The problem (not new with GLP-1s) is that people lose weight, get life insurance, and then regain.
The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.
The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.
The safety profile of the drugs with diabetics, and the health benefits that come from the associated weight loss may make permanent use a net benefit for most people. There appears to be little, if any, "course correction" effect from taking it for short periods of time.
I am not saying that those variations are great from a health point of view, but they are certainly not as bad as staying obese.
Letting your weight fluctuate up and down in giant swings is, in many ways, harder on the body than just staying at a steady weight, even if it's overweight.
There’s nothing in these drugs that makes you lose more muscle than fat, you don’t lose any more muscle than if you do a regular diet, not even slightly.
Second, the drugs don’t do anything to cause you to gain back mostly fat, and people going off them have more success, not less, than your average person who loses weight rapidly whether through diet or other means.
The average person who is 50lbs overweight because they gained 5lbs a year for a decade will lose all of that weight within 6 months with nearly entirely positive side effects, and if they stop taking it, will regain a bit less than they did before, meaning it would take another decade to get back to where they were. That is unequivocally a huge net positive.
It’s not like Testosterone which does have dramatic negative effects when taken long term and can cause dependency.
It also happens to be extremely effective at reducing bad habits, and yes those habit changes persist after quitting - not perfectly, but surprisingly so. This even works for smoking, drinking, and gambling.
Also it should be mostly used as an adjunct to strict diet and exercise.
I now take a one week break every few months and have not noticed any decline in effects over time.
My suggestion would be to find an endocrinologist that specialises in obesity and these weight loss drugs. They will have dealt with patients who have experienced tolerance and have developed ways to work around it from real life experience. Obviously well-studied protocols with evidence would be preferable, but with how new these drugs are there hasn't been long enough to collect it yet.
Making millions of people dependent on a drug to maintain basic health does not strike me as the best of ideas regardless. I understand why it's a good idea for many from an individual perspective and I'm not judging anyone, but from a societal perspective it does not seem like a reasonable solution.
The scale of the solution is allowed to match the scale of the problem which is on the order of 2/3 of adults or 200,000,000 people.
Look, I hope you're right. If in 20 years time we look back at these comments and no negative effects have manifested then I'll happily buy you a beer to celebrate. Hell, I'll buy you an entire crate of beer. But I think this is one hell of a risk to take.
The obesity trend has happened almost in lockstep with the proliferation of highly processed foods. Butter and animal fats being replaced with low quality, hydrogenated vegetable oils. Cane sugar being replaced with high fructose corn syrup and other highly processed sweeteners. Sodas and sugary juices replacing water. Food like substances with little to no nutritional value designed solely for taste and texture.
These things are calorically dense while containing nothing the body needs to thrive (though the calories will allow it to survive). They are easy to eat in large amounts and leave you feeling hungry. And unfortunately, these are the most affordable and readily available foods in the United States.
I don't think this is a conspiracy. It's just capitalism. These low quality ingredients are cheap and extremely shelf stable. In addition, the government subsidizes the production of this garbage.
So to say obesity has persisted through everything we've tried is a bit backwards. It would be more accurate to say "a percentage of the population has managed to avoid obesity despite all of the things we've tried."
- Make healthier food options more affordable and readily available - Better nutrition education - And if you really want to get the government involved, ban the use of some additives, oils, sweeteners, and dyes that allow the creation of many of these highly processed foods
But people want Ozempic, they will actively seek it out, and in numbers that can actually make a dent in the problem. In a way that people don't seek out healthy alternatives or exercise. Because people don't want to be healthy, they want to be skinny. You can't control people, you can only respond to them and, ya know, whatever works man.
I think there's more than one way to achieve that. It doesn't have to be bans or subsidies. A lot of it has to do with education and competition. Unfortunately, they are kind of a circular dependency.
- There's so much cheap, highly processed food out there. The companies pay for prime real estate on the shelves and expensive marketing. It is chemically engineered to exploit your pleasure senses when you eat it. That is a hard beast to fight without proper education. And not just the food pyramid, but in depth explanations on why you should avoid it and what to eat instead. There are large groups of the population that have no idea that pop tart or cereal are not a healthy breakfast option.
- If there were more companies creating and promoting healthy, less-processed food options, the price would naturally comedown due to competition. But without the education, these products just do not sell as well. If I gave you some natural peanut butter or almond butter (just almonds or peanuts - 1 ingredient) and I gave you a jar of a more common peanut butter like JIF (sugar + hydrogenated oil for better consistency) and you had no other information at all, you're choosing JIF 10 out of 10 times. It's cheaper, it taste better, and you don't have to stir it. These megacorps prey on that lack of knowledge.
More education -> make better choices when buying -> more companies selling those choices -> cheaper prices on those choices.
The thing with healthy food is not that they are expensive, because they aren't, raw veggies, whole grains, raw chicken, raw pork are not that expensive, especially if you buy in bulk. The problem is that it takes time to cook them, which people may not have, and in general (at least the USA), I feel like people suck at cooking, and don't really have a good food culture of enjoying cooking, like italians do for example.
I believe something similar happened to cigarettes, they are super taxed as well as all the health campaigning around them.
Matt Levine in his column actually addressed that GLP1 could cause the junk food/alcohol/other addictive stuff industries to lose a lot of money due to less consumption.
It's possible that junk food becomes a niche thing given enough time and GLP1.