> people can't "fake" clinical trial results like this to sell medication
Many clinical trials are controversial when they are positive.
Most clinical trials are subcontracted. The subcontractor has a deep interest in pleasing his client. You can select patients at the beginning of the trial, or during the trial you can report that a patient with a "bad" result, just dropped out of the study. And indeed in most clinical trials there is no strong adverse effects (just weak) reported except when patients die.
Moreover, the hospitals that implement the trial often only do the minimum to satisfy the principal investigator
Just look at the field of neurodegenerative diseases or ask patients how negligently they have been treated.
It is fine to be sceptical, but I think you should have taken a few minutes to read the method chapter in the study, seeing as that possibly could have eased your doubts. The first sentence cites the previously published design of the study. In the method chapter it is reported to be an "international, double-blind, randomized, placebo-controlled trial" with 3533 participants and a mean median follow-up of 3.4 years[0]. The cited article on the study of the trial states that "Participants were enrolled from 418 trial locations across 28 countries." [1]
> Many clinical trials are controversial when they are positive.
Which isn't the same as being "faked".
> Most clinical trials are subcontracted.
They are not subcontracted, clinical trial sites are identified. They are basically doctors interested in running a trial. Usually done at academic hospitals.
> The subcontractor has a deep interest in pleasing his client.
No they don't. They have no vested interest beyond their own careers and publications. Doctors only put a few hours into a clinical trial each month, usually their own patients. Most of the work is done by clinical trial staff. The costs of the trials are paid for by the sponsor, but that money doesn't go into the doctor's pocket, it's the hospital.
> You can select patients at the beginning of the trial, or during the trial you can report that a patient with a "bad" result, just dropped out of the study.
But pretty much every trial is triple blinded. The company, doctor and patient don't know if the patient got the drug or the placebo. Placebos are chosen to pretty much be identical to the drug (people get injections, take pills that look exactly the same).
And no, you can't just "say a patient dropped out". There is a predefined set of criteria that the doctor needs to follow. The patient needs to agree to follow them as well. But again, the doctor doesn't know who received what so how they can they "tweak" the results?
Plus if a patient drops out, the results are penalized. The data doesn't just disappear. All data needs to be reported to the FDA for every patient, including all follow ups.
> And indeed in most clinical trials there is no strong adverse effects (just weak) reported except when patients die.
This is 100% false. All adverse events need to be reported, whether caused by the drug or not. This is why relatively innocuous drug have weird side effects like "diarrhea, constipation". The top adverse events have to be reported, even if it's 0.01% who had them.
> Moreover, the hospitals that implement the trial often only do the minimum to satisfy the principal investigator
No, the hospital doesn't know which patient received the drug or not. If the patient needs a blood test, they get a blood test like any other patient.
And again, the process needs to be followed or else the deviation reported. All of that is reported to the FDA. If enough deviations happen, the FDA can say they won't approve the drug.
> Just look at the field of neurodegenerative diseases or ask patients how negligently they have been treated.
What are you talking about? Can you provide a source?
You've already made many statements that are clearly false, which you would know if you had done even basic research into the field using google. You clearly don't know the field very well, so I'm not sure why you feel like your "ideas" of how trials are run are of any value.
I think GP may be referring to CROs who generally do most of the ops of a clinical trial. Their incentive isn’t to have positive results though, it’s to milk the trial contract (cost plus contracting w/ ~no incentive to operate them quickly and efficiently) and then to have the results never get disputed by FDA. A CRO that fakes data is a CRO that will not survive very long.
Agreed on all your other points though, GP has no clue what they’re talking about.
Here's a potentially better alternative to Ozempic: glucose control.
Let people buy CGMs without a prescription, increase education about healthy habits from the point of view of minimizing glucose spikes [1][2], and the importance of metabolism for everything, including physical and mental health [3].
Yes, diet and exercise helps, but what you eat is also important, as well as when, and in what order. Once you learn about it (and have a CGM showing the effects in your body in realtime) you can't unsee it.
This is nonsense. There's no evidence that "glucose control" is helpful for anyone but actual diabetics. Glucose spikes are completely normal physiology and nothing to be concerned about unless your actually diabetic.
This whole "all sickness is metabolic disorder, caused by glucose" is a fringe grifter youtube quack theory. On the other hand, semaglutides have actual science behind them.
Echoing the other reply, there is a raging scientific debate between the energy balance model and the carbohydrate insulin model of obesity and diabetes. There are large cohorts of very smart scientists on both sides of this debate.
I just pointed to an entire book written by a psychiatrist and Harvard professor, with citations to hundreds of studies linking metabolism to metal disorders, insulin resistance, the effect of diet on mitochondrial dysfunction, and your argument is "trust me bro, it's quack theory"?
Don't you think you're being overly reductionist and close-minded, without even reading the evidence provided?
Probably the latter, but "just eating less" is next to impossible for a non-trivial minority of people much the way "just stopping heroin" would be for someone battling addiction.
An aid to help clear the noise in the brain seems to be unsurprisingly useful, then, in achieving these outcomes.
Sure, but Ozempic is not the only drug that suppresses appetite. So if the underlying benefits are from “just eating less,” then the study should also examine the effects of other pharmaceutical interventions that suppress appetite.
It's not the only drug that suppresses appetite, but GLP-1 agonists (Ozempic, Zepbound, etc) appear to work for a larger percentage of the population, and significantly outperform previous appetite suppressants.
There's also findings that suggest that it goes beyond simply suppressing appetite, but also manipulates the "reward" center in the brain. Individuals who take it to lose weight find that they have reduced desire to drink or smoke, suggesting it's less that they struggle with appetite and more the medicine helps overcome addictive behavior.
You certainly would, because not every case of obesity results from the same mechanisms. But just as with all the other what-about comments, this comment misses the point: this class of drug is wildly successful, and it's the most specific drug for this problem that's been developed so far
This is genuinely one of the stupidest conversations I’ve been involved in. If nicotine was as effective as Ozempic at appetite suppression then everyone would know about it, it would be commonly used in medicine to treat obesity and Ozempic would never have been created. I hope for your sake this is pedantry instead of ignorance.
Funding tends to be a constraint with larger studies, and it's best to keep studies focused anyway — less confounding variables.
Here, I'll pontificate a bit. For instance, study 1 finds that Ozempic is associated with a reduced risk of X. Study 2 is now funded to see if the association can be experimentally reproduced to establish a causative relationship. Competing institution gets Study 3 funded to test competing drug Mounjaro, reaches same conclusion. Study 4 by another institution finds same conclusion with a drug that acts in an entirely different manner, Buproprion. Study 5 by yet another institution finds similar results with amphetamines. Study 6 is funded on the premise that there's an underlying mechanism that needs to be explored, gets funding to study caloric restriction, gets similar results. Meanwhile, study 2 finds a causative relationship between Ozempic and X, concluding experimentally that Ozempic achieves X by inducing calorie restriction, which concurs with study 6.
I'm oversimplifying. But you see where I'm going with this. Much easier to both control and fund the smaller studies than a giant one, and you develop more knowledge in the process.
---
Also, I'm not an academic, so I could be wildly off base. Would appreciate a gut check by someone who actually does this for a living.
Just to hammer the point home, imagine suggesting a cure for heroin addiction is to amputate the arms so they can't shoot up. Then look up what gastric bypass surgery is.
For some reason we don't take food addiction seriously at all. You can't walk anywhere without seeing a picture of a Big Muck or something. Heroin addicts don't have to see their vice everywhere they go. Even cigarette addicts don't.
"Just eating less" may be very difficult, psychologically, in the context of an otherwise stressful and distracting life. However, I find that if you are able to eliminate those issues and focus on your own health and diet -- a big "if", I will grant -- then it's actually not that hard, on its own. You get used to it.
That GLP-1 agonists are as successful as they are and appear to modulate the reward center of the brain (per the latest research on the same class of drugs and smoking/alcohol cessation) suggests that it's certainly not just a psychological matter.
That's why I made the heroin comparison. People underappreciate the addictive properties of refined sugars.
My wife takes full dose. Shes lost 60 pounds in six months.
I have been taking the smallest dose.
Normally i can eat a full meal, and be hungrier at the end of it, then when i started.
For a couple of days after taking the small dose. I get full after a small amount. Then feel full for most of the day.
I need to go up to a higher dose as this effect fades before next dose.
It would be interesting to see a comparative study of glp1 agitators to intermittent fasting. It surprises me that people will spend huge amounts on a drug which makes them feel less full, rather than have the tiny amount of willpower it takes to just not eat.
Don't be so fast to assume that your willpower isn't just from genetic luck. You might as well be surprised some people are short. I mean, look how much better your life is as someone tall.
We humans are very quick to assume our positive traits and outcomes come from conscious decisions to make things that way. It's why every successful person has a book about how they chose to become successful. They just worked hard. It's something we want to believe rather than admit anything came down to luck of the draw.
You’re right in your argument about “just do this” suggestions without considering how hard it can be based on intrinsic factors.
I feel there is a point in the thread you’re commenting on though. It would be scientifically interesting to know whether the desired(positive) outcomes of this drug can be replicated by consciously controlling the quantity or quality of food without the use of the drug(by those who can). Still, presenting the result in a useful way rather than stating the drug is useless.
If you had a way to get the same results without any pharmaceutical intervention, and you’re a lucky one that _can_ do it, wouldn’t you want to know how?
It has been tested, Ozempic wins. These drugs are usually tested specifically on people who have tried and failed dieting and exercise interventions. I doubt any doctor is prescribing this without first asking, “have you tried diet and exercise?” The side effects can be pretty gnarly for some people and it’s very expensive and hard to obtain.
And not just genetic luck, but luck of childhood circumstances. Lots of people were given a deranged relationship to food as a child by their parents, leading in many cases to actual metabolic derangement as well.
The common theme in normal weight individuals is their comparative lack of food drive, not an outsized capacity for willpower.
When you talk to "skinny" people you'll hear things like they just forgot to eat or I just had a couple bites of cake then felt full/had enough.
Alternatively when you speak with heavier people you'll realize that they're white knuckling their entire lives (because calories are so abundant). On average they're actually exerting more willpower around food than skinnier people.
Not everyone of course, there are folks in either camp, but at population scale lack of food drive is what keeps people skinny in a calorie rich, low activity environment.
I definitely could have worded this better. I'm NOT suggesting that people who struggle with weight just don't have willpower. I was suggesting that it would be interesting to see a study comparing 2 modalities.
No and no. Anyone can't do it, and "anyone can do it" does not mean "everyone can do it".
Individuals' available choices are constrained by the choices of people around them. If you live in a food desert and your choices are oreos or krispy kremes, what then?
This hyperindividualism that ignores social context is irresponsible.
Ignoring population variation is worse. Half of people have IQs below 100 and likely cannot interpret nutrition labeling.
Please think before typing this kind of judgemental individualist stuff in future.
(BTW, my BMI is under 24. I'm not feeling attacked by your words. Just your laziness. Yes, laziness. I don't have natural empathy for people either, but I've learned to create an empathy model and run it in my head before commenting on others' behaviour. Your words show that you can take this bluntness.)
You know, insults don't change reality. And the view you are taking is so far removed from reality it is likely impossible for you to understand unless you are willing to stop and actually think.
> If you live in a food desert and your choices are oreos or krispy kremes, what then?
There are almost no real food deserts in the US. The term is a fabrication for political purposes. It is also a sad reflection of your perspective when you think people are so stupid that they can't make a choice between krispy kremes and healthier products. Or that they can't choose NOT to consume that shit.
So, I looked for data on food deserts. Because, you know, unlike you, I don't like to talk out of my ass. I found this:
Tons of food resources. From Piggly Wiggly to Food Giant and dozens of other outlets. Yet, the USDA's political mission lists this town as a food desert; a contorted definition combining average income and distance to supermarkets...none of which correlates to access to non-toxic food.
So, yeah, I have no clue what you are talking about.
And then...
> hyperindividualism that ignores social context is irresponsible.
Biology and science are not individualistic at all. Not sure what you are talking about. Again.
> Half of people have IQs below 100 and likely cannot interpret nutrition labeling.
I am trying very hard not to descend to your level and offer-up just how insulting I think this comment is to hundreds of millions of people. Hundreds of millions?
You have the sad view that, based on a single number that is mostly meaningless, over half the people cannot possibly comprehend a food label. I don't know what to call that without posting an insult, so I'll just point out that you are wrong.
Now, let me steel-man your insult pretending to be an argument:
Let's assume there are, in fact, food deserts such that people cannot possibly buy anything better than Oreo cookies and Krispy Kreme donuts. And, let's further assume that people below an IQ of 100 are just incapable of even reading a food label, much less comprehend it.
Well, if that's the case, you are making my argument: Which is that large government in general and the agencies they produce, are incompetent and even detrimental to society.
If the food desert is a real problem, the FDA and other agencies should help those communities by stepping in and bringing food choices to their vicinity. They don't.
If people below an IQ of 100 are incapable of comprehending food labels, the FDA (and others) should have stepped in decades ago with something as simple as a "Bad, OK, Good, Best" addition to the label to make these poor souls you consider too stupid to read and comprehend to be able to make a choice.
Or, better yet, these agencies should have collectively banned shit food from areas where people can't understand what they are buying and require businesses to only carry stuff that is at least neutral.
And then we have the DOE (Department of Education) and the thousand of school unions around the country, none of which have done a good job of delivering the kind of education that makes young adults with --according to you-- the ability to even begin to comprehend a food label.
Please think before posting this kind of uninformed nonsense in the future.
Some of the rare-ish side effects we've seen are genuinely concerning (gastroparesis is not fun!), but I didn't realize until recently that we actually have a lot of data about those side effects because GLP-1 agonists have on the market for a few decades now. And the safety profile is pretty good overall.
Granted, the specific formulations we're seeing spike in popularity are newer, and they've only recently been approved for weight loss rather than things like diabetes, but it's not a totally newfangled technology.
For comparison, some of the older-gen GLP-1 agonists have been around about as long as Humira has, and significantly longer than a lot of the drugs you see advertised on TV/video ads nowadays.
What I am saying is that, in the larger context, 300 million people, using drugs to control weight is the wrong approach. This does not lead to a healthier population at all.
The effects of our poisonous food system go way beyond the mere storage of energy as fat. The horrific nutritional profile seen out there today en masse, has consequences that do not evaporate simply by losing weight with a drug.
Speaking in terms of just the US --because I cannot be critical of food elsewhere-- what we want is a healthy population that consumes less drugs, has much lower incidences of all of the diseases caused by poisonous food, has less need for life-long interventionist medical care, etc.
Our population is sick. The problem is shit food (first), too much of it (second) and lack of exercise (third). Taking a pill for life will never change that. Not even close.
It isn't a solution. What's next, 300 million people taking a pill for life?
This is the kind of thing that bugs me about big government. The FDA is worthless. They are not protecting people where protection is needed. Watch the videos I posted. I'd be interested in what you might have to say.
Fair enough on the "nutrition in the US is terrible" front, and fair enough that we need interventions beyond just drugs, but why is "taking a pill for life" a bad thing in itself? Lots of people take drugs for life and are better off for it—a daily med like Trikafta is an incredible success story.
> why is "taking a pill for life" a bad thing in itself?
I would strongly suggest watching the two videos I posted. This should answer your question to a sufficient depth.
The simple answer: Because taking a pill does not fix root causes and the consequences of eating poison. In other words, the net result is not a healthier society at all. In fact, I think I could make a solid argument that this would create and perpetuate multi-generational sickness the likes of which we simply do not understand.
Perhaps the single most important element in this is that poisonous foods destroy gut bacteria. The microbiome is supremely important for health at levels most people don't understand. Taking a pill does not fix this at all. Even worse, taking a pill while continuing to eat garbage is likely even worse.
I am not a purist at all. I struggled with food most of my life, eventually being rewarded with type 2 diabetes. Years later, after a years-long effort to rectify bad eating habits, I reversed by diabetes and got off the meds --which are a formula for ever-worsening health.
This started with saying "Enough!" and finally understanding why both fasting and attending to your gut bacteria are extremely important tools for both getting healthier and staying healthy.
Lots of haters down-voting, insulting me and posting hateful comments. Yet nobody seems to want to stop for a moment and consider the idea that a human being did not evolve to eat the shit our food system produces and that it is this food that is making us both fat and sick.
To the haters I say: You are part of the problem. Grow up and learn something before you attack people who are essentially saying: You can be healthy without drugs. Because, you know, that's a hateful and selfish message, isn't it.
The example I gave, Trikafta, is a treatment for cystic fibrosis. Without drugs like this you would not be remotely healthy and are all but guaranteed to die young.
You're entitled to your beliefs about "poisonous foods," but I think people may not be receptive to what you're saying because it seems a bit like you're throwing out the baby with the bathwater here. Yes, eating well should be our ultimate goal. Yes, using drugs to mitigate the effects of a poor diet is a band-aid solution. (Although band-aid solutions are still a net good—that's why we have, you know, band-aids. Sometimes it's not possible or easy to fix root causes and the best you can do is stop the bleeding.)
But framing long-term medication use as a bad thing in itself is generally not convincing to anyone but the crunchiest of hippies or anti-establishment types. Prescription drugs restore a lot of people to normal functioning that they otherwise wouldn't achieve.
I agree that it would be better if we could prevent people from developing autoimmune diseases, or cancer, or unhealthy eating habits in the first place, but in the meantime we have... drugs. Which is better than not having drugs at all.
> The example I gave, Trikafta, is a treatment for cystic fibrosis. Without drugs like this you would not be remotely healthy and are all but guaranteed to die young.
Oh, c'mon, why don't you add colon, pancreatic and lung cancer to your list.
What a fucking ridiculous non-argument. Of course there are afflictions that have a requirement for drugs and serious medical intervention. Do you think I told my mother to eat better food while she was dyeing from pancreatic cancer last year? Don't fucking insult me. Grow the fuck up and learn to have an adult discussion!
I don’t disagree with most of what you said, and I wont say big government and more regulation is the answer, but I’m super skeptical that small government would yield better results as it relates to public health. Is your point that government, big or small, won’t solve the problems we’re facing, so why waste the money? If so, that seems like a defeatist attitude, which also doesn’t jive with me.
Many of the regulations in place today absolutely have a net positive impact on public health. Even many regs enforced by the FDA. Anyway, I’m just wondering what your solution is if big govt is the problem. Thanks.
> I’m super skeptical that small government would yield better results
Note that I did not make this argument. I am merely pointing out that these big government agencies have allowed people to be poisoned for decades.
Like I said in another comment: If people can't comprehend food labels, why hasn't the FDA come up with very basic labelling to ensure everyone gets it? Better yet, why don't we have serious restrictions on what companies can do to food?
I mean, I am very much for freedom in the classical liberal/libertarian range. However, there is a need for responsible regulatory oversight in certain domains. The FDA and the Department of Education are responsible for not working hard to ensure that both our food system is safe and kids are educated adequately. Instead we have a sick population, massive healthcare costs and all the collateral damage that causes.
> Is your point that government, big or small, won’t solve the problems we’re facing, so why waste the money?
No. The point is that we ought to demand that the people we pay to look after food, healthcare and education actually do their jobs. As I said before, some of this (a lot of this?) is a direct consequence of the failure of the very agencies that are supposed to do this work for us.
How to fix it? I'll quote a line from Fifth Element: Fire one million.
Seriously (and not), the "ruling class", so to speak, needs to be shocked into understanding who they work for. I cannot speak for other nations, I just know that what is happening here in the US is terrible at so many levels I don't even know where to start. Actually, I can speak for other nations: Argentina. I am very familiar with life and politics there. What is interesting is that everything that is happening in the US happened in Argentina in various forms over the last four decades or so. And the results are very visible. Javier Milei is working hard to fix that. We'll see if the entrenched government machinery allows him to succeed.
BTW, thanks for asking questions. I am so sick and tired of the typical HN ad-hominem approach that I rarely post any more. It's the fallacy of people who think they are smart, only to reveal the exact opposite when they speak. They also reveal just how hateful they are.
> This does not lead to a healthier population at all.
Based on what data? It sure looks like it results in a healthier population.
Your alternative seems to be essentially what we've been trying for decades: hoping, berating people and waiting for human behavior to stop being human.
For one thing because food manufacturers aren’t going to just sit around and watch their revenues get cut by 20-30%. Unless someone can explain why we’re already at the absolute lowest possible “units of satiation per unit of food,” I.e. our food cannot be made worse, then we should notice that we’ve just produced a massive/existential incentive to indeed make our food worse.
This is not how R&D works in practice. They don’t need to show 80% growth YoY. They need to show, say 8-12%. Easy enough, until an exogenous force defaults that to -20%. Suddenly your incentive to develop new methods and technologies has gone up dramatically.
No company is operating at full-tilt life or death 100% of the time simply because that’s not how economics works. E.g. when an oil reservoir “runs dry,” it’s not that it is literally dry, but that the remaining oil isn’t economically worthwhile to extract. They don’t call that “losses” or “dry,” they call that “deferrals” because they’ll come back to it when it’s economically sensical to do so.
R&D doesn’t happen by just theorizing what the maximum the market could sustain and then conjuring up those innovations out of thin air. It happens via sustained investment decisions over years. Those decisions are made in light of their costs and incentives, which change over time.
Either food can be “improved” under certain economic conditions (which are probably amplified by GLP-1s), or we’re at the theoretical maximum.
So you can give an argument why GLP-1s don’t produce strong incentive for R&D or you can argue that a stronger incentive won’t matter because we’re capped out, but historically the “if it could be better it would be better already” argument is disproved by capitalism on a daily basis.
>> using drugs to control weight is the wrong approach. This does not lead to a healthier population at all.
> Based on what data? It sure looks like it results in a healthier population.
You are kidding, right?
Please. Pretty please. With sugar on top. Go watch the two videos I posted and then come back and see just how ridiculous your answer is.
If you think taking a pill and losing weight is equivalent to getting healthy, well, all I can suggest is: Please stop and go learn something, because you truly do not understand what you are talking about.
Obesity is awful for you. This reduces obesity, substantially. It has serious risks and side effects, but certainly appears to be nowhere _near_ as bad as its benefits.
> appears to be nowhere _near_ as bad as its benefits
There is no long term data to be able to make that kind of an assertion. The data so far point to the risks as well as the need to effectively be on it for life:
From [0]:
<start quote>
The Potential Impact of Ozempic on the Body
There are some negative implications of Ozempic, particularly its correlation with various health factors, including, thyroid cancer, pancreatitis, and pancreatic cancer, hypoglycemia risks, acute kidney injury occurrences, gallbladder events, gastrointestinal disturbances, and cardiovascular effects.
<end quote>
What is clear is that embarking on a treatment that has such consequences, including the need to take this drug for life because:
<start quote>
"What hasn't been even described or reported in the peer-reviewed medical literature is what does maintenance on these medications look like,"..."if you get to your goal weight, and you completely stop these medications, the vast majority, not all, but the vast majority of people will regain the weight that's lost."
<end quote>
Which is precisely what I have been saying: The root causes are not addressed by a drug at all. It's a quick imaginary solution that is likely to come back in ten to twenty years and overload the medical system with unimaginable problems.
This is NOT how you build a healthy society, at all.
While I agree we should have a greater focus and regulation this kind of “drugs are bad” moralism is a real pain in the ass. Obesity is a complex drug and we should have many different approaches to fight it effectively.
Using the term "hooked" to describe using a prescribed drug for a chronic condition is pretty moralistic.
Are cystic fibrosis patients hooked on Trikafta? Are people with high blood pressure hooked on ace inhibitors? Or are they taking a medication to control their symptoms and improve their health?
Technically you don't need to take a drug to control your weight, and you could do it all naturally (although this is also debatable, given genetics). However, the reality is that most obese people don't have the time, money, circumstance, genetics or willpower to control their weight themselves. Ozempic is a shortcut to better health outcomes in these patients, why shouldn't they take it?
Pills used to lose weight do not address root causes. At all.
Pills used to lose weight do not address the damage caused by everything that got someone to become obese.
The root cause are processed industrialized foods that poison everyone over time. The damage done by these foods to the body permeates the entire body, from the gut to the brain. Pills do not address this at all. Therefore, bad behaviors continue, damage continues to be caused and the person gets sicker and sicker while using a fake solution for weight loss.
Period.
If you want to argue against the claim that pills are not needed, you have to argue against all known human and animal biology, chemistry and physics. Get a grip.
> You do not need to be hooked on a drug for life to control weight.
Cool. What other intervention shows proven, long-term weight loss? Not "if you actually manage to follow this", not this one ubermench lost a bunch of weight, but _actual_ effects in real people at a group level?
I won't answer your question because it is ridiculous flame bait.
As for "interventionist". My wife is a doctor. Do you know her #1 complaint about patients? Simple:
They don't do what they are told. They don't take their meds. They come back a month or two later with the same issues and still refuse to do as they are told.
So, yeah, losing weight (that's not her practice) isn't easy. However, losing weight using a pill isn't at all equivalent to being healthy. Not even close. The root causes were not dealt with and the damage cause by what got you there was never repaired. In other words, negative health effects, long term addiction to a fake non-solution and who knows what future consequences.
It is absolutely astounding to me to see people actually argue for this shit.
Simple thought experiment: If we banned all processed foods (painting with a wide brush here) for six months to a year, almost the entire population would shrink to healthier body composition, get healthier, have less inflammatory disease, need less healthcare and live a better life.
> I won't answer your question because it is ridiculous flame bait.
You won't answer because you have no desire to help people become healthier. Your goals are different. You just want to feel superior. You made it, and they can't. How dare they cheat by taking a drug that works? That's not fair!
> As for "interventionist". My wife is a doctor. Do you know her #1 complaint about patients? Simple:
> They don't do what they are told. They don't take their meds. They come back a month or two later with the same issues and still refuse to do as they are told.
K. Then they won't take this either I guess, right? Who cares then.
> Your goals are different. You just want to feel superior.
Your insults do not change reality...or science. All you are doing is working very hard to confirm your ignorance.
OK, I'll answer your stupid question. Stupid because you didn't even take the time to research peer-reviewed long-term medical studies to determine if your thinking aligns with reality. Well, it does not. You have no idea what you are talking about.
> What other intervention shows proven, long-term weight loss?
Methods that deliver proven long-term weight loss, from peer-reviewed studies:
Low-Carbohydrate Diets: Ketogenic or Atkins diet result in significant weight loss and improved metabolic health markers.
Mediterranean Diet: Studies have shown it can lead to sustainable weight loss and health benefits.
Intermittent Fasting: Research has indicated that intermittent fasting can lead to weight loss and improvements in metabolic health.
Aerobic Exercise: Consistently shown to contribute to weight loss and maintenance.
Resistance Training: Increase metabolic rate and promote fat loss.
Behavioral Therapy: Cognitive-behavioral therapy (CBT) and other behavioral interventions can help individuals change eating and activity habits, leading to sustained weight loss.
Self-Monitoring: Keeping a food diary, tracking physical activity, and regularly weighing oneself are strategies that have been linked to successful long-term weight loss.
Lifestyle Modification Programs: Combine diet, exercise, and behavioral therapy have been shown to be particularly effective. Examples include the Diabetes Prevention Program (DPP) and Look AHEAD (Action for Health in Diabetes) study.
Mindful Eating: Can help prevent overeating and promote healthier food choices.
Stress Reduction: Techniques such as yoga, meditation, and deep breathing exercises can reduce stress-related eating and support weight management.
Key Studies and Sources
Diabetes Prevention Program Research Group: The DPP study demonstrated that intensive lifestyle changes, including diet and exercise, can significantly reduce the incidence of type 2 diabetes and lead to long-term weight loss.
Look AHEAD Research Group: This study focused on individuals with type 2 diabetes and found that lifestyle interventions involving diet and physical activity resulted in sustained weight loss and improved health outcomes.
The Mediterranean Diet Study (PREDIMED): This large-scale study found that adherence to a Mediterranean diet is associated with reduced weight gain and lower cardiovascular risk.
In your desire to attack and diminish, the point you are missing is ridiculously simple:
I said, paraphrasing, that people do not need drugs at all to lose weight. That is a matter of indisputable science.
I did not say --go find it if I said it-- that people are lesser humans if they choose to use drugs.
I did not say --go find it-- it would be wrong to use a drug under medical supervision to help.
I did not say --go find it-- drugs do not have a place in a medically-supervised strategy to become healthier.
I did not say any of the things your mind seems to want to imagine I said. All I said is: Nobody needs drugs to lose weight. And this is absolutely true. I also said that drugs do not fix the underlying problems caused by years of bad nutrition and behaviors. And that, also, is absolutely true.
So, by all means, if you wish to continue to demonstrate just how ignorant you are, carry on. It's entertaining.
That sure is a big list of stuff that helps people _who manage to stick to it_. They're very difficult to stick to, judged by rates that people actually do it.
Most of them are less effective than the drug you hate. All of them can be done in addition to the drug you hate.
It all comes down to what medicine is for. Are we trying to help only those who have superhuman willpower? Or are we trying to help normal people too?
A few good questions there, with answers that go deeper into what society and government should be about.
It is absolutely true that there are issues sticking to a healthy diet. As I have said many times in this thread, while being attacked and accused of being some kind of an elitist jerk (I am not), I have battled this issue for years myself. My old-school parents came from a generation that was uninformed and imposed rules such as having to finish everything on your plate, etc. One example of some of the consequences of this is that I lost my sense of satiety. This is hard for some to understand. There are people out there --I was one of them-- who never felt full. That signal simply did not exist.
BTW, you put words in my mouth. I never said, I hated any drug, Ozempic included. All I have done in this thread is state a fact: No person needs drugs to lose weight. On HN, these inconvenient truths, get you a mob attack from every angle.
We could argue that it is difficult. Sure. What we cannot do is pretend that what I said isn't true, because it is.
Now, let's address the difficult part, which is important.
Yes, it is hard. We all know this.
Why?
Because our food system is filled with poisonous addictive shit. That's why.
Here's one of the many interesting elements in this story. The very same agency that approves something like Ozempic, the Food and Drug Administration, also has power over matters related to our food supply.
OK. Great. Isn't this agency supposed to have a layer of people with scientific training working on food and drug issues?
"For more than 100 years, the FDA has been working to carry out our mission of promoting and protecting public health, and that means your health."
Really?
So...the poisonous addictive food sold all over the US --you know, the stuff that makes it very hard to get healthy-- goes through their hands.
If their mission is, as they say, promoting and protecting public health, how is it that they approve a drug with horrific potential side effects to give the illusion of getting healthy without first addressing and regulating root causes?
The root cause of obesity, diabetes, metabolic disease and the myriad afflictions related to this (like cardiovascular disease) is our food supply. There is no doubt whatsoever that this is the case. None. At this point there are probably hundreds of peer-reviewed studies to prove this from almost any imaginable angle.
Why do they approve a non-solution in a form of a drug you have to be on for life? Do they not know that this drug does not fix the massive problems THEY ARE CAUSING by not "protecting public health" by treating bad food like the epidemic it has caused?
I've had people on this thread claim that people in this country are too stupid to read food labels. Bigoted positions aside, OK, let's say that is actually true. Why hasn't the FDA found a solution for that? For example, by severely limiting hyper-processed foods, sugar in its various forms, fillers, certain types of preservatives, etc. Why has the FDA allowed the sale and use of what I am going to call unnatural oils into our food system? You buy nuts thinking that they might be healthy for you, only to discover --if you look-- that they have been cooked in harmful oils.
This is a big topic. The FDA is almost single-handedly responsible for causing a metabolic disease epidemic in this nation.
It would be like a illicit drug rehabilitation center selling the same illicit drugs in their town. They sell both the root cause and a fake solution. That's the FDA.
On the effectiveness of the various programs I listed. They are extremely effective. In fact, they do something Ozempic cannot do: They reverse the root causes of not only getting fat, but all of the afflictions that come with that condition. You can literally reverse type 2 diabetes and metabolic disease. These are not fake solutions, they are real. And, yes, they take work. Well, people have to make a choice. Sometimes it can be hard.
That choice starts with fasting for three to five days. This isn't difficult at all. Ask anyone who has done it. The comments I frequently hear go along the lines of "I was very surprised because it was so easy. I was not hungry at all". Fasting for a few days (not intermittent fasting, a full 3 to 5 days, water only) actually rewires your brain. You come out of it a different person. And, from there, getting on a sensible diet is incredibly easy. All you have to do from that point forward is avoid crap: sugar, flours, juices, refined foods, hyper-processed foods. That means meats, vegetables and fruits. The entire range of good eating habits, from vegetarian on up is on the menu. This isn't difficult at all. Yet, from my experience, you have to start with a fast or the probability for failure is significantly greater.
> It all comes down to what medicine is for. Are we trying to help only those who have superhuman willpower? Or are we trying to help normal people too?
And we come to your last question, which is important. What is medicine for? Let's go with the definition given in the Wikipedia article as a starting point:
"Medicine is the science and practice of caring for patients, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others."
A few key points there. They list medical responsibilities for the promotion of health in this order:
In the context of metabolic illness, prevention is the only ethically-supportable path. This isn't really about weight loss. Weight gain is just one of the results of consuming bad food and, obviously, too much of it. One could very well argue weight gain is the least important side effect.
Sometimes I view contemporary medicine with a cynical eye. They are like the police cars that have the "To serve and protect" slogan on their doors. Cops, good intentions aside, are never there to prevent a crime. They are always there to put on a massive theatrical performance with cars, trucks, lights, vests, armament and more. Tough job, I respect them, but they don't protect anyone except for the rarest of circumstances.
Medicine is the same. In the US, doctors barely see you for a few minutes and toss pills at you for everything. It is only reasonable to expect doctors happily prescribing pills to lose weight rather than having to invest the time and effort necessary to actually accomplish what's in the middle of the scale in the definition above: prevention.
Why is this?
Well, once again, we have to look at our government agencies for mucking things up. Our healthcare system is convoluted beyond recognition at this point. The ACA didn't fix anything at all, it actually made it worse. Why? Because doctors have to treat people like cattle if they want to keep an office and make a living. We have the most ridiculous system one can imagine, one where, rather than "protect and serve" with whole life health support and services, we wait until someone comes to a doctor with a horrible metabolic disease, stroke or heart attack and then --just like the cops-- we put on an awesome job full of drugs and technology. We fix nothing. We prevent nothing. And we do not make anyone healthier.
Something like Ozempic is the tip of the iceberg. When you dare look below the surface and --to mix metaphors-- dare point out the emperor has no clothes, you get attacked mercilessly by those who simply cannot or do not want to think below that surface.
We have serious problems. We have an unhealthy society that is being poisoned every day with shit food that government agencies do not regulate as they should. People are up in arms about legalizing marijuana without even bothering to understand that they health disaster being caused by our industrialized food system is orders of magnitude worse than anything MJ could every be charged with.
Nobody needs drugs to lose weight. What people need are government agencies that actually do what they are supposed to do and "protect and serve" the population, not help poison them and then say "hey, just take this drug".
In the general case, the reason "they should just eat better and work out!" is a dumb argument against weight loss drugs in general is because the X% of the population that is obese don't and won't "just eat better and work out". If we could get them to we would have, decades ago. But we can't. It doesn't matter if it's addiction or laziness or genes or microplastics or 5G chemtrail brain worms that compel some people to eat worse and exercise less in the face of their deteriorating health. What matters is that they won't do those "lifestyle improvements anyone (theoretically) can do", so we need some other way to treat or prevent the resulting illnesses. Refusing to treat it is just pointless cruelty - and if you lack empathy or kindness, it's still an economic burden, so you should still want the treatment option.
In short, unless you have a miracle intervention of your own, the question is not "lifestyle changes or drugs", it's "let them get sick and rely on harsher drugs for those illnesses, or just use this preventative drug".
Also, in the specific case, of semaglutide - have you even read its mechanism of action? Appetite suppression through increased satiety is the closest thing imaginable to "injection that just convinces people to make the right lifestyle changes". All that's missing is the brain worm that induces restlessness and vegetable cravings.
No, you are wrong. It's a binary decision. Millions of people do it.
The key is to make the decision and stick to it.
The "magic pill" for sticking to the decision is starting with a 3 to 5 day water-only fast, which is easy. Ask anyone who has done it. This rewires your brain, removes cravings and more.
From there, just eat fruits, vegetables, fermented foods and your favorite range of proteins.
If type 2 diabetic, avoid high glycemic index foods and favor fiber (which slows down the rate of change of your blood glucose level). Except for extreme cases, a type 2 diabetic can be off medication a week after fasting. A decision that should be made under medical supervision, of course.
The key is that simple decision: Today, I stop eating for three days (or five, but three is a great starting point, with seven being amazing). And anyone can do this. Of course, again, consult with a medical professional for safety and recommendations.
Fasting IS NOT ABOUT LOSING WEIGHT. This is what I though for many years before I learned. Fasting sets off a wide range of biochemical processes in your body that are incredibly beneficial on more than one front. It is these changes, as well as the psychological perspective gained (Oh, wow, I don't have to eat every three hours!) that lead to weight loss, the reversal of inflammation and metabolic disease. The objective, however, again, isn't weight loss.
This is the best video I have found to explain the incredible changes and benefits of multi-day fasting. I would encourage everyone interested in improving their health to watch it. The topic is fascinating:
There's so much FREE information on this that anyone who is serious about understanding how to get healthy can go as deep as they might want to into the various topics in the span of a few days. Here's more:
How effective is telling people that? In what way is it different than what we've been telling people for decades? When would you estimate it will start being effective to tell people to put in the work and discipline? How many more decades?
Or maybe we should do something that works in reality for real groups of people.
For people with addiction problems, they can't. Addicts have this problem where they can't. They're sitting there thinking don't do it, don't do it, don't do it, and then what happens is they go and do the thing. They're unable to do that work and discipline because they are not tall enough.
It sounds like a miracle drug until you hear prolonged use turns your stomach into stone. They haven't been around long enough to fully understand the side effects unfortunately.
