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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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