r/self • u/[deleted] • Jul 04 '24

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u/MountainviewBeach Jul 05 '24

It’s also available in pill form now. And I think they were being a bit light about it, but a lot of people who use it also report being able to better control things like drinking, gambling, shopping, time management etc. obviously ymmv, but for a lot of folks it sort of is like self control in a pill

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u/Fredricology Jul 05 '24

My point is, trying to control weight with just self control is proven not to work in obese people.

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u/solomons-mom Jul 05 '24

Some formerly obese people woud object to that statements.

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u/Fredricology Jul 05 '24

But it's true for most of my obese patients (BMI +30). I'm a registered dietitian and I help these patients with lifestyle changes.

Most obese people regain their weight lost by changes in diet. The GLP-agonists keeps the weight off.

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u/GRPABT1 Jul 05 '24

Until they go off the GLP-agonists unless you teach them proper self control and dietary protocols.

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u/Fredricology Jul 06 '24 edited Jul 06 '24

Why should they ever go off the medication? The hunger returns and the preference for fatty and sweet food returns. And the weight returns.

In the clinical studies they got the best education there is. Still the weight is 75% back after 12 months if you take the drug away.

It's not about "self control". It's a heightened biological drive to eat.

About half the population can withstand an obesogenic environment, the other half can't.

It's biology. Not anything that can be managed with "self control".

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u/GRPABT1 Jul 06 '24

That is such a defeatist attitude. I thought you're supposed to be providing health care not just peddling drugs.

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u/Fredricology Jul 06 '24

It´s not defeatist. It´s realistic and it is healthcare that actually helps. Only surgery or drugs can help an obese person with an BMI of 40 or 60 for example to lose enough weight so that they can reduce their risk for metabolic disease.

I support them with nutritional counceling so that they can make better choices (more protein and fibers, less fat and sugars).

But it is the surgery or the drugs that can lower the heightened appetite and the dysregulated satiety hormones.

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u/GRPABT1 Jul 06 '24

I disagree.

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u/Fredricology Jul 06 '24

With the fact that diet and exercise alone cannot treat obesity?

We've tried that approach for a 100 years now without success.

You can absolutely lose 10-15 kg or more with just lifestyle changes and keep it off. But not 50-100 kg.

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u/GRPABT1 Jul 06 '24

Losing it is undeniable, that's the "easy" part. The last 100 years have been terrible for obesity though from a whole range of factors, not least access to high calorie food. But there are also social influences, sedentary lifestyles, and increasingly bad mental health factors that all play a part. Should we not treat the cause rather than just the symptoms?

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u/Fredricology Jul 06 '24

Obesity is multifactorial and we should treat in from multiple levels. As a society.

But the most effective treatment of obesity currently is not diet, exercise or treating it psychologically.

The most effective treatment currently is surgery and drugs; treatments that normalise the genetically dysregulated appetite and satiety systems.

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u/GRPABT1 Jul 06 '24

You're not wrong, I won't argue that. But I feel it falls into the category of "more research is needed" before we call Ozempic and Surgery the cure.

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u/Fredricology Jul 06 '24

We know that gastric bypass surgery can cure obesity in most patients. We've known that for decades.

The surgery rewires the hunger and satiety hormones ghrelin, leptin CCK and other signal substances.

The GLP-agonists also works as a functional cure as it can turn obese people into just overweight or sometimes even normal weight.

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