Eli Lilly's weight loss drug slashes the risk of diabetes in long-term trial
cnbc.com
cnbc.com
> has it changed what foods are desirable
No, although anecdotally some people find they can't eat high-fat foods any more. It has changed my reaction to hyperpalatable foods though, in that I don't really get the buzzing "just smoked a cigarette" effect from them any more.
> when using these products and switching to a healthy diet such as high protein, which already typically affects satiety, does it cause the inability to eat an adequate amount of calories to function properly
Not if you don't ramp your dosage up too quickly, but if you were to overdo it, then I guess it would.
IANAD, but anecdotally it has been seen that a substantial - and arguably worrisome - amount of the weight loss is in lean body mass[0], so probably. GLP-1 agonists are for many obese and at-risk diabetics a worthwhile trade-off. Losing that last pesky 10 lbs. because you don't want to give up your daily 500 calorie latte? Probably not.
[0] https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.157...
So far as i know, the signal that glp1 agonists are particularly worse for lean mass retention isn't strong enough to claim that they're worse for muscle mass retention than normal dieting.
Or it could be compulsive behavior, which can be diagnosed and treated either with counseling or medication.
Some of the most obese people I knew had serious psychological wounds that they never healed.
Personally I end up feeling the opposite - I can eat the same weekday lunch for days in a row, and often get a sense of boredom of food before fullness.
I enjoy food, but I also enjoy lots of other things.. and not every bite/meal needs to be a work of culinary art. Italians would probably find this sacrilege.
For me there's a sense of food fitting a function during the week - nutrient/calories, versus going out to dinner on weekend for the social/enjoyment aspects.
But to be clear, 1 nectarine and 75g of blackberries is still a pleasure at about 100 calories
I found some sort of balance where I go 5 times/week to the gym, increased muscles and eat very healthy (fruit, legumes, chicken, veggies). It still didn't solve the problem of being always hungry.
I could say it's psychological, but my son, 3, is the same: he is constantly looking for food. My daughter (6) is like my wife and she sometimes barely eats.
I'd love to lose weight though. I have been going to the gym a lot for the whole year, but my weight dropped only temporarily.
It worked INCREDIBLY well. I started adding carbs back into my diet. My blood sugar stayed in good shape. I started loosing weight too. Before Ozempic and going 0-carbs I lost ~20lbs over 14 months. After taking Ozempic I have lost ~80lbs.
I still STRONGLY desire sugar/sugary foods. My cravings for bread is really bad too.
Ozempic controlled my sugar so well that I have been able to add carbs back into my life.
All his markers improved, even diabetic markers, and blood pressure. He's off the 3 meds he was on.
I’d bet your dad is my like father-in-law, any type of restrictive diet for 90 days would be helpful.
Gotta go with the tried and trusted med industry.
What diet did you really try? Keto diet is known to ~easily fix T2D. A good company that can do that is virtahealth.com.
The only way to quit drugs (sugar) is to no take drugs at all, not take less drugs.
Source: I do keto diet but for other reasons. I was addicted to carbs, but not fat, and am no more. I would end up as T2D in 10-20 years though. If I restart carbs I will get addicted again.
Its not simple obesity. Many obese have eating disorders.
For permanent adherence, only quitting works.
Yes, it was measured first thing, and yes it was the 'Dawn Effect'. At that time my diet was 100% protein/fat, 0 carbs.Source: Pretty well known in keto epilepsy/cancer/psychiatry. I do epilepsy keto diet. Having high protein will increase glucose & lower ketones (tested blood many times with just 2 ingridients beef & beef fat). I aim for 80%-90% of calories from fat. Or 2 to 1 weight ratio of fat and protein/carbs.
For T2D you probably need just 60% fat calories though.
These drugs fix symptoms only, and only for ad long as you keep using them. They have adverse effects, and probably well beyond the published ones. Most signs point to T2D being caused by insulin resistance, which builds up through bad diet and lifestyle. You can 'fix' symptoms by forcing the body to pump out more insulin, but science and common sense would indicate that this could end up worse off in the long run.
What is this claim based on?
To the best of my knowledge, glucagon releasing glucose (from glycogen) allows the liver to make glucose even if no carbs have been consumed.
>The accumulation of an excessive amount of body fat can cause type 2 diabetes, and the risk of type 2 diabetes increases linearly with an increase in body mass index. Accordingly, the worldwide increase in the prevalence of obesity has led to a concomitant increase in the prevalence of type 2 diabetes.
I'd love to see the math on how much the governement would save just handing this out for free to people vs. paying the lifetime of medical costs and burdens to the medicare system, etc. Seems this is $1000 a month without insurance now, I wonder how low it needs to go to be cost effective? It's really expensive to be obese, have diabetes, cancer, heart disease...
From the insurance companies' perspective, what's really expensive is living too long, rather than dying early. My family has gold-plated health insurance by most standards, but it doesn't cover Ozempic.
You'd think they would hand out Ozempic like candy, but evidently they're afraid it will work too well.
We actually have the miracle “weight-loss pill” we’ve always dreamed of.
I get it, not actually a pill, but the point is there appears to be a straightforward way to attain a healthy weight that will work for a large proportion of people.
Some possible drawbacks…
affordability - if it’s $1K/mo, it’s actually not feasible for a large proportion of people.
maintaining - seems like you probably have to keep taking the drug forever to maintain the benefit. That is, if you stop, the weight comes back.
negative long-term consequences? - It’s great to hear about the positive consequences of this, but since it appears you have to take the drug long-term, what are the negative consequences to doing so?
Personally, I’m a couple months into a diet to get to a healthy weight (a light-weight form of calorie counting). It’s working (yay), but if I don’t do it just right I end up hungry for significant periods of time. That’s miserable, and if it happens too much I probably can’t maintain the diet.
A miracle weight-loss drug sure is looking attractive right now.
Have you read the drug label?
I actually just picked up my first dose today and I’m still not sure if I want to take it.
The GLP drugs very commonly cause GI issues. It isn’t clear yet if those effects can be permanent but they do remain at least for a while after stopping treatment.
[0] https://www.northernpublicradio.org/2024-08-19/ozempic-takes...
I saw in this thread that it reduces cravings to fatty food which is bad news.
My speculation is that it's a gut biota change driving the change in cravings, but I'm not sure there's much research on the mechanisms involved yet, since these drugs are very new, comparatively. A very small study apparently suggested it ameliorated some of the numbness to intense flavors that the obese have been shown to have in previous studies, so maybe I'm completely off base.
Of course, it is up to the user to 1) exercise and 2) eat healthy.
Again, we're trying to fix the symptom instead of dealing with the root cause -- because we don't want to give up our Mountain Dew and Frito Lay.
it gets harder and hard to constantly make good choices as you go down the income ladder not just due to the food environment but also because people on the whole just cognitively cannot make these decisions optimally all the time when they are tired, stressed, and overworked.
But it’s a problem of our own making because of large foodstuff corporations that force addictive garbage on everyone (through limited availability and high cost of healthy alternatives and the fact that junk food is literally everywhere and many times the only option). It’s a disaster and yet it’s hardly talked about — instead we look to drugs (which can make $$$) to fix the symptom.
To say nothing of, as the other poster said, how much time+money it can be to avoid, particularly when you've not got much spare income, so the difference might mean not having to skip a meal this week to afford your medication, even if it might be lead-filled or the equivalent that'll harm you over time (and not just directly, in money saved - making your own rounded meals costs a bunch of time, and sometimes upfront costs, and if you're that low on resources, you might not have that time to spare.)
I would agree the correct way to mitigate this is to do things like ban HFCS, among other things, and start aggressively researching the harms of anything remotely sweetener or addictive behavior-forming in foods, because if you remove the thing that triggers an excessive "MORE" response in some people, you better believe you're starting whack-a-mole with food companies finding other addictives that secretly cause your toes to fall off in 20 years but taste 5000x as sweet, or something.
Agreed. In today's world it's easier to stop smoking because cigarettes are not everywhere like they used to be, whereas it's hard to escape junk/highly processed food. It's like being an alcoholic when every vending machine and store sells your favorite whisky.
And that's why a social change is needed to stop pushing this garbage on everyone, starting when they are kids.
Nonetheless, there's a lot of low hanging fruit in terms of cutting out the very worse offenders (soda, high sugar foods, chips, snacks, etc.) and substituting with healthier alternatives, without having to do some crazy diet or skipping meals.
My biggest worry is for the next generation--when you grow up on garbage, it's hard to break that craving. (In our house we have a zero soda policy, and very little high carb and high sugar processed foods, but we always make sure to have fresh fruit and dried fruit and nuts readily available so the kids can grab that for a snack. But it's more expensive to do that and we have to forego other expenses, and sadly it's not something that's accessible to many Americans--and __that__ is where we need to see change.)
Diet has psychological, social, evolutionary, physiological, hormonal, economic, aspects (and more). Not only does that make it difficult to eat on a rational basis, people don’t even seem to be able to think or talk about diet rationally.
I think if you examine your comment, you’ll probably be able to spot some rather unlikely explicit and implicit assumptions, which will lead you to reconsider. I say this under the presumption you want to be a help (because if you don’t, no one gives a fuck what you have to say).
You want to think about causes that could actually explain the problem so that you can think of solutions that could actually work.
IMO, “eat better” is a good place to start, but the “how” is completely missing (not to mention, avoiding chips and pop is barely getting started with good eating). I think you need to think a little deeper about this.
which part do you think should be reconsidered?
In the US -- much more so than the rest of the world (though it's catching up elsewhere too) -- we are besieged by addictive garbage food everywhere. It's like cigarettes 60-70 years ago. Just one example, you used to be able to get cigarettes in hospitals, and today's equivalent is that hospitals are stocked with soda and other junk food (even in places like the NIH hospital, which I visit periodically; I was just shocked the first time I saw that, of all places where I would expect them to only or mostly have healthy alternatives. Same thing at my wife's nursing school; she was distressed at how only about 10% of the readily available snack offerings could be considered healthy. And if doctors and nurses don't have a healthy lifestyle they're unlikely to effectively help patients to.)
So yes, it is extremely difficult to eat healthy in the US, and it requires both discipline and money, which is tragic because low income people are impacted the most and have the hardest time even gaining access -- much less being able to afford -- anything other than high-calorie, low-nutrient food that the local 7-Eleven-equivalent is stocked full of.
> You want to think about causes that could actually explain the problem so that you can think of solutions that could actually work.
The problem is that our food distribution and availability is controlled by a small number of very large corporations whose primary concern is profits, at the expense of people's health (and the taxpayer's money in paying for rising health care costs, including weight loss drugs). The solution is similar to our approach to smoking -- regulations that made it harder for people to get addicted to smoking in the first place. But mostly, class action lawsuits.
> avoiding chips and pop is barely getting started with good eating
True, but when you see how many people walk out of Costco/Walmart with a shopping cart full of chips and soda, you realize pretty quickly that there is a lot of low hanging fruit when it comes to addressing the problem.
> I think you need to think a little deeper about this.
I have spent a lot of time thinking about this problem. What makes me so upset is that there seems to be very little thought given to this problem in the US -- other than looking for silver bullet, and coincidentally, highly profitable, drugs, instead of concerted efforts to combat what is a serious an ongoing nationwide health crisis, and one that affects the US much more than other countries (US obesity level is 2x UK and 4x France). I have yet to see any serious debate at the national level, by either party, to even begin to address the problem.
But it's like saying, "here's an (expensive) pill that can help you stop smoking, but we're going to continue pushing you to buy cigarettes with every vending machine you pass and with every ad you see". Instead of removing cigarettes from all the vending machines, making them harder to get, and taxing them so they're more expensive and a new generation is less likely to get hooked on them.
The food system is fundamentally broken, but there's no incentive to fix it because that would mean a loss of corporate profits.
* Yes, I get that this is supposedly a preventive study - but if your metric for diabetes is blood glucose level, and you take a drug that lowers blood glucose level, it's not surprising that people on it are found to "fail" to reach the given threshold for diabetes on average
These drugs are chemically induced intermittent fasting.
I’m okay with people saying “these drugs force people into healthy eating habits” but the weight loss itself is merely a symptom of the healthy eating habits that would be healthier on the body when done with discipline rather than chemically altering your digestion.
I have, and do, suffer from lack of discipline in facets of my own life.
I just want to be honest about these drugs.
I suppose that the drug also cures people with Parkinson's [0] through ... Discipline, right?
0: GLP-1 Receptor Agonists: A New Treatment in Parkinson’s Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11011817/
Is there a better word that I can use in the future to ensure that my message is one of support free from misinformation?
I feel your link and the other studies showing it helps people with various other addictions is evidence against the drug being a “fat melter”.
1. Ignore the continual and catastrophic failure of the idea that we can will ourselves out of an increasing crisis
2. Pat themselves on the back for their smug victim blaming
Hence the negative reaction. I don’t have an alternative word for you to use.
Humans at a population level have severe limits on what they can deal with. This is why tech companies use dark patterns, because exploiting and abusing people until they can’t put up resistance works fantastically. Suggesting that the real solution to mass exploitation is just to have the discipline to not be exploited would and should receive a negative reaction.
Ultimately, the solution to obesity is to make the fix as easy to obtain as the primary causes of the problem. Can’t wait for a gambling and (working) smoking vaccine.
Yes
> These drugs are chemically induced intermittent fasting.
No, they're a type of calorie restriction, as is intermittent fasting.
This just seems painfully pedantic.
> Intermittent fasting is any of various meal timing schedules that cycle between voluntary fasting (or reduced calorie intake) and non-fasting over a given period.[1][2] Methods of intermittent fasting include alternate-day fasting,[3] periodic fasting, such as the 5:2 diet, and daily time-restricted eating.[1][4]
Treatments that are "one (or N) & done" tend to be surgical procedures which physical change your body or vaccines which train your immune system (which has a sort of viral memory bank).
Most other regular drug treatments are introducing chemicals into the body which your body consumes/breaks down/etc. The body is always self repairing, replacing cells, etc.
As a layperson, I conceptualize altering brain chemistry via a drug is a temporary thing the way adjusting your pools chemistry is. You have to constantly replenish with new chemicals as everything is constantly breaking down and changing.
Weight lose drugs are just a shortcut for something that is possibly for the vast majority of people without any drugs. Don't get me wrong, they seem great! But a drug that can help with seizures, nerve pain, alcoholism and anxiety sounds a little more "wondery" to me.
I think pretty much anyone can find 5-6 hours in a week to go train something, it's really not much time at all.
If that were true about the human condition in the same way that it’s true for conservation of mass, we wouldn't be living longer and healthier lives than our forebears. Yet here we are.
Of course we should be aware of side-effects. But there’s no law of nature that says there have to be any serious ones.
Take out infectious disease, post-partum maternal deaths, no sanitation, and obvious lifestyle choices like smoking, and are we really living healthier lives than prior generations? I'm not so convinced.
Now I'll take our modern scientific advances over not having them. Give me modern sanitation, surgery, antibiotics, and vaccines for sure. But I'm not sure I'd call the way many American elders around me are living in their 70s to be healthy lives. Many lack mobility, are obese, are on a fistful of prescription drugs daily, and have constant pain. Except for the ones that ate well and in moderation, didn't drink much, and exercised their entire lives.
I just hope people take these GPL-1 drugs but also get their bodies moving (particularly strength training).
I think we need a huge investment in physical therapy. Everyone who is obese and working to reduce their weight and increases their activity needs PT, and we need PT specialists who know how to work with heavy people. I know a lot of fat people (including myself) who get injured and discouraged trying to follow workout advice intended for people in substantially better physical condition, and also a lot who have had trouble finding trainers or physical therapists who know how to work with them.
And also totally agree that we need to invest in PT and educating PTs on how to work with people in larger bodies. As a formerly unhealthy person who only found exercise in their 30s, it's ridiculous to me that my high school gym requirements didn't teach me how to safely lift weights or use a gym. They would just let us use a barbell without any proper training, and the first time I tried to bench press with some friends (because we probably saw someone in a movie doing it) I injured myself. Every high school student should be learning how to use a gym, get through a yoga class, learn some calisthenics, etc. Set them up for their life so it's not so intimidating as an adult. Instead, at least for me in the 90s, it was a lot of playing basketball and baseball, nothing to keep me healthy on my own in my life.
Not saying it’s easy, and no it isn’t as simple as calories in, calories out, but it is close to that simple. Working out, running, weightlifting, all that can happen later. Eating “right” and just walking a lot can induce a lot of positives.
I'm always around 12-13% body fat, but to get them to show, absolutely, it's all diet. I'm vegetarian, so that probably works against me, but I've never had that 8% body fat ripped look even with all the activity I do in a week.
Those things you list are the bits which made our lives healthier. Just because you can list them doesn't mean they didn't happen.
John Adams: 90
Samuel Adams: 81
Benjamin Franklin: 84
This is medicine, not witchcraft.
I've also read anecdotal reports of skin burning sensations from people that take it.
If people can take it to lose weight and curb food addiction while also beginning strength training for long term health, I think that's a positive.
Obese people are also at much greater risk for diabetes, heart failure, kidney failure, liver failure, depression, anxiety and suicide.
If a drug can add 20 years to my lifespan, I'll take it and worry about long-term side effects later.
Because without the drug, there's a good chance I'd die from something else before reaching the long term.
The bigger problem is frankly the reaction you display, that even if the side effects were actually zero that people feel that’s “unfair” and that others shouldn’t be taking a pill to do something their personal body chemistry doesn’t do properly.
Your thyroid medication is really a moral failing, you see. Just eat less and your weight will remain healthy.
https://en.m.wikipedia.org/wiki/Tirzepatide#/media/File%3ATi...
This seems to work very similar to Ozempic?
Yes, both drugs are Glucagon-like peptide-1 (GLP-1) receptor agonists.
https://www.genesislifestylemedicine.com/blog/the-science-be...
Will insurance costs come down if the US becomes healthier?
Health insurance prices in US are not related to demand, but to how much the market can bear. It may even go the other way, if drug companies decide to increase prices to make up for reduced demand ("we still need to recoup our drug R&D costs, so fewer sales means higher prices").
Edit: note that the weight loss drugs may not decrease healthcare spend. For example, if it leads to more people living longer and utilizing other more expensive healthcare such as dialysis or cancer treatments, then the net effect will be an increase. For example, 25% of all Medicare spend is just for dialysis or kidney related issues.
https://www.kidney.org/sites/default/files/fy2023_kidney_dis...
I know diabetes is up there, but I was also under the impression that cancer and cancer-adjacent issues were a much larger burden on the system than CVD or end-of-life care (or aging related problems like arthritis or dementia). Could be wrong though - I'd love to see numbers and statistics.
>Will insurance costs come down if the US becomes healthier?
No. Insurers are public companies and need to increase profits every quarter. Lowering costs harms this ability tremendously.
And selling their insurance at higher prices than their competitors harms their ability to sell their insurance to customers. Hopefully, you or your employer are shopping around, and not just for health insurance.
My rates are absurdly high, and I get effectively zero coverage. None of the plans I could chose from were all that different.
They literally have to get their prices approved by the state government regulator. To suggest they are colluding to ratchet up the amount of money they spend on healthcare is unsubstantiated conspiracy theory.
It’s actually funny, because at the same time, there are complaints of insurance denying coverage and requiring prior authorizations. So which is it? Insurance companies inflating healthcare spend to increase their profit, or denying coverage to reduce healthcare spend to increase profit?
Your premiums are high because the ACA mandates your premiums pay for healthcare that older and sicker people get. A huge portion is effectively a tax, from young and healthy to old and sick.
>Hard to shop around as an individual who doesn't work for a large corporation.
That must be because you are in a low population state, or a state where the regulators make it difficult for companies to compete. For example, New Jersey has many options for an individual to choose from:
https://www.nj.gov/dobi/division_insurance/ihcseh/ihcrates20...
Just as a caveat to this, UnitedHealth Group posted a FY'23 (according to their FY2023 investor report) profit of 22.4 billion USD. Profit, not revenue. Now, that's about a 6% margin (FY'23 net rev was 371.6 billion), so you're right about single digit profit margins, but the sheer scale of UHG is insane. They have plenty of room to reduce profits, and shouldn't be held to the same rules that non-essential service providers are held to.
They can, and absolutely should reduce the costs they pass along to end-users, especially those who are healthy and don't make claims.
>They literally have to get their prices approved by the state government regulator. To suggest they are colluding to ratchet up the amount of money they spend on healthcare is unsubstantiated conspiracy theory.
Those same regulators are just as susceptible to bribes, kickbacks, "lobbying" and other favors as any other politician.
>It’s actually funny, because at the same time, there are complaints of insurance denying coverage and requiring prior authorizations. So which is it? Insurance companies inflating healthcare spend to increase their profit, or denying coverage to reduce healthcare spend to increase profit?
It's both.
>That must be because you are in a low population state, or a state where the regulators make it difficult for companies to compete. For example, New Jersey has many options for an individual to choose from:
I don't live in a low population state. I live in one of the 3 most populated states. My rates are still sky high, which is odd considering I: don't consume alcohol, exercise religiously, eat cleanly, don't have a family history of any major diseases or illnesses, don't have preexisting conditions, am under 35, don't take any medication, and most importantly, haven't made a claim against my insurance in over a decade - the last time I have had any medical procedure of any major sort was an X-ray when I broke my wrist as an undergrad in college, and I paid cash for that. So, why are my rates still over $250 a month? I'm self-employed running a small startup with myself and a sibling as the only employees. While I made good money in a previous job, $250 a month for basically nothing is a sinkhole that I would like to avoid, $3k a year isn't much in the grand scheme of things, but it's $3k I could use to pay rent, invest into my company, invest into the markets, or just use to live my life. It's a waste.
> So, why are my rates still over $250 a month?
> don't consume alcohol, exercise religiously, eat cleanly, don't have a family history of any major diseases or illnesses, don't have preexisting conditions, am under 35, don't take any medication, and most importantly, haven't made a claim against my insurance in over a decade
The Affordable Care Act requires insurance companies to ignore all of that, and underwrite only based on tobacco use status and age. Even the age is not fully underwritten as the max premium has to be only 3x the least premium (see age rating factor). This explicitly makes insurance premiums a tax.
> They have plenty of room to reduce profits
No, they don’t. UNH has 6% profit margins because they have a huge healthcare provider component, and healthcare itself is high margin. The insurance business is 2% profit margin. See Elevance, CVS, Cigna, Humana, Molina, and Centene profit margins. All at 2%.
> It's both.
Sorry, but that makes no sense.
By the way, government leaders and asset rich wealthy people love the fact that you blame insurance companies. They got way with implementing a huge tax on the young and working people, and evade blame. That’s not even the only one, see lack Medicare tax on capital gains, and the egregious Additional Medicare Tax.
The productivity of today’s working youth is being transferred to old and sick people in greater and greater amounts, dictated by legislators in Congress, elected by active old voters, not the bosses at insurance companies.
Long term, I don't think this will necessarily decrease healthcare costs or the burden on the system. Ignoring the cost of the drugs, people not having diabetes means they're going to live longer and develop all the complex conditions that come with getting to be 75+.
But I do clearly have an eating issue, was wondering if I can use this to help control it... also what happens when people come off it..?
(My brother was in a similar situation as you. BMI out-of-control his whole life, really. No real health problems, though he felt it was just a matter of time. Tried all the things — and remains a very avid walker — but could not reduce his weight substantially until Ozempic. He’s looking good now, quality of life is higher, and I’ve got to believe he’ll live longer.)
Seems like diabetes is strongly correlated to your weight.
If this pill suppresses hungry, causing you to lose weight, have healthier teeth because you're eating less, and since you lost weight - less likely to get diabetes ... what's Correlation vs Causation here?
If you stop taking it you get fat again, that is what I have seen at least, but not with this drug in particular.