How long til we're all on Ozempic?

https://asteriskmag.com/issues/07/how-long-til-were-all-on-ozempic

by thehoff • 2 years ago

461 1457 2 years ago

Statins are regularly given to people with high cholesterol. I would bet that most older people take or qualify to take a statin. If it happens with statins, therefore, it's not out of the realm to think that most people will eventually be prescribed GLP-1 to reduce weight which will improve overall health. It makes sense.

zdragnar2• 2 years ago

Statins have gone through several prescribing guideline revisions in the last 10-20 years. Many people were incorrectly prescribed them and some have suffered for it.

Likewise, there can be serious complications when taking GLP-1 agonists and the like. Since they need to be taken in perpetuity (many gain all weight lost upon stopping use) they should be reserved for only people who have exhausted all other opportunities.

Most people over 65 should not be on statins. Most people should not be taking GPL-1 agonists.

throwaway63467• 2 years ago

I’m just back from the US and watching some TV there in the hotel it seems very much like they’re pushing it into the mainstream, they literally have a commercial where “fat” people congregate in the street to march together picking up Ozempic… So I totally assume it will be widespread in a few years unless they discover some serious side effects.

sph5• 2 years ago

Pretty much no one should be taking statins. The side effects are well studied, while the benefits are dubious at best.

For example: high cholesterol levels is actually positively correlated with longevity, believe it or not. If you consume a diet low in sugars, thus routinely burning fat when fasted, you will have "high" cholesterol in blood. How do you think fats are moved to cells in need? Through the blood, of course.

I'd go so far as to say that statins are pretty much a scam, that fixes a useless and quite complex metric such as cholesterol levels. Given that cholesterol levels are a diagnostic easily accessible to GPs, they prescribe statins to see this figure go lower, even if it doesn't make the person any healthier. Incidentally it's similar to taking GLP-1 agonists instead of learning to have a healthier relationship with food.

m0llusk• 2 years ago

Statins are a good comparison because most end their use after one or two years because of the side effects.

IncreasePosts• 2 years ago

My biggest fear is either there will be long term negative consequences to Ozempic et al, and a huge swath of the population will be dealing with issues 30 years form now - OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight.

sss1112• 2 years ago

There were several side effects related to pancreatic cancer associated with the precursors to GLP-1 drugs. The same companies promoting GLP-1s were responsible for driving up insulin prices. So I'm hedging my bets.

There's a really cool Modern MBA video [1] on this topic btw :)

[1] https://www.youtube.com/watch?v=7sUoZVke_30

cyberax11• 2 years ago

There were several side effects related to pancreatic cancer

In mice.

pixl9713• 2 years ago

Large epidemiological studies have shown the link between obesity and pancreatic cancer. A large population-based case-control study of pancreatic cancer demonstrated that obesity was associated with a statistically significant 50–60% increased risk of pancreatic cancer.

So does obesity, so there is that.

BoingBoomTschak3• 2 years ago

Well, the negative consequence on the value of willpower is pretty obvious. "In what measure" is the real question.

zarathustreal2• 2 years ago

Right, and the associated cultural impact of increasing hedonism

Spivak3• 2 years ago

You have the completely wrong take on this. Dieting destroys your relationship with food. Basically every adult woman exhibits some level of disordered eating because of it— "girl dinner" is both funny because it's true and sad.

Being able to lose weight while continuing to eat is a wonderful thing. There is no virtue in spending your willpower making your body do something it desperately doesn't want to do. That's some puritan shit.

optimalsolver2• 2 years ago

You know the way that software bloat expands to consume increased computational speed?

We're about to see the nutritional equivalent.

gedy2• 2 years ago

Keep in mind a lot of people who'd benefit from this may not last another 30 years due to age or health issues due to weight either.

m463• 2 years ago

right

the life expectancy of someone with bmi > 40 is -5 years

and for bmi > 50, -15 years.

So I suspect someone ~ 65 with high BMI should be on it, the side effects would be: living.

mritchie712• 2 years ago

Has there ever been a case where something like #2 has happened?

Don't think you need to worry about that one.

dustingetz• 2 years ago

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

rmellow• 2 years ago

Adding iodine to salt has greatly increased the population's IQ in countries that have adopted it.

https://pubmed.ncbi.nlm.nih.gov/15734706/

crooked-v15• 2 years ago

Sure: the popularization of coffee across western Europe in the 1600s and 1700s, and the way it replaced beer as the most common daytime casual drink. Much of the population went from spending all day mildly intoxicated to being mostly sober and with a caffeine pick-me-up.

dtquad• 2 years ago

There are some evidence that Ozempic/Wegovy actually cures more addictions than just food addiction.

    >The weight-loss jabs have apparently helped people kick habits from smoking to shopping, although scientists remain wary about recommending it as an addiction treatment

https://www.theatlantic.com/health/archive/2023/05/ozempic-a...

anigbrowl4• 2 years ago

Some athletes (especially weightlifters) use Tadalafil, an erectile dysfunction drug, because it also promotes bone density and muscle growth while having few observable side effects. This isn't really surprising, it's basically just a mild vasodilator. A better known drug in the same class Sildenafil (aka Viagra) is less mild, and associated with retinal damage if overused.

Blackthorn4• 2 years ago

Going by the results around addiction, I'm betting on #2 with reduced alcohol consumption.

fourside2• 2 years ago

I’m skeptical of the idea that across the general population we’d be healthier if we dialed up our insulin production. Serious question but has there ever been a case of humans benefitting from increasing a hormone like this? Since it’s an injection, It wouldn’t be a steady increase, but more likely have bursts of it. I don’t know how healthy that would be in the long run.

After what happened with OxyContin I think wed benefit from some skepticism when a new drug gets oversold.

aantix3• 2 years ago

GLP-1's have been around since 2005. Exenatide.

They're not new.

pixl9713• 2 years ago

Serious question but has there ever been a case of humans benefitting from increasing a hormone like this?

By itself this might be an ok question, but in context it's rather useless....

Diet and obesity changes by both lowering and increasing different hormone outputs in your body. You're balancing the question of "how is this hormone" versus "How bad is obesity on the body". Well, the answer is in, obesity is extremely unhealthy on the body in both the short and long term.

Drug overdoses cause somewhere around 100k deaths per year in the US. Obesity complications related deaths are in the 250-300k deaths per year.

You can be skeptical as you want, but behind smoking, obesity is the worst epidemic in the US.

gcr7• 2 years ago

I can understand this perspective. You're looking at it with healthy eyes.

But for fat people, the calculus looks different.

A decision to take semaglutides is a decision between the long-term negative effects of obesity *now*, or the possibility of long-term negative effects *later.*

Anecdotally, trans people have a similar calculus. Going unmedicated/unsupported brings significant mental health risk now[1], whereas going on hormone replacement may or may not cause complications much later in life (osteoperosis, hepotoxicity issues for some treatments, etc).

Either way, you gotta get to the "later in life" part before you can worry about the outlook there.

1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G

jncfhnb4• 2 years ago

I was curious and a bit skeptical that sex change operations materially affected suicide rates for trans people but available papers tended to find significant effect sizes of about 50% reduction

0x1DEADCA0• 2 years ago

No, they're making a choice between the long-term negative effects of not losing weight naturally, vs the possibility of long-term negative effects of using artificial methods. This isn't polemic, as even things as basic as birth control and advil have negative long term effects.

croissants• 2 years ago

Tangential, but

1: a CDC meta-review said that 26% of surveyed US trans students attempted suicide this year, N=20,103 surveyed, ~660 of which were trans. https://archive.ph/0H81G

This paper also finds that 5% of cisgender male and 11% of cisgender female students (out of ~8k surveyed for each) attempted suicide in the past year. It's kind of strange, because the age <=18 suicide rate (of "completed" attempts) is much smaller, approximately 1 in 5,000 to 1 in 10,000 [1].

[1] https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf, Figure 3

al_borland• 2 years ago

I'm not getting any of the benefits because I'm not overweight.

You’re already benefiting.

bryanlarsen• 2 years ago

a huge swath of the population will be dealing with issues 30 years form now

We've got 20 years of data on this class of drug. Certainly there could be some long term issues that we're not aware of yet, but it's not likely that there are significant issues that affect a large percentage of users after 30 years that didn't affect the small sample of users that have been using it for 20 years or the massive number of users that have been using it for 10.

DonnyV3• 2 years ago

How much of the data was done independent and how much was done by the same company or companies that benefit from it? We've seen this before. How many decades did people take aspirin thinking it was good for you to take everyday. How many decades did people drink wine thinking it was good for you in small dosage? How many people smoked using it as an appetite suppressant not knowing the long term effects?

The list goes on forever. I'm betting this ends the same way.

bee_rider2• 2 years ago

Medical FOMO? I wouldn’t worry too much about it, I mean, there are hypothetical upsides to countless decisions we haven’t made, right? We always miss some chances in life.

anigbrowl4• 2 years ago

OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight

Who the fuck cares? If you're not overweight and are reasonably then you're already winning in physiological terms. If you can maintain a good quality of life into old age and then die, what more do you want? Going through life worrying about whether you're missing out on some marginal health benefit from the drug-of-the-moment is neurotic.

pajeets• 2 years ago

i think overweightness should be seen more as a symptom and I share parent's concerns about ozempic's long term side effects being unknowable in the present

all in all general unease about dealing with symptoms and not the root cause of overweightness except in rare genetic cases, its overwhelmingly a dietary/exercise issue.

in this country the pill/drug is the answer and solution to everything but all this does is pile on more bandages without addressing the root cause which a very American solution.

I do not think the full ramifications are realized or knowable when there are profits to be made on both side of the fence, sort of like the whole opiate crisis in America started out as magazine ads blew up into a major crisis 20~30 years later.

julianeon• 2 years ago

But consider the tradeoff: it's okay to have serious health issues in 30 years, if you were projected to die in 20 years without it.

thr0waway001• 2 years ago

That's why I haven't taken it. I'm probably a guy who should. Overweight, with kidney disease person who, if I became diabetic, it would probably kill me.

I'm not, someone who doesn't really need it. For example, some average weight housewife who just wants to fit in a dress a little better.

And still, I won't use it even though I can afford it cause it's the long term consequences are not entirely understood.

webninja• 2 years ago

Yeah, once you start taking it, you can’t stop. It becomes a lifetime commitment.

rqtwteye• 2 years ago

It's a pretty sad thought that everybody will be on a drug that keeps weight in check while most people will still eat a basically toxic diet. Weight is certainly an important factor but there is more to a healthy life.

habitue• 2 years ago

Seems like just an orthogonal problem? If calorie input is solved, now all the moralizing and shaming can be about nutrition instead

mock-possum2• 2 years ago

And make no mistake we will find something new to moralize and shame about because that’s what we do

asib3• 2 years ago

Sure, but the "unhealthy but not excessively caloric" diet is not a problem ozempic attempts to address. As far as I understand, it simply limits your appetite. Potentially one can go on ozempic, lose weight, and still end up eating unhealthily, because the resulting diet is made up of nutritionally poor foods.

MBCook3• 2 years ago

No, but if it helps avoid the discussion because the very visible side effect is lessened, then in some ways things are worse. No squeaky wheel.

I’m glad it’s available for those who need it. But I agree with GP that there is another discussion we need to be having too we’ve avoided for far far too long.

giantg26• 2 years ago

And the argument you are replying to is that it's just covering up a symptom and not addressing the root problem holistically. Ozempic isn't a fix, it's a bandaid.

jprete• 2 years ago

Ozempic does not simply limit your appetite, it seems to also affect how much reward your brain feels from different foods (and activities!), which would make it easier to override those anticipated rewards with conscious choices.

kelseyfrog5• 2 years ago

From my understanding GLP-1 agonists can actually modulate the reward pathway reducing people's appetite for toxic diets.

We're not socially caught up yet to this information. I suspect there are folks who believe that regardless of similar outcome (reduction of toxic diet), that changing diet without medication is superior to those who change their behavior through pharmacological intervention. It's like the pre-1990s view on depression or anxiety - chemical intervention is a moral weakness.

andrewmcwatters• 2 years ago

You can literally do the same thing by eating a healthy diet for 2-4 weeks.

mrweasel7• 2 years ago

GLP-1 agonists can actually modulate the reward pathway reducing people's appetite for toxic diets.

There are also studies out showing that people just up their sugar intake, so I think the results on how it affects peoples diet is still pending. From what I've seen, people are eating less, but more of it is junk food and sugar.

I can absolutely see why people would want to be able to just take a drug and start losing weight, it's hard. My concern is that it takes more than a low body weight to be healthy. You still need exercise, and while that's not an effective weight-lose solution, it is something that most would add when trying to lose weight, and now they're missing out on that part. Arguably exercise is more important than your weight.

akira25018• 2 years ago

chemical intervention is a moral weakness.

As a default it is. And that's what it became. We stopped trying any other methods. Come in the door, have a set of symptoms that check all the boxes, walk out in 30 minutes with a prescription, doctor's office gets a bonus. Institutional psychiatric treatment is drugs first actual treatment later.

This is a _social_ problem. It should be discussed and addressed as such. You should not attempt to pervert this concern into an _individual_ issue in an effort to invoke a needless moral defense.

Karrot_Kream2• 2 years ago

There's a decent amount of evidence that the most toxic thing about modern diets is their amounts: calorie counts and such. Many things (sugars, ultra-processed foods (ugh I hate the NOVA classification), fat, etc) are fine in moderation. The dose makes the poison.

Fernicia• 2 years ago

Is it fundamentally any different from something like toothpaste?

Humans have created a technology (mechanised farming) with a side effect we haven't yet evolved to handle (an abundance of tasty calories), so it doesn't seem all that strange we would fix it with a technology (inhibiting the desire for said calories).

lostmsu2• 2 years ago

I think your statement is very funny. If the drug keeps weight in check on a toxic diet and that has the same outcome as "healthy life", then is that "healthy life" any more healthy then the drug+junkfood combo? Also, what is sad about it?

dr_dshiv• 2 years ago

It’s not clear to me that this is the case.

People in the Netherlands eat such shit food — but they are so healthy because they move a lot and aren’t obese.

I’m not sure that food quality is as important as we sometimes hope it is (after all, we pay for quality)

intothemild2• 2 years ago

I've been on wegovy for almost two years now, and I can attest to how much you just DONT want to eat junk anymore. It's one of the most commonly talked about things we discuss with other users over the last few years. That and lower want to drink, and gaining back so much of energy/time due to not having to think about food every 3 seconds of the day.

I'm super satisfied just having an apple or two now. The "omg I need to eat, ohh a burger" is gone.

chankstein38• 2 years ago

I'm not arguing at all here but just wanted to say, I've noticed similar effects just focusing on eating healthier over the last few years. I haven't taken anything to help I just wanted to stop eating poorly and now adays it's not "shove the entire box of cookies in my mouth" it's "have 1 cookie and don't finish it because it's too rich" and I haven't eaten fast food in as long as I can remember. I used to see a McDonald's french fry commercial or just think about them and need McDonald's. Now I see it and go "ah they were good but eh" and move on with my life.

Glad you're seeing benefits like that!

snarf21• 2 years ago

Serious question: Why not make toxic diet illegal or cost prohibitive? Lots of manufactured food is designed to be more addictive. Then add in constant advertising bombardment targeted at kids. Why is there up to double the sugar in US bread and soda versus Europe?

steveBK1233• 2 years ago

The politics of legislating diet are very fraught, let alone the implementation is incredible complicated.

Even blue state dem voters I know used to whinge about Michelle Obama and her veggies lol.

cyberax11• 2 years ago

basically toxic diet

This is a bullshit term. Even fast food is not "toxic", it's just calorie-dense.

I got overweight eating nothing but "healthy" diet because I have never _liked_ fast food.

petesergeant5• 2 years ago

while most people will still eat a basically toxic diet

It's a pretty sadder fact that people just make these wild assertions. Everyone I know (which is about 10 people in real life, myself included) who's used a GLP-1 drug found that they eat healthier because they've less desire for shittier food.

outworlder2• 2 years ago

while most people will still eat a basically toxic diet.

Had to scroll too far to find this. It's a great synergy isn't it? The food industry creates calorie concoctions that can barely be called food, are dirt cheap to make and rakes in profits. People get sick. The pharmaceutical industry sells drugs are stupid high profit margins so that people can keep on living.

It is not a conspiracy, but it's a good feedback loop for corporations. All that money allow them to flood the scientific community with their sponsored studies, dominate news broadcasts (confusing consumers) and even influence the food pyramid, which is almost upside down.

I've been on a slow quest to improve health and lose weight. It's really, really slow, far slower than what most people would like. But cutting added sugars to zero (including and most especially high fructose corn syrup) gave almost immediate benefits that kept me going. Sugars (and carbs in general) make you retain a lot of water. Cut those, and you'll see a major difference in the scale in a couple of weeks. Is it mostly water(but not entirely!) Yes. It doesn't matter, our lizard brains interpret that as success. That also reduces hunger, which is a positive feedback loop.

jaredwiener• 2 years ago

FWIW, I was prescribed a GLP-1, but my insurance will not cover it. It's incredibly expensive out of pocket.

gadflyinyoureye• 2 years ago

Only in the US. Other countries are like 90% less expensive. However, Medicare might try to get better deal since the next round of deal making can include it since the drug is 7 years old.

https://slate.com/technology/2023/07/ozempic-costs-a-lot-it-...

hombre_fatal4• 2 years ago

What about compounding pharmacies like Hims.com? It's $400/mo month to month but $200/mo if you pay a year upfront.

rootusrootus46• 2 years ago

$400/mo will get you tirzepatide (zepbound), if you're okay with semaglutide (ozempic) it'll probably be about half that.

Although tirzepatide just got knocked off the shortage list last week so it could become harder to get in compounded form.

gandalfian• 2 years ago

Seven years, December 2031. That's when the patent expires, the kinks and side effects will have been found/ironed out and it becomes a cheap plentiful generic. I'm healthy enough to wait.

apsec1122• 2 years ago

This compares Ozempic with past drugs, but sales of past drugs are almost always limited by demand. I'm not sure there's much to learn here for a drug that is limited by supply. Also, this part is silly:

"The announced investments across both companies total $32 billion. GLP-1s were 71% of Novo’s revenue in 2023, 16% of Lilly’s in 2023, and 26% of Lilly’s in 2024Q1. If these sales are proportional to the manufacturing capacity used to create those drugs, then about 40% of Novo and Lilly’s combined estimate of $45 billion in gross PP&E is for GLP-1s, for a total of $18 billion; $25 billion would then mean a 140% increase in GLP-1-relevant PP&E."

Manufacturing investment is not proportional to sales, because there's a fixed cost to making a certain drug regardless of how much you sell. If a rare-disease drug will have a few thousand patients ever - not uncommon! - you still need to figure out a synthesis path for that particular drug, run QC tests on the production line, get regulatory approval, etc. Economies of scale matter a lot (https://en.wikipedia.org/wiki/Experience_curve_effects).

cubefox8• 2 years ago

And apparently the pure manufacturing cost for Ozempic is relatively low:

the active drug in Ozempic can be produced for about 29 cents for a month’s supply, or 7.2 cents for a typical weekly dose, the research found. It’s not cheap to make — semaglutide costs over $70,000 per kilogram. But only a tiny quantity of the drug is used in each weekly dose.
https://fortune.com/europe/2024/03/28/ozempic-maker-novo-nor...

I think this makes it likely that strongly ramping up the supply is not a major problem.

rory• 2 years ago

By chance I just talked to someone with deeper knowledge on this and they said the current constraint is actually ramping up supply of the delivery mechanism, not the drug.

I have zero expertise on this, but would be curious if anyone knows what's special about Ozempic delivery that can't be served by a commodity syringe.

vessenes8• 2 years ago

Agreed. Don't forget they're spending on next-gen versions of these too -- Novo is testing a pill form that's apparently twice as effective as semaglutide(!) right now. It's easy to imagine that becomes part of many people's January routine -- stop drinking, take your pills, go to the gym for a month, slowly put the weight back on during the year, no problem.

Dumblydorr• 2 years ago

Not fully true- orphan drug status exists for rare diseases and gives advantages to companies who develop drugs for rare conditions. This includes longer exclusivity periods amongst other incentives, rendering these categories more feasible economically.

spondylosaurus6• 2 years ago

I'm shocked that TFA doesn't mention the (massive, booming) market for compounded semaglutide and tirzepatide. The long-term future is uncertain, but since these drugs have been under shortage status, third-party pharmacies can legally compound them to meet increased demand.

philipkglass3• 2 years ago

9 days ago the FDA declared the tirzepatide shortage over, though the other popular drugs in this class are still eligible for compounding based on shortage status:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...

fredgrott2• 2 years ago

for those that do not know there is a herb that targets GLP-1...its called Berberine

And yes its over the counter....I currently take one dose per day at 1200mg

aleksiy123• 2 years ago

How effective is it?

wizzwizz43• 2 years ago

Source? https://www.mcgill.ca/oss/article/medical-critical-thinking/... (2023) disagrees with you:

Neither is berberine any version of Ozempic, which is an analogue of glucagon-like-peptide-1 (GLP-1), a natural hormone that regulates blood sugar and helps people feel full. Berberine has nothing to do with GLP-1.
Perhaps the most interesting laboratory finding, given the rising global tide of type 2 diabetes, is the control that berberine may exert over blood sugar. But there is a problem. Berberine is virtually insoluble in water and has low intestinal absorption which means it has poor bioavailability. […] Because of berberine’s poor bioavailability, supplements on the market are likely to be useless. However, some derivative of berberine, may yet make it to the physician’s prescription pad. But it won’t be for weight loss.

zonkerdonker• 2 years ago

I was able to find this: https://www.sciencedirect.com/science/article/abs/pii/S00062....

Apparently most of the effect is due to activation of the "bitter taste reception pathways" in the gut. So even though it has very low bioavailibility, it can still stimulate GLP-1 secretion just simply due to its incredible bitterness

philipkglass3• 2 years ago

Interesting.

"Berberine induces GLP-1 secretion through activation of bitter taste receptor pathways"

https://www.sciencedirect.com/science/article/pii/S000629521...

But buyer beware when it comes to getting berberine from over-the-counter supplements:

"Variability in Potency Among Commercial Preparations of Berberine"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807210/

Nine of the 15 tested products (60%) failed to meet the potency standards of 90% to 110% of labeled content claim, as commonly required of pharmaceutical preparations by the U.S. Pharmacopeial Convention. Evaluation of the relationship between product cost and the measured potency failed to demonstrate an association between quality and cost. Variability in product quality may significantly contribute to inconsistencies in the safety and effectiveness of berberine. In addition, the quality of the berberine product cannot be inferred from its cost.

Worse still,

"Preparation and Evaluation of Antidiabetic Agents of Berberine Organic Acid Salts for Enhancing the Bioavailability"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337101/

Berberine—an isoquinoline alkaloid isolated from the rhizome of Coptidis rhizome, Cortex phellodendri, and other plant species—possesses a variety of pharmacological effects, including anti-cancer, anti-hyperglycemic, anti-hyperlipidemic, antimicrobial, anti-inflammatory, and antioxidant activities. However, its absolute bioavailability is as low as 0.68%. Low bioavailability greatly restricts the clinical development of berberine.

rootusrootus46• 2 years ago

I'd think it more likely that it'll be one of the next generation drugs, but I do agree with the premise that it will be really common.

A few weeks ago I started a low dose of tirzepatide (aka Mounjaro, aka Zepbound) and the side effects are interesting.

The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.

But there are some unexpected positives.

Obviously I am eating less. I have to log food not to keep it in check, but to make sure I'm eating enough and with the right nutrients. There's another possible negative here -- you get a lot of hydration from food, so if you start eating less you should carefully monitor your fluid intake to allow for that.

But I'm also more focused. Not nearly as distracted. I'm getting a lot of things done which I used to just procrastinate on until years had passed in some cases. Man, the garage is going to be clean and superbly organized in a few weeks.

And my emotions are quieter. Not just the food noise, that was expected, but I feel more relaxed. That's not what I expected, and I'm pleasantly surprised.

As an aside, what makes this all really noticeable is that it's a once-a-week injection, and the peaks and valleys are very obvious. Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.

Edit: Before someone asks, yes I have considered there may be long term effects. This is a risk, which I've decided I'm okay with at my age. Nobody gets to live forever anyway, and I was going to end up in an early grave via another route if I didn't do this. "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.

I do hope to taper off at some point if I can figure out an alternate strategy for staying lighter. Though I'll miss some of the positive side-effects.

jeffbee2• 2 years ago

Man, the garage is going to be clean and superbly organized in a few weeks.'

Manic behaviors also associated with older, popular diet drugs like meth.

cyberax11• 2 years ago

It's not the manic behavior, but the opposite. GLP-1 agonists appear to reduce the impulsive behavior.

rootusrootus46• 2 years ago

I said a few weeks ;-). The garage is pretty big, but not that big. It's going to be gloriously organized in a few weeks because I spend a half hour or so in the evenings to move the project forward. I'm very relaxed about it. I'm just doing exactly what I kept telling myself I should do to make the garage as organized as I want, rather than finding pretty much anything else to do.

Decades ago I tried phentermine for a couple months. Now that was a ride, and you might call the experience closer to manic. I was a machine. This is not like that.

copperx3• 2 years ago

It would be interesting to compare the anxiolytic effects of the drug versus the cancer anxiety caused by being on the drug.

The cancer anxiety could be reduced by frequent testing. e.g., having a thyroid ultrasound every 6 months, or a yearly abdominal MRI, just to make sure cancer is not brewing.

arcticbull12• 2 years ago

There's no evidence that GLP-1s cause cancer in any meaningful amount, but obesity definitely does. Either way the only cancer they found any correlation to was thyroid which is one of the most treatable -- over 99% survival rates.

gcr7• 2 years ago

Is cancer anxiety a common response?

I haven't seen any mention of cancer on r/zepbound

arcticbull12• 2 years ago

"Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.

Studies show it just doesn't work.

There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11 and the likelihood of going from severely obese to normal weight is 1 in 1667.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407685/

[edit] not to mention for those 1 in 11, the average weight regain over 5 years is 80%.

https://www.sciencedirect.com/science/article/pii/S000291652...

pfdietz7• 2 years ago

I've lost 27 pounds since May (12%). Eliminating most carbs and doing lots of walking. I think being on metformin helped.

patmcc2• 2 years ago

>>Studies show it just doesn't work.

It's not that "eat less and exercise more" doesn't work, it's that nobody does it, because it's really, really hard.

Calories in/Calories out is both completely true and completely useless for actual humans.

edit: that's unfair, mostly useless

CooCooCaCha2• 2 years ago

Eating less and exercising more does work, in fact that is how you lose weight. The problem is doing it consistently which is what these drugs help with.

lukasb• 2 years ago

Are there any studies that look at body fat % instead of weight? I don't care how much I weigh.

potta_coffee2• 2 years ago

It would work if people would actually do it. It 100% works. Human nature is such that people would rather take a drug than change their lifestyle. I've done it myself but it requires a complete realignment of lifestyle to make lasting change.

icedchai2• 2 years ago

Of course, it "doesn't work" because people don't keep it up. I started exercising regularly during covid and didn't stop. I cut out all the soda. It works.

oremolten• 2 years ago

it's interesting you state "Studies show it just doesn't work." While we are commenting on an article about a drug which makes you feel less hungry, there by "eating less". The drug doesn't make you use more calories, it simply "makes" you EAT LESS. Eating less(calories) than your body uses consistently for duration is literally the only way you can lose weight. (outside of literally losing limbs, or surgery to remove mass) Exercise only augments the process, it all comes back down to EATING LESS(calories).

AtlasBarfed2• 2 years ago

People need to understand what activity / exercise really is. The desperation of the medical establishment to get people to do ANY exercise meant the general advice is watered down.

It's the doom of the statistical distribution. Good outcomes are defined in relative terms on the bell curve, not on absolute performance which exercise is actually suited for.

In days of manual labor jobs and lots of walking, people likely burned 1500-4000 calories more per day than sedentary modern lifestyles. I can imagine farmers back in the days of 12-hour days of physical labor may burn 5000 or 6,000 calories. A pound of fat is 3500 calories.

Meanwhile, people that are generally following some 20 minutes of exercise five times a week, regimen of the medical establishment are likely really only burning about 300 to 400 calories tops in those 20 minutes sessions, if they even do that.

For the sake of argument, we're going to ignore the basal metabolic advantages of people that are burning an extra 1,500 to 3000 calories per day and the stimulated muscle growth that comes with it.

People back in olden days just on activity were burning a third to a half a pound extra of fat per day in terms of energy.

Meanwhile, modern people who "exercise" are burning maybe a tenth of a pound. Only when you get to "athletes" that are "training" do you get to the calorie burns that people's lives used to entail.

So it's important to keep in mind when people say exercise is ineffective in weight loss that they really are talking about very minor amounts of added activity by by modern medical standards.

Exercise is extremely effective at limiting weight if you get to what I call the 1000 calorie Hammer, where your exercise is adding an extra thousand calories or more per day to your activity. And you're simultaneously not going nuts on your diet.

A 1000 calories is a considerable amount of activity. For a 180 lb man, that's 4000 yards of swimming, 7 miles of running, or 25-30 miles of biking.

If you are a 120 lb woman, increase those distances by 50%. Most people consider those loads to be exercise obsessives, but practically that's what's necessary in order to employ exercise as a usable means for weight control and surviving the corn syrup world we're in

rybosworld2• 2 years ago

Studies show it just doesn't work.

Eating less and exercising most certainly does work, if the individual sticks to the routine.

I do agree it's difficult to stick to a routine because our modern lives are demanding and so we compromise by eating fast food and avoid going to the gym.

I think the exercise paradox video recently put out by Kurzgesagt has been a net negative for how people think about diet and exercise. The paper the video is based on is highly flawed.

That paper has a few major problems but these are the biggest:

1) The authors didn't control for body mass. The Hadza and Bolivians burned 52kcal per kg of body weight. Americans burned only 38kcal per kg of body weight. That is: the active groups burned significantly more calories than the inactive groups, on a pound-for-pound basis.

2) The active groups were defined as such because they walked ~12km per day. This is significant because the human body is exceptionally efficient at walking. It is certainly true that over a comparable span of time, you will burn less calories walking than you would running, or lifting weights.

GLP-1's are miracle drugs and people should take them if they at are high risk for obesity-related diseases.

But diet and exercise certainly do aid weight loss, and will have fewer negative side effects than a GLP-1 drug.

https://www.germanjournalsportsmedicine.com/archive/archive-...

bdndndndbve• 2 years ago

Homeostasis is a powerful force. Once you gain weight your body has a tendency to keep it, and overcoming that to establish a new equilibrium is difficult and uncomfortable.

bozhark2• 2 years ago

This is absurd.

Caloric intake and outtake is just that.

pugets3• 2 years ago

It does work. It couldn't not work. Each day of your life, you choose to do one of three things:

1. Consume more calories than your body will need to function

2. Consume as many calories as your body will need to function

3. Consume fewer calories than your body will need to function

When you consume more energy than you require, your body stores the remainder as fat. When you consume less energy than is required, your body converts your fat into usable energy.

Now obviously, this is an over-simplified explanation of nutrition. What you eat, when you eat it, how efficiently your body converts food to energy, and other factors will determine the little details. But the explanation I've provided is not nearly as over-simplified as "it just doesn't work."

To make a comparison, it would be like suggesting that the financial advice "earn more money than you spend" just doesn't work as a method of saving money, on the grounds that some % of Americans who try to save money end up in credit card debt.

confidantlake• 2 years ago

It works in the same way as crossing the finish line first works to win a race. Of course it works, do that and you win 100% of the time. It is not that it doesn't work, it is that it is extremely difficult to do.

adrian_b3• 2 years ago

I hear very often this theory that "it just doesn't work".

To be fair, I had also believed this for many years.

However, all the people who claim that "it just doesn't work", have never made any serious attempt to do "it", so they cannot know whether it does work or not.

I have been obese for more than a decade, during which I have made several attempts to lose weight, which have all failed, because they were not done in the right manner.

Then I have made a final attempt using the correct method, and I have lost about 35% of my initial body weight during about ten months, at a steady rate between 100 g and 150 g per day, i.e. about 1 kg per week.

This was more than 10 years ago and since then I have kept a constant weight. Because I have done this once, now I can control my weight and have any weight I want, even if I gain weight extremely easily. It is enough to eat one day like I was eating when I was obese to gain enough weight to require a week of weight losing diet to go back to the desired weight.

The rules for losing weight and maintaining the weight are very simple, but they must be observed and those who claim that "it doesn't work" never try to observe the rules, so it is entirely predictable that it cannot work for them.

First, it should be obvious that after losing weight one must eat differently as before, otherwise weight will be gained until reaching again the original weight.

To be able to control the weight, anyone who is or has been obese must stop eating until they feel satiated. At each meal, one must plan before beginning to eat how much to eat and then eat only the amount planned, never more than that. One must eat a fixed number of meals per day (preferably few, e.g. only two meals per day should be enough for an adult who has a sedentary lifestyle) and never eat between meals any kind of snacks or drink any sweet of fatty beverages. Between meals, only water or beverages without any calories (e.g. unsweetened herbal teas or tea or coffee) are acceptable intakes.

While losing weight, the most important thing is to weigh oneself every day with precise digital scales (with a resolution of 100 grams or less), at the same hour and in the same physiological conditions, i.e. in the same order with respect to meals and relieving oneself.

Whenever the weight is not less than the previous day, then the quantity of food planned for the current day must be diminished in comparison with the previous day. At the very beginning of losing weight there may be a delay, e.g. of a week or so between starting to eat less every day until the weight begins to decrease, but eventually it is possible to reach a steady state of a constant rate of losing weight per day.

When diminishing the amount of eaten food, only the carbohydrates and the non-essential fats must be reduced. The amount of proteins, essential fatty acids, vitamins and minerals must remain normal. To achieve this, one must eat a source of pure proteins, for example turkey breast or chicken breast or some kind of protein powders, so that eating enough proteins contributes only a minimum amount of calories. The rest of the nutrients can be provided mostly by non-starchy vegetables and perhaps by some supplements like fish oil. One could also eat almost anything that is not recommended, for instance chocolate, with the condition that the quantity is negligible, which can normally be achieved only when such treats are not eaten every day, but e.g. only once or twice per week.

These rules are simple and anyone who follows them will lose as much weight as desired. Obviously, this is easier said than done, because for the entire duration of the weight-losing diet one will be permanently hungry and one would tend to think about food and it will be difficult to resist temptations, so it is better to not keep in the house any kind of food that can be eaten immediately, without requiring some kind of preparation. Unfortunately, this is unavoidable and it is the price that must be paid. After the first few weeks, the hunger sensation diminishes in intensity and it always disappears for a few hours whenever you find some work to do that captures your attention.

As long as you do not want to follow such rules, you will not lose weight, but that is because you do not want to do it, not because it does not work.

Not wanting to do it is a valid reason, because one may abhor more the feeling of hunger during many months than being obese, but this decision must be described correctly and not be justified by the false claim that "it doesn't work". At least in my case, the improvement in my health and in what I was able to do (e.g. before losing weight climbing a few stairs would make me tired and sweaty) has made worthwhile any displeasure felt during losing weight and I have been very happy to have achieved that.

_heimdall3• 2 years ago

All this study really shows is an analysis of medical records with no background of the peoples' diet or lifestyle. The outcome should be obvious and expected, those who are overweight and obese were found to stay that way.

The fact that the rate of obesity in the US has pretty consistently risen for decades makes that clear, you don't need statistical models of medical records to know that the rate of obesity could only really keep going up if those already obese stay that way.

zahlman8• 2 years ago

There was a massive (18,000,000 people) cohort analysis published in 2023 that showed the likelihood of someone losing 5% of their body weight in any given year was 1 in 11

Unsurprising. They ran statistics on arbitrary overweight and obese people, with no idea of who was actively seeking to lose weight or who was just coming away from such an effort. If a significant fraction of the overweight/obese population did lose 5% of body weight/year, we wouldn't be seeing a bunch of overweight/obese people.

nullc• 2 years ago

Glad you're having a good time, but the broad ranging psychological effects are concerning.

noch2• 2 years ago

but the broad ranging psychological effects are concerning.

Fwiw, to me the symptoms he and others have described don't seem very different from those of long fasting. And I would definitely prefer those symptoms to the ones I had due to obesity which ranged from extreme fatigue, heart-pain, muscle spasms, depressive shame, restlessness and so forth.

firesteelrain3• 2 years ago

What kinds?

I have been taking tirz for 7 weeks and walking 5 miles a day + exercise. My depression is gone and I have lost 30 lbs. I am loving life.

noch2• 2 years ago

Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.

Perhaps coincidentally, this is similar to my experience with week long fasts: After 48 hours I feel like a precision missile cruising towards my target until about 5-6 days later.

But I will use a suitable GLP-1 based drug, because, man, fasting feels unbearably brutal for me after 6 days: profuse sweat, increased heart rate, brief but intense panic attacks, an insane level of sad (but not depressed) introspection, a hairpin trigger temper. I become a ridiculous mess. There's got to be a better way!

Thanks for sharing your experience and insight!

whatshisface2• 2 years ago

You could have food allergies that take a couple days to clear up.

pixl9713• 2 years ago

I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.

If you're willing to shoot up more often it moderates the effects better.

rootusrootus46• 2 years ago

I definitely am. That first shot took a solid 30 seconds and three false starts before I could jab it in, but it turns out to be a great big nothingburger once you do it. Can barely even feel it, nothing like the intramuscular shots like flu/etc. I could do this shot as often as necessary without batting an eye.

spondylosaurus6• 2 years ago

Might have to float this by my tirz-taking partner, especially if it helps with side effects. They always feel a little icky the day immediately after a dose.

nixosbestos2• 2 years ago

These are the same effects I got from doing OMAD and going gluten free. If I fuck up and eat processed food, the "food brain" comes back, and I start chasing dopamine like a fiend.

I'm a fan of these tools helping people get this insight, because otherwise people just accept that cloud as their normal.

iLoveOncall• 2 years ago

The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.

If you want to be successful long term in your weight loss, especially after stopping the drug, you should really invest in changing your mindset.

This is a massive positive, not at all a negative.

You got fat because you ate too much. If you don't understand what are normal portions now, you'll go back to your starting weight as soon as the drug isn't having effects anymore.

This is a lifestyle change that you MUST embrace to be successful long term.

setgree2• 2 years ago

There's some evidence that Ozempic improves general impulse control, e.g decreasing alcohol consumption [0], which the article mentions.

Also, as Tyler Cowen writes [1], this is probably going to translate into big improvements for animal welfare:

People lose weight on these drugs because they eat less, and eating less usually means eating less meat. And less meat consumption results in less factory farming. This should count as a major victory for animal welfare advocates, even though it did not come about through their efforts. No one had to be converted to vegetarianism, and since these drugs offer other benefits, this change in the equilibrium is self-sustaining and likely to grow considerably.

So overall, widespread Ozempic adoption seems like progress to me.

[0] https://www.npr.org/sections/health-shots/2023/08/28/1194526...

[1] https://www.bloomberg.com/opinion/articles/2024-07-20/animal...

tredre3• 2 years ago

big improvements for animal welfare

Is it? It might reduce the amount of animals killed, sure, but it won't improve the well-being of the ones that are still raised.

exitb2• 2 years ago

While this entire chain of thought seems a bit far fetched, I think the reasoning here is that if you lower the demand for meat, you don’t have to resort to factory farming.

elif2• 2 years ago

It also reduces the number of animals that suffer if the suffering is more important to your ethics.

eightysixfour5• 2 years ago

This gets into a deep philosophical question people spend too much time arguing about. In short, some would argue suffering is multiplied by the number of sentient beings that experience it, others would argue only the average "amount" of suffering matters. You can end with some absurd paradoxes if you take either to their extremes.

The reality is probably somewhere in the middle.

ben_w6• 2 years ago

Sounds like you're valuing <mean harm per animal> over <integral of harm over all animals>?

I don't get why that would be a better measure?

Tempat• 2 years ago

I suppose thinner people do probably walk their dogs more often…

throwaway888abc• 2 years ago

How long till we become voluntary Voyagers [0] ?

[0] https://www.imdb.com/title/tt9664108/

SV_BubbleTime4• 2 years ago

Yay, more dependence on the people that are causing the problems to begin with!

I swear covid was a personality test. If you came out of the last 4 years and are looking for more dependence on government and pharma… well, the horseshoe is a V I guess.

user395929935• 2 years ago

Naltrexone will do the same thing. For alcohol, opioid, or binge eating control. Improve T3 and helps with blood sugar, and its orally bioavailable.

WhatIsDukkha• 2 years ago

https://en.wikipedia.org/wiki/Naltrexone#Controversies

elif2• 2 years ago

That sounds speculative and would require some deep research to find if it's even happening.

I think it's equally plausible that the US increases food exports rather than lower production. Especially as production is subsidized.

pixl9713• 2 years ago

If this increases food stability around the world, then in general it's a good thing.

This said, obesity is exploding everywhere else in the world too, so it's not just a US problem.

kornork• 2 years ago

I think the assertion that "eating less usually means eating less meat" is probably false (though I couldn't read the article cuz paywall).

The first article talks plenty about why: people are eating less of the the things that are addictive to them, such as alcohol and cookies, which are a major source of calories.

akira25018• 2 years ago

Eating animals and animal welfare are two entirely different things. We could all be vegetarians and still be intentionally or unintentionally intolerably cruel to all other life on this planet.

pfdietz7• 2 years ago

I had a short conversation with an agronomist friend of mine. Crop prices are in the dumps right now, and I was wondering if it's because of these drugs. He said this is being openly discussed.

GeorgeTirebiter2• 2 years ago

What percentage of the population is on GLP-1 drugs right now?

Well "According to KFF polling from May 2024, 6% of all adults report that they currently are taking a GLP-1 drug, and 12% report that they've ever taken a GLP-1 drug".

Is 6% enough to affect crop prices? Presumably some ag economist can weigh in. Note it would only be a reduction per person, not a full 6% reduction in consumption.

nixosbestos2• 2 years ago

This matches experience with dieting and impulse control, without these drugs even. Two days of junk food and the food brain is SCREAMING in my head. So I just don't do it. It's also way more obvious when I mess up, that it makes my body feel bad.

But when I say food brain, it's everything. I want to vape, I want to have more coffee, then more beer, then some cannabis to go to sleep. Wake up and hit the dopamine cycle again. I have to take care of myself and ask "why am I doing this, could I just not, and if so I must not".

kbelder• 2 years ago

There's some evidence that Ozempic improves general impulse control

While remaining on the drug.

I expect your impulse control will be even worse after getting off of it, but I don't have a study to back that up.

amelius2• 2 years ago

There's some evidence that Ozempic improves general impulse control

What if it makes us get a better control over our consumption behavior in general?

Wouldn't some large companies have a problem with that and fight it?

indiebat4• 2 years ago

I don’t want this to come out insensitive or from under the rock, but why is taking a drug a novel & cool idea (all of a sudden/recently) as opposed to good old fashioned working out and not eating more than what you need? okay, this drug is all kinds of great and it’s the next best thing since green grapes, still not eating more and workout is better than taking drugs that effect your brain right? Are doctors required to explain this before prescribing this in US?

apsec1122• 2 years ago

Saying that the cure for obesity is to eat less is like saying that the cure for heroin addiction is to stop using heroin. It's both clearly true, and also useless.

chrismarlow9• 2 years ago

The cure is to teach from an early age about impulse control, moderation, and how to spot signs of addiction in yourself early. This goes for:

Social media

Drugs and alcohol

Food

Or literally any other addiction. I don't think this is a useless thing to discuss.

indiebat4• 2 years ago

Heroin changes brain chemically, it's (more) serious addiction than obesity, again being a little insensitive to obese people, but they're bad in comparison. And there are degrees of truthfulness & wrongness right!

About the point you're making, two generations before you and me, people where fit, more attentive & generally healthy (outside vaccines that prevent diseases now & positive effects due to advancements in medicine), what changed?

Not as platitude, but go from first principles, the choices you make everyday effects your mind (& the time you spend on particular activities), and if they aren't life affirming (for lack of better words), in due time you limit your options (ie less choices from your mind, bad food or less bad food or multiple bad ways to spend your time?), till you proclaim from high top mountains 'oh god, I'm helpless without acceptance from some higher power!'

This isn't to say, I'll be as preachy and asshole(ish) to a friend or someone I care about in similar need, I'll probably say 'seek medical help etc' like you. But thinking things through & arriving at truth is important, don't you think?

This is different to mental strength or controlling yourself etc, it's more about self reflection & freedom through discipline, respecting your life, decisions & thoughts more than your impulsive emotions in an ever distracting world, that kind of thing..

I don't think I'll change your mind or this will come across in good faith, that's okay, I'm in a reflective mood, and it's awfully chilly outside :-)

wiseowise13• 2 years ago

Well, of course if you’ve been jacking heroin for 30 years and all your veins are destroyed beyond repair it’s useless. It’ll take as much, or even more, to return back to normal.

codingdave• 2 years ago

Because not everyone has willpower and discipline. People who do have those strengths often think it is just as simple as saying, "Just take care of yourself", but it is not that easy for many people. High blood sugar also increases cravings, which makes it even harder, bringing on a downward spiral.

This drug can help break out of that spiral and fix the craving/willpower problems.

lurking_swe5• 2 years ago

what you say is mostly true, but I will point out that it does not break any spiral. It’s frequently reported that as soon as you stop taking Ozempic, the weight comes back immediately. so unless one resolves the underlying problem, you will be on this drug for life.

indiebat4• 2 years ago

Break out from the spiral

I see the point in this, but do you think it’s marketed as such and perhaps better question, used for exactly that and not more by vulnerable patients etc? (not well informed about long term side effects, some might even be unknown, if I might add)

I take my vaccines and generally gravitate to sanity over conspiracy stuff (that is to say, If I sound like that, i’m not)

tjader• 2 years ago

I don't think it's just people who have willpower and discipline, it seems to me that for most people it doesn't take as much willpower and discipline to stay at a reasonable weight. These arguments make it sound as if everyone who is at a reasonable weight is there through large amounts of willpower and discipline, but most people I know don't need to exercise X times per week and constantly watch what they eat to keep that weight.

It's much easier when you can trust your body feedback and rely on your regular hunger signals, but for most people who benefit from Ozempic for weight loss if they just trust their bodies they will get fat.

xvedejas• 2 years ago

Most people don't work out enough, or don't eat well enough. If we had some kind of intervention that would easily cause people to work out, we would use that intervention. If we had some kind of intervention that would easily cause people to eat well, we would use that intervention. The reason working out and good diet are good is because of good health outcomes. If we have some kind of intervention that skips straight to the good health outcomes, we would use that intervention. It seems like Ozempic is _that_ intervention, so we will use it. I will likely choose Ozempic for myself once it is available to me.

rootusrootus46• 2 years ago

I want everyone who says this to submit a picture. Just wearing gym shorts, so we can get a good look. I assume nobody making this a moral issue will have so much as love handles. Because if they do, why aren't they working out harder and eating a bit less?

I've met plenty of skinny fat people who think they're healthy.

rootusrootus46• 2 years ago

Man, some folks just don't want to be held to the same standard they want to hold everyone else to. Cowards ;-)

Modified3019• 2 years ago

Telling people they are morally bankrupt sinners (slothful and gluttonous) and heaping guilt and shame on their shoulders has unsurprisingly failed to stop the issue.

Why do you think that telling people to “just stop being fat” will suddenly start working?

cschneid• 2 years ago

In 2021 I lost a good chunk of weight the old fashioned way. From 250ish to 215. I did it with "good old fashioned working out and not eating more". It was a miserable, white-knuckle experience. I was eating healthy food, enough calories (moderate but sane deficit), but the only thing I thought about at all moments was getting to the next meal. What snack is low enough calories to have to make it. It was miserable. As soon as I let up a bit, everything unraveled and I found myself back in the 250s by the start of this year.

Now I'm on Tirzepatide (Zepbound), and I'm back to 235ish, and trending lower. I still work on eating healthy, but now I'm not just HUNGRY at all moments. My life continues, and I only have to make individual healthy choices at meal times, and grocery times, rather than a constant struggle at all waking moments. It's seriously a big difference.

DrillShopper4• 2 years ago

I still work on eating healthy, but now I'm not just HUNGRY at all moments.

I think this is something a lot of people pushing back against the GLP-1 agonists don't realize because they don't experience it: back before I started Mounjaro (another GLP-1 agonist) I was constantly hungry if I hadn't eaten a meal in the last 45 minutes. Absolutely zero hyperbole there - I once went to an all you can eat buffet, ate until I was over full, came home, and within about an hour and a half of that I was snacking on something because I was hungry. Not peckish. Not "feeling like a snack". Hungry to the point where that feeling intruded on my every thought until it was sated.

After starting Mounjaro that's GONE. Gone gone. I now have to set an alarm to remember to eat. It's absolutely phenomenal and likely the reason why I'll live past my forties instead of being stuck in that same cycle and dying of the effects of obesity.

DrillShopper4• 2 years ago

I don't think I've ever seen someone seriously put forth the argument "all you need is Ozempic".

For context: I am an overweight type 2 diabetic. I lost about 70 lbs before my doctor started me on Mounjaro (another GLP-1 agonist). My diet and exercise routine were far from perfect, and it took me about a year to lose that weight. My doctor started me on Mounjaro, both for type 2 diabetes and weight loss. I have lost 20 lbs in about a month on it, which means I will lose three times the weight if that pace keeps up (very unlikely). When my doctor and I discussed starting Mounjaro (which the doctor suggested, not me) he made it very, VERY clear that diet and exercise were important things to work on as the weight came off.

The key there is that the pace of weight loss will not keep up as the body's caloric needs reduce due to that weight loss. So naturally a GLP-1 user will plateau if they do not adjust their diet (and potentially exercise routine, though diet is much more important) as the weight comes off. You know what really makes it easier to have the energy to a healthy meal, to work out, and to take care of yourself? Losing weight! You know what helps form those healthy habits in people who did not form them during childhood? Reduced cravings for calorie dense food! Both of those things are where Ozempic and other GLP-1 drugs shine. It gives the person on them the space to make those changes without cravings, without feeling hungry, and at a faster pace than they could do naturally.

So yes, in the short term, these drugs are a great catalyst for change, but I don't see many medical professionals saying "oh just stick someone on Ozempic for life and that's that!" because for the vast majority of people who would use those drugs for weight loss cannot achieve their goals with just the drug alone.

honkycat2• 2 years ago

Why doesn't everyone play piano? Why isn't every person a super athlete? Why doesn't everyone meditate 40 minutes a day? Why doesn't everyone study super hard in school and become an engineer or doctor or lawyer?

The hard truth: Not everyone is capable of those things. Period.

40% of the US population is considered obese. That is a HUGE number. At a certain point, you can no longer blame individuals. There is something wrong, and we identify it as an environmental problem.

So if we have a drug that will make a huge amount of people healthy, what is the downside? And for the record: Ozempic affects appetite so they eat better, that is part of the drug.

wiseowise13• 2 years ago

Why doesn't everyone play piano? Why isn't every person a super athlete? Why doesn't everyone meditate 40 minutes a day? Why doesn't everyone study super hard in school and become an engineer or doctor or lawyer? The hard truth: Not everyone is capable of those things. Period.

We’re not talking about world class athlete. There a mile difference between world class athletes and not obese.

raincom• 2 years ago

Treat human beings or any organisms as biological machines. Here, many chemicals (hormones, for instance) regulate many processes in such machines. Whatever one has eaten so far, genetic history, environment, etc have changed hormones to a level where the model of dieting and working out doesn't work any longer. So, semaglutide and tirzepatide work on such regulatory hormones (GLP-1, GIP). In other words, what this research tells us that humans are not controlled by their personal will.

vundercind8• 2 years ago

Willpower and discipline don’t seem to be what keeps other countries skinnier than the US (and most of them are also getting fatter…) so I don’t know why we expect that to get the US out of this mess.

Evidence: people from skinnier countries move here and consistently get fatter. It’s a societal/environmental problem, if we’re talking about “what would a policy fix look like?” and not “what can I personally try to do to save myself despite being up against a societal/environmental problem?”

potta_coffee2• 2 years ago

It's just human nature. This is the health equivalent of trying to turn lead into gold. It's my unproven opinion that the negative effects of these treatments are understated and this will be a passing fad.

Eumenes4• 2 years ago

why is taking a drug a novel & cool idea

https://www.glamourmagazine.co.uk/article/post-your-pill-tre...

drug companies have spent millions on destigmatizing pharmaceuticals. its a superpower, apparently. a large swath of this userbase convinced themselves they have adhd and need medication for it. changing tabs on your chrome browser or not being able to do "deep work" = i have an uncurable disease and i require legal meth, for life. you can see how this translates to ozempic.

silicon valley/tech culture has prioritized get rich schemes, cure alls like adhd meds, you don't have to eat just drink soylent for every meal, etc. ozempic falls in line nicely there, and i think among this community and others in this vein, you'll see alot of support for it. its sad, because tech/programmers/IT people use to be very contrarian and open minded. you get in trouble for saying things like "personality responsibility", "discipline', "self-control".

Are doctors required to explain this before prescribing this in US?

doctors famously aren't trained on nutrition or fitness. ironically the prestige is being a specialist, not well rounded. strange.

connicpu4• 2 years ago

Completely missing the point of GLP-1 agonists. The point is that it breaks the cycle by giving you the willpower to eat less. It doesn't magically make the calories you eat not contribute to your weight, it just makes it easier to eat less and still feel full. It also counteracts insulin resistance, which is another problem inherent to obesity.

orangecat• 2 years ago

Why are we bothering with contraception and STD vaccines when people should just not have sex unless they're trying to get pregnant?

wiseowise13• 2 years ago

I’m sure you’ll find a lot of people in certain circle who’ll share the same view.

amatecha7• 2 years ago

This article seems to frame things in such a strange way. Maybe instead of trying to get everyone obesity medication, we can instead educate society so we all understand nutrition and diet and can combat the ever-persistent forces of corporations pushing unhealthy food on us?

gedy2• 2 years ago

Look we've been educating people about this for the past 50 years at least - education doesn't work with base impulses.

cbsmith4• 2 years ago

Yes, because what obese people lack is education.

amatecha7• 2 years ago

From my subjective experience in life, what they very often lacked was parents who set the right examples around food. I know that doesn't apply to everyone of course, but I've witnessed it time and time again - an upbringing with deeply disordered routines/practices around food. It's universal among obese people in my life. I speculate that better awareness of diet/nutrition might help to prevent passing on such behaviours, like not feeding the family exclusively a bucket of KFC or McDonalds, or using food as a reward, etc. etc.. I mean, medication won't actually solve what is caused by behaviour, right? Maybe the behaviour can be reduced on a broader scale, over time, via people making better-informed decisions? If parents know their habits around food are basically ensuring their kids will struggle with obesity, maybe they'll make the effort to do something different? Dunno, it seems like a reasonable consideration.

lostmsu2• 2 years ago

Educating people will hardly work. Bans on junk foods at government level might.

eniwnenahg• 2 years ago

In EU they banned the sale of oral tobacco (snus), which is safer than smoking tobacco. Snus once had cancer labeling but that was generally considered not-very-true and labeling was removed. Tobacco smoke causes cancer. Drug bans also built many overfilled prisons and likely contributed to the invention and spread of harmful drugs such as crystal meth and fentanyl. This is a one sided view of course. I like William Blakes work, "Auguries of Innocence".

amatecha7• 2 years ago

If educating people didn't work, we'd all be drinking cocaine soda and burning leaded fuel. I mean, there's a reason things have generally greatly improved over time for most of humanity. We know more things and act upon that knowledge. This applies to basically every single thing humans do. Maybe one day we won't be drinking sugar water and adulterating ~every piece of food on the shelf with high-fructose corn syrup?

ndsipa_pomu• 2 years ago

Unfortunately companies make more profit by pushing unhealthy food onto consumers which can be evidenced by the money they spend advertising it. They're exploiting our instincts to seek out high calorie foods which was an advantage when humans didn't have a ready supply of food available at all times, but nowadays leads to a whole host of illnesses.

filoleg2• 2 years ago

Why either/or?

Maybe we should try educate society on dangers of using heroin. I agree that it is a good thing, and we should continue educating people about its dangers. But clearly that alone didn’t solve the problem, and I think it would be a good idea to utilize alternative options as well (in addition to continuing the education of society on its dangers).

dghlsakjg3• 2 years ago

Do you think overweight people don't know why they're overweight?

There are plenty of obese people that understand nutrition just fine, there are obese people who understand it well enough to have lost significant weight and gained it all back.

Clearly there is something else going on that we haven't grasped yet.

amatecha7• 2 years ago

Education may involve "finding a strategy that works for you". There are so, so many different ways to combat disordered eating. These are learnable things. My thought around "better education" is that the cycle of disordered eating can be stopped at some point before parents pass it on to their kids, at least (as I just posted in adjacent comment https://news.ycombinator.com/item?id=41811916 ). I absolutely recognize how insanely difficult it is to come back from disordered eating and stay at a lower weight after finally reaching it.

Though, now that you ask, I do think that many people don't actually know why they are overweight. They say it's because "McDonald's is cheaper than buying good food", not realizing the McDonalds won't satiate them and they will eat/spend more because their body is starved for proper nutrition. Watch the series "Supersize vs. Superskinny" and observe how nearly every participant is utterly clueless as to the underlying causes of their challenges on either size of the disordered-eating scale.

2snakes• 2 years ago

Psychology of hunger behaviors.

slothtrop6• 2 years ago

Understanding nutrition, and eating habits in practice, are two very different things.

Regaining weight is the primary issue really. Most people are capable of losing weight, but gain it back, and it gets harder going forward. Metabolic adaptation is better understood now and among the factors (.e.g increasing caloric intake too quickly after weight loss), but falling into old habits that are culturally ubiquitous is a glaring part of the problem.

Former drug addicts are told now to sever contact with peers who partook in those indulgences as they're likely to pull them back in. With food, it can be more than a minor subculture. There are regions of the US that have much higher obesity rates than others. Not having family members and a romantic partner on board can be difficult.

triceratops3• 2 years ago

If we could do that through education, then we'd have made it illegal for corporations to push unhealthy food.

winterrx• 2 years ago

David Friedberg recently did an All-In Interview with the CEO of Eli Lilly. Interesting conversation over there that also talked about some key points of the article.

https://www.youtube.com/watch?v=023exhA9irY

tonymet3• 2 years ago

Yet another drug that patches up symptoms without addressing the root cause. People will be dependent on the drug for life. And we still don't know what the adverse effects are.

cubefox8• 2 years ago

We don't know the root cause yet and therefore can't treat it, so the drug is great for what it is.

tonymet3• 2 years ago

The root cause is depravity

jaco6• 2 years ago

I’m just as curious as to why some people are so willing to take numerous medications, while others go to any lengths to avoid them. Some people are happy to be on an SSRI, sleeping pill, statin, low dose aspirin, and a few others, and aren’t bothered by this. Other people seem instinctively revolted by prescription drugs, seeing toxins pushed by evil corporations. Is it a trust issue?

I personally detest and avoid all medicines other than antibiotics and vaccines. Pharmaceuticals have a long track record of harboring “side effects” that only become apparent years later.

In general, why are we surprised that the chronic use of any substance has negative effects? Humans evolved for thousands of years eating food and drinking water. Regularly consuming anything else is an abberration and self-experiment.

lurking_swe5• 2 years ago

I think the answer to your question is that people who avoid drugs understand that drugs do not fix anything permanently, in 99% of cases. They only treat symptoms. The people who avoid drugs attempt to treat the underlying problems.

of course it’s not always practical. For example, some skinny people are simply genetically predisposed to high blood pressure, even if they work out and eat pretty healthy. It’s rare, but these things happen.

jackcosgrove• 2 years ago

To address the question in your first paragraph, I think it's due to whether you think your locus of control is internal or external.

poorinterview4• 2 years ago

You can have an internal locus of control and still believe the benefits of taking something like an SSRI far outweigh the costs of attempting to address depression/anxiety more "naturally." I'd rather take an SSRI if it means more motivation to live healthily, positively, productively for myself and family. If anything, the drug could very well help someone discover their sense of agency.

Blackthorn4• 2 years ago

Nobody ever gets sus about needing to take heart medication every day to stay alive but the moment it becomes about how I take Lexapro every day they get real preachy.

poorinterview4• 2 years ago

Which is sorta funny because some antihypertensives are known to decrease anxiety.

rootusrootus46• 2 years ago

Maybe we can find a medication people will take that solves the preachy problem instead. That might achieve significant population-wide improvements.

akira25018• 2 years ago

Other people seem instinctively revolted by prescription drugs, seeing toxins pushed by evil corporations.

You can advertise drugs on TV in the USA. This certainly opens the door for bad drugs to get pushed out and marketed to people who don't have the technical skills to examine the claims and the risks of side effects objectively.

avoid all medicines other than antibiotics and vaccines

Just because it's been such a hobby horse lately I would have to add pain killers. There is absolutely a large potential for abuse but they also serve an incredible utility to modern medical care.

Regularly consuming anything else is an abberration and self-experiment.

Ozempic should be for people who are obese and have thoroughly demonstrated that they are not physically capable of exercising themselves enough to lose weight naturally.

Otherwise, this drug gets marketed as an obesity cure, but it's mostly dispensed for cosmetic purposes. If there are any side-effects, it will be a double tragedy for these people.

I'm with you, it's a little revolting, this specific drug.

poorinterview4• 2 years ago

Ozempic and similar drugs are being used by many to get rid of the food noise and insatiable hunger that have stood in the way of sustainable progress. These drugs are being used as catalysts for healthy living. The fact that they seem to work thus far is evidence that obesity is on some level driven by powerful hormonal forces that influence impulse control and willpower, which addressed, can give people the freedom to make better decisions and effectively pursue a lifestyle they've struggled to maintain.

The cosmetic narrative you're pushing is actually quite disgusting.

dopylitty• 2 years ago

I'm curious why you include antibiotics in your trusted medications list.

Over the past several years we've found that antibiotics have a huge impact on beneficial microbes in your body which then has downstream impacts on your health [0]. Oddly enough for the topic in this article exposure to antibiotics as a child may be linked to obesity[1]. They are also extremely over prescribed for things like viral illnesses [2].

I personally wouldn't take an antibiotic unless whatever malady I was suffering from was proven to not only be bacterial in origin but likely to progress without treatment.

Regarding your larger point some of the distrust of medications can be related to the fact that people know that medication producers' goal is to be profit for the most part.

Because they are for-profit the medicine producers can't be trusted to produce quality products or to produce products which resolve a problem rather than just reducing symptoms as long as the patient continues to pay for the medicine.

As with other problems we have a low trust society because it's a society built on for-profit enterprises rather than enterprises focused on doing the best thing for society.

0: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756738/ 1: https://www.nature.com/articles/ijo2014180 2: https://pubmed.ncbi.nlm.nih.gov/37876436/

pfdietz7• 2 years ago

I'm curious why you include antibiotics in your trusted medications list.

Because bacterial infections can be horribly lethal?

rootusrootus46• 2 years ago

seeing toxins pushed by evil corporations. Is it a trust issue?

That sounds a lot like the divide between people who see conspiracies everywhere and those who do not. In that case I would suggest it is just personality, not logical and not solved by improving trust.

jijji• 2 years ago

you can buy tirzepatide / semaglutide all day long from labs in china for between $4 per injection all the way down to $0.50 per injection depending on quantity and type (prepackaged in vial vs raw powder)

rootusrootus46• 2 years ago

After tirzepatide was taken off the shortage list last week, I notice that there are suddenly a lot more people talking about this route. It will be interesting to see how it plays out.

Probably exceeds my comfort level, and I'm lucky enough that I can pay the $550/month for name brand if necessary. A lot of people will just have to stop, though, and deal with the consequences.

optimalsolver2• 2 years ago

What happened to self-control?

crooked-v15• 2 years ago

The same thing that always happened to it: for a lot of people it just doesn't work.

DCH3416• 2 years ago

Screw that

moogly• 2 years ago

Turns out "just stop being fat lol" isn't very effectual advice.

pfdietz7• 2 years ago

It's the "git gud" of diet advice!

I wonder if GLP-1 agonists are going to break gaming addiction too.

triceratops3• 2 years ago

If you got it, use it. If you don't got it, there's a little help now.

avelis3• 2 years ago

That's not a thing when considering how UPF creates addiction to food in the brain. Big Food knows this.

hipadev23• 2 years ago

Who has time to eat? Founder mode all day every day.

cubefox8• 2 years ago

Now that's the spirit!

grecy15• 2 years ago

My god no.

I'm 42 and I've never taken more than the odd painkiller or antibiotic here or there - less than a pill a year on average I'm sure.

The last thing in the world I want is to be permanently on some drug that alters how my body works. I hike, snowboard, go to the gym and eat sensibly. That's all the "weight control" I need.

honkycat2• 2 years ago

Good for you man. 40% of the US is obese, we need a solution for better health outcomes.

ocular-rockular• 2 years ago

So drugs?

I think it's a lot simpler than that. US has an abusive relationship with junk/processed food. It's so deeply ingrained due to profit margins, wealth inequities, nonsensical subsidies, etc. that the only feasible solution is to introduce a drug that continues to allow that relationship to continue.

It's a lot easier of a solution than it is to tell companies to stop making garbage or saturating everything with sugar and HFCS. "Easier to see end of the world than end to capitalism" -- its the same shit packaged in a different story... Easier to introduce a drug to treat the symptoms than to solve the actual problem.

Mind you, I'm not implying that it is easy. We have collectively accepted this which makes change difficult if not impossible.

grecy15• 2 years ago

You make it sound like it’s out of your control.

The solution is already there. It’s free. It works for everyone, and even 60% of people in the US are doing it!

The right answer to being healthy is not more drugs.

crooked-v15• 2 years ago

Do you drink coffee or tea?

grecy15• 2 years ago

Coffee really affects me, so I gave it up. I drink decaf tea these days.

Why do you ask?

ironman14785• 2 years ago

` I hike, snowboard, go to the gym and eat sensibly. That's all the "weight control" I need.`

So you are likely in an income bracket that enables you to have an active lifestyle outside of work and take the time outside of work to cook, in addition to probably other hobbies. this is not a criticism of you, but if I had to guess, you simply have a life that many other's do not. I work out and take care of myself because I make $300k+, have less worries and responsibilities, and I actually have an easier job than when I was making less.

A lot of people don't have money or don't have the time for working out and making the correct meal choices. Yes, there are people who have money and time and are still overweight, however that is not the norm as you go up the income brackets. Many poorer people have long work days, with an additional long commute, and are more likely to have kids, meaning they have no time for themselves. They're not gonna go to the gym if they already have a long day and they probably aren't going to make healthy food choices when they're already beat up and have not a lot of time for themselves.

grecy15• 2 years ago

And you think the solution is a prescription drug?

tintedfireglass• 2 years ago

That's so dystopian. So you are just saying that society doesn't have time to take care of themselves, so we need some drugs to fix our collective horrid lifestyles? It's an easy temporary fix but what cascading effects might that cause on the future? Who knows?

pyrophane• 2 years ago

One thing that it seems we are just starting to talk about with these drugs is the associated muscle and bone density loss. I'm concerned that this generation of GLP-1 early adopters will wind up more frail and suffer a lower quality of life in old age as a result.

petesergeant5• 2 years ago

I've seen zero evidence that muscle loss from GLP-1-assisted weight-loss is any different to the muscle loss from simply eating less. Do you have a link to a study I've missed?

cyberax11• 2 years ago

One thing that it seems we are just starting to talk about with these drugs is the associated muscle and bone density loss.

Muscle loss is associated with _any_ kind of weight loss.

And GLP-1 drugs _improve_ the bone density: https://academic.oup.com/jcem/article/100/8/2909/2836097 It's likely simply because thinner people naturally move more.

ploppyploppy• 2 years ago

Can these negative effects be countered/offset by continuing weight training? I lift 2-4 days a week.

r00fus4• 2 years ago

My program strongly recommends some form of muscle training (pushups/weights/etc) as they see improvements from muscle development for weight loss and to counteract the muscle loss from losing weight.

The fact remains that having to carry around 50+ extra pounds of fat requires more muscle. When that requirement goes away so does your need for that musculature.

k__• 2 years ago

How are the side effects?

I read plastic surgeons said it was bad for your skin and people would look much older when they take it for a few months.

Yet, I also read it was generally good for your health, not just in terms of weight loss.

logicchains5• 2 years ago

I'm not a fan of the drug but that aging could just be due to the weight loss: skin generally looks more wrinkly (older) after losing weight.

jart5• 2 years ago

It depends how old you are. Skin loses its elasticity after a certain age. So weight is a problem you should spare no expense fixing sooner rather than later. Even if you do something about your weight at a later age, the health benefits for your heart for example will greatly outweigh the loose skin.

cyberax11• 2 years ago

One other note: the current peptide-based GLP-1 drugs are not likely to be the permanent solution. Injectables are just too problematic for that.

Several companies are now working on more classic small-molecule drugs targeting the same receptors. So it's likely that in several years we'll get a pill with the same effects.

Yes, there's technically a pill version of Ozempic already (Rybelsus), but it works by making the stomach wall to be slightly permeable to peptides. You can guess that it has pretty unpleasant side effects, and an awesome bioavailability of 0.7%

connicpu4• 2 years ago

I'm curious what about injectables makes them specifically problematic for long term use? Diabetics already have to inject insulin for the rest of their lives, and an injectable version of the same drug usually has fewer side effects since it doesn't have to pass through your gut metabolism. I may be biased, I have no fear of needles and have injected myself with sex hormones every week for nearly 7 years, so adding an autoinjector doesn't seem like that big a deal to me.

cyberax11• 2 years ago

They are more expensive. Autoinjectors are way more complicated than a pill bottle. You also can't freeze them, but they should be kept in a fridge.

Manufacturing standards also have to be way higher. I have no problem trusting Novo Nordisk to manufacture injectors safely, but I won't trust a random manufacturer from India or China.

The risk of accidental infection from injection also is not neglibible.

djsavvy• 2 years ago

My pet crackpot theory is that within the next 100 years semaglutide is going to be in the drinking water (much like fluoride) because the benefit to society is going to be too hard to pass up on. However, it seems that it's delivered via injection so maybe putting it in the water supply wouldn't even be effective.

cooljacob204• 2 years ago

I don't think anything that can influence our choices would ever get enough public approval for that.

logicchains5• 2 years ago

It's funny you say that because just now the US is starting to re-consider water fluoridation: https://www.theguardian.com/us-news/2024/oct/04/fluoridation... .

It's also relative uncommon in other developed countries; according to Wikipedia, "Out of a population of about three-quarters of a billion, under 14 million people (approximately 2%) in Europe receive artificially-fluoridated water. Those people are in the UK (5,797,000), Republic of Ireland (4,780,000), Spain (4,250,000), and Serbia (300,000)."

supportengineer4• 2 years ago

The benefits of fluoridation were amazing. I didn't have a single cavity until I was 25 and had moved away from that area to a non-fluoridated area.

rootusrootus46• 2 years ago

The funny thing is that if you live in Portland, famously one of the few large cities without fluoride in the water, the dentist can immediately tell if you grew up here.

I would guess that in today's world a lot of people get enough fluoride through processed foods being made in places that have fluoridated water.

Eumenes4• 2 years ago

The day Ozempic/similar drugs become approved for weight loss under ACA/Medicare is the day I stop paying taxes.

pfdietz7• 2 years ago

Good news! You'll probably be able to get GLP-1 agonists in prison.

snvzz4• 2 years ago

There are legal ways to stop paying taxes in a country, such as moving elsewhere.

It is a much safer assumption to make than tax evasion.

ogogmad• 2 years ago

I'll bite: Why?

rangestransform• 2 years ago

It’ll cost less than the effects of obesity

Moral hazard has never been a good reason for any sort of regulation, the same principle can be used to justify not covering motorcycle riders, people who trad climb, people who do snow sports, people who jaywalk, people who work at a desk and drive everywhere, etc etc etc

Eumenes4• 2 years ago

Thats like your opinion man. I personally don't want to pay for gluttony via my tax dollars. I don't care about smokers, junkies, or gambling addicts. If people want to donate to some ozempic fund, by all means.

And, motorcycles require special insurance, as does high-risk recreational sports like climbing. If you drive/commute to work, thats factored into your premiums. If you get hit by a car jaywalking, that is usually on you. Those examples have nothing to do with the prospect of tax-funded anti-fat pills.

valunord• 2 years ago

Fuck that. Just have some willpower! Some of us have been doing OMAD without assistance, just grunting through the stress and pain for years. It's much healthier than drugging up.

snvzz4• 2 years ago

After one year of OMAD and 15kg less, I am now at about ideal weight by BMI (22).

I didn't even need much if any willpower past the first couple days.

This push for Ozempic is utter madness.

steveBK1233• 2 years ago

One lurking concern I've had around this space is that junk food makers simply find a way to make their food even more addicting.

Arguably though, ozempic'd customers and shrinkflation'd products would be a recipe for amazing margin improvement. And they can dress it up as doing good because its better for people, (like the 100 calorie snack packaging).

sph5• 2 years ago

You can see that in the lab-grown burger space already: it is a massive opportunity for companies to create an ultra-processed version of meat, and label it as healthy as the public opinion has gone blindly against meat and on the vegan bandwagon. They'll claim it's more eco-friendly, they can sell it 5x the price of beef and rake billions.

rootusrootus46• 2 years ago

public opinion has gone blindly against meat

Only if you spend too much time online. In the grocery store, I don't see any indication that meat substitutes are gaining traction. If anything, popularity seems to be ebbing. The people choosing fake beef for their burgers are a tiny minority.

dfxm123• 2 years ago

Instead of a system that makes these drug available for purchase, I'd rather live in a system that promotes healthy food and active behavior. Unfortunately, I have to drive everywhere, work too many hours to have free time for recreation and have no idea which government subsidy is going to help big ag likely at the expense of my health.

All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.

from-nibly• 2 years ago

You don't have to worry about which government subsidy is going to help big ag at the expense of your health. It's all of them.

paulcole5• 2 years ago

This is like saying, "All things being equal, I'd prefer Santa Claus bring presents on Christmas Eve than have to go shopping for my kids."

It's like well duh of course you'd prefer the impossibly unrealistic miracle.

wizzwizz43• 2 years ago

Other countries do it. https://en.wikipedia.org/wiki/Change4Life

SapporoChris• 2 years ago

Of course it is impossible to live a healthy lifestyle and have healthy weight, if you ignore the 3/5ths of Americans that are not obese and the 7/8th of the global population.

llamaimperative36• 2 years ago

Impossibly unrealistic to change zoning to disincentivize car-dependent urban design?

Impossibly unrealistic to get rid of enormous sugar production subsidies that make it insanely cheap?

Impossibly unrealistic to simply tax added sugar?

TeeMassive6• 2 years ago

I'm glad for RFK Jr. for this reason.

Nobody talked about this in the mainstream conversations in the past.

labster• 2 years ago

People and officials have been talking about healthy eating for generations. Hard to get more mainstream than every doctor talking about diet and exercise.

llamaimperative36• 2 years ago

If you like RFK Jr "for this reason," you oughta looove Michelle Obama!

https://letsmove.obamawhitehouse.archives.gov/

Out from underneath the rock, people have been talking about this nonstop for decades.

gcr7• 2 years ago

If you have an open mind, I'd like to assign you some homework if you like. Take a look around r/zepbound and count the following:

1. Posts from folks who diet+exercise, or who have tried diet/exercise and nothing's worked so they then turned to Zepbound ("excited to hit the gym," "my diet is finally starting to work with Zepbound" and similar)

2. Posts from folks who haven't tried diet/exercise and turned to Zepbound first. (e.g. "I'm excited to eat dessert and laze around on my couch all day!" or "Zep is so much easier than before, no more keto for me" and similar)

Which group do you think would have more posts?

Selection bias probably prevents us from being able to count "Zepbound didn't work for me, but diet and exercise did" posts, which is why i suggest this.

Here's my hypothesis: I think self-control is generally uncorrelated to losing weight. Perhaps it's necessary to have self-control to lose weight "the simple way," but certainly not sufficient. I know lots of friends who've struggled and found it's not so simple.

llamaimperative36• 2 years ago

GP isn't talking about self-control, they're talking about the fact we've created a system that requires obscene amounts of self-control if you wish to maintain physical health.

People in the 50s weren't slimmer because they had ironclad determination to stay such.

dfxm123• 2 years ago

I'm not sure how this applies to my comment. I'm not saying anything about self control. I'm not against individuals taking GLP-1s. But, if we're at a point where we're all on drugs to treat lifestyle diseases, we should at least recognize that these lifestyles are largely chosen for us, and we should consider that doing something about that will reap us the benefits we're after.

acabal• 2 years ago

The more important point the comment you're replying to makes is not "what if people could diet and exercise" - i.e. accept the modern American lifestyle as given, plus force yourself to go to the gym and eat chicken and broccoli - but rather that the modern American lifestyle in fundamentally structured to lead to people being overweight.

Instead of being forced to drive everywhere for the most basic possible human needs - like getting groceries, going to the doctor, or dropping kids off at school - as is the case in 90% of America - what if you could walk to those places instead? You would get exercise as part of your every day life, with no extra effort!

What if instead of corn syrup being so heavily subsidized, we could use more filling sweeteners in a lower amount instead? What if people lived closer to agriculture, instead of in faraway suburban tract housing only accessible by car, so they had easier access to fresh meat and vegetables, instead of ultraprocessed package food?

These dreams are not "diet and exercise", they are a fundamental reshaping of American lifestyle that would directly lead to weight loss. We know this, because America used to look like this before, say, 1940. In old photos you see people in huge crowds in streets as they walked to their everyday errands, and menus and recipes of the era are mostly minimally processed food that is mostly local. Americans of the past were not overweight, because the way society arranged its physical existence didn't permit it!

eastbound• 2 years ago

I’m not obese, just before (1m75 / 82kg) but I have found self control impossible, except when I do intense sports (like musculation 3-6 times a week). Then only, and this is the magic part, I not only eat less, but also enjoy being more brave, with cold showers, being hungry, going to bed early and other efforts in life.

Spooky23• 2 years ago

The people in #1 won’t express it that way.

I was that guy. For a variety of reasons that aren’t relevant i developed insulin resistance over a relatively short time that made it increasingly difficult to lose weight. I’m in my mid 40s, which also makes it difficult.

I got on one of the GLP drugs 18 months ago. I am down 80 pounds, and am running 20 miles a week. I’ll be doing a half marathon in March. Ive dropped the dose twice and still going strong.

Taking the pill made exercise possible. Online everyone likes to apply a moral hazard thing to every discussion. GLP medication twiddled my dopamine system and allowed me to achieve my goals. Period. If you think that makes me weak, I cannot think of anything that I care less about.

huijzer• 2 years ago

I think self-control is generally uncorrelated to losing weight

Choosing to eat fewer processed foods is very effective but does not require that much self-control since appetite will fall automatically.

SirMaster2• 2 years ago

But don't you think that it's better to make the changes to prevent obesity rather than focus so much on a cure for after?

I don't have a problem with a cure only if it doesn't reduce the focus and effort on prevention.

There has to be a reason why so many more people are obese today than decades ago. I refuse to believe we can't find out why and make changes to reverse it.

But if it's so easy to cure, will enough people care about figuring out how to prevent it?

amelius2• 2 years ago

Not saying you're wrong but maybe group 2 is too lazy to open their browser and post their experience?

Wytwwww4• 2 years ago

Perhaps it's necessary to have self-control to lose weight it's not so simple.

Presumably people who have good self control and are not prone to developing addictions (due genetic or various semi-immutable cause) do not become obese in the first place. It might be fairly easy easy for them to lose weight they just don't need.

Aeglaecia• 2 years ago

counter hypothesis - the amount of self control exhibited by an average human is insufficient to self regulate when placed into a hyper enriched environment , for example the capitalistic profferings of junk food tv porn etc , we did not evolve around these hyper stimulatory activities, how on earth are we meant to adapt to them? drugs are not an answer, they are another bandaid making someone else money and allowing the underlying wounds to fester, the solution is education and awareness of this fucked up situation

bravetraveler2• 2 years ago

My hypothesis: this is more cultural than people want to admit. Try to skip out on too many engagements, sorry, meals and see how many connections you still have.

paulmist• 2 years ago

What is a realistic path to this? Being from Europe I visited US last year and was horrified at the quality of your food. You see a lot of documentaries/youtube videos/etc... discussing the problem, but how do you even go about this?

supportengineer4• 2 years ago

There's plenty of high quality food, you just have to know where to look. For example, come to the Bay Area and check out Whole Foods and any number of high-end restaurants.

diggan• 2 years ago

but how do you even go about this?

Maybe I'm too European to understand why not, but seems to me that regulations around food and what companies are allowed to put into it is really helpful in avoiding companies from just stuffing whatever down people's throat.

klaussilveira• 2 years ago

The US is a huge country (9,833,520 square kilometers!), so I find it curious that such generalization can be made about the food available here, or even the eating habits of 334,914,895 humans. I could say that I visited Amsterdam 2 years ago and I was shocked with the quality of the food.

But I would never do that, since I mostly ate at the Red Light District, and I couldn't possibly generalize the country eating habits with stores in a major tourist area.

gcr7• 2 years ago

We have good food, but you won't find it on "The Easy Path."

The Easy Path is that gentle encouragement to hit up Chipotle for lunch, because it's "right there."

The Easy Path says dinner's hard and you've had a long day, so get something simple, like take-out or microwave.

The Easy Path is entropy. The Easy Path is self-care over struggle. The Easy Path is simple carbs shown on prominent display in store shelves. The Easy Path is advertising.

Hitting the gym isn't on The Easy Path, but forgetting to cancel your gym membership is.

These days, big food companies love "The Easy Path" because it's so easy to commoditize, it's the "Path that Americans are Expected to Take." For financial stewards, being on The Easy Path turns lack of willpower into your ally.

On the other hand, getting good food in the US requires passing the marshmallow test: you have to meal prep, or you have to shop around the sides, or you have to get something on the salad menu. You have to say no to advertising. You have to expend willpower, the most limited of resources to the average American. You have to Go Hungry or Suffer, or have An Upset Stomach. You frequently have to spend more money or time.

Semaglutides are not currently on The Easy Path. Maybe they will be someday. I personally doubt that, because putting GLP-1 on The Easy Path would require big food companies to rethink their entire portfolio.

But you're not wrong in that they could be Easy Path-ajdacent. The dialectic would shift: food companies would shift around to be Organic and Nutritious and Less Calories and find other ways to stay on The Easy Path. Sugar and fat's addictiveness is highly Easy Path-enabling, and that's a pretty big vacuum to fill.

ActorNightly• 2 years ago

The first thing that would help is actually having a realistic discourse about food, and not the idiotic - "You shouldn't be eating processed food, its not good for you".

Like most of the food that we eat is not really that bad. Its not optimal for sure, especially for sedentary lifestyles, but a lot of the health problems are not directly tied into the actual food, rather the over-consumption of it, and passing down of bad genetics (for example, children of obese people are more likely to be obese).

European obesity tripled in the last 40 years as well, despite higher quality of food.

rootusrootus46• 2 years ago

Being from Europe

Why is the quality of food in Europe so much worse than southeast Asia?

Because you guys are way, way, way fatter than e.g. the Japanese.

Back on topic -- we have excellent food in the US, but regulations allow for highly processed crap to be sold too. Pretty sure most of the crappy processed foods are easily available in Europe, too.

vundercind8• 2 years ago

It’s been studied pretty well. Possible effective solutions to the US obesity epidemic are pretty much limited to:

1) Radically alter aspects of food culture, work culture, social policy, and business regulation.

2) Magic pill (/injection)

There appears to be no imminent progress on the many parts of #1 that need serious work, so if we want a big turn-around in the next half-century, #2 has suddenly and surprisingly become a real possibility.

jodrellblank10• 2 years ago

From the article "Estimates suggest GLP-1s can reduce body weight by at least 15% when taken regularly". That's a 5'10" man starting at 250lbs (obese, BMI > 35) and finishing at 220lbs (obese, BMI >30).

Or a 5'10" man starting at 220lbs (obese) and finishing at 187lbs (overweight, BMI > 26).

It ain't nothing, but that's not a magic pill which will fix the obesity epidemic. And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food.

NotPractical• 2 years ago

But is it time to give up just because there hasn't been much progress yet? It seems now that we have #2 there's little incentive for #1, whereas there was plenty incentive for #1 before even if little action.

sumtechguy• 2 years ago

I know someone who has lost about 60lbs. The reaction of most people is 'what pill did you take'. They find out it is basically no sugar and limited amounts of food with some mild exercise. Pretty much every one of them is 'thats hard' and do not do it. And frankly it is hard. Like 95% of a grocery store has way to much of what you need for your daily intake in some form or another. It is that 5% you have to dig thru the whole mountain of crap to find. Then once you find it hope like hell the manufacture does not stop selling it. Or enjoy making everything from scratch (even that is a pain).

I would not jump on that current pill yet. Wait and see. There are probably serious side effects that we mere plebes do not get to find out about yet (that is for 20 years from now). Like what is the side effects when you stop taking it? What if your dose is too high/low? What is the long term usage like for other parts of the body?

CM30• 2 years ago

Sounds similar to most major world/cultural issues today. You can make the exact same argument about climate change for example.

But at the same time, part of me wants to ask... why is this a problem? Why shouldn't we just use science and technology to fix human problems and remove any unfortunate consequences from society?

What's wrong with a world where anyone can eat as much of anything as they want, do no exercise at all, ignore their dental health and smoke like a chimney, yet still have perfect health without any downsides?

Objectively, it would be a better society, with everyone materially better off and a system that doesn't need anywhere near as many resources to care of its citizens.

Why would it matter what route is chosen here?

rootusrootus46• 2 years ago

Possible effective solutions to the US obesity epidemic

Just wanted to mention that this is not a US problem, and framing it as such won't help find solutions. Even in southeast Asia the rates over obesity are steadily increasing. Europe is already much fatter than southeast Asia. This is a worldwide phenomenon.

mmsc3• 2 years ago

When the majority of the population is so far gone from being in a healthy weight, promoting healthy food for the masses is not going to help that majority. Yes, walkable cities and so on would be great, and promotion of healthy food and habits is great (remember Michelle Obama asking "why are you people so fat wtf?") for future generations, but Ozempic et al. provides a solution where otherwise, a lot of people are simply "lost".

chairmansteve3• 2 years ago

The government isn't going to help you.

This evening, go for a one minute walk.

Tomorrow evening do the same.

Next evening do the same.

Repeat.

The journey of a thousand miles begins with the first step.

knowitnone2• 2 years ago

one minute? I'm sure that's not going help anyone to walk for one minute. 30 minutes at a minimum. 60 is good, 120 is great!

whatshisface2• 2 years ago

You would have to walk for several hours each day to balance out the overeating that's apparently due to GLP-1.

throwaway019254• 2 years ago

To paraphrase: Instead of relying on medication that helps with issues caused by our society, let's completely change the society so it's no longer the issue?

That's very idealistic, in my opinion.

itronitron• 2 years ago

It would be interesting to run an experiment where everyone in first world countries was able to (and had to) walk to the grocery store to buy their groceries. It seems like that would promote useful exercise while self regulating consumption.

knowitnone2• 2 years ago

I walk to the grocery store all the time. This was part of my weight loss strategy and I chose to walk to a farther grocery store. And yes, I did attain my weight loss goals.

fasteddie31003• 2 years ago

The two are not mutually exclusive.

ajkjk• 2 years ago

As compelling as the theory that "unhealthy behavior" is root cause of the obesity epidemics, at this point it seems to me that the weight of evidence suggests an actual physical disruption. It's not supposed to be _this hard_ for (some) people to maintain their weight; something is actually not working right.

https://slatestarcodex.com/2017/04/25/book-review-the-hungry... might be interesting in the same direction.

pkulak2• 2 years ago

I run three miles a day, never drive anywhere (bike or bus), eat reasonably healthy, and I'm still 20 pounds overweight. And what really scares me is that running is the only exercise I enjoy and if my weight fluctuates up just 5 pounds or so, I start getting hip/knee/foot etc pain. If I gain 10 pounds through some lapse in morality, I won't be able to run anymore and I'm cooked. If that happens, I'm banging down my doctor's door for a pill.

intothemild2• 2 years ago

So I'm a distance runner, who is on these drugs.. and yeah, It sucks, I LOVE running.. but running heavy SUCKS. Most people run to lose weight, I lose weight to run.

artursapek4• 2 years ago

It's probably seed oils tbqh

zahlman8• 2 years ago

I run three miles a day

Which will burn somewhere on the order of 400 excess calories - about as much as a typical North American muffin (or two of the big cookies from Subway). But worse, your body was probably going to use most of those calories on something else (fidgeting, running a higher body temperature, other immune responses including inflammation) anyway, assuming that you haven't been gaining weight with your current habits. Exercise is healthy and reduces stress, but it just isn't effective for weight control. Humans are animals, and animals have on the order of a billion years of homeostasis technology behind them.

eat reasonably healthy

Hardly anyone has any accurate picture of how much they consume, as measured in calories, except for those with actual explicit experience of measuring and accounting it.

If a pill happens to end up helping you eat an amount that lets you maintain a healthy weight, I'm all for that. But it's important to have your mental model properly calibrated.

dmead• 2 years ago

You'd prefer that. Great. Meanwhile we live in this reality.

hiAndrewQuinn2• 2 years ago

But you already live in a system that promotes that, quite heavily. Healthy food and active behavior make you more physically attractive, which is in turn linked to better life outcomes along almost every metric you can care to think of.

There is, in fact, already an enormous, fully endogenous incentive to do those things. The fact many people are not keeping in shape (myself included) suggests the allure of food really is just that appealing.

biztos• 2 years ago

I’m a standard-issue stress eater. I also like to work out.

When I’m really feeling the stress, even though I will tell myself at that time to just hang on and hit the gym later, the food is that much more of an instant fix that it wins out more often than not.

I’m sure that’s not just the actual food itself, but also the easy availability of it, and probably subliminal cultural factors such as advertising. But partly, yeah, it’s that my ancestors evolved to love eating when they had food, and their gift to me is that same desire in a world of endless plenty.

t-writescode• 2 years ago

But you already live in a system that promotes that

Correction. We live in a system that *rewards* that. The infrastructure and system itself expects us to drive everywhere (because it's either faster or literally at all possible), eat overprocessed food (because it's tastier (literally designed to be hyper-palpable) and faster), and to work for absurd hours.

If you somehow have spoons after all that, then you're expected to workout, etc, to gain the additional benefits; but the systems in play do not facilitate that, at all.

deanrtaylor• 2 years ago

The problem is that you can't undo millennia of evolution that has pushed us towards the situation where people are obsessed with food and struggle to limit themselves. We also shouldn't forget that not more than a century ago famine and rationing was still commonplace. Certainly my parents were still raised in an environment that hadn't gotten used to food being plentiful and were always forced to eat everything they had at all times and rewarded with food, this has been engrained in myself since I was young as well. I'm lucky that I managed to move away and isolate myself and lose a lot of weight but the important thing to note is that once I got down to a lower weight, everything was easier, getting up in the morning, walking, jogging, working out, talking to people, going outside. Now I've probably gained back 30% of what I lost and if I could take Ozempic to lose 5kg the rest would come a lot quicker because I'd be able to run further and have more energy generally.

All that is to say, these two are not mutually exclusive and if people receive this drug everything we already do to promote a healthy lifestyle will become much more realistic for many people, as far as I understand Ozempic removes the desire of hunger, it's not like people can continue their bad habits and take the drug and lose weight. Furthermore once they assume these habits, the generational cycle of raising children and over indulging will likely come to an end and we will probably not need the drugs as much.

TL;DR, people want to be healthy, they just don't have the tools or motivation to do it. Losing weight will likely be a gateway to many health improvements and benefits for future generations

blackqueeriroh2• 2 years ago

Uhhhhh, Ozempic has so many problems and side effects that get glossed over.

godshatter• 2 years ago

Can you keep the weight off once you stop using it? I don't particularly want to have my personal health be in the hands of one company especially if the culture stratifies into those who can afford to be the right weight and those that can't. Especially when it enters it's "enshittification" stage.

petesergeant5• 2 years ago

It's hard to keep weight off once you stop using it, but I've not seen anything to suggest it's harder to keep it off if you lost using GLP-1 than if you lost the weight the normal way. Most fat people I know have lost weight successfully more than once "the hard way" and then regained it.

olddog2• 2 years ago

I’m pretty sure all the Shortages of Ozempic and mounjaro are due to injector mechanism production factors and the fact that when the drug is transported in a reconstituted fashion in the injector, it needs to be kept in cold chain storage the whole way which makes logistics much much harder

My friends and I all live outside of the USA and we can get basically unlimited ampoules of powdered Mounjaro from China. It is very simple to reconstitute with Sterile water in a no touch way and works great. We have all had significant weight loss and improvement in blood pressure and glucose levels etc.

Waiting for these companies to get their act together, especially when mounjaro is a copycat drug is not acceptable. these drugs are biochemically very simple peptides with a couple of cross linkages and very easy to make in high quantities so there is no excuse for everyone who needs them to not be on them. a large portion of the world not having access to these drugs for the patent period and continuing to suffer all the effect of obesity is not morally acceptable.

cubefox8• 2 years ago

Arguably it is morally acceptable for them to charge high prices because drug development and doing phase 1/2/3 trials is very expensive. It's also risky, as most drugs fail. If companies aren't allowed to make a big profit when they finally struck gold means to remove the incentive of trying to develop ambitious new drugs.

m3kw9• 2 years ago

I think there will be a time when engineered chemicals will beat natural food, but right now this isn’t it. I’m talking about longetivity tech in the far/ or near future

subroutine3• 2 years ago

It will be interesting to see how health insurance companies deal with Ozempic. A few days ago a top article on HN posed the question: Millions of Americans could benefit from drugs like Ozempic; will they bankrupt the healthcare system?

Of course there are many health benefits to losing weight. Given there are clear, healthy, non-drug assisted ways to lose weight, should drug-assisted weight loss be considered an 'elective' procedure, so to speak (similar to liposuction). With so many people qualifying for this drug, would it be fair to increase insurance premiums for overweight individuals? (I say this as someone who could lose a few lbs). Should healthy active folks who keep their weight in-check naturally be required to foot some of the insurance premium bill for those who use this drug to lose weight? If someone rebounds multiple times after going off Ozempic do we continue to collectively pay? Will we be required to collectively pay for people to stay on Ozempic indefinitely to maintain a healthy weight?

https://www.latimes.com/science/story/2024-05-29/will-ozempi...

calvinmorrison• 2 years ago

The cost of someone being on Ozempic is going to be miles less than treating fatties for all the related obesity problems.

crooked-v15• 2 years ago

Yeah, right now the cost of the drug itself is high, but as that comes down and/or once the patents expire, it's a no brainer for insurance companies to fund it, in the same way that even the worst health insurance plans usually allow for cheap office visits and free flu vaccinations.

subroutine3• 2 years ago

I'd have to see some data to be convinced. There is nothing more problematic to health than aging. If we make all "fatties" thin we'll eventually get a bunch of geriatric cancer or dementia patients, or some other expensive age-related health problem (e.g. what is the lifetime healthcare cost-burden of obese people who live on average to 65 vs. thin people who live on average to 85 - just making up numbers here)

cthalupa30• 2 years ago

Another option: Move to a healthcare system that allows the government to negotiate drug prices with pharmaceutical companies so ozempic is no longer so expensive that it bankrupts us.

The UK gets their semaglutide meds from Novo Nordisk for ~£75 to ~£175 depending on the dosage for a month supply. It starts at ~$1k in the US. Tons of other countries with similar or better negotiated pricing.

Instead of implementing a system that would allow our government to have leverage to prevent this sort of thing from happening to begin with, we sit around, wait for enough everyday people to get screwed over by it to start raising a ruckus, and then some federal agencies fine you a infinitesimal amount compared to the profits you made, your CEO goes and testifies in front of Congress for a few minutes, and even on the most positive outcome side, they then reduce the prices, and basically never to the levels they negotiated with other countries.

Meanwhile they keep the overwhelming amount of money they made selling it to Americans at outrageous prices. And hell - that's capitalism, baby! I can't say I have any expectation of a company behaving any differently when this is a valid way to operate.

So we gotta make it not a valid way to operate.

farceSpherule• 2 years ago

A lot of people fail to realize that eating healthy and exercising is not enough for a lot of people who fight with their weight their entire lives.

Ozempic and Wegovy are game changes and have real, tangible health benefits.

One person told me, "No matter how much I eat or exercise, I have been 'hungry' my entire life. That ended when I started taking these drugs."

Uehreka• 2 years ago

I gained about 50 pounds the past decade and the past year I’ve been trying to lose it.

I weighed myself at the beginning: 205 lbs

I started running 30 minutes per day (heartrate training targeting about 140-150), every day, for 10 months. I kept my diet the same as before (though with a protein bar after the run). Weighed myself every week or two, always within a couple pounds of 205.

In March I ramped up my runs to 45 minutes per day with better interval planning. Still 205. I injured my ankle in May: 205. I’ve been busy and haven’t gotten back into running yet, just weighed myself, and after months of no activity: 205

Weight loss is hard. It is possible to put in a pretty strenuous amount of effort and willpower and see exactly zero results.

sph5• 2 years ago

What do you eat? I bet $10 either it's calorie-counted standard high carb diet or something that is low in protein and fats.

The physiology of dieting, and avoiding hunger, is pretty well understood at this point. Just don't ask your GP or they'll just tell you to stop eating red meat and eat more cereals as the "solution".

ninalanyon4• 2 years ago

You need to reduce your calorie intake. The exercise isn't enough to have a significant impact.

DonnyV3• 2 years ago

There are a couple things missing from routine. That protein bar is sabotaging your run. Those things are filled with sugar. You need to do 2 things. Change what your eating and do intermittent fasting to jump start your metabolism.

crooked-v15• 2 years ago

Just doing more exercise doesn't actually help much with losing weight, as it turns out. The human body will optimize around even intense exercise to reduce calorie burn to a homeostatically stable level. The exercise will still make you healthier (and have some marginal extra calorie burn from e.g. extra muscle mass), but you'll only lose serious weight if you also reduce what you eat.

There are a bunch of articles out there about it, but Kurzgesagt has a decent pop-science summary: https://www.youtube.com/watch?v=vSSkDos2hzo

cortesoft5• 2 years ago

Its a pretty well known fact that exercise alone (unless you are doing extreme athlete training) is not going to change your weight without a change in diet.

You can get healthier with exercise, but not smaller. That is almost entirely based on diet.

Just think about it; your thirty minutes of running probably burned between 300-500 calories. That one protein bar probably has about 300 calories by itself.

momojo• 2 years ago

Thanks for sharing. It must be discouraging to see no results after pretty rigorously following the mantra of "just try harder".

swat5352• 2 years ago

Exercising won't work, weight loss happens in the kitchen.. You can do some moderate exercise of course but you should count calories and eat less (don't forget to recalculate your requirements as you lose weight!).

bobro2• 2 years ago

Running for 30 minutes is maybe 200-400 calories. If you trigger your body to eat more because of that or you are more lazy throughout the day because you’re tired after running, it’s a wash. Exercise is not the route to weight loss. It’s like 80-90% diet.

sensanaty2• 2 years ago

Exercise by itself doesn't increase calorie burn all that much, it just strengthens your body in other ways. It's still very important, but to have a healthy weight you need to eat healthy (for most people this just translates to eating less) and diverse foods with good macro coverage.

You not changing your diet is the problem in this case, and that protein bar has so much sugar that by itself it's counteracting whatever effort the exercise had in the first place.

Also in my experience most people who say this kinda stuff (I train and eat healthy but can't lose weight!) actually don't eat healthy at all, because they simply don't know what that actually looks like.

Sohcahtoa82• 2 years ago

One person told me, "No matter how much I eat or exercise, I have been 'hungry' my entire life. That ended when I started taking these drugs."

I would change this to "No matter how much I eat, I have been hungry my entire life", because that's what my experience is.

I'm nearly always hungry. Doesn't matter what I eat or how much of it. High protein, high fiber, moderate fat, low carb, all the steps people say cures hunger, and I'm still hungry. 20 oz steak and a massive portion of broccoli, and I'll still get munchies an hour later. And before someone says "You're probably actually thirsty, but making the common mistake of thinking it's hunger", no, that's not it. I'm drinking plenty of water. My urine is almost clear.

People say things like "If you're hungry between meals, just eat a handful of nuts!", and I don't know if I want to laugh or cry, because I'll eat a handful, then another, and another, next thing I know, I've eaten literally 1,000 calories and I'M STILL FUCKING HUNGRY.

And so I get incredibly angry whenever someone says something like "omg these fatties have to take drugs because they don't know how to stop eating" as if everyone has the same experiences as them.

No, my hunger sensor is miscalibrated. Some of ya'll might go out to lunch and end up eating a large meal and not end up hungry for dinner and skip it. I'll go out to lunch, eat the large meal, and end up hungry 2 hours later. If I get the smaller meal, I'll leave the restaurant still being hungry.

I even tried keto. I did it for 9 months and went from 270 to 205 lbs, but even after 9 months, my hunger was not recalibrated. I was still hungry after every meal. After 9 months, I ran out of willpower. Gave into the hunger again. Slowly came back to 245 lbs and stayed there.

I wish I could try Ozempic. Maybe it would fix me. But I'm not diabetic, so my doc won't give it to me.

rootusrootus46• 2 years ago

Ozempic (or better, Zepbound) will solve that problem. I feel just like you, have had a similar experience, and I'm taking tirzepatide (Zepbound, basically) now.

Ignore the haters. Focus on what will make you successful.

my doc won't give it to me

Get another one. You can have more than one. Go to one biased in favor of selling you the drug, if that is what works. It is your health. Your doc is not your mom, he is your advisor, it is your body and your choice what to take.

Compounded semaglutide is relatively inexpensive. And over time the brand name stuff will start to come down because they are being undercut by the compounds. Zepbound, for example, is now available direct to consumer for $550/month (5mg, and not an autopen so you can easily split the dose to make it last longer if that still works for you). Still pretty expensive, but for a life changing drug it is worth it. I also expect the price will continue to drop, probably quite a lot in the upcoming years.

mft_2• 2 years ago

I wish I could try Ozempic. Maybe it would fix me. But I'm not diabetic, so my doc won't give it to me.

Wegovy (which is the same drug, with a different name) is licensed for weight loss, if you fulfill certain criteria:

adult patients with an initial body mass index (BMI) of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia) [0]

[0] https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/21...

dennis_jeeves22• 2 years ago

eating healthy and exercising is not enough for a lot

That's because both these interventions when followed in the way they are commonly understood are near completely incorrect. I blame the govt/medical profession for this.

Other factors: again I blame govt/medical profession for this - example it's difficult to get unprocessed food unless one reads labels carefully. For example it is near impossible to get milk that is not fortified with vitamin D. As they say: the road to hell is paved with good intent.

Granted that even after doing everything right there will be some people who will be obese, but that would be the minority. Again the govt/medical profession is to blame - for example I've heard that infants/kids are now given around 30 vaccines. With so many variables that have changed in the environment it now becomes difficult to isolate what is causing the health issues that predispose people to a lifetime of ill health

incognito124• 2 years ago

Wait, what is wrong with Vitamin D?

rasz• 2 years ago

It is enough, but there are people who dont have metal fortitude to eat healthy and just the right amount.

andrewla4• 2 years ago

I think Ozempic is a treatment of a symptom but not the underlying condition, but unlike many of the posters here, I do not think the underlying condition is "obesity". The below is mostly speculation.

Research especially into people with healthy body weight seems to indicate that there is something going on that is causing widespread obesity. That is, there's some sort of environmental "GLP-1 Turbocharger".

Maybe it relates to processed food, maybe it relates to microplastic contamination, maybe it's in the cheese, maybe it's an innocuous viral agent, maybe it's gut biome, maybe it's ADHD drugs, maybe it's SSRIs.

I suspect that Ozempic is helping us get back to a baseline level of exposure by counteracting this. And in the future if we're lucky we'll figure out what it is and try to correct it at the source.

jncfhnb4• 2 years ago

You think ozempic is counteracting this mystery force and it is mere unrelated coincidence that it results in eating substantially less?

andrewla4• 2 years ago

Yes?

A lizard whose bite makes its prey eat less is crazy but it exists.

A lizard whose bite makes its prey eat more is also crazy, but maybe it exists?

The first lizard is literal, the second lizard is a stand-in for whatever mystery force I am postulating the existence of.

When you look at the historic literature on diet and nutrition from the first half of the century it's like looking into another universe. People are obsessed with getting people to eat more to prevent malnutrition even when food is freely available. Something changed.

supportengineer4• 2 years ago

We all know the problem: processed food and lack of exercise.

We all know the solution: Organic vegetables, lean protein, and lots of exercise.

ninalanyon4• 2 years ago

Just reducing the vast intake of refined sugar in the US would help a lot.

andrewla4• 2 years ago

Maybe? I don't think we all know this. And some research, especially into people with unusual metabolism (but not necessarily known metabolic disorders) indicates that even with these restrictions, they need to operate at a significant calorie deficit simply to maintain a healthy weight. [1]

It might be that they are already exposed to enough processed food and pesticides that simply getting those things out of their diet is not sufficient, but I think it's clear that there's more going on here than a simple answer.

And, I think, most damningly, there are many people who maintain a healthy weight with no active efforts to maintain that weight, including a lack of exercise and consumption of processed food. It might be that a significant fraction of people are resistant to this effect or might just not enjoy the taste of processed food so naturally gain the benefits of avoidance.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/

crazygringo• 2 years ago

We really don't all know these.

There isn't anything even remotely close to a scientific consensus on any of those.

There are plenty of scientists who tell you to stop exercising when you want to lose weight, because the exercise leads you to eat more than you would otherwise, and is ultimately self-defeating -- to focus entirely on eating less, and then only add exercise back in once you've reached you target weight. And "processed food" is a highly non-scientific category that is way, way too disparate to be useful at all.

Organic vegetables might be nice, but there's zero evidence that organic vegetables are better at weight loss than non-organic. Also zero evidence regarding lean protein as opposed to fatty -- there's a big argument that fatty meat is better for weight loss, because the fat satiates so you wind up eating less calories overall.

Ferret74464• 2 years ago

Processed food isn't the problem. Processed food is the bullet, so to speak.

The person holding the gun is mental issues. Mental issues cause people to eat unhealthily.

kfinley• 2 years ago

I couldn't agree more.

Out of curiosity, last year, I purchased some test strips to test my drinking water. The strips showed typical contaminates: arsenic, lead, copper etc. they all registered in the "acceptable range". In the test, there was a test strip for QUATs (https://en.wikipedia.org/wiki/Quaternary_ammonium_cation), which caught my attention. It wasn't something that I would have thought to test for, but my water tested positive. I was curious, so I started testing other local water sources including bottled water from various brands; to my surprise they all tested positive for QUATs. The only local water I could find that didn't contain QUATs was distilled.

I thought maybe it was just in my area, so I started taking the test strips with me when I traveled. In the last year, I've tested the drinking water in multiple states and countries, and only one source has tested negative for QUATs. It was the water from a drinking fountain in the San Francisco Airport, interesting enough.

My suspicion is that QUATs are often flushed down the drain, and the molecules must be too small to be filtered out in the water treatment process.

I haven't found much research on the impact of QUATs on the human body, but I can help but think our mitochondria would be susceptible to damage.

avelis3• 2 years ago

I could suppose it's some of all of this. But my money is on UPF. The author of Ultra Processed People has an identical twin in NJ while he lives in the UK and their weights are vastly different.

__turbobrew__2• 2 years ago

My bet is pollutants in the water. The further up the waterstream (and higher elevation) the thinner on average people get.

grecy15• 2 years ago

You are doing an awful lot of mental gymnastics in search of a boogeyman that does not exist.

How mammals ingest, process, store and burn energy has been well understood for a very long time.

You know why some domestic dogs and cats are overweight? Is it ADHD or microplastics? Of course not, it’s because they’ve been eating more energy thaN they have been burning for a while.

Ozempic only stops you wanting to eat more, which perfectly proves the point. The boogeyman you are searching for is eating more energy than you burn.

cubefox8• 2 years ago

Obviously he suspects environmental contaminants mess up hormons such that we get more hungry than we are supposed to.

bozhark2• 2 years ago

Why would you ever take a pill for weight loss?

That’s seems entirely fucked up

Maxatar• 2 years ago

What is inherently wrong with taking a pill for weight loss?

I can understand being cautious about side-effects or efficacy, but if a pill existed that resulted in weight loss and was side-effect free, I can't imagine what would be inherently wrong about taking it.

Would it be preferable if it were a powder, or a cream? Is it the specific delivery format that has you concerned?

yapyap• 2 years ago

gonna be a good while

robohydrate2• 2 years ago

I've been on tirzepatide (Mounjaro) for 4 months now. I'm down 13% of my body weight. I realized that frequent cannabis consumption interferes with the weight loss, so I've kicked the habit from daily to occasionally on weekends. I've started walking 2-3 miles a day, 2-3 days a week regularly, in addition to eating less and being more motivated to calorie count.

All this to say, this drug has been life changing for me. I spend more time doing things I want to do, depression and anxiety have less of a hold on me now. I feel that this drug has allowed me to be the best version of myself I have been in a long time. The only side effects so far have been positive. I do worry about what I will do once it's time to titrate off the weekly dose and the best I can think of is that the habits I'm forming in the time on the drug I will have the resolve to continue after cessation.

I say this because I have battled depression, anxiety and obesity issues my entire life. I've had many failed attempts at getting back to a healthy, productive and non-obese lifestyle. I don't know what is so different about having the drug help me, but I can tell you that it has been different.

yieldcrv2• 2 years ago

Sounds like a kickstart you needed!

Aside from the disruption in cravings, the immediate results seem to have motivated you to do more.

robohydrate2• 2 years ago

You can't imagine how empowering it is to be able to say "No." to food. I stopped eating dessert except once a week. I can be in the company of other people and surrounded by delicious food and not feel the compulsion to eat until I am nauseous.

vessenes8• 2 years ago

Tirzepatide and Semaglutide are both known to reduce addiction / substance ingestion. I noticed I was just less interested in Alcohol when I started on Wegovy, and didn't realize it's a common effect until much later. I retained most of my disinterest after going off, too, FWIW.

dyauspitr• 2 years ago

Sounds like a miracle drug that helps with all afflictions that come with our modern life/sedentary living.

asyx• 2 years ago

I take mounjaro because I have T2 diabetes and it is a lot easier to stick to a diabetes appropriate diet. I was already normal weight and I lost 50kg 10 years ago but I could never really eat cleanly even after losing all that weight. The diabetes only improved that slightly.

Now, I can easily stick to a super low carb diet

beezlebroxxxxxx4• 2 years ago

Is the official recommendation that you continue to take it for the rest of your life? Or, is there a schedule to "wean" people off of it?

r00fus4• 2 years ago

Most weight management programs recommend you wean off - and also recommend other drugs if needed (metformin) to for maintenance.

The method of these programs is to use the GLP-1 medications to allow you to change your habits significantly while also reducing your weight. The goal being, you keep the new habits and your reduced metabolic requirements which allows you to keep the lower weight.

tjohns5• 2 years ago

Studies have show most people rapidly regain the weight once they stop taking GLP-1 drugs.

The dysfunctional biochemical processes that contributed to overeating are still present if you discontinue the drug. Your body has a natural set-point for the weight it wants to be at, and the hunger and food noise comes right back as your body tries to get you back to your old weight.

It's possible that after after a long enough time at a healthy weight your body's natural weight set-point will regulate itself back down. But this process take years.

mlsu2• 2 years ago

My view about obesity has shifted dramatically since Ozempic came out. Before this, I didn't think about it too much (I am not obese myself).

I notice now that there is a LOT of judgement, bias(?), around obesity, that people, obese or not, carry with them [1]. I certainly carried that bias, and the reason I noticed it was because Ozempic is literally an external substance that you take that simply makes obesity go away. So if you believe (like most of us unconsciously do) that obesity is a personal failing or an issue of willpower, an issue of personal merit -- HOW is it possible that a chemical pill, an external chemical process, can SO effectively resolve it? When no amount of hectoring and moralizing and willpower can? My inability to square that circle really changed my thinking about obesity in a fundamental way.

Already there is a reaction to Ozempic -- like people thinking that taking Ozempic is a personal failing, or judging celebrities, for taking it, thinking it's the "easy way out" -- I think the origin of that is this very deep unconscious bias that we all have about what obesity actually is fundamentally.

My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.

It's really heartening to hear your experience. Your post really struck me, I felt exactly the same way after getting on a CGM + Insulin Pump for my Type 1 Diabetes. Nobody EVER thought I had a lack of "personal responsibility" or an "issue of willpower" for going low or high on shots of Humilin and NPH.

Thank fucking god for Novo Nordisk.

---

[1] see: this thread!

mayukh• 2 years ago

Obesity is a side effect of the industrial food production system in advanced economies that is slowly spreading all over the globe.

How about alcohol and smoking ? Is that the same as obesity then

beezlebroxxxxxx4• 2 years ago

My understanding is that more research is pointing to obesity as, in some sense, a precursor/reaction to the onset of type 2 diabetes rather than type 1.

Once you get to quite obese you're dealing with physiological factors that make losing weight medically difficult from behavioral changes alone. It also makes the chances of "yo-yoing" the weight higher as well. At that point the treatment for obesity overlaps with the treatment for type 2 diabetes.

StefanBatory2• 2 years ago

I was obese myself, and I have different thoughts on that.

For me, it was purely an issue of personal falling and willpower issue. I was obese because of a diet I was indulging in; full of unhealthy things and snacks.

It was due to nobody else but myself.

fireflash38• 2 years ago

For some people it is clinical. For others it is mental/willpower. That said... It's exceptionally difficult in the modern world to do everything necessary to be at a healthy weight. Things are shoved at you constantly that are terrible for you. It's so, so much easier to eat poorly and to excess. Combine that with dopamine hits from consuming sugar/fat? No surprise people overeat.

kps3• 2 years ago

Not unlike diabetes, celiac, or clinical depression.

The latter is, like obesity, considered a personal failing (being one or more of the Seven Deadly Sins, depending on when you look), and medical treatment elicits similar reactions — both against it being ‘too easy’, and in favour of wholesale societal restructuring instead (“That trick never works!” — Rocky the Flying Squirrel).

scottyah• 2 years ago

The fact that a drug can cause a shortcut is completely normal I think, alcohol can nearly instantly give you the confidence that months of training would take, hallucinogens can give states of mind that monks spend years meditating and breathwork to achieve, steroids give shortcuts to massive gym gains, etc.

I see Ozempic as "taking the easy way out" the same way I see steroids as "taking the easy way out" (except it brings people closer to the norm of a average healthy person and will probably lengthen lifespans).

If you're in it to show mental fortitude for internet/social points, then it is "cheating", but if you're just in it for results it's perfectly acceptable and even recommended.

ElectricSpoon• 2 years ago

people thinking that taking Ozempic is a personal failing

Considering our society is pushes us toward sedentary highly-caloric lifestyles, I'd say we're set up to fail from the get-go. Therefore the failing is systemic not personal. I wouldn't compare to individual health issues. You can't cure celiac, but you sure could reduce the obesity using policies to drive the food industry toward less-sugar/more-fiber.

j-a-a-p3• 2 years ago

The willpower frame actually works pretty well for a lot of people. If not than in our society almost everybody would be obese. This pill will make things worse for the group that hangs out in the treadmills and drinks green and disgusting smoothies.

On topic, very happy this medicine exists, but let's pray god will keep the prescription only for BMI > 35.

rootusrootus46• 2 years ago

people thinking that taking Ozempic is a personal failing

I expect that the people who hold this viewpoint are afraid that their lack of being overweight will not be seen as badge of honor, a sign of superior morals and willpower.

To them I say -- GLP-1 agonists are good for anxiety, too!

slibhb• 2 years ago

I notice now that there is a LOT of judgement, bias(?), around obesity, that people, obese or not, carry with them [1]. I certainly carried that bias, and the reason I noticed it was because Ozempic is literally an external substance that you take that simply makes obesity go away. So if you believe (like most of us unconsciously do) that obesity is a personal failing or an issue of willpower, an issue of personal merit -- HOW is it possible that a chemical pill, an external chemical process, can SO effectively resolve it? When no amount of hectoring and moralizing and willpower can? My inability to square that circle really changed my thinking about obesity in a fundamental way.

I see no contradiction here. That ozempic works doesn't imply that willpower isn't real or that people can't lose weight via diet and exercise.

My view: It is a health condition, that people do not choose. Not unlike diabetes, celiac, or clinical depression. We should be focused on how to improve the lives of people who suffer with that health condition. We all agree insulin is unequivocally a good thing; that it's not a "personal failure" or "cheating" to take insulin; that it really is simple as, diabetes is a health condition and insulin is used to treat it. Ozempic? Same. Exact. Thing.

I'm very suspicious of "it's a health condition" applied to obesity, type 2 diabetes, and even depression. I absolutely believe that some people will be able to avoid or cure those "conditions" by changing their behavior. Of course that doesn't imply that there should be a taboo against medication to help people who can't. But my concern is that "it's a health condition" discourages people from examining their choices and making good ones.

lottin• 2 years ago

It's not just willpower but also lifestyle. It's rare for people who are physically active, and have a balanced diet, to suffer from obesity. I can eat A LOT without putting on a ton of weight, and it's because the types of foods I eat and because I do strength training, which means have a fair amount of muscle mass which acts as metabolic furnace. I'm a little overweight, at the moment, but it'd take a lot of effort on my part to become obese. I think treating obesity as a health condition is the wrong approach.

SirMaster2• 2 years ago

My view: It is a health condition, that people do not choose.

If this is true, then why are we so focused on curing it after the fact?

Are we also working on prevention?

If it's not a choice, then what is the cause? And why shouldn't we work on preventing that cause?

I mean it's clean that more people are obese today than in the past right? So what changed to cause that that isn't about people's choice? Why not work on reversing whatever those changes were that caused obesity to increase?

And a separate question:

If it's really not a choice, what would be the approximate rate of obesity among a group or population that all exercised regularly and ate healthy?

I don't think I can be convinced that not exercising regularly and not eating healthy is not a choice.

I just feel like the number of people that would be obese who are regularly exercising and eating healthy would be rather small. And if we agree that exercising regularly and eating healthy is a choice, then it seems at least for many who are obese, it indeed is choice.

I'm not going to say there aren't outliers or other special circumstances, but I still feel like for more people than not, it is indeed a choice.

buu7002• 2 years ago

Personally, I've never seen obesity as a failure of character or willpower, at least as long as I can remember having any particular views on it at all. I see it as a failure of information and choices.

Obesity was rare until the United States officially decided in 1977 that saturated fats were considered harmful. A few years later, it started rising to the current epidemic level. We've come a long way since the American Heart Association was recommending candy and soda as "healthy" alternatives to real food, but the idea that an optimal diet contains low saturated fat and high complex carbohydrates remains firmly entrenched in present-day nutritional and medical orthodoxy.

Imagine a counterfactual where Congress had reached the opposite conclusion, instead recommending a standard diet full of saturated fats, high in salts (both sodium and potassium), moderate in monounsaturated fats, low in polyunsaturated fats, and sparing in carbohydrates. The population and food industry would have moved in an entirely different direction. We'd have a whole different universe of nutritional advice, diet trends, restaurant menu options, and easily available processed foods. A lot would be the same, but large sections of the grocery store would look like lowcarbfoods.com, maybe burger joints would serve mozzarella sticks instead of fries, maybe instead of potato chips and corn chips people would eat pork rinds and kale chips, and maybe instead of rice or potatoes an average dinner would include all manner of delicious fried vegetables. Instead of a low(er)-fat (i.e. high(er)-carb) diet, doctors would tell fat people to try keto. Maybe that timeline's equivalent to trans fat would be sugar alcohols and artificial sweeteners, and governments would ultimately pressure the industry to transition to stevia, monk fruit, and inulin fiber.

In such an alternate universe, I'm sure the food industry would still work overtime to find ways to make many of its products shitty and addictive, and I'm sure the average person would still lean heavily on processed foods and fast food over home cooking and whole foods. I'm sure that would cause its own set of health issues, but what I highly doubt it would cause is an obesity epidemic. It's simply a lot harder to overeat fats than it is carbs. We'd also inherently have less insulin resistance, which means less type 2 diabetes, less dementia, and probably a good amount less of mental/neurological issues like depression and anxiety.

Unfortunately, we live in this universe. And in this universe, I find it really hard to blame individuals for struggling with obesity when we've practically purpose-built an environment to make us fat and keep us that way. In order to not be fat (by pre-1980 standards), you either have to win the genetic lottery, be extraordinarily physically active, put a high amount of effort into controlling your caloric intake, or be willing to go against the grain (no pun intended) on what you've most likely been led to believe for your entire life by everyone and everything around you. It's great to fall into one of those four buckets, but on a population scale it should be obvious that the majority wouldn't.

itsoktocry2• 2 years ago

For me, personally, it's that we don't really know the long term effects of these drugs ie are you actually "healthier". But we do know that diet and exercise work.

seer• 2 years ago

This is a very American way of thinking about it - not invented here vibes all over.

Of course people don’t choose to be obese, but the culture and environment inevitably pushes you to it. A proof of that is that there are places in the world, with similar genes, that don’t have the same problem in the degree that US does.

I don’t think it is a personal failing, more a collective one - the society itself has chosen a set of environmental factors as desirable (car centric, hectic, individualistic, processed cheap food etc) and it just results in more obese people.

Loose the cars (change to walk / cycle / public transport), spend on food as much as the rest of the world do (adjusted to PPP) and suddenly you don’t need ozempic.

It is still weird to me how US choose unironically to develop a drug for reducing addiction, and not putting societal pressure to fix the environmental issues. It’s a democracy, people do choose all of that and can’t really blame it on the government.

ekianjo• 2 years ago

The real question is why so many people are obese in 2024 in the US while it was a fraction of the population 50 years ago? And other countries have by far not been affected by the same trend. So effectively something is making people really sick on the US.

cactusplant73742• 2 years ago

I realized that frequent cannabis consumption interferes with the weight loss

Because you eat more or is there some other factor?

apwell23• 2 years ago

Have you noticed any effect on gastric emptying. As someone with 'tummy issues' ( ibs/gerd ect) i am apprehensive of messing with my digestive systems.

rootusrootus46• 2 years ago

Not the person you were responding to, but yes. Stomach empties much slower, which seems to effectively make it smaller. A normal size (pre-drug) meal will make me uncomfortably full and probably cause reflux.

That said, I've noticed in the past, and also now on this drug, that my gastrointestinal issues abate noticeably when I consume less food. Thought I had IBS and then I went on a significant diet and lost 40 pounds in 2020. The IBS resolved, and not after I lost 40 pounds -- it basically stopped altogether a matter of weeks after I changed my diet. That was educational. YMMV.

I'm still working out my approach to eating while taking tirzepatide. Old habits die hard, and I'm having to cut my meal size way back. This sucks because my problem with eating too much was about eating too often, or not when hungry, not about binging. So I have to eat pretty small meals now. It will take some adjustment to find the right way to get sufficient nutrition while volume limited, but I think it can be done.

spondylosaurus6• 2 years ago

If your IBS is the "stuff moves too fast" variety (so, IBS-D) GLP-1s seem to help a lot since they slow things down. If your problems already stem from things moving too slow... maybe not so much :P

glenstein• 2 years ago

I think this is such a helpful description of the totality of components working together to spur a positive outcome, which I think, at least in my personal experience, is an under-appreciated aspect of using a drug.

I've sometimes heard it said that it's an unhealthy reliance on a drug in place of curbing behavior, but I think it's important to understand it as, among other things, a stimulant to the activation of beneficial behaviors, which can be as critical as the drug itself.

colordrops4• 2 years ago

Did you notice that cannabis consumption interferes with weight loss due to interfering with motivation to stick to your health goals? Or did it interfere with your metabolism in some way?

asadhaider• 2 years ago

I can answer this, I've been on Ozempic in the past and prescribed Mounjaro (Tirzepatide) currently (month 3).

I've had a medical cannabis prescription for many years and vaporise up to 3g a day which is quite a bit. It definitely interferes with my cravings for food, as you know the common 'munchies' effect, making me eat when I'm not really hungry or binge snacks.

I gave up on Semaglutide (Ozempic) after a few months, but Tirzepatide is working a lot more effectively and has been better.

Cannabis also helps a lot with the nausea side effect for me which can be particularly bad the first few days going up a dosage every month. It takes six months to titrate from the starter dose to full strength, if necessary.

Also the downside a lot of people don't talk about is that most people need to be on these drugs for life. They also aren't cheap.

arijo23• 2 years ago

Cut on carbs and you will have all the benefits without the nasty side effects.

Check https://metabolicmind.org for details.

My own experience with the keto diet - https://www.feelingbuggy.com/p/finding-hope-after-decades-of...

kerbs• 2 years ago

It is not easy on the mind and body as to just cut carbs.

cgh• 2 years ago

I read your experience and it is indeed pretty incredible and I'm happy for you. I've used ketosis strategically for athletic reasons, to cut weight. So we both had strong motivations to use it. But for your typical obese person, it is a tremendous challenge to stick with it and at the end of the day, it's adherence that matters.

Put simply, it's easier to adhere to a drug than to a specific, somewhat anti-social diet.

fortran774• 2 years ago

This is true, but fat people have a hell of a time cutting out all carbs. For many of them, they'll eat the "low carb" option, and then have an occasional binge and it negates any benifits of low carb, and doesn't put them in ketosis, etc.

I strictly maintain my weight. If I catch it going over over 155# (I'm a 5'10" 61 year3 old male) I'll do a strict cut. And I know that either strictly counting calores OR going to as close to zero carbs will have the same net effect.

But a person who has obesity or is overweight will not be able to follow a diet. They are just incapable of doing so, or will lie to themselves or others about it and claim it's their "metabolism" or a medical condition, etc.

Etheryte2• 2 years ago

This is about as useful as telling someone who's obese to just eat less. Factually yes, it might help them, but practically they're clearly unable to implement it, probably for a plethora of underlying reasons.

slothtrop6• 2 years ago

You can just cut ultra-refined foods i.e. junk foods. No one is getting obese from lentils, broccoli and apples. Even so, avoiding weight gain is one thing and losing weight is another. While it helps to increase ratio of protein and fiber intake for satiety, that in itself does not guarantee a caloric deficit, which is what is necessary for weight loss.

alluro2• 2 years ago

I've got to say, pretty frustrating seeing answers like this. It just completely ignores all the real, valid difficulty that people have in fighting obesity. If you "just" follow this diet, that requires discipline, strong will, buying correct supplies, 2h of cooking a day, measuring, counting, adhering to strict eating timeline, for months (years for some people), you'll be golden! There is plenty of research into behaviour changes with obesity and mechanisms that prevent good decision making etc - apart from just the practicality of all of the above in one's daily life with work, kids...

I see in other replies that you've had success in losing weight, and congratulations - but that doesn't mean it can work for everyone else.

I don't look at any kind of "pill solution" lightly, and absolutely think lifestyle changes should be made as well - but I can definitely see how medication like this can help get people on track and get back control. It's very encouraging to hear about psychological effects in terms of self-control, decision making etc. I'm just worried that we'll discover serious negative side-effects before too long, as with previous attempts.

comechao• 2 years ago

I'm not sure if you tried but add a sport, can be table tenis, jiu-jitsu whatever. I did this too after got comfortable with the walks (that I still do).

siva7• 2 years ago

How do i get this?

pedalpete• 2 years ago

Have you been recommended an exercise regimen, or taken one up yourself? The one the great things about GLP-1s is that with the weight loss, it's easier to be more active once you've lost some of the weight. The negatives is that the current breed promote a loss in muscle mass as well as fat loss, so it is very important to do your best to maintain if not increase muscle while on them.

The next generation of drugs are including 2nd molecule...I'm blanking on the name, and a search isn't bringing it to me...which maintains or potentially increases muscle mass.

But curious what your experience with exercise has been.

I also didn't know there was a planned reduction in dosage, but the expectation is that you'll be on some type of GLP1 for life, is that not right?

cthalupa30• 2 years ago

Cagrilintide (paired with semaglutide) and retatrutide are the next wave, though I'm not aware of any research for either indicating an increase in muscle mass.

My understanding of the literature is that there's nothing special about semaglutide or tirzepatide that promote muscle loss - it's just people who lose weight based purely on diet tend to also lose muscle mass. Even bodybuilders lose some muscle mass when cutting.

It's up to the individual to increase their protein intake and exercise, the same way they would in any caloric deficit.

phil215• 2 years ago

None of the GLP1s cause more muscle loss than simply losing the same amount of weight without it. It’s the rapid weight loss without resistance training that causes it.

If you calorie restricted with the same exercise routine without the drug you’d see the same amount of lean muscle mass loss as you would taking the drug. This spreading of misinformation is actively harming people.

nessguy2• 2 years ago

I'm with you on this, tirzepatide has been life changing for me. I've struggled with my weight my whole life and I can actually imagine a future where I lose enough that I'm no longer ashamed of my weight.

I've been on tirzepatide for just over a year now. Before that, I managed to lose 6% of my body weight over the previous year. With tirzepatide, I've lost an additional 17% of my body weight, for a total of 23% over two years.

Tirzepatide isn't a magic drug that just makes you lose weight, it simply makes it much easier to avoid overeating.

It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.

gscott• 2 years ago

It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.

I had this problem as well. Being on tirzepatide I went from 220 to 185 in just six months because my previous insatiable hunger went away. It feels so powerful now choosing when to eat or not.

riffraff2• 2 years ago

It makes the difference between being so hungry that I can't fall asleep and having the ability to just go to sleep.

Forgive my ignorance and curiosity, was the feeling of hunger due to drastic reduction in portion size? Could you not eat some low-calories filling food?

I ask cause I've been overweight and sometimes obese most of my adult life, but when on a diet I usually feel "unsatisfied" but rarely actually hungry, e.g. I can eat a couple carrots or whatever and hunger goes away, but I would still crave a hamburger.

Still, I'm happy for you that you found something that works!

myprotegeai2• 2 years ago

In the future, this would be indistinguishable from an ad.

mahin• 2 years ago

Or even now?

blackqueeriroh2• 2 years ago

I’d like to make a couple of things clear here:

1) “obesity” has no clear clinical definition, nor is it really a disease. [1] 2) there has been no evidence yet that weight is at all a primary determinant of health [2] 3) Weight loss drugs must be taken forever or it’s nearly certain you will gain the weight back [3]

There’s a lot of great research these days that shows fatness is not what people think it is, and weight stigma is far more harmful than being fat itself [4].

Also, nobody knows what happens yet if you take these drugs for 30 years, and what we do know is that being fat hasn’t been proven to kill anyone.

I'd just say follow the money.

[1] https://www.science.org/content/article/obesity-doesn-t-alwa... [2] https://withinhealth.com/learn/articles/why-body-weight-isnt... [3] https://www.bbc.com/future/article/20240521-what-happens-whe... [4] https://bmcmedicine.biomedcentral.com/articles/10.1186/s1291...

legacynl2• 2 years ago

realized that frequent cannabis consumption interferes with the weight loss, so I've kicked the habit from daily to occasionally on weekends

Did you try to reduce your cannabis consumption before using tirzepatide?

Because although you say(feel) like the realization made you reduce your intake, I can hardly imagine that you were totally oblivious to the fact that smoking cannabis is unhealthy in the first place.

Do you feel like you think less about e.g. cannabis, or do you feel like it's easier to say no to that impulse?

Does it seem to mainly influence health choices or are you also less likely to be angry or does it interact work place interactions?

collingreen4• 2 years ago

Congratulations! This is such a great success story.

I love your tactic about building healthy habits while you have some support and leaning on those to carry you through the future.

Good job!

kelavaster• 2 years ago

Do a reality check that leas-frequent cannabis consumption with your target activity and intake levels doesn't also lead to weight gain .....

benreesman• 2 years ago

I’ve had an on and off battle with ad-hoc self medication for anxiety via heavy drinking for like twenty years, by “on and off” I mean that some situations didn’t really trigger it much, and other situations made it life defeating.

As close as I’ve come to an effective remediation was living abroad where the food wasn’t actively adversarial: capitalism can do many good things but it drives the quality of food to “edible plus epsilon”. Rich people eat pasture-raised shit for a reason. For me it just deleted that problem.

But I’m interested in this class of medication because it’s difficult bordering on impractical to eat well in some regions. People say just cook, well, there’s an infrastructure around that which amounts to a declared bias against those who didn’t settle down young. Much like people who met their partner before partnering became monetized, “easy for you to say”.

I hope you have success in your journey either way, and the less meds involved on average probably better, but if it works and has no bad side effects I don’t see why one would stop. Welcome to your new awesome life!

Every SV power player I’ve ever met was enhancing themselves via chemicals. It’s not tweeted about (other than when Garry Tan threatens elected officials), but it’s a quiet norm.

gooosle3• 2 years ago

You need to change your attitude if you want to lead a healthy lifestyle. Don't blame your failures and CHOICE to eat junk and not exercise on weed. You know what the healthy choices are, you know when you're not making them. You lack self control.

skue• 2 years ago

I don’t usually say something like this on HN, but you are completely and utterly wrong. The obesity epidemic cannot be reduced to some simple moral failure. Multiple twin concordance studies have shown 70%+ inheritability. Those of us who are fortunate enough to not struggle with obesity do so not because of some skillset that we have, but because our bodies do not maintain the same homeostasis.

For those of us old enough to remember what society looked like before the obesity epidemic kicked in, it’s hard to understand how something genetic can suddenly result in a dramatic change over a period of years. Our genetics didn’t change. Our food environment did. Experts disagree on what factors are responsible for this, and any random person had their own pet beliefs.

But this flat-earth-like notion of reducing obesity to an issue of basic willpower needs to be recognized for the drivel it is, along the related notion of calories in & calories out while ignoring the overwhelming role that basal metabolic burn plays and how it dynamically responds to changes in diet and exercise.

If you want to educate yourself, read Posner’s Burn [1], which is firmly grounded in empirical measurements of doubly labeled water to measure true metabolic consumption. Look up the reporting the NYT on past contestants of The Biggest Loser.[2]

[1] https://www.penguinrandomhouse.com/books/603894/burn-by-herm...

[2] https://www.nytimes.com/2016/05/02/health/biggest-loser-weig... (gift link)

Edit: Added links to sources.

renegade-otter• 2 years ago

I feel high on life when I am off the sauce, eat less, and walk more - without any drugs. Healthy lifestyle is the best medicine, and the biggest problem people have is not even genetic predisposition, it's impulse control. We all want that reward, right away.

mycall• 2 years ago

Have you looked at Psilocybin for your depression?

https://news.ycombinator.com/item?id=41818420

ein0p• 2 years ago

What annoys me is it’s like $100 in Europe and it’s available in a pill form there (so you could presumably easily reduce the dose and therefore the cost by breaking the pill in half). And no US insurance will cover any of it unless you have diabetes. Put another way, if I can find someone in Europe to prescribe it to me, and pay out of pocket for 90 days worth, I could take a free vacation to Europe every 3-4 months in perpetuity.

lol768• 2 years ago

How long til we're all on Ozempic?

It's genuinely quite depressing that so many people in the United States have a weight problem that the overwhelming majority of the population would benefit from this and headlines including "we are all" are not inaccurate.

I don't think other countries are necessarily perfect here, but 74% of Americans don't have a healthy weight when you look at their BMI. That's a staggering statistic. Something is seriously wrong societally, and the priority should absolutely be non-pharmaceutical interventions.

beezlebroxxxxxx4• 2 years ago

I agree. I think the conversation has unfortunately been dominated by an individualistic strain of moral judgement. Whether so and so, this person or that person, should take Ozempic-like drugs is often discussed in binary terms of near moral and personal failing or not. I think the drugs are helpful to people who really need them --- so long as the people really need them.

The problem is that conversation overshadows the much more important big picture conversation: An entire nation is now becoming synonymous with poor health from obesity and we're not addressing many of the core nationwide reasons for that.

America was once proud of and eager to prove how fit and able its people were. Now the very idea of proper nutrition and exercise is deemed a nonstarter, "impossible", or an imposition on personal liberties. The existence of Ozempic-like drugs should not absolve us from the imperative to change how we live as a nation for the sake of our health.

downrightmike• 2 years ago

We're all depressed and overworked and have been for decades. Food is an escape

marcosdumay3• 2 years ago

Add forced sedentarism into that set.

This is not exclusive to the US. The world is trending towards those, and different countries seem to only be at different distances from it, but the same velocity.

Also, industrialized food seems to be much more effective in causing dependency. Food preparation has overwhelmingly shifted into less healthy alternatives (even when they sound healthier in a naive review)... And there's a multitude of low probability high impact possible contributors that nobody knows if are important or not.

gklitz• 2 years ago

I have always and continue to feel this view of “food is an escape for cuz” model is wrong in line with the the “it’s about lack of will power” we are seeing with all these glp-1 drugs that are helping people that a big proportion of our population have what amounts to a hunger/craving defect and are just living how we all naturally do when listening to our body, but because something has messed up their balance they end up overweight instead of just maintaining their weight.

I’m hoping we at some point have a “lead in gas” moment and discover some culprit in softening agents in plastics or preservatives in foods that we find out is messing up peoples systems. I could imagine that there is something that has a minute effect on the short term and doesn’t show up if you only look at people for 1-2 years but causes significant disruption on the timescale of 5-10 years of exposure.

The obesity epidemic seems to have started in the 1960-1970, so the sedentary lifestyle of computer focused work came later, but it is still recent enough that culprits in the mass produced uniform product market could be a cause, or the advent of one type of fertilizer or antibiotic given to animals etc.

pixl9713• 2 years ago

I don't think other countries are necessarily perfect here,

America first... the rest of the world is playing catch up as quickly as possible.

In March of 2023, the World Obesity Federation (WOF) released a report(Link downloads document) stating that by 2035 over 4 billion people – more than half the world’s population – will be obese. and the priority should absolutely be non-pharmaceutical interventions.

Illegal. Or is should say Coca Cola can and will fight you to the death the moment you try. If you stand between the junk food companies and advertisers you will have an army of lawyers fighting you 'tobacco industry' style for the next 50 years.

Until the shit is off our shelves and out of our ads nothing will change.

jspash• 2 years ago

It really is a sad situation. As an American who spent the first 30 years of life in the US and over 20 in Europe, the difference is striking. However... here in the UK I see more and more "American-sized" people every year. _Something_ is changing. In the food and/or habits of the average Brit.

Anecdotally I would say Europeans as whole are getting ever so slighty larger. But just not at the rate as Americans. Ozempic seems like a god-send.

rootusrootus46• 2 years ago

But just not at the rate as Americans

The rate is probably comparable, it's the offset that's different. Won't be long until Europe is where the US is today (though I need to mention, this is regional, for example Colorado is at about 25%, and some European countries are already there).

Even Japan is getting steadily fatter, though they are way, way behind Europe and the US.

TacticalCoder• 2 years ago

It's genuinely quite depressing that so many people in the United States have a weight problem

I agree.

I'm 51 y/o and still totally fit. Always have been. I am completely in control of what my body intakes. I can fast for 12 hours from waking up until dinner: I do it regularly (as in at least five times a month, probably a bit more).

I did do sport like crazy when I was young but don't even bother that much. Some walking, taking the stairs instead of the elevator, some bicycling, some tennis. But at a gentle pace. "More haste, less speed" (thousands of years old saying).

It's crazy to poison oneself to the point where another poison (that Ozempic drug) is needed to counter the first poison.

I'm not saying it cannot help but sadly there's no way to say it nicely: if you need that, your body controls your mind.

It should be the contrary.

Something is seriously wrong societally ...

The biggest issue to me is we live in societies (not just in the US) where we victimize everyone. Nothing is never nobody's fault. We find excuses for just about everything.

We should go back thousands of years and read the classics: "healthy mind in a healthy body". Greek philosophers had already figured that in the Antiquity.

Mind over body.

soulbadguy10• 2 years ago

As every conversation with weigth management/obesity treatment, there are still people thinking that just more willing power / better habits is what's needed.

To those people I suggest you run an experiment : what ever your current body weigth is right now. Try loosing and keeping off 20%.

wiseowise13• 2 years ago

To those people I suggest you run an experiment : what ever your current body weigth is right now. Try loosing and keeping off 20%.

Easy peasy. I’d be borderline anorexie if I do that, but wouldn’t be much of a problem to achieve that.

switch0072• 2 years ago

Are you Dutch by any chance?

Because they seem have a society deeply structured around health, exercise and good eating habits. And they tend to have a "just do X, it's so easy" kind of attitude, forgetting they are benefitting massively from their environment and society and not just will power alone

highwayman47• 2 years ago

Why can’t there be a drug for chronically underweight

throw4847285• 2 years ago

For a second I thought it said Asterix Mag and started daydreaming about a story where Getafix invents a special magic potion which Obelix can use but it causes him to lose weight. Dargaud, I am available.

unkoman• 2 years ago

Most of us should probably be on appetite suppressors due to the industrial revolution making food more than abundant while pumping it full of empty calories.

anigbrowl4• 2 years ago

Just eat regular food. Hardly anything in my diet would be mysterious to a time traveler from 100 years ago, or indeed 200 years ago. Occasionally I enjoy chocolate or instant noodles but mostly it's just fruit, veg, meat, dairy, and grains. If you don't know what something is made out of or how, then don't eat it.

rootusrootus46• 2 years ago

Not a panacea. I stay fat no problem without junk food. Processed foods make me ill, so I make almost all my own meals from whole ingredients. Too many calories is too many calories no matter how you get it.

I'm a pretty good cook, though.

bowsamic2• 2 years ago

We have control though, it isn't 100% the environment. Imo that's just used as an excuse

zombiwoof• 2 years ago

Let’s all go on it, and steroids

xyst• 2 years ago

Maybe when food shortages become a thing, we can add Ozempic to the water supply to curb people’s appetites and reduce demand. \s

Kidding aside, I still think it’s extreme for off-label usage. Short term results are nice. But what about the long term? Once patients reach a desirable state, can they be titrated off the medication while maintaining their ideal labs and weight? What’s the rate of recidivism?

rootusrootus46• 2 years ago

off-label usage

Off label? Semaglutide is approved for weight loss.

OptionOfT• 2 years ago

As someone who struggled with their weight his whole life, this medication is a god send.

My wife and I cook every evening. We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.

Every morning I wake up and go on a 5 mile hike.

And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.

And you know what it is? It's volume. I eat too much. And I have no cookies at home. I have no chips at home. No soda, no alcohol. I drink black coffee with a splash of milk. I don't eat any sweeteners.

I have had weight loss surgery (lap band) which was later reversed as it hurt 24/7.

Now, on ZepBound I lost 20lbs in 2 months. I am not hungry. My brain can actually focus on the things that matter.

Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

ak_1115• 2 years ago

"Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?"

I think it is because if 90% of the population did half of what you do (and kudos for you for doing it), they wouldn't have a problem with weight, you just happen to be one of the unlucky few where it doesn't work and these drugs are useful.

karmajunkie4• 2 years ago

there are numerous studies posted in this thread demonstrating exactly the opposite.

keybored4• 2 years ago

Commenter: This drug helped me with weight loss.

Commenter 2: Kodus to you. Let me just discount your anecdote as being unlucky and keep my current belief. But again, kudos.

HN threads on weightloss are an utter waste of time.

colordrops4• 2 years ago

Have you every using a calorie/macro tracking app like My Fitness Pal or Cronometer? I was never successful losing weight until I scanned, weighed, and measured every single thing I put into my body and stuck to the target calories and macros entered into the app. Just being aware of exactly how much I was eating was often enough to find the motivation to control volume.

brianmcc5• 2 years ago

> I scanned, weighed, and measured every single thing I put into my body

Not being snarky, but is this truly "better" than a single weekly injection - 10 seconds and done for the week? I do think our wider society sees medications for overeating as "cheating". Perhaps we might benefit from rethinking that.

globular-toast• 2 years ago

I think there's a few factors at play:

1. People might want to help, but they don't think taking a pill every day for the rest of your life is a proper solution. I'm not aware of any such things for other addictions you mention,

2. People don't want other people to have it easier than they did. "I had to diet and exercise etc, you should too",

3. People don't want to help. They want other people to be fat because it makes them relatively more attractive.

mort963• 2 years ago

re: 1, there are plenty of people who take some medication at some interval for most of their life. People with ADHD, people with type 1 diabetes, most women, ... why do we find that totally unproblematic, but as soon as it's medication to help with obesity (which is a serious medical condition in its own right) it's suddenly such a big problem?

EDIT: And to be clear, there may be specifics with these particular drugs which are problematic, maybe they're by necessity expensive or resource intensive to manufacture, maybe they have problematic long-term effects, I don't know. I'm purely talking about the general aversion some people claim to have regarging taking some medication on an interval to help with a health problem. It makes little sense to me.

taejavu• 2 years ago

What kind of food do you and your wife cook? How much meat? How much gluten? Real butter or canola oil infused “spreads”? What oil do you cook with? Vegetable? Sunflower?

If you’re eating the right thing for your body, you’ll be satiated when you eat your full.

nawgz• 2 years ago

Bodies are highly imperfect and suggesting our digestive system and nervous system are geared for being fit and healthy rather than ensuring survival wrt food is absurdly naive.

sundvor• 2 years ago

(I only cook with extra virgin olive oil which I buy in 5L cans for $$ reasons. A lot of these vegetable oils are good for motor engines only!).

It really depends on you and the activity levels.

I used to ride to and from work - and I would ride hard, a solid 1.5 hour of riding every single workday. Yet this just caused me to gain weight as my appetite just shot through the roof. This new drug would have been SO good for me back then.

These days I find it easier to control my weight with regular strength exercise vs riding, as I tend to go too hard on the riding which causes me to feel famished. And then the control is just hard.

However when I just do (Olympic barbell) weights, a bacon, egg and onion + cheese omelette in real butter and EVOO does the trick to break my IF then, along with a WPI/milk shake- I get stronger and also lose weight. No need to keep eating. However, I'll then do cardio a couple of times per week which tends to undo the weight progress; I guess the real trick would be to stop doing the hard intervals I love on the Kickr, but going slow on the bike is nearly impossible for me. :-)

mrshadowgoose4• 2 years ago

Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

"Getting fit and staying fit" is a form of social capital, because it's extremely hard and only within reach of a small portion of the population. "Being fit" is strongly aligned with "being attractive" which confers all sorts of cross-cutting social benefits.

Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.

unclad59682• 2 years ago

In what ways is fitness not within reach for a large portion of the population?

unlikelytomato5• 2 years ago

I would say my concerns are far more in the range of downstream effects from the medication. Specifically, I am concerned with muscle retention. Concerns aside, it's a little hard of an argument to swallow having visited many other countries where these things are simply not an issue. How can it be argued that the cause is anything other than behavior when so many others are doing just fine? There is more to this story than painting people as evil.

zero-sharp8• 2 years ago

Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.

Nice one. I think it's a bad idea to be dependent on drugs for something you can achieve on your own, especially if the drugs don't have a long term safety profile. Pretty sure I read somewhere that they don't. If you're going to use them for a short period of time, that's fine. Don't say nobody warned you if that doesn't pan out though (or worse, you have a bad drug response).

l2silver• 2 years ago

Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.

I don't think this is just about a social club. Battling weight loss and habits is foundational to the human experience from the most recent centuries. Be it drugs, or anything else really that changes the nature of these challenges, people are going to feel discomfort because it's an attack on their understanding of the world, and in some ways, their beliefs.

jajko• 2 years ago

This is funny how black & white some folks here want the world to be painted if it suits them.

You know by far the biggest benefit of doing hard workouts or doing extreme sports? Its not muscle mass nor how much they lift. Its about how it changes your personality, resilience to mental or physical suffering and ease of overcoming it. You know, hardest part of doing anything is winning the mental resistance game and just start it. Keep doing this every day in various forms for decades... A very strong resilient personality under various circumstances is almost an unavoidable result if you are putting in enough effort.

If somebody can't even stop themselves buying and paying for junk food at grocery store or has to overeat constantly otherwise getting anxious, that part of personality is missing and another, less desirable is present.

Who would you prefer to have as a close colleague you depend on, life long partner, a close dependable friend? Who do you think women would prefer subconsciously? Societies have always some form of castes, even hardcore communists have/had them, in US one of very popular is based on career/income/wealth. And this is just another dimension or caste, so let's not act like we are not humans with flaws and subjective preferences, we don't give our respect out for free.

These medication help with none of above, in fact they strongly reinforce such behavior and personality traits. But to each their own. One benefit I can see that they could start / help with movement from former to the latter, but that's rarer than people like to admit.

user3939382• 2 years ago

It’s only within reach of a small portion because of industrialized food. Look at a graph of obesity rates in the US over several decades. Find literally any picture of people at any beach in the US in the 60s or 70s versus now.

dj_gitmo• 2 years ago

And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.

The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss. It's not surprising that it didn't help you lose weight.

theshackleford3• 2 years ago

The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss.

That’s not been my experience at all. My dosage absolutely significantly suppresses my appetite and always has. This has directly led to sustained weight loss. It did so badly enough at one point that I was underweight significantly.

I have to force myself to eat on my meds, even though the thought often makes me ill.

I’m on 30mg dexamfetamine daily.

“Dexamfetamine can make you want to eat less, so you may lose weight while taking it.

Some people gain weight, but weight loss is more common.”

Doesn’t seem to be hit everyone but equally doesn’t seem rare.

archsurface4• 2 years ago

You mention types of food but not quantities. A boat load of healthy food is still going to have an effect. Also, I for one don't consider walking to be exercise. It's fake exercise for people who don't like exercise to claim they exercise. My reason is that I cycle for eight months of the year then walk during the rainy months. By the end of the rainy months I get back on the bike and my fitness level is catastrophic - nothing. I've done this for five years, and have to say walking is just not good enough for exercise, not even close.

brianmcc5• 2 years ago

To be fair OP did say:

> And you know what it is? It's volume. I eat too much.

jart5• 2 years ago

What about someone who's carrying 100+ pounds of excess body weight? Would you consider walking to be fake exercise for them? I'd say that's a more heroic workout than joy riding.

phillipcarter• 2 years ago

Can't speak for OP, but generally speaking there's a lot of variability in peoples' perceptions of healthy food and caloric density. For example, a lot of people see nuts as health food, and yet they're some of the most calorically dense foods you can eat! Another example would be to crack open the Ottolenghi cookbook and make the delicious Lamb Siniyah, which among other things calls for a large amount of Tahini mixed with lemon juice to create a delicious crust over the top of the stew. Delicious, but incredibly calorically dense.

arandomusername5• 2 years ago

walking is exercise in the sense that it burns calories, specially when you're overweight as it's like having a 30kg (or more/less) backpack with you. Bonus points for incline.

But yeah, it's not HIIT. You won't really build up your fitness level by walking - it's not demanding enough. You need to be pushing yourself until you're out of breath, if you want to build up your cardiovascular health.

ip26• 2 years ago

Why do we find it acceptable to help...

I think if the widely available help for alcoholics, smokers, or opioid addicts mainly mitigated the negative consequences - enabling them to drink, smoke, or dope more - it wouldn't be nearly as acceptable.

I personally expect weight loss medication that simply makes people want to eat less will reach cultural acceptance.

Case in point, cigarettes have been known to suppress appetite for ages, and people have elected to smoke to help stay thin for decades. There was never any crushing social stigma attached to doing this as a weight loss strategy (that I know of).

aeonik• 2 years ago

wait, I thought that's exactly what ozempic did...

omikun• 2 years ago

I think a lot of it is dealing with hunger. If you can't stand being a little hungry, never mind very hungry, no diet will really help. I used to love being very hungry, not sure how I got there, but I wish I can go back there again. Having very little carbs and temptations in the house helps. Unfortunately it's not up to only me.

larodi2• 2 years ago

Perhaps the first person on HN who actively and without shame pays attention to the fact that Adderall is a very nice amphet cocktail. Surprising though you don't loose wait with it, sad also given the circumstances. But I envy you a little cause such ADHD boost is only illegal in EU.

Sometimes I wonder if it was a some neat trick by US gov to diagnose and put 1/5 of the population on amphetamines (2024 data +60mil prescriptions of Adderall), so that most everyone who is actually like smart or sensitive or anything of value to the industry, can (almost) freely microdose on it and as a result increase productivity.

Which... means 1/5 of the population suddenly increases output. Perhaps we all'd be on Aderall at some point, dunno bout the Ozempics...

dahinds• 2 years ago

I think you're incorrectly assuming that one prescription = one person. Far less than 20% of the population is taking Adderall, this CDC study says 4% in 2021.

https://www.cdc.gov/mmwr/volumes/72/wr/mm7213a1.htm

dahart2• 2 years ago

1/5 of the population suddenly increases output

I’ve heard studies show Adderall doesn’t help people without ADHD… googling now seems to confirm. Apparently lots of people, especially college kids, take it thinking it will help, but it actually can slow them down.

keybored4• 2 years ago

Maybe the government is looking out for smart people (me) by helping them be productive in their work for their employer or themselves

Weird daydreams on this site.

dehugger• 2 years ago

Seconding Zepbound, it has been absolutely life changing for me, and not only in terms of weight loss. It's expensive, but I am blessed with a tech salary that can afford it.

squidgedcricket2• 2 years ago

Would you mind sharing what your diet was like as a child?

I wonder if there's a connection between diet during development and adult processing of and cravings for food. Maybe eating candy for breakfast (cookiecrisp!) every day in elementary school messed a bunch of us up.

sexy_seedbox• 2 years ago

Not OP, but I ate sooo much Kellogg's and General Mill's sugary products in high school for breakfast (pop tarts, eggo waffles, all the disgusting cereals you can name...), but I took Centrum daily and played a ton of basketball after school. Almost 1 can of coke a day after school. No heath problems as an adult. But of course, genetics come into play as well, no overweight parents or relatives.

mixmastamyk• 2 years ago

Try a very low carb diet. Only eat until 80% full at mealtime. Get down to two meals a day, with a goal of only one. Fast the other times. This sounds hard but once you get to ketosis it is not that hard at all. Not hungry naturally, like the drug response.

Truth is, we really don't need more than one meal a day (maybe a snack) when we get older and our metabolism slows.

refurb• 2 years ago

And you know what it is? It's volume. I eat too much.

100% this.

I lived in Asia for a few years and obesity is rare (though increasing for youth). It's not like they get more exercise (most people don't) or eat healthy (it's mostly carbs), but 100% portion sizes.

I see people who work manual labor jobs eat lunch that is a bowl of noddles, a few thin slices of chicken or pork, and a few veggies. I highly doubt it exceeds 500 kcalories. It's probably half the portion size you'd get in the US.

Mystery solved. If you're only eating 1500 to 1800 kcal per day as an adult male doing manual labor, it's pretty obvious why you're at 10% body fat.

coffeebeqn5• 2 years ago

It's probably half the portion size you'd get in the US.

A lot of the sides in your average US restaurant is easily 1000kcal on its own

wiseowise13• 2 years ago

Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

For the same reason why skinny person taking steroids is frowned upon - it is perceived as a shortcut.

cthalupa30• 2 years ago

Supra-physiological levels of testosterone and steroids have incredibly well known and well researched short, medium, and long term side effects. They've been well known for forever.

In an alternate world where steroids had a good safety profile, it would be ridiculous to not use them if you were looking to add on muscle mass.

unraveller• 2 years ago

Anyone can list 50 no-no things they don't eat and omit the 5 types of foods they do choose that causes the most damage. Volume & variety are not to blame given most sauces are calorie dense. The issue generally is the person eating for pleasure conflicting with their stated aim to eat for weight maintenance.

If it tastes good spit it out. Countless people ready to tell you no sacrifice is needed in that domain but they have something to sell or trade.

pgwhalen• 2 years ago

In my experience, as someone who has gone on a small weight loss journey, you can eat things that taste good, you just have to eat less of them and more rarely.

static_motion• 2 years ago

It's volume. I eat too much.

Bingo. I've had this conversation with my girlfriend. She's not overweight by any means (160 cm ~55 kg) but I am quite underweight (182 cm, 65 kg, < 10% body fat) and the conclusion I've arrived at regarding our differences in body composition is because she routinely eats 1.3x to 1.5x the amount I eat. We both exercise and eat little junk food.

I'm convinced it has to do with upbringing. My family never ate a lot and the portions I was served as a kid weren't big. Nobody in my family is anything more than skinny. Her family however, they eat a lot (and healthy too, mind you). This is all influenced by other factors, her parents and grandparents grew up with not a lot to their names and with food scarcity, so when they reached a position in life where they could comfortably afford to eat they gained the habit of having big meals. My family was mostly more privileged in that regard so maybe they never felt the need to focus on food as much.

scotty793• 2 years ago

We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.
...
Yet... the number on the scale kept on creeping up.

That is absolutely terrifying. What oils did you use for cooking?

risenshinetech• 2 years ago

And you know what it is? It's volume. I eat too much.

Have you considered eating less?

hilux6• 2 years ago

Living a healthy lifestyle, so that you won't need Ozempic, is possible - even surrounded by all the drugs and booze and carbs.

I do it. Lots of people do it. The information is freely available, now more than ever.

From all I've read, Ozempic isn't a silver bullet, and has many side effects. It just helps people stave off the inevitable for a while.

pixl9713• 2 years ago

Well good for you, aren't you special...

Now what about the other 74% of the population.

You ever hear the saying "If you owe the bank $1000 dollars, that's your problem. If you owe the bank a million it's theirs"

This is a public health epidemic and no matter how much you scream "But I'm special" the rest of the world is going to fall apart around you. And yes, this issue is spreading to the entire world and not just the US.

hilux6• 2 years ago

no matter how much you scream "But I'm special"

You are deliberately missing my point: I'm not special.

Go back to reddit, where they appreciate your "style" of discussion.

wiseowise13• 2 years ago

and no matter how much you scream "But I'm special"

Literally opposite of what they’re saying. You’re the one who screams “I’m special, diet and exercise don’t work on me, I’m defying physics”.

Someone12344• 2 years ago

The population level statistics show that you're the exception and not the rule. Obviously if the side-effects are unpleasant, the alternative health implications must be even worse: Which they are.

hilux6• 2 years ago

This may sound cynical, but I believe it is also factual: in a capitalist society, generating revenue by making people sick (junk food), and then generating more revenue by curing them, and finally making a big pile by keeping them alive for a few more weeks, is the way it's "supposed" to work.

If everyone stayed healthy and then peacefully died one day in their sleep, I can't imagine how many $$$trillions that would remove from the US economy. (I know, there's an argument that healthy people would find other ways to generate revenue, but we have no path to realize that.)

Of course, a century of non-capitalist societies don't have a great track record either!

sureIy• 2 years ago

The information is freely available, now more than ever

You have to believe it to find it.

Noise is everywhere, now more than ever. I think finding proper information is going to be exponentially harder.

A couple of days ago I was "fighting" on Reddit about something that is as clear as day, with proof and all, with people who were completely sure of the opposite (side note: this is when I deleted my Reddit accounts)

hilux6• 2 years ago

Oh, I agree with you.

I just read that MTG and other Republican operatives are tweeting that hurricanes are created by the US government; now the MAGA want to kill meteorologists.

And despite all this, Trump has a 50-50 chance of winning the election.

DavidPiper• 2 years ago

The information is freely available, now more than ever.

Given the progress of the threads here, do you have any recommendations for cutting through the noise and finding good scientific information on weight loss, healthy eating, lifestyle, etc?

I agree with you that all the information is out there, but there seems to be an enormous amount of resistance in the threads here to threads to even simple things like:

- Fresh fruits and vegetables

- Lean proteins

- Cut out processed foods

- Cut out smoking, rec. drugs, and booze

- Eat less in general

- Stay hydrated - water is the only drink you really need

- Find ways to move more, esp. for people with sedentary jobs / lifestyles

- Sleep more

- Reduce stress

hilux6• 2 years ago

I don't have a silver bullet of health advice. Your list looks good.

The only things I'd change (what works for ME) is to reduce fruit (sugar). But if I could eat fruit all the time, I would.

And I eat as much fat as I want, definitely not just lean protein. Food should taste good!

And I practice intermittent and (sometimes) extended fasting. Dr. Jason Fung is an excellent resource.

You have to find what works for you. But for the majority who are overweight and obese while also on multiple meds and maybe also in pain and also self-medicated on booze and weed ... well, IMHO that's not really "working."

xkbarkar• 2 years ago

Disclaimer I have never been obese or suffered obesity.

If it was easy no one would be fat. The whole body acceptance movement is a sham and always will be. We dont find obesity attractive and we do not want to be obese. However for some reason 60% of us in the west are overweight. And it is extremely hard to lose the kilos. We are eating too much and we shame eachother for eating small portions or skipping meals.

But put simply, we have normalized large portions and eating five times per day.

And its super hard to cut the volume after a lifetime of large portions and eating ever two hours nonsense.

I sympathise with obesity sufferers and hope that the outcome of all of this is to normalise smaller portions and fewer meals again.

Cyclone_• 2 years ago

Well the title is a little silly even if it's meant to be provocative. There's a limit to just how many people would benefit from the drug, since those who exercise frequently enough wouldn't have the need for it ever.

dcchambers• 2 years ago

I hate that we are obsessed with treating the symptoms of our issues instead of the cause.

bitcoin_anon2• 2 years ago

If you treat the cause, the symptoms go away along with a possible stream of revenue for the "health" care industry.

rootusrootus46• 2 years ago

I feel the same way about heart disease and cancer.

Actually, no I don't. God bless modern medicine.

goshx2• 2 years ago

My wife was interested in taking the Ozempic route, and I am not fond of drugs.

We then started intermittent fasting together as a lifestyle, and it's been great. Losing weight while not restricting what we eat and feeling great as our body adapts and doesn't let us overeat. I just wonder about the long-term effects, but I'd rather take this risk than a drug like Ozempic.

seanthemon• 2 years ago

We did this, this happened to us: after a while you or her may get extremely obsessed with food and eventually get to the point where you overeat as a form of 'freedom' until you just can't stop.

IF works until it doesn't, then it REALLY doesn't work. My wife had a breakdown before we realized something was incredibly wrong. YMMV.

goshx2• 2 years ago

Thank you, I’ll pay attention to that.

rootusrootus46• 2 years ago

I've never been more insufferable and hangry than when fasting. I'm glad it works for you.

bitcoin_anon2• 2 years ago

The American Academy of Pediatrics suggests starting children on weight loss medication as early as 12 years old:

https://publications.aap.org/pediatrics/article/151/2/e20220...

The farmers are subsidized to grow the corn. 10% of SNAP benefits are spent on sugary drinks. Yet we're expected to believe that these children were born w/ the chronic disease of obesity and they'll need to be on these drugs their whole lives.

cdchn• 2 years ago

Obesity rate in the US has started to decline and it sounds like they're largely attributing it to ozempic et al.

aayala• 2 years ago

just eat healthy and be active

Animats• 2 years ago

Novo Nordisk just settled with Viatris, a company which was trying to have the Ozempic patent cancelled.[1] That would have killed their monopoly. "Terms of the settlement are confidential".

They just did the same thing with Mylan.[2]

And may have done something similar with Rio Pharmaceuticals.[3]

The Federal Trade Commission is also fighting that.[4]

[1] https://www.reuters.com/legal/litigation/novo-nordisk-settle...

[2] https://iplaw.allard.ubc.ca/2024/10/08/settlement-of-patent-...

[3] https://www.pacermonitor.com/public/case/52064967/NOVO_NORDI...

[4] https://www.cnbc.com/2024/04/30/ftc-challenges-patents-held-...

Retr0id• 2 years ago

As far as I can tell, the intended meaning of the question in the title is "how long until everyone who wants Ozempic can have it?".

But at first I read it in a more cynical and sinister way, the more literal interpretation - how long until everyone is on weight loss drugs?

In a world where such medications are normalized, fast-food/processed-food companies might just work harder to make their products more addictive and pervasive, and then we're all back to square one.

bobro2• 2 years ago

Seems like all the incentives have been in place for us to have already maximized food addictiveness. We have to at least be pretty far up the S curve. I’d guess just the opposite actually, that companies will refocus on the healthfulness of their products now that customers aren’t as susceptible to the addictive aspects.

bowsamic2• 2 years ago

I just calorie count. It's very easy and effective

sethaurus• 2 years ago

Those of us who find calorie-counting easy and effective are the blessed few. Most people appear to find it even harder than other behavior-change approaches to weight management.

nostromo2• 2 years ago

For the longest time people argued if overweight people ate too much or not. I’ve heard plausible sounding arguments on both sides.

It seems Ozempic has answered that question decisively, no? The solution to being overweight is eating less in almost all cases it seems. And feeling less hungry with Ozempic can help get you there.

rootusrootus46• 2 years ago

For the longest time people argued if overweight people ate too much or not.

Maybe uneducated people, but when was the last time anyone seriously doubted that excess calories make you fat? For serious people the discussion has always been about how to reduce the calories, because "just eat less" is provably ineffective. Simple minded people continuously suggest otherwise, but data really doesn't support their intuition at all.

nostromo2• 2 years ago

It’s never been as black and white as you’re saying.

Lot’s of medical practitioners will even advise you that it’s the quality of food you eat, more so than the quantity. Look at all the published research around processed foods and ultra-processed foods.

Other nutritionists will advise you that obesity is all about your macros. And that if you want to lose weight you need to increase fat and protein intake and limit carbs.

Others have argued it’s less about diet and more about exercise and having an active lifestyle.

There’s also a bunch of research showing that poor sleep might cause obesity.

Ozempic seems to have thrown all that out the window and says that one just needs to eat less if one is overweight.

Ferret74464• 2 years ago

when was the last time anyone seriously doubted that excess calories make you fat

There's quite a few people here on this page.

Although part of the problem is poor word choice. Eating less absolutely works. Telling people to eat less absolutely doesn't work, because people won't do it (if they did do it, then it absolutely would work).

tananan• 2 years ago

I hope that these drugs pull people back from nasty habits such that they eventually build the strength to do without them. As of yet, I do not see why it has to be a win-lose situation one way or the other. Crutches aren't evil - they are expedient while they are expedient.

Sometimes when you have a really strong habit, it becomes really hard to imagine yourself being otherwise. I welcome anything that helps people see beyond a prison they've put themselves in, as long as it doesn't put them in a worse prison.

Does Ozempic or whatever put one in a worse prison? This seems personal, and not a categorical matter.

Those who take it have a choice of how to develop their sense of identity in relationship to their treatment. It is here where the rubber hits the road - these abstract extremes of "you're suppressing your ability to grow" and "you're hopeless without it" are short-sighted and serve no good purpose.

archsurface4• 2 years ago

I don't share the American enthusiasm for pharmaceuticals. Exercise and healthy eating. I also don't have the other issues mentioned. Maybe the title is a bit clickbaity and I shouldn't be taking it so literally.

0xcde4c3db2• 2 years ago

I think we desperately need to answer the question of why GLP-1 agonists are so effective, and particularly whether it's counteracting something in the environment that has been acting to reduce GLP-1 (or other glucagon-related pathway) activity without us realizing it. The obesity data practically screams that something happened in North America ca. 1980 that messed up our metabolisms, and it may have spread to Europe after a delay. Unfortunately, it seems like one of those things where there are various people with pet theories and little substantial effort to get to the ground truth. Perhaps the inevitable search for "me-too drugs" will uncover something.

avelis3• 2 years ago

One aspect is that the US food system as a crap ton of UPF.

rootusrootus46• 2 years ago

How does that cause the rest of the world to also have decades-long steadily increasing obesity rates?

everfree• 2 years ago

UPF means "ultra-processed foods", in case anyone else had to look it up like I did.

rootusrootus46• 2 years ago

Europe has been climbing at a steady rate since at least 1975.

https://www.europeandatajournalism.eu/cp_data_news/europe-fa...

codersfocus2• 2 years ago

Glyphosate was introduced around that timeline.

asciimov• 2 years ago

Coke and Pepsi started using HFCS in 1980.

I’d be curious about side effects of the Depression and WW2 that took an extra generation to show up.

0xcde4c3db2• 2 years ago

I’d be curious about side effects of the Depression and WW2 that took an extra generation to show up.

While there might be a time span involved that could be described that way, as far as I've read there weren't any statistics that were "generational" in the usual sense of the term. Obesity rates started rising among all age groups at roughly the same time.

reducesuffering• 2 years ago

One very understated aspect that I haven't seen brought up:

If part of the obesity epidemic is trying to consume food to make up for nutrient deficiencies, these drugs will only worsen these nutritional deficiencies. You'll lose weight short-term, but long-term sabotaged your body trying to attain these. We've seen declining vitamins and minerals in natural food (industrial produce growth). Maybe some people make it up with a heavy supplement regimen, but I wouldn't be surprised to see a lot of now-normal-weight people on Ozempic having major health problems due to increasingly deficient Vitamin A (already 51%), K (71%), E (94%), Magnesium (61%), Potassium (97%), Calcium (49%).

rootusrootus46• 2 years ago

If part of the obesity epidemic is trying to consume food to make up for nutrient deficiencies

Is there evidence to support this hypothesis?

throwaway918299• 2 years ago

My friend and my father in law both went on it. They both became suicidal and had to stop. YMMV but that’s enough for me.

Eat less. Move more.

aucisson_masque4• 2 years ago

So basically eat shit and then take drugs to lose the weight you accumulated because of your bad diet ??

Am I the only one to realize how this is so wrong?

You would think When a pipe leaks, you fix it. You're not going to put a basin under it, empty it every day, pay for a new basin every few week and continue to have your damn pipe leak.

Oh man... If only you could teach people how to eat better instead.

rootusrootus46• 2 years ago

Am I the only one

No, definitely not. There's a few of you in this discussion.

leoh• 2 years ago

You are wrong because being overweight means that your endocrine system is very messed up and can make it extremely difficult to make meaningful changes to your diet and habits. Take a look at the preponderance of folks who have taken GLP-1s here and have affected tremendously positive changes to their diet and exercise habits.

aucisson_masque4• 2 years ago

Being overweight doesn't prevent you from putting less junk food in your mouth, and instead eating vegetable.

OfficeChad• 2 years ago

If only you could commit suicide...

siliconc0w• 2 years ago

It's pretty crazy to me that that we aren't already all on Ozempic. The cost to the country for all chronic conditions obesity causes will bankrupt the country. Insurers should basically be forced to cover all the downstream costs their policies create or they'll continue to kick the can.

Ideally we didn't addict our country to cheap junk food but that ship has sailed. If it were up to me I'd tax the shit out of any company selling a product with more than five grams of sugar and use that to buy the patent to tirzepatide and make generic medications available asap.

artursapek4• 2 years ago

I'm old enough to remember when "weight loss pills" was a cliche punch line. Thank God there's no way these miracle drugs will turn out to have some terrible long-term side effects!

xunil2ycom• 2 years ago

Are we all diabetic? Because that's why I'm on it.

Waterluvian• 2 years ago

I’ve lost 40lbs this year since I started trying. All I did was cut out breakfast and only ever eat if I feel hungry.

Thr first few weeks were hard. My body was hungry all the time. Now I feel hungry far less. I don’t get hungry until noon.

The problem is that if I ever cheat and pig out, like, say, this Thanksgiving weekend, it resets and I feel a week or two of miserable hunger again.

If I could cheat my brain in any way, it would be just not feeling hungry until noon, regardless of past actions.

snvzz4• 2 years ago

If I could cheat my brain in any way, it would be just not feeling hungry until noon, regardless of past actions.

Not eating too close to going to sleep suffices. I'd set the minimum at a good 4h.

ilikeitdark• 2 years ago

Drugs rule.

tightbookkeeper3• 2 years ago

HN must be aging.

se4u• 2 years ago

The real fun will be when there is enough of this chemical in our waste runoff that cattle and wildlife gives up eating

smugma• 2 years ago

Many in the thread have asked “why get off the drug?”

Regeneron is pursuing its own version of a magic weight loss drug and is arguing that the current batch of GLP1 drugs reduce muscle mass, which is one of the most important things to maintain as one passes middle age (comorbidity etc.)

https://www.ft.com/content/094cbf1f-c5a8-4bb3-a43c-988bd8e2d...

The co-founder of Regeneron has warned that blockbuster weight-loss drugs could cause “more harm than good” unless the rapid muscle loss associated with the treatments is solved...

Clinical studies suggest that patients treated with the new class of weight- loss drugs, known as GLP-1s, lose muscle at far faster rates than people losing weight from diet or exercise, exposing them to health problems, said George Yancopoulos, who also serves as Regeneron’s chief scientific officer.

p1dda• 2 years ago

The number of 'smart' people in this thread advocating for the use of a drug instead of doing the obvious which is STOP EATING JUNK FOOD is staggering. Also the article is nothing more than a pharma ad. Idiotic and corrupt.

gcanyon2• 2 years ago

To anyone thinking that exercise will fix anything: I've owned a Concept 2 rowing machine since 2005. In that time I've done an average of 100 workouts per year, for a total of over 35 days of rowing. Some workouts were relatively easy 120bpm heart rate; some were at a relatively brutal 160bpm. Concept 2 estimates I've burned just over 600,000 calories, or about 1,000 Big Macs. Could I have eaten 1,000 Big Macs in 19 years? I think so.

throwaway7439502• 2 years ago

"You can't outrun a bad diet."

wiseowise13• 2 years ago

I've owned a Concept 2 rowing machine since 2005.

Well here’s your problem. You should’ve bought barbell 20 years ago. Or at least a couple of kettlebells.

gcanyon2• 2 years ago

I've had kettlebells, and I've lifted weights. But to be clear, I never said I have a "problem" -- I have a reasonable weight, and at times I've been in the top half of the worldwide rankings on Concept 2's site. I'm just saying that rowing isn't (solely, if we're going to be picky) the reason I have a reasonable weight.

tiffanyh• 2 years ago

WFH & being sedentary

Since WFH, it’s scary to me how sedentary I have become.

It wouldn’t surprise me if I now walk < 1,000 steps per day.

I can easily go a couple of days and never even leave the house.

My waistline shows it. And I’m actually eating less than I did when I went into office.

I guess its basic thermodynamics.

naming_the_user• 2 years ago

The headline here seems like an extremely baity one.

A ton of people don’t have this issue at all. I hesitate to say “most” because both in the US and UK it seems the majority do.

But it still feels like a hack to me. The issue seems like it’s that most people are now basically sedentary. So we can solve the excess hunger via drugs, but is that really what we should be doing?

It feels to me that if we must have a wonder drug - it’d be one that gets people up and about and enjoying exercise. It seems really sad to me that so many feel that their physical form and embodiment is an annoyance rather than the gift it truly is.

llamaLord• 2 years ago

I find it fascinating how many things like this just completely gloss over the fact that some people have side-effects to these drugs that make them completely non-useable, and often it's some of the people who could most benefit.

I have ADHD, and have tried all the current generation of these drugs and absolutely CANNOT take them, they basically prevent my ADHD medication from working and I end up depressed and wanting to kill myself.

This idea of these drugs being a "cure-all" that we'll all just be taking one day proactively scares the shit out of me, because I worry it will mean that medical science will stall (as far as it relates to these types of conditions) for those of us who simply can't take these drugs.

cashsterling3• 2 years ago

If you are on a weight loss drug like Ozempic, make sure you are doing resistance training. Ozempic reduces your appetite and help you go into a calorie deficit. Bone mass, muscle mass, ligament and tendon mass can all suffer on a calorie deficit unless your body is get regular stimulus that 'muscle, bone, and connective tissue strength are still important.'

Also, changing your diet while on Ozempic to (1) cut down carbohydrate intake and (2) include more healthy protein (meat, eggs, fish, etc.), fats (nuts, olive oil, etc.) and fruits/veggie will supercharge your weight loss and your overall health gains.

hnburnsy2• 2 years ago

Ozempic is just scratching the surface, the pipeline is bursting...

...combinations of GLP-1 with other entero-pancreatic hormones with complementary actions and/or synergistic potential (such as glucose-dependent insulinotropic polypeptide (GIP), glucagon, and amylin) are under investigation to enhance the WL and cardiometabolic benefits of GLP-1 RA.

I count 18 or so here...

https://www.nature.com/articles/s41366-024-01473-y

jart5• 2 years ago

Thanks for sharing that link. Retatrutide looks especially promising since it targets three different receptors (GLP-1, GIP, and glucagon) instead of just GLP-1 like Ozempic. This triple action appears to have a more comprehensive effect on metabolism. So it may increase energy expenditure in addition to reducing calorie intake. This drug also showed significant improvements in lipid profiles, blood pressure, and liver fat reduction. If all goes well we should expect to have it in 3-4 years.

cthalupa30• 2 years ago

There are some concerns with retatrutide - it's popular among the bolder people willing to buy it as a research chemical, and both their reports and the clinical trials do show significantly higher resting heart rates as a common side effect.

Not a huge deal for people that have good heart health already, but since obesity tends to cause poor heart health...

I expect we'll still get it approved for weight loss use, but it'll be one that is going to take more observation on the patients using it

at_a_remove• 2 years ago

I long for something that would help me. I have a rare metabolic disorder where the recommendation is high carbohydrates, very high, and to never diet. Even a ten percent reduction in caloric intake can end in hospitalization, during which I am put on a frankly enormous amount of glucose or sucrose, among other things. The end result has been an insidious weight gain. Exercise? Well, aside from the fact that you can't outrun your fork, it sets off the same metabolic pathways that caloric restriction does and I am back to square one.

switch0072• 2 years ago

Stupid question but I wonder if the side-effects are a partial contributor to its success: feeling nauseous, upset stomachs, bloating, acid reflux etc? And are there similar, cheaper supplements/drugs that can induce nausea etc?

I know my appetite falls off a cliff if I'm nauseous/have an upset stomach/suffering from reflux.

hippich2• 2 years ago

From my experience, it is probably contributing, but certainly not the major way glp-1 work. And I certainly had periods where I would overeat while already feeling bloated or nauseated. Glp-1 certainly does something to the body, that regulate eating on hormonal or neuronal level.

ornornor2• 2 years ago

FWIW, junk food makers are thinking up new ways to stay relevant and still sell a modified version of their junk foods adapted to people on GLP-1 medicine… Nestle, Mondelez, etc are all scrambling to do so. Here is an article (in French) on the matter: https://www.letemps.ch/economie/ozempic-wegovy-mounjaro-nest...

martin82• 2 years ago

Don't think the hype will last long at all, since this ridiculous drug has extremely bad side effects, and works by enriching the body with millions of small fat cells that are all ready to blow up the moment you stop taking the drug. Or in orher words, it's a trap. If you take it, you have to take it forever and suffer extreme side effects, if you stop taking it, you will turn into a fat pig, worse than before, and you gained nothing.

It absolutely boggles my mind to always see Americans swallow everything and anything that big pharma serves them. It's insane behaviour.

Rnonymous• 2 years ago

What side effects?

Blowing up fat cells?

I was "find this page" for side effects, but see little discussion about them. So am honestly intrigued, and would love to hear more.

profmarshmellow2• 2 years ago

It disables your stomach... its like taking PPIs for gerd only to later find out the problem was low stomach acid and now your acid production capability has been permanently damaged by meds

ropable• 2 years ago

Up until the point where our modern food environment changes radically - the more people who need it and can take it, the better.

sirsinsalot3• 2 years ago

Seems to me this drug is an antidote for an unregulated capitalist system creating an environment that preys on the human condition and as a result makes people unhealthy.

It's just now selling you the antidote to the problems it made. Profit.

grimblee• 2 years ago

The absurdity of creating a drug to curb obesity instead of forcing industrials to make food healthier. The ravage of corruption, sorry lobbying, still killing us all for greed.

bravetraveler2• 2 years ago

Eternity, unless it's pumped into the water supply

wwarner• 2 years ago

Love this forecasting methodology

fredgrott2• 2 years ago

Okay, how I found out about berberine being over the counter...this medical article and study

https://pubmed.ncbi.nlm.nih.gov/34981502/

Imagine only spending $11 with no side effects to spending $300 and up with major side effects.....

hippich2• 2 years ago

One trend I noticed, whenever this topic is discussed in public forums, it attracts a lot of negativity from "just exercise and eat less" crowd (generalizing here). I wonder why it caused so much negative reaction? On the surface it shouldn't matter much, since it does not appear to harm ones who found a way to maintain healthy body without drugs. Yet it reliably causes a quite noticable number of folks to be quite aggressive towards either people using these drugs or companies making these. (Similar trend can be seen in other drugs like THC for example)?

GaryNumanVevo• 2 years ago

Personally, I'd never take Ozempic. I agree it definitely makes the 'eat less' goal achievable almost automatically for most people. But I think there's a real downside which is that any rapid weight loss will take muscle and bone density with it. Typically when you're using exercise to lose weight, you'll naturally end up building some muscle mass back. I think the side effects for people who take the drug and stay sedentary is going to be disastrous.

sp527• 2 years ago

I wonder why it caused so much negative reaction? On the surface it shouldn't matter much, since it does not appear to harm ones who found a way to maintain healthy body without drugs. Yet it reliably causes a quite noticable number of folks to be quite aggressive towards either people using these drugs or companies making these.

It's a combination of people thinking it violates the 'no free lunch' axiom of the universe and also deriving significant personal status and satisfaction from exerting discipline in eating and exercising religiously.

The 'no free lunch' axiom is a curious thing and seems derivative of western Puritanism and similar philosophies. It violates many people's intuitions that very good things might be obtained with relative ease, and also devalues said things. Some of these are the same people who cannot comprehend (or even accept) a post-singularity world without work. The peculiar morality that produces that belief overlaps rather substantially with the one that rejects the possibility of an easy solution to the problem of obesity.

Further, some of these people have the (perhaps unconscious) belief that they are morally superior to others who are less dedicated to health and fitness, and in particular to the obese.

If obesity can be resolved so fluidly and categorically, then at least two painful things happen for them: (1) their excessive effort towards weight control seems foolish and inefficient (i.e. devalued, as noted above) and (2) they lose a great deal of personal status. The latter is a consequence of the reasonably established notion that a significant proportion of many peoples' happiness is contingent on their relative frames of reference (i.e. not their position in an absolute sense). Again, this is often unconscious. These are not "bad" people, but rather merely victims of human instinct.

cdrini2• 2 years ago

Obesity rates are on the rise in all modern countries, and although the rate of growth is different, in no country does it show any signs of slowing down.

https://ourworldindata.org/grapher/share-of-adults-defined-a...

Are these drugs good? I'm not sure, but I think a lot of these drugs seem to be reducing how much people eat -- helping people break from the life time of bad habits they've learned since childhood from their parents/friend/media/fast food industry. I don't know if eating habits in childhood can embed themselves as permanent alterations to the person's biology, like myopia in eye sight. But if it does, then these drugs might be the "glasses" equivalent for metabolism/eating. Citation needed. But if so, then let's see if we can learn from our mistake with how glasses are perscribed, and instead of leaving children in the same environment that results in the development of the same diagnosis which will then require them to also take ozempic/use glasses/etc, and instead raise them so that they never develop the problem in the first place.

Note: even the myopia link is still being researched I believe, but more papers seem to be showing this potential relationship.

Variables:

- unhappiness increasing (citation needed)

- low income people buy cheap, processed food

- middle class people eat out at restaurants more since they can afford it

- upper class people likely the healthiest?

- unhealthy processed foods have become regular standard snacks (eg chips, cola) taking the place of healthy snacks like fruits/veg

- portion size increases in the home and at restaurants

- the fast food industries incentive to get people to eat more

- people developing bad eating habits at young ages, which are significantly harder to break later in life and could potentially result in permanent changes to metabolism (similar to how myopia has been linked to children spending a lot of time inside/books/screens)

- low availability of healthy fresh food -- when was the last time you got fruit as a snack in the middle of the day? Or for dessert?

- reduced mobility; sitting jobs, order to your door, work from home

cdrini2• 2 years ago

Some chat GPT research on some of the citation needed claims. There are some potential biological pathways, but more research needed to verify if/how these are actually applicable: https://chatgpt.com/share/670a798d-6abc-8012-bbf8-3b55a09f0b...

LinuxBender• 2 years ago

How long til we're all on Ozempic?

Just my own preference but I stopped doing tinker drugs some time ago and focus on things that make semi-permanent changes even if they are much smaller incremental changes. I call any drug that tinkers with feedback loops a tinker drug. An example for me personal was hypertension. I focused on finding the root cause which took a long time but now if I can't get a hold of the things I used to make changes I don't have to worry about a hard rebound swing back to and beyond where I was, something that BP drugs did when I could not get a hold of the drugs because of doctors screwing with me.

For weight I went with Berberine, prolonged fasting and paleo. It's slow but steady and for me personally slow and steady has been winning the race without side effects. That's just my methodological preference and not meant to be any form or fashion of advice for anyone else. I support people doing whatever they find works for them. This was just my long way of answering the question.

indigo0086• 2 years ago

Not a surprised that in the land of the obese (mostly by choice), weight loss poison is deemed a miracle drug

AbstractH24• 2 years ago

We were having the same discussion 5-10 years ago about Metformin. Just saying

How long til we're all on Ozempic?

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