I've been on tirzepatide (Mounjaro) for 4 months now. I'm down 13% of my body weight. I realized that frequent cannabis consumption interferes with the weight loss, so I've kicked the habit from daily to occasionally on weekends. I've started walking 2-3 miles a day, 2-3 days a week regularly, in addition to eating less and being more motivated to calorie count.
All this to say, this drug has been life changing for me. I spend more time doing things I want to do, depression and anxiety have less of a hold on me now. I feel that this drug has allowed me to be the best version of myself I have been in a long time. The only side effects so far have been positive. I do worry about what I will do once it's time to titrate off the weekly dose and the best I can think of is that the habits I'm forming in the time on the drug I will have the resolve to continue after cessation.
I say this because I have battled depression, anxiety and obesity issues my entire life. I've had many failed attempts at getting back to a healthy, productive and non-obese lifestyle. I don't know what is so different about having the drug help me, but I can tell you that it has been different.
Tirzepatide and Semaglutide are both known to reduce addiction / substance ingestion. I noticed I was just less interested in Alcohol when I started on Wegovy, and didn't realize it's a common effect until much later. I retained most of my disinterest after going off, too, FWIW.
I take mounjaro because I have T2 diabetes and it is a lot easier to stick to a diabetes appropriate diet. I was already normal weight and I lost 50kg 10 years ago but I could never really eat cleanly even after losing all that weight. The diabetes only improved that slightly.
I'm with you on this, tirzepatide has been life changing for me. I've struggled with my weight my whole life and I can actually imagine a future where I lose enough that I'm no longer ashamed of my weight.
I've been on tirzepatide for just over a year now. Before that, I managed to lose 6% of my body weight over the previous year. With tirzepatide, I've lost an additional 17% of my body weight, for a total of 23% over two years.
Tirzepatide isn't a magic drug that just makes you lose weight, it simply makes it much easier to avoid overeating.
It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.
> It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.
I had this problem as well. Being on tirzepatide I went from 220 to 185 in just six months because my previous insatiable hunger went away. It feels so powerful now choosing when to eat or not.
> It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.
Forgive my ignorance and curiosity, was the feeling of hunger due to drastic reduction in portion size? Could you not eat some low-calories filling food?
I ask cause I've been overweight and sometimes obese most of my adult life, but when on a diet I usually feel "unsatisfied" but rarely actually hungry, e.g. I can eat a couple carrots or whatever and hunger goes away, but I would still crave a hamburger.
Still, I'm happy for you that you found something that works!
I think this is such a helpful description of the totality of components working together to spur a positive outcome, which I think, at least in my personal experience, is an under-appreciated aspect of using a drug.
I've sometimes heard it said that it's an unhealthy reliance on a drug in place of curbing behavior, but I think it's important to understand it as, among other things, a stimulant to the activation of beneficial behaviors, which can be as critical as the drug itself.
Have you been recommended an exercise regimen, or taken one up yourself? The one the great things about GLP-1s is that with the weight loss, it's easier to be more active once you've lost some of the weight.
The negatives is that the current breed promote a loss in muscle mass as well as fat loss, so it is very important to do your best to maintain if not increase muscle while on them.
The next generation of drugs are including 2nd molecule...I'm blanking on the name, and a search isn't bringing it to me...which maintains or potentially increases muscle mass.
But curious what your experience with exercise has been.
I also didn't know there was a planned reduction in dosage, but the expectation is that you'll be on some type of GLP1 for life, is that not right?
Cagrilintide (paired with semaglutide) and retatrutide are the next wave, though I'm not aware of any research for either indicating an increase in muscle mass.
My understanding of the literature is that there's nothing special about semaglutide or tirzepatide that promote muscle loss - it's just people who lose weight based purely on diet tend to also lose muscle mass. Even bodybuilders lose some muscle mass when cutting.
It's up to the individual to increase their protein intake and exercise, the same way they would in any caloric deficit.
None of the GLP1s cause more muscle loss than simply losing the same amount of weight without it. It’s the rapid weight loss without resistance training that causes it.
If you calorie restricted with the same exercise routine without the drug you’d see the same amount of lean muscle mass loss as you would taking the drug. This spreading of misinformation is actively harming people.
Studies have show most people rapidly regain the weight once they stop taking GLP-1 drugs.
The dysfunctional biochemical processes that contributed to overeating are still present if you discontinue the drug. Your body has a natural set-point for the weight it wants to be at, and the hunger and food noise comes right back as your body tries to get you back to your old weight.
It's possible that after after a long enough time at a healthy weight your body's natural weight set-point will regulate itself back down. But this process take years.
Most weight management programs recommend you wean off - and also recommend other drugs if needed (metformin) to for maintenance.
The method of these programs is to use the GLP-1 medications to allow you to change your habits significantly while also reducing your weight. The goal being, you keep the new habits and your reduced metabolic requirements which allows you to keep the lower weight.
Did you notice that cannabis consumption interferes with weight loss due to interfering with motivation to stick to your health goals? Or did it interfere with your metabolism in some way?
I can answer this, I've been on Ozempic in the past and prescribed Mounjaro (Tirzepatide) currently (month 3).
I've had a medical cannabis prescription for many years and vaporise up to 3g a day which is quite a bit. It definitely interferes with my cravings for food, as you know the common 'munchies' effect, making me eat when I'm not really hungry or binge snacks.
I gave up on Semaglutide (Ozempic) after a few months, but Tirzepatide is working a lot more effectively and has been better.
Cannabis also helps a lot with the nausea side effect for me which can be particularly bad the first few days going up a dosage every month. It takes six months to titrate from the starter dose to full strength, if necessary.
Also the downside a lot of people don't talk about is that most people need to be on these drugs for life. They also aren't cheap.
Have you noticed any effect on gastric emptying. As someone with 'tummy issues' ( ibs/gerd ect) i am apprehensive of messing with my digestive systems.
Not the person you were responding to, but yes. Stomach empties much slower, which seems to effectively make it smaller. A normal size (pre-drug) meal will make me uncomfortably full and probably cause reflux.
That said, I've noticed in the past, and also now on this drug, that my gastrointestinal issues abate noticeably when I consume less food. Thought I had IBS and then I went on a significant diet and lost 40 pounds in 2020. The IBS resolved, and not after I lost 40 pounds -- it basically stopped altogether a matter of weeks after I changed my diet. That was educational. YMMV.
I'm still working out my approach to eating while taking tirzepatide. Old habits die hard, and I'm having to cut my meal size way back. This sucks because my problem with eating too much was about eating too often, or not when hungry, not about binging. So I have to eat pretty small meals now. It will take some adjustment to find the right way to get sufficient nutrition while volume limited, but I think it can be done.
If your IBS is the "stuff moves too fast" variety (so, IBS-D) GLP-1s seem to help a lot since they slow things down. If your problems already stem from things moving too slow... maybe not so much :P
My view about obesity has shifted dramatically since Ozempic came out. Before this, I didn't think about it too much (I am not obese myself).
I notice now that there is a LOT of judgement, bias(?), around obesity, that people, obese or not, carry with them [1]. I certainly carried that bias, and the reason I noticed it was because Ozempic is literally an external substance that you take that simply makes obesity go away. So if you believe (like most of us unconsciously do) that obesity is a personal failing or an issue of willpower, an issue of personal merit -- HOW is it possible that a chemical pill, an external chemical process, can SO effectively resolve it? When no amount of hectoring and moralizing and willpower can? My inability to square that circle really changed my thinking about obesity in a fundamental way.
Already there is a reaction to Ozempic -- like people thinking that taking Ozempic is a personal failing, or judging celebrities, for taking it, thinking it's the "easy way out" -- I think the origin of that is this very deep unconscious bias that we all have about what obesity actually is fundamentally.
My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.
It's really heartening to hear your experience. Your post really struck me, I felt exactly the same way after getting on a CGM + Insulin Pump for my Type 1 Diabetes. Nobody EVER thought I had a lack of "personal responsibility" or an "issue of willpower" for going low or high on shots of Humilin and NPH.
This is a very American way of thinking about it - not invented here vibes all over.
Of course people don’t choose to be obese, but the culture and environment inevitably pushes you to it. A proof of that is that there are places in the world, with similar genes, that don’t have the same problem in the degree that US does.
I don’t think it is a personal failing, more a collective one - the society itself has chosen a set of environmental factors as desirable (car centric, hectic, individualistic, processed cheap food etc) and it just results in more obese people.
Loose the cars (change to walk / cycle / public transport), spend on food as much as the rest of the world do (adjusted to PPP) and suddenly you don’t need ozempic.
It is still weird to me how US choose unironically to develop a drug for reducing addiction, and not putting societal pressure to fix the environmental issues. It’s a democracy, people do choose all of that and can’t really blame it on the government.
> people thinking that taking Ozempic is a personal failing
I expect that the people who hold this viewpoint are afraid that their lack of being overweight will not be seen as badge of honor, a sign of superior morals and willpower.
To them I say -- GLP-1 agonists are good for anxiety, too!
The fact that a drug can cause a shortcut is completely normal I think, alcohol can nearly instantly give you the confidence that months of training would take, hallucinogens can give states of mind that monks spend years meditating and breathwork to achieve, steroids give shortcuts to massive gym gains, etc.
I see Ozempic as "taking the easy way out" the same way I see steroids as "taking the easy way out" (except it brings people closer to the norm of a average healthy person and will probably lengthen lifespans).
If you're in it to show mental fortitude for internet/social points, then it is "cheating", but if you're just in it for results it's perfectly acceptable and even recommended.
> Not unlike diabetes, celiac, or clinical depression.
The latter is, like obesity, considered a personal failing (being one or more of the Seven Deadly Sins, depending on when you look), and medical treatment elicits similar reactions — both against it being ‘too easy’, and in favour of wholesale societal restructuring instead (“That trick never works!” — Rocky the Flying Squirrel).
It's not just willpower but also lifestyle. It's rare for people who are physically active, and have a balanced diet, to suffer from obesity. I can eat A LOT without putting on a ton of weight, and it's because the types of foods I eat and because I do strength training, which means have a fair amount of muscle mass which acts as metabolic furnace. I'm a little overweight, at the moment, but it'd take a lot of effort on my part to become obese. I think treating obesity as a health condition is the wrong approach.
My understanding is that more research is pointing to obesity as, in some sense, a precursor/reaction to the onset of type 2 diabetes rather than type 1.
Once you get to quite obese you're dealing with physiological factors that make losing weight medically difficult from behavioral changes alone. It also makes the chances of "yo-yoing" the weight higher as well. At that point the treatment for obesity overlaps with the treatment for type 2 diabetes.
> people thinking that taking Ozempic is a personal failing
Considering our society is pushes us toward sedentary highly-caloric lifestyles, I'd say we're set up to fail from the get-go. Therefore the failing is systemic not personal. I wouldn't compare to individual health issues. You can't cure celiac, but you sure could reduce the obesity using policies to drive the food industry toward less-sugar/more-fiber.
For some people it is clinical. For others it is mental/willpower. That said... It's exceptionally difficult in the modern world to do everything necessary to be at a healthy weight. Things are shoved at you constantly that are terrible for you. It's so, so much easier to eat poorly and to excess. Combine that with dopamine hits from consuming sugar/fat? No surprise people overeat.
I was obese myself, and I have different thoughts on that.
For me, it was purely an issue of personal falling and willpower issue. I was obese because of a diet I was indulging in; full of unhealthy things and snacks.
For me, personally, it's that we don't really know the long term effects of these drugs ie are you actually "healthier". But we do know that diet and exercise work.
The real question is why so many people are obese in 2024 in the US while it was a fraction of the population 50 years ago? And other countries have by far not been affected by the same trend. So effectively something is making people really sick on the US.
> I notice now that there is a LOT of judgement, bias(?), around obesity, that people, obese or not, carry with them [1]. I certainly carried that bias, and the reason I noticed it was because Ozempic is literally an external substance that you take that simply makes obesity go away. So if you believe (like most of us unconsciously do) that obesity is a personal failing or an issue of willpower, an issue of personal merit -- HOW is it possible that a chemical pill, an external chemical process, can SO effectively resolve it? When no amount of hectoring and moralizing and willpower can? My inability to square that circle really changed my thinking about obesity in a fundamental way.
I see no contradiction here. That ozempic works doesn't imply that willpower isn't real or that people can't lose weight via diet and exercise.
> My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.
I'm very suspicious of "it's a health condition" applied to obesity, type 2 diabetes, and even depression. I absolutely believe that some people will be able to avoid or cure those "conditions" by changing their behavior. Of course that doesn't imply that there should be a taboo against medication to help people who can't. But my concern is that "it's a health condition" discourages people from examining their choices and making good ones.
>My view: It is a health condition, that people do not choose.
If this is true, then why are we so focused on curing it after the fact?
Are we also working on prevention?
If it's not a choice, then what is the cause? And why shouldn't we work on preventing that cause?
I mean it's clean that more people are obese today than in the past right? So what changed to cause that that isn't about people's choice? Why not work on reversing whatever those changes were that caused obesity to increase?
And a separate question:
If it's really not a choice, what would be the approximate rate of obesity among a group or population that all exercised regularly and ate healthy?
I don't think I can be convinced that not exercising regularly and not eating healthy is not a choice.
I just feel like the number of people that would be obese who are regularly exercising and eating healthy would be rather small. And if we agree that exercising regularly and eating healthy is a choice, then it seems at least for many who are obese, it indeed is choice.
I'm not going to say there aren't outliers or other special circumstances, but I still feel like for more people than not, it is indeed a choice.
Personally, I've never seen obesity as a failure of character or willpower, at least as long as I can remember having any particular views on it at all. I see it as a failure of information and choices.
Obesity was rare until the United States officially decided in 1977 that saturated fats were considered harmful. A few years later, it started rising to the current epidemic level. We've come a long way since the American Heart Association was recommending candy and soda as "healthy" alternatives to real food, but the idea that an optimal diet contains low saturated fat and high complex carbohydrates remains firmly entrenched in present-day nutritional and medical orthodoxy.
Imagine a counterfactual where Congress had reached the opposite conclusion, instead recommending a standard diet full of saturated fats, high in salts (both sodium and potassium), moderate in monounsaturated fats, low in polyunsaturated fats, and sparing in carbohydrates. The population and food industry would have moved in an entirely different direction. We'd have a whole different universe of nutritional advice, diet trends, restaurant menu options, and easily available processed foods. A lot would be the same, but large sections of the grocery store would look like lowcarbfoods.com, maybe burger joints would serve mozzarella sticks instead of fries, maybe instead of potato chips and corn chips people would eat pork rinds and kale chips, and maybe instead of rice or potatoes an average dinner would include all manner of delicious fried vegetables. Instead of a low(er)-fat (i.e. high(er)-carb) diet, doctors would tell fat people to try keto. Maybe that timeline's equivalent to trans fat would be sugar alcohols and artificial sweeteners, and governments would ultimately pressure the industry to transition to stevia, monk fruit, and inulin fiber.
In such an alternate universe, I'm sure the food industry would still work overtime to find ways to make many of its products shitty and addictive, and I'm sure the average person would still lean heavily on processed foods and fast food over home cooking and whole foods. I'm sure that would cause its own set of health issues, but what I highly doubt it would cause is an obesity epidemic. It's simply a lot harder to overeat fats than it is carbs. We'd also inherently have less insulin resistance, which means less type 2 diabetes, less dementia, and probably a good amount less of mental/neurological issues like depression and anxiety.
Unfortunately, we live in this universe. And in this universe, I find it really hard to blame individuals for struggling with obesity when we've practically purpose-built an environment to make us fat and keep us that way. In order to not be fat (by pre-1980 standards), you either have to win the genetic lottery, be extraordinarily physically active, put a high amount of effort into controlling your caloric intake, or be willing to go against the grain (no pun intended) on what you've most likely been led to believe for your entire life by everyone and everything around you. It's great to fall into one of those four buckets, but on a population scale it should be obvious that the majority wouldn't.
The willpower frame actually works pretty well for a lot of people. If not than in our society almost everybody would be obese. This pill will make things worse for the group that hangs out in the treadmills and drinks green and disgusting smoothies.
On topic, very happy this medicine exists, but let's pray god will keep the prescription only for BMI > 35.
> realized that frequent cannabis consumption interferes with the weight loss, so I've kicked the habit from daily to occasionally on weekends
Did you try to reduce your cannabis consumption before using tirzepatide?
Because although you say(feel) like the realization made you reduce your intake, I can hardly imagine that you were totally oblivious to the fact that smoking cannabis is unhealthy in the first place.
Do you feel like you think less about e.g. cannabis, or do you feel like it's easier to say no to that impulse?
Does it seem to mainly influence health choices or are you also less likely to be angry or does it interact work place interactions?
What annoys me is it’s like $100 in Europe and it’s available in a pill form there (so you could presumably easily reduce the dose and therefore the cost by breaking the pill in half). And no US insurance will cover any of it unless you have diabetes. Put another way, if I can find someone in Europe to prescribe it to me, and pay out of pocket for 90 days worth, I could take a free vacation to Europe every 3-4 months in perpetuity.
I feel high on life when I am off the sauce, eat less, and walk more - without any drugs. Healthy lifestyle is the best medicine, and the biggest problem people have is not even genetic predisposition, it's impulse control. We all want that reward, right away.
I’ve had an on and off battle with ad-hoc self medication for anxiety via heavy drinking for like twenty years, by “on and off” I mean that some situations didn’t really trigger it much, and other situations made it life defeating.
As close as I’ve come to an effective remediation was living abroad where the food wasn’t actively adversarial: capitalism can do many good things but it drives the quality of food to “edible plus epsilon”. Rich people eat pasture-raised shit for a reason. For me it just deleted that problem.
But I’m interested in this class of medication because it’s difficult bordering on impractical to eat well in some regions. People say just cook, well, there’s an infrastructure around that which amounts to a declared bias against those who didn’t settle down young. Much like people who met their partner before partnering became monetized, “easy for you to say”.
I hope you have success in your journey either way, and the less meds involved on average probably better, but if it works and has no bad side effects I don’t see why one would stop. Welcome to your new awesome life!
Every SV power player I’ve ever met was enhancing themselves via chemicals. It’s not tweeted about (other than when Garry Tan threatens elected officials), but it’s a quiet norm.
I'm not sure if you tried but add a sport, can be table tenis, jiu-jitsu whatever. I did this too after got comfortable with the walks (that I still do).
You can't imagine how empowering it is to be able to say "No." to food. I stopped eating dessert except once a week. I can be in the company of other people and surrounded by delicious food and not feel the compulsion to eat until I am nauseous.
You need to change your attitude if you want to lead a healthy lifestyle. Don't blame your failures and CHOICE to eat junk and not exercise on weed. You know what the healthy choices are, you know when you're not making them. You lack self control.
I don’t usually say something like this on HN, but you are completely and utterly wrong. The obesity epidemic cannot be reduced to some simple moral failure. Multiple twin concordance studies have shown 70%+ inheritability. Those of us who are fortunate enough to not struggle with obesity do so not because of some skillset that we have, but because our bodies do not maintain the same homeostasis.
For those of us old enough to remember what society looked like before the obesity epidemic kicked in, it’s hard to understand how something genetic can suddenly result in a dramatic change over a period of years. Our genetics didn’t change. Our food environment did. Experts disagree on what factors are responsible for this, and any random person had their own pet beliefs.
But this flat-earth-like notion of reducing obesity to an issue of basic willpower needs to be recognized for the drivel it is, along the related notion of calories in & calories out while ignoring the overwhelming role that basal metabolic burn plays and how it dynamically responds to changes in diet and exercise.
If you want to educate yourself, read Posner’s Burn [1], which is firmly grounded in empirical measurements of doubly labeled water to measure true metabolic consumption. Look up the reporting the NYT on past contestants of The Biggest Loser.[2]
I've got to say, pretty frustrating seeing answers like this. It just completely ignores all the real, valid difficulty that people have in fighting obesity. If you "just" follow this diet, that requires discipline, strong will, buying correct supplies, 2h of cooking a day, measuring, counting, adhering to strict eating timeline, for months (years for some people), you'll be golden! There is plenty of research into behaviour changes with obesity and mechanisms that prevent good decision making etc - apart from just the practicality of all of the above in one's daily life with work, kids...
I see in other replies that you've had success in losing weight, and congratulations - but that doesn't mean it can work for everyone else.
I don't look at any kind of "pill solution" lightly, and absolutely think lifestyle changes should be made as well - but I can definitely see how medication like this can help get people on track and get back control. It's very encouraging to hear about psychological effects in terms of self-control, decision making etc. I'm just worried that we'll discover serious negative side-effects before too long, as with previous attempts.
This is about as useful as telling someone who's obese to just eat less. Factually yes, it might help them, but practically they're clearly unable to implement it, probably for a plethora of underlying reasons.
I read your experience and it is indeed pretty incredible and I'm happy for you. I've used ketosis strategically for athletic reasons, to cut weight. So we both had strong motivations to use it. But for your typical obese person, it is a tremendous challenge to stick with it and at the end of the day, it's adherence that matters.
Put simply, it's easier to adhere to a drug than to a specific, somewhat anti-social diet.
This is true, but fat people have a hell of a time cutting out all carbs. For many of them, they'll eat the "low carb" option, and then have an occasional binge and it negates any benifits of low carb, and doesn't put them in ketosis, etc.
I strictly maintain my weight. If I catch it going over over 155# (I'm a 5'10" 61 year3 old male) I'll do a strict cut. And I know that either strictly counting calores OR going to as close to zero carbs will have the same net effect.
But a person who has obesity or is overweight will not be able to follow a diet. They are just incapable of doing so, or will lie to themselves or others about it and claim it's their "metabolism" or a medical condition, etc.
You can just cut ultra-refined foods i.e. junk foods. No one is getting obese from lentils, broccoli and apples. Even so, avoiding weight gain is one thing and losing weight is another. While it helps to increase ratio of protein and fiber intake for satiety, that in itself does not guarantee a caloric deficit, which is what is necessary for weight loss.
1) “obesity” has no clear clinical definition, nor is it really a disease. [1]
2) there has been no evidence yet that weight is at all a primary determinant of health [2]
3) Weight loss drugs must be taken forever or it’s nearly certain you will gain the weight back [3]
There’s a lot of great research these days that shows fatness is not what people think it is, and weight stigma is far more harmful than being fat itself [4].
Also, nobody knows what happens yet if you take these drugs for 30 years, and what we do know is that being fat hasn’t been proven to kill anyone.
As someone who struggled with their weight his whole life, this medication is a god send.
My wife and I cook every evening. We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.
Every morning I wake up and go on a 5 mile hike.
And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.
And you know what it is? It's volume. I eat too much. And I have no cookies at home. I have no chips at home. No soda, no alcohol. I drink black coffee with a splash of milk. I don't eat any sweeteners.
I have had weight loss surgery (lap band) which was later reversed as it hurt 24/7.
Now, on ZepBound I lost 20lbs in 2 months. I am not hungry. My brain can actually focus on the things that matter.
Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?
> Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?
"Getting fit and staying fit" is a form of social capital, because it's extremely hard and only within reach of a small portion of the population. "Being fit" is strongly aligned with "being attractive" which confers all sorts of cross-cutting social benefits.
Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.
I would say my concerns are far more in the range of downstream effects from the medication. Specifically, I am concerned with muscle retention. Concerns aside, it's a little hard of an argument to swallow having visited many other countries where these things are simply not an issue. How can it be argued that the cause is anything other than behavior when so many others are doing just fine? There is more to this story than painting people as evil.
> Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.
I don't think this is just about a social club. Battling weight loss and habits is foundational to the human experience from the most recent centuries. Be it drugs, or anything else really that changes the nature of these challenges, people are going to feel discomfort because it's an attack on their understanding of the world, and in some ways, their beliefs.
It’s only within reach of a small portion because of industrialized food. Look at a graph of obesity rates in the US over several decades. Find literally any picture of people at any beach in the US in the 60s or 70s versus now.
>Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.
Nice one. I think it's a bad idea to be dependent on drugs for something you can achieve on your own, especially if the drugs don't have a long term safety profile. Pretty sure I read somewhere that they don't. If you're going to use them for a short period of time, that's fine. Don't say nobody warned you if that doesn't pan out though (or worse, you have a bad drug response).
This is funny how black & white some folks here want the world to be painted if it suits them.
You know by far the biggest benefit of doing hard workouts or doing extreme sports? Its not muscle mass nor how much they lift. Its about how it changes your personality, resilience to mental or physical suffering and ease of overcoming it. You know, hardest part of doing anything is winning the mental resistance game and just start it. Keep doing this every day in various forms for decades... A very strong resilient personality under various circumstances is almost an unavoidable result if you are putting in enough effort.
If somebody can't even stop themselves buying and paying for junk food at grocery store or has to overeat constantly otherwise getting anxious, that part of personality is missing and another, less desirable is present.
Who would you prefer to have as a close colleague you depend on, life long partner, a close dependable friend? Who do you think women would prefer subconsciously? Societies have always some form of castes, even hardcore communists have/had them, in US one of very popular is based on career/income/wealth. And this is just another dimension or caste, so let's not act like we are not humans with flaws and subjective preferences, we don't give our respect out for free.
These medication help with none of above, in fact they strongly reinforce such behavior and personality traits. But to each their own. One benefit I can see that they could start / help with movement from former to the latter, but that's rarer than people like to admit.
"Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?"
I think it is because if 90% of the population did half of what you do (and kudos for you for doing it), they wouldn't have a problem with weight, you just happen to be one of the unlucky few where it doesn't work and these drugs are useful.
I think if the widely available help for alcoholics, smokers, or opioid addicts mainly mitigated the negative consequences - enabling them to drink, smoke, or dope more - it wouldn't be nearly as acceptable.
I personally expect weight loss medication that simply makes people want to eat less will reach cultural acceptance.
Case in point, cigarettes have been known to suppress appetite for ages, and people have elected to smoke to help stay thin for decades. There was never any crushing social stigma attached to doing this as a weight loss strategy (that I know of).
> And you know what it is? It's volume. I eat too much.
100% this.
I lived in Asia for a few years and obesity is rare (though increasing for youth). It's not like they get more exercise (most people don't) or eat healthy (it's mostly carbs), but 100% portion sizes.
I see people who work manual labor jobs eat lunch that is a bowl of noddles, a few thin slices of chicken or pork, and a few veggies. I highly doubt it exceeds 500 kcalories. It's probably half the portion size you'd get in the US.
Mystery solved. If you're only eating 1500 to 1800 kcal per day as an adult male doing manual labor, it's pretty obvious why you're at 10% body fat.
> And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.
The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss. It's not surprising that it didn't help you lose weight.
> The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss.
That’s not been my experience at all. My dosage absolutely significantly suppresses my appetite and always has. This has directly led to sustained weight loss. It did so badly enough at one point that I was underweight significantly.
I have to force myself to eat on my meds, even though the thought often makes me ill.
I’m on 30mg dexamfetamine daily.
“Dexamfetamine can make you want to eat less, so you may lose weight while taking it.
Some people gain weight, but weight loss is more common.”
Doesn’t seem to be hit everyone but equally doesn’t seem rare.
1. People might want to help, but they don't think taking a pill every day for the rest of your life is a proper solution. I'm not aware of any such things for other addictions you mention,
2. People don't want other people to have it easier than they did. "I had to diet and exercise etc, you should too",
3. People don't want to help. They want other people to be fat because it makes them relatively more attractive.
re: 1, there are plenty of people who take some medication at some interval for most of their life. People with ADHD, people with type 1 diabetes, most women, ... why do we find that totally unproblematic, but as soon as it's medication to help with obesity (which is a serious medical condition in its own right) it's suddenly such a big problem?
EDIT: And to be clear, there may be specifics with these particular drugs which are problematic, maybe they're by necessity expensive or resource intensive to manufacture, maybe they have problematic long-term effects, I don't know. I'm purely talking about the general aversion some people claim to have regarging taking some medication on an interval to help with a health problem. It makes little sense to me.
> Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?
For the same reason why skinny person taking steroids is frowned upon - it is perceived as a shortcut.
Supra-physiological levels of testosterone and steroids have incredibly well known and well researched short, medium, and long term side effects. They've been well known for forever.
In an alternate world where steroids had a good safety profile, it would be ridiculous to not use them if you were looking to add on muscle mass.
Would you mind sharing what your diet was like as a child?
I wonder if there's a connection between diet during development and adult processing of and cravings for food. Maybe eating candy for breakfast (cookiecrisp!) every day in elementary school messed a bunch of us up.
Not OP, but I ate sooo much Kellogg's and General Mill's sugary products in high school for breakfast (pop tarts, eggo waffles, all the disgusting cereals you can name...), but I took Centrum daily and played a ton of basketball after school. Almost 1 can of coke a day after school. No heath problems as an adult.
But of course, genetics come into play as well, no overweight parents or relatives.
I think a lot of it is dealing with hunger. If you can't stand being a little hungry, never mind very hungry, no diet will really help. I used to love being very hungry, not sure how I got there, but I wish I can go back there again. Having very little carbs and temptations in the house helps. Unfortunately it's not up to only me.
Perhaps the first person on HN who actively and without shame pays attention to the fact that Adderall is a very nice amphet cocktail. Surprising though you don't loose wait with it, sad also given the circumstances. But I envy you a little cause such ADHD boost is only illegal in EU.
Sometimes I wonder if it was a some neat trick by US gov to diagnose and put 1/5 of the population on amphetamines (2024 data +60mil prescriptions of Adderall), so that most everyone who is actually like smart or sensitive or anything of value to the industry, can (almost) freely microdose on it and as a result increase productivity.
Which... means 1/5 of the population suddenly increases output. Perhaps we all'd be on Aderall at some point, dunno bout the Ozempics...
I think you're incorrectly assuming that one prescription = one person. Far less than 20% of the population is taking Adderall, this CDC study says 4% in 2021.
I’ve heard studies show Adderall doesn’t help people without ADHD… googling now seems to confirm. Apparently lots of people, especially college kids, take it thinking it will help, but it actually can slow them down.
Seconding Zepbound, it has been absolutely life changing for me, and not only in terms of weight loss. It's expensive, but I am blessed with a tech salary that can afford it.
Anyone can list 50 no-no things they don't eat and omit the 5 types of foods they do choose that causes the most damage. Volume & variety are not to blame given most sauces are calorie dense. The issue generally is the person eating for pleasure conflicting with their stated aim to eat for weight maintenance.
If it tastes good spit it out. Countless people ready to tell you no sacrifice is needed in that domain but they have something to sell or trade.
In my experience, as someone who has gone on a small weight loss journey, you can eat things that taste good, you just have to eat less of them and more rarely.
Bingo. I've had this conversation with my girlfriend. She's not overweight by any means (160 cm ~55 kg) but I am quite underweight (182 cm, 65 kg, < 10% body fat) and the conclusion I've arrived at regarding our differences in body composition is because she routinely eats 1.3x to 1.5x the amount I eat. We both exercise and eat little junk food.
I'm convinced it has to do with upbringing. My family never ate a lot and the portions I was served as a kid weren't big. Nobody in my family is anything more than skinny. Her family however, they eat a lot (and healthy too, mind you). This is all influenced by other factors, her parents and grandparents grew up with not a lot to their names and with food scarcity, so when they reached a position in life where they could comfortably afford to eat they gained the habit of having big meals. My family was mostly more privileged in that regard so maybe they never felt the need to focus on food as much.
Have you every using a calorie/macro tracking app like My Fitness Pal or Cronometer? I was never successful losing weight until I scanned, weighed, and measured every single thing I put into my body and stuck to the target calories and macros entered into the app. Just being aware of exactly how much I was eating was often enough to find the motivation to control volume.
>> I scanned, weighed, and measured every single thing I put into my body
Not being snarky, but is this truly "better" than a single weekly injection - 10 seconds and done for the week? I do think our wider society sees medications for overeating as "cheating". Perhaps we might benefit from rethinking that.
Try a very low carb diet. Only eat until 80% full at mealtime. Get down to two meals a day, with a goal of only one. Fast the other times. This sounds hard but once you get to ketosis it is not that hard at all. Not hungry naturally, like the drug response.
Truth is, we really don't need more than one meal a day (maybe a snack) when we get older and our metabolism slows.
You mention types of food but not quantities. A boat load of healthy food is still going to have an effect. Also, I for one don't consider walking to be exercise. It's fake exercise for people who don't like exercise to claim they exercise. My reason is that I cycle for eight months of the year then walk during the rainy months. By the end of the rainy months I get back on the bike and my fitness level is catastrophic - nothing. I've done this for five years, and have to say walking is just not good enough for exercise, not even close.
Can't speak for OP, but generally speaking there's a lot of variability in peoples' perceptions of healthy food and caloric density. For example, a lot of people see nuts as health food, and yet they're some of the most calorically dense foods you can eat! Another example would be to crack open the Ottolenghi cookbook and make the delicious Lamb Siniyah, which among other things calls for a large amount of Tahini mixed with lemon juice to create a delicious crust over the top of the stew. Delicious, but incredibly calorically dense.
What about someone who's carrying 100+ pounds of excess body weight? Would you consider walking to be fake exercise for them? I'd say that's a more heroic workout than joy riding.
walking is exercise in the sense that it burns calories, specially when you're overweight as it's like having a 30kg (or more/less) backpack with you. Bonus points for incline.
But yeah, it's not HIIT. You won't really build up your fitness level by walking - it's not demanding enough. You need to be pushing yourself until you're out of breath, if you want to build up your cardiovascular health.
What kind of food do you and your wife cook? How much meat? How much gluten? Real butter or canola oil infused “spreads”? What oil do you cook with? Vegetable? Sunflower?
If you’re eating the right thing for your body, you’ll be satiated when you eat your full.
Bodies are highly imperfect and suggesting our digestive system and nervous system are geared for being fit and healthy rather than ensuring survival wrt food is absurdly naive.
(I only cook with extra virgin olive oil which I buy in 5L cans for $$ reasons. A lot of these vegetable oils are good for motor engines only!).
It really depends on you and the activity levels.
I used to ride to and from work - and I would ride hard, a solid 1.5 hour of riding every single workday. Yet this just caused me to gain weight as my appetite just shot through the roof. This new drug would have been SO good for me back then.
These days I find it easier to control my weight with regular strength exercise vs riding, as I tend to go too hard on the riding which causes me to feel famished. And then the control is just hard.
However when I just do (Olympic barbell) weights, a bacon, egg and onion + cheese omelette in real butter and EVOO does the trick to break my IF then, along with a WPI/milk shake- I get stronger and also lose weight. No need to keep eating. However, I'll then do cardio a couple of times per week which tends to undo the weight progress; I guess the real trick would be to stop doing the hard intervals I love on the Kickr, but going slow on the bike is nearly impossible for me. :-)
Instead of a system that makes these drug available for purchase, I'd rather live in a system that promotes healthy food and active behavior. Unfortunately, I have to drive everywhere, work too many hours to have free time for recreation and have no idea which government subsidy is going to help big ag likely at the expense of my health.
All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.
If you have an open mind, I'd like to assign you some homework if you like. Take a look around r/zepbound and count the following:
1. Posts from folks who diet+exercise, or who have tried diet/exercise and nothing's worked so they then turned to Zepbound ("excited to hit the gym," "my diet is finally starting to work with Zepbound" and similar)
2. Posts from folks who haven't tried diet/exercise and turned to Zepbound first. (e.g. "I'm excited to eat dessert and laze around on my couch all day!" or "Zep is so much easier than before, no more keto for me" and similar)
Which group do you think would have more posts?
Selection bias probably prevents us from being able to count "Zepbound didn't work for me, but diet and exercise did" posts, which is why i suggest this.
Here's my hypothesis: I think self-control is generally uncorrelated to losing weight. Perhaps it's necessary to have self-control to lose weight "the simple way," but certainly not sufficient. I know lots of friends who've struggled and found it's not so simple.
GP isn't talking about self-control, they're talking about the fact we've created a system that requires obscene amounts of self-control if you wish to maintain physical health.
People in the 50s weren't slimmer because they had ironclad determination to stay such.
I'm not sure how this applies to my comment. I'm not saying anything about self control. I'm not against individuals taking GLP-1s. But, if we're at a point where we're all on drugs to treat lifestyle diseases, we should at least recognize that these lifestyles are largely chosen for us, and we should consider that doing something about that will reap us the benefits we're after.
The more important point the comment you're replying to makes is not "what if people could diet and exercise" - i.e. accept the modern American lifestyle as given, plus force yourself to go to the gym and eat chicken and broccoli - but rather that the modern American lifestyle in fundamentally structured to lead to people being overweight.
Instead of being forced to drive everywhere for the most basic possible human needs - like getting groceries, going to the doctor, or dropping kids off at school - as is the case in 90% of America - what if you could walk to those places instead? You would get exercise as part of your every day life, with no extra effort!
What if instead of corn syrup being so heavily subsidized, we could use more filling sweeteners in a lower amount instead? What if people lived closer to agriculture, instead of in faraway suburban tract housing only accessible by car, so they had easier access to fresh meat and vegetables, instead of ultraprocessed package food?
These dreams are not "diet and exercise", they are a fundamental reshaping of American lifestyle that would directly lead to weight loss. We know this, because America used to look like this before, say, 1940. In old photos you see people in huge crowds in streets as they walked to their everyday errands, and menus and recipes of the era are mostly minimally processed food that is mostly local. Americans of the past were not overweight, because the way society arranged its physical existence didn't permit it!
I was that guy. For a variety of reasons that aren’t relevant i developed insulin resistance over a relatively short time that made it increasingly difficult to lose weight. I’m in my mid 40s, which also makes it difficult.
I got on one of the GLP drugs 18 months ago. I am down 80 pounds, and am running 20 miles a week. I’ll be doing a half marathon in March. Ive dropped the dose twice and still going strong.
Taking the pill made exercise possible. Online everyone likes to apply a moral hazard thing to every discussion. GLP medication twiddled my dopamine system and allowed me to achieve my goals. Period. If you think that makes me weak, I cannot think of anything that I care less about.
> Perhaps it's necessary to have self-control to lose weight
> it's not so simple.
Presumably people who have good self control and are not prone to developing addictions (due genetic or various semi-immutable cause) do not become obese in the first place. It might be fairly easy easy for them to lose weight they just don't need.
But don't you think that it's better to make the changes to prevent obesity rather than focus so much on a cure for after?
I don't have a problem with a cure only if it doesn't reduce the focus and effort on prevention.
There has to be a reason why so many more people are obese today than decades ago. I refuse to believe we can't find out why and make changes to reverse it.
But if it's so easy to cure, will enough people care about figuring out how to prevent it?
I’m not obese, just before (1m75 / 82kg) but I have found self control impossible, except when I do intense sports (like musculation 3-6 times a week). Then only, and this is the magic part, I not only eat less, but also enjoy being more brave, with cold showers, being hungry, going to bed early and other efforts in life.
My hypothesis: this is more cultural than people want to admit. Try to skip out on too many engagements, sorry, meals and see how many connections you still have.
counter hypothesis - the amount of self control exhibited by an average human is insufficient to self regulate when placed into a hyper enriched environment , for example the capitalistic profferings of junk food tv porn etc , we did not evolve around these hyper stimulatory activities, how on earth are we meant to adapt to them? drugs are not an answer, they are another bandaid making someone else money and allowing the underlying wounds to fester, the solution is education and awareness of this fucked up situation
It’s been studied pretty well. Possible effective solutions to the US obesity epidemic are pretty much limited to:
1) Radically alter aspects of food culture, work culture, social policy, and business regulation.
2) Magic pill (/injection)
There appears to be no imminent progress on the many parts of #1 that need serious work, so if we want a big turn-around in the next half-century, #2 has suddenly and surprisingly become a real possibility.
Sounds similar to most major world/cultural issues today. You can make the exact same argument about climate change for example.
But at the same time, part of me wants to ask... why is this a problem? Why shouldn't we just use science and technology to fix human problems and remove any unfortunate consequences from society?
What's wrong with a world where anyone can eat as much of anything as they want, do no exercise at all, ignore their dental health and smoke like a chimney, yet still have perfect health without any downsides?
Objectively, it would be a better society, with everyone materially better off and a system that doesn't need anywhere near as many resources to care of its citizens.
> Possible effective solutions to the US obesity epidemic
Just wanted to mention that this is not a US problem, and framing it as such won't help find solutions. Even in southeast Asia the rates over obesity are steadily increasing. Europe is already much fatter than southeast Asia. This is a worldwide phenomenon.
From the article "Estimates suggest GLP-1s can reduce body weight by at least 15% when taken regularly". That's a 5'10" man starting at 250lbs (obese, BMI > 35) and finishing at 220lbs (obese, BMI >30).
Or a 5'10" man starting at 220lbs (obese) and finishing at 187lbs (overweight, BMI > 26).
It ain't nothing, but that's not a magic pill which will fix the obesity epidemic. And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food.
But is it time to give up just because there hasn't been much progress yet? It seems now that we have #2 there's little incentive for #1, whereas there was plenty incentive for #1 before even if little action.
I know someone who has lost about 60lbs. The reaction of most people is 'what pill did you take'. They find out it is basically no sugar and limited amounts of food with some mild exercise. Pretty much every one of them is 'thats hard' and do not do it. And frankly it is hard. Like 95% of a grocery store has way to much of what you need for your daily intake in some form or another. It is that 5% you have to dig thru the whole mountain of crap to find. Then once you find it hope like hell the manufacture does not stop selling it. Or enjoy making everything from scratch (even that is a pain).
I would not jump on that current pill yet. Wait and see. There are probably serious side effects that we mere plebes do not get to find out about yet (that is for 20 years from now). Like what is the side effects when you stop taking it? What if your dose is too high/low? What is the long term usage like for other parts of the body?
I run three miles a day, never drive anywhere (bike or bus), eat reasonably healthy, and I'm still 20 pounds overweight. And what really scares me is that running is the only exercise I enjoy and if my weight fluctuates up just 5 pounds or so, I start getting hip/knee/foot etc pain. If I gain 10 pounds through some lapse in morality, I won't be able to run anymore and I'm cooked. If that happens, I'm banging down my doctor's door for a pill.
Which will burn somewhere on the order of 400 excess calories - about as much as a typical North American muffin (or two of the big cookies from Subway). But worse, your body was probably going to use most of those calories on something else (fidgeting, running a higher body temperature, other immune responses including inflammation) anyway, assuming that you haven't been gaining weight with your current habits. Exercise is healthy and reduces stress, but it just isn't effective for weight control. Humans are animals, and animals have on the order of a billion years of homeostasis technology behind them.
>eat reasonably healthy
Hardly anyone has any accurate picture of how much they consume, as measured in calories, except for those with actual explicit experience of measuring and accounting it.
If a pill happens to end up helping you eat an amount that lets you maintain a healthy weight, I'm all for that. But it's important to have your mental model properly calibrated.
So I'm a distance runner, who is on these drugs.. and yeah, It sucks, I LOVE running.. but running heavy SUCKS. Most people run to lose weight, I lose weight to run.
To paraphrase: Instead of relying on medication that helps with issues caused by our society, let's completely change the society so it's no longer the issue?
What is a realistic path to this? Being from Europe I visited US last year and was horrified at the quality of your food. You see a lot of documentaries/youtube videos/etc... discussing the problem, but how do you even go about this?
We have good food, but you won't find it on "The Easy Path."
The Easy Path is that gentle encouragement to hit up Chipotle for lunch, because it's "right there."
The Easy Path says dinner's hard and you've had a long day, so get something simple, like take-out or microwave.
The Easy Path is entropy. The Easy Path is self-care over struggle. The Easy Path is simple carbs shown on prominent display in store shelves. The Easy Path is advertising.
Hitting the gym isn't on The Easy Path, but forgetting to cancel your gym membership is.
These days, big food companies love "The Easy Path" because it's so easy to commoditize, it's the "Path that Americans are Expected to Take." For financial stewards, being on The Easy Path turns lack of willpower into your ally.
On the other hand, getting good food in the US requires passing the marshmallow test: you have to meal prep, or you have to shop around the sides, or you have to get something on the salad menu. You have to say no to advertising. You have to expend willpower, the most limited of resources to the average American. You have to Go Hungry or Suffer, or have An Upset Stomach. You frequently have to spend more money or time.
Semaglutides are not currently on The Easy Path. Maybe they will be someday. I personally doubt that, because putting GLP-1 on The Easy Path would require big food companies to rethink their entire portfolio.
But you're not wrong in that they could be Easy Path-ajdacent. The dialectic would shift: food companies would shift around to be Organic and Nutritious and Less Calories and find other ways to stay on The Easy Path. Sugar and fat's addictiveness is highly Easy Path-enabling, and that's a pretty big vacuum to fill.
The US is a huge country (9,833,520 square kilometers!), so I find it curious that such generalization can be made about the food available here, or even the eating habits of 334,914,895 humans. I could say that I visited Amsterdam 2 years ago and I was shocked with the quality of the food.
But I would never do that, since I mostly ate at the Red Light District, and I couldn't possibly generalize the country eating habits with stores in a major tourist area.
Maybe I'm too European to understand why not, but seems to me that regulations around food and what companies are allowed to put into it is really helpful in avoiding companies from just stuffing whatever down people's throat.
There's plenty of high quality food, you just have to know where to look. For example, come to the Bay Area and check out Whole Foods and any number of high-end restaurants.
Why is the quality of food in Europe so much worse than southeast Asia?
Because you guys are way, way, way fatter than e.g. the Japanese.
Back on topic -- we have excellent food in the US, but regulations allow for highly processed crap to be sold too. Pretty sure most of the crappy processed foods are easily available in Europe, too.
The first thing that would help is actually having a realistic discourse about food, and not the idiotic - "You shouldn't be eating processed food, its not good for you".
Like most of the food that we eat is not really that bad. Its not optimal for sure, especially for sedentary lifestyles, but a lot of the health problems are not directly tied into the actual food, rather the over-consumption of it, and passing down of bad genetics (for example, children of obese people are more likely to be obese).
European obesity tripled in the last 40 years as well, despite higher quality of food.
But you already live in a system that promotes that, quite heavily. Healthy food and active behavior make you more physically attractive, which is in turn linked to better life outcomes along almost every metric you can care to think of.
There is, in fact, already an enormous, fully endogenous incentive to do those things. The fact many people are not keeping in shape (myself included) suggests the allure of food really is just that appealing.
> But you already live in a system that promotes that
Correction. We live in a system that *rewards* that. The infrastructure and system itself expects us to drive everywhere (because it's either faster or literally at all possible), eat overprocessed food (because it's tastier (literally designed to be hyper-palpable) and faster), and to work for absurd hours.
If you somehow have spoons after all that, then you're expected to workout, etc, to gain the additional benefits; but the systems in play do not facilitate that, at all.
I’m a standard-issue stress eater. I also like to work out.
When I’m really feeling the stress, even though I will tell myself at that time to just hang on and hit the gym later, the food is that much more of an instant fix that it wins out more often than not.
I’m sure that’s not just the actual food itself, but also the easy availability of it, and probably subliminal cultural factors such as advertising. But partly, yeah, it’s that my ancestors evolved to love eating when they had food, and their gift to me is that same desire in a world of endless plenty.
Of course it is impossible to live a healthy lifestyle and have healthy weight, if you ignore the 3/5ths of Americans that are not obese and the 7/8th of the global population.
As compelling as the theory that "unhealthy behavior" is root cause of the obesity epidemics, at this point it seems to me that the weight of evidence suggests an actual physical disruption. It's not supposed to be _this hard_ for (some) people to maintain their weight; something is actually not working right.
It would be interesting to run an experiment where everyone in first world countries was able to (and had to) walk to the grocery store to buy their groceries. It seems like that would promote useful exercise while self regulating consumption.
I walk to the grocery store all the time. This was part of my weight loss strategy and I chose to walk to a farther grocery store. And yes, I did attain my weight loss goals.
When the majority of the population is so far gone from being in a healthy weight, promoting healthy food for the masses is not going to help that majority. Yes, walkable cities and so on would be great, and promotion of healthy food and habits is great (remember Michelle Obama asking "why are you people so fat wtf?") for future generations, but Ozempic et al. provides a solution where otherwise, a lot of people are simply "lost".
The problem is that you can't undo millennia of evolution that has pushed us towards the situation where people are obsessed with food and struggle to limit themselves. We also shouldn't forget that not more than a century ago famine and rationing was still commonplace. Certainly my parents were still raised in an environment that hadn't gotten used to food being plentiful and were always forced to eat everything they had at all times and rewarded with food, this has been engrained in myself since I was young as well. I'm lucky that I managed to move away and isolate myself and lose a lot of weight but the important thing to note is that once I got down to a lower weight, everything was easier, getting up in the morning, walking, jogging, working out, talking to people, going outside. Now I've probably gained back 30% of what I lost and if I could take Ozempic to lose 5kg the rest would come a lot quicker because I'd be able to run further and have more energy generally.
All that is to say, these two are not mutually exclusive and if people receive this drug everything we already do to promote a healthy lifestyle will become much more realistic for many people, as far as I understand Ozempic removes the desire of hunger, it's not like people can continue their bad habits and take the drug and lose weight. Furthermore once they assume these habits, the generational cycle of raising children and over indulging will likely come to an end and we will probably not need the drugs as much.
TL;DR, people want to be healthy, they just don't have the tools or motivation to do it. Losing weight will likely be a gateway to many health improvements and benefits for future generations
People and officials have been talking about healthy eating for generations. Hard to get more mainstream than every doctor talking about diet and exercise.
This compares Ozempic with past drugs, but sales of past drugs are almost always limited by demand. I'm not sure there's much to learn here for a drug that is limited by supply. Also, this part is silly:
"The announced investments across both companies total $32 billion. GLP-1s were 71% of Novo’s revenue in 2023, 16% of Lilly’s in 2023, and 26% of Lilly’s in 2024Q1. If these sales are proportional to the manufacturing capacity used to create those drugs, then about 40% of Novo and Lilly’s combined estimate of $45 billion in gross PP&E is for GLP-1s, for a total of $18 billion; $25 billion would then mean a 140% increase in GLP-1-relevant PP&E."
Manufacturing investment is not proportional to sales, because there's a fixed cost to making a certain drug regardless of how much you sell. If a rare-disease drug will have a few thousand patients ever - not uncommon! - you still need to figure out a synthesis path for that particular drug, run QC tests on the production line, get regulatory approval, etc. Economies of scale matter a lot (https://en.wikipedia.org/wiki/Experience_curve_effects).
And apparently the pure manufacturing cost for Ozempic is relatively low:
> the active drug in Ozempic can be produced for about 29 cents for a month’s supply, or 7.2 cents for a typical weekly dose, the research found. It’s not cheap to make — semaglutide costs over $70,000 per kilogram. But only a tiny quantity of the drug is used in each weekly dose.
By chance I just talked to someone with deeper knowledge on this and they said the current constraint is actually ramping up supply of the delivery mechanism, not the drug.
I have zero expertise on this, but would be curious if anyone knows what's special about Ozempic delivery that can't be served by a commodity syringe.
I'm shocked that TFA doesn't mention the (massive, booming) market for compounded semaglutide and tirzepatide. The long-term future is uncertain, but since these drugs have been under shortage status, third-party pharmacies can legally compound them to meet increased demand.
9 days ago the FDA declared the tirzepatide shortage over, though the other popular drugs in this class are still eligible for compounding based on shortage status:
Not fully true- orphan drug status exists for rare diseases and gives advantages to companies who develop drugs for rare conditions. This includes longer exclusivity periods amongst other incentives, rendering these categories more feasible economically.
Agreed. Don't forget they're spending on next-gen versions of these too -- Novo is testing a pill form that's apparently twice as effective as semaglutide(!) right now. It's easy to imagine that becomes part of many people's January routine -- stop drinking, take your pills, go to the gym for a month, slowly put the weight back on during the year, no problem.
I'd think it more likely that it'll be one of the next generation drugs, but I do agree with the premise that it will be really common.
A few weeks ago I started a low dose of tirzepatide (aka Mounjaro, aka Zepbound) and the side effects are interesting.
The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.
But there are some unexpected positives.
Obviously I am eating less. I have to log food not to keep it in check, but to make sure I'm eating enough and with the right nutrients. There's another possible negative here -- you get a lot of hydration from food, so if you start eating less you should carefully monitor your fluid intake to allow for that.
But I'm also more focused. Not nearly as distracted. I'm getting a lot of things done which I used to just procrastinate on until years had passed in some cases. Man, the garage is going to be clean and superbly organized in a few weeks.
And my emotions are quieter. Not just the food noise, that was expected, but I feel more relaxed. That's not what I expected, and I'm pleasantly surprised.
As an aside, what makes this all really noticeable is that it's a once-a-week injection, and the peaks and valleys are very obvious. Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.
Edit: Before someone asks, yes I have considered there may be long term effects. This is a risk, which I've decided I'm okay with at my age. Nobody gets to live forever anyway, and I was going to end up in an early grave via another route if I didn't do this. "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.
I do hope to taper off at some point if I can figure out an alternate strategy for staying lighter. Though I'll miss some of the positive side-effects.
> "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.
Studies show it just doesn't work.
There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 and the likelihood of going from severely obese to normal weight is 1 in 1667.
Eating less and exercising most certainly does work, if the individual sticks to the routine.
I do agree it's difficult to stick to a routine because our modern lives are demanding and so we compromise by eating fast food and avoid going to the gym.
I think the exercise paradox video recently put out by Kurzgesagt has been a net negative for how people think about diet and exercise. The paper the video is based on is highly flawed.
That paper has a few major problems but these are the biggest:
1) The authors didn't control for body mass. The Hadza and Bolivians burned 52kcal per kg of body weight. Americans burned only 38kcal per kg of body weight. That is: the active groups burned significantly more calories than the inactive groups, on a pound-for-pound basis.
2) The active groups were defined as such because they walked ~12km per day. This is significant because the human body is exceptionally efficient at walking. It is certainly true that over a comparable span of time, you will burn less calories walking than you would running, or lifting weights.
GLP-1's are miracle drugs and people should take them if they at are high risk for obesity-related diseases.
But diet and exercise certainly do aid weight loss, and will have fewer negative side effects than a GLP-1 drug.
It does work. It couldn't not work. Each day of your life, you choose to do one of three things:
1. Consume more calories than your body will need to function
2. Consume as many calories as your body will need to function
3. Consume fewer calories than your body will need to function
When you consume more energy than you require, your body stores the remainder as fat. When you consume less energy than is required, your body converts your fat into usable energy.
Now obviously, this is an over-simplified explanation of nutrition. What you eat, when you eat it, how efficiently your body converts food to energy, and other factors will determine the little details. But the explanation I've provided is not nearly as over-simplified as "it just doesn't work."
To make a comparison, it would be like suggesting that the financial advice "earn more money than you spend" just doesn't work as a method of saving money, on the grounds that some % of Americans who try to save money end up in credit card debt.
it's interesting you state "Studies show it just doesn't work."
While we are commenting on an article about a drug which makes you feel less hungry, there by "eating less". The drug doesn't make you use more calories, it simply "makes" you EAT LESS.
Eating less(calories) than your body uses consistently for duration is literally the only way you can lose weight. (outside of literally losing limbs, or surgery to remove mass)
Exercise only augments the process, it all comes back down to EATING LESS(calories).
People need to understand what activity / exercise really is. The desperation of the medical establishment to get people to do ANY exercise meant the general advice is watered down.
It's the doom of the statistical distribution. Good outcomes are defined in relative terms on the bell curve, not on absolute performance which exercise is actually suited for.
In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. I can imagine farmers back in the days of 12-hour days of physical labor may burn 5000 or 6,000 calories. A pound of fat is 3500 calories.
Meanwhile, people that are generally following some 20 minutes of exercise five times a week, regimen of the medical establishment are likely really only burning about 300 to 400 calories tops in those 20 minutes sessions, if they even do that.
For the sake of argument, we're going to ignore the basal metabolic advantages of people that are burning an extra 1,500 to 3000 calories per day and the stimulated muscle growth that comes with it.
People back in olden days just on activity were burning a third to a half a pound extra of fat per day in terms of energy.
Meanwhile, modern people who "exercise" are burning maybe a tenth of a pound. Only when you get to "athletes" that are "training" do you get to the calorie burns that people's lives used to entail.
So it's important to keep in mind when people say exercise is ineffective in weight loss that they really are talking about very minor amounts of added activity by by modern medical standards.
Exercise is extremely effective at limiting weight if you get to what I call the 1000 calorie Hammer, where your exercise is adding an extra thousand calories or more per day to your activity. And you're simultaneously not going nuts on your diet.
A 1000 calories is a considerable amount of activity. For a 180 lb man, that's 4000 yards of swimming, 7 miles of running, or 25-30 miles of biking.
If you are a 120 lb woman, increase those distances by 50%. Most people consider those loads to be exercise obsessives, but practically that's what's necessary in order to employ exercise as a usable means for weight control and surviving the corn syrup world we're in
Of course, it "doesn't work" because people don't keep it up. I started exercising regularly during covid and didn't stop. I cut out all the soda. It works.
It works in the same way as crossing the finish line first works to win a race. Of course it works, do that and you win 100% of the time. It is not that it doesn't work, it is that it is extremely difficult to do.
All this study really shows is an analysis of medical records with no background of the peoples' diet or lifestyle. The outcome should be obvious and expected, those who are overweight and obese were found to stay that way.
The fact that the rate of obesity in the US has pretty consistently risen for decades makes that clear, you don't need statistical models of medical records to know that the rate of obesity could only really keep going up if those already obese stay that way.
>There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11
Unsurprising. They ran statistics on arbitrary overweight and obese people, with no idea of who was actively seeking to lose weight or who was just coming away from such an effort. If a significant fraction of the overweight/obese population did lose 5% of body weight/year, we wouldn't be seeing a bunch of overweight/obese people.
Homeostasis is a powerful force. Once you gain weight your body has a tendency to keep it, and overcoming that to establish a new equilibrium is difficult and uncomfortable.
It would work if people would actually do it. It 100% works. Human nature is such that people would rather take a drug than change their lifestyle. I've done it myself but it requires a complete realignment of lifestyle to make lasting change.
Eating less and exercising more does work, in fact that is how you lose weight. The problem is doing it consistently which is what these drugs help with.
I hear very often this theory that "it just doesn't work".
To be fair, I had also believed this for many years.
However, all the people who claim that "it just doesn't work", have never made any serious attempt to do "it", so they cannot know whether it does work or not.
I have been obese for more than a decade, during which I have made several attempts to lose weight, which have all failed, because they were not done in the right manner.
Then I have made a final attempt using the correct method, and I have lost about 35% of my initial body weight during about ten months, at a steady rate between 100 g and 150 g per day, i.e. about 1 kg per week.
This was more than 10 years ago and since then I have kept a constant weight. Because I have done this once, now I can control my weight and have any weight I want, even if I gain weight extremely easily. It is enough to eat one day like I was eating when I was obese to gain enough weight to require a week of weight losing diet to go back to the desired weight.
The rules for losing weight and maintaining the weight are very simple, but they must be observed and those who claim that "it doesn't work" never try to observe the rules, so it is entirely predictable that it cannot work for them.
First, it should be obvious that after losing weight one must eat differently as before, otherwise weight will be gained until reaching again the original weight.
To be able to control the weight, anyone who is or has been obese must stop eating until they feel satiated. At each meal, one must plan before beginning to eat how much to eat and then eat only the amount planned, never more than that. One must eat a fixed number of meals per day (preferably few, e.g. only two meals per day should be enough for an adult who has a sedentary lifestyle) and never eat between meals any kind of snacks or drink any sweet of fatty beverages. Between meals, only water or beverages without any calories (e.g. unsweetened herbal teas or tea or coffee) are acceptable intakes.
While losing weight, the most important thing is to weigh oneself every day with precise digital scales (with a resolution of 100 grams or less), at the same hour and in the same physiological conditions, i.e. in the same order with respect to meals and relieving oneself.
Whenever the weight is not less than the previous day, then the quantity of food planned for the current day must be diminished in comparison with the previous day. At the very beginning of losing weight there may be a delay, e.g. of a week or so between starting to eat less every day until the weight begins to decrease, but eventually it is possible to reach a steady state of a constant rate of losing weight per day.
When diminishing the amount of eaten food, only the carbohydrates and the non-essential fats must be reduced. The amount of proteins, essential fatty acids, vitamins and minerals must remain normal. To achieve this, one must eat a source of pure proteins, for example turkey breast or chicken breast or some kind of protein powders, so that eating enough proteins contributes only a minimum amount of calories. The rest of the nutrients can be provided mostly by non-starchy vegetables and perhaps by some supplements like fish oil. One could also eat almost anything that is not recommended, for instance chocolate, with the condition that the quantity is negligible, which can normally be achieved only when such treats are not eaten every day, but e.g. only once or twice per week.
These rules are simple and anyone who follows them will lose as much weight as desired. Obviously, this is easier said than done, because for the entire duration of the weight-losing diet one will be permanently hungry and one would tend to think about food and it will be difficult to resist temptations, so it is better to not keep in the house any kind of food that can be eaten immediately, without requiring some kind of preparation. Unfortunately, this is unavoidable and it is the price that must be paid. After the first few weeks, the hunger sensation diminishes in intensity and it always disappears for a few hours whenever you find some work to do that captures your attention.
As long as you do not want to follow such rules, you will not lose weight, but that is because you do not want to do it, not because it does not work.
Not wanting to do it is a valid reason, because one may abhor more the feeling of hunger during many months than being obese, but this decision must be described correctly and not be justified by the false claim that "it doesn't work". At least in my case, the improvement in my health and in what I was able to do (e.g. before losing weight climbing a few stairs would make me tired and sweaty) has made worthwhile any displeasure felt during losing weight and I have been very happy to have achieved that.
> Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.
Perhaps coincidentally, this is similar to my experience with week long fasts: After 48 hours I feel like a precision missile cruising towards my target until about 5-6 days later.
But I will use a suitable GLP-1 based drug, because, man, fasting feels unbearably brutal for me after 6 days: profuse sweat, increased heart rate, brief but intense panic attacks, an insane level of sad (but not depressed) introspection, a hairpin trigger temper. I become a ridiculous mess. There's got to be a better way!
Might have to float this by my tirz-taking partner, especially if it helps with side effects. They always feel a little icky the day immediately after a dose.
I definitely am. That first shot took a solid 30 seconds and three false starts before I could jab it in, but it turns out to be a great big nothingburger once you do it. Can barely even feel it, nothing like the intramuscular shots like flu/etc. I could do this shot as often as necessary without batting an eye.
These are the same effects I got from doing OMAD and going gluten free. If I fuck up and eat processed food, the "food brain" comes back, and I start chasing dopamine like a fiend.
I'm a fan of these tools helping people get this insight, because otherwise people just accept that cloud as their normal.
> The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.
If you want to be successful long term in your weight loss, especially after stopping the drug, you should really invest in changing your mindset.
This is a massive positive, not at all a negative.
You got fat because you ate too much. If you don't understand what are normal portions now, you'll go back to your starting weight as soon as the drug isn't having effects anymore.
This is a lifestyle change that you MUST embrace to be successful long term.
> but the broad ranging psychological effects are concerning.
Fwiw, to me the symptoms he and others have described don't seem very different from those of long fasting. And I would definitely prefer those symptoms to the ones I had due to obesity which ranged from extreme fatigue, heart-pain, muscle spasms, depressive shame, restlessness and so forth.
I said a few weeks ;-). The garage is pretty big, but not that big. It's going to be gloriously organized in a few weeks because I spend a half hour or so in the evenings to move the project forward. I'm very relaxed about it. I'm just doing exactly what I kept telling myself I should do to make the garage as organized as I want, rather than finding pretty much anything else to do.
Decades ago I tried phentermine for a couple months. Now that was a ride, and you might call the experience closer to manic. I was a machine. This is not like that.
It would be interesting to compare the anxiolytic effects of the drug versus the cancer anxiety caused by being on the drug.
The cancer anxiety could be reduced by frequent testing. e.g., having a thyroid ultrasound every 6 months, or a yearly abdominal MRI, just to make sure cancer is not brewing.
There's no evidence that GLP-1s cause cancer in any meaningful amount, but obesity definitely does. Either way the only cancer they found any correlation to was thyroid which is one of the most treatable -- over 99% survival rates.
My biggest fear is either there will be long term negative consequences to Ozempic et al, and a huge swath of the population will be dealing with issues 30 years form now - OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight.
I can understand this perspective. You're looking at it with healthy eyes.
But for fat people, the calculus looks different.
A decision to take semaglutides is a decision between the long-term negative effects of obesity *now*, or the possibility of long-term negative effects *later.*
Anecdotally, trans people have a similar calculus. Going unmedicated/unsupported brings significant mental health risk now[1], whereas going on hormone replacement may or may not cause complications much later in life (osteoperosis, hepotoxicity issues for some treatments, etc).
Either way, you gotta get to the "later in life" part before you can worry about the outlook there.
1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
> 1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
This paper also finds that 5% of cisgender male and 11% of cisgender female students (out of ~8k surveyed for each) attempted suicide in the past year. It's kind of strange, because the age <=18 suicide rate (of "completed" attempts) is much smaller, approximately 1 in 5,000 to 1 in 10,000 [1].
No, they're making a choice between the long-term negative effects of not losing weight naturally, vs the possibility of long-term negative effects of using artificial methods. This isn't polemic, as even things as basic as birth control and advil have negative long term effects.
I was curious and a bit skeptical that sex change operations materially affected suicide rates for trans people but available papers tended to find significant effect sizes of about 50% reduction
> a huge swath of the population will be dealing with issues 30 years form now
We've got 20 years of data on this class of drug. Certainly there could be some long term issues that we're not aware of yet, but it's not likely that there are significant issues that affect a large percentage of users after 30 years that didn't affect the small sample of users that have been using it for 20 years or the massive number of users that have been using it for 10.
How much of the data was done independent and how much was done by the same company or companies that benefit from it? We've seen this before. How many decades did people take aspirin thinking it was good for you to take everyday. How many decades did people drink wine thinking it was good for you in small dosage? How many people smoked using it as an appetite suppressant not knowing the long term effects?
The list goes on forever. I'm betting this ends the same way.
OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight
Who the fuck cares? If you're not overweight and are reasonably then you're already winning in physiological terms. If you can maintain a good quality of life into old age and then die, what more do you want? Going through life worrying about whether you're missing out on some marginal health benefit from the drug-of-the-moment is neurotic.
i think overweightness should be seen more as a symptom and I share parent's concerns about ozempic's long term side effects being unknowable in the present
all in all general unease about dealing with symptoms and not the root cause of overweightness except in rare genetic cases, its overwhelmingly a dietary/exercise issue.
in this country the pill/drug is the answer and solution to everything but all this does is pile on more bandages without addressing the root cause which a very American solution.
I do not think the full ramifications are realized or knowable when there are profits to be made on both side of the fence, sort of like the whole opiate crisis in America started out as magazine ads blew up into a major crisis 20~30 years later.
I’m skeptical of the idea that across the general population we’d be healthier if we dialed up our insulin production. Serious question but has there ever been a case of humans benefitting from increasing a hormone like this? Since it’s an injection, It wouldn’t be a steady increase, but more likely have bursts of it. I don’t know how healthy that would be in the long run.
After what happened with OxyContin I think wed benefit from some skepticism when a new drug gets oversold.
> Serious question but has there ever been a case of humans benefitting from increasing a hormone like this?
By itself this might be an ok question, but in context it's rather useless....
Diet and obesity changes by both lowering and increasing different hormone outputs in your body. You're balancing the question of "how is this hormone" versus "How bad is obesity on the body". Well, the answer is in, obesity is extremely unhealthy on the body in both the short and long term.
Drug overdoses cause somewhere around 100k deaths per year in the US. Obesity complications related deaths are in the 250-300k deaths per year.
You can be skeptical as you want, but behind smoking, obesity is the worst epidemic in the US.
There are some evidence that Ozempic/Wegovy actually cures more addictions than just food addiction.
>The weight-loss jabs have apparently helped people kick habits from smoking to shopping, although scientists remain wary about recommending it as an addiction treatment
Sure: the popularization of coffee across western Europe in the 1600s and 1700s, and the way it replaced beer as the most common daytime casual drink. Much of the population went from spending all day mildly intoxicated to being mostly sober and with a caffeine pick-me-up.
Some athletes (especially weightlifters) use Tadalafil, an erectile dysfunction drug, because it also promotes bone density and muscle growth while having few observable side effects. This isn't really surprising, it's basically just a mild vasodilator. A better known drug in the same class Sildenafil (aka Viagra) is less mild, and associated with retinal damage if overused.
Medical FOMO? I wouldn’t worry too much about it, I mean, there are hypothetical upsides to countless decisions we haven’t made, right? We always miss some chances in life.
That's why I haven't taken it. I'm probably a guy who should. Overweight, with kidney disease person who, if I became diabetic, it would probably kill me.
I'm not, someone who doesn't really need it. For example, some average weight housewife who just wants to fit in a dress a little better.
And still, I won't use it even though I can afford it cause it's the long term consequences are not entirely understood.
There were several side effects related to pancreatic cancer associated with the precursors to GLP-1 drugs. The same companies promoting GLP-1s were responsible for driving up insulin prices. So I'm hedging my bets.
There's a really cool Modern MBA video [1] on this topic btw :)
>Large epidemiological studies have shown the link between obesity and pancreatic cancer. A large population-based case-control study of pancreatic cancer demonstrated that obesity was associated with a statistically significant 50–60% increased risk of pancreatic cancer.
You have the completely wrong take on this. Dieting destroys your relationship with food. Basically every adult woman exhibits some level of disordered eating because of it— "girl dinner" is both funny because it's true and sad.
Being able to lose weight while continuing to eat is a wonderful thing. There is no virtue in spending your willpower making your body do something it desperately doesn't want to do. That's some puritan shit.
It's genuinely quite depressing that so many people in the United States have a weight problem that the overwhelming majority of the population would benefit from this and headlines including "we are all" are not inaccurate.
I don't think other countries are necessarily perfect here, but 74% of Americans don't have a healthy weight when you look at their BMI. That's a staggering statistic. Something is seriously wrong societally, and the priority should absolutely be non-pharmaceutical interventions.
I agree. I think the conversation has unfortunately been dominated by an individualistic strain of moral judgement. Whether so and so, this person or that person, should take Ozempic-like drugs is often discussed in binary terms of near moral and personal failing or not. I think the drugs are helpful to people who really need them --- so long as the people really need them.
The problem is that conversation overshadows the much more important big picture conversation: An entire nation is now becoming synonymous with poor health from obesity and we're not addressing many of the core nationwide reasons for that.
America was once proud of and eager to prove how fit and able its people were. Now the very idea of proper nutrition and exercise is deemed a nonstarter, "impossible", or an imposition on personal liberties. The existence of Ozempic-like drugs should not absolve us from the imperative to change how we live as a nation for the sake of our health.
It really is a sad situation. As an American who spent the first 30 years of life in the US and over 20 in Europe, the difference is striking. However... here in the UK I see more and more "American-sized" people every year. _Something_ is changing. In the food and/or habits of the average Brit.
Anecdotally I would say Europeans as whole are getting ever so slighty larger. But just not at the rate as Americans. Ozempic seems like a god-send.
The rate is probably comparable, it's the offset that's different. Won't be long until Europe is where the US is today (though I need to mention, this is regional, for example Colorado is at about 25%, and some European countries are already there).
Even Japan is getting steadily fatter, though they are way, way behind Europe and the US.
> It's genuinely quite depressing that so many people in the United States have a weight problem
I agree.
I'm 51 y/o and still totally fit. Always have been. I am completely in control of what my body intakes. I can fast for 12 hours from waking up until dinner: I do it regularly (as in at least five times a month, probably a bit more).
I did do sport like crazy when I was young but don't even bother that much. Some walking, taking the stairs instead of the elevator, some bicycling, some tennis. But at a gentle pace. "More haste, less speed" (thousands of years old saying).
It's crazy to poison oneself to the point where another poison (that Ozempic drug) is needed to counter the first poison.
I'm not saying it cannot help but sadly there's no way to say it nicely: if you need that, your body controls your mind.
It should be the contrary.
> Something is seriously wrong societally ...
The biggest issue to me is we live in societies (not just in the US) where we victimize everyone. Nothing is never nobody's fault. We find excuses for just about everything.
We should go back thousands of years and read the classics: "healthy mind in a healthy body". Greek philosophers had already figured that in the Antiquity.
>I don't think other countries are necessarily perfect here,
America first... the rest of the world is playing catch up as quickly as possible.
>In March of 2023, the World Obesity Federation (WOF) released a report(Link downloads document) stating that by 2035 over 4 billion people – more than half the world’s population – will be obese.
>and the priority should absolutely be non-pharmaceutical interventions.
Illegal. Or is should say Coca Cola can and will fight you to the death the moment you try. If you stand between the junk food companies and advertisers you will have an army of lawyers fighting you 'tobacco industry' style for the next 50 years.
Until the shit is off our shelves and out of our ads nothing will change.
This is not exclusive to the US. The world is trending towards those, and different countries seem to only be at different distances from it, but the same velocity.
Also, industrialized food seems to be much more effective in causing dependency. Food preparation has overwhelmingly shifted into less healthy alternatives (even when they sound healthier in a naive review)... And there's a multitude of low probability high impact possible contributors that nobody knows if are important or not.
I have always and continue to feel this view of “food is an escape for cuz” model is wrong in line with the the “it’s about lack of will power” we are seeing with all these glp-1 drugs that are helping people that a big proportion of our population have what amounts to a hunger/craving defect and are just living how we all naturally do when listening to our body, but because something has messed up their balance they end up overweight instead of just maintaining their weight.
I’m hoping we at some point have a “lead in gas” moment and discover some culprit in softening agents in plastics or preservatives in foods that we find out is messing up peoples systems. I could imagine that there is something that has a minute effect on the short term and doesn’t show up if you only look at people for 1-2 years but causes significant disruption on the timescale of 5-10 years of exposure.
The obesity epidemic seems to have started in the 1960-1970, so the sedentary lifestyle of computer focused work came later, but it is still recent enough that culprits in the mass produced uniform product market could be a cause, or the advent of one type of fertilizer or antibiotic given to animals etc.
I think Ozempic is a treatment of a symptom but not the underlying condition, but unlike many of the posters here, I do not think the underlying condition is "obesity". The below is mostly speculation.
Research especially into people with healthy body weight seems to indicate that there is something going on that is causing widespread obesity. That is, there's some sort of environmental "GLP-1 Turbocharger".
Maybe it relates to processed food, maybe it relates to microplastic contamination, maybe it's in the cheese, maybe it's an innocuous viral agent, maybe it's gut biome, maybe it's ADHD drugs, maybe it's SSRIs.
I suspect that Ozempic is helping us get back to a baseline level of exposure by counteracting this. And in the future if we're lucky we'll figure out what it is and try to correct it at the source.
Out of curiosity, last year, I purchased some test strips to test my drinking water. The strips showed typical contaminates: arsenic, lead, copper etc. they all registered in the "acceptable range". In the test, there was a test strip for QUATs (https://en.wikipedia.org/wiki/Quaternary_ammonium_cation), which caught my attention. It wasn't something that I would have thought to test for, but my water tested positive. I was curious, so I started testing other local water sources including bottled water from various brands; to my surprise they all tested positive for QUATs. The only local water I could find that didn't contain QUATs was distilled.
I thought maybe it was just in my area, so I started taking the test strips with me when I traveled. In the last year, I've tested the drinking water in multiple states and countries, and only one source has tested negative for QUATs. It was the water from a drinking fountain in the San Francisco Airport, interesting enough.
My suspicion is that QUATs are often flushed down the drain, and the molecules must be too small to be filtered out in the water treatment process.
I haven't found much research on the impact of QUATs on the human body, but I can help but think our mitochondria would be susceptible to damage.
I could suppose it's some of all of this. But my money is on UPF. The author of Ultra Processed People has an identical twin in NJ while he lives in the UK and their weights are vastly different.
A lizard whose bite makes its prey eat less is crazy but it exists.
A lizard whose bite makes its prey eat more is also crazy, but maybe it exists?
The first lizard is literal, the second lizard is a stand-in for whatever mystery force I am postulating the existence of.
When you look at the historic literature on diet and nutrition from the first half of the century it's like looking into another universe. People are obsessed with getting people to eat more to prevent malnutrition even when food is freely available. Something changed.
There isn't anything even remotely close to a scientific consensus on any of those.
There are plenty of scientists who tell you to stop exercising when you want to lose weight, because the exercise leads you to eat more than you would otherwise, and is ultimately self-defeating -- to focus entirely on eating less, and then only add exercise back in once you've reached you target weight. And "processed food" is a highly non-scientific category that is way, way too disparate to be useful at all.
Organic vegetables might be nice, but there's zero evidence that organic vegetables are better at weight loss than non-organic. Also zero evidence regarding lean protein as opposed to fatty -- there's a big argument that fatty meat is better for weight loss, because the fat satiates so you wind up eating less calories overall.
Maybe? I don't think we all know this. And some research, especially into people with unusual metabolism (but not necessarily known metabolic disorders) indicates that even with these restrictions, they need to operate at a significant calorie deficit simply to maintain a healthy weight. [1]
It might be that they are already exposed to enough processed food and pesticides that simply getting those things out of their diet is not sufficient, but I think it's clear that there's more going on here than a simple answer.
And, I think, most damningly, there are many people who maintain a healthy weight with no active efforts to maintain that weight, including a lack of exercise and consumption of processed food. It might be that a significant fraction of people are resistant to this effect or might just not enjoy the taste of processed food so naturally gain the benefits of avoidance.
You are doing an awful lot of mental gymnastics in search of a boogeyman that does not exist.
How mammals ingest, process, store and burn energy has been well understood for a very long time.
You know why some domestic dogs and cats are overweight? Is it ADHD or microplastics? Of course not, it’s because they’ve been eating more energy thaN they have been burning for a while.
Ozempic only stops you wanting to eat more, which perfectly proves the point. The boogeyman you are searching for is eating more energy than you burn.
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All this to say, this drug has been life changing for me. I spend more time doing things I want to do, depression and anxiety have less of a hold on me now. I feel that this drug has allowed me to be the best version of myself I have been in a long time. The only side effects so far have been positive. I do worry about what I will do once it's time to titrate off the weekly dose and the best I can think of is that the habits I'm forming in the time on the drug I will have the resolve to continue after cessation.
I say this because I have battled depression, anxiety and obesity issues my entire life. I've had many failed attempts at getting back to a healthy, productive and non-obese lifestyle. I don't know what is so different about having the drug help me, but I can tell you that it has been different.
Now, I can easily stick to a super low carb diet
I've been on tirzepatide for just over a year now. Before that, I managed to lose 6% of my body weight over the previous year. With tirzepatide, I've lost an additional 17% of my body weight, for a total of 23% over two years.
Tirzepatide isn't a magic drug that just makes you lose weight, it simply makes it much easier to avoid overeating.
It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.
I had this problem as well. Being on tirzepatide I went from 220 to 185 in just six months because my previous insatiable hunger went away. It feels so powerful now choosing when to eat or not.
Forgive my ignorance and curiosity, was the feeling of hunger due to drastic reduction in portion size? Could you not eat some low-calories filling food?
I ask cause I've been overweight and sometimes obese most of my adult life, but when on a diet I usually feel "unsatisfied" but rarely actually hungry, e.g. I can eat a couple carrots or whatever and hunger goes away, but I would still crave a hamburger.
Still, I'm happy for you that you found something that works!
I've sometimes heard it said that it's an unhealthy reliance on a drug in place of curbing behavior, but I think it's important to understand it as, among other things, a stimulant to the activation of beneficial behaviors, which can be as critical as the drug itself.
The next generation of drugs are including 2nd molecule...I'm blanking on the name, and a search isn't bringing it to me...which maintains or potentially increases muscle mass.
But curious what your experience with exercise has been.
I also didn't know there was a planned reduction in dosage, but the expectation is that you'll be on some type of GLP1 for life, is that not right?
My understanding of the literature is that there's nothing special about semaglutide or tirzepatide that promote muscle loss - it's just people who lose weight based purely on diet tend to also lose muscle mass. Even bodybuilders lose some muscle mass when cutting.
It's up to the individual to increase their protein intake and exercise, the same way they would in any caloric deficit.
If you calorie restricted with the same exercise routine without the drug you’d see the same amount of lean muscle mass loss as you would taking the drug. This spreading of misinformation is actively harming people.
The dysfunctional biochemical processes that contributed to overeating are still present if you discontinue the drug. Your body has a natural set-point for the weight it wants to be at, and the hunger and food noise comes right back as your body tries to get you back to your old weight.
It's possible that after after a long enough time at a healthy weight your body's natural weight set-point will regulate itself back down. But this process take years.
The method of these programs is to use the GLP-1 medications to allow you to change your habits significantly while also reducing your weight. The goal being, you keep the new habits and your reduced metabolic requirements which allows you to keep the lower weight.
I've had a medical cannabis prescription for many years and vaporise up to 3g a day which is quite a bit. It definitely interferes with my cravings for food, as you know the common 'munchies' effect, making me eat when I'm not really hungry or binge snacks.
I gave up on Semaglutide (Ozempic) after a few months, but Tirzepatide is working a lot more effectively and has been better.
Cannabis also helps a lot with the nausea side effect for me which can be particularly bad the first few days going up a dosage every month. It takes six months to titrate from the starter dose to full strength, if necessary.
Also the downside a lot of people don't talk about is that most people need to be on these drugs for life. They also aren't cheap.
That said, I've noticed in the past, and also now on this drug, that my gastrointestinal issues abate noticeably when I consume less food. Thought I had IBS and then I went on a significant diet and lost 40 pounds in 2020. The IBS resolved, and not after I lost 40 pounds -- it basically stopped altogether a matter of weeks after I changed my diet. That was educational. YMMV.
I'm still working out my approach to eating while taking tirzepatide. Old habits die hard, and I'm having to cut my meal size way back. This sucks because my problem with eating too much was about eating too often, or not when hungry, not about binging. So I have to eat pretty small meals now. It will take some adjustment to find the right way to get sufficient nutrition while volume limited, but I think it can be done.
I notice now that there is a LOT of judgement, bias(?), around obesity, that people, obese or not, carry with them [1]. I certainly carried that bias, and the reason I noticed it was because Ozempic is literally an external substance that you take that simply makes obesity go away. So if you believe (like most of us unconsciously do) that obesity is a personal failing or an issue of willpower, an issue of personal merit -- HOW is it possible that a chemical pill, an external chemical process, can SO effectively resolve it? When no amount of hectoring and moralizing and willpower can? My inability to square that circle really changed my thinking about obesity in a fundamental way.
Already there is a reaction to Ozempic -- like people thinking that taking Ozempic is a personal failing, or judging celebrities, for taking it, thinking it's the "easy way out" -- I think the origin of that is this very deep unconscious bias that we all have about what obesity actually is fundamentally.
My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.
It's really heartening to hear your experience. Your post really struck me, I felt exactly the same way after getting on a CGM + Insulin Pump for my Type 1 Diabetes. Nobody EVER thought I had a lack of "personal responsibility" or an "issue of willpower" for going low or high on shots of Humilin and NPH.
Thank fucking god for Novo Nordisk.
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[1] see: this thread!
Of course people don’t choose to be obese, but the culture and environment inevitably pushes you to it. A proof of that is that there are places in the world, with similar genes, that don’t have the same problem in the degree that US does.
I don’t think it is a personal failing, more a collective one - the society itself has chosen a set of environmental factors as desirable (car centric, hectic, individualistic, processed cheap food etc) and it just results in more obese people.
Loose the cars (change to walk / cycle / public transport), spend on food as much as the rest of the world do (adjusted to PPP) and suddenly you don’t need ozempic.
It is still weird to me how US choose unironically to develop a drug for reducing addiction, and not putting societal pressure to fix the environmental issues. It’s a democracy, people do choose all of that and can’t really blame it on the government.
I expect that the people who hold this viewpoint are afraid that their lack of being overweight will not be seen as badge of honor, a sign of superior morals and willpower.
To them I say -- GLP-1 agonists are good for anxiety, too!
I see Ozempic as "taking the easy way out" the same way I see steroids as "taking the easy way out" (except it brings people closer to the norm of a average healthy person and will probably lengthen lifespans).
If you're in it to show mental fortitude for internet/social points, then it is "cheating", but if you're just in it for results it's perfectly acceptable and even recommended.
The latter is, like obesity, considered a personal failing (being one or more of the Seven Deadly Sins, depending on when you look), and medical treatment elicits similar reactions — both against it being ‘too easy’, and in favour of wholesale societal restructuring instead (“That trick never works!” — Rocky the Flying Squirrel).
Once you get to quite obese you're dealing with physiological factors that make losing weight medically difficult from behavioral changes alone. It also makes the chances of "yo-yoing" the weight higher as well. At that point the treatment for obesity overlaps with the treatment for type 2 diabetes.
Considering our society is pushes us toward sedentary highly-caloric lifestyles, I'd say we're set up to fail from the get-go. Therefore the failing is systemic not personal. I wouldn't compare to individual health issues. You can't cure celiac, but you sure could reduce the obesity using policies to drive the food industry toward less-sugar/more-fiber.
For me, it was purely an issue of personal falling and willpower issue. I was obese because of a diet I was indulging in; full of unhealthy things and snacks.
It was due to nobody else but myself.
How about alcohol and smoking ? Is that the same as obesity then
I see no contradiction here. That ozempic works doesn't imply that willpower isn't real or that people can't lose weight via diet and exercise.
> My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.
I'm very suspicious of "it's a health condition" applied to obesity, type 2 diabetes, and even depression. I absolutely believe that some people will be able to avoid or cure those "conditions" by changing their behavior. Of course that doesn't imply that there should be a taboo against medication to help people who can't. But my concern is that "it's a health condition" discourages people from examining their choices and making good ones.
If this is true, then why are we so focused on curing it after the fact?
Are we also working on prevention?
If it's not a choice, then what is the cause? And why shouldn't we work on preventing that cause?
I mean it's clean that more people are obese today than in the past right? So what changed to cause that that isn't about people's choice? Why not work on reversing whatever those changes were that caused obesity to increase?
And a separate question:
If it's really not a choice, what would be the approximate rate of obesity among a group or population that all exercised regularly and ate healthy?
I don't think I can be convinced that not exercising regularly and not eating healthy is not a choice.
I just feel like the number of people that would be obese who are regularly exercising and eating healthy would be rather small. And if we agree that exercising regularly and eating healthy is a choice, then it seems at least for many who are obese, it indeed is choice.
I'm not going to say there aren't outliers or other special circumstances, but I still feel like for more people than not, it is indeed a choice.
Obesity was rare until the United States officially decided in 1977 that saturated fats were considered harmful. A few years later, it started rising to the current epidemic level. We've come a long way since the American Heart Association was recommending candy and soda as "healthy" alternatives to real food, but the idea that an optimal diet contains low saturated fat and high complex carbohydrates remains firmly entrenched in present-day nutritional and medical orthodoxy.
Imagine a counterfactual where Congress had reached the opposite conclusion, instead recommending a standard diet full of saturated fats, high in salts (both sodium and potassium), moderate in monounsaturated fats, low in polyunsaturated fats, and sparing in carbohydrates. The population and food industry would have moved in an entirely different direction. We'd have a whole different universe of nutritional advice, diet trends, restaurant menu options, and easily available processed foods. A lot would be the same, but large sections of the grocery store would look like lowcarbfoods.com, maybe burger joints would serve mozzarella sticks instead of fries, maybe instead of potato chips and corn chips people would eat pork rinds and kale chips, and maybe instead of rice or potatoes an average dinner would include all manner of delicious fried vegetables. Instead of a low(er)-fat (i.e. high(er)-carb) diet, doctors would tell fat people to try keto. Maybe that timeline's equivalent to trans fat would be sugar alcohols and artificial sweeteners, and governments would ultimately pressure the industry to transition to stevia, monk fruit, and inulin fiber.
In such an alternate universe, I'm sure the food industry would still work overtime to find ways to make many of its products shitty and addictive, and I'm sure the average person would still lean heavily on processed foods and fast food over home cooking and whole foods. I'm sure that would cause its own set of health issues, but what I highly doubt it would cause is an obesity epidemic. It's simply a lot harder to overeat fats than it is carbs. We'd also inherently have less insulin resistance, which means less type 2 diabetes, less dementia, and probably a good amount less of mental/neurological issues like depression and anxiety.
Unfortunately, we live in this universe. And in this universe, I find it really hard to blame individuals for struggling with obesity when we've practically purpose-built an environment to make us fat and keep us that way. In order to not be fat (by pre-1980 standards), you either have to win the genetic lottery, be extraordinarily physically active, put a high amount of effort into controlling your caloric intake, or be willing to go against the grain (no pun intended) on what you've most likely been led to believe for your entire life by everyone and everything around you. It's great to fall into one of those four buckets, but on a population scale it should be obvious that the majority wouldn't.
On topic, very happy this medicine exists, but let's pray god will keep the prescription only for BMI > 35.
Did you try to reduce your cannabis consumption before using tirzepatide?
Because although you say(feel) like the realization made you reduce your intake, I can hardly imagine that you were totally oblivious to the fact that smoking cannabis is unhealthy in the first place.
Do you feel like you think less about e.g. cannabis, or do you feel like it's easier to say no to that impulse?
Does it seem to mainly influence health choices or are you also less likely to be angry or does it interact work place interactions?
As close as I’ve come to an effective remediation was living abroad where the food wasn’t actively adversarial: capitalism can do many good things but it drives the quality of food to “edible plus epsilon”. Rich people eat pasture-raised shit for a reason. For me it just deleted that problem.
But I’m interested in this class of medication because it’s difficult bordering on impractical to eat well in some regions. People say just cook, well, there’s an infrastructure around that which amounts to a declared bias against those who didn’t settle down young. Much like people who met their partner before partnering became monetized, “easy for you to say”.
I hope you have success in your journey either way, and the less meds involved on average probably better, but if it works and has no bad side effects I don’t see why one would stop. Welcome to your new awesome life!
Every SV power player I’ve ever met was enhancing themselves via chemicals. It’s not tweeted about (other than when Garry Tan threatens elected officials), but it’s a quiet norm.
I love your tactic about building healthy habits while you have some support and leaning on those to carry you through the future.
Good job!
Aside from the disruption in cravings, the immediate results seem to have motivated you to do more.
Because you eat more or is there some other factor?
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For those of us old enough to remember what society looked like before the obesity epidemic kicked in, it’s hard to understand how something genetic can suddenly result in a dramatic change over a period of years. Our genetics didn’t change. Our food environment did. Experts disagree on what factors are responsible for this, and any random person had their own pet beliefs.
But this flat-earth-like notion of reducing obesity to an issue of basic willpower needs to be recognized for the drivel it is, along the related notion of calories in & calories out while ignoring the overwhelming role that basal metabolic burn plays and how it dynamically responds to changes in diet and exercise.
If you want to educate yourself, read Posner’s Burn [1], which is firmly grounded in empirical measurements of doubly labeled water to measure true metabolic consumption. Look up the reporting the NYT on past contestants of The Biggest Loser.[2]
[1] https://www.penguinrandomhouse.com/books/603894/burn-by-herm...
[2] https://www.nytimes.com/2016/05/02/health/biggest-loser-weig... (gift link)
Edit: Added links to sources.
https://news.ycombinator.com/item?id=41818420
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Check https://metabolicmind.org for details.
My own experience with the keto diet - https://www.feelingbuggy.com/p/finding-hope-after-decades-of...
I see in other replies that you've had success in losing weight, and congratulations - but that doesn't mean it can work for everyone else.
I don't look at any kind of "pill solution" lightly, and absolutely think lifestyle changes should be made as well - but I can definitely see how medication like this can help get people on track and get back control. It's very encouraging to hear about psychological effects in terms of self-control, decision making etc. I'm just worried that we'll discover serious negative side-effects before too long, as with previous attempts.
Put simply, it's easier to adhere to a drug than to a specific, somewhat anti-social diet.
I strictly maintain my weight. If I catch it going over over 155# (I'm a 5'10" 61 year3 old male) I'll do a strict cut. And I know that either strictly counting calores OR going to as close to zero carbs will have the same net effect.
But a person who has obesity or is overweight will not be able to follow a diet. They are just incapable of doing so, or will lie to themselves or others about it and claim it's their "metabolism" or a medical condition, etc.
1) “obesity” has no clear clinical definition, nor is it really a disease. [1] 2) there has been no evidence yet that weight is at all a primary determinant of health [2] 3) Weight loss drugs must be taken forever or it’s nearly certain you will gain the weight back [3]
There’s a lot of great research these days that shows fatness is not what people think it is, and weight stigma is far more harmful than being fat itself [4].
Also, nobody knows what happens yet if you take these drugs for 30 years, and what we do know is that being fat hasn’t been proven to kill anyone.
I'd just say follow the money.
[1] https://www.science.org/content/article/obesity-doesn-t-alwa... [2] https://withinhealth.com/learn/articles/why-body-weight-isnt... [3] https://www.bbc.com/future/article/20240521-what-happens-whe... [4] https://bmcmedicine.biomedcentral.com/articles/10.1186/s1291...
My wife and I cook every evening. We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.
Every morning I wake up and go on a 5 mile hike.
And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.
And you know what it is? It's volume. I eat too much. And I have no cookies at home. I have no chips at home. No soda, no alcohol. I drink black coffee with a splash of milk. I don't eat any sweeteners.
I have had weight loss surgery (lap band) which was later reversed as it hurt 24/7.
Now, on ZepBound I lost 20lbs in 2 months. I am not hungry. My brain can actually focus on the things that matter.
Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?
"Getting fit and staying fit" is a form of social capital, because it's extremely hard and only within reach of a small portion of the population. "Being fit" is strongly aligned with "being attractive" which confers all sorts of cross-cutting social benefits.
Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.
I don't think this is just about a social club. Battling weight loss and habits is foundational to the human experience from the most recent centuries. Be it drugs, or anything else really that changes the nature of these challenges, people are going to feel discomfort because it's an attack on their understanding of the world, and in some ways, their beliefs.
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Nice one. I think it's a bad idea to be dependent on drugs for something you can achieve on your own, especially if the drugs don't have a long term safety profile. Pretty sure I read somewhere that they don't. If you're going to use them for a short period of time, that's fine. Don't say nobody warned you if that doesn't pan out though (or worse, you have a bad drug response).
You know by far the biggest benefit of doing hard workouts or doing extreme sports? Its not muscle mass nor how much they lift. Its about how it changes your personality, resilience to mental or physical suffering and ease of overcoming it. You know, hardest part of doing anything is winning the mental resistance game and just start it. Keep doing this every day in various forms for decades... A very strong resilient personality under various circumstances is almost an unavoidable result if you are putting in enough effort.
If somebody can't even stop themselves buying and paying for junk food at grocery store or has to overeat constantly otherwise getting anxious, that part of personality is missing and another, less desirable is present.
Who would you prefer to have as a close colleague you depend on, life long partner, a close dependable friend? Who do you think women would prefer subconsciously? Societies have always some form of castes, even hardcore communists have/had them, in US one of very popular is based on career/income/wealth. And this is just another dimension or caste, so let's not act like we are not humans with flaws and subjective preferences, we don't give our respect out for free.
These medication help with none of above, in fact they strongly reinforce such behavior and personality traits. But to each their own. One benefit I can see that they could start / help with movement from former to the latter, but that's rarer than people like to admit.
I think it is because if 90% of the population did half of what you do (and kudos for you for doing it), they wouldn't have a problem with weight, you just happen to be one of the unlucky few where it doesn't work and these drugs are useful.
Commenter 2: Kodus to you. Let me just discount your anecdote as being unlucky and keep my current belief. But again, kudos.
HN threads on weightloss are an utter waste of time.
I think if the widely available help for alcoholics, smokers, or opioid addicts mainly mitigated the negative consequences - enabling them to drink, smoke, or dope more - it wouldn't be nearly as acceptable.
I personally expect weight loss medication that simply makes people want to eat less will reach cultural acceptance.
Case in point, cigarettes have been known to suppress appetite for ages, and people have elected to smoke to help stay thin for decades. There was never any crushing social stigma attached to doing this as a weight loss strategy (that I know of).
100% this.
I lived in Asia for a few years and obesity is rare (though increasing for youth). It's not like they get more exercise (most people don't) or eat healthy (it's mostly carbs), but 100% portion sizes.
I see people who work manual labor jobs eat lunch that is a bowl of noddles, a few thin slices of chicken or pork, and a few veggies. I highly doubt it exceeds 500 kcalories. It's probably half the portion size you'd get in the US.
Mystery solved. If you're only eating 1500 to 1800 kcal per day as an adult male doing manual labor, it's pretty obvious why you're at 10% body fat.
A lot of the sides in your average US restaurant is easily 1000kcal on its own
The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss. It's not surprising that it didn't help you lose weight.
That’s not been my experience at all. My dosage absolutely significantly suppresses my appetite and always has. This has directly led to sustained weight loss. It did so badly enough at one point that I was underweight significantly.
I have to force myself to eat on my meds, even though the thought often makes me ill.
I’m on 30mg dexamfetamine daily.
“Dexamfetamine can make you want to eat less, so you may lose weight while taking it.
Some people gain weight, but weight loss is more common.”
Doesn’t seem to be hit everyone but equally doesn’t seem rare.
1. People might want to help, but they don't think taking a pill every day for the rest of your life is a proper solution. I'm not aware of any such things for other addictions you mention,
2. People don't want other people to have it easier than they did. "I had to diet and exercise etc, you should too",
3. People don't want to help. They want other people to be fat because it makes them relatively more attractive.
EDIT: And to be clear, there may be specifics with these particular drugs which are problematic, maybe they're by necessity expensive or resource intensive to manufacture, maybe they have problematic long-term effects, I don't know. I'm purely talking about the general aversion some people claim to have regarging taking some medication on an interval to help with a health problem. It makes little sense to me.
For the same reason why skinny person taking steroids is frowned upon - it is perceived as a shortcut.
In an alternate world where steroids had a good safety profile, it would be ridiculous to not use them if you were looking to add on muscle mass.
I wonder if there's a connection between diet during development and adult processing of and cravings for food. Maybe eating candy for breakfast (cookiecrisp!) every day in elementary school messed a bunch of us up.
Sometimes I wonder if it was a some neat trick by US gov to diagnose and put 1/5 of the population on amphetamines (2024 data +60mil prescriptions of Adderall), so that most everyone who is actually like smart or sensitive or anything of value to the industry, can (almost) freely microdose on it and as a result increase productivity.
Which... means 1/5 of the population suddenly increases output. Perhaps we all'd be on Aderall at some point, dunno bout the Ozempics...
https://www.cdc.gov/mmwr/volumes/72/wr/mm7213a1.htm
I’ve heard studies show Adderall doesn’t help people without ADHD… googling now seems to confirm. Apparently lots of people, especially college kids, take it thinking it will help, but it actually can slow them down.
Weird daydreams on this site.
If it tastes good spit it out. Countless people ready to tell you no sacrifice is needed in that domain but they have something to sell or trade.
Have you considered eating less?
Bingo. I've had this conversation with my girlfriend. She's not overweight by any means (160 cm ~55 kg) but I am quite underweight (182 cm, 65 kg, < 10% body fat) and the conclusion I've arrived at regarding our differences in body composition is because she routinely eats 1.3x to 1.5x the amount I eat. We both exercise and eat little junk food.
I'm convinced it has to do with upbringing. My family never ate a lot and the portions I was served as a kid weren't big. Nobody in my family is anything more than skinny. Her family however, they eat a lot (and healthy too, mind you). This is all influenced by other factors, her parents and grandparents grew up with not a lot to their names and with food scarcity, so when they reached a position in life where they could comfortably afford to eat they gained the habit of having big meals. My family was mostly more privileged in that regard so maybe they never felt the need to focus on food as much.
Not being snarky, but is this truly "better" than a single weekly injection - 10 seconds and done for the week? I do think our wider society sees medications for overeating as "cheating". Perhaps we might benefit from rethinking that.
Truth is, we really don't need more than one meal a day (maybe a snack) when we get older and our metabolism slows.
> ...
> Yet... the number on the scale kept on creeping up.
That is absolutely terrifying. What oils did you use for cooking?
>> And you know what it is? It's volume. I eat too much.
But yeah, it's not HIIT. You won't really build up your fitness level by walking - it's not demanding enough. You need to be pushing yourself until you're out of breath, if you want to build up your cardiovascular health.
If you’re eating the right thing for your body, you’ll be satiated when you eat your full.
It really depends on you and the activity levels.
I used to ride to and from work - and I would ride hard, a solid 1.5 hour of riding every single workday. Yet this just caused me to gain weight as my appetite just shot through the roof. This new drug would have been SO good for me back then.
These days I find it easier to control my weight with regular strength exercise vs riding, as I tend to go too hard on the riding which causes me to feel famished. And then the control is just hard.
However when I just do (Olympic barbell) weights, a bacon, egg and onion + cheese omelette in real butter and EVOO does the trick to break my IF then, along with a WPI/milk shake- I get stronger and also lose weight. No need to keep eating. However, I'll then do cardio a couple of times per week which tends to undo the weight progress; I guess the real trick would be to stop doing the hard intervals I love on the Kickr, but going slow on the bike is nearly impossible for me. :-)
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All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.
1. Posts from folks who diet+exercise, or who have tried diet/exercise and nothing's worked so they then turned to Zepbound ("excited to hit the gym," "my diet is finally starting to work with Zepbound" and similar)
2. Posts from folks who haven't tried diet/exercise and turned to Zepbound first. (e.g. "I'm excited to eat dessert and laze around on my couch all day!" or "Zep is so much easier than before, no more keto for me" and similar)
Which group do you think would have more posts?
Selection bias probably prevents us from being able to count "Zepbound didn't work for me, but diet and exercise did" posts, which is why i suggest this.
Here's my hypothesis: I think self-control is generally uncorrelated to losing weight. Perhaps it's necessary to have self-control to lose weight "the simple way," but certainly not sufficient. I know lots of friends who've struggled and found it's not so simple.
People in the 50s weren't slimmer because they had ironclad determination to stay such.
Instead of being forced to drive everywhere for the most basic possible human needs - like getting groceries, going to the doctor, or dropping kids off at school - as is the case in 90% of America - what if you could walk to those places instead? You would get exercise as part of your every day life, with no extra effort!
What if instead of corn syrup being so heavily subsidized, we could use more filling sweeteners in a lower amount instead? What if people lived closer to agriculture, instead of in faraway suburban tract housing only accessible by car, so they had easier access to fresh meat and vegetables, instead of ultraprocessed package food?
These dreams are not "diet and exercise", they are a fundamental reshaping of American lifestyle that would directly lead to weight loss. We know this, because America used to look like this before, say, 1940. In old photos you see people in huge crowds in streets as they walked to their everyday errands, and menus and recipes of the era are mostly minimally processed food that is mostly local. Americans of the past were not overweight, because the way society arranged its physical existence didn't permit it!
I was that guy. For a variety of reasons that aren’t relevant i developed insulin resistance over a relatively short time that made it increasingly difficult to lose weight. I’m in my mid 40s, which also makes it difficult.
I got on one of the GLP drugs 18 months ago. I am down 80 pounds, and am running 20 miles a week. I’ll be doing a half marathon in March. Ive dropped the dose twice and still going strong.
Taking the pill made exercise possible. Online everyone likes to apply a moral hazard thing to every discussion. GLP medication twiddled my dopamine system and allowed me to achieve my goals. Period. If you think that makes me weak, I cannot think of anything that I care less about.
Presumably people who have good self control and are not prone to developing addictions (due genetic or various semi-immutable cause) do not become obese in the first place. It might be fairly easy easy for them to lose weight they just don't need.
Choosing to eat fewer processed foods is very effective but does not require that much self-control since appetite will fall automatically.
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I don't have a problem with a cure only if it doesn't reduce the focus and effort on prevention.
There has to be a reason why so many more people are obese today than decades ago. I refuse to believe we can't find out why and make changes to reverse it.
But if it's so easy to cure, will enough people care about figuring out how to prevent it?
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1) Radically alter aspects of food culture, work culture, social policy, and business regulation.
2) Magic pill (/injection)
There appears to be no imminent progress on the many parts of #1 that need serious work, so if we want a big turn-around in the next half-century, #2 has suddenly and surprisingly become a real possibility.
But at the same time, part of me wants to ask... why is this a problem? Why shouldn't we just use science and technology to fix human problems and remove any unfortunate consequences from society?
What's wrong with a world where anyone can eat as much of anything as they want, do no exercise at all, ignore their dental health and smoke like a chimney, yet still have perfect health without any downsides?
Objectively, it would be a better society, with everyone materially better off and a system that doesn't need anywhere near as many resources to care of its citizens.
Why would it matter what route is chosen here?
Just wanted to mention that this is not a US problem, and framing it as such won't help find solutions. Even in southeast Asia the rates over obesity are steadily increasing. Europe is already much fatter than southeast Asia. This is a worldwide phenomenon.
Or a 5'10" man starting at 220lbs (obese) and finishing at 187lbs (overweight, BMI > 26).
It ain't nothing, but that's not a magic pill which will fix the obesity epidemic. And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food.
I would not jump on that current pill yet. Wait and see. There are probably serious side effects that we mere plebes do not get to find out about yet (that is for 20 years from now). Like what is the side effects when you stop taking it? What if your dose is too high/low? What is the long term usage like for other parts of the body?
Which will burn somewhere on the order of 400 excess calories - about as much as a typical North American muffin (or two of the big cookies from Subway). But worse, your body was probably going to use most of those calories on something else (fidgeting, running a higher body temperature, other immune responses including inflammation) anyway, assuming that you haven't been gaining weight with your current habits. Exercise is healthy and reduces stress, but it just isn't effective for weight control. Humans are animals, and animals have on the order of a billion years of homeostasis technology behind them.
>eat reasonably healthy
Hardly anyone has any accurate picture of how much they consume, as measured in calories, except for those with actual explicit experience of measuring and accounting it.
If a pill happens to end up helping you eat an amount that lets you maintain a healthy weight, I'm all for that. But it's important to have your mental model properly calibrated.
That's very idealistic, in my opinion.
The Easy Path is that gentle encouragement to hit up Chipotle for lunch, because it's "right there."
The Easy Path says dinner's hard and you've had a long day, so get something simple, like take-out or microwave.
The Easy Path is entropy. The Easy Path is self-care over struggle. The Easy Path is simple carbs shown on prominent display in store shelves. The Easy Path is advertising.
Hitting the gym isn't on The Easy Path, but forgetting to cancel your gym membership is.
These days, big food companies love "The Easy Path" because it's so easy to commoditize, it's the "Path that Americans are Expected to Take." For financial stewards, being on The Easy Path turns lack of willpower into your ally.
On the other hand, getting good food in the US requires passing the marshmallow test: you have to meal prep, or you have to shop around the sides, or you have to get something on the salad menu. You have to say no to advertising. You have to expend willpower, the most limited of resources to the average American. You have to Go Hungry or Suffer, or have An Upset Stomach. You frequently have to spend more money or time.
Semaglutides are not currently on The Easy Path. Maybe they will be someday. I personally doubt that, because putting GLP-1 on The Easy Path would require big food companies to rethink their entire portfolio.
But you're not wrong in that they could be Easy Path-ajdacent. The dialectic would shift: food companies would shift around to be Organic and Nutritious and Less Calories and find other ways to stay on The Easy Path. Sugar and fat's addictiveness is highly Easy Path-enabling, and that's a pretty big vacuum to fill.
But I would never do that, since I mostly ate at the Red Light District, and I couldn't possibly generalize the country eating habits with stores in a major tourist area.
Maybe I'm too European to understand why not, but seems to me that regulations around food and what companies are allowed to put into it is really helpful in avoiding companies from just stuffing whatever down people's throat.
Why is the quality of food in Europe so much worse than southeast Asia?
Because you guys are way, way, way fatter than e.g. the Japanese.
Back on topic -- we have excellent food in the US, but regulations allow for highly processed crap to be sold too. Pretty sure most of the crappy processed foods are easily available in Europe, too.
Like most of the food that we eat is not really that bad. Its not optimal for sure, especially for sedentary lifestyles, but a lot of the health problems are not directly tied into the actual food, rather the over-consumption of it, and passing down of bad genetics (for example, children of obese people are more likely to be obese).
European obesity tripled in the last 40 years as well, despite higher quality of food.
There is, in fact, already an enormous, fully endogenous incentive to do those things. The fact many people are not keeping in shape (myself included) suggests the allure of food really is just that appealing.
Correction. We live in a system that *rewards* that. The infrastructure and system itself expects us to drive everywhere (because it's either faster or literally at all possible), eat overprocessed food (because it's tastier (literally designed to be hyper-palpable) and faster), and to work for absurd hours.
If you somehow have spoons after all that, then you're expected to workout, etc, to gain the additional benefits; but the systems in play do not facilitate that, at all.
When I’m really feeling the stress, even though I will tell myself at that time to just hang on and hit the gym later, the food is that much more of an instant fix that it wins out more often than not.
I’m sure that’s not just the actual food itself, but also the easy availability of it, and probably subliminal cultural factors such as advertising. But partly, yeah, it’s that my ancestors evolved to love eating when they had food, and their gift to me is that same desire in a world of endless plenty.
It's like well duh of course you'd prefer the impossibly unrealistic miracle.
Impossibly unrealistic to get rid of enormous sugar production subsidies that make it insanely cheap?
Impossibly unrealistic to simply tax added sugar?
https://slatestarcodex.com/2017/04/25/book-review-the-hungry... might be interesting in the same direction.
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This evening, go for a one minute walk.
Tomorrow evening do the same.
Next evening do the same.
Repeat.
The journey of a thousand miles begins with the first step.
All that is to say, these two are not mutually exclusive and if people receive this drug everything we already do to promote a healthy lifestyle will become much more realistic for many people, as far as I understand Ozempic removes the desire of hunger, it's not like people can continue their bad habits and take the drug and lose weight. Furthermore once they assume these habits, the generational cycle of raising children and over indulging will likely come to an end and we will probably not need the drugs as much.
TL;DR, people want to be healthy, they just don't have the tools or motivation to do it. Losing weight will likely be a gateway to many health improvements and benefits for future generations
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Nobody talked about this in the mainstream conversations in the past.
https://letsmove.obamawhitehouse.archives.gov/
Out from underneath the rock, people have been talking about this nonstop for decades.
"The announced investments across both companies total $32 billion. GLP-1s were 71% of Novo’s revenue in 2023, 16% of Lilly’s in 2023, and 26% of Lilly’s in 2024Q1. If these sales are proportional to the manufacturing capacity used to create those drugs, then about 40% of Novo and Lilly’s combined estimate of $45 billion in gross PP&E is for GLP-1s, for a total of $18 billion; $25 billion would then mean a 140% increase in GLP-1-relevant PP&E."
Manufacturing investment is not proportional to sales, because there's a fixed cost to making a certain drug regardless of how much you sell. If a rare-disease drug will have a few thousand patients ever - not uncommon! - you still need to figure out a synthesis path for that particular drug, run QC tests on the production line, get regulatory approval, etc. Economies of scale matter a lot (https://en.wikipedia.org/wiki/Experience_curve_effects).
> the active drug in Ozempic can be produced for about 29 cents for a month’s supply, or 7.2 cents for a typical weekly dose, the research found. It’s not cheap to make — semaglutide costs over $70,000 per kilogram. But only a tiny quantity of the drug is used in each weekly dose.
> https://fortune.com/europe/2024/03/28/ozempic-maker-novo-nor...
I think this makes it likely that strongly ramping up the supply is not a major problem.
I have zero expertise on this, but would be curious if anyone knows what's special about Ozempic delivery that can't be served by a commodity syringe.
https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...
A few weeks ago I started a low dose of tirzepatide (aka Mounjaro, aka Zepbound) and the side effects are interesting.
The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.
But there are some unexpected positives.
Obviously I am eating less. I have to log food not to keep it in check, but to make sure I'm eating enough and with the right nutrients. There's another possible negative here -- you get a lot of hydration from food, so if you start eating less you should carefully monitor your fluid intake to allow for that.
But I'm also more focused. Not nearly as distracted. I'm getting a lot of things done which I used to just procrastinate on until years had passed in some cases. Man, the garage is going to be clean and superbly organized in a few weeks.
And my emotions are quieter. Not just the food noise, that was expected, but I feel more relaxed. That's not what I expected, and I'm pleasantly surprised.
As an aside, what makes this all really noticeable is that it's a once-a-week injection, and the peaks and valleys are very obvious. Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.
Edit: Before someone asks, yes I have considered there may be long term effects. This is a risk, which I've decided I'm okay with at my age. Nobody gets to live forever anyway, and I was going to end up in an early grave via another route if I didn't do this. "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.
I do hope to taper off at some point if I can figure out an alternate strategy for staying lighter. Though I'll miss some of the positive side-effects.
Studies show it just doesn't work.
There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 and the likelihood of going from severely obese to normal weight is 1 in 1667.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407685/
[edit] not to mention for those 1 in 11, the average weight regain over 5 years is 80%.
https://www.sciencedirect.com/science/article/pii/S000291652...
It's not that "eat less and exercise more" doesn't work, it's that nobody does it, because it's really, really hard.
Calories in/Calories out is both completely true and completely useless for actual humans.
edit: that's unfair, mostly useless
Eating less and exercising most certainly does work, if the individual sticks to the routine.
I do agree it's difficult to stick to a routine because our modern lives are demanding and so we compromise by eating fast food and avoid going to the gym.
I think the exercise paradox video recently put out by Kurzgesagt has been a net negative for how people think about diet and exercise. The paper the video is based on is highly flawed.
That paper has a few major problems but these are the biggest:
1) The authors didn't control for body mass. The Hadza and Bolivians burned 52kcal per kg of body weight. Americans burned only 38kcal per kg of body weight. That is: the active groups burned significantly more calories than the inactive groups, on a pound-for-pound basis.
2) The active groups were defined as such because they walked ~12km per day. This is significant because the human body is exceptionally efficient at walking. It is certainly true that over a comparable span of time, you will burn less calories walking than you would running, or lifting weights.
GLP-1's are miracle drugs and people should take them if they at are high risk for obesity-related diseases.
But diet and exercise certainly do aid weight loss, and will have fewer negative side effects than a GLP-1 drug.
https://www.germanjournalsportsmedicine.com/archive/archive-...
1. Consume more calories than your body will need to function
2. Consume as many calories as your body will need to function
3. Consume fewer calories than your body will need to function
When you consume more energy than you require, your body stores the remainder as fat. When you consume less energy than is required, your body converts your fat into usable energy.
Now obviously, this is an over-simplified explanation of nutrition. What you eat, when you eat it, how efficiently your body converts food to energy, and other factors will determine the little details. But the explanation I've provided is not nearly as over-simplified as "it just doesn't work."
To make a comparison, it would be like suggesting that the financial advice "earn more money than you spend" just doesn't work as a method of saving money, on the grounds that some % of Americans who try to save money end up in credit card debt.
It's the doom of the statistical distribution. Good outcomes are defined in relative terms on the bell curve, not on absolute performance which exercise is actually suited for.
In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. I can imagine farmers back in the days of 12-hour days of physical labor may burn 5000 or 6,000 calories. A pound of fat is 3500 calories.
Meanwhile, people that are generally following some 20 minutes of exercise five times a week, regimen of the medical establishment are likely really only burning about 300 to 400 calories tops in those 20 minutes sessions, if they even do that.
For the sake of argument, we're going to ignore the basal metabolic advantages of people that are burning an extra 1,500 to 3000 calories per day and the stimulated muscle growth that comes with it.
People back in olden days just on activity were burning a third to a half a pound extra of fat per day in terms of energy.
Meanwhile, modern people who "exercise" are burning maybe a tenth of a pound. Only when you get to "athletes" that are "training" do you get to the calorie burns that people's lives used to entail.
So it's important to keep in mind when people say exercise is ineffective in weight loss that they really are talking about very minor amounts of added activity by by modern medical standards.
Exercise is extremely effective at limiting weight if you get to what I call the 1000 calorie Hammer, where your exercise is adding an extra thousand calories or more per day to your activity. And you're simultaneously not going nuts on your diet.
A 1000 calories is a considerable amount of activity. For a 180 lb man, that's 4000 yards of swimming, 7 miles of running, or 25-30 miles of biking.
If you are a 120 lb woman, increase those distances by 50%. Most people consider those loads to be exercise obsessives, but practically that's what's necessary in order to employ exercise as a usable means for weight control and surviving the corn syrup world we're in
The fact that the rate of obesity in the US has pretty consistently risen for decades makes that clear, you don't need statistical models of medical records to know that the rate of obesity could only really keep going up if those already obese stay that way.
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Unsurprising. They ran statistics on arbitrary overweight and obese people, with no idea of who was actively seeking to lose weight or who was just coming away from such an effort. If a significant fraction of the overweight/obese population did lose 5% of body weight/year, we wouldn't be seeing a bunch of overweight/obese people.
To be fair, I had also believed this for many years.
However, all the people who claim that "it just doesn't work", have never made any serious attempt to do "it", so they cannot know whether it does work or not.
I have been obese for more than a decade, during which I have made several attempts to lose weight, which have all failed, because they were not done in the right manner.
Then I have made a final attempt using the correct method, and I have lost about 35% of my initial body weight during about ten months, at a steady rate between 100 g and 150 g per day, i.e. about 1 kg per week.
This was more than 10 years ago and since then I have kept a constant weight. Because I have done this once, now I can control my weight and have any weight I want, even if I gain weight extremely easily. It is enough to eat one day like I was eating when I was obese to gain enough weight to require a week of weight losing diet to go back to the desired weight.
The rules for losing weight and maintaining the weight are very simple, but they must be observed and those who claim that "it doesn't work" never try to observe the rules, so it is entirely predictable that it cannot work for them.
First, it should be obvious that after losing weight one must eat differently as before, otherwise weight will be gained until reaching again the original weight.
To be able to control the weight, anyone who is or has been obese must stop eating until they feel satiated. At each meal, one must plan before beginning to eat how much to eat and then eat only the amount planned, never more than that. One must eat a fixed number of meals per day (preferably few, e.g. only two meals per day should be enough for an adult who has a sedentary lifestyle) and never eat between meals any kind of snacks or drink any sweet of fatty beverages. Between meals, only water or beverages without any calories (e.g. unsweetened herbal teas or tea or coffee) are acceptable intakes.
While losing weight, the most important thing is to weigh oneself every day with precise digital scales (with a resolution of 100 grams or less), at the same hour and in the same physiological conditions, i.e. in the same order with respect to meals and relieving oneself.
Whenever the weight is not less than the previous day, then the quantity of food planned for the current day must be diminished in comparison with the previous day. At the very beginning of losing weight there may be a delay, e.g. of a week or so between starting to eat less every day until the weight begins to decrease, but eventually it is possible to reach a steady state of a constant rate of losing weight per day.
When diminishing the amount of eaten food, only the carbohydrates and the non-essential fats must be reduced. The amount of proteins, essential fatty acids, vitamins and minerals must remain normal. To achieve this, one must eat a source of pure proteins, for example turkey breast or chicken breast or some kind of protein powders, so that eating enough proteins contributes only a minimum amount of calories. The rest of the nutrients can be provided mostly by non-starchy vegetables and perhaps by some supplements like fish oil. One could also eat almost anything that is not recommended, for instance chocolate, with the condition that the quantity is negligible, which can normally be achieved only when such treats are not eaten every day, but e.g. only once or twice per week.
These rules are simple and anyone who follows them will lose as much weight as desired. Obviously, this is easier said than done, because for the entire duration of the weight-losing diet one will be permanently hungry and one would tend to think about food and it will be difficult to resist temptations, so it is better to not keep in the house any kind of food that can be eaten immediately, without requiring some kind of preparation. Unfortunately, this is unavoidable and it is the price that must be paid. After the first few weeks, the hunger sensation diminishes in intensity and it always disappears for a few hours whenever you find some work to do that captures your attention.
As long as you do not want to follow such rules, you will not lose weight, but that is because you do not want to do it, not because it does not work.
Not wanting to do it is a valid reason, because one may abhor more the feeling of hunger during many months than being obese, but this decision must be described correctly and not be justified by the false claim that "it doesn't work". At least in my case, the improvement in my health and in what I was able to do (e.g. before losing weight climbing a few stairs would make me tired and sweaty) has made worthwhile any displeasure felt during losing weight and I have been very happy to have achieved that.
Caloric intake and outtake is just that.
Dead Comment
Perhaps coincidentally, this is similar to my experience with week long fasts: After 48 hours I feel like a precision missile cruising towards my target until about 5-6 days later.
But I will use a suitable GLP-1 based drug, because, man, fasting feels unbearably brutal for me after 6 days: profuse sweat, increased heart rate, brief but intense panic attacks, an insane level of sad (but not depressed) introspection, a hairpin trigger temper. I become a ridiculous mess. There's got to be a better way!
Thanks for sharing your experience and insight!
If you're willing to shoot up more often it moderates the effects better.
I'm a fan of these tools helping people get this insight, because otherwise people just accept that cloud as their normal.
If you want to be successful long term in your weight loss, especially after stopping the drug, you should really invest in changing your mindset.
This is a massive positive, not at all a negative.
You got fat because you ate too much. If you don't understand what are normal portions now, you'll go back to your starting weight as soon as the drug isn't having effects anymore.
This is a lifestyle change that you MUST embrace to be successful long term.
I have been taking tirz for 7 weeks and walking 5 miles a day + exercise. My depression is gone and I have lost 30 lbs. I am loving life.
Fwiw, to me the symptoms he and others have described don't seem very different from those of long fasting. And I would definitely prefer those symptoms to the ones I had due to obesity which ranged from extreme fatigue, heart-pain, muscle spasms, depressive shame, restlessness and so forth.
Manic behaviors also associated with older, popular diet drugs like meth.
Decades ago I tried phentermine for a couple months. Now that was a ride, and you might call the experience closer to manic. I was a machine. This is not like that.
The cancer anxiety could be reduced by frequent testing. e.g., having a thyroid ultrasound every 6 months, or a yearly abdominal MRI, just to make sure cancer is not brewing.
I haven't seen any mention of cancer on r/zepbound
But for fat people, the calculus looks different.
A decision to take semaglutides is a decision between the long-term negative effects of obesity *now*, or the possibility of long-term negative effects *later.*
Anecdotally, trans people have a similar calculus. Going unmedicated/unsupported brings significant mental health risk now[1], whereas going on hormone replacement may or may not cause complications much later in life (osteoperosis, hepotoxicity issues for some treatments, etc).
Either way, you gotta get to the "later in life" part before you can worry about the outlook there.
1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
> 1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G
This paper also finds that 5% of cisgender male and 11% of cisgender female students (out of ~8k surveyed for each) attempted suicide in the past year. It's kind of strange, because the age <=18 suicide rate (of "completed" attempts) is much smaller, approximately 1 in 5,000 to 1 in 10,000 [1].
[1] https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf, Figure 3
We've got 20 years of data on this class of drug. Certainly there could be some long term issues that we're not aware of yet, but it's not likely that there are significant issues that affect a large percentage of users after 30 years that didn't affect the small sample of users that have been using it for 20 years or the massive number of users that have been using it for 10.
The list goes on forever. I'm betting this ends the same way.
Who the fuck cares? If you're not overweight and are reasonably then you're already winning in physiological terms. If you can maintain a good quality of life into old age and then die, what more do you want? Going through life worrying about whether you're missing out on some marginal health benefit from the drug-of-the-moment is neurotic.
all in all general unease about dealing with symptoms and not the root cause of overweightness except in rare genetic cases, its overwhelmingly a dietary/exercise issue.
in this country the pill/drug is the answer and solution to everything but all this does is pile on more bandages without addressing the root cause which a very American solution.
I do not think the full ramifications are realized or knowable when there are profits to be made on both side of the fence, sort of like the whole opiate crisis in America started out as magazine ads blew up into a major crisis 20~30 years later.
After what happened with OxyContin I think wed benefit from some skepticism when a new drug gets oversold.
By itself this might be an ok question, but in context it's rather useless....
Diet and obesity changes by both lowering and increasing different hormone outputs in your body. You're balancing the question of "how is this hormone" versus "How bad is obesity on the body". Well, the answer is in, obesity is extremely unhealthy on the body in both the short and long term.
Drug overdoses cause somewhere around 100k deaths per year in the US. Obesity complications related deaths are in the 250-300k deaths per year.
You can be skeptical as you want, but behind smoking, obesity is the worst epidemic in the US.
They're not new.
Don't think you need to worry about that one.
https://pubmed.ncbi.nlm.nih.gov/15734706/
I'm not, someone who doesn't really need it. For example, some average weight housewife who just wants to fit in a dress a little better.
And still, I won't use it even though I can afford it cause it's the long term consequences are not entirely understood.
There's a really cool Modern MBA video [1] on this topic btw :)
[1]: https://www.youtube.com/watch?v=7sUoZVke_30
So does obesity, so there is that.
In mice.
the life expectancy of someone with bmi > 40 is -5 years
and for bmi > 50, -15 years.
So I suspect someone ~ 65 with high BMI should be on it, the side effects would be: living.
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You’re already benefiting.
Being able to lose weight while continuing to eat is a wonderful thing. There is no virtue in spending your willpower making your body do something it desperately doesn't want to do. That's some puritan shit.
We're about to see the nutritional equivalent.
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It's genuinely quite depressing that so many people in the United States have a weight problem that the overwhelming majority of the population would benefit from this and headlines including "we are all" are not inaccurate.
I don't think other countries are necessarily perfect here, but 74% of Americans don't have a healthy weight when you look at their BMI. That's a staggering statistic. Something is seriously wrong societally, and the priority should absolutely be non-pharmaceutical interventions.
The problem is that conversation overshadows the much more important big picture conversation: An entire nation is now becoming synonymous with poor health from obesity and we're not addressing many of the core nationwide reasons for that.
America was once proud of and eager to prove how fit and able its people were. Now the very idea of proper nutrition and exercise is deemed a nonstarter, "impossible", or an imposition on personal liberties. The existence of Ozempic-like drugs should not absolve us from the imperative to change how we live as a nation for the sake of our health.
Anecdotally I would say Europeans as whole are getting ever so slighty larger. But just not at the rate as Americans. Ozempic seems like a god-send.
The rate is probably comparable, it's the offset that's different. Won't be long until Europe is where the US is today (though I need to mention, this is regional, for example Colorado is at about 25%, and some European countries are already there).
Even Japan is getting steadily fatter, though they are way, way behind Europe and the US.
I agree.
I'm 51 y/o and still totally fit. Always have been. I am completely in control of what my body intakes. I can fast for 12 hours from waking up until dinner: I do it regularly (as in at least five times a month, probably a bit more).
I did do sport like crazy when I was young but don't even bother that much. Some walking, taking the stairs instead of the elevator, some bicycling, some tennis. But at a gentle pace. "More haste, less speed" (thousands of years old saying).
It's crazy to poison oneself to the point where another poison (that Ozempic drug) is needed to counter the first poison.
I'm not saying it cannot help but sadly there's no way to say it nicely: if you need that, your body controls your mind.
It should be the contrary.
> Something is seriously wrong societally ...
The biggest issue to me is we live in societies (not just in the US) where we victimize everyone. Nothing is never nobody's fault. We find excuses for just about everything.
We should go back thousands of years and read the classics: "healthy mind in a healthy body". Greek philosophers had already figured that in the Antiquity.
Mind over body.
America first... the rest of the world is playing catch up as quickly as possible.
>In March of 2023, the World Obesity Federation (WOF) released a report(Link downloads document) stating that by 2035 over 4 billion people – more than half the world’s population – will be obese. >and the priority should absolutely be non-pharmaceutical interventions.
Illegal. Or is should say Coca Cola can and will fight you to the death the moment you try. If you stand between the junk food companies and advertisers you will have an army of lawyers fighting you 'tobacco industry' style for the next 50 years.
Until the shit is off our shelves and out of our ads nothing will change.
This is not exclusive to the US. The world is trending towards those, and different countries seem to only be at different distances from it, but the same velocity.
Also, industrialized food seems to be much more effective in causing dependency. Food preparation has overwhelmingly shifted into less healthy alternatives (even when they sound healthier in a naive review)... And there's a multitude of low probability high impact possible contributors that nobody knows if are important or not.
I’m hoping we at some point have a “lead in gas” moment and discover some culprit in softening agents in plastics or preservatives in foods that we find out is messing up peoples systems. I could imagine that there is something that has a minute effect on the short term and doesn’t show up if you only look at people for 1-2 years but causes significant disruption on the timescale of 5-10 years of exposure.
The obesity epidemic seems to have started in the 1960-1970, so the sedentary lifestyle of computer focused work came later, but it is still recent enough that culprits in the mass produced uniform product market could be a cause, or the advent of one type of fertilizer or antibiotic given to animals etc.
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Research especially into people with healthy body weight seems to indicate that there is something going on that is causing widespread obesity. That is, there's some sort of environmental "GLP-1 Turbocharger".
Maybe it relates to processed food, maybe it relates to microplastic contamination, maybe it's in the cheese, maybe it's an innocuous viral agent, maybe it's gut biome, maybe it's ADHD drugs, maybe it's SSRIs.
I suspect that Ozempic is helping us get back to a baseline level of exposure by counteracting this. And in the future if we're lucky we'll figure out what it is and try to correct it at the source.
Out of curiosity, last year, I purchased some test strips to test my drinking water. The strips showed typical contaminates: arsenic, lead, copper etc. they all registered in the "acceptable range". In the test, there was a test strip for QUATs (https://en.wikipedia.org/wiki/Quaternary_ammonium_cation), which caught my attention. It wasn't something that I would have thought to test for, but my water tested positive. I was curious, so I started testing other local water sources including bottled water from various brands; to my surprise they all tested positive for QUATs. The only local water I could find that didn't contain QUATs was distilled.
I thought maybe it was just in my area, so I started taking the test strips with me when I traveled. In the last year, I've tested the drinking water in multiple states and countries, and only one source has tested negative for QUATs. It was the water from a drinking fountain in the San Francisco Airport, interesting enough.
My suspicion is that QUATs are often flushed down the drain, and the molecules must be too small to be filtered out in the water treatment process.
I haven't found much research on the impact of QUATs on the human body, but I can help but think our mitochondria would be susceptible to damage.
A lizard whose bite makes its prey eat less is crazy but it exists.
A lizard whose bite makes its prey eat more is also crazy, but maybe it exists?
The first lizard is literal, the second lizard is a stand-in for whatever mystery force I am postulating the existence of.
When you look at the historic literature on diet and nutrition from the first half of the century it's like looking into another universe. People are obsessed with getting people to eat more to prevent malnutrition even when food is freely available. Something changed.
We all know the solution: Organic vegetables, lean protein, and lots of exercise.
There isn't anything even remotely close to a scientific consensus on any of those.
There are plenty of scientists who tell you to stop exercising when you want to lose weight, because the exercise leads you to eat more than you would otherwise, and is ultimately self-defeating -- to focus entirely on eating less, and then only add exercise back in once you've reached you target weight. And "processed food" is a highly non-scientific category that is way, way too disparate to be useful at all.
Organic vegetables might be nice, but there's zero evidence that organic vegetables are better at weight loss than non-organic. Also zero evidence regarding lean protein as opposed to fatty -- there's a big argument that fatty meat is better for weight loss, because the fat satiates so you wind up eating less calories overall.
It might be that they are already exposed to enough processed food and pesticides that simply getting those things out of their diet is not sufficient, but I think it's clear that there's more going on here than a simple answer.
And, I think, most damningly, there are many people who maintain a healthy weight with no active efforts to maintain that weight, including a lack of exercise and consumption of processed food. It might be that a significant fraction of people are resistant to this effect or might just not enjoy the taste of processed food so naturally gain the benefits of avoidance.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/
The person holding the gun is mental issues. Mental issues cause people to eat unhealthily.
How mammals ingest, process, store and burn energy has been well understood for a very long time.
You know why some domestic dogs and cats are overweight? Is it ADHD or microplastics? Of course not, it’s because they’ve been eating more energy thaN they have been burning for a while.
Ozempic only stops you wanting to eat more, which perfectly proves the point. The boogeyman you are searching for is eating more energy than you burn.