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Comment by asdff | Hacker News Reader

I hear the most ironic stuff on glp from the people I know on it. So doctor is obviously a reasonable person with an interest in making people healthy, not trying to set up glp addicts, and are encouraging better diet and increased exercise while eventually tapering and getting them off the glp entirely as the final end goal.

The whole time they are telling me this I can't help but wonder what the hell is the point of the glp1 here? You still have to improve diet and regularly exercise anyhow. So its like there is no point. Might as well just rip the bandaid off, diet and exercise, get there 6 months slower, while not taking the glp. Like wouldn't you want to actually increase muscle mass while burning fat?

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If you are 3-400+ pounds, quickly shedding 100+ pounds makes exercising MUCH easier, and the accompanying loss in appetite will HOPEFULLY teach you better portion sizes. Countless morbidly overweight people have tried for years/decades to lose weight, without success, and GLPs allow them to bootstrap the process.

Yes, CICO, blah blah, but overcoming food addiction by asking people to eat less is like forcing a smoker who wants to quit to work at a cigar bar or something. You can't just not buy food, especially if you have a family you have to feed.

When you talk about morbidly obese usually that is when you start seeing egregious portion sizes. Like multiple plates of food. Multiple big macs. I'm pretty sure they are aware that a portion is just one big mac and probably not the largest fries and coca cola. GLP isn't much of a helper in that I don't think, and makes me think whenever they go off the glp they will just go back to multiple portions since the issue circles back to willfully ignoring recommended portions.

But that being said everyone I know on GLP (only like 3 people admittedly) isn't close to obese. Maybe at most 40-60lbs overweight. And again all getting the recommendations for diet and exercise interventions, which they are all starting up, but begs the question whether they could have just lost those couple dozen pounds starting up diet and exercise without having to go on the drug. Especially as the drug isn't actually "doing" anything like raising resting metabolic rate to physically burn more calories, but instead slowing digestion and making you feel as though you are more full to trick you into taking in less calories.

> while eventually tapering and getting them off the glp entirely as the final end goal

It's an honourable goal but the evidence isn't great for that

> You still have to improve diet and regularly exercise anyhow

You don't have to. Should though.

When the drugs are working as intended, you'll lose weight without 'trying' to improve your diet, exercise will speed up the weight loss, but isn't strictly necessary for it to "work". Encouraged, sure, but you'll get weight loss from the appetite suppression alone.

The 'high protein' advice is because a lot of glp1 consumers had poor diets to begin with, and they're catabolic drugs. Combine that with reduced appetite and you're at risk of insufficient protein consumption to maintain whatever muscle mass you started with.

Because long-term calorie restriction is 100x harder than popping a pill and downing a protein-and-fiber shake, and you can't outrun a burger but you can outlift a calorie deficit, so lumping them all together under "improve diet and exercise somehow" is a nonsensical rhetorical flourish / troll move?

I believe all glp are intravenous on the market currently unless some oral one is out now. Not sure what you are saying about trolling, I was genuine.

I lost weight the regular way. You don't understand how much will I expend to not continuously eat. The strategy I deploy: I never have ready-to-eat anything home, I cook everything just before I eat it, I chose ingredients based on their satiety index, I always have something to drink. I fast 5 days every year to 'reset' my grahlin levels (it still hurts, even if it's way less than it used to). I'm still at 26 BMI, so overweight (from 33 to 28 in 3 years, from 28 to 26 in 5).

I have a very good support system. Not to brag, but my parents are amazing, my family have a small amounts of doctors who helped me getting through it at first. My siblings are great too, and my SO support me despite my quirks. I love sailing, which is a great way to loose weight. And I'm a SWE, the easiest job there is when you're not bad at it, that makes good money without real responsibilities or stress. It was still fucking hard. If glp1 can help people less lucky than me, let them have it.

I realize there are probably a lot of low hanging fruit in my own consumption habits that let me generally coast into healthy BMI that for a lot of people, nonobvious tradeoffs might block. I'm a water and black coffee drinker for example. That puts me up a good couple hundred calories on the day compared to people who might reach for something sugary instead. I'm active every day, exercise, and play sports, another couple hundred calories from that. That's not even getting into the actual eating and I'm up probably well over a thousand calories on a lot of people a day.

The “easily constrained” people like the person you are responding too don’t understand. I’m not sure they ever will.

Ive also done it the right way, and it was literally easier, by far, to get a masters degree while working 40 hours a week than it was to drop from 250 to 175. Incomparable. The constant mental pressure to eat, to eat more, to search the cabinets, to stop at x on the way home, etc.

I’ve heard “wow sounds like a severe addiction” yeah no shit. It’s an addiction to a substance you MUST have 2-3x a day. Imagine if you needed alcohol twice a day to live.

I think you are right that I just don't think I will ever have a concept for it. For me I can easily skip an entire day of meals. I can be hungry. I've gone to bed hungry plenty of times in my life. I remember reading some Herman Hesse, Siddartha actually considers it a skill that he knows how to fast and be content.

Cigarette addiction is even more perplexing for me. I've had nicotine addiction before in college, quit, got the headaches and nausea and all that but IMO having the flu is worse, I just rode it out then it was done. I don't understand what goes on for someone who say wants to quit cigarettes, is trying to quit, is aware of the health issues, but still makes the very conscious dozen plus decisions that have to take place in sequence to get that next pack of cigarettes. I think deep down there is a side of them that is maybe extremely depressed, and self loathing, and maybe wants them to fail to quit because that would satisfy their own internal working model of themselves being a failure, too weak to ever quit. Something that goes beyond any one vice and is a general phenomenon, but unfortunately might never be appreciated with so many targeted vice-specific efforts vs understanding the wider whole.

> For me I can easily skip an entire day of meals.

I was like that earlier in life. It didn't last forever.

Why can't you fast? People of all ages do it for Ramadan.

I'm sure I could fast, but that's actually a separate issue from what you previously wrote:

> For me I can easily skip an entire day of meals.

You mentioned fasting during Ramadan. I had to look it up, it apparently allows a predawn meal and another meal after sunset, which can include meat and a dessert. Hardly skipping an entire day of meals! (and also rather less rigorous than the fasting rituals of some other faiths as well, although perhaps Islamic different sects have different takes on this)

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