay Area and check
| out Whole Foods and any number of high-end restaurants.
| hyggetrold wrote:
| +1 to this - what Europeans consider "the basics" for most
| Americans is filed under "luxury" or "bougie."
| cultofmetatron wrote:
| was in greece for three months. the quality of the BASIC
| fruits and vegetables at the regular local market down
| the street from where I was staying was on par with
| wholefoods. It was surreal how cheap it was to eat
| HEALTHY.
| fooker wrote:
| Have you been to Mexican grocery stores in the US?
| throwup238 wrote:
| Almost any ethnic grocery store will do since they cater
| to immigrant communities that are likely to be lower
| income. Here in SoCal some are cheaper than others but
| they're all way cheaper than Ralphs/Vons/Trader
| Joes/Costco/etc (I don't shop at WalMart so I'm not sure
| how they compare)
|
| There are also native stores that are increasingly
| entering into low cost produce like Grocery Outlet and
| then there are the usual like Food4Less but they tend to
| eventually move upmarket.
| fooker wrote:
| I wonder why, then, Europeans move to the US in such
| large numbers for academic and tech jobs.
| torlok wrote:
| They don't move because the food's better. How is your
| comment relevant to the discussion?
| philipkglass wrote:
| That's overkill. There are very marginal health benefits to
| eating organic watercress vs. eating whatever dark leafy
| green is currently on sale at the discount supermarket.
|
| The problem isn't that people go to supermarkets and they
| can't find any healthful ingredients to cook with. The
| problem is that they go to supermarkets and pass those over
| in favor of convenience foods that have been optimized for
| "craveability" [1].
|
| GLP-1 drugs can alter this behavior by reducing food
| cravings. Someone who's no longer craving the most
| craveable food can make more objective by-the-numbers
| buying decisions the next time they go grocery shopping.
|
| [1] https://www.npr.org/sections/thesalt/2015/12/16/4599810
| 99/ho...
| diggan wrote:
| > but how do you even go about this?
|
| Maybe I'm too European to understand _why not_ , but seems to
| me that regulations around food and what companies are
| allowed to put into it is really helpful in avoiding
| companies from just stuffing whatever down people's throat.
| klaussilveira wrote:
| The US is a huge country (9,833,520 square kilometers!), so I
| find it curious that such generalization can be made about
| the food available here, or even the eating habits of
| 334,914,895 humans. I could say that I visited Amsterdam 2
| years ago and I was shocked with the quality of the food.
|
| But I would never do that, since I mostly ate at the Red
| Light District, and I couldn't possibly generalize the
| country eating habits with stores in a major tourist area.
| gcr wrote:
| We have good food, but you won't find it on "The Easy Path."
|
| The Easy Path is that gentle encouragement to hit up Chipotle
| for lunch, because it's "right there."
|
| The Easy Path says dinner's hard and you've had a long day,
| so get something simple, like take-out or microwave.
|
| The Easy Path is entropy. The Easy Path is self-care over
| struggle. The Easy Path is simple carbs shown on prominent
| display in store shelves. The Easy Path is advertising.
|
| Hitting the gym isn't on The Easy Path, but forgetting to
| cancel your gym membership is.
|
| These days, big food companies love "The Easy Path" because
| it's so easy to commoditize, it's the "Path that Americans
| are Expected to Take." For financial stewards, being on The
| Easy Path turns lack of willpower into your ally.
|
| On the other hand, getting good food in the US requires
| passing the marshmallow test: you have to meal prep, or you
| have to shop around the sides, or you have to get something
| on the salad menu. You have to say no to advertising. You
| have to expend willpower, the most limited of resources to
| the average American. You have to Go Hungry or Suffer, or
| have An Upset Stomach. You frequently have to spend more
| money or time.
|
| Semaglutides are not currently on The Easy Path. Maybe they
| will be someday. I personally doubt that, because putting
| GLP-1 on The Easy Path would require big food companies to
| rethink their entire portfolio.
|
| But you're not wrong in that they could be Easy Path-
| ajdacent. The dialectic would shift: food companies would
| shift around to be Organic and Nutritious and Less Calories
| and find other ways to stay on The Easy Path. Sugar and fat's
| addictiveness is highly Easy Path-enabling, and that's a
| pretty big vacuum to fill.
| crooked-v wrote:
| > I personally doubt that, because putting GLP-1 on The
| Easy Path would require big food companies to rethink their
| entire portfolio.
|
| I think the drug industry is more powerful than the food
| industry, these days.
| gcr wrote:
| This duel of incentives will be a fascinating battle to
| watch in the coming years.
| Scoundreller wrote:
| Are they? People spend more on food than pharmaceuticals
| globally, but I do believe they're converging.
| valval wrote:
| Get ground beef in the supermarket, it's cheap and takes 7
| minutes to cook. If that's all you eat you can't be fat and
| out of shape. You also won't be hungry.
|
| At some point blaming society isn't going to cut it.
| llamaimperative wrote:
| At some point "have willpower" isn't going to cut it.
| That point was decades ago.
|
| _Blaming_ society sounds fatalistic, but yes we
| absolutely can _change_ society. There are mechanisms to
| do it, and the first step to utilizing any of them is
| people getting pissed off about the state of things and
| talking to other people about how pissed off they are
| about it.
| m_fayer wrote:
| I've done plenty of grinding it out in my life with no
| energy or time to spare.
|
| Even in that place you can do better than ground beef.
|
| Get an instant pot and invest in some rudimentary cooking
| skills. I've spent a whole year making variations on the
| same dish in 15 minutes, using that cooking as end-of-day
| stress relief. Shopping for the same handful of things
| once a week.
|
| It wasn't fine dining but it was healthy, cheap, and a
| few steps up from ground beef. Come now.
| yunwal wrote:
| > If that's all you eat you can't be fat and out of
| shape.
|
| I promise you if ground beef is all you eat you will be
| much worse than fat and out of shape.
| sumeruchat wrote:
| If the only option to stay healthy is to regularly eat
| ground beef from the supermarket wouldnt you say society
| has f**ed things up pretty badly :)
| squidlogic wrote:
| The Easy Path is a meal service like Factor that delivers
| healthy food directly to your door step.
|
| The Easy Path is signing up for a fitness class on a
| regular schedule and baking it into your morning routine.
|
| The Easy Path is not buying extra snacks - just don't have
| them laying around the house for you to eat when you're
| bored.
|
| The Easy Path is the path of least resistance. However, you
| have some agency over the environment you create for
| yourself, so that path of least resistance is to some
| degree under your control.
| FooBarBizBazz wrote:
| I think you're making this sound harder than it is.
|
| If you count calories and stick to a budget, you will lose
| weight, even if those calories come from deep-fried fast
| food. Sure, it's good to eat more whole fruits and
| vegetables, and you should, but weight loss doesn't require
| some kind of Edenic perfection. Stick to a calorie budget
| and you will lose weight, the end.
|
| We can add some second and third order provisos, sure. The
| next tip would be to go low carb. And to keep a spreadsheet
| with calorie numbers for everything you eat. Track what
| you're doing.
|
| But basically, if you eat 1500 kcal/day for nine months,
| you will be much thinner. We don't have to make it harder
| than that. It works. Perfection is not required.
| kemitche wrote:
| "Stick to a calorie budget" is the HARD part, and it's
| the thing that drugs like Ozempic help people with.
|
| People aren't obese just because they can't figure out
| how to count to 1500.
| ActorNightly wrote:
| The first thing that would help is actually having a
| realistic discourse about food, and not the idiotic - "You
| shouldn't be eating processed food, its not good for you".
|
| Like most of the food that we eat is not really that bad. Its
| not optimal for sure, especially for sedentary lifestyles,
| but a lot of the health problems are not directly tied into
| the actual food, rather the over-consumption of it, and
| passing down of bad genetics (for example, children of obese
| people are more likely to be obese).
|
| European obesity tripled in the last 40 years as well,
| despite higher quality of food.
| aezart wrote:
| > (for example, children of obese people are more likely to
| be obese)
|
| I would assume that this is related to gut biome and not
| genetic makeup.
| rootusrootus wrote:
| > Being from Europe
|
| Why is the quality of food in Europe so much worse than
| southeast Asia?
|
| Because you guys are way, way, _way_ fatter than e.g. the
| Japanese.
|
| Back on topic -- we have excellent food in the US, but
| regulations allow for highly processed crap to be sold too.
| Pretty sure most of the crappy processed foods are easily
| available in Europe, too.
| vundercind wrote:
| It's been studied pretty well. Possible effective solutions to
| the US obesity epidemic are pretty much limited to:
|
| 1) Radically alter aspects of food culture, work culture,
| social policy, and business regulation.
|
| 2) Magic pill (/injection)
|
| There appears to be no imminent progress on the many parts of
| #1 that need serious work, so if we want a big turn-around in
| the next half-century, #2 has suddenly and surprisingly become
| a real possibility.
| jodrellblank wrote:
| From the article " _Estimates suggest GLP-1s can reduce body
| weight by at least 15% when taken regularly_ ". That's a
| 5'10" man starting at 250lbs (obese, BMI > 35) and finishing
| at 220lbs (obese, BMI >30).
|
| Or a 5'10" man starting at 220lbs (obese) and finishing at
| 187lbs (overweight, BMI > 26).
|
| It ain't nothing, but that's not a magic pill which will fix
| the obesity epidemic. And these people have skipped changing
| their lifestyle, exercise, diet, and attitudes around food.
| vessenes wrote:
| I lost 100 lbs over 18 months. And, I found it much easier
| to change my lifestyle on a GLP-1 drug. Naturally thin
| people / people who don't have some environmental
| sensitivity are super judgy about GLP-1 drugs, and closet
| judgy about fat people. It's just not so simple as
| "lazy/poor diet/no exercise."
|
| I went from nutritionist appointments that were like "are
| you lying about your food intake? because if not, you have
| some serious problem with something in your environment" to
| "yep, it was easy to cut out a couple things that bothered
| me," and weight came off astonishingly rapidly.
| inglor_cz wrote:
| This is work in progress, though. 3rd generation
| medications are already way more efficient than 1st gen.
| Saxenda ever was. A further increase in efficiency is
| likely.
|
| "And these people have _skipped_ changing their lifestyle,
| exercise, diet, and attitudes around food. "
|
| That sounds very judgmental of you, like if they were
| skipping school. Bad truants!
|
| What about "found the necessary changes too
| hard/complicated to sustain"? That is closer to reality.
| People juggle all sorts of obligations, some are doing
| multiple jobs, commuting 90 minutes each way etc. - they
| may be just too fatigued to exercise regularly and cook
| healthy meals at home.
| kristjansson wrote:
| N.B. the claim from the quote is 'at least 15%', many users
| will realize larger benefits.
| NotPractical wrote:
| But is it time to give up just because there hasn't been much
| progress yet? It seems now that we have #2 there's little
| incentive for #1, whereas there was plenty incentive for #1
| before even if little action.
| vundercind wrote:
| I think fourish decades was enough time to see if we'd get
| our shit together on the pile of problems that need to be
| fixed to solve this the #1 way. We haven't, even a little.
|
| So no, I'm thrilled to see #2 show up to _maybe_ get our
| healthcare system to limp along for at least a couple
| decades longer than it was looking like it would.
| adventured wrote:
| Yes. Looking out 30, 50, 100 years science will further
| resolve the obesity problem that has plagued the US since
| the 1980s. There is no scenario where you radically alter
| such a gigantic, disconnected, complex culture such as the
| US has. The old joke was that the US would solve this with
| pills (so to speak), and that's what is going to happen.
|
| If you have a tiny, homogeneous culture it is still very
| difficult to radically alter it in the span of a couple
| decades (think: Sweden, Finland). For something the scale
| of the US, with the diversity of the US, there is no
| possibility. Anything suggested as comprehensive would be
| fantasy. There are only small changes that could be done,
| eg relating to sugar consumption limits in drinks and food;
| some would have a meaningful impact, however you still
| won't fundamentally change the culture's calorie problem.
|
| Getting thinner will do extraordinary things for rebooting
| the malfunctioning US. Obesity does a lot of harmful things
| to work ethic, longevity, quality of longevity,
| productivity, mental capabilities, to say nothing of course
| diabetes and cancer and so on.
| snovv_crash wrote:
| I think it's better not to sacrifice the wellbeing of our
| citizens at the feet of an ideology about exactly how we
| should be solving an obesity crisis.
|
| Besides, having healthier people will lead to better
| infrastructure for healthier lifestyles, purely based on
| demand. It's a virtuous cycle.
| sumtechguy wrote:
| I know someone who has lost about 60lbs. The reaction of most
| people is 'what pill did you take'. They find out it is
| basically no sugar and limited amounts of food with some mild
| exercise. Pretty much every one of them is 'thats hard' and
| do not do it. And frankly it is hard. Like 95% of a grocery
| store has way to much of what you need for your daily intake
| in some form or another. It is that 5% you have to dig thru
| the whole mountain of crap to find. Then once you find it
| hope like hell the manufacture does not stop selling it. Or
| enjoy making everything from scratch (even that is a pain).
|
| I would not jump on that current pill yet. Wait and see.
| There are probably serious side effects that we mere plebes
| do not get to find out about yet (that is for 20 years from
| now). Like what is the side effects when you stop taking it?
| What if your dose is too high/low? What is the long term
| usage like for other parts of the body?
| op00to wrote:
| GLP-1 agonists have already been marketed for 20 years. If
| there were effects, we'd have seen them by now.
| lurking15 wrote:
| Sharon Osbourne almost died, and I've read about enough
| people having serious problems on them including
| gastroparesis and bowel obstruction.
| vundercind wrote:
| ? All I can find are a bunch of articles about one or
| more interviews she gave where she complained it made her
| too skinny (if you're on it for weight loss rather than
| diabetes, you can simply adjust the dose down if you're
| finding it _too_ effective), nothing about almost dying.
| lurking15 wrote:
| > "I'm too gaunt and I can't put any weight on. I want
| to, because I feel I'm too skinny," she went on before
| warning people, "Be careful what you wish for."
|
| She abruptly stopped after losing much more than she
| wanted to lose.
|
| She looks ill frankly.
| op00to wrote:
| > "Osbourne said when she first began using the drug she
| felt nauseous for two to three weeks." > "You don't throw
| up physically, but you've got that feeling," she said. >
| She was also very thirsty and did not want to eat.
|
| No, it doesn't appear that some famous person almost
| died. The drug seemed to be effective for her. She
| noticed some mild nausea - she even said she didn't throw
| up. That's mild nausea. She was thirsty - this makes
| sense. Food contains water, so she was probably
| dehydrated which contributes to the nausea. She should
| have drank more water. Finally, she did not want to eat.
| That is the intended effect of the drug. Sounds like it
| did exactly what it was designed to do.
|
| Yes, gastroparesis can happen. This is not a shocker, as
| GLP-1 agonists affect the rate of gastric emptying.
| Gastroparesis is ... a slowing of gastric emptying. 750
| out of nearly 150,000 GLP-1 patients experienced
| gastroparesis. This is about double the incidence in the
| general population. In very rare cases of gastroparesis
| you can experience blockages, but that is very much the
| exception, not the rule. Even so, this is why it's
| important to meet regularly with your doctor, discuss how
| you're feeling while on the drug, and get medical
| attention if you discover you're not shitting and normal
| methods don't improve things.
|
| There are many useful, common drugs that have side
| effects that seem scary but are rare. ACE inhibitors are
| wonderful, well-tolerated drugs for controlling blood
| pressure, but long term use can cause kidney issues in
| very rare cases. Monitoring potassium levels allows for
| this side effect to be controlled well before kidney
| damage results.
| CM30 wrote:
| Sounds similar to most major world/cultural issues today. You
| can make the exact same argument about climate change for
| example.
|
| But at the same time, part of me wants to ask... why is this
| a problem? Why shouldn't we just use science and technology
| to fix human problems and remove any unfortunate consequences
| from society?
|
| What's wrong with a world where anyone can eat as much of
| anything as they want, do no exercise at all, ignore their
| dental health and smoke like a chimney, yet still have
| perfect health without any downsides?
|
| Objectively, it would be a better society, with everyone
| materially better off and a system that doesn't need anywhere
| near as many resources to care of its citizens.
|
| Why would it matter what route is chosen here?
| rootusrootus wrote:
| > Possible effective solutions to the US obesity epidemic
|
| Just wanted to mention that this is not a US problem, and
| framing it as such won't help find solutions. Even in
| southeast Asia the rates over obesity are steadily
| increasing. Europe is already _much_ fatter than southeast
| Asia. This is a worldwide phenomenon.
| vundercind wrote:
| It is global, but the US is among the leaders _and_ people
| who move here from skinnier countries tend to get fatter.
| Something about (odds are, a bunch of somethings about) the
| living environment we've created causes more obesity than
| the environments in most other countries, though yes, it's
| getting worse in those other countries, too.
| sschueller wrote:
| I would argue that the US has some fault to why other
| western nations are getting fatter.
|
| All of the US's worst fast food chains and food products
| have been exported. In my tiny city a Carl's Jr. Just
| opened! There is McDonald's, Burger King and Starbucks
| everywhere. There are also Dunkin donuts in the supermarket
| as well as oreos. In contrast there arent any Asian or
| Russian restaurants chains here.
|
| Local foods have become sweeter in order to compete and
| there are so many local burger restaurants now it's like I
| have moved to the US.
| rootusrootus wrote:
| > US has some fault
|
| That's par for the course, the world does love to blame
| us for their problems. Then they bitch when anyone
| suggests we've made some choices in the last 100 years
| that made their lives noticeably better (hello Marshall
| Plan!).
|
| > have been exported
|
| That's a convenient spin on "have been imported." Do you
| not make your own choices? If you don't want the crappy
| fast food, quit making your own copies of it!
|
| Since it's kind of on point for this discussion, I just
| thought I'd mention one amusing thing I noticed in London
| -- you can buy _higher calorie_ McDonalds food there. I
| could get a sasusage mcmuffin with _two_ patties, which
| isn 't a thing in the US. I almost wanted to do it just
| for the laughs, but frankly the UK version of McDonalds
| tastes even worse than the US version. I'm not sure
| exactly how that's possible.
|
| Y'all should stop importing the shittiest excuses for
| 'American' food. A lot of us never eat at these places in
| spite of them being so prevalent. We have a lot of great
| restaurants, even some of the ones that qualify as fast
| food.
| mmsc wrote:
| When the majority of the population is so far gone from being
| in a healthy weight, promoting healthy food for the masses is
| not going to help that majority. Yes, walkable cities and so on
| would be great, and promotion of healthy food and habits is
| great (remember Michelle Obama asking "why are you people so
| fat wtf?") for future generations, but Ozempic et al. provides
| a solution where otherwise, a lot of people are simply "lost".
| chairmansteve wrote:
| The government isn't going to help you.
|
| This evening, go for a one minute walk.
|
| Tomorrow evening do the same.
|
| Next evening do the same.
|
| Repeat.
|
| The journey of a thousand miles begins with the first step.
| knowitnone wrote:
| one minute? I'm sure that's not going help anyone to walk for
| one minute. 30 minutes at a minimum. 60 is good, 120 is
| great!
| chairmansteve wrote:
| They've got to start somewhere. Build the habit, get over
| the resistance.
|
| 1 minute will turn into 2 minutes, then 5 minutes.
|
| And 1 minute is infinitely better than 0 minutes.
| blamarvt wrote:
| I choose to interpret the post as saying "start small, and
| be consistent". If you were to tell someone to go for an
| _at least_ 30 minute walk every day many people would balk
| at you.
|
| Start with a minute walk. Make time in your day for it.
| Extend to a 2 minute walk. 5 minute. 15 minute. Etc.
| throwaway019254 wrote:
| To paraphrase: Instead of relying on medication that helps with
| issues caused by our society, let's completely change the
| society so it's no longer the issue?
|
| That's very idealistic, in my opinion.
| itronitron wrote:
| It would be interesting to run an experiment where everyone in
| first world countries was able to (and had to) walk to the
| grocery store to buy their groceries. It seems like that would
| promote useful exercise while self regulating consumption.
| knowitnone wrote:
| I walk to the grocery store all the time. This was part of my
| weight loss strategy and I chose to walk to a farther grocery
| store. And yes, I did attain my weight loss goals.
| fasteddie31003 wrote:
| The two are not mutually exclusive.
| ajkjk wrote:
| As compelling as the theory that "unhealthy behavior" is root
| cause of the obesity epidemics, at this point it seems to me
| that the weight of evidence suggests an actual physical
| disruption. It's not supposed to be _this hard_ for (some)
| people to maintain their weight; something is actually not
| working right.
|
| https://slatestarcodex.com/2017/04/25/book-review-the-hungry...
| might be interesting in the same direction.
| blackqueeriroh wrote:
| Uhhhhh, Ozempic has so many problems and side effects that get
| glossed over.
| godshatter wrote:
| Can you keep the weight off once you stop using it? I don't
| particularly want to have my personal health be in the hands of
| one company especially if the culture stratifies into those who
| can afford to be the right weight and those that can't.
| Especially when it enters it's "enshittification" stage.
| petesergeant wrote:
| It's hard to keep weight off once you stop using it, but I've
| not seen anything to suggest it's harder to keep it off if you
| lost using GLP-1 than if you lost the weight the normal way.
| Most fat people I know have lost weight successfully more than
| once "the hard way" and then regained it.
| olddog2 wrote:
| I'm pretty sure all the Shortages of Ozempic and mounjaro are due
| to injector mechanism production factors and the fact that when
| the drug is transported in a reconstituted fashion in the
| injector, it needs to be kept in cold chain storage the whole way
| which makes logistics much much harder
|
| My friends and I all live outside of the USA and we can get
| basically unlimited ampoules of powdered Mounjaro from China. It
| is very simple to reconstitute with Sterile water in a no touch
| way and works great. We have all had significant weight loss and
| improvement in blood pressure and glucose levels etc.
|
| Waiting for these companies to get their act together, especially
| when mounjaro is a copycat drug is not acceptable. these drugs
| are biochemically very simple peptides with a couple of cross
| linkages and very easy to make in high quantities so there is no
| excuse for everyone who needs them to not be on them. a large
| portion of the world not having access to these drugs for the
| patent period and continuing to suffer all the effect of obesity
| is not morally acceptable.
| m3kw9 wrote:
| I think there will be a time when engineered chemicals will beat
| natural food, but right now this isn't it. I'm talking about
| longetivity tech in the far/ or near future
| subroutine wrote:
| It will be interesting to see how health insurance companies deal
| with Ozempic. A few days ago a top article on HN posed the
| question: Millions of Americans could benefit from drugs like
| Ozempic; will they bankrupt the healthcare system?
|
| Of course there are many health benefits to losing weight. Given
| there are clear, healthy, non-drug assisted ways to lose weight,
| should drug-assisted weight loss be considered an 'elective'
| procedure, so to speak (similar to liposuction). With so many
| people qualifying for this drug, would it be fair to increase
| insurance premiums for overweight individuals? (I say this as
| someone who could lose a few lbs). Should healthy active folks
| who keep their weight in-check naturally be required to foot some
| of the insurance premium bill for those who use this drug to lose
| weight? If someone rebounds multiple times after going off
| Ozempic do we continue to collectively pay? Will we be required
| to collectively pay for people to stay on Ozempic indefinitely to
| maintain a healthy weight?
|
| https://www.latimes.com/science/story/2024-05-29/will-ozempi...
| calvinmorrison wrote:
| The cost of someone being on Ozempic is going to be miles less
| than treating fatties for all the related obesity problems.
| crooked-v wrote:
| Yeah, right now the cost of the drug itself is high, but as
| that comes down and/or once the patents expire, it's a no
| brainer for insurance companies to fund it, in the same way
| that even the worst health insurance plans usually allow for
| cheap office visits and free flu vaccinations.
| subroutine wrote:
| I agree if the cost becomes negligible or whenever it
| becomes cost effective (I'm sure the insurance companies
| will be tracking the data closely) - until then though?
| subroutine wrote:
| I'd have to see some data to be convinced. There is nothing
| more problematic to health than aging. If we make all
| "fatties" thin we'll eventually get a bunch of geriatric
| cancer or dementia patients, or some other expensive age-
| related health problem (e.g. what is the lifetime healthcare
| cost-burden of obese people who live on average to 65 vs.
| thin people who live on average to 85 - just making up
| numbers here)
| rootusrootus wrote:
| I agree. Fat people dropping dead in their 50s and 60s are
| way cheaper than the folks who hang on into their 90s
| getting steadily more infirm with chronic disease.
|
| I still expect that the cost will reach a point where
| insurance companies opt to 100% subsidize so everyone who
| wants it will get it.
| farceSpherule wrote:
| A lot of people fail to realize that eating healthy and
| exercising is not enough for a lot of people who fight with their
| weight their entire lives.
|
| Ozempic and Wegovy are game changes and have real, tangible
| health benefits.
|
| One person told me, "No matter how much I eat or exercise, I have
| been 'hungry' my entire life. That ended when I started taking
| these drugs."
| Uehreka wrote:
| I gained about 50 pounds the past decade and the past year I've
| been trying to lose it.
|
| I weighed myself at the beginning: 205 lbs
|
| I started running 30 minutes per day (heartrate training
| targeting about 140-150), every day, for 10 months. I kept my
| diet the same as before (though with a protein bar after the
| run). Weighed myself every week or two, always within a couple
| pounds of 205.
|
| In March I ramped up my runs to 45 minutes per day with better
| interval planning. Still 205. I injured my ankle in May: 205.
| I've been busy and haven't gotten back into running yet, just
| weighed myself, and after months of no activity: 205
|
| Weight loss is hard. It is possible to put in a pretty
| strenuous amount of effort and willpower and see exactly zero
| results.
| sph wrote:
| What do you eat? I bet $10 either it's calorie-counted
| standard high carb diet or something that is low in protein
| and fats.
|
| The physiology of dieting, and avoiding hunger, is pretty
| well understood at this point. Just don't ask your GP or
| they'll just tell you to stop eating red meat and eat more
| cereals as the "solution".
| pixl97 wrote:
| Eh, in a clinical setting only eating "good food" works
| fine.
|
| In the real world this is not what people experience.
| Especially those that experience mental food noise.
|
| Imagine there is a donut in a box at work. It's free, you
| can have it at any point. It's junk food, it's bad for you,
| it's not part of your diet and you don't want it. I mean
| you ate a high fiber food and protein earlier, you
| shouldn't be hungry at all. Now imagine there's an
| additional voice in your head that just slips in "Ok,
| finish that page your on and go pick up that donut". How
| long can you resist it? You probably won't even notice it
| since it's the normal stream of thought you have. At some
| point you'll end up with that donut in your hand.
|
| Now take a GLP-1. The voice gets silenced. If you smoke or
| drink you'll notice that you don't really want to do that
| either.
| esfandia wrote:
| Not the OP but I have tried to reduce my sugar intake, I'm
| walking more than before, and I still basically gain half a
| pound every year. I'd lose some weight for a few days, and
| gain it all back on the one day I'm a bad boy. It seems
| like there's an internal dial that decides what my weight
| is supposed to be, no matter how much I fight it. And the
| dial adds half a pound every year. I guess the dial is my
| metabolism as I age.
| ninalanyon wrote:
| You need to reduce your calorie intake. The exercise isn't
| enough to have a significant impact.
| DonnyV wrote:
| There are a couple things missing from routine. That protein
| bar is sabotaging your run. Those things are filled with
| sugar. You need to do 2 things. Change what your eating and
| do intermittent fasting to jump start your metabolism.
| crooked-v wrote:
| Just doing more exercise doesn't actually help much with
| losing weight, as it turns out. The human body will optimize
| around even intense exercise to reduce calorie burn to a
| homeostatically stable level. The exercise will still make
| you healthier (and have some marginal extra calorie burn from
| e.g. extra muscle mass), but you'll only lose serious weight
| if you also reduce what you eat.
|
| There are a bunch of articles out there about it, but
| Kurzgesagt has a decent pop-science summary:
| https://www.youtube.com/watch?v=vSSkDos2hzo
| cortesoft wrote:
| Its a pretty well known fact that exercise alone (unless you
| are doing extreme athlete training) is not going to change
| your weight without a change in diet.
|
| You can get healthier with exercise, but not smaller. That is
| almost entirely based on diet.
|
| Just think about it; your thirty minutes of running probably
| burned between 300-500 calories. That one protein bar
| probably has about 300 calories by itself.
| r00fus wrote:
| And that's where the GLP-1 meds come in. You get physically
| sick from eating your current (oversized) meal size. You
| don't have cravings. You can lose weight using GLP-1 even
| if you don't exercise strenuously/daily. However you lost a
| lot more if you have a regimen.
| rootusrootus wrote:
| > 300-500 calories
|
| Put another way, up to a pound a week of weight loss,
| changing _nothing_ about your diet.
| cortesoft wrote:
| Right, but the exercise made OP eat a protein bar, which
| has about as many calories as you were burning in
| exercise.
| rootusrootus wrote:
| The exercise _made_ OP eat a protein bar?
|
| I feel like you just inadvertently explained why dieting
| is not the answer.
| ironman1478 wrote:
| Speaking from experience, that assume that you are
| currently maintaining your weight. I think a lot of
| people are gaining weight slowly, so burning those
| calories actually just keeps you at your existing weight,
| not decreasing it.
|
| It's also really hard to not overeat after working out,
| especially if you do something like swimming, which makes
| you just so hungry. The hunger reduction is I'd like to
| try ozempic. I am active (I swim 3-4k yards hard 2-3
| times a week and surf once a week + walking generally),
| the hunger I have after swimming is so huge I just can't
| not eat something huge, even though I drink a ton of
| water and do all the other things people say to do to not
| get hungry.
| momojo wrote:
| Thanks for sharing. It must be discouraging to see no results
| after pretty rigorously following the mantra of "just try
| harder".
| swat535 wrote:
| Exercising won't work, weight loss happens in the kitchen..
| You can do some moderate exercise of course but you should
| count calories and eat less (don't forget to recalculate your
| requirements as you lose weight!).
| bobro wrote:
| Running for 30 minutes is maybe 200-400 calories. If you
| trigger your body to eat more because of that or you are more
| lazy throughout the day because you're tired after running,
| it's a wash. Exercise is not the route to weight loss. It's
| like 80-90% diet.
| rootusrootus wrote:
| > It's like 80-90% diet.
|
| And if you diet, you lose weight temporarily and trigger
| your body to eat more because you're hungry. Your body
| doesn't want there to be a route to weight loss, so it
| blocks them pretty effectively.
| sensanaty wrote:
| Exercise by itself doesn't increase calorie burn all that
| much, it just strengthens your body in other ways. It's still
| very important, but to have a healthy weight you need to eat
| healthy (for most people this just translates to eating less)
| and diverse foods with good macro coverage.
|
| You not changing your diet is the problem in this case, and
| that protein bar has so much sugar that by itself it's
| counteracting whatever effort the exercise had in the first
| place.
|
| Also in my experience most people who say this kinda stuff (I
| train and eat healthy but can't lose weight!) actually don't
| eat healthy _at all_ , because they simply don't know what
| that actually looks like.
| Sohcahtoa82 wrote:
| > One person told me, "No matter how much I eat or exercise, I
| have been 'hungry' my entire life. That ended when I started
| taking these drugs."
|
| I would change this to "No matter how much I eat, I have been
| hungry my entire life", because that's what my experience is.
|
| I'm nearly always hungry. Doesn't matter what I eat or how much
| of it. High protein, high fiber, moderate fat, low carb, all
| the steps people say cures hunger, and I'm still hungry. 20 oz
| steak and a massive portion of broccoli, and I'll still get
| munchies an hour later. And before someone says "You're
| probably actually thirsty, but making the common mistake of
| thinking it's hunger", no, that's not it. I'm drinking plenty
| of water. My urine is almost clear.
|
| People say things like "If you're hungry between meals, just
| eat a handful of nuts!", and I don't know if I want to laugh or
| cry, because I'll eat a handful, then another, and another,
| next thing I know, I've eaten _literally 1,000 calories_ and I
| 'M STILL FUCKING HUNGRY.
|
| And so I get _incredibly angry_ whenever someone says something
| like "omg these fatties have to take drugs because they don't
| know how to stop eating" as if everyone has the same
| experiences as them.
|
| No, my hunger sensor is miscalibrated. Some of ya'll might go
| out to lunch and end up eating a large meal and not end up
| hungry for dinner and skip it. I'll go out to lunch, eat the
| large meal, and end up hungry 2 hours later. If I get the
| smaller meal, I'll leave the restaurant still being hungry.
|
| I even tried keto. I did it for 9 months and went from 270 to
| 205 lbs, but even after 9 months, my hunger was not
| recalibrated. I was still hungry after every meal. After 9
| months, I ran out of willpower. Gave into the hunger again.
| Slowly came back to 245 lbs and stayed there.
|
| I wish I could try Ozempic. Maybe it would fix me. But I'm not
| diabetic, so my doc won't give it to me.
| rootusrootus wrote:
| Ozempic (or better, Zepbound) will solve that problem. I feel
| just like you, have had a similar experience, and I'm taking
| tirzepatide (Zepbound, basically) now.
|
| Ignore the haters. Focus on what will make _you_ successful.
|
| > my doc won't give it to me
|
| Get another one. You can have more than one. Go to one biased
| in favor of selling you the drug, if that is what works. It
| is your health. Your doc is not your mom, he is your advisor,
| it is _your_ body and _your_ choice what to take.
|
| Compounded semaglutide is relatively inexpensive. And over
| time the brand name stuff will start to come down because
| they are being undercut by the compounds. Zepbound, for
| example, is now available direct to consumer for $550/month
| (5mg, and not an autopen so you can easily split the dose to
| make it last longer if that still works for you). Still
| pretty expensive, but for a life changing drug it is worth
| it. I also expect the price will continue to drop, probably
| quite a lot in the upcoming years.
| dennis_jeeves2 wrote:
| >eating healthy and exercising is not enough for a lot
|
| That's because both these interventions when followed in the
| way they are commonly understood are near completely incorrect.
| I blame the govt/medical profession for this.
|
| Other factors: again I blame govt/medical profession for this -
| example it's difficult to get unprocessed food unless one reads
| labels carefully. For example it is near impossible to get milk
| that is not fortified with vitamin D. As they say: the road to
| hell is paved with good intent.
|
| Granted that even after doing everything right there will be
| some people who will be obese, but that would be the minority.
| Again the govt/medical profession is to blame - for example
| I've heard that infants/kids are now given around 30 vaccines.
| With so many variables that have changed in the environment it
| now becomes difficult to isolate what is causing the health
| issues that predispose people to a lifetime of ill health
| incognito124 wrote:
| Wait, what is wrong with Vitamin D?
| dennis_jeeves2 wrote:
| Vitamin D produces short-term results, in the long run it
| is harmful.
|
| I cannot find a good article on it at the moment but dig
| around and you should be able to find it. And yes I know
| people rave about vitamin D.
| andrewla wrote:
| I think Ozempic is a treatment of a symptom but not the
| underlying condition, but unlike many of the posters here, I do
| not think the underlying condition is "obesity". The below is
| mostly speculation.
|
| Research especially into people with healthy body weight seems to
| indicate that there is something going on that is causing
| widespread obesity. That is, there's some sort of environmental
| "GLP-1 Turbocharger".
|
| Maybe it relates to processed food, maybe it relates to
| microplastic contamination, maybe it's in the cheese, maybe it's
| an innocuous viral agent, maybe it's gut biome, maybe it's ADHD
| drugs, maybe it's SSRIs.
|
| I suspect that Ozempic is helping us get back to a baseline level
| of exposure by counteracting this. And in the future if we're
| lucky we'll figure out what it is and try to correct it at the
| source.
| jncfhnb wrote:
| You think ozempic is counteracting this mystery force and it is
| mere unrelated coincidence that it results in eating
| substantially less?
| andrewla wrote:
| Yes?
|
| A lizard whose bite makes its prey eat less is crazy but it
| exists.
|
| A lizard whose bite makes its prey eat more is also crazy,
| but maybe it exists?
|
| The first lizard is literal, the second lizard is a stand-in
| for whatever mystery force I am postulating the existence of.
|
| When you look at the historic literature on diet and
| nutrition from the first half of the century it's like
| looking into another universe. People are obsessed with
| getting people to eat more to prevent malnutrition even when
| food is freely available. Something changed.
| supportengineer wrote:
| We all know the problem: processed food and lack of exercise.
|
| We all know the solution: Organic vegetables, lean protein, and
| lots of exercise.
| ninalanyon wrote:
| Just reducing the vast intake of refined sugar in the US
| would help a lot.
| andrewla wrote:
| Maybe? I don't think we all know this. And some research,
| especially into people with unusual metabolism (but not
| necessarily known metabolic disorders) indicates that even
| with these restrictions, they need to operate at a
| significant calorie deficit simply to maintain a healthy
| weight. [1]
|
| It might be that they are already exposed to enough processed
| food and pesticides that simply getting those things out of
| their diet is not sufficient, but I think it's clear that
| there's more going on here than a simple answer.
|
| And, I think, most damningly, there are many people who
| maintain a healthy weight with no active efforts to maintain
| that weight, including a lack of exercise and consumption of
| processed food. It might be that a significant fraction of
| people are resistant to this effect or might just not enjoy
| the taste of processed food so naturally gain the benefits of
| avoidance.
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/
| kfinley wrote:
| I couldn't agree more.
|
| Out of curiosity, last year, I purchased some test strips to
| test my drinking water. The strips showed typical contaminates:
| arsenic, lead, copper etc. they all registered in the
| "acceptable range". In the test, there was a test strip for
| QUATs
| (https://en.wikipedia.org/wiki/Quaternary_ammonium_cation),
| which caught my attention. It wasn't something that I would
| have thought to test for, but my water tested positive. I was
| curious, so I started testing other local water sources
| including bottled water from various brands; to my surprise
| they all tested positive for QUATs. The only local water I
| could find that didn't contain QUATs was distilled.
|
| I thought maybe it was just in my area, so I started taking the
| test strips with me when I traveled. In the last year, I've
| tested the drinking water in multiple states and countries, and
| only one source has tested negative for QUATs. It was the water
| from a drinking fountain in the San Francisco Airport,
| interesting enough.
|
| My suspicion is that QUATs are often flushed down the drain,
| and the molecules must be too small to be filtered out in the
| water treatment process.
|
| I haven't found much research on the impact of QUATs on the
| human body, but I can help but think our mitochondria would be
| susceptible to damage.
| avelis wrote:
| I could suppose it's some of all of this. But my money is on
| UPF. The author of Ultra Processed People has an identical twin
| in NJ while he lives in the UK and their weights are vastly
| different.
| bozhark wrote:
| Why would you ever take a pill for weight loss?
|
| That's seems entirely fucked up
| Maxatar wrote:
| What is inherently wrong with taking a pill for weight loss?
|
| I can understand being cautious about side-effects or efficacy,
| but if a pill existed that resulted in weight loss and was
| side-effect free, I can't imagine what would be inherently
| wrong about taking it.
|
| Would it be preferable if it were a powder, or a cream? Is it
| the specific delivery format that has you concerned?
| yapyap wrote:
| gonna be a good while
| robohydrate wrote:
| I've been on tirzepatide (Mounjaro) for 4 months now. I'm down
| 13% of my body weight. I realized that frequent cannabis
| consumption interferes with the weight loss, so I've kicked the
| habit from daily to occasionally on weekends. I've started
| walking 2-3 miles a day, 2-3 days a week regularly, in addition
| to eating less and being more motivated to calorie count.
|
| All this to say, this drug has been life changing for me. I spend
| more time doing things I want to do, depression and anxiety have
| less of a hold on me now. I feel that this drug has allowed me to
| be the best version of myself I have been in a long time. The
| only side effects so far have been positive. I do worry about
| what I will do once it's time to titrate off the weekly dose and
| the best I can think of is that the habits I'm forming in the
| time on the drug I will have the resolve to continue after
| cessation.
|
| I say this because I have battled depression, anxiety and obesity
| issues my entire life. I've had many failed attempts at getting
| back to a healthy, productive and non-obese lifestyle. I don't
| know what is so different about having the drug help me, but I
| can tell you that it has been different.
| yieldcrv wrote:
| Sounds like a kickstart you needed!
|
| Aside from the disruption in cravings, the immediate results
| seem to have motivated you to do more.
| robohydrate wrote:
| You can't imagine how empowering it is to be able to say
| "No." to food. I stopped eating dessert except once a week. I
| can be in the company of other people and surrounded by
| delicious food and not feel the compulsion to eat until I am
| nauseous.
| yieldcrv wrote:
| This is interesting as this is my default, and I am pretty
| lean. I often have to remember to eat or check if I did,
| and lament that its a chore. I enjoy food and the dining
| experience, but I would be fine with that being an
| entertainment option once a week too.
|
| I wonder if there is enough research on how gut bacteria
| influences these things, because if this is what people
| want maybe I could sell mine.
| CBarkleyU wrote:
| This is something that I like to ask friends and
| acquaintances: Would you rather take a pill that gives
| you perfect nutrition and nullifies your hunger feeling
| or a pill that the gives you perfect nutrition and
| nullifies any other calories you eat.
|
| It's pretty much 50/50. Which is weird, as you'd think
| that eating is only a pleasure when hungry and I'm
| proposing them a way to get rid of hunger. Even weirder
| is that I personally would take the second pill and enjoy
| my gluttonous lifestyle.
|
| Regarding this thread: I personally decided for myself
| that if I can be stubborn towards my wife, friends and
| mom (and I am a stubborn SOB) I sure as hell can be
| stubborn towards my own bodily desires. I removed all
| meals except once per day and pretty much all desserts.
| Fuck what my body thinks it desires, if it needs it that
| much it can go fix a meal while I sleep.
| card_zero wrote:
| That's some philosophical weirdness right there. I guess
| we're kind of _into_ the biological aspects of the human
| condition and don 't want to part with them, because
| they're like a fun, mildly disgusting game. There'd have
| to be some other entertaining lifestyle that you gain in
| exchange, and you'd have to be sure you could dig it
| before you'd agree to the switch.
| vinkelhake wrote:
| I want both... Some days, in particular when working hard
| or focusing on something, food is just fuel and not
| something I want to spend time on. I'd definitely take
| that first pill for those days.
|
| But I also really like cooking. If I have the time I
| don't mind spending hours in the kitchen to prepare
| something. I don't really need that second pill _yet_ ,
| but sometimes you just want to pig out...
| card_zero wrote:
| I saw a documentary once about people who effortlessly
| remain at a healthy weight, and their activities were
| tracked for a couple of weeks, revealing;
|
| * Unexpected bursts of random activity like dancing for a
| few minutes or moving heavy furniture, that these people
| didn't even notice, while still doing no deliberate
| exercise,
|
| * Binging like suddenly eating a whole pizza, but then
| eating next to nothing the next day because "too busy",
| without putting thought into it. This would be bad for
| you on the scale of months, but fine over one week.
|
| So, of course, they made up for all the calories they
| seemed to be taking in. There's an implication that this
| is instinctual, or just fortunate habits. In my case, I
| also burn energy arguing, puzzling, and worrying, and I
| naturally radiate more heat than most, and although I'll
| happily _try_ to eat a whole tiramisu by myself I seem to
| have a small stomach and don 't attempt it often anyway.
| So although I think of myself as lazy and gluttonous, I
| guess I'm just fortuitously, circumstantially not.
| Imprison me in a restaurant, I'd probably get fat.
|
| Edit: right now I'm idly eating chocolate while I type.
| But I have no other food in the house, except three
| bananas. That's because I didn't organize it, because I'm
| lazy, but what "lazy" really means is a complex
| subconscious strategy, I think.
| vessenes wrote:
| Tirzepatide and Semaglutide are both known to reduce addiction
| / substance ingestion. I noticed I was just less interested in
| Alcohol when I started on Wegovy, and didn't realize it's a
| common effect until much later. I retained most of my
| disinterest after going off, too, FWIW.
| dyauspitr wrote:
| Sounds like a miracle drug that helps with all afflictions
| that come with our modern life/sedentary living.
| rafaelmn wrote:
| I'd say it's the opposite - if you don't exercise you end
| up skinny fat which is metabolically unhealthy as well. It
| helps with super accessible dopamine hits I guess - which
| is awesome - but need to combine it with exercise for
| maximum benefit.
|
| I wouldn't be surprised if they come up with a drug for
| that that's more sideffect free than testosterone/
| derivatives. Lean and ripped cocktail
| jjeaff wrote:
| Skinny fat is not nearly as metabolically unhealthy as
| fat fat.
| rafaelmn wrote:
| No argument here - just saying it's still not the
| endgame. Lean/ripped combo - now that's something I'd
| subscribe to/inject for regularly.
| queuebert wrote:
| Fat fat can better survive the coming post-AGI
| apocalyptic famines.
| wwweston wrote:
| Turns out it can also be useful during a personal
| apocalypse: having recently lost about 35lbs from
| emergency chest-cracking surgery, ended up pretty glad I
| wasn't at my leanest going into it (sadly, more of the
| weight lost was probably muscle wasting/deconditioning
| than fat stores, but on balance it was probably good I
| had at least 15lbs of fat stores to burn).
| vessenes wrote:
| This is true, but I'd qualify it. I'm MUCH more active
| than when I started, just naturally, and my heart health
| / true age stats (for what they're worth) are twenty
| years lower than when I started. I lost a lot of muscle,
| but as a percentage, my body fat is nearly half what it
| was when I started. 10/10 would do again.
|
| Recomping is a huge struggle, you just can't eat enough
| to add muscle bulk. Cycling on and off is tough because
| if you don't taper off it, your body is like "thanks for
| ending that long term caloric deficit, have you heard of
| cake?". So you definitely need to approach the muscle
| mass question seriously, but in no world was I healthier
| back when I had an extra 10 to 20lbs of muscle, and the
| rest in fat.
| vladgur wrote:
| Would you mind sharing before and after lean/fat
| percentages and or numbers? I am really curious if there
| is a way to optimize bulkng prior to getting on these
| drugs with a goal of retaining muscle mass(important as
| we age)
| vessenes wrote:
| Prefer not -- sorry! I'm here on my real name. If you
| want my advice, lose the weight then worry about it. A
| good amount of research indicates you tend to gain muscle
| mass in the fat/muscle percentage you start with;
| regardless if you are seriously in need of weight loss,
| the benefits of doing that far outweigh the (temporary?)
| downsides of losing some muscle mass for most people I
| bet.
| vladgur wrote:
| Totally understood. I do hear amazing results from people
| whose BMI is 35 or above.
|
| I wonder how well it works for people with Normal to
| Overweight BMI of about 25 to 35
| throwup238 wrote:
| Take a look at the protocol for the protein sparring
| modified fast which is a form of short to medium term
| fast that is designed to retain muscle mass by eating
| tons of protein with a large caloric deficit (1k+
| calories a day). You can easily convert it to a more
| sustainable Ozempic diet by adding more fat/carbs to make
| the lean protein more palatable.
|
| Fair warning though, this isn't an easy diet if you're
| not good at cooking and can't easily develop your own
| recipes. Lots of lean chicken breast so techniques like
| sous vide really help.
| marcosdumay wrote:
| Except for all the externally imposed ones.
|
| But yes, there's a reason people are celebrating those
| drugs.
| Alupis wrote:
| The problem with this (and all diet plans/drugs) is the
| lifestyle that led to problem in the first place.
|
| If you do not change your lifestyle, for real and not just
| superficially, then you will relapse with a vengeance.
|
| That is to say, be careful with using a drug as a crutch.
| Sure, it can artificially make you much more interested in
| not consuming so many calories and/or perhaps being more
| active than before - but you have to continue that
| lifestyle after stopping the drug.
|
| Will Ozempic users have developed the personal discipline
| to prevent themselves from relapse without the drug - or
| will they forever be on a the yo-yo of weight gain/loss?
| JamesBarney wrote:
| >If you do not change your lifestyle, for real and not
| just superficially, then you will relapse with a
| vengeance.
|
| Longterm glp-1 agonist research doesn't agree with this.
|
| > but you have to continue that lifestyle after stopping
| the drug.
|
| Why stop the drug?
|
| >Will Ozempic users have developed the personal
| discipline to prevent themselves from relapse without the
| drug - or will they forever be on a the yo-yo of weight
| gain/loss?
|
| A small % of people are able to achieve significant
| weight loss with diet and exercise. And an even smaller %
| of that group are able to maintain it for the long term.
| We've been trying to solve obesity this way for a 50
| years and have bubkis to show for it. If someone has high
| cholesterol we give them a statin, if they have high
| blood sugar we give them diabetes. Now if they're
| overweight we give them ozempic.
| Alupis wrote:
| > Why stop the drug?
|
| Why would you want to continue using a drug for the rest
| of your life?
|
| > Longterm glp-1 agonist research doesn't agree with
| this.
|
| Please explain. If you stop using the drug, because
| you've achieved your goals, what stops you from relapsing
| other than your own personal habits and lifestyle?
|
| > A small % of people are able to achieve significant
| weight loss with diet and exercise. And an even smaller %
| of that group are able to maintain it for the long term.
| We've been trying to solve obesity this way for a 50
| years and have bubkis to show for it. If someone has high
| cholesterol we give them a statin, if they have high
| blood sugar we give them diabetes. Now if they're
| overweight we give them ozempic.
|
| Yes, a pill for this, a pill for that... and there's no
| chance we'll discover these drugs have negative effects
| when used by a person for 50 years.
| JamesBarney wrote:
| > Why would you want to continue using a drug for the
| rest of your life?
|
| It's better than being obese. This is true of most drugs
| for chronic conditions. very few of them are curative,
| almost all of them treat the condition.
|
| > Longterm glp-1 agonist research doesn't agree with
| this.
|
| Sorry I wasn't clear, I meant with continued treatment
| you don't rebound.
|
| > Yes, a pill for this, a pill for that... and there's no
| chance we'll discover these drugs have negative effects
| when used by a person for 50 years.
|
| They might have negative side effects but obesity has
| very large negative side effects. I would be incredibly
| surprised if any of these drugs that have been used in
| diabetes treatment for a long time have anywhere close to
| the negative side effects of obesity.
| Alupis wrote:
| Obesity is a choice for most people who are obese. Yes,
| they lack the ability to discipline themselves into not
| over eating, but that is still a choice.
|
| This drug artificially makes them more likely to make a
| healthier choice. That's great. But the person's goal
| should be to develop those artificial choices into actual
| choices, ie. change their lifestyle, then get off the
| drug.
|
| Setting this up from the start as a "forever" thing is
| absolutely nuts.
| catlikesshrimp wrote:
| False. (All) People crave for food. Some people have
| stronger craving than others. In healthy people you call
| it "hunger". In obese people it is more like an
| addiction. Do you know people can be addictes to sex and
| to work, too?
|
| If you insist on the choice argument, the only way an
| addict can stop consuming is locking himself in a room
| and throwing away the key. Other than that, much help is
| needed, many changes are needed, and even chemicals are
| needed.
|
| "Choice" is victim blaming
| JamesBarney wrote:
| How much less likely do you think someone with high self
| control is to not be obese?
|
| 12%. Which shows that your intuitions about obesity and
| the causes are probably wrong.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717171/
| mort96 wrote:
| Lacking the ability to do something is, typically, not a
| choice.
| rixed wrote:
| > they lack the ability (...) but that is still a choice.
|
| Typo?
| data_spy wrote:
| The research says you gain the weight back:
|
| "For the two in every five patients who discontinue the
| treatments within a year, according to a 2024 JAMA study,
| this means that they are likely to rebound to their
| original weight with less muscle and a higher body fat
| percentage." The other issue is the muscle loss on being
| on these drugs as "Clinical data shows that 25 per cent
| of weight loss from Eli Lilly's shot resulted from a
| reduction in lean body mass, including muscle, while 40
| per cent of Novo Nordisk's jab was due to a drop in lean
| body mass." Via https://www.ft.com/content/094cbf1f-c5a8-
| 4bb3-a43c-988bd8e2d...
| JamesBarney wrote:
| Sorry I meant with continued use of the treatment you
| don't regain the weight. I agree if you stop taking the
| medication your weight will rebound.
| Alupis wrote:
| Right, so we doom some portion of the population to
| forever take a pill from big pharma? How is that
| acceptable with anyone?
|
| The goal should be to use Ozempic until you are in a
| better place to manage things yourself. The goal should
| not be to get people hooked on Ozempic for their entire
| lives.
|
| Perhaps Ozempic prescriptions should come with prescribed
| exercise with check-in and monitoring, or something.
| rootusrootus wrote:
| > doom some portion of the population to forever take a
| pill from big pharma
|
| That is temporary. The effects are real. The fact that
| you don't think big pharma should profit handsomely for
| making it happen is not the only alternative. Before too
| long semaglutide, as one example, will be out of patent
| and available as a generic. It won't cost a thousand
| bucks a month to big pharma, it'll be practically free.
| Cheap enough that most insurance plans will likely
| subsidize it all the way to zero out-of-pocket cost just
| because the ROI is so good.
| fragmede wrote:
| How my decisions will affect some company's bottom line
| is way behind "will this help me live a better, longer
| life" in my list of priorities, but I'm already on other
| medications that are generic for the rest of my life for
| other genetic defects I've been blessed with, though I'm
| not on Ozempic.
| JamesBarney wrote:
| > Right, so we doom some portion of the population to
| forever take a pill from big pharma? How is that
| acceptable with anyone
|
| This is literally how almost all medicine works that
| treats a chronic condition.
|
| > Perhaps Ozempic prescriptions should come with
| prescribed exercise with check-in and monitoring, or
| something.
|
| Why?
| formerly_proven wrote:
| > This is literally how almost all medicine works that
| treats a chronic condition.
|
| Tons and tons of people managed to fix this chronic
| medical condition of "picking up too much food with your
| own two hands and stuffing it into your face every single
| day" without requiring refill prescriptions for life. I'm
| not saying there aren't cases of so severe "food
| addiction" that this treatment would not be indicated,
| but it's clearly the first line treatment for fatness
| now, which is just wild: Let's just, uh, replace actual
| betterment, sustainable habits and healthy lifestyles
| with... chemically-restrained continued burger stuffing.
| tomrod wrote:
| We don't get pissed that elephants don't climb trees.
| What value is it to characterize people's obesity
| entirely as slovenness and gluttony? While there are
| certainly some slobs and glutton, dismissive
| judgmentality of everyone doesn't make sense.
|
| For this reason, I believe your comment is lacking in
| empathy for people who may struggle differently than you,
| yet struggle all the same.
| JamesBarney wrote:
| Sure of the almost 8 billion people in the world there
| are plenty who have successfully lost and kept off
| weight.
|
| But if you want to see if there is a reproduceable
| lifestyle intervention that treats obesity successfully
| in the long term you can look here. After a few hours of
| searching you will probably find the same thing I and
| almost all obesity researchers have concluded. There
| isn't one.
|
| https://pubmed.ncbi.nlm.nih.gov/
| foobarchu wrote:
| This thread has multiple people relating their personal
| stories of using ozempic to start building those healthy
| habits. Also, it doesn't just magically get rid of fat so
| you can eat more, its supposed to make you feel full
| longer (as I understand it, someone feel free to correct
| me on that).
|
| Plus, even if it did magically get rid of fat
| temporarily, I'd rather encourage people to do something
| rather than just shaming them for giving into a very
| human addiction.
|
| Your biggest concern around glp-1 drugs shouldn't be the
| overweight people successfully slimming down, it should
| be people who are already a healthy enough weight who
| think they need to be even skinnier (something I've
| encountered plenty of).
| BurningFrog wrote:
| I guess young people don't always know this, but there
| are plenty of medications a _lot_ of people take for the
| rest of their lives. Blood pressure and cholesterol pills
| are maybe the most common.
|
| This gives a vast number of people 5-10 years longer
| lives, and I think this is great thing, even if some
| pharma executives end up getting rich.
| Karrot_Kream wrote:
| Not just young people. High blood pressure runs in our
| family. A cousin, despite being healthy in most
| indicators, developed high blood pressure at 23. She's
| still going in her 50s just fine but has had to take
| blood pressure meds for the last 27 years.
| lizardlena wrote:
| > A small % of people are able to achieve significant
| weight loss with diet and exercise. And an even smaller %
| of that group are able to maintain it for the long term.
|
| Ozempic is only fighting symptoms of that, not the root
| of the problem which is the stigma around weightgain,
| being a big person, just fatphobia being extremly
| generalized and a lot of shame surrounding weight. While
| it's amazing for people who have medical conditions
| making them gain a lot of weight, just saying that they
| should take ozempic will not change people gaining too
| much weight. It's not anything like high cholesterol or
| high blood sugar in most cases.
| JamesBarney wrote:
| Fighting the symptoms of what?
|
| Taking ozempic will definitely keep people from gaining
| weight and will help them lose weight.
| Eisenstein wrote:
| A few questions:
|
| Can you qualify what you consider to be a 'symptom' vs a
| 'condition'?
|
| Is high cholesterol a symptom of something, or a
| condition itself? What about high blood sugar?
|
| Would you say that acid reflux is a symptom or a
| condition?
|
| Is a person that takes Prilosec daily to treat bad reflux
| treating the symptoms and not the underlying condition?
|
| What about people using asthma inhalers, or epipens:
| symptom or condition?
|
| Are people allowed to use the medicines if their
| underlying conditions are not being treated?
| perching_aix wrote:
| Sounds like it directly affects their lifestyle though?
| Being less drawn to addictions, and thus less engaged in
| related activities, is a pretty big lifestyle change.
| Alupis wrote:
| > Being less drawn to addictions, and thus less engaged
| in related activities, is a pretty big lifestyle change
|
| While on the drug. Will those changes remain if the user
| stops using the drug?
| Someone1234 wrote:
| What is the core of your point? That these drugs, that
| extend life, and reduce associated illnesses should be
| ignored or not used, because instead people can die
| sooner in some attempt to cure themselves the "correct"
| way?
|
| A corpse cannot learn healthy lifestyle habits. A living
| person who lost weight the immoral way or whatever you're
| trying to say, can of course.
| Alupis wrote:
| The point is you still need to develop a lifestyle that
| is healthy. The drug isn't a miracle, it's a band aid. If
| you do not change your lifestyle, and you discontinue
| using this drug, you will relapse. This is the same issue
| many people face when they diet as well, so it is nothing
| new.
|
| The point of my saying this is to point that out, because
| a lot of people in this thread seem to think it is
| totally ok to be on an Ozempic prescription for your
| entire life. That's horrifying for so many reasons.
| Others seem to think you take Ozempic until you're
| "cured" then you just live happily ever after. That's
| hardly going to be the case for many people who have
| struggled with weight for their entire lives.
| rixed wrote:
| I think we hear you, we should all take more care about
| bad lifestyle, everybody should exercise regularly and
| eat healthy food. But to be fair nobody has promoted a
| bad lifestyle, or said that, given there is this new drug
| let's care even less.
|
| At the contrary, given the testimonies it sounds like the
| drug helps people to adopt better habits, no?
| BurningFrog wrote:
| A lot of people take blood pressure, cholesterol, and
| other medications daily for their entire lives.
|
| If Ozempic ends up being another such drug, I don't think
| that's a bad thing.
| knifie_spoonie wrote:
| I'm not so sure about that.
|
| All the people I know who are on those for-life
| medications absolutely hate the fact that they have to
| keep taking those pills every day until they die.
| perching_aix wrote:
| They said that this specific effect was largely sustained
| after stopping with the drug, so... -\\_(tsu)_/-
| jacoblambda wrote:
| It really depends. If you break the addiction and it
| could very well remain.
|
| An example is tobacco/nicotine. If you stop smoking while
| you are on the drug and you break the addiction and the
| habit, you aren't going to reform that habit unless you
| start smoking again. And that's unlikely to occur because
| you no longer have the habit, you no longer have the
| chemical compulsion, and you aren't consuming any of it.
| Maybe stress could force a relapse due to weakness of
| mind but all things considered that's minor relative to
| the chemical addiction and the habit forming behavior.
|
| An example where you may see relapse is alcohol or
| marijuana where the substance comes almost more from a
| social environment than it does from the chemical draw.
| Like once the habit is broken, it's still easy to be put
| into situations where recreational use is common and more
| or less expected on rare or semiregular occasions. That
| of course could lead to new habits forming and leading to
| relapse or it may not depending on what other (hopefully
| healthy) habits the user is now taking part in, their
| stress level, and other aspects of their life.
|
| So the answer is of course that it depends but if the
| drug can reliably help people break habits then it can
| maybe also be useful in helping them avoid forming new
| bad habits or relapsing when the urge becomes too strong
| to resist.
| Someone1234 wrote:
| > Will Ozempic users have developed the personal
| discipline to prevent themselves from relapse without the
| drug - or will they forever be on a the yo-yo of weight
| gain/loss?
|
| Have alcoholics using Naltrexone? Or opioid addicts using
| Methadone, or smokers using nicotine gum/patches?
|
| See I'm bringing this up to point out the obvious double
| standard, people suffering from food addiction (i.e.
| literally the high from food) or binge-eating disorder,
| who finally have an effective treatment, are treated like
| it isn't addiction or illness, but a "lifestyle," but if
| you said this stuff about any other addiction people
| would call you out and be horrified.
|
| For people mildy overweight or accidentally obese, it is
| a wildly different illness for people with lifetime
| problems who have lost/regained weight tens of times and
| likely know more about nutrition than most healthy-weight
| people ever will.
| Alupis wrote:
| This is bunk. An actual chemical addiction is not the
| same as feeling an urge to drink 8 cans of coke a day, or
| being unable to not buy a bag of chips at the gas
| station.
| ben_w wrote:
| Is it, though?
|
| Your entire body and brain is a complex and messy
| chemical reaction.
|
| The opening sentence of the wikipedia article on
| addiction currently reads: "Addiction is a
| neuropsychological disorder characterized by a persistent
| and intense urge to use a drug or engage in a behavior
| that produces natural reward, despite substantial harm
| and other negative consequences."
|
| The page then lists "eating or food addiction" as
| examples, with food addiction being its own entire page.
| croes wrote:
| That doesn't prove it's an addiction.
|
| More likely it's listed as one so insurance company pay
| for the drugs.
|
| Addiction treatment gets payed, low self control not.
|
| Half Bake- Thur good goes to rehab NSFW
|
| https://youtu.be/uUPHlAbAf2I?si=TVVxffFprAtdJyAk
| stirfish wrote:
| People get addicted to gambling, and you don't put that
| in your body at all.
| spondylosaurus wrote:
| This is the example I'm shocked more people don't invoke
| in these discussions. Gambling addiction is indisputably
| real, and slot machines (or craps tables or the ponies
| down at the track) don't even have stick a needle in you
| to get you hooked. Actions and reactions are more than
| enough.
|
| Compulsive overeating relies on the same
| behavioral/reward mechanisms, with the added bonus of
| food being something you _do_ physically ingest in the
| process.
| mort96 wrote:
| The fact that people have this idea that "obese == unable
| to resist drinking 8 cans of coke per day" is honestly
| part of the problem.
| rixed wrote:
| Maybe, but shame has never been a very good cure overall.
| manacit wrote:
| Gambling? Porn? Sex?
|
| These are all things that we acknowledge are possible to
| be addicted to to that are not substances. Not to mention
| that coke has caffeine which is a chemical substance just
| as much as anything.
|
| You can pin addiction to anything as a personal weakness,
| including drugs. Why are some people able to smoke a few
| cigarettes or do a little bit of cocaine without ever
| getting addicted, when others are hooked on day one?
|
| If there's one thing that's been fun to see as the
| outcome of GLP-1 drugs, it's that a lot of people seem to
| have a real problem seeing people better themselves the
| "easy way".
| mathgeek wrote:
| A good way to frame addiction is via perceived rewards.
| You can be addicted to many things if you look at it as
| "the person expects a reward for an activity, often
| errantly". The worse addictions get into "the reward
| isn't even expected with a moment's clarity, but you do
| it anyway" territory.
| seadan83 wrote:
| The concern regarding a drug as a crutch is stil valid.
| Smokers/drinkers may deal with stress by
| smoking/drinking. After cessation, ways to deal with
| stress need to be learned from a new.
|
| "Addiction" is ambiguous and a term almost better not
| used. "Addiction" may constitute chemical dependency but
| can also be largely a set of habits. A set of habits and
| lifestyle are pretty much the same thing.
| CydeWeys wrote:
| The problem is that calling it a "crutch" is already
| presupposing a negative judgment of it. Use a neutral
| word; e.g. it is a weight loss aid.
| tomrod wrote:
| Some things simply are negative, and masking behind a
| neutral word makes the neutral word perceived as negative
| over time.
|
| Masking reality is not a good way to work within it nor
| modify it.
| goosedragons wrote:
| I think the difference is with food you have to eat it.
| You don't need alcohol, opioids or nicotine to live. With
| food it's much easier to fall back into similar or the
| same pattern as before because you can't avoid it.
| jrockway wrote:
| I don't think you expect to stop taking the drug. It's a
| for-life kind of thing.
|
| If a prescription for "lifestyle changes" were a drug, it
| would be one of the least effective drugs ever made. I
| read something directed at medical professionals that are
| skeptical of the GLP-1 receptor agonists and it asks, if
| you prescribe a drug and your patient refuses to take it,
| why would you keep prescribing that drug? Of course not.
| That's what lifestyle changes are, and the landscape has
| changed so that there are alternatives.
|
| (My employer is heavy on the "lifestyle changes" angle.
| They will not pay for GLP-1s, but they will send you a
| newsletter about losing weight if you want. Guess who's
| losing the weight.)
| metabagel wrote:
| > The problem with this (and all diet plans/drugs) is the
| lifestyle that led to problem in the first place.
|
| I don't think we fully know what led to the problem in
| the first place.
|
| I think it's a complex interaction between the types of
| foods we eat, and which are more affordable, our gut
| microbiome, and the amount and frequency of exercise
| which we are able to fit into our day.
|
| We have some pretty good ideas that reducing intake of
| high glycemic foods, safely reducing overall calorie
| intake, and getting regular exercise will help.
|
| However, it's the bad food which many families can most
| afford. Many people find it difficult to make time for
| exercise, since they are pretty exhausted from making a
| living. The foods which are bad for us tend to make us
| feel good in the short term.
|
| When a person has become obese, it is harder to start
| exercising, and it's harder to find exercises which don't
| hurt their feet, joints, back, or other parts of their
| body.
|
| Ideally, we would all have copious time to exercise, and
| healthy food would be abundant and affordable. But,
| that's generally not the case for most people.
|
| And some people seem to be genetically predisposed to
| gain weight.
| cam_l wrote:
| I figure for some people it will work as a crutch and for
| some it will work as a prosthetic. I guess that depends
| on whether you need to take some weight off and allow
| yourself to heal, or if you are actually missing that
| appendage. Metaphorically.
| arijo wrote:
| It's not a miracle drug. Check this Joe Rogan interview to
| understand at a deep level all the problems with a drug
| like Ozempic: https://www.youtube.com/watch?v=G0lTyhvOeJs
| karmajunkie wrote:
| you lost the debate the moment you cite joe rogan.
| beezlebroxxxxxx wrote:
| Is the official recommendation that you continue to take it for
| the rest of your life? Or, is there a schedule to "wean" people
| off of it?
| r00fus wrote:
| Most weight management programs recommend you wean off - and
| also recommend other drugs if needed (metformin) to for
| maintenance.
|
| The method of these programs is to use the GLP-1 medications
| to allow you to change your habits significantly while also
| reducing your weight. The goal being, you keep the new habits
| and your reduced metabolic requirements which allows you to
| keep the lower weight.
| beezlebroxxxxxx wrote:
| Interesting. If we think of effectiveness as maintained
| weight loss _and_ eventually no longer requiring the drug
| then the next few years and decades will be fascinating to
| see how effective they are long-term.
| r00fus wrote:
| I mean, that's the goal for any weight management plan
| honestly - to provide the structure for you to make your
| own change. That GLP-1 meds are so effective will make a
| huge difference for tons of folks.
|
| I think many people are going to use GLP-1s without a
| structure - and they may find it's not as easy to taper
| off without making a meaningful diet change.
| tjohns wrote:
| Studies have show most people rapidly regain the weight once
| they stop taking GLP-1 drugs.
|
| The dysfunctional biochemical processes that contributed to
| overeating are still present if you discontinue the drug.
| Your body has a natural set-point for the weight it wants to
| be at, and the hunger and food noise comes right back as your
| body tries to get you back to your old weight.
|
| It's possible that after after a long enough time at a
| healthy weight your body's natural weight set-point will
| regulate itself back down. But this process take years.
| pinko wrote:
| Is the idea of a set-point settled medical/scientific fact,
| or still a disputed theory?
| tjohns wrote:
| It's still a theory. We definitely don't know the
| underlying mechanism(s) of action, and it's likely
| there's more hidden complexity there.
|
| But rapid weight gain after weight loss (until you arrive
| somewhere near your old weight) is at least a well
| observed experimental effect. About 80% of people who
| lose weight, through any means, will revert back to their
| old weight.
|
| Source:
|
| https://www.ncbi.nlm.nih.gov/books/NBK592402/
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673773/
| JamesBarney wrote:
| Set-point theory is pretty much settled medical fact. The
| mechanism involves leptin, and you can easily see
| processes that defend bodyweight change in both
| directions. Though it will more aggressively defend
| weight loss than weight gain.
|
| In addition prey animals will defend against weight gain
| more aggressively than non-prey animals. Which makes
| sense from an evolutionary standpoint. If a lion gets fat
| he doesn't have nearly as much to worry about than if a
| gazelle gets fat.
| WalterBright wrote:
| A lion may also have to endure long periods of no food.
| JamesBarney wrote:
| > It's possible that after after a long enough time at a
| healthy weight your body's natural weight set-point will
| regulate itself back down. But this process take years.
|
| I've spent a fair amount of time pursuing obesity research
| and I've never seen that. The closest I've seen is
| researchers or studies mentioning "Maybe the set-point
| resets are x years" but never seen any direct evidence of
| this.
| spondylosaurus wrote:
| "You'll regress if you stop taking the drugs" may be true,
| but it seems like a double standard to frame it as a knock
| against weight loss drugs when this _also_ describes
| countless other interventions for chronic issues...
|
| Your lupus will flare up again if you stop taking
| Plaquenil! Your eyesight will be bad again when you take
| off your glasses!
| tjohns wrote:
| I actually agree entirely.
|
| I'm just being objective in stating that the evidence
| suggests that these drugs need to be taken long term to
| have lasting effects. Not everyone realizes this.
|
| But I think that's okay if it can get people back down to
| a healthy weight. The health impact from being overweight
| is serious, and we know that lifestyle intervention has a
| stunningly abysmal success rate.
|
| Anything we can do to reverse the obesity epidemic is a
| good thing.
| spondylosaurus wrote:
| More than fair :) I may have jumped to conclusions there
| because I generally see that line of thinking from people
| who go "...and therefore there's no point in taking
| meds," but you're right that not everyone realizes these
| are long-term drugs.
| mlsu wrote:
| My view about obesity has shifted dramatically since Ozempic
| came out. Before this, I didn't think about it too much (I am
| not obese myself).
|
| I notice now that there is a LOT of judgement, bias(?), around
| obesity, that people, obese or not, carry with them [1]. I
| certainly carried that bias, and the reason I noticed it was
| because Ozempic is literally an external substance that you
| take that simply makes obesity go away. So if you believe (like
| most of us unconsciously do) that obesity is a personal failing
| or an issue of willpower, an issue of personal merit -- HOW is
| it possible that a chemical pill, an external chemical process,
| can SO effectively resolve it? When no amount of hectoring and
| moralizing and willpower can? My inability to square that
| circle really changed my thinking about obesity in a
| fundamental way.
|
| Already there is a reaction to Ozempic -- like people thinking
| that taking Ozempic is a personal failing, or judging
| celebrities, for taking it, thinking it's the "easy way out" --
| I think the origin of that is this very deep unconscious bias
| that we all have about what obesity actually _is_
| fundamentally.
|
| My view: It is a health condition, that people do not choose.
| Not unlike diabetes, celiac, or clinical depression. We should
| be focused on how to improve the lives of people who suffer
| with that health condition. We all agree insulin is
| unequivocally a good thing; that it's not a "personal failure"
| or "cheating" to take insulin; that it really is simple as,
| diabetes is a health condition and insulin is used to treat it.
| Ozempic? Same. Exact. Thing.
|
| It's really heartening to hear your experience. Your post
| really struck me, I felt exactly the same way after getting on
| a CGM + Insulin Pump for my Type 1 Diabetes. Nobody EVER
| thought I had a lack of "personal responsibility" or an "issue
| of willpower" for going low or high on shots of Humilin and
| NPH.
|
| Thank fucking god for Novo Nordisk.
|
| ---
|
| [1] see: this thread!
| mayukh wrote:
| Obesity is a side effect of the industrial food production
| system in advanced economies that is slowly spreading all
| over the globe.
|
| How about alcohol and smoking ? Is that the same as obesity
| then
| kps wrote:
| > Obesity is a side effect of the industrial food
| production system in advanced economies that is slowly
| spreading all over the globe.
|
| Yes, for the first time in the millions of years of
| existence of humanity and pre-humanity, we consistently
| have enough to eat.
| beagle3 wrote:
| Is not just "having enough". People in New York had
| enough to eat for more than 60 years now - more like a
| 100 years. And ywt, up until the 1980s, obesity was a
| minor problem.
|
| All standards have since changed. I watched the 1st
| season of the Simpsons again recently. In one of the
| episodes, Homer weighs himself and is distressed when
| discovering he weighs 200 lbs. 30 years later, dieters
| who cross down from 200 lbs to 199 lbs call it "reaching
| onederland" and it is considered a huge success.
| WalterBright wrote:
| The US solved the food problem around 1800, being the
| first country to end the specter of famine.
| JamesBarney wrote:
| Neurologically addiction works very differently than
| obesity and research says longterm sobriety is far easier
| to maintain than long term weight loss.
| beezlebroxxxxxx wrote:
| My understanding is that more research is pointing to obesity
| as, in some sense, a precursor/reaction to the onset of type
| 2 diabetes rather than type 1.
|
| Once you get to quite obese you're dealing with physiological
| factors that make losing weight medically difficult from
| behavioral changes alone. It also makes the chances of "yo-
| yoing" the weight higher as well. At that point the treatment
| for obesity overlaps with the treatment for type 2 diabetes.
| mlsu wrote:
| Yep, it definitely is! I mentioned type 1 because I have
| it.
|
| As a contrast -- the point was that nobody judges me for
| having type 1 the way they judge people for having obesity.
|
| As an aside, I notice that sort of "lifestyle/willpower"
| type framing in discussions about type 2 also.
| DAGdug wrote:
| There are varying degrees of control over outcomes. The
| judgment comes from the correlation between an unobserved
| variable (effort at controlling or preventing obesity)
| with the observed variable (actual obesity).
| StefanBatory wrote:
| I was obese myself, and I have different thoughts on that.
|
| For me, it was purely an issue of personal falling and
| willpower issue. I was obese because of a diet I was
| indulging in; full of unhealthy things and snacks.
|
| It was due to nobody else but myself.
| fireflash38 wrote:
| For some people it is clinical. For others it is
| mental/willpower. That said... It's exceptionally difficult
| in the modern world to do everything necessary to be at a
| healthy weight. Things are shoved at you constantly that are
| terrible for you. It's so, so much easier to eat poorly and
| to excess. Combine that with dopamine hits from consuming
| sugar/fat? No surprise people overeat.
| kps wrote:
| > Not unlike diabetes, celiac, or clinical depression.
|
| The latter is, like obesity, considered a personal failing
| (being one or more of the Seven Deadly Sins, depending on
| when you look), and medical treatment elicits similar
| reactions -- both against it being 'too easy', and in favour
| of wholesale societal restructuring instead ("That trick
| never works!" -- Rocky the Flying Squirrel).
| scottyah wrote:
| The fact that a drug can cause a shortcut is completely
| normal I think, alcohol can nearly instantly give you the
| confidence that months of training would take, hallucinogens
| can give states of mind that monks spend years meditating and
| breathwork to achieve, steroids give shortcuts to massive gym
| gains, etc.
|
| I see Ozempic as "taking the easy way out" the same way I see
| steroids as "taking the easy way out" (except it brings
| people closer to the norm of a average healthy person and
| will probably lengthen lifespans).
|
| If you're in it to show mental fortitude for internet/social
| points, then it is "cheating", but if you're just in it for
| results it's perfectly acceptable and even recommended.
| ElectricSpoon wrote:
| > people thinking that taking Ozempic is a personal failing
|
| Considering our society is pushes us toward sedentary highly-
| caloric lifestyles, I'd say we're set up to fail from the
| get-go. Therefore the failing is systemic not personal. I
| wouldn't compare to individual health issues. You can't cure
| celiac, but you sure could reduce the obesity using policies
| to drive the food industry toward less-sugar/more-fiber.
| j-a-a-p wrote:
| The willpower frame actually works pretty well for a lot of
| people. If not than in our society almost everybody would be
| obese. This pill will make things worse for the group that
| hangs out in the treadmills and drinks green and disgusting
| smoothies.
|
| On topic, very happy this medicine exists, but let's pray god
| will keep the prescription only for BMI > 35.
| autoexec wrote:
| > The willpower frame actually works pretty well for a lot
| of people. If not than in our society almost everybody
| would be obese.
|
| In the US nearly 75% of the population is overweight and
| almost half are clinically obese. Sounds like "willpower"
| isn't working for the vast majority of people.
| Ygg2 wrote:
| > If not than in our society almost everybody would be
| obese.
|
| Isn't that already the case. I'm of belief, the failing
| isn't individual but societal. You have obese toddlers and
| wild animals in the US.
|
| I don't think this is a failure of willpower, it's a
| failure to investigate the actual causes of the obesity
| epidemic. Maybe it's sugar, perhaps it's highly processed
| oils, etc. Whatever it is, people aren't investigating it
| thoroughly enough.
| rootusrootus wrote:
| > people thinking that taking Ozempic is a personal failing
|
| I expect that the people who hold this viewpoint are afraid
| that their lack of being overweight will not be seen as badge
| of honor, a sign of superior morals and willpower.
|
| To them I say -- GLP-1 agonists are good for anxiety, too!
| slibhb wrote:
| > I notice now that there is a LOT of judgement, bias(?),
| around obesity, that people, obese or not, carry with them
| [1]. I certainly carried that bias, and the reason I noticed
| it was because Ozempic is literally an external substance
| that you take that simply makes obesity go away. So if you
| believe (like most of us unconsciously do) that obesity is a
| personal failing or an issue of willpower, an issue of
| personal merit -- HOW is it possible that a chemical pill, an
| external chemical process, can SO effectively resolve it?
| When no amount of hectoring and moralizing and willpower can?
| My inability to square that circle really changed my thinking
| about obesity in a fundamental way.
|
| I see no contradiction here. That ozempic works doesn't imply
| that willpower isn't real or that people can't lose weight
| via diet and exercise.
|
| > My view: It is a health condition, that people do not
| choose. Not unlike diabetes, celiac, or clinical depression.
| We should be focused on how to improve the lives of people
| who suffer with that health condition. We all agree insulin
| is unequivocally a good thing; that it's not a "personal
| failure" or "cheating" to take insulin; that it really is
| simple as, diabetes is a health condition and insulin is used
| to treat it. Ozempic? Same. Exact. Thing.
|
| I'm very suspicious of "it's a health condition" applied to
| obesity, type 2 diabetes, and even depression. I absolutely
| believe that _some people_ will be able to avoid or cure
| those "conditions" by changing their behavior. Of course
| that doesn't imply that there should be a taboo against
| medication to help people who can't. But my concern is that
| "it's a health condition" discourages people from examining
| their choices and making good ones.
| lottin wrote:
| It's not just willpower but also lifestyle. It's rare for
| people who are physically active, and have a balanced diet,
| to suffer from obesity. I can eat A LOT without putting on a
| ton of weight, and it's because the types of foods I eat and
| because I do strength training, which means have a fair
| amount of muscle mass which acts as metabolic furnace. I'm a
| little overweight, at the moment, but it'd take a lot of
| effort on my part to become obese. I think treating obesity
| as a health condition is the wrong approach.
| rixed wrote:
| What's the right approach?
|
| Had the right approach better results?
|
| If not, why is it the right approach?
| SirMaster wrote:
| >My view: It is a health condition, that people do not
| choose.
|
| If this is true, then why are we so focused on curing it
| after the fact?
|
| Are we also working on prevention?
|
| If it's not a choice, then what is the cause? And why
| shouldn't we work on preventing that cause?
|
| I mean it's clean that more people are obese today than in
| the past right? So what changed to cause that that isn't
| about people's choice? Why not work on reversing whatever
| those changes were that caused obesity to increase?
|
| And a separate question:
|
| If it's really not a choice, what would be the approximate
| rate of obesity among a group or population that all
| exercised regularly and ate healthy?
|
| I don't think I can be convinced that not exercising
| regularly and not eating healthy is not a choice.
|
| I just feel like the number of people that would be obese who
| are regularly exercising and eating healthy would be rather
| small. And if we agree that exercising regularly and eating
| healthy is a choice, then it seems at least for many who are
| obese, it indeed is choice.
|
| I'm not going to say there aren't outliers or other special
| circumstances, but I still feel like for more people than
| not, it is indeed a choice.
| buu700 wrote:
| Personally, I've never seen obesity as a failure of character
| or willpower, at least as long as I can remember having any
| particular views on it at all. I see it as a failure of
| information and choices.
|
| Obesity was rare until the United States officially decided
| in 1977 that saturated fats were considered harmful. A few
| years later, it started rising to the current epidemic level.
| We've come a long way since the American Heart Association
| was recommending candy and soda as "healthy" alternatives to
| real food, but the idea that an optimal diet contains low
| saturated fat and high complex carbohydrates remains firmly
| entrenched in present-day nutritional and medical orthodoxy.
|
| Imagine a counterfactual where Congress had reached the
| opposite conclusion, instead recommending a standard diet
| full of saturated fats, high in salts (both sodium and
| potassium), moderate in monounsaturated fats, low in
| polyunsaturated fats, and sparing in carbohydrates. The
| population and food industry would have moved in an entirely
| different direction. We'd have a whole different universe of
| nutritional advice, diet trends, restaurant choices, and
| easily available processed foods. A lot would be the same,
| but large sections of the grocery store would look like
| lowcarbfoods.com, maybe burger joints would serve mozzarella
| sticks instead of fries, maybe instead of potato chips and
| corn chips people would eat pork rinds and kale chips, and
| maybe instead of rice or potatoes an average dinner would
| include all manner of delicious fried vegetables. Instead of
| a low-fat (i.e. high(er)-carb) diet, doctors would tell fat
| people to try keto. Maybe that timeline's equivalent to trans
| fat would be sugar alcohols and artificial sweeteners, and
| governments would ultimately pressure the industry to
| transition to stevia, monk fruit, and inulin fiber.
|
| In such an alternate universe, I'm sure the food industry
| would still work overtime to find ways to make many of its
| products shitty and addictive, and I'm sure the average
| person would still lean heavily on processed foods and fast
| food over home cooking and whole foods. I'm sure that would
| cause its own set of health issues, but what I highly doubt
| it would cause is an obesity epidemic. It's simply a lot
| harder to overeat fats than it is carbs. We'd also inherently
| have less insulin resistance, which means less type 2
| diabetes, less dementia, and probably a good amount less of
| mental/neurological issues like depression and anxiety.
|
| Unfortunately, we live in this universe. And in this
| universe, I find it really hard to blame individuals for
| struggling with obesity when we've practically purpose-built
| an environment to make us fat and keep us that way. In order
| to not be fat (by pre-1980 standards), you either have to win
| the genetic lottery, be extraordinarily physically active,
| put a high amount of effort into controlling your caloric
| intake, or be willing to go against the grain (no pun
| intended) on what you've most likely been led to believe for
| your entire life by everyone and everything around you. It's
| great to fall into one of those four buckets, but on a
| population scale it should be obvious that the majority
| wouldn't.
| cactusplant7374 wrote:
| > I realized that frequent cannabis consumption interferes with
| the weight loss
|
| Because you eat more or is there some other factor?
| apwell23 wrote:
| Have you noticed any effect on gastric emptying. As someone
| with 'tummy issues' ( ibs/gerd ect) i am apprehensive of
| messing with my digestive systems.
| rootusrootus wrote:
| Not the person you were responding to, but yes. Stomach
| empties much slower, which seems to effectively make it
| smaller. A normal size (pre-drug) meal will make me
| uncomfortably full and probably cause reflux.
|
| That said, I've noticed in the past, and also now on this
| drug, that my gastrointestinal issues abate noticeably when I
| consume less food. Thought I had IBS and then I went on a
| significant diet and lost 40 pounds in 2020. The IBS
| resolved, and not after I lost 40 pounds -- it basically
| stopped altogether a matter of weeks after I changed my diet.
| That was educational. YMMV.
|
| I'm still working out my approach to eating while taking
| tirzepatide. Old habits die hard, and I'm having to cut my
| meal size way back. This sucks because my problem with eating
| too much was about eating too often, or not when hungry, not
| about binging. So I have to eat pretty small meals now. It
| will take some adjustment to find the right way to get
| sufficient nutrition while volume limited, but I think it can
| be done.
| spondylosaurus wrote:
| If your IBS is the "stuff moves too fast" variety (so, IBS-D)
| GLP-1s seem to help a lot since they slow things down. If
| your problems already stem from things moving too slow...
| maybe not so much :P
| glenstein wrote:
| I think this is such a helpful description of the totality of
| components working together to spur a positive outcome, which I
| think, at least in my personal experience, is an under-
| appreciated aspect of using a drug.
|
| I've sometimes heard it said that it's an unhealthy reliance on
| a drug in place of curbing behavior, but I think it's important
| to understand it as, among other things, a stimulant to the
| activation of beneficial behaviors, which can be as critical as
| the drug itself.
| colordrops wrote:
| Did you notice that cannabis consumption interferes with weight
| loss due to interfering with motivation to stick to your health
| goals? Or did it interfere with your metabolism in some way?
| asadhaider wrote:
| I can answer this, I've been on Ozempic in the past and
| prescribed Mounjaro (Tirzepatide) currently (month 3).
|
| I've had a medical cannabis prescription for many years and
| vaporise up to 3g a day which is quite a bit. It definitely
| interferes with my cravings for food, as you know the common
| 'munchies' effect, making me eat when I'm not really hungry
| or binge snacks.
|
| I gave up on Semaglutide (Ozempic) after a few months, but
| Tirzepatide is working a lot more effectively and has been
| better.
|
| Cannabis also helps a lot with the nausea side effect for me
| which can be particularly bad the first few days going up a
| dosage every month. It takes six months to titrate from the
| starter dose to full strength, if necessary.
|
| Also the downside a lot of people don't talk about is that
| most people need to be on these drugs for life. They also
| aren't cheap.
| arijo wrote:
| Cut on carbs and you will have all the benefits without the
| nasty side effects.
|
| Check https://metabolicmind.org for details.
|
| My own experience with the keto diet -
| https://www.feelingbuggy.com/p/finding-hope-after-decades-of...
| kerbs wrote:
| It is not easy on the mind and body as to just cut carbs.
| arijo wrote:
| I apologize for the shortcut - I should have given more
| context, though you can validate my assertion by going to
| this site: https://metabolicmind.org
|
| There is heavy research on the usage of the ketogenic diet
| for the treatment of metabolic and mental illness.
|
| I've written about my personal story here -
| https://www.feelingbuggy.com/p/finding-hope-after-decades-
| of...
| arijo wrote:
| I also recommend taking a look at this Joe Rogan
| interview to understand at a deep level all the problems
| with a drug like Ozempic -
| https://www.youtube.com/watch?v=G0lTyhvOeJs
| BadHumans wrote:
| Quoting Joe Rogan's podcast instead of literature is not
| going to go over well here.
| arijo wrote:
| Check the https://metabolicmind.org site then - you'll
| find plenty of research based evidence on the usage of
| the ketogenic diet as a metabolic therapy.
| cgh wrote:
| I read your experience and it is indeed pretty incredible and
| I'm happy for you. I've used ketosis strategically for
| athletic reasons, to cut weight. So we both had strong
| motivations to use it. But for your typical obese person, it
| is a tremendous challenge to stick with it and at the end of
| the day, it's adherence that matters.
|
| Put simply, it's easier to adhere to a drug than to a
| specific, somewhat anti-social diet.
| arijo wrote:
| It really helps if you use some LLM tool like ChatGPT or
| Claude to generate the keto recipes (sometimes with the
| ingredients you have available).
|
| If you stick to cooking keto recipes for a few weeks you
| end up internalizing the recipe patterns and you start
| cooking without even thinking about it.
| comechao wrote:
| I'm not sure if you tried but add a sport, can be table tenis,
| jiu-jitsu whatever. I did this too after got comfortable with
| the walks (that I still do).
| lol768 wrote:
| > How long til we're all on Ozempic?
|
| It's genuinely quite depressing that so many people in the United
| States have a weight problem that the overwhelming majority of
| the population would benefit from this and headlines including
| "we are all" are not inaccurate.
|
| I don't think other countries are necessarily perfect here, but
| 74% of Americans don't have a healthy weight when you look at
| their BMI. That's a _staggering_ statistic. Something is
| seriously wrong societally, and the priority should absolutely be
| non-pharmaceutical interventions.
| beezlebroxxxxxx wrote:
| I agree. I think the conversation has unfortunately been
| dominated by an individualistic strain of moral judgement.
| Whether so and so, this person or that person, should take
| Ozempic-like drugs is often discussed in binary terms of near
| moral and personal failing or not. I think the drugs are
| helpful to people who really need them --- so long as the
| people really need them.
|
| The problem is that conversation overshadows the much more
| important big picture conversation: An entire nation is now
| becoming synonymous with poor health from obesity and we're not
| addressing many of the core nationwide reasons for that.
|
| America was once proud of and eager to prove how fit and able
| its people were. Now the very idea of proper nutrition and
| exercise is deemed a nonstarter, "impossible", or an imposition
| on personal liberties. The existence of Ozempic-like drugs
| should not absolve us from the imperative to change how we live
| as a nation for the sake of our health.
| downrightmike wrote:
| We're all depressed and overworked and have been for decades.
| Food is an escape
| marcosdumay wrote:
| Add forced sedentarism into that set.
|
| This is not exclusive to the US. The world is trending
| towards those, and different countries seem to only be at
| different distances from it, but the same velocity.
|
| Also, industrialized food seems to be much more effective in
| causing dependency. Food preparation has overwhelmingly
| shifted into less healthy alternatives (even when they sound
| healthier in a naive review)... And there's a multitude of
| low probability high impact possible contributors that nobody
| knows if are important or not.
| pixl97 wrote:
| >I don't think other countries are necessarily perfect here,
|
| America first... the rest of the world is playing catch up as
| quickly as possible.
|
| >In March of 2023, the World Obesity Federation (WOF) released
| a report(Link downloads document) stating that by 2035 over 4
| billion people - more than half the world's population - will
| be obese. >and the priority should absolutely be non-
| pharmaceutical interventions.
|
| Illegal. Or is should say Coca Cola can and will fight you to
| the death the moment you try. If you stand between the junk
| food companies and advertisers you will have an army of lawyers
| fighting you 'tobacco industry' style for the next 50 years.
|
| Until the shit is off our shelves and out of our ads nothing
| will change.
| jspash wrote:
| It really is a sad situation. As an American who spent the
| first 30 years of life in the US and over 20 in Europe, the
| difference is striking. However... here in the UK I see more
| and more "American-sized" people every year. _Something_ is
| changing. In the food and/or habits of the average Brit.
|
| Anecdotally I would say Europeans as whole are getting ever so
| slighty larger. But just not at the rate as Americans. Ozempic
| seems like a god-send.
| rootusrootus wrote:
| > But just not at the rate as Americans
|
| The rate is probably comparable, it's the offset that's
| different. Won't be long until Europe is where the US is
| today (though I need to mention, this is regional, for
| example Colorado is at about 25%, and some European countries
| are already there).
|
| Even Japan is getting steadily fatter, though they are way,
| way behind Europe and the US.
| TacticalCoder wrote:
| > It's genuinely quite depressing that so many people in the
| United States have a weight problem
|
| I agree.
|
| I'm 51 y/o and still totally fit. Always have been. I am
| completely in control of what my body intakes. I can fast for
| 12 hours from waking up until dinner: I do it regularly (as in
| at least five times a month, probably a bit more).
|
| I did do sport like crazy when I was young but don't even
| bother that much. Some walking, taking the stairs instead of
| the elevator, some bicycling, some tennis. But at a gentle
| pace. "More haste, less speed" (thousands of years old saying).
|
| It's crazy to poison oneself to the point where another poison
| (that Ozempic drug) is needed to counter the first poison.
|
| I'm not saying it cannot help but sadly there's no way to say
| it nicely: if you need that, your body controls your mind.
|
| It should be the contrary.
|
| > Something is seriously wrong societally ...
|
| The biggest issue to me is we live in societies (not just in
| the US) where we victimize everyone. Nothing is never nobody's
| fault. We find excuses for just about everything.
|
| We should go back thousands of years and read the classics:
| "healthy mind in a healthy body". Greek philosophers had
| already figured that in the Antiquity.
|
| Mind over body.
| soulbadguy wrote:
| As every conversation with weigth management/obesity treatment,
| there are still people thinking that just more willing power /
| better habits is what's needed.
|
| To those people I suggest you run an experiment : what ever your
| current body weigth is right now. Try loosing and keeping off
| 20%.
| highwayman47 wrote:
| Why can't there be a drug for chronically underweight
| throw4847285 wrote:
| For a second I thought it said Asterix Mag and started
| daydreaming about a story where Getafix invents a special magic
| potion which Obelix can use but it causes him to lose weight.
| Dargaud, I am available.
| unkoman wrote:
| Most of us should probably be on appetite suppressors due to the
| industrial revolution making food more than abundant while
| pumping it full of empty calories.
| anigbrowl wrote:
| Just eat regular food. Hardly anything in my diet would be
| mysterious to a time traveler from 100 years ago, or indeed 200
| years ago. Occasionally I enjoy chocolate or instant noodles
| but mostly it's just fruit, veg, meat, dairy, and grains. If
| you don't know what something is made out of or how, then don't
| eat it.
| rootusrootus wrote:
| Not a panacea. I stay fat no problem without junk food.
| Processed foods make me ill, so I make almost all my own
| meals from whole ingredients. Too many calories is too many
| calories no matter how you get it.
|
| I'm a pretty good cook, though.
| bowsamic wrote:
| We have control though, it isn't 100% the environment. Imo
| that's just used as an excuse
| zombiwoof wrote:
| Let's all go on it, and steroids
| xyst wrote:
| Maybe when food shortages become a thing, we can add Ozempic to
| the water supply to curb people's appetites and reduce demand. \s
|
| Kidding aside, I still think it's extreme for off-label usage.
| Short term results are nice. But what about the long term? Once
| patients reach a desirable state, can they be titrated off the
| medication while maintaining their ideal labs and weight? What's
| the rate of recidivism?
| OptionOfT wrote:
| As someone who struggled with their weight his whole life, this
| medication is a god send.
|
| My wife and I cook every evening. We never eat food made in a
| factory. We buy raw products and spend a good amount of time
| every day cooking them.
|
| Every morning I wake up and go on a 5 mile hike.
|
| And still weight kept on coming on. Worse yet, I am on ADHD
| medication, which are amphetamines and actually make you lose
| weight. Yet... the number on the scale kept on creeping up.
|
| And you know what it is? It's volume. I eat too much. And I have
| no cookies at home. I have no chips at home. No soda, no alcohol.
| I drink black coffee with a splash of milk. I don't eat any
| sweeteners.
|
| I have had weight loss surgery (lap band) which was later
| reversed as it hurt 24/7.
|
| Now, on ZepBound I lost 20lbs in 2 months. I am not hungry. My
| brain can actually focus on the things that matter.
|
| Why do we find it acceptable to help people who struggle with
| alcohol abuse, or nicotine addiction, or opioid addiction, but
| not to help people who struggle with food abuse?
| ak_111 wrote:
| "Why do we find it acceptable to help people who struggle with
| alcohol abuse, or nicotine addiction, or opioid addiction, but
| not to help people who struggle with food abuse?"
|
| I think it is because if 90% of the population did half of what
| you do (and kudos for you for doing it), they wouldn't have a
| problem with weight, you just happen to be one of the unlucky
| few where it doesn't work and these drugs are useful.
| colordrops wrote:
| Have you every using a calorie/macro tracking app like My
| Fitness Pal or Cronometer? I was never successful losing weight
| until I scanned, weighed, and measured every single thing I put
| into my body and stuck to the target calories and macros
| entered into the app. Just being aware of exactly how much I
| was eating was often enough to find the motivation to control
| volume.
| brianmcc wrote:
| >> I scanned, weighed, and measured every single thing I put
| into my body
|
| Not being snarky, but is this truly "better" than a single
| weekly injection - 10 seconds and done for the week? I do
| think our wider society sees medications for overeating as
| "cheating". Perhaps we might benefit from rethinking that.
| colordrops wrote:
| For preventable diseases in general, prevention and self
| control should be attempted before medication. There are
| health benefits besides being skinny, and all medications
| have side effects. There's nothing wrong with medication,
| but addressing the root cause should be tried first, and
| then medication can be introduced if it doesn't work out.
| It's not an either-or, binary situation.
| globular-toast wrote:
| I think there's a few factors at play:
|
| 1. People might want to help, but they don't think taking a
| pill every day for the rest of your life is a proper solution.
| I'm not aware of any such things for other addictions you
| mention,
|
| 2. People don't want other people to have it easier than they
| did. "I had to diet and exercise etc, you should too",
|
| 3. People don't want to help. They want other people to be fat
| because it makes them relatively more attractive.
| mort96 wrote:
| re: 1, there are plenty of people who take some medication at
| some interval for most of their life. People with ADHD,
| people with type 1 diabetes, most women, ... why do we find
| that totally unproblematic, but as soon as it's medication to
| help with obesity (which is a serious medical condition in
| its own right) it's suddenly such a big problem?
|
| EDIT: And to be clear, there may be specifics with these
| particular drugs which are problematic, maybe they're by
| necessity expensive or resource intensive to manufacture,
| maybe they have problematic long-term effects, I don't know.
| I'm purely talking about the _general_ aversion some people
| claim to have regarging taking some medication on an interval
| to help with a health problem. It makes little sense to me.
| tjpnz wrote:
| As someone who takes meds for ADHD and would benefit from
| Ozempic I'm still hesitant. There aren't any non-drug
| options for my ADHD but there's a proven one for my weight.
| taejavu wrote:
| What kind of food do you and your wife cook? How much meat? How
| much gluten? Real butter or canola oil infused "spreads"? What
| oil do you cook with? Vegetable? Sunflower?
|
| If you're eating the right thing for your body, you'll be
| satiated when you eat your full.
| nawgz wrote:
| Bodies are highly imperfect and suggesting our digestive
| system and nervous system are geared for being fit and
| healthy rather than ensuring survival wrt food is absurdly
| naive.
| sundvor wrote:
| (I only cook with extra virgin olive oil which I buy in 5L
| cans for $$ reasons. A lot of these vegetable oils are good
| for motor engines only!).
|
| It really depends on you and the activity levels.
|
| I used to ride to and from work - and I would ride hard, a
| solid 1.5 hour of riding every single workday. Yet this just
| caused me to gain weight as my appetite just shot through the
| roof. This new drug would have been SO good for me back then.
|
| These days I find it easier to control my weight with regular
| strength exercise vs riding, as I tend to go too hard on the
| riding which causes me to feel famished. And then the control
| is just hard.
|
| However when I just do (Olympic barbell) weights, a bacon,
| egg and onion + cheese omelette in real butter and EVOO does
| the trick to break my IF then, along with a WPI/milk shake- I
| get stronger and also lose weight. No need to keep eating.
| However, I'll then do cardio a couple of times per week which
| tends to undo the weight progress; I guess the real trick
| would be to stop doing the hard intervals I love on the
| Kickr, but going slow on the bike is nearly impossible for
| me. :-)
| mrshadowgoose wrote:
| > Why do we find it acceptable to help people who struggle with
| alcohol abuse, or nicotine addiction, or opioid addiction, but
| not to help people who struggle with food abuse?
|
| "Getting fit and staying fit" is a form of social capital,
| because it's extremely hard and only within reach of a small
| portion of the population. "Being fit" is strongly aligned with
| "being attractive" which confers all sorts of cross-cutting
| social benefits.
|
| Some people feel cheated when medication allows others to
| "effortlessly" join this social club, and then become vile and
| hateful in response.
| unclad5968 wrote:
| In what ways is fitness not within reach for a large portion
| of the population?
| mrshadowgoose wrote:
| Studies have repeatedly shown that lifestyle modification
| does not result in sustained weight loss for most.
|
| Not going to waste my time providing sources to remedy your
| ignorance. You are more than capable of doing this research
| yourself.
| paulddraper wrote:
| Nor will I waste time proving the opposite.
|
| Until next time we meet on the internet. :salute:
| JamesBarney wrote:
| Yeah the problem with providing a study is that proving a
| negative is so hard. Everyone assumes there exists a
| successful RCT with a 5-10 year time horizon for weight
| loss via lifestyle interventions. And there just isn't
| one, and the only way to know that is to search for one.
| timeinput wrote:
| Something like 15% of the world lives in extreme poverty.
| This is darn near the best it's been in the history of the
| world (there used to be much more poverty by percentage),
| but this group would likely have trouble being fit. They
| might be skinny, but surely not fit.
|
| Ignoring that extreme the questions maybe different: How
| many hours does a median person have free from work,
| commute, and sleep? How much time must be spent managing
| exercise and diet to achieve fitness?
|
| I think if you took the time to answer those questions for
| the median or modal non-impoverished person in the world
| you might find that fitness is actually quite difficult to
| achieve.
|
| It seems really hard in the US.
| dj_gitmo wrote:
| > And still weight kept on coming on. Worse yet, I am on ADHD
| medication, which are amphetamines and actually make you lose
| weight. Yet... the number on the scale kept on creeping up.
|
| The therapeutic amphetamines dosages for ADHD is below the
| threshold required for produce meaningful weight loss. It's not
| surprising that it didn't help you lose weight.
| archsurface wrote:
| You mention types of food but not quantities. A boat load of
| healthy food is still going to have an effect. Also, I for one
| don't consider walking to be exercise. It's fake exercise for
| people who don't like exercise to claim they exercise. My
| reason is that I cycle for eight months of the year then walk
| during the rainy months. By the end of the rainy months I get
| back on the bike and my fitness level is catastrophic -
| nothing. I've done this for five years, and have to say walking
| is just not good enough for exercise, not even close.
| brianmcc wrote:
| To be fair OP did say:
|
| >> And you know what it is? It's volume. I eat too much.
| ip26 wrote:
| _Why do we find it acceptable to help..._
|
| I think if the widely available help for alcoholics, smokers,
| or opioid addicts mainly mitigated the negative consequences -
| enabling them to drink, smoke, or dope more - it wouldn't be
| nearly as acceptable.
|
| I personally expect weight loss medication that simply makes
| people want to eat less will reach cultural acceptance.
|
| Case in point, cigarettes have been known to suppress appetite
| for ages, and people have elected to smoke to help stay thin
| for decades. There was never any crushing social stigma
| attached to doing this as a weight loss strategy (that I know
| of).
| aeonik wrote:
| wait, I thought that's exactly what ozempic did...
| omikun wrote:
| I think a lot of it is dealing with hunger. If you can't stand
| being a little hungry, never mind very hungry, no diet will
| really help. I used to love being very hungry, not sure how I
| got there, but I wish I can go back there again. Having very
| little carbs and temptations in the house helps. Unfortunately
| it's not up to only me.
| hilux wrote:
| Living a healthy lifestyle, so that you won't need Ozempic, is
| possible - even surrounded by all the drugs and booze and carbs.
|
| I do it. Lots of people do it. The information is freely
| available, now more than ever.
|
| From all I've read, Ozempic isn't a silver bullet, and has many
| side effects. It just helps people stave off the inevitable for a
| while.
| pixl97 wrote:
| Well good for you, aren't you special...
|
| Now what about the other 74% of the population.
|
| You ever hear the saying "If you owe the bank $1000 dollars,
| that's your problem. If you owe the bank a million it's theirs"
|
| This is a public health epidemic and no matter how much you
| scream "But I'm special" the rest of the world is going to fall
| apart around you. And yes, this issue is spreading to the
| entire world and not just the US.
| Someone1234 wrote:
| The population level statistics show that you're the exception
| and not the rule. Obviously if the side-effects are unpleasant,
| the alternative health implications must be even worse: Which
| they are.
| sureIy wrote:
| > The information is freely available, now more than ever
|
| You have to believe it to find it.
|
| Noise is everywhere, now more than ever. I think finding proper
| information is going to be exponentially harder.
|
| A couple of days ago I was "fighting" on Reddit about something
| that is as clear as day, with proof and all, with people who
| were completely sure of the opposite (side note: this is when I
| deleted my Reddit accounts)
| Cyclone_ wrote:
| Well the title is a little silly even if it's meant to be
| provocative. There's a limit to just how many people would
| benefit from the drug, since those who exercise frequently enough
| wouldn't have the need for it ever.
| dcchambers wrote:
| I hate that we are obsessed with treating the symptoms of our
| issues instead of the cause.
| bitcoin_anon wrote:
| If you treat the cause, the symptoms go away along with a
| possible stream of revenue for the "health" care industry.
| rootusrootus wrote:
| I feel the same way about heart disease and cancer.
|
| Actually, no I don't. God bless modern medicine.
| goshx wrote:
| My wife was interested in taking the Ozempic route, and I am not
| fond of drugs.
|
| We then started intermittent fasting together as a lifestyle, and
| it's been great. Losing weight while not restricting what we eat
| and feeling great as our body adapts and doesn't let us overeat.
| I just wonder about the long-term effects, but I'd rather take
| this risk than a drug like Ozempic.
| seanthemon wrote:
| We did this, this happened to us: after a while you or her may
| get extremely obsessed with food and eventually get to the
| point where you overeat as a form of 'freedom' until you just
| can't stop.
|
| IF works until it doesn't, then it REALLY doesn't work. My wife
| had a breakdown before we realized something was incredibly
| wrong. YMMV.
| rootusrootus wrote:
| I've never been more insufferable and hangry than when fasting.
| I'm glad it works for you.
| bitcoin_anon wrote:
| The American Academy of Pediatrics suggests starting children on
| weight loss medication as early as 12 years old:
|
| https://publications.aap.org/pediatrics/article/151/2/e20220...
|
| The farmers are subsidized to grow the corn. 10% of SNAP benefits
| are spent on sugary drinks. Yet we're expected to believe that
| these children were born w/ the chronic disease of obesity and
| they'll need to be on these drugs their whole lives.
| cdchn wrote:
| Obesity rate in the US has started to decline and it sounds like
| they're largely attributing it to ozempic et al.
| aayala wrote:
| just eat healthy and be active
| Animats wrote:
| Novo Nordisk just settled with Viatris, a company which was
| trying to have the Ozempic patent cancelled.[1] That would have
| killed their monopoly. "Terms of the settlement are
| confidential".
|
| They just did the same thing with Mylan.[2]
|
| And may have done something similar with Rio Pharmaceuticals.[3]
|
| The Federal Trade Commission is also fighting that.[4]
|
| [1] https://www.reuters.com/legal/litigation/novo-nordisk-
| settle...
|
| [2] https://iplaw.allard.ubc.ca/2024/10/08/settlement-of-
| patent-...
|
| [3]
| https://www.pacermonitor.com/public/case/52064967/NOVO_NORDI...
|
| [4] https://www.cnbc.com/2024/04/30/ftc-challenges-patents-
| held-...
| Retr0id wrote:
| As far as I can tell, the intended meaning of the question in the
| title is "how long until everyone who wants Ozempic can have
| it?".
|
| But at first I read it in a more cynical and sinister way, the
| more literal interpretation - how long until _everyone_ is on
| weight loss drugs?
|
| In a world where such medications are normalized, fast-
| food/processed-food companies might just work harder to make
| their products more addictive and pervasive, and then we're all
| back to square one.
| bobro wrote:
| Seems like all the incentives have been in place for us to have
| already maximized food addictiveness. We have to at least be
| pretty far up the S curve. I'd guess just the opposite
| actually, that companies will refocus on the healthfulness of
| their products now that customers aren't as susceptible to the
| addictive aspects.
| bowsamic wrote:
| I just calorie count. It's very easy and effective
| nostromo wrote:
| For the longest time people argued if overweight people ate too
| much or not. I've heard plausible sounding arguments on both
| sides.
|
| It seems Ozempic has answered that question decisively, no? The
| solution to being overweight is eating less in almost all cases
| it seems. And feeling less hungry with Ozempic can help get you
| there.
| rootusrootus wrote:
| > For the longest time people argued if overweight people ate
| too much or not.
|
| Maybe uneducated people, but when was the last time anyone
| seriously doubted that excess calories make you fat? For
| serious people the discussion has always been about how to
| reduce the calories, because "just eat less" is provably
| ineffective. Simple minded people continuously suggest
| otherwise, but data really doesn't support their intuition at
| all.
| nostromo wrote:
| It's never been as black and white as you're saying.
|
| Lot's of medical practitioners will even advise you that it's
| the quality of food you eat, more so than the quantity. Look
| at all the published research around processed foods and
| ultra-processed foods.
|
| Other nutritionists will advise you that obesity is all about
| your macros. And that if you want to lose weight you need to
| increase fat and protein intake and limit carbs.
|
| Others have argued it's less about diet and more about
| exercise and having an active lifestyle.
|
| There's also a bunch of research showing that poor sleep
| might cause obesity.
|
| Ozempic seems to have thrown all that out the window and says
| that one just needs to eat less if one is overweight.
| rootusrootus wrote:
| All of those are permutations on the fundamental argument,
| not standalone arguments themselves. The idea with changing
| the quality of the food is that you'll eat less overall.
| Same with trying to adjust macros -- only unserious people
| suggest that calories are somehow different depending on
| source. The argument is that empty calories are less
| satisfying and will you to eat _more_ overall. It is all
| just different approaches to finding a strategy for eating
| fewer calories overall.
| tananan wrote:
| I hope that these drugs pull people back from nasty habits such
| that they eventually build the strength to do without them. As of
| yet, I do not see why it has to be a win-lose situation one way
| or the other. Crutches aren't evil - they are expedient while
| they are expedient.
|
| Sometimes when you have a really strong habit, it becomes really
| hard to imagine yourself being otherwise. I welcome anything that
| helps people see beyond a prison they've put themselves in, as
| long as it doesn't put them in a worse prison.
|
| Does Ozempic or whatever put one in a worse prison? This seems
| personal, and not a categorical matter.
|
| Those who take it have a choice of how to develop their sense of
| identity in relationship to their treatment. It is here where the
| rubber hits the road - these abstract extremes of "you're
| suppressing your ability to grow" and "you're hopeless without
| it" are short-sighted and serve no good purpose.
| archsurface wrote:
| I don't share the American enthusiasm for pharmaceuticals.
| Exercise and healthy eating. I also don't have the other issues
| mentioned. Maybe the title is a bit clickbaity and I shouldn't be
| taking it so literally.
| sensanaty wrote:
| The mental gymnastics people go through to justify their insane
| eating habits is unreal to me. The fact that we've gotten to the
| point where people would rather take a drug for the rest of their
| lives (cause remember, people who stop ozempic gain it back in
| record time because they didn't actually stop their shitty
| habits) rather than putting down the processed foods filled to
| the brim with sugars is rather depressing.
| rootusrootus wrote:
| I don't like processed foods and sugar in anything more than
| minimal quantities makes me ill. But I still get too many
| calories, at least as evidenced by my waistline.
|
| Are you sure the insanity isn't the assumption that it's just
| insufficient willpower or poor habits?
| 0xcde4c3db wrote:
| I think we desperately need to answer the question of _why_ GLP-1
| agonists are so effective, and particularly whether it 's
| counteracting something in the environment that has been acting
| to reduce GLP-1 (or other glucagon-related pathway) activity
| without us realizing it. The obesity data practically screams
| that _something_ happened in North America ca. 1980 that messed
| up our metabolisms, and it may have spread to Europe after a
| delay. Unfortunately, it seems like one of those things where
| there are various people with pet theories and little substantial
| effort to get to the ground truth. Perhaps the inevitable search
| for "me-too drugs" will uncover something.
| avelis wrote:
| One aspect is that the US food system as a crap ton of UPF.
| rootusrootus wrote:
| How does that cause the rest of the world to also have
| decades-long steadily increasing obesity rates?
| rootusrootus wrote:
| Europe has been climbing at a steady rate since at least 1975.
|
| https://www.europeandatajournalism.eu/cp_data_news/europe-fa...
| reducesuffering wrote:
| One very understated aspect that I haven't seen brought up:
|
| If part of the obesity epidemic is trying to consume food to make
| up for nutrient deficiencies, these drugs will only worsen these
| nutritional deficiencies. You'll lose weight short-term, but
| long-term sabotaged your body trying to attain these. We've seen
| declining vitamins and minerals in natural food (industrial
| produce growth). Maybe some people make it up with a heavy
| supplement regimen, but I wouldn't be surprised to see a lot of
| now-normal-weight people on Ozempic having major health problems
| due to increasingly deficient Vitamin A (already 51%), K (71%), E
| (94%), Magnesium (61%), Potassium (97%), Calcium (49%).
| throwaway918299 wrote:
| My friend and my father in law both went on it. They both became
| suicidal and had to stop. YMMV but that's enough for me.
|
| Eat less. Move more.
| aucisson_masque wrote:
| So basically eat shit and then take drugs to lose the weight you
| accumulated because of your bad diet ??
|
| Am I the only one to realize how this is so wrong?
|
| You would think When a pipe leaks, you fix it. You're not going
| to put a basin under it, empty it every day, pay for a new basin
| every few week and continue to have your damn pipe leak.
|
| Oh man... If only you could teach people how to eat better
| instead.
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