rich-cartwright

Honestly this is a pretty good description of the Fella program: "A holistic approach which addresses trauma, reasons for emotional eating, lifestyle replacements, recalibration of palate, satiation even at a deficit, and all the rest."

We designed Fella because "throwing drugs at it" is not the best solution for patients.

The crucial difference to your approach is the addition of the medication. Which if you speak to any obesity specialist MD, is exactly what they'd recommend: pharmacotherapy + psychological & behavioral intervention.

Please do not let moral posturing cause you to underrate the importance of a holistic approach which includes medication-assistance.

The thing is, if you speak to obesity specialist MDs, they really do come at this in a different way. They have a much more nuanced view of how underlying metabolism / biology interact with CICO.

I know personally because I used to believe a puritan CICO, but had a "viewquake" moment speaking with them and had to change a lot about what I believe!

Importantly they try to focus exclusively on practical solutions for the population: what will actually work in the world. They detach themselves from a lot of the moralizing we see.

I'm sorry this isn't clearer. The core part of the coaching program is focused on psychology: we even call it "psychological coaching" internally! That's the stress eating side, then also diving deeper into why we make the food choices & portion size choices we do.

My take: a approach focused only on changing behavior has good parts, but traditionally been way too much reliance on this and not enough on the psychological/cognitive side.

It's more that the muscles (assuming same muscle mass) have to do comparatively more work if they are carrying around more weight.

British founder here so I'm genuinely sorry about this! Thought I'd fixed it the day before we launched on HN. Our infra will be updated by end of this week.

If you'd like to be on our waitlist, just drop me a quick email on richie@joinfella.com and I'll make sure you're in our system.

Not at all trying to be cagey, and also not our pill. The main paper is here for more info about the most notable medication: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

Important to say this definitely isn't the only medication the doctor will prescribe. That's a decision to make in conjunction with the patient after a full medical history.

Correct that there are a host of causes, certainly not simple.

Thank you, really appreciate it.

Impressive you've kept it up your whole life!

I'm sure guys reading this have heard versions of this advice 100s of times before. I'll let one of them reply if they fancy it.

From our side: we focus on the evidence base, and does what is clinically most effective & sustainable for patients.

This is one solid behavioral tactic. Good to have in the toolbox for most people. Lot more to it than this!

Thank you for sharing.

Happy to help with any research if I can. A good starting point for the medication I referred to in my post is here: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

Guess I gotta step in here to protest "magic baldness cream".

We're not offering anything magic. The medication side has a compelling & growing evidence base: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

For the vast majority obesity doctors, a medication-assisted approach is now the gold standard.

The program side is also no magic. We do tough work, but with a strong evidence base, a powerful support structure and we give ourselves enough time (12-month program). We focus on the root causes of poor metabolic health: stress, sleep, exercise, dietary. From both the behavioral & psychological angles.

No magic here, just evidence-based interventions.

Interesting parallel.

Agreed about the willpower rambling and the usefulness. This is the crux for me.

Unsure how helpful this slapdown is after the guy is sharing something pretty vulnerable.

Okay all important context, thanks for this. Which state are you in?

If you drop me an email on richie@joinfella.com, we'll talk it through

Thanks man. Just so I've fully understood here:

> "The person who got the surgery would often lose only the plurality of the weight, and sometimes not even that."

By this you're meaning the whole family lost weight after one individual had bariatric surgery?

Yep more research being done on the hormone imbalance side. Nascent area though.

Helpful to know. Thank you.

Hadn't heard about H&S.

Will give it more of a think about best early adopters.

Noted. For reference, I've very much tried to design Fella to tackle all the root causes of obesity, which vary person to person: metabolic condition, stress, sleep, exercise, food types & volume, and hormone imbalances.

The stress eating side takes inspiration from a CBT-based approach. Lots of aspects to CBT, but an important part is to recognize what we're use the tool (relieve stress) & when we're using the tool (late evening) - then to find a better tool to replicate that stress relief.

Helpful to know, thanks!

Really nicely put.

re: powering through, any tactics you used? Or literally just there in bed promising yourself not to move?

Nice. Working hard to get to you as soon as we can!

We do work with T1 diabetics, and the weight loss prescription does bypass that line of questioning.

BUT. Cards on the table about qualifying for GLP-1 RAs: most insurance policies still don't include weight management medication, and if they do it is difficult to know how your insurance will react until the doctor writes the prescription. I know people smarter than me are working on changing this about the US healthcare system!

So we'd have to see exactly which medication was a fit after a conversation with the doctor.

Which state are you in by the way?

I think a lot about our framing and I know for sure we haven't nailed it yet.

It's fair to say your avg HN reader is very different to your avg American. For example, you seem already somewhat clued up about Semaglutide. You're likely interested in the biology behind it, and probably aren't afraid to parse the journal article about it.

I really wanna emphasize how different this is to your avg American.

So it's more my bad for not tailoring our language enough for a HN post.