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Being overweight overtakes tobacco smoking as the leading disease risk factor

malfist 2y ago
I saw a news article the other day that the obesity rate decreased instead of increased last year for the first time in well over a decade. I wonder how much GLP-1s have to do with all of that, and how much more they'll do.
- quaffapint 2y ago
  I do wonder how much affect it has. At least in the US most insurance companies won't cover them (unless you already have diabetes, for example) and at over $1,000 a month I can't see how the people who could really benefit from this to lower the numbers can possibly afford it.
  - malfist 2y ago
    From personal experience, it's ridiculously easy to get a compounded formulation from one of the telehealth suppliers, and it's cheap even though you can't submit it to insurance. I think I pay $200 and get two one month vials for it. It's been marvelous for me, I was just over the edge into overweight, so no one would prescribe it for me, even though I had a borderline pre-diabetes A1C, and reactive hypoglycemia runs in my family. My choices were gain another 10 pounds, or find a telehealth that wasn't bothered by not following the FDA rules so strictly. So that's what I did, I got a script from telahealth and now I'm smack dab in the middle of the healthy weight range (-24lb), haven't had a hypoglycemic incident since I started it, and as a bonus my IBS-D went away completely. I've reduced my dose to the point that I'm at the dose you start out on, and that has let me keep my weight constant without losing more or gaining more. Plan to stay this way for a year and then see about titrating it even more until I'm off of it. I also followed their instructions and only titrated up when I wasn't seeing weightloss, so I never hit the highest dose, and kept my weight loss to .75-1.5 lb/week. Perfectly sustainable. This has been miraculous, and something that multiple years of consistent dieting hasn't solved. And as a bonus, I can now do my strength training I love without feeling like I have to eat the house on the recovery day
    - aoanevdus 2y ago
      Random question about how those compounding pharmacies work. Can you order a higher dose and then just stretch it out by taking the minimum dose to save cost? Do they automatically bill you monthly or can you skip months?
      - malfist 2y ago
        That's kinda what I'm doing. They still send me enough for my max dose reached (1.5mg/wk), but I've titrated down (to 0.5mg/wk) since I'm at the weight I should be at, so I just use a vial for a month, and toss the remainder. They send me two vials at a time. The vials have a 6 month use by date, though evidence indicates semaglutide is stable for 1 year. I can log into the portal and tell it to skip a month, but since it's a push system, I don't get automatically billed. I actually have to do a checkin and the doc has to approve the refill. So if I have extra vials, I just skip that month's check in. There's some indication that you don't have to toss the vial after a month, the FDA set those limits assuming it was insulin that is used sometimes more than daily. 4 penetrations of the vial's membrane probably isn't enough to contaminate it, but I'd rather be on the safe side so I don't use the vial for more than a month at a time. My partner is a pharmacist, so that part of the influence for the safer approach.
      - daedrdev 2y ago
        I think which is usually they start you at a small dose, ramp you up in dosage, then ramp you down when its time to come off, that way you dont suddenly feel much hungrier when it goes away because you've slowly adjusted it.
    - sjsisjxjdjd 2y ago
      > something that multiple years of consistent dieting hasn't solved Did you continue to track calories while using the drug? As somebody who has successfully increased and decreased their body weight over the years (after initially being obese), if you’re able to diet consistently I don’t see why a drug is needed. My guess is whatever diet you were on was consistent for the weight you were at.
  - jimbob45 2y ago
    Doesn't seem like it will matter. The core patent expires in 2026[0] and the rest expire in 2033. It seems like most will have access to at least some form of the drug affordably within the next five years. [0]https://www.reddie.co.uk/2024/08/30/the-year-of-ozempic-an-ip-take/ https://www.reddie.co.uk/2024/08/30/the-year-of-ozempic-an-i...
  - danans 2y ago
    Ozempic is around $100/month in most western European countries, including the country of it's maker, Novo Nordisk. Sen. Bernie Sanders has been recently calling out this company for charging an order of magnitude more in the US, where it is priced like a cosmetic medical product.
bwestergard 2y ago
This paper provides a helpful breakdown of types of mortalities and how they're associated with BMI. It's interesting to see that the lowest All-cause mortality is at a BMI of 25. A BMI of 30 doesn't increase the hazard ratio that much, but a BMI of ~45 doubles it. The minimum for cancer mortality is notably lower (21) but perhaps surprisingly the minimum communicable disease mortality is at a BMI of 26. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30288-2/fulltext https://www.thelancet.com/journals/landia/article/PIIS2213-8...
- hooverd 2y ago
  My guess: less cells mean less cancer, but it's good to have reserves if you're fighting off a virus?
  - ethagknight 2y ago
    More likely relates to diet. There was a recent WashU study directly linking high fructose diets to increased cancer. Cancer cells are vigorously growing, needs lots of available fuel, a diet full of corn syrup fuels both fat and cancer.
    - JumpCrisscross 2y ago
      > a diet full of corn syrup fuels both fat and cancer Or sugar. Or modern fruits. The problem with HFCS isn't that it's got fructose (so does cane sugar) or is made from corn, it's that it's cheap sugar.
      - enaaem 2y ago
        How much fruit do you have to eat before it becomes harmful? I can imagine juice can easily be over consumed but solid fruit is very satiating.
        BobaFloutist 2y ago
        >solid fruit is very satiating. Very briefly.
hooverd 2y ago
I wonder if we'll see an increase in other nicotine related issues. It's hearsay from my gen-Z colleagues but apparently there's a bit of a ZYN/snus epidemic.
- xnx 2y ago
  Nicotine might be one of the least harmful things in cigarettes compared to tar, carbon monoxide, benzene, formaldehyde, cadmium, arsenic, etc. Nicotine by itself isn't too different from caffeine.
  - llamaimperative 2y ago
    > Nicotine by itself isn't too different from caffeine Yes it is You should actually look up the literature. Chronic use is actually harmful in a lot of the same ways that tobacco smoking is. Obviously it's a huge improvement over tobacco use, but it's also a huge downgrade from abstinence as a whole.
    - driverdan 2y ago
      It's not. The biggest health consequence of long term nicotine use is hardening of arteries. All of the lung problems, the worst side effects, are from smoking.
      - llamaimperative 2y ago
        https://academic.oup.com/function/article/2/3/zqab022/6247762 https://academic.oup.com/function/article/2/3/zqab022/624776...
- snovymgodym 2y ago
  Nicotine on its own frankly isn't that harmful outside of addiction. Not great for you, but it's orders of magnitude more healthy than being obese.
- k4rli 2y ago
  Zyn barely has any nicotine. In Europe most are 5x stronger but even 10x stronger pads at 50mg/g exist. This is nothing new. E-cig liquids have been as strong for a long time as well.
flippyhead 2y ago
Well, this is excellent news. I can start smoking again!
- yen223 2y ago
  I mean, no country had the guts to completely ban smoking...
  - jp0d 2y ago
    Australia and NZ are making it very hard to take up smoking!
  - WeylandYutani 2y ago
    Even if they did tobacco companies invented vaping so who has the last laugh?
INTPenis 2y ago
...in Australia might be worth adding.
deadbabe 2y ago
People are trying to make being overweight as something acceptable instead of a condition to be treated.
- formerly_proven 2y ago
  majority and all
- BadHumans 2y ago
  "People" is doing some heavy lifting here. There are some fringe people on trying to push that but most people I see are trying to explain that the main problem with obesity is that it is a food supply and class problem.
  - dsign 2y ago
    There are also tons and tons of people trying to lose weight, and having an awful time at it :-) . Just three minutes ago I was summarizing 2024 for myself. I did an awful lot of SUP, and tried to lose weight. Results: weight decreased, then increased back when I got into a relationship that included unhealthy habits. I got rid of the factors that worked against my weight control effort and now things are looking up again. But most people in my age are married and with kids, and they are not going to leave or even fight their significant other and the kids over the family's eating habits....
    - teaearlgraycold 2y ago
      Gotta set the family eating habits right from the start.
  - zer8k 2y ago
    I would not call billboards for clothing featuring morbidly obese people "fringe". "Fat acceptance" is actually quite popular. It's not fringe. Fringe is being a furry. The entire medical field walks on egg shells because of so called "fatphobia".
UweSchmidt 2y ago
It appears that sentiments that downplay or dispute the health risks are growing in large social media bubbles, with strong effects on the real world. Efforts to push back on serving unhealthy food are undermined, doctors discouraged from discussing weight with their patients as a personal and sensitive issue; overweight models validate unhealthy body compositions. This surely has to please the food industry, which is as culpable as the tobacco industry in harming peoples health. I would propose a concerted effort through mandatory levels of food quality that is served to the public (e.g. schools, hospitals), funded by a higher tax on sugary atrocities, limits on sale of sugary food and drinks to children, and an outright ban on any substance designed to create cravings.
- voisin 2y ago
  Rather than a tax on sugary food how about we cut subsidies that make simple carbs artificially cheap?
  - bumby 2y ago
    I believe the "artificially cheap simple carbs" is a secondary effect, with the primary effect of making corn cheap due to national security reasons. So before removing the subsidies, you'd want to have a plan for managing that risk.
    - deleted 2y ago
      [deleted]
    - slothtrop 2y ago
      The subsidies predate the "great grain robbery" where farmers sold large stockpiles to the Russians, which helped Nixon secure election victory. Before that, as part of the New Deal, was the Agricultural Adjustment Act which literally paid farmers to destroy livestock and not use land in order to boost prices for farmers. Strictly speaking, I don't think this was a case of national security. Today it's just a case of entrenched interests: large key midwestern farmers would stand to lose money, whether you have a tax or reduce subsidies. They stand to gain more by not mitigating obesity rates. Mind you they could diversify away from corn. If consumers eat whole grains or meat instead of sugar, that's still money for farmers. But it would entail growing pains.
siliconc0w 2y ago
Nicotine helps control weight so it also makes sense that as we smoke less we'll gain (even) more weight.
- hoppyhoppy2 2y ago
  The headline refers only to tobacco smoking, not vaping, patches, etc. I wonder how overall nicotine use (from all sources) looks
- Liquix 2y ago
  it may also help that tobacco-free nicotine products (vaping, pouches) are gaining popularity vs. more traditional and deadly administration routes (cigarettes). of course there are myriad cons and unknowns resulting from any nicotine habit, but cancer trending down is always good to see.
- grantseltzer 2y ago
  Excellent analysis and deduction!
naming_the_user 2y ago
Sometimes I read this stuff and think I live in the most ridiculous bubble. It's bizarre to me that people don't look after their health. I wake up and I'm like, right, there are three tracks - financial (go to work, develop career, run business, do admin, whatever), physical (exercise, keep relatively fit, don't eat 4000 cal a day unless bulking), social (don't just sit at home all day and become a gremlin). There are others but that's the main. I don't spend equal amounts of time on them but they're all there. It seems to me that apparently other people don't think of it this way. They just sort of wake up and do whatever on autopilot and go to sleep and whatever happens to them happens. What's that all about?
- asdasdsddd 2y ago
  We live in a bubble, the average american spends 2hrs a week with friends
- moduspol 2y ago
  I agree. I think you do live in the most ridiculous bubble.
- vile_wretch 2y ago
  You definitely live in a bubble but it isn't the kind you think it is
- whtsthmttrmn 2y ago
  Addiction, depression, it's a cycle. Something happens that causes depression, eating gives some feel good chemicals and being a sloth is to avoid potential disappointment.
- criddell 2y ago
  I don't think it's that complicated. When one side of that triangle ends up consuming too much of your time and attention, the other two suffer.
- amonon 2y ago
  Many people are on autopilot. They have not been taught to be intentional about the day to day fundamentals of their lives. For the most part, I think that used to be achieved through social contact which has substantially diminished in the past few decades.
declan_roberts 2y ago
We're probably less than 3 years away from health insurers making GLP-1s free as a cost-saving measure.
- kylehotchkiss 2y ago
  All funds currently diverted towards executive security details. Sorry, GLP-1 denied.
- OptionOfT 2y ago
  I'm just thinking for myself, how much money I save, even though I'm paying out of pocket for ZepBound. I sleep better, so I gain an hour per day. At that rate my out of pocket per month is still less than my hourly wage. Not to mention food and shoes (yes, I'm someone who was overweight and hiked 5 miles a day...).
jaco6 2y ago
We need to wake up to the reality that solving the obesity crisis (if it is actually something we want to solve—enough healthy people may be happy with paying double for healthcare) may require measures perceived by modern liberals as authoritarian or cruel. I think this because measures like what we did with tobacco—-public health demonization of junk foods and junk food consumption, banning advertisement of junk food, warning labels on junk food, and high excise taxes on junk food—are unlikely to ever be accepted by the healthy population that has no problem restricting its junk food intake to stay below BMI 30 (60+% of the population). They won’t want to pay double for chips just because obese people can’t stop themselves from eating two bags instead of one. The only alternative is to charge the obese population on the back end—when they pay for healthcare. Obese people would be made to pay a health insurance surcharge to compensate for the additional healthcare resources they consume. This measure will be decried as “insensitive” and “cruel.” Alternatively we could do both. By the way—ozempic et al are unlikely to solve the crisis as some hope. Studies show average long term, sustained weight loss of 10-20 pounds. Good, but not enough to help people who are hundreds of pounds overweight—a sizable portion of the obese population that costs the healthcare system so much.
- honkycat 2y ago
  Doing anything about the obesity epidemic has the same issue as 99% of our problems: People are getting rich off of selling cheap nasty food. You think a politician is going to go after billion dollar industries? Get real. It is a class issue, and an issue with the type of food that is "easy" to access for exhausted people with kids, long hours, etc...
- asciimov 2y ago
  A good place to start would be addressing overeating as a symptom not the cause.
  - meiraleal 2y ago
    that's the point. Cheap low quality food makes people wants to eat more (because it lacks nutrition the body needs). Turning them into recurring revenue.
bluSCALE4 2y ago
We should be looking at eating poorly as well.
dbg31415 2y ago
Most insurance plans in the US don't cover treatments, drugs, or surgeries that work for weight loss... Seems like they ought to.
hnburnsy 2y ago
Can we expect those Truth commercials to start fat shamming folks since tobacco and e-cigs are no longer a problem?
andersa 2y ago
It is much harder to treat a food addiction than a smoking one. The usual way to do that is to stop smoking entirely and eventually forget about it. You cannot stop eating. Food tastes good. We have infinite food available. The hell are we supposed to do about it?
- unclad5968 2y ago
  That's just because you consider all food equally. Nobody is out here dying from a vegetable or fruit addiction.
  - davzie 2y ago
    Tell that to Steve Jobs!
    - kibwen 2y ago
      We're being glib, but Jobs' extreme dietary predilections, regardless of whether they contributed to his cancer, definitely weren't motivated by anything that we'd classify as addiction.
- qwerty456127 2y ago
  The same - just stop eating (for some time between a day and a week). I tried (for a week) successfully and that was fun. This way you discover you have power to choose to eat or not to eat, also learn to distract yourself from hunger and forget about it for whatever time you choose to. Switching to keto first, supplementing minerals - helps a lot.
  - orwin 2y ago
    So I will second this post, but with a caveat: 'fun' is extremely relative. I was obese, 34 BMI, and did this. My first fast, the hunger 'spikes' were extremely painful. If 'broken leg' is a 10, the pain would be was a 6 to 9. Intermittently. Around every two hours, for a dozen minutes, from the end of the first day until the end of the second. I was prepared. A doctor was consulted before, my sister was around, I took the week off, and yes, I entered ketosis 2 days before the fast. Still, it was very difficult. It did help a ton though, because like my parent say, once you've gone hungry once and managed it fine ( day 3-4-5 were 'normal' to me), your body learn to accept hunger. I now leave every meal hungry, and it's fine. I went from 34 BMI to 28 in less than two years, without changing anything other than the quantities I ate. The 28 to 25 took 5 years and physical exercise.
jrochkind1 2y ago
So, since smoking can help you lose weight...
- heraldgeezer 2y ago
  Being slim and vaping or snusing might be better than just being fat honestly
yen223 2y ago
> Overweight, including obesity, overtook tobacco use as the leading risk factor in 2024, driven by a substantial fall (41%) in the burden attributable to tobacco use since 2003. According to the study, it's not so much that more people got fat, it's that fewer people are smoking. A lot of comments here missed this I think.
- sneak 2y ago
  It's rarely news when life gets safer and longer and the median person's risk of death falls. :/ Most people mistakenly think that the world is getting worse.
- slothtrop 2y ago
  Mostly yes, though people did get fatter.
- swatcoder 2y ago
  Imagine a chart with two lines spanning the last 50 years. One of those lines was very high at the beginning, and has generally been trending downwards. One of those lines was quite low at the beginning and has rapidly been trending upwards. The study is suggesting that we've reached a point where these two lines have finally crossed, which we probably could have anticipated coming sooner or later. That the most salient recent observation is a change to the prevalence of tobacco-attributed disease doesn't really change what it means for obesity-attributed risk to finally overtake it. That wouldn't have even been fathomable 50 years ago and the trendlines confirm exactly what needs urgent attention now.
- asciimov 2y ago
  And they excluded vaping.
  - lblume 2y ago
    Well, yes, because there are no large enough long-term studies that have been done on vaping that can show mortality to increase significantly (yet).
- 2y ago
gorjusborg 2y ago
I wonder if we'll ever get to a place where we hold food companies accountable for addictive, unheathy food being advertised and sold the way we hold tobacco companies accountable? I know there is a personal responsibility involved in both, but the situation seems similar.
- LPisGood 2y ago
  Things like soft drink taxes already begin to do that.
  - insane_dreamer 2y ago
    Have those stuck anywhere? I know it was trialed in a few places (Berkely for one) but I don't think it lasted. Great idea though; just like taxing tobacco helped reduce smoking (among other things)
    - vladvasiliu 2y ago
      We have taxes on sugary drinks in France. The tax depends on how much sugar is added, in kg / hl. Funnily, synthetic sweeteners are also taxed, but at a flat rate equal to the "up to 1 kg / hl" of sugar. See [0] for the official text. I'm not convinced this has had a great effect, since I hear there are more and more people who are considered obese [1]. [0] https://entreprendre.service-public.fr/vosdroits/F32101?lang=en https://entreprendre.service-public.fr/vosdroits/F32101?lang... [1] https://presse.inserm.fr/en/obesite-et-surpoids-pres-dun-francais-sur-deux-concerne-etat-des-lieux-prevention-et-solutions-therapeutiques/66621/ https://presse.inserm.fr/en/obesite-et-surpoids-pres-dun-fra...
- CodeWriter23 2y ago
  USDA shares the blame for placing Carbohydrates as the primary food source on the food pyramid.
  - worik 2y ago
    > USDA shares the blame for placing Carbohydrates as the primary food source on the food pyramid. I agree, but I have no real evidence, just a feeling. Is there any evidence?
skirge 2y ago
Never ending war with happy people.
kevwill 2y ago
There is no doubt in my mind that the alcohol consumption is much more of a contributing factor to not only the obesity but also the overall decline in health wellbeing and raise in suicide/depression. Alcohol is socially accepted poison, and I feel its consumption in any amount is significantly worse for the individual than any poor diet/exercise regiment.
- nemomarx 2y ago
  keep in mind alcohol is also poor diet - beer is especially heavy in carbs, very few alcoholic drinks are light really. alcohol is like having an extra side with a meal at least, but people would I think be more aware they were overeating if it was a plate of fries.
  - kevwill 2y ago
    Absolutely. There are a lot of people who get a whole extra day of kcal worth of beer in a week. Additionally people who drink a lot pretty much stop eating because they opt for the liquid lunch etc.
- ikmckenz 2y ago
  Per capita people drink drastically less alcohol than they did in the 80s, and Obesity rates have more than doubled in the period.
- latentcall 2y ago
  You can either drink a lot or eat a lot, but you can’t do both. Both will really hurt you.
heraldgeezer 2y ago
Honestly I have a BMI of 23 and feel like I have a "beer belly" If you are over 25 you just need to loose weight straight up
- nradov 2y ago
  There are a lot of people who are "skinny fat": normal BMI but low skeletal muscle mass. This puts them at greater risk of sarcopenia and metabolic conditions as they age.
  - heraldgeezer 2y ago
    Yea sounds like me :(
- criddell 2y ago
  BMI is a great tool for a population. It's often not very useful for an individual. A BMI of 23 is a 5' 10" man who is 160 lbs. It doesn't say anything about body composition.
heraldgeezer 2y ago
Honestly, fasting feels great and I just need that reminder that it does.
ggm 2y ago
I found the ABC (oz) news reporting a bit deficient on this. Leading disease risk factor doesn't have to mean its rising, it can be that smoking has fallen and now, people who would have died of COPD and Cancer caused by smoking die of COPD and different cancers, caused by morbid obesity. Its probably just me but I found the language around absolutes and relatives a bit flakey. The overall population is rising so absolutes trend upward but leading goes to relatives, and so the rate of increase against population increase is material.
naikrovek 2y ago
Excellent. I’ve never smoked but I am obese as hell. Maybe soon it will kill me and I can finally be done with this forever worsening hellscape called life.
yodsanklai 2y ago
According to https://dqydj.com/bmi-percentile-calculator-united-states/ https://dqydj.com/bmi-percentile-calculator-united-states/ 67% of American adults are overweight. Only 13% of them have a BMI less than 22 (center of the healthy BMI range). How does it translate to aesthetic preferences. Is someone with a BMI of 22 so far of the US norm that they would get strange looks, or would be considered unhealthy?
- pavel_lishin 2y ago
  I thought BMI was pretty debunked as a measure of health? I'm 5'11" or so, and weigh approximately 180 pounds. According to that website, I'm overweight with a BMI of 25.10. I certainly don't look overweight, I definitely don't feel overweight, and if I picked up my exercise regime again, I'd be more likely to gain muscle weight than lose weight. And yet, my BMI would get worse.
  - yodsanklai 2y ago
    A BMI of 25+ seems to be commonly accepted as overweight in most part of the world, at least in the medical sense. Whether it looks overweight or not is cultural. But you're right, very muscular persons are heavier and BMI isn't a good measure in that case, and it's not necessarily unhealthy if you don't have other risk factors. > For people who are considered obese (BMI greater than or equal to 30) or those who are overweight (BMI of 25 to 29.9) and have two or more risk factors, it is recommended that you lose weight. https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.ht...
  - DuckConference 2y ago
    I was definitely overweight (by waist and BF%) at 5'11" and 180lbs, and going by the stats I've seen that seems more common than your case of BMI overestimating BF%.
- hervature 2y ago
  I am going to assume you do not live in the USA based on this comment. Most supermodels, which I'm using as a proxy for aesthetic preference, have BMIs under 20.
deleted 2y ago
[deleted]
gdjskshh 2y ago
One of the most effective diets I'm aware of is the coffee and cigarette diet. Anytime you feel hungry, have a coffee and a cigarette first, then eat a little if you're still hungry. It has a much better compliance rate that other calorie-restriction diets.
- bumby 2y ago
  But does it lead to overall better health outcomes? It’s important to not miss the forest for the trees. Lower obesity is a generally a means to better health, not an end to itself.
  - bumby 2y ago
    I'd be curious the perspective on the downvoters. Smoking increases hazard rates by 3x. Even the extreme obesity (obesity III, formerly morbid obesity) increases hazard rates less than this. So the risk tradeoff for picking up smoking in favor of reducing obesity is not good. It's like saying you'll stop wearing a seatbelt to reduce the risk of being trapped in a burning car; your overall risk profile is still higher. Or is it that you don't think health is the goal of reducing obesity? If so, most of the metrics we use to deem obesity as sub-optimal are wrong, including those in TFA. Better compliance to a diet that increases overall health risk is not a good strategy IMO.
defart 2y ago
Just went a month without cigarettes today, yay! Still overweight :(

I saw a news article the other day that the obesity rate decreased instead of increased last year for the first time in well over a decade. I wonder how much GLP-1s have to do with all of that, and how much more they'll do.

quaffapint 2y ago
I do wonder how much affect it has. At least in the US most insurance companies won't cover them (unless you already have diabetes, for example) and at over $1,000 a month I can't see how the people who could really benefit from this to lower the numbers can possibly afford it.
- malfist 2y ago
  From personal experience, it's ridiculously easy to get a compounded formulation from one of the telehealth suppliers, and it's cheap even though you can't submit it to insurance. I think I pay $200 and get two one month vials for it. It's been marvelous for me, I was just over the edge into overweight, so no one would prescribe it for me, even though I had a borderline pre-diabetes A1C, and reactive hypoglycemia runs in my family. My choices were gain another 10 pounds, or find a telehealth that wasn't bothered by not following the FDA rules so strictly. So that's what I did, I got a script from telahealth and now I'm smack dab in the middle of the healthy weight range (-24lb), haven't had a hypoglycemic incident since I started it, and as a bonus my IBS-D went away completely. I've reduced my dose to the point that I'm at the dose you start out on, and that has let me keep my weight constant without losing more or gaining more. Plan to stay this way for a year and then see about titrating it even more until I'm off of it. I also followed their instructions and only titrated up when I wasn't seeing weightloss, so I never hit the highest dose, and kept my weight loss to .75-1.5 lb/week. Perfectly sustainable. This has been miraculous, and something that multiple years of consistent dieting hasn't solved. And as a bonus, I can now do my strength training I love without feeling like I have to eat the house on the recovery day
  - aoanevdus 2y ago
    Random question about how those compounding pharmacies work. Can you order a higher dose and then just stretch it out by taking the minimum dose to save cost? Do they automatically bill you monthly or can you skip months?
    - malfist 2y ago
      That's kinda what I'm doing. They still send me enough for my max dose reached (1.5mg/wk), but I've titrated down (to 0.5mg/wk) since I'm at the weight I should be at, so I just use a vial for a month, and toss the remainder. They send me two vials at a time. The vials have a 6 month use by date, though evidence indicates semaglutide is stable for 1 year. I can log into the portal and tell it to skip a month, but since it's a push system, I don't get automatically billed. I actually have to do a checkin and the doc has to approve the refill. So if I have extra vials, I just skip that month's check in. There's some indication that you don't have to toss the vial after a month, the FDA set those limits assuming it was insulin that is used sometimes more than daily. 4 penetrations of the vial's membrane probably isn't enough to contaminate it, but I'd rather be on the safe side so I don't use the vial for more than a month at a time. My partner is a pharmacist, so that part of the influence for the safer approach.
    - daedrdev 2y ago
      I think which is usually they start you at a small dose, ramp you up in dosage, then ramp you down when its time to come off, that way you dont suddenly feel much hungrier when it goes away because you've slowly adjusted it.
  - sjsisjxjdjd 2y ago
    > something that multiple years of consistent dieting hasn't solved Did you continue to track calories while using the drug? As somebody who has successfully increased and decreased their body weight over the years (after initially being obese), if you’re able to diet consistently I don’t see why a drug is needed. My guess is whatever diet you were on was consistent for the weight you were at.
- jimbob45 2y ago
  Doesn't seem like it will matter. The core patent expires in 2026[0] and the rest expire in 2033. It seems like most will have access to at least some form of the drug affordably within the next five years. [0]https://www.reddie.co.uk/2024/08/30/the-year-of-ozempic-an-ip-take/ https://www.reddie.co.uk/2024/08/30/the-year-of-ozempic-an-i...
- danans 2y ago
  Ozempic is around $100/month in most western European countries, including the country of it's maker, Novo Nordisk. Sen. Bernie Sanders has been recently calling out this company for charging an order of magnitude more in the US, where it is priced like a cosmetic medical product.

bwestergard 2y ago

This paper provides a helpful breakdown of types of mortalities and how they're associated with BMI. It's interesting to see that the lowest All-cause mortality is at a BMI of 25. A BMI of 30 doesn't increase the hazard ratio that much, but a BMI of ~45 doubles it. The minimum for cancer mortality is notably lower (21) but perhaps surprisingly the minimum communicable disease mortality is at a BMI of 26. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30288-2/fulltext https://www.thelancet.com/journals/landia/article/PIIS2213-8...

hooverd 2y ago
My guess: less cells mean less cancer, but it's good to have reserves if you're fighting off a virus?
- ethagknight 2y ago
  More likely relates to diet. There was a recent WashU study directly linking high fructose diets to increased cancer. Cancer cells are vigorously growing, needs lots of available fuel, a diet full of corn syrup fuels both fat and cancer.
  - JumpCrisscross 2y ago
    > a diet full of corn syrup fuels both fat and cancer Or sugar. Or modern fruits. The problem with HFCS isn't that it's got fructose (so does cane sugar) or is made from corn, it's that it's cheap sugar.
    - enaaem 2y ago
      How much fruit do you have to eat before it becomes harmful? I can imagine juice can easily be over consumed but solid fruit is very satiating.
      - BobaFloutist 2y ago
        >solid fruit is very satiating. Very briefly.

hooverd 2y ago

I wonder if we'll see an increase in other nicotine related issues. It's hearsay from my gen-Z colleagues but apparently there's a bit of a ZYN/snus epidemic.

xnx 2y ago
Nicotine might be one of the least harmful things in cigarettes compared to tar, carbon monoxide, benzene, formaldehyde, cadmium, arsenic, etc. Nicotine by itself isn't too different from caffeine.
- llamaimperative 2y ago
  > Nicotine by itself isn't too different from caffeine Yes it is You should actually look up the literature. Chronic use is actually harmful in a lot of the same ways that tobacco smoking is. Obviously it's a huge improvement over tobacco use, but it's also a huge downgrade from abstinence as a whole.
  - driverdan 2y ago
    It's not. The biggest health consequence of long term nicotine use is hardening of arteries. All of the lung problems, the worst side effects, are from smoking.
    - llamaimperative 2y ago
      https://academic.oup.com/function/article/2/3/zqab022/6247762 https://academic.oup.com/function/article/2/3/zqab022/624776...
snovymgodym 2y ago
Nicotine on its own frankly isn't that harmful outside of addiction. Not great for you, but it's orders of magnitude more healthy than being obese.
k4rli 2y ago
Zyn barely has any nicotine. In Europe most are 5x stronger but even 10x stronger pads at 50mg/g exist. This is nothing new. E-cig liquids have been as strong for a long time as well.

flippyhead 2y ago

Well, this is excellent news. I can start smoking again!

yen223 2y ago
I mean, no country had the guts to completely ban smoking...
- jp0d 2y ago
  Australia and NZ are making it very hard to take up smoking!
- WeylandYutani 2y ago
  Even if they did tobacco companies invented vaping so who has the last laugh?

INTPenis 2y ago

...in Australia might be worth adding.

deadbabe 2y ago

People are trying to make being overweight as something acceptable instead of a condition to be treated.

formerly_proven 2y ago
majority and all
BadHumans 2y ago
"People" is doing some heavy lifting here. There are some fringe people on trying to push that but most people I see are trying to explain that the main problem with obesity is that it is a food supply and class problem.
- dsign 2y ago
  There are also tons and tons of people trying to lose weight, and having an awful time at it :-) . Just three minutes ago I was summarizing 2024 for myself. I did an awful lot of SUP, and tried to lose weight. Results: weight decreased, then increased back when I got into a relationship that included unhealthy habits. I got rid of the factors that worked against my weight control effort and now things are looking up again. But most people in my age are married and with kids, and they are not going to leave or even fight their significant other and the kids over the family's eating habits....
  - teaearlgraycold 2y ago
    Gotta set the family eating habits right from the start.
- zer8k 2y ago
  I would not call billboards for clothing featuring morbidly obese people "fringe". "Fat acceptance" is actually quite popular. It's not fringe. Fringe is being a furry. The entire medical field walks on egg shells because of so called "fatphobia".

UweSchmidt 2y ago

It appears that sentiments that downplay or dispute the health risks are growing in large social media bubbles, with strong effects on the real world. Efforts to push back on serving unhealthy food are undermined, doctors discouraged from discussing weight with their patients as a personal and sensitive issue; overweight models validate unhealthy body compositions. This surely has to please the food industry, which is as culpable as the tobacco industry in harming peoples health. I would propose a concerted effort through mandatory levels of food quality that is served to the public (e.g. schools, hospitals), funded by a higher tax on sugary atrocities, limits on sale of sugary food and drinks to children, and an outright ban on any substance designed to create cravings.

voisin 2y ago
Rather than a tax on sugary food how about we cut subsidies that make simple carbs artificially cheap?
- bumby 2y ago
  I believe the "artificially cheap simple carbs" is a secondary effect, with the primary effect of making corn cheap due to national security reasons. So before removing the subsidies, you'd want to have a plan for managing that risk.
  - deleted 2y ago
    [deleted]
  - slothtrop 2y ago
    The subsidies predate the "great grain robbery" where farmers sold large stockpiles to the Russians, which helped Nixon secure election victory. Before that, as part of the New Deal, was the Agricultural Adjustment Act which literally paid farmers to destroy livestock and not use land in order to boost prices for farmers. Strictly speaking, I don't think this was a case of national security. Today it's just a case of entrenched interests: large key midwestern farmers would stand to lose money, whether you have a tax or reduce subsidies. They stand to gain more by not mitigating obesity rates. Mind you they could diversify away from corn. If consumers eat whole grains or meat instead of sugar, that's still money for farmers. But it would entail growing pains.

siliconc0w 2y ago

Nicotine helps control weight so it also makes sense that as we smoke less we'll gain (even) more weight.

hoppyhoppy2 2y ago
The headline refers only to tobacco smoking, not vaping, patches, etc. I wonder how overall nicotine use (from all sources) looks
Liquix 2y ago
it may also help that tobacco-free nicotine products (vaping, pouches) are gaining popularity vs. more traditional and deadly administration routes (cigarettes). of course there are myriad cons and unknowns resulting from any nicotine habit, but cancer trending down is always good to see.
grantseltzer 2y ago
Excellent analysis and deduction!

naming_the_user 2y ago

Sometimes I read this stuff and think I live in the most ridiculous bubble. It's bizarre to me that people don't look after their health. I wake up and I'm like, right, there are three tracks - financial (go to work, develop career, run business, do admin, whatever), physical (exercise, keep relatively fit, don't eat 4000 cal a day unless bulking), social (don't just sit at home all day and become a gremlin). There are others but that's the main. I don't spend equal amounts of time on them but they're all there. It seems to me that apparently other people don't think of it this way. They just sort of wake up and do whatever on autopilot and go to sleep and whatever happens to them happens. What's that all about?

asdasdsddd 2y ago
We live in a bubble, the average american spends 2hrs a week with friends
moduspol 2y ago
I agree. I think you do live in the most ridiculous bubble.
vile_wretch 2y ago
You definitely live in a bubble but it isn't the kind you think it is
whtsthmttrmn 2y ago
Addiction, depression, it's a cycle. Something happens that causes depression, eating gives some feel good chemicals and being a sloth is to avoid potential disappointment.
criddell 2y ago
I don't think it's that complicated. When one side of that triangle ends up consuming too much of your time and attention, the other two suffer.
amonon 2y ago
Many people are on autopilot. They have not been taught to be intentional about the day to day fundamentals of their lives. For the most part, I think that used to be achieved through social contact which has substantially diminished in the past few decades.

declan_roberts 2y ago

We're probably less than 3 years away from health insurers making GLP-1s free as a cost-saving measure.

kylehotchkiss 2y ago
All funds currently diverted towards executive security details. Sorry, GLP-1 denied.
OptionOfT 2y ago
I'm just thinking for myself, how much money I save, even though I'm paying out of pocket for ZepBound. I sleep better, so I gain an hour per day. At that rate my out of pocket per month is still less than my hourly wage. Not to mention food and shoes (yes, I'm someone who was overweight and hiked 5 miles a day...).

jaco6 2y ago

We need to wake up to the reality that solving the obesity crisis (if it is actually something we want to solve—enough healthy people may be happy with paying double for healthcare) may require measures perceived by modern liberals as authoritarian or cruel. I think this because measures like what we did with tobacco—-public health demonization of junk foods and junk food consumption, banning advertisement of junk food, warning labels on junk food, and high excise taxes on junk food—are unlikely to ever be accepted by the healthy population that has no problem restricting its junk food intake to stay below BMI 30 (60+% of the population). They won’t want to pay double for chips just because obese people can’t stop themselves from eating two bags instead of one. The only alternative is to charge the obese population on the back end—when they pay for healthcare. Obese people would be made to pay a health insurance surcharge to compensate for the additional healthcare resources they consume. This measure will be decried as “insensitive” and “cruel.” Alternatively we could do both. By the way—ozempic et al are unlikely to solve the crisis as some hope. Studies show average long term, sustained weight loss of 10-20 pounds. Good, but not enough to help people who are hundreds of pounds overweight—a sizable portion of the obese population that costs the healthcare system so much.

honkycat 2y ago
Doing anything about the obesity epidemic has the same issue as 99% of our problems: People are getting rich off of selling cheap nasty food. You think a politician is going to go after billion dollar industries? Get real. It is a class issue, and an issue with the type of food that is "easy" to access for exhausted people with kids, long hours, etc...
asciimov 2y ago
A good place to start would be addressing overeating as a symptom not the cause.
- meiraleal 2y ago
  that's the point. Cheap low quality food makes people wants to eat more (because it lacks nutrition the body needs). Turning them into recurring revenue.

bluSCALE4 2y ago

We should be looking at eating poorly as well.

dbg31415 2y ago

Most insurance plans in the US don't cover treatments, drugs, or surgeries that work for weight loss... Seems like they ought to.

hnburnsy 2y ago

Can we expect those Truth commercials to start fat shamming folks since tobacco and e-cigs are no longer a problem?

andersa 2y ago

It is much harder to treat a food addiction than a smoking one. The usual way to do that is to stop smoking entirely and eventually forget about it. You cannot stop eating. Food tastes good. We have infinite food available. The hell are we supposed to do about it?

unclad5968 2y ago
That's just because you consider all food equally. Nobody is out here dying from a vegetable or fruit addiction.
- davzie 2y ago
  Tell that to Steve Jobs!
  - kibwen 2y ago
    We're being glib, but Jobs' extreme dietary predilections, regardless of whether they contributed to his cancer, definitely weren't motivated by anything that we'd classify as addiction.
qwerty456127 2y ago
The same - just stop eating (for some time between a day and a week). I tried (for a week) successfully and that was fun. This way you discover you have power to choose to eat or not to eat, also learn to distract yourself from hunger and forget about it for whatever time you choose to. Switching to keto first, supplementing minerals - helps a lot.
- orwin 2y ago
  So I will second this post, but with a caveat: 'fun' is extremely relative. I was obese, 34 BMI, and did this. My first fast, the hunger 'spikes' were extremely painful. If 'broken leg' is a 10, the pain would be was a 6 to 9. Intermittently. Around every two hours, for a dozen minutes, from the end of the first day until the end of the second. I was prepared. A doctor was consulted before, my sister was around, I took the week off, and yes, I entered ketosis 2 days before the fast. Still, it was very difficult. It did help a ton though, because like my parent say, once you've gone hungry once and managed it fine ( day 3-4-5 were 'normal' to me), your body learn to accept hunger. I now leave every meal hungry, and it's fine. I went from 34 BMI to 28 in less than two years, without changing anything other than the quantities I ate. The 28 to 25 took 5 years and physical exercise.

jrochkind1 2y ago

So, since smoking can help you lose weight...

heraldgeezer 2y ago
Being slim and vaping or snusing might be better than just being fat honestly

yen223 2y ago

> Overweight, including obesity, overtook tobacco use as the leading risk factor in 2024, driven by a substantial fall (41%) in the burden attributable to tobacco use since 2003. According to the study, it's not so much that more people got fat, it's that fewer people are smoking. A lot of comments here missed this I think.

sneak 2y ago
It's rarely news when life gets safer and longer and the median person's risk of death falls. :/ Most people mistakenly think that the world is getting worse.
slothtrop 2y ago
Mostly yes, though people did get fatter.
swatcoder 2y ago
Imagine a chart with two lines spanning the last 50 years. One of those lines was very high at the beginning, and has generally been trending downwards. One of those lines was quite low at the beginning and has rapidly been trending upwards. The study is suggesting that we've reached a point where these two lines have finally crossed, which we probably could have anticipated coming sooner or later. That the most salient recent observation is a change to the prevalence of tobacco-attributed disease doesn't really change what it means for obesity-attributed risk to finally overtake it. That wouldn't have even been fathomable 50 years ago and the trendlines confirm exactly what needs urgent attention now.
asciimov 2y ago
And they excluded vaping.
- lblume 2y ago
  Well, yes, because there are no large enough long-term studies that have been done on vaping that can show mortality to increase significantly (yet).
2y ago

gorjusborg 2y ago

I wonder if we'll ever get to a place where we hold food companies accountable for addictive, unheathy food being advertised and sold the way we hold tobacco companies accountable? I know there is a personal responsibility involved in both, but the situation seems similar.

LPisGood 2y ago
Things like soft drink taxes already begin to do that.
- insane_dreamer 2y ago
  Have those stuck anywhere? I know it was trialed in a few places (Berkely for one) but I don't think it lasted. Great idea though; just like taxing tobacco helped reduce smoking (among other things)
  - vladvasiliu 2y ago
    We have taxes on sugary drinks in France. The tax depends on how much sugar is added, in kg / hl. Funnily, synthetic sweeteners are also taxed, but at a flat rate equal to the "up to 1 kg / hl" of sugar. See [0] for the official text. I'm not convinced this has had a great effect, since I hear there are more and more people who are considered obese [1]. [0] https://entreprendre.service-public.fr/vosdroits/F32101?lang=en https://entreprendre.service-public.fr/vosdroits/F32101?lang... [1] https://presse.inserm.fr/en/obesite-et-surpoids-pres-dun-francais-sur-deux-concerne-etat-des-lieux-prevention-et-solutions-therapeutiques/66621/ https://presse.inserm.fr/en/obesite-et-surpoids-pres-dun-fra...
CodeWriter23 2y ago
USDA shares the blame for placing Carbohydrates as the primary food source on the food pyramid.
- worik 2y ago
  > USDA shares the blame for placing Carbohydrates as the primary food source on the food pyramid. I agree, but I have no real evidence, just a feeling. Is there any evidence?

skirge 2y ago

Never ending war with happy people.

kevwill 2y ago

There is no doubt in my mind that the alcohol consumption is much more of a contributing factor to not only the obesity but also the overall decline in health wellbeing and raise in suicide/depression. Alcohol is socially accepted poison, and I feel its consumption in any amount is significantly worse for the individual than any poor diet/exercise regiment.

nemomarx 2y ago
keep in mind alcohol is also poor diet - beer is especially heavy in carbs, very few alcoholic drinks are light really. alcohol is like having an extra side with a meal at least, but people would I think be more aware they were overeating if it was a plate of fries.
- kevwill 2y ago
  Absolutely. There are a lot of people who get a whole extra day of kcal worth of beer in a week. Additionally people who drink a lot pretty much stop eating because they opt for the liquid lunch etc.
ikmckenz 2y ago
Per capita people drink drastically less alcohol than they did in the 80s, and Obesity rates have more than doubled in the period.
latentcall 2y ago
You can either drink a lot or eat a lot, but you can’t do both. Both will really hurt you.

heraldgeezer 2y ago

Honestly I have a BMI of 23 and feel like I have a "beer belly" If you are over 25 you just need to loose weight straight up

nradov 2y ago
There are a lot of people who are "skinny fat": normal BMI but low skeletal muscle mass. This puts them at greater risk of sarcopenia and metabolic conditions as they age.
- heraldgeezer 2y ago
  Yea sounds like me :(
criddell 2y ago
BMI is a great tool for a population. It's often not very useful for an individual. A BMI of 23 is a 5' 10" man who is 160 lbs. It doesn't say anything about body composition.

heraldgeezer 2y ago

Honestly, fasting feels great and I just need that reminder that it does.

ggm 2y ago

I found the ABC (oz) news reporting a bit deficient on this. Leading disease risk factor doesn't have to mean its rising, it can be that smoking has fallen and now, people who would have died of COPD and Cancer caused by smoking die of COPD and different cancers, caused by morbid obesity. Its probably just me but I found the language around absolutes and relatives a bit flakey. The overall population is rising so absolutes trend upward but leading goes to relatives, and so the rate of increase against population increase is material.

naikrovek 2y ago

Excellent. I’ve never smoked but I am obese as hell. Maybe soon it will kill me and I can finally be done with this forever worsening hellscape called life.

yodsanklai 2y ago

According to https://dqydj.com/bmi-percentile-calculator-united-states/ https://dqydj.com/bmi-percentile-calculator-united-states/ 67% of American adults are overweight. Only 13% of them have a BMI less than 22 (center of the healthy BMI range). How does it translate to aesthetic preferences. Is someone with a BMI of 22 so far of the US norm that they would get strange looks, or would be considered unhealthy?

pavel_lishin 2y ago
I thought BMI was pretty debunked as a measure of health? I'm 5'11" or so, and weigh approximately 180 pounds. According to that website, I'm overweight with a BMI of 25.10. I certainly don't look overweight, I definitely don't feel overweight, and if I picked up my exercise regime again, I'd be more likely to gain muscle weight than lose weight. And yet, my BMI would get worse.
- yodsanklai 2y ago
  A BMI of 25+ seems to be commonly accepted as overweight in most part of the world, at least in the medical sense. Whether it looks overweight or not is cultural. But you're right, very muscular persons are heavier and BMI isn't a good measure in that case, and it's not necessarily unhealthy if you don't have other risk factors. > For people who are considered obese (BMI greater than or equal to 30) or those who are overweight (BMI of 25 to 29.9) and have two or more risk factors, it is recommended that you lose weight. https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.ht...
- DuckConference 2y ago
  I was definitely overweight (by waist and BF%) at 5'11" and 180lbs, and going by the stats I've seen that seems more common than your case of BMI overestimating BF%.
hervature 2y ago
I am going to assume you do not live in the USA based on this comment. Most supermodels, which I'm using as a proxy for aesthetic preference, have BMIs under 20.

deleted 2y ago

[deleted]

gdjskshh 2y ago

One of the most effective diets I'm aware of is the coffee and cigarette diet. Anytime you feel hungry, have a coffee and a cigarette first, then eat a little if you're still hungry. It has a much better compliance rate that other calorie-restriction diets.

bumby 2y ago
But does it lead to overall better health outcomes? It’s important to not miss the forest for the trees. Lower obesity is a generally a means to better health, not an end to itself.
- bumby 2y ago
  I'd be curious the perspective on the downvoters. Smoking increases hazard rates by 3x. Even the extreme obesity (obesity III, formerly morbid obesity) increases hazard rates less than this. So the risk tradeoff for picking up smoking in favor of reducing obesity is not good. It's like saying you'll stop wearing a seatbelt to reduce the risk of being trapped in a burning car; your overall risk profile is still higher. Or is it that you don't think health is the goal of reducing obesity? If so, most of the metrics we use to deem obesity as sub-optimal are wrong, including those in TFA. Better compliance to a diet that increases overall health risk is not a good strategy IMO.

defart 2y ago

Just went a month without cigarettes today, yay! Still overweight :(