[HN Gopher] GLP-1 drugs - the biggest economic disruptor since t...
       ___________________________________________________________________
        
       GLP-1 drugs - the biggest economic disruptor since the internet?
       (2024)
        
       Author : herbertl
       Score  : 235 points
       Date   : 2025-03-01 19:33 UTC (3 hours ago)
        
 (HTM) web link (wildfirelabs.substack.com)
 (TXT) w3m dump (wildfirelabs.substack.com)
        
       | EarlKing wrote:
       | One person's results is not everyone's results. To say that this
       | is hyperbolic would be the understatement of the millennium.
        
         | TaupeRanger wrote:
         | What does this even mean? The results of GLP-1 meds are well
         | studied and widely understood to be game changing and likely
         | revolutionary. The other claims might be hyperbolic but results
         | of the medication on individuals is not really a question at
         | this point.
        
           | mordymoop wrote:
           | People are weirdly resistant to acknowledging the obvious
           | implications of things if those implications seem big.
           | There's a broad "nothing ever happens" heuristic that people
           | tend to mistake for wisdom.
        
           | danjl wrote:
           | The short term results are known, but we have very little
           | data about the long term effects as of yet.
        
             | TaupeRanger wrote:
             | Not remotely true. We have strong studies out to 10 years
             | at this point. Given the overwhelmingly positive results at
             | our current state, it would take a huge safety signal
             | occurring at 12-20+ years of usage to provoke a change in
             | recommendation, and this is exceedingly unlikely. Basically
             | all such signals are revealed by 10 years if they exist.
        
           | fourside wrote:
           | I think some skepticism is warranted. If this is a medication
           | that most of us can be on and it comes with positive health
           | benefits, that would mean that humans as a species have lower
           | than optimal GLP-1 levels. I guess it's possible that our
           | bodies are wired for a world that is unlike today's and that
           | these drugs correct for that. But drugs that doesn't come
           | with side effects. It also wouldn't be the first time that a
           | drug company manages to convince the medical community to
           | think a drug is healthier than it really is (OxyContin).
        
             | resoluteteeth wrote:
             | > I guess it's possible that our bodies are wired for a
             | world that is unlike today's and that these drugs correct
             | for that.
             | 
             | The constant access to unlimited tasty food we have now is
             | completely unprecedented in human history.
             | 
             | Other animals will also overeat if you give them unlimited
             | access to tasty high calorie food.
             | 
             | This is absolutely a situation we did not evolve to be able
             | to handle unfortunately. Lack of sufficient food was the
             | norm for most of our history, so it's not surprising that
             | we evolved to want to eat a calorie surplus if possible.
        
         | zemvpferreira wrote:
         | Yeah but a forecast 10 years out is a lot more fun/enlightening
         | if it's hyperbolic. It doesn't make much food for thought to
         | say 'We predict by 2030 the average consumer will have
         | purchased jeans 2 sizes smaller than in 2010'.
         | 
         | In any case, I hope they're directionally correct. A class of
         | widely-available drugs that lets us switch off impulses that
         | don't suit our environment and wellbeing any more would be
         | incredible and world-changing. I'm very curious to try GLP-1
         | agonists myself.
        
         | codr7 wrote:
         | I'm more worried about longer term side effects.
         | 
         | This sounds a lot like numbing "bad" feelings to me; there's no
         | way to selectively numb, it's all or nothing.
         | 
         | Impulsivity isn't all bad.
        
           | cm2187 wrote:
           | As opposed to the good long term effects of being obese?
        
             | Trasmatta wrote:
             | There are a lot of people who are _not_ obese that are
             | taking these drugs. That might be where the fear is coming
             | from.
        
               | smt88 wrote:
               | Something like 70% of the US is overweight, so there
               | actually aren't as many people who aren't experiencing
               | negative health effects from being overweight or obese as
               | you think
        
               | pessimizer wrote:
               | Nothing wrong about wanting to look hot if the danger
               | level is not high. I haven't heard about people trying to
               | use them to aid an eating disorder, like diabetics do
               | with insulin.
        
               | kortilla wrote:
               | Most of them likely are obese. Obesity is so normal that
               | what most people call "overweight" is actually obese and
               | the people they think are obese are morbidly obese.
        
             | codr7 wrote:
             | I realize obesity a major issue for a lot of people.
             | 
             | But is it worth giving up your impulses? I mean all of
             | them.
             | 
             | I have no proof that's how it works long term, but I do
             | feel the question should be asked before we dive in head
             | first.
        
               | dghlsakjg wrote:
               | Anecdotally, it isn't really giving up impulses. It
               | blunts the desire for a lot of the ones that are related
               | to consumption.
               | 
               | I can still get a wild idea at 9 pm and lose myself in
               | code. I still see flowers and buy them form my wife
               | without planning. I still have a bowl of ice cream before
               | bed sometimes.
               | 
               | The best way to describe it is that you still have the
               | impulse, but you are able to rationally consider it.
        
             | msabalau wrote:
             | As it happens, in the elderly, a BMI at the lower range of
             | "obesity" is better than having higher or lower weight.
             | 
             | Of course, with the shortage of geriatricians, most seniors
             | are unlikely to find this out.
        
               | cm2187 wrote:
               | Breaking news, being obese is good for your health. And
               | wait to learn about smoking!
        
               | treis wrote:
               | This probably isn't true. What's more likely to be true
               | is that it's hard to be overweight when your dying from
               | cancer or whatever.
        
           | nemo wrote:
           | My wife's taking GLP-1s for health reasons. The author's
           | ideas about the effects of these things are not evidence
           | based. It isn't a magic drug that makes people ascetics. She
           | eats less, but she still impulse buys clothes and things. The
           | idea that the drug numbs feelings is not at all what I see,
           | while some appetites are diminished, we still both do art,
           | enjoy going out doing all the same stuff as before. She's
           | lost weight, her vitals are looking better, and we eat out
           | less, that's it.
        
             | cameronh90 wrote:
             | I'm taking GLP-1s and it's absolutely reduced my
             | impulsiveness in ways besides food. Not completely, for
             | sure, and being less interested in food actually means more
             | time to spend on other hobbies.
             | 
             | But it's definitely done _something_ to my non-food
             | behaviour, albeit I 'm not sure what exactly. It may well
             | be that I was previously trying to satiate my constant
             | desperate hunger for food with other forms of harmful
             | addictive behaviour, and without the hunger, I just don't
             | need that as much. The concept of satisfying one craving
             | with another isn't new, after all.
        
       | macintux wrote:
       | Interesting, but I'm not sure I buy it.
       | 
       | I certainly don't think Simon is preparing for this massive
       | economic shift; I think they're reacting to an existing trend.
       | 
       | > America's largest mall operator, Simon Property Group, is
       | converting anchor stores into medical centers and wellness
       | spaces. They're doing this because they recognize the writing on
       | the wall.
       | 
       | Malls have been dying for years, and COVID felt like the nail in
       | the coffin.
        
         | dumbfounder wrote:
         | Malls around DC are crazier than ever. But I am not sure if
         | people are spending money or not.
        
           | bobthepanda wrote:
           | There are different classes of mall. In general those class A
           | malls targeted at higher income stores and shoppers have been
           | more resilient over the past decade than middle or lower.
           | (Nordstrom vs Macy's vs. Kmart)
        
           | WarOnPrivacy wrote:
           | I was last in NoVA in 2019 and shopped at the Sears at
           | Landmark. It was the last store. Crazy=yes.
        
           | ForTheKidz wrote:
           | It's straight up miserable to be in mclean/tysons between
           | october and february. Truly it is america's asshole. And yes,
           | people conspicuously consume more than ever. I think this is
           | likely not true of most malls, though, the shopping culture
           | here is just nuts.
        
         | mlhpdx wrote:
         | The large scale economic evidence in the article is as easily
         | attributed to population growth and aging.
        
         | iszomer wrote:
         | COVID? I felt it was horror subgenre of the backrooms. which
         | popularized the idea of liminal spaces, that sealed it's fate.
        
           | bobthepanda wrote:
           | There were a lot of different things happening but COVID
           | certainly cut out some straggling malls.
           | 
           | In general this was a correction. The US ranked first in 2018
           | for retail sq ft per capita at 23. To put this in context,
           | the next highest country, Canada, had 16 sq ft per person,
           | and most developed countries sit around 3-4 sq ft per person.
           | https://www.statista.com/statistics/1058852/retail-space-
           | per...
        
       | morkalork wrote:
       | Reading this you'd think we're on the cusp of the sort of utopian
       | society seen in Brave New World. Class hierarchy reinforced by
       | behaviour regulating drugs given to happy, subservient workers.
       | Hell, with all that talk of impulse control, I wonder what it
       | will do to people's motivation to protest and riot...
        
       | 6stringmerc wrote:
       | Access to impulse reduction via medication is problematic and
       | will be isolated in the US to those who, frankly speaking,
       | probably do not spend at a meaningful rate compared to their
       | asset (wealth) standing. It's a brilliant observation though that
       | if "something got in the water supply" and en masse consumer
       | behavior changed, then absolutely the ripple would be astounding
       | to watch. I still recall standing in a field outside Alliance
       | airport watching Amazon cargo jets landing at basically 30 minute
       | intervals and thinking "all that stuff and this system doesn't
       | make economic sense" and I for one eagerly await a...let's just
       | call it...recalibration.
        
       | aljgz wrote:
       | > When companies like Google see their healthcare costs drop by
       | $12,000 per employee annually and productivity increase by 25%,
       | we observe a restructuring of corporate America that makes remote
       | work a minor adjustment.
       | 
       | In my entire office, there's one overweight person that I know.
       | Out of thousands of employees. There could be more, and other
       | cities might be different, but you get the idea.
       | 
       | The author intentionally or mistakenly applies some numbers to
       | whole populations.
       | 
       | Keep chaining impacts while eliminating small coefficients, your
       | end result will be off by more than a few orders of magnitude.
       | 
       | EDIT: I need to be more clear about my point: My BigTech office
       | does not represent my country stats: Canada has a 26% obesity and
       | 36% overweight adult population. Just taking those numbers,
       | applying them to all populations is wrong.
       | 
       | The analysis is wrong in other subtle but important ways as well.
       | A 25% increase in performance of an allegedly low performing
       | group of a company would not increase the overall company's
       | efficency as much.
        
         | Marsymars wrote:
         | > In my entire office, there's one overweight person that I
         | know. Out of thousands of employees.
         | 
         | That seems incompatible with the numbers that show something
         | like 3/4 of the US population being overweight.
         | 
         | (And yeah, BMI isn't great, but it works pretty well with an
         | aggregate population of sedentary individuals, which the
         | population at large is.)
        
           | thundergolfer wrote:
           | The population of a specific Google office could be two std
           | deviations from the mean. My office area, SoHo NYC, has a
           | dramatically lower obesity rate than the USA average. Maybe
           | 10-20% of the population is overweight, let alone obese, and
           | it's mostly the service workers.
        
             | luckylion wrote:
             | But 1 of 1000s? That sounds like it's made up, or a very,
             | very, very fitness-focused company.
        
               | aljgz wrote:
               | I edited my response. I'm from Canada, but we also have a
               | 26% obesity stats.
        
         | brokensegue wrote:
         | 40% of Americans are obese and way more are merely overweight.
         | Either your office is small, a huge fluke, weirdly selected or
         | you're not observant enough.
        
           | Denvercoder9 wrote:
           | Or not in the US.
        
           | xboxnolifes wrote:
           | 6th option: They are overweight, but do not know, so they
           | don't recognize what overweight looks like. But also, it's
           | pretty easy to not look overweight if you're not obese. 30
           | pounds can be as little as a few waist sizes. I can gain and
           | lose 15 pounds without looking like I changed at all.
        
             | brokensegue wrote:
             | That counts as not observant to me
        
             | anal_reactor wrote:
             | When you're like 5kg overweight it can definitely hide
             | well, especially if your body shape is proportional.
        
           | treis wrote:
           | That 40% isn't evenly distributed.
        
           | bgnn wrote:
           | Luckily there's the rest of the world.
        
         | thfuran wrote:
         | >The author intentionally or mistakenly applies some numbers to
         | whole populations.
         | 
         | You're doing it far worse than they are. The obesity rate in
         | the US is something like 30%, with some regional variation.
        
       | SilasX wrote:
       | So... certain jobs will be obsolete because we found a silver
       | bullet for obesity?
       | 
       | This is in the vein of "we eliminated a massive category of
       | accidental deaths? But... but then what about the organ
       | waitlist?"
        
       | patrickhogan1 wrote:
       | Jevons paradox applied to healthy people vs unhealthy. Healthy
       | people create more demand not less.
       | 
       | You order out you just order healthier. Healthier food is more
       | expensive than junk food.
       | 
       | You buy an expensive bike. More clothes.
       | 
       | Healthcare is still expensive because people get older and older
       | people need more care.
        
         | sapiogram wrote:
         | I don't think Jevon's Paradox applies here. People won't buy
         | healthier food, they'll buy _less_ food.
        
           | tejtm wrote:
           | Food is the easiest expense to maintain. If you are eating
           | less, you absolutely may as well eat better.
        
       | m3kw9 wrote:
       | Looks like this is a worse case/best case scenario, rarely it
       | will happen like that. There will be some effect but if people
       | aren't eating muffins, they are eating power balls. Not drinking
       | beer, drinking tea. I would ear mark a 5-10% of that effect max,
       | he's going for 100%
        
       | cj wrote:
       | I started Tirzepatide 3-4 weeks ago. (Mostly as an experiment to
       | understand the hype around GLP's... I don't have diabetes and
       | only very slightly overweight at 20% body fat). Even at the
       | lowest 2.5mg starter dose which you're only allowed to stay on
       | for 1 month:
       | 
       | - Extreme appetite suppression to the point where I've started
       | calorie counting specifically to make sure that I'm eating
       | enough. It's incredibly easy to forget to eat.
       | 
       | - No more feelings of hunger. At all. This is somewhat
       | depressing. Eating is no longer enjoyable and feels like a chore.
       | I woke up hungry for the first time in a while a couple days ago
       | and was _excited_ - jumped out of bed and ran to eat something
       | just for the pure joy of it. I 've only felt that a few times in
       | the past few weeks, compared to every day off the drug.
       | 
       | - I completely stopped drinking. Have you ever been to a bar
       | after eating a big meal at a restaurant, and had trouble drinking
       | because you were too full from your meal? That's how I feel all
       | the time. 1 or 2 beers and it becomes uncomfortable to have
       | anymore.
       | 
       | - Normally I go grocery shopping and within 3-4 days, all the
       | "good stuff" (snacks) I bought are eaten. Now, since I stopped
       | snacking and eating much less, groceries simply last way longer.
       | <-- $$ saved in groceries significantly offsets the monthly price
       | of the medication
       | 
       | - My morning starbucks routine has changed from 2 food items to
       | just 1, which alone saves me $200/mo (sorry starbucks).
       | 
       | - Haven't noticed anything regarding impulse control outside of
       | food. No anecdata to share on that point...
       | 
       | After a few weeks on the drug, I'm 100% convinced that once this
       | drug is widely available and cheap... being overweight will be a
       | choice (choosing not to take the drug).
       | 
       | The most important aspect of the drug that makes it work so well
       | is it forces you to change your habits, no will power required.
       | It also punishes you for bad eating habits. (That late night trip
       | to McDonalds will have you feeling like shit the next day).
       | 
       | I'm the kind of person that used to be able to order just about
       | anything on a restaurant menu and clean my plate completely. Now
       | I simply can't do that. It's actually kind of embarrassing being
       | at a restaurant with friends and being completely uninterested in
       | the food.
        
         | devmor wrote:
         | > Extreme appetite suppression to the point where I've started
         | calorie counting specifically to make sure that I'm eating
         | enough. It's incredibly easy to forget to eat.
         | 
         | This is the largest of several reasons I hesitate to try it for
         | myself. I am a very big guy (I would be about 184lbs if I had
         | 0% bodyfat at my current musculature level). From the
         | experiences I hear, I would not only struggle to have enough
         | energy to do any kind of rigorous exercise, but struggle to
         | consume the amount of protein I require to even maintain my
         | current muscle mass.
         | 
         | I do have issues with overeating and the prospect of a drug
         | that prevents me from consuming too many calories is
         | attractive, but the side effects sound counterintuitive to any
         | kind of natural fitness.
        
           | meroes wrote:
           | I'm somewhat the same. I need to be active for other health
           | reasons (physical therapy, etc) and not eating enough saps my
           | ability to push forward physically.
        
           | cj wrote:
           | I've been hyper aware of the muscle loss caveats and I think
           | it's the most important thing to know when starting the drug.
           | 
           | You really need to prioritize protein intake and make sure
           | your calorie deficit isn't extreme.
           | 
           | Losing too much weight too quickly, with or without the help
           | of a drug, can be very unhealthy.
           | 
           | I drink 4 protein shakes a day (160g total) in addition to
           | regular food. If it weren't for the protein shakes I
           | definitely would be protein deficient.
           | 
           | You're 100% spot on with decreased energy at the gym. I've
           | had to pull back 4x weekly cardio to 1-2x weekly. Then again,
           | anyone who's in a calorie deficit has lower energy. It's not
           | a unique phenomenon of the drug, just a side effect of weight
           | loss.
        
             | ForTheKidz wrote:
             | > Then again, anyone who's in a calorie deficit has lower
             | energy.
             | 
             | Presumably if you're trying to lose weight, you have energy
             | to burn you carry around with you. A calorie deficit
             | doesn't imply lack of calories to burn. Presumably you're
             | _trying_ to trigger ketogenesis.
             | 
             | Granted, this is a lot less easy to access than simply
             | eating simple carbs right before a workout and likely a lot
             | less comfortable.
        
               | TeMPOraL wrote:
               | > _Presumably you 're trying to trigger ketogenesis._
               | 
               | Only if you're actually on a keto diet; most weight loss
               | routines run a calorie deficit without triggering
               | ketogenesis.
               | 
               | Also there's this whole thing about set points - you
               | probably got to your weight _somehow_ , and if it wasn't
               | through consistently making stupid choices over many
               | years, chances are this is what the body learned to
               | consider an equilibrium state. Which means that, if you
               | start running a calorie deficit, it's going to fight you
               | every step of the way. It will happily scale down
               | performance to conserve energy instead of burning the
               | accumulated fat, so you'll just be slow and groggy but
               | not lose weight. There's been reported cases where people
               | got mental illness-level obsessive thoughts about food,
               | which appeared when they were hungry, and stopped when
               | they ate _enough_.
               | 
               | The degree of this problem varies between people, but
               | it's generally not that easy to effectively lose weight,
               | and some people simply lost the genetic/environmental
               | lottery on this.
        
               | ForTheKidz wrote:
               | > The degree of this problem varies between people, but
               | it's generally not that easy to effectively lose weight,
               | and some people simply lost the genetic/environmental
               | lottery on this.
               | 
               | Yea, I think your eating and food habits you learn as a
               | child and teenager tend to shape you for life. I was
               | malnourished as a child (I was considered a picky eater)
               | but as an adult I've found it quite easy to keep within
               | the caloric bounds a doctor told me to keep to. One thing
               | I've noticed is that hunger just doesn't bother me the
               | way it does with people who struggle to lose weight or
               | with binge eating--mostly a pain in the ass (I need to
               | remind and force myself to eat), but occasionally
               | something I'm grateful for as I watch the people around
               | me struggle on an existential level with their cravings
               | and bodies.
               | 
               | I also don't have a sweet tooth, and I put that on not
               | being allowed sweets as a child except under very
               | exceptional circumstances. I'm also a (thankfully
               | recovering) alcoholic, so don't mistake this for being
               | generally good at avoiding cravings.
        
               | resoluteteeth wrote:
               | > Also there's this whole thing about set points - you
               | probably got to your weight somehow, and if it wasn't
               | through consistently making stupid choices over many
               | years, chances are this is what the body learned to
               | consider an equilibrium state.
               | 
               | The idea of set points is controversial and not
               | necessarily the accepted scientific consensus.
        
             | gcanyon wrote:
             | > Losing too much weight too quickly, with or without the
             | help of a drug, can be very unhealthy.
             | 
             | Is there evidence to back this up? It sounds reasonable,
             | especially without a limit on "too quickly" but (anecdata
             | incoming) I'm curious because:                  - When I
             | first tried a low-carb diet (for non-weight reasons) I lost
             | about thirty pounds in under three months without really
             | trying, and hit something like 12% bodyfat        - When I
             | started intermittent fasting (mostly unrelated to weight) I
             | again lost about thirty pounds, this time in a little over
             | three months, and probably ended up around 15% bodyfat
             | - Since then I found that neither low-carb nor intermittent
             | fasting had a significant effect on my weight, so:        -
             | When my doctor suggested I lose some weight I pretty
             | forcibly calorie restricted, and lost about thirty pounds
             | over four months (only down to about 20-something % that
             | time)        - And just recently, for cholesterol, I've
             | done it again and lost 25 pounds so far in something under
             | three months.
             | 
             | ...and as far as I know I haven't suffered any ill effects.
             | I have a concept 2 rowing machine, and I just rowed my
             | slowest 10K ever :-/ but I _did_ row a 10K, and I _am_ in
             | significant calorie deficit, and I probably _have_ lost a
             | fair bit of muscle along with fat, and I _have_ been away
             | from the rower for several months, so all up -\\_(tsu)_ /-
             | 
             | All of which to ask, what evidence do you have, and what's
             | "too quickly"?
        
               | machomaster wrote:
               | The issues with "too quickly" are:
               | 
               | 1. the loss of muscle mass
               | 
               | 2. low energy
               | 
               | 3. unnecessary suffering
               | 
               | 4. high fatigue
               | 
               | 4.1. inability to maintain the low calorie diet for long
               | enough
               | 
               | 4.2. relapse; jojo-dieting.
               | 
               | 1, 4.1 and 4.2 are the biggest problems.
        
           | zemvpferreira wrote:
           | If it makes you feel better, this class of drugs has been
           | part of bodybuilding cutting stacks for a while now. It makes
           | the process much easier and as long as you're diligent about
           | your shakes, no big deal.
        
             | meroes wrote:
             | Wild that a drug with no other side effects that we know of
             | besides pre existing pancreas issues can mute a
             | bodybuilder's hunger on a cut.
        
             | devmor wrote:
             | I would be interested in reading about that, but it doesn't
             | de facto make me feel any better given my anecdotal
             | experience with bodybuilders watching them take drastic
             | health risks for aesthetics - it just shifts my concern to
             | other points.
        
           | loeg wrote:
           | You can just take a lower dose, or cease taking the drug.
           | Appetite comes back. It's pretty low risk.
        
         | saurik wrote:
         | > Even at the lowest 2.5mg starter dose which you're only
         | allowed to stay on for 1 month...
         | 
         | So they are going to force you onto a higher dose?!
        
           | willis936 wrote:
           | Yes, up to 15 mg. Maintenance levels at 5, 10, and 15. If you
           | cannot tolerate a maintenance level you can still get it, but
           | insurance will not cover it ($1000/mo rather than $15/mo.)
           | This is not an unreasonable situation.
           | 
           | https://www.goodrx.com/zepbound/dosage
        
             | cj wrote:
             | Luckily during the "shortage" you can currently get GLP-1's
             | in vials rather than injection pens.
             | 
             | The brand name GLP's you can't control the dose. But when
             | you get it in a vial from a compounding pharmacy you can
             | inject however much or little you want.
             | 
             | Not looking forward to ever using the brand name version
             | specifically for this reason
        
               | dghlsakjg wrote:
               | The injection pen I have see has two marked dosages, but
               | there is nothing stopping you from injecting more or
               | less.
               | 
               | Basically it is a ratcheting mechanism where after ~10
               | clicks you get .25 mg dosage and 20 clicks gets you .50.
               | Basically, no doctor is going to endorse it, but you can
               | dial a dose to whatever amount you want.
        
               | blackeyeblitzar wrote:
               | Aren't any states like California trying to ban
               | compounding pharmacies? It's an unfortunate attack on
               | individual freedom, but I am not sure if we will still
               | have them 20 years from now.
        
               | dragonwriter wrote:
               | > Aren't any states like California trying to ban
               | compounding pharmacies?
               | 
               | No. California has not banned compounding pharmacies, nor
               | is there a significant movement to do so in the
               | legislature, among the people (who could do so by ballot
               | measure), or a proposal by the governor to do so.
               | California does require additional licensure for sterile
               | compounding, but that is very much not a ban on sterile
               | compounding or compounding more generally.
               | 
               | Relevant to GLP-1s, though, several state pharmacy boards
               | (not California's, as far as I know) have raised issues
               | that compounded GLP-1 drugs that they have seen appear to
               | be illegal, because they use a form other than the FDA-
               | approved base form of semaglutide (which is only
               | available from Novo Nordisk), and th3 form used is not
               | itself approved for human use, and have taken steps to
               | crack down on _that_. But that 's also not banning
               | compounding, but enforcing existing rules on compounding.
        
               | loeg wrote:
               | I get vials direct from Lilly and can choose what dose I
               | take. Ask your PCP to check out LillyDirect.
        
             | cm2187 wrote:
             | Hum, I don't know, here in the UK, no one is forcing you to
             | do anything. I am free to chose if I want to step up, down
             | or stay on the current dosage every month. And I took the
             | cautious approach to only step up when I stopped feeling
             | the effects at the current dosage, so 8 months in, I am
             | only starting on 10mg (range is 2.5 to 15mg in 2.5
             | increments).
        
             | blackeyeblitzar wrote:
             | Is that really true? I remember reading that people with
             | side effects often were given lower doses.
        
           | matt_heimer wrote:
           | It depends. The 5mg, 10mg, and 15mg were the doses tested and
           | recommended as maintence doses. The 2.5mg is meant as a
           | starter to reduce side effects but since most people don't
           | see results with it the recommendation is that you only take
           | it for 4 weeks. The 7.5mg and 12.5mg doses are meant as
           | transitional doses but you can stay on them longer than 4
           | weeks.
           | 
           | Some doctors will go by the Lilly recommendations but I think
           | more are allowing people to stay on the lowest dose providing
           | benefits. That leaves your health insurance as the only other
           | obstacle.
           | 
           | There is a chart at https://zepbound.lilly.com/hcp/dosage
           | 
           | I was one of the rare people that saw results with 2.5mg but
           | by the end of that first month I had plateaued. After 3
           | months at 5.0mg I've plateaued again and will probably move
           | up to 7.5mg in the near future and stay on it as long as I
           | can.
           | 
           | Some people like to go back to 2.5mg as their maintence dose
           | after reaching their weight loss goals.
        
           | op00to wrote:
           | The inbetween doses are just used for titration. They were
           | not studied as long term doses like the maintenance doses.
           | It's stupid, and you can get exceptions if you are
           | persistent. I preferred 7.5 mg over 10 mg for example.
        
         | willis936 wrote:
         | Yes well your PCP / pharmacist should not have prescribed you
         | an appetite suppressant when you have below average body fat %.
         | The effects are very worth it for people weighing them against
         | heart disease and mobility issues. It's not a Faustian bargain,
         | it's all right on the tin. When you stop taking it the effects
         | go away. If you want to be indulgent and it fits your lifestyle
         | you can reversibly make that decision. The power to make that
         | decision is difficult to overstate.
        
           | smallmancontrov wrote:
           | Why is it only appropriate for people with heart disease /
           | mobility issues but not for someone who is merely overweight?
           | This feels like finger-wagging for the sake of finger-
           | wagging.
        
             | willis936 wrote:
             | It isn't. 20% body fat is 6% below average. That isn't
             | "merely overweight", it's likely underweight. No, I don't
             | think underweight people should take appetite suppressants
             | and I don't think that qualifies as a hot take. I think
             | anyone who is medically overweight (which is a very modest
             | BMI qualifier for anyone with any amount of muscle) should
             | have the choice. Many US medical systems and insurers
             | agree, which is a good place to be.
        
               | MostlyStable wrote:
               | >it's likely underweight.
               | 
               | The only way this can possibly be correct is if you think
               | that the "correct" weight is whatever the population
               | average happens to be which is just...wild to me.
               | 
               | If we assume commenter is male (a statistical
               | likelihood), then 20% is the high end of normal, and
               | could very safely be halved. In the less likely case that
               | they are female, then it is right in the middle of the
               | normal range, and could safely be reduced by 5-10% at
               | least.
        
               | DuckConference wrote:
               | What are you smoking? 20% is a perfectly healthy bodyfat
               | number and (for a man) anything down to 15% or so is
               | fine. Sub 10% is when you pretty much need a crazy
               | bodybuilder lifestyle to maintain it. And on the other
               | side, 25% is around the lien where you start facing some
               | minor health risks from excess body fat.
        
               | loeg wrote:
               | Average is overweight, though.
        
               | pedalpete wrote:
               | You're confusing average with good. 15% body fat (for a
               | man) is completely healthy, so as the OP said, he is
               | slightly overweight.
        
           | aeturnum wrote:
           | > _Yes well your PCP / pharmacist should not have prescribed
           | you an appetite suppressant when you have below average body
           | fat %._
           | 
           | Why do you think this? I agree that people who have
           | associated risk factors should be prioritized, but if there's
           | enough for everyone why wouldn't we give it to anyone who
           | wants it?
        
             | willis936 wrote:
             | Because anorexia exists it would do harm to completely
             | unregulate access to appetite suppressants. Someone should
             | be looking out for people who would willingly wither away.
        
               | aeturnum wrote:
               | I don't think anyone is suggesting it should be over the
               | counter? Of course a doctor should monitor you while you
               | are on it. We shouldn't give it to people who would use
               | it to deepen a mental health diagnosis.
               | 
               | Those concerns have nothing to do with the fact that it's
               | ok for people to choose to start or stop medications if
               | they would prefer (supplies allowing).
        
             | SoftTalker wrote:
             | People who don't need to be chronically medicated should
             | not be. There are always side effects, and we don't even
             | know for sure what the long term risks of these medications
             | are yet.
             | 
             | And crowing about saving $200/mo not buying food at
             | Starbucks, well now Novo Nordisk is getting that.
             | 
             | Toast a bagel at home for $0.50/day instead.
        
               | aeturnum wrote:
               | I am not an expert but my impression is semaglutide has
               | been in development since the 90s and in use as a drug
               | for about a decade for people with diabetes. The drug and
               | mechanism are old, the use is new.
               | 
               | I do not agree that people who don't "need" to be
               | chronically medicated should not be. I think you can
               | decide to take whatever you want for your own reasons. I
               | am not going to tell you what you can and and can't take
               | - unless you're like...taking something that makes you
               | destructive or generate externalities or whatever. But
               | this seems like the opposite?
               | 
               | Lots of questions here around profit and the awful
               | medical system in the US, but on a basic level I think
               | people should be able to do what they prefer and is safe.
        
               | SoftTalker wrote:
               | I was giving advice, not proposing a prohibition against
               | doing what you want to do. It's your body, and your
               | health.
        
               | TeMPOraL wrote:
               | > _People who don 't need to be chronically medicated
               | should not be._
               | 
               | If they're like typical westerners, they already self-
               | medicate with coffee every day, with alcohol
               | occasionally, and a big fraction of them (though much
               | less than couple decades ago) also treat themselves with
               | tobacco smoke - and ironically, weight loss is one of the
               | few benefits some people actually use to defend their
               | smoking.
               | 
               | Do they _need_ all that medication? Well, it 's socially
               | unfavorable to say so wrt. alcohol, but ask any of the
               | daily coffee drinkers whether they need their morning
               | coffee...
        
           | cj wrote:
           | After using them, I think GLP-1's will eventually be
           | rebranded as a weight management / weight maintenance drug
           | rather than a weight loss drug in order to appeal to the
           | masses.
           | 
           | It's a very interesting feeling to feel like you're in full
           | control of what you eat, not influenced by random cravings or
           | hunger.
           | 
           | In my case I'm planning to only stay on it another month or 2
           | to drop 10lbs. I can easily see people cycling on/off this
           | drug throughout the year to keep weight in check while
           | removing will power from the equation completely. It's quite
           | remarkable.
        
             | layer8 wrote:
             | A rebranding to a non-prescription drug will depend on how
             | the prevalence x severity of side effects [0] turns out
             | longer-term. I hope that you are right, but it seems too
             | early to tell.
             | 
             | [0] https://www.sciencedirect.com/science/article/pii/S2667
             | 36812...
             | 
             | https://www.gov.uk/drug-safety-update/glp-1-receptor-
             | agonist...
        
               | SoftTalker wrote:
               | "Gastrointestinal side effects" I assume that is code for
               | excessive and frequent evacuation of watery feces.
        
               | layer8 wrote:
               | "common gastrointestinal side-effects of GLP-1RAs
               | treatment (including nausea, vomiting, diarrhoea and
               | constipation) can persist for several days and may affect
               | more than 1 in 10 patients"
        
               | op00to wrote:
               | For me, nausea only appears when I eat poorly - poor
               | quality, or more than I should. Also increasing a dose
               | can cause a bit of nausea for a few hours.
        
               | gwbrooks wrote:
               | People seem to handle it very differently, according to
               | my doc. I never had issues while taking Mounjaro or
               | Synjardy (a prescription pill for diabetes management
               | with similar side effects) alone, but the two together
               | meant I could count on a couple of bad days a week.
               | 
               | Sidebar: Mounjaro changed my life. I'd been very diabetic
               | (300 units of insulin a day) for years on end. Taking
               | that much insulin, my normally large frame got very large
               | indeed. A couple of months into the Mounjaro and I was
               | off insulin; a year into it and I was down 75 lbs and
               | healthier than I'd been in 20 years.
        
               | op00to wrote:
               | It's actually the opposite. GLP-1s slow down the
               | digestive tract, so my shits are far more well formed
               | than before. This isn't like olestra, where excess fat
               | caused diarrhea.
        
             | ctrlp wrote:
             | In this sense, I see adoption among some people as akin to
             | nootropics or attention management drugs like modafinil. A
             | way to have more control over your own mind. Interesting
             | times, I guess, but caveat emptor.
        
             | timr wrote:
             | They might be branded that way, but that's not what they
             | are. They have dramatic effects on the metabolic pathway
             | and insulin response that need to be carefully considered
             | if you're not actually diabetic.
             | 
             | I recommend that you listen to the most recent Peter Attia
             | podcast, which is a 2+ hour interview with Ralph DeFronzo
             | (diabetes expert) where he goes _deep_ into the effects of
             | GLP-1 agonists on insulin response and other metabolic
             | pathways. I came away with the impression that we 're being
             | too casual with how these drugs are being used -- if you're
             | overweight these impacts are probably all for the good, but
             | if you're not, it's more questionable.
             | 
             | https://peterattiamd.com/ralphdefronzo/
        
               | cj wrote:
               | I'll have to rewatch that video. Saw it a couple days ago
               | and walked away with the opposite take. DeFronzo spent a
               | whole lot of time heavily praising the generation of
               | drugs (including the next generation in phase 2 trials)
               | 
               | If there's a specific part you remember talking about the
               | negatives I'd be interested to hear.
               | 
               | I legitimately have a difficult time finding anything
               | negative when researching the drug, other than tolerable
               | side effects like GI upset.
        
           | casey2 wrote:
           | I assume GP isn't a woman, why do you think 20% is normal for
           | men. The point is that there are no side effects and there is
           | no reason to stop taking it, especially if it saves him
           | money.
           | 
           | Are you just using average as weasel words here? I get my
           | best pump and generally have the best workout sessions at
           | ~10-12%, which is easily maintainable for me, but definitely
           | not for most people, having a drug that makes it effortless
           | for most people is a GOOD thing. People shouldn't have to
           | suffer to get to <15% if they aren't born with good genetics?
           | 
           | And what about strength athletes who want to build up a large
           | runway? Now literally all of them can get down to ~7% no
           | problem, and have no problems on the way up either.
        
           | fallingknife wrote:
           | You shouldn't have to ask permission from a PCP / pharmacist
           | in the first place. Who are you to decide whether side
           | effects are worth it for anybody but yourself?
        
           | anonnon wrote:
           | > when you have below average body fat %
           | 
           | I can't speak to their choice of taking the drug, but it's
           | wild how warped people's perceptions are now of what
           | constitutes "healthy" and "fat" thanks to the obesity
           | epidemic. People remark on how George Costanza on Seinfeld
           | was once considered fat (because he was), or how Homer's
           | scale-tipping 300 lbs. in the _King-Size Homer_ episode of
           | The Simpsons was considered comically obese (because it was).
           | Never mind the fact that people almost always underestimate
           | how fat they actually are and are almost always disappointed
           | by their DEXA scans. Even if the OP 's estimate is correct
           | that they're just a little north of 20% BF (as a man),
           | they're still overweight, and specifically overfat, and
           | probably look soft and doughy.
        
         | Judgmentality wrote:
         | > My morning starbucks routine has changed from 2 food items to
         | just 1, which alone saves me $200/mo
         | 
         | > Now, since I stopped snacking and eating much less, groceries
         | simply last way longer. <-- $$ saved in groceries significantly
         | offsets the monthly price of the medication
         | 
         | JFC, how much were you spending on food? I just looked it up
         | and this drug costs hundreds of dollars per month, and
         | apparently that's just a fraction of your food budget. So you
         | were spending well over a thousand dollars on food each month?
        
           | cj wrote:
           | You can get wegovy generic for $299/mo and Zepbound generic
           | for $399/mo currently through telemedicine via compounding
           | pharmacies, without insurance.
        
             | dghlsakjg wrote:
             | Maybe they are in Canada.
             | 
             | Name brand Ozempic is $230 CAD or $160 from Costco up here
        
               | SoftTalker wrote:
               | [flagged]
        
               | dghlsakjg wrote:
               | What a take.
               | 
               | I have no idea what Americans overpaying for healthcare
               | has to do with a Danish drug company participating in the
               | Canadian Healthcare market.
               | 
               | I'd rather thank the Canadian government for having a
               | drug pricing review process.
               | 
               | If these companies don't want to sell their drugs here,
               | no one is making them. They are still here, so I think
               | it's safe to assume that they are still making money.
        
               | twoodfin wrote:
               | I don't think it should be controversial to say that if
               | the US imposed a Canadian-style price control regime on
               | more than the handful of drugs currently regulated by
               | Medicare, the future number of drugs developed and
               | commercialized would drop significantly.
               | 
               | It's just basic addressable market vs. development cost
               | math.
        
               | phatfish wrote:
               | Would the number of drugs developed drop, or would a few
               | luxury yacht companies go bankrupt?
        
               | twoodfin wrote:
               | The number of drugs developed would drop. In particular,
               | the really expensive to develop drugs that target rare
               | conditions, exploit novel pathways, or require difficult
               | synthesis.
               | 
               | The kinds of drugs that routinely experience years of
               | delayed availability in markets like Canada and the UK
               | until the learning curve has kicked in via the US and
               | other less constrained markets.
        
               | dghlsakjg wrote:
               | The drug companies in Canada are part of the drug pricing
               | process. Their development costs are considered. In
               | exchange, they get additional monopoly priveleges on
               | patented medicine.
               | 
               | Canada doesn't even have particularly low drug pricing
               | compared to the rest of the world, the opposite in fact.
               | Canada just had low drug prices compared to the most
               | expensive market on the planet.
               | 
               | It's possible that lower drug prices in one country would
               | disincentivize a global industry that touches almost
               | every human on earth. Or it could not.
        
               | loeg wrote:
               | It's unambiguously the case that the US subsidizes drug
               | development for the rest of the world, including non-US
               | pharma companies like Novo.
        
               | dghlsakjg wrote:
               | Just because they extract massive profits from the US
               | market does not mean that they would stop operating if
               | they only extracted healthy profits.
        
               | loeg wrote:
               | They would continue operating but fund less speculative
               | drug development.
        
               | pqtyw wrote:
               | I'm sure Novo Nordisk would survive even with slightly
               | lower margins.
               | 
               | Also what proportion of that $1,000 goes to the
               | manufacturer? From what I understand various middlemen
               | and such get a significant proportion of that without
               | providing any value?
               | 
               | e.g. https://www.ftc.gov/news-events/news/press-
               | releases/2024/09/...
        
               | dang wrote:
               | " _Eschew flamebait. Avoid generic tangents._ "
               | 
               | https://news.ycombinator.com/newsguidelines.html
        
           | hamandcheese wrote:
           | If you don't cook, it is very easy to spend $1000+ on food in
           | a month, especially if you live in a high cost of living
           | area.
           | 
           | I'm single, live alone, work a lot, and earn a lot. Food
           | delivery apps are hella expensive... but I still pay it quite
           | frequently. Yes, I am ashamed, thanks for asking.
        
         | tasty_freeze wrote:
         | I resonate with your comment about appetite loss. It is
         | surprising how much it has affected my happiness, to have this
         | few times a day pleasure taken away.
         | 
         | A month ago I suffered through a norovirus infection, the first
         | time for me. In three days I lost six pounds (my BMI is 21.2
         | now). At first I wasn't surprised or worried -- after all, I
         | had emptied out my digestive tract and was dehydrated. But a
         | month has gone by and my appetite has been AWOL. I've lost
         | another pound (5'11" @ 152 lbs). I have an appointment next
         | week with my doctor's PA to see if something else is going on.
         | 
         | The taste of food is the same, but the craving is lacking. When
         | I eat, my guts are telling my brain it is time to stop eating,
         | as if I had eaten a pound of mashed potatoes only an hour ago.
        
         | ForTheKidz wrote:
         | > That late night trip to McDonalds will have you feeling like
         | shit the next day
         | 
         | I've never had this reaction to fast food before. I only eat
         | mcdonalds every few months and yea it's not the highest quality
         | food, but I don't think there's anything in it to make you sick
         | any more than other burger places have. I imagine you'd have to
         | have restricted fast-food nutrition for quite some time before
         | you feel a difference.
         | 
         | I'd like to see a study comparing people who ate mcdonalds who
         | thought of it like slop vs those who saw it as a treat. I'm
         | curious how much of this is psychosomatic, or how much of the
         | craving for mcdonalds is rooted in feeling like crap in the
         | first place.
         | 
         | (Granted, I've never had an issue with maintaining my appetite
         | before, in fact I have issues keeping weight on, so I might
         | have a fundamentally different relationship with food.)
        
           | _diyar wrote:
           | The way I read it, i think the original commenter would
           | usually agree with you, but the effect of the drug turns the
           | post-fast food / treat satiation from joy to pain.
        
             | ForTheKidz wrote:
             | I believe you're correct. Apologies for the confusion.
        
           | WarOnPrivacy wrote:
           | >> That late night trip to Mcs will have you feeling like
           | crap the next day
           | 
           | > I've never had this reaction to fast food before.
           | 
           | I do. Because of it, I eat fastfood when I'm willing to pay
           | that price, ~5x/decade.
           | 
           | > I'd like to see a study comparing people who ate mcs who
           | thought of it like slop vs those who saw it as a treat. I'm
           | curious how much of this is psychosomatic.
           | 
           | The notion that our psychology could be holding us back from
           | fastfood completeness is one that never occurred to me. I
           | like how novel it is.
        
             | ForTheKidz wrote:
             | I believe you, but what do you think it is in the food that
             | causes such severe reactions for you but doesn't affect me
             | at all? Humans lived through periods of extreme starvation
             | and other forms of malnutrition--our genetics are extremely
             | clear on this, as is our tendancy to cannibalize our
             | muscles when they're underused. It seems absurd to me a
             | slightly different selection of nutrients could cause acute
             | distress. (Hence my recourse to psychology--which would map
             | well with the shift towards the moralization of nutrition
             | these past few decades.)
        
               | WarOnPrivacy wrote:
               | >I believe you, but what do you think it is in the food
               | that causes such severe reactions for you but doesn't
               | affect me at all?
               | 
               | Food sensitivities are primarily a lot of medical
               | questions, for which we have few answers. For example
               | many fresh breads will give me stomach cramps and
               | Rosacea. I can eat those same ingredients+amounts in
               | other foods and be fine.
               | 
               | Many fastfoods ramp my brainfog up to 11. I don't know
               | why. I'm in a poor position to consider the issue while
               | the brainfog is in play. I could consider it later but
               | the best I can hope for is unsubstantiated guesses.
        
         | ctrlp wrote:
         | I've heard similar accounts and it sounds pretty wild. I'm not
         | overweight and don't take anything but I do enjoy food. It
         | would be horrible to me to lose the enjoyment of such a primal
         | pleasure. If the choice is between being overweight and giving
         | up the pleasure of eating altogether, I can imagine plenty of
         | gourmands who would rather carry the extra weight for the
         | physical and social pleasures of food. I've heard anecdotal
         | reports of people losing their enjoyment of food permanently,
         | even when discontinuing the drug. Canot confirm but that would
         | be a high cost to pay, imho.
        
           | dghlsakjg wrote:
           | Counter-anecdote.
           | 
           | I have not lost my appreciation for good food, I just eat
           | less of it. I used to be unable to leave any food on my plate
           | regardless of how good or bad it was, now I'm perfectly happy
           | to leave something uneaten if it isn't to my taste.
        
             | alabastervlog wrote:
             | Same, I'm on one of them and I still love and enjoy eating
             | and am perfectly capable of eating my beloved junk food.
             | I'm just highly likely to feel done after a few bites
             | instead of... dozens and dozens of bites.
             | 
             | Losing the pleasure of food was one of my main concerns
             | starting it, and it hasn't been an issue _whatsoever_.
             | 
             | Meanwhile, I'm back down to my healthy weight range, which
             | I haven't seen since 2021, which was about the _third_ time
             | I 'd been at that weight and then ballooned up. I was just
             | about at the top of that range after _two months_ , down
             | about 30 pounds, and it took _no effort whatsoever_.
             | 
             | I feel amazing. Muscle mass is also doing fine, and I'm
             | well into middle age so any protective properties of youth
             | are largely gone, still having no problems there.
        
             | cm2187 wrote:
             | Same for me, I don't recognise those symptoms (loss of
             | taste, loss of impulses). My understanding is that all it
             | does it to replicate the signal the stomach sends when it
             | is full, and so you just feel full / a bit burpy, even on
             | an empty stomach. But you do enjoy the same taste than
             | before the drug.
             | 
             | That being said side effects vary and lots of people
             | mention it gives them nausea. I can easily imagine how that
             | would interfere with taste.
        
             | op00to wrote:
             | I actually appreciate food far more now, because I am no
             | longer worried that I have to consume "enough" food. A
             | small amount is just as satisfying. A large amount makes me
             | ill, and you only make that mistake once.
        
         | throwaway657656 wrote:
         | The above describes me but it is the consequence of my
         | behaviors/habits. Being a workaholic, I learned long ago to
         | ignore the leash that pulls me to the refrigerator. It seems by
         | brain no longer sends me a "you need to eat" signal similar to
         | the way free divers can become oblivious to the "you need to
         | breath" signal.
         | 
         | I wonder if with time, you can learn from this drug, form the
         | helpful habits/behaviors and then stop taking it.
        
         | fallingknife wrote:
         | That's interesting. I started ozempic about 3 months ago and
         | the effects are really not dramatic at all. Is Terzepatide
         | supposed to be more powerful?
        
           | loeg wrote:
           | Tirzepatide is supposed to be more powerful, but GP also just
           | appears to be relatively sensitive to the drug.
        
         | blitzar wrote:
         | Cocaine makes you feel really good and heroin is fun.
        
         | loeg wrote:
         | I started in November and am down ~25 lb.
         | 
         | > Even at the lowest 2.5mg starter dose which you're only
         | allowed to stay on for 1 month
         | 
         | Uh, you're allowed to stay there as long as you want. I was on
         | 2.5 for two months and asked my Dr to up the dose, as
         | progression kind of stalled in the second month. I've been
         | hanging out around 3.5-4.5mg/week since then losing ~5 lb/month
         | steadily.
         | 
         | Sounds like you're pretty sensitive to it, which is nice. You
         | can lower the dose even further if you think it's too strong at
         | 2.5mg/week.
         | 
         | It is definitely a game changer.
        
         | api wrote:
         | Does it have any impact on focus or motivation to get work
         | done, do hobbies or recreational activities, engage in human
         | relationships, sex, intellectual curiosity, etc.?
         | 
         | It would be fascinating and almost too good to be true if we
         | found a way to suppress only largely harmful (in our current
         | environment) urges but leave the good ones intact.
         | 
         | Something like that becoming widely available could change the
         | world, and mostly for the better. It would refocus our entire
         | economy on much more constructive pursuits instead of gambling,
         | addiction, and pandering to transient urges.
        
         | asveikau wrote:
         | > My morning starbucks routine has changed from 2 food items to
         | just 1, which alone saves me $200/mo (sorry starbucks).
         | 
         | Starbucks food is especially calorie dense. I realized this
         | when I lost a bunch of weight in 2018 and I noticed the calorie
         | counts on the printed cards that some stores have. Even for
         | junk food, Starbucks junk food is more calorific than average
         | for the same items.
         | 
         | I started to consider that for a typical customer's
         | consumption, McDonald's might actually be healthier than
         | Starbucks. Which totally goes against the image people have of
         | both places.
         | 
         | People think if they are "going for coffee", it's better for
         | you than having a milkshake and following it with candy. But
         | it's essentially what they're doing.
        
         | cm2187 wrote:
         | I am 8 months in, you do develop a tolerance over time to the
         | drug (and why you need to increase the dosage progressively). I
         | have gone up slower than the prescibed steps but still, this
         | drug is to help doing diets, I don't think it would work as a
         | long term medication. And as far as I can tell, when you get
         | off the drug or have become tolerant to the current dosage, it
         | is easy to gain back some weight if you are not careful. So the
         | point being I don't think it will suppress completely obesity,
         | but it will certainly help people make a time limited effort to
         | go down to a lower weight.
        
           | raincom wrote:
           | Some doctor advised a protocol: stay on GLP-1 for 3 months,
           | then take metformin for a month or two; then repeat the
           | cycle. I have to dig out the source for this.
        
         | decryption wrote:
         | I've been on tirzepatide for 8 weeks (2.5mg then 5mg) and have
         | a very similar conclusion as you. I started off at 160kg 8
         | weeks ago and now I'm down to 145kg. No other change in my
         | lifestyle except eating radically less. Two 500-calorie-ish
         | meals a day and some fruit as a snack, that's about it.
         | 
         | For decades I've struggled with diets but tirzepatide is the
         | only thing that's made me stick with it. Will power alone
         | wasn't enough, but with tirzepatide I'm very confident I'll get
         | down to a under 100kg for the first time since I was a
         | teenager, within a few months.
        
         | silverlake wrote:
         | This is me without any drugs. I'm very interested in food, but
         | I only want a few bites to taste.
        
         | wileydragonfly wrote:
         | Be careful with all this. At one point I had gone 72 hours
         | without eating or drinking anything and one beer by the pool
         | had me on the floor. I keep hydrated these days but sometimes
         | it's an effort.
        
           | wkearney99 wrote:
           | Atkins-ish diet caused the same thing for me with a car
           | accident back in the 90's. Sudden uptake of carbs with the
           | alcohol resulted in lost memory of over 13 hours, a '68 De
           | Ville convertible that got totaled and 2 months spent with a
           | wired jaw.
        
         | crazygringo wrote:
         | I'm curious -- do you have any brain fog? Are you able to
         | exercise? When you exercise, do you wind up eating more, i.e.
         | the caloric amount that you exercised?
         | 
         | I've never had any psychological difficulty with losing weight.
         | I don't care if I'm hungry.
         | 
         | But what happens when I eat less and lose weight is that I have
         | trouble concentrating. The glucose my brain needs just isn't
         | there. And if I do physical activity, forget about it -- my
         | blood sugar is going to my muscles and I'm unproductive for
         | hours afterwards as I just can't think. Also, if I go to the
         | gym, my muscles take a week to recover instead of a couple of
         | days, because they're just not getting the glucose they need to
         | repair themselves.
         | 
         | I don't hear any of these complaints from GLP users though,
         | which baffles me. Not eating enough affects us in lots of ways
         | besides just being hungry. How has it been for you?
        
           | op00to wrote:
           | No brain fog. I walk at a very brisk pace ~6 miles a day. My
           | calories are far less than before I started. I have to be
           | very careful to have enough protein. When I exert myself, the
           | recovery period is the same time as before.
        
             | crazygringo wrote:
             | Do you have any idea of how many calories you eat per day?
             | 
             | I get so confused because the small amounts of food that
             | people talk about eating on GLP, don't seem like enough to
             | sustain themselves long-term.
             | 
             | Are they exaggerating? Or do they talk about not eating
             | dinner, but that's because they had 1,700 calorie lunch at
             | the burger place? Or is that just during weight loss, and
             | then once a target weight is hit, they're eating like a
             | normal (healthy-weight) person again?
             | 
             | I just genuinely don't understand how people are
             | _surviving_ with the diets they describe.
        
               | op00to wrote:
               | Yes, I calorie track around 1900 calories average. Maybe
               | up to 2000?
               | 
               | They are probably losing muscle mass!
        
         | fire_lake wrote:
         | Since you are not terribly overweight you could reach a healthy
         | weight with relatively minor lifestyle and diet adjustments.
         | Isn't this preferable to the side effects (some probably
         | unknown) involved in these drugs? Genuine question.
        
         | op00to wrote:
         | The effects seemed to wane slightly for me, but it vastly
         | changed my relationship with food. I was raised in a family
         | with plenty of food, but food was used as a weapon of
         | manipulation and thus I was taught to eat as much as I can else
         | it might be taken away. With Zepbound I now eat appropriate
         | portions. Can't really stand more than a single beer. I don't
         | mind being at a restaurant and not really eating. I'll have a
         | bite of this or that and be happy.
         | 
         | My shits, however, have been glorious since starting the drug.
         | Truly pleasant steamers that rocket right out.
        
         | SubiculumCode wrote:
         | Where did you purchase it?
        
         | herpdyderp wrote:
         | > Eating is no longer enjoyable and feels like a chore
         | 
         | I used to view eating as a chore and it was great. Then (no
         | joke) I got into tech and everywhere I work they have fancy
         | food or frequent team lunches or something of that nature.
         | 
         | I wish I could go back.
        
         | anal_reactor wrote:
         | I understand that on population level we can't just tell
         | everyone "get on a diet", but when talking to you in
         | particular, why couldn't you... just get on a diet?
         | 
         | Personally, I love food. I can't live without stuffing candy in
         | my mouth. But I also have a tendency to get fat, so I weight
         | myself every day, and based on that I either have a diet day or
         | a cheat day. Moreover, I do a lot of physical exercise every
         | day. The idea of having to depend on a drug to live is scary to
         | me.
         | 
         | Having said the above, I'm sure that one day we'll create a
         | drug that makes life of majority of population better, and
         | we'll be able to administer it to everyone without major
         | consequences.
        
         | valunord wrote:
         | Thanks for experimenting with your body. I'll be sure to check
         | back in about ten years to see how all this shakes out.
         | 
         | Keto + intermittent fasting are my magic pill right now and
         | have been for some years.
        
       | luketheobscure wrote:
       | Is there a term for this style of writing? It's like a longform
       | linkedin post. I don't mean this as a criticism, it just seems
       | like written language is evolving to better capture our
       | diminishing attention spans.
        
         | rsync wrote:
         | I have been working on a new written form I refer to as an
         | "Iceberg Article":
         | 
         | https://john.kozubik.com/pub/IcebergArticle/tip.html
         | 
         | ... which is intended to present detailed, long-form treatments
         | of a subject yet, at the same time, provide something
         | interesting and actionable in a brief moment.
        
           | morkalork wrote:
           | National Geographic articles are the very embodiment of this
           | style.
        
         | robmerki wrote:
         | Hype cycle slop reminiscent of Business Insider, etc. Reminds
         | of me engagement bait threads on Twitter which always include
         | the "thread" emoji and the downward pointing finger emoji.
        
         | kordlessagain wrote:
         | Yeah, it's got that "visionary thought leader" vibe dialed up
         | to 11. There's some interesting analysis in there, but it leans
         | hard into the grandiosity--like he's the only one seeing the
         | big picture while the rest of the world sleepwalks into a $100
         | trillion shift.
        
         | moritonal wrote:
         | I've had a hunch it's about the shrinking width of pages. The
         | text-width is about 11-13 words (at a max-width of 728) and the
         | author seems to have written around this.
         | 
         | Because it's so thin, anything longer than 12 words becomes a
         | paragraph which "slows" the reader, so there are a lot of
         | punchy short sentences. This style would look silly if it was
         | written on a wider left-aligned blog.
        
           | jancsika wrote:
           | That's funny you mention text-width, I've noticed that with
           | "punchy" articles like these.
           | 
           | Alternatively, when I see the old-school blogs that fill the
           | entire page-width, I get the instant feeling I'm about to
           | read something opinionated and quixotic.
           | 
           | Sure enough, the last HN article with that style hit it--
           | _let 's rescue the web by sending around WASM-blobs to be
           | rendered to a common Wayland-like compositing surface_.
           | Thanks again, default CSS!
        
         | rustcleaner wrote:
         | I am a fan of Carroll Quigley's style of writing (Georgetown
         | University professor and ole Slick-Willie's mentor). I find
         | having DeepSeek restate articles in his style to be much more
         | enjoyably ingestible.
        
           | crmd wrote:
           | Wow, I just followed your suggestion and the output text was
           | exactly the style of writing I enjoy and try to employ
           | myself. Gonna check Quigley out. Thank you!
        
         | gukov wrote:
         | It gives me serious TED talk vibes. I guess it could be called
         | that. Or maybe it's the twitter thread style?
         | 
         | A lot of catchy one liner hook sentences ("they're literally
         | removing concession stands from NFL stadiums!") that sort of
         | add up to make the author's point.
         | 
         | I'm pretty sure fact checking line by line will make the whole
         | thing less impressive.
        
         | belter wrote:
         | TLDR: Dont eat so much, you wont be so fat.
        
         | zzgo wrote:
         | Broetry.
        
         | dghlsakjg wrote:
         | I think it can best be described as tweet storm/thread style
         | writing.
         | 
         | Everything has to be distilled down to ~200 char chunks that
         | can be understood on their own as well as within the wider
         | context.
        
         | thrance wrote:
         | Pseudo-insightful quips anthology?
        
       | mrtksn wrote:
       | I have been reading similar big promises about Ozempic
       | specifically. I've seen calculations on the impact over airlines
       | and many others things.
       | 
       | Wouldn't be easier just to look what happens in countries with
       | low obesity rates? Certainly its good but doesn't appear to be
       | 100T good.
        
         | jefffoster wrote:
         | It's not only the low obesity rates, the article states it
         | suppresses impulsiveness.
        
       | rsync wrote:
       | The real trend is deflation.
       | 
       | People are having fewer children.
       | 
       | Fewer miles are driven to fewer offices for fewer trips in cars.
       | 
       | Fewer impulse buys are being made and fewer dollars will be made
       | by advertisements (according to the ops conjecture).
       | 
       | This is not inflationary. It is the opposite.
       | 
       | We live in a _deeply deflationary_ world and we should not be
       | confused by the local, transitory inflation that we may be
       | experiencing at this moment.
        
         | fonkyyack wrote:
         | This! Consumption is made of impulse choices. (most of the
         | times).
         | 
         | Also we are having fewer children, does this drug reduce also
         | the impulse of having sexual desires? In that case that would
         | be even worst.
        
         | immibis wrote:
         | Monetary deflation is easy to solve: just print more money.
         | 
         | But who do you give it to? Well, obviously, you give it to
         | billionaires because they are the best at managing money
         | because they're billionaires. They can then spend it on wages,
         | without having to produce anything useful because they are just
         | getting free printed money.
        
       | dtquad wrote:
       | I'm from the country of Ozempic and Wegovy and neither Novo
       | Nordisk nor our media have been portraying these drugs as general
       | purpose anti-addiction drugs. However there have been some
       | international studies that reveal that it might actually be. Can
       | Novo Nordisk extend their patent of their existing drug if they
       | find new applications for the drug?
       | 
       | Some of Silicon Valley's excess productivity over the rest of the
       | world is driven by ADHD medication. Curious what happens when
       | they also start taking GLP-1 medication.
        
         | daveguy wrote:
         | Yes, a patent can be extended with a different use case. Drug
         | repurposing or repositioning is mostly done exactly because of
         | this financial benefit. Unfortunately that does not apply to
         | currently generic drugs, so pharmaceutical companies don't put
         | the resources into repurposing off-patent drugs that could be
         | helpful.
         | 
         | https://en.m.wikipedia.org/wiki/Drug_repositioning
        
       | p0w3n3d wrote:
       | Don't those drugs have serious side effects? I remember reading
       | something but not sure where
        
         | devmor wrote:
         | I recently did a bunch of consultation and research to decide
         | if I wanted to start taking them, and the only currently
         | discussed serious side effects are applicable exclusively to
         | people with a history of pancreatic disorders.
        
       | agnishom wrote:
       | The author is assuming that everyone will proactively start
       | taking this drug. But I don't understand why? If Jerry is not
       | obese, why would Jerry randomly start taking an anti-obesity
       | drug?
        
         | devmor wrote:
         | It is a bit of a silly proposition, considering that 40% of
         | Americans are obese, and many of that population cannot afford
         | $800-$2000 prescriptions.
        
           | casey2 wrote:
           | It's not silly at all. In 15-20 years this stuff will be
           | <$100 for weeks of use. For many people $800 dollars is less
           | than the they spend on food in the same time
        
             | dghlsakjg wrote:
             | Yup.
             | 
             | The current retail cost in Canada is ~$160 USD per syringe
             | for Ozempic.
        
             | devmor wrote:
             | That's a bit of a ridiculous assumption to make, given that
             | there are plenty of medications that have cost pennies to
             | make for decades and still retail for hundreds to
             | thousands.
             | 
             | Perhaps in non-US locations it will be that cheap for sure.
        
         | slevis wrote:
         | Because the author assumes that the drugs are not only anti-
         | obesity drugs but impulse controlling
        
           | casey2 wrote:
           | Correctly assumes*
        
             | mike_hearn wrote:
             | But this thread and the article's comment sections have
             | many people saying it doesn't really do that for them.
        
             | slevis wrote:
             | Well, the author did not reference any actual studies. But
             | some people here have shared an effect on their general
             | impulse control. Do you have any pointers to good studies
             | about this effect?
        
         | fullstackwife wrote:
         | The same mechanism: Jerry is not hungry, yet Jerry will eat
         | another slice of pizza.
        
         | casey2 wrote:
         | It's not an "anti-obesity drug" it's a "set your hunger level
         | to whatever you want drug"
         | 
         | If Jerry is a body builder he can get to whatever body fat % he
         | wants.
         | 
         | If Jerry wants to save money or doesn't want to wake up early
         | hungry he can do that too.
         | 
         | If Jerry has religious beliefs about impulses coming from
         | shaitan, he can get rid of them.
         | 
         | Besides, 75% of Americans are overweight/obese that's pretty
         | much everyone.
        
           | adammarples wrote:
           | The number one group of people who will never ever want a
           | powerful appetite suppressant are body builders. Lifting
           | weights isn't hard, eating 6 meals a day is and they don't
           | need to make it ten times harder for no reason.
        
             | matt_heimer wrote:
             | Many body builders go through bulk and cut phases.
        
       | textlapse wrote:
       | If a person is careful and sophisticated enough to warrant GLP-1
       | drugs, they probably weren't the ones that were binge drinking
       | and DUIing and doing careless things in the first place.
       | 
       | There are a lot of people who are sitting in front of a computer
       | or a phone playing Roblox/Fortnite and watching TikTok and so on
       | all day and night.
       | 
       | The economy evolves and will work around them...
        
       | slevis wrote:
       | Is GLP-1 really changing general impulse control? But I do buy
       | the argument. If impulse controlling drugs are going to be
       | effective, the economic impact is basically not quantifiable...
       | not only the economic impact but it would change society as a
       | whole in extremely fundamental ways (e.g. dating)
        
         | kadushka wrote:
         | So this drug would mess with my head - am I understanding it
         | right?
        
           | KaoruAoiShiho wrote:
           | Everything messes with your head, this adjusts the mess
           | levels.
        
           | bozhark wrote:
           | Maybe gut? Lot's of serotonin receptors there, right?
        
         | permanent wrote:
         | There is not evidence to suggest general impulse control.
         | That's extrapolation (beyond food items) and likely untrue
         | IMHO.
        
           | slevis wrote:
           | Some comments below someone claimed the opposite... do you
           | have any studies?
        
       | teleforce wrote:
       | >Consider this: When alcohol consumption drops 40% (as it does
       | for many people on these medications), we're not just talking
       | about lower beer sales. We're talking about:
       | 
       | Apparently in most muslim households this drops to 100% or zero
       | consumption, you don't need freaking drugs for that
        
         | phatfish wrote:
         | Converting to Islam feels like a bigger commitment than reading
         | side effects of the drug you are about to take.
        
       | timewizard wrote:
       | > alcohol spending fell 85%
       | 
       | You've replaced one drug with another. Freud would be proud.
       | 
       | > If you told someone in 1850 that air conditioning would reshape
       | the global economy, they'd think you were crazy.
       | 
       | This is incredibly misinformed. You've lived /with/ refrigeration
       | and /without/ malaria for so long you have no Earthly idea how
       | people in the opposite state lived their lives or saw the world
       | around them.
       | 
       | > We're discussing the first medication that effectively
       | regulates human impulse control. Think about that.
       | 
       | It has side effects. Think about that.
       | 
       | > The significant economic impact occurs in the second and third-
       | order effects.
       | 
       | Yes and many of them will be negative. This is hyper futurism
       | with zero grounding in the past. This is extremely lazy writing.
        
         | casey2 wrote:
         | I can't understand this type of thinking.
         | 
         | "you replaced this drug with hundreds of known downsides with
         | one that has none"
         | 
         | Nice nonargument for the rest of your post. It's somehow
         | misinformed to state the fact that the southern manufacturing
         | industry simply cannot exist before air conditioning
         | 
         | Frankly your attitude is evil and you are a proponent of evil.
        
           | timewizard wrote:
           | > with one that has none
           | 
           | I can't understand this type of thinking. Of course it has
           | downsides. You are being extremely disingenuous to say this.
           | Let alone not acknowledging that different people experience
           | different side effects. Plus you're completely ignoring the
           | /reasons/ why people drink in the first place and abandoning
           | any effort to impact those. Do you work for the company
           | producing this drug or are you genuinely this gullible?
           | 
           | > your attitude is evil and you are a proponent of evil.
           | 
           | So you label things you don't understand as evil? What is
           | this meant to accomplish?
           | 
           | If you really believe what you say then why aren't you
           | pressing for the drug to be free? For free consultations to
           | be given out? If it's truly this magical then it's very
           | irresponsible to let a for profit company own it, sell it,
           | and market it. Isn't it? Wouldn't that actually be evil? To
           | champion this cause merely to make money for a patent holder?
           | 
           | You diminish these terms in your careless use of them.
        
         | FitCodIa wrote:
         | Thank you for this comment!
         | 
         | First, those in power rebased the diet of the masses to carbs.
         | Consequence: an eternal epidemic of obesity, with the many
         | known complications and illnesses as a result.
         | 
         | Then, they now try to remedy the problem by fucking with the
         | human body's mechanisms. 100% guaranteed to cause terrible side
         | effects, in the long term. It's _always_ more complex than you
         | think. The more coveted a  "medication" for a _societal_
         | problem is -- with the problem being the pigswill that is fed
         | to the masses, and our absolutely terrible sedentary, movement-
         | less lifestyle --, the more quickly it will be greenlit, and
         | the greater damage it will do over time (those pesky  "unknown
         | unknowns"). The _hubris_ of human industry is unlimited; here
         | 's one example:
         | 
         | https://en.wikipedia.org/wiki/Thomas_Midgley_Jr.#Leaded_gaso...
         | 
         | > On October 30, 1924, Midgley participated in a press
         | conference to demonstrate the apparent safety of TEL, in which
         | he poured TEL over his hands, placed a bottle of the chemical
         | under his nose, and inhaled its vapor for sixty seconds,
         | declaring that he could do this every day without succumbing to
         | any problems.
         | 
         | Here's another:
         | 
         | https://en.wikipedia.org/wiki/Thalidomide_scandal
         | 
         | And the list goes on and on.
         | 
         | The obvious solution to the obesity epidemic is to dismantle
         | the food industry and the 8 hours workday. Our eating and
         | movement/exercise habits need to revert to not just pre-
         | industrial, but _pre-agricultural_ standards. Move a lot every
         | week (at least on 4 days per week), welcome hunger back into
         | our lives (hunger allows you to appreciate and enjoy simple
         | food -- intermittent fasting is amazing), and eat food with
         | high volume, but low calorie content, and /or with low glycemic
         | index. Our stomach volume and our blood sugar control had
         | evolved for those types of foodstuffs, yet due to said rebasing
         | of the diet of the masses to carbs, we've been filling our
         | bellies with artificial food that's _hyper-charged_ on calories
         | and that get absorbed _immediately_. That 's the _recipe_ for
         | growing fat tissue.
         | 
         | Two wrongs don't make a right.
         | 
         | And a final comment:
         | 
         | > Analysts predict that by 2030, 30% of American adults will be
         | on these medications
         | 
         | Why doesn't that prediction make everyone shit their pants,
         | from fear? Do you really want to make all those people
         | dependent on Big Pharma just so they can _eat healthily_? How
         | more _basic_ do our bodily needs get than that?
         | 
         | This meds are pure evil, they're a non-answer, they're a cop-
         | out, they only transfer power from Big Food to Big Pharma.
         | 
         | This is the same shit as trying to "cure" _society-wide_
         | depression and anxiety with drugs. It only suppresses (or
         | replaces) the symptoms, without fixing the root cause. We 're
         | depressed because our engineered societies make our lives
         | _meaningless_. The struggle for survival is real, and the
         | universe is unfair and indifferent, so we certainly need
         | society, to cope with that. Just not this way.
        
       | GZGavinZhao wrote:
       | I would feel like an absolute failure if I need medicine to help
       | create willpower.
       | 
       | EDIT: under the assumption of an average person who is not under
       | any medical condition that may result in lack of willpower
        
         | netsharc wrote:
         | Wasn't there an ADHD drug that was popular for hyper-
         | productivity, in the years where being productive was all the
         | hype?
        
           | ReptileMan wrote:
           | Yeah. Amphetamines. All of those are drugs are like a scooby
           | doo villain unmasking and amphetamines are underneath the
           | mask.
        
           | blitzar wrote:
           | Work place performance enhancing drugs are still a thing. If
           | you are not on them you are at a major disadvantage.
        
           | throwaway657656 wrote:
           | Not ADHD specifically, but about 12 years ago, the media was
           | hyping Provigil as a "secret weapon" of the ultra-productive.
           | 
           | Despite having a prescription, CVS told me that my insurance
           | wouldn't cover it and it would cost $1500 for 30 pills. I
           | walked away and then went back to buy it. If I could just get
           | 30 additional minutes of billable time per day per pill it
           | would be worth it.
           | 
           | I took about 5 over a week and destroyed the rest. It wasn't
           | good for anything but keep me awake in a semi-zombie low-
           | creative state. This very expensive drug/lesson was effective
           | and making me realize I need to seriously work on my impulse
           | control.
        
         | mhb wrote:
         | How would you feel if you were born with an unusual and
         | detrimental somatic condition that could be fixed with
         | medicine?
        
           | GZGavinZhao wrote:
           | Updated, I should clarify that assuming no medical needs.
        
         | cedws wrote:
         | This is the same line of thinking as "drug addicts should just
         | stop doing drugs."
        
           | GZGavinZhao wrote:
           | Apologies, I've updated to clarify that my comment is under
           | the assumption that the host is not already under a non-
           | natural influence or medical condition. For example, in the
           | case if there is a medicine that would help drug addicts with
           | their addiction I would be 100% for it.
        
             | cedws wrote:
             | Even so.
             | 
             | Food can evoke the same neurochemical response as hard
             | drugs or sex for some people. It is even more readily
             | available than either of those things, and it is advertised
             | and produced by multinational conglomerates with huge
             | advertising budgets. They have the resources to maximise
             | the attractiveness of their products and optimise the way
             | they taste to be as pleasurable to eat as possible. Usually
             | that means filling them with terrible ingredients.
             | 
             | It's not much different than social media. People get
             | addicted to social media because they don't stand a chance
             | against social media companies that employ an army of
             | people to optimise every facet of their product for
             | addictiveness.
             | 
             | Modern lifestyles are more sendentary than they used to be,
             | and that plays a part in the explosion of obesity, but so
             | do the conglomerates that produce the junk food.
        
         | layer8 wrote:
         | Not as much as if such medicine weren't available. ;)
        
         | furyofantares wrote:
         | I guess people whose strengths and weaknesses differ from your
         | own should feel like absolute failures then.
        
       | KaiserPro wrote:
       | I would point out that it isn't unforeseen, given that genz don't
       | drink, go out or do drugs to anywhere near the extent that
       | millennials did at the same age.
       | (https://www.statista.com/chart/30783/alcohol-consumption-by-...)
       | 
       | I would also gently point out the evidence for tempering alcohol
       | only seems to be evident with people who have high BMI
       | https://www.pulsetoday.co.uk/news/clinical-areas/mental-heal...
       | 
       | So yes, its worth thinking about how our economy is organised.
       | 
       | But the thing that is going to kneecap the US economy in the
       | short terms are one of the following:
       | 
       | o Tariffs
       | 
       | o Cutting government spending (especially welfare)
       | 
       | o a steep rise in unemployment caused by government firing of
       | civil servants
       | 
       | o fucking with the structure of the monetary system
       | 
       | o AI eliminating whole classes of jobs (taxi driving, phone
       | centers, clerical work, etc etc)
        
         | dehrmann wrote:
         | Genz just swapped traditional vices for social media...which
         | also deals with impulse control.
        
           | kansface wrote:
           | I wonder which is more harmful?
        
             | fallingknife wrote:
             | I can't say which is more harmful, but social media is a
             | hell of a lot less fun
        
               | anal_reactor wrote:
               | I take LSD every two to three months, and I'm always
               | excited to do so, even though I usually get bad trips.
               | Weed consistently gives me at least five minutes of joy
        
       | bawolff wrote:
       | >- Movie theaters becoming "social experience centers"
       | 
       | >- Retail spaces becoming venues to "try before you subscribe"
       | 
       | >- Restaurants becoming "social nutrition centers"
       | 
       | >- Shopping malls converting to "wellness districts"
       | 
       | Except for resturants, all of these have had problems for a long
       | time. People have been talking about the death of shopping malls
       | since the 90s.
       | 
       | Feels like other factors are in play here.
        
       | dboreham wrote:
       | This isn't a new idea. Jim Cramer has been warning about reduced
       | earnings by alcohol beverage companies and snack food vendors due
       | to GLP-1s for at least a year.
        
       | Earw0rm wrote:
       | The article posits that 80% of the top income quintile will be on
       | this medication.
       | 
       | I have to ask, why? (I'm not in the US, I should add). Like,
       | sure, is the average American overweight? Yes. Are 80% of the top
       | 20% of earners? Seems pretty doubtful, plenty of the rich look to
       | be in reasonable shape.
       | 
       | That statistic suggests that 80% of successful people have such
       | poor impulse control that they end up seriously overweight or
       | obese. And I say that as someone who likes a treat every couple
       | of days, but exercises enough to maintain a fairly healthy
       | weight.
       | 
       | Admittedly if there were a GLP1 for procrastination, I'd be on
       | that stuff like a shot...
        
         | cedws wrote:
         | There are some signs that these drugs have effects beyond just
         | apetite supression leading to weight loss. I recall reading
         | something about them having a direct slowing effect on the
         | metabolism, which increases longevity, among other benefits. I
         | can foresee it being used like a supplement among those who can
         | afford it.
        
         | gcanyon wrote:
         | > Admittedly if there were a GLP1 for procrastination, I'd be
         | on that stuff like a shot...
         | 
         | Me too! Maybe later... <kidding>
        
       | goda90 wrote:
       | I think an angle not covered is that the "impulse economy"
       | actually degrades impulse control. Advertising, social media
       | feeds, etc are all hammering away at people's willpower, and
       | getting is addicted to giving in to impulses. If these things
       | disappear, maybe even people who aren't on these drugs would have
       | more impulse control.
        
       | cedws wrote:
       | This class of the drugs is the biggest thing to happen in
       | medicine in a long time in my view (as somebody who does not work
       | in the industry.)
       | 
       | Is there any data to show they have an effect on other addictive
       | behaviours, like drug addiction, social media addiction, caffeine
       | addiction?
        
       | sub7 wrote:
       | My guess is there's also a long term explosion in
       | liver/stomach/pancreatic cancers coming which might be the
       | diabetes/heart attack/strokes of the 21st century.
        
         | SoftTalker wrote:
         | Read up on fen-phen.
        
       | Animats wrote:
       | Wow. And this is the first generation of this class of drugs.
       | Better drugs with fewer side effects are in the pipeline.
        
         | dist-epoch wrote:
         | Maybe, or maybe not.
         | 
         | Drugs are not like a smartphone. There is no reason to believe
         | you can improve on them (except on price)
        
           | _diyar wrote:
           | I see your point. But consider that drug generations are
           | generally not defined by the manufacturer, but by the broad
           | community of researchers and clinicians finding step-changes
           | in their effectiveness/side-effect tradeoffs.
           | 
           | So by definition, if they ever consider a "new generation" of
           | GLP1-agonists, they will be better by definition.
        
       | caycep wrote:
       | the economy depends on dopamine dysfunction in the VTA area i
       | guess
        
       | submeta wrote:
       | Big food corporations profit from ultra-processed foods that
       | manipulate our natural systems. They design products that
       | override satiety signals using calculated combinations of sugar,
       | fat and salt to activate brain dopamine pathways. Their priority
       | is profit growth, not consumer health.
       | 
       | The consequences are significant health issues like obesity,
       | diabetes and cardiovascular diseases. Healthcare systems struggle
       | with preventable conditions while millions experience declining
       | health and shorter lifespans. These corporations employ
       | questionable strategies: marketing to children, lobbying against
       | regulations, funding misleading research, and shifting
       | responsibility to consumers.
       | 
       | Medications like Ozempic represent a threat to this model by
       | reducing appetite and interrupting compulsive eating. Recent
       | industry concerns about declining sales show how these
       | medications could undermine their business approach. If consumers
       | regain control over their eating habits, corporations may finally
       | face consequences for practices that have profited from health
       | problems for decades.
        
         | crazygringo wrote:
         | > _Big food corporations profit from ultra-processed foods that
         | manipulate our natural systems._
         | 
         | I've just never bought this.
         | 
         | Does grandma manipulate you when she adds sugar to her cherry
         | pie? Does she manipulate you when she adds salt to her mashed
         | potatoes?
         | 
         | Foods -- "ultra-processed" or not -- don't "manipulate" you.
         | They literally just either taste better or taste worse.
         | Grandma, and her grandma before her, used sugar, fat, and salt,
         | and thank goodness they did. These are normal ingredients. It's
         | not like they're nicotine or heroin or something.
         | 
         | I mean, is a fig tree "manipulating" you when its figs ripen
         | with sugar so they'll be eaten?
         | 
         | You're not being manipulated. You're just choosing to eat what
         | you choose to eat based on what you like.
        
           | otterley wrote:
           | You should visit a food processing plant sometime. What they
           | are doing with food is not what your grandma does when she
           | cooks it from ingredients you can buy at the grocery store.
           | And I bet your grandma doesn't have a food chemistry lab to
           | guide her recipes.
           | 
           | Similarly, fig trees don't make Fig Newtons. They make figs.
        
             | crazygringo wrote:
             | Oh, I'm familiar with it. And you know what? They mostly
             | _are_ doing what grandma does. Just in vastly larger ovens
             | etc. Even if you want to talk about corn syrup, what do you
             | think grandma made her pecan pie with?
             | 
             | And the things that _are_ different -- emulsifiers,
             | stabilizers, natural /artifical flavors, etc. -- aren't
             | actually making the product unhealthy, at least not in any
             | way that causes weight gain. Those _aren 't_ sugars, fats,
             | or salt. They're just making it last longer on the shelf,
             | and have more flavor. But it's not changing the nutrition,
             | and it's not making us eat more of it.
             | 
             | You really think Chips Ahoy is making you fat in a way that
             | grandma's chocolate chip cookies don't?
        
               | otterley wrote:
               | I don't know if it's the nature of the products
               | themselves, or if it's because they're vastly cheaper and
               | more accessible. There's a natural limit to the numbers
               | of cookies to be had from Grandma before she goes "that's
               | enough," vs being able to get 64 at the local market
               | anytime you want for a pittance.
        
           | wakawaka28 wrote:
           | Yeah it's anti-capitalist rants at every turn around here.
           | Capitalism is the best system we have to make people happy in
           | a fair way. It's not a system to teach people the benefits of
           | moderation or charity. You're supposed to bring that to the
           | table yourself. There's no economic system in the world that
           | can fix character flaws.
        
           | lm28469 wrote:
           | No matter how I look at it 60g of sugar in small bottle of
           | coke is criminal. My wife bakes cakes for 10 people with less
           | added sugar.
           | 
           | Junk food definitely is designed to abuse our natural
           | instincts and needs, from packaging to ingredients. Go one
           | year without processed food, you won't physically be able to
           | drink coke or eat fastfood
        
         | fallingknife wrote:
         | "Big food corporations" lol. You think every professional chef
         | doesn't know the same tricks? There are basically 3 things that
         | taste good. Fat, salt, and sugar.
        
       | ReptileMan wrote:
       | Sounds dystopian. And also Ozempic face. To me it seems that it
       | doesn't activate all fat cells in the same way natural weight
       | loss does. I do have a feeling that GLP-1 agonists will
       | eventually bite us in the ass. Usually this is the way with
       | molecules that are too miracle - hello cocaine, plastics, teflon
       | and amphetamines. There may be some spectacular risks that will
       | become evident after decades.
        
       | dehrmann wrote:
       | Interesting article, but I do have a nit:
       | 
       | > Nike is shifting from "Just Do It" impulse messaging to long-
       | term wellness partnerships
       | 
       | My read of "just do it" is actually the opposite. It's a message
       | to dedicated athletes about not making excuses end executing.
        
         | _diyar wrote:
         | In marketing world, many consider the slogan "Just Do It" to
         | have a double meaning: 1) Don't make excuses, get after your
         | goals! (the one you're espousing) 2) Treat yourself, just buy
         | it (the one the articles author is emphasizing).
        
       | neilv wrote:
       | > _We 're discussing the first medication that effectively
       | regulates human impulse control._
       | 
       | Is this another numbing zombie drug, like over-prescribed anti-
       | depressants -- that some people genuinely need, but that make
       | some other people accept a situation that they would otherwise be
       | up to challenging and improving?
       | 
       | Also, are there side effects than can make it backfire for any
       | patients? https://en.wikipedia.org/wiki/Reaver_(Firefly)#Origin
        
       | lurk2 wrote:
       | It's an interesting idea, but ultimately being sensationalized.
       | The article starts off by making a compelling case that the
       | widespread adoption of these impulse-control drugs will disrupt
       | the economy and lead to many changes in business models built
       | around impulse buys. The issue is that these drugs only entered
       | the public consciousness within the last two years, and many of
       | the business model changes that the author implies are
       | attributable to the drugs have been going on for a lot longer
       | than that. His treatment of retail is an obvious one (he's
       | ignoring the impact of changing consumer practices that came
       | about due to online shopping). The replacement of anchor stores
       | with medical centers is another one - I can remember reading
       | about this on Hacker News in 2017.
       | 
       | I suspect his projections on the impacts these drugs will have on
       | crime rates and alcohol consumption are probably also overblown.
       | I could be wrong, but I would think that the sorts of people who
       | seek out prescription drugs for impulse control aren't likely to
       | overlap with people who drive drunk in the first place.
       | 
       | The anecdote about the lost muffin revenue was still quite
       | interesting.
        
         | sfpotter wrote:
         | ??? They're going to be trying to get on a weight loss drug,
         | not an "impulse control drug". And I don't see why you would
         | assume there's little overlap between people who desperately
         | want to lose weight and people who drive drunk.
        
           | lurk2 wrote:
           | From the article: "We're not just talking about weight loss.
           | We're discussing the first medication that effectively
           | regulates human impulse control. Think about that."
           | 
           | > I don't see why you would assume there's little overlap
           | between people who desperately want to lose weight and people
           | who drive drunk.
           | 
           | This is only a hunch, but I would guess that drunk driving is
           | associated with low conscientiousness and that the sorts of
           | people who are going to go through the trouble of getting
           | medicated to lose weight are unlikely to be the sorts of
           | people who drive drunk in the first place.
           | 
           | Maybe I was misinterpreting the point he was trying to make.
        
         | jajko wrote:
         | Revolution it may be, but yeah its made to be sensational,
         | which often means facts may be used out of context or twisted
         | for specific narrative.
         | 
         | Don't worry there will be tons of complementary businesses like
         | overpriced healthy food megastores and countless gyms that will
         | absorb unemployed workforce and all that 'suddenly available'
         | cash. Junk food is cheap, quality tasty healthy one not so
         | much.
        
       | jemmyw wrote:
       | I don't see any comments talking about it, and it's not mentioned
       | in the article, but if it changes impulse control I wonder what
       | effect that will have on politics. Hopefully one where people
       | will take a longer view and look at policies rather than
       | impulsively voting for the candidate they think they like the
       | most.
        
       | blitzar wrote:
       | For the rest of the world, not so much. For America however, this
       | is a huge disruptor.
       | 
       | The pride associated with having a body shape that a well trained
       | Ai would classify as Manatee rather than Human is rapidly
       | changing and _eventually_ society will be better off for it.
        
         | sarchertech wrote:
         | There are maybe a few thousand people in the country who are
         | proud of being fat.
         | 
         | Also everyone is getting fatter. America is just 30 years ahead
         | of most of the rest of the world in terms of obesity.
         | 
         | Take whatever country you care to name and the population of
         | that country 30 years ago would call the population today lard-
         | asses.
        
       | thrownawaysz wrote:
       | I'm on Saxenda (liraglutide) since last August. Started at 163kg,
       | so far 39kgs down I'm at 124kg right now. And I'm not stopping
       | here. Anything under 105kg is already good but I really want to
       | reach a two digit weight.
       | 
       | Saxenda + a calorie restricted diet is pretty much the best
       | combo. Can't complain, never felt any better.
        
       | rs186 wrote:
       | Off topic: Since we are doing clickbait titles, I thought ChatGPT
       | / Gen AI in general might be a better candidate for "the biggest
       | economic disruptor since the internet", based on hype, especially
       | from the "leaders" who claim that AGI is just a few months away.
        
       | justlikereddit wrote:
       | The article describes a psychotic lifestyle as normal.
       | 
       | I didn't need a drug to reject having breakfast at Starbucks. I
       | bake my own bread. I wake up early to have time to eat it in
       | peace. I take enough time to roast my own coffee beans. I commute
       | by bike.
       | 
       | It's about having some standards. A concept of a lifestyle and
       | person that isn't just a corpo drone.
        
       | wileydragonfly wrote:
       | I've lost 35lbs on them and won't ever stop using them.
        
       | skmurphy wrote:
       | The most significant takeaway for me from this analysis was that
       | many businesses were aligned with helping people become or remain
       | obese. Where do the opportunities flow to now that people can
       | apply their disposable income to items beyond food and alcohol?
       | Something similar happened during the "low carb" shift when
       | bakery goods sales decreased, but people shifted to high protein
       | (and perhaps high fat) food away from high carb. But it was still
       | food. This feels a little different.
        
       | raphman wrote:
       | Is this person an expert of any kind? They throw around dozens of
       | numbers without any sources. For example,
       | 
       | > 'A movie theater chain recently analyzed their user data and
       | discovered that 72% of their profits came from concessions,
       | primarily from impulse purchases made by people who swore they
       | "wouldn't buy anything."'
       | 
       | This combination of non-descript source, precise numbers, and
       | 'quotes' looks like the usual bullshit one reads in self-help
       | books. I conducted a quick online search but couldn't find any
       | direct source for this claim (although the number might be in the
       | right ballpark).
        
       | dhfbshfbu4u3 wrote:
       | This is just the start. Those in the know are already stacking:
       | 
       | GLP-1 Agonists, Senolytics, NMDA Modulators, Hormones and
       | Peptides, NAD+ and mTOR Modulation, Nootropics and Adaptogens...
       | 
       | Forget weight loss. These people are going for immortality.
        
       ___________________________________________________________________
       (page generated 2025-03-01 23:00 UTC)