5 ms·

No, the symptom is being treated, not the underlying issue. And that's ok, but treating the underlying issue, when possible, is better, as the problem ceases to

• crooked-v 3mo ago
  For many people, the "underlying issue" is fundamentally just being too hungry for how they live. GLP-1s absolutely treat that.
  • faangguyindia 3mo ago
    for many people the underlying issue is serious lack of education when it comes to nutrition. Not understanding calorie balance, not understanding calorie density of the food they eat. How many people know 1kg fat = 7700kcal that if they could create deficit of 7700kcal they could potentially lose 1kg bodyfat? Ofc, i know the relationship isn't that simple but for most people this roughly holds true. If you are eating granolas in breakfast, it may come across as a shock how many calories they pack, go ahead look it up many people believe that's a low calorie health breakfast option. Many people don't know 1g of carb or protein = 4kcal 1g of fats = 9kcal.
    • crooked-v 3mo ago
      Being aware that there are deceptively calorie-dense foods doesn't help the basic equation there. Anecdotes are not data, but my anecdotal experience is that if I ate nothing but bulk vegetables whenever my hindbrain wanted food, I would still be eating over my maintenance calories every day.
      • faangguyindia 3mo ago
        What's your maintenance calories and how did you calculate it? Most people calculate it wrong.
        • crooked-v 3mo ago
          It's about 1800 KCal, give or take, on a day of sedentary office work. I'm deeply familiar with it after years of calorie tracking. My grocery shopping and meals, most cooked from scratch on a daily basis, are designed around it to keep at a stable weight. If what you actually mean to say is "you're wrong, there's no way you could eat like that", the response is "give me nothing but heads of lettuce with salt and pepper, and there are days when I could still continue eating them the entire day whenever my stomach isn't literally full".
          • faangguyindia 3mo ago
            1800kcal is low, average woman has 2000kcal maintenance while male 2500kcal. People with that low of maintenance calories are usually sedentary and undermuscled.
    • dgabriel 3mo ago
      I understand calorie balance. I've been on a diet since I was 12 years old, and am now approaching 50. I've lost and regained the same 60lbs about 4 times now. I have logged every bite that goes into my mouth, and lived with a constant hunger for as long as I could take it. Then I ate until I felt satisfied and gained it all back. I know how many calories are in anything, and I can eyeball any serving size. I've been doing it for decades. When I take GLP-1s, I can just stop. My appetite and body maintains itself at a healthy weight, and I don't cry myself to sleep from either hunger or shame. I think I'm not the ignorant one.
      • faangguyindia 3mo ago
        I have no personal animosity toward you, but I've heard all this many times, so I'll respond accordingly. >I've been on a diet since I was 12 years old, and am now approaching 50. I've lost and regained the same 60lbs about 4 times now You can lose weight by crash dieting, which does not prove much. The first thing that comes to mind for people is simply: "I'll just eat very little and lose weight." It even works, but people quickly get results; it makes them miserable, and they gain it back. People get stuck between "eating too little" and "binge eating". >I have logged every bite that goes into my mouth, and lived with a constant hunger for as long as I could take it This proves you are sincere in calorie tracking, but it doesn't tell us much about what kind of deficit you were in. What were your maintenance calories, and how did you calculate them? What kind of deficit did you run over what time period? In my experience, while people know all these things, execution still requires knowing all the "gotchas". Going from 2700kcal calories to 1000kcal a day diet will make anyone hungry and miserable.
        • phil21 3mo ago
          > In my experience, while people know all these things, execution still requires knowing all the "gotchas". In my experience, people that think they know all the "gotchas" don't really know as much as they think they do. Knowing fat is calorie dense is great. Without context one would attempt to try to cut it out of your diet almost entirely. Sort of like what literally happened with the food industry in the 80's/90's and 00's. But then they would wonder why they are so hungry and likely consuming more sugars. Which is even worse for most folks due to glycemic index and how that interacts with hunger. A little bit of knowledge can be actively harmful. Common sense on this topic actually does far better than most who think they know better. Almost everyone knows what "healthy food" looks like without needing to know anything about much else. Education is not the issue.
    • toast0 3mo ago
      Plenty of people can take this intelectual knowledge and turn it into eating behaviors that work for them. But this intelectual knowledge doesn't really help if your body is telling you it's hungry all the time and it's hard not to eat something. Better choices can help, because different calories deliver different satiety; but some people don't get much satiety no matter what they eat. Calories in vs calories out is true, but it's very hard to measure calories out, so it's sometimes helpful and sometimes completely unhelpful. These drugs seem to help a lot of people in different ways, but if the underlying issue is that they don't get the satiety signals they need to eat healthy amounts without it, of course it's not surprising that when they stop medicating, they stop getting the satiety signals. There's a lot of variance among humans, but everybody seems to want a one size fits all approach to eating. That doesn't work; you have to find all the things that work for some people, and then try the most promising options until you find something that works for you. Many people crave novelty, and anyway people change over time, so something that works for someone today might not work for them next year, etc.
      • faangguyindia 3mo ago
        >But this intelectual knowledge doesn't really help if your body is telling you it's hungry all the time and it's hard not to eat something. Better choices can help, because different calories deliver different satiety; but some people don't get much satiety no matter what they eat. Maybe try to figure out why you’re feeling hungry. Is it because you’re running a 1000 kcal deficit? Can your body really tell whether you ate 200–300 kcal less today than you did yesterday? Most of us can easily notice a 1000 kcal difference, but very few can reliably detect a day-to-day difference of just 200–300 kcal. What are your maintenance calories? Are they around 1800 kcal, where even a 300 kcal deficit puts you on a 1500 kcal diet? That’s very little food for many people. In that case, it may be better to focus on increasing your maintenance calories by becoming more active in daily life. Deficit = TDEE - Intake either drop intake or boost tdee or do both. If you managed to boost your tdee to 2500kcal, now a deficit of 300kcal means you eat 2200kcal day to day and 2200kcal isn't very little food making diet easy to follow. >There's a lot of variance among humans, but everybody seems to want a one size fits all approach to eating. I think there isn't as much variance as people like to believe, how many people you see walking around you with 3 eyes? and 4 hands?
    • kube-system 3mo ago
      Bariatrics would be a much more simple discipline if it were a problem that could simply be solved with education. Education is the first step in any treatment, but it often fails to produce results alone.
    • teliosix 3mo ago
      This idea that it is education is just so incredibly stupid. Everyone knows what they need do to loose weight. The problem is we have an environment that in every way promotes over eating and eating hyperpalatable food is pleasurable in the moment.
  • Affric 3mo ago
    Right so it would seem increased physical exertion would be the answer. Yeah, humans should have more free time and do enough work or exercise each day to keep their body in shape.
    • spudlyo 3mo ago
      One might think that weight loss is simply an energy balance issue. Sadly, it's far more complicated than that. You can burn 500-800 calories in an hour of cardio, and you can consume 500-800 calories of food in a few minutes.
      • faangguyindia 3mo ago
        If you are eating 2700kcal a day which is what an average male probably eats in West Why would you eat 2700+800 = 3500kcal? when you can do with 2700kcal?
        • tsimionescu 3mo ago
          Because you're feeling peckish. Because you hadn't had a good burger in a while. Because you saw a good looking pizza on TV and you can't order less than a full pizza. Because your mother made this good lasagna and would feel offended if you didn't eat a portion because you'd already eaten earlier. Because you're sadand tired and just don't want to also feel hungry, and eating a pack of oreos dipped in nutella is more pleasant than cooking a steak. Because you're feeling self-destructive and it feels good to ruin your diet and get that feeling of satiety that you've been denying for a while. There are a million reasons like this. You need quite consistent motivation in order to not overeat; overeating is the default for most overweight and obese people.
          • faangguyindia 3mo ago
            Never had this issue tbh, I maintain 12% bodyfat year around and cannot relate to people who just eat when there is no need to eat.
  • Barrin92 3mo ago
    > the "underlying issue" is fundamentally just being too hungry for how they live operative phrase in that sentence "how they live". They need to live more active lives. And that's better than a weight loss drug because inactivity causes systemic disease beyond weight gain. GLP-1 drugs do to hunger what pain meds do to pain, but if you're overweight and your back is aching because you're sedentary the solution isn't a cocktail of drugs, it's to get off your ass, because that lifestyle is going to cause you biomechanical, metabolic and even cognitive issues down the road. There's disease you can't do anything about and need to treat with medicine, but if you're experiencing symptoms because your lifestyle is abusing your body change your life. There'll come a moment where there's no wonder pill to fix your issues and in that moment you're better of if you know how to actually get control of yourself. Which most import of all is going to give you the confidence that you can change. You don't want to be 50 years old and your only cope in life is praying that a pharma company mutes whatever symptoms plague you.
    • netheril96 3mo ago
      > They need to live more active lives. When I become more active, I also become more hungry due to the extra energy consumption. The net effect is little weight loss and more often than not weight gain. While being physically active is beneficial to health in many ways, it does little for losing or maintaining weight, at least for me.
      • faangguyindia 3mo ago
        deficit = tdee - intake Active life = higher TDEE which means you can eat more food while still maintaining same deficit.
        • kube-system 3mo ago
          Exercise also stimulates digestion and triggers a hunger response in many people. This is why exercise without diet often fails to result in weight loss.
          • 3mo ago
  • herbst 3mo ago
    Sounds like they eat the wrong things. So learning to eat properly and stopping with GLP after a while sounds more reasonable to me. Also that's how my mum got it in the swiss test run. It was never supposed to be long term, just to help change eating habits.
    • amanaplanacanal 3mo ago
      If telling people to eat better fixed obesity, we wouldn't have an obesity epidemic.
      • herbst 3mo ago
        I mean the idea is that GPT helps to reduce appetite while you learn to eat properly. Not to take GPT the rest of your life.
        • crooked-v 3mo ago
          Why not? If it doesn't have immediate side effects for a given person it's unlikely to have them later, and it will be dirt cheap as soon as the patents run out.
          • herbst 3mo ago
            > If it doesn't have immediate side effects for a given person it's unlikely to have them later Why would this sentence make any sense?
    • sfifs 3mo ago
      Is this advice coming from personal experience of significant diabetes and weight reversal or just online reading informed opinion? Physiology & psychology are quite complex and individualized and "just do this.." doesn't quite work at any sustainable level when people have jobs, families, mortgage, sick children & sick parents to also manage at the same time.
      • 3mo ago
• ajross 3mo ago
  > No, the symptom is being treated, not the underlying issue. That's a semantic argument. The "issue", medically, to most people viewing this as a health problem, is excess body fat and not eating behavior. I mean, you're not wrong, but this seems silly. YES, it would be better to have developed a cure for disordered and unrestrained eating. We didn't. And we don't really even know how. Oops, as it were. But we do have a treatment that avoids the most significant impacts of those problems. Medicine is harder than software engineering. Not all bugs are shallow even with all the eyes in the world.
  • fwip 3mo ago
    Additionally - GLP1 drugs work by changing those eating patterns.
    • hack1312 3mo ago
      But those changes don’t stick if the drug is discontinued.
      • nemomarx 3mo ago
        Diets also don't stick when you discontinue them. It would be an incredible advancement if we figured out a reliable and replicatable way to just eat less food, but until then I think a drug that makes you do that is pretty decent.
        • hack1312 3mo ago
          > Diets also don’t stick when you discontinue them. Yes, obviously. Which is why sustainable weight loss takes a commitment to making a change in lifestyle. What’s more sustainable, changing your lifestyle to maintain the weight you lost, or being beholden to taking a drug to maintain that same lifestyle change for a hope at maintenance?
          • macintux 3mo ago
• SoftTalker 3mo ago
  But that's not what the pharma companies want. They want you on the lifetime prescriptions that don't actually address the underlying problem.
  • thesmtsolver2 3mo ago
    Are they hiding true solutions treating the underlying issues?
    • joquarky 3mo ago
      Consider history, the incentives, and the current political climate.
    • SoftTalker 3mo ago
      I don't think they are hiding true solutions but they are not pursuing them. Their R&D is directed at treating common chronic conditions with drugs that you have to take forever. That's what makes them money. Treatments for rare conditions or true solutions do not. It's just economic incentives. That's also why when they do develop something for a rare condition, it costs you a bankrupting amount of money if you need it.
    • lenkite 3mo ago
      A researcher who discovered a "true solution" would be fired or assassinated or discredited via propaganda to utter irrelevance. Too many incoming billions at risk.
  • estearum 3mo ago
    Pharma companies don't control the availability of calories And anyway, demonstrably not true given that pharma companies are working on a number of drugs that are one-and-done treatments for things like Lp(a). We should figure out a way to make them fabulously wealthy for achieving breakthroughs like that even without a lifetime prescription.
• frgturpwd 3mo ago
  And what's the underlying issue, exactly?
  • photon_lines 3mo ago
    Eating ultra processed foods with added sugar / loads of calories. A huge reason why they're so destructive is because they lack fibre (which keep our microbiomes healthy) and lack compounds which are good for us. Try keeping weight on while eating minimally-processed food that is more vegan in nature: the amount you'll have to consume to keep the weight on is significant. When you start this diet, you won't like it that much and you will feel hungry since your microbiome is used to your old diet -- but try doing it for a month, and you'll see a huge shift in the way you feel and the foods which you crave (the above will start transforming your microbiome quite significantly). Do it for 3 - 6 months you'll wonder how in the world you ever lived without it.
    • anon84873628 3mo ago
      Them: The problem is making good food choice. The drug helps with that. You: The drug is a bandaid; just make good food choices. Antidepressants are the best analogy here. If the core problem is in your brain (or brain-body integration), then, for now, exogenous compounds are the only way to address the core issue.