Don't these plastic surgeons have a conflict of interest if they perform liposuction? Liposuction is probably wildly more profitable than prescribing a GLP-1 inhibitor.
People are coming to them with sagging skin from Ozempic. Since 6% of Americans are on it now (according to that article), how is that competition for the plastic surgeons?
> These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.
I've seen other data that says that 50% of weight lost on these drugs is muscle mass, which is high for weight loss. You should expect to lose both muscle and fat when losing weight, but that's a very high ratio. With weight lifting, you can attenuate that a bit, perhaps completely.
It would be interesting to see a study that compares people who take GLP-1 drugs and make no other modifications and others who lift heavy weights under supervision.
The other issue that should be studied is diet. If you eat a poor diet lacking in protein and then you take drugs to make you less hungry and now you just eat the same diet but less, you may not be getting nearly enough protein.
It would also be good to study the impacts of protein consumption while taking these drugs.
I also wonder about the velocity of weight loss. Losing weight too fast could also be part of the issue.
I wonder if using something like Retinol, which is proven to improve skin and make it look tighter, younger, and get rid of blemishes, marks, and sun damage, could be paired with Ozempic to keep skin more healthy along with a good skin routine?
The problem is she swallowed everything else too. The obesity is a massive problem that needs to be remedied and yes there may be side effects along the way but literally nothing else works for obesity except roux-en-Y gastric bypass. Palid skin is nothing compared to losing your foot to diabetes.
Nothing besides GLP-1s and roux-en-Y has been shown to help people lose a clinically significant (>5%) amount of their body weight and keep it off long term (>5y). Exercise does roughly speaking nothing to help you lose fat (it's great for all sorts of other things), and diet has not been shown to work long-term either due to changes in metabolic rate and hunger leading to ~zero compliance. Most people reverse trajectory around the 6 month mark, and average weight regain after 5 years is 80%.
Exercise most certainly helps you lose fat, and it helps you keep your blood sugar in check.
Exercise is often not good at helping people lose weight, but it is good at helping them lower their body fat and increase lean body mass.
You'd much rather someone be a muscular, overweight person than skinny-fat person. In particular, if you got someone lifting weights three times a week, it would have a noticeable impact on their body composition and overall health, regardless of weight.
The studies are pretty clear: aerobic exercise leads to some tepid reduction in body fat in exchange for massive effort, and resistance training increases fat-free mass but doesn't reduce fat.
> [aligned] with literature from the previous decade and recent systematic reviews concluding that participation in an exercise training program does favor weight loss, although of only modest magnitude. [1]
> Resistance training was the only exercise modality that failed to significantly decrease visceral adipose tissue. [1]
You suggest that "you'd much rather someone be a muscular, overweight person than skinny-fat person" -- but that's not really the case. Sheer fat mass, especially visceral adipose tissue, is what is associated with negative health consequences.
[edit] Even the article you linked to via the Times says the following.
> However, the amount of weight loss from exercise training is often disappointingly less than expected. [2]
Which aligns with their own findings that after 12 weeks of 3000kcal/week energy deficit they only lost about 5 pounds, see Table 2. So to lose 50 pounds you'd have to spend 2 years with a 3000kcal/week deficit, and keep adjusting periodically. The chances of compliance here are literally zero, and compliance is a major issue. In some senses, it's the major issue.
Also this study committed a major sin: they didn't follow up. Any study that shows anything meaningful in re: weight loss reverses after 6 months.
I don't know much about skin care, but given that Ozempic has side effects that affect the retina, it wouldn't be crazy to get plenty of vitamin A if you're taking it.
There's a few, but they are all pretty minor. It doesn't mix well with water (rash), so make sure to put it on right before you go to sleep. It can increase sun sensitivity of your skin, making it easier to have sun burn or additional sun damage, so again, put it on before bed. It can sometimes cause breakouts especially when you start using it, including a red bumpy rash. But after a few weeks, your skin typically adapts to it and the rash goes away.
The tricky part is there's all sorts of people that sell Retinol products but the amount of retinol is OTC. This isn't typically good enough, but you can go to your dermatologist to get a prescription strength that really works, and it's cheap.
They're minimal; retinol is usually mixed with a carrier oil or cream in various concentrations and applied topically. I would be surprised if it has an impact on the superficial musculoaponeurotic system (SMAS) referred to in the article, however.
I'd say a more important side effect that ought to be researched is possible thyroid tumors, including cancer.
> In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.
There are more options. Many medications are usually prescribed together with other meds, to help with the side effects. We may adjust the formulations, or learn what to compliment it with.
1. If other weight loss methods also have significant impacts on the skin, it seems plausible that a shared mechanism could be the most parsimonious explanation. Therefore, if this effect exists, it might be due to weight loss itself rather than specifically due to Ozempic. The article cites a study supporting the fact that dramatic weight loss has negative impacts on skin health.
2. GLP-1 agonists modify appetite, which could lead people to consume less satiating foods (e.g., protein). This might negatively affect both lean muscle and skin health. There is data supporting collagen supplementation for skin health, as collagen likely raises serum amino acids. This would have the opposite effect on skin health compared to a lower intake of protein.
3. The observations made by plastic surgeons might be influenced by healthy user bias. Ozempic is an expensive medication, and insurance coverage is generally granted to those who are already quite unhealthy. To make a fair comparison, these patients should be compared to individuals with similar health characteristics.
It's also worth adopting an engineering mindset and considering the trade-offs involved. For someone who is extremely metabolically unhealthy, the benefits of weight loss might outweigh potential negative effects on the skin in terms of long-term health.
I've been using tirzepatide since the end of february, since then I've lost 52lbs in about 25 weeks, if my fat skin was stretched and it's since relaxed at a rate of 2lbs per week then maybe right now it is like an old rubber band that's been unstretched, but in a few months time once the rate of loss reduces it will be ok. I'm almost 50 so tbh I expected it to be much worse, I've virtually no loose skin compared to the 6 inches I've lost around my waist.
> “Fifteen years ago, I would never have done a lower body lift on a patient unless they had gastric bypass, a lap band, or a gastric sleeve,” he says.
Right, because 15 years ago nobody else lost any weight. GLP-1s and roux-en-Y are literally the only two treatments shown in clinical studies that cause people to lose weight and keep it off indefinitely.
Maybe the skin is saggy because there’s nothing under it, maybe not? But at least they won’t have a stroke, heart attack, cancer or type 2.
Chemo is going to make you look much worse.
The new category of patient is “person who successfully lost weight and kept it off without gastric bypass.”
[edit] if you think I’m exaggerating there’s a great study from 2023 that tracked how many people lost more than 5% body weight in a given year.
Answer: 1 in 10, skewing mostly to people who had more to lose.
If you were morbidly obese your probability of achieving a healthy weight is 1 in 1667 in a year.
And if you manage to thread that needle your average weight regain over 5 years is 80%.
Wow. 10% success rate for diet is really lower than I thought. I'd have guessed 25% based on my experience (34 BMI to 25 over 6 years). Not that surprising though, loosing weight is the hardest, most painful thing I ever done.
It's strange how there is almost never a shortcut to anything. Like a universal law.
So now you might get free weight loss without making any effort at all, but you'll also look older in the process?
I have to say, my father has been taking it, and I noticed that he does look older all of a sudden...and his weight loss also plateaued. I thought it was just my imagination, but maybe not.
> strange how there is almost never a shortcut to anything. Like a universal law
There are win-win tradeoffs. Vitamins, for instance. If you're running a vitamin deficiency, there isn't a downside to increasing your intake of that vitamin. (Curing acute dehydration via IV is another shortcut that just works.)
The Ozempic story, for me, has been more about how we almost seem to be reflexively against the idea of a win-win. A lot of people want there to be a tragic downside to the drug for reasons that aren't entirely clear to me.
My perception is that we judge fat people as weak and contemptible and therefore a drug is allowing them to cheat their way out of their sin instead of paying the proper penance (diet and exercise).
It's well known that people treat fat people worse; I constantly wonder how aware people are of their own biases?
For what it's worth I've been fat before and I've been in shape before. I have my own biases that are beyond the scope of this comment. Never taken one of these drugs but only because of cost/access; I'm actually curious to experience them. If they work for people, I say they should take them.
Ozempic doesn't make you lose weight unless you do a diet. All it does is to make it easy to do a diet by suppressing the craving for food. So it's not like people are losing weight with ozempic while stuffing themselves with burgers.
As for exercise, it has many benefits but is a fairly minor contributor to weight loss. I am doing a bit of a hardcore diet at the moment (helped a ozempic competitor), lost 20kg/44lbs in 3 months, and I noticed no difference in change in weight whether I do 1h of exercise bike daily (max resistance) or whether I do a week without.
Believe me, I'm aware of calories in/calories out, but I've never really found it so simple. Exercise has benefits beyond purely burning calories. And moreover, if you want to change body composition rather than just lose weight, it's important (fitness types have the term "skinny fat" for people who don't weigh much but still have high body fat).
It's not that it's a sin to be fat, it's that there are side effects to taking the short cut, as outlined in the article, which was the point I was trying to make originally.
> The Ozempic story, for me, has been more about how we almost seem to be reflexively against the idea of a win-win. A lot of people want there to be a tragic downside to the drug for reasons that aren't entirely clear to me.
It's easy, substitute the obese with the smokers demographic. Imagine them whining that they smoke because it's an environmental issue, that they just can't do otherwise, that it's a metabolic issue and not a willpower one, a genetic thing, lack of access to alternatives... anything besides their own will.
I wonder how taking a medicine for the rest of your life is a win-win when there are places in the world where obesity is almost non existent and it's been proven to be largely lifestyle related. Besides, semaglutide just makes the subjects crave less, reinforcing the willpower role in weight loss.
I have read people in this forum state that if they eat less, they gain more weight for some unknown genetical issue, like thermodynamics do not apply to them.
I think it's pretty simple, unfortunately. A lot of folks have this visceral, instinctive horror of fat people, and instead of examining that, they convince themselves that what they actually despise is laziness and gluttony: inner vices expressed outwardly, like a medieval morality play.
But if there's a way to lose weight without major lifestyle change, it threatens that tidy moral barometer. Someone might look virtuous without actually being so. Cognitive dissonance ensues. So they hope and wish for anything to catch out and punish these "cheaters."
Cars, computers, and cellphones are unnatural. If you can get over those, you can get over recoiling in atavistic horror from people who don't meet your beauty standards.
Ever heard of Fen/phen? Was a big thing back in the 90's. Weight loss drug combo that was ultimately found to do major harm.
You have to keep a clear head as an early adopter in some things, and be aware of incentives. Remember, the pharma company pushing the drug/treatment to market is out to make money first. Having a knock-on problem down the line to fix also serves that purpose, and in fact, has been a tactic employed by other notorious pharma manufacturers. Lest we forget the lessons of the opioid crisis do quickly.
I have heard that people who lose weight quickly will typically look older due to the development of wrinkles and the development of harder features. Skin simply doesn't have time to keep up with the weight loss. I don't know if this is true but the theory could have some merit as far as our perception of people. The real question is: does something like ozempic change the biological age of someone?
You're going to need to include a weight percentage drop or something. I've wrestled/jiujitsued my entire life and we go up and down weight constantly, 2-30lb swings. We'll water + electrolyte fast for a week or two if we have to and drop 10-20lbs.
We all look 10-15 years younger than we are (35-45s).
But we're also not dropping 150-200lbs or whatever number you're potentially referring to to where skin would stretch. But prolonged, constant rapid dropping hasn't bothered our skin. I'm complimented all the time on mine.
Yeah totally, there would be umpteen different factors that would influence the "age perception" so to say. I also wonder how losing different types of weight(water fast vs longer timeframe fat/muscle loss) could impact this.
What kind of effort are you talking about? Weight loss has very little to do with exercise and mostly to do with how much you eat. Those drugs allow you to combat the carving when you restrict food. Is fighting the carving the "effort" you think people ought to make?
This, and there's seems to be a number of people with a misconception that getting medical assistance is either cheating, or you're not trying hard enough.
As someone who is quite strong and fit, but has a family history of obesity, and who has been packing on the kilos into their 40s - I've recently started with ozempic and it's a breakthrough drug. The incessant never ending demand to eat, that voice which never goes away and pervades every part of the day and task, the call which is almost impossible to ignore ore even after months of dieting and managing macros - it got moderated down from a 10/10 volume to about a 2/10 volume. I've started dropping the gut fat, and 6 weeks in my energy is coming back up to levels it was at 10 years ago.
I'm hoping that this isnt a permanent solution, but that it permits me to reset my bodies relationship with food, insulin, fat accumulation and hunger signals in the long term as the signalling cells senesce, the fat is reduced and demands less maintenance, etc.
It isn't a permanent solution, it's purely designed to drop weight. You have to do the mental and physical work to be able to maintain which is a different mindset.
> Weight loss has very little to do with exercise and mostly to do with how much you eat.
That's not an accurate statement. Over the past year I have averaged 2 hours of aerobics per day (~1500 active CAL). And I've simply buffeted my way eating multiple portions per day and haven't gained any weight.
It have a lot to do with a lot of exercises - it has little to do if you just had little exercise. It's all about the caloric balance, and it takes a lot of exercise to skew that balance while it's a lot easier to eat more.
IMO GLP-1 agonists are obviously not free, from first principles. They might be for diabetics who carefully manage their diet, but many (most?) people using them for weight loss usually already have shitty diets with poor macronutrient balance and micronutrient deficiencies. Eating less of the crappy food they were eating before just makes the true situation worse.
This is just the latest [1][2] evidence for the obvious muscle wasting that will happen to a human body that is starved of protein and micronutrients. The muscles under the skin are being cannibalized for protein that’s missing in the diet and other biochemical processes that restore them are starved of the nutrients they need to function.
Why do you think they just eat less of the same crappy food?
In my experience, it turned down the reward feedback for calorie dense food, and I would usually now prefer something like a lentil daal over a Dominos.
Because GLP-1 agonists don't change anything other than the cravings and/or reward feedback. They don't add healthy menu items to existing restaurants, they don't put new grocery stores in food deserts, teach people how to shop for healthy food or how to cook it so it's palatable, or in any way mitigate any of the socioeconomic factors that drive people to eating unhealthy food.
In my experience, the average American is looking at restaurants like McDonalds, Dominoes/PizzaHut, a local burger joint, and a "fancy" place like Olive Garden. They wouldn't be able to get something healthy like lentil daal if they wanted to, with the closest equivalent being a McDonald's salad.
It's worth noting that people, in this forum especially, would defend weight loss drugs at any cost. Because for them they mean being not-obese without any trace of effort. Controlling caloric input, maybe even leaving the house and moving... puff. Gone. Just take a pill daily for the rest of your life.
I don’t know, I think that might be a bias of some kind. The free shortcuts are obvious and so the alternative sounds ridiculous. No one claims to be a genius when they save time by driving instead of walking. But at the margin, of course everything has a trade off.
This is basically the ‘no free lunch’ principle, and the thing to keep in mind is that there’s no universal free lunch, but that doesn’t mean no individual lunch is ever free. (The classic example is insulin for diabetics, which most certainly is a win.)
seems pretty unsurprising to me that when you shift the equilibrium of some extremely complicated system that evolved over an extremely long time to improve some metric, that the side effects are mostly moving down some other metric you liked.
or even more boringly: almost only bad things get called side effects rather than being redefined into the benefits
I see older very skinny women who look old and frail due to being very skinny. You need some fat under that skin to plump it up to look youthful. Catherine Deneuve I believe was the one that said that after the age of 40 you have to chose between your face and your ass. I say all of this as a 40 something woman.
coffee definitely ruins my sleep no matter what time I drink it, so there's that.
My father also had headache his whole working life on Sundays, not realizing that drinking coffee all week days but not on the weekend, that was probably coffee withdrawal that was giving him a headache by day 2.
Certainly is a problem for me and I've seen others say the same. Every doctor I've been to has mentioned it as an issue.
"Caffeine — a major component of many varieties of coffee and tea — has been identified as a possible trigger for heartburn in some people. Caffeine may trigger GERD symptoms because it can relax the lower esophageal sphincter (LES)."
I get really bad GERD from coffee and black tea, a bit less from green tea.
I don't get GERD from Mate tea or energy drinks. So I think it's not the caffeine. Since they both contain high amounts of caffeine, even higher than black tea.
I've noticed that if I eat more fiber I can somewhat mitigate this. But it needs to be consistent. Not just a little extra fiber before coffee.
BTW a high-fiber diet can be a natural ozempic by raising GLP-1 levels.
There's no shot that the cure everything pill will have any negative health consequences, it's been working so well for me that I just spoke to my pharmacist and we're doubling my dose.
A quick explanation about what Ozempic is would be helpful in this case. Not every country uses the same name for their drugs and the brand names are often very different
That's an interesting remark, considering this is most famous drug on the face of the Earth, and only has one brand name worldwide (in a different dosage it's called Wegovy, and when it's released as a pill it will be called Rybelsus). Its generic name is Semaglutide.
Wouldn’t the most famous drug be: aspirin, heroin, cocaine, paracetamol, or maybe viagra?
I don’t know from your comment what it is, and it was unhelpful. Not really in the HN spirit. For future readers, it seems to be an anti-diabetic drug or artificial hormone originating in the 70s. More educated comments than mine are very welcome.
This is the first time I'm hearing about it. It seems here it's only prescribed to type 2 diabetes partients and doctors are strictly prohibited from prescribing it for weight loss.
Yes that might be what you read online but in reality there are 5 people at my work out of a team of ~35 on the medication purely for weight loss. Only one of these people was majorly obese, and the other 4 were nominally overweight (though probably technically obese).
Roughly 15 million Americans are on Ozempic, and about half of them do not use it at all for Diabetes treatment.
It says that a lot of people are on Ozempic. And that it changes the skin somehow. And that these people get plastic surgery.
If you search for "diabetes" in the article, then yeah, you'll find it about half way down, but by then I already stopped reading because I had no idea what the whole article was about.
So yeah, it might technically be in the article, but it wouldn't have hurt to put it in the post title now, would it?
Was this article written by an LLM? I had to scroll so far to get to the core content it kept promising, it's like it wasn't written for human consumption.
Ultimately this article is kind of a FUD nothing-burger. People's skin behaves the same anytime there is rapid weight loss.
> These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.
TFA contains mixed messaging. The part you quoted is discussing face skin, then later, also talking about face skin:
> (“We see a similar pattern in other causes of rapid weight loss, including gastric bypass surgery, he says.) In some cases, the loss of subcutaneous fat is significant enough that it impacts a patients’ ability to get injectables ..
So which is it?
My takeaway was that losing weight fast == problematic.
The article dials up the FUD factor to the max, which makes me question the quality of reporting and any intent to accurately inform vs. just get clicks.
>and any intent to accurately inform vs. just get clicks.
This is missing one option. The source - plastic surgeons - may be people that profit from liposuction treatment. To keep patients they might not want people to use ozempic, or at least get people to notice changes in the face faster and get a facelift.
I had an internship with a researcher who swore skin had different properties between races (not including color). Black populations had a different feel to adipose tissue. I think I could tell but he had examined thousands, he didn’t want to be the guy publishing a paper on that.
here’s my casual armchair analysis about some thing I know nothing about: Is this correlation instead of causation? I mean, if you’re dumping pounds rapidly and then your skin is all been stretched out…
> These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.
If you're using ozempic or any other form of semiglutide , you'll want to keep and prioritize a high protein diet to reduce or eliminate the muscle wasting that the drug causes.
Nothing worse than losing weight but most of the weight loss was muscle mass.
My impression from watching various people debating studies on the topic, is that even more important than protein is physical activity, when it comes to stopping muscle loss. Someone sitting in a box eating nothing for a month will come away from it with all sorts of health issues compared to someone who walks for half an hour and otherwise lives normally, despite the second person supposedly having higher energy and nutritional needs. Physical activity is a powerful signal to the body to maintain itself. This is why the health of bedridden people looks like a horrible feedback loop that destroys them.
Another issue that makes me wary is that normally when fasting, there’s an initial period of being hungry, followed by adaption and minimal/no hunger. After a few weeks (or longer if there are special circumstances), hunger should eventually return, and this is your signal to start eating again regardless of plans. What concerns me is that Ozempic may prevent the return of hunger signal. I could see this leading to malnutrition, which another post already mentioned in a different way.
In the UK those products are only available to people with a BMI > 30. If you have 20 or 30 kg to lose it is simply not true that most of the weight loss is muscle mass. The fat is visible and the fat loss is also visible. You might lose a bit of muscle mass, and doing exercise at the same time is good. But between the loss of a bit of muscle mass during the diet vs remaining obese, it is an easy trade off from a health point of view.
"These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage."
Are you suggesting sections elsewhere in the article suggest otherwise?
Not unlike the "massive muscle tone reduction" scare about GLP1 meds - you lose that muscle because you're also losing the fat you needed the extra muscle for...
> you lose that muscle because you're also losing the fat you needed the extra muscle for
That may be part of the cause, but it's also true that whenever you lose weight, you always lose some muscle. Even bodybuilders who are following the most aggressive protocol to minimize muscle loss (extremely high protein intake compared to other macros, along with intense strength training) will experience some amount of muscle loss along with fat loss when slimming down for competition.
