5 ms·

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 poi

by 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.
- mym1990 3y ago
  I don’t necessarily mean dangerous in the health aspect, although long term affects of these drugs are not know yet…I mean the dependency on needed the drug to keep a certain lifestyle, and then having an “oh shit” moment when you’re in a place that you can’t access it, whether that be traveling or the supply of it becomes scarce, or it gets banned, etc
  - reaperman 3y ago
    That sounds like the lesser of two evils to me. Get healthier now and maybe sometime later lose access to the thing that helps you be healthier...or don't get healthier now? Yeah, there are other, orthogonal, choices but I don't think they're part of this particular decision matrix.
    - deleted 3y ago
      [deleted]
    - nwienert 3y ago
      Yep. I lost 30lbs on it in 3 months. It took me 10 years to gain that weight. So I guess if it takes me 10 more years to gain it back I can look into taking it again.
      - unparagoned 3y ago
        People usually gain back that weight much quicker. All it could take is one bad month and you could gain it all back.
        nwienert 3y ago
        Totally impossible. I’d have to be eating like way more than I ever have to do that. I went off for three months and kept losing weight throughout. And the data from these drugs shows they gain it back at regular rate at most.
        CRConrad 3y ago
        I lost about 15-20 kg on Ozempic over about six months to a year, and held that weight for another year – continuing on 1 mg Ozempic / wk – until last autumn (2022). Then Ozempic was more widely approved than it had been before somewhere (for over-the-counter sales in the USA? Something like that.), and became unavailable in pharmacies where I live, in Finland. (AIUI, because it's more lucrative to sell it in the USA where prices aren't regulated like here, so all the limited supply is redirected there.) No problem, I was prescribed a substitute, a daily pill (brandname Rybelsus, forgot the active substance) in stead of the weekly injection pen. Worked the same, held my weight. (More of a hassle to take though, and tastes horribly, so on the whole I vastly prefer the Ozempic.) Then, earlier this spring, that prescription ran out. Being in the middle of changing my primary healthcare provider I couldn't immediately get it renewed. And to be honest I wasn't at first all that bothered; I thought now that I've lost so much weight, and kept it off for so long with the help of these drugs, maybe I've got into the habit of eating less, so I can stay constant without them? Nope – in just a few weeks, ballooned back up some 8-10 kg. Had to scramble a bit to get the pill prescription renewed, been on it again for a couple weeks, but still some 6-7 kg above where I was before they ran out. Sure hope I'll get back down the rest of the way. TLDR: Anecdata (n=1) says yes, going off the drugs even for a rather short while puts the weight back on quite quickly.
- 0zemp2c 3y ago
  How dangerous is it to have a new $1k/month bill you need to pay forever? So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic... Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk...
  - lotsofpulp 3y ago
    Given a significant percent of voters are overweight and obese, it would be very politically popular to legislate that health insurance must pay for GLP-1 antagonists.
    - Atsuii 3y ago
      Wouldn't this cause insurers to have to raise their premiums for everyone substantially?
      - ouid 3y ago
        No. The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year, but if not exceed it, they certainly come close. Moreover, it's not unheard of to mandate cheaper drug prices, and now that we understand how these drugs work, there will be more of them in the pipeline.
        nwiswell 3y ago
        > The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year This is a big claim to assert without evidence. If it was the case then insurers would already be adding the drugs to their formularies. There is undoubtedly a cost associated with obesity but you are suggesting that simply being overweight doubles the average cost of care[1], a figure that already includes overweight and obese people (which are of course a huge population in the US). A quick Google search turned up a report[2] that suggests that > This estimated public cost equates to an average marginal cost of $175 per year per adult for a one unit change in BMI for each adult in the U.S. population. So, even for the extreme case of a very obese person that has a very successful treatment and goes from 40 BMI to 25 BMI, you are only saving a hypothetical $2,625 per year (perhaps an underestimate due to inflation and the age of the paper). Therefore it would appear that unless insurers strike a deal with the drug companies (lower the price, make it up in volume), such a law would dramatically increase insurance premiums. A better compromise would be a law which requires insurance companies to offer co-insurance on these drugs up to the expected savings. [1] https://www.pgpf.org/blog/2023/01/why-are-americans-paying-more-for-healthcare#:~:text=The%20United%20States%20has%20one,only%20about%20half%20as%20much https://www.pgpf.org/blog/2023/01/why-are-americans-paying-m.... [2] https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe1201.pdf https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe12...
Ginden 3y ago
> 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. Medicine tried this. It's extremely hard to actually to do it in practice. Obviously, it's better solution, but we are living in real world, where we have to choose "good enough" solutions over those deemed "better, but infeasible for 90% of patients".
- smileysteve 3y ago
  "re-evaluating daily decisions" is exactly what suppressing these hormones allow people to do; so that they can make rational instead of hormone driven decisions.
KingMob 3y ago
> 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. These drugs would have to be pretty bad to counteract the massive health benefits from losing weight (even if they don't have diabetes). I've heard a few eye-openers in the comments, but unless they're more prevalent than I've read, or there's some ticking time bomb, the drugs are probably still a net health benefit.

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.

mym1990 3y ago
I don’t necessarily mean dangerous in the health aspect, although long term affects of these drugs are not know yet…I mean the dependency on needed the drug to keep a certain lifestyle, and then having an “oh shit” moment when you’re in a place that you can’t access it, whether that be traveling or the supply of it becomes scarce, or it gets banned, etc
- reaperman 3y ago
  That sounds like the lesser of two evils to me. Get healthier now and maybe sometime later lose access to the thing that helps you be healthier...or don't get healthier now? Yeah, there are other, orthogonal, choices but I don't think they're part of this particular decision matrix.
  - deleted 3y ago
    [deleted]
  - nwienert 3y ago
    Yep. I lost 30lbs on it in 3 months. It took me 10 years to gain that weight. So I guess if it takes me 10 more years to gain it back I can look into taking it again.
    - unparagoned 3y ago
      People usually gain back that weight much quicker. All it could take is one bad month and you could gain it all back.
      - nwienert 3y ago
        Totally impossible. I’d have to be eating like way more than I ever have to do that. I went off for three months and kept losing weight throughout. And the data from these drugs shows they gain it back at regular rate at most.
      - CRConrad 3y ago
        I lost about 15-20 kg on Ozempic over about six months to a year, and held that weight for another year – continuing on 1 mg Ozempic / wk – until last autumn (2022). Then Ozempic was more widely approved than it had been before somewhere (for over-the-counter sales in the USA? Something like that.), and became unavailable in pharmacies where I live, in Finland. (AIUI, because it's more lucrative to sell it in the USA where prices aren't regulated like here, so all the limited supply is redirected there.) No problem, I was prescribed a substitute, a daily pill (brandname Rybelsus, forgot the active substance) in stead of the weekly injection pen. Worked the same, held my weight. (More of a hassle to take though, and tastes horribly, so on the whole I vastly prefer the Ozempic.) Then, earlier this spring, that prescription ran out. Being in the middle of changing my primary healthcare provider I couldn't immediately get it renewed. And to be honest I wasn't at first all that bothered; I thought now that I've lost so much weight, and kept it off for so long with the help of these drugs, maybe I've got into the habit of eating less, so I can stay constant without them? Nope – in just a few weeks, ballooned back up some 8-10 kg. Had to scramble a bit to get the pill prescription renewed, been on it again for a couple weeks, but still some 6-7 kg above where I was before they ran out. Sure hope I'll get back down the rest of the way. TLDR: Anecdata (n=1) says yes, going off the drugs even for a rather short while puts the weight back on quite quickly.
0zemp2c 3y ago
How dangerous is it to have a new $1k/month bill you need to pay forever? So far there is no indication insurance companies are going to pay for 100 million Americans going on Ozempic who aren't diabetic... Anecdotally, another danger is people confusing less eating with a healthy diet. I know someone on Ozempic...eats less but what is eaten is the same old junk...
- lotsofpulp 3y ago
  Given a significant percent of voters are overweight and obese, it would be very politically popular to legislate that health insurance must pay for GLP-1 antagonists.
  - Atsuii 3y ago
    Wouldn't this cause insurers to have to raise their premiums for everyone substantially?
    - ouid 3y ago
      No. The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year, but if not exceed it, they certainly come close. Moreover, it's not unheard of to mandate cheaper drug prices, and now that we understand how these drugs work, there will be more of them in the pipeline.
      - nwiswell 3y ago
        > The additional costs to the healthcare system due to people being overweight probably exceed 12000/person/year This is a big claim to assert without evidence. If it was the case then insurers would already be adding the drugs to their formularies. There is undoubtedly a cost associated with obesity but you are suggesting that simply being overweight doubles the average cost of care[1], a figure that already includes overweight and obese people (which are of course a huge population in the US). A quick Google search turned up a report[2] that suggests that > This estimated public cost equates to an average marginal cost of $175 per year per adult for a one unit change in BMI for each adult in the U.S. population. So, even for the extreme case of a very obese person that has a very successful treatment and goes from 40 BMI to 25 BMI, you are only saving a hypothetical $2,625 per year (perhaps an underestimate due to inflation and the age of the paper). Therefore it would appear that unless insurers strike a deal with the drug companies (lower the price, make it up in volume), such a law would dramatically increase insurance premiums. A better compromise would be a law which requires insurance companies to offer co-insurance on these drugs up to the expected savings. [1] https://www.pgpf.org/blog/2023/01/why-are-americans-paying-more-for-healthcare#:~:text=The%20United%20States%20has%20one,only%20about%20half%20as%20much https://www.pgpf.org/blog/2023/01/why-are-americans-paying-m.... [2] https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe1201.pdf https://vinecon.ucdavis.edu/wp-content/uploads/2019/04/cwe12...

Ginden 3y ago

> 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. Medicine tried this. It's extremely hard to actually to do it in practice. Obviously, it's better solution, but we are living in real world, where we have to choose "good enough" solutions over those deemed "better, but infeasible for 90% of patients".

smileysteve 3y ago
"re-evaluating daily decisions" is exactly what suppressing these hormones allow people to do; so that they can make rational instead of hormone driven decisions.

KingMob 3y ago

> 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. These drugs would have to be pretty bad to counteract the massive health benefits from losing weight (even if they don't have diabetes). I've heard a few eye-openers in the comments, but unless they're more prevalent than I've read, or there's some ticking time bomb, the drugs are probably still a net health benefit.