Wegovy and Ozempic (semaglutide) associated with reduction in alcohol addiction
recursiveadaptation.com
recursiveadaptation.com
Mindful that this also lowers muscle mass (can weight train and eat enough protein to compensate slightly)
AND less easily mitigated lowers bone mass, weakens tendons, and weakens ligaments.
It’s a great option if the patient is diabetic and their current lifestyle/condition has worse outcomes than the side effects listed, but we’re hearing from celebrities like this is a vitamin D pill
> AND less easily mitigated lowers bone mass, weakens tendons, and weakens ligaments.
Does it do these things any more than losing the same amount of weight by other means in a similar time frame?
"Diet-induced weight loss reduces muscle mass without adversely affecting muscle strength" [1]. (Not sure about magnitudes.)
So to get back to your question, one could lose the weight in the best possible way by correcting their diet, eating less, doing HIIT, fasting, good supplements like creatine, stress reduction through breath work and meditation, and resistance training and end up in a very strong position.
Please anyone correct me on this.
(star) Anecdote about my friend: He went on Metformin for a few years, had lots of diarrhea, and lost about 30 pounds and is skinnier than me. At this point, he could really really get into a strong health position having had that shortcut. His eating habits even got a little better from wearing a glucose monitor. He's sick of the diarrhea which really keeps him from wanting to be out of the house for long, and is slowly looking for some intriguing physical activities. So I think these drugs can help people.
Yes, but actually doing that when you’re obese is extremely difficult and maintaining it is even harder than that. The best way I can describe how difficult, it’s like climbing Mt Everest and then discovering that you have to live up there. Lots of people do manage the climb, but staying up there is the real challenge and not a big percentage of people do. So, statements like yours while they’re technically true are ignorant of the biological and psycho-social dynamics of obesity, condescending (“why didn’t I think of just eating less!?”) and totally unhelpful.
From my own hiking experience, that the first few days my appetite is suppressed, and similar reports from others, anthropomorphizing the body a bit it says "well, if we're going to be moving around this much, I don't want to carry all this weight".
Just walk.
Is your plan sustainable through injury, and on vacation, and after being laid off and through holiday temptations, and through deep emotional turmoil, and just insidious calorie increases over time, and a million other real world scenarios that throw people off the wagon who have lifelong deep seated eating problems? This is so difficult for so many not because the obvious things work for everyone but because they don’t for a majority of people. We’ve tried all the obvious things!
If you're laid off you have more time to walk. If you're not walking that much quit your job and reduce your outgoings so that you can get a job that helps you survive past 45 without type 2 diabetes. Walking is very calming if you have emotional turmoil.
You don't get to a BMI that was much greater than 40 without eating disorders. Walking helps calm that, too.
I think people who say they have tried walking are lying to themselves. They're like the women who go to the gym and lift 2 lb dumbbells.
Walk ten miles a day for a year before telling me you've tried it.
Walking 10 miles a day isn't feasible for disabled and many injured people nor people who don't have 3+ hours spare to walk that far. If the principle is "do lots of exercise that you can do" yes we know about that, we've tried it many times, and the habit to sustain that didn't stick for the million and one reasons that they fail. Thankfully there are doctors and pharmaceutical companies that can understand recidivism statistics and don't just assume that obese people are morons or "lazy" or whatever ignorant and arrogant opinion you're espousing.
"Become a security guard" isn't sustainable advice for weight loss.
Source: I work at a healthcare company that does weight loss, among other things.
The obsession with emotional safety that is prevalent these days is probably killing people.
Maybe pull your head out of your ass long enough to realize that nobody wants to be fat under the immense societal pressure of random assholes telling them "you're going to die", and that poor self-control is actually a physical and mental issue.
This is like a tall person telling a short person "just reach higher! Ugh!".
However, there is some science now to suggest that the body has other means of lowering BMI and reducing fat burn when it thinks it's starving (IE - any time it's losing weight). So it could be that my body not being in a panic is also helping to lose weight. But I'd bet it's largely just less calories.
drugs don’t need to be used long-term to have a pretty good picture of the long-term tradeoffs, particularly when it’s something like cancer or obesity that has a clearly negative long-term outcome in the a sense of a successful intervention. Most interventions for obesity are ultimately not successful and to have one that is is a game changer, even if it has some minor side effects (and burden of proof cuts both ways - it’s not clear that they even exist etc, only that it would still be worth it if they did).
in the real world, things usually don’t turn out to have some stealth side effect that takes 30 years to manifest, and nobody is telling you to take them anyway, just to stop injecting yourself into private medical decisions around an approved, well-studied drug with a seemingly quite benign profile.
(why oh why do I suspect that semaglutide skepticism correlates heavily with the “respect my freedom to not wear a mask” crowd…)
> stealth side effect that takes 30 years to manifest
Heavy metal toxicity, cirrhosis, lung cancer, persistent infections that lead to cancer (HPV, Hep B, etc), silicosis, COPD, skin cancer, all sorts of diseases result from cumulative exposure.
> (why oh why do I suspect that semaglutide skepticism correlates heavily with the “respect my freedom to not wear a mask” crowd…)
Can you approach skepticism without ad hominem attacks?
See this disproportionality analysis from a nationwide population-based study of the French (full text, figure 2):
https://diabetesjournals.org/care/article/46/2/384/147888/GL...
1. Weekly vs daily administration, liraglutide and exenatide had to be injected daily which made the drug less attractive for patients and doctors vs metformin which is well known and a cheap pill.
2. Greater magnitude of effect. Liraglutide had less impact at prescribed dosage for both lowering A1C and weight loss so in combo with (1) made it less attractive than semaglutide.
3. Magnitude of weight loss from (2) now so significant it easily beats all previously approved weight loss drugs with few side effects. So entire GLP-1 agonist class of drugs reexamined as direct weight loss treatments vs just a modest but very welcome side effect of diabetes treatment. And once weekly administration meant it would have much better patient compliance than a daily injection.
GLP-1 increasingly looks like a vitamin.
It is "essential to [humans] in small quantities for proper metabolic function" [1]. But what our body produces gets eliminated in minutes [2]. Not everyone needs supplementation and too much can be harmful. But a deficit results in ultimately-fatal chronic conditions.
Sure, which is why I say looks like, not may be. If calcitrol were eliminated like GLP-1, a drug that activated the VDR would be beneficial to those with a deficiency [1].
These are the common effects of weight-loss and they and other risks are why you should be under the care of a specialist in obesity and/or diabetes, a nutritionist, and a trainer.
All the results are from lowering BMI, being fat is just this unhealthy.
These drugs aren't a free lunch and from my understanding can't be stopped without dramatic lifestyle changes or most of the weight comes right back. 20+ years of losing bone density and connective tissue mass is going to be catastrophic in old age for people who have to stay on it long term but really so is the obesity, diabetes, and heart disease. It's a tough moral quandary.
Losing weight means losing the muscle “scaffolding” also.
Until I see proof that these drugs result in dramatically more muscle mass loss, I’m going to assume the argument is FUD.
"Everything is a tradeoff" is almost a core belief for me, but in the same time, in technology, the "too-good-to-be-true" events does turn out to be real every once a while (I'm using technology here as a general concept).
I do understand GLP-1 does have some downsides, like cost, or in my own experience, nausea. But the tradeoff seems negligible compare to the upside. Part of me feels like that there is some hidden trade-off somewhere that we're not discovering, but part of me also wonders if it's a once in while technology jump, where it is just better.
Anyway, I guess I'm just a bit wary to throw away the "everything is a tradeoff" mental model that has worked quite well for me.
Giving them to children has been linked to many conditions such as obesity, allergies, and asthma [0]. They have saved countless lives from infections but their use and overuse has undoubtedly contributed to significant and widespread health problems.
There are considerable numbers of people who have severe complications with antibiotics, and their overuse over time has left us in a position where the functional pools of antibiotics keeps getting smaller and smaller and the pool of superbugs gets more and more virulent.
Who knows the long term ramifications of this new class of weight loss drugs. This smells to me like the Prozac craze in the 90s when everyone was on it or giving it to their kids. Or the olestra boom until everyone was literally crapping their pants.
Or tangentially, the over proscribing of novel opioids. Look what that has wrought in our society.
Could this new class of drugs be helpful, absolutely. Do we know the long term issues, nope. I think there are people who can use this therapeutically and there are others who use it as a quick fix because they have no self control. In a lot of ways it also feels a little ironic to look at fiction like the food indulgent scenes of “Hunger Games” and South Park and see that happening for real.
Every once in a while? Our lives are better in so many tangible ways than they were even 100, 200 years ago.
Just for a start - instead of 50% of children dying before the age of 5, we're down to tiny fractions of a percentage.
But sometimes things we're trading off are less relevant and so the equilibrium changes e.g. losing weigh is hard, because humans evolved in low-calorie environment and being able to stock fat was important.
https://www.healthline.com/health/semaglutide-withdrawal-sym...
Source?
And are the people losing 100 lbs regaining 70 of it? These statistics are provided in the aggregate [1]. I wouldn't assume the re-feeding of someone who lost 20 lbs will mirror someone who lost 100 lbs.
Also, conventional methods resulted in "more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained" [2]. So our baseline is the 100 lb person regaining 50 lbs following diet and exercise or whatever.
Why? We need to eat. We don't need to drink.
Removing alcohol for a year or more could allow both the body and environment to be adapted to a point where it is no longer presented in the same way.
Won’t be the case for everyone but I think even taking it for a limited amount of time could do a lot for a certain type of excessive drinker.
Skinny foreigners move here and gain weight. That’s a pretty strong indication that individual willpower doesn’t have much to do with why skinny countries are skinny. Why would we expect that to work here?
Our options that have any hope of actually working are a huge overhaul of probably a lot of things, including our food culture, zoning and city layouts, farm policy, and social safety net, to name a few—or, a miracle drug.
Realistically, if we want results this century, that leaves only the latter option.
1. https://en.wikipedia.org/wiki/Fundamental_attribution_error
What are you basing this assertion on?
> Skinny foreigners move here and gain weight.
Do you have any data to back this up?
> including our food culture, zoning and city layouts, farm policy, and social safety net, to name a few—or, a miracle drug.
Why do you think that only extreme solutions are available?
> Realistically, if we want results this century
I don't think there's anything realistic in what you've proposed.
“Why only extreme solutions?” 1) because zero non-extreme ones have worked, 2) because the root cause appears to be deeply embedded in a complex web of systems, which means addressing the root cause within a human lifespan is necessarily extreme, 3) the drugs arguably aren’t really extreme, and 4) supporting #3, the alternatives we’re currently reaching for are drugs to treat the outcome of the pattern of failures in behavior modification / willpower approaches, so this is really what we’re already doing just applied before things get extremely bad.
[edit] here, a couple examples, why not:
https://pubmed.ncbi.nlm.nih.gov/19538440/
Maybe it’s just me, but the last sentence of the abstract reads like a punch line:
“Future research is needed to identify the specific mechanisms through which living in the USA may adversely affect health outcomes.”
I chuckled. “Uh well we know it’s real bad but as for why, look, it’s fuckin’ complicated and probably gets political way faster than you’d expect”
(The paper appears to recommend weight gain prevention intervention programs for immigrants, because what else are you gonna do?)
https://www.nature.com/articles/s41366-024-01525-3
Paywalled but the summary provides some good info. Between this and others (also appearing on the first page of my ddg searches for this) one puts together a consistent picture
1) thanks to a ton of research and spending we’re getting better behavior modification programs! Hooray!
2) the ones that kinda work are a lot higher-touch than you probably expect. I.e. expensive and not accessible to lots of folks, for a variety of reasons.
3) despite all that the expensive state-of-the-art isn’t good enough to tackle the obesity crisis. It helps, but not enough, even if we could provide that help to everyone who needs it.
4) comically (again) this particular summary ends on a “… but now that we have really good weight loss drugs, maybe it’ll work!” note.
(“Just do a diet” without ongoing professional support is basically not effective at all for long term weight loss, on a population level)
As someone who is diabetic and who has lost a lot of weight on semaglutide I can assure you that several genuine and difficult attempts to modify behavior were attempted before getting on the drug.
I guarantee you that I'm not the only one - I'd expect the vast majority (75%+) of people using semaglutide to have attempted behavior modification before starting the drug.
You sound like the people who say that trans people should try psychological interventions (conversion therapy) before medically transitioning (which is also a lifelong medical commitment in many cases). Psychological interventions don't work, while medical transition does. It's the same here. Ozempic works while telling people to eat less does not.
I.e. if an obese person gets skinny with Ozempic and then stops taking it, can they keep the weight off?
If not, it seems like the "perfect" money-making drug, i.e. it doesn't cure anything permanently, its expensive, and patients have to take it until they die.
Now sure, it's obviously better than being obese and unhealthy, but does it bother anyone else (in a philosophical kind of way), that we are treating the symptoms and not the causes here? We're teaching people that everything can be solved by popping more pills and not treating the psychological issues that result in so much obesity. It also doesn't result in anyone learning any good lesson, e.g. that working gets results. In this case the lesson is, my bad decisions or mental health don't matter, I can just pop pills for all my problems...
Most can’t do that or they wouldn’t have needed it in the first place.
My understanding is that many do well on a much-reduced dose once reaching their desired weight, or simply stop the drug but then return to it for a couple months if they backslide.
[edit] nb a fair number can do pretty well without it, though, as they find it easier to stay motivated to maintain a good weight than to overcome the intertia and slooooow results of losing weight from an already-very-unhealthy weight. Doesn’t hurt that working out is a hell of a lot easier and more enjoyable when you’re already a healthy weight. Seems those who’ve in the past successfully put in effort to hold a healthy weight for a good amount of time but then eventually gained a bunch, have an easier time keeping their healthier weight for quite a while once off the drugs.
Then again I once knew someone who went through the pain and cost of a gastric bypass, which she then ironically bypassed by drinking melted ice cream. It all comes down to the patient.
I agree with everything you said, but what is the cause of obesity? It's convenience, abundance, corporations, and being sedentary. All of which are where most societies continue to move toward.
Just take the slim pill and stay put, everything is going to be alright
This thread is full of people that think that fat people are only fat because it didn't occur to them to be thin.
Considering the high prices of the marketed product, I would dispute the idea that generic manufacturers will not leap at the chance to get a taste. Even if it is technically complex, they have years to perfect a recipe, get it GMP qualified, and on shelves the day patents expire.
https://doi.org/10.1001/jamanetworkopen.2024.3474
https://www.fastcompany.com/91071415/your-1000-per-month-oze...
Over-priced temporary fixes should be the choice of last resort, not the first one.
You know what else is a temporary fix? Vitamin C for scurvy. Your body does not produce it endogenously. You are already a lifelong patient -- all humans are -- and it just so happens that the medication to treat it is part of your diet.
In the interim, the drug helps those in need of intervention.
https://www.fractyl.com/fractyl-health-demonstrates-signific...
----- We identified 3999 US adults weighted to an estimated population size of 93.0 million [M] (38% of US adults) who fit STEP 1 eligibility criteria. Applying STEP 1 treatment effects on weight loss resulted in an estimated 69.1% (64.3 M) and 50.5% (47.0 M) showing ≥ 10% and ≥ 15% weight reductions, respectively, translating to a 46.1% (43.0 M) reduction in obesity (BMI ≥ 30 kg/m2) prevalence. Among those without CVD, estimated 10-year CVD risks were 10.15% “before” and 8.34% “after” semaglutide “treatment” reflecting a 1.81% absolute (and 17.8% relative) risk reduction translating to 1.50 million preventable CVD events over 10 years.
The problem isn't the results, the problem is the factors that caused the obesity. I'm for it as long as it comes with healthy lifestyle changes as that's the only true way to have a long-term impact.
[0] https://www.independent.co.uk/life-style/pregnant-women-ozem...
[1] https://www.theguardian.com/science/article/2024/may/14/weig...
These drugs have the flavor of that. I'd be reluctant to take them not because the Thyroid cancer risk or loss of muscle mass. Or the possibility that if I stopped I might gain more weight then when I started.
I'd be reluctant because in it's weird hormonal backdoor way it seems to be really messing with your personality. I'm not convinced the grass is actually greener on the other side - I tend to be of the belief that it's no better or worse; it's just a different set of tradeoffs.
All that said while I'm not skinny I'm also not (in my and I assume my dr's judgement) a candidate for this drug. Maybe if I was I'd feel differently.
The dual action tirzepatide and the next generation retatrutide that has shown massive ability to reduce the long-term harm from obesity: https://www.vcuhealth.org/news/retatrutide-wiped-out-fat-in-...
I'm sure there will be many comments here discussing how awful the side effects are, but from what I can see they're almost all primarily associated with rapid weight loss in general - muscle mass reduction and whatnot seem inevitable when someone drops 100+ lbs of total body weight.
> 14 Mar 2024 --- Today, a coalition of Nestlé shareholders, with US$1.68 trillion in assets, has filed a resolution challenging the company to improve the healthfulness of its products.
Translation: shareholders are terrified of the impending collapse of the status quo business model and want the company to pivot to things GLP-1 patients want to eat.
It's not just the lack of hunger, but I don't get hangry, which was an even bigger problem than resisting the food. I'd get legitimately obsessive about the stupidest little things, to where I'd jeopardize my job and every relationship in my life if I kept going that way.
I knew things were different when I ate two pieces of pizza and then the box sat there in front of me for hours w/o me even thinking about it. Normally as soon as I knew everyone else had their fill, I would have finished the two pieces left in the box. If I tried to resist, the pizza would be calling me from inside the box every 5 seconds. It would be like a crack addict sitting there looking at a loaded crack pipe for 2 hours and not taking a hit.
Another moment was when I got the "I'm full, I don't want to finish this" message from my stomach while eating a small cakepop. I've gotten that feeling before from eating too much meat, like at a Brazilian steakhouse, but never from anything sweet and carby. Just knowing this is how some people live has been a huge eye-opener for me. I totally get the whole ectomorph/endomorph thing now.
So far I've lost 10 lbs. I make sure to get plenty of protein and have to force myself to eat sometimes. I try to eat more early in the week when I do my hardest workouts. I'm still lifting the same amount. I haven't gone up, but I haven't gone down, which is great.
I workout 4x a week and also walk/hike 20-30 miles/week. I'm 6'1, 240 lbs, large frame. I've been on a diet basically my whole adult life, except for when I start a new job, in which I always gain weight because I don't want to be hangry and I put the job first. Then I spend the rest of the tenure at that job trying to lose it.
For years, I've had zero unhealthy food in the house, and my biggest cheat has been an occasional breakfast burrito, or a medium sandwich and some ice cream after a long walk. That's been enough to not gain weight, but not enough to lose any more than 5-10 lbs, which I gain back over the holidays every year.
Anyway that's just my story. I suspect I'm a pretty big outlier in the amount of exercise I get and the habits I already had. I have enough in my HSA to afford about a year. I'm hoping to lose a bunch, snap back the usual 10 lbs or so, then stabilize.
Sorry didn't read too much into it but are they testing the reduction specifically for alcohol addiction or was alcohol addiction measured from people currently taking it for weight-loss/diabetes?
I worry that it might result in a resumption of previous patterns of behavior, yet with an additional ferocity.
Regaining two thirds of the weight [1] and lasting behavioral changes [2].
[1] https://pubmed.ncbi.nlm.nih.gov/35441470/
[2] https://www.wsj.com/health/pharma/what-happened-after-i-stop...
I'm 42 as well and looking to get some sort of GLP-1 agonist as my A1C just popped up to 5.7 after being normal my entire life which is a huge warning sign for me. I've cut out processed carbs (all white bread, sugary snacks, etc) and junk food/fast food, and upped my walking to 4+ miles a day. I'm noticing "slimming" but not weight loss. We'll see what happens with my A1C, but I am excited to get a little help. I'd like to lose ~40 pounds over the next two years.
(“Well that‘s because people don’t stick to them…” yes, that would be the reason they’re ineffective, that exact thing happens in the vast majority of cases)
That leaves injections or transdermals, and weighing in at over 4000 daltons, good luck with the transdermal route.
Lobbying is less out-in-the-open than ever before, so only way you’ll find out is if their shadow-lobbyists become embroiled in some legal scandal that involves betraying the ones paying them, and you won’t know until five or more years after it happens.
There are legitimate criticisms to be made of GLP agonists, but this isn't one of them.
How about instead we fix the problem by making healthy foods and active lifestyles cheaper and more prevalent?
The only "fix" is to ban these foods, perform public executions of food company executives, institute mandatory kcal rationing, and bring back relentless fat shaming and discrimination.
Personally, I prefer not living in a totalitarian dictatorship, so GLP-1 agonists seem like a slightly more humane option to me.
Good luck with that.
Unhealthy habits and diets are popular (and delicious), and a lot of people resented even the minimal effort required to wear a mask during a pandemic of an airborne disease.
In this view obesity is more like a tragic compulsion resulting from things out of a fat person's control and not some kind of "put down the cheeseburger sometime" activity to willpower onesself out of.
EDITED: Hey, am I saying something wrong or irrelevant here? (sitting at -3, but I don't think I've been particularly inflammatory or offtopic)
Interesting.
Every person I have ever known with ADHD was skinny, at least compared to the people around them.
Not saying my anecdata counts for anything, but it's funny how this works.
Impulse control issues? Some comorbidity?
Forgetfulness? For myself, at least, forgetting to eat makes me hungry, and then I overeat because I'm clearly going to wither away to nothing in moments and I lack self control. I'd be (more) overweight if this was a constant thing.