WeightWatchers files bankruptcy
wsj.com107 points by bookofjoe 2 days ago
107 points by bookofjoe 2 days ago
I'm not sure why this is being framed as an Ozempic story, when if anything it seems like it's more of a cautionary tale on not taking on $1.5 billion dollars of debt to buy back shares near all-time highs and crippling your company for over a decade before ultimately forcing it to file for bk.
https://www.prnewswire.com/news-releases/weight-watchers-ann...
Its stock tumbled ever since those highs and likely wouldn't have ever recovered had Oprah not bought and pumped it. To this day they still carry over a billion dollars in debt.
In fairness to the WW board of the last couple of years, they did make a of reasonable pivot to try to rectify the ship (like buying a telehealth service which prescribed Ozempic), but ultimately it seems like this buyback from 13 years ago created a burden that just made them unable to weather the storm gracefully.
The amount of companies going bankrupt because the board has taken all their money seems very high.
Don't forget the companies where Private Equity swoops in and takes all their money.
We seem to be squarely in the "loot all the well known brands, take whatever is not nailed down, and leave their carcasses by the side of the road" stage of Capitalism.
Where does it go from here? It seems grim.
Hopefully new upstarts with a vision for quality.
It seems that every brand starts out with noble intentions, then after rising to meteoric success, they get gutted and we have to wait for the new, high quality up start.
> taking on $1.5 billion dollars of debt to buy back shares near all-time highs
> To this day they still carry over a billion dollars in debt.
Bankruptcy sounds like the only option, but the initial borrowing sounds like incredible mismanagement.
Not mismanagement if you made a lot of shareholder value with the buybacks.
Generating shareholder value while wiping out twenty thousand jobs, killing the business and eventually going bankrupt. The epitome of business success
I think that's "extracting" shareholder value.
Like extracting value from a patient in the form of removable organs.
Literally the phrase is "unlocking brand value"
"brand value" -> trust people have in the company/product
"unlocking" -> betraying that trust in a bustout
But they didn't, as evidenced by the bankruptcy.
The whole, everything stupid a company does is "increasing shareholder value" meme is annoying. Not every dumb action a company does can be explained that way.
> But they didn't, as evidenced by the bankruptcy.
When shareholder value is used as short term and long term interchangeably, both can be true. Short term value at the cost of long term value.
What's the argument for stock buyback programs generally? We have more cash than we know how to spend reasonably?
It's like a tax free dividend. Dividends are taxable but if a company uses the cash they would have spent on a dividend on a buy back there's no taxable event for the investors. Those investors who want the cash can sell and pay the tax and the rest enjoy the higher share price
Incentivizing short-term investors to dump stock by boosting the price temporarily? I guess that's a strategy.
In a purely rational market, buying back shares doesn't boost stock price temporarily... it boosts it forever. You buy back shares and 'retire' them, thereby making everyone else's shares more valuable.
Now, if you're using debt to finance share buy backs, then yeah... it's a short term ploy. But most companies don't use buy backs this way.
> You buy back shares and 'retire' them, thereby making everyone else's shares more valuable.
But the cash outflow to purchase those shares makes the company less valuable at the same time. In a completely efficient market, the amount of money that the company pays to buy back a share should be exactly balanced by the ownership percentage of that share, resulting in no net change to the price of the company's other shares.
Yes but as a shareholder I get an untaxed unrealised capital gain instead of a taxable dividend. I’m not a fan of taxing unrealised capital gains but this particular loophole could do with closing
But the tax will be paid when the stock is sold. It is more like letting the investor choose when to realise the gain and trigger the tax vs dividend that will happen regardless of wether the investor needs the money at that time or not.
Or the stock is used as collateral for a tax free loan and never sold. Tax loophole engaged!
The loan may be tax free, but it is surely not interest free.
For the ultra-wealthy, it doesn't matter. Look up "Buy, borrow, die".
People who talk about "buy, borrow, die" never seem to mention interest.
Suppose your blended portfolio grows at 10%/year nominal, and you're in the 20% capital gains bracket. Then you would owe 2%/year taxes if you realized it every year. Would you not then need an interest rate lower than 2% nominal (i.e. 0% real, assuming 2% target inflation) to come out ahead? That's also assuming you're not already receiving some dividends/income or can't be selective about tax lots to sell.
You could say "well you can simply accumulate an interest balance without ever repaying the loan, and hope the assets appreciate faster than the interest compounds", but then shouldn't you have already levered up prior to ever considering taxes? So taking on additional loans pushes you outside of your risk tolerance? Do you borrow or pay taxes depending on your portfolio performance? How does this work?
I'd be interested in seeing what someone with an actual finance background has to say about this "strategy". The popular image is just "free money", but while I have enough assets to start buying things with margin loans myself, I'm failing to see how to get some of that free money.
It seems generally reasonable that using an asset to collateralize a loan should be a taxable event, but the narrative about how this gets used seems off to me when trying to figure out the details.
> Suppose your blended portfolio grows at 10%/year nominal, and you're in the 20% capital gains bracket. Then you would owe 2%/year taxes. Would you not then need an interest rate lower than 2% nominal (i.e. 0% real, assuming 2% target inflation) to come out ahead?
You're assuming that someone has a portfolio that has a cost basis that is very close to the current market value. Most ultra wealthy folks have holdings that have been held onto for a very long time, with cost basis' that might as well be $0 compared to the value of the assets. Even non-wealthy folks that saved in a traditional brokerage would have a cost basis that is very low compared to the value of the assets. During the 'accumulation' phase, there likely is not much being sold at all.
If you want to access this capital, then you're paying 20% on every dollar. You don't need a 2% interest rate to make out ahead in this situation, it can be substantially higher and still be a better deal than paying the cap gains taxes.
I suppose it depends on how spectacular your buying is (a common criticism of sales tax is that rich people don't buy much, relatively), but wouldn't you only need enough tax lots that are close to current market value? If you've been accumulating, you've probably got a blend of tax lots from "nearly 0 gain" to "nearly all gain". You're also going to be receiving some dividends or have some other income sources that you presumably re-invest to create recent tax lots. The only case where that wouldn't happen is if you got lucky on a concentrated bet you made. If you inherited your wealth, you got your step-up, so you're faced on day one with "okay I have tons of assets with cost-basis at market value, how do I do rich person tricks?" Is that group not a good fit for buy-borrow-die, and it only works for founders/early investors of companies that blew up?
Taking on loans also means you're adjusting how leveraged you are, so I feel like there's a missing risk analysis component here. Otherwise of course I'd just take out as many loans as I could right now to get that sweet 10% expected growth at only 6% interest or whatever. So I can't borrow to avoid the tax man because I already borrowed as much as people are willing to give me.
> Yes but as a shareholder I get an untaxed unrealised capital gain instead of a taxable dividend
In the US, stock buybacks are taxed. But, its a fairly negligible amount (1%).
To close the loophole, ban buybacks. Or at least severely restrict them in some way. If a company wants to return profits let them issue dividends.
Yes.
If you have more money than you're able to make good use of improving the company (r&d, acquisitions, new locations, whatever), you can give it back to investors. Which can be either a dividend or a buyback, and in theory (ie, ignoring pesky details like taxes) those are supposed to be equivalent.
> We have more cash than we know how to spend reasonably?
- pay your workers a good bonus?
- invest the money in the market?
- lower prices?
> What's the argument for stock buyback programs generally?
* https://www.forbes.com/sites/aalsin/2017/02/28/shareholders-...
That's silly. It's a business, not a charity. When I'm a shareholder in a business I don't want management wasting my capital by investing it in the stock market when they run out of growth opportunities. Just give me the cash back (preferably in the form of stock buy backs) and then I can invest that cash in other businesses myself.
> Give shareholders the right to vote on buybacks.
I like the idea of giving long-term shareholders an easier way to weigh in on buybacks.
No need. They aren't forced to change their % ownership and if they think the price is too high they should sell anyway.
> I'm not sure why this is being framed as an Ozempic story
I am. Because just like how I've always got someone else to blame for why I never cleaned my room, executives can always find someone else to blame for why the business they are running went to shit.
And the press loves to run with a good just-so story that paints some indefatigable foreign villain as the cause of a company's demise, instead of boring, banal mismanagement.
This is a dumb take. WW was dead no matter what they did. They got beat by the worlds greatest ever mousetrap - GLP-1s.
Stock buybacks are substantially equivalent to dividends. You issue a dividend when you have nothing to invest in that will develop shareholder value. Buybacks work the same way. You have a stock of capital, or a great borrowing opportunity, and nothing to do with it.
Most companies always have another idea to do a new thing, that might induce growth. WW did not. WW has been in trouble for decades, because their business model pre-supposes consumers are too stupid to use a search engine. (Does "weight watchers" work? No. No it doesn't.)
The debt-for-buyback swap is a symptom, not a cause. Management had nowhere to go, no vision for growth, and when you are out of ideas and you are offered an attractive loan, you do a buyback.
> Stock buybacks are substantially equivalent to dividends
There's a whole theory on this:
https://www.investopedia.com/terms/d/dividendirrelevance.asp
The easy way to see it is if all shareholders reinvest dividends, it's the same as a share buyback, only with the broker buying shares on your behalf rather than the company, and your ownership of the company includes a bonus fractional share.
Dividends are also a bit of an accounting game. You can pay yourself a "dividend" whenever you want buy selling shares. This is only 95% true, but if your share in a company just entitled you to 65 cents, the share is probably worth about 65 cents less since the money came from somewhere.
Buybacks also protect you from hostile takeovers, or from a competitor buying shares until they are entitled to a seat on the board.
The latter was the the end of several large German companies.
Because revenue took a very sharp decline when ozempic was approved.... which caused it to not be able to service debt. The company is worth zero. It was worth zero the minute the GLP-1s became viable. Whether it was financed with debt or equity matters not.
My 2 cents-
I lost 50 lbs or so on Mounjaro by the time I reached the maximum dosage. Then, a confluence of supply-chain issues and coverage issues eliminated ALL of it, and within a few short months I had regained all the weight. I finally got coverage again, and supply again (via Zepbound) and began slowly increasing my dosage again.
I'm now at the maximum dose and I've lost exactly 0 pounds from the peak.
So, a warning: Use of this drug seems to be a one-and-done. If you can't keep the weight down after you bottom out and after they take you off the drug, it MAY NOT work again.
Were you on a program that focused on diet/exercise changes? Did any of those habit changes stick?
The new program does, but hell man, a toddler who doesn't sleep through the night (ever... No family help, either) and who demands 100% attention when he's not at daycare is a massive, massive hit to your free time/motivation/energy/stress. He's wonderful but I'm absolutely fucking miserable right now.
Echoing others here: Yeah, don't be hard on yourself right now. When they get a bit older, you'll get healthier again. It's okay to slide back. The phrase 'relapse is part of recovery' comes to mind. Just focus on the kiddo for now, and you'll get time and energy back sooner than later. This happened to me too, and I managed to get back to a healthier body when we got done with teething. It's different for every kid, but you'll get there, don't worry.
Stay strong and keep going. When they start kindergarten you'll have more time for yourself and things will get better, I promise.
Getting out of school at 2:30 instead of daycare at 5pm says otherwise (my current stressor....).
Similar situation here and my conclusion is that getting in shape requires:
-exercise
-regular sleep
-good diet
With an infant and a toddler on board I can maybe do two, but typically one.
If it's any consolation sleep deprivation prevents long-term memories from being formed, so you won't remember most of this.
In the first three months after my first child was born there was definitely something happening, but I wouldn't know - I don't recall any of it.
I've got two toddlers and still manage to get outside for a run everyday. Used the Bob stroller when they were younger, now they ride bikes and I jog with them. When my son wouldn't sleep through the night for his first year (pre-walking), I'd set him in a play pen and run on the treadmill nearby.
Hang in there! And focus on the fun times. I'm assuming you're already tried many things, but if you haven't talked to your pediatrician, he might be able to help. Melatonin helped one of our foster kids fall asleep, but yeah, it didn't help him sleep all the way through the night. Good luck!
Of all the information I've seen about Semaglutides the only people I've seen it keep the weight off are:
1. High end personal trainers clients, for which semaglutide was used in conjunction with the trainer's workout regiment and diet.
2. Body builders and models, for which semaglutides simply replaced caffine/adderall/ephedrine.
The drugs can't induce the lifestyle change needed to keep the weight off (nor will it give you the motivation to go to the gym and build muscle). I'm thinking for now, it's a race to see how cheap these drugs can get and ensuring they have no side effects from very long term use. Overall I think the drugs are a net good and I'm interested for seeing the effects for myself, but I'm in good shape and $500/mo is still steep.
Have to say I basically take the opposite on everything you say here. I know quite a few people who aren't super active (myself included) who took it and went off and kept the weight off.
And they actually do induce lifestyle changes, which is the fascinating part. Not for everyone, but the impulse control changes are dramatic. I had a friend credit him going to therapy for the first time in his life and reading for the first time since high school to it which was crazy, but makes sense because it also helped him quit smoking weed so he had a lot more time.
Do you know which drug they took? Do you know if it was a compound? I'm a layman here and I'm interested in the success stories.
Ignoring the weightloss, I find the life quality improvements properties of the drug fascinating and it would be my number 1 reason for trying it.
The best is definitely Tirzepatide, it's both stronger and easier to tolerate. You can find it online from more or less reliable sources.
Personally, I’ve found that the best use case for GLP-1 drugs is reducing alcohol consumption.
Just wanted to share that observation.
Interesting. I’ve not seen that mentioned before.
I took Semaglutide for 6 months. Before Semaglutide I'd want to have a beer just about every day, but I'd only drink a few times a week. Once I started Semaglutide I completely lost the desire to drink alcohol.
The same was true for food. I thought about food all the time. But once Semaglutide started I just didn't think of food. I had to remember to eat.
Semaglutide in my experience really helps to eliminate addictive behavior in general, I believe. At least oral addictions (I'm not sure if it would help with e.g. gambling addiction).
I never understood why skinny people believed that fat people have no impulse control until I took the medication. Once I had that impulse control it was so much easier to make long-term decisions.
Yes. It turns out that food is addictive, like breathing.
(More practical note: alcohol contains a surprising amount of calories, especially in beers and sweet wines and ciders. Cutting alcohol consumption also helps weight loss.)
Did the cravings reoccur after you went off it?
It took about a year for the food cravings to come back. It has been almost 2 years since I stopped taking the medication and I still have no desire to drink.
I have a hunch that what it's really doing is regulating impulse control.
I'm not sure if that's what's really going on, but in my experience it's definitely one of the things going on.
glp-1 inhibitors turn out to be better for alcohol and smoking cessation than any other drug we have. Truly a miracle drug.
But they aren't actually prescribed for these things (yet?), right?
Reports from friends in the EU is that doctors are prescribing it for all sorts of things off label. Autoimmune, ADHD, OCD etc. I take it for ME/CFS and it works well for me, but I get grey market supply. I’ve been on a low dose of it for a few years now, I was already researching it when it became a craze, the mass adoption really helped dial in dose safety. A small percentage of people like myself are super sensitive to it and need much lower doses
Some people say it's an "off-label" use -- but that's up to the doctor and patient ultimately.
But I think that's okay -- because the main purpose is weight loss and reduction of caloric cravings. Alcohol is a caloric craving. So it should be fine.
That wasn't their main purpose as they were brought to market. Even the anti obesity is an off label use.
I don't think it would get me off alcohol though. I only drink to relax and be more social. Not because I enjoy it or the taste. But it means I drink rarely anyway.
I can tell you that being on it, food to me just tastes different.
So even if you didn't enjoy it, what typically happens to me anyway, is the off flavors get magnified.
Like the easiest one is Costco Chili. It tasted vastly different when I was off of it than on it. I taste more of the bitter notes. The complexity is more off putting to me.
I inject on say Sunday nights, and on Monday an IPA tastes terrible. But on Friday it tastes tolerable again. And this is a pretty consistent pattern I've noticed.
This is definitely true. I was on some for a little bit and it absolutely killed my taste for beer. Luckily I'm not dependent on alcohol so that wasn't a problem. But now that you mention it I wonder how effective it would be at helping an alcoholic wean themself off it.
That said, I didn't have as much problem with spirits and cocktails since they don't have as much volume and generally aren't as filling. There might be a danger of turning a beer drinker into a hard liquor drinker.
does it take away all the things you need to enjoy life ?
1. food
2. alcohol
3. gambling
4. smoking
last three are extreme cases but general principle should still apply.
Assuming good faith of your question:
Your body has other mechanisms to make you remember you need 1, like for water intake or breathing. Those mechanisms starts as soon as anyone birth and doesn’t need your intervention to become a need. 2, 3 and 4 however become needs as you decide (consciously or not) it is. Same with heroin, social media or basically any other think we call "addiction".
Food obviously is a bit confusing as our omnivorous and resilient condition let us satisfy it in many ways : you don’t really need green vegetables, meat, sugar, beans, fish, nuts, muschroom, roots etc… to survive but stopping them all together will kill you. Some subset (of quality/quantity) keeps you in a better condition than others.
Appart that condition effects, the way you that specific subset as a need has more to do with habits.
If the general principle were "things to enjoy life", you'd probably want to look at examples like
1. Finding love
2. Raising children
3. Helping others
4. Strengthening your body
5. Learning about the world
6. Participating in sports
7. Music (playing and listening)
8. Art (creating and appreciating)
Does it make people less inclined to seek those things or mute their enjoyment? Things like recreational drugs (alcohol, marijuana, and tobacco included), gambling, and (excess or poor) food sound to me like "self-destructive behaviors" for many people, which generally are things that make life less enjoyable, and the people participating in them know that (but nonetheless struggle to stop).
I'm of two minds on the ozempic thing.
On the one hand, i'm really happy for my friends and loved ones who have always struggled with weight find a solution that works for them.
On the other hand, i went through a non-drug assisted weight loss journey and improved countless things about my lifestyle besides just the number on the scale.
I worry this solution being available will just increase the number of sedentary people (which is also really bad for your health) and create a whole new set of people dependent on the pharma industry to be able to live their lives how they want
I'm on Zepbound (more effective than Ozempic for pure weight loss), and I'm the most active that I've been in 15+ years. Losing the weight gave me so much more energy, and made is significantly easier to work out properly. I lift weights three times a week and go on walks that are twice as long as when I started. There are also a ton of positive mental side effects. It's hard to describe the kind of hope I have after trying and failing for so long to keep my weight in check. Everything is just easier, which is not something I anticipated when I started.
I've never had any problems with my weight until the last year or so; guess I'm getting old? Currently ~106kg at about 2m, which puts my BMI just in the "overweight" category (imperfect measure, but still). Basically, I have what you'd call a "beer belly", which is very new for me. I don't like it.
Reading between the lines, I have the impression that you were fairly strongly overweight ("obese") and struggled with more serous weight issues throughout your life?
I share the concern of the previous poster not so much for people like you, where "lose weight to a manageable level ASAP" is generally a good thing, but for people like me who are "a bit fatter than they'd like" but not necessarily "obese". If you'd meet me, you wouldn't necessarily call me "fat".
Previously I would just eat whatever (not super unhealthy, but also not really healthy) and not really exercise beyond my stubborn insistence on walking or cycling everywhere.
I don't see weight loss rugs as a net positive for me. I made some positive changes to fix this, and if I were to take Ozempic I'd just revert back to my lazy git self, and not get all the benefits that a better diet and exercise give me.
> if I were to take Ozempic I'd just revert back to my lazy git self, and not get all the benefits that a better diet and exercise give me.
I don't think taking Ozempic is mutually exclusive with improving your diet and exercise.
it isn't mutually exclusive, but it is redundant and perhaps counterproductive.
See my potential warning here:
Here's a stark warning about diet and exercise: "90% of people who lose weight will likely regain it back."
https://www.michiganmedicine.org/health-lab/weighing-facts-t...
Weight loss is easier than keeping it off. There is only so much will power people have against food noise.
People really want these things - exercise, weight - to be important moral objectives for others, when they're not that important in the grand scheme of things. Now you'll just have to find another easy visual marker for ranking people by moral superiority.
I see your point but not really true. people in good shape vs. people who lost weight is pretty visible
It’s not really, and it’s more complicated than we think.
If we take a gander at Hollywood, we would be deceived into thinking it’s full of men who take really, really good care of themselves. But it’s not so - most are taking steroids, and even more are doing extreme starvation diets prior to roles.
We can actually see the inflation of physique in real time. Look back 5 years, then 10, then 20. Look at the protagonists - they represent the “peak” of what humans want to look like. By today’s standards, those super heros 20 years ago are scrawny.
I dunno about this. When I was growing up in the 80s and 90s, the biggest action stars were Schwarzenegger and Stallone. Most of the top action stars of today look a little lean compared to those 2 in my opinion.
We've definitely had a bit of a roller coaster in which we had stigma against steroids for a while and now we don't, since we have so many new, advanced, and stealthy steroids.
If you're as muscular as Schwarzenegger, some people will fancy you, others will say you're ugly and unnatural because you're taking steroids.
On weight, France (amongst others) had to ban extremely low BMI models*, which implies that people are very happy to look at — and desire to have — dangerous body forms.
The "stick figure" fashion models have been widely ridiculed for as long as I can remember, since the 90s. It mostly seems confined to the fashion industry: models outside of that tend to be thin, but not as extremely so. I'm not really clued up on that world to know why this is the case.
I remember the phrase "heroin chic" from that era.
Gisele Bündchen is one of the most famous runway models in the world. Surely, her BMI is below 18. (If you look at unstaged photos of her, she is so unbelievably thin. No one would think a relative who looked like that was healthy.) I am pretty sure that is the "legal" limit in France. How do they work around it? Does she never walk the runways in Paris?
This is such a classic HN overreach. The OP wrote:
> people in good shape vs. people who lost weight is pretty visible
People in good shape can be someone who runs/bikes/swims for 30-60 mins a few times a week.
Obesity is literally the major cause of ill health. Cancer, dementia, heart disease, diabetes, and strokes are all extremely unpleasant and are all credibly linked to excess weight.
The food industry is a lot like the tobacco industry. Everyone is aware of marketing around health and fitness. But the marketing and social programming that keeps people eating - ad campaigns, portion sizes, food consumption traditions that are billed as "family" events, even things like giant popcorn buckets in cinemas, or the idea that sweet things are "naughty" but also rewarding - gets a pass because it flies under the radar.
It's literally a double bind. Everyone gets two contradictory messages about food, starting from early childhood. And they cannot be reconciled.
So no. It is not about personal morality or shaming people for the sake of it.
Medically, economically, and personally, it really is that important.
You think exercise is "not that important in the grand scheme of things"? I urge you to do a bit of research on the topic, if you care about living a long and healthy life.
Consistent exercise is right below getting consistent quality sleep in the category of "benefits you would happily pay $1000/mo for if they came in a syringe". The benefits are both mental and physical. If you value your mind you should seriously consider paying attention to both.
Real question: I remember a long time ago reading a theory that the amount of time you spend on physical fitness is roughly equal to the amount of longevity gained. Said another way: If you spend one hour running for exercise, you might gain about one hour of extra longevity. It seems nearly impossible to study this theory at scale, but I am curious if there has been any other research.
To be clear, I'm not using this post to "dog whistle" that people should not exercise for fitness.
Even if that were the case, exercise can still be enjoyable for its own sake - and the high of having done it means the hours after are more enjoyable, too.
Alongside the quality of life and mental health improvements, too — some clear positives.
Great point: The mental health improvements cannot be understated. Even if the physical impact is net-neutral, the mental health impact is surely positive.
as someone who has always been a healthy (or even under) weight, but still struggled with keeping up an active lifestyle, this is the key - find some form of exercise that is actually enjoyable for you.
I have gone through multiple bouts of being able to do weightlifting for example for 6 months or so at a time. However, I always end up stopping (for longer than I could do it for) because it just isn't enjoyable. The monotony of doing the same lifts over and over again (even if the weight was increasing) just wasn't engaging enough to keep it as a part of my lifestyle.
I discovered rock climbing a year and a half ago and have been going every 2 or 3 days since (other than 2 weeks off one time due to injury). It's such an interesting sport that combines strength, agility, problem solving and collaboration. It's actually engaging which means I never have to be disciplined to continue doing it on days I don't feel up to it. The exercise isn't the point and yet my body is in better shape then it's ever been.
I think more people need to find that something.
If you think it's important for you, awesome. I personally think nuclear proliferation is a more important issue for the world than if I lose weight or not.
And that's okay for me, and it should be okay for you, too.
The parent said exercise though right, not weight loss? Exercise can/does lead to weight loss but it's certainly not the only benefit and might not even be the most important one.
> I personally think nuclear proliferation is a more important issue for the world than if I lose weight or not.
That's a bad comparison though.
A better one would be the effects that you losing weight (or getting in shape or whatever) would have on your life vs the effects that nuclear proliferation would have on your life.
Or the effects that globally eliminating obesity would have on life expectancy vs the effects that solving proliferation would have on life expectancy.
I completely disagree with you, as is my right. And you can disagree with me, and that's okay. I absolutely, truly believe nuclear proliferation is more dangerous than carbs. Fight me.
The problem with your argument are the words, "you" and "your".
You are making the mistake that pj50c is exactly arguing against. People arguing in effect, that "__you__ should do something."
"If only __you__ understood...."
"If only __you__ could control your lizard brain telling you you're hungry...."
Those are your beliefs. They are not mine. And this is what people talk about when respecting "boundaries".
I'm not saying you can't have you're opinion. And you can say, "I believe x, y, and z. And here's why...." And I'd be fine with that.
In fact, I'd probably be more open to listening to you.
No, that's not what I'm saying. I'm saying that of course comparing the effects of Intervention A on one person vs the effects of Intervention B on everyone will give a predetermined result. And that a proper comparison must either have an individual on both sides, or the whole group on both sides.
Awesome. I'm glad you said, "I".
My argument is that my carb intake is irrelevant compared to nuclear proliferation.
My argument goes like this. Carb intake does probably lower life significantly, but doesn't lead to potentially worse outcomes compared to say nuclear weapons in the hands of terrorists.
Carb intake usually affects people's life not early, but late. And if you believe that "carb intake" is a rational choice and not an urge made by the lizard brain then I would argue it's my choice -- my freedom -- and well get a boundary.
OTOH, a nuclear incident would affect a broad swath of people across all ages. And it's not their choice.
You argue like it's one or the other which is genuinely inane.
>Carb intake usually affects people's life not early, but late.
It affects people before more severe medical consequences start setting in too.
Realistically speaking it correlates extremely well with self control. Not perfect and I'm not talking about a few extra pounds. But morbid obesity? Yeah pretty much always ..
I don't know that that's true. For subset of people, this correlation may be true. To be extremely anecdotal though, I have never had trouble maintaining my weight even though I don't exercise, have a mostly sedentary lifestyle, and don't pay attention to my diet. I just got lucky in that I feel hungry more rarely than others. I think it would be absurd to say this is a reflection of my self control, and I am sure there are others that this applies to too.
This. 100%. I was blessed with good genes from my parents. It is so easy for me to maintain a reasonable weight. (Same for them.) Until very recently, I hardly did any exercise for more than 15 years, except the occasional weekend hike (nothing too crazy). Yes, there is some degree of self-control around eating, but lucky people with good genes love to wag their finger as people who struggle to maintain their weight. Whenever diet/weight issues come up on HN, there are always some very interesting posts by people with food control issues. They know their brain is broken (too hungry too frequently, etc.), but they cannot do very much about it. I'm happy to see that millions of people are finally able to lose weight and keep it off using GLP-1 drugs.
Being skinny does not, but being morbidly obese absolutely is a strong correlation to the point of it being a rounding error. Medical conditions that cause it are extremely rare.
For better or worse, as a formerly morbidly obese person I can say society doesn’t really care why - they absolutely take you less seriously overall regardless of the underlying reasons.
I would suggest that you're overstating the certainty of your view. At least in how it relates to rekenaut's point.
Purely focussing on people who are fat because they eat too much (which includes myself, albeit also now formerly morbidly obese thanks to Mounjaro):
(1) The studies find a statistically strong correlation, but that doesn't mean everyone who is morbidly obese has poor self control. The raw data still tends to show a big overlap of obese people with good self control and thin people with poor self control - so it's not reasonable to say anyone in that group is just a rounding error.
(2) The way that food self-control is usually measured is, for example, delayed gratification testing with food. It's not surprising that an obese person will do worse at this, but it doesn't necessarily mean the issue is self-control. It could be that their experience of hunger is stronger than the person who is able to exercise more restraint, so even if they're exercising the same level of self-restraint, they're going to give in sooner. It'd be like saying someone who can hold a plank for longer has more determination. There's a bit of that obviously, but then there's also (much more importantly) how fit and muscular you are.
(3) Self-control itself can be, and often is, a medical issue. Obviously there's ADHD/Autism/depression/thyroid issues/so on. which affect your mind in the general sense, but many common drugs including antidepressants, antipsychotics, antihistamines, etc. are also well known for causing obesity. Science still doesn't know why, exactly, they cause weight gain, other than it's through increased caloric intake - but not clear what drives it.
(4) This one is more speculative, but when I started taking Mounjaro, my general self-control increased. This is quite a common reported side effect. There's no evidence (yet?) that it directly affects your brain in any way that would affect self-control, but nevertheless it seems to for many. Separately, we know that being hungry seems to reduce your general self-control. It doesn't seem like a huge leap of logic to think that maybe the reason Mounjaro is having such powerful psychological effects on people is actually because being hungry is quite a powerful general non-specific motivator -- in which case, the studies testing calorie consumption against general measures of self-control might be producing a correct result but have the cause and effect the wrong way round.
Cards on the table, I'd say the proximal cause for why I'm fat is because I am less to resist food than the average person. However, my general self-control seems to be pretty much fine, and I only got fat after I started taking antidepressants for anxiety. Impulsive would be one of the last words anyone would use to describe me - it's just isolated to food as far as I can tell. Prior to Mounjaro, I was just thinking about eating pretty much all the time. While I'm eating, I'd be thinking about what I'm going to eat next. I was never NOT hungry.
> when I started taking Mounjaro, my general self-control increased. This is quite a common reported side effect.
Do you think part of your improved self-control is just feeling better about yourself? Allow me to extrapolate a bit here: If you are depressed, it is "easy" to throw away self-control and eat, eat, eat. Might the reverse also be true? If you are less depressed, it is easier to harness your self-control and eat less? It seems very plausible to me, but nearly impossible to prove the mechanism, except to observe it with a careful study.
Further, I am curious to hear more about the positive effects on your life after your self-control increased. Example: Are you doing better in relationships, or better at work... or the sun shines brighter in your life now... or what? These kinds of HN posts with high quality, first hand anecdata are some of my favourites.
I am not the commenter above. However, depression and lack of discipline/self-control form a negative feedback loop. Lack of discipline causes you to be depressed, which causes you to have less discipline. A lot of practices that seemed 'strict' to us that cultures would practice in the past are socially evolved ways to re-instill discipline via social shame. For example, the fasting days in the liturgical calendar. While you may have become undisciplined personally, when there's a fasting day that comes around every week, or an especially important one that comes by every year, you might decide to make a change.
For me personally, as a Catholic, I was able to kick my bad dietary habits during Lent. I wouldn't have been able to do it otherwise. The social pressure of having to abide by my rules helped me very much, and this was possible because my parents were 'strict' about Lent with us.
Ignoring the spiritual aspect completely, I think these practices are insanely useful which is why every culture has them. But we've thrown them out the window for some reason.
Why would it correlate with self-control? It seems much more likely to correlate with interests and food preferences. My old college roommate just loved vegetables and complained how he couldn't gain weight, so would take weight gainer powder. I suggested eating hamburgers and pizza, and he said that he couldn't stand the taste. His lack of weight had little to do with self-control.
And given how much weight can be impacted by relatively small changes in diet over a long period of time, makes me think that self-control likely plays little role. The fact that I love basketball and not video games doesn't give me more self-control. It just means I enjoy doing something that burns a lot of calories.
Agreed.
Something I've noticed with "naturally skinny" people: They simply don't have the appetite of the obese. They don't need to self-regulate their eating, as they just don't have the desire to eat. Their sense of hunger is properly calibrated. If they eat a large lunch, they won't even be hungry at dinner time and might just have a snack if they eat at all.
As an obese over-eater, I'm insanely jealous. I'm almost constantly hungry. For me to lose weight, I have to ignore the literal pain in my stomach and the strong biological urge to eat. I literally just finished my lunch 45 minutes ago which consisted of a roast beef sandwich (with like 8 oz of roast beef) and some chips. About 800 calories. I'm still hungry.
I'm not dehydrated and confusing thirst with hunger. My urine is almost completely clear.
> I suggested eating hamburgers and pizza, and he said that he couldn't stand the taste. His lack of weight had little to do with self-control.
Absolutely wild. Maybe that's the next level of human evolution: To have a brain that understands that food will always be readily available in modern civilization and so finding high-calorie foods delicious and providing a dopamine hit for consuming them isn't necessary.
This.
People assume that hunger is the same for everyone, and that can be used to simply rank the level of willpower people are exerting against the drive. But it's not. Some people have different appetites which leave them skinny or permanently hungry. Some people can and do eat a lot more than others for less weight gain.
This is why the drugs are so effective: they're appetite suppressants.
Have you tried replacing by volume? E.g. fill your stomach with a large salad (which can include some meat if necessary). And if you get hungry in 45 minutes, just eat more salad? You may also find that cutting out carby/starchy food will make you less hungry (once you get past the initial withdrawal symptoms), as long as you keep your stomach "satiated by volume" with low calorie/high nutrient food.
Another trick is to try splitting that sandwich in two and eating the second half after 45 minutes (when you get hungry again).
100% this. I had a handful of tortilla chips last night and today I had hunger cravings despite not doing any activity. Once you realize the link, it's hard to ignore the obvious.
> I'm still hungry.
Hunger signals can be very confusing. Is it an actual hunger signal or is it a craving for another hit of dopamine? As a formerly morbidly obese person, who through deliberate fasting has tried hard to understand what actual hunger feels like, I have to admit I still don't trust my own instincts in that regard.
Sometimes what I fear the most isn't hunger, but the let-down that comes with not being fully satisfied.
As a formerly obese person, I'd say it's both for me.
Prior to taking Mounjaro, I was pretty much constantly hungry when it was objectively incorrect to be - for example I had just eaten literally 30 mins prior. This was usually accompanied with stomach rumbling and the weird hungry rain stick noise in the back of the neck (I don't know what causes this but it's not uncommon), so I'm pretty sure it was "real" hunger.
Since taking Mounjaro, it's much easier now to distinguish between really being hungry, and being, I guess, psychologically hungry. Sometimes, now, if I've had a hard day or am in a poor mood, I want to eat chocolate just to make me feel better. That's something I didn't really notice before, maybe because it was always masked/coincident with physiological hunger? Perhaps the psychological side drove me to eat more or less healthily for pleasure, but I was still actually hungry in the first place.
So, as someone with DIRECT experience in this (from a family of morbidly obese people and on that route myself at one point), it's still completely self control. I totally understand what you mean by being able to consume anything and constantly hungry. This is a learned behavior; I'm sorry you learned it. I notice it with my children. My parents will want them to eat and they'll not want to. I just toss the food. My parents would force it on them were it not for my intervention.
The food must be tossed though because we have too much food in 2025, not too little. As i've explained to my parents and aunts and brother... if you consume the food you've not saved money by fully extracting the food's value. The food's value to your body is in a curve. Once you pass the nadir, the food becomes toxic. Thus, you are paying to kill yourself.
Anyway, yes, absolutely for someone with this learned behavior, it takes A LOT of work to unlearn it. It's taken me years and sometimes I still get the same hunger, but it dies down. You must understand that this ability to be hungry all the time is completely learned though. After several months of intermittent fasting very strictly, this finally went away. You must understand that you will feel incredibly free when one day you see something that tastes good, that you know tastes good, and don't feel the need to consume it.
Because of my DIRECT experience, I encourage others to pursue this path and do not give up. So while I understand completely where you are coming from, I also understand your friend's disgust over the pizza and hamburgers. This is the normal response to food, especially the highly greasy / sugary stuff like most modern food. The first time I had ice cream after a long no-carb diet, I could barely stomach it. Again, this is normal but no one told me that growing up; in fact, the opposite was encouraged.
> Absolutely wild. Maybe that's the next level of human evolution:
No it really just means you prioritize other things than filling your stomach.
One thing no one ever told me is that ... you don't have to eat. Indeed, on days where I do very little I barely eat anything. Again, that's NORMAL. It doesn't sound normal to many people because we were raised wrong. On days I do a lot of exercise or house work or physical labor (i have a desk job), then I eat more. That's normal. The eating three meals a day whether you need it or not is not normal at all.
If it's "completely self control" as you put it, why do appetite suppressants work? That suggests that hunger is at least a factor, no?
Because appetite suppressants remove the 'self' from the equation. They literally make it so the 'self' (whatever that is) is not in control. But that being said, if you take an appetite suppressant of your own accord (rather than doctor's orders), then you are fine. That's meta-self-control. For example, I know I am uncontrollable around chips. So... I stopped buying them and literally leave the room once I've had just a few. I cannot be around them. I know that and control myself.
A lot of the regain of weight after a diet is due to people starting diets due to doctor's orders and perceiving it as an intervention rather than as a 'rebirth' in a sense. I know there's a meme about vegans, but I don't blame them honestly. If you've ever been food addicted, finally getting it in control feels like a pseudo-religious experience.
> It just means I enjoy doing something that burns a lot of calories.
This says something about your personality. I tend to like active people for example. I find it hard to sit still. If you liked sitting and doing anything we would not be able to be friends.
This idea that your physical activity and physicality have zip-all to do with personality (i.e., the brain-in-vat model which is so common amongst the tech crowd) is the root cause of all this equivocating
>People really want these things - exercise, weight - to be important moral objectives for others
because they are. The visual changes are superficial. Exercise is important because it holistically moves people to a healthier and active lifestyle. It literally changes your mental state.
Ozempic is to weight loss what pain killers are to pain or sleeping pills are to insomnia, something that numbs a symptom (hunger in this case), without any impact on the underlying behavioral reasons that led towards the kind of lifestyle that promoted obesity.
It's a lot easier to be less sedentary when your knees aren't carrying 1.5x their rated weight and you don't become 50% sweat by mass after an hour.
It’s not about what’s easy. This is what the OP is talking about. Anyone who is in shape over a certain age pretty much has to wake up and choose the hard thing most days. Whether it’s bunions, old (or recent) injuries, GI problems, arthritis, inflammation—movement is good for all of these things. I know this from personal experience. If I stop moving for a few weeks it is very painful to get back into the groove. I’m currently dealing with some kind of lower GI problem that is affecting my energy and causing a lot of discomfort. I have foot problems, a messed up rotator cuff, etc.
But if you just keep showing up and putting in the effort (and most of all, not comparing yourself to anyone else, even your past self), the results will come.
Losing fat through exercise requires a high volume; excess weight will really put extra stresses on those injuries and other problems. If people have some shortcut toward reducing their weight so they can exercise more easily (rather than looking at it as the complete quick fix), it may not be a bad idea.
I don’t disagree there. And I was probably a bit aggressive with my take really. Not all healthy choices are hard ones, and exercise alone isn’t enough. Actually the hardest thing for me (and I have and continue to deal with addiction first-hand) is getting out of the mental ruts I’ve put myself in. I can choose not to eat poorly and to go exercise today, but if it’s just will-power and not a mindset change then it’s not going to be sustainable.
You can get very thin without moving a muscle and by diet alone.
I've come to the conclusion that some people by nature have such a strong bond with food whereby they don't have the willpower to operate with a caloric deficit.
I'd rather solve one of two major health problems (excess fat and insufficient activity) than neither of them.
For the morbidly obese, fat loss makes more activity much more feasible.
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Is discipline why some other countries have a lot more skinny people than the US?
Do they lose that discipline when they move to the US, and typically pack on weight? Like, is there a an anti-discipline barrier they have to walk through to get in?
It really doesn't look like discipline's a major factor in how a population stays in a healthy weight range, so it'd be surprising if it merits being the main focus of any effort to make a fat country skinnier.
>Is discipline why some other countries have a lot more skinny people than the US?
Yeah, I think it is. It's easier to be in bad shape than good shape.
I'm curious what you think it is?
It's 4 inputs, actually.
1) The culture (active, passive). Example: Germany, where people bike a lot more since gas costs so much; and ironically, their shitty Internet and cell service negatively impacts the phenomenon of everyone being glued to a screen. I think they're actually proud of it, at this point? Anyway, they're WAY fitter (despite, or perhaps partly because of, eating meats for breakfast instead of cereals!)
2) The food environment (preservatives, fructose, hidden carbs, bad artificial sweeteners, salts in everything, big serving portions, or more all-natural stuff)
3) Genes- There are literally over 500 discovered that affect your equilibrium weight. 251 genetic markers have been linked to sport-related traits (though only about half have been replicated in multiple studies). 13 genes have been identified so far that affect how the body responds to different types of exercise, including cardiovascular fitness and muscular strength.
4) And finally, there is willpower/discipline. Which is a finite resource, by the way, that gets resupplied by sleep and downtime, and which often needs to be drawn on for other things (like work and childrearing).
Think of it as a dial. In the middle, you stay the same weight. Tilt it slightly to the right (which is all too easy to do), and you are on a weight-gain schedule. Tilt it slightly to the left, and you will lose over time. If you're working against (1), (2), and (3), then (4) becomes MUCH harder to do.
So... why do so many of them gain weight when they move to the US? Again, are they walking through some kind of anti-willpower field on the way in? Do fat Americans gain willpower when they move to another country and lose weight?
Signs point toward a broad set of factors, mostly outside one's personal control, in one's environment mattering more than willpower.
It is the food. American food and beverages, ultra-processed, large portions, available everywhere and cheaper that healthy alternatives, non-satiating so you have to eat more...
In every single area of the world that gets introduced to such food, people become overweight and obese.
Ozempic reduces addictive behaviors, it's effectively a drug to improve discipline more than directly a weight loss drug.
It is a drug that suppresses addictive behavior.
Developing discipline is developing the ability to delay gratification for greater reward. Taking away the (need for) gratification means not having to learn the ability to delay.
A lot of people never need to learn the ability to delay, me included. I eat whatever I want, whenever I want, and I’m thin.
Peoples brains are all wired differently, and some are wired in such a way where they’re forced to struggle in modern society. I can sit here and say I’m more disciplined or better than others, but I’m just not. I’m lucky. If others can harness that luck, that’s good for them.
I don't think you can call should discipline if it implies a dependence on industry. What concerns me is how people will behave when industry leaves our lives.
I've tried it, as even a low dose gives the person much more willpower to make other life changes, which have nothing to do with the effects of feeling fuller.
Ozempic and other GLP-1 agonists can:
Modulate dopamine release in brain regions associated with reward and motivation, such as the mesolimbic system and nucleus accumbens.
Reduce the rewarding effects of food and possibly other addictive substances, which may explain the increased sense of control or willpower.
Some studies in animals show that semaglutide can alter dopamine metabolism and suppress dopamine-driven behaviors.
> What concerns me is how people will behave when industry leaves our lives.
If that happened, many many people would die of preventable medical conditions, or starvation, or many other causes. Let's avoid that.
As parent says, would you rather have “undisciplined” obese people or undisciplined non-obese people? Because those are the realistic choices here.
Someone else's lack of discipline has a far more negative effect on my life than their obesity does. So I reject this choice entirely—I'd rather we stop looking for easy fixes to hard problems.
I don't judge people for taking ozempic, but I am absolutely confused why people see this as a massive win for society. We're just doubling down on our dysfunction.
We can live in the world where people don't take GLP-1s, and there are a lot of fat, unhealthy, and undisciplined people. Or we can live in the world where people do take GLP-1s, and there are a lot of not-fat, healthier, still-undisciplined people. I would rather live in the second world. I don't understand why you want to live in the first world (over the second world).
I agree with you in the same way that casts don't fix the underlying problem - a broken bone, or band-aids don't fix the issue - a cut. Until people start to treat the real issue and stop relying on crutches, we're just covering up the problem.
So, what's your solution to "lack of self discipline"?
What is the physical basis for lack of self discipline?
> So, what's your solution to "lack of self discipline"?
IDK, wanting to be alive and happy?
> What is the physical basis for lack of self discipline?
That's just a category error. I just don't see obesity as worth caring about on an individual-level compared to the social dysfunction that produces it. If we can only address problems on an individual-level I don't really see why I should expect anything positive from society—that's just not rational.
You just avoided answering the questions entirely.
But you still want to pass judgement using your ill-defined concept of "self discipline."
This is just not addressing the issue.
What's causing the hormone issues? Who cares. Throw a pill at it and we can forget about it.
> Throw a pill at it and we can forget about it.
I don't really see myself ever forgiving the west for prioritizing medication over holistic treatment. I've been through way too many mental health institutions to ever trust medicated treatment.
Here’s a fun thought exercise - replace Ozempic/weight loss with any number of drug/mental health condition pairs.
I also hope there’s no long term worse side effects, but I agree with pjc50 in that most of the negative reaction is actually about feeling morally superior.
I agree, it's moralizing. The dependence on pharma is a real concern, particularly in a country (US obv) where they've got us all by the balls, but it's no less/more a problem here than for any other ailment requiring maintenance meds. We're still learning how the American diet and other environmental factors can literally change peoples' metabolism and it makes complete sense to me to treat the symptoms if we have the means to do so.
> Here’s a fun thought exercise - replace Ozempic/weight loss with any number of drug/mental health condition pairs.
Most disesases are not self inflicted. Obesity is
If obesity is 100% self inflicted, the fast food, snack food, and ancillary advertising industries should pack up and go home. They obviously do nothing.
Instead we have a system where these companies are allowed, even encouraged to make food that's terrible for you taste amazing, and market the shit out of it to increase shareholder value. But when they succeed at their jobs it's because you, the individual, fucked up. Well which one is it? Both can't be true.
You always have the option to not consume fast food, smoke cigarettes, etc.
We're setting up a battle of will between people and companies so we can feel good about our own self-control when some (most, in many countries) individuals lose that battle. What's the point?
Cigarettes are interesting because we recognized that running society like a car with accelerator and brake smashed down is sub-optimal. There are restrictions on tobacco marketing, consumption taxes, public health campaigns.
This is an incorrect assessment.
You're putting excess consumption in the same categorical bucket as controlled consumption.
Personal responsibility is a real thing. Its become a recent trend to blame everyone else for any problem you have.
The individuals making trade offs made the wrong choice. It sucks but it is their choice.
Passing the buck is a child behavior. Poor decisions leads to poor outcomes. More news at 11.
No one is saying personal responsibility doesn't exist. But what's the point of a system that rewards people who lure others into making poor personal choices around food? Just so those who don't make those bad choices can feel superior?
Is it a bad thing that cigarette companies can't advertise their poison anymore?
I'd very much rather have the chance at being more active by losing weight via GLP-1 class drugs than really having to fight two uphill battles at once. I think we're overall going to be seeing more positives than negatives coming out of this.
How much did you lose? What is your current food noise?
I really like Mark Lewis's take on YouTube - he's someone who is very fit in general but an injury threw him off and before he knew it, he had gained double digit kilos. This is someone who is motivated but also deals with high food noise.
I deal with low food noise. I am relatively active. I got up to <overweight> pounds slowly and over 8 months was able to lose 40. Even so, I had just one bad month at work and gained 7 pounds without significantly dropping my activity. Just a few meals out and not tracking my calories and I fell off of maintenance quickly. If I resistance train my ability to keep control of my calories falls off quickly because I just get too hungry.
I'd love just a maintenance level just because distraction-level hunger sucks.
>Just a few meals out and not tracking my calories and I fell off of maintenance quickly.
This is the big thing: it's amazing how little you can fall out of line and gain weight. A couple hundred calories a day and you're adding weight, every week. It really does take discipline.
What do you mean by "food noise"?
How much of your active attention is tracking on your hunger signals.
If I can't focus on my current task because I'm too hungry, that's food noise. If I can't get to sleep and am tossing and turning because I am too hungry, that's food noise. If all I can think about is a doughnut, or even if I'm chomping on raw broccoli and hating myself because it's just making me hungrier, that's food noise.
Oh.
I guess the concept isn't intuitive for me because, if anything, I experience the opposite of that. I can focus on a task for hours before suddenly realizing how hungry I am. (If only I had better control over which task I focus on....)
i used to be like that and i would love to be able to return to that. i'm not sure how i lost it.
Huh...if that's what food noise is, then I must be at a 24/7 rock concert.
You are likely a prime candidate for one of these drugs then. Are you considering it?
I am. I need to get a new primary care provider though, as my previous one moved, and I've just been insanely lazy about it.
Bags of rubbish calories lying all around us is what I assume. I have stopped eating outside of defined times to cut down on this.
I started on Zepbound March 1. The food noise is gone. I'm no longer distracted by intrusive thoughts around food/hunger, which after a lifetime of enduring such, is wonderful.
The strongest behavioral effect is that I no longer snack at all, a lifetime habit pre-March. That's resulted in ongoing weight reduction, ~9kg so far.
That, in turn, has encouraged me to increase my activity levels a lot. Offered as an anecdatum in which this drug is driving me away from the sedentary tarpit, rather than towards it. YMMV, of course.
Most programs that rely on GLP-1 meds also stress that lifestyle changes are needed to not only really lose weight, but also to keep that weight change once you stop taking the medication (or go to a maintenance dosage).
I'm taking the meds right now - what the medication allows me to understand is that without changing your sleep, exercise and diet, I simply won't be very successful even while on the meds.
You don't have to be "of two minds" about it, you can just let people do whatever they want. If you want to feel superior for losing weight without drugs, you can do too.
There's a clear parallel between that observation and AI. Instead of taking shortcuts to bypass activity that will improve our bodies, it will be the same thing but with our minds.
Yes, this is exactly why the pharma industry unironically refers to GLP-1 as a "miracle drug." The miracle is that it's expensive, it works, and people don't need to change their behavior. And as soon as you stop taking it, it stops working. It's perfect (for capitalism).
Good riddance! I'm pretty sure they caused more eating disorders than anything, creating return customers just like every other business.
I call bs... the utterly terrible customer experience is what lost them their customers. And constant changing of plans which became less and less effective... all of their 10$ a month customers don't suddenly have the budget to spend 1000$ a month on ozempic.
That’s why there’s all sorts of sketchy compounding pharmacies stepping up to the plate, not to mention the “research peptide” market…
> ... the past two years have been a fun experiment in semi-free-market medicine. I don’t mean the patent violations - it’s no surprise that you can sell drugs cheap if you violate the patent - I mean everything else. For the past three years, ~2 million people have taken complex peptides provided direct-to-consumer by a less-regulated supply chain, with barely a fig leaf of medical oversight, and it went great. There were no more side effects than any other medication. People who wanted to lose weight lost weight. And patients had a more convenient time than if they’d had to wait for the official supply chain to meet demand, get a real doctor, spend thousands of dollars on doctors’ visits, apply for insurance coverage, and go to a pharmacy every few weeks to pick up their next prescription.
This comment feels disingenuous. Peptides were first synthesized in the 80s and we have been providing peptide drugs to diabetes patients since the 2000s. So this “experiment in semi-free-market medicine” in which “there have been no more side effects than any other medication” is built on the back of 20yrs of research + 20yrs of commercial use.
To me it seems like quoted comment is trying to make a case for the deregulation in healthcare. Which is 1) a slippery slope and 2) not supported by the example they provided. It’s just a whole lot of libertarian vaporware
What's wild to me is the amount of effort and resources that have gone into weight loss around exercise and diet only for us to discover it is a hormone and brain chemistry issue around the gut and reward centers (GLP-1s). Shades of https://www.youtube.com/watch?v=02Or-Hx3yqc
It's the other way round: people love being judgemental about the diet and exercise habits of others, since it used to be a difficult-to-fake social signal, and apparent weight and fitness is an easy metric for that.
See also: white people being judgemental about people with darker coloured skins, to the extent that they may sometimes invest in skin lightening, meanwhile white people are investing in artificially darkening their skin with tans (because it's a symbol of conspicuous consumption, the ability to go to sunny places).
After a lifetime of being told it was a personal failing and expect a pill to fix our problems it turns out that what was we needed after all.
I had uncontrollable weight gain, a comorbidity of ME/CFS. GLP-1 agonists has helped a lot with both. I eat a strict diet and exercise as often as I can, which is less often than I’d like due to PEM. I think it’s likely that much of uncontrollable weight gain is due to autoimmune issues and GLP-1As do seem to help with that.
I started GLP-1As as soon as mainstream adoption started and so I could get safety data to help figure out dosing. I had already benefited from extended water fasts but it was rather challenging to keep doing that.
I'd be worried about declaring victory too soon. I hope we don't discover any serious long term side effects but it does seem like it's rare to get a free lunch when trying to change our bodies
GLP-1s have been around for decades. As far as medications go, that’s plenty long for “long-term” side effects to show up. Not saying it’s not possible, but it’s also not likely at this point.
Yes, and to be clear about where they were hiding, they started out as a treatment for diabetes.
There's enough evidence that it can cause liver damage that people taking semaglutide need to monitor their liver enzyme levels.
We should be monitoring liver enzymes anyway as part of yearly labs to identify issues like fatty liver. For what it's worth, since taking Zepbound, my borderline-but-not-yet-high enzymes are now smack in the middle. I'm on a few medications that have improved my health, but require monitoring to ensure that things don't go bad.
Obesity is now a bigger cause of liver failure and cirrhosis than alcoholism.
Frankly, I think even the most severe side effects we can dream up, short of dying, are probably nothing in comparison to the risks the people taking these drugs already face.
I never saw so much hand-wringing and pearl clutching when we started injecting botulism toxin into our faces to make them smoother.
Why are we so dead set on making sure overweight people struggle to put off the weight? Why can't it be easy for them?
I don't mock alcoholics for not being able to control themselves around alcohol. But we are determined to mock overweight people. Despite alcoholics having an easier time dealing with their vice.
Think about it, every other vice is controllable by simply avoiding the thing. Except for food. We must eat. It is a requirement. Having an issue with food is something you must deal with. You have to deal with the underlying issue. It requires true discipline. And it requires you to maintain that discipline 24/7. We don't ask that of any other vice.
I heard someone compare it to breathing. You have to breathe. You can't avoid breathing. But imagine a situation where taking deep breaths was considered undisciplined and weak. Sometimes your body craves air and you desperately want to inhale all the way, but people around you will roll their eyes at you. "There he goes again. He swears he just breathes through his nose, but we all know he opens his mouth when he thinks no one's watching."
There are already known short-term side effects, that's why it's not prescribed just for aesthetic weight loss, only to people whose weight poses health problems: https://www.gov.uk/drug-safety-update/glp-1-receptor-agonist... .
> There are already known short-term side effects, that's why it's not prescribed just for aesthetic weight loss, only to people whose weight poses health problems
I can't speak for countries other than the US, but here these drugs are being prescribed and used widely for entirely aesthetic reasons by many, many people.
Legally this isn't supposed to be true, but there are tons of online telehealth services that are clearly just rubberstamping prescriptions for anyone who wants one.
Same situation for prescriptions for pills to make your dick hard and baldness. There's CYA legal regulation for all of this but in the real world there's no actual barriers for anyone motivated to do so from getting their hands on this stuff.
> used widely for entirely aesthetic reasons by many, many people.
Do you have some numbers to back that up?
Post was made based on observational/anecdotal experience of knowing several people who take the drug without having had a hard medical need.
But its not hard to find various references to this as a widespread reality:
https://www.cato.org/blog/study-finds-glp-1s-are-effectively...
https://www.wired.com/story/glp1-ozempic-wegovy-semaglutide-...
https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/glp-1-o...
As of May 2024, 6% of the US population was currently taking a GLP-1 agonist medication (https://www.kff.org/health-costs/poll-finding/kff-health-tra...).
It is a bit more complicated though. Plenty of people have lost weight sustainably with diet and exercising. It just doesn't seem to work with everyone.
Diet and exercise methods don't[1] work for most people, for loss and especially for healthy weight maintenance.
With extreme levels of direct, personal involvement by multiple professionals (which is what rich people / celebrities have historically used, and variations of which have been studied by researchers) the efficacy level reaches "sort-of OK, but still not great". That's crazy-expensive, though, so not a realistic solution for the masses, plus the results are still pretty lackluster despite the cost.
[1] Could, hypothetically, yes "CICO", technically anyone could lose weight, but they in fact do not work when applied in the real world, statistically speaking.
Perhaps anecdotal but generally society doesn't seem to be setup to reward people making good choices.
Before the GLP-1 drugs became mainstream for weight loss, I know friends who were overweight who had enough money[0] to go on programs where your entire meal days are planned for you[1]. They'd ship you enough food for 2 weeks at a time, but you never had to think about what you were going to eat, it was all pre portioned and decided by your meal plan as part of the program.
They saw really meaningful results, lost weight, and as long as they were on the programs, they kept it off. As far as I could tell, the food wasn't anything special beyond being properly proportioned and nutrient dense - certainly achievable on ones own - but it seems the rigidity of it - that is, the fact they didn't have to make food choices every day - made it easy to stick to. The food prep itself was easy too - mostly throw it in a single skillet, microwaving it or putting it in the oven on a tray or in a baking dish was all it took.
I watched as they got healthier they were more active, felt better, seemed generally overall much happier.
Once the program was over or they for whatever reason had to stop, it didn't take long for the weight to come back, and they had discovered a big part of their problem was food anxiety - not knowing what they wanted to eat, having trouble with food cravings etc.
This has lead to me to suspect there are some seriously chronic issues with food culture in the US - namely, we haven't made doing the objectively best thing the easiest thing. Its too often out of reach due to cost, availability or time - which also speaks to other interconnected issues in the US that are going unaddressed.
For example, I know these programs worked exceedingly well for those I saw on them, why aren't they cheaper? Why don't we subsidize such things to nudge society in a better direction with food choices? We already subsidize the bad stuff - we should move those subsidies to better options.
[0]: I'm talking breakfast, lunch, dinner, and a small allotment of daily mini meals - really snacks.
[1]: This is the problem. To do this, you have to be of upper class means just to afford the food, and thats not even including the cost of the program associated with it, and in some cases its simply a meal delivery program and there's no additional anything, and its still expensive
USA food is absolutely crazy. Lots of stuff that’s banned in the EU. Lots of high fructose corn syrup. If you eat out, portion sizes are off the scale. I ordered a starter salad at a restaurant once when I was over on business, and it would have fed me for the entire day! (Won’t even start on the sauces!)
Everything involving food is screwed.
Soda in the US is batshit crazy, and has gotten way worse over recent decades. People will have the equivalent of a couple of candy bars worth of sugar with a lunch (and then do it again for dinner... plus have the equivalent of one or two more candy bars between meals) when they'd probably be grossed out by the idea of having a pile of skittles or something with their burger. But liquify it, and it's fine I guess?
We have free refills (was rare until some time around the late '90s—see the '80s film Gleaming the Cube where there's a sign on a Pizza Hut in a scene near the end of the movie advertising a special on pitchers of soda, which probably seems weird to anyone used to just having their soda constantly topped off, or walking to the fountain and doing it themselves) so it's easy to thoughtlessly sip down three or four glasses of soda with a long meal, and to-go sizes at fast food joints have ballooned in size in the last 20 years or so, like, the medium sizes are often larger than what I'd have classified as a large before.
>If you eat out, portion sizes are off the scale
And yet in a sister thread about Deliveroo we have people talking about what a "game changer" the delivery services are, eating 2 takeout meals a day without really understanding what's in the food. People eat too much.
I wonder how much of that is education.
Most people also don't seem to know that weight loss is simply Calories in - calories out, what their BMR is, how to track calories. Most people, even educated people, still seem to believe things like they have slow metabolism, that herbal teas can help, doing situps will reduce belly fat, and number of dumb shit the market tries to sell.
As a nation were just far too focused on $$$, and instead of focusing on fixing the root of the issue, were only incentivized to bandage the problem with producing more things that will make $$$. Sell shit food, people get fat, sell crap products for weigh loss, drugs, surgery, etc
Rehashing my regular humans are not calorimeters post.
Metabolism is driven by hormones, it’s very possible for signaling peptides to prevent weight gain no matter how much a person eats.
While a person who eats nothing will clearly lose weight knowing that isn’t helpful as it’ll lead to a substantial loss in quality of life and most probably it is not long term stable.
In my case I have ME/CFS at the same time that I have uncontrollable weight gain, I also did extended fasts to keep the weight off as best I could. It wasn’t a willpower thing, having to manage both while making enough money to survive is incredibly difficult and it was impossible to keep all the plates spinning at the same time. Post Exertional Malaise is very real for some people and triggers can cause me to be bed-bound for months on end. Thankfully not so much anymore since I’ve found a good combo of very strong medications.
When almost half the country is obese/overweight, these kind of medical conditions are not the cause. For 99% of people it is not a metabolic disorder.
What I am talking about is people saying things like "Wow you have fast metabolism", without even understanding what metabolism is. Having twice as fast metabolism would mean my body requires twice the amount of calories for the same cellular activity. That'd be terrible!
The truth is I am skinny because i barely eat and if I eat 500 calories above my calculated BMR, I gain 1 pound a week just like the science suggests. I think this is the fact for most people.
>While a person who eats nothing will clearly lose weight
That's a strawman. What I am saying is take your BMR+caloric expenditure from exercise - 500 calories, not starve yourself.
When giving a generalization it's important to constantly note that exceptions exist. On the percentage of exceptions I think it's higher than commonly thought for a few reasons, most autoimmune disorders are still undiagnosed and will remain undiagnosed for the duration of the persons life. Consider hEDS for example, a walking bag of symptoms yet still 20 years to get diagnosed from onset of symptoms for those who are eventually diagnosed - again most are never diagnosed.
The other reason is that autoimmune conditions can be induced - it's not a genetic switch where you have it or you don't though there is a substantial genetic component especially with regards to susceptibility. People with my genetic background hEDS from multiple TNXB SNPs are extremely susceptible. The US population is also in new circumstances - we're several generations into the generally accepted medical advice that intermittent fasting will impair your metabolism. Prior generations would fast much more frequently than todays, they would just call it skipping meals.
While what you are saying is technically correct the framing of it leads to poor conclusions and suboptimal strategy, it will meet the stated aim of weight loss but not meet the implied aim of a maintainable lifestyle. The source of the calories is incredibly important given the effect that has on the hormones, and the cadence of calories is also very important. Instead of counting calories a person would be better of eating one meal a day of heavy caloric foods with the occasional multi-day fast would be far more productive. Augmenting this with a GLP-1A would be even more productive.
That's a good point but consider that a lot of modern countries, were not seeing the same obesity epidemic. Its hard to believe the difference between say 5% obesity and 40% obesity is from metabolic disorders in populations.
>While what you are saying is technically correct the framing of it leads to poor conclusions and suboptimal strategy, it will meet the stated aim of weight loss but not meet the implied aim of a maintainable lifestyle. The source of the calories is incredibly important given the effect that has on the hormones, and the cadence of calories is also very important. Instead of counting calories a person would be better of eating one meal a day of heavy caloric foods with the occasional multi-day fast would be far more productive. Augmenting this with a GLP-1A would be even more productive.
I think you're right that there is an effect, if you have any data to back this up I'd love to this see. My assumption is the effects were talking about (in anyone who doesn't have a metabolic disorder), is a difference in 100-200 calories in metabolic rate. In my personal experience, which I admit is not the most convincing, simply counting calories regardless of source tracks very accurately with the expected weight gain/loss based on estimates.
NONETHELESS, I think my original point stands, that there is a ton of misinformation on how weight loss works.
You have to be careful how you define metabolic disorder, do you mean entirely genetic of which there are not many, or do you mean auto-immune of which there are very many. To the point I'd even suggest that it's the dominant factor. Also there are no places in Latin America which has 5% obesity - it's more like 5 to 20%. Really only leaves Sub Saharan Africa, and parts of South East Asia. Additionally Europe is 5-10% so it's not a 1st world 3rd world split as you are presenting.
Anyway, if you are interested in researching check out the field of dysautonomia - there are many good books on the topic. It's an established science but not well known so people are unlikely to come across it by chance.
The main problem is that these conditions are severely underdiagnosed, thankfully people can now access GLP-1As without diagnoses so are no longer reliant on the competence of doctors.
I am comparing modern countries so that relatively a lot of the factors, like access to food, stay the same as the US.
My question is, why does Switzerland, Norway, Sweden, France, Denmark have a <20% obesity rate, and Japan, South Korea have <6%, but the US has 40%+? Certainly this isn't all from metabolic disorders, undiagnosed or not?
You can also perhaps compare data historically. People have never been this overweight, and likewise people have never been eating this many calories. You can a historic chart showing caloric intake and BMI are strongly correlated (both countries with higher intake are higher BMI, and over time, rise in caloric intake is associated with higher BMI) https://www.sciencedirect.com/science/article/pii/S030691922... https://ars.els-cdn.com/content/image/1-s2.0-S03069192220005...
Lastly, metabolic disorders can be caused by being overweight and inactive, so I think the causality is often opposite the direction you're suggesting.
Your logic is scattered and incoherent. You still haven't pinned down your definition of metabolic disorder, as mentioned my definition includes those caused by auto-immune. I explicitly stated that poor quality of food eaten too regularly is causative in many cases, genetics and lifestyle also plays a factor. You're hung up on the number of calories, my position is that is entirely secondary to what those calories are and the cadence of intake. There needs to be a gap in the intake for the natural GLP-1As to take effect. The point of having a mental model is to help make wise choices to optimize an outcome - your model is reductive and far too simplistic and elides many important factors that should be considered. Your position was more tenable in the absence of the data we now have. GLP1-As work, people know it works, and no amount of 'diet and exercise' is the one true path to enlightenment religiosity is going to cause people to unlearn it. I understand the strong desire to blame people for their choices, empathy is painful, and I understand the assumption that there is a price for everything - that nothing comes for free. But that presupposes a prior optimal homeostasis which for a variety of reasons we did not have. Modern diets / lifestyles created a problem that now modern medicine can help with. As a side benefit the medication works for those with my genes where diet and exercise simply wouldn't work. And in my case it's not a modern ailment, people with my genetic profile have had a rough life since before Hippocrates.
In 2018, 73.6% of american adults were overweight, obese or severly obese.
https://www.niddk.nih.gov/health-information/health-statisti...
Are citizens of skinnier countries better-educated, then become less-so if they move to the US and (typically) pack on weight?
If it's not education keeping other countries skinny, why would adding more education be the way we get out of it?
(This works for other explanations, too, like "oh they have more willpower"—so do they lose willpower if they move to the US? No, more likely, a complex combination of factors mostly outside individual control are why they're skinnier in their home country and fatten up after moving to the US; more likely, it's harder to be skinny here)
>Are citizens of skinnier countries better-educated, then become less-so if they move to the US and (typically) pack on weight?
"skinnier" countries have way different lifestyles, less driving, more walking, less fast food culture, etc. They don't need to be educated on weight loss because they naturally are not prone to it due to these socioeconomic conditions.
Yes! One thing that would be pretty likely to work is radically changing our city layouts, patterns of settlement, methods of commute, density of living, food quality, food prices & price structuring, worker protection & time-off laws, and a bunch of other stuff.
In the meantime (so... indefinitely, because moving the needle on one of those things would be the work of a lifetime) we now have drugs that can do it.
> keeping other countries skinny
Those countries basically don't exist, or rather they just haven't caught up yet. From 1985 to 2016, there are 117 countries where obesity has increased by more that 10.0% (in absolute terms). In no country was the increase less than 1.9% (which was vietnam, where 1.9% in absolute terms is a 10x increase in the percent of people who are obese).
I lost weight by measuring calories, shedding ~25% of my body weight. It's still a battle and will always be. I keep exercising the whole time - I'm training for my first marathon right now (I've run the distance before, just not in an official race), but my weight slides up, I adjust, it slides back down. I think some people are just built to like food, it's not a matter of education.
> Most people also don't seem to know that weight loss is simply Calories in - calories out
It is a problem of education. For example, in reading the common research that shows basal metabolism, which you can’t control, will rapidly undo most of your conscious gains from caloric balance manipulation. And that in those with severe metabolic syndrome, the body will reduce BM to starvation levels before giving up a single fat cell.
Weight loss is not simply calories in - calories out. Fat is not burned and its metabolism does not change your weight.
Oxygen/CO2 exchange in the lungs is also a major component of weight change. Further, your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption.
And that's just addressing first order weight parameters.
>your body homeostatically manages your metabolism so in the long term you often return to the same weight regardless of your current calorie consumption
Then exercise more. That's how you increase the "calories out" part of the equation.
Yeah, it takes willpower.
Or it doesn’t take any willpower at all. I certainly don’t have to do this, and I’m thin. I eat whatever I want, whenever I want.
So why can I do that, but others can’t? It would be comforting to just say that I’m better. It would also be a lie.
There are generally a few answers to this. But they all boil down to:
* You never used to be fat.
Once you become fat, your body's homeostatic set point is permanently altered. Your body never destroys adipocytes — it only shrinks them. If you stay within some range of your current homeostatic set point, your body will either increase the size of your adipocytes, or decrease their size, depending on whether you're over- or under-consuming. But, after a certain amount of overconsumption, your body will actually create new adipocytes... And once you have them, you can never get rid of them, minus expensive and dangerous surgery.
The best you can do is shrink them. But, keeping the adipocytes shrunken takes significant willpower. So basically, once you get fat, you're going to have a hard time.
Pretty much the only alternative is somehow tricking your brain/gut into not getting hungry when it "should." Ozempic, etc seem to somehow allow you to not feel as hungry even when your adipocytes shrink, or at least alter your perceived set point to be more-shrunken. Bariatric surgery is similar although much more dangerous. (Liposuction actually removes adipocytes, but it's quite dangerous — and it doesn't remove visceral fat cells, which are the worst kind of fat from a health perspective.)
Now, there's a separate question of "why do some people get fat initially?" And that can result from poor childhood nutrition, or genes (e.g. Samoans), or exposure to certain chemical compounds (e.g. certain psychiatric medications), or natural aging (recent research indicates middle-aged mice, and probably thus middle-aged humans, have their stem cells trigger more adipocyte production), or just lifestyle. But it's the initial weight gain that ends up trapping people into the higher homeostatic set point, which is very difficult to recover from, even with dieting and exercise, since you will need to keep yourself basically constantly hungry either by eating less or by exercising much more even after you "lost" the weight — because while you lost weight on the scale, you didn't lose adipocytes, and adipocytes do not want to be kept empty.
I don't disagree that increased exercise is associated with weight loss. I don't think I denied that. We're mainly disagreeing about mechanisms. Ultimately, fat metabolism does not violate the conservation of mass/energy.
> willpower
I mean, sure, but if it was just willpower for everyone then we'd all speak 10 languages, play piano, be buff as hell, be emotionally stable, and no one would be an alcoholic.
But we're squishy apes that are regulated by hormones and live busy messy lives with cars that are probably needing a tire rotation 3000 miles ago and putting it off a few more miles won't really hurt.
Weight loss is absolutely a result of CICO, please site a source that states otherwise.
I have never heard another source citing Oxygen/CO2 exchange as a factor for weight change, again, please site a source. O2 levels are certainly a factor of cardio health which can be correlated to overall health and weight.
Yes, macros also matter. But, nothing matters as much as the simple math of calories in/calories out. Its disingenuous, borderline irresponsible, to suggest otherwise.
"Burning" fat doesn't violate conservation of mass/energy. Instead, weight loss occurs primarily through co2/oxygen exchange that is connected to metabolism.
https://www.bmj.com/content/349/bmj.g7257
(note I don't totally agree with this paper, and agree that if you eat almost no food, you will lose weight, and that exercise definitely seems to increase the metabolic rate and increased mass exchange in the lungs. Like I said, it's complicated).
I'm not being disingenous or irresponsible- I'm describing mainstream science based on biophysical data.
I don't think its accurate to say "weight loss occurs primarily through co2/oxygen exchange". CO2 being breathed out is the just the end product of weight loss.
https://www.bmj.com/content/349/bmj.g7257 is one analysis of oxygen/CO2 exchange being a major component of weight loss. As the authors say, it's really a question of chemistry; the CO2 you metabolize from your fat has to go somewhere.
To be clear, I think your instinctive reaction is correct. It would be extremely silly for someone to read this analysis and conclude that they'll lose weight if they learn some special breathing technique to maximize CO2 output. The point is that "calories in - calories out" as a diet strategy is the same kind of error.
By the way, if you ever want to start a scientific argument, bring up this paper among doctors and scientists. It never fails to start a big argument that is usually concluded with "human metabolism does not violate the conservation of mass/energy" (many doctors and scientists believe that "burning fat" with oxygen causes you to lose weight directly).
It is calories in/out. Other mechanisms factor in, but I’ll bet anyone my bottom dollar they’ll lose weight if they eat 700 kcal/day.
Yes, breathing is literally how weight is lost, I’m not sure what your point was there.
This is normally because those diets are unsustainable, or not sustained at any rate. If you change your habits such that you start introducing more calories, it's not a question of "if" you'll gain back weight, but when.
It's only fairly recently that we seem to have a better grip on what makes caloric restriction more sustainable, and accounting for effects like metabolic adaptation. Even then that information doesn't seem to reach most people.
Also understated is the impact of one's environment, and social support systems. It's much harder if you break from what your family and friends are doing. Some habits, I've seen with my own two eyes, can be regarded as an obligation.
I really believe the odds can turn around for a larger demographic, with a more optimal approach. Let's not forget that we've had far more invasive procedures than ozempic available to help facilitate weight-loss (like gastric bypass), and people still gain back weight on those, if they refuse to change their habits. Drinks, junk foods, and deep fried foods are not satiating compared to their caloric density, and that remains true regardless of surgery and pills. Nothing changes until it's internalized that binging has a price.
> Drinks, junk foods, and deep fried foods are not satiating compared to their caloric density, and that remains true regardless of surgery and pills.
But it doesn't remain true on GLP-1 medications, which is why they're so popular.
It does remain true, that's the entire point. With GLP-1 you can be more full than without, but that doesn't mean that a baked potato and french fries grant equivalent satiety! Your body also adapts somewhat to the medication.
If you factor in metabolic adaptation, then re-introduction of surplus calories will lead to regaining weight, even if they weren't as many calories as before.
For the reports of mediated cravings, also: some people don't just overeat from physical cravings, but for emotional satisfaction. A binge session on comfort food has almost nothing to do with hunger. This is something addressed through therapy, not pills.
I wouldn't argue for a strict equivalence, but research shows (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5073929) that people who go on GLP-1 drugs shift their food habits to decrease consumption of calorie-dense processed foods. It's hard to 100% prove this is causal (or that "calorie-dense processed" means low satiety), but it matches widely reported anecdotes (https://www.nytimes.com/2024/11/19/magazine/ozempic-junk-foo...) that GLP-1s cause hyperpalatable junk food to be unappealing. For me personally, I can't even eat a full slice of cake anymore.
I'd hold out for stronger evidence, because my own anecdotal experience is that those on GLP-1 periodically feel sick but otherwise still seek out the same foods they always had. Also they are very much still capable of binging, on days they don't feel particularly sick.
Diet and exercise don't work for most people, because they don't exercise enough and don't follow their diet. Simple as.
"It doesn't work because it doesn't work. Simple as."
Yeah, we all know why it doesn't work.
Is it normal to expect a process to work when you don't follow the process?
It's normal not to call that an effective intervention when only a small minority of the population can pull it off.
Things that do work ultimately do so by that mechanism (of course!) but not via people trying to eat better and exercise more per se. They do it by changing the circumstances under which a person is making decisions about eating and living, so better eating and more exercise in-fact happen, consistently and enduringly.
From most- to least-effective, over the long haul, it looks something like this:
1) GLP-1 agonists & friends,
2) Move to a skinnier country,
[a large gap]
3) Months and months, probably with periodic long refresher-sessions every year or two if you want it to actually last, of high-touch expensive help from multiple specialists, amounting to hours per week. This is the gold standard for what "actually works" as far as what can be done as an intervention, before Ozempic and such, and its outcomes are... so-so.
[another large gap]
4) Basically any diet & exercise plans or attempts to simply "eat less and move more"
(throw gastric bypass and stuff like that in there somewhere, not quite sure where they fall)
Part of any process is the ability to follow it. If you tell me you can drive blind folded by just memorizing the streets and driving precisely -- does that mean the process really works if no one can do it?
Just like people are poor because they do not work enough to earn enough and spend too much money... Simple as.
"Stop drinking" doesn't work for most alcoholics, because they go back to drinking. Simple as.
"Don't commit violent crimes" doesn't work for most violent criminals, because they go back to committing violent crimes. Simple as.
"Stop gambling" doesn't work for compulsive gamblers, because they go back to gambling. Simple as.
"Have superhuman willpower in a domain where I don't feel temptation" isn't a cure, it's unempathetic judgment.
5% of the US population self-report alcoholism.
Why does food addiction encompass 40% of the US population?
Possibly because you can completely avoid alcohol but you can't completely avoid food. Some large percentage of people who would have been addicted to other substances (due to less than optimal nature/nurture) but didn't, because they did not take those substances, instead became addicted to the substance of food.
It might be more useful to see addicts to every type of substance as a large pool of anxious people who came across a substance to self-soothe, and figure out how to address the anxiety problem first.
The US population probably isn't much different from the rest of the world, in that regard. What's different about them is they live in the US. Drop foreigners from skinnier countries in the US, and, as a cohort, they'll gain plenty of weight (as with lifelong Americans, some individuals will buck the trend, of course)
It's a complex social-environmental, economic, and political problem.
Cheaper, much easier to get, socially acceptable everywhere, ...
You won't get judged for eating alone at home, but start drinking alone at home...
[flagged]
> Diet and exercise works.
We literally have the science, and, over a population and over time, no, they per se do not.
The things that do mostly aren't accessible to normal people (three or four professional nutritionists and trainers and doctors helping out several hours per week; moving to a skinnier country) so "diet and exercise" has been the only available course to recommend, and it's better than nothing, but it's depressingly ineffective.
This is precisely the difference between could and does I was trying to highlight to address this kind of thing in advance: diet and exercise could work, like, on paper they work every single time! Hell, technically, they're even essentially all of the mechanism by which methods that do work, achieve their effect, just indirectly. But just trying to improve diet and increase exercise directly does not work, not over a population. For outliers, yeah, but for most, no. Improving those is a an effect of approaches that do work.
If it's not diet and exercise, what is it? Obesity is a relatively new problem. GLP-1 also seems to work - primarily through addressing diet. So again, curious what you mean when you say "diet and exercise" do not work.
>We literally have the science, and, over a population and over time, no, they per se do not.
Can you share it?
If someone refuses to eat much less food to get their weight under control, I don't see how a nutritionist or personal trainer would help. Maybe a psychiatrist could help them break their addiction.
> Maybe we should be asking people in shape what works
The answer has been mentioned in other parts of this thread:
They simply don't feel the hunger that obese people do. Some people eat a larger than normal lunch and then won't feel hungry at dinner time and will either just have a snack or skip the meal entirely.
Others, like me, can put down a 22 oz steak and then still feel hungry again just two hours later.
It's not a matter of habits, it's about what their body tells them. My body is always telling me to eat even after eating an irresponsibly large meal, and ignoring those signals difficult. Those people that are in shape don't have that problem. Their body is telling them to eat less.
From my limited experience, I can tell you that their body DOES tell them to eat. The trick is to not.
It's great that the trick works for you. From the experience of the entire population we know that it doesn't work at scale. Congrats on your exceptional self-control but what do we do about everyone else?
Diet and exercise would work, if not for the fundamental problem: most people cannot apply those methods.
Why they can't, I am unsure. Is it because hunger is a stronger drive than long-term planning? Is it because food is, like many other products and services sold in a capitalist economy, incentivised to develop in maximally addictive ways even without a deliberate choice by any supplier? Is it because advertising really does influence people? Overuse of antibiotics makes people hungry? Something else entirely?
Whatever the cause, people can't apply those methods. Which means they don't work for most people — not that they can't work for most people, they just don't.
The realistic solution puts car manufacturers and certain food processors out of business (unless they learn to compete as export-focused/non-addiction-based businesses), so... Yeah, maybe not so realistic. But the obesity stats of countries with robust public transit, walkable neighborhoods, biking infrastructure, and restrictions on highly-processed food speak for themselves.
In the end - as with so many issues - the question is if policymakers are going to throw capitalists or regular people under the bus.
Right, the non-drug solution that would actually work (we can observe it working in countries with different infrastructure, healthcare, culture, city design, food quality and costs and cost structures, and more—we can be fairly sure it's some combination of that stuff because the folks who live there put on weight if they move to the US) is "upend US society in a bunch of ways" so is, realistically, not workable, at least not on the scale of human lifetimes, though it still wouldn't be a bad thing to try to move somewhat closer to.
True, but some people might have favorable gut flora others do not (there was evidence of this with fecal transplants, with recipients acquiring the metabolic profile of the donor). The meta issue is that the human body and its interaction with gut flora and other systems are still somewhat unknown, and we are still simple monkeys using hammers on inputs of the body.
Why do we need GLP-1s? Is it because of Western diet? Misfiring reward centers (GLP-1s also appear to quell addictive behavior around alcohol and hard drugs)? Broad antibiotic usage along with more sterile living environments causing misbalanced gut flora (not producing sufficient quantities of natural GLP-1)? The most exciting phrase in science is not "Eureka!" but "That’s funny...".
I thought the long term solution was gene therapy for GLP-1 consumers, but now believe it's going to be probiotics that encourage gut flora that excretes sufficient quantities of GLP-1 for the desired metabolic outcome (based on most recent evidence and findings). If feasible, this is exciting because it is much harder to gate this therapy via the medical industrial complex (primarily insurance, pharma, PBMs, etc).
Scientists May Have Found a Natural Alternative to Ozempic - https://news.ycombinator.com/item?id=43874436 - May 2025
> GLP-1s also appear to quell addictive behavior around alcohol and hard drugs
Being on D2 agonist which has the exact opposite effect I wonder what taking both would result in.
> It just doesn't seem to work with everyone
Without a very precise definition of "work", these discussions quickly degrade to near uselessness.
There is a very large difference between "telling patients to exercise more and eat less doesn't result in long term weight loss" and "exercising more and eating less doesn't result in long term weight loss"
The former is true, and the latter is not.
I agree that from a clinical perspective the former definition is more relevant than the latter.
It's also "exercising more and eating less until you reach a target weight" doesn't result in long-term weight loss, while "exercising more and eating less for the rest of your life" does result in long-term weight loss.
Yes and no. Weight loss requires you to eat fewer calories than you actually burn for a period of time until you reach the weight you desire. Once you reach a desired weight, you can start eating more calories again, but less than what you were eating since you no longer burn as many calories due to less weight…
So, the losing weight part requires even more restriction, and then a much smaller amount of restriction once you reach your goal.
It’s not unreasonable to reduce calories to something like 1500/day when dieting. But very few people need to stay at that amount for the rest of their lives.
The way Ozempic works is basically by controlling desire so you eat less - it's the eating less (less calories consumed) that makes you lose weight. As you lose weight you will also be able to exercise more easily, which again will help to lose weight (more calories burnt).
At the end of the day it is just about diet and exercise - not eating more calories per day than you are burning via exercise.
> Plenty of people have lost weight sustainably with diet and exercising. It just doesn't seem to work with everyone.
The problem is, staying healthy is a matter of privilege.
You need to be able to afford to eat healthy (ultra-processed industrial food that's loaded with sugar is often much cheaper than quality produce), even if you have money, a decent chunk of Americans live in areas that are classified as "food deserts" [1], even if you are not in a food desert you still need to be able and have time to get to a store selling quality food, and you need someone with time available to cook healthy meals out of that. It used to be easier back in the time where one income was enough to feed a whole family and the women stayed as housewifes to actually do that, but these times are (thankfully) long gone.
Exercising suffers from similar "problems of privilege". Either you got the money and time to spare to go to a gym, or you got the money and space in your home to install your own gym... or you need actually safe roads where you can walk, jog or bike, and most of the US is so utterly car-dependent that it is outright unsafe to walk.
And on top of that you got the whole "living while Black" issue, with egregious instances like a pregnant Black woman arrested for walking her dog [2] - it's no surprise that the Black and Indigenous population has noticeably higher rates of diabetes [3] or oral health issues [4].
And on top of that, you got the whole issue with educating children about healthy foods, their parents being too poor to afford healthy foods, and that setting up these children for childhood obesity which perpetuates into adulthood. A lot of that is closely correlated with ethnicity and wealth as well.
It's a systemic issue, an insanely complex one at that, with no easy solution to be found - and certainly not a failure of any individual to stay healthy.
[1] https://en.wikipedia.org/wiki/Food_deserts_in_the_United_Sta...
[2] https://ca.news.yahoo.com/pregnant-black-woman-ticketed-walk...
[3] https://healthequitytracker.org/exploredata?mls=1.diabetes-3...
[4] https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs...
Strongly agreed.
Recently, I found a gym with group training classes which I absolutely love. They have a great sense of community, and now that I've found them I find it easy to motivate myself to show up and work out.
I have the good fortune that I can afford the $150/month fees. Not everyone can.
I think I get what you're saying, but surely the same could be said about all self-control issues. Exercise and diet is "all" it takes to lose weight, but the question is whether you have the self-control to do that yourself.
Self control and will power are loaded terms for chemical and electrical operations of the brain; executive function is an improvement. Regardless, it isn't magic or special, just wetware ops. Bugs in the human hardware or software? We patch the human, if we can and if they wish.
I wouldn't call it bugs - more cultural. Approx. 40% of Americans qualify as obese, compared to 28% of Canadians, 19% of Spanish, 15% of Swiss, etc.
https://data.worldobesity.org/rankings/
I'm originally from the UK (now US), which doesn't score so well either (28%), but the differences are obvious - massive portion sizes in US from deli sandwiches, foot long subs, movie buckets of popcorn, giant size sodas. People driving everywhere rather than walking.
It is actually exercise and diet, that drive reward and hormones.
For example, exercise has appetite suppression effect [1].
[1] https://med.stanford.edu/news/all-news/2022/06/anti-hunger-m...
Diet has appetite suppression effect [2].
Man, my diet suppressing hormones must be in the same place as my runner's high because when I get home from a long run the thing I want to do most is have a snack.
Runner's high is due to release of endocannabioids: https://pubmed.ncbi.nlm.nih.gov/35081831/
Please, switch to resistance exercises. As these do not release endocannabioids but endorphines, they have appetite suppression effect.
Resistance exercises help with sarcopenia and lower risk of all-cause mortality.
Yeah I cut down to one meal a day and after a year I just CANNOT eat as much as I used to. The result is permanent as far as I can tell. Or at least it will take me a year of going back to old habits to make my stomach big enough again
I usually have two meals a day, at evening and before sleep. Always after I am done with the work and training.
I think the change you experience is not about stomach size, but ketosis. Ketones are such a great source of energy compared to glucose, that raising glucose level by eating feels like you lose something, for me, at least.
If it were just a "hormone and brain chemistry issue" there wouldn't be huge differences across populations that can't be attributed to only genetic factors.
True if you assume we can't change the (societal) reward environment we live in.
What does the data tell us?
https://www.cdc.gov/obesity/adult-obesity-facts/index.html
https://www.who.int/news-room/fact-sheets/detail/obesity-and...
https://en.wikipedia.org/wiki/Obesity_in_China
https://en.wikipedia.org/wiki/Obesity_in_India
https://www.bloomberg.com/news/articles/2025-03-03/china-ind... | https://archive.today/UeI7X
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
> Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity.
Mostly it’s an issue of abundance in calories. Historically most people have worked such physical jobs in environments with limited food supply. In that environment it’s way harder to get obese, regardless of genetics or gut biome.
This is the same logic a lot of vegans use. Food is unlimited nowadays, so it doesn't make sense to indulge in the most resource intensive foods(meats) because it isn't feast or famine anymore.
Nothing we do nowadays is "natural" or "the way our ancestors did it" so its weird how folks cling onto "caveman diet" like it's some amazing thing. It's just excess consumption and a status symbol.
Prehistorically we straight up starved a lot of the time. Being able to get fat when in a time of abundance was an evolutionary advantage, we'd need that for the lean times. The fact that we are never in lean times is the problem, we're simply doing what our body was built to do.
This is dumb. It's like saying that weight loss is not a matter diet and exercise, but an anatomical issue of the stomach, that needs to be fixed with bariatric surgery.
No. Ozempic is a form of chemically-induced diet. Less invasive than bariatric surgery, but still just a hack to force you to consistently eat less. You can achieve the same by hiring a guy who follows you 24/7, and punches you in the face whenever you start eating too much.
This is a better take.
This is still a form of class based dieting.
But to be clear, a bro punching you isn't the same as altering your hormones.
Getting punched in the face releases all sorts of hormones in your body, trust me.
Considering how expensive it is, I'm surprised so many people are doing it.
Here in the UK, I'd much rather just cut my diet a little bit. Faced with the choice of eating less or paying around £250 a month for the maintance dose, that's actually a huge motivator to get me to diet.
I guess the ... "fat" lady has sung?
Also relevant, compounders are being sued by Eli Lilly right now. The compounding loophole is being welded shut:
https://glp1.guide/content/eli-lilly-suing-glp1-compounders-...
Only a partial patent expiry for Semaglutide in 2026, then full in 2033:
https://glp1.guide/content/patent-expirations-for-glp1-recep...
There's no free lunch, and anecdotally I know people who've gained back weight both after surgery, and after Ozempic. These are not tools that let you "do whatever you want" and still lose weight, but people have been sold the expectation that no habitual change is necessary. Even if your satiety is dialed back, some products are relatively non-satiating yet calorie-dense (e.g. sugary drinks and alcohol, junk food and deep fried foods).
You don't get to binge for free. In the words of Alan Carr (of "the Easy Way to Stop Smoking" fame), if you view a change in dietary habit as a sacrifice, for instance focusing on healthier food, then you will not succeed.
All that being said, it may still be useful. A popular view of pharmaceuticals for primary disorders like for instance insomnia is that they can help "bridge the gap" or get a start and recovery, but that they cannot be relied on in the long-term. Your chemistry adapts. That is similarly the most generous view I have of these products.
Anyway, the WW approach has obvious limitations for the same reason low-fat or low-carb does. In WW they use an arbitrary point system to obfuscate restriction, by encouraging protein and low-calorie density foods. Some foods are 0-1 in points (e.g. 0% cottage cheese), some are high regardless of how healthy they are (avocado). You can easily see the problem with this: you quickly hit a wall where you aren't automatically reducing calorie intake by mere virtue of what you are eating. The same thing happens with low-carb and low-fat: what are you going to do once you've cut out all fat and all carbs? Eat negative-carbs?
For sustainable WL of a large amount of weight, there is no way around counting. You cannot "intuitively" do it. And here it's important to stress that there's a major difference between avoiding weight-gain, and losing weight. If you're a person of average weight, you don't need to worry about counting jack if you simply have good eating habits. This is not enough when it comes to caloric restriction.
edit: re reduced cravings, some don't just overeat from physical cravings, but for emotional satisfaction. A binge session on comfort food is not about hunger. This is something to be addressed through therapy.
Hopefully during restructuring they can follow a plan to get leaner in a sustainable way.
Initial adjusting to a calorie limited diet is hard. Especially in a world where we are constantly bombarded my messaged specifically designed to trigger us to crave something and then buy it. But after an initial period or cravings and digestive unrest, the body adjusts to the new reduced calorie- or new food regimen- and you no longer feel hungry or have stomach upset.
We already have built-in "ozympic" functions- we just need to manually activate them. These drugs really do help some special cases, I don't deny that, but the fact the broad population have access to these drugs is not a natural state. We have no idea what the long-term effects will be. Long-term artifically induced effects of illness will eventually cause problems- erosive esophagitis and hemorrhoids are two examples- that have long-term health implications. Better to bite the bullet, if you have the ability, simply reduce your input, focus on foods that last longer in the digestive tract (whole plant foods), giving us fewer or more moderate glucose spikes, less craving and hunger later. Easier transition.
I've been tracking the weight loss industry for years through biohacking communities. Weight Watchers has been on a steady decline for a long time. From what I can tell, the biggest issue was regaining weight after stopping counting calories. Services like Noom likely ate a big chunk of their market share since they focus on underlying habits and mental health issues to make the transformation more sustainable. Weight Watchers also had a very old school MLM vibe that made it hard to attract younger generations. I'm kinda surprised they lasted this long.
> We have no idea what the long-term effects will be
Obesity kills before those long-term effects become relevant.
I've lost a significant amount of weight using the Obesity Code: https://www.doctorjasonfung.com/the-obesity-code it focuses on increasing our insulin sensitivity and reducing the overall levels of insulin in our bodies.
He focuses on not counting calories but instead focusing on eating real food (no processed stuff and avoiding sugar). He uses the the example of 100 calories of sugar does not impact our body the same as 100 calories of olive oil. This is a prime example of the McNamara Fallacy.
Here's a video here: https://www.youtube.com/watch?v=OgmFEb0b0TI
I'm a fan of weightloss in general, be it ozympic style or not; however, if you can do it naturally it's more cost effective. Dr Fung focuses on when you eat (intermittent fasting) and what you eat (avoid processed foods)
Heart disease and obesity are among the highest causes of mortality in the United States. This idea that everyone would be better off "biting the bullet" does not play out in reality.
Unless you are going to magically fix our food supply and reign in the economic incentives for selling garbage food, chemically induced weight loss is still a better option.
Making people sick and selling them the cure is a sanctioned part of American Capitalism. Making it illegal to do such things is demonized as socialism.
Telling people they are individually responsible for fighting a system designed to make them fat and then die might make you feel good and correct, but it's doing fuck all to solve the issue.
All is working as intended by the ghouls who drive policy that is friendly to the economy. Turning the entire country into one slow motion concentration camp.
This was my personal experience. I was hungry for a few weeks while transitioning to a daily 15-16 hour, but now only get hungry right before meal time.
I try not to eat or drink anything with more than 10 calories while "fasting", so mostly just drink water.
The worry about possible long term effects is legitimate (but not very significant, considering these drugs have been in use for quite a while for other purposes)
But, "it's not natural" complaints are, frankly, bullshit. Nothing about how humans live today is "natural" and we're better off for it.
> We already have built-in "ozympic" functions
The drug works by literally making it mentally easier to eat less. It's caffeine for discipline instead of energy. There's no "built-in" that works like that.
> natural
Yeah, "natural" would be living in constant fight-or-flight fear from being eaten and/or attacked by a neighboring tribe. Probably always quasi-starving and having low-level diarrhea from eating scavenged rancid food and dying before your 28th birthday.
> But after an initial period or cravings and digestive unrest, the body adjusts to the new reduced calorie- or new food regimen- and you no longer feel hungry or have stomach upset.
I don't think there's any evidence that this is actually the case.
