I've lost about 33% of my body weight throughout 2023 on Wegovy (the weight loss brand of semaglutide).
There were major weight related health complications I was having at 34 BMI and they're not happening now. I knew how to lose weight -- meticulously track every calorie, use diet and exercise to hit targets. I had done it before , down to -10% and -25% body mass twice in the past ten years. But it never stayed that way -- I found it incredibly hard to stick to my kcal in goal or to stay at a stable lower weight. I'd eat when I was hungry, and eat enough to stay at my long term stable weight. If I ever stopped tracking every calorie in, my default sense of "full" tended towards a caloric surplus.
This drug fills exactly the gap I was struggling to fill with previous attempts at weight loss. I've felt "full" at 1500 kcal/day for months (though have had more of an appetite in the past 1-2 months) and have ended almost every day with a caloric deficit. It's a serious pharmaceutical intervention and I read the literature on GLP-1 agonists for years before starting. There were side effects, notably reflux when eating too much, "sulfur burps", and a general feeling of malaise for the day after taking a dose for the first few months.
No idea what the long term consequences of staying on this drug forever will be. Haven't noticed any other behavior changes. Not particularly interested in the appearance angle (I felt like I looked okay before and look okay now, though I've needed new clothes due to dramatic changes in waist size).
But the health stuff is serious and real and if we can make this drug cheaply available to people who discuss it carefully with a doctor there is potential for a serious chronic disorder to be addressed much more effectively than it used to be.
> I'd eat when I was hungry, and eat enough to stay at my long term stable weight. If I ever stopped tracking every calorie in, my default sense of "full" tended towards a caloric surplus.
IIRC, stomachs are fairly elastic, and so can expand. If one consumes/d larger volumes for an extended period of time then that stretch could perhaps become permanent (AIUI), so to actually feel full you have to consume more—which then the rest of one's body has to deal with.
It's one of the things that gastric bands can help with, and also sleeve gastrectomy.
You feel full, but do you experience any other side effects eating 1500 calories a day? I've dieted on those levels before, and even without hunger or food fixation thoughts, my energy and focus would be wrecked.
>There were major weight related health complications I was having at 34 BMI and they're not happening now.
I also experience a lot of health complications past certain weight, but I find it's more correlated to my bodyfat than BMI. Reflux and other issues I use to experience at 27 BMI @ 30%bodyfat, I start feeling at 32 BMI @20% bodyfat after building a lot of muscle. Difference between 27BMI @ 170lbs and 32BMI @200lb for me is ~30lbs. And the caloric difference between 170lb sedentary life style where my body starts acting up and 200lb 1-3x per week exercise life style where I don't is over 600 calories, which opens up a lot of dietary flexiblity in my life. Looking better is plus. But also just eating more than what I was during my obesse days and have good energy all the time. That said if I get to 205lbs all those symptoms come rushing back. I can see myself and others going on ozempic route if it's a means to nudge baseline weight below health complication effects. But hard to imagine phases of being on such big deficits.
Time and changing my eating habits. Time is easy. The habits require more willpower. What worked for me was to reduce the carbs (potatoes, rice, bread) & replace them with vegetables. So I just eat a meal salad with a piece of meat now.
Intuition tells me effective diet pills are excellent crutches at not building habits. Seems like recipe for yoyo pilling, which to be fair isn't unlike seasonal dietting except pills make the dietting part predictable. Gut feeling is still massively accessible diet pills is net good in terms of public health if it reduces all the conditions associated to being overweight.
I don't agree. Nicotine patches help against the want for a cigarette, i.e. the craving, but not the habit of pulling out a cigarette while having a beer.
I wonder about the same thing in general for people taking this drug. I think the reason some people are overweight is because their body is asking for that much food not for the sake of caloies but to get adequate nutrition. (I am not sure what fraction this would apply to.)
I think there are a lot of theories about why people eat too much, and all of them apply to some people. I have been eating "healthier" for months, including about 5x as much vegetables as I had been previously into my eating, cutting back (but not eliminating) desserts. I still found that I did not lose weight because I was eating too much. I don't believe it was because I was not getting adequate nutrition - I just wanted food.
My grandmother likes to tell me about how she was perscribed amphetamines for weight loss in the the 1960s, and how she struggled to escape that. I'm wary of anything in this space that seems too good to be true, and articles like this one seem like a part of a massive media push to me. Almost reads like a "9/10 doctors smoke Camels" kind of situation.
I'm sure it's not a miracle solution. But it does seem unfair to compare it to amphetamines.
For a start, it does not appear to be psychoactive to any large degree, which is a huge difference. Of course there will be psychological effects from anything that changes your weight or lifestyle rapidly, but that's not the same as being psychoactive.
I think the largest issue will be sorting out the genuine side effects of the drug from the side effects that would happen from any major change in lifestyle/weight.
Here's the list of side effects from wikipedia:
> Possible side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion/heartburn, dizziness, abdominal distension, belching, hypoglycemia (low blood glucose) in patients with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease (GERD).[26] It can also cause pancreatitis, gastroparesis, and bowel obstruction.[27]
How many of the things in that list would you say a person who undergoes massive weight loss in short time without drugs would experience? Or massive changes in the amount and type of food that they eat? Especially if they also have complications with diabetes or pre-diabetes.
And also, how do these compare to the inevitable health problems that long term obesity will cause the same person if they don't take the drug?
These questions will not be easy question to answer. I expect to see a lot of arguments from both sides in the coming years.
Anecdata: I dropped 40 lbs in 60 days a few years ago, which most people would say is pretty extreme weight loss. I didn’t have any of the side effects you mentioned aside from some light fatigue and not as good as focus, but it was really not bad. Operated at perhaps 85% mental capability most of the time and was able to exercise just fine.
Now you might say well that’s interesting but i was talking about obese people taking this drug.
“The study also found that those in the 'obese' category ended up having the same risk of death as those in the 'normal' range, even when factors such as age, sex, family history of disease, socio-economic status, and smoking were taken into account.”
So there are plenty of justifications and reasons to take a drug like this - some good, some bad - but hand waving at the obvious dangers of being overweight or obese doesn’t hold up as well as you might think.
> Epidemiology researchers repeatedly have found that being overweight or obese is not as much of a mortality risk as conventional wisdom would suggest.
> Critics have contended that this "obesity paradox" is the result of poor methods. Using body-mass index (BMI) to measure obesity is likely the most problematic factor.
> Recent research that adjusts for the flaws inherent in BMI show that there is no paradox. The more body fat a person has, the more likely it is that they will die.
> Recent research that adjusts for the flaws inherent in BMI show that there is no paradox. The more body fat a person has, the more likely it is that they will die.
The study that you link to that suggests this makes absolutely zero attempts to control for wealth. I don’t think I need to take a health study in the USA seriously if it doesn’t consider the potential for wealth (access to healthcare, leisure time, poverty stress, etc) to be the cause of what it’s seeing.
You know those studies saying that a cup of wine a day is good for you? Huge numbers, compelling evidence. Turns out they were all wrong due to a pretty simple and 'obvious' bias. Plenty of people who stop drinking did so due to health conditions, both diagnosed and undiagnosed. And so when you just compared drinkers to non-drinkers, you were biasing towards healthy individuals in the drinking side, and the effect was significant enough to create a statistically significant 'discovery.'
All large scale observational studies are subject so such biases, and the one you linked to also seems a likely suspect there. The hidden confounders are pretty much infinite. The users of many of the worst of sorts of drugs, such as heroine and amphetamines, tend to be average to lower weight. They will die disproportionately young, which will drag their weight cohort substantially down. Another could be increases in things like body building, which show increases in BMI without the corresponding increase in body fat that it's supposed to represent.
I'm not saying any of these are the silver bullet, but rather that when you see a big observational study like this, that sort of skepticism should be the first thing to enter into your mind, as it's extremely often the case when you read about a [shocking discovery] based on big observational studies. Correlation is not causation, even with really big population sizes.
Seems like you have a belief, and this data that challenges that is rife with flaws while the data that supports that belief is good clean science.
> The users of many of the worst of sorts of drugs, such as heroine and amphetamines, tend to be average to lower weight. They will die disproportionately young, which will drag their weight cohort substantially down.
Right so this study was skewed by meth use, something that there’s a good chance they controlled for at least where they could, but other studies couldn’t possibly be skewed by drugs that cause weight gain and shorten lifespan.
My takeaway from this and similar studies is that body fat (especially as categorized by BMI) is mostly orthogonal to health. It’s possible to be fat + healthy, fat + unhealthy, slim + healthy, and slim and unhealthy.
And if that’s the case, burdening fat people with my own assumptions about their health is misguided, and dumb.
They did not control for these or countless other variables that could be confounding. You can read the exact study here [1]. This is just a general weakness in large scale observational studies. The reason the wine comparison is particularly apt is because it fits the exact same scheme. Studies specifically on alcohol demonstrate a million and one negative side effects with little to show for it, yet [shocking discovery] shows that a glass a wine day is actually beneficial for longevity? There needs to be an explanation for why.
And most often that answer is eventually found to be that [shocking discovery] was just reporting on a false correlation, driven by a confounding variable. It's the exact same here. There are countless extremely negative factors that being overweight weighs strongly into, yet somehow being overweight is good for life expectancy? There needs to be an explanation for why and, absent some revolutionary new discovery, by far the most likely explanation is a confounding variable.
I see they did not. I also see that in denmark in 2023 (not in the 1970s and early 2000s when the data was gathered) about 1.6% of 16-34yo’s had used meth that year. The prevalence of full blown meth addiction is going to be dramatically lower. 0.5% seems high but let’s go with that - 50 people in this study. Seems a bit of a reach to say that’s what’s skewing the data.
But the overarching point is: why is your default that fat is unhealthy and you must have bulletproof data to believe otherwise? My default is i don’t know one way or the other and I think health is probably way more complex than what % body fat you have and I don’t understand why so many people are determined to use it as a proxy for health.
The Search Engine podcast has a great recent episode on this. Pharmaceutical Speed was super abused back in the day, and this was the source of drug categorization under Nixon. Schedule 1 drug, etc.
This led to a dramatic drop in drug use. Big Pharma, in the quest to restoe its profits, pivoted to children.
Child fidgety? Can't pay attention? ADDERALL!
The episode is based on the author's first-person experience. I won't spoil the big reveal.
While I'm sure there's real value in the drug, articles like this one in Reuters [0], noting how much Novo Nordisk is spending on promotion, makes me suspicious that it's being overprescribed.
it turns out you don't actually have to spend a lot on marketing a miracle weight loss drug, word spreads pretty well on its own. lots of companies spend lots of money on promoting drugs and basically none every go viral like this. you don't hear phrases like "ozempic face" because of novo's marketing budget. you can even see this in how people still talk about ozempic despite the actual weight loss labelled name being wegovy, and despite zepbound (tirzepatide) arguably offering a better option with lower side-effect burden through dual agonism of GIP.
My diabetic mother has a 2mg prescription for it and nobody seems to have it available. For weight loss, this is a luxury drug. For others, it's a lot more important. Unfortunately, luxury drugs get bought out by luxury people, leaving the average person in the dust... I wish ozempic's distribution was less corrupt, but that ship seems to have sailed now.
Besides anecdotal evidence, what makes you believe that the people who are getting it need it less than your grandmother. Obesity kills people as surely, and sometimes faster, than diabetes.
Are your feelings on this influenced by the notion that obesity is a moral failing or a willpower issue?
Both can be managed (and symptoms resolved) by lifestyle changes. Both will return if someone returns to their old lifestyle. And the lifestyle changes that treat one often treat the other as well.
We could argue about whether either is "cured" or just "in remission", but it's illogical to say one is cured and the other isn't.
I first heard of “the weight loss shot” from a morbidly obese waste management company owner friend of mine. He has steadily lost weight and kept it off with what is basically a chemically induced fast. So it clearly works.
Anything that measurably reverses the insane growth rate of obesity is very welcome.
If all it takes is a weekly shot to reliably improve individual decision making with consumption then that would legitimately be revolutionary.
No free lunch still applies though, I’ll be interested to see what the long term externalities are.
This is just a first step towards GLP-1 gene therapy. It works in mice and pig models so far. Piece by piece, we spellcheck the genome. Human trials are targeted for next year.
It reminds me of accutane in a lot of ways. Some drugs are actually miraculous in how they solve problems, but can have some pretty nasty side effects. I wonder if Ozempic will end up like accutane as the final line of treatment when all other routes have been exhausted, or if the formulation will be refined to the point the side effects become minimal.
One interesting difference between Ozempic and accutane is that the accutane treatment is pretty much permanent after a dosage round but it seems like this Ozempic needs to be continuously taken to see effects. Which is great news for pharm companies
I can only speak for myself, but I stopped being obese and out of shape when I stopped being broke.
I began to eat fewer calories of higher quality food, hit my macros, and prevented muscle loss by going to the gym a few times a week.
It was a feedback loop with my social environment. Expectations of me changed when I finished school, and I didn't really think anything of it until I saw some results which only reinforced the new habits. Everyone was supportive and from there lots of other stuff in my life got cleaned up as well. I don't even drink as much as I used to.
I can't be alone in feeling this way. For me it was finding good people, being happy with my career, and not being so stressed out all the time as a result.
After 10 years of natural lifting, my maintenance calorie at sub 20% body fat is higher than when I was obese, normalized/settled at ~35% body fat around the same weight. Easier to maintain weigth and appearance than ever. And apart from hammering down some protein shakes, I eat whatever, like obesity days. That said eating clean does do wonders for my performance and energy levels. Ozempic probably has much greater gen pop appeal since it's a pill, and probably what one needs to stay on if they need to stablize below their natural setpoint. But sometimes I wonder if segments of population wouldn't be better off with a few dollars of testosterone and one day at gym a week before resorting to Ozempic. If only more longintunal research was done on moderate test usage. Arguably most slight-modest overweight people would look much better recompositing to more muscle at their current weight. That said I do have make an slight effort to be 5-10lbs shy of my setpoint weight during less active periods of winter. That few extra lbs is when I start experiencing health issues like gastric reflux and increase in blood pressure.
High stress, poor sleep quality, alcohol abuse, and obesity all reinforce each other in a feedback loop. Breaking out of that vicious cycle often requires a complete lifestyle change including a new environment and different friends.
Study that says these drugs could prevent 1.5 million cardiac events over 10 years...
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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.
https://news.ycombinator.com/item?id=37166206
The article suggests that when ozempic solves people’s weight loss issues, they will be happier and spend their money differently
But every discussion of ozempic inevitably brings up “ozempic face” which is some apparent aging and irreversible damage done to the skin/collagen.
So are we really changing the economy after obesity or are we just substituting one type of self-image issue with another, more difficult to treat one?
It can be, but weight fluctuation (which Ozempic deliberately causes) is also harmful and in some cases more harmful than overweight was to begin with. But also the issue isn't so much dangerously obese people taking it (on the whole probably good) but rather slightly overweight or not-even-overweight people taking it.
If this drug costs $1000/month does it really put money in people's pockets that they will use to buy other things that end up boosting the economy? They first need to be able to pay for the next hit of Ozempic.
I don't see the connection unless the ones producing the drug are getting all that money and buying new 3rd homes with custom furniture, new vehicles, etc. Since insurance evidently doesn't cover this for everyone there will be a lot of people paying ridiculous money to lose weight who will then be stuck on the lifetime drug treadmill as a health maintenance requirement drug.
Why don't we invest the money going to this expense in health education and public facilities for health maintenance - parks, gyms, etc.
I understand that many are already morbidly obese and need something like this drug to get them back in control of their own health outcomes but the overall goal should be to shed the extra weight and discontinue the drug while adopting healthy lifestyle habits.
This is probably a good take. I think though that the cost of health care only comes into play when the obese person begins to take action to try to change their situation or to manage their condition. Until that point their health care costs are minimal since they are not focused on staying healthy or becoming healthier. But yes, overcoming the consequences of obesity will be expensive, a lot more than this drug.
Wonder about economic impact of not just people going to restaurants less, but large percent of population operating on sigificant caloric deficit, which has adverse effects on energy levels and cognition. Basically smalls scale seasonal famine, because most likely, casual users are going to cycle on before summer hits. I'm reading 1000+ calorie deficits. I don't know about others, but that amount of deficit over weeks/months impairs my daily functioning outside of just hunger.
A couple of months ago I was in the hospital for routine surgery. When I was in the pre-op area I overheard the conversation happening in the bed next to mine where a person was about to go into unplanned surgery and was consulting with an anesthesiologist. The doctor was suggesting a certain course of action that the patient wasn't in to, but the doctor explained that his suggestion came from the position that ozempic was so new that there was so little understanding of how it interacted with anesthesia and other things in general, they had to proceed with extreme caution. He kept stressing how little was know about this drug when it came to an emergency or surgery setting.
That shit is real. I was never obese but somewhat overweight and lost half the excess weight in just 2 months even still being far from full dose (it escalates over 4 months to minimise side effects). Side effects so far: 3 days of bad headache close to the end of 1st month, and about two cases of 1-2 days of light to moderate headache after. Nothing else.
Plus, i completely quit drinking. Was never trying to even going to, i just didn't feel like drinking at all anymore about a month into it.
You don't actually have to be overweight. You just need to have trouble controlling your food intake.
I'm a healthy weight. But it's only because I eat one meal a day and feel terribly hungry the entire day. When I eat more than once a day I balloon up into the obese category. So I am a good candidate for these treatments despite currently being in the low end of "normal" BMI.
You know someone has a real issue with food if they're willing to stab themselves with a needle once a week rather than just voluntarily restraining themselves. Don't think I would ever do this.
Thankfully, my metabolism is not too bad. Not as good as my siblings who are all skinny but given how much I eat and given that I'm approaching middle age, I really can't complain.
It sounds like you have a fear of needles more than anything else. I've probably had 100 blood draws in my life, and those needs are far fatter and more painful than drug delivery needles. It isn't a big deal for most people.
Not sure what kind of response you expect from such comment? I have all the information about my fitness level and you have 0 information about it. It would be pointless for me to post my earlier comment online, anonymously, if I was actually overweight. It's not like I'm seeking confirmation about my fitness from people who've never even seen me.
There were major weight related health complications I was having at 34 BMI and they're not happening now. I knew how to lose weight -- meticulously track every calorie, use diet and exercise to hit targets. I had done it before , down to -10% and -25% body mass twice in the past ten years. But it never stayed that way -- I found it incredibly hard to stick to my kcal in goal or to stay at a stable lower weight. I'd eat when I was hungry, and eat enough to stay at my long term stable weight. If I ever stopped tracking every calorie in, my default sense of "full" tended towards a caloric surplus.
This drug fills exactly the gap I was struggling to fill with previous attempts at weight loss. I've felt "full" at 1500 kcal/day for months (though have had more of an appetite in the past 1-2 months) and have ended almost every day with a caloric deficit. It's a serious pharmaceutical intervention and I read the literature on GLP-1 agonists for years before starting. There were side effects, notably reflux when eating too much, "sulfur burps", and a general feeling of malaise for the day after taking a dose for the first few months.
No idea what the long term consequences of staying on this drug forever will be. Haven't noticed any other behavior changes. Not particularly interested in the appearance angle (I felt like I looked okay before and look okay now, though I've needed new clothes due to dramatic changes in waist size).
But the health stuff is serious and real and if we can make this drug cheaply available to people who discuss it carefully with a doctor there is potential for a serious chronic disorder to be addressed much more effectively than it used to be.