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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

#91

Post by f6v »

danpalmer wrote: post #76
rich-cartwright wrote: post #17

Earlier quoted context omitted.

100%. We're actually British founders so it's been a baptism of fire learning about the nuances of US healthcare! That said, the US is the focus for the moment, so we're not planning to expand to Europe for quite a while.

What was the reason for going after the US market instead of the UK market? I'm in the UK and would love to try Fella, especially if I could get it on the NHS with a GP referral.

> What was the reason for going after the US market instead of the UK market?

Might have something to do with exorbitant amount of money in the US healthcare.

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

#92

Post by rich-cartwright »

beebeepka wrote: post #42
civilized wrote: post #25

Earlier quoted context omitted.

Congrats on having a relatively easy time losing weight, but you're not the only person in the world, and not everyone's body works the same as yours. Your scolding of a clinically proven weight loss approach for not being what you did is solipsistic and ignorant. Your approach is, like the others, one among many that will work for some people.

You have a point but there is one common thing shared between every obese person. They eat too much, or the wrong things. That's a given and a simple fact that everyone knows but not everyone is willing to acknowledge. Sure, there are medical conditions that sometimes play a role. But how often is that the case? I actually don't know. Maybe your company could help with that? Good luck. There's obviously a market for…

"calories in" (too much or wrong things) is for sure important - but focusing solely on this when we're looking for practical solutions is not the most helpful framework for people who are fighting obesity.

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

#93

Post by criticaltinker »

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 advantages over other antidiabetic drugs is that it has a long duration of action, thus, only once-a-week injection is sufficient. [1]

> Side effects including nausea, vomiting, diarrhea, abdominal pain, and constipation may occur. In people with heart problems, it can cause damage to the back of the eye (retinopathy). Side effects include kidney problems, diabetic retinopathy, allergic reactions, low blood sugar, and pancreatitis. [1]

> Warning: Risk of Thyroid C-Cell Tumors - In rodents semaglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether semaglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. [2]

[1] https://en.wikipedia.org/wiki/Semaglutide

[2] https://www.drugs.com/sfx/semaglutide-side-effects.html

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

#94

Post by rich-cartwright »

throwawayboise wrote: post #53
civilized wrote: post #25

Earlier quoted context omitted.

Congrats on having a relatively easy time losing weight, but you're not the only person in the world, and not everyone's body works the same as yours. Your scolding of a clinically proven weight loss approach for not being what you did is solipsistic and ignorant. Your approach is, like the others, one among many that will work for some people.

GPs approach will work for almost all people, if they actually do it.

The sustainability of approaches is what we hear most from the Fellas. Most diets work in the short run but aren't sustainable long-term, especially when you're already battling against your metabolism.

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

#95

Post by dlevine »

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 eventually crept back. I have really good willpower, but I've read the research on willpower being a resource that you use up, and definitely agree with it.

For the past couple of months I have been on Noom. I have stuck to it, and I'm now thinner than I have been in a long time, but I'm a little bit skeptical that it's going to last long-term. But I'm getting married in less than 2 months, so I only need to stay where I am until the wedding, and then I can gain a few pounds.

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

#97

Post by criticaltinker »

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…

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 restriction significantly increased serum cortisol level in 13 studies (357 total participants). Fasting showed a very strong effect in increasing serum cortisol, while VLCD and LCD did not show significant increases. [2]

> The meta-regression analysis showed a negative association between the serum cortisol level and the duration of caloric restriction, indicating serum cortisol is increased in the initial period of caloric restriction but decreased to the baseline level after several weeks. [2]

[1] Influence of short-term dietary weight loss on cortisol secretion and metabolism in obese men https://www.researchgate.net/profile/Alexandra-Johnstone/pub...

[2] Systematic review and meta-analysis reveals acutely elevated plasma cortisol following fasting but not less severe calorie restriction https://www.tandfonline.com/doi/abs/10.3109/10253890.2015.11...

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

#98

Post by faichai »

rich-cartwright wrote: post #83
faichai wrote: post #77

Earlier quoted context omitted.

I felt miserable on Keto the first two times I tried it. I’ve found doing fasting in the month prior helped with the adaptation and a large part of the misery was loss of electrolytes. By using electrolyte powder I only really had one or two really miserable days this time round.

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 goes.

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

#99

Post by rich-cartwright »

deberon wrote: post #64

As somebody who has lost and gained weight a couple times, I can confidently say that losing weight on it’s own is hard. Really hard. I’ve had far more success deliberately changing my entire lifestyle and outlook on life. For me, it had to be a part of a wholistic health regimen. This included therapy, healthy eating, regular exercise, proper sleep, and a good balance of recreational activities (it’s important to ha…

Well written. These are all core aspects of our coaching program to improve metabolic health: improve sleep, reduce stress, more pleasurable activities, better food choices, sustainable exercise routine, reasonable portion sizes.

The "small goals" is also critical to counter all-or-nothing thinking. We use a mix of behavioral & cognitive approaches to try to cement the improved habits & ways of thinking.

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

#100

Post by lharries »

criticaltinker wrote: post #63
rich-cartwright wrote: post #21

Earlier quoted context omitted.

Spot on about fasting, and keto has solid evidence as well - https://www.virtahealth.com/ are a great company focused on this. The issue is we're starting to have a more nuanced understanding of the metabolic resistance people face when they undergo dietary changes - basically the body fights hard against you as you try to lose weight by dieting. So it's now industry-standard among obesity specialist doctors to see o…

Thanks for your response and taking the time to answer these questions. > basically the body fights hard against you as you try to lose weight by dieting Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes. > So it's now…

(Richie's co-founder here)

You're spot on with the link between mental health and obesity and the need for a holistic approach.

For many of the guys stress and anxiety will play a key part in their food habits. This is something that our coaches actively ask about and help manage if relevant. For other guys it might be sleep [1] or it might be macro-nutrients. The coaching will depend on the person and we make these changes supported by their medical team.

> Anecdotally I think many folks would agree. Any citations or references you could provide on this point would be greatly appreciated - I'm struggling to find any solid literature with the phrase "metabolic resistance" in the context of dietary changes.

"Long-term persistence of hormonal adaptations to weight loss" [2] and [3] are both interesting papers on this. With the summary being that weight loss results in prolonged changes in your hormones associated with increased appetite and thus weight regain. This results in a strong negative feedback cycle.

[1] https://pubmed.ncbi.nlm.nih.gov/28164452/ [2] https://pubmed.ncbi.nlm.nih.gov/22029981/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/

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