6 ms·

It is a bit more complicated though. Plenty of people have lost weight sustainably with diet and exercising. It just doesn't seem to work with everyone.

toomuchtodo 1y ago
True, but some people might have favorable gut flora others do not (there was evidence of this with fecal transplants, with recipients acquiring the metabolic profile of the donor). The meta issue is that the human body and its interaction with gut flora and other systems are still somewhat unknown, and we are still simple monkeys using hammers on inputs of the body. Why do we need GLP-1s? Is it because of Western diet? Misfiring reward centers (GLP-1s also appear to quell addictive behavior around alcohol and hard drugs)? Broad antibiotic usage along with more sterile living environments causing misbalanced gut flora (not producing sufficient quantities of natural GLP-1)? The most exciting phrase in science is not "Eureka!" but "That’s funny...". I thought the long term solution was gene therapy for GLP-1 consumers, but now believe it's going to be probiotics that encourage gut flora that excretes sufficient quantities of GLP-1 for the desired metabolic outcome (based on most recent evidence and findings). If feasible, this is exciting because it is much harder to gate this therapy via the medical industrial complex (primarily insurance, pharma, PBMs, etc). Scientists May Have Found a Natural Alternative to Ozempic - https://news.ycombinator.com/item?id=43874436 https://news.ycombinator.com/item?id=43874436 - May 2025
- arkh 1y ago
  > GLP-1s also appear to quell addictive behavior around alcohol and hard drugs Being on D2 agonist which has the exact opposite effect I wonder what taking both would result in.
alabastervlog 1y ago
Diet and exercise methods don't[1] work for most people, for loss and especially for healthy weight maintenance. With extreme levels of direct, personal involvement by multiple professionals (which is what rich people / celebrities have historically used, and variations of which have been studied by researchers) the efficacy level reaches "sort-of OK, but still not great". That's crazy-expensive, though, so not a realistic solution for the masses, plus the results are still pretty lackluster despite the cost. [1] Could, hypothetically, yes "CICO", technically anyone could lose weight, but they in fact do not work when applied in the real world, statistically speaking.
- andoando 1y ago
  I wonder how much of that is education. Most people also don't seem to know that weight loss is simply Calories in - calories out, what their BMR is, how to track calories. Most people, even educated people, still seem to believe things like they have slow metabolism, that herbal teas can help, doing situps will reduce belly fat, and number of dumb shit the market tries to sell. As a nation were just far too focused on $$$, and instead of focusing on fixing the root of the issue, were only incentivized to bandage the problem with producing more things that will make $$$. Sell shit food, people get fat, sell crap products for weigh loss, drugs, surgery, etc
  - dekhn 1y ago
    Weight loss is not simply calories in - calories out. Fat is not burned and its metabolism does not change your weight. Oxygen/CO2 exchange in the lungs is also a major component of weight change. Further, your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption. And that's just addressing first order weight parameters.
    - dgfitz 1y ago
      It is calories in/out. Other mechanisms factor in, but I’ll bet anyone my bottom dollar they’ll lose weight if they eat 700 kcal/day. Yes, breathing is literally how weight is lost, I’m not sure what your point was there.
    - jtmarl1n 1y ago
      Weight loss is absolutely a result of CICO, please site a source that states otherwise. I have never heard another source citing Oxygen/CO2 exchange as a factor for weight change, again, please site a source. O2 levels are certainly a factor of cardio health which can be correlated to overall health and weight. Yes, macros also matter. But, nothing matters as much as the simple math of calories in/calories out. Its disingenuous, borderline irresponsible, to suggest otherwise.
ipsento606 1y ago
> It just doesn't seem to work with everyone Without a very precise definition of "work", these discussions quickly degrade to near uselessness. There is a very large difference between "telling patients to exercise more and eat less doesn't result in long term weight loss" and "exercising more and eating less doesn't result in long term weight loss" The former is true, and the latter is not. I agree that from a clinical perspective the former definition is more relevant than the latter.
- SAI_Peregrinus 1y ago
  It's also "exercising more and eating less until you reach a target weight" doesn't result in long-term weight loss, while "exercising more and eating less for the rest of your life" does result in long-term weight loss.
  - Kirby64 1y ago
    Yes and no. Weight loss requires you to eat fewer calories than you actually burn for a period of time until you reach the weight you desire. Once you reach a desired weight, you can start eating more calories again, but less than what you were eating since you no longer burn as many calories due to less weight… So, the losing weight part requires even more restriction, and then a much smaller amount of restriction once you reach your goal. It’s not unreasonable to reduce calories to something like 1500/day when dieting. But very few people need to stay at that amount for the rest of their lives.
mschuster91 1y ago
> Plenty of people have lost weight sustainably with diet and exercising. It just doesn't seem to work with everyone. The problem is, staying healthy is a matter of privilege. You need to be able to afford to eat healthy (ultra-processed industrial food that's loaded with sugar is often much cheaper than quality produce), even if you have money, a decent chunk of Americans live in areas that are classified as "food deserts" [1], even if you are not in a food desert you still need to be able and have time to get to a store selling quality food, and you need someone with time available to cook healthy meals out of that. It used to be easier back in the time where one income was enough to feed a whole family and the women stayed as housewifes to actually do that, but these times are (thankfully) long gone. Exercising suffers from similar "problems of privilege". Either you got the money and time to spare to go to a gym, or you got the money and space in your home to install your own gym... or you need actually safe roads where you can walk, jog or bike, and most of the US is so utterly car-dependent that it is outright unsafe to walk. And on top of that you got the whole "living while Black" issue, with egregious instances like a pregnant Black woman arrested for walking her dog [2] - it's no surprise that the Black and Indigenous population has noticeably higher rates of diabetes [3] or oral health issues [4]. And on top of that, you got the whole issue with educating children about healthy foods, their parents being too poor to afford healthy foods, and that setting up these children for childhood obesity which perpetuates into adulthood. A lot of that is closely correlated with ethnicity and wealth as well. It's a systemic issue, an insanely complex one at that, with no easy solution to be found - and certainly not a failure of any individual to stay healthy. [1] https://en.wikipedia.org/wiki/Food_deserts_in_the_United_States https://en.wikipedia.org/wiki/Food_deserts_in_the_United_Sta... [2] https://ca.news.yahoo.com/pregnant-black-woman-ticketed-walking-195434227.html https://ca.news.yahoo.com/pregnant-black-woman-ticketed-walk... [3] https://healthequitytracker.org/exploredata?mls=1.diabetes-3.00 https://healthequitytracker.org/exploredata?mls=1.diabetes-3... [4] https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs//160-001-OralHlthBurdenDisparities.pdf https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs...
- impendia 1y ago
  Strongly agreed. Recently, I found a gym with group training classes which I absolutely love. They have a great sense of community, and now that I've found them I find it easy to motivate myself to show up and work out. I have the good fortune that I can afford the $150/month fees. Not everyone can.
HarHarVeryFunny 1y ago
The way Ozempic works is basically by controlling desire so you eat less - it's the eating less (less calories consumed) that makes you lose weight. As you lose weight you will also be able to exercise more easily, which again will help to lose weight (more calories burnt). At the end of the day it is just about diet and exercise - not eating more calories per day than you are burning via exercise.

toomuchtodo 1y ago

True, but some people might have favorable gut flora others do not (there was evidence of this with fecal transplants, with recipients acquiring the metabolic profile of the donor). The meta issue is that the human body and its interaction with gut flora and other systems are still somewhat unknown, and we are still simple monkeys using hammers on inputs of the body. Why do we need GLP-1s? Is it because of Western diet? Misfiring reward centers (GLP-1s also appear to quell addictive behavior around alcohol and hard drugs)? Broad antibiotic usage along with more sterile living environments causing misbalanced gut flora (not producing sufficient quantities of natural GLP-1)? The most exciting phrase in science is not "Eureka!" but "That’s funny...". I thought the long term solution was gene therapy for GLP-1 consumers, but now believe it's going to be probiotics that encourage gut flora that excretes sufficient quantities of GLP-1 for the desired metabolic outcome (based on most recent evidence and findings). If feasible, this is exciting because it is much harder to gate this therapy via the medical industrial complex (primarily insurance, pharma, PBMs, etc). Scientists May Have Found a Natural Alternative to Ozempic - https://news.ycombinator.com/item?id=43874436 https://news.ycombinator.com/item?id=43874436 - May 2025

arkh 1y ago
> GLP-1s also appear to quell addictive behavior around alcohol and hard drugs Being on D2 agonist which has the exact opposite effect I wonder what taking both would result in.

alabastervlog 1y ago

Diet and exercise methods don't[1] work for most people, for loss and especially for healthy weight maintenance. With extreme levels of direct, personal involvement by multiple professionals (which is what rich people / celebrities have historically used, and variations of which have been studied by researchers) the efficacy level reaches "sort-of OK, but still not great". That's crazy-expensive, though, so not a realistic solution for the masses, plus the results are still pretty lackluster despite the cost. [1] Could, hypothetically, yes "CICO", technically anyone could lose weight, but they in fact do not work when applied in the real world, statistically speaking.

andoando 1y ago
I wonder how much of that is education. Most people also don't seem to know that weight loss is simply Calories in - calories out, what their BMR is, how to track calories. Most people, even educated people, still seem to believe things like they have slow metabolism, that herbal teas can help, doing situps will reduce belly fat, and number of dumb shit the market tries to sell. As a nation were just far too focused on $$$, and instead of focusing on fixing the root of the issue, were only incentivized to bandage the problem with producing more things that will make $$$. Sell shit food, people get fat, sell crap products for weigh loss, drugs, surgery, etc
- dekhn 1y ago
  Weight loss is not simply calories in - calories out. Fat is not burned and its metabolism does not change your weight. Oxygen/CO2 exchange in the lungs is also a major component of weight change. Further, your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption. And that's just addressing first order weight parameters.
  - dgfitz 1y ago
    It is calories in/out. Other mechanisms factor in, but I’ll bet anyone my bottom dollar they’ll lose weight if they eat 700 kcal/day. Yes, breathing is literally how weight is lost, I’m not sure what your point was there.
  - jtmarl1n 1y ago
    Weight loss is absolutely a result of CICO, please site a source that states otherwise. I have never heard another source citing Oxygen/CO2 exchange as a factor for weight change, again, please site a source. O2 levels are certainly a factor of cardio health which can be correlated to overall health and weight. Yes, macros also matter. But, nothing matters as much as the simple math of calories in/calories out. Its disingenuous, borderline irresponsible, to suggest otherwise.

ipsento606 1y ago

> It just doesn't seem to work with everyone Without a very precise definition of "work", these discussions quickly degrade to near uselessness. There is a very large difference between "telling patients to exercise more and eat less doesn't result in long term weight loss" and "exercising more and eating less doesn't result in long term weight loss" The former is true, and the latter is not. I agree that from a clinical perspective the former definition is more relevant than the latter.

SAI_Peregrinus 1y ago
It's also "exercising more and eating less until you reach a target weight" doesn't result in long-term weight loss, while "exercising more and eating less for the rest of your life" does result in long-term weight loss.
- Kirby64 1y ago
  Yes and no. Weight loss requires you to eat fewer calories than you actually burn for a period of time until you reach the weight you desire. Once you reach a desired weight, you can start eating more calories again, but less than what you were eating since you no longer burn as many calories due to less weight… So, the losing weight part requires even more restriction, and then a much smaller amount of restriction once you reach your goal. It’s not unreasonable to reduce calories to something like 1500/day when dieting. But very few people need to stay at that amount for the rest of their lives.

mschuster91 1y ago

> Plenty of people have lost weight sustainably with diet and exercising. It just doesn't seem to work with everyone. The problem is, staying healthy is a matter of privilege. You need to be able to afford to eat healthy (ultra-processed industrial food that's loaded with sugar is often much cheaper than quality produce), even if you have money, a decent chunk of Americans live in areas that are classified as "food deserts" [1], even if you are not in a food desert you still need to be able and have time to get to a store selling quality food, and you need someone with time available to cook healthy meals out of that. It used to be easier back in the time where one income was enough to feed a whole family and the women stayed as housewifes to actually do that, but these times are (thankfully) long gone. Exercising suffers from similar "problems of privilege". Either you got the money and time to spare to go to a gym, or you got the money and space in your home to install your own gym... or you need actually safe roads where you can walk, jog or bike, and most of the US is so utterly car-dependent that it is outright unsafe to walk. And on top of that you got the whole "living while Black" issue, with egregious instances like a pregnant Black woman arrested for walking her dog [2] - it's no surprise that the Black and Indigenous population has noticeably higher rates of diabetes [3] or oral health issues [4]. And on top of that, you got the whole issue with educating children about healthy foods, their parents being too poor to afford healthy foods, and that setting up these children for childhood obesity which perpetuates into adulthood. A lot of that is closely correlated with ethnicity and wealth as well. It's a systemic issue, an insanely complex one at that, with no easy solution to be found - and certainly not a failure of any individual to stay healthy. [1] https://en.wikipedia.org/wiki/Food_deserts_in_the_United_States https://en.wikipedia.org/wiki/Food_deserts_in_the_United_Sta... [2] https://ca.news.yahoo.com/pregnant-black-woman-ticketed-walking-195434227.html https://ca.news.yahoo.com/pregnant-black-woman-ticketed-walk... [3] https://healthequitytracker.org/exploredata?mls=1.diabetes-3.00 https://healthequitytracker.org/exploredata?mls=1.diabetes-3... [4] https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs//160-001-OralHlthBurdenDisparities.pdf https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs...

impendia 1y ago
Strongly agreed. Recently, I found a gym with group training classes which I absolutely love. They have a great sense of community, and now that I've found them I find it easy to motivate myself to show up and work out. I have the good fortune that I can afford the $150/month fees. Not everyone can.

HarHarVeryFunny 1y ago

The way Ozempic works is basically by controlling desire so you eat less - it's the eating less (less calories consumed) that makes you lose weight. As you lose weight you will also be able to exercise more easily, which again will help to lose weight (more calories burnt). At the end of the day it is just about diet and exercise - not eating more calories per day than you are burning via exercise.