[HN Gopher] Launch HN: Fella (YC W20) - Tackling men's obesity u...
___________________________________________________________________
Launch HN: Fella (YC W20) - Tackling men's obesity using medication
and coaching
Hey HN! I'm Richie from Fella (https://www.joinfella.com), a
telehealth clinic for men with obesity. Fella helps men get to a
healthier weight by matching them with a board-certified obesity
doctor to prescribe an FDA-approved medication, while they
undertake personalized health coaching. I personally struggled
with stress eating for 6 years. During that time, I was at
Cambridge University, then built and sold my first company working
with the UK government. It was tough, and poor eating habits as a
teenager became a coping mechanism as an adult. Fella first
started as a "CBT+community" product to help men battling stress
eating. It resonated due to the stigma around men's eating
struggles. But we realized we were only half-serving most of our
customers: even when no longer stress eating, most guys weren't
getting to a healthier weight. So we started researching
effective, evidence-based treatments for obesity. When I say "we",
I really mean my co-founder Luke. He studied medicine at Cambridge
University, developing a patented AI approach to detecting cancer
at a YC bio company, before moving to Microsoft Research. He parses
bio papers better than me... Obesity treatment is about to
radically change. This is thanks to a breakthrough medication -- NY
Times called it a "game changer" in Feb 2021 [1]. The medication
was approved by the FDA in June 2021 [2]. It leads to an average
15% decrease in body weight, efficacy close to bariatric surgery
[3]. However, medication-assisted treatment for obesity is still
stigmatized by family doctors and therefore hard to access.
Moreover, only 10% of those using weight management services are
men, despite men representing 50% of those with obesity. This is
because almost all programs market to women, placing too much
emphasis on looks and not enough on health for a male audience.
Stress eating is widespread among bigger guys, but mostly ignored
-- with too much focus on willpower and "eat less, move more". This
needs to change. So we pivoted to the Fella you see today: a
telehealth experience with a board-certified obesity doctor for
FDA-approved medication, combined with personalized health
coaching. We went live in Texas in July, and are soon to be live in
California and New York. Fella is a 12-month program and costs
$149/month, paid quarterly. We'll bring costs down over time to
improve accessibility. We still have lots of difficulties ahead.
The main one could be insurance reimbursement: the latest wave of
medications are expensive and insurers don't like to cover them
[4]. We're excited to hear your ideas, questions, concerns,
feedback -- and maybe any personal stories. I'll be responding to
comments all day, or feel free to shoot me an email at
richie@joinfella.com. [1]
https://www.nytimes.com/2021/02/10/health/obesity-weight-los...
[2] https://www.fda.gov/news-events/press-announcements/fda-appr...
[3] https://www.nejm.org/doi/full/10.1056/NEJMoa2032183 [4]
https://www.bloomberg.com/opinion/articles/2021-07-19/weight...
Author : rich-cartwright
Score : 113 points
Date : 2021-08-21 14:36 UTC (8 hours ago)
| utunga wrote:
| You went to Cambridge how hard is it to understand that some
| people on the internet don't live in the US??
|
| I clicked on "are you eligible?" in attempt to determine exactly
| this question - but instead endured literally fifteen screens of
| Jedi mind trick sales process bullshit before finally hitting the
| old "What state are you in?" drop down that doesn't even give an
| option outside the US.
|
| Why?
|
| I hope you do one day make this service available overseas.. But
| in the meantime you've managed to really piss me off
| rich-cartwright wrote:
| I'm really sorry - I honestly thought we'd added that in
| yesterday in prep for having more exposure via HN. Very much my
| bad.
|
| If you still want to go down on our waitlist, please do drop me
| a line on richie@joinfella.com
| rich-cartwright wrote:
| Hey folks, Richie here, co-founder of Fella. I'll be responding
| to comments all day, or feel free to shoot me an email at
| richie@joinfella.com.
|
| If you'd like to check out the site: https://www.joinfella.com/
| qeternity wrote:
| Best intern we ever had ;)
| rich-cartwright wrote:
| Haha fancing seeing you here
| MattGaiser wrote:
| Ever think of branching into addiction? That's another place
| where evidence based care is sorely lacking.
| rich-cartwright wrote:
| It's a possibility. There's already another YC co doing great
| things in the addiction space: https://www.quitgenius.com/
|
| We'll have to see. We have a long way to go in the coming years
| reaching the 35 million men in the US who are fighting obesity.
| dave333 wrote:
| How long before there's a generic version of these drugs,
| Semaglutide and Liraglutide? I assume Medicare doesn't cover
| these yet.
| thegypsyking wrote:
| What visa are you guys on in the us? I work at big corp on l1 and
| would love to be a founder but waiting for green card...
| lharries wrote:
| You could go the O1 route. The Peter Roberts HN posts (the
| immigration attorney who does work for YC startups) has lots of
| great info on this area:
| https://news.ycombinator.com/item?id=27560781
| thegypsyking wrote:
| I'm aware about it in theory, but I think for people already
| in us on a work visa it's a chicken and egg problem between
| starting and getting the o1. I can't start anything as I can
| only work for my employer, and I can't get an o1 because I
| can't start anything. Looks like the founders are not
| interested in answering this one.
| rich-cartwright wrote:
| We're actually not based in the US right now as we had to
| return home for covid, and we're building a remote co.
|
| To be honest we sadly don't have any useful advice for US
| visas: it's not a fun system.
|
| Only thing is it's now more possible than ever to soak up
| US culture, run a US-focused company, but not be based in
| the US. But that's not what you wanna hear if you've built
| your life there. I'm sorry we can't be more helpful
| thegypsyking wrote:
| Thanks for answering! I guess it's true remote work is
| taking over, good luck with everything!
| ChemSpider wrote:
| The catch with this "wonder drug" semaglutide is: It has to be
| taken _life-long_, not just during a diet!
|
| So when you are 30 now, you will be on medication for the next
| 40+ years. This is a long time.
|
| => Long term side effects are not known yet. In animal studies,
| semaglutide caused thyroid tumors or thyroid cancer. It is not
| known whether these effects would occur in people using regular
| doses.
| lharries wrote:
| (Richie's co-founder here)
|
| > The catch with this "wonder drug" semaglutide is: It has to
| be taken _life-long_, not just during a diet!
|
| This is why the coaching part of the program is so important.
|
| Whether it's taken for a while or just for the first year will
| depend on the person, whether they are also diabetic and how
| much weight they have to lose. It's a personalized decision
| based on a conversation with their obesity doctor.
|
| After around 12-months on these medications the weight loss
| plateaus (at an average of 15% body weight). If one stops the
| medication then but hasn't made any changes to their lifestyle
| they'll likely put the weight back on. But during the 12 months
| of the program we will be tackling the other factors with the
| coach: sleep, stress, nutrition. And so after the first year it
| might well make sense to reduce the medication or stop
| completely.
|
| It's also likely we'll continue to see new medications and
| improvements with our understanding of obesity that makes being
| on this particular medication for 40+ years very unlikely.
|
| > Long term side effects are not known yet. In animal studies,
| semaglutide caused thyroid tumors or thyroid cancer. It is not
| known whether these effects would occur in people using regular
| doses.
|
| Semaglutide was FDA approved for diabetes in 2018 (3 years ago)
| and in June this year for weight management. It's part of a
| class of medication called GLP-1 RAs which operate in a similar
| way (they all stimulate the same GLP-1 receptor). Liraglutide
| is another common one that was approved by the FDA in 2010 (11
| years ago) for diabetes (by the EU in 2009) and for weight
| management in 2014. So there is a 3 year of history with this
| particular medication and an 11 year history for this class of
| medication.
|
| Here's more about the history of GLP-1s and other weight loss
| if you'd like:
| https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...
|
| It's worth noting that, as with any medication, there is a
| cost-benefit trade-off. In this case it will depend on
| someone's current weight, what they've tried in the past, and
| the risks of other conditions e.g. heart disease, diabetes, and
| their past medical history. Each person that joins Fella has an
| in-depth discussion about this with an independent obesity
| physician and is welcome to speak it through with their own PCP
| too.
|
| https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
| bambax wrote:
| Do you plan to open in Europe at some point?
| rich-cartwright wrote:
| 100%. We're actually British founders so it's been a baptism of
| fire learning about the nuances of US healthcare! That said,
| the US is the focus for the moment, so we're not planning to
| expand to Europe for quite a while.
| danpalmer wrote:
| What was the reason for going after the US market instead of
| the UK market?
|
| I'm in the UK and would love to try Fella, especially if I
| could get it on the NHS with a GP referral.
| rich-cartwright wrote:
| UK market is tricky for a few reasons. Very centralized
| decision-making for healthcare funding, and the timelines
| are too long for a startup to survive. Plus us Brits are
| definitely more hesitant of medication approaches in
| general, although that is changing.
|
| Both my parents, my sister and my brother-in-law work in
| the NHS - so lots of interesting family conversations about
| this!
| f6v wrote:
| > What was the reason for going after the US market instead
| of the UK market?
|
| Might have something to do with exorbitant amount of money
| in the US healthcare.
| rich-cartwright wrote:
| Bigger spend is definitely important. Drug approval,
| decentralized decision making, consumer norms all also
| important.
| newsclues wrote:
| Canada?
| rich-cartwright wrote:
| Not for the coming year. We'd love to as soon as we have
| capacity!
| [deleted]
| Eextra953 wrote:
| Great Idea!I checked out the website and it looks like it is
| targeted towards older men (40+). Was there any particular
| reasoning for this? I'm in my 20s and I know a lot of men my age
| who are obese. Was the program developed specifically for older
| men?
| rich-cartwright wrote:
| Really good question. In our customer dev, we tended to find
| the older guys were a more motivated initial audience because
| health concerns are more top of mind. Plus there's still a lot
| of hesitancy & stigma around medication for obesity, but the
| older guys are more ready to take that step.
|
| Fella works just as well for younger guys. Any more questions I
| can answer?
| aadvani wrote:
| A lot of docs I know are prescribing GLP1s already for weight
| loss, off label. When they get RCT data, get coverage, you guys
| will be way ahead. Congrats, amazing concept.
| aadvani wrote:
| I remember reading studies of 30-36 lbs in a year, IF they
| maintain diet and exercise. I see this adherence as your
| competitive advantage.
| rich-cartwright wrote:
| 15% average body weight loss was the breakthrough study:
| https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
|
| Important to emphasize that diet & exercise are only two
| parts of broader metabolic health. Sleep also very important.
|
| And something our program focuses a lot on is stress eating.
| Very prevalent and a big factor, but normally overlooked.
| dlevine wrote:
| I have done just about everything over the years to lose weight.
| I tend to exercise a ton naturally, so it has been more about
| eating less than exercising more. I would say that my natural
| weight is slightly overweight but not obese.
|
| I've tried various brands of keto (Atkins/4 Hour Body), Weight
| Watchers, eating slowly, cutting out sugar and wheat, juice
| fasts. Everything has worked for a time, but the weight has
| eventually crept back. I have really good willpower, but I've
| read the research on willpower being a resource that you use up,
| and definitely agree with it.
|
| For the past couple of months I have been on Noom. I have stuck
| to it, and I'm now thinner than I have been in a long time, but
| I'm a little bit skeptical that it's going to last long-term. But
| I'm getting married in less than 2 months, so I only need to stay
| where I am until the wedding, and then I can gain a few pounds.
| reilly3000 wrote:
| Hate to say it but marriage is a sure formula for men's weight
| gain.
| Hallucinaut wrote:
| And any subsequent kids are an exponential... at least during
| lockdown for me
| rich-cartwright wrote:
| There's a lot going on in terms of the kids angle:
| increased stress, sleep deprivation, hormone changes, less
| time for exercise & healthy eating. Not easy.
| watwut wrote:
| Is it possible that you are at healthy weight for you? Because
| given lifestyle you described, it is quite possible.
| criticaltinker wrote:
| > I've read the research on willpower being a resource that you
| use up, and definitely agree with it
|
| I don't enjoy subjecting you to cognitive dissonance here...but
| some highly cited research shows this belief may be a self
| fulfilling prophecy.
|
| _> Study 1 found that individual differences in lay theories
| about willpower moderate ego-depletion effects: People who
| viewed the capacity for self-control as not limited did not
| show diminished self-control after a depleting experience._ [1]
|
| _> Study 2 replicated the effect, manipulating lay theories
| about willpower._ [1]
|
| _> Study 3 addressed questions about the mechanism underlying
| the effect. _ [1]
|
| _> Study 4, a longitudinal field study, found that theories
| about willpower predict change in eating behavior,
| procrastination, and self-regulated goal striving in depleting
| circumstances. _ [1]
|
| _> Taken together, the findings suggest that reduced self-
| control after a depleting task or during demanding periods may
| reflect people's beliefs about the availability of willpower
| rather than true resource depletion. _ [1]
|
| [1] Ego Depletion--Is It All in Your Head? Implicit Theories
| About Willpower Affect Self-Regulation
| http://icelab.psych.uw.edu.pl/wp-content/uploads/2016/02/job...
|
| [2] Beliefs about willpower determine the impact of glucose on
| self-control
| https://www.pnas.org/content/pnas/110/37/14837.full.pdf
| dlevine wrote:
| Interesting! Thanks for sharing.
| pbhjpbhj wrote:
| Maybe the beliefs come from experiences of different 'types'
| and the types cause the beliefs?
| rich-cartwright wrote:
| Interesting, reading this now.
| rich-cartwright wrote:
| "so I only need to stay where I am until the wedding, and then
| I can gain a few pounds" - this is interesting
| sergiomattei wrote:
| Hi folks, congratulations on the launch.
|
| Are you considering expanding services for other chronic eating
| disorders? For example, chronic under eating.
| rich-cartwright wrote:
| Interesting question. We're no longer coming at this from an ED
| angle - I could & should write a whole blog about this at some
| point! Quick take: tackling obesity from a wider health angle
| (metabolic health, psychological health, behavioral health) is
| more needed than a narrower focus.
|
| A impressive co focused on serious, udner-eating EDs is
| https://equip.health/ if you're interested
| peteretep wrote:
| I had been very, very excited to start semaglutide, but about
| eight weeks ago I picked up a CBT-based eating book called The
| Beck Diet Solution and I've so far found it very very effective
| rich-cartwright wrote:
| Yep CBT (and third wave cognitive therapies in general) are
| very effective against emotion-based overeating (e.g. stress
| eating). Stress eating is widespread and addressing it is a
| core part of our coaching.
|
| Important to say not everyone struggles with stress eating,
| which is why our coaching program goes much broader than that.
|
| The metabolic medication aspect is also really helpful, which
| is why we combine the two for Fella.
| Smaug123 wrote:
| Not to suggest anything about your personal experience, but
| note that in general pretty much anyone can follow pretty much
| any diet for two months and lose weight if they try. The
| seriously hard bit - and the way you know you've found the
| right diet for you - is if you can follow it for the third
| month (and then all the months thereafter). Two months is
| roughly the upper limit for the "any diet will work for anyone"
| effect.
| impostervt wrote:
| Only available in Texas currently. When's the nationwide rollout?
| Any more precise than "soon"?
| rich-cartwright wrote:
| It's tough with the state-by-state regulation. CA & NY are in
| the coming month or two. Then the plan is the next 5-10 states
| by end of Q1 2022. We'll be sprinting to go fully nationwide by
| end of 2022.
| newman8r wrote:
| Is this just because of the prescription drug element of your
| program? If there weren't any medications involved, would you
| need any state certifications?
| rich-cartwright wrote:
| Yep exactly - the prescription drug element requires state-
| by-state medicine licenses.
| invokestatic wrote:
| Not affiliated, but I believe with every telemedicine company,
| the care providers need a medical license in each and every
| state they have patients in. So it will likely be a long time
| before they have "nationwide" coverage. This is why many
| telemedicine startups are only in a select handful of states.
| rich-cartwright wrote:
| Exactly this! Got there before me.
| derektlo wrote:
| Hey Richie we can help with that :) https://medallion.co/
| rich-cartwright wrote:
| Emailed you!
| deberon wrote:
| As somebody who has lost and gained weight a couple times, I can
| confidently say that losing weight on it's own is hard. Really
| hard. I've had far more success deliberately changing my entire
| lifestyle and outlook on life. For me, it had to be a part of a
| wholistic health regimen. This included therapy, healthy eating,
| regular exercise, proper sleep, and a good balance of
| recreational activities (it's important to have fun!). As
| somebody with chronic sleep problems, it's been interesting
| seeing how unhealthiness in one aspect of life (sleep in my case)
| can affect other areas of my life (my weight). It's hard to
| quantify this line of thinking, because in the end, all I did was
| eat less and exercise more to lose the weight. That advice isn't
| terribly helpful. Then again, it's very likely that "just be
| healthier" is just as unhelpful ;)
|
| I will say, don't be too hard on yourself. My stress eating would
| spiral (and still does!) when I get too hard on myself. Set small
| goals and objectives (no eating after dark, be mindful of what
| you put on your plate, no second helpings, etc) because
| completing these always feels good.
| rich-cartwright wrote:
| Well written. These are all core aspects of our coaching
| program to improve metabolic health: improve sleep, reduce
| stress, more pleasurable activities, better food choices,
| sustainable exercise routine, reasonable portion sizes.
|
| The "small goals" is also critical to counter all-or-nothing
| thinking. We use a mix of behavioral & cognitive approaches to
| try to cement the improved habits & ways of thinking.
| neom wrote:
| Looks like you're using a common and old Diabetes medication to
| control glucose, changing the regulation of appetite? I'm curious
| why this works best for men? Does it work in women?
| rich-cartwright wrote:
| Yep GLP-1 RAs are the gold-standard, if insurance coverage
| permits (because they are expensive if you have to pay out-of-
| pocket). The effect is roughly equal in men & women. The big
| breakthrough was the latest GLP-1 RA called Semaglutide, FDA
| approved in 2017 for diabetes and June 2021 for weight
| management. The main paper for that is here if you're
| interested:
|
| https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
| criticaltinker wrote:
| Interesting offering, definitely an important market.
|
| > So we started researching effective, evidence-based treatments
| for obesity
|
| Fasting has a tremendous amount science supporting it [1], can
| you articulate why you're pursuing the prescribed semaglutide
| approach instead?
|
| [1] Fasting: Molecular Mechanisms and Clinical Applications
| https://www.sciencedirect.com/science/article/pii/S155041311...
| TeeMassive wrote:
| I tried fasting and a pure keto diet. While they do work, I
| felt miserable. This is not sustainable for people like me who
| has to lose more than 100 pounds.
|
| Now I started losing weight by just balancing macro-nutrients;
| more protein, more vegetables, less carbs as opposed to
| absolutes "no" and "only" except for no sugary drinks and beer
| and deserts except in social occasions. Also big emphasis on
| weight lifting as opposed to cardio. Cardio helps with its own
| health benefits but is very poor for muscle growth and fat loss
| and should be seen as a compliment.
| faichai wrote:
| I felt miserable on Keto the first two times I tried it. I've
| found doing fasting in the month prior helped with the
| adaptation and a large part of the misery was loss of
| electrolytes.
|
| By using electrolyte powder I only really had one or two
| really miserable days this time round.
| rich-cartwright wrote:
| Interesting. How long have you been doing keto this time?
| faichai wrote:
| Only week 3, but finding it pretty great this time round,
| ketones actively suppressing appetite, eating about 2
| meals a day, down about 6kg so far. I still fast a couple
| of times a week, but being in ketosis already makes it
| crazy easy. Have enough energy for gym, though power
| slightly down.
|
| I hear people can hit a wall about 8 weeks in, but also
| hear that could be down to over-consuming seed oils. Will
| see how it goes.
| rich-cartwright wrote:
| Interesting to know, thanks.
| rich-cartwright wrote:
| Yep spot on about the sustainability. We hear this all the
| time from the Fellas.
| rich-cartwright wrote:
| Spot on about fasting, and keto has solid evidence as well -
| https://www.virtahealth.com/ are a great company focused on
| this.
|
| The issue is we're starting to have a more nuanced
| understanding of the metabolic resistance people face when they
| undergo dietary changes - basically the body fights _hard_
| against you as you try to lose weight by dieting.
|
| So it's now industry-standard among obesity specialist doctors
| to see obesity as a "metabolic disease" which, for the vast
| majority of people, needs a medical approach which doesn't rely
| on willpower.
| criticaltinker wrote:
| Thanks for your response and taking the time to answer these
| questions.
|
| > basically the body fights _hard_ against you as you try to
| lose weight by dieting
|
| Anecdotally I think many folks would agree. Any citations or
| references you could provide on this point would be greatly
| appreciated - I'm struggling to find any solid literature
| with the phrase "metabolic resistance" in the context of
| dietary changes.
|
| > So it's now industry-standard among obesity specialist
| doctors to see obesity as a "metabolic disease" which, for
| the vast majority of people, needs a medical approach which
| doesn't rely on willpower.
|
| I agree that the current standard of care is largely focused
| on prescription medication. Is there strong evidence
| supporting the claim that the majority of people need
| treatment that doesn't rely on willpower? I'm particularly
| interested in the well documented association between obesity
| and mental health [1], and I think Fella would be especially
| compelling if a holistic approach to treatment was offered.
|
| [1] The High Prevalence of Poor Physical Health and Unhealthy
| Lifestyle Behaviours in Individuals with Severe Mental
| Illness https://www.researchgate.net/profile/David-
| Scott-76/publicat...
| lharries wrote:
| (Richie's co-founder here)
|
| You're spot on with the link between mental health and
| obesity and the need for a holistic approach.
|
| For many of the guys stress and anxiety will play a key
| part in their food habits. This is something that our
| coaches actively ask about and help manage if relevant. For
| other guys it might be sleep [1] or it might be macro-
| nutrients. The coaching will depend on the person and we
| make these changes supported by their medical team.
|
| > Anecdotally I think many folks would agree. Any citations
| or references you could provide on this point would be
| greatly appreciated - I'm struggling to find any solid
| literature with the phrase "metabolic resistance" in the
| context of dietary changes.
|
| "Long-term persistence of hormonal adaptations to weight
| loss" [2] and [3] are both interesting papers on this. With
| the summary being that weight loss results in prolonged
| changes in your hormones associated with increased appetite
| and thus weight regain. This results in a strong negative
| feedback cycle.
|
| [1] https://pubmed.ncbi.nlm.nih.gov/28164452/ [2]
| https://pubmed.ncbi.nlm.nih.gov/22029981/ [3]
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/
| criticaltinker wrote:
| Thank you for the excellent response and citations. I
| think you and Richie are on to something here - wishing
| you the best of luck.
| lharries wrote:
| Thank you! I enjoyed your great comments too
| zadler wrote:
| What's the connection between stress eating and metabolic
| disease?
| rich-cartwright wrote:
| 1. Stress causes the adrenal glands to release a hormone
| called cortisol, and cortisol increases appetite.
|
| 2. When stressed, we look for relief - and for a lot of
| people that relief comes as food, or the act of eating
| itself.
|
| Both of these often lead to overeating which is a cause of
| metabolic disease.
| jimmaswell wrote:
| > basically the body fights hard against you as you try to
| lose weight by dieting.
|
| I used to weigh 310lbs, now I'm 215lbs. All I did was count
| calories to maintain a deficit and the results were
| essentially the same as predicted by the math. I was a bit
| hungry sometimes at first as I adjusted to it but that's
| really it. Prioritizing protein and fat over carbs helps with
| that.
|
| What ways does the body tend to fight against people?
| faichai wrote:
| Losing weight is essentially a stress on the body, the
| response of which is to produce a lot of cortisol, which in
| turn can mess with testosterone and other hormones.
|
| For me the caloric restriction leads to so much cortisol
| that I can't really sleep properly no matter how much I try
| to exhaust myself.
|
| Keto seems to be kinder (in week 3, of trying it for the
| 3rd time, previous times unsuccessful). But too early to
| say for sure.
| criticaltinker wrote:
| Thanks for pointing out the relationship between caloric
| restriction and cortisol production. Your statements and
| anecdotes seem to be well supported by the literature.
|
| _> Starvation caused a rise in plasma cortisol [...] but
| no change in total urinary cortisol metabolites. _ [1]
|
| _> very low calorie diet (VLCD) did not alter plasma
| cortisol and markedly reduced cortisol metabolite
| excretion [...]. _ [1]
|
| _> Overall, caloric restriction significantly increased
| serum cortisol level in 13 studies (357 total
| participants). Fasting showed a very strong effect in
| increasing serum cortisol, while VLCD and LCD did not
| show significant increases. _ [2]
|
| _> The meta-regression analysis showed a negative
| association between the serum cortisol level and the
| duration of caloric restriction, indicating serum
| cortisol is increased in the initial period of caloric
| restriction but decreased to the baseline level after
| several weeks. _ [2]
|
| [1] Influence of short-term dietary weight loss on
| cortisol secretion and metabolism in obese men
| https://www.researchgate.net/profile/Alexandra-
| Johnstone/pub...
|
| [2] Systematic review and meta-analysis reveals acutely
| elevated plasma cortisol following fasting but not less
| severe calorie restriction https://www.tandfonline.com/do
| i/abs/10.3109/10253890.2015.11...
| rich-cartwright wrote:
| Great links.
| rich-cartwright wrote:
| Anecdotally: I also used to struggle to sleep when I was
| dieting. My sensation was intense hunger when I was in
| bed where I couldn't stop thinking about food in the
| kitchen.
| bserge wrote:
| Extreme hunger, like others said. I'd class it as a subset
| of impulsive behavior, which is basically your primitive
| brain doing it's caveman shit and not listening to _you_ ,
| the conscious mind.
|
| Apparently some people don't have this problem, which makes
| me incredibly envious (or would if I could feel anything).
|
| It's this nagging thought of "JESUS CHRIST YOU'RE GONNA DIE
| IF YOU DON'T EAT A LOT RIGHT NOW!"
|
| I've experienced it after hard days at work (construction),
| multi hour lifting, cycling 50km. Same shit every time.
| Surprisingly, unlike what my dumbass brain says, I don't
| die if I eat only a little and just go to sleep.
|
| Counting calories didn't work btw. It actually made it
| worse as my primitive brain would _know_ it 's "starving".
| rich-cartwright wrote:
| Said like a true Fella. I hear this _a lot_.
| jjeaff wrote:
| I used to be able to do that in my twenties. Now, in my
| thirties, it appears I have lost that ability. Cutting my
| calories seems to causey body to go into a sort of
| hibernation where it becomes more efficient and conserves
| more calories.
|
| In other words, my metabolic burn rate at rest and while
| active seems to go down significantly.
| zinclozenge wrote:
| Unfortunately there are people like me who don't only feel
| a bit hungry, when I eat at a deficit there are times where
| I get so hungry my thoughts are completely consumed by the
| hunger. The only way for me to successfully lose weight was
| to have days where I simply eat nothing at all.
|
| Sounds counter-intuitive but after getting over the initial
| extreme hunger I found that the hunger sensations would
| diminish into a background noise, of sorts. That and the
| rules are easy to follow: eat nothing. When I'd eat at a
| deficit I'd frequently justify to myself that eating a
| little bit more than I was planning on doing was ok because
| it was only a little. And then I'd do that several times
| until I felt completely satiated, defeating the purpose.
| rich-cartwright wrote:
| The complete fasting approach is pretty common among
| Fellas I've spoken with. Lot of the guys have powerful
| "all-or-nothing" traits, where it feels easier to have a
| strict intense rule than a more nuanced approach.
|
| The issue comes when you therefore become so hungry your
| body drives you to eat a lot of food all at once. But I'm
| interested that you notice your hunger sensations
| actually diminish over time.
| speeder wrote:
| I will use myself as an example: I have Hashimoto disease,
| and even treated my metabolism can get so slow that I need
| to eat so little that I start to have nutrient deficits,
| for example one of the past dieting attempts resulted in
| hair loss, brittle nails, cracking skin, because I needed
| so little calories that when I consumed exactly what I
| needed, I ended with a protein deficit.
|
| Only solution I found that worked was go for pure
| weightlifting, literally train as if I was aiming to he an
| Olympic champion, and even then I still ended overweight (I
| am 1.75m tall, smallest weight I managed, that was then I
| was training heavily and had a diet that was almost 100%
| protein, was 98kg)
| jimmaswell wrote:
| That's interesting. That weight isn't necessarily
| unhealthy if it's largely muscle from all the training.
| Did you end up with a low body fat percentage despite the
| weight?
| mylons wrote:
| i'm in a similar spot as the OP. lifting helps, but i'm
| still pretty fat. 5'11" 250lbs. worksets are 355lb squat,
| 225lb bench, 425lb deadlift, 175lb overhead press. it's
| hard to tell i'm strong, but i'm slightly more slender at
| this weight than i was before lifting. it definitely
| helps with aches and pains i used to have, primarily back
| pain.
| rich-cartwright wrote:
| Those are some tasty numbers.
| rich-cartwright wrote:
| Really interesting to know, thank you.
| lharries wrote:
| Great to hear you've had success.
|
| [1] is an interesting paper which gives you some hormonal
| examples. Effectively when you try and lose weight your
| body responds by increasing the hormones associated with
| greater satiety and weight regain. And these change may
| persists for a while -- this papers documenting the change
| lasting past a a year. This will very by person however so
| if you have something which works for you keep going.
|
| [1] https://pubmed.ncbi.nlm.nih.gov/22029981/
| diskzero wrote:
| I am glad to see this. I was involved in a similar startup that
| became bogged down due to reasons that had nothing to do with the
| validity of the approach you are taking.
|
| As I am sure you are aware, obesity is a complex issue and many
| of the suggestions sufferers get such as eat less, exercise more,
| try fasting, go keto, etc. are simply not helpful in and of
| themselves. Neither is just prescribing the latest medications
| without other forms of support.
|
| I hope your concept of telehealth, medical supervision and
| personal coaching is one that will get results. Obesity is a
| serious issue that is robbing society of people and potential.
| rich-cartwright wrote:
| Thank you very much for this. Kind message.
|
| What was the previous startup by the way? Always interested in
| improving my knowledge of the space!
| cesher wrote:
| Where is Washington state in your rollout plan? 2021? 2022?
| lharries wrote:
| (Richie's co-founder here) We are aiming for Washington by the
| end of 2021. If you'd like me to let you know when we launch
| there feel free to fill in the "Am I Eligible" quiz and join
| the waitlist or send an email to luke@joinfella.com and I'll
| add you manually
| cesher wrote:
| Already filled it out, thank you!
| rich-cartwright wrote:
| Perfect! Working our hardest to get live in WA in the
| coming quarters.
| TeeMassive wrote:
| Any plan for Canada?
| rich-cartwright wrote:
| Our focus is the US for the coming year or two. The state-by-
| state expansion is tricky for telehealth companies. But we're
| British founders so we recognize that this is needed in many
| other countries in the coming years!
| ryanSrich wrote:
| Do you help people account for family lifestyles and cooking for
| more than just themselves? I used to do 2-3 day fasts, but now
| that I'm married with kids I find it almost impossible to do so
| since I cook and prep all the meals.
|
| I tried low carb and keto. It works fine for me, but selling my
| wife on a breakfast that consists of 6 eggs and a pound of bacon
| is a hard sell. So there's always bread and pasta in the house,
| which makes it harder to resist.
| MagicWishMonkey wrote:
| My wife is lifelong vegetarian, and I'm a big fan of keto.
| We've basically adapted to a "I make food for myself, she makes
| food for herself and we split responsibility for making food
| for the kids" workflow and it works out pretty well.
|
| It helps a lot that I do the grocery shopping, I try to avoid
| buying stuff that I'll be too tempted by - like regular carb
| tortillas or plain tortilla chips.
| rich-cartwright wrote:
| Keeping food out of the house is a powerful behavioral
| device. It takes away the "Ability" part from the Fogg
| Behavior Model if you find that framework helpful.
| rich-cartwright wrote:
| Yep really good point about the family dynamics - lots of the
| Fellas talk about how having teenage kids around makes the
| dietary side really tough.
|
| How the coaching works in the program is that we dive in at the
| start to really understand the 1-3 key leverage points where we
| can make the most impact - then focus all our coaching time on
| these.
| gnicholas wrote:
| It sounds like the medication is an important part of this plan.
| Is it something that you anticipate someone would take
| indefinitely, or only to get down to a target weight?
|
| Also, can you give some ELI5 background on how the medication
| works in the body?
| criticaltinker wrote:
| _> Semaglutide, sold under the brand name Ozempic among others,
| is an anti-diabetic medication used for the treatment of type 2
| diabetes and chronic weight management. _ [1]
|
| _> Semaglutide acts like human glucagon-like peptide-1 (GLP-1)
| such that it increases insulin secretion, thereby increasing
| sugar metabolism. It is distributed as a metered subcutaneous
| injection in a prefilled pen or as an oral form. One of its
| advantages over other antidiabetic drugs is that it has a long
| duration of action, thus, only once-a-week injection is
| sufficient. _ [1]
|
| _> Side effects including nausea, vomiting, diarrhea,
| abdominal pain, and constipation may occur. In people with
| heart problems, it can cause damage to the back of the eye
| (retinopathy). Side effects include kidney problems, diabetic
| retinopathy, allergic reactions, low blood sugar, and
| pancreatitis. _ [1]
|
| _> Warning: Risk of Thyroid C-Cell Tumors - In rodents
| semaglutide causes dose-dependent and treatment-duration-
| dependent thyroid C-cell tumors at clinically relevant
| exposures. It is unknown whether semaglutide causes thyroid
| C-cell tumors, including medullary thyroid carcinoma (MTC), in
| humans as human relevance of semaglutide-induced rodent thyroid
| C-cell tumors has not been determined. _ [2]
|
| [1] https://en.wikipedia.org/wiki/Semaglutide
|
| [2] https://www.drugs.com/sfx/semaglutide-side-effects.html
| rich-cartwright wrote:
| Yep Semaglutide is the key medication. Important to emphasize
| it appears to be a safe medication.
| gnicholas wrote:
| What is the evidence on safety? The side effects sound
| potentially pretty serious, and as if the likelihood goes
| up the longer you take it. If this has only been around for
| a couple years, I'm not sure I'd jump on this just yet.
| More details would be useful!
| lharries wrote:
| (Richie's co-founder here)
|
| Semaglutide was FDA approved for diabetes in 2018 (3
| years ago) and in June this year for weight management.
| It's part of a class of medication called GLP-1 RAs which
| operate in a similar way (they all stimulate the same
| GLP-1 receptor). Liraglutide is another common one that
| was approved by the FDA in 2010 (11 years ago) for
| diabetes (by the EU in 2009) and for weight management in
| 2014. So there is a 3 year of history with this
| particular medication and an 11 year history for this
| class of medication.
|
| Here's more about the history of GLP-1s and other weight
| loss if you'd like: https://blogs.sciencemag.org/pipeline
| /archives/2021/02/15/gl...
|
| The main side effects that people seem to get are nausea
| and vomiting when adjusting to the dose, this is likely
| due to the slowing down of food leaving your stomach.
| This is documented in the study of nearly two thousand
| people which lasted for 68 weeks here [1] (where you can
| also see the other side effects).
|
| It's worth noting that, as with any medication, there is
| a cost-benefit trade-off. In this case it will depend on
| someone's current weight, what they've tried in the past,
| and the risks of other conditions e.g. heart disease,
| diabetes, and their past medical history. Each person
| that joins Fella has an in-depth discussion about this
| with an independent obesity physician and is welcome to
| speak it through with their own PCP too.
|
| https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
| gnicholas wrote:
| Thanks for your candor. It would be interesting to see
| what positive effects can be achieved for what types of
| patients at various different dosing levels.
|
| I'm not at a weight where I'd want to add additional
| cancer risk in order to lose weight, and unfortunately
| the data on this sort of incremental risk probably takes
| decades to be fully realized. Perhaps I'd feel
| comfortable taking a smaller dose if there were a
| shorter-than-ideal track record of people taking larger
| doses without much additional risk.
| rich-cartwright wrote:
| It's better to think of the medication as more similar to other
| medications taken for chronic conditions (e.g. hypertension)
| than a quick fix magic pill.
|
| The papers show consistent weight loss for ~52 weeks, then
| plateauing off onto 68 weeks. If you suddenly stop taking the
| medication, the weight creeps back on. The research therefore
| suggests you can likely slowly taper off the medication after
| year 1, but with medical supervision to ensure that doesn't
| lead to weight gain. This is also why improved mindset & habits
| are also important.
|
| https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
|
| ELI5: increases satiety, decreases appetite.
| lharries wrote:
| (Richie's co-founder here)
|
| > ELI5 for how it works in the body:
|
| GLP-1 RAs such as Semaglutide are increasingly looking like the
| best class of medication for weight management [1]
|
| GLP-1 RA = Glucagon-like peptide 1 receptor agonist.
|
| These medications stimulates a receptor in your body which
| results in a reduction in body weight and three main effects: 1
| - Slowing down gastric emptying so food stays in your stomach
| for longer (this is thought to be why there is sometimes nausea
| when starting the medication) 2 - Making you feel full by
| working on your central nervous system 3 - Managing glucose
| control (which is why it's used for people with diabetes too)
|
| [1] gives you a great summary of the field up to now and how it
| works.
|
| > Is it something that you anticipate someone would take
| indefinitely, or only to get down to a target weight?
|
| This will depend on the person, whether they are also diabetic
| and how much weight they have to lose and is decided through a
| conversation with their obesity doctor. After around 12-months
| on these medications the weight loss plateaus (at an average of
| 15% body weight). If one stops the medication then but hasn't
| made any changes to their lifestyle they'll likely put the
| weight back on. But during the 12 months of the program we will
| be tackling the other factors with the coach: sleep, stress,
| nutrition. And so after the first year it might well make sense
| to reduce the medication or stop completely.
|
| Let me know if you have any more questions.
|
| [1]
| https://blogs.sciencemag.org/pipeline/archives/2021/02/15/gl...
| robomartin wrote:
| I don't know how young you are. Great story, but, sorry, no.
| Every single weight loss program claims exactly what you claim.
| And they all deliver pretty much exactly the same results. My
| guess is that about 10 to 20 percent of weight loss program
| participants achieve sustainable life-long objectives, keep the
| weight off and change their lifestyle. The rest are in a range
| between utter failure and yo-yo diet programs to some short term
| success, no long term behavioral modification and ultimately, a
| return to their prior state or worse.
|
| Every single bullet point you list requires one thing that you
| cannot control --nobody can: A personal decision to change. And
| no pill is going to force this decision.
|
| Look, maybe you are well-meaning, however, what you are looking
| to do here is no different from the myriad weight loss
| supplements out there. I know people who made millions peddling
| Garcinia Cambogia, Forskolin and other weight loss supplements on
| Amazon. I know people who swear by the stuff. I would be willing
| to bet that, statistically speaking the results are not very
| different from almost any other purported solution.
|
| At the end of the day, the day weight loss isn't difficult at
| all.
|
| In its harshest form its as simple as eating less. Even if you
| eat junk, if you eat less, you lose weight. Physics.
|
| A more sophisticated approach is to learn and decide to eat
| better. In both cases no exercise is required beyond normal
| activity.
|
| Even a person who is confined to bedrest --no exercise at all--
| will lose weight if they consume less matter than their bodies
| process into energy and excrete. My mother passed away a couple
| of months ago. A couple of months before that she simply did not
| want to eat very much at all. The amount of weight she lost was
| incredible.
|
| The issue with obesity is bad food, unhealthy eating habits being
| promoted from childhood and a situation where adults almost can't
| escape all the things that make them sick.
|
| And yet, after all of that, it becomes a matter of making a
| decision. And it is a very difficult decision to make for most.
| To use an analogy, it takes far more effort to help someone who
| becomes a drug addict than to guide them down the right path from
| early childhood. That also happens to be far better for society.
|
| To use a business parallel: You can build the best hotel, have
| the greatest and most amazing rooms, serve incredible food and
| have amazing customer service. And yet, you cannot force people
| to take a vacation.
|
| And so, all the bullet points in your argument sound fantastic.
| If you go to Jenny Craig, or Weight Watchers, they pretty much
| claim exactly the same things. And their road to success is paved
| with the sorry bodies of the millions of people who thought they
| found magic, only to end-up exactly where they started --or
| worse.
|
| The right solution isn't a pill. Its investing time, money and
| effort to change what we are doing about food and how we are
| destroying our kids health by not acting with their best interest
| in mind.
|
| That said, congratulations. With YC's backing there's probably no
| doubt your startup will have a unicorn-scale exit. If there's one
| market segment were the same story can be used again and again to
| make billions it is the weight loss industry. So, again,
| congrats. Brilliant move.
| dang wrote:
| Please stop posting these rants. Hounding someone like this
| after you already personally attacked them is crossing into
| harassment. I already asked you to stop once, and you've
| responded by doing more of it, not once but twice. Seriously
| not cool.
|
| We detached this comment from
| https://news.ycombinator.com/item?id=28258175.
| robomartin wrote:
| I understand. You need to protect a YC-funded startup from
| criticism. No problem. I get it. Money is more important.
|
| Just go ahead and delete everything I have written on this
| thread. That will be the easiest path.
|
| Lesson learned, don't be critical of YC companies.
|
| Got it.
| dang wrote:
| People criticize YC-funded startups all the time on HN.
| Just look at the beating these guys took yesterday:
| https://news.ycombinator.com/item?id=28247379.
|
| We go out of our way to moderate threads _less_ when a YC
| startup is involved (https://hn.algolia.com/?dateRange=all&
| page=0&prefix=false&qu...), but your behavior in this
| thread has been so egregious that I don't have a choice.
| "Less" doesn't mean "zero".
| mattmorley wrote:
| Congratulations on the launch fella team!
|
| What would you say the biggest learning is you've had since
| starting this journey?
| rich-cartwright wrote:
| Thanks Matt!
|
| Few things:
|
| 1. As we said in the post, men represent only ~10% of those
| using weight management services in the US, despite
| representing ~50% of those with obesity. Pretty fascinating to
| reflect on the reasons why.
|
| 2. There are only ~5000 board-certified obesity doctors in the
| US, roughly one for every 70000 Americans.
|
| 3. Binge Eating Disorder is the most common eating disorder,
| and has above 20% clinical prevalence in those above 40 BMI.
|
| Maybe most importantly: the bias towards willpower and the
| stigma against medical treatment for obesity (medication or
| surgery) is very real, _especially_ among family doctors. This
| will change over the coming decade, but it 's deeply routed.
| wxnx wrote:
| This is really interesting as someone who works as part of a
| group who takes products similar to this to market! Thank you for
| sharing.
|
| You mentioned the medication is as effective in women as it is in
| men. While I understand men are underserved in this space and so
| I respect the decision to focus on that population on that basis,
| I'm curious if there are business elements to that decision as
| well? Would you ever expand to serving women, given that they
| seem to be a larger potential customer pool?
| rich-cartwright wrote:
| Sweet what's the group you're part of? Sounds interesting.
|
| It's obviously a great question about the focus on men, and
| something we think a lot about.
|
| My take: the whole industry is focused on women, and there are
| already cool companies taking a medication approach with
| branding clearly focused on women:
| https://www.joincalibrate.com/, https://joinfound.com/,
| https://www.formhealth.co/
|
| I'm a fan of what these folks are doing. But you speak to any
| Fellas (our name for our customers!) and they _know_ those
| programs aren 't aimed at them. Every week we hear something
| like "I'm fed up of being the only guy in the group".
|
| From a business side, the bet we're taking is that if we manage
| to crack the messaging/framing/branding for the male audience,
| that's a great business. Plus how men think about their health
| is drastically changing as concepts of masculinity change, so
| the potential customer pool is growing rapidly.
|
| In terms of future expansion: we don't know yet. At least not
| for the coming few years - there are a lot of bigger guys out
| there we want to help (35 million men have obesity)!
| wxnx wrote:
| Thanks very much for answering!
|
| Sorry, if I'd had the foresight to use a throwaway I'd drop a
| link to our group, but I prefer not to publicly associate my
| HN account with work. We're a small team of software and data
| engineers, machine learning scientists, and health policy
| folks at a large research institution in Canada that take on
| clients to work on stuff like this (from early stage research
| to approvals to deployment). I'd be happy to reach out with
| my contact info privately if you're interested, just let me
| know.
|
| That makes sense! I wondered if it had something to do with
| the group component, and I agree that the customer pool is
| growing.
|
| Congratulations on the launch!
| rich-cartwright wrote:
| Sounds really interesting. Would love to hear from you: my
| email is richie@joinfella.com
| paulocal wrote:
| How is the drug different than victoza or any of the other weight
| management drugs that are currently under investigation for
| causing pancreatic cancer?
| lharries wrote:
| (Richie's co-founder here)
|
| Victoza is the brand name for Liraglutide. The drug we are
| primarily interested in is Semaglutide. Both Semaglutide and
| Liraglutide are GLP-1 receptor agonists.
|
| It's worth doing your own research and consulting a doctor but
| the experts I've spoken to (academics and clinicians) along
| with the studies state that: "GLP-1 analogues did not increase
| the risk for pancreatic cancer when compared to other
| treatments" (from a Nature Scientific Reports meta-analysis
| paper published in 2019) [1].
|
| Here is the postmarket FDA safety information on Victoza if you
| are interested: https://www.fda.gov/drugs/postmarket-drug-
| safety-information...
|
| [1] https://www.nature.com/articles/s41598-019-38956-2
| paulocal wrote:
| I get how when compared to other treatments for diabetes it
| may not increase your risk but when we are comparing with
| other treatments for weight management or just no treatment
| at all, I find it hard to believe that it doesn't
| significantly increase the risk for pancan. I understand it's
| FDA approved but so have been all other drugs in its class
| that are allegedly linked to pancreatic cancer.
| robomartin wrote:
| I am sorry, but this is nothing less than an abomination. Drugs,
| drugs, drugs. More drugs. Let's drug everyone. Let's have
| everyone popping pills for everything. Why not. And make
| millions, billions, while we are at it.
|
| And your sob story? Do you think you are the only person in the
| world who has had to deal with stress? This is ridiculous. How
| about this for stress: My grandparents were genocide survivors.
| They saw portions of their family killed in the most horrific
| ways. And they somehow managed that and moved on. Me, personally,
| I've had one pretty horrific business failure that drove me to
| the edge of understanding why people take their own lives after
| ending-up in the hospital twice due to stress.
|
| WE DO NOT NEED PILLS!
|
| Yes, I am yelling.
|
| We need action on better food quality and education. People are
| filling themselves up with nothing but crap. Ketogenic diets and
| balanced living work, 100% of the the time. Exercise and activity
| is the magic "pill" that manages stress.
|
| Frankly, I am astounded that YC would fund and support something
| like this. I don't care about your credentials and sob story.
| This is an abomination. Yes, you are likely to make billions.
| Congratulations. You are not going to fix a damn thing. All you
| are going to accomplish is to get millions of people hooked on
| yet another "once daily" legal drug of some sort.
|
| If you truly cared about helping people you would work towards
| fixing what's actually wrong rather than getting millions of
| people to pop pills.
|
| What when they stop? Huh?
|
| They will have developed no good habits at all. They will not
| have a clue as to how to manage stress. They sure as fuck are not
| going to understand that exercise is important and necessary.
| They are not going to become discerning about what they eat. And
| our industrialized toxic food industry isn't going to change a
| thing. They will pop your pills as they suck-in a two liter drink
| with insane amounts of sugar and inhale cheap carbohydrates in
| their burritos, burgers, pizza, etc.
|
| Weight management isn't at all about eating less. It's about not
| eating food that actively want to slowly kill you and, yes,
| engaging in a modicum of exercise in order to deal with insulin
| resistance, keep bones strong, etc.
|
| I've had my own battles with this. Lots of people do. Until I
| finally listened to my wife (an MD). So I proposed an experiment:
| I would do no exercise at all other than taking walks with her a
| few evenings per week. She was pushing me to take-up a low carb
| ketogenic-style diet. As an engineer, I wanted to isolate
| exercise from a change in eating habits. That's what we did. And
| the results were hard to ignore. It was slow going, but the fat
| just came off --without having to run a marathon every day to
| burn extra calories. I eat as much as I want. No restrictions
| other than "don't eat garbage/sugars/simple carbs, etc.". After
| dropping two pant sizes and feeling "normal" again I can now go
| for the finishing touch and add exercise to this in the form of
| strength training.
|
| The most important outcome was to reeducate myself about what and
| how I should be eating. That's it. It's as simple as that. No
| drug is going to do that. Ever. Unless the intent is to hook
| people for their $149 per month in perpetuity.
|
| Sorry, to take such an aggressive tone. This is, to use the term,
| deplorable. Shame on you. Invest the money educating people on
| how NOT to use a drug to improve their lives. Pills isn't a long
| term sustainable solution. You are bound to ruin more lives than
| you save. And you are not going to do anything about improving
| the quality of the food that our population consumes.
|
| Think of kids. Their food choices --particularly in the case of
| lower education parents-- boil down to choices between different
| kinds of toxic garbage. By the time they leave high school they
| have already imprinted horrible habits and done damage to their
| bodies. And now you show up and say "Take this pill...we will
| save you". Sick.
| someguydave wrote:
| you could make the same argument about any modern technology
| rich-cartwright wrote:
| It is interesting how divisive conversations around weight
| can be. For a lot of people, it represents a broader theme of
| we view individualism & morality.
| civilized wrote:
| Congrats on having a relatively easy time losing weight, but
| you're not the only person in the world, and not everyone's
| body works the same as yours. Your scolding of a clinically
| proven weight loss approach for not being what you did is
| solipsistic and ignorant. Your approach is, like the others,
| one among many that will work for some people.
| beebeepka wrote:
| You have a point but there is one common thing shared between
| every obese person. They eat too much, or the wrong things.
| That's a given and a simple fact that everyone knows but not
| everyone is willing to acknowledge.
|
| Sure, there are medical conditions that sometimes play a
| role. But how often is that the case? I actually don't know.
| Maybe your company could help with that?
|
| Good luck. There's obviously a market for your services.
| rich-cartwright wrote:
| "calories in" (too much or wrong things) is for sure
| important - but focusing solely on this when we're looking
| for practical solutions is not the most helpful framework
| for people who are fighting obesity.
| robomartin wrote:
| > Your scolding of a clinically proven weight loss approach
| for not being what you did is solipsistic and ignorant.
|
| Far from ignorant. It is an absolute fact --thermodynamics--
| that no human being needs a pill to lose weight. So, stop
| with the holier-than-thou come-back and think.
|
| This is no different from selling crap weight loss
| supplements to people. Why? Because they do not need that
| either. The fact that something is clinically proven means
| nothing. Why? Because people don't need it.
|
| > Your approach is, like the others, one among many that will
| work for some people.
|
| It isn't my approach. I only had to lose about 30 lbs. I
| could have done that going back to strength training, which
| was I was into before the pandemic hit. I decided to see if
| there was any merit to what my wife, the MD, was telling me.
|
| Major "duh" moment: Of course it had merit! And of course it
| can work for absolutely everyone!
|
| And, guess what, it does not cost $150 per month. No pills
| necessary.
|
| The problem with obesity, particularly in the US, is
| systemic. Our food is unmitigated garbage and we train our
| kids to eat and crave this garbage from early childhood
| times. By the time they become young adults they are well on
| their way to a life of dealing with weight problems and a
| straight line into diabetes and other ailments.
|
| You can't fix inflammation from food with pills, unless you
| want to be popping them for the rest of your life and end-up
| with other problems because of it.
|
| This is going to sound weird: I am always astounded by how
| much I have learned by raising and training GSD's (German
| Shepherd Dogs). Stay with me for a second.
|
| One of our GSD's developed a very serious problem a number of
| years ago. His skin smelled horrible and he lost all hear
| from his chest and belly. His coat looked dull, almost dead.
|
| Not knowing what was going on I sought advice from our vet.
| He suggested I take him to a veterinary dermatologist. $2,500
| and bunch of shots and pills later, we went home with a plan.
| Pop pills every day. Get this magical shot once a month.
|
| Sure enough, in about four weeks his coat was nice and shinny
| again, his skin didn't smell and hair started to come back to
| his chest.
|
| Back we went for another shot and more pills. This was
| running about $600 per month. The dermatologist said he'd
| have to be on this program for the rest of his life. Wow.
|
| I decided to reach out to a number of GSD groups and
| breeders. A theme emerged from these conversations very
| quickly: Change his food. He is having allergic reaction to
| his food. Stop the nonsense the dermatologist is selling you.
|
| So, I did. I figured I could try for a couple months and, if
| nothing changed, go back to the treatment.
|
| We went with a high quality food with twice the protein
| content and far less junk carbs, etc.
|
| Less than a month later this dog was in what I might describe
| as the best shape of his life. He looked great, was happy,
| didn't have smelly skin, his coat grew back on this chest and
| belly and was pretty much the picture of a healthy dog. This
| was many years ago. He has been on this better-food diet
| every since and looks and feels wonderful.
|
| We have lost sense of just how important good food is for our
| bodies and minds. We accept that the garbage we buy at the
| market and restaurants is normal. Well, it isn't. This is the
| problem. The vet dermatologist was administering a government
| approved drug to my dog. It worked. And yet that was not
| really the solution, because it did not address the
| underlying problem. And that's the issue I have this startup.
| It isn't a solution. At all. Nobody needs this to lose
| weight.
| throwawayboise wrote:
| GPs approach will work for almost all people, if they
| actually do it.
| luckylion wrote:
| I've lost plenty of weight with intermittent fasting. It
| totally works. My sleep schedule went crazy, no matter what
| I did. My ability to focus was completely lost, as if I was
| constantly overdosing on coffee.
|
| Yes, it works, and maybe it works easy & side-effect free
| for some, but tbh I'd rather be overweight and die 10 years
| earlier, than live like that.
| rich-cartwright wrote:
| The sustainability of approaches is what we hear most from
| the Fellas. Most diets work in the short run but aren't
| sustainable long-term, especially when you're already
| battling against your metabolism.
| civilized wrote:
| [citation needed]
| rich-cartwright wrote:
| Eloquently written.
| rose_cook wrote:
| > "They sure as fuck are not going to understand that exercise
| is important and necessary. They are not going to become
| discerning about what they eat. They will...inhale cheap
| carbohydrates in their burritos, burgers, pizza, etc"
|
| Who are you referring to with these wide-sweeping, derogatory
| stereotypes, who are "they"? I genuinely find it shocking that
| you find it appropriate to group together the millions of
| people who struggle with obesity for various and legitimate
| reasons as "they".
|
| Maybe also think about your privilege as an "engineer" with a
| wife who is a doctor before offering these unneeded criticisms
| on "lower educated parents".
|
| It's narratives like those in this post which alienate people
| who are already struggling, and paint obesity as a moral
| failing. You are the one with a moral failing right now.
|
| So I guess I'm yelling too..
|
| WE DO NOT NEED TO DEMONIZE AND DEHUMANIZE MILLIONS OF PEOPLE
| BASED ON THEIR SOCIOECONOMIC BACKGROUND, EDUCATION OR HEALTH.
| TeeMassive wrote:
| >WE DO NOT NEED PILLS!
|
| >Yes, I am yelling.
|
| If pills work then what's the problem? It seems to me that
| you're making an appeal to nature
| (https://yourlogicalfallacyis.com/appeal-to-nature). Given all
| the health problems associated with obesity from cancer to
| cardiovascular problems then whatever side effects the pills
| have are probably negligible in comparison.
|
| > Weight management isn't at all about eating less. It's about
| not eating food that actively want to slowly kill you and, yes,
| engaging in a modicum of exercise in order to deal with insulin
| resistance, keep bones strong, etc.
|
| Yes nutrition and exercise are important, but even if it's
| common knowledge it's obviously working like abstinence based
| sexual education is working to prevent STDs and teenage
| pregnancy because like we have a natural urge to sex we also
| have a natural urge to eat calories and while saving energy.
|
| > "Take this pill...we will save you". Sick.
|
| A lot of pills are necessary to prolong and maintain quality of
| life. What's "sick" about this?
| stef25 wrote:
| Assuming obesity is largely due to mental issues like stress
| eating, the solution should also be a mental one. It's
| basically an addition. Most people are perfectly capable of
| quitting but don't because it's easier not to.
|
| This includes myself. I recently put on a bit of weight and I
| know exactly why: second servings, having a few beers,
| difficulties sticking to a diet with kids and dietary
| allergies in the house, no time or too lazy for exercise.
| It's all on me.
|
| Something that can be fixed by just putting your mind to it
| shouldn't have to be treated with pills.
|
| For some people it will probably be the hardest thing they
| ever do - I'm not downplaying this. So, for people who don't
| have the willpower pills is probably the best solution.
| rich-cartwright wrote:
| Interesting references.
| rich-cartwright wrote:
| It's important you've written this. We need to have frank
| conversations about obesity. It affects a lot of people and a
| lot of people have very strong views on the best solution.
|
| I'll focus on one area of your post: "They will have developed
| no good habits at all. They will not have a clue as to how to
| manage stress. They sure as fuck are not going to understand
| that exercise is important and necessary. They are not going to
| become discerning about what they eat...They will pop your
| pills as they suck-in a two liter drink with insane amounts of
| sugar and inhale cheap carbohydrates in their burritos,
| burgers, pizza, etc."
|
| I want to emphasize how wrong you are here.
|
| Fella is a 12-month program, with continued support for the
| rest of your life after that first year. The program is focused
| on:
|
| - building resilience to stress & other testing emotions
|
| - building a sustainable exercise habit which is enjoyable and
| sustainable
|
| - building healthier eating habits which are realistic &
| sustainable
|
| - building sleep habits which help improve metabolic health
|
| In terms of the medication, it's really important to listen to
| obesity specialists here. They are trying to find practical
| solutions to help people. It's clear that moral indignation
| isn't working so far.
|
| These are all legitimate concerns you raise. Know that I have
| researched this deeply, and genuinely believe this is the best
| practical solution to help the most amount of people.
|
| Please let me know your thoughts.
| djrogers wrote:
| > It's clear that moral indignation isn't working so far.
|
| This is my favorite HN line in ages, kudos!
|
| PS - in California and signed up for the wait list.
| rich-cartwright wrote:
| Glad to have you!
| dang wrote:
| Of course obesity is an emotional topic but attacking someone
| personally about it is way, way beyond the pale.
|
| Breaking the HN guidelines will get you banned here, regardless
| of how right you are, or feel you are, about obesity and other
| topics. No more of this, please.
|
| https://news.ycombinator.com/newsguidelines.html
| robomartin wrote:
| Funding a company to effectively hook people on pills by
| taking advantage of their vulnerability, mental state and
| frustration is nothing less than profane. It's one thing to
| turn people into ad-clicking drones, quite another to hook
| them on drugs when they do not need them.
|
| You might object to my lashing out. Well, sometimes it is
| important to take a strong stance. And, yes, sometimes those
| promoting magical solutions are culpable and should be
| scolded.
|
| Am I wrong? I do not think so. Nobody needs pills to lose
| weight. Nobody. That is a matter of both biology and physics.
| I'll defy anyone to prove otherwise. Have we become insane?
|
| The problem is that we have industrialized bad food choices
| and have created a marketplace where it is actually difficult
| to escape stuff that is bad for you.
|
| Just last night we were at a restaurant. A few tables over
| was a family where every single member, kids included, were
| twice the size of a normal and healthy person. Their table
| was full of all of the wrong choices. And, on top of that,
| large free-refill glasses of soft drinks. At the end of their
| meal they all had cake and ice cream. Wow.
|
| My youngest kids just started in-person high school again.
| The school has free food for every student. Its absolute
| garbage. The word "junk" doesn't even begin to cover it. The
| healthiest thing they have is apple juice, with nearly 40
| grams of sugar per serving. My kids pack a lunch, just a
| simple sandwich them make themselves every morning. Not very
| expensive at all. Not hard to make. We don't make them, the
| kids do and have been doing so for years. They also drink
| water. We have no soft drinks at home. The kids grew up
| drinking water and have no cravings whatsoever for soft
| drinks, candy, ice cream, etc. Sure, we occasionally have the
| stuff at parties, but that's the exception rather than the
| rule. And, no, they are not deprived. They simply do not care
| for the stuff because they did not become addicted to any of
| it as they grew up.
|
| Every family relying on the State/City/County/School district
| to feed their kids is, in return, having their kids poisoned.
| Worse yet, their kids are being programmed to become addicted
| to food that is absolutely horrible for them. When they come
| out of school they are well on their way to diabetes and
| other problems.
|
| Pills?
|
| Please.
|
| Our kids are coming into adulthood biologically programmed
| for high levels of sugar and carbohydrate consumption. It's
| all they eat since they are done with breast feeding. No pill
| is going to fix that level of programming.
|
| People who reach high levels of obesity are susceptible to
| the kinds of things that are going to cause them to spend
| money popping all kinds of pills every day. They are
| suffering, lots of them are depressed and our government and
| regulatory agencies have failed them --which is part of the
| reason they got there.
|
| We don't need pills. The problem is systemic. Fund startups
| who will deal with this and not ones that are no different
| from any other yo-yo diet program by any other name.
|
| Does anyone really think someone is going to change life-long
| habits after popping pills for a year? What is far more
| likely to happen is that they will become dependent on said
| pills, which is great for a revenue stream and a billion
| dollar exit to a pharmaceutical giant, not so great for the
| individual.
|
| What is beyond the pale here isn't my choice of language or
| intensity, it's the ultimate significance of what this
| startup represents. No different from the abomination that
| bariatric surgery is. Great business. Horrible for the
| individual. I know two people who nearly died after having
| it.
|
| Who am I kidding. There's money in suffering. I'll bet it
| will be a fantastic IPO one day. Maybe you should start
| marketing outside schools. Just like smoking, that's your
| future user base. Congratulations.
| symlinkk wrote:
| Very well written and I find it hard to disagree.
| rich-cartwright wrote:
| If you had a bigger family member who had tried everything,
| what would you recommend to them?
| vcg3rd wrote:
| You apparently don't let people sign-up who are willing to pay
| out of pocket. Shame.
| rich-cartwright wrote:
| This is probably a bug in our infra! We're on it now to fix. If
| you email richie@joinfella.com I'll sort you.
| lharries wrote:
| It should be possible -- select "Uninsured" when you try and
| sign up (although I realize now that we can make that clearer).
| Email me at luke@joinfella.com if you have any issues
| rich-cartwright wrote:
| haha Luke beat me to it
| ensiferum wrote:
| Intermittent fasting offers a great alternative that is
| completely free! The problem Fe Business perspective is of course
| that there's nothing to sell. No pills no magic nutrition plan or
| foods or exercise regime. And best of all...no calorie counting!
|
| If you're fasting and feel hungry while carrying body fat it
| means your metabolism is broken. Insulins levels are high and
| thus prevent the use of stored body fat for energy. It's possible
| to reverse this condition but it can take time up to 6 months
| approx.
|
| I really recommend to watch a pod cast with Dr. Benjamin Bikman.
|
| https://www.youtube.com/watch?v=TfSJFPu50_A
|
| It's incredible how fasting just works. I've lost 10kg of bf and
| 10cm from my waistline without counting a single calorie or
| feeling hungry at all over the course of 6 months. And I haven't
| lost strength either and my workouts are as intense as before.
| After i started fasting it took me a about 6 weeks to start
| seeing visible changes.
| lharries wrote:
| (Richie's co-founder here) Great to hear that intermittent
| fasting has been working well for you! There's also interesting
| research about the longevity benefits even if you're not
| looking for weight loss.
|
| The best approach for getting to a healthier weight will vary
| by person. If you've put on a few pounds over the holidays but
| are otherwise fine then Fella is not for you. We're focusing on
| guys with a higher BMI (30+), they've tried everything
| including intermittent fasting, keto, Weight Watchers, etc.
| Normally they will have had short term results (even losing
| 60lbs+) but then put the weight back on. This is often the case
| for the guys that have been at a higher weight for a longer
| period of time as their metabolism is in a different place.
| ensiferum wrote:
| I sincerely hope regardless of methods you're able to help
| people and of course manage a to build a successful business
| well. Best of luck.
| lharries wrote:
| Thank you! You too
| tarr11 wrote:
| I tried Noom twice. I was the only man in the support group both
| times. It didn't really speak to me or work for me.
|
| Definitely interested in this!
| rich-cartwright wrote:
| We've heard this a lot..
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