Life After Ozempic

https://english.elpais.com/health/2024-03-12/life-after-ozempic.html

by belter • 2 years ago

30 59 2 years ago

english.elpais.com

gwern• 2 years ago

In other words, they got worse. “They had gained unhealthy weight,” explained Signe Sørensen Torekov, professor of biomedical sciences at the University of Copenhagen and lead author of the study. On the other hand, the people who had continued to exercise on their own were able to better maintain their weight and preserved more muscle mass. The results clearly indicate that people taking these drugs can “maintain a healthy weight” even after stopping the medication. “But they need to exercise,” Torekov added.

That does not follow, because this is simply yet another correlational result: the selective attrition after randomization is not itself randomized and therefore can be confounded. It is also possible that the people who got sicker or unhealthier after stopping the useful drug then stopped exercise.

(It is, in fact, not just possible, but must be the case to at least some degree: unless you want to argue that getting unhealthier would have no impact on whether you were able & willing to keep exercising...? Regardless of whether exercise has any effect, sick or fat people find it harder to exercise, and so would do it less than healthy or thin people.)

AtlasBarfed• 2 years ago

I've known two people that managed substantial weight loss in the ye short run. Imo they made a huge mistake not initiating a substantial physical exercise regimen now that they were lighter and the stress on tendons and ligaments reduced.

Javier Diaz, the featured success story appears to have done that.

exabrial• 2 years ago

If one already has a healthy exercise regime, does the weight come back? There’s the question. And what are the long term health risks? I think I’ve seen thyroid issues, but I don’t know what the risk factors are

arcticbull6• 2 years ago

The relationship has yet to be established. Some studies show a statistically significant increase in the risk of thyroid cancers - about a 58% increase - when taking GLP-1s for a long period of time. [1] That said the lifetime risk of thyroid cancer is 1.8% for women and 0.6% for men. [2] This would take you up to 2.8% for women and 0.95% for men. However thyroid cancer is extremely treatable, and when localized, has a 99.9% 5-year survival.

Note also that the causal relationship here may be weak or non-existent. Other research shows that it is less likely to cause thyroid cancer than taking insulin, and most treatments for type II are correlated with thyroid cancer risk. [3]

The health risks of obesity absolutely dwarf the hypothetical increase in thyroid cancers. Obesity is itself a risk factor for basically all cancers including thyroid. Frankly, even if there was a 100% chance of thyroid cancer due to GLP-1 usage, that would still be a massive win for population health.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563602/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473679/

[3] https://www.medscape.com/viewarticle/997713

kerkeslager• 2 years ago

Original study: https://clinicaltrials.gov/study/NCT04122716

I only skimmed the study, but at a glance, the study seems fine, if a bit unremarkable, but the article reporting the study seems a bit confused.

1. The study doesn't study Ozempic (Semaglutide), it studies Liraglutide. Why is the article titled "Life after Ozempic"?

2. Okay, so some patients stopped taking a weight loss drug and stopped exercising, and gained weight. That's pretty much exactly what you'd expect, yet the article seems to be presenting this as if it's a problem with Liraglutide. "Medicine doesn't work when you don't take it" is a bizarre criticism.

opello3• 2 years ago

And the follow-up study: https://www.sciencedirect.com/science/article/pii/S258953702...

The conclusion to the follow-up study might have a clue to (1.):

The addition of supervised exercise to obesity pharmacotherapy seems to improve healthy weight maintenance after treatment termination compared with treatment termination of obesity pharmacotherapy alone.

Ozempic in the title could be a stand-in for "obesity pharmacotherapy" and maybe they chose the more recognizable brand name.

It's also not very surprising that those in the supervised exercise group were better off a year later, they'd developed a healthy habit.

arcticbull6• 2 years ago

Liraglutide is a GLP-1 very similar to semaglutide, but at this point I think Ozempic is the "Kleenex" of GLP-1s. I'd be very surprised if one GLP-1 had a particularly different post-use profile than another.

snvzz6• 2 years ago

Put the fork down. Can't be that hard.

Sugar cravings (what these people confuse with actual hunger) do not take that long to go away.

Fasting is cheaper than eating. These drugs are expensive and have nasty side effects.

_mlbt• 2 years ago

Diet alone tends to be only part of the solution. Exercise, cardio in particular, is the key to effective and lasting weight loss.

opello3• 2 years ago

I'm pretty sure we know this isn't true at all. Diet is the greatest contributing factor to weight gain or loss. Exercise will make you healthier. In your example, cardio (e.g. high-intensity interval training), will give you a stronger cardiovascular system, which will likely make you "feel better" (less strained, more comfortable) when moving around in the world. And strength training (e.g. resistance training) will make you stronger and more comfortable when trying to lift things or even yourself.

Moldoteck• 2 years ago

Exercise is for health/muscles/good muscle shape etc... Sport will actually make you want to eat more. For weight loss (if there aren't health conditions/hormones that mess things up) it's just diet(what you eat and how you eat and how much you eat)

red-iron-pine• 2 years ago

cardio is important, but you can easily eat more calories than you burn in an average run. a small side of fries with your burger would undo the caloric burn.

"shoulders are built at the gym; abs are built at the dinner table"

klausa3• 2 years ago

This is pretty much exactly the opposite of what modern science tells us about weight loss, and especially the _psychology_ of it.

It _is_ that hard, and even if you starve yourself, the body just lowers your BMR to compensate.

I highly recommend reading this: https://highline.huffingtonpost.com/articles/en/everything-y...

snvzz6• 2 years ago

I highly recommend reading...

An article promoting fat acceptance?

I hope something is done about this dangerous cult that keeps the obese away from getting the help they need.

lm284692• 2 years ago

I eat once a day until my stomach is on the verge of explosion, weight lift or climb virtually every day of the week, and I'm losing fat

I'm nowhere close to starvation either since my lifts are going up

If you keep the diet that made you obese and reduce it by 50% you'll feel like shit, if you have a proper diet you can eat until your jaws physically hurt and still have room for extra calories

PeterStuer5• 2 years ago

Putting the fork down really does seem to be hard for some people. Their brain goes into a total panic response without the food. They genuinely experience missing a meal as a lifethretening situation, not just for themselves, but also for their kids and even pets.

Compare it to people with vertigo. Get a grip and just stand on the edge, while technically correct, will not solve the problem.

If someone would discover a strong gut-brain behavioral influencing parasite link, I would not be surprized, but I have 0 knowledge on the subject.

DiabloD34• 2 years ago

We actually do understand this, scientifically. They are suffering from a high caloric but low nutrition diet. If you put someone on a diet that is high in all of their required nutrients (all the vitamins, all the minerals, all the different amino acids) but otherwise has a caloric density approximating their BMR (so, slightly below their maintenance requirements), their brain won't drive them into a panic and missing a meal isn't a big deal.

Insulin mismanagement is a bitch.

ecronant• 2 years ago

I am on a strict diet right now. The problem is people don't track calories enough.

If I just go by how I feel I will end up eating so much more than I think I am eating.

Then it is frustrating thinking your on a diet when you really haven't cut any calories so the scale isn't going down.

Bodybuilders have had this figured out for a long time. There is no bodybuilder ever that doesn't track their calories when getting ready for a bodybuilding show because otherwise your going to over eat.

Not tracking calories is just a stupid strategy. No one goes running without knowing how far or long they are running for. No one lifts weights without having any idea how much the weights weigh. For some reason people expect to be able to do this with food of all things when we have evolved to eat as much as we can.

givemeethekeys• 2 years ago

It's very hard because my mind hates it when I lose weight.

- When I exercise rigorously, my mind tells me that I need to eat to recover fully. I end up eating more calories than I burnt during the workout.

- When I lose weight, I find that I'm much more negative and I have to constantly remind myself that it is the weight loss (and the lack of eating).

I still do it because I think being light is better for my back and knees than being heavy, but I can't say that it is easy.

lm284692• 2 years ago

It would be much easier if industrials didn't use every trick in the book to feed you addictive shit

But I agree that some people have very little self reflection, discipline, will to change and just expect a magic pill

JohannesH• 2 years ago

Anecdote incoming.

During my young adulthood I always gained weight, slowly but steadily until it evened out at around 103 kg.

Around when I was in my early 30s, I got sick to the point I lost 15 kg weight in two weeks, and over the next 3 years I lost 8 kg more, and got down to a low of about 78 kg, mostly due to healthy eating and exercise. I started running half marathons, I became more social and happy and life was generally better.

I'm positive that my sickness altered some chemistry in my body/brain. I didn't have any cravings, my sense of smell was altered and smelling food from McDonalds seemed repulsive to me, I was less impulsive and so on. Life was just easier, for about 3-4 years.

As my sickness receded I slowly got back into my old habits. McDonalds started to become attractive again, snacks slowly creeped back into my daily routine and running became more and more difficult. This recession took about 6-8 years and I'm now back at around 103 kg.

I often look back and wish I could recreate the effects of that period somehow. I've tried "putting down the fork" countless times. I've tried all kinds of weight loss strategies but it just seems so much harder than it was back then.

The sickness I got was Sarcoidosis. Initially I was treated with adrenocortical hormones because I had unexplained high fewers, swollen knees and ancles and rapid weight loss. What eventually led to my diagnosis was a doctor "randomly" asking for a chest x-ray even though I was mostly hurting in my legs. That xray showed I had enlarged granulomas all over my lungs. The hormone treatment lasted for roughly 2 months. But I was going for scans and lung checkups for 3 years after my diagnosis, until everything settled down. My sarcoidosis was fairly mild and I don't have any lasting symptoms.

Personally I'm convinced something happened in my body that made everything easier while I was "sick". I'm not sure if it was the rapid weight loss in the start, the adrenocortical hormone treatment or some other hormonal change caused by the Sarcoidosis itself that caused it. I just know that to me it felt like I was living the life of a thin person on the "other side" for a few years until I was back to my normal self again.

opello3• 2 years ago

Personally I'm convinced something happened in my body that made everything easier while I was "sick".

There's evidence that shows major life events can lead to it being easier to adopt changes in behavior, like a new habit of healthy eating and regular exercise.

I've tried all kinds of weight loss strategies but it just seems so much harder than it was back then.

If it's not too forward and you can adhere to it, I would suggest tracking everything you eat. Given some (1-2 weeks) of baseline data collection, make some tweaks to the macronutrient composition (protein/fat/carbs) of your diet. From that play with it until you find what you need to feel "full" in what you eat and in a way that is sustainable.

I may be strange in that I'm happy eating the same thing all the time. I don't think this is a simple or straight forward process, but approaching it with curiosity and rigor seems to have worked well for me.

mjfl• 2 years ago

I’m currently on day 20 of a fast!

DiabloD34• 2 years ago

You better be writing a blog entry about this when you're done.

snvzz6• 2 years ago

Congrats.

Also, remember that is where it starts to get dangerous.

DiabloD34• 2 years ago

It has never been about how much you eat... unless you truly do have an eating disorder where you are eating far in excess of your daily maintenance value, (anywhere from 1800 to 2400 depending on the individual).

What makes the difference is what you eat. Unmanaged insulin levels, even for so-called "healthy" individuals, leads to weight gain, especially in areas of the body associated with heart disease and stroke.

Your body requires multiple PHds in multiple medical and biochemical disciplines to understand. Trying to slap CICO on everything is both ingenuous and gaslighting.

Want to lose weight? If you already have a healthy calorie intake, decrease simple/refined carbs, increase healthy fats, avoid unhealthy refined oils from plant sources (margarine, crisco, other synthetic lard/fat replacements), increase meat protein if you're not getting at least 4 oz a day, avoid grains entirely if need-be (but certainly, less is more).

Still not working? Increase salt intake, low salt diets interfere with the angiotensin-renin system. Even with people with high blood pressure, lowering sodium intake often drives blood pressure higher (a documented life-saving quirk of physiology), but increasing potassium decreases blood pressure reliably.

Easiest way to achieve this is just to eat a normal, ungimmicky, unbullshitted, whole foods diet. Is it ultraprocessed? Is there more weird-ass chemicals on the box's ingredient list than not? Can you make this, yourself, in your kitchen, following a basic recipe? No? Then don't eat it.

cherryteastain4• 2 years ago

Tell us how the body violates the 1st law of thermodynamics and you will earn a Nobel prize in physics.

arcticbull6• 2 years ago

That's great advice, except for reality getting in the way. Every study on this shows that you are as likely to get good results telling people to "just eat less and exercise more" as you are telling depressed people to "just be happy. Can't be that hard. What do you even have to be sad about?" Your body is highly motivated to maintain your weight set point, adjusting your BMR and pushing you towards compensatory eating.

Basically every long-term weight loss study shows that you will regain 80%+ of the weight you lose through diet and exercise over a few years. [1]

Specifically, it has been estimated that for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss. Despite these predictable physiologic phenomena, the typical response of the patient is to blame themselves as lazy or lacking in willpower, sentiments that are often reinforced by healthcare providers [...] [1]

Obesity is a disorder of the GABA-ergic central nervous system, which is, I suspect not coincidentally, where GLP-1s work.

These drugs are expensive and have nasty side effects.

They're expensive because they work, and previously the only clinically proven effective alternative was bariatric surgery. That's both more risky, and much more expensive. The side effects are actually minimal, and during the clinical trials very few people dropped out due to side-effects. The newer dual- and triple-receptor agonists have yet fewer side effects.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/

cherryteastain4• 2 years ago

for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss.
Obesity is a disorder of the GABA-ergic central nervous system

This is too reductive. As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight.

That said, I get that many people just cant resist that hungry feeling. However, I've seen so many people who make these arguments eat tons of ready meals, desserts loaded with sugar, giant milkshakes etc. If they were serious about losing weight they could at least eat things like cucumbers or lettuce that keep you full with minimal amount of calories ingested.

The gist of it to me seems like these drugs are for people who are willing to pay thosands of $ to feel as full as when they were eating their 5000kcal/day diet without having to endure the feeling of not eating that amount. Which, contrary to your claim, boils down to the willpower issue. These drugs let you buy your way out of the willpower requirement.

yungporko• 2 years ago

obese people returning to a healthy weight without gaining the weight back within 5 years virtually never happens but yeah if only they would try "putting down the fork". fat people must just be really stupid.

steeve• 2 years ago

Can't be that hard.

My man has no idea what he's talking about.

helpfulmandrill• 2 years ago

The evidence would suggest that it is that hard for an majority of the human population, within the current western social context, food environment etc.

I say that as someone who has lost significant weight and kept it off for a number of years. But it was not as simple as "put down the fork". I basically have to calorie count every morsel. If I left it to my own mind or just told myself to "put down the fork" I'd be fat again in no time. My mind fundamentally doesn't seem to know when I have eaten enough food.

krageon• 2 years ago

If it can't be that hard, it would be a near-universally adopted solution already. It's not, because it is hard.

Perhaps with a little empathy, you could take whatever no doubt reasonable and well-meaning intention you have and bring it to people in a way that is actually constructive. That way someone might even be helped.

PeterStuer5• 2 years ago

Anecdotal. The people I have seen on semaglutide still eat as much as they can, but they feel "full" pretty soon. If that brake goes off, they would just be back to their old diet in no time.

snvzz6• 2 years ago

Discipline isn't profitable; selling drugs and trash food is.

HDThoreaun4• 2 years ago

Why are you trying to make this about profit? Discipline is hard and tasty food makes people happy. Companies responding to what people want isn’t evil

Life After Ozempic

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