We’re nearing the utopic phase for this drug (if we aren’t already there)
Mindful that this also lowers muscle mass (can weight train and eat enough protein to compensate slightly)
AND less easily mitigated lowers bone mass, weakens tendons, and weakens ligaments.
It’s a great option if the patient is diabetic and their current lifestyle/condition has worse outcomes than the side effects listed, but we’re hearing from celebrities like this is a vitamin D pill
IIUC, it depends how the patient would lose that weight. Afaict, these drugs work by lowering appetite overall and making people poop out lots of food before it's fully digested. If the patient macros are still bad, the same proportions as before the drug, they'll have deficiencies such as protein, fiber, electrolytes, vitamins (esp fat-soluble ones), etc. But hopefully it's just for short term. (star)
So to get back to your question, one could lose the weight in the best possible way by correcting their diet, eating less, doing HIIT, fasting, good supplements like creatine, stress reduction through breath work and meditation, and resistance training and end up in a very strong position.
Please anyone correct me on this.
(star) Anecdote about my friend: He went on Metformin for a few years, had lots of diarrhea, and lost about 30 pounds and is skinnier than me. At this point, he could really really get into a strong health position having had that shortcut. His eating habits even got a little better from wearing a glucose monitor. He's sick of the diarrhea which really keeps him from wanting to be out of the house for long, and is slowly looking for some intriguing physical activities. So I think these drugs can help people.
> one could lose the weight in the best possible way by correcting their diet, eating less, doing HIIT, fasting
Yes, but actually doing that when you’re obese is extremely difficult and maintaining it is even harder than that. The best way I can describe how difficult, it’s like climbing Mt Everest and then discovering that you have to live up there. Lots of people do manage the climb, but staying up there is the real challenge and not a big percentage of people do. So, statements like yours while they’re technically true are ignorant of the biological and psycho-social dynamics of obesity, condescending (“why didn’t I think of just eating less!?”) and totally unhelpful.
I don't think HIIT or fasting is necessary. A workmate's father (BMI >> 40) went to BMI < 30 by getting a job as a security guard, and walking ten miles a night.
From my own hiking experience, that the first few days my appetite is suppressed, and similar reports from others, anthropomorphizing the body a bit it says "well, if we're going to be moving around this much, I don't want to carry all this weight".
> walking ten miles a night…From my own hiking experience
Is your plan sustainable through injury, and on vacation, and after being laid off and through holiday temptations, and through deep emotional turmoil, and just insidious calorie increases over time, and a million other real world scenarios that throw people off the wagon who have lifelong deep seated eating problems? This is so difficult for so many not because the obvious things work for everyone but because they don’t for a majority of people. We’ve tried all the obvious things!
If you're laid off you have more time to walk. If you're not walking that much quit your job and reduce your outgoings so that you can get a job that helps you survive past 45 without type 2 diabetes. Walking is very calming if you have emotional turmoil.
You don't get to a BMI that was much greater than 40 without eating disorders. Walking helps calm that, too.
I think people who say they have tried walking are lying to themselves. They're like the women who go to the gym and lift 2 lb dumbbells.
Walk ten miles a day for a year before telling me you've tried it.
> Walk ten miles a day for a year before telling me you've tried it.
Walking 10 miles a day isn't feasible for disabled and many injured people nor people who don't have 3+ hours spare to walk that far. If the principle is "do lots of exercise that you can do" yes we know about that, we've tried it many times, and the habit to sustain that didn't stick for the million and one reasons that they fail. Thankfully there are doctors and pharmaceutical companies that can understand recidivism statistics and don't just assume that obese people are morons or "lazy" or whatever ignorant and arrogant opinion you're espousing.
Is this backed by any science, btw? If it is just so simple there should be studies on it. Trying to make cheap and easy weight loss happen is one of the most well funded research arms.
Just because your friend's dad did it doesn't mean it's easy. It's not like everyone can just spend eight hours a night walking, and it also sounds like your friend's dad ate less just because he didn't have as much time to eat what he used to eat before.
"Become a security guard" isn't sustainable advice for weight loss.
Source: I work at a healthcare company that does weight loss, among other things.
Oh wow, that's such a great idea! We never tried telling people to get their priorities straight, but now that you mention it, it seems like such an obvious way to sustained weight loss! You're a genius!
Yeah, we do, and they know. The attitude of "if they just knew they shouldn't eat, their brain wouldn't be broken any more" is tiring, and, frankly, idiotic.
Maybe pull your head out of your ass long enough to realize that nobody wants to be fat under the immense societal pressure of random assholes telling them "you're going to die", and that poor self-control is actually a physical and mental issue.
This is like a tall person telling a short person "just reach higher! Ugh!".
But for two people who weigh the exact same to begin with, and eat the exact same after starting, does the person on the drug lose more muscle mass than the person not on the drug?
I don't think so based on personal experience. I'm losing weight on the drug because I'm eating less.
However, there is some science now to suggest that the body has other means of lowering BMI and reducing fat burn when it thinks it's starving (IE - any time it's losing weight). So it could be that my body not being in a panic is also helping to lose weight. But I'd bet it's largely just less calories.
It only lowers muscle mass and bone density because your body only secretes the bare minimum amount of insulin needed to maintain while on it. Put another way, you want insulin sensitivity when you cut, but you want insulin resistance when you bulk. If you know what you're doing it can greatly increase your strength and lean body mass. I took compounded semaglutide for one week, cut about 15 lbs, then bulked 45+ lbs over the next few months.
Oof, testosterone comes with a ton of downsides (your body will stop making its own). We are really careful about people who start on testosterone replacement therapy, as it's a lifelong thing.
What’s interesting is that Bryan himself claimed to have stopped TRT and was able to restore his levels to baseline levels. I have clinical hypogonadism so I was probably going to need lifelong TRT anyway. My LH and FSH were normal but testosterone and estradiol were both low. It was a sudden drop too.
Obesity has a whole galaxy of side effects an absurdly strong correlation with a large increase in all-cause mortality. From a cost-benefit standpoint, ozempic would be an obvious win even if the side effects were much worse than they actually are.
yes. everyone knows chemotherapy agents are going to be bad, and that they can’t be continued forever etc, and yet the long-term prognosis is absolutely clear as to what happens if you don’t take them.
drugs don’t need to be used long-term to have a pretty good picture of the long-term tradeoffs, particularly when it’s something like cancer or obesity that has a clearly negative long-term outcome in the a sense of a successful intervention. Most interventions for obesity are ultimately not successful and to have one that is is a game changer, even if it has some minor side effects (and burden of proof cuts both ways - it’s not clear that they even exist etc, only that it would still be worth it if they did).
in the real world, things usually don’t turn out to have some stealth side effect that takes 30 years to manifest, and nobody is telling you to take them anyway, just to stop injecting yourself into private medical decisions around an approved, well-studied drug with a seemingly quite benign profile.
(why oh why do I suspect that semaglutide skepticism correlates heavily with the “respect my freedom to not wear a mask” crowd…)
Not a great analogy, as not many people use chemotherapy agents daily, for life (unless you die while taking them, of course) and those can have crippling side effects that are way worse in some populations than simply dying from cancer.
> stealth side effect that takes 30 years to manifest
Heavy metal toxicity, cirrhosis, lung cancer, persistent infections that lead to cancer (HPV, Hep B, etc), silicosis, COPD, skin cancer, all sorts of diseases result from cumulative exposure.
> (why oh why do I suspect that semaglutide skepticism correlates heavily with the “respect my freedom to not wear a mask” crowd…)
Can you approach skepticism without ad hominem attacks?
You know that GLP-1s aren't new, right? There are diabetics who have been on them continuously for decades; it's only the realization that they can treat obesity which is new. If there were common and severe side-effects from continuous long-term use, they'd already have shown up in diabetic patients.
1. Weekly vs daily administration, liraglutide and exenatide had to be injected daily which made the drug less attractive for patients and doctors vs metformin which is well known and a cheap pill.
2. Greater magnitude of effect. Liraglutide had less impact at prescribed dosage for both lowering A1C and weight loss so in combo with (1) made it less attractive than semaglutide.
3. Magnitude of weight loss from (2) now so significant it easily beats all previously approved weight loss drugs with few side effects. So entire GLP-1 agonist class of drugs reexamined as direct weight loss treatments vs just a modest but very welcome side effect of diabetes treatment. And once weekly administration meant it would have much better patient compliance than a daily injection.
> We’re nearing the utopic phase for this drug (if we aren’t already there)
GLP-1 increasingly looks like a vitamin.
It is "essential to [humans] in small quantities for proper metabolic function" [1]. But what our body produces gets eliminated in minutes [2]. Not everyone needs supplementation and too much can be harmful. But a deficit results in ultimately-fatal chronic conditions.
> Good thing they're not GLP-1. They're GLP-1 agonists
Sure, which is why I say looks like, not may be. If calcitrol were eliminated like GLP-1, a drug that activated the VDR would be beneficial to those with a deficiency [1].
> Mindful that this also lowers muscle mass (can weight train and eat enough protein to compensate slightly)
AND less easily mitigated lowers bone mass, weakens tendons, and weakens ligaments.
These are the common effects of weight-loss and they and other risks are why you should be under the care of a specialist in obesity and/or diabetes, a nutritionist, and a trainer.
Yeah, I'm with you. It seems like there are some almost miraculous results from this class of drugs, but I'm very concerned what's going to rear it's head 5, 10, 15 years down the line
I don't envy anyone tasked with calculating the risk/reward benefit of this drug versus obesity and friends.
These drugs aren't a free lunch and from my understanding can't be stopped without dramatic lifestyle changes or most of the weight comes right back. 20+ years of losing bone density and connective tissue mass is going to be catastrophic in old age for people who have to stay on it long term but really so is the obesity, diabetes, and heart disease. It's a tough moral quandary.
It seems like the most corrupt time with the government almost entirely asleep at the regulatory switch. Perhaps that's just a coincidence that so many "miraculous" results seem to exist.
> more severe unknown incidents like thyroid and pancreatic cancer
Alcoholism, diabetes and obesity don't give you long enough to get these cancers. Even if we had evidence GLP-1 agonists massively increased the risk of these cancers, which we don't, despite them having been studied and prescribed for decades [1][2], the tradeoff makes sense for much of the population.
To put that into perspective, annual cost of diabetes to America is $1,200 per capita ($1,300 adjusted for inflation [2]. 40% more than a month of Ozempic [3].
One twelfth of Americans have diabetes [4]. If the government could negotiate just a 10% bulk discount, the payback period on buying every American with diabetes Ozempic would be around a year. Even if everyone ceased treatment after that, even if you only did this for a couple years, we'd see a permanent boost in productivity and health across the American population.
Government could build their own plants, these drugs are not under patent, just the drug+delivery mechanism is. This says $5 per month as actual costs.
"Semaglutide is expected to become patent-free in the United States no earlier than December 2031" [1].
We could probably strike a volume deal for ~$200 for 5 years and then $75 (the upper end of your study’s estimate for manufacturing cost) for another 5.
This really depends how you calculate cost to society. Everyone dies, and the healthiest people die the slowest. So when you look at the cost of the alternatives the difference looks much smaller or non-existant. If the alternative of getting a heart attack at 57 is retiring at 67, collecting social security for 20 years, getting Alzheimers at 73 and spending 10 years in a Medicare funded memory care facility, obesity and alcoholism don't look as expensive.
From your third link, the metastudy with the most power: "GLP-1 receptor agonists had no significant effects on the occurrence of thyroid cancer (RR 1.30, 95% CI 0.86-1.97), hyperthyroidism (RR 1.19, 95% CI 0.61-2.35), hypothyroidism (RR 1.22, 95% CI 0.80-1.87), thyroiditis (RR 1.83, 95% CI 0.51-6.57), thyroid mass (RR 1.17, 95% CI 0.43-3.20), and goiter (RR 1.17, 95% CI 0.74-1.86)."
The only significant finding was "an increased risk of overall thyroid disorders (RR 1.28, 95% CI 1.03-1.60)."
Scientific literacy is important. The contributions to that meta-study were predominantly looking at 1-2 year outcomes, with a few outliers, which gives means it draws little insight with regard to what might apply from long-term (or lifetime!) use.
The abstract of the paper itself concludes "However, due to the low incidence of these diseases, these findings need to be examined further." suggesting that the authors didn't even find their own work to be conclusive about the short/medium-term risks at the scale of widespread use, let alone the long-term risks that they weren't even analyzing.
Straw man. Nobody claimed these studies prove GLP-1 agonists are totally safe. Just that they don't show "severe unknown incidents like thyroid and pancreatic cancer" [1].
> suggesting that the authors didn't even find their own work to be conclusive about the short/medium-term risks at the scale of widespread use, let alone the long-term risks that they weren't even analyzing
Sure. That's a straightforward reading of the paper. Again, nobody argued these aren't thesre. Just that present data don't sustain it as a serious problem.
>However, no major safety concerns have arisen to date, although definitive conclusions for pancreatic cancer, thyroid cancer and DRP complications cannot be drawn at this point. When compared with the beneficial effects of these drugs on glucose metabolism, blood pressure, body weight and cardiovascular (and potentially even renal) endpoints, these agents have an overall beneficial risk/benefit-profile for treatment of patients with T2D.
Tangentially, I wonder how people mentally model "too-good-to-be-true"?
"Everything is a tradeoff" is almost a core belief for me, but in the same time, in technology, the "too-good-to-be-true" events does turn out to be real every once a while (I'm using technology here as a general concept).
I do understand GLP-1 does have some downsides, like cost, or in my own experience, nausea. But the tradeoff seems negligible compare to the upside. Part of me feels like that there is some hidden trade-off somewhere that we're not discovering, but part of me also wonders if it's a once in while technology jump, where it is just better.
Anyway, I guess I'm just a bit wary to throw away the "everything is a tradeoff" mental model that has worked quite well for me.
Antibiotic tradeoffs are enormous. They can completely and permanently ruin your microbiome.
Giving them to children has been linked to many conditions such as obesity, allergies, and asthma [0]. They have saved countless lives from infections but their use and overuse has undoubtedly contributed to significant and widespread health problems.
That’s a bit of a straw man. While the benefits of antibiotics are certainly untold millions of lives saved, we’re only now understanding their long term impacts on our gut biome. Let alone their overuse in factory farms.
There are considerable numbers of people who have severe complications with antibiotics, and their overuse over time has left us in a position where the functional pools of antibiotics keeps getting smaller and smaller and the pool of superbugs gets more and more virulent.
Who knows the long term ramifications of this new class of weight loss drugs. This smells to me like the Prozac craze in the 90s when everyone was on it or giving it to their kids. Or the olestra boom until everyone was literally crapping their pants.
Or tangentially, the over proscribing of novel opioids. Look what that has wrought in our society.
Could this new class of drugs be helpful, absolutely. Do we know the long term issues, nope. I think there are people who can use this therapeutically and there are others who use it as a quick fix because they have no self control. In a lot of ways it also feels a little ironic to look at fiction like the food indulgent scenes of “Hunger Games” and South Park and see that happening for real.
> "Everything is a tradeoff" is almost a core belief for me, but in the same time, in technology, the "too-good-to-be-true" events does turn out to be real every once a while (I'm using technology here as a general concept).
Every once in a while? Our lives are better in so many tangible ways than they were even 100, 200 years ago.
Just for a start - instead of 50% of children dying before the age of 5, we're down to tiny fractions of a percentage.
But sometimes things we're trading off are less relevant and so the equilibrium changes e.g. losing weigh is hard, because humans evolved in low-calorie environment and being able to stock fat was important.
The biggest problem with semaglutide is once you stop taking it things like blood sugar and body weight start to go back to where they were before. On average people gain back 70% of the weight they lost on the drug within the first year when they stop taking it. It seems likely this is going to be true with other addictions as well such as alcohol. While the effects are impressive, without addressing the underlying causes such as psychological factors that cause people to overeat or abuse other substances like alcohol it seems like we are just replacing one form of chemical dependance with another, albeit a healthier one.
While this is oft repeated, it’s not very relevant. First of all, some weight is kept off, which is a huge win. Secondly, the drug can be taken again. Thirdly, it will be a second chance for millions at a heather lifestyle. Once you get so fat, it becomes a doom spiral of low physical activity and low body image. Personal willpower and choice can have a huge impact but its very hard to start exercising when you can barely walk down the street.
It's not just that the weight is gained back but the rate that it's gained back. Imagine someone loosing 100 pounds on semaglutide and then gaining 70 pounds of it back in 1 year when they stop taking it. That's over 1 pound a week of weight gain, likely much faster than that individual gained the 100 pounds originally. That type of rapid weight gain is associated with even worse health effects than carrying the extra 100 pounds probably was, and that's just at 1 year, where will this individual be in 2 years, 3 years etc? Will they really keep that other 30% weight off? We don't have the data yet, but it doesn't seem likely they will. I'm not saying we shouldn't use these drugs, just that we need to understand that they are only the first step to a much longer strategy to improved health.
> That type of rapid weight gain is associated with even worse health effects than carrying the extra 100 pounds probably was
Source?
And are the people losing 100 lbs regaining 70 of it? These statistics are provided in the aggregate [1]. I wouldn't assume the re-feeding of someone who lost 20 lbs will mirror someone who lost 100 lbs.
Also, conventional methods resulted in "more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained" [2]. So our baseline is the 100 lb person regaining 50 lbs following diet and exercise or whatever.
> it seems likely this is going to be true with other addictions as well such as alcohol
Why? We need to eat. We don't need to drink.
Removing alcohol for a year or more could allow both the body and environment to be adapted to a point where it is no longer presented in the same way.
Agreed, speaking from experience taking a long break from alcohol does wonders to reset the brain’s idea of what’s “normal” plus the simple act of just disrupting an engrained habit.
Won’t be the case for everyone but I think even taking it for a limited amount of time could do a lot for a certain type of excessive drinker.
i’m not sure whether there’s any physiological basis for this, but subjectively having an addiction feels a lot like having an additional need in the same vein as hunger and thirst. The addict’s mind is convinced it does “need” the substance.
It’s worse than that for e.g. alcohol and opiates. The organism lets the addict know in no uncertain terms it needs the substance. It’s not a choice the mind does unless you’re a zen master or something.
How is this any different than treatments for high blood pressure and other chronic illnesses? I hear this refrain often, which diminishes the incredible achievement and benefit of these new drugs.
I think there are two kinds of people, those for whom taking medications for the rest of their lives is unthinkable, and those for whom it's completely normal. I'm definitely in the latter camp but the cultures colliding can be a real surprise.
Just... keep taking it then? What's the downside of taking a drug that has a number of beneficial effects, especially the reduction of addictions (food, alcohol) that have high fatality rates?
Well then maybe we shouldn't use it unless the consequences are severe enough to warrant them. In particular we shouldn't use them without trying behavior modification first.
Behavior modification has been failing for decades. It had its shot.
Skinny foreigners move here and gain weight. That’s a pretty strong indication that individual willpower doesn’t have much to do with why skinny countries are skinny. Why would we expect that to work here?
Our options that have any hope of actually working are a huge overhaul of probably a lot of things, including our food culture, zoning and city layouts, farm policy, and social safety net, to name a few—or, a miracle drug.
Realistically, if we want results this century, that leaves only the latter option.
Google either of those first two things. The answers are in the first page, no need to provide a citation and open up “well I don’t like that citation” cans of worms, pick your source, there will be a mountain of them. Dig a little on any of them and you’ll be on actual meta-studies and such. Neither is a controversial claim, or even close to it.
“Why only extreme solutions?” 1) because zero non-extreme ones have worked, 2) because the root cause appears to be deeply embedded in a complex web of systems, which means addressing the root cause within a human lifespan is necessarily extreme, 3) the drugs arguably aren’t really extreme, and 4) supporting #3, the alternatives we’re currently reaching for are drugs to treat the outcome of the pattern of failures in behavior modification / willpower approaches, so this is really what we’re already doing just applied before things get extremely bad.
Paywalled but the summary provides some good info. Between this and others (also appearing on the first page of my ddg searches for this) one puts together a consistent picture
1) thanks to a ton of research and spending we’re getting better behavior modification programs! Hooray!
2) the ones that kinda work are a lot higher-touch than you probably expect. I.e. expensive and not accessible to lots of folks, for a variety of reasons.
3) despite all that the expensive state-of-the-art isn’t good enough to tackle the obesity crisis. It helps, but not enough, even if we could provide that help to everyone who needs it.
4) comically (again) this particular summary ends on a “… but now that we have really good weight loss drugs, maybe it’ll work!” note.
(“Just do a diet” without ongoing professional support is basically not effective at all for long term weight loss, on a population level)
> In particular we shouldn't use them without trying behavior modification first.
As someone who is diabetic and who has lost a lot of weight on semaglutide I can assure you that several genuine and difficult attempts to modify behavior were attempted before getting on the drug.
I guarantee you that I'm not the only one - I'd expect the vast majority (75%+) of people using semaglutide to have attempted behavior modification before starting the drug.
You sound like the people who say that trans people should try psychological interventions (conversion therapy) before medically transitioning (which is also a lifelong medical commitment in many cases). Psychological interventions don't work, while medical transition does. It's the same here. Ozempic works while telling people to eat less does not.
I'm an interested bystander to this obesity drug mania currently happening but I'm curious as to whether the folks taking this for obesity or being overweight have to take it for the rest of their lives?
I.e. if an obese person gets skinny with Ozempic and then stops taking it, can they keep the weight off?
If not, it seems like the "perfect" money-making drug, i.e. it doesn't cure anything permanently, its expensive, and patients have to take it until they die.
Now sure, it's obviously better than being obese and unhealthy, but does it bother anyone else (in a philosophical kind of way), that we are treating the symptoms and not the causes here? We're teaching people that everything can be solved by popping more pills and not treating the psychological issues that result in so much obesity. It also doesn't result in anyone learning any good lesson, e.g. that working gets results. In this case the lesson is, my bad decisions or mental health don't matter, I can just pop pills for all my problems...
They can keep it off if they keep eating like they’re on it.
Most can’t do that or they wouldn’t have needed it in the first place.
My understanding is that many do well on a much-reduced dose once reaching their desired weight, or simply stop the drug but then return to it for a couple months if they backslide.
[edit] nb a fair number can do pretty well without it, though, as they find it easier to stay motivated to maintain a good weight than to overcome the intertia and slooooow results of losing weight from an already-very-unhealthy weight. Doesn’t hurt that working out is a hell of a lot easier and more enjoyable when you’re already a healthy weight. Seems those who’ve in the past successfully put in effort to hold a healthy weight for a good amount of time but then eventually gained a bunch, have an easier time keeping their healthier weight for quite a while once off the drugs.
It seems to depend on the person. If they use it like a 'miracle drug' then they'll tend to have relapse on cessation. If they use it as an opportunity to build new, healthy habits they have a better chance. No doubt underlying biology plays a role too, after all some people are overweight because they found themselves in a rut, and other are overweight because they're constantly hungry. Those latter people tend to relapse.
I'm also be interested in how this can affect a change of gut biome. Ie if a biome is partly responsible for diet cravings, would something like this help you restart your biome and put you in a better position to maintain?
I suppose it could? The issue is that people can conceivably just eat small portions of unhealthy foods. It would certainly be a boost if they were willing to make an effort though, get some serious fiber in there, find a good yogurt, that sort of thing.
Then again I once knew someone who went through the pain and cost of a gastric bypass, which she then ironically bypassed by drinking melted ice cream. It all comes down to the patient.
> Now sure, it's obviously better than being obese and unhealthy, but does it bother anyone else (in a philosophical kind of way), that we are treating the symptoms and not the causes here?
I agree with everything you said, but what is the cause of obesity? It's convenience, abundance, corporations, and being sedentary. All of which are where most societies continue to move toward.
Have you tried exercising when you're fat? I've gained 20 lbs in the past year and, while I used to love playing tennis twice a week, now even walking is a chore.
This thread is full of people that think that fat people are only fat because it didn't occur to them to be thin.
Then take the pill. Oh it had serious side effects? Take another pill for every single one of them. Oh they both have side effects? Well, take anoth...
Very exciting, we're going to see some serious "at scale" behavioral changes (obesity decline, addiction decline, possibly even social media usage decline) as soon as the cost of GLP-1 agonists gets driven down and manufacturing scales up.
I wonder which will happen first: discovery of effective small-molecule drugs in this class, or improvements of peptide manufacturing to the point that cheap generics become possible. There are only 7 years left on the semaglutide patent but its manufacturing is currently so complicated that I don't expect really cheap generics after patent expiration.
I am not familiar with the specifics of manufacturing these drugs, but peptide molecules have been synthesized for decades. What makes these special?
Considering the high prices of the marketed product, I would dispute the idea that generic manufacturers will not leap at the chance to get a taste. Even if it is technically complex, they have years to perfect a recipe, get it GMP qualified, and on shelves the day patents expire.
My understanding is that the manufacturing costs have nothing whatsoever to do with why they’re so expensive. It’s already damn near aspirin-cheap to make.
Unfortunately, the story for people who discontinue the drug is less rosey. Many regain some or all of the weight lost; it appears to be a temporary alternative to stomach surgery.
Does this happen any more often than when people lose weight by other means? I was under the impression that something like 90-95% of people who lose significant weight gain a lot of it back.
The overpricing is not inherent to the manufacturing of these drugs as far as I understand, it's an artifact of the American healthcare system.
You know what else is a temporary fix? Vitamin C for scurvy. Your body does not produce it endogenously. You are already a lifelong patient -- all humans are -- and it just so happens that the medication to treat it is part of your diet.
A study says these drugs could prevent 1.5 million cardiac events over 10 years, add in a reduction in alcoholism and the governments should be giving away these drugs to save on healthcare costs...
----- We identified 3999 US adults weighted to an estimated population size of 93.0 million [M] (38% of US adults) who fit STEP 1 eligibility criteria. Applying STEP 1 treatment effects on weight loss resulted in an estimated 69.1% (64.3 M) and 50.5% (47.0 M) showing ≥ 10% and ≥ 15% weight reductions, respectively, translating to a 46.1% (43.0 M) reduction in obesity (BMI ≥ 30 kg/m2) prevalence. Among those without CVD, estimated 10-year CVD risks were 10.15% “before” and 8.34% “after” semaglutide “treatment” reflecting a 1.81% absolute (and 17.8% relative) risk reduction translating to 1.50 million preventable CVD events over 10 years.
Except it's not meant as a drug you take for life, as it will require higher and higher dosages in order to get the body to respond.
The problem isn't the results, the problem is the factors that caused the obesity. I'm for it as long as it comes with healthy lifestyle changes as that's the only true way to have a long-term impact.
The effects of GLP-1 drugs are fascinating and I am curious whether we will see approvals beyond the current diabetic and weight-loss applications.
In just the last months stories of increased fertility [0] and reduction of heart attack risk [1] popped up, but more data is definitely needed to fully asses the effects.
Anyone read David Brin's story "The Giving Plague."?
These drugs have the flavor of that. I'd be reluctant to take them not because the Thyroid cancer risk or loss of muscle mass. Or the possibility that if I stopped I might gain more weight then when I started.
I'd be reluctant because in it's weird hormonal backdoor way it seems to be really messing with your personality. I'm not convinced the grass is actually greener on the other side - I tend to be of the belief that it's no better or worse; it's just a different set of tradeoffs.
All that said while I'm not skinny I'm also not (in my and I assume my dr's judgement) a candidate for this drug. Maybe if I was I'd feel differently.
I'm sure there will be many comments here discussing how awful the side effects are, but from what I can see they're almost all primarily associated with rapid weight loss in general - muscle mass reduction and whatnot seem inevitable when someone drops 100+ lbs of total body weight.
I'm curious how much damage GLP-1 agonists will do to the extremely profitable industries that depend on addiction before we'll start hearing scare stories about extremely rare side effects, followed by politically expedient bans.
> 14 Mar 2024 --- Today, a coalition of Nestlé shareholders, with US$1.68 trillion in assets, has filed a resolution challenging the company to improve the healthfulness of its products.
Translation: shareholders are terrified of the impending collapse of the status quo business model and want the company to pivot to things GLP-1 patients want to eat.
I've been on Zepbound for 5 weeks now and it's basically a miracle drug as far as I'm concerned. Food still tastes good, but the urge is gone. It's like going from being a sex addict to someone with very low sex drive.
It's not just the lack of hunger, but I don't get hangry, which was an even bigger problem than resisting the food. I'd get legitimately obsessive about the stupidest little things, to where I'd jeopardize my job and every relationship in my life if I kept going that way.
I knew things were different when I ate two pieces of pizza and then the box sat there in front of me for hours w/o me even thinking about it. Normally as soon as I knew everyone else had their fill, I would have finished the two pieces left in the box. If I tried to resist, the pizza would be calling me from inside the box every 5 seconds. It would be like a crack addict sitting there looking at a loaded crack pipe for 2 hours and not taking a hit.
Another moment was when I got the "I'm full, I don't want to finish this" message from my stomach while eating a small cakepop. I've gotten that feeling before from eating too much meat, like at a Brazilian steakhouse, but never from anything sweet and carby. Just knowing this is how some people live has been a huge eye-opener for me. I totally get the whole ectomorph/endomorph thing now.
So far I've lost 10 lbs. I make sure to get plenty of protein and have to force myself to eat sometimes. I try to eat more early in the week when I do my hardest workouts. I'm still lifting the same amount. I haven't gone up, but I haven't gone down, which is great.
I workout 4x a week and also walk/hike 20-30 miles/week. I'm 6'1, 240 lbs, large frame. I've been on a diet basically my whole adult life, except for when I start a new job, in which I always gain weight because I don't want to be hangry and I put the job first. Then I spend the rest of the tenure at that job trying to lose it.
For years, I've had zero unhealthy food in the house, and my biggest cheat has been an occasional breakfast burrito, or a medium sandwich and some ice cream after a long walk. That's been enough to not gain weight, but not enough to lose any more than 5-10 lbs, which I gain back over the holidays every year.
Anyway that's just my story. I suspect I'm a pretty big outlier in the amount of exercise I get and the habits I already had. I have enough in my HSA to afford about a year. I'm hoping to lose a bunch, snap back the usual 10 lbs or so, then stabilize.
How much of this is just the fact that alcohol is typically 'banned' from patients taking this drug?
Sorry didn't read too much into it but are they testing the reduction specifically for alcohol addiction or was alcohol addiction measured from people currently taking it for weight-loss/diabetes?
AFAIK it’s Metformin you’re not supposed to have with alcohol. You can drink on Wegovy and Ozempic, it’s just highly unlikely to seem very appealing, in a “well that sounded good but I drank half of my first drink and don’t really want the rest” sort of way.
Semaglutides are the AI of the medical field right now. Every press release that drops about them seems to be about how _even more_ transformative it is. Crazy stuff if the side effects of this drug become manageable and no long-term side effects appear.
Ozempic and Metformin stack is a cheap anti-aging regimen. Although you may need to add B12 as both seem to affect B12 levels and cause B12 deficiency. Methylated B12 intravenous or stacking the injection w/ B12 will alleviate this problem.
I’d be interested to see what the weight gain would be for people who lose weight through diet and exercise over time. My hunch is we’d see people gain significant weight back. I’ve seen this from colleagues who had weight loss surgery, lost a bunch of weight, then gained it back over a few years.
You just hit the nail on the head. I have had two large weight losses in my life. Both through diet and exercise. The first time I lost 70 lbs with a low-carb/keto diet (at the time it was called Atkins, so this was the early 2000's and I was 21). It took 3 months of running/walking 3 miles a day. The second time was when I was 37 I lost 95 lbs and it took 8 months of calorie restriction combined with weight lifting and jogging 3 miles a day. Both times due to 'Things' I fell back into poor eating habits and lack of exercise due to injury. I found myself recently 70 lbs back from my lowest weight and decided that I would try Wegovy. It has been 2 weeks and I have already lost 11lbs (not sustainable at all and ymmv). I remember the control I had from the big push when I was 38 (I am now 42) and that control feels back. I am taking the Wegovy to get back down to a weight where I feel comfortable working out in a way that minimizes my risk for injury while at the same time reminding myself what that self control felt like. At this point I am just desperate to get some results as I have felt completely off the rails for 2 years now.
First, great job on the weight loss! Those are two major accomplishments, and you shouldn't get down on yourself for not being able to maintain something your body has evolved to avoid. If you did it before, you can do it again, but it might just take longer.
I'm 42 as well and looking to get some sort of GLP-1 agonist as my A1C just popped up to 5.7 after being normal my entire life which is a huge warning sign for me. I've cut out processed carbs (all white bread, sugary snacks, etc) and junk food/fast food, and upped my walking to 4+ miles a day. I'm noticing "slimming" but not weight loss. We'll see what happens with my A1C, but I am excited to get a little help. I'd like to lose ~40 pounds over the next two years.
We do see exactly that, diets are infamously ineffective at keeping weight off.
(“Well that‘s because people don’t stick to them…” yes, that would be the reason they’re ineffective, that exact thing happens in the vast majority of cases)
I took Rybelsus (pill version of Ozempic) for 7 months last year. I lost 8 kg and then I slowly tapered off over the course of 3 months. I'm now +10 kg. :/
Makes me wonder what the mechanism is. Some drug that treats depression also helps people quit smoking. It treats a specific brain chemical not treated by some depression drugs.
Ten-to-one they’re already working on getting it restricted as much as possible.
Lobbying is less out-in-the-open than ever before, so only way you’ll find out is if their shadow-lobbyists become embroiled in some legal scandal that involves betraying the ones paying them, and you won’t know until five or more years after it happens.
This sounds like naturalistic fallacy, and the same argument could be applied to suggest all medication is bad. Also, our ancestors evolved to deal with food scarcity. It is precisely our adaptation for scarcity that predisposes modern humans for obesity.
There are legitimate criticisms to be made of GLP agonists, but this isn't one of them.
That's an unrealistic fix. Even if Doritos, Big Macs, and french fries were expensive, most people would still eat them for their hyperpalatability.
The only "fix" is to ban these foods, perform public executions of food company executives, institute mandatory kcal rationing, and bring back relentless fat shaming and discrimination.
Personally, I prefer not living in a totalitarian dictatorship, so GLP-1 agonists seem like a slightly more humane option to me.
> How about instead we fix the problem by making healthy foods and active lifestyles cheaper and more prevalent?
Good luck with that.
Unhealthy habits and diets are popular (and delicious), and a lot of people resented even the minimal effort required to wear a mask during a pandemic of an airborne disease.
Presumably the opposite of the thing that goes wrong when you mess with the same by systematically engineering a hyperstimulus to exploit it for money.
I'm really interested if, in the future, obesity will be treated like alcohol-induced fatty liver, track marks, and other medical signs of addiction and not some kind of moral failure on the obese person. This also tracks with knowing addiction can sometimes be caused by childhood trauma (obese people are more likely to be traumatized as kids), genetic predisposition(obesity runs in families), and neurodevelopmental diseases like ADHD (obesity prevalence higher in people with ADHD).
In this view obesity is more like a tragic compulsion resulting from things out of a fat person's control and not some kind of "put down the cheeseburger sometime" activity to willpower onesself out of.
EDITED: Hey, am I saying something wrong or irrelevant here? (sitting at -3, but I don't think I've been particularly inflammatory or offtopic)
> neurodevelopmental diseases like ADHD (obesity prevalence higher in people with ADHD)
Interesting.
Every person I have ever known with ADHD was skinny, at least compared to the people around them.
Not saying my anecdata counts for anything, but it's funny how this works.
Impulse control issues? Some comorbidity?
Forgetfulness? For myself, at least, forgetting to eat makes me hungry, and then I overeat because I'm clearly going to wither away to nothing in moments and I lack self control. I'd be (more) overweight if this was a constant thing.
It might be that this is still undergoing research. Originally published in 2002 [1] a later followup paper in 2019 [2] points out ADHD points to a number of inflammation-related conditions like asthma and obesity. It's still not known the exact underlying mechanisms! I'm just really interested that obesity seems to be increasingly not a voluntary choice.
Mindful that this also lowers muscle mass (can weight train and eat enough protein to compensate slightly)
AND less easily mitigated lowers bone mass, weakens tendons, and weakens ligaments.
It’s a great option if the patient is diabetic and their current lifestyle/condition has worse outcomes than the side effects listed, but we’re hearing from celebrities like this is a vitamin D pill