Life After Ozempic
english.elpais.com
english.elpais.com
I only skimmed the study, but at a glance, the study seems fine, if a bit unremarkable, but the article reporting the study seems a bit confused.
1. The study doesn't study Ozempic (Semaglutide), it studies Liraglutide. Why is the article titled "Life after Ozempic"?
2. Okay, so some patients stopped taking a weight loss drug and stopped exercising, and gained weight. That's pretty much exactly what you'd expect, yet the article seems to be presenting this as if it's a problem with Liraglutide. "Medicine doesn't work when you don't take it" is a bizarre criticism.
The conclusion to the follow-up study might have a clue to (1.):
> The addition of supervised exercise to obesity pharmacotherapy seems to improve healthy weight maintenance after treatment termination compared with treatment termination of obesity pharmacotherapy alone.
Ozempic in the title could be a stand-in for "obesity pharmacotherapy" and maybe they chose the more recognizable brand name.
It's also not very surprising that those in the supervised exercise group were better off a year later, they'd developed a healthy habit.
That does not follow, because this is simply yet another correlational result: the selective attrition after randomization is not itself randomized and therefore can be confounded. It is also possible that the people who got sicker or unhealthier after stopping the useful drug then stopped exercise.
(It is, in fact, not just possible, but must be the case to at least some degree: unless you want to argue that getting unhealthier would have no impact on whether you were able & willing to keep exercising...? Regardless of whether exercise has any effect, sick or fat people find it harder to exercise, and so would do it less than healthy or thin people.)
Do you actually think people can actually taste the extra sugar, after some threshold?
"Why are you trying to make this about profit? Discipline is hard and Cocaine makes people happy. Companies responding to what people want isn’t evil"
The market environment is extremely creative (this isn't a bad thing) and players will always try to externalize everything but the profit. This is why regulation should put boundaries.
The externalities in this case are caused by the producer/promoter, as an externalized health risk. What you are probably refering to is the secondary effect of aggregate increased healthcare cost.
Javier Diaz, the featured success story appears to have done that.
Note also that the causal relationship here may be weak or non-existent. Other research shows that it is less likely to cause thyroid cancer than taking insulin, and most treatments for type II are correlated with thyroid cancer risk. [3]
The health risks of obesity absolutely dwarf the hypothetical increase in thyroid cancers. Obesity is itself a risk factor for basically all cancers including thyroid. Frankly, even if there was a 100% chance of thyroid cancer due to GLP-1 usage, that would still be a massive win for population health.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563602/
Sugar cravings (what these people confuse with actual hunger) do not take that long to go away.
Fasting is cheaper than eating. These drugs are expensive and have nasty side effects.
The big problem with sports and serious exercise is that this desire to eat more tapers off very slowly if you start exercising less. I know several people from college who where pretty serious athletes while at school, but then started exercising much less after graduation, and they all put on a lot of weight very quickly, even though they stayed reasonably physically active and are on the whole pretty fit.
"shoulders are built at the gym; abs are built at the dinner table"
It _is_ that hard, and even if you starve yourself, the body just lowers your BMR to compensate.
I highly recommend reading this: https://highline.huffingtonpost.com/articles/en/everything-y...
An article promoting fat acceptance?
I hope something is done about this dangerous cult that keeps the obese away from getting the help they need.
Past ~30 years have shown us that the latter _very clearly_ doesn't work, but sure, a "dangerous cult".
I'm nowhere close to starvation either since my lifts are going up
If you keep the diet that made you obese and reduce it by 50% you'll feel like shit, if you have a proper diet you can eat until your jaws physically hurt and still have room for extra calories
Compare it to people with vertigo. Get a grip and just stand on the edge, while technically correct, will not solve the problem.
If someone would discover a strong gut-brain behavioral influencing parasite link, I would not be surprized, but I have 0 knowledge on the subject.
Insulin mismanagement is a bitch.
If I just go by how I feel I will end up eating so much more than I think I am eating.
Then it is frustrating thinking your on a diet when you really haven't cut any calories so the scale isn't going down.
Bodybuilders have had this figured out for a long time. There is no bodybuilder ever that doesn't track their calories when getting ready for a bodybuilding show because otherwise your going to over eat.
Not tracking calories is just a stupid strategy. No one goes running without knowing how far or long they are running for. No one lifts weights without having any idea how much the weights weigh. For some reason people expect to be able to do this with food of all things when we have evolved to eat as much as we can.
- When I exercise rigorously, my mind tells me that I need to eat to recover fully. I end up eating more calories than I burnt during the workout.
- When I lose weight, I find that I'm much more negative and I have to constantly remind myself that it is the weight loss (and the lack of eating).
I still do it because I think being light is better for my back and knees than being heavy, but I can't say that it is easy.
But I agree that some people have very little self reflection, discipline, will to change and just expect a magic pill
During my young adulthood I always gained weight, slowly but steadily until it evened out at around 103 kg.
Around when I was in my early 30s, I got sick to the point I lost 15 kg weight in two weeks, and over the next 3 years I lost 8 kg more, and got down to a low of about 78 kg, mostly due to healthy eating and exercise. I started running half marathons, I became more social and happy and life was generally better.
I'm positive that my sickness altered some chemistry in my body/brain. I didn't have any cravings, my sense of smell was altered and smelling food from McDonalds seemed repulsive to me, I was less impulsive and so on. Life was just easier, for about 3-4 years.
As my sickness receded I slowly got back into my old habits. McDonalds started to become attractive again, snacks slowly creeped back into my daily routine and running became more and more difficult. This recession took about 6-8 years and I'm now back at around 103 kg.
I often look back and wish I could recreate the effects of that period somehow. I've tried "putting down the fork" countless times. I've tried all kinds of weight loss strategies but it just seems so much harder than it was back then.
The sickness I got was Sarcoidosis. Initially I was treated with adrenocortical hormones because I had unexplained high fewers, swollen knees and ancles and rapid weight loss. What eventually led to my diagnosis was a doctor "randomly" asking for a chest x-ray even though I was mostly hurting in my legs. That xray showed I had enlarged granulomas all over my lungs. The hormone treatment lasted for roughly 2 months. But I was going for scans and lung checkups for 3 years after my diagnosis, until everything settled down. My sarcoidosis was fairly mild and I don't have any lasting symptoms.
Personally I'm convinced something happened in my body that made everything easier while I was "sick". I'm not sure if it was the rapid weight loss in the start, the adrenocortical hormone treatment or some other hormonal change caused by the Sarcoidosis itself that caused it. I just know that to me it felt like I was living the life of a thin person on the "other side" for a few years until I was back to my normal self again.
There's evidence that shows major life events can lead to it being easier to adopt changes in behavior, like a new habit of healthy eating and regular exercise.
> I've tried all kinds of weight loss strategies but it just seems so much harder than it was back then.
If it's not too forward and you can adhere to it, I would suggest tracking everything you eat. Given some (1-2 weeks) of baseline data collection, make some tweaks to the macronutrient composition (protein/fat/carbs) of your diet. From that play with it until you find what you need to feel "full" in what you eat and in a way that is sustainable.
I may be strange in that I'm happy eating the same thing all the time. I don't think this is a simple or straight forward process, but approaching it with curiosity and rigor seems to have worked well for me.
Also, remember that is where it starts to get dangerous.
What makes the difference is what you eat. Unmanaged insulin levels, even for so-called "healthy" individuals, leads to weight gain, especially in areas of the body associated with heart disease and stroke.
Your body requires multiple PHds in multiple medical and biochemical disciplines to understand. Trying to slap CICO on everything is both ingenuous and gaslighting.
Want to lose weight? If you already have a healthy calorie intake, decrease simple/refined carbs, increase healthy fats, avoid unhealthy refined oils from plant sources (margarine, crisco, other synthetic lard/fat replacements), increase meat protein if you're not getting at least 4 oz a day, avoid grains entirely if need-be (but certainly, less is more).
Still not working? Increase salt intake, low salt diets interfere with the angiotensin-renin system. Even with people with high blood pressure, lowering sodium intake often drives blood pressure higher (a documented life-saving quirk of physiology), but increasing potassium decreases blood pressure reliably.
Easiest way to achieve this is just to eat a normal, ungimmicky, unbullshitted, whole foods diet. Is it ultraprocessed? Is there more weird-ass chemicals on the box's ingredient list than not? Can you make this, yourself, in your kitchen, following a basic recipe? No? Then don't eat it.
When you understand why I asked those two questions, then that will answer your question far better than me spending a dozen pages to answer you. The statistics available to the average consumer are not a level playing field.
Basically every long-term weight loss study shows that you will regain 80%+ of the weight you lose through diet and exercise over a few years. [1]
> Specifically, it has been estimated that for each kilogram of lost weight, calorie expenditure decreases by about 20–30 kcal/d whereas appetite increases by about 100 kcal/d above the baseline level prior to weight loss. Despite these predictable physiologic phenomena, the typical response of the patient is to blame themselves as lazy or lacking in willpower, sentiments that are often reinforced by healthcare providers [...] [1]
Obesity is a disorder of the GABA-ergic central nervous system, which is, I suspect not coincidentally, where GLP-1s work.
> These drugs are expensive and have nasty side effects.
They're expensive because they work, and previously the only clinically proven effective alternative was bariatric surgery. That's both more risky, and much more expensive. The side effects are actually minimal, and during the clinical trials very few people dropped out due to side-effects. The newer dual- and triple-receptor agonists have yet fewer side effects.
> Obesity is a disorder of the GABA-ergic central nervous system
This is too reductive. As a person who used to be fat and lost ~20kg over a few months by eating only 1 meal/day, I cannot symphatize with people who say they cant lose weight because of their genetics or whatever because you are supposed to feel hungry when losing weight.
That said, I get that many people just cant resist that hungry feeling. However, I've seen so many people who make these arguments eat tons of ready meals, desserts loaded with sugar, giant milkshakes etc. If they were serious about losing weight they could at least eat things like cucumbers or lettuce that keep you full with minimal amount of calories ingested.
The gist of it to me seems like these drugs are for people who are willing to pay thosands of $ to feel as full as when they were eating their 5000kcal/day diet without having to endure the feeling of not eating that amount. Which, contrary to your claim, boils down to the willpower issue. These drugs let you buy your way out of the willpower requirement.
So generally, anecdotes aren't a substitute for data. Which is why I linked to a meta analysis that incorporated 29 long-term studies that followed people for five years. Don't you think in the face of that, that your experience may be either (a) not representative of people in general or (b) you haven't waited long enough to see what happens next to yourself?
> These drugs let you buy your way out of the willpower requirement.
Or and hear me out, similar to the way your body maintains its set temperature by adjusting various factors - it also maintains a set weight. And that over a longer period of time you are as likely to "will" your way to a new weight set point as you are to a new temperature set point. Despite being able to temporarily lower your body temperature by taking cold swims.
Because frankly, that's what the data says.
If you read the link I provided you might learn something interesting...
But even if this was the case (and it's not) who cares? The goal is to get people to a healthy weight. Since moralizing hasn't done anything, and your approach has been an utter failure, why should you hold this drug that objectively works against anyone?
> for all practical purposes, “a calorie is a calorie” when it comes to body fat and energy expenditure differences between controlled isocaloric diets varying in the ratio of carbohydrate to fat
So, calories in calories out. All you have to do is not ingest them. And if you do, who made that choice? The rest of the paper seems to be talking about factors such as "the obesogenic environment" which completely factor out the agency of the individual. It's like saying it's not your fault that you are an alcoholic or gambling addict because supermarkets sell alcohol and there are bookies just around the corner.
I understand what you mean by "who cares". I get that these drugs are a net positive good because they greatly reduce harm with minimal effort. That's great, but it's ultimately like administering narcan to an opioid addict. No one argues narcan is bad (it's proven and effective at preventing OD deaths), but also no one argues it is a solution to the addiction (you cant shoot up as much as you want and take narcan if things go unwell). Obesity of course is not as destructive (to a single individual) as an opioid addiction, but the fact that you regain the weight as soon as you stop taking ozempic etc shows that it's a bandaid.
That is not at all a conclusion you can draw from the link I provided. This is the conclusion I would draw.
> > In addition to adaptations in energy expenditure with weight loss, body weight is regulated by negative feedback circuits that influence food intake. Weight loss is accompanied by persistent endocrine adaptations that increase appetite and decrease satiety thereby resisting continued weight loss and conspiring against long-term weight maintenance.
But it just feels better to blame the individual.
> That's great, but it's ultimately like administering narcan to an opioid addict. No one argues narcan is bad (it's proven and effective at preventing OD deaths), but also no one argues it is a solution to the addiction (you cant shoot up as much as you want and take narcan if things go unwell).
But that's not how it works at all. It would be like taking a drug that makes you find opioids unappealing, and stopping you from shooting up in the first place.
Honestly you're basically making the case that any chronic condition isn't worth treating because it'll come back if you stop taking the treatment. And that chronic conditions are actually moral failings.
> Obesity of course is not as destructive (to a single individual) as an opioid addiction, but the fact that you regain the weight as soon as you stop taking ozempic etc shows that it's a bandaid.
I'm not sure that's not true. The leading causes of death in the US are heart disease (#1), cancer (#2), stroke (#5) and diabetes (#8) and kidney disease (#10). These are all diseases you are at risk of due to obesity. Opioid overdoses don't even make the list. In fact 15% of prescription opioid use is itself due to obesity. [1]
Obesity is responsible for ~380,000 deaths in the US per year vs about 80,000 opioid deaths. [1] So buddy if this was narcan for obesity (it's not) you should be pretty bullish on it.
[1] https://journals.lww.com/pain/fulltext/2019/10000/the_contri...
Doesn't that describe a huge class of drugs. Lots of maladies will eventually go away by themselves if you ignore them, drugs just makes the process faster and more comfortable. I mean what are pain killers other than a way to buy yourself a way out of the willpower requirement to ignore your pain.
Right now I'm taking the extreme tactic of just not eating foods 3 days out of the week and that's working. Slowly. But no one who eats as healthy as me should have to do this. I show people my meals. I prepare them myself. I don't make fried foods. My meals are not low carb, but it's not like I eat pasta every day. I show professionals my meals. No one can say there's anything wrong with them.
The bizarre part is that at nearly 40 my medical stats are perfect. It makes doctors not bother me too much about my weight. People would kill for the kind of resting heart rate, cholesterol, etc I have at my age. This is just where my body likes to be if I'm not gonna walk 2 or 3 hours a day.
I'm not saying I'm like most people because i definitely have family who say they don't drink they just have a glass of wine or family members who complain that I only keep water in the house while lamenting they only ever seem to gain weight, but for some people weight loss is not so simple. If I have to skip eating all together every other day to lose a pound a week, something is strange.
My own anecdote: I lost 68kgs naturally by sheer “willpower” in 12 months. My weight stayed stable for about 18 months and then I slowly started to regain weight despite maintaining my exercise regime, my appetite was becoming more and more difficult to regulate, and I’d regained about 10-15kg’s after 2.5years. I decided I wasn’t prepared to go back to my much more obese starting weight, and so I got a prescription for a GLP1. I feel much better, I still actually decide what foods I’m going to eat, but weirdly on this medication, I’ve got a preference for fresh fruit and vegetables, and lean cuts of meat.
After my experience with weight loss, both “willpower” and substantial loss, a little regain and a GLP1 my anecdotal experience suggests to me that obesity is not a willpower issue, but rather a physiological issue with living in an environment that’s saturated with unhealthy food.
If only 1 or 2 people were struggling with obesity then sure maybe it would be a them issue, but this issue effects so many people that it’s got to be something far deeper than there being some sort of moral failing of the individual suffering from obesity.
I don't understand why we just take anecdotes seriously in conversations about weight, in a way that we simply would not anywhere else. We have data about this. There's boatloads of studies over decades and decades.
Obesity is genetic and epigenetic, and it's a chronic condition. Most people when exposed to an environment with lots of food/stress/etc will gain weight. Some will become obese. Some will not. Those that don't, will increase their energy expenditure and return to roughly normal in time. Those that become obese will not. [1]
We know those who become obese have an insanely hard time losing the weight because when they try, their metabolism slows down and their hunger goes up well in excess of what would be expected based on their reduction in fat mass. As you were beginning to experience, substantially everyone who loses a clinically significant amount of weight will return to roughly where they started over a few years without meaningful intervention.
My man has no idea what he's talking about.
I say that as someone who has lost significant weight and kept it off for a number of years. But it was not as simple as "put down the fork". I basically have to calorie count every morsel. If I left it to my own mind or just told myself to "put down the fork" I'd be fat again in no time. My mind fundamentally doesn't seem to know when I have eaten enough food.
Perhaps with a little empathy, you could take whatever no doubt reasonable and well-meaning intention you have and bring it to people in a way that is actually constructive. That way someone might even be helped.