4 ms·

That's great advice, except for reality getting in the way. Every study on this shows that you are as likely to get good results telling people to "just eat les

That's great advice, except for reality getting in the way. Every study on this shows that you are as likely to get good results telling people to "just eat less and exercise more" as you are telling depressed people to "just be happy. Can't be that hard. What do you even have to be sad about?" Your body is highly motivated to maintain your weight set point, adjusting your BMR and pushing you towards compensatory eating. Basically every long-term weight loss study shows that you will regain 80%+ of the weight you lose through diet and exercise over a few years. [1] > Specifically, it has been estimated that for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss. Despite these predictable physiologic phenomena, the typical response of the patient is to blame themselves as lazy or lacking in willpower, sentiments that are often reinforced by healthcare providers [...] [1] Obesity is a disorder of the GABA-ergic central nervous system, which is, I suspect not coincidentally, where GLP-1s work. > These drugs are expensive and have nasty side effects. They're expensive because they work, and previously the only clinically proven effective alternative was bariatric surgery. That's both more risky, and much more expensive. The side effects are actually minimal, and during the clinical trials very few people dropped out due to side-effects. The newer dual- and triple-receptor agonists have yet fewer side effects. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/

cherryteastain 3y ago
> for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss. > Obesity is a disorder of the GABA-ergic central nervous system This is too reductive. As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight. That said, I get that many people just cant resist that hungry feeling. However, I've seen so many people who make these arguments eat tons of ready meals, desserts loaded with sugar, giant milkshakes etc. If they were serious about losing weight they could at least eat things like cucumbers or lettuce that keep you full with minimal amount of calories ingested. The gist of it to me seems like these drugs are for people who are willing to pay thosands of $ to feel as full as when they were eating their 5000kcal/day diet without having to endure the feeling of not eating that amount. Which, contrary to your claim, boils down to the willpower issue. These drugs let you buy your way out of the willpower requirement.
- arcticbull 3y ago
  > As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight. So generally, anecdotes aren't a substitute for data. Which is why I linked to a meta analysis that incorporated 29 long-term studies that followed people for five years. Don't you think in the face of that, that your experience may be either (a) not representative of people in general or (b) you haven't waited long enough to see what happens next to yourself? > These drugs let you buy your way out of the willpower requirement. Or and hear me out, similar to the way your body maintains its set temperature by adjusting various factors - it also maintains a set weight. And that over a longer period of time you are as likely to "will" your way to a new weight set point as you are to a new temperature set point. Despite being able to temporarily lower your body temperature by taking cold swims. Because frankly, that's what the data says. If you read the link I provided you might learn something interesting... But even if this was the case (and it's not) who cares? The goal is to get people to a healthy weight. Since moralizing hasn't done anything, and your approach has been an utter failure, why should you hold this drug that objectively works against anyone?
  - cherryteastain 3y ago
    I read the abstract, intro and conclusion (paper reviewers often read less!). I'd say if anything the paper supports my assessment, particularly this bit: > for all practical purposes, “a calorie is a calorie” when it comes to body fat and energy expenditure differences between controlled isocaloric diets varying in the ratio of carbohydrate to fat So, calories in calories out. All you have to do is not ingest them. And if you do, who made that choice? The rest of the paper seems to be talking about factors such as "the obesogenic environment" which completely factor out the agency of the individual. It's like saying it's not your fault that you are an alcoholic or gambling addict because supermarkets sell alcohol and there are bookies just around the corner. I understand what you mean by "who cares". I get that these drugs are a net positive good because they greatly reduce harm with minimal effort. That's great, but it's ultimately like administering narcan to an opioid addict. No one argues narcan is bad (it's proven and effective at preventing OD deaths), but also no one argues it is a solution to the addiction (you cant shoot up as much as you want and take narcan if things go unwell). Obesity of course is not as destructive (to a single individual) as an opioid addiction, but the fact that you regain the weight as soon as you stop taking ozempic etc shows that it's a bandaid.

cherryteastain 3y ago

> for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss. > Obesity is a disorder of the GABA-ergic central nervous system This is too reductive. As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight. That said, I get that many people just cant resist that hungry feeling. However, I've seen so many people who make these arguments eat tons of ready meals, desserts loaded with sugar, giant milkshakes etc. If they were serious about losing weight they could at least eat things like cucumbers or lettuce that keep you full with minimal amount of calories ingested. The gist of it to me seems like these drugs are for people who are willing to pay thosands of $ to feel as full as when they were eating their 5000kcal/day diet without having to endure the feeling of not eating that amount. Which, contrary to your claim, boils down to the willpower issue. These drugs let you buy your way out of the willpower requirement.

arcticbull 3y ago
> As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight. So generally, anecdotes aren't a substitute for data. Which is why I linked to a meta analysis that incorporated 29 long-term studies that followed people for five years. Don't you think in the face of that, that your experience may be either (a) not representative of people in general or (b) you haven't waited long enough to see what happens next to yourself? > These drugs let you buy your way out of the willpower requirement. Or and hear me out, similar to the way your body maintains its set temperature by adjusting various factors - it also maintains a set weight. And that over a longer period of time you are as likely to "will" your way to a new weight set point as you are to a new temperature set point. Despite being able to temporarily lower your body temperature by taking cold swims. Because frankly, that's what the data says. If you read the link I provided you might learn something interesting... But even if this was the case (and it's not) who cares? The goal is to get people to a healthy weight. Since moralizing hasn't done anything, and your approach has been an utter failure, why should you hold this drug that objectively works against anyone?
- cherryteastain 3y ago
  I read the abstract, intro and conclusion (paper reviewers often read less!). I'd say if anything the paper supports my assessment, particularly this bit: > for all practical purposes, “a calorie is a calorie” when it comes to body fat and energy expenditure differences between controlled isocaloric diets varying in the ratio of carbohydrate to fat So, calories in calories out. All you have to do is not ingest them. And if you do, who made that choice? The rest of the paper seems to be talking about factors such as "the obesogenic environment" which completely factor out the agency of the individual. It's like saying it's not your fault that you are an alcoholic or gambling addict because supermarkets sell alcohol and there are bookies just around the corner. I understand what you mean by "who cares". I get that these drugs are a net positive good because they greatly reduce harm with minimal effort. That's great, but it's ultimately like administering narcan to an opioid addict. No one argues narcan is bad (it's proven and effective at preventing OD deaths), but also no one argues it is a solution to the addiction (you cant shoot up as much as you want and take narcan if things go unwell). Obesity of course is not as destructive (to a single individual) as an opioid addiction, but the fact that you regain the weight as soon as you stop taking ozempic etc shows that it's a bandaid.