5 ms·

Can we talk about the elephant in the room for a second? tens of millions of people are taking this, and they'd need to keep taking this medication for the effe

Can we talk about the elephant in the room for a second? tens of millions of people are taking this, and they'd need to keep taking this medication for the effects of the drug to remain. If there is a legitimate hormonal imbalance or genetic defect, I get it. But short of that, are there not only two root causes left? Which in my opinion would be: 1) Poor diet, which includes poor quality in food supply 2) Poor choices being made, or made for people. This includes car-centric cities, sedentary lifestyle and similar well known ailments of modern life. The root cause isn't being solved, only the adverse effects are temporarily inhibited so long as people continue to afford dependency on the pharmaceutical industry. How can any medical professional support this? It is already so hard to trust American medicine; doctors having intimate financial relationships with pharma is already a public secret. This certainly doesn't help. They already ruined generations by blaming weight gain on fats instead of sugar because of these corrupt relationships with pharma and other corporate types. I don't doubt the efficacy of the medicine, but the disease is not fatness, it is the reason we get fat that needs to be solved. Rarely do shortcuts result in long term solutions. Why is this different? How do I know this won't expose us to higher cancer risks, new types of diseases like nutrition absorption disorders or becoming over dependent on these medicines and developing malnutrition? I just don't get the lack of skepticism.

toxik 2y ago
If an individual's environment causes them to self-harm by stabbing themselves with a knife, you take away the knife before (if) you look at the root cause. The body wants to maintain whatever weight it usually has, if you can keep that weight lower using drugs, there is absolutely a way to stop using the drug and keep the weight loss. You need lifestyle changes, of course, and that is something these GLP-1 agonists do for you. They make you not want to eat.
- omgwtfbyobbq 2y ago
  This. We have however many millennia of natural selection influencing our genetic characteristics, and that's been shoehorned into a very different lifestyle over the past few hundred years. Ideally, we could allow everyone enough time off enough exercise, rest, and so on, to emulate what has shaped us for the first however many millennia, but we haven't. Using a medication to compensate for that seems reasonable, provided we've accurately estimated it's negatives, etc...
Calavar 2y ago
I am a doctor, so let me give you the perspective from the other side. A friend of mine who works in primary care has a policy of not prescribing semaglutide unless a patient has tried at least three months of diet/exercise first. She now has a long list of patients who decide to screw that and self-refer to a specialist who'd write them the script. I don't work in primary care myself, but this more or less matches my own experience - 95% of people do not want to put in the effort of changing diet, exercise, and other lifestyle habits. They want a quick fix. In the words of Ronnie Coleman, "Everybody wants to be a bodybuilder, but nobody wants to lift no heavy-ass weights." So I really do think the popularity of semaglutide is a bottom up phenomenon. There is has been huge consumer demand for a weight loss drug for decades, and pharma is only now meeting that demand. > doctors having intimate financial relationships with pharma is already a public secret A small number of elite doctors have intimate relationships with pharma. The other 99% who are prescribing semaglutide do not profit from it. In fact, it's the other way around. You can't bill for the act of prescribing medications, but there are dedicated billing codes for counseling a patient on diet/lifestyle modification.
- ddorian43 2y ago
  What most people don't know is that patients are terrible. I'm not a doctor but I know some doctors and patients. Many are unlucky to have unforgiving disorders. This is easily seen in T2D which is mostly diet related and fixable.
- CalRobert 2y ago
  I agree with you, but people shouldn't really have to put in the effort to change diet or exercise or lifestyle habits. But the environment that produces those habits SHOULD change. I lost a bunch of weight when I moved to Dublin and started walking everywhere. Then I moved to the Netherlands and lost even more, and got stronger. I didn't particularly try, I just lived somewhere where I used my own body to get around and the "normal" portion sizes were actually somewhat sane (a bag of Doritos here is maybe a third the size of one in the US). I was 280 pounds when I lived in suburban California. I'm 180 pounds now. Build bike lanes and public transport, put schools where kids can walk to them, and maybe don't sell a thousand calories of chips in a personal-sized and marketed bag, and it should get better. As an added bonus you get a lot less air pollution (and noise pollution, etc.) and less people being run over!
bsder 2y ago
Getting weight off temporarily is generally helpful for getting weight off permanently. For someone who is 100+ pounds overweight, losing a big chunk of that has a whole set of knock on effects (lower appetite, ability to actually exercise without pain, more general energy, fewer depressive episodes, etc.), that help make permanent weight loss a lot more achievable. In addition, semaglutide can be tried before a doctor would normally do a gastric bypass (and probably makes that operation a lot easier even if it doesn't completely work). And, before you go blaming everyone that their dietary choices are their own fault, do be aware that the total number of fat cells is highly conserved in the human body. In addition, fat cells "remember" the weight when they were created and only turn over at about 20-25% per year. If you were obese in adolescence and teenage years due to the habits your parents taught you, that can be really difficult to correct as an adult. Sure, these kinds of drugs are wrong for losing those 20 pounds that you should remove via diet, some extra exercise and some lifestyle changes. Yeah, a lot of people are stupidly using these drugs from dumb reasons instead of what they should be using them for. That doesn't make the drugs useless.
jonahx 2y ago
> The root cause isn't being solved, only the adverse effects are temporarily inhibited so long as people continue to afford dependency on the pharmaceutical industry. How can any medical professional support this? > I just don't get the lack of skepticism. Simple answer is people like to eat, lack discipline, and want to look good. None of these will ever change, and so the economic pressure is immense and unstoppable. Until it's proven that these drugs have serious side effects (and that's a real possibility), people will gamble on the risk/reward. I wouldn't touch them yet myself, but I can see it's a fait accompli. As for solving the root cause, doctors and policy makers have tried everything, to little or no avail. And so we're back to those 3 variables that won't change.
- latentcall 2y ago
  > Simple answer is people like to eat, lack discipline, and want to look good. This is indeed a simple answer, and way over simplified. You can walk into any grocery store in the US and most of the floor space is dedicated to packaged poison and chemicals masquerading as food.
  - jonahx 2y ago
    That's part of it, for sure. But even fixing that, I am confident you'd still have an obesity epidemic in the US (and many other places). The causal tendrils of the problem go so deep. And fixing grocery choices won't happen. It would require a level of government intervention and control that wouldn't be tolerated. You could argue it was done successfully with cigarettes, but food would be a thousand times harder legally, culturally, and practically.
- twelve40 2y ago
  > Simple answer is people like to eat, lack discipline, and want to look good this is not the answer to the question they asked, just a useless triviality. They are not asking _why_ people would like this, it's obvious, they are asking how is this possible to continue eating garbage and living a bad lifestyle, and keep losing weight, and is it then still a health positive or not?
cen4 2y ago
Medical Professional don't have a finance or business background, therefore they and their thoughts matter very little to how corporate wonderland decides anything. Unless some kid of a billionaire dies...
dzhiurgis 2y ago
AFAIK semis solve your 1st point precisely - people don’t like junk food anymore and they prefer smaller portions.
pyaamb 2y ago
imo, you wont get a complete model that explains whats happening unless you include the mental health aspect and how it all ties into this. the gut-brain connection is real. but its like just because it is harder to measure, we act as though it does not exist.
anal_reactor 2y ago
1. As individuals we're already completely dependent on the inventions of modern civilization, so putting yet another thing onto the list won't actually change much. 2. Your argument boils down to "if there exists a traditional way to solve a problem then we should keep doing things the old way, even if the old way costs more time, energy, and money; for example it's better to use a sickle instead of combine harvester because combine harvesters are evil because they make people lazy" which is exactly how you avoid civilizational progress. > Rarely do shortcuts result in long term solutions. This sentence is so ridiculous it deserves a witty insult but the etiquette of this website stops me.
torginus 2y ago
The very point of this study is that ozempic's effects go beyond what one would experience if they went on a very strict diet. It's literally better than self-discipline.
Terr_ 2y ago
> The root cause isn't being solved [...] they'd need to keep taking this medication for the effects of the drug to remain. Hold up, how is impermanence such a black-mark when it's also true of everything else? Exercising must be continued indefinitely, or else the benefits fade, and the same is true of dieting. Your post suggests that there is some kind of superior one-and-done weight-loss fix that is being overlooked or neglected, but I don't think we even have consensus on what this "root cause" is, and it's not clear why we should expect a perma-fix to be just around the corner. Is the root problem "humans aren't calibrated for abundant food"? Is the single-event fix a form of gastric-restriction surgery? Genetic editing?
glenstein 2y ago
I have to offer a hard disagree here for a number of reasons. First of all this is just blatantly disregarding the first order quality of life benefits, which is beyond inexcusable. The second chance at an elevated quality of life counts as legitimate rationale in and of itself. Even a 'season' of improved quality of life needs to matter to those of us who value health and life. But secondly, as a consequence of the above, it can dramatically shift the odds of maintaining good habits in a positive direction. It's easier to initiate and sustain momentum from a position of strength, of enjoying a benefit that's already in hand, than it is to try and summon the extraordinary willpower necessary to initiate and power through a long-term health journey. I don't see any reason to force people to take path that except for a confused desire to impose pull-yourself-up-by-your-bootstraps moralizing. Third, it appears to come with the benefit of moderating cravings for alcohol, which in and of itself is such a critical health benefit is that it could compensate for even quite serious side effects, if it had them. Fourth, it does address significant root causes. Unlike a bariatric surgery or gastric sleeve, it is an intervention that impacts cravings and metabolic processes at their source. Different people are born with different exposures to the risks given our reward and addiction systems. Our relationships to those risks is not more or less healthy, more or less attestament to our self-control, many of us are getting those benefits for free and aren't truly challenged. Nor should we be. Whatever our initial state we didn't "earn" that and once again I think it's confused moralizing true require people to essentially rewire their reward systems out of a subjective belief that that's more pure path to self regulation. Fifth, it is a medicine and medicines involve tradeoffs. Being qualified to prescribe medicines involves being trained to think coherently about a trade-offs. If you're not trained, then ignoring benefits and focusing on negatives might feel like it's some form of enlightened skepticism. But it's just as much malpractice to ignore the benefits of medicine as it would be to ignore negative side effects. Even it's necessary to maintain a lifelong relationship with the specific form of medicated intervention, that can be a net positive trade-off for long-term quality of life.
- twelve40 2y ago
  The comment author has zero moralizing and zero denial of quality of life benefits, or any of this. They simply seem to say that if a person doesn't eliminate the root cause of their obesity, they will still continue to suffer from health damage (or maybe even more, tbd) despite the actual benefits of this pill - and this is not discussed, unlike the hyped-up benefits, which btw may mislead people to think that they shouldn't change now that their appetite+weight is magically reducing, and all-positive publicity also encourages people who have little need for this pill to hoard it and drive the price(profits) up. A number of other things you mention are pretty subjective. It's just as hard for me to diet and exercise when I'm BMI 19 or BMI 25. In fact, that's true for 90+% of people, because everyone almost universally rebounds to bad habits, in all studies. This "power through a long-term health journey" is your whole life, always, there is no start or stop to this until we die or give up, even with this pill. The pill may help with the BMI part, but it obscures the fact that there is still very real health damage from bad diet and bad lifestyle no matter what your BMI or even visceral fat is.
twelve40 2y ago
Excellent question! This is the picture I'm getting so far: * the observable weight loss seems real based on reports - that's easy to measure, and harder to fabricate like "blaming fats" conspiracies of the past. Unless there is truly massive numbers falsification in all these studies, which i doubt. So that's kind of exciting. * stuff like this article about visceral fat might also be true, so that's also easy to get excited about, and might even be true. Major downsides are transparent and predictable - this is not magic, or willpower replacement for health, because: * if you keep eating garbage, you will still suffer health damage despite losing weight. If I eat nothing but twinkies for a year, and this pill makes me feel full after two twinkies a day, I will lose weight, I will also kill my liver and suffer severe malnutrition - you are right! A less extreme, average American food will also produce health damage while losing weight on this pill. * if you live a bad lifestyle while on this pill, you will still lose weight, but will damage your health exposing yourself to things like diabetes, CVD, etc. * the big unknown for me - curious about that - do people develop tolerance for this pill? and another big one, do they rebound violently (much worse than usual) once they stop taking it after a while? or not. This is easier to cover up and harder to measure. * other more subtle things like is there a link to higher cancer risks over time, etc, but the first two "cons" points are big enough for me already. TLDR: this is a way to look better and soften some effects of obesity, but does not help with continuing health damage that still needs to be addressed in a more traditional way unfortunately. Lack of skepticism is not because the massive downsides are unknown or absent, but because apparently they are less of a concern to users+marketers.
yc-kraln 2y ago
> But short of that, are there not only two root causes left? No. Let me paraphrase the conversation I had with the head of obestity at one of Europe's leading research hospitals (top 5 in EU): Once you get a certain amount of overweight, regardless of the cause, there are so many regulation systems in your body (at least 20 that we know of) which kick in to keep you overweight that it is not possible to diet and exercise your way back to a healthy weight without picking up a new disease (eating disorder, exercise additiction, etc.). The people who manage it spend the rest of their lives obsessively weighing everything they eat, exercizing every day, and even then if they slip up or lose mobility or something, inevitably they will become overweight again. The only known medical treatment is operating on the stomach. This changes enough of the regulation systems (including the hormonal ones) that it has a reasonable chance of sticking. GLP-1 seems to offer a second option. It continues to astonish me that eating disorders which result in weight loss are (correctly) accepted by society as diseases with complex causes which can include lifestyle and self-control but also mental health and innumerable other things, but if you're overweight clearly you are a sad sack of shit that just can't open their mouth without shoving food in it.
glp1guide 2y ago
> Can we talk about the elephant in the room for a second? tens of millions of people are taking this, and they'd need to keep taking this medication for the effects of the drug to remain. This is untrue, you can stop taking the drug and the effects will persist, most people keep weight off after coming off the drugs. I've assembled some stuff on this here: https://glp1.guide/content/do-people-regain-all-the-weight-lost-on-glp1-receptor-agonists/ https://glp1.guide/content/do-people-regain-all-the-weight-l... There are anecdotal reports of astounding levels of hunger returning (more than before perhaps) but this can be solved by a more gradual wean-off (like the ramp up). > I just don't get the lack of skepticism. There has never been such a con-free, researched solution to weight loss (and originally these drugs were meant to treat type 2 diabetes, so it's more like we have a viagra situation on our hands). Don't read what the media puts out, go back and read the research papers. It's not magic -- it's well researched, and while it's not clear exactly every effect, there is a growing body of evidence.
thefz 2y ago
> If there is a legitimate hormonal imbalance or genetic defect, I get it. 'No Way to Prevent This,' Says Only Nation Where This Regularly Happens.
consteval 2y ago
> Poor diet > Poor choices > legitimate hormonal imbalance or genetic defect The legitimate hormonal imbalance and genetic defect is being human. Our brains and bodies were never intended to operate in a setting with a surplus of extremely nutritious food. To me, it is clear that food can be extremely addictive, maybe even more so than traditional avenues of addiction like nicotine or alcohol. It's obvious that modern day foods are constructed in such a way to ensure this addiction. They have appropriate amounts of fat, sodium, and sugar to give an immediate good feeling to people, as well as increase their dopamine for a while. The reality is that the obesity epidemic is the primary killer in the first world. We have moved past the point where we can close our ears and yell "bootstraps! bootstraps!!!" Clearly this is bigger, more complex, and more sinister than online armchair doctors will have you believe. Look around you. I see a society of sickness. Did everyone magically, at the same time, become lazy? Is everyone just stupid? I don't think so.

toxik 2y ago

If an individual's environment causes them to self-harm by stabbing themselves with a knife, you take away the knife before (if) you look at the root cause. The body wants to maintain whatever weight it usually has, if you can keep that weight lower using drugs, there is absolutely a way to stop using the drug and keep the weight loss. You need lifestyle changes, of course, and that is something these GLP-1 agonists do for you. They make you not want to eat.

omgwtfbyobbq 2y ago
This. We have however many millennia of natural selection influencing our genetic characteristics, and that's been shoehorned into a very different lifestyle over the past few hundred years. Ideally, we could allow everyone enough time off enough exercise, rest, and so on, to emulate what has shaped us for the first however many millennia, but we haven't. Using a medication to compensate for that seems reasonable, provided we've accurately estimated it's negatives, etc...

Calavar 2y ago

I am a doctor, so let me give you the perspective from the other side. A friend of mine who works in primary care has a policy of not prescribing semaglutide unless a patient has tried at least three months of diet/exercise first. She now has a long list of patients who decide to screw that and self-refer to a specialist who'd write them the script. I don't work in primary care myself, but this more or less matches my own experience - 95% of people do not want to put in the effort of changing diet, exercise, and other lifestyle habits. They want a quick fix. In the words of Ronnie Coleman, "Everybody wants to be a bodybuilder, but nobody wants to lift no heavy-ass weights." So I really do think the popularity of semaglutide is a bottom up phenomenon. There is has been huge consumer demand for a weight loss drug for decades, and pharma is only now meeting that demand. > doctors having intimate financial relationships with pharma is already a public secret A small number of elite doctors have intimate relationships with pharma. The other 99% who are prescribing semaglutide do not profit from it. In fact, it's the other way around. You can't bill for the act of prescribing medications, but there are dedicated billing codes for counseling a patient on diet/lifestyle modification.

ddorian43 2y ago
What most people don't know is that patients are terrible. I'm not a doctor but I know some doctors and patients. Many are unlucky to have unforgiving disorders. This is easily seen in T2D which is mostly diet related and fixable.
CalRobert 2y ago
I agree with you, but people shouldn't really have to put in the effort to change diet or exercise or lifestyle habits. But the environment that produces those habits SHOULD change. I lost a bunch of weight when I moved to Dublin and started walking everywhere. Then I moved to the Netherlands and lost even more, and got stronger. I didn't particularly try, I just lived somewhere where I used my own body to get around and the "normal" portion sizes were actually somewhat sane (a bag of Doritos here is maybe a third the size of one in the US). I was 280 pounds when I lived in suburban California. I'm 180 pounds now. Build bike lanes and public transport, put schools where kids can walk to them, and maybe don't sell a thousand calories of chips in a personal-sized and marketed bag, and it should get better. As an added bonus you get a lot less air pollution (and noise pollution, etc.) and less people being run over!

bsder 2y ago

Getting weight off temporarily is generally helpful for getting weight off permanently. For someone who is 100+ pounds overweight, losing a big chunk of that has a whole set of knock on effects (lower appetite, ability to actually exercise without pain, more general energy, fewer depressive episodes, etc.), that help make permanent weight loss a lot more achievable. In addition, semaglutide can be tried before a doctor would normally do a gastric bypass (and probably makes that operation a lot easier even if it doesn't completely work). And, before you go blaming everyone that their dietary choices are their own fault, do be aware that the total number of fat cells is highly conserved in the human body. In addition, fat cells "remember" the weight when they were created and only turn over at about 20-25% per year. If you were obese in adolescence and teenage years due to the habits your parents taught you, that can be really difficult to correct as an adult. Sure, these kinds of drugs are wrong for losing those 20 pounds that you should remove via diet, some extra exercise and some lifestyle changes. Yeah, a lot of people are stupidly using these drugs from dumb reasons instead of what they should be using them for. That doesn't make the drugs useless.

jonahx 2y ago

> The root cause isn't being solved, only the adverse effects are temporarily inhibited so long as people continue to afford dependency on the pharmaceutical industry. How can any medical professional support this? > I just don't get the lack of skepticism. Simple answer is people like to eat, lack discipline, and want to look good. None of these will ever change, and so the economic pressure is immense and unstoppable. Until it's proven that these drugs have serious side effects (and that's a real possibility), people will gamble on the risk/reward. I wouldn't touch them yet myself, but I can see it's a fait accompli. As for solving the root cause, doctors and policy makers have tried everything, to little or no avail. And so we're back to those 3 variables that won't change.

latentcall 2y ago
> Simple answer is people like to eat, lack discipline, and want to look good. This is indeed a simple answer, and way over simplified. You can walk into any grocery store in the US and most of the floor space is dedicated to packaged poison and chemicals masquerading as food.
- jonahx 2y ago
  That's part of it, for sure. But even fixing that, I am confident you'd still have an obesity epidemic in the US (and many other places). The causal tendrils of the problem go so deep. And fixing grocery choices won't happen. It would require a level of government intervention and control that wouldn't be tolerated. You could argue it was done successfully with cigarettes, but food would be a thousand times harder legally, culturally, and practically.
twelve40 2y ago
> Simple answer is people like to eat, lack discipline, and want to look good this is not the answer to the question they asked, just a useless triviality. They are not asking _why_ people would like this, it's obvious, they are asking how is this possible to continue eating garbage and living a bad lifestyle, and keep losing weight, and is it then still a health positive or not?

cen4 2y ago

Medical Professional don't have a finance or business background, therefore they and their thoughts matter very little to how corporate wonderland decides anything. Unless some kid of a billionaire dies...

dzhiurgis 2y ago

AFAIK semis solve your 1st point precisely - people don’t like junk food anymore and they prefer smaller portions.

pyaamb 2y ago

imo, you wont get a complete model that explains whats happening unless you include the mental health aspect and how it all ties into this. the gut-brain connection is real. but its like just because it is harder to measure, we act as though it does not exist.

anal_reactor 2y ago

1. As individuals we're already completely dependent on the inventions of modern civilization, so putting yet another thing onto the list won't actually change much. 2. Your argument boils down to "if there exists a traditional way to solve a problem then we should keep doing things the old way, even if the old way costs more time, energy, and money; for example it's better to use a sickle instead of combine harvester because combine harvesters are evil because they make people lazy" which is exactly how you avoid civilizational progress. > Rarely do shortcuts result in long term solutions. This sentence is so ridiculous it deserves a witty insult but the etiquette of this website stops me.

torginus 2y ago

The very point of this study is that ozempic's effects go beyond what one would experience if they went on a very strict diet. It's literally better than self-discipline.

Terr_ 2y ago

> The root cause isn't being solved [...] they'd need to keep taking this medication for the effects of the drug to remain. Hold up, how is impermanence such a black-mark when it's also true of everything else? Exercising must be continued indefinitely, or else the benefits fade, and the same is true of dieting. Your post suggests that there is some kind of superior one-and-done weight-loss fix that is being overlooked or neglected, but I don't think we even have consensus on what this "root cause" is, and it's not clear why we should expect a perma-fix to be just around the corner. Is the root problem "humans aren't calibrated for abundant food"? Is the single-event fix a form of gastric-restriction surgery? Genetic editing?

glenstein 2y ago

I have to offer a hard disagree here for a number of reasons. First of all this is just blatantly disregarding the first order quality of life benefits, which is beyond inexcusable. The second chance at an elevated quality of life counts as legitimate rationale in and of itself. Even a 'season' of improved quality of life needs to matter to those of us who value health and life. But secondly, as a consequence of the above, it can dramatically shift the odds of maintaining good habits in a positive direction. It's easier to initiate and sustain momentum from a position of strength, of enjoying a benefit that's already in hand, than it is to try and summon the extraordinary willpower necessary to initiate and power through a long-term health journey. I don't see any reason to force people to take path that except for a confused desire to impose pull-yourself-up-by-your-bootstraps moralizing. Third, it appears to come with the benefit of moderating cravings for alcohol, which in and of itself is such a critical health benefit is that it could compensate for even quite serious side effects, if it had them. Fourth, it does address significant root causes. Unlike a bariatric surgery or gastric sleeve, it is an intervention that impacts cravings and metabolic processes at their source. Different people are born with different exposures to the risks given our reward and addiction systems. Our relationships to those risks is not more or less healthy, more or less attestament to our self-control, many of us are getting those benefits for free and aren't truly challenged. Nor should we be. Whatever our initial state we didn't "earn" that and once again I think it's confused moralizing true require people to essentially rewire their reward systems out of a subjective belief that that's more pure path to self regulation. Fifth, it is a medicine and medicines involve tradeoffs. Being qualified to prescribe medicines involves being trained to think coherently about a trade-offs. If you're not trained, then ignoring benefits and focusing on negatives might feel like it's some form of enlightened skepticism. But it's just as much malpractice to ignore the benefits of medicine as it would be to ignore negative side effects. Even it's necessary to maintain a lifelong relationship with the specific form of medicated intervention, that can be a net positive trade-off for long-term quality of life.

twelve40 2y ago
The comment author has zero moralizing and zero denial of quality of life benefits, or any of this. They simply seem to say that if a person doesn't eliminate the root cause of their obesity, they will still continue to suffer from health damage (or maybe even more, tbd) despite the actual benefits of this pill - and this is not discussed, unlike the hyped-up benefits, which btw may mislead people to think that they shouldn't change now that their appetite+weight is magically reducing, and all-positive publicity also encourages people who have little need for this pill to hoard it and drive the price(profits) up. A number of other things you mention are pretty subjective. It's just as hard for me to diet and exercise when I'm BMI 19 or BMI 25. In fact, that's true for 90+% of people, because everyone almost universally rebounds to bad habits, in all studies. This "power through a long-term health journey" is your whole life, always, there is no start or stop to this until we die or give up, even with this pill. The pill may help with the BMI part, but it obscures the fact that there is still very real health damage from bad diet and bad lifestyle no matter what your BMI or even visceral fat is.

twelve40 2y ago

Excellent question! This is the picture I'm getting so far: * the observable weight loss seems real based on reports - that's easy to measure, and harder to fabricate like "blaming fats" conspiracies of the past. Unless there is truly massive numbers falsification in all these studies, which i doubt. So that's kind of exciting. * stuff like this article about visceral fat might also be true, so that's also easy to get excited about, and might even be true. Major downsides are transparent and predictable - this is not magic, or willpower replacement for health, because: * if you keep eating garbage, you will still suffer health damage despite losing weight. If I eat nothing but twinkies for a year, and this pill makes me feel full after two twinkies a day, I will lose weight, I will also kill my liver and suffer severe malnutrition - you are right! A less extreme, average American food will also produce health damage while losing weight on this pill. * if you live a bad lifestyle while on this pill, you will still lose weight, but will damage your health exposing yourself to things like diabetes, CVD, etc. * the big unknown for me - curious about that - do people develop tolerance for this pill? and another big one, do they rebound violently (much worse than usual) once they stop taking it after a while? or not. This is easier to cover up and harder to measure. * other more subtle things like is there a link to higher cancer risks over time, etc, but the first two "cons" points are big enough for me already. TLDR: this is a way to look better and soften some effects of obesity, but does not help with continuing health damage that still needs to be addressed in a more traditional way unfortunately. Lack of skepticism is not because the massive downsides are unknown or absent, but because apparently they are less of a concern to users+marketers.

yc-kraln 2y ago

> But short of that, are there not only two root causes left? No. Let me paraphrase the conversation I had with the head of obestity at one of Europe's leading research hospitals (top 5 in EU): Once you get a certain amount of overweight, regardless of the cause, there are so many regulation systems in your body (at least 20 that we know of) which kick in to keep you overweight that it is not possible to diet and exercise your way back to a healthy weight without picking up a new disease (eating disorder, exercise additiction, etc.). The people who manage it spend the rest of their lives obsessively weighing everything they eat, exercizing every day, and even then if they slip up or lose mobility or something, inevitably they will become overweight again. The only known medical treatment is operating on the stomach. This changes enough of the regulation systems (including the hormonal ones) that it has a reasonable chance of sticking. GLP-1 seems to offer a second option. It continues to astonish me that eating disorders which result in weight loss are (correctly) accepted by society as diseases with complex causes which can include lifestyle and self-control but also mental health and innumerable other things, but if you're overweight clearly you are a sad sack of shit that just can't open their mouth without shoving food in it.

glp1guide 2y ago

> Can we talk about the elephant in the room for a second? tens of millions of people are taking this, and they'd need to keep taking this medication for the effects of the drug to remain. This is untrue, you can stop taking the drug and the effects will persist, most people keep weight off after coming off the drugs. I've assembled some stuff on this here: https://glp1.guide/content/do-people-regain-all-the-weight-lost-on-glp1-receptor-agonists/ https://glp1.guide/content/do-people-regain-all-the-weight-l... There are anecdotal reports of astounding levels of hunger returning (more than before perhaps) but this can be solved by a more gradual wean-off (like the ramp up). > I just don't get the lack of skepticism. There has never been such a con-free, researched solution to weight loss (and originally these drugs were meant to treat type 2 diabetes, so it's more like we have a viagra situation on our hands). Don't read what the media puts out, go back and read the research papers. It's not magic -- it's well researched, and while it's not clear exactly every effect, there is a growing body of evidence.

thefz 2y ago

> If there is a legitimate hormonal imbalance or genetic defect, I get it. 'No Way to Prevent This,' Says Only Nation Where This Regularly Happens.

consteval 2y ago

> Poor diet > Poor choices > legitimate hormonal imbalance or genetic defect The legitimate hormonal imbalance and genetic defect is being human. Our brains and bodies were never intended to operate in a setting with a surplus of extremely nutritious food. To me, it is clear that food can be extremely addictive, maybe even more so than traditional avenues of addiction like nicotine or alcohol. It's obvious that modern day foods are constructed in such a way to ensure this addiction. They have appropriate amounts of fat, sodium, and sugar to give an immediate good feeling to people, as well as increase their dopamine for a while. The reality is that the obesity epidemic is the primary killer in the first world. We have moved past the point where we can close our ears and yell "bootstraps! bootstraps!!!" Clearly this is bigger, more complex, and more sinister than online armchair doctors will have you believe. Look around you. I see a society of sickness. Did everyone magically, at the same time, become lazy? Is everyone just stupid? I don't think so.