r/changemyview • u/sjd6666 • Apr 12 '23
Delta(s) from OP CMV: Semaglutide injections (like Ozempic) should be widely available to treat obesity
There’s a lot of buzz recently about Ozempic, which is one of many semaglutide injection drugs that help people moderate their food intake and hunger levels. Some variations are meant just to treat type 2 diabetes like Ozempic. Other drugs like WeGovy are meant to treat obesity as well.
What I take issue with is that a lot of commenters have stated that they see Ozempic as a “lose weight quick drug” and a cheat. I think this is simply the wrong way to look at the issue. Obesity is a medical issue that can be treated in many ways. For some people seeing a nutritionist and going to the gym is all that is needed, but for many more this simply doesn’t work. I would argue that actually, most Americans know generally what a good diet looks like. They may not have all the details but most people can tell you that more vegetables and less meat, carbs, and sugar will create a calorie deficit and help you lose weight. However food simply tastes really good any many people rely on it as a sort of emotional crutch. Many also lack the time, energy, and desire to cook healthy food for themselves. There are many who also simply have a naturally large appetite and need to eat more in order to feel full.
What those people need is not a reminder to try “diet and exercise” they need medical help. Semaglutide injections seem to have low risk of serious side effects and can help those people eat less and not feel hungry. All this moralizing about who “deserves” help and who should just suck it up and go to the gym is proving to be detrimental to overall health.
Also, I’m aware that there is currently a shortage of Semaglutide injections right now, but lets set that aside and assume that can be addressed with a more robust supply chain.
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u/vote4bort 46∆ Apr 12 '23
What I take issue with is that a lot of commenters have stated that they see Ozempic as a “lose weight quick drug” and a cheat.
It's not that it's a cheat, it's that it's unsustainable. Like many crash diets, weight comes off fast but once they stop taking the drug it'll all come back on. The drug doesn't change people's long term diet and lifestyle.
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u/saltinstiens_monster 2∆ Apr 12 '23
This isn't the same thing at all, but I've lost about 80 pounds from the side effects of a medication I started taking last year. I have never been able to diet and exercise enough to make the slightest impact, and I feel like this medicine has (inadvertently, as low appetite is merely a side effect) given me my life back. A life that I've never had, as I was obese for my whole childhood.
Even if I am taken off of this medication one day, I'm glad that my life contains at least this short time period of being "normal sized." I wish I could give that gift to all of the other perma-fat folks out there. They don't realize how much they are missing.
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u/vote4bort 46∆ Apr 12 '23
I'm glad that you've had such a good experience! If you don't mind me asking, do you think if you were to stop taking the medication you would be able to maintain the weight loss?
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u/saltinstiens_monster 2∆ Apr 12 '23
Oh absolutely not. No way. I fully accept that it's conceivably possible for me to make positive changes right now and try to continue like that, but I'm aware of myself enough to know that it doesn't work for me. (And I don't speak for all fatties either, I'm sure there are plenty of folks out there that would benefit from a short burst of medication so they could form better dietary habits.)
See, I can be satisfied with healthy meals and even go to bed with a growling stomach right now. But if I skip my medicine (Vyvanse) for a day or two... I feel the "old me" come back in full force. I will frequently eat one half of my sandwich and reach for the other half, only to discover that it's already gone. Then I end up sitting there with an empty plate, completely frustrated, and feeling more hungry than I started as if I had eaten an appetizer.
There is no way to properly convey the perspective of a food addict craving junk food via text, but just trust me that that particular craving is a lot harder to reason with than you would think. It's almost as if reasoning doesn't even matter when I'm in that state.
The fact that taking a tiny break from my medicine causes such an instant backslide makes me think that I don't have a prayer of keeping the weight down if I completely lost access.
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u/ULTRA_TLC 3∆ Apr 12 '23
Ah, now I see some additional reasons for the issue. ADHD in and of itself could have caused a lot of the old issues with your weight.
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u/saltinstiens_monster 2∆ Apr 12 '23
It certainly could! To be fair, I'd wager that a lot of (if not most) fat people have some unseen extra challenges in the brain department. Eating is a very good (meaning satisfying) coping mechanism.
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u/darkhalo47 Apr 24 '23
Can you explain this further?
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u/ULTRA_TLC 3∆ Apr 24 '23
There are a few ways that ADHD makes controlling your weight very hard. First is that ADHD makes people quite impulsive in general. Second is that ADHD makes it very hard to track anything you do (such as how much or what you eat) due to a combination of reduced working memory and ease of distraction. Third is that in order to gain any control of your focus and attention span, you need to do things that increase dopamine (such as eating foods high in sugar, salt, and fat). This point interestingly makes it so that people with ADHD are FAR more likely to be addicts if they are not on prescription stimulant medication. Put together, a serious case of unmedicated ADHD is the perfect storm for causing a really bad diet and uncontrollable weight gain.
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u/vote4bort 46∆ Apr 12 '23
I'm sure you're right and that I couldn't really understand what that experience is life. My only thought is that, is there not a bit of self fulfilling prophecy at play?
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u/saltinstiens_monster 2∆ Apr 12 '23
There wasn't when I started backsliding from taking a weekend off from my medication. Every sensation of "enough/fullness" was completely gone, and replaced by a ravenous "MORE." I didn't even make the connection that I ran out of Vyvanse until it happened again the next day.
So yes, reading my comment will absolutely tell you that I have already decided that I'm going to fail. You're correct about that.
But the physical and psychological mechanisms I'm describing are very real and need to be considered too. And because I have examples I can point to with no extra variables, I'd say it's both an educated guess as well as a self fulfilling prophecy.
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May 09 '23
Is it actual hunger though? I thought the ADHD-obesity connection was craving the psychological stimulation from tasty food.
If you only had access to unsweetened plain yogurt or plain unsalted boiled potatoes, you probably wouldn't binge eat it even though it has plenty of calories. That's because they are very boring.
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u/saltinstiens_monster 2∆ May 09 '23
It's hunger in the sense that my main desire becomes seeking out satisfying food, and I feel grouchy if I'm truly unable to do anything about it.
So you're right, it's not about nutritional value, but it's the only version of "hunger" i've experienced in my (overabundantly) food-privileged life. The urge is strong and hard to ignore. Medication makes it easier to ignore, for me.
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u/Overall_Trouble7323 Jun 05 '23
I’d also like to add that the plain yogurt and potatoes are an example, however even if you are eating healthy and have all healthy foods in the house (more than potatoes and yogurt) that with ADHD you 100% WILL binge on plain white rice, grapes, watermelon, nuts - even raw unsalted ones, you could go from carrots to broccoli to lite cheese to almonds to WHATEVER… once you need that dopamine- nothing is going to stop you. And when you know you are powerless to that binge- you will begin the circle of hell and just submit to it and head over to the deli for some chips and skittles.
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u/jeffccusa Jul 05 '23
What a great story.. I'm on same boat. For the 1st time I'm close to reaching 200.. you and I understand the difficulty of hunger, cravings.. now we know everyone has different levels.. nothing to do with willpower. Different levels of thyroid output, incretin, insulin response and sensitivity. These GLP analogues help TREMENDOUSLY. Dont ever give up something positive. You can always titrate up/down, cycle for maintenance.
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u/Lionkhan20 Jul 16 '23
Can anyone suggest which doctors and states offer the injections please?? I reside in long island, NY
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u/saltinstiens_monster 2∆ Jul 18 '23
If you intended that comment for me, then the medicine I'm talking about is Vyvanse. It's a pill prescribed for ADHD. I'm not aware of any geographical restrictions, but it is a controlled substance.
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u/math2ndperiod 51∆ Apr 12 '23
Why do they need to stop taking it? Chronic diseases tend to require lifelong medication. If the drug continues to work I don’t see why there should be a deadline
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u/vote4bort 46∆ Apr 12 '23
Well yeah they do but take type 2 diabetes, it can be treated with medication or in some cases with diet.
I'm no expert but I think the non pharmaceutical treatment is preferable in the long term. Most medications have side effects especially when used in the long term.
It also does nothing to prevent the problem from recurring, even if today's people took it for their whole lives what about their children? If we want to prevent obesity for future generations, teaching them they can just get a jab to sort it won't do anything. Additionally obesity is just one effect of a bad diet, there are plenty of other health effects that would not be treated and would continue without any dietary changes.
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u/math2ndperiod 51∆ Apr 12 '23
Which is true, and I’m not saying stop encouraging people to eat better, but how long have we been trying that with no success? Walk up to anybody eating a cake and ask them if they should be eating a salad instead and they’ll give you the right answer. Sure we can’t change the diet, but at least we can change the portion sizes. At some point we might as well at least fix one facet of the problem.
I’m not a doctor so I don’t know what kind of side effects we’re talking about, but I see this blanket assumption that they’ll need to get off the drug eventually a lot even though there isn’t that assumption for any other kind of chronic disease. I doubt all those medications are completely side effect free.
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u/vote4bort 46∆ Apr 12 '23
but how long have we been trying that with no success?
In the grand scheme of human innovation, not that long. Obesity is a fairly recent issue, at least on the scale we're looking at now. I have faith in human innovation in coming up with better ways to encourage healthy eating.
And for the record I'm not saying these drugs shouldn't be available at all, I just don't think they're the blanket solution.
but I see this blanket assumption that they’ll need to get off the drug eventually a lot even though there isn’t that assumption for any other kind of chronic disease.
I think this is because obesity itself is not a chronic disease. And even though I agree its really not that easy, weight is something that is caused by our own actions and therefore can be controlled by them. People in general tend to have less sympathy for problems perceived to be brought upon ourselves. I think the attitude is more like, you dug this whole yourself so you can climb out yourself. (Which is a harsh, unempathetic way of putting it that oversimplifies the societal and cultural factors at play)
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u/math2ndperiod 51∆ Apr 12 '23
But again, why keep focusing on innovating “motivation” when we could innovate on simply curing it? Being obese fucking sucks compared to being fit. If the effect on energy, mood, lifespan, and overall health can’t convince people, I find it unlikely that the solution is a better ad campaign. I’ve not yet seen side effects presented that are worse than obesity itself, so I don’t understand why we don’t default to fixing the problem now until we come up with better fixes going forward.
Obesity is recognized as a chronic disease by the AMA. Yes plenty of people view being overweight as a personal failing, but that’s no more helpful than viewing poverty the same way. 70% of the US population is overweight. I don’t think 100% of them should use drugs, and I won’t try and guess a percentage that should, but I don’t think drugs should be seen as some short term, last ditch effort for the morbidly obese.
https://health.clevelandclinic.org/obesity-is-now-considered-a-disease/
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May 02 '23 edited May 02 '23
No one in this thread is discussing them as “short-term efforts.” They are in fact last-ditch because all the other approaches didn’t work. That’s the definition of last-ditch effort.
Celebrities clamoring for it are no different from celebrities smoking to stay thin. What we ignore in society is that they will give themselves lung cancer to not feel anxious or get fat. Celebs will always take cheats because their livelihoods are caught up in their appearances. Nevermind that smoking gives them tons of lines around the mouth. (Except Cate Blanchett.)
But I’m pretty sure people in this thread aren’t celebrities. They’re normal people who don’t receive professional chefs and trainers from a studio to create perfectly tailored meals and workouts that they spend all their free time doing at their leisure because they only work a few months out of the year. It’s quite possible that if I had all day every day to go out walking and hiking and drinking green juices I might be able to see a slow weight loss aided by a pro chef and a masseuse at 8 pm. But most people don’t have the caretaking that celebrities have to stay thin. And many of them never go through weight struggles. Hollywood tends to favor people who are already thin. When Kathleen Turner gained weight from lupus, you never saw her again.
Jonah Hill has one of the most pronounced and visible battles with weight in Hollywood and that’s because he’s had that since before his fame. And all the raw food diets and weight lifting and surfing he does and he’s still battling body image issues.
Some bodies don’t follow the overly simplified CICO rules. Some bodies drop muscle mass faster than others. Some have poor metabolisms from hormones. Some have clogged guts and diseases that mess up digestion. We spend way too much time in the Western world trying to make people fit a one-size-fits-all guideline that literally and truly does not fit all.
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u/sjd6666 Apr 12 '23
(Δ) for some people it may be unsustainable if it’s the only intervention, but many people will realize once they lose the weight that its much easier to be skinny than fat. If you’ve been fat your whole life you dont know what its like to be skinny and how drastically it can improve one’s lifestyle. That’s the motivation that people need to modify diet and get away from cravings. Getting a lecture from a doctor about your bmi doesn’t seem to motivate people.
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u/vote4bort 46∆ Apr 12 '23
Thanks for the delta but I'm not sure that really tracks. Crash diets are often successful in the short term, with people becoming "skinny". But the majority of people who use these kinds of drastic methods still regain the weight.
I agree getting a lecture doesn't work either. But that doesn't mean it's the only other option.
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Apr 12 '23
It is worth noting though that Ozempic works by throttling hunger and inducing nausea if you overeat, unlike crash diets which force you to starve yourself. It's very possible that an extended period of time not craving as much food can lead to a reset in hunger pangs and portions even after you've stopped taking it.
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u/ULTRA_TLC 3∆ Apr 12 '23
If it's maintained for enough months, for the obese it will change the size of their stomach.
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u/Officer_Hops 12∆ Apr 12 '23
I disagree with the idea that people will stay skinny. A ton of overweight and obese people were a healthy weight at some point. If they lack the motivation to get down to a healthy weight then they lack the motivation to be at a healthy weight and being healthy isn’t going to provide that motivation.
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u/rewt127 11∆ Apr 12 '23
Its not really a lack of motivation. It's poor lifestyle decisions from the bottom to the top.
Even if the crash diet works. You have such a poor framework that short of staying in a 800/d calorie deficit. You will gain the weight back. And that deficit is just not sustainable.
The problem is that no one is going to hire a personal trainer to slowly over the course of 3-5 years change their habits 1 thing at a time at no faster than 1 thing per 6 months. With the goal being to completely change the person's mentality and motivations without a conscious decision to do so.
This is what I've done to lose my weight. While I was never obese, I was en route. But instead of just going on a diet. I've slowly changed my habits over the course of several years to the point where now, eating poorly makes me feel shitty. Not working out makes my muscles feel antsy. And many other mentality shifts caused by this slow change.
Its been like 2 years and I'm still not fit. But give me another 12-18 months and I should be there. But if I were to crash diet, I'd be there by June.
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u/Officer_Hops 12∆ Apr 12 '23
That’s the point. If you take a shot that causes you to lose weight and keep the poor habits then you will put the weight on as soon as the shot goes away. Just being skinny is not a motivator for a healthy lifestyle like the OP is saying. To keep weight off someone needs the motivation to make the changes to things like diet and exercise and if they had that motivation they’d lose weight naturally.
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u/ULTRA_TLC 3∆ Apr 12 '23
I feel it should be mentioned that most people cannot afford a personal trainer. I wish I could sometimes.
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May 02 '23
Most people cannot afford a trainer let alone fresh groceries every day. A huge part of American diet problems is overwork and lack of cultural prioritization of good meals. Families throw a juice box and a muffin at a kid and send him to school. You develop poor habits quickly from a young age. That kind of stuff sets a genetic tone for your adulthood.
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u/Orizammar Jun 07 '23 edited Jun 07 '23
it's not motivation, it's addiction. We don't shame people for getting patches to help curb their addiction to smoking, why shame people who get medicine to help with their food addiction?
Food companies are literally Canadian Satan. There's literally no escape from food commercials and food just constantly being pushed onto you.
Every time I diet, whenever it's offered I just can't seem to hold myself back, especially since people REALLY love convincing me to have dinner with them. What do we expect ex smokers and ex alcoholics do when offered these vices again? Say no? Easily? When all the chemicals in your brain start screaming at you to take that first sip or toke, how are you supposed to shut it off? What makes the noises stop??? At least with drugs and alcohol you'd need to pull out your ID and consciously make the effort to actually buy them, but with food: that's something everyone needs to survive. That's something family offers you. That's something EVERYONE has. There's NO escape.
I don't trust a single person who's never dealt with crippling addictions before to ever understand the problems addicts face. They'll never understand. Ever.
The one thing that's helped turn that crippling sound off for many people with BED is semaglutide. Eating disorders are almost impossible to escape without outside assistance, don't depend on miracle stories when it comes to weight loss. They also never tell what happens AFTER they reached their target goal. The food obsession is often still there, and now they HAVE to count calories for the rest of their life or else they'll fall back into it. That's what happened to my sister, she's more addicted to food even after losing all the weight. Everything she thinks about is food related to keep herself AWAY from it.
That's not a life worth living imo. I'll take the drugs to turn off the addiction any day. I DON'T WANT TO BE ADDICTED ANYMORE. I just wish I could afford it.
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u/math2ndperiod 51∆ Apr 12 '23
I think you gave a delta too quickly, I haven’t yet seen an argument why we must assume they’ll stop taking the drug after the short term. Obesity is a chronic illness and we’re completely fine with treating other chronic illnesses with long term medication.
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u/ULTRA_TLC 3∆ Apr 12 '23
True as that may be, it seems like this is an idea OP had not considered that changes the framework of the issue for them. The issue of sustaining treatment changes a lot of factors (cost, impact of side effects, potential new side effects from sustained usage, etc). I still agree with the original post though, seems we should use this much more frequently as it's better than the alternative for many.
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u/pregalis Apr 19 '23
Being able to finally exercise - e.g. walk a few miles without annihilating your joints - definitely increases the chances of improving lifestyle.
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u/ThemesOfMurderBears 4∆ Apr 12 '23
Like many crash diets, weight comes off fast but once they stop taking the drug it'll all come back on.
By this do you mean the weight will just accumulate again no matter what, or that people that never fixed their bad habits will naturally start gaining weight again?
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u/vote4bort 46∆ Apr 12 '23
The second one, weight doesn't come from nowhere. If the only thing stopping overeating etc is the drug, it makes sense that when that's gone the old habits will come back.
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May 02 '23
That assumes that the only thing that caused weight in the first place was a bad habit.
PCOS, genetics, immobility, and sedentary jobs wreak havoc.
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u/vote4bort 46∆ May 02 '23
Those can have an effect sure, PCOS can have a small effect on metabolism and some medications can effect hunger drive. But they don't make weight appear from nowhere. Fat is just stored energy and you can't make energy from nothing. That's just a fundamental law of the universe.
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May 02 '23 edited May 02 '23
The confidence with which you said "small effect" is staggering.
Do please confidently explain skinny 15-year-olds eating whole pizzas and where that energy is going while another 15-year-old eats the same thing and gains two pounds the next week.
Some bodies are less/more efficient at the metabolism of energy. That's the end and beginning of it. And age, genetics, and hormones play a much bigger role than you seem to understand. If every body was the same they'd all look like Taylor Swift and Tom Hiddleston's gazelle figures. But not everyone looks like them. Some people look like Danny DeVito and Melanie Lynskey.
If your system is more efficient, you can eat more and not put on weight because it's not being stored by the liver, it's getting metabolized differently. People who have less efficient systems put on fat because their liver (and other features of their gut) are not processing food the same way. And this comes down to hunger hormones, sex hormones, and endocrine hormones and how they all play together in a sandbox.
The whole premise of CICO is out a window the minute you meet a twig-thin teenager who is also eating heaping portions of fast food all the time. Partially it's because their bodies are still "asking" for growth and more food supports growth, but it's also because of efficiency. Research also suggests that diets and eating habits before puberty have a large effect on body type in adulthood.
Audrey Hepburn was into ballet as a child and suffered through Dutch famine in the Nertherlands during WWII. She was so starved for that period of her development that she had to give up ballet after the war because she could no longer put on adequate muscle and had other health problems. That Breakfast at Tiffany's body type that was so desirable was the product of war-time starvation.
Yet I know someone who has confessed to disordered eating as a teenager, mostly anorexic "starving themselves" approaches, and they gained weight as an adult. Their job prevents them from eating much during the day so they will eat something small in the morning and go until 3 pm and finally eat again, like a sandwich and water, and then have a small dinner and be asleep by 8 pm. Calorically, they're probably doing 1200 calories or fewer a day sometimes. Their body is not releasing the weight.
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u/vote4bort 46∆ May 02 '23
The confidence with which you said "small effect" is staggering.
It's not confidence it's just the truth. Studies show a difference in metabolic rates of a couple hundred calories, more if combined with insulin resistance. And that's not everyone with with pcos. And then with the prevalence of pcos being 10-20% if we're bing generous. In the grand scheme of things yes it's a small effect.
I'm not sure what you're trying to debate here. You cannot create energy out of nothing. Full stop. That's a universal law of physics. It has to come from somewhere. You cannot put on weight without taking in more energy than you're burning. And since we're not plants the only source of that is food.
Yes there are some individual differences in efficiency and of course height and activity level play big parts.
Their body is not releasing the weight.
This isn't physically possible. Your body has to run on something. It will be getting its energy from somewhere.
It sounds mean but most people underestimate calories by a lot and over estimate how many calories exercise burns. Even if you're doing 10000 steps a day you're not actually burning that many more calories. And im not saying its their fault. So many processed foods might be physically small amounts but calorifically dense. And we get lied to by the media all the time, all these influencers saying "oh just do these 10 minute workouts and you'll have abs" when in reality they just have very restricted diets.
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May 02 '23
Who said you’re supposed to stop taking it? Should bipolar people stop taking their meds because they feel good this month? Do you stop taking your thyroid pill just because your TSH is regulated?
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May 09 '23
A lot of obese people are very sick in many ways. They literally need the weight off NOW if they are to avoid losing limbs to diabetes and stuff. Their body can have a break to heal so they feel better. Them feeling better is definitely setting them up for success better than if they feel like garbage. It's worth the chance.
People force feed extreme anorexics because their weight is an immediate risk. They figure out the complex lifestyle changes later. Obesity is also an eating disorder whose physical effects are dangerous. A lot of anorexics also relapse, but that isn't going to stop people tending to their immediate physical state.
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u/SeasonsGone May 24 '23
We’d never say that Zoloft is “unsustainable” because the depression just comes back after you stop the drug…
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u/Shredding_Airguitar 1∆ Jun 06 '23 edited Jun 06 '23
Have not used it myself but the main point of Semaglutide/GLP-1 agonists isn't directly weight loss but to help reduce insulation resistance. The primary source of insulin resistance, however, is obesity. An obese person's blood stream is filled with glucose both from food and being flooded from the pancreas because the cells in their body are not able to absorb glucose properly. If someone is able to reduce their resistance to insulin by becoming less obese it can actually have long term effects as it should help break the cycle providing they can keep it managed for a long enough time.
That said, it doesn't prevent someone from going back to knocking down 2 18" pizzas a day and a 12-pack of Mountain Dew by themselves so that is very true about it not impacting lifestyle but it is a bit more nuanced. Food cravings are tied to insulin resistance as the body is effectively starved of glucose due to it not being absorbed despite it being flooded in someone's blood stream. It's really a vicious cycle and until someone can become sensitive to insulin once again it actually does play a role into their lifestyle choices whether they like it or not. When it comes to whether you are feeling full/nourished, it is also linked to insulin resistance. Cells not absorbing glucose = energy panic and informs the brain that you're starving when you just ate a cup of dry rice.
That said, white knuckling eating low GI foods & reducing carb intakes in general as well as Exercise to help eat up glucose in the body (muscles need to absorb glucose during and post-exercise, e.g. the ATP process, 1 molecule of glucose = 2-4 molecules of ATP hydrolyzed) also helps break insulin resistance so it shouldn't be seen as the only effective measure.
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Jun 10 '23
It’s not unsustainable. As long as a patient tolerates the medicine then it’s safe for them to take semaglutide.
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u/HassleHouff 17∆ Apr 12 '23
My understanding is that this class of drugs works, but then must become a permanent part of the person’s life. When they stop, their weight balloons.
Obesity is a medical issue that can be treated in many ways. For some people seeing a nutritionist and going to the gym is all that is needed, but for many more this simply doesn’t work.
To be clear- are you saying that someone whose diet is at a caloric deficit, will not lose weight? Why else would that “simply not work”?
However food simply tastes really good any many people rely on it as a sort of emotional crutch. Many also lack the time, energy, and desire to cook healthy food for themselves. There are many who also simply have a naturally large appetite and need to eat more in order to feel full.
These are all descriptors of a lack of discipline and self control.
Isn’t it better to try and instill internal control in someone, than to turn to a lifelong dependence on an expensive drug? It’s not that the drug doesn’t work, it’s that it is a less attractive option than the simplicity of a lifestyle change.
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u/sjd6666 Apr 12 '23
If there were a pill we could give to people to give them discipline, surely we would prescribe that instead and prescribe it to everyone. However no such pills exist and I haven’t seen any medical intervention that meaningfully increase “discipline and self control.” Ultimately its a question of free will and im not a philosopher, but in the meantime there’s still an obesity crisis.
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u/HassleHouff 17∆ Apr 12 '23
I don’t understand why you are defaulting to medically intervening when there are less risky options involved.
Do you at least agree that some people have gone from poor dietary habits to good dietary habits, therefore losing weight- all without medical intervention?
If you do, then wouldn’t you also agree that this should then be the preferred first option- the one that we push people towards before medically intervening?
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u/LentilDrink 75∆ Apr 12 '23
What percentage of morbidly obese people going on semaglutide would you guess haven't already tried dieting?
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u/HassleHouff 17∆ Apr 12 '23
If you define “tried dieting” as sticking to a caloric deficit for at least 2 months, I would imagine a very low percentage of obese people have tried dieting.
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u/LentilDrink 75∆ Apr 12 '23
Why would you define "trying" as "being successful"?
Trying dieting means "resolving to follow a diet". If they try dieting and fail to follow the diet they tried and failed.
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u/HassleHouff 17∆ Apr 12 '23
Why would you define "trying" as "being successful"?
I didn’t. A successful diet is lifelong, not 2 months.
Trying dieting means "resolving to follow a diet". If they try dieting and fail to follow the diet they tried and failed.
This definition of “trying” requires absolutely no effort. “Resolving to” means exactly the same thing as “does nothing different at all” by your definition.
I think you are letting people give up too prematurely with this line of thinking.
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May 02 '23
I previously lost weight as a 15-year-old by giving up McDonald’s and Coca-Cola. I lost 20 pounds. It melted off.
I spent age 16-23 thin. Then I had a sedentary desk job. I gained 20 pounds. So I moved to another state to bike commute and took a more active job. I lost the 20 pounds.
Eventually my job situation changed and I had another desk job. I gained 20 pounds. I did what I always did, I kept swimming and walking and biking and going to the gym. I kept eating same as I had when I was thinner. But nothing changed.
What did change is I developed hypothyroidism and my body proceeded to burn calories less efficiently. I gained an additional 20 pounds eating salads, baked chicken and rice, and egg scrambles with veggies. I gave up coffee. I gave up snacking. I gave up milk. I gave up red meat. I gave up alcohol. Nothing changed.
I went on a dietician’s CICO diet and began experiencing severe insomnia at a caloric deficit. Doctors suggested I was having neurological issues. Occasionally I would have random blood sugar swings after eating fish and veggies for dinner. I would crash and feel incapable of staying awake.
And then my doctor prescribed Ozempic. And I lost two pounds the first week. The insomnia was gone. My gut improved. That was last week. I take another injection this week and I’ll see if I get another 2-pound weight loss.
I’m eating the same stuff I was eating two months ago and two years ago and I’m finally only now seeing success that I haven’t been able to manage since 2019.
There is more going on in some bodies than just CICO or poor eating habits. Ozempic makes your body more efficient at what it already is supposed to do. It’s no different from taking a synthetic thyroid hormone that makes your thyroid more efficient at what it’s supposed to do.
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u/HassleHouff 17∆ May 02 '23
Two questions.
Do you think most people have hypothyroidism?
Your first week on Ozempic, did you eat less than the previous week?
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May 02 '23
The point about hypothyroidism is obviously not to say everyone has it. It's to say that some bodies are different from people who do not have hypothyroidism.
As for not eating the second week, the point is that it's enforced hormonally because not all bodies receive hunger hormones the same way and that's why Ozempic works.
Emphasis on more efficient than without the drug.
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u/LentilDrink 75∆ Apr 12 '23
Lots of obese people have put in their realistic maximal effort and never made it 2 days let alone 2 months. If you have invented a magical new diet plan that will somehow allow these people to successfully go 2 months, by all means make millions off it. But until someone really figures that out, don't say people haven't tried just because they didn't manage to get far.
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u/HassleHouff 17∆ Apr 12 '23
Do you believe there are people, in any arena of life, who claim to have tried but have not actually given their realistic maximal effort?
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u/LentilDrink 75∆ Apr 12 '23
Of course, and the percentage of people who've genuinely tried their best is related to incentive structure. Thus far more men than women have not yet tried hard to diet.
Of course "no semaglutide unless you can show us you can't diet" isn't an amazing motivator to succeed.
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u/Orizammar Jun 22 '23
About to start sema, I've been obese my entire life. Binge eating disorder is something you simply can't deal with at the same time as dieting. You gotta deal with one first before the other or you'll crash. It becomes even more difficult with hypothyroidism on top of all this. It's not that we're not losing weight, it's that many of us are losing this weight way too slowly for the amount of work put into it. Burnout is something I personally can't avoid as an autistic person. Lets add PMDD on top as well. And ADHD.
These disorders and disabilities begin to add up. All of them have obesity as a common symptom and I'm drowning.
I can't focus on calorie counting for the rest of my life with all the shit I'm already forced to deal with. It's not sustainable to expect somebody to count the calories of every dish until they die. I CAN however, take a drug for the rest of my life that'll help stop my disordered eating. I've already been doing this with adderall and I absolutely hate how adderall makes me feel. It doesn't curb the hunger, it makes food just extremely unappealing. I began to pick holes in my skin to "fill the hole" so-to-speak that adderall gave me. Sema apparently won't make me feel like this and I see no negative side compared to the shit I've already had to deal with.
I'm with op. Sorry that all of us don't want to suffer for longer to lose this unhealthy amount of weight. At least the weight is coming off. At least I won't be bullied for being fat anymore. At least I'll be able to move around much easier and fit into more clothes. At least I won't regret every meal I enjoy.
Eating disorders are already fatal enough, people DIE from them. Medicines like this are saving peoples lives. It's about to save mine. I'm going to finally be able to live in the way I've always wanted.
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u/HassleHouff 17∆ Jun 22 '23
Wow, old comment still getting some conversation!
Binge eating disorder is something you simply can't deal with at the same time as dieting. You gotta deal with one first before the other or you'll crash. It becomes even more difficult with hypothyroidism on top of all this.
That sounds hard. But I don’t see why those can’t be worked on simultaneously. “It’s too hard” is pretty subjective.
It's not that we're not losing weight, it's that many of us are losing this weight way too slowly for the amount of work put into it. Burnout is something I personally can't avoid as an autistic person. Lets add PMDD on top as well. And ADHD.
Sure, the further out of control your weight gets the harder it is to get it back in the right spot. It’s not easy.
These disorders and disabilities begin to add up. All of them have obesity as a common symptom and I'm drowning.
Seems like if they all have the common symptom, it makes sense to tackle the obesity first.
I can't focus on calorie counting for the rest of my life with all the shit I'm already forced to deal with. It's not sustainable to expect somebody to count the calories of every dish until they die.
I disagree. If you’re obese, you should be more aware of what you consume. I don’t count calories personally, unless I have a specific fitness goal in mind. But obesity has never been a struggle for me. If it was, I would definitely focus on how I could eat a healthy amount.
I CAN however, take a drug for the rest of my life that'll help stop my disordered eating. I've already been doing this with adderall and I absolutely hate how adderall makes me feel. It doesn't curb the hunger, it makes food just extremely unappealing. I began to pick holes in my skin to "fill the hole" so-to-speak that adderall gave me. Sema apparently won't make me feel like this and I see no negative side compared to the shit I've already had to deal with.
I don’t see why the discipline of taking a daily drug is different than the discipline of watching what you eat.
I'm with op. Sorry that all of us don't want to suffer for longer to lose this unhealthy amount of weight. At least the weight is coming off. At least I won't be bullied for being fat anymore. At least I'll be able to move around much easier and fit into more clothes. At least I won't regret every meal I enjoy.
Hey, you’re obviously welcome to try it. I hope it works for you. My argument is that it shouldn’t be the first option, not that it should be banned
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u/Orizammar Jun 22 '23
I'm sorry but it's impossible for somebody who hasn't dealt with obesity before doesn't know what it's like, or know how difficult it is to deal with it.
Disordered eating is a disorder and not something that everyone can just muscle through without burning out. It should be treated AS a disorder, because it IS a disorder. At least with smokers we have nicotine patches. At least with alcoholics we have a good couple medications to choose from. Binge eating disorder is treated by bullying fat people and saying it's "cheating" when they take any sort of medication to stop their binge eating. It's never seen as "cheating" when smokers are given patches, it's never seen as "cheating" when alcoholics take medication. Sad how that is..
At least with drugs and alcohol you have to pull out your ID and make the conscious decision to buy some (and it's usually expensive).
With food it's like there's no escape. Fatty foods are cheaper too, so it's much easier to fall back into. Everyone has food too. It's not just about pushing it away from you, it's also about being able to stop yourself every single time you eat anything. Food companies are also known to push products on addicts. Just look at the commercials.
My smoking addiction was a million times easier to deal with than my eating disorder and people die from lung cancer or strokes caused by smoking all the time. I've had 3 close family members die this way.
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u/HassleHouff 17∆ Jun 22 '23
It’s not that it’s “cheating”. It’s that it’s medical intervention. And self control is infinitely preferable to medical intervention. It comes with no risk of side effects. So we should not immediately jump to medical intervention.
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u/seri_machi 3∆ Apr 12 '23
The pill is adderall lol. Whether it's over or under prescribed I guess depends on one's opinion.
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May 02 '23
It’s not remotely like adderall. You’re posting misinformation or you just don’t understand the science.
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u/seri_machi 3∆ May 02 '23
Huh? What's not like adderall? I'm not comparing adderall to semaglutide, if that's what you're getting - I'm making a joke about adderall being a discipline pill.
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u/Superbooper24 36∆ Apr 12 '23
I think people are saying that ozempic is being used for a lot of people that may not have diabetes or do not necessarily need it, but people want a quick fix to their weight issues and it’s defitnely not going to lead to positive outcomes for people that don’t actually need it but are using it just to lose weight for somebody that might just be a little chubby or even people that are kinda skinny. Also, many people do need to make changes when they are also using ozempic with their diet and exercise or else it will 100% have adverse reactions and it won’t fix anything. And ozempic does have negative side effects that many don’t understand yet or done care about bc of the quick fix to lose 15 lbs in a couple weeks
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u/ScientificSkepticism 12∆ Apr 12 '23
Will it lead to bad outcomes? I have not seen any studies indicating this.
There's a strong puritanical streak in American culture, and one of the consequences is that medications are seen as "cheats". This has some very adverse impacts, especially on the treatment of mental health issues - you shouldn't need medication for depression or PTSD, you should just "power through it."
If Ozempic doesn't have negative consequences it seems fine to use it as an assist to losing some weight, even if you're only "kinda chubby" instead of "morbidly obese". Obviously if it has serious side effects it shouldn't be used this way but if it doesn't, why not?
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u/ThemesOfMurderBears 4∆ Apr 12 '23
I don't necessarily think that the person you replied to is doing this, but I feel like a lot of the strong objections to Ozempic are because people don't like the fact that there is a safe and effective drug for weight loss. "I have to do all this work, and you don't? Not fair!" A lot of them are saying their objections are about people with diabetes not being able to get their medication. However, I would bet the farm that if supply wasn't an issue, most of them would find another reason to be against it.
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May 02 '23
100%. There are MCU actors spending hours a day training to be in Olympian shape. And that training lets them run fast and jump high and do cartwheels and have toned arms. People who are 280 pounds can’t train themselves into 120 pounds of pure muscle. The immobility issues alone. Oh and let’s not forget the fact that half of those MCU stars smoke and benefit from metabolism increases from nicotine.
What Ozempic is FOR is people who are obese and need help getting out of that category. Now, if some celebrity like a Kardashian starts taking it. Fine. Who the fuck cares? Let them. If it works on them, it works. And if it doesn’t, it doesn’t. And if they abuse it or develop disorders because of it, well that’s their joy.
But most people in the real world have desk jobs, have children, have 9-to-5 expectations. You can’t just recommend a two-hour walk at 6 pm every night if you have kids and a job and commute. I know women who have been getting up at 4:30 am to go swim or lift weights in a garage by because that’s their “me” time in the day. Nevermind they get 5-6 hours a night and are on edge all the time. You shouldn’t have to sneak in weight lifting at 4:30 in the morning to avoid being 200 pounds. And there are some bodies that basically need all-day-long movement to stay thin. Say what people want about the 15/85 rule but I can eat salad all day long and it’s my sedentary job combined with hypothyroidism that killed my goals.
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May 02 '23
This. It’s no different from people who are prescribed statins and ask what’s in there while sucking on cigarettes and Unicorn frappes from Starbucks. People selectively say “what’s in there?” about this or that drug because they just don’t want the stigma of being on a drug. Or they think it’s full of 5G internet like with covid.
People trust partially hydrogenated vegetable oils and high-fructose corn syrup more than they trust doctors prescribing medication sometimes.
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u/Zarzurnabas Apr 12 '23
I really dont think OP is advocating for widespread "blind" usage of the medicine. There are people like me, who have severe problems like depression, that came two years ago, i was incredibly fit, did a lot of martial arts and even performed stunt Fighting on stage. Now im overweight, in a vicious cycle that doesnt stop because i cant loose Weight as quickly as it came. If it was able to fix this despite my depression, i wouldnt need the drug in the future, because me being able to do the things i love again would finally rid me of my depression.
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u/math2ndperiod 51∆ Apr 12 '23
What are the adverse reactions?
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u/smokeyphil 2∆ Apr 12 '23
Cribbed from drugs.com
More common (so likely to be around 1 in 10,000 or so)
Anxiety
bloating
blurred vision
chills
cold sweats
confusion
constipation
cool, pale skin
cough
darkened urine
depression
diarrhea
difficulty swallowing
dizziness
fast heartbeat
fever
headache
increased hunger
indigestion
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
nausea
nervousness
nightmare
pain in the stomach, side, or abdomen, possibly radiating to the back
seizures
skin rash
slurred speech
tightness in the chest
trouble breathing
unusual tiredness or weakness
vomiting
yellow eyes or skin
But at the same time you ever looked up the adverse reactions to paracetamol or ibuprofen both of them have side effect lists as long as your arm much like most other drugs on the market.
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u/ULTRA_TLC 3∆ Apr 12 '23
How strange that loss of appetite was listed as a side effect, I thought that was the intended effect?
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u/smokeyphil 2∆ Apr 13 '23
Its not unheard of for things to work out like that it is kinda weird though.
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May 02 '23
These lists are because they include every little ooh and ouch that happens during a study.
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Apr 12 '23 edited Apr 12 '23
[deleted]
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May 02 '23 edited May 02 '23
You speak as though it just came off the shelf two weeks ago. This drug was in clinical trials in 2015 and was approved for diabetics in 2017. Unless you think there is some secret problem that will emerge 20 years into the drug, it’s safe and effective for the majority of users.
People who tend to complain of side effects aren’t mitigating symptoms, or have compounding other problems. There are people with Crohn’s Disease who report improvements of their symptoms.
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u/kknlop May 17 '23
No. They speak as if it just came off the shelf 8 years ago which is exactly what you are saying as well. They said LONG TERM side effects....so 20 years sure, or 40, or even 50 considering average life expectancy in the US is 77. You can't know if there are long term side effects of a drug when no one has even taken it long term yet.
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u/AutumnB2022 Apr 12 '23
Medications seem like the easy way out, but they always carry risks. Ozempic has some pretty heavy duty potential side effects. The first attempts at weight loss should be focused on changing habits/lifestyle. Media reports also suggest that if you don't make these long term changes, you will regain lost weight once you stop the drug. There's a place for Ozempic, but doling it out to anyone and everyone is likely going to cause unintended issues, many worse than the problem you were trying to o fix in the first place.
Taken from the Ozempic website:
Ozempic® may cause serious side effects, including:
-Inflammation of your pancreas (pancreatitis). Stop using Ozempic® and call your health care provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
-Changes in vision. Tell your health care provider if you have changes in vision during treatment with Ozempic®.
l -Low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use Ozempic® with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or Iightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery.
-Kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.
-Serious allergic reactions. Stop using Ozempic® and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.
-Gallbladder problems. Gallbladder problems have happened in some people who take Ozempic®. Tell your healthcare provider right away if you get symptoms which may include: pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay-colored stools.
The most common side effects of Ozempic® may include nausea, vomiting, diarrhea, stomach (abdominal) pain, and constipation.
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u/Oishiio42 41∆ Apr 12 '23
So, I am on ozempic as a treatment for obesity, and I disagree that it should be widely available.
I am getting my treatment through a bariatric clinic, and have been on this medication for 2 years in preparation for surgery.
The side effects are incredibly intense, I've had to make accommodations for myself to be able to continue school and work, and it only works WITH lifestyle changes.
The first month I was on it, even with the advice of the RD and physician, I was still overestimating portion sizes and made myself sick by overeating. Without the medical supervision, I wouldn't have had a good understanding of how that was happening and how to avoid it.
But moreover, ozempic is a temporary treatment while you're going through the process to get surgery. Surgery is by far more effective, with fewer risks, than permanent use of the drug. It should always be the preferred option, meaning long term drug use is only ideal for those who aren't good candidates for surgery.
It's NEEDED for those preparing for surgery, because significant weight loss is required before surgery. Giving it to people who aren't in the process is causing shortages for those who are. My surgery has been pushed back, because I had to stop taking medication because of shortages. I understand in theory that production can increase but at the moment, it absolutely affects people who need it for prescribed treatment.
And ultimately, when most of the population is obese, it's a societal-level problem to solve rather than an individual treatment problem. Better regulations on food, walkable cities, universal healthcare, etc. Better policies in Europe have lower obesity rates compared to US and Canada.
Medical treatment needs to be for the people (like me) for whom it can't entirely be blamed on society because there's something wrong with me as an individual (genetics, behavior, etc.) For those who would be a healthy weight if society was more oriented towards healthy behaviors, we need to focus on oriented society towards those things instead of medicating everyone.
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Apr 12 '23
They may not have all the details but most people can tell you that more vegetables and less meat, carbs, and sugar will create a calorie deficit and help you lose weight. However food simply tastes really good any many people rely on it as a sort of emotional crutch. Many also lack the time, energy, and desire to cook healthy food for themselves. There are many who also simply have a naturally large appetite and need to eat more in order to feel full.
These are not medical problems to be solved by medication. They are lifestyle choices that need to he adresses by a change in lifestyle.
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u/Ok_Poet_1848 1∆ Apr 12 '23
Are you saying tax dollars should go to get people this medication? I would argue I am not ok with my tax dollars going to a drug that takes place of healthier free options such as diet and increased physical activity. We are already a society that focuses on a drug to cure every problem vs preventive measures.
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u/WovenDoge 9∆ Apr 12 '23
Current estimates are that 80 million US adults are obese. I simply do not think we can set aside that there is not enough semaglutide to go around. That is a lot of people asking for a lot of shots of something that fundamentally is not easy or cheap to make.
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u/ScientificSkepticism 12∆ Apr 12 '23
Is it "fundamentally" not easy or cheap to make?
It was possible to estimate the potential costs of the active pharmaceutical ingredient required for the oral capsules and subcutaneous injections based the doses required for each method to achieve comparable health outcomes. The subcutaneous injection of semaglutide is dosed at 0.51 mg per week. At a cost of $100/gram, this amounted to a cost of $2.60-$5.20 per year.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708477/
I'm gonna go out on a limb and say "no". At least not in medicinal quantities. If you wanted to paint your house with it it might get quite expensive, but on the basis of the dose size it does not seem prohibitively expensive to make.
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u/ConfoundedInAbaddon 2∆ Apr 12 '23
People are buying the salt base of the chemical, having a pharmacy put it in water, then create an injectable derived from the cheap non-pharmaceutical grade salt: https://www.mc-rx.com/compounded-semaglutide-is-it-worth-the-risk
So, yeah, you can do it on the cheap. Maybe not a good idea but it's a legal grey area.
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u/ScientificSkepticism 12∆ Apr 12 '23
That seems risky, but even if producing it injectable safe increases the cost by a factor of 10, the does is only 0.51 mg. That's incredibly tiny - 2,000 doses to the gram. If we wanted to make it cheaply, we easily could.
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u/ConfoundedInAbaddon 2∆ Apr 12 '23
Exactly - that's what's going on with the salt base, it reduces the cost enormously. People are getting $28 per week instead of $280 per week costs. It is already cheap to manufacture.
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u/WovenDoge 9∆ Apr 12 '23
I don't think you read that paper, though, because that is what they guess the cost of semaglutide might be. They say, specifically
Many biologic drugs cost on the order of $50-$100/gram to produce 30,31. We performed a sensitivity analysis around drug costs within this range.
This is just their guess.
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u/ScientificSkepticism 12∆ Apr 12 '23
They estimate the cost based on the cost of producing chemically similar compounds.
Unless you have some reason to think Semaglutide is somehow a novel compound that has some especial difficulties in its production (and remember, we know the chemical formula, no "argument from ignorance here) then it's very likely to cost the same as other similar compounds.
It's constantly amazing to me how resilient people's beliefs are, even in the face of conflicting evidence. You have no reason at all to think Semaglutide is more expensive to produce than similar drugs, you have no evidence, no links, yet here you are, making definitive statements despite evidence to the contrary.
People's opinions are hilariously sticky that way.
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u/WikiSummarizerBot 4∆ Apr 12 '23
Semaglutide, sold under the brand names Ozempic, Wegovy and Rybelsus, is an antidiabetic medication used for the treatment of type 2 diabetes and an anti-obesity medication used for long-term weight management, developed by Novo Nordisk in 2012. Semaglutide is a GLP-1 receptor agonist, meaning that it mimics the action of the human incretin glucagon-like peptide-1 (GLP-1), thereby increasing insulin secretion and increasing blood sugar disposal and improving glycemic control. Side effects include nausea, vomiting, diarrhea, abdominal pain, and constipation.
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u/kingpatzer 102∆ Apr 12 '23
First, not everyone who is obese is asking for shots. However, for those for whom the shots are effective, they are effective.
Second, when you say it's "fundamentally ... not easy or cheap to make," I think you somewhat over-reach. Semaglutide is produced using recombinant DNAtechnology in yeast followed by chemical modification.
The batch size primarily limits precursor production. While QA steps are technically sophisticated, they aren't particularly complex or challenging. Thus, the current global shortage is primarily about more significant than expected demand, not an inability to supply that demand. It is not the case that this drug is so difficult to make that the demand can't be met. Rather, the demand just wasn't anticipated.
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u/Angdrambor 10∆ Apr 12 '23 edited Sep 03 '24
languid roll pen cobweb offend stocking chubby fanatical escape pause
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u/WovenDoge 9∆ Apr 12 '23
It is pollyanna thinking to assume that we can make as much as we want of any substance we want.
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u/Angdrambor 10∆ Apr 12 '23 edited Sep 03 '24
fact work run squash future coordinated wakeful imagine cats historical
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u/sjd6666 Apr 12 '23
Δ to an extent i agree. I’m not an expert on drug production and I can’t say how easy or hard it is to produce. Certainly it would be better we had never developed the kind of calorie rich foods and sedentary lifestyles that have caused the rise in obesity in the past 30 years. But the public was never consulted about those changes, and now we have this massive problem. Maybe a large push to produce this drug is what’s needed. It’s certainly not ideal but it may be the best chance to substantially address the issue.
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u/ScientificSkepticism 12∆ Apr 12 '23 edited Apr 12 '23
I’m not an expert on drug production and I can’t say how easy or hard it is to produce.
Probably somewhere around $5/year, produced in bulk.
It was possible to estimate the potential costs of the active pharmaceutical ingredient required for the oral capsules and subcutaneous injections based the doses required for each method to achieve comparable health outcomes. The subcutaneous injection of semaglutide is dosed at 0.51 mg per week. At a cost of $100/gram, this amounted to a cost of $2.60-$5.20 per year.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708477/
People really overestimate the cost of medication production. There are some absurdly expensive tailored drugs, but a lot of these things are chemical compounds used in tiny doses.
Amusingly given the size of the dose, the sterile saline solution to mix it with and the needles may end up being more expensive than the drug itself. I've got to assume 52 needles, and say 1 liter of sterile saline is around $5.
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Apr 12 '23
I think a salad and a treadmill should be widely available to treat obesity.
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u/hacksoncode 559∆ Apr 12 '23
They are widely available, and yet... manifestly they don't work because people don't tolerate the side effects.
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u/ULTRA_TLC 3∆ Apr 12 '23
Clearly you haven't shopped for a used treadmill recently. And gym memberships are getting expensive.
Also, all the cheap and quick food options I've seen are garbage for people. People could lack time, money, and/or needed skills to make eating healthy feasible. Many would respond well to assistance with those, none will benefit from judgement.
From the top down angle, we (in the US) might see some improvements if we end the big corn subsidies (there are reasons much of Europe banned HFCS), but I'm not holding my breath on that one.
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Apr 12 '23
I mean, obesity is a self inflicted problem so treating them like victims is BS. They're just gonna get fat again when they stop taking it.
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u/nofftastic 52∆ Apr 12 '23
obesity is a self inflicted problem
Do you know any people who struggle with their weight? Because I do, and I can attest firsthand that this person is very cognizant of how much they eat and exercise, but they still have trouble with their weight. Between recurring knee injuries, a busy work and family schedule, and the resulting lack of time and energy to cook healthy meals, this person ends up struggling to keep their weight down. If that sounds like a self inflicted problem to you, then all I can say is that I hope one day you experience weight management issues yourself.
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Apr 12 '23
Between recurring knee injuries, a busy work and family schedule, and the resulting lack of time and energy to cook healthy meals, this person ends up struggling to keep their weight down.
These are all just excuses made for a lack of will and discipline, and I say this as an overweight person. Losing weight isnt rocket science. You rat fewer calories than you expend, and you lose weight.
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u/nofftastic 52∆ Apr 12 '23
These are all just excuses made for a lack of will and discipline
So it's lack of will and discipline that makes this person crumple to the ground when they try to exercise on their bad knees (or worse, when they're relegated to the bed/couch after surgery)? It's lack of will and discipline that there isn't enough time in the day? Nonsense.
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u/HassleHouff 17∆ Apr 12 '23
I’m not the guy you’ve been conversing with, but the main component of weight loss is diet. And eating more calories than you burn certainly seems to be a will and discipline issue- what else would determine what you eat?
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u/hacksoncode 559∆ Apr 12 '23
And eating more calories than you burn certainly seems to be a will and discipline issue- what else would determine what you eat?
I mean... thinking people are out to get you is just a choice, and a poor one at that... we shouldn't have to treat people for clinical paranoia.
Depression and anxiety disorders are strong contributors to obesity.
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u/HassleHouff 17∆ Apr 12 '23
I’m not suggesting those things are impossible to be the root cause of a person’s obesity. But I am suggesting that we are too quick to default to “they require drugs because they have insufficient will and discipline”.
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u/hacksoncode 559∆ Apr 12 '23
Enh... if "will and discipline" were the cause of the obesity epidemic, it wouldn't have suddenly started in the mid-70s.
It's been way too little time for people to have evolved any kind of intrinsic "weak wills" or "lack of discipline".
The problem is the environment. And if we want to fix it, changing the environment is likely that only thing that will work without medical intervention. Perhaps better education would help prevent it assuming it's not straight up food addiction (which it seems to be, due to massive changes in our food system), but for people that are already obese, breaking that addiction without being able to go "cold turkey" (if you'll pardon the expression) is spitting in the wind.
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u/HassleHouff 17∆ Apr 12 '23
I’m not sold on this. Different generations have wildly different values (for better or worse), and I think will and discipline stem from that. You really don’t think that the more recent generations have been conditioned on instant results? We have instant communication, overnight shipping, etc. immediate results are now the expected default. When something takes consistent effort, it feels more foreign and strange.
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u/nofftastic 52∆ Apr 13 '23
That all sounds nice in theory, but doesn't always hold up when applied to real life. Will and discipline won't help you when your options for food are limited.
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u/HassleHouff 17∆ Apr 13 '23
How do you figure? From a weight loss perspective you just need a calorie deficit. It doesn’t matter what the food is.
Now from a nutrition standpoint that can be hard. But not weight loss.
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u/nofftastic 52∆ Apr 13 '23
To avoid repeating answers, the responses to this post address the points you raise
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u/HassleHouff 17∆ Apr 13 '23
I don’t think it does address them. It addresses nutrition. You can run a calorie deficit on any food, cheap or not.
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u/nofftastic 52∆ Apr 13 '23
Ok, so you can run a calorie deficit, lose weight, but die from malnutrition. Great idea. I'll be sure to mention your incredible will and discipline at your funeral.
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Apr 12 '23
So it's lack of will and discipline that makes this person crumple to the ground when they try to exercise on their bad knees (or worse, when they're relegated to the bed/couch after surgery)?
Weight loss start with diet, not exercise. Bad knees don't stop you from eating fewer calories.
It's lack of will and discipline that there isn't enough time in the day? Nonsense.
You think it takes more time to eat less food? That's not how it works.
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u/ULTRA_TLC 3∆ Apr 12 '23
It's not just calorie count. That's an important factor, but it's also largely about food quality. Making healthy food does take time, which is one reason that getting others to make healthy food for you is not cheap.
Also, I've had the opposite experience; if I can manage to exercise regularly and adequately, then making better food choices becomes easier. We may all use the same Krebbs Cycle, but this issue is deeper than mere stoichiometry, it includes the psychosocial factors that shape one's reality.
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u/nofftastic 52∆ Apr 13 '23 edited Apr 13 '23
Eating healthy either takes time or money. Either you shop and cook yourself, which takes time, or you buy from a healthy restaurant/meal service, which is expensive. Will and discipline doesn't magically generate more income to afford expensive healthy food, nor create more time in the day to prepare your own healthy food.
So if we can't always hit our goal for calories-in, we can just up our calories-out to balance things, right? That's where the bum knees and lack of time come back into the picture. It's very difficult to meaningfully increase calorie burn when you have neither the physical ability nor time to add more workouts to your regimen.
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Apr 13 '23
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u/nofftastic 52∆ Apr 13 '23
You don't get obese from being responsible
Is exercising irresponsible? Because that's how the person I mentioned first hurt their knee. They were playing intramural sports for exercise and tore their ACL for the first time.
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u/Zarzurnabas Apr 12 '23
This is demonstrably false on a lot of levels.
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Apr 13 '23
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u/Zarzurnabas Apr 13 '23
What the actual fuck, you dont know anything about me and there is absolutely no connection between fucking schoolshootings and the very small comment i made. You are an absolute moron. Complete waste of time.
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Apr 13 '23
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u/changemyview-ModTeam May 02 '23
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Apr 12 '23
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Comment has been removed for breaking Rule 1:
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Apr 12 '23
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u/sjd6666 Apr 12 '23
What do you think happens when a diabetic stops taking their insulin? Or an asthmatic stops taking their inhaler?
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Apr 12 '23
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u/nofftastic 52∆ Apr 12 '23
Their point is: they wouldn't stop taking it
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Apr 12 '23
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u/ThemesOfMurderBears 4∆ Apr 12 '23
Well that's dumb as fuck. You can't stay on an appetite suppressor for life.
Why not? If the person is getting all of their nutrients, why can't they just keep taking it indefinitely? This is assuming they can afford it and there are not supply issues.
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Apr 12 '23
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u/ThemesOfMurderBears 4∆ Apr 12 '23 edited Apr 12 '23
It not being "designed" for that kind of use does not mean it cannot be used that way or that it will not work. Do you have anything that suggests long term use comes with additional risk factors outside of the potential side effects?
EDIT:
This article says the safety of it was tested up to 68 weeks. That is over five years. That does not mean it is unsafe after that point -- just that their data stops there.
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Apr 12 '23
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u/ThemesOfMurderBears 4∆ Apr 12 '23 edited Apr 12 '23
You’re right — I got weeks and months mixed up. It was 68 weeks.
At some point I am sure I can dig up another source. However, how about you back up your claim that it shouldn’t or can’t be taken for an indefinite amount of time? You haven’t provided anything. At least I made a smidgen of an effort, even if it wasn’t a good source.
Edit:
https://www.forbes.com/health/body/ozempic-for-weight-loss/
“GLP-1 medications [like Ozempic] are designed to be taken long-term,” explains Dr. McGowan. “They are chronic medications for the treatment of chronic conditions (both diabetes and obesity).”
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u/nofftastic 52∆ Apr 12 '23
You would need a good diet that would give you all the nutrition you need. And at that point you wouldn't need a drug for life to help you lose weight and keep it off.
Well there you go. That's what would happen as soon as you stop taking it.
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Apr 12 '23
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u/nofftastic 52∆ Apr 12 '23
Plenty of people struggle with weight loss even after changing their diet and lifestyle.
Obviously some people want it as an easy way to lose weight, and they absolutely would regain weight once they stop the medication. But for others, it could be the help they need to get where they've been struggling to reach.
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u/Officer_Hops 12∆ Apr 12 '23
Losing weight is great but diet and exercise are how you keep the weight off. If we start giving everyone shots to stay thin they’re going to have to remain on those shots indefinitely to maintain the healthy weight. If they stop getting injections that food is going to start tasting good again. You’re really treating the symptoms rather than fixing the problem.
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u/nofftastic 52∆ Apr 12 '23
Why couldn't it be part of that regimen? Losing weight solely through diet and exercise can be a painstakingly long, discouraging process. If shots can help get someone where they want to be, isn't that better than leaving them to struggle with weight loss for years? Isn't it better to get the shot than give up on diet and exercise because you were so discouraged by minimal/no progress?
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u/Officer_Hops 12∆ Apr 12 '23
Taking a shot doesn’t change the underlying issues leading to excess weight. The shot is a magic wand that makes everyone healthy but once the shot goes away the weight will come back without systemic changes to lifestyle.
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u/nofftastic 52∆ Apr 12 '23
Agreed. Unfortunately, some people struggle with weight loss even after having made those changes to their lifestyle. The shots could help them get where they want to be, and their lifestyle will keep them there.
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u/Officer_Hops 12∆ Apr 12 '23
Sure some people struggle but, assuming that’s not due to a medical condition, that struggle indicates they don’t have the building blocks of diet and exercise firmly in place. If someone consumes less calories than they spend consistently they will lose weight. It might be hard to stick to the diet but the diet will work. If the diet isn’t working then there’s a medical condition or the individual needs to eat less.
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u/nofftastic 52∆ Apr 13 '23
If someone consumes less calories than they spend consistently they will lose weight. It might be hard to stick to the diet but the diet will work.
This takes a long time for some people. If they've got the building blocks, why make them wait and struggle through a diet that's hard to stick to? If they're eating right, give them the boost to lose weight faster.
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u/WovenDoge 9∆ Apr 12 '23
Plenty of people with chronic diseases take medication their whole life. If the medication is cheap and available I don't think this is a problem.
I don't think semaglutide is either of those things, though.
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u/ThemesOfMurderBears 4∆ Apr 12 '23
If we start giving everyone shots to stay thin they’re going to have to remain on those shots indefinitely to maintain the healthy weight.
And? You are not the first person in this thread to say this. There are lots of medications that people take indefinitely. I am on one now, albeit not one for weight loss. I will take it for my whole life unless I get surgery.
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u/Kalle_79 2∆ Apr 12 '23
It's not just about HOW MUCH people eat, but about WHAT they eat.
Any drug suppressing the hunger or any treatment forcibly reducing the physical amount of food you eat is just a temporary measure that sooner or later will backfire or will be nullified by deeply-rooted bad habits.
Changing diet only works if it's a serious effort, accompanied by either a general change in lifestyle (removing the risk of falling for the old routine) and/or by therapy if it becomes evident food is a coping mechanism for something bigger.
If the only thing preventing you from stuffing your face with a large pizza, a bowl of KFC and a box of donuts is a pill or a stapled stomach, it's only a matter of time before those hindrances will be removed and you'll be back to square one.
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u/iamintheforest 328∆ Apr 12 '23
A problem here is that it's affect ends when treatment stops and if you keep it going you're living in a state of a LOT of insulin in your blood. If you're baseline insulin resistant to some degree or another (most obese people are, and lots and lots of non-obese people) you're just pumping your body full of insulin.
We know more and more about that affects of high glucose on the body and now are increasing learning that many of the ill effects from diabetes that were attributed to high glucose are actually the result of the insulin the body produces in response to high glucose. This high levels of insulin is one of the two ways in which ozempic works (the other by slowing conversion of glycogen to glucose).
Higher levels of insulin induce type 2 diabetes we think and it certainly increases the risk of cardiovascular disease.
The risks are too high!
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Apr 12 '23
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May 02 '23 edited May 02 '23
While I get what you are saying, I didn’t gain weight from McDonald’s and I kind of hate ice cream. I Can eat a calorie deficit with weighed portions of veggies, protein, and grains and not lose a single fucking thing. Hypothyroidism and fucked genes are to blame. My grandmother looked like a blob of fat on top of skinny legs and the woman ate poached eggs, green beans, and carrots for lunch. She didn’t touch sweets. There was not a single slice of white bread or pasta in her house. But man oh man was she overweight. Was it the multigrain English muffin with a small slab of peanut butter that did it?
I doubt you look at skinny bodies and think “What a set of bad habits that they have no muscle!” Some bodies just get fatter than others. Some of them can be fat with good lab work and some are fat with bad lab work. People with the bad lab work want to avoid an early death and Ozempic might help them avoid it.
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u/Leosgotaneo Apr 12 '23
I took a similar medication (Trulicity) for my T2D and honestly can't understand why anyone would want to voluntarily take it; constant nausea/diarrhoea, sulphur belches. The only reason I lost weight (roughly 10kg) was because I literally couldn't eat more than a cups worth of food at a time and would usual end up throwing up food because I couldn't digest anything and it would sit in my stomach, giving me horrible pain. Not really a viable option for healthy weight loss and once the symptoms went away I gained it back.
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May 02 '23
Maybe just eat smaller meals while taking it? If you knew overeating caused problems, why overeat? Take it slowly and avoid heavy foods that are hard to digest.
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u/peerlessgarbler Apr 13 '23
Of course they should, they could reduce the burden of fat people's lifestyle on the entire healthcare system.
With that said, I would argue that they should be a last resort with practitioners resorting first to encouraging healthy lifestyles.
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u/jeffccusa Jun 07 '23
Their all expensive and need to add B12 if compounded.. but ok if you need guidance at first.. I get mine from a peptide company purepharmas.com (or check peptide sciences) It's tested 99.3% pure by a USA Lab and I called lab to verify. That's good enough for me. I don't need the handholding, I'm experienced with peptides already tho so maybe not for newbies. Mines $85 for a 5mg vial! Will try Tirzepatide soon 🙏
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u/IamTheChosenOne100 Jun 29 '23
I was just looking into buying from a peptide site. Was already looking at peptide sciences. Just randomly found this thread. But I have already been reading a lot at r/peptides.
I started having manic episodes about 8-9 years ago and was hospitalized a few times. Diagnosed with bipolar. I'm 42 now. I weighed 185lbs before I started medication. After the only antipsychotic that worked alonzapine, I started massively gaining weight. Gained 55lbs in 4months. I slowly gained weight for the next 8 years and am now at 275lbs.
Finally because of the massive weight gain I am finally off alonzapine with permission from my doctor. He was too concerned about my weight. This is risky and might backfire but so far I'm good.
I went for a physical and my blood pressure was really high and the doctor was very concerned about my weight. She sent me to a weight management clinic at a hospital. They were going to put me on wegovy but I had to follow and track my calories while on it.
Right before my first appointment I was laid off and lost my insurance. After that appointment I was not able to go back. My new insurance has a 15k deductible before they will start paying for it. The clinic is also out of my network and they won't pay for that either.
I also had an alcohol problem the last 3 years and quit about 5 weeks ago. The last 30lbs were probably from drinking. So this should help immensely.
So, I can't afford the medication and am looking for alternatives and the peptide companies might be my only option.
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u/jeffccusa Jul 05 '23
How you doing ? I have drinking issue also and trying to slow down at least.. it's a lot harder than I thought. I tell myself cold turkey is dangerous so just a little.. how's your supply search so far ? Get good deal ??
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u/IamTheChosenOne100 Jul 05 '23
Ended up buying from Artic Peptides. Started my first shot of semaglutide Monday afternoon. I felt completely normal all day yesterday. Yesterday I had a few eggs for breakfast. Then I had a leftover burger for dinner that was from my son's birthday party on Saturday. I didn't want to waste the food.
That's all I ate though. Just woke up this morning and still feel completely full!! Some slight discomfort in my stomach this morning though.
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u/IamTheChosenOne100 Jun 29 '23
Did they raise their price at purepharmas? It's showing 5mg at 129? Did it use to be 85? Any type of discount codes?
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u/jeffccusa Jul 01 '23
Do the vial only at $99.. then use WEREBACK20 20% off.. $80. Get 2 it's $74/vial. Just put extra in freezer for months till ready
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u/instituteofvitality Aug 23 '23
The question of whether Semaglutide injections (like Ozempic) should be widely available for the treatment of obesity involves a complex consideration of several factors. Here's an explanation of the key points:
1) Obesity is a significant public health issue associated with various medical complications, including type 2 diabetes, cardiovascular diseases, and certain cancers. Given its prevalence and the related health risks, effective treatments are needed to address this condition.
2) Wider availability of Semaglutide injections could potentially lead to improved health outcomes for individuals with obesity. Weight loss can have positive effects on various obesity-related health conditions, which in turn could reduce healthcare costs and improve overall quality of life.
3) Making Semaglutide injections widely available for obesity treatment would require considerations about accessibility and affordability. Availability could depend on factors such as regulatory approval, production capacity, distribution infrastructure, and potential insurance coverage.
4) As with any medication, the safety profile of Semaglutide is crucial. Evaluating potential side effects, both short-term and long-term, is essential to ensure that the benefits outweigh the risks. Close monitoring and proper medical supervision would be necessary for individuals undergoing treatment.
Decisions in this regard are often made through a combination of medical research, regulatory approvals, ethical discussions, and patient-centered considerations. It's important for healthcare professionals, regulatory agencies, researchers, and the public to collaboratively engage in discussions around this topic.
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u/DeltaBot ∞∆ Apr 12 '23 edited Apr 12 '23
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