It's great because we had no other way to address this problem at a population level. Not any realistic ones, anyway.
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.
I helped my dad lose 50 lbs by finally, after 10 years, getting him to give up bread, sugar, potatoes.
It took buying him 2 months of a bluetooth glucose monitor. Once he saw what certain foods do, he believed me finally.
At 65 years old, healthier than I remember since he was 40 and I was a teen.
It doesn't require some weird injection.
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".
> 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.
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?
> 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.
having the understanding of the science and self motivated enough to make lifestyle changes already puts you a couple standard deviations out of the population average, such that I don't really think its helpful as a comparison or something to model after
you are misunderstanding my point. There is a selection bias. Those with the reading comprehension and scientific aptitude to make a statement like "the science is clear" with accuracy and confidence is already exceedingly rare.
My assertion is that the success of long term weight changes is not independent from that variable.
That's an assertion there is to my knowledge no evidence for.
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.
I find this hard to believe. Wegovy is authorised for sale in the EU for weight loss (IE not Ozempic which is for diabetes. Yes I know it's the same drug). If you can't find someone to prescribe it, that's on you. Find a better doctor or pharmacist. In all seriousness, please do - obesity is no joke and taking ownership of this by at the very least finding a doctor who will support you might be one of the most important and life changing decisions you make.
And it's thanks to that kind of dishonorable practice that $NVO has lost 64% of its value over the last year. This is how the world rewards the makers of the most successful and helpful drug in history.
A huge chunk of Novo losing it's valuation is the fact that Eli Lilly is absolutely destroying them on the next generations of these. Tirzepatide is better than Semaglutide, and Retatrutide is better than Tirzepatide. Mazdutide looks to be a particularly good fit for Asia for a variety of reasons. And from Novo, Cagrilintide/CagriSema look to be a bust. Rybelsus is a bust.
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.
They’ve been rewarded enough (~$14.65B USD net profit 2024), and are lucky they’re allowed to capture any further economic benefit from the sale of a simple compound (imho).
... a simple compound that was already developed and in-use, so the current patent (the one that's made it a big, ongoing news story and a kind of social phenomenon) is rewarding only going through the approval process for using it for weight loss, specifically, not development of a new drug.
> 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.
Run a study of your approach and show good results over a cohort for 2+ years and you'll make an entire sub-field of medical scientists very happy.
[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.
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.
Pull out method is a less viable method of preventing pregnancy, and especially less viable at preventing STDs. However, it's still considered a contraceptive strategy.
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.
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.
The zeitgeist has pushed the idea carbs/grains and sugar are terrible over the last 40 years on and off, so that seems to say more about the medical industrial complex, than anything. That's fair, but if that message has been pushed so consistently, why didn't we see a real decrease in the consumption of those things and the associated weight loss?
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.
I find that almost all doctors give useless advice. On multiple occasions I've been advised that there was nothing wrong but they can run a scan "if I insist" and then bam, the exact problem I expected shows up clear as day.
Doctors don’t get paid for writing prescriptions. They don’t get kickbacks for writing prescriptions. A small subset of doctors are paid by pharmaceutical companies to run trials or provide expertise, but you can look that up since it’s publicly available information, and it’s not based on them prescribing you anything.
At most a drug rep comes by and brings donuts or something to talk about their new drugs.
Now go drill down into what those payments are for. The vast majority is for running trials. Each payment is tracked, and you can drill down into each one.
If you don’t want a doctor who takes money to run clinical trials, use this database to avoid them. It’s not hard.
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.
They get paid in lower risk deductibles. If a patient demands a drug they saw on commercials, the doctor can reduce liability by prescribing it in many cases.
Anti-shame culture is not what we’re talking about. What we were talking about was doctors prescribing pills that patients asked for to lower their liability, which is nonsense.
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.
Huh? Drug reps have scorecards for the doctors they call on and throw perks at the top performers or influencers. It also depends on the speciality - dermatologists working for price equity mills are almost evaluated like salespeople. Source: girlfriend is a rep.
Each one of those has to be reported and the information is publicly available.
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.
I've been on here for 10+ years I think at this point. New throwaway, named throwaway to not even lie, every few months.
I tweet with Paul G every now and then positively, because I'm nicer on there. But sorry you dont think I provide value.
For someone as clever as you, I'm sure it's obvious why using a throwaway greatly diminishes the value of what you're saying.
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.
It should not be surprising as to why someone would be suspicious in 2025, if someone is insulting anyone who got success from a drug by saying "my dad's dirt worked for him" and then complaining about declining quality on the forums.
Use throwaway identity, pay the price.
I'm glad your dad is healthy and yes, carbs cause issues.
I think its great you helped your dad lose weight but what is your issue with others choosing a different path? The health benefits of losing weight are massive . Why is it important to you that they do it how you want them to do it? Study after study has sung the praises of GLP-1s.
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.
I helped my dad lose 50 lbs by finally, after 10 years, getting him to give up bread, sugar, potatoes. It took buying him 2 months of Ozempic. Once he saw what stopping the cravings for certain foods can do, he believed me finally. At 65 years old, healthier than I remember since he was 40 and I was a teen. It doesn't require some weird bionic arm implant.
He could have lost all that weight and still had bread, sugar, and potatoes but instead he gave up what he clearly enjoyed. Now he gets to live out the rest of his life fighting cravings, telling himself he's not allowed to enjoy food. How utterly sad.
Believe me, cutting out bread and sugar completely is 10x easier than some kind of lifelong moderation for a person that has struggled for it already for most of his life.
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.
The choice is no longer between "cutting out bread and sugar completely" and "some kind of lifelong moderation for a person that has struggled." The choice is now between "cutting out bread and sugar completely" and "removing the struggle to moderate bread and sugar."
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?
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.
Obviously it’s not much easier or the drug wouldn’t be so valuable.
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.
I made no moral statement. Behavior modification has worked great for several formerly obese people that I know. They made permanent lifestyle changes without relying on drugs. I really don't care whether people take weight loss drugs or not but the reality is that there are cheaper and safer alternatives.
You’ve been here since 2007, you’re not dumb. Stating it’s “much easier” when it’s obviously not betrays something.
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.
Because people are choosing deliberately to get pleasure to eat unhealthy stuff instead of being healthy. And that’s a reasonable thing to do. Immediate pleasure trumps future hypothetical gains.
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…).
None of which addresses the point. Combating all of those urges and changing your habits via willpower is still far more difficult than a weekly injection that provides huge help in combating said urges.
As someone who in the past lost ~50lbs and has mostly kept it off for more than a decade this is just horse shit. It's incredibly hard even as someone who was only a bit overweight and not obese and it is still a struggle 15 years later, even more so than it was when I was younger
> Now he gets to live out the rest of his life fighting cravings, telling himself he's not allowed to enjoy food. How utterly sad.
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.
Additionally, some of us give up foods for reasons other than weight loss. I have no weight issues today, nor have I personally struggled with it in the past, yet I also gave up stuff like drinking soda because diabetes runs in my family.
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.
>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.
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 superior 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 for almost one third of Americans? That costs literally billions in healthcare costs? 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?
I'm pretty okay with semaglutide and I understand its prospective benefits, both on a personal and societal level. My point was that the father of this person clearly has that oh-so-superior and elusive brain chemistry you suppose I have based on the account shared, so it was both immensely asinine to write what you did, as well as straight up false. That you could have went through all these other points without being an asshole about it, from the get-go. That there's a person on the other side of the screen too, and maybe, just maybe, they weren't meaning unwell, and didn't deserve a fucking brainwash about how they're actually torturing their loved one - you know, just like how people don't deserve one about how they can totally lose weight unassisted and are just being "weak willed" or whatever. That you escalated, and that thinking you're justified in doing so doesn't actually make it any fucking better.
You made the story about you, when nobody asked. Check the comment I responded to. You did exactly what people always seem to jump out of their seats to do when this drug is mentioned: crowd the conversation with anecdata about how you did it better.
It's blatantly obvious that what I said was an anecdote and what benefits semaglutide harbors. I'm well aware and am in full agreement with it. Always has been. Now if only you condeded to having been unnecessarily and disproportionately hurtful.
Bread, sugar and potatoes exist on a spectrum from highly processed/refined (truly problematic) to minimally processed whole food versions (nutritionally valuable). There's no reason to give up minimally processed whole food versions of these.
What a bizarre, illogical comment. Did you even read what @throwawaylaptop wrote above? While most of us can handle she carbs just fine, some people have to pretty much eliminate them (regardless of processing level) in order to lose fat.
I find it odd you included potatoes in the list of foods to give up. Boiled potatoes in particular rank at the very top of the satiety index[1], meaning they keep you full longer with less calories than other food (likely due to a combo of high water and fiber content.) I recently lost a modest 10 lbs and mashed potatoes (even with some added butter and milk) were a staple of my diet—keeping me from feeling hungry even at a calorie deficit.
Yes, if you don't need it because there is a natural method that starts fixing your problem in the first week (like cutting all carbs does for being fat), then injecting insulin for your easily fixable problem would also be up there with injecting weird stuff into yourself.
If you told millions of people that bread, sugar, pasta and bread are basically killing them, and to flat out stop eating them.. you probably would help people lose weight (and save many lives too).
My dad has finally understood that grains are for people that need help maintain weight or gaining weight.
You don’t think people ate carbs 3 times a day in the past? The majority of humans for the majority of recorded history have eaten some kind of bread, rice, potatoes, porridge, or corn with the majority of their meals.
Also in the majority of recorded history being fat was a sign of wealth. I don't think the majority of humans had a surplus of carbs available to overeat them. It's not that carby foods are inherently bad, there's just something bad about the way they fit into modern society, for some people.
Modern wheat is a very modern invention. You have to be pretty gullible to believe that something that has only existed for 50 years has existed for millennia.
But millions of people are being told; "cutting carbs helps with losing weight" is, I dare to argue, commonly known.
> 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.
23% of PRC citizens are overweight or obese, compared to 73% of Americans. In the PRC, rice is typically had with every lunch and dinner, and sometimes breakfast as well. Plain old white rice, the worst kind from a glucose perspective.
Heroine would also help them lose weight also. Maybe cocaine too, but I'm not sure. So it's not "all that matters".
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".
You are showing your own ass with this ridiculous analogy. What are the negative effects of ozempic? Because the negative effects of heroin (not "heroine") and cocaine are well known and grossly outweigh "not being fat."
From people I know that have used Ozempic/Wegovy, the side effects are basically that they get a bit nauseated a few hours after an injection. That's it.
> 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)
Moving to higher elevations in the US causes people to become less fat, so you can do this by moving to Colorado.
> It's great because we had no other way to address this problem at a population level. Not any realistic ones, anyway.
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
Yep, overeating (and, to some degree, not enough moving around) is the reason. True.
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.
It has more to do with the American food supply than anything else. The obesity rate skyrocketed as we started to consume food-like substances instead of food.
Strip out all the signals that let the body know it has enough, and it is easier to overeat.
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.