[robohydrate]

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.

[vessenes]

Tirzepatide and Semaglutide are both known to reduce addiction / substance ingestion. I noticed I was just less interested in Alcohol when I started on Wegovy, and didn't realize it's a common effect until much later. I retained most of my disinterest after going off, too, FWIW.

[dyauspitr]

Sounds like a miracle drug that helps with all afflictions that come with our modern life/sedentary living.

[Alupis]

The problem with this (and all diet plans/drugs) is the lifestyle that led to problem in the first place.

If you do not change your lifestyle, for real and not just superficially, then you will relapse with a vengeance.

That is to say, be careful with using a drug as a crutch. Sure, it can artificially make you much more interested in not consuming so many calories and/or perhaps being more active than before - but you have to continue that lifestyle after stopping the drug.

Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?

[Someone1234]

> Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?

Have alcoholics using Naltrexone? Or opioid addicts using Methadone, or smokers using nicotine gum/patches?

See I'm bringing this up to point out the obvious double standard, people suffering from food addiction (i.e. literally the high from food) or binge-eating disorder, who finally have an effective treatment, are treated like it isn't addiction or illness, but a "lifestyle," but if you said this stuff about any other addiction people would call you out and be horrified.

For people mildy overweight or accidentally obese, it is a wildly different illness for people with lifetime problems who have lost/regained weight tens of times and likely know more about nutrition than most healthy-weight people ever will.

[seadan83]

The concern regarding a drug as a crutch is stil valid. Smokers/drinkers may deal with stress by smoking/drinking. After cessation, ways to deal with stress need to be learned from a new.

"Addiction" is ambiguous and a term almost better not used. "Addiction" may constitute chemical dependency but can also be largely a set of habits. A set of habits and lifestyle are pretty much the same thing.

[CydeWeys]

The problem is that calling it a "crutch" is already presupposing a negative judgment of it. Use a neutral word; e.g. it is a weight loss aid.

[golol]

What's wrong eith a medicine as a crutch? If you break your leg you use a damn crutch and that's good. If you suffer from an illness and we have a medicine that's worse than the illness and affordable - go for it. Phrasing it as a crutch suggests it is somehow only a temporary that prevents you from finding a "real" solution by changing your "lifestyle". It doesn't matter, only outcomes matter.

[cbsmith]

> The concern regarding a drug as a crutch is stil valid.

People with pacemakers can't get off of them either, but it doesn't have the same stigma. Diabetics often need regular insulin injections, but it doesn't have the same stigma. People with high-blood pressure often need regular medication, but it doesn't have the same stigma. It's mostly antidepressants and now Ozempic which have this stigma.

> A set of habits and lifestyle are pretty much the same thing.

I believe the DSM does not consider them "pretty much the same thing".

[namaria]

'Anew' is an adverb: learn anew.

'Learn from a new' is missing an object.

[goosedragons]

I think the difference is with food you have to eat it. You don't need alcohol, opioids or nicotine to live. With food it's much easier to fall back into similar or the same pattern as before because you can't avoid it.

[dazc]

The other problem being the availability of healthy food. Those without the time or facility to cook are dependent upon stores selling convenience foods which are anything but healthy, those foods labelled as such being some of the worst examples.

Despite not being overweight and taking regular exercise, I have recently been diagnosed as diabetic and now see the world in a different light. It really is quite shocking how many aisles in. a typical supermarket are stocked with complete junk food.

[seadan83]

Chemical dependency I believe can confuse the brain, where it actually does think you need the drug to live.

It can be very hard to avoid booze or cigarettes. They are everywhere. Potentially throughout all of a person's social group. Maybe at home if spouse or parents smoke.

As a former smoker, changing diet was easier for me than to change a smoking habit

[bitnasty]

Actually not true. All addicts develop lifestyles around their addictions. Alcoholics often have many social connections that involve alcohol, what they do for fun involves alcohol, etc. A successful recovery typically involves changing this lifestyle to make the problem behaviors easier to avoid.

[nox101]

People that move out of the USA generally lose weight. Especially if they move to a country with snaller portions and more walking. People that move to the USA generally gain weight. Evidence that it's lifestyle.

[NilMostChill]

That's evidence of environmental factors.

[pclmulqdq]

I would suggest that you look at food labels of "equivalent" products on both sides of the Atlantic. US packaged foods have a lot more sugar (and general calories) than those in Europe, even when they are the "same."

[grepfru_it]

Just needs to be a walking friendly city. You will lose weight in eg NYC or Seattle

[gooosle]

Most of the obese people I know are completely clueless about nutrition and exercise (even though they think they know a lot).

[Alupis]

This is bunk. An actual chemical addiction is not the same as feeling an urge to drink 8 cans of coke a day, or being unable to not buy a bag of chips at the gas station.

[ben_w]

Is it, though?

Your entire body and brain is a complex and messy chemical reaction.

The opening sentence of the wikipedia article on addiction currently reads: "Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences."

The page then lists "eating or food addiction" as examples, with food addiction being its own entire page.

[manacit]

Gambling? Porn? Sex?

These are all things that we acknowledge are possible to be addicted to to that are not substances. Not to mention that coke has caffeine which is a chemical substance just as much as anything.

You can pin addiction to anything as a personal weakness, including drugs. Why are some people able to smoke a few cigarettes or do a little bit of cocaine without ever getting addicted, when others are hooked on day one?

If there's one thing that's been fun to see as the outcome of GLP-1 drugs, it's that a lot of people seem to have a real problem seeing people better themselves the "easy way".

[jdhendrickson]

I find this attitude strange. I am a very physically fit man, I do not know what it is like to walk in the shoes of someone who has an addiction to food, but I do know people eat themselves to death. People deal with debilitating diseases that are directly linked to the amount they are eating. People literally destroy their body and live in the wreckage, and you think that it's not an addiction? If not an addiction what exactly is going on?

[wtetzner]

Seed oils (used in almost everything these days) contain a lot of linoleic acid, which is a precursor to endocannabinoids, potentially giving you the munchies. If eating gives you the munchies, making you want to eat more, I'd call that a chemical addiction.

I think avoiding bad foods is a better solution than reaching for drugs, but if the drugs help break the cycle, it could be beneficial.

[mort96]

The fact that people have this idea that "obese == unable to resist drinking 8 cans of coke per day" is honestly part of the problem.

[stirfish]

People get addicted to gambling, and you don't put that in your body at all.

[__blockcipher__]

It’s the same thing. Obviously withdrawals and such are different but the core mechanism of disregulated reward processing leading to compulsive behavior engagement is exactly the same.

[JamesBarney]

>If you do not change your lifestyle, for real and not just superficially, then you will relapse with a vengeance.

Longterm glp-1 agonist research doesn't agree with this.

> but you have to continue that lifestyle after stopping the drug.

Why stop the drug?

>Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?

A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term. We've been trying to solve obesity this way for a 50 years and have bubkis to show for it. If someone has high cholesterol we give them a statin, if they have high blood sugar we give them diabetes. Now if they're overweight we give them ozempic.

[data_spy]

The research says you gain the weight back:

"For the two in every five patients who discontinue the treatments within a year, according to a 2024 JAMA study, this means that they are likely to rebound to their original weight with less muscle and a higher body fat percentage." The other issue is the muscle loss on being on these drugs as "Clinical data shows that 25 per cent of weight loss from Eli Lilly’s shot resulted from a reduction in lean body mass, including muscle, while 40 per cent of Novo Nordisk’s jab was due to a drop in lean body mass." Via https://www.ft.com/content/094cbf1f-c5a8-4bb3-a43c-988bd8e2d...

[JamesBarney]

Sorry I meant with continued use of the treatment you don't regain the weight. I agree if you stop taking the medication your weight will rebound.

[s1artibartfast]

Some regain, some don't. Some people have multiple heart attacks.

It is really that simple.

[Alupis]

> Why stop the drug?

Why would you want to continue using a drug for the rest of your life?

> Longterm glp-1 agonist research doesn't agree with this.

Please explain. If you stop using the drug, because you've achieved your goals, what stops you from relapsing other than your own personal habits and lifestyle?

> A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term. We've been trying to solve obesity this way for a 50 years and have bubkis to show for it. If someone has high cholesterol we give them a statin, if they have high blood sugar we give them diabetes. Now if they're overweight we give them ozempic.

Yes, a pill for this, a pill for that... and there's no chance we'll discover these drugs have negative effects when used by a person for 50 years.

[JamesBarney]

> Why would you want to continue using a drug for the rest of your life?

It's better than being obese. This is true of most drugs for chronic conditions. very few of them are curative, almost all of them treat the condition.

> Longterm glp-1 agonist research doesn't agree with this.

Sorry I wasn't clear, I meant with continued treatment you don't rebound.

> Yes, a pill for this, a pill for that... and there's no chance we'll discover these drugs have negative effects when used by a person for 50 years.

They might have negative side effects but obesity has very large negative side effects. I would be incredibly surprised if any of these drugs that have been used in diabetes treatment for a long time have anywhere close to the negative side effects of obesity.

[tikhonj]

> Why would you want to continue using a drug for the rest of your life?

Because it is a substantial net benefit to your life?

Same reason I might want to continue with, say, a regular exercise routine or meditation practice.

[justinclift]

> ... if they have high blood sugar we give them diabetes.

That sounds like a hell of a treatment plan. o_O

[bregma]

It doesn't work. I keep trying to get off the diabetes and I just relapse after a few weeks. It doesn't help that my body tries to hide the glucose everywhere, like attached to hemoglobin or in my liver in the form of glycogen so it can share a hit with me first thing every morning.

Nope, not going back to the doctor that gave me diabetes. That was a mistake.

[lizardlena]

> A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term.

Ozempic is only fighting symptoms of that, not the root of the problem which is the stigma around weightgain, being a big person, just fatphobia being extremly generalized and a lot of shame surrounding weight. While it's amazing for people who have medical conditions making them gain a lot of weight, just saying that they should take ozempic will not change people gaining too much weight. It's not anything like high cholesterol or high blood sugar in most cases.

[JamesBarney]

Fighting the symptoms of what?

Taking ozempic will definitely keep people from gaining weight and will help them lose weight.

[Eisenstein]

A few questions:

Can you qualify what you consider to be a 'symptom' vs a 'condition'?

Is high cholesterol a symptom of something, or a condition itself? What about high blood sugar?

Would you say that acid reflux is a symptom or a condition?

Is a person that takes Prilosec daily to treat bad reflux treating the symptoms and not the underlying condition?

What about people using asthma inhalers, or epipens: symptom or condition?

Are people allowed to use the medicines if their underlying conditions are not being treated?

[fortran77]

> While it's amazing for people who have medical conditions making them gain a lot of weight,

You mean matter is created out of thin air because of a "medical condition" and not by eating too much food?

[cthalupa]

I'm someone that has spent many years of my life eating well and exercising regularly, including weightlifting. I'm also someone who has spent the past decade doing neither of those things, with one attempt in the middle to correct my behavior interrupted by a knee injury.

I'm currently on tirzepatide and have also started to resume exercise, and I'm enjoying it like I did when I was younger - I expect I'll be able to go off of it when I get to my goal weight.

But at the same time, there's not any real reason that people would need to go off the drugs, outside of cost. So far we don't see any adverse reactions in the vast majority of people. Some people have reactions from rapid weight loss - gallstones, hair loss, etc. but these are also risks in crash diets, etc.

We accept that people will need lifelong medication (often with worse side effects) for other illnesses that have less risk to all cause mortality, etc., than obesity. Why would we be unwilling to do it for obesity?

The fact of the matter is that despite the risks and downsides of obesity being well known in America, 42% of American adults are obese. No amount of education or knowledge that has gotten us on the whole to eat better or exercise more. Plainly, being on these GLP1 medications is preferable to being obese based on all current knowledge.

[CydeWeys]

> The fact of the matter is that despite the risks and downsides of obesity being well known in America, 42% of American adults are obese.

It's down to 40% and dropping now, thanks essentially solely to GLP1 agonists! This will, no lie, save our country trillions of dollars in increased years of quality of life (and thus productivity) and reduced healthcare costs.

[metabagel]

> The problem with this (and all diet plans/drugs) is the lifestyle that led to problem in the first place.

I don't think we fully know what led to the problem in the first place.

I think it's a complex interaction between the types of foods we eat, and which are more affordable, our gut microbiome, and the amount and frequency of exercise which we are able to fit into our day.

We have some pretty good ideas that reducing intake of high glycemic foods, safely reducing overall calorie intake, and getting regular exercise will help.

However, it's the bad food which many families can most afford. Many people find it difficult to make time for exercise, since they are pretty exhausted from making a living. The foods which are bad for us tend to make us feel good in the short term.

When a person has become obese, it is harder to start exercising, and it's harder to find exercises which don't hurt their feet, joints, back, or other parts of their body.

Ideally, we would all have copious time to exercise, and healthy food would be abundant and affordable. But, that's generally not the case for most people.

And some people seem to be genetically predisposed to gain weight.

[sirsinsalot]

If you compare the typical American diet and ingredients to the rest of the world, the answer is clear.

The problem is most Americans (where the obesity crisis is worst) don't know their country's businesses are selling them rubbish and their government is subsidising it.

[jrockway]

I don't think you expect to stop taking the drug. It's a for-life kind of thing.

If a prescription for "lifestyle changes" were a drug, it would be one of the least effective drugs ever made. I read something directed at medical professionals that are skeptical of the GLP-1 receptor agonists and it asks, if you prescribe a drug and your patient refuses to take it, why would you keep prescribing that drug? Of course not. That's what lifestyle changes are, and the landscape has changed so that there are alternatives.

(My employer is heavy on the "lifestyle changes" angle. They will not pay for GLP-1s, but they will send you a newsletter about losing weight if you want. Guess who's losing the weight.)

[nwienert]

> you will relapse with a vengeance

You say this - but not from experience (correct me if I'm wrong and you have taken a GLP-1 agonist).

I say this because as someone who has taken it, I found one of the craziest parts is how they do seem to help you set better habits, and those habits do stick, and it's not like some fake thing.

For example MJ helped me do the following: entirely stopped late night snacking, stopped craving sweets, stop smoking weed. And it doesn't come back when I go off, even after months.

I wasn't especially overweight when I went on (maybe 20lbs), I did it for the incredible immune system benefit which seem to heal my immune disorder, but I was stunned at the results outside of it.

I get that people hate the idea of something that helps you be better without having to "put in work", but in the weirdest and best way possible, it seems to do that, at least in part.

[coffeebeqn]

> people hate the idea of something that helps you be better without having to "put in work"

This is kind of an incredible reaction many people seem to have. Isn’t this just a net positive? Even if someone feels like gatekeeping good health, ozempic is only giving you maybe 60% of the benefits of a healthy diet and regular exercise. It’s not taking anything away from people who put in the effort

[golol]

"Everything comes at a cost" as a meme is really deeply integrated in our culture. Since thousands of years probably.

[monkeycantype]

The genetics of hunger are fascinating, people literally feel very different levels of hunger. My family are mostly all quite fit and healthy, but this is because exercise and dieting are a cultural obsession in my family to an un-mentally healthy extent, because as I understand through conversation with others We feel an unusually high level of hunger, I can be full to bursting and hunger does not stop. I tried semaglutide, it was the first time I can recall ever feeling the absence of hunger. To think that my family and I are likely nowhere near the top of the hunger spectrum astonishes and horrified me

[slothtrop]

Yes, what's true and often understated about weight-loss is that people usually do lose weight when they decide to, but gain it back. Aside from lifestyle, metabolic adaptation is one factor. Since metabolism is lower, increasing calorie intake too quickly leads to weight-gain, and metabolism remains worse than it was before.

[perching_aix]

Sounds like it directly affects their lifestyle though? Being less drawn to addictions, and thus less engaged in related activities, is a pretty big lifestyle change.

[Alupis]

> Being less drawn to addictions, and thus less engaged in related activities, is a pretty big lifestyle change

While on the drug. Will those changes remain if the user stops using the drug?

[CuriousCosmic]

It really depends. If you break the addiction and it could very well remain.

An example is tobacco/nicotine. If you stop smoking while you are on the drug and you break the addiction and the habit, you aren't going to reform that habit unless you start smoking again. And that's unlikely to occur because you no longer have the habit, you no longer have the chemical compulsion, and you aren't consuming any of it. Maybe stress could force a relapse due to weakness of mind but all things considered that's minor relative to the chemical addiction and the habit forming behavior.

An example where you may see relapse is alcohol or marijuana where the substance comes almost more from a social environment than it does from the chemical draw. Like once the habit is broken, it's still easy to be put into situations where recreational use is common and more or less expected on rare or semiregular occasions. That of course could lead to new habits forming and leading to relapse or it may not depending on what other (hopefully healthy) habits the user is now taking part in, their stress level, and other aspects of their life.

So the answer is of course that it depends but if the drug can reliably help people break habits then it can maybe also be useful in helping them avoid forming new bad habits or relapsing when the urge becomes too strong to resist.

[Someone1234]

What is the core of your point? That these drugs, that extend life, and reduce associated illnesses should be ignored or not used, because instead people can die sooner in some attempt to cure themselves the "correct" way?

A corpse cannot learn healthy lifestyle habits. A living person who lost weight the immoral way or whatever you're trying to say, can of course.

[perching_aix]

They said that this specific effect was largely sustained after stopping with the drug, so... ¯\_(ツ)_/¯

[homebrewer]

Yeah, no. Speaking of "personal discipline" makes it obvious you have never seriously dealt with addicts. Solving it long term is basically impossible for some of us; pretty sure because of how our brains are wired at the physical level. I know all the (popular) science, I discussed it with a good doctor whom I personally know, I know you're supposed to change your habits long-term (and how you're supposed to do it), and I recently lost 15 kgs of weight for the fourth time in my life. The longest time I managed to maintain healthy weight was maybe 3-4 years. If Ozempic (or whatever) actually solves this, I'm ready to go on it for the rest of my life.

I also live in a "vodka belt" and know several alcoholics who tried very hard to maintain their "personal discipline". It's impossible for most of them -- almost all relapse in a few years' time.

[zero-sharp]

I'm one of those people who has repeatedly lost weight by managing food intake. I'm talking about losing over 30 pounds, more than once. It might have been three times. Oh yea and I've kept it off for close to a decade now. I didn't use drugs. At times I used a food scale to manage portions. At times I literally just microwaved broccoli for a snack/meal. I still do it periodically if I'm feeling self-conscious. Does it suck? Yep. Have you guys ever tried those things?

I mention this because I feel like you need somebody who has gone through the experience to actually have credibility in the conversation, to tell you that personal discipline is a real thing that can achieve results. I think it's ridiculous how quickly you dismissed the parent post.

[phil21]

I've gone through that experience multiple times as well. Also over 30lbs each time. Also having kept it off for years, although not quite a decade for my longest period. COVID was my last regression, as it was for many who lost it and maintained it the way we both did.

The GLP-1's are a game changer. I will never lose weight the "white knuckle" way again. I can, and I have proven it to myself and others. It's not complicated as you say - it's quite simple.

It's simply such a giant imposition on your life and mental well being that I am thankful others won't have to go through it as their only option in the future. The sheer chunk it takes out of my executive function means I can't perform nearly as well at other tasks in life. The GLP-1 class of drugs make it trivial in comparison. Like a performance enhancer for a diet.

I also have worked out a hell of a lot more taking Tirzepatide than I ever did counting calories on a food scale. This is because I feel so much better it's not even a comparison - primarily mentally, but also physically due to the other positive side effects the drug has associated with it. Plus I don't feel guilty when I go out with friends to a burger joint - I eat half and feel perfectly satiated, no guilt or "cheat day" required. My energy levels are not comparable. I have much more time in my day available for other activities, such as keeping appointments with my personal trainer at the gym or taking 6 miles of walks per day.

Losing weight and maintaining an active healthy lifestyle doesn't have to "suck" any more.

I feel like you need someone who has gone through both experiences to actually have credibility in this conversation. Willpower isn't a special trait, it's not something to lord over other people.

[mrcrumb1]

At what point are you willing to concede that it might not be feasible for someone that isn't you? If it were 10% harder do you think you would have stuck through it? 50% harder? The numbers say the proportion of people who are successful is very small and there are sure a lot of people who are trying

Edit: I'll add that I've successfully shed 100lbs through discipline before. With the life I currently as caretaker for my son I don't nearly as much room in my life for the mental overhead that sort of change in diet required me in the past.

[nunez]

So I was, also, a firm believer of the "gotta fix your lifestyle" school of thought regarding weight management until I was introduced to the Maintenance Phase podcast (hosted by Aubrey Gordon and Michael Hobbes).

This podcast, and Aubrey's book "What We Don't Talk About When We Talk About Fat," opened my eyes to the fact that many people are just _born_ hungrier than others.

The body will weigh what the body wants to weigh, no matter how many fad diets or drugs you throw at it.

Unfortunately, those whose bodies that don't conform to our modern, eugenicized definition of "healthy" and don't particularly care for working out at all times are dealt a lifelong sentence of social ostracizing, "have you tried this diet" and "calories in, calories out," mostly against their will.

To wit: I can easily scarf down 3000+ calories per day. EASILY. I also know people who struggle to eat 2000 calories per day. I've seen this dynamic with kids in the same family as well.

I'm not saying that it's impossible to make healthier choices. Everyone can benefit from a balanced diet and more exercise. I'm saying that some people will naturally be heavier than others, and that should be okay.

[cam_l]

I figure for some people it will work as a crutch and for some it will work as a prosthetic. I guess that depends on whether you need to take some weight off and allow yourself to heal, or if you are actually missing that appendage. Metaphorically.

[mitjam]

It seems to be more like an orthosis than a crutch as it helps the body to get back into a healthy state instead of replacing it‘s functionality.

[legacynl]

Well that's the whole point of the novelty of this drug.

This drug somehow effects our emotional resilience and/or the strength of our response to emotional decisions and/or the way our brain weighs different options regarding to long-term planing.

Basically instead of your suggestion of not treating drugs as a crutch, and trying hard to restructure your life; this drug basically does exactly that. It gives you the decision making of a person that already did fight the addiction and restructured his life. The only thing then is for the person to actually restructure his life by living his newly well-decisioned life for a while.

That's why it is sometimes bad advice to tell people not to use medicine as a 'crutch'. Just like actual crutches, they actually are meant to be able to temporarily support a person. If somebody needs a 'crutch' they should fully use it, especially if it can help them ultimately solve the need for the crutch.

I get what you're trying to say with the crutch thing, but personally this kind of attitude prevented me from considering medication much earlier. Even though we all feel deep in our hearts that standing by yourself is better than relying on some crutch, nobody cares, and nobody is going to give you any bonuspoints if you make it to your death without any help. If any type of medication or treatment can help you, for the love of all that is good, use it.

[skywhopper]

Did you even read the top level comment here where the person addresses this? Anyway, this sort of moralizing is incredibly inhelpful. Very few people are obese because they lack “discipline”. Certainly they are no less disciplined than most non-obese folks in the world. All sorts of factors play into obesity that have nothing to do with “discipline”: genetics, gut microbiome, local environment, food availability, mental health, physical disease.

There’s some small percentage of people for whom “discipline” is enough, but when people talk like you are with the implicit assumption that all fat people are lazy and immoral due to lack of “discipline”, you only reinforce the misinformation about the causes of obesity and make it harder to address novel causes with novel treatments.

[sheepscreek]

As someone very close to an Ozempic user, I can tell that you have no idea what you’re talking about.

Would we consider insulin a crutch? Think of this as something in the same league. At least that is the case for a good chunk of the target audience.

[marcosdumay]

Except for all the externally imposed ones.

But yes, there's a reason people are celebrating those drugs.

[rafaelmn]

I'd say it's the opposite - if you don't exercise you end up skinny fat which is metabolically unhealthy as well. It helps with super accessible dopamine hits I guess - which is awesome - but need to combine it with exercise for maximum benefit.

I wouldn't be surprised if they come up with a drug for that that's more sideffect free than testosterone/ derivatives. Lean and ripped cocktail

[vessenes]

This is true, but I'd qualify it. I'm MUCH more active than when I started, just naturally, and my heart health / true age stats (for what they're worth) are twenty years lower than when I started. I lost a lot of muscle, but as a percentage, my body fat is nearly half what it was when I started. 10/10 would do again.

Recomping is a huge struggle, you just can't eat enough to add muscle bulk. Cycling on and off is tough because if you don't taper off it, your body is like "thanks for ending that long term caloric deficit, have you heard of cake?". So you definitely need to approach the muscle mass question seriously, but in no world was I healthier back when I had an extra 10 to 20lbs of muscle, and the rest in fat.

[vladgur]

Would you mind sharing before and after lean/fat percentages and or numbers? I am really curious if there is a way to optimize bulkng prior to getting on these drugs with a goal of retaining muscle mass(important as we age)

[throwup238]

Take a look at the protocol for the protein sparring modified fast which is a form of short to medium term fast that is designed to retain muscle mass by eating tons of protein with a large caloric deficit (1k+ calories a day). You can easily convert it to a more sustainable Ozempic diet by adding more fat/carbs to make the lean protein more palatable.

Fair warning though, this isn't an easy diet if you're not good at cooking and can't easily develop your own recipes. Lots of lean chicken breast so techniques like sous vide really help.

[vessenes]

Prefer not -- sorry! I'm here on my real name. If you want my advice, lose the weight then worry about it. A good amount of research indicates you tend to gain muscle mass in the fat/muscle percentage you start with; regardless if you are seriously in need of weight loss, the benefits of doing that far outweigh the (temporary?) downsides of losing some muscle mass for most people I bet.

[jjeaff]

Skinny fat is not nearly as metabolically unhealthy as fat fat.

[queuebert]

Fat fat can better survive the coming post-AGI apocalyptic famines.

[wwweston]

Turns out it can also be useful during a personal apocalypse: having recently lost about 35lbs from emergency chest-cracking surgery, ended up pretty glad I wasn't at my leanest going into it (sadly, more of the weight lost was probably muscle wasting/deconditioning than fat stores, but on balance it was probably good I had at least 15lbs of fat stores to burn).

[azinman2]

It’s actually worse in terms of metabolic disease, surprisingly.

https://www.mayoclinic.org/diseases-conditions/metabolic-syn....

[rafaelmn]

No argument here - just saying it's still not the endgame. Lean/ripped combo - now that's something I'd subscribe to/inject for regularly.

[eli_gottlieb]

Honestly, sounds like our "modern lifestyle" is designed to get everyone addicted to something, and the healthiest possible addiction is, as it turns out, an anti-addiction medication.

[arijo]

It's not a miracle drug. Check this Joe Rogan interview to understand at a deep level all the problems with a drug like Ozempic: https://www.youtube.com/watch?v=G0lTyhvOeJs

[arijo]

I know this going to be blasfemy but the real problem here is carb addiction and we should be treating the root cause not the symptoms with a drug with unpredictable long term consequences.

[gizajob]

I'd second this opinion – weight can be lost so easily by dropping the majority of carbs. By that I mean base one's nutrition on meat / fish / eggs / vegetables / fruit, with no pasta, no bread, no sweets, no cake, no chips/crisps, no biscuits / cookies etc (and no booze too, or at least keeping it very minimal or sporadic).

If you do 1000+ calories a day of exercise above your basic metabolic rate / consumption, you will lose 1kg/2lb per week. I'm doing this at the moment (and then will be continuing beyond) and it really does work. I do, however, have the luxury of spending 3-5 hours a day in the gym & fitness classes and swimming pool, and cycle there and back. My Apple Watch is amazing at tracking the calories burned in all these exercises, so I know that I'm burning 3500 - 4800 calories a day from exercise. It's trivial to then only eat around 2000-2500 calories a day. This can barely even be classified as a diet, just healthy choices.

The availability of cheap calories and easy carbs everywhere really is the peril of the western diet. Eating vegetables and protein is a little strange at first but the weight will drop off without having to feel hungry. Hence I'll be joining you in the blasphemy, but this really is a solution to excess weight and it's simple maths that cannot be cheated by the body – unless one has some kind of extreme medical condition, the body simply will not stay heavy while running a deficit and a high protein and low "lazy" carb diet. And I'm saying this as someone who has a decent amount invested in both Novo Nordisk and Eli Lily stocks...

Yet it seems that now these drugs exist, it's easier and quicker to take them as a fast track, because if you're 50kg / 100lb overweight, then to say to someone "you need to exercise quite a lot every day, while not eating cheap carbs, for a whole year and then continue beyond" it simply seems too difficult and hard.

[karmajunkie]

you lost the debate the moment you cite joe rogan.

[arijo]

I would listen to what his guests on this particular podcast have to say before jumping into conclusions just because the interviewer is Joe Rogan.

I have no particular opinion on him - I’m just interested in what the interviewees in this specific episode have to say about metabolic health which has direct implications on the massive usage of drugs like ozempic.

[cthalupa]

I'll start with stating that Joe Rogan has, as the years have gone on, resulted to more and more fringe guests on basically every subject.

Then I'll point out that these guests are MDs, not PhDs.

And then I'll point out this bit from the description:

> Dr. Casey Means is the Co-Founder of Levels Health, which provides insights into metabolic health through real-time data. Calley Means is the Co-Founder of Truemed, which enables HSA spending on healthy food, supplements and exercise. They are the co-authors of "Good Energy."

Their livelihood is based on selling people apps, services, hardware, supplements, etc. around a certain lifestyle. They've got direct financial incentive to be against GLP1 medications.

For any specific claims, well, if you're going to use a video for reference, present the specific claims, timestamps, etc. You can't expect random people on the internet to watch a two and a half hour video off of nothing more than "you'll understand at a deep level the problem with glp1 drugs!"

[asyx]

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.

Now, I can easily stick to a super low carb diet

[nessguy]

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.

[gscott]

> 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.

[riffraff]

> 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!

[nessguy]

> was the feeling of hunger due to drastic reduction in portion size?

While that was sometimes the case, it wasn't always so. Sometimes the feeling of hunger was almost random, and certainly stronger than it should have been. This was likely caused by insulin resistance.

When I got out of bed because I was too hungry to go to sleep I didn't always make great food choices. I'd tend to eat a 200-400 calorie 'snack', which felt like it wiped out any progress.

Now that I'm on tirzepatide I still feel hunger and cravings, but I suspect it's more in line with what regular people feel. Even if I haven't eaten much during the evening and am a little hungry at night, it's not the type of hunger that stops me from being able to get to sleep.

> Still, I'm happy for you that you found something that works!

Thanks!

I'm honestly in the category of people that have considered weight loss surgery, but I've seen enough problems from that that I've never really wanted to risk the associated problems.

From all the reading I've done it sounds like tirzepatide is almost as effective as weight loss surgery. And people are going to have a hard time convincing me that weight loss surgery is 'safer' than a GLP-1 injection.

[glenstein]

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.

[pedalpete]

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?

[cthalupa]

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.

[coffeebeqn]

Bodybuilders lose muscle and they do a lot of hypertrophy training and high protein eating to counteract it. Probably the average ozempic taker does neither of those so they end up losing more

[cthalupa]

Sure. You're going to lose some muscle mass no matter what you do. And yeah, if you don't do either of those things, you're going to lose even more.

But fat people actually frequently have quite a bit of lean body mass - it takes muscle to carry around all that weight, even if you're sedentary. If I somehow maintained the LBM shown in my DEXA scan at the start of tirzepatide, by the time I got to my goal weight, I'd be looking more jacked than when I was lifting 3 times a week.

Obviously, I won't. I'm adding more and more cardio and lifting back in as my weight is dropping and it becomes more maintainable for my joints, etc., and I've been supplementing protein since the start, and I'm sure I'll still lose plenty. But I have the room to lose A LOT and still be in the healthy range of body fat%.

[hyperG]

There is a linear relationship between fat loss and caloric restriction until about 7 or 8% body fat.

The idea that caloric restriction is causing all this muscle loss is one of the dumbest ideas we currently have.

It is simply not true.

[cthalupa]

What is your argument? That losing weight does not result in muscle volume loss? That GLP-1s are somehow special and only losing weight via them causes muscle loss?

IFBB bodybuilders getting weekly DEXA scans and running multiple steroids including cycles specifically designed to help prevent muscle loss during cuts still lose muscle mass when losing weight for shows, despite taking every drug under the sun, working out an obscene amount, eating huge amounts of protein.

Your body will break down muscle when losing weight. You can do a lot to prevent the vast majority of it, but there is going to be some no matter what you do.

[phil21]

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.

[beezlebroxxxxxx]

Is the official recommendation that you continue to take it for the rest of your life? Or, is there a schedule to "wean" people off of it?

[tjohns]

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.

[spondylosaurus]

"You'll regress if you stop taking the drugs" may be true, but it seems like a double standard to frame it as a knock against weight loss drugs when this also describes countless other interventions for chronic issues...

Your lupus will flare up again if you stop taking Plaquenil! Your eyesight will be bad again when you take off your glasses!

[tjohns]

I actually agree entirely.

I'm just being objective in stating that the evidence suggests that these drugs need to be taken long term to have lasting effects. Not everyone realizes this.

But I think that's okay if it can get people back down to a healthy weight. The health impact from being overweight is serious, and we know that lifestyle intervention has a stunningly abysmal success rate.

Anything we can do to reverse the obesity epidemic is a good thing.

[spondylosaurus]

More than fair :) I may have jumped to conclusions there because I generally see that line of thinking from people who go "...and therefore there's no point in taking meds," but you're right that not everyone realizes these are long-term drugs.

[JamesBarney]

> It's possible that after after a long enough time at a healthy weight your body's natural weight set-point will regulate itself back down. But this process take years.

I've spent a fair amount of time pursuing obesity research and I've never seen that. The closest I've seen is researchers or studies mentioning "Maybe the set-point resets are x years" but never seen any direct evidence of this.

[pinko]

Is the idea of a set-point settled medical/scientific fact, or still a disputed theory?

[tjohns]

It's still a theory. We definitely don't know the underlying mechanism(s) of action, and it's likely there's more hidden complexity there.

But rapid weight gain after weight loss (until you arrive somewhere near your old weight) is at least a well observed experimental effect. About 80% of people who lose weight, through any means, will revert back to their old weight.

Source:

https://www.ncbi.nlm.nih.gov/books/NBK592402/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673773/

[karmajunkie]

i lost about 30 lbs a couple of years ago, white knuckling my way through starving myself on a medically supervised diet. within two months of going off the diet, i was back at the exact weight i started at, to the pound, and haven’t varied >2lbs since, no matter what i eat. consider me convinced on the setpoint theory.

[eli_gottlieb]

There are lots of physiological parameters with set-points, such as body temperature. The problem for weight gain/loss is that instead of one set-point for body weight itself, you have maybe 5-10 set and operating points that are indirectly related to body weight, but not direct measurements of it. They don't all have to be "working right" to keep you healthy, but if too many become disordered at once, you're gonna have a problem.

[JamesBarney]

Set-point theory is pretty much settled medical fact. The mechanism involves leptin, and you can easily see processes that defend bodyweight change in both directions. Though it will more aggressively defend weight loss than weight gain.

In addition prey animals will defend against weight gain more aggressively than non-prey animals. Which makes sense from an evolutionary standpoint. If a lion gets fat he doesn't have nearly as much to worry about than if a gazelle gets fat.

[WalterBright]

A lion may also have to endure long periods of no food.

[r00fus]

Most weight management programs recommend you wean off - and also recommend other drugs if needed (metformin) to for maintenance.

The method of these programs is to use the GLP-1 medications to allow you to change your habits significantly while also reducing your weight. The goal being, you keep the new habits and your reduced metabolic requirements which allows you to keep the lower weight.

[beezlebroxxxxxx]

Interesting. If we think of effectiveness as maintained weight loss and eventually no longer requiring the drug then the next few years and decades will be fascinating to see how effective they are long-term.

[coffeebeqn]

Even if you start gaining weight after a year or two I guess you could cycle back on it right ?

[r00fus]

I mean, that's the goal for any weight management plan honestly - to provide the structure for you to make your own change. That GLP-1 meds are so effective will make a huge difference for tons of folks.

I think many people are going to use GLP-1s without a structure - and they may find it's not as easy to taper off without making a meaningful diet change.

[colordrops]

Did you notice that cannabis consumption interferes with weight loss due to interfering with motivation to stick to your health goals? Or did it interfere with your metabolism in some way?

[asadhaider]

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.

[apwell23]

Have you noticed any effect on gastric emptying. As someone with 'tummy issues' ( ibs/gerd ect) i am apprehensive of messing with my digestive systems.

[rootusrootus]

Not the person you were responding to, but yes. Stomach empties much slower, which seems to effectively make it smaller. A normal size (pre-drug) meal will make me uncomfortably full and probably cause reflux.

That said, I've noticed in the past, and also now on this drug, that my gastrointestinal issues abate noticeably when I consume less food. Thought I had IBS and then I went on a significant diet and lost 40 pounds in 2020. The IBS resolved, and not after I lost 40 pounds -- it basically stopped altogether a matter of weeks after I changed my diet. That was educational. YMMV.

I'm still working out my approach to eating while taking tirzepatide. Old habits die hard, and I'm having to cut my meal size way back. This sucks because my problem with eating too much was about eating too often, or not when hungry, not about binging. So I have to eat pretty small meals now. It will take some adjustment to find the right way to get sufficient nutrition while volume limited, but I think it can be done.

[spondylosaurus]

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

[mlsu]

My view about obesity has shifted dramatically since Ozempic came out. Before this, I didn't think about it too much (I am not obese myself).

I notice now that there is a LOT of judgement, bias(?), around obesity, that people, obese or not, carry with them [1]. I certainly carried that bias, and the reason I noticed it was because Ozempic is literally an external substance that you take that simply makes obesity go away. So if you believe (like most of us unconsciously do) that obesity is a personal failing or an issue of willpower, an issue of personal merit -- HOW is it possible that a chemical pill, an external chemical process, can SO effectively resolve it? When no amount of hectoring and moralizing and willpower can? My inability to square that circle really changed my thinking about obesity in a fundamental way.

Already there is a reaction to Ozempic -- like people thinking that taking Ozempic is a personal failing, or judging celebrities, for taking it, thinking it's the "easy way out" -- I think the origin of that is this very deep unconscious bias that we all have about what obesity actually is fundamentally.

My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.

It's really heartening to hear your experience. Your post really struck me, I felt exactly the same way after getting on a CGM + Insulin Pump for my Type 1 Diabetes. Nobody EVER thought I had a lack of "personal responsibility" or an "issue of willpower" for going low or high on shots of Humilin and NPH.

Thank fucking god for Novo Nordisk.

---

[1] see: this thread!

[seer]

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.

[cthalupa]

Obesity is rising rapidly over much of the developed world, both in Europe and Asia, on a trajectory fairly similar to the historical trajectory of it in the US. Obesity in adult men in North Korea more than doubled between 2009 and 2019. The UK is already up to 26% obesity. 36% of adults in Mexico are obese.

America is an unfortunate pioneer in obesity, but it is not even remotely unique to America.

> It is still weird to me how US choose unironically to develop a drug for reducing addiction

Novo Nordisk, the company behind Ozempic, is Danish. (Eli Lilly is American, though, for the tirzepatide drugs.)

I don't disagree with your fundamental premise - a huge amount of the initial conditions for obesity are environmental. But they're incredibly far ranging, incredibly intertwined with modern life in much of the developed world. Unwinding those, even with strong support from the people, would take decades.

We should still do it. But in the mean time, there's a hell of a lot of people that would die earlier than they would if they weren't obese. And a hell of a lot of them can significantly increase their lifespan with the help of these drugs.

[eli_gottlieb]

> Obesity in adult men in North Korea more than doubled between 2009 and 2019.

Ok, someone needs to explain how thoroughly non-Western, undeveloped countries, more known for starvation and malnutrition than overabundance of food, are developing an obesity problem!

[GeorgeTirebiter]

Must be in the air? Seriously, maybe abundant low-quality sources? AI sez:

The diet in North Korea is characterized by a heavy focus on grains, but has changed over time to include more animal protein:

Grains, Rice, wheat, and maize are the main sources of calories in the North Korean diet. In 1961, over 70% of calories came from grains, and that number dropped to 61% five decades later.

Animal protein Before 2000, North Korea's diet was mostly vegetarian, with meat eaten only a few times a year. However, since 2005, the availability of animal protein has increased, with an emphasis on poultry, pigs, rabbits, sheep, goats, and cattle.

Other foods Popular foods in North Korea include kimchi, red pepper paste, soybean paste, soup, and rice dishes. A traditional meal might include side dishes, a main course like noodles, porridge, or grilled meat, and rice dishes.

Regional differences People in rural areas and mountain valleys eat more vegetables and herbs, while people in coastal areas have access to seafood.

Healthy options The upper class in North Korea favor healthy, balanced diets, including chicken wraps and tofu rice.

[cthalupa]

Sorry - this was entirely due to me also talking politics with some friends earlier in the day. Switched up SK and NK when I typed this.

Obesity in adult men in South Korea more than doubled between 09 and 19.

[eli_gottlieb]

That makes a lot more sense considering that South Korea is not known for starving its population half to death.

[oblio]

How does obesity increasing correlate with aging? I'd expect that as people age, they start taking less care of their bodies as it's harder to do it.

[cthalupa]

Your expectations are correct - there's a strong correlation between the two.

[oblio]

Then a decent chunk of these simple analyses are useless. All advanced countries are aging.

[cthalupa]

Note: I meant to type South Korea here, not North.

[rootusrootus]

> 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!

[scottyah]

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.

[kps]

> 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).

[lottin]

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.

[barrkel]

It's the other way.

When you eat more than your energy consumption rate, you're less hungry. When you eat less, you're more hungry. You think the activity would stop you getting obese, but it's actually that you aren't hungry enough to overeat, despite high activity.

I'm not overweight, never mind obese. I pay no attention to diet or exercise. If I'm really hungry one day, I can end up overeating something I quickly deep fried from the freezer. And then I barely eat the next day. Not consciously. I'm just not hungry for a long time after I overeat.

Energy homeostasis is the big thing you're not accounting for. Excercise doesn't really do anything much for your weight, just your fitness.

[makeitdouble]

> It's rare for people who are physically active, and have a balanced diet, to suffer from obesity.

Looking at it from the other angle: can obese people be active and have a balanced diet ?

The answer is yes. In particular you can be obese and maintain your BMI at the same level while being fairly active and not overeating, that happens a lot with people gaining weight and reacting to it, but without going down.

From the pool of people physically active and with a balanced diet, what's the split of obesity is a question I don't have the answer to, but the lifestyle part doesn't look like a good differenciator to me if we're solely focusing on current obesity.

PS:if you eat a LOT more without gaining much weight, imagine eating a LOT less and see very little change.

[anon84873628]

It's weird for you to say that "people who have the habits for not being obese aren't obese." What's the real point?

Note that "have a balanced diet" is doing a lot of work here. Our modern environment is saturated with super calorically dense, hyper palatable food. THAT is the cause of the obesity epidemic -- it's not endocrine disruptors or seed oils or office jobs or anything else.

And the ability to refrain from eating cheap processed food, which has been specifically engineered to hack your brain, requires education, discipline, and willpower. As does hitting the gym.

It's not surprising that most people don't innately have this ability, and have ended up sick from it. That sickness is a medical issue regardless of how we got there.

[rixed]

What's the right approach?

Had the right approach better results?

If not, why is it the right approach?

[beezlebroxxxxxx]

My understanding is that more research is pointing to obesity as, in some sense, a precursor/reaction to the onset of type 2 diabetes rather than type 1.

Once you get to quite obese you're dealing with physiological factors that make losing weight medically difficult from behavioral changes alone. It also makes the chances of "yo-yoing" the weight higher as well. At that point the treatment for obesity overlaps with the treatment for type 2 diabetes.

[mlsu]

Yep, it definitely is! I mentioned type 1 because I have it.

As a contrast -- the point was that nobody judges me for having type 1 the way they judge people for having obesity.

As an aside, I notice that sort of "lifestyle/willpower" type framing in discussions about type 2 also.

[DAGdug]

There are varying degrees of control over outcomes. The judgment comes from the correlation between an unobserved variable (effort at controlling or preventing obesity) with the observed variable (actual obesity).

[ElectricSpoon]

> 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.

[fireflash38]

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.

[StefanBatory]

I was obese myself, and I have different thoughts on that.

For me, it was purely an issue of personal falling and willpower issue. I was obese because of a diet I was indulging in; full of unhealthy things and snacks.

It was due to nobody else but myself.

[ripply]

You don’t place any blame on the people that marketed and created that diet? Or the regulators who allowed that to happen? At a certain point people’s well being and health should come before a mega corporation’s profits. The whole world would be better off if unhealthy food was more strictly regulated. Children grow up not learning healthy eating habits that last into adult hood and some never learn them.

[StefanBatory]

No, I do not. It was my decision to keep doing so, it was a bad coping mechanism I developed. My actions are nobody else fault but mine.

[itsoktocry]

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.

[makeitdouble]

> we do know that diet and exercise work.

Stricly speaking we don't.

This is "common sense" and the official recommendation, but fundamentally we don't have solid long term reproductible experiments[0], and due to the nature of the problem (humans living their life in a complex society) we'll probably never have a good answer.

I've read many many studies spanning a few months and calling it a day (did the subjects rebound ? who knows), other taking a very small and homogenic pathological group, making it follow a strict regimen and end the experiment right after the subjects are let free again. But nothing with an actually rigorous protocol that gives a clear undisputable result.

In a way I feel a lot of researchers are bound to their common sense and think they either don't need to prove the obvious, or it brings them nothing to let the room for controversial results ? (nobody's paying for research that says current policy is dumb)

[0] If you have any double blind study with more than a hundred subjects taken randomly from the general population (including "healthy" subjects), with a control group, spanning more than 3 years of observations I'd be dying to read it..

If you think that's a high bar, obesity is touted to be the worst health crisis the US has to deal with with tremendous impacts, putting at least that much effort into research doesn't seem outlandish.

[CydeWeys]

Everyone who's obese has been prescribed exercise and a better diet. It's the quintessential doctor cliche, and yet it indeed hasn't worked for them. GLP1 agonists do.

[arandomusername]

> Stricly speaking we don't.

Yes we do, because it works. Exercise burns more calories. Diet limits your calorie intake.

If you rebound into not doing exercise and overeating, that's on you.

[makeitdouble]

> If you have any double blind study with more than a hundred subjects taken randomly from the general population (including "healthy" subjects), with a control group, spanning more than 3 years of observations I'd be dying to read it

[arandomusername]

Do you also need a blind study to tell you that jumping out of a plane without a parachute will kill you?

[bozleh2]

> But we do know that diet and exercise work.

Sure - if you ignore the incredibly poor % of people who comply with a prescription of diet and exercise. If you include compliance then the drugs are way way way ahead.

[cthalupa]

We know for sure that obesity is one of the single biggest increases in all-cause mortality. We know it is directly linked to most of the top disease-related causes of death.

> But we do know that diet and exercise work.

Do you think the ~40% of American adults that are obese don't know that they should eat better and exercise more? That they don't understand that they're cutting decades off their life?

Yes, it is 100% within the power of the overwhelming majority of them to fix things. And I think evolution has kept shame with us for a purpose and that it can be a useful emotion. But I also think it's plainly apparent that neither are causing a real reduction in obesity.

So, should all the people in the world that are obese just continue to fail at losing weight despite knowing what they should, in theory, be doing to resolve it? Because, despite being obese being one of the riskiest things you can do in life for your health and lifespan, we don't know if there might maybe be long term effects from something we know will get them to lose weight?

This room is on fire! I could run out that door over there - I know if I open it and go through I'll leave this room that is currently on fire - but, should I? What if whatever is on the other side of the door is just as bad as being on fire, or worse?!

[mayukh]

Obesity is a side effect of the industrial food production system in advanced economies that is slowly spreading all over the globe.

How about alcohol and smoking ? Is that the same as obesity then

[kps]

> Obesity is a side effect of the industrial food production system in advanced economies that is slowly spreading all over the globe.

Yes, for the first time in the millions of years of existence of humanity and pre-humanity, we consistently have enough to eat.

[beagle3]

Is not just “having enough”. People in New York had enough to eat for more than 60 years now - more like a 100 years. And ywt, up until the 1980s, obesity was a minor problem.

All standards have since changed. I watched the 1st season of the Simpsons again recently. In one of the episodes, Homer weighs himself and is distressed when discovering he weighs 200 lbs. 30 years later, dieters who cross down from 200 lbs to 199 lbs call it “reaching onederland” and it is considered a huge success.

[WalterBright]

The US solved the food problem around 1800, being the first country to end the specter of famine.

[JamesBarney]

Neurologically addiction works very differently than obesity and research says longterm sobriety is far easier to maintain than long term weight loss.

[ekianjo]

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.

[cthalupa]

It's simply not true that this trend isn't impacting other countries. Mexico is only 6% behind the US. The UK is 16%. Obesity is rising rapidly in South Korea - more than doubled in adult males between 2009 and 2019.

America pioneered the obesity epidemic, but a huge chunk of the rest of the developed world is doing their best to catch up.

[slibhb]

> 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.

[SirMaster]

>My view: It is a health condition, that people do not choose.

If this is true, then why are we so focused on curing it after the fact?

Are we also working on prevention?

If it's not a choice, then what is the cause? And why shouldn't we work on preventing that cause?

I mean it's clean that more people are obese today than in the past right? So what changed to cause that that isn't about people's choice? Why not work on reversing whatever those changes were that caused obesity to increase?

And a separate question:

If it's really not a choice, what would be the approximate rate of obesity among a group or population that all exercised regularly and ate healthy?

I don't think I can be convinced that not exercising regularly and not eating healthy is not a choice.

I just feel like the number of people that would be obese who are regularly exercising and eating healthy would be rather small. And if we agree that exercising regularly and eating healthy is a choice, then it seems at least for many who are obese, it indeed is choice.

I'm not going to say there aren't outliers or other special circumstances, but I still feel like for more people than not, it is indeed a choice.

[buu700]

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.

[fortran77]

Do you view a chronic smoker as a failure of character or willpower?

[buu700]

I wouldn't say inherently. Trying and failing to quit is plainly a failure of willpower on some level, albeit an understandable one given varying levels of nicotine addiction. Perhaps it could also be a failure of information (helpful techniques, etc.), although I'm not familiar enough to comment in detail on what quitting smoking is like.

On the other hand, is picking up the habit in the first place, or choosing not to attempt to quit, a failure of character? I'm not sure that's for anyone other than the individual to decide. I personally feel it's unwise given that in 2024 smoking tobacco is pretty much universally known and accepted to be wildly unhealthy, but if someone weighs the tradeoffs and decides that maybe it has social and/or professional and/or mental benefits for them that outweigh the downsides, I wouldn't call that a character flaw so much as a decision that I'd highly disagree with. I'd say the same whether we were discussing tobacco or meth.

---

Edit: More to the point I now see you were probably getting at, there's a pretty big difference in the knowledge and time/resource investment required to stop buying cigarettes (which costs nothing) and to adopt a low-carb or ketogenic diet that a particular individual would be happy with long-term. I've been keto for over 12 years, and I have a routine that I enjoy, know my way around a kitchen, know what foods I like, and know all the right ingredients and recipes to use to create any food I might want to eat in a keto-friendly form that's as good as or better than what I could otherwise buy at a store or restaurant. For example, I make some of the best ice cream I've had anywhere (sometimes in flavors that I've never seen commercially available), and the one time I cheated for a New York slice I was disappointed because it didn't hold up to the pizza I'd already been making at home.

Maintaining my diet takes zero willpower, because I enjoy it even more than my diet from when I was fat, and I never had to starve myself or give up my sweet tooth. The problem is that for that to work it required not just the inclination to research and adopt keto in the first place (a major hurdle in itself), but turning it into a dedicated hobby with development of knowledge and skills that I wouldn't expect the average person to casually pick up. That may work for me, but isn't a scalable solution for the population at large. On the other hand, if I could magically reformulate every food product in the world based on what I know from experience works, no one would struggle to eat a high-fat diet because that would just be the default instead of high-carb.

[j-a-a-p]

The willpower frame actually works pretty well for a lot of people. If not than in our society almost everybody would be obese. This pill will make things worse for the group that hangs out in the treadmills and drinks green and disgusting smoothies.

On topic, very happy this medicine exists, but let's pray god will keep the prescription only for BMI > 35.

[autoexec]

> The willpower frame actually works pretty well for a lot of people. If not than in our society almost everybody would be obese.

In the US nearly 75% of the population is overweight and almost half are clinically obese. Sounds like "willpower" isn't working for the vast majority of people.

[j-a-a-p]

That is not logical. If willpower fails, how could a pill be a solution? That is like suggesting to give everybody methadon, because the substance dependency issues are just too overwhelming. Or even better, give certain kids from 12 to 6 years old a gun to solve the school shootings issue.

If we give up on willpower, we have no plan b.

[Ygg2]

> If not than in our society almost everybody would be obese.

Isn't that already the case. I'm of belief, the failing isn't individual but societal. You have obese toddlers and wild animals in the US.

I don't think this is a failure of willpower, it's a failure to investigate the actual causes of the obesity epidemic. Maybe it's sugar, perhaps it's highly processed oils, etc. Whatever it is, people aren't investigating it thoroughly enough.

[j-a-a-p]

I live in lala land. Obese children are rare, however overweight is 11% and declining from 15% post covid.

The school where my kids go to has zero obese and zero overweight kids (n = 300).

We have Starbucks, McDonalds, Dunkin' Donuts and the same brands like Heinz and Coca Cola. Pizza.

So, I am optimistic willpower can prevent us from a new Ozempic disorder. I suggest to go for willpower and not pills. If willpowers falls short, in my country when a child becomes obese, child welfare steps in. So let the government intervene (yep, you will lose your parental power) with a lifestyle program.

[legacynl]

> 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?

[ein0p]

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.

[kelavaster]

Do a reality check that leas-frequent cannabis consumption with your target activity and intake levels doesn't also lead to weight gain .....

[renegade-otter]

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.

[benreesman]

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.

[collingreen]

Congratulations! This is such a great success story.

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!

[comechao]

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).

[yieldcrv]

Sounds like a kickstart you needed!

Aside from the disruption in cravings, the immediate results seem to have motivated you to do more.

[robohydrate]

You can't imagine how empowering it is to be able to say "No." to food. I stopped eating dessert except once a week. I can be in the company of other people and surrounded by delicious food and not feel the compulsion to eat until I am nauseous.

[yieldcrv]

This is interesting as this is my default, and I am pretty lean. I often have to remember to eat or check if I did, and lament that its a chore. I enjoy food and the dining experience, but I would be fine with that being an entertainment option once a week too.

I wonder if there is enough research on how gut bacteria influences these things, because if this is what people want maybe I could sell mine.

[card_zero]

I saw a documentary once about people who effortlessly remain at a healthy weight, and their activities were tracked for a couple of weeks, revealing;

* Unexpected bursts of random activity like dancing for a few minutes or moving heavy furniture, that these people didn't even notice, while still doing no deliberate exercise,

* Binging like suddenly eating a whole pizza, but then eating next to nothing the next day because "too busy", without putting thought into it. This would be bad for you on the scale of months, but fine over one week.

So, of course, they made up for all the calories they seemed to be taking in. There's an implication that this is instinctual, or just fortunate habits. In my case, I also burn energy arguing, puzzling, and worrying, and I naturally radiate more heat than most, and although I'll happily try to eat a whole tiramisu by myself I seem to have a small stomach and don't attempt it often anyway. So although I think of myself as lazy and gluttonous, I guess I'm just fortuitously, circumstantially not. Imprison me in a restaurant, I'd probably get fat.

Edit: right now I'm idly eating chocolate while I type. But I have no other food in the house, except three bananas. That's because I didn't organize it, because I'm lazy, but what "lazy" really means is a complex subconscious strategy, I think.

[CBarkleyU]

This is something that I like to ask friends and acquaintances: Would you rather take a pill that gives you perfect nutrition and nullifies your hunger feeling or a pill that the gives you perfect nutrition and nullifies any other calories you eat.

It's pretty much 50/50. Which is weird, as you'd think that eating is only a pleasure when hungry and I'm proposing them a way to get rid of hunger. Even weirder is that I personally would take the second pill and enjoy my gluttonous lifestyle.

Regarding this thread: I personally decided for myself that if I can be stubborn towards my wife, friends and mom (and I am a stubborn SOB) I sure as hell can be stubborn towards my own bodily desires. I removed all meals except once per day and pretty much all desserts. Fuck what my body thinks it desires, if it needs it that much it can go fix a meal while I sleep.

[vinkelhake]

I want both... Some days, in particular when working hard or focusing on something, food is just fuel and not something I want to spend time on. I'd definitely take that first pill for those days.

But I also really like cooking. If I have the time I don't mind spending hours in the kitchen to prepare something. I don't really need that second pill yet, but sometimes you just want to pig out...

[card_zero]

That's some philosophical weirdness right there. I guess we're kind of into the biological aspects of the human condition and don't want to part with them, because they're like a fun, mildly disgusting game. There'd have to be some other entertaining lifestyle that you gain in exchange, and you'd have to be sure you could dig it before you'd agree to the switch.

[cactusplant7374]

> I realized that frequent cannabis consumption interferes with the weight loss

Because you eat more or is there some other factor?

[gooosle]

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.

[skue]

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]

[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.

[gooosle]

> The obesity epidemic cannot be reduced to some simple moral failure.

You're the only one to bring up morality so far in this comment chain.

> 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.

That's just utter bullshit. Homeostasis is heavily influenced by lifestyle choices.

> But this flat-earth-like notion of reducing obesity to an issue of basic willpower needs to be recognized for the drivel it is,

No, your incessant need to convince yourself and everyone else that something as straightforward as controlling your calorie intake is in fact a complex and naturally intractable problem that requires drugs and counseling is what's flat-earth-like drivel and utter bullshit.

> 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.

You're cherry picking terrible studies that happen to fit the preconceived notions you desperately want to believe, because they make you feel better about being undisciplined and weak-willed. Your understanding of nutrition, exercise and health are also clearly very minimal.

[mycall]

Have you looked at Psilocybin for your depression?

https://news.ycombinator.com/item?id=41818420

[siva7]

How do i get this?

[myprotegeai]

In the future, this would be indistinguishable from an ad.

[mahin]

Or even now?

[myprotegeai]

I'm trying to give them the benefit of the doubt that it is a real experience, but yes it currently reads like marketing material aimed at the obese, depressed tech worker.

[arijo]

Cut on carbs and you will have all the benefits without the nasty side effects.

Check https://metabolicmind.org for details.

My own experience with the keto diet - https://www.feelingbuggy.com/p/finding-hope-after-decades-of...

[alluro2]

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.

[addicted]

And there’s no truth to it either.

Cutting carbs only helps to the extent you’ve reduced calorie intake.

People drop their calories too low, and then they take a cheat week after a year or so where they eat pasta, and suddenly they feel a lot better and they’re back to eating more calories and back to gaining weight, leading to yo-yo dieting, which may even be worse than just having a higher than healthy but static weight.

[arijo]

That’s not true - the ketogenic diet is not a calorie restriction diet. It was invented early last century by a medical doctor to simulate fasting and treat epilepsy in children. Low calorie diet lead to yo-yo dieting which is not the case for keto were you are allowed to eat enough calories to be satiated. The binge eating comes for the oscillating glucose and insulin levels driven by the consumption of refined carbs. Carb addiction is the problem and that’s the root cause we should be addressing to stop the metabolic health epidemic that has only been getting worse despite all the pharma profits.

[phil21]

I’ve done keto a couple times in the past, even back when it was called Atkins. It absolutely was a calorie deficit diet since it was difficult to eat that many calories consistently to go over my BMR for more than a few days at a time.

Friends doing it also had the same experience as I did.

Not saying it isn’t as advertised, but everyone on it I knew (n=14 or so) was getting results from fewer calories after we all decided to start carefully logging food intake.

It’s a great diet that works, but via other mechanisms for many vs ketosis.

It’s still a restriction diet that poses a lot of challenges for most to remain consistent with on a long term basis.

[Etheryte]

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.

[Izkata]

For Millennials in the US, it might be very useful. We grew up with this food pyramid being pushed at us all the time: https://en.wikipedia.org/wiki/Food_pyramid_%28nutrition%29?u...

That's a lot of carbs. Only like 3 years ago did I learn they changed it around 20 years ago to be less carb-centric.

[addicted]

No one in the US follows the food pyramid.

Go see what people are eating in real life. There are a lot of studies.

Americans eat way more meat, almost no fruits and vegetables, and a lot of carbs.

The point is that the food pyramid has absolutely no impact and pointing to it and making correlations with it is like doing astrology to explain why you broke your hand while playing basketball the other day.

Edit: you do a great job to illustrate how little anyone knows about these food guidelines.

It took you 17 years to even learn they’ve changed.

[Izkata]

> Edit: you do a great job to illustrate how little anyone knows about these food guidelines.

> It took you 17 years to even learn they’ve changed.

I gave an age range for a very specific reason: That's the age group this food pyramid was pushed hard on kids. I didn't know it changed because I was finishing gradeschool as the change happened.

You don't have to memorize and precisely follow it to have internalized generic things like "lots of carbs = good". They are supposed to be our bodies' main source of energy and there's really no way you can have too much (or so we were taught at the time).

[riffraff]

It's super weird I saw this food pyramid in a school book in Hungary (where I live) a couple years ago, and I was wtf?

I'm Italian we eat a ton of carbs, but the pyramid I was shown as a kid decades ago had vegetables at the bottom

https://www.alimenti-salute.it/sites/default/files/sites/def...

[arijo]

Implementing a ketogenic diet is not the same as a caloric restriction diet - it’s an inversion of the macronutrient pyramid - heavy on fat, moderate on protein and low on carbs.

Even if you consume the same calories as in a traditional diet you’ll likely lose weight. Check the https://metabolicmind.org site for more insightful information.

[slothtrop]

It's not nearly in the same ballpark.

[cgh]

I read your experience and it is indeed pretty incredible and I'm happy for you. I've used ketosis strategically for athletic reasons, to cut weight. So we both had strong motivations to use it. But for your typical obese person, it is a tremendous challenge to stick with it and at the end of the day, it's adherence that matters.

Put simply, it's easier to adhere to a drug than to a specific, somewhat anti-social diet.

[arijo]

It really helps if you use some LLM tool like ChatGPT or Claude to generate the keto recipes (sometimes with the ingredients you have available).

If you stick to cooking keto recipes for a few weeks you end up internalizing the recipe patterns and you start cooking without even thinking about it.

[kerbs]

It is not easy on the mind and body as to just cut carbs.

[arijo]

I apologize for the shortcut - I should have given more context, though you can validate my assertion by going to this site: https://metabolicmind.org

There is heavy research on the usage of the ketogenic diet for the treatment of metabolic and mental illness.

I've written about my personal story here - https://www.feelingbuggy.com/p/finding-hope-after-decades-of...

[arijo]

I also recommend taking a look at this Joe Rogan interview to understand at a deep level all the problems with a drug like Ozempic - https://www.youtube.com/watch?v=G0lTyhvOeJs

[BadHumans]

Quoting Joe Rogan's podcast instead of literature is not going to go over well here.

[arijo]

Check the https://metabolicmind.org site then - you’ll find plenty of research based evidence on the usage of the ketogenic diet as a metabolic therapy.

[fortran77]

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.

[arijo]

I’m 1.78m, 50 years old, my initial weight 2 month ago before I started the keto diet was 154kg and two months later I’m almost 130kg. Eating the same amount of calories as before.

[claudenm]

This is an extremely unhealthy rate of weight loss. All guidance centers around .5-1kg/week as both safe and sustainable.

[arijo]

Not if you start from an extremely obese starting point like I did. I don’t recommend this rate to people with normal weight.

[claudenm]

This is also wrong. It’s extremely unhealthy, unsafe and unsustainable to lose 15% of your body weight in 2 months.

[fortran77]

Yes. But a real keto diet, where you are in ketosis, is impossible for most fat people to follow. They will inevitably cheat (“tee hee hee! It doesn’t count if it’s birthday cake! I’m so naughty”) and be in ketosis.

[arijo]

I’m fat, I’ve been cooking my own keto meals for more than two months, I’ve consistently been in ketosis and yesterday was my 50th birthday :)

[slothtrop]

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.

[arijo]

If your primary macro consumption is fat, your body will enter a state of ketosis burning fat instead of glucose. As long as your calorie intake of fat is less than your basal metabolism corrected by some factor, you will lose weight and feel satiated - you do not need to follow a calories restriction. Believe me - I tried both ways and the ketogenic diet never left hungry - always satiated.

[slothtrop]

I'm aware of how keto works. In fad diets focused on composition, short run WL is typical followed by stagnation. What's one going to do when they stop losing weight, eat negative carbs?

> you do not need to follow a calories restriction.

Weight loss comes down to energy balance. People tend to consume fewer calories at the outset when going low-fat or low-carb (in large part because protein is afforded a higher fraction, and it is more satiating), but clearly that does not mean that you'll always have a caloric deficit. Eventually, you'll need to reduce intake to continue losing weight.

[arijo]

Yes I actually used ChatGPT to calculate what would be the required daily amount of calories to achieve my target weight in 6 months - the big difference is I always feel satiated and that the body being in ketosis ensures I’m not accumulating but burning fat.

[blackqueeriroh]

I’d like to make a couple of things clear here:

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...