There is usually no free lunch when it comes to pharma, and extrapolating long term or lifetime dependence as being equivalent to short term interventions is an unsupported leap.
For many people food is one of the few things in life that gives them some form of joy. I won’t ever take any drug that will take that away from me. Life is depressing enough as is.
What we need is a weight loss drug that lets you eat unlimited amounts of food, preferably even suppressing the feeling of fullness, without gaining weight.
They don’t stop eating, just overeating. Getting joy from food is different from self medicating with overconsumption. (For the record, I love food. I also don’t have an issue maintaining a healthy weight and physique.)
I am on GLP-1 (Zepbound). I have done Weight Watchers multiple times. I'd lose the weight for a little bit, then it would come back. The reason was _I was hungry all the time_. It's not sustainable. As someone else in WW told me: "The easy bit is losing the weight. The hard part is continuing to eat that way your whole life."
It's simply a faulty hunger sensor in my body. It was not what I was eating, simply how much.
GLP-1s fix the sensor. It's really simple. Nothing else to it.
I still enjoy food (although my palette has turned away from anything greasy, which is for the better anyway), but I can finally understand why someone would eat half a plate of something and say "I'm good" and actually mean it rather than trying to diet/starve themselves.
I was able to drink an Italian soda this week and not feel like "oh God I'm drinking my calories I'm going to be punished for this on the scales later".
Sure, I don’t get the instant giant dopamine spikes from binge eating $30 worth of Taco Bell or a couple large pizzas. Once in a while I do miss that, but I can still do it now that I’m a few years into the weight staying off. It’s just not worth how shit I feel the next couple days afterward.
But healthy Whole Foods? What was once kind of meh for me is now something I look forward to and explore. Both going out to foodie type spots, and cooking at home. Both gourmet and basic. Just tasting the nuances and everything in some well prepared veggies or whatnot is great and not something I used to appreciate.
I also don’t constantly feel like crap with stomach issues either. I suppose there is less “addictive” type vice enjoyment in my life in some way, but the tradeoff has been life changing. I certainly still get plenty of joy from many of my meals when I feel the need!
Totally transformative.
I'm pretty sure when food goes right through me that I'm not getting any of those calories. Otoh, I have some idea of what types of foods (and how much) will trigger and the foreknowledge of that certainly reduces the joy of eating some foods I otherwise enjoy.
I still have trouble with calorie balance, but although I enjoy many kinds of ice cream, I have no problem going into an ice cream shop with friends and not ordering anything, even if I'm hungry. A 'single' scoop is way beyond my limit, and if I order a scoop, I won't order a scoop, take two bites and toss the rest, I'll eat the whole thing, so it's not worth it.
When I was doing bike commuting with real hills, I could eat anything, but now I work from home and can't convince myself to put that much time in the saddle just to eat whatever.
This is the problem to be addressed, not hoping for a miracle drug that will let you chuck down 5,000 calories a day and be healthy, imho.
Woe is them I guess for their chemical dependence.
Until starting tirzepitide I always thought about food, now I don't. Had depressive issues since I was a teenager as well. I took Wellbutrin for 20 years and had an interruption in the last six weeks due to an insurance issue. Payed for the tirzepetide out of pocket, take that once a week, my depression is manageable without the Wellbutrin for the first time in my life. I'm still going thru depression, but that's due to my husbands death in early March. If I wasn't taking my weekly shot I would easily be morbidly obese and probably suicidal. The cost isn't an issue either, I would spend more on food that I'm not buying or eating each month than it costs to buy the medication.
Just because something might not be interesting to someone doesn't mean it has no value. I have no interest in sports, but that doesn't mean they shouldn't exist. I could argue they shouldn't be as prominent in society but that's a different argument.
If you have struggled with your weight, depression, have early warning signs of cardiac problems and a range of other conditions it can be worth considering semaglutide or terzepitide. As long as you stick to the lowest dose that's effective the side effects are minimal to non existent. Categorically dismissing these drugs is as silly as refusing pain meds because "god designed us to experience pain".
There's metabolism, food density, food availability, psychology, culture, economics, etc in play, but it's important not to lie to ourselves that the proximal cause of obesity isn't from over consumption.
I dislike the rejection of evidence. These drugs solve a problem. Preaching personal responsibility does not. In that way it almost reminds me of drug prohibition and abstinence-only rhetoric.
Yes. Specifically, how basal metabolism is not a consciously-controlled rate that modifies itself against diet and exercise to the point that in some people with serious metabolic syndrome it may be impossible for them to lose weight through diet and exercise without suffering nutritional shortfalls.
Also, the clinical evidence around what works for people losing weight and getting healthier and what doesn’t. Like, I get we have a powerful fast-food and sugary-drinks lobby in America, but wow is it wild seeing people get uppity about third parties’ private healthcare decisions like this.
The average person does not understand how weight loss works; many people do not know the concept of maintenance calories, and don't know how calorie surplus or deficit works.
Simply putting them on drugs for life isn't a solution. The average person does not have metabolic syndrome, yet the average person is increasingly becoming obese or perhaps already is obese in many countries.
Plenty of people are on drugs for life for a variety of things that have less health impact than being overweight.
It literally is "a" solution.
The questions should be: is it the best solution that currently exists? And is it the best that can exist?
It may be that widespread availability of weight loss drugs that actually work ends the economic incentives to promote foods which themselves promote over-eating.
Or it may be that it triggers an arms race with food manufacturers seeking out things that override the weight loss drugs.
Or there may be negative side-effects we have yet to learn about, like there have been for so many other things that previously seemed amazing or miraculous.
That said, 2026 US GLP-1 healthcare sales projections run between 60 and 100 billion [1]. it will be interesting to see if these miricle drugs can really provide that much benefit/offset that much cost.
For comparison, Medicare part D is ~150 billion in its entirety. https://evolvancemarketresearch.com/reports/glp-1-weight-los...
The payment part is almost entirely pushing against GLP-1 agonists. Nobody has a long-term financial stake in patient costs to care that lifetime costs will likely be lower; insurers are just looking at the next couple years against expected churn. Another cost of tying health insurance to employment.
Why I ate too much is uninteresting to me. I also don’t have some moral hang up over it. Give me that easy button all day long so I can focus on shit in my life that actually matters.
If it makes someone feel better about themselves to believe in woo-woo science that violates the laws of physics and ascribe magical properties to GLPs, why do you care?
Why we should not care about putting people on drug who do can benefit from making lifestyle changes, being less sedentary and leaning about maintenance calories and how calorie surplus and deficit works?
if there is no resistance, simply prescribing GLPs to average person may become a new normal.
Why is it a problem if there's wider access to these drugs? So far, afaik, there's been no long term major adverse effects, and especially I've seen no reports of adverse effects that extend beyond use of the drug (as has been the case with previously popular weight loss drugs that could injure people's hearts).
We're 5 years since fda approval specifically for weight loss and 9 years since fda approval for type 2 diabetes. That's a pretty good amount of time to find serious problems, although certainly many withdrawn drugs were on the market for longer, ex wikipedia says Ranitidine was the biggest selling prescription drug in 1987, but was found to be problematic in 2019 (apparently a new formulation is available as of late 2025!)
Sure, there are other ways to work on weight, just like there are other ways to work on allergies and exercises some people say are effective for vision problems. But we don't force people to give up pets or move somewhere that has fewer triggering allergens, we let them take allergy pills; we let people use eyeglasses or contact lenses or have their eyeballs adjusted so they can see; etc. There's a tool that's effective for many people, why not use it?
Because it's useless advice that doesn't work in practice. As witnessed by decades of failure, with the only thing turning the tide on the obesity epidemic on a population scale being GLP-1 drugs.
> if there is no resistance, simply prescribing GLPs to average person may become a new normal.
Probably not ideal, but until Western society decides to change from the ground up it's better than the alternative which showed literally nothing but failure. One is something that works, the other is something that will take multiple generations to correct.
I think you are looking at research on obese people but applying it to average people who are simply overweight.
I spent every ounce of effort I could muster last year to lose weight and dropped 36 kg, however there was never a point where that got easy to maintain, where my body wasn't screaming at me to eat. Crying oneself to sleep from hunger after walking 20000 steps per day is not how I could live the rest of my life. I understand that that is not the case for you, but you must understand that hunger and food cravings are not the same for all people.
There are people literally starving to death because they can't force themselves to eat and of course many more people eating until it kills them. How can you not realize that you happen to be naturally in between these two extremes?
Basically, you walking 20,000 boosts your maintenance calories up, since
deficit = tdee (maintenance) - intake
Once you've lost the weight, there is no need to maintain "deficit" to stay at that weight when you do not understand something as simple as this. I’ve no doubt what you did was perhaps over-restrictive, which made you suffer.
which means no you do not need to walk 20K steps for life, nor you need to perma lower your calorie intake, you just need to eat at maintenance calories after getting to your target weight.
>There are people literally starving to death because they can't force themselves to eat and of course many more people eating until it kills them.
They are rare, so rare i don't run into them at all.
so what?
So I'm not sure your first sentence is universally accurate.
We have decades of research showing this is more in the "excess acid production" realm of things.
It seems unlikely to extend to bariatric surgery outcomes.
> This idea that Americans are genetically pre-ordained to be fat seems like fanciful thinking.
This idea that Americans are genetically pre-ordained to lack willpower seems like fanciful thinking.
This seems like one of those "replication crisis" claims.
> That's why they could stop being fat, if only they chose to.
So they're pre-ordained not to?
I have a loved one who certainly chooses to, to the point of having had bariatric surgery; GLPs have been an important follow-up. It's really not as simple as you make it out to be.
> You don't go from 12% obesity to 40% obesity in 40 years due to a genetic shift, but rather a cultural one.
What if that cultural one is letting the processed foods industry engineer everything to be deeply addicting?
No. I'm saying it's within their power, so they aren't pre-ordained either way. You were suggesting that it's impossible for a large percentage of the population to not be obese without medical intervention, that it was comparable to excessive acid production which is a genetic anomaly and out of an individual's own control.
> What if that cultural one is letting the processed foods industry engineer everything to be deeply addicting?
Sure, the industry bears some blame and is part of the cultural issue, but even if presented with addicting substances, it is both an individual choice to consume them and a collective cultural choice not to regulate them.
Plus, cars and all "comforts" eating into your physical activities?
The timing is just about right to blame it on Reagan, either the theory that neoliberalism leads to "structured stress" or than some environmental chemical got approved in that time frame.
The idea that it being genetic or not should matter is odd? Who cares why people are fat? They inarguably are fat and will by all available evidence be skinnier and healthier on a glp drug.
I fail to see the need for additional analysis or consideration?
Digging into the root cause or petitioning to tweak the food supply to reduce HFCS are admirable, but entirely orthogonal to the questions: "will taking ozempic et al make an overweight person's life better?" and "will making ozempic et al widely available improve America as a whole?"
Having 40% of your population on a lifetime drug seems like it could cause significant issues in the long-term, especially if there are unforeseen longterm side effects. Medical intervention seems like it should be a last resort, not something half the population is subscribed to by default, so if the problem can be addressed by other means, it really should be.
GLP-1s have been used widely for 20+ years now.
Look up what percentage of people take antidepressants. Why don't they just try being happy?
Look up what percentage of people regularly take OTC pain killers, Benadryl, etc. Why don't they just tough it out?
You are only picking on GLP-1s which happen to treat obesity among other illnesses. All of the other medications I listed are treating conditions with non-pharmaceutical interventions, but you haven't stated a problem with a huge percentage of the population using them.
If your problem is with chronic medication use, this isn't the one to pick on. It is insanely effective.
> not something half the population is subscribed to by default, so if the problem can be addressed by other means, it really should be.
What makes you think that these people haven't tried other options. What makes you think this is the default option, and not a later option? Do you think they are unaware of diet and exercise? Do you think that they choose to be fat? Do you think that people that can get PHDs doing world changing science, climb mountains, run Fortune 500 companies, hell - run marathons, are just too undisciplined or stupid to lose weight?
If there's a genuine chemical imbalance that needs correcting, whether that's causing obesity or depression it certainly warrants medical intervention. That should only account for a couple of % of people, however. If 40% of your population is on antidepressants, in other words 40% of your population is chronically depressed, that points to much, much deeper root issues pervading society, and I do not in fact think it's a great idea to "solve" that by drugging up half the population on antidepressants for life either.
> Look up what percentage of people regularly take OTC pain killers, Benadryl, etc. Why don't they just tough it out?
It's funny you mention this because American doctors will in fact tell people who literally need painkillers to function to tough it out, after overcorrecting for a period where they were handing out chronic medication like candy and causing more problems than they solved.
> If your problem is with chronic medication use, this isn't the one to pick on. It is insanely effective.
My problem is with the scale of chronic medication use. Chronic medication is life-saving as a targeted intervention for people who genuinely need it, and I have no problems with that. Using it as a population-wide bandaid for every societal issue instead of fixing root causes is bound to end poorly, though. What happens when 50% of the population is on some cocktail of GLPs, stimulants, painkillers, sleep meds, and antidepressants simultaneously because it was deemed easier and more instantly gratifying to prescribe chronic medication for everything than addressing any actual causes?
> Do you think they are unaware of diet and exercise? Do you think that they choose to be fat?
I think they are perfectly aware of diet and exercise and mostly choose not to bother because it has become culturally accepted to disregard one's own health for the joy of a Big Mac and a Coca Cola or 15. It is worth noting that the obesity rate for Asian Americans is only 16%, despite being exposed to the same environment and food industry. Did eg. caucasian American genetics take a nosedive in 40 years, or did they just normalise being self-indulgent to an unhealthy degree? I think one of those explanations is more likely than the other, even if it's not something they'd like to hear.
Don't you then start trying to figure out how you can reduce the uses of those precriptions, while maintaining the health figures they're helping to produce? Isn't the answer to do something better than doing nothing? Work with the problem in front of you? etc.
I dunno. What happened when 99% of the population got the polio and measles vaccines?
I don't get this weird thing people do where they act like their bodies don't follow the laws of conservation of energy.
However, not all calories are the same, metabolism is dynamic, and the brain is complex and exerts a powerful influence over behavior.
Increasing exercise will make you hungrier and most people are simply unable to resist this and end up not losing weight. It is why there is a common saying that "you cannot outrun your fork." Restricting calories generally is difficult in today's environment with plentiful calorie dense food everywhere. People don't cook as much as they used to and restaurant meals have more calories than ever.
AFAIK GLP-1 drugs work because they calm the minds desire to eat which is baked in deeply from millions of years of our ancestors struggling to get sufficient food.
When I was working out at Crunch (long after I got kicked out of that other gym) I would go across the street and get two tacos at Taco Bell which is good from the perspective of athletic performance because it puts back the glycogen you use and you'll use the protein to make muscle. But from an energy perspective it's close to neutral.
Muscle is good for you anyway in many ways, not least metabolic and in terms of mental health. I had an elite athlete workload back in the time I was trying to start a business based on foundation models about a decade early and it helped me keep it together though now I have
https://my.clevelandclinic.org/health/diseases/23920-athlete...
and my cardiologist told me to exercise less! I am still obese in terms of either BMI or fat percentage but I just saw a specialist for "medical weight loss" (e.g. Zepbound) I was told I had a huge lean body mass and that would help me lose weight. Wearing normal clothes I don't really look fat but in the wrong gym clothes next to the fit 20% of college students I have one hell of a gut.
You can’t really exercise enough to offset the food you can eat in a day, even if you somehow were able to dedicate all your time to exercising you would still have to limit your food intake.
Add to that the fact that exercise is mind numbingly boring and you have to conclude it is not a practical solution at all.
It's odd how people act as tho there's a "moral argument" against using a tool to help reach the goal. It feels a lot like the argument that "morals are from religion", as if you need god to know that murder isn't really a productive activity (unless you work in a slaughterhouse).
I wish American money could go back to having "mind your business" printed on it instead of "in god we trust", it was a huge loss to all of us when that garbage was passed. It was also a huge loss when everyone just decided to go along with saying "taxpayer money" instead of saying "public funds/money", but slippery psychological slopes are everywhere.
More importantly: I don’t want to eat less. I want to eat more. There is so much amazing food.
People racing the Tour Divide, a 2700 mile solo unsupported bikepacking race through the Rocky Mountains, lose weight when riding their bikes 18 hours a day for 2-3+ weeks straight. They describe being unable to choke down enough food even though what they are eating is very calorie dense. Hotdogs, burritos, burgers, pizza, a pound of gummies every day, chocolate milk and ice cream when resupplying, McDonalds where they fill their hydration bladders with PowerAde, anything they can get their hands on quickly when they arrive at a small mountain town which frequently has nothing more than a gas station.
https://www.facebook.com/groups/tourdivide/posts/24754803527...
Obviously not a practical solution as you say but they do exercise enough to offset the food when eating as much as they can.
It’s not practical in the least for the average office worker to outrun the fork. It’s just silly advice and pointless to even bring up. When it takes an hour or more of treadmill work to cancel a single donut you don’t need to think about it any longer than that.
You exercise for health. Not to lose weight. Until you are at the margins and can consistently create an extra 100-200 calorie deficit by walking for an hour every evening or whatever.
My three gym days a week don’t do much for the scale. Those are for physical and mental health. The weight part is in the kitchen.
This is not true. There are plenty of activities that a healthy, enthusiastic person can do for quite a few hours per day that burn calories rapidly, and it takes serious effort to eat enough to offset the calorie usage. Think distance running, skiing, cycling, rowing, etc.
Sometimes people go to extreme technological measures to optimize their ability to consume calories (see recent record-setting marathon results). Sometimes people rely on extremely calorie-dense foods (butter, nuts, etc) so they can carry meals with them that are not wildly calorie-deficient for their long, unsupported travels.
When people are burning calories at this rate, they are probably not doing it for exercise — they’re probably either doing it because it’s fun or it’s part of an adventure.
I’m suspect that, if someone is overweight but in good enough shape to cross-country ski for six hours a day, then even if their body tends toward telling them to eat too much, they could probably lose weight by doing so for many days in a row.
Most people though will just eat more when they exercise, though dieticians say that more muscle is good for your metabolism and almost everybody would benefit from getting in some cardio and weights (i'm one of the rare exceptions who's been told to moderate my exercise, but I am the kind of person who can't understand how other people can make it through the day without going to the gym.)
People at the extreme end can struggle to eat enough food to maintain body condition, like I had a friend in college who trained for ultramarathons and you couldn't pinch anything on him even though he was eating all the time. Olympic swimmer Michael Phelps was a representative for the blockbuster heartburn medication Prilosec because he was burning 10,000 calories a day on his side!
That doesn't make it an easy thing to do.
Fat people are aware of diet and exercise. They aren't stupid.
Until you have been chronically obese, or helped someone that is chronically obese, you don't understand that it is a deeply rooted subconscious issue, not a physics issue.
Fat people don't want to be fat, anymore than depressed people want to be sad. But something in their minds or bodies makes it non-optional. Pharmaceutical interventions change that thing.
When people - in their millions - say that this is the only effective thing, you could, I dunno, believe them. Or at least believe the pharmacological/medical science, which is, to circle back, all just physics.
With regards to omeprazole, I changed my diet a bit and no longer needed the omeprazole. I don't know exactly what it was, but if you can get off of a drug because you don't need it anymore that seems ideal.
It’s possible to ignore sadness as well as hunger.
This is all that needs to be said and this is also not that profound of a point. It's literally just harm reduction.
Why do people have such a problem with harm reduction? Why do they feel the need to feel oh-so-smart and point out "weeellll acccktschually there is still some harm so its better if you didn't need the harm reduction therapy and instead just i dunno magically not require it"
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 motivation.
That's also why when they do develop something for a rare condition, it costs a bankrupting amount of money.
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.
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.
I think I'm not the ignorant one.
>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.
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.
https://www.reddit.com/r/tirzepatidecompound/comments/1omfgx...
which is often shared on fitness subreddits, nowhere it asks people to completely stop eating fats.
furthermore i run dieting app with thousands of users so i am not the one who is going to promote zero sugar or fat diet.
My app: https://macrocodex.app/
I highly doubt this. A lot of people think stuff like juice smoothies, granolas or dates are healthy. Or more generally organic or grassfed or "no added sugar" or "high-protein" high-sugar or "unprocessed" stuff.
People are actively misinformed about what's healthy by a constant bombardment of ads, fads and "common sense".
The unbelievably low success rate of diet and exercise programs for long-term weight reduction is widely documented and quite consistent with the earlier poster's experience.
where is your data from? what protocol did they follow?
People tend to not want advice when they're not seeking it, and when someone wants to dissect every detail of what they've done that hasn't worked, when they mentioned it merely as an anecdote, it tends to be perceived as condescending.
About advise part, I am not looking to offer him any advise I am simply defending the method and ideas, so that other people can find success with it similar to what I've done for me and for many others.
How much weight did you lose, and how long have you kept it off?
Giving up the very difficult route of changing lifestyle for the easier alternative of taking drugs for weight loss comes with both biological and social consequences.
The people talking about that shouldn't be bullied to feel ashamed of not taking or recommending taking drugs.
Curious: how big of a calorie deficit did you run, and what was your macro (protein/fat/carbs) balance.
My personal experience is going low on carbs (especially added sugars) and high on fiber and protein made running a deficit suck much less in terms of feeling satisfied.
Also, a 10% deficit was okay (I was hungry but could mostly ignore it). A 25% deficit was very annoying and about as much as I'd care to do.
For some people, diet and lifestyle changes help control blood pressure. Other people need to take meds for the rest of their lives, anyway. We don't shame them for it.
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.
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?
I know several people who are feeling hungry because they're not dead, regardless of how much calorie surplus or deficit they have.
We can do the same activities and eat the same meals and I'll be satied and they will be hungry. Or I can confuse the hell out of them when we do some big activity and I say "i'm not hungry, we worked too hard"... or when we miss a meal by several hours and I tell them "I'm not hungry anymore, it's been too long... but I should probably eat something"
> I think there isn't as much variance as people like to believe,
Oh sure, I don't think everyone is really a unique snowflake, there are patterns. You can find lots of people in these threads who have a broken hunger sensor. You can find lots of people in these threads that can manage this intellectually. I don't see a lot of people in these threads like me who keep a healthy(ish) weight because IBS punishes them for bad food choices, but I'm sure they're out there. Plenty of people out there where celiac drives their relationship between calories in and calories out.
Diet research would be a lot more interesting if there were ways to classify people by their 'metabolism type' and then see what can work for which type. Maybe there would be more reproducability that way, too.
Are you saying 1000kcal vs 200kcal deficit makes no difference?
>Diet research would be a lot more interesting if there were ways to classify people by their 'metabolism type' and then see what can work for which type. Maybe there would be more reproducability that way, too.
You can easily track your maintenance calories, by tracking your weight vs intake overtime.
For a lot of people, the reason they feel hungry is because the way their brain works is that they feel better when they feel full and their life sucks for some reason, so they want to feel better. Hence overeating. It’s entirely a psychological issue for a person like this. Counting calories is not going to help them. In fact, them even being able to maintain a calorie counting regime is downstream of resolving their anxiety/stress/depression. In other words, diet and exercise are not the beginning in the causal chain required for them to lose weight.
And you’re getting absolutely no traction in this thread because you’re completely oblivious to this. Which is common for someone for whom diet and exercise is easy to control.
i am not trying to gain traction, i already know what i am saying applies to vast majority of people and i've yet to come across people who feel 200-300kcal deficit is impossible to apply for them because of their insane appetite.
In most cases where people say this, they are sedentary so their TDEE is very low, applying deficit makes them end up in very low calorie zone where they feel miserable.
Why all these people who are failing can't actually define their fitness journey by putting some numbers into perspective?
because they calculated nothing, they just winged it. I am not denying that there aren't people who cannot control eatingg, there are but they are rare.
I regularly hear from overweight and obese people who come to me, “I’m genetically predisposed to being fat.” Yet after a few months, we often make significant progress.
Many of them have also tried “deficit dieting,” and it didn’t work for them. But when I looked more deeply into their methods, I found they had calculated their maintenance calories incorrectly.
They were running huge, unsustainable deficits. They weren’t doing any Zone 2 cardio, which is an easy way to boost maintenance calories, and most of them were largely sedentary.
Many times, their diet consisted mostly of packaged, processed foods, and they weren’t eating enough protein or healthy fats or vegetables.
Simply fixing these issues led to major transformations. I’ve yet to come across someone who is truly resistant to these changes.
I do not doubt existence of people who simply cannot sustain even a small deficit or people who have no control over their diet but i've among 1000s of people i worked on i never found even 1 such person.
I keep an open mind maybe i'll eventually find such person, so far i've not.
For me I always feel hungry. Always ready to eat more. Always.
It doesn't seem to matter what I eat or how much, I have no "off switch" apart from maybe being asleep. I sit at big family meals like Christmas or thanks giving and people around me are all "man I am going to pop if I have another bite" and yet I am still reaching for more while simultaneously thinking about what is for dessert. Once I start eating for the day, that's it game over I am going to be thinking about when I can eat next the entire waking time. I have done calorie counting for years (with deficits of usually around 400-800, tracking macros etc making sure I get enough protein) and am fairly active (running 20-25km a week, strength sessions 1-2 times a week) but even when I am not counting calories or especially active that doesn't stop me wanting to eat the whole damn time.
Dieting or not, exercising or not, it makes no difference I am always ready and willing to eat more. I am in a constant mental state of food binge.
I usually stop eating when the food physically runs out on my plate, so portion control when making meals etc needs to be airtight. I work at a BigCo where there is unlimited free food at every turn, so just going to get a coffee is a nightmare as you can imagine as I am surrounded by things to eat. Like e.g. on a bad day I might end up having 6 or 7 bananas a day just to avoid picking up a chocolate bar or donut instead. It's nuts (..and yes there are nuts too and also too easy to just grab a handful...)
I think of it like an alcoholic. But an alcoholic can "go sober" and just cut it out and not get that first taste that leads to the spiralling binge. I've got to eat to stay alive though so every day I "fall off the wagon"
I am seriously considering the pill form now that is a thing. The refrigerated injections just seemed like they were incompatible with a normal busy life with travel etc
It's totally overwhelming and often hard to concentrate with this constant overriding urge to think about eating all the time. It's like gravity, inescapably pulling me in.
People say "Oh I forgot to have lunch!" and it simply does not compute for me. How can someone forget?! Having lunch is my overriding constant nagging thought since having that last mouthful of breakfast. It only stops when I get to start thinking about eating dinner as soon as I have stopped eating lunch. Repeat. Every moment of every day. Eat. Eat. Eat.
It's a like a stuck record or whatever. Over and over. I want to turn it off.
I'd get it if I was solely existing on a diet of junk food that is designed to do this, but I am not. Since I've been tracking every last gramme of food I've been eating on and off for well over a decade I can tell you that it is very much "healthy" and low in processed and/or junk foods. I just never feel full and want to eat more.
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".
People with that low of maintenance calories are usually sedentary and undermuscled.
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.
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.
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.
Active life = higher TDEE which means you can eat more food while still maintaining same deficit.
For example, a lifting session may burn 200-300kcal and then they'd think they've burned a lot, so they will end up eating 500kcal back.
so as a result there is no deficit there.
Even people who track their calories perfectly often eat when hungry because it is the most basic of human instincts and our brains and bodies are wired to respond accordingly.
>Even people who track their calories perfectly often eat when hungry because it is the most basic of human instincts and our brains and bodies are wired to respond accordingly.
Many people can track calories, hardly any of them are tracking calorie burn and no the ones from your watches or displayed on cardio devices aren't correct.
Many times the eating more issue you are seeing is because average guy may estimate that 1 lifting session burns 800-1000kcal. How do i know? i've asked random people in gym this question.
It is hard to accurately calculate the calories burned in a lifting session but the ability to count calories has little to do with the causes of obesity. Even if a person could count them perfectly that doesn’t mean they are capable of manipulating the numbers to meet their goals.
If you live in a place where waking to get your daily life needs met is possible, good for you!
Personally, I look at GLP-1 agonists akin to wearing glasses. Some people are just born without the ability to regulate their appetite in accordance with our society, but there is a tool / prosthetic to change that. That said, it's not one or the other, it's always great to be more active.
Yeah, humans should have more free time and do enough work or exercise each day to keep their body in shape.
Why would you eat 2700+800 = 3500kcal? when you can do with 2700kcal?
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.
This is similar to how most people drink alcohol occasionally, maybe sometimes get drunk at a party and even enjoy it, would even be unhappy to have to significantly reduce their alcohol consumption (e.g. when taking some medication) - and yet have nothing similar to alcoholism, might go weeks without drinking without even noticing, and would never even consider having a drink before work.
I've helped many people lose weight, become jacked, and go from underweight to a healthy weight. I regularly hear from overweight and obese people who come to me, “I’m genetically predisposed to being fat.” Yet after a few months, we often make significant progress.
Many of them have also tried “deficit dieting,” and it didn’t work for them. But when I looked more deeply into their methods, I found they had calculated their maintenance calories incorrectly.
They were running huge, unsustainable deficits. They weren’t doing any Zone 2 cardio, which is an easy way to boost maintenance calories, and most of them were largely sedentary.
Many times, their diet consisted mostly of packaged, processed foods, and they weren’t eating enough protein or healthy fats or vegetables.
Simply fixing these issues led to major transformations. I’ve yet to come across someone who is truly resistant to these changes.
I do not doubt existence of people who simply cannot sustain even a small deficit or people who have no control over their diet but i've among 1000s of people i worked on i never found even 1 such person.
I keep an open mind maybe i'll eventually find such person, so far i've not.
Note that I'm not speaking as someone who has just accepted being overweight/obese. I was hovering around 105kg in my early 20s, then I gathered the motivation to go down to ~75kg over the course of a year, then maintained myself around 80-85kg for the next 5 years, then in a bad period went back to overeating and was hovering around 100kg again for a few years, and now I'm in the process of going back down (currently around 86-88kg after 6 months of actually working on losing weight - so about two thirds of the way to where I'd like to be, given I've also been building some muscle mass).
So I'm not someone who just throws up their hands and says "I'll always be fat", or maybe pushes themselves for a fad diet one month and is proud of losing 5kg that come back right away. My experience though is that appetite control and managing food cravings are the most important parts of managing my own weight, and that the nutrient content of food has virtually nothing to do with it. I can eat a whole steak with 400g of steamed peas and some asparagus, with some butter and cheese, and then feel hungry and unsatisfied 4-6h later when the stomach isn't as full. And if I'm not in a good headspace, I may well then grab a McDonald's menu to get rid of the feeling of hunger and get some satisfaction that the steak and vegetables didn't actually address on that day - and the exact opposite can happen on other days.
This is why for me things like One Meal A Day (OMAD) has been mucn more useful than actual careful nutrient tracking. Being able to tell myself "it's OK that I'm feeling hungry right now, I'll eat that X tomorrow and be satisfied" has been the single biggest helper. I've not yet been tempted to try out GLP-1s (afraid of the side effects, the food problem isn't that bad), but I imagine they could be a huge help if they removed the need for such willpower-based mechanisms.
From my experience stuff like Intermittent fasting, OMAD is not really needed.
Something especially useful to many people is being able to visualize, their maintenance calories vs calorie intake, see this: https://macrocodex.app/assets/hero-tdee-line.png
When dieting properly, you should focus on long term weight trends rather than daily fluctuations.
Yeah I know bodybuilders manage to get jacked and many of them are doing nothing but maintain their body and are taking anabolic steroids and thyroid hormone and stimulants and who knows what.
People in pro sports take PEDs.
>can be very physically active and muscular but still pretty fat.
you can retain higher muscle mass at higher bodyfat% like Sumo Wrestler.
being lean limits amount of lean mass you can carry.
>Yeah I know bodybuilders manage to get jacked and many of them are doing nothing
bodybuilders who take PEDs do not easily gain fat because steroids change nutrition partitioning.
also, some bodybuilders take DNP, clen, t3 etc... but many bodybuilders also do hours of zone2 cardio.
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.
Why would this sentence make any sense?
I stand by my words that just using Ozembic without changing your habits on the way can't be the right way. And as far as I know studies suggest that that is actually the case. Like with any diet really
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.
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.
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?
Well-studied problem.
It makes more sense when you realize that something like sheer dieting/exercising willpower isn't why some populations are skinnier than others. Pick another country with a healthier-weight population, start placing some of them in the US, and they'll gain weight. Put them back, and it'll drop again.
If "just diet and exercise" (the advice, and individual effort to that effect) aren't what are keeping some populations skinnier, why would it cure a population with an obesity epidemic?
Just off the top of my head the food (portions, quality, etc) in the USA combined with how much people no longer can walk vs being required to drive are a huge contributor to weight gain of immigrants to the USA.
There are of course other decisions that might help cope, like moving to one of the few walkable cities we have or structuring your life to reduce the lifestyle, but those all have a lot of other effects like completely upending your current life.
What’s a person supposed to do about a problem that’s probably tangled up in several major areas and would require large reforms across the economy? We can’t even get mandatory minimum paid leave or healthcare for everyone (both of which might well be components of fixing it “right” anyway!)
This is likely a problem that spans our food culture, business culture, economic structure, built geography, and social benefits system, among other things.
You can spend a lifetime fighting those and be fat the whole time because despite massive effort and objectively incredible achievements you and your movement only got us 5% (that’s a lot!) down the road towards fixing these things, in fifty years.
Or you can take a weekly shot and be well on your way in a month.
Working on the “real” fix is definitely something we should do (it’s not like the causes of this aren’t causing other things to suck, too) but even people doing that would probably like something available that they, not just their great-grandchildren, can have.
We’ve tried shaming people into being healthy. Amazingly enough, it doesn’t work very well.
It could definitely use more support, but it doesn't do a ton if the structure of people's lives is being changed by other factors. (Car based commutes, long work hours, lack of exercise at their job, the cheapness of certain kinds of foods, food advertising.)
If we had a lot more political power to work on public health programs, maybe. But obesity rates are rising throughout the developed world regardless of local culture so there is a ton of work needed there.
That's some pretty... charged language. But even so: the drug, clearly. People take drugs reliably as a matter of empirical fact. People likewise emphatically don't "change their lifestyles" as a general rule. If they did we wouldn't be talking about this new drug, would we?
People take drugs if they can afford them; will GLP-1’s be available dirt-cheap to the masses or limited to those fortunate enough to have health insurance.
(For comparison: Countless scores of diets are discontinued daily.)
Meanwhile: Diets have been discontinued by people of all income levels for as long as we've had diets to discontinue. Some people succeed with their diets, and some don't.
I don't even know I read this board and all the fucking dumb opinions.
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.
Not a doctor, but I would at least try to look into this. Best of luck!
You’re not providing anything of note, so merely saying “I’ve looked into it. I’m good” seems like it’s the correct reply.
Long term PPI use has non-trivial risks, including magnesium and other micronutrient deficiencies, and can lead to things like SIBO and other primarily gut related morbidity.
I would definitely suggest sitting down with your doctor if you were not specifically instructed to take it for that long.
I’d recommended getting up to date knowledge about the options before providing advice on them, starting with safer h2 antagonists like famotidine.
And a lot of these medications have side effects that can affect quality of life negatively in other ways. That doesn't mean they're not helpful, or shouldn't be taken. But the "no free lunch" rule usually applies, sometimes to a noticeable degree.
Oh, there’s consequences? One of those is an almost universal weight gain measured in the dozens of kilos? You want help with that?
Sorry, it’s against Calvinist/puritan morality to help you with that by providing a medicine to counteract that. You need to do it the hard way (regardless of the statistics that show you will just be obese now until you die thanks to the meds which, I maintain, that you must take).
Wow. I had no idea.
Come on, why is it that whenever GLP-1s come up on this site, the comments are filled with people helpfully pointing out this fact as if no one knows it already?
First, I don't personally have it out for GLP-1s specifically.
Second, here's the thing about side effects: there are a good number of examples across multiple categories of drugs showing that some people experience side effects doctors and pharmaceutical companies have insisted aren't real or are exceedingly rare, with evidence later showing this not to be the case.
For instance, there is a growing body of evidence that a subset of people who take SSRIs experience life-altering sexual dysfunction that persists long after the SSRIs are discontinued. Up until fairly recently, that this was happening at all was basically dismissed by all but a small number of practitioners. Now, there's a name for this and even some warning labels.
In the US, which is only one of two developed countries in the world that allows pharma companies to advertise directly to consumers, there are huge incentives to minimize side effect profiles and even to bias clinical trials so that benefits are exaggerated and downsides are underestimated.
I took antihistamines basically throughout my 20s. My allergy specialist said there's no reason not to. I developed some other issues and wanted to stop taking antihistamines to see if that would help (or get a hint whether they were causing it) - but that got me into itching hell for weeks.
In some online forums people reported the same and shared ways to get out of that "addiction" without going insane from itching.
My doctor didn't want to believe it and there was no research on it. That only appeared a few years later in the form of a paper called "Unbearable Pruritus After Withdrawal of (Levo)cetirizine" (2016). In the US, the FDA issued a warning in 2025, which is also the time when I heard about it. None of the doctors I went to back then reported this to anyone, so I'm surprised it got discovered at all.
As for my other issues I have no way of knowing whether they had anything to do with long-term antihistamine use. I'm a sample size of one, and none of the other stuff is quite as clear-cut as "unbearable itching".
I've had other issues with prescription drugs that didn't make the official list of side-effects and sometimes those side-effects don't just go away once I stop taking the drug.
That's why I'm very cautious when trying drugs I never had before, and even more so when it comes to taking them long-term.
My experience was about antihistamines, which are definitely effective.
My impression was it was weekly at first for 1-few months then monthly for like 5 years.
Wish i had started like yestercade :(
In any case, it's worth doing the skin prick allergy shot testing so you can have some idea of what common allergens affect you and the intensity of each.
GLP1 agonist type incretins have been available for over 20 years at this point. The first marketing approval was in 2005 for exenatide (Byetta), indicated for T2DM. Exenatide was the first in class for GLP1 agonists. Then came Liraglutide (Victoza) for the same indication around 2010, and received marketing approval for weight loss (as Saxenda) 4 years later. After that around 2017 was semaglutide (Ozempic & Wegovy).
T2DM is a chronic disease, so patients who started exenatide had to stay on it life long.
These drugs are nothing new and were already being used for T2DM. It only caught public attention because semaglutide achieved double the mean BW loss over liraglutide, making it meaningful for weight loss. Novo Nordisk first got approval for Ozempic for T2DM in 2017 and then received approval for it to be marketed for weight loss under Wegovy only in 2021, but by then clinicians were already prescribing it off-label, strictly speaking, for weight loss.
I don't know how much we could extend this "they've been around for a long time" to tirzepatide (Eli Lilly: Mounjaro & Zepbound) because it's the first dual agonist. It targets GLP1 and GIP, and thus it's meaningfully separated from the others. This goes for retatrutide (again Eli Lilly) as well if it eventually comes to market as it would be the first triple-agonist targeting the aforementioned + GCGR, the glucagon receptor.
After discontinuation, most patients regain around 60-80% of the weight they've lost with the medication - but this figure is limited to the study duration, so the weight regain might have continued beyond that. A good starting point for dipping your toes into outcomes would be the STEP and SURMOUNT trials, these were the trials they did for marketing approval. (They did multiple rounds of these, I believe STEP4 and SURMOUNT4 specifically had groups that stopped therapy mid-way).
We see this rebound effect with weight loss mediated solely via lifestyle modification as well, however. Still no idea why. Very broadly speaking, only a small proportion of obese/overweight patients will manage to keep the weight off, and the rest of the patient population tends to be divided into two groups: those who regain most of it (usually around half of the lost weight will be regained within 2 years, and 80% by follow up year 5), and those who regain more weight than they had lost. There hasn't been a way to tell preemptively which group the patient will land in at the time of beginning of lifestyle modification.
On top of this, yoyo-ing is also a phenomenon we tend to see. Obese and overweight patients who've managed to lose weight once will regain, lose again and so on. This phenomenon is associated with worse outcomes than being obese alone, so it is important to do long-horizon thinking when initiating therapy (be it lifestyle or pharmacotherapy) e.g. is the patient willing to stay on pharmacotherapy indefinitely? what about an indefinite maintenance dose if the patient succeeds with lifestyle modification alone? has the patient had lost and regained significant amount of wt prior? etc.
Maybe in America you do, here in Europe I am not so sure about that
But since you specifically bring up omeprazole: I backed off of pantoprazole by getting a prescription for half-dose pills (since they're time released, you can't just cut them in half), then decreasing frequency (alternating days, then tapering off) and retained the benefits.
There are plenty of confounding factors in my case, but checking occasionally if you can back out of a drug is worthwhile.
Many people taking these kind of drugs are gambling with their well being. No doubt that in many cases that gamble is worth it.
But issues that can be solved with non-pharmaceutical solutions, such as with weight loss and lifestyle changes, are really better solved that way if possible. There's no risk of longterm effects and it helps foster a larger culture of healthy living in society generally, reducing the lilihood of the problem in the general population.
> Many people taking these kind of drugs are gambling with their well being. No doubt that in many cases that gamble is worth it.
You use the word "gamble" and it is correct, but the connotation is a negative one.
We take a risk in everything we do. We seldom know the long term effects of anything. Right now I drink tea, and I drink tea quite often. Is this healthy? Does it have long term negative effects?
With GLP-1 medications, deciding to not take one, if you are overweight, is also a gamble. A pretty huge one. Obesity very often leads to type-2 diabetes, and the first step is prediabetes. Should someone with high BMI and high A1C avoid GLP-1 because we don't yet know the long term effects? We do know the long term effects of being overweight.
No, it's really not "pretty likely." These drugs are extremely well studied, have been for a long time across now hundreds of thousands of clinical trial participants over decades.
The downsides of obesity however are immense. Far, far worse than people intuit.
Agreed non-pharmaceutical interventions are preferable when they work. But it turns out – empirically – that it's very hard to implement these successfully.
The underlying issue is being treated, it's treated by taking the drug. It works. It's doing its job.
I'd be curious as to how you came to this conclusion.