Launch HN: Fella (YC W20) – Tackling men's obesity using medication and coaching

> ELI5 for how it works in the body:

GLP-1 RAs such as Semaglutide are increasingly looking like the best class of medication for weight management [1]

GLP-1 RA = Glucagon-like peptide 1 receptor agonist.

These medications stimulates a receptor in your body which results in a reduction in body weight and three main effects: 1 - Slowing down gastric emptying so food stays in your stomach for longer (this is thought to be why there is sometimes nausea when starting the medication) 2 - Making you feel full by working on your central nervous system 3 - Managing glucose control (which is why it's used for people with diabetes too)

[1] gives you a great summary of the field up to now and how it works.

> Is it something that you anticipate someone would take indefinitely, or only to get down to a target weight?

This will depend on the person, whether they are also diabetic and how much weight they have to lose and is decided through a conversation with their obesity doctor. After around 12-months on these medications the weight loss plateaus (at an average of 15% body weight). If one stops the medication then but hasn't made any changes to their lifestyle they'll likely put the weight back on. But during the 12 months of the program we will be tackling the other factors with the coach: sleep, stress, nutrition. And so after the first year it might well make sense to reduce the medication or stop completely.

Let me know if you have any more questions.

[1] https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...

To be honest we sadly don't have any useful advice for US visas: it's not a fun system.

Only thing is it's now more possible than ever to soak up US culture, run a US-focused company, but not be based in the US. But that's not what you wanna hear if you've built your life there. I'm sorry we can't be more helpful

Semaglutide was FDA approved for diabetes in 2018 (3 years ago) and in June this year for weight management. It's part of a class of medication called GLP-1 RAs which operate in a similar way (they all stimulate the same GLP-1 receptor). Liraglutide is another common one that was approved by the FDA in 2010 (11 years ago) for diabetes (by the EU in 2009) and for weight management in 2014. So there is a 3 year of history with this particular medication and an 11 year history for this class of medication.

Here's more about the history of GLP-1s and other weight loss if you'd like: https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...

The main side effects that people seem to get are nausea and vomiting when adjusting to the dose, this is likely due to the slowing down of food leaving your stomach. This is documented in the study of nearly two thousand people which lasted for 68 weeks here [1] (where you can also see the other side effects).

It's worth noting that, as with any medication, there is a cost-benefit trade-off. In this case it will depend on someone's current weight, what they've tried in the past, and the risks of other conditions e.g. heart disease, diabetes, and their past medical history. Each person that joins Fella has an in-depth discussion about this with an independent obesity physician and is welcome to speak it through with their own PCP too.

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183