It's a pretty sad thought that everybody will be on a drug that keeps weight in check while most people will still eat a basically toxic diet. Weight is certainly an important factor but there is more to a healthy life.
I've been on wegovy for almost two years now, and I can attest to how much you just DONT want to eat junk anymore. It's one of the most commonly talked about things we discuss with other users over the last few years. That and lower want to drink, and gaining back so much of energy/time due to not having to think about food every 3 seconds of the day.
I'm super satisfied just having an apple or two now. The "omg I need to eat, ohh a burger" is gone.
I'm not arguing at all here but just wanted to say, I've noticed similar effects just focusing on eating healthier over the last few years. I haven't taken anything to help I just wanted to stop eating poorly and now adays it's not "shove the entire box of cookies in my mouth" it's "have 1 cookie and don't finish it because it's too rich" and I haven't eaten fast food in as long as I can remember. I used to see a McDonald's french fry commercial or just think about them and need McDonald's. Now I see it and go "ah they were good but eh" and move on with my life.
From my understanding GLP-1 agonists can actually modulate the reward pathway reducing people's appetite for toxic diets.
We're not socially caught up yet to this information. I suspect there are folks who believe that regardless of similar outcome (reduction of toxic diet), that changing diet without medication is superior to those who change their behavior through pharmacological intervention. It's like the pre-1990s view on depression or anxiety - chemical intervention is a moral weakness.
As a default it is. And that's what it became. We stopped trying any other methods. Come in the door, have a set of symptoms that check all the boxes, walk out in 30 minutes with a prescription, doctor's office gets a bonus. Institutional psychiatric treatment is drugs first actual treatment later.
This is a _social_ problem. It should be discussed and addressed as such. You should not attempt to pervert this concern into an _individual_ issue in an effort to invoke a needless moral defense.
If it's a social problem then the non-pharmaceutical cure is obviously not white-knuckling a diet and exercise regimen individually. It needs a holistic, society-level solution. More time off work, less car-dependent suburbs, more bike lanes and subsidies for bikes, more agricultural subsidies for healthy food and less for corn. Realistically we aren't going to get those things.
> not white-knuckling a diet and exercise regimen individually
Obesity rates have not been constant. There are clearly multiple modes to this problem and history suggests that this class of people is the minority of the visible issue.
> more bike lanes and subsidies for bikes
You don't need this so much as you need roundabouts and actual _human_ scale infrastructure in cities. Some smaller towns in the midwest got the memo from Europe and are starting to adapt easily.
> more agricultural subsidies for healthy food and less for corn
I think the amount of subsidy overall is a problem. I think we could to take another page from Europe and start banning food additives. We can stop classifying highly processed foods as foods and instead as desserts and tax them appropriately. A lot of this is already in motion.
> Realistically we aren't going to get those things.
We used to have these things. I don't understand your position of social excuse couched in social pessimism. So instead of addressing the problem just accept that pharmaceutical and insurance companies will now enrich themselves off this created problem?
You know, we can solve _two_ problems at once, if GLP-1 has some short term benefit then great, but to plan on it existing in the long term for weight management is utter madness.
Are chemical interventions designed with the best outcomes for the patient or the best outcomes for society? I suspect it's the latter. It's cheap and if you're lucky it's effective. When it goes bad it can ruin lives and families. As a _default_ it's a moral weakness.
Is this a solvable problem? Yes, but it's monumental, encompassing everything from the way we structure our civil society and work life from the forms of food and entertainment that we incidentally or directly subsidize.
We accidentally built something gross. It moves really fast, though.
Just some notes. This would be a lot easy to take this seriously if it wasn't seeped in moral purity. It is rhetorically unappetizing.
Re-wording it so that you say your end goal was better outcomes for people and restructuring society to achieve that is a noble goal. It's easier for people to want to agree with than being a moral policeman.
> GLP-1 agonists can actually modulate the reward pathway reducing people's appetite for toxic diets.
There are also studies out showing that people just up their sugar intake, so I think the results on how it affects peoples diet is still pending. From what I've seen, people are eating less, but more of it is junk food and sugar.
I can absolutely see why people would want to be able to just take a drug and start losing weight, it's hard. My concern is that it takes more than a low body weight to be healthy. You still need exercise, and while that's not an effective weight-lose solution, it is something that most would add when trying to lose weight, and now they're missing out on that part. Arguably exercise is more important than your weight.
Exercise strengths your cardiovascular system, immune system, improves bone strength, builds muscle (which helps you as you age, preventing the risk of falling and fall related injury), improves mental health, reduces stress. If your in good physical shape, it's less of an issue if you carry around a little extra fat.
You can still be in bad health, even if your weight is spot on, but it's rare that you exercise a lot, but is overall unhealthy.
In terms of tangible outcomes, it helps you live longer or something compared to weight loss? greater reported life satisfaction? Or is this more of a personal value?
That's a trivial claim about any medication that changes behavior. You can achieve the same thing that the medication does by "just" having different behavior.
I eat almost zero processed foods and very little sugar - mostly from fruit. I shop exclusively on the perimeter of the grocery store and eat at a restaurant maybe once a month, with all my meals cooked at home. I try my best to limit portions.
I have been overweight my entire life. I have successfully lost weight with up to eight months of calorie restriction, so my willpower is just fine, thank you. I have always gained it back, and you calling me out for some kind of moral turpitude is not helpful.
Your "eat like an adult" finger waggling is condescending, and claiming anyone who thinks obesity is more complex than "just eat better food, bro" is anti-intellectual and anti-science is just insulting - and not particularly "pro science" either.
In 8 months of losing 2 pounds a week, you would have lost roughly 64 pounds. You could have been losing more than that which is common on diets where added sugar is removed. But you're talking to someone who has worked with people with class 3 obesity and has seen the weight successfully stay off.
You're omitting details. You simply didn't change your eating habits. Statistically, this detail you shared is also overwhelmingly the documented reason why people fail to keep off weight. Almost entirely, people who reside in higher classes of obesity have no idea what their relative consumption habits are in comparison to those with lower BMIs.
This may come as a surprise to you, but most other countries where obesity is not a problem, most sugar consumption is also from fruit and these peoples' diets _don't_ contain anywhere near the amount of added sugar an American diet does. This isn't a special thing to point out, you just think it is because you have no other frame of reference.
There are a lot of statistics in dietary behavioral studies and dietary reinforcement that are mostly uninteresting because, frankly, people omit details.
You can lose considerable weight at speeds that are actually not recommended simply by dropping added sugar from American diets. So much so that you would need to taper off this removal to stay around 2 pounds of weight loss a week instead of dropping this consumption pattern cold turkey.
The biggest difficulty in sourcing food materials or eating out is that we have sugar in everything. We have added sugar in things that in other countries you would have never added sugar into to begin with.
The reinforcement habit is directly tied to food reward, sugar consumption, and ghrelin production. Anyone who tells you otherwise is lying and is simply refuting what we have come to understand about food science over the years.
And frankly, we as a people have not yet completely matured out of the phase of producing or accepting low-fat foods being replaced with high sugar content. Plenty of other nations never had this problem at all, never inherited it, and as a result, don't have to grow out of it.
It is staggering how much of our food is incompatible with healthy weight homeostasis, and all of our common supermarkets absolutely work against you unless you are otherwise taught differently.
* * *
Edit:
If you're baking bread for your family every day, even without added sugar, and you don't see the problem here, I don't know how anyone can help you.
I'm not calling you a liar. I said you were omitting details. You didn't mention that you're frequently eating carbs. Now you mention that you're baking, and presumably eating, bread every day.
I bake bread for my family every day because I can't get bread in Canada that has no sugar. I'm aware of how insidious sugar is.
You obviously deal with a lot of obesity that is caused by excessive sugar consumption. Your conclusion - and smuggled assumption - is that all obesity is caused by sugar. This is trivially refuted by finding obese people in non-high-sugar societies, or from a time period before sugar became ubiquitous.
Calling me a liar does not make your position stronger.
Response edit: I have four school aged children who get a sandwich for lunch every day. It takes no time at all for a family of six to go through a 650g loaf of bread, and it doesn't require overeating - I'm the only one in my family with a weight problem, and I bake the bread I don't eat it. Your assumption that everyone in the world is exactly like you is truly breathtaking.
> This is trivially refuted by finding obese people in non-high-sugar societies, or from a time period before sugar became ubiquitous.
Those people definitely existed, but were pretty rare. Maybe you are one of them. Statistically, probably not.
> I bake bread for my family every day because I can't get bread in Canada that has no sugar. I'm aware of how insidious sugar is.
That is definitely way, way better than anything store bought, so it's great that you are doing that. However, even without added sugar, bread will start converting to sugar immediately after being in contact with saliva(and will continue once the pancreas enters the picture). So you are eating sugar every day still, possibly quite a lot of it.
I had to severely decrease bread consumption, as well as anything containing simple carbs, to decrease my insulin resistance.
>Those people definitely existed, but were pretty rare. Maybe you are one of them. Statistically, probably not.
Mexico has approximately the same per-capita sugar consumption as Italy, Spain and France, yet the obesity rate exceeds that of the U.S. Norway has 50% more per-capita sugar consumption than the US and very little obesity. I don't think eating little sugar or refined food, yet being overweight makes me a statistical anomaly at all.
I'm not claiming some kind of magic variation in base metabolic rates. I'm only saying that it is too simplistic to point at refined sugar and say that a complex problem has that one simple cause. (And that to solve it one need only learn to be an adult).
I don't eat bread by the way, I bake it for my family. I do revert to eating potatoes and pasta though, which is no doubt to blame for my weight fluctuations. My irritation in this discussion comes only from the ridiculous claim that if I were only to eat like a grown-up for two weeks, food cravings would disappear and my problems would be solved.
Mexican cuisine employs large amounts of fat, directly, or in the form of cheese. Take a trip to Italy, Spain, or France. It's a very different eating atmosphere. The portions and ingredients aren't comparable, and in Europe, there are greater food protections that straight up don't exist in North America.
Carrefour et Monoprix ne ressemblent pas du tout à ceux de WalMart, etc. You can't compare them. Their food selection makes ours in the states look embarrassing, and I wouldn't be surprised if it were the same for Canada. It's superior on all fronts.
It isn't too simplistic to look at sugar or general carbohydrates and say, this ingredient has the highest reconstitution of habit developing behaviors compared to that of any other macronutrient. Your body's ability to reinforce food habituation compared to any other macronutrient on a graphed scale makes every other macro look like peanuts. It's sugar. It's carbs. It's a fact. It's scientifically proven. I implore you to do the reading yourself. Fat also has a high recidivation rate, but it pales in comparison to carbohydrates.
For your own health and the risk that you'll tell others otherwise as well, just dismiss me and read these studies yourself.
It's that easy, and the reality is that no one adjusts for it. Your supermarkets don't care and all of the people around you probably don't realize it either. It's cultural. It's in your beer. It's in your coffee creamer. It's everywhere.
It is the dietary equivalent of global warming denial. Seriously. I have watched people with class 3 obesity drop 40 pounds in one month, which is terribly hard on your body and not recommended, by immediately switching off high carb, high fat diets.
Yes, your food cravings do truly, really, disappear within a span of 2-4 weeks. Within 30 to 60 days, people can and do form rejection habits with little documented "willpower" in the same way these individuals using GLP-1 hormones do.
Because it's the same activation vector. You increase incretins production through rich protein consumption. People suffer from the effects that you describe because of leptin resistance. For people in extreme weight class categories, you don't get off after a few months, fat cells stay in your body for years in dormant, reduced volume form.
Of course I eat carbs when I shouldn't. Not the bread, but I eat potatoes sometimes, and too much fruit. I'm not denying that I eat too much.
The point is you claim that if we gluttons would just cut out sugar for 2 weeks and learn to be an adult, our appetites and cravings would disappear. That's nonsense, and your dismissal of data that doesn't fit your narrative makes your accusations towards others of being anti-science both hollow and ironic.
2 lbs a week is a 1000 calorie per day deficit. My loss was closer to half a kilo a week. I have fluctuated between 85 and 210 kg since I was 16 or so. I am now 54.
Of course I am not saying my body violates the laws of thermodynamics. After some time I succumb to cravings and begin overeating again, a bit at first and then more. I am not denying this is behaviour driven. My only point with the fruit aside was that I'm not consuming my sugar from chocolate milk or sugary breakfast cereal, not that I think fructose is exempt.
But to suggest that all I have to do is eat healthfully for a few weeks and my cravings will be gone is infuriating. I have eaten healthfully for years and years, and eaten at a calorie deficit (of healthy food) for many months at a time. And the cravings NEVER go away. I always go to bed thinking of food.
Maybe I should get a nutrition degree and then my body will conform to what your textbooks say should happen.
Could you provide some of those papers? I'm interested on what you are saying, but I am not able to find what you are mentioning using the link you provided.
It goes on and on and on. In lab mice, it has been shown you can alter production in as little as 10 days. Human hormone production has similar turn around times.
Have you considered that maybe it is an evolutionary trait that it is hard to do certain things? That the people who can expend the effort and discipline, perhaps have a better configuration than those that can’t or don’t?
The exact same argument can be applied to literally any medical issue, and it is a pointless one.
Someone has an elevated risk of skin cancer due to their genetics? Probably an evolutionary trait that it is more likely for some people to get skin cancer within their lifetime. That doesn’t mean that using sunscreen and providing those people with related medical care (if the need arises) is some crime against nature and will end up hurting evolutionary prospects of the human race.
> Someone has an elevated risk of skin cancer due to their genetics? Probably an evolutionary trait that it is more likely for some people to get skin cancer within their lifetime.
The question is how a trait fares in the modern world.
Maybe a trait was useful to an ancestor but not to you today trying to navigate a calorie rich world of convenience. Just like a trait useful to a nomadic hunter might work against you when you're expected to sit at a desk job if you want to make the money necessary to fulfill your ambitions.
It may very well be the case that we end up medicating away traits that were useful at some point in our lineage but not today. I just don't see how it matters much beyond the thought exercise.
Weird that the ones skinnier foreigners with a “better configuration” get genetically altered (I guess) to a worse configuration when they move to the US, then.
hilariously, the toxic food companies are worried that ozemic will kill their profits. Maybe the pharma industry can fight the food industry conglomerates.
My point is that skinny populations don’t seem to be skinnier than the US population due to greater genetically-backed willpower (better “configuration”). At least, if it’s a factor, it’s overwhelmed by other factors, it seems.
Studies show nothing but high-touch interventions by specialists actually works for losing weight and keeping it off for a study cohort (i.e. might represent a population-level solution).
These are impractically expensive and still less effective than one might expect.
Researchers seem to be eager about the promise of supplementing the very-best programs they’ve been able to find… with GLP-1 agonists. Because that might finally make them really effective.
That’s how bad the entire body of all other solutions we’ve looked at is.
Not to argue for or against Ozempic, but there is a difference between what motivated individuals can achieve on their own, and what one can expect of the general population.
Do you have the time to seek out and keep healthy food? Can you afford it? Do you have the executive function and impulse control etc to bring to bear the necessary self discipline?
You’re making some pretty casual assumptions about people’s abilities.
If all it took to get the same feeling of GLP-1 agonists was success at the diet for 2-4 weeks, I would have a lot less experience being successful at diets for 2-4 weeks. A whole lot less.
> You can literally do the same thing by eating a healthy diet for 2-4 weeks.
You have been downvoted, but that's true(and supported by evidence and science). Statistically, what most people have is sugar addiction. Simple carbs in general completely mess up your hunger hormones.
The problem is that most people don't know what a healthy diet is. The food pyramid isn't it. Drinking a bunch of juice isn't it. Cereal is candy. They try "eating healthy", fail (not realizing what they are eating isn't healthy at all) and give up.
Sure, but the "unhealthy but not excessively caloric" diet is not a problem ozempic attempts to address. As far as I understand, it simply limits your appetite. Potentially one can go on ozempic, lose weight, and still end up eating unhealthily, because the resulting diet is made up of nutritionally poor foods.
Ozempic does not simply limit your appetite, it seems to also affect how much reward your brain feels from different foods (and activities!), which would make it easier to override those anticipated rewards with conscious choices.
And the argument you are replying to is that it's just covering up a symptom and not addressing the root problem holistically. Ozempic isn't a fix, it's a bandaid.
That's great. We still give crutches to people who break their legs and bandaids to people with wounds. We don't tell them that being completely healed is better than using those aids.
Bandaids serve a genuinely useful health-promoting purpose. I suspect we'll find the same is true of GLP-1s even if it only addresses part of the entire problem.
Only when applied correctly and with other interventions. Using ozempic without diet and exercise changes is like putting a bandaid on a .5" deep wound without sterilizing it.
because ozempic reduces the food cravings, patients are able to implement and stick with a diet change. it's not like "put down that cheeseburger and have a salad" is something they haven't heard before and haven't internalized already, it's just their brain won't do it. ozempic gives them the space on their brain to actually do it.
My original impression was that it was suppose to be a crutch, helping you get started on a healthy lifestyle. So if you are to heavy to exercise without hurting yourself it could help you lose that initial weight. Or it can help you with your appetit, while you adjust your diet.
You also can't stay on Ozempic, you have to continuously increase you dose to get the same effect, so it's simply not viable to keep taking it for an extend period of time. That's at least the impression I've been getting from talking to people working at pharmacies.
Sure, but so what? Until we can permanently change aspects of our brain, like our proclivity for addiction, then all interventions are bandaids on top of an underlying problem.
Even behavioral changes like avoiding fast food don't fix the underlying problem in your brain. It's topical.
It's amazing how the subject of Ozempic brings out such trivial claims uttered with a serious face.
The combination of bad diet and lack of exercise. Specifically in the context of this conversation, its about how ozempic will not fix a bad diet. Eating less of a bad diet is better than eating more of a bad diet, but is still a bad diet in the end.
No, but if it helps avoid the discussion because the very visible side effect is lessened, then in some ways things are worse. No squeaky wheel.
I’m glad it’s available for those who need it. But I agree with GP that there is another discussion we need to be having too we’ve avoided for far far too long.
I wasn’t talking about nutrients at all. I was referring to the problems of over processed foods with lots of chemicals to increase shelf life and improve color and make them more addictive.
I’m not against Ozempic. But without it maybe the continued expansion of the obesity epidemic would have pushed the discussion.
If this accidentally prevents that discussion, I think that’s a problem. I’m not suggesting any change to the drug’s availability. Only concern over an important discussion.
Maybe it’s naïve. But it’s getting harder and harder to ignore, and worse and worse.
As we export our food to more and more places, it starts to happen to them.
I hear about people who take trips to Europe. They eat a ton, feel better, and lose weight.
They get back home, start eating food here (even healthy food) and feel worse again. Gain it back despite eating less.
We’ve tried ignoring it. We’ve tried blaming genetics, character, fat in foods, sugar, and willpower. But none of those have explained/fixed it. Because I don’t think that’s the problem.
I want the evidence to keep piling up. I don’t want anyone to suffer unnecessarily, but I don’t want a new excuse to stop progress again.
It doesn’t have to be either/or. But if we give up the chance for the debate because a new miracle drug “solved“ it nothing will change.
There's a decent amount of evidence that the most toxic thing about modern diets is their amounts: calorie counts and such. Many things (sugars, ultra-processed foods (ugh I hate the NOVA classification), fat, etc) are fine in moderation. The dose makes the poison.
Is it fundamentally any different from something like toothpaste?
Humans have created a technology (mechanised farming) with a side effect we haven't yet evolved to handle (an abundance of tasty calories), so it doesn't seem all that strange we would fix it with a technology (inhibiting the desire for said calories).
Serious question: Why not make toxic diet illegal or cost prohibitive? Lots of manufactured food is designed to be more addictive. Then add in constant advertising bombardment targeted at kids. Why is there up to double the sugar in US bread and soda versus Europe?
I think your statement is very funny. If the drug keeps weight in check on a toxic diet and that has the same outcome as "healthy life", then is that "healthy life" any more healthy then the drug+junkfood combo? Also, what is sad about it?
> while most people will still eat a basically toxic diet
It's a pretty sadder fact that people just make these wild assertions. Everyone I know (which is about 10 people in real life, myself included) who's used a GLP-1 drug found that they eat healthier because they've less desire for shittier food.
> while most people will still eat a basically toxic diet.
Had to scroll too far to find this. It's a great synergy isn't it? The food industry creates calorie concoctions that can barely be called food, are dirt cheap to make and rakes in profits. People get sick. The pharmaceutical industry sells drugs are stupid high profit margins so that people can keep on living.
It is not a conspiracy, but it's a good feedback loop for corporations. All that money allow them to flood the scientific community with their sponsored studies, dominate news broadcasts (confusing consumers) and even influence the food pyramid, which is almost upside down.
I've been on a slow quest to improve health and lose weight. It's really, really slow, far slower than what most people would like. But cutting added sugars to zero (including and most especially high fructose corn syrup) gave almost immediate benefits that kept me going. Sugars (and carbs in general) make you retain a lot of water. Cut those, and you'll see a major difference in the scale in a couple of weeks. Is it mostly water(but not entirely!) Yes. It doesn't matter, our lizard brains interpret that as success. That also reduces hunger, which is a positive feedback loop.
