I started Tirzepatide 3-4 weeks ago. (Mostly as an experiment to understand the hype around GLP's... I don't have diabetes and only very slightly overweight at 20% body fat). Even at the lowest 2.5mg starter dose which you're only allowed to stay on for 1 month:
- Extreme appetite suppression to the point where I've started calorie counting specifically to make sure that I'm eating enough. It's incredibly easy to forget to eat.
- No more feelings of hunger. At all. This is somewhat depressing. Eating is no longer enjoyable and feels like a chore. I woke up hungry for the first time in a while a couple days ago and was excited - jumped out of bed and ran to eat something just for the pure joy of it. I've only felt that a few times in the past few weeks, compared to every day off the drug.
- I completely stopped drinking. Have you ever been to a bar after eating a big meal at a restaurant, and had trouble drinking because you were too full from your meal? That's how I feel all the time. 1 or 2 beers and it becomes uncomfortable to have anymore.
- Normally I go grocery shopping and within 3-4 days, all the "good stuff" (snacks) I bought are eaten. Now, since I stopped snacking and eating much less, groceries simply last way longer. <-- $$ saved in groceries significantly offsets the monthly price of the medication
- My morning starbucks routine has changed from 2 food items to just 1, which alone saves me $200/mo (sorry starbucks).
- Haven't noticed anything regarding impulse control outside of food. No anecdata to share on that point...
After a few weeks on the drug, I'm 100% convinced that once this drug is widely available and cheap... being overweight will be a choice (choosing not to take the drug).
The most important aspect of the drug that makes it work so well is it forces you to change your habits, no will power required. It also punishes you for bad eating habits. (That late night trip to McDonalds will have you feeling like shit the next day).
I'm the kind of person that used to be able to order just about anything on a restaurant menu and clean my plate completely. Now I simply can't do that. It's actually kind of embarrassing being at a restaurant with friends and being completely uninterested in the food.
I’m not going to lie all this sounds like heaven to me.
I absolutely hate the way my appetite works. I have a genuine dysfunction with food. It goes back as far as I can remember. My cravings never stop, even after being satiated. It’s an endless cycle of weight gain then loss then gain as my willpower fluctuates for a variety of reasons.
My insurance only recently started to cover these weight loss drugs, and I have been looking into them over the last month because I think I’m an ideal candidate for it.
If it gives this kind of control over cravings and appetite I’m really looking forward to how this can genuinely make my life better
I'm a few months into this drug as well, and I have to say, it doesn't offer control. What it offers is a lack of cravings & appetite. That is different, remarkably so.
Control would mean I might still feel hungry. Ever. Or that I could decide to eat heavily at one meal, but I don't and as long as I take the drugs, I won't. That doesn't feel like control, it feels like I've had something removed. I guess it's a matter of perspective?
I don't know if its a common sentiment but this drug treatment is the hardest thing I've ever done for my health. I'm not sure I'll be able to continue though. It's like I've robbed myself of the one joy I had left and now I have none. Tread carefully.
The difference here may simply be in how our mental health relates to food.
It sounds to me like it brings you enjoyment you miss. I respect that.
Food for me isn’t that. The lack of cravings and appetite means I would be firmly in the drivers seat with it. It means I can eat exactly the amount I’m suppose to and not feel like I must have more
Note that if you're doing this treatment at home (aka bought a vial and a syringe off the Internet and are injecting yourself), you can simply give yourself slightly less next injection. It's not a binary "hunger (y/n)" but more of a spectrum. (anecdotally)
I don’t understand what’s missing. What was the joy?
For me, hunger is misery, and so is feeling over-full. I’d do anything to take that away (well, short of sacrificing my financial security to pay the market rate for the drug.)
I've been on them for over a year now. I was 320lbs at my peak. I'm down to 247 as of today. I have about another 27 pounds to lose, and then I think I'll be where my doctor wants me.
Here's my experience (n=1):
* Zepbound is better than Wegovy. Wegovy has more side effects than Zepbound. Also the Zepbound pen is better than Wegovy.
* If you're worried about needles, don't be. The injection feels more like a rubber band snapping at the skin. And you'll get used to it.
* I typically have moody days maybe 2 or 3 days after I inject. I attribute that to blood sugar changes.
* Food tastes differently to me now. Food I used to really like can sometimes now just be okay. I don't like french fries so much anymore like I used to (they're good, but not what I remember). The huge bowl of chips I got from the Mexican restaurants don't taste as good anymore. Potatoes aren't really as attractive anymore. I prefer protein.
* I had constipation, which is a side effect. There was a stool softener I took from costco that helped. Eventually that went away.
* I got a bike for exercise. It's nice in that I feel like I actually go places rather than sitting on a Peloton. I also get fresh air. I had to find something I wanted to do, and I hate walking frankly.
* As I lost weight my alcohol tolerance dropped, but it's to be expected but still surprising when one beer hits you harder than it used to.
Maybe some tips:
* Nausea might a be a side effect, more so with Wegovy than Zepbound according to my doctor. So I guess plan to take it easy if you can.
* Your relationship with food will change, so be prepared mentally for that. Food used to make you happy maybe, and now it won't. So figure out what activities and interests that make you happy which don't involve food.
* Sugar is the one thing that can still ruin your progress. So be careful with desserts/candies/sweets/sugared sodas/etc.
* There's some debate about whether diet sodas spike your insulin levels or not. I would recommend going to black coffee to get your caffeine if you haven't already, and black coffee will also help to stimulate your bowels as well. That said, diet sodas are still better than sugared sodas.
I'm a major snacker in my 40s, have been most of my adult life. When I don't have my daughter I would fill myself up with cookies, cereal, and chocolate candy. I've been a few months off of all of that shit, accidentally didn't really plan it, I just haven't had any cravings whatsoever. I'm sure it could come back easily but it's not here and I don't miss it. I've lost a lot of fat. I'm not just eating fruit and vegetables, but I'm finding meals alone are enough.
So compounders can no longer legally sell tirzepatide and will soon (April-May) be unable to legally sell semaglutide.
That said, the lowest doses direct from Lilly without insurance are $350-500/mo. And if you can do math, you can pay for a higher dose and spread it out over time to achieve a lower average price.
I've heard similar accounts and it sounds pretty wild. I'm not overweight and don't take anything but I do enjoy food. It would be horrible to me to lose the enjoyment of such a primal pleasure. If the choice is between being overweight and giving up the pleasure of eating altogether, I can imagine plenty of gourmands who would rather carry the extra weight for the physical and social pleasures of food. I've heard anecdotal reports of people losing their enjoyment of food permanently, even when discontinuing the drug. Canot confirm but that would be a high cost to pay, imho.
I have not lost my appreciation for good food, I just eat less of it. I used to be unable to leave any food on my plate regardless of how good or bad it was, now I’m perfectly happy to leave something uneaten if it isn’t to my taste.
Same, I'm on one of them and I still love and enjoy eating and am perfectly capable of eating my beloved junk food. I'm just highly likely to feel done after a few bites instead of... dozens and dozens of bites.
Losing the pleasure of food was one of my main concerns starting it, and it hasn't been an issue whatsoever.
Meanwhile, I'm back down to my healthy weight range, which I haven't seen since 2021, which was about the third time I'd been at that weight and then ballooned up. I was just about at the top of that range after two months, down about 30 pounds, and it took no effort whatsoever.
I feel amazing. Muscle mass is also doing fine, and I'm well into middle age so any protective properties of youth are largely gone, still having no problems there.
Same for me, I don't recognise those symptoms (loss of taste, loss of impulses). My understanding is that all it does it to replicate the signal the stomach sends when it is full, and so you just feel full / a bit burpy, even on an empty stomach. But you do enjoy the same taste than before the drug.
That being said side effects vary and lots of people mention it gives them nausea. I can easily imagine how that would interfere with taste.
I actually appreciate food far more now, because I am no longer worried that I have to consume “enough” food. A small amount is just as satisfying. A large amount makes me ill, and you only make that mistake once.
I'm curious -- do you have any brain fog? Are you able to exercise? When you exercise, do you wind up eating more, i.e. the caloric amount that you exercised?
I've never had any psychological difficulty with losing weight. I don't care if I'm hungry.
But what happens when I eat less and lose weight is that I have trouble concentrating. The glucose my brain needs just isn't there. And if I do physical activity, forget about it -- my blood sugar is going to my muscles and I'm unproductive for hours afterwards as I just can't think. Also, if I go to the gym, my muscles take a week to recover instead of a couple of days, because they're just not getting the glucose they need to repair themselves.
I don't hear any of these complaints from GLP users though, which baffles me. Not eating enough affects us in lots of ways besides just being hungry. How has it been for you?
It's because people are different, sometimes on a genetic level. What works well for one person does not work well at all for another, like the parent commenter, I do not work well without carbs. Keto puts me in a low-energy, semi-depressed state, while eating +80% of my calories as starch led me to lose about 15lbs of fat and now I'm the lowest body fat % I've ever been in my adult and teen life and my HOMA-IR went from 3 to 1.6!!!!
And my genetics also showed this to be the case too!
It got a bit complicated; it was a long research project, and it led to me starting my current company, Patchwork. Currently, it's at a few hundred. https://www.patchworkfood.com
Your muscle repair would come primarily from protein.
I used to train quite intensely and this protocol worked for me (timings matter):
- 45 mins before workout: small bowl of oatmeal with milk
- 30-0 mins before workout start: 1 liter of water pre-hydration
- During workout: 1/2 liter of water per half hour of intense cardio training, less so for resistance
- Straight after workout: double black espresso coffee (high caffeine)
- Hit sauna for extensive slow cool-down, drinking one sports drink (sugars and electrolytes)
- hour later: full meal of mainly lean protein
Never had issues with muscle pains or "fog".
If you go really deep beyond your usual sustain, feeling physically exhausted and needing rest afterwards is normal. Eating your way through it is not the way to go.
> Your muscle repair would come primarily from protein.
This is a common misconception.
Yes, muscles are made from protein, and so you need additional protein to provide new "building blocks".
But the process of muscle repair uses a far greater amount of glucose to actually do the work of assembly. Estimates are generally that you need something like 10x as many calories from carbs/fats to build muscle, compared to the actual protein required.
So no -- muscle repair actually comes primarily from glucose, if you're measuring calories. But the point is that you need both. If you eat plenty of protein but your blood sugar is low, the muscle growth/repair will be extremely slow, or just not happen at all.
Also, your protocol is entirely about the workout. I'm talking about the 48h afterwards, when the growth actually occurs in response to the stresses incurred during the workout.
No brain fog. I walk at a very brisk pace ~6 miles a day. My calories are far less than before I started. I have to be very careful to have enough protein. When I exert myself, the recovery period is the same time as before.
Do you have any idea of how many calories you eat per day?
I get so confused because the small amounts of food that people talk about eating on GLP, don't seem like enough to sustain themselves long-term.
Are they exaggerating? Or do they talk about not eating dinner, but that's because they had 1,700 calorie lunch at the burger place? Or is that just during weight loss, and then once a target weight is hit, they're eating like a normal (healthy-weight) person again?
I just genuinely don't understand how people are surviving with the diets they describe.
> I just genuinely don't understand how people are surviving with the diets they describe.
Because obese folks have stored energy reserves. The body is really good at adapting and using them.
I was attempting to be at a 1k/day calorie deficit during my peak weight loss phase. I typically met or beat this target, usually eating around 1200-1600 calories/day plus a lot of walking - 25k steps/day minimum as an absolute non-negotiable. I'd check my step counter before bed, and put pants back on and go for a "midnight" walk if I was under my count for the day.
The first few weeks were quite hard, but it was pretty smooth sailing after that. Lots of naps. After that I was tired some days, but not overly so. I peaked at about 30lbs/mo weight loss for ~3 months, then tapered off to 5-10lbs/mo for my final 30ish I had to lose.
I don't really suggest anyone else attempt to "crash" their program like I did - but it's how my brain operates. I need immediate and obvious results, and those turn into a feedback loop for me. Being a bit more tired each day was perfectly acceptable for the goals being achieved.
That said - I wish I had started resistance training when I started my dieting program. I took it up at the very end of my weight loss, and it took me about 9mo to get back to roughly the same lean muscle mass as I had before I lost weight. I'm still working on min/maxing body comp about 18mo later.
The best weight loss program is the one that works for you. Pretty much full stop. It's going to be highly individualized. Some folks will do much better with a small deficit for a few years, but I know from experience that would never work for me.
I think a lot of the stuff you see on-line about "forgetting to eat dinner" is exaggerated and folks starting off on the drugs being amazed at it. Very few people will post a "well, I'm a bit less hungry" type of result. Everyone I know on them eventually became somewhat habituated to this sort of effect, but everyone is highly different. For me, I considered Tirzepatide a performance enhancing drug for my diet. I still went to bed hungry most nights - it was just far easier to chain together days and weeks of doing so on the drug vs. off. It still took a lot of willpower and habit building for me to pull it off at that level.
> Do you have any idea of how many calories you eat per day?
My baseline was in the ballpark of 3000-4000 cal/day. I'm losing about 5 lb/month, or 1.25 lb/week; assuming it's all fat, that's a 4400 cal/week deficit or ~625/day. 600 cal a day less is kind of a lot! Some people starting fatter than I was take bigger doses and have bigger deficits.
> Are they exaggerating?
In my experience: I'm not hungry for breakfast at all. Lunch: I try to have it, definitely have it if I exercised. (But if I didn't exercise it's pretty easy to just ignore hunger signals and eat my first meal at dinner.) Dinner is like, smaller than it was when I wasn't on the drugs. And then some post-dinner snacking.
I'm on the low end of the Rx dose range (2.5-15mg/week); on a higher dose, eating even less is plausible.
> Or do they talk about not eating dinner, but that's because they had 1,700 calorie lunch at the burger place?
1700 cal meals are mostly out of the question for me on these drugs. Your gastric emptying is slowed down, so you just can't house big meals in the same way.
> Or is that just during weight loss, and then once a target weight is hit, they're eating like a normal (healthy-weight) person again?
Yes, I think this is a big piece of it. To actually lose weight, you need to eat less than the sustainable steady state.
Oh, OK. So depending on your height, that sounds fine.
So you're still eating plenty, but the point is that you no longer have any desire to over-eat?
And so at a restaurant you still order and eat, but the food just doesn't mean "enjoyment" the way it used to?
That makes a lot more sense then. If food becomes more about removing a negative feeling of discomfort, than a positive feeling of deliciousness, right then overeating would never make any sense.
Yeah, I am 6’2 and broad chested etc - I am consistently losing like 2 pounds a week, give or take. If I am less active like due to illness, that slows down. I think any faster than that, and I’d be worried about crashing back to my old weight or other side effects.
I went out to eat today, and enjoyed my food. I didn’t order a big burger, but a smaller sandwich. I had a bite of an appetizer, but not more than a bite. Still super enjoyable, but it might be even better now because I don’t feel like a fat pig afterwards due to reasonable portion size.
I am food motivated like a dog, for whatever that’s worth.
No brain fog, but in my experience it does impact exercise (similar to any other caloric deficit). Both maximal efforts (e.g., heavy barbell squats) and endurance (hours on the bike).
I resonate with your comment about appetite loss. It is surprising how much it has affected my happiness, to have this few times a day pleasure taken away.
A month ago I suffered through a norovirus infection, the first time for me. In three days I lost six pounds (my BMI is 21.2 now). At first I wasn't surprised or worried -- after all, I had emptied out my digestive tract and was dehydrated. But a month has gone by and my appetite has been AWOL. I've lost another pound (5'11" @ 152 lbs). I have an appointment next week with my doctor's PA to see if something else is going on.
The taste of food is the same, but the craving is lacking. When I eat, my guts are telling my brain it is time to stop eating, as if I had eaten a pound of mashed potatoes only an hour ago.
Maybe, Norovirus affected GIP and GLP-1 hormones. This could be a new research avenue for weight loss. GIP and GLP-1 are product of the research about the Gila monster lizard, which eats three or four times a year and survives.
Awesome stuff. Envious, here (NL) its impossible to get a prescription.
For an alternative approach for comparison: My wife and I eat low carb and fast every other day for a year now. Around the 2nd month mark we got the exactly same outcome: food became a chore. We sometimes dont eat for 2-3 days when travelling or busy. I dont remember feeling hungry in about a year. We do sports - I sure have less peak power, but can sustain moderate efforts for longer (I use a power meter and Hr strap - my vo2max dropped). I feel significantly sharper mentally and managed to learn a new language (Dutch, from zero to B2) in a year - while working a cto job. Not eating easily gives 3hr extra a day, incl. what I get from waking up early.
Saves us a ton on groceries and eating out. The only thing we do watch out is carbs - I can eat a kebab or two tacos but dont eat any sweets, eat bread or drink beer/soda. Weight stabilized at my high school level. Not sure if I can recommend it as it is a bit tricky to practice, especially while having a job that requires routine socializing, but - it does work. The only really difficult thing is to start and endure the first two weeks or so.
No, I eat a lot less in general and a whole lot of veggies.
I followed the same routine 4 years ago, then I stopped and when I started eating carbs my vo2max recovered overnight. I think one cant have it all - either you run on stored energy which caps the power to weight ratio - or on readily available glucose and glycogen. Its fine, I am not an athlete, I do sports to feel good. I dont see an impact on raw strength - just on anaerobic performance.
Anaerobic - i feel more or less normal while under aerobic load, and i can sustain significantly less anaerobic load - i used to be able to maintain 1600W for about 30 seconds (equivalent to a sprint to a finish line at pro-cyclist level). I can barely touch 1000W while on fast/low carb diet. I did a few experiments, and after carb loading I get an immediate increase in anaerobic perf.
Not everyone can take these drugs. Some people will have severe side effects. It's very common to have nausea, vomiting, etc., and some people will experience these frequently enough that the prescribing doctor will rescind the prescription.
I tried, I got some results but it meant that my entire body’s digestive system felt like it stopped working. Constipation, nausea at the drop of a hat, finding I’d have to take a fast acting prescription anti nausea multiple times a day. I’m not that overweight, and I felt like my body was getting far less healthy and like I was starving myself. This is on the lowest starter dose, too! It just… yeah, it works as I’d expect an extreme appetite suppressant would.
This was me. I’ve been on them for four years and actually gained fifty pounds
The drug keeps me from binge eating, which is huge, but if I take enough to actually lose weight then I have weekly bouts of food poisoning because the sugars in my gut start to ferment. An entire day sitting on the toilet while holding a bucket because it’s coming out both ends.
The oral semaglutide (sublingual dissolving) is like 10% as effective as the injected version. But it presumably could be given in higher doses to counteract that. I'd be shocked if the manufacturers aren't working on a more effective non-injectable version.
> My morning starbucks routine has changed from 2 food items to just 1, which alone saves me $200/mo (sorry starbucks).
Starbucks food is especially calorie dense. I realized this when I lost a bunch of weight in 2018 and I noticed the calorie counts on the printed cards that some stores have. Even for junk food, Starbucks junk food is more calorific than average for the same items.
I started to consider that for a typical customer's consumption, McDonald's might actually be healthier than Starbucks. Which totally goes against the image people have of both places.
People think if they are "going for coffee", it's better for you than having a milkshake and following it with candy. But it's essentially what they're doing.
I am 8 months in, you do develop a tolerance over time to the drug (and why you need to increase the dosage progressively). I have gone up slower than the prescibed steps but still, this drug is to help doing diets, I don't think it would work as a long term medication. And as far as I can tell, when you get off the drug or have become tolerant to the current dosage, it is easy to gain back some weight if you are not careful. So the point being I don't think it will suppress completely obesity, but it will certainly help people make a time limited effort to go down to a lower weight.
Some doctor advised a protocol: stay on GLP-1 for 3 months, then take metformin for a month or two; then repeat the cycle. I have to dig out the source for this.
I’ve been on it for over 2 years now. Yes you plateau, and if you go off of it (as I had periodically), you will regain weight. Hoping my weight loss resumes now that I’m back to the maximum dosage for a few weeks. As it’s 5pm and I just ate for the first time today, I can confidently confirm that my appetite is well suppressed.
Interesting, what is the end game then if you need to be on the drug to keep the weight off but you also develop resistance to it over time?
I wonder how the body reacts after being on the drug for years at a time and then you cut it off, are the cravings stronger than before you started the drug?
Doesn't mean you go back all the way up. And I don't know if the resistance wears off if you stop taking it. What I am hoping is to end up in an end state where I can keep the weight within a 5-7kg range and go on the drug for 2-3 months once a year to go back to the bottom of the range.
I think the craving is primarily a function of how much your stomach expects food, ie the more food the more craving, but also you can get it used to a lower regime. And to external factors like stress, tiredness, cold, etc.
Yes well your PCP / pharmacist should not have prescribed you an appetite suppressant when you have below average body fat %. The effects are very worth it for people weighing them against heart disease and mobility issues. It's not a Faustian bargain, it's all right on the tin. When you stop taking it the effects go away. If you want to be indulgent and it fits your lifestyle you can reversibly make that decision. The power to make that decision is difficult to overstate.
After using them, I think GLP-1’s will eventually be rebranded as a weight management / weight maintenance drug rather than a weight loss drug in order to appeal to the masses.
It’s a very interesting feeling to feel like you’re in full control of what you eat, not influenced by random cravings or hunger.
In my case I’m planning to only stay on it another month or 2 to drop 10lbs. I can easily see people cycling on/off this drug throughout the year to keep weight in check while removing will power from the equation completely. It’s quite remarkable.
They might be branded that way, but that's not what they are. They have dramatic effects on the metabolic pathway and insulin response that need to be carefully considered if you're not actually diabetic.
I recommend that you listen to the most recent Peter Attia podcast, which is a 2+ hour interview with Ralph DeFronzo (diabetes expert) where he goes deep into the effects of GLP-1 agonists on insulin response and other metabolic pathways. I came away with the impression that we're being too casual with how these drugs are being used -- if you're overweight these impacts are probably all for the good, but if you're not, it's more questionable.
I’ll have to rewatch that video. Saw it a couple days ago and walked away with the opposite take. DeFronzo spent a whole lot of time heavily praising the generation of drugs (including the next generation in phase 2 trials)
If there’s a specific part you remember talking about the negatives I’d be interested to hear.
I legitimately have a difficult time finding anything negative when researching the drug, other than tolerable side effects like GI upset.
He's praising them for people with clear metabolic syndrome, and I'm reading between the lines as someone with prior knowledge. As a simple example, while it's probably good to inhibit gluconeogenesis in people with elevated A1c, doing so in a healthy person could lead to hypoglycemia.
I don't have a list of exact timestamps, but there are multiple places where he discusses the impacts of the GLP-1 agonists (of various generations) on insulin signaling, glucose transport etc., and the conversation is generally complex, nuanced, and wide-ranging. We don't understand everything these drugs are doing, but they're clearly banging around a complicated metabolic/hormonal system with a big, blunt hammer.
Yeeeeah, he says that "they're quite safe", but it's in the context of a wider conversation focused on people with metabolic syndrome. I wouldn't be eager to extrapolate from that comment to "let's put this in the water supply" (exaggerating for the sake of argument).
A rebranding to a non-prescription drug will depend on how the prevalence × severity of side effects [0] turns out longer-term. I hope that you are right, but it seems too early to tell.
People seem to handle it very differently, according to my doc. I never had issues while taking Mounjaro or Synjardy (a prescription pill for diabetes management with similar side effects) alone, but the two together meant I could count on a couple of bad days a week.
Sidebar: Mounjaro changed my life. I'd been very diabetic (300 units of insulin a day) for years on end. Taking that much insulin, my normally large frame got very large indeed. A couple of months into the Mounjaro and I was off insulin; a year into it and I was down 75 lbs and healthier than I'd been in 20 years.
It’s actually the opposite. GLP-1s slow down the digestive tract, so my shits are far more well formed than before. This isn’t like olestra, where excess fat caused diarrhea.
fwiw tirzepatide (likely the GIP component) cleared up my lifelong IBS within days of my first dose.
I consider it a likely lifelong medication now simply due to that night and day difference to my life. It’s extremely rare I have a day where I need to be within 5 minutes of a restroom now.
My primary care doctor mentioned this might be a side effect when I first started, and she ended up being more correct than even she expected to be.
It’s wild. I’ve never experienced burping food and tasting what I ate earlier, food just kinda rolls right through. Now, I get to really enjoy it a second time.
“common gastrointestinal side-effects of GLP-1RAs treatment (including nausea, vomiting, diarrhoea and constipation) can persist for several days and may affect more than 1 in 10 patients”
In this sense, I see adoption among some people as akin to nootropics or attention management drugs like modafinil. A way to have more control over your own mind. Interesting times, I guess, but caveat emptor.
Why is it only appropriate for people with heart disease / mobility issues but not for someone who is merely overweight? This feels like finger-wagging for the sake of finger-wagging.
It isn't. 20% body fat is 6% below average. That isn't "merely overweight", it's likely underweight. No, I don't think underweight people should take appetite suppressants and I don't think that qualifies as a hot take. I think anyone who is medically overweight (which is a very modest BMI qualifier for anyone with any amount of muscle) should have the choice. Many US medical systems and insurers agree, which is a good place to be.
The only way this can possibly be correct is if you think that the "correct" weight is whatever the population average happens to be which is just...wild to me.
If we assume commenter is male (a statistical likelihood), then 20% is the high end of normal, and could very safely be halved. In the less likely case that they are female, then it is right in the middle of the normal range, and could safely be reduced by 5-10% at least.
> The only way this can possibly be correct is if you think that the "correct" weight is whatever the population average happens to be which is just...wild to me.
The medical definition of overweight is basically if you're some number of standard deviations above the average from whenever they ran the stats, so population average = correct weight seems like as reasonable a standard.
I tried to find corroborating sources and couldn't, so take this for what it's worth, but Claude seems to think the cutoffs are based on epedmiological evidence for health impacts at various BMIs, which, even if that _wasn't_ how it was arrived at, seems like a better option.
What are you smoking? 20% is a perfectly healthy bodyfat number and (for a man) anything down to 15% or so is fine. Sub 10% is when you pretty much need a crazy bodybuilder lifestyle to maintain it. And on the other side, 25% is around the lien where you start facing some minor health risks from excess body fat.
I assume GP isn't a woman, why do you think 20% is normal for men. The point is that there are no side effects and there is no reason to stop taking it, especially if it saves him money.
Are you just using average as weasel words here? I get my best pump and generally have the best workout sessions at ~10-12%, which is easily maintainable for me, but definitely not for most people, having a drug that makes it effortless for most people is a GOOD thing. People shouldn't have to suffer to get to <15% if they aren't born with good genetics?
And what about strength athletes who want to build up a large runway? Now literally all of them can get down to ~7% no problem, and have no problems on the way up either.
> Yes well your PCP / pharmacist should not have prescribed you an appetite suppressant when you have below average body fat %.
Why do you think this? I agree that people who have associated risk factors should be prioritized, but if there's enough for everyone why wouldn't we give it to anyone who wants it?
People who don't need to be chronically medicated should not be. There are always side effects, and we don't even know for sure what the long term risks of these medications are yet.
And crowing about saving $200/mo not buying food at Starbucks, well now Novo Nordisk is getting that.
I am not an expert but my impression is semaglutide has been in development since the 90s and in use as a drug for about a decade for people with diabetes. The drug and mechanism are old, the use is new.
I do not agree that people who don't "need" to be chronically medicated should not be. I think you can decide to take whatever you want for your own reasons. I am not going to tell you what you can and and can't take - unless you're like...taking something that makes you destructive or generate externalities or whatever. But this seems like the opposite?
Lots of questions here around profit and the awful medical system in the US, but on a basic level I think people should be able to do what they prefer and is safe.
> People who don't need to be chronically medicated should not be.
If they're like typical westerners, they already self-medicate with coffee every day, with alcohol occasionally, and a big fraction of them (though much less than couple decades ago) also treat themselves with tobacco smoke - and ironically, weight loss is one of the few benefits some people actually use to defend their smoking.
Do they need all that medication? Well, it's socially unfavorable to say so wrt. alcohol, but ask any of the daily coffee drinkers whether they need their morning coffee...
The consequences of tobacco are so well known and so negative that they are legally mandated to be graphically depicted on every cigarette packet around here, and the main reason they are not banned is the observed impossibility that undid Prohibition in the USA.
So, sure, we don't know the long term risks of semaglutide ("just" 30 years or so) — but I say let people try it if they want, we let them use things we explicitly know to be dangerous, so why should we stand in the way of something that only might be eventually?
This really just seems like a shit take to me. Everything has side effects, that doesnt mean everything is a net negative. People should be able to weigh the pros and cons of chronic medication and decide if it improves their life.
Because anorexia exists it would do harm to completely unregulate access to appetite suppressants. Someone should be looking out for people who would willingly wither away.
Putting Ozempic over the counter at a local pharmacy would be more than enough to keep people from wasting away, the same thing they do with asthma medication. In 2025, if you really want something, a dark web tutorial is 30 seconds away. And from what I've heard from a client, Ozempic on the dark web is roughly 5x cheaper.
sure thing, but can you trust it ?
There are so many horror stories abroad (like LATAM), that despite the 4x price point, people still buy US-manufactured GLPs instead of going to a foreign market to get the same prescription.
This is being injected directly into your flesh, there cannot be any mistake, or shortcut.
I don't think anyone is suggesting it should be over the counter? Of course a doctor should monitor you while you are on it. We shouldn't give it to people who would use it to deepen a mental health diagnosis.
Those concerns have nothing to do with the fact that it's ok for people to choose to start or stop medications if they would prefer (supplies allowing).
You shouldn't have to ask permission from a PCP / pharmacist in the first place. Who are you to decide whether side effects are worth it for anybody but yourself?
I can't speak to their choice of taking the drug, but it's wild how warped people's perceptions are now of what constitutes "healthy" and "fat" thanks to the obesity epidemic. People remark on how George Costanza on Seinfeld was once considered fat (because he was), or how Homer's scale-tipping 300 lbs. in the King-Size Homer episode of The Simpsons was considered comically obese (because it was). Never mind the fact that people almost always underestimate how fat they actually are and are almost always disappointed by their DEXA scans. Even if the OP's estimate is correct that they're just a little north of 20% BF (as a man), they're still overweight, and specifically overfat, and probably look soft and doughy.
It's weird that I've never been overweight and you describe basically how I normally feel.
I've never felt hungry in the morning. I've never eaten a lot. When I was younger, I often forced myself to eat more, because I felt bad about how I wasn't "big enough" (which feels silly now as a proper adult).
Impulse buying food and snacking is something I only do if I haven't eaten for a long time, i.e. if I'm actually very hungry.
If I go out drinking, I also make a point not to eat very much before or during the drinking, because otherwise I just feel sick after like one beer.
I've been on tirzepatide for 8 weeks (2.5mg then 5mg) and have a very similar conclusion as you. I started off at 160kg 8 weeks ago and now I'm down to 145kg. No other change in my lifestyle except eating radically less. Two 500-calorie-ish meals a day and some fruit as a snack, that's about it.
For decades I've struggled with diets but tirzepatide is the only thing that's made me stick with it. Will power alone wasn't enough, but with tirzepatide I'm very confident I'll get down to a under 100kg for the first time since I was a teenager, within a few months.
> The most important aspect of the drug that makes it work so well is it forces you to change your habits, no will power required. It also punishes you for bad eating habits. (That late night trip to McDonalds will have you feeling like shit the next day).
But the late night trip to McD's always makes you feel like shit the next day, it's just that we then forget and do it again. (Same with drinking).
> Extreme appetite suppression to the point where I've started calorie counting specifically to make sure that I'm eating enough. It's incredibly easy to forget to eat.
This is the largest of several reasons I hesitate to try it for myself. I am a very big guy (I would be about 184lbs if I had 0% bodyfat at my current musculature level). From the experiences I hear, I would not only struggle to have enough energy to do any kind of rigorous exercise, but struggle to consume the amount of protein I require to even maintain my current muscle mass.
I do have issues with overeating and the prospect of a drug that prevents me from consuming too many calories is attractive, but the side effects sound counterintuitive to any kind of natural fitness.
I’ve been hyper aware of the muscle loss caveats and I think it’s the most important thing to know when starting the drug.
You really need to prioritize protein intake and make sure your calorie deficit isn’t extreme.
Losing too much weight too quickly, with or without the help of a drug, can be very unhealthy.
I drink 4 protein shakes a day (160g total) in addition to regular food. If it weren’t for the protein shakes I definitely would be protein deficient.
You’re 100% spot on with decreased energy at the gym. I’ve had to pull back 4x weekly cardio to 1-2x weekly. Then again, anyone who’s in a calorie deficit has lower energy. It’s not a unique phenomenon of the drug, just a side effect of weight loss.
> Then again, anyone who’s in a calorie deficit has lower energy.
Presumably if you're trying to lose weight, you have energy to burn you carry around with you. A calorie deficit doesn't imply lack of calories to burn. Presumably you're trying to trigger ketogenesis.
Granted, this is a lot less easy to access than simply eating simple carbs right before a workout and likely a lot less comfortable.
> Presumably you're trying to trigger ketogenesis.
Only if you're actually on a keto diet; most weight loss routines run a calorie deficit without triggering ketogenesis.
Also there's this whole thing about set points - you probably got to your weight somehow, and if it wasn't through consistently making stupid choices over many years, chances are this is what the body learned to consider an equilibrium state. Which means that, if you start running a calorie deficit, it's going to fight you every step of the way. It will happily scale down performance to conserve energy instead of burning the accumulated fat, so you'll just be slow and groggy but not lose weight. There's been reported cases where people got mental illness-level obsessive thoughts about food, which appeared when they were hungry, and stopped when they ate enough.
The degree of this problem varies between people, but it's generally not that easy to effectively lose weight, and some people simply lost the genetic/environmental lottery on this.
> The degree of this problem varies between people, but it's generally not that easy to effectively lose weight, and some people simply lost the genetic/environmental lottery on this.
Yea, I think your eating and food habits you learn as a child and teenager tend to shape you for life. I was malnourished as a child (I was considered a picky eater) but as an adult I've found it quite easy to keep within the caloric bounds a doctor told me to keep to. One thing I've noticed is that hunger just doesn't bother me the way it does with people who struggle to lose weight or with binge eating—mostly a pain in the ass (I need to remind and force myself to eat), but occasionally something I'm grateful for as I watch the people around me struggle on an existential level with their cravings and bodies.
I also don't have a sweet tooth, and I put that on not being allowed sweets as a child except under very exceptional circumstances. I'm also a (thankfully recovering) alcoholic, so don't mistake this for being generally good at avoiding cravings.
> Also there's this whole thing about set points - you probably got to your weight somehow, and if it wasn't through consistently making stupid choices over many years, chances are this is what the body learned to consider an equilibrium state.
The idea of set points is controversial and not necessarily the accepted scientific consensus.
> Losing too much weight too quickly, with or without the help of a drug, can be very unhealthy.
Is there evidence to back this up? It sounds reasonable, especially without a limit on "too quickly" but (anecdata incoming) I'm curious because:
- When I first tried a low-carb diet (for non-weight reasons) I lost about thirty pounds in under three months without really trying, and hit something like 12% bodyfat
- When I started intermittent fasting (mostly unrelated to weight) I again lost about thirty pounds, this time in a little over three months, and probably ended up around 15% bodyfat
- Since then I found that neither low-carb nor intermittent fasting had a significant effect on my weight, so:
- When my doctor suggested I lose some weight I pretty forcibly calorie restricted, and lost about thirty pounds over four months (only down to about 20-something % that time)
- And just recently, for cholesterol, I've done it again and lost 25 pounds so far in something under three months.
...and as far as I know I haven't suffered any ill effects. I have a concept 2 rowing machine, and I just rowed my slowest 10K ever :-/ but I did row a 10K, and I am in significant calorie deficit, and I probably have lost a fair bit of muscle along with fat, and I have been away from the rower for several months, so all up ¯\_(ツ)_/¯
All of which to ask, what evidence do you have, and what's "too quickly"?
Anecdotally (but in line with what I read about this), I got gallstones after getting rid of 30 kgs in about 6 months, which is too fast for losing a third of your body weight. Since I had a scan before starting the diet for unrelated reasons, I'm sure they weren't there before.
1. I can't speak to that, no analysis here and the time frame (the low carb thing was back around 2008) is too long for meaningful comparison.
2. Maybe? For normal things, not really, but when I try to row for an hour I feel it. I definitely get cold more easily.
3. I'm not built that way. The low carb thing was completely annoyance-free. As I said, the goal there wasn't weight loss, but raising my HDL; the weight literally came off by accident. Intermittent fasting doesn't bother me at all. Calorie restriction, which I generally do by A. going longer without food -- up to 2+ days; and B. eating less/less carb-rich/processed foods; can be somewhat unpleasant if I push it too hard, but I generally don't. Some days I'm feeling it (in a good way) so I go longer without food, some days I'm not, and I don't sweat which is which much.
4. Generally not a factor for me.
4.1. Definitely not a factor. Two times like I said, weight loss wasn't really the goal, so not relevant; and two times I hit the goal I set (last time), or went further (this time).
4.2 Doesn't really apply, since I've never been visibly overweight? Like, my waist has never been close to half my height. I'm tall, so the large numbers aren't as much of a factor. Regaining weight has never happened to me faster than about 10 pounds/year (just a guesstimate).
The interesting thing will be once I stop losing weight and start rowing again seriously, can I get back to a reasonable performance level. Fingers crossed...
If it makes you feel better, this class of drugs has been part of bodybuilding cutting stacks for a while now. It makes the process much easier and as long as you're diligent about your shakes, no big deal.
I would be interested in reading about that, but it doesn't de facto make me feel any better given my anecdotal experience with bodybuilders watching them take drastic health risks for aesthetics - it just shifts my concern to other points.
I’m somewhat the same. I need to be active for other health reasons (physical therapy, etc) and not eating enough saps my ability to push forward physically.
I don't have a published study to back this up, but in my 10 < n < 100 experience, the alcohol suppression effect is limited to occasional-to-moderate drinkers.
Giving a GLP-1 to a heavy drinker/alcoholic results in a skinny alcoholic.
Given that the overwhelming majority of alcohol is consumed by heavy+ drinkers this isn't the gamechanger people think it is.
I'm a heavy drinker (1.5 bottles of wine a day -or the equivalent- everyday, for at least 5 years). I started a GLP-1 at 2.5mg two weeks ago after the most recent study was released[1].
In just the two weeks at that low dose it's been quite effective.
In fact the only reason I'm replying to your comment is because instead of being a bottle deep in front of the TV at this point in the evening I got bored after one glass and decided to noddle around on the internets.
Ask any heavy drinker/alcoholic and they will tell you that one doesn't just have 'one' drink and then move on with something else. One is always too much, and never enough. Now it feels like enough.
Does it have any impact on focus or motivation to get work done, do hobbies or recreational activities, engage in human relationships, sex, intellectual curiosity, etc.?
It would be fascinating and almost too good to be true if we found a way to suppress only largely harmful (in our current environment) urges but leave the good ones intact.
Something like that becoming widely available could change the world, and mostly for the better. It would refocus our entire economy on much more constructive pursuits instead of gambling, addiction, and pandering to transient urges.
I've never had any lack of focus or motivation to get anything done since I started Tz.
I did have some energy loss, especially at first, but I assume that was because my body was struggling to cope with a lack of carbs. However, after a couple of weeks that for the most part disappeared.
This sounds like my whole life, I've always been trim and have never understood the joy people get from food. Facinating to see there's a drug that recreates that physiology.
Two years ago I was some 7-8kg beyond my target weight range. I started calorie cutting, and filling myself with salads etc before each meal. Also added some more changes like taking longer times to eat. I used to, and sadly back to it, eat in a flash. Initially it was hard so increased a bit and then a bit and then in a few days it was stabilised at a calorie intake point which was still significantly below my normal need. And in next few days it dropped further. So next 3-4 months when I was watching calories and trying to keep in check - I didn't have to worry about eating less calories, but I had to worry about taking sufficient calories. Because surprisingly I stopped feeling hungary even eating lesser calories.
I am talking about being okay in 900-1000 while my normal need was ~2500 and nutritionist had suggested to target around 2000 for first few weeks then bring it down to 15-1600 and then slowly bring it up near normal as weight settled. But by the end of 2nd week or 3rd I was struggling to finish 900-1000. I used to kinda force eat.
There was no medication involved in any way (not for this purpose; not for anything else).
It depends. The 5mg, 10mg, and 15mg were the doses tested and recommended as maintence doses. The 2.5mg is meant as a starter to reduce side effects but since most people don't see results with it the recommendation is that you only take it for 4 weeks. The 7.5mg and 12.5mg doses are meant as transitional doses but you can stay on them longer than 4 weeks.
Some doctors will go by the Lilly recommendations but I think more are allowing people to stay on the lowest dose providing benefits. That leaves your health insurance as the only other obstacle.
I was one of the rare people that saw results with 2.5mg but by the end of that first month I had plateaued. After 3 months at 5.0mg I've plateaued again and will probably move up to 7.5mg in the near future and stay on it as long as I can.
Some people like to go back to 2.5mg as their maintence dose after reaching their weight loss goals.
Yes, up to 15 mg. Maintenance levels at 5, 10, and 15. If you cannot tolerate a maintenance level you can still get it, but insurance will not cover it ($1000/mo rather than $15/mo.) This is not an unreasonable situation.
Luckily during the “shortage” you can currently get GLP-1’s in vials rather than injection pens.
The brand name GLP’s you can’t control the dose. But when you get it in a vial from a compounding pharmacy you can inject however much or little you want.
Not looking forward to ever using the brand name version specifically for this reason
The injection pen I have see has two marked dosages, but there is nothing stopping you from injecting more or less.
Basically it is a ratcheting mechanism where after ~10 clicks you get .25 mg dosage and 20 clicks gets you .50. Basically, no doctor is going to endorse it, but you can dial a dose to whatever amount you want.
Aren’t any states like California trying to ban compounding pharmacies? It’s an unfortunate attack on individual freedom, but I am not sure if we will still have them 20 years from now.
> Aren’t any states like California trying to ban compounding pharmacies?
No. California has not banned compounding pharmacies, nor is there a significant movement to do so in the legislature, among the people (who could do so by ballot measure), or a proposal by the governor to do so. California does require additional licensure for sterile compounding, but that is very much not a ban on sterile compounding or compounding more generally.
Relevant to GLP-1s, though, several state pharmacy boards (not California’s, as far as I know) have raised issues that compounded GLP-1 drugs that they have seen appear to be illegal, because they use a form other than the FDA-approved base form of semaglutide (which is only available from Novo Nordisk), and th3 form used is not itself approved for human use, and have taken steps to crack down on that. But that's also not banning compounding, but enforcing existing rules on compounding.
I think the issue is more the FDA has hit compounding by announcing semaglutide and tirzepatide are no longer in shortage - so compounding pharmacies aren't legally able to sell the cheaper compounded versions. Since most insurances don't cover GLP-1 for weight loss, this is a huge issue given they cost almost $2000/month in the US out of pocket.
I was approved for semaglutide but now compounding pharmacies like Hims are stating their cheaper (<$200/month) compounded versions are out of stock.
First, there's no legislation. What is happening is that the branded drug was in shortage so compounding pharmacies were legally allowed to step in under existing regulations.
The shortage status was first updated in the summer, and Novo went on a lawsuit spree. Suing everyone mentioning GLP on a website.
But, there have been more back and forths since, very recent.
TLDR what is restricted now is not the sale of the compound, but the manufacture of it. Therefore, you can keep selling inventory past the restriction, but of course that will either run out, expire, or be restricted as well. As of now, if everything stays the same, expect the last few compound pharmacies to run out of product at the end of Q3/25 .
However, I understand there's groundbreaking legislation being worked on that will dramatically change the status quo for the better, meaning more choice for end consumers and less profits for Novo.
Hum, I don't know, here in the UK, no one is forcing you to do anything. I am free to chose if I want to step up, down or stay on the current dosage every month. And I took the cautious approach to only step up when I stopped feeling the effects at the current dosage, so 8 months in, I am only starting on 10mg (range is 2.5 to 15mg in 2.5 increments).
If you want lower dosage, then there's a simple trick: just use less frequent injections. For example, try one in 10 days instead of 1 every week. It will result in lower steady-state GLP-1 levels.
The inbetween doses are just used for titration. They were not studied as long term doses like the maintenance doses. It’s stupid, and you can get exceptions if you are persistent. I preferred 7.5 mg over 10 mg for example.
Ozempic has been in use for diabetic patients for at least a decade if you want to look at the research of its long term results in that population - which is fairly large to constitute a good sample sizing.
So that means we'll have a good twenty years of data to finally look at, which is what I was saying. I do not trust any medicine unless it has far more data than what we have in this regard at this point. I work in a related field and I can simply say most things we trust should not be trusted and should require far more testing.
I am much more daring in my will to experiment but I do agree.
Keto, fasting and also breaking the "foodie" culture that eating and going out to eat becomes a hobby.
I didn't order/dine in at all from a restaurant in 2024. It is much easier to not over eat the boring keto meals I make myself. My "cheating" is eating basmati or jasmine rice with a stir fry instead of cauliflower rice.
There is actually not enough known side effects for me to take GLP-1s. They are either complete miracle drugs or side effects we don't currently understand haven't come out in the wash yet.
We have a pretty good track record when a new powerful medication like this is introduces of doing things quite wrong. There are probably risk mitigation strategies we will learn in the coming decades that we simply can't know right now. Otherwise, these are basically free lunch miracle drugs. That seems an easy short.
I'm pretty sure keto has not been extensively studied for anything but the management of epilepsy in children that do not respond to medication. So tbh this is an odd comparison.
The above describes me but it is the consequence of my behaviors/habits. Being a workaholic, I learned long ago to ignore the leash that pulls me to the refrigerator. It seems by brain no longer sends me a "you need to eat" signal similar to the way free divers can become oblivious to the "you need to breath" signal.
I wonder if with time, you can learn from this drug, form the helpful habits/behaviors and then stop taking it.
I understand that on population level we can't just tell everyone "get on a diet", but when talking to you in particular, why couldn't you... just get on a diet?
Personally, I love food. I can't live without stuffing candy in my mouth. But I also have a tendency to get fat, so I weight myself every day, and based on that I either have a diet day or a cheat day. Moreover, I do a lot of physical exercise every day. The idea of having to depend on a drug to live is scary to me.
Having said the above, I'm sure that one day we'll create a drug that makes life of majority of population better, and we'll be able to administer it to everyone without major consequences.
> That late night trip to McDonalds will have you feeling like shit the next day
I've never had this reaction to fast food before. I only eat mcdonalds every few months and yea it's not the highest quality food, but I don't think there's anything in it to make you sick any more than other burger places have. I imagine you'd have to have restricted fast-food nutrition for quite some time before you feel a difference.
I'd like to see a study comparing people who ate mcdonalds who thought of it like slop vs those who saw it as a treat. I'm curious how much of this is psychosomatic, or how much of the craving for mcdonalds is rooted in feeling like crap in the first place.
(Granted, I've never had an issue with maintaining my appetite before, in fact I have issues keeping weight on, so I might have a fundamentally different relationship with food.)
The way I read it, i think the original commenter would usually agree with you, but the effect of the drug turns the post-fast food / treat satiation from joy to pain.
>> That late night trip to Mcs will have you feeling like crap the next day
> I've never had this reaction to fast food before.
I do. Because of it, I eat fastfood when I'm willing to pay that price, ~5x/decade.
> I'd like to see a study comparing people who ate mcs who thought of it like slop vs those who saw it as a treat. I'm curious how much of this is psychosomatic.
The notion that our psychology could be holding us back from fastfood completeness is one that never occurred to me. I like how novel it is.
I believe you, but what do you think it is in the food that causes such severe reactions for you but doesn't affect me at all? Humans lived through periods of extreme starvation and other forms of malnutrition—our genetics are extremely clear on this, as is our tendancy to cannibalize our muscles when they're underused. It seems absurd to me a slightly different selection of nutrients could cause acute distress. (Hence my recourse to psychology—which would map well with the shift towards the moralization of nutrition these past few decades.)
>I believe you, but what do you think it is in the food that causes such severe reactions for you but doesn't affect me at all?
Food sensitivities are primarily a lot of medical questions, for which we have few answers. For example many fresh breads will give me stomach cramps and Rosacea. I can eat those same ingredients+amounts in other foods and be fine.
Many fastfoods ramp my brainfog up to 11. I don't know why. I'm in a poor position to consider the issue while the brainfog is in play. I could consider it later but the best I can hope for is unsubstantiated guesses.
I was in the overeating column (4000+ calories a day, no sugar drinks) and going into month 3 I am fighting to hit 1500 every day except the day before shot day and shot day. YMMV of course, but it is very effective for me so far.
> Eating is no longer enjoyable and feels like a chore
I used to view eating as a chore and it was great. Then (no joke) I got into tech and everywhere I work they have fancy food or frequent team lunches or something of that nature.
The effects seemed to wane slightly for me, but it vastly changed my relationship with food. I was raised in a family with plenty of food, but food was used as a weapon of manipulation and thus I was taught to eat as much as I can else it might be taken away. With Zepbound I now eat appropriate portions. Can’t really stand more than a single beer. I don’t mind being at a restaurant and not really eating. I’ll have a bite of this or that and be happy.
My shits, however, have been glorious since starting the drug. Truly pleasant steamers that rocket right out.
Be careful with all this. At one point I had gone 72 hours without eating or drinking anything and one beer by the pool had me on the floor. I keep hydrated these days but sometimes it’s an effort.
Atkins-ish diet caused the same thing for me with a car accident back in the 90's. Sudden uptake of carbs with the alcohol resulted in lost memory of over 13 hours, a '68 De Ville convertible that got totaled and 2 months spent with a wired jaw.
Interesting, this sounds like my normal state. I cope by only eating tasty calorie-dense meals and snacks, never skipping meals or snacks, and weight lifting to increase my appetite. Otherwise I become significantly underweight.
One thing this comment ignores is the very non-zero chance, which increases with dose and time on the drug, of developing gastropwresis. Gastropwresis will ruin your life to the point where you may never be hale to eat normal solid food ever again.
> being overweight will be a choice (choosing not to take the drug)
This may be an ignorant take and if it is I apologize, but isn't it a choice anyway? A calorie deficit and minimal exercise will have you cutting body fat. Or am I missing something here?
People aren’t computers. Eating fixation and compulsion empirically override the more rational mind in millions of people. One of the effects of these drugs is making eating a more “impersonal” or “detached” kind of decision, so it feels like a real choice rather than something that you think you have a say in but really the more base instincts will override.
That is fair. Most people in my circle are some form of endurance athlete, climbers, etc so I live in a bubble but some of the comments I see feel alarming- like an over correction in the opposite direction.
There is a segment of people where GLP-1 medications just don't work, 68% stop within a year, and dosing keeps on escalating up and up. It will help a lot of people, but it is not going to be the panacea early results show.
Since you are not terribly overweight you could reach a healthy weight with relatively minor lifestyle and diet adjustments. Isn’t this preferable to the side effects (some probably unknown) involved in these drugs? Genuine question.
Depends. I tried Ozempic and felt fine but every time I bumped up the dose I’d feel a vague feeling of dread, until I got to the max dosage then I didn’t lose any weight but also felt like I was going to die at any moment. It was bad. I discontinued usage then immediately went back to 300 pounds from 260.
Zepbound/Mounjaro on the other hand has been fantastic. I just noticed I was hurting my muscles a lot and realized it was because I was losing muscle mass. I started taking protein shakes and that seems to have fixed it. Wish I’d realize it sooner as I’ve hurt my hip joint and can’t ride my bike which was primarily how I was exercising, so I need to go to physical therapy. I’m on 10mg and frozen at 260, have an appointment to go to the next dosage on Monday. Hopeful I’ll keep losing weight and get down to around 200.
Absolutely understand. Never had joint issues, but after being on Tz for a couple of months, I had knee and hip pain.
I'm convinced it was muscle loss, because after I boosted my protein intake and exercise, they started to go away. All but gone now (thankfully).
> Even at the lowest 2.5mg starter dose which you're only allowed to stay on for 1 month
... what? Get a better medical provider, you can stay on 2.5mg as long as it's effective. Your hunger will come back. Going up every month is poor practice if you have hunger-suppressing effects, whatever the manufacturer says: speak to an endocrinologist who's experienced with prescribing it instead. The first couple of weeks I had no appetite, but I stayed on 2.5mg for three months and had a healthy appetite by the end, and continued to take it slow. Lost about 1kg a week, and enjoyed my food just fine.
Respectfully, you're in week 3, I think it's worth giving it a few months before you start sharing your experiences of it on the internet.
The much more common experience of this drug -- when you've been on it a little while and you've found a good dosage -- is you enjoy food, you have an appetite, you're just not ALWAYS thinking about food. There is enough anecdata in the many subreddits to constitute actual data about what a typical experience taking any of these things feels like.
> Even at the lowest 2.5mg starter dose which you're only allowed to stay on for 1 month
Uh, you're allowed to stay there as long as you want. I was on 2.5 for two months and asked my Dr to up the dose, as progression kind of stalled in the second month. I've been hanging out around 3.5-4.5mg/week since then losing ~5 lb/month steadily.
Sounds like you're pretty sensitive to it, which is nice. You can lower the dose even further if you think it's too strong at 2.5mg/week.
> My morning starbucks routine has changed from 2 food items to just 1, which alone saves me $200/mo
> Now, since I stopped snacking and eating much less, groceries simply last way longer. <-- $$ saved in groceries significantly offsets the monthly price of the medication
JFC, how much were you spending on food? I just looked it up and this drug costs hundreds of dollars per month, and apparently that's just a fraction of your food budget. So you were spending well over a thousand dollars on food each month?
I'm sure Novo Nordisk would survive even with slightly lower margins.
Also what proportion of that $1,000 goes to the manufacturer? From what I understand various middlemen and such get a significant proportion of that without providing any value?
I have no idea what Americans overpaying for healthcare has to do with a Danish drug company participating in the Canadian Healthcare market.
I’d rather thank the Canadian government for having a drug pricing review process.
If these companies don’t want to sell their drugs here, no one is making them. They are still here, so I think it’s safe to assume that they are still making money.
I don’t think it should be controversial to say that if the US imposed a Canadian-style price control regime on more than the handful of drugs currently regulated by Medicare, the future number of drugs developed and commercialized would drop significantly.
It’s just basic addressable market vs. development cost math.
The drug companies in Canada are part of the drug pricing process. Their development costs are considered. In exchange, they get additional monopoly priveleges on patented medicine.
Canada doesn’t even have particularly low drug pricing compared to the rest of the world, the opposite in fact. Canada just had low drug prices compared to the most expensive market on the planet.
It’s possible that lower drug prices in one country would disincentivize a global industry that touches almost every human on earth. Or it could not.
The number of drugs developed would drop. In particular, the really expensive to develop drugs that target rare conditions, exploit novel pathways, or require difficult synthesis.
The kinds of drugs that routinely experience years of delayed availability in markets like Canada and the UK until the learning curve has kicked in via the US and other less constrained markets.
Personally, I think that they would cut other cost centers before they cut the only department that ensures their long term success
The industry could save tens or of billions per year by not advertising (this is a US thing, drug ads are nonexistent in many places), and eliminating pricing games, cost rebate programs, coupons, drug reps, etc. These are all significant costs and friction that don’t exist in most other countries.
My personal feeling is that claiming that the worlds least cost efficient healthcare system with many layers of added complexity is the driver behind pharmaceutical budgets is marginal.
And of course you have to consider that a significant portion of drug research costs are paid by government and other institutional grants
Your comments come across as more aggressive than perhaps you intend them to. We've had to ask you similar things before.
Telling someone that their spending is "fucking egregious" and "who knows what else you didn't mention", would land with most people as quite a provocation. The fact that cj replied courteously says something good about cj, but your comment broke the site guidelines and we need you not to do that.
It's easy to underestimate the amount of provocation in one's own comments—we all do that to some extent. I don't know if it's helpful or not but here are a bunch of past attempts I've made to explain this: https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
I dont track it. I order instacart a couple times a month which costs $300 per order. Plus eating out. So about $1k or more a month. Single, live alone.
If you don't cook, it is very easy to spend $1000+ on food in a month, especially if you live in a high cost of living area.
I'm single, live alone, work a lot, and earn a lot. Food delivery apps are hella expensive... but I still pay it quite frequently. Yes, I am ashamed, thanks for asking.
Is this person an expert of any kind? They throw around dozens of numbers without any sources. For example,
> 'A movie theater chain recently analyzed their user data and discovered that 72% of their profits came from concessions, primarily from impulse purchases made by people who swore they "wouldn't buy anything."'
This combination of non-descript source, precise numbers, and 'quotes' looks like the usual bullshit one reads in self-help books. I conducted a quick online search but couldn't find any direct source for this claim (although the number might be in the right ballpark).
This article also throws out a bunch of trends and then attributes them to Ozempic with no evidence.
> America's largest mall operator, Simon Property Group, is converting anchor stores into medical centers and wellness spaces.
Maybe that's because malls have been struggling for years and are trying new tactics in response to that?
> Whole Foods is shifting from endcap promotions to subscription services.
So many industries are shifting to subscription services, because it's so lucrative. What evidence do we have that this is triggered by Ozempic patients??
When will I get downvote privileges on this site...
Yeah, I’m also having a lot of trouble finding sources for the specific claims they’re making (even, say, the NFL stadium redesign thing, which feels like it should be easy to find). And taking into account the AI-generated lead image, I’m a bit skeptical of all this.
It certainly leads to less sex. Seems a lot of vaguely-defined experts (economists/demographers/??) are very concerned we're not having enough, so more impulse-regulating drugs seem relevant.
Then again, maybe everyone being a 10 would level that out a bit?
I take LSD every two to three months, and I'm always excited to do so, even though I usually get bad trips. Weed consistently gives me at least five minutes of joy
>I would point out that it isn't unforeseen, given that genz don't drink, go out or do drugs to anywhere near the extent that millennials did at the same age
I certainly don’t think Simon is preparing for this massive economic shift; I think they’re reacting to an existing trend.
> America's largest mall operator, Simon Property Group, is converting anchor stores into medical centers and wellness spaces. They're doing this because they recognize the writing on the wall.
Malls have been dying for years, and COVID felt like the nail in the coffin.
In October of 2023, when Walmart CEO told Bloomberg [0] that ozempic was partially responsible for sales declining, other shares including Coca-Cola [1] started to fall as well....
I think this is the appropriate response — it’s clear that lack of appetite control is driving purchases a nontrivial amount of the time for junk foods — companies that depend on that revenue have never really had a challenge until now
There are different classes of mall. In general those class A malls targeted at higher income stores and shoppers have been more resilient over the past decade than middle or lower. (Nordstrom vs Macy’s vs. Kmart)
It's straight up miserable to be in mclean/tysons between october and february. Truly it is america's asshole. And yes, people conspicuously consume more than ever. I think this is likely not true of most malls, though, the shopping culture here is just nuts.
Because in a lot of places there is nothing else fun to do. There is in particular nothing to do for teenagers. They aren’t welcome at most places and the mall is about the only place where you can go and (a) not be run out of there and (b) not have your parents worried that you are getting up to no good. So teenagers grow up in the malls and as adults are habitually going back.
There were a lot of different things happening but COVID certainly cut out some straggling malls.
In general this was a correction. The US ranked first in 2018 for retail sq ft per capita at 23. To put this in context, the next highest country, Canada, had 16 sq ft per person, and most developed countries sit around 3-4 sq ft per person. https://www.statista.com/statistics/1058852/retail-space-per...
> When companies like Google see their healthcare costs drop by $12,000 per employee annually and productivity increase by 25%, we observe a restructuring of corporate America that makes remote work a minor adjustment.
In my entire office, there's one overweight person that I know. Out of thousands of employees. There could be more, and other cities might be different, but you get the idea.
The author intentionally or mistakenly applies some numbers to whole populations.
Keep chaining impacts while eliminating small coefficients, your end result will be off by more than a few orders of magnitude.
EDIT: I need to be more clear about my point: My BigTech office does not represent my country stats: Canada has a 26% obesity and 36% overweight adult population. Just taking those numbers, applying them to all populations is wrong.
The analysis is wrong in other subtle but important ways as well. A 25% increase in performance of an allegedly low performing group of a company would not increase the overall company's efficency as much.
40% of Americans are obese and way more are merely overweight. Either your office is small, a huge fluke, weirdly selected or you're not observant enough.
6th option: They are overweight, but do not know, so they don't recognize what overweight looks like. But also, it's pretty easy to not look overweight if you're not obese. 30 pounds can be as little as a few waist sizes. I can gain and lose 15 pounds without looking like I changed at all.
Well, here in boulder, there are a lot of tech workers, and it is one of the thinnest cities in one of the thinnest states. Having said that, Colorado in 2025 despite being one of the thinnest states is still fatter than the fattest state in 1990.
Homer Simpson was meant to be a fat idiot barely hanging on.
In the 40 years since the first episode he's gone to being average weight and fitness.
Economically he's now wildly successful for being able to own a house on a single income with three kids. There are people making over $800,000 today who can't afford that.
> I suggest you look up how much raising children costs today vs the 1980s in both money and time.
I’m married, living in suburban California raising two of them on a single income much lower than $800,000 (much lower than 2/3 of that, too, since the hypotherical was 3 kids and I don't want that go be a distraction), I don't need to look up anything about a 1980s comparison to know that that $800k claim is sheer insanity.
> Two kids today are a much bigger status symbol than a 5 million dollar house.
No, they aren't. I mean, don't get me wrong I’d rather have my kids than the $5M house, but they definitely are not more of a status symbol than the $5M house would be.
Most of these studies use BMI which doesn't differentiate between muscle mass and fat. The number is likely much lower. Additionally, your numbers are off. I think you are looking at the number of people considered overweight, not obese. There were only three states in 2023 with an obesity rate over 40% [0]. The number usually hovers between 30 and 35%.
The population of a specific Google office could be two std deviations from the mean. My office area, SoHo NYC, has a dramatically lower obesity rate than the USA average. Maybe 10-20% of the population is overweight, let alone obese, and it’s mostly the service workers.
Obesity causes many health problems, but it's also a symptom - of our poor relationship with food, of the way American society is set up around instant gratification, of the predatory nature of food manufacturers.
Though treating the symptom is undeniably good, it also lets the deeper problems that lead to it go unchecked, and my fear is that it will lead to novel problems down the line. How recreational drugs are being replaced by social media is a good example of this; less harm to the body, undeniably good, but still harmful to the mind, and enabling new industries to pop up and find new ways to exploit people.
To be clear my problems aren't with Ozempic, and I believe it should be researched further and, if safe (which seems to be the case), widely available. But the fact is that many nations are able to maintain healthy weight without drugs, and I think if we fail to continue asking why that is, the same societal patterns that led to self-destructive individual behavior in the first place will remain unaddressed.
I agree with everything you've written, and I think your thoughts about Ozempic are spot on.
In the US, though, I don't mean to be super pessimistic but the problems are now so ingrained that I don't really see them improving for at least several generations. Stuff like:
1. Basically everywhere except for a few notable cities are organized around the car. Even if you wanted to walk places in a lot of towns it's near impossible or dangerous due to the road architecture. Fixing this now that it's built is an enormous challenge. I'll be long dead and gone before even a dent is made in it.
2. For decades we've been going in the wrong direction, and I don't see that changing anytime soon. I'm often shocked and saddened by how, well, "thick" high schoolers are these days. Like when I was a kid, there were certainly "fat kids", but it really wasn't that common. And we had a joke that when people went to college they would gain the "freshman 15" due to the all-you-can-eat dining hall plans. To me it looks like the freshman 15 now starts for high school freshman. And while I don't have kids, I've also heard others say how childhood has drastically changed since I was a kid. So much "hanging out", which used to be a physical activity, is now just done on phones. Except for organized sports, kids these days get much less "ad hoc" physical activity. High school is usually the thinnest/most fit a lot of people will be in their lives, and so I think we've condemned a ton of kids to a lifetime of obesity and health problems.
I'm all for changing our structural issues, but I'll take an imperfect solution now over something I don't think will come to pass for decades.
The destructive behavior is overeating and this treatment eliminates the overeating. The problem is human beings are imperfect creatures. This drugs corrects the hormone imbalance that leads to overeating. It is fixing the actual problem.
The idea that medical treatment makes us weaker is genuinely harmful nonsense on the order of claiming vaccines make us sick, and you should seriously reconsider your position here.
Where did these hormone imbalances come from, when and why did they arise, why aren't they uniformly distributed across the globe? Answering these questions may lead to a root cause of obesity and obviate the need for medication altogether.
Do you believe overeating to not be the equivalent of depression, schizophrenia, addiction, or bipolar disorder requiring medical intervention? If so, why? This is brain chemistry.
Suppose a country had very low rates of depression, and another had very high rates. Is that just brain chemistry? Or does maybe one country have problems that cause many people to have depression? Or to push subclinical tendencies into clinical territory?
The US is that but for obesity. Yes, absolutely some individuals have brain chemistry that predisposes them to this.
But also maybe it's related to the cheapest and easiest forms of food being McDonald's-tier shit and 64oz beverages that are literally so much sugar that it would be unpalatable were it not dissolved in acid and carbonated?
The US isn’t even the top 9. Obesity is a global epidemic of Western disease. The food isn’t the cause, it’s the symptom of the brain chemistry. If it isn’t available, yes, the disease may not present. But if available, due to hormones causing the drive, it presents. Like cigarettes (nicotine), like cocaine, like alcoholism. Same reward center.
Are we more likely to give GLP-1s to everyone? Or outlaw calorie dense, nutrition lacking products? I argue the former, based on all available evidence.
Nobody was suggesting solutions, but in regards to GLP-1 agonists as solving the 'problem' perfectly, no, it's just solving the symptoms. The problem is scientific advancement creating hyper palatable food and drink with no nutritional value and low satiety, combined with the food drive increases that comes with eating and drinking that food, combined with the removal of general fitness and mobility as a core requirement to being able to receive food and drink. I'm not saying there's a way to put back in the box but let's not kid ourselves that these drugs are a perfect solution either.
I think GLP-1s are a great hack until gene therapy can be used to fix the underlying genetic issue that leads to the brain chemistry expression requiring the temporary GLP-1 patch.
It can be manufactured inexpensively, scales up, and will be as common as insulin or Metformin.
All the countries above US have less than 1M population and generally poor countries. Saying that obesity is not related to the underlying social problems in the US showing this data is ridiculous.
> 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.
Do you have any concern that it's an over correction and leads to significant undereating? Which is also terrible for you. Genuine question for the record.
name some nations that maintain healthy weight without drugs? your dogma isn't supported by the data. obesity is a public health problem and it's not caused simply by junk food
Japan and South Korea. Much of southern Europe. It depends how you define healthy, but most of Europe has obesity rates below 20%. And that's just if you're counting rich countries.
The article posits that 80% of the top income quintile will be on this medication.
I have to ask, why? (I'm not in the US, I should add). Like, sure, is the average American overweight? Yes. Are 80% of the top 20% of earners? Seems pretty doubtful, plenty of the rich look to be in reasonable shape.
That statistic suggests that 80% of successful people have such poor impulse control that they end up seriously overweight or obese. And I say that as someone who likes a treat every couple of days, but exercises enough to maintain a fairly healthy weight.
Admittedly if there were a GLP1 for procrastination, I'd be on that stuff like a shot...
There are some signs that these drugs have effects beyond just apetite supression leading to weight loss. I recall reading something about them having a direct slowing effect on the metabolism, which increases longevity, among other benefits. I can foresee it being used like a supplement among those who can afford it.
> blindness, osteoporosis, depression, digestive and metabolic issues
I believe each of those are listed in the link he provided. It's up to the individual to make their own decisions as to their own health. At least the information exists with which to make informed decisions.
You're technically right but when people like this keep insisting it's safe in spite of clear evidence to the contrary, and they point to catch-all disclaimers that bury the lead, you might understand how someone would overestimate the safety of the drug.
Furthermore, people who say GLP-1 drugs are commonly prescribed omit the fact that diabetics are the main consumers, and their bodies probably work very different from those of normal people.
That says T2D is bad (indeed, arguably a lot worse than popular understanding), not GLP-1's are candy.
Have to wonder if people really understood the consequences, would they still allow themselves to get in that state? Then again, used to be that smoking was something 1-in-3 did, so...
Anyway, seems pretty settled that fixing T2D with GLP-1's is a lot less harmful than not, but using them on healthy people is a different story.
I doubt it's that high of a ratio. Even if it was, you need to break it down into weight loss versus diabetic cases. I'm sure the dosage is different along with the mechanism of action, even though the substance is the same.
Imagine saying that starches have extended more lives than they have cost, without breaking down the analysis any further. Clearly the health impact depends on the quantities and patterns of consumption. This is the kind of muddling that is now happening with GLP-1 drugs.
> Admittedly if there were a GLP1 for procrastination, I'd be on that stuff like a shot...
This might be my biggest unknown with GLP1s, how does it affect people with reward system issues — it could dramatically worsen a procrastination problem if it dampen the will to reward seek.
Then again it has only seemed to do this for vices so far
Big food corporations profit from ultra-processed foods that manipulate our natural systems. They design products that override satiety signals using calculated combinations of sugar, fat and salt to activate brain dopamine pathways. Their priority is profit growth, not consumer health.
The consequences are significant health issues like obesity, diabetes and cardiovascular diseases. Healthcare systems struggle with preventable conditions while millions experience declining health and shorter lifespans. These corporations employ questionable strategies: marketing to children, lobbying against regulations, funding misleading research, and shifting responsibility to consumers.
Medications like Ozempic represent a threat to this model by reducing appetite and interrupting compulsive eating. Recent industry concerns about declining sales show how these medications could undermine their business approach. If consumers regain control over their eating habits, corporations may finally face consequences for practices that have profited from health problems for decades.
> Big food corporations profit from ultra-processed foods that manipulate our natural systems.
I've just never bought this.
Does grandma manipulate you when she adds sugar to her cherry pie? Does she manipulate you when she adds salt to her mashed potatoes?
Foods -- "ultra-processed" or not -- don't "manipulate" you. They literally just either taste better or taste worse. Grandma, and her grandma before her, used sugar, fat, and salt, and thank goodness they did. These are normal ingredients. It's not like they're nicotine or heroin or something.
I mean, is a fig tree "manipulating" you when its figs ripen with sugar so they'll be eaten?
You're not being manipulated. You're just choosing to eat what you choose to eat based on what you like.
No matter how I look at it 60g of sugar in small bottle of coke is criminal. My wife bakes cakes for 10 people with less added sugar.
Junk food definitely is designed to abuse our natural instincts and needs, from packaging to ingredients. Go one year without processed food, you won't physically be able to drink coke or eat fastfood
> No matter how I look at it 60g of sugar in small bottle of coke is criminal.
I hate to tell you how much sugar grandma put in her lemonade, and in her sweet tea...
> My wife bakes cakes for 10 people with less added sugar.
That's extremely unusual. Different types of cakes take different amounts of sugar, but it's generally somewhere between 150g and 300g for an average-sized cake that might give 10 slices. That's between 3/4 and 1.5 cups of sugar. And that's without frosting or anything extra.
A cake with less than 60 grams of sugar... I don't even know what you'd call that. I mean, you'd never make a sponge cake or chocolate cake with such little sugar. It wouldn't even taste like cake. It would be more like a slightly sweet... bread?
I'm very curious what one of your cake recipes is!
Because sugar also greatly affects the texture of cake -- it retains moisture, prevents gluten formation, incorporates air... reducing sugar by 75% is going to make for a very dry, tough, and dense cake.
I can't even imagine how you're going to make a cake recipe work with 75% less sugar. And it's not an American thing -- it's not like European cakes are any different. Also, cakes don't work with 4x sugar either. Americans aren't overloading sugar that you need to compensate for, because that doesn't work for cakes either.
Are you sure you haven't confused it with just simply less frosting or something? Because a 10-slice cake with less than 60 grams of sugar just isn't really going to work, with everything I know about baking.
In that specific case it was a cheese cake. But I've made made fruit cakes with virtually no added sugar, just fruits, and sometimes even that is quite sweet
I can't eat cakes from coffee shops &co because they taste waaaaay too sweet.
Ah, I see. Those aren't really cakes at all, despite the names. Thanks, that makes more sense.
You're just extremely sensitive to sugar. The average person is not.
But also, that's not necessarily an adaptation. I went for an entire year once without sugar. Once I went back (after finishing losing weight), nothing tasted overly sweet. It still tasted exactly as I remembered. I could (and can) still drink a Coke and it tastes great.
I mean, especially when I work out, I wind up ingesting a lot of glucose. It's just what my body needs to fuel itself, to keep my blood sugar from getting too low.
Many foods and beverages include ingredients whose sole purpose is to hide how sweet it is because otherwise it would be unbearable in your mouth. Gives you a stronger high once it reaches your stomach though.
What do you mean no? This is a widely known and commonly used approach. Citric acid, salt and bitter compounds are some of the most prevalent options. This isn't even remotely close to a controversial opinion.
I mean no. All those compounds are used for flavor. They aren't used to mask sweetness.
Manufacturers design foods to taste good, not for some secondary effect of sugar in the stomach.
The idea that the sweetness would be "unbearable in your mouth" is just plain silly. People suck on lollipops which are pure sugar -- are those "unbearably" sweet? What you're saying doesn't hold up to even the slightest scrutiny.
Manufacturers aren't going to waste money on additional sugar and then try to undo the taste with other ingredients. That's not a thing.
No, you're the one in denial. Just have a look at the decade old book "Salt Sugar Fat: How the Food Giants Hooked Us" to see the flaw in your assumptions.
It details many Concrete examples of exactly how the companies are manipulating everything about food for profit.
Kessler, further FDA head has written about this topic extensively as well.
Do you go to grandma every day to eat calory packed food? Does grandma deploy dozens of scientists who design food so that it has an addicting effect? Dozens of marketing experts who confront you with images to consume the junk? Lobbyists who try to convince that sugar is not causing health problems? Your analogy does not work. These corporations are creating products that cause massive health issues that cost society billions.
You should visit a food processing plant sometime. What they are doing with food is not what your grandma does when she cooks it from ingredients you can buy at the grocery store. And I bet your grandma doesn’t have a food chemistry lab to fine tune her recipes.
Similarly, fig trees don’t make Fig Newtons. They make figs.
Oh, I'm familiar with it. And you know what? They mostly are doing what grandma does. Just in vastly larger ovens etc. Even if you want to talk about corn syrup, what do you think grandma made her pecan pie with?
And the things that are different -- emulsifiers, stabilizers, natural/artifical flavors, etc. -- aren't actually making the product unhealthy, at least not in any way that causes weight gain. Those aren't sugars, fats, or salt. They're just making it last longer on the shelf, and have more flavor. But it's not changing the nutrition, and it's not making us eat more of it.
You really think Chips Ahoy is making you fat in a way that grandma's chocolate chip cookies don't?
I don’t know if it’s the nature of the products themselves, or if it’s because they’re vastly cheaper and more accessible. There’s a natural limit to the number of cookies to be had from Grandma before she says “that’s enough,” vs being able to get 64 at the local market anytime you want for a pittance.
Really just feels to me like youre blaming the wrong entity here. Why is it too much to expect adults to act like adults and make decisions for themselves? If the companies were selling directly to kids sure but why is it their fault that people cant control themselves?
> Why is it too much to expect adults to act like adults and make decisions for themselves?
Because people don't act rationally. The model of a human as a rational actor who deeply considers all of the potential impacts of their decisions is a fiction that has been proven flawed by countless studies. Those actions can have externalities and consequences for which the public bears the cost, not just the actor.
> why is it their fault that people cant control themselves
Nobody's ascribing fault here; rather, we're trying to understand the bigger picture.
I dont believe that people who eat unhealthy food have any doubts about the effect of the food. They just dont care that its unhealthy, that isnt an externality.
> Nobody's ascribing fault here; rather, we're trying to understand the bigger picture.
The bigger picture is that more products that people enjoy is a good thing, and if some people cant handle that its not societys fault.
The externality is increased public health care cost. Obesity leads to increased risks of heart attacks, diabetes, strokes, etc. And there’s a strong between poverty and obesity, making it more likely the public will pay the cost of treatment.
There are other externalities as well; for example, we still haven’t really solved the problems created by all the plastic packaging used with processed foods.
I’m wondering if it’s a little of both. I’m not a nutritionist, but one operating theory I’ve read is that many processed foods are manufactured in such a way that they make you feel less full than a homemade equivalent would.
Yeah, I agree. People really seem desperate to believe it all comes down to boogeyman adulterants, but it's a huge red herring and completely unnecessary for ending up with a culture of junk food, obesity, and calorie surplus.
Drop dough into frying oil and then roll it in powdered sugar.
Drop potato slices into frying oil and then salt them.
You don't need boogeyman R&D chemicals to make food that you can't stop eating. What changed is the accessibility of these things. You can go to 7-11 and buy thousands of calories of packaged donuts for dollars. Combined with there only being junk food in US quickmarts compared to, say, cheap bento boxes in Japanese 7-11.
It is far more likely that the obesity crisis is a combination of a lack of healthy food culture combine with industrial revolution of mass produced food capacity. Since you don't want to drop your industrial capability, the only other option is to change societal food culture and their relationship to food. Or just take drugs. That works too
Does grandma have a profit motive? Does grandma care about your wellbeing? Is grandma a vast conglomerate of strangers who couldn't give two flying fucks about you on a good day?
Is plain old sugar, animal fat, and salt unhealthy in large quantities? Of course, but eating grandma's mashed potatoes and cherry pie once a week will not materially affect your health. Meanwhile you pass 8 taco bells on your way home from her house, not to mention the 3 fast food ads you heard on youtube or the radio. Come on.
> > Big food corporations profit from ultra-processed foods that manipulate our natural systems.
> I've just never bought this
Yours is a rather strange reading if you truly mean to absolve the food of sinister intent. Clearly it has none.
Nor must the corporate entity producing it. That's the nature of moloch. You get bad outcomes even without outright villainy on anyone's part.
The food is being "manipulated" in the same way Grandma manipulates it, sure. Grandma bakes a pie from whole ingredients, sourced perhaps from an area farm or maybe even her backyard, with her bare hands. Show me how a Twinkie is made. The naturalistic fallacy is irrelevant.
It is simply wrong, not to mention naive, to think companies do not optimize their products to maximize impulse/repeat consumption. They are most certainly aware of dopamine pathways. This is one, and indeed a big one, of those
> other things
you mention. Convenience and advertising are big ones too. Why do we need so much convenience, and see so much advertising? Perhaps it has to do with the ordering of our lives around the very sort of institutions that sell us ultra-processed foods.
Food companies maximizing the utility we get from eating their food is a good thing actaully. Im very grateful for all the delicious food on the market. Not the companies fault that some people never learned to consume in moderation.
> Does grandma manipulate you when she adds sugar to her cherry pie?
Manipulation implies a purpose, so I’d say no. Does grandma have an ulterior motive? She adds sugar to express herself through the art of baking or does she need a favor?
> I mean, is a fig tree "manipulating" you when its figs ripen with sugar so they'll be eaten?
Yeah it's anti-capitalist rants at every turn around here. Capitalism is the best system we have to make people happy in a fair way. It's not a system to teach people the benefits of moderation or charity. You're supposed to bring that to the table yourself. There's no economic system in the world that can fix character flaws.
Yeah, lets sell cigarettes and blame consumers for health issues because, you know, capitalism is the best system we have and the burden is on the consumers.
The burden IS on consumers though. Tobacco, alcohol, caffeine, sugar, and even bottled water can be harmful in excess. How about video games and porn? I don't think it's the government's job to tell you that you can't have basic things like that just because it might make your health worse in some way if you go crazy with it. Capitalism isn't there to teach you moderation, it's to get you what you want or need efficiently.
I actually feel the opposite. Ozempic is a massive risk to health food companies. When people know they can eat whatever they want and not gain weight they'll only eat what tastes best. All mcdonalds no sweet green so to speak.
"Big food corporations" lol. You think every professional chef doesn't know the same tricks? There are basically 3 things that taste good. Fat, salt, and sugar.
GLP-1 drugs also manipulate our natural systems. It's not a panacea. There are early indications of increased suicidal ideation in cohorts that take this drug. Caveat emptor
Monetary deflation is easy to solve: just print more money.
But who do you give it to? Well, obviously, you give it to billionaires because they are the best at managing money because they're billionaires. They can then spend it on wages, without having to produce anything useful because they are just getting free printed money.
Is GLP-1 really changing general impulse control? But I do buy the argument. If impulse controlling drugs are going to be effective, the economic impact is basically not quantifiable... not only the economic impact but it would change society as a whole in extremely fundamental ways (e.g. dating)
I think an angle not covered is that the "impulse economy" actually degrades impulse control. Advertising, social media feeds, etc are all hammering away at people's willpower, and getting is addicted to giving in to impulses. If these things disappear, maybe even people who aren't on these drugs would have more impulse control.
In marketing world, many consider the slogan "Just Do It" to have a double meaning: 1) Don't make excuses, get after your goals! (the one you're espousing) 2) Treat yourself, just buy it (the one the articles author is emphasizing).
What does this even mean? The results of GLP-1 meds are well studied and widely understood to be game changing and likely revolutionary. The other claims might be hyperbolic but results of the medication on individuals is not really a question at this point.
People are weirdly resistant to acknowledging the obvious implications of things if those implications seem big. There’s a broad “nothing ever happens” heuristic that people tend to mistake for wisdom.
I think some skepticism is warranted. If this is a medication that most of us can be on and it comes with positive health benefits, that would mean that humans as a species have lower than optimal GLP-1 levels. I guess it’s possible that our bodies are wired for a world that is unlike today’s and that these drugs correct for that. But drugs that doesn’t come with side effects. It also wouldn’t be the first time that a drug company manages to convince the medical community to think a drug is healthier than it really is (OxyContin).
> I guess it’s possible that our bodies are wired for a world that is unlike today’s and that these drugs correct for that.
The constant access to unlimited tasty food we have now is completely unprecedented in human history.
Other animals will also overeat if you give them unlimited access to tasty high calorie food.
This is absolutely a situation we did not evolve to be able to handle unfortunately. Lack of sufficient food was the norm for most of our history, so it's not surprising that we evolved to want to eat a calorie surplus if possible.
Not remotely true. We have strong studies out to 10 years at this point. Given the overwhelmingly positive results at our current state, it would take a huge safety signal occurring at 12-20+ years of usage to provoke a change in recommendation, and this is exceedingly unlikely. Basically all such signals are revealed by 10 years if they exist.
My wife's taking GLP-1s for health reasons. The author's ideas about the effects of these things are not evidence based. It isn't a magic drug that makes people ascetics. She eats less, but she still impulse buys clothes and things. The idea that the drug numbs feelings is not at all what I see, while some appetites are diminished, we still both do art, enjoy going out doing all the same stuff as before. She's lost weight, her vitals are looking better, and we eat out less, that's it.
I'm taking GLP-1s and it's absolutely reduced my impulsiveness in ways besides food. Not completely, for sure, and being less interested in food actually means more time to spend on other hobbies.
But it's definitely done something to my non-food behaviour, albeit I'm not sure what exactly. It may well be that I was previously trying to satiate my constant desperate hunger for food with other forms of harmful addictive behaviour, and without the hunger, I just don't need that as much. The concept of satisfying one craving with another isn't new, after all.
Something like 70% of the US is overweight, so there actually aren't as many people who aren't experiencing negative health effects from being overweight or obese as you think
Most of them likely are obese. Obesity is so normal that what most people call “overweight” is actually obese and the people they think are obese are morbidly obese.
Nothing wrong about wanting to look hot if the danger level is not high. I haven't heard about people trying to use them to aid an eating disorder, like diabetics do with insulin.
Anecdotally, it isn’t really giving up impulses. It blunts the desire for a lot of the ones that are related to consumption.
I can still get a wild idea at 9 pm and lose myself in code. I still see flowers and buy them form my wife without planning. I still have a bowl of ice cream before bed sometimes.
The best way to describe it is that you still have the impulse, but you are able to rationally consider it.
I personally can't believe humanity is in such a state of decay that the two options allowed to be discussed are "50% of the population is morbidly obese, has 0 impulse control and will literally eat themselves to the grave" and "ozempic for life for 50% of the population"
Are we just a bunch of NPCs waiting for the orders? One day it's McDonald's selling you the disease the next it's Novo Nordisk selling you the cure, and you apparently have to clap at that "miracle"?
I'm not sure what you mean by "allowed". It's common and quite popular to discuss other strategies for controlling obesity. If someone invented a diet or exercise plan that works as well as Ozempic, it would be huge. But nobody's yet been able to do so, which I suspect is because diet and exercise are fundamentally not effective anti-obesity strategies.
Yeah but a forecast 10 years out is a lot more fun/enlightening if it's hyperbolic. It doesn't make much food for thought to say 'We predict by 2030 the average consumer will have purchased jeans 2 sizes smaller than in 2010'.
In any case, I hope they're directionally correct. A class of widely-available drugs that lets us switch off impulses that don't suit our environment and wellbeing any more would be incredible and world-changing. I'm very curious to try GLP-1 agonists myself.
If a person is careful and sophisticated enough to warrant GLP-1 drugs, they probably weren’t the ones that were binge drinking and DUIing and doing careless things in the first place.
There are a lot of people who are sitting in front of a computer or a phone playing Roblox/Fortnite and watching TikTok and so on all day and night.
The most significant takeaway for me from this analysis was that many businesses were aligned with helping people become or remain obese. Where do the opportunities flow to now that people can apply their disposable income to items beyond food and alcohol? Something similar happened during the "low carb" shift when bakery goods sales decreased, but people shifted to high protein (and perhaps high fat) food away from high carb. But it was still food. This feels a little different.
This isn't a new idea. Jim Cramer has been warning about reduced earnings by alcohol beverage companies and snack food vendors due to GLP-1s for at least a year.
It's an interesting idea, but ultimately being sensationalized. The article starts off by making a compelling case that the widespread adoption of these impulse-control drugs will disrupt the economy and lead to many changes in business models built around impulse buys. The issue is that these drugs only entered the public consciousness within the last two years, and many of the business model changes that the author implies are attributable to the drugs have been going on for a lot longer than that. His treatment of retail is an obvious one (he's ignoring the impact of changing consumer practices that came about due to online shopping). The replacement of anchor stores with medical centers is another one - I can remember reading about this on Hacker News in 2017.
I suspect his projections on the impacts these drugs will have on crime rates and alcohol consumption are probably also overblown. I could be wrong, but I would think that the sorts of people who seek out prescription drugs for impulse control aren't likely to overlap with people who drive drunk in the first place.
The anecdote about the lost muffin revenue was still quite interesting.
??? They're going to be trying to get on a weight loss drug, not an "impulse control drug". And I don't see why you would assume there's little overlap between people who desperately want to lose weight and people who drive drunk.
From the article: "We're not just talking about weight loss. We're discussing the first medication that effectively regulates human impulse control. Think about that."
> I don't see why you would assume there's little overlap between people who desperately want to lose weight and people who drive drunk.
This is only a hunch, but I would guess that drunk driving is associated with low conscientiousness and that the sorts of people who are going to go through the trouble of getting medicated to lose weight are unlikely to be the sorts of people who drive drunk in the first place.
Maybe I was misinterpreting the point he was trying to make.
The way ozempic is currently marketed is as a weight loss drug. People can be overweight for many reasons. Impulse control might be one of them.
Drunk driving is associated with low impulse control due to being drunk. Being drunk might be associated with the kind of lack of impulse control that ozempic targets.
Revolution it may be, but yeah its made to be sensational, which often means facts may be used out of context or twisted for specific narrative.
Don't worry there will be tons of complementary businesses like overpriced healthy food megastores and countless gyms that will absorb unemployed workforce and all that 'suddenly available' cash. Junk food is cheap, quality tasty healthy one not so much.
For the rest of the world, not so much. For America however, this is a huge disruptor.
The pride associated with having a body shape that a well trained Ai would classify as Manatee rather than Human is rapidly changing and _eventually_ society will be better off for it.
The author is assuming that everyone will proactively start taking this drug. But I don't understand why? If Jerry is not obese, why would Jerry randomly start taking an anti-obesity drug?
The number one group of people who will never ever want a powerful appetite suppressant are body builders. Lifting weights isn't hard, eating 6 meals a day is and they don't need to make it ten times harder for no reason.
Even if they are right, do people want to voluntarily start taking drugs to control their impulses? Au contraire, I think a lot of people, either ideologically or subconciously, appreciate the hedonistic lifestyle
Well, the author did not reference any actual studies. But some people here have shared an effect on their general impulse control. Do you have any pointers to good studies about this effect?
It's not silly at all. In 15-20 years this stuff will be <$100 for weeks of use. For many people $800 dollars is less than the they spend on food in the same time
That's a bit of a ridiculous assumption to make, given that there are plenty of medications that have cost pennies to make for decades and still retail for hundreds to thousands.
Perhaps in non-US locations it will be that cheap for sure.
My guess is there's also a long term explosion in liver/stomach/pancreatic cancers coming which might be the diabetes/heart attack/strokes of the 21st century.
The article warns about impending future inequality:
> Imagine two employees. One can afford these medications, the other cannot. One has regulated impulses, higher energy, better focus, and lower healthcare costs. The other doesn't. In a few years, data shows the first is three times more likely to be promoted.
> Scale that across society.
I'm not sure this is a reasonable worry. Ozempic is going out of patent in less than a year's time. There will be cheap generics all over the place. Purportedly the drug has a very low unit cost and uncomplicated manufacturing process, and every potential generic manufacturer knows it'll be a huge hit. That means we should expect it to rapidly become a commodity that's quite available.
If it really does cut food, alcohol, and cigarette costs so dramatically then I suspect a decent amount of poorer people would budget for the drug even if it didn't become cheap. It's not like poor people don't buy food, alcohol, or cigarettes today -- if it's a net savings and health/life improvement, it's even more worth buying than the alternative.
when semaglutide and tirzepatide first came out, they were being synthesized in labs across the world for pennies per milligram, as with all compounds.
Sorry a bit late here, but both Tirzepatide and Semaglutide are off the shortage list, and the promise to not seek legal action that is currently allowing some compounders to operate freely will likely end sometime soon.
Literally, the only reason any compounder today (that is brave enough) can produce Tirzepatide or Semaglutide is because the FDA has promised to not pursue legal action for a short period to enable people to find other solutions.
Prices are about to go back up/a bunch of options are about to leave the market. See: Novo Nordisk's share price/related news.
Again this is not great news but if you zoom out it’s amazing that obesity might be a solved problem basically completely in like 10 years.
Obviously GLP1s don’t work for everyone but they work for a lot of people, maybe we can focus the remaining resources on a smaller group of people with greater struggles
For years, I had the opposite problem most have with their weight. My main problem was gaining it. Food was not enough - I will loose weight relying on food alone.
It seems that with food, I often don't like the taste or texture, or the sensation associated with eating. I also tend to feel full relatively quickly.
My solution was to make a shake - in this shake, I put a large amount of olive oil, mixed in with other ingredients which cancelled out the taste. Easy to consume over the day.
Over several years of having the shake, I got to a weight I'm happy with. I'm now in total control and can regulate my weight simply by adding or removing the olive oil in my shake. Over the past year I've started weight training 5 days a week and adding protein to the shake with good results.
When I go on holidays and don't have access to my blender, I reliably loose a bit of weight - probably the opposite problem most have when they go on holidays.
I'm also non drinker. Never really got on board with alcohol, didn't like the sensations of the effects.
I still eat normal meals much the same as before, just a smaller serving than what most others have.
I don't see any comments talking about it, and it's not mentioned in the article, but if it changes impulse control I wonder what effect that will have on politics. Hopefully one where people will take a longer view and look at policies rather than impulsively voting for the candidate they think they like the most.
I think the most likely political effect is from media consumption. There have been anecdotal reports of the drug helping people avoid doomscrolling compulsions, which likely means less exposure to various political social media.
Sure there is. All the way back to aspirin. Before aspirin, there was salicylic acid, which has some painkiller effect but tastes awful and causes stomach upset. Researchers at Bayer found that tacking on an acetyl group produced acetylsalicylic acid, with the same painkiller effect but fewer side effects. That's aspirin.
Drug companies are trying to improve on Ozelympic.[1] The big win will be when somebody comes up with a pill form rather than an injectable.
I see your point. But consider that drug generations are generally not defined by the manufacturer, but by the broad community of researchers and clinicians finding step-changes in their effectiveness/side-effect tradeoffs.
So by definition, if they ever consider a "new generation" of GLP1-agonists, they will be better by definition.
I'm from the country of Ozempic and Wegovy and neither Novo Nordisk nor our media have been portraying these drugs as general purpose anti-addiction drugs. However there have been some international studies that reveal that it might actually be. Can Novo Nordisk extend their patent of their existing drug if they find new applications for the drug?
Some of Silicon Valley's excess productivity over the rest of the world is driven by ADHD medication. Curious what happens when they also start taking GLP-1 medication.
Yes, a patent can be extended with a different use case. Drug repurposing or repositioning is mostly done exactly because of this financial benefit. Unfortunately that does not apply to currently generic drugs, so pharmaceutical companies don't put the resources into repurposing off-patent drugs that could be helpful.
as another person mentioned in this thread about people already combining glp's with other drugs, i can see scenarios in which some people abuse glps with adderall or even pain killers to become literal zombies - foregoing breakfast/lunch breaks, working longer hours... imo it could establish an even greater work demand from companies (implicitly) where if you're not on it, you're not "trying" hard enough.
Looks like this is a worse case/best case scenario, rarely it will happen like that. There will be some effect but if people aren’t eating muffins, they are eating power balls. Not drinking beer, drinking tea. I would ear mark a 5-10% of that effect max, he’s going for 100%
When I had my first real programming gig in the early 90s, I worked 14+ hours a day and ate fast food exclusively (often in very large quantities). My weight ballooned to nearly 400 pounds.
Then I got sick…
I couldn’t eat anything with fat. Just the thought of it made me physically ill. I ended up dropping half my body weight in 18 months.
What I learned is that it is possible to break your body in many ways.
The article describes a psychotic lifestyle as normal.
I didn't need a drug to reject having breakfast at Starbucks. I bake my own bread. I wake up early to have time to eat it in peace.
I take enough time to roast my own coffee beans.
I commute by bike.
It's about having some standards. A concept of a lifestyle and person that isn't just a corpo drone.
I'm on Saxenda (liraglutide) since last August. Started at 163kg, so far 39kgs down I'm at 124kg right now. And I'm not stopping here. Anything under 105kg is already good but I really want to reach a two digit weight.
Saxenda + a calorie restricted diet is pretty much the best combo. Can't complain, never felt any better.
Much as I have read research and heard stories of the knock-on health improvement effects of GLP-1s... Expect a lot of that economic value to be captured by pharmaceutical companies charging for them. And insurance companies charging higher premiums, because they're paying for everyone to be on them.
I recently did a bunch of consultation and research to decide if I wanted to start taking them, and the only currently discussed serious side effects are applicable exclusively to people with a history of pancreatic disorders.
Some people experience major side effects. Neither my wife (semaglutide) nor I (tirzepatide) have had any negative effects apart from minor upper GI disturbances when moving up to a higher dose. These dissipate within a week or so.
That said, these are definitely serious drugs and I wouldn't be taking one if my quality and length of life weren't threatened by metabolic syndrome, and if I hadn't been trying for decades to solve the problem without medication.
Speculative/Limited Data: Senolytics, Hormones and Peptides, NAD+, Nootropics and Adaptogens.
Keep in mind that the absence of published RCTs does not mean an intervention is ineffective; it may just be proprietary knowledge. Plenty of rich, private labs out there doing that kind of work today.
You've replaced one drug with another. Freud would be proud.
> If you told someone in 1850 that air conditioning would reshape the global economy, they'd think you were crazy.
This is incredibly misinformed. You've lived /with/ refrigeration and /without/ malaria for so long you have no Earthly idea how people in the opposite state lived their lives or saw the world around them.
> We're discussing the first medication that effectively regulates human impulse control. Think about that.
It has side effects. Think about that.
> The significant economic impact occurs in the second and third-order effects.
Yes and many of them will be negative. This is hyper futurism with zero grounding in the past. This is extremely lazy writing.
"you replaced this drug with hundreds of known downsides with one that has none"
Nice nonargument for the rest of your post. It's somehow misinformed to state the fact that the southern manufacturing industry simply cannot exist before air conditioning
Frankly your attitude is evil and you are a proponent of evil.
I can't understand this type of thinking. Of course it has downsides. You are being extremely disingenuous to say this. Let alone not acknowledging that different people experience different side effects. Plus you're completely ignoring the /reasons/ why people drink in the first place and abandoning any effort to impact those. Do you work for the company producing this drug or are you genuinely this gullible?
> your attitude is evil and you are a proponent of evil.
So you label things you don't understand as evil? What is this meant to accomplish?
If you really believe what you say then why aren't you pressing for the drug to be free? For free consultations to be given out? If it's truly this magical then it's very irresponsible to let a for profit company own it, sell it, and market it. Isn't it? Wouldn't that actually be evil? To champion this cause merely to make money for a patent holder?
You diminish these terms in your careless use of them.
First, those in power rebased the diet of the masses to carbs. Consequence: an eternal epidemic of obesity, with the many known complications and illnesses as a result.
Then, they now try to remedy the problem by fucking with the human body's mechanisms. 100% guaranteed to cause terrible side effects, in the long term. It's always more complex than you think. The more coveted a "medication" for a societal problem is -- with the problem being the pigswill that is fed to the masses, and our absolutely terrible sedentary, movement-less lifestyle --, the more quickly it will be greenlit, and the greater damage it will do over time (those pesky "unknown unknowns"). The hubris of human industry is unlimited; here's one example:
> On October 30, 1924, Midgley participated in a press conference to demonstrate the apparent safety of TEL, in which he poured TEL over his hands, placed a bottle of the chemical under his nose, and inhaled its vapor for sixty seconds, declaring that he could do this every day without succumbing to any problems.
The obvious solution to the obesity epidemic is to dismantle the food industry and the 8 hours workday. Our eating and movement/exercise habits need to revert to not just pre-industrial, but pre-agricultural standards. Move a lot every week (at least on 4 days per week), welcome hunger back into our lives (hunger allows you to appreciate and enjoy simple food -- intermittent fasting is amazing), and eat food with high volume, but low calorie content, and/or with low glycemic index. Our stomach volume and our blood sugar control had evolved for those types of foodstuffs, yet due to said rebasing of the diet of the masses to carbs, we've been filling our bellies with artificial food that's hyper-charged on calories and that get absorbed immediately. That's the recipe for growing fat tissue.
Two wrongs don't make a right.
And a final comment:
> Analysts predict that by 2030, 30% of American adults will be on these medications
Why doesn't that prediction make everyone shit their pants, from fear? Do you really want to make all those people dependent on Big Pharma just so they can eat healthily? How more basic do our bodily needs get than that?
This meds are pure evil, they're a non-answer, they're a cop-out, they only transfer power from Big Food to Big Pharma.
This is the same shit as trying to "cure" society-wide depression and anxiety with drugs. It only suppresses (or replaces) the symptoms, without fixing the root cause. We're depressed because our engineered societies make our lives meaningless. The struggle for survival is real, and the universe is unfair and indifferent, so we certainly need society, to cope with that. Just not this way.
The Wikipedia article you linked states that Midgley actually knew the dangers:
> tetraethyl lead was known to be acutely toxic by those involved in the development of leaded gasoline. This included Midgley, who publicly insisted that there was nonetheless no health hazard posed
W.r.t. making people dependent on big pharma:
I have multiple allergies and although the drugs I take have side effects, I would not function without them ~8-10 months of the year (where I live, the pollen season is expanding with global warming).
I am somewhat dependent on big pharma for quality of life, but the alternative is strictly much worse for me.
I know it is a more mature type of drug, but the automatic kneejerk reactions against “Big Pharma” is unwarranted IMO.
> We're discussing the first medication that effectively regulates human impulse control.
Is this another numbing zombie drug, like over-prescribed anti-depressants -- that some people genuinely need, but that make some other people accept a situation that they would otherwise be up to challenging and improving?
Sounds dystopian. And also Ozempic face. To me it seems that it doesn't activate all fat cells in the same way natural weight loss does. I do have a feeling that GLP-1 agonists will eventually bite us in the ass. Usually this is the way with molecules that are too miracle - hello cocaine, plastics, teflon and amphetamines. There may be some spectacular risks that will become evident after decades.
Reading this you'd think we're on the cusp of the sort of utopian society seen in Brave New World. Class hierarchy reinforced by behaviour regulating drugs given to happy, subservient workers. Hell, with all that talk of impulse control, I wonder what it will do to people's motivation to protest and riot...
Off topic: Since we are doing clickbait titles, I thought ChatGPT / Gen AI in general might be a better candidate for "the biggest economic disruptor since the internet", based on hype, especially from the "leaders" who claim that AGI is just a few months away.
>Consider this: When alcohol consumption drops 40% (as it does for many people on these medications), we're not just talking about lower beer sales. We're talking about:
Apparently in most muslim households this drops to 100% or zero consumption, you don't need freaking drugs for that
Access to impulse reduction via medication is problematic and will be isolated in the US to those who, frankly speaking, probably do not spend at a meaningful rate compared to their asset (wealth) standing. It’s a brilliant observation though that if “something got in the water supply” and en masse consumer behavior changed, then absolutely the ripple would be astounding to watch. I still recall standing in a field outside Alliance airport watching Amazon cargo jets landing at basically 30 minute intervals and thinking “all that stuff and this system doesn’t make economic sense” and I for one eagerly await a…let’s just call it…recalibration.
And it's a problem: 8.5 million working diligently to make the world less efficient, less healthy - generally less up-to-speed - is NOT a good thing. It's not something to long for. It's not something to protect through ... what? forced impulse buying? or other subsidies. It's something to change urgently - or at least get ready for. (And some of the businesses mentioned do think about it.)
Still it would be nice if society - in particular the US - put some effort into succeding at these transitions. These transitions do not need to be "one day you have a job, the next you don't and good luck". For one thing these transitions are never sudden - they have 5-10 years thereabout. For another there are options, "illegal to fire" (France, insane), "work or train" (Denmark is it?, admirable idea), "ease of starting and running new businesses" (various countries, the US not in the lead). By contrast, we regularly see indefinite term subsidies, and minimal education / training planning.
Is there a term for this style of writing? It's like a longform linkedin post. I don't mean this as a criticism, it just seems like written language is evolving to better capture our diminishing attention spans.
I've had a hunch it's about the shrinking width of pages. The text-width is about 11-13 words (at a max-width of 728) and the author seems to have written around this.
Because it's so thin, anything longer than 12 words becomes a paragraph which "slows" the reader, so there are a lot of punchy short sentences. This style would look silly if it was written on a wider left-aligned blog.
That's funny you mention text-width, I've noticed that with "punchy" articles like these.
Alternatively, when I see the old-school blogs that fill the entire page-width, I get the instant feeling I'm about to read something opinionated and quixotic.
Sure enough, the last HN article with that style hit it-- let's rescue the web by sending around WASM-blobs to be rendered to a common Wayland-like compositing surface. Thanks again, default CSS!
It gives me serious TED talk vibes. I guess it could be called that. Or maybe it's the twitter thread style?
A lot of catchy one liner hook sentences ("they're literally removing concession stands from NFL stadiums!") that sort of add up to make the author's point.
I'm pretty sure fact checking line by line will make the whole thing less impressive.
I am a fan of Carroll Quigley's style of writing (Georgetown University professor and ole Slick-Willie's mentor). I find having DeepSeek restate articles in his style to be much more enjoyably ingestible.
Wow, I just followed your suggestion and the output text was exactly the style of writing I enjoy and try to employ myself. Gonna check Quigley out. Thank you!
... which is intended to present detailed, long-form treatments of a subject yet, at the same time, provide something interesting and actionable in a brief moment.
Yeah, it's got that "visionary thought leader" vibe dialed up to 11. There's some interesting analysis in there, but it leans hard into the grandiosity—like he's the only one seeing the big picture while the rest of the world sleepwalks into a $100 trillion shift.
Hype cycle slop reminiscent of Business Insider, etc. Reminds of me engagement bait threads on Twitter which always include the “thread” emoji and the downward pointing finger emoji.
Not ADHD specifically, but about 12 years ago, the media was hyping Provigil as a "secret weapon" of the ultra-productive.
Despite having a prescription, CVS told me that my insurance wouldn't cover it and it would cost $1500 for 30 pills. I walked away and then went back to buy it. If I could just get 30 additional minutes of billable time per day per pill it would be worth it.
I took about 5 over a week and destroyed the rest. It wasn't good for anything but keep me awake in a semi-zombie low-creative state. This very expensive drug/lesson was effective and making me realize I need to seriously work on my impulse control.
Apologies, I've updated to clarify that my comment is under the assumption that the host is not already under a non-natural influence or medical condition. For example, in the case if there is a medicine that would help drug addicts with their addiction I would be 100% for it.
Food can evoke the same neurochemical response as hard drugs or sex for some people. It is even more readily available than either of those things, and it is advertised and produced by multinational conglomerates with huge advertising budgets. They have the resources to maximise the attractiveness of their products and optimise the way they taste to be as pleasurable to eat as possible. Usually that means filling them with terrible ingredients.
It's not much different than social media. People get addicted to social media because they don't stand a chance against social media companies that employ an army of people to optimise every facet of their product for addictiveness.
Modern lifestyles are more sendentary than they used to be, and that plays a part in the explosion of obesity, but so do the conglomerates that produce the junk food.
I have the same reasoning but the opposite conclusion, we should seriously reconsider our lifestyle choices, as a society, instead of just throwing a magic pill in the mix and closing our eyes on the fact that we're building a completely insane system in which humans are everything but thriving
I'm doing that at my scale, helping friends and family with willpower and nutrition. So far I helped a dozen of people get control over their life's, including my father in law who lost 40kg and basically cured his health issues in less than a year. He could have taken ozempic but instead of that we taught him about the important of meal timing, how macro nutrients work, the effet of insulin/ghrelin on appetite, calorie counting, the benefits of walking an hour a day, &c.
100% free and he doesn't have to rely on a magic pill now that he understands what's going on.
When people are educated and motivated you can bring them wherever you want. Nutrition has to fit in the greater picture, if you're obese and addicted to shit food you most likely have much bigger problems in life, usually fixing the root causes unlocks the rest.
It's a philosophical argument. There's a great Radiolab about this (if you can tolerate their banter). Man is acting weird and offensive. People treat him as you'd expect. Then it is discovered that he has a tumor that is causing his behavior. Now he receives sympathy and treatment.
The point being that we all have different brain configurations which cause our behavior. Some we call tumors. Others are "normal". Your definition of "medical needs" is where the interesting meta-discussion takes place.
- Extreme appetite suppression to the point where I've started calorie counting specifically to make sure that I'm eating enough. It's incredibly easy to forget to eat.
- No more feelings of hunger. At all. This is somewhat depressing. Eating is no longer enjoyable and feels like a chore. I woke up hungry for the first time in a while a couple days ago and was excited - jumped out of bed and ran to eat something just for the pure joy of it. I've only felt that a few times in the past few weeks, compared to every day off the drug.
- I completely stopped drinking. Have you ever been to a bar after eating a big meal at a restaurant, and had trouble drinking because you were too full from your meal? That's how I feel all the time. 1 or 2 beers and it becomes uncomfortable to have anymore.
- Normally I go grocery shopping and within 3-4 days, all the "good stuff" (snacks) I bought are eaten. Now, since I stopped snacking and eating much less, groceries simply last way longer. <-- $$ saved in groceries significantly offsets the monthly price of the medication
- My morning starbucks routine has changed from 2 food items to just 1, which alone saves me $200/mo (sorry starbucks).
- Haven't noticed anything regarding impulse control outside of food. No anecdata to share on that point...
After a few weeks on the drug, I'm 100% convinced that once this drug is widely available and cheap... being overweight will be a choice (choosing not to take the drug).
The most important aspect of the drug that makes it work so well is it forces you to change your habits, no will power required. It also punishes you for bad eating habits. (That late night trip to McDonalds will have you feeling like shit the next day).
I'm the kind of person that used to be able to order just about anything on a restaurant menu and clean my plate completely. Now I simply can't do that. It's actually kind of embarrassing being at a restaurant with friends and being completely uninterested in the food.
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