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

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

#111

Post by rich-cartwright »

gnicholas wrote: post #86

It sounds like the medication is an important part of this plan. Is it something that you anticipate someone would take indefinitely, or only to get down to a target weight? Also, can you give some ELI5 background on how the medication works in the body?

It's better to think of the medication as more similar to other medications taken for chronic conditions (e.g. hypertension) than a quick fix magic pill.

The papers show consistent weight loss for ~52 weeks, then plateauing off onto 68 weeks. If you suddenly stop taking the medication, the weight creeps back on. The research therefore suggests you can likely slowly taper off the medication after year 1, but with medical supervision to ensure that doesn't lead to weight gain. This is also why improved mindset & habits are also important.

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

ELI5: increases satiety, decreases appetite.

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

#112

Post by rich-cartwright »

criticaltinker wrote: post #93
gnicholas wrote: post #86

It sounds like the medication is an important part of this plan. Is it something that you anticipate someone would take indefinitely, or only to get down to a target weight? Also, can you give some ELI5 background on how the medication works in the body?

> Semaglutide, sold under the brand name Ozempic among others, is an anti-diabetic medication used for the treatment of type 2 diabetes and chronic weight management. [1] > Semaglutide acts like human glucagon-like peptide-1 (GLP-1) such that it increases insulin secretion, thereby increasing sugar metabolism. It is distributed as a metered subcutaneous injection in a prefilled pen or as an oral form. One of its adva…

Yep Semaglutide is the key medication. Important to emphasize it appears to be a safe medication.

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

#113

Post by rich-cartwright »

faichai wrote: post #98
rich-cartwright wrote: post #83

Earlier quoted context omitted.

Interesting. How long have you been doing keto this time?

Only week 3, but finding it pretty great this time round, ketones actively suppressing appetite, eating about 2 meals a day, down about 6kg so far. I still fast a couple of times a week, but being in ketosis already makes it crazy easy. Have enough energy for gym, though power slightly down. I hear people can hit a wall about 8 weeks in, but also hear that could be down to over-consuming seed oils. Will see how it go…

Interesting to know, thanks.

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

#114

Post by Hallucinaut »

reilly3000 wrote: post #106
dlevine wrote: post #95

I have done just about everything over the years to lose weight. I tend to exercise a ton naturally, so it has been more about eating less than exercising more. I would say that my natural weight is slightly overweight but not obese. I've tried various brands of keto (Atkins/4 Hour Body), Weight Watchers, eating slowly, cutting out sugar and wheat, juice fasts. Everything has worked for a time, but the weight has eve…

Hate to say it but marriage is a sure formula for men’s weight gain.

And any subsequent kids are an exponential... at least during lockdown for me

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

#115

Post by gnicholas »

rich-cartwright wrote: post #112
criticaltinker wrote: post #93

Earlier quoted context omitted.

> Semaglutide, sold under the brand name Ozempic among others, is an anti-diabetic medication used for the treatment of type 2 diabetes and chronic weight management. [1] > Semaglutide acts like human glucagon-like peptide-1 (GLP-1) such that it increases insulin secretion, thereby increasing sugar metabolism. It is distributed as a metered subcutaneous injection in a prefilled pen or as an oral form. One of its adva…

Yep Semaglutide is the key medication. Important to emphasize it appears to be a safe medication.

What is the evidence on safety? The side effects sound potentially pretty serious, and as if the likelihood goes up the longer you take it. If this has only been around for a couple years, I'm not sure I'd jump on this just yet. More details would be useful!

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

#116

Post by rich-cartwright »

zinclozenge wrote: post #43
jimmaswell wrote: post #37

Earlier quoted context omitted.

> basically the body fights hard against you as you try to lose weight by dieting. I used to weigh 310lbs, now I'm 215lbs. All I did was count calories to maintain a deficit and the results were essentially the same as predicted by the math. I was a bit hungry sometimes at first as I adjusted to it but that's really it. Prioritizing protein and fat over carbs helps with that. What ways does the body tend to fight aga…

Unfortunately there are people like me who don't only feel a bit hungry, when I eat at a deficit there are times where I get so hungry my thoughts are completely consumed by the hunger. The only way for me to successfully lose weight was to have days where I simply eat nothing at all. Sounds counter-intuitive but after getting over the initial extreme hunger I found that the hunger sensations would diminish into a ba…

The complete fasting approach is pretty common among Fellas I've spoken with. Lot of the guys have powerful "all-or-nothing" traits, where it feels easier to have a strict intense rule than a more nuanced approach.

The issue comes when you therefore become so hungry your body drives you to eat a lot of food all at once. But I'm interested that you notice your hunger sensations actually diminish over time.

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

#117

Post by rich-cartwright »

criticaltinker wrote: post #97
faichai wrote: post #73

Earlier quoted context omitted.

Losing weight is essentially a stress on the body, the response of which is to produce a lot of cortisol, which in turn can mess with testosterone and other hormones. For me the caloric restriction leads to so much cortisol that I can’t really sleep properly no matter how much I try to exhaust myself. Keto seems to be kinder (in week 3, of trying it for the 3rd time, previous times unsuccessful). But too early to say…

Thanks for pointing out the relationship between caloric restriction and cortisol production. Your statements and anecdotes seem to be well supported by the literature. > Starvation caused a rise in plasma cortisol [...] but no change in total urinary cortisol metabolites. [1] > very low calorie diet (VLCD) did not alter plasma cortisol and markedly reduced cortisol metabolite excretion [...]. [1] > Overall, caloric…

Great links.

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

#118

Post by rich-cartwright »

faichai wrote: post #73
jimmaswell wrote: post #37

Earlier quoted context omitted.

> basically the body fights hard against you as you try to lose weight by dieting. I used to weigh 310lbs, now I'm 215lbs. All I did was count calories to maintain a deficit and the results were essentially the same as predicted by the math. I was a bit hungry sometimes at first as I adjusted to it but that's really it. Prioritizing protein and fat over carbs helps with that. What ways does the body tend to fight aga…

Losing weight is essentially a stress on the body, the response of which is to produce a lot of cortisol, which in turn can mess with testosterone and other hormones. For me the caloric restriction leads to so much cortisol that I can’t really sleep properly no matter how much I try to exhaust myself. Keto seems to be kinder (in week 3, of trying it for the 3rd time, previous times unsuccessful). But too early to say…

Anecdotally: I also used to struggle to sleep when I was dieting. My sensation was intense hunger when I was in bed where I couldn't stop thinking about food in the kitchen.

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

#119

Post by rich-cartwright »

speeder wrote: post #46
jimmaswell wrote: post #37

Earlier quoted context omitted.

> basically the body fights hard against you as you try to lose weight by dieting. I used to weigh 310lbs, now I'm 215lbs. All I did was count calories to maintain a deficit and the results were essentially the same as predicted by the math. I was a bit hungry sometimes at first as I adjusted to it but that's really it. Prioritizing protein and fat over carbs helps with that. What ways does the body tend to fight aga…

I will use myself as an example: I have Hashimoto disease, and even treated my metabolism can get so slow that I need to eat so little that I start to have nutrient deficits, for example one of the past dieting attempts resulted in hair loss, brittle nails, cracking skin, because I needed so little calories that when I consumed exactly what I needed, I ended with a protein deficit. Only solution I found that worked w…

Really interesting to know, thank you.

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

#120

Post by rich-cartwright »

mylons wrote: post #109
jimmaswell wrote: post #59

Earlier quoted context omitted.

That's interesting. That weight isn't necessarily unhealthy if it's largely muscle from all the training. Did you end up with a low body fat percentage despite the weight?

i’m in a similar spot as the OP. lifting helps, but i’m still pretty fat. 5’11” 250lbs. worksets are 355lb squat, 225lb bench, 425lb deadlift, 175lb overhead press. it’s hard to tell i’m strong, but i’m slightly more slender at this weight than i was before lifting. it definitely helps with aches and pains i used to have, primarily back pain.

Those are some tasty numbers.
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