> Please do not let moral posturing cause you to underrate the importance of a holistic approach which includes medication-assistance.

I get that you're a founder. It would be great to not cast aspersions on people. "I think your approach sucks" is not "moral posturing", and I'd question how many ethical doctors would recommend something insurance will not cover with an unknown end date to the treatment plan as "pharmacotheraphy" out of the gate.

For those who cannot gain muscle mass, injecting testosterone would also work (and would work for weight loss). Messing about with the endocrine system is tricky. Your body is really good at homeostasis. It's also really good at saying "welp, I guess that's covered, so I'm good" when exogenous sources of hormones are introduced.

Is this part of the treatment plan? What about diabetic patients (who appear to be a small part of the studies leading to approval)? How are you going to control for hyperglycemic ketoacidosis?

What's the long term effect of this on alpha cells and pancreatic health? How long is the titration for normal pancreatic function to resume? When exogenous glucagon is removed, what are the hunger levels of patients? Bounceback effect on weight if appetite is increased in the meantime?

Yes, use every tool in your toolbox, but there are a lot of unanswered questions about the medication in question, and a lack of insurance coverage. I've been overweight. Your body is not a formula in the "I calculated CICO, and...", but it does follow basic rules in a "I tracked my calories religiously, and over the last 2 weeks, my average daily intake was X, and the scale change was Y, so I need to modulate intake/activity up/down/stay the same" until you reach your goal.

That's hard for some (many) people. It's also completely sustainable. We want an "easy" way to do things. Sometimes "easy" things have detrimental effects in the long term, which are not apparent during clinical trials or short (let's say 3-5y or less) term, medically speaking.

Doctors would recommend pharmacotheraphy for obese patients because the health effects of being obese are dramatic, and almost certain to be worse than whatever the health effects of the drug are, because they have relationships with the vendors, because they are not sure whether the patient could affect the same change in health without them, etc.

However, if presented with the choice of "Patient X is able to achieve the desired outcome without the addition of medication", that would be the choice every time. You can filter that through the scale to "Patient X is unable to achieve the desired outcome without incurring significant financial burden/hardship by taking a new-to-market drug with unknown long-term consequences and an unpredictable prognosis once pharmaceutical intervention ceases, but the outcomes are so much better that this risk is warranted", which seems to be close to the starting point of the pitch here.

Medical ethics are not moral posturing.

Edit: your cofounder is doing a great job (https://news.ycombinator.com/item?id=28260302) addressing the tradeoffs here.

Not to put too fine a point on it, but this is not the greatest venue for comments like the last one in that chain (yours) (https://news.ycombinator.com/item?id=28261777). People here want to know how it works, why it works, what your pitch is, why we should recommend it, etc.

I am not your target demographic and never would be for a variety of reasons, not least of which being that I've been a competitive athlete in weight-class based sports for almost my entire life (outside of the 5-6 year period where i stopped training and became obese). I am here commenting, though, and you can make a fair guess about who I know based on the demographics of the US and their intersection with the market demographics of software engineers. Lots of overweight people with the kind of income which could afford this.

Like many people on HN, I read a lot. I'd hazard to guess that I come across many more startup ideas and news articles than most people I know, and I do bring them up in conversation. Fella is the sort of thing which I could recommend (well, "here's now insulin/leptin/glucago intersect as part of the HPS axis, and there are GLP-1 analogues, with this startup which may be able to help"), but I'm unlikely to if it leaves a bad taste in my mouth as yet another shill for medicating the symptoms instead of addressing the cause(s).

If I see responses like "this is the sort of stuff our customers talk to their doctors about" and not "this is why you should become our customer", I'm gonna write you off, and that's probably a fair assumption for HN in general. The comments are not the place for elevator pitches, marketing, etc. It reads like "I'm happy to answer your questions once you pay me, but not here".