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Comment by firesteelrain | Hacker News Reader

I was on Mounjaro for two months. I was also dieting and walking 10k steps a day. I lost 25 lb and my A1C went down to 5.0 from 5.7. All my cholesterol numbers were in range. I stopped taking it and lost 25 more. I haven’t regained the weight. People who gain it back did not learn the lesson and did not effectively change their habits. You need the discipline - and a good support system. But if you don’t have that and continue old habits then you will gain weight back. The original problem isn’t solved.

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This is akin to saying a severely anxious person should be able to take an SSRI for a few months, learn how to change their thinking, and stay off antidepressants for the rest of their life. So simple. Must be their fault if they can't pull it off.

Perhaps that works for some people. I'm glad it seems to have worked for you. But the facts of the world we live in show that it doesn't work for most. "Learn the lesson and be disciplined!" is not effective advice.

The analogy to your example is that someone who has to take Mounjaro for diabetes will always have to take it even after losing say 100 pounds. Or Metaformin even.

GLP-1 in those cases helps manage the problem better.

But for those who are not in those cases where Type 2 Diabetes has sunk in, then they need to use the opportunity to get better while on it and kick themselves into high gear or they will have learned nothing from the experience

That is the ideal model for treatment of those types of mental health disorders. Often patients have blockers that prevent them from resolving underlying issues. But through a drug they can get into a headspace that allows them to work through them with talk therapy, and then learn new habits and eventually go off the drug.

In practice, this doesn't happen that often, no, but it's a theoretical goal. Probably because we're in the pre-GLP-1 era with regard to mental health meds. Maybe that will change.

I feel like your example shows the inverse of what you want. SSRI are actually great at helping the person develop healthy mechanisms (compared to GLP-1s), because they reduce the mood swings & negative thoughts, allowing the person to be more productive & be more involved in their therapy, in reading, journaling, doing sports, etc. It's just that it might take two or three years and not months, which is fine because SSRI also have much more limited side effects compared to GLP-1s.

GLP-1s don't do that directly.. but at least they might help people move more, and give them confidence to do more for their health instead of seeing it as a lost cause.

How are people so consistently wrong about GLP-1s? The side effects are minuscule in comparison to SSRI’s and the effects on improving habits are massive.

SSRIs barely have side effects

GLP-1 - Mild nausea, always temporary and in the beginning, easy to avoid by tapering dose. Extremely effective.

SSRI - about 10% chance of major sexual disfunction, often permanent, significant likelihood of sleep disturbance, majority get blunted emotions. Debatably effective.

Not really comparable.

As someone who's currently experiencing significant and crippling gastroparesis due to GLP-1's, being reductive about the side effects is not particularly helpful.

Lower your dose a little? Gastroparesis is a choice on these and only at high doses for long periods, you get signs weeks in advance and you choose to stay on a high dose. Myself never experienced it even when I had extremely strong effects (near 500 cals a day for a few weeks), but I did have some slowness, I lowered my dose and was fine.

I've never heard of the sleep disturbance thing, and I think you just made up the permanence of the sexual disfunction thing

It’s trivial to look this up which is funny - I double checked everything i said, so I know it’s true, and never claimed you’re making things up. But you are claiming I’m making things up while obviously not even doing basic research.

Very wrong analogy. Anxiety is not something that you gain by buying junkfood due to low budget or laziness or simply being raised with very wrong values re food and health. On the other hand, every single ice cream, pizza, burger with fries, cupcake or beer contributing to resulting weight is a voluntary choice (with some mental drama around).

There is simply no way around the simple fact that there is only 1 way to eating well long term - that is lesser, more healthy portions. GLP1 may show a person what things could and should look like, what is achievable but the path needs to be walked by themselves. The alternative is either lifelong consumption of this chemical with various bad side effects or premature death (or both, to be seen since nobody has a clue).

You need to remember that people experience reality differently. For you eating the healthy number of calories may be easy. For others it very much is not. I have heard it described as leaving your thermostat at 45 in the winter to save money on your gas bill. Sure, you could do it, but it would cause a lot of suffering. GLP-1s are able to change the way people experience hunger so that it only feels like the thermostat is at 65 instead of 45.

You think that controlling your anxiety and controlling what you put into your mouth are equal things?

I would say that controlling what you put into your mouth is easier than controlling your anxiety.

I would say that in at least some cases over eating and anxiety are both symptoms of underlying problems. Stress, emotional issues, and trauma can all lead someone to either of the two.

As someone that uses food as a coping mechanism for stress, I agree with the GP - if the underlying problem isn't resolved, the weight will come back.

When "putting something in your mouth" is the result of a mental component, is there a difference?

I think there is a big difference when one still ultimately requires a physical act in the end and one is all mental.

You can much more easily use the physicality of your surroundings to physically deny yourself the food than you can deny yourself anxious thoughts.

With eating there are 2 components to it, mental and physical, so you have more opportunities and more options and avenues to potentially control it.

The additional options to control it should IMO make it at least some amount easier to control in the end since some people may be able to take advantage of physical controls to limit themselves where that's not an option for anxiety.

>I would say that controlling what you put into your mouth is easier than controlling your anxiety

Then explain why people have so much trouble with it without resorting to a thought-terminating cliche

As someone who took SSRIs for a while my plan w my doctor was always to use meds for support as I developed a toolkit to deal with my emotions without medication and then to re-evaluate periodically to see if the meds were still necessary. It took a few years, but eventually we weaned me off. I'm glad we did, now that my life is in a better place and I'm a bit more agile with my thinking I'm quite glad to be rid of all the gross side effects of the drug, but when I was having a rough time those side effects were well worth the stabilization the drug brought me.

> People who gain it back did not learn the lesson

Considering it took you a miracle drug to learn the lesson, that seems like a humorously arrogant take.

I lost almost 15 kg (~33 lbs) over the last two months and I didn't even try that hard. I never had problems with my weight, but over the last few years it slowly crept up to ~107kg (at ~1.95cm), at which point I realised I had to do something. Reasonably sure I could do a The Machinist Christian Bale if I wanted to.

I also quit smoking with relatively little effort twice (once in my early 20s, and then again a few years ago after I picked up smoking again during COVID). It wasn't easy-easy, but if I hear the struggles some other people go through, it was relatively easy.

Some people are just wired different. I have plenty of other issues, but on this sort of thing, for whatever reason I seem to be lucky.

Someone who had to take a drug to learn how to control their weight should not be lecturing others on how to do it.

Posting what I posted below:

I have been off since Oct 2024. Also, I did continue to lose weight the traditional way. After I stopped, a coworker told me about Vida which my work offers as a health benefit.

Using the Vida service where I got a registered dietician to show me what to eat, I tracked my food and water intake and tracked my exercise. I had protein and fiber goals to hit.

You can’t do it all on the medicine - it is a lifestyle change. The medicine was the catalyst but not the reason I kept the weight off. I wanted it. But because I wanted it, I wanted to use the support system that my work paid for.

I think there is a lesson to be learned here

> People who gain it back did not learn the lesson and did not effectively change their habits. You need the discipline

This is deeply misguided. I’m glad that the little assist was enough for you, but if “healthy habits” were enough then people who’d lost weight the traditional way would keep it off.

Further, unless you’ve been off it for more than six months, I’d hold your judgement on this one.

I have been off since Oct 2024. Also, I did continue to lose weight the traditional way.

After I stopped, a coworker told me about Vida which my work offers as a health benefit.

Using the Vida service where I got a registered dietician to show me what to eat, I tracked my food and water intake and tracked my exercise. I had protein and fiber goals to hit.

I think there is a lesson to be learned here

> but if “healthy habits” were enough then people who’d lost weight the traditional way would keep it off.

That's because a lot of the "traditional way" methods are pseudoscience at best, outright quackery that's going to send you into serious malnutrition issues or eating disorders at worst. Every two or three months you see a new diet fad pushed through the yellow press rags, and none of it anywhere near being considered scientifically valid - usually it's some VIP shilling some crap story to explain how they lost weight, of course without telling the people that they have the time for training and the money to pay for proper food, 1:1 training and bloodwork analysis.

I would have thought the "traditional way" would simply be eat less, move more (by changing your habits of course).

GLP-1 makes you want to eat less. So you are correct.

The problem is, most people aim way too high in their weight-loss target and sending their bodies into starvation mode, which will lead the body to reacquire the lost body fat as soon as possible - aka when people are happy with their body weight and scale up their food intake to caloric neutral again.

There is no such thing as starvation mode. If you consistently don't overeat, you won't gain your weight back.

I know some serious cases where there were non-habitual problems but... "healthy habits" is nothing to laugh about. People literally are what their habits are. All of our behaviour is habits, and changing behaviour takes time and effort.

The good news is that it is not impossible, and it really is possible to change bit by bit for most people suffering from obesity.

I don't think somebody who walks 10k+ a day, maybe goes to gym a couple of time a week, limits calorie intake to a comfortable and reasonable 2000 kcal per day, would suddenly bounce back to 130kg!

Some people DO keep it off. Ive never been obese but ive been overweight, extremely unhealthy, pre diabetic, couch-potato for years at a time. For me, it's always a matter of getting into the mindset that these things are not just "not good," they are literally poison for me!

I've seen a few obese friends of mine lose weight and gain it back. And while I can't put words in their mouths, I have never noticed them have the attitude that "being obese will kill me."

How long ago was this?

I started in Aug 2024 and stopped in Oct 2024. I paid for it from one of the pharmacies that made it in Florida. I injected myself with insulin needles that they send you.

Depends on your ultimate high's. That's a pretty good indication of diabetes (any form).

I've had pretty good hb1ac's when my blood sugar's were all over the place and in no way healthy.

I've seen so many reports of people losing weight one way or another, and saying they kept it off, and I think only once has it been more than a year. Usually under 6 months.

Personally I lost a ton of weight doing full-on keto (I specify, because some people just kinda cut out carbs) and then kept it off for over 2 years. But I put the weight back on after that, albeit slowly (over the course of maybe 7 years).

I've also done Mounjaro, and I can keep it off a while after I go off it, but not that long.

YES, you have to change your habits, maybe lifestyle, maybe deal with other issues in order to keep it off. But I think, not only is that difficult, it's not a "you did it and you're done" deal. It's easy to slip backwards, and I won't make any claims about you personally, but for anyone who's kept it off for less than a year, I think the good money would be on it coming back within another year. I doubt someone is "out of the woods" even two years on.

I don’t see myself gaining 50 lb back. I would have to eat a TON which I don’t

A small energy surplus over time is enough

You have to eat 500 extra calories per day for 7 days to gain a pound. Thats basically two 20oz cokes per day. I used to drink that

For most people that is very true, I have seen it repeatedly.

I don't know what my secret is, I lost 100lb and have kept it off for a good 5 years now. But it is a bit of an uphill battle. If I wanted to, I could easily just give in to temptation and slip right back but it hasn't happened yet.

No offense, but that's not particularly impressive and you're bragging about your discipline a bit prematurely. It's highly likely in the next ten years you will regain most of the weight back.

I've known many, many, people to lose weight via extreme diets such as keto. Such diets are unsustainable for almost everyone. It will work for a year or two, but inevitably, they will falter. Often it only takes a very small amount of stress - maybe a hard project at work.

I have never met anyone who uses something like keto successfully. It has always failed, with everyone I've talked to. That doesn't your diet is as extreme as keto. But, it does mean you're not out of the woods, and your perspective on this isn't exactly trustworthy.

My partner on this medicine over a period of two years went from 300 to 197. They have not gained it back after stopping. Their diabetes was reversed and is now in prediabetes. They still has to take Metformin.

In order for me to gain all that weight back, I would have to eat a ton of calories per day and completely stop moving/exercise.

It’s been nearly a year since I started losing all that weight and I haven’t slide back on my diet. It does take discipline

> In order for me to gain all that weight back, I would have to eat a ton of calories per day and completely stop moving/exercise.

Yes, this is what usually happens. You've spent far, far more time with those calories than without.

> It’s been nearly a year

Okay, that's not a very long time is my point. It's much too early to think it's over.

I'm not saying that it's not possible to get off GLP-1s and maintain a good lifestyle. I'm saying that I don't think it's a moral failing or a lack of... sigh... "discipline" if people need to be on these drugs for life. Frankly, I think it's very rich that a baby skinny person is lecturing us on discipline. You've been doing this for less than a year. Discipline means sticking to habits for a long period of time, even when times are tough. I would not classify less than a year as that.

Okay will report back in one year.

First off I just wanna say awesome and I send positive energy to you and you’re gonna do great.

But then I just wanna talk about how long life is in terms of weight gain! Even two years is an “short” amount of time!

Last month, I looked over my doc where I keep track of my weight and I’ve been gaining about 1 pound a year since I started tracking it… 20 years ago. That’s a significant amount and I maybe have 30 years left to go! (this comment is not about you specifically, just musing on how long life is in terms of weight gain)

I know! I am totally aware. My FIL died sitting in a recliner basically from age 55 to 70. He didn't move, didn't watch what he ate. We saw that happen over a long period until he died about 3 years ago. It started with toes, then loss of a leg.

Since that happened, it really kicked us into motion plus shaking the COVID funk!

I wish you the best as well

suprised your a1c was only 5.7 despite being obese .

From what I understand you don’t have to be obese and have type 2 diabetes. In my case, I was obese and did not have diabetes but I might have been going down that road

A lot of skinny people with a family history of diabetes find that they can become diabetic/pre-diabetic as they age.

The trick to avoid it is to put on muscle mass, which regulates your blood glucose levels.

Thank you. I will keep monitoring my A1C and lifting weights

I recomped 30lbs of fat to lean mass and had a 2 point drop in A1C. Real shit.

Get after it!

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