7 ms·

It's very effective for sure. But I also think it's ripe for abuse. I've seen healthy people on it to lose only 10 lb instead of making slight changes. I don't

It's very effective for sure. But I also think it's ripe for abuse. I've seen healthy people on it to lose only 10 lb instead of making slight changes. I don't think we know enough about its long term effects and how damaging it can be to be on severe calorie restriction for some periods of time. It's like an induced eating disorder in a way and I wonder about the psychological changes that accompany it.

jstummbillig 2y ago
We should stop thinking of this complex in terms of "abuse" and "slight changes". We suck to varying degrees and obesity is obviously a societal issue. We need help. We should keep looking for better options, we can and should always keep an eye on potential consequences down the line — and we can always elongate that line — but the very real, proven consequences of being overweight/having high blood pressure can be calculated like those that are attached to burning coal and they are worth tackling without prejudice, within the guidelines of what good science deems safe. Anything we can do to help with cardiovascular issues needs to be explored. Doing otherwise would simply be immoral and irresponsible. We have tried eating salads and going for quick walks. It's always great when that's enough to change one person for the better. When it's not, we should help with empathy. Currently, there simply is no clearer, quicker path to doing more than these drugs, on a societal level.
- VS1999 2y ago
  I'm going to be skeptical of putting millions of on a new drug, permanently, to mask some underlying issue in society. Is there any evidence that people can be weaned off this after losing weight? Or is it expected to be permanent? This was not an issue in the past and whatever the root cause is, it's never going to be treated if we can just drug everyone into acting like they used to.
  - jstummbillig 2y ago
    You fix the immediate problems where you can. You buy time. You find better solutions down the line. When a person is dead, you can't find a better solution. It's "masking" the issue as much as chemotherapy is "masking" the issue. People are dying. We have tried appeals to salads and quick walks. Unless you got anything up your sleeve, I recommend we stick to the ol' "keep more people alive with the best stuff we currently got" plan, until information pops up, that makes this look like the morally worse option. But in that regard preventing death is fairly hard to beat as a baseline.
    - squigz 2y ago
      > We have tried appeals to salads and quick walks. This bit made me laugh, as if public health initiatives have been taken remotely seriously by the past few decades. It seems quite a jump to go from "maybe try a a salad?" to putting millions of people on medication. Did that happen with tobacco? Alcohol?
      - jstummbillig 2y ago
        > It seems quite a jump to go from "maybe try a a salad?" to putting millions of people on medication. It's a hyperbole, meaning to say: The problem is so frustratingly silly and solution is so obvious and simple — just eat a little less, move a little more — that I understand how hard it is to accept that it might just be the completely wrong approach. What makes it fairly obvious to me is that despite clear and long standing conflicting beauty ideals, the massive societal advantages beauty affords, and an industry build around weight loss (not even drugs, stuff like Weight Watchers), people still struggle. If you have good insight into why informing about tobacco worked to the degree it did (although lung cancer is still the leading cause of cancer death) other than claiming vague un-seriousness, I am all ears. Otherwise I have a hard time understanding this as an information problem.
        squigz 2y ago
        > If you have good insight into why informing about tobacco worked to the degree it did My point here was that we seemed to approach tobacco/alcohol a bit more methodically - taxes (i.e., increasing costs for cigarettes), regulations (i.e., where alcohol can be sold), education (i.e., scary cigarette packaging) - whereas we seem to be saying, "Well, we did very little and got no results, so let's go nuclear!" when it comes to obesity It seems to me that, if obesity is so harmful to society, places like McDonalds and other (provably) unhealthy food shouldn't be as cheap or as easy to get as it is. > The problem is so frustratingly silly and solution is so obvious and simple — just eat a little less, move a little more — that I understand how hard it is to accept that it might just be the completely wrong approach. It certainly is frustrating, and I feel that more than I probably should. Probably something to reflect on.
  - idle_zealot 2y ago
    Are you asking what the root cause of obesity is? It's eating too much and not exercising enough. It's not some mystery. Or is the question about why people behave in this self-destructive way? People on average are bad at impulse control. Snack companies take advantage. People feel varying levels of discomfort vs exhilaration when exercising. For some it ultimately feels nice, for some it is unpleasant. Of those for whom it is unpleasant only some have the forethought and leeway to establish and maintain a healthy lifestyle. Of those for whom it is pleasant some face time or schedueling contraints that make an active lifestyle difficult. If there's a root cause to be fixed its that the human body responds poorly to acting on its impulses in our current built environment. You can solve that by altering the environment, the body, or the impulses. Ozempic seems to work by altering the impulses.
    - Almondsetat 2y ago
      >You can solve that by altering the environment, the body, or the impulses. Incorrect. You patch that by altering the environment OR the body OR or the impulses. To fix that you need to alter all 3
      - JumpCrisscross 2y ago
        > To fix that you need to alter all 3 We have tons of evidence to the contrary in multiple disciplines. Like, have you never made a conscious dietary change?
        Almondsetat 2y ago
        Most dietary changes fail, I don't think that's a good example actually. In any case, yes I have, but the only time it has worked was when I changed my environment (stopped slouching at home bored with a full pantry) and my impulses (filled my days with activities so that boredom hunger wouldn't strike). Only changing one would make me last a couple of weeks max
        JumpCrisscross 2y ago
  - objektif 2y ago
    I agree with you that this does not address the underlying issue. But root cause you speak of may not really be that simple to fix. Is the root cause people spend much more time in their offices working and hence are more inactive? Is it the crappy American diet? For example, many people around me gained weight after they became parents. Especially women after birth. It is just insanely difficult to work hard in an office job, take care of young kids and exercise etc all at the same time. As you age things get very difficult as well. I eat significantly less than what I used to just few years ago but still have 5-10lbs extra.
prepend 2y ago
How is that abuse? Obviously meds don’t work for everyone, but the aim is to have population level effects.
- evantbyrne 2y ago
  Maybe abuse is not the right term, but certainly not necessary to drop 10lbs. I workout pretty casually, and when I go on a cut I can lose 1lb/day. It wouldn't surprise me if an inactive person could lose that in a month. And the act of practicing self control would be beneficial. Maybe you are onto something with your comment about population-level effects though, I wouldn't know.
  - kdnvk 2y ago
    1lb/day isn’t sustainable at all, that would require a 3500 calorie deficit. You’re losing water weight.
    - evantbyrne 2y ago
      Sure some of the weight in those first ten days might have been water, but it stayed off. Possibly because my diet didn't immediately revert to pre-cut levels but it's hard to say given it didn't go back up and I wasn't exactly suffering. A 1000 calorie deficit over a month would still cut 8lbs. No problem for an overweight man who is likely eating well in excess of 3000 calories. The point is that major interventions aren't really necessary for that level of weight loss, and imo practicing the self-control needed to lose 10lbs should be beneficial to pretty much anyone. Let me put it this way: it should be way harder for a couch potato to train for a 5k run than to lose 10lbs on a cut.
      - prepend 2y ago
        > The point is that major interventions aren't really necessary for that level of weight loss It’s about effective interventions. Obviously major interventions are needed as there is a huge amount of obese and overweight in the US and many other methods have been attempted. It’s not about theoretically possible (ie, a bodybuilder can do it) but effective population interventions that result in people successfully losing weight. Think about people going to medical school and becoming a doctor. It’s obviously possible but if you said the solution to income inequality was for everyone to go to medical school and be doctors that would not be a very effective intervention. Not being obese is not being wealthy. It’s simple what to do, but difficult to stick to a successful plan.
dangus 2y ago
I lost 40 pounds the classic way. Just better diet, eating less. And like the majority of people who lost weight, I gained it back. Why? I don’t know. My body just wants to eat more. I have to be constantly vigilant or else I’ll fall into my old habits of what my body demands that I eat. I’ll eat dinner and then still be hungry. I think you’re getting this backwards. I already have an eating disorder.
- someotherperson 2y ago
  > I’ll eat dinner and then still be hungry I'd take the odds that you eat too fast. Slow down and carefully chew every single bite. Put the cutlery down in-between bites.
  - dangus 2y ago
    Thanks for the advice. It’s so helpful. Why didn’t I think of that? All the people who have never been fat have the best advice that us fatties totally appreciate and want to hear even when we never asked for it. In fact, it’s extra awesome when people bring up obvious advice when we don’t ask for it because fat people like me are actually less smart than you! So it’s really helpful to have a helping hand and I thank you for it. Thank you for downplaying a disease that almost half of the population has and for blaming it on me as an individual. Because obviously if half the country has the exact same ailment as me, it’s really a sign of the dangerous virality of the fast paced chewing lifestyle. Since most people who lost weight gain it back at some point statistically, it really makes logical sense that it’s all about how fast we are all chewing our food. All the celebrities and pundits on TV and in social media talk about how we need to chew our food faster, so it’s hard to escape that perverse influence.
    - Dove 2y ago
      I'm sorry to hear about your troubles. I have occasionally shared them. :( If you're interested, I do have a recommendation for you. For my money, Joel Greene is the best scientific thinker on the topic of diet and health, and his recent book "The Way" does a lot to replace frustration and confusion on the topic with sense and helpful advice. I recommend it if you've had success with a diet, and then regained the weight, and now nothing works - that's the exact problem he's focused on. Above and beyond whether you like his suggested solution, he does a lot to uncover mechanisms and explain the complexity of the problem. For what it's worth, I think your experience is completely normal. Nearly universal, even.

jstummbillig 2y ago

We should stop thinking of this complex in terms of "abuse" and "slight changes". We suck to varying degrees and obesity is obviously a societal issue. We need help. We should keep looking for better options, we can and should always keep an eye on potential consequences down the line — and we can always elongate that line — but the very real, proven consequences of being overweight/having high blood pressure can be calculated like those that are attached to burning coal and they are worth tackling without prejudice, within the guidelines of what good science deems safe. Anything we can do to help with cardiovascular issues needs to be explored. Doing otherwise would simply be immoral and irresponsible. We have tried eating salads and going for quick walks. It's always great when that's enough to change one person for the better. When it's not, we should help with empathy. Currently, there simply is no clearer, quicker path to doing more than these drugs, on a societal level.

VS1999 2y ago
I'm going to be skeptical of putting millions of on a new drug, permanently, to mask some underlying issue in society. Is there any evidence that people can be weaned off this after losing weight? Or is it expected to be permanent? This was not an issue in the past and whatever the root cause is, it's never going to be treated if we can just drug everyone into acting like they used to.
- jstummbillig 2y ago
  You fix the immediate problems where you can. You buy time. You find better solutions down the line. When a person is dead, you can't find a better solution. It's "masking" the issue as much as chemotherapy is "masking" the issue. People are dying. We have tried appeals to salads and quick walks. Unless you got anything up your sleeve, I recommend we stick to the ol' "keep more people alive with the best stuff we currently got" plan, until information pops up, that makes this look like the morally worse option. But in that regard preventing death is fairly hard to beat as a baseline.
  - squigz 2y ago
    > We have tried appeals to salads and quick walks. This bit made me laugh, as if public health initiatives have been taken remotely seriously by the past few decades. It seems quite a jump to go from "maybe try a a salad?" to putting millions of people on medication. Did that happen with tobacco? Alcohol?
    - jstummbillig 2y ago
      > It seems quite a jump to go from "maybe try a a salad?" to putting millions of people on medication. It's a hyperbole, meaning to say: The problem is so frustratingly silly and solution is so obvious and simple — just eat a little less, move a little more — that I understand how hard it is to accept that it might just be the completely wrong approach. What makes it fairly obvious to me is that despite clear and long standing conflicting beauty ideals, the massive societal advantages beauty affords, and an industry build around weight loss (not even drugs, stuff like Weight Watchers), people still struggle. If you have good insight into why informing about tobacco worked to the degree it did (although lung cancer is still the leading cause of cancer death) other than claiming vague un-seriousness, I am all ears. Otherwise I have a hard time understanding this as an information problem.
      - squigz 2y ago
        > If you have good insight into why informing about tobacco worked to the degree it did My point here was that we seemed to approach tobacco/alcohol a bit more methodically - taxes (i.e., increasing costs for cigarettes), regulations (i.e., where alcohol can be sold), education (i.e., scary cigarette packaging) - whereas we seem to be saying, "Well, we did very little and got no results, so let's go nuclear!" when it comes to obesity It seems to me that, if obesity is so harmful to society, places like McDonalds and other (provably) unhealthy food shouldn't be as cheap or as easy to get as it is. > The problem is so frustratingly silly and solution is so obvious and simple — just eat a little less, move a little more — that I understand how hard it is to accept that it might just be the completely wrong approach. It certainly is frustrating, and I feel that more than I probably should. Probably something to reflect on.
- idle_zealot 2y ago
  Are you asking what the root cause of obesity is? It's eating too much and not exercising enough. It's not some mystery. Or is the question about why people behave in this self-destructive way? People on average are bad at impulse control. Snack companies take advantage. People feel varying levels of discomfort vs exhilaration when exercising. For some it ultimately feels nice, for some it is unpleasant. Of those for whom it is unpleasant only some have the forethought and leeway to establish and maintain a healthy lifestyle. Of those for whom it is pleasant some face time or schedueling contraints that make an active lifestyle difficult. If there's a root cause to be fixed its that the human body responds poorly to acting on its impulses in our current built environment. You can solve that by altering the environment, the body, or the impulses. Ozempic seems to work by altering the impulses.
  - Almondsetat 2y ago
    >You can solve that by altering the environment, the body, or the impulses. Incorrect. You patch that by altering the environment OR the body OR or the impulses. To fix that you need to alter all 3
    - JumpCrisscross 2y ago
      > To fix that you need to alter all 3 We have tons of evidence to the contrary in multiple disciplines. Like, have you never made a conscious dietary change?
      - Almondsetat 2y ago
        Most dietary changes fail, I don't think that's a good example actually. In any case, yes I have, but the only time it has worked was when I changed my environment (stopped slouching at home bored with a full pantry) and my impulses (filled my days with activities so that boredom hunger wouldn't strike). Only changing one would make me last a couple of weeks max
        JumpCrisscross 2y ago
- objektif 2y ago
  I agree with you that this does not address the underlying issue. But root cause you speak of may not really be that simple to fix. Is the root cause people spend much more time in their offices working and hence are more inactive? Is it the crappy American diet? For example, many people around me gained weight after they became parents. Especially women after birth. It is just insanely difficult to work hard in an office job, take care of young kids and exercise etc all at the same time. As you age things get very difficult as well. I eat significantly less than what I used to just few years ago but still have 5-10lbs extra.

prepend 2y ago

How is that abuse? Obviously meds don’t work for everyone, but the aim is to have population level effects.

evantbyrne 2y ago
Maybe abuse is not the right term, but certainly not necessary to drop 10lbs. I workout pretty casually, and when I go on a cut I can lose 1lb/day. It wouldn't surprise me if an inactive person could lose that in a month. And the act of practicing self control would be beneficial. Maybe you are onto something with your comment about population-level effects though, I wouldn't know.
- kdnvk 2y ago
  1lb/day isn’t sustainable at all, that would require a 3500 calorie deficit. You’re losing water weight.
  - evantbyrne 2y ago
    Sure some of the weight in those first ten days might have been water, but it stayed off. Possibly because my diet didn't immediately revert to pre-cut levels but it's hard to say given it didn't go back up and I wasn't exactly suffering. A 1000 calorie deficit over a month would still cut 8lbs. No problem for an overweight man who is likely eating well in excess of 3000 calories. The point is that major interventions aren't really necessary for that level of weight loss, and imo practicing the self-control needed to lose 10lbs should be beneficial to pretty much anyone. Let me put it this way: it should be way harder for a couch potato to train for a 5k run than to lose 10lbs on a cut.
    - prepend 2y ago
      > The point is that major interventions aren't really necessary for that level of weight loss It’s about effective interventions. Obviously major interventions are needed as there is a huge amount of obese and overweight in the US and many other methods have been attempted. It’s not about theoretically possible (ie, a bodybuilder can do it) but effective population interventions that result in people successfully losing weight. Think about people going to medical school and becoming a doctor. It’s obviously possible but if you said the solution to income inequality was for everyone to go to medical school and be doctors that would not be a very effective intervention. Not being obese is not being wealthy. It’s simple what to do, but difficult to stick to a successful plan.

dangus 2y ago

I lost 40 pounds the classic way. Just better diet, eating less. And like the majority of people who lost weight, I gained it back. Why? I don’t know. My body just wants to eat more. I have to be constantly vigilant or else I’ll fall into my old habits of what my body demands that I eat. I’ll eat dinner and then still be hungry. I think you’re getting this backwards. I already have an eating disorder.

someotherperson 2y ago
> I’ll eat dinner and then still be hungry I'd take the odds that you eat too fast. Slow down and carefully chew every single bite. Put the cutlery down in-between bites.
- dangus 2y ago
  Thanks for the advice. It’s so helpful. Why didn’t I think of that? All the people who have never been fat have the best advice that us fatties totally appreciate and want to hear even when we never asked for it. In fact, it’s extra awesome when people bring up obvious advice when we don’t ask for it because fat people like me are actually less smart than you! So it’s really helpful to have a helping hand and I thank you for it. Thank you for downplaying a disease that almost half of the population has and for blaming it on me as an individual. Because obviously if half the country has the exact same ailment as me, it’s really a sign of the dangerous virality of the fast paced chewing lifestyle. Since most people who lost weight gain it back at some point statistically, it really makes logical sense that it’s all about how fast we are all chewing our food. All the celebrities and pundits on TV and in social media talk about how we need to chew our food faster, so it’s hard to escape that perverse influence.
  - Dove 2y ago
    I'm sorry to hear about your troubles. I have occasionally shared them. :( If you're interested, I do have a recommendation for you. For my money, Joel Greene is the best scientific thinker on the topic of diet and health, and his recent book "The Way" does a lot to replace frustration and confusion on the topic with sense and helpful advice. I recommend it if you've had success with a diet, and then regained the weight, and now nothing works - that's the exact problem he's focused on. Above and beyond whether you like his suggested solution, he does a lot to uncover mechanisms and explain the complexity of the problem. For what it's worth, I think your experience is completely normal. Nearly universal, even.