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Interesting offering, definitely an important market. > So we started researching effective, evidence-based treatments for obesity Fasting has a tremendous am

Interesting offering, definitely an important market. > So we started researching effective, evidence-based treatments for obesity Fasting has a tremendous amount science supporting it [1], can you articulate why you're pursuing the prescribed semaglutide approach instead? [1] Fasting: Molecular Mechanisms and Clinical Applications https://www.sciencedirect.com/science/article/pii/S1550413113005032 https://www.sciencedirect.com/science/article/pii/S155041311...

rich-cartwright 5y ago
Spot on about fasting, and keto has solid evidence as well - https://www.virtahealth.com/ https://www.virtahealth.com/ are a great company focused on this. The issue is we're starting to have a more nuanced understanding of the metabolic resistance people face when they undergo dietary changes - basically the body fights hard against you as you try to lose weight by dieting. So it's now industry-standard among obesity specialist doctors to see obesity as a "metabolic disease" which, for the vast majority of people, needs a medical approach which doesn't rely on willpower.
- criticaltinker 5y ago
  Thanks for your response and taking the time to answer these questions. > basically the body fights hard against you as you try to lose weight by dieting Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes. > So it's now industry-standard among obesity specialist doctors to see obesity as a "metabolic disease" which, for the vast majority of people, needs a medical approach which doesn't rely on willpower. I agree that the current standard of care is largely focused on prescription medication. Is there strong evidence supporting the claim that the majority of people need treatment that doesn't rely on willpower? I'm particularly interested in the well documented association between obesity and mental health [1], and I think Fella would be especially compelling if a holistic approach to treatment was offered. [1] The High Prevalence of Poor Physical Health and Unhealthy Lifestyle Behaviours in Individuals with Severe Mental Illness https://www.researchgate.net/profile/David-Scott-76/publication/51588172_The_High_Prevalence_of_Poor_Physical_Health_and_Unhealthy_Lifestyle_Behaviours_in_Individuals_with_Severe_Mental_Illness/links/00b4951d102b879e3f000000/The-High-Prevalence-of-Poor-Physical-Health-and-Unhealthy-Lifestyle-Behaviours-in-Individuals-with-Severe-Mental-Illness.pdf https://www.researchgate.net/profile/David-Scott-76/publicat...
  - lharries 5y ago
    (Richie's co-founder here) You're spot on with the link between mental health and obesity and the need for a holistic approach. For many of the guys stress and anxiety will play a key part in their food habits. This is something that our coaches actively ask about and help manage if relevant. For other guys it might be sleep [1] or it might be macro-nutrients. The coaching will depend on the person and we make these changes supported by their medical team. > Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes. "Long-term persistence of hormonal adaptations to weight loss" [2] and [3] are both interesting papers on this. With the summary being that weight loss results in prolonged changes in your hormones associated with increased appetite and thus weight regain. This results in a strong negative feedback cycle. [1] https://pubmed.ncbi.nlm.nih.gov/28164452/ https://pubmed.ncbi.nlm.nih.gov/28164452/ [2] https://pubmed.ncbi.nlm.nih.gov/22029981/ https://pubmed.ncbi.nlm.nih.gov/22029981/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
    - criticaltinker 5y ago
      Thank you for the excellent response and citations. I think you and Richie are on to something here - wishing you the best of luck.
      - lharries 5y ago
        Thank you! I enjoyed your great comments too
- zadler 5y ago
  What’s the connection between stress eating and metabolic disease?
  - rich-cartwright 5y ago
    1. Stress causes the adrenal glands to release a hormone called cortisol, and cortisol increases appetite. 2. When stressed, we look for relief - and for a lot of people that relief comes as food, or the act of eating itself. Both of these often lead to overeating which is a cause of metabolic disease.
- jimmaswell 5y ago
  > basically the body fights hard against you as you try to lose weight by dieting. I used to weigh 310lbs, now I'm 215lbs. All I did was count calories to maintain a deficit and the results were essentially the same as predicted by the math. I was a bit hungry sometimes at first as I adjusted to it but that's really it. Prioritizing protein and fat over carbs helps with that. What ways does the body tend to fight against people?
  - zinclozenge 5y ago
    Unfortunately there are people like me who don't only feel a bit hungry, when I eat at a deficit there are times where I get so hungry my thoughts are completely consumed by the hunger. The only way for me to successfully lose weight was to have days where I simply eat nothing at all. Sounds counter-intuitive but after getting over the initial extreme hunger I found that the hunger sensations would diminish into a background noise, of sorts. That and the rules are easy to follow: eat nothing. When I'd eat at a deficit I'd frequently justify to myself that eating a little bit more than I was planning on doing was ok because it was only a little. And then I'd do that several times until I felt completely satiated, defeating the purpose.
    - rich-cartwright 5y ago
      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.
      - andi999 5y ago
        Isn't it actually well known that you are not hungry when fasting (after a couple of days)?
        rich-cartwright 5y ago
- Unbeliever69 5y ago
  This has been so true to me. At the beginning of the pandemic I started keto. The first six months the weight fell off then I just hit a wall right around the time I began exercising (a full season of skiing) and weight lifting. For the last month I've been combining keto with IF and I'm getting a tiny bit of headway. My body just seems to be fighting VERY hard to resist my best efforts. And while I'm not checking to see if my body is in ketosis, my diet is significantly more strict compared to when I started keto 1.5 yr ago. I keep doing keto (despite the plateau) because it has helped me in many other ways (sleep, asthma, chronic fatigue, mental health etc.) For reference I am 51 yo.
  - rich-cartwright 5y ago
    Interesting to hear this personal experience. If you're interested in some research behind this: "Long-term persistence of hormonal adaptations to weight loss" - [1] and [2] are both interesting papers on this. With the summary being that weight loss results in prolonged changes in your hormones associated with increased appetite and thus weight regain. This results in a strong negative feedback cycle. [1] https://pubmed.ncbi.nlm.nih.gov/22029981/ https://pubmed.ncbi.nlm.nih.gov/22029981/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/ tldr: our bodies make it v difficult for folks!
TeeMassive 5y ago
I tried fasting and a pure keto diet. While they do work, I felt miserable. This is not sustainable for people like me who has to lose more than 100 pounds. Now I started losing weight by just balancing macro-nutrients; more protein, more vegetables, less carbs as opposed to absolutes "no" and "only" except for no sugary drinks and beer and deserts except in social occasions. Also big emphasis on weight lifting as opposed to cardio. Cardio helps with its own health benefits but is very poor for muscle growth and fat loss and should be seen as a compliment.
- rich-cartwright 5y ago
  Yep spot on about the sustainability. We hear this all the time from the Fellas.
- faichai 5y ago
  I felt miserable on Keto the first two times I tried it. I’ve found doing fasting in the month prior helped with the adaptation and a large part of the misery was loss of electrolytes. By using electrolyte powder I only really had one or two really miserable days this time round.
  - rich-cartwright 5y ago
    Interesting. How long have you been doing keto this time?
    - faichai 5y ago
      Only week 3, but finding it pretty great this time round, ketones actively suppressing appetite, eating about 2 meals a day, down about 6kg so far. I still fast a couple of times a week, but being in ketosis already makes it crazy easy. Have enough energy for gym, though power slightly down. I hear people can hit a wall about 8 weeks in, but also hear that could be down to over-consuming seed oils. Will see how it goes.
      - rich-cartwright 5y ago
elric 5y ago
Fasting is a migraine trigger for me. Many other migraineurs agree. Other migraineurs see benefits from fasting. My point being: there is no "one size fits all" approach to weight loss.
- rich-cartwright 5y ago
  Important to hear this. I'd say there's a huge lack of empathy (understanding that someone can have a very different experience) in this space because of how it's tied in with society's take on individualism & moral responsibility.
agentdrtran 5y ago
As someone who has tried both: semaglutide and smaller diet changes have been a lot easier for me than fasting, which did work but was stressful and extremely difficult to do long term.
- rich-cartwright 5y ago
  Thanks for sharing, important to hear anecdotal evidence.

rich-cartwright 5y ago

Spot on about fasting, and keto has solid evidence as well - https://www.virtahealth.com/ https://www.virtahealth.com/ are a great company focused on this. The issue is we're starting to have a more nuanced understanding of the metabolic resistance people face when they undergo dietary changes - basically the body fights hard against you as you try to lose weight by dieting. So it's now industry-standard among obesity specialist doctors to see obesity as a "metabolic disease" which, for the vast majority of people, needs a medical approach which doesn't rely on willpower.

criticaltinker 5y ago
Thanks for your response and taking the time to answer these questions. > basically the body fights hard against you as you try to lose weight by dieting Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes. > So it's now industry-standard among obesity specialist doctors to see obesity as a "metabolic disease" which, for the vast majority of people, needs a medical approach which doesn't rely on willpower. I agree that the current standard of care is largely focused on prescription medication. Is there strong evidence supporting the claim that the majority of people need treatment that doesn't rely on willpower? I'm particularly interested in the well documented association between obesity and mental health [1], and I think Fella would be especially compelling if a holistic approach to treatment was offered. [1] The High Prevalence of Poor Physical Health and Unhealthy Lifestyle Behaviours in Individuals with Severe Mental Illness https://www.researchgate.net/profile/David-Scott-76/publication/51588172_The_High_Prevalence_of_Poor_Physical_Health_and_Unhealthy_Lifestyle_Behaviours_in_Individuals_with_Severe_Mental_Illness/links/00b4951d102b879e3f000000/The-High-Prevalence-of-Poor-Physical-Health-and-Unhealthy-Lifestyle-Behaviours-in-Individuals-with-Severe-Mental-Illness.pdf https://www.researchgate.net/profile/David-Scott-76/publicat...
- lharries 5y ago
  (Richie's co-founder here) You're spot on with the link between mental health and obesity and the need for a holistic approach. For many of the guys stress and anxiety will play a key part in their food habits. This is something that our coaches actively ask about and help manage if relevant. For other guys it might be sleep [1] or it might be macro-nutrients. The coaching will depend on the person and we make these changes supported by their medical team. > Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes. "Long-term persistence of hormonal adaptations to weight loss" [2] and [3] are both interesting papers on this. With the summary being that weight loss results in prolonged changes in your hormones associated with increased appetite and thus weight regain. This results in a strong negative feedback cycle. [1] https://pubmed.ncbi.nlm.nih.gov/28164452/ https://pubmed.ncbi.nlm.nih.gov/28164452/ [2] https://pubmed.ncbi.nlm.nih.gov/22029981/ https://pubmed.ncbi.nlm.nih.gov/22029981/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
  - criticaltinker 5y ago
    Thank you for the excellent response and citations. I think you and Richie are on to something here - wishing you the best of luck.
    - lharries 5y ago
      Thank you! I enjoyed your great comments too
zadler 5y ago
What’s the connection between stress eating and metabolic disease?
- rich-cartwright 5y ago
  1. Stress causes the adrenal glands to release a hormone called cortisol, and cortisol increases appetite. 2. When stressed, we look for relief - and for a lot of people that relief comes as food, or the act of eating itself. Both of these often lead to overeating which is a cause of metabolic disease.
jimmaswell 5y ago
> basically the body fights hard against you as you try to lose weight by dieting. I used to weigh 310lbs, now I'm 215lbs. All I did was count calories to maintain a deficit and the results were essentially the same as predicted by the math. I was a bit hungry sometimes at first as I adjusted to it but that's really it. Prioritizing protein and fat over carbs helps with that. What ways does the body tend to fight against people?
- zinclozenge 5y ago
  Unfortunately there are people like me who don't only feel a bit hungry, when I eat at a deficit there are times where I get so hungry my thoughts are completely consumed by the hunger. The only way for me to successfully lose weight was to have days where I simply eat nothing at all. Sounds counter-intuitive but after getting over the initial extreme hunger I found that the hunger sensations would diminish into a background noise, of sorts. That and the rules are easy to follow: eat nothing. When I'd eat at a deficit I'd frequently justify to myself that eating a little bit more than I was planning on doing was ok because it was only a little. And then I'd do that several times until I felt completely satiated, defeating the purpose.
  - rich-cartwright 5y ago
    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.
    - andi999 5y ago
      Isn't it actually well known that you are not hungry when fasting (after a couple of days)?
      - rich-cartwright 5y ago
Unbeliever69 5y ago
This has been so true to me. At the beginning of the pandemic I started keto. The first six months the weight fell off then I just hit a wall right around the time I began exercising (a full season of skiing) and weight lifting. For the last month I've been combining keto with IF and I'm getting a tiny bit of headway. My body just seems to be fighting VERY hard to resist my best efforts. And while I'm not checking to see if my body is in ketosis, my diet is significantly more strict compared to when I started keto 1.5 yr ago. I keep doing keto (despite the plateau) because it has helped me in many other ways (sleep, asthma, chronic fatigue, mental health etc.) For reference I am 51 yo.
- rich-cartwright 5y ago
  Interesting to hear this personal experience. If you're interested in some research behind this: "Long-term persistence of hormonal adaptations to weight loss" - [1] and [2] are both interesting papers on this. With the summary being that weight loss results in prolonged changes in your hormones associated with increased appetite and thus weight regain. This results in a strong negative feedback cycle. [1] https://pubmed.ncbi.nlm.nih.gov/22029981/ https://pubmed.ncbi.nlm.nih.gov/22029981/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/ tldr: our bodies make it v difficult for folks!

TeeMassive 5y ago

I tried fasting and a pure keto diet. While they do work, I felt miserable. This is not sustainable for people like me who has to lose more than 100 pounds. Now I started losing weight by just balancing macro-nutrients; more protein, more vegetables, less carbs as opposed to absolutes "no" and "only" except for no sugary drinks and beer and deserts except in social occasions. Also big emphasis on weight lifting as opposed to cardio. Cardio helps with its own health benefits but is very poor for muscle growth and fat loss and should be seen as a compliment.

rich-cartwright 5y ago
Yep spot on about the sustainability. We hear this all the time from the Fellas.
faichai 5y ago
I felt miserable on Keto the first two times I tried it. I’ve found doing fasting in the month prior helped with the adaptation and a large part of the misery was loss of electrolytes. By using electrolyte powder I only really had one or two really miserable days this time round.
- rich-cartwright 5y ago
  Interesting. How long have you been doing keto this time?
  - faichai 5y ago
    Only week 3, but finding it pretty great this time round, ketones actively suppressing appetite, eating about 2 meals a day, down about 6kg so far. I still fast a couple of times a week, but being in ketosis already makes it crazy easy. Have enough energy for gym, though power slightly down. I hear people can hit a wall about 8 weeks in, but also hear that could be down to over-consuming seed oils. Will see how it goes.
    - rich-cartwright 5y ago

elric 5y ago

Fasting is a migraine trigger for me. Many other migraineurs agree. Other migraineurs see benefits from fasting. My point being: there is no "one size fits all" approach to weight loss.

rich-cartwright 5y ago
Important to hear this. I'd say there's a huge lack of empathy (understanding that someone can have a very different experience) in this space because of how it's tied in with society's take on individualism & moral responsibility.

agentdrtran 5y ago

As someone who has tried both: semaglutide and smaller diet changes have been a lot easier for me than fasting, which did work but was stressful and extremely difficult to do long term.

rich-cartwright 5y ago
Thanks for sharing, important to hear anecdotal evidence.