[smooth_remmy]

Petro Dobromylskyj is one of the foremost experts of fat metabolism. He has a blog called Hyperlipid where he's been blogging about fat metabolism and interpreting research for close to 10 years.

He thinks the GLP-1 inhibitor drugs will be a disaster in the long term because they 1) cause weight loss but also 2) cause the body to create lots of new adipocyte (fat cells). Increasing the number of adipocytes is very unusual after puberty. As long as you are taking the GLP-1 inhibitor drugs you will lose or maintain weight, but as soon as you stop you will gain a lot of weight back.

Here is the blog post: https://high-fat-nutrition.blogspot.com/2023/01/glp-1-agonis...

[JamesBarney]

I don't know if I'd call a veterinary anaesthetist a foremost expert on fat metabolism. His thoughts on insulin signaling are not consistent with the consensus among obesity researchers. He thinks glp-1 works through uncoupling or fat browning which is just not true.

The consensus among most obesity researchers is the cause of obesity is primarily neurological, not metabolic. Basically the brain can't properly regulate weight in the current obesogenic environment. When you look at GWAS most of the genes related to obesity are active in the brain, (as opposed to genes for diabetes which are more closely related to fat/metabolism etc...).

I'd describe Petro Dobromylskyj as a smart hobbyist with an outsiders views of obesity, not a foremost expert on fat metabolism.

[givemeethekeys]

Is human metabolism really so different from other mammalian metabolism?

[jononomo]

He is basically the world's leading expert, but you can only see credentials, lol.

[1024core]

Given that injections cost ~ $1000/month, you're saying basically that it'll be a great recurring revenue stream for the companies. A CFO's wet dream.

[nerdawson]

I did a little bit of research and for people in the UK it appears to be substantially less. I found a few health companies offering it for <$250/mo. I’ll probably wait until it’s readily available on the NHS but it is tempting.

[paulpauper]

consider that treating obesity-related consequences also costs money and enriches companies as well. I think its worth it

[wins32767]

The only thing I see from him on google scholar is about mechanical ventilation for small animals. What's his background?

[m_a_g]

Here is an introduction I found from his blog:

>I am Petro Dobromylskyj, always known as Peter. I'm a vet, trained at the RVC, London University. I was fortunate enough to intercalate a BSc degree in physiology in to my veterinary degree. I was even more fortunate to study under Patrick Wall at UCH, who set me on course to become a veterinary anaesthetist, mostly working on acute pain control. That led to the Certificate then Diploma in Veterinary Anaesthesia and enough publications to allow me to enter the European College of Veterinary Anaesthesia and Analgesia as a de facto founding member. Anaesthesia teaches you a lot. Basic science is combined with the occasional need to act rapidly. Wrong decisions can reward you with catastrophe in seconds. Thinking is mandatory. I stumbled on to nutrition completely by accident. Once you have been taught to think, it's hard to stop. I think about lots of things. These are some of them.

[rootusrootus]

Oh man, the first result for him on Google is a link to a YouTube video. That makes my BS meter instantly peg.

[aussiesnack]

> one of the foremost experts of fat metabolism.

What makes you say that? In my experience, there are no 'experts' in empirical fields who are no themselves deeply and practically engaged with actual research. Being well-read does not make you an expert. Writing blog posts and appearing on YT doesn't make you an expert. Critics are not experts. To be an expert in anything you have to get your hands dirty.

Nothing I can see from this guys publications or bio make it seems like he's an expert in human fat metabolism at all, let alone a 'foremost' one. I base this on a fairly cursory survey, so I'm happy to be corrected. But convincing corrections would absolutely require details regarding what he has contributed to the field.

[post_break]

So drug companies should be seeing alarm bells going off. You can profit off this drug, and it's an endless supply of revenue.

[JamesBarney]

With every weight loss intervention when you stop you gain back the weight. GLP-1 agonists don't seem to be any different than another other intervention.

[smooth_remmy]

The point is that you could gain back the original weight plus more. Most adults who become obese have not increased their number of fat cells - their fat cells just become larger.

The GLP-1 drugs literally increase the number of fat cells.

[ceejayoz]

> With every weight loss intervention when you stop you gain back the weight. GLP-1 agonists don't seem to be any different than another other intervention.

Except for one thing: it's fairly easy to not stop a drug. You just... keep taking it. Long-term use of these drugs for maintenance purposes looks entirely feasible. Not quite as easy to maintain as a gastric bypass, but close enough to be a big deal.

The same isn't true for exercise and diet; it's very easy to fall off those wagons.

[paulpauper]

gastric bypass does not have this problem as bad

[wolverine876]

> one of the foremost experts of fat metabolism

Is it correct that the source is a veterinary anaesthesiolgist?

https://news.ycombinator.com/item?id=34252195

[jononomo]

Yes, he is the world's leading expert on this subject because credentials aren't everything

[koboll]

>As long as you are taking the GLP-1 inhibitor drugs you will lose or maintain weight, but as soon as you stop you will gain a lot of weight back.

Sounds like the opposite of a disaster for pharmaceutical companies.

Well, on the upside, the demand for this is so great that cheap generics shouldn't be too far away, right? And it seems like an insurance no-brainer to cover it for life, right?

[hollerith]

The cheap generics never appear till the last of the patents have expired regardless of demand.

[milleramp]

I wonder how breaking old habits and establishing new habits over a year or so would stop a serious rebound?

[paulpauper]

The low success rates of diets suggest very hard to establish new habits

[linsomniac]

It is, in my personal experience, all to easy to fall back into the old habits.

[KirillPanov]

I think the big lesson from Semaglutide is that bad eating habits are not the primary cause of obesity. More likely they are correlated due to common causation.

[csours]

N of 1, but I've gone off it for months and maintained my weight.

[aantix]

How much did you lose, how long did you take it, and how long have you been off of it?