From reading about this and Ozempic it appears the main functionality is reducing appetite / blood sugar spikes which results in weight loss. I am curious for those who are using it who have traditionally had a relatively poor diet (refined carbs, sugars, etc), has it changed what foods are desirable or does it simply reduce the amount eaten? In addition, when using these products and switching to a healthy diet such as high protein, which already typically affects satiety, does it cause the inability to eat an adequate amount of calories to function properly?
I was diagnosed with Diabetes 2 years ago.
As soon as I found out I immediately changed my diet.
0 carbs
My blood sugar would still go too high.
My fasting blood sugar (first reading in the morning after waking up. "12+hr fasting") was often the highest of the day.
I spent the next 14 months trying different drugs to mitigate my blood sugar levels.
So one day out of desperation I asked my Doctor if i could try ozempic.
It worked INCREDIBLY well.
I started adding carbs back into my diet.
My blood sugar stayed in good shape.
I started loosing weight too.
Before Ozempic and going 0-carbs I lost ~20lbs over 14 months.
After taking Ozempic I have lost ~80lbs.
I still STRONGLY desire sugar/sugary foods.
My cravings for bread is really bad too.
Ozempic controlled my sugar so well that I have been able to add carbs back into my life.
Is it even possible to have high blood sugar while eating zero carbs? You could be catabolising muscle mass but that would be a case of extreme malnutrition and/or type 1 diabetes.
These drugs fix symptoms only, and only for ad long as you keep using them. They have adverse effects, and probably well beyond the published ones. Most signs point to T2D being caused by insulin resistance, which builds up through bad diet and lifestyle. You can 'fix' symptoms by forcing the body to pump out more insulin, but science and common sense would indicate that this could end up worse off in the long run.
Did you measure 1 hour after wake up? At wakeup there's the "dawn effect" where glucose rises/ketones fall.
What diet did you really try? Keto diet is known to ~easily fix T2D. A good company that can do that is virtahealth.com.
The only way to quit drugs (sugar) is to no take drugs at all, not take less drugs.
Source: I do keto diet but for other reasons. I was addicted to carbs, but not fat, and am no more. I would end up as T2D in 10-20 years though. If I restart carbs I will get addicted again.
It's probably the protein. Not eating fat should also feel horrible too, messing hormones etc.
Source: Pretty well known in keto epilepsy/cancer/psychiatry. I do epilepsy keto diet. Having high protein will increase glucose & lower ketones (tested blood many times with just 2 ingridients beef & beef fat). I aim for 80%-90% of calories from fat. Or 2 to 1 weight ratio of fat and protein/carbs.
For T2D you probably need just 60% fat calories though.
Why is your preferred set of professionals better than another? Do you have research showing that treating obesity as a substance abuse disorder has positive outcomes?
My dad was like you. At age 61 I finally got him to try 90 days of only fresh home squeezed/extracted vegetable juice. Technically all his calories those 3 months came from the sugars in the vegetables (celery, beets, carrots, cucumbers, tomato, orange).
All his markers improved, even diabetic markers, and blood pressure. He's off the 3 meds he was on.
Definitely. I'm not saying that 10 lbs of vegetables a day is healthy or anything. That would be crazy. You gotta add processed hormone injected meats, boiled dairy, and preservatives to get a healthy balanced diet.
Population that spends more every decade and gets less healthy, vs senior citizen that gets off all his meds by changing his eating habits by trying juice for 90 days.
No, although anecdotally some people find they can't eat high-fat foods any more. It has changed my reaction to hyperpalatable foods though, in that I don't really get the buzzing "just smoked a cigarette" effect from them any more.
> when using these products and switching to a healthy diet such as high protein, which already typically affects satiety, does it cause the inability to eat an adequate amount of calories to function properly
Not if you don't ramp your dosage up too quickly, but if you were to overdo it, then I guess it would.
I am curious too. I'm not "obese" by the medical defs (84kg, 177cm, 50s) but I could eat forever and constantly and I find that every time I finish some small amount of work (need to switch to the next issue) I get up and walk to the refrigerator looking for a snack. I generally keep from overeating by just not having any junk food nearby (though that's harder at work) and almost no calorie laden drinks. I don't feel hungry, I just seem to love eating. So I wonder if Ozempic would have any affect if all it does is remove my appetite since it "feels" like I don't have one most of the time.
Yes, the psychology of eating is generally under explored topic.
Some of the most obese people I knew had serious psychological wounds that they never healed.
Personally I end up feeling the opposite - I can eat the same weekday lunch for days in a row, and often get a sense of boredom of food before fullness.
I enjoy food, but I also enjoy lots of other things.. and not every bite/meal needs to be a work of culinary art. Italians would probably find this sacrilege.
For me there's a sense of food fitting a function during the week - nutrient/calories, versus going out to dinner on weekend for the social/enjoyment aspects.
I'm 35, same weight and similar symptoms.
I'm just always hungry.
I found some sort of balance where I go 5 times/week to the gym, increased muscles and eat very healthy (fruit, legumes, chicken, veggies). It still didn't solve the problem of being always hungry.
I could say it's psychological, but my son, 3, is the same: he is constantly looking for food. My daughter (6) is like my wife and she sometimes barely eats.
I'd love to lose weight though. I have been going to the gym a lot for the whole year, but my weight dropped only temporarily.
From what I understand about Ozempic and friends is that it's not meant for super long-term use (I can't remember the exact time, like months to a year at most). Do you feel like that's reasonable? As in, do you feel like this is letting you form better habits that will continue after you stop using it? Or do you even have a feel for that (probably hard to guess how you will feel when you are off it)?
There have been long-term studies of semaglutide much longer than a year. I'm not aware of any finding that indicates that long-term use should be avoided. There is some indication that the weight loss plateaus within the first several years for most people, but the weight control and blood sugar control effects are persistent.
does it cause the inability to eat an adequate amount of calories to function properly
IANAD, but anecdotally it has been seen that a substantial - and arguably worrisome - amount of the weight loss is in lean body mass[0], so probably. GLP-1 agonists are for many obese and at-risk diabetics a worthwhile trade-off. Losing that last pesky 10 lbs. because you don't want to give up your daily 500 calorie latte? Probably not.
If you dont resistance train, any weight loss regimen will cause a loss of lean body mass, medications aren't different from an "organically" achieved caloric deficit. Training and size of the deficit as well as genetics heavily shift the proportion of adipose to lean tissue (which includes water) lost.
So far as i know, the signal that glp1 agonists are particularly worse for lean mass retention isn't strong enough to claim that they're worse for muscle mass retention than normal dieting.
You answered your own question. “… reducing appetite…” . It’s all about CICO but also not about that. The real game-changer is the fact people don’t have to have the will power of a Zen guru to fight off the hunger pangs. That’s the 90% you should take away from this. It’s almost effortless, and that’s a huge deal. People have been proposing what you say for a 100 years and obesity only got worse. If a drug can fix it relatively safely more power to them.
>The accumulation of an excessive amount of body fat can cause type 2 diabetes, and the risk of type 2 diabetes increases linearly with an increase in body mass index. Accordingly, the worldwide increase in the prevalence of obesity has led to a concomitant increase in the prevalence of type 2 diabetes.
I'd love to see the math on how much the governement would save just handing this out for free to people vs. paying the lifetime of medical costs and burdens to the medicare system, etc. Seems this is $1000 a month without insurance now, I wonder how low it needs to go to be cost effective? It's really expensive to be obese, have diabetes, cancer, heart disease...
It's really expensive to be obese, have diabetes, cancer, heart disease...
From the insurance companies' perspective, what's really expensive is living too long, rather than dying early. My family has gold-plated health insurance by most standards, but it doesn't cover Ozempic.
You'd think they would hand out Ozempic like candy, but evidently they're afraid it will work too well.
It's also a $12k a year medication that potentially half their customers would want and qualify for under if obesity is qualifying alone. I can understand why they'd quake in fear at the cost. It's a real shame as these drugs will course correct the obesity epidemic and give millions of people decades of life they probably would not have gotten.
We actually have the miracle “weight-loss pill” we’ve always dreamed of.
I get it, not actually a pill, but the point is there appears to be a straightforward way to attain a healthy weight that will work for a large proportion of people.
Some possible drawbacks…
affordability - if it’s $1K/mo, it’s actually not feasible for a large proportion of people.
maintaining - seems like you probably have to keep taking the drug forever to maintain the benefit. That is, if you stop, the weight comes back.
negative long-term consequences? - It’s great to hear about the positive consequences of this, but since it appears you have to take the drug long-term, what are the negative consequences to doing so?
Personally, I’m a couple months into a diet to get to a healthy weight (a light-weight form of calorie counting). It’s working (yay), but if I don’t do it just right I end up hungry for significant periods of time. That’s miserable, and if it happens too much I probably can’t maintain the diet.
A miracle weight-loss drug sure is looking attractive right now.
> negative long-term consequences? - It’s great to hear about the positive consequences of this, but since it appears you have to take the drug long-term, what are the negative consequences to doing so?
The GLP drugs very commonly cause GI issues. It isn’t clear yet if those effects can be permanent but they do remain at least for a while after stopping treatment.
Yes muscle loss is common due to rapid weight loss, usually without compensation like strength training. The effect of the drug is in reducing appetite so it is literally equivalent to calorie restriction, not some sort of fat targeting drug. But I think the public assumes it will create the “right” weight loss. Unfortunately older drug users won’t be able to regain that muscle mass easily.
The problem is that for some people, it's not just "make better choices" - there's various research that shows once you made those poor choices, or had them made for you when younger, some of the marks that leaves on your brain's expectations last. Various people have remarked on how they've tried avoiding large classes of food that might be "unhealthy" and exercised intensely, and nothing changed for them without this.
To say nothing of, as the other poster said, how much time+money it can be to avoid, particularly when you've not got much spare income, so the difference might mean not having to skip a meal this week to afford your medication, even if it might be lead-filled or the equivalent that'll harm you over time (and not just directly, in money saved - making your own rounded meals costs a bunch of time, and sometimes upfront costs, and if you're that low on resources, you might not have that time to spare.)
I would agree the correct way to mitigate this is to do things like ban HFCS, among other things, and start aggressively researching the harms of anything remotely sweetener or addictive behavior-forming in foods, because if you remove the thing that triggers an excessive "MORE" response in some people, you better believe you're starting whack-a-mole with food companies finding other addictives that secretly cause your toes to fall off in 20 years but taste 5000x as sweet, or something.
"Availability of hyperpalatable foods" and "urge to eat hyperpalatable foods to excess" are both prior causes to "eating hyperpalatable foods to excess", even if neither of them are a root cause (and I don't think the root cause can be addressed). GLP-1 agonists address both symptoms and causes.
Diet has psychological, social, evolutionary, physiological, hormonal, economic, aspects (and more). Not only does that make it difficult to eat on a rational basis, people don’t even seem to be able to think or talk about diet rationally.
I think if you examine your comment, you’ll probably be able to spot some rather unlikely explicit and implicit assumptions, which will lead you to reconsider. I say this under the presumption you want to be a help (because if you don’t, no one gives a fuck what you have to say).
You want to think about causes that could actually explain the problem so that you can think of solutions that could actually work.
IMO, “eat better” is a good place to start, but the “how” is completely missing (not to mention, avoiding chips and pop is barely getting started with good eating). I think you need to think a little deeper about this.
In the US -- much more so than the rest of the world (though it's catching up elsewhere too) -- we are besieged by addictive garbage food everywhere. It's like cigarettes 60-70 years ago. Just one example, you used to be able to get cigarettes in hospitals, and today's equivalent is that hospitals are stocked with soda and other junk food (even in places like the NIH hospital, which I visit periodically; I was just shocked the first time I saw that, of all places where I would expect them to only or mostly have healthy alternatives. Same thing at my wife's nursing school; she was distressed at how only about 10% of the readily available snack offerings could be considered healthy. And if doctors and nurses don't have a healthy lifestyle they're unlikely to effectively help patients to.)
So yes, it is extremely difficult to eat healthy in the US, and it requires both discipline and money, which is tragic because low income people are impacted the most and have the hardest time even gaining access -- much less being able to afford -- anything other than high-calorie, low-nutrient food that the local 7-Eleven-equivalent is stocked full of.
> You want to think about causes that could actually explain the problem so that you can think of solutions that could actually work.
The problem is that our food distribution and availability is controlled by a small number of very large corporations whose primary concern is profits, at the expense of people's health (and the taxpayer's money in paying for rising health care costs, including weight loss drugs). The solution is similar to our approach to smoking -- regulations that made it harder for people to get addicted to smoking in the first place. But mostly, class action lawsuits.
> avoiding chips and pop is barely getting started with good eating
True, but when you see how many people walk out of Costco/Walmart with a shopping cart full of chips and soda, you realize pretty quickly that there is a lot of low hanging fruit when it comes to addressing the problem.
> I think you need to think a little deeper about this.
I have spent a lot of time thinking about this problem. What makes me so upset is that there seems to be very little thought given to this problem in the US -- other than looking for silver bullet, and coincidentally, highly profitable, drugs, instead of concerted efforts to combat what is a serious an ongoing nationwide health crisis, and one that affects the US much more than other countries (US obesity level is 2x UK and 4x France). I have yet to see any serious debate at the national level, by either party, to even begin to address the problem.
It’s like saying “you could learn 12h a day Japanese and be fluent in months instead on relying on crap google translate”. Some can easily learn languages, for others it’s super hard. Same for changing eating habits. For these people ozempic is the achievable goal, far better that the status quo.
No the analogy is more like “if you smoke you will get lung cancer. So stop smoking”. Most people in the US used to smoke 50 years ago. Now they don’t. Collective lifestyle changes are possible.
The problem is with smoking, you can go "cold turkey" and the cravings will go away after a while and you just have to avoid starting again. Not easy but achievable.
With food, you cannot stop eating so no "cold turkey" and you have to keep a watch on what and how much you eat all the time. Much easier to slip.
Not to mention the variance in food calories for similar looking foods that can easily tip you over the max goal.
It is like walking through a mine field all day every day, it never ends, you are never "out of it".
> With food, you cannot stop eating so no "cold turkey" and you have to keep a watch on what and how much you eat all the time. Much easier to slip.
Agreed. In today's world it's easier to stop smoking because cigarettes are not everywhere like they used to be, whereas it's hard to escape junk/highly processed food. It's like being an alcoholic when every vending machine and store sells your favorite whisky.
And that's why a social change is needed to stop pushing this garbage on everyone, starting when they are kids.
Nonetheless, there's a lot of low hanging fruit in terms of cutting out the very worse offenders (soda, high sugar foods, chips, snacks, etc.) and substituting with healthier alternatives, without having to do some crazy diet or skipping meals.
My biggest worry is for the next generation--when you grow up on garbage, it's hard to break that craving. (In our house we have a zero soda policy, and very little high carb and high sugar processed foods, but we always make sure to have fresh fruit and dried fruit and nuts readily available so the kids can grab that for a snack. But it's more expensive to do that and we have to forego other expenses, and sadly it's not something that's accessible to many Americans--and __that__ is where we need to see change.)
The prevalence of obesity has risen dramatically in the United States over the years. I find it hard to believe the average level of self control has fallen that much in so few generations. It's more likely to be a systemic problem, which is better solved collectively.
Yes, and its rapid rise means that it’s due to the environment/lifestyle not genetic predisposition. Therefore the collective remedy is also environmental/lifestyle related.
you would have to fix the entire system of food availability. we are still programmed to pack on and store energy as soon as it's available.
it gets harder and hard to constantly make good choices as you go down the income ladder not just due to the food environment but also because people on the whole just cognitively cannot make these decisions optimally all the time when they are tired, stressed, and overworked.
Fixing the system of food availability is exactly what is needed. And I 100% agree that it disproportionately impacts lower income because of healthy food deserts.
But it’s a problem of our own making because of large foodstuff corporations that force addictive garbage on everyone (through limited availability and high cost of healthy alternatives and the fact that junk food is literally everywhere and many times the only option). It’s a disaster and yet it’s hardly talked about — instead we look to drugs (which can make $$$) to fix the symptom.
But it's like saying, "here's an (expensive) pill that can help you stop smoking, but we're going to continue pushing you to buy cigarettes with every vending machine you pass and with every ad you see". Instead of removing cigarettes from all the vending machines, making them harder to get, and taxing them so they're more expensive and a new generation is less likely to get hooked on them.
The food system is fundamentally broken, but there's no incentive to fix it because that would mean a loss of corporate profits.
There's a lot of information you can find if you spend some time to do the research before making declarations on the topic, but studies have shown significant reductions in alcohol consumption, for one thing. Anecdotally, multiple people I know who are on GLP-1 agonists have said that they feel much less of a desire to drink and have much less when they do.
I believe the anecdotes I've seen were about people on this drug finding that they thought about formerly favorite unhealthy foods and viscerally recoiled at the idea of eating them.
My speculation is that it's a gut biota change driving the change in cravings, but I'm not sure there's much research on the mechanisms involved yet, since these drugs are very new, comparatively. A very small study apparently suggested it ameliorated some of the numbness to intense flavors that the obese have been shown to have in previous studies, so maybe I'm completely off base.
There's humor that a drug developed to treat diabetes, using a peptide we know physiologically to lower blood sugar, and secondarily found to also help drop weight is now getting headlines showing that it does its stated purpose.*
* Yes, I get that this is supposedly a preventive study - but if your metric for diabetes is blood glucose level, and you take a drug that lowers blood glucose level, it's not surprising that people on it are found to "fail" to reach the given threshold for diabetes on average
This is the closet thing to a wonder drug for the 21st century. You can see the transformation ...people who used to be obese seeing the fat melt off, when nothing else seemed to work.
But what are the long-term side effects? You don't get something for nothing. There is no such thing as a magic pill that makes you magically lose weight without any consequences.
If that were true about the human condition in the same way that it’s true for conservation of mass, we wouldn't be living longer and healthier lives than our forebears. Yet here we are.
Of course we should be aware of side-effects. But there’s no law of nature that says there have to be any serious ones.
we wouldn't be living longer and healthier lives than our forebears
Take out infectious disease, post-partum maternal deaths, no sanitation, and obvious lifestyle choices like smoking, and are we really living healthier lives than prior generations? I'm not so convinced.
This shares energy with: "All right... all right... but apart from better sanitation, the medicine, education, wine, public order, irrigation, roads, a fresh water system, and public health ... what have the Romans ever done for us?"
Those things you list are the bits which made our lives healthier. Just because you can list them doesn't mean they didn't happen.
Quality of life and amount of life as a healthy adult has actually increased astronomically. Are you saying we just throw out all our medical discoveries and advances and returned to “if he dies, he dies” mentality? Most people used to work from dawn til dusk in a patch of dirt just to keep food on the table.
Not sure why you're getting down-voted, it's a common meme for people to think everyone just died by their 40s. It seems like if you made it to 40 you often could be living into your 70s [1] throughout much of human history.
Now I'll take our modern scientific advances over not having them. Give me modern sanitation, surgery, antibiotics, and vaccines for sure. But I'm not sure I'd call the way many American elders around me are living in their 70s to be healthy lives. Many lack mobility, are obese, are on a fistful of prescription drugs daily, and have constant pain. Except for the ones that ate well and in moderation, didn't drink much, and exercised their entire lives.
I just hope people take these GPL-1 drugs but also get their bodies moving (particularly strength training).
I agree, but I also think that in most cases people are more likely to be able to transition to an active, healthy lifestyle with moderate eating if they have help taking weight off. Being heavy makes exercise painful, exhausting, and often more dangerous.
I think we need a huge investment in physical therapy. Everyone who is obese and working to reduce their weight and increases their activity needs PT, and we need PT specialists who know how to work with heavy people. I know a lot of fat people (including myself) who get injured and discouraged trying to follow workout advice intended for people in substantially better physical condition, and also a lot who have had trouble finding trainers or physical therapists who know how to work with them.
Oh absolutely, which is why I said I hope people can take these and add some sort of resistance training as they lose the weight.
And also totally agree that we need to invest in PT and educating PTs on how to work with people in larger bodies. As a formerly unhealthy person who only found exercise in their 30s, it's ridiculous to me that my high school gym requirements didn't teach me how to safely lift weights or use a gym. They would just let us use a barbell without any proper training, and the first time I tried to bench press with some friends (because we probably saw someone in a movie doing it) I injured myself. Every high school student should be learning how to use a gym, get through a yoga class, learn some calisthenics, etc. Set them up for their life so it's not so intimidating as an adult. Instead, at least for me in the 90s, it was a lot of playing basketball and baseball, nothing to keep me healthy on my own in my life.
The old saying goes: abs are made in the gym, revealed in the kitchen.
Not saying it’s easy, and no it isn’t as simple as calories in, calories out, but it is close to that simple. Working out, running, weightlifting, all that can happen later. Eating “right” and just walking a lot can induce a lot of positives.
Yeah, it's wild how much you need to pay attention to diet to get those abs to show. I don't work out for aesthetics, but I train pretty hard for my age (40 -- muay thai a 2-3x per week, kettlebells a couple days, ashtanga yoga a day or two, and I'll throw in 5 mile runs here and there in a week).
I'm always around 12-13% body fat, but to get them to show, absolutely, it's all diet. I'm vegetarian, so that probably works against me, but I've never had that 8% body fat ripped look even with all the activity I do in a week.
I guess I'm cherry-picking but I'm always impressed that 200 years ago you had founding fathers living 80+ which is higher than today's average male American lifespan (76).
In any case, long-term obesity leads to (and is worsened by) decreased exercise, which results in decreased bone density and muscle loss. There might be an argument for avoiding GLP-1 agonists for slightly overweight people, but for obese people it seems unlikely that the risks outweigh the benefits.
Yeah, because there's a (previously observed) paradoxical effect where decreasing blood glucose levels can accelerate the progress of diabetic retinopathy.
It’s actually chemistry, and given that we don’t really know how a lot of the human body subsystems interact in 2024, it’s closer to witchcraft than medicine.
GLP-1 drugs have been studied for decades and the side effects are incredibly low/small.
The bigger problem is frankly the reaction you display, that even if the side effects were actually zero that people feel that’s “unfair” and that others shouldn’t be taking a pill to do something their personal body chemistry doesn’t do properly.
Your thyroid medication is really a moral failing, you see. Just eat less and your weight will remain healthy.
Gabapentin may be a wonder drug, helping with heretofore barely-treatable conditions and the ravages of addiction.
Weight lose drugs are just a shortcut for something that is possibly for the vast majority of people without any drugs. Don't get me wrong, they seem great! But a drug that can help with seizures, nerve pain, alcoholism and anxiety sounds a little more "wondery" to me.
I don’t think the data supports that it is possible for the majority of people. On traditional diets, Between 80 and 85 percent of those who lose a large amount of weight regain it. Source: https://stanfordhealthcare.org/medical-conditions/healthy-li....
Well, it's possible for the majority of people, it's just that the majority of people can't keep up with the things that make it possible. It's a ton of work (and money!) to keep up with a good diet, walk thousands of steps per day, and exercise 4-5x per week. Between needing to drive to do everything and making food as addictive as possible, we've designed everything about contemporary life to work against being healthy.
I just mean it's physically possible, it's not like we as humans are physically unable to and require a drug to do it for us. But most people aren't willing to grind through the beginning phase that is physically and emotionally difficult to get to the part where training becomes beautiful. I've had moments on psychedelics where I've just cried from gratitude that I found my practices and disciplined myself to root out the deep fears and insecurities that held me back. I didn't want to live with them anymore and wanted to see what this body is capable of in this lifetime. It's ridiculous what out bodies are capable of. It's like getting handed a lambo and instead we keep it parked in our garage all the time. But those first 6 months were extremely difficult, literally bloody from injuries, and required a commitment that every week I'd go train 5 times, no excuses.
I think pretty much anyone can find 5-6 hours in a week to go train something, it's really not much time at all.
The wonder here is effective brain manipulation rather than fat melting.
These drugs are chemically induced intermittent fasting.
I’m okay with people saying “these drugs force people into healthy eating habits” but the weight loss itself is merely a symptom of the healthy eating habits that would be healthier on the body when done with discipline rather than chemically altering your digestion.
Humans are biochemical machines. Hormones (chemicals) regulate many systems in humans. So, you want people to eat less and work out more, when hormones, or biochemical subsystems, are messed up?
Anecdotally, the people I know who have been taking GLP-1 agonists have not been following eating patterns consistent with "intermittent fasting". They're just eating less (especially snacking).
When it comes to words like discipline or willpower, they are typically a signal that the poster is about to:
1. Ignore the continual and catastrophic failure of the idea that we can will ourselves out of an increasing crisis
2. Pat themselves on the back for their smug victim blaming
Hence the negative reaction. I don’t have an alternative word for you to use.
Humans at a population level have severe limits on what they can deal with. This is why tech companies use dark patterns, because exploiting and abusing people until they can’t put up resistance works fantastically. Suggesting that the real solution to mass exploitation is just to have the discipline to not be exploited would and should receive a negative reaction.
Ultimately, the solution to obesity is to make the fix as easy to obtain as the primary causes of the problem. Can’t wait for a gambling and (working) smoking vaccine.
> Intermittent fasting is any of various meal timing schedules that cycle between voluntary fasting (or reduced calorie intake) and non-fasting over a given period.[1][2] Methods of intermittent fasting include alternate-day fasting,[3] periodic fasting, such as the 5:2 diet, and daily time-restricted eating.[1][4]
Intermittent fasting is different than calorie restriction. There are calorie-restricted diets where you eat small amounts constantly throughout the day (this used to be the go-to recommendation of doctors). Intermittent fasting doesn't even necessarily entail calorie restriction.
Hopefully they reduce the cost overall. As soon as people are taken off it, whether that be because they finished their trial or they get out priced, appetite shoots right back to what it was before and the weight comes back with it unless the person changed their habits.
This seems to be a great outcome if you're the drugmaker. You don't want your medicine to cure the patient, otherwise they'll stop buying it. I bet if they found an alternate drug that worked permanently after N doses, they'd bury it and never productize it.
As far as I know the pharmaceutical companies have not adopted a strategy of attempting to undermine or block surgical treatments, which you'd expect if their operating strategy was as you say.
Love a good conspiracy & not a biologist / chemist, but I don't thing such a drug is even possible in our current state of technology.
Treatments that are "one (or N) & done" tend to be surgical procedures which physical change your body or vaccines which train your immune system (which has a sort of viral memory bank).
Most other regular drug treatments are introducing chemicals into the body which your body consumes/breaks down/etc. The body is always self repairing, replacing cells, etc.
As a layperson, I conceptualize altering brain chemistry via a drug is a temporary thing the way adjusting your pools chemistry is. You have to constantly replenish with new chemicals as everything is constantly breaking down and changing.
Yes, semaglutide (made by Novo Nordisk, brand names Ozempic, Wegovy) is a GLP-1 agonist; tirzepatide (made by Eli Lilly, brand names Mounjaro, Zepbound) is a dual GLP-1 and GIP agonist. Tirzepatide is newer and more effective, otherwise they're very similar - once a week injection, significantly reduces appetite, the use cases are diabetes and weight loss. Eli Lilly also have retatrutide in their pipeline which is a triple (GLP-1, GIP, glucagon) agonist, and which will likely be even better and will be available in a couple of years.
ACA compliant health insurance premiums are only for healthcare for under 65 year olds. I’m sure there is quite a bit of spend in there for diabetes/CVD/and other obesity related health issues, but the bigger impact would be on Medicare spending (65+ year olds), which is a federal expense.
Edit: note that the weight loss drugs may not decrease healthcare spend. For example, if it leads to more people living longer and utilizing other more expensive healthcare such as dialysis or cancer treatments, then the net effect will be an increase. For example, 25% of all Medicare spend is just for dialysis or kidney related issues.
>Any estimates on how much this will relieve our healthcare system.. aren't diabetes and CVD the biggest burdens?
I know diabetes is up there, but I was also under the impression that cancer and cancer-adjacent issues were a much larger burden on the system than CVD or end-of-life care (or aging related problems like arthritis or dementia). Could be wrong though - I'd love to see numbers and statistics.
>Will insurance costs come down if the US becomes healthier?
No. Insurers are public companies and need to increase profits every quarter. Lowering costs harms this ability tremendously.
> No. Insurers are public companies and need to increase profits every quarter. Lowering costs harms this ability tremendously.
And selling their insurance at higher prices than their competitors harms their ability to sell their insurance to customers. Hopefully, you or your employer are shopping around, and not just for health insurance.
That is because those are the lowest prices possible. Insurance companies earn tiny low single digit profit margins. Almost every dollar they collect goes out as an expense for claims.
They literally have to get their prices approved by the state government regulator. To suggest they are colluding to ratchet up the amount of money they spend on healthcare is unsubstantiated conspiracy theory.
It’s actually funny, because at the same time, there are complaints of insurance denying coverage and requiring prior authorizations. So which is it? Insurance companies inflating healthcare spend to increase their profit, or denying coverage to reduce healthcare spend to increase profit?
Your premiums are high because the ACA mandates your premiums pay for healthcare that older and sicker people get. A huge portion is effectively a tax, from young and healthy to old and sick.
>Hard to shop around as an individual who doesn't work for a large corporation.
That must be because you are in a low population state, or a state where the regulators make it difficult for companies to compete. For example, New Jersey has many options for an individual to choose from:
>That is because those are the lowest prices possible. Insurance companies earn tiny low single digit profit margins. Almost every dollar they collect goes out as an expense for claims.
Just as a caveat to this, UnitedHealth Group posted a FY'23 (according to their FY2023 investor report) profit of 22.4 billion USD. Profit, not revenue. Now, that's about a 6% margin (FY'23 net rev was 371.6 billion), so you're right about single digit profit margins, but the sheer scale of UHG is insane. They have plenty of room to reduce profits, and shouldn't be held to the same rules that non-essential service providers are held to.
They can, and absolutely should reduce the costs they pass along to end-users, especially those who are healthy and don't make claims.
>They literally have to get their prices approved by the state government regulator. To suggest they are colluding to ratchet up the amount of money they spend on healthcare is unsubstantiated conspiracy theory.
Those same regulators are just as susceptible to bribes, kickbacks, "lobbying" and other favors as any other politician.
>It’s actually funny, because at the same time, there are complaints of insurance denying coverage and requiring prior authorizations. So which is it? Insurance companies inflating healthcare spend to increase their profit, or denying coverage to reduce healthcare spend to increase profit?
It's both.
>That must be because you are in a low population state, or a state where the regulators make it difficult for companies to compete. For example, New Jersey has many options for an individual to choose from:
I don't live in a low population state. I live in one of the 3 most populated states. My rates are still sky high, which is odd considering I: don't consume alcohol, exercise religiously, eat cleanly, don't have a family history of any major diseases or illnesses, don't have preexisting conditions, am under 35, don't take any medication, and most importantly, haven't made a claim against my insurance in over a decade - the last time I have had any medical procedure of any major sort was an X-ray when I broke my wrist as an undergrad in college, and I paid cash for that. So, why are my rates still over $250 a month? I'm self-employed running a small startup with myself and a sibling as the only employees. While I made good money in a previous job, $250 a month for basically nothing is a sinkhole that I would like to avoid, $3k a year isn't much in the grand scheme of things, but it's $3k I could use to pay rent, invest into my company, invest into the markets, or just use to live my life. It's a waste.
Re-read my comment. It answers all of your questions.
> So, why are my rates still over $250 a month?
> don't consume alcohol, exercise religiously, eat cleanly, don't have a family history of any major diseases or illnesses, don't have preexisting conditions, am under 35, don't take any medication, and most importantly, haven't made a claim against my insurance in over a decade
The Affordable Care Act requires insurance companies to ignore all of that, and underwrite only based on tobacco use status and age. Even the age is not fully underwritten as the max premium has to be only 3x the least premium (see age rating factor). This explicitly makes insurance premiums a tax.
> They have plenty of room to reduce profits
No, they don’t. UNH has 6% profit margins because they have a huge healthcare provider component, and healthcare itself is high margin. The insurance business is 2% profit margin. See Elevance, CVS, Cigna, Humana, Molina, and Centene profit margins. All at 2%.
> It's both.
Sorry, but that makes no sense.
By the way, government leaders and asset rich wealthy people love the fact that you blame insurance companies. They got way with implementing a huge tax on the young and working people, and evade blame. That’s not even the only one, see lack Medicare tax on capital gains, and the egregious Additional Medicare Tax.
The productivity of today’s working youth is being transferred to old and sick people in greater and greater amounts, dictated by legislators in Congress, elected by active old voters, not the bosses at insurance companies.
>Any estimates on how much this will relieve our healthcare system.. aren't diabetes and CVD the biggest burdens?
Long term, I don't think this will necessarily decrease healthcare costs or the burden on the system. Ignoring the cost of the drugs, people not having diabetes means they're going to live longer and develop all the complex conditions that come with getting to be 75+.
> Will insurance costs come down if the US becomes healthier?
Health insurance prices in US are not related to demand, but to how much the market can bear. It may even go the other way, if drug companies decide to increase prices to make up for reduced demand ("we still need to recoup our drug R&D costs, so fewer sales means higher prices").
Price will come down and, in the meantime, compounding pharmacies are filling the gap in addressing stock shortages and high prices. Just be sure to use a reputable pharmacy if you decided to go that route.
The patent should expire in 20 years or so, and presumably there will be advancements in mechanisms to administer it/generics that bring down the price.
Semaglutide will fall out of patent protection in 2031 in the US, earlier in other countries. Drug patents do last 20 years (in the US), but the patent date is always some time before the medication is first sold. You also don't get a new patent for finding a new application of the same drug. So a diabetes treatment drug that's now used for weight loss without sufficient modification will expire at the same time as it originally would have even if it gets a new marketing name. Different formulations based on the original drug could get a new patent, though.
Can non-diabetics use this? Even though I'm morbidly obese (by BMI) I don't have any related health conditions (eg diabetes, blood pressure etc) (yet), probably because I'm still fairly active.
But I do clearly have an eating issue, was wondering if I can use this to help control it... also what happens when people come off it..?
Yes, it's treatment for obesity too, not just diabetes. Many of the people who come off it gain back a significant amount of weight (good to keep in mind that most people regain weight regardless of the method of weight loss, this effect isn't specific to this medication).
Yes. Talk to your doctor. IMO, far better to address your weight before it causes health problems than after.
(My brother was in a similar situation as you. BMI out-of-control his whole life, really. No real health problems, though he felt it was just a matter of time. Tried all the things — and remains a very avid walker — but could not reduce his weight substantially until Ozempic. He’s looking good now, quality of life is higher, and I’ve got to believe he’ll live longer.)
Yes, they aid in weight loss. Ozempic is the same class of drug. Long-term effects and discontinuation are your roulette wheel to spin. Ask your doctor.
As this is temporary, a more important way to deal with diabetes II is to use a painless measurement device. You cannot manage without measurement. Once you have numbers, you can control the drug use and the food intake. Of course making your own bread helps. But making your own meals even better. As all these help to understand and control. But eaten outside you have to use measurements
Seems like diabetes is strongly correlated to your weight.
If this pill suppresses hungry, causing you to lose weight, have healthier teeth because you're eating less, and since you lost weight - less likely to get diabetes ... what's Correlation vs Causation here?
You can keep eating shit, you don't need to exercise,
just take a diet pill every day for the rest of your life.
(Or regular injections or whatever means of delivery.
If you stop taking it you get fat again, that is what I
have seen at least, but not with this drug in particular.
Or you know you can find a middle ground and learn to eat better while also losing weight and not having to fight the cravings every second of every day. It has been like a reset for some of the people I’ve know and the doctors weaned them off it after the weight loss. Mind you that’s only 2 people but I can’t think of anything that would make them “different” all that much from the general populous. They picked up better eating habits along the way as well.
