4 ms·

Ozempic was approved in the US for treatment for type 2 diabetes, but over a third of users are taking it off-label, they have no history of diabetes¹. Of cours

Ozempic was approved in the US for treatment for type 2 diabetes, but over a third of users are taking it off-label, they have no history of diabetes¹. Of course one can phrase it in a way that makes it sound like they're suffering from a disease and are getting the "medication" they need. Would you say the same about folks using benzos off-label though? We use positive language (medication) or negative (drug abuse) depending on the picture we want to paint. The point is these are examples of things that shouldn't exist, because for most of us who're healthy and able bodied, we can take our trash and throw it in a bin. And we don't need to inject drugs, we should better train to be disciplined and eat less. Obesity in places like the US is mainly cultural. By trying to solve the problem with technology instead of changing the attitude towards health, they will only become more dependent on drugs. ¹ https://edition.cnn.com/2023/09/27/health/semaglutide-equitable-access/index.html https://edition.cnn.com/2023/09/27/health/semaglutide-equita...

dghlsakjg 2y ago
Semaglutide for weight loss isn't off label. Using Semaglutide in the Ozempic auto-dispenser is off-label. Using it in a different syringe sold under the name Wegovy is the only difference. Same drug, different packaging. It is the exact same medication, delivered via injection, except one is sold in a fancier syringe. Either way, off-label usage of drugs doesn't bother me. If someone is using off-label Benzodiazepines as an effective treatment under the supervision of a competent doctor, that seems like a good thing. Sometimes I use bandaids to protect against blisters even though the packaging doesn't indicate that usage. It isn't a moral failing to get an effective use out of something that wasn't designed for it? > Obesity in places like the US is mainly cultural. By trying to solve the problem with technology instead of changing the attitude towards health, they will only become more dependent on drugs. What you aren't grasping is that actual experts don't see it this way. The use of Semaglutide points to the fact that obesity is caused, at least in part, by a hormonal imbalance. How is culture unbalancing hormones? Experts still don't understand why so many people in some areas are affected. Actual scientists have done controlled studies and found that culturally similar people in different geographies have wildly varying rates of obesity. We live in a culture, where (as you have proven) people will openly judge, insult and shame strangers for being fat. Being fat isn't culturally accepted anywhere (maybe a few isolated cultures are the exception). Nobody wants to be fat. There is a multi-billion dollar industry that serves people doing everything they can to NOT be fat, and it is notoriously ineffective. If being dependent on pharmaceutical intervention is what it takes to help people live longer, more independent lives, that costs society less in the long run, then that's fine. We happily accept lifelong pharmaceutical dependency for a range of conditions, including ones that are purely quality of life related. Do you go around telling burn victims that cosmetic reconstructive surgery is a moral failing? I understand that lifestyle affects weight. "Eat less and exercise more". Every fat person already knows this. People who have the willpower to get PHDs, to run successful companies, to do every difficult thing in life, fail at losing weight and keeping it off. Being fat is not a moral failing. Its like telling depressed people to cheer up. It doesn't work, and it isn't a moral failing to have clinical depression. Lifestyle choices can affect depression, and it is treatable without medication sometimes. But oftentimes pharmaceutical interventions are the best option.
- scrollop 2y ago
  Obesity rates have tripled in the us over the last 60 years- https://usafacts.org/articles/obesity-rate-nearly-triples-united-states-over-last-50-years/ https://usafacts.org/articles/obesity-rate-nearly-triples-un... Please show me references substantiating your claim that obesity is "in partz due to hormonal imbalance." As a doctor, I would say most obesity is due to a combination of - people eating the "wrong" foods (ie not whole foods) - much of this is likely due to the change in food manufacturing over the last 60 years ie. Cheaper to make processed foods ie More profit - advertising especially psychologically asculpted advertising - less physical activity dt. Variou reasons IMO it is extremely unlikely that a substantial proportion of obese people have "a hormonal imbalance" ( unless you mean one created by the excess adipose tissue, altered probiotic balance with subsequent host hormonal effects in a positive feedback loop etc). If you really want to lose weight, and you have enough resolve, then cutting out all sugar and processed foods and eating a whole plant food diet with a mixture of hiit and weight training will bring people to a good weight in (I'll make an educated guess) 95% of cases. The problem, as I see it, is that food corporations aRe doing everything they can to addict people to their processed foods, people are doing less exercise/movement on average, and these are becoming culturally ingrained. "hormonal imbalance" - gt your doctor to do a blood test and check tfts, fsh/lh, hba1c etc In the vast majority of cases, it will not be a "hormonal imbalance" and I have to question why you want to think this. Less "blame" on theindividual? I think the solution is - good education from a young age - change corporate actions - change the culture Obviously, difficult, though we can all find good information for an individual level.
  - dghlsakjg 2y ago
    Here you go, this is just the literature I found in 5 minutes on mechanisms for why people tend to return to their original weight after losing weight, but then stop gaining: https://academic.oup.com/edrv/article/38/4/267/3892397?login=false https://academic.oup.com/edrv/article/38/4/267/3892397?login... https://www.nature.com/articles/nature05026 https://www.nature.com/articles/nature05026 https://www.festiwalbiegowy.pl/sites/default/files/upload/regulaminy/otylosc https://www.festiwalbiegowy.pl/sites/default/files/upload/re... - zrodlo.pdf https://www.sciencedirect.com/science/article/pii/S1550413112002926 https://www.sciencedirect.com/science/article/pii/S155041311... Here’s a CDC study showing that there is a long term trend of people getting more exercise even as obesity rates rise: https://www.cdc.gov/nchs/data/nhis/earlyrelease/EarlyRelease201803.pdf https://www.cdc.gov/nchs/data/nhis/earlyrelease/EarlyRelease... My broader point is that, yes, external factors like low activity lifestyles and a diet that contains too much processed food are contributors. But what they are contributing to is an internal mechanism as well. Explain why some rail thin people get no exercise and eat nothing but garbage? Why do some fat people eat whole foods based diets and get daily exercise, but persist in being fat? When people regain weight, why do they tend to regress back to their original weight range, but not continue beyond that? Why has modern medicine been relatively unable to treat obesity until we started injecting GLP-1 hormone analogues? Why has saturated fat consumption been dropping as obesity has been rising? Why has refined sugar consumption been dropping with no effect on obesity? The science on root causes of obesity are evolving quite a bit. I would hope you are more open minded to hearing from your patients and experts in the field. Treat your obese patients with more dignity, and don’t treat their condition like it is a moral failing, or something entirely within their control. Talk to your patients about the level of effort some of them go towards losing weight. You might be shocked to learn the amount of literal blood, sweat and tears expended, and how much their efforts are seemingly in vain. Everyone, not just doctors, know that eat less, eat better, exercise more is the recommended way to lose weight. But it just doesn’t work in the long term.
xboxnolifes 2y ago
We've tried to change attitude around obesity, exercise, eating habits, etc. We should keep trying, but let's not pretend it's a new, unchallenged issue. Changing the culture of a country is hard.

dghlsakjg 2y ago

Semaglutide for weight loss isn't off label. Using Semaglutide in the Ozempic auto-dispenser is off-label. Using it in a different syringe sold under the name Wegovy is the only difference. Same drug, different packaging. It is the exact same medication, delivered via injection, except one is sold in a fancier syringe. Either way, off-label usage of drugs doesn't bother me. If someone is using off-label Benzodiazepines as an effective treatment under the supervision of a competent doctor, that seems like a good thing. Sometimes I use bandaids to protect against blisters even though the packaging doesn't indicate that usage. It isn't a moral failing to get an effective use out of something that wasn't designed for it? > Obesity in places like the US is mainly cultural. By trying to solve the problem with technology instead of changing the attitude towards health, they will only become more dependent on drugs. What you aren't grasping is that actual experts don't see it this way. The use of Semaglutide points to the fact that obesity is caused, at least in part, by a hormonal imbalance. How is culture unbalancing hormones? Experts still don't understand why so many people in some areas are affected. Actual scientists have done controlled studies and found that culturally similar people in different geographies have wildly varying rates of obesity. We live in a culture, where (as you have proven) people will openly judge, insult and shame strangers for being fat. Being fat isn't culturally accepted anywhere (maybe a few isolated cultures are the exception). Nobody wants to be fat. There is a multi-billion dollar industry that serves people doing everything they can to NOT be fat, and it is notoriously ineffective. If being dependent on pharmaceutical intervention is what it takes to help people live longer, more independent lives, that costs society less in the long run, then that's fine. We happily accept lifelong pharmaceutical dependency for a range of conditions, including ones that are purely quality of life related. Do you go around telling burn victims that cosmetic reconstructive surgery is a moral failing? I understand that lifestyle affects weight. "Eat less and exercise more". Every fat person already knows this. People who have the willpower to get PHDs, to run successful companies, to do every difficult thing in life, fail at losing weight and keeping it off. Being fat is not a moral failing. Its like telling depressed people to cheer up. It doesn't work, and it isn't a moral failing to have clinical depression. Lifestyle choices can affect depression, and it is treatable without medication sometimes. But oftentimes pharmaceutical interventions are the best option.

scrollop 2y ago
Obesity rates have tripled in the us over the last 60 years- https://usafacts.org/articles/obesity-rate-nearly-triples-united-states-over-last-50-years/ https://usafacts.org/articles/obesity-rate-nearly-triples-un... Please show me references substantiating your claim that obesity is "in partz due to hormonal imbalance." As a doctor, I would say most obesity is due to a combination of - people eating the "wrong" foods (ie not whole foods) - much of this is likely due to the change in food manufacturing over the last 60 years ie. Cheaper to make processed foods ie More profit - advertising especially psychologically asculpted advertising - less physical activity dt. Variou reasons IMO it is extremely unlikely that a substantial proportion of obese people have "a hormonal imbalance" ( unless you mean one created by the excess adipose tissue, altered probiotic balance with subsequent host hormonal effects in a positive feedback loop etc). If you really want to lose weight, and you have enough resolve, then cutting out all sugar and processed foods and eating a whole plant food diet with a mixture of hiit and weight training will bring people to a good weight in (I'll make an educated guess) 95% of cases. The problem, as I see it, is that food corporations aRe doing everything they can to addict people to their processed foods, people are doing less exercise/movement on average, and these are becoming culturally ingrained. "hormonal imbalance" - gt your doctor to do a blood test and check tfts, fsh/lh, hba1c etc In the vast majority of cases, it will not be a "hormonal imbalance" and I have to question why you want to think this. Less "blame" on theindividual? I think the solution is - good education from a young age - change corporate actions - change the culture Obviously, difficult, though we can all find good information for an individual level.
- dghlsakjg 2y ago
  Here you go, this is just the literature I found in 5 minutes on mechanisms for why people tend to return to their original weight after losing weight, but then stop gaining: https://academic.oup.com/edrv/article/38/4/267/3892397?login=false https://academic.oup.com/edrv/article/38/4/267/3892397?login... https://www.nature.com/articles/nature05026 https://www.nature.com/articles/nature05026 https://www.festiwalbiegowy.pl/sites/default/files/upload/regulaminy/otylosc https://www.festiwalbiegowy.pl/sites/default/files/upload/re... - zrodlo.pdf https://www.sciencedirect.com/science/article/pii/S1550413112002926 https://www.sciencedirect.com/science/article/pii/S155041311... Here’s a CDC study showing that there is a long term trend of people getting more exercise even as obesity rates rise: https://www.cdc.gov/nchs/data/nhis/earlyrelease/EarlyRelease201803.pdf https://www.cdc.gov/nchs/data/nhis/earlyrelease/EarlyRelease... My broader point is that, yes, external factors like low activity lifestyles and a diet that contains too much processed food are contributors. But what they are contributing to is an internal mechanism as well. Explain why some rail thin people get no exercise and eat nothing but garbage? Why do some fat people eat whole foods based diets and get daily exercise, but persist in being fat? When people regain weight, why do they tend to regress back to their original weight range, but not continue beyond that? Why has modern medicine been relatively unable to treat obesity until we started injecting GLP-1 hormone analogues? Why has saturated fat consumption been dropping as obesity has been rising? Why has refined sugar consumption been dropping with no effect on obesity? The science on root causes of obesity are evolving quite a bit. I would hope you are more open minded to hearing from your patients and experts in the field. Treat your obese patients with more dignity, and don’t treat their condition like it is a moral failing, or something entirely within their control. Talk to your patients about the level of effort some of them go towards losing weight. You might be shocked to learn the amount of literal blood, sweat and tears expended, and how much their efforts are seemingly in vain. Everyone, not just doctors, know that eat less, eat better, exercise more is the recommended way to lose weight. But it just doesn’t work in the long term.

xboxnolifes 2y ago

We've tried to change attitude around obesity, exercise, eating habits, etc. We should keep trying, but let's not pretend it's a new, unchallenged issue. Changing the culture of a country is hard.