Hacker News Reader

Comment by mrshadowgoose | Hacker News Reader

> 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.

View on HN

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.

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.

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.

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.

>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).

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.

Reply on news.ycombinator.com