4 ms·

As far as I understand it, the one major issue is that it can make a temporary problem (overweight) a chronic one. As a counter-example, most people experience

As far as I understand it, the one major issue is that it can make a temporary problem (overweight) a chronic one. As a counter-example, most people experience depression at least once in their life and most of these take antidepressants on a temporary basis (the exception being those who are genetically/developmentally depressed - i.e. chronic/lifelong). Once the underlying issue has been addressed with therapy or what-have-you, these people can cease use of the drug. This is not the case with Ozempic. If you take it to lose weight then cessation will cause rapid weight gain. You'll be stuck with it for the rest of your life, for something that can [again] usually be permanently solved with other forms of treatment. I think this is morally fine. However, it does mean that these people will suffer even more harm if they are ever find themselves unable to afford/obtain Ozempic. We would effectively be duplicating the current issue that we have with insulin.

borski 2y ago
> This is not the case with Ozempic. If you take it to lose weight then cessation will cause rapid weight gain. You'll be stuck with it for the rest of your life, for something that can [again] usually be permanently solved with other forms of treatment. This is not true. If you stop taking GLP-1 meds, you will revert back to whatever it was you were like prior to taking them, unless you have made significant lifestyle changes. So: you take a GLP-1 med, change nothing, lose a bunch of weight, get off it, and still eat McDonald’s every day? Yeah, you’ll gain it back. But if you exercise regularly (specifically strength training) and adjust your diet, which is what every single doctor worth their salt will tell you you must do, then you can get off of it over time or go to a much lower dose. These drugs are not and should not be prescribed to people who are simply “temporarily overweight.” It is not like magically getting off the GLP-1 meds makes you ravenous; it’s all about whether or not you’ve changed anything while on it.
- calmoo 2y ago
  But isn't one of the effects of GLP-1 is that it literally makes you not crave junk food? It doesn't just metabolize food more, or however that works, it also changes your dietary behaviours.
  - borski 2y ago
    Not in the way you're implying. I should mention that I'm in a clinical trial for CagriSema (and it's a head-to-head efficacy trial against tirzepatide, so not blind, with no placebo, but randomized), so I am speaking from experience. It works in a few ways, but the vast majority of the benefit is just from delayed gastric emptying (food sticks around in you longer) which makes you feel fuller, and it helps remove hunger in general. If you're not careful, you'll find yourself simply not eating, so you have to be careful - that's a lot of why it leads to nausea. People don't eat, don't hydrate, and they get sick. Turns out that happens with or without the drug; not eating and not drinking will make you nauseous. If you have a bag of french fries, you will find yourself sick because you overdid it. It doesn't make them taste any less good. You just learn about portion control somewhat through force, because when you screw it up you feel ill. The other thing it does is remove the "food noise" so many of us simply exist with. I didn't know this was a thing, but it is - I grew up very impoverished, and we didn't always have food. I am also genetically predisposed to retaining more weight than necessary. Looking back now, I was constantly seeking a next snack or a next meal, almost before I finished my previous one, subconsciously. My days were split, in my head, into mealtimes and the times between mealtimes, which were usually snacking time. But between the habit, the ADHD, and the predisposition to always be thinking about it, it was an impossible habit to break. I didn't realize this until talking to my wife, who doesn't have this problem. She also didn't used to think every food tasted incredible. Just some. Meanwhile, there was almost nothing I ate that didn't taste fantastic, in my brain. That has also adjusted to be more "normal," but historically whenever my mom has stopped, that adjustment didn't revert. It would appear to have been stable, as it helps your brain and body simply figure out it isn't starving all the time. It's kind of hard to explain, so I hope that made sense.
    - calmoo 2y ago
      Thanks for sharing your experience, very interesting!
- zamalek 2y ago
  I agree with your sentiment in general. The problem is how people are actually using it, especially the rich. We shouldn't prescribe antidepressants for life so easily, but we do. We shouldn't feed livestock antibiotics, but we do. We shouldn't solve an eating/sedentary disorder with Ozempic, but we do.
  - borski 2y ago
    What is the alternative? Sure, I agree people misuse medications sometimes. So should we not help people curb their obesity and/or T2D because some folks misuse it? Of course not. People misuse Sudafed and use it to make meth, or drink Robitussin to get high. I would be very upset if I lost access to those medications when I was sick, simply because we decided to make rules about the exception. :)
    - zamalek 2y ago
      I'm really not sure what the alternative is.
- orwin 2y ago
  My uncle and his wife were on GPL-1 (not Ozempic) from 2019 to 2022,stopped, took a bit of their belly back but are clearly not obese anymore, even if still overweight. Without discernable change in their behavior (they might cook a bit more)
  - borski 2y ago
    That's great! But I guarantee you there is a discernible change in behavior to them.
ryathal 2y ago
Obesity isn't a temporary problem, practically every weight loss solution fails at 2-5 year outlooks. If this drug has to be taken for decades it's still better than decades of obesity.
- zamalek 2y ago
  Any condition that is not chronic is temporary by definition. It doesn't matter if it can be cured in 5 years or 20. If a person is dependant on a drug to maintain health, then they have a chronic condition. This is exactly why I italicized usually.
HDThoreaun 2y ago
> for something that can [again] usually be permanently solved with other forms of treatment. Just not true. The vast majority of obese people who try to lose weight without GLP-1 agonists fail. The only other option that consistently works is stimulants but the side effects for those is even worse, see requiem for a dream.

borski 2y ago

> This is not the case with Ozempic. If you take it to lose weight then cessation will cause rapid weight gain. You'll be stuck with it for the rest of your life, for something that can [again] usually be permanently solved with other forms of treatment. This is not true. If you stop taking GLP-1 meds, you will revert back to whatever it was you were like prior to taking them, unless you have made significant lifestyle changes. So: you take a GLP-1 med, change nothing, lose a bunch of weight, get off it, and still eat McDonald’s every day? Yeah, you’ll gain it back. But if you exercise regularly (specifically strength training) and adjust your diet, which is what every single doctor worth their salt will tell you you must do, then you can get off of it over time or go to a much lower dose. These drugs are not and should not be prescribed to people who are simply “temporarily overweight.” It is not like magically getting off the GLP-1 meds makes you ravenous; it’s all about whether or not you’ve changed anything while on it.

calmoo 2y ago
But isn't one of the effects of GLP-1 is that it literally makes you not crave junk food? It doesn't just metabolize food more, or however that works, it also changes your dietary behaviours.
- borski 2y ago
  Not in the way you're implying. I should mention that I'm in a clinical trial for CagriSema (and it's a head-to-head efficacy trial against tirzepatide, so not blind, with no placebo, but randomized), so I am speaking from experience. It works in a few ways, but the vast majority of the benefit is just from delayed gastric emptying (food sticks around in you longer) which makes you feel fuller, and it helps remove hunger in general. If you're not careful, you'll find yourself simply not eating, so you have to be careful - that's a lot of why it leads to nausea. People don't eat, don't hydrate, and they get sick. Turns out that happens with or without the drug; not eating and not drinking will make you nauseous. If you have a bag of french fries, you will find yourself sick because you overdid it. It doesn't make them taste any less good. You just learn about portion control somewhat through force, because when you screw it up you feel ill. The other thing it does is remove the "food noise" so many of us simply exist with. I didn't know this was a thing, but it is - I grew up very impoverished, and we didn't always have food. I am also genetically predisposed to retaining more weight than necessary. Looking back now, I was constantly seeking a next snack or a next meal, almost before I finished my previous one, subconsciously. My days were split, in my head, into mealtimes and the times between mealtimes, which were usually snacking time. But between the habit, the ADHD, and the predisposition to always be thinking about it, it was an impossible habit to break. I didn't realize this until talking to my wife, who doesn't have this problem. She also didn't used to think every food tasted incredible. Just some. Meanwhile, there was almost nothing I ate that didn't taste fantastic, in my brain. That has also adjusted to be more "normal," but historically whenever my mom has stopped, that adjustment didn't revert. It would appear to have been stable, as it helps your brain and body simply figure out it isn't starving all the time. It's kind of hard to explain, so I hope that made sense.
  - calmoo 2y ago
    Thanks for sharing your experience, very interesting!
zamalek 2y ago
I agree with your sentiment in general. The problem is how people are actually using it, especially the rich. We shouldn't prescribe antidepressants for life so easily, but we do. We shouldn't feed livestock antibiotics, but we do. We shouldn't solve an eating/sedentary disorder with Ozempic, but we do.
- borski 2y ago
  What is the alternative? Sure, I agree people misuse medications sometimes. So should we not help people curb their obesity and/or T2D because some folks misuse it? Of course not. People misuse Sudafed and use it to make meth, or drink Robitussin to get high. I would be very upset if I lost access to those medications when I was sick, simply because we decided to make rules about the exception. :)
  - zamalek 2y ago
    I'm really not sure what the alternative is.
orwin 2y ago
My uncle and his wife were on GPL-1 (not Ozempic) from 2019 to 2022,stopped, took a bit of their belly back but are clearly not obese anymore, even if still overweight. Without discernable change in their behavior (they might cook a bit more)
- borski 2y ago
  That's great! But I guarantee you there is a discernible change in behavior to them.

ryathal 2y ago

Obesity isn't a temporary problem, practically every weight loss solution fails at 2-5 year outlooks. If this drug has to be taken for decades it's still better than decades of obesity.

zamalek 2y ago
Any condition that is not chronic is temporary by definition. It doesn't matter if it can be cured in 5 years or 20. If a person is dependant on a drug to maintain health, then they have a chronic condition. This is exactly why I italicized usually.

HDThoreaun 2y ago

> for something that can [again] usually be permanently solved with other forms of treatment. Just not true. The vast majority of obese people who try to lose weight without GLP-1 agonists fail. The only other option that consistently works is stimulants but the side effects for those is even worse, see requiem for a dream.