See also: white people being judgemental about people with darker coloured skins, to the extent that they may sometimes invest in skin lightening, meanwhile white people are investing in artificially darkening their skin with tans (because it's a symbol of conspicuous consumption, the ability to go to sunny places).
I had uncontrollable weight gain, a comorbidity of ME/CFS. GLP-1 agonists has helped a lot with both. I eat a strict diet and exercise as often as I can, which is less often than I’d like due to PEM. I think it’s likely that much of uncontrollable weight gain is due to autoimmune issues and GLP-1As do seem to help with that.
I started GLP-1As as soon as mainstream adoption started and so I could get safety data to help figure out dosing. I had already benefited from extended water fasts but it was rather challenging to keep doing that.
Frankly, I think even the most severe side effects we can dream up, short of dying, are probably nothing in comparison to the risks the people taking these drugs already face.
I can't speak for countries other than the US, but here these drugs are being prescribed and used widely for entirely aesthetic reasons by many, many people.
Legally this isn't supposed to be true, but there are tons of online telehealth services that are clearly just rubberstamping prescriptions for anyone who wants one.
Same situation for prescriptions for pills to make your dick hard and baldness. There's CYA legal regulation for all of this but in the real world there's no actual barriers for anyone motivated to do so from getting their hands on this stuff.
Do you have some numbers to back that up?
But its not hard to find various references to this as a widespread reality:
https://www.cato.org/blog/study-finds-glp-1s-are-effectively...
https://www.wired.com/story/glp1-ozempic-wegovy-semaglutide-...
https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/glp-1-o...
Why are we so dead set on making sure overweight people struggle to put off the weight? Why can't it be easy for them?
I don't mock alcoholics for not being able to control themselves around alcohol. But we are determined to mock overweight people. Despite alcoholics having an easier time dealing with their vice.
Think about it, every other vice is controllable by simply avoiding the thing. Except for food. We must eat. It is a requirement. Having an issue with food is something you must deal with. You have to deal with the underlying issue. It requires true discipline. And it requires you to maintain that discipline 24/7. We don't ask that of any other vice.
Nothing we do nowadays is "natural" or "the way our ancestors did it" so its weird how folks cling onto "caveman diet" like it's some amazing thing. It's just excess consumption and a status symbol.
Why do we need GLP-1s? Is it because of Western diet? Misfiring reward centers (GLP-1s also appear to quell addictive behavior around alcohol and hard drugs)? Broad antibiotic usage along with more sterile living environments causing misbalanced gut flora (not producing sufficient quantities of natural GLP-1)? The most exciting phrase in science is not "Eureka!" but "That’s funny...".
I thought the long term solution was gene therapy for GLP-1 consumers, but now believe it's going to be probiotics that encourage gut flora that excretes sufficient quantities of GLP-1 for the desired metabolic outcome (based on most recent evidence and findings). If feasible, this is exciting because it is much harder to gate this therapy via the medical industrial complex (primarily insurance, pharma, PBMs, etc).
Scientists May Have Found a Natural Alternative to Ozempic - https://news.ycombinator.com/item?id=43874436 - May 2025
Being on D2 agonist which has the exact opposite effect I wonder what taking both would result in.
With extreme levels of direct, personal involvement by multiple professionals (which is what rich people / celebrities have historically used, and variations of which have been studied by researchers) the efficacy level reaches "sort-of OK, but still not great". That's crazy-expensive, though, so not a realistic solution for the masses, plus the results are still pretty lackluster despite the cost.
[1] Could, hypothetically, yes "CICO", technically anyone could lose weight, but they in fact do not work when applied in the real world, statistically speaking.
Most people also don't seem to know that weight loss is simply Calories in - calories out, what their BMR is, how to track calories. Most people, even educated people, still seem to believe things like they have slow metabolism, that herbal teas can help, doing situps will reduce belly fat, and number of dumb shit the market tries to sell.
As a nation were just far too focused on $$$, and instead of focusing on fixing the root of the issue, were only incentivized to bandage the problem with producing more things that will make $$$. Sell shit food, people get fat, sell crap products for weigh loss, drugs, surgery, etc
Oxygen/CO2 exchange in the lungs is also a major component of weight change. Further, your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption.
And that's just addressing first order weight parameters.
Yes, breathing is literally how weight is lost, I’m not sure what your point was there.
I have never heard another source citing Oxygen/CO2 exchange as a factor for weight change, again, please site a source. O2 levels are certainly a factor of cardio health which can be correlated to overall health and weight.
Yes, macros also matter. But, nothing matters as much as the simple math of calories in/calories out. Its disingenuous, borderline irresponsible, to suggest otherwise.
To be clear, I think your instinctive reaction is correct. It would be extremely silly for someone to read this analysis and conclude that they'll lose weight if they learn some special breathing technique to maximize CO2 output. The point is that "calories in - calories out" as a diet strategy is the same kind of error.
https://www.bmj.com/content/349/bmj.g7257
(note I don't totally agree with this paper, and agree that if you eat almost no food, you will lose weight, and that exercise definitely seems to increase the metabolic rate and increased mass exchange in the lungs. Like I said, it's complicated).
I'm not being disingenous or irresponsible- I'm describing mainstream science based on biophysical data.
Apologies for the tone in my original comment. I misdirected work stress this morning.
Then exercise more. That's how you increase the "calories out" part of the equation.
Yeah, it takes willpower.
I mean, sure, but if it was just willpower for everyone then we'd all speak 10 languages, play piano, be buff as hell, be emotionally stable, and no one would be an alcoholic.
But we're squishy apes that are regulated by hormones and live busy messy lives with cars that are probably needing a tire rotation 3000 miles ago and putting it off a few more miles won't really hurt.
So why can I do that, but others can’t? It would be comforting to just say that I’m better. It would also be a lie.
* You never used to be fat.
Once you become fat, your body's homeostatic set point is permanently altered. Your body never destroys adipocytes — it only shrinks them. If you stay within some range of your current homeostatic set point, your body will either increase the size of your adipocytes, or decrease their size, depending on whether you're over- or under-consuming. But, after a certain amount of overconsumption, your body will actually create new adipocytes... And once you have them, you can never get rid of them, minus expensive and dangerous surgery.
The best you can do is shrink them. But, keeping the adipocytes shrunken takes significant willpower. So basically, once you get fat, you're going to have a hard time.
Pretty much the only alternative is somehow tricking your brain/gut into not getting hungry when it "should." Ozempic, etc seem to somehow allow you to not feel as hungry even when your adipocytes shrink, or at least alter your perceived set point to be more-shrunken. Bariatric surgery is similar although much more dangerous. (Liposuction actually removes adipocytes, but it's quite dangerous — and it doesn't remove visceral fat cells, which are the worst kind of fat from a health perspective.)
Now, there's a separate question of "why do some people get fat initially?" And that can result from poor childhood nutrition, or genes (e.g. Samoans), or exposure to certain chemical compounds (e.g. certain psychiatric medications), or natural aging (recent research indicates middle-aged mice, and probably thus middle-aged humans, have their stem cells trigger more adipocyte production), or just lifestyle. But it's the initial weight gain that ends up trapping people into the higher homeostatic set point, which is very difficult to recover from, even with dieting and exercise, since you will need to keep yourself basically constantly hungry either by eating less or by exercising much more even after you "lost" the weight — because while you lost weight on the scale, you didn't lose adipocytes, and adipocytes do not want to be kept empty.
Metabolism is driven by hormones, it’s very possible for signaling peptides to prevent weight gain no matter how much a person eats.
While a person who eats nothing will clearly lose weight knowing that isn’t helpful as it’ll lead to a substantial loss in quality of life and most probably it is not long term stable.
In my case I have ME/CFS at the same time that I have uncontrollable weight gain, I also did extended fasts to keep the weight off as best I could. It wasn’t a willpower thing, having to manage both while making enough money to survive is incredibly difficult and it was impossible to keep all the plates spinning at the same time. Post Exertional Malaise is very real for some people and triggers can cause me to be bed-bound for months on end. Thankfully not so much anymore since I’ve found a good combo of very strong medications.
What I am talking about is people saying things like "Wow you have fast metabolism", without even understanding what metabolism is. Having twice as fast metabolism would mean my body requires twice the amount of calories for the same cellular activity. That'd be terrible!
The truth is I am skinny because i barely eat and if I eat 500 calories above my calculated BMR, I gain 1 pound a week just like the science suggests. I think this is the fact for most people.
>While a person who eats nothing will clearly lose weight
That's a strawman. What I am saying is take your BMR+caloric expenditure from exercise - 500 calories, not starve yourself.
The other reason is that autoimmune conditions can be induced - it's not a genetic switch where you have it or you don't though there is a substantial genetic component especially with regards to susceptibility. People with my genetic background hEDS from multiple TNXB SNPs are extremely susceptible. The US population is also in new circumstances - we're several generations into the generally accepted medical advice that intermittent fasting will impair your metabolism. Prior generations would fast much more frequently than todays, they would just call it skipping meals.
While what you are saying is technically correct the framing of it leads to poor conclusions and suboptimal strategy, it will meet the stated aim of weight loss but not meet the implied aim of a maintainable lifestyle. The source of the calories is incredibly important given the effect that has on the hormones, and the cadence of calories is also very important. Instead of counting calories a person would be better of eating one meal a day of heavy caloric foods with the occasional multi-day fast would be far more productive. Augmenting this with a GLP-1A would be even more productive.
>While what you are saying is technically correct the framing of it leads to poor conclusions and suboptimal strategy, it will meet the stated aim of weight loss but not meet the implied aim of a maintainable lifestyle. The source of the calories is incredibly important given the effect that has on the hormones, and the cadence of calories is also very important. Instead of counting calories a person would be better of eating one meal a day of heavy caloric foods with the occasional multi-day fast would be far more productive. Augmenting this with a GLP-1A would be even more productive.
I think you're right that there is an effect, if you have any data to back this up I'd love to this see. My assumption is the effects were talking about (in anyone who doesn't have a metabolic disorder), is a difference in 100-200 calories in metabolic rate. In my personal experience, which I admit is not the most convincing, simply counting calories regardless of source tracks very accurately with the expected weight gain/loss based on estimates.
NONETHELESS, I think my original point stands, that there is a ton of misinformation on how weight loss works.
Anyway, if you are interested in researching check out the field of dysautonomia - there are many good books on the topic. It's an established science but not well known so people are unlikely to come across it by chance.
The main problem is that these conditions are severely underdiagnosed, thankfully people can now access GLP-1As without diagnoses so are no longer reliant on the competence of doctors.
My question is, why does Switzerland, Norway, Sweden, France, Denmark have a <20% obesity rate, and Japan, South Korea have <6%, but the US has 40%+? Certainly this isn't all from metabolic disorders, undiagnosed or not?
You can also perhaps compare data historically. People have never been this overweight, and likewise people have never been eating this many calories. You can a historic chart showing caloric intake and BMI are strongly correlated (both countries with higher intake are higher BMI, and over time, rise in caloric intake is associated with higher BMI) https://www.sciencedirect.com/science/article/pii/S030691922... https://ars.els-cdn.com/content/image/1-s2.0-S03069192220005...
Lastly, metabolic disorders can be caused by being overweight and inactive, so I think the causality is often opposite the direction you're suggesting.
https://www.niddk.nih.gov/health-information/health-statisti...
It is a problem of education. For example, in reading the common research that shows basal metabolism, which you can’t control, will rapidly undo most of your conscious gains from caloric balance manipulation. And that in those with severe metabolic syndrome, the body will reduce BM to starvation levels before giving up a single fat cell.
If it's not education keeping other countries skinny, why would adding more education be the way we get out of it?
(This works for other explanations, too, like "oh they have more willpower"—so do they lose willpower if they move to the US? No, more likely, a complex combination of factors mostly outside individual control are why they're skinnier in their home country and fatten up after moving to the US; more likely, it's harder to be skinny here)
"skinnier" countries have way different lifestyles, less driving, more walking, less fast food culture, etc. They don't need to be educated on weight loss because they naturally are not prone to it due to these socioeconomic conditions.
In the meantime (so... indefinitely, because moving the needle on one of those things would be the work of a lifetime) we now have drugs that can do it.
Those countries basically don't exist, or rather they just haven't caught up yet. From 1985 to 2016, there are 117 countries where obesity has increased by more that 10.0% (in absolute terms). In no country was the increase less than 1.9% (which was vietnam, where 1.9% in absolute terms is a 10x increase in the percent of people who are obese).
It's only fairly recently that we seem to have a better grip on what makes caloric restriction more sustainable, and accounting for effects like metabolic adaptation. Even then that information doesn't seem to reach most people.
Also understated is the impact of one's environment, and social support systems. It's much harder if you break from what your family and friends are doing. Some habits, I've seen with my own two eyes, can be regarded as an obligation.
I really believe the odds can turn around for a larger demographic, with a more optimal approach. Let's not forget that we've had far more invasive procedures than ozempic available to help facilitate weight-loss (like gastric bypass), and people still gain back weight on those, if they refuse to change their habits. Drinks, junk foods, and deep fried foods are not satiating compared to their caloric density, and that remains true regardless of surgery and pills. Nothing changes until it's internalized that binging has a price.
But it doesn't remain true on GLP-1 medications, which is why they're so popular.
If you factor in metabolic adaptation, then re-introduction of surplus calories will lead to regaining weight, even if they weren't as many calories as before.
For the reports of mediated cravings, also: some people don't just overeat from physical cravings, but for emotional satisfaction. A binge session on comfort food has almost nothing to do with hunger. This is something addressed through therapy, not pills.
Before the GLP-1 drugs became mainstream for weight loss, I know friends who were overweight who had enough money[0] to go on programs where your entire meal days are planned for you[1]. They'd ship you enough food for 2 weeks at a time, but you never had to think about what you were going to eat, it was all pre portioned and decided by your meal plan as part of the program.
They saw really meaningful results, lost weight, and as long as they were on the programs, they kept it off. As far as I could tell, the food wasn't anything special beyond being properly proportioned and nutrient dense - certainly achievable on ones own - but it seems the rigidity of it - that is, the fact they didn't have to make food choices every day - made it easy to stick to. The food prep itself was easy too - mostly throw it in a single skillet, microwaving it or putting it in the oven on a tray or in a baking dish was all it took.
I watched as they got healthier they were more active, felt better, seemed generally overall much happier.
Once the program was over or they for whatever reason had to stop, it didn't take long for the weight to come back, and they had discovered a big part of their problem was food anxiety - not knowing what they wanted to eat, having trouble with food cravings etc.
This has lead to me to suspect there are some seriously chronic issues with food culture in the US - namely, we haven't made doing the objectively best thing the easiest thing. Its too often out of reach due to cost, availability or time - which also speaks to other interconnected issues in the US that are going unaddressed.
For example, I know these programs worked exceedingly well for those I saw on them, why aren't they cheaper? Why don't we subsidize such things to nudge society in a better direction with food choices? We already subsidize the bad stuff - we should move those subsidies to better options.
[0]: I'm talking breakfast, lunch, dinner, and a small allotment of daily mini meals - really snacks.
[1]: This is the problem. To do this, you have to be of upper class means just to afford the food, and thats not even including the cost of the program associated with it, and in some cases its simply a meal delivery program and there's no additional anything, and its still expensive
Everything involving food is screwed.
And yet in a sister thread about Deliveroo we have people talking about what a "game changer" the delivery services are, eating 2 takeout meals a day without really understanding what's in the food. People eat too much.
We have free refills (was rare until some time around the late '90s—see the '80s film Gleaming the Cube where there's a sign on a Pizza Hut in a scene near the end of the movie advertising a special on pitchers of soda, which probably seems weird to anyone used to just having their soda constantly topped off, or walking to the fountain and doing it themselves) so it's easy to thoughtlessly sip down three or four glasses of soda with a long meal, and to-go sizes at fast food joints have ballooned in size in the last 20 years or so, like, the medium sizes are often larger than what I'd have classified as a large before.
In the end - as with so many issues - the question is if policymakers are going to throw capitalists or regular people under the bus.
Reminder that the US auto industry would have collapsed during the GFC without a bailout. Balancing food industry profits against the healthcare costs carried by the poor and middle class in this country becuse of the lack of access to high-quality food produces a net negative bottom line, one of many deleterious dynamics inflating both personal and public debt. But if you hide all of that, you get to go back to your constituents and say that you're supporting manufacturing jobs and shareholder value for their retirement funds.
It's a choice between securing a few people's livelihoods and lifestyles, and securing the general well-being of a lot more people. We could change that choice, and we could do it very quickly, if we wanted to. But people would rather CICO tut-tut strangers on the internet.
"Don't commit violent crimes" doesn't work for most violent criminals, because they go back to committing violent crimes. Simple as.
"Stop gambling" doesn't work for compulsive gamblers, because they go back to gambling. Simple as.
"Have superhuman willpower in a domain where I don't feel temptation" isn't a cure, it's unempathetic judgment.
Why does food addiction encompass 40% of the US population?
It might be more useful to see addicts to every type of substance as a large pool of anxious people who came across a substance to self-soothe, and figure out how to address the anxiety problem first.
You won't get judged for eating alone at home, but start drinking alone at home...
It's a complex social-environmental, economic, and political problem.
Yeah, we all know why it doesn't work.
Things that do work ultimately do so by that mechanism (of course!) but not via people trying to eat better and exercise more per se. They do it by changing the circumstances under which a person is making decisions about eating and living, so better eating and more exercise in-fact happen, consistently and enduringly.
From most- to least-effective, over the long haul, it looks something like this:
1) GLP-1 agonists & friends,
2) Move to a skinnier country,
[a large gap]
3) Months and months, probably with periodic long refresher-sessions every year or two if you want it to actually last, of high-touch expensive help from multiple specialists, amounting to hours per week. This is the gold standard for what "actually works" as far as what can be done as an intervention, before Ozempic and such, and its outcomes are... so-so.
[another large gap]
4) Basically any diet & exercise plans or attempts to simply "eat less and move more"
(throw gastric bypass and stuff like that in there somewhere, not quite sure where they fall)
Without a very precise definition of "work", these discussions quickly degrade to near uselessness.
There is a very large difference between "telling patients to exercise more and eat less doesn't result in long term weight loss" and "exercising more and eating less doesn't result in long term weight loss"
The former is true, and the latter is not.
I agree that from a clinical perspective the former definition is more relevant than the latter.
So, the losing weight part requires even more restriction, and then a much smaller amount of restriction once you reach your goal.
It’s not unreasonable to reduce calories to something like 1500/day when dieting. But very few people need to stay at that amount for the rest of their lives.
The problem is, staying healthy is a matter of privilege.
You need to be able to afford to eat healthy (ultra-processed industrial food that's loaded with sugar is often much cheaper than quality produce), even if you have money, a decent chunk of Americans live in areas that are classified as "food deserts" [1], even if you are not in a food desert you still need to be able and have time to get to a store selling quality food, and you need someone with time available to cook healthy meals out of that. It used to be easier back in the time where one income was enough to feed a whole family and the women stayed as housewifes to actually do that, but these times are (thankfully) long gone.
Exercising suffers from similar "problems of privilege". Either you got the money and time to spare to go to a gym, or you got the money and space in your home to install your own gym... or you need actually safe roads where you can walk, jog or bike, and most of the US is so utterly car-dependent that it is outright unsafe to walk.
And on top of that you got the whole "living while Black" issue, with egregious instances like a pregnant Black woman arrested for walking her dog [2] - it's no surprise that the Black and Indigenous population has noticeably higher rates of diabetes [3] or oral health issues [4].
And on top of that, you got the whole issue with educating children about healthy foods, their parents being too poor to afford healthy foods, and that setting up these children for childhood obesity which perpetuates into adulthood. A lot of that is closely correlated with ethnicity and wealth as well.
It's a systemic issue, an insanely complex one at that, with no easy solution to be found - and certainly not a failure of any individual to stay healthy.
[1] https://en.wikipedia.org/wiki/Food_deserts_in_the_United_Sta...
[2] https://ca.news.yahoo.com/pregnant-black-woman-ticketed-walk...
[3] https://healthequitytracker.org/exploredata?mls=1.diabetes-3...
[4] https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs...
Recently, I found a gym with group training classes which I absolutely love. They have a great sense of community, and now that I've found them I find it easy to motivate myself to show up and work out.
I have the good fortune that I can afford the $150/month fees. Not everyone can.
At the end of the day it is just about diet and exercise - not eating more calories per day than you are burning via exercise.
https://data.worldobesity.org/rankings/
I'm originally from the UK (now US), which doesn't score so well either (28%), but the differences are obvious - massive portion sizes in US from deli sandwiches, foot long subs, movie buckets of popcorn, giant size sodas. People driving everywhere rather than walking.
For example, exercise has appetite suppression effect [1].
[1] https://med.stanford.edu/news/all-news/2022/06/anti-hunger-m...
Diet has appetite suppression effect [2].
Please, switch to resistance exercises. As these do not release endocannabioids but endorphines, they have appetite suppression effect.
Resistance exercises help with sarcopenia and lower risk of all-cause mortality.
I think the change you experience is not about stomach size, but ketosis. Ketones are such a great source of energy compared to glucose, that raising glucose level by eating feels like you lose something, for me, at least.
https://www.cdc.gov/obesity/adult-obesity-facts/index.html
https://www.who.int/news-room/fact-sheets/detail/obesity-and...
https://en.wikipedia.org/wiki/Obesity_in_China
https://en.wikipedia.org/wiki/Obesity_in_India
https://www.bloomberg.com/news/articles/2025-03-03/china-ind... | https://archive.today/UeI7X
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
> Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity.
No. Ozempic is a form of chemically-induced diet. Less invasive than bariatric surgery, but still just a hack to force you to consistently eat less. You can achieve the same by hiring a guy who follows you 24/7, and punches you in the face whenever you start eating too much.
This is still a form of class based dieting.
But to be clear, a bro punching you isn't the same as altering your hormones.