robohydrate
9 hours ago
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
9 hours ago
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
9 hours ago
Sounds like a miracle drug that helps with all afflictions that come with our modern life/sedentary living.
Alupis
8 hours ago
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
8 hours ago
> 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
8 hours ago
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
6 hours ago
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
6 hours ago
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
2 hours ago
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.
cthalupa
4 hours ago
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.
Alupis
4 hours ago
> 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
4 hours ago
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.
throwup238
3 hours ago
> But no one has proposed mechanisms for GLP1 peptides.
I'm worried about long term malnutrition leading to significant loss of muscle mass, osteoporosis, and other deficiencies that eventually lead to infirmity and brings forward the immobility death spiral much earlier in late age through weak muscles and bones. Most of the long term studies on GLP-1 agonists that I've reviewed have been on diabetic patients who already had to carefully control their diets and we still don't know what decades of poor diet on Ozempic will do.
For very obese people the tradeoff is still pretty damn good though.
__blockcipher__
3 hours ago
One obvious risk would be blunting of longer term GLP-1 receptor activation. Imagine type 2 diabetes but for ghrelin.
To use an analogy amphetamines have a honeymoon period, and it feels like a lot of people on these weight loss drugs haven’t been on them long enough to get past the honeymoon period and see what the effects are after 10, 20, etc years
blackeyeblitzar
2 hours ago
GI issues are fairly common and sometimes linger after stopping too. Loss of muscle mass is also common.
jart
2 hours ago
Is there any evidence those things aren't just side effects of eating less food?
unethical_ban
3 hours ago
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
2 hours ago
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.goosedragons
6 hours ago
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.
seadan83
2 hours ago
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
nox101
4 hours ago
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
3 hours ago
That's evidence of environmental factors.
grepfru_it
4 hours ago
Just needs to be a walking friendly city. You will lose weight in eg NYC or Seattle
bitnasty
an hour ago
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.
Alupis
8 hours ago
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
8 hours ago
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
7 hours ago
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
manacit
7 hours ago
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".
tharkun__
an hour ago
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.
mathgeek
6 hours ago
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.
jdhendrickson
4 hours ago
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
4 hours ago
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.
mort96
7 hours ago
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.
rixed
6 hours ago
Maybe, but shame has never been a very good cure overall.
wtetzner
4 hours ago
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.
stirfish
7 hours ago
People get addicted to gambling, and you don't put that in your body at all.
spondylosaurus
7 hours ago
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
30 minutes ago
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.
__blockcipher__
3 hours ago
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.
cthalupa
5 hours ago
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
an hour ago
> 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.
JamesBarney
8 hours ago
>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
8 hours ago
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
8 hours ago
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.
Alupis
8 hours ago
Right, so we doom some portion of the population to forever take a pill from big pharma? How is that acceptable with anyone?
The goal should be to use Ozempic until you are in a better place to manage things yourself. The goal should not be to get people hooked on Ozempic for their entire lives.
Perhaps Ozempic prescriptions should come with prescribed exercise with check-in and monitoring, or something.
BurningFrog
7 hours ago
I guess young people don't always know this, but there are plenty of medications a lot of people take for the rest of their lives. Blood pressure and cholesterol pills are maybe the most common.
This gives a vast number of people 5-10 years longer lives, and I think this is great thing, even if some pharma executives end up getting rich.
Karrot_Kream
6 hours ago
Not just young people. High blood pressure runs in our family. A cousin, despite being healthy in most indicators, developed high blood pressure at 23. She's still going in her 50s just fine but has had to take blood pressure meds for the last 27 years.
JamesBarney
7 hours ago
> Right, so we doom some portion of the population to forever take a pill from big pharma? How is that acceptable with anyone
This is literally how almost all medicine works that treats a chronic condition.
> Perhaps Ozempic prescriptions should come with prescribed exercise with check-in and monitoring, or something.
Why?
formerly_proven
6 hours ago
> This is literally how almost all medicine works that treats a chronic condition.
Tons and tons of people managed to fix this chronic medical condition of "picking up too much food with your own two hands and stuffing it into your face every single day" without requiring refill prescriptions for life. I'm not saying there aren't cases of so severe "food addiction" that this treatment would not be indicated, but it's clearly the first line treatment for fatness now, which is just wild: Let's just, uh, replace actual betterment, sustainable habits and healthy lifestyles with... chemically-restrained continued burger stuffing.
foobarchu
5 hours ago
This thread has multiple people relating their personal stories of using ozempic to start building those healthy habits. Also, it doesn't just magically get rid of fat so you can eat more, its supposed to make you feel full longer (as I understand it, someone feel free to correct me on that).
Plus, even if it did magically get rid of fat temporarily, I'd rather encourage people to do something rather than simply shaming them for giving into a very human addiction.
Your biggest concern around glp-1 drugs shouldn't be the overweight people successfully slimming down, it should be people who are already a healthy enough weight who think they need to be even skinnier (something I've encountered plenty of).
CydeWeys
an hour ago
> its supposed to make you feel full longer (as I understand it, someone feel free to correct me on that).
It's complicated. This is commonly reported by people taking it, but it's not the only mechanism. Also commonly reported are that it reduces hunger levels flat out across the board, makes you feel full after eating less food, and that as you get used to eating less food your stomach physically gets smaller and you can't even eat as much food at all even if you tried to force yourself to (e.g. at a big holiday meal full of delicious food where you want to eat everything so long as physically able to, well past the point of hunger).
foobarchu
an hour ago
Thanks for the clarification!
tomrod
6 hours ago
We don't get pissed that elephants don't climb trees. What value is it to characterize people's obesity entirely as slovenness and gluttony? While there are certainly some slobs and glutton, dismissive judgmentality of everyone doesn't make sense.
For this reason, I believe your comment is lacking in empathy for people who may struggle differently than you, yet struggle all the same.
cthalupa
4 hours ago
Yes, it is within the realm of human power for every individual to not be obese.
But the fact of the matter is... a huge chunk of people don't succeed. 42% of American adults are obese. "Eat better and exercise" has not resolved the issue.
I spent a good chunk of my adult life eating well, doing cardio, lifting weights and loving it. Then I got busy with life and stopped. And it has been incredibly difficult to get back to that and gets harder as I get older. I don't think I'm some paragon of willpower - if so, I wouldn't have fallen off the wagon. But I think it would also be silly to think that if someone who has a proven track record of maintaining that for years can struggle with maintaining it for a lifetime, there's probably a lot of people who have never even had that much success who are going to have even worse of a time.
Are we going to moralize over bp meds and statins too? If people can't adapt, fuck 'em, let 'em die young?
BurningFrog
3 hours ago
This is such a judgmental take.
There are two ways to lower weight. Eat less, and Ozempic. I don't think it's any of my business which one people pick. The important thing is that they become healthy.
I've realized people are very different. Some can just decide to eat less by applying a little willpower. For others, that's incredibly hard. If you're in group 1, it's easy to think everyone is and be appalled how others can't even put in that little bit of effort.
JamesBarney
6 hours ago
Sure of the almost 8 billion people in the world there are plenty who have successfully lost and kept off weight.
But if you want to see if there is a reproduceable lifestyle intervention that treats obesity successfully in the long term you can look here. After a few hours of searching you will probably find the same thing I and almost all obesity researchers have concluded. There isn't one.
phil21
4 hours ago
Can you provide evidence that a statistically significant portion of the population have managed to maintain weight loss in the manner you describe?
The evidence I see does not support your claim. Obesity rates have only gone up during my lifetime and the folks I know in the medical field have consistently mentioned how diet and exercise simply does not have any sort of patient compliance. The folks who successfully do it are outliers.
I will go for the harm reduction principle on this one. The molecules themselves are trivially mass produced for less than $10 a dose and are already being sourced for that cost by folks who are willing to take a bit more risk to do so. Cost seems to be about the only major side effect so far.
amanaplanacanal
an hour ago
You are recommending a course of action that just doesn't work for the great majority of people. Why?
rootusrootus
8 hours ago
> doom some portion of the population to forever take a pill from big pharma
That is temporary. The effects are real. The fact that you don't think big pharma should profit handsomely for making it happen is not the only alternative. Before too long semaglutide, as one example, will be out of patent and available as a generic. It won't cost a thousand bucks a month to big pharma, it'll be practically free. Cheap enough that most insurance plans will likely subsidize it all the way to zero out-of-pocket cost just because the ROI is so good.
Tagbert
2 hours ago
I take a statin as something in my body produces high levels of cholesterol even on a low fat diet. I will always take a statin. It works well and there are few side effects.
My spouse must take a thyroid medicine every day for life.
Not taking these pills is life threatening. How is taking them not acceptable?
fragmede
8 hours ago
How my decisions will affect some company's bottom line is way behind "will this help me live a better, longer life" in my list of priorities, but I'm already on other medications that are generic for the rest of my life for other genetic defects I've been blessed with, though I'm not on Ozempic.
Alupis
8 hours ago
> 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
8 hours ago
> 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.
Alupis
8 hours ago
Obesity is a choice for most people who are obese. Yes, they lack the ability to discipline themselves into not over eating, but that is still a choice.
This drug artificially makes them more likely to make a healthier choice. That's great. But the person's goal should be to develop those artificial choices into actual choices, ie. change their lifestyle, then get off the drug.
Setting this up from the start as a "forever" thing is absolutely nuts.
JamesBarney
7 hours ago
How much less likely do you think someone with high self control is to not be obese?
12%. Which shows that your intuitions about obesity and the causes are probably wrong.
mort96
7 hours ago
Lacking the ability to do something is, typically, not a choice.
rixed
6 hours ago
> they lack the ability (...) but that is still a choice.
Typo?
kortex
4 hours ago
Hot take: "choice" is a myth when it comes to long-term executive processing, one doesn't choose to be obese/not, drug addicted/not, etc, the same way one chooses whether they want chicken or beef ramen for lunch. It's an unending grind of executive functioning against more basal impulses, that is heavily influenced by the blend of nature and nurture and life events.
PlattypusRex
4 hours ago
Blaming victims and being ignorant is a choice, one you made multiple times in this thread.
catlikesshrimp
7 hours ago
False. (All) People crave for food. Some people have stronger craving than others. In healthy people you call it "hunger". In obese people it is more like an addiction. Do you know people can be addictes to sex and to work, too?
If you insist on the choice argument, the only way an addict can stop consuming is locking himself in a room and throwing away the key. Other than that, much help is needed, many changes are needed, and even chemicals are needed.
"Choice" is victim blaming
tikhonj
3 hours ago
> 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
28 minutes ago
> ... if they have high blood sugar we give them diabetes.
That sounds like a hell of a treatment plan. o_O
lizardlena
8 hours ago
> 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
7 hours ago
Fighting the symptoms of what?
Taking ozempic will definitely keep people from gaining weight and will help them lose weight.
fortran77
5 hours ago
> 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?
Eisenstein
7 hours ago
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?
metabagel
6 hours ago
> 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.
jrockway
6 hours ago
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.)
monkeycantype
2 hours ago
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
perching_aix
8 hours ago
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
8 hours ago
> 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?
jacoblambda
8 hours ago
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
8 hours ago
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.
BurningFrog
7 hours ago
A lot of people take blood pressure, cholesterol, and other medications daily for their entire lives.
If Ozempic ends up being another such drug, I don't think that's a bad thing.
knifie_spoonie
6 hours ago
I'm not so sure about that.
All the people I know who are on those for-life medications absolutely hate the fact that they have to keep taking those pills every day until they die.
eichin
5 hours ago
eh, my inner "prepper" is annoyed by the dependency, the rest of me is pleased that I've already lived longer than any of my male ancestors. (Kind of hard to sneer at advanced technology given what I do for a living :-)
Alupis
8 hours ago
The point is you still need to develop a lifestyle that is healthy. The drug isn't a miracle, it's a band aid. If you do not change your lifestyle, and you discontinue using this drug, you will relapse. This is the same issue many people face when they diet as well, so it is nothing new.
The point of my saying this is to point that out, because a lot of people in this thread seem to think it is totally ok to be on an Ozempic prescription for your entire life. That's horrifying for so many reasons. Others seem to think you take Ozempic until you're "cured" then you just live happily ever after. That's hardly going to be the case for many people who have struggled with weight for their entire lives.
Wytwwww
5 hours ago
> That's horrifying for so many reasons
Why? AFAIK Ozempic seems to work by "modifying" behaviour and reducing the appeal of overeating and possibly engaging in other addictive behaviours.
It's not some magic pill that you take and then don't actually have to change anything about your lifestyles. It seems similar to antidepressants, ADHD drugs etc. in that way and a lot of people take those for extended periods or even their entire lives.
Besides potential side-effects etc. what's to horrifying about it?
rixed
6 hours ago
I think we hear you, we should all take more care about bad lifestyle, everybody should exercise regularly and eat healthy food. But to be fair nobody has promoted a bad lifestyle, or said that, given there is this new drug let's care even less.
At the contrary, given the testimonies it sounds like the drug helps people to adopt better habits, no?
Alupis
5 hours ago
> given the testimonies it sounds like the drug helps people to adopt better habits, no?
No, it helps people live a better lifestyle so long as they remain on this drug. The feeling/impulses are artificially suppressed.
Maybe they come right back if you stop taking the drug. One would hope you can take the drug until in a good place to take over on your own. Time will see - a great experiment is about to take place.
Wytwwww
5 hours ago
> feeling/impulses are artificially suppressed.
A lot of people are less capable of controlling those impulse on their own and are inherently more prone to developing addictions than others due to genetic/etc. reasons. Yes they can make different choices, change their lifestyles, adopt certain routines etc. all which would require a huge amount of effort just to get on part with people who can achieve those things (relatively) almost effortlessly.
Why should they be forced to suffer due to something they have limited control over?
perching_aix
8 hours ago
They said that this specific effect was largely sustained after stopping with the drug, so... ¯\_(ツ)_/¯
nwienert
5 hours ago
> 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.
homebrewer
5 hours ago
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
2 hours ago
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.
cam_l
6 hours ago
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.
slothtrop
4 hours ago
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.
marcosdumay
8 hours ago
Except for all the externally imposed ones.
But yes, there's a reason people are celebrating those drugs.
rafaelmn
9 hours ago
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
jjeaff
9 hours ago
Skinny fat is not nearly as metabolically unhealthy as fat fat.
queuebert
8 hours ago
Fat fat can better survive the coming post-AGI apocalyptic famines.
wwweston
8 hours ago
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).
rafaelmn
8 hours ago
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.
vessenes
8 hours ago
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
8 hours ago
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
7 hours ago
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
7 hours ago
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.
arijo
7 hours ago
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
3 hours ago
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.
karmajunkie
6 hours ago
you lost the debate the moment you cite joe rogan.
arijo
5 hours ago
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.
glenstein
8 hours ago
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.
nessguy
4 hours ago
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
an hour ago
> 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.
pedalpete
5 hours ago
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
4 hours ago
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.
phil21
4 hours ago
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.
mlsu
9 hours ago
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
7 minutes ago
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.
rootusrootus
7 hours ago
> 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!
kps
8 hours ago
> 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).
scottyah
8 hours ago
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.
lottin
7 hours ago
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.
anon84873628
an hour ago
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.
barrkel
5 hours ago
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
5 hours ago
> 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.
rixed
6 hours ago
What's the right approach?
Had the right approach better results?
If not, why is it the right approach?
beezlebroxxxxxx
9 hours ago
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
9 hours ago
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
8 hours ago
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
8 hours ago
> 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
8 hours ago
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.
itsoktocry
3 hours ago
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
2 hours ago
> 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
an hour ago
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.
bozleh2
3 hours ago
> 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.
mayukh
9 hours ago
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
8 hours ago
> 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
8 hours ago
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
8 hours ago
The US solved the food problem around 1800, being the first country to end the specter of famine.
JamesBarney
8 hours ago
Neurologically addiction works very differently than obesity and research says longterm sobriety is far easier to maintain than long term weight loss.
slibhb
7 hours ago
> 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
7 hours ago
>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.
StefanBatory
8 hours ago
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.
buu700
7 hours ago
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
5 hours ago
Do you view a chronic smoker as a failure of character or willpower?
buu700
5 hours ago
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
7 hours ago
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
7 hours ago
> 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.
Ygg2
7 hours ago
> 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.
arijo
7 hours ago
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
3 hours ago
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.
Etheryte
5 hours ago
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
3 hours ago
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.
arijo
5 hours ago
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
4 hours ago
It's not nearly in the same ballpark.
cgh
6 hours ago
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
6 hours ago
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
7 hours ago
It is not easy on the mind and body as to just cut carbs.
arijo
7 hours ago
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
7 hours ago
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
6 hours ago
Quoting Joe Rogan's podcast instead of literature is not going to go over well here.
arijo
5 hours ago
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.
slothtrop
4 hours ago
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
3 hours ago
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
3 hours ago
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
3 hours ago
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.
fortran77
5 hours ago
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
5 hours ago
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
an hour ago
This is an extremely unhealthy rate of weight loss. All guidance centers around .5-1kg/week as both safe and sustainable.
fortran77
4 hours ago
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
3 hours ago
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 :)
beezlebroxxxxxx
9 hours ago
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?
r00fus
9 hours ago
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
8 hours ago
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.
r00fus
7 hours ago
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.
tjohns
9 hours ago
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
7 hours ago
"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
7 hours ago
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
6 hours ago
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
8 hours ago
> 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
8 hours ago
Is the idea of a set-point settled medical/scientific fact, or still a disputed theory?
tjohns
8 hours ago
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:
karmajunkie
5 hours ago
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.
JamesBarney
8 hours ago
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
6 hours ago
A lion may also have to endure long periods of no food.
comechao
6 hours ago
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).
siva7
5 hours ago
How do i get this?
colordrops
8 hours ago
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
7 hours ago
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
8 hours ago
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
7 hours ago
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
7 hours ago
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
cactusplant7374
9 hours ago
> I realized that frequent cannabis consumption interferes with the weight loss
Because you eat more or is there some other factor?
yieldcrv
9 hours ago
Sounds like a kickstart you needed!
Aside from the disruption in cravings, the immediate results seem to have motivated you to do more.
robohydrate
9 hours ago
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
8 hours ago
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
6 hours ago
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
7 hours ago
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
6 hours ago
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
6 hours ago
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.