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> When someone takes an anti-obesity medication like Mounjaro, the amount of fat the body wants to maintain is re-regulated, usually to a lower weight. “When yo

> When someone takes an anti-obesity medication like Mounjaro, the amount of fat the body wants to maintain is re-regulated, usually to a lower weight. “When you take the medication away, that defended fat mass goes back up, and weight is regained,” Jastreboff said. “In order to continue to maintain the new re-regulated defended fat mass, and weight reduction, you have to continue taking the medication.” This doesn’t seem worth it to me. I’m sure a lot of people would like to lose 25lbs but you’re making a deal with the devil to get it. It almost makes me think they design these drugs to make a recurring revenue stream instead of fixing the issue permanently.

lm28469 4y ago
> instead of fixing the issue permanently. That would require a major cultural shift, we're far far away from that
kemiller2002 4y ago
The real problem is not as a weight loss drug, but as a way to regulate diabetes. My girlfriend is on it, because the other medications don't work outside of insulin which has it's own difficulties. The sudden raise in price and her insurance refusing to pay for it means she either has to do it out of pocket or try and switch to something else which may or may not work. The real problem with using it as a weight loss is that it doesn't solve the underlying problem. Mounjaro makes it so that you can't eat. Eat too much and you get sick (seriously like 2 bites and you're done eating). Overeating is a psychological problem. The drug doesn't fix you wanting the food, it just makes it so that you can't eat it. Take the barrier away, and you're back to where you started.
- diordiderot 4y ago
  > The drug doesn't fix you wanting the food Shouldn't it _eventually_ have a pavlovian effect where you associate all food with nausea?
  - cjbgkagh 4y ago
    It seems strongly linked and such links are quickly extinguished. If there is a delay and randomness on getting sick it’ll be weakly linked and more durable.
  - ilikecakeandpie 4y ago
    It doesn't really work like that. The way it was explained to me, it slows your digestion down so you feel/are fuller for longer. It took a lot less for me to be satiated and effectively eliminated any kind of binge eating, but it wasn't because it made me nauseous; I just felt full. Once I got off the drug, I started eating more again. There are side effects, especially initially with loose stool and some nausea, but generally they don't last. I'm sure they persist with some but that's effectively every medication. The goal isn't to change the relationship with food where it makes one physically ill when seeing or eating food EDIT: My experience is with Ozempic, not Mounjaro. They may work differently
- drewbug01 4y ago
  > Eat too much and you get sick (seriously like 2 bites and you're done eating). While I’ve know some people experience more severe GI issues or nausea with the drug, this is quite the exaggeration. A drug that made it difficult or impossible to actually consume enough food to survive (more than “two bites”) would be wildly unsafe to prescribe.
  - hungryforcodes 4y ago
    Not at all short term. This is EXACTLY what fasting is. In fact a pill you could take in the morning that would suppress your appetite for 24 hours would be fantastic. You could use it three days a week with no ill effects and loose weight.
    - drewbug01 4y ago
      True. The comment I was replying to was talking about Mounjaro, which is a weekly injectable - and thus no way to do it for only three days a week. In that context, if Mounjaro made it impossible to eat to the degree the commenter described, it would be wildly unsafe (because of how long each shot lasts).
  - LazyMans 4y ago
    The first three days were like this.
  - me-vs-cat 4y ago
    This is not an exaggeration for my wife. For a full day after taking her weekly shot, she eats about 2 bites per meal.
- briffle 4y ago
  >Overeating is a psychological problem. Many would argue that drugs like this and Ozempic are showing that overeating is more of a hormone problem then a psychological problem.
- bedast 4y ago
  If she has insurance and a diabetes diagnosis, the coupon should apply. The coupon is still there. I use it.
drewbug01 4y ago
That “yo-yo effect” is frequently seen with people who try to lose significant amounts of weight. If you take the perspective of someone who has struggled with weight loss in the past (especially if prior results were not great and had trouble keeping the weight off anyways) - it’s not so much of a deal with the devil, if the drug actually works.
bryanrasmussen 4y ago
>“In order to continue to maintain the new re-regulated defended fat mass, and weight reduction, you have to continue taking the medication. I mean surely that can't be a 100% always the case, I would think it is either continue to take the medication or do a strenuous weight reduction program / eat less + exercise. but why is that important, because some people might be so obese that they need to lose 25 lbs (maybe more, just following what was written) to get to a point where the exercise part of that equation is at all doable.
ilikecakeandpie 4y ago
It is tough, but that initial "whoosh" can be the momentum someone needs to help them continue/maintain healthy habits they built during that time. I was put on Ozempic last year for a short amount of time. That, combined with changing of diet and starting an exercise routine, lead me to lose ~60 pounds in a relatively short amount of time (~8 months). I'm not taking the medication anymore and I did gain about 20 pounds back, but it's a lot easier going on a walk or run when you're carrying net 40 fewer pounds. Willpower and discipline are simple things but they're not easy. In my opinion, it's important that the patient uses it as boost instead of a crutch and don't get too discouraged if/when they wean off and gain some weight back.
- halfmatthalfcat 4y ago
  It may be a cynical take but I highly doubt most people searching for this drug are going to do what you have done. Props to you for sure but I fear this will just create another cycle of dependence that only benefits the company manufacturing the drug.
  - ilikecakeandpie 4y ago
    It absolutely can be something that creates a cycle of dependence but I tend to look at it as harm reduction at that point. Weekly injections aren't a fun process though and, at least for me, I was striving to be off any/all medication. Being told you're effectively Type II at 34 was not a fun experience for me and I've been trying to control/put it into remission without having to take Metformin and Ozempic. To be clear, I'm not intending to shame or throw shade at those who take or need the drugs, I just want to do all in my power avoid them as much as I can.
- GaryNumanVevo 4y ago
  I'm glad you were able to use Ozembic in that way, to me, that's the best use case. However, I don't see that being the norm, if you can just take Ozembic and keep those 60 pounds off permanently as long as you can afford it, then people are just going to do that
CuriouslyC 4y ago
For a lot of people, being obese impacts their ability to live an active lifestyle and desire to be social, which causes them to sit around and eat more, causing them to get fatter in a vicious cycle. Breaking the cycle for these people will have long term benefits. Other people just have a disorder, where they literally don't feel the full signals that normal people do, so they only feel "full" when their stomachs are stuffed to discomfort. These people are already consigned to a life of suffering, either from being obese or from constant hunger and an inability to have a normal relationship with food. In this case being on a medication for the rest of your life is the lesser of two evils.
bedast 4y ago
The biggest problem using these drugs for weight loss is they need to be used as part of a program that also includes making lifestyle changes. If you don't push the changes and just do things to your limits, when you stop the drug, your unchanged habits make you gain the weight back. This is one of the biggest things people with obesity struggle with. This is seen as a miracle cure for obesity because it doesn't require work, just a weekly injection and watch the weight melt off. But making lifestyle changes (changing eating habits, increasing activity, etc) is the most reliable way to make this a permanent fix. But that's putting the patient to work and they don't want that.
- treis 4y ago
  That's just not really true. People tend to gain weight and stabilize. It's not like they suddenly get will power. Most everyone has a weight they will end up at if they eat to satiation. These drugs lower that weight. Of course will power and environment changes can keep you at a lower weight but it's a constant struggle against your body.
- cameronh90 4y ago
  I take Wegovy for obesity, and it completely changes my behaviour. I don't often think about food any more, and when I do, I am quite happy preparing a small amount of healthy food. Not only that, I have more energy so I maintain a far more active lifestyle. Given that I can go for months without those "bad habits", but if I stop taking it they come back, I think they're more than habits. Habits break if you stop doing them for a while, these compulsions don't. Until I took this drug, I didn't know what it was like to be able to not constantly think about food and being hungry. I've been overweight for nearly my entire life since I was a breastfeeding baby, and this is the first time in my life that I don't feel like I'm being held hostage to my hunger. I have lost weight and maintained a healthy weight for periods of time, but I'm just hungry the whole time and eventually the hunger starts beating my willpower. For what it's worth I also have problems with anxiety. Similarly I tried years of therapy/mediation/mindfulness/etc. to get rid of my anxiety but it never went away until I took sertraline. Now, I live a pretty much anxiety-free life as long as I take a pill a day.

lm28469 4y ago

> instead of fixing the issue permanently. That would require a major cultural shift, we're far far away from that

kemiller2002 4y ago

The real problem is not as a weight loss drug, but as a way to regulate diabetes. My girlfriend is on it, because the other medications don't work outside of insulin which has it's own difficulties. The sudden raise in price and her insurance refusing to pay for it means she either has to do it out of pocket or try and switch to something else which may or may not work. The real problem with using it as a weight loss is that it doesn't solve the underlying problem. Mounjaro makes it so that you can't eat. Eat too much and you get sick (seriously like 2 bites and you're done eating). Overeating is a psychological problem. The drug doesn't fix you wanting the food, it just makes it so that you can't eat it. Take the barrier away, and you're back to where you started.

diordiderot 4y ago
> The drug doesn't fix you wanting the food Shouldn't it _eventually_ have a pavlovian effect where you associate all food with nausea?
- cjbgkagh 4y ago
  It seems strongly linked and such links are quickly extinguished. If there is a delay and randomness on getting sick it’ll be weakly linked and more durable.
- ilikecakeandpie 4y ago
  It doesn't really work like that. The way it was explained to me, it slows your digestion down so you feel/are fuller for longer. It took a lot less for me to be satiated and effectively eliminated any kind of binge eating, but it wasn't because it made me nauseous; I just felt full. Once I got off the drug, I started eating more again. There are side effects, especially initially with loose stool and some nausea, but generally they don't last. I'm sure they persist with some but that's effectively every medication. The goal isn't to change the relationship with food where it makes one physically ill when seeing or eating food EDIT: My experience is with Ozempic, not Mounjaro. They may work differently
drewbug01 4y ago
> Eat too much and you get sick (seriously like 2 bites and you're done eating). While I’ve know some people experience more severe GI issues or nausea with the drug, this is quite the exaggeration. A drug that made it difficult or impossible to actually consume enough food to survive (more than “two bites”) would be wildly unsafe to prescribe.
- hungryforcodes 4y ago
  Not at all short term. This is EXACTLY what fasting is. In fact a pill you could take in the morning that would suppress your appetite for 24 hours would be fantastic. You could use it three days a week with no ill effects and loose weight.
  - drewbug01 4y ago
    True. The comment I was replying to was talking about Mounjaro, which is a weekly injectable - and thus no way to do it for only three days a week. In that context, if Mounjaro made it impossible to eat to the degree the commenter described, it would be wildly unsafe (because of how long each shot lasts).
- LazyMans 4y ago
  The first three days were like this.
- me-vs-cat 4y ago
  This is not an exaggeration for my wife. For a full day after taking her weekly shot, she eats about 2 bites per meal.
briffle 4y ago
>Overeating is a psychological problem. Many would argue that drugs like this and Ozempic are showing that overeating is more of a hormone problem then a psychological problem.
bedast 4y ago
If she has insurance and a diabetes diagnosis, the coupon should apply. The coupon is still there. I use it.

drewbug01 4y ago

That “yo-yo effect” is frequently seen with people who try to lose significant amounts of weight. If you take the perspective of someone who has struggled with weight loss in the past (especially if prior results were not great and had trouble keeping the weight off anyways) - it’s not so much of a deal with the devil, if the drug actually works.

bryanrasmussen 4y ago

>“In order to continue to maintain the new re-regulated defended fat mass, and weight reduction, you have to continue taking the medication. I mean surely that can't be a 100% always the case, I would think it is either continue to take the medication or do a strenuous weight reduction program / eat less + exercise. but why is that important, because some people might be so obese that they need to lose 25 lbs (maybe more, just following what was written) to get to a point where the exercise part of that equation is at all doable.

ilikecakeandpie 4y ago

It is tough, but that initial "whoosh" can be the momentum someone needs to help them continue/maintain healthy habits they built during that time. I was put on Ozempic last year for a short amount of time. That, combined with changing of diet and starting an exercise routine, lead me to lose ~60 pounds in a relatively short amount of time (~8 months). I'm not taking the medication anymore and I did gain about 20 pounds back, but it's a lot easier going on a walk or run when you're carrying net 40 fewer pounds. Willpower and discipline are simple things but they're not easy. In my opinion, it's important that the patient uses it as boost instead of a crutch and don't get too discouraged if/when they wean off and gain some weight back.

halfmatthalfcat 4y ago
It may be a cynical take but I highly doubt most people searching for this drug are going to do what you have done. Props to you for sure but I fear this will just create another cycle of dependence that only benefits the company manufacturing the drug.
- ilikecakeandpie 4y ago
  It absolutely can be something that creates a cycle of dependence but I tend to look at it as harm reduction at that point. Weekly injections aren't a fun process though and, at least for me, I was striving to be off any/all medication. Being told you're effectively Type II at 34 was not a fun experience for me and I've been trying to control/put it into remission without having to take Metformin and Ozempic. To be clear, I'm not intending to shame or throw shade at those who take or need the drugs, I just want to do all in my power avoid them as much as I can.
GaryNumanVevo 4y ago
I'm glad you were able to use Ozembic in that way, to me, that's the best use case. However, I don't see that being the norm, if you can just take Ozembic and keep those 60 pounds off permanently as long as you can afford it, then people are just going to do that

CuriouslyC 4y ago

For a lot of people, being obese impacts their ability to live an active lifestyle and desire to be social, which causes them to sit around and eat more, causing them to get fatter in a vicious cycle. Breaking the cycle for these people will have long term benefits. Other people just have a disorder, where they literally don't feel the full signals that normal people do, so they only feel "full" when their stomachs are stuffed to discomfort. These people are already consigned to a life of suffering, either from being obese or from constant hunger and an inability to have a normal relationship with food. In this case being on a medication for the rest of your life is the lesser of two evils.

bedast 4y ago

The biggest problem using these drugs for weight loss is they need to be used as part of a program that also includes making lifestyle changes. If you don't push the changes and just do things to your limits, when you stop the drug, your unchanged habits make you gain the weight back. This is one of the biggest things people with obesity struggle with. This is seen as a miracle cure for obesity because it doesn't require work, just a weekly injection and watch the weight melt off. But making lifestyle changes (changing eating habits, increasing activity, etc) is the most reliable way to make this a permanent fix. But that's putting the patient to work and they don't want that.

treis 4y ago
That's just not really true. People tend to gain weight and stabilize. It's not like they suddenly get will power. Most everyone has a weight they will end up at if they eat to satiation. These drugs lower that weight. Of course will power and environment changes can keep you at a lower weight but it's a constant struggle against your body.
cameronh90 4y ago
I take Wegovy for obesity, and it completely changes my behaviour. I don't often think about food any more, and when I do, I am quite happy preparing a small amount of healthy food. Not only that, I have more energy so I maintain a far more active lifestyle. Given that I can go for months without those "bad habits", but if I stop taking it they come back, I think they're more than habits. Habits break if you stop doing them for a while, these compulsions don't. Until I took this drug, I didn't know what it was like to be able to not constantly think about food and being hungry. I've been overweight for nearly my entire life since I was a breastfeeding baby, and this is the first time in my life that I don't feel like I'm being held hostage to my hunger. I have lost weight and maintained a healthy weight for periods of time, but I'm just hungry the whole time and eventually the hunger starts beating my willpower. For what it's worth I also have problems with anxiety. Similarly I tried years of therapy/mediation/mindfulness/etc. to get rid of my anxiety but it never went away until I took sertraline. Now, I live a pretty much anxiety-free life as long as I take a pill a day.