16 ms·

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 w

by 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.
      - deleted 3y ago
        [deleted]
      - burnerburnito 3y ago
        I've felt incredible hunger and pain. I've had a lifetime of voluntary fasting, sure, but I've also had an experience this year where I spent weeks starving while already underweight and sick as hell withdrawing from a couple drugs, unable to sleep for more than 20-30 minutes tops, and suffering from a (still mostly mystery) intestinal issue. I was SO hungry, it was indeed one of my dominant thoughts other than wanting to kill myself (or distract myself with hot hand warmers in between puking). It virtually never truly went away, other than when I was distracted by even worse senations. What I then struggle to understand is why my obese and well-off father with a LOT of free time can't make the decision to stop eating fast food, can't consistently stick with not buying presumably very immediately gratifying and pleasurable fast food that often makes him feel sick later. Why I could actually have made radical changes to my diet years before I ever had that level of extreme suffering, or consistently rejected taking any opioids or weed even when my tolerances were probably more reset 1 or 2 weeks in and they could've provided substantial short-term escape from that hell. I ask in this manner not to try to "brag", as if there's some achievement in meaningless and random suffering, but rather to ask about and understand how you might interpet it. I feel like I've experienced severe and truly engulfing hunger + pain. Coming out of that, I don't understand why some people can't escape the "addiction" of overeating unhealthy food, let alone too much of it, and others can escape the throes of drug dependency. What could be so alien about someone like me compared against my own father, as opposed to his being in an active refusal to try? Ultimately, it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure, and yet given the same opportunities of similar constant cheap pleasures I've mostly avoided them in seeing the longer term pain lying in wait behind their facade. I feel as though the only definitive observation I can make there is that most obese people can't seem to see their condition similarly. They can get hyped up selling themselved and those around them a meme "diet plan" while its easy in their mind, but once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
- hackeraccount 3y ago
  Sure but it's like trying to hide the keys to the liquor cabinet from yourself. Ultimately it's the root cause that interests people not the consequence of it.
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).

by tjohns 3y ago

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.
    - deleted 3y ago
      [deleted]
    - burnerburnito 3y ago
      I've felt incredible hunger and pain. I've had a lifetime of voluntary fasting, sure, but I've also had an experience this year where I spent weeks starving while already underweight and sick as hell withdrawing from a couple drugs, unable to sleep for more than 20-30 minutes tops, and suffering from a (still mostly mystery) intestinal issue. I was SO hungry, it was indeed one of my dominant thoughts other than wanting to kill myself (or distract myself with hot hand warmers in between puking). It virtually never truly went away, other than when I was distracted by even worse senations. What I then struggle to understand is why my obese and well-off father with a LOT of free time can't make the decision to stop eating fast food, can't consistently stick with not buying presumably very immediately gratifying and pleasurable fast food that often makes him feel sick later. Why I could actually have made radical changes to my diet years before I ever had that level of extreme suffering, or consistently rejected taking any opioids or weed even when my tolerances were probably more reset 1 or 2 weeks in and they could've provided substantial short-term escape from that hell. I ask in this manner not to try to "brag", as if there's some achievement in meaningless and random suffering, but rather to ask about and understand how you might interpet it. I feel like I've experienced severe and truly engulfing hunger + pain. Coming out of that, I don't understand why some people can't escape the "addiction" of overeating unhealthy food, let alone too much of it, and others can escape the throes of drug dependency. What could be so alien about someone like me compared against my own father, as opposed to his being in an active refusal to try? Ultimately, it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure, and yet given the same opportunities of similar constant cheap pleasures I've mostly avoided them in seeing the longer term pain lying in wait behind their facade. I feel as though the only definitive observation I can make there is that most obese people can't seem to see their condition similarly. They can get hyped up selling themselved and those around them a meme "diet plan" while its easy in their mind, but once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
hackeraccount 3y ago
Sure but it's like trying to hide the keys to the liquor cabinet from yourself. Ultimately it's the root cause that interests people not the consequence of it.

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).