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Comment by neverokay | Hacker News Reader

Ozempic? Or just eating less?

Probably the latter, but "just eating less" is next to impossible for a non-trivial minority of people much the way "just stopping heroin" would be for someone battling addiction.

An aid to help clear the noise in the brain seems to be unsurprisingly useful, then, in achieving these outcomes.

Sure, but Ozempic is not the only drug that suppresses appetite. So if the underlying benefits are from “just eating less,” then the study should also examine the effects of other pharmaceutical interventions that suppress appetite.

It's not the only drug that suppresses appetite, but GLP-1 agonists (Ozempic, Zepbound, etc) appear to work for a larger percentage of the population, and significantly outperform previous appetite suppressants.

There's also findings that suggest that it goes beyond simply suppressing appetite, but also manipulates the "reward" center in the brain. Individuals who take it to lose weight find that they have reduced desire to drink or smoke, suggesting it's less that they struggle with appetite and more the medicine helps overcome addictive behavior.

Nicotine suppresses appetite as well and that has been used by humans for thousands of years.

That’s so silly, these drugs aren’t even anywhere near the same league of effectiveness. There’s plenty of fat people who take nicotine all day.

Hmmm...if as many people consumed semeglutide you would have examples of fat people in that population as well.

You certainly would, because not every case of obesity results from the same mechanisms. But just as with all the other what-about comments, this comment misses the point: this class of drug is wildly successful, and it's the most specific drug for this problem that's been developed so far

https://www.healthline.com/health-news/ozempic-glp-1-drugs-m...

Here's a good piece running through the failure modes in lay terms.

This is genuinely one of the stupidest conversations I’ve been involved in. If nicotine was as effective as Ozempic at appetite suppression then everyone would know about it, it would be commonly used in medicine to treat obesity and Ozempic would never have been created. I hope for your sake this is pedantry instead of ignorance.

Sure, it's just not as good as Ozempic at doing that particular job.

> Ozempic is not the only drug that suppresses appetite

If there were a drug that is equally as effective with the same or fewer downsides, then it would've been just as popular for that use case already.

Someone else mentioned nicotine. There are still a lot of "unsuccessful" nicotine users compared to Ozempic.

Funding tends to be a constraint with larger studies, and it's best to keep studies focused anyway — less confounding variables.

Here, I'll pontificate a bit. For instance, study 1 finds that Ozempic is associated with a reduced risk of X. Study 2 is now funded to see if the association can be experimentally reproduced to establish a causative relationship. Competing institution gets Study 3 funded to test competing drug Mounjaro, reaches same conclusion. Study 4 by another institution finds same conclusion with a drug that acts in an entirely different manner, Buproprion. Study 5 by yet another institution finds similar results with amphetamines. Study 6 is funded on the premise that there's an underlying mechanism that needs to be explored, gets funding to study caloric restriction, gets similar results. Meanwhile, study 2 finds a causative relationship between Ozempic and X, concluding experimentally that Ozempic achieves X by inducing calorie restriction, which concurs with study 6.

I'm oversimplifying. But you see where I'm going with this. Much easier to both control and fund the smaller studies than a giant one, and you develop more knowledge in the process.

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Also, I'm not an academic, so I could be wildly off base. Would appreciate a gut check by someone who actually does this for a living.

Just to hammer the point home, imagine suggesting a cure for heroin addiction is to amputate the arms so they can't shoot up. Then look up what gastric bypass surgery is.

For some reason we don't take food addiction seriously at all. You can't walk anywhere without seeing a picture of a Big Muck or something. Heroin addicts don't have to see their vice everywhere they go. Even cigarette addicts don't.

"Just eating less" may be very difficult, psychologically, in the context of an otherwise stressful and distracting life. However, I find that if you are able to eliminate those issues and focus on your own health and diet -- a big "if", I will grant -- then it's actually not that hard, on its own. You get used to it.

That GLP-1 agonists are as successful as they are and appear to modulate the reward center of the brain (per the latest research on the same class of drugs and smoking/alcohol cessation) suggests that it's certainly not just a psychological matter.

That's why I made the heroin comparison. People underappreciate the addictive properties of refined sugars.

Edit: people also looked at the opiate angle too, apparently. https://pennstatehealthnews.org/2024/04/qa-can-weight-loss-d...

My wife takes full dose. Shes lost 60 pounds in six months. I have been taking the smallest dose.

Normally i can eat a full meal, and be hungrier at the end of it, then when i started.

For a couple of days after taking the small dose. I get full after a small amount. Then feel full for most of the day. I need to go up to a higher dose as this effect fades before next dose.

> Normally i can eat a full meal, and be hungrier at the end of it, then when i started.

how?! what exactly are you eating that's making you feel hungrier, not full?

https://www.google.com/search?q=chinese+food+makes+you+hungr...

It would be interesting to see a comparative study of glp1 agitators to intermittent fasting. It surprises me that people will spend huge amounts on a drug which makes them feel less full, rather than have the tiny amount of willpower it takes to just not eat.

Don't be so fast to assume that your willpower isn't just from genetic luck. You might as well be surprised some people are short. I mean, look how much better your life is as someone tall.

We humans are very quick to assume our positive traits and outcomes come from conscious decisions to make things that way. It's why every successful person has a book about how they chose to become successful. They just worked hard. It's something we want to believe rather than admit anything came down to luck of the draw.

You’re right in your argument about “just do this” suggestions without considering how hard it can be based on intrinsic factors.

I feel there is a point in the thread you’re commenting on though. It would be scientifically interesting to know whether the desired(positive) outcomes of this drug can be replicated by consciously controlling the quantity or quality of food without the use of the drug(by those who can). Still, presenting the result in a useful way rather than stating the drug is useless.

If you had a way to get the same results without any pharmaceutical intervention, and you’re a lucky one that _can_ do it, wouldn’t you want to know how?

It has been tested, Ozempic wins. These drugs are usually tested specifically on people who have tried and failed dieting and exercise interventions. I doubt any doctor is prescribing this without first asking, “have you tried diet and exercise?” The side effects can be pretty gnarly for some people and it’s very expensive and hard to obtain.

And not just genetic luck, but luck of childhood circumstances. Lots of people were given a deranged relationship to food as a child by their parents, leading in many cases to actual metabolic derangement as well.

The common theme in normal weight individuals is their comparative lack of food drive, not an outsized capacity for willpower.

When you talk to "skinny" people you'll hear things like they just forgot to eat or I just had a couple bites of cake then felt full/had enough.

Alternatively when you speak with heavier people you'll realize that they're white knuckling their entire lives (because calories are so abundant). On average they're actually exerting more willpower around food than skinnier people.

Not everyone of course, there are folks in either camp, but at population scale lack of food drive is what keeps people skinny in a calorie rich, low activity environment.

I definitely could have worded this better. I'm NOT suggesting that people who struggle with weight just don't have willpower. I was suggesting that it would be interesting to see a study comparing 2 modalities.

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