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Comment by mym1990 | Hacker News Reader

mym1990

I am not holding Ozempic to needing to be the cure for anything. My point is that people without diabetes are looking to this drug for weight loss, at which point they create a dangerous dependency, with no hard evidence that their actual health improves. This is opposed to coming up with long term solutions that involve re-evaluating daily decisions that lead to some of these diseases in the first place. If Ozempic is a good treatment for blood sugar control, which could be a good factor to consider in weight fluctuation, maybe reduce the amount of sugar one eats?

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Is it really a dangerous dependency? There's been no evidence of anything happening once individuals go off of semaglutide or tirzepatide other than the tendency of gaining weight to the original levels and/or blood sugar readings returning to the pre-medication levels. This is the most common outcome anyone has trying literally any calorie-reducing diet, medication or not. There's no evidence that people are ending up worse for having been on the medication, except for some who experience gastro effects early on and can simply quit.

Also, yes, you can absolutely advocate for a low-carb/low-sugar diet for those with poor blood sugar control. The issue there is that virtually every medical professional has advocated for similar diets for diabetics or those with blood sugar control issues for centuries, or even millennia - there is evidence of recommended diets for those with diabetes since BCE. This does not mean that those diets are easy or pleasant to follow, whereas all evidence indicates that common issues with appetite and energy on a limited calorie or low-carb diet are less prevalent with these new peptides than those trying to go it alone.

I don’t necessarily mean dangerous in the health aspect, although long term affects of these drugs are not know yet…I mean the dependency on needed the drug to keep a certain lifestyle, and then having an “oh shit” moment when you’re in a place that you can’t access it, whether that be traveling or the supply of it becomes scarce, or it gets banned, etc

That sounds like the lesser of two evils to me. Get healthier now and maybe sometime later lose access to the thing that helps you be healthier...or don't get healthier now? Yeah, there are other, orthogonal, choices but I don't think they're part of this particular decision matrix.

Yep. I lost 30lbs on it in 3 months. It took me 10 years to gain that weight.

So I guess if it takes me 10 more years to gain it back I can look into taking it again.

People usually gain back that weight much quicker. All it could take is one bad month and you could gain it all back.

I lost about 15-20 kg on Ozempic over about six months to a year, and held that weight for another year – continuing on 1 mg Ozempic / wk – until last autumn (2022). Then Ozempic was more widely approved than it had been before somewhere (for over-the-counter sales in the USA? Something like that.), and became unavailable in pharmacies where I live, in Finland. (AIUI, because it's more lucrative to sell it in the USA where prices aren't regulated like here, so all the limited supply is redirected there.) No problem, I was prescribed a substitute, a daily pill (brandname Rybelsus, forgot the active substance) in stead of the weekly injection pen. Worked the same, held my weight. (More of a hassle to take though, and tastes horribly, so on the whole I vastly prefer the Ozempic.)

Then, earlier this spring, that prescription ran out. Being in the middle of changing my primary healthcare provider I couldn't immediately get it renewed. And to be honest I wasn't at first all that bothered; I thought now that I've lost so much weight, and kept it off for so long with the help of these drugs, maybe I've got into the habit of eating less, so I can stay constant without them? Nope – in just a few weeks, ballooned back up some 8-10 kg. Had to scramble a bit to get the pill prescription renewed, been on it again for a couple weeks, but still some 6-7 kg above where I was before they ran out. Sure hope I'll get back down the rest of the way.

TLDR: Anecdata (n=1) says yes, going off the drugs even for a rather short while puts the weight back on quite quickly.

An average person would have to eat 5500 kcal per day to gain this much weight in a month. It's probably not impossible, but I would say it is very unlikely.

Totally impossible. I’d have to be eating like way more than I ever have to do that.

I went off for three months and kept losing weight throughout.

And the data from these drugs shows they gain it back at regular rate at most.

But given that the actual health benefits of ozempic(for me weight loss is not indicative of better health) have not actually been seen yet, you are quite possibly just taking on both evils at the same time.

On the contrary: GLP1 agonists show broad health benefits across the board.

Check this 24-month clinical trial with >3000 participants[0]. It showed improvements in rates of:

- Cardiovascular death

- Non-fatal Myocardial Infarction

- Non-fatal Stroke

- Revascularisation

- HbA1c

- Fasting Plasma Glucose

- Body Weight

- Lipid Profile ( total cholesterol, LDL cholesterol and triglycerides)

- Urinary Albumin to Creatinine Ratio

- Systolic blood pressure (mmHg)

- "overall health related quality of life namely bodily pain, general health, mental component summary, mental health, physical component summary, physical functioning, role-emotional, role-physical, social functioning and vitality." (each of these categories were "quantitatively" measured using a calibrated questionnaire - - and they all showed a dose-response relationship -- 1.0mg semaglutide made a bigger improvement than 0.5 mg, vs. two different placebos)

0: https://clinicaltrials.gov/ct2/show/results/NCT01720446?term...

>the dependency on needed the drug to keep a certain lifestyle, and then having an “oh shit” moment when you’re in a place that you can’t access it, whether that be traveling or the supply of it becomes scarce, or it gets banned, etc

It sounds like you're realizing what it's like to really depend on a medication.

The anxieties and risks you're describing are what people with diabetes, cancer, HIV, bipolar disorder, schizophrenia, depression, ADHD, etc. deal with on a daily basis for their entire life.

Yeah, it is frightening! Sometimes a guy like this[0] comes along and makes your life even worse!

https://en.wikipedia.org/wiki/Martin_Shkreli

How dangerous is it to have a new $1k/month bill you need to pay forever?

So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic...

Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk...

Given a significant percent of voters are overweight and obese, it would be very politically popular to legislate that health insurance must pay for GLP-1 antagonists.

Wouldn't this cause insurers to have to raise their premiums for everyone substantially?

No. The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year, but if not exceed it, they certainly come close. Moreover, it's not unheard of to mandate cheaper drug prices, and now that we understand how these drugs work, there will be more of them in the pipeline.

> The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year

This is a big claim to assert without evidence. If it was the case then insurers would already be adding the drugs to their formularies.

There is undoubtedly a cost associated with obesity but you are suggesting that simply being overweight doubles the average cost of care[1], a figure that already includes overweight and obese people (which are of course a huge population in the US).

A quick Google search turned up a report[2] that suggests that

> This estimated public cost equates to an average marginal cost of $175 per year per adult for a one unit change in BMI for each adult in the U.S. population.

So, even for the extreme case of a very obese person that has a very successful treatment and goes from 40 BMI to 25 BMI, you are only saving a hypothetical $2,625 per year (perhaps an underestimate due to inflation and the age of the paper).

Therefore it would appear that unless insurers strike a deal with the drug companies (lower the price, make it up in volume), such a law would dramatically increase insurance premiums. A better compromise would be a law which requires insurance companies to offer co-insurance on these drugs up to the expected savings.

[1] https://www.pgpf.org/blog/2023/01/why-are-americans-paying-m....

[2] https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe12...

> If it was the case then insurers would already be adding the drugs to their formularies.

American healthcare system has perverse incentivizes. Most unhealthy groups are generally least likely to be privately insured, so insurers are incentivized to prioritize health issues affecting working-age adults, while neglecting those which will be someone's else concern in future.

You can also factor in that all those obesity related heart complications will turn into an extra decade of cancer treatments.

Why would a $1k/month drug increase costs more compared to the status quo of expensive bariatric surgeries and complicated heart failure/joint issues/osteoarthritis/sleep apnea etc. cases that arise from obesity? Massively reducing obesity rates seems like a good thing from the POV of an insurer.

> So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic...

What’s the cost/benefit of weight loss and diabetes control vs $12k/year? I would expect people with high obesity are very expensive to insure and insurance can’t drop people any more. It may be cheaper to pay for ozempic (especially at whatever negotiated rate insurance pays) than to pay for the alternative negative health outcomes.

That and ozempic goes generic in 2031 and mounjaro in 2027 so soon this won’t be a question of $1000/month but maybe $1000/year at which point insurers will probably force customers to take it or pay higher rates.

Most of the data is showing that Ozempic is not required long term though so a single year might be all that's required; and for the morbidly obese;

$12k is going to be less than the typical admission to a hospital (for injury, illness, heart disease, diabetes related incident.)

> Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk...

There is anecdotal evidence that eating less is, in itself, so much more healthy that it doesn't really matter what you eat. Nutrition professor Mark Haub ate nothing but "convenience store food" for 10 weeks at a caloric deficit and all of his health metrics improved while he lost 27lbs.

http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/...

Move country, it costs about a tenth of that in the UK.

One month supply us about £135 which is about $170 at todays rate.

> My point is that people without diabetes are looking to this drug for weight loss, at which point they create a dangerous dependency, with no hard evidence that their actual health improves.

These drugs would have to be pretty bad to counteract the massive health benefits from losing weight (even if they don't have diabetes). I've heard a few eye-openers in the comments, but unless they're more prevalent than I've read, or there's some ticking time bomb, the drugs are probably still a net health benefit.

> This is opposed to coming up with long term solutions that involve re-evaluating daily decisions that lead to some of these diseases in the first place.

Medicine tried this. It's extremely hard to actually to do it in practice. Obviously, it's better solution, but we are living in real world, where we have to choose "good enough" solutions over those deemed "better, but infeasible for 90% of patients".

"re-evaluating daily decisions" is exactly what suppressing these hormones allow people to do; so that they can make rational instead of hormone driven decisions.

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