6 ms·

So my wife and I have been talking about this recently. She is not overweight, but after we had our child, she put on some extra weight. She's keen on losing it

by LASR 3y ago

So my wife and I have been talking about this recently. She is not overweight, but after we had our child, she put on some extra weight. She's keen on losing it now and going back to her pre-pregnancy weight. She's been very consistent in going to the gym and has seen some good results. But it does require a lot of motivation and effort. She's tempted to ask our GP about Ozempic, but also afraid of unknown risks that comes with going off-label. My opinion is that she should continue in the old-fashioned-way because it's been working well, not just for weight-loss, but also as an escape from childcare. But now seeing people lose weight very much faster than her, I almost see her lose the motivation to do it the old-fashioned way. Some of her gym friends are on it, and so is a daily reminder for her. So I am a bit mixed on this. We're also planning to have another child soonish, so unsure if this even factors in. I am worried that collectively, the world has gone a bit too fast in using this for minor weight-loss.

tjohns 3y ago
The thing to keep in mind with Ozempic (and other GLP-1 agonists) is that it's essentially a forever drug. The data is clear that when you stop taking it, you will gain the weight back, rapidly, with almost near certainty. For folks who are risking health complications due to obesity and yet still struggle to achieve meaningful weight loss, this can be an acceptable tradeoff. Especially considering the increased life expectancy. The health benefits of being in a normal weight range can't be overstated. But if you're "not overweight", or are fortunate enough to make progress through diet and exercise, you probably don't want to be taking this for the rest of your life. It's not cheap and there can be side effects. And if you're not planning to take it for the rest of your life, there's no point.
- hypomanic 3y ago
  I'm sure people can use diet and exercise to keep the weight off. At the end of the day, it's all "calories in calories out".
  - tjohns 3y ago
    There's a hormonal component to weight loss. Some people literally do not get a reliable "I'm full, stop eating" signal from their bodies. For other people, eating is stress response. (Sometimes one becomes the other.) If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive - it's literally one of our most basic hardwired instincts. Even more so if you have a particularly stressful life or get poor sleep, which also feeds into the hormone issues. So yes, it is always "calories in - calories out"... but unless you're willing to lock people in a lab and have a third-party control the diet, you also have to consider the mental and biological factors that drive how many calories people's bodies are seeking out. Diet and exercise do work for some people, and is always the best option when it works. But we also know from decades of failed diets that they do not work for many people - lifestyle modification has a terrible success rate.
    - rrrrrrrrrrrryan 3y ago
      > If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive Trying to ignore being hungry it is a poor strategy. The solution is to to make peace with the sensation of hunger. I do think most obesity should be treated as a mental health issue rather than a physical health issue. The issue isn't that the person is obese - that's the symptom. The issue is that they're overheating. "What's driving me to overeat?" is the question they need to be asking themselves, and that answer will be the first piece of the puzzle.
      - xvector 3y ago
        It is the literal feeling of incredible hunger. That is not a normal thing to expect people to live with. The average person does not feel constantly hungry and thus not the urge to overeat. Most obese people became obese in childhood. In obese people, especially those from childhood that were forced to always clean their plate, signaling pathways for satiation tend to stop working, so consuming a "normal" amount of food becomes difficult. Furthermore, mechanisms for hunger in obesity function very similarly to mechanisms for cocaine or alcohol addiction. Drugs like Ozempic finally allow their biological signals for "you've had enough food" to actually work, so obese people can lose weight because they feel satiated like normal people do. FWIW I have lost weight both ways - 80lbs through sheer will, and 25lbs through Mounjaro. I vastly prefer the second. The former is the hardest thing I have ever done (or will likely ever do) in my life. It was harder than getting into a top college, harder than anything relating to my career, harder than literally any other endeavor I've taken. It is definitely unreasonable to expect the average person to expend so much extreme mental effort when alternatives exist to become healthy.
- fieldcny 3y ago
  I don’t understand the mechanics of the weight coming back, like you use this, your appetite changes you eat less etc, doesn’t your body adjust to the lower caloric intake and all that. How is it that once you stop taking everything reverts?
  - tjohns 3y ago
    Look at it this way: Your body secrets a certain amount of hunger hormones. The GLP-1 drugs act in a way that blocks those hormones. (I'm greatly simplifying here.) In response, your body secretes more hormones, so you take more GLP-1 drugs. Increase until you reach a stable balance that adequately controls the hunger. Now, when you stop taking the GLP-1 drugs, you have a flood of surplus hunger hormones... and the hunger comes back with a vengeance. Plus, you probably haven't learned any effective coping skills for dealing with that hunger while taking the drug - so you're likely to revert to old lifestyle practices. Or at least that's my understanding. The endocrine system is complicated. However, mechanism aside, the data is clear that people regain the weight once they stop. There's a relevant study here: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725 https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
- credit_guy 3y ago
  > it's essentially a forever drug Not necessarily. When you get to the target weight, you don't need to go straight from the dose you are on to zero, you can, and probably should, lower the dose little by little, just like you raised the dose at the beginning of the regimen. If you are at 2mg, you first go to 1mg, see if your weight is stable, then if it is, go to 0.5 mg, then 0.25 mg. In the near future there will be oral versions of the GLP-1 antagonists, to you will be able to fine-tune even more precisely the dose, for example, you could figure if you can skip some days. The body has some "weight memory". But I heard this memory disappears after about 10 years. If you take Ozempic for 2 years, go in very low dose maintenance mode for 8 years, and then stop taking it, but keep an eye to see if you need to start again, what other dieting option offers you this type of choice?
  - rrrrrrrrrrrryan 3y ago
    I read that there were oral GLP-1 antagonists being researched a while back, but they failed clinical trials because they weren't effective. I do think they'll probably be available eventually, but I don't think it's as trivial a problem to solve as you're implying.
  - yc-kraln 3y ago
    Rybelsus. It's a daily pill. It already exists and works fine
- rrrrrrrrrrrryan 3y ago
  > if you're not planning to take it for the rest of your life, there's no point I'm at the age where I'm attending a ton of weddings, and many of the brides and grooms go on Ozempic for a few months before the wedding, fully acknowledging they'll probably gain all the weight back afterward (despite their best efforts to keep it off!) The weight loss may not be permanent, but it's a day where most people are probably photographed and recorded more than any other day in their lives, and those captured images are indeed pregnant. The added stress and hectic nature of planning a large wedding makes it quite difficult to diet, exercise, and lose weight the natural way as well (I imagine).
hotpotamus 3y ago
I was under the impression that to use these drugs medically, you do need to be overweight - BMI 27 and some related condition like high blood pressure or you need to be obese (BMI 30+) or have diabetes. I wonder what people are saying to get them prescribed for more trivial weight loss. I wonder what this is doing to our insurance premiums because it sure isn't cheap, but other than that, I say if you want to take it, then go for it. I probably would if the cost was reasonable.
- xvector 3y ago
  I have seen people gain weight just to push themselves over the edge to get the drug. Once they are on it, they more a quickly reach their goal weight than they would have otherwise. Others will simply lie about their weight to their primary care, increasing it slightly to match the BMI bar. Finally, some people will get the drug from compound pharmacies. TL;DR - yes, it probably impacts premiums, but insurance companies are somewhat evil for attaching so many restrictions around a drug that every overweight person should have free access to. It is frankly ridiculous that these companies have the power to get between a doctor and patient, and what the doctor deems medically necessary.
orev 3y ago
Please understand, the gym is NOT for weight loss! This is a myth perpetuated by both food and gym industries. Weight loss happens 90% in the kitchen (what you eat). Exercise is important for health, but do not expect to lose weight. Make sure you/she are doing the right things that will lead to the expected goal.
- orwin 3y ago
  Gym is great for increasing your metabolism (muscle consume more than fat). Is good for the last 2-3 kilos, useless for the first 20s (I know, I was obese). Another solution for the last 2-3 kilos is going below necessary kcal, but this can have consequences, especially if you're not young.
sn9 3y ago
Getting a food scale to measure what you're eating and an app like Macrofactor can make "what to do" really easy. It will figure out your TDEE and give you the information you need to hit a particular rate of weight loss or gain. Strength and endurance training now is still a great idea for the health benefits and for building her body up before the next pregnancy.

by LASR 3y ago

tjohns 3y ago

The thing to keep in mind with Ozempic (and other GLP-1 agonists) is that it's essentially a forever drug. The data is clear that when you stop taking it, you will gain the weight back, rapidly, with almost near certainty. For folks who are risking health complications due to obesity and yet still struggle to achieve meaningful weight loss, this can be an acceptable tradeoff. Especially considering the increased life expectancy. The health benefits of being in a normal weight range can't be overstated. But if you're "not overweight", or are fortunate enough to make progress through diet and exercise, you probably don't want to be taking this for the rest of your life. It's not cheap and there can be side effects. And if you're not planning to take it for the rest of your life, there's no point.

hypomanic 3y ago
I'm sure people can use diet and exercise to keep the weight off. At the end of the day, it's all "calories in calories out".
- tjohns 3y ago
  There's a hormonal component to weight loss. Some people literally do not get a reliable "I'm full, stop eating" signal from their bodies. For other people, eating is stress response. (Sometimes one becomes the other.) If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive - it's literally one of our most basic hardwired instincts. Even more so if you have a particularly stressful life or get poor sleep, which also feeds into the hormone issues. So yes, it is always "calories in - calories out"... but unless you're willing to lock people in a lab and have a third-party control the diet, you also have to consider the mental and biological factors that drive how many calories people's bodies are seeking out. Diet and exercise do work for some people, and is always the best option when it works. But we also know from decades of failed diets that they do not work for many people - lifestyle modification has a terrible success rate.
  - rrrrrrrrrrrryan 3y ago
    > If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive Trying to ignore being hungry it is a poor strategy. The solution is to to make peace with the sensation of hunger. I do think most obesity should be treated as a mental health issue rather than a physical health issue. The issue isn't that the person is obese - that's the symptom. The issue is that they're overheating. "What's driving me to overeat?" is the question they need to be asking themselves, and that answer will be the first piece of the puzzle.
    - xvector 3y ago
      It is the literal feeling of incredible hunger. That is not a normal thing to expect people to live with. The average person does not feel constantly hungry and thus not the urge to overeat. Most obese people became obese in childhood. In obese people, especially those from childhood that were forced to always clean their plate, signaling pathways for satiation tend to stop working, so consuming a "normal" amount of food becomes difficult. Furthermore, mechanisms for hunger in obesity function very similarly to mechanisms for cocaine or alcohol addiction. Drugs like Ozempic finally allow their biological signals for "you've had enough food" to actually work, so obese people can lose weight because they feel satiated like normal people do. FWIW I have lost weight both ways - 80lbs through sheer will, and 25lbs through Mounjaro. I vastly prefer the second. The former is the hardest thing I have ever done (or will likely ever do) in my life. It was harder than getting into a top college, harder than anything relating to my career, harder than literally any other endeavor I've taken. It is definitely unreasonable to expect the average person to expend so much extreme mental effort when alternatives exist to become healthy.
fieldcny 3y ago
I don’t understand the mechanics of the weight coming back, like you use this, your appetite changes you eat less etc, doesn’t your body adjust to the lower caloric intake and all that. How is it that once you stop taking everything reverts?
- tjohns 3y ago
  Look at it this way: Your body secrets a certain amount of hunger hormones. The GLP-1 drugs act in a way that blocks those hormones. (I'm greatly simplifying here.) In response, your body secretes more hormones, so you take more GLP-1 drugs. Increase until you reach a stable balance that adequately controls the hunger. Now, when you stop taking the GLP-1 drugs, you have a flood of surplus hunger hormones... and the hunger comes back with a vengeance. Plus, you probably haven't learned any effective coping skills for dealing with that hunger while taking the drug - so you're likely to revert to old lifestyle practices. Or at least that's my understanding. The endocrine system is complicated. However, mechanism aside, the data is clear that people regain the weight once they stop. There's a relevant study here: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725 https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
credit_guy 3y ago
> it's essentially a forever drug Not necessarily. When you get to the target weight, you don't need to go straight from the dose you are on to zero, you can, and probably should, lower the dose little by little, just like you raised the dose at the beginning of the regimen. If you are at 2mg, you first go to 1mg, see if your weight is stable, then if it is, go to 0.5 mg, then 0.25 mg. In the near future there will be oral versions of the GLP-1 antagonists, to you will be able to fine-tune even more precisely the dose, for example, you could figure if you can skip some days. The body has some "weight memory". But I heard this memory disappears after about 10 years. If you take Ozempic for 2 years, go in very low dose maintenance mode for 8 years, and then stop taking it, but keep an eye to see if you need to start again, what other dieting option offers you this type of choice?
- rrrrrrrrrrrryan 3y ago
  I read that there were oral GLP-1 antagonists being researched a while back, but they failed clinical trials because they weren't effective. I do think they'll probably be available eventually, but I don't think it's as trivial a problem to solve as you're implying.
- yc-kraln 3y ago
  Rybelsus. It's a daily pill. It already exists and works fine
rrrrrrrrrrrryan 3y ago
> if you're not planning to take it for the rest of your life, there's no point I'm at the age where I'm attending a ton of weddings, and many of the brides and grooms go on Ozempic for a few months before the wedding, fully acknowledging they'll probably gain all the weight back afterward (despite their best efforts to keep it off!) The weight loss may not be permanent, but it's a day where most people are probably photographed and recorded more than any other day in their lives, and those captured images are indeed pregnant. The added stress and hectic nature of planning a large wedding makes it quite difficult to diet, exercise, and lose weight the natural way as well (I imagine).

hotpotamus 3y ago

I was under the impression that to use these drugs medically, you do need to be overweight - BMI 27 and some related condition like high blood pressure or you need to be obese (BMI 30+) or have diabetes. I wonder what people are saying to get them prescribed for more trivial weight loss. I wonder what this is doing to our insurance premiums because it sure isn't cheap, but other than that, I say if you want to take it, then go for it. I probably would if the cost was reasonable.

xvector 3y ago
I have seen people gain weight just to push themselves over the edge to get the drug. Once they are on it, they more a quickly reach their goal weight than they would have otherwise. Others will simply lie about their weight to their primary care, increasing it slightly to match the BMI bar. Finally, some people will get the drug from compound pharmacies. TL;DR - yes, it probably impacts premiums, but insurance companies are somewhat evil for attaching so many restrictions around a drug that every overweight person should have free access to. It is frankly ridiculous that these companies have the power to get between a doctor and patient, and what the doctor deems medically necessary.

orev 3y ago

Please understand, the gym is NOT for weight loss! This is a myth perpetuated by both food and gym industries. Weight loss happens 90% in the kitchen (what you eat). Exercise is important for health, but do not expect to lose weight. Make sure you/she are doing the right things that will lead to the expected goal.

orwin 3y ago
Gym is great for increasing your metabolism (muscle consume more than fat). Is good for the last 2-3 kilos, useless for the first 20s (I know, I was obese). Another solution for the last 2-3 kilos is going below necessary kcal, but this can have consequences, especially if you're not young.

sn9 3y ago

Getting a food scale to measure what you're eating and an app like Macrofactor can make "what to do" really easy. It will figure out your TDEE and give you the information you need to hit a particular rate of weight loss or gain. Strength and endurance training now is still a great idea for the health benefits and for building her body up before the next pregnancy.