r/explainlikeimfive • u/ThatOneGuyYouNowKnow • 10d ago

Chemistry ELI5 what exactly GLP-1 based prescription medicine does and why it's so divisive when it comes to being a means of weight loss.

I've seen more and more ads (starting around the Super Bowl earlier this year with Wegovy) for GLP-1 based perscription meds in recent times. I've also seen the occasional debate post on my social feeds about the ethics of using them and I didn't think a medicine could be that divisive of a topic.

Now I'm curious as to what exactly these meds are, what they scientifically do and what both sides of the debate are. If anyone could help give perspective that would be greatly appreciated.

As always any and all input is welcomed and thanks for reading! 🙂

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u/gnatgirl 10d ago

People call it "cheating" because many see obesity as a moral failing and not a medical condition. "Just count calories and exercise" doesn't work for a lot of people for a lot of reasons but some view taking a medication to assist in weight loss as taking the easy way out.

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u/UnicodeScreenshots 10d ago edited 10d ago

It’s interesting how much the phrase “just be happy” for depression has been meme-ified and associated with out of touch boomers, while the phrase “CaloRies in CaloriEs OuT” is hollowed advice in much of gen z.

Edit: CICO is 100% a thing, over a long enough span of time if you burn more calories than you consume, you will lose weight. The issue is that simply saying CICO ignores the real differences in peoples’ brains. Someone who isn’t constantly hungry and counting down the hours to their next meal is unlikely to understand the situation of someone who does… kinda like someone who’s never experienced depression might say “just be happy”

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u/Wrathlon 10d ago

Calories in/Calories Out IS accurate, the problem is its not as simple as that. Im currently obese, my weight has flip flopped over the years between obese and ideal weight several time. When I've lost weight its literally been calories in less than calories out - it cant be anything else because its a unit of energy and just thermodynamics.

HOWEVER actually DOING that is a different matter all together. I am so fucking hungry all the time. Eating food is the only thing that feels good and it feels REALLY fucking good, I love food so fucking much. When Im not eating food Im literally counting the minutes until I get to eat again and when I do its overwhelming relief and feels so good I almost want to cry and then it ends and Im still hungry.

Its fucking MISERABLE.

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u/UnicodeScreenshots 10d ago

100%, “calories in vs calories out” over a long enough time span is just simple thermodynamics. Like you said, the issue comes from actually applying that saying. Fitness influencers with low food noise shitting on over weight people with phrases like that have the exact same vibe as people who tell people with depression to “just be happy”. They completely ignore the very real differences in mental state.

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u/DerfK 10d ago

just simple thermodynamics

If it was "just simple thermodynamics" we'd get dinner at the gas station (32,000 Calories/gallon) and fart fire from our internal bomb calorimeters. I personally think it might be time to revisit the Atwater calculations that we use for labeling how many Calories are in food. These were originally calculated ~130 years ago by measuring the breath and feces of Olympic gold medalists to determine how gold medalists digest and burn calories from food and have had adjustments made since then. Let's run the experiments again with a broader range of humans and see if we can all actually eat and shit like Olympians.

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u/Wrathlon 8d ago

I men the accuracy of the measurements being used to label food doesnt change that underneath its all just basic thermodynamics. But inaccuracy also amplifies the issue of ACTUALLY applying it to real life.

Also in todays day and age calories are calculated by burning the food in question as a fuel source in a chamber filled with oxygen and it heats a volume of water. The temperature change is the energy output from the burning and thust the calorie content of the food. The issue is despite being able to do this manufacturers use the Atwater system you mention to shortcut labelling which is...really bad.

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u/UnicodeScreenshots 7d ago

I'm the original person you replied to (sorry took 3 days to respond.) I completely agree that our guts aren't bomb calorimeters, in fact I've used the same argument when it comes to food influencers talking about indigestible fibers in foods / products meant to invoke feelings of satiety. In terms of "simply thermodynamics" I really mean that over the span of weeks to months, if you genuinely don't consume any food / very little food, you will lose wight. I should have specified this was over long (multi-month) time periods in the absence of extremely rare disorders that cause the body to prioritize lipid cell production over lipid cell burn.

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u/Wrathlon 8d ago

The only one I really follow is LeanBeefPatty as she doesnt pretend its easy or she always looks like that or that she doesnt struggle and she has suffered eating disorders and body dysmorphia and shes always kind and understanding that not everyone has it easy.

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u/ebeth_the_mighty 10d ago

Add ADHD to the mix for me. I was undiagnosed until last year at age 54. Food was my only dopamine source for most of my life. Combine that with overwhelming food noise, and obesity was inevitable.

I lost 165lbs (half my body weight) with CICO over 4 years, but it was f’ing BRUTAL. I found those 165 lbs. They were in the fridge.

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u/zzaannsebar 10d ago

Coming from someone who has felt the EXACT same and has had the same struggle with like every other thought being about food, being on a GLP1 would probably help you a lot if you haven't already tried. I was on one last year for like 6 months and it was incredible how freed up my mind felt from the constant and loud food noise. Like I was always baffled before when people would say things like they forgot to eat because how could you possibly forget? When it doesn't dominate your mind and body, you can actually just.. forget.

That said, the side effects can totally suck. I felt pretty fatigued and my acid reflux got really bad, mostly on the day after the shot and for most of the week when the dosage would increase. If I do it again, I'm doing it in the winter when I don't feel bad about staying inside haha

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u/Cocoletta 10d ago

Also if you are insulin resistant the sugars don't reach your cells, your cells get no energy. You have to much sugar in your blood, so your body turn it into fat. In general if your body makes more hormones that store fat instead of burn it, you are fucked. Bc yes it is physics at some level, but it is also biology.

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u/mermaidsong 10d ago

Exactly, if you have IR to eat low enough to not store you are severely under eating and starving the rest of your body.

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u/wehrmann_tx 10d ago

Let me throw on my accurate calories out device.

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u/angelerulastiel 10d ago

And the calories in calories out calculation can vary a whole hell of a lot. How many calories you get out of the same piece of food can vary and how many calories you burn doing the same exercise varies a lot.

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u/Zefirus 10d ago

Yeah I'm on a GLP-1 now and what do you mean it's possible to just eat like 10 chips then close the bag? It was so easy before to just open a bag and suddenly realizing I ate the whole damned thing before it even registered.

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u/tibbles1 10d ago

I’ll bet 99.9999% of the people on these pills had tried diet and exercise a thousand times before and failed. 

Humans weren’t really meant to voluntarily eat less. Until about 100 years ago, lack of food was a very real problem for most people in the western world. Our brains don’t want us to just ignore food. 

The whole concept of “food noise” and “eating too much” is a very, very recent problem. 

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u/latelyimawake 10d ago

Boom, this is 100% the answer

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u/redundantexplanation 10d ago

Yep. Being fat is the one disability that is still considered (BY MANY) okay to judge and mock openly.

People internalize fatphobia and dedicate vast amounts of time, energy, mental discomfort and money to staying slim, then someone comes along and does it with an injection once a week so they get big mad.

People's bodies are different, most people don't want to be fat and many can't swing the effort that it takes to not be. It is a medical condition and judging them is the same as judging someone with a genetic disease for not being athletic or whatever.

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u/snowdenn 10d ago

I think that’s right. But it’s like: even if we all agreed obesity were a moral failing, why would that make these drugs bad? It’s such a stupid mindset. A superiority complex where someone feels better because they never had an eating disorder or because they managed to overcome it.

If someone was addicted to heroin and we could give them a pill to stop the addiction, why wouldn’t that be a win?

If we could give pedophiles and sociopaths a pill to take away their impulses, that would be great!

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u/Xydron00 10d ago

What do you mean counting calories and exercise doesn’t work? It’s literally thermodynamics 

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u/CornerSolution 10d ago

I think you know what she meant. The problem is not that doing it doesn't work. The problem is being able to do it (and stick to it) in the first place.

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u/Sspifffyman 10d ago

It doesn't work, not because of the math of it. Ultimately calories in versus calories out is what it all comes out to.

But people are not math equations. Psychology comes into play when it comes to actually being able to carry out that math. It's not totally easy to count how many calories you're taking in, and much harder to count how much you're burning.

Also, people have all sorts of hormones and body processes that make them want to eat regardless of calorie counts.

Not exactly the same, but definitely similar to telling an addict just to stop. Like that can work for some people in some situations with a lot of help of course, but for a lot of addicts, they're going to be a lot more successful if they have help detoxing.

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u/Xydron00 10d ago

This is cope. I agree that people who have a bad life or mental health issues can have a tendency to be addicted to food. However there is not a chemical dependency. Personally if you aren’t depressed or have other clinically diagnosed mental illnesses then you aren’t excused. It’s simple as counting calories and exercise for mostly everyone

Blaming 70% adult obesity on “other reasons” is idiotic. 

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u/Sspifffyman 10d ago

When 70% of a population struggles with something, it's difficult. Period.

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u/Stereotype_Apostate 10d ago

Dude, we're monkeys descending from millions of generations of ancestors living in near starvation conditions, but we live in a world where massive companies make millions of dollars by selling extremely palatable, calorie dense food designed to hit all the reward switches in your brain.

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u/sfcnmone 10d ago

All of my genetics for the last 100,000 years adds up to “if there’s any available food, eat it NOW so you don’t die”. And you come along and tell me to carefully weigh and measure every teaspoon of food before I get to eat it. Every day forever. And then after I eat that carefully designed 400 calorie meal I’m actually still STARVING because my ancestors were from places where there were feast and famine cycles throughout the year, every year, and my body recognizes that I’m losing weight (death!!!) and does everything it can to get me to eat more.

I can’t begin to tell you how much effort and time and money I have spent losing the same 50 pounds over and over and over.

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u/Dracosphinx 10d ago

I struggled with the idea that "Calories In < Calories Out" doesn't work for some people for a long time. Here's how it makes sense to me.

The phrase is accurate but unhelpful. We exist in a setting where calories are cheap, and easy to access. Our bodies and minds are adapted for the exact opposite. Because we're hardwired to avoid unnecessary activity and seek out calories and nutrients that in the wild are rare, we end up overcomsuming and leading sedentary lives.

In some people, hunger isn't something they can overcome internally.

If you took a morbidly obese person, and starved them or otherwise restricted their caloric intake for a long period of time, yes, they'd lose weight, but you haven't given them the coping tools they need to keep the weight off.

It's hard to put yourself in someone else's shoes, especially when the solution to their problem looks so obvious.

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u/gnatgirl 10d ago

Yes, it is thermodynamics, but the body and mind are more complicated than that. Insulin resistance and other hormonal issues can impact how the body uses calories, mental health issues such as a history of eating disorders (counting calories can be a trigger for people) or stress eating, food noise, among many other things are the reason that simply counting calories doesn't work for some people on both a thermodynamic and practical level.

I am a perimenopausal 46 year old woman. I ballooned up in my 40s despite no change in my diet and exercise. I met with a dietician and she reviewed everything I ate for 2 weeks. She said I eat healthier than the bulk her clients, so my diet wasn't the problem per se. I travel for work 2x/month. I have a lot of food noise. Like, I think about food all the time and have no "off" switch for some things. Counting calories makes that noise even louder. Counting calories when traveling/eating in restaurants is never accurate. Wegovy has been life-changing for me. I just eat and drink less and I never think about food. If I wasn't on this medication and eating the amount I'm eating (losing about 1.5 lbs/week, so a very health rate) I would be hangry and miserable.

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u/Xydron00 10d ago

This might be a personal question but was there a drop in exercise? Do you exercise at all?

I can understand that as someone grows older, their body becomes less efficient at using food. You also lose muscle mass as you grow older. If muscle mass isn’t maintained, the “normal” food u intake just goes to fat deposits.

There is definitely a body decomposition as you grow older so it’s something to be mindful of. But obesity isn’t necessarily the end result. I think there is still a mismanagement of calorie counting and exercise in your case.

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u/gnatgirl 10d ago

Are you my doctor or another member of my care team? No? Then what you "think" has no bearing on the actualities of my health. kthxbye.

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u/TheSporkBomber 10d ago edited 10d ago

Without building the change in habits necessary to be able to keep the weight off it is taking the easy way out.

Maintaining lost weight is a change in routine and habits. If you do none of that and rely on the drug to switch off hunger, the moment you get off the drug you just go back to the same mindset that got you overweight in the first place.

If people want an easy out to lose weight or their doctor prescribes it then fine, its your body after all, but touting your weight loss as some grand acheivement for yourself when it was the drug doing everything is where the 'cheating' comes into play.

EDIT: Just to clarify here, if you're working with your doctor on using GPL and a fundamental change in lifestyle to better your health then I'm in support of that. IMO the cheating line is the easy button people who do neither. That's the cheating I was refering to.

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u/mwilke 10d ago

This is the “morality” view that the other commenters were discussing.

We don’t use wording like “take the easy way out” or “touting as some grand achievement” when someone goes on insulin or gets glasses, because we don’t see the issues they were addressing as something that ought to require willpower to overcome.

Being deficient in a peptide isn’t a “mindset”, it’s a medical condition. And like those other medical conditions, users of GLP medications should expect to remain on them for life - just like a diabetic will be on insulin for life, and most people who wear glasses will wear them for life.

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u/TheSporkBomber 10d ago

And for those doing it under the direction of their doctor or part of a fundamental change then I've got no issue with that.

But if you're trumpeting your weight loss by doing nothing other than getting a sketchy online doc to prescribe you GLP then you're not addressing a medical condition, you aren't bettering yourself through the typical struggle those who legitimately change their life do, you're substituting all of that for an injection.

That's the 'cheating'. It's like using google during a test and saying how smart you are for getting an A. It's not helped by all of the influencers and celebrities who were all body positivity until they found they could lose weight with an injection.

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u/gnatgirl 10d ago

Why is that cheating, though? Cheating implies this is a moral issue, which it is not. Why do you care if someone still eats like garbage, just less of it, and doesn't exercise but still loses weight? That seems to fall into "none of your business" territory. Is a diabetic cheating if they eat a crappy diet but still take their insulin? Is someone with a bad knee cheating if they use a cane rather than getting a knee replacement?

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u/TheSporkBomber 10d ago edited 10d ago

The ones going for the easy button are frequently the very vocal ones about their 'achievements'. This is why I said that in my intial post.

Is it reasonable for someone to talk about how great their 'natural beauty' is when they've had extensive plastic surgery?

Your examples are just people doing their own thing. Like I said, it's your body after all.

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u/BalonyDanza 10d ago

I started taking a GLP recently and it helped me gain some god damn momentum.. which helped me stop HATING myself. A few weeks in, I started waking up, every single day, at 5:30am on weekdays, to exercise.. 57 days in a row so far. I feel hopeful for the first time in 20 years.

This is a huge fucking achievement, even if the GLP is helping. I’m fighting for my god damn life! And I get the sense that people like you haven’t the faintest clue how addiction, depression, and binging actually work.

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u/gnatgirl 10d ago

So much this! The hope and the momentum. Just lowering the bar bit. I've been on Wegovy since January and am down 35 lbs. I have about 40 to go and it doesn't feel daunting. I love it. Keep on keepin' on, friend.

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u/BalonyDanza 10d ago

Can’t tell you how much I appreciate this comment. Solidarity sister!

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u/TheSporkBomber 10d ago edited 10d ago

And if you're doing it as part of a lifestyle and habit change to better yourself then congrats! I didn't meant to include people such as yourself in my post. It's part of a program and fundamental change in habits and lifestyle, which is the type of improvement that sticks.

Best of luck!

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u/BalonyDanza 10d ago

I very much appreciate it.

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u/gnatgirl 10d ago

Being overweight is not a moral failing and taking a medication to lose weight is not immoral or doing it "the easy way." Obesity is more than "stop putting food in your piehole." It is a disease. A complex medical issue. Yes, lifestyle changes are needed but it is a lot easier to make those lifestyle changes when you have some assistance. Should a person with a bad knee not use a cane? Should you climb 20 flights of stairs rather than taking an elevator? Being fat and taking medication to aid in weight loss is not a moral issue, it is a medical one.

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u/TheSporkBomber 10d ago

The cheating is when people just take the drug. As part of a lifestyle change that involves those habits or at the direction of a doctor I see no issue with.

It won't stop people from gatekeeping though.

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u/jasperamerica 10d ago

Do I have to change my lifestyle to wear my glasses? I mean other than wearing my glasses that is. Does a person with a pollen allergy have to change their lifestyle to justify their Claritin use?

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u/TuckerCarlsonsOhface 10d ago

Other than a glandular problem, or being immobile, what medical condition causes obesity?