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As someone currently using semaglutide, and having lost 40 lbs with it after around 10 years of trying to lose the weight, you are severely underestimating the variance in the willpower required for people to lose weight. Of-fucking-course the healthiest choice is to never have been fat in the first place, just like it's better to never start smoking cigarettes, but once you're addicted and fat, it makes no sense at all to insist on trying (and failing) to do it without help. Semaglutide helps you make better choices and dig yourself out of the hole, sure, it might not be healthy by itself (just like nicotine patches), but it sure as shit is healthier than having a 45lb plate strapped to your back all the time.
Are you out of the hole, though? I'd happily pay for 6 months of semaglutide to lose 20 pounds, if I expected the 20 pounds to stay off, but from what I've read it sounds like you basically have to continue taking semaglutide forever if you don't want your appetite and then your equilibrium weight to shoot right back up to its pre-intervention point.
It may be that "continue taking semaglutide forever" is still healthier than "stay 40 pounds overweight forever", though, I admit.
My strategy is a month of semaglutide on, followed by three or so months off, repeat. The cycles let me keep a six pack most of the year and at times of my choosing without having to deal with the psychological effects of a deep cut. The appetite suppression lasts maybe a month after cessation for me.
Of course, this is entirely vanity oriented, and I wouldn't claim it's at all healthy compared to the alternative. Though certainly better than the last weight loss drug I was on...
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I am "out of the hole" in the sense that once you've lost all the weight, you can start eating at maintenance again, which is much easier than eating at a deep deficit. So pre-semaglutide my daily maintenance calories might have been like 3500, and I was eating at like 3600, very slowly gaining weight. During semaglutide I'm eating 2300, which is a very deep deficit, made much easier due to the appetite reduction. After semaglutide, my reduced body weight will push my maintenance calories at around 3000, which will be much easier to maintain, either with discipline or with low-dose semaglutide. I think that the state of being obese does some kind of permanent damage to appetite regulation, so that anyone who has ever been significantly overweight will basically need to be on some sort of permanent diet for the rest of their lives, and there's no scenario in which they eat "naturally" and don't gain all the weight back.
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