> strange how there is almost never a shortcut to anything. Like a universal law

There are win-win tradeoffs. Vitamins, for instance. If you're running a vitamin deficiency, there isn't a downside to increasing your intake of that vitamin. (Curing acute dehydration via IV is another shortcut that just works.)

The Ozempic story, for me, has been more about how we almost seem to be reflexively against the idea of a win-win. A lot of people want there to be a tragic downside to the drug for reasons that aren't entirely clear to me.

My perception is that we judge fat people as weak and contemptible and therefore a drug is allowing them to cheat their way out of their sin instead of paying the proper penance (diet and exercise).

It's well known that people treat fat people worse; I constantly wonder how aware people are of their own biases?

For what it's worth I've been fat before and I've been in shape before. I have my own biases that are beyond the scope of this comment. Never taken one of these drugs but only because of cost/access; I'm actually curious to experience them. If they work for people, I say they should take them.

It's not that it's a sin to be fat, it's that there are side effects to taking the short cut, as outlined in the article, which was the point I was trying to make originally.

Ozempic doesn't make you lose weight unless you do a diet. All it does is to make it easy to do a diet by suppressing the craving for food. So it's not like people are losing weight with ozempic while stuffing themselves with burgers.

As for exercise, it has many benefits but is a fairly minor contributor to weight loss. I am doing a bit of a hardcore diet at the moment (helped a ozempic competitor), lost 20kg/44lbs in 3 months, and I noticed no difference in change in weight whether I do 1h of exercise bike daily (max resistance) or whether I do a week without.

Believe me, I'm aware of calories in/calories out, but I've never really found it so simple. Exercise has benefits beyond purely burning calories. And moreover, if you want to change body composition rather than just lose weight, it's important (fitness types have the term "skinny fat" for people who don't weigh much but still have high body fat).

Fat soluable vitamin toxicity? https://www.ncbi.nlm.nih.gov/books/NBK234920/

Because apparently a surprising number of people can't calculate bodyweight doses.

But gluttony is a sin!

I thought everybody was saying Gluten was bad...

I think it's pretty simple, unfortunately. A lot of folks have this visceral, instinctive horror of fat people, and instead of examining that, they convince themselves that what they actually despise is laziness and gluttony: inner vices expressed outwardly, like a medieval morality play.

But if there's a way to lose weight without major lifestyle change, it threatens that tidy moral barometer. Someone might look virtuous without actually being so. Cognitive dissonance ensues. So they hope and wish for anything to catch out and punish these "cheaters."

> A lot of folks have this visceral, instinctive horror of fat people

Because humans spent some hundred thousand years on earth with no fat human in sight, and only around 3-400 with the ultra obese. It's unnatural.

Case in point.

Cars, computers, and cellphones are unnatural. If you can get over those, you can get over recoiling in atavistic horror from people who don't meet your beauty standards.

> Cars, computers, and cellphones are unnatural

They are not a part of, or the whole human body

> The Ozempic story, for me, has been more about how we almost seem to be reflexively against the idea of a win-win. A lot of people want there to be a tragic downside to the drug for reasons that aren't entirely clear to me.

It's easy, substitute the obese with the smokers demographic. Imagine them whining that they smoke because it's an environmental issue, that they just can't do otherwise, that it's a metabolic issue and not a willpower one, a genetic thing, lack of access to alternatives... anything besides their own will.

I wonder how taking a medicine for the rest of your life is a win-win when there are places in the world where obesity is almost non existent and it's been proven to be largely lifestyle related. Besides, semaglutide just makes the subjects crave less, reinforcing the willpower role in weight loss.

I have read people in this forum state that if they eat less, they gain more weight for some unknown genetical issue, like thermodynamics do not apply to them.

Ever heard of Fen/phen? Was a big thing back in the 90's. Weight loss drug combo that was ultimately found to do major harm.

You have to keep a clear head as an early adopter in some things, and be aware of incentives. Remember, the pharma company pushing the drug/treatment to market is out to make money first. Having a knock-on problem down the line to fix also serves that purpose, and in fact, has been a tactic employed by other notorious pharma manufacturers. Lest we forget the lessons of the opioid crisis do quickly.

I have heard that people who lose weight quickly will typically look older due to the development of wrinkles and the development of harder features. Skin simply doesn't have time to keep up with the weight loss. I don't know if this is true but the theory could have some merit as far as our perception of people. The real question is: does something like ozempic change the biological age of someone?

You're going to need to include a weight percentage drop or something. I've wrestled/jiujitsued my entire life and we go up and down weight constantly, 2-30lb swings. We'll water + electrolyte fast for a week or two if we have to and drop 10-20lbs.

We all look 10-15 years younger than we are (35-45s).

But we're also not dropping 150-200lbs or whatever number you're potentially referring to to where skin would stretch. But prolonged, constant rapid dropping hasn't bothered our skin. I'm complimented all the time on mine.

https://old.reddit.com/r/wrestling/comments/2r9nwy/whats_the...

Yeah totally, there would be umpteen different factors that would influence the "age perception" so to say. I also wonder how losing different types of weight(water fast vs longer timeframe fat/muscle loss) could impact this.

What kind of effort are you talking about? Weight loss has very little to do with exercise and mostly to do with how much you eat. Those drugs allow you to combat the carving when you restrict food. Is fighting the carving the "effort" you think people ought to make?

This, and there's seems to be a number of people with a misconception that getting medical assistance is either cheating, or you're not trying hard enough.

As someone who is quite strong and fit, but has a family history of obesity, and who has been packing on the kilos into their 40s - I've recently started with ozempic and it's a breakthrough drug. The incessant never ending demand to eat, that voice which never goes away and pervades every part of the day and task, the call which is almost impossible to ignore ore even after months of dieting and managing macros - it got moderated down from a 10/10 volume to about a 2/10 volume. I've started dropping the gut fat, and 6 weeks in my energy is coming back up to levels it was at 10 years ago.

I'm hoping that this isnt a permanent solution, but that it permits me to reset my bodies relationship with food, insulin, fat accumulation and hunger signals in the long term as the signalling cells senesce, the fat is reduced and demands less maintenance, etc.

Yeah, that's the force that makes you go out of the cave to chase a mammoth. Strong force to fight back.

It isn't a permanent solution, it's purely designed to drop weight. You have to do the mental and physical work to be able to maintain which is a different mindset.

> Weight loss has very little to do with exercise and mostly to do with how much you eat.

That's not an accurate statement. Over the past year I have averaged 2 hours of aerobics per day (~1500 active CAL). And I've simply buffeted my way eating multiple portions per day and haven't gained any weight.

It have a lot to do with a lot of exercises - it has little to do if you just had little exercise. It's all about the caloric balance, and it takes a lot of exercise to skew that balance while it's a lot easier to eat more.

IMO GLP-1 agonists are obviously not free, from first principles. They might be for diabetics who carefully manage their diet, but many (most?) people using them for weight loss usually already have shitty diets with poor macronutrient balance and micronutrient deficiencies. Eating less of the crappy food they were eating before just makes the true situation worse.

This is just the latest [1][2] evidence for the obvious muscle wasting that will happen to a human body that is starved of protein and micronutrients. The muscles under the skin are being cannibalized for protein that’s missing in the diet and other biochemical processes that restore them are starved of the nutrients they need to function.

[1] https://news.ycombinator.com/item?id=37558780

[2] https://news.ycombinator.com/item?id=39326333

Why do you think they just eat less of the same crappy food?

In my experience, it turned down the reward feedback for calorie dense food, and I would usually now prefer something like a lentil daal over a Dominos.

Because GLP-1 agonists don't change anything other than the cravings and/or reward feedback. They don't add healthy menu items to existing restaurants, they don't put new grocery stores in food deserts, teach people how to shop for healthy food or how to cook it so it's palatable, or in any way mitigate any of the socioeconomic factors that drive people to eating unhealthy food.

In my experience, the average American is looking at restaurants like McDonalds, Dominoes/PizzaHut, a local burger joint, and a "fancy" place like Olive Garden. They wouldn't be able to get something healthy like lentil daal if they wanted to, with the closest equivalent being a McDonald's salad.

I don’t know, I think that might be a bias of some kind. The free shortcuts are obvious and so the alternative sounds ridiculous. No one claims to be a genius when they save time by driving instead of walking. But at the margin, of course everything has a trade off.

What about people who are naturally thin?

I see older very skinny women who look old and frail due to being very skinny. You need some fat under that skin to plump it up to look youthful. Catherine Deneuve I believe was the one that said that after the age of 40 you have to chose between your face and your ass. I say all of this as a 40 something woman.

Not fat, you need muscle mass, that's why some older people hunch over.

Harder to gain weight. Getting called skinny, etc.

Coffee being the only exception.

coffee definitely ruins my sleep no matter what time I drink it, so there's that.

My father also had headache his whole working life on Sundays, not realizing that drinking coffee all week days but not on the weekend, that was probably coffee withdrawal that was giving him a headache by day 2.

Even coffee is without its downsides and risks. There are cardiovascular risks, acid reflux, sleep issues, and probably more.

I though GERD was not caused by coffee [1]: "Drinking coffee or tea and adding milk or sugar was not associated with reflux symptoms or EE"

[1]: https://journals.lww.com/tcmj/_layouts/15/oaks.journals/down...

Certainly is a problem for me and I've seen others say the same. Every doctor I've been to has mentioned it as an issue.

"Caffeine — a major component of many varieties of coffee and tea — has been identified as a possible trigger for heartburn in some people. Caffeine may trigger GERD symptoms because it can relax the lower esophageal sphincter (LES)."

https://www.healthline.com/health/gerd/coffee-tea

I get really bad GERD from coffee and black tea, a bit less from green tea.

I don't get GERD from Mate tea or energy drinks. So I think it's not the caffeine. Since they both contain high amounts of caffeine, even higher than black tea.

I've noticed that if I eat more fiber I can somewhat mitigate this. But it needs to be consistent. Not just a little extra fiber before coffee.

BTW a high-fiber diet can be a natural ozempic by raising GLP-1 levels.

seems pretty unsurprising to me that when you shift the equilibrium of some extremely complicated system that evolved over an extremely long time to improve some metric, that the side effects are mostly moving down some other metric you liked.

or even more boringly: almost only bad things get called side effects rather than being redefined into the benefits

This is basically the ‘no free lunch’ principle, and the thing to keep in mind is that there’s no universal free lunch, but that doesn’t mean no individual lunch is ever free. (The classic example is insulin for diabetics, which most certainly is a win.)

It's worth noting that people, in this forum especially, would defend weight loss drugs at any cost. Because for them they mean being not-obese without any trace of effort. Controlling caloric input, maybe even leaving the house and moving... puff. Gone. Just take a pill daily for the rest of your life.