Older Americans Are About to Lose a Lot of Weight

https://www.theatlantic.com/health/archive/2024/02/ozempic-weight-loss-older-americans-boomers/677371/

by paulpauper • 2 years ago

17 126 2 years ago

paulpauper2• 2 years ago

Batsis said. But even when a weight-loss treatment benefits an older patient, what happens when it ends? People tend to regain fat, but they don’t recover bone and muscle,

This is false. People can regain muscle, such as after an injury or paralysis. Resistance training works at all ages.

Also one must take into the marginal utility of these drugs, which may not justify the cost if the result is only a little extra life expectancy.

sickofparadox• 2 years ago

Obesity does lower life expectancy by a lot, that is not 'the narrative'. The marginal utility of an anti-obesity drug goes beyond extending life expectancy into a huge number of areas that come together to increase quality of life, mobility, memory, and ability to live independently. With fewer young people to care for the rapidly aging population, making these people require less care overall is a necessity if we are going to ensure they live with dignity.

Kirby64• 2 years ago

It’s much harder to regain muscle, though. Especially as you’re older. And if weight loss drugs are done without regard for diet (ie you just eat chips… but fewer chips), then muscle loss would be expected.

NotGMan• 2 years ago

The problem for old people is that it's hard to get bone and muscle, as most of them simple will not exercise.

Also stomach acid drops a lot in old people which makes protein digestion even harder.

In the ideal world, assuming GLP1 is not toxic long-term and that they can keep the weight off, people would exercise to regain muscle.

But if those people got obese in the 1st place, do you really think many of them will suddenly uptake exercise for more than a New Years resolution week or two?

earthtograndma• 2 years ago

Yes.

0cf8612b2e1e2• 2 years ago

People can also lose weight through discipline. Yet here we are.

Retric• 2 years ago

It works on short timescales but discipline has almost zero correlation with long term (5+ years) weight loss.

Drugs, bariatric surgery, and even techniques / lifestyle change make a difference. Discipline alone gets eroded by various hormonal systems aiming to return lost weight.

snapcaster6• 2 years ago

Exactly, "here we are" meaning we're in a place where we can admit that the "discipline" approach has completely failed and we need another idea?

Etheryte• 2 years ago

You've cut the quote out of context and as such missed what is being said. It might help to rephrase the quoted sentence: when an older patient stops weight-loss treatment, on average they regained the fat, but didn't recover the bone and muscle. The point isn't about what's possible, it's about real outcomes that happened. The older you get, the less your body responds to resistance training.

switchbak2• 2 years ago

After the age of 50, there's a marked and steady yearly loss of muscle mass. This is a huge driver of morbidity in older folks. This has been studied extensively and isn't particularly controversial. [1]

I would expect the proportion of people > 50 that perform resistance based weight training to be small. Adding a drug that diminishes your muscle mass when you can least afford to lose it sounds like it could be terrible for that aging population.

1: https://generic.wordpress.soton.ac.uk/mrclec/research/muscul...

tuatoru3• 2 years ago

At 63, I have gained about 4 kilos of muscle mass and lost about two kilos of abdominal fat in three months by doing more rucking (backpacking, up hills).

Older people need a high protein diet, but muscle gain isn't impossible, nor is muscle loss inevitable.

Sakos2• 2 years ago

I would expect the proportion of people > 50 that perform resistance based weight training to be small. Adding a drug that diminishes your muscle mass when you can least afford to lose it sounds like it could be terrible for that aging population.

Then prescribe weight training in addition to it. This isn't rocket science. Older folks should be doing exercise to offset the potential loss in muscle and bone mass anyway. It works. We've proven it works. We've proven it improves health outcomes and quality of life long-term going into old age. This isn't just something that should be waved away with "ah, well, we've proven people lose muscle mass, nothing we can do about it".

lmpdev• 2 years ago

As someone who’s been 150kg and 75kg, fat, fit and everything in between I can guarantee you fat and muscle/bone do not build or atrophy at the same rate, both volumetrically and temporally

Bones and joints are especially slow to adapt (in both directions). Even losing ~0.25kg/w for a year is sufficient to cause my shoulders to frequently sublux if I attempt to raise my arm above shoulder height

And trivially, gaining weight without proper training or too quickly can result in insufficient time for your bones and joints to adapt, placing them under potentially dangerous stress

The time scale the article is talking about does not follow the same trends as recovery from sudden and complete mobility cessation (injury/paralysis)

Resistance training does work at all ages, but the degree to which it is effective varies greatly, and its recommendation is potentially dangerous if applied bluntly to all people

QuercusMax2• 2 years ago

Article is from February. Paywall-free archive: https://archive.is/n9Ots

JKCalhoun• 2 years ago

Economists say the cost to Medicare of giving new drugs for obesity to just a fraction of this aging generation would be staggering—$13.6 billion a year, according to an estimate published in The New England Journal of Medicine last March.

Man, drive the prices of these drugs down already.

Can an LLM tell me how to synthesize semaglutide? Can a YouTuber take a stab at producing liraglutide in the home lab? Maybe an underground railroad of sorts between neighboring countries where the drug is sold for less....

andrewla5• 2 years ago

2031 is when it becomes entirely (in the US) unencumbered by patents for its use in weight loss according to Wikipedia.

The initial patents seem to date to ~2008 which means that as of 2028 the synthesis will be free of patents, but you won't be able to market a generic for weight loss until the non-exclusivity period ends. [1]

There are already "compounding" pharmacies in the US that sell it cheaper; I can't seem to find a straight answer on what the hell this means though.

[1] https://www.fda.gov/drugs/development-approval-process-drugs... if you're interested in the FDA's summary -- I found this to be almost entirely useless though.

simoncion2• 2 years ago

...I can't seem to find a straight answer on what the hell this means though.

This may help to explain it: <https://www.astralcodexten.com/p/the-compounding-loophole>.

Sakos2• 2 years ago

1) Drugs in medicare need to be cheaper, absolutely, but that's regulatory/legal issue, not something that can be solved by tech.

2) $13.6 billion sounds like a lot. But what is it costing the entire economy by not "curing" obesity with these drugs? How much is spent on health care, how much lost utility and lost quality of life is there for older Americans who are obese?

kwhitefoot3• 2 years ago

I'm still wondering why so many people are so much heavier now than they were fifty years ago and why instead of attempting to medicate our way out of the problem we don't try to attack the actual cause.

Aaronstotle• 2 years ago

I am going to guess that its a combination of the prevalence of ultra-processed foods coupled with a steep decline in physical activity.

kiba5• 2 years ago

We're going to need to medicate our way of the problem while waiting for a public healthy policy that actually works.

It's not like we didn't try, but what we tried didn't work and never really iterated toward something that works.

tomcar2883• 2 years ago

It works for me. The secret is simple: Eat food, real food. the trick is to know what real food is (6 main food groups: Beans, whole grains, veg, fruits, nuts/seeds, tubers)

tourmalinetaco3• 2 years ago

The reason nothing has worked is because food companies, who pay out massively to regulators, rewire our basic desires to make us buy more of their sugary slop. And now, we have medical companies, who also pay out heavily, trying to cash in even more. I highly suggest reading “ Salt Sugar Fat: How the Food Giants Hooked Us“ by Michael Moss, and “The End of Overeating: Taking Control of the Insatiable American Appetite” by David A. Kessler, former head of the FDA.

mensetmanusman• 2 years ago

Activity levels have collapsed.

You can save yourself years of extra health-span standing in any way more than sitting.

Turns out knowledge work is just as dangerous as physical work, you just die in a different way and the coffin is larger.

naveen99• 2 years ago

But life expectancy is higher now with knowledge work and lower activity levels.

klingoff2• 2 years ago

This is true and contributes to poor health, but I don't think it is the primary factor for weight. It is very hard to excersize yourself out of a high calorie diet.

It's really pretty shocking how much added sugar there is in anything with more than 1 ingredient, and getting more sweetness in is basically a race with every other element of someone's diet. The 1980s had it junk food, but there was still other food.

otabdeveloper43• 2 years ago

The human body doesn't have a power-saving mode.

You burn roughly as many calories walking as you do sleeping.

teekert5• 2 years ago

Apparently it's not exercise! [0]

Yes exercise is very healthy, that has been proven, but loosing weight is mostly a matter of eating less, at least according to this (reputable) meta source. Apparently, over eating but not getting fat (which holds true for me), leads to other problems (also true for me, I have an autoimmune disorder).

Eat less to lose weight. Exercise more to be healthy.

(nice, got my first downvotes in less time it takes to watch 1/10th of my source ;))

[0] https://www.youtube.com/watch?v=vSSkDos2hzo

amriksohata• 2 years ago

Nonsense this is what the food industry tried to tell us when we know it's sugar

tuatoru3• 2 years ago

Talking about "activity" is like identifying an organism as "a plant". There is huge diversity.

Walk uphill 400 metres altitude gain every day, and you will lose weight, yes. Run uphill 400m every day and you will lose even more. Carry a backpack, and ... you will put on muscle.

Walking or running on the flat, not so much.

groby_b• 2 years ago

Because we don't know why. We have many suspects, but no concrete evidence for any of those, and in many cases, not even clear mitigations. (Let's pretend for a moment it's e.g. all about PFAS, what do you actually do about them? And what do you do once there's the inevitable political outcry that it's just spoilsports from the other side trying to ruin your life?)

And so we medicate, because that's the only thing where people can say "my neighbor did it, and look, it worked for them, I'll do it too".

logicchains• 2 years ago

We know exactly why; the average American dietary caloric intake has increased to three thousand and something, which is more than the average person burns, especially if the person is as sedentary as the average American. More calories eaten + less exercise = more weight gained.

rrr_oh_man2• 2 years ago

Because we don't know why.

Really?

It’s Calories In - Calories Out.

tomcar2883• 2 years ago

Yes, Most people don't know why. But nutritional researchers like Micheal Gregor (he and his team have read over 20,000 research papers! just for one book - how not to die) know why. The problem is all the people who get the most views on youtube, TV and social media are the people who are best at operating businesses and SEO. they often don't know all the research (and even give bad advice sometimes) and hence we get all this back and forth that we see all over the place. Meanwhile, the real researchers who know what they're talking about and are very knowledgable about nutrition and health don't have time for SEO and running a successful media empire. they're content doesn't get viewed very much.

Jtsummers2• 2 years ago

Our diets have gotten worse and we've become even more sedentary.

Why don't we attack that? Because 30+ years of evening news clips showing obese people walking or sitting and handwringing about the obesity crisis have done nothing, and that seems to be the extent of our ability to act.

cma• 2 years ago

Fifty years ago there were like 3-5 TV channels in rural America, no smartphones, and a good bit less automation in rural work. That may have made it more physically involved, and there was a higher proportion of people living rurally vs cities than now too.

tomcar2883• 2 years ago

what i find fascinating is, you'll see soooo many advertisements about various medications for so many illnesses, all of which are under the umbrella of metabolic syndrome. and then in the background, you'll see people consuming ice cream and pizza, etc. these ads aren't randomly constructed. every short scene is designed to communicate a certain message.

bendigedig• 2 years ago

Neoliberalism is allergic to addressing most root causes.

RobRivera• 2 years ago

You'd be surprise how much dietary choices and options impact this in America.

Go to Europe and eat home cooked meals there. Your health will improve

dboreham• 2 years ago

Go to Europe where there's public transportation.

yurishimo3• 2 years ago

As someone who moved to Europe and also lost quite a bit of weight, the bigger factor was eating out is hella more expensive here. Junk food is also more expensive though still relatively cheap, at least in the Netherlands.

But yea, the EU does a lot better job policing what goes into food and it shows. Fruits and vegetables and meat that I buy here spoil within 2-4 days (and 4 is pushing it)! I had to adjust my purchasing habits because it would go bad before I could eat it all.

The public transportation and push to cycle and walk definitely helps, but at least where I live in the south, most families still own at least one car. The difference is that they only use it to drive to work and for trips. Any errands are done on foot or on a bicycle.

toomuchtodo• 2 years ago

Corn subsidies, and what ag subsidies incentivize in general. There is no lobby for a healthy diet, or providing subsidies for it.

aantix2• 2 years ago

There’s been no shortage of proposed solutions and education.

Weight loss is apparently a 90 billion dollar industry.

It’s just that the long term weight loss outcomes are still abysmal.

New approaches are gladly welcomed.

yurishimo3• 2 years ago

Because we’re genetically engineered to crave stuff that is awful for our bodies in high amounts. Finding sugar in the wild meant foraging for berries for hours or fighting bees for honey. Now you can buy it at the supermarket cheaper than a head of lettuce.

iskander• 2 years ago

we don't try to attack the actual cause

It's cars and large houses peripherally connected to amenities by car-only infrastructure.

People love this lifestyle and will fight you very energetically if you try to do anything to nudge city layouts towards the previous level of walkability.

mysterydip• 2 years ago

fight you very energetically

Until they run out of breath, anyway.

tonetegeatinst• 2 years ago

While the biking/walkable city is a nice concept, it ignores how it is incompatible with certain lifestyles and hobbies.

Anyone into machining, high powered rocketry, or shooting or hunting.

YMMV but I doubt you could have a magazine and pass inspection from the BATFE or your state inspection for fireworks or explosives. And dense living near a gun range is impossible unless you got money to build a long range that can catch any stray rounds, when done in a rural area this is done using natural land and hills or building dirt mounds, which a walkable city would not have.

jackcosgrove• 2 years ago

There are many causes, one of which that hasn't been mentioned already is the decline in smoking.

I'm not saying we start smoking to lose weight, but it does suppress appetite. Now we have FDA approved medications that can do that.

ProfessorLayton• 2 years ago

People may be heavier than 50y ago, but people are also taller than they were half a century ago.

"...the average height of a man aged 20-74 years increased from just over 5-8 in 1960 to 5-9 ½ in 2002" [1].

Despite the higher weight, life expectancy has increased too [2]. I'm not trying to handwave obesity rates, but pointing out that it's a mixed narrative.

[1] https://www.cdc.gov/nchs/pressroom/04news/americans.htm

[2] https://www.census.gov/content/dam/Census/library/publicatio...

QuercusMax2• 2 years ago

My parents had 4 boys, two of them in the early 70s and two in the early 80s.

Our heights are, in order, from oldest to youngest:

* 5' 7", same as our father

* 5' 9"

* 5' 11"

* 6'

Now obviously the sample size is quite small, but we've always wondered if nutrition had something to do with it.

adonese• 2 years ago

You are not alone in this.

https://slimemoldtimemold.com/2021/07/07/a-chemical-hunger-p...

This series of blog posts goes through various theories (and myths) regarding obesity.

gruez• 2 years ago

A rebuttal to that piece:

https://www.lesswrong.com/posts/7iAABhWpcGeP5e6SB/it-s-proba...

Their thesis doesn't hinge entirely on lithium, but their sloppy work and responses to the rebuttal mean people should take their work with a huge grain of salt.

teaearlgraycold2• 2 years ago

Eating healthy, in the appropriate amounts, and exercising daily is the solution - obviously. Moving the mountains necessary to change America's average diet and lifestyle is much harder than giving out a drug. I agree that the drug isn't the "right" solution. But I'll take a half measure over what we've been getting.

keybored6• 2 years ago

So are you wondering? Or you do know the "actual cause"?

kwhitefoot3• 2 years ago

The proximate cause is obvious: more calories consumed than are necessary to maintain weight.

I do understand that the causes of over eating are not necessarily so simple.

What I wonder about is that essentially no government has an explicit policy to combat this despite its obvious negative consequences.

andrewla5• 2 years ago

I believe Yudkowsky has put forth a theory that somewhere in our environment there is a "GLP Supercharger" that's causing the opposite effect of the GLP-1 agonists.

If a lizard bite can make you thinner, maybe there's a metaphorical lizard bite that's making us fatter.

paulpauper2• 2 years ago

Some people get fat just looking at food, and this may get worse with age. Slow metabolisms, bad genes can play a role. This does not necessarily explain rising rates of obesity over time, but it can explain how some people become obese so easily despite not eating that much or why obesity is so hard to treat or the high failure rates of dieting.

tuatoru3• 2 years ago

My step-grandson has taken up boxing at the age of 15. He has lost five percent of his body mass simply by ceasing to drink soft drinks ("pop", in some parts of the USA).

Drink water or black tea or coffee.

ams92• 2 years ago

People aren’t eating the right foods and not exercising enough. The cause is very simple, the solution is not. It’s hard to get millions of people to make lifestyle changes and that’s even assuming they have access to healthier food in the first place.

OptionOfT• 2 years ago

Our food is no longer made by people. It is made by companies who make money taking the cheapest ingredients, reconstituting and selling it as 'food'.

I recommend reading this book https://www.amazon.com/Ultra-Processed-People-Science-Behind... (or the audiobook) to learn what makes our 'food' so much worse than 50 years ago.

If you want something more moving, this is good documentary by the same the doctor: https://www.youtube.com/watch?v=5QOTBreQaIk

thefz3• 2 years ago

why instead of attempting to medicate our way out of the problem we don't try to attack the actual cause

Have you noticed that every time this discussion comes up in this forum, simple personal intervention is glossed over as a solution? Causes for obesity, for HN users, are:

- The Environment - The Lack of Walkable Cities - The Policymakers™ - Too Many Cars - The Government Lobbied By Food Corps et cetera.

While none of the above has directly put calories into a person's mouth, and the only responsibility is on the mouth owner, we sometimes forget that the simple solution to the obesity crisis is: caloric restriction. This solution however has a major drawback: it requires being slightly uncomfortable for a tiny amount of time, which is unacceptable to most. So, enter the Magic Pill: No effort is required whatsoever, and we can keep on blaming external factors for what enters our mouth.

belZaah• 2 years ago

Oh were it that easy. While, absolutely, you could not gain weight with a calorie deficit, a targeted calorie deficit alone is not a direct path to loosing weight. If what you eat goes straight to fat (sugar, highly processed foods etc), you’ll still be lacking immediately available sugars to fuel your day. Cue your body slowing down the metabolism while resisting using the fat reserves. What you say is true (and, per personal experience, even the discomfort might not be there) only if the food eaten is of high quality and varied.

beezlebroxxxxxx2• 2 years ago

It's good to have a tool like GLP-1 in the quiver. But we really need to start focusing on childhood weight stats/obesity. School lunches are often disgusting, if offered at all. "Lunch food" served at grocery stores is often more like candy. Whole cohorts of kids enter and leave the public school system with poor diet and nutrition habits that will persist for life, with the high likelihood of corresponding lifelong health problems as well. I feel it is a social and moral imperative for everyone to take a hard look at the future many of these kids will have.

This is not even mentioning the growing sedentariness of many young people's lives. This stat explodes as people enter the workforce. Simply going for a 30min to 1hr walk once a day can give you more exercise than enormous swathes of the population.

DavidPeiffer• 2 years ago

School lunches are often disgusting, if offered at all.

Are there any instances where school lunches are not offered at all? I believe it's a requirement for public schools across the US, but I'm not sure if that requirement would extend to private schools.

beezlebroxxxxxx2• 2 years ago

It is a requirement to offer lunch in public schools in the US. Very few states are free. Some kids qualify for "reduced" cost depending on the district and their parent's income. The variance in the quality can be huge depending on the district.

I was in school in the 2000s. My school's food was almost always more like fast food than actual meals. Fruits and vegetables were not a big component, or weren't available at all, and the food never seemed "fresh". A lot of kids were kind of embarrassed to be seen eating the food. I know some kids that often skipped meals to just eat candy or went to cheaper vending machine fare.

ks2048• 2 years ago

It would be an interesting turn of events if our economy tanked from huge numbers of people buying significantly less food.

melling• 2 years ago

What percentage of GDP is food? And if that dropped 10-20%?

swe_dima• 2 years ago

Last year I decided to give a try to semaglutides, at the time I was exercising pretty heavy, both weight lifting and long distance running.

And then I went to vacation to Maldives for a couple of weeks. Not much chance to exercise when you are locked on a tiny island.

I surely lost some fat during these 2 weeks, but the amount of muscles I lost? Jeeez! I think it offset my training goals by 2 months.

I realized how unhealthy it was, you are literally starving and not feeling it, and I kept myself on a low dose!

When you consume food it's not just calories, it's also nutrients, if you eat a lot less you are body is missing out on all the essentials!

So it might be a magic pill in some sense, but in other it's extremely unhealthy.

Later that year I have actually lost more weight by doing more long-distance running, that motherfucker burns calories big time and in a healthier way.

snapcaster6• 2 years ago

Can you talk more about the muscle loss? I've read that, but is it any different from the loss of strength when dieting "naturally"? Like, I've lost significant amounts of weight before and my bench press/etc. all went down just due to loss of body mass. Are you saying it's somehow worse than that in terms of muscle loss?

Older Americans Are About to Lose a Lot of Weight

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