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Comment by noah_buddy | Hacker News Reader

Many people (will only speak to America), view being fat as a literal moral failing. Gluttony or overeating are not the sin, but being fat.

(From that perspective:)a miracle cure that allows someone to stop being fat is like an indulgence (in the Roman Catholic sense). It’s a cheat, a shortcut that allows the unworthy to reach a state they do not deserve.

My opinion is to wait long enough to validate there are no long term harms, but beyond that, yeah, adjust the priors, it could be a modern aspirin.

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> Many people (will only speak to America), view being fat as a literal moral failing. Gluttony or overeating are not the sin, but being fat.

I feel like I've seen and heard more of the opposite: The trend is to avoiding anything that might make someone feel blame for arriving in their situation.

With obesity the trend is to blame some combination of "our food supply", trending science topics like microplastics or the microbiome, and genetics.

I've heard countless people explain to me that dieting doesn't work for them. It's not hard to find people claiming they ate <1000 calories per day and still gained weight. Even Eliezer Yudkowsky, a figurehead of the "rationalist" movement, has written about "metabolic disprivilege" and claimed that his genetics do not allow him to lose weight through dieting. This thinking runs deep.

What's interesting about GLP-1 inhibitors is that they modulate the intake portion of the diet, which shatters these previous notions that some people had "metabolic disprivilege" and simply could not lose weight by reducing caloric intake. They just make it easier to reduce food intake.

> I feel like I've seen and heard more of the opposite: The trend is to avoiding anything that might make someone feel blame for arriving in their situation.

> I've heard countless people explain to me that dieting doesn't work for them.

I think you're being a tad reductive – "dieting right now doesn't work for me for reasons I can't control" and "reducing calorie intake will help me reduce weight" aren't necessary contradictory, and don't imply "I'm going to attribute it all to biology/blame it on something general".

Anyway, let me assert the opposite: as a partner of a nutritionist who's talked (with anonymity) about her clients, the majority of the people she's worked with, who struggle with sustainably reducing calorie intake over the course of years, come to dieting with that logic, and _then_ struggle against specific barriers, and _then_ blame themselves. (A recent example: "because of my work schedule I don't get enough sleep, which leads to weight gain and time only for frozen food – on top of my predispositions".)

In that case, GLP-1 inhibitors as an intervention _complements_ the way her clients think about dieting.

> and _then_ blame themselves.

I was responding to a comment about Americans blaming others, not dieters blaming themselves.

The concept of "blame" isn't really helpful anyway. The problem I frequently see is that blame becomes something to be avoided, which turns into a game of externalizing the source of the problem, which makes people think the problem is out of their hands.

A similar pattern happens in addiction and addiction counseling, where well-meaning friends and family try to soften the blow by telling the person that the addiction was not their fault, it was the result of their circumstances or bad influences. Addiction counselors have to undo this thinking and find a way to gently get the person to take some ownership of their role in arriving at the problem, which is the first step to having some control over correcting it.

For nutrition, when people convince themselves that they have a hidden metabolic disadvantage that makes caloric restriction not work for them, they're more likely to give up than anything.

> Even Eliezer Yudkowsky, a figurehead of the "rationalist" movement, has written about "metabolic disprivilege" and claimed that his genetics do not allow him to lose weight through dieting. This thinking runs deep.

I thought EY's point was different. Am I misremembering? I thought it was about not being able to do mental work productively when dieting enough to loose weight(maybe maintain a low weight too, though I do not remember that being mentioned explicitly).

It's a long story. His description of "dieting" was extreme calorie restriction. He was eating something like 800 calories per day (don't quote me on the exact number) and then was complaining that he didn't feel well when doing that (to the surprise of absolutely nobody).

Then it turned into a false dichotomy between the 800 calorie severe calorie restriction or no dieting at all. Then he just started declaring he'd delete any comments that suggested dieting.

I agree with you, but it's important to remember that "dieting down" is way harder for a lot of people. I am and always was skinny through my life. Whenever I need to eat less, I can do it without much effort. However, I have friends who would faint if they tried to diet down the way that I do. I don't know why that happens, but I've seen happening and it changed my perspective about this subject. If Ozempic can help with that, I will never criticize someone who uses it.

Genetics do factor. It's not just a question of genetics affecting metabolism. People literally don't feel hunger with the same intensity as one another. It's like sex drive. There are both very horny people and asexuals out there. There are also people who routinely forget to eat. For many people though, the notion of "forgetting to eat" seems completely alien, because those signals are much stronger for them.

It's clearly both. Someone with stronger motivation to stay healthy can survive in adverse conditions, but a society that pushes unhealthy lifestyle harder is going to catch more people out. It's obvious that Americans aren't just all individually lazier than the rest of the world. Their cities and food are unhealthy.

Primary source on Yud's weight-loss efforts: https://www.lesswrong.com/posts/udFuYqqNdpdo5ym3f/?commentId...

If anything it vindicates those people's beliefs. If you've seen the way someone can take Ozempic and survive on a few mouthfuls of food each day, while exercising 30 minutes each day, and become much less fat, but still be fat, then you'd understand. When your endocrine system is that dysfunctional, you need to exercise about 4 hours a day to look normal, and for most people that simply isn't a realistic lifestyle change, especially when every cell in your body is telling you that you must hibernate to survive. This is something that rightfully should be treated as medical issue.

Why is it that the people who hate fat people, are the ones most opposed to the treatment that will give them the choice to not be fat? If you hate the obese so much, then do you really want to live in a world where the majority of people are obese? It's like burning down a city to be king of the ashes. Some people can only feel superior if others are suffering for it.

And also the idea that it is "easy" to lose weight is completely out of touch. If it was there wouldn't be millions of people trying hard, spending money on trying and failing for decades, and entire businesses addressing that.

RFK Jr's "let them eat less" is paradoxically the modern version of "let them eat cake"!

I think many people confuse simple with easy.

It IS simple to reduce your weight. There are like, two things you need to do. It is, however, VERY hard to actually do those things.

Even then, limiting calorie intake isn't all that difficult; there's a reason why intermittent fasting took off and so many people were getting results from it.

It is that difficult, otherwise everyone would do it.

Not necessarily. Some people respond well too intermittent fasting but not everyone. Some people respond to keto but not everyone. And just because you respond doesn't mean it's gonna take you to where you need to be.

I've always been skinny but for some reason I've gained weight recently. Even with keto, intermittent fasting, tirzeptide, and workouts twice a week I have only lost 5 lbs in months. When I was skinny and forgot to eat, I would feel a little crappy but still could function. Now I begin to feel incredibly depressed, I can't sleep nor focus. This solidified it to me that there's a circuit in your brain that controls feeding and if it's out of whack it'll punish you until you eat. Dieting takes months and no one can go that long without sleep. So it's still a practical problem, its just hard to see if your system is well calibrated.

> Even with keto, intermittent fasting, tirzeptide, and workouts twice a week I have only lost 5 lbs in months.

If you're combining a ketogenic diet AND intermittent fasting AND a GLP-1 inhibitor AND exercise and you're still losing less weight than observed in the Ozempic studies, it's likely that there's more to this story.

Ketogenic dieting does not automatically translate to weight loss. Keto simply makes it easier to reduce caloric intake. It's actually very easy to gain weight on a keto diet due to the high caloric density of consuming that much fat.

> Now I begin to feel incredibly depressed, I can't sleep nor focus.

Honestly if you're having these dramatic negative effects from minor caloric restriction with GLP-1 inhibitors, something else is going on.

Ive heard this same sentence, verbatim, repeated throughout the course of decades for particular fad diets. Decades.

The irony is that all that

"it's so easy"

"it's just calories in, calories out"

"if you eat according to this plan and make sure to get 8 hours of sleep a day, you won't even feel the cravings"

Is stuff that fat people say. They totally buy into it and buy all of the products to help them convince themselves this is true. Then they get disillusioned when it doesn't work, have a crisis of faith, then go to the next fad to get over the self-hatred caused by their failure at sticking to something so easy.

Intermittent fasting is great. It got me from 225 to 165, kept it off for the past few years with no effort (my entire metabolism recalibrated to 165-175, I guess.) I also know people who cry actual tears when they're very late for a meal, or panic. Those people need therapy and/or maybe an injection to artificially lower their appetites to the level where I also artificially lowered my own appetite.

Intermittent fasting is no more natural than injections. Dieting is modernity.

I’m certain IF more closely resembles how humans ate for millions of years, not knowing when our next meal would come before becoming an agrarian society, and we haven’t had much time to evolve since then.

So, yeah, dieting is modern, but so is an abundance of food. Both are equally unnatural.

This is literally the argument keto, carnivore, and caveman diet people make. "I feel like this is how we ate 10,000 years ago, so it must be natural and therefore good!"

We also didn't get vaccines for most of history. That doesn't mean remaining unvaccinated is good.

For the record, keto works for me (including bloodwork to prove it) but is unsustainable. My mind is never sufficient compared to when I'm eating normally. It's observable in my work and parenting. Although, last time I was on keto, my cholesterol was through the roof. I went off keto and three months later numbers were back to normal. And I wasn't consuming a shitton of meat and butter or anything. I was pretty close to exactly the right numbers for optimal health. Just...something made the numbers terrible and I've no idea why. Did a re-test to confirm. Same awful cholesterol.

On IF I actually got fatter. Numbers worse. Less healthy. Couldn't exercise as vigorously.

For me, calorie counting works. It's also not sustainable, because with kids you get in a rush and if you have a normal social life you eat at places you can't calorie count.

To stay healthy I just try as hard as I can and exercise (distance running, weightlifting, tennis when I can, which is pretty rare with three young children).

We didn't have vaccines millions of years ago, so we didn't evolve with them. We've always been eating, so our bodies literally evolved completely around resource acquisition.

Why is this such a complex concept for so many? I literally cannot think of anything simpler.

Limiting calorie intake is easy. Consuming near unlimited calories is even easier and a lot more fun.

I will tell you the secret: resistant fiber supplements.

There's other zero-calorie foods too, but they tend to cause intestinal discomfort rather than improve it.

Not that I think it's necessarily appropriate to discuss here, but I've also been of the opinion that fiber is pretty dang necessary for health. It limits calorie uptake, it massively helps shield against sugar uptake, it helps us poop better, etc.

Started having sweetened oatmeal for a midnight snack and already I feel better all over.

But it's not.

What you're referring to, is the basic concept of thermodynamic calorie in/calorie out. Yes, you can "just" reduce food and lose weight if you hit deficit numbers.

But if you don't do it correctly, you'll feel like trash, you'll suffer bad cravings, and put yourself in a stressful mental situation for days, possibly putting your job at risk.

You have to:

- Eat less than what you're already eating

- But enough to nourish yourself so you keep being in good shape for your work and hobbies

- Manage hunger

- Make the change sustainable so you can keep doing it for the rest of your life.

It's specially hard when your work is entirely sedentary, you live alone and, ironically, when you have a salary that let's you order food every day.

A lot of people don't have it hard. Maybe because they have someone cooking for them at home, because they meal prep the entire week, or because their work is so physically intensive they can just wing it and burn everything with what they need to do for a living anyway.

Right, so exactly like I said, it's very simple. If you want to lose weight, reduce calories.

If you add extra modifiers like "I want to feel great while doing it" and "I want to lose weight while sedentary" and "I want to continue eating whatever stupid thing I want" and "I need to be able to scroll tiktok for at least 3 hours, leaving no time for cooking", it gets much more complicated.

Side note: LOL at "but if you're craving food you might get fired!!1!" - this is professional victimhood at its finest.

Inaccurate in my opinion. Let's say you eat 2500 calories a day usually. But you want to lose weight so you reduce it to 1800.

Except your calories are from pop tarts.

If you ate 100 calories of pop tarts every hour you're awake for total of 1800 calories... At the end of the month you'd be fatter.

If you ate 1800 calories of pop tarts once a day in 1 hour, you might maintain weight or loose a little. Maybe.

If you had 3600 calories of pop tarts in a few hour window, and then didn't eat again for 48 hours, you'd lose weight in a month.

Insulin control is 99% of losing weight. Yes thermodynamic blah blah, but unless you pay attention to hormone control that controls metabolism in general, it's not going to work without insane willpower to keep your 'calories out' higher than your body wants.

If you repeated the 3600 calories every 48 hours with beef instead, you'd lose weight like never before.

> If you ate 100 calories of pop tarts every hour you're awake for total of 1800 calories... At the end of the month you'd be fatter.

This is thermodynamically impossible unless your daily calorie use is less then 1800 calories.

Are you saying raising your insulin levels hourly, 18 times a day, will not do anything to your metabolism? Did you even read my post, or did you just instantly reply with the same pedantic reply which my post was specifically meant to address?

> Are you saying raising your insulin levels hourly, 18 times a day, will not do anything to your metabolism?

What metabolic effect do you expect from raising your insulin levels hourly?

It is only thermodynamically impossible if you assume 100% efficiency in energy extraction from food, but in practice we only extract a very small amount of energy from matter. Thermodynamically you could extract ~10^12 kcal from a Pop Tart if you converted its mass into energy.

Not that I agree that for a human metabolism meal timing makes much of a difference in energy extraction, but it wouldn't be thermodynamically impossible.

It's insane to me that people keep talking about the energy in part. Forget that.

Realize that WHAT you put in can change what energy out is.

If I gave you 1800 calories of vodka at 8am, would your use the same amount of energy during the day, and even make it to your 7pm gym? No.

Ok, well sugar isnt exactly the same obviously, but it can also affect what you do that day, how your body acts, your brain even.

Your energy out gets totally messed with after you have tons of alcohol for obvious reasons. Something similar happens on sugar/spiked insulin levels. Can you willpower through it and increase your energy out by running til you drop dead and lose weight? Sure. But it's not easy.

What's way easier is not having the insulin spike in the first place.

Yes it can affect what you do. That's the calories out part of the equation.

Nobody claims that the quality of what you eat has no effect on you, but every study shows that if you maintain the same calorie intake and expenditure it doesn't really matter how you consume the calories or how you expend it.

Well then luckily that shows you hopefully how bad studies are. Because I assume that you agree that eating 100 calories of Pop-Tarts per hour for 18 hours for 30 days, would give you a different result than eating 3 days worth of Pop-Tarts in a few hours once every 3 days for a month.

To not understand that would mean that while believing some studies, you completely ignore all the studies that have been done on insulin and weight gain.

> Because I assume that you agree that eating 100 calories of Pop-Tarts per hour for 18 hours for 30 days, would give you a different result than eating 3 days worth of Pop-Tarts in a few hours once every 3 days for a month.

I agree that you would feel very differently in those situations and it's likely you wouldn't spend the same amount of energy unless you really make an effort to do it.

I don't agree that if you do make an effort to spend the same amount of energy you would have different results with regards to weight loss.

Two weird assumptions here...1, that massive amounts of constant blood sugar/insulin don't affect metabolism.

2, that in the face of crazy long term insulin/hormone disruption, people will continue to be just as active as if they had a sane diet of mostly meat and vegetables.

I'm starting to see why everyone is so unhealthy.

Insulin control is about managing hunger more than a direct cause for weight.

You don't even need to do keto or wacky "just meat" diets to handle insulin. Protein consumption prevents insulin spikes for around 1-2 hours after eating. Also, proteins and fats slow down digestion.

Turns out, the good old Mediterranean diet is spot-on for a healthy lifestyle.

? Insulin is not about management of hunger. I think you got your hormones mixed up.

But yes, meat and vegetables is basically what I'd recommend. Never pasta or bread or sugar unless you need help gaining weight.

Meat and vegetables would make me sedentary from having inadequate glycogen for physical work and exercise.

How about: some pasta and bread to enable physical exertion.

I know a guy that has had meat only for 3 years now. Most fit guy I know.

My father and I have avoided carbs for a few years now. Can do home renovations, gardening, dirt bike riding, and hikes better than we ever did eating carbs. Unless you're doing long distance hikes/running/hard core sports, I really don't think that's true.

He’s probably thinking of ghrelin (or NPY), but leptin and insulin both act as satiety signals too, although weaker than the hunger signal.

That's exactly why I liked being on keto. Never felt hungry, had way more energy, mental health improved a lot. No other diet had those effects. I've been off it for a while and I feel gross again.

The first law of thermodynamics applies to closed systems, which your body is not. Yes it is true that, very broadly speaking, eating more results in weight gain past a certain point. But first principles are not the most proximate reason for that by a long shot.

> Eat less than what you're already eating

Not true for most people. You need to eat fewer calories, not less food. I counted calories for a few weeks an was very surprised.

You can fill yourself up with lower calorie food too. Most people don’t eat enough vegetables. They basically take up space in the gut, make you feel full, while you get your 5 calories from an entire bowl of lettuce or whatever.

> And also the idea that it is "easy" to lose weight is completely out of touch. If it was there wouldn't be millions of people trying hard, spending money on trying and failing for decades, and entire businesses addressing that.

This is a touchy topic, but I would like to point out that you're missing the obvious confirmation bias that comes with this observation.

There are many people who modulate their weight by changing what they eat, how much they eat, reducing snacking, meal planning, and changing their shopping habits.

You don't see them among the millions of people failing to lose weight or paying for expensive solutions because they quietly solve their problem.

I'm also not suggesting it's easy, but we should acknowledge that many people do successfully control and modulate their weight through dietary and habit changes. There's a survivorship bias problem that occurs when you only look at the remaining sub-group who has the most difficulty with this.

and there are people who don't get fat no matter what they eat. Not sure what difference it makes to the millions of people I am refering to. Not even sure what is your point.

> and there are people who don't get fat no matter what they eat.

This is a myth.

When you actually track what these people eat, their daily caloric intake averages out to numbers you'd expect. At best, the difference between "fast metabolism" and "slow metabolism" people in studies comes out to a couple hundred calories per day.

You may witness someone consume 2 pizzas and a soda in one sitting without getting fat, but that person is consuming fewer calories for the rest of the day or the week to offset it.

I think what they mean is "they eat whatever they want and however much they want" and still don't get fat.

Some people just only want to eat an amount that doesn't get them fat. They aren't using any willpower or anything, they just don't want to eat more than a healthy amount for them.

I am not one of those people (I am overweight when I eat as much as I want), but I am for other things. For example, I don't drink very often (only maybe 10 times a year) and don't get very drunk when I do. I just don't feel a desire to drink very often. It takes zero self discipline to not drink for an extended period of time because I don't have the desire for it.

On the other hand, many alcoholics struggle mightily to avoid drinking. It takes all their willpower to not drink.

Everyone is different in their ability to avoid different addictions.

I feel like the word metabolism is often misunderstood. My metabolism is just the number of calories I need to maintain my weight. If I start being more active my metabolism increases, if I become less active it decreases.

So, metabolism is really just an expression of how active we are. Some athletes eat 5-10,000 calories a day just to maintain their weight. Hard working laborers also need a lot more calories than office workers.

Meanwhile, people blame their metabolism as if it's just a trait they can't control like their height. You absolutely can increase your metabolism, just move more. This is also likely a big reason why many people gain weight in adulthood - in school we have weekly gym classes and we spend lots of time running around ad playing with friends etc. Then we grow up and our activity level plummets, but we don't adjust our diet to accommodate our much lower metabolism.

With 40% of US adults overweight, that is a substantial plurality though. It's not confirmation bias when it's more then 1 in every 3 people.

> It's not confirmation bias when it's more then 1 in every 3 people

If you construct your argument to exclude the 2 out of 3 people who are not overweight and then point out that the remaining 1/3 is overweight, that's the definition of confirmation bias.

It's also a disingenuous argument because not all of those 40% are actively trying and failing to modulate their weight in any way. Most people just don't care.

No way that it’s only 40%. Well over half are overweight. Any definition claiming only 40% is lumping in a lot of fatties with the “not overweight”.

They got the right number with the wrong descriptor. It's about 40% obese (and 78% overweight, last I remember).

> I'm also not suggesting it's easy, but we should acknowledge that many people do successfully control and modulate their weight through dietary and habit changes.

For example: weightlifters. It’s standard operating procedure to “bulk up” - periods where lifters overeat to promote muscle growth - and then diet to “cut” weight to drop the fat gained during the bulking period while keeping the muscle. They tend to be extremely motivated individuals though.

The selection bias also works for genetics. For me, it's basically impossible to become fat.

Doesn't ozempic just make you eat less because you're less hungry?

> Many people (will only speak to America), view being fat as a literal moral failing. Gluttony or overeating are not the sin, but being fat.

As an American with a sister with thyroid issues, I can say that is absolutely not true for the majority of Americans. People are mostly sympathetic to those who are not obvious slobs.

People are mostly sympathetic when it's physical issues. Psychological issues are treated as diseases of the soul that you only need God or willpower or whatever to fix. And most fat people are fat because of the incentives in our society, but admitting that also goes against certain political ideologies...

What are the incentives for people to be fat, out of curiosity? Do you mean farm subsidies for corn, for example?

At a low level, yes, corn, but at a high level: more consumption = more money.

Everyone benefits from you being fat. Your doctors, your car manufacturer, food manufacturers, everyone. Except maybe health insurance. But they're not hurt too too much.

There is no doctor on Earth who goes to work and thinks "thank god for fat people or I wouldn't have a business".

There's plenty of doctors and surgeons who wish there were less fat people, because they enormously complicate doing surgery on and managing in hospitals.

> There is no doctor on Earth who goes to work and thinks "thank god for fat people or I wouldn't have a business".

I agree, but this isn't how incentives work.

Ultimately, there are billions of dollars at play here that rely directly on obesity. The mechanisms of the market and human behavior transcend moral judgement.

> There is no doctor on Earth who goes to work and thinks "thank god for fat people or I wouldn't have a business".

What about everybody that works in liposuction?

You mean the job that makes an irreversible removal of fat from your body? Repeat liposuction is considered unsafe, so you will find very, very few people who want to predate on someone via lipo.

They want to "fix you," too.

It's not that there are incentives for you to be fat, but there are incentives for things which happen to cause you to be fat.

The car industry is a huge one. Making people drive everywhere means more car sales, more fuel sales, more infrastructure built for more cars. And it also makes you fat as a side effect.

How would you even know the cause of obesity of a stranger? This is why viewing being fat as a moral failing is mistake regardless of the cause. I'm pretty sure a lot of people view your sister the same way just because they have no idea she has thyroid issues

With respect, neither of you are qualified to speak for majority of Americans, but given the amount of effort, money, ink, and television dedicated to looking better and losing weight combined with the fact that there's even a thing called fat phobic that even requires definition just to push back on all that...

I think there's sufficient reason to believe that "Overweight = bad" is a common standard that at least people hold themselves to.

We must live on different timelines. Pre ozempic America was the proudest nation of fat people I have ever encountered (excluding the costal elites of course).

It's weird because I agree with you, but also have to acknowledge that the "pushback against fat phobia" was for some reason a thing.

Third American here, and the push for fat acceptance was so little of my media consumption that it surprised me so many people spent so much time and energy on the topic.

> People are mostly sympathetic to those who are not obvious slobs.

Maybe once they hear the story, but most people assume every fat person they see is a slob

You can be gluttonous and still thin. I eat 2 lbs of ground beef a day, with tons of cheese on it. For breakfast I have 6-8 eggs, with cheese. I have my morning coffee with heavy whipping cream. For desert, I whip up some of the heaving whipping cream and have it with frozen berries thawed out. It drives gfs nuts but they're too anti fat to try it.

Eggs have about 60 calories each.

Cooking 2lbs of ground beef could yield a little over 1500 calories (Source https://www.uhhospitals.org/health-information/health-and-we... )

A tablespoon of heavy whipping cream is 50 calories.

There's nothing incompatible with what you wrote and a 2500 calorie diet.

This confuses a lot of people who associate certain foods with becoming fat, or think that eating fat makes you fat.

It's entirely possible to eat what you described and maintain a neutral weight.

There isn’t any real secret to this: This combination of foods leads to you eating a calorically neutral amount every day.

That’s a horrifying amount of saturated fat per day, though. This is an extreme risk for heart disease.

I agree of course. Only note is when I say coffee with heavy cream, I mean like half a cup of it into espresso to make a cream latte.

And over a cup whipped for desert.

But I'm also 6'4".

When I ate the standard American diet I was about 40 lbs heavier than I am now.

That’s a horrifying amount of saturated fat per day, though. This is an extreme risk for heart disease.

I keep hearing this, yet after 13 years of keto my cholesterol is still 100. Being fat is much higher-risk than eating fat.

I'm all for obese people taking Ozempic if they really need it, as well as thoroughly studying its long-term benefits and risks, but the fact that we're at the point of considering medical intervention as the population-wide solution to obesity is an abject failure of policy. Looking at our nutritional guidelines, you'd think everyone in America was an extreme athlete. All we have to do is:

1. Take something like the food pyramid, and put vegetables on the bottom, put fat/dairy/coconut and protein/meat/eggs/soy/mycelium in the next level up, put fruit in the next level up, and put starches and sugars on top. In other words: eat real food, mostly plants, without extreme high-carb macros, and treat fruits as dessert. Reverse the failed policy of demonizing saturated fat, and make this the official dietary recommendations for at least a generation.

2. Provide an incentive structure to use lower-GI ingredients in food products. For example, largely replace sugar with inulin fiber sweetened with stevia and/or monk fruit, and largely replace flour with alternatives made from blends of flax, wheat gluten, and resistant starch; no one will notice the difference. Stop letting Cheerios of all things market itself as "heart healthy", at least with its current formulation.

In this world, people would eat way more veggies because they'd grow up with parents and restaurants preparing them properly (with saturated fat and salt). Even for those who didn't, high fiber fortification of UPFs would provide a reasonable backstop. The low-fat/low-salt era's reframing of healthy food as "bland" is a crime against humanity.

For any fat people we still have after that, sure, put them all on Ozempic. It just shouldn't be the expected default that unmedicated people are fat while the medical establishment shrugs its shoulders and doubles down on half a century of empirically bad advice.

> Take something like the food pyramid, and put vegetables on the bottom, put fat/dairy/coconut and protein/meat/eggs/soy/mycelium in the next level up, put fruit in the next level up, and put starches and sugars on top

You might be happy to know we replaced the food pyramid years over a decade ago. With MyPlate, a visual representation of what your plate ought to look like when it's healthy. Half fruits and vegetables (mostly veggies), a little over 25% grains, a little under 25% protein (protein and fruits are depicted as the same). Dairy is the smallest of all, as a small cup off to the side.

Totally disagree with your idea that starches (grains + potatoes, I assume was your thinking) as the smallest thing. You say "eat real food, mostly plants" and then exclude fruits and grains. You keep complicating your own rule without explaining the complication.

> demonizing saturated fat

are you a cattle rancher? There is oodles of research that saturated fat is bad for you. Full stop.

Here are some literature reviews:

- https://pubmed.ncbi.nlm.nih.gov/34649831/ (they actually have received funding from the beef industry and yet still agree that it looks like a diet high in SFA is linked to atherosclerotic heart disease)

On the other hand, you have bad faith actors like the ones who wrote this:

- https://pubmed.ncbi.nlm.nih.gov/36477384/ where they argue the anti-SFA crowd is a conspiracy-theory laden, unscientific group. If you read their (laughable) conflict of interest statement, they never once actually say anything about themselves, instead just bragging about how they're producing "revelations [that have] never before seen the light"

I actually am too lazy to pull up more. But keto people love to talk about how it's all a conspiracy. I'm glad it works for you. It obviously doesn't work for humans at large.

You might be happy to know we replaced the food pyramid years over a decade ago. With MyPlate

No, not particularly. It's fine if you disagree with me, but MyPlate isn't similar to what I'm proposing.

are you a cattle rancher? There is oodles of research that saturated fat is bad for you. Full stop.

You're very confident about this. Are you a potato rancher? I've never personally seen a study which convincingly backed this claim up. What I have seen are plenty of bad studies which conflated "high-fat" with "high-calorie", or otherwise failed to isolate the effects of saturated fats.

Where's the long-term study showing that a diet with ~40%+ calories from non-UPF saturated fats, ~15% or fewer calories from carbohydrates, and an ample supply of green vegetables promotes atherosclerosis relative to a control diet with lower SFAs, higher carbs, and equal calories? Has this even been demonstrated in mice? Has reproducibility been demonstrated? Because I haven't seen it, and not for lack of trying.

But keto people love to talk about how it's all a conspiracy.

I never used the word "conspiracy". I don't doubt the government's policies in this area have been perfectly well-intentioned, but it's nevertheless a fact that we didn't have an obesity epidemic before the government began pushing guidelines that resemble the modern ones upon the 1977 conclusion of the McGovern committee.

If these guidelines and the studies used to justify them are so "obviously" great, it's funny how directly they correlate with the exact opposite of their intended effect.

The Journal of the American College of Cardiology has a good paper stating that saturated fat is not linked with CVD or mortality.

https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.05.077

That still pales in comparison to what a lot of obese people are consuming. Some ground beef is nothing compared to chugging a 2L coke a day.

That's like 4000 calories. How much do you weigh / what's your exercise like?

I'm 6'4", 205. It's probably closer to 3000 calories. But then I also skip meals other than dinner when I'm super busy, which probably averages me out lower. It's a lot easier to skip meals when your body is used to burning fat for energy instead of carbs.

The weight loss mechanism largely just comes from suppressing appetite though, so it still lines up with the penance for sin narrative. It’s not that different from wearing a hair-shirt and whipping yourself if you find yourself having lustful thoughts. Only instead of a whip you just feel kind of uncomfortable and nauseous if you eat too much.

That's true of semaglutide, but newer peptides like tirzepatide (a dual-agonist) and retatrutide (a triple agonist) have additional effects like improving insulin sensitivity, and simultaneously slowing the release of glucagon and activating glucagon receptors, which directly increases fat oxidation and thermogenesis.

I'd describe the effects as basically the opposite of self-torture. Self-torture is dieting/fasting without the drugs. With them, it's great. No afternoon light-headedness and difficulty concentrating, no hunger pangs, no "hangry" effect, no cravings you have to keep suppressing. Just smooth sailing. (though experiences do seem to vary—as do dosage levels)

I agree with this take but want to add that once everyone is doing it, these opinions will change drastically and everyone will pretend like they were never against it.

Another interesting question is where do people go from there? What is the next signal of virtue, I wonder.

I'm not a Catholic, but wasn't the idea of an indulgence that God intentionally allowed an alternative path to redemption, such that if you buy an indulgence, you are (at least by their definition) worthy and deserving?

I always thought of this as essentially the same idea as with Civ allowing you different paths to victory.

Yes indulgences mean something different in Catholicism, they remit the "temporal effects" of Sin ie its spiritual consequences but don't "forgive" it like "Sacrament of Reconciliation" would..

I think that parent is perhaps confusing it with the sin of Gluttony.

My point was that many people view ozempic and other drugs like Martin Luther viewed buying an indulgence: a cheat for the undeserving.

I thought Martin Luther's issue was more with the organization selling indulgences than the undeserving buying them. He preached justification by faith alone. Not some org selling justification.

The idea was for the bishop to pocket money and wave a wand and say “saved” after someone with means did something morally embarrassing. It was a racket and also a useful PR tool.

>My opinion is to wait long enough to validate there are no long term harms, but beyond that, yeah, adjust the priors, it could be a modern aspirin.

it can be more than aspirin. Such an effect on glucose should, among other things, be affecting cancer, probably in a very positive way.

There's also a horseshoe effect here. At the other end are people who advocate for fat acceptance and see the GLP-1 drugs as another source of pressure to be thin. (Not everyone can take semaglutide etc without unpleasant side effects).

> Gluttony or overeating are not the sin, but being fat.

This is a strange thing to say. If you do something normal, and you end up in a normal state, why would that be a moral failing? There's no such thing as "overeating". Different people eat different amounts. The same person eats different amounts at different times.

> (From that perspective:)a miracle cure that allows someone to stop being fat is like an indulgence (in the Roman Catholic sense). It’s a cheat, a shortcut that allows the unworthy to reach a state they do not deserve.

This is incoherent. If you believe that being fat is a sin, but that the things you do that make you fat are not sins, then a miracle cure that makes you thin removes the only sin you were committing. You can't be unworthy if you're not fat. In order for a miracle cure to be "cheating", it is necessary that the sin is in the behavior and not the result.

Everyone defines normal differently and people are quite good at judging those that are not their normal.

Did you mean to respond to someone else?

>My opinion is to wait long enough to validate there are no long term harms,

What's your threshold on that? How many years is "long enough"? Trying to calibrate my own sense of risk.

Not OP but 10-15 years for most drugs. Took about a decade for the general consensus around Oxy to change.

Haven't these been out for a very long time, just not for weight loss?

A quick Wikipedia search shows Exenatide was FDA approved in 2005 for diabetes.

Ozempic itself has been in use for almost a decade now (originally approved for type 2 diabetes in 2017). Many millions of people have taken it, without much in the way of serious complication.

Exenatide had been in use since about 2005, and by 2019 had more than a million people on it. Some of those patients have literally been on it for 20 years. It does have a worse side-effect profile than Ozempic (or the more modern GLP-1's like zepbound), but even then the benefits outweigh the risk for those diabetics.

Today it is hard to argue the benefits of modern GLP-1s don't outweigh their risks. They've been extensively tested, the class of drug has been around for decades, and they are used by many millions of people.

I personally lost 120 pounds on Zepbound in a little less than a year. It's been life changing, and anyone who thinks I might be less healthy now is very clearly wrong. Literally every aspect of my life has been greatly improved.

I'm a late adopter to most things.

my estimate would bigger than others and I would put it at 30-50years.

I take smoking as a cautionary tale, in the beginning it was pushed as not just a recreational thing but a healthy activity that bring benefits with papers published to sing praises about it. my parents were even nudged by their teachers/doctors/etc when they were young to try smoking.

now we all know that smoking is beyond bad and all that early "research" was just people paid off by big companies to promote it.

I think a lot of people share similar concerns, but the benefits of a successfully therapy are so extreme it would take quite a lot to derail ozempic. People easily gain 5 or more years of lifespan by not being obese, avoid myriad related health conditions, and are truly much better off. It would take a lot to reduce someone's life expectancy by a comparable amount and we haven't seen that much besides gastrointestinal issues.

We performed the surgical options like stomach reduction before this which come with serious danger for comparison

Under-discussed benefit: being able to have all your clothes actually fit at the same time (no wardrobe scattered between your "skinny" weight and your "fat" weight and rarely being in the right place for more than a handful of pieces to fit entirely correctly) so you can spend up a little on nicer clothes without worrying you'll only be able to wear them part of the time. Worst case, you start to pack on a little too much and they start getting tight, you increase the dose or go back on the drugs for a week or three (or just do it the old fashioned way—hey, it works some of the time, temporarily) and ta-da, right back where you want to be—you're not going to pack on weight and find yourself unable to lose, so buying "skinny clothes" isn't mortgaged against your future success at forcing yourself to eat less.

> I take smoking as a cautionary tale, in the beginning it was pushed as not just a recreational thing but a healthy activity

While i agree the gist of what you are saying, also important to mention that humans started cultivating tobaco when mamoths still roamed the Earth. There was indeed a concentrated pro-smoking publicity campaign by tobaco manufacturers in the 1930s, but it was hardly “in the beginning” of our tobaco use.

> with papers published to sing praises about it

Links to these papers? I’ve always been curious because I’ve seen this claim many times, especially on HN but no one has ever managed to actually provide a source on one.

> with papers published to sing praises about it

There is no modern-style research touting the benefits of smoking qua smoking. I will grant you there might've been some crank self-publishing something, like some of Aristotle's writings.

But you won't find what we'd consider today an acceptable, reputable form of research saying this.

There’s two sides to that coin. Obesity has known long term harms. So what we are looking for in a deal breaker can’t be a small but statistically significant increase in some cancer or other. We’d need something as bad as smoking to outweigh the benefits.

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