5 ms·

Wow, it's hard to think of a better example of a correlational study measuring something that would obviously be confounded by the thing being studied. Don't fo

Wow, it's hard to think of a better example of a correlational study measuring something that would obviously be confounded by the thing being studied. Don't forget that most GLP-1 users are obese and many will continue to be after treatment (as it only causes a reduction in 10%-20% of body weight). And they're rich. So the headline is "rich obese people spend more in restaurants than average". No shade on people taking the drug btw. I'm on tirzepatide myself.

firecall 9mo ago
Do we know what the reason is for the limits of around 10-20%?
- hsuduebc2 9mo ago
  As you lose weight, your body needs fewer calories to run. That “needed amount” keeps dropping with your size, until it eventually equals what you’re eating on the medication. At that point you’re no longer in a deficit, so weight loss slows or stops.
  - doubleunplussed 9mo ago
    That is true but requires some extra assumptions to explain why people don't keep losing weight - because the strongest influence on most people's appetite in the short run is how much of a deficit or surplus they're currently in. Thus as TDEE drops, so does hunger. In "setpoint theory" there's an additional hunger drive based on whether you are below or above a given level of adiposity - your "setpoint". This is often given as an explanation for why people can't keep weight off, and is the sort of thing you'd need to posit to explain why people on GLP-1 inhibitors can't as easily get to lower levels of adiposity.
- rootusrootus 9mo ago
  I don't know that there's a consensus on what the limit really is. Semaglutide is good for about 15%, tirzepatide about 20%, and retatrutide about 25%. Some people don't get that much, some people get a lot more. Personally, tirzepatide got me just over 35%. I never got anywhere near max dose, either, I am what is colloquially referred to as a super responder.
  - vladgur 9mo ago
    Sorry for personal questions please answer any OR none as you feel comfortable 1) How is your energy/stamina following the 35% loss 2) Have you done any dexascans/bodyspecs to measure your lean mass percentage before and after your loss 3) Did you take any steps to reduce the muscle loss? 4) with 35% loss, what BMI are you at?
    - jaggederest 9mo ago
      Not the original guy, but down 32%, for a point of comparison: 1) Amazing, like being a decade and a half younger 2) Not before, planning one in the next couple months, but I use skinfold and impedance and they say I've dropped from about 48% to ~20% as I've dropped from 272 to 186, lean mass seems maybe 5kg lower than I started with? Less lean mass loss than I expected. 3) Weight bearing exercise and medium-high protein intake (>80g/d) 4) Per above, starting BMI 37.9 -> ending BMI 25.9
      - vladgur 9mo ago
        these are amazing numbers -- how long did this loss take?
        jaggederest 9mo ago
        Just over 2 years from end to end, the majority towards the end when I finally got onto the right GLP-1 medication.
        rootusrootus 9mo ago
        To add my own anecdata, it took me a bit over a year (September 2024 to December 2025) to lose the weight. I averaged about 1.5 pounds a week consistently.
      - rootusrootus 9mo ago
        Your stats are very similar. I started at something like 274 (though my overall highest point ever was 284 a couple years ago) and now I'm down to 181. It's a huge difference, as you say it's like being 15-20 years younger. Life changing.
phil21 9mo ago
> as it only causes a reduction in 10%-20% of body weight This was simply when the studies ended. Weight loss for most definitely tails off, but doesn't completely stop if you continue longer than the 18mo SURMOUNT-4[0] study went for with Tirzepatide. I also do not know if this was patients going on maintenance dosing, staying the same, or ramping up doses to the full 15mg max dose. Would need to re-read it as it's been some time. fwiw Tirzepatide is actually around 25% average loss vs. 20%. My anecdotal evidence from my peer group shows that the vast majority can go further than 25% (if needed) and then maintain it - but that does require significant lifestyle changes to maintain. The few who simply kept eating junk but less of it had far less drastic results. I do consider it a performance enhancing drug for dieting due to that fact. Those that use it as one tool of many seem to do incredibly well. Those that use it as the only tool have much worse outcomes. No surprises there, but it was surprising to me how durable so far those who decided to make life changes have stuck with it now over the course of around 3+ years. My random guess would be that if you use it to break habits and establish new ones, you tend to become a super responder. I like to tell people it was perhaps roughly 60% of my weight loss (36% or so, but I tapered off due to hitting my goal) was due to the drug, 40% due to other factors like eating better and creating new workout habits. The drug simply made it much easier than previous attempts at dieting, and the results turned into a feedback loop. Another pet theory of mine is that if you use it to break a food addiction, you end up being able to stay on the wagon easier. This is based on other life experiences with other substances - the longer you stay off, the easier it becomes (for most) to abstain. Especially if you create new habits in their place. I no longer crave those late night taco bell runs like I once did even when (mostly) off the drug itself. [0] https://pubmed.ncbi.nlm.nih.gov/38078870/ https://pubmed.ncbi.nlm.nih.gov/38078870/
- danielscrubs 9mo ago
  I know I will be downvoted into oblivion for this but here goes: Im sorry to be crass but if someone makes lifestyle changes after taking drugs its 100% the drugs. Kind of tired of people taking anabolic steroids and then claiming it's a smaller part of their success or people being born rich talking about hard work whilst being on the golf course. Just be happy that we live in a time where drugs have been painstakingly researched and move on without the ego boost. Be humble. https://nymag.com/news/features/money-brain-2012-7/ https://nymag.com/news/features/money-brain-2012-7/

firecall 9mo ago

Do we know what the reason is for the limits of around 10-20%?

hsuduebc2 9mo ago
As you lose weight, your body needs fewer calories to run. That “needed amount” keeps dropping with your size, until it eventually equals what you’re eating on the medication. At that point you’re no longer in a deficit, so weight loss slows or stops.
- doubleunplussed 9mo ago
  That is true but requires some extra assumptions to explain why people don't keep losing weight - because the strongest influence on most people's appetite in the short run is how much of a deficit or surplus they're currently in. Thus as TDEE drops, so does hunger. In "setpoint theory" there's an additional hunger drive based on whether you are below or above a given level of adiposity - your "setpoint". This is often given as an explanation for why people can't keep weight off, and is the sort of thing you'd need to posit to explain why people on GLP-1 inhibitors can't as easily get to lower levels of adiposity.
rootusrootus 9mo ago
I don't know that there's a consensus on what the limit really is. Semaglutide is good for about 15%, tirzepatide about 20%, and retatrutide about 25%. Some people don't get that much, some people get a lot more. Personally, tirzepatide got me just over 35%. I never got anywhere near max dose, either, I am what is colloquially referred to as a super responder.
- vladgur 9mo ago
  Sorry for personal questions please answer any OR none as you feel comfortable 1) How is your energy/stamina following the 35% loss 2) Have you done any dexascans/bodyspecs to measure your lean mass percentage before and after your loss 3) Did you take any steps to reduce the muscle loss? 4) with 35% loss, what BMI are you at?
  - jaggederest 9mo ago
    Not the original guy, but down 32%, for a point of comparison: 1) Amazing, like being a decade and a half younger 2) Not before, planning one in the next couple months, but I use skinfold and impedance and they say I've dropped from about 48% to ~20% as I've dropped from 272 to 186, lean mass seems maybe 5kg lower than I started with? Less lean mass loss than I expected. 3) Weight bearing exercise and medium-high protein intake (>80g/d) 4) Per above, starting BMI 37.9 -> ending BMI 25.9
    - vladgur 9mo ago
      these are amazing numbers -- how long did this loss take?
      - jaggederest 9mo ago
        Just over 2 years from end to end, the majority towards the end when I finally got onto the right GLP-1 medication.
      - rootusrootus 9mo ago
        To add my own anecdata, it took me a bit over a year (September 2024 to December 2025) to lose the weight. I averaged about 1.5 pounds a week consistently.
    - rootusrootus 9mo ago
      Your stats are very similar. I started at something like 274 (though my overall highest point ever was 284 a couple years ago) and now I'm down to 181. It's a huge difference, as you say it's like being 15-20 years younger. Life changing.

phil21 9mo ago

> as it only causes a reduction in 10%-20% of body weight This was simply when the studies ended. Weight loss for most definitely tails off, but doesn't completely stop if you continue longer than the 18mo SURMOUNT-4[0] study went for with Tirzepatide. I also do not know if this was patients going on maintenance dosing, staying the same, or ramping up doses to the full 15mg max dose. Would need to re-read it as it's been some time. fwiw Tirzepatide is actually around 25% average loss vs. 20%. My anecdotal evidence from my peer group shows that the vast majority can go further than 25% (if needed) and then maintain it - but that does require significant lifestyle changes to maintain. The few who simply kept eating junk but less of it had far less drastic results. I do consider it a performance enhancing drug for dieting due to that fact. Those that use it as one tool of many seem to do incredibly well. Those that use it as the only tool have much worse outcomes. No surprises there, but it was surprising to me how durable so far those who decided to make life changes have stuck with it now over the course of around 3+ years. My random guess would be that if you use it to break habits and establish new ones, you tend to become a super responder. I like to tell people it was perhaps roughly 60% of my weight loss (36% or so, but I tapered off due to hitting my goal) was due to the drug, 40% due to other factors like eating better and creating new workout habits. The drug simply made it much easier than previous attempts at dieting, and the results turned into a feedback loop. Another pet theory of mine is that if you use it to break a food addiction, you end up being able to stay on the wagon easier. This is based on other life experiences with other substances - the longer you stay off, the easier it becomes (for most) to abstain. Especially if you create new habits in their place. I no longer crave those late night taco bell runs like I once did even when (mostly) off the drug itself. [0] https://pubmed.ncbi.nlm.nih.gov/38078870/ https://pubmed.ncbi.nlm.nih.gov/38078870/

danielscrubs 9mo ago
I know I will be downvoted into oblivion for this but here goes: Im sorry to be crass but if someone makes lifestyle changes after taking drugs its 100% the drugs. Kind of tired of people taking anabolic steroids and then claiming it's a smaller part of their success or people being born rich talking about hard work whilst being on the golf course. Just be happy that we live in a time where drugs have been painstakingly researched and move on without the ego boost. Be humble. https://nymag.com/news/features/money-brain-2012-7/ https://nymag.com/news/features/money-brain-2012-7/