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GLP-1 pills are coming, and they could revolutionize weight-loss treatment

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Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#91

Earlier quoted context omitted.

> don’t think being addicted to laziness and having a glutinous appetite is exactly comparable to say, being addicted to heroin Based on what? The reward pathways are remarkably similar. And unlike heroin, you can't go cold turkey on eating.

Well the food addiction or sedentariness addiction diagnosis are a lot more controversial than a heroin addiction diagnosis, though I can see how they have some things in common. I think labelling any observable manifestation of poor impulse control as a medical addiction is more of a social trend than a legitimate scientific discovery. The bigger difference though is that we all eat food, and for most of us includes…

> labelling any observable manifestation of poor impulse control as a medical addiction is more of a social trend than a legitimate scientific discovery

What gives you the confidence to overrule medical professionals on this? (Note: I am not a doctor and have zero medical training.)

> We’re all (more or less) exposed to the “addictive substance”, it’s just some people have the ability to deprive ourselves constantly indulging that impulse, while others don’t

One, I’d challenge we’re all similarly exposed. I grew up in a house with no sugary sodas and plenty of leafy greens with each meal. Many people did not.

Two, we know from drug addiction that there is no global measure of addictiveness. Some people can smoke a cigarette or cigar or two, on average, per year. Others get hooked after their first draw. There is no reason to suspect something similar isn’t happening with obesity.

Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#92

Earlier quoted context omitted.

Do we know what the long-term affects are? Is there any lasting benefit if someone stops taking these types of medication? If one does keep taking it indefinitely, does the addiction-suppression effect stay the same, or reduces over time?

There are side effects, but the risk profile is known (is my understanding). It is (at this time) believed to be a forever drug, just like diet and exercise stop working if you stop them. A longer term fix is likely gene therapy (Fractyl Health has a clinical trial in progress, REMAIN-1) vs chronic maintenance. GLP-1s allow us to poke at the human to see what happens. Gene therapy will, hopefully, allow us to impleme…

> just like diet and exercise stop working if you stop them

I suppose, but that assumes you are viewing them as temporary weight loss interventions rather than lifestyle.

The key is to want to be healthy, and to arrive at a sustainable balance of nutrition and exercise level that works for you to stay at a healthy weight. Fad diets where you are denying yourself pleasures, or going hungry are not sustainable, nor is any extreme exercise regime that you find unpleasant or does not comfortably fit in with your routine.

Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#93

Earlier quoted context omitted.

I would say that your suggestion that grown adults should be absolved of responsibility for their own decisions is actually a quintessentially childish idea. The fact that you are so deeply offended by any suggestion otherwise is even more childish.

You're both wrong. Obesity increasingly looks like addiction--as with any addiction, it takes two to tango. But once you have an addict, shame is an ineffective treatment. Debating giving an obese person GLP-1 drugs is akin to challenging methadone for heroin addicts.

I never suggested shame as an effective treatment. But refusing to acknowledge the reality of the situation is not an effective way to discuss the problem. Obesity is the result of lifestyle choices, and those choices do impose their costs on everybody in society. Which is why I would be very happy (and I would suggest everybody should be happy) if an effective way to address the problem was discovered.

The fact that an obese person is harming other people as well as themselves might be an uncomfortable truth for them to hear. But ignoring it doesn’t make it go away.

Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#94

Earlier quoted context omitted.

You're both wrong. Obesity increasingly looks like addiction--as with any addiction, it takes two to tango. But once you have an addict, shame is an ineffective treatment. Debating giving an obese person GLP-1 drugs is akin to challenging methadone for heroin addicts.

I never suggested shame as an effective treatment. But refusing to acknowledge the reality of the situation is not an effective way to discuss the problem. Obesity is the result of lifestyle choices, and those choices do impose their costs on everybody in society. Which is why I would be very happy (and I would suggest everybody should be happy) if an effective way to address the problem was discovered. The fact that…

> Obesity is the result of lifestyle choices, and those choices do impose their costs on everybody in society

Granted. But why does it need to be said?

I'm a skiier. That lifestyle choice alone probably has a higher risk-adjusted cost to our healthcare system than if I were fat. I'd still miffed if prior to setting a bone my doctor decided to lecture me on the risks of skiing. I'd be positively furious if I got that from my health insurer.

> fact that an obese person is harming other people as well as themselves might be an uncomfortable truth for them to hear

Why do they need to hear it? There isn't a need. What they need is to not be obese anymore. That's treatment. My point is skipping the lecture and going straight to treatment is how we solve most medical problems.

Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#95

Earlier quoted context omitted.

This is sold as Contrave / MySimba, albeit adding metformin to the mix is a little unusual https://en.m.wikipedia.org/wiki/Naltrexone/bupropion

For those not aware: Metformin is a popular (unapproved?) nootropic.

My guess is metformin is here because of its effects on blood sugar. It is available as a prescription drug for this purpose.

Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#96
post #87

Earlier quoted context omitted.

> I don’t think being addicted to laziness and having a glutinous appetite is exactly comparable to say, being addicted to heroin. Your opinion is that of a petulant child. Many years of research has shown that obesity is not this simple. Many chemical processes take place that influence one's ability to make better health choices, and many external factors put constraints on those choices as well. This is the exact…

> Being obese is not a moral failing. Source?

Well, my not being obese isn't a moral virtue.

Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#97

Earlier quoted context omitted.

Do we know what the long-term affects are? Is there any lasting benefit if someone stops taking these types of medication? If one does keep taking it indefinitely, does the addiction-suppression effect stay the same, or reduces over time?

So long as an appropriate level of hormone exists in the body (they're injecting hormones doing this) the effect stays the same. This is like wondering if women need to supplement increasing amounts of estrogen over time (as opposed to supplementing only when needed i.e. birth control or menopause). You can take it indefinitely, but you must take it indefinitely in order for it to keep its effectiveness because the b…

What people inject is not the hormone itself, but a secretagogue (aside from people who directly inject insulin).

> You can take it indefinitely, but you must take it indefinitely in order for it to keep its effectiveness because the body isn't producing enough of the hormone.

I don't think we consider this (weight gain due to overeating) to be a GLP-1 deficiency, although I'd be interested to see research on that.

Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#99

Earlier quoted context omitted.

Do we know what the long-term affects are? Is there any lasting benefit if someone stops taking these types of medication? If one does keep taking it indefinitely, does the addiction-suppression effect stay the same, or reduces over time?

There are side effects, but the risk profile is known (is my understanding). It is (at this time) believed to be a forever drug, just like diet and exercise stop working if you stop them. A longer term fix is likely gene therapy (Fractyl Health has a clinical trial in progress, REMAIN-1) vs chronic maintenance. GLP-1s allow us to poke at the human to see what happens. Gene therapy will, hopefully, allow us to impleme…

AFAIK Fractyl's "drug" is not gene therapy but a surgery where they remove part of the lining of your colon. It is not currently possible (nor will it likely be) to use gene therapy for obesity treatments. The technology is not suitable for this kind of medical application.

slide 5: https://www.fractyl.com/wp-content/uploads/2024/10/DGVS-2024...

Re: GLP-1 pills are coming, and they could revolutionize weight-loss treatment

#100

Earlier quoted context omitted.

Diet and exercise don't have negative side effects and they are free. Exercise is social too and has lots of side effect benefits beyond the obvious fitness ones

> Diet and exercise don't have negative side effects and they are free They're absolutely not free. They fail at a high rate, which incurs medical costs. And when they work, they require--in practice--a lot of follow-up and coaching. It's fairy-tale level mindblowing that we can look at the status quo where nearly half of the industrialised world is obese and get haughty about a drug that medically, demonstrably impr…

Tell me how much does it cost to do push ups? How much does it cost to do squats? Failing at doing any of these does not incur medical costs. And yes, it takes effort and willpower (like anything worthwile in this life). But none of those cost money.

It's fairy-tale level mindblowing that we can look at the status quo where nearly half of the industrialised world is obese and get haughty about a free method (see physical exercise) that medically, demonstrably improves patient outcomes with no negative side effects.

That drug is the medical equivalent of a goldberg machine.

Exercising your willpower will have more benefits than physical exercise alone: mental health, cardiovascular and strength fitness and you could go on. And it is free. No big farma making money from you

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