The main difference between GLP-1 agonists and telling people to eat less/better is that one works and one doesn't.
Those drugs let people experience intermittent fasting and fasting by reducing hunger and snacking.
The danger of suppressing hunger signals is that hunger could've been a important que for nutritional needs.
Muscle loss is severe danger of gpl-1, And muscle size is tied to longevity.
So although promising it's not without danger. And there are other paradigms but those are not yet explored yet the underlying mechanisms work the same.
Edit: Let's keep HN a place where discussion can be held without just kneejerk down voting.
Edit2: great discussion thanks all.
This shows you haven't tried GLP-1s. I've been doing IF for ten years, doesn't stop me from being overweight. GLP-1s do.
Reducing food intake, and insuline while keeping hunger down is.
Important aspect is keeping hunger down. And if your fasting/excersicsing you can experience the same.
The discussion on weight unfortunately almost always focused on total weight.
But we would like to retain our muscles, and reduce adipose tissue(fat).
With gpl1 people are able to fast, stop snacking and reduce food intake because hunger signals are blocked.
But a fasting lifestyle, which goes further then just IF. And a focus on nutrition(vitamins, minerals, quality sources) could the same.
Furthermore the effects of lowering inflammation of gpl1 is only logical reduction in food intake/fasting will lead to autophagy.
IF/Fasting and other new nutritional paradigms are still new and uncharted. It's not clear yet what the full effects are, and how to implement them correctly.
GLP-1s work for many more people than any other diet advice we've ever had.
So in that aspect we agree completely. A few years ago people would call you mad for fasting, and now we have drug that allows people to life the fasting lifestyle.
And if there is a medical reason I'm not making the argument against. I'm making the argument that it's a intervention and that healyhy nutrition, healthy relationship with food will is the long-term solution.
And order todo that we would need to explore other nutritional paradigms than the current one.
Edit: - Fasting lifestyle, like omad(eat once a day) removes the feeling of hunger and thoughts about food, until it's the moment to eat.
It's nothing like the fasting lifestyle, it just quiets the food noise.
> I'm making the argument that it's a intervention and that healyhy nutrition, healthy relationship with food will is the long-term solution.
That's like saying "I'm making the argument that diabetes medication is an intervention, and that producing healthy amounts of insulin is the long-term solution". Yeah, it's all well and good, except it doesn't work.
You can yell at people for not <insert favorite reason here>, but, at the end of the day, people have tried diet, they've struggled with it, and it's failed. No matter how much yelling you do, they won't stop. It's like trying to talk a meth addict out of their addiction.
And hunger is painful.
Hunger is something that is left to the patient to cope with -- usually badly. Sure there could be support groups and exercise groups, but nobody is going to be there in your bed when you're trying to fall asleep with hunger pains.
I don't eat because I'm hungry. I eat because food is there, or because I remembered that food exists, or because I have nothing better to do, or because stuff tastes good. I can't remember the last time I was hungry.
The weird thing is I can go a really long time without food. I can go 36 hours easily without eating something, hunger doesn't bother me at all. After 36 hours, I think "huh, I should probably eat something".
Such situations where I forget to eat are really, really, really rare. I have to basically be on my own and working on something fun, because that's when I both don't have food in the house and don't want to spend the two minutes it takes to order something.
Kids who went hungry at school had behavioral problems, and couldn't focus on schoolwork. The solution was to give the kids breakfast, not to tell them to cope with hunger until they got home.
Fasting is just one such tool.
Yes! I do! It lowers the risk of stroke and heart attack!
I dont think making up quotes and responding to yourself is a productive way to carry on a conversation.
We will see what happens long term the second time around.
[1]https://www.tctmd.com/news/defying-earlier-glp-1-data-study-...
The article suggests that non-weight loss side effects of GLP1s are also worth considering taking the medication for. If you’re maintaining a healthy weight, while taking the drug, you shouldn’t experience the muscle atrophy.
Also, muscle size isn’t tied to longevity, usable muscle and a certain strength and physical ability is tied to longevity. Muscle size is a convenient proxy. Also cardiovascular ability in a related way. You basically just need to be able to move and carry things and act in your environment in a responsible way at an old age so you don’t fall or hurt yourself.
People who tout the dangers of glp1 - and there ARE risks! - are also ignoring the "what did you do instead of a glp1" and the answer is.... remain overweight, which has many risks!
Yes glp1 might increase the risk of a certain kind of cancer. But guess what, it also reduces the risks of many other cancers tied to obesity!
It's hard for me to take hand-wringing over glp1s seriously. Appeals to "JUST do x" are lost in the "just" - hello if people could just do intermittent fasting, or eat less calories, well then there would be less obesity. The obesity epidemic is literally a rebuttal to any of these arguments.
Which currently are not studied enough, to create clear nutritional guidelines for the public.
Gpl1 and those paradigms work through the same mechanisms action (autophagy, ketones, reducing food intake).
If there is acute problem with health such as (morbidly)obesity then gpl-1 could be a great intervention.
But its not long term solution, nutrition and a healthy relationship with food and lifestyle is.
Muscles are very important for health, but let's not go into that. For muscle size I linked to meta study about muscle size and all cause mortality (longevity)
> Conclusions: Low SMI(skeletal muscle mass Index) was significantly associated with the increased risk of all-cause mortality.
> Which currently are not studied enough, to create clear nutritional guidelines for the public.
We have very clear, very obvious nutritional guidelines for the public, and we have lots of research on the healthy food to eat. The TLDR guidelines that would have a positive impact on most people is "eat less". Doesn't seem to work, and it's not an informational problem.
(1) its not long term solution, nutrition and a healthy relationship with food and lifestyle is.
The reality is that plenty of people will just never have this. Some people are "weak" or "genetically predisposed" or "addicted" or "impoverished" or any other number of things that people use to explain poor diet. No amount of nutritional guidelines will fix this. That's just the (unfortunate) reality. Now what do we do?
(2) GLP-1 medication (according to the article) have other benefits beyond nutrition, eg addiction, Alzheimer's, kidney health, etc. These benefits could be very real (some are still being studied). If they turn out real, how does our relationship with the drug change, how that its not just a replacement for a "healthy relationship with food and lifestyle"?
You've mentioned muscle being a proxy for health. Do you consider going to the gym and working out to be a "long term solution"? Why is spending an hour a day performing an artificial activity (lifting weights) generally considered a healthy lifestyle, but taking safe preventative medication not considered part of a healthy lifestyle?
(Generally) society considers vaccines to be safe and healthy, and we recommend them for everyone from a young age. They're obviously quite artificial, and they trick our body by stimulating certain biological pathways artificially.
What is different about certain medication like GLP1 meds that keep us from considering it part of a safe, healthy lifestyle?
You don't have to go to the gym to activate and stimulate muscles. But our bodies are made for daily usage of muscles.
We always had downtrodden, poor, weak people, in any society. But in the 1970's they were not obese.
We dont take daily vaccins they are a intervention. Gpl1 could be intervention for obesity patients.
The danger of long term usage of gpl1 is that our bodies emerged ecosystems that we don't understand yet. By reducing hunger signals that their motivate a person to get nutrition such as protein, vitamins and minerals, etc Leads to malnutrition, muscle loss and other diseases.
Your point is that there is no problem with current paradigm of nutrition while at the same time promoting a agent that stops the addictive nature of our current nutritional paradigm.
If you use gpl-1, And it works for you that is great and we should be grateful that gpl-1 is available. My only advice would be, to lift weights or callisthenics to keep your muscle size and strength. And to explore other nutritional paradigms that can help you maintain the weight loss without gpl-1.
These medications do so much more than this. First, they have all sorts of direct metabolic benefits beyond just eating less, and secondly, studies are linking them to non-metabolic benefits too.
You don’t have to go to the gym to stimulate your bodies, but most people require it because they won’t do it naturally in their life. You don’t need GLP1s to regulate your metabolism, but it seems most people aren’t doing it naturally in their life.
In 1970s, people died of hunger. We’re also not in the 70s and won’t be going back. Our society has a surplus of unhealthy food and an uneven distribution of healthy food. The food is engineered in labs to be addictive. Our society doesn’t make room for regular physical exercise. So many things wrong, and until we start regulating the food industry, the best we can do is correct mistakes.
I’m also not sure there is any real evidence that the GLP1s are causing malnutrition because of “hunger signals”. But ensuring proper nutrition of vitamins and micronutrients is not that hard to monitor.
I’ve never used a GLP1 antagonist. I’m not one to brag to strangers on the internet, but I view myself as rather healthy and athletic. It’s a lot of work, it’s not that fun, it takes a lot of time. I just don’t believe that the only right way to be healthy is waste an hour in the gym every morning and do “hard work”. If there was a CrossFit pill, I’d be here supporting that too.
Some things (working out, vaccines) are basically just a net-good on the health of society. Why isn’t it possible that this is included in that list?
I’m thinking, whatever negative side effects we find for GPL-1 in the future, they will have to be pretty massive to offset all these benefits.
This is an age old problem in the obesity treatment and research community. It never seems to go away. It's come up with bariatric surgery, with other methods, and now GPL1- agonists.
The issue for me is that "telling people to eat less" is sort of a strawman in some ways. It doesn't work.
What does work, however, at least according to evidence I've seen, is giving people strategies for losing weight, therapy, support, and so forth. It doesn't work for everyone but it does for some.
I would rather people try that first as it can be self-sustaining and doesn't require medication.
I'm not opposed to the medication or people using it, in fact I think it's a good thing, but it seems a little dangerous to me to create a culture where people are just told "take this pill, pay lots of money for it, because nothing else will work" which is not actually true. I don't think we're at that point but it's easy for me to imagine.
I am tempted to make a snide remark, but I suppose that won't do any good.
Eating less works. Telling people to eat less and exercise self control doesn't work very often.
As kubectl_h mentions [1], the future is better understanding and fine tuning the mechanisms responsible. I think gene therapy is the end goal (permanent fix vs chronic maintenance with GLP-1s), but others have indicated in previous threads that might not be possible. We need more information and research. This is only the beginning of the "Aha!" moment (The most exciting phrase to hear in science, the one that heralds new discoveries, is not “Eureka” but “That's funny...” —Isaac Asimov).
Our ancient environment was hostile as well.
> It patches malfunctioning reward centers
It has an impact on them. It does not "patch" them. This is not a rational way to describe any drug.
> it reduces overall inflammation
It can inhibit certain inflammatory pathways.
> it provide cardiovascular protective properties.
It reduces the number of cardiovascular events. Whether that number is normal to begin with is not considered here.
> We need more information and research.
You certainly do.
https://www.axios.com/2024/01/18/ozempic-wegovy-weight-loss-...
https://www.axios.com/2024/01/19/weight-loss-drugs-america-o...
https://recursiveadaptation.com/p/the-growing-scientific-cas...
https://www.jpmorgan.com/insights/global-research/current-ev...
Edit: I simply do not understand the hostility towards this simple intervention, my apologies.
Oh. Thank you. That's very generous. I assumed we started from that position but apparently not.
> the market will deliver to the demand.
Yes, because our healthcare market is perfect, and we should acquiesce to it's demands. The same could be said of opioid pain killers.
> The cost benefit ratio is obvious
Which entities cost benefit ratio, exactly? The patients? Are you _sure_ you have data which allows you to say that?
> even accounting for potential side effects at scale.
You're free to your opinion. The market will repeat history.
Obviously there are multiple factors, as I said I think the relative satiety of food also plays a role. US food spending has been more or less static over the last two decades while obesity rates have continued to climb so cost can't explain everything (though as an aside, I do think lower costs probably take some time to have an effect). But even if there are multiple factors at play, cost really should not be discounted as a huge driver, especially if we're taking a public health approach to addressing the problem. If we just attribute obesity to individual moral failings, as some are wont to do, I think we're really doing a disservice to ourselves
[0] https://www.cepr.net/in-the-good-old-days-one-fourth-of-inco...
[1] https://www.cia.gov/the-world-factbook/field/average-househo...
That GLP-1 has benefits is good. That we could possibly rearrange our food system so we don't need it anymore is better.
You can acknowledge both without hurting _anyone_. You entirely lack an argument.
Ya so you want to change a system that involves millions of selfish actors and corporations looking to profit and that have entrenched themselves, and are protected by freedom of association versus a choice between a doctor and a patient.
I can tell you which one will be more successful.
because..?
> That we could possibly rearrange our food system so we don't need it anymore is better.
Will this be before or after we fix capitalism/finish building communism?
I'd love to re-imagine our food of food production and consumption, but it sounds like you're arguing that because food production and consumption is a better solution, we shouldn't be promoting GLP-1 agonists.
Sorry, but one is exists in reality and the other exists in our imaginations. When we let our imaginations take precedence over reality, we live in a fantasy and the consequence is that we get neither. Effectively this argues for neither, and that's a bad deal for everyone.
Therapies are contingent on being available. That’s uniform. What’s unique about glp-1s is that they are very effective in weight loss and many other things. As compared to alternatives that aren’t.
If we are back at the point of supply chain issues that interrupt GLP-1 for any significant amount of time you're starting to look at issues like we had during covid that are going to have all kinds of other effects.
From my understanding getting the pre-compounded components isn't that difficult, and that India and China are making versions of it now.
The time argument might be relevant, but even then, most Brazilians do have cheap and easy access to a very healthy lunch in restaurants or to-go meals, purchased or prepared, with rice, beans, meat, salad... The breakfast is probably bread, but I'd say most people don't eat a lot of that in the morning. Getting proper nutrition at night will probably be problematic, but it's also a smaller window...
But, like I said, processed food is quite expensive here. For instance, a 1 kg of chicken breast goes by less than a third the price of a McDonald's combo. A pack of cookies or snacks will be like double the price of a 1 kg of bananas...
It'll be great if we do, although I don't know of any promising research avenues and I lean towards the hypothesis that the average human metabolism is simply tuned to mild obesity under conditions of widespread food availability.
- these drugs are good and a paradigm shift in the treatment of obesity (and have other benefits)
- we must not lose sight of the need to address a thoroughly sick food industry that necessitate so many people needing to use these. Junk food advertising, lack of subsidies for fresh vegetables, HFCS, food deserts, etc.
Chile is experimenting with banning junk food ads to children and is seeing some early behaviour changes.
The point which people seem to be wilfully missing is that we can have both these drugs and advocate for cracking down on a food system that deliberately poisons everyone in society. Having everyone be on this drug because we shrug and say "free market innit" while big corps continue to feed us crap is not a solution, obviously.
* Food deserts are a problem, but the vast majority of Americans don't live in one. We just don't typically want to eat a pile of fresh veggies when there's other options available.
* Criticisms of HFCS are, as far as I can tell, entirely viral misinformation - not once have I seen someone point to concrete evidence that HCFS is worse than table sugar.
It seems to me that this entire idea of a poisonous food system is an epicycle to avoid the obvious conclusion, that our bodies are calibrated on average to eat ourselves into obesity when we have the means to do so. If you don't start from the premise that there must be an external reason we're getting heavier, it's very hard to explain why potato chips should be any more unhealthy than a traditional breakfast of potatoes and bacon.