[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.

[tomrod]

Some things simply are negative, and masking behind a neutral word makes the neutral word perceived as negative over time.

Masking reality is not a good way to work within it nor modify it.

[CydeWeys]

Some things simply are negative, sure. I think we can all agree that murder is negative on the whole, for example.

But you are making a HUGE leap here in assuming that GLP1 agonists "simply are negative". You have not remotely supported this logical leap. All studies in fact have shown that GLP1 agonists are significantly positive: That they improve health, reduce obesity, reduce all-cause mortality, etc. You are denying observed reality across a large number of double blinded, objective clinical trials.

[collingreen]

I just keep following your comments down the page and giving you upvotes.

I think folks using drugs (or meditation or habits or diet or any other thing) to intentionally make their life better is amazing and should be celebrated.

If some things are easy for you but not others try to be grateful for yourself without having to be petty or wanting others to be worse off.

[tomrod]

To be clear, I don't think GLP1 agonists are "negative." I think the blend of environmental, food supply, and other factors that led many adults, in the US and elsewhere, to need obesity intervention is the negative. GLP1 agonists are an inherent crutch.

Much like if we geoengineered cloud seeding or similar light blocking and fail to reduce CO2, the treatment masks the cause and can lead to worse outcomes globally (even if some folks are better off - and I hope they are!).

[firecall]

I don’t agree they are a crutch.

However, if they are, then modern life is a sledge hammer that’s constantly breaking your legs.

Our (US, UK, Australia and so on) life styles and food chain have created this obesity problem.

We are now a sedentary population, and low-nutrient high-calorie food is being made readily available to stressed, tired, overworked, and economically challenged people. When you are stressed and tired, you don’t make the best choices!

These drugs are not so much a crutch as they are a rescue helicopter!

We still need education though.

These drugs might reduce hunger, but they won’t stop you from consuming junk-food. People are used to overeating, and a feeling full isn’t always what’s stopping them from eating!

So we do absolutely need to address the root of problem….

[cthalupa]

What's the explanation for why GLP1 medications are negative things? There are a very minor subset of people that have some medically significant adverse reactions, but it is VERY small. We don't have any evidence to my knowledge of any long term risks with being on it.

[blackeyeblitzar]

GI issues are fairly common and sometimes linger after stopping too. Loss of muscle mass is also common.

[cthalupa]

The GI issues tend to be minor. Unpleasant, but not exactly any more debilitating than a lactose intolerant person deciding that they really really wanted that extra large milkshake. Some people have it worse - but those, to my understanding, very much are in the minority.

Tirzepatide also has significantly fewer GI issues.

Muscle mass loss happens in any sort of weight loss where you don't eat enough protein and get enough exercise. There's no current evidence that when you control for calorie deficit, diet macros, level of exercise, bmr, etc., that people lose more muscle mass on GLP1 agonists to my knowledge.

[jart]

Is there any evidence those things aren't just side effects of eating less food?

[phil21]

GI issues are almost always minor. Folks are used to zero discomfort in their lives so the social media reporting of such is wildly overdone.

Tirzepatide is being investigated as a therapy for IBS. Within two weeks of being on the drug I was able to start living a life not scheduled around being near a restroom. This was suggested as a potential side effect by my doctor before taking it for weight loss, due to the GIP component in the drug which slows down your digestive track.

It could be I’m eating less. However I have went on crash diets before with absolutely no change to my constant lifetime GI issues, and have eaten extremely clean the past half decade due to a partner who cooks amazing healthy meals that would exceed most definitions of the term.

I’ve long since reached my goal weight and target body composition- but I plan on sticking to a low dose of Tirzepatide for the rest of my life since it gave me my life back. No more popping Imodium every few hours on vacation while simultaneously fasting. Just a normal life these days. I can enjoy a breakfast if I feel like it without it ruining the rest of my morning. Heck, I can even eat shitty greasy food at the state fair with only mild discomfort most folks would have from such poor choices.

Every study (still limited in number) I’ve read more or less refutes all the social media hysteria. There is a whole lot of smoke but no fires yet to be seen. They may still be coming.

The things that are not wholesale misinformation seem to be the requirement to cease use many weeks before going into surgery, potentially needing to be on it for your whole life, and the side effect it currently has on your finances. Nothing else seems to hold up under scientific scrutiny yet.

Perhaps I will regret this decision in 20 years, but I’m willing to take that risk to have some of the best quality of life years I’ve had yet.

[Alupis]

> We don't have any evidence to my knowledge of any long term risks with being on it.

Nobody has yet been on these drugs for an entire lifetime - which is what is being advocated in this thread.

[cthalupa]

Sure. But what's the proposed mechanism? For many - not all, obviously - medications, we have an understanding of potential long term risks. Animal studies catch some of them, others we know are potentially risky even without animal studies, e.g. drugs that increase angiogenesis have a risk of increasing tumor growth.

But no one has proposed mechanisms for GLP1 peptides.

Meanwhile, we know obesity is one of the largest long term risks to health in existence, and one of the most prevalent.

[unethical_ban]

If someone has a broken leg, the word "crutch" isn't derogatory in the first place.

Cessation tools are not negative. Yes, root causes of abuse should be addressed, but aids are aids.

[CydeWeys]

    Crutch (n)
    a : a support typically fitting under the armpit for use by the disabled in walking
    b : a source or means of support or assistance that is relied on heavily or excessively

Use a is a neutral, non-judgmental, literal use of the word. Use b is clearly a pejorative, judgmental, metaphorical use of the word. The two are not the same.

[seadan83]

> relied on heavily or excessively

That _OR_ is doing a lot of work. I believe that 'or' makes the word not objectively pejorative. Context is important. A no-true-scotsman insinuation, or an insinuation that the crutch will never be removed does lack empathy and would seem pejorative to me.

Though, an empathetic concern that the crutch will never be removed - is not necessarily pejorative IMO. Either way, the crutch is a tool to "healing." Context matters.

[collingreen]

Is this an argument that you should use crutch and everyone ever will always read it as version b?

It might be more good faith to just pick language that is more clear. The alternative feels a lot like pretending to be one thing while trying to make people think something else - it rings just like a bad faith "Im just asking questions"

[borski]

The negative connotation of a crutch implies that you are past the point of needing it and should be standing on your own two feet. If a thing is not meant to be temporary, or if you'll never be able to perform a task as well without it as you could with it, then it's a tool rather than a crutch.

Thus, calling GLP-1 meds a “crutch” implies that they are unnecessary, and that the patient should be able to do it without medication, which then creates guilt and shame where there shouldn’t be any.

[fknorangesite]

> If someone has a broken leg, the word "crutch" isn't derogatory in the first place.

It is so profoundly disingenuous to pretend not to know what the word "crutch" means or what connotations it has in this context. Like, come on.

[ab5tract]

Is using glasses to see a crutch? Asking as someone who needs them as much as I need the prescribed-for-life medications I’ve been prescribed.

[seadan83]

Reflecting on this, I think that 'for-life' aspect is very key. A 'seeing aid' vs 'seeing crutch'. Crutches are usually meant to be temporary. A walking stick is the walking aid equivalent. Hence, for weight loss, is medication meant to be the life long solution? As a facilitator to move the needle for people - very helpful. The underlying question about lifestyle and habits never changing is where the life long crutch concern comes in.

[nswest23]

All these people are calling it a crutch are moralizing tongue clicking, holier than thou Calvinists who think you shouldn’t be able to be thin unless you bootstrapped yourself to thinness with your own blood sweat and tears, as though this viewpoint represents some abstract understanding of the world instead of merely a smug sense of self righteousness.

[seadan83]

Crutches allow broken legs to heal properly. It could be that some simply don't have that same strong negative connotation.

What is more, getting hung up on the wording is missing the larger point.

[buzzerbetrayed]

Crutch and “weight loss aid” aren’t synonymous at all. You can’t ask someone to use a word that has a less negative connotation if they mean completely different things. They intentionally said crutch because they’re specifically talking about people who use it as a crutch. Not people who just use it as 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.

[names_are_hard]

Agreed. After I broke leg the physical therapist saw me walking without aids and said I should go back to using a cane and explained that I'll heal better and faster if I use help than if I don't. Made me realize that the expression "using x as a crutch" doesn't make sense if it's supposed to imply that x is an impediment to progress.

[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.

[tonyedgecombe]

>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.

Is it impossible to buy healthy food in your region? The average American spends six hours a day watching TV, do they really not have enough time to cook a meal? Just how many people do not have a cooker in their home? Is it cheaper to buy preprocessed food rather than the raw ingredients in that meal?

It seems to me the real problem is the supply of food is abundant and corporations have gone to extraordinary lengths to make it very palatable. Add in peoples tendency to chose the easy option (ready meals, eating out) and you get an obesity epidemic.

[collingreen]

Everyone has 24 hours a day. We could all move to the cheapest CoL areas, grow our own food, and run marathons all day every day. Everyone, including you, could sneak one more rep in instead of some activity in the day. This holier-than-thou attitude of dismissing people is lame.

Empathy can go a long way and the more we can have for each other the better we will collectively be.

[tonyedgecombe]

>This holier-than-thou attitude of dismissing people is lame.

If you want to solve the problem you have to understand it. I see lots of dubious suggestions like lack of time when working hours have reduced massively in recent history[1].

>Empathy can go a long way and the more we can have for each other the better we will collectively be.

If our read my second paragraph then you will see I'm not laying the blame at individuals.

[1] https://ourworldindata.org/working-hours

[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

[tsimionescu]

While you're chemically addicted to a substance, yes, the body thinks you literally need it to survive. The point is what happens after you break the chemical addiction, you go through withdrawal, and can function again. The brain stops feeling you need it in that same way after this process. But it's almost impossible for someone who went through alchohol or nicotine or opioid withdrawal to ever consume that again and not relapse into addiction.

If the same logic applies to a "food addiction", then discontinuing the drug that helped you go over the initial addiction is going to be almost impossible, since you can't abstain from food.

[seadan83]

Withdrawal can often be both a mental and chemical process. The desire to do something and constantly thinking about it can be just as much habit as it is chemical.

We are mostly on the same page I think. To the point though, re: food - it is not all equal. Fast food, ice cream, fried food, candy, chips- it is quite different from cooking your own meals and snacking on things like fruit, veggies and hummus (etc..)

Similar to your first point, I can't buy ice cream because I have no self control over it. (I would not say I have a food problem, it would therefore be a lot harder for others I believe)

While I agree "you can't abstain from food", it might be a bit overly reductive. Not all food is responsible for 'problem' eating. Similar to near absolutely (or absolutely) avoiding booze/nicotine, there might be similar foods that must be avoided. Which comes back to habits, changes to how a person snacks, when they eat, how long is spent in food prep,more grocery store trips, how they shop in the grocery store (etc)

[seec]

I think smoking is particularly hard because most of the really bad effects come much further down the line. You can smoke for years (even tens of) without much problem and if you do some sports even the cardio/breathing effects are largely mitigated (I know, this is what I do).

So, it's easy to only think about how good it makes you feel at the moment.

But alcohol will show nasty side effects rather sooner than later, it will show on your face, you will feel liver problems very fast and since you are in a secondary state when inebriated you will seem out of place when not in that state.

Both of those substances have the particular effect that if you use them repeatedly over a short (1-2 week) period of time in moderate but sustained quantities, you will get chemically addicted. This is nasty and the reason why every parent tries to make this fact known to their children (more or less successfully depending on method).

Food addiction in my opinion is very different, it comes purely from psychological factors and should be very easy to correct on time. It's not something that comes around in 1 week or 2. Even if you overeat 1000 kcal (1/3 more than the average of 2000) over the course of 2 weeks, you would only gain 2kg of body fat at worse. It's really a very long sustained process to really become obese, it's not like chemicals that can get you in 2 weeks max.

While it's hard to lose what you gained (you basically need to starve a little bit) it's not that hard to make adjustment to life choice to avoid making the situation much worse.

[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.

[maigret]

https://usa.streetsblog.org/2023/04/14/exactly-how-much-less...

[ta_1138]

An environment that physically makes you more sedentary as, outside of a couple of cities, many things that would be sensibly done through walking in other countries involve driving.

You can easily tell this is the case by seeing where the obesity is less prevalent

[hnburnsy]

Maybe peer and societal influences too?

[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."

[amarcheschi]

I visited us in summer, from Italy. Bread was so sugary. Cakes were sugary. Everything was much more sugary than here

[grepfru_it]

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

[lazyasciiart]

I'm in Seattle, and I can tell you that foreigners don't move here and lose weight.

[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.

[croes]

That doesn't prove it's an addiction.

More likely it's listed as one so insurance company pay for the drugs.

Addiction treatment gets payed, low self control not.

Half Bake- Thur good goes to rehab NSFW

https://youtu.be/uUPHlAbAf2I?si=TVVxffFprAtdJyAk

[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".

[mathgeek]

A good way to frame addiction is via perceived rewards. You can be addicted to many things if you look at it as “the person expects a reward for an activity, often errantly”. The worse addictions get into “the reward isn’t even expected with a moment’s clarity, but you do it anyway” territory.

[naijaboiler]

It doesn’t matter what the actual addiction is, the reward circuitry in the brain is pretty much similar.

Addiction is basically highjacking our brain wiring that’s meant to help us expend energy chasing things that we need for survival (food, reproduction), and using it to chase other things

[tharkun__]

But you are addicted to a substance in those cases.

Sure, you don't take the substance directly. But the things you do have your body produce/release the substance.

A dopamine high is a dopamine high. Even though you didn't buy a dopamine pill from a shady dude in the parking lot.

[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?

[fragmede]

Addiction is this really scary thing I saw on tv about downtown Philadelphia and fentanyl killing people buy that's far away and couldn't happen here. Sure, I have friends who are fat and are unable to stop themselves from drinking 8 cans of coke a day but they're not shooting up with needles and I know them so they can't be this scary kind of person called an addict. Also I know this one girl who's glued to her phone all day and can't do anything else and she's also definitely not an addict.

Addiction hits the same part of the brain, no matter if it's chemical, physical, or digital. Just because our culture sees them differently doesn't make it the same underlying problem.

[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.

[zero-sharp]

>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.

If you listen to nutrition gurus, you'll hear claims like "food X contains chemical Y and chemical Y is either itself toxic or metabolizes to something toxic, therefore you shouldn't eat X". I promise you I can find videos where somebody has found something bad about spinach and will try to convince you not to eat it. It's a bad way to reason.

Identifying individual biological pathways isn't enough to make (dietary) prescriptions. Often, the metabolites of the food aren't produced in high enough quantities to make a measurable effect (on health, or this case behavior). This kind of thing has to be studied at the level of behavior.

[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.

[elzbardico]

As much as we pretend otherwise and rationalize stuff because the greatest sin for our generation is being judgemental, I am pretty sure this is the case in a lot of instances.

[rixed]

Maybe, but shame has never been a very good cure overall.

[vkou]

Shaming people is fantastic at making me feel self-righteous, though, which is the best metric by which I can evaluate treatments and interventions for other people.

(When I feel charitable, I can instead wring my hands and hemm and haww about the unknown consequences of people using medication to solve their health problems. I can't outline what exactly those consequences are, but I can certainly hemm and haww.)

[stirfish]

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

[spondylosaurus]

This is the example I'm shocked more people don't invoke in these discussions. Gambling addiction is indisputably real, and slot machines (or craps tables or the ponies down at the track) don't even have stick a needle in you to get you hooked. Actions and reactions are more than enough.

Compulsive overeating relies on the same behavioral/reward mechanisms, with the added bonus of food being something you do physically ingest in the process.

[FabHK]

Gambling addiction also has the highest suicide rate among addictions, so definitely serious. The Atlantic had an article recently arguing that allowing sport gambling in the USA was a mistake, imposing huge costs on the most vulnerable.

[coffeebeqn]

It’s also popular in other forms these days. Wallstreetbets options gambling, most of crypto, the way many people are “trading” these is purely gambling with some bro-astrology.

When I was a poor teenager I was gambling online and it is an incredible way to lose money unlike anything. With the click of a button you can throw $100 or $1000 into the void- and you often follow it up until your account is empty. Hard to do with many other substances.

[__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.