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https://astralcodexten.substack.com/p/semaglutidonomics https://astralcodexten.substack.com/p/semaglutidonomics These new weight loss medications are the solut

https://astralcodexten.substack.com/p/semaglutidonomics https://astralcodexten.substack.com/p/semaglutidonomics These new weight loss medications are the solution to obesity. Imo this is one of the biggest medical advances of the century and at least in urban areas of wealthy countries, I don’t think we’ll see obese people anymore in 10 years. The pharma companies realized they’ve got something truly revolutionary so they took the old tried and true drug dealer strategy. Get ‘em hooked for free/cheap and then bump the price to capture the value. Can’t say it’s surprising, they’re just following the incentives. And as the link goes through, these drugs have the potential to be worth many billions of dollars over their lifespan.

msrenee 4y ago
Are they the solution to obesity? I'm curious as to whether the weight stays off long term. 10 or more years at least or else it's just another bandaid. What we need is better access to nutritious food that doesn't take up so much of folk's scant downtime and tight income. I understand there's lots of reasons people are obese that aren't just laziness, but the drug doesn't solve those either. They're still not getting the nutrition they need. It's an improvement having poor nutrition with a lower BMI rather than poor nutrition and their current BMI, but not any kind of solution in my opinion.
- icelancer 4y ago
  People saying that you have to be on X drug forever to solve your problem as if it's some silver bullet argument think.... what exactly about Type I diabetics who need to inject insulin every day, forever, to solve their problem?
  - msrenee 4y ago
    I get where you're coming from and want to clarify that my issue is not that you may have to stay on it for the rest of your life. I'm concerned that even while on the drug, your body could get accustomed to it, and you'd end up eating the same as before taking the drug. This happens a lot with bariatric surgery. I realize that that's due to the elasticity of the stomach, but the body adapts and with many medications that have weight loss as a side effect, your body eventually sorts itself out and you start gaining weight again.
- HDThoreaun 4y ago
  Depressed people take ssri’s their entire life. People with ADHD take adderal or the like. I don’t see any reason to think of obesity as a different type of disease. Some people just find it extremely difficult to keep off weight, it doesn’t matter what kind of food they’re eating. Yes they could eat less, just like I could keep my thermostat at 45 in the winter to save on my heating bill. But that’s not a realistic solution for most obese people.
  - DangitBobby 4y ago
    It 100% matters what food you are eating, no matter who you are or what conditions you may have.
  - lm28469 4y ago
    > I don’t see any reason to think of obesity as a different type of disease. Because it's man made and completely avoidable. Look at tobacco for example, it was the exact same thing until it wasn't because we woke up and decided to act on the issue Helping currently obese people to get out of the loop is good, breaking the system we built that make more and more people obese would be better. Also, being obese is only a part of the complications of eating shit and not exercising, the rest of the symptoms will catch up eventually, there are no magic pills
    - HDThoreaun 4y ago
      > breaking the system we built that make more and more people obese would be better. The system exists because people like it. I don't think it's possible to break it at this point considering how people normally react to having their life made worse. You can't stop people from eating what they want, but these drugs make it possible to change what they want.
      - lm28469 4y ago
        > You can't stop people from eating what they want, You can certainly stop advertising junk food to kids, that would be a good start. You can also regulate things you know, like not having your entire daily sugar requirement in a single can of soda Btw if you still eat the same garbage you'll still absolutely wreck your body, obese or not, you'll need a diabetes pill, a cardiovascular disease pill, a blood pressure pill, a kidney boosting pill, &c. You are what you eat, quite literally.
- hansvm 4y ago
  Not less nutritious food? Or is the argument that the [everything else] to calorie ratio should be higher?
  - azdle 4y ago
    > Or is the argument that the [everything else] to calorie ratio should be higher? Yep, that. My understanding of this argument (which for the record, I'm loosely convinced is probably true, but probably isn't the only, and maybe not the main, factor) is that your body's hungry signal is it needs non-calorie nutrients, but our food is less nutrient dense so you get a lot more calories than your body is prepared to handle for a given quantity of nutrients.
    - sjfidsfkds 4y ago
      If this were right, you could cure your obesity by mixing the right multivitamin into your food? It seems like if fixing some nutrient deficiency were all it took, we’d have figured it out ages ago.
- drewbug01 4y ago
  > 10 or more years at least or else it's just another bandaid. I wonder what the long-term health outcomes would be between two groups: one group that was obese the whole time, and another group whose obesity was delayed by ten years. I suspect the latter group would end up having fewer negative health outcomes over the course of their life - 10 years of essentially “reduced wear and tear” on different systems in their bodies. That is to say - even if it’s a bandaid, it may still be really useful for public health.
  - msrenee 4y ago
    I expect they would as well. However, I was replying to a comment that claimed this drug or something similar could be the solution to obesity and I have serious doubts about that. An improvement in health and longevity, even if it's substantial, is not the same as a solution. For example, if we discovered a drug that delayed severe illness/death from cancer for 5 years, it certainly wouldn't be called a solution to cancer. It would be amazing for sure, but that doesn't solve the cancer problem.
insapio 4y ago
I take Mounjaro. For obesity. I thought back in '05 when I first started learning about DPP-4 inhibitors it wouldn't be too long before we realized obesity/T2DM were aspects of the same whole, but it'd take decades before we got to an effective therapy. This is pretty much it. Zero side effects (other than the side effects from losing weight too fast, still have to pay attention to diet). We'll see if there's long term pancreatic/other issues down the line; but comparing risk against obesity, I still feel like I come out ahead on risk. I expect to be taking some low level of a GLP/GIP/next-twincretin/next-tricretin forever. If I didn't now; I figure I'd keep running and dieting and meditating to steel my willpower; continue slighty overeating and slowly gaining fat and insulin resistance. And then I'd still end up taking a GLP/GIP years down the line after I finally developed T2DM. I'd gladly spend $12k/year for the extra healthspan, and it seems many, many people are prepared to do the same.
- throwaway12245 4y ago
  >obesity/T2DM That's the gorilla in the room. Most type 2 diabetes is treatable via diet and exercise.
- GaryNumanVevo 4y ago
  Surely eating healthier and exercising costs less than $12k a year right?
  - lincolnq 4y ago
    …no? Exercising 2h/week (close to the minimum) costs 100 hours per year, at $100/hr that’s close to 10k already and that doesn’t include the attention cost, or anything to do with diet
    - deleted 4y ago
      [deleted]
    - anonporridge 4y ago
      Every human still needs at least that amount of exercise (and ideally a lot more) to avoid cardiopulmonary disease, age related strength, balance, and bone density deterioration, and a myriad of other health issues, even if we could take a pill to cure obesity. If you have to do it anyway to have a long healthspan, and it generally has the side effect of assisting in controlling weight, then why lean on the costly drug?
GaryNumanVevo 4y ago
I don't think that it's a good idea to have the majority of Americans dependent on a single manufacturers drug to maintain a healthy weight.
- matthewdgreen 4y ago
  The Semaglutide patents expire in 2029 and it's already available (borderline illegally) from China via compounding pharmacies. Tirzepatide doesn't expire until 2037, unfortunately.
refurb 4y ago
They never “got em hooked for cheap” because “the cheap price” was for diabetes not obesity. Pharma companies arent allowed to have copay programs for off label use. Promoting off-label use is why Pfizer was fined $3B. Its illegal.
jeroenhd 4y ago
The solution to obesity is a lifestyle change, or dealing with the underlying (psychological) problems. I'm all for aiding people in their lifestyle changes, through medicine or other means, but there is no drug that can fix obesity. Medicating obesity is like taking pills to make smoking healthy. This is just the next step in the ultimate dream, losing weight without putting in effort necessary. If you need to keep taking pills to keep your healthy weight, you're just suppressing symptoms of something bigger.
- HDThoreaun 4y ago
  This is about as helpful as saying the solution is to pray more. You're not wrong, but very few obese people are willing/able to do it. > Medicating obesity is like taking pills to make smoking healthy. This is wrong though. Eating is not unhealthy. Overeating is. These drugs stop people from overeating.
  - jeroenhd 4y ago
    I've never met anyone who just managed to lose lots of weight and maintain their healthy weight all by themselves. Combating obesity requires huge changes to one's lifestyle, with months or even years of feeling (slightly) hungry as a side effect. Very few people have such discipline. It's not a measure of willing, it's about access to treatment that isn't a nice, quick, profitable pill that you end up hooked on.
    - HDThoreaun 4y ago
      But that's the point... These drugs simply make you less hungry. They take what was the herculean task of eating less than your body urges you to and turns it into feeling totally stuffed after 1000 calories a day. It's no longer a question of willpower or suffering all day feeling hungry.
- azan_ 4y ago
  Oh yes, weight loss has to have this moral purity where it is achieved through pure willpower, otherwise it does not count.

msrenee 4y ago

Are they the solution to obesity? I'm curious as to whether the weight stays off long term. 10 or more years at least or else it's just another bandaid. What we need is better access to nutritious food that doesn't take up so much of folk's scant downtime and tight income. I understand there's lots of reasons people are obese that aren't just laziness, but the drug doesn't solve those either. They're still not getting the nutrition they need. It's an improvement having poor nutrition with a lower BMI rather than poor nutrition and their current BMI, but not any kind of solution in my opinion.

icelancer 4y ago
People saying that you have to be on X drug forever to solve your problem as if it's some silver bullet argument think.... what exactly about Type I diabetics who need to inject insulin every day, forever, to solve their problem?
- msrenee 4y ago
  I get where you're coming from and want to clarify that my issue is not that you may have to stay on it for the rest of your life. I'm concerned that even while on the drug, your body could get accustomed to it, and you'd end up eating the same as before taking the drug. This happens a lot with bariatric surgery. I realize that that's due to the elasticity of the stomach, but the body adapts and with many medications that have weight loss as a side effect, your body eventually sorts itself out and you start gaining weight again.
HDThoreaun 4y ago
Depressed people take ssri’s their entire life. People with ADHD take adderal or the like. I don’t see any reason to think of obesity as a different type of disease. Some people just find it extremely difficult to keep off weight, it doesn’t matter what kind of food they’re eating. Yes they could eat less, just like I could keep my thermostat at 45 in the winter to save on my heating bill. But that’s not a realistic solution for most obese people.
- DangitBobby 4y ago
  It 100% matters what food you are eating, no matter who you are or what conditions you may have.
- lm28469 4y ago
  > I don’t see any reason to think of obesity as a different type of disease. Because it's man made and completely avoidable. Look at tobacco for example, it was the exact same thing until it wasn't because we woke up and decided to act on the issue Helping currently obese people to get out of the loop is good, breaking the system we built that make more and more people obese would be better. Also, being obese is only a part of the complications of eating shit and not exercising, the rest of the symptoms will catch up eventually, there are no magic pills
  - HDThoreaun 4y ago
    > breaking the system we built that make more and more people obese would be better. The system exists because people like it. I don't think it's possible to break it at this point considering how people normally react to having their life made worse. You can't stop people from eating what they want, but these drugs make it possible to change what they want.
    - lm28469 4y ago
      > You can't stop people from eating what they want, You can certainly stop advertising junk food to kids, that would be a good start. You can also regulate things you know, like not having your entire daily sugar requirement in a single can of soda Btw if you still eat the same garbage you'll still absolutely wreck your body, obese or not, you'll need a diabetes pill, a cardiovascular disease pill, a blood pressure pill, a kidney boosting pill, &c. You are what you eat, quite literally.
hansvm 4y ago
Not less nutritious food? Or is the argument that the [everything else] to calorie ratio should be higher?
- azdle 4y ago
  > Or is the argument that the [everything else] to calorie ratio should be higher? Yep, that. My understanding of this argument (which for the record, I'm loosely convinced is probably true, but probably isn't the only, and maybe not the main, factor) is that your body's hungry signal is it needs non-calorie nutrients, but our food is less nutrient dense so you get a lot more calories than your body is prepared to handle for a given quantity of nutrients.
  - sjfidsfkds 4y ago
    If this were right, you could cure your obesity by mixing the right multivitamin into your food? It seems like if fixing some nutrient deficiency were all it took, we’d have figured it out ages ago.
drewbug01 4y ago
> 10 or more years at least or else it's just another bandaid. I wonder what the long-term health outcomes would be between two groups: one group that was obese the whole time, and another group whose obesity was delayed by ten years. I suspect the latter group would end up having fewer negative health outcomes over the course of their life - 10 years of essentially “reduced wear and tear” on different systems in their bodies. That is to say - even if it’s a bandaid, it may still be really useful for public health.
- msrenee 4y ago
  I expect they would as well. However, I was replying to a comment that claimed this drug or something similar could be the solution to obesity and I have serious doubts about that. An improvement in health and longevity, even if it's substantial, is not the same as a solution. For example, if we discovered a drug that delayed severe illness/death from cancer for 5 years, it certainly wouldn't be called a solution to cancer. It would be amazing for sure, but that doesn't solve the cancer problem.

insapio 4y ago

I take Mounjaro. For obesity. I thought back in '05 when I first started learning about DPP-4 inhibitors it wouldn't be too long before we realized obesity/T2DM were aspects of the same whole, but it'd take decades before we got to an effective therapy. This is pretty much it. Zero side effects (other than the side effects from losing weight too fast, still have to pay attention to diet). We'll see if there's long term pancreatic/other issues down the line; but comparing risk against obesity, I still feel like I come out ahead on risk. I expect to be taking some low level of a GLP/GIP/next-twincretin/next-tricretin forever. If I didn't now; I figure I'd keep running and dieting and meditating to steel my willpower; continue slighty overeating and slowly gaining fat and insulin resistance. And then I'd still end up taking a GLP/GIP years down the line after I finally developed T2DM. I'd gladly spend $12k/year for the extra healthspan, and it seems many, many people are prepared to do the same.

throwaway12245 4y ago
>obesity/T2DM That's the gorilla in the room. Most type 2 diabetes is treatable via diet and exercise.
GaryNumanVevo 4y ago
Surely eating healthier and exercising costs less than $12k a year right?
- lincolnq 4y ago
  …no? Exercising 2h/week (close to the minimum) costs 100 hours per year, at $100/hr that’s close to 10k already and that doesn’t include the attention cost, or anything to do with diet
  - deleted 4y ago
    [deleted]
  - anonporridge 4y ago
    Every human still needs at least that amount of exercise (and ideally a lot more) to avoid cardiopulmonary disease, age related strength, balance, and bone density deterioration, and a myriad of other health issues, even if we could take a pill to cure obesity. If you have to do it anyway to have a long healthspan, and it generally has the side effect of assisting in controlling weight, then why lean on the costly drug?

GaryNumanVevo 4y ago

I don't think that it's a good idea to have the majority of Americans dependent on a single manufacturers drug to maintain a healthy weight.

matthewdgreen 4y ago
The Semaglutide patents expire in 2029 and it's already available (borderline illegally) from China via compounding pharmacies. Tirzepatide doesn't expire until 2037, unfortunately.

refurb 4y ago

They never “got em hooked for cheap” because “the cheap price” was for diabetes not obesity. Pharma companies arent allowed to have copay programs for off label use. Promoting off-label use is why Pfizer was fined $3B. Its illegal.

jeroenhd 4y ago

The solution to obesity is a lifestyle change, or dealing with the underlying (psychological) problems. I'm all for aiding people in their lifestyle changes, through medicine or other means, but there is no drug that can fix obesity. Medicating obesity is like taking pills to make smoking healthy. This is just the next step in the ultimate dream, losing weight without putting in effort necessary. If you need to keep taking pills to keep your healthy weight, you're just suppressing symptoms of something bigger.

HDThoreaun 4y ago
This is about as helpful as saying the solution is to pray more. You're not wrong, but very few obese people are willing/able to do it. > Medicating obesity is like taking pills to make smoking healthy. This is wrong though. Eating is not unhealthy. Overeating is. These drugs stop people from overeating.
- jeroenhd 4y ago
  I've never met anyone who just managed to lose lots of weight and maintain their healthy weight all by themselves. Combating obesity requires huge changes to one's lifestyle, with months or even years of feeling (slightly) hungry as a side effect. Very few people have such discipline. It's not a measure of willing, it's about access to treatment that isn't a nice, quick, profitable pill that you end up hooked on.
  - HDThoreaun 4y ago
    But that's the point... These drugs simply make you less hungry. They take what was the herculean task of eating less than your body urges you to and turns it into feeling totally stuffed after 1000 calories a day. It's no longer a question of willpower or suffering all day feeling hungry.
azan_ 4y ago
Oh yes, weight loss has to have this moral purity where it is achieved through pure willpower, otherwise it does not count.