I understand it’s being misused by people who don’t need it, particularly in the entertainment industry. But I’m almost 400 lbs and my eating is worse than it’s ever been and I’m just in desperate need to rid myself of this obsession with always eating more no matter what. Does anyone here have any experience with it? I’ve heard it just works by making you nauseous but I’ve read elsewhere that that’s just a common side effect. At this point I’m nauseous most of the time anyway.
You should know that some evidence suggests weight loss via GLP1 drugs might be stable e.g. https://www.nature.com/articles/s41591-024-02996-7 while some contradicts this. The overall picture of long term weight loss is extremely bleak: https://pmc.ncbi.nlm.nih.gov/articles/PMC5764193/
Lifestyle changes aren’t really a more sustainable intervention than anything else. For a lot of people it seems like losing weight = feel hungry for the rest of your life and commit to calorie counting forever.
Feeling hungry all the time has a lot to do with diet, I’ve found. You can feel more satiated with better diet choices like eating healthy fats and proteins which give a full feeling for longer than carbohydrates.
Diet and lifestyle changes are the ONLY sustainable way to keep the weight you lost off. Saying these aren’t more “sustainable” than other “interventions” is wrong. Like, dead wrong. You are throwing out buzzwords here to qualify your wrong assertion in way to make it sound more right but it’s still wrong. GLP-1 is an intervention. Diet and lifestyle changes are not. They are what you are doing long term. It’s a different step or element to the weight loss and healthy living journey.
I’m not against GLP-1. I think it’s it’s great to get yourself on the path. Kick start it. I’m saying that once you stop taking it you’d better have changed some things about your relationship to exercise and food. If you go back to the way things were before, you’ll gain it back. It’s how you got it in the first place.
I mean the research is right there. You shouldn’t confuse causality. Eating twice as much food as you need is a behaviour that starts happening for some reason, just trying really hard not to is unlikely to be successful if the underlying reason is still present. If you treat the underlying reason, which might for example be disregulation in hormone pathways involved in hunger signalling, the behaviour will likely stop on its own.
also:
intervention (IN-ter-VEN-shun) In medicine, a treatment, procedure, or other action taken to prevent or treat disease, or improve health in other ways.
The research all points to lifestyle and diet changes being the best way to keep weight off which is the core of what I was saying. The decades of evidence is thorough and conclusive. Sometimes the science does back up conventional knowledge. This is one of those times.
If you want to talk about treating the underlying reasons for physical health issues related to diet then you may as well advocate for a full psychological evaluation before any other intervention. I’m not even against that as for many people their unhealthy relationship with food and their own health is seated in trauma. Maybe even for most people but I don’t care enough to search the data on that.
Interestingly, it looks like a monoclonal antibody known as bimagrumab may be helpful in conjunction with GLP-1 agonists for focusing weight loss on bodyfat specifically, rather than general (incl. lean body mass. Since it’s still in trials at Lilly, there’s not a lot of good citeables yet but the combination therapy seems to be highly effective in causing the type of weight loss that is least susceptible to this issue.
Huh what the fuck? That’s completely beyond my layperson understanding of human biology. Cool if true.
I tend to be of the opinion that weight is overemphasised in health (and also that socially it’s completely fucking obnoxious to fuss over someone else’s alledged health) relatively to stuff like cardio and muscular strength and endurance. Still it’s undeniable that many people feel substantial psychological distress over their body weight and some people are severely impacted by being fat. Having actually effective interventions would be rad. As a trans woman I am on team modify your body however you like.
It’s so horrible that the standard medical and social approach is basically “Bully people until they commit to a cycle of self denial, lapse, and repeat. This is cool and good.”
To be honest, the average layperson’s understanding of biology unfortunately becomes entirely useless and often counterproductive to having a useful understanding of pharmacology. You start talking about agonists and inhibitors and half the time common sense becomes actively detrimental to understanding and the peak of scientific knowledge is “we have no idea why or how this shit works, only that it does. Check back in with us in 10-30 years and maybe we’ll know like 20% more of an answer.”
You find a binding site that does some shit and you slap an inhibitor on that bad boy and suddenly all your lab rats are jacked. Then like 15 years later someone else accidentally finds a single antibody doing some weird shit and you start cloning it, and hey what the fuck jacked rats again? What if we make this into a muscular dystrophy gene therapy drug?
Then like another 10 years later somebody connects a couple dots between that old abandoned muscular dystrophy gene therapy drug and a weight loss drug and here we go!
Pharmacology aside, there’s so much wrong with the way we handle obesity, which should be treated as a structural, societal disorder rather than an individual issue. Why does almost everyone relapse? Well, it’s not like the carbohydrate snack hell at the grocery store got any better, and the advertising hell just keeps worsening apace. Protein is expensive, carbs are cheap. You can’t walk anywhere and everything is built around cars and jobs where you sit around for 9+ hours and come home too exhausted to do any exercise. You try to create positive lifestyle changes, but everything around you is trying to push you into doing the exact opposite of that. Trying to push individualistic management rather than overall societal change is wholly ineffective as we’ve seen.
Obesity is absolutely a disease that dramatically worsens a person’s quality of life and health in basically every way. The impact of body mass on joints and of bodyfat percentage on cardiovascular health are undeniable and there is simply no truth to the concept of “fat but fit.” It’s better to think of obesity as a progressive degenerative disorder, in that it takes a toll over time and its effects are more dramatic the longer a person is affected and the older they get.
While hopefully these therapies will help people, ultimately it’s basically a problem of slapping a bandage over the actual problem: highly processed diets with little nutritional value and sedentary lifestyles made more or less mandatory by industrial capital.
I have some nitpicks, firstly vegetable based protein is extremely cheap in most places I’ve seen. I think when you say protein you really mean animal products?
Re obesity and health it’s more complicated. At extremes being fat is inarguably detrimental, but a lot of medical focus is myopic and population trends cannot necessarily be directly applied to individuals. Like personally I’m thin, have been my whole life, I’m also active and almost every joint in my body is shot because I’m hypermobile and weak. Meanwhile my wife is a bit chubby and has been her whole life, she’s inactive but strong. Her skeleton is in much better condition. Bloodswise we’re ok but my liver is slightly damaged from alcoholism. If you looked at us you’d probably say that I look healthier, but that’s because fatness of overemphasised. She is definitely much healthier and will likely outlive me and enjoy much greater quality of life.
She might be even healthier if she lost some weight, maybe she would develop an ED and be way worse off. She’d probably be much healthier if she started each day with 5 km run but no doctor ever asks her about that, or me whether I’ve considered started running or weight training at a regular health check. Many doctors talk to her about weight loss. This bias, and focus on something visually apparent is not really justified.
I had a colleague tell me that GLP-1s inhibit individual fat cell (adipocyte) growth, but can ultimately lead to adipocyte proliferation, especially if lifestyle modifications aren’t made, and that this is a major factor in rebound weight gain. Can’t speak to the veracity myself and am having trouble interpreting the literature off-hand.
This sort of detail is well beyond my level of expertise. All I know is that at this point they appear to work about as well as anything else and be a lot more comfortable that hardcore calorie counting and denial for a lot of people, with usually tolerable side effects. Some evidence suggests long term success and some suggests that they’re just like everything else. As far as I know there is no data yet on whether it is safe to spend a lifetime going on and off them as one would expect to end up doing with any diet regime; which would be relevant if they have about average long term results.
Below Lydmila linked a combo therapy which seems to have interesting results, so that’s exciting.