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Comment by 0xB31B1B | Hacker News Reader

I’m currently taking one of these drugs and it has been no less than a miracle in my life. I became obese when I was around 5, topping out around a 34 BMI. When I was 20 I lost a substantial amount of weight the old fashioned way (diet and exercise), and within 8 months I was BMI 23. Losing weight was extremely challenging and socially isolating.

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.

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I'm also on one of these drugs (Tirzepatide) and have been for a few months. The first time I remember knowing I was fat was when a babysitter made fun of me for it at age 6. I've been fat ever since and I'm in my late 30s now.

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.

What finally got me on right way on controlling hunger was just getting used to eating once a day and dropping a lot of the quick-burning foods that made me go hungry quicker. Not necessarily going super healthy but stuff like eating less bread/pasta and more say baked potatoes so still nice tasty food that doesn't get me into diet sadness mood, just shifting away from carbs

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.).

Yeah, I've never struggled with weight the way other comments in this thread have, but I made similar changes when I was younger and they've been one of the best things I've done. I have one largish meal a day, with one smaller or a snack, and focus on low GI foods but in a mild way. When I get that "brain is bored" style hunger I go for tea with a squirt of water enhancer in it lately.

Yeah when I tried the "eat a bunch of small meals during the day" way I felt like some constantly munching pasture animal and also had to plan for all that. And any social plans threw a wrench in it, as getting used to frequent meals also made me go brain hungry quicker.

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've done all of these things. I've essentially been on a diet since I was 17. I am not (especially) fat, but the amount of mental and emotional energy I burn on not being fat is huge. It is a daily struggle. Like one of the parent posts, I've achieved a number of other hard things in my life that took sustained effort and willpower.

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.

I have gerd, and was like, I was wondering if this would make it easier for me to eat small amounts and not have as much heartburn... then I read this:

> 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.

The heartburn has been quite minor, and only at night. Tums has been plenty for controlling it. (But I don't have GERD.) The heartburn itself is definitely not the cause of the weight loss for me, haha.

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.

I just read through the side effect information.

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.

One of the likely factors in my gerd issues is being about 20 lbs overweight, so I wonder how this balances out.

> 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.

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.

Common advice does address this. A lot of dieting has been, in my experience, finding ways to make less food make me fuller, or to think less about being full. For example, intermittent fasting is a great way to do both.

> 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.

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'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.

I have a similar experience.

I was just saying the exact same thing to my wife yesterday. We’re both trying to lose weight, for the millionth time in the 20 years we’ve been together. Exasperated, I just said “I don’t get it. I was an artist who had no technical background, and was able to teach myself computer science and now I’m a highly successful engineer. I did that. And yet I can’t lose 10 pounds to save my life.”

It’s so hard to eat healthy, I honestly cannot fathom how people do it.

> 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.

> 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?

I didn't say anything about genetics, though I wouldn't be surprised if that plays a part. Might be how you were raised. Might be simply your cumulative life path leaving you in a particular state. Might be toxins in the environment. It doesn't matter; in the existing present, people have wildly different responses to food and diet.

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.

> 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.

Out of curiosity, what kind of food were you obsessing over, specifically? Why were you craving that kind of food, instead of, say, lettuce?

For me, it was primarily carbs. Not potato chips or anything particularly greasy, but things like tortillas, rice, noodles, bread, potatoes.

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.

Well, simple carbs (which includes sugar) are highly addictive, so I can't say I'm surprised. Your brain was trying to get you your fix by convincing you that you were starving. In contrast, if you were truly starving you'd eat anything -- including lettuce ; )

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.

Let's say there were a drug that made people motivated to study hard and get a lot of work done. Would the successes people reaped from that be less useful to themselves and people around them, than those which other people reaped from being natively predisposed in that direction?

We’re products of our nature and environment. Belief in free will, virtue, etc. are useful beliefs, but they’re also just not true.

Free will is a product of our nature.

If your eyes got bad, would you get glasses?

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.

Instead of thinking in terms of "everything", "everyone", etc, it may help to think in terms of bell curves and outliers on that curve.

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).

> Next: if you can believe that one person is such an outlier, can you believe that hundreds are? Thousands? Millions?

Yes, those people exist as outliers. But a population-level outlier theory doesn't explain why obesity is growing in the population.

ADHD used to be only a tiny amount of outliers and is growing, thanks to the lifestyle we lead.

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.

> ADHD used to be only a tiny amount of outliers and is growing, thanks to the lifestyle we lead.

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.

same thing we now have an environment that challenges our starvation signals in ways our ancestors never had to deal with. They never had an ever present source of dense calory food.

If increased stress and the demand for 8 hours of uninterrupted mentally challenging work exacerbates ADHD, why wouldn't increased food availability - especially high density ones - exacerbate obesity in those with a a satiety loop defect.

If you eat until you are no longer physically capable of eating more it sure matters if you ate vegetables or pastries.

> ADHD used to be only a tiny amount of outliers and is growing, thanks to the lifestyle we lead.

That's speculative I believe. Last I checked, I think they chalked this up to better diagnosis.

I've had the same experience and I agree. It's deeply ingrained but it's not hardwired so it can be changed, it just requires going against the grain in almost every area of your life in order to avoid being impacted by the modern food environment (in America at least).

You make a sound argument, but it doesn't explain, why in one country 1% of the people are in this situation, and in another country 30%.

Given that those countries have massively different foods available, massively different environments available, require people to spend massively different amount of physical effort during the day, it would not be that shocking.

> there is at least one person whose brain is set up to constantly hammer them with feelings of hunger

Not only was there a fascinating example of this the unfortunate man was documented by a doctor of the era.

https://en.wikipedia.org/wiki/Tarrare

The statistical/genetic view of obesity and observed weight gain in general, which is useful in its descriptiveness, fails to explain, behaviorally, why people 30-40-50 years ago-I was young in one of those decades-were much less likely to be not only obese but also overweight. And while it is true that much more high-calorie food is available today than back then, a lot of butter was used, pasta and bread were widely consumed, and if one wanted to be fat, one could easily become fat.

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.

Lab animals kept on strict diets and routines for decades have been mysteriously gaining weight as well. (https://www.nature.com/articles/news.2010.628)

There's more than just social acceptance of obesity and pajamas in the grocery store at work.

Increased calorie consumption is the offender, there is little doubt about that. By carefully measuring food, one loses and gains weight accordingly (taking into account age, physical activity, etc.).

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.

> By carefully measuring food, one loses and gains weight accordingly (taking into account age, physical activity, etc.)

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...)

"Hard work and discipline" are multipliers for the output of an otherwise-balanced brain and body chemistry. But they're no substitute for fixing that balance when it is imbalanced.

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.

I don't think _everything_ comes down to genetics, but a lot of stuff does, including the attributes you mentioned here.

Why are you more worried about "good old fashioned hard work and discipline" than taking a scientific and results-oriented approach to improve people's lives? Do you want to see people toil and suffer for its own sake?

Funnily enough one could argue that we're also biologically predisposed to apply certain moral judgements to the behaviour of other people and our own. After all, our environment of selection didn't include the ability to alter much of our body chemistry.

Genetics and microbiome are the biggest factors, but training, habits and environment (how accessible is that junk food?) also matters.

There is 0% chance that human genetics changed this much in the last 100 years (3-4 generations). Look at photos from 100 years ago, people were mostly thin.

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.

But this doesn’t dismiss the idea that some people are genetically predisposed to be far hungrier. While true cheap and abundant calories facilitate obesity, that probably synergizes with people who have naturally voracious appetites. Someone in the pre-industrialized past wouldn’t have been able to binge on so much calorie dense food, but they may very well have felt gnawing hunger more strongly than their peers.

> Is everything pre-determined by genetics?

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.

I applaud that self knowledge.

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.)

I'm in a similar boat as you. COMPLETE opposite experience as other folks, to the point of pathology. I could not overeat to save my life. I cannot lift weights and expect any growth due to lack of caloric intake. When I try to exceed 2k calories in a day, I find myself so full I need to lie down and groan for an hour until things move and digest. Force any more down and I'll vomit. I cannot concentrate with a meal in my stomach, so I wake at 9, eat ~500cal at 1pm, and leave the rest til I'm done work at 8.

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.

Since May, I have (very deliberately) put on ~16kg of mass, going from a BMI of 17.5 to 22.8. Started at around 2500kcal/day, currently at 3500kcal/day.

> 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.

Thanks! Congrats on the 16kg.

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.

I've known a few women with metabolism like yours. They actually had to work at keeping their body weight up. Their friends envied their slim figures, but it was a genuine health concern for them.

I'm sorry, but I'm a decently in shape person that tried semaglutide for reasons other than losing weight and I disagree.

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.

> I get a little upset when the rest of you get to have insurance pay ridiculous sums of money for a medication

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.

Yeah, and that's a definite bonus. It's the attitude I've read from people taking it that grinds my gears - when I read the semaglutide subreddit it was full of people saying "oh, so this is what skinny people feel like."

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.

> The rest of us have worked hard our entire lives to stay skinny and now you all get a cheat.

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.

They could say that but they may very well be wrong. Obviously we can’t switch bodies and say, but I’m a non-diabetic person of a healthy weight that’s taken semaglutide. All I’m saying is the “full” you get when taking that drug was absolutely foreign to me.

> The rest of us have worked hard our entire lives to stay skinny [...]

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.

> 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.

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.

> Can you eat an entire pizza and still be hungry except it's physically painful to eat?

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).

> Can you eat an entire pizza and still be hungry except it's physically painful to eat?

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.

It's funny hearing people debate this topic on HN where the community skews heavily male. The vast majority of women have experienced both of these states of mind and in fact do so on a monthly basis. Three weeks out of the month I get hungry, I eat, I get full, and I don't feel hungry again or think about food at all for hours. You could put a cupcake in front of my face when I was full and I wouldn't even look at it. It requires zero effort to behave this way. Yet during that fourth week I get a constant gnawing feeling in my stomach that never goes away except in the first few minutes after eating something (usually simple carbs). I think about food nearly every minute of the day. Then one day it's like a switch flips and I'm back to having a perfectly normal appetite and satiety signals. It's an excellent lesson in how we're all at the mercy of our biology to some extent.

I’m a male with hormonal issues and I’ve also taken growth hormone peptides that make you ridiculously hungry. I’m no stranger to how hormones can affect our bodies. All I’m saying is that the type of satiety you get on semaglutide isn’t natural and I’ve never felt it before in my life.

Oh I definitely believe you on that. I haven't taken semaglutide myself but from what I've read it seems to increase satiety by slowing digestion, which is why it has nausea as a side effect, and I can't imagine that that's the same as the normal feeling of satiety you get from eating reasonable amounts. Did it make you less hungry in a sick way rather than a neutral way, maybe?

What semaglutide does is make the idea of putting more food in your stomach when it’s full…not nauseating, but something akin to that. It’s hard to describe. It almost feels like theres just no more room and the food will come back up. The main point I’m trying to get across is that (probably, sample size of 1) isn’t how healthy weight people feel.

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.

> she was limiting herself to 1400 calories a day

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.

> This is closer to disordered eating than healthy eating.

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.

>It's unfortunately normal for our biology to basically want to shove calories down our mouths all the time.

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 was like this for a long time, then I got older. That said, you seem to be following your body's instincts well, so good for you.

> 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 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.

I'd be very careful with this kind of reasoning. We just do not know the insides of others peoples heads. How can you rule out that there are differences between peoples appetites?

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.

Right, I’m sure there are extreme outliers on each side, but when half the population is fat it’s clearly not just that. The only point I was really getting at is that semaglutide doesn’t make you “feel like all those skinny people do and look how easy they’ve had it.”

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.

> It’s so hard to eat healthy, I honestly cannot fathom how people do it.

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.

There's a lot of words here so you took some time to write this.

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?

Indeed!

> 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!

I'm really just that cringey IRL.

I'll take a wild guess and say it's for those who "cannot fathom how people [eat healthy]."

You got it.

I am sorry that my post bothered you, I will keep your sensibilities in mind the next time I choose to share personal experiences on HN.

“Has a high amount of fat” isn’t the same thing as “unhealthy”. “Has a high amount of calories” isn’t either.

Wanting to lose weight isn’t necessarily about health, and eating a lot of fat is an effective way to lose weight.

Eating a lot of fat is an effective way to lose weight, I agree.

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.

[1] https://news.ycombinator.com/item?id=32818910

> It’s so hard to eat healthy, I honestly cannot fathom how people do it.

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.

This would be more persuasive if it wasn't more or less the opposite of what current nutrition research suggests about fat and satiety.

Fat and non-satiating carbs in combination (e.g. chips) is bad because you will consume loads of calories without feeling full. Most seed oils (i.e. fat) actually seem to be quite unhealthy. If people avoid that shit when being told to avoid fat in general, I think it's actually a net positive.

Apart from them seemingly equating fat and sugar as equally bad, the comment was spot on.

"Potato chips are bad for you" is a noncontroversial statement. "If you want to lose weight, avoid fats", on the other hand, is deeply controversial and probably wrong.

I think that many people discover a particular diet that works for them psychologically and expect that to be the case for everyone.

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.

This is exactly what helped me get my weight down: Lots of protein (whey / casein powder is pretty cheap nowadays if you search online; the exact formula is irrelevant unless you are doing top-tier bodybuilding; I'd suggest casein since it digests more slowly so it keeps you "full" for a longer time, and for me this seems to work) and lots of dietary fibers (wheat bran; drink a lot of water and eat it piece by piece over time; getting a lump of this stuck in your throat really sucks...)

Other than that your comment seems to contradict itself, I'd fully agree.

> 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 meant that you stated,

> 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.

I see. That makes sense.

Yeah - I probably didn't word that the best.

There's no conclusive single position of "current nutrition research".

Citation?

Every study done on ketogenic diets, for starters.

When I said fat I was thinking of the types of fats you eat when eating out.

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.

"Deep fried" is a problem because it almost always saturates carbohydrate-heavy food in fat. There's no debate about whether potato chips are probably just as harmful! But it turns out: the baked potato chips are just as harmful. Vegetable oil on its own is probably not a problem at all. Research on ketogenic diets suggests bacon simply isn't a problem: it's an extremely high-satiety food (it's physically difficult to eat a lot of it!).

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.

Aren't baked potato chips generally cooked in oil?

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.

It's complicated.

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.

I don't buy that line of reasoning. I'm personally going between "I don't crave sweets at all" for weeks to "give me everything we have at home and when I go for groceries I will buy more". Maybe there are people who keep certain preferences or bodily functions for years, I am not one of them. My need for sleep is also drastically going up and down in bouts of months (when I need 8h, I need 8h and 9h is better, and when I am fine with 6h I am fine with 6h or if need be 5h, this changes every few months and then stays for a few months, not limited to a certain time of the year).

Just eat only liver, eggs, and ribeye steaks -- you can absolutely stuff yourself and you will lose weight. The problem is that as a society we are sending the wrong message about what healthy food is -- nothing from a plant is really good for humans to eat. A diet of only red meat, however, will not only get you in phenomenal shape, but it will also clear up a dozen other major and minor health issues. It is the perfect human diet and it is a tragedy that this is not understood.

I support anyone experimenting with their diet to see what works for them, but I wouldn't be so confident about extreme diets like carnivore working for everyone.

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.

I honestly love the idea of individual experimentation. Like, there has to be a not-quite-scientific-but-almost-scientific approach that people can reasonably handle on their own. I'd love to see a book that outlines how to find the right diet that works for you. Like an operational guidebook showing you how to cut out specific foods, and how to watch for and observe changes to see what the effects are on your body.

Hope you don’t have hemachromatosis.

Next you'll be warning me about scurvy, lol

> It’s so hard to eat healthy, I honestly cannot fathom how people do it.

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.

Ironically, we're just about to buy smaller plates for a completely unrelated reason. We moved into a new apartment and the cupboards are more shallow than our previous place, and our plates don't allow the doors to close all the way. So we're buying a smaller dish set that will fit. I hope that helps!

It will be painful.

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

Popcorn has loads of carbs, and low satiety. Eat boiled potatoes.

A potato is far more energy dense than popcorn. 2 cups of popcorn looks like a good amount of food, but it's only ~150cal. A good way to trick your brain into thinking it's doing a lot of eating.

Source: worked for me. And is a basically daily staple

why hot tea?

You just don't want it bad enough. You like food more than you like being thin. That's all.

There’s clearly more to motivation, dependency, and even addiction than just how “bad enough” someone wants something.

I was diagnosed with something a few years ago which if I didn't change my diet (no beef, pork, fried foods, no foods with preservatives, low to no salted foods, increase water intake to 3/4 a gallon a day & started eating fresh fruit)that in ten to 20 years id be stuck in bed too tired to do anything/ enjoy life.

For me that forced me to eat healthy daily and it has almost healed my affliction upon religiously following such a diet.

What do “preservatives” have to do with it?

Most nutrition advice is so bad you basically shouldn’t believe anything anyone tells you, including, especially if it’s from an expert.

You've trained your gut biome to expect a certain composition of foods, it takes a bit for it to calibrate to something different. After a few weeks you can easily get used to different types of food.

> 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.

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.

> Not that hard to stop yourself from going to the store again or ordering more

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.

Have you watched the new Brendan Fraser movie "The Whale"? If so, what did you think about it?

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.

> And eating only candy makes me sick, so I should also buy crisps so I can alternate and keep eating.

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...

The problem with food is that you can't cut it completely like drugs or cigarettes, rehab schemes are not going to work because the temptation and use is always there, multiple times a day.

No, but maladaptive coping (eg addictions, including eating your emotions) can be replaced with something healthier. It's also possible they've been emotionally neglected or abused (trauma always makes these things much more messier to address without addressing it first) and that's how maladaptive coping develops (or maybe they never learned them from parents for another reason, or maybe they picked up on a parents unhealthy coping style).

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).

Thanks for sharing. I didn't really understand it (though I didn't doubt it) until I read your comment. What a hard burden to carry; I completely understand the state of watching myself do something unwanted (though not with food).

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.

Can you give an example of this?

An example of a healthy outlet? Enjoyable exercise, studying something I'm interested in, creative outlets like writing a story.

> 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.

The point of this article seems to be that that is changing. Doctors actually have something to offer you now.

If you're content with where you are then that's fine. I won't claim it's going to be easy to change things. But I do think there are few things you could change that will nearly guarantee success:

- 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.

> people that have never actually been fat. "I did it and I lost 15 pounds

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.

I'm 40 and I can't pinpoint when my metabolism changed. I can pinpoint exactly when I moved in with my girlfriend, who cooks delicious food, instead of me ordering a salad a day as my main meal, but my metabolism itself seems to have hardly changed at all.

A recent study found basically no change in metabolism from the age of 20-60: https://www.bbc.com/news/health-58186710

People usually just start packing on a few pounds a year (or more) in their 20s and it adds up.

>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.

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).

> high protien, high fat, and zero carb

Basically a keto diet, of course it works due to ketosis.

I think the problem with Ketosis is that people are too busy trying to eat a lot of fats. You just need healthy fats, protein and vegetables.

You don't need vegetables.

A carnivore diet is not necessarily a ketogenic diet, although it is a zero-carb diet. If you eat enough protein then your body will make glucose from it and keep you out of ketosis. But I agree that a diet of only red meat is absolutely ideal no matter which angle you look at it from.

If you eat enough protein then your body will make glucose from it and keep you out of ketosis

Cite for this, please?

They’re probably talking about gluconeogenesis.

https://en.wikipedia.org/wiki/Gluconeogenesis

Yes, but that's not a cite that says eating lots of protein can take you out of ketosis; it's just a Wikipedia article on gluconeogenesis.

I didn't believe it either... it seems to be mentioned in a bunch of keto literature online, like this one [1]. Some folks say it stimulates insulin, and some say it upregulates gluconeogenesis. I haven't found anything authoritative, so I remain skeptical.

[1] https://www.verywellfit.com/gluconeogenesis-2242007

https://en.wikipedia.org/wiki/Gluconeogenesis

So, it's just a thing you think might happen, because there is such a thing as gluconeogenesis? I went looking, and the only cite I found was a study suggesting this does not in fact happen.

A carnivore diet can include many other foods than beef and butter. Being high in protein is also a choice, and not a necessarily a great idea. (I'm getting moderate protein and high fat.)

>Being high in protein is also a choice, and not a necessarily a great idea.

Why is it not a great idea?

I've heard people say "I'm only being sated by the extras/side dishes, give me 1kg of meat and I will eat 1kg of meat as the main course" and to a degree I understand, at least for "normal" dishes with meat and carbs. Maybe it actually works if you crank the fat contents up.

You are right.

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.

I know what you mean. My doctor prescribed Naltrexone. The first day I took it I ate half my dinner and felt full for the first time in my life. As a middle-aged man I had never had that feeling before. Previously I assumed what people meant by feeling full is that you felt like you literally can't eat anymore.

Unfortunately that stopped working for me after a few months. Hopefully this one will work better.

If that doesn't work out, I think they make a combination drug of naltrexone/bupropion if the naltrexone worked for you originally. The latter drug activates parts of the brain that are responsible for emesis and it works well with the reward blocking effects of naltrexone.

Good luck either way.

Bupropion also helps increase dopamine and norepinephrine levels within the synaptic cleft. It was somewhat helpful for me when I wanted to reduce smoking. I was able to go from losing my mind if I went 90 minutes without a smoke to losing my mind after 3-4 hours without a smoke. I've heard anecdotal evidence from people I know that it helped with weight loss.

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.

Does your appetite not adjust to your intake?

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.

> I still like food, and I still get hungry. But it doesn't dominate my thoughts.

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.)

Please try eating only liver, eggs, and ribeye steaks and drinking only water. You can absolutely stuff yourself on this diet and you will nevertheless get in shape. It breaks my heart that people have such an upside down idea about what healthy food is -- people think they should avoid red meat and eat fruits and vegetables and "heart healthy grains" when in fact the only thing they should eat is red meat. It is a tragedy almost beyond description -- there are millions of people in your situation who have been thwarted in their weightless journeys at every turn because we've been getting the wrong information about what food is healthy for us to eat. In addition to losing weight, you will also completely eliminate heartburn. Just try it.

I did this and lost 18% of my body weight (BMI 36 to 29) after reading Gary Taubes. It works. The resulting blood chemistry worried my doctor.

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.

> 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!

I've been cycling "liver, eggs, & steak" + I add BONEMARROW.

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.

If you don’t mind sharing, we’re you prescribed tirzepatide for type 2 diabetes, or was this an off-label prescription for weight loss?

How much weight did you end up losing on that stuff?

> 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’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.

Just curious in regards to saying you never really feel full ..have you ever counted daily calories you consumed on average?

I was fat/overweight all my life until I was about 24. I had enough of it and I went from ~94kg to about 85kg quite quickly (through calorie deficit), then over 1-2 years I went to a low of about 72kg. I am about 75-76 now, and have been oscillating in the 72-77 range for the past 5 years or so. It still requires me to be mindful of how much I eat, which has become part of my daily life. I'm not very strict about it, I have days when I eat more and then I compensate by eating less.

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.

I've heard from many sources that maintaining a weight level is harder than losing weight, and that has been my own experience.

> everyone, even the skinny folks, should be on GLP1 drugs

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 always really strange to me whenever someone enthusiastically advocates that others use experimental drugs whose long-term side effects have not yet been discovered. if you want to try em yourself then go for it I guess, but I'm good thanks.

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).

It’s illegal for doctors to get kickbacks in the US. The most the average doctors gets is lunch provided to go to a lecture from a drug company.

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).

> have got average people to think it's perfectly normal to try putting random chemical compositions into their bodies and see what happens

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.)

if expressing any less-than-positive opinions about pharmaceutical corporations is enough for you to make an immediate learned mental association with a popular dismissive political buzzword label, then I suggest asking yourself why exactly this is the first thing that came to mind, and what that might mean from a marketing perspective.

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.

That's fair, but speaking as an occasional 15mg Adderall XR person for about 10 years now- You're not addicted to it. The downer when you go off it will take a few days (I take 2 days, you may take a day or 2 more) and will be a bitch, but it will pass. I go off mine on weekends so that I don't adapt to it.

this has not been my experience. I have tried for up to four days before and it's just miserable, it's like all the bad parts of being stoned and drunk and none of the good parts. when you've been on something since adolescence it's hard to break away. after I re-accrue time off after my wedding this coming summer I'm thinking about about taking a week off to try to go clean again but I'm deathly afraid of the sheer drop-off in productivity that will occur. I have lived more of my life on this drug than not, and getting off of it terrifies me, even though I hate it.

Maybe take a vacation off work for more than a week and do it then, when it's relatively safer? You can sleep it off (you will need to sleep more).

The only proven way to live longer and reduce your risk of essentially every disease is to reduce caloric intake. So unless you are underweight, the benefits could outweigh any side effects. I am not advocating that everyone take these drugs--but I understand why someone might suggest it

Why would I need a drug for that?

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.

> The only proven way to live longer and reduce your risk of essentially every disease is to reduce caloric intake.

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.

>Has this been proven in humans?

Seems like it but it still might not be worth it:

https://slatestarcodex.com/2019/12/12/acc-does-calorie-restr...

This is false.

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.

Why not just follow a diet of only beef, eggs, and liver? This is the most nutrient dense diet you can follow and as a result you'll reduce your calorie intake while increasing your feelings of satiety. Also, you'll resolve a dozen major and minor health conditions.

The main point against it for me is not that it is a new drug; it is that, if I reduce my caloric intake, I won't have enough calories to maintain my normal daily activity levels.

The parent post said:

> 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.

I'd be curious as to what the effects would actually be on you (though I agree that it seems at best useless and potentially harmful for you). Would your weight zone shift downwards, or would it do nothing?

To be fair our ideas of normal are extremely skewed. If you look at photos from say 1962, you'd consider most people "skinny" (even photos of places like the US). Yet even then, 23% of American adults were obese according to the CDC. Even in 1987, the actor that played Private Pyle in Full Metal Jacket gained 75lbs to play a comically obese Marine. Today he looks fitter than most people you'd see everyday.

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.

> 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 only proven way to live longer and reduce your risk of essentially every disease is to reduce caloric intake.

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.

Being a young and very healthy person I felt this way about the COVID vaccine.

Why? Plenty of young and healthy people died of COVID. Only some vaccines are mRNA types, and, in the USA anyway, all vaccines went through the same testing process as any other medication, they simply sped the process up by layering some of the steps - all that means is that rather than wait to see if one study passes before doing the next one (save money or whatever), they just overlapped them. Even for MRNA vaccines, that's 2 decade old tech.

Were you also worried about cold vaccines?

Could this help alleviate some of your concerns? : https://www.hopkinsmedicine.org/health/conditions-and-diseas...

I'm with you except for the cold vaccines line. Did you mean flu vaccines?

yes, thank you

>all vaccines went through the same testing process as any other medication, they simply sped the process up by layering some of the steps - all that means is that rather than wait to see if one study passes before doing the next one (save money or whatever), they just overlapped them

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.

> The normal process involves at least 4-5 years of observation to identify long-term side effects.

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.

Vaccines don’t have long term side effects. They have short term side effects.

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.

Isn't the goal of a vaccine to induce a long term side effect?

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.

> Isn't the goal of a vaccine to induce a long term side effect?

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.

How does that square with this though?

> 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's biology. It's not like we're dealing with robots with little timers in them here. They'd be "long term" side effects simply because they're so rare it'd take years to observe one. So, if you carefully watch a very large population, you'd find them sooner.

Taleb: https://www.youtube.com/watch?v=gAlHjWctpLw

What about something like cancer? If you get diagnosed with some form of cancer tomorrow, it's probably not because some cell first mutated yesterday, right?

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".

IDK if dude is smarter than you are, but he's a domain expert. He knows enough about the subject that it would likely take you something in the range of a decade of dedicated time, research, engagement, and experience to reach an equivalence. You're probably quite capable of this, if you decide to go down this path.

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?

NNT is certainly smart and is an expert, but what domain? Last time I checked it was mathematical risk modelling and options trading, not medical research. And the most robust modelling on a flawed premise is still flawed.

As sibling says, I vaguely know of the guy in the video as a math expert, not as some expert in a particularly relevant field of medicine.

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?

> Plenty of young and healthy people died of COVID.

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...

Correct, more unhealthy and old people died of COVID.

More drunk people are involved in car accidents than sober. Yet I still put on my seatbelt.

Do you put on a seat belt when you're at a car dealer and try sitting in a car? You never know, a car might come through the window and hit the car you're in and you'll be glad you had that seat belt on.

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.

Your analogy doesn't make sense, mine does. You're ignoring the two other upsides of a covid vaccine, that being lower likelihood of contracting covid, and, lower likelihood of spreading covid if infected. These are valuable social side effects of getting vaccinated with a highly tested, demonstrably safe vaccine.

I’m using the most important measure - risk. Regardless of whether your claims are true or not, they are simply moot if the risk is low, and the risk is low, very low for young and healthy people.

Much like needing a seat belt in a stationary car parked in a building where no other cars move around.

Another reason your analogy fails is it makes sense to always put your seatbelt on when you get into a car, regardless of if your initial intention is, for whatever reason, to remain stationary in the parking garage: typically one gets into a car and immediately begins driving. It's a very good idea to 99% of the time have your seatbelt on when you're in a car. The habit of putting your seatbelt on when getting into a car, and only taking it off immediately before getting out of the car, is a very good one to have. Given that the downside of wearing your seatbelt is essentially nothing, the added "cost" of wearing your seatbelt the 1% of the time you're in your car and it's sitting in a parking garage is well worth it. Plus, you're eliminating the risk of driving off and forgetting to put your seatbelt on, after sitting comfortably with it off and immobile for however long.

I even put on my seat belt when I realise I've forgotten something in the car. I get in, put the seat belt on - for all the reasons you gave - and then I get my umbrella or phone or whatever it is (which can be a pain with the seat belt on, but I'm doing this for society so I make sure to take my responsibilities seriously) and then take off the seat belt and get out, safe in the knowledge that I dealt with all that minuscule risk in the best way possible.

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…

[1] https://www.cdc.gov/vaccines/vpd/vaccines-list.html

Many of those we do all get vaccinated against as children. It sounds like you're opposed to vaccines until they pass a magic "recently dead" threshhold? Apparently that threshhold is higher than 6.7 million, which is COVID's death count so far. So where's it at? 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?

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?

> Many of those we do all get vaccinated against as children.

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...

> - please, tell us all why we should get the Yellow Fever vaccine even though most of us are not at risk of catching it

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

> 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."

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.

> Thank you for providing a near perfect example of the appeal to authority fallacy.

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

> Appeal to authority is only a rhetorically valid challenge if the authority is wrong.…

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...

[5] https://unherd.com/thepost/study-into-mrna/

[6] https://www.bmj.com/content/375/bmj.n2635#main-content

> 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).

...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.

> 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...

Very very few young and healthy (eg sensible bmi, some exercise, no smoking) people died of COVID. I think it was about a dozen in the UK.

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).

Not worried about flu vaccines because they’ve been around forever. MRNA vaccines are relatively new and weren’t observed for long term side effects like other vaccines.

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.

This is absolute disinformation and you should be ashamed. Delete this.

I'm not exactly skinny as I have some muscle mass, still I'm pretty thin. I do not have to think about restricting calories and I'm still that way. I do not like to eat much sweets, I preferred a schnitzel since I was a child, so that's one thing. But sometimes I get a huge hunger when I feel my body trembling.

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.

Same - Mounjaro / Tirzeparide is nothing short of life changing.

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!

Oh really? Got any more info on that drug?

I wonder if somone studied „dragon breath” and „vacuuming” exercise vs surgery. I am 15 pounds overweight but I have a feeling that since doing these I look much better and don’t eat that much

The FDA recommended against it. https://www.fox29.com/news/fda-warns-against-eating-dragons-...

By „Dragon breath” I meant breathing exercise that works belly muscles, you exhale trough teeth

What drug are you talking about? I did some research and I can't find it. Only talk of them ramping up Mounjaro by 2025.

Have the side effects stopped? Or have you only been on it 3 months? My wife has been on Ozempic for longer than three months and the side effects haven't stopped. The nausea is typically bad for a few days after taking each dose but some of the others linger most of the cycle. For some I can see that tradeoff being okay but I can't see non-obese, non-diabetic folks making that trade-off for longevity. I know I wouldn't.

could you elaborate on the trade-off for longevity? is this based on the supposition that dieting is good for longevity?

for me, the side effects lessened over time, and are pretty low now. Everyone reacts differently though.

Fat guy here: these side effects are pretty scary for somebody like me.

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.

it could be the effects of caloric restriction. 3 months, in the context of a whole life plus increased lifespan is not that much time.

Another fat guy here. I haven't taken any of these drugs, but I stopped eating processed food (or anything with added sugar), avoided late night snacks, and lost around 30 pounds in 8 months as a result. I had the fatigue and such early in the process, but it sorted itself out eventually. The most important thing I recognized was that if I avoided eating late at night, I didn't feel awful waking up in the morning. I'm embarrassed to say it took more than a year to change my behavior, despite my clear understanding of the harm of snacking all the time.

> I'm embarrassed to say it took more than a year to change my behavior

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!

> I'm embarrassed to say it took more than a year to change my behavior, despite my clear understanding of the harm of snacking all the time.

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.

Time it properly. Pick the end of the year around December when things are slow. That knocks off a month. Save the vacation time to knock off 2 weeks in January. White knuckle it through February.

You have to try something.

> Pick the end of the year around December when things are slow.

Ah yes, December: famously known for its lack of social engagements.

I was quite overweight for 20 years, now I'm just a bit thicc on my way to a lean muscular physique. It feels good. The biggest factor was getting away from the wrong people and habits. I'm not a fan of artificial intervention because I believe I should be able to get my body in line. It takes time for your body to adjust to the absolute shit you did to it for decades. I always said in my head "this is payback for what I did to me for 20 years, how can I expect to just turn on a dime." There is a good chance I will be the sexiest 40 something for miles around (I live in the middle of nowhere, but still!) The best feeling is looking great in clothes. Finding well fitting stuff is now fun.

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".

> Losing weight was extremely challenging and socially isolating.

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.

Because if you want to lose quickly, and once you get the discipline to lose you do want it to be quick, you have to restrict your calories A LOT.

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.

I would love to know what sort of healthy cut has a 6"2 male eating that low a calorie count. That is approaching weight class athlete cutting numbers which is near uniformly considered very bad for you.

If he’s not exercising and is largely sedentary then 1400 calories for an adult male is a serious deficit, but not extreme. If he added in an hour of high intensity interval training or something that would be extreme and potentially hazardous.

Someone who is 6'2" would need to weigh 195 lbs to be considered at all overweight. The BMR for a median 55 year old male is around 1800 calories, and thats for someone just marginally overweight.

I don't believe these BMR calculators are reliable at all. I am 45 and 6'1" and 1800 a day keeps me locked at 240.

I don’t think they are particularly accurate either and I know self reported calorie counts aren’t accurate either.

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.

Yeah, I don't weigh my food, so I am just making educated guesses. The only time I knew for certain how much I was eating was when I ate about 0 calories for an entire month - due to advanced gallbladder disease and a hilarious series of diagnostic missteps. I lost 20 pounds. Gained it all back almost immediately after my surgery.

same

The problem with severe caloric restriction is that your metabolism slows down. This isn't true of water fasting up to 4-5 days at a time where your metabolism increases ~10-15%, and your body produces significant quantities of HGH which help you burn fat while preserving muscle.

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.

I've tried many things and I prefer intermittent fasting over diets and calorie counting. Changing diet a bit is still important (cutting carbs and focusing on stuff that keeps me satiated for longer), but it's easier to manage say going to event (just fast day before/after), or when having some bigger meal for whatever (socializing etc) reason I can always just eat later tomorrow.

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.

What's severe caloric restriction mean, here? From memory I've read that 750kcal and even 1000kcal under TDEE are effective. A TDEE of 2400kcal would be normal for a young 6'2" male who does a bit of light cardio, and 2150kcal wouldn't be unusual for someone who's sedentary.

Some studies, including one that followed The Biggest Loser contestants [1] showed that your basal metabolic rate goes down as much as 23% as a result of significant caloric restriction and remains lower for at least the 6 years of the study - even if the weight is regained. For these contestants the restriction was very significant, though I'm not sure if it's quantified in the study.

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 amount of calorie would be without taking into account any exercise. Then on top of that, if you exercise (I didn't), you would just eat back the calories you consume via exercising to not be at an unhealthy level.

I would _strongly_ suggest you consult a qualified dietician or physician before cutting that dramatically.

Potassium. They always forget the potassium.

> Going to a night club without drinking is not fun at all for example.

This is where coke and mdma come in.

I'd rather fast day before/after than go to event only to be miserable when everyone around me is eating food I want to eat

OP commented on a weight-loss scheme of eating every other day. Given the social attitudes around eating (which I suspect to be the #1 most common social activity), this alone has the obvious potential to eliminate ~%50 of the most likely socializing opportunities.

I agree that eating every other day would be socially isolating but OP stated he ate every other day 7 years after his original bout of weight loss which he said he did, “the old fashioned way.”

They said every other day was easier than "normal" dieting.

You can plan your fasting days around it. If you have some crazy social schedule, maybe this doesn't work. But I don't go out every night.

I find fasting depressing. It makes me incredibly anxious.

Sounds convenient...

If you're not eating every other day you can still go to the eating place and sit with folks. Also you can just talk more since they have to eat and you don't. Sounds like MORE socializing.

This is funny, so the more you talk, the more you are socialising, and if you are listening, you are not socialising?

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!

People feel really uncomfortable sitting down to have a meal with someone who isn't eating.

Being the only person eating can feel weird, but if I'm one person among a group I don't feel strange not eating and I've never picked up that it was strange for anyone else. Sometimes I don't feel like eating, and I don't force myself.

Why not just order something with no calories. If I go out for a meal and I'm not hungry, I'll get a salad. It's like 50 kcal.

I eat, get a bunch of vitamins, and socialize.

> If you're not eating every other day you can still go to the eating place and sit with folks.

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.

It's generally perceived as awkward to not eat when you're with others in a place that's specifically for eating

Eating food and drinking alcohol is a core part of most social activities. When you're losing weight, you can't really fuck up, you really need to stick to your diet. I found it difficult to maintain my diet in social settings (going to a friends party, eating at a restaurant with friends, going to a bar to celebrate something, etc) so I just stopped doing all of those things for 8 months. Like, if you're trying to quit heroin you're not going to go hang out with your old heroin buddies all the time and you're not going to do go near the places that sell heroin. Now, imagine that instead of being addicted to heroin, you're addicted to food, and all of the places that sell heroin are all the places that sell candy or burgers or really anything nowadays, and all of your "heroin friends" are really just your normal friends who have healthy relationships with food. Its really difficult to get away from it. When you're addicted to food, the only real way to improve is to quit it cold turkey style and that means some serious lifestyle changes.

Thanks for the answer. In my own experience I went from eating out every day at work to packing a lunch and eating in the cafeteria. It didn’t mean less socialization at lunch but I did start eating with different people and I realize that is hard or not even an option for some. I set a rule for myself to only eat out once a week and that did the trick.

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.

It probably depends where you live and your social groups. In MT it seems that there are two main groups of people. Those who are into outdoor activities (healthier lifestyle) and your other group which is more adverse to the outdoors and prefer to socialize in Bars or at events. If you fall into the latter, it can be socially isolating if you want to lose weight or maintain a healthy eating habit.

Everyone is addicted to food - what you're describing sounds like a great way to set yourself up for failure.

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.

No, everyone needs food. Not everyone is addicted to it.

Maybe in the loosey-goosey "I'm addicted to chocolate" way, but not in the "I habitually over-consume despite the negative consequences" way.

> Everyone is addicted to food - what you're describing sounds like a great way to set yourself up for failure.

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.

I just plan for it and eat less before/after event. I also got used to just eating rarer so say skipping dinner coz there is some event in the evening isn't a big deal

That makes sense but it may also be that you just need to make different social circles. There are tons of casual sports teams, for example, and those people are all bonding over playing volleyball casually (not at a high level or something) or things like hiking. Now your social activities are helping you lose weight

Nope, lots of casual sports teams will have people say, "hey we couldn't really socialize during the game, let's go grab a beer afterwards?". Hiking is similar, "hey let's take a break and eat some lunch."

Bring your lunch with you.

If you do order out, get a salad and skip the dressing.

"I brought cookies for the team today, who wants one"

Then take up trad climbing or jiu-jitsu. Ok those aren't for everyone, but your tone is way too dismissive. There are many, many social groups that will naturally encourage better exercise and fitness, if folks are interested.

Be overweight, bust out your healthy lunch at work. People will flat out tell you "Oh, it's so good you are trying to be healthy." So already you are being told that they thought you didn't care before and you have finally decided to make the "right" decision.

Slim people hear this in response to eating healthy food, too. In my experience, people are genuinely impressed/inspired to see healthy meals, or feel guilty about consuming junk they brought with them (so their comments are actually to themselves, small reminders that this is perhaps how they ought to be eating).

I was put on topomax for extreme migraines. Turned out a side effect was zero appetite. Unfortunately another side effect was to lose of about 60 iq points. Loved the weight loss. Missed having a brain.

That's why it's called dope-a-max. My wife had the same experience.

Was it literally like just being less smart? Or was it sedation/fog?

Like staying up 30 hours. But not feeling tired. You can function. But higher concepts are not possible. A “for loop” was very challenging. Also you make a lot of really stupid decisions.

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 the process with insurance? About a year ago I tried to get on semaglutide and my insurer shut down every option. It was extremely demoralizing.

Check out compounding pharmacies or peptides.

What's the pricing you've seen?

Congrats on this drug working

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.

Congratulations that's fantastic! Best of luck keeping it up!

> Losing weight was extremely challenging and socially isolating

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.

I've done keto for three months and my body's ability to process fat has completely changed. I honestly think were never meant to eat as many carbs as we do in a day.

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'm doing carnivore -- it's like keto but better.

The lack of vegetables in some diets really hinders the processing food. I find fiber to be a very essential component meat on its own doesn't do it.

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.

You don't need fiber in your diet at all and when you remove it you will be amazed how much your digestion improves.

Are you sure your pancreas is going to live long and prosper under constant stress of incretin mimics pushing it to release more insulin?

For those less familiar with BMI, each point of BMI for a man is about 7 pounds. So 34-->23 BMI = -77 lbs. 31-->26 BMI = -35 lbs

It depends on height, so how can you say that?

It’s an approximation

Probably because height is normally distributed and it’s easy to predict someone’s height within a range.

I’d bet a lot of money the person in the story is not 6 foot 5 inches

I’m 6 4 though, so not far off

In that case 8 pounds per point of BMI, so it’s still a reasonable approximation.

there's a difference between being full and feeling full. is it still known that the human body is healthy with this level of dieting and lack of nutrition?

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

> there's a difference between being full and feeling full.

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.

> 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 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.

Having felt both “brain hunger/body hunger” And “obesity hunger/glp1 hunger” they are very different. The glp1 drugs remove a compulsion to eat that many thin people just don’t have. It’s like being a smoker, and then nearly instantly no longer craving cigarettes and finding the smell of ciagrettes unappealing. It’s not a remotely subtle change at all.

Yeah the "I know I don't need to eat but I want to" is the most annoying part of trying to get thinner

> was eating <1k calories per day for a long time and feeling full.

That sounds like half a days meals? Could it not be some of the side effects were actually from you starving?

That’s the effect of the drug.

I'm very skeptical of the 2000kcals/day normal intake.

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.

So it works by reducing hunger? Bit obvious if you eat less than 1kcal per day you will lose weight.

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.

> So it works by reducing hunger? Bit obvious if you eat less than 1kcal per day you will lose weight

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.

> Every animal will engorge itself given the chance.

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.

> I expect to be on this drug long term

This is a feature, not a bug.

If this drug produced some kind of permanent physical change, that would be a pretty scary thing.

Erm, the intented permanent physical change for the user is establishing normal weight, at which point you would assume, that you can establish healthy routines and ideally move on without the drug.

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.

Permanent change kinda fucking sucks if it turns out drug also have side effects.

How so? Why can't people simply stop taking it once they reach their goal weight?

My source was another comment:

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.

I get the opposite of brain fog. I feel sharper on semaglutide than off of it.

What's the drug?

Trizepatide, brand name is mounjaro. It’s a similar drug to semaglutide.

Dulaglutide (Trulicity) is Eli Lilly's first generation GLP-1 drug. Semaglutide is of a similar generation.

Tirzepatide (Mounjaro) is Lilly's next generation therapy, targeting both GLP-1 and GIP

https://en.wikipedia.org/wiki/Tirzepatide

FYI: GoodRX says it costs $1K/month.

The next gen lily drug is expected to cost $1500 for a 30-day supply.

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.

But insurance covers most of it?

Maybe? Probably not!

No. Not at all.

Depending on your risk tolerance, you can get it from rather sketchy Chinese UGLs for $100/month.

>longevity effects

Are you referring to any specific studies?

How much do you pay per month?

I think the main problem aside from the side effects you listed is the fact that frequent injections sounds really inconvienent, and the cost is pretty prehibitive unless insurance is covering it.

If you're getting a ~20% weight loss in 6 months, the cost is a steal compared to the alternatives.

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.

> frequent injections sounds really inconvienent

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.)

It is expensive but so is treating health consequences of obesity

Let's hope this changes and insurance companies cover it

I'm taking saxenda, which requires a daily injection and it's totally fine. It takes like 2 minutes. The needle is tiny and most of the time you barely feel it.

How's it working for you? It's the one that's available where I live, but the reviews I've read of it have me thinking I'd be better off waiting until the newer versions come out?

I've found it super helpful. I've lost 30 lbs so far. I counting calories, but the drug makes it much easier because you're just less hungry. I didn't have any major side effects, but some people do. I plan to switch to Wegovy once it's available, though.

I would rather die young than deal with those side effects. And those of us who are competitive endurance athletes need the oxidative stress; it's not necessarily a bad thing depending on timing and volume. Plus we will probably find other harmful side effects after long term use. There is no free lunch when you mess around with basic metabolism; everything has a price (not just in money).

You would rather die than suffer through three months of occasional strong nausea, constipation and brainfog? I hope that's hyperbole or that you have someone to talk to.

It sounded like it was decades of side effects, rather than 3 months. Presumably that affects the calculus

Especially since we're talking about possibly dying a couple years early vs definite awful side effects

I'm willing to bet that there are some other long-term side effects that haven't even been detected yet. Since I'm not obese I'll let others take the risk.

First off, no, not everyone should be on these drugs, there are side effects as well as known drug interactions that can be dangerous and not everyone needs them.

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.

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