It's not just obesity. Drugs like Ozempic will change the world
economist.com
economist.com
> Another early pharmacologic approach to alcoholism treatment used psychostimulants to create a feeling of well-being and obviate the euphoric effects of alcohol. Bloomberg (1939) administered amphetamine to 21 alcoholic patients, who became more alert and energetic and reported no desire to drink (see also Bowman and Jellinek, 1941). Reifenstein and Davidoff (1940) found that amphetamine was of benefit in cases of acute alcohol intoxication and recommended it to treat depression in institutionalized alcoholics (see also Bowman and Jellinek, 1941).
Of course, I'm interested, but I will let medical science do the damage first before I elect to dive in.
[1] https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2007....
How can some engineered drug be a solution to a life choice problem? Typical human behavior to look for easy "solutions" that don't actually solve anything, just delay or temporarily mitigate a problem.
If I want to move cars across a body of water then engineering is a great approach. Why would it not also be a great approach if I want to change my eating habits?
Not this simple.
Choice isn't binary, it's incredibly complex. There're millions of individual little effects that go into each and every one of your choices. You actually have no idea how much influences you have over your "choices". In fact, almost everything you do in life is completely out of your control - you just do it, it's habit. Is brushing my teeth a choice? Certainly, I do it, but I also don't make that choice ever, it just happens.
Why is it that some can drink every week and be fine, but some can't ever drink because they are alcoholics? Why is it that I am able to eat as much as I want, and I'm not fat?
You could just be lucky enough that you do not have a propensity to overeat. Neither do I. But be humble, have some humility. You and I are privileged. I did nothing to earn this. I eat what I want, when I want. It's merely a coincidence the what and when happens to not harm me.
I don’t agree that you’re not allowed to be proud of the condition you spend those moments in.
I would rather be proud of my achievements. I suppose if you don't have those, you might settle on pride in something more superficial.
I would say almost every single obese person doesn't want to be obese. And every single alcoholic doesn't want to be an alcoholic.
What you're suggesting might work FOR YOU. That doesn't mean it's a solution. Look around you, is it working? No, right? Why then do you insist you're correct when every piece of evidence on this planet proves you wrong?
I go to the gym extensively, and yet I struggle to just maintain my weight
I eat very healthy, I just eat too much.
The hunger suppression is real and what's intersting that this is the first time I've felt that I'm "not in control of my thoughts". Of course it's my own decision to take the drug is not about that. But I'm not hungry anymore, I don't binge eat anymore, and I generally don't enjoy food as before. Like even if I have my favorite foods it's just an OK experience. It's like I'm eating because I know I need energy to live but otherwise it's totally gone as the "main focus" from my daily life (which was my main eating disorder)
What do you mean?
I found it remarkable that almost immediately after taking the drug it began to work.
And by work I mean that it removed any thoughts I had about eating.
What you feel like eating isn’t a thought or conversation with yourself that you have any more.
It’s a rather strange feeling, but also one you don’t notice as it’s an absence of something that you don’t even miss once it’s gone!
LOL - seeing as this is HN, I’ll make a joke and go as far to say that these drugs are a productivity unlock hack!
Why waste time eating when you could be building the next unicorn!
I cherish every meal I have and everything tastes amazing to me, since I only eat to hunger. Food can’t get better to me than the stuff I eat every day, so I don’t go out or spend money on fancy food. I just eat what keeps me healthy.
I’m not sure if it’s a good or bad thing that people are now able to join this camp without destroying their relationship with food through questionable activities.
My theory is that something goes haywire in the body and causes many issues. Obesity being the most visible of these but far from the only issue.
GLP-1 agonists reverse this thing that went haywire and fix many issues
https://www.medicalnewstoday.com/articles/weight-loss-drugs-...
That article is all just correlation. Which cause is more likely?
If a drug can cure an out-of-control appetite, can it cure chemical addictions? Compulsive gambling? None of these are beautiful emotions.
https://news.unchealthcare.org/2023/12/use-of-glp-1-receptor...
I smoked. The desire to have a cig was debilitating. And I didn't want it, I never wanted it. But the sheer desire would bring me to my knees.
Perhaps, but it's also the source of suffering.
I like food, don't get me wrong, but being constantly hungry is very annoying
Surely it's not that simple.
They're more cautious now when it comes to pregnancy related drugs. As someone who was not born with flippers instead of hands, I'm pretty happy about that.
BZZT! Wrong.
Thalidomide had _never_ been approved in the USA for the morning sickness, thanks to the FDA. The only pregnant people receiving it were getting experimental pre-approval samples (now illegal) and during the clinical trials. See, for example: https://www.reuters.com/article/fact-check/fda-did-not-appro...
It was used, and marketed, for morning sickness primarily in other countries (Germany in particular). It's an important distinction, because the US FDA actually stopped it's approval in the US. It seems that "only" about 20,000 American study participants were given the drug at that time. So more than half of the dead/deformed babies came from Germany.
Had the German equivalent of the FDA prevented the drug from going to market many babies might not have been born with deformities.
There are VERY good reasons to be slow in approving drugs that might impact a fetus.
That's not true. I started on liraglutide, which is a previous-gen GLP-1 agonist. It was approved for that purpose in early 2010-s. It worked, but it required daily injections due to its short half-life. It also was unpleasant, as you could feel its effects wax and wane throughout the day.
Ozempic was approved for diabetes in 2018, but became available in sufficient quantities for that purpose in 2019. Doctors started prescribing it off-label for weight loss in 2020 (that's when I also got switched to it), and it was approved by the FDA for weight-loss in mid-2021.
So while we could have moved faster, it's not like there were decades of time lost.
EDIT - Just wanted to note that the cancer thing has only been seen in rats. Not humans. After 20 years we'd probably have seen it by now.
Somebody very near and dear to me was diagnosed with thyroid cancer ten years ago, and now has no thyroid. She's hardly inconvenienced by it & hasn't even gained any weight since then. Just gotta remember to take those T4 tablets in the morning, is all.
Point is: If you weigh in the balance [lives saved or QALY gained due to GLP agonist administration] vs. [lives lost or QALY lost due to thyroid cancer secondary to GLP agonist administration], it's not even going to be remotely close. "Lives saved" will probably win by an enormous margin, maybe a factor of twenty or so.
If GLP-1 inhibitors get people screened for thyroid cancers more frequently, or lead to improved treatments for thyroid cancer, they will almost certainly lead to a reduction in thyroid cancer deaths -- even if, as some surmise, they are responsible for an increase in thyroid cancer cases. Even without this effect, if you balance [QALY lost] versus [QALY gained] GLP-1 agonists should come out so far ahead that it's almost laughable.
In any case, I believe it is wise to talk about these things openly and without fear.
> agonist
nit: these are not the same
Also, not all thyroid cancers are created equally (like papillary vs medullary), not every one taking GLP-1 RAs are morbidly obese, etc.
> Also, not all thyroid cancers are created equally (like papillary vs medullary)
Granted, but how is this relevant? I've heard that those drugs may -- this is still, as yet, uncertain -- increase the likelihood of follicular thyroid cancer, which is a very weak type. I have not heard that they increase one's likelihood of coming down with the anaplastic variant. (The only truly deadly one, but quite rare.) If caught early enough, papillary, follicular, and medullary are all easily treatable and indeed curable.
> not every one taking GLP-1 RAs are morbidly obese
Again, sure, but how is it relevant?
For instance, my impression is that lung cancer rates only really become strongly pronounced — in the sense of being statistically detectable in the small population sizes you find in clinical studies, rather than the entire US population — after like 15 years of smoking. (Correct me if I’m wrong.)
It is common to see this repeated, but there is some literature that correlates thyroid cancer in humans with usage of GLP-1 agonists.
One example (2023): https://pubmed.ncbi.nlm.nih.gov/36356111/
I suppose it helps to emphasize that there are trade offs with all drugs, and that you'll need to work with your doctor to adapt a program suited to your own risk tolerance.
We go through this every 10 years or so, for at least the last 100 years. The market doesn't really have the patience to wait to see the aggregate or long-term effects of new "pop culture" drugs and formulations so we just charge ahead and then let another generation deal with whatever mess. When the pharmaceutical companies really luck out, the cleanup can even come through yet another such wonder drug.
0: https://mediaproxy.salon.com/width/1200/https://media.salon....
Or the boom of compounded tinctures at the turn of the century, but again, that's kind of a cheat, because it becomes the impetus for modern regulation and was full of all kinds of wild crap.
But once we have regulation, we get the wartime boom of amphetamines and stimulants for energy and weight-loss; the mid-century boom of early barbiturates, tranquilizers, and sleeping pills; another boom of new stimulants and weight-loss drugs in the eighties, along with a boom of anabolic steroids; another boom of anti-anxiety drugs in the benzodiazepem class, as well as new anti-depressants; then a boom of opioid painkillers with purportedly "abuse preventing" formulations; etc
Each of these booms was absurdly popular during its heyday, generating tremendous amounts of revenue and reaching into countless homes, variously disturbing both physical health and familial/emotional security in significant ways, and then was turned against because of all the secondary effects that they brought with them.
In many cases, these secondary effects were noted early on but simply held in denial because of how freaking much people wanted to feel more energized or calmer or more rested or thinner or whatever in a world that seemed to be putting impossible demands on them. In other cases, people just didn't know where to look for the secondary effects and so they weren't anticipated.
In either case, the drugs always looked really rosy to the public and generally delivered on their prima facie promises.
Socially, these drugs are fitting an almost identical profile. Medically, maybe they'll finally prove to be the exception. We'll have to see.
This is all to say, because of the current state of health norms (at least in the US), it just has to not do too much damage long term and the pro's can still outweigh the con's of its use.
[0] https://injuryfacts.nsc.org/all-injuries/deaths-by-demograph...
Compared to the long-term effects of obesity, Alzheimers, and addiction? Everything treatable by Ozempic, et al. has immediate short-term effects, and long term effect that significantly effect longevity.
The fearmongering around Ozempic not knowing the long-term effects would have to be is unnessicary. Yes, it sucks to have to be stuck taking a medication for the rest of your life, but would you rather be stuck with a delibitating disease and die 10 years early, or have to take a medication for the rest of your life?
I'd rather have a cure for that disease instead of lifelong medication. While not nearly as profitable it is far preferable over a lifelong dependency.
And there is no shortage of moralizing and FUD about these drugs. Just read this comment thread.
EDIT: I do not mean to say Ozempic is useless or dangerous, only that celebrating it as a solution to the problem of obesity is. It is certainly a tool that helps people. I don't think it should be relied on continously. People need to live healthy lives to be healthy. I am not perfect, no one is. Losing weight is hard.
Easier said than done. However for the vast majority of the people taking these drugs, these drugs enable them to finally do that.
We live in a world of enormous abundance, exacerbated by companies min-maxing foods to have the most addictive properties humanly possible, at cheap prices.
EDIT: obsession -> neuroticism
The scales of the two problems are not even remotely comparable.
[0]: https://obesity.procon.org/us-obesity-levels-by-state/ and https://stateofchildhoodobesity.org/data-by-policy/
Obesity has been linked to a huge number of health harms and they've been known for decades.
[1]: https://www.who.int/news-room/questions-and-answers/item/obe... and https://www.niddk.nih.gov/health-information/weight-manageme...
I think you may be right that there's room for nuance about obesity, especially moralization about it, but you simply cannot deny that it's a huge problem in the US
Of course not. I just don't like how most conversations about health get subsumed into the much less productive conversation about how destructive obesity is.
The reality is, to me, obesity is born of addiction. Which is why ozempic is exciting. Because it's not a solution that relies on moralizing or fatphobia or shaming.
Their lifestyle changes to be healthier by eating less, which many are unable to do without help because the human body has millions of years of baked in evolution demanding we overeat if able
EDIT: celebrating Ozempic as a simple solution to obesity is literally what I'm referencing my Dad doing
Many people make different choices on those drugs. Eg once they’ve lost some weight and it’s easier to move, they move more and the sedentary lifestyle changes. Similarly, I’ve seen antidepressants used to get enough functioning and control back that the chain of causes and effects can start to be addressed and intervened in.
It's been reported to reduce cravings related to food, alcohol, and cigarettes, you are saying your father while on the drug consumes the same?
Or is it that he uses it for a while, then lapses, repeat ad naseum?
If it's the second scenario, that's personal responsibility, not much to do there really, he has been given all the tools to improve but chooses not to, and that will catch up to him, no matter ozempic usage.
Did you actually see it being sold in the way you're describing, or are you just extrapolating from social media rot?
Ozempic has side effects, so we cna do a cost benefit analysis to argue that the various benefits of not being obese outweigh its problems. We clearly see many people are unable to loose weight without it, given nearly 50% of people are at an unhealthy weight, thus its likley a net positive.
Until Ozempic, the US obesity rate has literally never declined since it started rising.
Thus people clearly are not loosing weight. What do you propose instead? Nothing else is working
Ah, so the same thing that has repeatedly been tried and failed every time everywhere around the world for the last 50 years. Yeah, let's just keep on giving that a go.
That is the same question people were asking about Prozac thirty years ago, with the same concern about continuing to use a drug for the rest of one's life. The idea may sound scary, but in practice people make a simple calculation: so long as the drug continues to make your life better, why wouldn't you continue taking it?
If humans stopped eating sugar we wouldn't need most dentists. Should we stop celebrating dental advances?
From their FAQ: "Ozempic® is a medicine for adults with type 2 diabetes that, along with diet and exercise, may improve blood sugar. While not for weight loss, Ozempic® may help you lose some weight."
"Oh they'll all tell you you don't need to do anything just takes this pill and then the pill fixes you hurr durr!" Okay nobody says that. Nobody has ever said that. You made that up, everyone who says that makes that up.
If you go to the doctor and you smoke the first thing out of their mouth is "quit smoking". If you're obese they're gonna DRILL "lifestyle changes" into your skull.
Where the fuck is this absolute delusion that "big pharma just gives pills!!1!" coming from? This has literally never been how medicine works.
The way this is phrased is a little rude, but hey it's the internet.
I'm actually curious where this idea comes from as well. I hear it all the time, but have never experienced anything close to it in all of my years on the planet. Is it some kind of political trope? Something that used to be true that older people haven't realized changed a long time ago? Does it come from 70's sitcoms?
It's certainly never happened to me with any of the doctors I've ever seen, met, or worked with, and I have decades of experience in healthcare adjacent fields. All of the doctors I've known actually really cared about their patients and would often complain that the patient just wanted pills and weren't more compliant when it came to things like diet, exercise, and quitting their vices.
Call me cynical, but maybe because Big Pharma has the deepest pockets and is one of the largest (if not the largest) spender on advertising out there.
Imagine if there were a button on your head that when you pushed it all alcohol in you blood would be cleared out with no negative effect on your liver. In that case, heavy drinking would NO LONGER BE an unhealthy lifestyle. Kids would be able to drink alcohol with no problems.
This drug is a symptom of a sick culture, and not cause to celebrate. I don't at all blame the individuals that have this prescribed to them for taking it, but it just seems like a technochratic solution addressing superficial symptoms of a much larger problem.
This thing objectively and subjectively improves the lives of the people you share this world with. If you have a problem with that it might be time to turn your gaze inward.
Yes, and like a band-aid it will help sick people heal. Which is a good thing, that should be celebrated.
I don't believe that I've ever heard anyone espouse the idea that nothing else in the patients life should change, or that the drugs alone are a complete answer. Although, that seems to be the counter position to your argument.
Everyone knows that fat people need to eat less and exercise more, including the fat people. These drugs help them do that. The drugs are advertised, sold, and prescribed that way and include advice to that effect in the informational pamphlets they come with in addition to usually including a lecture from your physician.
What else do you need before you can just be happy for people that are struggling a little less now?
Obesity, diabetes, have all risen, especially in kids since the 90s, what changed, and what caused this? Are we still having the same causes, or because we can get a lifetime prescription to Ozempic and cover up the worse symptoms, we're ok with it? This is a massive red flag that something is wrong with this situation, not because some people are losing weight, but because some people are getting people sick and others are selling a cure at their expense. Encouraging another lifelong prescription is not addressing the causes and encouraging people to benefit off of making people sick.
I can accept that there may be larger root causes left to address, as long as we can also be clear that these drugs are also a huge win for individual health while society works on those, possibly intractable, root causes.
It's obviously going to be faster to treat individuals than it is to change our entire societies relationship with food and how we produce it, and we shouldn't just let all the fat people die while we figure it out.
I'll answer this one.
The human body is designed and built to eat as much as possible, as often as possible. The brain will prod, poke, and even force you to eat.
For all of human history and prehistory, this is incredibly advantageous. A greedy approach to food consumption allows lower risk of starvation, and fat reserves can be utilized to provide survival mechanisms when food is short.
For the first time in human history and prehistory, we have an abundance of food.
Some humans, a minority, are able to simply fight their biological urges or they may not even have those urges. If this were 10,000 years ago, they would surely be one of the first to die. Now, however, this is advantageous.
Every single part of our biology is in contradiction with modern society. It's not a shock that humans have a problem with obesity. If I gave my dog infinite kibble, I give him a month before he has killed himself.
We are not built for this.
Instead the same measures that work here work in western countries as well. Free food at schools in the US and Europe has led to less obesity. Teaching cooking at school has led to less obesity. Teaching appreciation of the own physical self as a gift that one is responsible for rather than a burden has led to less obesity.
None of this requires throwing even more money at pharma to balance out the out-of-control American food industry (originating from the unscrupulous tobacco industry) which pays pharma to create more addictive foods. And yes, our bodies did not evolve to handle those ultra-processed foods laden with additives, but that is not normal food! Look up how the American food industry wreaked havoc in Latin America, leading to insane rates of obesity in mere years.
I mean, sure... We should fix all the everything, but we can also help the people who are dying right now while we do that. They aren't mutually exclusive.
Imagine rejecting a cure for cancer because it might encourage smokers to continue. That would just be silly.
Fast food is addictive because it contains high amounts of fats, sodium, and carbs. That's all there is to it.
This is exactly what this medication does. I don't understand what confusion there is - this medication undoes the damage that a poor lifestyle choice creates, then gives the user to choose again.
Thankfully, I've never been addicted to anything other than food. I never liked alcohol, nor did I get any positive feeling from it. So, I don't drink. I've never been enticed by drugs, so I've never used them. I went to Atlantic City once, but have never gambled another day in my life. Being spared from these other addictions isn't a matter of my amazing willpower. I'm simply not drawn to those addictions. Nor do I think that people who battle those addictions simply have a lack of willpower. I believe it's much deeper than that.
I agree that celebrating a medication as a cure-all solution is problematic. But, I don't think that's what most people think about GLP-1s. I think most most people simply want, and deserve, a little help in a difficult and complex world.
Do people not know what Ozempic does?
Ozempic doesn't make you sit around, eat like a pig and you lose weight. That's not what it does.
Ozempic makes you eat less, curbing overconsumption. People on Ozempic are also much more likely to exercise. It does not "support an unhealthy lifestyle". It literally does the opposite.
> People need to live healthy lives to be healthy
Okay, Ozempic helps people live healthy lives. Just like having a personal trainer helps people live healthy lives.
Would you say having a personal trainer is "supporting an unhealthy lifestyle"? Of course you wouldn't.
We seem to be rapidly approaching an inflection point, brought on by the compounding distributors such as Hims, that will need to be resolved: there are probably more people on the compounded version of this drug than most suspect and that number is growing by the tens of thousands every day. Meanwhile, Norvo Nordisk is trying to shut down this channel of distribution. That would be a bad idea and I think the FDA must be aware of that. This conflict between NN and the compounders needs to be resolved.
Personally I think the promise of this drug makes it a moral issue and have little sympathy for NNs position here: they will need to capitulate on their control over it and accept some kind of suboptimal pricing agreement. The potential positive outcomes of this drug supersedes their sole claim to it IMO.