Hacker News Reader

Comment by OptionOfT | Hacker News Reader

As someone who struggled with their weight his whole life, this medication is a god send.

My wife and I cook every evening. We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.

Every morning I wake up and go on a 5 mile hike.

And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.

And you know what it is? It's volume. I eat too much. And I have no cookies at home. I have no chips at home. No soda, no alcohol. I drink black coffee with a splash of milk. I don't eat any sweeteners.

I have had weight loss surgery (lap band) which was later reversed as it hurt 24/7.

Now, on ZepBound I lost 20lbs in 2 months. I am not hungry. My brain can actually focus on the things that matter.

Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

View on HN

> Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

"Getting fit and staying fit" is a form of social capital, because it's extremely hard and only within reach of a small portion of the population. "Being fit" is strongly aligned with "being attractive" which confers all sorts of cross-cutting social benefits.

Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.

In what ways is fitness not within reach for a large portion of the population?

Studies have repeatedly shown that lifestyle modification does not result in sustained weight loss for most.

Not going to waste my time providing sources to remedy your ignorance. You are more than capable of doing this research yourself.

Nor will I waste time proving the opposite.

Until next time we meet on the internet. :salute:

Yeah the problem with providing a study is that proving a negative is so hard. Everyone assumes there exists a successful RCT with a 5-10 year time horizon for weight loss via lifestyle interventions. And there just isn't one, and the only way to know that is to search for one.

How does "burning more calories than you consume" not result in weight loss for most people, lmao?

How do people not realize that the digestive system is dynamic and that as you change the calories in (and the type of calories) that the body changes the out.

You can't outrun thermodynamics. But your body will change its efficiency.

Because your metabolism changes. If you ate 700 calories per day it would be harder for you to lose weight than if you ate 1400 and worked out.

You’d still be eating less, but retaining more weight. Why? Because your metabolism slows down significantly if you don’t fuel it, and that makes it harder to lose weight, not easier.

Most things in life are not binary, and are affected by more than just a single choice.

Yeah. So that's why working out is the solution lol. How is this controversial?

Because working out, alone, is not the solution. You could work out all day and still not lose a pound. Plenty of studies have shown this.

Moreover, have you ever tried to work out at 450 lbs? No? It is an immense effort, often literally impossible for most people at that weight, and the best they can manage is a walk around the block before their cardio can’t keep up.

What then?

See above, where I reminded people (which includes you) that things are rarely binary.

Proving a negative is a hard and sometimes an annoying in itself ask plus you're probably frustrated with the general attitude to this kind of conversation (especially if your main expectation/experience is others don't like the pill answer out of spitefulness) but that doesn't make this kind of response any more okay here.

For others open to listening to why it's often out of reach: Outside the go-to "motivation" type discussion gravitation (and, keep in mind, not everyone can just 'motivate themselves past their addictions' in the first place or they wouldn't be addictions) it is also disproportionately hard for those struggling in other ways of life (financially, mentally, physically/genetically). Some of these can be cascaded effects, like support systems (e.g.not everyone's partner is willing or able to go all in on it like above). Others can be that it is medically not as easy for some people to lose weight at a given intake amount which makes it just that much harder.

Most people would like very VERY much to be fit. That most still aren't fit should be a good indicator it's out of most's reach to "just eat less" independently. All this said as a person who is not overweight themselves but has been around many people in different situations, abilities, and luck that have left them unable to be so as well.

Oh well, back to my unhealthy lifestyle because study of some thousand something in one country said it’s impossible to change!

I didn't ask if lifestyle modification resulted in sustained weight loss. I asked in what ways is fitness not accessible to the majority of people.

Something like 15% of the world lives in extreme poverty. This is darn near the best it's been in the history of the world (there used to be much more poverty by percentage), but this group would likely have trouble being fit. They might be skinny, but surely not fit.

Ignoring that extreme the questions maybe different: How many hours does a median person have free from work, commute, and sleep? How much time must be spent managing exercise and diet to achieve fitness?

I think if you took the time to answer those questions for the median or modal non-impoverished person in the world you might find that fitness is actually quite difficult to achieve.

It seems really hard in the US.

I don't understand, impoverished people aren't taking Ozempic, either.

Parent poster wasn't referring to Ozempic but a general healthy lifestyle. Which requires resources many people do not have such as time, money, education etc.

The work-life balance & climate in some areas of the US (and other areas of the world) does make it hard to exercise... but that's only part of the story.

Eating healthier requires very little extra time: perhaps 2-3 hours a week for shopping and meal prep.

- making a salad take 5 minutes.

- baking 10 meals worth of chicken takes 30-45 minutes, with about 5-10 minutes of actual prep time.

- baking a few meals worth of salmon, or some other fish is about the same as chicken.

- cutting up an apple takes 1-2 minutes. Bananas, peaches are ready to go, almost no prep required.

- steaming fresh broccoli takes 3-5 min of prep... and about 15-20 minutes total.

- Equally important is making small decisions to avoid or limit less healthy foods, which requires no time at all and often saves us money [that we can spend on healthier foods instead].

Exercising: 30-60 minutes a day, most days, is ideal but anything is better than nothing. A morning and evening 20 minute walk is great place to start (and can be so relaxing). If a person spends time on Hacker News, they could instead allocate that time to exercise. There are free 15 minutes yoga videos on Youtube. A set of push ups requires 60 seconds. Sometimes I do body weight squats at my desk at work (especially during Teams calls, camera off of course).

Sleep: get at least 7 hours of sleep a night... ideally starting to bed before 11pm. more sleep gives us more energy to put towards being awesome during the day and more energy for exercise and doing the extra work to eat better.

I think almost everyone can set aside 6-10 hours in their week towards building their health. It is a matter of priorities... a person's health should be one of their top priorities.

just look around outside

Fitness require making efforts and determination.

Taking a pill doesn't.

That's why it will always be out of reach of some people.

Fitness is in reach for almost everyone on Hacker News. There are folks who have serious health issues or disabilities that preclude exercise... but the rest of us [the majority?] can walk more, do body weight squats, some form of incline push ups, and so forth and build larger successes on top of smaller ones. We can start by taking a morning and evening walk.

We all can make healthier decision about what food we put into our bodies (a lot could be done to make our food supply healthier, as well). I find I have to be more strict about eating right as I get older to maintain my health.

I feel like folks saying 'fitness' isn't in reach [for most/many of us] is a cop out. This is anecdotal, but i know people who have lost 100+ lbs in their 40's and 50's and completely turned their life around; I know people who have reversed Type-2 diabetes through diet and exercise. These people have busy lives with a lot of responsibility... some of these people live in city areas where access to gyms or outdoor spaces for walking, etc. is not convenient.

I have a few doctors and other medical professionals in my family... knowing what I know, I am 'almost terrified' of becoming metabolically unhealthy and overweight. Many of the maladies that afflict us are metabolic disorders (in whole or in part) due to the long term effects of poor diet, lack of exercise & quality sleep (high stress doesn't help either). Poor metabolic health tremendously increases risk of almost every disease and malady: diabetes, heart disease, heart attack, dementia & Alzhiemer's, many cancers, stroke, depression and other mental illnesses, sleep apnea, susceptibility to infectious disease, etc. Poor metabolic health also indirectly leads to higher likelihood of issues causing chronic pain: e.g., herniated discs in the spine, ankle/knee/hip problems, migraine headaches.

I'm glad Ozempic exists but it is not a cure... it is an aid towards building a healthier life. Use Ozempic as a tool, by all means!!, to start your journey and get yourself into a better situation physically. But please use that good start to pursue the 'best/healthy you'... do it for yourself.

I would say my concerns are far more in the range of downstream effects from the medication. Specifically, I am concerned with muscle retention. Concerns aside, it's a little hard of an argument to swallow having visited many other countries where these things are simply not an issue. How can it be argued that the cause is anything other than behavior when so many others are doing just fine? There is more to this story than painting people as evil.

The “more to this story” is likely endocrine disruptors in addition to (and associated with) the other “behavior” issues you’re alluding to.

And our answer to it is… another endocrine disruptor. But this time we’ll call it something else (GLP-1 agonists) and laugh all the way to the bank.

> How can it be argued that the cause is anything other than behavior when so many others are doing just fine?

Aren’t you are ignoring the way western society influences behavior? eg lack of walkability of suburbs, massive price difference between fresh and processed foods, constant advertising of junk food & alcohol.

How do people move around cities? They teleport?

Where there’s a will there’s a way.

> constant advertising of junk food & alcohol.

Nobody is forcing you to eat those.

> Nobody is forcing you to eat those.

No, I think force feeding junk food is pretty rare but that seems like a straw man.

Consider children. Their brains are not fully developed and they have little agency in determining the food they have access to. Childhood obesity is on the rise. So blame the children’s choices?

Ok, sure, blame the parents. I agree of course it is the parents responsibility, but the cards are often stacked against parents by big corporations with government subsidies (in the us).

It’s really weird to me to argue that this is completely a problem at the individual level and not a social one—and I see no other way to interpret your comment.

> Consider children. Their brains are not fully developed and they have little agency in determining the food they have access to. Childhood obesity is on the rise. So blame the children’s choices?

Been there. It’s always bad parenting. I had to fix shitton of issues myself, because of idiot parents.

The point is that the isn't some mysterious force we cannot comprehend. If the odds are stacked against us, change the odds instead of medicating everyone.

At the same time, we are all still individuals. We agency to make life decisions. I generally don't subscribe to the notion that people are helpless even in the face of a big scary corporation. There are two competing ideas. Either 1 there is some unknown force creating this problem(but doesn't extended to the entire human population for some reason) or 2 we know there are environmental causes. For #2, why systemically stack a drug on top if we know what the boogy man is? #1 we need to seriously buckle down on research on what the environmental/behavior factor is so we can bring everyone back to human baseline. Using drugs for people already in great suffering is one thing, but that is very different from widespread distribution as a preventative.

I think you lost the thread (literally the context of threads I was responding to), because much of what you’re saying aligns with my point. OP was mocking the idea that environmental factors should be taken into account and advocating a no-excuses policy of individual responsibility.

If you think I am advocating medication or implying that “people” are helpless against corporations, read again. I agree with most of what you say although I am not sure we need more research (although of course I don’t discourage it). Maybe one day we’ll prove that the government subsidizing corn so that big corporations (spun off from former tobacco companies as another comment pointed out) can super cheaply mass produce syrup which our evolutionary biology finds difficult to resist and market directly to children turns out to be bad for health outcomes and good for profits (for the medical industrial complex as well). Oh wait, we already know that.

> Where there’s a will there’s a way.

Yeah? Even if I’m disabled, I should got for a walk, just because I want to?

Pretending the world is binary is a fun exercise, but it is always untrue.

We’re talking about people who are able but unwilling to make the effort.

Are we? Because most people have this conversation and talk about people they think are able and unwilling, when in reality the vast majority are willing and unable, for one reason or another.

>Nobody is forcing you to eat those.

No, but social conditioning normalises it and those in the lower socioeconomic areas of living buy the cheapest rather than most nutritional food and are way less likely to read informative articles or posts about healthy eating. It really is heavily influenced by a lack of supply of healthy affordable food.

Not sure why you are downvoted. I had the same question about who’s behavior we are referring to. Attributing obesity simply to individual behavior and choices is pretty myopic. Just look at government subsidies for corn. There are larger forces than the individual at play. This is a social problem.

It seems the article is now behind a paywall (can only get a reddit link w/ a screenshot atm [0]) but there was a study that showed body composition after 25% weight loss in terms of fat mass and fat-free mass (and the portion of fat-free mass that was skeletal muscle mass) after traditional several interventions, and also compared the breakdown of weight lost in terms of FM and FFM for several GLP-1 medications:

- diet alone

- diet + extra protein

- diet + exercise

- retatrutide

- tirzepatide

- semaglutide

tldr is that, despite some muscle loss, muscle as a percentage of body composition is higher (~50% FFM at start, whereas weight lost with GLP-1 meds ranged from 25%-39% of muscle). It also seems like the muscles will likely function better with less insulin resistance:

> Intentional weight loss causes a greater relative decrease in body fat than FFM or SMM, so the ratio of FFM/SMM to fat mass increases. Accordingly, physical function and mobility improve after weight loss despite the decrease in FFM/SMM, even in older adults with decreased FFM and SMM at baseline. In addition, weight loss improves the “quality” of remaining muscle by decreasing intramyocellular and intermuscular triglycerides and increasing muscle insulin sensitivity

https://www.reddit.com/r/tirzepatidecompound/comments/1dtzr2...

How will the person have less insulin resistance when GLP-1 medications stimulate the release of insulin?

It seems to me we're curbing eating by flooding with insulin, when one of the big damaging effects of overeating is insulin floods. (Or perhaps I'm misreading, perhaps insulin floods are only bad b/c they cause insulin resistance which causes more overeating?)

You aren’t being flooded with insulin with the GLP-1 meds. You have food in your body, but my insulin levels, on average, are possibly lower than yours (if I’m in need or a GLP-1 med) despite eating the same amount.

A GLP-1 med stimulates the release of insulin slowly over a sustained period of time, not just as a massive spike when I eat.

Everyone (that isn’t diabetic) has a massive insulin spike when they eat something that spikes their glucose. GLP-1 meds don’t make that better in any way.

Are you saying that us fatties should move to those other countries where our “behavior” will be kept in check?

I don't understand the hostility. I am attempting to discuss the topic on a discussion site. My point is not too instruct any one person on what the exact correct solution is. However, I find the selective vision with this topic to be dishonest and ultimately damaging to the conversation(and progress by extension). One can still come to the conclusion that drugs tip the balance positivity enough to use them without sweeping other realities under the rug.

> Concerns aside, it's a little hard of an argument to swallow having visited many other countries where these things are simply not an issue.

Which countries? As far as I know, most Western countries have roughly similar issues with obesity, at least directionally.

It can be quite eye-opening to travel from say, the UK to Hungary. Walk down a busy street in London and you'll see many overweight people. Walk down a similar street in Budapest, and you'll see very few.

The numbers don't seem to bear out your impression, Hungary has higher rates overall than the UK. Perhaps there is more social mixing in the neighborhoods you visit in London vs Budapest.

This is the essence of the moral argument: Someone chooses to abuse a substance, they become a more frequent abuser, and the abuse piles up damage, which the person ignores to continue abusing.

The essence of the argument against drug interventions is that the root cause is personal choice, and therefore a drug is a shortcut or crutch and does not address the root cause.

Many people feel that the real cause is the structural changes to the person's brain, body, and daily routine that reinforce, and are reinforced by the initial tiny over-consumption, which compounds over time. It's like a debt where you are stuck paying interest, no matter how much you'd like to pay off the debt. Addiction is a system in which the person's willpower goes against everything they have set up over decades. It's unreasonably challenging for nearly everyone to walk it all back. Insulin resistance is one of the most pernicious effects of even small over-eating over time. The body and mind do not feel satiated even though enough calories have been consumed. It's not "I would enjoy another slice of pizza", it can be "I am still starving".

And yes, the environment in which we live, where it is less stigmatized to overeat, and food is treated a certain way, more like a drug than fuel, is part of that system.

I think some of the observed muscle loss might be just burning the fat tissue embedded inside muscles (marbling).

Some, but sarcopenia caused by rapid weight loss is a well known phenomenon. I think the tie to ozempic is a little overblown, but is is a real issue.

In a “traditional” weight loss strategy, you paired calorie deficit with an increase in physical activity (cardio, resistance training, etc). This increased physical activity helped protect you from muscle loss (your body tended to recognize that muscle was important so it burned fat at a higher rate)

With ozempic, people can lose weight without changing their sedentary lifestyle. Since your muscles are not needed, your body is free to grab energy from wherever it can. In some studies, almost half of weight loss can come from lean tissue.

Is it better to for an obese person to lose weight vs not lose weight? Absolutely. But it would be even better if they also changed their lifestyle to protect their muscle mass.

I'm curious how is lean mass measured and why do we think what we measure is actually lean.

I'm not denying that under some circumstances like in the case of severely obese patients their bodies might think protein is better energy source than fat but in people with normally functioning bodies it shouldn't happen a lot especially if they get enough protein in their weight loss diet.

>Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.

Nice one. I think it's a bad idea to be dependent on drugs for something you can achieve on your own, especially if the drugs don't have a long term safety profile. Pretty sure I read somewhere that they don't. If you're going to use them for a short period of time, that's fine. Don't say nobody warned you if that doesn't pan out though (or worse, you have a bad drug response).

> Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.

I don't think this is just about a social club. Battling weight loss and habits is foundational to the human experience from the most recent centuries. Be it drugs, or anything else really that changes the nature of these challenges, people are going to feel discomfort because it's an attack on their understanding of the world, and in some ways, their beliefs.

The idea is this drug kick starts people to form new habits going forward. As witnessed by other commenters I. This thread as well.

Precisely. It doesn’t do the work for you.

This is funny how black & white some folks here want the world to be painted if it suits them.

You know by far the biggest benefit of doing hard workouts or doing extreme sports? Its not muscle mass nor how much they lift. Its about how it changes your personality, resilience to mental or physical suffering and ease of overcoming it. You know, hardest part of doing anything is winning the mental resistance game and just start it. Keep doing this every day in various forms for decades... A very strong resilient personality under various circumstances is almost an unavoidable result if you are putting in enough effort.

If somebody can't even stop themselves buying and paying for junk food at grocery store or has to overeat constantly otherwise getting anxious, that part of personality is missing and another, less desirable is present.

Who would you prefer to have as a close colleague you depend on, life long partner, a close dependable friend? Who do you think women would prefer subconsciously? Societies have always some form of castes, even hardcore communists have/had them, in US one of very popular is based on career/income/wealth. And this is just another dimension or caste, so let's not act like we are not humans with flaws and subjective preferences, we don't give our respect out for free.

These medication help with none of above, in fact they strongly reinforce such behavior and personality traits. But to each their own. One benefit I can see that they could start / help with movement from former to the latter, but that's rarer than people like to admit.

That’s cute. You know nothing about me, but assume I’m not resilient.

I have achieved much, largely due to my resilience. It would be very difficult to argue, after growing up very impoverished and getting to where I am today, that I am not resilient.

I played sports, lots. I competed in martial arts. Resilience isn’t my issue.

But thanks for telling me I have a moral problem I don’t have, instead of perhaps considering that what people are telling you might be the truth.

You don’t always know better, even if it flies in the face of what it is you do know.

It’s only within reach of a small portion because of industrialized food. Look at a graph of obesity rates in the US over several decades. Find literally any picture of people at any beach in the US in the 60s or 70s versus now.

"Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?"

I think it is because if 90% of the population did half of what you do (and kudos for you for doing it), they wouldn't have a problem with weight, you just happen to be one of the unlucky few where it doesn't work and these drugs are useful.

there are numerous studies posted in this thread demonstrating exactly the opposite.

Which studies? I find it hard to imagine that it has been proven that for most people having a low-carb unprocessed meal once a day, no alcohol, and 5-mile daily hikes as the original poster does would would not eliminate sever weight issues.

There are clearly minority of people who can only achieve weight loss using drugs but for most people they can achieve the same effect by a lifestyle change, has this been proven incorrect?

I think the best empirical result for this is to compare US with any other western country (say Japan or France) or even US states with each other, clearly lifestyle plays a huge role in obesity.

> There are clearly minority of people who can only achieve weight loss using drugs but

Are you suggesting there are people who can burn more energy than they ingest for a prolonged period of time and not lose weight?

That… would fundamentally rewrite everything we know about how mammals consume energy.

Of course not. Nobody needs drugs to lose weight, they need to consume less energy than they use.

No for example they might have severe food addiction that it makes it hard for them to reduce food consumption otherwise.

Commenter: This drug helped me with weight loss.

Commenter 2: Kodus to you. Let me just discount your anecdote as being unlucky and keep my current belief. But again, kudos.

HN threads on weightloss are an utter waste of time.

I don't think that's particularly charitable, GGP said themselves that their issue is volume, that they're doing well in many other ways. GP is saying if everyone could do what they've done, many fewer would have the problem, and so maybe it would have less stigma.

> I don't think that's particularly charitable,

As a direct reply to the challenge that the original poster made:

> > Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

They said nah, you were unlucky. In other words just dismiss his point outright.

Is that still uncharitable? Then so be it.

> GGP said themselves that their issue is volume, that they're doing well in many other ways.

Yes they said that they have a food addiction.

- The alcoholic said that his problem is the volume of alcohol intake

- The smoker said that…

Then asked why we won’t help food addicts. Just waffle on about self-discipline or hint at it.

This question is still yet to be answered.

> GP is saying if everyone could do what they've done, many fewer would have the problem, and so maybe it would have less stigma.

Maybe if those people had more self-discipline. Then maybe there would be less of a stigma.

You’re using the rationalized stigma to explain the stigma. This is at best circular.

Maybe we would respect ex-smokers more if they had the discpline to not ingest nicotine gum.

This is quite snarky. I was giving kudos because the commentator first exhausted all the lifestyle options that extremely often work in reducing obesity to ensure their issue is more than just lifestyle choice then finally taking the drug, rather than short circuiting the process. This is sensible policy in deciding to take any drug for the rest of your life for a chronic illness.

In other words I was giving kudos that the commentator put in a lot of effort to verify that it was an illness in their case.

It’s your assumption that 90%+ of people don’t do this that is the issue.

People seem to think that once these drugs became popular, suddenly obese people around the world awoke from a deep slumber, like zombies, and decided to see a doctor for the first time in their lives about their weight.

Please. These people are walking into doctor’s office having given up hope because most of them have, to one extent or another, tried everything.

Our society does not make it pleasant to be obese, no matter how you feel about body positivity or anything else.

The implication that obese people have never considered or tried eating less, working out more, etc., is in and of itself the problem. It implies laziness and imbues negative morality, when the reality is that most people who are obese know it, hate it, and have tried most of their lives to overcome it, unsuccessfully.

So now that there’s a medication that can help kickstart their creation of new habits for the first time in their lives, I don’t see how that is a bad thing.

Where did I make assumption that majority of obesity drug users don’t put this effort? I was more saying majority of those who try what the poster tried end up not needing the drug. These two statements are very different and it is a common logical fallacy to conflate them.

> I think it is because if 90% of the population did half of what you do (and kudos for you for doing it), they wouldn't have a problem with weight, you just happen to be one of the unlucky few where it doesn't work and these drugs are useful.

From https://news.ycombinator.com/item?id=41813589

It is simply not true that if 90% of the population “tried to lose weight the right way” that they wouldn’t have a problem with it. That is an assumption you are making, and the underlying postulate is that that same 90% hasn’t tried.

I agree, how can anyone comes at this number ? Is there a study of any kind backing up this number ? Or is it just garbage empirical evidence from what the poster saw around him (which cannot possibly represent 90% of people). Does the poster know the life of obese people to arrive at this number or is it just a belief/sterotype

> This is quite snarky. I was giving kudos because the commentator first exhausted all the lifestyle options that extremely often work in reducing obesity to ensure their issue is more than just lifestyle choice then finally taking the drug, rather than short circuiting the process. This is sensible policy in deciding to take any drug for the rest of your life for a chronic illness.

> In other words I was giving kudos that the commentator put in a lot of effort to verify that it was an illness in their case.

The illness being addiction/food abuse?

Again we circle back to the question that OP posed. Because I have never seen someone say that they are an alchololic or smoke/tobacco addict and then get told: okay maybe, but first you should put in the work and find out if you really are that.

(Step one: admit that you are an addict. Step two, uh, confirm that you really are?)

Why do we find it acceptable to help...

I think if the widely available help for alcoholics, smokers, or opioid addicts mainly mitigated the negative consequences - enabling them to drink, smoke, or dope more - it wouldn't be nearly as acceptable.

I personally expect weight loss medication that simply makes people want to eat less will reach cultural acceptance.

Case in point, cigarettes have been known to suppress appetite for ages, and people have elected to smoke to help stay thin for decades. There was never any crushing social stigma attached to doing this as a weight loss strategy (that I know of).

wait, I thought that's exactly what ozempic did...

> And you know what it is? It's volume. I eat too much.

100% this.

I lived in Asia for a few years and obesity is rare (though increasing for youth). It's not like they get more exercise (most people don't) or eat healthy (it's mostly carbs), but 100% portion sizes.

I see people who work manual labor jobs eat lunch that is a bowl of noddles, a few thin slices of chicken or pork, and a few veggies. I highly doubt it exceeds 500 kcalories. It's probably half the portion size you'd get in the US.

Mystery solved. If you're only eating 1500 to 1800 kcal per day as an adult male doing manual labor, it's pretty obvious why you're at 10% body fat.

> It's probably half the portion size you'd get in the US.

A lot of the sides in your average US restaurant is easily 1000kcal on its own

That's insane. It's also not just about calories. The amount of corn syrups used in drinks is crazy too. Your body will just spike your glucose and dump it to fat.

It amazes me that Americans head scratch over their obesity epidemic then reach for a product to solve the issues their food industry and culture made for them.

> And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.

The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss. It's not surprising that it didn't help you lose weight.

> The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss.

That’s not been my experience at all. My dosage absolutely significantly suppresses my appetite and always has. This has directly led to sustained weight loss. It did so badly enough at one point that I was underweight significantly.

I have to force myself to eat on my meds, even though the thought often makes me ill.

I’m on 30mg dexamfetamine daily.

“Dexamfetamine can make you want to eat less, so you may lose weight while taking it.

Some people gain weight, but weight loss is more common.”

Doesn’t seem to be hit everyone but equally doesn’t seem rare.

I think there's a few factors at play:

1. People might want to help, but they don't think taking a pill every day for the rest of your life is a proper solution. I'm not aware of any such things for other addictions you mention,

2. People don't want other people to have it easier than they did. "I had to diet and exercise etc, you should too",

3. People don't want to help. They want other people to be fat because it makes them relatively more attractive.

re: 1, there are plenty of people who take some medication at some interval for most of their life. People with ADHD, people with type 1 diabetes, most women, ... why do we find that totally unproblematic, but as soon as it's medication to help with obesity (which is a serious medical condition in its own right) it's suddenly such a big problem?

EDIT: And to be clear, there may be specifics with these particular drugs which are problematic, maybe they're by necessity expensive or resource intensive to manufacture, maybe they have problematic long-term effects, I don't know. I'm purely talking about the general aversion some people claim to have regarging taking some medication on an interval to help with a health problem. It makes little sense to me.

As someone who takes meds for ADHD and would benefit from Ozempic I'm still hesitant. There aren't any non-drug options for my ADHD but there's a proven one for my weight.

> People with ADHD, people with type 1 diabetes, most women, ... why do we find that totally unproblematic

ADHD medicine is highly problematic. The medications are controlled to ridiculous levels, and there are strong social stigmas against both the condition and the disorder.

Notice how the problematic things with ADHD medication are manufactured problems which don't need to exist.

> Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

For the same reason why skinny person taking steroids is frowned upon - it is perceived as a shortcut.

Supra-physiological levels of testosterone and steroids have incredibly well known and well researched short, medium, and long term side effects. They've been well known for forever.

In an alternate world where steroids had a good safety profile, it would be ridiculous to not use them if you were looking to add on muscle mass.

> Supra-physiological levels of testosterone and steroids have incredibly well known and well researched short, medium, and long term side effects. They've been well known for forever.

I’m pretty sure if you have professional pharmacist working on you then you can mitigate the issues and make it semi healthy. The point is that it is being frowned upon not because of health issues, but because it’s not an “honest work”.

You can make short cycles once or twice a year relatively safe for some steroids. Keep close track of your liver enzymes and blood pressure, discontinue if those look bad, otherwise stay on for 4-6 weeks, take half a year off, repeat. Got exposed to people doing that when I was in the gym frequently, still keep up with some now, all their levels look fine.

But even with significant additional intervention, when you move beyond that to the "blast and cruise" setup, those interventions are just mitigating factors, not truly preventative.

I get what you're saying, I've never touched any of them myself, because the juice wasn't worth the squeeze (hah), but if they did have very good safety profiles, I would have zero problem with anyone taking them and would think it would be silly if anyone did.

Would you mind sharing what your diet was like as a child?

I wonder if there's a connection between diet during development and adult processing of and cravings for food. Maybe eating candy for breakfast (cookiecrisp!) every day in elementary school messed a bunch of us up.

Not OP, but I ate sooo much Kellogg's and General Mill's sugary products in high school for breakfast (pop tarts, eggo waffles, all the disgusting cereals you can name...), but I took Centrum daily and played a ton of basketball after school. Almost 1 can of coke a day after school. No heath problems as an adult. But of course, genetics come into play as well, no overweight parents or relatives.

I think a lot of it is dealing with hunger. If you can't stand being a little hungry, never mind very hungry, no diet will really help. I used to love being very hungry, not sure how I got there, but I wish I can go back there again. Having very little carbs and temptations in the house helps. Unfortunately it's not up to only me.

Perhaps the first person on HN who actively and without shame pays attention to the fact that Adderall is a very nice amphet cocktail. Surprising though you don't loose wait with it, sad also given the circumstances. But I envy you a little cause such ADHD boost is only illegal in EU.

Sometimes I wonder if it was a some neat trick by US gov to diagnose and put 1/5 of the population on amphetamines (2024 data +60mil prescriptions of Adderall), so that most everyone who is actually like smart or sensitive or anything of value to the industry, can (almost) freely microdose on it and as a result increase productivity.

Which... means 1/5 of the population suddenly increases output. Perhaps we all'd be on Aderall at some point, dunno bout the Ozempics...

I think you're incorrectly assuming that one prescription = one person. Far less than 20% of the population is taking Adderall, this CDC study says 4% in 2021.

https://www.cdc.gov/mmwr/volumes/72/wr/mm7213a1.htm

Yes you are right. One prescription gives one person access to pills and then they resurface for many others on the black market. You can be absolutely sure it’s very popular among STEM students, not the least because they can understand why would they need it. I can only imagine the pressure to stay in Ivy League university, would totally make it reasonable to use one if you do five exams in a row.

Since you can find it being sold at raves in EU I’m absolutely sure a) it works; b) not convinced only one in five prescribed takes it and all other toss it in the toilet; c) there’s a surge in use and demand.

When I also found my high profile friend working FAANG for years, who’s straight edge and goes regularly to church’s is taking it for productivity boost, and happy about it… well I realised what actually is happening.

Indeed the good thing about adhd is tis a very vague diagnosis. And yes it works well on many undiagnosed people, and particularly in countries where ADHD is not a recognised ontology.

So let’s be real and honest.

Besides media is hyping in September’24 about dangerous shortage of Adderall as if people are left with no access to vitals. It is hyped more than the fact that coffee prices are likely to double and triple in months to come.

> 1/5 of the population suddenly increases output

I’ve heard studies show Adderall doesn’t help people without ADHD… googling now seems to confirm. Apparently lots of people, especially college kids, take it thinking it will help, but it actually can slow them down.

My understanding is the amph. works the same in everyone - minus the edge cases.

The main difference is that the magnitude is greater in people with ADHD than those without. A reduction in hyperactivity, for example, is not really apparent in people that are not overtly hyperactive to begin with.

Beside, ADHD is kind of a nebulous label for a lot of symptoms. Having ADHD vs. not having ADHD is not exactly binary.

“Taking ‘Smart Drugs’ Like Adderall Without ADHD Actually Decreases Productivity”

https://www.forbes.com/sites/darreonnadavis/2023/06/14/takin...

> a new study finds that using these drugs while not suffering from attention-deficit/hyperactivity disorder decreases productivity and increases the amount of time needed to complete tasks.

People using it for studying don’t take adderall to be more productive, they take it to be productive for much longer. It’s a stimulant that keeps you up all night and lets you study, not makes your studying more efficient.

That is not true. Vyvanse, caffeine, etc., helps my brain calm down and focus. I don’t get hyper. In fact, if I have too much caffeine, I start yawning.

My wife, who does not have ADHD (at all), gets hyper from stimulants.

That’s the difference.

That's the difference between two individuals, not necessarily the difference between having ADHD and not having ADHD.

Being tired after drinking caffeine is common.

I am not suggesting anyone use their response to stimulants as a diagnosis of ADHD. However, speak to anyone who has it and they will relay that stimulants make them calm, not hyper.

People without ADHD get hyper, not calm. Some others also get calm.

But people with ADHD who take stimulants do not get hyper.

Not a study, but this article was enjoyable. Some of the experiences there say it made their writing overly perseverative on detail, too expansive, too many edits and re-writes. Sort of faster in the short term but slower over the long term?

https://pioneerworks.org/broadcast/club-med-adderall

> Maybe the government is looking out for smart people (me) by helping them be productive in their work for their employer or themselves

Weird daydreams on this site.

Seconding Zepbound, it has been absolutely life changing for me, and not only in terms of weight loss. It's expensive, but I am blessed with a tech salary that can afford it.

Anyone can list 50 no-no things they don't eat and omit the 5 types of foods they do choose that causes the most damage. Volume & variety are not to blame given most sauces are calorie dense. The issue generally is the person eating for pleasure conflicting with their stated aim to eat for weight maintenance.

If it tastes good spit it out. Countless people ready to tell you no sacrifice is needed in that domain but they have something to sell or trade.

In my experience, as someone who has gone on a small weight loss journey, you can eat things that taste good, you just have to eat less of them and more rarely.

> And you know what it is? It's volume. I eat too much.

Have you considered eating less?

> It's volume. I eat too much.

Bingo. I've had this conversation with my girlfriend. She's not overweight by any means (160 cm ~55 kg) but I am quite underweight (182 cm, 65 kg, < 10% body fat) and the conclusion I've arrived at regarding our differences in body composition is because she routinely eats 1.3x to 1.5x the amount I eat. We both exercise and eat little junk food.

I'm convinced it has to do with upbringing. My family never ate a lot and the portions I was served as a kid weren't big. Nobody in my family is anything more than skinny. Her family however, they eat a lot (and healthy too, mind you). This is all influenced by other factors, her parents and grandparents grew up with not a lot to their names and with food scarcity, so when they reached a position in life where they could comfortably afford to eat they gained the habit of having big meals. My family was mostly more privileged in that regard so maybe they never felt the need to focus on food as much.

Have you every using a calorie/macro tracking app like My Fitness Pal or Cronometer? I was never successful losing weight until I scanned, weighed, and measured every single thing I put into my body and stuck to the target calories and macros entered into the app. Just being aware of exactly how much I was eating was often enough to find the motivation to control volume.

>> I scanned, weighed, and measured every single thing I put into my body

Not being snarky, but is this truly "better" than a single weekly injection - 10 seconds and done for the week? I do think our wider society sees medications for overeating as "cheating". Perhaps we might benefit from rethinking that.

For preventable diseases in general, prevention and self control should be attempted before medication. There are health benefits besides being skinny, and all medications have side effects. There's nothing inherently wrong with medication, but addressing the root cause should be tried first, and then medication can be introduced if it doesn't work out. It's not an either-or, binary situation.

Self control has gotten harder as the foods on offer have gotten more sugary and dense compared to traditional foods. Produce is also less available and less nutritious than it once was.

No doubt.

I don't disagree. As I've gotten older though I am just increasingly convinced that for the regular person going about their life, the fight against cheap and terrible and calorie-laden - but tasty! - processed foods is not an even one. Perhaps some form of counter-balance is just not such a bad thing?

There is a reason for that perception. We are regularly finding out how there are damaging ripple effects from drugs that were claimed to be completely safe.

I would compare something like scale measurements to sex education. If kids were all exposed to some period of measurement of foods to learn what they were eating, it would stick. Studies show that ANY form of tracking causes people to make more mindful choices. Everyone I know personally that is taking these drugs uses it as a crutch entirely. They take it and make even worse food choices than before. It's very sad and I worry about the next issue they will cause with this behavior to then stack another medication on top.

There is one way it may be useful, even if only done for a short time: You may not be eating what you think you're eating.

I started doing it mostly out of curiosity, and it turned out one of the meals I thought it was high-calorie was actually lower than my other meals.

>is this truly "better" than a single weekly injection - 10 seconds and done for the week?

Yes, obviously. I'm stunned that it needs to be said, but since it apparently does:

1. You propose taking a medication regularly which is probably completely unnecessary, and paying for it regularly. (This was worse with "metabolism boosters" etc. since the patient would be paying for the medication to have the privilege of eating more, and thus paying more for the extra food.)

2. Knowing what you eat, and being able to denominate it in calories, is knowledge. I thought we were hackers here? My experience has been that ordinary people have some truly absurd ideas about how fattening certain things are or aren't, or about how much they're actually eating, or about what healthy daily intake ranges, portion sizes etc. look like. (They also have absurd ideas about how much it costs to "eat healthy", as well as about the connection between "healthy" food and caloric intake.)

But since when did techniques which obsessive systemizers like us use play out well with the general population..? We're not discussing what works well for a niche community of hackers, but what will work for the hundred million+ on a sustainable long term basis.

I think "perfect is the enemy of good" applies here. People en masse are not controlling their intake. They just aren't. They can't do it. We can rage about it and criticise - and many do for all the good that's doing - or we can explore options. Medications with few side effects have some appeal here. Evolutions will likely reduce those. Eventually that will not be a strong argument against the medication option is my prediction.

Try a very low carb diet. Only eat until 80% full at mealtime. Get down to two meals a day, with a goal of only one. Fast the other times. This sounds hard but once you get to ketosis it is not that hard at all. Not hungry naturally, like the drug response.

Truth is, we really don't need more than one meal a day (maybe a snack) when we get older and our metabolism slows.

> We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.

> ...

> Yet... the number on the scale kept on creeping up.

That is absolutely terrifying. What oils did you use for cooking?

You mention types of food but not quantities. A boat load of healthy food is still going to have an effect. Also, I for one don't consider walking to be exercise. It's fake exercise for people who don't like exercise to claim they exercise. My reason is that I cycle for eight months of the year then walk during the rainy months. By the end of the rainy months I get back on the bike and my fitness level is catastrophic - nothing. I've done this for five years, and have to say walking is just not good enough for exercise, not even close.

To be fair OP did say:

>> And you know what it is? It's volume. I eat too much.

I missed that.

What about someone who's carrying 100+ pounds of excess body weight? Would you consider walking to be fake exercise for them? I'd say that's a more heroic workout than joy riding.

I've seen such people jogging - intervals - short jog, short walk, short jog, ... They didn't look comfortable, but when I'm cycling uphill toward the end of a hard ride with nothing left in the burning legs I start grimacing too. What do you want? No free lunch.

Can't speak for OP, but generally speaking there's a lot of variability in peoples' perceptions of healthy food and caloric density. For example, a lot of people see nuts as health food, and yet they're some of the most calorically dense foods you can eat! Another example would be to crack open the Ottolenghi cookbook and make the delicious Lamb Siniyah, which among other things calls for a large amount of Tahini mixed with lemon juice to create a delicious crust over the top of the stew. Delicious, but incredibly calorically dense.

I think healthy/unhealthy food dichotomy is psychologically the same as religious dieting. It fosters feelings of purity, self control, and is a form of in-group signaling.

But our bodies grind down substances to extract calories. It’s a simple mechanism. You can eat McDonalds everyday if you manage intake.

walking is exercise in the sense that it burns calories, specially when you're overweight as it's like having a 30kg (or more/less) backpack with you. Bonus points for incline.

But yeah, it's not HIIT. You won't really build up your fitness level by walking - it's not demanding enough. You need to be pushing yourself until you're out of breath, if you want to build up your cardiovascular health.

What kind of food do you and your wife cook? How much meat? How much gluten? Real butter or canola oil infused “spreads”? What oil do you cook with? Vegetable? Sunflower?

If you’re eating the right thing for your body, you’ll be satiated when you eat your full.

Bodies are highly imperfect and suggesting our digestive system and nervous system are geared for being fit and healthy rather than ensuring survival wrt food is absurdly naive.

(I only cook with extra virgin olive oil which I buy in 5L cans for $$ reasons. A lot of these vegetable oils are good for motor engines only!).

It really depends on you and the activity levels.

I used to ride to and from work - and I would ride hard, a solid 1.5 hour of riding every single workday. Yet this just caused me to gain weight as my appetite just shot through the roof. This new drug would have been SO good for me back then.

These days I find it easier to control my weight with regular strength exercise vs riding, as I tend to go too hard on the riding which causes me to feel famished. And then the control is just hard.

However when I just do (Olympic barbell) weights, a bacon, egg and onion + cheese omelette in real butter and EVOO does the trick to break my IF then, along with a WPI/milk shake- I get stronger and also lose weight. No need to keep eating. However, I'll then do cardio a couple of times per week which tends to undo the weight progress; I guess the real trick would be to stop doing the hard intervals I love on the Kickr, but going slow on the bike is nearly impossible for me. :-)

Maybe using too much oil in your food? It's got crazy calories.

Eat low calorie (and ideally high protein) after exercising. Fruit and Veg are amazing for this.

Reply on news.ycombinator.com