I’m so curious to see how this will play out in the long term. Right now, in my household, my husband has recently started on Wegovy, while I’m focusing hard on diet and exercise. We’re basically...
I’m so curious to see how this will play out in the long term. Right now, in my household, my husband has recently started on Wegovy, while I’m focusing hard on diet and exercise. We’re basically running a small side-by-side comparison of the new vs. old approaches to weight loss. Over the past month, we’ve both lost weight, but our diets are drastically different.
He can eat whatever he feels like, but he also doesn’t feel like eating much. Often, he complains that nothing sounds good or that he just can’t bring himself to eat anything by dinnertime. On the other hand, I’m following a diet plan designed by a dietitian, tailored to specific goals. I’m hungry and so incredibly sick of the restrictions. It’s frustrating to watch my husband lose weight while eating mozzarella sticks, Oreos, and other junk food, while I’m strictly adhering to protein minimums, carb maximums, daily exercise, and other, less enjoyable, rules.
What really strikes me, though, is that he’s now essentially dependent on Wegovy unless he’s willing to risk gaining the weight back. His habits have actually worsened because the medication has altered his desire for food so much. He’s not learning where the balance is—he’s just constantly hitting the limit and relying on the chemical loss of appetite to stop him. It feels like getting good at bowling with the bumpers on.
Meanwhile, I’m slowly reinforcing habits that are not only healthier physically but also mentally. Or at least, that’s what I have to tell myself.
It is not great to rely on medication, but the amount of people who can improve through willpower alone is low. If someone can do it through sheer force of will, that is preferable. However, not...
It is not great to rely on medication, but the amount of people who can improve through willpower alone is low. If someone can do it through sheer force of will, that is preferable. However, not everyone is built for this, and we should adjust to that reality instead of focusing too much on a "perfect world" scenario that will never happen to some people.
I agree. And it really makes me wonder how our culture's relationship with food is going to change. I am hoping for some positives, like maybe normalizing smaller portion sizes in food.
I agree. And it really makes me wonder how our culture's relationship with food is going to change. I am hoping for some positives, like maybe normalizing smaller portion sizes in food.
Absolutely. Hopefully, after culture adjusts to an improved baseline in their relationship with food, newer generations won't develop food addiction in the first place. So maybe our grandkids...
Absolutely. Hopefully, after culture adjusts to an improved baseline in their relationship with food, newer generations won't develop food addiction in the first place. So maybe our grandkids won't need any medication at all, since there will be nothing for the medication to correct.
Man, this boils my blood. Apply this logic to another medication or medical intervention and see how insensitive it actually is: Yes. That's how medication works. When you stop taking it, you stop...
Exemplary
Man, this boils my blood. Apply this logic to another medication or medical intervention and see how insensitive it actually is:
Wheelchairs don't help paraplegic people learn to use their legs. If you take away their wheelchair, they can't get around anymore.
Yes. That's how medication works. When you stop taking it, you stop getting the benefits. Countless studies and general cultural awareness has made it beyond clear that we cannot simply shame away obesity. It. Doesn't. Work.
In theory if you could just convince someone to ignore their biology, their culture, their environment, and all the other factors that lead to their food habits then sure, we'd be golden. But that's basically saying "if people just cared less what other people thought we wouldn't have an anxiety epidemic, and treating their anxiety isn't going to teach them how they could be less anxious without treatment". It's dismissive, insensitive, and misses the point.
I don't think it's correct to compare obesity and paraplegia. One is curable, the other is not. And while losing weight has inherent health benefits, someone eating a diet consisting solely of...
I don't think it's correct to compare obesity and paraplegia. One is curable, the other is not. And while losing weight has inherent health benefits, someone eating a diet consisting solely of mozzarella sticks and cookies isn't going to be significantly healthier than an obese person who eats a more balanced diet.
I agree that we can't shame away obesity, but we should also consider why these medications are being prescribed for weight loss in the first place - a desire to improve the health of patients. If that's the goal, and the patient starts eating less healthily when taking the medication, is the medication really achieving it's goal?
We don't cure anorexia or bulimia by giving them a pill that makes them fatten up. Mostly because it doesn't exist, but also because it wouldn't actually solve the underlying issue.
Obesity isn't the actual problem, it's just a very obvious symptom of the problem (unhealthy eating habits) that has yet to be addressed. And by comparing obesity to paraplegia, you're ignoring the underlying issue that can still be fixed. I can't speak to how to actually fix it, but I'd imagine it requires a lot of mental health professionals and a lot of time and money that individuals and insurance companies don't want to pay for.
(This comment does not apply to those who are taking it for diabetes, as there is a different primary goal for that use case.)
Fat guy on GLP1 meds here. This comment tracks exactly with how I've been treated my whole life. I'm fat because I must not know what healthy eating looks like or worse, I just choose to eat...
Exemplary
Fat guy on GLP1 meds here. This comment tracks exactly with how I've been treated my whole life. I'm fat because I must not know what healthy eating looks like or worse, I just choose to eat poorly. I eat nothing but cookies and mozzarella sticks. I'm either stupid or don't have the willpower to eat a vegetable. And now that I'm on medication that is helping me lose weight, I am cheating and I don't deserve to lose weight.
All I can say is that you are way, way off the mark about the causes of obesity. Most obese people are extremely aware of "healthy eating habits". They know why they are fat- they eat too much. People who have never dealt with obesity cannot begin to understand what it is like to have their bodies DEMAND more food all while they know that they have had plenty already. This is the underlying issue of obesity: it is a negative feedback loop caused by hormonal imbalances that signal hunger.
Buddy, my mental health is fine. I don't need a therapist to tell me to eat less, I've known that since I was 12. My body has defective hunger signaling that I am taking medication to correct. It's causing me to lose weight. It's giving my my life back.
Apologies, I didn't mean offence by using the example of mozzarella sticks and cookies - that's just what tyrny (at the top of this thread) said her husband eats. I was not generalizing it to...
Apologies, I didn't mean offence by using the example of mozzarella sticks and cookies - that's just what tyrny (at the top of this thread) said her husband eats. I was not generalizing it to everyone, but I was specifically talking about the group of people who use semaglutide and are eating less healthily than they did before.
I have also struggled with eating issues throughout my life. I've eaten incredibly unhealthy for most of my life, and until a few years ago, it was mostly hidden and unaddressed because I didn't look fat. So from that perspective, I'm worried that people who use these drugs to lose weight without addressing eating habits are just going to go through the same issues I did. Is it better than being obese? I have no idea - I've never been obese. But I do know that having a "normal" weight can still come with countless health problems when the underlying issue is ignored.
I think you're overindexing on one anecdotal experience with semaglutides. It is not common for a person's diet to be worse on semaglutides. If anything, people find it easier to eat healthier, as...
I think you're overindexing on one anecdotal experience with semaglutides. It is not common for a person's diet to be worse on semaglutides. If anything, people find it easier to eat healthier, as their general desire for food decreases, so the gap between mozzarella sticks and carrots is much closer together on ozempic.
Obesity isn't the actual problem
It is. Even sumo wrestlers, who eat carefully controlled diets created by professional, comprising entirely of healthy foods, and who have substantially more muscle mass than most couch potato americans, face significant decreases in life expectancy from their weight. It's not the only problem - if you are thin and still type 2 diabetic because of genetic dispostion your 1300 calories are just refined sugar, that's still bad. But it's not like it would be better if you have 3000 calories of refined sugar a day either.
This is one thing the GLP1 skeptics keep missing. (To be clear, I'm saying you're absolutely correct.) To give a real world example, imagine eating dinner, and shortly after you're still hungry...
If anything, people find it easier to eat healthier, as their general desire for food decreases, so the gap between mozzarella sticks and carrots is much closer together on ozempic.
This is one thing the GLP1 skeptics keep missing. (To be clear, I'm saying you're absolutely correct.)
To give a real world example, imagine eating dinner, and shortly after you're still hungry again. Your dinner was healthy, consisted of an acceptable amount of calories and protein, but your body says "no, I need more."
Many people will seek fast food at this point. Taco Bell once jumped on this trend by advertising themselves as a "Fourth Meal" destination.
This is the norm for many people. If you've never experienced this regularly, you're somewhat fortunate.
And what else is normal? Working a sedentary job for 9 hours a day, spending an hour preparing food for dinner, and possibly 1-2 hours of commute time depending on your work situation. This only makes things harder.
No comments on the comparison to paraplegics. Yep, it is. Having obesity creates a large amount of long term harm to your body. Doctors will first tell a patient to eat better and exercise,...
No comments on the comparison to paraplegics.
If that's the goal, and the patient starts eating less healthily when taking the medication, is the medication really achieving it's goal?
Yep, it is. Having obesity creates a large amount of long term harm to your body. Doctors will first tell a patient to eat better and exercise, because the side effects for that treatment plan are minimal, whereas the benefit is extremely large. If that treatment plan does not work (for example, roughly all of the time in the US), they move on to alternative plans, such as prescribing semaglutide and exercise. Presumably if that is ineffective they will move on to gastric bypass surgery.
Just underlining this: obesity is a disease, which kills several hundred thousand people yearly in the USA. Any argument that a treatment which cures obesity is more harmful than obesity needs to contend with the fact that leaving it untreated kills you. Most side effects are less severe than death.
Here is a document intended for practitioners to explain how and when to prescribe semaglutide. The section titled “ Enhancing Healthcare Team Outcomes” explains that a comprehensive treatment plan also involves a dietician, for what it’s worth, so doctors are trying to make long term change for folks. It’s just that we can’t cure the ills of modern society with a pill.
Eating nothing but mozzarella sticks and cookies also creates a large amount of long term harm. I'm certainly not qualified to say which is worse - it's just a different type of harm. In theory,...
Eating nothing but mozzarella sticks and cookies also creates a large amount of long term harm. I'm certainly not qualified to say which is worse - it's just a different type of harm. In theory, semaglutide on its own could be a form of harm reduction (assuming malnutrition is less harmful than obesity).
Like you said, semaglutide should be used as part of a comprehensive treatment plan including a dietitian. While that would be great, I haven't seen any evidence (or anecdotes) indicating that's happening. I also haven't seen evidence the other way, but I have seen a bunch of anecdotes (including this thread). If it's happening on a large scale and I'm just ignorant to that, great! But if, like all the anecdotes I've seen, it just results in worse eating patterns, then that's a much bigger problem in the long term that needs to be addressed.
Mostly I'm worried that we're doing the easy first step of harm reduction without caring about what comes next (because it's hard, time consuming, and/or expensive), and (like many other forms of harm reduction) someone will point to this in 5-10 years and say "see? It doesn't work", because no one put in the effort of fixing the overall issue(s) while the harm was being reduced.
Just quoting your article: And quoting mine re. deaths attributable to obesity: So in response to your statement, malnutrition is bad but obesity is worse (thousands vs hundreds of thousands...
Eating nothing but mozzarella sticks and cookies also creates a large amount of long term harm. I'm certainly not qualified to say which is worse - it's just a different type of harm. In theory, semaglutide on its own could be a form of harm reduction (assuming malnutrition is less harmful than obesity).
Just quoting your article:
Between 1999 and 2020, 93,244 older adults died from malnutrition.
And quoting mine re. deaths attributable to obesity:
The estimated number of annual deaths attributable to obesity among US adults is approximately 280000 based on HRs from all subjects and 325000 based on HRs from only nonsmokers and never-smokers.
So in response to your statement, malnutrition is bad but obesity is worse (thousands vs hundreds of thousands dead/year). And after skimming your link I didn’t see any notes on separating out comorbidity of obesity and malnutrition, so they could have obliquely been measuring the same factors.
But if, like all the anecdotes I've seen, it just results in worse eating patterns, then that's a much bigger problem in the long term that needs to be addressed.
[…]
someone will point to this in 5-10 years and say "see? It doesn't work", because no one put in the effort of fixing the overall issue(s) while the harm was being reduced.
Fair concern imo. I feel that unhealthy people living to see 2035 is better than ~2000000 to ~3000000 fathers, mothers, siblings and friends dropping dead from a preventable illness, so I’m firmly on the side of giving everyone drugs while we figure out how to help them long term, since the alternative is literally letting them drop dead.
To be clear, here are my positions:
every person afflicted by obesity that is not responsive to lifestyle change treatment should immediately start pharmaceutical treatment for it (if eligible),
in the long term this will cause fewer people to be dead, but those people will now be unhealthy and suffer from other illnesses,
all moral panic about pharmaceutical therapies in obesity treatment are inherently unethical,
we need to figure out how to help people long term. That requires difficult changes, but it’s better to have the opportunity to change than to be six feet under.
^ totally fair if you disagree on any of those points, but I’m happy to back them up as necessary. I think your position is that semaglutide is bad because people are ill (but not dead) after taking it, and I disagree that death is preferable to illness. Definitely probable that I’m misreading your statement though, because imo that’s a brutal stance to take. I’m almost certainly reading what you’re saying incorrectly.
Thanks for your response. I think I agree with everything you've said. Except: To be clear, I don't think semaglutide is bad. And after this discussion, I no longer think it's conditionally bad...
Thanks for your response. I think I agree with everything you've said. Except:
I think your position is that semaglutide is bad because people are ill (but not dead) after taking it
To be clear, I don't think semaglutide is bad. And after this discussion, I no longer think it's conditionally bad (i.e. without addressing the underlying eating issues). I do still worry that some number of people are going to use it without changing anything else and think that's good enough (maybe it is), but I mostly worry about those who use it and change their eating habits for the worse.
Overall though, I think people in that last category are not in the majority. Even if they make up 49% of users (and I don't think it's nearly that high) it seems like the overall population (as a whole) would be healthier by taking semaglutide to lose weight rather than avoiding it because of potential future adverse outcomes.
Theoretically, yes. Empirically, most treatments (except for GLP-1 agonists) have very poor success rates. It might feel different because "free will", but that's not a scientific way to look at...
I don't think it's correct to compare obesity and paraplegia. One is curable, the other is not.
Theoretically, yes. Empirically, most treatments (except for GLP-1 agonists) have very poor success rates. It might feel different because "free will", but that's not a scientific way to look at things. The only thing that matters is outcome.
Obesity isn't the actual problem, it's just a very obvious symptom of the problem (unhealthy eating habits) that has yet to be addressed.
But GLP-1 agonists work by reducing appetite, which does address the underlying cause. Even if a person's diet is still nutritionally deficient, "merely nutritionally deficient" beats "nutritionally deficient and also too many calories" by a mile.
(This comment does not apply to those who are taking it for diabetes, as there is a different primary goal for that use case.)
Actually, it should, because one of the primary management strategies for type 2 diabetes is diet and weight loss. Many cases will essentially go into remission if controlled.
i have a friend who recently decided she wanted to lose a lot of weight, and has been basically starving herself since, to great effect. (she wasn't fat and was happy with her weight before. not...
Empirically, most treatments (except for GLP-1 agonists) have very poor success rates. It might feel different because "free will", but that's not a scientific way to look at things. The only thing that matters is outcome.
i have a friend who recently decided she wanted to lose a lot of weight, and has been basically starving herself since, to great effect. (she wasn't fat and was happy with her weight before. not saying whether i think this is a good idea :p.) i think it's more that some people are capable of exercising willpower around food consumption etc, and some people aren't, and obviously people looking for help with weight loss will belong to the latter group because the former doesn't need any help
How are they not? Being overweight or obese, having high cholesteral, high blood pressure, high blood sugar and all the other ailments that come from dietary sources are just bad for you. Even if...
How are they not? Being overweight or obese, having high cholesteral, high blood pressure, high blood sugar and all the other ailments that come from dietary sources are just bad for you. Even if it's only while you're on the medication, any time you can right the ship is good.
High blood pressure medication is a lifelong commitment, but it's hardly decried for that.
What I am saying is that, to some people, it is worth it to keep taking a medication forever. I never meant to express the notion that these medications will educate someone so they no longer need...
What I am saying is that, to some people, it is worth it to keep taking a medication forever. I never meant to express the notion that these medications will educate someone so they no longer need them. So the improvement is real as long as they keep taking the medication. The goal of the medication is to curb overeating, not to educate. That is how medications work.
I love posting about how much I love ozempic and I very much believe it’s a miracle drug (you can check my post history) But word of warning to him…there is a maximum dose. If he eats like...
I love posting about how much I love ozempic and I very much believe it’s a miracle drug (you can check my post history)
But word of warning to him…there is a maximum dose. If he eats like absolute junk he’s going to hit that upper limit some day years from now, and it’s not going to work as well.
This would be a great time for him to get a therapist to work on his relationship to food.
As someone who gained a lot of weight this past year after being fairly physically fit--an injury took me out of the gym for a while during a time that my job also suddenly became intensely...
As someone who gained a lot of weight this past year after being fairly physically fit--an injury took me out of the gym for a while during a time that my job also suddenly became intensely stressful and I ended up falling into disordered eating--I'm half-debating taking the shortcut myself.
I'm still hesitant and won't pull the trigger without some long conversations with my doctor. I am back on a steady gym routine although my eating habits haven't improved much, so after 2 months I've only lost about 3 pounds. I'm telling myself that since I'm very familiar with the process and habits of a healthy lifestyle, that maybe taking a semiglutide for a bit can just be a kind of hard reset to get me back to where I was physically 18 months ago without having to spend another year of a slow and tortuous process to get there.
I have at least 30 pounds to lose (30 would be acceptable, 40 would be ideal) so it's not going to happen quickly the old-fashioned way, regardless of how orthodox I get with it. I'm middle-aged so pushing myself too hard in the gym risks the kind of injury that got me here a year ago. Crash diets are almost certainly more dangerous than Ozempic would be.
But I don't know, it just...............feels wrong? I can't really explain it. I'm not hugely worried about side effects or long-term morbidities because these drugs have been thoroughly studied for decades at this point. Certainly I'm cautious that it won't really matter without also resetting my diet, or I'll just be back where I am now as soon as I go off it. But I've also historically been pretty good about my diet before 2024, so maybe it'd be fine? I don't know.
The biggest thing I'm curious about is energy levels--I know that anecdotes are not data, but does your husband feel any difference in his energy levels, does he get tired easily, is his sleeping affected at all? I think maybe my own biggest hesitancy is in wondering if it would limit my appetite so much that I would struggle to eat enough to maintain energy for the 5 workouts per week that I'm currently doing.
I think that's because our culture — presuming you're in the West — values agency and self-control. I see the use of semaglutide as biohacking for modern food culture that our brains simply have...
But I don't know, it just...............feels wrong?
I think that's because our culture — presuming you're in the West — values agency and self-control.
I see the use of semaglutide as biohacking for modern food culture that our brains simply have not evolved to handle; many people cannot exercise enough agency, they are defeated. For millennia our ancestors lived in lean times: hunger was plenty, nutrition was scarce, and they had to be extremely physically active to acquire nutrition, so their brains told them to eat single possible calorie because they needed it. Now we live in a time when we can Doordash an entire cake to our front door and the most physical activity we have to do is walk from the couch to the front door.
A complete restaurant meal — entree, side, drink(s), maybe dessert — can blow past 2000 calories easily. Looking at the Cheesecake Factory's nutritional guide (just because theirs is the most detailed): their Pasta Carbonara with Chicken has 2160 calories. Add in a drink (300 for a cocktail) and a slice of plain cheesecake (830) and you're looking at a meal of 3290 calories. I have been to a Cheesecake Factory and have witnessed people do this.
I try to budget 400~600 calories for breakfast and lunch (each) and then 800~1200 for dinner, depending on the day's physical activity. I also run 4~6 miles a day and bike everywhere, not owning a car. It's not super difficult per se, but I find myself frequently tempted by delicious-looking calorie bomb goodies everywhere I look.
Definitely. It's how I gained nearly 50lbs in just a year, from 180->230lbs. It sounds like I'm exaggerating for effect, but I'm not: in 2024 there was only a single-digit number of days that I...
A complete restaurant meal — entree, side, drink(s), maybe dessert — can blow past 2000 calories easily. Looking at the Cheesecake Factory's nutritional guide (just because theirs is the most detailed): their Pasta Carbonara with Chicken has 2160 calories. Add in a drink (300 for a cocktail) and a slice of plain cheesecake (830) and you're looking at a meal of 3290 calories. I have been to a Cheesecake Factory and have witnessed people do this.
Definitely. It's how I gained nearly 50lbs in just a year, from 180->230lbs. It sounds like I'm exaggerating for effect, but I'm not: in 2024 there was only a single-digit number of days that I didn't eat at a restaurant or order takeout. Back-calculating from my current BMI, TDEE, and sedentary lifestyle in 2024, I was eating an estimated 3200 calories per day. Double what I was consuming in 2023.
I'm being better about it now but not as better as I would like. I do think there's the Western shame element of agency and self-control playing a factor in hesitating to take "the easy way out" with something like Ozempic. But then again, it's not like I don't take other medications for things I can't control, so I'm likely just being stubborn.
Two things happened almost simultaneously: I injured my shoulder in late 2023 at a martial arts tournament which completely halted my exercise regimen. In January of 2024 I was promoted to Vice...
Two things happened almost simultaneously: I injured my shoulder in late 2023 at a martial arts tournament which completely halted my exercise regimen. In January of 2024 I was promoted to Vice President at my job, reporting to a new President who was frankly so bad at their job that they in short order either fired or caused to resign over half of my department, so I was suddenly working 14-hour days to make up the difference.
I had to eat on the run because I had no time to cook for myself or manage my diet, and that turned into stress-eating for comfort in the evenings because I was exhausted and miserable. For all of 2024, I had no time for hobbies or exercise, but I did have time to go pick up a 2500-calorie order of Thai food and eat it in front of the TV in the hour between walking away from my computer and going to bed, which counted as my only recreation.
I was able to leave that job for a much better one in mid-December 2024, and since then I've mostly completed rehab on my shoulder (which I'd put off because I had no time for physical therapy appointments), so I'm getting back into exercising and making my own meals. Although it's notably reduced, I'm still eating too much restaurant food, now more out of sheer habit than anything else if I'm being honest. So weight loss has been slow, but it's at least going the right direction. Not as fast as I'd prefer, knowing that I was in literal fighting shape 18 months ago, hence debating the Ozempic question.
I'm sure you've tried a lot of things, but I'm curious how often you order healthier options? For a few years, I ate McDonald's almost every other day, and I actually ended up fitter because I ate...
I'm sure you've tried a lot of things, but I'm curious how often you order healthier options? For a few years, I ate McDonald's almost every other day, and I actually ended up fitter because I ate so many salads and grilled chicken sandwiches! Personally, I like trying the healthy options because I've found there's way more variety in salads than you'd expect (especially when the definition is stretched to sides like Chinese smashed cucumber or French carrot salads).
Not that it made a difference getting to my current weight, but I did often order things like salads with grilled chicken or rice plates with beef and vegetables, etc. If I order a burger I never...
Not that it made a difference getting to my current weight, but I did often order things like salads with grilled chicken or rice plates with beef and vegetables, etc. If I order a burger I never get sides. I actually never eat fast food; I live in a city rife with great local restaurants so I was usually getting Asian or Indian food, or from a favored place near me that does great burgers and salads.
It was less about the quality of the food and more about the volume, really. I likely would not have gained any weight or had any adverse effects on my health if I'd just eaten normal serving sizes of the food I was ordering. But for example, there's a local family-owned Thai place near me I often ordered pad see ew with beef and broccoli several times a week. One order of that is enough to feed two or three people and I'd eat all of it in a sitting, easily 2000+ calories. The grilled chicken salads I was also getting a couple nights a week were easily enough for two people and covered in their house-made blue cheese dressing (so good!), so there's no way it was less than 1500 calories I'm guessing.
Again, I'm doing better about it--getting takeout less often, ordering smaller dishes and saving some as leftovers, etc. It's just a habit I need to finish getting out of.
Our culture views weight gain as a moral failing. You gained weight because you didn't work hard enough, which is obviously bad. When you lose weight, you are congratulated for your hard work. It...
But I don't know, it just...............feels wrong?
Our culture views weight gain as a moral failing. You gained weight because you didn't work hard enough, which is obviously bad. When you lose weight, you are congratulated for your hard work. It doesn't matter why, people who lose weight due to health problems get the same reaction.
Using medication for weight loss is looked upon as cheating. I know this because I have been told it by many people in the 15 or so years I've been on semaglutide and later terzepitide. It doesn't matter that I was on them to control my blood sugar, I was cheating because I lost a considerable amount of weight as a side effect.
I'm 51, male. I've been taking wegovy myself for about 6 months now. I haven't lost a ton of weight, maybe 12 lb or so, but that's okay. Part of it is that I had already lost quite a bit of weight...
I'm 51, male. I've been taking wegovy myself for about 6 months now. I haven't lost a ton of weight, maybe 12 lb or so, but that's okay. Part of it is that I had already lost quite a bit of weight beforehand, and only started taking it when I stalled out. What is amazing to me is that an entire host of biomarkers of general health have greatly improved for me. My a1c, which had been creeping up to the pre-diabetic level, is now solidly back in the normal. My blood pressure is lower. My resting heart rate is lower. My recovery at the gym is significantly better. So many things are just better, it sounds like I'm a shill, but it's just been an amazing experience. I could not give less of a fig if this is a medicine I'm dependent on. I already need my asthma inhaler for the rest of my life, and I don't care about that. If I had developed diabetes, I'd be dependent on insulin for the rest of my life, and now it looks like I'll be able to avoid that. Why, then, should I care about this? It's not like it's a new drug either; semaglutide has been around for decades, so I'm not worried about unknown long-term side effects, either.
Fair point. I already take other meds I'm dependent on (Lyrica + Relafin for peripheral nerve pain related to my autoimmune disease) so I'm not entirely sure why I'm hung up on one more, ha ha....
I already need my asthma inhaler for the rest of my life, and I don't care about that. If I had developed diabetes, I'd be dependent on insulin for the rest of my life, and now it looks like I'll be able to avoid that. Why, then, should I care about this?
Fair point. I already take other meds I'm dependent on (Lyrica + Relafin for peripheral nerve pain related to my autoimmune disease) so I'm not entirely sure why I'm hung up on one more, ha ha.
It's interesting that you find gym recovery easier on it, as that's something I'm currently struggling with a lot, even though my protein and nutrient intake is pretty good overall. Would you say the Wegovy is directly helping with recovery, or that it's more a downstream effect of the other positive results it's giving you?
That is a difficult question to answer, and I'm sure the answer is it's a mix of both, simply because being overweight is so bad for you across the board. That being said, I do think it's having a...
That is a difficult question to answer, and I'm sure the answer is it's a mix of both, simply because being overweight is so bad for you across the board.
That being said, I do think it's having a direct effect beyond the secondary ones. Part of what it does is make your cells more receptive to the effects of insulin, after all, which is a strongly anabolic hormone. It doesn't surprise me, then, that my gym performance has improved faster than it had been.
[Edit] I do want to add that there is some adjustment time required. Every time I went up in dose, it took about a week or two for the sleepiness to wear off. It does go away pretty quickly, but it is there. Also, you really do have to dedicate some brain time to relearning how to eat, because if you don't, you will experience GI side effects that are unpleasant. Thankfully, it makes it so that it is much easier to learn how to eat properly than it had been, so it's really not that hard. It just does take real attention. To get the most out of it, you can't just go on autopilot.
Hm, that is a tough one. From my observations he does seem to have less energy, but he would probably blame work stress right now, which to be fair is high. The biggest thing I am noticing and...
Hm, that is a tough one. From my observations he does seem to have less energy, but he would probably blame work stress right now, which to be fair is high.
The biggest thing I am noticing and that he complains about is that food doesn't taste good. He has complained about foods he normally likes tasting like ash, or just not really being enjoyable. He also has noticed that he really taps out in terms of eating around 6 or 7, so his dinners are very minimal (I made his favorite homemade chili last night and he managed half a scoop). And every time his dosage increases (it seems to be something that tapers up) he deals with nausea and stomach upset. Because of these things (and probably with some stress eating mixed in) he has leaned hard into just eating comfort foods during the daytime. I am worried about his protein intake with all of this.
Interesting. I imagine that's part of what makes it easier to eat less, but I'm wondering if that's normal. In my case I'm not entirely sure how much it would impact me--I got COVID early on, in...
The biggest thing I am noticing and that he complains about is that food doesn't taste good. He has complained about foods he normally likes tasting like ash, or just not really being enjoyable.
Interesting. I imagine that's part of what makes it easier to eat less, but I'm wondering if that's normal.
In my case I'm not entirely sure how much it would impact me--I got COVID early on, in February of 2020 right before the US lockdowns started, and it entirely killed my palate like it did to a lot of people, but for me it seems to be permanent. Years later, even now I still have almost zero sense of smell, and very little of taste. It's recovered a little bit and I can taste a few certain things again, other flavors I can taste again but they're completely twisted....anything vanilla tastes like drinking bottled cheap perfume now for example, pickles taste like eating geraniums for some odd reason. A lot of flavors I still can't detect at all. The volume I was eating at last year was completely stress-eating, and limited entirely to meals containing the few ingredients I could taste but I wasn't eating for flavor.
Point being that a few months of losing what little sense of taste I do have I'm guessing would be "annoying but tolerable". But it does raise the question of if I would go back to my current eating habits as soon as I had any taste at all again--for example, I remember right around this time last year I was able to start tasting sweet things more fully again, and I spent a month kickstarting this current weight absolutely housing tubs of ice cream as a result. Tubs, not pints. Not a position I'd want to find myself again, which bears me thinking about.
Food doesn't taste any different to me. No one that I know who is taking it, which is about a half dozen people, have told me that food tastes any different to them, either. For what it's worth.
Food doesn't taste any different to me. No one that I know who is taking it, which is about a half dozen people, have told me that food tastes any different to them, either. For what it's worth.
Food never literally tasted different to me, but it was an extreme learning curve to recognize how much of my enjoyment of food was mental. These drugs dramatically reduce that mental reward from...
Food never literally tasted different to me, but it was an extreme learning curve to recognize how much of my enjoyment of food was mental. These drugs dramatically reduce that mental reward from food, so I can imagine it suddenly feeling like stuff doesn't taste as good anymore.
If all food tasting like ash only recently started, within last 2-4 weeks or so, regardless of when he started the med, especially if the reduced appetite has only been further decreasing since...
If all food tasting like ash only recently started, within last 2-4 weeks or so, regardless of when he started the med, especially if the reduced appetite has only been further decreasing since around the same time, I would have him get it checked out asap. Despite losing most of my sense of taste and smell to COVID in 2020, there was only one period since then where all food actually did taste like ash and I had absolutely no appetite whatsoever and difficulty forcing myself to eat. And that was in 2021 where I learned I had a gastric bleed from some specific medication I was taking for something else.
I'm not trying to hit a panic button here but I'd recommend at least quickly ruling it out. Wegovy as I understand it doesn't cause stomach bleeding on its own but long periods of high stress certainly can. IANAD, but as someone who came uncomfortably close to full exsanguination because I put off asking my doc about it for too long, it's really not something you want to take a "wait and see" stance on.
Others have suggested that this is a cultural/morality issue, but I'm not so sure. My first thought was that it feels a bit wrong because it's short-circuiting a survival mechanism. Hunger and...
it just...............feels wrong?
Others have suggested that this is a cultural/morality issue, but I'm not so sure. My first thought was that it feels a bit wrong because it's short-circuiting a survival mechanism. Hunger and digestion are normal and fundamental functions to keep our bodies alive, and it feels weird to artificially turn that signal down.
Perhaps another angle is that it's a reflection of trends in society that seem to be moving counter to what is healthy for the human body. It's a luxury to have excess food because we're sure we won't die from hunger, but it ends up being bad for us anyway. Having drugs to help with this problem just seems to highlight this incompatibility.
Of course, I don't judge anyone using the drug. Seems like a lot of people have benefitted from it so far. I just also feel like there's something icky about the concept.
It is indeed bypassing a survival mechanism, but I don't think that is a bad thing. Sexual reproduction is also a human survival mechanism, but serves no survival purpose in modern society. We do...
It is indeed bypassing a survival mechanism, but I don't think that is a bad thing. Sexual reproduction is also a human survival mechanism, but serves no survival purpose in modern society. We do so many medical things to bypass this survival mechanism, including using hormones to remove periods entirely. Even mechanical contraceptives bypass normal bodily functions. Does birth control "just......................feel wrong"?
Humanity is so far removed from survival conditions. I don't feel like being "natural" is necessary at all. It is worth considering how the human body typically functions, but there is nothing special of the natural way of doing things that makes them inherently better.
You're thinking about it backwards. GLP1 medications correct an existing short-circuit in people with obesity. Obese people have an out of control hunger signal that is always firing & demanding...
You're thinking about it backwards. GLP1 medications correct an existing short-circuit in people with obesity. Obese people have an out of control hunger signal that is always firing & demanding food. These medications dial that signal back down to normal levels. It's no less natural than arthritis medication, insulin, thyroid medication or birth control.
I work in pharmaceutical research, and I'm not even slightly against the use of drugs to treat various conditions, including in this case. While the use of these kinds of drugs may be a practical...
I work in pharmaceutical research, and I'm not even slightly against the use of drugs to treat various conditions, including in this case. While the use of these kinds of drugs may be a practical treatment for obesity (I don't think it's "cheating" at all), I still feel like there's something I don't feel 100% comfortable with about the concept. I think the word "natural" is used in a lot of preachy ways while meaning different things to each person, so it ends up being kind of a loaded term that I tend to avoid using. In any case, the two points I commented on above are things that apply to GLP1 agonists but don't apply to the other examples you gave.
It feels wrong because folks feel like weight gain is a moral issue, but there emerging evidence that suggests that there are many more factors into body weight than just self control such as...
It feels wrong because folks feel like weight gain is a moral issue, but there emerging evidence that suggests that there are many more factors into body weight than just self control such as genetics, mental health, physical ability, and stuff that we don’t really know how to explain yet. But in all honesty I don’t want to dive into this deeply right now, maybe I’ll make a separate post about it in the future.
I’ll let you come to your own conclusions about the potential risks as I don’t want to persuade you into it. I am heavily biased and pro-ozempic.
I do want to answer your question about energy levels even though I am not OP. Yes, you will feel much more tired. You will get tired more easily. Working out is much harder. That said, it isn’t impossible and you do adjust.
Heh... I managed to lose 90 lbs and keep it off for five yeras. Then I got in a motorcycle accident and gained way more than I lost cause I got myself back in bad habits (after getting too skinny...
Heh... I managed to lose 90 lbs and keep it off for five yeras. Then I got in a motorcycle accident and gained way more than I lost cause I got myself back in bad habits (after getting too skinny cause I wasn't eating after the accident.. then going, ooh, have an excuse to pig out right now, but then it was hard to stop). I wonder if wegovy was around when I had just started gaining if it would have helped me get back on track to losing and keeping the weight off.
As is I'm recently back to trying to get my eating under control but sadly it took not just me not being happy taht I was back to being severely obese (cause I wasn't happy about it but I really do love food and wasn't unhappy enough to be willing to try to restrict myself again after getting back in bad habits) but my parents giving me really good financial incentive was just hte push I needed to try to stop the snowballing. Only lost 10 lbs so far but at least it seems to be going down (and better it at least isn't going up like it was before).
Honestly the behavioral and societal aspects are the things that bother me the most about GLP agonists. Obesity is not just a disorder, it’s a symptom. It’s a product of the types of food, the...
Honestly the behavioral and societal aspects are the things that bother me the most about GLP agonists. Obesity is not just a disorder, it’s a symptom. It’s a product of the types of food, the society that produces it, and the societal forces that lead to us consuming what we do.
One way to view the current situation is that people are eating badly because corporations produce food that is available quickly without much labor and is hyper palatable. Many of us go to them because we are chained to work for corporations and to make a living requires so much out of us. And now we are reaching out to corporations to provide us the solutions to the problems that those have lead to. We are paying them so much that they are some of the most profitable companies on the planet, while at the same time locking ourselves to their solution for life or else it comes back. And where does this solution leave us right now? Only those who can afford them can get those drugs. Homeless people are being left out, and there are tons of jobs that society is dependent on that don’t make enough to afford them, like teachers, agricultural workers, and the like.
I do feel this very much. I have a sibling with a condition which would likely greatly benefit from these drugs. When my family found about other people effectively reversing the condition and...
I do feel this very much. I have a sibling with a condition which would likely greatly benefit from these drugs. When my family found about other people effectively reversing the condition and knew my husband was on Wegovy they got excited about it, thinking maybe my sibling could do it too. But we know they couldn't afford it and they were so disheartened when we let them know how expensive it was. It sucks seeing this miracle drug be available to one member of my family and not another.
Health is about a lot more than weight. Things like fatty liver disease and all sorts of issues caused by not getting the right nutrients for a body over time. These are the issues people will...
Health is about a lot more than weight.
Things like fatty liver disease and all sorts of issues caused by not getting the right nutrients for a body over time.
These are the issues people will encounter if they eat junk with large calorie restrictions: They don't get what the body needs.
Diet is more than just not eating too much, but not eating too much is an important part of any diet.
As some one trying to lose the weight the old fashioned way, I think one thing that has really helped me lose weight while not feeling hungry is while I have smaller portions of the more calorific...
As some one trying to lose the weight the old fashioned way, I think one thing that has really helped me lose weight while not feeling hungry is while I have smaller portions of the more calorific stuff, I also include a salad with it (and I mean some vinagrette dressing on top of greens and tomatoes and some cranberries. No huge amounts of cheese or fattening stuff other than the dressing and I think in smallish doses vinagrette isn't too bad). That has really helped to keep myself from feeling too hungry, which has helped shrink my stomach so it is even easier to feel full quickly, and it is me eating healthier then I used to (as I had no veggies before).
I hate to sound cliche about the whole joke about only eating salads when you diet about it, but the one thing I discovered is that no, I don't need to eat just salads, but they help fill up my stomach so I can have less of the more fattening things and still feel full. Plus I find it helps me appreciate the taste of the other food more.
Yeah, I swear by a side of roasted vegetables with every meal. Some roasted brussel sprouts or broccoli with a little bit of oil and vinegar to make it pop, and I'm so much more satisfied with my...
Yeah, I swear by a side of roasted vegetables with every meal. Some roasted brussel sprouts or broccoli with a little bit of oil and vinegar to make it pop, and I'm so much more satisfied with my meals.
As an aside, I’ve heard of similar sentiments re. blood pressure medication and anti-depressants. In both cases, though, afaik it’s generally acknowledged that the medicine is there to prevent the...
As an aside, I’ve heard of similar sentiments re. blood pressure medication and anti-depressants. In both cases, though, afaik it’s generally acknowledged that the medicine is there to prevent the immediate and permanent damage that the illness can cause (eg organ damage and life-altering behaviours), and that long term change has to result from someplace else. For example, if the blood pressure is due to dietary concerns, taking statins buys time for people to seek out support in finding more sustainable ways to keep themselves fed healthfully.
In practice, though, many of the factors which cause people to require those first line treatments are systemic (eg being crushed by debt, work, family, etc. is not solved by taking a pill a day) so people stay dependent on medication much longer than is advisable. Still, the principle is that they would be dead or severely injured otherwise, so it’s still preferable.
Anyways, just figured I’d bring it up since the topic is a smidge close to heart for me. I hope you two can find a way to live healthy, longer lives, however that’s accomplished.
I keep waiting for the “startling new dangers associated with Ozempic” headlines to drop. Maybe I’m just jaded but it feels like there’s too much unbridled optimism around these drugs. I’m...
I keep waiting for the “startling new dangers associated with Ozempic” headlines to drop. Maybe I’m just jaded but it feels like there’s too much unbridled optimism around these drugs. I’m reminded of the early days of vapes, when everybody was talking about what a healthy alternative to smoking they were.
I think at some point cynicism becomes harmful. It's certainly good to be careful about any new drug, but semaglutides have been prescribed for a while now (since the 1970s), so there have been...
I think at some point cynicism becomes harmful. It's certainly good to be careful about any new drug, but semaglutides have been prescribed for a while now (since the 1970s), so there have been patients on it for over 50 years now. They've gone through two sets of clinical studies now, one for the original use for diabetes, one for weight loss.
If there's particular issue with the methodology, I think that's fine to raise, but general FUD doesn't seem helpful.
The wide spread usage for a different purpose is a new factor though. It was a diabetes drug and those users have a different set of behaviors from non-diabetics. General toxicity shouldn't be a...
The wide spread usage for a different purpose is a new factor though. It was a diabetes drug and those users have a different set of behaviors from non-diabetics. General toxicity shouldn't be a concern but acute organ damage still might be. There's going to be new drug mixing as well that may cause unique issues. I just don't feel like being on the cutting edge of medicine unless there's a real need, and chubby people don't have as life threatening a need to hop on this drug.
I feel like you might be underselling the medical benefits for obese people. Hundreds of thousands of people die every year from obesity-related diseases, and quality of life is much better at a...
I feel like you might be underselling the medical benefits for obese people. Hundreds of thousands of people die every year from obesity-related diseases, and quality of life is much better at a healthier weight. Sure, it's debatable for people that are only slightly overweight, but insurers generally don't cover that BMI range.
I'm not dismissing them. I said that people shouldn't jump on it unless there's a real need. Combating stubborn obesity is a valid reason to take it. Trying to cut a few pounds or using it as a replacement for diet and exercise is dubious at best.
Yeah, especially when the known effects of the drug are so ridiculously good (for people who need them.) Diabetes and Obesity will destroy your body beyond repair much quicker than any potential...
Yeah, especially when the known effects of the drug are so ridiculously good (for people who need them.) Diabetes and Obesity will destroy your body beyond repair much quicker than any potential side effects.
They work, in part, by restricting gastric motility and causing pseudo gastroparesis. Gastroparesis is already known to not at all be a benign condition. It’s far less likely to have any bizarre...
They work, in part, by restricting gastric motility and causing pseudo gastroparesis. Gastroparesis is already known to not at all be a benign condition.
It’s far less likely to have any bizarre unknown effects and far more likely to prove why gastroparesis is harmful and lifespan-shortening.
I could definitely benefit from semaglutide, but I also have been kind of wary and waiting for more studies, but I’m at the point where my increased health from losing weight may outweigh...
I could definitely benefit from semaglutide, but I also have been kind of wary and waiting for more studies, but I’m at the point where my increased health from losing weight may outweigh potential side effects. I’ve been hitting the gym hard, but I’m still having issues losing (tbf I’m also lifting a lot and getting noticeably more muscle), so I’m planning on talking to my doctor about it this week since I was already going.
The evidence is sort of mixed, it may help you quit using cigarettes, but then you also have to quit vaping and you can even increase your nicotine use vaping. Plus plenty of people start by...
The evidence is sort of mixed, it may help you quit using cigarettes, but then you also have to quit vaping and you can even increase your nicotine use vaping. Plus plenty of people start by vaping, rather than only using them to quit. And the long term effects are still a concern
Basically like, sort of, sometimes, for some folks. The American Lung Association and the CDC aren't nearly as positive as the NHS, but even the NHS is like "don't start vaping without trying to quit smoking and plan to quit vaping too"
Agreed, you have to have a desire to quit; not necessarily a plan. I switched from tobacco to vaping as it was definitely less bad smelling than cigarettes. I did ultimately want to quit. You have...
Agreed, you have to have a desire to quit; not necessarily a plan.
I switched from tobacco to vaping as it was definitely less bad smelling than cigarettes. I did ultimately want to quit. You have to be willing to be a bit of a DIYer and make your own vape juice since although you can buy juice in varying nicotine levels, DIYing lets you taper down the nicotine the way you want to. After about 4-5 years of vaping I started trimming the amount of nicotine until I got to 0. I took about 2 years, I think. Continued to vape at 0 for another couple of months just out of habit but realized I was picking up the vape less often naturally. Moved it off my work desk and within another few weeks I had pretty much forgotten about it. I still love the smell of cigarette smoke, though!
Yeah that's a fair pivot, it was more that that was how the NHS framed it as "before you even begin using a vape to quit smoking, plan to quit vaping too" And that was the most positive vape outlook.
Yeah that's a fair pivot, it was more that that was how the NHS framed it as "before you even begin using a vape to quit smoking, plan to quit vaping too"
What bothers me the most about this is how expensive these medications are. In the US, we already live in a world where low income people tend to be overweight because they can't afford or flat...
What bothers me the most about this is how expensive these medications are. In the US, we already live in a world where low income people tend to be overweight because they can't afford or flat out don't have access to healthy food.
Most insurance companies don't cover these medications unless you have a diabetes diagnosis. If you do get it covered for weight loss, they then cut you off when your BMI drops and you are magically considered better. The VA doesn't cover this class of drugs at all.
They don't have to be as expensive as they are. I in fact hate the one time use pens that Mounjaro and Wegovy come in, disposing of them is a huge pain compared with individual pen needles or syringes and they're a gigantic waste of plastic. They all used to be available in vials at a fraction of the cost, but without crossing a border you can now only get those in compounding pharmacies.
Drug companies don't just have patents on the medications, they have patents on the pens, this is a non trivial part of the cost. Ozempic updates their pens with new parts and patents when the old ones run out.
So now low income people are overweight and they will stay overweight. They will end up diabetic and have heart problems which could have been avoided.
I've been on compound tirzepatide (Zepbound) for 4 months and have lost 55 lbs. with 50-ish more to go. It's a miracle, life-saving drug. I've heard all the questions, many of which are in this...
I've been on compound tirzepatide (Zepbound) for 4 months and have lost 55 lbs. with 50-ish more to go. It's a miracle, life-saving drug. I've heard all the questions, many of which are in this very thread:
"What happens when you stop the medication?"
You gain weight. What happens when you stop your blood pressure medication? It goes up. Don't stop the meds. Some people need medication. Some need it forever.
"What about side effects? What about more studies?"
Tirzepatide is extremely well studied. I'm not worried about side effects or potential side effects. I'm worried about the actual effects of obesity. Pancreatitis, gastroparesis, etc. are all worth knowing about but many people take many drugs that have a small risk of serious side effects and yet the weight-loss medications are the ones that bring out the armchair pharmacists ready to scold folks (see the next point).
"Random noises about cheating, morality, etc."
My body is defective and signals that it needs way more food than it actually does. This medication corrects that defect. It's actually crazy that besides maybe alcoholism, obesity is the only disease that people get looked down on for having, and if fat people don't suffer enough to lose weight, they get even more shit from those around them.
"What about the cost?"
This is the real concern. In the US, our system of paying for drugs is so messed up and relying on insurance to cover these medications is far from ideal. I am lucky to be able to get my medication. But until our system completely changes or, until some kind of federal action requires insurers to cover weight-loss medications, it will not improve. I fully believe that making semaglutide & tirzepatide available to people who need it would drastically decrease overall healthcare costs. I also hope that the widespread use of these drugs will start to cause a shift in the way people with obesity are treated and judged by others. It's now a treatable medical condition but until our insurance policies catch up with that fact, these drugs will remain out of reach of a lot of people who need them.
I'm curious about this if you or someone else happens to know more. Does stopping the medication have some rebound-hunger, or does hunger return to levels prior to taking the medication? It seems...
"What happens when you stop the medication?"
You gain weight. What happens when you stop your blood pressure medication? It goes up. Don't stop the meds. Some people need medication. Some need it forever.
I'm curious about this if you or someone else happens to know more. Does stopping the medication have some rebound-hunger, or does hunger return to levels prior to taking the medication? It seems almost definitive that people are bound to the drug for life based on much of the discussion, but I wondered if there weren't some people or some paths that worked for some people where it was a temporary measure? Mostly because some of the descriptions I've read it seems to be that people's eating habits can change and their diets can change when taking the medication, and I didn't know if its not possible for those habits to carry a person through a phase where they stop taking the drug. But I do realize, part of the reason why people sometimes need the drug is because that part of their brain keeps signaling hunger, I suffer from this myself, and if they stop taking it then its quite possible the hunger will override the habits, I just didn't know if that was the case the overwhelming majority of the time.
From what I've seen, people who discontinue their medicine report gaining weight and being hungry "like before". Many people need to stop their GLP medication if they need surgery. These meds...
From what I've seen, people who discontinue their medicine report gaining weight and being hungry "like before". Many people need to stop their GLP medication if they need surgery. These meds interfere with anesthesia and need to be discontinued 1-4 weeks before surgery during which time they feel hungrier and even gain weight. Also the long-term SURMOUNT-1 and SURMOUNT-2 studies showed weight gain following the end of the medication.
Ideally (and this is my plan), folks stay on a therapeutic dose until they reach their goal weight and then titrate down to a maintenance dose. That would be a dose or dosing schedule that allows a person to eat at their maintenance calories. For instance, I am currently eating about 1200 calories a day, which puts me in a large deficit. But once I get to my goal weight, I will need to eat about 1800-2000 calories to maintain it (not gain or lose weight). I plan to reduce the amount of tirzepatide I take at roughly the rate I increased it until I find a level that balances my intake and output. That could also mean spacing out doses further than my current weekly schedule, or possible "microdosing" and taking doses closer together. Solving that puzzle for myself will be a good problem to have- I look forward to it.
Can you share a bit more about the compounded version? Do you have to self-measure the dose into your own syringe? My interpretation of compounded products is that they were made legal during a...
Can you share a bit more about the compounded version?
Do you have to self-measure the dose into your own syringe?
My interpretation of compounded products is that they were made legal during a shortage, but that legal window is closing unless an appeal is voted through by some governing body?
Sure. I'm going to speak in generalities here. Doctors can write prescriptions for compound medication which will be filled by compound pharmacies. Lots of people access this by using telehealth...
Sure. I'm going to speak in generalities here. Doctors can write prescriptions for compound medication which will be filled by compound pharmacies. Lots of people access this by using telehealth doctors who work with specific pharmacies, which in turn ship medication to the patient.
The medication typically arrives in vials and the patient will need to draw their dose into a syringe themselves. Most commonly for GLP1 meds, these are insulin syringes. This has many benefits compared to using prefilled single-use pens, which is how the name-brand medicine generally comes. The patient is in control of their dose and not beholden to the one-size-fits-all dosing schedule that the brands use. Also way less waste.
Controlling the dose allows the patient to use only the amount of medication they need to get the appetite suppression they need while minimizing side effects. It also means that their medication lasts longer, which is cheaper.
There are some legal issues right now, notable with the FDA taking tirzepatide (Zepbound) off of their shortage list even though there is still a national shortage still going on. Groups are suing the FDA to get that changed. Also compounding pharmacies are trying to use custom dosing as a way around the shortage issue. This uncertainty has led many people to stockpile medication. Some others are turning to ordering grey market medication directly from China, bypassing the whole thing. This has some attractive qualities: grey market medication is a fraction (1/10th) of the price of even compounded medication. It is also packaged in a powder (freeze dried) form, which can be stored in the freezer for an even longer shelf life, leading to the ability to stockpile multiple years of medicine.
Of course, ordering unlabeled powder from China is risky. It is not actually illegal, but customs could seize the shipments nonetheless. And how do you know what you're getting? There's a level of trust involved. There are whole communities set up to try to coordinate testing by analytical labs.
So there's a range of options besides having a primary care doctor prescribe Zepbound and insurance paying for it. I've personally explored many of these myself and settled in a place where my personal risk tolerance lets me get the medication I need and not go broke doing it. If you have more questions, I would be happy to discuss privately.
Dr. Robert Califf, the former chief of the Food and Drug Administration, says he hardly recognizes his colleagues. So many are now so thin.
“Looking good,” he says he tells his fellow cardiologists at conferences and meetings.
There are no studies documenting the percentage of doctors taking the drugs. But physicians “are a good litmus test for drugs that are highly effective,” Dr. Califf said. If doctors who read the papers describing clinical-trial results are rushing to get a new drug, that is an indication that it’s really promising.
His colleagues’ use of Wegovy and Zepbound reminds him of the use of statins, drugs that lower cholesterol, in their early days. Cardiologists, who were most familiar with the consequences of high cholesterol levels, were among the first to take the drugs in large numbers.
Many newly thin cardiologists and diabetes specialists, like so many of their patients, had risk factors for heart disease. Or their blood sugar was creeping up. Or just the physical strain of carrying excess weight made everyday life burdensome. They say they like their new looks but also their new health and energy. In a way, they feel like members of a club.
I want to start by saying I encourage anyone who wants to, to become an active participant and advocate in taking care of their health, if you find value in a treatment for your lifestyle, you...
Exemplary
I want to start by saying I encourage anyone who wants to, to become an active participant and advocate in taking care of their health, if you find value in a treatment for your lifestyle, you should continue doing what works for you.
That being said, I think what we are seeing here is the curtain being pulled on two areas of our world that we don't particularly like to look at, and those are: ableism and addiction.
Until you experience the dark ends of those spectrums, they are probably areas of life you don't think about often. I'm sorry for people who are experiencing the hate and judgement that these two areas bring out in many members of our society. I think many people experience food or eating addiction and are treated poorly, or outright invalidated in their experiences.
I think for this thread I will not touch too deeply on either of those topics, but would like to rather focus on some of the clinical trial data.
I did a precursory search to try and find some of the most impactful and/or long term studies of semaglutide clinical trials. I looked for both studies that used it for diabetes treatment and/or obesity. The study that came up a lot, and is listed in the main Wikipedia entry, was this one, Once-Weekly Semaglutide in Adults with Overweight or Obesity. Despite lifestyle intervention being a core component of this study, many people seem to be leaving that out of their narrative when discussing the results, including portions of the study that describe additional help, such as counseling:
Participants received individual counseling sessions every 4 weeks to help them adhere to a reduced-calorie diet (500-kcal deficit per day relative to the energy expenditure estimated at the time they underwent randomization) and increased physical activity (with 150 minutes per week of physical activity, such as walking, encouraged).
There is no "semiglutide only" group, without lifestyle intervention, only a placebo group (fake drug injection + lifestyle intervention).
When I looked for another study, I found this one, [https://pmc.ncbi.nlm.nih.gov/articles/PMC9556320/#Sec8]("Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial"). I first thought there was no lifestyle intervention, but there is:
Behavioral intervention consisted of counseling by a dietitian or similarly qualified healthcare professional every 4 weeks via in-person visits or telephone on adherence to a reduced-calorie diet (500 kcal deficit a day relative to the energy expenditure estimated at randomization) and increased physical activity (150 minutes a week encouraged, for example, walking), both recorded daily (via a diary, app or other tools, which were reviewed during counseling sessions); beyond these criteria for behavioral intervention, no further standardization of behavioral intervention was applied across study sites.
The other portion of patient selection, made me wonder how applicable the study is to a large portion of patients struggling with obesity, patient exclusion criteria included:
History of major depressive disorder within 2 years before screening.
Diagnosis of other severe psychiatric disorder (for example, schizophrenia, bipolar disorder).
A Patient Health Questionnaire-9 score of ≥15 at screening.
A lifetime history of a suicidal attempt.
Suicidal behavior within 30 days before screening.
Suicidal ideation corresponding to type 4 or 5 on the Columbia-Suicide Severity Rating Scale within the past 30 days before screening.
Basically, can someone find me a clincial trial study that did not or does not include lifestyle intervention including behavioral counseling or caloric restriction? I doubt we are going to find a study that was like, "yes, we let the patients eat whatever they want" or "we put patients on a caloric surplus diet, including traditionally really bad foods".
I'm sure these studies don't exist, because no one in their right mind (no company, at least, which, don't forget, many of these studies are funded by Novo Nordisk) is going to set themselves up for that type of research.
So what can we conclude? We can conclude that compared to lifestyle change alone, lifestyle change + semiglutide is more efficacious at weight loss. However, we cannot conclude anything really, about semiglutide + no lifestyle change. I'm also very curious, based on the exclusion of those with mental health illnesses, how efficacious this is for people across the spectrum. If you remember from my opening statements, I believe that obesity can be a symptom of food addiction and that food addiction is a maladaptive coping mechanism, but what are you trying to cope with? If that is not identified, you may just transition to a different coping mechanism (which could also be unhealthy).
TL;DR - all clinical trials are sterilized and artificial experiments designed to make mathematically conclusive decisions. Make sure the clinicial trial data you're quoting, actually shows what you think you're quoting.
Random Asides
We seem to have a history of sweeping caloric restriction under the rug here (I'm speaking as someone living in the USA).
Is the dietary and nutrition sciences field just rife with pressure to ignore caloric restriction? What I mean by this is, every single diet or exercise "fad" that comes out, whenever it is "studied" they control caloric restriction. I'm thinking of things like when they study ketogenic diets, Atkins, HIIT, etc.
When I put my tinfoil hat on, I'm like, "this has to be because we do not want to face something head on like, maybe we should address portion sizes, or perhaps address the endless lobbying and forced exposure to sugar and HFCS, or the lobbying from the breakfast industries to drink milk and orange juice everyday" these are not just lifestyle changes we would be asking for, but societal changes, which apparently we cannot have any of >:O
End rant, thank you for reading.
PPS. We have an obsession with abstinence only-style treatment for anything we deem morally/physically reprehensible. Can't get sober enough to come to a treatment facility fully sober? Sucks to be you. Have a slide back while in treatment? Kicked out, sucks to be you.
Edit: found a retrospective study showing GLP-1 antagonists work better than a placebo even without lifestyle interventions: https://pmc.ncbi.nlm.nih.gov/articles/PMC9877131/ While it's not strong...
While it's not strong evidence, I think the mechanism of action would make the drugs effective even without lifestyle intervention. They function in two ways: reducing hunger, and slowing down digestion.
If someone was addicted to food and simply ate to eat, they'd still have to eat less because their digestion is slowed by the drug. This is part of why people complain about nausea on the drugs; trying to overeat makes people feel sick. As many people on the medication report, the drug lowers the threshold of what counts as overeatting.
Working from the other side, reduced hunger should make people seek out food less. People eat more when they're hungry, so I think it's reasonable to assume the opposite is also true: people eat less when they're not hungry. Why bother eating if you're not hungry for anything?
You can't operate medical data on "seems like it should work" though. People eat for a wide variety of reasons unrelated to hunger and are more likely to stop using medication that makes them feel...
You can't operate medical data on "seems like it should work" though. People eat for a wide variety of reasons unrelated to hunger and are more likely to stop using medication that makes them feel ill. So folks who do feel hunger still and thus eat enough to feel sick, or folks who eat for other reasons besides just physical hunger may be selecting out of the on-going studies by dropping out.
I would not be a candidate for any of these studies, for example.
u/Carrie, I was able to find a retrospective study using health records from diabetics taking GLP-1 antagonists. The drugs work for weight loss even without lifestyle intervention:...
u/Carrie, I was able to find a retrospective study using health records from diabetics taking GLP-1 antagonists. The drugs work for weight loss even without lifestyle intervention: https://pmc.ncbi.nlm.nih.gov/articles/PMC9877131/
Doctors prescribe medications for poorly-studied off-label uses all the time. GLP-1 antagonists being used without lifestyle coaching is pretty mild compared to other common off-label drugs.
Someone ceasing a medication because they get sick from overeatting doesn't exactly mean it doesn't work. It's pretty common to try several antidepressants due to side effects to find one that's well tolerated.
Im not saying that it can't be prescribed that way, whether it should or not, I'm saying you can only judge based on data, not vibes. "Sick from overeating" is only one of the reasons that people...
Doctors prescribe medications for poorly-studied off-label uses all the time. GLP-1 antagonists being used without lifestyle coaching is pretty mild compared to other common off-label drugs.
Someone ceasing a medication because they get sick from overeatting doesn't exactly mean it doesn't work. It's pretty common to try several antidepressants due to side effects to find one that's well tolerated.
Im not saying that it can't be prescribed that way, whether it should or not, I'm saying you can only judge based on data, not vibes.
"Sick from overeating" is only one of the reasons that people stop taking the meds. (Also I said they're still hungry so they eat, which doesn't mean they "overate" it means their meds made them sick when they didn't lose their appetite and ate food.) A lot of people do stop because of the side effects. It's possible a different formulation would work for them, but it's also possible that it wouldn't. If people can't tolerate the medications, for whatever reason, then they're not going to keep taking them and their data will often not be included in the studies.
My stance on weight loss as "the goal" of health is clearly documented on Tildes. I'm tired of focusing on treating symptoms instead of underlying causes, most of which haven't been studied or have few answers "Just lose weight" wouldn't actually solve any of them, just "lower my risk" mostly of being diagnosed with the things I already have. I already take medication that affects my appetite and have to deliberately ignore my hunger signals to eat and so I have no interest in a medication that does more of that, with more side effects, that I couldn't afford even if I wanted to.
But what others want to do with their bodies is their choice. I'm just tired of the assumption that you can tell someone's health by looking at their body, and being told that really I should want to lose weight by society all day long, implicitly and explicitly. Meds that work for people are great. But they will not work for everyone and everyone shouldn't be on them all the time. At some point using low appetite to avoid caloric intake is just med assisted anorexia, even if you're fat.
Where are you getting that the nausea is caused by overeating? Many people experience at least some nausea when they start taking it, they experience it all the time. I was nauseated for years...
Where are you getting that the nausea is caused by overeating? Many people experience at least some nausea when they start taking it, they experience it all the time. I was nauseated for years while on it, all the time.
The person I was replying to claimed that was a cause of the nausea. So I got it from them. But I think my point can be broadly applied to anyone whose side effects are negative enough to have...
The person I was replying to claimed that was a cause of the nausea.
So I got it from them. But I think my point can be broadly applied to anyone whose side effects are negative enough to have them choose to quit the med, ultimately that the decision point.
Permanent nausea is even worse but everyone's experience will be different for certain
Ah, I read that differently than you did, I took it more as a broad statement that overeating makes you feel sick. You’re right, it is different for everyone. Some people get no nausea and for...
Ah, I read that differently than you did, I took it more as a broad statement that overeating makes you feel sick. You’re right, it is different for everyone. Some people get no nausea and for others it goes away after a few weeks.
I have a family member that was taking one of the existing compounds for weight loss and the digestive symptoms were unbearable. Now they're on a different one for diabetes alongside metformin and...
I have a family member that was taking one of the existing compounds for weight loss and the digestive symptoms were unbearable. Now they're on a different one for diabetes alongside metformin and I can't imagine that combo is a ton better but it seems more manageable.
(They're not overweight, they've just dieted their whole life (and mine) and I don't understand chasing five pounds at 60+ but I have strong feelings about diet culture for a reason. )
I’m so curious to see how this will play out in the long term. Right now, in my household, my husband has recently started on Wegovy, while I’m focusing hard on diet and exercise. We’re basically running a small side-by-side comparison of the new vs. old approaches to weight loss. Over the past month, we’ve both lost weight, but our diets are drastically different.
He can eat whatever he feels like, but he also doesn’t feel like eating much. Often, he complains that nothing sounds good or that he just can’t bring himself to eat anything by dinnertime. On the other hand, I’m following a diet plan designed by a dietitian, tailored to specific goals. I’m hungry and so incredibly sick of the restrictions. It’s frustrating to watch my husband lose weight while eating mozzarella sticks, Oreos, and other junk food, while I’m strictly adhering to protein minimums, carb maximums, daily exercise, and other, less enjoyable, rules.
What really strikes me, though, is that he’s now essentially dependent on Wegovy unless he’s willing to risk gaining the weight back. His habits have actually worsened because the medication has altered his desire for food so much. He’s not learning where the balance is—he’s just constantly hitting the limit and relying on the chemical loss of appetite to stop him. It feels like getting good at bowling with the bumpers on.
Meanwhile, I’m slowly reinforcing habits that are not only healthier physically but also mentally. Or at least, that’s what I have to tell myself.
It is not great to rely on medication, but the amount of people who can improve through willpower alone is low. If someone can do it through sheer force of will, that is preferable. However, not everyone is built for this, and we should adjust to that reality instead of focusing too much on a "perfect world" scenario that will never happen to some people.
I agree. And it really makes me wonder how our culture's relationship with food is going to change. I am hoping for some positives, like maybe normalizing smaller portion sizes in food.
Absolutely. Hopefully, after culture adjusts to an improved baseline in their relationship with food, newer generations won't develop food addiction in the first place. So maybe our grandkids won't need any medication at all, since there will be nothing for the medication to correct.
This is just the optimist in me talking ;)
I misread that as “optometrist” and was wondering why you have an eyesight specialist in you, and why that’s relevant to food habits...?
You've heard the phrase "You've gotta watch what you eat"?
Man, this boils my blood. Apply this logic to another medication or medical intervention and see how insensitive it actually is:
Yes. That's how medication works. When you stop taking it, you stop getting the benefits. Countless studies and general cultural awareness has made it beyond clear that we cannot simply shame away obesity. It. Doesn't. Work.
In theory if you could just convince someone to ignore their biology, their culture, their environment, and all the other factors that lead to their food habits then sure, we'd be golden. But that's basically saying "if people just cared less what other people thought we wouldn't have an anxiety epidemic, and treating their anxiety isn't going to teach them how they could be less anxious without treatment". It's dismissive, insensitive, and misses the point.
I don't think it's correct to compare obesity and paraplegia. One is curable, the other is not. And while losing weight has inherent health benefits, someone eating a diet consisting solely of mozzarella sticks and cookies isn't going to be significantly healthier than an obese person who eats a more balanced diet.
I agree that we can't shame away obesity, but we should also consider why these medications are being prescribed for weight loss in the first place - a desire to improve the health of patients. If that's the goal, and the patient starts eating less healthily when taking the medication, is the medication really achieving it's goal?
We don't cure anorexia or bulimia by giving them a pill that makes them fatten up. Mostly because it doesn't exist, but also because it wouldn't actually solve the underlying issue.
Obesity isn't the actual problem, it's just a very obvious symptom of the problem (unhealthy eating habits) that has yet to be addressed. And by comparing obesity to paraplegia, you're ignoring the underlying issue that can still be fixed. I can't speak to how to actually fix it, but I'd imagine it requires a lot of mental health professionals and a lot of time and money that individuals and insurance companies don't want to pay for.
(This comment does not apply to those who are taking it for diabetes, as there is a different primary goal for that use case.)
Fat guy on GLP1 meds here. This comment tracks exactly with how I've been treated my whole life. I'm fat because I must not know what healthy eating looks like or worse, I just choose to eat poorly. I eat nothing but cookies and mozzarella sticks. I'm either stupid or don't have the willpower to eat a vegetable. And now that I'm on medication that is helping me lose weight, I am cheating and I don't deserve to lose weight.
All I can say is that you are way, way off the mark about the causes of obesity. Most obese people are extremely aware of "healthy eating habits". They know why they are fat- they eat too much. People who have never dealt with obesity cannot begin to understand what it is like to have their bodies DEMAND more food all while they know that they have had plenty already. This is the underlying issue of obesity: it is a negative feedback loop caused by hormonal imbalances that signal hunger.
Buddy, my mental health is fine. I don't need a therapist to tell me to eat less, I've known that since I was 12. My body has defective hunger signaling that I am taking medication to correct. It's causing me to lose weight. It's giving my my life back.
Apologies, I didn't mean offence by using the example of mozzarella sticks and cookies - that's just what tyrny (at the top of this thread) said her husband eats. I was not generalizing it to everyone, but I was specifically talking about the group of people who use semaglutide and are eating less healthily than they did before.
I have also struggled with eating issues throughout my life. I've eaten incredibly unhealthy for most of my life, and until a few years ago, it was mostly hidden and unaddressed because I didn't look fat. So from that perspective, I'm worried that people who use these drugs to lose weight without addressing eating habits are just going to go through the same issues I did. Is it better than being obese? I have no idea - I've never been obese. But I do know that having a "normal" weight can still come with countless health problems when the underlying issue is ignored.
I think you're overindexing on one anecdotal experience with semaglutides. It is not common for a person's diet to be worse on semaglutides. If anything, people find it easier to eat healthier, as their general desire for food decreases, so the gap between mozzarella sticks and carrots is much closer together on ozempic.
It is. Even sumo wrestlers, who eat carefully controlled diets created by professional, comprising entirely of healthy foods, and who have substantially more muscle mass than most couch potato americans, face significant decreases in life expectancy from their weight. It's not the only problem - if you are thin and still type 2 diabetic because of genetic dispostion your 1300 calories are just refined sugar, that's still bad. But it's not like it would be better if you have 3000 calories of refined sugar a day either.
This is one thing the GLP1 skeptics keep missing. (To be clear, I'm saying you're absolutely correct.)
To give a real world example, imagine eating dinner, and shortly after you're still hungry again. Your dinner was healthy, consisted of an acceptable amount of calories and protein, but your body says "no, I need more."
Many people will seek fast food at this point. Taco Bell once jumped on this trend by advertising themselves as a "Fourth Meal" destination.
This is the norm for many people. If you've never experienced this regularly, you're somewhat fortunate.
And what else is normal? Working a sedentary job for 9 hours a day, spending an hour preparing food for dinner, and possibly 1-2 hours of commute time depending on your work situation. This only makes things harder.
No comments on the comparison to paraplegics.
Yep, it is. Having obesity creates a large amount of long term harm to your body. Doctors will first tell a patient to eat better and exercise, because the side effects for that treatment plan are minimal, whereas the benefit is extremely large. If that treatment plan does not work (for example, roughly all of the time in the US), they move on to alternative plans, such as prescribing semaglutide and exercise. Presumably if that is ineffective they will move on to gastric bypass surgery.
Just underlining this: obesity is a disease, which kills several hundred thousand people yearly in the USA. Any argument that a treatment which cures obesity is more harmful than obesity needs to contend with the fact that leaving it untreated kills you. Most side effects are less severe than death.
Here is a document intended for practitioners to explain how and when to prescribe semaglutide. The section titled “ Enhancing Healthcare Team Outcomes” explains that a comprehensive treatment plan also involves a dietician, for what it’s worth, so doctors are trying to make long term change for folks. It’s just that we can’t cure the ills of modern society with a pill.
Eating nothing but mozzarella sticks and cookies also creates a large amount of long term harm. I'm certainly not qualified to say which is worse - it's just a different type of harm. In theory, semaglutide on its own could be a form of harm reduction (assuming malnutrition is less harmful than obesity).
Like you said, semaglutide should be used as part of a comprehensive treatment plan including a dietitian. While that would be great, I haven't seen any evidence (or anecdotes) indicating that's happening. I also haven't seen evidence the other way, but I have seen a bunch of anecdotes (including this thread). If it's happening on a large scale and I'm just ignorant to that, great! But if, like all the anecdotes I've seen, it just results in worse eating patterns, then that's a much bigger problem in the long term that needs to be addressed.
Mostly I'm worried that we're doing the easy first step of harm reduction without caring about what comes next (because it's hard, time consuming, and/or expensive), and (like many other forms of harm reduction) someone will point to this in 5-10 years and say "see? It doesn't work", because no one put in the effort of fixing the overall issue(s) while the harm was being reduced.
Just quoting your article:
And quoting mine re. deaths attributable to obesity:
So in response to your statement, malnutrition is bad but obesity is worse (thousands vs hundreds of thousands dead/year). And after skimming your link I didn’t see any notes on separating out comorbidity of obesity and malnutrition, so they could have obliquely been measuring the same factors.
Fair concern imo. I feel that unhealthy people living to see 2035 is better than ~2000000 to ~3000000 fathers, mothers, siblings and friends dropping dead from a preventable illness, so I’m firmly on the side of giving everyone drugs while we figure out how to help them long term, since the alternative is literally letting them drop dead.
To be clear, here are my positions:
^ totally fair if you disagree on any of those points, but I’m happy to back them up as necessary. I think your position is that semaglutide is bad because people are ill (but not dead) after taking it, and I disagree that death is preferable to illness. Definitely probable that I’m misreading your statement though, because imo that’s a brutal stance to take. I’m almost certainly reading what you’re saying incorrectly.
Thanks for your response. I think I agree with everything you've said. Except:
To be clear, I don't think semaglutide is bad. And after this discussion, I no longer think it's conditionally bad (i.e. without addressing the underlying eating issues). I do still worry that some number of people are going to use it without changing anything else and think that's good enough (maybe it is), but I mostly worry about those who use it and change their eating habits for the worse.
Overall though, I think people in that last category are not in the majority. Even if they make up 49% of users (and I don't think it's nearly that high) it seems like the overall population (as a whole) would be healthier by taking semaglutide to lose weight rather than avoiding it because of potential future adverse outcomes.
Theoretically, yes. Empirically, most treatments (except for GLP-1 agonists) have very poor success rates. It might feel different because "free will", but that's not a scientific way to look at things. The only thing that matters is outcome.
But GLP-1 agonists work by reducing appetite, which does address the underlying cause. Even if a person's diet is still nutritionally deficient, "merely nutritionally deficient" beats "nutritionally deficient and also too many calories" by a mile.
Actually, it should, because one of the primary management strategies for type 2 diabetes is diet and weight loss. Many cases will essentially go into remission if controlled.
i have a friend who recently decided she wanted to lose a lot of weight, and has been basically starving herself since, to great effect. (she wasn't fat and was happy with her weight before. not saying whether i think this is a good idea :p.) i think it's more that some people are capable of exercising willpower around food consumption etc, and some people aren't, and obviously people looking for help with weight loss will belong to the latter group because the former doesn't need any help
How are they not? Being overweight or obese, having high cholesteral, high blood pressure, high blood sugar and all the other ailments that come from dietary sources are just bad for you. Even if it's only while you're on the medication, any time you can right the ship is good.
High blood pressure medication is a lifelong commitment, but it's hardly decried for that.
What I am saying is that, to some people, it is worth it to keep taking a medication forever. I never meant to express the notion that these medications will educate someone so they no longer need them. So the improvement is real as long as they keep taking the medication. The goal of the medication is to curb overeating, not to educate. That is how medications work.
I love posting about how much I love ozempic and I very much believe it’s a miracle drug (you can check my post history)
But word of warning to him…there is a maximum dose. If he eats like absolute junk he’s going to hit that upper limit some day years from now, and it’s not going to work as well.
This would be a great time for him to get a therapist to work on his relationship to food.
I firmly agree. I am walking the tightrope walk of not ignoring what looks self destructive and also not becoming a complete nag.
As someone who gained a lot of weight this past year after being fairly physically fit--an injury took me out of the gym for a while during a time that my job also suddenly became intensely stressful and I ended up falling into disordered eating--I'm half-debating taking the shortcut myself.
I'm still hesitant and won't pull the trigger without some long conversations with my doctor. I am back on a steady gym routine although my eating habits haven't improved much, so after 2 months I've only lost about 3 pounds. I'm telling myself that since I'm very familiar with the process and habits of a healthy lifestyle, that maybe taking a semiglutide for a bit can just be a kind of hard reset to get me back to where I was physically 18 months ago without having to spend another year of a slow and tortuous process to get there.
I have at least 30 pounds to lose (30 would be acceptable, 40 would be ideal) so it's not going to happen quickly the old-fashioned way, regardless of how orthodox I get with it. I'm middle-aged so pushing myself too hard in the gym risks the kind of injury that got me here a year ago. Crash diets are almost certainly more dangerous than Ozempic would be.
But I don't know, it just...............feels wrong? I can't really explain it. I'm not hugely worried about side effects or long-term morbidities because these drugs have been thoroughly studied for decades at this point. Certainly I'm cautious that it won't really matter without also resetting my diet, or I'll just be back where I am now as soon as I go off it. But I've also historically been pretty good about my diet before 2024, so maybe it'd be fine? I don't know.
The biggest thing I'm curious about is energy levels--I know that anecdotes are not data, but does your husband feel any difference in his energy levels, does he get tired easily, is his sleeping affected at all? I think maybe my own biggest hesitancy is in wondering if it would limit my appetite so much that I would struggle to eat enough to maintain energy for the 5 workouts per week that I'm currently doing.
I think that's because our culture — presuming you're in the West — values agency and self-control.
I see the use of semaglutide as biohacking for modern food culture that our brains simply have not evolved to handle; many people cannot exercise enough agency, they are defeated. For millennia our ancestors lived in lean times: hunger was plenty, nutrition was scarce, and they had to be extremely physically active to acquire nutrition, so their brains told them to eat single possible calorie because they needed it. Now we live in a time when we can Doordash an entire cake to our front door and the most physical activity we have to do is walk from the couch to the front door.
A complete restaurant meal — entree, side, drink(s), maybe dessert — can blow past 2000 calories easily. Looking at the Cheesecake Factory's nutritional guide (just because theirs is the most detailed): their Pasta Carbonara with Chicken has 2160 calories. Add in a drink (300 for a cocktail) and a slice of plain cheesecake (830) and you're looking at a meal of 3290 calories. I have been to a Cheesecake Factory and have witnessed people do this.
I try to budget 400~600 calories for breakfast and lunch (each) and then 800~1200 for dinner, depending on the day's physical activity. I also run 4~6 miles a day and bike everywhere, not owning a car. It's not super difficult per se, but I find myself frequently tempted by delicious-looking calorie bomb goodies everywhere I look.
Definitely. It's how I gained nearly 50lbs in just a year, from 180->230lbs. It sounds like I'm exaggerating for effect, but I'm not: in 2024 there was only a single-digit number of days that I didn't eat at a restaurant or order takeout. Back-calculating from my current BMI, TDEE, and sedentary lifestyle in 2024, I was eating an estimated 3200 calories per day. Double what I was consuming in 2023.
I'm being better about it now but not as better as I would like. I do think there's the Western shame element of agency and self-control playing a factor in hesitating to take "the easy way out" with something like Ozempic. But then again, it's not like I don't take other medications for things I can't control, so I'm likely just being stubborn.
Why did you eat so much more in 2024 than 2023?
Two things happened almost simultaneously: I injured my shoulder in late 2023 at a martial arts tournament which completely halted my exercise regimen. In January of 2024 I was promoted to Vice President at my job, reporting to a new President who was frankly so bad at their job that they in short order either fired or caused to resign over half of my department, so I was suddenly working 14-hour days to make up the difference.
I had to eat on the run because I had no time to cook for myself or manage my diet, and that turned into stress-eating for comfort in the evenings because I was exhausted and miserable. For all of 2024, I had no time for hobbies or exercise, but I did have time to go pick up a 2500-calorie order of Thai food and eat it in front of the TV in the hour between walking away from my computer and going to bed, which counted as my only recreation.
I was able to leave that job for a much better one in mid-December 2024, and since then I've mostly completed rehab on my shoulder (which I'd put off because I had no time for physical therapy appointments), so I'm getting back into exercising and making my own meals. Although it's notably reduced, I'm still eating too much restaurant food, now more out of sheer habit than anything else if I'm being honest. So weight loss has been slow, but it's at least going the right direction. Not as fast as I'd prefer, knowing that I was in literal fighting shape 18 months ago, hence debating the Ozempic question.
I'm sure you've tried a lot of things, but I'm curious how often you order healthier options? For a few years, I ate McDonald's almost every other day, and I actually ended up fitter because I ate so many salads and grilled chicken sandwiches! Personally, I like trying the healthy options because I've found there's way more variety in salads than you'd expect (especially when the definition is stretched to sides like Chinese smashed cucumber or French carrot salads).
Not that it made a difference getting to my current weight, but I did often order things like salads with grilled chicken or rice plates with beef and vegetables, etc. If I order a burger I never get sides. I actually never eat fast food; I live in a city rife with great local restaurants so I was usually getting Asian or Indian food, or from a favored place near me that does great burgers and salads.
It was less about the quality of the food and more about the volume, really. I likely would not have gained any weight or had any adverse effects on my health if I'd just eaten normal serving sizes of the food I was ordering. But for example, there's a local family-owned Thai place near me I often ordered pad see ew with beef and broccoli several times a week. One order of that is enough to feed two or three people and I'd eat all of it in a sitting, easily 2000+ calories. The grilled chicken salads I was also getting a couple nights a week were easily enough for two people and covered in their house-made blue cheese dressing (so good!), so there's no way it was less than 1500 calories I'm guessing.
Again, I'm doing better about it--getting takeout less often, ordering smaller dishes and saving some as leftovers, etc. It's just a habit I need to finish getting out of.
Our culture views weight gain as a moral failing. You gained weight because you didn't work hard enough, which is obviously bad. When you lose weight, you are congratulated for your hard work. It doesn't matter why, people who lose weight due to health problems get the same reaction.
Using medication for weight loss is looked upon as cheating. I know this because I have been told it by many people in the 15 or so years I've been on semaglutide and later terzepitide. It doesn't matter that I was on them to control my blood sugar, I was cheating because I lost a considerable amount of weight as a side effect.
I'm 51, male. I've been taking wegovy myself for about 6 months now. I haven't lost a ton of weight, maybe 12 lb or so, but that's okay. Part of it is that I had already lost quite a bit of weight beforehand, and only started taking it when I stalled out. What is amazing to me is that an entire host of biomarkers of general health have greatly improved for me. My a1c, which had been creeping up to the pre-diabetic level, is now solidly back in the normal. My blood pressure is lower. My resting heart rate is lower. My recovery at the gym is significantly better. So many things are just better, it sounds like I'm a shill, but it's just been an amazing experience. I could not give less of a fig if this is a medicine I'm dependent on. I already need my asthma inhaler for the rest of my life, and I don't care about that. If I had developed diabetes, I'd be dependent on insulin for the rest of my life, and now it looks like I'll be able to avoid that. Why, then, should I care about this? It's not like it's a new drug either; semaglutide has been around for decades, so I'm not worried about unknown long-term side effects, either.
Fair point. I already take other meds I'm dependent on (Lyrica + Relafin for peripheral nerve pain related to my autoimmune disease) so I'm not entirely sure why I'm hung up on one more, ha ha.
It's interesting that you find gym recovery easier on it, as that's something I'm currently struggling with a lot, even though my protein and nutrient intake is pretty good overall. Would you say the Wegovy is directly helping with recovery, or that it's more a downstream effect of the other positive results it's giving you?
That is a difficult question to answer, and I'm sure the answer is it's a mix of both, simply because being overweight is so bad for you across the board.
That being said, I do think it's having a direct effect beyond the secondary ones. Part of what it does is make your cells more receptive to the effects of insulin, after all, which is a strongly anabolic hormone. It doesn't surprise me, then, that my gym performance has improved faster than it had been.
[Edit] I do want to add that there is some adjustment time required. Every time I went up in dose, it took about a week or two for the sleepiness to wear off. It does go away pretty quickly, but it is there. Also, you really do have to dedicate some brain time to relearning how to eat, because if you don't, you will experience GI side effects that are unpleasant. Thankfully, it makes it so that it is much easier to learn how to eat properly than it had been, so it's really not that hard. It just does take real attention. To get the most out of it, you can't just go on autopilot.
Hm, that is a tough one. From my observations he does seem to have less energy, but he would probably blame work stress right now, which to be fair is high.
The biggest thing I am noticing and that he complains about is that food doesn't taste good. He has complained about foods he normally likes tasting like ash, or just not really being enjoyable. He also has noticed that he really taps out in terms of eating around 6 or 7, so his dinners are very minimal (I made his favorite homemade chili last night and he managed half a scoop). And every time his dosage increases (it seems to be something that tapers up) he deals with nausea and stomach upset. Because of these things (and probably with some stress eating mixed in) he has leaned hard into just eating comfort foods during the daytime. I am worried about his protein intake with all of this.
Interesting. I imagine that's part of what makes it easier to eat less, but I'm wondering if that's normal.
In my case I'm not entirely sure how much it would impact me--I got COVID early on, in February of 2020 right before the US lockdowns started, and it entirely killed my palate like it did to a lot of people, but for me it seems to be permanent. Years later, even now I still have almost zero sense of smell, and very little of taste. It's recovered a little bit and I can taste a few certain things again, other flavors I can taste again but they're completely twisted....anything vanilla tastes like drinking bottled cheap perfume now for example, pickles taste like eating geraniums for some odd reason. A lot of flavors I still can't detect at all. The volume I was eating at last year was completely stress-eating, and limited entirely to meals containing the few ingredients I could taste but I wasn't eating for flavor.
Point being that a few months of losing what little sense of taste I do have I'm guessing would be "annoying but tolerable". But it does raise the question of if I would go back to my current eating habits as soon as I had any taste at all again--for example, I remember right around this time last year I was able to start tasting sweet things more fully again, and I spent a month kickstarting this current weight absolutely housing tubs of ice cream as a result. Tubs, not pints. Not a position I'd want to find myself again, which bears me thinking about.
Food doesn't taste any different to me. No one that I know who is taking it, which is about a half dozen people, have told me that food tastes any different to them, either. For what it's worth.
I will have to have my husband check in with his doctor about this then. Hopefully it isn't a warning of something negative happening.
Food never literally tasted different to me, but it was an extreme learning curve to recognize how much of my enjoyment of food was mental. These drugs dramatically reduce that mental reward from food, so I can imagine it suddenly feeling like stuff doesn't taste as good anymore.
If all food tasting like ash only recently started, within last 2-4 weeks or so, regardless of when he started the med, especially if the reduced appetite has only been further decreasing since around the same time, I would have him get it checked out asap. Despite losing most of my sense of taste and smell to COVID in 2020, there was only one period since then where all food actually did taste like ash and I had absolutely no appetite whatsoever and difficulty forcing myself to eat. And that was in 2021 where I learned I had a gastric bleed from some specific medication I was taking for something else.
I'm not trying to hit a panic button here but I'd recommend at least quickly ruling it out. Wegovy as I understand it doesn't cause stomach bleeding on its own but long periods of high stress certainly can. IANAD, but as someone who came uncomfortably close to full exsanguination because I put off asking my doc about it for too long, it's really not something you want to take a "wait and see" stance on.
Others have suggested that this is a cultural/morality issue, but I'm not so sure. My first thought was that it feels a bit wrong because it's short-circuiting a survival mechanism. Hunger and digestion are normal and fundamental functions to keep our bodies alive, and it feels weird to artificially turn that signal down.
Perhaps another angle is that it's a reflection of trends in society that seem to be moving counter to what is healthy for the human body. It's a luxury to have excess food because we're sure we won't die from hunger, but it ends up being bad for us anyway. Having drugs to help with this problem just seems to highlight this incompatibility.
Of course, I don't judge anyone using the drug. Seems like a lot of people have benefitted from it so far. I just also feel like there's something icky about the concept.
It is indeed bypassing a survival mechanism, but I don't think that is a bad thing. Sexual reproduction is also a human survival mechanism, but serves no survival purpose in modern society. We do so many medical things to bypass this survival mechanism, including using hormones to remove periods entirely. Even mechanical contraceptives bypass normal bodily functions. Does birth control "just......................feel wrong"?
Humanity is so far removed from survival conditions. I don't feel like being "natural" is necessary at all. It is worth considering how the human body typically functions, but there is nothing special of the natural way of doing things that makes them inherently better.
You're thinking about it backwards. GLP1 medications correct an existing short-circuit in people with obesity. Obese people have an out of control hunger signal that is always firing & demanding food. These medications dial that signal back down to normal levels. It's no less natural than arthritis medication, insulin, thyroid medication or birth control.
I work in pharmaceutical research, and I'm not even slightly against the use of drugs to treat various conditions, including in this case. While the use of these kinds of drugs may be a practical treatment for obesity (I don't think it's "cheating" at all), I still feel like there's something I don't feel 100% comfortable with about the concept. I think the word "natural" is used in a lot of preachy ways while meaning different things to each person, so it ends up being kind of a loaded term that I tend to avoid using. In any case, the two points I commented on above are things that apply to GLP1 agonists but don't apply to the other examples you gave.
It feels wrong because folks feel like weight gain is a moral issue, but there emerging evidence that suggests that there are many more factors into body weight than just self control such as genetics, mental health, physical ability, and stuff that we don’t really know how to explain yet. But in all honesty I don’t want to dive into this deeply right now, maybe I’ll make a separate post about it in the future.
I’ll let you come to your own conclusions about the potential risks as I don’t want to persuade you into it. I am heavily biased and pro-ozempic.
I do want to answer your question about energy levels even though I am not OP. Yes, you will feel much more tired. You will get tired more easily. Working out is much harder. That said, it isn’t impossible and you do adjust.
Heh... I managed to lose 90 lbs and keep it off for five yeras. Then I got in a motorcycle accident and gained way more than I lost cause I got myself back in bad habits (after getting too skinny cause I wasn't eating after the accident.. then going, ooh, have an excuse to pig out right now, but then it was hard to stop). I wonder if wegovy was around when I had just started gaining if it would have helped me get back on track to losing and keeping the weight off.
As is I'm recently back to trying to get my eating under control but sadly it took not just me not being happy taht I was back to being severely obese (cause I wasn't happy about it but I really do love food and wasn't unhappy enough to be willing to try to restrict myself again after getting back in bad habits) but my parents giving me really good financial incentive was just hte push I needed to try to stop the snowballing. Only lost 10 lbs so far but at least it seems to be going down (and better it at least isn't going up like it was before).
Honestly the behavioral and societal aspects are the things that bother me the most about GLP agonists. Obesity is not just a disorder, it’s a symptom. It’s a product of the types of food, the society that produces it, and the societal forces that lead to us consuming what we do.
One way to view the current situation is that people are eating badly because corporations produce food that is available quickly without much labor and is hyper palatable. Many of us go to them because we are chained to work for corporations and to make a living requires so much out of us. And now we are reaching out to corporations to provide us the solutions to the problems that those have lead to. We are paying them so much that they are some of the most profitable companies on the planet, while at the same time locking ourselves to their solution for life or else it comes back. And where does this solution leave us right now? Only those who can afford them can get those drugs. Homeless people are being left out, and there are tons of jobs that society is dependent on that don’t make enough to afford them, like teachers, agricultural workers, and the like.
I do feel this very much. I have a sibling with a condition which would likely greatly benefit from these drugs. When my family found about other people effectively reversing the condition and knew my husband was on Wegovy they got excited about it, thinking maybe my sibling could do it too. But we know they couldn't afford it and they were so disheartened when we let them know how expensive it was. It sucks seeing this miracle drug be available to one member of my family and not another.
If your sibling lives in California, Wegovy is now covered by Medi-Cal, just FYI. It's a relatively new development.
Health is about a lot more than weight.
Things like fatty liver disease and all sorts of issues caused by not getting the right nutrients for a body over time.
These are the issues people will encounter if they eat junk with large calorie restrictions: They don't get what the body needs.
Diet is more than just not eating too much, but not eating too much is an important part of any diet.
As some one trying to lose the weight the old fashioned way, I think one thing that has really helped me lose weight while not feeling hungry is while I have smaller portions of the more calorific stuff, I also include a salad with it (and I mean some vinagrette dressing on top of greens and tomatoes and some cranberries. No huge amounts of cheese or fattening stuff other than the dressing and I think in smallish doses vinagrette isn't too bad). That has really helped to keep myself from feeling too hungry, which has helped shrink my stomach so it is even easier to feel full quickly, and it is me eating healthier then I used to (as I had no veggies before).
I hate to sound cliche about the whole joke about only eating salads when you diet about it, but the one thing I discovered is that no, I don't need to eat just salads, but they help fill up my stomach so I can have less of the more fattening things and still feel full. Plus I find it helps me appreciate the taste of the other food more.
Yeah, I swear by a side of roasted vegetables with every meal. Some roasted brussel sprouts or broccoli with a little bit of oil and vinegar to make it pop, and I'm so much more satisfied with my meals.
Air fryer brussel sprouts and string bean with a little balsamic, honey, and parmesan is one of my absolute favorite sides. Good stuff!
As an aside, I’ve heard of similar sentiments re. blood pressure medication and anti-depressants. In both cases, though, afaik it’s generally acknowledged that the medicine is there to prevent the immediate and permanent damage that the illness can cause (eg organ damage and life-altering behaviours), and that long term change has to result from someplace else. For example, if the blood pressure is due to dietary concerns, taking statins buys time for people to seek out support in finding more sustainable ways to keep themselves fed healthfully.
In practice, though, many of the factors which cause people to require those first line treatments are systemic (eg being crushed by debt, work, family, etc. is not solved by taking a pill a day) so people stay dependent on medication much longer than is advisable. Still, the principle is that they would be dead or severely injured otherwise, so it’s still preferable.
Anyways, just figured I’d bring it up since the topic is a smidge close to heart for me. I hope you two can find a way to live healthy, longer lives, however that’s accomplished.
It takes some time to settle in. But in my experience, it ultimately makes it so much easier to choose the good choices.
I keep waiting for the “startling new dangers associated with Ozempic” headlines to drop. Maybe I’m just jaded but it feels like there’s too much unbridled optimism around these drugs. I’m reminded of the early days of vapes, when everybody was talking about what a healthy alternative to smoking they were.
I think at some point cynicism becomes harmful. It's certainly good to be careful about any new drug, but semaglutides have been prescribed for a while now (since the 1970s), so there have been patients on it for over 50 years now. They've gone through two sets of clinical studies now, one for the original use for diabetes, one for weight loss.
If there's particular issue with the methodology, I think that's fine to raise, but general FUD doesn't seem helpful.
The wide spread usage for a different purpose is a new factor though. It was a diabetes drug and those users have a different set of behaviors from non-diabetics. General toxicity shouldn't be a concern but acute organ damage still might be. There's going to be new drug mixing as well that may cause unique issues. I just don't feel like being on the cutting edge of medicine unless there's a real need, and chubby people don't have as life threatening a need to hop on this drug.
I feel like you might be underselling the medical benefits for obese people. Hundreds of thousands of people die every year from obesity-related diseases, and quality of life is much better at a healthier weight. Sure, it's debatable for people that are only slightly overweight, but insurers generally don't cover that BMI range.
Yeah, especially when the known effects of the drug are so ridiculously good (for people who need them.) Diabetes and Obesity will destroy your body beyond repair much quicker than any potential side effects.
They work, in part, by restricting gastric motility and causing pseudo gastroparesis. Gastroparesis is already known to not at all be a benign condition.
It’s far less likely to have any bizarre unknown effects and far more likely to prove why gastroparesis is harmful and lifespan-shortening.
I could definitely benefit from semaglutide, but I also have been kind of wary and waiting for more studies, but I’m at the point where my increased health from losing weight may outweigh potential side effects. I’ve been hitting the gym hard, but I’m still having issues losing (tbf I’m also lifting a lot and getting noticeably more muscle), so I’m planning on talking to my doctor about it this week since I was already going.
Are you old enough to remember fen-phen? If so, that may be the cause.
I haven't paid attention. Aren't vapes still pretty useful for people who want to quit smoking?
The evidence is sort of mixed, it may help you quit using cigarettes, but then you also have to quit vaping and you can even increase your nicotine use vaping. Plus plenty of people start by vaping, rather than only using them to quit. And the long term effects are still a concern
Basically like, sort of, sometimes, for some folks. The American Lung Association and the CDC aren't nearly as positive as the NHS, but even the NHS is like "don't start vaping without trying to quit smoking and plan to quit vaping too"
Agreed, you have to have a desire to quit; not necessarily a plan.
I switched from tobacco to vaping as it was definitely less bad smelling than cigarettes. I did ultimately want to quit. You have to be willing to be a bit of a DIYer and make your own vape juice since although you can buy juice in varying nicotine levels, DIYing lets you taper down the nicotine the way you want to. After about 4-5 years of vaping I started trimming the amount of nicotine until I got to 0. I took about 2 years, I think. Continued to vape at 0 for another couple of months just out of habit but realized I was picking up the vape less often naturally. Moved it off my work desk and within another few weeks I had pretty much forgotten about it. I still love the smell of cigarette smoke, though!
Yeah that's a fair pivot, it was more that that was how the NHS framed it as "before you even begin using a vape to quit smoking, plan to quit vaping too"
And that was the most positive vape outlook.
What bothers me the most about this is how expensive these medications are. In the US, we already live in a world where low income people tend to be overweight because they can't afford or flat out don't have access to healthy food.
Most insurance companies don't cover these medications unless you have a diabetes diagnosis. If you do get it covered for weight loss, they then cut you off when your BMI drops and you are magically considered better. The VA doesn't cover this class of drugs at all.
They don't have to be as expensive as they are. I in fact hate the one time use pens that Mounjaro and Wegovy come in, disposing of them is a huge pain compared with individual pen needles or syringes and they're a gigantic waste of plastic. They all used to be available in vials at a fraction of the cost, but without crossing a border you can now only get those in compounding pharmacies.
Drug companies don't just have patents on the medications, they have patents on the pens, this is a non trivial part of the cost. Ozempic updates their pens with new parts and patents when the old ones run out.
So now low income people are overweight and they will stay overweight. They will end up diabetic and have heart problems which could have been avoided.
I've been on compound tirzepatide (Zepbound) for 4 months and have lost 55 lbs. with 50-ish more to go. It's a miracle, life-saving drug. I've heard all the questions, many of which are in this very thread:
"What happens when you stop the medication?"
You gain weight. What happens when you stop your blood pressure medication? It goes up. Don't stop the meds. Some people need medication. Some need it forever.
"What about side effects? What about more studies?"
Tirzepatide is extremely well studied. I'm not worried about side effects or potential side effects. I'm worried about the actual effects of obesity. Pancreatitis, gastroparesis, etc. are all worth knowing about but many people take many drugs that have a small risk of serious side effects and yet the weight-loss medications are the ones that bring out the armchair pharmacists ready to scold folks (see the next point).
"Random noises about cheating, morality, etc."
My body is defective and signals that it needs way more food than it actually does. This medication corrects that defect. It's actually crazy that besides maybe alcoholism, obesity is the only disease that people get looked down on for having, and if fat people don't suffer enough to lose weight, they get even more shit from those around them.
"What about the cost?"
This is the real concern. In the US, our system of paying for drugs is so messed up and relying on insurance to cover these medications is far from ideal. I am lucky to be able to get my medication. But until our system completely changes or, until some kind of federal action requires insurers to cover weight-loss medications, it will not improve. I fully believe that making semaglutide & tirzepatide available to people who need it would drastically decrease overall healthcare costs. I also hope that the widespread use of these drugs will start to cause a shift in the way people with obesity are treated and judged by others. It's now a treatable medical condition but until our insurance policies catch up with that fact, these drugs will remain out of reach of a lot of people who need them.
I'm curious about this if you or someone else happens to know more. Does stopping the medication have some rebound-hunger, or does hunger return to levels prior to taking the medication? It seems almost definitive that people are bound to the drug for life based on much of the discussion, but I wondered if there weren't some people or some paths that worked for some people where it was a temporary measure? Mostly because some of the descriptions I've read it seems to be that people's eating habits can change and their diets can change when taking the medication, and I didn't know if its not possible for those habits to carry a person through a phase where they stop taking the drug. But I do realize, part of the reason why people sometimes need the drug is because that part of their brain keeps signaling hunger, I suffer from this myself, and if they stop taking it then its quite possible the hunger will override the habits, I just didn't know if that was the case the overwhelming majority of the time.
From what I've seen, people who discontinue their medicine report gaining weight and being hungry "like before". Many people need to stop their GLP medication if they need surgery. These meds interfere with anesthesia and need to be discontinued 1-4 weeks before surgery during which time they feel hungrier and even gain weight. Also the long-term SURMOUNT-1 and SURMOUNT-2 studies showed weight gain following the end of the medication.
Ideally (and this is my plan), folks stay on a therapeutic dose until they reach their goal weight and then titrate down to a maintenance dose. That would be a dose or dosing schedule that allows a person to eat at their maintenance calories. For instance, I am currently eating about 1200 calories a day, which puts me in a large deficit. But once I get to my goal weight, I will need to eat about 1800-2000 calories to maintain it (not gain or lose weight). I plan to reduce the amount of tirzepatide I take at roughly the rate I increased it until I find a level that balances my intake and output. That could also mean spacing out doses further than my current weekly schedule, or possible "microdosing" and taking doses closer together. Solving that puzzle for myself will be a good problem to have- I look forward to it.
Can you share a bit more about the compounded version?
Do you have to self-measure the dose into your own syringe?
My interpretation of compounded products is that they were made legal during a shortage, but that legal window is closing unless an appeal is voted through by some governing body?
Sure. I'm going to speak in generalities here. Doctors can write prescriptions for compound medication which will be filled by compound pharmacies. Lots of people access this by using telehealth doctors who work with specific pharmacies, which in turn ship medication to the patient.
The medication typically arrives in vials and the patient will need to draw their dose into a syringe themselves. Most commonly for GLP1 meds, these are insulin syringes. This has many benefits compared to using prefilled single-use pens, which is how the name-brand medicine generally comes. The patient is in control of their dose and not beholden to the one-size-fits-all dosing schedule that the brands use. Also way less waste.
Controlling the dose allows the patient to use only the amount of medication they need to get the appetite suppression they need while minimizing side effects. It also means that their medication lasts longer, which is cheaper.
There are some legal issues right now, notable with the FDA taking tirzepatide (Zepbound) off of their shortage list even though there is still a national shortage still going on. Groups are suing the FDA to get that changed. Also compounding pharmacies are trying to use custom dosing as a way around the shortage issue. This uncertainty has led many people to stockpile medication. Some others are turning to ordering grey market medication directly from China, bypassing the whole thing. This has some attractive qualities: grey market medication is a fraction (1/10th) of the price of even compounded medication. It is also packaged in a powder (freeze dried) form, which can be stored in the freezer for an even longer shelf life, leading to the ability to stockpile multiple years of medicine.
Of course, ordering unlabeled powder from China is risky. It is not actually illegal, but customs could seize the shipments nonetheless. And how do you know what you're getting? There's a level of trust involved. There are whole communities set up to try to coordinate testing by analytical labs.
So there's a range of options besides having a primary care doctor prescribe Zepbound and insurance paying for it. I've personally explored many of these myself and settled in a place where my personal risk tolerance lets me get the medication I need and not go broke doing it. If you have more questions, I would be happy to discuss privately.
https://archive.ph/lazXh
I want to start by saying I encourage anyone who wants to, to become an active participant and advocate in taking care of their health, if you find value in a treatment for your lifestyle, you should continue doing what works for you.
That being said, I think what we are seeing here is the curtain being pulled on two areas of our world that we don't particularly like to look at, and those are: ableism and addiction.
Until you experience the dark ends of those spectrums, they are probably areas of life you don't think about often. I'm sorry for people who are experiencing the hate and judgement that these two areas bring out in many members of our society. I think many people experience food or eating addiction and are treated poorly, or outright invalidated in their experiences.
I think for this thread I will not touch too deeply on either of those topics, but would like to rather focus on some of the clinical trial data.
I did a precursory search to try and find some of the most impactful and/or long term studies of semaglutide clinical trials. I looked for both studies that used it for diabetes treatment and/or obesity. The study that came up a lot, and is listed in the main Wikipedia entry, was this one, Once-Weekly Semaglutide in Adults with Overweight or Obesity. Despite lifestyle intervention being a core component of this study, many people seem to be leaving that out of their narrative when discussing the results, including portions of the study that describe additional help, such as counseling:
There is no "semiglutide only" group, without lifestyle intervention, only a placebo group (fake drug injection + lifestyle intervention).
When I looked for another study, I found this one, [https://pmc.ncbi.nlm.nih.gov/articles/PMC9556320/#Sec8]("Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial"). I first thought there was no lifestyle intervention, but there is:
The other portion of patient selection, made me wonder how applicable the study is to a large portion of patients struggling with obesity, patient exclusion criteria included:
Basically, can someone find me a clincial trial study that did not or does not include lifestyle intervention including behavioral counseling or caloric restriction? I doubt we are going to find a study that was like, "yes, we let the patients eat whatever they want" or "we put patients on a caloric surplus diet, including traditionally really bad foods".
I'm sure these studies don't exist, because no one in their right mind (no company, at least, which, don't forget, many of these studies are funded by Novo Nordisk) is going to set themselves up for that type of research.
So what can we conclude? We can conclude that compared to lifestyle change alone, lifestyle change + semiglutide is more efficacious at weight loss. However, we cannot conclude anything really, about semiglutide + no lifestyle change. I'm also very curious, based on the exclusion of those with mental health illnesses, how efficacious this is for people across the spectrum. If you remember from my opening statements, I believe that obesity can be a symptom of food addiction and that food addiction is a maladaptive coping mechanism, but what are you trying to cope with? If that is not identified, you may just transition to a different coping mechanism (which could also be unhealthy).
TL;DR - all clinical trials are sterilized and artificial experiments designed to make mathematically conclusive decisions. Make sure the clinicial trial data you're quoting, actually shows what you think you're quoting.
Random Asides
We seem to have a history of sweeping caloric restriction under the rug here (I'm speaking as someone living in the USA).Is the dietary and nutrition sciences field just rife with pressure to ignore caloric restriction? What I mean by this is, every single diet or exercise "fad" that comes out, whenever it is "studied" they control caloric restriction. I'm thinking of things like when they study ketogenic diets, Atkins, HIIT, etc.
When I put my tinfoil hat on, I'm like, "this has to be because we do not want to face something head on like, maybe we should address portion sizes, or perhaps address the endless lobbying and forced exposure to sugar and HFCS, or the lobbying from the breakfast industries to drink milk and orange juice everyday" these are not just lifestyle changes we would be asking for, but societal changes, which apparently we cannot have any of >:O
End rant, thank you for reading.
PPS. We have an obsession with abstinence only-style treatment for anything we deem morally/physically reprehensible. Can't get sober enough to come to a treatment facility fully sober? Sucks to be you. Have a slide back while in treatment? Kicked out, sucks to be you.
Edit: found a retrospective study showing GLP-1 antagonists work better than a placebo even without lifestyle interventions: https://pmc.ncbi.nlm.nih.gov/articles/PMC9877131/
While it's not strong evidence, I think the mechanism of action would make the drugs effective even without lifestyle intervention. They function in two ways: reducing hunger, and slowing down digestion.
If someone was addicted to food and simply ate to eat, they'd still have to eat less because their digestion is slowed by the drug. This is part of why people complain about nausea on the drugs; trying to overeat makes people feel sick. As many people on the medication report, the drug lowers the threshold of what counts as overeatting.
Working from the other side, reduced hunger should make people seek out food less. People eat more when they're hungry, so I think it's reasonable to assume the opposite is also true: people eat less when they're not hungry. Why bother eating if you're not hungry for anything?
You can't operate medical data on "seems like it should work" though. People eat for a wide variety of reasons unrelated to hunger and are more likely to stop using medication that makes them feel ill. So folks who do feel hunger still and thus eat enough to feel sick, or folks who eat for other reasons besides just physical hunger may be selecting out of the on-going studies by dropping out.
I would not be a candidate for any of these studies, for example.
u/Carrie, I was able to find a retrospective study using health records from diabetics taking GLP-1 antagonists. The drugs work for weight loss even without lifestyle intervention: https://pmc.ncbi.nlm.nih.gov/articles/PMC9877131/
Doctors prescribe medications for poorly-studied off-label uses all the time. GLP-1 antagonists being used without lifestyle coaching is pretty mild compared to other common off-label drugs.
Someone ceasing a medication because they get sick from overeatting doesn't exactly mean it doesn't work. It's pretty common to try several antidepressants due to side effects to find one that's well tolerated.
Im not saying that it can't be prescribed that way, whether it should or not, I'm saying you can only judge based on data, not vibes.
"Sick from overeating" is only one of the reasons that people stop taking the meds. (Also I said they're still hungry so they eat, which doesn't mean they "overate" it means their meds made them sick when they didn't lose their appetite and ate food.) A lot of people do stop because of the side effects. It's possible a different formulation would work for them, but it's also possible that it wouldn't. If people can't tolerate the medications, for whatever reason, then they're not going to keep taking them and their data will often not be included in the studies.
My stance on weight loss as "the goal" of health is clearly documented on Tildes. I'm tired of focusing on treating symptoms instead of underlying causes, most of which haven't been studied or have few answers "Just lose weight" wouldn't actually solve any of them, just "lower my risk" mostly of being diagnosed with the things I already have. I already take medication that affects my appetite and have to deliberately ignore my hunger signals to eat and so I have no interest in a medication that does more of that, with more side effects, that I couldn't afford even if I wanted to.
But what others want to do with their bodies is their choice. I'm just tired of the assumption that you can tell someone's health by looking at their body, and being told that really I should want to lose weight by society all day long, implicitly and explicitly. Meds that work for people are great. But they will not work for everyone and everyone shouldn't be on them all the time. At some point using low appetite to avoid caloric intake is just med assisted anorexia, even if you're fat.
Where are you getting that the nausea is caused by overeating? Many people experience at least some nausea when they start taking it, they experience it all the time. I was nauseated for years while on it, all the time.
The person I was replying to claimed that was a cause of the nausea.
So I got it from them. But I think my point can be broadly applied to anyone whose side effects are negative enough to have them choose to quit the med, ultimately that the decision point.
Permanent nausea is even worse but everyone's experience will be different for certain
Ah, I read that differently than you did, I took it more as a broad statement that overeating makes you feel sick. You’re right, it is different for everyone. Some people get no nausea and for others it goes away after a few weeks.
I have a family member that was taking one of the existing compounds for weight loss and the digestive symptoms were unbearable. Now they're on a different one for diabetes alongside metformin and I can't imagine that combo is a ton better but it seems more manageable.
(They're not overweight, they've just dieted their whole life (and mine) and I don't understand chasing five pounds at 60+ but I have strong feelings about diet culture for a reason. )