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

You went to Cambridge how hard is it to understand that some people on the internet don't live in the US??

I clicked on "are you eligible?" in attempt to determine exactly this question - but instead endured literally fifteen screens of Jedi mind trick sales process bullshit before finally hitting the old "What state are you in?" drop down that doesn't even give an option outside the US.

Why?

I hope you do one day make this service available overseas.. But in the meantime you've managed to really piss me off

I've lost plenty of weight with intermittent fasting. It totally works. My sleep schedule went crazy, no matter what I did. My ability to focus was completely lost, as if I was constantly overdosing on coffee.

Yes, it works, and maybe it works easy & side-effect free for some, but tbh I'd rather be overweight and die 10 years earlier, than live like that.

Glad to have you!

The catch with this "wonder drug" semaglutide is: It has to be taken _life-long_, not just during a diet!

So when you are 30 now, you will be on medication for the next 40+ years. This is a long time.

=> Long term side effects are not known yet. In animal studies, semaglutide caused thyroid tumors or thyroid cancer. It is not known whether these effects would occur in people using regular doses.

(Richie's co-founder here)

> The catch with this "wonder drug" semaglutide is: It has to be taken _life-long_, not just during a diet!

This is why the coaching part of the program is so important.

Whether it's taken for a while or just for the first year will depend on the person, whether they are also diabetic and how much weight they have to lose. It's a personalized decision based on 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.

It's also likely we'll continue to see new medications and improvements with our understanding of obesity that makes being on this particular medication for 40+ years very unlikely.

> Long term side effects are not known yet. In animal studies, semaglutide caused thyroid tumors or thyroid cancer. It is not known whether these effects would occur in people using regular doses.

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...

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