> That is a highly Mormon run state that has strong stances on how you should live your life. Even if you are a "goi" (I use the word loosely to illustrate the cultural metaphor in a us v them mentality) to them.
I think you're crossing a line here. You are accusing the Mormons in Utah of having a us-versus-them mentality. But your own comment tries to turn readers against Mormons.
Never forget: The Missouri Executive Order 44, also known as the Mormon Extermination Order, was issued on October 27, 1838, by Governor Lilburn Boggs. The order authorized the expulsion of Mormons from the state and is sometimes referred to as the "Mormon Kill Law". However, the order was rescinded by Governor Christopher S. "Kit" Bond in 1976.
I think we should all be more charitable to Mormons after what they've been through.
That was 185 years ago, how charitable have Utah mormons been this year to the LGBT community? The unspoken intentions of this bill given the state's recent legislative priorities are absolutely horrifying and far more deserving of criticism and deep skepticism than charity.
Petro Dobromylskyj is one of the foremost experts of fat metabolism. He has a blog called Hyperlipid where he's been blogging about fat metabolism and interpreting research for close to 10 years.
He thinks the GLP-1 inhibitor drugs will be a disaster in the long term because they 1) cause weight loss but also 2) cause the body to create lots of new adipocyte (fat cells). Increasing the number of adipocytes is very unusual after puberty. As long as you are taking the GLP-1 inhibitor drugs you will lose or maintain weight, but as soon as you stop you will gain a lot of weight back.
I don't know if I'd call a veterinary anaesthetist a foremost expert on fat metabolism. His thoughts on insulin signaling are not consistent with the consensus among obesity researchers. He thinks glp-1 works through uncoupling or fat browning which is just not true.
The consensus among most obesity researchers is the cause of obesity is primarily neurological, not metabolic. Basically the brain can't properly regulate weight in the current obesogenic environment. When you look at GWAS most of the genes related to obesity are active in the brain, (as opposed to genes for diabetes which are more closely related to fat/metabolism etc...).
I'd describe Petro Dobromylskyj as a smart hobbyist with an outsiders views of obesity, not a foremost expert on fat metabolism.
1. If the expert consensus is that the cause is neurological rather than metabolic, it seems more important to not that human neurology really is so different than other mammalian neurology.
2. Clinical anesthesiology is pretty far from this topic.
The only published paper I can find by him is on small animal ventilation, so I don’t think he’s a “foremost expert” on fat metabolism in animals either.
World leading experts usually have an impressive publishing record in the field, often a top academic research position and a long record of speaking at important global conferences on the area.
Does he have all those? I'm honestly asking, I've never heard of him.
Hey, you basically worship credentials, so you're not going to be impressed with a person who doesn't have them regardless of their breadth and depth of knowledge. I don't know what to tell you.
I did a little bit of research and for people in the UK it appears to be substantially less. I found a few health companies offering it for <$250/mo. I’ll probably wait until it’s readily available on the NHS but it is tempting.
My US doctor recommended it to me last week and said there was a way for it to cost about $200/mo if I want to do that. I thought it was strange that he said it that way instead of just saying the price, but I didn't follow up because we were 45 minutes into the appointment and I was ready to get out of there.
I'm supposed to book a follow up appointment after I've read about it, so I guess I'll find out what he means then.
They typically are income blind and make your out-of-pocket price negligible. I'm on a med (Skyrizi) that's $18k per shot, one every three months; their assistance program ensures I don't pay more than $5.
They chip in on the deductible/coinsurance/copay, you don't skip the medication due to cost, and they still get significant money out of your insurer. Everybody wins, until everyone's premiums go up next year.
Your doc was probably referring to purchasing semaglutide from a compounding pharmacy, which is usually in the $200/month range (depending on dose). Compounded versions don't typically come in the user friendly "injection pen" format that brand name versions do, so not everybody is comfortable with that option.
It does but it doesn’t mean you get any treatment available. They carefully make decisions on what treatments they can/should provide. This may be offered eventually but at the moment it’s a case of be very fat and get offered gastric sleeve or just be overweight and no treatments are offered other than advice about losing weight
Semaglutide is available on the NHS but I wouldn't currently qualify. It'd only be prescribed if I met certain criteria such as having type 2 diabetes.
It's a case of either paying for a private prescription now, or waiting until it's made more accessible on the NHS.
Considering the benefits of good diets and exercise, I think it's worth it not trying to hack or shortcut our way to a healthy life with weird drugs or whatever.
>I am Petro Dobromylskyj, always known as Peter. I'm a vet, trained at the RVC, London University. I was fortunate enough to intercalate a BSc degree in physiology in to my veterinary degree. I was even more fortunate to study under Patrick Wall at UCH, who set me on course to become a veterinary anaesthetist, mostly working on acute pain control. That led to the Certificate then Diploma in Veterinary Anaesthesia and enough publications to allow me to enter the European College of Veterinary Anaesthesia and Analgesia as a de facto founding member. Anaesthesia teaches you a lot. Basic science is combined with the occasional need to act rapidly. Wrong decisions can reward you with catastrophe in seconds. Thinking is mandatory. I stumbled on to nutrition completely by accident. Once you have been taught to think, it's hard to stop. I think about lots of things. These are some of them.
youtube consistently steers everyone who touches it to more and more extreme content with the passage of time. It's not unique, and often times that content tends to be anti-science.
I'm not the OP but youtube is tainted for anything other than entertainment and a few select channels like the ones by PBS e.g Space Time.
That's in stark contrast to my opinion about YouTube. I have a huge list of highly trust worthy subscriptions / reference channels and no other social media platform comes close. If you live on your subscriptions channel, you never need to worry about content being thrown at you, or radicalization rabbit holes.
I can easily find upper graduate university lectures for complex topics. YouTube makes it easy to link first sources unlike other image/video platforms. Also, since they appear on official pages of reputed sources (conference channel, university channel) there is a certain level of reliability irrespective of who the speaker is.
Lastly, search for any popular video on YouTube and you will see just as many 'response' videos. While not intentional, it helps avoid echo chambering as the counter argument is readily available .
> If you live on your subscriptions channel, you never need to worry about content being thrown at you, or radicalization rabbit holes.
Ok, but you understand why someone might be weary that the most common first hit for someone might be an arbitrary youtube video given your premise is living on the channels you've subscribed to.
The bulk of youtube's content is garbage. You have to go sifting through the content over time, suffering through the recommendation engine (or a shortcut - ask friends who've already lived through that nightmare) to find the geese who lay the good eggs.
Note that they're also talking about Google search ranking. People who are actual experts in things tend to have meatier hits at the top than J Random Vlogger.
Every time some rando on the 'net claims "do your own research" they'll send a link to a YouTube video of some charming BS artist with no qualifications peddling ideological garbage to whomever is credulous enough to watch it uncritically.
Are there good YT channels? Yeah. But 9 times out of 10 (or more) when I search for some rando's recommended expert and the first result is a YT video, it's crap. Utter crap.
I nearly choked when my sister-in-law told me a couple years ago about some really convincing anti-vaccine information she had read which made her very nervous. I asked her what she'd heard, and she gave me a link to a YT video by Dr. Shiva. Yes, THAT Dr. Shiva. Ha! I tried to break it to her gently, but I'm pretty sure she still decided he was a credible source of information.
What makes you say that? In my experience, there are no 'experts' in empirical fields who are no themselves deeply and practically engaged with actual research. Being well-read does not make you an expert. Writing blog posts and appearing on YT doesn't make you an expert. Critics are not experts. To be an expert in anything you have to get your hands dirty.
Nothing I can see from this guys publications or bio make it seems like he's an expert in human fat metabolism at all, let alone a 'foremost' one. I base this on a fairly cursory survey, so I'm happy to be corrected. But convincing corrections would absolutely require details regarding what he has contributed to the field.
With every weight loss intervention when you stop you gain back the weight. GLP-1 agonists don't seem to be any different than another other intervention.
The point is that you could gain back the original weight plus more. Most adults who become obese have not increased their number of fat cells - their fat cells just become larger.
The GLP-1 drugs literally increase the number of fat cells.
I suppose the concern goes something like this. Under certain metabolic conditions, each fat cell (in a region) decides it needs to be size X, and grows / shrinks accordingly. And under other conditions, each fat cell (in the same region) decides it needs to be size X*3.
If there are more fat cells, then and they all decide to increase in size, then that could be a substantial weight gain, beyond what would be expected otherwise.
Liposuction is no answer. Your body puts back the removed fat cells in other places.
The human body has VERY strong setpoints about weight. Fat cells "remember" the weight that you had when they were created. You have to hold your weight at a point for something like 3-5 years before your body relents enough that the setpoint moves.
The aggregation of the tiny setpoints creates your larger setpoint by either drawing out from or pushing into your bloodstream the lipids that they have.
This is one of the most infuriating things about the "you just need to eat less" crowd. That's simply the first step. But you somehow need to maintain that for years while your body readjusts since fat cells turn over fairly slowly in your body (about 20-25% per year).
Maintaining a lower body weight while your body is actively fighting you for years is a superhuman level of willpower that very few of us can muster.
I specifically asked doctors and they were like "I dunno. Well, that was a fun 5 minute conversation, give me $300"
I guess it's never too late, though. I've been slacking off on getting in shape, since it does take raw willpower 20 times a day every day in order to get there and stay there, and it's not that compelling to think that I'm going to be stuck rolling willpower checks all the time forever.
If I just have to get in shape and force myself to stay that way through raw willpower for ~4 years in order to stay that way for free afterward, though, that sounds like a more worthwhile goal
It is never too late. And please don't beat yourself up when you fail. Simply sigh, dust yourself off, and try to do better. Given that you have to maintain this for years, you will sometimes fail--it's inevitable.
There is increasing amounts of science behind this stuff, but it's also buried behind a gargantuan pile of crap.
It's what I thought of here also. Most notably, liposuction has faired very poorly in studies of long-term health outcomes. Without the requisite changes in lifestyle or metabolism the fat that gets sucked out is replaced very quickly and has almost no decrease in risk of obesity-related illnesses.
> Weight gain was reported in 43 percent of the responders, with 56 percent of them gaining between 5 and 10 pounds 6 months after their surgery. Fat return was reported in 65 percent of the responders.
https://pubmed.ncbi.nlm.nih.gov/16651945/
Liposuction isn't a solution for fat loss beyond some localised cosmetic reduction. You can't use it to put a morbidly obese person in normal BMI range.
My point is that you end up with fewer fat cells, but unsure whether this has any impact on weight regain.
(Which is worth assessing if there are concerns about these drugs increasing the number of fat cells (otherwise unusual in adulthood) and creating a risk of fat volume rebound beyond initial levels after discontinuation).
Weight is back to baseline within a few months after lipectomy and sometimes greater than baseline. In animal models there is regeneration of fat cell number following lipectomy along with increase in cell size, and which mechanism predominates depends on how large the fat cells were before (manipulated by reducing food). This is the critical fat cell size hypothesis, and in humans there is similarly evidence that fat cell number increases (hyperplasia) in advanced stages of obesity after the cells reach critical size (hypertrophy) but I'm not aware of that being studied in situ in lipectomy recovery. I'd make a confident guess that it depends on how obese the patient is and perhaps their baseline number of fat cells.
But there are a lot of different mechanisms and feedbacks at play and I'm not sure how much insight can be gained from comparing localised lipectomy to systemic adipocyte proliferation resulting from a drug.
This sounds especially bad cosmetically, because the fat will show up in some place it didn't used to. I would imagine it could make you look even worse.
> With every weight loss intervention when you stop you gain back the weight. GLP-1 agonists don't seem to be any different than another other intervention.
Except for one thing: it's fairly easy to not stop a drug. You just... keep taking it. Long-term use of these drugs for maintenance purposes looks entirely feasible. Not quite as easy to maintain as a gastric bypass, but close enough to be a big deal.
The same isn't true for exercise and diet; it's very easy to fall off those wagons.
A family member has had gastric bypass. You can have everything “replumbed” if complications require failing back to something similar to previous state.
With that said, I would be interested if new weight loss drugs negate the need for gastric bypass in the first place. Comes across as medieval and barbaric if the hormones/drugs are superior.
Credentials aren’t everything but at the least I want someone to be in the field doing things in practice (research or patients) everyone else including me should shut up otherwise.
I don't see evidence that this person knows what they are talking about. I see they talk a lot about it, but we know very well that talking, including in the specific manner they do (at length, citing lots of stuff), are also traits of people who are completely deceived or deceiving, conspiracy theorists and fabulists, etc.
>As long as you are taking the GLP-1 inhibitor drugs you will lose or maintain weight, but as soon as you stop you will gain a lot of weight back.
Sounds like the opposite of a disaster for pharmaceutical companies.
Well, on the upside, the demand for this is so great that cheap generics shouldn't be too far away, right? And it seems like an insurance no-brainer to cover it for life, right?
Problem with diets is that your body responds to this new habit by panicking, thinking you’re going through a famine and reduces metabolism to compensate for reduced caloric intake while increasing hunger. It’s like if you’re he body responded to brushing your teeth every day by making you obsess over caramel corn. Most habit changes don’t have this “body actively fighting you with increasing ferocity” effect that caloric restriction does.
But what if your “good diet” DOES send your body into a panic? That is, physiologically, what occurs with many obese people when they lose weight, REGARDLESS OF WHICH DIET THEY PICK.
Keywords were "after adjustment period". Your body will Panic if you quit smoking, alcohol, or many hard drugs. That doesn't mean it's a bad idea to do so.
Your body will also panic if you start working out vigorously, confront hard but necessary situations, or many other aspects of human life.
If a prescription help someone make a productive transition, that's great. My point is simply that I'm cautious of potentially lifelong crutches to avoid making difficult changes, and there's value in cultivating the ability to maintain your personal homeostasis if you can
Again, with the idea it’s just a willpower thing to overcome some hurdle. The “panic period” is permanent for many obese people. There’s literally no end to fighting your body once you’ve lost substantial weight, it’s ALWAYS trying to lower metabolism and increase hunger to compensate. It’s not a few months and then you’re good, it’s forever. This is why a treatment like this is so necessary.
If there are easy alternatives with the same outcomes, hard things absolutely should not be done (unless you're practicing for an emergency situation where the easy thing is not available.)
Even in a utilitarian framework, there is more to consider besides outcomes, such as costs.
Examples of costs could be be the reoccurring monetary cost for the rest of your life, and being dependent on the supply of medicine to maintain your health.
Additionally, there are personal advantages to being an individual that is capable of doing and regularly practices "hard things".
No doubt. The old habits are easier. It’s way easier to order in food and lay in bed than to cook and workout. Of course, it’s overly reductionist to assume weight loss is as easy as “stop laying around, eat healthy, and exercise.”
It kind of is that simple, but there are so many factors that help prevent us from good habits. I think my biggest issue is that food is one of the few things in my life that’s ever evoked a positive response for me. I’ve gone years without being fat, but it comes back because of some issue I encounter, and I lack the tools to deal with it in a better way. So I get depressed and eat, and eventually hate myself for falling apart again, and so we go, forever and always.
I think the big lesson from Semaglutide is that bad eating habits are not the primary cause of obesity. More likely they are correlated due to common causation.
380->340 over 6 months. I was off for 6 months and maintained 340 with diet changes and exercise. You cannot go back to the old diet and expect to maintain. I'm back on now to lose some more.
Some other things I've learned:
Take the first shot on an empty stomach. Expect the first 3 days to be rough. Hunger is more than one sensation, and when you have severe calorie deficit, your body will feel very bad (at least at first).
It is critical to control your food environment - don't bring junk food home, don't go to restaurants too often.
I learned to slow down and enjoy the food reward, instead of trying to chase it. No words will tell you how to do this for yourself.
There is a feeling that I call "future hunger", where I don't feel bad, but I feel like I will in a while. In the past, my body and mind would get frantic when I felt this way. Now I have a very small snack and ask myself "do you feel bad right now, or do you feel like you're going to feel bad". Again, these words may not translate.
More than one serving of salty and sugary snacks should NEVER be within arms reach, and preferably not in the same room. Your mind will remember these snacks and oftentimes eat them without conscious effort.
I would say: if its Tier 1 cities like Mumbai do not have a reliable supply of electricity and running water (infrastructure necessary for industry), then it is not industrialized.
Instead of trust busting these companies, the libertarian answer to them would be to invalidate their patents.
Google partially remains a search monopoly because of its search patents - of which it has many. If the state invalidates its patents and then moves out of the way, other competitors will naturally become successful.
There is no need to break up companies. Just take away some of their state-imposed advantages like patents.
> Google partially remains a search monopoly because of its search patents
According to this piece on Google's patent strategy, big tech benefits when the value of patents decreases anyway, which cuts against your argument[0].
Google gets pretty much everything it wants anyway, the gist of this piece is that individual patent holders that sue tech companies get a lot more value out of patents than the big companies do. Big companies benefit as the value of patents decrease, which is what you're calling for here.
One huge reason for this is the network effect advantages that big tech companies have. Anyone can build a Facebook clone that copies most of the primary functionality, but it'll never gain traction because why would anyone leave the already-established social media network? All of their friends are already on there.
In Google's case, numerous search engine alternatives have existed for years and yet Google remains pretty strong. I cannot find a case of Google asserting patent authority over a competing search engine, which tells me that it's doing just fine maintaining it's hold over the search market "naturally".
Consumer technology use is notoriously habitual and cannot achieve market equilibrium when patents are removed. Sorry, but this is an oversimplified argument that doesn't reflect how Google's technology functions in the search market.
I guess it could be, but I think his point is that from a libertarian angle, the government should be out of the picture as much as possible. And one of the biggest ways to do this is invalidating software patents which would remove some of the massive barriers of entry needed to compete against the Googles/Facebooks.
That makes sense. If the original complaint wasn't "busting trusts" is opposed to libertarian values, but rather "some of the existing techniques to bust trusts" is opposed to libertarian values, then this makes sense as the libertarian friendly approach to busting trusts.
AMA is a bad actor. They refuse to allow junior doctors (doctors who are MD school graduates but who have not completed residency) to practice medicine in ANY capacity.
Common sense says that junior doctors should have the same practice rights as physician assistants - but the AMA refuses to let that happen. They are a medical cartel.
A few states have allowed junior doctors to start practicing medicine in a limited capacity, because every other doctor so damn expensive. But the AMA does not support those states' decision.
Does the AMA want that or is that the purview of state medical boards? AMA doesn't set practice laws. The people who lobby against new grad MDs having the same practice rights as NPs/PAs are NPs and PAs (more NPs). NPs lobby against assistant-physician laws because why would you want someone who has had 500 hours of clinical shadowing while completing their part-time online, direct-entry, 100% acceptance, diploma-mill school (NP) vs. a new-grad physician who's had 2 years of physiology, anatomy, and pharmacology and 2 years with 5000 clinical hours where there's actually an expectation that you contribute treatment plans and care to the team. The fact that the AMA has been asleep at the wheel and unable to stop NPs from getting independent practice in 20+ states show that they don't have any real influence on who practices where.
What do you have to do before you prescribe a drug? Make a diagnosis, which is what is taught in medical school and not in pharmacy school. Pharmacists are frequently embedded in care teams in hospitals and primary care clinics where they make medication recommendations and know how to get drugs approved by insurance companies (sad that this has to happen...).
> This is basically a red flag for any relationship. If the only thing making or allowing a person to be happy in life is their partner then something is wrong. Mental health is no joke and not being able to enjoy life is usually a symptom of an underlying cause. Depression is probably the most common but anxiety disorders can be similarly hard.
There is a great amount of neuro-diversity in the human species. Some people are wired to be rugged individualists who could enjoy living by themselves in a cabin in the woods. Other people are wired to need to be around their family.
For some people, its not a choice, its how their brain is wired.
I think the issue is how extreme the statement "It’s arguable she’s the only reason I’m able to be happy" is. I think there is nothing necessarily wrong with that if you find a partner who is comfortable with providing this author's needs. In my mind though that statement signals a codependent relationship which are generally not seen to be a great thing. I'm not saying they are in a codependent relationship as an FYI, but it sounds like something people in that type of relationship would say. Like can the person not be happy at all if they were not in a relationship? Can they not find satisfaction in their job, hobbies, volunteer work, etc? yes it might not be fulfilling as being in a relationship, but to have a binary happy / not happy state based only on being in a relationship seems extreme. This is just going based on how the author worded it. Maybe a better way to have written their statement would be "less happy".
I found standing alone to be unpleasant so i found a "leaning chair" that allows me to slightly lean back as I stand. I do that 80% of the time and sit 20% of the time.
The leaning chair is basically a waist-high wall that you lean against. It does help me to better tolerate standing all day. Only downside is that it can hurt my knees if i don't use it correctly.
I think you're crossing a line here. You are accusing the Mormons in Utah of having a us-versus-them mentality. But your own comment tries to turn readers against Mormons.
Never forget: The Missouri Executive Order 44, also known as the Mormon Extermination Order, was issued on October 27, 1838, by Governor Lilburn Boggs. The order authorized the expulsion of Mormons from the state and is sometimes referred to as the "Mormon Kill Law". However, the order was rescinded by Governor Christopher S. "Kit" Bond in 1976.
I think we should all be more charitable to Mormons after what they've been through.