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Comment by firesteelrain | Hacker News Reader

I take tirzepatide, cut down my calories to about 1500, walk 4-6 miles a day, and exercise 3 times a week. With the help of tirzepatide, I have been able to curb the cravings. I have lost about 25 pounds so far with 25 more to go. I always understood that it was on shaky ground however pay the $350/mo to get 5 mg of tirzepatide. My work has a Medical Weight Loss program that uses semaglutide instead which is free. I plan to switch to that. If it becomes unavailable, then I will have to switch back to regular discipline, food tracking, exercise, etc that I probably should have did all along. I will do whatever I have to do in the meantime to safely lose weight.

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> that I probably should have did all along

I think you've accomplished something really incredible with your weightloss and I'm very proud of you! .... but this part right here concerns me.

The reasons for eating beyond maintenance calories are broad, complicated and robust and I don't think it's fair to say "I should have just been more disciplined, 4head". The negative side-effects of food cravings can be really serious and "too hard" to fight against and that's a reasonable enough stance, especially when there are chemical changes you can make for yourself, such as this medication, that can help you.

In a very related sense, I was taking a (relatively) high dosage of a medication for myself that I needed for a time. I gained 30 pounds over about 2 years while on that stronger medication. I also tried to lose weight; but the cravings for food were becoming too much - far too much; and I had just come off the best shape of my life, where I actually had to force myself to eat *more* so that I would gain muscle. I just plain wasn't hungry. But this med I was on, yeah, I just ate more, regularly. It was easier - but trying to slow down my eating? The cravings were bad. Unlike any I'd ever had. And if I didn't eat, I was tired, angry, unfocused, a world of problems.

Now that I've reduced this medication (with the help of a psychiatrist), the cravings have effectively disappeared; and when they are present, it's very easy to overpower them and just move on. They don't cause my to be literally unable to sleep. I don't lose all my focus, it's just ... easier - easier enough that it's actually doable.

And a medication changed helped that.

Crutches are a very good thing when you can't walk or when it hurts too much to walk. It's okay to use a crutch. It is not a personal failing, it is a medical aide and an accessibility tool.

Please, I encourage you, give yourself some grace :)

I agree, but let me get on a soapbox for a moment. In the context of weight loss, "cravings" is just a judgemental way of saying "hunger".

I have gained a ton of weight in the past four years, going from a BMI of 19 to a BMI of 28. I do not have "cravings". I experience constant hunger. I got tired of being hungry all the time and started eating until I am no longer hungry, and that's why I'm fat now.

Calories in, calories out, and all that nonsense that doesn't account for hunger is just a way of dismissing the very real struggle of people who, for whatever reason, have a disproportionate amount of hunger relative to the amount of energy they need on a daily basis.

Do you feel like there are different kinds of hunger?

For me there is the kind I can usually ignore and the “I feel sick” kind I can’t.

Not the person you're responding to; but, it's called "hangry" for a reason!

I definitely have the:

  * "I could eat"
  * "I should probably eat soon"
  * "Everyone around me is now annoying and I hate everyone and everything and why is this work problem so hard and darn it, I have a meeting in 3 minutes? Who schedules a meeting at this time?!" level.

There is another kind of hunger that kicks in when you’re actually dying from not eating.

I had advanced gallbladder disease that went misdiagnosed for a long time and the last month I was able to eat about 500 total calories. I had a desperate desire to eat something, anything, that is impossible to describe accurately.

One interesting thing I have noticed on tirzepatide is I am much better able to differentiate when I am thirsty vs. when I am hungry. Before, if I wasn't getting to "my mouth is dry" levels of thirst, they were indistinguishable for me.

It frequently became a guessing game for me to try and figure out which it was - did I gamble that I just needed to drink some more, and run the risk of feeling worse from what turned out to be actual hunger? Or did I just eat some food, which also included drinking more fluids, and make sure I was back to feeling OK soon after?

I can tell you which option I chose most of the time, particularly if I was busy with work or a personal project.

Now, I have a much easier time differentiating.

Thank you for the add. You've clarified something I didn't even realize needed clarifying! This is a fantastic way of thinking about it.

>In the context of weight loss, "cravings" is just a judgemental way of saying "hunger".

I always assumed cravings was when something sounded good and you could eat it but weren't necessarily hungry. Like most days I have a craving for some ice cream but I'm not actually physically hungry. Ignoring that craving means that I eat a lot less overall.. it doesn't mean that I end up eating alternative foods instead.

>I experience constant hunger. I got tired of being hungry all the time and started eating until I am no longer hungry, and that's why I'm fat now.

You seem like someone that Ozempic type drugs would help since they slow down digestion and make you feel full for longer.

> I always assumed cravings was when something sounded good and you could eat it but weren't necessarily hungry.

I do not eat when I am not hungry. Why would I do that? I'm already fat enough.

A lot of people do though, the confuse the desire to have a rush from sweets or the lack of feeling overly stuffed as being hungry. Hell, we all do something similar during holidays when we choke down that extra serving of our favorite food because we enjoy the taste, despite being beyond full.

There was an interesting theory that obesity was connected to a duller taste sense. I think that can relate to the dulling effect when repetitively eating the same thing.

In essense, when one has a craving for something expected/remembered that is actually unattainable, one over eats.

Of course, that conflicts with a common theory of smoking and weight loss being about taste reduction as opposed to an alternative craving as a substitute or some other cause.

> common theory of smoking and weight loss being about taste reduction

I didn't realize that was a thing people thought. I know smoking screws up your sense of taste but I assumed the prevailing thought was that something about nicotine or some other part of smoking just curbs hunger.

I can only offer what has worked for me, at one point losing over 170 lbs. Admittedly gaining 50 back thanks to the good old pandemic making some bad habits easy again and limiting my chosen form of exercise due to swimming pool closures. Thankfully back on the right track and down 30 and still dropping since June.

The name of the game in controlling hunger is finding a diet that creates satiety. For me this was keto. Getting that fat macro up to 75% was the magic bullet, if I was below that, I had “cravings”. If I was at or above that I was fine.

I am not suggesting that is the right way of eating for everyone. I think diet is an individual endeavor, but for me it was the right way to keep that hunger at bay.

>I take tirzepatide

Same. Down 80. Healthy weight for the first time since I was a child. Taking this has led me to feeling less shame about my previous weight and that maybe a lot of this discipline you talk about might also be some of our biology just being not super compatible with modernity. I've personally gone from feeling a bit like a fat cat who you have to take the bowl away from to one who just eats responsibly. Wouldn't really be an issue for the cat in the wild or us 100 years ago. But here we are needing to take away our own bowls. Maybe it really just isn't as easy for some of us.

>> our biology just being not super compatible with modernity.

This! our body through millions of years of evolution is just not built for an abundance of easy to obtain dense caloric food, while living in relative leisure. It just isn't.

CICO proponents don't understand you are asking an individual to fight millions of years of evolution with self-discipline.

Once you lose the weight it is critical to get fit, because you won't have the same amount of weight stressing your connective tissue.

Besides all the other benefits of exercise, it will help keep the weight off. You can't stay on ozempic forever.

You can’t / shouldn’t however my beef with the compounders is that they encourage people to stay dependent via maintenance doses once they reach their goal weight.

Fitness is absolutely important. One thing I've found is that it's not just physically easier to do that work but mentally easier as I approached a healthy number on the scale.

Out of curiosity, do you find yourself eating more nutritiously or just fewer calories?

For most people (now), their food habits don't deliver very good nutrition in just 1500 calories and the problems with that compound if they're living an active life that needs more nutrients. Neurotic dieters have hurt themselves through that problem for decades, as so much cultural focus in on "calories in, calories out" that they don't even think about whether their broader nutritional needs are still being met during calorie restriction.

Do you find that these drugs have provided any help in making your diet sufficiently dense in nutrition to compensate for the reduction in volume? I hear that they strongly affect appetite and food appeal, so I worry for what it might mean for people who dive in without taking nutrition density seriously. It seems so easy to just buy the drug and let it help you eat less, but that's such a dangerous thing to do naively.

I find it significantly easier to eat healthier foods.

I am struggling with getting enough calories in general - even on the lowest dose I have to force myself to eat more than a meal a day. But I don't miss the processed/fried/etc. foods while on tirzepatide the way I do when I'm just counting calories, etc. I throw in a a protein shake and a broad spectrum of supplements to help. (I stick to the ones that have actual research studies to back their efficacy - examine.com is great for quickly sorting things into 'ignore as marketing garbage' and 'research more' piles)

I've also found it significantly easier to be motivated to work out.

> do you find yourself eating more nutritiously or just fewer calories?

I am definitely eating better and watching what I eat. Mostly because I care now. I am up to 80-100g of protein per day. I stopped drinking soda altogether. I drink water multiple days. I am no longer suffering from sleep apnea.

> Do you find that these drugs have provided any help in making your diet sufficiently dense in nutrition to compensate for the reduction in volume? I hear that they strongly affect appetite and food appeal

You are satiated faster when used in combination with protein heavy meals. I am also weighing my food and following the serving sizes.

They do affect your appetite but I also think it was a mindshift because I can stop taking the medication after it wears off beyond my weekly shot and I am not that hungry anymore. I attribute it to maybe my stomach got smaller and I used this opportunity to retrain myself and have better healthy eating habits.

I absolutely eat better than before. Part of it may be mindfulness, but overall I do not crave specific kinds of foods like I did before and by that I mean... any specific kind of food.

One way of thinking about it is that I have always enjoyed fruits like apples, blueberries, etc but I have always enjoyed a bag of chips or a great sandwich more. What I've found now is if I keep fruits, yogurts, cottage cheese etc in the fridge I will opt for them over the more junky foods, or at least just as much.

It’s a lot easier to exercise when you weigh 30 lbs less. Runners claim more than 2 seconds per mile per pound.

It doesn't get easier, you just go faster.

If you go for your 5km, then all in all, it's easier (you are done sooner)

You'll have to define easy. If you go faster, that means you're outputting more wattage per second. You may get there faster, but you've used up the new capacity that your body has developed so you're back to what are likely similar levels of discomfort.

By your definition, Usain Bolt running the fastest 100m time ever set by a human is having an easier time than me because I do it slower.

What most people mean by easier is that it "feels" easier: this would be accomplished by aiming to take the same amount of time even in the face of capacity increasing.

force = mass * acceleration

work = force * displacement

work = mass * acceleration * displacement

lower mass, less work.

> If you go faster, that means you're outputting more wattage per second.

It's not just a comparison of fast versus slow, it's also heavy versus lighter body weight. You can move faster at lower weights while spending the same amount of energy as someone moving more weight slowly.

The net result is that it's easier to run a fixed distance when you're in shape. The same energy output makes you move faster, making the run shorter in time duration, meaning you actually spend less energy.

Further, getting in better shape often coincides with improvements in metabolic efficiency, so you get further benefits.

Usain Bolt has exceptionally improved musculature and metabolism for sprinting over the standard person, so his maximum energy output results in an exceptional speed.

At that point, we aren't talking about equivalent energy outputs anymore, which means it isn't relevant to the "easier" qualifier.

Of course it's objectively easier, particularly if you hold some variables constant (distance or pace) relative to weight.

The wrinkle is that most runners run to a pain point. Over time, I went from neverrunning to running decent mileage per week, and my runs hurt _more_ now than they did when I started because I run to a pain point. I run further, faster, and more frequently and I have a higher pain tolerance, so it hurts more while I run and the recovery is rougher.

So my runs are at least as hard, but yes, I'd absolutely destroy the version of me that thought three miles was an accomplishment by any objective metric.

Thanks, this is what I was trying to articulate with my original comment. I've never heard of a runner who gets a little faster and decides "oh ok, I'll just take it easier now". You don't get fitter by training with respect to yesterday's fitness.

One thing that I think is important to note is that a lot of people in this position aren't going to be wanting to become Runners with a capital R - they're going to be looking for the minimal effective dose to be healthy. Some, of course, will catch the bug and enjoy it enough and start to push themselves, but there are a lot of people who just go find some recommended weekly amount from the american cardiovascular society or something they heard on a podcast and set that as their goal and have no desire to move past it.

It's easier, less weight falling on your knees, hips, and ankles for one. The aerobic endurance also becomes easier to build because you are moving less weight, i.e. expending less energy, per step.

The majority of people who run do not set their intensity by measuring the weight on their knees.

If you take someone with a fixed fitness and reduce their mass, they will expend less energy per unit of time, but in order to effectively train you need to keep a target intensity, so you increase the amount of distance you cover per step or increase your cadence, either / both of which increases the energy consumed per unit of time.

That's all I mean when I say that you just go faster.

You don't think running with, say, an extra 50 lbs of weight is more difficult?

I'm on the heavy side for a distance runner, but compared to the general population, I've never been very heavy or very light (BMI currently around 26). I mostly run longer distances (a half marathon most weeks, lots of six mile runs, full marathons and the distances to train for them about twice a year).

In my experience, qualitatively, what you say is absolutely true. I don't even notice a change in pace if my weight floats up or down a bit, I mostly run at a specific level of effort and the pace adjusts itself depending on how much I've over-indulged. However, there are thresholds.

If I try to run a pace that is too slow, there's a point where it almost becomes more shuffle than run, gait goes to hell, and there's a loss of efficiency. As I've gotten more fit (but not lighter) I can now do zone 2 running on the flat with workable form, but this wasn't always the case. It's still less efficient than a fast pace, but at least it looks like running.

So if one is too heavy to even run with actual running form for any length of time, it's harder to be heavy. That's okay, they should probably try run/walk intervals until they get there.

On the other hand, it can also be harder when you're more fit. My pain tolerance has gone way up. I can just beat the ever living snot out of myself, and if I'm not careful, I do just that. It's much easier to do too many miles way too quickly now and that starts manifesting itself in all kinds of noisome ways. Find anyone who considers themselves a runner and get them talking about their injuries and you better not have anywhere else you need to be.

I got up to half marathon walking distance at a little over 3 hours for six weeks this summer, and have been in PT ever since. 'Too hard' doesn't necessarily manifest the day you make the mistakes. It could be weeks later.

Yes, I agree. I mentally consider "running" to include "walking, if that's the speed you should be at for your target intensity". I do a lot of walking on my runs even still :)

It is significantly easier if you are starting from being totally sedentary.

I've gone from fit and powerlifting for years to fat for years to trying to get back into lifting, etc. (the latter, multiple times) and while age is a bit of a confounding factor, the fatter I am, the more difficult exercise is - both cardio and resistance training. It's just harder on your tendons and ligaments. It's not insurmountable, and training can make those more resilient as well, but when you're starting from effectively zero, doing that a 250lb is tougher than doing it at 200 is tougher than doing it at 175, etc.

Running is pretty high impact, too. It's going to put quite a lot of stress on your joints.

I'd recommend everyone incorporate exercise as much as they can regardless of their weight, but I've found it easier and easier to ramp mine back up as my weight has gone down.

You have to be able to do the activity long enough to get benefits, such as cardio. And an extra 20 lbs can put that in jeopardy. Once you hit that threshold, the weight doesn't matter. But getting off the plateau you're stuck on is the first big step.

By easier I was referring to intensity, rather than the experience of your ligaments.

Presumably now that you've gotten into powerlifting you don't still lift the same weight you did when you started. If you did, it would indeed be easier. But you probably lift more weight, so that the intensity is similar.

(To be completely transparent, I wasn't trying to state a universal truth. That phrase is just a common tongue-in-cheek joke among runners and cyclists; I misread the crowd a bit assuming it'd be recognized)

Sure - you want to keep ramping up the intensity, otherwise yeah, you're not making any gains, be it in cardiovascular performance/VO2 max/max weight you can lift/number of reps you can do/etc. And yeah, I missed the joke.

There are a lot of people that seem to think that obese people can fairly easily just stand up on day one and start working their ass off, though, and that this is the only thing holding them back from changing their lifestyle, so I made the faulty assumption your comment was along those lines.

(These days I'm thinking I'm going to be move towards being more focused on the hypertrophy aspect - less likely to injure myself, and I gotta do something to fill out at least some of the loose skin that awaits me on the other end of the weight loss journey)

I started out getting injured just walking 2 miles. It was bad. I weighed 255 lb at start and that didnt seem like a lot but it makes sense now why I would get injured just walking around a big city like Washington DC with my family. I was out of shape. Now I can walk 6 miles a day every day (this took me 2 months to get to) without injury.

Great to hear the kind of progress you are making. Keep it up!. One thing I have found to be successful for exercising(weight training, running, swimming) is taking a mindful and inquisitive approach to it. It goes like this:

- Be mindful of when your mind wanders from paying attention to Form(Posture/Gait/Technique), Breath and Pace. When it wanders, bring it back to focus on these aspects.

- Try observing when the first feeling and proceeding thought enters your mind and try separating the feeling like tiredness, anxiousness, overwhelmed from the distracting thoughts you have due to it(e.g. "I wanna quit", or "I can't do this"). But stay with the feeling and this thought. Just observe it and bring back your attention to the aforementioned things: your Form, Breath and Pace. Over time the though and feeling dissipate and you come to be at ease with the process.

Over time, this has helped my motivation because often I was fighting my thoughts(which in the long run is like stuffing mail in a full post box) and not paying attention to the actual exercise.

>I probably should have did all along

I don't know if weight loss via calorie tracking and self control is really worthwhile if you can just do a cycle of appetite suppressant to keep weight around target baseline.

Seems like drugs have made weight management a solved problem. No reason to over think it for genpop if you can cycle drugs.

The unsolved problem is body composition -> picking right exercise regimes and diet macronutrients so you're losing more fat than muscle.

But really that should also be a solved problem if west weren't stupid about steroids and poured serious research into them.

Just eat4 grams of inulin gummies and a teaspoon of allulose in the morning amd evening. Costs maybe 30 bucks a months also pounds glp1 just like semaglutide. Mirafiber makes some decent ones in usa market. Restorafiber is sold in two packs at costco for cgep in canada

Won’t that make you go poop more often ?

nah, I still poop once a day. What it does do is hit the same receptor (glp-1) by changing the gut microbiome away from bacteria that suppresses glp-1 to ones that activate glp-1 (allulose is also a glp-1 activator). Be prepared for 3 weeks of sitting on a fart volcano though.

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