I don't know how to feel about the idea that we need treatment for being overweight in general.
https://recursiveadaptation.com/p/the-growing-scientific-cas...
> The consistency that I'm hearing from all across patient groups is gain of control, whereas previously, there was a loss of control… All of a sudden they're able to step back and say, 'oh, well I had this shopping phenomenon that was going on, gambling, addiction, or alcoholism, and all of a sudden, it just stopped,' - Dr. Gitanjali Srivastava, Vanderbilt Medical Center
GLP-1s allow us to poke at the human to see what happens. Gene therapy will, hopefully, allow us to implement a permanent fix vs a hotfix (once the risk profile of such a genetic modification is better understood).
Engineer for the way the world is, not the way we wish it was. From your comments, you appear to operate under the belief that people can free will their way to success ("The better option seems to be face the appetite head on rather than putting it on a temporal cage"). That is not what the evidence shows, and I wouldn't ask anyone with a brain chemistry imbalance or dysfunction to attempt to will the condition away when proven interventions are readily and inexpensively available.
TLDR We are improving agency in humans using bioengineering, broadly speaking.
https://www.who.int/news-room/fact-sheets/detail/obesity-and...
https://www.cdc.gov/obesity/php/data-research/adult-obesity-...
You seem to imply that people have no self-control and are unable to power through difficulties. Because this is what is all about at the end of the day: self-control, one of the main things that separate us from the rest of the animal kingdom. It is the ability to regulate one's emotions, behaviors, and impulses in the face of temptations and urges.
What your parents taught you, your teachers taught you all those years during compulsory education lies on a solid foundation of self-control. Civilisation as we know is built upon it. Depends on it.
Yet your language implies that this is not the case. That humans are effectively, like toddlers, unable to use their self regulating powers to reign upon their emotions for the sake of a much better outcome in the long term. Fully unable to choose healthier foods or foods with lower calories. Fully unable to engage in free physical activities such as walking, jogging or running.
Truly makes you wonder how civilisations exist at all.
The idea that you can improve an individual's agency by having to temporarily disable a part of their brain is nonsensical. Surely, you can temporarily improve a specific decision making outcome (do I eat now?) by doing this. But you are not improving their agency anymore than you can by putting a gun on their head. In both cases, there is an external force temporarily suppressing a part of their normal decision making so they decide not to eat.
The underlying problem: lack of self-control is still there. You just tackled a symptom. There are others (deciding not to engage in physical activity for example).
A better solution would tackle the lack of self-control rather than some of the symptom. There is already some research on this area and some potential suggestions that if further investigated could help provide a better solution. But unfortunately, the solutions are virtually free and don't involve a lifetime subscription (could very well end up like diabetes medication which is arguably more critical for affected people yet with companies endlessly increasing the patents Disney style) to a drug.
They're absolutely not free. They fail at a high rate, which incurs medical costs. And when they work, they require--in practice--a lot of follow-up and coaching.
It's fairy-tale level mindblowing that we can look at the status quo where nearly half of the industrialised world is obese and get haughty about a drug that medically, demonstrably improves patient outcomes.
It's fairy-tale level mindblowing that we can look at the status quo where nearly half of the industrialised world is obese and get haughty about a free method (see physical exercise) that medically, demonstrably improves patient outcomes with no negative side effects.
That drug is the medical equivalent of a goldberg machine.
Exercising your willpower will have more benefits than physical exercise alone: mental health, cardiovascular and strength fitness and you could go on. And it is free. No big farma making money from you
Are you serious? How is "taking time" meaning that is not free? And you can't possible use that as a side effect. Brain fog is not even a common side effect. In fact, doing exercise is actually one of the recommended ways to tackle brain fog.
No no no. Obesity is very high in the US, but it's a big problem for lots of the world. It's a hard one to compare because different places use different cut-offs, but bringing this back to the UK: "64.0% of adults aged 18 years and over in England were estimated to be overweight or living with obesity [of which 40% are obese]"[0].
0: https://www.gov.uk/government/statistics/update-to-the-obesi...
I suppose, but that assumes you are viewing them as temporary weight loss interventions rather than lifestyle.
The key is to want to be healthy, and to arrive at a sustainable balance of nutrition and exercise level that works for you to stay at a healthy weight. Fad diets where you are denying yourself pleasures, or going hungry are not sustainable, nor is any extreme exercise regime that you find unpleasant or does not comfortably fit in with your routine.
slide 5: https://www.fractyl.com/wp-content/uploads/2024/10/DGVS-2024...
> You can take it indefinitely, but you must take it indefinitely in order for it to keep its effectiveness because the body isn't producing enough of the hormone.
I don't think we consider this (weight gain due to overeating) to be a GLP-1 deficiency, although I'd be interested to see research on that.
No negative long term effects have been observed in humans yet, but some animals in trials were at a higher risk of cancer.
We haven't observed any evidence that the addiction-suppression effect reduces over time yet. However, we haven't been studying that effect for very long.
It's more accurate to say that if you're depending on the appetite suppression to eat a sustainable amount of calories, you will begin to gain weight again after stopping the drug.
It's possible to use a GLP-1 agonist to lose weight and then keep it off with a proper diet. I took tirzepatide (Mounjaro) for 6 months, lost ~45 lbs., and have not gained any back after stopping the drug in July.
Notably a wide array of food either make them sick to their stomach or have colon related issues (diarrhea or constipation).
I suspect i do observe reward changes as well, but especially in the first few weeks it felt like i was observing weight loss strictly because they struggled to eat so much food without getting sick. So many of the foods they still wanted would just make them sick immediately or hours later.
I think they read that much of this is temporary to the ramp-up time, though. So hopefully in ~6 months they'll be on the full dose and won't have so many nausea/diarrhea issues.
Can you name some of the foods? Never been on GLP-1 drugs. But a good amount of fast food leaves me feeling lethargic and, if I eat it too quickly, nauseated afterwards.
On top of that, fatty meals, larger meals, and iirc fast carb heavy meals would all cause either nausea or diarrhea. Interestingly their mother is on the identical same generic GLP-1 shot, and has mostly the same side effects. It's kinda difficult to enumerate all the foods that went poorly, and it doesn't always feel logical. We eat a lot (entirely?) home cooked meals, so it's not like i'm even talking fast food here.
Off the top of my head a lot of dark green vegs have been working well. Brassicas and the like.
I should note that they're still quite happy on the drug. They still eat normally enough that it's not like they're only eating broccoli or something. We just have to plan meals very purposefully. It's also a lot of trial and error to find the subset that works.
It's worth pointing out that it's a minority of people who get any side-effects. I felt weird the first few days, but after that I only got myself into trouble if I'd forgotten to eat all day and then was faced with a hyper-satiating food with no natural portions -- an on-table buffet, someone placing endless bowls of chips and dips in front of me at a party, etc.
Before I started taking mine, I had to spend a whole month living the diet I'd be on (I lost 10lbs just with that diet change alone) to prepare. Lots of water, lots more fiber. Avoiding certain foods.
When I started taking the meds, my weight started to drop further and it was a minimal change to eat smaller portions (I felt full earlier). No side effects at starting dose.
Usually the 2nd/3rd tier of dose increases are where people get worse symptoms so your SO may be in for a more difficult time.
Some people don't tolerate the meds. Hopefully your SO is giving feedback to the doctor to course correct.
That's not really my experience. For myself, and the ten or so people I've persuaded to start taking them, nobody has really done much different other than listening to their body. I'd strongly encourage people to count calories to make sure they're eating enough, but I'd strongly encourage that of anyone who can't trust the hunger signals their body is throwing out in either direction.
Problem is i don't know what we could have predicted. The only thing the doctor predicted was the protein, which we did prepare on.
The other things have largely been a surprise and most importantly erratic.
> Usually the 2nd/3rd tier of dose increases are where people get worse symptoms so your SO may be in for a more difficult time.
I believe they're on the 3rd tier atm and the symptoms are lessening, though it's difficult to say if it's that or our successful adjustments.
And yea the doctor is aware - both my SO and their parent had doctors that planned to only increase tiers when they get reduced symptoms. So the doctor was planning for it at least, even if we weren't prepared on the specific foods they'd have issues with.
I see this said all the time about GLP-1 agonists, and it's a mischaracterization. It is true that when you stop taking the drug, your appetite is no longer suppressed, but you can still keep the weight off by eating a sustainable amount of calories.
Usually, the biggest challenge with weight loss is sticking with it, since it's normally miserable and takes a very long time. Taking a GLP-1 agonist speeds the process and makes it much more tolerable. I lost ~45 lbs. (~205 to ~160) in 6 months by taking tirzepatide (Mounjaro), and if I had done it without the drug it would have taken at least twice as long and been much more difficult.
This was always true and we know this is not the reason why people are overweight
I'm perfectly capable of maintaining my weight at ~160 lbs, but losing a large amount of weight to get there was difficult enough that I didn't try. A friend did pretty much everything to lose weight after she had children but couldn't, went on GLP-1 agonist for a few months, lost it all and kept it off since.
People always lament that, like most drugs, the effects of a GLP-1 agonist stop when you stop taking it. What I'm saying is it doesn't necessarily matter. Some people will need continued support, some won't. Taking the drug isn't a "life sentence" and you aren't guaranteed to re-gain the weight after you stop.
Notably it also slows digestion though, so you feel full earlier and for longer.
Semaglutide is a GLP-1 agonist only. Retratutide is a newer drug that is triple-action.
Generally on these drugs the action does not induce more "calorie burning", they are used mostly to modulate caloric intake.
>I don't know how to feel about the idea that we need treatment for being overweight in general.
Obesity is by orders of magnitude the worst public health issue facing humanity. Obesity makes every disease worse. Obese people are more likely to develop cancer, cardiovascular issues, respiratory issues, dementia, diabetes, and other afflictions. Obesity often leads to depression, lack of motivation, lower libidos, overall worse moods in general.
Of course there are "levels" to it, it's not to say everyone has to be a bodybuilder to be happy and healthy. Of course not. This is not about being slightly overweight, or "wanting to lose 15 lbs for summer"... But in almost every way, being fat makes life worse for the majority of people.