Comment by arcticbull | Hacker News Reader

Comment by arcticbull | Hacker News Reader

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That's great advice, except for reality getting in the way. Every study on this shows that you are as likely to get good results telling people to "just eat less and exercise more" as you are telling depressed people to "just be happy. Can't be that hard. What do you even have to be sad about?" Your body is highly motivated to maintain your weight set point, adjusting your BMR and pushing you towards compensatory eating.

Basically every long-term weight loss study shows that you will regain 80%+ of the weight you lose through diet and exercise over a few years. [1]

> Specifically, it has been estimated that for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss. Despite these predictable physiologic phenomena, the typical response of the patient is to blame themselves as lazy or lacking in willpower, sentiments that are often reinforced by healthcare providers [...] [1]

Obesity is a disorder of the GABA-ergic central nervous system, which is, I suspect not coincidentally, where GLP-1s work.

> These drugs are expensive and have nasty side effects.

They're expensive because they work, and previously the only clinically proven effective alternative was bariatric surgery. That's both more risky, and much more expensive. The side effects are actually minimal, and during the clinical trials very few people dropped out due to side-effects. The newer dual- and triple-receptor agonists have yet fewer side effects.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/

> for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss.

> Obesity is a disorder of the GABA-ergic central nervous system

This is too reductive. As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight.

That said, I get that many people just cant resist that hungry feeling. However, I've seen so many people who make these arguments eat tons of ready meals, desserts loaded with sugar, giant milkshakes etc. If they were serious about losing weight they could at least eat things like cucumbers or lettuce that keep you full with minimal amount of calories ingested.

The gist of it to me seems like these drugs are for people who are willing to pay thosands of $ to feel as full as when they were eating their 5000kcal/day diet without having to endure the feeling of not eating that amount. Which, contrary to your claim, boils down to the willpower issue. These drugs let you buy your way out of the willpower requirement.

> As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight.

So generally, anecdotes aren't a substitute for data. Which is why I linked to a meta analysis that incorporated 29 long-term studies that followed people for five years. Don't you think in the face of that, that your experience may be either (a) not representative of people in general or (b) you haven't waited long enough to see what happens next to yourself?

> These drugs let you buy your way out of the willpower requirement.

Or and hear me out, similar to the way your body maintains its set temperature by adjusting various factors - it also maintains a set weight. And that over a longer period of time you are as likely to "will" your way to a new weight set point as you are to a new temperature set point. Despite being able to temporarily lower your body temperature by taking cold swims.

Because frankly, that's what the data says.

If you read the link I provided you might learn something interesting...

But even if this was the case (and it's not) who cares? The goal is to get people to a healthy weight. Since moralizing hasn't done anything, and your approach has been an utter failure, why should you hold this drug that objectively works against anyone?

I read the abstract, intro and conclusion (paper reviewers often read less!). I'd say if anything the paper supports my assessment, particularly this bit:

> for all practical purposes, “a calorie is a calorie” when it comes to body fat and energy expenditure differences between controlled isocaloric diets varying in the ratio of carbohydrate to fat

So, calories in calories out. All you have to do is not ingest them. And if you do, who made that choice? The rest of the paper seems to be talking about factors such as "the obesogenic environment" which completely factor out the agency of the individual. It's like saying it's not your fault that you are an alcoholic or gambling addict because supermarkets sell alcohol and there are bookies just around the corner.

I understand what you mean by "who cares". I get that these drugs are a net positive good because they greatly reduce harm with minimal effort. That's great, but it's ultimately like administering narcan to an opioid addict. No one argues narcan is bad (it's proven and effective at preventing OD deaths), but also no one argues it is a solution to the addiction (you cant shoot up as much as you want and take narcan if things go unwell). Obesity of course is not as destructive (to a single individual) as an opioid addiction, but the fact that you regain the weight as soon as you stop taking ozempic etc shows that it's a bandaid.

Why do you think it’s like narcan; instead of comparing it to, say, methadone?

> So, calories in calories out. All you have to do is not ingest them.

That is not at all a conclusion you can draw from the link I provided. This is the conclusion I would draw.

> > In addition to adaptations in energy expenditure with weight loss, body weight is regulated by negative feedback circuits that influence food intake. Weight loss is accompanied by persistent endocrine adaptations that increase appetite and decrease satiety thereby resisting continued weight loss and conspiring against long-term weight maintenance.

But it just feels better to blame the individual.

> That's great, but it's ultimately like administering narcan to an opioid addict. No one argues narcan is bad (it's proven and effective at preventing OD deaths), but also no one argues it is a solution to the addiction (you cant shoot up as much as you want and take narcan if things go unwell).

But that's not how it works at all. It would be like taking a drug that makes you find opioids unappealing, and stopping you from shooting up in the first place.

Honestly you're basically making the case that any chronic condition isn't worth treating because it'll come back if you stop taking the treatment. And that chronic conditions are actually moral failings.

> Obesity of course is not as destructive (to a single individual) as an opioid addiction, but the fact that you regain the weight as soon as you stop taking ozempic etc shows that it's a bandaid.

I'm not sure that's not true. The leading causes of death in the US are heart disease (#1), cancer (#2), stroke (#5) and diabetes (#8) and kidney disease (#10). These are all diseases you are at risk of due to obesity. Opioid overdoses don't even make the list. In fact 15% of prescription opioid use is itself due to obesity. [1]

Obesity is responsible for ~380,000 deaths in the US per year vs about 80,000 opioid deaths. [1] So buddy if this was narcan for obesity (it's not) you should be pretty bullish on it.

[1] https://journals.lww.com/pain/fulltext/2019/10000/the_contri...

These drugs let you buy your way out of the willpower requirement.

Doesn't that describe a huge class of drugs. Lots of maladies will eventually go away by themselves if you ignore them, drugs just makes the process faster and more comfortable. I mean what are pain killers other than a way to buy yourself a way out of the willpower requirement to ignore your pain.

I'll provide another data point. While I too lost that much weight by eating one meal a day that was just the extra weight I got due to the combo of covid trapped in side and new child. But once I got back to my "normal" 20kg overweight by BMI I fundamentally cannot lose this weight. I eat one meal a day. Except Fridays where I have a take out meal. I don't drink. Because I can't due to medication. I have 2 sodas max a week. Doesn't matter still nearly obese. I have been this way since I got a car. There's something about walking and taking the bus that I can't emulate through going to the gym.

Right now I'm taking the extreme tactic of just not eating foods 3 days out of the week and that's working. Slowly. But no one who eats as healthy as me should have to do this. I show people my meals. I prepare them myself. I don't make fried foods. My meals are not low carb, but it's not like I eat pasta every day. I show professionals my meals. No one can say there's anything wrong with them.

The bizarre part is that at nearly 40 my medical stats are perfect. It makes doctors not bother me too much about my weight. People would kill for the kind of resting heart rate, cholesterol, etc I have at my age. This is just where my body likes to be if I'm not gonna walk 2 or 3 hours a day.

I'm not saying I'm like most people because i definitely have family who say they don't drink they just have a glass of wine or family members who complain that I only keep water in the house while lamenting they only ever seem to gain weight, but for some people weight loss is not so simple. If I have to skip eating all together every other day to lose a pound a week, something is strange.

> As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight.

My own anecdote: I lost 68kgs naturally by sheer “willpower” in 12 months. My weight stayed stable for about 18 months and then I slowly started to regain weight despite maintaining my exercise regime, my appetite was becoming more and more difficult to regulate, and I’d regained about 10-15kg’s after 2.5years. I decided I wasn’t prepared to go back to my much more obese starting weight, and so I got a prescription for a GLP1. I feel much better, I still actually decide what foods I’m going to eat, but weirdly on this medication, I’ve got a preference for fresh fruit and vegetables, and lean cuts of meat.

After my experience with weight loss, both “willpower” and substantial loss, a little regain and a GLP1 my anecdotal experience suggests to me that obesity is not a willpower issue, but rather a physiological issue with living in an environment that’s saturated with unhealthy food.

If only 1 or 2 people were struggling with obesity then sure maybe it would be a them issue, but this issue effects so many people that it’s got to be something far deeper than there being some sort of moral failing of the individual suffering from obesity.

> If only 1 or 2 people were struggling with obesity then sure maybe it would be a them issue, but this issue effects so many people that it’s got to be something far deeper than there being some sort of moral failing of the individual suffering from obesity.

I don't understand why we just take anecdotes seriously in conversations about weight, in a way that we simply would not anywhere else. We have data about this. There's boatloads of studies over decades and decades.

Obesity is genetic and epigenetic, and it's a chronic condition. Most people when exposed to an environment with lots of food/stress/etc will gain weight. Some will become obese. Some will not. Those that don't, will increase their energy expenditure and return to roughly normal in time. Those that become obese will not. [1]

We know those who become obese have an insanely hard time losing the weight because when they try, their metabolism slows down and their hunger goes up well in excess of what would be expected based on their reduction in fat mass. As you were beginning to experience, substantially everyone who loses a clinically significant amount of weight will return to roughly where they started over a few years without meaningful intervention.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226269/

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