24 votes

Half of people on weight loss drugs quit within one year, Danish study finds – more likely to stop taking the drugs if they were younger, lived in poorer areas, or were men

22 comments

  1. [20]
    Sodliddesu
    Link
    If all beneficial controls are lost after 1 whole year of taking the medicine, clearly patients are not building any better habits. I noticed the article doesn't mention any forms of therapy or...

    All of the beneficial effects on appetite control are lost if the medication is stopped” [said Reimar W. Thomsen, one of the study’s authors and a professor of metabolic disease epidemiology at Aarhus University in Denmark.]

    That suggests the drugs’ price point could be making it harder for people to continue accessing them, the researchers said.

    If all beneficial controls are lost after 1 whole year of taking the medicine, clearly patients are not building any better habits. I noticed the article doesn't mention any forms of therapy or support mentioned but they do go into the cost

    costs up to €313, compared with about €120 in neighbouring Germany.

    Which is kind of funny - they gloss over the physical side effects, don't mention actually building better habits/relationship to food, and surmise that clearly it's because they're poor and should take it for the rest of their lives.

    Hell.

    27 votes
    1. [19]
      snake_case
      (edited )
      Link Parent
      Theyre expensive and the patient can never stop taking them, but these patients weren’t going to work on it themselves otherwise. If they were, obesity wouldn’t be an epidemic. What the US gov...

      Theyre expensive and the patient can never stop taking them, but these patients weren’t going to work on it themselves otherwise. If they were, obesity wouldn’t be an epidemic.

      What the US gov could do is give subsidies for healthy food programs, but, that wouldn’t make any particular person super rich so we cant do that.

      Edit* I’m using “weren’t going to work on it” phrasing but it also includes and “weren’t going to work on it because they cant work on it”

      16 votes
      1. [5]
        F13
        Link Parent
        This is an extremely uncharitable and nearly hostile take. Obesity is an epidemic, but a person's weight doesn't tell you anything about their character, as you seem to imply. And it certainly...

        these patients weren’t going to work on it themselves otherwise. If they were, obesity wouldn’t be an epidemic.

        This is an extremely uncharitable and nearly hostile take. Obesity is an epidemic, but a person's weight doesn't tell you anything about their character, as you seem to imply. And it certainly isn't the case we can solve (or could have avoided) the obesity epidemic if people were just better at working on things.

        23 votes
        1. [3]
          cheep_cheep
          Link Parent
          Thanks for saying this. I grew up with an insanely high metabolism and was probably underweight through my teens, and I didn't understand until my 30s how difficult modern food culture can be to...

          Thanks for saying this. I grew up with an insanely high metabolism and was probably underweight through my teens, and I didn't understand until my 30s how difficult modern food culture can be to navigate if you have a less ridiculous metabolism.

          Thought experiment: consider the state of the junk food industry. Companies make billions of dollars in profit to make foods that are addictive, with food chemists on staff who can mimic the flavours of fruits so they can use various cheaper and shelf-stable chemicals, with marketers who will bombard you with images of these delicious things no matter where you are - TV, internet, or just out for a drive or on the bus. People spend their entire careers learning the best ways into tricking us into buying stuff we don't need. If you go out to a sporting event or movie, they're not selling you whole grains and vegetables - they're selling you delicious crap. The deck is really stacked against the average human, especially if you live in the States. So, I try to consider all of these things when thinking about weight and weight loss - when should we be doing more to limit advertising and the components of these foods, vs. blaming people for being physically and mentally manipulated by these ridiculous industries?

          9 votes
          1. [2]
            chocobean
            Link Parent
            Same: even as a younger adult I could eat two full size dinners in an evening plus desserts and unlimited snacks. All that marketing and food science stacked against all of us, but for a long...

            Same: even as a younger adult I could eat two full size dinners in an evening plus desserts and unlimited snacks. All that marketing and food science stacked against all of us, but for a long while I was immune. It wasn't until recently when I began to experience persistent heartburn that I started paying attention to the food I'm eating: embarrassingly , in hind sight, it was simply overeating, and I had no idea what that even meant until now. I was just eating the way I had always eaten, but "in a different body", the same behaviour was making me sick.

            Counting calories now, it's crazy to me that my regular boredom snacks were easily 500+ calories a pop, let alone American sized meals and waking up from hunger for late night meals. It's also crazy to me that, now, a 300 cal lunch doesn't make me feel hungry until dinnertime. That's not will power or habit or good decision making. What if my brain didn't get the memo and still sent the signals for "need midnight meal"? I'd be stuck between having to choose between ravaging hunger pains and indigestion.

            Being thin isn't a virtue: for me it was unearned, with no knowledge no curiosity no drive no determination no struggle behind it. When I look at myself now or another person who is or isn't thin, it's not possible for me to know how much care and intentionality and effort they're putting in, even if they're say, gasp eating food in public.

            5 votes
            1. F13
              Link Parent
              This right here is my whole thing. Popular culture tells us that if you're fat, it's a lack of discipline, or willpower, or education, or access, or whatever. And it could be one, all, or none of...

              it's not possible for me to know how much care and intentionality and effort they're putting in

              This right here is my whole thing. Popular culture tells us that if you're fat, it's a lack of discipline, or willpower, or education, or access, or whatever. And it could be one, all, or none of those things. You just don't know.

              4 votes
        2. thereticent
          Link Parent
          E: read your other comment. I see what you're saying now.

          I didn't read that as blaming anything on obesity. I thought they were saying the people in the study who dropped out with no improvement clearly did not improve their lifestyle. Not saying I agree, but it's different.

          E: read your other comment. I see what you're saying now.

          4 votes
      2. [10]
        Sodliddesu
        Link Parent
        Sometimes, you need a push to help you get to work on it. Three months to learn what a smaller portion is. Three more months to learn how to make healthier choices. Three months to deal with the...

        Sometimes, you need a push to help you get to work on it. Three months to learn what a smaller portion is. Three more months to learn how to make healthier choices. Three months to deal with the backslide when you rediscover brownies and lose the self control. You get what I'm saying.

        But for all control to be lost means that the drug is being used unsupervised and unassisted. Just take the drug to lose weight. No need to work on yourself. The idea that it's a forever medication implies that something is completely broken in an individual and this report blames that on... Their ability to afford the drug.

        This article is specifically about Danes though. I'm certain the US has entirely different cross sections to with about.

        10 votes
        1. F13
          Link Parent
          I appreciate your angle but I still think you're missing an important point. Medication can literally change how your body and brain respond to food. It's like saying after driving a motorcycle...

          I appreciate your angle but I still think you're missing an important point. Medication can literally change how your body and brain respond to food. It's like saying after driving a motorcycle for a while, people should be figuring out how to gain some of their fuel efficiency when going back to their car. There are some lessons to be learned, but how available those lessons are and how effective they ultimately even can be depends on a person's physiology.

          22 votes
        2. Lyrl
          Link Parent
          Some people take antidepressants for a while, and are then able to go off them. Other people take antidepressants their entire lives. And some judge the antidepressants-for-life people as having...

          Some people take antidepressants for a while, and are then able to go off them. Other people take antidepressants their entire lives. And some judge the antidepressants-for-life people as having something completely broken as individuals, but I believe that is profoundly unhelpful. I similarly find judging people who benefit from GLP1 drugs as unhelpful.

          19 votes
        3. [4]
          Akir
          Link Parent
          This is why I’m ultimately disappointed at GLP agonists. It’s the same kind of disappointment I get when I hear people talking about “CICO”. People get metabolic syndrome (which includes obesity...

          This is why I’m ultimately disappointed at GLP agonists. It’s the same kind of disappointment I get when I hear people talking about “CICO”.

          People get metabolic syndrome (which includes obesity but also diabetes and other issues) because of their habits. People get those habits from society. Society adopts their habits from influences. When we zoom into communities, we see that food availability is an issue, especially access to healthy foodstuff. And there are even more issues to be addressed on the individual - too many to count, frankly. So if we wanted to end metabolic syndrome to improve public health we would have to address all of the causes. Instead we let the wolves run wild and say if you are rich enough we now have a way to force your body to be healthy. You just have to pay forever.

          The crazy thing is that metabolic syndrome has tremendous monetary cost to society because people with those issues need expensive lifelong healthcare. It’s reasonable to believe that social programs put into place would actually be cheaper than what we pay for their medical issues. But we don’t actually fucking care about these people, so everyone’s getting fucked over.

          12 votes
          1. [3]
            JCPhoenix
            Link Parent
            Didn't realize that "CICO" was the abbreviation for that kinda thing. I've practiced intermittent fasting for several years now and that (plus the pandemic and everything being closed during it)...

            Didn't realize that "CICO" was the abbreviation for that kinda thing. I've practiced intermittent fasting for several years now and that (plus the pandemic and everything being closed during it) helped me lose weight - like 20-25lbs - and then further maintain.

            I was telling a friend who's mentioned she's gained at least 100lbs over the last few years to maybe look into that. Except when we started talking about it deeper, it's clear that there are some significant social and psychological factors at play here. For her growing up, food was always considered a positive experience. Her dad always brought sweets and snacks home after work for his girls, so food for her is associated with love and affection and family and all that. She enjoys baking a lot as a hobby and shows love for others through baking cookies and cakes and pies and other sweets. Several of us in our friend group have received "care packages" of cookies from her (which are excellent, btw!). Unfortunately, her dad unexpectedly died about a year ago. I'm pretty sure obesity was a factor in his death. Anyway, she misses her father, so she's remembering him and their relationship through food.

            There are other social factors, but that's not even getting into the medical side of things. So I quickly realized that me telling her about and "extolling the virtues" of intermittent fasting ain't gonna be enough. She has to change her whole mindset about food. Her whole relationship to it. And given the trauma and grief that she's processing and dealing with, that's not something I can handle. I'm not sure she can handle that fully on her own, even though she does want to lose weight. That's going to require potentially professional help on top of whatever willpower she can muster.

            And she's just one person out of the millions who have unhealthy relationships with food. In modern times, most of us probably have unhealthy eating habits to some degree (I'm probably still a little overweight, for example). Like you say, this is a societal issue. But we're not treating it like one.

            12 votes
            1. [2]
              tanglisha
              Link Parent
              Also be aware that intermittent fasting often doesn’t work as well for women as it does for men. If you’re a woman yourself, congratulations on being one of those that it worked for!

              Also be aware that intermittent fasting often doesn’t work as well for women as it does for men. If you’re a woman yourself, congratulations on being one of those that it worked for!

              6 votes
              1. JCPhoenix
                Link Parent
                I'm a dude, but I actually didn't know there was a biological sex component to it! I did a quick search because I was curious of the differences and saw this: You know, my friend did say that the...

                I'm a dude, but I actually didn't know there was a biological sex component to it! I did a quick search because I was curious of the differences and saw this:

                Hunger may be more pronounced in women during intermittent fasting, but this can be managed with self-control and adjustment to the fasting routine.

                You know, my friend did say that the few times she's tried intermittent fasting, that it was really difficult to deal with the hunger. That it was all she could think about. I get that at the start it's difficult, but I would never describe it that way. It was actually pretty easy to distract myself by playing a game or working on a project or even just sitting on reddit. I just assumed it was a personal willpower thing. Not a potential biological sex thing!

                4 votes
        4. Minori
          Link Parent
          Would we use this argument for antidepressants? If the drugs help people live healthier lives, what's the harm in staying on them? If the only concern is cost, governments should bring down the...

          Would we use this argument for antidepressants? If the drugs help people live healthier lives, what's the harm in staying on them?

          If the only concern is cost, governments should bring down the prices to reap the social benefits. Obesity is a public health epidemic; treating it greatly benefits both individuals and countries.

          8 votes
        5. [2]
          snake_case
          Link Parent
          Right like kinda what I was getting at is that we as a society do know how to help people lose weight on a societal level. We provide them with better quality food. The reason we subsidize this...

          Right like kinda what I was getting at is that we as a society do know how to help people lose weight on a societal level. We provide them with better quality food.

          The reason we subsidize this drug and not literally anything else that would actually help people long term is because they’re profiting off the obesity epidemic.

          4 votes
          1. redbearsam
            Link Parent
            I'm not sure it's as simple as just that (though I'd agree it's a part of a solution). Some folks don't have access to higher quality food. Some folks don't choose it.

            I'm not sure it's as simple as just that (though I'd agree it's a part of a solution).

            Some folks don't have access to higher quality food. Some folks don't choose it.

            4 votes
      3. [3]
        teaearlgraycold
        Link Parent
        No you'd also need to change so much more. Your suggestion would help with nutrition, but not with obesity. People that gravitate towards calorie dense foods need the absense of such foods, or at...

        What the US gov could do is give subsidies for healthy food programs, but, that wouldn’t make any particular person super rich so we cant do that.

        No you'd also need to change so much more. Your suggestion would help with nutrition, but not with obesity. People that gravitate towards calorie dense foods need the absense of such foods, or at least for those foods to be inconvenient to acquire. You can train yourself to eat less, I've done so in the past, but changing life circumstances can make your training obsolete.

        If people need to be active to go about their lives and can't get junk food they'll absolutely lose weight. And they'll keep it off for as long as those conditions persist. Alternatively, we can provide everyone with appetite suppressants for as long as they live.

        7 votes
        1. RoyalHenOil
          Link Parent
          I'm inclined to agree. I have (unintentionally) been losing a weight over the last few months due to a stomach problem that makes anything with a gummy or chewy texture — which includes most...

          I'm inclined to agree.

          I have (unintentionally) been losing a weight over the last few months due to a stomach problem that makes anything with a gummy or chewy texture — which includes most readily available high-calorie foods — painfully indigestible. Despite my condition, I still sometimes sneak a spoonful of rice or a bite of bread, even though it leaves me in pain and nauseous for three days. I just can't help myself.

          Many of us — perhaps due to the omnipresent threat of starvation that our ancestors faced — simply don't have a lot of self-control around high-calorie foods. Their ready availability is a pretty recent phenomenon that we (as a society/culture and perhaps as a species) haven't adjusted to.

          7 votes
        2. snake_case
          Link Parent
          I’m not talking about some simple fix here, I’m talking about subsidizing changing our entire food culture. Right now the focus is on a balance between what food can travel the longest distances...

          I’m not talking about some simple fix here, I’m talking about subsidizing changing our entire food culture.

          Right now the focus is on a balance between what food can travel the longest distances and stay edible and what food tastes the best. Those are the only two things driving the entire way Americans feed ourselves.

          What we would have to do is instead subsidize locally produced highly nutritious food. Its a total 180 from the past like, 100 years of food innovation.

          7 votes
  2. [2]
    patience_limited
    Link
    @soliddesu, I'll reply to your misinformed moralizing with a foundational study on physiological appetite rebound after weight loss. Summary quote: In the long term, all things are possible -...

    @soliddesu, I'll reply to your misinformed moralizing with a foundational study on physiological appetite rebound after weight loss. Summary quote:

    In summary, our results provide the first quantification of the energy intake feedback control system in free-living humans. We found that appetite increased by ~100 kcal/day above baseline per kilogram of lost weight – an effect several-fold larger than the corresponding energy expenditure adaptations. The few who successfully maintain weight loss over the long term do so by heroic and vigilant efforts to maintain behavior changes in the face of increased appetite along with persistent suppression of energy expenditure (40) in an omnipresent obesogenic environment. Permanently subverting or countering this feedback control system poses a major challenge for the development of effective obesity therapies.

    In the long term, all things are possible - reforming the food, transportation, and labor systems to prevent obesity in the first place. In the short term, GLP-1 agonists are the best available means to mitigate the damage and let people attain a healthy body weight without the crazy-making permanent food noise. We need to make these drugs more cheaply available and provide long-term support systems.

    Full disclosure: I am a successful GLP-1 user, down 50 pounds and now working towards a maintenance plan.

    19 votes
    1. tanglisha
      Link Parent
      Obesity as a moral failing seems to underlie all discussions about it, hopefully unconsciously. There’s also an implication that this is a problem we know how to solve, which implies a single...

      Obesity as a moral failing seems to underlie all discussions about it, hopefully unconsciously. There’s also an implication that this is a problem we know how to solve, which implies a single cause - overeating when a person can choose to eat less.

      15 votes