Ask HN: Anyone try semaglutide / Wegovy for weight loss?
Thinking to ask my doc to hook me with this to help with the obesity. Curious to hear experiences from HN crew who has tried it.
Like, 'lost 80 pounds in 3 months without exercising' levels of success.
I know there are many unhealthy things about this weight loss strategy, but it would've been even more unhealthy to stay 'morbidly obese', rather than my current state, which is classified as just plain old 'overweight'
I actually did take semaglutide recently just to try it. What it does is make you not hungry or have cravings. It was working, but I stopped because of the side effects. I was constantly queasy for 2-3 days after injection and My workouts were interrupted due to those stomach pains. I stopped and am just going to start intermittent fasting post the holidays.
Some people don’t have side effects so it may be worth it for you.
Again, I'm not a doctor, and this is not medical advice.
I take modafanil for focus. It works but my tolerance has been shooting ip lately. Do you think it’s worth trying Armodafanil?
Keto naturally leads me to lots of largely unprocessed whole foods. Eggs, cheese, chicken, milk, some red meat, butter, etc - organic / cage free / free range / not treated with hormones, of course.
I suspect this permanent change in diet is what has allowed me to keep the weight off, though the more extreme regimen was what allowed me to lose so much so fast.
1. The problem it solves is obsessive appetite. I used to read about people saying things like "oh, I was working so hard, I forgot to eat" and I wondered how that was even a possible thing. This takes certain types of people from being constantly hungry to what appears to be "normally" hungry. If you are overweight because you are CONSTANTLY hungry, even right after you eat, this is the solution for you.
2. To everyone else, the people who just really like donuts or whatever, I am not sure what this will do for you. I don't mean it won't help, I just literally mean I have no idea, because my personal experience doesn't speak to this.
3. Intermittent fasting. Because it's impossible to talk about dieting without someone bringing this up. I think IF is wonderful, but, for people like me who have appetite issues, these drugs are helpful for following IF. But I would say the two are not related--they solve different problems.
4. I had zero side effects, but had to jump through an INSANE amount of hoops to get this stuff.
One big problem with semaglutide is that it's really expensive to access - even with goodrx, wegovy (which has semaglutide as an active ingredient) can cost ~$1400*! So, for many people who are uninsured or underinsured it's simply not attainable.
My startup has been working on this problem all year and we just launched a semaglutide program for $149/month - including medication and provider visits.
http://henrymeds.com/semaglutide/?referrer=hn
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Wegovy pricing:
I'm now on Kaiser in the Bay Area, and they do not cover semaglutide. In the short time I spent off of it, I gained 40#. I complained to my PCP (actually my series of 4 rotating PCPs -- medical staffing seems in disarray at the moment) and they found some injectable alternative for me (Liraglutide) which is more annoying being injection instead of pill, but I'm back to 290# after only 3 months with it.
I understand they're both in the same category of how they act. The semaglutide tastes absolutely horrible, and I've had some mild gastrointestinal effects from both -- I joke they they turn any sugar I eat into gas and discomfort, so that's their "secret" -- but I think if you're in the group who these have a profound effect for, it's worth a try I would think.
$0.02 :)
I am one of those that experiences pretty unbearable side effects from it. The rate seems to be much higher than actually reported (something like 20% it seems). Nausea goes away after the first couple of weeks for me, but the lethargy never did, not even after 3 months. And the lethargy is BAD. Like, career-affecting bad. I would literally fall asleep on my keyboard at 4pm.
It definitely was doing the trick though, and if I had ANY energy to go to the gym in the afternoon (which I NEVER did), I could've lost a lot of weight. It just solved the hunger "problem" for me, it made me only eat for sustenance - but at the cost of being constantly tired.
I gave up after 3 months. Did lose a few kilos but the main interesting effect was the change in appetite. And I say change, not suppression, but it affected things like cravings and snacking as well as just making me full faster. I can definitely see why it would work really well for those who tolerate it.
Sema is meant to be better, but most people who have bad sides with lira have the same issues with sema, so I don't have my hopes up.
She was nowhere near obese. Started at 5'6" 137 lbs. After five weeks, she's down to 123. No side effects. She just says food isn't appealing any more. At first, she kept making full meals but not finishing them, and eventually she started actually planning and making smaller meals.
There doesn't seem to be much doubt it works, but most people do seem to report at least experiencing some nausea. As a side note, I'm starting to get tired of every thread on eating and weight control getting filled up with intermittent fasting evangelists. I'm going to assume they mean time-restricted feeding, not real fasting, and there is plenty of research on this. In some people, it results in better diet adherence than simply eating less but at your pre-existing regular schedule. This seems to even be true for a more or less average of people. But it is not true for all people. Some people do really well on it. Some people do really terribly. This is true of virtually any dietary intervention. Individual variation usually exceeds the differences between group mean results of different approaches. Stop assuming that what worked for you will automatically work exactly the same for everyone.
I use this value because a BMI that high will cause without any doubt lingering issues with your body, and reducing it is extremelly important for your health (more than anything)
If you have a BMI between 30 and 35, you can probably do without if you pay attention to what you eat and what you cook. I had a BMI of 32, i cut it down with a sleep schuedule, then later fasted 5 days (under medical control) to understand that being hungry was OK and i did not have to eat something everytime i felt a small tingling, and that helped me not eating between meal. I'm not advocating for fasting, what i mean is that for this BMI (probably sightly lower, i have a weird body type), change in lifestyle can be enough and more important for your health. I started cooking and stuff too.
I understand that sleeping and cooking more is not always possible (it took COVID to take out the 45min commute time in my case), so if you don't have time, you should take medication. It has secondary effect, but being clinically obese does too.
If you have a manageable BMI (to me its 28), i don't think it will have any impact, because eating habit can only do so much without sacrificing too much. The only way i managed to loose weight since i hit 28 BMI is making my metabolism faster, IE high stress situations and sport. I started rock climbing (i'm more of a windsurf guy usually), this helped, i will reach 25 in a month or two. A caveat though: my ideal weight for climbing is now a lot lower than what it was before i started, reaching it would put me at around 22 BMI when i was aiming 25 a year ago.
Honestly, it’s like a miracle. I’ve been fat since I was 6 years old. I’ve occasionally lost weight (though never made it to “normal”), but only through pretty intense, focused effort to restrict calories. I’ve always gained it back (and then some) after I can’t sustain that effort. (Call it lack of willpower or whatever, but this is how it works for the vast, vast majority of people.)
Anyway, on tirzepatide, it’s simply effortless. Food is still good, and I still like to eat, but I don’t think about it all day. I eat a reasonable amount, feel full, and don’t have the urge to eat again for hours and hours. That’s honestly a new experience for me. My entire life “eat when you’re actually hungry” would have meant eating all day every day, basically. I’ve been losing weight at a consistent 2.5 lbs / week on this drug. I fully intend to be on it for the rest of my life (or other drugs in the class as they come out).
As for side effects: I’ve had precisely none. No nausea, constipation, heartburn, etc. I understand those are common but I haven’t experienced them at all.
If your doctor won’t prescribe it, there is a company called Calibrate that will work with your insurer to get it for you (https://www.joincalibrate.com/)
My company insurance won't cover any of them unless it's diabetes-only, and of course, I make "too much" (which really isn't even $50k/year) to get on any assistance programs through the pharmas themselves.
Anyone have any suggestions?
I'm in a similar position, but what made the last time different (down 120 lbs in a year) was education.
First step was simple calorie counting. You don't have to do it forever, but there are calories hiding in the most non-obvious places, and I'm convinced this is what sabotages people who think they should be losing weight but aren't.
For example, a breakfast of eggs and whole grain toast sounds healthy... but coat the pan in a little too much oil, and that's easily an extra 50 calories. Butter the toast? Easy to add another 50 calories. Do that 4 times in a week and you could have just ate a double cheeseburger, and the double cheeseburger would have actually made you fuller.
Now multiply small mistakes like that across your other meals and you have a recipe for feeling like you're starving yourself, not seeing results, and rebounding in frustration.
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I also used to think it was just a lack of willpower that caused me to eat out of control, but things like not getting enough protein, eating foods that are designed to be addicting, and multitasking while I ate, were all working against me.
I decided to stop using willpower as an excuse. If I gained weight, I analyzed why I had gained or overate without thinking "I need to be harder on myself" or "I need to be stronger". Often times patterns emerged, like "I didn't get enough protein that day so I ended up overeating at dinner", or even things as specific as "when I started to introduce food X into my diet, my weight loss slowed down" which revealed I was miscounting the calories on them.
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From there you can start to build strategies on your education. Like yesterday, visiting family I had barely eaten all day. They ordered pizza and I knew that was a terrible combination for me: ravenously hungry + delicious pizza felt like a recipe for overeating.
So as soon as they ordered the pizza, I drank a protein shake (150 calories, 30g of protein) and drank as much water as I could. By the time the pizza arrived, that "ravenous hunger" was just a dull hunger, I was able to eat a single slice and feel full.
The old me would have tried to power through that with "iron will", but failed, went back down after everyone fell asleep, and ate every single left over piece.
Sometimes you need to accept that willpower is not enough, and that's especially true in modern times. We've invented foods that simply could not exist before in terms of how addictive they are, and how little nutrition they provide.
That's why people can demolish a box of Oreos and still feel hunger, but try it with that many cookies made from scratch in a home kitchen for example, and those same people will just get sick. It turns out when you don't get to "cheat" with binders and artificial flavors optimized to the Nth degree by highly paid researchers, you can't really recreate the uniquely bad for you foods that these companies can.
Having someone else come up with a diet isn't really what I'm talking about. I'm talking about internalizing the stuff, so that it's not just a constant willpower battle.
I used to have the same "etc." mentality about all that "Whole food protein stuff", but actually sitting down myself and learning the underlying concepts rather than the fads was completely different than getting talked down to by a professional or reading some weight loss guide.
Just look at my example about pizza, I didn't have the willpower so I "shortcutted" around my willpower. If I had tried to make it a battle of willpower I would have lost. It's small things like that which make it less constant of a battle.
Same with not multitasking while eating, something I learned was that I overeat when I'm multitasking because it's harder to sense when I cross the line from hungry to full.
tl;dr, I didn't mean just "food education", as in learning to read labels, but learning about your own relationship with food, like the emotional component, the situations where your willpower is tested most, so you can develop strategies specific to yourself.
A dietitian can't do that for you, it's a deeply personal thing.
If you are obese you can easily lose 2 pounds a week just by counting calories. I lost 90 pounds in 7 months despite eating burgers, pizza and sweet stuff whenever I wanted, just less than before. No exercising required either (it's good for your overall health, but almost entirely useless for weight loss).
What is the most important information I should know about Wegovy™?
Wegovy™ may cause serious side effects, including: Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Wegovy™ and medicines that work like Wegovy™ caused thyroid tumors, including thyroid cancer. It is not known if Wegovy™ will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.
https://www.wegovy.com/FAQs/frequently-asked-questions.html
edit: For a safer way to lose weight, including other benefits in regards to reducing cancer risks, look into intermittent fasting. Success with your weight loss, great step into becoming more healthy!
> However, people should seek the advice of a diabetes professional before embarking on such a diet.
https://www.medicalnewstoday.com/articles/can-intermittent-f...
I’ve tried them all.
Calorie counting. Keto. IF. Full on water fasting. Paleo. Meal prep / logging. Weight watchers. Everything works for a time. None are sustainable for me.
More specifically, pharmacological therapy of obesity is indicated in patients with BMI > 30kg/m^2 or >= 27kg/m^2 [1] with another aggravating condition, such as DM2 or hypertension.
[1] Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 2, 1 February 2015, Pages 342–362, https://doi.org/10.1210/jc.2014-3415
But few drugs, including Wegovy, have a Black Box Warning. Even fewer where the increased risks in humans are unknown at the time of FDA approval, and only backed by rodent studies.
I'm going to make a personal offer here which I wouldn't normally do, but after a six year journey, I've finally figured out what works (for me at least, and I think for other people like me). I've managed to take off 50 pounds, and I now know that I'll never be fat again.
The skinny people are wrong, it's not exercise, it's not willpower, it's not some magic fad diet (not no carb, not no fat, not no suger, etc.). There are some real changes, simple changes (though definitely not easy), and you can be in control again.
If you'd like to give it a try, I created a gmail account with the two initials of this site and the word weight. Send me an email, and if I'm not already overloaded, I'll try to help you out. You've got to be at least 50 pounds overweight (and I'll ask you to verify it). I'll prioritize people who've ever lost a significant amount of weight (shows you can work hard at weight loss), and it'll probably take at least six months to make the necessary changes before you can lose weight, but once you do, you can be as aggressive with the weight loss as you want (I lost 50 pounds in about 4 months).
Check my comments on this site, I'm a real person with a real history. This is not one weird trick, and I'm not charging anyone. The changes you need to make will probably cost you some money (not going to me), and they will be hard, but you won't be spending time in a gym, you won't be hungry or starving, and the changes you make will be sustainable.
[Edit] To be clear on the money, this is not some way for me to make money, I'm talking about the cost of a doctor visit to see if you have a thyroid problem, or perhaps the cost of your food being more expensive. There is no money that will go to me in any way whatsoever.
If I am able to help people, and it's not just for me that it works, I'll open up and share this more publicly later.