> Suboxone is a compound of two drugs that decreases one’s cravings for opioids while blocking their effects. It is safer and less cumbersome than methadone, which requires daily or weekly visits to a clinic, and more effective than any abstinence-based treatment, which requires people to withstand cravings and suppress physical discomfort.
This highlights one of the issues I have with articles like this about Ozempic at this current moment - this glosses over something major with these two particular drugs. With methadone, yes, it will keep you off of heroin, but you'll also likely never, ever get off of methadone because the withdrawal is 1) just as horrible and severe as heroin and 2) can last months. To the point where you'd almost be better off just kicking the heroin the "old fashioned" way. suboxone is similar - the drug isn't without side effects either. Of course, that isn't to say these things aren't useful - to have a methadone/suboxone dependency is way preferable to heroin addiction.
My only real point is that we should wait to see what long term side effects these drugs have before calling them miracles and glossing over their down sides, because I think the end effect of that is counterproductive to medicine. I'm always immediately skeptical as to what drugs pharmaceutical companies are pushing out, due to the history I've witnessed so far in my lifetime.
That all said Ozempic probably would've saved a relative of mine's life. In the end, they'd likely not care about the side effects all that much.
> I'm always immediately skeptical as to what drugs pharmacies are pushing out
Major nitpick here. Pharmacies aren't pushing anything. Pharmaceutical companies are pushing these drugs.
Worse yet, independent pharmacies have only been losing money selling GLP-1 agonists. Insurance companies have begun to collude using pricing networks. They claim that the market value that pharmacies get the drugs for is too high, even though they are still patented and brand-name, so the insurance and pharmaceutical companies together are the ones that set the price. Then they refuse to reconcile the cost minus the deductible. Last I knew, it was about -42$ on a month prescription.
Pharmacies are absolutely pushing stuff, the DOJ has repeatedly investigated and fined pharmacies for things they did during the opioid epidemic. The entire industry is so incestuous that it's almost not even worth distinguishing as if the singleton Mom and Pop drug stores still exist, even if they do in some form these days.
Walmart, Walgreens, and CVS? You mean those small pharmacies--two of which also contain insurance companies, and the other one still has its own clinics?
Pharmacies can only give out what people are prescribed, the only things they can push are OTC products. They can't get and sell scheduled drugs without being explicitly tracked.
But you're right about health care in the US. We need a single-payer system to get prices lower, but that means fairness and cutting out unnecessary costs. The whole health insurance industry would cease to exist, and all the people abusing it don't want that to happen.
Cost Plus Drugs exist because the mega pharmacy chains have been colluding to keep prices of both patented and generic prescriptions artificially high. They're not pushing medications (that would require a physician's approval), but they are extracting money from patients once their doctor has done that.
Another problem with OTC is that it leads to healthcare discrimination based on income and insurance quality since these are often not covered.
The US desperately needs to do away with for-profit health insurance and mega hospital corporations, severely limit the patenting and absurd profiteering in pharma, and replace Medicaid and Medicare with better single-payer, universal healthcare like the rest of the world does more cheaply and with better outcomes.
> Pharmacies can only give out what people are prescribed, the only things they can push are OTC products. They can't get and sell scheduled drugs without being explicitly tracked.
I think they can - specifically, the pharmacies that mix drugs locally can mix and sell a drug that's declared in shortage. IIRC Ozempic was in that situation recently.
You mean compounding? They are allowed to dilute to create a specific strength or combine constituents, but they can't actually create stuff from scratch on site any more than you or I can. That would be a laboratory. It's not like you can just buy semaglutide or the derivatives anywhere. It would have to come from the pharmaceutical company.
I looked it up, and I believe what you've heard about ended up just being people offering fake Ozempic.
You're right, I was thinking about compounding pharmacies.
> It's not like you can just buy semaglutide or the derivatives anywhere. It would have to come from the pharmaceutical company.
Pharmaceutical companies don't make those on their own either, they're contracting it off to drug manufacturing plants. The thing I read the other day said that compounding pharmacies order the same stuff from the same factories directly.
We actually have a lot of data on Ozempic and GLP-1s generally, going back to the first GLP-1 FDA approval in 2005:
• Exenatide - FDA approved in 2005
• Liraglutide / Saxenda - FDA approved in 2010
• Dulaglutide / Trulicity - FDA approved in 2014
• Semaglutide / Ozempic/Wegovy - FDA approved in 2017
• Tirzepatide / Mounjaro - FDA approved in 2022
Ozempic / Semaglutide was FDA approved in 2017, but clinical trials started in 2008. That was 16 years ago. Obviously it's always possible there are even longer term side effects we're unaware of, but generally if this class of drug caused large scale problems for kidneys, liver, etc, we'd likely know by now.
>of course, that isn't to say these things aren't useful - to have a methadone/suboxone dependency is way preferable to heroin addiction.
Heroin will cause you to be sick.
Suboxone will make you go into a blind rage so manic you will never find yourself without it.
For those who actually "need" Suboxone, it is a magnitude easier to taper off of than the reasons for needing it - unfortunately a medical system with perverted incentives shrowd how (read: trivially, comfortably) easy it is to start and taper off of Suboxone, even from literally incredulous depths of synthetic opiate addiction - sometimes without even as much as a single iota of withdrawal.
It is literally easier to start and taper with Suboxone without Big Pharma - with no paper work inhibiting your and jeopardizing your future in perpetuity, as a nice perk.
Recreational suboxone use makes fentanyl look like a child's game.
Methadone, however well-intentioned, or altruistic in its creators' motives, is a resignment to the inevitable life-long dependency. Chemical handcuffs.
> Methadone, however well-intentioned, or altruistic in its creators' motives, is a resignment to the inevitable life-long dependency. Chemical handcuffs.
It’s of course less common these days but back from what I remember 20 or so years ago they did not inform patients very well to this reality. My experience was not for addiction, but was prescribed 10mg methadone daily for severe chronic pain, took it for a few years - that’s a relatively small dose and I cannot tell in plain English words how awful it was getting off of it. Tapering does not really work, the smallest reduction in dose will send you into just as severe withdrawal symptoms as if you cold turkey’d. I ended up buffering the withdrawal with tramadol, which was the only other thing I could take, but the entire process lasted about 6 months til I felt entirely normal again and the first month was 24/7 full blown acute withdrawals.
I’ve since quit smoking cigarettes and laughed at how easy it was in comparison.
They are a 2nd-best alternative to just doing the work to change your behavior.
If you are overweight, eat less/eat better and exercise.
If you are addicted to alcohol or drugs, quit.
Those are the ideals. If you can do those things it's better than depending on chemicals that for-profit pharmaceutical companies would love to see you buying for the rest of your life.
But if you can't do those things, it's probably better than continuing the status quo. Better to pay Reckitt Benckiser than support some criminal fentanyl dealers. I feel that many people have never really tried, or tried but did not appreciate that it would be really hard, and gave up.
I have health issues, a hormone inbalance which caused havoc on my body. One of the symptoms was extreme craving to the point that I drank half a pint of diluted orange juice (one part juice, three parts water) with phyllium husk and hydrolised guar gum every hour to create goop to fill my stomach. I couldn't stand the craving. I ate lots of fried mushrooms, too (not deep fried, just a little bit of butter).
Then I asked my doctor to give me a different medicament, because I suspected a variation of a deficiency. Her answer was: I don't have experience with that medicament, but after four months she relented. One week later my craving was much, much less.
This experience astounded me extremely deeply.
I have come to the conclusion that there are some body processes, let's say instincts, that can go astray.
Compare this to drowning. Even if people know that there's only water, they try breathe. It's just too strong an instinct.
Having experienced this, I now respect obese people. They just have the bad luck that their instinct of eating derailed. Now they not only lost body fitness but also respect.
> One of the symptoms was extreme craving to the point that
I have a kidney disorder that causes me to waste potassium. Without a supplement, I can't get enough in my natural diet without eating like 10-20 avocados a day, or 6 cups of spinach.
A fun side effect of hypokalemia is that your muscles get really sore, like you just did a full body workout. So, you can literally feel when your potassium is low.
The low salt coincides with some of the most intense food cravings I've ever experienced. I don't crave foods high in potassium, however; just foods with a lot of regular NaCl. So, my body does its best to tell me I need to eat something, triggering a psychological compulsion to get it, but the compulsion is to eat the wrong thing.
I'm just one data point, but I think this might extrapolate out to more people than just me. If you're compelled to overeat, you might be missing some key nutrient that just isn't present in abundance in your current diet. The trick is finding out what it is.
Random related thought - awhile back there was a series of blog posts that got pretty popular (I can't remember the blog's name) trying to investigate the root cause of obesity. They settled on some odd conclusions, but one of the things they noted in their meta-analysis of extant obesity research is that places with lower obesity have more of a particular dissolved mineral (they asserted lithium was the root cause, but I didn't find their conclusions convincing) in their drinking water.
It could be that there are trace elements that, if you don't have mineral-rich drinking water, are otherwise hard to get from a standard diet that drive this craving behavior that I've experienced.
I am not sure but I think my body couldn't generate enough of a specific hormone and then the body's reaction was as if I was starving because that hormone is controlling the metabolism inside the organes. So, probably nothing was missing in my food but because my metabolism was low it was like I was starving but I wasn't.
quick question, do you do any physical activity? or if your hormone imbalance did not allow you to do it, now that you have a different medicament, have you started doing sport? Not just a walk in the evening, like minimum 3 times a week 1 hour of high intensity workout, possibly supervised?
Yes, I started doing a lot of hiking. Today I walked more than 2000 foot up to a hill and back and still felt fine and had a quick stroll along a river the evening. I shoot many pictures of mushrooms, and a friend told me I caught a rare mushroom (lycoperdon echinatum) and Thursday I am going up again with him because he never saw one.
that's great, but it's not proper training, it's a hike, fantastic activity but (especially growing older) our life is mostly sedentary and it helps a lot to do a proper sport or intense activity at least 3 times a week (i personally workout every day, but sat and sun, for 1 hour with a high intensity sport, not weightlifting).
The older you grow the harder it is for the system to process the amount of stuff we eat (especially high calories, highly processed food that is available nowadays) and doing a high intensity activity (heartrate up, muscular stress etcetc) is, in my opinion, fundamental and often ignored by people.
> I feel that many people have never really tried, or tried but did not appreciate that it would be really hard, and gave up.
With all due respect, this is nonsense. This is a very common trope, but I can guarantee you the vast vast vast majority of people who are obese have tried “eating less and moving more,” and that is not new advice to them. Nobody who has been obese for a long time walks into a doctor’s office going “okay I finally think I want that injection that will help me lose weight” as if they just suddenly noticed they’re obese.
There are lots of reasons they might not have been able to deal with it before, and “laziness” is not usually in the top 5. Genetics, means, access to knowledge, living in a food desert, depression, etc. are all far more likely causes.
Being obese sucks. People who are obese are far more aware of that than anyone choosing to judge them from afar.
On the topic of the obesity epidemic, it's worth noting that lab rats with controlled diets are also getting fatter over time. The leading theories are microbiome shifts or environmental contamination (microplastics?,) but afaik no conclusive cause has been found.
When people fail at health, (as when they fail at finance or addiction), a lot of propaganda tells us to blame individuals, with no sympathy or awareness of our failing systems.
Many (most?) people have a fundamental need to feel superior to some "other". This need is strong enough to the point where they'd rather be doing poorly themselves so long as there is at least some other group that's doing worse. Were you to give them an opportunity to significantly improve their own lives but in a way that everyone ends up on the same level, they'd balk.
Obesity is one of the few conditions that are socially acceptable to openly mock, and as such, it's like catnip to people who need to feed their inferiority complex.
Re: your first few sentences, I’m not sure how common this is, but I’ve heard that pedophiles in prison are frequently assaulted by the other prisoners for this reason.
(Don’t want to try to find a source for this - consider it as hearsay)
I actually think this is worse in countries with socialized medicine, because now you're not just "openly mockable" but you're also "taxing the system" with your "vice"
> We also had initial results from the FLOW trial, suggesting that Ozempic prevents diabetics with kidney disease from needing dialysis.
Between this and the 2nd order decrease in renal disease from the reduction in diabetes and high blood pressure, Ozempic would have to end up having some truly awful long term effects to net out negative in utilitarian terms.
The US spends 130 G$/yr (0.5% of the _entire_ GDP) on dialysis, and that undercounts just how awful being on dialysis is in subjective terms.
It's so awful that kidney disease is basically one of the conditions that triggers Medicare coverage at any age. It's basically one of the very few ways you can get socialized healthcare in the US.
> Between this and the 2nd order decrease in renal disease from the reduction in diabetes and high blood pressure, Ozempic would have to end up having some truly awful long term effects to net out negative in utilitarian terms.
On a population level, you're absolutely correct. But as an individual, I want to know what I'm getting into for long term effects. I might personally find them objectionable. So I'll wait and see.
Sure, but we already know the long term effects of diabetes and high blood pressure, and they are awful. By waiting to see, you are explicitly choosing to take those long term effects in an attempt to avoid the unknown long term effects of the new drug.
Obviously, it might be that the long term effects are worse, but we shouldn’t act like waiting is a zero cost choice.
I want to point out that this is a hypothetical. I don't have diabetes, and I had in mind more of its still-off-label use as an appetite suppressant for weight loss.
These drugs are not quite as new as often reported. Byetta has been around since 2005 and Victoza since 2010. The difference is that the latest iteration of GLP-1 meds are more effective, and we've discovered they can help with a lot more than just Type 2 Diabetes.
My mom was on Victoza (she has T2D). Ozempic is better for her, and more effective, both at managing her weight and her diabetes. Her A1C has gone down from over 11% (!!!!) to 6.7%.
So yeah, sure, we need more studies on long-term effects. But these aren't drug classes that have only been around since they got popular in 2020. They've been around a lot longer than that.
Moreover: we know well the drawbacks of long-term diabetes and/or obesity. It doesn't end well, on average.
> 130 G$/yr (0.5% of the _entire_ GDP) on dialysis
Why is dialysis a reasonable endpoint for comparison? How do you know that market functions properly and that prices reflect actual costs of providing service?
> to net out negative in utilitarian terms.
Life long attachments to drugs are universally negative. You only have to ask, "what happens when the supply chain is disrupted?" If you've never been anywhere where alcohol was suddenly hard to get you might not understand how hidden and pernicious these problems can be.
The cost problem will decline over time, as patents run out. The underlying drug is old.
The food industry is worried.[1] "One big concern for the industry is the importance of so-called “super consumers”, who drive an outsized share of spend. For instance, consider this recent estimate: 9% of adults drive 34% of candy consumption. Assume that one-third of those adults successfully adopt Ozempic or another GLP-1, and that’s a roughly 10% hit to category sales."
I've literally just been buying powder mixes instead of energy drinks (see: mio, crystal light, etc...) and using caffeine pills for the caffeine. I could just do plain water, but then I have that minor desire for flavor. Absolutely not necessary, but helps cut the urge for an expensive can of energy drink.
My last purchase was a 4.75 can of Gatorade flavor (not uh, low cal, alas), makes 9 gallons, far cheaper than energy drink. But you can buy low/no cal flavoring too. I think this might be the future (til they jack prices to reach parity with canned/premixed drinks cuz the market says they can).
Precisely. OTOH, I am glad that more and more are switching to sweeteners like Monkfruit rather than aspartame and the rest. (Yes, I know the jury is out on them being carcinogenic, blah blah, I don't care - I'm just glad that people seem to want to see a greater variety of sweeteners like Monkfruit and Allulose on the market)
There's some belief that diet sodas, while not as bad as sugared sodas, are not that great either. I'm sure, though, a doctor would still tell me that he would rather have me drink diet mountain dew than the sugared stuff if it came to one or another.
I started drinking black coffee and flavored sparkling waters, and frankly both are delicious now. Aspartame tastes odd. Sucralose tastes less odd. And stevia is just terrible.
I take 3mg of Rybelsus, the pill form of Ozempic, every day for diabetes. This is about half the recommended dosage, but the major side effect for me has been gastric distress...on the full 7mg daily dose I was frequently nauseous, to the point where it rendered me unable to work some days. 3mg is supposedly the dosage you start out with for a month before moving up to 7mg, but 3mg has relieved most of my stomach distress, kept my daily blood sugar numbers down, and probably helped with weight loss (I'm down 15 pounds since February, a steady reduction that started a good 3 or 4 months before starting Rybelsus). The weight loss is a bonus for me; I'm in it for the diabetes benefits. When I was on the full dose, I often felt full. The half dose has the same effect, just not as much.
Fortunately my insurance covers most of the cost; at $25 a month, it's over 2.5x higher than any of my other prescriptions, but well within my budget. We'll see how long that lasts, especially since I plan to retire at the end of 2025 and go onto Medicare.
The injectables are substantially more expensive under my insurance, and I really don't like the idea of self-injection.
The 3mg Rybelsus tablet are substantially more comfortable to use than the 7mg; minor stomach discomfort and none of the nausea I experienced with the 7mg tablets, yet my A1C is, if not quite as well controlled, definitely in the acceptable range.
> Ozempic seems to be something of a miracle. It’s a very effective treatment for diabetes as well as high blood pressure, heart failure, and kidney disease. New evidence suggests that it improves depression and reduces suicidality, and it also seems, unexpectedly, to reduce non-food-related addictive behaviors, like gambling. Studies are underway to see if it prevents cancer and Alzheimer’s disease.
reminds me of cortisone, which was also hailed (and partially is) a sort of panacea. Turned out not to be a cure for everything, and with some significant downsides, while still being a very valuable drug.
It's hard to differentiate because so many of the positive effects of GLP-1 drugs correlate so well with just... weight loss.
So in that sense, we will have to see - but if obesity and/or T2D is a trigger for lots of other diseases (and we know it is), then it would appear that fighting it effectively would help fix metabolic syndrome and many of the other diseases that are often comorbid with it.
This approach will definitely save someone's life (and probably already is) but there's no golden pill that will, long term, give a healthy, in shape, body to people without effort.
Eating disorders are a thing and often have to do with the mind or genetics, but there are so many people just letting go to cravings and having terrible habits when it comes to eating, don't want to do any sacrifice and just let themselves go for so long than it becomes a serious health issues for them.
I see plenty of parents feeding the kids like they are going to do foie gras out of them...
People eating pastries like it's chewing gum, bagels like it's a snack...
some of my American colleagues have never drunk just plain water...only sodas...and a lot of it.
I really feel like this is just the trick the food (and healthcare) industry was waiting for to allow those people to eat as much as they want and don't get fat (and possibly get ill later), and the fashion industry to push for a "cheap way" to reach beauty standards (which is why this practice has mostly became popular thanks to famous people using it).
Plus there are pretty common side effects (1 out of 10 experiences them) and it fundamentally creates a dependency to a drug, because without changing habits, if a patient stops using the drug, they'll regain the weight in a short time...
Most people think they have a condition but in reality it's just them not trying to solve the problem and complaining about it.
> This approach will definitely save someone's life (and probably already is) but there's no golden pill that will, long term, give a healthy, in shape, body to people without effort.
Why? Is there any rational reason for such pill not to exist? Just because it seems "unfair" to the people who spent more effort to achieve the same?
The whole history of scientific progress is about achieving good things with less effort.
it's not unfair, the whole history of scientific progress is to cure unsolvable things with science. this seems pretty solvable to me ;)
it's pretty much the same as giving everyone anti anxiety pills cause it's less effort than fixing the root causes.
I don't understand how this doesn't fix "the root cause".
The root cause of obesity is a propensity to eat too much. The root cause of alcoholism is a propensity to drink.
It follows some people are lucky and simply don't have this propensity. For those not as lucky, we can get rid of it.
The root cause of obesity IS NOT "eating too much". That's a symptom! Why do some people want to eat more than others? Are they weak? Are they stupid? Fat chance. What's wrong with their hormones and brains that this is the case? This is what Ozempic addresses. You have it backwards here: people claiming that diet and exercise are the answer are actually not looking at the root cause, people developing drugs like Ozempic are looking at the root cause.
1% of people have that root cause. The stuff I have seen in the united states is not root cause it's just bad habits. happy for them to get any pills, injection or whatever they think they need to feel good and better. Lazy people, lazy solution. We'll see long term how that works out, as much as anything diet related the usa has implemented in the past 50 years.
Incorrect, if only 1% of people had it only 1% of people would be obese.
If you're arguing that, in the past 50 years, something magically occurred to make people magically lazier that's a bold argument. The problem here is that you're using individual problems and language to conceptualize a societal problem. It just doesn't work that way.
Either you propose societal solutions and societal explanations, or you have absolutely no idea what you're talking about. From where I'm standing, you sound clueless.
it's not magic, processed food is something recent, sugary food/drinks is something recent, bad habits and lazy sedentary life is something recent.
if you don't see this then I don't know how to explain it to you. It's habit related and habit can be fixed, pills are not the best solution in my opinion.
Right, so as you've just admitted, the ROOT CAUSE is not eating too much. The ROOT CAUSE is the societal circumstances that push people to eat more. You're aware of what root cause means, right?
Listen, I understand it's convenient to believe that we can simply be better and fix problems. But look around you. If habits can be "fixed", we wouldn't be in this mess. This phase of sitting around with our thumbs up our asses and going "uh uhhh fatty eat less" are over. We need real solutions, made by people with thinking brains.
in the same society there are people that don't follow the bad habit advertised by society and with the amount of information and alternatives present today, I am sorry, but it's too easy to blame "society" and wait for someone else to do something.
It's up to them.
The solution won't come from anywhere else and yes, we can simply be better.
Says who? You? Why would this be the case? You can't just say things and assume they're true. The solution could, and almost certainly will, come from drugs which curb addiction.
> yes, we can simply be better
Again, says who? What's your evidence for this? Because this has been our approach since forever and guess what - it's not working. That's not my opinion.
You can play blind and deaf all day, I don't care. But eventually you have to take your thumb out of your ass and start using your brain.
>I really feel like this is just the trick the food (and healthcare) industry was waiting for to allow those people to eat as much as they want and don't get fat (and possibly get ill later)
The whole point is you don't want food. You spend significantly, massively less on the food industry.
If anything, it would be better for the food industry for it to be banned.
> because without changing habits, if a patient stops using the drug, they'll regain the weight in a short time...
Not a short time, in whatever the time would normally be they would gain the weight if they continue on their prior habits, or in a less time if they only mildly improve their habits, and a lot longer time if they make significant changes, and not at all if they make dramatic changes.
So far, it has little to nothing to do with the drug. This line of argument always makes no sense to me, because whatever weight was lost with the drug, wasn't gained in that time. So you remove the weight lost, and the weight that would have been gained.
It's like setting yourself back to a starting line in a race. Yes, maybe you still run as fast, and will make it back to where you were, but it has nothing to do with the setting yourself back to the starting line.
It's such a weird line of thinking. It really makes no sense to me.
Since you might still keep running, we shouldn't bother setting you back at the starting line....
One study looked at patients with obesity or overweight without diabetes who stopped taking tirzepatide 10 mg or 15 mg after taking it for 36 weeks. Patients who stopped taking tirzepatide experienced a 14% weight regain after 1 year.
However, there are not enough studies to draw scientific conclusions, but all evidence points to what I said.
As does the discussion in places like reddit by people doing it. If they change their habits, they don't gain weight back. If they only change them somewhat, it just happens more slowly.
I've been on semaglutife for a month now. My food cravings haven't disappeared, but their "volume" in my head went from a 10 to a 2.
I no longer agonize over thinking about yummy unhealthy foods. I no longer want to treat myself outside of lunch and dinner. I no longer want portions beyond being full.
Even if the weight loss aspects didn't work, the upside in clear headedness and not dedicating energy to thinking about food has been worth it.
It's not just weight loss that Ozempic and the other GLP-1 drugs encourage. They also help people stop drinking to excess, and help lower pangs for other harmful drugs like heroin.
I believe that these attributes are so promising, that the idea of government subsidized Ozempic just seems like great domestic policy to me. I believe that whichever politician pitches this idea first will get a ton of support from the public and the press.
I'm on liraglutide (Saxenda) for 2 months, can't get semaglutide (Ozempic) in my country without being diagnosed with diabetes
Anyway. Food cravings gone, I was eating like 10 times a day before that. At least, but sometimes even more. Now I'm on intermittent fasting/OMAD and has 0 problems. No hunger, no cravings. Feeling significantly better.
There is so much money to be made with these drugs that if there were any negative effects with Ozempic, the money needed to keep them out of the news would look like pocket change in comparison. That's why I try not to be an early adopter for drugs.
I am currently doing an old fashioned diet to get my body weight down and reduce my blood pressure (which actually has normalized already).
There appear to be a lot of people who derive a significant amount of their self-confidence and self-image from not being fat, and looking down on people who are. They seem to get pretty upset when people who they've been able to dismiss as fat become not fat, and hate that these drugs allow the users of them to take away that moral superiority -- various GLP1 subreddits are full of stories about them.
I'd never encountered anyone like that in real life, but they show up over and over again on any discussion of these drugs. It's very strange to me.
It exists in the same line of argumentation as being against student loan debt forgiveness because one had to pay off one's own loans, except about something that is even more determined by one's birth.
Some alleles give people a tendency to gain weight via a higher appetite, slower metabolism, addiction to substances (in this case food). But no matter your alleles, you still have to pick up your fork and start attacking those triple portions of nachos. Let's not forget that 1-2 generations ago, the percentage of obese people was much lower than today, but the proportions of the above-mentioned alleles are very unlikely to have changed in 30-50 years.
Perhaps food is more ultra-processed now. Micro-plastics. Gut flora disruption. Seed oils. 5G vaccines. Name a fad and there's a [whatever the antonym for panacea is] for why obesity rates are higher.
It's feels unfair that a single Halloween Oreo cookie is 70 calories. The caloric density of modern and delicious food is absolutely insane.
And so, aside from a rare treat, which mostly leaves me sad (because I only get to eat two), I eat things that aren't ultra-processed 5G seed oil based. And my weight remains controlled despite said 5G vaccines, seed oils, and gut flora disruption.
Ozympic seems like a net good if it helps people control their weight. It just always seems preposterous when people blame "ultra-processed food" as the root problem, rather than the over consumption of said food as the problem.
I wrote that someone has to pick up that fork to eat those nachos. However, processed food makes it easier to eat more calories than you need. Ice cream used to be a once-a-week treat. Now, you can buy a pint of a caloric bomb for 2.99 USD. I'm not suggesting a conspiracy, but as someone who exercises frequently and eats similar food when traveling, I can say with conviction that something is going on with the food sold in the US. For example, I often get pimples on my face after eating pork or beef in the US. I never get pimples when I eat pork or beef in Europe or South America.
I have more problems not getting fat when I'm in the US and I feel more bloated. The usual explanation, which has merit, is that portions are bigger in the US and people move less than in other countries. However, I eat 95% of my meals at home, cooked by me, and I exercise 1 or 2 times daily.
>It exists in the same line of argumentation as being against student loan debt forgiveness because one had to pay off one's own loans
No, it doesn't. There's no fixed national budget for weight loss. There's also not perverse incentives that come with subsidizing supply. It's not an economic question.
There are valid policy-based arguments to be had against student debt loan forgiveness, but the personal grievance of "why should they get a break when I paid off my debt?" is not one.
In order to forgive a debt, someone else has to assume the debt. Nobody cares about that in general. If, say, someone's parent assumes the student debt of their child, you are not going to hear a thing. But when it is government forgiveness the constituents of that government often feel they are being left the bag holder, which is where you start to see complaint.
If you lose weight on Ozempic, there is no evidence that someone else needs to assume the weight you lost, so it is not clear where you find a parallel.
The parallel is "I had to work hard to lose weight / maintain my low weight, why should they get a magic pill?" Unfairness can be perceived even when it only exists in a vague cosmic sense and has no bearing in material reality.
I think you forgot to mention the parallel? I guess, seemingly, that would be "I had to work hard to pay my student debt, why should they get to have their parents pay for it?" but that is not a sentiment that is common enough to speak of. Yeah, sure, I'm sure at least one person in history has had that thought before, but not the point of it being notable to talk about on HN. Most people who see another have their loans paid for think "Good for them". There must be something else?
The "I had to work hard to pay my student loan, and now I have to work hard to pay yours too?" sentiment is much more common and I could see that show up here, but it is not a parallel. That's a very different idea that has no parallel. I don't have to work off the weight you lost.
"being against student loan debt forgiveness because one had to pay off one's own loans"
> but that is not a sentiment that is common enough to speak of
It crops up every time the issue is discussed online. On places like Twitter, at least.
> I don't have to work off the weight you lost.
Again, this blend of envy, spite, and petty injustice crops up quite often. "Why did I have to exercise when they could afford a gastric bypass?"
You seem unfamiliar with how petty people can be online. There are plenty of people who get personally aggrieved when they think someone got a free lunch / might get a free lunch even when the lunch isn't paid by them / they were unfortunate enough to miss out on free lunch day.
> that is not a sentiment that is common enough to speak of
> It crops up every time the issue is discussed online. On places like Twitter, at least.
Only when it pertains to government forgiveness, because of the bag holding problem.
Nobody cares when it is an unrelated entity that is willing to become the bag holder (e.g. parents). In fact, it has become almost expected that entities like parents will become the bag holders when it comes to college debt.
The bag holding problem is something quite different, not a parallel.
> "Why did I have to exercise when they could afford a bypass?"
So it crops up quite often, but only when it comes to weight loss-related matters?
I am familiar with the common use, but it speaks to people in a lower class envying those in a higher class. Here we have people in the same class, just with different paths to get there. So, you must have a pet definition?
Regardless, I've never heard a "self-made" rich person complain "I had to work hard to get here. Why oh why wasn't I born rich like that Saudi prince?". They seem to only ever be proud that they were able to become rich. Again, I suppose it has probably happened once, but does not seem common enough to speak of.
It might be more common in terms of political power rather than wealth. Nixon, for example, hated the Ivy League-educated eastern establishment ruling elites that he displaced.
Probably not, though, given that you couldn't find an example of envy and decided to randomly reach for hatred instead for some reason. Again, I suppose it has probably happened once, but is clearly not common enough to speak of (you literally were unable to speak of it).
Here, a House Representative questioning student loan relief announced in August 2022. Not framed as an issue of others paying for the debtors, but rather "what relief do those who already paid off their debt receive?"
Valid question. Given that they are assuming the debt, what relief are they getting to pass it off onto the next bag holder? Anyone assuming the debt would ask the same question.
No, you keep finding diversions to avoid answer the question.
Let's face it: The question is unanswerable as there is no parallel and there never was.
Your never ending quest to try and find that which does not exist is commendable, and hilarious, but to think that it is answering some kind of question is nonsensical.
Here's an example of someone who's paid off their debt, is unhappy at the prospect of others getting relief, but not complaining about being the one to have to pick up the tax bill in order to deliver that relief:
> Student loan forgiveness rewards bad decision making
I took out a $160,000 student load a decade ago
I saved every penny I made to pay it back in full. I ended up paying over $300,000 on the loan
Now I'm getting punished because I was too responsible and paid back my loan too quickly?
I lived in a $500 a month rat and cockroach infested sun room in Boston for years to pay back this debt
If I would have instead ignored my debt and bought cars and useless luxury items I'd get a free $300,000 check?
I'm as a-political as it gets. I hate all politicians. But this is insanity and rewards the WORST behavior
It has been said over and over that it no doubt has happened, but is not common enough that anyone here would speak to it. Digging deep into the depths of what HN largely considers a trolling website to find some random nobody has ever heard of once saying what you want to hear is not indicative of anything.
I'm surprised you don't take your comedy show on the road. People would pay good money for the laughs you've brought us.
> but is not common enough that anyone here would talk about it
But I don't care about whether or not people on HN would talk about it. I'm saying that it exists. Ultimately it is a moral judgment about personal responsibility. You find it in attacks on "welfare queens" similarly. Yes, of course there is always the element of being an aggrieved taxpayer. But there is also the vague cosmic - puritanism? - critique of "why should they have it easy when I had it hard?" I'm glad that you uphold HN as a place that is above such sentiment. But here I agree with you! I do not take such critiques seriously. Yet they abound, and they are a clear parallel to people attacking Ozempic because they find it "too easy" for becoming or staying thin. And so, we come full circle.
> not indicative of anything.
This entire sub-discussion is about fallacious arguments, and it is a fallacious argument that I am saying it exists. Therefore it is entirely germane for me to bring up a trolling website to find an argument used by a random nobody, as it proves the existence of a narrative. Perhaps you may quibble that it is not a narrative that exists in abundance. Then we are simply arguing preponderance, because I have already established existence.
> But I don't care about whether or not people on HN would talk about it.
You certainly don't have to care, but that is the discussion taking place. It is a necessary precondition for this supposed parallel to exist.
If you're trying to tell us that you can't focus and are flailing around like one of those whacky blow up thingys down at the used car lot, have fun with that. It no doubt goes well with your comedy show.
> This entire sub-discussion is about fallacious arguments
Oh, I see, so you really are unable to focus. I get why you appear to be so confused now. It is not so much that you're confused in what you write, but that you're off in your own world. Well, that's pretty funny, at least.
> I'd never encountered anyone like that in real life,
How many people tell you their deepest asshole feelings right off the bat? They feel you out of you're in the same hate canoe and then they let loose. Doesn't mean they are not there.
A good point, but many people on these subreddits are apparently surrounded by "friends" and family like this who are happy to tell them how disappointed they are that they're "cheating" at losing weight.
Maybe some, there are also people who cheer for the capacity of humanity to figure out solutions that can benefits humanity. I view the perspective you describe as people externalizing their own insecurity. I do not view it as a critic towards people who have an excess of stored potential energy, but merely a signal that they haven't made peace with their own internal feelings about themselves. They need love, acceptance. They are on their own journey, everyone has the capacity to grow. Let's help everyone.
I have had to work very, very, very hard to not be obese. Runs in the family, and I am literally always hungry. A slice of pizza sets off a reaction in my brain like cigarettes used to, and I get a huge buzz. Anything sweet makes me crave something else sweet 10x more. I've had periods of being bigger and periods of being smaller, but I think most people who'd meet me didn't immediately peg me as fat -- I have literally 20 years of weight measurements showing me bouncing between being in great shape and being a little bigger, the same 15kgs being gained and lost over and over.
These drugs are a god-send for me, because I am no longer constantly thinking about food all the fucking time, and I can easily eat normal people portions without having to burn huge amounts of self control on it.
The idea that the drugs are not "fair" is very strange thinking.
I know people who are slim and have roughly similar sentiment about the drug.
Then again I also know people who'd happily deny stimulant medication to people with ADHD, because "it's not fair".
Crabs in a bucket, I'd say. It doesn't help that in general, our culture still operates on the assumption that being fat is one's own fault and entirely under control of an average person, except for "legitimate medical excuses" like type 1 diabetes, despite plenty of evidence to the contrary. We've made progress on getting rid of such notions in case of depression, autism and ADHD, so maybe we'll do that with obesity too, in some distant future. Until then, people on Ozempic will hear plenty of "that's not fair", and "if you were a better person, you wouldn't need this".
EDIT: Maybe we'll get obesity to be seen more like smoking: something that's easy to walk into, but beyond average person's ability to walk out of without help.
>> I know people who are slim and have roughly similar sentiment about the drug.
It reveals that for some trim people, their underlying feelings all along have been a sense of personal value and positivity around the fact that they are trim and others fat.
They feel unhappy that other might be admitted to the trim club.
My attitude has nothing to do with your consumption. I have a negative opinion of the drug. I don't have a negative opinion of people who feel desperate enough to use it.
I mean, turn your thinking around, why is being thin so important to them that they would take a very powerful class of drug just to achieve it? Why then would they waste a minute of their time afterwards being worried about external opinions of how they achieved it?
What's actually important here? Their health and appearance or the opinions of their peers? Are they altering their appearance solely for the opinion of their peers?
> and "if you were a better person, you wouldn't need this".
I think you've accidentally encoded that precise understanding here.
I exploded in size as soon as I hit puberty and have never been able to take off the weight. I ate the same foods as my brother and we did roughly the same activities. Puberty was a night and day switch from scrawny kid to fat kid and it’s been a constant challenge since. My son is desperately trying to gain weight for a dirty bulk. He’ll put down a full pizza by himself in a night and has to force himself to keep eating more calories. When we go out to eat he picks meals based on what has the most calories. He’s still a rail and can’t keep on weight. And apart from lifting 2-3 times a week for roughly half an hour he’s completely sedentary so he’s no expending a tremendous amount of calories through other activity. For some people, staying thin is just their normal and not some diligent attention to what they consume.
These drugs are praised because they require zero effort, from people that already want to give none, than classical methods such as caloric restriction. There has always been a way out of obesity, it's just that people does not want to take it.
They do not require zero effort, and the people taking them to not already want to give no effort. Please reserve your moral judgments.
These drugs don't work without 'classical methods' such as caloric restriction.
> There has always been a way out of obesity, it's just that people does not want to take it.
Common trope, and absolute nonsense. It is the rare person who has been obese for most or all of their lives and prefers it that way or has never thought about or done anything to try and fix it. That is not how people show up at doctor's offices to ask about Ozempic. They show up in tears, at the end of their rope, or having completely given up.
Should we not help them just because you think it's "unfair" that you were genetically more gifted than they, perhaps? I doubt you'd agree with that.
This thread seems needlessly heated. How is it a moral judgement to say that some folks don't put in the effort to control calorie input? Losing weight sucks. It's worse the bigger you are. But they're not gaining weight by magic. They're consuming more calories than they burn. It is as simple as that (yes, yes, yes -- gut flora, metabolism disruption, vernal equinox, micro-plastics, etc. etc. There are plenty of variables that change the efficiency of the mechanism, but none that override the core mechanism.)
fwiw, Ozympic sounds great to me if people want to take it. Also great if they don't.
> How is it a moral judgement to say that some folks don't put in the effort to control calorie input?
The implication that anyone reading it walks away with is "... and it is because they don't care enough to try and/or are lazy." If that wasn't your intent, cool, but that is most often the implication.
My only point is that most folks who "don't put in the effort" have put in the effort, and have failed. Multiple times, over and over again.
Sure, some lazy folks exist. It is a tiny minority of those who are obese, though, most of whom have given up because they had tried and failed countless times, or have simply accepted that there is no hope for them (cue tears and depression).
I have been obese for more than a decade, during which I have made many failed attempts of losing weight.
Because of the many failures, I was pretty convinced that what you say is true and no matter what I do I cannot lose weight.
Nevertheless, eventually I have made one more attempt, which was successful, so after about ten months I have reached a weight of only 2/3 of the weight that I had previously.
Then, after learning thus how to control my weight, I have kept it constant for more than a decade, until today. Losing weight was a rather unpleasant experience, especially in the beginning, but then the improvements in my quality of life have been so noticeable that the effort has certainly been worthwhile.
Looking back at time when I was obese, I regret a lot that I did not lose weight earlier and I consider that my failed attempts of losing weight had been quite stupid, because I should have realized that I am not doing all that is necessary for success.
The final attempt that was successful started with a way to measure accurately my changes in weight from a day to another, to determine the effect of the changes in diet, and it required a complete change both in what I was eating and in how I was eating.
Now it is very obvious for me why all my early attempts were not successful, because they were doomed from the start, since I was not doing them in the right way. However at that time, I was not aware of this and I did not think enough about the manner in which I should handle this problem.
After my own experience, I find it very hard to believe in the theories that for many or most obese people there are objective reasons for them to be obese instead of the fact that they have just never been taught what to eat and how to eat in order to preserve their health (in a detailed, practical way, not with generalities like "do not eat too much").
Both my grandfather and my father had been obese and they both had diabetes in old age, so I certainly did not have any help from genetic inheritance. It is enough for me to eat during a single day like I was eating when I was obese, to gain enough weight that I would need at least a week to lose it again.
The only thing with which I agree is that for poor people who are obese it is extremely difficult to lose weight, because all their time is occupied with ensuring their subsistence, so it is hard for them to reserve time for things like cooking at home, learning about how to compose a healthy diet, doing some physical exercises and so on.
That is fantastic that that was true for you. I, too, have tried many times to lose weight, and I hadn’t given up. The closest I got was losing 55 lbs, which worked great, until I dislocated my shoulder and had to have surgery, which meant I couldn’t work out for a long time.
For many people, it is simply a lot easier to lose and maintain weight, even if it doesn’t feel that way at the time. If we were to perform the same actions, in the same way, my body may simply have a predilection to maintaining a higher weight. (This is a real phenomenon, bodies have “set weights,” this is how stalls happen, etc.)
Is it impossible? No, of course not. But is it much much harder for some than others? Absolutely.
Yes, if anyone eats fewer calories than they expend they will lose weight. That is how thermodynamics works.
But the level of difficulty with which that can happen varies greatly.
One of the main changes in my habits that was absolutely necessary in order to lose weight, then maintain it at the desired level, was that previously I was eating whenever I felt the need and until I felt completely satiated, while since then I make every day a plan with when to eat, what to eat and how much to eat and then I stick to the plan, I never eat anything more than previously planned and outside the planned meals I do not eat or drink anything else, e.g. snacks or juices, except for drinking water.
Obviously during all the time when I was losing weight and even some time after that I was feeling hungry all the time, so I had to make some efforts to not eat beyond what I had planned. Nevertheless, if you work or do anything else that occupies your attention, the feeling of hunger disappears for some time, even if it reappears after some hours.
So having to cope with hunger is unavoidable for this goal. However, eventually my body became accustomed with a much lower food intake and the hunger disappeared. Now, when I eat food that I cook myself, I may not eat again for an entire day without becoming hungry. I have experimented and I have eaten again some industrially-produced food, like I was eating in the past, and with that I have become hungry just a couple of hours after eating it, exactly like before losing weight, so I believe that switching to self cooking is also a necessary condition for avoiding hunger when eating little.
I don’t disagree with that. When I did keto for about 10 months, I was very similar. The challenge with this was, of course, maintaining it - I’m an extrovert, and being social often meant being around people at dinner, drinking, etc. Even if I abstained (which I did), you still felt a bit “out of place.”
As for hunger - you’re right. I was able to curb hunger simply by eating better. But I was never able to curb the “food noise” that was constantly in my head in a sustainable way.
Moreover, my body does really attempt to retain weight. Unless I’m absolutely perfect, I will gain weight fast and take it off extremely slowly. That is now how everybody’s body works. Many people struggle to put on weight. That is not the case for me.
I do not disagree that lifestyle changes matter, and that Ozempic is not sustainable without them.
> It is the rare person who has been obese for most or all of their lives and prefers it that way or has never thought about or done anything to try and fix it. That is not how people show up at doctor's offices to ask about Ozempic. They show up in tears, at the end of their rope, or having completely given up.
If this was the case, there would have been no drug shortage. Instead, everyone is showing up asking for it because it's the easiest way out. No diet, no effort, nothing. Just take the pill or do the shot, boom. I wonder if you are being serious or just so much deluded. There is no drugging out of thermodynamics.
Ignoring the many, many logical issues with your post for a moment: so what? Who cares if it no longer requires effort to be skinny? Why should it require effort to be skinny? And why do you care either way?
How do these drugs affect cardiovascular health compared to exercising?
Basically if you run/bike a lot you’ll burn more calories and lose weight if you eat at a deficit. But you’ll also improve your heart health, lower your resting heart rate, etc.
Do these drugs help in that way at all or just with losing the weight? It would be amazing if we had a drug that improved people’s heart health.
Heart issues due to sedentary lifestyle would still exist, but many cardiovascular issues are long term side effects of obesity and poor diet. I.e. High blood pressure, high triglyceride levels, high HDL cholesterol, diabetes, are very common obesity related comorbidities. These all increase the risk for heart diseases. In short, Yes as long as there isn't other even more dangerous heart related side effects of Ozempic/Wegovy/et al., it would improve heart health.
They work in tandem. These drugs to appear to have cardio-protective effects, but they also help you lose weight, which in turns helps you work out. Any doctor prescribing a GLP-1 med will prescribe it with a lifestyle change of working out and eating better, and it is in the literature as well.
Doing nothing and only taking the pill will help, just because it helps you lose weight, which has its own cardio benefits, but that is not how it is intended to be taken. It is intended to be taken with an exercise and diet regimen.
You can’t outrun your fork. These are different parts of the problem. Also: achieving a reasonable weight makes it much easier to get into an exercise program.
I don’t think the first part is true though, any distance runner or cyclist that has experienced the “bonk” knows that they didn’t eat enough.
But yup if you’re very obese, running won’t be good for your joints. Swimming would be better, but unless you have a pool or live on a lake it’s much less convenient.
The first part is true. It is ultimately a problem of thermodynamics.
The distance runner or cyclist is not obese in your example.
There is simply no way to exercise enough if obese to create the caloric deficit needed.
This is all really part of the problem. Telling obese people to exercise more and don't restrict calories too much just doesn't work. What works if obese is a massive calorie deficit over time because an obese person has a massive amount of calories stored by definition.
It is just a much different situation compared to a distance runner that is already very learn. That person does have to worry about not consuming enough calories exactly because they don't have the stored calories the obese person does.
"Enough" is a lot more than a casual bike ride. I used to have a bike commute that totaled 30 miles. Yes, I was in good shape. But it took 4 times longer than driving and required having a shower at the office.
So Ozempic is "maybe a good thing" because it would make it easier for teens and kids to get to the office for the job while maintaining a slim physical appearance?
A study says these drugs could prevent 1.5 million cardiac events over 10 years, add in a reduction in alcoholism and governments should be giving away these drugs to save on healthcare costs...
----- We identified 3999 US adults weighted to an estimated population size of 93.0 million [M] (38% of US adults) who fit STEP 1 eligibility criteria. Applying STEP 1 treatment effects on weight loss resulted in an estimated 69.1% (64.3 M) and 50.5% (47.0 M) showing ≥ 10% and ≥ 15% weight reductions, respectively, translating to a 46.1% (43.0 M) reduction in obesity (BMI ≥ 30 kg/m2) prevalence. Among those without CVD, estimated 10-year CVD risks were 10.15% “before” and 8.34% “after” semaglutide “treatment” reflecting a 1.81% absolute (and 17.8% relative) risk reduction translating to 1.50 million preventable CVD events over 10 years.
I don’t understand what body positivity has to do with Ozempic. You should accept the things you cannot or have chosen not to change. If you opt to change them then why should acceptance matter anymore?
Once a fat person becomes healthy, there’s still plenty for them to hate or accept about their body. But now they get to do that while also not burdened with health problems.
> The Moral Panic Over Ozempic Misses the Point The media has made the drugs about body politics and our obsession with thinness. That’s the wrong story.
If you stop doing a thing that has a positive effect on you, the positive effect is gone. Like, if you stop exercising, you lose muscle you've gained by exercising. Does that make exercising a bad thing?
As far as I understand it, the one major issue is that it can make a temporary problem (overweight) a chronic one.
As a counter-example, most people experience depression at least once in their life and most of these take antidepressants on a temporary basis (the exception being those who are genetically/developmentally depressed - i.e. chronic/lifelong). Once the underlying issue has been addressed with therapy or what-have-you, these people can cease use of the drug.
This is not the case with Ozempic. If you take it to lose weight then cessation will cause rapid weight gain. You'll be stuck with it for the rest of your life, for something that can [again] usually be permanently solved with other forms of treatment.
I think this is morally fine. However, it does mean that these people will suffer even more harm if they are ever find themselves unable to afford/obtain Ozempic. We would effectively be duplicating the current issue that we have with insulin.
Obesity isn't a temporary problem, practically every weight loss solution fails at 2-5 year outlooks. If this drug has to be taken for decades it's still better than decades of obesity.
Any condition that is not chronic is temporary by definition. It doesn't matter if it can be cured in 5 years or 20. If a person is dependant on a drug to maintain health, then they have a chronic condition.
> This is not the case with Ozempic. If you take it to lose weight then cessation will cause rapid weight gain. You'll be stuck with it for the rest of your life, for something that can [again] usually be permanently solved with other forms of treatment.
This is not true. If you stop taking GLP-1 meds, you will revert back to whatever it was you were like prior to taking them, unless you have made significant lifestyle changes.
So: you take a GLP-1 med, change nothing, lose a bunch of weight, get off it, and still eat McDonald’s every day? Yeah, you’ll gain it back.
But if you exercise regularly (specifically strength training) and adjust your diet, which is what every single doctor worth their salt will tell you you must do, then you can get off of it over time or go to a much lower dose.
These drugs are not and should not be prescribed to people who are simply “temporarily overweight.”
It is not like magically getting off the GLP-1 meds makes you ravenous; it’s all about whether or not you’ve changed anything while on it.
My uncle and his wife were on GPL-1 (not Ozempic) from 2019 to 2022,stopped, took a bit of their belly back but are clearly not obese anymore, even if still overweight. Without discernable change in their behavior (they might cook a bit more)
But isn't one of the effects of GLP-1 is that it literally makes you not crave junk food? It doesn't just metabolize food more, or however that works, it also changes your dietary behaviours.
Not in the way you're implying. I should mention that I'm in a clinical trial for CagriSema (and it's a head-to-head efficacy trial against tirzepatide, so not blind, with no placebo, but randomized), so I am speaking from experience.
It works in a few ways, but the vast majority of the benefit is just from delayed gastric emptying (food sticks around in you longer) which makes you feel fuller, and it helps remove hunger in general. If you're not careful, you'll find yourself simply not eating, so you have to be careful - that's a lot of why it leads to nausea. People don't eat, don't hydrate, and they get sick. Turns out that happens with or without the drug; not eating and not drinking will make you nauseous.
If you have a bag of french fries, you will find yourself sick because you overdid it. It doesn't make them taste any less good. You just learn about portion control somewhat through force, because when you screw it up you feel ill.
The other thing it does is remove the "food noise" so many of us simply exist with. I didn't know this was a thing, but it is - I grew up very impoverished, and we didn't always have food. I am also genetically predisposed to retaining more weight than necessary. Looking back now, I was constantly seeking a next snack or a next meal, almost before I finished my previous one, subconsciously. My days were split, in my head, into mealtimes and the times between mealtimes, which were usually snacking time. But between the habit, the ADHD, and the predisposition to always be thinking about it, it was an impossible habit to break.
I didn't realize this until talking to my wife, who doesn't have this problem. She also didn't used to think every food tasted incredible. Just some. Meanwhile, there was almost nothing I ate that didn't taste fantastic, in my brain. That has also adjusted to be more "normal," but historically whenever my mom has stopped, that adjustment didn't revert. It would appear to have been stable, as it helps your brain and body simply figure out it isn't starving all the time.
It's kind of hard to explain, so I hope that made sense.
I agree with your sentiment in general. The problem is how people are actually using it, especially the rich.
We shouldn't prescribe antidepressants for life so easily, but we do. We shouldn't feed livestock antibiotics, but we do. We shouldn't solve an eating/sedentary disorder with Ozempic, but we do.
What is the alternative? Sure, I agree people misuse medications sometimes.
So should we not help people curb their obesity and/or T2D because some folks misuse it? Of course not.
People misuse Sudafed and use it to make meth, or drink Robitussin to get high. I would be very upset if I lost access to those medications when I was sick, simply because we decided to make rules about the exception. :)
> for something that can [again] usually be permanently solved with other forms of treatment.
Just not true. The vast majority of obese people who try to lose weight without GLP-1 agonists fail. The only other option that consistently works is stimulants but the side effects for those is even worse, see requiem for a dream.
I'm just glad something this effective is available. Obesity is a novel epidemic. Being very fat is supposed to be the exception to the rule, and not the default.
You not liking it wouldn't make it a dystopia. But regardless, I wouldn't be concerned. We humans are interested in the rare and exotic, so I would bet that if being overweight ever becomes unusual, we'll soon see a shift of some people back towards it.
Written like someone who's never lost weight in their life. You don't lose weight by working out, unless you're at like 4+ hours per day. It only takes a couple minutes to eat more calories than a typical workout session burns.
What matters is convincing your entire body that you're not in danger of starvation. That it's not a dire emergency that you're expending more calories than you're consuming. That that millions of years of evolved emergency systems no longer are leading you in the direction you desire. And keeping your focus on that for every minute of the 6+ hours per day where your body is screaming that you need more food.
GLP-1 agonists very slightly help with that. Ok, they probably help more than slightly if the dosage is tuned carefully, but you do need to worry more about side effects at higher doses as well. Medication is no panacea, but the fact is that we evolved in a very different environment than the one in which we now live. Many people benefit from some help bringing our body's impulses into sync with our new environment.
If you'd really lost a significant amount of weight before, you'd know that exercise does not lead to weight loss. You wouldn't suggest it as a solution to anything.
Exercise is an important adjunct to weight loss. Just for the purposes of feeling good, you need your body's emergency response to the loss of caloric reserves to not include cutting muscle to lower your basal metabolic rate. The only way to do that is consistent exercise. It is critical to healthy loss of significant amounts of weight. But it isn't the cause.
So if you wanted to show off how superior you are to everyone with lives that require them to spend time on stuff other than losing weight, if you knew what you were talking about you'd say something like "imagine taking drugs instead of eating less." In addition to being cruel and mocking, your comment indicated a clear lack of understanding how the body even works.
I used to bike 30 miles a day and never lost weight. Cardio is good for pretty much one thing: building cardio.
To lose weight, you have to eat less. GLP-1 receptor agonists make your brain think that enough food is actually enough food, rather than "panic, I'm going to die if I don't eat more".
Some people take drugs and don't work out. Some people work out and don't take drugs. Some people take drugs TO work out. Some people work out THEN take drugs. Some people work out to AVOID taking drugs.
Who cares, everything's a drug anyways.
If there was a wetware interface to your brain that you could deploy code into and you wrote a patch for your own obesity, given that we're on HN in the first place, you'd likely think it was cool.
Deploying the instructions via organic chemistry? Lame! Dismiss it!
The whole thing just reminds me of Mr. Mandelbaum on Seinfeld having "worked out with Charles Atlas in the 50's" -- times change!
I take it you are talking about anabolic steroids.
Most people don't understand that a person will not simply gain huge amounts of muscle by taking them. It does allow more lean mass gain, but only if muscle are being stimulated to grow and extra calories are being consumed.
I'm talking about having the self-discipline to work out, which is the same self-discipline required for fasting. If you manage to work out, you can manage to not eat. All I hear is a bunch of excuses and trying to create lab drugs to work around this fundamental weakness of character. It won't work, because the same weakness will simply destroy you through some other thing you won't control for better outcomes.
But I wonder whether I'd say the same if I hadn't learned to lose and keep off all the weight I needed to, before it came along.
(If the downvotes are because I sound like I'm bragging, that's fair but also not my intent. What I mean to say is, I suspect I'd view this class of drug and indication less dispassionately and with more of an appetite for risk, if I weren't so lucky as to have no pressing need for the benefit.)
Granted, although I might counter that given so broad an apparent increase in the scope of the indication, 2017-2021 (? I can't immediately find a date for Ozempic specifically) and 2021- might best be taken as at least partially distinct.
I think that's an argument less well advanced by me than by someone who could design such a study, though, not least because they'll know far better than I whether the proposition makes any real sense.
Has there ever been a point in human history in which we basically started taking a drug daily for the rest of our lives with no side effect whatsoever?
Depends on where you draw the line for "drug". Of the top of my head, some population-wide (or nearly so) public health efforts that we consider effective: fluoride in the water, iodized salt, and baby aspirin for older people. There are probably some vitamin supplements that would do a lot of good if most people took them.
Summary of the linked article: (1) We should reevaluate the benefits/harms of fluoridated water as a public health intervention. (2) The studies used to justify it in the past were flawed, especially by not accounting for a huge improvement in other dental health habits across the world. (3) Fluoride provides no additional benefits when consumed (it's just meant to affect tooth enamel), which means consuming it is inefficient and increases the risk of harm (bone weakening, nerve and brain cell damage).
The article steps around the fact that Ozempic encourages poor nutrition and entrenches body dysmorphia. Working out and eating responsibly not only creates far more longevity, but it mentally empowers you to be the custodian of your own wellness.
It's nice that that worked for you. Please clarify how "ozempic encourages poor nutrition" (it doesn't), and how it "entrenches body dysmorphia" (it doesn't).
Specifically, doctors prescribing GLP-1 meds counsel you on diet and exercise because it is necessary for the GLP-1 meds to be most effective, and "working out and eating responsibly" is not new advice to people who have been obese for a long time. Also, the moral judgment of "just need to work harder" is trash, and untrue. I guarantee you people who have been obese a long time have not spent their entire lives just "being okay with it." They walk into a doctor's office crying, not knowing what to do, at the end of their rope, or they have simply completely given up ever trying again because it has never worked.
Sometimes, it is laziness. It would be absurd for me to argue that is never true. But that is a tiny minority, and I would bet money on that.
You know what creates far more longevity? Not being obese, and working out and eating responsibly. Sometimes, in order to achieve that, some people need help; and we finally have some help in the form of these GLP-1 medications.
I'm not sure why anyone would be against people finally getting healthy.
Well I'd say it encourages poor nutrition by allowing people to continue to eat terrible food, while briefly suppressing their appetite for it by slowing down gastric emptying. While this isn't every case, people's nutritional choices are unchallenged and often remain unchanged.
That flows to the dysmorphia stuff. I meant that it indirectly encourages body dysmorphia because it side-steps the shame and compulsive behavior that lead to the person's original obesity. So long after the weight-loss, you remain freighted with the toxic "weight-based" mental model of your body, rather than a holistic one of nutrition and well-being.
> Well I'd say it encourages poor nutrition by allowing people to continue to eat terrible food, while briefly suppressing their appetite for it by slowing down gastric emptying. While this isn't every case, people's nutritional choices are unchallenged and often remain unchanged.
Someone on a nicotine patch can still smoke while they have it on. Does a nicotine patch encourage smoking?
The way the medication is supposed to be prescribed is with lifestyle changes, including diet and exercise. People don't have to follow that, but it certainly doesn't encourage them to eat worse.
> That flows the dysmorphia stuff. I meant that it indirectly encourages body dysmorphia because it side-steps the shame and compulsive behavior that lead to the person's original obesity. So long after the weight-loss, you remain freighted with the toxic "weight-based" mental model of your body, rather than a holistic one of nutrition and well-being.
I can see how you would logic that out, but it isn't true in my experience, on average. The shame and compulsive behavior that led to the person's original obesity usually compounds on itself, and people come to these medications when they want help. No doctor is forcing these down an obese patient's throat, or injecting them directly. It is still up to the patient to decide they want help.
Most don't simply want to be thin. Most want to play with their kids, be able talk a walk around the block, be able to breathe better, and so on. Obese people don't want to be thin - they want to be healthy. In fact, most assume they will never be thin, because it seems so unattainable. They just want to get to a place where they aren't dying faster than everyone else each day.
So no, I don't think anyone on this medication "develops" body dysmorphia in the sense you're thinking, though I could see why having not gone through it you might thing it does.
In the past I have managed to lose weight with a soul crushing diet and regular exercise. In the last five years, that hasn’t worked and I’m clinically obese again.
In my case, working out and eating soul crushing diets, and having that NOT work has had the opposite effect on my mental empowerment, as you can imagine.
So I finally broke down to my doctor of 6 years and she said let’s try Ozempic. Doesn’t look like insurance is going to pay for it though…
Sorry to hear that. Look, I see what you're saying. But a punitive mentality is never going to lead anywhere. At least not for very long.
My personal experience has been shifting my goal from "weight loss" to the much more empowering role of being a caretaker. This paradigm shift was the hack that finally got me out of terrible eating cycles, and put me in a much better place.
There is definitely a place for Ozempic, particularly as a stop-gap in acute obesity. But I believe it defers personal responsibility for one's nutrition and well-being.
Wasn't this the drug that also had the occasional effect of stopping people's digestive tract cold so they could no longer eat? Or am I thinking of something else.
The problem with Ozempic isn't the drug. It's that we have to take a drug to counter the literal poison that's been fed to us, with full subsidization from our government.
We allow poison in food, but not led in our water, radioactive waste in our backyards. Why?
It's just the same old thing. If someone worked hard to get somewhere, they hate it when someone else gets that for free. Oh, but you didn't really make that art, you used a brush, you used a diffusion model, blah blah. Oh but you didn't really work out. Oh but you didn't really write that Python program in 100 lines, it actually relies on these million lines of stdlib + firmware. If it works, it works. If it doesn't, it doesn't. That's how it is.
I have a personal bias to small effect consistent medication over high effect rare medication, but I have at least one friend who has seen great results with Ozempic. So I'm glad to see more people can access this drug.
After all, I can't really see. I use glasses or contact lenses.
Well I'm sympathetic to your point of view, but there I think there are some small chinks in the armour of this argument. To give two examples:
1. I read an article about plastic surgery for show dogs in Brazil: as it pointed out the dogs presented beautifully but their offspring had the original flaws which were undesirable. Might seem absurd but it highlights the possibility of a result being achieved in a way that is inauthentic and has the seeds of future failure within it.
2. There are many things in life in which the result is merely evidence of a journey undertaken which is in itself understood to prove something that is otherwise not visible. For example one might say that someone who did a tremendous amount of exercise has shown focus and determination...the visible result may be them appearing fit. So again maybe the visible result is sometimes just a signifier of the effort it took and that might be considered the important aspect. It really depends on the observer and what they care about.
In a sense you and I with our glasses are like Brazilian show dogs - we can see alright but indeed our vision is flawed and when I lose my glasses I can feel pretty helpless.
Which is pretty weird because just qualitatively ozempic wont get you into “great shape” - just helps you not be very unhealthily overweight. You still need to do the weights and nutrition for muscles or cardio for great cardiovascular health
This highlights one of the issues I have with articles like this about Ozempic at this current moment - this glosses over something major with these two particular drugs. With methadone, yes, it will keep you off of heroin, but you'll also likely never, ever get off of methadone because the withdrawal is 1) just as horrible and severe as heroin and 2) can last months. To the point where you'd almost be better off just kicking the heroin the "old fashioned" way. suboxone is similar - the drug isn't without side effects either. Of course, that isn't to say these things aren't useful - to have a methadone/suboxone dependency is way preferable to heroin addiction.
My only real point is that we should wait to see what long term side effects these drugs have before calling them miracles and glossing over their down sides, because I think the end effect of that is counterproductive to medicine. I'm always immediately skeptical as to what drugs pharmaceutical companies are pushing out, due to the history I've witnessed so far in my lifetime.
That all said Ozempic probably would've saved a relative of mine's life. In the end, they'd likely not care about the side effects all that much.