Hacker Newsnew | past | comments | ask | show | jobs | submitlogin

A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true?

From what I have heard, all of these issues come back as soon as someone comes off the drug. So either a person is committing to a lifetime of being dependent on this drug, or a person is committing to some period of time of ideal living, followed by a possible time of depression after reverting to the status quo.




I'm not sure why "it stops working when you stop taking it" is used as an argument against these new peptides. This is the way almost every medication we encounter works.

Tylenol might get rid of your headache, but that headache can come back tomorrow. Stop taking birth control and you might get pregnant. Stop taking Claritin and your allergies return. Stop taking insulin, and, as with these new peptides, you lose control over your blood sugar. Stop taking Adderall, and not only will your ADHD symptoms come back, you'll also experience withdrawal.

Almost no medications are "one and done", and I'm not sure why Ozempic or Mounjaro are being held to needing to be a cure when it's clear that they're effective, repeatable treatments for blood sugar control and (likely related) weight gain.


I am not holding Ozempic to needing to be the cure for anything. My point is that people without diabetes are looking to this drug for weight loss, at which point they create a dangerous dependency, with no hard evidence that their actual health improves. This is opposed to coming up with long term solutions that involve re-evaluating daily decisions that lead to some of these diseases in the first place. If Ozempic is a good treatment for blood sugar control, which could be a good factor to consider in weight fluctuation, maybe reduce the amount of sugar one eats?


Is it really a dangerous dependency? There's been no evidence of anything happening once individuals go off of semaglutide or tirzepatide other than the tendency of gaining weight to the original levels and/or blood sugar readings returning to the pre-medication levels. This is the most common outcome anyone has trying literally any calorie-reducing diet, medication or not. There's no evidence that people are ending up worse for having been on the medication, except for some who experience gastro effects early on and can simply quit.

Also, yes, you can absolutely advocate for a low-carb/low-sugar diet for those with poor blood sugar control. The issue there is that virtually every medical professional has advocated for similar diets for diabetics or those with blood sugar control issues for centuries, or even millennia - there is evidence of recommended diets for those with diabetes since BCE. This does not mean that those diets are easy or pleasant to follow, whereas all evidence indicates that common issues with appetite and energy on a limited calorie or low-carb diet are less prevalent with these new peptides than those trying to go it alone.


I don’t necessarily mean dangerous in the health aspect, although long term affects of these drugs are not know yet…I mean the dependency on needed the drug to keep a certain lifestyle, and then having an “oh shit” moment when you’re in a place that you can’t access it, whether that be traveling or the supply of it becomes scarce, or it gets banned, etc


That sounds like the lesser of two evils to me. Get healthier now and maybe sometime later lose access to the thing that helps you be healthier...or don't get healthier now? Yeah, there are other, orthogonal, choices but I don't think they're part of this particular decision matrix.


Yep. I lost 30lbs on it in 3 months. It took me 10 years to gain that weight.

So I guess if it takes me 10 more years to gain it back I can look into taking it again.


People usually gain back that weight much quicker. All it could take is one bad month and you could gain it all back.


I lost about 15-20 kg on Ozempic over about six months to a year, and held that weight for another year – continuing on 1 mg Ozempic / wk – until last autumn (2022). Then Ozempic was more widely approved than it had been before somewhere (for over-the-counter sales in the USA? Something like that.), and became unavailable in pharmacies where I live, in Finland. (AIUI, because it's more lucrative to sell it in the USA where prices aren't regulated like here, so all the limited supply is redirected there.) No problem, I was prescribed a substitute, a daily pill (brandname Rybelsus, forgot the active substance) in stead of the weekly injection pen. Worked the same, held my weight. (More of a hassle to take though, and tastes horribly, so on the whole I vastly prefer the Ozempic.)

Then, earlier this spring, that prescription ran out. Being in the middle of changing my primary healthcare provider I couldn't immediately get it renewed. And to be honest I wasn't at first all that bothered; I thought now that I've lost so much weight, and kept it off for so long with the help of these drugs, maybe I've got into the habit of eating less, so I can stay constant without them? Nope – in just a few weeks, ballooned back up some 8-10 kg. Had to scramble a bit to get the pill prescription renewed, been on it again for a couple weeks, but still some 6-7 kg above where I was before they ran out. Sure hope I'll get back down the rest of the way.

TLDR: Anecdata (n=1) says yes, going off the drugs even for a rather short while puts the weight back on quite quickly.


An average person would have to eat 5500 kcal per day to gain this much weight in a month. It's probably not impossible, but I would say it is very unlikely.


Totally impossible. I’d have to be eating like way more than I ever have to do that.

I went off for three months and kept losing weight throughout.

And the data from these drugs shows they gain it back at regular rate at most.


But given that the actual health benefits of ozempic(for me weight loss is not indicative of better health) have not actually been seen yet, you are quite possibly just taking on both evils at the same time.


On the contrary: GLP1 agonists show broad health benefits across the board.

Check this 24-month clinical trial with >3000 participants[0]. It showed improvements in rates of:

- Cardiovascular death

- Non-fatal Myocardial Infarction

- Non-fatal Stroke

- Revascularisation

- HbA1c

- Fasting Plasma Glucose

- Body Weight

- Lipid Profile ( total cholesterol, LDL cholesterol and triglycerides)

- Urinary Albumin to Creatinine Ratio

- Systolic blood pressure (mmHg)

- "overall health related quality of life namely bodily pain, general health, mental component summary, mental health, physical component summary, physical functioning, role-emotional, role-physical, social functioning and vitality." (each of these categories were "quantitatively" measured using a calibrated questionnaire - - and they all showed a dose-response relationship -- 1.0mg semaglutide made a bigger improvement than 0.5 mg, vs. two different placebos)

0: https://clinicaltrials.gov/ct2/show/results/NCT01720446?term...


>the dependency on needed the drug to keep a certain lifestyle, and then having an “oh shit” moment when you’re in a place that you can’t access it, whether that be traveling or the supply of it becomes scarce, or it gets banned, etc

It sounds like you're realizing what it's like to really depend on a medication.

The anxieties and risks you're describing are what people with diabetes, cancer, HIV, bipolar disorder, schizophrenia, depression, ADHD, etc. deal with on a daily basis for their entire life.

Yeah, it is frightening! Sometimes a guy like this[0] comes along and makes your life even worse!

https://en.wikipedia.org/wiki/Martin_Shkreli


How dangerous is it to have a new $1k/month bill you need to pay forever?

So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic...

Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk...


Given a significant percent of voters are overweight and obese, it would be very politically popular to legislate that health insurance must pay for GLP-1 antagonists.


Wouldn't this cause insurers to have to raise their premiums for everyone substantially?


No. The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year, but if not exceed it, they certainly come close. Moreover, it's not unheard of to mandate cheaper drug prices, and now that we understand how these drugs work, there will be more of them in the pipeline.


> The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year

This is a big claim to assert without evidence. If it was the case then insurers would already be adding the drugs to their formularies.

There is undoubtedly a cost associated with obesity but you are suggesting that simply being overweight doubles the average cost of care[1], a figure that already includes overweight and obese people (which are of course a huge population in the US).

A quick Google search turned up a report[2] that suggests that

> This estimated public cost equates to an average marginal cost of $175 per year per adult for a one unit change in BMI for each adult in the U.S. population.

So, even for the extreme case of a very obese person that has a very successful treatment and goes from 40 BMI to 25 BMI, you are only saving a hypothetical $2,625 per year (perhaps an underestimate due to inflation and the age of the paper).

Therefore it would appear that unless insurers strike a deal with the drug companies (lower the price, make it up in volume), such a law would dramatically increase insurance premiums. A better compromise would be a law which requires insurance companies to offer co-insurance on these drugs up to the expected savings.

[1] https://www.pgpf.org/blog/2023/01/why-are-americans-paying-m....

[2] https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe12...


> If it was the case then insurers would already be adding the drugs to their formularies.

American healthcare system has perverse incentivizes. Most unhealthy groups are generally least likely to be privately insured, so insurers are incentivized to prioritize health issues affecting working-age adults, while neglecting those which will be someone's else concern in future.


You can also factor in that all those obesity related heart complications will turn into an extra decade of cancer treatments.


Why would a $1k/month drug increase costs more compared to the status quo of expensive bariatric surgeries and complicated heart failure/joint issues/osteoarthritis/sleep apnea etc. cases that arise from obesity? Massively reducing obesity rates seems like a good thing from the POV of an insurer.


> So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic...

What’s the cost/benefit of weight loss and diabetes control vs $12k/year? I would expect people with high obesity are very expensive to insure and insurance can’t drop people any more. It may be cheaper to pay for ozempic (especially at whatever negotiated rate insurance pays) than to pay for the alternative negative health outcomes.

That and ozempic goes generic in 2031 and mounjaro in 2027 so soon this won’t be a question of $1000/month but maybe $1000/year at which point insurers will probably force customers to take it or pay higher rates.


Most of the data is showing that Ozempic is not required long term though so a single year might be all that's required; and for the morbidly obese;

$12k is going to be less than the typical admission to a hospital (for injury, illness, heart disease, diabetes related incident.)


> Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk...

There is anecdotal evidence that eating less is, in itself, so much more healthy that it doesn't really matter what you eat. Nutrition professor Mark Haub ate nothing but "convenience store food" for 10 weeks at a caloric deficit and all of his health metrics improved while he lost 27lbs.

http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/...


Move country, it costs about a tenth of that in the UK.

One month supply us about £135 which is about $170 at todays rate.


> My point is that people without diabetes are looking to this drug for weight loss, at which point they create a dangerous dependency, with no hard evidence that their actual health improves.

These drugs would have to be pretty bad to counteract the massive health benefits from losing weight (even if they don't have diabetes). I've heard a few eye-openers in the comments, but unless they're more prevalent than I've read, or there's some ticking time bomb, the drugs are probably still a net health benefit.


> This is opposed to coming up with long term solutions that involve re-evaluating daily decisions that lead to some of these diseases in the first place.

Medicine tried this. It's extremely hard to actually to do it in practice. Obviously, it's better solution, but we are living in real world, where we have to choose "good enough" solutions over those deemed "better, but infeasible for 90% of patients".


"re-evaluating daily decisions" is exactly what suppressing these hormones allow people to do; so that they can make rational instead of hormone driven decisions.


(If the answer is "because you'll learn to eat less or eat in a more healthy fashion", it may well be that the metabolic issues that are creating heightened blood sugar or appetite issues may not be able to be resolved by diet alone in those who respond well to these peptides.)


>From what I have heard, all of these issues come back as soon as someone comes off the drug. So either a person is committing to a lifetime of being dependent on this drug, or a person is committing to some period of time of ideal living, followed by a possible time of depression after reverting to the status quo.

This is true of every weight loss intervention: Weight Watchers, low-carb, keto, Whole 30, etc. Once people stop complying with them, they gain the weight back.

Most people don't realize how dismal the stats on long-term weight loss are. Almost no one maintains a substantial amount of weight loss for many years by following "just eat healthy and exercise" advice. The only intervention that does reliably work is bariatric surgery. The jury is still out on the new GLP drugs.


> The only intervention that does reliably work is bariatric surgery.

My understanding is surgery only works reliably because failure to comply with life style changes post-op is easily fatal and ethical doctors only perform the operation after patients have demonstrated that ability. In all but the most extreme patients, about a fifth to a third of the target weight loss has to happen pre-op for doctors to even consider the procedure. The surgery is essentially a sword of Damocles hanging over patients, reminding them that they'll die much faster than normal if they over eat.


Failure to comply with the post op diet might be fatal within the first few months of recovery (although I haven't heard of that happening, I'm sure someone has died from eating too much), but after that, you are going to be mostly healed up. And its the long term that will determine if the weight loss sticks. It certainly isn't just because the surgery selects for people with willpower. Because almost everyone who has it has gone through years of losing and gaining back their weight over and over.

Bariatric surgery usually works for 3 reasons. First and most obvious is that it reduces your stomach size so you simply can't eat as much. Second, in most cases, reducing the surface area of the stomach reduces the amount of hunger hormones that get released thus making you less hungry all the time. And the third is malabsorption. Meaning that of the food you do eat, you absorb less of the calories than you did before. So if it were possible, you could potentially eat the same amount as before but still lose weight.


New addictions post bariatric surgery is fairly common. Gambling for instance [1] replaces food.

[1] https://www.researchgate.net/publication/332884264_Gambling_...


best to read the study before commenting on it

In the addiction literature, the development of gambling dependence after bariatric surgery is limited. Mitchel et al. reported that 2 cases presented with post-operative gambling addiction in their 3-year screening study in 201 post-op case (5). In our case, the presence of genetic background may be a risk factor for the develop-ment of gambling

2 out of 200 cases is not that common and close to baseline level


Clinically, what causes the urge to have an addiction? Like in your statement, replacing food with gambling. I would assume that these are fundamentally two different reward systems for the brain, or maybe not?


" failure to comply with life style changes post-op is easily fatal"

My understanding is naive but I always thought it was no longer possible to fail to comply after this intervention?


No, you can seriously damage your stomach, which is now already severely scarred.


You can rupture your GI sutures if you do not adhere to the post-op diet, and risk death.


Diets fail because ppl lose willpower. These new drugs in theory make this easier


The first days, weeks and months are often the hardest time when quitting a substance. If this drug helps a smoker not smoke for 3 months, by that time the nicotine addiction has weakened considerably. They've gotten past the hardest part. I see no downside to that.

Similarly, if a person loses 30 pounds on this drug, then stops using the drug and reverts to normal habits, it will take a while to regain those 30 pounds. And the long term shift of maintaining the new body weight doesn't require any radical changes (unlike losing 30 pounds, which does require sustained radical changes).


That is not what happened to me. I took it for 2 months and then I wanted to get off. I did not go back to normal. Mentally I felt like I needed more food and more junk food than I ever did before using the drug.

My hypothesis is that it supressed my body's natural production of whatever chemical in my brain helps me not go overboard with food. With that supressed by the drug I had an uncontrollable desire for food and currently I am fatter than I was before taking the drug in the first place.


Did you quit cold turkey? Or did you slowly taper it off?

I'm taking Rybelsus (pill form of semaglutide) and there are 3, 7 and 14 mg versions. My plan is to take 14 mg for a couple more months, then switch to 7 mg for 1-2 months and then 3 mg for a month before stopping taking it completely.


> Mentally I felt like I needed more food and more junk food than I ever did before using the drug

This is consistent with hungry brain hypothesis. Your hypothalamus detects that you have less body fat than amount set on "lipostat" and it tries to get fat content back to this set amount.


An interaction with leptin? Or are you just feeling hungry after the side effects wore off?

You also said it stopped working while you were taking it in another post; are you just talking about satiety or one of the other effects like insulin production or glucagon release? Are you diabetic or just overweight?


This same thing happened to me when I quit smoking without assistance from a drug.


This is what I thought as well, that the habits that drive some of these activities would be dramatically weakened, but it looks like the body is not actually re-aligning to a new homeostatis level, so when a person gets off the drug, the body is trying to get back to the old level. I don't think it all comes back to habits, often your body is working really hard against you to get back a level it feels is right(whether that level is 'healthy' or not).


> The first days, weeks and months are often the hardest time when quitting a substance. If this drug helps a smoker not smoke for 3 months, by that time the nicotine addiction has weakened considerably.

I love(d) nicotine and it was the only substance that I ever was addicted to. I tried dozens of times to quit and the only thing that helped was getting treatment for my ADHD. Quitting nicotine was easy for me on methylphenidate. I only tried combining them and nearly went to the ER, so I quickly learnt that I can't take them both. But when I'm on methylphenidate I just don't crave nicotine that much. It took 2-3 years to completely not get any nicotine cravings at all.


Makes sense given the mechanism of action.

I describe my adhd as being addicted to nicotine and stopping cold turkey. Except you're not addicted to nicotine, what you're addicted to is a stimulus that is inconsistent and changes constantly. Your cigarette is a constantly changing thing.

Methylphenidate really messed me up, I found Lisdexamfetamine much much more effective.

I still use nicotine, though in vape form these days.


>I only tried combining them and nearly went to the ER

Could you elaborate on that? I'm currently still a smoker (working on it...) and on Concerta. Your note alarms me :)


Not the person you're replying to, but what helped me quit was the book "How to stop smoking" by Alan Carr. Highly recommend working through it and taking his point about cold turkey in good faith. Good luck!


I have a fun experience with the Alan Carr book. The first time I read it, I was laughing the whole way through thinking about how much it was written like straight-up brainwashing propaganda, but I had committed to a friend to reading it all the way through. I got to the end where the final bit is something like "now just say out loud 'I am a non-smoker and when I wake up tomorrow I will never have a cigarette again'". I chuckled, thought it was ridiculous, and the next morning I woke up and didn't have a smoke. That lasted about 2 years until I got extremely drunk one night after a rough breakup, had smoked the whole night, and was pretty much instantly hooked again.

Ten years later I went through the exercise again, but sadly it didn't work nearly as well as it had the first time around.


One thing that kind of opened my eyes is his asking the reader "what do you prefer about your cigarette brand?" It made me realize that they all taste like sh*t.


Nicotine physical addiction is over with in less than a week. The remainder is psychological habit and classical conditioning.


In my experience, different drugs have different effects on different people, sometimes radically so, and overly-generalizing is less than useless when trying to learn and understand how drugs work, both on an individual level and a societal level.


Imagine being 250 lbs and feeling like you are starving constantly, despite eating a lot every day. You decide to lose weight. You do something you hate, like calorie restriction and working out like a dog. You lose 80 lbs in 1 year. Bravo. Everyone tells you how great you look. You feel great. All that hard work was worth it. The fatness and a million other things really motivated you to do the hard work. I've done this a couple of times.

Next day after hitting your goal, the starvation is still there. The desire to eat is still there. Hating working out is still there. But now you have to do this herculean effort every day not to get better. Not to lose weight. Just to maintain. Your brain wants you to gain 80 lbs and will never stop nagging you. Not on a good day. Not on a bad day.

Then something really shitty happens in your life. Like it does for everyone. You slip. Eventually you start to gain back the weight. You just want to die. You feel like a failure. You hate yourself.

That's the trick. Hitting goal weight the first time or two is relatively "easy". But you've achieved nothing if you aren't able to maintain weight loss. That's the failure of all approaches prior to these GLP1 and similar drugs.

Having set the scene, now compare it to semaglutide. You have a drug that regulates your brain. Gets rid of the constant nagging to eat. You get normal brain. You lose weight.

Now you have to pick, take a once a week drug for life to maintain, or do a herculean effort to fight the brain urges and work out to maintain.

Which do you think will be more successful?


This perfectly encapsulates my experience. I'm hesitant to ask for this medication because of side effects and because it's got a 2 year limit in my country, so I don't want to go through it all then have to stop and ultimately put it all back on. Shit sucks, bro.


Do some research into compound pharmacies as a worst picture backup. I know several people on them successfully. Peptides can't be patented. Semaglutide is a peptide. They are patenting the delivery mechanism AFAICT. As to sides, ramp up slowly. Maybe you won't have any. Also, there are new drugs coming that are even better. I'm sure the shortages and whatnot will be sorted out. The solution is out there. They can't stop this train.


> Peptides can't be patented.

This is...mostly wrong. Like both normal wrong, and "x-y problem" wrong. There is definitely some truth in there, but the full explanation would require an actual lawyer, because there's a LOT of layers of complication.

Just so people don't have to simply take my word against yours, here's Jacob Sherkow, JD, a professor of law and medicine at the Illinois College of Medicine on the topic:

> semaglutide that's "made, used, sold, offered to be sold, or imported into the United States is possibly an act of infringement, if Novo were to sue them"

But this isn't just about patents -- that's the "x-y problem" that I was talking about. It may not be legal to import active ingredients of FDA-approved drugs. Most peptides (AOC-9604, BPC-157, Ibutamoren, Ipamorelin, etc) are "legal" because they're not considered drugs. Once they're FDA approved, they become not legal to import/re-sell unless you're a compounding pharmacy. It wouldn't generally be legal to import fexofenadine (OTC allergy medication), for example, even though it's not a controlled substance. Because importing non-FDA drugs is generally not legal unless you're a licensed part of the medical supply chain.

So yes, compounding pharmacies can provide it to you and you offload the legal gray areas onto them. But just saying "they can't be patented" kind of hides most of the legal quandaries. From a practical perspective, many organizations and individuals do import these things without worrying about legal consequences, because enforcement is very low. But I wouldn't formally pretend the legal issues don't exist at all levels.

https://www.medpagetoday.com/special-reports/exclusives/9962...


I believe you.

Look, I read a bunch of contradictory stuff on the internet about this and am close to a good number of people in healthcare who told me compound pharmacies are legit and that there's a lot of FUD on the internet.

But I'm not pretending to be an expert in law or medicine.

People need to research this and do what they feel comfortable with.

That said, I'd personally prefer if the prices came down, the supply remained highly available and it was covered by insurance and the companies like Novo who spent money to create these solutions got paid for it. It's a miracle and they deserve what money they make off it.


To your point, there is a ton of gray area. One site I can responsibly link here is https://www.peptidesciences.com/ -- they're very careful about working to stay on the right side of the law, and they sell semaglutide and tirzepatide for ostensibly "not-for-human-consumption" (and at very, very high prices). So the raw ingredient, in non-medical settings, is not inherently impossible to import and sell legally. But I'm not fully convinced they're immune to lawsuits or legal action.


I'm gonna end the conversation here and let you have the last word, because I don't even feel comfortable talking about compounding pharmas.

From what I've read, sites like the above are really dangerous, because people are ordering from them and like you said, are NOT for human consumption.

Compound pharmacies, from what I understand, are meant for human consumption. From the healthcare people I know personally, including my own doctor, they have been used for ages and are totally legit. But folks should just talk to their doctor before taking anything.


This is exactly what happened to me. The clinic I went to recommended starting out with 1/10 the normal dose for the first month to make sure I would tolerate it. Then we would move up each month.

It worked so well I didn't want to move up so for month 2 I stuck with 1/10th the amount. During that month the effects wore off so I had to take more to get the same impact. I chose to just quit.

2 months after quiting I am 7 pounds fatter than I was when I started with the drug. I suspect that most people will need to keep taking more and more of it to get the same benefits they got from the recommended dose. I am really concerned this is going to lead to a bigger health crises than the one it purported to solve.


> I am really concerned this is going to lead to a bigger health crises than the one it purported to solve.

A lot of diabetics taking it to regulate blood sugar (particular the feedback loop with insulin and hunger) have said it's changed their life... but for people who are merely overweight I think the benefits may not always be worth the side effects. IMO the correlation between weight and health is not as strong as people often assume.

Anecdotal, but if you looked at me and my partner, you'd probably assume I was the "healthier" one based on our respective body types. But they're strong, fit, and rarely get sick (knock on wood); meanwhile I'm a lifelong wimp with a host of autoimmune issues. I outsource all of the heavy lifting to them, literally—if the trash is too heavy for me to take to the dumpster, they get to do it instead :P

So to your point about health crises, yeah. It seems foolish to put my partner on a weight loss drug just so they could "look" healthier while nursing a bunch of unpleasant side effects that would make them far sicker than they were before.


Obesity is the number one cause of heart disease, which is the number one killer in this country. No, its health effects are not being overstated.


Sure, but that doesn't mean everyone who's overweight has high blood pressure and therefore should go on "shit your brains out" medication.

EDIT: Also, to my previous anecdote, despite being the skinny one compared to my partner, I actually do have several heart problems! (Thank you inflammatory diseases.) But you wouldn't guess that by looking at me, because weight is not a 1:1 indicator of health.


I think weight is the wrong thing to target for gauging health, but it is the thing that is in everyone's face and easy to see. Undernourishment is just a big of a problem as over-nourishment. Targeting the four horsemen(t2 diabetes, Alzheimer's, heart disease, cancer) is a better use of time and money, but they are relatively much harder to identify early.


> Undernourishment is just a big of a problem as over-nourishment.

Having been recently diagnosed with Crohn's I 100% agree. Getting skinnier during a bad flare makes people think I'm in better health, because I look a certain way that aligns with their expectations, but it really just means my gut isn't absorbing any nutrients. Turns out being at my lowest weight in years was a Very Bad Thing and not a sign I was doing anything right.

Which, again, is an interesting juxtaposition with my partner who weighs more than me but whose body functions correctly and whose biomarkers come back normal, unlike mine.


> Targeting the four horsemen(t2 diabetes, Alzheimer's, heart disease, cancer) is a better use of time and money, but they are relatively much harder to identify early.

All of these diseases have significant input from bad diet and metabolic disorder. Alzheimer's is considered a variation of t2d in some circles.


> A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true?

It does sound too good to be true. However, it's possible that the drug is working on all of these through the same mechanism: by altering the brain's reward system.

If that's true, the drug doesn't make you not want to eat, it makes you not want stuff, in general. That could potentially suppress a wide array of addictive behaviors. I also wonder if that suppression might look a lot like clinical depression, though.


Reports from people using this don't indicate that they feel depressed at all. They either get a ton of nausea if their dose is too high, or they just don't get cravings to eat tons of "bad" food. Most people I've talked with on low doses report they can still eat large meals, but it has to be a pretty conscious, determined decision.

No one's been reporting depression that I've seen. And these groups ('fitness enthusiasts') experiment with enough other things that do cause depression that they're quite sensitive to changes in "well-being", "outlook on life", "mood", and "energy levels". It would be more widely reported in these circles if it did resemble depression.


For a lot of people, it's kind of a choice of which substance you are going to be dependent on. It's all expensive and sad, but between Ozempic and cigarettes, alcohol, or overeating, Ozempic has got to be healthier, and quite possibly cheaper in the long run.


I took it and started out with a small dose. The impact of that dose wore off eventually and the plan at my clinic was to raise it over time.

I am concerned that maybe there isn't a dose where you can stop taking more and keep the results. I am worried that everybody will need to keep taking more as they build up more tolerance to it. The study that showed how effective the drug is was 60 weeks long.

That is a long time, but it doesn't show what happens if somebody plans on staying on the drug for years.


do you know what tolerance effects are acknowledged by the makers/doctors? I was thinking this was more like insulin; is it more like an opiate?


Is a drug or drug-like-food (ie, sugar) dependency really the only option?


Most research indicates "yes", conditioned on the consensus of what comprises the modern lifestyle.

I've been trying to understand what changed to create the obesity epidemic. Many things contribute, but it's hard to identify the smoking gun. My understanding is that one major lever seems to be the advent of snacks, refrigeration, and microwaves. Drastically reduced food prep overhead has radically alerted eating patterns.


It seems pretty obvious that the massive injection of sugar in the 60s and 70s into diets paved the way for pretty much everything else that followed(snacks, fast food, convenient food, etc). I guess we can all ignore that diabetes is driven by insulin resistance and the body's inability to process glucose, which is conveniently also the predominant thing in our food today, because we would rather look the other way and continue living in a fairy tale...that is until we are disease ridden in our 40s, at which point we can live out the rest of our lives on meds and in the hospital.


To pile on other popular theories on smoking guns, there is a widespread decrease in physical activity levels. Physical activity can delay or prevent type 2 diabetes, as well as having widespread benefits on almost every system of the body. Physical activity also improves mental health, which impacts some behaviors around emotional/addiction driven over eating.


We do more physical activity now than people did in the 70s and 80s and we are significantly fatter also. I doubt it's that.


I doubt we do more physical activity now than people did in the 70s and 80s.

Sure, people may go to the gym more... But they also take the lift or the escalator in stead of the stairs much more, and the car in stead of a bicycle or walking. Any source for your claim?


Read Gary Taubes


Versus, like, "just suck it up"? No, but empirically that strategy has had poor results across the wider population. It seems like it would work, but usually doesn't. At some point people look for more effective strategies.


It's that, or dropping out of modern life, as far as I can tell.

Everyone's on something and/or coping in unhealthy ways.


What do you suggest otherwise? Clearly whatever we're doing now has led us to this point.


No, there's also badmington.


Healthier in what sense? There is little knowledge of long term side effects and it isn't even approved for weight loss, it is specifically for people with diabetes.


Semaglutide, the active ingredient in Ozempic, is absolutely approved in the US for weight loss. Ozempic is the trade name for the diabetes medication, Wegovy is the trade name for the weight loss medication. They are the exact same medication, in the same formulation.


Ah, good to know!


What if the greatest harm is that the easy path of modifying our biology prevents us ever needing to gain the self-knowledge and build the fulfilling lives that lets us thrive in a world surrounded by potential addictions?

I consider myself a much wiser and stronger person in recovery than I was before addiction. Who would I be if I took a magic pill and was still the person that sought oblivion? What will humanity be if it doesn't need such self-knowledge and resilience? What impact will that make in say, our future politics?


This feels like the same logic as "I had to pay off my student loans, so other people should have to suffer like that too." Suffering does not make you better later despite what millennia of Christian theology has told people about its supposed purgative effects. It seems pretty rad to me to be able to just not suffer through the bad part of getting over a major life problem, and I for one am happy that people will be able to skip that part and get on to the part where they live well.


This is not an argument that suffering is valuable, it's that drug-seeking behaviours are a symptom of poor psychology / life-fulfilment.

The fear is that by removing symptoms, we no longer find it important to address the root cause. The symptoms should be treated as a warning signal. It sounds dystopian to make poor psychology and poor life-fulfilment a consequence free norm.


> A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true?

What other desires does it lessen? Does it suppress every hedonistic impulse? What does it do to creativity? Impulsivity? Does it make you more susceptible to or resistant to persuasion? Feels like reporting ‘oh it has these other unintended psychological/behavioral responses. Neat!’ is ignoring a whole can of worms that that opens.


I think the body of work around what this drug does outside of its impact on patients with diabetes is pretty limited, which is what is scary about everyone jumping on this one.


A lot of addiction is caused by social issues or mental health issues, but it's really hard to deal with those issues when someone is also dealing with the effects of addiction. A drug like this could provide an opportunity to fix the underlying issues causing addiction in the first place.

And for some people they will have to take this for life, which isn't so different from many other medications.


Yeah, I honestly don’t see a problem with taking a drug for life, as long as the side effects are minimal and the logistics are simple. I’m in my early 30’s and have a family history of bad cholesterol. So once a day I will take a statin for the rest of my life. Not a problem, little to no side effects and pretty easy to manage, and not the end of the world if I miss one day every so often. Twice a day is not so easy to manage and plan but once a day is definitely manageable for a lot of people


Isn't that the case for every diet? You can lose weight on diets and then gain it back when you start eating the way you used to.


Could be worse. Omeprazole not only stops working after you get off it, your issues actually become much more severe. Once you're on it, you are unlikely to ever be able to get off of it.


do you have stats to confirm your assertion about this drug because it seems as speculation as saying "well maybe if I was 100lbs less I would have more energy, be happier with myself and therefore have more willpower to have a more healthy relationship with food".


If something affects so many basic functions of the body, the side effects must be intense as well


>From what I have heard, all of these issues come back as soon as someone comes off the drug

Same as with drugs for hypertension, depression, hyperglycemia and many, many others. Not every drug is supposed to somehow permanently cure you.


The same could be said even for interventions like "don't eat surplus calories" and "life weights". Once you stop, you don't get the benefits and you'll regress.

"But you have to do it forever" shouldn't be a convincing dismissal after 10 seconds of thought.


By completely changing your lifestyle and retuning your habits your health isn't hinging on one single point of failure (a drug you need to take).

If I stop going to the gym for a couple of months, I'm probably not going to gain any weight because I still eat healthy and stay active.




Consider applying for YC's Fall 2025 batch! Applications are open till Aug 4

Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: