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

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

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

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

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

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

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

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

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

But curious what your experience with exercise has been.

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

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

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

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

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

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

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

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

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

Thank fucking god for Novo Nordisk.

---

[1] see: this thread!

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

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

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

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

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

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

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

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

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

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

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

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

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

Congratulations! This is such a great success story.

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

Good job!

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

Sounds like a kickstart you needed!

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

> I realized that frequent cannabis consumption interferes with the weight loss

Because you eat more or is there some other factor?

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

Have you looked at Psilocybin for your depression?

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

How do i get this?

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

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

Check https://metabolicmind.org for details.

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

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

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

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

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

I'd just say follow the money.

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

> Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

"Getting fit and staying fit" is a form of social capital, because it's extremely hard and only within reach of a small portion of the population. "Being fit" is strongly aligned with "being attractive" which confers all sorts of cross-cutting social benefits.

Some people feel cheated when medication allows others to "effortlessly" join this social club, and then become vile and hateful in response.

"Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?"

I think it is because if 90% of the population did half of what you do (and kudos for you for doing it), they wouldn't have a problem with weight, you just happen to be one of the unlucky few where it doesn't work and these drugs are useful.

Why do we find it acceptable to help...

I think if the widely available help for alcoholics, smokers, or opioid addicts mainly mitigated the negative consequences - enabling them to drink, smoke, or dope more - it wouldn't be nearly as acceptable.

I personally expect weight loss medication that simply makes people want to eat less will reach cultural acceptance.

Case in point, cigarettes have been known to suppress appetite for ages, and people have elected to smoke to help stay thin for decades. There was never any crushing social stigma attached to doing this as a weight loss strategy (that I know of).

> And you know what it is? It's volume. I eat too much.

100% this.

I lived in Asia for a few years and obesity is rare (though increasing for youth). It's not like they get more exercise (most people don't) or eat healthy (it's mostly carbs), but 100% portion sizes.

I see people who work manual labor jobs eat lunch that is a bowl of noddles, a few thin slices of chicken or pork, and a few veggies. I highly doubt it exceeds 500 kcalories. It's probably half the portion size you'd get in the US.

Mystery solved. If you're only eating 1500 to 1800 kcal per day as an adult male doing manual labor, it's pretty obvious why you're at 10% body fat.

> And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.

The therapeutic amphetamines dosages for ADHD is below the threshold required for produce meaningful weight loss. It's not surprising that it didn't help you lose weight.

I think there's a few factors at play:

1. People might want to help, but they don't think taking a pill every day for the rest of your life is a proper solution. I'm not aware of any such things for other addictions you mention,

2. People don't want other people to have it easier than they did. "I had to diet and exercise etc, you should too",

3. People don't want to help. They want other people to be fat because it makes them relatively more attractive.

> Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

For the same reason why skinny person taking steroids is frowned upon - it is perceived as a shortcut.

Would you mind sharing what your diet was like as a child?

I wonder if there's a connection between diet during development and adult processing of and cravings for food. Maybe eating candy for breakfast (cookiecrisp!) every day in elementary school messed a bunch of us up.

I think a lot of it is dealing with hunger. If you can't stand being a little hungry, never mind very hungry, no diet will really help. I used to love being very hungry, not sure how I got there, but I wish I can go back there again. Having very little carbs and temptations in the house helps. Unfortunately it's not up to only me.

Perhaps the first person on HN who actively and without shame pays attention to the fact that Adderall is a very nice amphet cocktail. Surprising though you don't loose wait with it, sad also given the circumstances. But I envy you a little cause such ADHD boost is only illegal in EU.

Sometimes I wonder if it was a some neat trick by US gov to diagnose and put 1/5 of the population on amphetamines (2024 data +60mil prescriptions of Adderall), so that most everyone who is actually like smart or sensitive or anything of value to the industry, can (almost) freely microdose on it and as a result increase productivity.

Which... means 1/5 of the population suddenly increases output. Perhaps we all'd be on Aderall at some point, dunno bout the Ozempics...

Seconding Zepbound, it has been absolutely life changing for me, and not only in terms of weight loss. It's expensive, but I am blessed with a tech salary that can afford it.

Anyone can list 50 no-no things they don't eat and omit the 5 types of foods they do choose that causes the most damage. Volume & variety are not to blame given most sauces are calorie dense. The issue generally is the person eating for pleasure conflicting with their stated aim to eat for weight maintenance.

If it tastes good spit it out. Countless people ready to tell you no sacrifice is needed in that domain but they have something to sell or trade.

> And you know what it is? It's volume. I eat too much.

Have you considered eating less?

> It's volume. I eat too much.

Bingo. I've had this conversation with my girlfriend. She's not overweight by any means (160 cm ~55 kg) but I am quite underweight (182 cm, 65 kg, < 10% body fat) and the conclusion I've arrived at regarding our differences in body composition is because she routinely eats 1.3x to 1.5x the amount I eat. We both exercise and eat little junk food.

I'm convinced it has to do with upbringing. My family never ate a lot and the portions I was served as a kid weren't big. Nobody in my family is anything more than skinny. Her family however, they eat a lot (and healthy too, mind you). This is all influenced by other factors, her parents and grandparents grew up with not a lot to their names and with food scarcity, so when they reached a position in life where they could comfortably afford to eat they gained the habit of having big meals. My family was mostly more privileged in that regard so maybe they never felt the need to focus on food as much.

Have you every using a calorie/macro tracking app like My Fitness Pal or Cronometer? I was never successful losing weight until I scanned, weighed, and measured every single thing I put into my body and stuck to the target calories and macros entered into the app. Just being aware of exactly how much I was eating was often enough to find the motivation to control volume.

Try a very low carb diet. Only eat until 80% full at mealtime. Get down to two meals a day, with a goal of only one. Fast the other times. This sounds hard but once you get to ketosis it is not that hard at all. Not hungry naturally, like the drug response.

Truth is, we really don't need more than one meal a day (maybe a snack) when we get older and our metabolism slows.

> We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.

> ...

> Yet... the number on the scale kept on creeping up.

That is absolutely terrifying. What oils did you use for cooking?

You mention types of food but not quantities. A boat load of healthy food is still going to have an effect. Also, I for one don't consider walking to be exercise. It's fake exercise for people who don't like exercise to claim they exercise. My reason is that I cycle for eight months of the year then walk during the rainy months. By the end of the rainy months I get back on the bike and my fitness level is catastrophic - nothing. I've done this for five years, and have to say walking is just not good enough for exercise, not even close.

What kind of food do you and your wife cook? How much meat? How much gluten? Real butter or canola oil infused “spreads”? What oil do you cook with? Vegetable? Sunflower?

If you’re eating the right thing for your body, you’ll be satiated when you eat your full.

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

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

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

Which group do you think would have more posts?

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

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

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

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

2) Magic pill (/injection)

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

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

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

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

That's very idealistic, in my opinion.

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

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

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

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

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

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

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

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

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

The government isn't going to help you.

This evening, go for a one minute walk.

Tomorrow evening do the same.

Next evening do the same.

Repeat.

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

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

The two are not mutually exclusive.

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

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

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

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

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

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

> the active drug in Ozempic can be produced for about 29 cents for a month’s supply, or 7.2 cents for a typical weekly dose, the research found. It’s not cheap to make — semaglutide costs over $70,000 per kilogram. But only a tiny quantity of the drug is used in each weekly dose.

> https://fortune.com/europe/2024/03/28/ozempic-maker-novo-nor...

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

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

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

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

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

Studies show it just doesn't work.

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

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

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

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

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

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

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

Thanks for sharing your experience and insight!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But for fat people, the calculus looks different.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You’re already benefiting.

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

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

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

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

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

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

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

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

I agree.

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

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

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

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

It should be the contrary.

> Something is seriously wrong societally ...

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

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

Mind over body.

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

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

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

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

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

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

I couldn't agree more.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Europe has been climbing at a steady rate since at least 1975.

https://www.europeandatajournalism.eu/cp_data_news/europe-fa...

Coke and Pepsi started using HFCS in 1980.

I’d be curious about side effects of the Depression and WW2 that took an extra generation to show up.

Glyphosate was introduced around that timeline.

One aspect is that the US food system as a crap ton of UPF.

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

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

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

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

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

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

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

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

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

I weighed myself at the beginning: 205 lbs

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

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

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

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

>eating healthy and exercising is not enough for a lot

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

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

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

Disclaimer I have never been obese or suffered obesity.

If it was easy no one would be fat. The whole body acceptance movement is a sham and always will be. We dont find obesity attractive and we do not want to be obese. However for some reason 60% of us in the west are overweight. And it is extremely hard to lose the kilos. We are eating too much and we shame eachother for eating small portions or skipping meals.

But put simply, we have normalized large portions and eating five times per day.

And its super hard to cut the volume after a lifetime of large portions and eating ever two hours nonsense.

I sympathise with obesity sufferers and hope that the outcome of all of this is to normalise smaller portions and fewer meals again.

The population level statistics show that you're the exception and not the rule. Obviously if the side-effects are unpleasant, the alternative health implications must be even worse: Which they are.

> The information is freely available, now more than ever.

Given the progress of the threads here, do you have any recommendations for cutting through the noise and finding good scientific information on weight loss, healthy eating, lifestyle, etc?

I agree with you that all the information is out there, but there seems to be an enormous amount of resistance in the threads here to threads to even simple things like:

- Fresh fruits and vegetables

- Lean proteins

- Cut out processed foods

- Cut out smoking, rec. drugs, and booze

- Eat less in general

- Stay hydrated - water is the only drink you really need

- Find ways to move more, esp. for people with sedentary jobs / lifestyles

- Sleep more

- Reduce stress

> The information is freely available, now more than ever

You have to believe it to find it.

Noise is everywhere, now more than ever. I think finding proper information is going to be exponentially harder.

A couple of days ago I was "fighting" on Reddit about something that is as clear as day, with proof and all, with people who were completely sure of the opposite (side note: this is when I deleted my Reddit accounts)

Well good for you, aren't you special...

Now what about the other 74% of the population.

You ever hear the saying "If you owe the bank $1000 dollars, that's your problem. If you owe the bank a million it's theirs"

This is a public health epidemic and no matter how much you scream "But I'm special" the rest of the world is going to fall apart around you. And yes, this issue is spreading to the entire world and not just the US.

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

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

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

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

> For the longest time people argued if overweight people ate too much or not.

Maybe uneducated people, but when was the last time anyone seriously doubted that excess calories make you fat? For serious people the discussion has always been about how to reduce the calories, because "just eat less" is provably ineffective. Simple minded people continuously suggest otherwise, but data really doesn't support their intuition at all.

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

Seems like all the incentives have been in place for us to have already maximized food addictiveness. We have to at least be pretty far up the S curve. I’d guess just the opposite actually, that companies will refocus on the healthfulness of their products now that customers aren’t as susceptible to the addictive aspects.

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

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

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

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

> big improvements for animal welfare

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

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

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

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

> There's some evidence that Ozempic improves general impulse control

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

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

>There's some evidence that Ozempic improves general impulse control

While remaining on the drug.

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

How long till we become voluntary Voyagers [0] ?

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

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

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

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

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

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

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

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

Muscle loss is associated with _any_ kind of weight loss.

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

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

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

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

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

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

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

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

Do you drink coffee or tea?

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

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

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

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

Thanks for sharing that link. Retatrutide looks especially promising since it targets three different receptors (GLP-1, GIP, and glucagon) instead of just GLP-1 like Ozempic. This triple action appears to have a more comprehensive effect on metabolism. So it may increase energy expenditure in addition to reducing calorie intake. This drug also showed significant improvements in lipid profiles, blood pressure, and liver fat reduction. If all goes well we should expect to have it in 3-4 years.

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

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

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

Yes, because what obese people lack is education.

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

Why either/or?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

> why is taking a drug a novel & cool idea

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

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

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

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

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

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

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

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

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

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

"You can't outrun a bad diet."

> I've owned a Concept 2 rowing machine since 2005.

Well here’s your problem. You should’ve bought barbell 20 years ago. Or at least a couple of kettlebells.

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

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

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

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

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

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

I feel the same way about heart disease and cancer.

Actually, no I don't. God bless modern medicine.

If you treat the cause, the symptoms go away along with a possible stream of revenue for the "health" care industry.

We did this, this happened to us: after a while you or her may get extremely obsessed with food and eventually get to the point where you overeat as a form of 'freedom' until you just can't stop.

IF works until it doesn't, then it REALLY doesn't work. My wife had a breakdown before we realized something was incredibly wrong. YMMV.

I've never been more insufferable and hangry than when fasting. I'm glad it works for you.

> If part of the obesity epidemic is trying to consume food to make up for nutrient deficiencies

Is there evidence to support this hypothesis?

> I wonder why it caused so much negative reaction? On the surface it shouldn't matter much, since it does not appear to harm ones who found a way to maintain healthy body without drugs. Yet it reliably causes a quite noticable number of folks to be quite aggressive towards either people using these drugs or companies making these.

It's a combination of people thinking it violates the 'no free lunch' axiom of the universe and also deriving significant personal status and satisfaction from exerting discipline in eating and exercising religiously.

The 'no free lunch' axiom is a curious thing and seems derivative of western Puritanism and similar philosophies. It violates many people's intuitions that very good things might be obtained with relative ease, and also devalues said things. Some of these are the same people who cannot comprehend (or even accept) a post-singularity world without work. The peculiar morality that produces that belief overlaps rather substantially with the one that rejects the possibility of an easy solution to the problem of obesity.

Further, some of these people have the (perhaps unconscious) belief that they are morally superior to others who are less dedicated to health and fitness, and in particular to the obese.

If obesity can be resolved so fluidly and categorically, then at least two painful things happen for them: (1) their excessive effort towards weight control seems foolish and inefficient (i.e. devalued, as noted above) and (2) they lose a great deal of personal status. The latter is a consequence of the reasonably established notion that a significant proportion of many peoples' happiness is contingent on their relative frames of reference (i.e. not their position in an absolute sense). Again, this is often unconscious. These are not "bad" people, but rather merely victims of human instinct.

Personally, I'd never take Ozempic. I agree it definitely makes the 'eat less' goal achievable almost automatically for most people. But I think there's a real downside which is that any rapid weight loss will take muscle and bone density with it. Typically when you're using exercise to lose weight, you'll naturally end up building some muscle mass back. I think the side effects for people who take the drug and stay sedentary is going to be disastrous.

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

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

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>If I could cheat my brain in any way, it would be just not feeling hungry until noon, regardless of past actions.

Not eating too close to going to sleep suffices. I'd set the minimum at a good 4h.

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

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

From my experience, it is probably contributing, but certainly not the major way glp-1 work. And I certainly had periods where I would overeat while already feeling bloated or nauseated. Glp-1 certainly does something to the body, that regulate eating on hormonal or neuronal level.

Some chat GPT research on some of the citation needed claims. There are some potential biological pathways, but more research needed to verify if/how these are actually applicable: https://chatgpt.com/share/670a798d-6abc-8012-bbf8-3b55a09f0b...

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

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

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

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

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

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

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

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

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

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

Is it fundamentally any different from something like toothpaste?

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

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

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

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

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

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

> while most people will still eat a basically toxic diet

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

> basically toxic diet

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

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

> while most people will still eat a basically toxic diet.

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

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

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

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

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

> Neither is berberine any version of Ozempic, which is an analogue of glucagon-like-peptide-1 (GLP-1), a natural hormone that regulates blood sugar and helps people feel full. Berberine has nothing to do with GLP-1.

> Perhaps the most interesting laboratory finding, given the rising global tide of type 2 diabetes, is the control that berberine may exert over blood sugar. But there is a problem. Berberine is virtually insoluble in water and has low intestinal absorption which means it has poor bioavailability. […] Because of berberine’s poor bioavailability, supplements on the market are likely to be useless. However, some derivative of berberine, may yet make it to the physician’s prescription pad. But it won’t be for weight loss.

Interesting.

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

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

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

"Variability in Potency Among Commercial Preparations of Berberine"

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

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

Worse still,

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

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

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

How effective is it?

Now that's the spirit!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

> avoid all medicines other than antibiotics and vaccines

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

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

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

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

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

Those of us who find calorie-counting easy and effective are the blessed few. Most people appear to find it even harder than other behavior-change approaches to weight management.

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

It’ll cost less than the effects of obesity

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

I'll bite: Why?

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

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

This push for Ozempic is utter madness.

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

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

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

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

Screw that

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

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

> off-label usage

Off label? Semaglutide is approved for weight loss.

I don't like processed foods and sugar in anything more than minimal quantities makes me ill. But I still get too many calories, at least as evidenced by my waistline.

Are you sure the insanity isn't the assumption that it's just insufficient willpower or poor habits?

> “Is it bad for my liver to be off most of the time?” It's generally not healthy to keep your major organs in the off state. If you never open your eyes, you go blind.

I feel like this is missing the obvious follow up question, “is it bad for my liver to be on most of the time?”

You are wrong because being overweight means that your endocrine system is very messed up and can make it extremely difficult to make meaningful changes to your diet and habits. Take a look at the preponderance of folks who have taken GLP-1s here and have affected tremendously positive changes to their diet and exercise habits.

> Am I the only one

No, definitely not. There's a few of you in this discussion.

If only you could commit suicide...

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

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

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

What side effects?

Blowing up fat cells?

I was "find this page" for side effects, but see little discussion about them. So am honestly intrigued, and would love to hear more.