Scientists who laid groundwork for weight-loss drugs win Lasker medical award | Hacker News Reader

Scientists who laid groundwork for weight-loss drugs win Lasker medical award

washingtonpost.com

27 pointsbookofjoe52 comments

Popping miracle pills while still eating garbage, and avoiding any physical activity, will kill you alike. Obesity is not a disease, it's a symptom of other issues, like: bad diet, bad habits, mental illness. It's like trying to cure a broken bone with morphine - because it doesn't hurt, it doesn't mean the problem went away.

The "miracle pills" work by preventing you from eating garbage. They don't magically make you lose weight; they make you lose appetite, and also (as I understand it) get super sick if you eat garbage.

They literally temporary induce gastroparesis (slow stomach emptying), that is why some people may vomit food they ate 2-3 days ago.

Fun fact: this side effect can become permanent, even if you stop taking the drug!

Sounds like a super fun miracle pill people are just taking for funsies.

> literally temporary induce gastroparesis (slow stomach emptying)

Can induce. We don't know "the precise prevalence of gastroparesis caused by semaglutide," though we know it's "unusual" [1].

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10874596/

Obesity is a symptom of being constantly exposed to hyper palatable foods that for most people require massive force of will to abstain from them in a way never before seen by humans.

Eating crap is bad, but eating less crap is actually far better than obesity from “good” foods.

Yeah, this "epidemic" isn't a worldwide phenomenon. There's definitely societal factors of environment and lobbying that helped get it to this point. Telling someone to "eat less" is about as helpful as telling someone depressed to "get better".

The question is why aren't people in India, China, Japan, Vietnam, Africa, SE-Asia fat? It's not like hyper palatable foods don't exist in all cultures.

Why only some rich western countries with large disposable incomes and cushy lifestyles have a problem with people eating way too much?

Why do some people in the west (especially the US) always need to outsource the responsibility of their own bad actions and lifestyle choices to "societal factors and culture"?

Am I fat because I'm a lazy pig? No, it's obviously society's and the food's fault lol.

> Why aren't people in India, China, Japan, Vietnam, Africa, SE-Asia fat?

They are.

"Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country's population" [1]. (It's about 7% in America [2].) Meanwhile in China, "the incidence of overweight and obesity among school-age children...was 15.5% in 2010, rising to 24.2% in 2019 and soaring to 29.4% in 2022" [2]. Same story in Vietnam: "The prevalence of overweight among children aged under 5 years increased from 5.6% in 2010 to 7.4% in 2019. For overweight and obesity among children aged 5 to 19 years, prevalence rose from 8.5% and 2.5% in 2010 to 19% and 8.1% in 2020, respectively" [3].

The only country you're right about is Japan, though overweightness is growing there, too [4]. Same across Africa [5].

There is absolutely a systemic effect causing obesity to rise worldwide. That doesn't remove individual agency from the equation. But it's sort of like the opiate crisis: you can have both flawed individual decisionmaking and a systemic bias that fixes the dice while offering more rolls.

[1] https://en.wikipedia.org/wiki/Obesity_in_India

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357130/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9947684/

[4] https://www.japantimes.co.jp/news/2024/08/28/japan/science-h...

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721807/

>They are. "Obesity in India has reached epidemic proportions in the 21st century, with morbid obesity affecting 5% of the country's population"

5% of the population is hardly enough to call them fat but fair enough, seems like the entire world is getting fatter as they become more wealthy and industrialized.

> 5% of the population is hardly enough to call them fat

But 7% is? India and America have statistically similar rates of morbid/severe obesity.

That said, about 74% of Americans are overweight or obese [1]. The fattest Indian states barely break 40%. But if you only looked at middle class and above, I wouldn't be surprised to see numbers similar to America's.

[1] https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/obe...

I always wondered how well would it go down if we used same arguments for being poor. Just earn more, spend less. Get rid of anything that costs too much money.

> for most people require massive force of will to abstain from them in a way never before seen by humans.

Is the bar this low nowadays? It doesn't even require that much willpower - we're not talking firewalking here - it's only that the fight is constant. https://0x0.st/XYet.webp

If it didn't require that much willpower; then the obesity rates wouldn't be what they are, right?

It might be easy for you, but it clearly is very, very hard for a lot of people.

> If it didn't require that much willpower; then the obesity rates wouldn't be what they are, right?

You're missing one variable in your equation, mate.

I'm not sure I get the point you're trying to make.

But who wants to fight constantly? Frankly that seems more unhealthy than a chill pill for appetite.

I think cadence of eating is probably more important than quality, which is not to say that quality is unimportant. I think we just eat too often. I think people were steered away from fasting with the notion that fasting will impair your metabolism - skipping meals used to be quite common.

For a long time eating many small meals throughout the day was advised to keep your metabolism high. Looks like that was completely counterproductive…

Now the advice is to limit eating to an 8 hour range of the day, and possibly fast for a whole day occasionally to decrease your insulin resistance.

Many older people have a laugh at fasting as they describe it as young people finding out about skipping meals and calling it a new thing. But such fasting was pretty much successfully stamped out of the culture so it did have to be rediscovered. Fasting was tied to vanity and corporate corrupted science conspired to successfully frame fasting as counter productive and bad for your health.

When I was a 8yo child the government sent in health advisors to teach children about low salt and low fat diets that are high in carbs. The two health advisors were the most unhealthy looking people I had seen in my entire life up to that point. One was the fattest person I had ever seen and the other was the skinniest - both looked like they were knocking on deaths door. I wondered if they ate lunch together and how that would look. I figured, as a start, I should do the opposite of whatever these two suggest - I dismissed the food pyramid guidelines and resolved to eat a more traditional diet on the basis that people who ate such a diet looked like they lived longer and healthier lives. One of the many instances that instilled my general mistrust of the government. I would find out later that it was corporate corruption of food science that inspired these teachings and my simple heuristic held me in good stead.

I work for a company that does (among other things) weight loss. I will tell our patients about this immediately, as none of them has ever tried diet or exercise, they just went from being overweight to "might as well shoot myself up with some stuff", thank you for the amazing insight.

Why is it always people feel like this is their moment to shine, and go through the trouble of creating an account, just to say other people shouldn't take medicine to cure what ails them?

Since around a year ago, my go-to answer for this question is now "propaganda", aka "some marketing department somewhere astroturfing".

There is always this unshakable belief that whatever process causes people to gain weight is totally reversible with some gumption and will power.

Absolutely, and there is a very noticeable divide between people for whom exercise and CICO work: "just eat less and exercise more, bro" - and those, like me, where you will absolutely try anything and everything for many years with little affect until you eventually give in and try something that finally kills that little voice that appears on waking that constantly tells you that you want food, need food, need this specific food.

I tend to agree - much more needs to be done to tackle poor nutrition - however just like controlled use of morphine in serious pain situations - they do have there place.

The key is to use them as a catalyst, rather than a crutch.

So I would only allow them to be prescribed in the cases of very serious obesity as part of a plan than moves them on to diet and exercise.

> It's like trying to cure a broken bone with morphine

it's not like that. it's like trying to cure obesity by having fat people eat less, because that's what it is.

Doesn't work like that.

Firstly, you can't eat junk when you're on this stuff, it makes you feel really sick. So you're spectacularly wrong about that.

Having taken it myself, what it actually did was fix my fuel gauge. It stopped me craving high-carb food when I was already full. I felt what other people had described as feeling full for the first time in over a decade.

On the other hand, the side effects can be horrid. Be careful taking this stuff. It is easy to get dehydrated, drink plenty of fluids.

So stop your high-horsing and I say this emphatically, go away. Never, ever, say that again.

And I'm being deliberately harsh here because people like you are part of the problem.

You are not helping. We've tried guilt shaming people for decades now and IT DOES NOT WORK.

It is actually some sort of problem with the body. Commonly known as a disease.

I now KNOW that I'm not weak or without willpower. I KNOW you are wrong.

Whatever crap a scientist came up with and put in high carb food, that now infests all our food, destroys the body's ability to feel full on a portion of the population.

Before this I have tried, and stuck to for long periods, low carb, calorie counting, lots of exercise. Didn't work.

Wegovy was a true eye opener that something's wrong with my "sated" and "full" body fuel indicators.

I couldn't stay on it as it was making me feel too ill, but even being on it for 6 months seems to have help change my 'baseline'.

It doesn't work for everyone, it can make some people really ill, and I did it a bit too casually and it is in reality strong stuff so I would definitely recommend talking to a doctor first.

Actually, obesity is (also) a disease and treating it improves all kinds of outcomes even without other interventions.

[flagged]

There's nothing at all interesting about this. People take insulin their whole lives, and statins, metformin, immunosuppressants if they're transplant receivers, steroids for asthma, losartan for blood pressure, Levoxyl for thyroid malfunction, probably many dozens more. You take drugs for the rest of your life because that is a superior option to the alternative, which is suffering (or dying) from the condition the drug treats. Nobody who takes those drugs wishes the drugs didn't exist. Only people on message boards do. They have the luxury of comparing them to fantasy football therapeutics and morality plays.

The pharma company that invents a pill you take once and stay stably at your goal weight for the rest of your life will make approximately 8.6 bajillion dollars. Nobody's holding it back to preserve profits for Wegovy or whatever.

Until the lawsuits. Many miracle weight loss products have come to market and have done well initially only to discover some side effect. At least you can join the class action lawsuit and don't need to shell out anything to find out your preexisting issue means they don't have to payout.

You can say that about every new long term therapeutic. For what it's worth: these are not especially new drugs; they're just being used for a new purpose.

There have been a variety of weight loss miracle therapeutic with little success which is not the case for all medical areas.

That doesn't seem like it would have much to do with uncertainty about side effects, given these drugs were already widely used.

I applaud your patience for replying to the pitchfork mob of "have you tried just not being fat?".

>Nobody who takes those drugs wishes the drugs didn't exist. Only people on message boards do

you can't just work out and cure asthma. You can't lobby the government to increase air quality and improve your asthma. That's the issue.

We were sold a problem, the government subsidized it, and people are getting medals for a financial solution. That's what's interestingly distinct about this case. we're using miracle medicine to mitigate something that should be fixed with better lifestyle changes (including the ingredients and portions in food that allows that to proliferate).

People are getting medals for a breakthrough in pharmacology. This is an article about scientists.

I feel this isn't answering my reply with a charitable interpretation. But that's fine, I don't think there's much conversation HN is going to have on this topic. The obesity epidemic topics tends to be a sore spot here.

My sore spot is that I have family working in drug discovery chemistry and this thread belittles that work in the service of some toxic combination of "do you even lift bro" and "big pharma". This is HN, on a subject that is about science, and it's not the GLP-1 advocates who seem to be sore about it.

> You can't lobby the government to increase air quality and improve your asthma

What? Yes you can. How do you think we got the EPA?

While I agree with the general point, for some number of people obesity isn't treatable by lifestyle changes.

You carry stable insurance and good benefits, and you've been seeing your PCP for decades. They help you find specialists when needed, and you've established trust and rapport; the front-desk staff welcomes you by name, smiling.

Your loved ones are available, and willing to discuss and support your decisions. You head to the pharmacy every month, same day of the week, and pick up your prescriptions together. Your loved ones help you divvy everything up and measure out exactly 8oz of water, because that's what the label says to drink.

Your physicians monitor you, and you've already accomplished lifestyle changes, a better diet, and plenty of exercise, because you shop at a nice grocery store, your dependents cook at home, and you can afford a gym membership and a personal trainer.

Yet sometimes these fall short, and so you agree to treatment. You may report debilitating side effects, and your prescriber adjusts everything until everyone's satisfied. Your insurance is covering everything, and your loved ones rarely need to follow up on billing errors or to appeal decisions.

Your alarm sounds every 8 hours, and your dependents pour another 8oz of water, and you take your meds, obedient unto death. You're following all directions and faithful to the system. Your health and life itself is in good hands; no need to be concerned about garbage forums or fake gurus who wrote a self-published book.

You're voting for Kamala, or Mitt Romney, and expanding health care, because that is justice for the world. Your advance directives are in order, and power of attorney assigned to dependents, who are in tune with your wishes, and ready to put you in their car, or call 911, if you should be incapacitated or helpless. Suffering is alleviated by warm relationships and a loving touch.

> smoking, measels, etc. are much worse and people don't seem to care nearly as much.

Not a lot of people smoking and getting measles these days. But obesity is, apparently, back on the rise and impacts at least 40% of the US population.

Something like 70% of the US population is overweight or obese.

Restauranter's nightmare. It's like 150 bucks / month in most of world vs 1000 in US, once generics drop to 20, most people can come out ahead in groceries.

> smoking,[]. are much worse

Sure smoking effects are worse but there's a easy solution: never start smoking. But you can't stop eating..

> a business has developed a treatment that requires patients to pay the company for the rest of their lives or they revert

I know plenty of people who took semaglutide, hit a target weight and then stopped. The research shows a statistically-significant permanent effect [1].

[1] https://pubmed.ncbi.nlm.nih.gov/35441470/

People do take other drugs for the rest of their lives, as commenters point out, and which I didn't address in my initial comment above:

Those drugs often treat problems that can't otherwise be treated, such as diabetes. Weight loss has other treatments, though we now know it's often not as simple and easy as many thought (often it's not just 'eat less'). Certainly there will be a substantial net benefit for many people.

On the other side, the dosing requirement matches the current trend in business, which is rent capture. When does the patent run out?

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