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.
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.
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.
"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)
Maybe we should be asking people in shape what works, not asking people out of shape what doesn't.
Diet and exercise works.
We literally have the science, and, over a population and over time, no, they per se do not.
The things that do mostly aren't accessible to normal people (three or four professional nutritionists and trainers and doctors helping out several hours per week; moving to a skinnier country) so "diet and exercise" has been the only available course to recommend, and it's better than nothing, but it's depressingly ineffective.
This is precisely the difference between could and does I was trying to highlight to address this kind of thing in advance: diet and exercise could work, like, on paper they work every single time! Hell, technically, they're even essentially all of the mechanism by which methods that do work, achieve their effect, just indirectly. But just trying to improve diet and increase exercise directly does not work, not over a population. For outliers, yeah, but for most, no. Improving those is a an effect of approaches that do work.
Can you share it?
Why they can't, I am unsure. Is it because hunger is a stronger drive than long-term planning? Is it because food is, like many other products and services sold in a capitalist economy, incentivised to develop in maximally addictive ways even without a deliberate choice by any supplier? Is it because advertising really does influence people? Overuse of antibiotics makes people hungry? Something else entirely?
Whatever the cause, people can't apply those methods. Which means they don't work for most people — not that they can't work for most people, they just don't.
The answer has been mentioned in other parts of this thread:
They simply don't feel the hunger that obese people do. Some people eat a larger than normal lunch and then won't feel hungry at dinner time and will either just have a snack or skip the meal entirely.
Others, like me, can put down a 22 oz steak and then still feel hungry again just two hours later.
It's not a matter of habits, it's about what their body tells them. My body is always telling me to eat even after eating an irresponsibly large meal, and ignoring those signals difficult. Those people that are in shape don't have that problem. Their body is telling them to eat less.
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.
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.
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].
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.
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).
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.
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.
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.
On the one hand, i'm really happy for my friends and loved ones who have always struggled with weight find a solution that works for them.
On the other hand, i went through a non-drug assisted weight loss journey and improved countless things about my lifestyle besides just the number on the scale.
I worry this solution being available will just increase the number of sedentary people (which is also really bad for your health) and create a whole new set of people dependent on the pharma industry to be able to live their lives how they want
For the morbidly obese, fat loss makes more activity much more feasible.
https://www.michiganmedicine.org/health-lab/weighing-facts-t...
Weight loss is easier than keeping it off. There is only so much will power people have against food noise.
Reading between the lines, I have the impression that you were fairly strongly overweight ("obese") and struggled with more serous weight issues throughout your life?
I share the concern of the previous poster not so much for people like you, where "lose weight to a manageable level ASAP" is generally a good thing, but for people like me who are "a bit fatter than they'd like" but not necessarily "obese". If you'd meet me, you wouldn't necessarily call me "fat".
Previously I would just eat whatever (not super unhealthy, but also not really healthy) and not really exercise beyond my stubborn insistence on walking or cycling everywhere.
I don't see weight loss rugs as a net positive for me. I made some positive changes to fix this, and if I were to take Ozempic I'd just revert back to my lazy git self, and not get all the benefits that a better diet and exercise give me.
I don't think taking Ozempic is mutually exclusive with improving your diet and exercise.
I really like Mark Lewis's take on YouTube - he's someone who is very fit in general but an injury threw him off and before he knew it, he had gained double digit kilos. This is someone who is motivated but also deals with high food noise.
I deal with low food noise. I am relatively active. I got up to <overweight> pounds slowly and over 8 months was able to lose 40. Even so, I had just one bad month at work and gained 7 pounds without significantly dropping my activity. Just a few meals out and not tracking my calories and I fell off of maintenance quickly. If I resistance train my ability to keep control of my calories falls off quickly because I just get too hungry.
I'd love just a maintenance level just because distraction-level hunger sucks.
If I can't focus on my current task because I'm too hungry, that's food noise. If I can't get to sleep and am tossing and turning because I am too hungry, that's food noise. If all I can think about is a doughnut, or even if I'm chomping on raw broccoli and hating myself because it's just making me hungrier, that's food noise.
I guess the concept isn't intuitive for me because, if anything, I experience the opposite of that. I can focus on a task for hours before suddenly realizing how hungry I am. (If only I had better control over which task I focus on....)
This is the big thing: it's amazing how little you can fall out of line and gain weight. A couple hundred calories a day and you're adding weight, every week. It really does take discipline.
On weight, France (amongst others) had to ban extremely low BMI models*, which implies that people are very happy to look at — and desire to have — dangerous body forms.
> people in good shape vs. people who lost weight is pretty visible
People in good shape can be someone who runs/bikes/swims for 30-60 mins a few times a week.
If we take a gander at Hollywood, we would be deceived into thinking it’s full of men who take really, really good care of themselves. But it’s not so - most are taking steroids, and even more are doing extreme starvation diets prior to roles.
We can actually see the inflation of physique in real time. Look back 5 years, then 10, then 20. Look at the protagonists - they represent the “peak” of what humans want to look like. By today’s standards, those super heros 20 years ago are scrawny.
For better or worse, as a formerly morbidly obese person I can say society doesn’t really care why - they absolutely take you less seriously overall regardless of the underlying reasons.
Congratulations!
Purely focussing on people who are fat because they eat too much (which includes myself, albeit also now formerly morbidly obese thanks to Mounjaro):
(1) The studies find a statistically strong correlation, but that doesn't mean everyone who is morbidly obese has poor self control. The raw data still tends to show a big overlap of obese people with good self control and thin people with poor self control - so it's not reasonable to say anyone in that group is just a rounding error.
(2) The way that food self-control is usually measured is, for example, delayed gratification testing with food. It's not surprising that an obese person will do worse at this, but it doesn't necessarily mean the issue is self-control. It could be that their experience of hunger is stronger than the person who is able to exercise more restraint, so even if they're exercising the same level of self-restraint, they're going to give in sooner. It'd be like saying someone who can hold a plank for longer has more determination. There's a bit of that obviously, but then there's also (much more importantly) how fit and muscular you are.
(3) Self-control itself can be, and often is, a medical issue. Obviously there's ADHD/Autism/depression/thyroid issues/so on. which affect your mind in the general sense, but many common drugs including antidepressants, antipsychotics, antihistamines, etc. are also well known for causing obesity. Science still doesn't know why, exactly, they cause weight gain, other than it's through increased caloric intake - but not clear what drives it.
(4) This one is more speculative, but when I started taking Mounjaro, my general self-control increased. This is quite a common reported side effect. There's no evidence (yet?) that it directly affects your brain in any way that would affect self-control, but nevertheless it seems to for many. Separately, we know that being hungry seems to reduce your general self-control. It doesn't seem like a huge leap of logic to think that maybe the reason Mounjaro is having such powerful psychological effects on people is actually because being hungry is quite a powerful general non-specific motivator -- in which case, the studies testing calorie consumption against general measures of self-control might be producing a correct result but have the cause and effect the wrong way round.
Cards on the table, I'd say the proximal cause for why I'm fat is because I am less to resist food than the average person. However, my general self-control seems to be pretty much fine, and I only got fat after I started taking antidepressants for anxiety. Impulsive would be one of the last words anyone would use to describe me - it's just isolated to food as far as I can tell. Prior to Mounjaro, I was just thinking about eating pretty much all the time. While I'm eating, I'd be thinking about what I'm going to eat next. I was never NOT hungry.
> when I started taking Mounjaro, my general self-control increased. This is quite a common reported side effect.
Do you think part of your improved self-control is just feeling better about yourself? Allow me to extrapolate a bit here: If you are depressed, it is "easy" to throw away self-control and eat, eat, eat. Might the reverse also be true? If you are less depressed, it is easier to harness your self-control and eat less? It seems very plausible to me, but nearly impossible to prove the mechanism, except to observe it with a careful study.
Further, I am curious to hear more about the positive effects on your life after your self-control increased. Example: Are you doing better in relationships, or better at work... or the sun shines brighter in your life now... or what? These kinds of HN posts with high quality, first hand anecdata are some of my favourites.
And given how much weight can be impacted by relatively small changes in diet over a long period of time, makes me think that self-control likely plays little role. The fact that I love basketball and not video games doesn't give me more self-control. It just means I enjoy doing something that burns a lot of calories.
Something I've noticed with "naturally skinny" people: They simply don't have the appetite of the obese. They don't need to self-regulate their eating, as they just don't have the desire to eat. Their sense of hunger is properly calibrated. If they eat a large lunch, they won't even be hungry at dinner time and might just have a snack if they eat at all.
As an obese over-eater, I'm insanely jealous. I'm almost constantly hungry. For me to lose weight, I have to ignore the literal pain in my stomach and the strong biological urge to eat. I literally just finished my lunch 45 minutes ago which consisted of a roast beef sandwich (with like 8 oz of roast beef) and some chips. About 800 calories. I'm still hungry.
I'm not dehydrated and confusing thirst with hunger. My urine is almost completely clear.
> I suggested eating hamburgers and pizza, and he said that he couldn't stand the taste. His lack of weight had little to do with self-control.
Absolutely wild. Maybe that's the next level of human evolution: To have a brain that understands that food will always be readily available in modern civilization and so finding high-calorie foods delicious and providing a dopamine hit for consuming them isn't necessary.
People assume that hunger is the same for everyone, and that can be used to simply rank the level of willpower people are exerting against the drive. But it's not. Some people have different appetites which leave them skinny or permanently hungry. Some people can and do eat a lot more than others for less weight gain.
This is why the drugs are so effective: they're appetite suppressants.
Another trick is to try splitting that sandwich in two and eating the second half after 45 minutes (when you get hungry again).
The food must be tossed though because we have too much food in 2025, not too little. As i've explained to my parents and aunts and brother... if you consume the food you've not saved money by fully extracting the food's value. The food's value to your body is in a curve. Once you pass the nadir, the food becomes toxic. Thus, you are paying to kill yourself.
Anyway, yes, absolutely for someone with this learned behavior, it takes A LOT of work to unlearn it. It's taken me years and sometimes I still get the same hunger, but it dies down. You must understand that this ability to be hungry all the time is completely learned though. After several months of intermittent fasting very strictly, this finally went away. You must understand that you will feel incredibly free when one day you see something that tastes good, that you know tastes good, and don't feel the need to consume it.
Because of my DIRECT experience, I encourage others to pursue this path and do not give up. So while I understand completely where you are coming from, I also understand your friend's disgust over the pizza and hamburgers. This is the normal response to food, especially the highly greasy / sugary stuff like most modern food. The first time I had ice cream after a long no-carb diet, I could barely stomach it. Again, this is normal but no one told me that growing up; in fact, the opposite was encouraged.
> Absolutely wild. Maybe that's the next level of human evolution:
No it really just means you prioritize other things than filling your stomach.
One thing no one ever told me is that ... you don't have to eat. Indeed, on days where I do very little I barely eat anything. Again, that's NORMAL. It doesn't sound normal to many people because we were raised wrong. On days I do a lot of exercise or house work or physical labor (i have a desk job), then I eat more. That's normal. The eating three meals a day whether you need it or not is not normal at all.
Hunger signals can be very confusing. Is it an actual hunger signal or is it a craving for another hit of dopamine? As a formerly morbidly obese person, who through deliberate fasting has tried hard to understand what actual hunger feels like, I have to admit I still don't trust my own instincts in that regard.
Sometimes what I fear the most isn't hunger, but the let-down that comes with not being fully satisfied.
Prior to taking Mounjaro, I was pretty much constantly hungry when it was objectively incorrect to be - for example I had just eaten literally 30 mins prior. This was usually accompanied with stomach rumbling and the weird hungry rain stick noise in the back of the neck (I don't know what causes this but it's not uncommon), so I'm pretty sure it was "real" hunger.
Since taking Mounjaro, it's much easier now to distinguish between really being hungry, and being, I guess, psychologically hungry. Sometimes, now, if I've had a hard day or am in a poor mood, I want to eat chocolate just to make me feel better. That's something I didn't really notice before, maybe because it was always masked/coincident with physiological hunger? Perhaps the psychological side drove me to eat more or less healthily for pleasure, but I was still actually hungry in the first place.
This says something about your personality. I tend to like active people for example. I find it hard to sit still. If you liked sitting and doing anything we would not be able to be friends.
This idea that your physical activity and physicality have zip-all to do with personality (i.e., the brain-in-vat model which is so common amongst the tech crowd) is the root cause of all this equivocating
And that's okay for me, and it should be okay for you, too.
That's a bad comparison though.
A better one would be the effects that you losing weight (or getting in shape or whatever) would have on your life vs the effects that nuclear proliferation would have on your life.
Or the effects that globally eliminating obesity would have on life expectancy vs the effects that solving proliferation would have on life expectancy.
The problem with your argument are the words, "you" and "your".
You are making the mistake that pj50c is exactly arguing against. People arguing in effect, that "__you__ should do something."
"If only __you__ understood...."
"If only __you__ could control your lizard brain telling you you're hungry...."
Those are your beliefs. They are not mine. And this is what people talk about when respecting "boundaries".
I'm not saying you can't have you're opinion. And you can say, "I believe x, y, and z. And here's why...." And I'd be fine with that.
In fact, I'd probably be more open to listening to you.
My argument is that my carb intake is irrelevant compared to nuclear proliferation.
My argument goes like this. Carb intake does probably lower life significantly, but doesn't lead to potentially worse outcomes compared to say nuclear weapons in the hands of terrorists.
Carb intake usually affects people's life not early, but late. And if you believe that "carb intake" is a rational choice and not an urge made by the lizard brain then I would argue it's my choice -- my freedom -- and well get a boundary.
OTOH, a nuclear incident would affect a broad swath of people across all ages. And it's not their choice.
To be clear, I'm not using this post to "dog whistle" that people should not exercise for fitness.
I have gone through multiple bouts of being able to do weightlifting for example for 6 months or so at a time. However, I always end up stopping (for longer than I could do it for) because it just isn't enjoyable. The monotony of doing the same lifts over and over again (even if the weight was increasing) just wasn't engaging enough to keep it as a part of my lifestyle.
I discovered rock climbing a year and a half ago and have been going every 2 or 3 days since (other than 2 weeks off one time due to injury). It's such an interesting sport that combines strength, agility, problem solving and collaboration. It's actually engaging which means I never have to be disciplined to continue doing it on days I don't feel up to it. The exercise isn't the point and yet my body is in better shape then it's ever been.
I think more people need to find that something.
The food industry is a lot like the tobacco industry. Everyone is aware of marketing around health and fitness. But the marketing and social programming that keeps people eating - ad campaigns, portion sizes, food consumption traditions that are billed as "family" events, even things like giant popcorn buckets in cinemas, or the idea that sweet things are "naughty" but also rewarding - gets a pass because it flies under the radar.
It's literally a double bind. Everyone gets two contradictory messages about food, starting from early childhood. And they cannot be reconciled.
So no. It is not about personal morality or shaming people for the sake of it.
Medically, economically, and personally, it really is that important.
But if you just keep showing up and putting in the effort (and most of all, not comparing yourself to anyone else, even your past self), the results will come.
I also hope there’s no long term worse side effects, but I agree with pjc50 in that most of the negative reaction is actually about feeling morally superior.
Most disesases are not self inflicted. Obesity is
Instead we have a system where these companies are allowed, even encouraged to make food that's terrible for you taste amazing, and market the shit out of it to increase shareholder value. But when they succeed at their jobs it's because you, the individual, fucked up. Well which one is it? Both can't be true.
You're putting excess consumption in the same categorical bucket as controlled consumption.
Personal responsibility is a real thing. Its become a recent trend to blame everyone else for any problem you have.
The individuals making trade offs made the wrong choice. It sucks but it is their choice.
Passing the buck is a child behavior. Poor decisions leads to poor outcomes. More news at 11.
I'm taking the meds right now - what the medication allows me to understand is that without changing your sleep, exercise and diet, I simply won't be very successful even while on the meds.
The strongest behavioral effect is that I no longer snack at all, a lifetime habit pre-March. That's resulted in ongoing weight reduction, ~9kg so far.
That, in turn, has encouraged me to increase my activity levels a lot. Offered as an anecdatum in which this drug is driving me away from the sedentary tarpit, rather than towards it. YMMV, of course.
We already have built-in "ozympic" functions- we just need to manually activate them. These drugs really do help some special cases, I don't deny that, but the fact the broad population have access to these drugs is not a natural state. We have no idea what the long-term effects will be. Long-term artifically induced effects of illness will eventually cause problems- erosive esophagitis and hemorrhoids are two examples- that have long-term health implications. Better to bite the bullet, if you have the ability, simply reduce your input, focus on foods that last longer in the digestive tract (whole plant foods), giving us fewer or more moderate glucose spikes, less craving and hunger later. Easier transition.
But, "it's not natural" complaints are, frankly, bullshit. Nothing about how humans live today is "natural" and we're better off for it.
> We already have built-in "ozympic" functions
The drug works by literally making it mentally easier to eat less. It's caffeine for discipline instead of energy. There's no "built-in" that works like that.
Yeah, "natural" would be living in constant fight-or-flight fear from being eaten and/or attacked by a neighboring tribe. Probably always quasi-starving and having low-level diarrhea from eating scavenged rancid food and dying before your 28th birthday.
I don't think there's any evidence that this is actually the case.
Unless you are going to magically fix our food supply and reign in the economic incentives for selling garbage food, chemically induced weight loss is still a better option.
Making people sick and selling them the cure is a sanctioned part of American Capitalism. Making it illegal to do such things is demonized as socialism.
Telling people they are individually responsible for fighting a system designed to make them fat and then die might make you feel good and correct, but it's doing fuck all to solve the issue.
All is working as intended by the ghouls who drive policy that is friendly to the economy. Turning the entire country into one slow motion concentration camp.
He focuses on not counting calories but instead focusing on eating real food (no processed stuff and avoiding sugar). He uses the the example of 100 calories of sugar does not impact our body the same as 100 calories of olive oil. This is a prime example of the McNamara Fallacy.
Here's a video here: https://www.youtube.com/watch?v=OgmFEb0b0TI
I'm a fan of weightloss in general, be it ozympic style or not; however, if you can do it naturally it's more cost effective. Dr Fung focuses on when you eat (intermittent fasting) and what you eat (avoid processed foods)
Obesity kills before those long-term effects become relevant.
You don't get to binge for free. In the words of Alan Carr (of "the Easy Way to Stop Smoking" fame), if you view a change in dietary habit as a sacrifice, for instance focusing on healthier food, then you will not succeed.
All that being said, it may still be useful. A popular view of pharmaceuticals for primary disorders like for instance insomnia is that they can help "bridge the gap" or get a start and recovery, but that they cannot be relied on in the long-term. Your chemistry adapts. That is similarly the most generous view I have of these products.
Anyway, the WW approach has obvious limitations for the same reason low-fat or low-carb does. In WW they use an arbitrary point system to obfuscate restriction, by encouraging protein and low-calorie density foods. Some foods are 0-1 in points (e.g. 0% cottage cheese), some are high regardless of how healthy they are (avocado). You can easily see the problem with this: you quickly hit a wall where you aren't automatically reducing calorie intake by mere virtue of what you are eating. The same thing happens with low-carb and low-fat: what are you going to do once you've cut out all fat and all carbs? Eat negative-carbs?
For sustainable WL of a large amount of weight, there is no way around counting. You cannot "intuitively" do it. And here it's important to stress that there's a major difference between avoiding weight-gain, and losing weight. If you're a person of average weight, you don't need to worry about counting jack if you simply have good eating habits. This is not enough when it comes to caloric restriction.
edit: re reduced cravings, some don't just overeat from physical cravings, but for emotional satisfaction. A binge session on comfort food is not about hunger. This is something to be addressed through therapy.
Just wanted to share that observation.
But I think that's okay -- because the main purpose is weight loss and reduction of caloric cravings. Alcohol is a caloric craving. So it should be fine.
I don't think it would get me off alcohol though. I only drink to relax and be more social. Not because I enjoy it or the taste. But it means I drink rarely anyway.
So even if you didn't enjoy it, what typically happens to me anyway, is the off flavors get magnified.
Like the easiest one is Costco Chili. It tasted vastly different when I was off of it than on it. I taste more of the bitter notes. The complexity is more off putting to me.
I inject on say Sunday nights, and on Monday an IPA tastes terrible. But on Friday it tastes tolerable again. And this is a pretty consistent pattern I've noticed.
Off-label for Ozempic - the whole point of Wegovy is the “weight management” indication.
The same was true for food. I thought about food all the time. But once Semaglutide started I just didn't think of food. I had to remember to eat.
Semaglutide in my experience really helps to eliminate addictive behavior in general, I believe. At least oral addictions (I'm not sure if it would help with e.g. gambling addiction).
I never understood why skinny people believed that fat people have no impulse control until I took the medication. Once I had that impulse control it was so much easier to make long-term decisions.
(More practical note: alcohol contains a surprising amount of calories, especially in beers and sweet wines and ciders. Cutting alcohol consumption also helps weight loss.)
That said, I didn't have as much problem with spirits and cocktails since they don't have as much volume and generally aren't as filling. There might be a danger of turning a beer drinker into a hard liquor drinker.
1. food
2. alcohol
3. gambling
4. smoking
last three are extreme cases but general principle should still apply.
I lost 50 lbs or so on Mounjaro by the time I reached the maximum dosage. Then, a confluence of supply-chain issues and coverage issues eliminated ALL of it, and within a few short months I had regained all the weight. I finally got coverage again, and supply again (via Zepbound) and began slowly increasing my dosage again.
I'm now at the maximum dose and I've lost exactly 0 pounds from the peak.
So, a warning: Use of this drug seems to be a one-and-done. If you can't keep the weight down after you bottom out and after they take you off the drug, it MAY NOT work again.
1. High end personal trainers clients, for which semaglutide was used in conjunction with the trainer's workout regiment and diet.
2. Body builders and models, for which semaglutides simply replaced caffine/adderall/ephedrine.
The drugs can't induce the lifestyle change needed to keep the weight off (nor will it give you the motivation to go to the gym and build muscle). I'm thinking for now, it's a race to see how cheap these drugs can get and ensuring they have no side effects from very long term use. Overall I think the drugs are a net good and I'm interested for seeing the effects for myself, but I'm in good shape and $500/mo is still steep.
And they actually do induce lifestyle changes, which is the fascinating part. Not for everyone, but the impulse control changes are dramatic. I had a friend credit him going to therapy for the first time in his life and reading for the first time since high school to it which was crazy, but makes sense because it also helped him quit smoking weed so he had a lot more time.
https://glp1.guide/content/eli-lilly-suing-glp1-compounders-...
Only a partial patent expiry for Semaglutide in 2026, then full in 2033:
https://glp1.guide/content/patent-expirations-for-glp1-recep...
Here in the UK, I'd much rather just cut my diet a little bit. Faced with the choice of eating less or paying around £250 a month for the maintance dose, that's actually a huge motivator to get me to diet.
https://www.prnewswire.com/news-releases/weight-watchers-ann...
Its stock tumbled ever since those highs and likely wouldn't have ever recovered had Oprah not bought and pumped it. To this day they still carry over a billion dollars in debt.
In fairness to the WW board of the last couple of years, they did make a of reasonable pivot to try to rectify the ship (like buying a telehealth service which prescribed Ozempic), but ultimately it seems like this buyback from 13 years ago created a burden that just made them unable to weather the storm gracefully.
Now, if you're using debt to finance share buy backs, then yeah... it's a short term ploy. But most companies don't use buy backs this way.
But the cash outflow to purchase those shares makes the company less valuable at the same time. In a completely efficient market, the amount of money that the company pays to buy back a share should be exactly balanced by the ownership percentage of that share, resulting in no net change to the price of the company's other shares.
If you have more money than you're able to make good use of improving the company (r&d, acquisitions, new locations, whatever), you can give it back to investors. Which can be either a dividend or a buyback, and in theory (ie, ignoring pesky details like taxes) those are supposed to be equivalent.
It lacks a moral component.
> We have more cash than we know how to spend reasonably?
- pay your workers a good bonus?
- invest the money in the market?
- lower prices?
> What's the argument for stock buyback programs generally?
* https://www.forbes.com/sites/aalsin/2017/02/28/shareholders-...
I like the idea of giving long-term shareholders an easier way to weigh in on buybacks.
Unless you're Berkshire, most investors don't want this. They buy a company for its success in widgetry. If they wanted to pay someone to invest in the market, they'd buy an actively managed fund.
> To this day they still carry over a billion dollars in debt.
Bankruptcy sounds like the only option, but the initial borrowing sounds like incredible mismanagement.
Like extracting value from a patient in the form of removable organs.
But that isn't really true when you're talking about plays like this. More people are made worse off than better.
The whole, everything stupid a company does is "increasing shareholder value" meme is annoying. Not every dumb action a company does can be explained that way.
When shareholder value is used as short term and long term interchangeably, both can be true. Short term value at the cost of long term value.
They do sometimes (but not always) generate plenty of value for the people making those decisions.
Most companies always have another idea to do a new thing, that might induce growth. WW did not. WW has been in trouble for decades, because their business model pre-supposes consumers are too stupid to use a search engine. (Does "weight watchers" work? No. No it doesn't.)
The debt-for-buyback swap is a symptom, not a cause. Management had nowhere to go, no vision for growth, and when you are out of ideas and you are offered an attractive loan, you do a buyback.
The latter was the the end of several large German companies.
There's a whole theory on this:
https://www.investopedia.com/terms/d/dividendirrelevance.asp
The easy way to see it is if all shareholders reinvest dividends, it's the same as a share buyback, only with the broker buying shares on your behalf rather than the company, and your ownership of the company includes a bonus fractional share.
Dividends are also a bit of an accounting game. You can pay yourself a "dividend" whenever you want buy selling shares. This is only 95% true, but if your share in a company just entitled you to 65 cents, the share is probably worth about 65 cents less since the money came from somewhere.
I am. Because just like how I've always got someone else to blame for why I never cleaned my room, executives can always find someone else to blame for why the business they are running went to shit.
And the press loves to run with a good just-so story that paints some indefatigable foreign villain as the cause of a company's demise, instead of boring, banal mismanagement.
Look at all the comments discussing the drug instead of the company. If there is a topic people are interested in, stuff it in the headline.
Because of inflation and market growth, a company that isn't shrinking should usually be sorta close to an all-time high.
bookofjoe•16h ago