Like, I figured we were just never going to solve it, given the two possibilities were "radically re-engineer US culture such that moving to the US doesn't make previously-skinny people fatter" (with other countries heading the same direction as us needing to make similar moves, one supposes) or "find a miracle drug". Neither seemed likely. Turns out, decent odds we've managed the latter! Which was always the more likely of the two, but I still wouldn't have rated it as very likely.
Individually, there's (previously) been nothing better to suggest than "try harder (and, maybe, smarter)".
Statistically it was almost useless, but it's the best we had. It's not bad advice exactly, it's just extremely unlikely to work for long-term, sustained weight loss.
It also very much appears to be the case that weight gain and loss are heavily influenced by environmental factors. Skinnier countries aren't skinnier because the people there have more willpower, it seems, but because they live in a skinnier country and are surrounded by the culture, laws, physical layouts of the created world, et c., that come with that. It'd be kinda weird if we expected "just try harder" to work very well when that's evidently not the mechanism by which skinny countries are skinny. Alternatively, if it is willpower doing it, we're just adding a step, because then it appears that environment strongly influences willpower, instead, since the same observations hold.
Sure, sometimes it works for individuals. In fact, it often works temporarily, causing a yo-yo effect. It can work for long periods (many years without a slip) but that's rare.
If your solution to the obesity crisis is "people need to try harder" your solution is demonstrably not helpful. Can it work for one person? Yes. Over a population, will it? No, it won't, it's amazingly ineffective, even very expensive high-touch interventions involving multiple experts aimed at weight loss and lifestyle change and such are wildly less effective than "inject GLP-1 agonists" or "move somewhere skinnier".
So "try harder" isn't going to work when the doctors don't even know what they're talking about.
I'm losing faith in this forum. People would prefer to give people pharma bs because no processed carbs is too much of an ask. Pathetic.
[EDIT] It's not that your approach can't work, it's that if (for example) people had as hard a time following the directions for condoms as they do following diet & workout plans, we'd never allow condoms to be sold as contraceptives, they'd not even be close to being OK to promote as useful for that purpose. It wouldn't matter if a few people could follow the directions and it worked 100% of the time for them.
Anyway, it does work, people just aren't told to do it firmly. Doctors dance around it.
I have been using pullout method for 25 years, very consistently with basically 50 women at this point, and not one pregnancy scare (other than one girl trying to pass off her pregnancy as mine once). Same for many of my friends.
does nothing about stds though.
https://www.plannedparenthood.org/learn/birth-control/withdr...
For every 100 people who use pull out method perfectly, within a year, 4 will get pregnant. Since not everyone does a great job doing it, in reality 22 get pregnant every year.
Here's a great overview page: https://www.plannedparenthood.org/learn/birth-control in summary, condoms are 87% effective at preventing pregnancy, and withdrawal is 78% effective.
For a going-steady couple that isn't worried about STDs, keeps an emergency contraceptive ('morning after pill') ready for oopsie mistakes, and live in a country that grants women bodily autonomy (or have discussed and accepted that a mistake might lead to a child), pullout is a perfectly valid contraceptive mechanism. There are better, but considering that basically every method except a condom/internal condom can cause extreme discomfort or bad side effects to the woman in the relationship, I think it's totally fine to choose pull-out.
And they had 86% adherence for a year. If they'd studied this farther out and it went the same way as basically any study that's done that, adherence would be a lot worse in another couple years. And that's in a group that's exceptionally motivated vs. the general population—has an actual illness they're trying to treat, and has opted in to the study knowing what it's asking of them and for how long.
I am on a GLP-1 level calorie restricted diet right now without a GLP-1 and of course it is just miserable.
I love eating a giant sandwich at night that is more calories than what I am eating all day now but it isn't the taste it is the brain chemical release.
It is an addiction like any other addiction. I have never felt that same craving for chicken breast.
They're morons for the most part.
In their 8 minute session with you, they are worse than chatgpt basically.
If anything it’s somewhat of a lemon market that’s worse than average because it’s not a great career generally to leverage skill into wealth (relatively compared to other options), but it lets risk averse people on rails get a decent outcome.
To spell it out for you: there is value to having some notion of persistent identity even on pseudonymous forums. Anyone can use a throwaway and say anything - and valiantly admitting you're using a throwaway doesn't change this fact.
Use throwaway identity, pay the price.
I'm glad your dad is healthy and yes, carbs cause issues.
Maybe if the anti-carb society offered some payola, the story would be different.
At most a drug rep comes by and brings donuts or something to talk about their new drugs.
Source wife is a doctor.
It’s certainly not enough of an effect that doctors make decisions on what to prescribe based on their malpractice insurance premiums.
There are no healthy habit recommendations anymore in many practices due to anti shame culture etc.
This is different to other parts of the world with healthier citizens.
Doctors are humans though and if people repeatedly ask for a specific treatment some percentage of them will offer it. That’s how drug advertising impacts prescriptions. Nothing to do with liability.
https://www.mdlinx.com/article/a-physician-s-guide-to-accept...
Increased reporting requirements and a cap on the value of these gifts that is far too low for box seats.
My wife's a physician, and I've seen these things change dramatically. Sometimes some food for the whole office will get dropped off. Or donuts. No one's getting box seats to a pro sports game anymore.
Perks for prescriptions is illegal.
If your GF is really keeping score and rewarding doctors for performance, she’s breaking anti kickback laws. All that has to happen is for prosecutor to make the connection.
I know a guy who spent 3 years in prison for something very very close to what you just described. He was just a rep and he said he was just doing what his company told him to do, but they threw him under the bus and now he’s a felon.
If you don’t want a doctor who takes money to run clinical trials, use this database to avoid them. It’s not hard.
> In the 1970s, Jens Juul Holst and Joel Habener began research on the GLP-1 hormone [...] Research continued, and in 1993, Michael Nauck managed to infuse GLP-1 into people with type 2 diabetes, stimulating insulin while inhibiting glucagon and bringing blood glucose to normal levels. However, treating diabetes patients with GLP-1 hormones resulted in significant side effects, leading researchers financed by Novo Nordisk to start looking to develop a suitable compound for therapeutic use. In 1998, a team of researchers at Novo Nordisk led by the scientist Lotte Bjerre Knudsen developed liraglutide, a glucagon-like peptide-1 receptor agonist that could be used to treat diabetes.
GLP-1 is a hormone that naturally occurs in the human body. Novo Nordisk was responsible for turning it into a diabetes medication. They were responsible for turning it into a weight loss medication.
Where are you getting your facts from?
Other "newcomers" in the GLP-1 space are also showing more promise than what Novo has in the pipeline. Boehringer Ingelheim has Survodutide in the pipeline as well, along with plenty of others.
They're the least interesting game in town when it comes to the incretin mimetics at this point.
> If your solution to the obesity crisis is "people need to try harder" your solution is demonstrably not helpful. Can it work for one person? Yes. Over a population, will it? No
Are you an individual or a population though? Take off the telescopes (and data, and science), and look at the world through your own eyes.
No one needs (or can) to address the obesity crisis in the population. The only crises that can be solved are the ones individuals find in themselves.
Lots of people successfully make changes and lose weight, but exceedingly few manage to keep it low over time.
My assertion is that the success of long term weight changes is not independent from that variable.
There's no evidence to suggest that reading comprehension or scientific aptitude has any link whatsoever to ability to maintain the willpower to stick to a diet. It seems distinctly non-obvious to think it would matter.
And all the evidence is that diets works soo poorly that the effect would need to be astronomical for it to counter-act just how unlikely they are to effect lasting change.
People in the US eat absolute shit. Even the bread is full with sugar.
Good for capitalism if you can feed that to the people and then give them an injection to be healthy again I guess.
Do we have data on that?
I guess you could look at natural experiments, like people who lost and won H1B lotteries, and see if only the ones actually making it to the US get fat?
What’s weird about it? Is insulin some weird injection? What about epinephrine?
It seems like a lot of people need something other than "don't eat bread" though.
My dad has finally understood that grains are for people that need help maintain weight or gaining weight.
No fat person should ever be eating them.
It's strange to make the culprit of a modern epidemic foods that have been with us for millenia.
I said in my other posts.. if someone needs help maintaining or gaining weight, eat those things.
If you are overweight, you should be eating ZERO of them.
"Basically killing them" means whatever the current obesity and type 2 diabetes epidemic means.
I know it's hard to believe in the US as today it even gets harder in Germany to find it.
The problem is eating shitty cheap mass produced food.
Same goes for "vegetable oil". Check out how it is made and you will probably respect olive oil more or some good ol butter.
Also it is possible to drink water. You don't need soda from dawn till dusk .
> No fat person should ever be eating them.
This is absolutism and controlling. Carbs have their place in a balanced diet, but key emphasis on diet. Too much (like the US diet) isn't good, none at all isn't good either. Everything in moderation. I don't understand why dieting / weight loss conversations are always going into extremes and absolutes.
What matters is, are the negative side effects and long term consequences better for you than the alternatives. One of them is "remaining fat". The other is "doing what other people have proven works.. cut all carbs".
Is ozempic worse than being fat?
And he is extremely happy with his new sugar and bread free life of increased mobility, less pain, and much lower blood pressure. At 64, he's learning how to ride a dirtbike and doing pretty well at it.
You're clearly an advocate for your father making healthy choices. So why would you advocate against the use of a drug that makes that easier?
Unless we talk about eating disorders.
Telling your mind to do a thing is only ever easy in retrospect and when you find a "trick" that works for you. For some people that trick is getting clear feedback about glucose levels in your bloodstream. But any trick that works for one person might not work for the next. So it is good that there are many approaches.
People make such a moral crusade of this - the drug works, people will take it. Behavior modification works in theory and fails for most in practice. Even for those that can make it work usually don’t hold out indefinitely.
We likely agree that doing it without drugs is probably better, but it’s definitely harder and it’s not clear yet how much better it will even be.
I’ve successfully lost 70lbs (250->180) three times and gotten fit, but it’s a constant effort and psychic drain to maintain the lower weight. If the drug (which I haven’t taken yet) made it easy that’d be a relief. It’s much easier to just manage exercise.
I suspect people that don’t have as much difficulty just get a different amount of joy from eating. For me I felt I could relate to the way an alcoholic described trying to quit drinking, except it’s harder in a way because you have to eat.
If changing your habits was much easier then we wouldn't need these medications and the world wouldn't keep getting fatter. People have known how to not be fat for a long time, yet the obesity rate has been rising worldwide, even in countries that have traditionally been skinny.
It's not like fat people on the whole are ignorant of how to become not-fat and never attempt to do so.
And it’s exactly the same situation with financial education, debt, university degrees, or in general any long term endeavors that requires the sacrifice of the immediate pleasure.
Of course, we still have a non trivial percentage of people that suffer from eating disorders, and use food as a way to emotionally regulate themselves because that’s what they learned as children (child is unhappy, give him a candy…).
I don't understand what drives people to write such intentionally asinine comments. Do you get off on hurting others or something?
There were quite a few foods I let go of when I decided to drop weight. Can't say I miss them much, certainly not to the extent to say something like "wow, i can't enjoy food anymore" or "now i'm fighting cravings all the time!!". And I legitimately have no interest in reintegrating them into my diet.
Turns out, some kinds of food are just dumb to consume, and my enjoyment of them is legitimately secondary. To the extent that discovering how harmful they were, they became inherently less enjoyable, and it was well possible for the habits and the cravings to subside over time. You don't try to go hit a balance with crack addiction, why would you try to hit a balance consuming 5 bazillion calorie rubbish?
Cutting out certain classes of foods from one's diet is absolutely possible and there's nothing necessarily wrong with it.
Your story has been told over and over and over. We get it. Congratulations. You win. You don't need GLP1s to sustain your weight loss. You don't experience food noise. You made all the right choices. Your brain and genetics are superiors to the 30% of American adults who have been told to eat less and move more and still haven't managed to improve their health through weight loss.
Now that you've been properly congratulated for your superiority, are you interested at all in understanding the complex systems that prevent 100 million Americans from achieving the success you have? Like, any intellectual curiosity at all about a problem that causes untold suffering almost one third of Americans? About stress, anxiety, access to healthy foods, or the novel mechanisms by which a drug which was discovered through studying the venom of a Gila monster operates on the human gut and brain? Or are you only interested in re-telling the world how you don't have the problem that we're trying to solve?
While I do miss it sometimes, I'm perfectly fine with sparkling water. Sure I'll have soda once in a while, but it's now officially a "treat", and not all that sad about it.
If I ever struggle with weight gain in the future, I see no reason to skip a tool that makes that much easier.
It appears that your major issue is that you are simply angry people are taking a short cut. Which seems odd, why would it bother you how someone lost weight, why not just be happy for them?
I got on GLP1s in January. I went from 6'1 240lb to 209lbs with defined abs benching 405lbs at 46 years old. I've worked out my entire life but never been lean like this. I like eating bread (steak, eggs, toast, ketchup and hot sauce is perhaps the single greatest breakfast in the history of the world. The toast is very important!) and potatoes are freaking incredible (mashed with Worcestershire sauce... bruv).
The bulk of my calories are protein but I generally eat what I want if I desire it. I just desire less of it. I had a roast beef sub from Jersey Mike's today with my kid, it was delicious. Their honey mustard is the bee's knees. I had a medium sub though and not a large.
The only change is now I essentially don't eat after 6pm. I just set that goal and the GLP-1 helped me keep it. The only side effects I have had is lower cholesterol and lower BP and that is while running 700mg of test. I'm going to hop on metformin next month after this cycle and target eliminating the fatty liver markers I have had for the last 20 years.
They work friend, they are good for you and they make people live happier healthier lives.
Embrace better living through chemistry.
Moving to higher elevations in the US causes people to become less fat, so you can do this by moving to Colorado.
https://journals.plos.org/plosone/article?id=10.1371/journal...
um, go out and exercise? compared to your ancestors from a century ago, you live a relative life of luxury. THIS IS WHY YOU ARE FAT. Too much food in, not enough burning calories. So simple. Im sure there are people who are clinically fat, broken metabolism, but there are tens of millions of obese in the USA alone, are they all metabollically disabled? I doubt it
But “just personally do better” doesn’t work very well when applied as a medical intervention (they have tried, and checked, over and over, a hundred different ways), even with lots of follow-up and monitoring, and it also doesn’t appear to be how other countries manage to be skinnier than the US. Between those two things, it really doesn’t look like a viable way to solve the obesity crisis—it doesn’t work when we try it, and it doesn’t seem to be what’s working anywhere else.
Strip out all the signals that let the body know it has enough, and it is easier to overeat.
If I were doom scrolling when Adderall kicked in, the risk is I'd continue doing it for hours.
If some rando internet dude thinks I’m weak or stupid, fine with me. It’s a drug that has improved my life in ways that are difficult to describe.
Something that eliminates all your drives except your sex drive, a miracle drug surely.
Weird that this is not talked about more, but I don't see a lot of ads in general so maybe it is.
Our biology is parsimonious. I'd bet that when our brains first started processing higher-level stresses, it salvaged the hunger pathway instead of engineering something biochemically new.
In a lot of ways these other behaviors are similar, it wouldn’t shock me if it’s a shared underlying mechanism originally to encourage eating a calorie surplus.
No.
> Perhaps it stops the addiction without stopping the general desire to drink with friends.
The anecdotes I've heard come from people who aren't addicted, either.
I no longer get that dopamine rush of the first drink.
Some people go as far as describing it as anhedonia. I kinda get it.
Though many people mention feeling sick as a common side effects, I can very well imagine that they would lose any pleasure from food and drink.
This is going to accelerate when every one and their mother (with industrial capacity) starts making generic Ozempic/Wegovy (Semaglutide) next year due to Canada's patent protection lapse[0].
https://glp1.guide/content/novo-nordisk-patent-protections-l...
I wonder if this is for wealthy people
(...who might be the target market - being overweight might be a disease of affluence)
In 2026, patent protections that lapse are going to cause a tidal wave:
https://glp1.guide/content/novo-nordisk-patent-protections-l...
For context, the previous calculus was:
https://glp1.guide/content/patent-expirations-for-glp1-recep...
(~2033 for the US)
Theoretically, the tidal wave of generic Semaglutide wouldn't hit the US or EU due to patent protections there... But see the aforementioned note about capitalism.
Note that there is already generic Liraglutide as well:
https://glp1.guide/content/another-generic-liraglutide-launc...
Tirzepatide (Mounjaro/Zepbound) > Semaglutide (Ozempic/Wegovy/Rybelsus) > Liraglutide
But having any of these available is a step change.
> (...who might be the target market - being overweight might be a disease of affluence)
This might be true on the margin but is mostly untrue these days. The lack of access to healthy unprocessed food and the free time to exercise are becoming increasingly problems for those who are NOT wealthy.
https://glp1.guide/content/research-on-glp1-signaling-in-the...
https://glp1.guide/content/research-suggesting-glp1-is-a-bra...
https://glp1.guide/content/are-glp1s-primarily-brain-drugs/
This is the killer feature of Semaglutide and GLP1 Receptor Agonists widely. They were originally commonly thought about as digestion-slowing, and while that is part of it, the real change is that it's a brain drug.
Oh also, on whether people gain back the weight:
https://glp1.guide/content/do-people-regain-all-the-weight-l...
tl;dr - most people (i.e. over 50%) do not.
Are there severe side effects that aren't extremely rare? can you provide data on this?
We know for a fact the inverse happens: girl starves herself for years to slim down to become a ballerina, eventually decides it's not worth it and tries to stop being so dangerously thin and... can't. She never feels hungry. Every time she eats she can only stomach a few bites before pushing it away. Just eat ice cream? Instant puke. She cannot gain weight no matter what.
Obviously she broke her metabolic system and she obviously did it through diet.
Yes it's possible for some skinny people to gain weight. But that doesn't mean every skinny person simply can decide to be fat just by eating. It's like climbing Mount Everest for some skinny people to put weight on, even if they really desperately want to.
I don't think the situation with obese people is all that different.
For the pure fat experience I suggest corticosteroids, lithium or a random antipsychotic. Insulin is also very useful here, but a tad dangerous.
If it has to be muscle mass, then anabolic steroids of course are preferable. But beta adrenergic agonists like clenbuterol also seem to have some effect.
And there are many more.
What's the job that the weight gain intervention needs to do for you, that any type of food does not? Are you for example disgusted to swallow anything?
No, but a pill can make you want to eat more or fidget less etc.
The study tested a black pepper-based beverage (BPB) containing 20 mg gallic acid equivalent of polyphenols.
Key findings:
- Lowered hunger by 17%
- Reduced desire to eat by 15%
- Decreased prospective food consumption by 17%
- Increased satiety by 14%
- Increased fullness by 16%
What didn't change:
- Blood glucose and insulin responses
- Gastrointestinal discomfort
- Gut hormones (PYY and GLP-1)
Approach:
- The beverage was consumed 10 minutes before a meal
- It contained water-extracted black pepper compounds (not piperine, which isn't water-soluble)
- The extraction used hot water at 90°C for 3 minutes
If you want to try this:
1. Make a black pepper extract: Steep 20g of black pepper in 100ml of hot water (90°C) for 3 minutes, then strain and dilute with 900ml of water
2. Timing: Consume about 10-15 minutes before meals
3. Monitor your response: Track your appetite sensations to see if it works for you
Critical notes:
- The appetite-suppressing effects appear to be from water-soluble polyphenols (like apigenin and luteolin compounds), not piperine
- The study was short-term, so long-term effects are unknown
- Individual responses may vary
- This won't affect your blood sugar or metabolism directlyPlease don’t do this.
mary jane, marijuana, wacky-tobacky, pot, weed...
And while the person is clearly sick, every loved one tries to help by hoping to find food they can eat. Yet it just doesn't work. I've personally seen feeding tubes put in, to help in this regard.
There's some mechanism involved, and I've often wondered if the body knows food will also feed the tumor and is attempting to starve it. Regardless, the 'switch' is there.
I literally cannot imagine how this is possible. Don't you feel full? Doesn't your body start refusing to swallow? Doesn't the food turn tasteless and start making you nauseous? 100-200kcal over your BMR, sure, but beyond that?
Throughout history, occasional lavish feasts have been very common in nearly every culture.
It sounds 'obvious', but I don't think it's obvious that she did it through diet.
No, she picked up a mental behavioral disorder that has nothing to do with her metabolism.
If he overeats he said he feels kinda bad (with heartburn the next day).
And then I saw some of the stories on HN about how it's changed peoples lives for the better. And then people in my life started taking it and singing its praises. I'm very bullish on GLP-1s now and I've very excited to see all the lives it improves. I'm not saying this thing is 100% miracle with no downsides, but this seems to be a generally large net positive.
It's a bit hard for me to comprehend how big of an impact this can have for someone since I've been very fortunate to never struggle with my weight, but I'm (slightly embarrassingly) tearing up writing this because of how many people I've seen have huge positive effects on their physical and mental health (due to body image).