12 comments

  • Taikonerd 1 hour ago
    Interesting link: a company called Fractyl Health is studying a surgical procedure they call "Revita," that they hope can keep weight off for patients after they discontinue GLP-1s.[0]

    The premise, IIUC, is that obesity is driven partly by mucosal overgrowth on the duodenum. This thicker-than-expected layer of mucus is less porous, which leads your digestive system to underestimate the number of calories you've consumed. Revita basically re-surfaces the duodenum.

    So, the idea is that you get to a lower weight with the GLP-1 drugs, and then Revita can hopefully reset your set point there.

    Their first clinical trial is still in progress, but I think it's interesting to watch.

    [0]: https://www.fractyl.com/our-platforms/revita/

    • toomuchtodo 3 minutes ago
    • refibrillator 14 minutes ago
      Fascinatingly, the body already has a mechanism for this: fasting. One of the many beneficial side effects is rapid mucosal atrophy, decreasing villus height and crypt depth.

      You can find evidence of this in the literature, but it’s absurdly understudied, because big pharma would rather sell you a subscription to life.

      Fortunately there are many good people in the world, especially in the field of medicine, who want to help their patients unconditionally. So there are glimmers of hope, like some of the top cardiologists in the world going against status quo and treating patients with fasting regimes instead of surgery.

    • harvey9 1 hour ago
      Surprised this is still in first trial. I can recall reading about something like it in 2017. Apparently clearing the duodenal mucosa is a preparatory step for a gastric band fitting, but they found patients were making improvements before the bands were being fitted so a study was started to see if this less invasive procedure might be enough by itself.
    • hamandcheese 48 minutes ago
      > Revita basically re-surfaces the duodenum.

      Does this reduce mucous production going forward? Otherwise, it seems like it would be a temporary effect.

      • Taikonerd 36 minutes ago
        My impression (and I'm not a scientist) is that the mucosal overgrowth comes from eating an obesogenic diet. (Some combination of too much sugar / salt / wrong types of fat?)

        If you get the procedure and don't go back to an obesogenic diet, then it should be permanent.

  • jmward01 1 hour ago
    Other medications become lifelong medications but without this level of scrutiny. I am 100% in favor of finding a more permanent treatment, but switching blood pressure meds, and cholesterol meds, and other daily meds for a single once a week med is a massive improvement, especially since the all source mortality data keeps rolling in showing the efficacy here is orders of magnitude better than all the other medications out there. A constant issue here is that we keep calling this a 'weight loss drug' and society views being fat as a moral failing ant that you 'just don't have the will power' to overcome. We need to stop. If this is a lifelong drug it is worth it compared to the relatively ineffective, and just as lifelong, alternatives out there.
    • 3rodents 1 hour ago
      I don’t think that’s a fair assessment. I’m all for life-long drugs that help with weight loss, I don’t view it as a moral failing. That said, it is easy to see why so many people are concerned about these drugs: people taking them can look terrible (“ozempic face”). Gaunt, sick, hollowed out, look at people like Sharon Osbourne, that’s the public face of these drugs. And so when people are committing to life-long use of these drugs, it is being viewed with the very visible side effects in mind, and that is concerning to a lot of people after these drugs seemingly appeared overnight.
      • hamandcheese 57 minutes ago
        "Ozempic face" is actually just "unhealthy rapid weight loss face". Ozempic makes it easier to starve yourself, but that isn't how it's supposed to be used.
        • yellow_postit 44 minutes ago
          Many of the fly by night digital proscribes just jack the dosage to show rapid gains. Coupled with people lying on BMI to get a script is a bad combination and why it’s so obvious.
        • manmal 37 minutes ago
          It’s also accelerated muscle loss, even heart tissue. I‘m not saying it’s not worth it, but this should be kept on the radar for sure.
        • tartoran 34 minutes ago
          Taking Ozempic also drops a lot of muscular mass and that ozempic face look totally makes sense.

          There's no free lunch or wonder drug. While it's effective at weight loss it has a lot of unwanted side effects. And when stopping the drug the weight gain comes back so not sure if it's worth it.

    • AaronAPU 47 minutes ago
      But it is factually true that it’s a matter of willpower, no amount of reframing it is going to change that.

      It’s not like others like myself, currently on a cut cycle, don’t experience hunger. The idea that we are just “lucky” ignores all the willpower and discipline we fight through to do it ourselves.

      I’ve eaten about 800 calories today and it is 4pm. Just finished 90 minutes on the indoor bike. My stomach feels hungry. I experience that and just sit with it. That is the difference.

      • 3rodents 12 minutes ago
        People are different. Using your own achievements as evidence of other’s failings isn’t useful, we are all different. I can fast for 23 hours a day, 365 days a year (omad) with ease, not because I have more willpower than my fat friends, but because I’m different. My fat friends are objectively stronger and more resilient than me in almost every aspect of life, yet by your measure, because hunger doesn’t bother me, I have more willpower than them? Willpower isn’t measured on outcomes.
      • manmal 34 minutes ago
        Congrats, your metabolism (FAO, gluconeogenesis, insulin sensitivity, …) works well. Don’t assume that’s the case for everyone, because it’s well researched that this is highly individual.
        • paulpauper 29 minutes ago
          The ability to tolerate discomfort is probably as genetic/inante as metabolism.
        • AaronAPU 32 minutes ago
          You know nothing about my metabolism.
          • manmal 30 minutes ago
            Well one of those has to work well or you would have fainted by now.
      • afavour 37 minutes ago
        How can you say that with any certainty, though? How do you know that hunger hits you in the exact same way it does another person? That overcoming it requires the exact same amount of willpower in all people?
        • AaronAPU 33 minutes ago
          My hunger feels 8 trillion times worse than an obese person’s. Since I am making the claim, everyone else has to affirm it now.
          • afavour 15 minutes ago
            But you’re disproving your own point. Other people’s experiences aren’t knowable so you can’t say it’s just a willpower issue.
      • XorNot 23 minutes ago
        On the one hand I'm impressed but 800 is really super low. I was losing about a kilo a week at the peak of my diet eating double that.
    • paulpauper 31 minutes ago
      A constant issue here is that we keep calling this a 'weight loss drug' and society views being fat as a moral failing ant that you 'just don't have the will power' to overcome. We need to stop. If this is a lifelong drug it is worth it compared to the relatively ineffective, and just as lifelong, alternatives out there.

      I have noticed much less moralizing over the issue now compared to 2-3 years ago. I think more people realize these drug are safe and effective and not 'taking the easy way out', but rather a treatment for a medical problem than just blaming laziness or gluttony.

      • thefz 27 minutes ago
        The article explains they they are not safe nor effective
  • OptionOfT 1 hour ago
    Being overweight is a chronic disease.

    Just like alcoholism, or any kind of other addictions.

    I've struggled with alcohol abuse, and once you come to the realization that you're abusing it, the fix FOR ME was relatively simple: I stopped (under medical supervision) drinking, or to be more precise: I stopped starting to drink. I have no problems not drinking, I have a problem that when I start I cannot stop.

    I have the same issue with food. Not eating is a lot easier than stopping to eat. But I cannot completely stop eating.

    Yet with alcohol people are like: hey, good for you.

    With my weight issues people are like: dude, just eat less, or exercise more.

    (I stopped sharing the food story with people).

    • jchw 56 minutes ago
      It's frustrating.

      "Just Eat Less" is roughly the way to lose weight, but the problem is not that fat people are so unbelievably stupid that they didn't know this. I am sure for some people it really is that simple. Not us.

      My weight has been a bit of a rollercoaster. I've never been terribly thin, but I've been "not technically obese" from time to time. I'm currently back on the downswing, but God, what a pain in the ass. It feels like gaining weight is incredibly easy and losing it is incredibly hard (and I do believe this is validated by the science, because you wind up with more fat cells when you first gain weight, which I guess is both relieving and terrifying.)

      No matter how many attempts it takes to fix my body, I'm obviously going to just keep trying, because obesity is horrible for you in so many ways. It saps your energy, it's carcinogenic, it increases your blood pressure and risk of heart disease, but it feels like one of those struggles that is never-ending. I've improved my diet numerous times but it never feels like it's quite enough.

      • filoleg 40 minutes ago
        > It feels like gaining weight is incredibly easy and losing it is incredibly hard

        I feel like there is more to it.

        Obviously, I sympathize with you, and I noticed that when I switch from a bulking cycle to a cutting cycle, it is a bit difficult to adjust for the first couple of weeks as well.

        But by god, I truly am struggling to switch the other way around, and it takes me months to adjust to the bulking cycle, even with the help of stuff like weed. And when I don’t work out aggresively and don’t keep track of my cycle, it feels just natural for me to default to eating way less, as opposed to the other way around.

        To be clear, this isn’t meant to be a dig at your take. All I mean is that, I feel like the whole issue is a bit more complex.

        • paulpauper 33 minutes ago
          But by god, I truly am struggling to switch the other way around, and it takes me months to adjust to the bulking cycle, even with the help of stuff like weed

          You could just have good genetics in which your body is resistant to weight gain or you have a low appetite to begin with. As shown by the worldwide obesity epidemic, this is apparently quite an uncommon problem. 75% of country overweight or obese.

          • toyg 14 minutes ago
            > good genetics

            This moral judgement whereby losing weight is "good" in absolute, is such bullshit. For most of history, humans have fought starvation literally every day, and often had to make do with minimal caloric intake for weeks or months - in that context, genetics that kept you thin were definitely very bad.

            • paulpauper 4 minutes ago
              Having a smaller appetite could have been advantageous by allowing food to last longer
      • TheOtherHobbes 39 minutes ago
        There's a lot of very visible and conscious messaging about losing weight.

        There's an equal and opposite level of messaging to keep eating, which is less conscious and runs under the radar.

        Snacks are literally designed to be addictive. TV ads start from birth. Most restaurants have huge portion sizes. "Family" and "Festival" events assume overeating is expected. Junk food is cheap and quality food is expensive. Overeating is framed as being "naughty" but also indulgent and nurturing.

        All of this is a huge social problem that's not acknowledged at all.

        It's very, very hard to Just Eat Less when there's a constant barrage of messaging encouraging you to do the opposite, and you're not even aware of it.

        The contradictory messaging is actually a classic crazy-making psychological double bind. So of course it's very difficult to make a dent in this, and even harder to permanently change habits so all the contradictions no longer influence you.

        • paulpauper 36 minutes ago
          Most restaurants have huge portion sizes.

          ppl keep blaming this, but this is contradicted by shrinkflation, yet people still are getting fatter than ever. There is nothing to stop someone from buying more food to offset smaller portions.

          • toyg 18 minutes ago
            Shrinkflation is typically a retail issue, where pricing per unit is a massive psychological factor and competition is fierce and immediate (literally the next shelf). For restaurants it's much easier to just raise prices, or to bulk up plates with cheap stuff like bread.
      • paulpauper 40 minutes ago
        (and I do believe this is validated by the science, because you wind up with more fat cells when you first gain weight, which I guess is both relieving and terrifying.)

        the data is pretty clear . the vast majority of dieters fail, even when the bar for success is set really low, like a 2-5% long-term weight loss of starting body weight for an obese person is considered a success.

      • jeffbee 53 minutes ago
        > the problem is not that fat people are so unbelievably stupid that they didn't know this

        I don't suggest this applies to you, but even a small amount of searching around and reading stuff on the web will reveal a substantial subgroup of outright thermodynamics deniers.

        • wwweston 39 minutes ago
          Can you provide an example of someone who outright denies thermodynamics?

          I’m familiar with people who believe that there are details of how a body metabolizes fuel , expends energy, and generally operates that escape analysis focused on fuel volume and physical activity. I am familiar with people who characterize this as denial of the laws of thermodynamics, but I am not familiar with anyone who seems to believe that there are situations in which the laws of thermodynamics are outright suspended.

        • randallsquared 37 minutes ago
          > outright thermodynamics deniers

          I've heard people say this before, but when reading those arguments it mostly turns out to be people who think there's something more complicated going on with digestion, excretion, or metabolism such that eaten calories are more efficiently used for some, and burned off or passed through without full processing to some degree for people who self-reportedly "can't gain weight".

          • paulpauper 27 minutes ago
            Right, the body can choose to either convert surplus calories to fat or waste heat. The latter could explain how some individuals are much more resistant to weight gain than others. This is also supported by overfeeding studies, in which controlling for relevant factors, some people gain much more fat on a deliberate calorie surplus than others.
    • true2octave 1 hour ago
      What works for me is to eat highly nutritious low-glycemic food until I feel full (eggs, avocado, quinoa, etc)

      Otherwise I over eat crap and gain weight easily

      • skrebbel 1 hour ago
        How many years have you been able to keep that diet up?
      • paulpauper 25 minutes ago
        the problem is, obese or formerly obese people clan eat a lot of anything before the full feeling sets in, no matter what. Eggs, chicken..does not matter.
    • throw93994orj 33 minutes ago
      Other countries do not have obese people, but have many drinkers!

      It is issue of food and ingrediences. Too many sugars, fructose syrups from corn... If fat american moves to asian country, he loses fat, without changing a diet.

    • paulpauper 42 minutes ago
      I have observed that being addicted drugs gets way more sympathy than being addicted to food even though the neural pathways and other factors are the same.
    • metalman 48 minutes ago
      since I also share the ability to cold turkey on most anything, what you can completly stop eating is processed food, or anything that requires an advanced chemical engineering degree to decipher, ditch most of the carbs, ALL of the sugar. Meat, veggies,fruit,grains,nuts,the most complex packaged foods I buy are yogurt, and bread from an outfit that contracts farmers to grow wheat, pickles, stuff from wierd and wonderfull ethnic groceries where they openly miss there country and insist on having you try the good stuff!, wild food, tucked away farm markets, but most of all, I put my body in charge, which requires listening, but once you realy clean up, perhaps you will find as I have, that certain off the record indulgences have very significant negative phisiological repercusions, on a one to one basis. but this practice is not for dilly dalyiers, so
      • ThrowawayTestr 44 minutes ago
        I really, really, really like mayonnaise though
  • asciimov 1 hour ago
    > "The environment that people live in needs to be one that promotes health, not weight gain. […] Obesity is not a GLP-1 deficiency," he says.

    This is my biggest issue with weight healthcare, the idea that if only the patient would eat correctly they wouldn’t be overweight. It’s not some moral failing a person often over eats, it very well could be some physiological issue that should be treated. It would be like telling someone with asthma that they just need to get into better shape to breathe better.

    • diziet 53 minutes ago
      I don't have a horse in this race, but from my personal experience eating satiating whole foods with lower glycemic index, higher fiber and protein content makes it very difficult to gain excessive weight.

      On the asthma front, from experiences with someone close to me -- getting in great physical shape (with caveats regarding training) DID indeed help greatly with broncho-constriction and higher scores on FEV. Basically symptoms and inhaler use went down tremendously over a few years and a physical transformation.

      • randallsquared 30 minutes ago
        Before GLP-1s, there was rarely any such thing as "satiation" for me. Getting full was something that happened without the feeling of having had enough. The main effect of wegovy, for me, was having a feeling of not needing to eat rather than just feeling too full to eat. It was quite an experience, and one I am not sure I had had in more than 30 years.
    • kiba 55 minutes ago
      Until we are able to fix the environment and culture, we're stuck with medications like this. The good news is that glp1 medicine can be used to break addictive behaviors, so it is the very tool that can help change our environment by reducing demand for junk food.

      We still need to talk to our Congress critters.

    • XorNot 54 minutes ago
      That's what GLP-1 drugs are doing? Like...this is the premier argument as to why they work.
  • iwanttocomment 45 minutes ago
    We need to start looking at obesity as a hunger disorder, and not as the result of an addiction, a lack of knowledge about nutrition, or a lack of self control.

    When an obese person regulates their eating and loses weight, the hunger often doesn't go away - and often increases. This is physical, not psychological hunger. When the obese person almost inevitably returns to eating to fullness, they regain weight.

    When a person takes GLP-1s, hunger is greatly reduced, and an obese person can eat less food while still achieving satiety without gaining weight. When they stop taking the GLP-1s, the hunger returns, and when they return to eating to fullness, they regain weight.

    Similarly, when a person takes stimulant weight loss medication, they can eat less food while experiencing less hunger, and thus lose weight. Similarly, when they go off of the stimulant (or develop a tolerance), the hunger returns and when they return to eating to fullness, they regain weight.

    In many obese people, the hunger is present even when they eat a nutritious meal at the appropriate number of calories to maintain their weight. Common advice is to say "this mix of macros or foods makes me satisfied!" and, well, that's great for you but not universal.

    People who naturally feel reasonably satisfied with an appropriate number of calories to maintain their weight still experience hunger, but not with the intensity or insatiability of that hunger that many obese people do.

    While it does occur with some who have severe eating disorders, most obese people do not overeat themselves into obesity by continuing to eat long after they're full. They eat until the hunger goes away.

    It's the hunger. Take away the hunger, and the weight goes down. Bring back the hunger and the weight goes up. It's simple, it's obvious, and few say it.

    • paulpauper 16 minutes ago
      In many obese people, the hunger is present even when they eat a nutritious meal at the appropriate number of calories to maintain their weight. Common advice is to say "this mix of macros or foods makes me satisfied!" and, well, that's great for you but not universal.

      Yup..the high failure rate of dieting is true regardless of the type of food or the macros. Lecturing to 'just eat healthy' as the default mode of advice does not work for the large majority of obese people..this is supported by the literature and anecdotal evidence.

  • maxaw 20 minutes ago
    I definitely lost weight easily on wegovy and just as easily gained it back when I stopped taking it. The whole experience definitely drove home how I needed to improve my mental health alongside any “purely physical” intervention. Same situation when I lost weight by meticulously calorie counting.

    I think obesity is hard to fix even when you are not a “thermodynamics denier” (as another commenter said) because all you can practice is moderation from the get go. How many people would fail to fix their alcoholism if complete abstinence, even just a period of complete abstinence to rewire the brain, was never an option? They actually had to go down to the pub and practice stopping everyday at 1 pint?

  • kozikow 49 minutes ago
    I did lose 30-40kg about 2 years ago on Ozempic.

    I don't count calories. I went off Ozempic (now Mounjaro) and I gain weight at about 0.5-1kg a month.

    As I am resistance (gym) training, significant % of that ends up being muscle mass rather than fat.

    So I end up taking Mounjaro for about 1-2 months every 3-4 months, approximately 33% of the time being "on".

    Funnily, I end up with bulk/cut periods without doing them explicitly. This ends up working well for growing muscles.

    Notice all people in the story are women. I guess pairing GLP-likes with bodybuilding works quite well for men. As times goes on, I end up needing mounjaro less due to my increased muscle mass.

    • cryzinger 33 minutes ago
      When you restart taking it after an "off" period, do you immediately resume whatever dose you were at before? Or do you taper up each time? (Curious because I know for many people, side effects level out after they've been at a given dose for long enough, but temporarily return whenever they increase their dose; not sure how "off" periods affect that kind of tolerance.)
    • paulpauper 22 minutes ago
      I don't count calories. I went off Ozempic (now Mounjaro) and I gain weight at about 0.5-1kg a month.

      yeah that is how ppl become obese. over 2-5 years it adds up

      Notice all people in the story are women.

      Probably due to social media. Women may be more inclined to show off their success online. Also, women respond better to these drugs compared to men.

  • spaceman_2020 34 minutes ago
    If you’re substantially overweight, you have to wonder if the long term side effects of GLP-1 are better than being obese

    That said, its a little disheartening to see people who are 10-15kg overweight also resort to these drugs - this kind of excess weight can be fought with simply diet and exercise

  • Sol- 42 minutes ago
    Then just continue to take them? The article just once seems to mention side effects and these were suspected to be related to rapid weight loss and less to the drug itself.

    Pointless human interest story with some rent-a-quote expert sprinkled in that tries to imply some ominous danger but can't come up with any hard data on that themselves.

  • Asooka 1 hour ago
    Can't be worse long-term than inhaling nicotine, the previous widely deployed strategy to combat food cravings.
  • jeffbee 55 minutes ago
    I guess it's a dialect thing, but I have become accustomed to disregarding absolutely every article that employs the word "jab".
    • fogleman 48 minutes ago
      That's just what they call it in British English, and this is a BBC article.
    • eterm 48 minutes ago
      > (British) A medical hypodermic injection (vaccination or inoculation).

      From https://en.wiktionary.org/wiki/jab

      I hope that helps

    • XorNot 31 minutes ago
      The word itself is just insufferable at this point. The media collectively went bonkers for it while describing COVID vaccine delivery.
  • belter 1 hour ago
    TLDR: "...evidence so far suggests that, between one and three years after stopping the medication, people will see a "significant proportion of weight" go back on...Somewhere in the region of 60 to 80% of the weight that you lost will return..."
    • isoprophlex 1 hour ago
      Taking recovered drug addicts and placing them in a situation where everyone's using all the time would probably lead to equally bad outcomes.

      Our food is too rich in calories, too abundantly available, and too addictive for most people.

    • stinos 1 hour ago
      What's striking here is that this is roughly the same outcome as essentially every other diet (with the intent of losing weight) out there. It's just more expensive. And possibly more hyped.
      • mgraczyk 1 hour ago
        And it works much better for most people
        • nostrebored 1 hour ago
          Yeah I think this is the missing piece. Same impact as dieting but with higher adherence and duration is a huge win.
        • tartoran 31 minutes ago
          > And it works much better for most people

          I thing it takes less effort to be effective but it has pretty bad side effects.

      • geraldwhen 1 hour ago
        Diet is the food you eat. If you change the food you eat, you’ve changed your diet.

        Any attempt at a temporary food change is already a failure for long term health.

      • blindriver 1 hour ago
        It's not hyped. It's the most effective way I've seen the people around me lose weight. Some of them have lost a tremendous amount of weight very quickly.

        But a know a couple of them that went off it and the weight came back pretty quickly. It really is just a suppression of hunger, nothing more than that.

        • hamandcheese 52 minutes ago
          > It really is just a suppression of hunger, nothing more than that.

          It is actually a lot more than that. Many people on Ozempic report better impulse control (food or otherwise). Many stop or significantly reduce alcohol intake. It seems that gut hormones are linked to reward pathways in the brain.

        • sixtyj 54 minutes ago
          It can be hyped because jabs bring immediate results. And it can be prescribed by almost every doctor so number of people who can report is big, and therefore visible results can be further disseminated (hyped).

          But… treatment is working.

          Question is at what cost.

          If something is too good to be true, one has to ask what is behind it. But perhaps it is a similar situation to when antibiotics were invented.

          • XorNot 27 minutes ago
            Most developed medical technology doesn't have "a cost". That's puritan morality theater masquerading as wisdom.
      • fuckyah 46 minutes ago
        [dead]
    • BoingBoomTschak 51 minutes ago
      Surprise surprise, it's not like the drug did anything to improve the patient's discipline...