I'm not a doctor and this isn't medical advice, but I had extraordinary success with weight loss doing intermittent fasting (8 hour feeding window, 16 hour fasting window) + very low calorie diet (1000 kcal/d) + keto (20g net carbs per day max) + armodafinil as an appetite suppressant.
Like, 'lost 80 pounds in 3 months without exercising' levels of success.
I know there are many unhealthy things about this weight loss strategy, but it would've been even more unhealthy to stay 'morbidly obese', rather than my current state, which is classified as just plain old 'overweight'
Want to +1 to this. I’ve struggled with weight my whole life. I bounce back and forth, but every time I’ve lost significant weight (30-50lbs) it was through intermittent fasting.
I actually did take semaglutide recently just to try it. What it does is make you not hungry or have cravings. It was working, but I stopped because of the side effects. I was constantly queasy for 2-3 days after injection and My workouts were interrupted due to those stomach pains. I stopped and am just going to start intermittent fasting post the holidays.
Some people don’t have side effects so it may be worth it for you.
Armodafinil seems to have filled a similar purpose for me that semaglutide does for you. Headaches from it are solved by taking choline, and the insomnia is minimized by taking it before 7 AM and only taking it every other day (long half-life). It's prescription-only in the US, but it's OTC in India and there are plenty of companies that will send it to you without a prescription. Even though it's a stimulant, it's chemically not an amphetamine, and I suspect that's part of why I've never had troubles with customs. Also makes me a 10x coder. I get more work done in a day on that than I do in a week off of it.
Again, I'm not a doctor, and this is not medical advice.
I use it for weight loss, but it has auxiliary benefits - like increasing my productivity at my tech job, which is an aspect I think some others on this tech forum might appreciate as well, in addition to the appetite suppression.
Similar experience here. Sedentary lifestyle but on a 20/4 intermittent fasting schedule without any effort towards calorie restriction I've lost around 30lbs in 4 months. I've struggled in the past with calorie restrictions because it introduces a complex negotiation into my life, every calorie matters and I must consider the value of the enjoyment of a donut today vs. the discomfort I'll feel the next day because I'll be running on donuts instead of a healthy meal... but with intermittent fasting, I have a very simple rule: no food before 3pm and no food after 7pm. During that time I can eat whatever I want, which naturally gravitates towards good food because that's what my body craves after fasting, most days, but on days where I feel compelled to eat an entire pizza, so be it, that's fine, I don't have to think about it, I just eat the pizza (and something healthy too). I think it would be physically impossible for me to gain weight on this 20/4 schedule.
Sorry to rain on your parade, but you will regain the lost weight as soon as you stop with the appetite suppression regimen. The only permanent weight loss solution is to revamp the feeding paradigm by examining the core motivation for excess food and toxic quasi-nutrients.
Sorry to rain on your parade, but this was in fall of 2020 and I have not regained the weight. I still eat mostly keto, probably closer to an average of 1600 kcal/d now (I don't count calories anymore), and don't use the appetite suppressants anymore either, except for when I have a ton of work, maybe once a month average. I initially regained 20 pounds in the 6 months following the diet thanks to some rebound junk food, but it came back off once I got back to eating healthy.
Keto naturally leads me to lots of largely unprocessed whole foods. Eggs, cheese, chicken, milk, some red meat, butter, etc - organic / cage free / free range / not treated with hormones, of course.
Most people who rapidly lose weight will gain it back. The keyword here is most. There are exceptions to pretty much everything. There's no reason to doubt this person is one. That doesn't make their strategy good advice.
Before the regimen where I lost 80 lbs in 3 months, I regularly ate fast food, pizza, etc. After the regimen (off appetite suppressants, no longer calorie counting, no longer doing intermittent fasting), I still am doing keto, meaning I avoid the junk I used to eat that got me to current+80 lbs.
I suspect this permanent change in diet is what has allowed me to keep the weight off, though the more extreme regimen was what allowed me to lose so much so fast.
What about my story? I’m 170lbs down using keto and IF and have kept it off going into my 5th year. Also was an insulin dependent Type 2 diabetic who was off insulin 3 months in and haven’t taken it since.
So much to say on this subject but will try to keep this concise. This class of drug is absolutely a miracle cure but with some footnotes.
1. The problem it solves is obsessive appetite. I used to read about people saying things like "oh, I was working so hard, I forgot to eat" and I wondered how that was even a possible thing. This takes certain types of people from being constantly hungry to what appears to be "normally" hungry. If you are overweight because you are CONSTANTLY hungry, even right after you eat, this is the solution for you.
2. To everyone else, the people who just really like donuts or whatever, I am not sure what this will do for you. I don't mean it won't help, I just literally mean I have no idea, because my personal experience doesn't speak to this.
3. Intermittent fasting. Because it's impossible to talk about dieting without someone bringing this up. I think IF is wonderful, but, for people like me who have appetite issues, these drugs are helpful for following IF. But I would say the two are not related--they solve different problems.
4. I had zero side effects, but had to jump through an INSANE amount of hoops to get this stuff.
I just mean that in a perfect world (or even one with a normal health care system), my doctor should have reached out to me and said "hey, there is a new class of drugs that might help you". Instead, I had to hear about it on my own, read a bunch of studies, explain what it was to my doctor, then go through a ton of insurance back and forth to get them to prescribe it.
Wow, this is not a topic I expected to see on HackerNews!
One big problem with semaglutide is that it's really expensive to access - even with goodrx, wegovy (which has semaglutide as an active ingredient) can cost ~$1400*! So, for many people who are uninsured or underinsured it's simply not attainable.
My startup has been working on this problem all year and we just launched a semaglutide program for $149/month - including medication and provider visits.
We're currently hiring frontend and backend developers to make healthcare more affordable for people with chronic conditions. If you're interested apply here and let us know you come from HN!
How can HenryMeds associated pharmacy get semaglutide? Someone has to be be making it for them, which is confusing. I'm tempted to sign up, but there's a really weird sense where it seems it can't be real because there's no apparent source?
I took it for about 12 months when I lived in Portland and it was covered by OHP. I went from about 370# down to 290# in that time.
I'm now on Kaiser in the Bay Area, and they do not cover semaglutide. In the short time I spent off of it, I gained 40#. I complained to my PCP (actually my series of 4 rotating PCPs -- medical staffing seems in disarray at the moment) and they found some injectable alternative for me (Liraglutide) which is more annoying being injection instead of pill, but I'm back to 290# after only 3 months with it.
I understand they're both in the same category of how they act. The semaglutide tastes absolutely horrible, and I've had some mild gastrointestinal effects from both -- I joke they they turn any sugar I eat into gas and discomfort, so that's their "secret" -- but I think if you're in the group who these have a profound effect for, it's worth a try I would think.
I have tried Liraglutide, have some sema in the fridge but not had a chance to test it. Both are proper injection pens from Novo Nordisk, expensive as f*ck.
I am one of those that experiences pretty unbearable side effects from it. The rate seems to be much higher than actually reported (something like 20% it seems). Nausea goes away after the first couple of weeks for me, but the lethargy never did, not even after 3 months. And the lethargy is BAD. Like, career-affecting bad. I would literally fall asleep on my keyboard at 4pm.
It definitely was doing the trick though, and if I had ANY energy to go to the gym in the afternoon (which I NEVER did), I could've lost a lot of weight. It just solved the hunger "problem" for me, it made me only eat for sustenance - but at the cost of being constantly tired.
I gave up after 3 months. Did lose a few kilos but the main interesting effect was the change in appetite. And I say change, not suppression, but it affected things like cravings and snacking as well as just making me full faster. I can definitely see why it would work really well for those who tolerate it.
Sema is meant to be better, but most people who have bad sides with lira have the same issues with sema, so I don't have my hopes up.
My wife is currently taking it. We live near a bunch of upper class white lady lifestyle type places that will prescribe for just about anyone, and she talked about it forever, but kept not doing it. I finally just bought her some from an underground lab.
She was nowhere near obese. Started at 5'6" 137 lbs. After five weeks, she's down to 123. No side effects. She just says food isn't appealing any more. At first, she kept making full meals but not finishing them, and eventually she started actually planning and making smaller meals.
There doesn't seem to be much doubt it works, but most people do seem to report at least experiencing some nausea. As a side note, I'm starting to get tired of every thread on eating and weight control getting filled up with intermittent fasting evangelists. I'm going to assume they mean time-restricted feeding, not real fasting, and there is plenty of research on this. In some people, it results in better diet adherence than simply eating less but at your pre-existing regular schedule. This seems to even be true for a more or less average of people. But it is not true for all people. Some people do really well on it. Some people do really terribly. This is true of virtually any dietary intervention. Individual variation usually exceeds the differences between group mean results of different approaches. Stop assuming that what worked for you will automatically work exactly the same for everyone.
If you have a BMI > 35, you should take it absolutely. You will discover quite fast if it works (you will feel fed quicker than usual).
I use this value because a BMI that high will cause without any doubt lingering issues with your body, and reducing it is extremelly important for your health (more than anything)
If you have a BMI between 30 and 35, you can probably do without if you pay attention to what you eat and what you cook. I had a BMI of 32, i cut it down with a sleep schuedule, then later fasted 5 days (under medical control) to understand that being hungry was OK and i did not have to eat something everytime i felt a small tingling, and that helped me not eating between meal. I'm not advocating for fasting, what i mean is that for this BMI (probably sightly lower, i have a weird body type), change in lifestyle can be enough and more important for your health. I started cooking and stuff too.
I understand that sleeping and cooking more is not always possible (it took COVID to take out the 45min commute time in my case), so if you don't have time, you should take medication. It has secondary effect, but being clinically obese does too.
If you have a manageable BMI (to me its 28), i don't think it will have any impact, because eating habit can only do so much without sacrificing too much. The only way i managed to loose weight since i hit 28 BMI is making my metabolism faster, IE high stress situations and sport. I started rock climbing (i'm more of a windsurf guy usually), this helped, i will reach 25 in a month or two. A caveat though: my ideal weight for climbing is now a lot lower than what it was before i started, reaching it would put me at around 22 BMI when i was aiming 25 a year ago.
I’m not on semaglutide, but I am on tirzepatide (aka Mounjaro), which is the newest drug in the same class.
Honestly, it’s like a miracle. I’ve been fat since I was 6 years old. I’ve occasionally lost weight (though never made it to “normal”), but only through pretty intense, focused effort to restrict calories. I’ve always gained it back (and then some) after I can’t sustain that effort. (Call it lack of willpower or whatever, but this is how it works for the vast, vast majority of people.)
Anyway, on tirzepatide, it’s simply effortless. Food is still good, and I still like to eat, but I don’t think about it all day. I eat a reasonable amount, feel full, and don’t have the urge to eat again for hours and hours. That’s honestly a new experience for me. My entire life “eat when you’re actually hungry” would have meant eating all day every day, basically. I’ve been losing weight at a consistent 2.5 lbs / week on this drug. I fully intend to be on it for the rest of my life (or other drugs in the class as they come out).
As for side effects: I’ve had precisely none. No nausea, constipation, heartburn, etc. I understand those are common but I haven’t experienced them at all.
I had the same experience. I did a medically supervised weight loss phase assisted by Mounjaro, which worked shockingly well for me. Very low calorie (800-1,000 per day), but still high energy and no hunger even under pressure. Steady blood sugar ( have a GCM just for fun), consistent weight loss, and no side effects.
I feel like I could have written this myself. And I am also fairly certain that someday the cause(s) of this constant hunger will be identified and we'll someday be spared of people criticizing our "willpower".
I asked my doctor about it and they prescribed it. They had previously prescribed Wegovy/semaglutide but it’s very supply constrained right now so I was never able to actually take it.
I have heard a lot about this recently and a number of people in my life ask about it. My mother in law takes Ozempic (which is similar) and had good results (she is a T2 diabetic).
If your doctor won’t prescribe it, there is a company called Calibrate that will work with your insurer to get it for you (https://www.joincalibrate.com/)
I wasn't impressed with Calibrate. The coaching aspect is very minimal and after several months of waiting (with no response from support) they let me know that my insurance wouldn't cover the treatment. They did refund most of what I paid but I was out $200 or so plus a lot of time.
It will stop your hunger, but you will still fight your bad habits or social eating. If you eat like “normal” you will have a bad time. Your stomach will hurt, you will feel miserable. Gotta have your partner help and stop eating out or eat separately for a few months.
I've tried both Liraglutide and Semaglutide. It definitely works, but it takes a while to dial in the right dosage that lowers your hunger but doesn't make you nauseous and miserable at the same time.
I can't get any of these medications. I've tried, I just can't afford it.
My company insurance won't cover any of them unless it's diabetes-only, and of course, I make "too much" (which really isn't even $50k/year) to get on any assistance programs through the pharmas themselves.
I'm in a similar position, but what made the last time different (down 120 lbs in a year) was education.
First step was simple calorie counting. You don't have to do it forever, but there are calories hiding in the most non-obvious places, and I'm convinced this is what sabotages people who think they should be losing weight but aren't.
For example, a breakfast of eggs and whole grain toast sounds healthy... but coat the pan in a little too much oil, and that's easily an extra 50 calories. Butter the toast? Easy to add another 50 calories. Do that 4 times in a week and you could have just ate a double cheeseburger, and the double cheeseburger would have actually made you fuller.
Now multiply small mistakes like that across your other meals and you have a recipe for feeling like you're starving yourself, not seeing results, and rebounding in frustration.
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I also used to think it was just a lack of willpower that caused me to eat out of control, but things like not getting enough protein, eating foods that are designed to be addicting, and multitasking while I ate, were all working against me.
I decided to stop using willpower as an excuse. If I gained weight, I analyzed why I had gained or overate without thinking "I need to be harder on myself" or "I need to be stronger". Often times patterns emerged, like "I didn't get enough protein that day so I ended up overeating at dinner", or even things as specific as "when I started to introduce food X into my diet, my weight loss slowed down" which revealed I was miscounting the calories on them.
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From there you can start to build strategies on your education. Like yesterday, visiting family I had barely eaten all day. They ordered pizza and I knew that was a terrible combination for me: ravenously hungry + delicious pizza felt like a recipe for overeating.
So as soon as they ordered the pizza, I drank a protein shake (150 calories, 30g of protein) and drank as much water as I could. By the time the pizza arrived, that "ravenous hunger" was just a dull hunger, I was able to eat a single slice and feel full.
The old me would have tried to power through that with "iron will", but failed, went back down after everyone fell asleep, and ate every single left over piece.
Sometimes you need to accept that willpower is not enough, and that's especially true in modern times. We've invented foods that simply could not exist before in terms of how addictive they are, and how little nutrition they provide.
That's why people can demolish a box of Oreos and still feel hunger, but try it with that many cookies made from scratch in a home kitchen for example, and those same people will just get sick. It turns out when you don't get to "cheat" with binders and artificial flavors optimized to the Nth degree by highly paid researchers, you can't really recreate the uniquely bad for you foods that these companies can.
My problem isn’t food education. I’ve worked with a dietician program supervised by a bariatric doctor. Whole Foods adequate protein calorie counting etc. works for a while but the need for constant willpower battle is a bitch.
My entire comment is about how I learned to accept that I can't rely on constant willpower, did you read the whole thing or discard it as just being "learn what macros are"?
Having someone else come up with a diet isn't really what I'm talking about. I'm talking about internalizing the stuff, so that it's not just a constant willpower battle.
I used to have the same "etc." mentality about all that "Whole food protein stuff", but actually sitting down myself and learning the underlying concepts rather than the fads was completely different than getting talked down to by a professional or reading some weight loss guide.
Just look at my example about pizza, I didn't have the willpower so I "shortcutted" around my willpower. If I had tried to make it a battle of willpower I would have lost. It's small things like that which make it less constant of a battle.
Same with not multitasking while eating, something I learned was that I overeat when I'm multitasking because it's harder to sense when I cross the line from hungry to full.
tl;dr, I didn't mean just "food education", as in learning to read labels, but learning about your own relationship with food, like the emotional component, the situations where your willpower is tested most, so you can develop strategies specific to yourself.
A dietitian can't do that for you, it's a deeply personal thing.
I started using semaglutide 5 months ago. Combined with proper nutrition and working out (mainly walking 3x week), I have managed to lose 20kg in 5 months. I absolutely recommend it for people who have trouble losing weight.
It's important to note that due to a shortage, people who need this for an on-label use (diabetes) can't get ahold of it, due to the widespread off-label use (weight loss).
Also interesting to note obesity and inactive lifestyle are the leading causes of type 2 diabetes, so overweight individuals not becoming diabetic may reduce overall strain on diabetes medication supply.
As an ex-obese person, you and I both know that you don't eat because you're hungry, but because you like it / you're bored / any other reason. Hunger-cutting medicine doesn't help with that.
If you are obese you can easily lose 2 pounds a week just by counting calories. I lost 90 pounds in 7 months despite eating burgers, pizza and sweet stuff whenever I wanted, just less than before. No exercising required either (it's good for your overall health, but almost entirely useless for weight loss).
Semaglutide seems to be able to weaken urges, not just suppress the sensation of hunger. A lot of people have reported having a significantly lessened urge to drink alcohol, too. I wouldn't dismiss it out of hand.
I think it is fair to say that there is a variety of reasons why people are obese. Some people certainly eat out of boredom, for emotional reasons, taste, etc. But there are people who also feel hungry all the time. Those people will benefit. Others may as well.
What is the most important information I should know about Wegovy™?
Wegovy™ may cause serious side effects, including:
Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Wegovy™ and medicines that work like Wegovy™ caused thyroid tumors, including thyroid cancer. It is not known if Wegovy™ will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.
edit: For a safer way to lose weight, including other benefits in regards to reducing cancer risks, look into intermittent fasting. Success with your weight loss, great step into becoming more healthy!
> A recent review of the evidence suggests that this type of diet may help people with type 2 diabetes safely reduce or even remove their need for medication.
> However, people should seek the advice of a diabetes professional before embarking on such a diet.
I'd like to note that every drug has its sets of side effects, and that the use of GLP-1 agonists in clinical vignettes such as in the case of an obese patient with DM are seriously considered.
More specifically, pharmacological therapy of obesity is indicated in patients with BMI > 30kg/m^2 or >= 27kg/m^2 [1] with another aggravating condition, such as DM2 or hypertension.
[1] Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 2, 1 February 2015, Pages 342–362, https://doi.org/10.1210/jc.2014-3415
Every drug has its sets of mild or severe side effects.
But few drugs, including Wegovy, have a Black Box Warning. Even fewer where the increased risks in humans are unknown at the time of FDA approval, and only backed by rodent studies.
Calorie counting.
Keto.
IF.
Full on water fasting.
Paleo.
Meal prep / logging.
Weight watchers.
Everything works for a time. None are sustainable for me.
I can't imagine taking a drug for weightloss would be more beneficial / effective than simply counting your calories and eating in a slight caloric deficit.
It’s as close to a miracle drug that I have encountered. I lost 40 pounds; side effects include constipation and related minor G.I. stressors which weren’t ideal, but in my opinion the positives completely outweigh the negatives. a big/wonderful unexpected side effect was I lost all appetite for alcohol, which was a big plus.
I myself at one point took Contrave for weight loss, and it was effective at cutting appetite (with the side effect of terrible motion sickness), however I don't recommend it.
I'm going to make a personal offer here which I wouldn't normally do, but after a six year journey, I've finally figured out what works (for me at least, and I think for other people like me). I've managed to take off 50 pounds, and I now know that I'll never be fat again.
The skinny people are wrong, it's not exercise, it's not willpower, it's not some magic fad diet (not no carb, not no fat, not no suger, etc.). There are some real changes, simple changes (though definitely not easy), and you can be in control again.
If you'd like to give it a try, I created a gmail account with the two initials of this site and the word weight. Send me an email, and if I'm not already overloaded, I'll try to help you out. You've got to be at least 50 pounds overweight (and I'll ask you to verify it). I'll prioritize people who've ever lost a significant amount of weight (shows you can work hard at weight loss), and it'll probably take at least six months to make the necessary changes before you can lose weight, but once you do, you can be as aggressive with the weight loss as you want (I lost 50 pounds in about 4 months).
Check my comments on this site, I'm a real person with a real history. This is not one weird trick, and I'm not charging anyone. The changes you need to make will probably cost you some money (not going to me), and they will be hard, but you won't be spending time in a gym, you won't be hungry or starving, and the changes you make will be sustainable.
[Edit] To be clear on the money, this is not some way for me to make money, I'm talking about the cost of a doctor visit to see if you have a thyroid problem, or perhaps the cost of your food being more expensive. There is no money that will go to me in any way whatsoever.
If I am able to help people, and it's not just for me that it works, I'll open up and share this more publicly later.
No monetization. As I said, not making money, just being honest about what it's going to be. In terms of email harvesting, I just don't want to be overloaded on my personal email account. Personal email is for my personal stuff, this is just for helping out.
I'm a little bit disappointed in the downvotes, though if no one ends up contacting me, my life goes on as normal. I do want to make one thing clear, however, when I say cost money, I mean perhaps for the change in what you eat, the cost of a doctor visit to make sure you don't have a thyroid problem, etc.
Like, 'lost 80 pounds in 3 months without exercising' levels of success.
I know there are many unhealthy things about this weight loss strategy, but it would've been even more unhealthy to stay 'morbidly obese', rather than my current state, which is classified as just plain old 'overweight'