6 ms·

We need to push lifestyle change to treat obesity - diet, exercise, sleep - vs. pharmaceuticals. Big pharma just keeps rolling out v2.0, 3.0, etc. for the custo

by eggy 3y ago

We need to push lifestyle change to treat obesity - diet, exercise, sleep - vs. pharmaceuticals. Big pharma just keeps rolling out v2.0, 3.0, etc. for the customers they've built through advertising and having doctor's marketed to push them on their patients along with government lobbying. He'll, how many COVID boosters did Big Pharma try to push at $30bn a round going into their purses?

eggy 3y ago
Remember that obesity and its attendant maladies were the leading co-morbidity in COVID deaths, but that was conveniently memory-holed for fear of fat shaming. I read a post about the 14-year-old or close girl who died from COVID. The parents said she was healthy, and yet the photo portrayed an obviously obese teen. Nature and reality do not practice tolerance in these cases. Maybe some shame is not an absolutely bad thing.
- pseudalopex 3y ago
  > Remember that obesity and its attendant maladies were the leading co-morbidity in COVID deaths, but that was conveniently memory-holed for fear of fat shaming. Obesity is not the most common or most severe risk factor for COVID death. And it was discussed much.
kiba 3y ago
If it works, it works. Don't be afraid of pharmaceuticals, but at the same time take advantage of lifestyle changes. If you're going to lose weight through appetite surpassing medicine, you will lose muscle mass along side with fat. If you're not careful, you might become fatter as you become more skinny, hence 'skinny fat'. Drugs are just tools like any other.
jmbwell 3y ago
I think any trustworthy physician is going to include diet, exercise, and other lifestyle changes as part of a comprehensive obesity treatment plan. Pharmaceuticals can be a valuable tool as well. A patient and their doctor are going to know more about the approaches that are right for them than anyone on some thread here.
JimtheCoder 3y ago
While I do agree with lifestyle changes, it is very clear at this point it doesn't work for the majority of people. Doing the same thing over and over and expecting a different result is the definition of insanity, or something like that...
- Night_Thastus 3y ago
  Source on "majority"? It seems like for the vast majority of people it's the opposite - they just eat too much and what they eat isn't helping. (Soda/sugar waters, chips, fatty meat, etc) If they lack the motivation or determination to see through a diet, that's on them. The resources to count calories are there, it's not nearly as hard as it would have been 20 years ago. Now, some people genuinely have some form of disease or unusual case where medication is 100% needed and no lifestyle change would help - and those people should get whatever treatment best suits them. But 36% of the US (obese) is not an unusual edge case, some rare genetic disorder or disease.
  - JimtheCoder 3y ago
    What I meant was a doctor telling a patient to "make lifestyle changes" an then expecting actual change doesn't work for the majority of people. Do I have hard data on this? No.
    - Night_Thastus 3y ago
      Oh. You're not saying lifestyle choices are ineffective, you're saying telling people to make those changes is ineffective. Yes, that I would completely agree on.
      - hock_ads_ad_hoc 3y ago
        I think you’re actually not very well informed despite being confident of your position. The body attempts to maintain stasis at a given weight. “Lifestyle choices” as a solution are essentially a constant uphill fight against your body and its signals. High probability of failure, because there is no point at which your body stops telling you to eat more to reach the weight it thinks you should be. I think now that we actually have a solution, we can stop saying this “lifestyle choices” junk. The reality is people rarely have a true choice.
gumby 3y ago
Not everyone can make this change — the causes of obesity are not well understood. For the morbidly obese, exercise carries risk too — to joints and the heart, for instance. A large weight reduction (whether via GLP-1 antagonists, gastric band, or exogenous trauma) can both motivate and make easier other changes like the ones you advocate.
- eggy 3y ago
  I think the most obvious causes of obesity are known - higher than needed caloric intake and lack of any activity. All the other factors are piled on top of those two simple facts as to why people cannot work on either or both of those two facts. >> For the morbidly obese, exercise carries risk too — to joints and the heart, for instance. All exercise? Like simply walking 1/2 to 3 miles per day at a leisurely pace? Being morbidly obese carries way more risk, and no amount of meds will help someone who can't bring themselves to even walk somewhere. I know one person who was morbidly obese, had the surgery to limit their capacity to eat, and yes, they look better in clothes, but they are on a ton of meds, and they refuse to walk more. I was in Mekkah and they took the electric cart instead of walking during umrah. Anyone I know who is on mental and/or diet pills are not doing well even after years of following this advice. I don't see the long-term benefits. Hell, I just read an add for some heart supplements on Amazon where people say, "I've been taking it for a week, and I don't feel anything yet." The instant gratification of social media and modern conveniences have softened everyone from taking some self responsibility and applying some self discipline. We can't save everyone who is self destructing. Big Pharma is sure making out like a bandit. Last I had cable TV over 10 years ago, all it had were ads for pills with the cliche afterword on the side effects in lower volume and spoken much more quickly. Isn't it obvious?
  - pseudalopex 3y ago
    > Anyone I know who is on mental and/or diet pills are not doing well even after years of following this advice. Many kinds of medicines mitigate not cure. And most people I know do not much discuss medical treatment when it is going well. Especially around people inclined to sanctimonious lectures.
gataca 3y ago
A better push would be to prevent the food industry from poisoning us with ultra-processed food and corn syrup. Having food regulation would go a long way in preventing obesity and many other negative health outcomes.
- topikk 3y ago
  No one solution is going to reverse the obesity epidemic. Better food labeling, ingredient regulations, health education for all age groups, cost of living reduction, food desert reductions, and likely many more things will need to be addressed if we hope to see noticeable changes.
ribosometronome 3y ago
Are you similarly against treating type 2 diabetes, heart disease, cancer, etc as we should instead be having lifestyle changes, avoiding the risks that lead to those diseases, reducing environmental risks?
mrweasel 3y ago
These new drugs are not a replacement for a health diet and exercise. Drugs like Ozempic, or Wegovy, aren't a permanent solutions, once you stop taking them the effect stops and you can't take them forever. They are only meant to get you motivated and help start up a lower calorie diet. We are also now seeing people where diet and exercise simply isn't working as expect. There was a study that indicated that PFAS pollution affects the metabolism in some people during the night. Normally you still burn calories while you sleep, but for some elevated PFAS levels causes their bodies to basically stop burning calories during the night. You're not wrong the pushing lifestyle changes should be the primary goal, but the world isn't that black and white. Peoples circumstances are different and ignoring pharmaceuticals on principle isn't particularly productive. Just like ignoring lifestyle coaching is foolish.
- JediWing 3y ago
  They're permanent as long as you keep taking them, like blood pressure medicines or statins.
  - garciasn 3y ago
    Is it true that your body adjusts to the drug and once you stop taking it you can no longer process shit correctly, exacerbating the problems and forcing you to remain on it for life?
    - hock_ads_ad_hoc 3y ago
      No
    - JediWing 3y ago
      I believe studies have mostly shown significant rebound upon cessation, but statistically it's been below 100% weight regain. Some anecdotes have people ceasing and getting heavier, but I don't think that's been shown at a population level.
- JimtheCoder 3y ago
  "There was a study that indicated that PFAS pollution affects the metabolism in some people during the night. Normally you still burn calories while you sleep, but for some elevated PFAS levels causes their bodies to basically stop burning calories during the night." I would be interested in reading that study...
JediWing 3y ago
Suggesting lifestyle change as a cure for obesity presupposes that obese people simply lack the knowledge of what must be done. The real struggle is in the doing. Many tout "listen to your body" as a solution, or "think about how junk food makes you feel" as one of the go-to solutions in "lifestyle change". For the first time in my life I was able to adhere to this advice, because I'm on semaglutide. My body now actually is telling me that too much junk food feels bad. Before now, it actually felt VERY VERY GOOD to eat nearly unlimited junk food. There is something going on in my body that prevents the proper signaling of "too much food feels bad", and this medicine corrects that for me and countless others.
- eggy 3y ago
  <<Suggesting lifestyle change as a cure for obesity presupposes that obese people simply lack the knowledge of what must be done. You presuppose lack of knowledge, not me. Contrarily, I call out the lack of self discipline knowing what they must do. Every obese person I know is aware of what is wrong and what they must do. Ozempic and semaglutide trick your body into thinking it has eaten. If you take it for a year, but still eat the same calories per day, you do not lose weight. It still requires some discipline. From pricing without insurance these seem to be >$200 per month medications. That's a lot of money for Big Pharma considering they suggest you take it for at least a year and the obesity rate in America. Call me old fashioned and relying on some common sense, but there are longer term and healthier solutions than relying on a pill for all of your troubles. >>Before now, it actually felt VERY VERY GOOD to eat nearly unlimited junk food. So downing a bucket or two of chicken wings felt good to the last wing? I doubt it. You've conditioned yourself to still like it when bursting at the seams. Again some discipline would go a long way rather than a pill. Let's see where all this medication puts this generation down the road - from all sorts of mental health pills to diet pills, etc. I don't think it's the right path, and there are those making money hand-over-fist while everyone plugs into the matrix.
  - pseudalopex 3y ago
    Ozempic is semaglutide. And you must see not eating when you are not hungry requires less discipline than not eating when you feel hungry. I might call you old fashioned. I would not call you relying on some common sense.
terryf 3y ago
I took Ozempic for the first time three months ago. I'm 45 years old. Three months ago was the first day that I can remember when I wasn't hungry. Really, now I understand people when they say that "I don't want more food". Because I always wanted more food. Of course, I realized that it's important to not over-eat, and with effort it was possible. But that's exactly the point. It's always a struggle against one of the most basic instincts you have - to not be hungry. Every day. All the time. This is the thing that is missing from the "just eat less" slogan. That for some people it's harder than others. Honestly, I really had no idea that people felt like I feel on Ozempic. I just thought I was weak for not being able to say no to food. I could eat until my stomach felt pysically stuffed full and still feel hungry and desire for more food. In the context of war and hunger is my struggle the hardest one? Of course not, but it's still a struggle. Feeling fat sucks and feeling like you're weak for not being able to say no to somethig that you really really want all the time sucks.
- jayroh 3y ago
  I see you. I see you 100%
renewiltord 3y ago
Bro, that's what we've been pushing for 20 years. At some point, this really sounds like all the big-C Communists. "We just didn't try it properly". Enough. There's a public health crisis and a cure is sitting here. We are going to use the cure and you can go do the old thing. Mounjaro and Ozempic and alikes are going to be here.
flerchin 3y ago
Nah. I'm also not affected by this issue, but I have much more compassion. When I go out to eat with my friends. We all eat about the same, but some are much larger. In general, folks know what to do, and they need help.
jstarfish 3y ago
You're making the same mistaken assumption everyone else makes-- obese people are obese because they're lazy/unmotivated, as if there is only one reason this happens to them. It's Boomer logic, and should be dismissed since they clearly failed to solve this problem themselves. There are many different reasons for obesity and sending everyone to fat camp won't solve anything. Group 1 are the lazy people. Obesity is a behavioral issue for them. They eat because they overate for some time, and they are now prone to hunger because of it. Lifestyle changes do help this group-- the stomach contracts and they start to subsist off of smaller portions because they're not filling an enlarged vessel. FWIW, my own doctor recommends drinking water as a replacement for food, to satiate the oral fixation of eating. It fills the stomach just the same and you go through the same motions. Group 2 are the people who overeat because of some dopamine deficiency. We look at what they consume, horrified-- carbs, fats, sodium, sugar. Think about it: these are all party foods. Parties are where people have fun, and fun makes us happy. This leads to a deadly spiral of eating increasing amounts of unhealthy food that elicits positive feelings and discourages you from ever leaving your bedroom. Lifestyle changes could help this group, but the underlying issue needs to be addressed. Diet/exercise/sleep doesn't relieve you of your loneliness or struggles to pay the rent. Group 3 is genetic predisposition; some people just retain water/fat/etc. more than others. Exercise as a first step does not help, and stresses their taxed cardiovascular system. Diet is not a factor. These people need to be on medications like spironolactone and ozempic, not treadmills-- the latter will kill them. These are just the cliques I've identified by association; I'm not a doctor, but I play one well enough to know the problem isn't as simple as you make it out to be.
jimcsharp 3y ago
I don't know how takes like this aren't equivalent to telling ADHD sufferers to meditate and create task lists to treat their inability to focus. I think we should get over considering mental issues to be moral failings.

by eggy 3y ago

eggy 3y ago

Remember that obesity and its attendant maladies were the leading co-morbidity in COVID deaths, but that was conveniently memory-holed for fear of fat shaming. I read a post about the 14-year-old or close girl who died from COVID. The parents said she was healthy, and yet the photo portrayed an obviously obese teen. Nature and reality do not practice tolerance in these cases. Maybe some shame is not an absolutely bad thing.

pseudalopex 3y ago
> Remember that obesity and its attendant maladies were the leading co-morbidity in COVID deaths, but that was conveniently memory-holed for fear of fat shaming. Obesity is not the most common or most severe risk factor for COVID death. And it was discussed much.

kiba 3y ago

If it works, it works. Don't be afraid of pharmaceuticals, but at the same time take advantage of lifestyle changes. If you're going to lose weight through appetite surpassing medicine, you will lose muscle mass along side with fat. If you're not careful, you might become fatter as you become more skinny, hence 'skinny fat'. Drugs are just tools like any other.

jmbwell 3y ago

I think any trustworthy physician is going to include diet, exercise, and other lifestyle changes as part of a comprehensive obesity treatment plan. Pharmaceuticals can be a valuable tool as well. A patient and their doctor are going to know more about the approaches that are right for them than anyone on some thread here.

JimtheCoder 3y ago

While I do agree with lifestyle changes, it is very clear at this point it doesn't work for the majority of people. Doing the same thing over and over and expecting a different result is the definition of insanity, or something like that...

Night_Thastus 3y ago
Source on "majority"? It seems like for the vast majority of people it's the opposite - they just eat too much and what they eat isn't helping. (Soda/sugar waters, chips, fatty meat, etc) If they lack the motivation or determination to see through a diet, that's on them. The resources to count calories are there, it's not nearly as hard as it would have been 20 years ago. Now, some people genuinely have some form of disease or unusual case where medication is 100% needed and no lifestyle change would help - and those people should get whatever treatment best suits them. But 36% of the US (obese) is not an unusual edge case, some rare genetic disorder or disease.
- JimtheCoder 3y ago
  What I meant was a doctor telling a patient to "make lifestyle changes" an then expecting actual change doesn't work for the majority of people. Do I have hard data on this? No.
  - Night_Thastus 3y ago
    Oh. You're not saying lifestyle choices are ineffective, you're saying telling people to make those changes is ineffective. Yes, that I would completely agree on.
    - hock_ads_ad_hoc 3y ago
      I think you’re actually not very well informed despite being confident of your position. The body attempts to maintain stasis at a given weight. “Lifestyle choices” as a solution are essentially a constant uphill fight against your body and its signals. High probability of failure, because there is no point at which your body stops telling you to eat more to reach the weight it thinks you should be. I think now that we actually have a solution, we can stop saying this “lifestyle choices” junk. The reality is people rarely have a true choice.

gumby 3y ago

Not everyone can make this change — the causes of obesity are not well understood. For the morbidly obese, exercise carries risk too — to joints and the heart, for instance. A large weight reduction (whether via GLP-1 antagonists, gastric band, or exogenous trauma) can both motivate and make easier other changes like the ones you advocate.

eggy 3y ago
I think the most obvious causes of obesity are known - higher than needed caloric intake and lack of any activity. All the other factors are piled on top of those two simple facts as to why people cannot work on either or both of those two facts. >> For the morbidly obese, exercise carries risk too — to joints and the heart, for instance. All exercise? Like simply walking 1/2 to 3 miles per day at a leisurely pace? Being morbidly obese carries way more risk, and no amount of meds will help someone who can't bring themselves to even walk somewhere. I know one person who was morbidly obese, had the surgery to limit their capacity to eat, and yes, they look better in clothes, but they are on a ton of meds, and they refuse to walk more. I was in Mekkah and they took the electric cart instead of walking during umrah. Anyone I know who is on mental and/or diet pills are not doing well even after years of following this advice. I don't see the long-term benefits. Hell, I just read an add for some heart supplements on Amazon where people say, "I've been taking it for a week, and I don't feel anything yet." The instant gratification of social media and modern conveniences have softened everyone from taking some self responsibility and applying some self discipline. We can't save everyone who is self destructing. Big Pharma is sure making out like a bandit. Last I had cable TV over 10 years ago, all it had were ads for pills with the cliche afterword on the side effects in lower volume and spoken much more quickly. Isn't it obvious?
- pseudalopex 3y ago
  > Anyone I know who is on mental and/or diet pills are not doing well even after years of following this advice. Many kinds of medicines mitigate not cure. And most people I know do not much discuss medical treatment when it is going well. Especially around people inclined to sanctimonious lectures.

gataca 3y ago

A better push would be to prevent the food industry from poisoning us with ultra-processed food and corn syrup. Having food regulation would go a long way in preventing obesity and many other negative health outcomes.

topikk 3y ago
No one solution is going to reverse the obesity epidemic. Better food labeling, ingredient regulations, health education for all age groups, cost of living reduction, food desert reductions, and likely many more things will need to be addressed if we hope to see noticeable changes.

ribosometronome 3y ago

Are you similarly against treating type 2 diabetes, heart disease, cancer, etc as we should instead be having lifestyle changes, avoiding the risks that lead to those diseases, reducing environmental risks?

mrweasel 3y ago

These new drugs are not a replacement for a health diet and exercise. Drugs like Ozempic, or Wegovy, aren't a permanent solutions, once you stop taking them the effect stops and you can't take them forever. They are only meant to get you motivated and help start up a lower calorie diet. We are also now seeing people where diet and exercise simply isn't working as expect. There was a study that indicated that PFAS pollution affects the metabolism in some people during the night. Normally you still burn calories while you sleep, but for some elevated PFAS levels causes their bodies to basically stop burning calories during the night. You're not wrong the pushing lifestyle changes should be the primary goal, but the world isn't that black and white. Peoples circumstances are different and ignoring pharmaceuticals on principle isn't particularly productive. Just like ignoring lifestyle coaching is foolish.

JediWing 3y ago
They're permanent as long as you keep taking them, like blood pressure medicines or statins.
- garciasn 3y ago
  Is it true that your body adjusts to the drug and once you stop taking it you can no longer process shit correctly, exacerbating the problems and forcing you to remain on it for life?
  - hock_ads_ad_hoc 3y ago
    No
  - JediWing 3y ago
    I believe studies have mostly shown significant rebound upon cessation, but statistically it's been below 100% weight regain. Some anecdotes have people ceasing and getting heavier, but I don't think that's been shown at a population level.
JimtheCoder 3y ago
"There was a study that indicated that PFAS pollution affects the metabolism in some people during the night. Normally you still burn calories while you sleep, but for some elevated PFAS levels causes their bodies to basically stop burning calories during the night." I would be interested in reading that study...

JediWing 3y ago

Suggesting lifestyle change as a cure for obesity presupposes that obese people simply lack the knowledge of what must be done. The real struggle is in the doing. Many tout "listen to your body" as a solution, or "think about how junk food makes you feel" as one of the go-to solutions in "lifestyle change". For the first time in my life I was able to adhere to this advice, because I'm on semaglutide. My body now actually is telling me that too much junk food feels bad. Before now, it actually felt VERY VERY GOOD to eat nearly unlimited junk food. There is something going on in my body that prevents the proper signaling of "too much food feels bad", and this medicine corrects that for me and countless others.

eggy 3y ago
<<Suggesting lifestyle change as a cure for obesity presupposes that obese people simply lack the knowledge of what must be done. You presuppose lack of knowledge, not me. Contrarily, I call out the lack of self discipline knowing what they must do. Every obese person I know is aware of what is wrong and what they must do. Ozempic and semaglutide trick your body into thinking it has eaten. If you take it for a year, but still eat the same calories per day, you do not lose weight. It still requires some discipline. From pricing without insurance these seem to be >$200 per month medications. That's a lot of money for Big Pharma considering they suggest you take it for at least a year and the obesity rate in America. Call me old fashioned and relying on some common sense, but there are longer term and healthier solutions than relying on a pill for all of your troubles. >>Before now, it actually felt VERY VERY GOOD to eat nearly unlimited junk food. So downing a bucket or two of chicken wings felt good to the last wing? I doubt it. You've conditioned yourself to still like it when bursting at the seams. Again some discipline would go a long way rather than a pill. Let's see where all this medication puts this generation down the road - from all sorts of mental health pills to diet pills, etc. I don't think it's the right path, and there are those making money hand-over-fist while everyone plugs into the matrix.
- pseudalopex 3y ago
  Ozempic is semaglutide. And you must see not eating when you are not hungry requires less discipline than not eating when you feel hungry. I might call you old fashioned. I would not call you relying on some common sense.

terryf 3y ago

I took Ozempic for the first time three months ago. I'm 45 years old. Three months ago was the first day that I can remember when I wasn't hungry. Really, now I understand people when they say that "I don't want more food". Because I always wanted more food. Of course, I realized that it's important to not over-eat, and with effort it was possible. But that's exactly the point. It's always a struggle against one of the most basic instincts you have - to not be hungry. Every day. All the time. This is the thing that is missing from the "just eat less" slogan. That for some people it's harder than others. Honestly, I really had no idea that people felt like I feel on Ozempic. I just thought I was weak for not being able to say no to food. I could eat until my stomach felt pysically stuffed full and still feel hungry and desire for more food. In the context of war and hunger is my struggle the hardest one? Of course not, but it's still a struggle. Feeling fat sucks and feeling like you're weak for not being able to say no to somethig that you really really want all the time sucks.

jayroh 3y ago
I see you. I see you 100%

renewiltord 3y ago

Bro, that's what we've been pushing for 20 years. At some point, this really sounds like all the big-C Communists. "We just didn't try it properly". Enough. There's a public health crisis and a cure is sitting here. We are going to use the cure and you can go do the old thing. Mounjaro and Ozempic and alikes are going to be here.

flerchin 3y ago

Nah. I'm also not affected by this issue, but I have much more compassion. When I go out to eat with my friends. We all eat about the same, but some are much larger. In general, folks know what to do, and they need help.

jstarfish 3y ago

You're making the same mistaken assumption everyone else makes-- obese people are obese because they're lazy/unmotivated, as if there is only one reason this happens to them. It's Boomer logic, and should be dismissed since they clearly failed to solve this problem themselves. There are many different reasons for obesity and sending everyone to fat camp won't solve anything. Group 1 are the lazy people. Obesity is a behavioral issue for them. They eat because they overate for some time, and they are now prone to hunger because of it. Lifestyle changes do help this group-- the stomach contracts and they start to subsist off of smaller portions because they're not filling an enlarged vessel. FWIW, my own doctor recommends drinking water as a replacement for food, to satiate the oral fixation of eating. It fills the stomach just the same and you go through the same motions. Group 2 are the people who overeat because of some dopamine deficiency. We look at what they consume, horrified-- carbs, fats, sodium, sugar. Think about it: these are all party foods. Parties are where people have fun, and fun makes us happy. This leads to a deadly spiral of eating increasing amounts of unhealthy food that elicits positive feelings and discourages you from ever leaving your bedroom. Lifestyle changes could help this group, but the underlying issue needs to be addressed. Diet/exercise/sleep doesn't relieve you of your loneliness or struggles to pay the rent. Group 3 is genetic predisposition; some people just retain water/fat/etc. more than others. Exercise as a first step does not help, and stresses their taxed cardiovascular system. Diet is not a factor. These people need to be on medications like spironolactone and ozempic, not treadmills-- the latter will kill them. These are just the cliques I've identified by association; I'm not a doctor, but I play one well enough to know the problem isn't as simple as you make it out to be.

jimcsharp 3y ago

I don't know how takes like this aren't equivalent to telling ADHD sufferers to meditate and create task lists to treat their inability to focus. I think we should get over considering mental issues to be moral failings.