4 ms·

I said that you may be an extreme outlier. You're also larger than every NFL player in history, everyone in World's Strongest Man, etc. A 10 mile jog (let's say

I said that you may be an extreme outlier. You're also larger than every NFL player in history, everyone in World's Strongest Man, etc. A 10 mile jog (let's say 80-100 minutes of uninterrupted running) is the sort of "I could eat 50 eggs" number people pull out. At 6'5", you are an outlier. 2kcal is too low, much as it's too high for the average woman. This doesn't mean that metabolism is a "colloquial" term. It means that "the physical, psychological, and emotional components" is a long way of saying "it's hard", and "the experiential variance I'm describing" is "the payoff did not seem to be worth the cost". In general, my post wasn't intended to be an attack on you. It's that "I cut calories and I lost weight" is not anecdotal. It's factual. The anecdote, if any, is "I'm larger than the largest professional athletes and I can still perform". Since it's hard to stick with cutting calories for many people, throwing drugs at it with Fella is not the right answer. A holistic approach which addresses trauma, reasons for emotional eating, lifestyle replacements, recalibration of palate, satiation even at a deficit, and all the rest should be explored alongside drugs so "I cut calories and I lost weight" is easier to stick with.

luckylion 5y ago
> It's that "I cut calories and I lost weight" is not anecdotal. It's factual. It simplifies the problem though, because for many, that approach has side-effects that seriously affect quality of life, like sleep, concentration, mood swings, depression etc. Speaking of depression, I often get a similar vibe in those threads, where undoubtedly someone will jump in and say "all you have to do is lift heavy weights and change your diet a bit". It feels like they haven't experienced what other people have, so their advice sounds tone-deaf, a version of "let them eat cake". > Since it's hard to stick with cutting calories for many people, throwing drugs at it with Fella is not the right answer. If it works, it's great. Because obviously the "just change your life to be like me and hope for the best" approach doesn't work for most people, or they'd do it.
- rich-cartwright 5y ago
  Really nicely put. I've wanted to bring up how physicians treatment of depression has radically changed in the last few decades (to have a much greater appreciation of the medication-assistance), but I didn't want to bring it up myself as I thought it may be too confusion/controversial.
- kec 5y ago
  If calorie restriction is causing those side effects, it is an indicator that the person is "doing it wrong" by either restricting their intake far more than is healthy or more likely their diet is very sub optimal (eg, 100% carbs causing blood sugar to spike and then crash when they "run out" of calories). These are problems of application which are easy to fix with a food journal and perhaps a bit of research, not really a great argument against calorie restrictions effectiveness.
  - rich-cartwright 5y ago
    I feel like this is a pretty bold statement, and I'm not sure how much evidence there is behind this.
rich-cartwright 5y ago
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.
- evol262 5y ago
  > Please do not let moral posturing cause you to underrate the importance of a holistic approach which includes medication-assistance. I get that you're a founder. It would be great to not cast aspersions on people. "I think your approach sucks" is not "moral posturing", and I'd question how many ethical doctors would recommend something insurance will not cover with an unknown end date to the treatment plan as "pharmacotheraphy" out of the gate. For those who cannot gain muscle mass, injecting testosterone would also work (and would work for weight loss). Messing about with the endocrine system is tricky. Your body is really good at homeostasis. It's also really good at saying "welp, I guess that's covered, so I'm good" when exogenous sources of hormones are introduced. Is this part of the treatment plan? What about diabetic patients (who appear to be a small part of the studies leading to approval)? How are you going to control for hyperglycemic ketoacidosis? What's the long term effect of this on alpha cells and pancreatic health? How long is the titration for normal pancreatic function to resume? When exogenous glucagon is removed, what are the hunger levels of patients? Bounceback effect on weight if appetite is increased in the meantime? Yes, use every tool in your toolbox, but there are a lot of unanswered questions about the medication in question, and a lack of insurance coverage. I've been overweight. Your body is not a formula in the "I calculated CICO, and...", but it does follow basic rules in a "I tracked my calories religiously, and over the last 2 weeks, my average daily intake was X, and the scale change was Y, so I need to modulate intake/activity up/down/stay the same" until you reach your goal. That's hard for some (many) people. It's also completely sustainable. We want an "easy" way to do things. Sometimes "easy" things have detrimental effects in the long term, which are not apparent during clinical trials or short (let's say 3-5y or less) term, medically speaking. Doctors would recommend pharmacotheraphy for obese patients because the health effects of being obese are dramatic, and almost certain to be worse than whatever the health effects of the drug are, because they have relationships with the vendors, because they are not sure whether the patient could affect the same change in health without them, etc. However, if presented with the choice of "Patient X is able to achieve the desired outcome without the addition of medication", that would be the choice every time. You can filter that through the scale to "Patient X is unable to achieve the desired outcome without incurring significant financial burden/hardship by taking a new-to-market drug with unknown long-term consequences and an unpredictable prognosis once pharmaceutical intervention ceases, but the outcomes are so much better that this risk is warranted", which seems to be close to the starting point of the pitch here. Medical ethics are not moral posturing. Edit: your cofounder is doing a great job (https://news.ycombinator.com/item?id=28260302 https://news.ycombinator.com/item?id=28260302) addressing the tradeoffs here. Not to put too fine a point on it, but this is not the greatest venue for comments like the last one in that chain (yours) (https://news.ycombinator.com/item?id=28261777 https://news.ycombinator.com/item?id=28261777). People here want to know how it works, why it works, what your pitch is, why we should recommend it, etc. I am not your target demographic and never would be for a variety of reasons, not least of which being that I've been a competitive athlete in weight-class based sports for almost my entire life (outside of the 5-6 year period where i stopped training and became obese). I am here commenting, though, and you can make a fair guess about who I know based on the demographics of the US and their intersection with the market demographics of software engineers. Lots of overweight people with the kind of income which could afford this. Like many people on HN, I read a lot. I'd hazard to guess that I come across many more startup ideas and news articles than most people I know, and I do bring them up in conversation. Fella is the sort of thing which I could recommend (well, "here's now insulin/leptin/glucago intersect as part of the HPS axis, and there are GLP-1 analogues, with this startup which may be able to help"), but I'm unlikely to if it leaves a bad taste in my mouth as yet another shill for medicating the symptoms instead of addressing the cause(s). If I see responses like "this is the sort of stuff our customers talk to their doctors about" and not "this is why you should become our customer", I'm gonna write you off, and that's probably a fair assumption for HN in general. The comments are not the place for elevator pitches, marketing, etc. It reads like "I'm happy to answer your questions once you pay me, but not here".
nevinera 5y ago
> I cut calories and I lost weight" is not anecdotal. It's factual I think perhaps you're misunderstanding what "anecdote" means? Anecdotes can certainly be factual - the point is not that it's false, it's that it's not sufficiently representative. In particular, I wasn't challenging his assertion that cutting calories allowed him to lose weight, only the implicit claim that doing so is a universally straightforward and successful approach to effecting actual weight loss. > and all the rest should be explored alongside drugs Well yes! That's my position! I don't think "drugs will solve this problem", I think the problem is solvable, and that we need to understand it and its context better in order to do so. I'm a tinkerer, I've been experimenting with my own habits, diet, and activities constantly trying to better understand how I can be healthier and still happy, and there have been some real gains from that process. I feel like (a) you don't agree with the approach Fella is taking (which is fine, you've clearly looked into it more than I have), and (b) you've decided that my opinions about the effectiveness of diets are somehow "on their side". I think I've been really clear about this, but I have no stake in their game, aside from being excited to see that people are trying to do something other than convince fat people that this diet will totally work (and if it doesn't it's because they were yet again bad people that deserve to be fat.) > "the physical, psychological, and emotional components" is a long way of saying "it's hard", and "the experiential variance I'm describing" is "the payoff did not seem to be worth the cost". Not even close. But you seem intelligent, so I'm left wondering if you're intentionally misinterpreting me to score some kind of internet points? The intent of those phrases is to emphasize that the costs to the humans involved vary. They are different. So yeah, "the payoff did not seem to be worth the cost", in the same sense that a man with a bad knee would evaluate the cost/value of paying for a taxi differently.

luckylion 5y ago

> It's that "I cut calories and I lost weight" is not anecdotal. It's factual. It simplifies the problem though, because for many, that approach has side-effects that seriously affect quality of life, like sleep, concentration, mood swings, depression etc. Speaking of depression, I often get a similar vibe in those threads, where undoubtedly someone will jump in and say "all you have to do is lift heavy weights and change your diet a bit". It feels like they haven't experienced what other people have, so their advice sounds tone-deaf, a version of "let them eat cake". > Since it's hard to stick with cutting calories for many people, throwing drugs at it with Fella is not the right answer. If it works, it's great. Because obviously the "just change your life to be like me and hope for the best" approach doesn't work for most people, or they'd do it.

rich-cartwright 5y ago
Really nicely put. I've wanted to bring up how physicians treatment of depression has radically changed in the last few decades (to have a much greater appreciation of the medication-assistance), but I didn't want to bring it up myself as I thought it may be too confusion/controversial.
kec 5y ago
If calorie restriction is causing those side effects, it is an indicator that the person is "doing it wrong" by either restricting their intake far more than is healthy or more likely their diet is very sub optimal (eg, 100% carbs causing blood sugar to spike and then crash when they "run out" of calories). These are problems of application which are easy to fix with a food journal and perhaps a bit of research, not really a great argument against calorie restrictions effectiveness.
- rich-cartwright 5y ago
  I feel like this is a pretty bold statement, and I'm not sure how much evidence there is behind this.

rich-cartwright 5y ago

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.

evol262 5y ago
> Please do not let moral posturing cause you to underrate the importance of a holistic approach which includes medication-assistance. I get that you're a founder. It would be great to not cast aspersions on people. "I think your approach sucks" is not "moral posturing", and I'd question how many ethical doctors would recommend something insurance will not cover with an unknown end date to the treatment plan as "pharmacotheraphy" out of the gate. For those who cannot gain muscle mass, injecting testosterone would also work (and would work for weight loss). Messing about with the endocrine system is tricky. Your body is really good at homeostasis. It's also really good at saying "welp, I guess that's covered, so I'm good" when exogenous sources of hormones are introduced. Is this part of the treatment plan? What about diabetic patients (who appear to be a small part of the studies leading to approval)? How are you going to control for hyperglycemic ketoacidosis? What's the long term effect of this on alpha cells and pancreatic health? How long is the titration for normal pancreatic function to resume? When exogenous glucagon is removed, what are the hunger levels of patients? Bounceback effect on weight if appetite is increased in the meantime? Yes, use every tool in your toolbox, but there are a lot of unanswered questions about the medication in question, and a lack of insurance coverage. I've been overweight. Your body is not a formula in the "I calculated CICO, and...", but it does follow basic rules in a "I tracked my calories religiously, and over the last 2 weeks, my average daily intake was X, and the scale change was Y, so I need to modulate intake/activity up/down/stay the same" until you reach your goal. That's hard for some (many) people. It's also completely sustainable. We want an "easy" way to do things. Sometimes "easy" things have detrimental effects in the long term, which are not apparent during clinical trials or short (let's say 3-5y or less) term, medically speaking. Doctors would recommend pharmacotheraphy for obese patients because the health effects of being obese are dramatic, and almost certain to be worse than whatever the health effects of the drug are, because they have relationships with the vendors, because they are not sure whether the patient could affect the same change in health without them, etc. However, if presented with the choice of "Patient X is able to achieve the desired outcome without the addition of medication", that would be the choice every time. You can filter that through the scale to "Patient X is unable to achieve the desired outcome without incurring significant financial burden/hardship by taking a new-to-market drug with unknown long-term consequences and an unpredictable prognosis once pharmaceutical intervention ceases, but the outcomes are so much better that this risk is warranted", which seems to be close to the starting point of the pitch here. Medical ethics are not moral posturing. Edit: your cofounder is doing a great job (https://news.ycombinator.com/item?id=28260302 https://news.ycombinator.com/item?id=28260302) addressing the tradeoffs here. Not to put too fine a point on it, but this is not the greatest venue for comments like the last one in that chain (yours) (https://news.ycombinator.com/item?id=28261777 https://news.ycombinator.com/item?id=28261777). People here want to know how it works, why it works, what your pitch is, why we should recommend it, etc. I am not your target demographic and never would be for a variety of reasons, not least of which being that I've been a competitive athlete in weight-class based sports for almost my entire life (outside of the 5-6 year period where i stopped training and became obese). I am here commenting, though, and you can make a fair guess about who I know based on the demographics of the US and their intersection with the market demographics of software engineers. Lots of overweight people with the kind of income which could afford this. Like many people on HN, I read a lot. I'd hazard to guess that I come across many more startup ideas and news articles than most people I know, and I do bring them up in conversation. Fella is the sort of thing which I could recommend (well, "here's now insulin/leptin/glucago intersect as part of the HPS axis, and there are GLP-1 analogues, with this startup which may be able to help"), but I'm unlikely to if it leaves a bad taste in my mouth as yet another shill for medicating the symptoms instead of addressing the cause(s). If I see responses like "this is the sort of stuff our customers talk to their doctors about" and not "this is why you should become our customer", I'm gonna write you off, and that's probably a fair assumption for HN in general. The comments are not the place for elevator pitches, marketing, etc. It reads like "I'm happy to answer your questions once you pay me, but not here".

nevinera 5y ago

> I cut calories and I lost weight" is not anecdotal. It's factual I think perhaps you're misunderstanding what "anecdote" means? Anecdotes can certainly be factual - the point is not that it's false, it's that it's not sufficiently representative. In particular, I wasn't challenging his assertion that cutting calories allowed him to lose weight, only the implicit claim that doing so is a universally straightforward and successful approach to effecting actual weight loss. > and all the rest should be explored alongside drugs Well yes! That's my position! I don't think "drugs will solve this problem", I think the problem is solvable, and that we need to understand it and its context better in order to do so. I'm a tinkerer, I've been experimenting with my own habits, diet, and activities constantly trying to better understand how I can be healthier and still happy, and there have been some real gains from that process. I feel like (a) you don't agree with the approach Fella is taking (which is fine, you've clearly looked into it more than I have), and (b) you've decided that my opinions about the effectiveness of diets are somehow "on their side". I think I've been really clear about this, but I have no stake in their game, aside from being excited to see that people are trying to do something other than convince fat people that this diet will totally work (and if it doesn't it's because they were yet again bad people that deserve to be fat.) > "the physical, psychological, and emotional components" is a long way of saying "it's hard", and "the experiential variance I'm describing" is "the payoff did not seem to be worth the cost". Not even close. But you seem intelligent, so I'm left wondering if you're intentionally misinterpreting me to score some kind of internet points? The intent of those phrases is to emphasize that the costs to the humans involved vary. They are different. So yeah, "the payoff did not seem to be worth the cost", in the same sense that a man with a bad knee would evaluate the cost/value of paying for a taxi differently.