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Speaking as someone who had the same kind of reservations, I think you sound exactly like me, and if I had any advice to my past self, it would be "get on it as early as it's available, start much lower than anyone thinks is sane, and never ever stop".

I got a concierge doctor who absolutely evaluates what I ask for skeptically, and pay for my GLP medications out of pocket, so I feel ethically totally comfortable with this position. The downsides are real and significant, it's not a "fun" medication, but just the change in how I feel is worth every penny, let alone the massive reduction in heart attack risk, liver enzyme numbers, and so on.

What downsides have you experienced?

Gastrointestinal - nausea, extreme fullness, paradoxically both rapid and slow transit (I recommend lots of fiber, but that will make you too full too), bloating, all kinds of negative stuff, and obviously if you're on a calorie deficit because you get full off a single bite of food you're going to have low energy and feel pretty garbage on that front (thus ramp slowly), but also some jitteryness, all manner of things. I would call the first week on a tiny dose something like a very mild GI bug or flu, in terms of everything I experienced.

That said, I'm extremely prone to side effects, most people I know who have tried them started at maybe half the standard dose and had zero side effects at all. I'm the best possible guinea pig for these things, because if I can tolerate it, almost anyone who isn't frankly allergic or something can.

The other downside, obviously, is injections - you will need to learn how to use sterile technique to inject yourself or pay the incredibly high costs for the pens. The pills are also an option but I have no personal experience and their bioavailability is so low I don't know that I fully trust them.

They will completely change your relationship with food and alcohol, too. Your tastes will probably shift, nearly everybody I know who is on them has essentially given up booze (maybe a couple drinks a year, more or less)

In my experience, basically all downsides can be solved by lowering the dose, and not escalating dosages as fast as the doctors tell you.

Mine were mainly around bloating and abdominal pain, but I solved it by spacing the doses out further to once every 10 days (I'm already about as low as you can get at 1mg without making it difficult to measure accurately in the normal insulin syringe). My working theory is some people don't clear the drug as fast as the modeled rate, so once every 7 days starts to slowly accumulate. I didn't have symptoms until after 12 weeks on a weekly dose.

I personally found that it seemed to globally lower any kind of reward-seeking behavior - initially it was alcohol (didn't make a dramatic difference for food), but pretty quickly I quit the running habit I'd had for years. My resting heart rate shot up, my heart rate variability plumetted, and a couple months in I stopped feeling motivated to get out of bed in the morning. I lost about a half a pound a week, which was lower than I had by calorie counting in the past.

Quit the Wegovy and added a low dose of bupropion, and all of that reversed in a month.

I am overweight, not obese, have an A1C of 4.7, and run regularly. I've never had food noise. YMMV.

Interestingly, hedonism is killed in me by metformin, in food and unrelated domain.

> I'm sure I could find an unethical doctor to prescribe it if I looked hard enough

I'd say the only unethical doctors here would be the ones not prescribing it for you based on your description of your life and needs.

Guidelines are guidelines, not strict rules for a reason. BMI is not the end-all measurement to decide if you are a candidate for these drugs.

Find a competent doctor who understands GLP-1s and you might be surprised.

I have a Kaiser Permanente health plan via the ACA. I assume based on capitalist incentives that Kaiser would fire my primary care physician for prescribing outside the official guidelines.

But I've been thinking about this for a while and I'll talk to him anyway about the prospect of going on a low-dose GLP-1. If he's unreceptive then I'll ask about how to find a trustworthy out-of-network physician who isn't bound by the same incentives.

Why wait?

If you feel unable to fix your diet without it, and you think it's safer to get on it, why not make it happen?

> At my weight, I'm not a candidate for going on a GLP-1. I'm sure I could find an unethical doctor to prescribe it if I looked hard enough,

FWIW, BMI as low as 27.0 is on-label ish, so if you went to an ordinary doctor with some rocks in your pocket you might be able to get a prescription relatively easily. I got a prescription from my GP with a nominal BMI right around there (I didn't take my shoes off or empty my pockets for the scale).

Very american thread and comments.

At most I was 24 BMI and I felt like a fat bastard during COVID. Work from home in sweatpants and I got up to 24 BMI. 77-78kg, 182cm. I just did not weigh myself so I actually did not notice I had gained! But I did and decided to do something about it.

But I lost the weight pretty quickly.

I grew up at 60-65kg and that is where I feel at home in my body. I feel like myself basically.

I should add I am 35, so certainly no spring chicken.

"omg how did you lose it"

Very easy.

1. Weight loss is done through diet, not exercise. Exercise is great for the body, but not a primary weight loss.

2. If you work an office job you do not need 3 full meals a day. Eat a light breakfast, a full lunch and a light meal for dinner.

3. On the weekends, fast. If you are committed, this weekend, buy like 4-5 litre of sugar free/diet soda, flavoured water zero calories, and caffeine pills. To distract yourself, play a high dopamine grind game like Diablo IV, PoE, Borderlands, WoW/FFXIV, CS, Valorant etc.

Just drink, do not eat. Hunger is temporary and will last like 1h for me, then the body "gives up". Do a 24h or 48h water fast, you will drop 5kg easy and feel way less bloated. Repeat next weekend...

Set an alarm every 2-3h to get up and walk. Get your 10k steps in everyday by walking outside.

"omg that's unhealthy"

Yes, ofc but it is more healthy than being overweight or close to overweight, agreed?

"you can only do this because ur a Swedish chad and you have walkable cities!!"

I'm a degenerate gamer.

Commenting here to add I am at 22 BMI and also feel fat. I am also a degenerate gamer. I realized gaming is actually feeding my ADHD and makes my brain feel "nice". My whole life is just dopamine seeking. My sleep has been trash for years.

Bad sleep also worsens my diet and makes me more hungry.

For me to have a healthy lifestyle I need to treat my ADHD first and quit multiplayer games.

You can probably get a prescription for a low dose, but you'll be self pay.

You should start Metformin now and thank me later.

Metformin is miserable. Why go on that over a GLP-1?

Because its OTC, xtremelly safe and and it works.

What issues do u have with it.

It has negative side effects in many people: https://www.mayoclinic.org/drugs-supplements/metformin-oral-...

GLP-1 also does and it also wasn't used by millions of people in last 50 years.

It's not OTC in the US.