rich-cartwright

Well said. These are the kinds of nuanced conversations that our Fellas have with their doctor.

I've really never thought about that flip before.

> "eat an insane amount of food. The food tastes 10x better, and the sensation when eating it is pure bliss"

This stuck out for me. Especially interesting that taste & eating sensation are both heightened.

Interesting. How long is eventually by the way?

Yep I've just been reading up on this now actually: ghrelin & leptin changes after day 2 of a fast.

Thanks for sharing man.

Important to emphasize there is a large variety of causes: stress eating is certainly a big part for a lot of people, but it's far from universal & far from the whole story.

"Something that can be fixed by just putting your mind to it shouldn't have to be treated with pills" is I think an interesting statement. I'm unconvinced "putting your mind to it" is as simple as it's made out to be.

Important to hear this.

An important takeaway from all this is that people react very differently to similar regimes, and projecting our own (successful) experience of a regime onto someone else is likely to not represent their experience.

Well said. My take from research: structures from a CBT-based approach are really helpful and should be more widespread - but for most people are not sufficient in staying at a healthier weight long-term.

These are relatively new medications, so I think roughly a decade for Liraglutide and more for Semaglutide but I'd have to check. Medicare doesn't cover them yet sadly.

There is another promising obesity medication in Phase 3 trials at the moment so it's fair to expect increased competition & decreased prices in the coming years - although it's obviously hard to predict.

Agree it's early days in terms of longitudinal follow-up studies. We're looking forward to playing a part in those studies ourselves.

We're definitely watching this closely.

It's worth noting that, as with any medication, there is a cost-benefit trade-off. In this case it will depend on someone's current weight, what they've tried in the past, and the risks of other conditions e.g. heart disease, diabetes, and their past medical history. Each person that joins Fella has an in-depth discussion about this with an independent obesity physician and is welcome to speak it through with their own PCP too.

Also agree it's definitely possible, although would need to know more about OP.

Really smart to pick this. The econometrician in me smiled.

Important that you bring up the age factor. We're doing more research now with our doctors on how best to adjust treatment based specifically on male hormonal changes with age.

Said like a true Fella. I hear this a lot.

Glad to have you!

I'm really sorry - I honestly thought we'd added that in yesterday in prep for having more exposure via HN. Very much my bad.

If you still want to go down on our waitlist, please do drop me a line on richie@joinfella.com

We're actually not based in the US right now as we had to return home for covid, and we're building a remote co.

To be honest we sadly don't have any useful advice for US visas: it's not a fun system.

Only thing is it's now more possible than ever to soak up US culture, run a US-focused company, but not be based in the US. But that's not what you wanna hear if you've built your life there. I'm sorry we can't be more helpful

There's a lot going on in terms of the kids angle: increased stress, sleep deprivation, hormone changes, less time for exercise & healthy eating. Not easy.

Interesting, reading this now.

"so I only need to stay where I am until the wedding, and then I can gain a few pounds" - this is interesting

Those are some tasty numbers.

Really interesting to know, thank you.

Anecdotally: I also used to struggle to sleep when I was dieting. My sensation was intense hunger when I was in bed where I couldn't stop thinking about food in the kitchen.

Great links.

The complete fasting approach is pretty common among Fellas I've spoken with. Lot of the guys have powerful "all-or-nothing" traits, where it feels easier to have a strict intense rule than a more nuanced approach.

The issue comes when you therefore become so hungry your body drives you to eat a lot of food all at once. But I'm interested that you notice your hunger sensations actually diminish over time.

Interesting to know, thanks.

Yep Semaglutide is the key medication. Important to emphasize it appears to be a safe medication.

It's better to think of the medication as more similar to other medications taken for chronic conditions (e.g. hypertension) than a quick fix magic pill.

The papers show consistent weight loss for ~52 weeks, then plateauing off onto 68 weeks. If you suddenly stop taking the medication, the weight creeps back on. The research therefore suggests you can likely slowly taper off the medication after year 1, but with medical supervision to ensure that doesn't lead to weight gain. This is also why improved mindset & habits are also important.

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

ELI5: increases satiety, decreases appetite.

Thank you very much for this. Kind message.

What was the previous startup by the way? Always interested in improving my knowledge of the space!