Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

news.ycombinator.com

Post reply on HN
Print view View original

241–250 of 318 posts

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

#241

Post by Zababa »

evol262 wrote: post #199
nevinera wrote: post #190

Earlier quoted context omitted.

This is what's known as an 'anecdote', and is at the crux of the issues surrounding men's weight loss. This approach, and other very obvious and straightforward ones do indeed work perfectly well for a fair fraction of the population, but they perform poorly for another large fraction, and fail abysmally for yet a third. While there are no doubt plenty of people that could lose weight fairly readily if they gave it s…

This is what's known as an 'anecdote', and is at the crux of the issues surrounding weight loss. Virtually every _controlled_ study shows that metabolic differences between adults are within a margin of +/- 15%, with essentially no way to eat the same amount of calories as a 200lb person and stay at 465lbs. Not least of which because your basal metabolic rate is much higher at that weight. Virtually every study shows…

> Virtually every _controlled_ study shows that metabolic differences between adults are within a margin of +/- 15%, with essentially no way to eat the same amount of calories as a 200lb person and stay at 465lbs. Not least of which because your basal metabolic rate is much higher at that weight.

That sound a bit wrong to me. Fat needs energy to maintain itself? Isn't it just an energy store? If you're 465lbs with the same muscle percentage as someone 200lbs maybe that's how it works, but no one at 465lbs has less than 15/20% body fat.

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

#242

Post by senojretep356 »

diskzero wrote: post #82

I am glad to see this. I was involved in a similar startup that became bogged down due to reasons that had nothing to do with the validity of the approach you are taking. As I am sure you are aware, obesity is a complex issue and many of the suggestions sufferers get such as eat less, exercise more, try fasting, go keto, etc. are simply not helpful in and of themselves. Neither is just prescribing the latest medicati…

Agree - I think psychology is everything. It's odd that drinking too much and drugs is always put down to trauma, stress, and psychological treatment is seen as number 1, whereas with food addiction - it's often ignored to the very last.

People can argue until they're blue in the face but if you eat less calories than you burn you will lose weight. The problem is people with trauma plus a food addiction are not able to do this.

Is there any research around where you live and propensity for morbid obesity - especially living by the sea? I could only find one study which did support this theory but it was in the UK. I live in Bondi Beach where socialising is essentially exercising - surfing, swimming, kayaking etc etc and anecdotally I don't think I've ever seen a morbidly obese person in over 30 years (I know this sounds ridiculous and maybe it's because they never leave the house but it's true).

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

#245

Post by rich-cartwright »

notjulianjaynes wrote: post #237
rich-cartwright wrote: post #179

Earlier quoted context omitted.

I think a lot about our framing and I know for sure we haven't nailed it yet. It's fair to say your avg HN reader is very different to your avg American. For example, you seem already somewhat clued up about Semaglutide. You're likely interested in the biology behind it, and probably aren't afraid to parse the journal article about it. I really wanna emphasize how different this is to your avg American. So it's more…

If your cagey about whats in your pill my gut reaction is it either doesnt work or youre overcharging for it. I am average American.

Not at all trying to be cagey, and also not our pill. The main paper is here for more info about the most notable medication: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

Important to say this definitely isn't the only medication the doctor will prescribe. That's a decision to make in conjunction with the patient after a full medical history.

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

#246

Post by rich-cartwright »

sandbags wrote: post #244

I tried going through your sign up process to see if I could just get notified if you start in the U.K. but it seems you assume anyone coming to the site is in the US. I for one would welcome something like this.

British founder here so I'm genuinely sorry about this! Thought I'd fixed it the day before we launched on HN. Our infra will be updated by end of this week.

If you'd like to be on our waitlist, just drop me a quick email on richie@joinfella.com and I'll make sure you're in our system.

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

#247

Post by rich-cartwright »

Zababa wrote: post #241
evol262 wrote: post #199

Earlier quoted context omitted.

This is what's known as an 'anecdote', and is at the crux of the issues surrounding weight loss. Virtually every _controlled_ study shows that metabolic differences between adults are within a margin of +/- 15%, with essentially no way to eat the same amount of calories as a 200lb person and stay at 465lbs. Not least of which because your basal metabolic rate is much higher at that weight. Virtually every study shows…

> Virtually every _controlled_ study shows that metabolic differences between adults are within a margin of +/- 15%, with essentially no way to eat the same amount of calories as a 200lb person and stay at 465lbs. Not least of which because your basal metabolic rate is much higher at that weight. That sound a bit wrong to me. Fat needs energy to maintain itself? Isn't it just an energy store? If you're 465lbs with th…

It's more that the muscles (assuming same muscle mass) have to do comparatively more work if they are carrying around more weight.

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

#248

Post by rich-cartwright »

donnythecroc wrote: post #238
evol262 wrote: post #228

Earlier quoted context omitted.

Diets don't fail because they're inherently flawed and the system is more complex than we think it is. Diets fail because people fail. "I tried and I failed, but I still do all this physical stuff or could if I wanted to" is dishonesty, whether intended or not. Asserting that, for some unspecified (but large) fraction of the population, tracking your caloric intake and energy expenditure versus the number on the scal…

It does look like Fella is addressing psychological issues which I think are huge. The issue if you deny that calories in v calories burnt is the essential metric is you end up with the problem with bariatric surgery where people literally eat to the point of severe pain and don't lose weight. It's why responsible surgeon always require significant calorie restriction weight loss before surgery.

I'm sorry this isn't clearer. The core part of the coaching program is focused on psychology: we even call it "psychological coaching" internally! That's the stress eating side, then also diving deeper into why we make the food choices & portion size choices we do.

My take: a approach focused only on changing behavior has good parts, but traditionally been way too much reliance on this and not enough on the psychological/cognitive side.

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

#249

Post by rich-cartwright »

evol262 wrote: post #228
rich-cartwright wrote: post #216

Earlier quoted context omitted.

Unsure how helpful this slapdown is after the guy is sharing something pretty vulnerable.

Diets don't fail because they're inherently flawed and the system is more complex than we think it is. Diets fail because people fail. "I tried and I failed, but I still do all this physical stuff or could if I wanted to" is dishonesty, whether intended or not. Asserting that, for some unspecified (but large) fraction of the population, tracking your caloric intake and energy expenditure versus the number on the scal…

The thing is, if you speak to obesity specialist MDs, they really do come at this in a different way. They have a much more nuanced view of how underlying metabolism / biology interact with CICO.

I know personally because I used to believe a puritan CICO, but had a "viewquake" moment speaking with them and had to change a lot about what I believe!

Importantly they try to focus exclusively on practical solutions for the population: what will actually work in the world. They detach themselves from a lot of the moralizing we see.

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

#250

Post by rich-cartwright »

evol262 wrote: post #233
nevinera wrote: post #201

Earlier quoted context omitted.

> overreport their physical activity, like "I can jog 10 miles", or "I play tennis about 7 hours a week", or "I regularly make 60 mile bike rides". If you do, you're the extreme outlier, and it doesn't change the data. Assuming you can do those things, you're almost certainly still in your 20s, and the health effects of your weight haven't really caught up with your body yet I'm 37, and 6'5". and if you're calling me…

I said that you may be an extreme outlier. You're also larger than every NFL player in history, everyone in World's Strongest Man, etc. A 10 mile jog (let's say 80-100 minutes of uninterrupted running) is the sort of "I could eat 50 eggs" number people pull out. At 6'5", you are an outlier. 2kcal is too low, much as it's too high for the average woman. This doesn't mean that metabolism is a "colloquial" term. It mean…

Honestly this is a pretty good description of the Fella program: "A holistic approach which addresses trauma, reasons for emotional eating, lifestyle replacements, recalibration of palate, satiation even at a deficit, and all the rest."

We designed Fella because "throwing drugs at it" is not the best solution for patients.

The crucial difference to your approach is the addition of the medication. Which if you speak to any obesity specialist MD, is exactly what they'd recommend: pharmacotherapy + psychological & behavioral intervention.

Please do not let moral posturing cause you to underrate the importance of a holistic approach which includes medication-assistance.

Post reply on HN