We're the founders of men’s health company, here to answer your questions on the correlation between weight and men’s health conditions. Ask us anything!

One big topic with weight loss is alcoholic drinks. Is it true that there is a double-whammy type of effect with alcohol and sugars? That they're metabolized by similar systems so drinking them together is more taxing than either alone? Would it be "officially recommended" to try a scotch vs. a beer, for instance, because the scotch contains less sugars?

Hi u/JustMakeMarines, alcohol and sugars do end up as similarly metabolized products that are later metabolites of glucose - the basic sugar required for all of our metabolic pathways as humans, but the process alcohols like ethanol and sugars like maltose and longer oligo/polysaccharides get there is different. Your liver uses specific enzymes to transform alcohols into molecules called Acetyl CoA, which comes from glucose, and traditional sugar carbs get made into glucose and then Acetyl CoA.

So in a sense, you do get more calories by drinking alcohols and sugars. For beer, it not only has ethanol, which is usually 4-6% of the volume, but also has lots of un-fermented sugars like oligo/polysaccharides from the hops. So beer usually has many more calories than a scotch, which has much fewer saccharides but a lot more alcohol. Saccharides are a lot more calorically dense than ethanol. If you're trying to lose weight, drink less beer and more scotch, but always remember to drink in moderation.

Warning, do not drink more scotch. If you want to lose weight, quit drinking. If you drink regularly, nothing will make you lose weight faster. I used to drink scotch daily. Not only was it very expensive, but I got fat as hell. Cutting back honestly didn't cause me to lose much weight at all, but with I quit completely, I started losing weight very fast, after an initial couple week delay.

Absolutely! Cutting out alcohol entirely is usually the best option for weight loss because of how it affects your overall metabolism and your overall behavior for living a healthier lifestyle. This is the same reasoning that applies for cutting out sodas, even if they are Diet or 0 calories. However, if you felt that no matter what, you need a drink or two a day due to other reasons, drinking scotch in lieu of beer would be significantly fewer calories.

Why do all men like to cup the water around their chest with their hand and then let it splash on the tub when they're taking a shower? Every guy I've ever asked says they like to do this but none of us know why. Yeah, I know it's not a health question but what the hell, maybe you got some answers.

Hi u/Charlie_Im_Pregnant, I'm Rohit, one of the founders. If I said I didn't do that as a kid and even occasionally now, I'd be lying! To be honest, I'm not sure why we do it - maybe because it is just fun! Also probably because we don't have breasts to obstruct the cupping of water?

I also did the old 'I'm a waterbender' technique too, by putting my hands in the spray of the shower and letting the streams of water run off my individual fingers.

My doctor prescribed me Ozempic and it worked great to suppress my appetite. But after three months my insurance cut me off. Even with the discount program and online coupons it was still over $1,000. How do you guys deal with insurance limitations?

u/50StatePiss We work directly with your insurance and continue blood work over the course of our program to indicate "medical necessity" for medications. We also have a tech stack built out that allows us to obtain prior authorizations in an easier manner than just a regular doctor's office.

Would you ever expand to weight gain for those struggling? Are there pharmacological approaches to weight gain?

There are pharmacological approaches to weight gain, yes. These are typically utilized to support individuals that are underdeveloped due to some other condition (e.g. HGH).

Testosterone can also be used to increase muscle mass and has other positive effects demonstrated in the research. Companies do offer TRT currently, and this may be an area we expand to in the future as well.

How does your approach to weight differ from the diet industry? Specifically how does it encourage weight loss without fat shaming or encouraging eating disorders

Hi u/Jacobmaez, the diet industry focuses on more generalized techniques that don't take into account an individual's biology. In fact, every person has a different metabolism and different genetics that play into weight.

With our approach, the first step is to do a complete metabolic workup, which is ordered by our providers, to determine how to best approach weight loss for a specific individual. Our doctors determine the best medication, if they deem it necessary, for an individual, and our health coaches work directly with members to come up with specific lifestyle changes and goals that are based on their biology.

Our health coaches are also trained to recognize the signs of eating disorders and other negative weight loss strategies and work directly with members to make health, positive changes.

Right, so what diagnostics do you do exactly? Are any of the medications your doctors routinely prescribe actually used on-label for the purpose of weight loss?

u/BBlasdel We only prescribe on-label medications.

The diagnostics we do include complete metabolic lab work-ups as well as diagnostics for contraindications of weight loss medications, such as thyroid issues.

Is BMI still the best measurement for a person's weight? Are there updated suggested BMI figures for adults? Can you share a recent chart for both men and women?

BMI is still considered the standard, but it may not be the best measurement for a persons weight. You can have a high BMI, but be mainly muscle (think high performance athletes). That's why we perform blood work for members to understand their complete metabolic profile and understand what health risks they have as well.

Here's a chart from Harvard on BMI, but there's a lot of research out there on specific adjustments for different genders, races, etc. For example, lower BMI's are considered overweight for individuals of Asian descent.

Hey, I'm not struggling w/ obesity myself, but I do work out quite intensely (amateur bodybuilder). I forgot who said this, but I read somewhere that if you're classed as obese on the bmi scale, whether it's because of excess fat or excessive muscle, the stress on your organs is nearly the same, because they're not designed to support that much mass regardless of body composition. Obviously, being muscular is healthier in general than being fat, but is the organ thing true?

Muscle mass tends to improve health and is correlated with increased longevity00138-7/fulltext). I can't find any real research that supports the theory that excess muscle strains the body's organs in any manner similar to obesity's effect on the body.

Generally, a safe bet is moderation with all health related choices.

Is there a connection between weight loss and male lower back pain?

As in does weight loss help alleviate lower back pain?

_LouSandwich_, 100%. That's actually how we got into this industry, from seeing patients who had obesity struggle with severe back pain and lower back conditions such as fractures and herniations. Here's a great meta analysis on the connection between obesity and back pain: https://academic.oup.com/aje/article/171/2/135/130619?login=true. TL/DR obesity increases the risk of LBP by about 53% (OR 1.53).

Hi!

I have ADHD and as a result I impulsively eat a lot of sugary foods and I find it particularly hard to control this impulse.

Do you have any recommendations?

Do you have any recommendations?

We don't want to provide any medical advice outside the bounds of our expertise; our best recommendation would be to work with a psychologist on managing ADHD to manage these impulses.

However, you can limit these impulses by reducing supply of them around your house and replacing them with other alternatives. Sugary foods are okay every once in a while, but finding foods you like outside of these that can satisfy your cravings is often a good strategy. Also replacing sugary, processed foods with more natural sugars from fruits can help you manage how much you're intaking.

Lastly, a food diary can help with managing how much sugary foods you're intaking because it forces you to keep track of them on the fly and realize in the moment that you're acting on an impulse.

Is it realistic for a teenager to try and gain a kilogram every month? (I’m trying to gain weight)

Very reasonable. Try eating foods that are very nutrient dense, likes foods with lots of carbs and fats. Eat a slice of two of toast with butter everyday, try to eat lots of pasta and sandwiches. Eat more calories than your required daily amount.

Do you guys study the affects obesity has on fascia? From my understanding of anatomy, the affect having too much weight has on our connective tissue can not be understated - range of motion is phenomenally limited in many obese ppl making it impossible to activate certain muscle groups, making exercise of the important muscle groups all the more difficult....combined with sedentary lifestyle, do you think we should re-approach the idea that exercise is a fundamental part of weight loss ?

u/hellaquestions we don't directly look into the effect on fascia, but there is a body of research that has begun to investigate this. For example, this paper talks about how obesity can increase risk of fascia-related diseases such as plantar fasciitis.

Exercise doesn't have to mean going to the gym and lifting for a whole routine. Many of our members start with simple cardio, like going on a walk each day, and moving on to other exercises with the support of health coaches to continue to activate key muscle groups.

What does your company do specifically to help men lose weight? And what is your value-add in the market -- couldn't a man work with a local doctor to develop a weight-loss plan?

u/TTTT27 Our program offers doctor-prescribed weight loss medication, 1:1 health coaching, and community-based competitions that help men connect with peers and keeps men accountable with weight loss. Essentially, the market is extremely fragmented and expensive. To get the same care we provide, you'd have to see a primary care doctor, a health coach, a personal trainer, a nutritionist, go to forums online, etc. whereas we provide all these aspects in one platform.

Currently, there are key access and coverage issues with FDA-approved weight loss medications that make it harder for primary care offices to get weight loss medications to users. These practices also lack the high touch accountability that a program like ours can provide. Typically people lose the motivation to continue with plans if they don't have support on at least a weekly basis, which our health coaches provide.

Is it just my imagination, or do more and more people suffer from obesity every year?

You're correct, u/gencoloji. According to the CDC, the prevalence of obesity increased by over 10% from 2000 to 2018 (30.5% to 42.4% of Americans).

There is a lot of conflicting information about diet sodas and diet foods. Is there any definitive information on how sugar alternatives impact weight loss/gain?

u/slowgonomo according to the research, there does not appear to be a direct correlation between aspartame-sweetened alternatives. There is research that attempts to correlate drinking or eating diet foods with other habits, like increased consumption of solid calories or increased appetite, but there are multiple conflicting papers on this topic.

I'd say the data is really still inconclusive for this as of now.

There is some research that indicates drinking diet sodas compared to no soda increases risks of conditions like diabetes.

So I have to walk with a cane and have nerve damage in my legs. Is there a way I can do cardio and other exercises without using my legs so much?

u/Sinicalkush, there are many non-leg cardio workouts. A few great examples are the "arm bicycle", erging (using rowing machine), or water aerobics. Water aerobics especially reduce the impact on your body and nerves, which may make it easier on you as well.

I know you said your focus is on being overweight, but what about chronic diseases and being underweight? I'm a 33 year old 5'7" male and I weigh 100 pounds. About a year ago I was 86 pounds, but thankfully I was able to gain a decent amount of weight recently (with much effort). I suffer from GERD, gastroparesis, and a slew of other digestive diseases. I'm extremely worried about my longevity because I've seemed to plateau with gaining weight, and no matter how many doctors I go to none of them can seem to help me get past the 100 lb mark. What sort of health problems should I be proactive in terms of looking for if I continue to be this severely underweight?

Hi u/FeckOffCups, our expertise is in weight loss, so we may not be the best resource since weight gain is a completely different ballgame.

However, lots of the calculus in weight gain/loss is associated with caloric input. Try to eat calorie dense foods like carbs and fats more often than other food types. This means eating more bread, pasta, etc. Best of luck with your endeavors!

how do you determine Obesity if the BMI is faulty and out of date?

Hi u/CBML50, one of the first things we do for our program is ask our patients to re-weight themselves and get metabolic bloodwork done to get a full picture of their current health. In fact, there is a large discordance between people who are actually have obesity/are overweight and people who think they have obesity/are overweight. In this article, 70% of people have weight related issues, but only around half of them self identify as having issues.

Best way to lose belly fat?

Diet and Exercise.

Diet and exercise are certainly a great way to lose weight, but it's important to realize weight is not just related to what you eat and how much you exercise. There are significant genetic and metabolic aspects that play into weight gain and weight loss, just as with any condition. Mental state (e.g. depression), stress, and sleep are also key factors that play into weight gain. That's why having a health coach and doctor involved in the process can really help people who have tried to lose weight unsuccessfully, because they can address other factors in a person's life that play into their weight.

That's why having a health coach and doctor

They gonna tell you to eat healthy and exercise.. but charge you for it.

Sure but they can also be more specific I assume. As someone that has struggled to lose weight despite working hard at it, I would love for someone to come along and tailor an approach for me that would be effective.

u/The-Go-Kid We specifically tailor our approach to best serve you, as well as grouping you with a small group of peers to compete in weekly challenges and discuss successful strategies.

Our doctors help determine whether medications could be an appropriate avenue for weight loss as well, in addition to determining if there are specific underlying causes for your specific weight gain based on the metabolic testing they request.

From dealing with this ourselves, like you, we realized how much of a struggle it is to manage weight without support and accountability; hence we formed Alfie for ourselves and men like us.

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u/The-Go-Kid it appears cannabis may have a positive effect on weight loss by increasing metabolism, but there are other side effects that have stopped research into certain areas of utilizing cannabis for weight loss.

Not the OP: Each person's body stores fat preferentially in different places. For instance, some might store it more in their legs, in their butts, or in their breasts, leading to a variety of body-shapes.

If you have belly-fat that's "external", i.e. subcutaneous fat under the skin, that's a different matter than internal organ-fat that ends up in your liver. You'll see older men with fatty livers and fatty organs, they may have an extremely large gut while their other body areas seem skinny. This is NOT good, our organs do not want fat stored in them to that degree.

Like the other comment said, the best way to lose fat is to take in less calories. The easiest way IMO is to never drink calories. Cut out sugar from the coffee, cut out alcoholic drinks, cut out sugary beverages like sodas, fruit juices, etc. These things are the easiest to cut out and will give you MUCH bigger impact than tinkering with your diet.

It will be hard at first: your micro-biome, your gut bacteria, will be angry at you for 2-4 weeks. But once you get off these drinks, you'll find your cravings go WAY down as your bacteria and your body itself adjusts. My family made the switch when I was in high school and all of our BMI's dropped a fair bit due to this one change.

JustMakeMarines addresses the variations in weight gain really well. Dieting is the certainly the best way to lose weight, but it's important to diet in a healthy way, rather than cutting out multiple aspects of your diet and immediately gaining back the weight once you stop. This is why 80-95% of people put back the weight once they've tried a habit based weight loss method alone.

Can you define habit based weight loss? What other methods are there? Thanks!

u/TumescentAndroid habit based weight loss includes making changes to your lifestyle alone to lose weight, such as diets, exercise, sleep, stress reduction, etc.

There are FDA-approved medications that help people who have tried to lose weight before but done so unsuccessfully, such as GLP-1 medications, which our doctors prescribe.

These medications mimic your body's natural GLP-1 hormones and work by making you feel full and suppressing your appetite for longer than normally. They are very safe, with minimal side effects. When combined with habit changes, they have been shown to provide 15% weight loss in under one year.

How do you reconcile your endeavors with fat-based oppression in society? What steps have you taken to be explicitly anti-oppression in your work?

Being overweight or having obesity is severely stigmatized in our society. We focus on the scientific impacts of weight to help people realize that weight gain is a result of their biology, not just their lifestyle choices. We focus on obesity as a disease (which it is) rather than an identifier of people, and use specific training to make sure our employees use people-forward language and work with members to address the psychological impacts of weight gain as well.

On what basis do you assert that “obesity is a disease”? Obesity is an actuarial construct used to categorize risk.

It sounds like your approach embodies internalized fat-phobia.

Obesity is a disease as classified by the International Statistical Classification of Diseases and Related Health Problems, a medical classification list by the World Health Organization.

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actkms, weight gain has significant negative effects on mental health. Weight gain and obesity increase risk of depression by up to 55% compared to individuals in the normal weight range. In addition, weight gain has been shown to reduce Health Related Quality of Life (HRQoL), which covers mood and mental state.