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Given that obesity is sorta culture war related and in the news a lot, I figured this story would be relevant: Weight-Loss Stocks Soar After Obesity-Drug Study Spurs Investor Frenzy
I am more convinced than ever that these drugs are not only the future of wright loss, but similar to Paxil, is also going to a part of culture too and another tool or crutch to mitigate the downsides of modernity, except instead of social anxiety , it's too much food. We're sorta collectively inflicted this on ourselves, as victims of our own success. The pendulum if progress has swung so far towards abundance that we need modern technology just to try to undo it.
I'm posting my reply here at the top level original post, but it is really a reply, or series of replies, to comments further down.
I used to be obese, I've used semeglutide, and I no longer am. There's more too it than that though.
I didn't grow up fat. I've always been a bit on the big side though. When I was 22 I was 6'3" and about 255lbs. I was very active, had a black belt in Judo, competed regularly and had excellent cardio. I was, probably genetically, just big. I was also jacked from 2-4 days a week hitting the weights. My favorite cardio has always been swimming.
About 8 years ago I was diagnosed with cancer. I don't want to get into the finer details but it was rough. After many surgeries I've been cancer free for about 4 years now. There were bad complications from a surgery and I was bed ridden on and off for almost a year with a wheelchair after for a while. During these years my dietary and activity habits of a lifetime vanished. This post is really about habits.
After beating the cancer, regaining my mobility, and returning to the world my appetite came roaring back one day. My ability to be physically active lagged behind. Additionally I became severely depressed. My career trajectory was irrevocably trashed by the cancer. I wasn't "tough" any more, lost my black belt (you have to actually maintain activity in Judo where the belts are competition classes that reflect ability, no ability=no belt). My finances were ok despite being out of work so I consoled myself with snacks. Lots of snacks. You don't really think about your dietary habits, built unconsciously over a lifetime, until they are gone. I was overeating all the time and was constantly starving. I could eat so much that it was physically difficult to stand up and walk around, and I was still starving. All the time.
Obesity is a physical symptom of mental unwellness, and its like quicksand. Or maybe its like any other addiction. Imagine being a heavy smoker, deciding you need to quit, but you still have to smoke 2-3 cigarettes a day for the rest of your life, or you would die. Food addiction can't be "quit" in the classic sense like drugs or alcohol. You can live without those. There also aren't trillions of dollars in advertising to sell you heroin everywhere, nor huge R&D departments to develop super-tobacco. Food has all of these things.
I couldn't be active, I was in constant pain (And still am), got more depressed about it, and ate more. Rinse and repeat until I was about 100lbs overweight. It was impossible to reign in with just "willpower", if such a thing even exists. After returning to my meditative practice I was determined to make a change so I spoke with a doctor who suggested the semeglutide.
It took about 5 weeks for the berserk, constant hunger to switch off. The other primary effect is I felt full faster. Through some mechanism this drug speeds up the internal sensation that says "you're full now". This was enough to reforge my relationship with food. No calorie counting, no "willpower", no tricks.
Being heavy itself is self-reinforcing. Being fat makes you want to eat more. This drug short-circuits this feedback loop and provided the slack in my bad habits I needed to readjust. The body gets used to a certain amount of caloric intake and screams at you if it doesn't get it under normal circumstances, but the body can be "trained" though reduced intake to expect fewer calories. The drug suppresses that "screaming" for more food, the constant hunger that is only reinforced by eating, not sated.
After about 15 months it was largely complete, by body now expects 1500-2000 calories per day. The doctor was pretty alarmed at how little I was eating for someone who is 6'3'', suggesting 2500-2800. I don't know what happened to my metabolism but at 2500 calories a day I immediately began gaining weight again, fast, so I'm back to about 1700 or so daily. I'm not hungry like I was after the cancer anymore, I've been off the drug for about 6 months now and haven't put any of it back, no longer experience constant hunger, and am swimming again for the first time in 8 years.
I could not have done any of this without semeglutide. Obesity is a tailspin of depression and increased hunger that most people cannot pull out of. People who are very self satisfied in their own weight and judgemental of the obese have no understanding of any of these issues. Their bodies are trained to expect a certain amount of calories and activity and are largely on autopilot. They put almost zero effort into their own weight control, congratulate themselves on their moral superiority for being thin, and wallow in their hatred of others.
This last point often gets overlooked in out culture. Many people absolutely hate fat people. They despise them with a vitriol usually reserved for heretics or murderers. They keep it under wraps as its not socially acceptable to express these opinions in our present culture safely, but will pounce on any opportunity to lash out at the hated other, who they are superior too. Maybe there is some evolutionary advantage to this.
I used to be one of these people. I lived in the gym and the dojo. I reveled in defeating my opponents in competition. I had a lifetime of good diet and exercise habits, until I didn't. This is the opportunity these drugs offer, a break in the dysfunctional cycle of poor diet to give the body time to be re-trained. Even this is too much for some people though. Fat people, being morally inferior, deserve nothing but suffering forever until they die in misery apparently.
It's incredible how similar this sounds to my adhd meds, which also happen to be common eating disorder meds.
'The ability to quiet my screaming mind' is exactly how I would describe them. In my case, it is the constant urge to click on whichever interesting thing enters my peripheral vision or peripheral mind-space. I have also noticed something similar. Even when I am off my Adhd meds, I can now quiet my mind a little better than before.
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You also had fucking cancer and still struggle with chronic pain; your fatness had rather more to do with bad luck than the median fat person's. Still: I appreciate your story. Respect.
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I'll give the pushback while mostly agreeing. There are two sides to the fat people hate.
Yes, there is some latent contempt for fat people. But it didn't come from nowhere, and is not frequently directed at people who just happen to be fat. Nearly every conversation I've seen or heard of people trashing fat people has been in the context of delusional fat people making outlandish claims about how it's impossible to be healthy and the people trashing them nearly universally praise fat people who are recovering by working out and fixing their diet. And this makes sense because the loudest contingent of people who hate on fat people are former fat people where the pushback is against ideas that they see as having hurt them. They see the shame they are heaping on fat people as trying to instill in them the same mentality that got them out of the hole. And in a world without semiglutide, a world we've all had to live in for the majority of our lives, the experience of having your coping about how you're "big boned" or have a "slow metabolism" is bullshit and that there exists a clear, if difficult way out. And once you've found your way out and seen what that mentality was doing to you it can be infuriating to see other people transmit those memes.
Am I saying there is no limit to how much cruelty fat people should endure? Am I saying that it isn't harder for some people than others? No and no. But overcoming them was worth so much more than I can really express. It is simply true that it is much much worse to be fat.
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Thanks for sharing your experiences, I can relate to a lot of it. Speaking as an overweight but formerly obese person, I don't think that people in general really hate fat people that much. They hate the idea of themselves being fat, and may resent fat people for getting away with being fat when they wouldn't be able to live with themselves for being fat, but I think that generally people are as accepting of fat people as they are of dwarves or the mentally challenged or some exotic ethnic minority or whatever. Fat people probably hate ourselves more than the average person hates us.
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Amazing post, thanks for sharing your experience.
I share the perspective you describe. I know I have an absolutely ravenous appetite but at 6'2" 220lbs with half-assed diet scrutiny but lots of weightlifting and HIIT cardio I'm pretty happy with how I look and what I'm physically capable of at my age. But I also know (and often forget) how easy it is to fall off the wagon. I dislocated a kneecap while giving someone a lapdance (I wish I could say it was worth it but no it fucking wasn't) but it took several months of ineffective physical therapy to find out that I had a complete ACL tear.
Just finding out the news led me to completely give up on all my habits because given how long ACL surgery recovery takes, why bother? My weight ballooned by 15lbs just in the month leading up to the surgery. After the surgery I was stuck on crutches for several weeks and because I was also unemployed at the time, I also had absolutely nothing to do except eat a lot, so I gained another 15lbs on top of that. My surgery recovery took far longer than it needed to, because I'd constantly oscillate between "oh fuck me I don't fit in my clothes anymore, I gotta start cutting NOW" and "oh fuck me I am too fucking exhausted from cutting calories to do any of my physical rehab, and still too debilitated to have the option to go HAM at the gym like I used to. That tension was agonizing to deal with in the moment and eventually resolved with time, but I forget how lucky I am that I have the health and enough positive life circumstances that allow me to turn things around if I need to.
This reminds me of an experience I had. I was on a cycling trip. We were riding all day, every day. I was eating approximately all of the calories, and I saw that it was good. Then one day, I banged up my knee enough that I was going to have to stop riding, potentially for the remainder of the trip. I realized quickly, "Uhhh, damn, my appetite is still yuge, but I just ain't burning that much anymore." Thankfully, I had a pretty deep experience with counting my calories in the past, so I just forced myself to cut back, basically immediately, all the way to where I would have been without all the activity. Also thankfully, I was still spending all my time with a really positive group that I really liked, so my mood was still good, and I was able to just make the switch without too much agony. I'm exceedingly grateful that I wasn't stuck at home by myself or something, because I can imagine the psychological effects wouldn't have been nearly as pleasant.
I think this is perhaps one of the biggest divides between the people who say, "We're not morally judging; we're just saying that this is reality and that you have to find ways to make plans, enforce those plans, and have a proper support system to succeed," and those who think that the first category is simply morally condemning them. Like, no, I feel like most of us genuinely understand that there are strong psychological factors at play. There are strong psychological factors at play when people like, become alcoholics, too. Lots of people can tell stories of how this or that setback led them to the bottle spiral. I get that. But that it doesn't mean there isn't a path out. It doesn't mean that you have zero agency or ability to climb out of the spiral. Nor does it deny the real physiological damage of alcoholism/obesity or the physical effects that can contribute to the spiral. We just want people to succeed. We want them to win. We want them to learn and to overcome. We don't want them to believe the lie that they are totally and completely helpless in the face of some magical force that like, causes some bodies to consume 500cal/day, feel the physical/psychological effects of being in a deep cut, and yet still somehow gain weight. The more that people tell that lie, the more hopeless they will feel, and the worse the psychological spiral will be.
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I empathize a lot with this comment. I did not go through a drastic life change like you did. I was just always a skinny guy whatever I ate ... until I turned about 22.
I started gaining weight slowly. An additional 10 to 15 pounds a year, but I went from skinny to pushing the obese BMI weight category in 5 years. And then suddenly I started losing a bunch of weight. I thought it was great until I visited a doctor ... my liver was getting destroyed by sugar. I had type II diabetes and I wasn't even 30.
Its been a few years. I've managed to get my blood sugar levels in line. I completely quit sugar, started intermittent fasting, and I'm on metformin which gives me explosive diarrhea anytime I fail myself and eat too much sugar (and no, the punishment of explosive diarrhea was not enough to really stop me from eating sugar).
I think quitting sugar has easily been the most difficult thing I have ever done in my life. Not that I've racked up a whole bunch of difficult life experiences. But quitting sugar is always gonna be on that list of metrics.
I had a lifetime of bad diet and mediocre exercise habits. And it took 25 years before I paid the price. In an alternate world where obesity related problems aren't treated as a medical issue, I'd be fucked. The battery of blood tests that diagnosed the diabetes and liver problems wouldn't have existed in that alternate world. I would have just blissfully kept eating sugar for a few more years before organ failure and possibly death.
I'm glad you seem to be doing better. I'm glad there is another tool in toolbox for dealing with obesity.
Holy balls. You might want to talk to your doctor about MODY - maturity-onset diabetes of the young. Is there a strong family history of diabetes? 28 is very young to wind up with diabetes, poor dietary habits or no. I've seen it, at 25...but that person had a BMI of 70.
My dad has diabetes, but he was diagnosed with it in his old age, after me actually.
My A1C is under control these days. But yes it is strange how early it happened, the doctor was very confused.
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Congrats on beating cancer (I have a close family member going through that right now), and I'm quite enthused that you broke the cycle and have found your way back toward good habits!
But I have to ask, who are you talking to in this thread? There's like the one guy with one line who was immediately banned, but where is there anyone with anything even approximating vitriol usually reserved for heretics or murderers? Where is there anyone who is saying that fat people are morally inferior or that they deserve nothing but suffering forever until they die in misery? I see literally no one saying anything remotely like this... but I see multiple people claiming that other people think stuff like this. Like, nobody thinks this.
To the crowd, what is the phenomenon that is causing a variety of folks to conjure up cartoonish fat haters?
It kind of feels like the undercurrent to everything @Walterodim has said in this thread.
There are other examples but I hate this thread so I don't want to find them. I say I sense that undercurrent in those comments because they are the kinds of things I would say back when I was Flex Mentallo, so I might be typical minding, but I don't think I am. He refuses to try to understand alternative perspectives and simply decides they are lying about their values. That is the behaviour of people who believe themselves morally superior.
The first comment is in response to someone that literally said they "can't imagine people spending hours at a time contracting their muscles presumably for fun, instead of enjoying gathering new knowledge or engaging in the debates with educated people from around the world", as though that's actually a set of interests that compete with cycling. The second is a comment that I stand by. I do think maintaining fitness is superior to neglecting physicality, so no objection there.
That said, the idea that I "despise them with a vitriol usually reserved for heretics or murderers" is absurd and completely unsupported. Yeah, I think obesity is usually a product of gluttony and sloth, but no, I don't hate people for having normal human failings. I do hate that we have a massively subsidized medical system that profits immensely from medicalization of everything from obesity to sadness and dispenses hundreds of billions in drugs per year. I'm sure that there are people, such as the topline commenter in this sub thread, that really do benefit from that, but I'm appalled by pharmaceutical solutions to character issues as a normal matter of course.
You say it's a character issue, but it's difficult for me to credit the modern phenomenon of mass obesity to sudden onset degeneracy rather than the mass availability of Oreo biscuits. Maybe we were always gluttons in search of a buffet big enough to kill us.
The Oreo dates back to 1912; it was a slightly sweeter of the 1908 Hydrox. The obesity epidemic is not that old.
In 1912 Joe Average couldn't afford to buy a shit ton of Oreos and also did a lot more physical activity.
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I assumed 'vitriol reserved for heretics and murderers' was the kind of hyperbole often used by people who feel unjustly despised, because never mind the motte, there are so few people anywhere in Western society who vocally hate fat people on the same level as murderers. It was considered impolite to be visibly disgusted by fat people even before the body positivity movement was created.
Anyway hate is the kind of word everyone rates differently, would I be wrong to assume you consider fat people broken? Or that you think obesity is repugnant? If charles hadn't explained his situation and had just said "I used to be obese, I've used semeglutide, and I no longer am", would you not have assumed he was just taking a lazy shortcut?
I would consider them "broken" in the same way that anyone that has a reparable defect is.
Yes, of course it is.
Yes, because the vast majority of obese people are obese for straightforward reasons that don't have much to do randomly distributed crises. The correct prior remains that it's not that complicated of a story - modern food is too delicious, too plentiful, too subsidized, too cheap, and many people just eat too much of it. I still think drug treatments are a shortcut that I'm unconvinced of the long-run efficacy of. If it works and gets people back on track, that's great. I don't think the cornucopia of pharmaceuticals approach to health is actually working out very well and I'm not excited about subsidizing it. I do wish individuals well though.
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