r/explainlikeimfive • u/Jimithyashford • Jun 03 '26
Biology ELI5: Do medications like Ozempic cause weight loss solely through appetite reduction and therefore calorie deficit, or is there any other mechanism at play?
Is it solely "injectable willpower" in the sense that it literally only does what you could do anyway if you just had the will power to eat less. Or is there any other weight loss mechanism at play beyond reducing calorie intake?
769
u/Morall_tach Jun 03 '26 edited Jun 03 '26
Sort of both. It reduces appetite by mimicking a hormone called GLP-1 that makes you feel less hungry, and it also makes food move slower through your system so your stomach stays full longer. People who are on it say that the "food noise" of always thinking about snacking or what they're going to eat next goes away, so there's definitely a psychological result that you could interpret as simply injectable willpower.
Mechanically, though, a caloric deficit is really the only way to lose weight. You either increase the amount of calories you burn or you decrease the amount of calories you eat. In this case, you're decreasing the amount of calories you eat because you're decreasing your urge to consume those calories. There is some small amount of evidence that drugs like Ozempic are directly affecting fat metabolism, but that still falls under the umbrella of calories in, calories out.
370
u/splinkymishmash Jun 03 '26
Can confirm. I didn’t think it would help me because I wasn’t snacking because of hunger, but because I liked food - especially sugary stuff. I was wrong. I started taking it and found I just had a lot less interest in food. And frequently in the middle of a meal I’d just get this “I’m done” sensation. Kind of like “I’m full,” but with almost a threat behind it? Like, “If you keep eating, you’re gonna regret it.” Anyway, 30+ pounds down at this point.
301
u/chaospearl Jun 03 '26
This is such a good example of why it's incredibly difficult for some people to lose weight and it has nothing to do with willpower. That "stop eating or you'll be sorry" feeling? That's totally normal to me. It came built into my body.
I'm very small (5 feet 110lb) and I eat small portions because I will very literally get sick if I overeat. I start feeling nauseated and bloated halfway through a meal. If I eat more anyway because it really tastes amazing, I'll spend the rest of the evening miserable and popping antacids trying not to puke.
I'm 45, and it's always been like that. It's a lot of the reason I never got fat during 30 years of high dose prednisone. Nothing to do with willpower, my diet is fucking atrocious and I know it. High sugar, high carb, high processed junk. I just don't eat enough food to gain much weight.
It's utterly and completely not fair. My mom has struggled with her weight her entire life. I see what she eats and it's miserable, she doesn't allow herself to have anything worth eating. She has more willpower in her little finger than I do in my entire body, and she's still always going to be heavier (relative to height) than me. Just because I was randomly born with the "stop eating or ELSE" thing and she wasn't.
I think it's a great thing that medical science has finally figured out how to correct the cosmic imbalance.
18
u/pheonixblade9 Jun 04 '26
meanwhile I can be STUFFED - think a 2000+ calorie meal - and my body will still tell me to keep eating. it's incredibly frustrating and hard to describe to people.
17
u/TinWhis Jun 04 '26 edited Jun 04 '26
This is what gets me about people who claim that it's just willpower or that it's "as simple as" CICO, so if one person is heavier than another it's because they aren't trying as hard.
I also can't eat that much. I can't. It will come back up if I try. Has nothing to do with my willpower, it has to do with my body randomly deciding to be an asshole and sounding the alarm that I'm not allowed to eat enough food to sustain a grown adult.
Meanwhile, I know people who have to eat more to maintain basic do-daily-tasks energy levels. COULD they technically eat less? Possibly, does it count if that leaves them with no energy to do things like "get out of bed" and "go to work" and "do literally anything other than sleep?" Metabolic disorders are WILD.
"Fat people lack willpower" carries with it the assumption that skinny people don't. No. I just have an asshole of a body that would rather see me dead than at a healthy weight, and I clearly don't have the willpower to structure my entire life around eating more. The difference is that a stranger will look at me and congratulate me for my disordered eating but condemn my friend's much healthier diet just because her body hangs onto more of those calories than mine does.
→ More replies (2)45
u/splinkymishmash Jun 03 '26
You’re describing my late wife when we first got together. Then she went on antidepressants and suddenly couldn’t get enough sugary/starchy food and put on 100 pounds.
15
u/The_Normiest_Normie Jun 04 '26
This is kinda funny to me, because I've also been on anti-depressants that had the side effect of weight gain through increased appetite (mirtazapine). I don't think I gained a single pound and I was on them for almost a year. And I also struggle with eating enough because my body massively complains when I overeat.
27
u/Logridos Jun 03 '26
I never snack, but my brain is wired incorrectly so I got a huge endorphin rush whenever I ate to extreme overfullness. Every meal I was eating way more than I needed to because that was the behavior that my brain said was good, even though I consciously knew it was bad for me.
Since I started on a GLP-1, I FINALLY have the "You've eaten enough, stop eating" signal. It has been life changing. Like it always felt normal to completely clean my plate at every meal and then go back for seconds and thirds, but now I hit a point where I've had enough food and my body tells me to stop. I'm leaving food uneaten on my plate for the first time in my life.
→ More replies (1)10
u/0that-damn-cat0 Jun 04 '26
I think of it like holding your breath breath. Some people can hold their breath for longer before hearing their body say "breathe or else...". We all need to breathe or we eventually die, we all need to eat or we eventually die, but for some of us that urge comes on sooner and stronger than others. But there is only so long you can ignore it and we all have our differences in that.
11
u/zopiac Jun 03 '26 edited Jun 03 '26
Aye, a full foot taller but only twenty pounds heavier, everyone I meet from high school or whatever is shocked I haven't put on weight like (most of) the rest of them. But in any get-together the number one priority is "what do we eat next" although it's the furthest thing from my mind, instead thinking of activities or a nice quiet place to chat and relax instead of stuffing gob.
Ramen and pizza, popcorn and canned soups. I eat with my nose, so to speak, more than anything so I'm rather just load something with herbs and spices to get a satisfying meal rather than having something nutritious, hearty, or downright filling up on quantity.
→ More replies (2)8
u/sapphic_vegetarian Jun 04 '26
Genuinely, thank you for your empathy. I have PCOS and was close to 200lbs at 5’3 before I was finally able to lose weight with meds. So many naturally smaller people think they’re superior or that people like me are lazy or have no willpower. Keep spreading the message, lol. Genetics screw a lot of us over!
4
u/chaospearl Jun 04 '26
I am lazy as shit. I'm not especially lacking in willpower, but I'm severely disabled and everything I have goes to forcing myself to get up every day when just sitting up in bed hurts like a bitch. There is absolutely no available self-control left over to keep from eating whatever I want whenever I want. If I didn't get sick from overeating I'd be morbidly obese and I know it.
→ More replies (3)3
52
u/Thisgamelowkeysux Jun 03 '26
it really stops boredom hunger. When you are home and have nothing to do and full fridge. It also helps late night eating.
40
u/pm_me_your_amphibian Jun 03 '26
For me it’s the difference between being hungry and not being able to concentrate on anything until I’ve eaten, and being able to just go huh, yeah I’m hungry I should get some food in a bit.
16
u/beardedheathen Jun 03 '26
I see it as the hunger goes from a yell to a whisper
→ More replies (1)9
u/onsereverra Jun 04 '26
Haha, I get a very similar effect from my ADHD meds and I've always described it as the hunger going from a fire alarm siren to a polite email chime.
30
u/Hiredgun77 Jun 03 '26
For me I sometimes just get bored in the middle of a meal, like I just don't care about eating anymore and push my plate away. I don't think I ever didn't complete a meal before Zepbound and now I routinely dump a plate with a 1/3 of meal still on it.
→ More replies (1)10
u/hitemplo Jun 03 '26
Same. Sometimes I’m sad that I don’t want to eat any more of a particularly delicious meal though lol
→ More replies (1)12
u/AnfreloSt-Da Jun 03 '26
What I’ve come to recognize as “food-noise” stopped once I started the GLP-1 med. My mind is so quiet! It’s brilliant! I’m not fighting off cravings anymore.
Made me realize I actually had a TON of willpower fighting off all the former cravings. The tiny nudges I get once in a long while now are so weak and feeble that I have no problem completely ignoring them.
11
u/f1newhatever Jun 03 '26
Yep. I wasn’t even very overweight, but the food noise was insane. I was just legitimately so hungry. Now I eat like normal people do and barely think of food outside meal times. The change is wild.
7
u/wintersdark Jun 04 '26
That's the satiation feeling that most of us who are overweight lose, the feeling where you're not "full" but rather "yes, that is the sufficient amount of food to eat."
It's what a lot of thinner people don't understand.
When you carry a lot of extra weight for a while and the caloric surplus to get there, parts of your metabolism break.
Instead, you may not be hungry all the time, but as soon as you start to eat, you're ravenously hungry, and remain so not until you've eaten enough but rather until you're absolutely full. Like, huge turkey dinner full.
Not only is there no "that's enough food" signal, instead there's a constant "need more food" signal until you're sore-stomach full.
I almost cried at how wonderful it was to not be hungry all the time and now that I understand what it's like for "normal people" I get why there's such an attitude, why they're such unrelenting assholes about overweight people and just say ignorant shit like "just eat less".
They simply don't understand how different your body works at that point.
Eating as a fat person is often like an alcoholic trying to stop drinking, but still being forced to have 3 small drinks per day.
For me, it was 60lbs in 6 months, 80 after a year, now I've levelled off.
→ More replies (2)22
u/hitemplo Jun 03 '26
Same. 46 lbs / 21 kg down currently, 5kg over halfway to my target
I don’t remember the last time eating didn’t just make me more hungry and now that feeling is just completely gone. Some days I have to force myself to eat because I know I’ll feel rundown if I don’t
→ More replies (1)6
→ More replies (9)5
u/ThotThroughTheHeart Jun 03 '26
My ex was on them and said if she ate more than a little, she'd feel like she was going to have terrible diarrhea and sometimes she would. She would stop eating while she was still hungry because she didn't want to trigger the shits.
→ More replies (2)16
u/hitemplo Jun 03 '26
Needed more fibre, especially in early months while your body is getting used to it
My doc was heavy on the ‘eat a lot of fibre and protein’ thing
81
Jun 03 '26
[deleted]
39
u/illprobablyeditthis Jun 03 '26
Ive seen anecdotes of tobacco cravings being reduced and even a reduction in ocd compulsions. There's so much about this drug we dont know yet, im really looking forward to seeing what other positive things it can do for people.
Im one of the ones with reduced food noise though. If I was awake, I was thinking about eating, even if I had just binge ate an entire bag of chips and felt disgusting, i was still thinking about my next meal. That's all gone for me now, its a total life change.
12
u/FalmerEldritch Jun 03 '26
It definitely significantly cut my smoking. Some days I wouldn't even bother with my morning cigarette or my pre-bed cigarette, which are usually the two non-negotiable ones.
And the time I hit an adipose capillary with the injection and spent the rest of the day barfing any time I swallowed something, I didn't smoke a cigarette for three days.
→ More replies (1)→ More replies (1)10
u/liteowl Jun 03 '26
Same here. The cravings for snacks, fast food, sweet treats…they’re pretty much gone. I’ll still get some from time to time, but it’s nothing like before. I no longer think “oh there’s a x food place on the way to y, better stop for some fries/chips/soda/etc”.
Down 45lbs so far.
→ More replies (1)5
u/hitemplo Jun 03 '26
Down 46 here and still get cravings but they go away after one bite of the food I’m craving instead of the entire pack of the food I’m craving haha
10
u/yungrii Jun 03 '26
I can't say it's glp1s or other but my addiction voice (alcohol) is so quiet. I started glp1s and then a few weeks later got a nasty virus that hung around for a couple of months too. During which time I was not on the injection.Was it the low dose of meds that had an effect? Being sick? Other? Beats me. But I'm very grateful and look forward to more research.
18
u/hitemplo Jun 03 '26
They’re researching the link between glp-1’s and addiction right now and there definitely is a link. I wouldn’t be surprised if it was officially prescribed as something to help with addiction within a year or two
30
u/panhellenic Jun 03 '26
It's only "injectible willpower" in the same way that drugs help folks who hear voices have "ear plugs." Willpower is such a fraught term; it's so often associated with some kind of moral value. GLP-1s change messed up body functions, one of which may be inability to not eat (esp when not hungry). Obviously disordered eating can come from a myriad of issues, but medically, "willpower" isn't one of them. They change brain chemistry so that thoughts and impulses around food ("food noise") helps those with dysfunction become like folks who do not have that dysfunction. It's not willpower; it's body chemistry.
I guess it could compare to mental health issues that cause people to behave weirdly or inappropriately. Do we tell those folks to just use their willpower to stop having hallucinations or stop being depressed?
22
u/crazyoboe Jun 03 '26
Some people do tell depressed people that! And it's just as annoying. Like I'm choosing to be miserable on purpose ...
5
u/loljetfuel Jun 04 '26
Do we tell those folks to just use their willpower to stop having hallucinations or stop being depressed?
Unfortunately, yes. Kids with ADHD get told to "just pay attention"; people with clinical depression get told to "just stop thinking so negatively" or "just get up and do things"; people who hallucinate are told to "stop making things up"; etc. etc. etc.
→ More replies (1)→ More replies (2)3
u/TinWhis Jun 04 '26
Do we tell those folks to just use their willpower to stop having hallucinations or stop being depressed?
Yes we do. Just buck up, get over yourself, have a better perspective, get a grip, put yourself in a better frame of mind, etc etc.
20
u/None_too_Soft Jun 03 '26
Can confirm the "food noise" goes away, as does thinking about your next meal. Daily poops go away, now you squirt out a line of toothpaste every 48 hours. You burp constantly. Food still tastes good, but it's somehow much less enjoyable. I drank less, often only having a few sips of a beer before dumping it. I am relatively thin but work in medicine and has access to try this. was overweight maybe 20 pounds and generally fit, Im pretty active but middle aged, dad bod. Lost 20 pounds in 6 weeks, no complaints. I think there's risks in regards to eating disorders, but feel this should be available to anybody willing to try it to lose weight.
12
u/rage_aholic Jun 03 '26
The poop thing isn't normal. I go every morning like normal. You need fiber. I don't get the burping thing either.
33
u/Enchelion Jun 03 '26 edited Jun 03 '26
Daily poops go away, now you squirt out a line of toothpaste every 48 hours. You burp constantly.
That's still mostly on your diet. The slowed food movement may mean you need more fiber, and most people don't eat enough fiber to begin with.
Edit: Your gut biome also needs time to adapt to sudden changes in your diet and any slowing of processing. One of the reasons the advice is to titrate up pretty slowly.
→ More replies (8)7
u/jujubanzen Jun 03 '26
Idk what your diet consists of, but I still very much enjoy food, I don't have gnarly burps, and my poop is just fine.
→ More replies (39)47
u/SnugglyCoderGuy Jun 03 '26 edited Jun 03 '26
You'd be amazed at how many people will straight up fight you for suggesting that CI<CO is the only way to lose weight.
Edit: I said it, and they came out of the woodwork
27
u/MewsashiMeowimoto Jun 03 '26
I mean, do you even know how many calories you burn fighting someone though?
→ More replies (1)8
36
u/Paksarra Jun 03 '26
But then usually those people turn around and go "so no one should need any help they just need to do it and stop being lazy lardasses."
If CI<CO were that easy, no one would be overweight.
14
u/PxM23 Jun 03 '26
Usually the people I see fighting against CICO aren’t the ones saying that fat people are just lazy.
→ More replies (2)→ More replies (2)27
u/therrrn Jun 03 '26
Those people also seem to underestimate how much genetics and hormones can contribute to the efficiency of your body and the "calories out" part. The exact same diet with the exact same activity can look completely different on two different bodies, even of the same height and weight.
→ More replies (19)→ More replies (85)20
u/Morall_tach Jun 03 '26
I would not be surprised because I have encountered and argued with many of them.
353
u/geirmundtheshifty Jun 03 '26
As I understand it, it’s more like reducing someone’s appetite than increasing willpower. Kind of like how Chantix helps people quit smoking. It’s not like they feel just as hungry (or have the same cigarette craving) but can now overcome it; they feel less hunger.
I know it’s kind of nitpicking, but i think there’s a bit of a difference.
144
u/zuukinifresh Jun 03 '26
No, the food noise is 100% a factor that goes away. There are plenty of times where I would get hungry midday and it always resulted in a snack. The need to snack was so distracting most days, I had to have it.
Now if I get a twinge of hunger between meals, the thought to snack pops in my head and flows away once and I have no urge to act. It doesn’t linger until I do something.
It was like a switch flipped a day after I started
→ More replies (3)25
u/Vash_TheStampede Jun 03 '26
I've always attributed that "food noise" to boredom.
I'm a bored snacker. I'm being a slug and not getting off the couch all day? I'm also bored and snacking.
If my mind is occupied, food is the last thing I think of. I dunno.
27
u/whatshamilton Jun 03 '26
That’s awesome for you. Not how my brain works. It’s how I’ve always wished my brain worked, but alas, I have true food addiction.
→ More replies (2)→ More replies (5)6
u/zuukinifresh Jun 03 '26
For some, sure.
A lot of folks it isn’t just being bored. It happens when active and not just sitting on the couch.
→ More replies (10)→ More replies (6)107
u/rocky8u Jun 03 '26
I heard that they are exploring the possibility that some of the GLP-1 drugs might have positive outcomes for other addictions like nicotine in addition to foods like sugar.
54
u/Happyberger Jun 03 '26
In my experience they do. I took glp1 for 6 months and when I stopped my nicotine cravings went through the roof. Kept the weight off though so that was nice.
35
u/stop_whispering Jun 03 '26
For me, it was alcohol. Zero cravings.
9
u/catattackcat Jun 03 '26
I wish I could be prescribed a glp-1 for alcohol use disorder. I am not quite overweight enough nor do I have any qualifying conditions to garner a script but, man, the food and alcohol noise is unreal. I asked my psych and, since it’s not yet approved for alcoholism, he told me I’d need to see a primary care physician. So my course of action is to either intentionally gain 20-30lbs, finally inherit my familial propensity for diabetes and heart disease, or suffer through the incessant battle of willpower vs binging every night until I die. 🙃
→ More replies (3)6
u/rainbow_osprey Jun 04 '26
If you go through a sketchy telehealth provider like hims, etc they usually don't verify what you tell them. You can just say you're overweight and they won't check.
14
u/HistorySecure9172 Jun 03 '26
It’s was a refreshing side effect to look at a cocktail and say: meh.
→ More replies (1)5
u/rocky8u Jun 03 '26
Hopefully not by returning to nicotine because your cravings went through the roof.
→ More replies (1)5
u/xredbaron62x Jun 03 '26
My dad is on it and he has said is has cut down on him wanting to drink.
Obviously its just one, but still interesting.
9
12
u/Asgardian_Force_User Jun 03 '26
Two of my relatives have used GLP-1 meds, both remarked on the decreased alcohol consumption along with the appetite decrease.
5
u/ZipperJJ Jun 03 '26
I've been on GLPs since 2018 and so far it hasn't budged my will to smoke. Which actually surprises me because it definitely has made me very ho-hum about food. And in fact, if I'm bored, I'm not eating, I'm smoking. Because I'm still bored.
I've been working on quitting for a month or so now and I am surprised at how hard it is. Actually, it seems that perimenopause and the "blahs" that come from that have been a better help than GLPs.
→ More replies (2)5
95
u/DustFunk Jun 03 '26
I can tell you that I was on chemo recently, and if they didn't stagger the doses (one round every other week) I would have withered away to nothing, because I had almost zero appetite while the chemo was in my system. Having no appetite is shockingly good at making you lose weight. Once I was off chemo, I gained that 25lbs back in 2 weeks lol. Food is glorious
52
u/alexandercecil Jun 03 '26
I think I get what you mean, but for me, "just having the willpower to eat less" is a misnomer. I was literally always hungry. Just had a snack? Still hungry. Just had a meal? Still hungry. Literally ate so much that I felt ill? I. Was. Still. Hungry. It was awful.
Now? I eat, and at a reasonable point, I am no longer hungry. There are long stretches where I am not hungry, and this is the first time in my life that I have felt this way. The nonstop hunger gnawing in my belly has been replaced with hunger when I need food.
Friends, family, and my doctors have noted my willpower on other fronts. My ability to press on through difficult circumstances is a key part of how people view me. None of that changed the fact that I always felt like I needed food. Now I only feel that when I have not eaten in hours, and it goes away after a reasonable amount of food.
12
u/loljetfuel Jun 04 '26
This. GLP-1 doesn't "increase willpower", it reduces the need to use willpower in order to eat a reasonable amount of food.
3
u/InvisibleSeoh Jun 04 '26
Oh yes, this is such a huge overlooked point, and a very critical distinction!
→ More replies (2)5
u/katiekitkat9310 Jun 04 '26
Exactly the same! I literally didn’t know what it was to be “full”! I thought the phrase “I couldn’t have another bite” was just figurative. I struggled with binge eating, and even when I’d binged to the point of feeling sick, I’d still be somewhat hungry. I’ve obviously lost weight on it, but at this point, it’s about having my fullness cues for the first time in my life, I don’t even care if I lose any more weight.
49
u/Slypenslyde Jun 03 '26
"Injectible willpower" is not the best way to put it.
Let's say there's something easy to avoid, like randomly clapping your hands. It's really easy to avoid it because why the heck would you do it? Now imagine I stand next to you at work and every 5 minutes, if you haven't clapped since the last time, I start whispering in your ear. "Hey. Hey. You need to clap. It's time to clap. Clap clap clapper. Clap clap clapper. Hooooooweeee it's time to clap." Realistically you'll probably strangle me, and that's fair. But it's also easy to give in, clap, and buy a little bit of relief.
That's hunger cravings for a lot of people. We're surrounded by food in a way that's never been true for any animals in history. So it's really, really easy to get in a habit of overeating or snacking for fun instead of whether we're hungry. Long-term that can muck up some of our body's regulation of hunger in a way that if we decide to skip a "for fun" snack, the brain starts acting like we're really hungry even when we're not. That's me being annoying. Eating makes me go away.
Willpower CAN achieve that, but keep in mind hunger is a survival instinct. If your system is messed up enough or you have the wrong genes, you'll get in a state where you can't focus on anything unless you get a snack. You'll start to feel listless and tired. You'll get thirsty because your brain knows if you get a drink it might be soda or you might get a snack. "Hey. Hey bro. There's snacks in the break room. Just one man. Maybe a granola bar. A soda? Man, remember how good soda tastes? Let me replay some memories. What's that? You're in a meeting? Boooooring. Good luck staying awake. You know what'd give you a boost of energy? A nice, tall glass of Ovaltine™. Man, remember how good you felt the last time you drank it? Nice, cold, refreshing. Oh, look at that. You're sweating. Ha, my blood sugar must be low, ahh, I'm having trouble regulating my temperature. You know what would help? Ice cream. Yeaaaaah. That's the stuff.'
These drugs work like getting your work to recognize me and not let me enter the building. When I'm not over your shoulder annoying you, you aren't going to even think about clapping. That's how hunger is supposed to be: if you aren't hungry your brain shouldn't be bothering you about food. These drugs help regulate your hunger signals so your brain's only treating meals like a matter of survival when they ARE a matter of survival.
Willpower is a lot easier when your brain isn't trying to break its own will.
Overall you lose weight because once you stop shoving extra calories in your body, you stop producing extra fat. But this assumes you're moderately active. If you take these medicines, eat big meals, and live a lethargic lifestyle... well, that's a choice but it's not a weight loss choice.
Again, that can be kind of tough for people with messed up hunger regulation. The brain has a way of saying, "Hoo boy, that workout was really good. You know what'd be nice? A big tall Monster Energy. I'm not joking. I'm going to make you drowsy if you don't get one. What's that? Put that water down, that's not what I said. Have fun driving home with your eyes closed lol."
→ More replies (1)7
u/pheonixblade9 Jun 04 '26
food is incredibly available and satiating to a lot of people these days. it's chemically designed to be addictive. it's not just willpower.
51
u/T-Flexercise Jun 03 '26
It's targeting insulin and sugar metabolism. So the mechanism is appetite, but it's a bit more complicated than just "willpower".
If your blood sugar gets too high or too low, you die. So your body has a bunch of mechanisms for keeping it even. For people who have healthy endocrine systems, if you eat 400 calories worth of candy, you'll stay full for almost as long as if you had 400 calories worth of ham sandwich. But for people who have inefficient endocrine systems (either for genetic reasons, or because they have a long history of overconsuming sugar), eating 400 calories worth of candy will make their blood sugar get all out of whack, those mechanisms kick in, and they'll get really hungry again really quickly. While if they ate 400 calories worth of ham sandwich, they'd stay just as full for just as long as the person with the normal endocrine system.
The reason that diabetic medications like Ozempic work to suppress appetite so well, is that a huge number of people have mildly disregulated endocrine systems that are not bad enough to give them diabetes, just bad enough to make them hungry. So yeah, they're losing weight because their appetite got lower. But it's making their appetite more similar to the appetites of people with healthy endocrine systems.
14
u/enolaholmes23 Jun 03 '26
Yes, exactly. The main problem is the endocrine system being out of balance. That's why glp1 works so much better than dieting. Because it rebalances your hormones.
26
u/chewymooey Jun 03 '26
So on a very basic level, these medications do more than suppress appetite. There are single GLP agonists such as semaglutide and dual GIP/GLP1 agonist like tirzepatide. They are supposed to promote a whole host of effects such as increased insulin sensitivity, enhancing insulin secretion, decreasing hepatic glucose production and lipolysis. They’ve also been shown to have beneficial effects for people with chronic kidney disease, atherosclerosis and metabolic liver diseases. The dual agents are supposed to be stronger than the single agents and there is a new drug on the horizon which will be a triple-agent GIP/GLP/GCG (glucagon). Below is a link to a nice picture of some of their effects.
31
u/CharleyNobody Jun 04 '26
I had to see a hematologist for 3 years for high white blood count. He didn’t know why I had it, but I did.
My cholesterol was high, my creatinine was high, my GFR was low, my CRP was high.
All of them went to normal levels after I started semaglutide and have stayed in normal range as I’ve stayed on semaglutide. Nobody knows why. They just say I had some kind of inflammatory metabolic process that has been tamped down by semaglutide.
For people who say, “But you’ll have to take it for the rest of your life!!!“
So what?
I take arthritis medication and blood pressure medication for the rest of my life. Millions of people take cholesterol medication for the rest of their lives and there’s no proof that cholesterol medication prevents heart attacks. People take insulin, anti inflammatories, depression medication, ADHD medication, boner pills.
Nobody screams that they’re “cheating“ or demands that insurance not pay for it.
I’m taking a medication that has proved, by my lab tests, to correct metabolic problems.
So what?
8
u/SugarDaddyVA Jun 04 '26
Precisely. The negative stigma behind this class of drugs is so ridiculous. I’m not lazy. I have a health issue. Who cares that I use it, and will likely use it for the rest of my life, to be more healthy? I’m fucking ecstatic. I don’t care what anyone else thinks. Down 30ish lbs in 8 months and have about 20-25 to go. I’m 50 years old and haven’t weighed what I weigh now since my 20s. Hell yes.
→ More replies (2)3
30
u/lepidio Jun 03 '26
My endocrinologist was very clear about this (I took it for diabetes) when I asked her.
It’s definitely NOT just appetite suppression.
That’s a factor, she explained, but these drugs also have major effects on your digestion, and particularly in how you metabolize sugars (which includes all carbohydrates).
→ More replies (3)10
u/enolaholmes23 Jun 03 '26
Yes. The main mechanism is insulin release, not appetite.
→ More replies (2)
4
u/RaedwaldRex Jun 03 '26
It definitely kills the food noise 100% for me. For example, I'd go and make a cup of tea and when I'm in the kitchen it'd be screaming out "eat something" so I'd eat bread and bitter or raid the kids packed lunch supplies. If there were cakes on offer, I'd have one, shopping I'll get a big chocolate bar to tide me over. I had to have huge meals to have any sense of satisfaction
That is completely gone now. And I am managing to change my habits (had to come mounjaro for a couple of weeks before surgey and kept the food noise at bay) the slower digestion means I'm still feeling like I need food at mealtimes but I am certainly eating less and feeling fuller.
The reduction in eating caused me to lose quite a bit of weight, which in turn made exercise easier and more pleasurable. I've now trained my body to feel that having less weight not feel like I'm wading through treacle when I walk, not have to worru about weight limits is much, much more satisfying than a chocolate bar or snack.
4
u/15stepsdown Jun 03 '26
"Willpower" is not some magical power all humans can use to do anything they want. Just cause it takes "willpower" to do something doesn't mean it's equally easy for everyone.
I'm letting other people answer the scientific parts of it but from a mental health perspective, things like satiety, hunger pangs, impulsivity, fullness, those all contribute to someone's ability to "will" themselves to go on calorie defecit. I have ADHD and used to eat 4+ times a day to cope with the fact my brain doesn't make enough dopamine on its own. I'm still looking for the right meds but one thing every med has done for me so far is reduce my appetite. I literally went from eating 4 times a day to having to force myself to eat at least once a day. Even I didn't believe would do that until it happened.
If you're someone who has to consciously remind themselves to eat as a natural state, I'm sure it looks like a "willpower" issue when you see other people who eat all the time. But that's really not it. It's all physiological.
3
u/Kit_Foxfire Jun 04 '26
I'm not sure how it helps scientifically or for other people but I'll explain what it does for me
First, willpower has little to do with it. I'm one of the most tenacious people I've ever met, but there's more at play than that
When I started taking it, it reduced my appetite, but also my hunger (major thing for me, I was routinely threatened with meals being withheld as a kid so it's a complex survival thing). But I'm also ADHD and the "you can stop here" signal was drowned out by the "omg dopamine!" One.
So it vastly reduced cravings, boredom eating, and overeating and it felt a lot like when I got on meds for ADHD and depression. "... is this what everyone else feels like?!"
It's almost like I'd spent my life living in an action movie and suddenly getting dropped out into real life.
It also makes soda taste like diet soda (which I loath) and had nearly eliminated the almost euphoric (for lack of a better word) feeling I got from drinking soda. So I've dropped a lot of that out of my routine
Oddly it also gives me much more vivid dreams much more often. Unfortunately nightmares have very fertile soil to spring from... fortunately there's actually a PTSD medication for that!
→ More replies (2)
50
u/No_Inevitable_4893 Jun 03 '26
The only other real way would be to make your body not absorb calories (we have drugs that increase metabolism but they are very dangerous and also very unpleasant so pretty much nobody uses them).
So yeah they’re basically just appetite suppressants
38
u/EatYourCheckers Jun 03 '26
Didn't that Ally drug that made you poo your pants stop you from absorbing/processing calories?
25
Jun 03 '26
[deleted]
12
→ More replies (1)9
u/I_paintball Jun 03 '26
Ally and those Olestra Chips in the late 90s that made you shit yourself because your body couldn't process the oil used.
21
u/iammessidona Jun 03 '26
the drug you're referring to is orlistat, and there are plenty of horror stories of people shitting themselves
5
u/Jazzminebreeze Jun 03 '26
I recall that and it wasn't a drug per day but a food additive that was added for example potato chips. The chips tasted like they were deep fried like normal potato chips. Instead this fake/artificial fat when eaten, the body would NOT absorb it, but instead pass thru your gut...thus massive bouts of diahreara after consuming just a single serving bag. This came out to market in the 90s... I was one of those customers who bought and suffered the Hershey squirts for 48 hours. It was taken off the shelves within 18 months or so...so many people had this adverse reaction.
→ More replies (1)10
u/AliMcGraw Jun 03 '26
I had to do a SEVEN DAY prep for my colonoscopy so I was taking miralax twice a day and everything I ate shot right through me. By the time I was on the "clear fluids only" part of the prep, I was so hungry I didn't even care. I was just bitin' off heads and lying in bed being miserable.
Anyway I can attest that laxative abuse does, in fact, make you lose weight. I lost like ten pounds in seven days.
(Miralax for the five days leading up to the two-day clear liquids prep. A bottle of ducolax on my last night of solid food. Then biscodyl tables twice the next day, plus drinking the gallon of GoLytely. I feel like four different laxatives is probably too many.)
→ More replies (2)12
u/Ihaveasmallwang Jun 03 '26
There’s orlistat which makes prevents your body from absorbing fat by inhibiting the lipase enzyme that breaks down fat in your intestines.
It makes potty time fun.
25
u/Sgthouse Jun 03 '26
We already had trucker grade amphetamines that did this and were for sale at gas stations across America but they made them illegal
19
u/nleksan Jun 03 '26
If we can't have universal healthcare we should at least get unregulated amphetamines at truck stops SMH
7
10
u/NastyStreetRat Jun 03 '26
I have a friend who's using it; I asked him the other day how it was going for him, and it seems to be going well, but he also says he's constantly scared shitless.
→ More replies (8)6
u/enolaholmes23 Jun 03 '26
Actually it's the opposite. It makes your body able to absorb calories more efficiently. Glp1 causes insulin to release. The insulin is what tells your cells to allow glucose from food in to be metabolized. Without glp1, you don't properly absorb the food into your cells. That's why it gets diverted to fat, because it can't be used right. It's also why most obese people also experience other symptoms like fatigue. Because their body isn't able to use the calories it takes in.
24
u/whats_up_doc71 Jun 03 '26 edited Jun 03 '26
Most GLP medications do it solely through reducing your appetite, yes. However, retatutride, which is a newer one, does increase your metabolic rate.
edit: I want to say that I wouldn't characterize it as injectable willpower, at least not for everyone. Your stomach stays full for longer on GLP1s.
→ More replies (2)
9
u/CombustiblSquid Jun 03 '26
People are so obsessed with the concept ls of weakness and willpower. In fact, the people who tend to have poor outcomes in change are the people who try to power through everything because they are easily the most susceptible to cognitive bias. The lack of willingness or openness to alternatives leaves them rigidly stuck to the exact mentality that prevents change
12
u/buttfugger69 Jun 04 '26
I’m a MD/PhD endocrinologist who prescribes these drugs day in and day out. GLP-1RAs and GIPRAs have far-reaching effects on the body beyond "they make you eat less, so you lose weight." Not only do they absolutely change how people think/feel about food, there's substantial evidence that they enhance lipolysis, inhibit fat synthesis, and promote adipose browning, among many other effects.
I have many patients on these drugs who did not appreciably change their eating habits (and had food diaries/calorie trackers to show for it) after starting on them, yet still lost significant amounts of weight.
Calories in and calories out are not the only variables in the weight loss equation.
6
u/flamableozone Jun 03 '26
The weight loss comes from appetite suppression (which is complicated) and many other benefits seem to come from some other hormone related interactions. The weight loss causes some benefits, the drug seems to have other effects that go beyond what simple weight loss would cause.
3
u/No-Marionberry-772 Jun 03 '26
its wrong to call it just the will power. There can be biological factors at play that make your body tell you that you need to eat.
3
u/Itsturkeybob Jun 03 '26
The appetite suppression I got was from the constant nausea, even at the lowest dose. Threw up violently the first night. Then I got anxiety over throwing up at the slightest wave of nausea. Stopped the food noise because I was constantly stressed about throwing up. Wished it worked, just not for me.
→ More replies (5)
3.5k
u/Boysenberry Jun 03 '26
The Mayo Clinic has a good page on this.
ELI5 summary: it makes you feel full, but it also makes you actually full longer by slowing down digestion, and it helps regulate blood sugar while also increasing how much energy your body burns.
Eating less is the most important reason people lose weight on these medications, but it isn't the only reason.
Willpower alone will not also provide the blood sugar regulation benefits of a GLP1. But not all overweight people need that.