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A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true? From what I have heard, all of these issues come back a

by mym1990 3y ago

A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true? From what I have heard, all of these issues come back as soon as someone comes off the drug. So either a person is committing to a lifetime of being dependent on this drug, or a person is committing to some period of time of ideal living, followed by a possible time of depression after reverting to the status quo.

karaterobot 3y ago
For a lot of people, it's kind of a choice of which substance you are going to be dependent on. It's all expensive and sad, but between Ozempic and cigarettes, alcohol, or overeating, Ozempic has got to be healthier, and quite possibly cheaper in the long run.
- nancyhn 3y ago
  Is a drug or drug-like-food (ie, sugar) dependency really the only option?
  - oniony 3y ago
    No, there's also badmington.
  - deegles 3y ago
    What do you suggest otherwise? Clearly whatever we're doing now has led us to this point.
  - karaterobot 3y ago
    Versus, like, "just suck it up"? No, but empirically that strategy has had poor results across the wider population. It seems like it would work, but usually doesn't. At some point people look for more effective strategies.
  - yamtaddle 3y ago
    It's that, or dropping out of modern life, as far as I can tell. Everyone's on something and/or coping in unhealthy ways.
  - acjohnson55 3y ago
    Most research indicates "yes", conditioned on the consensus of what comprises the modern lifestyle. I've been trying to understand what changed to create the obesity epidemic. Many things contribute, but it's hard to identify the smoking gun. My understanding is that one major lever seems to be the advent of snacks, refrigeration, and microwaves. Drastically reduced food prep overhead has radically alerted eating patterns.
    - mym1990 3y ago
      It seems pretty obvious that the massive injection of sugar in the 60s and 70s into diets paved the way for pretty much everything else that followed(snacks, fast food, convenient food, etc). I guess we can all ignore that diabetes is driven by insulin resistance and the body's inability to process glucose, which is conveniently also the predominant thing in our food today, because we would rather look the other way and continue living in a fairy tale...that is until we are disease ridden in our 40s, at which point we can live out the rest of our lives on meds and in the hospital.
      - htag 3y ago
        To pile on other popular theories on smoking guns, there is a widespread decrease in physical activity levels. Physical activity can delay or prevent type 2 diabetes, as well as having widespread benefits on almost every system of the body. Physical activity also improves mental health, which impacts some behaviors around emotional/addiction driven over eating.
        novok 3y ago
        We do more physical activity now than people did in the 70s and 80s and we are significantly fatter also. I doubt it's that.
        CRConrad 3y ago
        I doubt we do more physical activity now than people did in the 70s and 80s. Sure, people may go to the gym more... But they also take the lift or the escalator in stead of the stairs much more, and the car in stead of a bicycle or walking. Any source for your claim?
- justinbaker84 3y ago
  I took it and started out with a small dose. The impact of that dose wore off eventually and the plan at my clinic was to raise it over time. I am concerned that maybe there isn't a dose where you can stop taking more and keep the results. I am worried that everybody will need to keep taking more as they build up more tolerance to it. The study that showed how effective the drug is was 60 weeks long. That is a long time, but it doesn't show what happens if somebody plans on staying on the drug for years.
  - jasonfarnon 3y ago
    do you know what tolerance effects are acknowledged by the makers/doctors? I was thinking this was more like insulin; is it more like an opiate?
- mym1990 3y ago
  Healthier in what sense? There is little knowledge of long term side effects and it isn't even approved for weight loss, it is specifically for people with diabetes.
  - iwanttocomment 3y ago
    Semaglutide, the active ingredient in Ozempic, is absolutely approved in the US for weight loss. Ozempic is the trade name for the diabetes medication, Wegovy is the trade name for the weight loss medication. They are the exact same medication, in the same formulation.
    - mym1990 3y ago
      Ah, good to know!
trasz4 3y ago
>From what I have heard, all of these issues come back as soon as someone comes off the drug Same as with drugs for hypertension, depression, hyperglycemia and many, many others. Not every drug is supposed to somehow permanently cure you.
- hombre_fatal 3y ago
  The same could be said even for interventions like "don't eat surplus calories" and "life weights". Once you stop, you don't get the benefits and you'll regress. "But you have to do it forever" shouldn't be a convincing dismissal after 10 seconds of thought.
  - mcntsh 3y ago
    By completely changing your lifestyle and retuning your habits your health isn't hinging on one single point of failure (a drug you need to take). If I stop going to the gym for a couple of months, I'm probably not going to gain any weight because I still eat healthy and stay active.
aplusbi 3y ago
A lot of addiction is caused by social issues or mental health issues, but it's really hard to deal with those issues when someone is also dealing with the effects of addiction. A drug like this could provide an opportunity to fix the underlying issues causing addiction in the first place. And for some people they will have to take this for life, which isn't so different from many other medications.
- SOLAR_FIELDS 3y ago
  Yeah, I honestly don’t see a problem with taking a drug for life, as long as the side effects are minimal and the logistics are simple. I’m in my early 30’s and have a family history of bad cholesterol. So once a day I will take a statin for the rest of my life. Not a problem, little to no side effects and pretty easy to manage, and not the end of the world if I miss one day every so often. Twice a day is not so easy to manage and plan but once a day is definitely manageable for a lot of people
standardUser 3y ago
The first days, weeks and months are often the hardest time when quitting a substance. If this drug helps a smoker not smoke for 3 months, by that time the nicotine addiction has weakened considerably. They've gotten past the hardest part. I see no downside to that. Similarly, if a person loses 30 pounds on this drug, then stops using the drug and reverts to normal habits, it will take a while to regain those 30 pounds. And the long term shift of maintaining the new body weight doesn't require any radical changes (unlike losing 30 pounds, which does require sustained radical changes).
- justinbaker84 3y ago
  That is not what happened to me. I took it for 2 months and then I wanted to get off. I did not go back to normal. Mentally I felt like I needed more food and more junk food than I ever did before using the drug. My hypothesis is that it supressed my body's natural production of whatever chemical in my brain helps me not go overboard with food. With that supressed by the drug I had an uncontrollable desire for food and currently I am fatter than I was before taking the drug in the first place.
  - 1123581321 3y ago
    An interaction with leptin? Or are you just feeling hungry after the side effects wore off? You also said it stopped working while you were taking it in another post; are you just talking about satiety or one of the other effects like insulin production or glucagon release? Are you diabetic or just overweight?
  - yamazakiwi 3y ago
    This same thing happened to me when I quit smoking without assistance from a drug.
  - rolisz 3y ago
    Did you quit cold turkey? Or did you slowly taper it off? I'm taking Rybelsus (pill form of semaglutide) and there are 3, 7 and 14 mg versions. My plan is to take 14 mg for a couple more months, then switch to 7 mg for 1-2 months and then 3 mg for a month before stopping taking it completely.
justinbaker84 3y ago
This is exactly what happened to me. The clinic I went to recommended starting out with 1/10 the normal dose for the first month to make sure I would tolerate it. Then we would move up each month. It worked so well I didn't want to move up so for month 2 I stuck with 1/10th the amount. During that month the effects wore off so I had to take more to get the same impact. I chose to just quit. 2 months after quiting I am 7 pounds fatter than I was when I started with the drug. I suspect that most people will need to keep taking more and more of it to get the same benefits they got from the recommended dose. I am really concerned this is going to lead to a bigger health crises than the one it purported to solve.
- spondylosaurus 3y ago
  > I am really concerned this is going to lead to a bigger health crises than the one it purported to solve. A lot of diabetics taking it to regulate blood sugar (particular the feedback loop with insulin and hunger) have said it's changed their life... but for people who are merely overweight I think the benefits may not always be worth the side effects. IMO the correlation between weight and health is not as strong as people often assume. Anecdotal, but if you looked at me and my partner, you'd probably assume I was the "healthier" one based on our respective body types. But they're strong, fit, and rarely get sick (knock on wood); meanwhile I'm a lifelong wimp with a host of autoimmune issues. I outsource all of the heavy lifting to them, literally—if the trash is too heavy for me to take to the dumpster, they get to do it instead :P So to your point about health crises, yeah. It seems foolish to put my partner on a weight loss drug just so they could "look" healthier while nursing a bunch of unpleasant side effects that would make them far sicker than they were before.
  - mym1990 3y ago
    I think weight is the wrong thing to target for gauging health, but it is the thing that is in everyone's face and easy to see. Undernourishment is just a big of a problem as over-nourishment. Targeting the four horsemen(t2 diabetes, Alzheimer's, heart disease, cancer) is a better use of time and money, but they are relatively much harder to identify early.
coffeebeqn 3y ago
If something affects so many basic functions of the body, the side effects must be intense as well
jameshart 3y ago
> A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true? What other desires does it lessen? Does it suppress every hedonistic impulse? What does it do to creativity? Impulsivity? Does it make you more susceptible to or resistant to persuasion? Feels like reporting ‘oh it has these other unintended psychological/behavioral responses. Neat!’ is ignoring a whole can of worms that that opens.
- mym1990 3y ago
  I think the body of work around what this drug does outside of its impact on patients with diabetes is pretty limited, which is what is scary about everyone jumping on this one.
thomascgalvin 3y ago
> A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true? It does sound too good to be true. However, it's possible that the drug is working on all of these through the same mechanism: by altering the brain's reward system. If that's true, the drug doesn't make you not want to eat, it makes you not want stuff, in general. That could potentially suppress a wide array of addictive behaviors. I also wonder if that suppression might look a lot like clinical depression, though.
- reaperman 3y ago
  Reports from people using this don't indicate that they feel depressed at all. They either get a ton of nausea if their dose is too high, or they just don't get cravings to eat tons of "bad" food. Most people I've talked with on low doses report they can still eat large meals, but it has to be a pretty conscious, determined decision. No one's been reporting depression that I've seen. And these groups ('fitness enthusiasts') experiment with enough other things that do cause depression that they're quite sensitive to changes in "well-being", "outlook on life", "mood", and "energy levels". It would be more widely reported in these circles if it did resemble depression.
iwanttocomment 3y ago
I'm not sure why "it stops working when you stop taking it" is used as an argument against these new peptides. This is the way almost every medication we encounter works. Tylenol might get rid of your headache, but that headache can come back tomorrow. Stop taking birth control and you might get pregnant. Stop taking Claritin and your allergies return. Stop taking insulin, and, as with these new peptides, you lose control over your blood sugar. Stop taking Adderall, and not only will your ADHD symptoms come back, you'll also experience withdrawal. Almost no medications are "one and done", and I'm not sure why Ozempic or Mounjaro are being held to needing to be a cure when it's clear that they're effective, repeatable treatments for blood sugar control and (likely related) weight gain.
- iwanttocomment 3y ago
  (If the answer is "because you'll learn to eat less or eat in a more healthy fashion", it may well be that the metabolic issues that are creating heightened blood sugar or appetite issues may not be able to be resolved by diet alone in those who respond well to these peptides.)
- mym1990 3y ago
  I am not holding Ozempic to needing to be the cure for anything. My point is that people without diabetes are looking to this drug for weight loss, at which point they create a dangerous dependency, with no hard evidence that their actual health improves. This is opposed to coming up with long term solutions that involve re-evaluating daily decisions that lead to some of these diseases in the first place. If Ozempic is a good treatment for blood sugar control, which could be a good factor to consider in weight fluctuation, maybe reduce the amount of sugar one eats?
  - iwanttocomment 3y ago
    Is it really a dangerous dependency? There's been no evidence of anything happening once individuals go off of semaglutide or tirzepatide other than the tendency of gaining weight to the original levels and/or blood sugar readings returning to the pre-medication levels. This is the most common outcome anyone has trying literally any calorie-reducing diet, medication or not. There's no evidence that people are ending up worse for having been on the medication, except for some who experience gastro effects early on and can simply quit. Also, yes, you can absolutely advocate for a low-carb/low-sugar diet for those with poor blood sugar control. The issue there is that virtually every medical professional has advocated for similar diets for diabetics or those with blood sugar control issues for centuries, or even millennia - there is evidence of recommended diets for those with diabetes since BCE. This does not mean that those diets are easy or pleasant to follow, whereas all evidence indicates that common issues with appetite and energy on a limited calorie or low-carb diet are less prevalent with these new peptides than those trying to go it alone.
015UUZn8aEvW 3y ago
>From what I have heard, all of these issues come back as soon as someone comes off the drug. So either a person is committing to a lifetime of being dependent on this drug, or a person is committing to some period of time of ideal living, followed by a possible time of depression after reverting to the status quo. This is true of every weight loss intervention: Weight Watchers, low-carb, keto, Whole 30, etc. Once people stop complying with them, they gain the weight back. Most people don't realize how dismal the stats on long-term weight loss are. Almost no one maintains a substantial amount of weight loss for many years by following "just eat healthy and exercise" advice. The only intervention that does reliably work is bariatric surgery. The jury is still out on the new GLP drugs.
- akiselev 3y ago
  > The only intervention that does reliably work is bariatric surgery. My understanding is surgery only works reliably because failure to comply with life style changes post-op is easily fatal and ethical doctors only perform the operation after patients have demonstrated that ability. In all but the most extreme patients, about a fifth to a third of the target weight loss has to happen pre-op for doctors to even consider the procedure. The surgery is essentially a sword of Damocles hanging over patients, reminding them that they'll die much faster than normal if they over eat.
  - jasonfarnon 3y ago
    " failure to comply with life style changes post-op is easily fatal" My understanding is naive but I always thought it was no longer possible to fail to comply after this intervention?
    - SamoyedFurFluff 3y ago
      No, you can seriously damage your stomach, which is now already severely scarred.
    - confoundcofound 3y ago
      You can rupture your GI sutures if you do not adhere to the post-op diet, and risk death.
rolisz 3y ago
Isn't that the case for every diet? You can lose weight on diets and then gain it back when you start eating the way you used to.
atchoo 3y ago
What if the greatest harm is that the easy path of modifying our biology prevents us ever needing to gain the self-knowledge and build the fulfilling lives that lets us thrive in a world surrounded by potential addictions? I consider myself a much wiser and stronger person in recovery than I was before addiction. Who would I be if I took a magic pill and was still the person that sought oblivion? What will humanity be if it doesn't need such self-knowledge and resilience? What impact will that make in say, our future politics?
- chadlavi 3y ago
  This feels like the same logic as "I had to pay off my student loans, so other people should have to suffer like that too." Suffering does not make you better later despite what millennia of Christian theology has told people about its supposed purgative effects. It seems pretty rad to me to be able to just not suffer through the bad part of getting over a major life problem, and I for one am happy that people will be able to skip that part and get on to the part where they live well.
  - atchoo 3y ago
    This is not an argument that suffering is valuable, it's that drug-seeking behaviours are a symptom of poor psychology / life-fulfilment. The fear is that by removing symptoms, we no longer find it important to address the root cause. The symptoms should be treated as a warning signal. It sounds dystopian to make poor psychology and poor life-fulfilment a consequence free norm.
AnIdiotOnTheNet 3y ago
Could be worse. Omeprazole not only stops working after you get off it, your issues actually become much more severe. Once you're on it, you are unlikely to ever be able to get off of it.
joedevon 3y ago
Imagine being 250 lbs and feeling like you are starving constantly, despite eating a lot every day. You decide to lose weight. You do something you hate, like calorie restriction and working out like a dog. You lose 80 lbs in 1 year. Bravo. Everyone tells you how great you look. You feel great. All that hard work was worth it. The fatness and a million other things really motivated you to do the hard work. I've done this a couple of times. Next day after hitting your goal, the starvation is still there. The desire to eat is still there. Hating working out is still there. But now you have to do this herculean effort every day not to get better. Not to lose weight. Just to maintain. Your brain wants you to gain 80 lbs and will never stop nagging you. Not on a good day. Not on a bad day. Then something really shitty happens in your life. Like it does for everyone. You slip. Eventually you start to gain back the weight. You just want to die. You feel like a failure. You hate yourself. That's the trick. Hitting goal weight the first time or two is relatively "easy". But you've achieved nothing if you aren't able to maintain weight loss. That's the failure of all approaches prior to these GLP1 and similar drugs. Having set the scene, now compare it to semaglutide. You have a drug that regulates your brain. Gets rid of the constant nagging to eat. You get normal brain. You lose weight. Now you have to pick, take a once a week drug for life to maintain, or do a herculean effort to fight the brain urges and work out to maintain. Which do you think will be more successful?
- tgmatt 3y ago
  This perfectly encapsulates my experience. I'm hesitant to ask for this medication because of side effects and because it's got a 2 year limit in my country, so I don't want to go through it all then have to stop and ultimately put it all back on. Shit sucks, bro.
  - joedevon 3y ago
    Do some research into compound pharmacies as a worst picture backup. I know several people on them successfully. Peptides can't be patented. Semaglutide is a peptide. They are patenting the delivery mechanism AFAICT. As to sides, ramp up slowly. Maybe you won't have any. Also, there are new drugs coming that are even better. I'm sure the shortages and whatnot will be sorted out. The solution is out there. They can't stop this train.
lost_tourist 3y ago
do you have stats to confirm your assertion about this drug because it seems as speculation as saying "well maybe if I was 100lbs less I would have more energy, be happier with myself and therefore have more willpower to have a more healthy relationship with food".

karaterobot 3y ago

For a lot of people, it's kind of a choice of which substance you are going to be dependent on. It's all expensive and sad, but between Ozempic and cigarettes, alcohol, or overeating, Ozempic has got to be healthier, and quite possibly cheaper in the long run.

nancyhn 3y ago
Is a drug or drug-like-food (ie, sugar) dependency really the only option?
- oniony 3y ago
  No, there's also badmington.
- deegles 3y ago
  What do you suggest otherwise? Clearly whatever we're doing now has led us to this point.
- karaterobot 3y ago
  Versus, like, "just suck it up"? No, but empirically that strategy has had poor results across the wider population. It seems like it would work, but usually doesn't. At some point people look for more effective strategies.
- yamtaddle 3y ago
  It's that, or dropping out of modern life, as far as I can tell. Everyone's on something and/or coping in unhealthy ways.
- acjohnson55 3y ago
  Most research indicates "yes", conditioned on the consensus of what comprises the modern lifestyle. I've been trying to understand what changed to create the obesity epidemic. Many things contribute, but it's hard to identify the smoking gun. My understanding is that one major lever seems to be the advent of snacks, refrigeration, and microwaves. Drastically reduced food prep overhead has radically alerted eating patterns.
  - mym1990 3y ago
    It seems pretty obvious that the massive injection of sugar in the 60s and 70s into diets paved the way for pretty much everything else that followed(snacks, fast food, convenient food, etc). I guess we can all ignore that diabetes is driven by insulin resistance and the body's inability to process glucose, which is conveniently also the predominant thing in our food today, because we would rather look the other way and continue living in a fairy tale...that is until we are disease ridden in our 40s, at which point we can live out the rest of our lives on meds and in the hospital.
    - htag 3y ago
      To pile on other popular theories on smoking guns, there is a widespread decrease in physical activity levels. Physical activity can delay or prevent type 2 diabetes, as well as having widespread benefits on almost every system of the body. Physical activity also improves mental health, which impacts some behaviors around emotional/addiction driven over eating.
      - novok 3y ago
        We do more physical activity now than people did in the 70s and 80s and we are significantly fatter also. I doubt it's that.
        CRConrad 3y ago
        I doubt we do more physical activity now than people did in the 70s and 80s. Sure, people may go to the gym more... But they also take the lift or the escalator in stead of the stairs much more, and the car in stead of a bicycle or walking. Any source for your claim?
justinbaker84 3y ago
I took it and started out with a small dose. The impact of that dose wore off eventually and the plan at my clinic was to raise it over time. I am concerned that maybe there isn't a dose where you can stop taking more and keep the results. I am worried that everybody will need to keep taking more as they build up more tolerance to it. The study that showed how effective the drug is was 60 weeks long. That is a long time, but it doesn't show what happens if somebody plans on staying on the drug for years.
- jasonfarnon 3y ago
  do you know what tolerance effects are acknowledged by the makers/doctors? I was thinking this was more like insulin; is it more like an opiate?
mym1990 3y ago
Healthier in what sense? There is little knowledge of long term side effects and it isn't even approved for weight loss, it is specifically for people with diabetes.
- iwanttocomment 3y ago
  Semaglutide, the active ingredient in Ozempic, is absolutely approved in the US for weight loss. Ozempic is the trade name for the diabetes medication, Wegovy is the trade name for the weight loss medication. They are the exact same medication, in the same formulation.
  - mym1990 3y ago
    Ah, good to know!

trasz4 3y ago

>From what I have heard, all of these issues come back as soon as someone comes off the drug Same as with drugs for hypertension, depression, hyperglycemia and many, many others. Not every drug is supposed to somehow permanently cure you.

hombre_fatal 3y ago
The same could be said even for interventions like "don't eat surplus calories" and "life weights". Once you stop, you don't get the benefits and you'll regress. "But you have to do it forever" shouldn't be a convincing dismissal after 10 seconds of thought.
- mcntsh 3y ago
  By completely changing your lifestyle and retuning your habits your health isn't hinging on one single point of failure (a drug you need to take). If I stop going to the gym for a couple of months, I'm probably not going to gain any weight because I still eat healthy and stay active.

aplusbi 3y ago

A lot of addiction is caused by social issues or mental health issues, but it's really hard to deal with those issues when someone is also dealing with the effects of addiction. A drug like this could provide an opportunity to fix the underlying issues causing addiction in the first place. And for some people they will have to take this for life, which isn't so different from many other medications.

SOLAR_FIELDS 3y ago
Yeah, I honestly don’t see a problem with taking a drug for life, as long as the side effects are minimal and the logistics are simple. I’m in my early 30’s and have a family history of bad cholesterol. So once a day I will take a statin for the rest of my life. Not a problem, little to no side effects and pretty easy to manage, and not the end of the world if I miss one day every so often. Twice a day is not so easy to manage and plan but once a day is definitely manageable for a lot of people

standardUser 3y ago

The first days, weeks and months are often the hardest time when quitting a substance. If this drug helps a smoker not smoke for 3 months, by that time the nicotine addiction has weakened considerably. They've gotten past the hardest part. I see no downside to that. Similarly, if a person loses 30 pounds on this drug, then stops using the drug and reverts to normal habits, it will take a while to regain those 30 pounds. And the long term shift of maintaining the new body weight doesn't require any radical changes (unlike losing 30 pounds, which does require sustained radical changes).

justinbaker84 3y ago
That is not what happened to me. I took it for 2 months and then I wanted to get off. I did not go back to normal. Mentally I felt like I needed more food and more junk food than I ever did before using the drug. My hypothesis is that it supressed my body's natural production of whatever chemical in my brain helps me not go overboard with food. With that supressed by the drug I had an uncontrollable desire for food and currently I am fatter than I was before taking the drug in the first place.
- 1123581321 3y ago
  An interaction with leptin? Or are you just feeling hungry after the side effects wore off? You also said it stopped working while you were taking it in another post; are you just talking about satiety or one of the other effects like insulin production or glucagon release? Are you diabetic or just overweight?
- yamazakiwi 3y ago
  This same thing happened to me when I quit smoking without assistance from a drug.
- rolisz 3y ago
  Did you quit cold turkey? Or did you slowly taper it off? I'm taking Rybelsus (pill form of semaglutide) and there are 3, 7 and 14 mg versions. My plan is to take 14 mg for a couple more months, then switch to 7 mg for 1-2 months and then 3 mg for a month before stopping taking it completely.

justinbaker84 3y ago

This is exactly what happened to me. The clinic I went to recommended starting out with 1/10 the normal dose for the first month to make sure I would tolerate it. Then we would move up each month. It worked so well I didn't want to move up so for month 2 I stuck with 1/10th the amount. During that month the effects wore off so I had to take more to get the same impact. I chose to just quit. 2 months after quiting I am 7 pounds fatter than I was when I started with the drug. I suspect that most people will need to keep taking more and more of it to get the same benefits they got from the recommended dose. I am really concerned this is going to lead to a bigger health crises than the one it purported to solve.

spondylosaurus 3y ago
> I am really concerned this is going to lead to a bigger health crises than the one it purported to solve. A lot of diabetics taking it to regulate blood sugar (particular the feedback loop with insulin and hunger) have said it's changed their life... but for people who are merely overweight I think the benefits may not always be worth the side effects. IMO the correlation between weight and health is not as strong as people often assume. Anecdotal, but if you looked at me and my partner, you'd probably assume I was the "healthier" one based on our respective body types. But they're strong, fit, and rarely get sick (knock on wood); meanwhile I'm a lifelong wimp with a host of autoimmune issues. I outsource all of the heavy lifting to them, literally—if the trash is too heavy for me to take to the dumpster, they get to do it instead :P So to your point about health crises, yeah. It seems foolish to put my partner on a weight loss drug just so they could "look" healthier while nursing a bunch of unpleasant side effects that would make them far sicker than they were before.
- mym1990 3y ago
  I think weight is the wrong thing to target for gauging health, but it is the thing that is in everyone's face and easy to see. Undernourishment is just a big of a problem as over-nourishment. Targeting the four horsemen(t2 diabetes, Alzheimer's, heart disease, cancer) is a better use of time and money, but they are relatively much harder to identify early.

coffeebeqn 3y ago

If something affects so many basic functions of the body, the side effects must be intense as well

jameshart 3y ago

> A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true? What other desires does it lessen? Does it suppress every hedonistic impulse? What does it do to creativity? Impulsivity? Does it make you more susceptible to or resistant to persuasion? Feels like reporting ‘oh it has these other unintended psychological/behavioral responses. Neat!’ is ignoring a whole can of worms that that opens.

mym1990 3y ago
I think the body of work around what this drug does outside of its impact on patients with diabetes is pretty limited, which is what is scary about everyone jumping on this one.

thomascgalvin 3y ago

> A drug that promotes weight loss, lessens the desire to smoke, drink, etc...sounds too good to be true? It does sound too good to be true. However, it's possible that the drug is working on all of these through the same mechanism: by altering the brain's reward system. If that's true, the drug doesn't make you not want to eat, it makes you not want stuff, in general. That could potentially suppress a wide array of addictive behaviors. I also wonder if that suppression might look a lot like clinical depression, though.

reaperman 3y ago
Reports from people using this don't indicate that they feel depressed at all. They either get a ton of nausea if their dose is too high, or they just don't get cravings to eat tons of "bad" food. Most people I've talked with on low doses report they can still eat large meals, but it has to be a pretty conscious, determined decision. No one's been reporting depression that I've seen. And these groups ('fitness enthusiasts') experiment with enough other things that do cause depression that they're quite sensitive to changes in "well-being", "outlook on life", "mood", and "energy levels". It would be more widely reported in these circles if it did resemble depression.

iwanttocomment 3y ago

I'm not sure why "it stops working when you stop taking it" is used as an argument against these new peptides. This is the way almost every medication we encounter works. Tylenol might get rid of your headache, but that headache can come back tomorrow. Stop taking birth control and you might get pregnant. Stop taking Claritin and your allergies return. Stop taking insulin, and, as with these new peptides, you lose control over your blood sugar. Stop taking Adderall, and not only will your ADHD symptoms come back, you'll also experience withdrawal. Almost no medications are "one and done", and I'm not sure why Ozempic or Mounjaro are being held to needing to be a cure when it's clear that they're effective, repeatable treatments for blood sugar control and (likely related) weight gain.

iwanttocomment 3y ago
(If the answer is "because you'll learn to eat less or eat in a more healthy fashion", it may well be that the metabolic issues that are creating heightened blood sugar or appetite issues may not be able to be resolved by diet alone in those who respond well to these peptides.)
mym1990 3y ago
I am not holding Ozempic to needing to be the cure for anything. My point is that people without diabetes are looking to this drug for weight loss, at which point they create a dangerous dependency, with no hard evidence that their actual health improves. This is opposed to coming up with long term solutions that involve re-evaluating daily decisions that lead to some of these diseases in the first place. If Ozempic is a good treatment for blood sugar control, which could be a good factor to consider in weight fluctuation, maybe reduce the amount of sugar one eats?
- iwanttocomment 3y ago
  Is it really a dangerous dependency? There's been no evidence of anything happening once individuals go off of semaglutide or tirzepatide other than the tendency of gaining weight to the original levels and/or blood sugar readings returning to the pre-medication levels. This is the most common outcome anyone has trying literally any calorie-reducing diet, medication or not. There's no evidence that people are ending up worse for having been on the medication, except for some who experience gastro effects early on and can simply quit. Also, yes, you can absolutely advocate for a low-carb/low-sugar diet for those with poor blood sugar control. The issue there is that virtually every medical professional has advocated for similar diets for diabetics or those with blood sugar control issues for centuries, or even millennia - there is evidence of recommended diets for those with diabetes since BCE. This does not mean that those diets are easy or pleasant to follow, whereas all evidence indicates that common issues with appetite and energy on a limited calorie or low-carb diet are less prevalent with these new peptides than those trying to go it alone.

015UUZn8aEvW 3y ago

>From what I have heard, all of these issues come back as soon as someone comes off the drug. So either a person is committing to a lifetime of being dependent on this drug, or a person is committing to some period of time of ideal living, followed by a possible time of depression after reverting to the status quo. This is true of every weight loss intervention: Weight Watchers, low-carb, keto, Whole 30, etc. Once people stop complying with them, they gain the weight back. Most people don't realize how dismal the stats on long-term weight loss are. Almost no one maintains a substantial amount of weight loss for many years by following "just eat healthy and exercise" advice. The only intervention that does reliably work is bariatric surgery. The jury is still out on the new GLP drugs.

akiselev 3y ago
> The only intervention that does reliably work is bariatric surgery. My understanding is surgery only works reliably because failure to comply with life style changes post-op is easily fatal and ethical doctors only perform the operation after patients have demonstrated that ability. In all but the most extreme patients, about a fifth to a third of the target weight loss has to happen pre-op for doctors to even consider the procedure. The surgery is essentially a sword of Damocles hanging over patients, reminding them that they'll die much faster than normal if they over eat.
- jasonfarnon 3y ago
  " failure to comply with life style changes post-op is easily fatal" My understanding is naive but I always thought it was no longer possible to fail to comply after this intervention?
  - SamoyedFurFluff 3y ago
    No, you can seriously damage your stomach, which is now already severely scarred.
  - confoundcofound 3y ago
    You can rupture your GI sutures if you do not adhere to the post-op diet, and risk death.

rolisz 3y ago

Isn't that the case for every diet? You can lose weight on diets and then gain it back when you start eating the way you used to.

atchoo 3y ago

What if the greatest harm is that the easy path of modifying our biology prevents us ever needing to gain the self-knowledge and build the fulfilling lives that lets us thrive in a world surrounded by potential addictions? I consider myself a much wiser and stronger person in recovery than I was before addiction. Who would I be if I took a magic pill and was still the person that sought oblivion? What will humanity be if it doesn't need such self-knowledge and resilience? What impact will that make in say, our future politics?

chadlavi 3y ago
This feels like the same logic as "I had to pay off my student loans, so other people should have to suffer like that too." Suffering does not make you better later despite what millennia of Christian theology has told people about its supposed purgative effects. It seems pretty rad to me to be able to just not suffer through the bad part of getting over a major life problem, and I for one am happy that people will be able to skip that part and get on to the part where they live well.
- atchoo 3y ago
  This is not an argument that suffering is valuable, it's that drug-seeking behaviours are a symptom of poor psychology / life-fulfilment. The fear is that by removing symptoms, we no longer find it important to address the root cause. The symptoms should be treated as a warning signal. It sounds dystopian to make poor psychology and poor life-fulfilment a consequence free norm.

AnIdiotOnTheNet 3y ago

Could be worse. Omeprazole not only stops working after you get off it, your issues actually become much more severe. Once you're on it, you are unlikely to ever be able to get off of it.

joedevon 3y ago

Imagine being 250 lbs and feeling like you are starving constantly, despite eating a lot every day. You decide to lose weight. You do something you hate, like calorie restriction and working out like a dog. You lose 80 lbs in 1 year. Bravo. Everyone tells you how great you look. You feel great. All that hard work was worth it. The fatness and a million other things really motivated you to do the hard work. I've done this a couple of times. Next day after hitting your goal, the starvation is still there. The desire to eat is still there. Hating working out is still there. But now you have to do this herculean effort every day not to get better. Not to lose weight. Just to maintain. Your brain wants you to gain 80 lbs and will never stop nagging you. Not on a good day. Not on a bad day. Then something really shitty happens in your life. Like it does for everyone. You slip. Eventually you start to gain back the weight. You just want to die. You feel like a failure. You hate yourself. That's the trick. Hitting goal weight the first time or two is relatively "easy". But you've achieved nothing if you aren't able to maintain weight loss. That's the failure of all approaches prior to these GLP1 and similar drugs. Having set the scene, now compare it to semaglutide. You have a drug that regulates your brain. Gets rid of the constant nagging to eat. You get normal brain. You lose weight. Now you have to pick, take a once a week drug for life to maintain, or do a herculean effort to fight the brain urges and work out to maintain. Which do you think will be more successful?

tgmatt 3y ago
This perfectly encapsulates my experience. I'm hesitant to ask for this medication because of side effects and because it's got a 2 year limit in my country, so I don't want to go through it all then have to stop and ultimately put it all back on. Shit sucks, bro.
- joedevon 3y ago
  Do some research into compound pharmacies as a worst picture backup. I know several people on them successfully. Peptides can't be patented. Semaglutide is a peptide. They are patenting the delivery mechanism AFAICT. As to sides, ramp up slowly. Maybe you won't have any. Also, there are new drugs coming that are even better. I'm sure the shortages and whatnot will be sorted out. The solution is out there. They can't stop this train.

lost_tourist 3y ago

do you have stats to confirm your assertion about this drug because it seems as speculation as saying "well maybe if I was 100lbs less I would have more energy, be happier with myself and therefore have more willpower to have a more healthy relationship with food".