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I don't think the point is that GLP-1 inhibitors are "cheating," but that maybe some therapy for addiction (of all kinds) and a shift in focus toward health is

I don't think the point is that GLP-1 inhibitors are "cheating," but that maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life. So many people regain all the weight they lost after stopping these drugs, so it doesn't make meaningful progress and just covers the problem. At some point, we may find that these drugs cause long-term health problems of their own, too.

borski 2y ago
> I don't think the point is that GLP-1 inhibitors are "cheating," but that maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life. There is no guarantee that I’ll have to be on it for the rest of my life. But also, I was not “addicted” to food. I spent 18 months changing my lifestyle, nutrition, and exercise habits, and I lost zero weight. I gained health (hikes were no longer a problem, I was fully capable of working out after enough time doing it, etc.), but no weight loss. Yes, I tracked. Yes, I ate below my expenditure. My body holds onto weight. So yeah, I agree with more help for people with addictions, period. I do not see how it is a “replacement” for a medication that is clearly helping people. A lack of therapy was not my problem. > So many people regain all the weight they lost after stopping these drugs, so it doesn't make meaningful progress and just covers the problem. And so many people don’t. Also, we’re learning. Quit cold turkey and yeah, you’ll gain. Taper, and you likely won’t: https://www.pharmacist.com/Pharmacy-News/coming-off-glp-1s-slowly-could-be-key-to-preventing-weight-regain https://www.pharmacist.com/Pharmacy-News/coming-off-glp-1s-s... > At some point, we may find that these drugs cause long-term health problems of their own, too. Or we may not; these drugs have been around since 2005. They’re not new, despite most people having just heard of them now. But we know for a fact that obesity kills. Again: your contention is that instead of using this medication that helped me get healthier over the last 7 months and will help me get healthier yet over the next 7-8, you would have preferred that I “accept” that I have a problem imbued with negative morals (“addiction”) and try my hardest to break it. The thing is, I had already done that for the entirety of my life, remained obese, and would have died of it eventually. Can I be disciplined? Absolutely. I even lost 55 lbs doing keto for 10 months. I ran a startup, and successfully sold it. Discipline wasn’t my issue. I’m not suggesting you should use a GLP-1 med. I’m suggesting you shouldn’t be the arbiter of whether it is helpful or not; it’s effects should be.
- pclmulqdq 2y ago
  I was not talking about your personal experience. You may have actually benefitted from the main intended pharmacological effects of this drug, since it appears to be affecting your metabolism (your "body holds onto weight" comment suggests that). This is a diabetes drug, remember. The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food. Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns.
  - borski 2y ago
    > The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food. Citation needed. This is the main assumption you are making that I, and others, vehemently disagree with. The implication is that this is the first time people have suddenly decided they don’t like being obese. That’s absurd. The people on these medications have tried everything. Talk to literally any obesity doctor and ask them about their patients. This assumption is the problem. Nothing about the meds is easy. It just makes it possible for people to change when they couldn’t before. I don’t know why people feel a need to argue against that. > Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns. Sure, and I don’t disagree. And I’m all for people doing that too. If it works, great! On average, it doesn’t, for the vast majority of people, though it does work for some, and that’s great. I agree it’s a preferable approach. But if it worked for most people, it would have worked. But if it doesn’t work? Previously, people just accepted that they were going to be obese and miserable, and that it was their fault, which led to depression, etc., further making it “impossible” to ever fix. So if there is a medication that helps people change their lifestyle to get healthy, and also appears to be extremely effective, and has a good safety profile… that’s bad?
CydeWeys 2y ago
> maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life. It doesn't work for nearly as many people as GLP-1 agonists do. There are many different treatment methods that have been tested and evaluated, and being told to diet and exercise through therapy barely works at all. GLP-1 by contrast works very well. > At some point, we may find that these drugs cause long-term health problems of their own, too. Almost sounds like wishful thinking on your part -- you might want to stop and consider why you're so invested in these drugs having long-term side effects.
- pclmulqdq 2y ago
  I was referring to real therapy, not simply being told to diet and exercise: https://bpsmedicine.biomedcentral.com/articles/10.1186s13030-020-00177-9 https://bpsmedicine.biomedcentral.com/articles/10.1186s13030... CBT is very good at breaking addictions and other bad thought patterns, and it is the scientific basis on which most hard drug rehabs work. There's no reason to suggest that it works less on food than on heroin.
  - borski 2y ago
    > There's no reason to suggest that it works less on food than on heroin. And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related. The people who GLP-1 drugs help have not “never tried anything,” including but not limited to “real therapy.” If CBT and other modalities help someone, great! But they often don’t, and when they don’t, it’s absurd to want them to continue to suffer instead of get help with medication.
    - pclmulqdq 2y ago
      > And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related. Citation needed. As I understand it, serious therapeutic psychological treatments for obesity are highly stigmatized in the US. You may be projecting your own experience onto a group that does not share it. By the way, CBT as used for depression and for obesity are totally different types of CBT. CBT methods are highly tailored to the specific thought pattern you want to prevent.

borski 2y ago

> I don't think the point is that GLP-1 inhibitors are "cheating," but that maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life. There is no guarantee that I’ll have to be on it for the rest of my life. But also, I was not “addicted” to food. I spent 18 months changing my lifestyle, nutrition, and exercise habits, and I lost zero weight. I gained health (hikes were no longer a problem, I was fully capable of working out after enough time doing it, etc.), but no weight loss. Yes, I tracked. Yes, I ate below my expenditure. My body holds onto weight. So yeah, I agree with more help for people with addictions, period. I do not see how it is a “replacement” for a medication that is clearly helping people. A lack of therapy was not my problem. > So many people regain all the weight they lost after stopping these drugs, so it doesn't make meaningful progress and just covers the problem. And so many people don’t. Also, we’re learning. Quit cold turkey and yeah, you’ll gain. Taper, and you likely won’t: https://www.pharmacist.com/Pharmacy-News/coming-off-glp-1s-slowly-could-be-key-to-preventing-weight-regain https://www.pharmacist.com/Pharmacy-News/coming-off-glp-1s-s... > At some point, we may find that these drugs cause long-term health problems of their own, too. Or we may not; these drugs have been around since 2005. They’re not new, despite most people having just heard of them now. But we know for a fact that obesity kills. Again: your contention is that instead of using this medication that helped me get healthier over the last 7 months and will help me get healthier yet over the next 7-8, you would have preferred that I “accept” that I have a problem imbued with negative morals (“addiction”) and try my hardest to break it. The thing is, I had already done that for the entirety of my life, remained obese, and would have died of it eventually. Can I be disciplined? Absolutely. I even lost 55 lbs doing keto for 10 months. I ran a startup, and successfully sold it. Discipline wasn’t my issue. I’m not suggesting you should use a GLP-1 med. I’m suggesting you shouldn’t be the arbiter of whether it is helpful or not; it’s effects should be.

pclmulqdq 2y ago
I was not talking about your personal experience. You may have actually benefitted from the main intended pharmacological effects of this drug, since it appears to be affecting your metabolism (your "body holds onto weight" comment suggests that). This is a diabetes drug, remember. The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food. Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns.
- borski 2y ago
  > The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food. Citation needed. This is the main assumption you are making that I, and others, vehemently disagree with. The implication is that this is the first time people have suddenly decided they don’t like being obese. That’s absurd. The people on these medications have tried everything. Talk to literally any obesity doctor and ask them about their patients. This assumption is the problem. Nothing about the meds is easy. It just makes it possible for people to change when they couldn’t before. I don’t know why people feel a need to argue against that. > Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns. Sure, and I don’t disagree. And I’m all for people doing that too. If it works, great! On average, it doesn’t, for the vast majority of people, though it does work for some, and that’s great. I agree it’s a preferable approach. But if it worked for most people, it would have worked. But if it doesn’t work? Previously, people just accepted that they were going to be obese and miserable, and that it was their fault, which led to depression, etc., further making it “impossible” to ever fix. So if there is a medication that helps people change their lifestyle to get healthy, and also appears to be extremely effective, and has a good safety profile… that’s bad?

CydeWeys 2y ago

> maybe some therapy for addiction (of all kinds) and a shift in focus toward health is a better idea than being on a drug for the rest of your life. It doesn't work for nearly as many people as GLP-1 agonists do. There are many different treatment methods that have been tested and evaluated, and being told to diet and exercise through therapy barely works at all. GLP-1 by contrast works very well. > At some point, we may find that these drugs cause long-term health problems of their own, too. Almost sounds like wishful thinking on your part -- you might want to stop and consider why you're so invested in these drugs having long-term side effects.

pclmulqdq 2y ago
I was referring to real therapy, not simply being told to diet and exercise: https://bpsmedicine.biomedcentral.com/articles/10.1186s13030-020-00177-9 https://bpsmedicine.biomedcentral.com/articles/10.1186s13030... CBT is very good at breaking addictions and other bad thought patterns, and it is the scientific basis on which most hard drug rehabs work. There's no reason to suggest that it works less on food than on heroin.
- borski 2y ago
  > There's no reason to suggest that it works less on food than on heroin. And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related. The people who GLP-1 drugs help have not “never tried anything,” including but not limited to “real therapy.” If CBT and other modalities help someone, great! But they often don’t, and when they don’t, it’s absurd to want them to continue to suffer instead of get help with medication.
  - pclmulqdq 2y ago
    > And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related. Citation needed. As I understand it, serious therapeutic psychological treatments for obesity are highly stigmatized in the US. You may be projecting your own experience onto a group that does not share it. By the way, CBT as used for depression and for obesity are totally different types of CBT. CBT methods are highly tailored to the specific thought pattern you want to prevent.