[Teknoman117]

I’m always kind of envious of the people who were able to lose weight on GLP-1 drugs. I lost a bunch of weight a few years ago, and still need to lose a lot more (430 lb -> 330, goal 240), but I fell out of the good habits for, well, no good reasons…

Decided to try Ozempic and was on it for about 6 months. Didn’t do a single thing for my appetite unfortunately, even on the max dose.

Sample size of one here, but if you’ve got mental health struggles that feed into your eating patterns, GLP-1s might not help with your weight problems.

[brap]

Wegovy/Ozempic didn’t do anything for me for months. Then my doc put me on Tirzepatide+Phentermine combo and I forgot what being hungry even feels like.

[vladgur]

Do you have to remind yourself to consume things like proteins, etc to prevent muscle loss?

[cthalupa]

I couldn't hit my macros on tirzepatide - couldn't get enough protein without feeling sick to my stomach. One of the reasons I swapped to reta.

(though as a general note for anyone reading, just getting enough protein isn't enough - you need muscle stimulus too. Getting enough protein will help reduce the amount lost but if you really want to stop it, you gotta do resistance training)

[bobsmooth]

How long have you been on Phentermine? For me it stopped working after only a couple weeks.

[sublinear]

I went down from 390lbs to 240lbs gradually over 5 years. I have maintained a weight of 240lbs since then (6'1" tall).

The first year was the most dramatic loss of 100lbs. I was miserable and didn't know what I was doing other than counting calories. The rest of it was more considerate of total nutrition, and that's what made my good eating habits stick.

I say this because while I'm not a doctor I think GLP-1 is probably unnecessary for the vast majority of patients. Better food and information is more available than ever before.

I would strongly advise to watch your A1C and get out of the diabetes danger zone if you are. Most people can drop a few percent in as little as 6 months and it makes a massive difference in mental health. Blood glucose has a direct impact on the brain and overall cardiovascular health. If you drink alcohol, you might want to take a break also to let your liver/kidneys/pancreas do their jobs properly and restore insulin sensitivity and other hormones. Look into the "fruit paradox", and more generally get a good salad in for lunch to address nutrient deficiencies. Not crappy salads either. You're not a rabbit. Treat them like the amazing sandwiches without bread that they are.

Sounds like old advice, because it is, but I find people aren't listening because they want to more deeply understand why to do it and what the effects are. Convenience and unintuitive pricing are false bargains that get in the way of healthier habits. Focus on nutrition and not quantity. Change your groceries, change your life.

[rootusrootus]

> I say this because while I'm not a doctor I think GLP-1 is probably unnecessary for the vast majority of patients.

We have mountains of evidence that willpower fails for something like 99% of everyone, which is far from a vast majority. I applaud anyone's efforts to become healthier, however (though 240 at 6'1" is still obese, I would still explore medicine if I could not get any lower "naturally").

[sublinear]

Thanks for the reply. Your perspective framing this as "willpower" is precisely what I'm concerned about.

I didn't need any willpower to do this and I'm not even humblebragging nor think of myself as a tough guy. I'm saying that healthy habits are simply a matter of understanding. If someone wants to take GLP-1 on top of that, it's their call. Many seem to be under the impression it's so vital for their specific situation to lose weight or avoid a heart attack and I think that's plainly false. We shouldn't be feeding fear, and humans aren't that unique.

I did not change my diet. If anything I just added more variety with a specific intent and it worked. Even just changing the order in which one eats things (fiber before sugary foods) can make a big difference. Once I got the blood glucose under control all the strong cravings and eating mistakes basically went away on their own without my conscious effort. The body is all connected and driven by hormones.

[cthalupa]

> I'm saying that healthy habits are simply a matter of understanding.

Plenty of people have heard everything there is to hear on this, understand it, and still fail to implement it.

> I did not change my diet.

You plainly did. You do not lose weight without your diet changing.

> If anything I just added more variety with a specific intent and it worked.

This is changing your diet.

> Even just changing the order in which one eats things (fiber before sugary foods) can make a big difference

Changing your diet to eat more filling foods is a very frequently recommended thing, yes.

> Once I got the blood glucose under control all the strong cravings and eating mistakes basically went away on their own without my conscious effort.

My blood glucose has always been excellent. It did not stop me from having food noise and cravings.

[sublinear]

Sorry, you're right. I meant that I did not make significant changes to my diet. My point was I didn't really change what I eat, but how I eat. I still hate certain vegetables like carrots, kale, brussel sprouts, etc. and just added more of the nutritionally equivalent and culinarily far superior vegetables I was already eating.

That's not willpower. That's looking things up in the USDA database and tweaking my existing recipes. Why force nasty carrots onto the plate when I can eat spinach, cantaloupe, pumpkin, sweet potato, etc.?

I guess I also didn't emphasize enough that I took things super slowly? Taking 5 years to do what I did is a really modest goal. I just wanted to manage risk with minimal change. This is the pareto principle in action.

If we're really going to argue over stats, the effects of GLP-1 is meaningless noise in comparison and probably way harder to commit to. I just wanted to eat good and not feel like shit all the time. Isn't that what everyone wants? What if instead of there being "one weird trick" or a "miracle drug", we consider that basic nutrition is simply misunderstood and full of hundreds of weird tricks that are proportionally much easier to implement and they're damn tasty too?

[cthalupa]

I'm not knocking anyone meeting their goals without GLP-1s. It's obviously possible in absolute terms - people have been making great body transformations for as long as we've had fat people.

But everything you did, plenty of people try to do and fail at it. You are making it sound like this is all it takes and that it's easy. It might have been for you! But it might not be for other people.

The fact of the matter is the overwhelming majority of people that are obese and go on GLP-1s have tried other interventions before and failed at them. ~70% of all obese people have tried to lose weight in general, ~50% have recurring attempts, and while I don't have stats to back it up I am confident that the sort of people who are willing to go and inject themselves every week are the sort of people that have tried to lose weight in other ways.

> probably way harder to commit to.

A subcutaneous injection once a week is nothing. Dealing with constant food noise? I could maintain that if the rest of my life was stress free, and that's how I would drop 30lb. Once stress came back? So did the weight. Because for me, rearranging food doesn't matter if I still can't stop thinking about it even if I'm not actually hungry.

I'm on reta. It does barely anything to suppress my appetite - physical hunger has never been my issue. And I can easily eat however much I want - most days I am below 2k calories, but Saturday was an annual event with friends and I'm sure between food and alcohol I was probably at 5k calories for the day. But what reta does, is absolutely murders my food noise. I don't think about food constantly. I don't go eat because I got bored. The only thing I have to commit to for it is, once a week, put a needle on my injector pen, twist the dial to the right dosage, poke it into a spot where I still have subcutaneous fat, depress the twist top. Once a month I reconstitute a new vial.

[jakevoytko]

My doctor, who is on the older side, told me that he went through his records when GLP-1s started being prescribed for weight loss. He wanted to calculate what percentage of his patients (a) he had advised to lose weight, (b) reduced their weight to healthy levels, (c) and kept it off.

From the starting population of overweight people, only 3% of people dropped down to, and stayed, a healthy weight.

[meetingthrower]

that's too bad. I'm microdosing tirz -- 1/2 the "starter" dose they use to titrate you on, so essentially 1/4 of the therapeutic dose. Totally helped me reduce appetite driven snacking and eating. I still enjoy food, but now I leave half a beer left on the table. No problem. Makes you wonder what free will is like.

I am in a totally different setup than you though - 225 weight, goal to get down to 180 (my Army weight was 170.) I exercise a lot, and lost 30 pounds through diet two years ago. But it was the hardest thing I've done since Ranger school! So paintful to not eat enough. Gained it all back. I'm in month one of tirz and it is as easy as pie.

[Teknoman117]

Yeah, the 18 months it took me to lose that first 100 pounds was about the most miserable I've ever been in my entire life. Constantly hungry, constantly thinking about food, exercising 3 hours a day, having to sit out of social events because more than half of them involve going to restaurants, etc.

It really opened my eyes to just how food centric society is.

[cthalupa]

That's unfortunate! It might be worth checking out Tirzepatide or Retatrutide once it is released. The GIP and Glucagon receptors might be better targets for you, even if the GLP-1 receptor seems to not help.

[01100011]

It lets me more or less skip a meal but holy hell I am craving sugar more than ever. On the whole I'm cutting calories and have lost a lot of weight, I just wish I didn't want sugar this much.

[Teknoman117]

I’ve always been more of a savory kind of person myself. I’d take biscuits and gravy or a steak over sweets any day!

But I feel you on sugar. Took me a long time to cut sugar cravings. A decade ago I cut regular soda out of my diet, which a few years later led to me cutting out pretty much anything sweetened. Realistically it wasn’t the sweetness for me, it was the “mouthfeel” or doing something with your mouth. Just straight sparkling water satisfied the entire craving for me.

The hardest thing for me to give up / heavily cut back on was fried things. Maybe that’s the result of my parents using french fries as the reward food when I was a kid…

[bitwize]

Try allulose-sweetened stuff. Allulose is a sugar your body doesn't metabolize like sucrose. It has zero calories and does not increase your blood sugar. It's a component of maple syrup and so does taste a bit maple-y, but better than most artificial sweeteners and even stevia leaf extract (stevia and aspartame have a "tang" to them I dislike).

[bradleyy]

Hey, I can identify. Sending good thoughts your way.

[pitched]

I really had thought (with no research) the correlation between mental health and glp1 effectiveness went the other way around. Thank you for this check-your-biases moment, you probably just saved me a ton of embarrassment down the line, if these drugs ever enter my life.

[phil21]

I don’t think there is remotely enough data on the subject to make any confident statements either way yet.

I think the only very confident thing I can say after watching and helping dozens of folks get started on these drugs is that everyone’s biology is vastly different.

I have friends who have lost close to a hundred pounds on the starting doses of their chosen GLP-1. I have other friends who barely lost anything after a year at max dose. Some of these people in both groups are highly motivated to lose weight and some are simply taking the drug as a magic fix and expending zero other effort into changing their lives. Some have very difficult mental issues and relationships with food, some have very few hangups on the subject.

I have never been able to predict with high confidence how any particular person is going to react to taking them. By and large the results are close to magical for the majority of folks, and there may be some correlation with folks who combine the drug with other lifestyle changes - but those are just general averages I see and certainly not scientific.

[tsoukase]

Try Fluoxetine 20mg, first 1 per day, later 2. Glp-1 doesn't work in stress related obesity.

[rjurney]

So try Mounjaro. It works better.

[rootusrootus]

You missed out on both of the weight suppression tricks, which really does suck. Appetite suppression (or reduction of food noise) is pretty useful, but GLP1s also tend to punish you mightily if you overeat. For me, even if I were hungry, overeating will make me hurt for hours. I could not gain weight on this even if I wanted to.

There are some difference, too, between the various drugs. I never tried ozempic, I went directly to tirzepatide (zepbound). And then to retatrutide. I will say that reta is in some ways the most interesting, because it has less appetite suppressing activity than tirzepatide (this is common, not just me), but it still cuts my stomach capacity quite a lot, and ramps up my metabolism. I had stalled at about 90 pounds down with tirzepatide, and reta immediately knocked off another 15. I track calories, and I had changed nothing. Felt more hungry, still lost more weight. Wild.

From one rando to another, I recommend trying tirzepatide. Or try semaglutide again but stacked with cagrilintide -- some people get pretty great results with that, similar to tirz.

[Teknoman117]

Yeah I might just have to go get it out of plan. Kaiser covers Ozempic, but none of the Tirzepatide based medications. (Edit: looks like that might have changed)

I am a big guy (6’4, 330 lbs), but I was amazed that Ozempic just seemed to do nothing. I was having the gastric side effects, but I could still eat 3000 calories a day if I cheated without feeling anything.

[gedy]

I highly recommend Zepbound, you might try it.

[AussieWog93]

Similar experience here with Tirzepatide. Overeating is punished swiftly and painfully.

If it works for you, look into getting one of the 15mg pens and counting clicks in order to get more doses per vial. I've been on the one pen for 3 months now and it's still got plenty of juice left.

[rootusrootus]

One of the quirks of buying brand name GLP1s in the US is that we don't get the dial-a-dose pens, every autopen is one-shot. Some people disassemble them to get multiple doses, but at that point you might as well get the cheaper brand name vials or go with compound or gray.

[phil21]

Lilly Direct sells zepbound in “single use” vials you make draws from. Very trivial to add bacteriostatic water to them and do some simple math to divide the dose. I have a few friends who do this.

You can also take apart the pens and do the same thing, but it’s a lot more involved and you’ll need to source some sterile reusable vials for it.

[Teknoman117]

When I was on Ozempic in the US (Bay Area), it was a dial-a-dose Ozempic branded pen. Came with 4-6 single use needles you’d screw onto the end before use, and discard into a sharps bin after.

[amelius]

Did you try those zero-sugar candy bars (often labeled as protein bars)? They work quite well for me, no messing with GLP-1 necessary.

[j-conn]

Which do you like? Barebells salty peanut and chocolate dough over here. Though the sugar alcohols certainly aren’t great for you either, I think they were recently linked to stroke risk

[amelius]

I'm a Barebells Coco Choco "fan", though I'm aware of the stories around sugar alcohols. I think those bars are way too sweet anyway. They could use far less sweeteners. Would love to hear about more responsible options.

[bitwize]

Munk Pack is a good brand. They're like Kind bars but sweetened with allulose.

[amelius]

Thanks for the link. I also hate the sugar alcohols.

However:

> But allulose isn’t approved for use in Canada or Europe. There, it’s considered a “novel food,” which means it hasn’t been available long enough for sufficient testing, according to those governments’ standards.

> And it’s important to know that the FDA’s GRAS status doesn’t mean that allulose has been rigorously tested.

> “We don’t have studies regarding the safety of allulose at this time,” Dr. Hazen shares. “But if it follows similar trends to what we see in some other sugar substitutes that are sugar alcohols like erythritol, I would suggest there’s reason to be cautious about how much of it you consume.”

https://health.clevelandclinic.org/what-is-allulose

[bitwize]

I don't consume more than like a few grams per day to sweeten things like coffee, as well as the 5g or so in a single Munk bar. I seem to tolerate it well.