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Comment by msrenee | Hacker News Reader

Are they the solution to obesity? I'm curious as to whether the weight stays off long term. 10 or more years at least or else it's just another bandaid. What we need is better access to nutritious food that doesn't take up so much of folk's scant downtime and tight income. I understand there's lots of reasons people are obese that aren't just laziness, but the drug doesn't solve those either. They're still not getting the nutrition they need. It's an improvement having poor nutrition with a lower BMI rather than poor nutrition and their current BMI, but not any kind of solution in my opinion.

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Depressed people take ssri’s their entire life. People with ADHD take adderal or the like. I don’t see any reason to think of obesity as a different type of disease. Some people just find it extremely difficult to keep off weight, it doesn’t matter what kind of food they’re eating. Yes they could eat less, just like I could keep my thermostat at 45 in the winter to save on my heating bill. But that’s not a realistic solution for most obese people.

It 100% matters what food you are eating, no matter who you are or what conditions you may have.

> I don’t see any reason to think of obesity as a different type of disease.

Because it's man made and completely avoidable. Look at tobacco for example, it was the exact same thing until it wasn't because we woke up and decided to act on the issue

Helping currently obese people to get out of the loop is good, breaking the system we built that make more and more people obese would be better.

Also, being obese is only a part of the complications of eating shit and not exercising, the rest of the symptoms will catch up eventually, there are no magic pills

> breaking the system we built that make more and more people obese would be better.

The system exists because people like it. I don't think it's possible to break it at this point considering how people normally react to having their life made worse. You can't stop people from eating what they want, but these drugs make it possible to change what they want.

> You can't stop people from eating what they want,

You can certainly stop advertising junk food to kids, that would be a good start. You can also regulate things you know, like not having your entire daily sugar requirement in a single can of soda

Btw if you still eat the same garbage you'll still absolutely wreck your body, obese or not, you'll need a diabetes pill, a cardiovascular disease pill, a blood pressure pill, a kidney boosting pill, &c. You are what you eat, quite literally.

> You can also regulate things you know, like not having your entire daily sugar requirement in a single can of soda

This will never happen in the US. I wouldn't mind, by anyone who votes for this would be dead in the water politically.

If the weight stays off even after 10 years on the drug, then that's great in my book. Nicotine, caffeine, and bariatric surgery all reduce your appetite in the short run, but your body eventually adapts and your weight starts climbing again. Until we've got more than a couple years of data, I'm not holding out hope that this drug won't eventually lose its punch for maintaining a lower weight.

The main problem to my mind is that cheap, easy, accessible foods are high in both fat and carbs. Fat is satiating, but super calorie dense. Carbs are less calorie dense, but spike your blood sugar. After your blood sugar levels drop, your body signals that you're hungry again in spite of the fact that you've eaten plenty of calories. So now you're starving again and you've surpassed the number of calories you can reasonably utilize without storing it as fat. Add in the fact that evolution hasn't even begun to catch up with the current situation where calories are not a scarce resource (in the US and similar countries) and your body is screaming to eat while the eating's good. This causes you to comsume way too many calories and nowhere near enough vitamins and minerals.

It's a lot of work to eat right anymore. You're working 40 hours a week if you're lucky, you're exhausted and feel like shit and you may not even be able to afford what you need to be eating to maintain a healthy weight.

And, just to make things more fun, there's 1000 sources telling you 1000 different things about what you should and shouldn't eat to be healthy. Cholesterol is bad for you - wait, no it isn't. Eat whole grains. No, don't, that's sugar! Eat fruit. Oh no, fruit is basically all sugar. No it isn't, it's full of fiber and that cancels out the sugar. Don't eat fats, except unsaturated fats, but those are calorie dense. Vegetable oil is unsaturated, but that's bad for you too in a different way.

It's damn frustrating. If it were as easy as just eating less, no one would be obese. Back to the point of the article, however, I don't think it's as simple as taking a magic pill. How many miracle weight loss drugs have come and gone over the last decade? I'm not holding my breath that this is the one that will turn out to work forever with no severe downsides.

It’s funny because I signed up to get Wegovy shots and still haven’t gotten approval, but I started dieting in preparation and I’ve lost 15 pounds this month. I’m eating red meat and the authentic, bubbly living kimchi from the Asian market that they keep in a stinky fridge separate from everything else.

But people act like I have three heads when they ask me how I lost weight and I answer honestly. They just feel like it has to be a net negative somehow, that it’s not allowed that I eat prime ribeyes (just one, I’m not that hungry m) every night and lose weight.

A month ago I was throwing up every day and eating 5000+ calories per day. I hope I don’t go back this time.

> How many miracle weight loss drugs have come and gone over the last decade?

Realistically, none. These are the only ones that have ever been found to actually work, everything else is either homeopathy or has terrible side effects. I agree that having food that tastes better is the main culprit for the obesity epidemic, but I don't think the answer is making tasty, addictive, food harder to access. Those foods are popular because people like them, they bring people happiness. It absolutely is a lot of work to eat right, but it doesn't have to be with these drugs.

I'm certainly not advocating making those foods more difficult to access. Exactly the opposite, in fact. I think we need to make access to healthier food cheaper and easier.

As far as there being no severe side effects, it looks like semaglutide was looked at for medical use in 2012 and didn't go to clinical trials until 2016. Then there's tirzepatide, which I think is the part that's the big breakthrough recently, wasn't approved for use until the end of 2021. I don't believe we have the data yet to really say that it's safe long-term. I sure hope it is, but this is a very new treatment.

> 10 or more years at least or else it's just another bandaid.

I wonder what the long-term health outcomes would be between two groups: one group that was obese the whole time, and another group whose obesity was delayed by ten years.

I suspect the latter group would end up having fewer negative health outcomes over the course of their life - 10 years of essentially “reduced wear and tear” on different systems in their bodies. That is to say - even if it’s a bandaid, it may still be really useful for public health.

I expect they would as well. However, I was replying to a comment that claimed this drug or something similar could be the solution to obesity and I have serious doubts about that. An improvement in health and longevity, even if it's substantial, is not the same as a solution. For example, if we discovered a drug that delayed severe illness/death from cancer for 5 years, it certainly wouldn't be called a solution to cancer. It would be amazing for sure, but that doesn't solve the cancer problem.

People saying that you have to be on X drug forever to solve your problem as if it's some silver bullet argument think.... what exactly about Type I diabetics who need to inject insulin every day, forever, to solve their problem?

I get where you're coming from and want to clarify that my issue is not that you may have to stay on it for the rest of your life. I'm concerned that even while on the drug, your body could get accustomed to it, and you'd end up eating the same as before taking the drug. This happens a lot with bariatric surgery. I realize that that's due to the elasticity of the stomach, but the body adapts and with many medications that have weight loss as a side effect, your body eventually sorts itself out and you start gaining weight again.

Not less nutritious food? Or is the argument that the [everything else] to calorie ratio should be higher?

> Or is the argument that the [everything else] to calorie ratio should be higher?

Yep, that.

My understanding of this argument (which for the record, I'm loosely convinced is probably true, but probably isn't the only, and maybe not the main, factor) is that your body's hungry signal is it needs non-calorie nutrients, but our food is less nutrient dense so you get a lot more calories than your body is prepared to handle for a given quantity of nutrients.

If this were right, you could cure your obesity by mixing the right multivitamin into your food? It seems like if fixing some nutrient deficiency were all it took, we’d have figured it out ages ago.

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