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Comment by hawski | Hacker News Reader

I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more. At least looking at USA from Europe. The problem of sugar content, dietary choices and portion sizes remains. It is similar to gas guzzling cars.

Sorry if it seems not empathic enough, that was not my intention. I know that the use of such drugs may be medically necessary.

Edit: To serious answers: I was wrong, I stay corrected.

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> I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more.

https://en.wikipedia.org/wiki/List_of_common_misconceptions

"Wealthy Ancient Romans did not use rooms called vomitoria to purge food during meals so they could continue eating and vomiting was not a regular part of Roman dining customs. A vomitorium of an amphitheatre or stadium was a passageway allowing quick exit at the end of an event."

"Two of the most notable examples from Ancient Rome center on the emperors Vitellius and Claudius who were notorious for their binge eating and purging practices. Historian Suetonius writes that “Above all, however, he [Vitellius] was … always having at least three feasts, sometimes four in a day — breakfast, lunch, dinner, and a drinking party — and easily finding capacity for it all through regular vomiting” (Suetonius, Vit, 13) [1]. Similarly, the emperor Claudius was infamous for never leaving a meal until overfed, after which a feather was placed in his throat to stimulate his gag reflex (Suetonius, Claud, 33) [2]. In his writing, Suetonius takes on a disapproving tone when describing the eating habits of Claudius and Vitellius, as highlighted by the use of words such as “luxury,” “cruelty,” and “stuffed”(Crichton, 204). This tone indicates that although binge eating and purging were accepted, albeit uncommon in Roman culture, the practices were negatively associated with gluttony and a lack of self-control. "

~ Ancient Hunger, Modern World by Solia Valentine

Via: https://escholarship.org/content/qt2594j40t/qt2594j40t_noSpl...

[1]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext... [2]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus:abo:ph...

Hit pieces aren't a modern invention.

https://blog.oup.com/2014/11/roman-emperor-tiberius-capri-su...

> Stories of this kind were part of the common currency of Roman political discourse. Suetonius devotes similar space to the sexual transgressions of Caligula, Nero, and Domitian – such behaviour is to be expected of a tyrant. The remoteness of the emperor’s residence itself must have fuelled the most lurid imaginations back in Rome.

Suetonius was born in 69 AD; Vitellius was emperor in 69 AD and Claudius was emperor from 41-54. They weren't contemporaries.

If you think that's bad just wait until you hear what Hillary was doing in that pizzeria basement!

The Romans were no stranger to just making shit up.

Purely from a cost perspective - imagine a 79 year old grandma.

Heavily overweight. She is already partially immobile. Pre-diabetic. She may have other conditions, further complicated by her weight. She's on a fixed income.

Which is more probable -

1) A dietary intervention that she attends once a week that revamps her entire daily consumption (but remember, she's on a fixed income) along with some intense exercise?

2) put her on a single medication that changes her tastes for sugary and starchy foods, reduces her cravings, reduces inflammation, and in turn, will make her lighter and more mobile.

It is a no-brainer for Medicare. This will save so many downstream costs.

These drugs (mostly) don't allow you to eat more unhealthy food, instead they make it easier to have the self control to avoid over eating / choose healthier foods.

To add, they actually prevent you from eating some bad foods too. At least in the compound versions that i know people on.

If they eat a lot of foods (some even good), their gastro issues are significant. So not only has it had substantial mental shifts around what they desire, but a bunch of foods are just not edible even if they wanted them anyway.

From what I understand these medications make you want to eat less in the first place, so it's not quite the same thing.

Yup. The people i know on this didn't even get it for the weight, but the behavior changes. This isn't letting them eat the same stuff and lose weight, this is changing what they want to eat.

They went from ADHD driven boredom eaters to not even thinking about food.

I have ADHD and the dopamine dysregulation really makes it hard to avoid eating things with sugar in it.

The semaglutide really helps, I'm on a lower dose of it 0.5mg/week and have been on it for over a year. I've lost a fair bit of weight but that has stabilized. It costs me ~$30 per month and I save much more than that on eating less food.

For me it really helps with chronic fatigue which was destroying my life. I think it really is a wonder drug for people with auto-immune issues. I was insanely sensitive to it when I started which I think is common with people with ADHD so I started really low and only very slowly worked my way up.

Sorry if it seems not empathic enough…

You should apologize for making it obvious that you don’t know how the drugs work (as illustrated by sibling comments). If your analogy is “gas-guzzling cars”, I would suggest you revisit your reading on the topic.

The ancient Rome vomiting thing is a myth. https://en.m.wikipedia.org/wiki/Vomitorium

My understanding is that the drugs keeps you from wanting to eat as much.

That's just not how these drugs work at all.

I think it's just a case of our ape bodies not being prepared for a modern world where calories are abundant - which is a good thing! It means people don't starve in developed countries.

We wear clothes because we evolved to not have hair. We wear glasses because we spend more time focusing on nearby objects. Some people need GLP-1 agonists because their body makes them consume food it doesn't need, and there's no scarcity to stop them. It's okay to use technology to adapt our bodies to a different world.

If everyone 30+ bmi can get to 30 for “free” (not sure where the subsidizing stops, for me it’s free if I’m over 30 bmi), that’s just too tantalizing to pass up, even if the moral applies.

At least it takes a load off one problem (obesity related diseases). Could it actually exacerbate unethical farming even more or lead to even worse outcomes? Hope not.

This reminds me of my idea to replace EBT with unlimited amounts of soylent

"load off" groan...

I've read that obesity and smoking are net positives for the cost of state-supplied medical care because it causes people to die younger and quicker.

My real concern is what you stated: the by treating some of the symptoms of a toxic food system we will avoid treating the causes (in the USA, we would do well to take soft drinks out of schools and treat adding sugar to foods as an sin to be taxed)

You may be wrong in the specifics of the mechanism of calorie reduction (reducing appetite vs reducing calorific absorption), but not in the general philosophy.

The obesity crisis (specifically in the US, but elsewhere too) has been caused by bad food essentially - food that is not only nutrient deficient, but also engineered to be as cheap as possible and addictive as possible to get you to buy more of it.

As ever, the US is attempting to fix the symptoms, as opposed to the underlying cause, following the general idea of 'if everyone does what they like, things will turn out ok (somehow)'.

Probably negative health implications of these drugs will surface as people become habituated, and we can continue to shake our heads and wonder how it all went so wrong over there.

It's unclear what the exact cause of the obesity epidemic is. Ultra processed foods are one theory, but not the only one. The US has been down the path before of making public policy from unsettled science, and it led to probably worse food.

Anecdotally, I can say that you absolutely can get quite fat on a diet of abundant "quality", minimally-processed food. It's just a little more expensive. I don't know how the food supply arguments about obesity can land anywhere other than "we should make calories more expensive" or "we should make it illegal to make food taste good", neither of which are remotely politically viable or morally justifiable.

I wonder how much the smoking habit of the greatest generation kept the obesity at bay?

One of the mechanisms of operation is to reduce your desire to eat.

Taking a step back, obesity actually is an adaptation. When food is scarce, you want your body to extract and store every gram of nutrition it can get. And that would provide a distinct advantage when you're trying to reproduce.

The thing is, GLPs don't only suppress eating. There are plenty of substances out there that can do that...and there are plenty of people who can't lose weight by starving themselves, because your body will try to maintain its weight.

The question should be "why isn't everyone obese, given the huge amount of calories available to humans?"

> The question should be "why isn't everyone obese, given the huge amount of calories available to humans?"

We're close.

According to the CDC, approximately 73.6% of American adults are considered overweight, including those who are obese

> obesity actually is an adaptation

Obesity is not an adaptation. It's a total aberration. Storing energy in the form of fat is an adaptation. Becoming obese is overloading your entire system.

> why isn't everyone obese

Well... they sure are trying...

These drugs reprogram the weights in the LLM between the gut and brain, leading to lower calorie intake.

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