this post was submitted on 30 Jun 2025
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Allow me to echo a common bit of advice. Any weight loss you do must be accompanied by an overall diet and lifestyle change in order to be permanent. Weight loss treatments and drugs are fine if you are using them with medical supervision (sounds like you are) as a way to kick start this transition in diet and lifestyle for a more healthy and manageable future for maintaining your weight and governing your health. But that lifestyle and diet change is key. Don't squander your chance to get on the right tract to start taking control of your health. Make the changes. Stick to them and you'll see success.
You should know that some evidence suggests weight loss via GLP1 drugs might be stable e.g. https://www.nature.com/articles/s41591-024-02996-7 while some contradicts this. The overall picture of long term weight loss is extremely bleak: https://pmc.ncbi.nlm.nih.gov/articles/PMC5764193/
Lifestyle changes aren't really a more sustainable intervention than anything else. For a lot of people it seems like losing weight = feel hungry for the rest of your life and commit to calorie counting forever.
Huh what the fuck? That's completely beyond my layperson understanding of human biology. Cool if true.
I tend to be of the opinion that weight is overemphasised in health (and also that socially it's completely fucking obnoxious to fuss over someone else's alledged health) relatively to stuff like cardio and muscular strength and endurance. Still it's undeniable that many people feel substantial psychological distress over their body weight and some people are severely impacted by being fat. Having actually effective interventions would be rad. As a trans woman I am on team modify your body however you like.
It's so horrible that the standard medical and social approach is basically "Bully people until they commit to a cycle of self denial, lapse, and repeat. This is cool and good."
I have some nitpicks, firstly vegetable based protein is extremely cheap in most places I've seen. I think when you say protein you really mean animal products?
Re obesity and health it's more complicated. At extremes being fat is inarguably detrimental, but a lot of medical focus is myopic and population trends cannot necessarily be directly applied to individuals. Like personally I'm thin, have been my whole life, I'm also active and almost every joint in my body is shot because I'm hypermobile and weak. Meanwhile my wife is a bit chubby and has been her whole life, she's inactive but strong. Her skeleton is in much better condition. Bloodswise we're ok but my liver is slightly damaged from alcoholism. If you looked at us you'd probably say that I look healthier, but that's because fatness of overemphasised. She is definitely much healthier and will likely outlive me and enjoy much greater quality of life.
She might be even healthier if she lost some weight, maybe she would develop an ED and be way worse off. She'd probably be much healthier if she started each day with 5 km run but no doctor ever asks her about that, or me whether I've considered started running or weight training at a regular health check. Many doctors talk to her about weight loss. This bias, and focus on something visually apparent is not really justified.
I had a colleague tell me that GLP-1s inhibit individual fat cell (adipocyte) growth, but can ultimately lead to adipocyte proliferation, especially if lifestyle modifications aren't made, and that this is a major factor in rebound weight gain. Can't speak to the veracity myself and am having trouble interpreting the literature off-hand.
This sort of detail is well beyond my level of expertise. All I know is that at this point they appear to work about as well as anything else and be a lot more comfortable that hardcore calorie counting and denial for a lot of people, with usually tolerable side effects. Some evidence suggests long term success and some suggests that they're just like everything else. As far as I know there is no data yet on whether it is safe to spend a lifetime going on and off them as one would expect to end up doing with any diet regime; which would be relevant if they have about average long term results.
Below Lydmila linked a combo therapy which seems to have interesting results, so that's exciting.
Feeling hungry all the time has a lot to do with diet, I've found. You can feel more satiated with better diet choices like eating healthy fats and proteins which give a full feeling for longer than carbohydrates.
Diet and lifestyle changes are the ONLY sustainable way to keep the weight you lost off. Saying these aren't more "sustainable" than other "interventions" is wrong. Like, dead wrong. You are throwing out buzzwords here to qualify your wrong assertion in way to make it sound more right but it's still wrong. GLP-1 is an intervention. Diet and lifestyle changes are not. They are what you are doing long term. It's a different step or element to the weight loss and healthy living journey.
I'm not against GLP-1. I think it's it's great to get yourself on the path. Kick start it. I'm saying that once you stop taking it you'd better have changed some things about your relationship to exercise and food. If you go back to the way things were before, you'll gain it back. It's how you got it in the first place.
I mean the research is right there. You shouldn't confuse causality. Eating twice as much food as you need is a behaviour that starts happening for some reason, just trying really hard not to is unlikely to be successful if the underlying reason is still present. If you treat the underlying reason, which might for example be disregulation in hormone pathways involved in hunger signalling, the behaviour will likely stop on its own.
also:
intervention (IN-ter-VEN-shun) In medicine, a treatment, procedure, or other action taken to prevent or treat disease, or improve health in other ways.
The research all points to lifestyle and diet changes being the best way to keep weight off which is the core of what I was saying. The decades of evidence is thorough and conclusive. Sometimes the science does back up conventional knowledge. This is one of those times.
If you want to talk about treating the underlying reasons for physical health issues related to diet then you may as well advocate for a full psychological evaluation before any other intervention. I'm not even against that as for many people their unhealthy relationship with food and their own health is seated in trauma. Maybe even for most people but I don't care enough to search the data on that.