Ozempic is changing people's skin, say plastic surgeons
allure.com
allure.com
Plastic surgeons are like the bank in casino: they always win in the end.
- it's just stretched skin
- people get on ozempic but are not eating nutritious diets, so now they are malnourished
> These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.
It would be interesting to see a study that compares people who take GLP-1 drugs and make no other modifications and others who lift heavy weights under supervision.
The other issue that should be studied is diet. If you eat a poor diet lacking in protein and then you take drugs to make you less hungry and now you just eat the same diet but less, you may not be getting nearly enough protein.
It would also be good to study the impacts of protein consumption while taking these drugs.
I also wonder about the velocity of weight loss. Losing weight too fast could also be part of the issue.
I assume you mean as a therapeutic/last resort treatment?
Exercise is often not good at helping people lose weight, but it is good at helping them lower their body fat and increase lean body mass.
You'd much rather someone be a muscular, overweight person than skinny-fat person. In particular, if you got someone lifting weights three times a week, it would have a noticeable impact on their body composition and overall health, regardless of weight.
The data also shows that exercise can lower appetite, but it has to be at least 300 minutes of vigorous exercise a week: https://www.nytimes.com/2020/12/09/well/move/to-lose-weight-...
> [aligned] with literature from the previous decade and recent systematic reviews concluding that participation in an exercise training program does favor weight loss, although of only modest magnitude. [1]
> Resistance training was the only exercise modality that failed to significantly decrease visceral adipose tissue. [1]
You suggest that "you'd much rather someone be a muscular, overweight person than skinny-fat person" -- but that's not really the case. Sheer fat mass, especially visceral adipose tissue, is what is associated with negative health consequences.
[edit] Even the article you linked to via the Times says the following.
> However, the amount of weight loss from exercise training is often disappointingly less than expected. [2]
Which aligns with their own findings that after 12 weeks of 3000kcal/week energy deficit they only lost about 5 pounds, see Table 2. So to lose 50 pounds you'd have to spend 2 years with a 3000kcal/week deficit, and keep adjusting periodically. The chances of compliance here are literally zero, and compliance is a major issue. In some senses, it's the major issue.
Also this study committed a major sin: they didn't follow up. Any study that shows anything meaningful in re: weight loss reverses after 6 months.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365736/
[2] https://journals.physiology.org/doi/full/10.1152/ajpregu.000...
Also 43 minutes of HIIT sounds like a nightmare. I do 30 minutes HIIT and I'm completely spent afterwards, there is no way to reach 43 minutes.
Also with 7 days/week of 43 minutes a day + weight lifting your body will be overtrained so injuries will kick in.
Obviously it's a bit different if you do ONLY vigorous training, but then you lose all the benefits of weight lifting and stretching.
The tricky part is there's all sorts of people that sell Retinol products but the amount of retinol is OTC. This isn't typically good enough, but you can go to your dermatologist to get a prescription strength that really works, and it's cheap.
It's an important side effect that ought to be researched.
> In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.
She had the unwrinkled face of a woman who had never been calorically challenged.
1. If other weight loss methods also have significant impacts on the skin, it seems plausible that a shared mechanism could be the most parsimonious explanation. Therefore, if this effect exists, it might be due to weight loss itself rather than specifically due to Ozempic. The article cites a study supporting the fact that dramatic weight loss has negative impacts on skin health.
2. GLP-1 agonists modify appetite, which could lead people to consume less satiating foods (e.g., protein). This might negatively affect both lean muscle and skin health. There is data supporting collagen supplementation for skin health, as collagen likely raises serum amino acids. This would have the opposite effect on skin health compared to a lower intake of protein.
3. The observations made by plastic surgeons might be influenced by healthy user bias. Ozempic is an expensive medication, and insurance coverage is generally granted to those who are already quite unhealthy. To make a fair comparison, these patients should be compared to individuals with similar health characteristics.
It's also worth adopting an engineering mindset and considering the trade-offs involved. For someone who is extremely metabolically unhealthy, the benefits of weight loss might outweigh potential negative effects on the skin in terms of long-term health.
Right, because 15 years ago nobody else lost any weight. GLP-1s and roux-en-Y are literally the only two treatments shown in clinical studies that cause people to lose weight and keep it off indefinitely.
Maybe the skin is saggy because there’s nothing under it, maybe not? But at least they won’t have a stroke, heart attack, cancer or type 2.
Chemo is going to make you look much worse.
The new category of patient is “person who successfully lost weight and kept it off without gastric bypass.”
[edit] if you think I’m exaggerating there’s a great study from 2023 that tracked how many people lost more than 5% body weight in a given year.
Answer: 1 in 10, skewing mostly to people who had more to lose.
If you were morbidly obese your probability of achieving a healthy weight is 1 in 1667 in a year.
And if you manage to thread that needle your average weight regain over 5 years is 80%.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
Total Diet Replacement (TDP) is apparently also quite effective. This isn't the article I read, but it's talking about the same trial(Direct) so here you go: https://tdmr-europe.com/2024/01/17/experts-demonstrate-total...
So now you might get free weight loss without making any effort at all, but you'll also look older in the process?
I have to say, my father has been taking it, and I noticed that he does look older all of a sudden...and his weight loss also plateaued. I thought it was just my imagination, but maybe not.
There are win-win tradeoffs. Vitamins, for instance. If you're running a vitamin deficiency, there isn't a downside to increasing your intake of that vitamin. (Curing acute dehydration via IV is another shortcut that just works.)
The Ozempic story, for me, has been more about how we almost seem to be reflexively against the idea of a win-win. A lot of people want there to be a tragic downside to the drug for reasons that aren't entirely clear to me.
It's well known that people treat fat people worse; I constantly wonder how aware people are of their own biases?
For what it's worth I've been fat before and I've been in shape before. I have my own biases that are beyond the scope of this comment. Never taken one of these drugs but only because of cost/access; I'm actually curious to experience them. If they work for people, I say they should take them.
As for exercise, it has many benefits but is a fairly minor contributor to weight loss. I am doing a bit of a hardcore diet at the moment (helped a ozempic competitor), lost 20kg/44lbs in 3 months, and I noticed no difference in change in weight whether I do 1h of exercise bike daily (max resistance) or whether I do a week without.
It's easy, substitute the obese with the smokers demographic. Imagine them whining that they smoke because it's an environmental issue, that they just can't do otherwise, that it's a metabolic issue and not a willpower one, a genetic thing, lack of access to alternatives... anything besides their own will.
I wonder how taking a medicine for the rest of your life is a win-win when there are places in the world where obesity is almost non existent and it's been proven to be largely lifestyle related. Besides, semaglutide just makes the subjects crave less, reinforcing the willpower role in weight loss.
I have read people in this forum state that if they eat less, they gain more weight for some unknown genetical issue, like thermodynamics do not apply to them.
But if there's a way to lose weight without major lifestyle change, it threatens that tidy moral barometer. Someone might look virtuous without actually being so. Cognitive dissonance ensues. So they hope and wish for anything to catch out and punish these "cheaters."
Because humans spent some hundred thousand years on earth with no fat human in sight, and only around 3-400 with the ultra obese. It's unnatural.
Cars, computers, and cellphones are unnatural. If you can get over those, you can get over recoiling in atavistic horror from people who don't meet your beauty standards.
They are not a part of, or the whole human body
You have to keep a clear head as an early adopter in some things, and be aware of incentives. Remember, the pharma company pushing the drug/treatment to market is out to make money first. Having a knock-on problem down the line to fix also serves that purpose, and in fact, has been a tactic employed by other notorious pharma manufacturers. Lest we forget the lessons of the opioid crisis do quickly.
Because apparently a surprising number of people can't calculate bodyweight doses.
We all look 10-15 years younger than we are (35-45s).
But we're also not dropping 150-200lbs or whatever number you're potentially referring to to where skin would stretch. But prolonged, constant rapid dropping hasn't bothered our skin. I'm complimented all the time on mine.
https://old.reddit.com/r/wrestling/comments/2r9nwy/whats_the...
As someone who is quite strong and fit, but has a family history of obesity, and who has been packing on the kilos into their 40s - I've recently started with ozempic and it's a breakthrough drug. The incessant never ending demand to eat, that voice which never goes away and pervades every part of the day and task, the call which is almost impossible to ignore ore even after months of dieting and managing macros - it got moderated down from a 10/10 volume to about a 2/10 volume. I've started dropping the gut fat, and 6 weeks in my energy is coming back up to levels it was at 10 years ago.
I'm hoping that this isnt a permanent solution, but that it permits me to reset my bodies relationship with food, insulin, fat accumulation and hunger signals in the long term as the signalling cells senesce, the fat is reduced and demands less maintenance, etc.
That's not an accurate statement. Over the past year I have averaged 2 hours of aerobics per day (~1500 active CAL). And I've simply buffeted my way eating multiple portions per day and haven't gained any weight.
It have a lot to do with a lot of exercises - it has little to do if you just had little exercise. It's all about the caloric balance, and it takes a lot of exercise to skew that balance while it's a lot easier to eat more.
This is just the latest [1][2] evidence for the obvious muscle wasting that will happen to a human body that is starved of protein and micronutrients. The muscles under the skin are being cannibalized for protein that’s missing in the diet and other biochemical processes that restore them are starved of the nutrients they need to function.
In my experience, it turned down the reward feedback for calorie dense food, and I would usually now prefer something like a lentil daal over a Dominos.
In my experience, the average American is looking at restaurants like McDonalds, Dominoes/PizzaHut, a local burger joint, and a "fancy" place like Olive Garden. They wouldn't be able to get something healthy like lentil daal if they wanted to, with the closest equivalent being a McDonald's salad.
or even more boringly: almost only bad things get called side effects rather than being redefined into the benefits
My father also had headache his whole working life on Sundays, not realizing that drinking coffee all week days but not on the weekend, that was probably coffee withdrawal that was giving him a headache by day 2.
[1]: https://journals.lww.com/tcmj/_layouts/15/oaks.journals/down...
"Caffeine — a major component of many varieties of coffee and tea — has been identified as a possible trigger for heartburn in some people. Caffeine may trigger GERD symptoms because it can relax the lower esophageal sphincter (LES)."
I don't get GERD from Mate tea or energy drinks. So I think it's not the caffeine. Since they both contain high amounts of caffeine, even higher than black tea.
I've noticed that if I eat more fiber I can somewhat mitigate this. But it needs to be consistent. Not just a little extra fiber before coffee.
BTW a high-fiber diet can be a natural ozempic by raising GLP-1 levels.
I don’t know from your comment what it is, and it was unhelpful. Not really in the HN spirit. For future readers, it seems to be an anti-diabetic drug or artificial hormone originating in the 70s. More educated comments than mine are very welcome.
Roughly 15 million Americans are on Ozempic, and about half of them do not use it at all for Diabetes treatment.
I swear in Europe if you stop 10 people on the street, 9 will ask you what the hell you are talking about
If you search for "diabetes" in the article, then yeah, you'll find it about half way down, but by then I already stopped reading because I had no idea what the whole article was about.
So yeah, it might technically be in the article, but it wouldn't have hurt to put it in the post title now, would it?
Ultimately this article is kind of a FUD nothing-burger. People's skin behaves the same anytime there is rapid weight loss.
> (“We see a similar pattern in other causes of rapid weight loss, including gastric bypass surgery, he says.) In some cases, the loss of subcutaneous fat is significant enough that it impacts a patients’ ability to get injectables ..
So which is it?
My takeaway was that losing weight fast == problematic.
The article dials up the FUD factor to the max, which makes me question the quality of reporting and any intent to accurately inform vs. just get clicks.
This is missing one option. The source - plastic surgeons - may be people that profit from liposuction treatment. To keep patients they might not want people to use ozempic, or at least get people to notice changes in the face faster and get a facelift.
> These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.
Nothing worse than losing weight but most of the weight loss was muscle mass.
Another issue that makes me wary is that normally when fasting, there’s an initial period of being hungry, followed by adaption and minimal/no hunger. After a few weeks (or longer if there are special circumstances), hunger should eventually return, and this is your signal to start eating again regardless of plans. What concerns me is that Ozempic may prevent the return of hunger signal. I could see this leading to malnutrition, which another post already mentioned in a different way.
"These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage."
Are you suggesting sections elsewhere in the article suggest otherwise?
That may be part of the cause, but it's also true that whenever you lose weight, you always lose some muscle. Even bodybuilders who are following the most aggressive protocol to minimize muscle loss (extremely high protein intake compared to other macros, along with intense strength training) will experience some amount of muscle loss along with fat loss when slimming down for competition.
> "We’re still waiting to find out," says Dr. Few. "I don't think anybody can tell you definitively that there's not an inherent change to the skin."