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234 points Eumenes | 14 comments | | HN request time: 0.676s | source | bottom
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cm2187 ◴[] No.42199591[source]
> emerging research showing that up to 40 per cent of the weight lost by people using weight-loss drugs is actually muscle

That's the sort of headlines that smells like bullshit to me.

My understand of those drugs is that they don't actually make you lose weight, they just cut your appetite so you can follow a diet to lose weight without hunger hammering at the door. So to start with, if that's the case, all they are observing is the effect of a diet. Not sure the diet drug has much to do with it.

Then I went from 133kg to 88kg with these diet drugs. Even though I exercised every day, I am sure I also lost some muscle mass as well, just because I don't have to carry 45kg every time I make a move anymore. Seems logical and would probably be concerned if it was any other way.

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throwup238 ◴[] No.42199679[source]
The next line of the article after that 40% quote:

> Carla Prado, a nutrition researcher in the Faculty of Agricultural, Life & Environmental Sciences and lead author on the commentary, explains this rate of muscle decline is significantly higher than what is typically observed with calorie-reduced diets or normal aging and could lead to a host of long-term health issues — including decreased immunity, increased risk of infections and poor wound healing.

The rather obvious problem is that these GLP1 agonists don't improve your diet. If you continue to eat a protein and nutrient deficient diet (which is probably a majority of Americans) with caloric restriction on top of that, that leads to excessive muscle loss that you wouldn't see in a weight loss diet. This normally doesn't happen without GLP1 agonists, because these diets are too difficult to stick to for most people. Those who stick to them usually turn to nutritious high satiety whole foods that help combat the negative effects of caloric restriction.

Losing weight without losing muscle mass is very hard. It requires extreme diets like a protein sparring modified fast where 80%+ of your calories are from lean protein while running a 50% caloric deficit. If this research is correct, then using GLP1 agonists shortcuts the feedback loops that make the diets hard to stick to, but they shift the tradeoffs from weight to overall nutrition.

"When a measure becomes a target, it ceases to be a good measure" and all that.

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1. llamaimperative ◴[] No.42199850[source]
> The rather obvious problem is that these GLP1 agonists don't improve your diet

My understanding from initial anecdotes is this is actually literally wrong. Which was surprising to me, too. But people on GLPs tend to prefer more nutritious food (high protein and high fiber). I'm not sure if this has been studied directly in clinical trials yet but I know that food manufacturers have been reorienting their products toward healthier meal configurations in response to the GLPs.

I predicted the exact opposite of this, but so far I appear to have been wrong.

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2. throwup238 ◴[] No.42199907[source]
I’ve heard that anecdote from HN users many times but based on my meatspace social group of (mostly) California yuppies, that effect is vastly overstated. Even some of the diabetics I know on Ozempic have started using it as an excuse for a shittier diet. Now my sample size is barely ten people on Ozempic/Wegovy so take it with a grain of salt and what not, but I’m skeptical.

I bet there’s a large group of people - possibly over represented on HN and other online communities - that just need a little nudge to suppress their cravings and eat healthier, but that’s far from universal. For a lot of people, they wouldn’t even know where to start to eat healthier except choosing a salad over a burger at the takeout menu. Even with drugs masking cravings, many people just haven’t had good health or culinary education.

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3. llamaimperative ◴[] No.42199933[source]
Odd Lots (Bloomberg finance podcast) had an episode back in June or something interviewing a food design consultant, and their focus groups came back very strongly in favor of healthier meal compositions. Agreed though, it's hard to know things :) Hopefully some real studies on this will be done soon.
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4. leoqa ◴[] No.42199980{3}[source]
Industry led focus group is not a legitimate source.
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5. llamaimperative ◴[] No.42200004{4}[source]
Uhhhh, in general this is true, but in this particular scenario they have a stronger incentive than almost anyone to understand true preference shifts created by these drugs.

It doesn't mean they end up with the correct findings, but they are absolutely incentivized to try to produce correct findings.

Lazy and inapplicable heuristics are not legitimate insights.

6. throwaway2037 ◴[] No.42200013[source]
This observation is very interesting. I hope that it is studied more closely and we can read some peer reviewed research on the matter. One idea popped into my head: Could part of the cause be that people's mood and self-esteem improves during (GLP1 agonist-induced low hunger) weight loss? TL;DR: If you feel like shit about yourself (and body), then you are more likely to eat poorly, and vice versa.
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7. llamaimperative ◴[] No.42200042[source]
That's an excellent hypothesis. Wouldn't be surprised at all if that was a component!
8. throwup238 ◴[] No.42200081{3}[source]
Did the consultant describe the change in focus group results or just the latest ones?

I was under the impression that consumers have been asking for healthier food compositions for decades, probably since the 70s or 80s when all the FUD around fat started. Maybe GLP1 agonists bring their buying choices more inline with the focus group results which would be an interesting phenomenon.

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9. llamaimperative ◴[] No.42200097{4}[source]
I forget the design of the experiment but I remember feeling that my prior assumptions (which were in line with GP) were potentially wrong, so it must've been moderately convincing. I work in clinical trials so I'm not a complete buffoon on experiment design, but accordingly I'm also aware a good experiment is obscenely difficult to conduct, and obviously this was nothing close to an actual RCT.
10. adastra22 ◴[] No.42200166{4}[source]
Depends on the focus group. Some are put together too establish that a product is wanted. Those are junk and useless. Others like this are designed to tease out trends and their accuracy is very valuable to the companies that commission them.
11. burnt-resistor ◴[] No.42200167[source]
I take mirtazepene because it's the only antidepressant that works for me; unfortunately, it's also a massive orexigetic. And also unfortunately I have original Medicare that doesn't cover semaglutide until I develop additional heart problems or diabetes, so I'm forced to buy compounded semaglutide for 10% of the retail cost (but still higher than the rest of the world) out-of-pocket from a local large, retail, independent pharmacy that wouldn't risk bankruptcy selling fake medications.

And I don't eat meat for non-dietary reasons that include existential risks to all of humanity:

- Pandemics - Where did the "Spanish" flu (and influenza A, Asian flu, HK flu, and 2009 pandemics) and COVID come from?

- Antibiotic resistance - Most classes of antibiotics used in humans are also used to make industrially-farmed animals grow faster, leading to greater antibiotic resistance and more potential bacterial pandemics too

- Climate change - 17%, at least

- Air pollution - Not just the smell of pig crap in the air

- Water pollution - Ag runoff has been ruining river delta systems

- Soil pollution - (It's gross)

- Fewer available calories for total consumption

- More expensive foods by less supply and more demand

(Never bother with "meat is murder" dramatic preaching because most people who eat meat suffer from cognitive dissonance preventing them from admitting their lifestyle choice causes animal cruelty.)

When I was on and could afford semaglutide, I improved my diet by consuming a high protein product with a low calorie breakfast nutrition supplement. I'm sure I probably could've accomplished similar with a multivitamin and a protein product. What I need to change is eating more low calorie, high fiber fruits and vegetables that don't taste like cardboard or a mowed lawn. My diet has gone to shit again because the insatiable, all-consuming (no pun intended) hunger has returned. I can't afford semaglutide right now so I must become unhealtier than simply obesity in a similar but lesser way than women who can't get surgeries until they're septic and dying from failed ectopic pregnancies before it will be covered... because somehow obesity is completely my lack of willpower when I wasn't obese before mirtazapine.

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12. astura ◴[] No.42200366[source]
>My understanding from initial anecdotes is this is actually literally wrong. Which was surprising to me, too. But people on GLPs tend to prefer more nutritious food (high protein and high fiber).

Not only that but prescribers and patients have noticed that GLP-1 agonists also appear to significantly reduce people's consumption of drugs like alcohol, nicotine and opioids. At least in some populations.

Much more research is needed but right now it's extremely promising that they will have a place in addiction treatment in the future.

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13. llamaimperative ◴[] No.42200395[source]
Yep! So far it looks like GLPs might just be a generic "craving-reducer." Pretty wild stuff if it holds (and we continue not to see significant adverse effects).
14. 123yawaworht456 ◴[] No.42200706{3}[source]
no wonder you're depressed