11 ms·

Wegovy and Ozempic (semaglutide) associated with reduction in alcohol addiction

76 points by henryaj 2y ago

toomuchtodo 2y ago
Very exciting, we're going to see some serious "at scale" behavioral changes (obesity decline, addiction decline, possibly even social media usage decline) as soon as the cost of GLP-1 agonists gets driven down and manufacturing scales up.
- lushdogg 2y ago
  What else will we see? More bowel obstructions?
- philipkglass 2y ago
  I wonder which will happen first: discovery of effective small-molecule drugs in this class, or improvements of peptide manufacturing to the point that cheap generics become possible. There are only 7 years left on the semaglutide patent but its manufacturing is currently so complicated that I don't expect really cheap generics after patent expiration.
  - vundercind 2y ago
    My understanding is that the manufacturing costs have nothing whatsoever to do with why they’re so expensive. It’s already damn near aspirin-cheap to make.
    - toomuchtodo 2y ago
      Correct, cost is ~$5 for a month supply, and could be made for as low as 89 cents. https://doi.org/10.1001/jamanetworkopen.2024.3474 https://doi.org/10.1001/jamanetworkopen.2024.3474 https://www.fastcompany.com/91071415/your-1000-per-month-ozempic-costs-5-to-make-says-study https://www.fastcompany.com/91071415/your-1000-per-month-oze...
  - 0cf8612b2e1e 2y ago
    I am not familiar with the specifics of manufacturing these drugs, but peptide molecules have been synthesized for decades. What makes these special? Considering the high prices of the marketed product, I would dispute the idea that generic manufacturers will not leap at the chance to get a taste. Even if it is technically complex, they have years to perfect a recipe, get it GMP qualified, and on shelves the day patents expire.
- zdragnar 2y ago
  Unfortunately, the story for people who discontinue the drug is less rosey. Many regain some or all of the weight lost; it appears to be a temporary alternative to stomach surgery.
  - toomuchtodo 2y ago
    Targeted gene therapy is the end goal, versus chronic management. We bug fix the human. Think of this as pharma print statement debugging. In the interim, the drug helps those in need of intervention. https://www.fractyl.com/fractyl-health-demonstrates-significant-improvement-in-glucose-control-and-obesity-inpreclinical-studies-of-its-rejuva-glp-1-based-pancreatic-gene-therapy-glp1-pgtxcompared-to-chronic-semaglutide-at/ https://www.fractyl.com/fractyl-health-demonstrates-signific... https://www.remain1study.com/remain-1-study/ https://www.remain1study.com/remain-1-study/
  - suzzer99 2y ago
    Does this happen any more often than when people lose weight by other means? I was under the impression that something like 90-95% of people who lose significant weight gain a lot of it back.
    - zdragnar 2y ago
      Other means have fewer side effects and cost insurance companies less, meaning they cost you less. Over-priced temporary fixes should be the choice of last resort, not the first one.
      - sunshowers 2y ago
        The overpricing is not inherent to the manufacturing of these drugs as far as I understand, it's an artifact of the American healthcare system. You know what else is a temporary fix? Vitamin C for scurvy. Your body does not produce it endogenously. You are already a lifelong patient -- all humans are -- and it just so happens that the medication to treat it is part of your diet.
  - sunshowers 2y ago
spacephysics 2y ago
We’re nearing the utopic phase for this drug (if we aren’t already there) Mindful that this also lowers muscle mass (can weight train and eat enough protein to compensate slightly) AND less easily mitigated lowers bone mass, weakens tendons, and weakens ligaments. It’s a great option if the patient is diabetic and their current lifestyle/condition has worse outcomes than the side effects listed, but we’re hearing from celebrities like this is a vitamin D pill
- xcskier56 2y ago
  Yeah, I'm with you. It seems like there are some almost miraculous results from this class of drugs, but I'm very concerned what's going to rear it's head 5, 10, 15 years down the line
  - rasz 2y ago
    >miraculous results All the results are from lowering BMI, being fat is just this unhealthy.
    - ssijak 2y ago
      It looks like it lowers addictions of all kinds which are not BMI related
  - throwup238 2y ago
    I don't envy anyone tasked with calculating the risk/reward benefit of this drug versus obesity and friends. These drugs aren't a free lunch and from my understanding can't be stopped without dramatic lifestyle changes or most of the weight comes right back. 20+ years of losing bone density and connective tissue mass is going to be catastrophic in old age for people who have to stay on it long term but really so is the obesity, diabetes, and heart disease. It's a tough moral quandary.
    - inquirerGeneral 2y ago
      [dead]
manacit 2y ago
It's exciting to see when we're so early in the journey of GLP-1 drugs. The dual action tirzepatide and the next generation retatrutide that has shown massive ability to reduce the long-term harm from obesity: https://www.vcuhealth.org/news/retatrutide-wiped-out-fat-in-liver-of-obese-patients https://www.vcuhealth.org/news/retatrutide-wiped-out-fat-in-... I'm sure there will be many comments here discussing how awful the side effects are, but from what I can see they're almost all primarily associated with rapid weight loss in general - muscle mass reduction and whatnot seem inevitable when someone drops 100+ lbs of total body weight.
kingkawn 2y ago
Mess with the fundamental hormonal balance honed over the eons of hunger and survival? What could go wrong?
- delabay 2y ago
  Same could be said for the prevalence of processed food.
- wuiheerfoj 2y ago
  Implying getting clinically obese hasn’t already messed with the hormonal balance of hunger and survival?
- jonnycoder 2y ago
  If you mean by mass producing energy dense processed foods that are much cheaper than meat and fruit, then yes I agree
  - SirMaster 2y ago
    But should we praise this as the fix? How about instead we fix the problem by making healthy foods and active lifestyles cheaper and more prevalent?
    - op00to 2y ago
      Yes. We should.
    - ben_w 2y ago
      > How about instead we fix the problem by making healthy foods and active lifestyles cheaper and more prevalent? Good luck with that. Unhealthy habits and diets are popular (and delicious), and a lot of people resented even the minimal effort required to wear a mask during a pandemic of an airborne disease.
    - worez 2y ago
      sure, but how realistic is that, really?
sibeliuss 2y ago
What are the typical effects of someone stopping the drug abruptly? Have those been studied? I worry that it might result in a resumption of previous patterns of behavior, yet with an additional ferocity.
- JumpCrisscross 2y ago
  > What are the typical effects of someone stopping the drug abruptly? Have those been studied? Regaining two thirds of the weight [1] and lasting behavioral changes [2]. [1] https://pubmed.ncbi.nlm.nih.gov/35441470/ https://pubmed.ncbi.nlm.nih.gov/35441470/ [2] https://www.wsj.com/health/pharma/what-happened-after-i-stopped-taking-a-weight-loss-drug-124abfb4 https://www.wsj.com/health/pharma/what-happened-after-i-stop...
  - alexb_ 2y ago
    Wait, you can stop taking it and you STILL lose 1/3rd of the weight on average? This drug really is a miracle.
    - derbOac 2y ago
      I think the weight regain is within the first year or something, so presumably if you follow them for longer the percent weight regained goes up.
  - op00to 2y ago
    I’d be interested to see what the weight gain would be for people who lose weight through diet and exercise over time. My hunch is we’d see people gain significant weight back. I’ve seen this from colleagues who had weight loss surgery, lost a bunch of weight, then gained it back over a few years.
    - vundercind 2y ago
      We do see exactly that, diets are infamously ineffective at keeping weight off. (“Well that‘s because people don’t stick to them…” yes, that would be the reason they’re ineffective, that exact thing happens in the vast majority of cases)
yuy910616 2y ago
Tangentially, I wonder how people mentally model "too-good-to-be-true"? "Everything is a tradeoff" is almost a core belief for me, but in the same time, in technology, the "too-good-to-be-true" events does turn out to be real every once a while (I'm using technology here as a general concept). I do understand GLP-1 does have some downsides, like cost, or in my own experience, nausea. But the tradeoff seems negligible compare to the upside. Part of me feels like that there is some hidden trade-off somewhere that we're not discovering, but part of me also wonders if it's a once in while technology jump, where it is just better. Anyway, I guess I'm just a bit wary to throw away the "everything is a tradeoff" mental model that has worked quite well for me.
- malfist 2y ago
  Would you also categorize antibiotics as too good to be true because the trade offs are relatively minor?
  - dopylitty 2y ago
    Antibiotic tradeoffs are enormous. They can completely and permanently ruin your microbiome. Giving them to children has been linked to many conditions such as obesity, allergies, and asthma [0]. They have saved countless lives from infections but their use and overuse has undoubtedly contributed to significant and widespread health problems. 0: https://academic.oup.com/femsre/article/42/4/489/5045017 https://academic.oup.com/femsre/article/42/4/489/5045017
  - punkybr3wster 2y ago
    That’s a bit of a straw man. While the benefits of antibiotics are certainly untold millions of lives saved, we’re only now understanding their long term impacts on our gut biome. Let alone their overuse in factory farms. There are considerable numbers of people who have severe complications with antibiotics, and their overuse over time has left us in a position where the functional pools of antibiotics keeps getting smaller and smaller and the pool of superbugs gets more and more virulent. Who knows the long term ramifications of this new class of weight loss drugs. This smells to me like the Prozac craze in the 90s when everyone was on it or giving it to their kids. Or the olestra boom until everyone was literally crapping their pants. Or tangentially, the over proscribing of novel opioids. Look what that has wrought in our society. Could this new class of drugs be helpful, absolutely. Do we know the long term issues, nope. I think there are people who can use this therapeutically and there are others who use it as a quick fix because they have no self control. In a lot of ways it also feels a little ironic to look at fiction like the food indulgent scenes of “Hunger Games” and South Park and see that happening for real.
odiroot 2y ago
Will there be a heavy lobbying from fast food, sweetened drinks, alcohol etc industry to ban this drug? One wonders.
- deleted 2y ago
  [deleted]
- vundercind 2y ago
  Ten-to-one they’re already working on getting it restricted as much as possible. Lobbying is less out-in-the-open than ever before, so only way you’ll find out is if their shadow-lobbyists become embroiled in some legal scandal that involves betraying the ones paying them, and you won’t know until five or more years after it happens.
KittenInABox 2y ago
I'm really interested if, in the future, obesity will be treated like alcohol-induced fatty liver, track marks, and other medical signs of addiction and not some kind of moral failure on the obese person. This also tracks with knowing addiction can sometimes be caused by childhood trauma (obese people are more likely to be traumatized as kids), genetic predisposition(obesity runs in families), and neurodevelopmental diseases like ADHD (obesity prevalence higher in people with ADHD). In this view obesity is more like a tragic compulsion resulting from things out of a fat person's control and not some kind of "put down the cheeseburger sometime" activity to willpower onesself out of. EDITED: Hey, am I saying something wrong or irrelevant here? (sitting at -3, but I don't think I've been particularly inflammatory or offtopic)
- doubled112 2y ago
  > neurodevelopmental diseases like ADHD (obesity prevalence higher in people with ADHD) Interesting. Every person I have ever known with ADHD was skinny, at least compared to the people around them. Not saying my anecdata counts for anything, but it's funny how this works. Impulse control issues? Some comorbidity? Forgetfulness? For myself, at least, forgetting to eat makes me hungry, and then I overeat because I'm clearly going to wither away to nothing in moments and I lack self control. I'd be (more) overweight if this was a constant thing.
  - KittenInABox 2y ago
    It might be that this is still undergoing research. Originally published in 2002 [1] a later followup paper in 2019 [2] points out ADHD points to a number of inflammation-related conditions like asthma and obesity. It's still not known the exact underlying mechanisms! I'm just really interested that obesity seems to be increasingly not a voluntary choice. 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130024/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130024/ 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826981/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826981/
- CMCDragonkai 2y ago
  Interestingly the more we science out people's behaviour the less we will believe in our own free will.
fiftyfifty 2y ago
The biggest problem with semaglutide is once you stop taking it things like blood sugar and body weight start to go back to where they were before. On average people gain back 70% of the weight they lost on the drug within the first year when they stop taking it. It seems likely this is going to be true with other addictions as well such as alcohol. While the effects are impressive, without addressing the underlying causes such as psychological factors that cause people to overeat or abuse other substances like alcohol it seems like we are just replacing one form of chemical dependance with another, albeit a healthier one. https://www.healthline.com/health/semaglutide-withdrawal-symptoms https://www.healthline.com/health/semaglutide-withdrawal-sym...
- EA-3167 2y ago
  Just... keep taking it then? What's the downside of taking a drug that has a number of beneficial effects, especially the reduction of addictions (food, alcohol) that have high fatality rates?
- cobbernicusrex 2y ago
  How is this any different than treatments for high blood pressure and other chronic illnesses? I hear this refrain often, which diminishes the incredible achievement and benefit of these new drugs.
  - sunshowers 2y ago
    I think there are two kinds of people, those for whom taking medications for the rest of their lives is unthinkable, and those for whom it's completely normal. I'm definitely in the latter camp but the cultures colliding can be a real surprise.
- JumpCrisscross 2y ago
  > it seems likely this is going to be true with other addictions as well such as alcohol Why? We need to eat. We don't need to drink. Removing alcohol for a year or more could allow both the body and environment to be adapted to a point where it is no longer presented in the same way.
saberience 2y ago
I'm an interested bystander to this obesity drug mania currently happening but I'm curious as to whether the folks taking this for obesity or being overweight have to take it for the rest of their lives? I.e. if an obese person gets skinny with Ozempic and then stops taking it, can they keep the weight off? If not, it seems like the "perfect" money-making drug, i.e. it doesn't cure anything permanently, its expensive, and patients have to take it until they die. Now sure, it's obviously better than being obese and unhealthy, but does it bother anyone else (in a philosophical kind of way), that we are treating the symptoms and not the causes here? We're teaching people that everything can be solved by popping more pills and not treating the psychological issues that result in so much obesity. It also doesn't result in anyone learning any good lesson, e.g. that working gets results. In this case the lesson is, my bad decisions or mental health don't matter, I can just pop pills for all my problems...
- EA-3167 2y ago
  It seems to depend on the person. If they use it like a 'miracle drug' then they'll tend to have relapse on cessation. If they use it as an opportunity to build new, healthy habits they have a better chance. No doubt underlying biology plays a role too, after all some people are overweight because they found themselves in a rut, and other are overweight because they're constantly hungry. Those latter people tend to relapse.
  - unshavedyak 2y ago
    I'm also be interested in how this can affect a change of gut biome. Ie if a biome is partly responsible for diet cravings, would something like this help you restart your biome and put you in a better position to maintain?
    - EA-3167 2y ago
      I suppose it could? The issue is that people can conceivably just eat small portions of unhealthy foods. It would certainly be a boost if they were willing to make an effort though, get some serious fiber in there, find a good yogurt, that sort of thing. Then again I once knew someone who went through the pain and cost of a gastric bypass, which she then ironically bypassed by drinking melted ice cream. It all comes down to the patient.
alexb_ 2y ago
So how long is it until we start putting this in the water?
- caeril 2y ago
  These mimetics are peptides, which don't hold their structure very well when they interact with the pepsin your stomach secretes. That leaves injections or transdermals, and weighing in at over 4000 daltons, good luck with the transdermal route.
xxmarkuski 2y ago
The effects of GLP-1 drugs are fascinating and I am curious whether we will see approvals beyond the current diabetic and weight-loss applications. In just the last months stories of increased fertility [0] and reduction of heart attack risk [1] popped up, but more data is definitely needed to fully asses the effects. [0] https://www.independent.co.uk/life-style/pregnant-women-ozempic-babies-b2517305.html https://www.independent.co.uk/life-style/pregnant-women-ozem... [1] https://www.theguardian.com/science/article/2024/may/14/weight-loss-drug-semaglutide-reduce-heart-attack-risk-study https://www.theguardian.com/science/article/2024/may/14/weig...
- ec109685 2y ago
  Obesity is such a huge factor in many diseases it is logical that that reducing it, has these other beneficial properties.
mullingitover 2y ago
I'm curious how much damage GLP-1 agonists will do to the extremely profitable industries that depend on addiction before we'll start hearing scare stories about extremely rare side effects, followed by politically expedient bans.
- countvonbalzac 2y ago
  Interestingly there are extremely profitable industries on either side of this fight
- baq 2y ago
  Oh they’re worried, there’s basically nothing they can do to keep the business as is. They are trying to pivot, though, e.g. https://m.nutritioninsight.com/news/shareholders-challenge-nestle-to-lead-market-with-healthier-offerings.html https://m.nutritioninsight.com/news/shareholders-challenge-n... > 14 Mar 2024 --- Today, a coalition of Nestlé shareholders, with US$1.68 trillion in assets, has filed a resolution challenging the company to improve the healthfulness of its products. Translation: shareholders are terrified of the impending collapse of the status quo business model and want the company to pivot to things GLP-1 patients want to eat.
suzzer99 2y ago
I've been on Zepbound for 5 weeks now and it's basically a miracle drug as far as I'm concerned. Food still tastes good, but the urge is gone. It's like going from being a sex addict to someone with very low sex drive. It's not just the lack of hunger, but I don't get hangry, which was an even bigger problem than resisting the food. I'd get legitimately obsessive about the stupidest little things, to where I'd jeopardize my job and every relationship in my life if I kept going that way. I knew things were different when I ate two pieces of pizza and then the box sat there in front of me for hours w/o me even thinking about it. Normally as soon as I knew everyone else had their fill, I would have finished the two pieces left in the box. If I tried to resist, the pizza would be calling me from inside the box every 5 seconds. It would be like a crack addict sitting there looking at a loaded crack pipe for 2 hours and not taking a hit. Another moment was when I got the "I'm full, I don't want to finish this" message from my stomach while eating a small cakepop. I've gotten that feeling before from eating too much meat, like at a Brazilian steakhouse, but never from anything sweet and carby. Just knowing this is how some people live has been a huge eye-opener for me. I totally get the whole ectomorph/endomorph thing now. So far I've lost 10 lbs. I make sure to get plenty of protein and have to force myself to eat sometimes. I try to eat more early in the week when I do my hardest workouts. I'm still lifting the same amount. I haven't gone up, but I haven't gone down, which is great. I workout 4x a week and also walk/hike 20-30 miles/week. I'm 6'1, 240 lbs, large frame. I've been on a diet basically my whole adult life, except for when I start a new job, in which I always gain weight because I don't want to be hangry and I put the job first. Then I spend the rest of the tenure at that job trying to lose it. For years, I've had zero unhealthy food in the house, and my biggest cheat has been an occasional breakfast burrito, or a medium sandwich and some ice cream after a long walk. That's been enough to not gain weight, but not enough to lose any more than 5-10 lbs, which I gain back over the holidays every year. Anyway that's just my story. I suspect I'm a pretty big outlier in the amount of exercise I get and the habits I already had. I have enough in my HSA to afford about a year. I'm hoping to lose a bunch, snap back the usual 10 lbs or so, then stabilize.
DoreenMichele 2y ago
Makes me wonder what the mechanism is. Some drug that treats depression also helps people quit smoking. It treats a specific brain chemical not treated by some depression drugs.
mise_en_place 2y ago
Ozempic and Metformin stack is a cheap anti-aging regimen. Although you may need to add B12 as both seem to affect B12 levels and cause B12 deficiency. Methylated B12 intravenous or stacking the injection w/ B12 will alleviate this problem.
slashtom 2y ago
How much of this is just the fact that alcohol is typically 'banned' from patients taking this drug? Sorry didn't read too much into it but are they testing the reduction specifically for alcohol addiction or was alcohol addiction measured from people currently taking it for weight-loss/diabetes?
- vundercind 2y ago
  AFAIK it’s Metformin you’re not supposed to have with alcohol. You can drink on Wegovy and Ozempic, it’s just highly unlikely to seem very appealing, in a “well that sounded good but I drank half of my first drink and don’t really want the rest” sort of way.
hnburnsy 2y ago
A study says these drugs could prevent 1.5 million cardiac events over 10 years, add in a reduction in alcoholism and the governments should be giving away these drugs to save on healthcare costs... ----- We identified 3999 US adults weighted to an estimated population size of 93.0 million [M] (38% of US adults) who fit STEP 1 eligibility criteria. Applying STEP 1 treatment effects on weight loss resulted in an estimated 69.1% (64.3 M) and 50.5% (47.0 M) showing ≥ 10% and ≥ 15% weight reductions, respectively, translating to a 46.1% (43.0 M) reduction in obesity (BMI ≥ 30 kg/m2) prevalence. Among those without CVD, estimated 10-year CVD risks were 10.15% “before” and 8.34% “after” semaglutide “treatment” reflecting a 1.81% absolute (and 17.8% relative) risk reduction translating to 1.50 million preventable CVD events over 10 years. https://news.ycombinator.com/item?id=37166206 https://news.ycombinator.com/item?id=37166206
- slashtom 2y ago
  Except it's not meant as a drug you take for life, as it will require higher and higher dosages in order to get the body to respond. The problem isn't the results, the problem is the factors that caused the obesity. I'm for it as long as it comes with healthy lifestyle changes as that's the only true way to have a long-term impact.
hackeraccount 2y ago
Anyone read David Brin's story "The Giving Plague."? These drugs have the flavor of that. I'd be reluctant to take them not because the Thyroid cancer risk or loss of muscle mass. Or the possibility that if I stopped I might gain more weight then when I started. I'd be reluctant because in it's weird hormonal backdoor way it seems to be really messing with your personality. I'm not convinced the grass is actually greener on the other side - I tend to be of the belief that it's no better or worse; it's just a different set of tradeoffs. All that said while I'm not skinny I'm also not (in my and I assume my dr's judgement) a candidate for this drug. Maybe if I was I'd feel differently.
nunez 2y ago
Semaglutides are the AI of the medical field right now. Every press release that drops about them seems to be about how _even more_ transformative it is. Crazy stuff if the side effects of this drug become manageable and no long-term side effects appear.

76 points by henryaj 2y ago

Very exciting, we're going to see some serious "at scale" behavioral changes (obesity decline, addiction decline, possibly even social media usage decline) as soon as the cost of GLP-1 agonists gets driven down and manufacturing scales up.

lushdogg 2y ago
What else will we see? More bowel obstructions?
philipkglass 2y ago
I wonder which will happen first: discovery of effective small-molecule drugs in this class, or improvements of peptide manufacturing to the point that cheap generics become possible. There are only 7 years left on the semaglutide patent but its manufacturing is currently so complicated that I don't expect really cheap generics after patent expiration.
- vundercind 2y ago
  My understanding is that the manufacturing costs have nothing whatsoever to do with why they’re so expensive. It’s already damn near aspirin-cheap to make.
  - toomuchtodo 2y ago
    Correct, cost is ~$5 for a month supply, and could be made for as low as 89 cents. https://doi.org/10.1001/jamanetworkopen.2024.3474 https://doi.org/10.1001/jamanetworkopen.2024.3474 https://www.fastcompany.com/91071415/your-1000-per-month-ozempic-costs-5-to-make-says-study https://www.fastcompany.com/91071415/your-1000-per-month-oze...
- 0cf8612b2e1e 2y ago
  I am not familiar with the specifics of manufacturing these drugs, but peptide molecules have been synthesized for decades. What makes these special? Considering the high prices of the marketed product, I would dispute the idea that generic manufacturers will not leap at the chance to get a taste. Even if it is technically complex, they have years to perfect a recipe, get it GMP qualified, and on shelves the day patents expire.
zdragnar 2y ago
Unfortunately, the story for people who discontinue the drug is less rosey. Many regain some or all of the weight lost; it appears to be a temporary alternative to stomach surgery.
- toomuchtodo 2y ago
  Targeted gene therapy is the end goal, versus chronic management. We bug fix the human. Think of this as pharma print statement debugging. In the interim, the drug helps those in need of intervention. https://www.fractyl.com/fractyl-health-demonstrates-significant-improvement-in-glucose-control-and-obesity-inpreclinical-studies-of-its-rejuva-glp-1-based-pancreatic-gene-therapy-glp1-pgtxcompared-to-chronic-semaglutide-at/ https://www.fractyl.com/fractyl-health-demonstrates-signific... https://www.remain1study.com/remain-1-study/ https://www.remain1study.com/remain-1-study/
- suzzer99 2y ago
  Does this happen any more often than when people lose weight by other means? I was under the impression that something like 90-95% of people who lose significant weight gain a lot of it back.
  - zdragnar 2y ago
    Other means have fewer side effects and cost insurance companies less, meaning they cost you less. Over-priced temporary fixes should be the choice of last resort, not the first one.
    - sunshowers 2y ago
      The overpricing is not inherent to the manufacturing of these drugs as far as I understand, it's an artifact of the American healthcare system. You know what else is a temporary fix? Vitamin C for scurvy. Your body does not produce it endogenously. You are already a lifelong patient -- all humans are -- and it just so happens that the medication to treat it is part of your diet.
- sunshowers 2y ago

spacephysics 2y ago

We’re nearing the utopic phase for this drug (if we aren’t already there) Mindful that this also lowers muscle mass (can weight train and eat enough protein to compensate slightly) AND less easily mitigated lowers bone mass, weakens tendons, and weakens ligaments. It’s a great option if the patient is diabetic and their current lifestyle/condition has worse outcomes than the side effects listed, but we’re hearing from celebrities like this is a vitamin D pill

xcskier56 2y ago
Yeah, I'm with you. It seems like there are some almost miraculous results from this class of drugs, but I'm very concerned what's going to rear it's head 5, 10, 15 years down the line
- rasz 2y ago
  >miraculous results All the results are from lowering BMI, being fat is just this unhealthy.
  - ssijak 2y ago
    It looks like it lowers addictions of all kinds which are not BMI related
- throwup238 2y ago
  I don't envy anyone tasked with calculating the risk/reward benefit of this drug versus obesity and friends. These drugs aren't a free lunch and from my understanding can't be stopped without dramatic lifestyle changes or most of the weight comes right back. 20+ years of losing bone density and connective tissue mass is going to be catastrophic in old age for people who have to stay on it long term but really so is the obesity, diabetes, and heart disease. It's a tough moral quandary.
  - inquirerGeneral 2y ago
    [dead]

manacit 2y ago

It's exciting to see when we're so early in the journey of GLP-1 drugs. The dual action tirzepatide and the next generation retatrutide that has shown massive ability to reduce the long-term harm from obesity: https://www.vcuhealth.org/news/retatrutide-wiped-out-fat-in-liver-of-obese-patients https://www.vcuhealth.org/news/retatrutide-wiped-out-fat-in-... I'm sure there will be many comments here discussing how awful the side effects are, but from what I can see they're almost all primarily associated with rapid weight loss in general - muscle mass reduction and whatnot seem inevitable when someone drops 100+ lbs of total body weight.

kingkawn 2y ago

Mess with the fundamental hormonal balance honed over the eons of hunger and survival? What could go wrong?

delabay 2y ago
Same could be said for the prevalence of processed food.
wuiheerfoj 2y ago
Implying getting clinically obese hasn’t already messed with the hormonal balance of hunger and survival?
jonnycoder 2y ago
If you mean by mass producing energy dense processed foods that are much cheaper than meat and fruit, then yes I agree
- SirMaster 2y ago
  But should we praise this as the fix? How about instead we fix the problem by making healthy foods and active lifestyles cheaper and more prevalent?
  - op00to 2y ago
    Yes. We should.
  - ben_w 2y ago
    > How about instead we fix the problem by making healthy foods and active lifestyles cheaper and more prevalent? Good luck with that. Unhealthy habits and diets are popular (and delicious), and a lot of people resented even the minimal effort required to wear a mask during a pandemic of an airborne disease.
  - worez 2y ago
    sure, but how realistic is that, really?

sibeliuss 2y ago

What are the typical effects of someone stopping the drug abruptly? Have those been studied? I worry that it might result in a resumption of previous patterns of behavior, yet with an additional ferocity.

JumpCrisscross 2y ago
> What are the typical effects of someone stopping the drug abruptly? Have those been studied? Regaining two thirds of the weight [1] and lasting behavioral changes [2]. [1] https://pubmed.ncbi.nlm.nih.gov/35441470/ https://pubmed.ncbi.nlm.nih.gov/35441470/ [2] https://www.wsj.com/health/pharma/what-happened-after-i-stopped-taking-a-weight-loss-drug-124abfb4 https://www.wsj.com/health/pharma/what-happened-after-i-stop...
- alexb_ 2y ago
  Wait, you can stop taking it and you STILL lose 1/3rd of the weight on average? This drug really is a miracle.
  - derbOac 2y ago
    I think the weight regain is within the first year or something, so presumably if you follow them for longer the percent weight regained goes up.
- op00to 2y ago
  I’d be interested to see what the weight gain would be for people who lose weight through diet and exercise over time. My hunch is we’d see people gain significant weight back. I’ve seen this from colleagues who had weight loss surgery, lost a bunch of weight, then gained it back over a few years.
  - vundercind 2y ago
    We do see exactly that, diets are infamously ineffective at keeping weight off. (“Well that‘s because people don’t stick to them…” yes, that would be the reason they’re ineffective, that exact thing happens in the vast majority of cases)

yuy910616 2y ago

Tangentially, I wonder how people mentally model "too-good-to-be-true"? "Everything is a tradeoff" is almost a core belief for me, but in the same time, in technology, the "too-good-to-be-true" events does turn out to be real every once a while (I'm using technology here as a general concept). I do understand GLP-1 does have some downsides, like cost, or in my own experience, nausea. But the tradeoff seems negligible compare to the upside. Part of me feels like that there is some hidden trade-off somewhere that we're not discovering, but part of me also wonders if it's a once in while technology jump, where it is just better. Anyway, I guess I'm just a bit wary to throw away the "everything is a tradeoff" mental model that has worked quite well for me.

malfist 2y ago
Would you also categorize antibiotics as too good to be true because the trade offs are relatively minor?
- dopylitty 2y ago
  Antibiotic tradeoffs are enormous. They can completely and permanently ruin your microbiome. Giving them to children has been linked to many conditions such as obesity, allergies, and asthma [0]. They have saved countless lives from infections but their use and overuse has undoubtedly contributed to significant and widespread health problems. 0: https://academic.oup.com/femsre/article/42/4/489/5045017 https://academic.oup.com/femsre/article/42/4/489/5045017
- punkybr3wster 2y ago
  That’s a bit of a straw man. While the benefits of antibiotics are certainly untold millions of lives saved, we’re only now understanding their long term impacts on our gut biome. Let alone their overuse in factory farms. There are considerable numbers of people who have severe complications with antibiotics, and their overuse over time has left us in a position where the functional pools of antibiotics keeps getting smaller and smaller and the pool of superbugs gets more and more virulent. Who knows the long term ramifications of this new class of weight loss drugs. This smells to me like the Prozac craze in the 90s when everyone was on it or giving it to their kids. Or the olestra boom until everyone was literally crapping their pants. Or tangentially, the over proscribing of novel opioids. Look what that has wrought in our society. Could this new class of drugs be helpful, absolutely. Do we know the long term issues, nope. I think there are people who can use this therapeutically and there are others who use it as a quick fix because they have no self control. In a lot of ways it also feels a little ironic to look at fiction like the food indulgent scenes of “Hunger Games” and South Park and see that happening for real.

odiroot 2y ago

Will there be a heavy lobbying from fast food, sweetened drinks, alcohol etc industry to ban this drug? One wonders.

deleted 2y ago
[deleted]
vundercind 2y ago
Ten-to-one they’re already working on getting it restricted as much as possible. Lobbying is less out-in-the-open than ever before, so only way you’ll find out is if their shadow-lobbyists become embroiled in some legal scandal that involves betraying the ones paying them, and you won’t know until five or more years after it happens.

KittenInABox 2y ago

I'm really interested if, in the future, obesity will be treated like alcohol-induced fatty liver, track marks, and other medical signs of addiction and not some kind of moral failure on the obese person. This also tracks with knowing addiction can sometimes be caused by childhood trauma (obese people are more likely to be traumatized as kids), genetic predisposition(obesity runs in families), and neurodevelopmental diseases like ADHD (obesity prevalence higher in people with ADHD). In this view obesity is more like a tragic compulsion resulting from things out of a fat person's control and not some kind of "put down the cheeseburger sometime" activity to willpower onesself out of. EDITED: Hey, am I saying something wrong or irrelevant here? (sitting at -3, but I don't think I've been particularly inflammatory or offtopic)

doubled112 2y ago
> neurodevelopmental diseases like ADHD (obesity prevalence higher in people with ADHD) Interesting. Every person I have ever known with ADHD was skinny, at least compared to the people around them. Not saying my anecdata counts for anything, but it's funny how this works. Impulse control issues? Some comorbidity? Forgetfulness? For myself, at least, forgetting to eat makes me hungry, and then I overeat because I'm clearly going to wither away to nothing in moments and I lack self control. I'd be (more) overweight if this was a constant thing.
- KittenInABox 2y ago
  It might be that this is still undergoing research. Originally published in 2002 [1] a later followup paper in 2019 [2] points out ADHD points to a number of inflammation-related conditions like asthma and obesity. It's still not known the exact underlying mechanisms! I'm just really interested that obesity seems to be increasingly not a voluntary choice. 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130024/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC130024/ 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826981/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826981/
CMCDragonkai 2y ago
Interestingly the more we science out people's behaviour the less we will believe in our own free will.

fiftyfifty 2y ago

The biggest problem with semaglutide is once you stop taking it things like blood sugar and body weight start to go back to where they were before. On average people gain back 70% of the weight they lost on the drug within the first year when they stop taking it. It seems likely this is going to be true with other addictions as well such as alcohol. While the effects are impressive, without addressing the underlying causes such as psychological factors that cause people to overeat or abuse other substances like alcohol it seems like we are just replacing one form of chemical dependance with another, albeit a healthier one. https://www.healthline.com/health/semaglutide-withdrawal-symptoms https://www.healthline.com/health/semaglutide-withdrawal-sym...

EA-3167 2y ago
Just... keep taking it then? What's the downside of taking a drug that has a number of beneficial effects, especially the reduction of addictions (food, alcohol) that have high fatality rates?
cobbernicusrex 2y ago
How is this any different than treatments for high blood pressure and other chronic illnesses? I hear this refrain often, which diminishes the incredible achievement and benefit of these new drugs.
- sunshowers 2y ago
  I think there are two kinds of people, those for whom taking medications for the rest of their lives is unthinkable, and those for whom it's completely normal. I'm definitely in the latter camp but the cultures colliding can be a real surprise.
JumpCrisscross 2y ago
> it seems likely this is going to be true with other addictions as well such as alcohol Why? We need to eat. We don't need to drink. Removing alcohol for a year or more could allow both the body and environment to be adapted to a point where it is no longer presented in the same way.

saberience 2y ago

I'm an interested bystander to this obesity drug mania currently happening but I'm curious as to whether the folks taking this for obesity or being overweight have to take it for the rest of their lives? I.e. if an obese person gets skinny with Ozempic and then stops taking it, can they keep the weight off? If not, it seems like the "perfect" money-making drug, i.e. it doesn't cure anything permanently, its expensive, and patients have to take it until they die. Now sure, it's obviously better than being obese and unhealthy, but does it bother anyone else (in a philosophical kind of way), that we are treating the symptoms and not the causes here? We're teaching people that everything can be solved by popping more pills and not treating the psychological issues that result in so much obesity. It also doesn't result in anyone learning any good lesson, e.g. that working gets results. In this case the lesson is, my bad decisions or mental health don't matter, I can just pop pills for all my problems...

EA-3167 2y ago
It seems to depend on the person. If they use it like a 'miracle drug' then they'll tend to have relapse on cessation. If they use it as an opportunity to build new, healthy habits they have a better chance. No doubt underlying biology plays a role too, after all some people are overweight because they found themselves in a rut, and other are overweight because they're constantly hungry. Those latter people tend to relapse.
- unshavedyak 2y ago
  I'm also be interested in how this can affect a change of gut biome. Ie if a biome is partly responsible for diet cravings, would something like this help you restart your biome and put you in a better position to maintain?
  - EA-3167 2y ago
    I suppose it could? The issue is that people can conceivably just eat small portions of unhealthy foods. It would certainly be a boost if they were willing to make an effort though, get some serious fiber in there, find a good yogurt, that sort of thing. Then again I once knew someone who went through the pain and cost of a gastric bypass, which she then ironically bypassed by drinking melted ice cream. It all comes down to the patient.

alexb_ 2y ago

So how long is it until we start putting this in the water?

caeril 2y ago
These mimetics are peptides, which don't hold their structure very well when they interact with the pepsin your stomach secretes. That leaves injections or transdermals, and weighing in at over 4000 daltons, good luck with the transdermal route.

xxmarkuski 2y ago

The effects of GLP-1 drugs are fascinating and I am curious whether we will see approvals beyond the current diabetic and weight-loss applications. In just the last months stories of increased fertility [0] and reduction of heart attack risk [1] popped up, but more data is definitely needed to fully asses the effects. [0] https://www.independent.co.uk/life-style/pregnant-women-ozempic-babies-b2517305.html https://www.independent.co.uk/life-style/pregnant-women-ozem... [1] https://www.theguardian.com/science/article/2024/may/14/weight-loss-drug-semaglutide-reduce-heart-attack-risk-study https://www.theguardian.com/science/article/2024/may/14/weig...

ec109685 2y ago
Obesity is such a huge factor in many diseases it is logical that that reducing it, has these other beneficial properties.

mullingitover 2y ago

I'm curious how much damage GLP-1 agonists will do to the extremely profitable industries that depend on addiction before we'll start hearing scare stories about extremely rare side effects, followed by politically expedient bans.

countvonbalzac 2y ago
Interestingly there are extremely profitable industries on either side of this fight
baq 2y ago
Oh they’re worried, there’s basically nothing they can do to keep the business as is. They are trying to pivot, though, e.g. https://m.nutritioninsight.com/news/shareholders-challenge-nestle-to-lead-market-with-healthier-offerings.html https://m.nutritioninsight.com/news/shareholders-challenge-n... > 14 Mar 2024 --- Today, a coalition of Nestlé shareholders, with US$1.68 trillion in assets, has filed a resolution challenging the company to improve the healthfulness of its products. Translation: shareholders are terrified of the impending collapse of the status quo business model and want the company to pivot to things GLP-1 patients want to eat.

suzzer99 2y ago

I've been on Zepbound for 5 weeks now and it's basically a miracle drug as far as I'm concerned. Food still tastes good, but the urge is gone. It's like going from being a sex addict to someone with very low sex drive. It's not just the lack of hunger, but I don't get hangry, which was an even bigger problem than resisting the food. I'd get legitimately obsessive about the stupidest little things, to where I'd jeopardize my job and every relationship in my life if I kept going that way. I knew things were different when I ate two pieces of pizza and then the box sat there in front of me for hours w/o me even thinking about it. Normally as soon as I knew everyone else had their fill, I would have finished the two pieces left in the box. If I tried to resist, the pizza would be calling me from inside the box every 5 seconds. It would be like a crack addict sitting there looking at a loaded crack pipe for 2 hours and not taking a hit. Another moment was when I got the "I'm full, I don't want to finish this" message from my stomach while eating a small cakepop. I've gotten that feeling before from eating too much meat, like at a Brazilian steakhouse, but never from anything sweet and carby. Just knowing this is how some people live has been a huge eye-opener for me. I totally get the whole ectomorph/endomorph thing now. So far I've lost 10 lbs. I make sure to get plenty of protein and have to force myself to eat sometimes. I try to eat more early in the week when I do my hardest workouts. I'm still lifting the same amount. I haven't gone up, but I haven't gone down, which is great. I workout 4x a week and also walk/hike 20-30 miles/week. I'm 6'1, 240 lbs, large frame. I've been on a diet basically my whole adult life, except for when I start a new job, in which I always gain weight because I don't want to be hangry and I put the job first. Then I spend the rest of the tenure at that job trying to lose it. For years, I've had zero unhealthy food in the house, and my biggest cheat has been an occasional breakfast burrito, or a medium sandwich and some ice cream after a long walk. That's been enough to not gain weight, but not enough to lose any more than 5-10 lbs, which I gain back over the holidays every year. Anyway that's just my story. I suspect I'm a pretty big outlier in the amount of exercise I get and the habits I already had. I have enough in my HSA to afford about a year. I'm hoping to lose a bunch, snap back the usual 10 lbs or so, then stabilize.

DoreenMichele 2y ago

Makes me wonder what the mechanism is. Some drug that treats depression also helps people quit smoking. It treats a specific brain chemical not treated by some depression drugs.

mise_en_place 2y ago

Ozempic and Metformin stack is a cheap anti-aging regimen. Although you may need to add B12 as both seem to affect B12 levels and cause B12 deficiency. Methylated B12 intravenous or stacking the injection w/ B12 will alleviate this problem.

slashtom 2y ago

How much of this is just the fact that alcohol is typically 'banned' from patients taking this drug? Sorry didn't read too much into it but are they testing the reduction specifically for alcohol addiction or was alcohol addiction measured from people currently taking it for weight-loss/diabetes?

vundercind 2y ago
AFAIK it’s Metformin you’re not supposed to have with alcohol. You can drink on Wegovy and Ozempic, it’s just highly unlikely to seem very appealing, in a “well that sounded good but I drank half of my first drink and don’t really want the rest” sort of way.

hnburnsy 2y ago

A study says these drugs could prevent 1.5 million cardiac events over 10 years, add in a reduction in alcoholism and the governments should be giving away these drugs to save on healthcare costs... ----- We identified 3999 US adults weighted to an estimated population size of 93.0 million [M] (38% of US adults) who fit STEP 1 eligibility criteria. Applying STEP 1 treatment effects on weight loss resulted in an estimated 69.1% (64.3 M) and 50.5% (47.0 M) showing ≥ 10% and ≥ 15% weight reductions, respectively, translating to a 46.1% (43.0 M) reduction in obesity (BMI ≥ 30 kg/m2) prevalence. Among those without CVD, estimated 10-year CVD risks were 10.15% “before” and 8.34% “after” semaglutide “treatment” reflecting a 1.81% absolute (and 17.8% relative) risk reduction translating to 1.50 million preventable CVD events over 10 years. https://news.ycombinator.com/item?id=37166206 https://news.ycombinator.com/item?id=37166206

slashtom 2y ago
Except it's not meant as a drug you take for life, as it will require higher and higher dosages in order to get the body to respond. The problem isn't the results, the problem is the factors that caused the obesity. I'm for it as long as it comes with healthy lifestyle changes as that's the only true way to have a long-term impact.

hackeraccount 2y ago

Anyone read David Brin's story "The Giving Plague."? These drugs have the flavor of that. I'd be reluctant to take them not because the Thyroid cancer risk or loss of muscle mass. Or the possibility that if I stopped I might gain more weight then when I started. I'd be reluctant because in it's weird hormonal backdoor way it seems to be really messing with your personality. I'm not convinced the grass is actually greener on the other side - I tend to be of the belief that it's no better or worse; it's just a different set of tradeoffs. All that said while I'm not skinny I'm also not (in my and I assume my dr's judgement) a candidate for this drug. Maybe if I was I'd feel differently.

nunez 2y ago

Semaglutides are the AI of the medical field right now. Every press release that drops about them seems to be about how _even more_ transformative it is. Crazy stuff if the side effects of this drug become manageable and no long-term side effects appear.