Goodbye, Ozempic
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We unfortunately usually dont get to hear many chiming in to say that they tolerated it just fine. I do (2mg/week), down 45lbs.
Being heavy is really bad for you. Don't be so quick to write it off d/t the possibility of vomiting.
I get stomach upset and a bit of reflux when I overeat, but that makes total sense given the goal of the medicine.
Honestly the metformin I was prescribed at the same time as semaglutide makes me feel worse more consistently, and even that is tolerable.
I say go for it OOP. It shouldn't cause any permanent damage trying it out.
I suspect that the couple of cases of severe vomiting I had, may relate to either eating too much, or eating at the wrong time, or both. So I think that if I'm more careful in the future, I can avoid those occurrences.
Overeating is definitely bad, since Ozempic - as I heard it described - "slows down the movement of food through your digestive system, which leads to a feeling of fullness". That effect apparently being part of how/why Ozempic leads to weight loss. But that also suggests that you have to be really careful about not eating too much or you might overload your system in a way that exacerbates the side effects. My subject feeling is also that timing is an issue: I think that eating late makes it more likely that the bad side effects will occur. I'm trying to shift to making lunch my largest meal of the day, and then eating a very light dinner, and preferably earlier than in past years. Time will tell if this theory is right or not, but it's where I'm leaning at the moment.
At some point I start noticing an intense "bloat" / gas feeling - with lots of burping and farting - as well as possibly some nausea and diarrhea. This will last for a few hours. Maybe 3 or 4? I wasn't keeping notes unfortunately. Then, at some point I'll just have a sudden urge to vomit (it comes on fast) where I'm lucky to make it to the bathroom to expel everything into the toilet. The actual vomiting last 2-3 minutes, after which I go back to feeling relatively normal, other than slightly drained feeling, and that slightly acid-scarred feeling in my throat.
The worst part, in many ways, is cleaning up afterwards. Even though I've made it to the bathroom both times this has happened, the stream of vomit is so intense that I can't necessarily keep it all in the toilet. When I said "power vomiting" that was no joke. So inevitably some winds up on the floor, the wall beside the toilet, my clothes (if I'm wearing any), etc. Getting the bathroom clean and back to smelling normal is... not fun.
That said, even on days when there's no outright vomiting, I do experience moderately frequent nausea, which is rather annoying. Since I am diabetic, I've chosen to simply accept the side effects as being acceptable in service of the "greater good". But yeah, consider talking to you doctor and just see what he/she has to say. Maybe a smaller dose could help you with your weight, while not leading to the nausea / vomiting / etc. I'll note that I didn't start getting that stuff until my doc upped my dose from .25mg / week to 1mg / week. YMMV.
It’s gross, but didn’t last.
This has helped me learn to simply be happy with my size. Our bodies are not all meant to be skinny like the people we see on TV or instagram. There is a natural variance even for people with healthy diets and good exercise routines.
I can't enumerate everything that Aubrey Gordon shares in her excellent book, but I can say that learning to accept myself has been far more rewarding than constantly trying to chase weight loss schemes that only leave me back where I started. I feel confident and sexy now without any weight loss, and this is leading more people to be very obviously more attracted to me (because confidence is sexy!). I realized I never needed to lose weight to be attractive, I needed to accept myself for who I am.
I would urge anyone considering these treatments, whose lifelong effects we still do not understand, to learn about anti-fatness and how we have all been misled in to believing that everyone is supposed to be skinny.
Here's a great article from Aubrey to get started: https://www.npr.org/2023/01/12/1148169767/anti-fatness-keeps...
Finally I want to say that if anyone is just going to come in here and say being fat is unhealthy, or repeat any of the common tropes about weight loss, you're not going to get anywhere with me. The whole point of Aubrey's work is that these so-called common sense ideas are so deeply held in our society that few have really questioned them, and it takes more than a cursory examination to try to make sense of how we got here. Repeating the basic ideas does nothing to advance this conversation. If you must respond, read the article above before criticizing the basics of what I am saying. Aubrey can explain it far better than I can.
Yes, these issues have been studied and questioned. In traditional hunter-gatherer societies (people whose diet and lifestyle matches what humans evolved for), obesity is almost unheard of, as are diabetes and other metabolic diseases. But when these same hunter-gatherers adopt a modern lifestyle and diet, their rates of these diseases go way up. From this evidence, we can conclude that obesity is not a purely natural phenomenon, but caused in part by modern lifestyles.
Do you actually have studies you can link to that can show this? With a quick search I see a study [1] that both acknowledges that data on hunter-gatherers is light and also finds that total energy expenditure (which I assume is what you mean by the "lifestyle" part of "lifestyle and diet") is roughly the same between this hunter-gatherer society and western cultures:
"Like other complex, continuous traits (e.g., stature), environment can clearly influence TEE, as is evident in the elevated energy expenditures of traditional farmers (Table 1). Nonetheless, TEE is remarkably similar across a broad, global sample of populations that span a range of economies, climates, and lifestyles (Fig. 1, ,2).2). Not only is TEE statistically indistinguishable between Westerners and Hadza foragers, but the range of TEE within Western, foraging, and farming populations largely overlap, both at the individual and population levels (Table 1, Fig. 1, ,2).2). We hypothesize that TEE may be a relatively stable, constrained physiological trait for the human species, more a product of our common genetic inheritance than our diverse lifestyles."
It's also well documented that obesity rates have skyrocketed in recent decades (for example https://ourworldindata.org/grapher/share-of-adults-defined-a... ).
From this evidence, we can conclude that obesity isn't a purely natural phenomenon, it's cause by modern lifestyles. But what part of said lifestyles?
We need to look for a culprit(s) that:
a) hunter-gathers are insulated from, and
b) has greatly increased in just the past few decades, following the trend in rising obesity rates.
As you note, there seems to be big change in energy expenditure between hunter-gatherers and us, so that can be ruled out. That would seem to leave us diet changes and environmental contaminants.
Sugar is commonly cited as a cause of obesity, but recent increases in obesity rates have been much higher than those in sugar consumption (https://onlinestatbook.com/2/case_studies/sugar.html ). Also, there are hunter-gatherers who eat lots of honey (https://journals.plos.org/plosone/article?id=10.1371%2Fjourn...) and they are not obese.
So what could it be? I don't claim to know the answer, but there are two possibilities that seem plausible to me, that satisfy conditions (a) and (b) above:
- Environmental contaminants: http://achemicalhunger.com/
- Vegetable oils: https://www.jeffnobbs.com/posts/what-causes-chronic-disease
I feel as though your comment here only serves to underscore my original point. We can speak at the population level about fatness overall, but we still do not have any definitive answers for why we see rates increasing or what fat individuals could do to lose weight. Aubrey Gordon has extensively studied diet and weight loss trends that suggest fat people can become skinny people, and has done an incredible job documenting the ways in which these schemes fail to achieve results for most people. If what fat people really want is to be healthy and feel good about themselves, focusing on weight loss may be entirely the wrong objective. If you are eating a healthy diet and getting moderate exercise, you can be healthy even if you are not losing weight. Conversely, people who are naturally skinny can eat a horrible diet and be very unhealthy without being chastised as "unhealthy" by the casual observer. The focus on fatness and weight loss leaves people who struggle to lose weight feeling horrible about themselves, and helps perpetuate anti-fatness in our society which only serves to make fat people's lives even worse.
It can simultaneously be true that we are getting fatter as a population and also that common weight loss beliefs are incorrect. Aubrey Gordon's work is crucial in helping us understand how our society mistreats fat people and how common misconceptions about health, weight loss, and what it means to be fat perpetuate harm against fat people.
I broadly agree; current advice isn't working, and we shouldn't shame people for following bad advice and failing to achieve results. But that doesn't mean we should throw our hands up and ignore the problem either. Obesity is strongly linked to a host of health issues like diabetes and heart disease, it's an urgent problem to fix. At a societal level, we need more and more varied scientific research to find the causes of the crisis
At the personal level, it can be worthwile to keep trying different lifestyle changes; if you do eventually find something that works for you, you'll live a longer and healthier life.
(Addendum: everyone's metabolism is different. Something is causing the rise in obesity, but that something may affect you differently than other people. And maybe you would have had an unusually high weight naturally, even without the something.)
A couple of months go the drug stopped being back ordered and the pharmacy said they were prioritizing diabetics. Not sure how they can tell — perhaps my other prescriptions?
I believe the weight loss dosage of semaglutide is well over 2 mg.
“Calories in” is half. “Calories out” (the amount you burn) is the other half.
Having been on the “nothing but diet” train for long windows of my life I can confidently say that if you don’t pair the former and latter, you’ll end up in the yo-yo cycle. Over and over again. Took a long time for me to understand that and I STILL struggle.
Exercise and training would increase your burn rate and allow you to do less caloric restriction but at the end of the day it comes down to eating less calories.
The real struggle is in the doing.
Many tout "listen to your body" as a solution, or "think about how junk food makes you feel" as one of the go-to solutions in "lifestyle change".
For the first time in my life I was able to adhere to this advice, because I'm on semaglutide.
My body now actually is telling me that too much junk food feels bad.
Before now, it actually felt VERY VERY GOOD to eat nearly unlimited junk food.
There is something going on in my body that prevents the proper signaling of "too much food feels bad", and this medicine corrects that for me and countless others.
You presuppose lack of knowledge, not me. Contrarily, I call out the lack of self discipline knowing what they must do. Every obese person I know is aware of what is wrong and what they must do.
Ozempic and semaglutide trick your body into thinking it has eaten. If you take it for a year, but still eat the same calories per day, you do not lose weight. It still requires some discipline. From pricing without insurance these seem to be >$200 per month medications. That's a lot of money for Big Pharma considering they suggest you take it for at least a year and the obesity rate in America.
Call me old fashioned and relying on some common sense, but there are longer term and healthier solutions than relying on a pill for all of your troubles.
>>Before now, it actually felt VERY VERY GOOD to eat nearly unlimited junk food.
So downing a bucket or two of chicken wings felt good to the last wing? I doubt it. You've conditioned yourself to still like it when bursting at the seams. Again some discipline would go a long way rather than a pill. Let's see where all this medication puts this generation down the road - from all sorts of mental health pills to diet pills, etc. I don't think it's the right path, and there are those making money hand-over-fist while everyone plugs into the matrix.
Well there's your problem. You're failing to believe and listen to the people who actually experience the problem, and insist that it simply can't be true.
I would overeat because the pleasure signals never stopped.
But sure, over 40% of Americans are obese and it's a personal moral failing, not something systemic.
> Again some discipline would go a long way rather than a pill
I lost about 40lb 10 years ago through diet and exercise. I did intense exercises at least 3x a week, and watched what I ate strictly.
Guess what: it all came back and then some, because I was white knuckling my way through life, and it was unsustainable.
You know nothing about my level of discipline, so you ought not comment on it.
> Let's see where all this medication puts this generation down the road
My bet is longer and healthier lives.
I hope so for your sake, but I highly doubt it for all the medications being touted for mental health and obesity.
> I lost about 40lb 10 years ago through diet and exercise. I did intense exercises at least 3x a week, and watched what I ate strictly.
How long did you do this for? Did you keep doing this along with the Ozempic or similar, or did you cut it down and only take the meds?
For what it's worth, it's better to do moderate exercise everyday (walking a mile or two daily) then to overdo it 2 or 3x per week with regards to regulating your metabolism and making it favorable for fighting off your hunger and maintaining a healthy body weight.
I have found the number one thing in my diet throughout my whole life has been sugar. It is the worst for your health and weight. I never bought into the sugar substitutes; I just cut back drastically on sugar. That and walking everyday would have a big impact on people's lives and the obesity epidemic. The discipline I speak of is just getting out everyday, not necessarily the gym or high-intensity exercise. Most obese people I know personally think they eat less than they do, and do not see how inactive they truly are.
I hear your struggle, and I am not commenting on your discipline. Only that discipline is needed and many people need an objective bar on what level that is outside of their own echo chamber. I am not saying this is you, but in my opinion this is most of the battle for the suffering.
I might call you old fashioned. I would not call you relying on some common sense.
Really, now I understand people when they say that "I don't want more food". Because I always wanted more food. Of course, I realized that it's important to not over-eat, and with effort it was possible.
But that's exactly the point. It's always a struggle against one of the most basic instincts you have - to not be hungry. Every day. All the time.
This is the thing that is missing from the "just eat less" slogan. That for some people it's harder than others. Honestly, I really had no idea that people felt like I feel on Ozempic.
I just thought I was weak for not being able to say no to food. I could eat until my stomach felt pysically stuffed full and still feel hungry and desire for more food.
In the context of war and hunger is my struggle the hardest one? Of course not, but it's still a struggle. Feeling fat sucks and feeling like you're weak for not being able to say no to somethig that you really really want all the time sucks.
>> For the morbidly obese, exercise carries risk too — to joints and the heart, for instance.
All exercise? Like simply walking 1/2 to 3 miles per day at a leisurely pace? Being morbidly obese carries way more risk, and no amount of meds will help someone who can't bring themselves to even walk somewhere.
I know one person who was morbidly obese, had the surgery to limit their capacity to eat, and yes, they look better in clothes, but they are on a ton of meds, and they refuse to walk more. I was in Mekkah and they took the electric cart instead of walking during umrah.
Anyone I know who is on mental and/or diet pills are not doing well even after years of following this advice. I don't see the long-term benefits. Hell, I just read an add for some heart supplements on Amazon where people say, "I've been taking it for a week, and I don't feel anything yet." The instant gratification of social media and modern conveniences have softened everyone from taking some self responsibility and applying some self discipline. We can't save everyone who is self destructing. Big Pharma is sure making out like a bandit. Last I had cable TV over 10 years ago, all it had were ads for pills with the cliche afterword on the side effects in lower volume and spoken much more quickly. Isn't it obvious?
Many kinds of medicines mitigate not cure. And most people I know do not much discuss medical treatment when it is going well. Especially around people inclined to sanctimonious lectures.
Would any doctor actually tell a morbidly obese person not to exercise, because it would be too risky for their heart?
Maybe in the 1900's, but in modern times?
And the reality is that simply taking in fewer calories will often cause your body to burn fewer calories because your body is meant to conserve energy for the times when it is needed to run away from the bigger predators.
Discipline is easier when you aren't hungry it turns out.
The food labels on your food packages are determined by calorimetry. But your body digests some food more readily than other foods, also affected by what else you eat with it, how you prepare it, etc. Also your body encourages you to eat certain things to get various nutrients: you rarely eat those nutrients alone; typically they come along with a bunch of other stuff. Then peoples' feedback systems are heavily influenced by all sorts of things: signals from your gut biome, your emotions and response to social signals and learning, various kinds of signalling reflecting what you eat (and those signals are empirically hacked by food engineers), and random brain bugs, among others.
Exercise is hardly scientifically measurable either. It's not like that "calories burned" reading on your bike, is comparable to a bike from a different manufacturer, much less a different kind of exercise.
We are also now seeing people where diet and exercise simply isn't working as expect. There was a study that indicated that PFAS pollution affects the metabolism in some people during the night. Normally you still burn calories while you sleep, but for some elevated PFAS levels causes their bodies to basically stop burning calories during the night.
You're not wrong the pushing lifestyle changes should be the primary goal, but the world isn't that black and white. Peoples circumstances are different and ignoring pharmaceuticals on principle isn't particularly productive. Just like ignoring lifestyle coaching is foolish.
Some anecdotes have people ceasing and getting heavier, but I don't think that's been shown at a population level.
We need to recognize that caloric surplus and deficit is hugely impacted by deviations in many things that impact efficiencies (eg hormones, enzymes, etc…).
I would be interested in reading that study...
Doing the same thing over and over and expecting a different result is the definition of insanity, or something like that...
If they lack the motivation or determination to see through a diet, that's on them. The resources to count calories are there, it's not nearly as hard as it would have been 20 years ago.
Now, some people genuinely have some form of disease or unusual case where medication is 100% needed and no lifestyle change would help - and those people should get whatever treatment best suits them.
But 36% of the US (obese) is not an unusual edge case, some rare genetic disorder or disease.
Do I have hard data on this? No.
Yes, that I would completely agree on.
I think now that we actually have a solution, we can stop saying this “lifestyle choices” junk. The reality is people rarely have a true choice.
But just because it's hard doesn't mean it's not doable. For the vast majority of people it is doable without any form of medication. It will be slow and uncomfortable, but doable.
I think that a prescription should be a last-resort option for people who genuinely have a condition that makes a traditional method not possible. There's a variety of reasons for that, from monetary ones to health concerns about being on something like these medications long-term.
Traditional methods are already out there and this health crisis is just getting worse each year. The average person is clearly not having success with them, and saying "if they just try harder" or putting some different spin on them hasn't done a thing to fix the trajectory of this problem in the past 30 years, so I can pretty confidently say that there is zero chance they will somehow solve this societal problem in the future.
Being significantly overweight has immense health consequences and imposes huge costs on both the individual and society. I think it's incredibly, incredibly unlikely that the costs or health risks of this medication are higher than the well-documented costs of people continuing to be significantly overweight.
And FWIW: I say this as a thin person with no trouble with my own weight.
Sure it's hard but if I ate till I couldn't regularly I'd end up several thousand calories over what my body needs for maintenance.
Struggling successfully is struggling.
Don't be afraid of pharmaceuticals, but at the same time take advantage of lifestyle changes.
If you're going to lose weight through appetite surpassing medicine, you will lose muscle mass along side with fat. If you're not careful, you might become fatter as you become more skinny, hence 'skinny fat'.
Drugs are just tools like any other.
A patient and their doctor are going to know more about the approaches that are right for them than anyone on some thread here.
Obesity is not the most common or most severe risk factor for COVID death. And it was discussed much.
In general, folks know what to do, and they need help.
Group 1 are the lazy people. Obesity is a behavioral issue for them. They eat because they overate for some time, and they are now prone to hunger because of it. Lifestyle changes do help this group-- the stomach contracts and they start to subsist off of smaller portions because they're not filling an enlarged vessel. FWIW, my own doctor recommends drinking water as a replacement for food, to satiate the oral fixation of eating. It fills the stomach just the same and you go through the same motions.
Group 2 are the people who overeat because of some dopamine deficiency. We look at what they consume, horrified-- carbs, fats, sodium, sugar. Think about it: these are all party foods. Parties are where people have fun, and fun makes us happy. This leads to a deadly spiral of eating increasing amounts of unhealthy food that elicits positive feelings and discourages you from ever leaving your bedroom. Lifestyle changes could help this group, but the underlying issue needs to be addressed. Diet/exercise/sleep doesn't relieve you of your loneliness or struggles to pay the rent.
Group 3 is genetic predisposition; some people just retain water/fat/etc. more than others. Exercise as a first step does not help, and stresses their taxed cardiovascular system. Diet is not a factor. These people need to be on medications like spironolactone and ozempic, not treadmills-- the latter will kill them.
These are just the cliques I've identified by association; I'm not a doctor, but I play one well enough to know the problem isn't as simple as you make it out to be.