[xnx]

This is definitely a historic moment in US public health. Today we look at photos and marvel at how prevalent smoking was 50 years ago (in restaurants, in hospitals, in airplanes, etc.). 40 years from now people will look at photos from the last decade and be in disbelief at how widespread obesity was.

[boc]

It also hopefully opens up the door to responsibly talk about how obesity will shorten your life significantly. There isn't a concept of "healthy obesity" when you look at your body's bloodwork. My buddy lost a friend who was only 38 due to complications from morbid obesity. It was tragic.

Cheap, effective interventions like this are incredible for our future populace.

[intothemild]

Sadly that "healthy obesity" or HAES (Healthy At Every Size) people are very much against this or any kind of weight loss. It kind of undermines their whole movement.

I want to point out, I disagree with the HAES people, you are not healthy at every size.. you're going to have some people who are more healthy than others regardless of some amount of weight... But not obesity, not that size.

[jwestbury]

I'll note: HAES, at least initially, was about living a healthier lifestyle regardless of weight, especially recognising that without this latest batch of weight loss drugs, sustainable weight loss is incredibly difficult, and that weight loss in general can have some paradoxical effects such as increased appetite and lowered BMR.

[nathanyz]

This cannot be understated. Obesity is being changed from a willpower problem to a chronic disease that is treatable. The follow-on effects of this are huge.

[candiddevmike]

What are the side effects? There's never a free lunch with biological systems...

[belltaco]

Free lunches are part of the problem that led us here in the first place.

[qwertox]

It was sugar.

[Obscurity4340]

More glucose == more brain power /s

[nathanyz]

It slows down gastric emptying as one of the primary ways it helps people feel full longer, so there a slew of possible GI side effects (nausea, constipation, diarrhea). In general they are manageable due to being able to adjust dosages to where patients still lose significant weight and minimize the impact of those side effects.

[xnx]

Possibly none. These drugs are bringing our appetite under control in an environmental that is full of readily available, appetizing, easy to digest, high-calorie foods.

[molsongolden]

I've seen the benefits of these drugs for people close to me but this whole concept still feels a bit dystopian.

Companies selling $500-$1,000/mo drugs to counteract the garbage food and "food products" other companies are producing and marketing to us.

[bb88]

Well... when we were like cave men and calories were hard to get, hunger pangs make more sense from an evolutionary standpoint.

But now, through farming technologies, food has never been more abundant. Yes we've saved people from dying of famine, but then the corn producers grew so much more corn that were beyond America's daily dietary need, they then could use much of it for HFCS, say. Or you know, Taco Bell's fourthmeal.

[Spooky23]

In a few years the pill versions will be $40/mo.

[jwestbury]

Should be noted: Basically nothing is a "willpower" problem, in reality. Psychological research is fairly clear on this: People who make good decisions are people who don't even consider the bad decisions, not people who have some higher level of "willpower."

[derefr]

Any good studies yet on direct causal factors linking the American diet to (what I presume would be called) glucagon insufficiency?

[rs_rs_rs_rs_rs]

>Obesity is being changed from a willpower problem to a chronic disease that is treatable

It's absolutely a willpower problem. These medications won't fix that for you. You stop taking them and you will gain weight again.

[belltaco]

All forms of contraception are also solving a "willpower problem". Food is even more of a basic need compared to sex, so evolution has it made it so that it's really hard to eat less.

[bb88]

Hunger is caused by not enough glucagen-like peptides (GLP-1, etc) being distributed to the brain from the gut. Obesity is not so much a food "addiction" as it is the body's failure to properly regulate it's own fullness.

I've heard this called "food noise" by those who are obese. GLP-1 agonists reduce the so called food noise -- that's all it does.

In that light your argument is like trying to tell schizophrenics, "Hey, stop hearing those voices in your head!" I think we tried that for over a century.

[intothemild]

I can speak to the food noise.

I hit my 30's, and became a dad, I lost my ability to run as much as I did. Now a decade later that's changed. But in that time I gained a lot of weight. I started running again. I'm a distance type of runner so I'm talking 6-15km a day, 6-7 days a week.

With that out of the way. After doing that for 6 months I was wondering WHY am I not losing weight? Like basically nothing. I counted every calorie, kept myself in a caloric deficit, used a TDEE spreadsheet to keep readjusting my daily caloric needs. Nothing was working.

Went to the doctor, he did blood work, it was all pretty much normal for someone obese. He asked me how hungry I am. I said I'm constantly hungry and it's just willpower alone that keeps me from eating, unless I had a drink, so I usually refused to drink.

I was put on Ozempic/Wegovy.

Pretty much two weeks later, I stopped thinking about food. Gone. Just gone. Before I would wake, and I'd be planning every meal.. when, what. How much, etc. If anything got in the way of a meal, I would be super irate. I was counting down seconds... Every single thought in my head was food.

Now gone.

I sometimes forget to eat.

So yeah. Food noise is real, and it suuuucks.

Side note: the weight loss helped my running a lot! And the weight loss seems to have stalled... But I don't care. I'm just happy to have this extra energy from not thinking about food every second of every day. :)

[lifty]

Fully agree with you. I think the unknown that still remains is why that noise is created. It must be related to modern food processing, besides the abundance of food.

[bb88]

I don't necessarily agree with that premise it's modern food processing.

The evolutionary human condition was primarily hunger. Animals fought over food. Humans fought, went to war over it. Nature has been that way for millions of years.

So now only in the past 100 years food has become abundant. Do you expect our evolution to change with it to be that quick too? That's really only 4 or 5 generations.

One data point here. In the 1700's, 1800's the rich were the ones that were fat, because they were the ones that had the abundance.

[lifty]

That doesn’t explain the discrepancy between USA and other regions of the world where obesity rates are much lower but food is equally abundant.

[nathanyz]

The amount of willpower required to maintain differs from person to person. So yes you can willpower your way to a healthy weight, but the amount of mental energy required is going to vary significantly between people. The drug proves it as it basically flips people with a high willpower requirement to feel more in the normal range where it is easier to eat less.

[aantix]

We commonly accept that are large ranges of inner experience.

Different levels of anxiety, depression, focus, pain, sexuality. All that we can manipulate with medication, to bring within a range we find suitable.

So why can't ones inner experience of hunger be vastly different from someone else?

[aantix]

Long-term success numbers on 10-year weight loss are abysmal. Everyone gains it back.

Eating right, exercising, taking this medication - if you stop any of these, yes, you will gain back weight.

[intothemild]

I'm on Wegovy, I'm told it will be for 2 years max... Then I'm weaned off it. My biggest fear is when I come off, the hunger and food noise returns.

I would happily continue to be on this med for the rest of my life, side effects and all.

[aantix]

What's their reasoning for "2 years max"?

[mortallywounded]

How? You give an obese person a pill and they shrink. They will go back to obese when they stop taking the pill and resume the diet and lifestyle that got them obese to begin with.

What we need is a radical change in the food we eat and how we live our lives. It's easier than ever to not move all day. Sugar in one form or another is our primary diet. These problems won't go away.

[intothemild]

What I do hope these drugs do, is offer people ways to get themselves into healthier lives. One of the things I hear/read all the time is how "people just need to stop eating bad" or some such.. it's practically your comment here.

The issue with that thinking is it's super black and white, that willpower alone is the cure to weight loss.

So let's do a little thought experiment , what about all those naturally thin people, like really thin.. they can eat what they want and remain thin, find it hard to put on muscle. If it's really really hard for them to gain weight... Then isn't the inverse also true? Aren't there also people who are trying to do everything they can but for similar get inverted reasons just cannot lose weight?

The problem with relying on willpower alone is there's a finite amount of it.

Yes, for some people they have terrible willpower, they have terrible diets, and they do not work out. But they aren't the only ones. There's definitely others who are trying but failing... And you can only fail for so long before you give up.

So going back to my first point. I hope these drugs enable a new option, to get them past a certain point where they can lose weight without the failure... Begin to make better choices... Gain more confidence and willpower.

[mortallywounded]

Options are good.

My own mother struggled with her weight and opted for surgery at one point while I was in college. It did help her lose weight and keep it off. However, I honestly believe that surgery was a large factor in her death many years later. She was never the same after it. She lost the weight, but I would say she never obtained a healthy body and mind.

I don't say those things lightly. Surgery and other interventions are fine, but they shouldn't become our goto solution for these problems. There are absolutely other problems at play here. Willpower may be one of them, but the way food is mass produced and our usage of sugar additives seems to be a huge factor (we now have obese children...).

This lecture changed my mind on many arguments in this space: https://www.youtube.com/watch?v=dBnniua6-oM

[xnx]

> What we need is a radical change in the food we eat and how we live our lives.

That for sure would obviate the need for such pharmaceutical countermeasures, but achieving such radical change would be very difficult and time consuming. I'm glad we have some options to improve the quality and quantity of peoples lives while we work on that.