‘Breakthrough’ obesity drugs that have stunned researchers
nature.com
nature.com
7 years later, I had a bad ankle injury and regained weight to about 29 BMI. This time I lost weight by doing an “eat every other day” diet. This was also extremely challenging, but easier than just counting calories and working out. After Covid and a lack of exercise I was back to BMI 30. I started taking tirzeparide this summer and have gone from BMI 31 to BMI 26 and still dropping. This is by far the easiest way to lose weight. The side effects for the first 3 months are quite bad, and include off and on strong nausea, extreme fatigue, brain fog, and constipation. I was eating <1k calories per day for a long time and feeling full. I expect to be on this drug long term. My blood work shows extreme improvements in cholesterol, BP, and other key health indicators. I believe that everyone, even the skinny folks, should be on GLP1 drugs for the longevity effects. They changed they induce in diet reduce the oxidative stress on the human body, even if the person is already thin.
Tirzepatide (Mounjaro) is Lilly's next generation therapy, targeting both GLP-1 and GIP
The US government stated $18000 per year was a fair price to pay.
There is no money in the cure. We sell you the disease, and charge you 5x for the treatment.
Fwiw I am obese.
I’d bet a lot of money the person in the story is not 6 foot 5 inches
I don't think this is the most interesting or curious discussion we can be having about these drugs --- the science story is much more interesting and relevant than HN's general opinions about "big pharma" or the obesity epidemic, and the science story stays interesting even if you think the drugs are not a net good --- but of the non-science discussions we can be having, the pricing seems like the least interesting thing happening here. These are injections whose competition is major surgery.
So's obesity.
> the cost is pretty prehibitive unless insurance is covering it
Given the costs of treating the various obesity side-effects, they're pretty likely to. (They'll probably require a few hurdles prior, though.)
Let's hope this changes and insurance companies cover it
clearly can't be the case for someone who is obese so I'm wondering if this is true then if it's limited to folks who are struggling with obesity that can endure this
Implying that something is off if you "feel" but are "not" full? How do you define full? Having a "healthy" amount of food in your stomach? However you define it, with asserting that, you have to acknowledge the closely related idea that there's something off if you are "full" (as you've defined it) but still not feeling full - or satiated. It's that broken state that so many of us are desperate to solve.
I'm on a GLP-1 agonist after years of diets, gym memberships, shame, etc. etc. and this medicine is nothing short of amazing for me. It feels like it has fixed things I didn't even realize were wrong and it has changed my relationship with food in very positive ways. It is now so much easier to eat - some food but not too much food - just like I've seen so many of my friends with healthy BMIs do forever and have always had to consciously fight to do, day in, day out.
But even more than that, it's changed my desire for alcohol and reduced my consumption patterns there as well. Moving is easier -- and that effect happened faster than weightless, suggesting a reduction in systemic inflammation as well.
The side effects were a little rough for the first two weeks, but after ~3 months on it, I'd happily be on this for life given the positive impacts I've seen, barring any unexpected/unseen side effects.
I call it "brain hunger" and "body hunger". Over time I learned to notice the difference.
Brain hunger is just brain going "heeey, your stomach is empty, I don't like it", or "we just did a bunch , it's evening, me want tasty food as reward", or "we haven't eaten that tasty thing for a while, give food now?". The "fuck off brain, you're not hungry, you're bored" state.
Body hunger is change in physiology, not just "tummy feeing empty", my hands and legs get colder and I feel a bit more awake and on edge. And, well, annoyed.
I lost 45 lbs myself with diet and excise, bmi is 25. Hoping it works. If it does not I at least know I have a fallback plan.
Especially since we're talking about possibly dying a couple years early vs definite awful side effects
Once I was hacking out of house and noticed garbage can needed put away. So I got out of car while driving away. Promptly got caught on seatbelt and got dragged away. Stopped driving until I was off that Medication.
The alternate med. Diamox makes me sleepy. But otherwise Doesn’t make me dumb.
I know people that do great on topomax. But it has a reputation
How was it socially isolating? I’m curious because I exercise and diet and this is not my experience. I understand it being challenging though.
I'm not OP but when I was losing, as a 6"2 male, I was eating between 1200 and 1400 calories a day. This does not allow you to eat anything outside of small meals and drink anything outside of water or diet sodas.
I was still going sometimes to the restaurant with friends but my choice was limited to the unique salad on the menu (which you can't eat whole because it would be too much) and my drink would be a diet coke. Same when we were going to the bar, I would just have diet soda or water.
I was lucky that all of my friends were absolutely supportive and didn't mind at all, but it still limits you. Going to a night club without drinking is not fun at all for example.
The important thing here is that a 1200 calorie diet for someone that big is an extreme outlier and I’d like to know what the actual protocol was.
If there wasn’t a lot of consideration about actual composition of diet or if this was a longer term protocol I’d be extra leery of it.
You can be healthy with a zero calorie diet if done correctly and for the proper time period, but you should be consulting an expert if you do.
And for anecdata I’m 6’0, 215 and 45. 1700 calories is a crash diet for me.
Severe caloric restriction diets are actually not particularly effective if your goal is to permanently lose significant quantities of weight and keep it off - once you plateau it really sucks. Of course I mean if you power through and keep at it you will, but IME, periodic fasting is a much easier way to lose weight and keep it off.
Not hazardous, really, as you point out. The whole point of stored fat is to be used.
Citations available on request, I have NCBI links for each of my points but it takes a while to dig up.
Usually one big meal after noon and that's about it, plus occasional coffee or cup of cocoa. If I have event in the evening I just don't eat during the day or get a milky beverage to get me by, then depending on how much I ate I either delay dinner the next day or skip the next day altogether.
Here's another interesting one. Check out the Energy Expenditure section of [2].
> The gross BMR decreased in all the subjects during semistarvation, the average decline being 17.1% after 19 days (54) and 21.4% after 13 days (55). [3]
Based on this data, I would expect your BMR to go down by 20% over a period of three weeks, and remain there for the rest of your life were you to continue this for a while. So you'd have to, as an 'average' person, reduce intake by 500kcal to account for metabolic adaptation, then another 500kcal to lose 1lb per week.
That aligns with your suggestion that 750kcal-1000kcal reduction should show results for most people.
[1] https://pubmed.ncbi.nlm.nih.gov/27136388/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673773/
[3] https://journals.physiology.org/doi/abs/10.1152/jappl.1958.1...
This is where coke and mdma come in.
Also since taunting yourself with food is not a concern, you assume your willpower and concentration is perfect, you never need safety precautions!
You can go work on high voltage cables 80 meters in the air without rubber gloves or safety harness - since you are more agile without gloves, and you save time by not needing to move around the carabiner, you will be more productive!
Don't wear a seatbelt, a helmet, remove airbags, sell your protective gear! Don't buy insurance! Remove safety from your gun! Store your bleach, poisons and fruit juice in identical containers! Leave sharp object lying around on the floor! Don't make spare copies of house keys!
I eat, get a bunch of vitamins, and socialize.
It sounds like you can't really sympathize because you haven't experienced this, but I can help you empathize if you're interested. Context, I've moved from between 16% and 30% bodyfat several times in the last 15 years, I've struggled with weight my whole life.
For some overweight people, like me, there's a high willpower cost to avoiding food that's present. A strategy for weightloss that's worked for me is to simply remove all snacks from the house, and when I order food, order an appetizer only, or, if I'm with someone, slide half my food onto their plate. If I have to, I'll try to eat half, and then right away ask the waiter to box up the rest or whatever.
Seems silly, right? Why not just take a look at my plate, make a rational evaluation of the calories there, and only eat until I hit within my calorie budget? I'm perfectly capable of making that calculation, I've been counting calories for a decade, I'm pretty darn accurate at this point. So why don't I just do that? Why don't I just work out every day? Why don't I just study my mandarin flashcards every day like I know I need to? Why don't I always put my clothes away as soon as I take them out of my dryer?
I don't have a catchall answer, all I know is that for whatever reason, some or all humans have gaps between their ideal self and their true self, and sometimes you gotta do silly tricks to jump those gaps. A silly trick that works for me is keeping food I shouldn't eat, out of site.
So TLDR when I'm hardcore dieting, going to an eating place with the intention of not eating is an extremely exhausting exercise. There's many opportunities for me to fail there, from when I sit down everyone's looking at the menu (maybe if I just get something small, maybe if I just eat half it's ok) through to when food and drinks come (well I can snack on some of the shared appetizer, that's no big deal). I will quite literally catch my eyes darting from whoever I'm conversing with to a plate of fries again and again. Every single time it happens I have to tell myself "no," with the full list of rational reasons why that "no" is more important than my impulsive desire borne from both hunger and just like, mouth boredom or whatever, to eat the fry.
So knowing that about myself, when I'm hardcore dieting, I just try to avoid setting myself up to fail like that, and thus, it's a socially isolating time. Especially when I lived in the USA and outside of like, rock climbing and motorcycling, there was basically no time people got together that didn't involve food, cause you had to drive or whatever and your hangout time would probably overlap with a meal or two.
I also stopped going to a weekly bar event with friends and honestly haven’t talked to them nearly as much since then. Similar to eating out though I eventually replaced that with a watch party/game night/discussion club with a different new group of friends. Those events have drinks but not really as a focus.
I didn’t make all of these changes simultaneously though which reduced some of the challenge. None of it is easy though and I still feel bad for not keeping in touch with some folks I was previously close to.
You can eat socially, you can have days you overeat and then fast the difference, etc. Pigeonholing yourself to super restrictive regimen - for what ? It's not like you have a deadline to lose the weight - and if your routine isn't easily sustainable you're just going to revert to old behavior as soon as something else starts taking your focus.
The only thing that matters with these things is trends and long term adherence.
Maybe in the loosey-goosey "I'm addicted to chocolate" way, but not in the "I habitually over-consume despite the negative consequences" way.
as someone who has to be reminded to eat by their significant other or family lest I fall ill, from a long-line of people with the same trait, no -- not everyone is addicted to food.
I enjoy food, I consume food, but it doesn't produce any level of compulsion like an addiction does.
If you do order out, get a salad and skip the dressing.
I've lost significant amounts of weight (60+ pounds) three times in my adult life, through simple calorie restriction (intermittent fasting, including before I'd ever heard the term). Every time, I've gained the weight back. At the beginning of 2022, I was the heaviest I've ever been.
I've accomplished very hard things in my life, including those that take sustained effort. Sufficient willpower isn't a problem for me in general. I honestly only ever hear "it's easy, just eat less and move more" from people that have never actually been fat. "I did it and I lost 15 pounds, no big deal!" and the like. 15 pounds is easy for me to temporarily lose too. I've done it enough times I should know ;)
I've heard people say that the solution is to eat (healthy food) when you're hungry, and stop when you're full. The thing is, I'm never full. I can eat until I physically can't eat anymore (not something I do regularly, of course), and as soon as my stomach has emptied a bit, I feel fairly hungry again. "Eat until you feel full" is literally a human experience I had never really had.
On this drug, I finally know what people are talking about. I still like food, and I still get hungry. But it doesn't dominate my thoughts. I eat, and don't feel like eating again for hours. I eat something that I'd normally easily eat all of like a big burrito or whatever, and I feel quite full halfway through with no desire to finish. I'm steadily losing weight, with none of the usual preoccupation with hunger, ascetic adherence to a strict calorie plan, etc. But above all, I feel like I must be experiencing what most thin people experience all the time. I'll be perfectly happy to take the drug for the rest of my life, though I do hope affordability improves.
As for side effects: I've had some heartburn, but none of the other commonly reported side effects.
Also figuring out when I'm "brain hungry" (brain is bored and wants to munch on something/get reward for hard day at work) and when I'm "body hungry" (body actually wants some energy and is slowing down, fingers/feet getting colder etc.).
Now getting some frozen pizza for dinner coz I'm lazy/don't have time no longer ruins diet pace for this week
> When I get that "brain is bored" style hunger I go for tea with a squirt of water enhancer in it lately.
Anything with a bunch of milk works well for me for quashing hunger. Weirdly enough I usually feel more hungry in the evening than morning next day (at the very least for first 1-2 hours)
I can easily eat 7-8,000 calories in a day, and there's no amount of stairmaster can fix that.
I've also previously taken modafinil, and had situations where I've had caffeine having been caffeine-free for a while, and the appetite-suppression properties have me thinking "this is what normal people must feel like". I cannot wait until these drugs become available in the country I mostly live in.
> As for side effects: I've had some heartburn, but none of the other commonly reported side effects.
And I looked up the less side effects, it is a laundry list of gerd symptoms.
I can confirm, these symptoms will help you lose weight, but I mean that tounge in cheek, I hope this drug helps a lot of people but doesn't have much in the way of side effects.
But intuitively it does make sense, because one of the primary effects of the drug is slowing down gastric emptying, so it causing heartburn isn't exactly surprising.
Gerd was reported in 5% of Wegovy users compared to 3% in the placebo arm. It’s a risk but it’s not a huge risk.
Nausea especially in the first few weeks was more common, but it was only bad enough to cause <2% of people to discontinue the trial.
This is what all the common advice doesn’t address.
The only thing that has helped for me in the past was an SNRI (sibutramine) that was later withdrawn from the market. Then all the weight came back.
There's something similar here I've noticed while testing myself in the past: At least for me, it seems like hunger occurs when the stomach empties by a certain percent of its last maximum. No matter if I barely eat anything, or eat until max capacity, hunger starts after my stomach empties a bit further, but it doesn't take until I'm actually empty (tested by the size of the following meal), and the hunger tends to end after reaching the last maximum. To use some made-up numbers to demonstrate, it's like I can bounce back and forth between 60% full and 90% full or 20% and 30% full, and once I've gone a cycle or two on either of those, the low ends of 60% and 20% make me feel equally hungry and the high ends of 90% and 30% equally full, but I've digested more when the baseline is on the higher end.
It can be difficult pushing from the higher range to the lower range though, have to ignore/squelch the hunger long enough to reach it.
I have a similar experience.
It’s so hard to eat healthy, I honestly cannot fathom how people do it.
When I started taking semaglutide, I finally understood it. I'd eat a salad... and be full and more than satisfied! I'd look at a muffin right after lunch, and go "eh, better things to do with my time" instead of immediately having an overriding desire to eat eat eat. Before, I could eat half a pizza and still be hungry (way out of what my body needs); now, a slice is more than sufficient and satiety lasts well into the next morning.
GLP-1 agonists makes eating healthy trivial and automatic, instead of a dieting state where you're thinking about food literally constantly throughout the day for months or years on end.
Too many people are convinced that everyone has the same subjective experiences of hunger and craving, but it's simply not the case. Some people implicitly hold this idea because it's a convenient ideology that allows people to morally congratulate themselves for having a functioning satiety circuit.
Where does this line of thinking stop?
Is everything pre-determined by genetics?
Is everyone who is smarter than me, just actually lucky that their dopamine system works correctly, and mine doesn't, and hasn't since I was a very young kid?
I'm sure this response will get down voted but its an honest question. This line of thinking that everything is genetically pre-determined seems both accurate and somewhat depressing.
It means that if I'm skinny and can't gain weight, I need to take steroids and lift. Or if I'm fat, I should take a GLP-1 agonist. If I'm underperforming in my career or school, I should take adderal or similar pharma solutions.
What role does good old fashioned hard work and discipline have in this day and age?
As for your actual question, it depends on the particular thing we're talking about. For obesity, we've tried telling people to do more hard work and discipline, and it's been a spectacular failure. Plenty of people who do work hard and have incredible discipline in other areas of their life fail when it comes to getting to a normal BMI. There are large subjectivities involved, but when I got down to a 22 BMI at one point via the hard work and discipline route, I was constantly overwhelmed with thoughts of food, literally every waking second; this was despite trying and adhering to probably a half dozen different diets. Most people able to maintain a constant 22 BMI don't experience this.
This also is more common in our current society, for whatever reason (likely not genes, since we're close enough to our grandparents), than it was historically. This isn't some natural state of affairs we live in.
So, bring on the drugs! If there are ones that help other things with minimal side effects, bring them on too. Everyone wins, because we end up with a better, happier, more productive society.
Out of curiosity, what kind of food were you obsessing over, specifically? Why were you craving that kind of food, instead of, say, lettuce?
As to why, who knows. I'd be "starving" but have zero desire to eat lettuce, but then jump on the first chance I got to eat a couple cups of rice.
So, maybe you already tried that, but there's a psychological/addiction angle that's seldom explored when it comes to simple carbs and obesity.
That said, if there's a drug that you can take that'll numb those cravings down to a healthy level, there's nothing wrong with that.
My brain doesn't produce the same amount of dopamine as a non-ADHD human's brain. It's morally neutral to fix that with medication, same as it's morally neutral to wear glasses, imo.
Would you be willing to believe that, out of 7+ billions people in the world, there is at least one person whose brain is set up to constantly hammer them with feelings of hunger? (I'm not sure how a basic proposition like this could be rejected, since the chemicals and processes that govern hunger are something that science actually has some understanding of, and we also know that basically anything can go haywire.)
Next: if you can believe that one person is such an outlier, can you believe that hundreds are? Thousands? Millions? Whatever size that group is, it seems like a possible answer to your worry of when these lines of thinking stop. Perhaps some outlying group of people do actually need something more than "good old fashioned hard work and discipline", especially considering that thousands of years of people repeating such sentiments hasn't solved quite a lot of problems (beyond just obesity).
Yes, those people exist as outliers. But a population-level outlier theory doesn't explain why obesity is growing in the population.
Obesity is similar. This feeling of hunger is thrown out of whack often not by genetic but by lifestyle. I’m lucky enough that I haven’t felt it all my life, but I have felt it during multiple phases of my life; i know exactly how eating the wrong kinds of food can teach your body to eat more than it needs and to adapt to that new number.
Our environment sucks ass.
I think this might be a misunderstanding. Rates of ADHD may be higher but I think it's more likely we have an environment which now challenges people with ADHD more than in the past.
The advent of electrical lighting did not cause an increase in pattern-reactive epilepsy, it just created conditions in which pattern-reactive epilepsy were more likely to be triggered. I believe now is the same.
If you eat until you are no longer physically capable of eating more it sure matters if you ate vegetables or pastries.
That's speculative I believe. Last I checked, I think they chalked this up to better diagnosis.
Not only was there a fascinating example of this the unfortunate man was documented by a doctor of the era.
If the problem was all in poor impulse control and hunger felt differently by some people genetically predisposed to feel it (but >30 percent in some states in the U.S. feel it that way?), there would have been many more fat people in the 1970s, 1980s, and 1990s, when highly palatable food became available. And, I reiterate, those who wanted to or had no problem getting fat could certainly do so. In fact, there were (some) fat people even then.
One thing that has certainly changed over the decades is the social acceptance of obesity and being fat in general. In my country, which is not the United States, people are still asked what happened when they put on a few visible pounds or promise to start working on it before anyone says anything.
I recently visited Buenos Aires and the difference in weight between women and men compared to what I see in the United States/California was hard to believe. It was quite surprising to see so many women and men young and old in good shape, or at least at a good weight.
But in the United States (and other countries) being fat and terribly out of shape is personally and socially accepted. Let me take an opposing and politically incorrect position for a moment, strange as it may seem: if I had a kid who was overweight, I would firmly tell him or her that he or she must lose weight. Would that work? It's hard to say, but it's something I wouldn't accept lightly.
But it's like the differences we see in the way people dress, even though clothes are not part of a physiological process that is apparently easy to hijack. How is it that people show up dressed in a way that 30-40 years ago would have appeared offensive to others-I'm thinking of going to the supermarket in pajamas. Well, for one thing, that way of dressing and showing up in public has become accepted. People of my parents' generation would have been ashamed to show up in public in pajamas. Ashamed to show up in public in pajamas. But nowadays, whether one considers the loosening of dress codes as good or bad, it is socially accepted and becomes almost a need. In fact, for the younger generation, what was once considered normal (for most people), such as making phone calls or being groomed, is almost physiologically intolerable.
There's more than just social acceptance of obesity and pajamas in the grocery store at work.
The social acceptability of being fat leads to psychologically easier consumption of calories. Personally, if it were not for the shame I would feel, I would eat 1 kg of ice cream every night. I have a great appetite, but also a great capacity for restraint.
The "mysterious weight gain" not explained by calories is, at this point, rather speculative.
That was the problem. The lab animals have had their food careful measured for several decades with essentially the same food/lifestyle, but weight was being gained at a rate higher than other animal populations. Because it's unknown the "why" part is speculative, but they've got some interesting ideas. Changes in animal husbandry standards, endocrine-disrupting chemicals and infectious agents were considered as possible factors.
From the study:
"There are multiple conceivable explanations for these observations. Feral rats could be increasing in weight because of selective predation on smaller animals or because just as human real wealth and food consumption have increased in the United States, rats which presumably largely feed on our refuse, may also be essentially richer. But these factors cannot account for the findings in the laboratory animals that are on highly controlled diets, which have varied minimally over the last several decades." (https://royalsocietypublishing.org/doi/full/10.1098/rspb.201...)
An analogy: "hard work" is what your car's engine does when you throttle it up. But that "hard work" isn't going to take you very far — or even in the right direction — if the car's wheels aren't aligned and balanced equidistantly on the car's axle. This "imbalance" will mean that any power put into the system, just gets shunted into running you faster and faster in circles, and/or into "spinning your wheels" and "burning out."
Bringing the car into balance is an overriding concern. You won't get anywhere without first doing that, no matter how hard you push the engine. Once you've done that, though, then the amount of power you're pushing through the engine — your "hard work and discipline" – becomes relevant.
So no, we’re not genetically predetermined to be hungry.
There’s something in our environment that’s messing with our circuits. Either some toxins (e.g. endocrine disrupters) or hyper palatable food (artificially engineered for max enjoyment and min satiety), or maybe something else.
Well, much more is, than isn't, it seems. You may trim the sails, but life will provide you your wind direction... And in this case:
"As many as 400 genes have been shown to affect body weight in one way or another."
https://www.genomicseducation.hee.nhs.uk/blog/obesity-is-it-...
As someone who's always been thin and doesn't have a strong appetite, I couldn't agree more. I'm just enough outside the norm yo be able to recognize it.
There are times when I simply can't force myself to finish my food and it goes to waste, but the upside is that many people assume that people in my body fat range are somehow virtuous for not "overeating". That's not the case at all - I don't eat particularly healthy, don't have any particular exercise routine beyond walking, and I don't limit myself. I just get full quickly and have a metabolism that burns what I eat.
It's always hard to know others' experiences. I have a friend who genuinely tried to help me lose weight in college with the typical advice and a lot of support: he had the strategy of just eating until he was full and then stopping, and he just couldn't get why that didn't work for me. But when he hit his 30s, he suddenly started ballooning up and suddenly couldn't put his strategy into practice, to his great frustration. Did his willpower dry up overnight? Nope; something else changed to upregulate his appetite.
(I pointed him to semaglutide, and he's already halfway to returning to his college weight.)
Sometimes I lose 15lbs when having a bout of constipation due to goddamn IBS.
Every person in my life, friend or foe or family or partner finds it clever and completely acceptable to tell me I'm "too skinny and need to eat more".
Others without my experience just don't get it. Glad these overweight folks have a tool to help them.
> I could not overeat to save my life
You are likely eating the wrong foods. It is _highly individual_ what kind of food can people eat in large caloric quantities. Start calorie tracking and experimenting more, you can figure this out. Some people do well with oatmeal (tastes like soggy sawdust to me), some with various nuts (peanut butter is a fitness industry staple), others make themselves milkshakes etc etc.
Progressive overload is key here, don't just expect to start eating 4000kcal/day, it is not going to happen (and would not be productive anyway).
> I cannot concentrate with a meal in my stomach
Same here. I feel like eating makes me lose about 10 IQ points, not great (though I am at a place in life where I can make this sacrifice). Maybe more sugar would be helpful here.
You may also find the /r/gainit subreddit englightening.
I've been trying to eat more since I was 20 (am 34 now). It's been getting more difficult as I get older, especially with the onset of IBS a few years ago - now more foods and what used to be regular quantities cause my stomach to balloon.
All my experimentation has landed me on.. a mostly meat diet. Which I don't love (it's expensive, kills animals, impacts climate) but I can digest it more easily than vegetables or grains.
Oats are my everyday ~500cal first meal. If you find them unpalatable, try my recipe (it's literally my favorite thing to eat):
Combine in a jar night before and leave in fridge: 1/2 cup rolled oats, 1/2-1cup water/alt milk (amount depending on consistency you enjoy), half scoop flavorless protein powder, tbsp peanut butter, raisins, walnuts, pumpkin seeds, chia seeds, maybe 1/2 banana (if you need it to be a little sweeter).
I prepare mason jars with dry ingredients for the week, and add water to one or two every evening and put in fridge. Oat+raisin+pb combo tastes like my fav cliff bar. Banana + walnut are also amazing together.
I also recently got a vitamix and have been making vegetable smoothies midday to try and get more of them in my diet. I still cannot drink more than 500ml, else extreme fullness and bloating, but it's something. I'll add oats + avocado + protein powder to make it a meal with proper macros, but then I get to regular dinner time mostly full :)
Eating when full is a real bane for me. But there's bigger fish to fry in life, so I'll be a skinny guy.
While I'm sure we all are a bit different satiety wise (and I've found it greatly depends on how much I've been eating overall recently), your experience on the drug is not what the rest of us feel like all the time. It's unfortunately normal for our biology to basically want to shove calories down our mouths all the time. I consciously pace my food intake every single day. I just had a huge plate of nachos, some christmas cookies, and a pickle...and I could still eat more. The only reason I ate that much is because I feel a cold coming on so I relaxed my usual limits.
The kind of "fullness" you get on semaglutide isn't natural. I've never felt like that my entire life. The closest thing would be after something like a Thanksgiving meal, but that's more of a "my stomach hurts" than "I really don't feel like I can put more in my stomach."
My sister in law is the skinniest, most in shape person I know. She's 35, has had 3 kids, and has abs, an ass she clearly worked for, etc. My wife (unfortunately) regularly compares herself to her and in this case also thinks like you, that it just comes naturally. She gave me her old phone so I could test some stuff on it as I don't have an Android phone handy. She didn't wipe it. MyFitnessPal was on there, and she was limiting herself to 1400 calories a day.
Almost all of us work for it. Truth be told, and please hold your downvotes for this, I get a little upset when the rest of you get to have insurance pay ridiculous sums of money for a medication that makes it easier for you than the rest of us, side effects aside, and you think it's simply evening out the playing field.
And it needs to be said in case my wife ever finds this: she's also ridiculously hot and even though she can't see it has, at times, been skinnier than her sister.
If this was well and truly about the money you'd support it, because it's going to be cheaper than paying for long-term medical costs of obesity.
No, how you feel on the drug isn't how most of us skinny people feel. I'm probably somewhat uniquely qualified to make that distinction at the moment. The rest of us have worked hard our entire lives to stay skinny and now you all get a cheat. It's one thing if you recognize it, but it's beyond annoying if you don't.
Someone could just as easily say that you've had access to a cheat your entire life and are now bitter other people have access to it. The fact that you have a stronger satiety response does not mean you are morally superior or are more entitled to a healthy life than others.
Disagree.
I am skinny.
I spent almost no time thinking about it.
I eat whatever I want. If I overeat, my body feels bad... it tells me to stop.
After fasting 24 hours, my hunger turns off. I have no cravings. I am not eyeing chips and cookies with lust. I do not dream of roast chicken dinner.
Our human experiences of hunger and satiety differ more than I ever would have imagined.
Now should I look for a moral judgement? On me? On you?
I think I'll find something more positive to do with the rest of my day.
You give some thought to it every day, but do you think about it every minute? You could still eat more, but do you still have the same intrusive hunger to eat that you did before you started the nachos?
> Almost all of us work for it.
Your claim here seems to be that you work for it harder than people who have less success. But do you have any actual evidence of that?
Like, can you truthfully say that to keep your presumably healthy BMI you overcome nearly constant thoughts about how hungry you are? Can you eat an entire pizza and still be hungry except it's physically painful to eat?
People vary in their experiences of satiety. Many people do manage to be thin without constantly feeling hunger; that's what being on semaglutide does.
Yes. Except that it’s not physically painful not to eat (that would happen probably at 1 1/2 pizzas, but I almost never go there).
I’ve been feeling this way and limiting my food intake since teenage years (almost half my life). Sometimes more, other times less successfully (six pack to love handles, but never beyond that).
Same as the other poster, yes, but I can also still eat more without pain if it's a Large Domino's Pepperoni Pizza. If it's the Dominos "Deep Dish" though, that's my maximum. I can regularly put away a large Little Caesars pepperoni without trying, it's just a "normal meal".
The difference between me and people fatter than me is that after a large meal like this, my body stops "demanding" food for 1-2 days. Thats what keeps my weight in a +/- 3 lb range.
I know the difference because every once in a blue moon after I turned 30, my body's hunger signals will make me un-satiable. The experience of suddenly being unable to diet was jarring. I've managed to fix that somehow, thankfully. But it was very, very clear over several weeks that dieting was entirely beyond my control no matter how much willpower I had.
And yes, I could easily eat more than one pizza. It’s a habit to simply stop at a few pieces, or more if I haven’t eaten much that day.
I’ve also taken growth hormone peptides that make you insatiably hungry. Literally insatiable - far beyond what I assume could be natural. I still usually limited myself. If I needed more I made popcorn or something and then went to bed hungry.
This is closer to disordered eating than healthy eating.
> The rest of us have worked hard our entire lives to stay skinny and now you all get a cheat
Ah, the student loan forgiveness argument, and the pro-spanking argument: I suffered, so you should as well, because suffering is intrinsically moral and pleasure is bad.
I believe she was losing what little weight she gained during pregnancy.
It’s not about suffering. Like I said, as long as you’re aware of it I don’t really care past the fact that I’m paying for it with my insurance premiums…but as someone else pointed out, it should be cheaper in the long run.
Not for me.
>I consciously pace my food intake every single day. I just had a huge plate of nachos, some christmas cookies, and a pickle...and I could still eat more. The only reason I ate that much is because I feel a cold coming on so I relaxed my usual limits.
This is completely alien to my experience.
I eat until I get full, then I stop eating. I do not have any difficulty whatsoever maintaining a healthy weight. I don't think about calories at all. I have no idea how many calories or nutrients are in anything I eat; I've never paid attention to the that part of the label. It does not enter my mind for even a moment.
Sometimes I exercise regularly, sometimes I slip and get lazy for a while. Sometimes I eat a lot of fast food, sometimes I pull myself together and make better stuff at home. Throughout all this, my weight does not noticeably budge at all. I've been 20-22 BMI for my whole adult life.
>Almost all of us work for it. Truth be told, and please hold your downvotes for this, I get a little upset when the rest of you get to have insurance pay ridiculous sums of money for a medication that makes it easier for you than the rest of us, side effects aside, and you think it's simply evening out the playing field.
I didn't work for it. It doesn't mean I'm a good and diligent person, it means I got lucky with my biochemistry and genetics. In another life, a different sperm would have met a different egg and I'd end up with different alleles and I'd end up fat.
It isn't fair that I'm living my life on diet easy-mode. If semaglutide can replicate this for people who aren't so genetically lucky, that's a fucking miracle.
I don't really think this is a healthy way to look at it.
Yes every day is a struggle for most of us. I've been in the "healthy" BMI for a majority of my adult life, but only just barely. This requires constant effort and work for me. I assume that most "fit" people are similarly fixated on the quest to remain healthy.
But clearly, there's "something" that we have which makes it possible for us to succeed at this, which people who do not succeed lack. I don't begrudge them taking a shortcut, and I don't mind if they never understand my version of the struggle here, because I don't claim to understand theirs.
Fundamentally, we need to understand that our physiology has not evolved in a situation where we are both sedentary and have unlimited, good tasting food at our disposal, and any tools we have to make this situation easier should be embraced.
Personally, I eat when I am hungry. My body typically generates hunger signals around the times I routinely eat. At other times I'm usually not hungry. Sometimes, I'll eat just for taste, but that is rare. I've had periods of time where I was trying to gain weight for fitness reasons and it was a real struggle. My natural state is to be skinny and it's quite hard for me to deviate from that. There a plenty of people like me and there are also plenty of people who tend to be overweight unless they actively fight it.
Clearly there are differences. There are extremes and their is a continuum between those extremes. You can exert some amount of willpower to change your position on the continuum, but the closer to the extremes you are, the harder it will be to arrive at a "normal" position.
And this is just inherent feelings of appetite. Some people may additionally be subconsciously eating to fill some kind of emotional hole or trauma. There is a lot going on and I wouldn't want to be too quick to judge.
Apart from people like you, perhaps. I also have a friend like that but he has pretty severe untreated ADD so I think that plays a part.
Learn to cook well so that eating out would result in lower quality meals compared to what you could make yourself.
Once you're controlling what goes into your meals, instead of outsourcing it, that makes it easier to control portion sizes, how much fat/oils go into things (I've found that restaurant dishes have an absurd amount of fat in them even when eating at "good" places), how things are sweetened, what you can use as healthier substitutes and what not.
You can eliminate almost all sugars with low to zero calorie substitutes, you can replace bread/panko/etc with low-carb flours, if you're frying you don't need more than a teaspoon of cooking oil, many sauces you can learn to make yourself instead of buying corn syrup and soybean oil-laden sauces from stores, etc.
Make it a rule to not buy things that come in boxes, buy fresh or flash frozen ingredients and make things from scratch. Stay in the produce, meat and fish sections of the store and ignore everything else outside of things like spices, frozen vegetables and protein.
Give yourself some leeway, too. You don't want to go into an all-or-nothing mindset, because that might lead you to giving up on eating healthily altogether if you break your diet. If you can find a way to treat yourself with something healthy that you like, that would be great. Sometimes I crave pancakes, despite them being nearly 100% carbohydrates. I eventually ended up with a recipe that substitutes wheat flour with almond and coconut flour, and to replace the syrup, a berry sauce reduction sweetened with erythritol. Barely any carbohydrates and the berry sauce is better than maple syrup, IMO, and goes with a lot of different meals.
tldr: reduce the opportunities to eat unhealthily, and increase the opportunities to eat healthily, even if you don't take those opportunities all of the time.
Who is it for?
Why do you think this is a new/novel idea the person you are replying to, and others reading it, has/have not heard before?
> Sometimes I crave pancakes, despite them being nearly 100% carbohydrates. I eventually ended up with a recipe that substitutes wheat flour with almond and coconut flour, and to replace the syrup, a berry sauce reduction sweetened with erythritol. Barely any carbohydrates and the berry sauce is better than maple syrup,
This reads like an elaborate troll, at that!
Wanting to lose weight isn’t necessarily about health, and eating a lot of fat is an effective way to lose weight.
However the fats used in restaurants are often used for frying, and likely have been used repeatedly for many hours. Oils used for frying can quickly produce compounds that are not great to consume, like various aldehydes, VOCs, free radicals etc[1]. If they've been used for hours, the chances of those compounds being in your food are high.
They are often low quality, as well, like soybean oils that can be high in fats that can be unhealthy in excess and might contribute to CVD.
I bring up the fat thing not because I think fats are the reason why people gain weight, I'm well aware of how high fat low carb diets are effective. I bring it up because restaurants often put fats into food you might not put it in at home, and the food can soak a lot of it up, turning what might be a 500 calorie dish into something that's 1200 calories or more. If you're trying to watch what you eat, eating out can make that hard because you don't know exactly how much food you're actually eating, and you can't really rely on nutritional breakdowns you might find online or from the establishments themselves.
The foods the fats are in also seem to be high in carbohydrates, which isn't great for ketosis.
I also bring it up because of Ulillillia's decision to degrease the pizzas that were the only thing he ate. By doing that he was able to lose weight while literally only eating pizza for every meal for years.
It's honestly just what you're used to.
If you eat tonnes of sugar and fat then that's what you crave.
If you cut sugar out of your diet, after a while the amount of sugar you used to eat will taste wayyy too sweet. Same with fat - eating chips for example will leave a gross fatty taste in your mouth.
99% of food bought out will have a whole lot of oil, fat, and sugar in it.
Eating healthy starts by controlling what goes into your own food. Cook and prepare meals yourself. Once you're in the habit of doing this you simply start to replace bad food for good.
Don't buy junk in the first place, then you won't eat it. Always shop for food when you've already eaten (and thus not hungry). Slowly reduce / eliminate the amount of fatty and sugary food in your meals. Just drink water (seriously, just water, no sweeteners).
Combine that with an exercise routine and you'll be set.
Apart from them seemingly equating fat and sugar as equally bad, the comment was spot on.
I do wish that more people understood the basic research on satiety, though. I suspect more diets would be successful if people were eating ~2g of lean protein per kg of goal weight along with a lot (I'm not sure if people have studied amounts here) of dietary fiber.
Other than that your comment seems to contradict itself, I'd fully agree.
I'm not sure what you mean by this. Could you elaborate?
> I think that many people discover a particular diet that works for them psychologically and expect that to be the case for everyone.
and then did just that for a high-protein, high-fiber diet. OTOH, that worked for me too, so it is certainly something to try.
Re-reading your comment though, I realized that I probably misunderstood it and that you were referring to independent research that came to the same conclusion.
Yeah - I probably didn't word that the best.
Lots of deep fried, Canola oil or vegetable oils, bacon etc.
I agree that "fat" isn't harmful, but I do think people get a taste for the nasty ones.
Bacon might be a problem for other reasons; for instance, maybe the CVD correlation with saturated fats will pan out. But in terms of basic metabolism, appetite, and hunger, the current trend seems to be away from the idea that people should avoid bacon-like fats.
I'm not here to say "bacon is the answer" so much as to say that your original post, suggesting that there's a simple nutritional answer to this problem, is both glib and not especially well-informed. The truth is: this stuff is very complicated, and there's a lot of uncertainty.
I agree that nutrition is complicated, and I am in no way an expert, but I really don't think we need to get so complicated to live a moderately healthy lifestyle.
In general most people know what foods they should be avoiding. I'm not saying stop eating avocados and almonds (although I've heard avocados use a ridiculous amount of water to farm). I am saying maybe don't chow down on potato chips, pizza and then eat a muffin - and then repeat roughly the same diet the next day... when I think of fatty foods, these are the types of food that come to my mind (and I'm assuming that's what comes to mind for the general population as well).
Of course if we go down a technical track or move away from the general population nutrition gets complicated super quickly.
On the subject of vegetable oils, this is why I say to avoid them - https://chriskresser.com/how-industrial-seed-oils-are-making...
Lastly, bacon is delicious.
Here's some more of my non-expert opinion: delicious things should be eaten in moderation.
People with satiety issues (for instance, with hormonal disregulation, issues with insulin resistance, etc) aren't necessarily as well served by the "everything in moderation" message.
Food cravings aren't purely intellectual any more than needing to urinate is; intellectually, I can hold it until I find an acceptable bathroom, but physically, the severity of the urge and thus the energy required to regulate it varies based on how much liquid I've consumed, how long I've been waiting, and whether anything I drank is diuretic.
Similarly: depending on your hormonal profile, different foods will probably have different impacts both on satiety (the feeling of being full, of additional food being a welcome stimulation) and on "cravings". Some people can eat a "balanced" diet in moderation, across all the macronutrients, and be just fine; some people will consume simple carbohydrates (bread, rice) and immediately have an urge to eat more, as a dose-dependent response to the carbohydrates they've consumed.
For those people, "eat a little of everything, don't overdo it on the bacon" might not be good advice. There is in fact not that much evidence that eating bacon (or other high-fat, high-protein foods) is especially bad for you. But those foods also tend to quickly produce satiety, and they don't seem to generate food cravings directly in response to their consumption. Maybe for them the bacon, cheese, and eggs is a good call, as long as they're steering clear of the carbohydrates. It's a very big open question right now.
(Again: I'm only considering the goal of minimizing caloric consumption --- weight management --- not other food health considerations.)
Different people are different, and one of the things we are probably getting very wrong in dealing with nutrition is trying to come up with a single set of guidelines for everybody.
Nothing from a plant is healthy? That sort of absolute statement flies in the face of history and common sense and I can't imagine it's true for all humanity.
There are some simple tricks you can try if you're currently maintaining a stable weight. The simplest is to get slightly smaller plates. Your brain will naturally try to visually match what your old portions looked like on the old plates, but now the plates are smaller so you're eating a bit less.
No other change in behaviour is needed to see some benefits, but of course going for a half hour walk after dinner and shifting more of the food you put on that plate towards greens also helps.
That's probably the most important lesson you need to learn before starting.
1. log your weight everyday on a graph
2. eat very small portions, no carbs
3. when hungry force yourself to drink a large glass of water
4. drink hot tea at scheduled intervals
5. eat lots of popcorn, get the raw grains from Safeway and put them in microwave for 4 mins in a large bowl with a cover
Source: worked for me. And is a basically daily staple
For me that forced me to eat healthy daily and it has almost healed my affliction upon religiously following such a diet.
Most nutrition advice is so bad you basically shouldn’t believe anything anyone tells you, including, especially if it’s from an expert.
I feel exactly the way you do, and yes, I was fat, lost it in one go and never gained it back. I try to keep my BMI around 18, never went over 20 since losing weight. It's been around 15 years now. I still have the exact same unlimited appetite I have always had. If you put food I like in front of me, I'm going to eat it.
I don't do anything special. I eat the same foods I always have, just less of them. Got really good at counting and never get more food than I need. The trick is to not put yourself in a situation where you have to stop eating in the first place. It's hard to just stop eating something you want to eat. Not that hard to stop yourself from going to the store again or ordering more (especially when other people are around).
I feel like most people never get serious enough about counting, try to eat stuff they don't enjoy, waste effort on exercise or let other people interfere.
Well, actually...
I'm fat. Like BMI 40 fat. Most of my life I have been fat. I was laughed at in school for it, as far back as I can remember. It probably wasn't all that bad when I think back. Certainly not as bad as now. But I was the fat kid in class, and I felt like the fat kid.
Anyway, I have lost a lot of it at a few points. Once by going to a place with more disease than I could handle. Months of intermittent diarrhea helps apparently. And once I reduced intake to about 1200 kcal per day for a year, combined with walking around for 5 hours everyday. I got to BMI 26 or something. Not very obese, but still overweight. It felt amazing to be able to do a lot of things, but it also took a LOT of time and effort.
But then I got a job, and kids. And I started to backslide. Just an hour per day walking during my commute, instead of 5 during the day... And oh, that pastry looks gooood. Slowly at first, with intermittent periods of faster backsliding because life required a bit more from me.
I got it back faster than I lost it.
I have re-lost it a few times after that. Each time the losses are a bit less, and the peaks get a bit higher. I always gain it back faster than I lose it. And annoyingly, initially, gaining it back feels way better than losing ever does. Like finally laying down after a day of strenuous work. Or like the first breaths of fresh air after being cooked up in stale air for a while.
During my losing periods the things you describe help. Keep the food away, and you don't have to expend effort to not eat it. I even enjoy the healthy stuff.
But that's not how it is during my gaining periods, oh no. I get bored with the good food, and start craving the bad. I go to the shops to buy stuff. A small packet of candy at first, or a pastry. But that spirals out of control quickly. Soon I start scheming:
* How can I get the food without my family noticing?
* If I go to multiple shops I can buy twice as much without looking like a greedy fuck.
* Oh, and I won't be able to go tomorrow, so I should make sure I have supplies for the day.
* And eating only candy makes me sick, so I should also buy crisps so I can alternate and keep eating.
I'm in gaining mode now. I ate a box of Pringles, a box of cookies, and a box of candy, just today. In addition to the regular meals with my family. I'm here. I see myself doing this, but I can't seem to stop. Until it runs its course. After a few months or a year or two, I can usually cycle back into a losing mode for a few months.
A doctor might help, but I'm not going. The medical state of the art of dealing with obesity seems to be "just don't". A consult seems pointless and humiliating.
I've learned to take and make fat jokes, and other than that to not think too much about this. My BMI will probably keep oscillating higher and higher, and I guess that means I'll get some obesity disease at some point. Maybe that'll stop it, but I'm not confident it will.
I guess we all have our issues, and this seems to be mine. C'est la vie.
In the movie he does some of the things you mention, but I don't think he was vilified in the movie. I saw him as a hero at the end. Some fat people on youtube were very offended by "The Whale", I'm curious if it is universally offensive to large people.
This one hit hard. If you swapped "crisps" and "candy" for "MDMA" and "ketamine", people would tell you to go to rehab.
No judgment here, but a lot of your behaviour sounds like addiction underpinned by a coping mechanism. If you replaced <food> with alcohol or drugs people would point out how your relationship with the substance is pathological.
IMO food is the most cruel of addictions as it is fuelled by our most primal of instincts to survive, it is also why I think Big Sugar is the most sinister of institutions...
Not even remotely a doctor, so take all this with a grain of salt if you're in a similar spot. Mostly based on my own life experiences and having to work on childhood trauma and what that entailed in my case (food addition being just one amongst many maladaptive coping mechanism).
One thing that's helped me: I just make a rule to myself, 'go from one healthy thing to another'. I just try to find more and more relatively healthy (or at least harmless) and appealing outlets and tell myself that, whatever I do, I may not do something ideal but I'm going to choose one of them.
(A healthy outlet is one where I feel better after I do it than when I start.)
I don't follow it perfectly, of course, but it has helped result in a major shift.
The point of this article seems to be that that is changing. Doctors actually have something to offer you now.
- There's no good or bad food. The number is the only thing that matters. Don't feel bad about eating chips and candy everyday. That's pretty much what I do. All you need is to hit the number.
- Always keep track of how much you've eaten. A big binge is not an excuse to stop counting. After a year or so, counting will become second nature and can be done purely with mental math. But initially, you want to write all the numbers down. Date | calories in | morning weight.
- Don't tie the counting efforts to any other effort. You mention walking 5 hours a day. That's some other unrelated thing. Don't ever mentally link this to your weight loss effort. If you want to do it, do it, but it should have nothing to do with losing weight. Counting and keeping records is your primary job.
- Your family should know what you're up to. They're there to help you achieve your goals. If you've already eaten, they shouldn't let you have a family meal with them. If they just let you get away with this, let them know you don't appreciate it. When you mess up, they should care and think it's a bad thing.
- Get this idea of a "cycle" out of your head. There is no cycle, every day is a new day. Your behavior only looks like some cycle caused by external forces post facto. Everybody trying to form a habit has a similar experience. There is nothing weight loss specific going on here. When you break a good streak everything can go out of the window. This is why it's important to keep the required actions as simple as possible. The more you couple different efforts the harder it's going to be. When you mess up you have to take the loss and move on. A good streak helps but don't dwell on breaking it.
- You have to have a sense of urgency and importance. Those around you should too. "I guess that means I'll get some obesity disease at some point" - just think how ridiculous that sounds. You know you can potentially prevent a serious disease (most people never have that opportunity) but you're just gonna sit there and let some cycle run its course. I mean, come on! How can you wake up everyday and not want to stop it today? What about your children? Perhaps they will inherit your eating habits (stats do show high heritablity), perhaps it would be nice to show them how to keep it under control? You owe it to them. Why doesn't your spouse think that's a huge deal?
It's one of the few things in life where you are literally guaranteed to get a good result if you do what you're supposed to do. There's a lot of advice on how to do this or that, get rich or whatever. But you can never prove these things are guaranteed to work so I can understand if people have a hard time motivating themselves. With weight loss you have a 100% guarantee of success. Personally, I don't see it as some random little problem. Pretty much any effort in life looks like this. You want an outcome, you think of the necessary actions and then the entire ballgame is about actually implementing these actions.
Also people who have never had an older metabolism. It's different. I was also skinny despite eating a ton and hardly exercising when I was 25. Everyone I know over about 30 can identify when their metabolism suddenly changed. Diet (and to a lesser extent exercise) advice from those who haven't hit their own wall yet is worthless for those who have. Those people need to stop over-generalizing their (limited) experience as universal truth.
People usually just start packing on a few pounds a year (or more) in their 20s and it adds up.
I hear people following a carnivore diet have had success in dealing with this satiety issue. The only things you can eat with this diet are butter (or ghee), beef, and salt.
There is a claim that nutrient difficiency causes the scenario you are describing. Your body is being deprived of what it really needs with your current diet and requires more consumption to continue its search for a particular set of nutrients.
The carnivore diet is not a silver bullet but worth a try. I will also mention it is high protien, high fat, and zero carb which has been shown to result in massive weight loss in relatively short periods of time (counterintuitive, I know).
Basically a keto diet, of course it works due to ketosis.
Cite for this, please?
Why is it not a great idea?
The high fat requirement is neglected when most first start this diet. People have been trained to fear excess fat so it does take extra directed effort to break out of the mindset.
Many manufacturers also remove fat so nutrition labels are more attractive to misdirected consumers ...this will generally lead followers of this diet away from overly processed foods (added benefit).
I had this exact same experience when I was prescribed a drug that, as a side effect, blocked receptors in parts of the brain responsible for signalling satiety from food.
I went from having trouble eating enough food to maintain a healthy weight, and just not being hungry, to suddenly being unable to feel full at all. It was like I always had room for more, no matter how much I ate. And I was constantly hungry, felt like I was starving 24/7 and would ruminate about food so much that it impacted my ability to sleep or concentrate. My brain was obsessed with preventing me from "starving" and it ultimately dissolved the illusion of willpower that I thought I had.
No longer take that drug, but it was an eye opening experience. I didn't know that was a thing people could experience, as someone who was always skinny. It really drove home that we are products of our biology and made me more empathetic with those who struggle with food.
Unfortunately that stopped working for me after a few months. Hopefully this one will work better.
Good luck either way.
Personally, I can say that while Bupropion didn't help me lose weight that it did at least help me stop gaining weight. I've never taken it with naltrexone though. In fact, I'm long-term opiod agonist therapy for chronic pain developed in my early 20s. This actually has more or less the opposite effect of opiod antagonists such as naltrexone. They've definitely had a negative effect on my ability to lose or maintain my weight, although I seem to have achieved some kind of balance where my body plateaus after a certain weight.
I did a “dirty bulk” while working at Trader Joe’s in my 20s. At the beginning I could barely eat one frozen mac and cheese. A month of heavy eating later and I could easily finish 2 and still feel hungry.
Im older now so I don’t eat like that anymore, but it is still very noticeable to me how easily I get full when I am dieting hard.
This is how I feel as a default, I am a perpetually skinny person. Thank you for putting this into words from your perspective in such a crisp way. I wish everyone would have the same (non dominating) relationship with food as a normal occurance (and not some immense mountain to continually climb.)
Worse, it’s excruciatingly boring. The 60th serving of fatty steak is no longer delicious. I lusted for a crouton. Even onions are a cheat in a glycemic load regime.
When I was single, strategies like having no sugar, alcohol, or refined carbs in the house were practical, but living with a family and especially with young kids, they really aren’t.
I regained it all and more. I’ve made follow-on efforts and had several +/- 30lb swings.
I started tirzepatide three months ago. I echo what others have said above: I never understood satiety before this. Keeping keto takes excruciating willpower in comparison. I now know what it feels like to eat 3/4 of a normal dinner with balanced macros and not think about food till lunchtime the next day.
There’s a big difference between maintaining constant vigilance against desire and having none.
This is exactly the case I make for fasting to those who ask why I like it. Nothing to count. It's super effective, much easier than people assume, and very quick. Also gives you a ton of energy and focus.
Glad you found something that works!
Been doing this for 5 years, and I've lost an average of 1.5 Pounds per month, for a total of 90 pounds.
Pretty sustainable, considering I'm only keeping it up roughly 50% of the time.
I’ve had a weirdly similar experience due to wildly different histories.
When I was a kid I was on medication that f’ed with my appetite so I literally never learned what hunger was as a kid. As an adult and long off the medication, I just eat and don’t understand the signals my body produces.
When I was younger, I had a healthy and active body and didn’t notice my diet was bad until first I graduated and took a desk job then it accelerated with Covid when I became sedentary and snacks were constantly available. I put on weight very quickly.
I think the mistake people make is they think they can go on a diet temporarily, then go back to the old eating habits and not get fat again. That is nonsense of course, which is why dieting doesn't work. Dieting implies something temporary and you need something permanent.
This is a feature, not a bug.
If this drug produced some kind of permanent physical change, that would be a pretty scary thing.
But the drug is designed (intentionally or not) in a way, that makes this very hard, keeping the user dependant on it. So I would call this a bug, but I can see people still choosing it over the alternative.
https://news.ycombinator.com/item?id=34251674
"cause the body to create lots of new adipocyte (fat cells). Increasing the number of adipocytes is very unusual after puberty. As long as you are taking the GLP-1 inhibitor drugs you will lose or maintain weight, but as soon as you stop you will gain a lot of weight back."
But the source seems to be a bit tainted, so I am not sure if any of this is really true.
Seriously? No thanks. Think I'll give you all a few decades to see what the long-term effects are like, and let my body largely take care of itself except when specific medical issues indicate that an intervention is in order.
it's interesting to take a step back and realize just how much pharmaceutical corporations have got average people to think it's perfectly normal to try putting random chemical compositions into their bodies and see what happens. maybe nothing will happen. maybe you'll get some mild nausea. maybe you'll suddenly develop an urge to kill yourself. but just try it and see what happens! ask your doctor if it's right for you (and if they get any kickbacks from it).
A free lunch isn’t enough to convince anyone to sit through an hour long lecture they weren’t already going to.
But if you’re worried that your doctor is one of the small percentage of doctors who is paid to give those lectures, you can look them up. All payments are publicly available. You can easily find exactly how much they were paid, when, and for what.
(The $20 in provided lunch is also required to be reported).
This smells like you devoured some anti-vaxxer BS, btw. But for the record, these things go through a ton of testing and clinical trials. The reason science types are excited is BECAUSE this class of drug looks safe AND effective... based on the data.
(And I'm also down 35+ lbs on tirzepatide, so far. This is the way.)
I was prescribed 20mg daily of time-release amphetamines when I was 13, and that was 18 years ago. I have consumed somewhere in the range of 1300 grams of amphetamines in this time period. I have a dependency on it and I hate it. whose idea was it to give a 13-year-old amphetamines just because he spent too much time thinking about computers instead of focusing on middle school classwork. and a good mix of various antidepressants, none of which worked and all of which had unpleasant side effects.
the medical system in this country, which its pharmaceutical corporations are fully complicit in, is far from pure and righteous and unquestionably benevolent. if marketing (or propaganda, depending on how you want to look at it) has conditioned you to believe otherwise, then I don't know what else I can tell you.
I could probably just eat better (ie not one meal a day) and get “healthy”…not that I’m unhealthy now. Maybe, I prefer to live in denial.
Three small meals a day and cut out the snacks and no drugs for me to take for the rest of my life.
Has this been proven in humans? The last review article I read mentioned that it was true for lab mice, but resulted in a suppressed immune response, which would result in early mortality for mice not living in a sterile (specific pathogen free; SPF) labitat.
Seems like it but it still might not be worth it:
https://slatestarcodex.com/2019/12/12/acc-does-calorie-restr...
You burn ~50 calories per hour doing nothing.
You're saying that the only way to live longer is to lay down and do nothing and IV ~50 calories per hour into your body.
You're not going to live very long like that.
You're obviously not going to live very long if you simply never eat and starve to death.
> everyone, even the skinny folks, should be on GLP1 drugs
But as a skinny person, I can already easily reduce caloric intake as much as I want to. My body is "blessed" with weak food cravings and solid blood glucose levels while fasting.
So while I do recommend these drugs to people who need them, I don't think they'd help me at all more than merely deciding one day to monitor and control my weight to a very narrow target range. It's like the opposite of "its easy! Just eat less!" ... you guys are telling skinny people "Oh but eating at a maintenance/deficit will be too hard for you to do just by thinking you want to! You'll need a drug!"
I can easily lose 20-40 lbs just by getting lazy and not cooking myself food. It's literally no challenge at all. But neither is gaining 20-40 lbs when I want to. I know this is relatively unique, I don't blame obese people for "lack of will". I know they have different biochemistry because it doesn't take me any willpower to gain or lose weight on demand. It's literally as effortless as deciding to wear more dressy clothes this year. I'm 6-foot tall and I can set and indefinitely maintain almost any weight I want between 145 and 200 lbs within +/- 3 lbs, with very little effort.
Over 190 lbs gets a bit hard to maintain, under 155 also gets a bit hard to maintain. Supposedly "normal" BMI for my height goes all the way down to 136 lbs but I think that's probably total bullshit -- that's very, very, very skinny.
If you look at the US today, an average of just 1 in 4 people are not medically overweight or obese. What was considered (and is factually) obese, is now considered "chubby" or "curvy" if not normal by most Americans for whom that is normal.
This is why I hate the 'body positivity' movement as it is right now. It's great that this movement tries to make (especially young) people understand that you don't need to have a tiny cover model body to look good (an that it's unhealthy too). But what it's turned into is that obese people are becoming an example to others without any attention to health issues.
It's no longer allowed to advertise smoking pretty much anywhere, but glorifying (morbid) obesity on social media and TV is fine. Meanwhile, obesity is arguably as bad as or worse than smoking.
The problem with this is how a continuous caloric deficit affects your quality of life. Your body tends to adapt by making you feel tired and killing your libido. Not to mention that being underweight becomes a health hazard past a certain age.
IMO, if you aren't overweight, eating a healthy diet and enough calories to maintain your weight will give you the best combination of longevity and durability.
Were you also worried about cold vaccines?
Could this help alleviate some of your concerns? : https://www.hopkinsmedicine.org/health/conditions-and-diseas...
This is misinformation. The normal process involves at least 4-5 years of observation to identify long-term side effects; you can't speed this up, as no matter how many people you test, it's not going to make long-term side effects manifest sooner. And while the technology has been around for 20 years, it certainly hasn't been trialed on humans until very recently, due to difficulty finding a safe delivery mechanism.
If you have for instance an Ebola vaccine, how can you show it works when there's only a few hundred cases a year? You can't just infect people. You have to vaccinate a bunch of test candidates and wait. Sometimes years until you can show a statistical advantage.
With COVID literally everyone had it so they could show it worked by the end of the weekend.
> ... it's not going to make long-term side effects manifest sooner.
They're looking for short-term side effects, they're testing efficacy and they're looking for 'long-term side-effects.' A long-term side-effect here doesn't mean one that's latent for years before presenting, it's one that presents quickly (days, weeks) but causes lasting harm. So yeah they're looking for them but they're not primarily vaccinating people and then following them for 4-5 years to see if something miraculously goes wrong 3 years later. That's what VAERS is for.
> And while the technology has been around for 20 years, it certainly hasn't been trialed on humans until very recently, due to difficulty finding a safe delivery mechanism.
mRNA vaccines and adenoviral vector vaccines have been in development since the 1970s. Vaccines have been around since 1721. We know what kinds of effects to expect, and they're (a) overwhelmingly short term and (b) we know of no mechanism where latent effects might randomly appear 4-5 years later since we know these platforms don't alter DNA.
We know from having extensively characterized the platform over fifty years that if nothing happens within the first few months, nothing's going to happen.
So really the parent post is right. Development went fast because we (a) leveraged a platform we'd extensively characterized and knew a ton about (b) were able to show efficacy very quickly due to prevalence of the disease within the population (c) layered a bunch of steps.
[edit] They didn't exactly YOLO this and I think that's born out by the fact we have like 5 different vaccines developed over comparable timeframes, administered billions of times all with the absolute bare minimum of adverse effects and incredible efficacy. Frankly it beggars belief that lightning struck so many times and we just got lucky a few billion times over. Maybe we were careful, and maybe the system worked.
And if they did have long term side effects, we’d observe them in the trials because they’d occur in the short term at a low probability.
I'm no doctor, but why would a long term side effect necessarily manifest itself in the short term? That seems like a non-obvious conclusion.
No, long-term means something we can’t detect for a few years. You can detect vaccine effectiveness right away.
Especially in a pandemic when it’s easy to get challenged.
> And if they did have long term side effects, we’d observe them in the trials because they’d occur in the short term at a low probability.
That would essentially be a "robot with a little timer". And it's just the only one a layman like myself can come up with off the cuff. I have to assume there are more.
Edit: I watched the video, and this guy is presumably much smarter than I am, so I wouldn't be surprised if I'm missing something, but it doesn't seem very convincing.
He's basically just claiming what you said, that conditions that take an extended amount of time to manifest just dont exist. That in some portion of the population, those conditions will necessarily manifest quickly. The video doesnt explain why I should believe that other than saying something like "these things are possible, but very unlikely".
If you don't want to go down this path, though, know that it probably will just take that breadth of experience to develop the understanding and intuition necessary to be able to say and explain things on the subject with confidence.
You should believe it because you trust people like the one in the video when they tell you it's a good idea to clean your wounds to prevent infection. You vaguely understand this has something to do with germs, but you (probably) don't know all about the various actual diseases that cause open wound infections, their outcomes, their treatments, the history of research behind it, etc. It's an entire field of medicine, actually. Luckily for you, a lot of the important stuff can be condensed into a single important general-action for the populations: clean your wound with soap and water, then, cover it with a bandage.
So why do you trust domain experts when they tell you about first aid, and not what they tell you about hugely more complex subjects, such as vaccinations and drug trials?
Why the sudden skepticism now? During a pandemic, of all times? If this was a movie, the climax / resolution would be the development of a vaccine - thank god, the experts delivered us from this terror. What were you expecting instead? 10 years of lockdown while we wait for things to shake out?
But even so, I was expecting to watch the video and have it explain why I should believe x, and instead I found it just reiterating that I should believe x.
This is a little off topic for the thread (I was originally just responding to the claim that "Vaccines don’t have long term side effects"), but based on what you said:
Would you feel the same way about "you should clean your wounds to prevent infection" as you would with "you should inject this compound that we invented 1 (or 2 or 3) years ago?
The median age of death due to COVID-19 in the UK[1], as of January 2021, was 83. I haven't checked but there is little reason to think this has changed much.
From page 9 of Public Health England's Excess Weight and COVID-19 report[2] of July 2020:
> patients with COVID-19 living with overweight (BMI ≥25kg/m2) or obesity (BMI ≥30kg/m2), compared with patients with a healthy weight (BMI 20 to <25kg/m2) are more likely to be hospitalised if infected with COVID-19
A report came out at the end of the year titled Associations of Physical Inactivity and COVID-19 Outcomes Among Subgroups[3]:
> The ORs are striking. In the full sample, those who were consistently inactive were 191% more likely to be hospitalized and 391% more likely to die than those who were consistently active. Dose‒response effects were mostly present across sex, race/ethnicity, age category, BMI category, and history of cardiovascular disease and hypertension, although the CIs sometimes included one. Although the odds were highest for patients in the always inactive category, every lower category of physical inactivity increased the odds of adverse COVID-19 outcomes.
We now have reams of data and analysis that backs this up again and again and again - some of which was even known in the first 6 months of the pandemic (which makes a lot of the official advice, like lockdowns and denying access to parks and gyms, negligent and reckless in my view). To associate COVID-19 mortality with youth and health is perverse, unless it's to say "it's very rare".
[1] https://www.ons.gov.uk/aboutus/transparencyandgovernance/fre...
[2] https://www.gov.uk/government/publications/excess-weight-and...
[3] https://www.ajpmonline.org/article/S0749-3797(22)00526-8/ful...
More drunk people are involved in car accidents than sober. Yet I still put on my seatbelt.
Most people won't though, they see the risk for what it is, too low for them to worry about. It is, of course, up to you.
Much like needing a seat belt in a stationary car parked in a building where no other cars move around.
Do I need to add /s or was that clear enough? The idea that I should put a seat belt on while looking at a car inside a car dealership just in case I forget to put on my seat belt when I'm going for a drive (keeping in mind that all modern cars have seat belt indicators) is such a reach that I'm aghast that you bothered me and anyone else who has the misfortune to read your comment with such low quality nonsense.
You believe in taking the vaccine under all circumstances, we get that, but to provide this kind of garbage - and it is garbage - to justify it, only makes your position seem weaker than it was before you wrote that. I'm am not a student and this is not the 4th floor common room for new undergrads.
What other medical interventions do you believe we should provide to people who are at close to zero risk from the maladies they protect against? Please peruse this list[1] and tell us all which we should or shouldn't get, or maybe we should get them all just in case. Perhaps tell everyone why they should get the Yellow Fever vaccine even though they are not at risk of contracting it usually. You never know, perhaps they'll bump into someone just back from an area with Yellow Fever and contract it and we'll have to call in Dr House and his team…
lol, should we stop vaccinating against polio (in that list you linked) cause nobody's died from it recently? I mean, the chance of dying from polio is 0, right?
You say this isn't an undergraduate dorm basement but you're using couch-in-the-garage arguments here. Honestly the CDC article for parents concerned about vaccinating their kids basically handles what you've said so far: https://www.unicef.org/parenting/health/parents-frequently-a...
> But these diseases are not present in my community. Do I still need to vaccinate my child?
> Yes. Although the diseases may be eliminated in your country or region, our increasingly interconnected world means that these diseases could spread from areas where they are still present.
> What is herd immunity?
> If enough people in your community are immunized against a certain disease, you can reach something called herd immunity. When this happens, diseases can’t spread easily from person to person because most people are immune. This provides a layer of protection against the disease even for those who cannot be vaccinated, such as infants.
> Herd immunity also prevents outbreaks by making it difficult for the disease to spread. The disease will become more and more rare, sometimes even disappearing entirely from the community.
Even if the risk of outright death to you is low, you have a responsibility to create a link in the herd immunity chain (even though covid vaccines don't provide true immunity), to help prevent those rare few who legitimately shouldn't get vaccinated, from getting infected. That's not even mentioning that COVID doesn't necessarily have to kill you to make you wish you'd got vaccinated: i know plenty who got infected pre-vaccines that suffer long term side effects in terms of their breathing ability, one of whom was a marathon runner. Tell me he wasn't healthy before?
Why do you reject this social responsibility, that has the upside of making a possible covid infection for you dramatically less likely to hospitalize you, let alone prevent long covid as well as simply make an infection less uncomfortable?
It's not relevant as I did not ask about getting vaccines for things that are a risk or where the benefits outweigh the risks. Have you thought about arguing against the points I made? I know it's convenient to use a straw man but it's really not very interesting and it looks weak.
> It sounds like you're opposed to vaccines until they pass a magic "recently dead" threshhold?
I'm opposed to medical interventions where the benefits do not outweigh the risks. You know, like doctors and people like that. It's why they usually don't give out medicine like sweeties. <cough> opioid crisis <cough cough>.
> Apparently that threshhold is higher than 6.7 million, which is COVID's death count so far. So where's it at?
As I've pointed out (repeatedly), the vast, vast majority of those were with comorbidities such as age and/or health problems related to obesity. Those people, who we know are at high risk and for whom the benefits outweigh the risks should probably get vaccinated, if they wish to.
> Or perhaps you erroneously believe it's possible to live in a functional society where nobody has any responsibilities whatsoever to eachother and the maintenance of that society?
Thank you, Chairman Mao, for your insightful words. The nail that stands up truly should be knocked down! How many more straw men while I have to endure…?
> lol, should we stop vaccinating against polio (in that list you linked) cause nobody's died from it recently? I mean, the chance of dying from polio is 0, right?
…and there we have another straw man, apparently by a teenager, "lol". The benefits of the polio vaccine outweigh the risks. I can keep repeating this until you get it into your head. "lol".
> Even if the risk of outright death to you is low, you have a responsibility to create a link in the herd immunity chain
No, I don't, and there will be no herd immunity for COVID-19. This has been known for at least 18 months now (even the NYT will reported that[1], on a loooong time lag) and was the likely outcome long before that.
> That's not even mentioning that COVID doesn't necessarily have to kill you…
The risks of disease severity that correlate with known comorbidities hold for every stage of the disease, from hospital admission, to ICU admission, to use of respirator, to death. It's not that you get healthy people all the way to the ICU and then suddenly it's the fatties getting respirators and dying. Jesus wept. If you won't look at the data at least apply some common sense.
> i know plenty who got infected pre-vaccines that suffer long term side effects in terms of their breathing ability, one of whom was a marathon runner. Tell me he wasn't healthy before?
Anecdotes are not data, and such a small number of healthy people have encountered severe disease that, unless you believe in magic, he had a comorbidity that is yet to be understood or known - either in general or in his specific case (do you have his blood tests or know if he's one of the people that produce low amounts of interferon?) We do not live in the world of Harry Potter. Or, you know, you could just look at the literature:
> The marathon running population does not constitute solely persons with excellent cardiovascular health. Marathon runners, especially those with a family history of heart disease and other coronary risk factors, should not consider themselves immune to either sudden death or to coronary heart disease
> Why do you reject this social responsibility
Because it only exists in your head.
> that has the upside of making a possible covid infection for you dramatically less likely to hospitalize you
The effect of exercise was greater than any of the vaccines on all health events related to COVID-19. Read the paper Associations of Physical Inactivity and COVID-19 Outcomes Among Subgroups I shared above.
> let alone prevent long covid as well as simply make an infection less uncomfortable?
If you're talking about preventing COVID-19 then you should look up what sterilizing immunity[3] is, and note that none of the COVID-19 vaccines provide it.
As to comfort, when I had COVID-10 I found that painkillers helped a lot.
So, I asked a specific question that you ignored so I will make it more specific and explicit - please, tell us all why we should get the Yellow Fever vaccine even though most of us are not at risk of catching it and hence, the benefits cannot outweigh the risks. It'll be interesting watching you argue against medical orthodoxy.
[1] https://www.nytimes.com/2021/05/03/health/covid-herd-immunit...
[2] https://pubmed.ncbi.nlm.nih.gov/3298928/#article-details
[3] https://thehill.com/changing-america/well-being/prevention-c...
That's pointless, let's just go to the heart of the issue here. You, for some reason, are special, and smarter than all of us idiots that listened to our doctor when they said "get the covid vaccine."
So, when I answer your question as to why we don't get the Yellow Fever vaccine, "because doctors don't recommend it, but doctors do recommend getting the COVID vaccine," tell us why you are right, and why they are wrong to say we should get the COVID vaccine.
I can only think of two possibilities: the vast majority of doctors across the entire planet are stupider than you, or, they're all lying for... some reason. So, which is it?
In short, you're doing what you've accused me of doing: not really answering the question, *why NOT get the COVID vaccine?* Given that basically every health professional across the world recommends near everyone to get a COVID vaccine, including young and healthy people, what's your *good reason* not to? Because something vaguely about "opioid epidemic?" Not good enough, that's a unique-to-America problem, we don't have the same issue here with our health advice re: medication and vaccination.
Doctors recommend that young, healthy people get a COVID vaccine because the possibility of a side effect are extremely small, compared to the possibilities for the same person having a really bad COVID infection with long term effects. The possibilities of COVID vaccination side effects are also low enough to justify the social benefits of a vaccinated population. Though true herd immunity won't happen, every step each of takes to reduce the chance of infection, helps in the overall reduction of fatal or severe infections. It'd be great if it was black and white, but part of why covid is such a virulent pandemic is because that's not possible with this disease. It was the same with wearing masks: nope, wearing a mask doesn't completely eliminate the spread of covid, but the studies bear out that it reduces infection rate: https://www.pnas.org/doi/10.1073/pnas.2119266119 (among others)
You said you don't think you'd get a severe covid infection, then claim I don't know my friend well enough to say why they would. You guessed at comorbidity, that could be detected through a blood panel, despite the greater medical field not being fully certain on exactly what comorbidity could cause a bad covid infection among a young health person, and whether said comorbidity could be detected in a blood panel.
You don't actually know for sure whether or not you're susceptible to a bad COVID infection, unless, again, you know something the rest of the world doesn't, which, you don't. So, the statistics indicate that you, like most people, should just get a COVID vaccine.
If the term "social responsibility" makes you hear the soviet national anthem in your head, I'm very curious how you feel about littering, playing loud music in public, and opting to hold in a pee until you get to a public bathroom. And if you think everyone that uses words like "lol" is a teenager, I'm really curious how you are at parties lmao
Thank you for providing a near perfect example of ad hominem. You avoid answering the straightforward question that is in no way "pointless" and instead attack me as a person. I'll take that as a telling win, as will anyone else reading this.
> So, when I answer your question as to why we don't get the Yellow Fever vaccine, "because doctors don't recommend it, but doctors do recommend getting the COVID vaccine," tell us why you are right, and why they are wrong to say we should get the COVID vaccine.
Thank you for providing a near perfect example of the appeal to authority fallacy. Firstly, not all doctors nor medical professionals, epidemiologists etc do recommend getting the vaccine for all individuals.
> tell us why you are right
Secondly, I have.
> You don't actually know for sure whether or not you're susceptible to a bad COVID infection, unless, again, you know something the rest of the world doesn't, which, you don't. So, the statistics indicate that you, like most people, should just get a COVID vaccine.
This is faulty reasoning. The fact is that statistically I am unlikely to be the kind of person with a comorbidity, apparent or not, known or not. Hence, the risk as can be assessed is small. Unknowns unknowns, to quote Donald Rumsfeld for a moment, are not a useful part of a risk assessment. I guess we'll find you hiding in your home made nuclear bunker waiting for the alien invasion? No, didn't think so.
> If the term "social responsibility" makes you hear the soviet national anthem in your head, I'm very curious how you feel about littering, playing loud music in public, and opting to hold in a pee until you get to a public bathroom.
None of those examples involve a medical procedure, an invasive one at that. A better example would be the forced abortions and impregnations that the three best known types of nasty socialists, the Soviets, the Maoists and the Nazis, imposed on some people. They would call that "social responsibility" too.
> And if you think everyone that uses words like "lol" is a teenager, I'm really curious how you are at parties lmao
People who would say "lol" at a party are people I'd like to avoid so it's not a concern of mine. People who are unable to handle their cognitive dissonance in the face of information that counters their ill informed, ill thought out notions, who let emotion go to their head and respond irrationally, they certainly do resemble teenagers in many ways.
Appeal to authority is only a rhetorically valid challenge if the authority is wrong. It's not. And there's not one single authority I'm appealing to here: it's all the people on earth most qualified to say whether or not people should get vaccinations. If "appeal to authority" means "you can't ever ask qualified people what to do in a situation they're qualified to discuss, that's appeal to authority!" then I really don't know how you can have any sort of rational basis for existence at all. You can't trust your doctor, you can't trust your car mechanic, you can't trust a camera review website, you can't trust a chef to make you good food, I mean, what on earth kind of intellectual basis for existence is that? Absurdity.
> Firstly, not all doctors nor medical professionals, epidemiologists etc do recommend getting the vaccine for all individuals.
Almost all do for almost all people. I never tried to argue that everyone should get a covid vaccine, just that those who doctors recommend should, should. Very simple. The cases where someone shouldn't are rare and well documented. Your argument that the young and healthy shouldn't doesn't apply here. It's moot to bring it up at all, and it's bad rhetoric.
> This is faulty reasoning. The fact is that statistically I am unlikely to be the kind of person with a comorbidity, apparent or not, known or not. Hence, the risk as can be assessed is small. Unknowns unknowns, to quote Donald Rumsfeld for a moment, are not a useful part of a risk assessment. I guess we'll find you hiding in your home made nuclear bunker waiting for the alien invasion? No, didn't think so.
The chance of you having a negative side effect from a covid vaccine that's worse than a bad covid infection, is lower than the chance of you having a really bad covid infection. So, why don't you get the vaccine? Why do you decide that you're more worried about a side effect from a covid vaccine, than you are about a bad covid infection? The statistics don't hold for your reasoning, it's you engaging in faulty reasoning. This on top of the social benefit upsides of slowing the spread of COVID, reducing hospitalization, etc.
> A better example would be the forced abortions and impregnations that the three best known types of nasty socialists, the Soviets, the Maoists and the Nazis,
As far as I know nobody's forcing anybody to get covid vaccinations. I'm arguing that you should do so, not be forced to. My argument is more medically and ethically sound, that's all. So if you're a rational person with good ethics, you should get vaccinated. That should be enough, there's no reason to involve State violence to enforce it. Also, since when are the nazis socialists lmao. Wait... because the German translates to "national socialism?" I've never actually encountered someone that took the nazis at such face value lol. Do you also believe the Democratic People's Republic of North Korea is a democratic republic? In any point it doesn't really matter to me what the nazis called social responsibility, their idea of society is ethically horrifying, so we need not consider their opinions on the concept of social responsibility.
> People who would say "lol" at a party are people I'd like to avoid so it's not a concern of mine.
That's a self report for being boring at parties fam
> People who are unable to handle their cognitive dissonance in the face of information that counters their ill informed, ill thought out notions, who let emotion go to their head and respond irrationally, they certainly do resemble teenagers in many ways.
Yet you're the one that believes, in the face of overwhelming evidence, that they shouldn't get a covid vaccine.
My earlier accusation that you must be smarter isn't an ad hominem - your claim is extraordinary and thus requires extraordinary evidence, and also requires a better explanation. Heliocentric theory isn't just bad because the evidence doesn't back it, it also requires a whole stack of bad explanations to justify it, inventing magic beings to carry around globes of light to explain what we observe in the sky. Your idea, that almost all doctors on earth are telling almost all people on earth to get a COVID vaccine are either wrong or lying, requires an extraordinary explanation. Either a massive failure in the scientific process in thousands of research centers across the globe - including in countries that are actively engaged in propaganda wars with eachother and normally very motivated to counter eachother!. Or, conspiracy, which, you know, if you want to be on the side of the flat earthers, please by all means, but at least be aware of the hilarious irony of doing so and then turning around and accusing those of us that got vaccinated as engaging in "cognitive dissonance."
You haven't provided a good argument to not get vaccinated. You dropped a lot of links around, but none of them counter the core argument: most people, as recommended by their doctors, should get a COVID vaccine.
> as will anyone else reading this.
lol, nobody is reading this, days old and deeply buried thread. Just me and you here.
Nobo
That whole paragraph is erroneous from the start.
The truth or falsity of a statement that appeals to authority is not what make it fallacious - nor would it for any logical fallacy. As the name hints at, it is the logic which is in question, the reasoning, the form, not the truth. "2 + 2 = 4 because n + 2 = 4" is fallacious yet the statement "2 + 2 = 4" is correct. Appeal to authority is a fallacy of relevance - like ad hominem - because it does not address the reasoning. 2 + 2 = 4 isn't true because my maths teacher says it's true, and to say it is because my maths teacher is a maths teacher or has a degree in maths is irrelevant to why 2 + 2 = 4 is correct (or not).
Schoolboy error.
> And there's not one single authority I'm appealing to here: it's all the people on earth most qualified to say whether or not people should get vaccinations.
Except for notable exceptions:
“No. Thinking that everyone must be vaccinated is as scientifically flawed as thinking that nobody should. COVID vaccines are important for older high-risk people, and their care-takers. Those with prior natural infection do not need it. Nor children.” - Martin Kulldorff, until recently he was professor of medicine at Harvard Medical School. I'll let Wikipedia continue:
> He is a member of the US Food and Drug Administration's Drug Safety and Risk Management Advisory Committee and a former member of the Vaccine Safety Subgroup of the Advisory Committee on Immunization Practices at the US Centers for Disease Control and Prevention.
Or we can look at his fellow signatory to the Great Barrington Declaration, Sunetra Gupta:
“What we’ve seen is that in normal, healthy people, who are not elderly or frail or don’t have comorbidities, this virus is not something to worry about no more than how we worry about flu,”
“most of us don’t need to worry about coronavirus,”
and unquoted but attributed[1]: “Gupta said that she thinks the coronavirus pandemic will end naturally and will become part of our lives just like influenza.”
Sunetra Gupta is an infectious disease epidemiologist and a professor of theoretical epidemiology at the Department of Zoology, University of Oxford.
So you're stuck with your appeal to authority, and you've multiplied it with argumentum ad populum.
> Your argument that the young and healthy shouldn't doesn't apply here. It's moot to bring it up at all, and it's bad rhetoric.
I don't think you understand what moot means, and as for bad rhetoric, "lol".
Case in point:
> The chance of you having a negative side effect from a covid vaccine that's worse than a bad covid infection, is lower than the chance of you having a really bad covid infection.
Now that's moot.
> So, why don't you get the vaccine?
Because I'm not at risk. (See, it was moot)
> This on top of the social benefit upsides of slowing the spread of COVID, reducing hospitalization, etc.
a) Thanks again, Mao
b) Isolating when symptomatic slows the spread more effectively
c) It reduces hospitalisation for those at risk
> As far as I know nobody's forcing anybody to get covid vaccinations.
Let's look at the first result I got for "Biden vaccine mandate" from NBC News[2] to see your wilful ignorance:
*Biden announces sweeping vaccine mandates affecting millions of workers*
> My argument is more medically and ethically sound, that's all.
On that[3]:
> The measles vaccine provided sterilizing immunity in most people. > That's not the case with these vaccines. > How can mandates be moral in this case? With a non-sterilizing product, it's nobody's business except mine if I want to get vacced or not. > > Sunetra Gupta @SunetraGupta > Jan 28, 2022 > Replying to @neorevolt > Exactly
Well well. Not so moral, in the eyes of a world renowned expert in vaccines.
Your argument is based on false premises and a lack of basic knowledge. It is littered with errors of reasoning and fact which makes it in no way ethically sound. Much like moot and fallacy, I doubt you know what sound means in the context of argument.
> Also, since when are the nazis socialists lmao. Wait... because the German translates to "national socialism?"
Yes, I based it entirely on the name.I wouldn't, for instance, have bothered to know basic facts about the most important event of the 20th century before coming to that conclusion, just the name. Why didn't they call themselves international socialists? I wonder. Why are they against individual liberty? I can't fathom. Why does the 25 point plan read like a socialist manifesto. Who knows?
Jesus wept.
> My earlier accusation that you must be smarter isn't an ad hominem - your claim is extraordinary
It's ordinary, medical orthodoxy, which is why mandates and pushing for not at risk populations to vaccinate is contentious.
> Your idea, that almost all doctors on earth are telling almost all people on earth to get a COVID vaccine are either wrong or lying, requires an extraordinary explanation.
I haven't ever claimed such a thing, while you are making a claim on behalf of "all doctors on earth" that they haven't made either. The more correct claim is that doctors in top government positions are telling people to get a COVID vaccine. Others contradict them (I can give you a long list).
> Either a massive failure in the scientific process in thousands of research centers across the globe
From [4]:
> Randomized trials show all-cause mortality reduction from the AZ/J&J/S adenovirus-vector vaccines (RR=0.37, 95%CI:0.19-0.70) but not from the Pfizer/Moderna mRNA vaccines (RR=1.03, 95%CI 0.63-1.71). By Dr. @StabellBenn et al.
And from Stabell-Benn's interview with Unherd[5]:
> It is also a bit of a Pandora’s box, I think, for health authorities, because if they start acknowledging these effects there is also the huge problem of potential negative non-specific effects that have actually been brought to the attention of the WHO already 20 years ago, but they haven’t really responded with the investigations. So you can see the potential backlash for the WHO, for vaccination programmes, if it actually comes out that some vaccines have carried these negative non-specific effects.
> So I’ve been in this business for many years and I know that there are powers out there who aren’t interested in really digging into these findings. And again, it also has implications for the way we test vaccines, so you can see it is complicated stuff also for companies, for regulators, if we need to design vaccine phase 3 trials which do not only study the specific disease but also study all-cause mortality and morbidity.
If the mRNA vaccines aren't as effective then the risk/benefit ratio changes, so I should take something like the AZ vaccine, but that was withdrawn in several countries as the risks outweighed the benefits, but I should still get the vaccine, right?
You might also note this[6], in the BMJ, November 2021:
> A regional director who was employed at the research organisation Ventavia Research Group has told The BMJ that the company [Pfizer] falsified data, unblinded patients, employed inadequately trained vaccinators, and was slow to follow up on adverse events reported in Pfizer’s pivotal phase III trial. Staff who conducted quality control checks were overwhelmed by the volume of problems they were finding. After repeatedly notifying Ventavia of these problems, the regional director, Brook Jackson (video 1), emailed a complaint to the US Food and Drug Administration (FDA). Ventavia fired her later the same day. Jackson has provided The BMJ with dozens of internal company documents, photos, audio recordings, and emails.
That's a massive failure - and possible conspiracy - in some research centers across the globe. Isn't funny how that company's claims of vaccine efficacy and safety are now being questioned? What's really funny (not haha) is how they weren't questioned more before, but we have the Twitter Files to answer that conundrum.
> if you want to be on the side of the flat earthers,
Kulldorf, Gupta and Stabell-Benn are flat earthers? Interesting.
> please by all means, but at least be aware of the hilarious irony of doing so and then turning around and accusing those of us that got vaccinated as engaging in "cognitive dissonance."
And there we have your go-to, a straw man. I have written repeatedly that it is up to people to decide whether they get the vaccine, and that they should base it on their situation i.e. risk/benefit and good conscience. I've not accused anyone of cognitive dissonance for getting vaccinated. I have, however, observed cognitive dissonance in you, and we're about to see some more:
> You haven't provided a good argument to not get vaccinated.
Uh huh.
> You dropped a lot of links around,
Right.
> but none of them counter the core argument
Didn't read them, I see. Finally:
> > as will anyone else reading this.
> lol, nobody is reading this, days old and deeply buried thread. Just me and you here.
I often read entire threads on HN. Perhaps this isn't the place for you, it requires a higher standard of thought, which itself requires concentration.
[1] https://www.hindustantimes.com/india-news/most-of-us-won-t-n...
[2] https://www.nbcnews.com/politics/white-house/biden-announce-...
[3] https://twitter.com/SunetraGupta/status/1487003944274563073
[4] https://twitter.com/MartinKulldorff/status/15169233540784496...
...right, but the math teacher is less likely to teach you bad math, than, say, an antivaxxer on hackernews. And the great thing is, the greater medical authority is, as I said, not one person, but tens of thousands of people among thousands of institutions in hundreds of countries. I'm not "appealing to authority," I'm appealing to basic reasoning at this point.
> US Food and Drug Administration's Drug Safety and Risk Management Advisory Committee and a former member of the Vaccine Safety Subgroup of the Advisory Committee on Immunization Practices at the US Centers for Disease Control and Prevention.
You immediately begin appealing to authority, lol.
> Thanks again, Mao
If you genuinely believe doing things for the betterment of the world is communism, your ethical system, and understanding of history, is bonkers. But, we already knew that, because you continue to claim the nazis were socialists. No, they were not.
> Isolating when symptomatic slows the spread more effectively
...except you can be asymptomatic infectious.
> It reduces hospitalisation for those at risk
Which, again, roll the dice on that. If you believe you are at higher chance of bad vaccine side effect than bad covid infection, you're simply wrong.
> Biden announces sweeping vaccine mandates affecting millions of workers
I fail to see any similarity between this and nazis sterilizing jews at gunpoint. Wait a second... are you saying that under capitalism, all labor is extracted through force of violence, because one will be homeless and starve if one doesn't work, and thus anything that affects one's ability to do employment is the same as sentencing them to homelessness and starvation, and in the usa, no healthcare? Woah that's weird, I hear the soviet national anthem.
You're talking about this gupta person again, let's see how much better they are at virology than the entire world of experts they're disagreeing with. Ah, in May of 2020, they said
> "the epidemic has largely come and is on its way out in [the UK]. So, I think [the infection fatality rate] would be definitely less than one in a thousand, and probably closer to one in ten thousand."
Weird, turns out it's actually about 2.3 in a thousand, or as high as 6.6 in a thousand. https://www.imperial.ac.uk/mrc-global-infectious-disease-ana... so they were either double off in their expert estimate... or far, far more off base. As for "it's on the way out," in May of 2020, hahaha, yeah, some fantastic, smarter-than-everyone-else expert you've got there.
Your champion of the antivax cause is not a very popular person, which isn't itself an indictment if they had good science, but... they don't. Their science has been off every single time. Could it be that the greater scientific community disagrees with Gupta because... Gupta is wrong?
> but we have the Twitter Files to answer that conundrum.
oh ffs, if you want to see hunter biden's dick you can just google it
> Kulldorf, Gupta and Stabell-Benn are flat earthers? Interesting.
No but they all have these super weird ties to the American Institute for Economic Research, libertarian think tank famous denying climate change as a major risk, or this whizz bang of an article justifying sweat shop labor https://doi.org/10.1007/s12122-006-1006-z fun group of folks! But definitely these guys are more trustworthy than the greater scientific community that basically roundly disagrees with them.
Their brainchild, that Barrington Declaration, is weird to bring up, arguing for "protecting vulnerable groups" against infection, while the signatories get on TV and argue against any sort of mandate doing just that. No wonder they were accused of being politically motivated, they're constantly contradicting themselves. They also just say wrong things - Remember when Kulldorff argued that influenza was deadlier than COVID, despite it only killing one kid that year? Against COVID's 1k?
You basically are just restating the various viewpoints of Barrington signatories, but those have all been probed to destruction. Big fan of herd immunity? So was Sweden. The only upside is now we can at least point at them and say "well, it was said this strategy wouldn't work, and as we can see, it didn't." Here, you like wikipedia, they collated all the oppositions to Barrington https://en.wikipedia.org/wiki/Great_Barrington_Declaration#C...
But this is a lot of words for what I think is really happening here: You're some form of conservative (maybe in your country you call it "libertarianism"), conservatives identify alongside covid denialism, so you do too. Your weird ideas about nazi political ideology and minimizing of their destructive actions by comparing it to, lol, vaccine mandates, illustrates this further. It never mattered what the science said, Your People said COVID is fake so you do too.
> Perhaps this isn't the place for you, it requires a higher standard of thought, which itself requires concentration.
yeah, popular at parties for sure
Good luck in life, I won't reply further.
That's a blessing.
> I'm not "appealing to authority," I'm appealing to basic reasoning at this point.
No, what you wrote in that paragraph is a further appeal to authority. It's what the cool kids call doubling down.
> You immediately begin appealing to authority, lol.
I'll explain what an appeal to authority is again for those who think they're too cool for school.
Most informal logical fallacies, when made, are fallacies of relevance as they do not address the logic of a statement or line of reasoning (else, necessarily, they are a failing of the logic, but mostly people make fallacies of relevance). As you pointed out, a maths teacher is less likely to teach bad mathematics but that isn't a valid or sound defence of any particular mathematical statement that a maths teacher makes. In order to defend a particular statement a mathematician has to do what maths teachers tell their students to do, show the working.
To state someone's expertise in an area is not a fallacy of relevance unless it sits in place of reasoning, otherwise it only provides context. If the reasoning is supplied then look at the reasoning.
From the Stanford Encyclopedia of Philosophy[1]:
> 9. The ad verecundiam fallacy concerns appeals to authority or expertise. Fundamentally, the fallacy involves accepting as evidence for a proposition the pronouncement of someone who is taken to be an authority but is not really an authority. This can happen when non-experts parade as experts in fields in which they have no special competence—when, for example, celebrities endorse commercial products or social movements. Similarly, when there is controversy, and authorities are divided, it is an error to base one’s view on the authority of just some of them.
So, look at the information, weigh it up, and come to what you think is right. Try to avoid making glaringly obvious mistakes along the way, like the ones you have repeatedly made.
> Big fan of herd immunity? So was Sweden. The only upside is now we can at least point at them and say "well, it was said this strategy wouldn't work, and as we can see, it didn't."
Firstly, who isn't a fan of herd immunity? Do you even understand what it is?
Lastly, because what else needs to be said about Sweden after this, the data[2] shows that Sweden did not make a horrible mistake with their approach.
I can skip the rest, sifting out substantive argument from the conspiracy theories and ad hominem from that is surely a waste of time, but this caught my eye and gave me a good chuckle:
> But this is a lot of words for what I think is really happening here: You're some form of conservative (maybe in your country you call it "libertarianism"), conservatives identify alongside covid denialism, so you do too. Your weird ideas about nazi political ideology and minimizing of their destructive actions by comparing it to, lol, vaccine mandates, illustrates this further. It never mattered what the science said, Your People said COVID is fake so you do too.
Cognitive dissonance often requires that you create some evil character, an other, for those you disagree with. (ironically, something Soviets, Mao, and Nazis did). Suffering from it certainly hasn't helped with the accuracy of those guesses, I'd suggest you give it up as soon as possible.
Do try though to pick up a history book in future, at the very least.
[1] https://plato.stanford.edu/entries/fallacies/
[2] https://ourworldindata.org/explorers/coronavirus-data-explor...
A few hundred young people had heart damage from moderna: https://www.cidrap.umn.edu/rare-heart-related-side-effects-h...
Probably no deaths though: https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Disclaimer: I think on the net it was sensible for young healthy people to take even Moderna as COVID can cause serious long term damage, but it wasn't costless and we aren't completely sure that it was a net benefit to the healthy young for them to vaccinate (this is ignoring the large effects from things like them infecting others or taking up healthcare resources).
Johns Hopkins to me is part of the same machine making anyone who doesn’t get a vaccine an outcast. I would trust them about as much as the CCP regarding COVID’s origins.
I do think that if there would be famine I would just die. I also don't think it would be good for me to restrict caloric intake. There are certainly ways to make my diet healthier, but caloric restriction is not it.
That sounds like half a days meals? Could it not be some of the side effects were actually from you starving?
Mankind has survived with far less than that, and I don't mean in mass hunger period.
If it's like the 1,5l/day of water intake, which is the result of studies funded by... mineral water companies.
It's not hard to believe big corporations in the food sector financing these studies through non-profit organizations.
A question I often get is "how effective is it?"
The SURMOUNT-1 study released in April 2022 showed 22.5% average reduction in weight for people on the highest dose of Mounjaro. For a 250 lbs person who should weigh 150 lbs (so 100 lbs of extra weight), this would result in them losing 56 lbs or 56% of their excess weight.
For context, bariatric surgery has the following success:
- Gastric Band: 35% - 45% of excess weight lost - Gastric Sleeve: 60% - 75% of excess weight lost
The fact that a once a week injection is having results similar to bariatric surgery is insane, and this is only the early innings of this shift. Lilly has another drug in the works (will likely be released in late 2025) that is reporting better results than Mounjaro.
Wild and exciting times!
The article mentions "along with some lifestyle changes". Is what they mean?
Every animal will engorge itself given the chance. All that is happening is the great abundance of cheap food and less activity. Thats it - except maybe for a tiny minority with metabolism / hormone issues.
Yeah, its obvious, even to those who are grossly overweight.
What these drugs do is make it easier, here, on this particular planet, for people who struggle to control their appetite to actually do so.
Not every animal. Mice given semaglutide don't gorge when presented with food to feed on freely, to the point where their weight drops >10% compared to control after a month.
3 months of noticeably extra fatigue on top of my current baseline level of exhaustion seems to threaten serious psychological effects.
3 months of brain-fog sounds like a great way to get fired and really fuck up my life.
If my "gastro situation" was noticeably worse than the unpredictable wildy-swinging nightmare it already is, I honestly have no idea how bad the consequences could be for my social life (I would be the flakiest person anybody knows and everybody hates that guy) and ability to make plans / focus long enough to do any work.
For some reason, I don't know why but I've always been this way, there's nothing my body hates and wants to avoid more than throwing up. I dread it. I'm not so sure I enjoy life enough to get through 3 months of nausea.
That's nothing to be embarrassed about - I've taken decades to learn "easy" lessons". You should be proud you made the change and you can focus on the incredible results you have achieved!
You shouldn't be - this is the crux to why weight loss is so hard, and something I try to harp on any time I get.
Yes, just for reference, I was fat too once (more than 40lb above my ideal weight). I managed to lose the weight, just like parent, through small, sustainable lifestyle changes.
It's simple: eat less, move more.
But it's not easy. Start small, do things you can do do for the rest of your life.
You have to try something.
Ah yes, December: famously known for its lack of social engagements.
You can do it. If I can do it.
Be warned that people who know you from the other physique will mock you for taking care of yourself. Be glad they are mocking you, it means you did something right. I felt such a sting the first time, it was traumatizing. "Shouldn't you be happy for me?" Turns out the answer is "no".
It sounds like a very similar symptoms except only for the first few weeks of Keto. Ketosis is where the body starts to use fats to produce its own sugars for the blood rather than relying on carbs to suppliment.
Anyway I'm off keto now and I find myself capable of burning fat simply by being more physical. It's really weird.
I think the fat gimmick in keto is just that too. It certainly helps but don't be fooled into eating unhealthy amounts to lose weight.
This line alone tells me you're legit be a use nobody talks about this aspect of doing what needs to be done to lose that kind of weight.
From everything I've heard, I'd take this class of drug in a heartbeat if I thought I had any chance at all of getting a prescription. It is apparently a double edged sword that all of my health metrics peg me at above average health, except that I'm a bit overweight again after the COVID times.
Second, please, please, please stop listing your BMI as if it were a definitive measure of health. To begin with it doesn't correlate well with actual percentage body fat because it doesn't differentiate between fat and muscle. Second, the study which created the BMI was based on a population sample from a single town and all participants were within 4 inches of each other in height, and nearly all were effectively average height with similar lean body masses. If your lean body mass does not conform to the expected range from that study, BMI cannot accurately determine if you are obese, skinny, a body builder or just tall/short.
Finally, rapid weightloss is dangerous, and if you're eating fewer than 1k calories in a day while experiencing extreme fatigue and brain fog, you are more likely to be losing significant muscle mass than fat. This is may be extremely because your heart could be weakened, which could kill you. It's great that your cholesterol and overall weight is down, it's terrifying that you're eating so few calories while being unable to maintain enough physical activity to keep your body from canabilizing vital muscle tissues.
Are you referring to any specific studies?
In the context where we have gone from obesity rates of 13 percent to 40, to suggest that people have a natural weight and that's the cause of this seems absurd to me.
There. Fixed it for you :) Yes, to me it seems like capitalism creates a society where most people get addicted just trying to cope with everyday life. For some it's alcohol, for some it's OxyContin, for some it's food, for some it's all-nighters in World of Warcraft.
"59.3 million (21.4%) people over age 12 used illicit drugs in the past year."
"Underage [..] 29% reported drinking alcohol"
https://www.verywellmind.com/rates-of-illicit-drug-abuse-in-...
Looks like weed and alcohol already are 50% of all citizens... I don't find it difficult to imagine that the other half ab-uses food.
Can I ask that you read a large number of history books across any number of cultures on addictive behaviors throughout history, because you'll find that anytime a society had an excess of time and labor/production that people find addictive behaviors to enjoy. This is not recent. This is not capitalism. This is humanity.
What capitalism has done is given everybody enough free time from starvation to actually follow addictive pursuits.
If you wanted to live with the same amount of 'lifestyle' as a serf did then you'd likely only have to work a few hours a week. The issue is I don't think most people want to live that lifestyle. We like clean water to drink. We like sheltered houses with electricity. We love having a house that is too large and filling it up with an inordinate amount of crap. We love living in expensive places with a lot to do. Turns out wanting all that requires a lot of stuff.
At one point in my life I was more interesting in not working and messing around and doing other things. I worked around 40 hours a month for a few years and made enough of a living to pay my bills (hey, computer work pays good). So it's not impossible for at least some people to live like that , though with rent increases not sure if it's possible these days. But with all that said, I like having all the stuff that working a full time job gives to me, so there is that.
It almost seems like capitalism has brought us not free time, but an unquenchable desire for "having a house that is too large and filling it up with an inordinate amount of crap".
The top comment even recommends that everyone should be taking it. Yikes.
I know I'll get downvoted to hell for this but I could have absolutely nailed a quiz of "who is going to get really fat after high school." Nobody that I would have defined as a "hard worker" has gotten fat.
Yea, people tend to forget pre-green revolution people going hungry for longer periods of time and mass starvation were really common. We made a trade, between the sudden and terrible outcome of starving and hunger to one of long term consequences like obesity and disease.
Perhaps the effect of limitless food on obesity rates takes time to manifest and is compounded in successive generations.
There has to be excess calories in the first place, much like there must be oxygen for there to be a fire (don't you try to get florine involved in this).
Humans eating behavior seems to be driven by the first few years of our lives. If you eat like garbage as a kid, it follows you into adulthood. The US was (somewhat, there are still plenty of other even fatter countries) first with the TV to counter advertising that taught us that Trix was part of a balanced breakfast and that we should carry a coke wherever we go.
Other countries likely had confounding factors that slowed the excess calorie uptake. For example common traditional meals that were only replaced slowly. Other things that can tip the scale are things like higher walkability in their cities.(for example higher walkability in the US correlates with lower body mass).
But as stated, those confounding factors only slowed the fattening, it didn't stop it and the EU now is growing in weight just like the US did in the past.
I would counter you're incorrect, we're only 2 to 3 generations (maybe 4 now that I'm getting old) past never starving. On an evolutionary timescale this is nothing when talking about an impulse hundreds of millions of years old.
Our bodies never developed any means to prevent eating more than we needed other than "Oh $deity my belly hurts" and "Hmm, I better save some of this for tomorrow because food could run out then instead".
Peoples weight just cannot be said to be a "natural number" in this environment. Something is causing this and your average person is obese because of it, not because of their "natural weight"
Based on what evidence? There are plenty of countries where people are not suffering from malnutrition and yet obesity rates are low compared to the U.S.
These people are taking a medical finding and blowing it wildly out of proportion to support their agenda. It's an unfortunately common tactic.
I don't quite think it's entirely fair to blame on willpower in modern western society though. We have a food supply that is unnaturally calorie dense, and optimized for hyper strong flavor, shelf stability, and profit, and rarely for health. We're also much more sedentary.
From the point of view of public healthy, you need to think like a public health expert. From this perspective it makes perfect sense to talk about "natural weights" as something that can change (and has risen) over time. The calorie dense food environment and sedentary lifestyles are things that exist in the background here. Given these background facts, the weights of the great majority of people (who don't have the time, means, willpower, etc to resist) are going to rise to a new higher "natural" point. For some, foods will be so calorie dense and provide so little nutrition or satiety that they experience runaway obesity. These are just predictable downstream effects of the environment, and so the perspective of the public health expert is that individuals aren't to be blamed and you have to fix the environment. Ban soda in public schools, etc etc.
The evidence is a little slim (no pun), but there's one theory which I find quite compelling. The theory is that eating foods with high flavor-calorie association increases your set point, and eating foods with low flavor-calorie association decreases your set point.
Flavor-calorie association is when your body knows that a particular flavor results in getting lots of calories in the near future. The flavor-calorie association will be higher for foods that are more flavorful or more calorically dense, and flavor-calorie associations can only be developed for foods you eat regularly. This explains why I lose a bit of weight whenever I go somewhere new – I'm trying new foods, so what I'm eating has doesn't have any flavor-calorie association, so my body's set point goes down, so I get full more quickly, causing me to eat fewer calories overall, causing me to lose weight. And since foods have gotten much more flavorful and calorically dense in the past half-century, it would explain why people's set points have gone up.
There's a simple way to test this theory at home. Extra-light olive oil (not extra-virgin) is tasteless and textureless. So, find a 2-hour window of your day when you don't taste anything with flavor, and have two tablespoons of extra-light olive oil right in the middle of that window. Since the oil has no flavor, it should have no flavor-calorie association, and your set point should go down. I've been doing this, and I've been getting full faster and that's been causing me to lose weight. (If you want to google more info, it's called the shangri-la diet.)
(Note that if you try this, your toothpaste probably counts as a flavor.)
Although I suspect there's something to your hypothesis as well. I don't know about a spoonful of oil, but I have gone through phases where food seems less "rewarding" on a physiological level, and as a result I feel more satisfied with less.
Think of it like body temperature: normally, your body maintains a certain core temperature, and it will respond in a negative feedback loop when the temperature deviates from that set point. Conditions like infections can induce where your body raises that set point to fight the infection, and it takes time for that set point to come back down.
Something similar appears to happen with people's weight. Hormonal or other changes cause the body to gain weight, and once that happens, it resists losing weight in various ways: increasing appetite, changes to basal metabolic rate, changes to metabolic pathways involved in breaking down nutrients from food, all sorts of things. Deviously, fat cells actually produce hormones that play into these changes, which is one of many reasons why losing weight is usually harder than gaining it. And when people do manage to lose weight, often after a huge exertion of effort and willpower and major lifestyle changes, their set point may not have changed, and so as soon as they slip up even a little bit, they quickly regain back to their set point.
So they're not suggesting that there's some mystical force out there that decides some percentage of the population should be overweight. They're referring to the idea of a set point for body weight that is difficult to change without drugs or bariatric surgery.
Or maybe this is the case, but it is thrown off hard by our modern diets. Our natural set point is in the healthy range, but our meal is x calories per Y food now so it ends up artificially high.
The explanation just doesn't line up with what we've seen. I get that it's hard to lose weight once you've gained it, but that's different. This is absolving us of being responsible for our obesity as a whole.
Today, there are a bunch of factors that have combined to move people's set points higher than they should be: calorie-dense diets, sedentary lifestyles, plastics, drugs like antidepressants and lithium compounds in the water supply, and who knows what else. No one is arguing that the "natural" set point is 300 pounds or whatever. The point is that there is no natural set point because it's a function of many different variables.
Kind of, but increasing doesn't go indefinitely either. People have multiple "set points", not one moveable one, long known among people intentionally increasing their weight as "plateaus".
Your body’s set point is a weight that it wants to go back to. The set point can change, but not without great effort. Small efforts will simply result in temporary weight gain/loss and eventual reversion to the set point weight. Great efforts (long term changes in diet and lifestyle, not just a 7 day juice fast) are required to re-set your set point higher or lower.
Think of a hamster crawling up a giant mixing bowl or something, set on a particular spot on the kitchen floor. The hamster can walk forwards up the side of the bowl, but the bowl has not moved and since the sides of the bowl are very steep, the hamster will slide back down to the middle of the bowl where he started. If he wants to get to a different part of the kitchen, he will have to really slam his body against the side of the bowl, or work hard in a different way, to “nudge” the whole bowl across the floor so it’s now sitting at a different “set point”
> but it is thrown off hard by our modern diets.
Yes. I think the dominant theory is that it has something to do with gut microbiomes, and in particular sugar and/or artificial sweeteners screw it up pretty badly.
Somehow I became a sugar person from a meat person after I immigrated to Canada. Not sure what the cause was though.
It just means that bodies have a set point that they'll defend. And that weight changes. If you get fat, no matter how you do it, your body will defend that weight and if you lose will take action, increase hunger, reduce metabolism, etc. making it near impossible to keep it off even if you lose it.
TLDR: The modern obesity epidemic is mostly a mystery, things like higher caloric food, western diet bad don't tell the whole story. Most likely answers are chemical contaminants in our foods and water i.e. lithium or PFAS chemicals. Interestingly enough both wild animals and lab animals(rats) have been getting fatter over time as well which clearly invalidates the "bad diet" theory. The Human body has a lipostat, you "natural weight" mechanism if you will and it seems these contaminants increase the lipostat and this results in widespread obesity.
I think it tells more of the story than contaminants does. A candy bar is packed with calories and not that filling. This didn't exist a long time ago.
This wasn’t a steady, gentle trend as food got better, or diets got worse. People had access to plenty of delicious, high-calorie foods back in 1965. Doritos were invented in 1966, Twinkies in 1930, Oreos in 1912, and Coca-Cola all the way back in 1886. So what changed in 1980?"
That correlation with income is almost entirely driven by women.
Rich men aren't much thinner than middle class or poor men.
Rich women are just a lot thinner than middle class or poor women.
This tells a different story than cheap processed food.
Hunger is also impossible to compare, as it is an internal sensation.
Response to hunger is trained, but it is extremely hard to retrain.
Also, people simply can't be trusted when it comes to self-reporting of their own regimen. Whether it's not being honest with one's self, or being embarrassed, ill informed, or plain delusional, lots of people will report that they've done "all the right things" to lose weight when they in fact have not. It's far more common that people suffering from obesity remain fat because they are thwarting their own progress, or are being given shitty advice from crackpot dieticians, and less common that there is some chronic hormonal condition that can't be corrected by diet. If your pancreas is still working, as well as your thyroid, your pituitary, your hypothalamus, etc., you probably can correct your obesity without drugs.
But people want the "pill" or the "shot", even though the chances are really good that they could get most of the work done cutting out exogenous sugar and alcohol. And I can't necessarily blame them because I obesity drugs can be a life changing thing for those stuck in the 300+ lbs range. What worries me about these kind of drugs is if people think it's okay to get fat and prediabetic because they can just get a prescription. I guess that's great if they can, but that also seems like a form of low level megalomania of sorts, and results in one fewer thing for people to take personal responsibility over. It's good for the mind to put effort and work into something. It infantilizes the mind to allow it to not have to put rigor into anything.
My belief is Japan doesn't have as much of an obesity problem.
Sure, I'd love a drug that lets me eat more calories and not get fat but I'd also love it if we some how managed to stop eating so many cookies, donuts, potato-chips, sugary sodas, giant portion meals, etc.... I'd also love it if we designed more areas to be walkable and bikeable.
I lived ~15 years in Japan. I never missed owning car because the country is designed not to need a car. I also spent a year in Europe and Singapore and again, never missed owning car for the same reasons.
Let me also add that in Japan, at least in big cities like Tokyo, Osaka, Kyoto, you are almost always 1-2 minutes away from junk food. You can walk to a convenience store and find whole aisles of pastries, chips, ice cream, candies, etc and yet somehow the Japanese manage not to pig out.
Similarly there are bakeries all over full of donuts, etc...
Somethings that help are the portions are often smaller. Certainly for potato chips most bags in Japan are 1/3th the size of the average bag in the USA. Similarly cookies are small and come in small portions vs the USA where pretty much any supermarket sells cookies in packages of 20 to 40 cookies and each cookie is giant 300-500 calories each.
I guess this is one of those, we're not going to get people to stop eating too much so we have to find another solution? I can just imagine once I get this drug I'll start eating more because I can and companies will ramp up the portion sizes even more.... TACO TIME!!!!!
I think the deal is that the drug suppresses your appetite so you do actually eat less
People do have a natural weight, and a fraction of people are genetically predisposed to be overweight regardless of lifestyle. But what I find impossible to accept is that somehow that number has mushroomed in the past half-century and particularly in the U.S.
I've lived and/or worked on every continent over the past 40 years, and nowhere have I seen the degree of obesity that is commonplace in the U.S. (I have not been to the Pacific Islands--I know they have the highest obesity rates there for reasons I haven't researched, but they're also a very small population). Anecdotes aside, the obesite rate in the US is nearly twice as high as some European countries (and not because people in those countries are malnourished).
It's pretty clearly the food. Living in other countries I never had to worry about weight, but as soon as I moved to the U.S. I started gaining weight right away even though I eat quite healthy. It's just very very hard to escape processed foods in the U.S. unless you 1) have money to buy more expensive food, and 2) are very conscious about it and make considerably effort to stick to fresh fruits, veggies, rice, fish, etc., no fast food, sodas, packaged foods, etc. etc.
It's also well documented that obesity is correlated with income, and it's not hard to see why, when the grocery options in low-income areas have very little healthy, minimally-processed food. Nutritional inequality is a huge issue and there's very little action taken about it. Just think about how cheap and easy it is to get unlimited refills of soda -- with a soda fountain nearly everywhere you go, compared to eating fresh food. Many people have neither the time nor money to eat healthy, and despite "be healthy" slogans, etc., nearly everything around us conspires against eating healthy (unless you have lots of $).
I'm happy that obesity-reduction pills are coming on the market because some people are naturally predisposed to gaining weight and will be helped greatly by the pills. But what I hope doesn't happen (but already see happening) is that being used to paper-over this huge problem of nutritional inequality that is the root cause of much (though not all) of the obesity in the U.S. at least.
But when I say I cook from scratch I mean it. If I want beans I buy a bag of dried beans. I will sometimes buy canned Marzano tomatoes from Italy, ingredients: tomatoes.
And then there are the millions of cats with hyperthyroidism that has been connected to canned cat food.
And I generally buy in bulk at the outdoor market so relatively few beans even come in contact with the packaging.
Some history. https://elemental.medium.com/the-bizarre-and-racist-history-...
What seems absurd to me is to jump to conclusions instead of taking a scientific approach to eliminating factors until we find causation.
It annoys me too! Human genes haven't changed radically over the last 100 years. We're not dogs or cats where generations can be measured in a year if not months, we're talking roughly 30 years between generations, so no, it's not "genes" or "set point". The answer is obvious for anyone paying even a passing interest to history: we largely went from an agrarian society to a sedentary one, eating more and moving less. It's that simple. Combine this with capitalism pushing the fast food industry to make profits at any externalized cost, and the results are obvious.
As an aside, it always amuses me how people talk about "set point" but never address that it only goes up. If "set point" is a thing, you'd think there would be some people with a lower one, or at a minimum it wouldn't go up (hence it being set), but no one likes to admit that . . .
We’re subsidizing companies that create unhealthy addictive food and subsidizing companies to create drugs to counter the unhealthy addictive food. This is an enormous waste of resources.
To your comment, maybe more countries should attempt to implement programs similar to the UK's success in lowering sodium intake by slowly adjusting the sodium content of all manufacturered foods. https://www.nature.com/articles/jhh2013105
Why should that be true? Your kids aren't going off to WW2 to die. You aren't going to starve if bugs ate your crops. You aren't going to get clubbed and robbed if you follow a forest path.
The fact I'm not going to die tomorrow from starvation is an actual reduction in stress.
The fact that someone on the TV is screaming 24/7 that I'm going 'fucking die because THEY are out to get me' is a contrived stressor that has a real effect on everybody in society.
No. I lived through part of the cold war.
In WW2 everybody knew families with dead sons or sons that came back in pieces or sons that just disappeared. My neighbor in the 60s was a paratrooper, who came back missing a leg.
Sugar consumption is going down and it doesn't seem to have any impact.
Calorie equated studies show no difference between low fat or low carb diets.
It all boils down to excess calories.
Regressive taxes also don't work well. I don't always eat super healthy. Making unhealthy food cost more wouldn't have any measurable impact, except maybe tanking my 401k because half the Fortune 500 goes out of business.
People complained about cigarette taxes wouldn’t be effective but they are.
The stock market didn’t crash either despite the multibillion dollar tobacco companies being affected.
Hell I'd be ok with banning all forms of food advertising and requiring that all foods be blank packages with nothing but the ingredients, nutrition facts, and a short description of how they were prepared. I'd prefer that world on general principle. But I don't think it would fix the obesity epidemic.
Now, what are we doing?
* Getting people to stop consuming sugary drinks and other very unhealthy items (maybe that would require drugs at this point)?
* Or offer people drugs so this side-effect of an unhealthy diet can be avoided?
If we're offer a way to continue a bad diet without this effect, it seems very likely further bad effects will appear X many years from now from a combination of the drugs and the bad diet. Because virtually all drugs taken forever accumulate side-effects over since the body did evolve to process them (these drugs may indeed be needed at times but the point remains).
Anyway, 'getting people to stop' turns out to be impossible for some. The drugs are meant to help with that.
Diet soda and bottled water exist and somehow people still keep choosing sugary drinks. In fact people often have a ready excuse for why they consider diet soda more unhealthy!
At the end of the day, or maybe week, or possible even month you have to eat or you're going to die. Simply put you require caloric intake to survive. Yea, you can ban coke and candybars, and hell that's a good idea. But what about bread? Or do you monitor and watch to make sure everyone only eats two slices? Make sure foods at restaurants only have so many calories per serving and ensure they people can only buy one meal per meal?
At some point it still falls apart because it is human nature to massively overconsume since the vast majority of history we've been calorie short. You're dealing with an animal response here that is going to be very difficult to override to the under/normal consumption side.
I eat junk food mainly because it takes me no effort and still tastes good: for me the addiction is not having to put in any effort to be satiated, more than the taste itself.
And when I do eat junk food I don't eat a crazy amount in volume. But the calorie density of them makes it such that I ate a crazy amount of calories. It's not that I eat a bag of chips per day. But a small bag of chips is 240 calories, while carrot chips of the same mass/volume are 20 calories.
Do I prefer junk food over some healthy food -- yes, probably so (but I love broccoli). But I don't know that my eating habits are drastically different between the two. To put it another way, if the junk food I ate suddenly became healthy for you, I think people say I was just eating a healthy diet.
I may have an unusually addictive personality given that I've had issues with abusing other substances, but I noticed these addictive food behaviors in myself from a very young age before I'd ever touched alcohol or drugs. They bear little resemblance to how I eat when presented with fresh foods. We probably all have varying degrees of susceptibility to addictive junk foods and I'm just more susceptible than you (though also lucky enough to be very energetic and active so I haven't actually ended up overweight).
If you just mean "if you don't eat, you die", I don't think that qualifies as an addiction.
If you mean "if you suddenly eat a lot more for some meal than you usually do, you will likely be more hungry the next day than usual", I also don't think that really qualifies. It's not the same kind of thing?
With food, the desire to eat is part of the proper functioning, not due to damage due to previous food usage.
I don’t know how to precisely make this distinction because I am not a neuroscientist (neurobiologist?) .
But I’m still fairly confident that this distinction can be made in theory, and not just in practice.
Probably something about how some compounds (that generally aren’t present in the brain in substantial quantities) bind to some receptors, and this has such and such consequences, and then later when said compounds are not present, either some other receptors are plugged or inactive or are active, or some other chemicals are present in higher or lower than normal concentrations, in ways that cause problems which would in some ways be alleviated by the aforementioned compounds that are not typically in the brain in large quantities, and which would not be alleviated by whatever other compounds that would activate reward centers or whatever.
When someone is addicted to nicotine, they are addicted to specifically nicotine. When someone is addicted to alcohol, they are addicted to specifically alcohol.
And you needing water every three days is meaningful. In fact, that's a great definition! Its clear what the meaning in the case of water is. I'm not sure what saying "Doritos" is addictive means? I love Doritos, but when I traveled abroad I went six months without seeing a bag and never thought of them. What exactly does "specifically addictive" mean?
But it's not difficult to stop. From a volume/mass perspective I eat fairly small amount of Doritos in sittings compared to most "healthy" food. Its just that Doritos are super calorie dense. I definitely eat a higher mass of eggplant in a sitting than Doritos. And when I don't have access to Doritos, I don't ever think of doing anything unethical or illegal to obtain access.
Now your point is that people may eat themselves into unhealthy situations and want to stop. That is probably true, although I wonder how much of that is convenience, rather than addiction.
The problem is not the food. The problem is obesity. The food is only an issue because some people have overly strong appetites relative to the abundance of food. If we can cure obesity, then we can literally have our cake and eat it too.
Humans obviously value tasty and flavorful food, and its existence adds joy to people's lives. That's why they'll pay hundreds of dollars per meal for the best restaurants. In sum total the development of GLP-1 agonists has maybe cost $20 billion in research at most. That's literally less than 0.1% of global GDP, hardly an "enormous waste of resources".
[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
This is a critical question, because GLP-1 agonists like semaglutide are far more effective at weight loss (with much lower dropout rates) than any diet known to mankind. So if the benefit of the Med diet is mediated by weight loss, who cares in the age of GLP-1 agonists? It's like arguing about the fastest hot air balloon after the invention of the jet engine.
[1]https://www.semanticscholar.org/paper/Obesity-Mediates-the-A...
If we spent 10% of what we spent on food advertising on large, well funded cohort studies, we'd be far better off as a species.
Humanity's greatest crime is how little science we fund.
HFCS is notorious for the bad effects on the body, versus something like honey.
Same for the Intuit, simpler animal fats vs hydrogenated "trans" fats?
I feel like the key difference in their diets is it's not overly processed and full of things we've decided to put in there for cost reasons (corn subsidies making HFCS cheaper than cane sugar, and trans fats are cheaper than more expensive animal products).
As for HFCS, there's basically zero evidence that they're a major contributor to obesity versus other types of sugar. (In fact, honey consumed by the Hazda has almost the same balance as sugar as HFCS). We have multiple points of evidence to counteract this. 1) Mexico uses substantially less HFCS compared to other types of sugar, but Mexican obesity rates are as high as the US. 2) HFCS, and sugar in general, consumption has declined over the past 20 years. Yet obesity continues to increase. 3) HFCS was widely consumed in the 1980s, when the obesity rate was de minims.
We transitioned from a hunter gatherer, to an agrarian, to an industrial society - because most people needed to do much physical activity to survive, even when food was plentiful.
The information age is much more sedentary, but people have evolved needs to eat a certain amount of volume to feel satiated. The fact that our foods are super nutritious/calorie dense makes matters worse.
I have a hard time believing this without some very strong evidence for this claim. There's already existing evidence for greatly varying health effects of differences in cooking method, oil-type, omega ratios in fats, amino-acid ratios in proteins, glycemic index of carbs, sodium content, etc etc. It's hard for me to reconcile the suggestion that the content of food does not affect whether it is "substantially unhealthy"...
Again this shouldn't shock us, because we know hunter-gatherers across the globe eat tremendously varied diets that come in all sorts of extremes. Yet, modern diseases of affluence (heart disease, diabetes, etc.) are virtually non-existent in these populations. The only thing they have in common is a lack of obesity and non-sedentary lifestyle.
And surely you also agree with the science that we now have drugs that are far more effective at reducing obesity than any diet known to man.
Not sure about the drugs, particularly if treatment has to continue indefinitely in order for people to keep the weight off. Someone else on here linked to a blog post about how those drugs increase the number of fat cells in the body but prevent fat cell hypertrophy, suggesting that rebound weight gain after the drugs are stopped could potentially leave patients worse off than they started. Most adults do not gain new fat cells when they gain weight, their existing fat cells merely get bigger. Leaving people with more fat cells than they had to begin with might make it even harder for them to maintain a lower weight without the drugs, given that fat cells are metabolically active. Who knows how many people may end up stopping them due to side effects or complications like the thyroid tumors these drugs are known to cause in mice. We know very little about the potential unintended consequences of these drugs.
It's common sense.
And also easily provable at the limit: whose healthier at the end of 10 years, subject A consuming 2k calories of salad and lean meat per day, or subject B consuming 2k calories of vodka per day?
At least we know they'll both weigh the same, because thermodynamics, right?
We need to tax the ** out of high calorie foods to fund the extreme cost on health care/society that overeating is causing.
Disagree.
> who consume 50% of their diets in sugar (e.g. the Hadza)
"Their diet is made up almost exclusively of food that they forage on the forest and includes fiber rich and highly nutritious berries, bananas and honey while any meat they eat is hunted and caught wild." (https://healthyfocus.org/the-hadza-diet-and-the-key-to-a-hea...)
They don't eat sugar. Fruits & vegetables with lots of fiber, wild game. Nothing like westerners diet ... so not really comparable, imho.
"... the Inuit's bodies have adapted to better handle the process of gluconeogenesis, in which the body turns fat and protein into useable glucose. The Inuit have larger livers and a larger volume of urine than the average human, which helps their bodies to process the byproducts of their diet." (https://oureverydaylife.com/486115-the-inuit-diet.html)
Also ... not applicable to a typical westerner.
> The problem is not the food. The problem is obesity.
The food is the problem.
Eat whole foods, mostly plants, minumum fats & sugar, and obesity is problem no more.
> the development of GLP-1 agonists has maybe cost $20 billion
What's the total cost of obesity? The cost of diabetes ? It is an enormous waste of resources.
Quality of food is certainly declining, but we are also seeing weight increases in lab rats with extremely controlled diets, so food probably isn't the entire story. There's no accepted explanation for this, but good candidates that might apply to humans are: subtle toxicity by microplastics, and changes in gut microbiomes.
That said, there’s more to the story. For instance, type 2 diabetes in children did NOT EXIST before ~1980, even though there was plenty of abundance and environmental contaminants. This suggest that there is a major issue with the food itself. If you look at where there is the most obesity, within the US or in the world, you also find a strong correlation with processed food. For instance, the Pacific Islanders who suffered obesity epidemics which coincided with processed food replacing their traditional diets.
Any quantity of this food, long term, is likely the reason for the explosive amount of health issues in the population, including many cancers we now commonly deal with.
One of the biggest changes to my health I ever noticed was a switch not in how I ate, but in WHAT I ate.
When I switched my diet over to high quality foods, organic and garden grown, meat I purchased from a local hunter, it made a substantial impact on my health, helped to fix a lot of my cholesterol and blood sugar numbers, and my overall health shot through the roof. No pills required, just decent ingredients, garden grown food, high quality meat.
We do not need the excessive amount of sugar in our food to fully enjoy it. The general public is just totally numb to it because of over consumption and companies are literally competing on having the sweater product.
Such a little price to pay to save your body from horrible side effects
The often-cited studies suggesting Inuit populations were protected from heart disease (Bang and Dyerberg, Feldman et al) comes from limited data which has since been refuted as unreliable and insufficient. The hypotheses they generated don't hold up to the greater balance of data we have, and despite attempts to confirm findings, it simply hasn't happened.
Some studies have suggested to a lesser degree that Inuit populations have marginally smaller rates of coronary artery disease (and other cardiovascular complications), but far more have determined that rates are the same or in some cases/time frames even worse, and risk of stroke has generally trended higher as well. These are all incidents of mortality which have a very, very high correlation with diets which are high in animal fats (as well as salt, regarding strokes).
Here is one very good look at this type of data, and if you look you can also find others: https://pubmed.ncbi.nlm.nih.gov/25064579/
I agree that obesity is a major issue (especially in the case of sugar; it appears less harmful to the body when the sugar is needed and thus used immediately, but harmful when it hangs around and gets turned into fat. This is the main cause of the surge in fatty liver disease, for example), but there is very little and often very poor evidence that obesity is what causes atherosclerosis to occur and become a mortal danger. It seems to be dangerous regardless of weight, and exercise doesn't appear to be wholly protective against it either.
Inuits have actually served as a good example as to why this is true. Even when their obesity rates were lower, their lifestyles required more activity than average, and when studies accounted for BMI, their CAD rates were still on par with western populations according to most data.
Sadly, this means it can be a problem when food tastes too good. The term of art is "hyperpalatable". Studies have shown that even lab animals gorge themselves and get fat and unhealthy when they get human junk food.
I think many people would be grateful to have hyperpalatable food restricted or limited or less visible to them, so the temptation is removed or moderated. How we implement that in society, in a liberal or authoritarian way or somewhere in between, is a separate question.
Junk food corporations make profit by selling food, and they are extremely good at this. They rely on intense advertising, making the food addictive, targeting children. As a side effect, people get obese since they consume more calories that what they need.
I don't know about GLP-1, but my intuition tells me that no drug is going to make eating Mac Donald's and drink Coke healthy, even if it doesn't make you obese.
American food is shit. Most people have no clue what healthy food is, even if they intend to eat a healthy diet.
Edit: you will get fat assuming you are like most people and do not expend greater than 4k calories / day in total
We now know, for example, that fibre is very good for our microbiome. Exclude it from your diet and you'll suffer.
> it is certainly possible to create a "healthy" everyday-McDonalds diet (but you would be changing the meal to the point it won't be recognizable)
So it is possible or not? Why the quotes?
> You can still become obese eating 3000 kcals of salad every day without exercising
I'd like to see you try (just salad as you wrote, no oils and animal based products, please).
That is a lot of kale.
You can keep believing the ads, or just search the term in google/duckduckgo and spend 5 minutes reading different sources.
Just a few examples (first link from a search engine):
"Fiber. You eat 160 calories in almonds, but you absorb only 130. The fiber in the almonds delays absorption of calories into the bloodstream, delivering those calories to the bacteria in your intestine, which chew them up. Because a calorie is not a calorie.
Protein. When it comes to food, you have to put energy in to get energy out. You have to put twice as much energy in to metabolize protein as you do carbohydrate; this is called the thermic effect of food. So protein wastes more energy in its processing. Plus protein reduces hunger better than carbohydrate. Because a calorie is not a calorie.
Fat. All fats release nine calories per gram when burned. But omega-3 fats are heart-healthy and will save your life, while trans fats clog your arteries, leading to a heart attack. Because a calorie is not a calorie.
Sugar. This is the "big kahuna" of the "big lie." Sugar is not one chemical. It's two. Glucose is the energy of life. Every cell in every organism on the planet can burn glucose for energy. Glucose is mildly sweet, but not very interesting (think molasses). Fructose is an entirely different animal. Fructose is very sweet, the molecule we seek. Both burn at four calories per gram. If fructose were just like glucose, then sugar or high-fructose corn syrup (HFCS) would be just like starch. But fructose is not glucose. Because a calorie is not a calorie."
Your attitude is the same as a religious person telling depressed people they need jesus rather than prozac.
Before the 80s, food also was packed with fat and sugar, and advertised constantly. I subjectively feel that people saw far more food advertising in the 80s and before than they do now. And the government diet suggestions were to increase your consumption of carbs and reduce fats.
edit: and people definitely drank far more Coke, and McDonald's meals were far less healthy.
Yes, I mean the cause of the obesity epidemics we're witnessing. Not the reason why every single obese person is obese.
My subjective feeling as a European traveling to the US is that it's extremely hard to eat healthy food there. In some states, it seems everybody is obese, including children, and I myself need to fight actively not to gain weight there. People there don't seem to realize that their diet is very unhealthy, and I'm not even sure they make the connection with their obesity. And this trend is happening in Europe too, with a few years lag behind the US.
But this is only my conviction and I didn't find the data to back up my intuition. How do you explain why obesity rate went from 10% to 40% in a few decades?
Again, only hypotheses at this time, but the existing data is far from fluffy and there’s a lot more in the pipes.
The most compelling research I’ve seen used various semi-controlled diets (unfortunately diet was indicated but ultimately self reported by subjects, as it didn’t occur strictly in a controlled environment) with some subjects receiving fecal transplants. Those receiving diverse flora from transplants succeeded much better in losing weight and keeping it off some months later. The study needed stricter controls and more subjects, but it’s a fascinating start.
I’ll point out that the cause of the differences in results isn’t necessarily gut flora alone, too — it’s all super preliminary. This comment is mostly just to say “there are other factors, we just aren’t sure what yet but we have some interesting leads”.
I still managed to lose 40 pounds via calorie restriction and absolutely no change in exercise.
I basically did strict keto for 6 months. CICO is a real thing. Even hypothyroid, you're not going to gain weight if you aren't intaking the calories.
a) don't eat so much they get obese, or b) take an anti-obesity drug so they don't get obese
Which is ridiculous. They would still get sick and die early due to lack of nutrition.
They are, im not fat (visible flexed abs) I did a blood test and found some issues. I cut out the saturated fats I was eating. Brownies, butter, slow cooked meats. tests were normal again.
Imagine that you are at the beach, and you can choose how deep you want to wade or how far you want to swim. If you like the water and the sun and the waves, this is very pleasant to imagine.
Now imagine that you are dropped into the ocean at night 200 meters from shore and you can't see land, you can't see lights. This is very unpleasant to imagine.
Our current food system is much like the second scenario.
Instead of framing it as whether or not it is possible to be healthy in this system, ask if the system is consistent with the goals of being healthy. Is a candy bar and a bag of chips consistent with the goals of being healthy?
If you are dropped in the ocean in the middle of the night, it is possible to swim to land. But it is also very likely that many people will not be able to swim to land in that scenario.
> The food is only an issue because some people have overly strong appetites relative to the abundance of food.
Then why is it advertised? Are food advertisements consistent with the goal of health?
People genuinely enjoy those foods because they're closer to their bliss point than natural analogues. Increasing salt, fat and sugar content of processed foods doesn't mean they're better for consumers. They just mean they're more addictive. People consume more of them and are more likely to purchase them in the future.
https://en.wikipedia.org/wiki/Bliss_point_(food)
We have no issues identifying that restrictions on tobacco are acceptable from a public health standpoint - the same chemical reward hijacking is being done with food.
Interestingly, a reduction in consumption of processed foods would also likely have a significant impact on the need for health interventions with drugs. We have massive industries propped up by people’s cravings for junk.
People enjoy drugs, I agree. Some get addicted and die though.
I mean, there are responsible/functioning heroin users, it doesn't mean heroin is safe for everyone
> If we can cure obesity
Or you know, practice self control, which is easily in the top 3 of good traits to have and practice. But that's only a part of the equation, the other being the food industry abusing our monkey brains by adding all kind of additives to their food to trigger the right pathways so that we keep consuming their products.
I for one am happy that I escaped this hellish cycle and mostly consume fresh products, but I completely understand how people get tricked into eating heavily processed food and basically slowly sabotage their whole body
> Humans obviously value tasty and flavorful food, and its existence adds joy to people's lives.
We also enjoy all kind of things that cause harm to ourselves or others, this is an extremely weak argument, maybe the weakest of all concerning that topic
Perhaps the alienation of workers from the fruits of their labor? It's underrated how depressing it is to not get to eat the sausage you broke your back making.
Still, I think its possible to make the idea of "purpose" more concrete. You could define "true meaning and purpose" to be goals that are greater than oneself that require one's full potential in mind and body and sacrifice of immediate pleasures for long-term gain. The widespread nature of obesity indicates that many people don't consider a healthy body as necessary for their goals and hence don't sacrifice immediate food gratification for those goals. Hence most people don't have goals that require their full body potential.
Simply put if you take mammalian models and allow them to eat all they want they blow up like little balloons. This is no different from bears feasting on salmon for the last millions of years. Creatures are designed to overconsume because the ones that didn't in the past didn't make it thru the lean times.
And the reverse is also true, if you go a while without eating anything high in sugar, what used to taste normal can taste almost unbearably sweet. Exceedingly hard to do with it added to just about all things in absurd amounts though.
Of course it is, which is fantastic for the economy. Like the Industrial War Complex, it's horrifically bad for people and resources, but does wonders for the pockets of those in power
People love to bitch about the "diet industry" (which as a whole, seems to be almost entirely bro-science and snake oil), but the profits made there pale in comparison to fast food and processed food. It's really something that we should fix, like we did with tobacco and alcohol.
Fixing food deserts, even though they are not really widespread enough to entirely account for the obesity epidemic, needs to happen as well.
And taking subsidies away from animal products like meat, dairy and corn (specifically for HFCS) would go a long ways to improving the standard American diet (aka, SAD).
He thinks the GLP-1 inhibitor drugs will be a disaster in the long term because they 1) cause weight loss but also 2) cause the body to create lots of new adipocyte (fat cells). Increasing the number of adipocytes is very unusual after puberty. As long as you are taking the GLP-1 inhibitor drugs you will lose or maintain weight, but as soon as you stop you will gain a lot of weight back.
Here is the blog post: https://high-fat-nutrition.blogspot.com/2023/01/glp-1-agonis...
The GLP-1 drugs literally increase the number of fat cells.
(Which is worth assessing if there are concerns about these drugs increasing the number of fat cells (otherwise unusual in adulthood) and creating a risk of fat volume rebound beyond initial levels after discontinuation).
But there are a lot of different mechanisms and feedbacks at play and I'm not sure how much insight can be gained from comparing localised lipectomy to systemic adipocyte proliferation resulting from a drug.
The human body has VERY strong setpoints about weight. Fat cells "remember" the weight that you had when they were created. You have to hold your weight at a point for something like 3-5 years before your body relents enough that the setpoint moves.
The aggregation of the tiny setpoints creates your larger setpoint by either drawing out from or pushing into your bloodstream the lipids that they have.
This is one of the most infuriating things about the "you just need to eat less" crowd. That's simply the first step. But you somehow need to maintain that for years while your body readjusts since fat cells turn over fairly slowly in your body (about 20-25% per year).
Maintaining a lower body weight while your body is actively fighting you for years is a superhuman level of willpower that very few of us can muster.
I specifically asked doctors and they were like "I dunno. Well, that was a fun 5 minute conversation, give me $300"
I guess it's never too late, though. I've been slacking off on getting in shape, since it does take raw willpower 20 times a day every day in order to get there and stay there, and it's not that compelling to think that I'm going to be stuck rolling willpower checks all the time forever.
If I just have to get in shape and force myself to stay that way through raw willpower for ~4 years in order to stay that way for free afterward, though, that sounds like a more worthwhile goal
There is increasing amounts of science behind this stuff, but it's also buried behind a gargantuan pile of crap.
Good luck.
Is there any evidence of this? I've never seen any evidence the setpoint ever moves down.
This is also common in all weight loss interventions, though the reason is generally from metabolic slowdown, not the creation of new adipose tissues.
If there are more fat cells, then and they all decide to increase in size, then that could be a substantial weight gain, beyond what would be expected otherwise.
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
https://pubmed.ncbi.nlm.nih.gov/27387697/
With that said, I would be interested if new weight loss drugs negate the need for gastric bypass in the first place. Comes across as medieval and barbaric if the hormones/drugs are superior.
Except for one thing: it's fairly easy to not stop a drug. You just... keep taking it. Long-term use of these drugs for maintenance purposes looks entirely feasible. Not quite as easy to maintain as a gastric bypass, but close enough to be a big deal.
The same isn't true for exercise and diet; it's very easy to fall off those wagons.
It kind of is that simple, but there are so many factors that help prevent us from good habits. I think my biggest issue is that food is one of the few things in my life that’s ever evoked a positive response for me. I’ve gone years without being fat, but it comes back because of some issue I encounter, and I lack the tools to deal with it in a better way. So I get depressed and eat, and eventually hate myself for falling apart again, and so we go, forever and always.
Examples of costs could be be the reoccurring monetary cost for the rest of your life, and being dependent on the supply of medicine to maintain your health.
Additionally, there are personal advantages to being an individual that is capable of doing and regularly practices "hard things".
This is similar to exercise. You body goes through a period of panic and resistance.
This is why consistency is important for both diet and exercise, so you dont have to struggle and battle to rebuild the habit.
Your body will also panic if you start working out vigorously, confront hard but necessary situations, or many other aspects of human life.
If a prescription help someone make a productive transition, that's great. My point is simply that I'm cautious of potentially lifelong crutches to avoid making difficult changes, and there's value in cultivating the ability to maintain your personal homeostasis if you can
I'm supposed to book a follow up appointment after I've read about it, so I guess I'll find out what he means then.
For trirzepatide: https://www.mounjaro.com/hcp/savings-resources
They typically are income blind and make your out-of-pocket price negligible. I'm on a med (Skyrizi) that's $18k per shot, one every three months; their assistance program ensures I don't pay more than $5.
They chip in on the deductible/coinsurance/copay, you don't skip the medication due to cost, and they still get significant money out of your insurer. Everybody wins, until everyone's premiums go up next year.
Individual consumers pay basically nothing and companies are still incentivized to innovate and create new medicines
They pay via premiums - mine went up to $2,792/month this year - or if their employer pays those, via the resulting wage impact.
And, as a result, we spend 2-3x what the rest of the OECD spends on healthcare - public and private spending - with roughly the same health outcomes.
Look at 1800rxonline.
It's a case of either paying for a private prescription now, or waiting until it's made more accessible on the NHS.
>I am Petro Dobromylskyj, always known as Peter. I'm a vet, trained at the RVC, London University. I was fortunate enough to intercalate a BSc degree in physiology in to my veterinary degree. I was even more fortunate to study under Patrick Wall at UCH, who set me on course to become a veterinary anaesthetist, mostly working on acute pain control. That led to the Certificate then Diploma in Veterinary Anaesthesia and enough publications to allow me to enter the European College of Veterinary Anaesthesia and Analgesia as a de facto founding member. Anaesthesia teaches you a lot. Basic science is combined with the occasional need to act rapidly. Wrong decisions can reward you with catastrophe in seconds. Thinking is mandatory. I stumbled on to nutrition completely by accident. Once you have been taught to think, it's hard to stop. I think about lots of things. These are some of them.
I'm not the OP but youtube is tainted for anything other than entertainment and a few select channels like the ones by PBS e.g Space Time.
I can easily find upper graduate university lectures for complex topics. YouTube makes it easy to link first sources unlike other image/video platforms. Also, since they appear on official pages of reputed sources (conference channel, university channel) there is a certain level of reliability irrespective of who the speaker is.
Lastly, search for any popular video on YouTube and you will see just as many 'response' videos. While not intentional, it helps avoid echo chambering as the counter argument is readily available .
Ok, but you understand why someone might be weary that the most common first hit for someone might be an arbitrary youtube video given your premise is living on the channels you've subscribed to.
The bulk of youtube's content is garbage. You have to go sifting through the content over time, suffering through the recommendation engine (or a shortcut - ask friends who've already lived through that nightmare) to find the geese who lay the good eggs.
Are there good YT channels? Yeah. But 9 times out of 10 (or more) when I search for some rando's recommended expert and the first result is a YT video, it's crap. Utter crap.
I nearly choked when my sister-in-law told me a couple years ago about some really convincing anti-vaccine information she had read which made her very nervous. I asked her what she'd heard, and she gave me a link to a YT video by Dr. Shiva. Yes, THAT Dr. Shiva. Ha! I tried to break it to her gently, but I'm pretty sure she still decided he was a credible source of information.
Is it correct that the source is a veterinary anaesthesiolgist?
What makes you say that? In my experience, there are no 'experts' in empirical fields who are no themselves deeply and practically engaged with actual research. Being well-read does not make you an expert. Writing blog posts and appearing on YT doesn't make you an expert. Critics are not experts. To be an expert in anything you have to get your hands dirty.
Nothing I can see from this guys publications or bio make it seems like he's an expert in human fat metabolism at all, let alone a 'foremost' one. I base this on a fairly cursory survey, so I'm happy to be corrected. But convincing corrections would absolutely require details regarding what he has contributed to the field.
The consensus among most obesity researchers is the cause of obesity is primarily neurological, not metabolic. Basically the brain can't properly regulate weight in the current obesogenic environment. When you look at GWAS most of the genes related to obesity are active in the brain, (as opposed to genes for diabetes which are more closely related to fat/metabolism etc...).
I'd describe Petro Dobromylskyj as a smart hobbyist with an outsiders views of obesity, not a foremost expert on fat metabolism.
2. Clinical anesthesiology is pretty far from this topic.
Does he have all those? I'm honestly asking, I've never heard of him.
Some other things I've learned:
Take the first shot on an empty stomach. Expect the first 3 days to be rough. Hunger is more than one sensation, and when you have severe calorie deficit, your body will feel very bad (at least at first).
It is critical to control your food environment - don't bring junk food home, don't go to restaurants too often.
I learned to slow down and enjoy the food reward, instead of trying to chase it. No words will tell you how to do this for yourself.
There is a feeling that I call "future hunger", where I don't feel bad, but I feel like I will in a while. In the past, my body and mind would get frantic when I felt this way. Now I have a very small snack and ask myself "do you feel bad right now, or do you feel like you're going to feel bad". Again, these words may not translate.
More than one serving of salty and sugary snacks should NEVER be within arms reach, and preferably not in the same room. Your mind will remember these snacks and oftentimes eat them without conscious effort.
Sounds like the opposite of a disaster for pharmaceutical companies.
Well, on the upside, the demand for this is so great that cheap generics shouldn't be too far away, right? And it seems like an insurance no-brainer to cover it for life, right?
I was retching horribly one night at 2 am, but didn't throw up. I've felt clammy and dizzy a few times. (Possibly hypoglycemic?)
I honestly feel like it's changing how I feel about food. I don't want to eat empty carbs, anywhere near as much. Because I feel like they make me feel sick. I'm eager to have more, smaller meals. I'm eager to have protein.
I had previously done a keto diet, except maybe I wasn't really in ketosis? It was medically supervised, doing New Direction complete meal replacements. I lost a bunch of weight, but... gained it back.
So now semaglutide. Dr urging surgery as a possibility. I'm eager to not do surgery. Fingers crossed for Wegovy.
I did a keto diet obsessively for a while and I still have a psychological revulsion to drinking coke or eating cake even a year later. Those sorts of things are long term wins.
I'm happy for you, but I didn't get that benefit you got.
It worked great as a way to lose weight. And for people who need to lose weight to prepare for surgery, I still think it's a neat program.
But I was just not equipped to survive returning to normal foods. And stress.
People have different metabolic situations, but if you haven't tried fasting+restriction, it's pretty interesting.
This is where I struggled with OMAD. It's easy to not eat up to the first meal. But not snacking after dinner takes some real heart.
(More seriously: if I'm careful about macros with, like, a late lunch, I'm usually good for the rest of the day. If I make an omelette at 3-4PM, I'm probably not eating another meal that day.)
I'm a strong believer in being able to eat enough to become satiated without overdoing the negative macros. So it's mostly a matter of finding the right stuff to eat in those moments.
It's a strange, thin line to walk. Trans fats are unhealthy in any quantity, so I refuse to eat them. But they are still (secretly) all over the place, so in practice it looks a lot like an eating disorder.
It's easy to take it too far, but "just because you're paranoid, does not mean they're not out to get you."
Be careful. You'd be amazed at what harm the brain can do to the body.
Take a moment to consider what your reaction is before continuing.
...
The comments I'm reading here are diverse and fascinating. Weight loss, diet, and fitness are almost quasi-religious issues that people tend to have strong and personal reactions to. The unfit are desperate for a solution, especially an easy one. The very fit subconsciously resent the notion that people could achieve, with a pill, what they have achieved through discipline and hard work (or genetic luck). Others are keen to point out diverse evils of modern society that they believe are the true culprits which must be tackled instead of masking their effect with a pill.
Nutrition and fitness are classic examples of pseudo-science. Studies that would meet the bare minimum standards of scientific rigour in any other field are practically impossible. Getting a statistically significant sample of people to go on special diets or exercise regimens long term is just not feasible. Whenever an "expert" makes a tentative statement on what they think might be the case, media picks it up and amplifies it. Butter is bad for you. Butter is good for you. Blueberries are superfood. Keto diets. Crossfit. etc. Countless "experts", often with no credentials and no compelling data, are happy to write best-selling self-improvement books. They assume that what works for them (or didn't work, but seems like it should have) will work for everyone. Everyone wants to know how to be healthy, fit, and happy, so there is insatiable demand for books that are, by scientific standards, pure spit-balling.
Then medicine and drug research, which are legally required to be at last somewhat scientific but are always profit-motivated, enter the fray. They can prove a drug meets safety standards and quantify certain specific effects, but interactions with the pseudo-science of the greater health industry eventually become unavoidable.
Perhaps the first step to becoming more objective about drugs like this is to recognize that we really aren't.
*a hypothetical one, not the one being discussed here
I think it's pretty well agreed upon in the medical community (and proven) that a healthy diet (lots of fruit and vegetables, not too much sugar, etc) and regular exercise leads to better health. It's not pseudo-science. Neither is the statement that consuming more calories than you burn will make you put on weight.
Let me tell you, the number of thin people I've met who got there through discipline and hard work is vanishingly small compared to those genetically blessed. This is probably why it's such an appealing delusion -- who doesn't want the world to think they're disciplined and hardworking, instead of just lucky?
And that's called an healthy lifestyle
I'm full (and would get nauseated if I continued eating) with an amount of food that would leave my sibling still feeling constant hunger pangs... the feeling of "fullness" here is the genetic/hormonal blessing
People who stay "fit" and hit a lot are the opposite of lucky, they probably have thyroid issues or other similar issues that will cause more serious problems down the road.
People who think they're lucky are obese with a food addiction problem
https://pubmed.ncbi.nlm.nih.gov/19158209/
Conclusions: Ingestion of 3 g cinnamon reduced postprandial serum insulin and increased GLP-1 concentrations without significantly affecting blood glucose, GIP, the ghrelin concentration, satiety, or GER in healthy subjects.
I know because one of my friends has a cinnamon farm, and what he makes at his place is nothing compared to the cinnamon I could buy from supermarkets when I was living in the Netherlands. Look for Sri Lankan markets if you are looking for unaltered stuff.
I've been on Semaglutide for 6 months now. Weight is down from 97kg to 83kg, blood HbA1C is down into pre-diabetes levels. (Also, my knees don't hurt!)
The down side of semaglutide:
1. Continuous low-grade nausea, as in, "am I going to throw up?" levels of stomach upset. Feeling nauseous for six months is No Fun Whatsoever.
2. Appetite suppression: it's like a chemical gastric band. My stomach capacity is way down. It makes family meal planning pretty much impossible: it makes the rare celebratory restaurant meal difficult (I'm limited to either two starter-sized portions or a main portion, and expect to leave some on the plate or feel bloated for 12-18 hours afterwards).
3. Muscle loss, not just fat loss. There's a pandemic surge and the health service here is in crisis so I'm not going to the swimming pool (my main form of exercise -- low joint impact). Consequently I'm not getting enough exercise. I have noticed that on semaglutide you lose weight from all tissues -- not just white adipose, so I'm losing muscle density as well. (New Year's Resolution: once the current COVID peak passes, go back to the pool during off-peak hours.)
Upshot: I'm going to persist for a while longer then when the weight loss slows off I'll talk to my GP about a medication review and maybe reducing the dosage to a maintenance level (in hope of keeping the benefits and reducing the side-effects). I would not recommend this medication to someone who is only a bit overweight -- it's a first-generation GLP-1 agonist, and like H2 antagonists in the 1970s and 1980s there will be a deluge of me-too drugs over the next few years that are cheaper/better/have fewer side-effects. If you can wait, wait.
I don't pretend to know the solution, but I do think drug availability should be prioritized to those who need it the most, not those who can pay the most (the weight loss brand of the same drug is being marketed for 2x-5x the cost of the diabetic brand, or so I've been told).
> the weight loss brand of the same drug is being marketed for 2x-5x the cost of the diabetic brand, or so I've been told
Drug pricing is a hell of a drug.
This seems to be a short term problem, and the solution is to simply make more of the drug to match demand.
which unfortunately might not align with the incentives of capitalism.
edit: You could even argue, in a conspiratorial mind, that by getting people addicted to sugar ($0.0002 / mg) in order to then get them addicted to a drug that costs ($10/mg) is peak "Capitalism"
Oh you absolutely could argue that. That's pretty much right on the money. It doesn't require conspiratorial up-front planning. Just a tragedy of the commons in an environment of capitalistic incentives without the necessary constraints around it.
I read a statement from Novo Nordisk to their investors where they said they simply underestimated demand for the drugs. They expected a slow uptake and instead received an explosive one. They are working hard to increase production.
Also going to preface this by saying I have struggled with weight my entire life and have lost and gained substantial weight through diet alone, always gaining it back and then some — but I think I found something that has worked for me and I have been reflecting on what I wish I was told a long time ago.
It's not necessarily a problem to be "obese", meaning you can have extra fat on top of muscle but also be metabolically healthy. In those cases, the extra weight is just causing your calfs to be huge.
Instead of focusing on getting skinny, I started focusing on getting strong. All of a sudden diet was a supplemental tool to this goal, and not the main thing. I just made sure to eat more protein, and if I had a "bad day" of eating, I chalked it up to my body having more energy to synthesize new muscle :) Before a bad day would "undo" days of suffering on an energy deficit, and I would just give up. But if you frame it as: look, you have struggled your entire life to be 'thin', when in reality, your ability to be obese was a hidden superpower. Stop fighting it and lift weights, you were probably _made_ for this!
In this context I'm weirdly happy with my genetics? there are so many "hard gainers" that do everything in their power to put on 10bs so they can gain muscle. I'm gaining muscle without hardly trying. How many other obese, inactive people are like me and would respond amazingly to resistance training ALONE as well?
I focused on strength training and protein for a long time when I started, that was fun and easy, and my body composition started to change. Then I started to notice the changes, and now I have purposeful short-duration "cuts" in my routine and it seems like at some point I'll eventually not be obese.
Just trying to say that I wonder what would happen if people were told, "hey, you don't need to diet right now, just come in and train twice a week and eat more protein". Of course "energy toxicity" is absolutely real, but lean body mass can improve health markers A LOT before worrying about that.
What does your plan look like long-term? Are you just going to keep gaining muscle and working out for the rest of your life, or do you plan to stop?
Obviously your TDEE is going to go up with more muscle. I wonder if there's a stable point where you can eat a 'normal' (read: not protein heavy) diet while working out, so that muscle is only maintained.
What happened was I put on a ton of muscle, and actually lost some weight... in the end I was 12lbs lighter, which doesn't seem like a lot but with the amount of muscle is EXTREMELY noticeable.
For me, seeing my body get more stronger and more muscular was a revelation, it's really fun to see the growth in those areas, much more than suffering to get "skinny fat". So now I'm actually working 4-6 week stints of weight loss into my program where I target 2lbs of fat loss week, while keeping the training intensity high (with lower volume to combat fatigue) to maintain the muscle I have built. I'll follow that with 2-3 months of maybe a slight surplus in calories to build (which comes with some fat gain). A few cycles of that and I'll be golden :)
From a health span and longevity standpoint, having lean body muscle is absolutely crucial for aging, and it's something I plan to not stop doing, even if I fall off the nutrition wagon completely, I'll at least be increasing my bone density and muscle mass which will counteract a lot of whatever bad food habits I'm doing at the time.
The cool thing about muscle vs just pure weight loss, is that muscle isn't super hard to maintain once you have it. The amount of stimulus you need to keep the muscle, especially in an energy balance or surplus environment is surprisingly small it turns out. So to me it's much more rewarding than a crash diet that can be completely erased and then-some in a matter of months.
I wish I had this frame of mind a long time ago, it has personally helped me tremendously.
The FDA will likely approve the diabetes drug tirzepatide for weight loss - https://news.ycombinator.com/item?id=34220996 - Jan 2023 (100 comments)
Tirzepatide delivered up to 22.5% weight loss in obese or overweight adults - https://news.ycombinator.com/item?id=33221121 - Oct 2022 (21 comments)
Because calorie intake is substantially impacted by things like satiety. As the article's subtitle heavily hints at, "A class of drugs that quash hunger" is beneficial in moving that bit of the equation.
Consider, though, that quite a few obese people "feel bad" at least in part because of the health and social impacts of their weight.
"Assuming no changes in behavior" doesn't make sense, because the drug makes people feel full after a smaller amount of calories and thus changes behavior.
Anyway, semantics of hunger/fullness aside, the effect of the drug is behavioral - people taking it do end up eating significantly less, which leads to substantial weight loss.
In the same way that the economy is a function of people trading things, sure. Why do we even need economic policy?
So are physicians, and most patients. It's just a lot harder than it sounds to sustain. There's the old adage that "the definition of insanity is trying the same thing over and over expecting different results"; attempting to cure obesity by telling patients "exercise more, eat less" is precisely that.
https://www.cbc.ca/news/health/obesity-research-confirms-lon...
> But if we check back after five or 10 years, there's a good chance they will have put the weight back on. Only about five per cent of people who try to lose weight ultimately succeed, according to the research. Those people are the outliers, but we cling to their stories as proof that losing weight is possible.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
> In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained.
"Just eat right and exercise more" may work for a small number of people, but for most it's setting folks up to fail. It's good that we're starting to get medication options that can help folks achieve those changes; bariatric surgery works, but it's a big deal for the body.
It may work for most people - those studies are performed on a fraction of the remainder.
70% of adult Americans are overweight, so no, probably not.
> those studies are performed on a fraction of the remainder
Why would you believe that?
Take a 'large enough' population of animals and give them an all you can eat buffet for months. What percentage of them becomes overweight? It won't be 100%, but the numbers should be pretty high. I have a very strong feeling (sadly no evidence, they won't let me trap random people in cages for months at a time to test this) that the human numbers and the animal numbers will look very much alike.
My what? I was countering an absolutist position; I wasn't presenting my own.
And yes, animals can be made to starve to death as well, if you give them a bar to push that gives a dopamine hit. That doesn't mean we should shrug and say, "Well, it's inevitable that I'm going to die now, because I failed once" the first time we fail to refrain from getting such a hit.
People who are obese or grossly obese often aren't just eating a "little extra" here and there. Imagine more like "extra pizza a day" or "eat a cake once a week because that seems like a good idea".
That is why weight loss is hard to achieve. If you are hungry, it's hard to--over an entire day--avoid eating 300 extra calories.
1Kg of human fat is around 8000kcals give or take. 50lbs is 22Kg. 176000kcal. It's 586x "extra slices of pizza", almost two years of overeating every day.
It's easy to say "put down the pizza," but pizza is just an example.
300 calories is also 1/4 a cup of rice (50 cals), 1/3 service of chicken (100 cals) an egg (78 cals), a teaspoon of olive oil (40 cals), and a toast (75 cals).
There are lot of reasons its hard to cut weight. Measuring calorie intake to 300 calories is hard enough. But also, its easy to eat a bit more at each meal if you are hungry (and it adds up).
It's the other way round: the point of the drug is to change behavior. By changing the hunger response.
The hunger response is not quite as low-level as, say, the breathing response, but you'll notice that it's very difficult to choose to stop or reduce your breathing below a level that your body will accept, and after a very short while your conscious will will simply be overridden.
Anyone will lose significant weight on a strict enough diet. Unfortunately, severe calorie restriction does things to your metabolism -- basically, your body notices there's not enough food, and tries to slow everything down so that your existing stores will last as long as possible. This (a) isn't good for you, since major organs are having to limp along, and (b) means your diet gets less effective, as "calories out" aggressively shrinks. There's evidence that this lasts for a fair while after a diet stops, making it really easy to regain weight.
Then, psychologically, most people have a hard time sticking with any sort of long term diet. Unless you have an abnormally low hunger response, ignoring feeling hungry all the time (even just a little bit) is very hard. Cheating on your diet is very alluring, and your body gives you all the rewards for doing things that feel like they're avoiding you slowly starving to death.
The latter point is where these drugs come in. By suppressing hunger signals, dieting suddenly becomes easy, removing the escalating willpower requirement. (Honestly, I'd worry about whether you'd still suffer the metabolic effects of calorie restriction even if you're not noticing the hunger, but hopefully that's being studied and they're only prescribed along with a solid nutritional plan...)
Who said anything about "strict" or "severe calorie restriction" ?
To loose weight a person need only regularly eat 100 or 200 calories less than their daily requirement. For many who are obese, we're talking about having one less can of coke per day, or one less slice of a whole pizza or less ice cream every day.
A severely obese person can perfectly well eat McDonald's every single day, and eat more calories than a regular gym junkie and STILL lose weight!
The desire to eat is driven by our hormones and these are not easily overridden by willpower. In fact, study after study shows that willpower is insufficient for most people. Hunger is produced by a complex set of factors that we do not fully understand. What we eat and how we live plays a big part in how hungry we feel.
Calories should not be counted like some fungible currency. Each food is a complex and poorly understood cocktail of organic chemistry. Food is not processed by the body in the same way or at the same speed. In the most simple sense, unprocessed whole foods digest the slowest and provide the most even energy to the body, while highly processed food is digested quickly and leaves you hungry again soon. And above all else, fiber is the most amazing thing that can be in your food to regulate your digestion and make you feel more full.
And the consumption of energy is also not a matter of willpower to go to the gym. The body regulates is caloric burn to suit its environment, again, based on a complex and poorly understood web of signals. But in simple terms, trying to eat less can also caus your body to go into a "low power mode" where you burn less energy, ultimately being counterproductive.
The magic of this drug is that is hijacks one of the important hormone pathways involved in hunger and causes you to eat less calories without a single conscious thought. If proven out as safe and effective, it could be the silver bullet in an obesity epidemic that has never had any easy solutions before.
The one thing I've always done is avoid foods with added sugar and in general processed food. There's good evidence that the consumption of "ultra-processed" food is associated with the obesity epidemic and that these food are what people weight-maintenance processes out of balance.
Given this, adding a drug to solve that problem might not be a panacea. What other bad effects could result from a strong drug plus a crap diet? We'll start another mass experiment to find, I suppose.
What you are talking about substantially in your post is about willpower with regards to eating and exercise which is totally different.
And sure, there is an energy equation here thermodynamically, but it is unhelpful. It would be something like:
Calories in * X = Calories consumed * Y + Fat stored * Z Where X, Y and Z are unknown and barely controllable factors related to hunger, type of food, digestion, microbiome, hormones, genetics, metabolism, environment, society and so on.
Instead look at the evolutionary incentives. If you starve you are going to die and it is going to fucking hurt the entire time you are dying.
With that one line of information you now understand not only humans but the vast majority of animal life on this planet and why almost all animals get fat if you leave a full food dish around. We are optimized to avoid starving at all costs. When winter comes you could die. When the summer drought comes you could die. Your animal brain is yelling at you to pack on the pounds now that the eating is good because the lean times are coming. Our animal brain has no understanding or concept that times are good, we need to slow down. It has never been a primary evolutionary driver.
Most equations don't fight back when you try to balance them. But this one does.
Care to write it?
if (calories in < calories used) then lose weight (burn fat previously stored to keep running the machine)
You can make that on a daily, monthly or yearly timescale, it makes no difference.
Everything we know about physics says it is the only way.
Most people will have a +/- 25 lbs window, where the feedback loop is minimal. But once they step outside this window the nudges become increasingly strong. This is why it's generally easy to lose 15 lbs, but really hard to lose 50 lbs. Also why many can lose weight under very targeted lifestyle interventions, but rapidly snap back as soon as they relax even a little bit. Finally it's why the vast majority of normal weight people don't need to count calories, their metabolic setpoint intuitively matches their appetite to their caloric needs.
"Eat fewer calories" is technically a solution, in the same way that "stop drinking alcohol" is a solution for an alcoholic. The problem is someone who has an obese-level metabolic setpoint will literally be ravenous 24/7 once they get down to healthy weight. If you haven't experienced this yourself, try fasting for 48 hours, putting out a bowl of chips on the table in front of you, and resist the urge to eat even one while you try to do something else. That is what it's like to be an obese person trying to lose a large amount of weight.
GLP-1 agonists work by short circuiting the hormones that regulate hunger. It's basically the equivalent of moving your metabolic setpoint 100 pounds lower. The need to explicitly count calories no longer exists, because your appetite will naturally limit itself well below the point of caloric expenditure.
I imagine if a prescribed diet from a doctor also came with mental health counseling, that overcoming the satiation issue could be a lot easier for more people. It really is a frame of mind issue that prevents most peoples weight loss from being more successful.
The fact is you can choose to starve yourself to death if you put your mind to it. I would counter that with 'why the hell would you want to'. Wasting a huge portion of my brain time to tell myself (oh yea, don't eat) seems like a massive waste of time and energy.
>to act on hunger requires conscious effort
Does it? I'd like to develop a test where I starve a large people for a little while. Then while I distract them with something I put some easy to eat like chips in their peripheral view and see how many of them realize they started consuming the chips. My ethicist says I can't do this unfortunately, but I imagine that a significant fraction of the group will not realize when they started eating them.
That's not what the ascetics come to learn. They aren't even thinking about the hunger at all when they are fasting. The sensation is barely registered in their thought. Plus even with your example for those people who do not realize what they are doing with the chips, if you are serious about dieting you wouldn't set yourself up for such temptation like having a bag of tempting candy perhaps in plain view. You'd do what people who quit smoking do and throw away the junk food or otherwise get it out of easy access. Then you've given yourself another layer of friction that requires even more conscious effort to overcome: if you want to act on your craving for chips, you now have to go to the store and buy them.
But that's the point. You live in a world full of this stuff and a huge portion of people do not have the option to setup the world in such a manner they can avoid temptations being around them.
People that fail to quit smoking have the biggest problem when other smokers offer them cigs. And smokers are a 'small' portion of the population, we all eat. That's why we came up with things like bupropion and varenicline so people can quit smoking. Most people tried and failed to quit smoking multiple times.
Citation? This goes against everything I've heard from credentialed experts and against my own experience as well. For one thing, it's unclear how you'd explain the weight gain of the median person in the western world over the last 30 years. For another, it's very strange that people like me (previously) gained 5-10 pounds a year, if our bodies were supposedly trying to keep us at a particular set point.
But the point is this is a slow and continuous process that occurs over years or even decades. Discontinuously making a big shift in weight, up or down, is basically impossible. Which is why despite very high rates of obesity, it's basically unheard of for someone to gain 50 lbs in a short period of time. Almost all weight gain takes the form of 5 lbs one year, 5 lbs another year, and so on.
The phenomena of an ever increasing set point I believe is down to periods of willful over-indulgence that overruns the power of our hormonal homeostasis to recover from so it settles higher than it started when pushed too hard.
Christmas, holidays, times of stress, home-baking passions (my downfall), liquid calories and ultra calorie dense eating-for-leisure that don't stimulate our sense of fullness early enough to stop.
The cruelty is that it's a hell of a lot easier to eat when not hungry than to push a plate away when jonesing for it, so it keeps going up.
Maybe if more people at least simulated how much a hunter gatherer moved a day, we'd see a much healthier population versus continuing this sedentary behavior that we have not evolved to do while remaining healthy. Agriculture which enabled a sedentary lifestyle for many people did not happen long enough ago for our species to be well adapted to this behavior; it was only 10,000 years ago, while our ancestors had been hunting and gathering for at least 2 million years, likely foraging even longer still.
You don't need a drug, but changing habits is very hard and obesity very deadly.
I wonder if rather than a placebo they had a control group also try to lose with caloric restriction and defined plateaus where they maintain a weight for some period of time. For example instead of lose 1lb/week for 52 weeks, lose 1lb/week for 12 weeks, maintain weight for 8 weeks, repeat. Maybe the element of the body "remembering" a weight happens when you plateau at a weight for a while? Kinda like giving the body some time to adjust as you lose.
Other than this is mostly useless in itself.... Calorie restriction really only works well under medical supervision (multiple studies show people suck at calorie counting and avoiding calorie intake). Once the supervision is over, most people gain the weight back.
I have a feeling it may happen with this shot too, and if so I foresee it will have primary treatment to lose weight then a secondary to maintain status.
On paper dieting is the easiest thing. You literally need to watch one hole and it is right under your nose, but in practice it isnt that easy.
Appetite is great way to control obesity - if you dont want to eat you wont
> "Sometimes the medicines most often used to treat ADHD can cause weight loss. Stimulant drugs like methylphenidate (Ritalin) and amphetamine/dextroamphetamine (Adderall) make you less hungry and make your body burn calories faster than usual. Some of them are even used to help people lose weight or treat binge eating.Oct 26, 2021"
More technically:
https://pubmed.ncbi.nlm.nih.gov/1523237/
"The effects of amphetamine on body weight and energy expenditure" (1992) Jones et. al
However, in many cases if people stop taking such drugs they can regain the weight, and the drugs can be addictive if dose regimens are not carefully managed (which doesn't seem to be a problem with ADHD). Note also these drugs are much cheaper than this new class, likely by a factor of 10.
In the long run, new behaviors (quitting alcohol and sugary foods, increasing exercise, reducing overall calorie intake, etc.) are probably needed for persistant long-term effects on reducing obesity.
What in the environment is slowly poisoning everyone so their bodies don't work normally?
Here's a clue, one of hundreds in the medical literature:
"The endocrine disrupting potential of monosodium glutamate (MSG) on secretion of the glucagon-like peptide-1 (GLP-1) gut hormone and GLP-1 receptor interaction" https://twitter.com/hashtag/AtmosphericRiver?src=hashtag_cli...
There is a huge bias against anyone saying anything in food or otherwise causing anything more than a trivial negative health effect. Everyone says eat healthy, but there's so much more the government in the U.S could do to protect the average consumer from damaging unnecessary food additives. The EU is much better about these food additive issues.
We simply don't have much of an idea how the human hormone system works, or how it reacts to all the chemicals present in the "Standard American Diet."
…
> Nutter is concerned that people might start these treatments — whose side effects, such as nausea and vomiting, can be severe — to escape weight stigma, rather than to serve a true health need
So the side effects aren’t “serious” — they’re just potentially “severe”? I’m confused.
The side-effects of this particular treatment "can be severe", but that doesn't imply anything about the side-effects of any other treatment (combination of medication, dose, RoA, and interval) for drugs in this class. Heck, they could probably fix the nausea/vomiting just by making a pill that contains an adjunct anti-emetic like ondansetron, like they do for cancer drugs.
This is an unfair framing by the researchers
For a while I worked in pharma on a drug program for a harmless* "ailment", nail fungus. What I learned is that some people suffer serious psychological consequences, such as marital issues or avoiding situations where they might be barefoot, like the beach. People who have it in their hands may avoid social situations all together, which is even worse and reduces life expectancy.
We have a natural cultural bias in this regard. It's not just the phantom of the opera: in films the hero usually has a clear complexion and the villain often does not (not always to the extent of Darth Vader of course). Now we understand more about disease etiology this bias is no longer helpful, and is in fact destructive.
Losing weight addresses true health needs (increased rates of cancer, cardiac issues etc) but weight stigma has important side effects as well.
* The various fungi that attack skin, scalp, nails etc eat a particular shape of squalene which some people make (referred to unfairly in the medical literature as a "squalene defect"). You're not going to catch it from another person -- there's a good chance you're breathing the spores right now. Either you're genetically predisposed or you're not. And all it does is munch on a tiny amount of your body and causes no other problem.
I'm hesitant to measure weight loss as a pure good in of itself because it isn't evident to me that just losing weight has a causative effect on reducing specific diseases.
We've got plenty of clear evidence that being significantly overweight has health impacts.
https://pubmed.ncbi.nlm.nih.gov/12457296/
https://academic.oup.com/ajcn/article/74/5/579/4737391
https://www.cell.com/cell-metabolism/fulltext/S1550-4131(16)...
https://www.bmj.com/content/359/bmj.j4849
https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
Yeah, but low calorie diets (lower than your daily calories expenditure) always do.
This is not a "turns out". Anyone who believed that just having a "low fat" diet will make them leaner, didn't really know how losing fat works. Fat is a macronutrient (and quite useful one) just making it lower tells you absolutely nothing on its own.
People don’t want to hear it, but we do nobody any favors by pretending this is more complicated than it is. It’s actually pretty simple. The solution is to adjust calories in vs calories out. Fast a few days a week. Cut out bread, sugar and other simple carbs.
We don’t help alcoholics or opioid addicts by enabling them with statements like “when not getting drunk isn’t enough…”
The pharma industry will enable addicts because it wants money. Fat people need love, though love, and a home without good tasting, or high calorie foods.
This is a little over-simplistic. The "pharma industry" is not a monolith, and is made up in large part by academics who love spending their time thinking about how to make the world better, and by doctors who have no conflict of interest, etc etc.
Gambling can be fun, and nothing wrong with casinos, but in the long run they are optimized for one thing. A casino that is not optimized for profit will disappear.
Same is true for the healthcare industry. If a corporation is not optimized to make money they disappear.
I think it’s valuable from a financial perspective to avoid casinos. I think it’s valuable from a health perspective to avoid drugs, to the extent possible. But, yes, casinos can be fun, and you can even profit from them if you play your cards right.
I noticed skinny people tended to eat less and skip meals. I noticed bariatric surgery worked, for awhile.
I tried fasting. I’m now quite healthy. Exercise doesn’t help lose weight, but it can be a better way to change your biochemistry than eating tasty food. People should be told these 2 simple things, and none of the other stuff that doesn’t really help. It’s simple. Eat less.
> However, some researchers worry that these drugs play into some societies’ obsession with being thin. Body size isn’t always a good predictor of health. “I’m really hesitant to be excited about something that I think is potentially harmful from a weight stigma perspective”
Any idea if this applies to Amlodipine-Benazepril?
[0]: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120....
They can absolutely mess with mood, but in both directions. https://www.health.harvard.edu/mind-and-mood/blood-pressure-...
Doctors in Croatia tend to be very flippant with medications. This goes as far as pharmacies having to sometime refuse giving medications due to known adverse interactions (sometimes dangerous even). Apparently their software should warn them of this the same way pharmacies get alerted of it, but I guess they dont care?
It's also complicated by the fact that blood pressure is highly individual. There doesn't seem to be one level that is good for all.
What's the difference, just the degree of being overweight? And the height of course, but drugs won't make anyone shorter.
Someone who weighs 150lbs — but who is 6'8" — is actually underweight. To be that weight at that height, they'd have to have so little fat and muscle that they'd be positively scrawny-looking, and would be experiencing many of the same problems (e.g. always being cold, muscle spasms, brain fog, paresthesia from demyelination of nerves) that someone who is 5'8" and 90lbs does.
Someone who weighs 200lbs at 6'8" looks, and is, healthy; just like someone who weighs 140lbs at 5'8".
> Some researchers also worry that by offering a weight solution in societies that prize thinness, these drugs could also inadvertently reinforce the disputed link between excess weight and health. One study found that nearly 30% of people who are considered obese are metabolically healthy.
The abstract from that article also points out that a significant share of non-obese people are metabolically unhealthy:
> Nearly half of overweight individuals, 29% of obese individuals and even 16% of obesity type 2/3 individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy.
Further, the way that study measures (cardio)-metabolic health is itself multi-dimensional:
> Using the blood pressure, triglyceride, cholesterol, glucose, insulin resistance and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI.
https://www.nature.com/articles/ijo201617
I think we may need to admit that weight is a low cost and highly visible variable which is a poor proxy for actual health and as in business, optimizing for the wrong metric will eventually lead to dysfunction.
I.e. if you do someone's bloodwork and a treadmill test, and they look metabolically normal, knowing whether their BF% is high (or if their BMI is high) doesn't seem to tell you more about whether they're going to die. If they're fat but fit, trying to lower their BMI or BF% doesn't seem to be about making them healthier.
If we're talking about interventions which might involve putting someone on medication with side effects for the rest of their lives, just do the extra tests! There's no reason to reduce the decision input variables to just "are they obese?" when better indicators are known.
Sure, I'll grant that BMI is not the end all be all metric of health, but its a hell of a strong indicator, and pretending that its okay for your health to be obese is farcical.
I don't believe that's true. There are some cases (like powerlifters) who can be at an obese BMI but still have strong cardiovascular fitness, but unless you are in that narrow category, if you are obese you do not have strong aerobic fitness. 'Decent physical condition' alone belies that you are not 'extremely' healthy. Decently healthy maybe, but certainly not extremely. Even if you are still metabolically healthy, you are at increased risk for adverse long-term outcomes (source: https://pubmed.ncbi.nlm.nih.gov/24297192/). That is more than just a psychological issue, no matter how much you try to handwave it away.
In studies where diet and lifestyle are controlled for, metabolically health overweight are not at greater risk.
The issue is we are pointing to fatness and not diet and exercise. It’s causing people to seek ways to get thin assuming it’ll help. But some people are thin no matter what they do, some are fat. However there’s a correlation between poor lifestyle choices and being fat and good life style choices and being thin. This skews uncontrolled studies towards fat is bad even with good metabolic health, because having a good metabolic health but maintaining it with poor inputs will have a long term bad outcome.
In one of the reference below, the conclusion is: (i) Higher fitness should be considered a characteristic of metabolically healthy but obese phenotype. (ii) Once fitness is accounted for, the metabolically healthy but obese phenotype is a benign condition, with a better prognosis for mortality and morbidity than metabolically abnormal obese individuals.
https://academic.oup.com/jcem/article/97/7/2482/2834446?logi... https://academic.oup.com/jcem/article/97/7/2482/2834446?logi... https://diabetesjournals.org/care/article/28/2/391/24045/Met...
LOL
> The notion that you can not be fat while eating a high quality low calorie diet and exercising is simply false
You actually believe this shit? If you eat a calorie deficit, you will lose weight, full stop. 'High quality low calorie diet' is gobbledygook to make you feel better. You can eat absolute shit and lose weight if you eat appropriate portions. Or do you not believe in the conservation of energy?
> metabolically healthy but obese phenotype is a benign condition, with a better prognosis for mortality and morbidity than metabolically abnormal obese individuals
so, if you compare yourself only to obese people, you're healthier if you're metabolically healthy. And that is some kind of interesting scientific conclusion? Is this a study done exclusively by fat people to make themselves feel better?
Healthy at any size doesn’t mean someone who is morbidly obese is healthy - the strain on their heart is significant. But that’s true for any human of large size regardless of “what” constitutes their body mass. But the correlation is the fat goes with unhealthy diet and lifestyle. But not everyone who is fat is unhealthy.
They even discuss this in the article for goodness sakes.
In another comment I provided these references: In one of the reference below, the conclusion is: (i) Higher fitness should be considered a characteristic of metabolically healthy but obese phenotype. (ii) Once fitness is accounted for, the metabolically healthy but obese phenotype is a benign condition, with a better prognosis for mortality and morbidity than metabolically abnormal obese individuals.
https://academic.oup.com/jcem/article/97/7/2482/2834446?logi... https://academic.oup.com/jcem/article/97/7/2482/2834446?logi... https://diabetesjournals.org/care/article/28/2/391/24045/Met...
I don't think that's true. However, some people can withstand bad diets. As an example, I had a morbidly obese uncle that ate copious quantities of bacon, white bread, and processed food, yet his blood work and lipid levels were always in the healthy range, which always surprised my family (my mother managed a clinical lab and did the bloodwork for my uncle).
My uncle eventually passed away after he became crippled after a bathroom fall due to his weight. He became depressed and committed suicide (he was a physician and had access to morphine). Overweight is always a health risk, even if your bloodwork is ok.
It also depends on what is the price of that weight loss. Quite a few diets make you loose weight and simultaneously make you much less healthy or less fit - because your body is missing nutricients it actually needs.
As in opinions presented as evidence, from an almost random person, without actually providing any.
Especially around social subjects like the BLM protests.
One thing I loved about 60 minutes back in the day, was their ability to present a story from multiple points of views.
When I started reading Nature at my former employers, many many years ago, I felt their articles were like that.
At some point it started to look like cherrypicking a single viewpoint, often with obvious political taint.
Maybe it was always like that and I just used to idolize it.
I still very much love the magazine though but stopped subscribing. Its really expensive.
When I get my hands on a copy these days I just filter what I perceive as woke crap from the rest and skip those articles.
I wonder if that is such a good thing… Edit: typo and context
If she's worried about other negative outcomes, such as people not being able to afford the drug, she should say so. It might be an editorial fuck-up on Nature's side, of course: they just want to print some soothing words to demonstrate their neutrality.
Who cares? Helping half of people with a problem to overcome it is great. Journalists and editors need to push back against simplistic concepts like 'one size fits all' and the urge to rank everything, which just leads to bimodal distributions and the accompanying bad outcomes when they are imposed by economic force.
I can easily drop 20-40lbs if I cut sugar out of my diet. Then it stops. I've cycled 15miles/day for 7 years (on non-snowy days). During that time I went on a water-only fast, (7days on, eat one day, then 14days eat one day, then 7 days more of fasting before I stopped.) I lost 13 lbs during that period. I was doing a keto diet before and after this period. I was killing myself trying to have a high energy output with minimal caloric intake.
In the end, winter came and I stopped. Total weight loss during that time: 35lbs. There is no way I can lose the extra 160lbs that I need to drop. My body just won't drop it.
I'm diabetic now. I take metformin and invokana. As of today I'm down almost 30lbs since august.
Lifestyle changes maybe enough for you. That's awesome, good for you. Don't make blanket assumptions and think that they are true.
IMHO, it would be much easier to just stop eating processed foods and sugar (and sugar substitutes).
I cut down on sugar drastically and started intermittent fasting, losing 20 lbs in about 5 months without doing anything else.
We think good glucose control is at the center of a whole host of medical issues, inside and outside the hospital. Bringing critically ill patients under control has been found to reduce mortality rates by up to 30%, results which have been repeated several times in thousands of patients. These drugs, which are less intense than insulin therapy, confer similar glucoregulatory effects, which has all sorts of cascading hormone benefits etc.
Exciting stuff, thanks for sharing!
How many have of us have eaten despite not being hungry?
So it's appetite suppression is a side effect. That's good because it means it gets reported.
Looking at the SPC[0] we can see decreased appetite is "common" (1~10%), while nausea is "very common"(>10% report).
That means more people feel nauseated on semiglutide than feel less hungry.
Add in other GI disturbances (diarrhoea is also "very common") and one can see why people lose weight with it.
Having been on semaglutide, it both makes you feel full with smaller portions and changes what you want to eat. The foods which make you feel nauseous are those that make you gain weight. However the change in desire isn’t only against foods which make you feel nauseous, but also towards foods that you might not eat. It’s truly very interesting.
It would be incredibly sad if the price to pay for not becoming obese is not enjoying any food at all.
Disclaimer: I’m not advocating this - just sharing info.
Isn't eating less food (whether your appetite is curbed or not) a lifestyle change? It's not that lifestyle changes aren't enough. It's that the size of your change wasn't big enough.
Sure, and one of the things we conclusively know about obesity is that people struggle enormously to sustain that sort of lifestyle change in the long term.
Hence, medications that help with that. In this case, by reducing hunger.
Of course we should deal with the mental side but it will be a million times easier to deal with after you aren’t a fat fuck.
Also it implies disrespect and ignorance of the reasons why someone eats more than is considered healthy. It's a mockery of a person's perceived failure to adapt to abstract adversity. And someone who had psychological issues with addiction and dealt with them would be very unlikely to mock these things.
I can give you (even if I don't necessarily agree) that some fat people will go to other addictions which are harmful, but that is still not a reason not to pursue this. There are plenty of fat people who aren't going to relapse into some other addiction or at least not as hard.
Edit: A drug that allows you to indulge without consequence in this context would be a bad thing. It would allow people to eat non-stop without the consequences and would increase the demand for food in the modern nations to unreasonable levels. If you think about it, this kind of drug would have the same outcome as bulimia (think, hunger games).
Why wouldn't satiety drugs be helpful?
Edit: It might have novelty support but I'm confident that in the long run people will choose to indulge and get the dopamine.
To my mind it's strange that there seems to be a circular argument which starts with sedentary life style and "bad" foods cause obesity so exercise and diet control seems like a fix but that is countered by exercise doesn't help (much) and dieting has only temporary effects.
If my summary is reasonably correct it seems to me what's needed is more understanding of the outcome before using drugs to "fix it".
I wonder if a drug is less likely to be lobbied against than the types of changes such investigations might suggest.
The likely reason is the changes in lifestyle thanks to the changes in technology. Is "let's just get rid of the past 70 years of technological advancement" something that we'll seriously consider?
Agreed, that's the commonly held reason but when one attempts to reverse what the changes seem to have been, by exercising more and eating less, that doesn't seem to work. My point is that perhaps we need to better understand what the changes have been, that perhaps they are more subtle than they are commonly held to be.
1. The amount of available cheap calories in convenient easy to eat packaging is orders of magnitudes higher than it was in the past.
2. Work and activity has changed so dramatically that we would not recognize the world of the past.
Now the nuance here is understanding all the small ramifications that are far more invisible to us. Think of a coke bottle and how many calories that contains, I mean it's a huge amount. But now think about the convenience of it. You can carry it with you just about anywhere. The vast majority of jobs will let you carry it around work or leave it on your desk to drink from all day. It doesn't matter how much your work out, if you drink one extra coke per day, you've added more calories in than you're working off.
But then add in all the small things that keep us from walking/exercising as much. Way fewer of our jobs are 'hard work' and been replaced by machines. We tend not to let our kids run around like wild creatures outside the house all day. Instead they are probably home, on the entertainment system of some kind with a coke in their hand. Kids also consume junk all day that is specifically marketed to them. You have to add all these factors in.
The question is much more: why did people start moving less & eating more? Each have complex factors (less physical jobs, increased wealth, food addictiveness, cultural shifts, etc.), and on THOSE, there's lots of debate.
But we absolutely know what causes obesity at a population level.
Uncontrolled insulin levels cause obesity because of insulin's dual role in fat storage. The key is to change one's diet such that insulin levels are lowered and the stored fat can be utilized for metabolic needs.
Exercise is important for general health but trying to lose weight by exercising doesn't work if the diet stays the same. Food is just too calorie rich and the body too calorie efficient. The adage 'get fit in the gym, get slim in the kitchen' applies.
Genetically, a small number of people might have metabolic issues causing obesity.Drugs might be the right choice for them but for the vast majority of us, we just need to take a hard look at our diet.
Why would they introduce lifestyle changes alongside the drug? Doesn't that complicate the analysis?
https://www.nejm.org/doi/10.1056/NEJMoa2032183
> Participants were randomly assigned in a 2:1 ratio, through the use of an interactive Web-based response system, to receive semaglutide at a dose of 2.4 mg administered subcutaneously once a week for 68 weeks or matching placebo, in addition to lifestyle intervention...
Who says some participants wouldn't just start eating trash? I know I did after I lost some weight due to a bad case of something my child brought in from daycare.
Two immediate thoughts:
How much of it was actually the lifestyle changes? It would be more interesting if there were no lifestyle changes...
This apparently works by suppressing appetite, but doesn't cocaine do the same thing? Constant needle marks from weekly injections might result in more social complications than anything else...
That's why the placebo group in the trial also gets the same lifestyle changes.
> This apparently works by suppressing appetite, but doesn't cocaine do the same thing?
Sure. If they were otherwise identical, that'd be a good point, but they're not.
> Constant needle marks from weekly injections might result in more social complications than anything else...
My daughter has to give herself growth hormone injections every day, and has for nearly a decade now. You don't get needle marks from these sorts of small dosage subcutaneous injection.
Ah, my only experience is with things like vaccines and drawing blood; those marks last around a week on me.
Daily injections can leave a little under-the-skin scarring (feels a little like cellulite) so you have to vary the site a bit, but for most folks that's the worst of it. Well worth it for these sorts of results.
You can say the same of opium, heroin, morphine, oxycodone, fentanyl, and Naloxone. Many of which have had i ical trials done and all of which are abused and addictive.
I simply don't trust clinical trials by large pharmaceutical companies any longer.
Cocaine isn't a viable weight-loss drug because its downsides outweigh the benefits. The downsides of semaglutide and tirzepatide are nothing like that of cocaine, and thus the calculus works out better for them.
> You can say the same of opium, heroin, morphine, oxycodone, fentanyl, and Naloxone.
Setting aside the fact that including naloxone in that list is a bit bizarre - it counteracts the rest of the list, everyone should have some in their first aid kit - those medications have benefits that make them sometimes appropriate clinically. (Similarly, cocaine is used medically and in a very controlled fashion in rare cases, like persistent bad nosebleeds.)
Ref: https://www.asam.org/docs/default-source/public-policy-state...
The article answers this further down:
> Those receiving weekly injections of semaglutide lost, on average, 14.9% of their body weight after 16 months of treatment; those who received a placebo lost 2.4% on average.
Per the article still a lot of work to do in this area, but on the face of it this could be an alternative to bariatric surgery for 1/3 of people.
> Those receiving weekly injections of semaglutide lost, on average, 14.9% of their body weight after 16 months of treatment; those who received a placebo lost 2.4% on average.
Doesn't really have anything to do with the question about lifestyle changes. That question basically centers around whether the 14.9% weight loss occurred independent of or as a result of lifestyle changes downstream from the semaglutide.
It would be nice to have an affordable, low dose of one of these obesity drugs to make the fight a bit easier.
I don’t know if that’s a scientifically proven thing, but indeed i simply can not gain weight, whatever i eat. As if i had zero fat cells.
The only downside is that I’m often cold, which is of course far easier to manage. I’m not a water person though, as its nontrivial to “dress up” for swimming.
It’s a miracle, please spread it. The next generation could avoid the fatness problem alltogether.
What I take from this is that the actual reason is, "I had parents that were concerned enough with my nutrition to not feed me much sugar as a child, and those healthy eating habits probably didn't stop after age 2-3. I now cannot gain weight, even if I eat what I perceive as a lot of food (because I grew up eating healthy food and portion sizes)."
I was one of those "I can't gain weight/put on muscle" people for a long time. I eventually tried eating literally double what I would normally eat, and as expected, I started gaining weight.
I think healthy eating habits would be the last thing that came to my friends minds when describing me.
I totally agree I'm only a sample of one that I know of, but the fact that this doctor relative of ours told my parents the cause-and-effect relationship beforehand, and it worked out, makes me believe the theory. Either way, I keep recommending it to my friends getting babies, so I'll be able to collect more data in the next 50 years. ;)
The thing is, that's the kind of gamble that costs nothing and might have immense upside, so it would be kinda silly not to apply it. My 2c.
It only works if all the companies agree to cover it.
I'm on high dose (60 mg) mirtazapine motivates immense weight gain as a side-effect.
I'm +30% overweight (260 lbs vs. 200 / 117 kg vs 90) and the hunger for carbs is beyond ravenous.
Stimulants are nonstarters because I'm already on a beta blocker for inappropriate sinus tachycardia, and other meds for "physiological" anxiety (can never relax).
A poster below me said that, at a population level, diet and exercise do not work. That’s mostly true. Most people don’t permanently change their diet and other lifestyle long term. I think that ignoring that they do work in the short term, and could work in the long term if adherence were better, overlooks something important.
Moving past that, we are an obese population. Or, at least, very overweight. Supposing diet and exercise do not work, what are we to do? I’d propose we look toward rectifying the causes. There are innumerable environmental factors today that make us fat: pollution, drug side effects, food advertising, alcohol, social pressure, widespread sedentary jobs and lifestyle, etc., etc., etc. If we focused on solving the problems that are making us obese, we wouldn’t need these drugs (or at least, not nearly to the extent we do). We used to live in a world like that. We know what it looks like. We know the consequences. We know our bodies and society can tolerate that world, and that it would solve our issues. Why not aim for a return?
Instead we will opt for another technical solution to our technical problem of obesity, causing all manner of unknown risks later on, and falling back to another technical solution to that technical problem. We will continue to layer on technique after technique to patch holes in the solutions we left in our last layer of solutions. The holes will grow larger and larger as we stack on more layers with more holes, and solutions will grow smaller and smaller as technology grows ever more specialized. The cycle is not sustainable.
Look at people who successfully lost weight with diet -- studies show that almost all of them will regain most of their weight within 5 years. And the basic reason is because almost all dieting regimes are shitty, unsustainable way to live and at the end people are left tired of the diet and looking to get back to the eating habits they love and caused the problem in the first place.
Also calorie restriction comes with a host of other problems. You need to provide better nutrition while on a diet -- your body still needs same things but now there is less food with which it has to be delivered. But if you got obese you probably don't know how to eat properly.
Prolonged calorie restriction causes muscle wasting. You can counteract it to a certain degree for some time with exercise. Which if you are obese you probably don't know how to.
Calorie restriction also typically causes basal metabolic rate drop. Which means you have to keep tightening the diet to see results. And when you are off the diet it will be extremely difficult to impossible to keep your weight.
You can still cause a lot of damage to your body by snacking and eating wrong foods even if you are on calorie restricted diet. It is better to learn to not snack and keep your eating window to 4-6 hours every day rather than eat through entire day.
I personally dislike meds like this. It is good it exists but I would never take them or recommend to anybody. There are a lot of medications that are supposed to help (like metformin) but all these meds do not address the main cause of the problem -- which is what you eat, how you eat and when you eat it.
--
For background, I got obese once and lost weight. Then regained the weight over a decade. Being engineer and problem solver, I vowed to understand the shit out of the problem, loose the weight properly and never regain it back. Which seems to be working. Understanding how to loose weight allowed me to do fantastic things like loose weight at 3 times the rate I did it previously while not feeling hungry or cold.
The previous time I was on calorie restricted diet loosing and I was completely miserable for almost entire year, cold, slow, irritated, unable to focus.
This time I completed the same weight loss in 4 months while actually feeling better than ever (at least most of the time). Most important for me, it is not interfering with my work.
I am also not taking any meds.
I am not preaching any diets here. I am just suggesting that if you are feeling hungry throughout your diet you are probably doing something wrong and it would be worth the while to understand what and how to fix it. And the only way this happens is if you get interested. No drug is going to magically fix it for you.
These drugs are not the solution for all people, but they may well be a part of it for many. The interventions you're advising - "don't snack", "exercise more", have the same pattern you're talking about with dieting - alone, they tend to fail in the long-term.
It's easier to learn to eat better (and enjoy things like veggies) if you're not feeling starving all the time. It's easier to learn to exercise (and enjoy it) if you're not obese.
> all these meds do not address the main cause of the problem -- which is what you eat, how you eat and when you eat it
"Just don't do that" hasn't historically had a great track record of addressing it, either.
The trick with all lifestyle changes is to start as small as possible. Don't try to overhaul your eating and exercising habits overnight, but instead start from something small like "buy some fresh fruits every time you buy groceries" or "go outside for a bit every day whatever time you feel like it".
>The previous time I was on calorie restricted diet loosing and I was completely miserable for almost entire year, cold, slow, irritated, unable to focus.
>This time I completed the same weight loss in 4 months while actually feeling better than ever (at least most of the time). Most important for me, it is not interfering with my work.
How did you do it?
That said, I red 3-4 dozen books related to weight loss, dieting, habit formation, nutrition, metabolism, diabetes, etc. and countless articles and youtube videos. I made notes of various topics that seemed important and repeated rather frequently and then tried cross-referencing to find which ideas are bunk and which seemed to be well supported.
Starting the process, my goals were to overdetermine the success (ie. do a bunch of things at the same time to ensure success) and to build understanding of topics to the point where I can see how everything fits together and builds confidence I know what I am doing.
Here is an unsorted list of ideas from my memory that I think helped me the most:
* building habits and prepare for what to do after achieving target weight is super important. Weight loss time should be spent learning right habits, building habit chains, discovering/learning healthy dishes, etc.
* managing family is also super important -- if your wife and kids have habits that will collide with your goals they can become worst enemies of the progress achieved,
* become healthy to loose weight rather than loose weight to become healthy -- focus on identifying and fixing health problems and weight loss should more or less come as a consequence
* it is better to do 20% of effort for 80% of benefit in each area rather than try to perfect any one of areas at the cost of others. Don't plan to become an athlete -- it is enough to jog every day for half an hour at comfortable pace. Don't plan for perfect diet -- it is enough to eat "healthy" most of the time. Etc.
* it is better to learn and get to love new, healthy foods and add them to your diet than to try to remove unhealthy things you love. Add new foods/dishes and let them slowly displace bad ones.
* commit to eating a portion of fresh fruit and vegetables, every day, however small. The goal is to build habits so that there is always fresh fruit/veggies at home, so that you automatically search/reach for them at the grocery, so that you have opportunity to test various things and learn new dishes.
* commit to doing any amount of exercise every day. As above, the goal is to build habits, not to become an athlete. The first thing I did was to improve my fitness to the point I could be jogging every day.
* don't start all changes at the same time -- introduce enough delay for each change to get accustomed and to be able to properly focus on that one change
* I found intermittent fasting (4-6 hours eating window, 18-20 hours of fasting) to be probably the single most important thing to improve health and loose weight. It also has benefit of being sustainable and can be additionally combined with calorie restriction and/or keto.
* The best eating window is probably somewhere in the middle of the day. There needs to be enough time before going to bed so that significant portion of fasting happens during sleep (aids recovery) but not too much or it might cause cravings in the evening and make it difficult to adhere.
* I found there are various easy strategies to decrease blood glucose ofter a meal that do not require making huge changes in diet: reduce carb intake during meal, precede carbs with protein/fat, precede carbs with any kind of acid (deactivates enzymes and further reduces blood glucose after a meal).
* A physical exercise like a walk immediately after a meal helps purge blood sugar. While exercise itself does not make the body any less insulin resistant, the effect is as if insulin was more effective.
* I found prolonged fasting and/or keto diet to be good temporary solutions to various problems. After some research I would probably not advise anybody to stay on keto for very long, but spending some time on it gives you superpower of metabolic flexibility, and this ease of being able to hop on and off carbs without ill effects greatly helps with being able to adhere to intermittent/prolonged fasts.
* Carbs make you crave more carbs. If you have problem with hunger while restricting calories, probably the easiest thing you can do is to cut carbs temporarily.
* You probably don't need to get on keto diet to get most of the benefits. MCT oil in morning coffee is enough to generate ketones to stimulate mitochondria to multiply and waste more enrgy.
* The main benefit of keto is that it is darn hard to eat so much fat and cutting carbs suppresses (unhealthy, extra) hunger.
* Running at easy pace (easy = you can still talk easily) for at least 20-30 minutes regularly is ideal to cause mitochondria to multiply. Mitochondria are your friends when loosing weight because this is how your fat gets turned to heat. The more mitochondria you have the easier it is to burn through fat.
* Running at any higher pace or for much longer probably is not advisable. The benefits are incremental but a risk of injury grows significantly making it absolutely not worth it from purely health/weight loss perspective.
behavorial interventions for weight loss don't work clinically. the only other intervention that comes close to the effect size of GLP-1 agonists is surgery.
you can argue that they treat the symptoms and not the disease, sure. the mechanisms of systemic obesity aren't well understood. but it's inarguable that this is disease of homeostatic misregulation, the set point is too high. which is why behavioral interventions fail.
we don't talk down to the people suffering from other diseases of homeostatic misregulation (eg diabetes) for their moral failings, we treat it. but that's how diabetes is treated now, "just stop being fat".
It is very much in analogous to where depression was 30 years ago. Now, therapy and anti-depressants are widespread and destigmatized.
The difference is that while SSRIs are only marginally better than placebo, GLP-1 agonists are _incredibly_ effective. Huge effect sizes.
I think in 30 years you're going to look back on your opinions now and be embarrassed that you were telling people to avoid a very effective and safe pharmaceutical intervention and "just stop being depressed"
I've been having the same conversation over and over again since GLP-1 agonists were approved and it's always the same. People who are opposed to a very effective pharmaceutical intervention but are not able to articulate any cogent reason as to why. It's just stigma.
Why does THAT not stun researchers? Oh... can't make any money from selling people unprocessed foods and even less from not selling carbs...
The article's subheadline is "A class of drugs that quash hunger".
> There are many others drugs that lower appetite
Not this well and/or not this safely.
Which ones are prescribed in the US, on label, to treat obesity?
I do not feel wired, foggy or feel like my personality or sleep cycle has been affected in the slightest.
So sure we can drug everyone to try and fix it, but that’s not actually fixing the cause.
5 years later, I had a bad knee, and lost most of my gains. Dr. Bronner put me on a steady diet of Carne Asada and Kale, and I've been a wiry lean pooping machine ever since!
He's a miracle worker, send him all your money now!
Mounjaro is not widely available outside the US yet.
If I knew it was safe in the long term I’d take it in a heartbeat. However, I’m concerned that there could be long term issues with the drug (perhaps a resistance/“yo-yo” effect where the potency wears off and I gain back my original weight plus more than I would have otherwise over, say, 10 or 20 years).
Is that the sort of thing that’s in the realm of the possible/plausible or is this more like a vaccine where there are some strong theoretical reasons why we don’t expect it to have long term issues?
At that point, such headlines are justified. What would you have written instead? Something lukewarm like “Obesity drugs show efficacy in many patients”?
Putting the word "stigma" on things is a sure sign of a grifter. Instead of helping solve it, they're trying to make it a social science problem.
Being overweight is unhealthy. There's no serious dispute about that. So people recognizing that fact is "stigma?"
It's not just an individual problem, it's a societal problem. There's a new "Gatorade Fit" commercial with, easily, a 300lb woman in it...the brand is literally "Fit," being 300lbs is not fit in any way shape or form. Why is this happening? Even when/if I'm 10-20lbs overweight, I don't want someone patting me on the back saying I'm actually "fit" or anything close to it. It's such a weird lie that makes it feel like I'm living in a bizzarro world.
https://www.youtube.com/watch?v=cPgOCWbqjgo
Advertisements used to be aspirational. They either still are and people's aspirations have changed, or they are not and there's some other more current explanation for why this ad and others act as a mirror showing a person who they already are (fat) rather than who they aspire to be (not fat).
Said another way, there's nothing explicitly stating that the woman has a goal of becoming thinner. She is shown as well as two other thinner people. They're all doing their own form of exercising while clothed in activewear. The implication could be that the fat woman's goal is to become less fat or that she is comfortable as she is and fits in as part of Team Gatorade™. I suspect the message they're trying to convey is the latter.
Are the fitness goals of the other 2 actors explicitly stated?
Should fitness products only advertise with actors who are ALREADY fit and maintaining that fitness?
What exactly are you expecting? How exactly do you want fat people to be portrayed in advertisements for fitness that allows them to attempt to get fit?
No.
Reread my comment. I said nothing about how I expect fat people to be portrayed or what is right or wrong about this ad.
The one thing I suggested is that I believe Gatorade is attempting to create an ad that is welcoming toward fat people regardless of their goals. At least, that is my interpretation given in the current year. Further evidence of my interpretation is that fat people were not shown in Gatorade ads several decades ago, e.g.: https://www.youtube.com/watch?v=Y6xcLDKCzh4
Comparing the ad from the 90s to now shows that the older ad was aspirational. I'm sorry if that makes you upset, I did not create the Gatorade ad. I only interpreted it.
1 gram of sugar per half liter https://www.gatorade.com/fuel/hydration/gatorade-fit/16-ounc...
At least it's almost sugar free, relative to normal gatorade anyway. I think advertising regular sugary gatorade to fat people as a fitness product would be tantamount to stochastic murder.
Is that actually true? From what I understand, obesity will cost you dearly in life expectancy, and most of the cost comes in the last few years of normal life expectancy. Someone who dies of heart attack at 63 isn't going to run up huge bills from age 77 to 85.
I believe there was a similar calculation for smokers. The health cost in higher cancer rates are outweighed in what you save on costly treatment for the elderly + fewer pension payments.
https://pubmed.ncbi.nlm.nih.gov/33470881/
"Adults with obesity in the United States compared with those with normal weight experienced higher annual medical care costs by $2,505 or 100%, with costs increasing significantly with class of obesity, from 68.4% for class 1 to 233.6% for class 3. The effects of obesity raised costs in every category of care: inpatient, outpatient, and prescription drugs. Increases in medical expenditures due to obesity were higher for adults covered by public health insurance programs ($2,868) than for those having private health insurance ($2,058). In 2016, the aggregate medical cost due to obesity among adults in the United States was $260.6 billion. The increase in individual-level expenditures due to obesity varied considerably by state (e.g., 24.0% in Florida, 66.4% in New York, and 104.9% in Texas)."
Only looking at the obesity-related health-care cost without looking at the earlier-death-related savings doesn't get you a clear picture. All obese people becoming healthier might actually cost the health-care system more. I understand that's not a comfortable way to think about it for some people, but I do believe it's useful to consider.
Here's a study on lifetime costs for smokers vs nonsmokers: https://www.nejm.org/doi/full/10.1056/nejm199710093371506
In Germany, healthcare spending for women is about 20% larger per person which is primarily explained by the 5 years additional life expectancy. You'll see that it's not obvious that an obese person dying 10 years earlier will necessarily have the same life time cost because their life is much shorter, and cost rises rapidly when you're past retirement age.
Even outside of the medical realm, people that are grossly obese use more resources, including fuel, which effects everyone. It is very much a problem for everyone.
And yeah, we’re all living in bizarro world.
We took the extreme of anorexia being healthy to obesity being healthy. The fact is neither extreme is healthy. Being not anorexic is not the same as being obese, there's a huge range of fairly healthy weights in between the two in terms of body fat percentages and muscle ratios.
https://pubmed.ncbi.nlm.nih.gov/33470881/
"Adults with obesity in the United States compared with those with normal weight experienced higher annual medical care costs by $2,505 or 100%, with costs increasing significantly with class of obesity, from 68.4% for class 1 to 233.6% for class 3. The effects of obesity raised costs in every category of care: inpatient, outpatient, and prescription drugs. Increases in medical expenditures due to obesity were higher for adults covered by public health insurance programs ($2,868) than for those having private health insurance ($2,058)."
If an obese person's healthcare costs an extra $2,000 annually for each of the age years covered in the study, that's $90,000 over their lifetime (ignoring inflation/time value of money to keep the numbers simple). But older people tend to have disproportionately higher healthcare costs.
To be kinda crass: If hypothetically obese people die at the age of 70 instead of 75, those 5 years of health care they don't need might have cost more than $90,000. Just a few ER or ICU visits can exceed that $90,000 amount, and the gap gets even starker if you take into account things like long term care and assisted living.
Another way to look at it, even staying within the 20-65 age group, is as a form of survivorship bias (or maybe there's a better term? Seems kinda bayesian but my stats days are well behind me)
For an extreme example, pretend that some adults take up the hobby of BASE jumping, and I have a study showing that their healthcare costs $10,000 per year, vs only $5,000/yr for non-base jumpers. A non-basejumping adult only needs $225k of healthcare before they become a senior citizen, but a basejumper needs $450k! So basejumping increases overall costs in the healthcare system, right?
But wait! BASE jumping is a dangerous activity (hence the medical bills), and many BASE jumpers die young. Let's say that every year 5% of BASE jumpers have fatal accidents, which means that the average base jumper dies around the age of 33. A BASE jumper who only needs medical care for 13 years doesn't cost the full $450k, they would only use $130k of healthcare. Which actually makes their lifetime medical bills much cheaper than that of a non-jumper!
A popular furphy spread from questionable assumptions.
FYI
> A major report published in 2016 by the National Cancer Institute and World Health Organization concluded that in high-income countries, lifetime health care costs are greater for smokers than for non-smokers, even after accounting for the shorter lives of smokers.
Tobacco issues and health care costs (with reference to some world class epidemiology studies) discussed at length here:
https://www.tobaccoinaustralia.org.au/chapter-17-economics/1...
Of course, the wrinkle with approach is that that as you mention, the reality is that nothing could be furthest from the truth. Obesity is fastest growing and most deadly American chronic condition. The outsized impact of type 2 diabetes on payer spend, both medical and pharmacy, cannot be overstated.
And when you put that all together, it makes a commercial like the one you mentioned seem banal and sinister at the same time.
It does make sense and strikes me as irrational to celebrate something which is clearly harmful to society
and neither is she a doctor or biological scientist. Rather, she's trying to get in on a lucrative field which she has no expertise in.
No, needfully harsh. "body image" is an invented term and "expertise" just means she got some papers published in journals controlled, most likely, by her friends. "Getting quoted in journals" would appear on her application for tenure, if she doesn't have it already.
Also, reporters don't just happen to call up random people and ask for an opinion. You call them and offer it. Get on HARO<haro@helpareporter.com> if you want to be quoted, too.
Just to point out one potentially complicating factor Dr. Robert Lustig's work appears to show that our diets increasingly include processed foods which are strongly associated with health problems including weight gain and metabolic disease. So if you can completely avoid institutional food such as served at company canteens and figure out and stick to a good diet then maybe. Even then it seems like the stigma is just sloppiness that results in perfectly respectable contributions to society not being recognized.
Early on I made a habit out of becoming friends with fat people I met because their exposure to social stigma tended to make them strong as individuals.
If anything it seems like the person who is addicted to something that should be stigmatized is you.
Asking because as a person who has lost a lot of weight (and kept it off) I would like to get them to reconsider their review process.
Various things have lead to me eating/drinking (alcohol) to excess and becoming more overweight than ever.
My long-winded point is that it seems specifically to be my personal actions that have caused my obesity -- poor food choices and lack of exercise. Others from the same background, others at the same workplace, etc., are not obese.
I would hate anyone to start telling me being fat is OK and that I shouldn't bother to do anything about it.
Do you have a good source for this?
It's not "stigmatizing" to call something unhealthy which is, at least potentially, controllable. And you cited no information at all about "endocrine disruptors" for the vast majority of obese people.
Are you for real? Serious question.
> I think I will wait for some version that does not cause "strong nausea, extreme fatigue, brain fog, and constipation".
Did fasting help with weight control. Why are you considering these drugs ?
I am not considering these drugs. I responded to "I believe that everyone, even the skinny folks, should be on GLP1 drugs for the longevity effects."
When I was doing keto, I never experienced the keto flu that many complain about. If these are the same symptoms, maybe the same benefits are achieved without taking the drug.
You can get brain fog from a large caloric deficit before your body adjusts to it, which this by design, will induce.
I don't know, but I'd be fine gambling on it. You don't seem to be, which is also fine.
[0]: https://sitn.hms.harvard.edu/flash/2020/can-calorie-restrict...
The point that I'd like to make is- if you think a comparison between hunter/gathers and the modern human is illustrative for a diet where our phenotype thrives best, sure, their food arrive at more irregular intervals than the modern human and they probably binged on what was in season at the time (which might give us pointers for our own diet) but I think the concept of perpetual calorie restriction as a full time human diet is infantile and quacky.
But so, the idea that everyone should take drug designed to make you thin by making you not feel hunge including thin people is scary.
I see a lot of health influencers always say whatever diet they are doing is best because nothing bad has shown up on their bloodwork.
I am not really sure if bloodwork is all it takes to asses your health.
Many people have this weird view of the "bloodwork" where they treat the results of them like a character screen in an RPG game.
> where the medical system is focused less on charging people money and more on evidence based treatments, blood tests are done to find something specific, not to "see how a person is doing"
I am not sure what insurance you are using in USA but my insurance is super stingy about approving any blood tests that doctor doesn't think are super necessary. All the health influencers i mentioned in earlier comment seem to be paying out of pocket for tests like 'insulin sensitivity' because insurance doesn't pay for those.
The fact that your father got diagnosed too late is incredibly sad, and I truly feel for you, as that's the disease that took my grandfather too. But that does not offset the fact that if you screen people "yearly" you end up with more unnecessary interventions, painful tests, and potential false positives, and generally bad outcomes than if you don't do it.
You could just as easily find a story about someone who had an unnecessary blood test that revealed something potentially troubling, they went to have a more invasive tests that resulted in them getting hurt from treating what turned out to be a false positive.
Sure, but only one bit of evidence.
For example, there's evidence that on a population level routine screening for prostate cancer may do more harm than good, because it frequently isn't lethal, and the resulting interventions (often for false positives) can have a negative impact themselves.
https://www.nbcnews.com/health/health-news/when-prostate-tes...
> The American study found annual screening did not lower the chances of dying of prostate cancer.
> A recent Johns Hopkins University study found surprisingly high rates of hospitalization after prostate biopsies and a 12-fold greater risk of death in those who develop infections.
https://www.sciencedaily.com/releases/2013/09/130929142622.h...
> "Yet in order to prevent one death from prostate cancer in the 1,000 men screened for PSA, the number of biopsies would double with 154 additional prostate biopsies, and, of 35 additional prostate cancers diagnosed, 12 additional cases of impotence and three additional cases of incontinence would occur. Thus, the harm from routine PSA testing can have a serious effect on the quality of life of patients and provides additional evidence against the use of organised screening for prostate cancer," he says.
My original comment still stands.
https://www.mskcc.org/cancer-care/types/prostate/screening/s...
It is not. Steve Jobs had good bloodwork and low BP, still died a a few years later.
Steroid-taking health influencers like to show bloodwork to convince followers they are still healthy. Let's see 20+ years down the road...
If true, it suggests being superpower smart ignoring advice is a life threatening condition.
But it also says CAM (complementary and alternative medicine) has even slimmer: next to none in their language.
I think people's eagerness to jump from changes in markers to actual longevity is quite unfortunate. Medical "breakthroughs" often founder on such confusion and amateurs approaching things this way. See Goodhart's Law [1] (much as I generally regret the hn/geek tendency to lean these law, here it's reasonable).
Though communicating the difference between things that are only proven on surrogate markers and things shown to actually affect the real desired outcome is important, I agree.
No drinking alcohol, like metformin?
If so, I suspect you could get a large fraction of the improvement gained from a population-wide deployment of these drugs, at zero cost, if everyone just stopped drinking alcohol. "But that's unreasonable!" Right, so if that's also required for taking this drug, then....
I take Metformin (not for diabetes, but weight and age) and my doc has never said a word about alcohol. A quick google suggests the possible bad interactions are diabetes related, so probably not applicable.
It’s listed as an example of a drug that has the “disulfiram effect” when mixed with alcohol.
See the “Similarly acting substances” section of https://en.m.wikipedia.org/wiki/Disulfiram
Yeah, look at all these super-old people like Alan Greenspan, Warren Buffett, Kissinger, Munger who pretty much have terrible diets, obese, no exercise yet still going strong, productive. Shows the power of genes. "Your BMI is below 23, therefore we will skip the colonoscopy and prostate/PSA exam and blood work," said no doctor ever (unless the doctor wants to get sued, I suppose).
It's that underlying foundation that you don't see that gives them the margin to have a burger.
I don't buy your theory that secret to longevity is a personal chef or a nutrition expert.
Not to mention that makeup, specific lighting, timed pumps and short term dieting tricks can be used for movies. How an actor looks on the day of a shoot isn't how they walk around looking.
There are lots of surprising findings w/r/t pharmaceuticals if you start really digging. Lots of missed opportunity for overall improvement in the human condition that aren't being exploited.
The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy
> From 1996 to 2001, Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona, and California. More than 5000 physicians, pharmacists, and nurses attended these all-expenses-paid symposia, where they were recruited and trained for Purdue's national speaker bureau.
> One of the cornerstones of Purdue's marketing plan was the use of sophisticated marketing data to influence physicians’ prescribing.
> Purdue “aggressively” promoted the use of opioids for use in the “non-malignant pain market.” A much larger market than that for cancer-related pain, the non–cancer-related pain market constituted 86% of the total opioid market in 1999. Purdue's promotion of OxyContin for the treatment of non–cancer-related pain contributed to a nearly tenfold increase in OxyContin prescriptions
> A consistent feature in the promotion and marketing of OxyContin was a systematic effort to minimize the risk
> Controlled drugs, with their potential for abuse and diversion, can pose public health risks that are different from—and more problematic than—those of uncontrolled drugs when they are overpromoted and highly prescribed.
These drugs are not of that nature.
It didn't give me nausea but it did give me dry mouth and made me not really want to eat. However, when I got home I was ravenous and would always eat two dinners.
Similarly, that Penicillin turned out to save millions of lives, doesn't mean that these drugs will be very beneficial.
Every day is a new day, every event a potential surprise...
> Every day is a new day, every event a potential surprise...
This is a thought terminating cliche, and has no bearing on pharmacology and societal impact.
These drugs are about to be very heavily prescribed, and widely introduced - when, in fact, they should be slowly rolled out to those who need them the most. People who should be given this drug are those whose weight is so severe that it has immediate effects on negative health outcomes.
There are going to be people who want to drop a couple of BMI points in time for Summer without eating and exercise, and any doctor (or person) who enables this use in the short term (the next 5 years, at least) is irresponsible.
In fact, your example of penicillin is a perfect example: who cares about any potential downsides to a drug when not using the drug has the downside of death?
Also, fuck 'longevity.' The population of the world has doubled during my lifetime and this is a Bad Thing which is wiping out vast numbers of other species. Call me misanthropic if you like but humans are overrated and the maximization of our species' footprint is not a desirable outcome. I expect to live for a shorter time than my parents have (partly due to my own choices, partly environmental factors) and while that's disappointing in some ways I've been fortunate enough to enjoy reasonably good health and resultant quality of life. My idea of biological success is no living to the greatest age possible but having sufficient fitness and autonomy to be physically and mentally active while I'm alive. I have enough experience of injury and near-death situations to know that I'm OK with dying, and have no intention of begging to escape the inevitable.
More about our socioeconomic and political structure than raw population numbers.
Every piece of meat, for example, require the conversion of plant matter into meat. There's going to be energy loss. If we eat more plants and less meat, we would pollute less, and less meat animals and presumably more wild animals.
My idea of biological success is no living to the greatest ago possible but having sufficient fitness and autonomy to be physically and mentally active while I'm alive.
Unless you die in an accident, you're going to live longer due to being healthier.
You are making assumptions, about his lifestyle choices.
Also, medicine might have improved, but so have subjectivly stress and fear and terror (economic outlook, climate change, etc..) A good reminder to turn that smartphone off now.
Seriously, 30-40 years ago I would have eagerly agreed with you. Much as I continue to like technology and feel optimistic about it overall, I greatly doubt that a century from now there will be any non-military space colonies in existence; long term existence is more likely to exist in silico than for biological bodies. One major influence on my thinking about this is the fact that we landed people on the Moon from 1969 to 1972 and then just gave up on it for 50 years. Now in middle age, I cannot overstate my sense of betrayal by earlier generations that decided to devote themselves to financial engineering instead.
You could be right though, haha. I felt exactly the same way when I was growing up in the 80s and 90s. Space was dead, there's no future, etc etc
What if we all live forever? https://en.wikipedia.org/wiki/Quantum_suicide_and_immortalit...
If you don't want to be banned, you're welcome to email hn@ycombinator.com and give us reason to believe that you'll follow the rules in the future. They're here: https://news.ycombinator.com/newsguidelines.html.
It's so simple anyone can do it and see results in weeks.
The technique is "eat less"