The premise, IIUC, is that obesity is driven partly by mucosal overgrowth on the duodenum. This thicker-than-expected layer of mucus is less porous, which leads your digestive system to underestimate the number of calories you've consumed. Revita basically re-surfaces the duodenum.

So, the idea is that you get to a lower weight with the GLP-1 drugs, and then Revita can hopefully reset your set point there.

Their first clinical trial is still in progress, but I think it's interesting to watch.

[0]: https://www.fractyl.com/our-platforms/revita/

Just like alcoholism, or any kind of other addictions.

I've struggled with alcohol abuse, and once you come to the realization that you're abusing it, the fix FOR ME was relatively simple: I stopped (under medical supervision) drinking, or to be more precise: I stopped starting to drink. I have no problems not drinking, I have a problem that when I start I cannot stop.

I have the same issue with food. Not eating is a lot easier than stopping to eat. But I cannot completely stop eating.

Yet with alcohol people are like: hey, good for you.

With my weight issues people are like: dude, just eat less, or exercise more.

(I stopped sharing the food story with people).

When an obese person regulates their eating and loses weight, the hunger often doesn't go away - and often increases. This is physical, not psychological hunger. When the obese person almost inevitably returns to eating to fullness, they regain weight.

When a person takes GLP-1s, hunger is greatly reduced, and an obese person can eat less food while still achieving satiety without gaining weight. When they stop taking the GLP-1s, the hunger returns, and when they return to eating to fullness, they regain weight.

Similarly, when a person takes stimulant weight loss medication, they can eat less food while experiencing less hunger, and thus lose weight. Similarly, when they go off of the stimulant (or develop a tolerance), the hunger returns and when they return to eating to fullness, they regain weight.

In many obese people, the hunger is present even when they eat a nutritious meal at the appropriate number of calories to maintain their weight. Common advice is to say "this mix of macros or foods makes me satisfied!" and, well, that's great for you but not universal.

People who naturally feel reasonably satisfied with an appropriate number of calories to maintain their weight still experience hunger, but not with the intensity or insatiability of that hunger that many obese people do.

While it does occur with some who have severe eating disorders, most obese people do not overeat themselves into obesity by continuing to eat long after they're full. They eat until the hunger goes away.

It's the hunger. Take away the hunger, and the weight goes down. Bring back the hunger and the weight goes up. It's simple, it's obvious, and few say it.

This is my biggest issue with weight healthcare, the idea that if only the patient would eat correctly they wouldn’t be overweight. It’s not some moral failing a person often over eats, it very well could be some physiological issue that should be treated. It would be like telling someone with asthma that they just need to get into better shape to breathe better.

I don't count calories. I went off Ozempic (now Mounjaro) and I gain weight at about 0.5-1kg a month.

As I am resistance (gym) training, significant % of that ends up being muscle mass rather than fat.

So I end up taking Mounjaro for about 1-2 months every 3-4 months, approximately 33% of the time being "on".

Funnily, I end up with bulk/cut periods without doing them explicitly. This ends up working well for growing muscles.

Notice all people in the story are women. I guess pairing GLP-likes with bodybuilding works quite well for men. As times goes on, I end up needing mounjaro less due to my increased muscle mass.

I ask this because when I was younger, I also had tastebuds warped by hyper-palatable foods, but after incrementally getting my diet to such a clean and optimized place, I literally feel bad even while chewing and tasting something like a donut, heavily salted and oiled potato chips, or candy. It's probably like how I would have felt if I literally mixed a tablespoon of oil and sugar or salt together and swallowed it.

Is it that hard to shift the system toward better habits by incremental introduction of better ones, and crowding out the bad? Exercise helps here, because once you begin to enjoy fitness, you get a stronger feedback loop with the bad food creating bad outcomes.

I think obesity is hard to fix even when you are not a “thermodynamics denier” (as another commenter said) because all you can practice is moderation from the get go. How many people would fail to fix their alcoholism if complete abstinence, even just a period of complete abstinence to rewire the brain, was never an option? They actually had to go down to the pub and practice stopping everyday at 1 pint?

I missed doses long enough that I had to start at the beginning, but I avoided that because I had to book and appointment with my doctor and get prescribed the lower dose, etc.

So I gained the weight all back and then lose it again when I got back on the doses.

Pointless human interest story with some rent-a-quote expert sprinkled in that tries to imply some ominous danger but can't come up with any hard data on that themselves.

That said, its a little disheartening to see people who are 10-15kg overweight also resort to these drugs - this kind of excess weight can be fought with simply diet and exercise