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Scott's most recent post had someone linking to an article in the Atlantic about debunking a study, I went and read it and got sucked into the Atlantic rabbit hole.
Link one: Don't avoid romance says more people are single nowadays and unhappier nowadays because more people have avoidant attachment styles in the past, with some (mostly circumstantial) evidence that the amount of avoidant attachment is increasing. Ends with an exhortation to not be avoidant but doesn't examine the question I would have thought would be of interest, which is why more and more people don't have healthy attachment styles. (Aftereffects of higher divorce rate? Internet usage? Weaker community institutions? Microplastics? I'm just spitballing ideas but wouldn't a marked societal-leve change in people's psychology be something you'd want to investigate the causes of?)
Link two: The Ozempic Flip Flop as someone who gets full very quickly and doesn't have a very strong appetite, I've never really had good mental image of what it's like for normal people with normal appetites let alone obese people with obese appetites. This article in particular presents people who lost weight, noticed immediate massive benefits in their life they're desperate to keep, and yet still can't keep the weight from coming back. It is just the satiety setpoint being set so high it's torture for them to not eat to the point of overeating? I'm trying to match it to my own points of reference for "willpower" struggles but failing. I force myself to go to the gym despite not enjoying exercise, but that's forcing myself to do something, not forcing myself not to do something, so generally speaking once I overcome the activation barrier of inertia the hard part is over. I intermittently (deliberately, as opposed to non-deliberately) fast and can be hungry and craving food but to a pretty easily overcome extent. But what makes someone — who for months now has been eating much less — be unable to maintain the amount they've been eating for months but instead be compelled to keep eating more even though it's actively physically hurting them (and costing them in other ways, like socially). How much stronger incentive can you get? It makes me feel like at some level for some people food is an addictive substance like drugs. (And also still trying to understand how this gets spread — is it really hyperpalatable foods? Something else? We can watch countries become more obese... Whatever the underlying thing that makes someone susceptible to this is, it does appear to be something a country can acquire)
Yes.
The mechanism via which the body "hungers" is somewhat complex, but can be usefully simplified down to the action of ghrelin, a hormone produced in the stomach which makes you hungrier, and leptin, which does the opposite.
Surprisingly, obese people have more adipose tissue, which produces leptin. However, it ceases to have the usual satiety inducing effect, as the body becomes resistant to its action. The way this is perceived is the body interpreting the lack of signal for being full as a sign of starvation.
And starvation sucks. Other than disease, it's probably what's killed the most humans in all of history, and you can imagine that it's a very unpleasant state that the individual feels compelled to rectify. The easiest solution being to eat more, till the pain goes away.
They're also being struck with a double-whammy. In lean people, eating causes suppression of the levels of ghrelin, in obese people, it doesn't. So they feel less full, with the same amount of food, as compared to those at a healthy weight. Hence they feel compelled to not just eat, but eat excessive amounts for the sake of relief.
I can only reiterate that starving sucks, and the body will drive you crazy in order to avoid that feeling. It's too dumb to know or care that you are, objectively, perfectly well fed. Waterboarding feels just as bad as actual drowning despite the ~nil risk of death.
While doctors usually feel compelled to tell their patients to watch their weight and diet, this almost never actually works. I consider myself a pragmatic one, and advice that isn't actioned in practise is about as useless as advice that doesn't work at all. I was on the Ozempic hype-train well before it was cool.
My mother is very obese, and has been for over half her life now. She's diabetic, and has developed fatty liver with hepatic fibrosis. Her own commitments to working out and dieting never held. She's a doctor herself, so she knows, on an intellectual level, what the risks are. She's been driven to tears by the scolding she gets from my grandpa or my dad who genuinely care for her and want her to lose weight, and after gentle suggestions failed, were driven to tough love.
None of it worked. She loved to eat, and reducing her caloric intake was pure agony. For a long time, I was resigned to the seeming inevitability that she'd head into cirrhosis, and I'd have to steel myself up for a liver donation. It's a nasty, nasty surgery, nothing like giving away a kidney. It leaves a grossly disfiguring scar, leaving aside the significant risk of death during and after the procedure. I'd do it for my mom, because I do love her.
Eventually, when Ozempic, or oral formulations of semaglutide, became available in the Indian market, I badgered her into seeing her endocrinologist and getting it prescribed. Despite the initial nausea and diarrhea, she eventually adapted, and lost the lost weight she's ever managed, and kept it that way. Right now, my priority is hounding her into going to that gent again and getting that dose upped, it's well overdue.
Exhortations to exercise failed. Asking her to watch her portion size and not snack failed. Driving her to tears failed.
The pill didn't.
When people get on their high horse and claim that using drugs to solve your problems is a crutch, it takes everything I have to not tell them to go fuck themselves with a rusty pole. It saved my mom, fuck you. Nothing you have to offer, including your empty words, comes close.
To hell with willpower. A world where we can power through our problems with pills is a better one as far as I'm concerned.
I'm a doctor for many reasons, but ranking highly among them is that I have an urge to find solutions to problems that actually work. Telling people to use their will to get over depression or diabetes doesn't, and the same is true for obesity. Claiming the moral high ground and virtue signaling? Doesn't beat adding years of healthy lifespan.
that's what people don't understand about "well let's just shame fat people into not over-eating".
If you really make me feel bad, what happens? I feel bad, I cry, I hate myself. There's no quick fix, because even immediately going on a starvation diet will not shift significant amounts of weight in time for all the "good job, you are now not a disgusting lard bucket" to make up for the shaming.
You know what does make me feel better in the short term? Eating.
Congratulations, now you've driven me to eat even more.
(Yes, I'm on Ozempic now. I haven't lost weight, but it'd doing good for my blood sugar. Weirdly, I'm eating both less and more, since I don't eat as much at one sitting, but now I'm constantly eating small snacks and meals. No idea what the hell is going on there).
I do not necessarily claim that fat-shaming doesn't work. I just think that it's cruel, and the efficacy is far less than ideal.
There are societies, like China or Korea, where the social opprobrium for gaining weight is so strong that most people will do just about anything to avoid it. It likely also drives people into depression, eating disorders, while also sucking.
Locking people in a fat camp and beating them with sticks for eating will, I strongly believe, reduce the obesity rate. I don't endorse such tactics, even if they work.
(You don't see no fatties coming out of Auschwitz, do you?)
I'm not an endocrinologist, but it might be worth asking them to increase the dose. More Ozempic is, very roughly speaking, more weight lost. There are also alternative drugs that work even better, but they're harder to get.
Problem is, yes I would lose weight if you locked me in a camp and beat me with sticks. But to keep the weight off, you'd have to keep me locked up for life, or give me my own personal 'beat me with sticks and knock the food out of my hands' 24/7 person.
Changing habits is hard and willpower won't let me power my way to the new regime. I managed to willpower my way to stop biting my nails after years and years of that, but I can't willpower 'just stop fucking eating, you fat bitch'.
Congratulations, ceasing nail-biting is very difficult. This makes me think you have a better shot at fixing your diet than a random obese person off the street, since you've already achieved one lifestyle change from willpower alone. I hope that you have greater success now that you have chemical assistance. Good luck.
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Well obviously.
But when I broke my leg I got a crutch.
What the fuck I was supposed to do? Crawl? Walk on leg with broken bone, injure it further and howl in agony?
Crutches exist for a reason! There are stupid way to use them, I guess, but typical use of crutches is extremely useful in an obvious way!
I do not have problems solved by Ozempic as far as I know, but if I could pop a safe pill to solve procrastination issues I would do it!
When people call something "a crutch" they refer to the specific chronic problems they cause in long term use, and in particular that you can get habituated to them in a way that stops you from taking the harder steps required to get back to walking normally.
In this case it seems particularly evident that the issue with drugs that trick you into not feeling hunger at your normal rate is that it becomes that much harder to operate normally without them.
Unlike OP, I think a world where people can only solve their problems by becoming addicted to complex and expensive drugs is a bad one.
Now of course the effects of obesity are so bad that it's probably better to take the drug if you can't muster the willpower, but it's like taking opiates for back pain. Weening yourself off of the drug should be the ultimate goal, otherwise you're just embracing a different kind of slavery.
You simply regain your appetite, and around half the weight back in a year if you stop Ozempic. I don't see how that's not strictly better than not taking it.
The hell is a "complex" drug? Does it have a hard to pronounce name? Does it have a large molecular weight? Does it act on more than one signaling pathway?
Ozempic isn't particularly expensive. Most middle class people in the West can afford it, if it's not covered by insurance. There are legal or grey market sources that are significantly cheaper. And as more alternatives arise, including generics, it'll only get cheaper.
Gym memberships cost money too.
And Ozempic isn't "addictive". Do people not know what that word means?
Is insulin addictive to a diabetic, because they'd fall sick or even die if they stopped?
I would like to see you wean yourself off oxygen and water. Perhaps, to be less challenging or immediately lethal, clothing or shelter. Otherwise what are you but a slave to biological necessity?
This is all such immensely confused thinking that I don't know how such beliefs can even arised. At the very least, it is factually incorrect.
I'm not making the argument against taking the drug, I'm making the argument against being stuck in a local maximum.
One that relies on an international supply chain for its industrial production and the existence of a large enough empire to secure sea lanes. A type-2 technology.
Apparently they don't anymore.
From The Oxford English Dictionary, Volume 1:
From The Oxford Advanced Learner's Dictionary:
Saying diabetics are addicted to insulin because they would die without it is a tautology.
So is saying men are slaves to biological necessity. These are realities well understood since antiquity.
Such addictions may well be natural, but they are cumbersome, and one of the common criticisms of modernity is that it has tricked people into novel addictions under the guise of liberating them from natural ones. I would have thought this line of reasoning to be popular enough as to not demand explanation. But here we are.
I could throw it all back in your direction, but I'm afraid I know too well the source of your confusion, and it is that you think American Psychologists among other colleges of experts have dominion over the English language and its conceptual space. As if they can declare the valence of things by fiat.
It is an all too common sort of delusion that leads people to demand pronouncements from these priests as to whether certain lifestyles are or are not illnesses.
But as we are now in a place that is open to people who are not adherents of this religion, I therefore enjoin you to consider that such authority is not self-evident.
You probably mean minima.
Now, you define a "complex" drug as one that relies on international supply chains and "the existence of a large enough empire to secure sea lanes". I have to admit, this is a.. novel definition. Are you typing this on a "simple" device? The phone or computer you are using relies on a supply chain of such staggering, globe-spanning complexity that it makes Ozempic's look trivial. If you have taken a Tylenol in the past decade, there is an excellent chance it was manufactured in India or China and shipped across those same sea lanes. Unless you are a primitivist writing on handmade parchment, you are a beneficiary of these "complex" systems. It seems strange to draw the line here, at a medication that saves lives.
Oh, not all diabetics would die. They could, in an ideal world, live short but tortured lives! Is that a tautology?
So? Care to reproduce such arguments in full instead of waving at them?
You will not literally die without electricity or information technology. You seem to conveniently enjoy that particular fruit of modernity, while crying about this one.
Once again, the number of people who eschew electricity or computers seems awfully small. Modernity is, on the whole, quite nice. It could still do with improving.
I am not an American Psychologist, nor do I think they have "dominion over the English language". I also happen to think you're twisting that poor thing to your own ends, with willful ignorance of your actions.
Spare me your sophistry. If you Google "definition of addiction", one of the first hits is the Wikipedia article for the same, which says that:
Ozempic doesn't cause "substantial harm". Any negative consequences are grossly outweighed by the upsides of not being obese, let alone diabetic.
Your definition is ridiculously archaic, and by that definition, one could be addicted to collecting stamps, to morning walks, or to breathing. You have diluted the word to uselessness.
I have no "authority" over you, and never claimed to. Short of mod-abuse by banning you, which I've never done and have little inclination to do. I still have little patience for such clearly confused, utterly sloppy thinking, with the added temerity of trying to take the moral high ground through word-play.
No.
I suppose Jacques Ellul only died 30 years ago. But I would have expected everyone here to be long familiar with this ancient history given we discuss the philosophical implications of AI on the daily.
Of course.
The section on medicine as a human technique is of course most relevant to this conversation, but I don't recommend skipping around if you are unfamiliar with philosophy of technology and the associated jargon.
No. Semiconductors are arguably the most complex things mankind has ever made. Especially using this definition.
No, it's a non sequitur.
I'm not sure what part of my writing evoked any kind of detectable emotion. I assure you it is purely analytic. I'm critical of modernity whilst living in it. What else could be reasonable?
Call me an ungrateful atheist for living in creation if you must. I can't help but look at what I'm doing.
So I was indeed right to believe you take the DSM-V to have the power to decide the meaning of a word that has existed since the 1500s.
I think the fact that you'd take Wikipedia's word over that of Oxford reflects poorly on your conception of the world, frankly. But this is a silly semantics exercise anyways. I have clarified what I meant beyond doubt. If my vocabulary irks you, so be it.
No, I've used in in a way you don't like, which is common and in accord with its historical usage. There is a difference.
You misunderstand. It is the expert authority on your own language and thinking I recommend you remedy, not your authority on me.
No. A local maximum is a peak. You seem to be arguing that people on Ozempic are stuck in a state that is better than the alternative (obesity), but not the absolute best possible state (some imagined ideal of pure willpower). If we're torturing a metaphor, that's a local minimum of negative outcomes. But why let basic logic or the meaning of words get in the way of your grand philosophical pronouncements?
And? Darwin died 140 years ago, but we don't treat his theories as gospel just because he's dead. Age doesn't make an argument correct, and name-dropping French philosophers doesn't make your position any less incoherent.
Ah, an appeal to an obscure academic to justify your terror of the modern world. I don't need to have read him to recognize the staggering hypocrisy of your position. You lament the "complex drug" that relies on global supply chains while typing your screed on a device whose complexity makes a vial of semaglutide look like a sharpened stick. This isn't a coherent critique of "technique"; it's just selective, convenient moralizing.
What would be reasonable is to apply your critique consistently, instead of drawing an arbitrary line at a medication that saves people from suffering. You enjoy the fruits of modernity that allow for your comfort and your intellectual hobbies, but you condemn the fruits that rescue others from a life of pain and metabolic disease. It's the pinnacle of entitled, ivory-tower thinking.
Spare me. I didn't cite the DSM-V; I cited the common, modern, functional understanding of a word as it is used by virtually everyone who isn't deliberately trying to be obtuse. You're clinging to an archaic definition from a historical dictionary as if it's a sacred text, precisely because it allows you to dilute the word "addiction" into meaninglessness. By your logic, a marathon runner is "addicted" to running and I am "addicted" to washing my hands between patients. It's a semantic game to avoid confronting the vacuity of your argument. Context matters. If we're talking about cars, I don't define "transmission" as "the act of sending a message" just because that's what it meant in 1400.
This isn't about Oxford vs. Wikipedia. This is about clarity vs. deliberate obfuscation. You are using language as a weapon to feel intellectually superior, not as a tool to understand the world.
And let's be clear about what you're really arguing for when you strip away the philosophical fluff. You say weaning off the drug should be the goal to avoid "slavery." For many, the alternative isn't freedom; it's a return to the biological slavery of a body screaming for food, a slavery that leads to diabetes, liver failure, and an early grave.
You can sit there and pontificate about "novel addictions" and the failings of modernity. I have to look my mother in the eye. I've seen the "natural" state you seem to prefer, and it's ugly and it's brutal. So frankly, you can keep your dusty dictionary and your non-sequitur arguments. They are useless. The pill works.
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Well it's interesting because that connotation actually is a lot more recent than the word and came about alongside new discoveries in neuropsychology and the concept of "productive struggle" through the work of John Dewey and Lev Vygotsky (of "zone of proximal development" fame). The latter actually did inspire the use of that analogy in Bernstein's work on motor development.
To my mind, it's probably more of an artifact of the developing supremacy of Trancendentalism in American culture, and all its ideas of "self-reliance", but you can't quite say the analogy has no scientific backing since it sort of came out of scientific discoveries in the first place.
Crutches don't (that I know of) have anything special to them except that they're an easy to visualize example of the neuropsy phenomenon in question.
Of course, I'm not saying we ought to ban morphine on the sole grounds it is addictive. Simply that the tendency to medicate people for life is a danger and that one should want natural health to be the outcome, even if some of the steps on that path are sticky.
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Precisely. I'm not sure why that terminology even came into the picture, given that it's not a reference to malingering, which is the only other remotely plausible way to misuse a crutch.
May I introduce you to our lord and savior, prescription stimulants? Not sure how I'd have become a doctor without them.
How do I get prescription stimulants without a prescription?
(If I had enough conscientiousness to be able to get a prescription, I wouldn't need the stimulants.)
You need to know a guy who knows a guy. Or peruse the Dark Net, I suppose. If you were in college or uni, you'd probably know someone pawning off their pills.
I managed to get a prescription, and I certainly need the stimulants dawg. If you're in the States, then there's probably an online pill-mill that makes it easy, if you can't make yourself physically go see a shrink.
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I am very happy that these drugs helped your mother. I do not disparage anything about these drugs or anyone who chooses to take them.
...however.
You, like many others, go too far. Changing your lifestyle does actually work; it's just that many people don't do it. There are a bunch of reasons why they don't do it, and that's okay. They may be perfectly fine using a drug. Nothing wrong with that. But don't tell people that changing their lifestyle doesn't work, because it does.
Let's take something like, I don't know, becoming a doctor. I've heard that this process sucks. I've heard that plenty of folks burn out or fail at some point. I'm sure someone's mother somewhere failed in trying to become a doctor, regardless of how much her family tried to make her do it. Nevertheless, I think there are still fine reasons to say, "Here are the objective things you need to accomplish to become a doctor, and here are a variety of subjective tips to help you pattern your life in a way that is conducive to achieving that goal, if you so choose." Some people won't do it, and that's okay (in fact, the vast majority of people right now don't become doctors). We don't have a pill yet that magically gives people all the required knowledge of a doctor. But even if we did, it wouldn't be a reason to say that the other (true, good) information "doesn't work".
Ah, the good old "all that's needed is just some willpower" argument.
If anything would drive me to be a biological determinist, it's this. Oh, you find it easy to cut down eating, take more exercise, make necessary changes and stick to them?
Do you want a medal for that? Because it's not on you, it's not you making up your mind and applying willpower that does it. It's the genetic luck of the draw of having the fortunate combination of heredity and environment that gave you the physiological and psychological phenotype that means you can eat less, exercise more, and stick to changes.
Both my parents smoked. My father was able to give up smoking and never go back. My mother tried and failed, many times, to give it up and eventually she died of the lung cancer it gave her.
That was not a question of willpower, because my mother was not less strong-willed than my father, or more resistant to change. I don't know why she couldn't stop. She didn't know why she couldn't stop. She wanted to stop, she tried, she failed over and over.
Tell me "all that's needed is just some willpower" about that, and I will spit in your smug face.
Ah, the good old strawman. Actually, very very bad old strawman.
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As much as I hate to intrude on another's discussion, I'm simply going to point at my own experience in terms of weight loss and shrug helplessly.
Like you, I was of a similar attitude. Like you, I felt the majority of weight-gain and weight-loss issues was a matter of people simply not wanting to put in the effort. I still do, to a point - too many people think a diet is like an on-off switch, when I've found it really boils down to actively changing how and what you eat - it's a lifestyle shift, not something you do for a month to fit into your summer bikini. And why not? I did exactly that. I lost 70 pounds from strict CICO and modifying my diet.
However.
I'm not going to go more indepth into my own history of weight loss and weight gain. Instead, I'm going to point to my brother, who has also done the entire weight-loss via keto. And while he was able to lose the weight, there was a plateau, a wall in terms of weight loss he was unable to get past before he simply gave up - the juice wasn't worth the squeeze in terms of the effort he was putting in.
Full disclaimer, he's never been an obese-looking butterball or as heavy as I am, though I'm sure if you put in his BMI stats he'd be labeled as obese.
On semaglutide, he blew through that wall in a few short months and is still loosing weight. He's currently at the weight he was in high school, and hasn't hit a plateau. If things continue as is, both he and I will be at weights we've never been before, ever, and have no idea what we will look like.
I'm no doctor, no medical expert or scientist. I am but a dabbling amateur, stumbling around and trying to piece together a picture of the world. And as time has gone by, I'm becoming more and more convinced that our modern diet has done extreme damage to our bodies, damage that some can adapt to and overcome, and others can't. That we are subject to the cruel tyranny of the flesh that our minds are unable to overcome, even when we fervently wish otherwise. We've learned our lesson, burned our fingers and become wise, but we still carry the scars that we can't fix by ourselves no matter how we wish otherwise.
So we use drugs. Problem solved.
...now, on the gripping hand, I also have experience similar to self_made_human where getting people to loose weight forces you to do the equivalent of making a recalcitrant dog take their medicine, no matter how much they hate it, cause, y'know, they'll die otherwise, but such is life.
I don't think you have accurately captured my attitude. In fact, I think you have gotten it completely wrong.
Perhaps so. Biological processes in general do not seem to be fully-reversible, especially when you include the effects of aging. Nevertheless, that is not an argument against the measurable physiological benefits of certain lifestyle changes.
So educate me, then. Because the phrase 'Changing your lifestyle does actually work; it's just that many people don't do it.' falls pretty well in line with what my attitude would have been a year or more ago.
It isn't meant to be. My point isn't 'lifestyle changes don't work' it's that 'lifestyle changes can sometimes only work to a point'.
You went wrong a single sentence later:
Possibly so. I'd need to see some high quality research on this question to know much either way, where those points might be, whether they can be predicted, etc.
...do you not equate the phrase 'it's just that many people don't do it.' to 'not wanting to put in the effort'? I would think them rather similar.
Compare what I wrote:
I don't know to what extent a clustering can be identified that can be simply labeled "not wanting to put in the effort".
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I'm not denying that lifestyle changes work! If they didn't, why would doctors feel obligated to recommend them?
What I'm saying is that advising lifestyle changes rarely works. I don't have firm figures at hand, but I suspect that the number of people I've recommended such eminently sensible things like losing weight, stopping smoking and going to gym grossly outweigh (pun not intended) the number who actually did anything about it.
If there was a magic pill that did nothing else but make people go to the gym, it would be one of the most revolutionary advances in medicine of all time! It would be Nobel Prize worthy. We now, thankfully, have a pill that, if not literally magical, meets the "sufficiently advanced technology" threshold when it comes to obesity. It certainly beats even the most sage advice in terms of practical utility.
This is much more circumspect than your original comment. The problem of advice-giving is significantly different in nature, and it has significant dependency on a wide variety of external, contingent factors that are not-necessarily related to the typical time-independent, mechanistic processes that the biological and medical sciences study. If you would please kindly continue to be this circumspect in future comments, that would be appreciated.
I'm not being circumspect. I am merely elaborating on a point I've made, which was interpreted in a sense I didn't intend (I'm not accusing you of an intentional, bad faith claim, misinterpretations happen). I don't see any additional hedging, or caveats at play.
I would like to think I'm usually quite clear in what I mean via what I say, not that this is any guarantee of people interpreting it exactly as intended. Even legal documents and contracts, intended to maximize clarity and leave no room for error, often end up in the courts. They also make for riveting reading.
Then by all means, please elaborate on how you intended the following sentence to be interpreted:
That telling people to make lifestyle changes is highly ineffective? That implies nothing about whether or not the changes themselves don't work. I consider it clear enough, in the context of the comment. In fact, the very next sentence is:
The only reason we even bother trying is that telling people to do things is rather cheap and low-effort. In rare cases, they might even listen. It also makes us feel good, and ticks boxes.
So, in this sentence, what is the "problem" that is in need of a solution? Is it, like, "the problem of trying to decide what to tell people"? Or what?
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Sorry, what? You're just off the mark. Aside from the inherent differences between adversarial processes and other dynamic processes.
I don't know how this analogy is supposed to work. The point of the development of military doctrine is to build up a body of professional knowledge, generally to the purpose of, indeed, destroying the enemy (though there are sometimes tweaks for political constraints or other political objectives). This is, indeed, intended to be "what works".
Is the point of your analogy that the endeavor of developing military doctrine is simply fallacious from the get-go? This has other implications that I can think of. For example, rather than moving TRADOC, as Trump did, I think this point of view says that he should have simply eliminated it altogether. Of course, I think you can tell that I don't think that this is the point of the analogy, but I'm kind of struggling to see what the point is.
Maybe, on the other end, it's something along the lines of, "It's not terribly helpful to be a 400lb guy in a bed who just writes somewhere on the internet, 'Hurr durr, have you tried killing the bad guys?'"? I mean, sure? Yeah, I just don't get what you're going for, and I don't get how it's relevant to what I've said.
Mathematically speaking, I would distinguish the two. This may be a complicated and difficult environment, but it is not an adversarial one. There are deep mathematical differences between the two.
Oh, well then this is just the standard, all-too-common, strawman. You're responding to a figment of your imagination, not anything I've written.
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Thank you!
(If it wasn't clear in my original post, I'm a willpower skeptic, I think it's profoundly stupid to assume obesity is a willpower problem, even if I don't know how to imagine the experience of what it feels like to fight the urge to eat without using willpower as a proxy for the challenge)
Many things about basic biology aren't common knowledge! I don't see a specific reason for why this isn't better known.
There's a single drug called metraleptin, which was once considered immensely promising for treating leptin resistance. Didn't work, failed miserably in trials.
It does, however, work excellently in a rare genetic condition called congenital leptin deficiency, and is occasionally used for lipodystrophy. The difference is that CLD patients lack leptin in the first place, which is giving them the recombinant version helps, whereas obese people have bodies that ignore leptin levels, regardless of how much more we can throw in.
GLP-1 drugs sidestep the whole problem by using an entirely different pathway (I did say I was simplifying! Keeping my head straight about how exactly Ozempic works gives me a headache)
We don't really know how bariatric surgery works.
I'm not kidding here, we genuinely are rather unsure about the mechanism of action. Most of the commonly advanced suggestions were found to be wrong or inadequate at best.
Yes, these do help a little bit, but nowhere near as much as Ozempic does.
Hunger is surprisingly complicated, and has multiple mechanisms behind it.
The act of chewing and tasting sends signals to the brain that prepare the body for food (this is the "cephalic phase response"). This can satisfy the "oral fixation" component of hunger, the simple desire to be chewing on something.
The stomach wall contains mechanoreceptors that sense stretch. When you eat a large volume of food (like a huge salad or a bowl of broth), these receptors are activated, regardless of the calorie content. Trying to fill yourself with low calorie food is an approach known as "volumetrics", and it works okay.
I don't think just drinking water would work as well, because you'd need an uncomfortable amount to fill your stomach, and the body would quickly realize that it's just water, without calories. The ancestral environment definitely had water, and didn't have diet coke (citation hopefully not needed). If starving people tried to keep themselves content by going to a pond, it was probably weeded out quick.
My apologies for giving you the impression that was targeted at you. It was meant entirely for the people who think the usage of Ozempic is some kind of moral failing, and they're not an imaginary strawman, at least not on Twitter. I don't seem to recall much in the way of pushback against Ozempic here, barring people who still have reservations about its safety profile (it's remarkably safe, we have evidence for that claim, and loads of it).
I know, which is why I've resisted the blandishments of doctors trying to sell this to me. I know I'd be one of the patients who didn't stick to the stringent lifestyle changes you have to make along with the surgery, and I'd be one of the ones who over-eat to the extent of bursting the sleeve.
Oh, I've tried the fibre tablets thing - eat this tablet before a meal, drink water, it'll swell up inside your stomach and make you feel full and you'll eat less. Never worked for me because I never got the "feeling full" bit even after taking more than the recommended dose (luckily, I think/hope eating too much fibre is not a bad thing as such).
https://pubmed.ncbi.nlm.nih.gov/18586571/
In other words, it doesn't really matter if you're a good boy/girl and listen to your doctors after you've had most of your stomach removed. Of course, bariatric surgery isn't a truly permanent solution, weight tends to come back after several years, but it was a good option before Ozempic made it somewhat obsolete.
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Is it safe in the two senses of:
Doesn’t cause any appreciable loss of strength, at least not beyond what losing that amount of weight would normally do via not eating (exercise held constant)
One can stop taking it without any negative consequences beyond just the loss of the benefits?
I’m interested in taking it but haven’t done a deep-dive into the subject yet. Any resources you’d recommend?
If you're exercising/working out while taking it, you should be fine. I'm on 21 weeks of semaglutide and haven't noticed any lack of physical capability while training martial arts. If anything, I seem more capable, and I'm beginning to wonder if semaglutide has a side-effect of blocking soreness, but this might just be psychosomatic on my part.
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You will lose muscle along with the weight, if you solely use it for weight loss without additional exercise. But the degree of muscle loss is about the same as going on a diet, fasting, or, if memory serves, bariatric surgery. If you exercise alongside, you can stave most of this off.
Indeed. You will regain roughly half the weight you lost in a year of use after a year of disuse. But no other negative effects, to the best of my knowledge.
(I take oral semaglutide, so I'm putting
moneypills where my mouth is.)Scott, as always, has an excellent write up:
Why does Ozempic cure all disease?
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