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My grandmother likes to tell me about how she was perscribed amphetamines for weight loss in the the 1960s, and how she struggled to escape that. I'm wary of an

My grandmother likes to tell me about how she was perscribed amphetamines for weight loss in the the 1960s, and how she struggled to escape that. I'm wary of anything in this space that seems too good to be true, and articles like this one seem like a part of a massive media push to me. Almost reads like a "9/10 doctors smoke Camels" kind of situation.

esperent 3y ago
I'm sure it's not a miracle solution. But it does seem unfair to compare it to amphetamines. For a start, it does not appear to be psychoactive to any large degree, which is a huge difference. Of course there will be psychological effects from anything that changes your weight or lifestyle rapidly, but that's not the same as being psychoactive. I think the largest issue will be sorting out the genuine side effects of the drug from the side effects that would happen from any major change in lifestyle/weight. Here's the list of side effects from wikipedia: > Possible side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion/heartburn, dizziness, abdominal distension, belching, hypoglycemia (low blood glucose) in patients with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease (GERD).[26] It can also cause pancreatitis, gastroparesis, and bowel obstruction.[27] https://en.wikipedia.org/wiki/Semaglutide https://en.wikipedia.org/wiki/Semaglutide How many of the things in that list would you say a person who undergoes massive weight loss in short time without drugs would experience? Or massive changes in the amount and type of food that they eat? Especially if they also have complications with diabetes or pre-diabetes. And also, how do these compare to the inevitable health problems that long term obesity will cause the same person if they don't take the drug? These questions will not be easy question to answer. I expect to see a lot of arguments from both sides in the coming years.
- kennywinker 3y ago
  > And also, how do these compare to the inevitable health problems that long term obesity will cause Did you know that being in the BMI “overweight” category is healthier than any other category, including “healthy” and “underweight”? https://www.sciencealert.com/the-healthiest-weight-might-actually-be-overweight-massive-study-finds https://www.sciencealert.com/the-healthiest-weight-might-act... Now you might say well that’s interesting but i was talking about obese people taking this drug. “The study also found that those in the 'obese' category ended up having the same risk of death as those in the 'normal' range, even when factors such as age, sex, family history of disease, socio-economic status, and smoking were taken into account.” So there are plenty of justifications and reasons to take a drug like this - some good, some bad - but hand waving at the obvious dangers of being overweight or obese doesn’t hold up as well as you might think.
  - saurik 3y ago
    > Did you know that being in the BMI “overweight” category is healthier than any other category, including “healthy” and “underweight”? I think we don't believe this anymore? I am linking to some Hacker News discussions as this is the only website I use (lol). https://news.ycombinator.com/item?id=34930641 https://news.ycombinator.com/item?id=34930641 https://news.ycombinator.com/item?id=35121904 https://news.ycombinator.com/item?id=35121904 > Key Takeaways: > Epidemiology researchers repeatedly have found that being overweight or obese is not as much of a mortality risk as conventional wisdom would suggest. > Critics have contended that this "obesity paradox" is the result of poor methods. Using body-mass index (BMI) to measure obesity is likely the most problematic factor. > Recent research that adjusts for the flaws inherent in BMI show that there is no paradox. The more body fat a person has, the more likely it is that they will die.
    - kennywinker 3y ago
      > Recent research that adjusts for the flaws inherent in BMI show that there is no paradox. The more body fat a person has, the more likely it is that they will die. The study that you link to that suggests this makes absolutely zero attempts to control for wealth. I don’t think I need to take a health study in the USA seriously if it doesn’t consider the potential for wealth (access to healthcare, leisure time, poverty stress, etc) to be the cause of what it’s seeing.
  - somenameforme 3y ago
    You know those studies saying that a cup of wine a day is good for you? Huge numbers, compelling evidence. Turns out they were all wrong due to a pretty simple and 'obvious' bias. Plenty of people who stop drinking did so due to health conditions, both diagnosed and undiagnosed. And so when you just compared drinkers to non-drinkers, you were biasing towards healthy individuals in the drinking side, and the effect was significant enough to create a statistically significant 'discovery.' All large scale observational studies are subject so such biases, and the one you linked to also seems a likely suspect there. The hidden confounders are pretty much infinite. The users of many of the worst of sorts of drugs, such as heroine and amphetamines, tend to be average to lower weight. They will die disproportionately young, which will drag their weight cohort substantially down. Another could be increases in things like body building, which show increases in BMI without the corresponding increase in body fat that it's supposed to represent. I'm not saying any of these are the silver bullet, but rather that when you see a big observational study like this, that sort of skepticism should be the first thing to enter into your mind, as it's extremely often the case when you read about a [shocking discovery] based on big observational studies. Correlation is not causation, even with really big population sizes.
- SOLAR_FIELDS 3y ago
  Anecdata: I dropped 40 lbs in 60 days a few years ago, which most people would say is pretty extreme weight loss. I didn’t have any of the side effects you mentioned aside from some light fatigue and not as good as focus, but it was really not bad. Operated at perhaps 85% mental capability most of the time and was able to exercise just fine.
BurningFrog 3y ago
Your grandmother can also tell you about all the previously devastating diseases that have become easily cured in her lifetime. Very good things do happen in this field!
TJSomething 3y ago
While I'm sure there's real value in the drug, articles like this one in Reuters [0], noting how much Novo Nordisk is spending on promotion, makes me suspicious that it's being overprescribed. [0] https://www.reuters.com/investigates/special-report/health-obesity-novonordisk-doctors/ https://www.reuters.com/investigates/special-report/health-o...
- collegeburner 3y ago
  it turns out you don't actually have to spend a lot on marketing a miracle weight loss drug, word spreads pretty well on its own. lots of companies spend lots of money on promoting drugs and basically none every go viral like this. you don't hear phrases like "ozempic face" because of novo's marketing budget. you can even see this in how people still talk about ozempic despite the actual weight loss labelled name being wegovy, and despite zepbound (tirzepatide) arguably offering a better option with lower side-effect burden through dual agonism of GIP.
renegade-otter 3y ago
The Search Engine podcast has a great recent episode on this. Pharmaceutical Speed was super abused back in the day, and this was the source of drug categorization under Nixon. Schedule 1 drug, etc. This led to a dramatic drop in drug use. Big Pharma, in the quest to restoe its profits, pivoted to children. Child fidgety? Can't pay attention? ADDERALL! The episode is based on the author's first-person experience. I won't spoil the big reveal.
- alfiedotwtf 3y ago
  > Child fidgety? Can't pay attention? ADDERALL! At least it was a step up 1940s ads: Child fidgety? Can't pay attention? LOBOTOMY!
cscurmudgeon 3y ago
Interesting how the irrational distrust of companies and capitalism evaporates when it comes to pharma and gets replaced with gullibility.
WirelessGigabit 3y ago
To this date Vyvanse can make you lose weight by reducing binge-eating episodes: https://www.drugs.com/vyvanse.html https://www.drugs.com/vyvanse.html

esperent 3y ago

I'm sure it's not a miracle solution. But it does seem unfair to compare it to amphetamines. For a start, it does not appear to be psychoactive to any large degree, which is a huge difference. Of course there will be psychological effects from anything that changes your weight or lifestyle rapidly, but that's not the same as being psychoactive. I think the largest issue will be sorting out the genuine side effects of the drug from the side effects that would happen from any major change in lifestyle/weight. Here's the list of side effects from wikipedia: > Possible side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion/heartburn, dizziness, abdominal distension, belching, hypoglycemia (low blood glucose) in patients with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease (GERD).[26] It can also cause pancreatitis, gastroparesis, and bowel obstruction.[27] https://en.wikipedia.org/wiki/Semaglutide https://en.wikipedia.org/wiki/Semaglutide How many of the things in that list would you say a person who undergoes massive weight loss in short time without drugs would experience? Or massive changes in the amount and type of food that they eat? Especially if they also have complications with diabetes or pre-diabetes. And also, how do these compare to the inevitable health problems that long term obesity will cause the same person if they don't take the drug? These questions will not be easy question to answer. I expect to see a lot of arguments from both sides in the coming years.

kennywinker 3y ago
> And also, how do these compare to the inevitable health problems that long term obesity will cause Did you know that being in the BMI “overweight” category is healthier than any other category, including “healthy” and “underweight”? https://www.sciencealert.com/the-healthiest-weight-might-actually-be-overweight-massive-study-finds https://www.sciencealert.com/the-healthiest-weight-might-act... Now you might say well that’s interesting but i was talking about obese people taking this drug. “The study also found that those in the 'obese' category ended up having the same risk of death as those in the 'normal' range, even when factors such as age, sex, family history of disease, socio-economic status, and smoking were taken into account.” So there are plenty of justifications and reasons to take a drug like this - some good, some bad - but hand waving at the obvious dangers of being overweight or obese doesn’t hold up as well as you might think.
- saurik 3y ago
  > Did you know that being in the BMI “overweight” category is healthier than any other category, including “healthy” and “underweight”? I think we don't believe this anymore? I am linking to some Hacker News discussions as this is the only website I use (lol). https://news.ycombinator.com/item?id=34930641 https://news.ycombinator.com/item?id=34930641 https://news.ycombinator.com/item?id=35121904 https://news.ycombinator.com/item?id=35121904 > Key Takeaways: > Epidemiology researchers repeatedly have found that being overweight or obese is not as much of a mortality risk as conventional wisdom would suggest. > Critics have contended that this "obesity paradox" is the result of poor methods. Using body-mass index (BMI) to measure obesity is likely the most problematic factor. > Recent research that adjusts for the flaws inherent in BMI show that there is no paradox. The more body fat a person has, the more likely it is that they will die.
  - kennywinker 3y ago
    > Recent research that adjusts for the flaws inherent in BMI show that there is no paradox. The more body fat a person has, the more likely it is that they will die. The study that you link to that suggests this makes absolutely zero attempts to control for wealth. I don’t think I need to take a health study in the USA seriously if it doesn’t consider the potential for wealth (access to healthcare, leisure time, poverty stress, etc) to be the cause of what it’s seeing.
- somenameforme 3y ago
  You know those studies saying that a cup of wine a day is good for you? Huge numbers, compelling evidence. Turns out they were all wrong due to a pretty simple and 'obvious' bias. Plenty of people who stop drinking did so due to health conditions, both diagnosed and undiagnosed. And so when you just compared drinkers to non-drinkers, you were biasing towards healthy individuals in the drinking side, and the effect was significant enough to create a statistically significant 'discovery.' All large scale observational studies are subject so such biases, and the one you linked to also seems a likely suspect there. The hidden confounders are pretty much infinite. The users of many of the worst of sorts of drugs, such as heroine and amphetamines, tend to be average to lower weight. They will die disproportionately young, which will drag their weight cohort substantially down. Another could be increases in things like body building, which show increases in BMI without the corresponding increase in body fat that it's supposed to represent. I'm not saying any of these are the silver bullet, but rather that when you see a big observational study like this, that sort of skepticism should be the first thing to enter into your mind, as it's extremely often the case when you read about a [shocking discovery] based on big observational studies. Correlation is not causation, even with really big population sizes.
SOLAR_FIELDS 3y ago
Anecdata: I dropped 40 lbs in 60 days a few years ago, which most people would say is pretty extreme weight loss. I didn’t have any of the side effects you mentioned aside from some light fatigue and not as good as focus, but it was really not bad. Operated at perhaps 85% mental capability most of the time and was able to exercise just fine.

BurningFrog 3y ago

Your grandmother can also tell you about all the previously devastating diseases that have become easily cured in her lifetime. Very good things do happen in this field!

TJSomething 3y ago

While I'm sure there's real value in the drug, articles like this one in Reuters [0], noting how much Novo Nordisk is spending on promotion, makes me suspicious that it's being overprescribed. [0] https://www.reuters.com/investigates/special-report/health-obesity-novonordisk-doctors/ https://www.reuters.com/investigates/special-report/health-o...

collegeburner 3y ago
it turns out you don't actually have to spend a lot on marketing a miracle weight loss drug, word spreads pretty well on its own. lots of companies spend lots of money on promoting drugs and basically none every go viral like this. you don't hear phrases like "ozempic face" because of novo's marketing budget. you can even see this in how people still talk about ozempic despite the actual weight loss labelled name being wegovy, and despite zepbound (tirzepatide) arguably offering a better option with lower side-effect burden through dual agonism of GIP.

renegade-otter 3y ago

The Search Engine podcast has a great recent episode on this. Pharmaceutical Speed was super abused back in the day, and this was the source of drug categorization under Nixon. Schedule 1 drug, etc. This led to a dramatic drop in drug use. Big Pharma, in the quest to restoe its profits, pivoted to children. Child fidgety? Can't pay attention? ADDERALL! The episode is based on the author's first-person experience. I won't spoil the big reveal.

alfiedotwtf 3y ago
> Child fidgety? Can't pay attention? ADDERALL! At least it was a step up 1940s ads: Child fidgety? Can't pay attention? LOBOTOMY!

cscurmudgeon 3y ago

Interesting how the irrational distrust of companies and capitalism evaporates when it comes to pharma and gets replaced with gullibility.

WirelessGigabit 3y ago

To this date Vyvanse can make you lose weight by reducing binge-eating episodes: https://www.drugs.com/vyvanse.html https://www.drugs.com/vyvanse.html