What Happens When Ozempic Takes over Your Town
bloomberg.com
bloomberg.com
Still, I think NNT < NNH all things considered.
https://getyarn.io/yarn-clip/dd4f2296-2186-45d6-b42a-10966b4...
2) Your "aside" there is the whole thing though. Obesity drives a lot of costs sure, but Obamacare legislation enshrined health insurance companies and pharmacy benefit managers as essentially government-backed money printing machines, so it's going to take tremendous effort to change any legislation, because they can and will spend literally billions of dollars to keep their monopolistic position.
If we spent half the money involved in this scam in removing added sugar from the grocery store shelves we'd beat that epidemic (don't believe me? Look at pictures of people living before the low-fat high carb poisoning in the 80s and 90s)
I firmly believe that, decades from now, we will look back in horror at what food manufacturers have done to us.
We already know that people on semaglutides buy less junk food because to them it is less addictive. Less demand, less supply. If anything, this seems like a useful way to smooth the transition to less unhealthy food supply.
https://www.bbc.com/future/article/20240521-what-happens-whe...
The same trend was seen after the 2021 trial, known as Step 1. After 68 weeks of semaglutide injections, the average patient lost more than 15% of their body weight, but within 12 months of treatment ending, patients regained two thirds of their prior weight loss on average. This was associated with a similar level of reversion to the patients' original baselines in some markers of their cardiometabolic health – a category which includes conditions such as diabetes and heart attacks.
Both Rubino and other experts around the world have seen similar patterns when administering GLP-1 drugs in their clinics. "There will be a small proportion of people, 10% maximum, that are able to maintain [all] the weight they've lost," says Alex Miras, a clinical professor of medicine at Ulster University.
It seems to me some people have a broken reward system and some... don't. Some people can live life without ever seeking out a vice, and some people are unable to live without a vice.
Probably, from an evolutionary perspective, this made sense. But when you have a surplus of addictive things like sugar, nicotine, and alcohol, combined with mass society-wide manipulation to indulge via advertisement... well this functionality of the human brain makes less sense.
GLP1s have also shown to help with drug and alcohol cravings so there's an entire other area to explore.
I could see where the government simply makes them available to most people.
You can go even cheaper and buy the peptide yourself from places like peptide sciences and compound it yourself, less than $100 for a 3 months supply, but you increase your risk profile pretty significantly going that route. My partner is a pharmacist and that type of mixing (assuming you do everything correctly) is considered acceptable for "immediate emergency use", not mix up and use for a month or three and keep it in the fridge in the meantime. It's a small risk to be sure, but non-sterile compounding at home is riskier than having a compounding pharmacy do it the right way.
Weight loss via caloric restriction inevitably results in losing lean muscle mass along with body fat.
That's why diet and exercise are paired -- diet loses the weight, and exercise helps to reduce the loss of muscle.
While there's nothing stopping people from pairing Ozempic with exercise to achieve a similar result, I doubt many are. Those ecstatic about the rapid weight loss achieved by these drugs may not be so happy if they were viewing their progress on something that measured their full body composition, rather than just their weight.
These are miracle drugs for people who are morbidly obese and suffering from severe weight-related problems. Those folks can use Ozempic to rapidly lose fat and muscle to get them out of their immediate crisis, and then work to rebuild as much of that lean muscle mass as they can later.
However, people who are just using Ozempic as an easier alternative to diet and exercise are not only taking away supply of this drug from people who really need it to deal with morbid obesity, they're setting themselves up for health problems later in life if enough of their muscle mass has degraded that they start struggling to do everyday activities. Unfortunately, by the time people reach this point, it's unlikely that they'll be able to do anything about other than resort to assistive technology like wheelchairs to regain their mobility.
https://newatlas.com/medical/drug-mimics-exercise-weight-los... ("Drug that mimics exercise triggers weight loss and builds lean muscle")
If you can build a system to stick to strength training, excellent, but many cannot. I struggle myself sticking to my strength training routine.
I struggle to just make myself take a daily 1 mile walk. It's not that I can't, it's just that my brain keeps telling me there are better things that I can be doing with my time. Bring on the bioengineering!
Clearly, the self-discipline approach just doesn't work. Not on a soceital scale.
Less people dying and people feeling healthier is a good thing. For everyone, you and I included. It also helps that Ozempic also reduce addiction to nicotine, alcohol, and potentially other drugs.
The human condition is complex and it's becoming obvious, to me, the human body and brain were never meant to exist in the kind of society we have. A society of food surplus, sedentary work, and high stressors. Yes, we will adapt - but tools to aid our survival along the way I think could be good.
Most of the data defending the economic harms of obesity are deeply flawed for various reasons, such as:
- Generally low-quality data
- Data that ignores external factors
- Data that doesn't account for behavioral issues like doctors ignoring or minimizing medical complaints made by obese people simply because they're obese
- Data that overemphasizes BMI, an extremely flawed health metric, etc.)
- The criteria for "obesity" itself having changed over the years (based on BMI, of course),
- and others.
There are definitely issues that obesity exacerbates in many people (mobility and cardiovascular), but the overarching purpose behind stats like the ones that you pointed out is to shame people who are (a) naturally hungrier than the average person with a "socially acceptable" frame, while (b) living in car-centric suburbs that discourage things like walking because (c) these suburbs are cheaper than living in cities that have somewhat-functional public transportation because they were created before the car was invented.
- Why BMI is flawed, from Nature: https://www.nature.com/articles/d41586-023-03143-x
- Everything You Know About Obesity is Wrong, from Huffington Post (the author co-runs a podcast on the topic): https://highline.huffingtonpost.com/articles/en/everything-y...
- Obesity was long considered a personal failing. Science shows it's not, from USA Today: https://www.usatoday.com/in-depth/news/health/2022/07/26/ame...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/
This is broadly confirmed across a number of studies, a study of European healthcare found lifetime spending increases too.
https://pubmed.ncbi.nlm.nih.gov/37222003/
What’s even worse is that from a financial sense, private insurance generally covers the deaths earlier in life, while ozempic (or any other anti-obesity drug) will push a lot more of that spending onto the federal Medicare budget in the long term.
Ozempic is apocalyptic for the Medicare and social security budgets, even if it were free (and Medicare doesn’t cover anyone who’s not a senior anyway). Any drug that broadly extents life would be - we would be equally affected by a free pill that gave everyone another 2 years of life, too. We budgeted based on X number of fat people paying in, but never receiving benefits (via life-expectancy actuarial tables), if you extend life then the payout increases.
- In the short term, the fitness industry (a multi-billion dollar market) and its dependents will crater,
- Smaller, European-like, serving sizes will become the norm, and
- You'll see more and much larger investments in de-alcoholifying beers, wines and spirits.
I do not think this class of drugs will accelerate the adoption of universal healthcare in the US.
For one, the healthcare industry employs a ton of people in towns like Bowling Green. (HCA, the biggest healthcare network in the US, is headquarted in Nashville, TN. Nashville is definitely bigger than Bowling Green, but people that lie in Murfreesboro and other small towns around Nashville work at HCA. Also, many insurance companies are headquartered in the Midwest, where jobs are relatively scant compared to the big coastal cities.) Any policy that ends with "and tens of thousands of jobs will be lost" is political suicide.
Also, the modern healthcare industry in the US was built and designed around private, employer-provided health insurance. Reverse-engineering decades-old business logic and institutional process to fit a government-provided system would be a gigantic and extremely expensive underatking that we would pay for (through taxes).
Quite the quote
- more trendiness of muscles/fitness
- plastic surgery (like the russian/housewives-of inflated lips)
People are lazy, I get it, but ozempic should provide the enabler for big people to get fit: it gets rid of a whole lot of fat that increases stresses on their joints. So you lose weight with ozempic, and then you could ... ideally ... start a good fitness program.
But we all know it will be used just for the pill popping convenience.
I believe Ozempic will probably lead to a lot of thin, but sarcopenic people.
Greasy, fatty, hyper processed foods are a quick trip to nausea-ville for me. The thought of a meatlovers pizza physically turns my stomach now. I am irrationally happy when my partner wants to go out to eat and we go somewhere that has grilled salmon on a salad. I'm not being driven by all the little fats and salts and cheeses they add to food to make it more additive, I can freely choose, and enjoy, healthier less processed options.
It's also crazy the portion sizes. Like I'm losing just under a pound a week, that should mean I have roughly a 400 calorie a day deficit (roughly 1.5 klondke bars). I routinely eat half of what's served in restaurants, or a third, and still have a minuscule deficit. Portion sizes in the US are just too damn big, and everyone expects them.
My partner has found it harder to eat large meals since I'm not eating large meals and he's lost weight too. It's been fantastic for both of us.
Hell yeah sounds good to me.
Just as an anecdote, I used to not understand how people got so fat. Just eat less lol? I’ve been a little light for my size pretty much my whole life, so I didn’t quite understand. In fact, if it were up to me I probably wouldn’t eat at all. So the concept of being overweight was foreign to me and I assumed that fat people must be lazy/weak/whatever. As I got older and a little more in tune with my body, I noticed what sugar cravings are really like. And my god, when that part of the brain complains, it gets front and center stage. I specifically remember trying hard to resist reaching for a soda for like an hour. I conceded and drank one. I couldn’t focus otherwise. Then I realized that there are people (typically easily spotted) that live every day of their life like this. And I get that the brain is hardwired for gluttony- I will literally never eat enough food in my life- so it’s a rather natural thing to want Calories. I’m lucky that I’ve got a passable relationship with food. I feel for those who struggle with it. I’m also glad that there is a stop-gap in drugs like ozempic that help effectively curtail eating, today. I’m also hopeful that the drugs of tomorrow will be even safer and more effective than we have now and that the systemic sources of obesity in society erode away. I think the future is only getting brighter (and lighter) for the millions struggling with their weight.
It's an hormonal imbalance, I 'fixed' it by fasting (you need access, time and money to do that in a controlled way, but you can also wing it. Careful, the second day is extremely painful). If you can fix it with medication and without torturing yourself (which the fast felt like), more power to everyone.
[edit] also you have a pretty empathic way of thinking.
This isn't really true. Or it doesn't have to be.
If you look at people with high muscle mass, you'll notice something. They eat a lot. Like... a lot.
Michael Phelps famously ate close to 10,000 calories a day. Now granted, he swam a lot. But did he burn 8,000 calories a day swimming and hitting the gym? No.
When you have more muscle, you burn more calories. Always, even when you sleep. So while a 20 minute run might only burn 150 calories... how many did you burn by running 20 minutes every day and building up leg muscles? Now it's harder to tell.
Personally I always used exercise, then you don't need to starve yourself, and you get all the benefits of hard exercise. But it's a discipline either, and hard for your typical weak-willed average first worlder.
First worlders have jobs and good economies as a consolation prize I guess.
Getting fit is a big psychological and lifestyle barrier, I agree. But, not having an excess 50-200 lbs sure helps if someone does try to start.
No I don't think you do.
We are dealing with a global crisis of obesity. We have a disease more prolific than ever before. There is something about the human brain that is wrong or imcompatible with the modern surplus of food. Something about our reward centers doesn't work. Not with modern society.
Addiction of this scale cannot be solved with individual actions. "Just stop" doesn't save an alcoholic, nor does it save a smoker. Fundamentally we need to rewrite how we view obesity.
We need solutions. Not more of this "try harder" fluff. Because it just doesn't work. If what you're saying is true, we wouldn't be in this mess. Obesity is more complex than we give it credit. It goes back to the food industry, health industry, advertisement. We can't just ignore everything and continue our "do nothing" approach.
This is not a discipline problem, this is a human problem. The solution MUST then target humans, not their actions. If that's a drug, for now, that's fine.
And there are examples like Iceland (this is secondhand from when Iceland made the World Cup, I don't have stats) where strongly enforced/encouraged sports participation leads to huge generational improvements in overall health.
Exercise has a 1 month hump. You need to stick to it for 1 month before it sticks and your body's endorphin rush + increased pain tolerance overcomes the initial discomfort/shock of exercise. One month is obviously a long way.
It does seem insurmountable to some degree based on decades of slow descent to the obesity valley that is America, but there are counterexamples in the world.
But we also have never had a government that REALLY embraced comprehensive fitness and health policies over a generational timespan, despite ample evidence it would improve productivity, reduce health care costs, increase mental health, improve quality of life, increase intelligence, improve cooperation / social interaction / culture, and probably increase fecundity and turn around the demographic declines of advanced first world economies.
That means extensive changes to schooling, heavily incentivizing the reconfiguration of urban centers for more human power transport, lots of facilities, probably a sea change of health care policy. There are huge and powerful lobbies that would probably kill those initiatives, from big corn syrup, big tobacco, big media, AMA, etc.
You're describing a societal solution. Not an individual one.
To be clear, you are agreeing with me. We need top-down big solution from the government and it needs to start in our schools.
The trouble is societal change is very slow. Very. For now, a drug will do. Because the alternative will take 80 or so years to take effect.
Nowadays the sky's the limit for how beautiful one can be.
This should not be surprising. Attraction is pretty hard-wired into humans by evolution, and for most of our existence, food has been scarce. There is absolutely no reason why a time of more plentiful food due to agriculture (relative to most of human history) would have resulted in changing the body types we generally prefer. To say nothing of evolution's timescales, which are measured in tens of thousands of generations for significant changes like that.
https://www.reddit.com/r/AskHistorians/comments/8044k7/is_it...
https://www.masseyeandear.org/news/press-releases/2024/07/pr...
Free lunch is good. We should strive for free lunch. You can actually make things better with no cost.
These days is feels like a good segment of the population is decidedly anti-solution. Doesn't matter what the solution is, they don't want it. They take a "do nothing and hope it works" approach to everything.
The "magic pill of health" aura that surrounds these new drugs is clearly opaque in terms of what the trade offs are, partly because its still way too early to know.
Back to my original post, there is some evidence of risk of going blind as a result from taking Ozempic et al. Might be worth the risk for some, even many. I'm fully in support of options and letting people make informed choices. Informed being the key word here. It will take time for things to shake out, I do hope there is a net positive since we are talking about millions of people after all.
Correlation does not imply causation. Especially this one.
"The researchers compared patients who had received prescriptions for semaglutide compared to those taking other diabetes or weight loss drugs. Then, they analyzed the rate of NAION diagnoses in the groups, which revealed the significant risk increases."
I don't interpret it at all as you do - if they're taking "other diabetes or weight loss drugs" they're clearly not part of the "healthy population".
Second week on Mounjaro and it's crazy how all my overeating triggers, hunger pangs and sugar cravings are just gone.
After a month of Wegovy, I was barely eating and not hungry. Have lost 35 lbs. so far after going just on the side of obesity due to complications of the only antidepressant I've ever found to pull me mostly out of otherwise treatment-resistant depression. Too often, people will casually blame others for not having "stronger self-control" when the motivations, opportunities, and compounding factors make it extremely difficult or impractical to resist. Even so, Medicare doesn't cover Wegovy or Zepbound, but will cover Ozempic and Mounjaro because it's all about discriminating against obesity.