[joshuamcginnis]

Studies show almost all subjects regained the weight and reversed gains within 2 years. This means underlying issues (e.g., food addiction) aren't being addressed. Short of changing habits, the only maintenance solution is lifelong drug use and that doesn't sit well with me.

[wpm]

Why not? People take depression meds, blood pressure meds, all kinds of meds for their whole life. I'll be on omeprazole for reflux my whole life. It doesn't solve the underlying problem of my gut being prone to overpumping acid into my stomach. So omeprazole is problematic?

The underlying issue is being treated, it's treated by taking the drug. It works. It's doing its job.

I'd be curious as to how you came to this conclusion.

[htk]

No, the symptom is being treated, not the underlying issue. And that's ok, but treating the underlying issue, when possible, is better, as the problem ceases to exist.

[SoftTalker]

But that's not what the pharma companies want. They want you on the lifetime prescriptions that don't actually address the underlying problem.

[crooked-v]

For many people, the "underlying issue" is fundamentally just being too hungry for how they live. GLP-1s absolutely treat that.

[faangguyindia]

for many people the underlying issue is serious lack of education when it comes to nutrition.

Not understanding calorie balance, not understanding calorie density of the food they eat.

How many people know 1kg fat = 7700kcal that if they could create deficit of 7700kcal they could potentially lose 1kg bodyfat? Ofc, i know the relationship isn't that simple but for most people this roughly holds true.

If you are eating granolas in breakfast, it may come across as a shock how many calories they pack, go ahead look it up many people believe that's a low calorie health breakfast option.

Many people don't know

1g of carb or protein = 4kcal

1g of fats = 9kcal.

[dgabriel]

I understand calorie balance. I've been on a diet since I was 12 years old, and am now approaching 50. I've lost and regained the same 60lbs about 4 times now. I have logged every bite that goes into my mouth, and lived with a constant hunger for as long as I could take it. Then I ate until I felt satisfied and gained it all back. I know how many calories are in anything, and I can eyeball any serving size. I've been doing it for decades. When I take GLP-1s, I can just stop. My appetite and body maintains itself at a healthy weight, and I don't cry myself to sleep from either hunger or shame.

I think I'm not the ignorant one.

[faangguyindia]

I have no personal animosity toward you, but I've heard all this many times, so I'll respond accordingly.

>I've been on a diet since I was 12 years old, and am now approaching 50. I've lost and regained the same 60lbs about 4 times now

You can lose weight by crash dieting, which does not prove much. The first thing that comes to mind for people is simply: "I'll just eat very little and lose weight." It even works, but people quickly get results; it makes them miserable, and they gain it back.

People get stuck between "eating too little" and "binge eating".

>I have logged every bite that goes into my mouth, and lived with a constant hunger for as long as I could take it

This proves you are sincere in calorie tracking, but it doesn't tell us much about what kind of deficit you were in. What were your maintenance calories, and how did you calculate them?

What kind of deficit did you run over what time period?

In my experience, while people know all these things, execution still requires knowing all the "gotchas".

Going from 2700kcal calories to 1000kcal a day diet will make anyone hungry and miserable.

[dotcoma]

Wow. I wish you could find a way to do this without meds, but I certainly can’t blame you for taking them.

[toast0]

Plenty of people can take this intelectual knowledge and turn it into eating behaviors that work for them.

But this intelectual knowledge doesn't really help if your body is telling you it's hungry all the time and it's hard not to eat something. Better choices can help, because different calories deliver different satiety; but some people don't get much satiety no matter what they eat.

Calories in vs calories out is true, but it's very hard to measure calories out, so it's sometimes helpful and sometimes completely unhelpful.

These drugs seem to help a lot of people in different ways, but if the underlying issue is that they don't get the satiety signals they need to eat healthy amounts without it, of course it's not surprising that when they stop medicating, they stop getting the satiety signals.

There's a lot of variance among humans, but everybody seems to want a one size fits all approach to eating. That doesn't work; you have to find all the things that work for some people, and then try the most promising options until you find something that works for you. Many people crave novelty, and anyway people change over time, so something that works for someone today might not work for them next year, etc.

[faangguyindia]

>But this intelectual knowledge doesn't really help if your body is telling you it's hungry all the time and it's hard not to eat something. Better choices can help, because different calories deliver different satiety; but some people don't get much satiety no matter what they eat.

Maybe try to figure out why you’re feeling hungry. Is it because you’re running a 1000 kcal deficit?

Can your body really tell whether you ate 200–300 kcal less today than you did yesterday?

Most of us can easily notice a 1000 kcal difference, but very few can reliably detect a day-to-day difference of just 200–300 kcal.

What are your maintenance calories? Are they around 1800 kcal, where even a 300 kcal deficit puts you on a 1500 kcal diet? That’s very little food for many people.

In that case, it may be better to focus on increasing your maintenance calories by becoming more active in daily life.

Deficit = TDEE - Intake

either drop intake or boost tdee or do both.

If you managed to boost your tdee to 2500kcal, now a deficit of 300kcal means you eat 2200kcal day to day and 2200kcal isn't very little food making diet easy to follow.

>There's a lot of variance among humans, but everybody seems to want a one size fits all approach to eating.

I think there isn't as much variance as people like to believe, how many people you see walking around you with 3 eyes? and 4 hands?

[crooked-v]

Being aware that there are deceptively calorie-dense foods doesn't help the basic equation there. Anecdotes are not data, but my anecdotal experience is that if I ate nothing but bulk vegetables whenever my hindbrain wanted food, I would still be eating over my maintenance calories every day.

[faangguyindia]

What's your maintenance calories and how did you calculate it? Most people calculate it wrong.

[Barrin92]

> the "underlying issue" is fundamentally just being too hungry for how they live

operative phrase in that sentence "how they live". They need to live more active lives. And that's better than a weight loss drug because inactivity causes systemic disease beyond weight gain.

GLP-1 drugs do to hunger what pain meds do to pain, but if you're overweight and your back is aching because you're sedentary the solution isn't a cocktail of drugs, it's to get off your ass, because that lifestyle is going to cause you biomechanical, metabolic and even cognitive issues down the road.

There's disease you can't do anything about and need to treat with medicine, but if you're experiencing symptoms because your lifestyle is abusing your body change your life. There'll come a moment where there's no wonder pill to fix your issues and in that moment you're better of if you know how to actually get control of yourself. Which most import of all is going to give you the confidence that you can change. You don't want to be 50 years old and your only cope in life is praying that a pharma company mutes whatever symptoms plague you.

[netheril96]

> They need to live more active lives.

When I become more active, I also become more hungry due to the extra energy consumption. The net effect is little weight loss and more often than not weight gain. While being physically active is beneficial to health in many ways, it does little for losing or maintaining weight, at least for me.

[Affric]

Right so it would seem increased physical exertion would be the answer.

Yeah, humans should have more free time and do enough work or exercise each day to keep their body in shape.

[spudlyo]

One might think that weight loss is simply an energy balance issue. Sadly, it's far more complicated than that. You can burn 500-800 calories in an hour of cardio, and you can consume 500-800 calories of food in a few minutes.

[ajross]

> No, the symptom is being treated, not the underlying issue.

That's a semantic argument. The "issue", medically, to most people viewing this as a health problem, is excess body fat and not eating behavior.

I mean, you're not wrong, but this seems silly. YES, it would be better to have developed a cure for disordered and unrestrained eating. We didn't. And we don't really even know how. Oops, as it were. But we do have a treatment that avoids the most significant impacts of those problems.

Medicine is harder than software engineering. Not all bugs are shallow even with all the eyes in the world.

[fwip]

Additionally - GLP1 drugs work by changing those eating patterns.

[hack1312]

But those changes don’t stick if the drug is discontinued.

[ssl-3]

Is the drug at risk of being discontinued? If so, then can that risk be quantified in any way?

(For comparison: Countless scores of diets are discontinued daily.)

[nemomarx]

Diets also don't stick when you discontinue them.

It would be an incredible advancement if we figured out a reliable and replicatable way to just eat less food, but until then I think a drug that makes you do that is pretty decent.

[ElProlactin]

> People take depression meds, blood pressure meds, all kinds of meds for their whole life.

And a lot of these medications have side effects that can affect quality of life negatively in other ways. That doesn't mean they're not helpful, or shouldn't be taken. But the "no free lunch" rule usually applies, sometimes to a noticeable degree.

[soared]

Omeprazole is not great long term FYI - worth talking to your doctor or getting a second opinion to discuss.

[catigula]

I’ve been taking high doses long term for over a decade and I don’t really have any substantial issues.

[derekja]

The primary concern is reduced stomach acid leading to nutrient deficiencies, particularly b12. There have been some long term studies correlating to dementia as a result. And some studies that have not found this. So the jury is still out, but keeping an eye on some nutritional markers is not a bad idea.

[dotcoma]

Good for you, but this mere fact does not mean it’s ideal.

Not a doctor, but I would at least try to look into this. Best of luck!

[hamhock666]

If you can find a way to use your own free will and self-discipline to stop the bad condition then that seems preferable to using a drug. Maybe someone doesn't have the willpower in which case it's good that we have the drug.

With regards to omeprazole, I changed my diet a bit and no longer needed the omeprazole. I don't know exactly what it was, but if you can get off of a drug because you don't need it anymore that seems ideal.

[paulddraper]

I mean…that’s just like depression medication.

It’s possible to ignore sadness as well as hunger.

[hamhock666]

There are usually ways to fix the problems in your life, like sadness and hunger, without resorting to using drugs. Maybe not everyone but it is something we should strive for.

[tuckerman]

Why is that something to strive for though? Maybe for some people that mental energy is better spent everywhere. If there is a simple and safe pharmaceutical solution for a problem, that sounds like great progress to me!

[joshuamcginnis]

I think there's a distinct difference between taking medicine for things you can fix on your own (diet + exercise) vs things you cannot (excess acid production).

[ceejayoz]

> things you can fix on your own (diet + exercise)

We have decades of research showing this is more in the "excess acid production" realm of things.

[applfanboysbgon]

We also know there's a replication crisis in psychology and medicine, that it's easy to publish results that show the effect you're looking for, that there are rich, developed countries with obesity rates <5%, and that the obesity rate for Western countries spiked in recent years. This idea that Americans are genetically pre-ordained to be fat seems like fanciful thinking.

[ceejayoz]

> We also know there's a replication crisis in psychology and medicine…

It seems unlikely to extend to bariatric surgery outcomes.

> This idea that Americans are genetically pre-ordained to be fat seems like fanciful thinking.

This idea that Americans are genetically pre-ordained to lack willpower seems like fanciful thinking.

[applfanboysbgon]

Of course they aren't genetically pre-ordained to lack willpower. That's why they could stop being fat, if only they chose to. The issue is cultural, not genetic. You don't go from 12% obesity to 40% obesity in 40 years due to a genetic shift, but rather a cultural one.

[thereisnospork]

>This idea that Americans are genetically pre-ordained to be fat seems like fanciful thinking.

The idea that it being genetic or not should matter is odd? Who cares why people are fat? They inarguably are fat and will by all available evidence be skinnier and healthier on a glp drug.

I fail to see the need for additional analysis or consideration?

Digging into the root cause or petitioning to tweak the food supply to reduce HFCS are admirable, but entirely orthogonal to the questions: "will taking ozempic et al make an overweight person's life better?" and "will making ozempic et al widely available improve America as a whole?"

[applfanboysbgon]

> I fail to see the need for additional analysis or consideration?

Having 40% of your population on a lifetime drug seems like it could cause significant issues in the long-term, especially if there are unforeseen longterm side effects. Medical intervention seems like it should be a last resort, not something half the population is subscribed to by default, so if the problem can be addressed by other means, it really should be.

[crooked-v]

I'm not on GLP-1s, but I've been looking at very seriously because something I can't "fix on my own" is just... always feeling hungry. That's just how my body works. Exercise doesn't help; there's no reasonable amount of exercise that will help with my office-worker stomach wanting 3000 calories a day. So far through my life I've just lived with it and managed my diet as best I can and it just absolutely sucks.

[buck746]

Terzepitide took me from always wanting food to actually being able to focus on other things fully. I was concerned with being able to inject myself weekly, but it's easy and worth the 1-2 minutes a week. If you start, the dosage schedule is more a suggestion than an absolute. I noticed side effects getting worse so I dropped back to a lower dose and have held there for a couple months now. Only real drawback has been from a friend giving me a hard time after seeing the vial in my fridge, but he seems to be coming around after seeing obvious results.

[throwatdem12311]

Why would exercise use help? Burning calories makes your body want to eat, obviously - this is how our bodies are supposed to work.

[untrust]

Exercise absolutely helps as it helps regulate blood sugar more effectively. A surprising effect of building muscle and exercising is that your body becomes more insulin sensitive and your blood sugar stabilizes instead of having drastic swings.

[habinero]

Yeah, I posted elsewhere about it, but GLPs instantly switched that feeling off like it was throwing a breaker. It's wild.

[saberience]

Exercise will help. It's Physics, it's not an opinion based thing that works for some people and not others. It's energy in vs energy out. If you simply eat less calories then you exercise/use, you WILL lose weight.

I don't get this weird thing people do where they act like their bodies don't follow the laws of conservation of energy.

[hackingonempty]

It is of course true that caloric input is a thermodynamic limit and restricting it sufficiently relative to caloric expenditure will cause you to lose weight. (Lisa, in this household we obey the laws of thermodynamics...)

However, not all calories are the same, metabolism is dynamic, and the brain is complex and exerts a powerful influence over behavior.

Increasing exercise will make you hungrier and most people are simply unable to resist this and end up not losing weight. It is why there is a common saying that "you cannot outrun your fork." Restricting calories generally is difficult in today's environment with plentiful calorie dense food everywhere. People don't cook as much as they used to and restaurant meals have more calories than ever.

AFAIK GLP-1 drugs work because they calm the minds desire to eat which is baked in deeply from millions of years of our ancestors struggling to get sufficient food.

[Aaargh20318]

The problem with exercise is that our bodies are quite efficient with their energy usage. A few minutes of ‘calories in’ takes many hours of ‘calories out’ to burn.

You can’t really exercise enough to offset the food you can eat in a day, even if you somehow were able to dedicate all your time to exercising you would still have to limit your food intake.

Add to that the fact that exercise is mind numbingly boring and you have to conclude it is not a practical solution at all.

[buck746]

More importantly we have decades of irrefutable evidence that diet and exercise alone are about as effective as abstinence only sex education. It's great there are people that can just decide to eat less, but it's foolish to assume that can work for everyone.

It's odd how people act as tho there's a "moral argument" against using a tool to help reach the goal. It feels a lot like the argument that "morals are from religion", as if you need god to know that murder isn't really a productive activity (unless you work in a slaughterhouse).

I wish American money could go back to having "mind your business" printed on it instead of "in god we trust", it was a huge loss to all of us when that garbage was passed. It was also a huge loss when everyone just decided to go along with saying "taxpayer money" instead of saying "public funds/money", but slippery psychological slopes are everywhere.

[tayo42]

You can pick better activities for exercise. You don't have to run on a treadmill

[hackingonempty]

> You can’t really exercise enough to offset the food you can eat in a day, even if you somehow were able to dedicate all your time to exercising you would still have to limit your food intake.

People racing the Tour Divide, a 2700 mile solo unsupported bikepacking race through the Rocky Mountains, lose weight when riding their bikes 18 hours a day for 2-3+ weeks straight. They describe being unable to choke down enough food even though what they are eating is very calorie dense. Hotdogs, burritos, burgers, pizza, a pound of gummies every day, chocolate milk and ice cream when resupplying, McDonalds where they fill their hydration bladders with PowerAde, anything they can get their hands on quickly when they arrive at a small mountain town which frequently has nothing more than a gas station.

https://www.facebook.com/groups/tourdivide/posts/24754803527...

Obviously not a practical solution as you say but they do exercise enough to offset the food when eating as much as they can.

[dghlsakjg]

It's physics that you just need to go a certain speed to put an object in orbit.

That doesn't make it an easy thing to do.

Fat people are aware of diet and exercise. They aren't stupid.

Until you have been chronically obese, or helped someone that is chronically obese, you don't understand that it is a deeply rooted subconscious issue, not a physics issue.

Fat people don't want to be fat, anymore than depressed people want to be sad. But something in their minds or bodies makes it non-optional. Pharmaceutical interventions change that thing.

When people - in their millions - say that this is the only effective thing, you could, I dunno, believe them. Or at least believe the pharmacological/medical science, which is, to circle back, all just physics.

[SpaceNugget]

They said exercise doesn't help them with reducing the feeling of hunger. I don't know why they thought it would, because generally if you do a lot of exercise you get more hungry not less hungry, but regardless, you are responding to something that wasn't said.

[crooked-v]

Exercise will burn calories, yes. But my life doesn't fit the several hours of exercise a day, every day, forever, that would be needed as an already-small person to burn the 1000+ excess calories a day my body is constantly hungry for.

[habinero]

Why? They both get you to the same place, and one is vastly more likely to work. I don't get the weird moralizing around this.

[9x39]

If they were a normal weight they would not have been prescribed the drug. The underlying issue is they're overweight because they eat too much. Anything more is speculation.

There is usually no free lunch when it comes to pharma, and extrapolating long term or lifetime dependence as being equivalent to short term interventions is an unsupported leap.

[MPSimmons]

Oh hi, I'm a heart attack survivor who had GLP-1 prescribed by my cardiologist for its heart-protecting benefits. I told my cardiologist that I wasn't losing weight as fast as I thought I would, and he said, quote, "I don't care about you losing weight. That's not why I prescribed you this."

So I'm not sure your first sentence is universally accurate.

[Aaargh20318]

That’s the problem with these new weight loss drugs. Ultimately they work by reducing food intake.

For many people food is one of the few things in life that gives them some form of joy. I won’t ever take any drug that will take that away from me. Life is depressing enough as is.

What we need is a weight loss drug that lets you eat unlimited amounts of food, preferably even suppressing the feeling of fullness, without gaining weight.

[dotcoma]

> For many people food is one of the few things in life that gives them some form of joy.

This is the problem to be addressed, not hoping for a miracle drug that will let you chuck down 5,000 calories a day and be healthy, imho.

[wincy]

I’m on the max dosage of Zepbound and ate an entire six course meal at a Michelin star restaurant last year. It was an incredible experience. I just don’t eat an entire frozen pizza by myself, or box of zebra cakes where I’d then wake up with horrifying heartburn at three in the morning anymore. My life is so much better and my relationship with food is still totally fine. Sure I’ll have a treat sometime, but I’m not finding myself hungry at 11pm driving to the store to buy a box of them because I feel like I’m starving. I was well on the path to becoming diabetic and it felt like something I could barely control. When I’d try to diet I’d wake up shaking from night time blood sugar drops. All that hell is gone now.

[MPSimmons]

It doesn't take away joy. It does cause me to be slapped in the face with the "full" feeling while I am in the middle of eating, which is like 15 minutes earlier than I used to get it. I don't overeat anymore because I would be literally miserable if I did. It would be like force-feeding myself. But before I get that full feeling, food is excellent.

[SubiculumCode]

Have you taken this drug? Because they don't reduce my enjoyment of food. Quite the opposite; I enjoy it more...its just that I get full feeling much quicker, and am less likely to go graze in the kitchen. But enjoy? No, I enjoy my food quite a bit.

[toast0]

Maybe there's something that you can take to simulate IBS...

I'm pretty sure when food goes right through me that I'm not getting any of those calories. Otoh, I have some idea of what types of foods (and how much) will trigger and the foreknowledge of that certainly reduces the joy of eating some foods I otherwise enjoy.

I still have trouble with calorie balance, but although I enjoy many kinds of ice cream, I have no problem going into an ice cream shop with friends and not ordering anything, even if I'm hungry. A 'single' scoop is way beyond my limit, and if I order a scoop, I won't order a scoop, take two bites and toss the rest, I'll eat the whole thing, so it's not worth it.

When I was doing bike commuting with real hills, I could eat anything, but now I work from home and can't convince myself to put that much time in the saddle just to eat whatever.

[JumpCrisscross]

> that will take that away from me

They don’t stop eating, just overeating. Getting joy from food is different from self medicating with overconsumption. (For the record, I love food. I also don’t have an issue maintaining a healthy weight and physique.)

[cflewis]

This is it.

I am on GLP-1 (Zepbound). I have done Weight Watchers multiple times. I'd lose the weight for a little bit, then it would come back. The reason was _I was hungry all the time_. It's not sustainable. As someone else in WW told me: "The easy bit is losing the weight. The hard part is continuing to eat that way your whole life."

It's simply a faulty hunger sensor in my body. It was not what I was eating, simply how much.

GLP-1s fix the sensor. It's really simple. Nothing else to it.

I still enjoy food (although my palette has turned away from anything greasy, which is for the better anyway), but I can finally understand why someone would eat half a plate of something and say "I'm good" and actually mean it rather than trying to diet/starve themselves.

[JumpCrisscross]

My friends who have been on it can genuinely enjoy food more now. There is no guilt. The portions make restaurant budgets more manageable. And they’re trying more of the menu. They liked food before. I think they can genuinely love it now, and that’s really great to experience with them, even aside from the massive lifestyle benefits losing weight brings.

[SubiculumCode]

So many misconceptions in these threads; your take is spot on and accurate.

[phil21]

I dunno. It’s not universal, but I have a newfound joy when it comes to food after being on a GLP-1 and losing about 100lbs.

Sure, I don’t get the instant giant dopamine spikes from binge eating $30 worth of Taco Bell or a couple large pizzas. Once in a while I do miss that, but I can still do it now that I’m a few years into the weight staying off. It’s just not worth how shit I feel the next couple days afterward.

But healthy Whole Foods? What was once kind of meh for me is now something I look forward to and explore. Both going out to foodie type spots, and cooking at home. Both gourmet and basic. Just tasting the nuances and everything in some well prepared veggies or whatnot is great and not something I used to appreciate.

I also don’t constantly feel like crap with stomach issues either. I suppose there is less “addictive” type vice enjoyment in my life in some way, but the tradeoff has been life changing. I certainly still get plenty of joy from many of my meals when I feel the need!

[wincy]

You and I are kindred souls here buddy, I haven’t had heartburn in months and it used to be an almost daily occurrence. When it does occur it’s fixed by one Tums. I’ve lost 120 pounds taking Zepbound. My life used to be Waking up and downing half a bottle of Pepto because my stomach was an acid volcano. Doctors telling me that it’s just the way my life is now, and to take PPIs. Eating a pizza in one sitting. Feeling the urge at 11pm to go get fast food after eating dinner because I was so hungry. Now if I get Taco Bell it’s like $8 and it still tastes good, but I tucked into cauliflower and Caesar dressing as a snack today instead.

Totally transformative.

[thereisnospork]

Nonsense, one not just as easily say they are overweight because they aren't taking enough GLP-1 agonists. A patient with scurvy is proscribed vitamin C - they might even need to take it for the rest of their lives to stay healthy.

Woe is them I guess for their chemical dependence.

[buck746]

One could even argue food is a lifetime chemical dependance. An assortment of chemicals really with the amino acids, lipids and sugars involved. People who are against these medications typically draw arbitrary lines for what treatments are "acceptable".

Until starting tirzepitide I always thought about food, now I don't. Had depressive issues since I was a teenager as well. I took Wellbutrin for 20 years and had an interruption in the last six weeks due to an insurance issue. Payed for the tirzepetide out of pocket, take that once a week, my depression is manageable without the Wellbutrin for the first time in my life. I'm still going thru depression, but that's due to my husbands death in early March. If I wasn't taking my weekly shot I would easily be morbidly obese and probably suicidal. The cost isn't an issue either, I would spend more on food that I'm not buying or eating each month than it costs to buy the medication.

Just because something might not be interesting to someone doesn't mean it has no value. I have no interest in sports, but that doesn't mean they shouldn't exist. I could argue they shouldn't be as prominent in society but that's a different argument.

If you have struggled with your weight, depression, have early warning signs of cardiac problems and a range of other conditions it can be worth considering semaglutide or terzepitide. As long as you stick to the lowest dose that's effective the side effects are minimal to non existent. Categorically dismissing these drugs is as silly as refusing pain meds because "god designed us to experience pain".

[9x39]

I think you dislike the personal responsibility angle, which is fine but separate from caloric intake being the source of obesity. The fat is stored energy from food, it would violate conservation of energy otherwise.

There's metabolism, food density, food availability, psychology, culture, economics, etc in play, but it's important not to lie to ourselves that the proximal cause of obesity isn't from over consumption.

[JumpCrisscross]

> dislike the personal responsibility angle

I dislike the rejection of evidence. These drugs solve a problem. Preaching personal responsibility does not. In that way it almost reminds me of drug prohibition and abstinence-only rhetoric.

[9x39]

The evidence of where their fat stores came from?

[phil21]

Who is lying? I was fat because I ate too much.

Why I ate too much is uninteresting to me. I also don’t have some moral hang up over it. Give me that easy button all day long so I can focus on shit in my life that actually matters.

If it makes someone feel better about themselves to believe in woo-woo science that violates the laws of physics and ascribe magical properties to GLPs, why do you care?

[faangguyindia]

>If it makes someone feel better about themselves to believe in woo-woo science that violates the laws of physics and ascribe magical properties to GLPs, why do you care?

Why we should not care about putting people on drug who do can benefit from making lifestyle changes, being less sedentary and leaning about maintenance calories and how calorie surplus and deficit works?

if there is no resistance, simply prescribing GLPs to average person may become a new normal.

[flextheruler]

Unfortunately for a lot of people with weight issues it stems from becoming overweight during puberty which is uniquely bad. Your body's appetite signals are permanently impaired if you become overweight during puberty because during this window your fat cells don't just increase in size, but also in number and this increased quantity does not go away once created. Fat cell shrink as weight is loss, but they are not destroyed and they are responsible for appetite signaling. It's one of the reasons that childhood obesity is actually leagues worse than it first appears and I think should be considered child abuse in extreme circumstances.

[apt-apt-apt-apt]

What you said isn't unique to puberty, it's the same with being overweight in adulthood (AIUI).

[dmayle]

The issue isn't food addiction, it's a broken hunger response (broken by Howard Moskowitz intentionally in the name of profits)...

You have to change your food regimen completely (higher fiber, more protein, less sugar, less carbs, less fat), and that's tough to do when you're surrounded by options that aren't...

I think the real problem is that the symptom we're trying to treat is "overweight", and it's actually a two-stage problem... Fix the hunger response... and only then work on fixing the weight... Fixinig the latter without fixing the former means you'll always gain the weight back, fixing the former doesn't guarantee you lose weight (and is only temporary, if you're using drugs for it)... You have to go after both problems.

[basch]

We shouldn’t ignore grocery stores and marketing.

Aisles and aisles of sugar drinks and colorful sugar packaging.

The way society leaves it up to people to make their own decisions creates the problem at scale.

Society essentially has to take weekly injections to avoid the temptation of coca cola.

[mynameisash]

What breaks the hunger response, and how does one fix it?

Maybe it's well-known, but I read the starvation response Wikipedia page[0] and didn't grok it.

[0] https://en.wikipedia.org/wiki/Starvation_response

[SoftTalker]

Buy unprocessed food and prepare it yourself. Don't add sugar. Eating processed food and even most restaurant food is eating food that's designed to make you want more, not satiate you.

[mynameisash]

I guess I should have asked about the technical mechanism of what causes and what actually 'breaks', and then what the technical remedy is.

[PaulHoule]

It's not like anything else in terms of drugs, surgery, or lifestyle changes has been proven safe and effective. A person who is dependent on opiates or caffeine or cannabis can possibly live without those substances, you can't go "cold turkey" from food.

Funny I just shot myself with a Zepbound autoinjector for the first time! My primary care doc told me he thought I was a good candidate a year ago but that he had trouble getting insurance to pay for it, it took me a year to get in with a specialist, insurance approved it right away, and now I am supposed to keep a food an exercise log.

I am well in the obese BMI range but I've been active my whole life (e.g. I can't see how people can get through the day without going to the gym or something) so I have a high lean mass and don't look that fat with my clothes on. I've struggled for years with various conditions associated with "metabolic syndrome" and I'm on numerous maintenance medications already and may be able to delete some of them.

I am currently around 250 lbs which has been my usual for the past 20 years or so. Had some luck with Zone, ketogentic and bean plan diets but couldn't stay on any of them indefinitely. Got my weight down to about 208 lb in six months when I quit taking antidepressants at my doctor's suggestion (never went back), had something like a manic episode where I manifested an "evil twin" who was vain highly motivated [1] and worked out like... a maniac and I also discovered I had TMJ dysfunction and took load off my jaw by throwing comically random food (cashews, seaweed, celery, potatoes, carrots, pork, ...) into a pot and grinding it with an immersion blended. Not sustainable, not least because my evil twin's antics got me kicked out of the gym.

[1] as-a-fox one axiom is that "I never push on a string" and have a hierarchy of goals, non-goal goals and non-goals; my non-goal goals are his OKRs

[SubiculumCode]

And this morning, I cut another hole in my belt. Turns out, losing weight and being thin was never about willpower or laziness in the face of absolute food abundance. It was mostly about whether a person was born lucky enough to have a moderate appetite, or was born burdened by exaggerated appetite.

The underlying issue is physiological food cravings, not some personal failing or lack of willpower, and GLP-1 absolutely addresses those "underlying issues". That it isn't some one and done pill is hardly a realistic expectation as that would require probably genetic and epigenetic reprogramming.

[nihonde]

The idea that appetites are assigned at birth is a bold claim. Is there evidence to support it?

[9x39]

Well, not assigned by the hospital or your parents, but being a DNA-based lifeform a genetic baseline is a safe assumption. Experiences vary after that:

https://pmc.ncbi.nlm.nih.gov/articles/PMC3052625/

[s1artibartfast]

I think there is much stronger evidence that it is metabolic damage from overconsumption in an earlier stage in life.

Not unlike if you shatter your legs, your recovery may be long and incomplete.

[SubiculumCode]

Genetics and epigenetic factors.

[JumpCrisscross]

> almost all subjects regained the weight and reversed gains within 2 years

Source? I thought it was 2/3rds of the weight regained, which is still a substantial long-term loss.

[rfv6723]

The only underlying issue is an evolutionary mismatch: human evolution is too slow to keep pace with the modern abundance of food.

What we now call food addiction is exactly what kept our ancestors alive during famines.

[vidarh]

Given that we know that diets and changing habits doesn't have lasting effects, what doesn't sit well with me is to risk my health to avoid taking a drug that helps.

[brazukadev]

changing habits do have lasting effects, I'm not part of this "we" that doesn't know that.

[topgrain2]

People talk past each other on this because for an individual it technically can work, and sometimes does, but on a population level, as extensively studied by people whose job it is to study that, it definitely does not work. Even with tons of regular attention from professionals and a cohort selected to have above-average motivation, it’s surprisingly poorly-performing (and that’s a crazy expensive level of intervention)

Think about how we describe contraceptives, medically speaking: a failure rate is tracked and promoted that’s the in the wild rate of failure, not the ideal-use rate of failure (which can be effectively zero!). The diet and exercise equivalent of a contraceptive couldn’t be sold, because its failure rate would be way higher than its success rate.

So “we” (people who’ve paid attention to the science on it) know it doesn’t work (on a population level), like for-sure definitely does not work, but a person reads this assertion of fact and goes “but wait it worked for me, this person must be dumb or something” but that’s not it. It’s two different perspectives on what it means for it to “work”.

[yakz]

I think it'd be more accurate to say that informing people that they should change their behavior doesn't work. A person changing their behavior can escape obesity. The reality is that most people won't be able to change their behavior without some other kind of assistance.

[topgrain2]

Even with extensive assistance (which is way too expensive to widely deploy) outcomes are weak.

Last I checked, researchers in the specific area of high-touch weight interventions were excited that they finally had a tool that might more-than-barely work… in glp-1 agonists.

[yakz]

I didn’t mean to suggest that GLP-1s don’t count as assistance.

Informing people that they can avoid pregnancy and STDs if they’d just stop fucking each other doesn’t work at scale either.

[vidarh]

If you succeed at changing your habit, it works.

However, all the evidence is that the vast majority of people fail at changing their habits in ways that produce lasting weight loss, so it does not generally work as advice for reducing your weight.

So you're technically right, but it is irrelevant, because we don't know how to actually get people to change habits with any meaningful rate of success.

At this point it is downright harmful and wildly unethical to recommend it when we now have a far more successful option.

[SOLAR_FIELDS]

Statins are a well understood mechanism of action for controlling cholesterol. We generally understand that people with cholesterol problems leverage statin therapy to address those, and there is a well audited corpus of placebo controlled double blind trials that demonstrate the efficacy of the solution for statin therapy. If you discontinue the statins, you lose the benefit to some extent. How is this situation fundamentally different?

[mukbangpervert]

What facts do you have that make you certain that the underlying issue is "food addiction" rather than, say, a difference in body chemistry that changes perceived hunger levels?

[3stacks]

It’s the food equivalent of declaring bankruptcy. If you don’t fix the behaviours you’ll just end up in debt again.

[kolinko]

This assumes underlying behaviours are core reason. Research (tein, adoption) suggests otherwise

[yakz]

Practically speaking, any person could starve themself (short of death) and lose weight. In almost all cases there is no magic to storing more energy than you need.

[shadowpho]

Practically speaking any person cannot maintain that for significant length of time. Dieting has like a 99% fail rate by year 2. It’s hard to maintain that for many people — your body will keep you in starvation mode, keep you hungry and hang on to every calorie received.

[PeterHolzwarth]

A couple years of reduced weight, and all the benefits that entails, doesn't sound bad.

[LaurensBER]

I've gained and lost 10kg twice in my life. Maintaining the weight loss isn't that hard once you've a rhythm dialed in.

In my case I just weight myself daily, track the weight and scale my food consumption with the current trend. If I'm gaining weight I'll skip a meal.

It takes a while to figure out what works for you but I can tell you that making small lifestyle changes to maintain your weight is fairly easy compared to figuring out how to lose 10 kg.

[coffeemug]

When I was lifting weights I went from 170lbs to 210, and back to 170. Doing that isn’t technically hard, and maintaining is even easier. But I had to think about it _all_ the time. Maybe it’s because I’m older now, but I just don’t want to spend that much effort thinking about food.

[faangguyindia]

lifting weight isn't efficient for weight loss.

Without calorie deficit, you'll not lose much weight by lifting alone.

[SoftTalker]

You'll probably gain weight in fact. Muscle is heavier than fat.

[kolinko]

Just because it wasn’t hard for you doesn’t mean it isn’t hard for the others. Grom what you said it seems you just had some bad habits you had to fix and that’s it.

[crooked-v]

Plenty of people have lifelong drug use of, say, caffeine, or aspirin as a blood thinner, or various antihistamines. Why is this somehow worse? Particularly keeping in mind that it's very easy to make, so once the patents expire, it's going to be dirt cheap as generics everywhere.

[joshuamcginnis]

I'm just sharing my personal preference and not trying to tell people how to live their lives. I don't like personally like the idea that I'll only be healthy if I take this drug for the rest of my life when I could (again - speaking for me), be more disciplined about the food I put into my body.

[m1keil]

Why this has to be all or nothing?

You can use the drug to loose weight while trying to understand the underlying problem.

[kolinko]

“be more disciplined” - did you read any studies about the sources of obesity? Or do you struggle with weight since childhood yourself?

[fragmede]

The drug stops working if you stop taking it? Shocking! Heart medication for hypertension also stops working if you don't take it. Sure there's a vast conspiracy by the pharmaceutical industry to hook us all on drugs because we can't learn to exercise, but that's hardly Ozempic's fault. Now if you were looking at brain surgery that zaps the reward center of the brain causing permanent changes so the patient was less addicted to food, but the patient kept needing to have brain surgery, then you'd have a point, but "drug stops working if you don't take it" is hardly the gotcha some make it out to be. Insulin also stops working for diabetics if they don't take it. That's kind of medication's whole deal.

Now that we know obesity can be controlled via medication, and it'll cost $foo over the lifetime of the patient, the next step is to optimize. If there is a treatment involving ultrasonic brain surgery that costs less than $foo, the expectation is for the market to find that. Ultrasonic brain surgery is in its infancy, but it's already showing utility for Alzheimer's and addiction. The real question is if the pharma companies are going to be able to keep it from going mainstream because it's less profitable for them.

[gedy]

The "underlying issues" are not all moral failings as you hint. In my case, as I've aged my appetite due blood sugar/insulin resistance/etc means I'm basically hungry all the time if I restrict calories to maintain lower body weight. Yes - even if I exercise frequently. Yes - even with healthy food and snacks. My wife tells me my stomach is growling at night.

I will slowly gain about 10-15lbs a year due to excess calories if I try to maintain weight at < overweight BMI. GLP-1 drugs have been great to take that edge off.

[anon291]

Why? If you have too much help or whatever being produced such that your body eats too much, just take a drug. The harm of being fat is worse than anything ozempic does