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

FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

investor.lilly.com

Post reply on HN
Print view View original

81–90 of 95 posts

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#81

Post by mortallywounded »

intothemild wrote: post #78
mortallywounded wrote: post #73

Earlier quoted context omitted.

How? You give an obese person a pill and they shrink. They will go back to obese when they stop taking the pill and resume the diet and lifestyle that got them obese to begin with. What we need is a radical change in the food we eat and how we live our lives. It's easier than ever to not move all day. Sugar in one form or another is our primary diet. These problems won't go away.

What I do hope these drugs do, is offer people ways to get themselves into healthier lives. One of the things I hear/read all the time is how "people just need to stop eating bad" or some such.. it's practically your comment here. The issue with that thinking is it's super black and white, that willpower alone is the cure to weight loss. So let's do a little thought experiment , what about all those naturally thin pe…

Options are good.

My own mother struggled with her weight and opted for surgery at one point while I was in college. It did help her lose weight and keep it off. However, I honestly believe that surgery was a large factor in her death many years later. She was never the same after it. She lost the weight, but I would say she never obtained a healthy body and mind.

I don't say those things lightly. Surgery and other interventions are fine, but they shouldn't become our goto solution for these problems. There are absolutely other problems at play here. Willpower may be one of them, but the way food is mass produced and our usage of sugar additives seems to be a huge factor (we now have obese children...).

This lecture changed my mind on many arguments in this space: https://www.youtube.com/watch?v=dBnniua6-oM

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#82

Post by aantix »

intothemild wrote: post #80
aantix wrote: post #59

Earlier quoted context omitted.

Long-term success numbers on 10-year weight loss are abysmal. Everyone gains it back. Eating right, exercising, taking this medication - if you stop any of these, yes, you will gain back weight.

I'm on Wegovy, I'm told it will be for 2 years max... Then I'm weaned off it. My biggest fear is when I come off, the hunger and food noise returns. I would happily continue to be on this med for the rest of my life, side effects and all.

What's their reasoning for "2 years max"?

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#83

Post by aantix »

rs_rs_rs_rs_rs wrote: post #37
nathanyz wrote: post #16

Earlier quoted context omitted.

This cannot be understated. Obesity is being changed from a willpower problem to a chronic disease that is treatable. The follow-on effects of this are huge.

>Obesity is being changed from a willpower problem to a chronic disease that is treatable It's absolutely a willpower problem. These medications won't fix that for you. You stop taking them and you will gain weight again.

We commonly accept that are large ranges of inner experience.

Different levels of anxiety, depression, focus, pain, sexuality. All that we can manipulate with medication, to bring within a range we find suitable.

So why can't ones inner experience of hunger be vastly different from someone else?

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#84

Post by petesergeant »

Obscurity4340 wrote: post #76
bb88 wrote: post #71

Earlier quoted context omitted.

Depends upon the insurance. The doctor can certainly prescribe it though.

Do you think there's a way to "compel" this availabillity by litigation via best practices or medical recognition of what the FDA recognizes as "Gold standard" for medications?

The problem isn't prescription in the US, the problem is whether or not someone's insurance will cover weight-loss medications as they're expensive. If you have the cash, Mounjaro was easily available to you in the US already for weight-loss, and finding a doctor to prescribe it wasn't (much of) a problem.

The various subreddits concerned with this certainly talk about whether or not insurance should be legally compelled to cover obesity.

Just to tack this on to "what's the gold standard", the gold standard is GLP-1 receptor agonists, and nothing before that has been anywhere near as effective without serious side effects. Things have basically been stimulants (phentermine, ephedrine), bulking agents (like fiber), things that mess with fat absorption (orlistat, which prevents it; olestra, which is a fat substitute), or treatments that reduce the active area of your stomach (bypass, stapling, sticking a balloon in your stomach). All are either ineffective or come with really bad side-effects.

GLP-1 receptor agonists are really the only game in town, like Viagra was when it came out. The evolution has basically been (as I understand it):

* Liraglutide / Victoza / Saxenda (works OK)

* Semaglutide / Ozempic / Wegovy (works well)

* Tirzepatide / Mounjaro / Zepbound (works great)

In each case, they've been a diabetic medication that turns out to be great at weight-loss.

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#85

Post by petesergeant »

molsongolden wrote: post #36

With these drugs, is there any mechanism at work beyond "patients have a lower appetite and eat less food"? I've only read a few papers and articles but what I've seen is that all of the hormone triggering leads to 1) decreased appetite 2) slowed gastric emptying which also decreases appetite. Patients lose weight due to eating less but usually regain the weight when stopping the drug since they then go back to their…

> With these drugs, is there any mechanism at work beyond "patients have a lower appetite and eat less food"?

Those are definitely the key routes, but I suspect from my experience (and so the do the drug companies!) that there's some kind of mediation of reward system going on there too. Simply put: I no longer get a massive dopamine hit from sugary food. A candy bar still tastes great, but I don't immediately want to eat another one like I used to, even if I'm genuinely hungry. My addictive response to food is gone.

My favourite foods still taste great, I just no longer have to expend all of my energy in not having three portions.

> Can the same effect be replicated by eating a higher fiber and higher fat diet with more whole foods to feel full longer and slow gastric emptying?

No. Like many people who've been on a perpetual diet, I have tried -- at length -- virtually every style of eating known to man. The food noise always comes back. Even before I started, I was eating very healthily as a base-line, mostly vegetables, mostly vegan, mostly whole foods, tracking my fiber to make sure it was high. But I've also tried and sustained for many months keto, paleo, "slow carb", all sorts.

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#86

Post by petesergeant »

gen220 wrote: post #35

Has anybody here taken this category of drug, lost significant weight, and kept it off after dropping the drug? I've seen great success stories, but I'm kind of nervous of the long-term effects of taking a drug like this for your whole lifetime (i.e. what's implied by the "chronic" in "chronic weight management"). It seems like it might be a great off-ramp from obesity to a body weight where the risk of injury in exe…

> a great off-ramp from obesity

I, and many many other overweight people, have successfully lost a lot of weight in the past. There's no off-ramp when you look at the data, you always gain it back.

Mounjaro is no different from any other way of losing weight in that respect, except it doesn't rely on willpower, so you can keep taking it, and keep the weight off.

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#87

Post by poopchute »

bb88 wrote: post #63
chownie wrote: post #60

Earlier quoted context omitted.

The caveat being that taste is subjective. If we're talking raw with no sauce I can't say there's any vegetable I'm keen to snack on, certainly none on your list.

Particularly if your body craves protein, then carrots won't really cut it.

I'm specifically talking about when you're hungry and want to eat, but your calorie budget is very small. Obviously you should still be eating an appropriate amount of protein over the course of a day.

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#88

Post by poopchute »

Spivak wrote: post #68
ng12 wrote: post #66

Earlier quoted context omitted.

Eating at a ~500 calorie deficit is not starving.

Call it what you want but for some unlucky people when they run a deficit they completely shut down mentally. Their ability to lose weight is entirely dependent on how long they're able to avoid doing any mentally taxing activity.

I get major brain for on intermittent fasting. I have to spread out my protein and carbs over the day, so for me calorie restriction works best.

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#89

Post by bb88 »

petesergeant wrote: post #84
Obscurity4340 wrote: post #76

Earlier quoted context omitted.

Do you think there's a way to "compel" this availabillity by litigation via best practices or medical recognition of what the FDA recognizes as "Gold standard" for medications?

The problem isn't prescription in the US, the problem is whether or not someone's insurance will cover weight-loss medications as they're expensive. If you have the cash, Mounjaro was easily available to you in the US already for weight-loss, and finding a doctor to prescribe it wasn't (much of) a problem. The various subreddits concerned with this certainly talk about whether or not insurance should be legally compe…

And that's what's available today.

Lilly has the so-called "Triple-G" shot in trials right now. Retartrutide shows even better weight loss potential than Tirzepatide

Re: FDA Approves Lilly's Zepbound (Tirzepatide) for Chronic Weight Management

#90

Post by jwestbury »

intothemild wrote: post #77
boc wrote: post #24

Earlier quoted context omitted.

It also hopefully opens up the door to responsibly talk about how obesity will shorten your life significantly. There isn't a concept of "healthy obesity" when you look at your body's bloodwork. My buddy lost a friend who was only 38 due to complications from morbid obesity. It was tragic. Cheap, effective interventions like this are incredible for our future populace.

Sadly that "healthy obesity" or HAES (Healthy At Every Size) people are very much against this or any kind of weight loss. It kind of undermines their whole movement. I want to point out, I disagree with the HAES people, you are not healthy at every size.. you're going to have some people who are more healthy than others regardless of some amount of weight... But not obesity, not that size.

I'll note: HAES, at least initially, was about living a healthier lifestyle regardless of weight, especially recognising that without this latest batch of weight loss drugs, sustainable weight loss is incredibly difficult, and that weight loss in general can have some paradoxical effects such as increased appetite and lowered BMR.
Post reply on HN